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[asmallchild]

Hey everyone,

I had a quick question regarding job prospects as a first-year private practice general dermatology attending. I understand that compensation depends on many factors, including but not limited to, partnership, location, volume, compensation model, days/week, etc, but I’m curious what some of the highest salaries you have seen advertised or offered for a first-year attending in general dermatology. I will have a hefty student loan debt burden at the completion of my training and large financial goals. Location does not matter, days/week does not matter, and honestly satisfaction with my work environment does not matter as this would be a temporary position as I work to build a sizable nest egg and pay off debt. Eventually, I would transition to a work environment and location that I desired, but this would be at least several years down the line.

Thanks for any insight,
Huggy

Take an offer from a PE-group in flyover country. Make sure it's a salaried position because if any part of their large initial offer is via bonus/productivity, you typically will not meet it as a first year attending.

It's an interesting question, I would think a surgical subspecialty or a shift-based specialty (emergency medicine?) would lend itself better to cranking up the workload to pay off debt. Even if you wanted to work weekends, groups that don't currently offer weekend hours may not be inclined to rearrange their structure to accommodate someone who wanted to work weekends or late hours.

That being said, I'm sure the advice everyone will hand out here is that it's a marathon, not a sprint. You didn't incur that debt load overnight, I wouldn't pressure yourself to pay it off overnight. Practices that offer sky high 1st year compensation are often floating numbers based off of unreasonable bonuses or will pay you that much your 1st year and then look to terminate you when your actual productivity does not match up with what they have paid you.

The best advice I got for the job search is to always ask for the contact information of the last physician who left the group. As I've mentioned many times, the group's response to the question is sometimes more helpful than speaking with the last physician directly. I sadly found groups that churned through 5 first year attendings in 5 years. It was very clear what they were trying to do. The reverse holds true too. Solid groups probably aren't going to be enamored with a candidate who hops from job to job. So when you finally find the work environment and location that you desire, they may not be interested if your employment history is year to year transitions in search of the highest paycheck.

We are lucky that in the end, this is dermatology. It is not the highest paid specialty out there but I don't think you will be struggling financially. Focus on landing the best job (this means taking into account factors beyond compensation), focus on being a good dermatologist, focus on the basics of finance (live like a resident in the first few years of attendinghood, save a significant chunk of income, invest it, etc...), and you'll most likely be more than OK financially.

 

[SunBakedTrash]

 

[doctalaughs]

Location does not matter, days/week does not matter, and honestly satisfaction with my work environment does not matter as this would be a temporary position as I work to build a sizable nest egg and pay off debt. Eventually, I would transition to a work environment and location that I desired, but this would be at least several years down the line.

This is not a great way to think about things.

Finding a good group with high long-term potential earning potential is going to serve you better than finding one that “promises” you a lot.

I usually don’t hire people that jump around a lot (red flag) so going in to “make a few years of a high salary” may hurt your eventual job prospects where you want to go.

The truth is you aren’t going to make 800k your first year out (and probably not close) no matter what you do, even if you are willing to work anywhere for any number of hours. It will take time to build your practice — and no one is going to hand over all their patients and adjust their whole business to accommodate a new untested doc.

Avoid academics, avoid saturated cities and from there just pick a place with a healthy base salary but possible long-term high earnings. If you find a place that wants someone 5 days a week you’ll do just fine and work plenty hard. If you can pick a city that is under-saturated with dermatologists and a practice that is growing (ie needs partners, with a good reputation)— in a few years you’ll be making far more than the starting.

 

[OraclePL]

Thank you for such a thoughtful reply! I understand and agree with the argument that it's a marathon, not a sprint and that eventually, I will be more than OK financially. I guess I just grossly underestimated how bad it would feel leaving med school with a debt burden of 400k. I spend a lot of my free time studying finance, reading financial forums and books, and planning on ways to reverse my current financial situation. It doesn't help that my family is nearing retirement and in an objectively horrible financial position that I would like to at least partially remedy. I absolutely want to be the best dermatologist that I can be and join a practice that fulfills my personal and professional goals, but 400k of debt (with an additional 4 years of interest awaiting me) is hard to ignore when selecting a job. I don't plan to hop around practices year to year. However, I understand your point that some practices may terminate my employment if I can't meet unrealistic expectations. Ideally, I would work in a remote area for 2-5 years, practice geographic arbitrage, make significantly more than my other first-year colleagues, and gain experience as an attending before moving to where I would love to work and become a partner in a practice. I do understand however that those 2-5 years could have been spent living in a desirable area working towards partnership rather than in the boonies.

I myself was in a very similar position to you. My recommendation is to look for jobs primarily in the Midwest. in addition to higher salaries, many hospitals will offer student loan assistance. It sounds exactly like what you are looking for.

 

[reno911]

I think you're looking at this all wrong. I'll chime in like everyone else. You have to think long term.

If you take a short term position where you don't want to be and then move after 5 years to where you think you want to be, your cumulative salary after 10 years will almost certainly be higher if you went with the place you where you really wanted to live from the very beginning (of course, there are exceptions). So in trying to make more money, you're actually going to almost certainly going to make less.

Your mentality is not uncommon and a lot of employers prey upon it. They offer high salaries up front with little prospect for serious gains. But these look better on paper than someone else who may not guarantee much but is willing to give you a decent percentage of collections, good partnership pathways, etc.

If it's money you want, don't pick the job that's going to pay you the most now. Pick the job that is going to pay you the most after practicing there for 10 years.

 

[OraclePL]

i’ll go against the grain a little bit. A lot of people are treating this like it’s one or the other, that if you take a job with a high upfront salary then you’ll always make less over the long run. That isn’t necessarily true.

Of course if you buy into a thriving private practice in the right location, that will set you up for the highest ceiling. However a lot of the big first year offers are in areas that are under saturated and have high patient volumes and are going to provide high incomes even in later years when a person is on a productivity model only.

 

[reno911]

i’ll go against the grain a little bit. A lot of people are treating this like it’s one or the other, that if you take a job with a high upfront salary then you’ll always make less over the long run. That isn’t necessarily true.

Of course if you buy into a thriving private practice in the right location, that will set you up for the highest ceiling. However a lot of the big first year offers are in areas that are under saturated and have high patient volumes and are going to provide high incomes even in later years when a person is on a productivity model only.

This is true, but OP's plan is to leave in 2-5 years, so he'll never realize those "high incomes even in later years".

 

[OraclePL]

This is true, but OP's plan is to leave in 2-5 years, so he'll never realize those "high incomes even in later years".

Yeah very true.

To the OP, I'd say - plans change. Once you establish and build up a patient base it's harder to leave than you anticipate as a resident. But despite this, many people do leave their first job in a few years. As a resident you just don’t realize what’s important and don’t know the ins and outs of private practice and different practice models, that first job is really a learning experience that will teach you what you want in a job and in a career. That’s why I don’t think a resident should feel pressure to find "the" group that will set them up for the next 30 years, you just don’t have a good frame of reference as a resident to evaluate practices. Usually you learn at the first job and then look for the permanent/long term one the second time around.

My advice is just to interview as broadly as possible. Focus on the Midwest. I think you’ll find what you’re looking for. I saw plenty of loan assistance programs in medium sized Midwest cities. You won't necessarily end up living in the sticks. I'd be wary of the PE groups, but there are very good non PE offers out there that will satisfy what you're looking for.

 

[drpatricktran]

highest ever i saw was 600k, but most of the high ones i think are like 400s-500s. kaiser in california i think offered like 425 or 450 to start for gen derm