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[time to move on]

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Considering a job with a well-known company who says all pathologist start with the same salary.

The job is as a solo pathologist in a somewhat rural area with a busy workload. I think it's unreasonable to be treated like the pathologists at bigger groups with less call, etc... and will negotiate no matter what. In terms of MGMA, what % should I be aiming for? I'm a fellowship-trained pathologist with 4+ years experience in a general signout setting as well as medical director experience.

Anyone ever tried to negotiate with a company that says all pathologists start out with the same salary? what was your experience?

 

[Alteran]

Just based on what I know about the market in my area, including the non-academic, multidisciplinary practices that hire pathologists, I doubt you'll get any more than what the set starting salary is because they'll always find someone to take that salary. However, I'm assuming that's for freshly minted pathologists. Was it stated explicitly that all pathologists irrespective of subspeciality training or years of practice experience are started at the same salary?

If so, my logic would go like this: if you are either early or mid-career and the initial drop in pay, while significant, is negated by a large increase in guaranteed salary that's either in the ballpark of what your making or even exceeds it, may be worth it. Otherwise, you may want to hold out for a better opportunity.

 

[WEBB PINKERTON]

If it's rural, you need to take it.

Go rural.

 

[Med Director New England]

If this ‘set’ starting salary is below what it will take to get you to leave your current position then sounds like you should pass or try to negotiate.

I am surprised to hear anyone is actually hiring in the midst of all the current circumstances. I imagine they have a stronger position in a negotiation than you do unfortunately.

 

[time to move on]

If it's rural, you need to take it.

Go rural.

I'm going from extreme rural to a bit less rural. I'm with you! Rural is the way to go.

 

[time to move on]

If this ‘set’ starting salary is below what it will take to get you to leave your current position then sounds like you should pass or try to negotiate.

I am surprised to hear anyone is actually hiring in the midst of all the current circumstances. I imagine they have a stronger position in a negotiation than you do unfortunately.

They seem a bit desperate to be honest with you. I'm not in a hurry to leave my current practice so i'm taking my time looking for jobs and people ARE hiring (obviously less, but they are). I'm hearing a lot of retirement replacement stories.

I would say their offer is a bit lower than my current salary + bonus, but close enough. The only big difference would be going from a group to a solo practice.

 

[time to move on]

Just based on what I know about the market in my area, including the non-academic, multidisciplinary practices that hire pathologists, I doubt you'll get any more than what the set starting salary is because they'll always find someone to take that salary. However, I'm assuming that's for freshly minted pathologists. Was it stated explicitly that all pathologists irrespective of subspeciality training or years of practice experience are started at the same salary?

If so, my logic would go like this: if you are either early or mid-career and the initial drop in pay, while significant, is negated by a large increase in guaranteed salary that's either in the ballpark of what your making or even exceeds it, may be worth it. Otherwise, you may want to hold out for a better opportunity.

I agree with them always finding someone who will take whatever they offer. And yes, they said everyone irrespective of subspecialty. But they did say after 3 years you may get promoted to medical director and make more. In this case, I'd be the medical director right away.

 

[deleted314957]

They are intending to hire you as the MEDICAL DIRECTOR of a hospital. You DO NOT get paid the same as someone fresh out of training with no experience.


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[time to move on]

They are intending to hire you as the MEDICAL DIRECTOR of a hospital. You DO NOT get paid the same as someone fresh out of training with no experience.


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Exactly my point. It's unreasonable to treat me like the rest starting out. Let's see if they see it that way.

 

[time to move on]

anyone with knowledge and suggestions of what a reasonable salary would be? I feel I shouldn't settle for less than 350k

 

[time to move on]

this is the latest MGMA in my area.

10th %tile 25th %tile Median 75th %tile 90th %tile
$212,742 $280,240 $352,858 $434,000 $661,413

 

[gbwillner]

They seem a bit desperate to be honest with you. ....

This means they will pay more.

 

[WEBB PINKERTON]

I'm going from extreme rural to a bit less rural. I'm with you! Rural is the way to go.

I'd stay where you are now. Don't take the job if it is less rural.

