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negotiating pay raise

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  • Avatar skiMD 
    Participant
    Status: Physician
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    Joined: 02/03/2016

    I have a meeting with division director this upcoming week as part of a long overdue review. He brought up a pay raise as one of the topics. I want to go into this meeting as prepared as I can to negotiate the best deal. Will give as much background as I can.

    About 18 months into clinical practice from fellowship. Hem/Onc. Northeast. I am part of an academic group but I work exclusively in a satellite community hospital. I function as a general hem/onc rather than disease subspecialist. The job in reality is much more clinical than academic though the director stills sees me as an academic albeit as a clinical educator rather than research. My current pay is reflective of the academic role (low 200s). Four full clinic days a week. One partner onsite who is probably about 2-3 years from retirement. I am the only physician onsite two days a week at the infusion center with no midlevel assistance on those days – sick visits, infusion reactions, etc all are on me. Call workload is light but it is still on every other week mon-thurs and q4 weekends. New pt volume is up 22% over the past year. Infusion volume is up about 10%. We have develop a breast multidisciplinary clinic over the past year as well.

    Aside from pointing out the volume stats, what would be my best strategy? Ideally I’d like a 10% bump but perhaps that’s selling myself short or too much. Any help would be appreciated.

    #98157 Reply
    Avatar StarTrekDoc 
    Participant
    Status: Physician
    Posts: 2049
    Joined: 01/15/2017

    Being an academic institution, it’s hard to break the mentality of that and community pay equivalents.

    Since you’re working more community level, things you may want to be armed with going into the meeting:

    1.  Current Community:  Workload/RVU production and pay comparisons to your level of work/pay/experience.   ie What would you be paid for your work in the community?   Hard to find at times unless you have a fellow colleague doing the same work willing to share.    Can kick the tires of local groups hiring too (never hurts).

    2.  Academic comparisons:   prorate expected work and actual work.   If you’re working more clinical hours (or different ones), they should prorate the salary and adjust AT LEAST 1:1 of academics to clinical.   One may argue that academics bring in $ from the school, but the reality unless it’s research dollars, the funding from the school tends to be minimal.  If they use that, ask for the breakdown of the stipends of those activities and then adjust the prorated clinical work from there.  Clinical work and income is vastly higher than anything the school reimburses.   If you’re scheduled the same hours, but yours is a higher acuity and production (infusion center AND RVUs), you should be able to negotiate at least a productivity bonus scale for this; but I would rather see you have a number attached to the value of the additional infusion center responsibilities first for a flat rate that won’t be subject to workload fluctuations and yearly reassessments.  It’s cleaner and easier long term.

    We have the same issue at our institution.  I’ve been an advocate to attach a value to each and every activity that the physician does in the three realms – clinical, research, teaching.   Then one can measure and move physicians around and balance everything accordingly.

    #98166 Reply
    Liked by q-school
    jfoxcpacfp jfoxcpacfp 
    Moderator
    Status: Financial Advisor, Accountant, Small Business Owner
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    Joined: 01/09/2016

    Wow – the fact that he brought up the pay raise gives you leverage going in to the meeting. Have you thought about seeing if Jon at Contract Diagnostics could assist? Would be worth at least a call, I think.

    Johanna Fox Turner, CPA, CFP, Fox Wealth Mgmt & Fox CPAs ~
    http://www.fox-cpas.com/for-doctors-only ~ [email protected]

    #98172 Reply
    Liked by MochaDoc
    Avatar wideopenspaces 
    Participant
    Status: Physician
    Posts: 1138
    Joined: 01/12/2016

    I agree with knowing what your value is outside of academics. Can they recruit easily into your position? Also consider what is most important to you- time or money. I’m in academic psychiatry and they can’t replace me. The pay gap between us, the VA and the other hospitals in town is such that they just straight up gave us a 10 percent raise last year. I also used the fact that they can’t replace me to work less hours after having my son. Now that I’m thinking about getting back to my usual hours (0.75 FTE) I convinced them to stop making me book 10 percent over ( to make up for no shows) so I’m getting paid the same for less time at work. However I also improved my billing so it’s a win/ win, I get what I want ( less hours and more money) and they get what they want too.

