Write your own ideal contract

[powermd]

I'm still in the process of figuring out what are reasonable expectations in a contract for when I go hunting this fall and next year, and I'm sure others are similarly confused. Post your own ideal contract expectations and let's discuss whether or not it's consistent with reality!

I'll start:

My training: MD/MBA, anesthesia residency, no fellowship plans

Position sought: Partnership track general anesthesiology job in/near a medium/large city in Southeast, with possibility of administrative/management responsibilities (at some point)
Cases: Bread & butter general, OB, community peds, ortho, major vascular, neuro, some hearts okay, basic pain (ESIs)
$$$: 300K to start, $2K/call, post-call day off, partners must incrementally earn $100K more than my base salary for every additional year leading to partnership (max 3 years). Immediate partnership would be better, but if the $$ are there, I'm willing to wait a bit.
Vacation: 6 weeks or more
Call schedule: In house q7 or better, out of hospital q4 or better
Malpractice: Full coverage + tail
Benefits: Solid medical/dental plans available
Retirement policy: If you no longer provide services to the practice, you don't draw income from the practice.

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[EtherMD]

I'm still in the process of figuring out what are reasonable expectations in a contract for when I go hunting this fall and next year, and I'm sure others are similarly confused. Post your own ideal contract expectations and let's discuss whether or not it's consistent with reality!

I'll start:

My training: MD/MBA, anesthesia residency, no fellowship plans

Position sought: Partnership track general anesthesiology job in/near a medium/large city in Southeast, with possibility of administrative/management responsibilities (at some point)
Cases: Bread & butter general, OB, community peds, ortho, major vascular, neuro, some hearts okay, basic pain (ESIs)
$$$: 300K to start, $2K/call, post-call day off, partners must incrementally earn $100K more than my base salary for every additional year leading to partnership (max 3 years). Immediate partnership would be better, but if the $$ are there, I'm willing to wait a bit.
Vacation: 6 weeks or more
Call schedule: In house q7 or better, out of hospital q4 or better
Malpractice: Full coverage + tail
Benefits: Solid medical/dental plans available
Retirement policy: If you no longer provide services to the practice, you don't draw income from the practice.

Without a fellowship your demands are a bit high and unlikely to be met. However, with a fellowship in Pain or Cardiac (with the understanding of TEE certification) your odds of getting the contract listed above is about 90%.

Are you a Chief Resident? Are your letters stating you are one of best Residents at your institution? What Medical School and Residency did you graduate from? Remember, as a new graduate what are YOU bringing to the table?

You are looking for a 90th percentile job in the southeast. This means $500,000 salary or more plus full benefit package as a partner. Please answer my questions if you want my opinion.

 

[EtherMD]

Alternatively,

You can PM me and I will reply. This way your info. is kept confidential.

 

[mille125]

I'm still in the process of figuring out what are reasonable expectations in a contract for when I go hunting this fall and next year, and I'm sure others are similarly confused. Post your own ideal contract expectations and let's discuss whether or not it's consistent with reality!

I'll start:

My training: MD/MBA, anesthesia residency, no fellowship plans

Position sought: Partnership track general anesthesiology job in/near a medium/large city in Southeast, with possibility of administrative/management responsibilities (at some point)
Cases: Bread & butter general, OB, community peds, ortho, major vascular, neuro, some hearts okay, basic pain (ESIs)
$$$: 300K to start, $2K/call, post-call day off, partners must incrementally earn $100K more than my base salary for every additional year leading to partnership (max 3 years). Immediate partnership would be better, but if the $$ are there, I'm willing to wait a bit.
Vacation: 6 weeks or more
Call schedule: In house q7 or better, out of hospital q4 or better
Malpractice: Full coverage + tail
Benefits: Solid medical/dental plans available
Retirement policy: If you no longer provide services to the practice, you don't draw income from the practice.

It is great that you have started thinking about these things before you apply. There is a lot to learn from this exercise. In the real world the group presents you with a contract. However, for the sake of brevity, I will play the role of the group (I actually am an employer) and will counter your contract. Negotiation is about give and take (you will learn this). I think that the new hires may be able to learn from it.