 

[time to move on]

Due to the extreme circumstances that the hospital took against physicians salaries with COVID, I would feel safer at a place that didn't have to go through such extreme measures to get through this situation. I think solo pathologists will be the safest out there for the next couple years.

 

[KeratinPearls]

lol extreme rural. Is there like one grocery store there? The only place to shop is Walmart?

Why do you like extreme rural so much of I may ask?

 

[time to move on]

lol extreme rural. Is there like one grocery store there? The only place to shop is Walmart?

Why do you like extreme rural so much of I may ask?

Yes, Walmart and that's it. I personally thought job security was excellent since they really struggle to bring physicians in. COVID changed everything. We also have a really easy workload and a lot of flexibility on the job as far as when you come in and leave. Beats an 8-5 every day of the year.

 

[gbwillner]

lol extreme rural. Is there like one grocery store there? The only place to shop is Walmart?

Why do you like extreme rural so much of I may ask?

We need to understand hellohellopath's definitions of the following terms:

rural
extreme rural
extreme rural!!!
suburban
urban
extreme urban

Then we can better advise.

 

[WEBB PINKERTON]

If there is a Walmart, then that is not extreme rural. Boy, you don't know what extreme rural is. I don't even have cell phone service in my neck of the woods.

Everyone is going through extreme measures or will be going through extreme measures before this is over. All of us will be taking significant salary hits.

 

[gbwillner]

If there is a Walmart, then that is not extreme rural. Boy, you don't know what extreme rural is. I don't even have cell phone service in my neck of the woods.

Everyone is going through extreme measures or will be going through extreme measures before this is over. All of us will be taking significant salary hits.

I read that comment in a Hank Hill voice.

My definitions:

rural- you have to drive 20 minutes to get to Starbucks
extreme rural- you get funny looks if you ask for an espresso at the only place that serves coffee in town
extreme rural!!!- Wherever Web lives or were LADoc stores his guns and post-apocalyptic MREs (likely a cave must be included)
suburban - Metro LA, Phoenix, Atlanta or Houston; Starbucks never more than a mile away
urban - SF, DC, Boston- Starbucks within a 5 minute walk
extreme urban - NYC- >1 Starbucks within rock-throwing distance at any time

 

[D1b()4]

anyone with knowledge and suggestions of what a reasonable salary would be? I feel I shouldn't settle for less than 350k

Yes, ask at least 400k.

 

[time to move on]

Yes, ask at least 400k.

Will do!

 

[time to move on]

If there is a Walmart, then that is not extreme rural. Boy, you don't know what extreme rural is. I don't even have cell phone service in my neck of the woods.

Everyone is going through extreme measures or will be going through extreme measures before this is over. All of us will be taking significant salary hits.

How would you describe extreme measures? how about a 70% cut in salary?

 

[AZpath]

Due to the extreme circumstances that the hospital took against physicians salaries with COVID, I would feel safer at a place that didn't have to go through such extreme measures to get through this situation. I think solo pathologists will be the safest out there for the next couple years.

I am a solo medical director in a rural area. It is not an easy job.
There are benefits but it is lonely. I had another pathologist working with me. They left and I am alone for a while now.
I own the practice and I am getting killed financially by COVID like everyone else.
What makes you think that the new hospital is so much safer?
Docs in our hospital owned practices took a cut for now (not near the 70% forced on you).
Many of the rural indi practices are in much worse shape than the hospital.
They are looking at pulling money out of savings to run their practices.

Cuts due to COVID should not influence your decision unless the hospital is poorly managed and you don't think there business will return.

Consideration should be:
- Are you comfortable solo ?
- Is the new hospital in so much better shape? Many rural hospital were already in trouble before COVID.
- How is the hospital going the back you up?
- On a salary gig you want outside consults as need no questions asked.
- Next do you like the community better?
- Long term out look salary and benefits?
- How hard is the workload and call?
- Could work increase and you are making the same?
- Finally initial salary ?