    Just remember that you are likely in a position of power, so ask for whatever will make you happy and willing to stay. It sounds like they will at least give you some kind of raise and if it’s not enough, you can go elsewhere.

    #98175 Reply
    Vagabond MD Vagabond MD 
    Participant
    Status: Physician
    Posts: 3474
    Joined: 01/21/2016

    I said this recently, in another thread and context, but it applies here, too:

    “I think that 75% (or more, maybe 90%+) of docs hold the upper hand in their employment relationships, but only about 25% realize it and even fewer know how to capitalize on it. We are accustomed to sucking it up, getting along, not making waves, being a team player, blah, blah, blah, and our overlords use this to walk all over us.”

    Knowing what others in a similar position earn, academic and private practice, would be helpful in the negotiation. I would also recommend aiming higher than you think you can get, and even if you cannot get there, it forces your boss to explain the compensation structure to you and better serve you for future negotiations there, and elsewhere.

    Based on my experience interviewing mid-career with an academic practice, the compensation structure was far more complicated and opaque, and I had the sense that possibly everyone had a unique deal. In PP, at least in my specialty, the starting point is that everyone works equally and splits the pot equally, and any deviation is transparent, usually reflecting doing additional work (or, in my case now, doing less work).

    "Wealth is the slave of the wise man and the master of the fool.” -Seneca the Younger

    #98181 Reply
    Avatar Bartl007 
    Participant
    Status: Physician
    Posts: 74
    Joined: 01/30/2016

    Somehow my login from med school still works for the resources page my school gave us for choosing a medical specialty which includes lots of useful data points.

     

    All salary data is based upon current MGMA data.

     

    Attached are the heme onc numbers.

     

    Based on average of 52.7 work hours per week.

    Hope it helps

    Attachments:
    You must be logged in to view attached files.
    #98273 Reply
    Liked by SLC OB
    Avatar Docbeans 
    Participant
    Status: Physician
    Posts: 172
    Joined: 01/11/2016
    Splash Refinancing Bonus

    I said this recently, in another thread and context, but it applies here, too:

    “I think that 75% (or more, maybe 90%+) of docs hold the upper hand in their employment relationships, but only about 25% realize it and even fewer know how to capitalize on it. We are accustomed to sucking it up, getting along, not making waves, being a team player, blah, blah, blah, and our overlords use this to walk all over us.”

     

    Click to expand…

    I cant like this enough!! Thank you for saying it out loud. We value your voice, having been in the game for so long- that this is indeed your view point.

    I am currently going through the mental exercise of figuring out how to change my compensation structure (IC in PP) and needed to hear this.

    #198516 Reply
    Liked by Vagabond MD
    Avatar ZZZ 
    Participant
    Status: Spouse
    Posts: 702
    Joined: 06/18/2018

    They already know how much more they’re willing to pay you. Say it’s an extra 50k/yr.

    If you ask for an extra 75k/yr, they’ll counter with 50 and you’ll get 50.

    Ask for 25k and you’ll get 25k.

    Are you willing to leave if you don’t get to a certain #?

    #198518 Reply
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    10% selling yourself short.   At least 20%.  Practice first so you don’t sound like you are asking a question.

     

    #198534 Reply
    MPMD MPMD 
    Participant
    Status: Physician
    Posts: 2509
    Joined: 05/01/2017

    From what you posted you are working private practice.

    That being the case I would tell your director you want private practice compensation or that you expect a greatly reduced workload.

    This thing of hiring “academics” and having them grind out community work for academic pay really pisses me off.

    I don’t know that much about private practice heme-onc but it seems like there are plenty of large groups with shared call etc.

    #198567 Reply
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    Dude, you are seriously underpaid.

