Tips for negotiating your first job?

[dri]

Hi all,

I am about to graduate from residency and have a few offers that I am trying to decide between. I am very pleased with my options, but I am hoping to negotiate a higher base salary for one of them. Any suggestions on how to approach this? All my options are private practice. I do not want to come across as difficult or unreasonable and I certainly don't want to burn any bridges. Also, how common are signing bonuses these days? Are moving expenses often covered? Any insight or tips would be appreciated.

Thanks!

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[CarpetWindow7]

In my experience; signing bonus, moving expenses, CME should all be standard wording in a contract.

 

[Bgladney]

Moving expenses are in almost all contracts along with CME and vacations. Signing Bonuses are hit or miss.....just depends on the practice. Typically they will be in the $5,000 range so don't expect to get rich off them.

There usually is some room in negotiations but it is important not to over reach. How you behave in these negotations could affect the practices thoughts of you when it comes to partnership and being a partner in the future.

 

[wysdoc]

Hi all,

I am about to graduate from residency and have a few offers that I am trying to decide between. I am very pleased with my options, but I am hoping to negotiate a higher base salary for one of them. Any suggestions on how to approach this? All my options are private practice. I do not want to come across as difficult or unreasonable and I certainly don't want to burn any bridges. Also, how common are signing bonuses these days? Are moving expenses often covered? Any insight or tips would be appreciated.

Thanks!

Base salary is partially a risk for the hiring practice until they see your patient flow, surgical volume, etc. If you look for a contract that will change to some production-based payments after your first year, you will reap your profits at that time. Common mistakes are to ask for too much base salary to start, and poor understanding of the overhead of a busy eye practice.

 

[mjohnsonets]

I think you can negotiate the base salary some - I would say that I don't typically see negotiations on them deviate more than 10-15% of the original offer. If the base salary is adequate and the practice is expecting you to be busy quickly (has shown you this to be reasonably expected) you would likely have more room negotiating the bonus structure. The practice would likely find this more palatable and you are likely to find it better for you if you get busy.

As others have stated moving expenses are very common but sign-on bonuses from private practices not as common.

 

[CarpetWindow7]

I will say depending on region of county you’re looking at, signing bonus can be significantly more than whats been mentioned here.

 

[LightBox]

Signing bonus, moving reimbursement, etc are not very inportant. Only thing that matters long term is partnership. Everything else is pennies on the dollar.

 

[Dusn]

LightBox is correct if partnership works out. But unfortunately most people I know get screwed over and never get offered partnership, have their practice get sold to private equity before they make partner, or get a ridiculously high ~$1 million buy in.

The other option is to go for the highest possible starting salary. Save up and invest. Or use it as seed money to start your own practice in the near future.

Or just start your own practice from the beginning.

But to answer your question -- just ask for what you want. If they don't give it to you, turn down their offer politely and be prepared to walk away. My first practice came back with a higher offer a month later.

 

[dri]

Thanks everyone for your input! I really appreciate it and I think it will be helpful for me moving forward. It's nice to hear what others have experienced so I can be more prepared for my negotiations.

 

[hello lady!]

Agree with not placing too much stock on the starting salary. I had some practices dazzle impressive initial starting compensation packages in front of me. After getting into it I found out they were going to screw me once I finally got there and signed.

 

[salami bahama]

Agree with not placing too much stock on the starting salary. I had some practices dazzle impressive initial starting compensation packages in front of me. After getting into it I found out they were going to screw me once I finally got there and signed.

Thanks for your input! What were the ways they were going to screw you? No track for partnership? Have you see way too many patients?

 

[cubsrule4e]

Hi all,

I am about to graduate from residency and have a few offers that I am trying to decide between. I am very pleased with my options, but I am hoping to negotiate a higher base salary for one of them. Any suggestions on how to approach this? All my options are private practice. I do not want to come across as difficult or unreasonable and I certainly don't want to burn any bridges. Also, how common are signing bonuses these days? Are moving expenses often covered? Any insight or tips would be appreciated.

Thanks!

Again, base means nothing if youre ultimately structured as production based. If thats the case I wouldnt even make an argument over increasing the base unless youre joining a practice thats not very busy, which these days would be pretty uncommon unless theyre just starting out. My starting salary was 185, but within 3-4 months I was already hitting productivity bonus and making more than that each month.

 

[PCC108050]

What would be consider a high end bonus structure for one on a production scale?

 

[Openglobetrotters]

Could someone explain what bonus structure is typically like?

 

[mjohnsonets]

Bonus structure varies greatly depending on the practice with a lot of influence brought on by overhead.

Once you have brought in 2.5-3.5x your base salary in net collections you then get a percentage of your collections over top of that, typically 25-35%. Oculoplastics can have higher percentages and lower thresholds due to the lower overhead of their practice but it does depend on whether they're in an oculo only practice or multi-specialty. Retina can also have a lower threshold and a higher percentage.

There are many who claim the market standard of an employed ophthalmologist in private practice is 30% of their collections. A higher-end bonus structure would be one above 30% historically but I have seen the percentage drift upwards as practice compete for physicians. I have one practice I work with where their bonus structure goes up to 50% since their overhead is so low.

 

[dantt]

There are many who claim the market standard of an employed ophthalmologist in private practice is 30% of their collections. A higher-end bonus structure would be one above 30% historically but I have seen the percentage drift upwards as practice compete for physicians. I have one practice I work with where their bonus structure goes up to 50% since their overhead is so low.