From Real World Anesthesiology Group:
1) Your salary request is quite high especially for someone without a fellowship. MGMA and salary.com quote an anesthesiologist salary at 225k at the 50th percentile. It could be argued that your starting salary should be lower than this to start. However, we will keep your 300K salary with the following restrictions.
a) You are an independent contractor and pay all of your own benefits (including malpractice, health, life, disability). You will not be eligible for retirement until you become partner. Partnership is three years and your salary will not change until you become partner. Our partners have a guaranteed W2 from the hospital at 454K.
b) Each week of vacation that you take subtracts 6K from your salary. You chose how much you want to take for a max of 6 weeks.

2) Call schedule is q5 as nonpartner and q7 as partner
3) Concerning tail, we will only pay it if you are discharged from the practice without cause. This is more than fair and customary.
4) Concerning partnership, it needs to be three years because we have to evaluate if you are a good fit with us. Board certification is a prerequisite.



I hope this generates some questions/comments.

 

[johankriek]

It is great that you have started thinking about these things before you apply. There is a lot to learn from this exercise. In the real world the group presents you with a contract. However, for the sake of brevity, I will play the role of the group (I actually am an employer) and will counter your contract. Negotiation is about give and take (you will learn this). I think that the new hires may be able to learn from it.

From Real World Anesthesiology Group:
1) Your salary request is quite high especially for someone without a fellowship. MGMA and salary.com quote an anesthesiologist salary at 225k at the 50th percentile. It could be argued that your starting salary should be lower than this to start. However, we will keep your 300K salary with the following restrictions.
a) You are an independent contractor and pay all of your own benefits (including malpractice, health, life, disability). You will not be eligible for retirement until you become partner. Partnership is three years and your salary will not change until you become partner. Our partners have a guaranteed W2 from the hospital at 454K.
b) Each week of vacation that you take subtracts 6K from your salary. You chose how much you want to take for a max of 6 weeks.

2) Call schedule is q5 as nonpartner and q7 as partner
3) Concerning tail, we will only pay it if you are discharged from the practice without cause. This is more than fair and customary.
4) Concerning partnership, it needs to be three years because we have to evaluate if you are a good fit with us. Board certification is a prerequisite.



I hope this generates some questions/comments.

My advice.. Never ever ever ever ever ever get into a partnership track with anesthesia group that is making money off of you. NEVER EVER. If you do you have only YOURSELF to blame when you are screwed...... The above arrangement is not a fair situation. It only benefits the partners. I like the q7 call for partners and q5 for non partners.. hilarious

 

[Noyac]

My advice.. Never ever ever ever ever ever get into a partnership track with anesthesia group that is making money off of you. NEVER EVER. If you do you have only YOURSELF to blame when you are screwed...... The above arrangement is not a fair situation. It only benefits the partners. I like the q7 call for partners and q5 for non partners.. hilarious

This would surely limit your job prospects.

 

[EtherMD]

My advice.. Never ever ever ever ever ever get into a partnership track with anesthesia group that is making money off of you. NEVER EVER. If you do you have only YOURSELF to blame when you are screwed...... The above arrangement is not a fair situation. It only benefits the partners. I like the q7 call for partners and q5 for non partners.. hilarious

Johan,

Why not post your situation over the previous 4 years? W-2 plus benefits or 1099? Please explain the difference to the Residents.

 

[EtherMD]

This would surely limit your job prospects.

I understand Johan's concerns about private practice Groups. A few new graduates have been "burned" by Groups taking advantage of the uniformed and uneducated.

But, this does not mean there are not good Groups out there with a history of treating people fairly. Ask questions, get the Group's history and sign a fair contract. In short, do your homework and re-check the answers several times before signing anything.

With no experience, no fellowship and no connections getting that 90th percentile job is going to be tough; not impossible, just very tough.
Howver, if you add just 12 more months to your CV then the odds improve greatly in your favor. I don't understand why someone in today's environment wouldn't strongly consider the fellowship year. Just 12 more months could mean 40% or more to your income for decades. Unless you are prepared to go wherever the money is (this means all States, all towns, etc.)
the odds of getting that $500,000 per year job are not in your favor. But, with 12 more months of training the whole situation changes and you have more control over location and practice type.

 

[militarymd]

I'm still in the process of figuring out what are reasonable expectations in a contract for when I go hunting this fall and next year, and I'm sure others are similarly confused. Post your own ideal contract expectations and let's discuss whether or not it's consistent with reality!

