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Advice on academic ophthalmology contract/salary???

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  • Avatar Noob to WCI 
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    Joined: 12/10/2017

    Hoping to get some advice on an upcoming contract negation for my wife.

    Background:

    Academic general optho for 4 years. Practice is set up like a private practice. She works at community clinics and surgery center owned by the academic hospital. No research or teaching duties. She’s about to be the senior surgeon at the clinics she works in due to retirement by 2 older docs. Her current annual wRVU production is about 5500-6000, the wRVU would likely be higher but she is required to spend 1-2 days a week to cover rural outpatient clinics that see less than 10 patients/day (these clinics are about 45-60 min drive each way). Big issue is that bonus structure payout is highly wRVU based. She needs to get closer to 7200 annual wRVU to get bonus pay. Her current salary is about $170k (this seems below market pay even for academics). The bonuses are paid out quarterly and would be about $50k each, if you hit the wRVU numbers. Her bonus structure doesn’t seem like its gonna happen if she keeps having to cover these rural clinics and cause her to lose out on fair compensation.

    2017 MGMA data says 50%tile academic optho pay is $250k-300k at annual wRVU of 6000. I think she should ask for minimum base of $250k and change the schedule to make hitting the wRVU targets more feasible. Anyone have advice or experience with academic optho pay/bonus structure?

    #240381 Reply
    Avatar Lizzie 
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    Status: Physician
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    Joined: 08/22/2019

    Talking to others, 170K is not unusual for general ophtho in a desirable geographic location (I know people who signed for less than 125K in cities).

    As far as a contract, I would focus on the satellites.  For general ophtho, it is unusual to have to go to a location more often than monthly, so one option would be to space them out so she goes less frequently and sees more patients per visit.  It would also be prudent to see if either of the docs leaving have busier satellites they go to that she could go to instead.

    Obviously, you can also try for higher pay or fewer satellites but I think that may be a harder sell.

    Good luck!

    #240537 Reply
    Liked by Zaphod
    Avatar mjohnson 
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    Status: Physician
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    Joined: 05/05/2019

    That seems very low.  I know an ophtho in a non for profit health system that makes ~ 1.5 million and his partners make at least a million if working full time.

    #240663 Reply
    Avatar Dusn 
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    Status: Physician
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    Joined: 01/02/2018
    Splash Refinancing Bonus

    What area of the country are you?  What’s the noncompete?  What leverage does she have?  I agree, your wife is getting severely underpaid.   Ophtho is a predatory field with large noncompetes, where younger ophthalmologists are, IMO frequently getting screwed, and somehow both Lizzie and mjohnson are correct in the range of salaries they’ve quoted – despite there being such a large disparity in their numbers.   I think the higher end of salary range really has to do with having ownership, ASC etc.

    I would apply to other jobs so that she can go to the negotiating table with higher offers or leave if they don’t give her what she wants.   Is there a VA nearby?  Because the VA will probably pay her about 100K higher than her current salary with likely better benefits (and will not be restricted by her noncompete).  If they know she can’t leave, unfortunately her negotiating power will be limited.

    Unfortunately it sounds like they’re using her to build up their satellite clinics without adequate compensation.

    I’d read the book “Never Split the Difference” and watch some videos on negotiating on youtube (Deepak Malhotra is good: https://www.youtube.com/watch?v=km2Hd_xgo9Q ).  But I think she also needs some leverage from competing job offers.

    And if she ever decides to go out into solo practice, this blog might be a good resource:

     https://solobuildingblogs.com/2017/07/30/my-story-why-i-opened-my-solo-practice/

     

    #240725 Reply
    Avatar ZZZ 
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    “Practice is set up like a private practice. ”

    Except for the pay part. Have her scout out other jobs to see what the market is, and you’ll gain the leverage of having the option to leave. Sounds like they need her more than she needs them, play your hand.

    #240790 Reply
    Liked by Lizzie
    Zaphod Zaphod 
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    Status: Physician, Small Business Owner
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    Joined: 01/12/2016

    For those satellite clinics I agree with trying to stack them or even now that shes established the referral lines and let people know she exists, they will likely drive to you.

    Its a bit ridiculous from an efficiency standpoint to have the doctor drive to the pt instead of vice versa. Its good for establishing but after that just say find us at 1234 ave now. Referring docs will just send them to your clinic instead of whatever satellite. This worked for our group.

    #240933 Reply
    Liked by Eye3md, Lizzie
    Avatar jdkelso 
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    Status: Attorney
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    The MGMA data that you have does not look correct.  It is low.  I am looking at the 2019 data.  The 2017 data is not that far off the 2019 data.  It is not the academic data but that is because you said they run this like a private practice.  Some medical schools run the clinic like a private practice but still low ball the physician on comp.  If that is the case, it will be difficult to fight the system because it is designed to pay less.  They take that “other money” and use it for the dean’s parties and staff, research and indigent care.  The fight for your wife will be overcome the restrictions of the system and she may be in a position to fight for higher pay but she may need to be prepared to walk away to bet their attention.

    #240971 Reply
    Liked by Tim
    Avatar AR 
    Participant
    Status: Physician
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    Joined: 03/10/2016

    I always chuckle when I hear “academic, but set up like a private practice” or something along those lines.  It’s an oxymoron.   “Academic” introduces certain unavoidable, intrinsic inefficiencies that make “like a private practice” impossible (unless you have an incredibly liberal definition of “like”).