 

[time to move on]

I am a solo medical director in a rural area. It is not an easy job.
There are benefits but it is lonely. I had another pathologist working with me. They left and I am alone for a while now.
I own the practice and I am getting killed financially by COVID like everyone else.
What makes you think that the new hospital is so much safer?
Docs in our hospital owned practices took a cut for now (not near the 70% forced on you).
Many of the rural indi practices are in much worse shape than the hospital.
They are looking at pulling money out of savings to run their practices.

Cuts due to COVID should not influence your decision unless the hospital is poorly managed and you don't think there business will return.

Consideration should be:
- Are you comfortable solo ?
- Is the new hospital in so much better shape? Many rural hospital were already in trouble before COVID.
- How is the hospital going the back you up?
- On a salary gig you want outside consults as need no questions asked.
- Next do you like the community better?
- Long term out look salary and benefits?
- How hard is the workload and call?
- Could work increase and you are making the same?
- Finally initial salary ?

You mention very relevant questions to ask in a situation like this.

Bottom line, no one is safe, but I do believe some jobs are safer than others.

When you are a solo pathologist, they can't really get rid of you (unless you suck). If you work in a group setting and things continue to be slow (which I believe they will), one person or all are going to suffer. This was not a decision I made due to anger. I know my current employer was already in trouble before COVID and I just don't see a good future here anymore. I came here to gain experience and with 4 years I feel pretty comfortable. I appreciate all the points you made, you're right on point.

 

[AZpath]

Sounds like this is a good time move, especially if you like the community and the hospital.
Most solid hospitals should be able to at least offer the median MGMA for medical director salary for the area.
You might cut them a break on the 1st year provided the salary falls inline after that.

 

[LADoc00]

Obviously the new normal says go rural, go rural, go rural.

Clarify please though: this is a company which is employing you to staff and be the lone wolf at a rural hospital? I assume this is Quest?

Why not take the job, find out what the hospital is paying Quest to pay you and just offer the CEO a significant discount to cut out the middle man and contract with you directly?

Seems like an easy win to me. Especially if whoever the well known player is having a hard time filling the spot.

1.) Take job.
2.) Get contract between hospital and Quest.
3.) Undercut Quest
4.) Profit.

 

[LADoc00]

I read that comment in a Hank Hill voice.

My definitions:

rural- you have to drive 20 minutes to get to Starbucks
extreme rural- you get funny looks if you ask for an espresso at the only place that serves coffee in town
extreme rural!!!- Wherever Web lives or were LADoc stores his guns and post-apocalyptic MREs (likely a cave must be included)
suburban - Metro LA, Phoenix, Atlanta or Houston; Starbucks never more than a mile away
urban - SF, DC, Boston- Starbucks within a 5 minute walk
extreme urban - NYC- >1 Starbucks within rock-throwing distance at any time

By this definition I have not seen extreme rural. In the remote Northern foothills of California there is still espresso. In fact I hiked 2 hours into a Mexican jungle years back only to stumble on an internet cafe which not only had espresso but would put liquor into for you.

I like this, the GB espresso rating, like the Waffle House Index.

Lone Wolf Pathology is AWESOME but absolutely not for everyone. YMMV.

 

[time to move on]

Obviously the new normal says go rural, go rural, go rural.

Clarify please though: this is a company which is employing you to staff and be the lone wolf at a rural hospital? I assume this is Quest?

Yes, the lone wolf. Not Quest, but close enough.

Why not take the job, find out what the hospital is paying Quest to pay you and just offer the CEO a significant discount to cut out the middle man and contract with you directly?

Is this legal? You'd think they'd have some sort of agreement which would not allow that. And if I can do that, why not do it before I take the job and cut out the middle man right away?

Seems like an easy win to me. Especially if whoever the well known player is having a hard time filling the spot.

1.) Take job.
2.) Get contract between hospital and Quest.
3.) Undercut Quest
4.) Profit.

 

[AZpath]

Rural spectrum :
Very Rural - Not even a Walmart or box store for > 20 miles . Perhaps a restaurant or two and a general stores
Rural - Walmart in town or nearby. Limited retail and restaurants.
Rancho deluxe rural - Walmart and multiple box stores/ corporate chains. Most of what you have in suburbs just not a deep selection.
You make trip to the big city every now and then.

