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  • Zaphod Zaphod 
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    Status: Physician, Small Business Owner
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    Joined: 01/12/2016

    Being in a lcol usually increases your pay for doctors. Still think you’re way underpaid unless you dont do much wRVUs, which I’d be shocked by really. There may be few job openings but really any place that wants to be seen as elite/etc…you’d think they’d be willing to pay for it. All the transplant people I know also did a lot of vascular access cases as well. Dont know how well that pays though.

    Man, good on you, thats a sacrifice for that pay.

    Its hard to say how the compensation survey stacks up as its shocking how many people dont even understand exactly how theyre paid, their benefits, etc…I’ve seen people that dont even know for sure how much they make, wild.

    #238715 Reply
    Avatar wa2106 
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    Status: Physician
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    Joined: 11/29/2017

    Actually median salary for transplant surgeons at academic medical centers (per AAMC; 2017-2018) is $325k.  Would at bare minimum take that number to leadership and ask for a raise.

    #238727 Reply
    Liked by childay
    MPMD MPMD 
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    Status: Physician
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    Joined: 05/01/2017

    Actually median salary for transplant surgeons at academic medical centers (per AAMC; 2017-2018) is $325k.  Would at bare minimum take that number to leadership and ask for a raise.

    Click to expand…

    that is absolutely shocking to me.

    i would have guessed base in the high 400s.

    also kind of a difficult career as the job market outside of academics must be almost zero.

    the only thing i can think is that the work at the top of the ladder might be relatively easy only b/c of what is generally a small army of fellows, residents, and APPs? def not saying it’s not a challenging field or disparaging anyone’s work in any way, i really don’t know anything about it. i

    #238729 Reply
    Liked by wonka31, childay
    CordMcNally CordMcNally 
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    Status: Physician
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    Actually median salary for transplant surgeons at academic medical centers (per AAMC; 2017-2018) is $325k.

    Click to expand…

    This absolutely floors me.

    “But investing isn’t about beating others at their game. It’s about controlling yourself at your own game.”
    ― Benjamin Graham, The Intelligent Investor

    #238730 Reply
    Avatar wa2106 
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    Status: Physician
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    Joined: 11/29/2017

    Actually median salary for transplant surgeons at academic medical centers (per AAMC; 2017-2018) is $325k.  Would at bare minimum take that number to leadership and ask for a raise.

    Click to expand…

    that is absolutely shocking to me.

    i would have guessed base in the high 400s.

    also kind of a difficult career as the job market outside of academics must be almost zero.

    the only thing i can think is that the work at the top of the ladder might be relatively easy only b/c of what is generally a small army of fellows, residents, and APPs? def not saying it’s not a challenging field or disparaging anyone’s work in any way, i really don’t know anything about it. i

    Click to expand…

    Should add that’s for assistant professors which I assume OP is.  Also for southeastern region which I used for a proxy for LCOL area.  Good news is the median increases to 441k for associate professors.

    #238737 Reply
    Avatar Hemonc 
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    Status: Physician
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    All These surveys are not reliable and under representative of MD true worth . MGMA is only survey which is someone close to reality . Those who report to these surveys are usually toward start of career which brings down amount even more. Employers use non MGMA surveys to rip MDs. I’m sorry to say but you are not being treated fairly and you need to ask around to get an idea about your true worth. It’s sad that salaries are income questions are considered taboo topic in our society which lead to MDs out of fellowship ripped by CEO with these AMGA / like surveys … Brother you need to re-evaluate your worth and start asking close friends about income potential ideas to educate yourself as sole earner … Definitely make the move and look around to get 500k plus atleast with better growth potential

    #238746 Reply
    Liked by Zaphod
    Avatar Allixi 
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    Status: Physician
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    Joined: 03/16/2016
    Earnest refinancing bonus

    Some food for thought:

     

    What would you deal with as far as clinical issues go? I spent some time on a transplant service where boundaries were clearly drawn: each surgeon only did livers, or kidneys/vascular access, and never the twain shall meet. That is, except one person who only did vascular access and procurements (no actual transplantation). I’d imagine this would affect your bargaining power when negotiating salary.

    I don’t know if this will be true throughout the country, but major metropolitan areas tend to have sicker patients and more competition for organs. Our service would have half its pts in the ICU at any given time, infected with some of the nastiest organisms (carbapenem-resistant klebiellas and enterococcus and such). Will you have residents/fellows, or NP/PAs for the floor care?

     

    Unfortunately, I can’t speak to any of the financial aspects – I am also shocked it’s that low.

    #238748 Reply
    Avatar treesrock 
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    Status: Physician
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    I’m just joining the chorus at how shocked I am your salary is that low.  Considering how hard you worked to get thru residency and fellowship, and how much your institution can bill for your procedures, I’m astonished.

    Edited to add that I would totally make the move.

    #238766 Reply
    Avatar folkher0 
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    Status: Physician
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    Joined: 12/22/2016

    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.

     

    #238772 Reply
    Liked by wa2106
    Avatar nephron 
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    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.

    #238778 Reply
    Avatar redsand 
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    Status: Physician
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    Joined: 01/08/2017
    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

    #238784 Reply
    Liked by Dreamgiver
    Zaphod Zaphod 
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    Status: Physician, Small Business Owner
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    Joined: 01/12/2016
    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.

    #238803 Reply
    Liked by folkher0, childay
    Avatar folkher0 
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    Status: Physician
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    Joined: 12/22/2016

    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.

    #238847 Reply
    Avatar NutADuc 
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    Status: Other Professional
    Posts: 41
    Joined: 08/29/2016

    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.

    #238881 Reply
    Liked by Zaphod
    Avatar Nysoz 
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    Status: Physician
    Posts: 78
    Joined: 10/23/2017

    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

    #238891 Reply

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