I'll start:

My training: MD/MBA, anesthesia residency, no fellowship plans

Position sought: Partnership track general anesthesiology job in/near a medium/large city in Southeast, with possibility of administrative/management responsibilities (at some point)
Cases: Bread & butter general, OB, community peds, ortho, major vascular, neuro, some hearts okay, basic pain (ESIs)
$$$: 300K to start, $2K/call, post-call day off, partners must incrementally earn $100K more than my base salary for every additional year leading to partnership (max 3 years). Immediate partnership would be better, but if the $$ are there, I'm willing to wait a bit.
Vacation: 6 weeks or more
Call schedule: In house q7 or better, out of hospital q4 or better
Malpractice: Full coverage + tail
Benefits: Solid medical/dental plans available
Retirement policy: If you no longer provide services to the practice, you don't draw income from the practice.

You can ASK for anything, but most of the time, the group will be OFFERING a contract that you can take or not.

In the coming years, as many have alluded to already, good grads won't be hard to come by.

 

[Planktonmd]

The buttom line, you will always be taken advantage of, the question is how much.

 

[powermd]

The buttom line, you will always be taken advantage of, the question is how much.

That is the point of this thread. I need a starting point to determine what I should reach for, what is realistic, and what I should reject.

I know that I will most often be offered a contract I can accept or reject, but writing my own contract seemed like a reasonable place to start.

So far the responses have been great!

 

[johankriek]

This would surely limit your job prospects.

yep it does.. sad and depressing isn't it that its too much to ask for to be treated fairly financially.

 

[urgewrx]

$$$: 300K to start, $2K/call, post-call day off, ..

That's the Columbia way. 120k base and 1.5k per call. Right? I don't think private practice groups pay per call. Am I wrong?

 

[urgewrx]

a) You are an independent contractor and pay all of your own benefits (including malpractice, health, life, disability). You will not be eligible for retirement until you become partner. Partnership is three years and your salary will not change until you become partner. Our partners have a guaranteed W2 from the hospital at 454K.
b) Each week of vacation that you take subtracts 6K from your salary. You chose how much you want to take for a max of 6 weeks.
3) Concerning tail, we will only pay it if you are discharged from the practice without cause. This is more than fair and customary.

Are you a relative of Houdini? You have a way of turning 300k in to $20!

 

[johankriek]

Johan,

Why not post your situation over the previous 4 years? W-2 plus benefits or 1099? Please explain the difference to the Residents.

Ive never been paid with a w-2.


For the past four years i have been in southern california. I first took a job strictly fee for service. I am still there. Eat what you kill. somedays i do four good cases.. others i do 2 bad ones. some days i dont get any consults. I do work at 2 other hospitals where i take call for a set amount for a 24 hour stint. maybe 4 times a month. post call i go to the fee for service place if im scheduled or to see if i can pick up some cases. the schedule at my principal hospital comes out a week before so i know whats going on. Sometimes the cases get cancelled or I get done at like noon which is no good. at that point I also have priveleges at another specialty hospital and i go over there to see if i could help with some add ons. My practice is not ideal because i end up going from one place to the other sometimes more than once. moreover, my salary fluctuates from month to month. but i dont have any partners, that i have to worry about. I have someone doing my billing, 5 percent, i have my own malpractice which is reasonable matures at 14k,(best in nation really i think), and i pay my own health and disability insurance. I take about 7-10 weeks vacation per year. I make about average nothing crazy. Once in a blue moon i will do a week there week here locuming in phoenix

I much prefer getting paid as an independent contractor over a w2 because the writeoffs are much better and more extensive and i get to put more money into a retirement account. the downside is you have to pay your benefits.

 

[mille125]

This would surely limit your job prospects.

absolutely

 

[mille125]

Are you a relative of Houdini? You have a way of turning 300k in to $20!

No, I actually turned 300k into about 225 K which is where I wanted to start in the first place. This was obviously just an illustration but it brings up a few points. In reality most of the contracts will look closer to mine than the original poster's. Giving a brand new grad (not board certified nor fellowship trained) 300K plus benefits is not fair to the group. When you go into any negotiation you need to be fair to both sides. 300K seemed to be important to him so I let him keep it while adding some other provisions for the group to even the playing field. Of course, with further discussion I am sure that an agreement could be reached that all sides feel is fair. But there needs to be give and take on both sides. In reality I do not feel that the contract that I proposed is unfair.