    I’m sure this is what your group strives to do and some may even be naive enough to believe that they are achieving it.  But you shouldn’t fall into that trap.  Academic is academic, despite all representations to the contrary.

    #241187 Reply
    Liked by q-school
    Avatar Dont_know_mind 
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    Status: Physician
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    Joined: 11/21/2017

    I’m not an ophthalmologist, but I’m shocked at how low the salary mentioned is.

    #241195 Reply
    Avatar SValleyMD 
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    Status: Physician
    Posts: 473
    Joined: 05/12/2016

    Agree. I thought at first it was for an optometrist

    Our academic ophthalmology guys were in 600k plus range..

    #241210 Reply
    Zaphod Zaphod 
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    Joined: 01/12/2016

    I always chuckle when I hear “academic, but set up like a private practice” or something along those lines.  It’s an oxymoron.   “Academic” introduces certain unavoidable, intrinsic inefficiencies that make “like a private practice” impossible (unless you have an incredibly liberal definition of “like”).

    I’m sure this is what your group strives to do and some may even be naive enough to believe that they are achieving it.  But you shouldn’t fall into that trap.  Academic is academic, despite all representations to the contrary.

    Click to expand…

    Yes.

    I fondly think back on all the lectures from life long academics telling us how private practice worked and differences, etc…very much no idea as one might expect.

    #241265 Reply
    Avatar Good Life 
    Participant
    Status: Physician
    Posts: 35
    Joined: 05/25/2017

    Hoping to get some advice on an upcoming contract negation for my wife.

    Background:

    Academic general optho for 4 years. Practice is set up like a private practice. She works at community clinics and surgery center owned by the academic hospital. No research or teaching duties. She’s about to be the senior surgeon at the clinics she works in due to retirement by 2 older docs. Her current annual wRVU production is about 5500-6000, the wRVU would likely be higher but she is required to spend 1-2 days a week to cover rural outpatient clinics that see less than 10 patients/day (these clinics are about 45-60 min drive each way). Big issue is that bonus structure payout is highly wRVU based. She needs to get closer to 7200 annual wRVU to get bonus pay. Her current salary is about $170k (this seems below market pay even for academics). The bonuses are paid out quarterly and would be about $50k each, if you hit the wRVU numbers. Her bonus structure doesn’t seem like its gonna happen if she keeps having to cover these rural clinics and cause her to lose out on fair compensation.

    2017 MGMA data says 50%tile academic optho pay is $250k-300k at annual wRVU of 6000. I think she should ask for minimum base of $250k and change the schedule to make hitting the wRVU targets more feasible. Anyone have advice or experience with academic optho pay/bonus structure?

    Click to expand…

    If she is generating 6000 wRVU and getting paid 170k she is getting royally screwed. Many academic or hospital system employees are paid purely on wRVU production. Many places look at MGMA data and base it off of that. Using your MGMA data if the average doc makes $275,000 producing a wRVU of 6000, then that means they made $45.83 per RVU.  I would ask them to look at a model where you are paid purely on production, or close to that, and ask them what dollar amount per RVU they would be willing to pay.  Even if they paid $40 per RVU she should be paid $240,000 if she were generating 6000 wRVU. If she is getting paid 170k for 6000 wRVU she is $28.33 per RVU. That is absurdly low for ophthalmology.  An intermediate (undilated) return office visit reimburses 0.92 RVU.  So she’s getting paid about $26 dollars right now for an intermediate return office visit (e.g. somebody with dry eyes, glaucoma, etc…).

    #241268 Reply
    Liked by Dusn
    Avatar Tim 
    Participant
    Status: Accountant
    Posts: 3301
    Joined: 09/18/2018

    “Academic is academic, despite all representations to the contrary.”

    The definition of “academic “ has changed as well. One used to include at least a portion of work devoted to tasks related to the medical school and actually in the primary teaching hospital.

    No more. “Healthcare organizations “ now sprinkle the suburbs, private practices purchased and physicians under contract simply for services performed. No research or teaching responsibilities, but a small “comp provided for academic duties “. Translation, you may have residents assigned to the clinic or the OSC or suburban hospital, so make nice and do your work and go to required meetings. Non-tenured tract positions are really “employed physicians “. They call it “academic “, but the healthcare organization has a medical school component and non-profit group employing physicians as well. Just like a private hospital chain, it’s a business.
    The link for research and teaching used to be “academic”, few and far between.
    Anecdotally, they don’t play “nice” with private groups that resist “joining”.

    #241273 Reply
    Liked by Dreamgiver
    Avatar TheDangerZone 
    Participant
    Status: Physician
    Posts: 33
    Joined: 12/23/2018

    I am in “academic” ophthalmology and salary is production based for everyone in the practice. First 8,000 wRVUs is paid at $28, 8,000-11,500 at $45 and >11,500 is paid at $66. Contrary to what someone else said, in my experience most other ophthalmology academic institutions pay a base with a production bonus. The base is usually determined by experience and need.

    My very first year in practice I generated ~1,000 wRVUs a month which included plenty of slower days. I would not be where I am if I was only able to produce 6,000 annual wRVUs.

    How busy is she? Are the clinics inefficient or are there too many mouths to feed? Is there potential for production growth? I agree the satellite is dragging her production down.  Can she do anything to establish and build a better referral network? From a purely financial standpoint she could likely be doing much better (unless this is a highly saturated area). She can ask for a raise but I wouldn’t be surprised if they don’t budge.

    #241435 Reply

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