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  • Job offer salary negotiations

    Wanting to get everyone's thoughts on a job offer I received recently.

    For background, just finishing training in a surgical sub-specialty. Have been on the job hunt for over a year now. The main hurdle has been finding a job in a specific larger metropolitan area where family is based in which I have the opportunity to start out at least partially practicing in my sub-specialty and being able to focus in on it more as my career progresses.

    I have received 2 other offers in different locations. One in a very large metropolitan area and another in a smaller city with no family but within a 2-3 hour drive of family. The former I have since declined as the pay to COL ratio was just too high to justify without family in the area. The second offer still stands and is closer to the MGMA median in my specialty. This second offer is in the same geographic region as this new offer but is still a few hour drive from it. Also, for us it is not a super desirable location to be in.

    The newest offer: 3 year contract with base guarantee plus incentive bonuses. The yearly base guarantee is significantly less than MGMA averages (around 300K less). It increases minimally each year for the three years. The bonus incentive kicks in once I meet my guarantee in collections. Starts at 30% of collections year 1 and goes up 10% each year up to year 3 when it is 50%. After year 3 I would switch to pure 50/50 model. Partnership not a guarantee but a good possibility if I'm interested.

    This current offer is in our #1 preferred location where family is located and is the only offer I have there. It is a large metropolitan area and a MCOL area. It is a private practice which is technically multi-specialty but the majority is made up of my specialty. They have sent me numbers data and most, if not all, of the physicians are doing quite well. Some are really killing it. This is based on a 50/50 collections model.

    My thoughts and questions about the situation are this. It is my only offer in our #1 location. I definitely could get a higher guarantee getting a hospital job in a different location. While the base guarantee is quite low, with the bonus incentive I can potentially increase my yearly salary a decent amount if I am busy enough. However, I look at it as taking a moderate pay cut for the first few years with the good possibility and hope that once my practice is up and going I can make more than if I ever worked for a hospital (and that's just working as an "employee" under 50/50 model. Could make even more if I become a partner which is a good possibility but not an outright guarantee or "partner track").

    Regardless, I am inclined to ask for a higher guarantee, at least for the first 2 years while my practice ramps up. I'm possibly also considering asking for higher percentage of bonus incentive earlier on (year 1-2) as well. Ultimately, this is best overall job offer I have considering practice setup, location, independence and future earning potential. Is it common to have to take such a significant pay cut in this situation with a private practice where there potential for greater earnings later on? How much more would people recommend I ask for in each of these categories without rocking the boat too much and hurting my chances of securing the position or even just creating a tense working environment if I do end up there regardless?

  • #2
    Originally posted by legoman View Post
    Wanting to get everyone's thoughts on a job offer I received recently.

    For background, just finishing training in a surgical sub-specialty. Have been on the job hunt for over a year now. The main hurdle has been finding a job in a specific larger metropolitan area where family is based in which I have the opportunity to start out at least partially practicing in my sub-specialty and being able to focus in on it more as my career progresses.

    I have received 2 other offers in different locations. One in a very large metropolitan area and another in a smaller city with no family but within a 2-3 hour drive of family. The former I have since declined as the pay to COL ratio was just too high to justify without family in the area. The second offer still stands and is closer to the MGMA median in my specialty. This second offer is in the same geographic region as this new offer but is still a few hour drive from it. Also, for us it is not a super desirable location to be in.

    The newest offer: 3 year contract with base guarantee plus incentive bonuses. The yearly base guarantee is significantly less than MGMA averages (around 300K less). It increases minimally each year for the three years. The bonus incentive kicks in once I meet my guarantee in collections. Starts at 30% of collections year 1 and goes up 10% each year up to year 3 when it is 50%. After year 3 I would switch to pure 50/50 model. Partnership not a guarantee but a good possibility if I'm interested.

    This current offer is in our #1 preferred location where family is located and is the only offer I have there. It is a large metropolitan area and a MCOL area. It is a private practice which is technically multi-specialty but the majority is made up of my specialty. They have sent me numbers data and most, if not all, of the physicians are doing quite well. Some are really killing it. This is based on a 50/50 collections model.

    My thoughts and questions about the situation are this. It is my only offer in our #1 location. I definitely could get a higher guarantee getting a hospital job in a different location. While the base guarantee is quite low, with the bonus incentive I can potentially increase my yearly salary a decent amount if I am busy enough. However, I look at it as taking a moderate pay cut for the first few years with the good possibility and hope that once my practice is up and going I can make more than if I ever worked for a hospital (and that's just working as an "employee" under 50/50 model. Could make even more if I become a partner which is a good possibility but not an outright guarantee or "partner track").

    Regardless, I am inclined to ask for a higher guarantee, at least for the first 2 years while my practice ramps up. I'm possibly also considering asking for higher percentage of bonus incentive earlier on (year 1-2) as well. Ultimately, this is best overall job offer I have considering practice setup, location, independence and future earning potential. Is it common to have to take such a significant pay cut in this situation with a private practice where there potential for greater earnings later on? How much more would people recommend I ask for in each of these categories without rocking the boat too much and hurting my chances of securing the position or even just creating a tense working environment if I do end up there regardless?
    not enough specifics. what field? exact salary numbers? I am a little confused. if you can post each offer with a few lines on each that would be the best. otherwise, the simple answer is being by family is everything

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