With all due respect Matt, the competitive market standard is 30% of collections. If you're not in LA, SF, NYC, DC, Boston, Miami, etc, you should most definitely not settle for 30%.

 

[mjohnsonets]

With all due respect Matt, the competitive market standard is 30% of collections. If you're not in LA, SF, NYC, DC, Boston, Miami, etc, you should most definitely not settle for 30%.

No offense taken, this is one of the harder things to pin down when negotiating a contract. The general ranges I see (anterior segment) are 30-35% on recent years contracts. I have worked with docs who in their previous contracts have accepted lower than 30%, as low as 20% I've seen. As you pointed out, these are typically in large cities. I said many who claim because 30% is something I hear frequently cited by experienced admins.

I should have chosen my words a little better seeing now that higher-end may not have been the best choice. Above average/standard may have been better. As dantt pointed out though, rural vs. suburban vs. city, and other factors are involved too. To my first point, it varies greatly.

 

[Openglobetrotters]

Bonus structure varies greatly depending on the practice with a lot of influence brought on by overhead.

Once you have brought in 2.5-3.5x your base salary in net collections you then get a percentage of your collections over top of that, typically 25-35%. Oculoplastics can have higher percentages and lower thresholds due to the lower overhead of their practice but it does depend on whether they're in an oculo only practice or multi-specialty. Retina can also have a lower threshold and a higher percentage.

There are many who claim the market standard of an employed ophthalmologist in private practice is 30% of their collections. A higher-end bonus structure would be one above 30% historically but I have seen the percentage drift upwards as practice compete for physicians. I have one practice I work with where their bonus structure goes up to 50% since their overhead is so low.

Besides bonus structures, are there a list of Details in the contract that we should be paying Particularly attention to? Or things details that may be confusing to physicians who may be looking at contracts for their first time.

 

[mjohnsonets]

Besides bonus structures, are there a list of Details in the contract that we should be paying Particularly attention to? Or things details that may be confusing to physicians who may be looking at contracts for their first time.

I have started a thread on this in young ophthalmologists hoping it will grow into a resource for these questions: What you wish you had known before your first position out of residency/fellowship

If you're an experienced doc reading this thread please contribute.

Overall the things to look for that are non salary/bonus related are:
- Partnership language(if applicable) - is it defined or left open ended as in "it will be discussed after two years"? Can they define what is required for it?
- Tail coverage - will your practice cover it if you leave, it's expensive and you have to have it
- Non-compete - can be distanced from where you physically practice or any locations the practice has. Use a map tool to see where you might not be _____________able to work if you leave: Draw a circle with a radius on a map
____________- this is to be heavily considered if you move home or to your "dream" location. It can have long term ramifications on your family if you leave
- Which locations you will practice at - is it defined or left open ended?
- Call responsibilities

Not all of these things may be up for negotiation depending on the practice but are all things to put serious thought to.

 

[Ophthough]

Just went through this process, n=1, my 2 cents, for what it’s worth:

- start looking for a job early. Some practices look for years for a new associate, you can start looking early too when time is on your side and there’s no pressure to make a decision right away
- talk to as many people as you can, get a feel for what you want in a practice as you continue to interview (you will notice you like the vibe of some places more than others)
- it is standard for the practice to fly you out and pay for accommodations when you interview at the practice (some places mainly in large metro areas did not want to pay for me to come interview, and I took this as a sign that they were not serious about bringing me on)
- don’t be afraid to negotiate your salary! Both for the financial reward of a higher salary but also as a way to gauge how busy you will be in practice (they won’t offer you a high salary if you won’t be busy enough to generate significant revenue starting off, no one wants to lose money on an associate). It is also the first of many conversations you will have with your potential future partner (new equipment? New tech? Change in the contract?), so don’t be afraid to be assertive and find out their negotiation style with you. It is important that you be able to communicate with your potential future partners about these big topics going forward.
- bonus should ideally be around 30% starting at 2x base salary but you won’t find this everywhere. Will vary based on physician density (urban vs rural), etc. Depending on how things are structured, bonus can be more important than starting salary so pay attention to this too. You can negotiate bonus structure just like any other part of your contract.
- private equity has been pushing up starting salary #s across the board bc their practices are structured differently than physician owned private practice. Some private practices are feeling the heat from this and upping their offers for starting salaries as well. Starting salary is important BUT the really important thing, and the thing that is a better indicator of what you’ll make long term, is what you’ll be making 5 years in. This seems to depend significantly on partnership. If you are joining a private equity owned group, I would negotiate hard for a good starting salary as in some of these places, your salary grows linearly / time based on seniority, with an added production bonus.
- ask ALL your questions about all aspects of the practice, be open, they should be open in return
- recruiters and contract lawyers have seen a lot and can give good perspective on trends in different areas, average salaries, as well as what is considered standard vs nonstandard in any contract
- keep looking until you find the practice that feels right and doesn’t have any big red flags, in a location you wouldn’t mind settling down in
— remember, you will never know what is within your reach at the bargaining table if you don’t ask for it first!!

In the end you can do all the research, ask all the questions, and do all the negotiation you want. Be reasonable and make sure they are reasonable back to you. At the end of the day, signing with a practice is a trust fall and you have to just hope it all works out for the best. Good luck to all!! (And hoping my own “trust fall” into my first job this year works out.)