The second point is to look at the total benefit package and not just the salary. Full benefits usually add 50-75K to the package.


Good luck to all

 

[mille125]

i would be interested to know what was perceived as unfair in the contract that i proposed.

 

[mille125]

Ive never been paid with a w-2.


For the past four years i have been in southern california. I first took a job strictly fee for service. I am still there. Eat what you kill. somedays i do four good cases.. others i do 2 bad ones. some days i dont get any consults. I do work at 2 other hospitals where i take call for a set amount for a 24 hour stint. maybe 4 times a month. post call i go to the fee for service place if im scheduled or to see if i can pick up some cases. the schedule at my principal hospital comes out a week before so i know whats going on. Sometimes the cases get cancelled or I get done at like noon which is no good. at that point I also have priveleges at another specialty hospital and i go over there to see if i could help with some add ons. My practice is not ideal because i end up going from one place to the other sometimes more than once. moreover, my salary fluctuates from month to month. but i dont have any partners, that i have to worry about. I have someone doing my billing, 5 percent, i have my own malpractice which is reasonable matures at 14k,(best in nation really i think), and i pay my own health and disability insurance. I take about 7-10 weeks vacation per year. I make about average nothing crazy. Once in a blue moon i will do a week there week here locuming in phoenix

I much prefer getting paid as an independent contractor over a w2 because the writeoffs are much better and more extensive and i get to put more money into a retirement account. the downside is you have to pay your benefits.

it seems to work for you and that is good. it is definitely not a practice pattern for all or even the majority

 

[Bougie]

How does powermd's MBA play into his bargaining? Useless for now? Useful later when he moves higher up the ladder? Did you get your MBA prior to medical training? More or less useful in private practice vs academics?

 

[powermd]

No, I actually turned 300k into about 225 K which is where I wanted to start in the first place. This was obviously just an illustration but it brings up a few points. In reality most of the contracts will look closer to mine than the original poster's. Giving a brand new grad (not board certified nor fellowship trained) 300K plus benefits is not fair to the group. When you go into any negotiation you need to be fair to both sides. 300K seemed to be important to him so I let him keep it while adding some other provisions for the group to even the playing field. Of course, with further discussion I am sure that an agreement could be reached that all sides feel is fair. But there needs to be give and take on both sides. In reality I do not feel that the contract that I proposed is unfair.

The second point is to look at the total benefit package and not just the salary. Full benefits usually add 50-75K to the package.


Good luck to all

What doesn't seem fair is the possibility of working 2 years 364 days and the next morning being told you will not be made a partner.

How about an arrangement where I am 'evaluated' for 6 months, and then a partnership decision is made. If yes, then I can continue to work for the full pre-partner income period (2-3yrs) with guaranteed partnership, or I can leave to pursue partnership elsewhere. Would this stipulation be difficult to achieve in most practices?

The 'ideal' contract I posted was the best I currently hope to achieve in most areas of the contract. I certainly don't expect to get everything listed. It's ALL up for negotiation. If I had to prioritize, I would do it as follows (most to least important):

Suitability to the practice, quality of the partners, warm, friendly, cooperative atmosphere at work.
Salary/partnership interval/partnership income value.
Potential for career growth within the practice, ASC, hospital, etc.
Location (small/medium city in Southeast, aesthetically pleasing surroundings, stuff to do indoors and outdoors).
Call schedule
Benefits
Vacation

 

[urgewrx]

From Real World Anesthesiology Group:
1) Your salary request is quite high especially for someone without a fellowship. MGMA and salary.com quote an anesthesiologist salary at 225k at the 50th percentile. It could be argued that your starting salary should be lower than this to start. However, we will keep your 300K salary with the following restrictions.
a) You are an independent contractor and pay all of your own benefits (including malpractice, health, life, disability). You will not be eligible for retirement until you become partner. Partnership is three years and your salary will not change until you become partner. Our partners have a guaranteed W2 from the hospital at 454K.
b) Each week of vacation that you take subtracts 6K from your salary. You chose how much you want to take for a max of 6 weeks.
2) Call schedule is q5 as nonpartner and q7 as partner
3) Concerning tail, we will only pay it if you are discharged from the practice without cause. This is more than fair and customary.
4) Concerning partnership, it needs to be three years because we have to evaluate if you are a good fit with us. Board certification is a prerequisite.

