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  • jdkelso
    replied
    I just pulled up the MGMA data.  It is more private practice focused.  The AAMC data is very low.  The MGMA data has academic jobs as well and it is low and similar to the AAMC.

    They have general transplant, heart, heart lung, and liver.  They don't get super granular because the MGMA data is all based on reporting and when the sample size is low they don't report.  (So, if you read this make sure your practice reports so the data will be good.)

    The transplant median comp is 503 with 92 responders.

    I help folks with their employment agreements and you really need to decide on the life style changes/issues.  You will have a lot higher costs and the ease of life will be harder for you than your family.  However, your kids are young and you may want to be in a different community before they are school age.  There are more non-financial considerations with your situation than usual, which is probably why you reached out to this community.  For you it seems like it is not all about the money because you can make either work.  The loss of the medical school and research aspect also could end up being more of a bummer than you anticipate.  Plus if it is more private practice, then no M&M..or much less of that....

    I think this move financially will probably be a wash with potentially a more complicated life for you.  The other concern is even if you get a performance bonus, there are only so many organs.  It is not like you can just start marketing and open the flood gates unless you want to change what you do or there are vast improvements in 3d printing or organs.  Patient volume is very important and it would be really important to make sure this new offer has sufficient patient volume, especially if the compensation is based on productivity.

     

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  • Tim
    replied
    Rule #1- Take care of you and your family’s happiness and well being.
    Rule #2- Take care of your professional life in terms of satisfaction and compensation.
    The goal is to balance work and life as much as possible.

    Leave a comment:


  • folkher0
    replied




    That said – with a high housing bill and private schools your financial growth will be slower, even with the raise I suspect.  As others have said, there are a ton of details (RVU-based bonus, practice growth, partner status) that can change the salary at both places.  That commute will be a burden – you may miss some evenings with your family.  Less call would help reduce that hit – but lots of call and long commute will be tough.

    I think the most important thing is long-term career growth.  Is there a better senior mentor at one of these places who would help boost your career?  Is one place too full of big names or other rising stars for you to shine?  Can you negotiate other aspects (call, academic support) that will make you more successful in the long term? If the big city sets you up to excel in your specialty, you will be better for it even if you have to live like a resident longer.  You will also get a better shot at the next job you want.

    Personally, I would not want to move back to a big city unless it was for a dream job.
    Click to expand...


    This is a great perspective. I’ve been thinking along these lines.

    Leave a comment:


  • wideopenspaces
    replied
    I think if you guys want to move you can definitely make it work on your income. I would consider a housing situation with a shorter commute and access to good public schools, but that's just me. Good luck making your decision!

    Leave a comment:


  • Gomer
    replied
    I am in a similar point in my career and family life.  In my surgical subspecialty, which is mostly academic, less than 500k is the norm.  I enjoy my academic practice and living in a smaller city.  If you got an academic job in a competitive field, where some people don't even get to use their fellowship training, you are probably quite good at your job and enjoy it. Making the absolute most $ does not seem to be your priority.

    That said - with a high housing bill and private schools your financial growth will be slower, even with the raise I suspect.  As others have said, there are a ton of details (RVU-based bonus, practice growth, partner status) that can change the salary at both places.  That commute will be a burden - you may miss some evenings with your family.  Less call would help reduce that hit - but lots of call and long commute will be tough.

    I think the most important thing is long-term career growth.  Is there a better senior mentor at one of these places who would help boost your career?  Is one place too full of big names or other rising stars for you to shine?  Can you negotiate other aspects (call, academic support) that will make you more successful in the long term? If the big city sets you up to excel in your specialty, you will be better for it even if you have to live like a resident longer.  You will also get a better shot at the next job you want.

    Personally, I would not want to move back to a big city unless it was for a dream job.

