The 95th Percentile Rural Compensation

petomed

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      Longtime nontrad here, I’ll apply to med school one day...but just got off the phone with a buddy of mine. He’s in his first job after residency, working at an urgent care. He’s been in his position about 6 months now and let slip he could easily clear 500k if he moved from his current NYC‘ish area to the rural midwest and worked 40-50 hrs/wk, and likely clear 1 mill if he searched hard enough. Again, that’s without dinging beyond 50 hrs/wk.

      Let’s do the math on that. Assuming 50 hrs/wk and no vacation, 50*52 = 2,600 hrs. To make 500k, the hourly rate would need to be $192/hr. To hit 1 mill, its double that, $385/hr. He also said he believes he could hit that hourly rate without committing to tons of shifts, just dropping in for a few each month.

      Is that the real deal or is he full of it? I mean, 1/10th of a mill is still 100k. You could work one tenth of each year, barely breathing on patients, and still have ’good’ income. I call b.s. If this is really the calculus, then I’m in great shape since I already want to work super rural. But I cannot believe that hourly rate isn’t severely inflated by an ego.

      Is this the city folk pipe dreaming about rural compensation, or is that actually the situation?
       
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      GreenDuck12

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        Rural areas tend to compensate more highly since folks don’t want to live there. Desirable locations like NYC don’t have to do this. In private practice, as a partner, there are many FM docs that clear 400k. With mid level encroachment and health insurers starting to provide care directly these setups will become more and more rare. I agree that the setup your friend describes is unlikely depending on your friends specialty.
         

        NonTradVince

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          Rural areas tend to compensate more highly since folks don’t want to live there. Desirable locations like NYC don’t have to do this. In private practice, as a partner, there are many FM docs that clear 400k. With mid level encroachment and health insurers starting to provide care directly these setups will become more and more rare. I agree that the setup your friend describes is unlikely depending on your friends specialty.
          Thanks for the reply. He did an internal medicine residency with a ho-hum GME program. That's not to bash, just that it was status quo. Can he really get into a clinically-based position making $192-385/hr as per-diem with minimal shift commitments?
           
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            No. As an IM doc you're not finding a gig making $400/hr even if you're covering solely nights with an open ICU unless you're also the proud owner of a pez dispenser Rx pad. And if that's the case the DEA will come a knockin', not a question of if but when.

            As an IM doc I always hear about these jobs in BFE promising a 40 hour work week for $500k a year. When you actually start looking at the jobs and what they would entail and the actual pay it never holds true. Can you make $200/hr? Absolutely but the job is going to suck, such as covering nights and an open ICU with an admit average of 12, or as a rounder covering a census of 25-30 with 6+ admits.

            Realistically even in BFE you'll have a hard time cracking $175/hr for anything with a good work life balance. At an urgent care in NYC your friend is probably making ~$100/hr (or less) and dreams about answering the job ads he gets emailed promising "$450k+ year to come work in the beautiful rural midwest, just 6 hours from the big city"
             
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            Rapsidy

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              Something else to consider is telehealth services were already expanding before Covid-19, and this pandemic greatly accelerated that process. I’m not saying a TV doctor replaces an in person doctor but it does somewhat address the rural situation problem in the short term. So any opportunities that may be there now if as other posters have said they were even realistic are probably becoming fewer and farther in between.
               

              FrkyBgStok

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                As someone initially interested in rural medicine, another to consider is what real rural medicine means. In some areas, you may be one of the only doctors in the area making the 50 hour work week way more than 50 hours very fast. The rural docs I know that “make bank” work way more than people realize.
                 

                NITRAS

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                  I know a couple IM docs that make $500k.
                  One was (before COVID) a 2 FTE nocturnist (2 weeks on, 1 week off). The other 1 FTE hospitalist, 0.5 FTE nocturnist, and covers a SNF, and director of said SNF. He has since cut out the 0.5 FTE nocturnist cause it was too much with a wife in residency and two kids.

                  I am not in BFE either, but am one hour from major metro and am at 600+bed hospital.
                   

                  efle

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                    Based on one of the recent MGMA surveys, in the midwest and south a lot of people in Rads & Gas are clearing 500k, not so much IM.

                    Past that it's all surgeons and other procedure heavy fields (cards, GI) in that income range.
                     

                    petomed

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                      I know a couple IM docs that make $500k.
                      One was (before COVID) a 2 FTE nocturnist (2 weeks on, 1 week off). The other 1 FTE hospitalist, 0.5 FTE nocturnist, and covers a SNF, and director of said SNF. He has since cut out the 0.5 FTE nocturnist cause it was too much with a wife in residency and two kids.

                      I am not in BFE either, but am one hour from major metro and am at 600+bed hospital.
                      I believe making 500k is possible, if you work more than 2600-hr per year. Can you make that 500k with only 50 hrs per week on average? Namely, can you hit $192/hr as an IM doc? $385/hr? These are the claims my city-bound urgent care doc buddy is flouting in the rural Midwest.
                       

                      anbuitachi

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                        Based on one of the recent MGMA surveys, in the midwest and south a lot of people in Rads & Gas are clearing 500k, not so much IM.

                        Past that it's all surgeons and other procedure heavy fields (cards, GI) in that income range.

                        Its very difficult these days with Gas, unless you are a partner then maybe, problem is jobs with reasonable partnerships have dried up, now you are looking at 4-5 year partnership tracks where you make very low amounts for 4-5 years before becoming a partner, then after, may break 500k. you would have to spend 10 years there to even break even. not many are willing to guarantee they will want to stay 10 years at 1 location.

                        Other way is to work signifcant amount of hours. I have colleagues that make 500k+ but it certainly is not 40-50 hrs a week. More like double that.

                        In my opinion, as well as many i talk to, unless your desire is to be in a rural area long term, aiming for 500k in medicine w 40-50 hours is most likely going to disappoint. If you desire a large city, there are many jobs out there that will earn you more money over the course of your career.
                         
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                        Nocturnist

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                          I'm a nocturnist 4 years out of IM residency making 550k a year. I work around 20 shifts a month, about 3000 hours a year. Base salary is $180/hr, not including a guaranteed yearly bonus as well as productivity bonus. Extra shifts are sometimes paid at 200-250 an hour if they cant fill them. I'm at a community hospital a few miles outside a northeast city. Closed ICU, average 6 admits a night, cross coverage mostly handled by mid levels and rapid response split between the other nocturnists. Very comfortable/easy work for those who dont mind working nights and half their weekends/holidays. I've not felt burnt out at any point, if I wasn't traveling abroad every month I'd happily work more. Most night gigs in the northeast are going to be around $150-175 an hour. You're not going to make over 500k without pushing 60 hours a week but can very comfortably be in the 300-400k's for 40-50 hour weeks. I'm not aware of anybody in IM being able to make over 1M unless they're a hospital CEO or shareholder of a successful practice/urgent care chain. For all this talk about rural/undesirable locations paying ungodly sums of money, I havent actually seen any real world examples of this from posts I've read, people I've spoken to, or job postings I've seen. More often, at least in the northeast- the most lucrative positions are anywhere in the community/ non-academic hospitals, often surprisingly close to town. The real allure of those rural jobs is just the insanely low cost of living.
                           
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