1 Agree. Starting salary seems high.
a) 300k is not high if you have to pay for you own benefits.
Being inelegible for retirement until making partner- I find this disrespectful. I would never cosider such a job. There are certain ways to fix this, like: You are elegible for retirement with 1:1 contribution which are vested after 3 years or immediately if the group "let's you go". If you leave the group before 3 years, you only take what you put in.
3 year partnership- seems long in this market. You would have to pay me more to consider anything more than 2.
Salary does not change while non-partner- Don't like it. Could live with it? Maybe. As experience and familiarity with the group goes up, so should the salary.

b)No vacation- suddenly 300k without benefits, retirement and no vacation is looking like 200K. I wouldn't take anything less than 2 weeks paid vacation. Avoids burn-out, better for me and group.

2) Call schedule- can live with it. Off the next day, or out before 2pm.

3)Tail- If the group let's me go, for whatever reason, they pay for it.

4) Board certification prerequisite- seems reasonable.


I would rather prefer 225k. Group pays for benefits. Retirement included. 2 weeks paid vacation. 25K increase per year.

 

[urgewrx]

How about an arrangement where I am 'evaluated' for 6 months, and then a partnership decision is made. If yes, then I can continue to work for the full pre-partner income period (2-3yrs) with guaranteed partnership, or I can leave to pursue partnership elsewhere. Would this stipulation be difficult to achieve in most practices?

Never heard of this, but seems like a good way to protect yourself. Has anyone heard of this?

You definetely need "evaluations" stipulated in your contract at least every 3 months, so that if they fire you after 3 years you can sue them if you had good evaluations. Evaluations must be discussed with you periodically. Keep a copy for yourself. No evaluation on file is automatically an excellent evaluation.

 

[powermd]

How does powermd's MBA play into his bargaining? Useless for now? Useful later when he moves higher up the ladder? Did you get your MBA prior to medical training? More or less useful in private practice vs academics?

It's a master of health administration which I did immediatly after finishing college. It wasn't from a top-tier program, but it wasn't community college either. I worked for a managed care company for one year, then entered med school. My hope is to ultimately do something administrative or entrepreneurial in medicine, while continuing some degree of clinical practice.

 

[EtherMD]

Never heard of this, but seems like a good way to protect yourself. Has anyone heard of this?

You definetely need "evaluations" stipulated in your contract at least every 3 months, so that if they fire you after 3 years you can sue them if you had good evaluations. Evaluations must be discussed with you periodically. Keep a copy for yourself. No evaluation on file is automatically an excellent evaluation.

Very reasonable. We evaluate at 6 months then again at 12 months. No issues then partnership secured. You must still do additional 12 months as part of your contract before full financial partnership is obtained. It is very hard to recruit and retain a first rate, fellowshipped trained MD so we want you to succeed. 24 month track the norm but 36 months fairly common for jobs at the 90th percentile as well.

 

[johankriek]

partnership means very little to me since in one fell swoop the hospital can and will send you a walking. then what? so my thinking is.. pay me what im worth now.... and we will both be happy.. not to mention if there is a change in CEO. who hates guys like militarymd... then you all get to pack your bags... so my negotiation is.. listen i dont wanna be your partner.. just pay me what the market rate is for an anesthesiologist,,, well make a year contract.. and at 7 or 8 months if you dont wanna renew my contract.. give me 20 grand and i walk ... dont pay for anything.. ill take care of everything.. my mal practice health and disability.. dont pay me if i am not working...

 

[vivi1129]

Would a regional fellowship from a place like HSS also help secure a good job in private practice? I am wondering about it because it's not an accredited fellowship like pain/ICU/cardiac.