    The revenue you generate for the organization is among the highest of any specialty.  Ask the director about this calculation, your “contribution margin”.  Your salary is absolutely meaningless in comparison

    If you are working 4 full days, seeing patients in the hospital and billing efficiently you should be clearing 5000 RVU.  Figure this out and multiply by say $101 to gauge where you might ought to be.

    Another kink is whether you are being paid for physician wRVU generated by chemotherapy administration.  Yep, the infusion codes contain a small physician wRVU embedded in them that is meant to compensate you fairly for all the time you spend answering questions about infusion, blood counts, being available to respond to chemo reactions, etc.  Educate yourself on these.  It is about 20% of your E&M wRVU.  Some institutions pay this and some dont, so the the surveys are polluted.

    Is your practice leveraged by advanced practitioners? If so, you can ask for reasonable comp for supervison.

    Do you do administrative work, i.e. help run your clinic, practice etc?  You may have colleagues who shun this in favor of seeing patients or going home.  You should be able to get an hourly rate for this.

    Do you love the job and the organization?  They may be constrained by their academic physician pay scale.  Thats why they love to stroke you for your academic prowess.  Consider exploring the marketplace.  Heme Onc is in shortage mode and you are extremely valuable elsewhere.

    Good Luck!

    #198573 Reply
    Avatar SLC OB 
    Participant
    Status: Physician
    Posts: 565
    Joined: 06/23/2018
    Attached are the heme onc numbers.

    Click to expand…

    This is good info… you need the MGMA numbers… our Hem/Onc get paid a TON more than you. I am in a small rural hospital… they provide HIGH QUALITY care, no high production and get paid well for it.

    I agree:

    Dude, you are seriously underpaid.

    Click to expand…

    The question is… are you tied to the area? Could you leave?

    I think you need data (print the stuff from Docbeans if you don’t have any other data) and then ask for those higher salary. I also agree with:

    If you ask for an extra 75k/yr, they’ll counter with 50 and you’ll get 50. Ask for 25k and you’ll get 25k.

    Click to expand…

    Or if you ask for $25K, you will only get $15K

    Go for GOLD! And let us know how it turns out!

     

    #198579 Reply
    Lordosis Lordosis 
    Participant
    Status: Physician
    Posts: 1847
    Joined: 02/11/2019

    Dude us family practice guys make in the upper 200s.  Glad you are realizing your worth.  Get what you deserve!

    “Never let your sense of morals prevent you from doing what is right.”

    #198605 Reply
    SerrateAndDominate SerrateAndDominate 
    Participant
    Status: Physician
    Posts: 487
    Joined: 02/01/2018

    From what you posted you are working private practice.

    That being the case I would tell your director you want private practice compensation or that you expect a greatly reduced workload.

    This thing of hiring “academics” and having them grind out community work for academic pay really pisses me off.

     

    Click to expand…

    Absolutely agree. I see this happen a lot. It’s one thing to do academics because you want to teach and do research; that comes with the relative understanding that you won’t make near as much in the community. But I’ve seen a lot of good doctors get put into these satellite places taking way less than they are worth.

     

    OP, negotiate and dominate

    Earn everything.

    #198607 Reply
    Liked by Tim, Lordosis, Peds
    q-school q-school 
    Participant
    Status: Physician
    Posts: 2629
    Joined: 05/07/2017

    Wow – the fact that he brought up the pay raise gives you leverage going in to the meeting. Have you thought about seeing if Jon at Contract Diagnostics could assist? Would be worth at least a call, I think.

    Click to expand…

    i’m looking at it differently.  the fact that the boss brought up the pay raise means the deal is going to change.  he is going to give more work and hope that he can sell it with more money.  the other partner on the verge of retirement is concerning.  brings up a lot of questions about the future-call, coverage, vacations, etc etc  plus various organizational goals need to be implemented.  it would be better if there was a transition plan already implemented.  of course, most places can’t think that far ahead, so we often find physicians to be placed in terrible situations during times of transition.  they’ve already shown they are willing to pay him below average wages.

    of course i could be wrong.  hope i am.

    good luck.

     

    #198609 Reply
    Liked by Zaphod

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