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  • Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    If you are eager to work, the important detail is the production-based compensation model.  How much per RVU?  Compare with MGMA.  Also, they will presumably need to use a survey to adjust $/RVU periodically.  Ask them what the schedule is for market based comp resets and what survey they use (e.g. MGMA).  Ask them for the current survey data they are using for you comp.  Also ask about value-based comp.  Do you lose or gain if certain quality metrics are not met?

    Another important detail is the staffing ratios.  FM production can be leveraged by staff, for example doing annual wellness visits, or helping with transition care management codes.  It is much harder to produce in poorly staffed clinics.  Also this is important for your frustration level and when you get home at night.  Find out about this during a visit/interview.  Ask what the RVU production is for your colleagues to get a feel for your earning potential.

    FM for a large clinic network is likely not going to be very negotiable except around the edges–signing, relocation bonuses etc.

    Good luck!

    in reply to: Evaluating Contract Offer #201030 Reply
    Liked by Tim
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    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.

     

    Click to expand…

    Agree, the boss may simply be smart, looking at the problem of recruiting a replacement or losing tens of millions in gross margin on chemotherapy if he can’t.  The OP won’t be able to do it alone. There are many hospitals in the US with or formerly with small oncology programs that are chronically under or un-staffed because there is a shortage of medical oncologists.  The younger ones are attracted to more urban hospitals and the overall demographic is weighted to physicians in their 50’s, many of whom are financially secure and not completely happy with the transition from private practice to hospital employment. Infusion volumes are going up in part because people with advanced cancers (the patients who require the most care and attention) are living longer owing to new immune therapies and other treatment advances.  The aging baby boom is increasing the patient population, increased longevity/time on treatment, a wave of upcoming physician retirements–a major crisis in supply is forecast and is already happening in some areas.  If there is any specialty where doctors have leverage, this is it.

    in reply to: negotiating pay raise #198629 Reply
    Liked by q-school
    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!

    in reply to: negotiating pay raise #198573 Reply
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    From what I know from working on similar non-clinical comp with the corporate attorneys is that the pay for your clinical research time would need to be based on a formula that is defensible from a fair market value standpoint.  Our attorneys would probably say that this is not the same work as seeing patients, so could not be compensated at the same rate they pay you as an oncologist.  They would probably argue that you need to use the standard “medical director” compensation rate, which at our organization is $150/hr.  So that approach would involve calculating an average time a physician would spend for each patient.  One could break it down to enrollment and annual maintenance for time on trial.  This would be the kind of comp proposal that might pass legal muster at our organization.

    I think to do this there needs to be some executive interest in increasing clinical trial accrual.

    in reply to: Clinical Research Compensation Model? #186338 Reply
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    Yes, we frontloaded our 10+ year old DAF in 2017 with 5-7 years of expected charitable contributions…and then we gave about a third of that to charity in 2018, our largest charitable year ever (including our largest single gift ever). We still gave another couple thousand dollars in smaller donations for which we will not get Federal tax deduction.

     

    Click to expand…

    This is exactly what we did.  Also paid off the mortgage in early 2018, so will anticipate being on standard deduction from now on.  When the DAF spends down, we will probably have one more “6 year” DAF contribution to make before eligible for qcd’s.  Depending on tax scheme at that time, would presumably itemize that year.

    in reply to: Has the new tax law affected your charitable giving? #184104 Reply
    Liked by Vagabond MD
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    I think this is very difficult to address in a contract for the reasons stated above.  Nobody can really commit to actions in 3 years, and the rules of the game are changing faster than that.

    1. I would first look at the comp and assess it’s fairness in the market

    2. Look at fairness of comp in the overall practice (i.e. over the 3 years are the partners making a lot off your back or mostly recouping their costs in bringing you on).

    3. As addressed above, look a their reputation, track record in advancing to partnership and familiarize yourself with the terms.  Partnership is like a marriage, and your long-term happiness is going to have many dimensions.

    4. Partnership can be a mixed bag.  In my case, being a partner included pressure to buy into a building in a declining area at a ridiculous valuation.  It worked out, but only after we separated that issue from the practice.