 

[zippy2u]

$200/hr. Clock starts 1 hr. b/f start time on OR record. Clock ends 30 minutes after anesthesia end time or if in surg ctr, when pt. leaves the building. $500 to carry call beeper from home, $800 if in house and then $200/hr if I work. I determine if I want to take call. Vacation when I want and how long I want because I ain't gettin' paid by the boss man. I pay my own malpractice and anything else. Past, present and future--no use for partnership or any form of meetings. Get paid every week. Boss man can get rid of me on a moment's notice but I'll give him a minimum of 2 weeks 'cause I'm a nice guy. The whole shebang done with a firm Southern-style handshake---old skool. Regards, ---Zip

 

[Planktonmd]

$200/hr. Clock starts 1 hr. b/f start time on OR record. Clock ends 30 minutes after anesthesia end time or if in surg ctr, when pt. leaves the building. $500 to carry call beeper from home, $800 if in house and then $200/hr if I work. I determine if I want to take call. Vacation when I want and how long I want because I ain't gettin' paid by the boss man. I pay my own malpractice and anything else. Past, present and future--no use for partnership or any form of meetings. Get paid every week. Boss man can get rid of me on a moment's notice but I'll give him a minimum of 2 weeks 'cause I'm a nice guy. The whole shebang done with a firm Southern-style handshake---old skool. Regards, ---Zip

Zippy, are you doing your own cases or supervising CRNA's?

 

[zippy2u]

I go with the flow and do whatever it takes to get the job done-- I do both but much rather do my own cases. Regards, ---- Zip

 

[Pilot Doc]

What do the partners owners among you think of the following scenarios:

Scenario A: Partner salary $500K, typical new employee salary $250K (W2, group pays beneits). 2 years to partnership.

Scenario B: New grad salary $500K (same as partner), partnership buy-in at two year of $500K. This gives the group the same financial benefit, but includes an incentive to take the person as a partner. A hybrid system ($375K salary, $250K buyin) would be possible as well.

 

[urgewrx]

Dude, what about taxes? Every time money exchanges hands you have to pay tax.

At 500k who wants to be a partner?
​

 

[EtherMD]

What do the partners owners among you think of the following scenarios:

Scenario A: Partner salary $500K, typical new employee salary $250K (W2, group pays beneits). 2 years to partnership.

Scenario B: New grad salary $500K (same as partner), partnership buy-in at two year of $500K. This gives the group the same financial benefit, but includes an incentive to take the person as a partner. A hybrid system ($375K salary, $250K buyin) would be possible as well.

Scenario 'A' very plausible but what are YOU bringing to the GRoup? What advanced set of skills/knowledge sets you apart from the herd? You want a 90th percentile job then show why YOU are the one to be hired. Sorry, but this is when the rubber hits the road. After all those years of hard work in school DO THE EXTRA 12 months so YOU get the job.

 

[johankriek]

$200/hr. Clock starts 1 hr. b/f start time on OR record. Clock ends 30 minutes after anesthesia end time or if in surg ctr, when pt. leaves the building. $500 to carry call beeper from home, $800 if in house and then $200/hr if I work. I determine if I want to take call. Vacation when I want and how long I want because I ain't gettin' paid by the boss man. I pay my own malpractice and anything else. Past, present and future--no use for partnership or any form of meetings. Get paid every week. Boss man can get rid of me on a moment's notice but I'll give him a minimum of 2 weeks 'cause I'm a nice guy. The whole shebang done with a firm Southern-style handshake---old skool. Regards, ---Zip

thats what im talking 'bout

 

[EtherMD]

partnership means very little to me since in one fell swoop the hospital can and will send you a walking. then what? so my thinking is.. pay me what im worth now.... and we will both be happy.. not to mention if there is a change in CEO. who hates guys like militarymd... then you all get to pack your bags... so my negotiation is.. listen i dont wanna be your partner.. just pay me what the market rate is for an anesthesiologist,,, well make a year contract.. and at 7 or 8 months if you dont wanna renew my contract.. give me 20 grand and i walk ... dont pay for anything.. ill take care of everything.. my mal practice health and disability.. dont pay me if i am not working...

I agree with your concept but disagree with the approach. If your FIRST year salary on a two year track is higher than what you are making now why not take the chance on the Group?

My Group treats everyone equally. Same Call and same perks. The first year salary for an employee is higher than what you are making now. The second year is substantially higher with partnership being worth much, much more than your current income. The logical choice is to work a little harder with the chance of earning a lot more money. I agree that a long partnership track makes little fiscal sense and low first year salary is unfair. But, a job that pays you at least your current income level or more in the first year should be considered. 24 months takes care of your buy in and you are equal work wise from day one.