    Leave a comment:


  • Tim
    replied
    •There are a number of cost of living calculators that you can use to compare the difference including taxes and housing either rent or own. Some parse the info down to suburbs as well. It’s a mix and match.
    •You are in a sweet spot at the 4 yr mark.
    •Consider the different academic environments. Some value the research side and others more the production and have “supplemental pay” not included in the “public disclosures. Incentive pay can include call coverage and “academic performance goals”.
    • The department “budget” gives some leeway for what’s needed to get the “right person”. How big is the leeway is the unknown. $350k turns into $450k, but that happens with a competitive offer. Base and incentives. The “trick” is to fit in and get them to give the best they can handle.
    • Surveys give averages, but not the size and specific.
    Good luck.

    Leave a comment:


  • octopus85
    replied




    according to an MGMA spreadsheet posted in the medical school subreddit 3 days ago for 2019, general transplant was $452k, kidney $368k, liver $400k if I’m looking at it right. so as others are saying you’re likely being underpaid

    as transplant/hpb are you currently taking in house call or home being 20 minutes away? would that change with your commute being 40 minutes at new place? my limit for commute is 30 minutes personally.

    would you get more procurement opportunities?

    you say your partner is excited to move… happy spouse happy house
    Click to expand...


    I had to pull that reddit thread up:

    https://www.reddit.com/r/medicalschool/comments/cokkn2/serious_2018_mgma_data_for_those_curious/

     

    Like most of the commenters, I'm shocked at the low numbers, and am assuming this is filtered by academic only.

     

    The 2016 MGMA data I have (just a summary) says Transplant (Liver) median is $505k, and Transplant (Kidney) is $401k

    Leave a comment:


  • folkher0
    replied
    Thanks for the data, team. Great stuff and very useful. The volumes on these surveys are relatively low compared to the ASTS survey that most transplant surgeons typically refer to.  Essentially our whole field (just looked again, over 300 responses) completes it, so I don't know the biases implicit in the small sample sizes of the other surveys.

    If you don't believe me about salaries, remember that state university faculty are public employees and salaries are often searchable on the internet.  Obviously total compensation may be in excess of posted salaries, but at least you can get an idea.

    In any case it is very useful stuff and deeply appreciated.

    Leave a comment:


  • Nysoz
    replied
    according to an MGMA spreadsheet posted in the medical school subreddit 3 days ago for 2019, general transplant was $452k, kidney $368k, liver $400k if I'm looking at it right. so as others are saying you're likely being underpaid

    as transplant/hpb are you currently taking in house call or home being 20 minutes away? would that change with your commute being 40 minutes at new place? my limit for commute is 30 minutes personally.

    would you get more procurement opportunities?

    you say your partner is excited to move... happy spouse happy house

    Leave a comment:


  • NutADuc
    replied
    http://physiciancompensation.org/PDFs/2015RSPWB/2015Survey.pdf

     

    This is a bit dated but still useful. Page 54 has data for academic transplant surgeons. Hope it gives you some negotiating power whether you choose to stay or go.

    Leave a comment:


  • folkher0
    replied
    Thanks, Zaphod, this is useful.  I don't have access to MGMA, but I would love to explore it a bit: information is power...

    FWIW I don't do thoracic transplant, just everything below the diaphragm. Not sure how you can sort MGMA. I would love to see how many abdominal transplant surgeons are in the database.

    Leave a comment:


  • Zaphod
    replied


    But I know that I bill a lot more in terms of dollar value than my salary. And I do not believe the institution collects all that is billed…and it loses money on other clinical services.
    Click to expand...


    There is a ton to the bill, your salary and professional bills are actually a small part of it. Just look at the breakdown of the RVU for example. Of course there are facility fees as well, and then all the downstream revenue you generate by operating or putting someone in the hospital. That is admission, daily, rn care, supplies, labs, path, and so on and so forth. It can get quite crazy.

    Of course your facility is only going to show you the small side, and they also love to expense a bunch of things you dont use or apply to you to your clinic or whatever. Im sure there are some specialties that 'dont make their salary' or dont seem superficially to bring in a lot, but they allow everyone else to do their job which brings in far more than that salary (hospitalists, plastics, etc..).

    BTW, mgma shows median income of 511k on 6900 wRVUs. That is total comp so includes benefits and not for say kidney/heart, just general.