 

[D1b()4]

Rural spectrum :
Very Rural - Not even a Walmart or box store for > 20 miles . Perhaps a restaurant or two and a general stores
Rural - Walmart in town or nearby. Limited retail and restaurants.
Rancho deluxe rural - Walmart and multiple box stores/ corporate chains. Most of what you have in suburbs just not a deep selection.
You make trip to the big city every now and then.

I think rancho deluxe rural should be renamed to urban light.

 

[ScubaV]

If there is a Walmart, then that is not extreme rural. Boy, you don't know what extreme rural is. I don't even have cell phone service in my neck of the woods.

Everyone is going through extreme measures or will be going through extreme measures before this is over. All of us will be taking significant salary hits.

Extreme rural: Pathology lab set up in a tree stand using a solar powered microscope with a leatherman knife to cut slides and an herb witch who concocts stains from local flora. Specimens are actually taken from squirrels and deer delivered by a surgeon who only appears when the herb witch gives you the "special drink".

 

[WEBB PINKERTON]

Remember when those studies came out about labs replacing formalin with honey? We did that and we replaced Xylene with olive oil.

 

[CDX-2]

Remember when those studies came out about labs replacing formalin with honey? We did that and we replaced Xylene with olive oil.

I think I read somewhere online about using Oil of Wintergreen instead of Xylene? It'd smell a lot nicer too...

 

[Napoleon1801]

Extreme rural: Pathology lab set up in a tree stand using a solar powered microscope with a leatherman knife to cut slides and an herb witch who concocts stains from local flora. Specimens are actually taken from squirrels and deer delivered by a surgeon who only appears when the herb witch gives you the "special drink".

Alright I'm interested. But how is the reimbursement?

 

[Zarniwoop]

Why isn't the Dollar General included in the rural definition? If you are anywhere near a Walmart you are not rural.

Also, rural should be flat and ugly with no water nearby except possibly a uranium-polluted creek.
The Grand Tetons may be technically rural, but that shouldn't count.

 

[WEBB PINKERTON]

Dollar general has carved out a nice niche in rural areas. Unfortunately they are the only source of food for many people where I live.

 

[AZpath]

Hell yes. We have 2 Dollar Generals and 2 Family dollar stores in town. In addition to Target and we have 3 other grocery stores.
(Like I said - Rancho deluxe rural) .

 

[LADoc00]

Rancho deluxe rural seems like the way to go.

?: are there actual hospitals in the very/extreme rural of America? Im serious, I have no clue and have never encountered one personally.

 

[Alteran]

Rancho deluxe rural seems like the way to go.

?: are there actual hospitals in the very/extreme rural of America? Im serious, I have no clue and have never encountered one personally.

At one time perhaps, but Obamacare did a pretty good job of wiping out a great many of those.

 

[mark-ER]

Obamacare did a pretty good job of

Not just obamacare, but healthcare consolidation writ large. Also agree, rancho-deluxe "rural" (think Jackson Hole WY, Los Alamos NM, Taos NM, Traverse City MI) are the way to go... specialized tech/industry sector and lots of well-off folks with need for access regardless of price/insurance (boutique concierge service).

 

[WEBB PINKERTON]

Rural hospitals were disappearing far before Obamacare. The loss of middle class jobs due to factory closings did them in more than anything. Also, predatory health systems and physicians rolling into town cherry picking the profitable stuff hurt as well.

We also had too many hospitals in some areas. I lost count of how many times I saw a pissed off group of physicians start their own hospital for an area that serves maybe 30,000 people. Then you end up with two money losers. You can say what you want about certificates of need, but I do believe they are necessary.

 

[ScubaV]

The future of people's jobs, not just in healthcare, is something I find really fascinating. First it was manufacturing and industrial jobs being outsourced to Mexico, China, etc. But automation and increased technological efficiency will threaten a lot more in the near future. In the meantime we're left with mostly healthcare and service industry work, which are needed more in population centers. With modern supply chains and globalized infrastructure, what economic value do rural communities even have outside, say, agriculture or tourism? Should small, dying towns whose one main factory or plant closed down even continue to exist?

I don't mean this in a disparaging way, just more of a thought experiment and wondering about the future.