 

[johankriek]

What do the partners owners among you think of the following scenarios:

Scenario A: Partner salary $500K, typical new employee salary $250K (W2, group pays beneits). 2 years to partnership.

Scenario B: New grad salary $500K (same as partner), partnership buy-in at two year of $500K. This gives the group the same financial benefit, but includes an incentive to take the person as a partner. A hybrid system ($375K salary, $250K buyin) would be possible as well.

see the whole buy in thing means nothing because the accounts receivables is only as strong as the relationship with the hospital. Its not like a lawyer who builds a strong practice. In anesthesia, they are given( or earned by greasing some palms) the contract which comes with business automatically. next time you talk to any one who is offering you partner, ask them what the buy out is? If there is a buy in, there must be a buy out !! As you are asking him this LOOK HIM DEAD IN THE EYE.. My guess is, there is no buy out.. if you buy in at half a million, thats what you should get out of it..

 

[urgewrx]

$200/hr. Clock starts 1 hr. b/f start time on OR record. Clock ends 30 minutes after anesthesia end time or if in surg ctr, when pt. leaves the building. $500 to carry call beeper from home, $800 if in house and then $200/hr if I work. I determine if I want to take call. Vacation when I want and how long I want because I ain't gettin' paid by the boss man. I pay my own malpractice and anything else. Past, present and future--no use for partnership or any form of meetings. Get paid every week. Boss man can get rid of me on a moment's notice but I'll give him a minimum of 2 weeks 'cause I'm a nice guy. The whole shebang done with a firm Southern-style handshake---old skool. Regards, ---Zip

Guys, I think he was talking about his ideal contract, not his real one.

 

[EtherMD]

see the whole buy in thing means nothing because the accounts receivables is only as strong as the relationship with the hospital. Its not like a lawyer who builds a strong practice. In anesthesia, they are given( or earned by greasing some palms) the contract which comes with business automatically. next time you talk to any one who is offering you partner, ask them what the buy out is? If there is a buy in, there must be a buy out !! As you are asking him this LOOK HIM DEAD IN THE EYE.. My guess is, there is no buy out.. if you buy in at half a million, thats what you should get out of it..

That is why our 24 month track includes the buy-in. If you leave you get your buy-out like everyone else. TWO Years is a good deal provided you join a fair Group.

 

[EtherMD]

What could someone expect to earn without a fellowship in today's market place? I assume you are NOT Chief Resident and finished a second tier program.

Group: 24 or 36 month track
First year salary: $225,000 plus benefits
Second Year: $250,000 plus benefits
Third year: $275,000 plus benefits

Partner: $375,000-$425,000 depending on Call, case load, payer mix, etc.

This is not bad and represents an upper 25th percentile job. IF you want more than $500,000 per year a fellowship or Chief would help. If you want to join a Group with a 2 year track or shorter and earn $500,000 plus then a fellowship is needed more than 90% of the time.

 

[militarymd]

The concept of making "partner" and making MORE money only remains true as long as there is ALWAYS an employee who is going to work for a lower salary.

Once a group reaches equilibrium...ie no employees, then your income is just a shared piece of the pie as defined by the operating agreement.

It is conceivable that you can make less after making partnership if the total revenue drops because of a myriad of reasons ...3rd party payers change their rates, local factory closes, hospital stops subsidy, etc....this happened to a Mayo clinic grad I know.

What you need to look at is TOTAL revenue generated by the group...and ultimately how that revenue is divided amongst the partners....and how the new guy fits in over the time period before they make you "partner".

 

[EtherMD]

The concept of making "partner" and making MORE money only remains true as long as there is ALWAYS an employee who is going to work for a lower salary.

Once a group reaches equilibrium...ie no employees, then your income is just a shared piece of the pie as defined by the operating agreement.

It is conceivable that you can make less after making partnership if the total revenue drops because of a myriad of reasons ...3rd party payers change their rates, local factory closes, hospital stops subsidy, etc....this happened to a Mayo clinic grad I know.