    Leave a comment:


  • redsand
    replied


    Considering how hard you worked to get thru residency and fellowship, and how much your institution can bill for your procedures, I’m astonished.
    Click to expand...


    The institution has to pay for the non-clinical staff salaries and capital improvements and all sorts of things...perhaps, that explains part of it. As someone in academics (in a small, non-procedural field that does not graduate enough trainees per year for the number of open jobs), I get it. I think physicians make up less than 10% of staff in the academic medical center where I work. Yes the institution can bill facility fees for services provided by other staff. But I know that I bill a lot more in terms of dollar value than my salary. And I do not believe the institution collects all that is billed...and it loses money on other clinical services.

    Another thing to consider is that some people in academics do a lot of research, and therefore, revenue from clinical work might be low because they might be only 10-20% FTE clinical. I do not know whether this would apply to the OP. However, if clinical effort and billing is a low part of one's overall employment in academia, I don't know that numbers like $400,000+ make sense if most of the time is spent in research. I'm not a surgeon, though....


    Who knows, when I get tenure and have job security into my 70s and all I have to do is rot in the backrow of M&M maybe it will all be worth it…
    Click to expand...


    Lol at the imagining that scenario

    Leave a comment:


  • nephron
    replied
    A 400 K salary will put you well above the median salary of most towns, even the hcol environments so I think that you should be able to live where you want.   Most hcol places have good school districts if you choose places just outside of the city lines so if you choose wisely, you can probably avoid the private school costs unless you are going for religious reasons.    The commute is a downside, but a 40 minute commute is not too unreasonable, just make sure that it really is a 40 minute commute as some the cities you cited can easily be much more then that if you do live outside city lines.   Most transplant centers/tertiary care facilities are not in good locations to live so I'm surprised your commute is so short right now, I imagine most that work in these centers are dealing with longer commutes.  I don't see the problem with taking the new job if you really think that the people will be that much better to work with and your salary will be higher even if the cost of living is higher.   I wouldn't pick to live someplace for 20-30 years of life just to save on cost of living, you have to spend your money on something so it might as well be an enjoyable place to live.   I don't understand why people are so shocked to see your salary, the job market in academics is a whole different ball game.   Your medical transplant colleagues are starting in the low 100's at some of the big academic centers, some people just like the prestige that comes with working there.   I know of more then one transplant nephrologist working as a hospitalists in local community hospitals because they discovered the pay difference was too great and the job was not all they anticipated, but again, if you are going to be spending over 40 hrs a your waking hours in  place, it might as well be doing something you enjoy.

    Leave a comment:


  • folkher0
    replied
    This is funny.  Everyone thinks that I deserve more.  I agree!  But the market for transplant surgeons is what it is.

    I guess my field..... is probably not like your field.  90% of jobs are academic. Usually as a hospital employee.  Very few jobs. Big cities have 4-5 programs, each with 5-6 surgeons.  Smaller markets have fewer, smaller, programs. I'm gonna ballpark that there are about 300 of us in the country.  Given the small size of the field, and the total number of respondents to the survey, I believe its accurate.

    Our fellowships graduate 20-30 board eligible fellows a year.  Many don't get jobs in transplant. The AAMC survey jibes with our compensation survey.  And most salaries are negotiated based on the survey.  My friends of my vintage around the country generally have salaries in line with the survey as well, though there are a few places that are less academic with more favorable compensation models.

    So... I guess you guys are probably happy you never went into transplant.

    Anyway, I'm ok with all that.  I still enjoy my crazy job. I'm not burned out (yet), and I'm doing fine financially. I knew I was never gonna kill it, but no one is shedding any tears for me. I'm smart enough with my money to live the life I want to live.Who knows, when I get tenure and have  job security into my 70s and all I have to do is rot in the backrow of M&M maybe it will all be worth it...

    So my original question, evaluating/negotiating this new job, in an HCOL environment where compensation surveys fail, is still open for anyone else who wants to chime in. Many responses have been helpful.

     

    Leave a comment:

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