 

[Zarniwoop]

Lots of rural hospital consolidation, with a health network covering a large geographic area filled with small towns. Headquarters are typically in the main town of 10,000-50,000 people, and you might have 5-20 pathologists there, who travel on an as needed basis to the even more rural outposts / clinics for CAP inspections and the occasional frozen. The main town of 10-50K may or may not be worthy of a Walmart. Will definitely have a couple of Dollar Generals.
I think it is very uncommon for a pathologist to be based in the truly remote towns. Those are mainly family docs who do well financially and can have a pretty sweet existence. Think lots of hunting and float plane trips.

 

[LADoc00]

Not just obamacare, but healthcare consolidation writ large. Also agree, rancho-deluxe "rural" (think Jackson Hole WY, Los Alamos NM, Taos NM, Traverse City MI) are the way to go... specialized tech/industry sector and lots of well-off folks with need for access regardless of price/insurance (boutique concierge service).

You are starting a very good list here. Any want to add to it?
Would places like Palm Springs or Monterey be included? Sonoma/Napa Wine Country? Tahoe? The problem with California is Im not seeing any place that would fit into this narrative well.

 

[gbwillner]

You are starting a very good list here. Any want to add to it?
Would places like Palm Springs or Monterey be included? Sonoma/Napa Wine Country? Tahoe? The problem with California is Im not seeing any place that would fit into this narrative well.

I kinda think places like Carlsbad and other small beach towns sorta fits. Not too far from LA/SD, pretty laid back, lots of space, etc. Probably high per capita income with low crime and access to all amenities. Cost is still relatively insane. I'm actually not sure why anyone lives in CA, actually. Especially LA.

 

[KeratinPearls]

I kinda think places like Carlsbad and other small beach towns sorta fits. Not too far from LA/SD, pretty laid back, lots of space, etc. Probably high per capita income with low crime and access to all amenities. Cost is still relatively insane. I'm actually not sure why anyone lives in CA, actually. Especially LA.

Beautiful beaches, great weather, awesome food, diversity, cool vibes in different parts of LA. A lot of exciting things going on. But yeah it’s not for everyone and it’s expensive to live there. Traffic sucks as well. A lot of homeless people.

 

[deleted314957]

You are starting a very good list here. Any want to add to it?
Would places like Palm Springs or Monterey be included? Sonoma/Napa Wine Country? Tahoe? The problem with California is Im not seeing any place that would fit into this narrative well.

The prettiest places of California have too many GD fires & taxes. LA and SF are cesspools.


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[octopusprime]

I would add some places in WA for climate, lack of state income tax, proximity to both mountains and the ocean. Beautiful state with lots to offer.

 

[Guest8]

Beautiful beaches, great weather, awesome food, diversity, cool vibes in different parts of LA. A lot of exciting things going on. But yeah it’s not for everyone and it’s expensive to live there. Traffic sucks as well. A lot of homeless people.

Agreed. Weather, ocean, food would be my top reasons to live in CA. Great city life but with great nature nearby. Beaches, mountains, lakes, deserts. Pretty much has everything. If I had one state to choose to live in it would be CA and it would be near or in LA. But alas I was born in New England and all my family and longtime friends are here, so here I stay. But for retirement I could see moving to CA.

 

[gbwillner]

Opinions are like... you know. I think I could live anywhere, but I'd live almost anywhere in CA before I would live in LA. For background, I grew up near and spent a lot of time in LA. Much of my family is there so I still have to spend a lot of time there.

Is there great weather? Yes, if you ignore the smog. Are there nice beaches? Yes, especially if you live near them. Is there great food? Yes, if you can afford it, as a night out at even an ok restaurant easily sets you back $100 per person. To me, nothing makes up for the terrible traffic or terrible cost of living. You also get nothing for your money- houses are generally old and small. Due to stupid tax assessment rules no one improves their houses to avoid increasing their taxes, so unless you are in Beverly Hills most neighborhoods look like a dump. Public transit is non-existant because the city is too spread out.

Now, Laguna Beach? Sure. Oceanside? No problem. Irvine? OK. But any closer than that and it's no thanks from me.