What you need to look at is TOTAL revenue generated by the group...and ultimately how that revenue is divided amongst the partners....and how the new guy fits in over the time period before they make you "partner".

You are correct. A new graduate must ask the tough questions like what is ythe current income (last W-2)? How much will my becoming partner dilute the income? Will total revenue increase by hiring me? Realistically, what can I expect as partner? How many others will be hired before me and after me?
How is the relationship with the hospital/administration? Does everyone pull their own weight and do the same call? Does a retirement track exist (bad idea)? Does thenew hire get a say in the Group from day one concerning cases, call, suggestions, etc.? Is the Group respectd inthe hospital? Do they work hard or sit around the lounge all day? How many rooms do they supervise? What is a typical day, week or month look like? Do I like the Group, the hospital, the job, the location and the pay? Do they seem fair and have they let anyone go right before partnership (bad sign)? Finally, do they look you in the eye when answering all these questions or do they hesitate and talk around the subject?

 

[johankriek]

If your FIRST year salary on a two year track is higher than what you are making now why not take the chance on the Group?

.

It wont be higher.


Trust me I have spken to groups before before accepting my current fate that is now. I dont like my arrangement right now. there is aboslutely no stability and my work business changes very abruptly and without notice. i can prolly make more with much less work if i joined a group. I am constantly either looking for cases, asking people to do their cases or taking peoples calls which they are happy to give up. the calls are what makes me maintain my income to an acceptable level in the upper limits of average. But i guess i have to live with this instablility to have my independence and freedom. i suppose i can maintain this income level if ive done it for four years. The only thing that can change is that a group can come and take over. But we cover the place pretty good that the hospital wont do that. Plust its not that type of culture.

 

[Coastie]

Misread the post. Sorry!

 

[Coastie]

Error on my part..sorry!

 

[EtherMD]

Ether, 375-425k + benefits as partner a "high 25th percentile" job?

Come now.

Too low for you? Almost everyone that I finished Residency with is making this amount or more (first tier program). I would never accept a partnership track where the end result was not at least $375,000. Why bother with a track? AMC's pay $325-$350,000 per year (health care and malpractice as benefits but not retirement or disability). I know of several openings right now for new graduates. My numbers are real world or the AMC's wouldn't be offering those numbers would they?

 

[urgewrx]

Ether, what's AMC?
​

 

[johankriek]

Too low for you? Almost everyone that I finished Residency with is making this amount or more (first tier program). I would never accept a partnership track where the end result was not at least $375,000. Why bother with a track? AMC's pay $325-$350,000 per year (health care and malpractice as benefits but not retirement or disability). I know of several openings right now for new graduates. My numbers are real world or the AMC's wouldn't be offering those numbers would they?

sheridan has incredible negotiating power... they basically get what they bill. i talked to one of them on the phone a few years ago. They have a team of lawyers on the payroll.. i think and i could be wrong, partner no partner there are very few day to day anesthesiologists making 500 k. very few.. if you are making 500 k you are doign something else.

 

[EtherMD]

Ether, what's AMC?
​

Anesthesia Management Company. They are have the hospital contract and hire the MD's and CRNA's. They usually get 15-20% off the top as a management fee. The rest is used to pay anesthesia providers.

 

[EtherMD]

sheridan has incredible negotiating power... they basically get what they bill. i talked to one of them on the phone a few years ago. They have a team of lawyers on the payroll.. i think and i could be wrong, partner no partner there are very few day to day anesthesiologists making 500 k. very few.. if you are making 500 k you are doign something else.

According to published data 10% of all practices in the southeast are making $523,000 or more plus benefits. Thus, while rare 10% is not an insignificant number and the practices do exist. I know of at least 6 making that much or more in the south. In Colorado, Indy, certain parts of Indiana, etc. there are many practices earning that much (more actually) money. In the Northeast MANY practices earn more than that on a routine basis. There are many MD's in Texas (Dallas area) earning more than that as well.

BUt, the real question is what is the job like to earn that money? Perhaps, the low 400's gives you a good lifestyle and a nice income. There is a lot to be said for balance in one's life.

 

[urgewrx]

I got something in the mail yesterday like this: 370k hospital employed, + sign on bonus. Only catch: middle of nowhere.

What do you think? Are they desperate? Can you talk them into 400k, or 425k?
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