    5. Noncompete terms are key. If they don’t offer you partnership in 3 years, you should be free to practice elsewhere or on your own

    in reply to: Private practice and asking for partnership #182249 Reply
    Liked by Bruce
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    I have one working for a large nonprofit system that (probably) won’t fail

    Came about only the last few years as a result of mergers/consolidation

    Also, old enough so balance won’t be very large when I retire or separate.  Size and timing mitigate risk somewhat

    High tax bracket now, plan has flexible withdrawal options

    in reply to: 457b #182244 Reply
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    Turn on coffee maker

    Meditate 30 min

    Drink coffee and read the news online

    Shower and head out

    Have tried to exercise in the morning but can’t really face it until the coffee/reading is done and by then it is too late.  Works better in the evening, especially when the days get longer

    in reply to: Morning Routine #181516 Reply
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    Negotiate

    Don’t listen to the recruiter

    $/wRVU may be difficult to move, but if you have current pay to show them, it is a good place to start.

    Signing bonus is frequently negotiable, since it is one-time and doesn’t necessarily affect internal pay equity issues. Discuss distance, actual relocation costs etc.

    If not ready to jump, string them along and let them see how their recruitment efforts go, there may be a learning curve.

    Good luck!

    in reply to: MGMA #175221 Reply
    Liked by Zaphod
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    Any suggestions on the best self-directed IRA custodian for this type of investment?  Some of the fees I see seem designed to bleed.

    in reply to: Broadmark Real Estate Lending Fund #173241 Reply
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    This is an article of faith with large health care company administrators.  Like other forms of ideology, it is difficult to discuss in an open and honest way.  In my experience, when you drill down and try to ask questions like fairness among specialties, providing the wrong incentives, “teaching to the test” rather than providing appropriate care, etc., you get a lot of mumbo jumbo.  The fact is there isn’t a good model out there, but here we go.

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

    You may have an easy way to have your cake and eat it too.

    The key is that you say you are on salary not production.  Embrace the medical director role, BUT make sure all your effort comes out of your clinical time.  Otherwise, you will be burning yourself out and resenting the lack of extra comp.  Keep track and make sure that you keep reminding them you can’t be in two places at once.  As your role and indispensability increases, you will have more leverage.  There is no question you need to fulfill this role.  For now, compensate yourself by restricting your clinical effort; later on you can ask for more comp.  If this doesn’t fly, then ask them how this is supposed to work?

     

    in reply to: Can I rectify this mistake: Not negotiating shrewdly? #162730 Reply
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018
    alpha investing

    I would validate the opinion on the repair.  In terms of value, get a good mechanic’s take on the car and problems you might anticipate over the next few years.

    May be reasonable to buy another one, but in the range you can afford, you could be buying a similar problem.

    Sounds like your mom wants to help.  I could get too personal here, but that’s completely natural.  You are doing your part being a hard working medical student.  Helping your car hassles go away is a small thing in comparison.  I would think about that option.

    in reply to: med student car dilemma #156429 Reply
    Liked by q-school
    Avatar BlueCollarMD 
    Participant
    Status: Physician
    Posts: 19
    Joined: 08/20/2018

    Your question encompasses many different things, and there is a wide world in Pharma that is available to you. Basic science can be good if you get lucky in biotech; otherwise the salary and competition will be with other PhDs and may not maximize your value as a fellowship trained physician. On the translational side you may be looking at setting up and running trials as a new hire but eventually you may be of greater value in determining clinical strategy, valuing acquisitions or other areas. Starting salaries will be less than clinical jobs with likely more travel. Depending on your specialty there may also be less work, night call etc. Longer term there is opportunity for equity upside. Go ahead and check it out now. Find people in the areas that interest you and ask to talk to them.  I am sure you will get a warm welcome.

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

    Not with Mayo, but consider this:

    Mayo model is based on recruiting the best docs, developing them and keeping them.  Hard to believe, but this approach is totally alien to most large health care companies, where production, churn and burn, is the norm and administrators regard physicians as interchangeable units.  So the benefits of this model require some deep thinking about your career development, teaching, research, involvement in institutional efforts to improve quality and value that go beyond just production.

    The salary comparison will necessarily be rough, but to get an idea, look at MGMA median comp for hospital-owned practice in your specialty, benchmarked to median RVU.  Your Mayo recruiters have these numbers and hopefully will provide them.

    Part of the discussion should be to understand their expectations regarding this median RVU number.  What are their expectations and how do they keep track of your performance?

    Good luck and congrats

    in reply to: Mayo questions #152943 Reply
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