Are pediatricians fresh out of residency taken advantage of in Salary Negotiations?

[psychMDhopefully]

I'm aware that people say Peds is compensated less because there are a high number or medicare patients etc. But I looked at the MGMA data and peds has the lowest starting salary for primary care 165k, but in 5-7 years they have a similar/slightly higher income to internal medicine-250k. There is also a huge difference between what female and male pediatricians make. So is the low median starting salary for pediatrics a result of female residents just not being aggressive in salary negotiations? I think females are more likely to taking low ball salaries and this drives down how much guys can ask for as well. For instance, if a male pediatrician interviews for a job, and decides he will work for no less than 200k base, he doesn't have much leverage when the female peds applicant that interviews right behind him will take 140k.

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[mvenus929]

I think part of the problem with salary negotiations is that it seems like no one is allowed to talk about their salary, so new grads don't have the slightest idea how much to expect. And when you're making $55K and get offered $120K, it can seem like a pretty big jump.

 

[BigRedBeta]

It's not uncommon for people joining OP practices to get a salary for the first 2-3 years while building a patient panel, and then in year 3-4 having more of their income based on what billing they actually generate. If you're not taking over for a retiring physician and their panel, it can take a while to build a business. Don't forget about the efficiency gained in practice as well. Resident continuity clinic probably never has more than 6 patients in a 3 hour clinic...going from 30 minute appointments to 15 or 20 minutes blocks - takes some practice.

 

[Stitch]

I think all specialties ought to be more open about salaries, what to expect, work hours and how to negotiate. I definitely think new grads are taken advantage of, they don't know what to ask, or even how to evaluate whether a potential practice they consider joining is solvent. We in general need to talk about these things more and include them in residency education (because there's not enough to do as is, right??).

As far as women making less, that's definitely true. My wife was told 'here's our offer, and we don't negotiate.' Her male counterpart with the exact same experience made $20k/year more.

 

[NurWollen]

I think all specialties ought to be more open about salaries, what to expect, work hours and how to negotiate. I definitely think new grads are taken advantage of, they don't know what to ask, or even how to evaluate whether a potential practice they consider joining is solvent. We in general need to talk about these things more and include them in residency education (because there's not enough to do as is, right??).

As far as women making less, that's definitely true. My wife was told 'here's our offer, and we don't negotiate.' Her male counterpart with the exact same experience made $20k/year more.

Is she a general pediatrician?

 

[Stitch]

Is she a general pediatrician?

She was at the time. She's s subspecialist now.

 

[physicsnerd42]

Honestly, I think so. My wife is an outpatient pediatrician who recently finished residency. She works half time and barely earns more than I do as a resident and has no benefits other than malpractice insurance. That's General Peds.

I think, overall, pediatricians are taken advantage of. Children's hospitals are some of the most lucrative hospitals around and attendings make peanuts compared to their adult counterparts. Look at Peds cardiology vs adult non-invasive cardiology. Look at PICU vs MICU or SICU. Peds heme/onc makes half of adult heme/onc. Peds GI makes about the same as gen Peds whereas adult GI makes much more (think double). A buddy of mine is an adult hospitalist making north of $300k per year; good luck finding a Peds hospitalist job anywhere that makes that. I know that Medicaid reimburses less than private insurance or Medicare and that we do fewer procedures in children, but the disparities are crazy. Overall, I'm still glad I'm in Peds, but I think we should be honest with med students about the financial opportunity cost of pediatrics. If you ask people if pediatrics is worth making $5 million less over their careers to do Peds vs. medicine, they may have to stop and think about it.

 

[Stitch]

I agree the disparities are crazy and unfair, but peds hospitals generally aren't as lucrative as you might think. Pediatric reimbursement is far less because kids are considered 'easy' or 'not that sick' even though we all know that simply isn't true. We (as a profession) and our professional organizations spend less time lobying for improved reimbursement through medicaid, upon which a lot of our population depends. Peds hospitals tend to make money via neonatology, surgery, and sometimes cardiology if they do CT surgery. Most other peds specialties lose money or break even.

 

[Perrotfish]

I think part of the problem with salary negotiations is that it seems like no one is allowed to talk about their salary, so new grads don't have the slightest idea how much to expect. And when you're making $55K and get offered $120K, it can seem like a pretty big jump.

I'm curious, what do you guys think is a good initial job offer for:

1) Pure outpatient peds (M-F, 20-30 patients/day)

2) Hospitalist peds (one week on, one week off)

3) Traditional full scope Pediatrics (M-F 20-30 clinic patients/day, Q4-6 call for mommy pager, ER calls, and inpatient/nursery coverage on call days)

Also what is a reasonable amount of time to consider a job offer once its made? How long do you have to say yes or no?

 

[Stitch]

I'm curious, what do you guys think is a good initial job offer for:

I assume you're asking about private practice and not an academic center? Remember that area/location is also going to make a huge difference in salary. Rural vs urban, etc.

 

[NurWollen]

As a med student, it seems like peds jobs are less likely that other specialties to advertise a specific compensation in job listings online. I know that's not exactly the best resources for evaluating compensation. But it's just something interesting I noticed.

 

[Perrotfish]

I assume you're asking about private practice and not an academic center? Remember that area/location is also going to make a huge difference in salary. Rural vs urban, etc.

Private practice. Big town or small city.

 

[Stitch]

Private practice. Big town or small city.

I can tell you some numbers I have seen in that context. These were for someone fresh out, and they certainly don't speak for everyone or everything.
Hospitalist (which included 14-16 shifts a month, 12 hours each): Offers around $140k (the academic center in the same town was offering 100k for hospitalist position, which I thought was ridiculously low).
Pure outpatient: $120k, but I have definitely seen higher, closer to $150k. Some will depend on whether you are salaried or whether you 'eat what you kill.'
Inpatient plus call and ER consulting: no idea.

 

[Giic]

I think part of the problem with salary negotiations is that it seems like no one is allowed to talk about their salary, so new grads don't have the slightest idea how much to expect. And when you're making $55K and get offered $120K, it can seem like a pretty big jump.

That's exactly what it is. Noone ever told me what to expect after PICU fellowship. I had NO CLUE. So I accepted the first salary I was offered because it was 3x my fellowship salary. I remember being SO HAPPY (I thought it was a lot of money).

I later found out that I was severely low-balled. My fellowship classmates at other jobs were making up to 100K more than I was (granted it was private practice, but still.....). I sincerely had no clue, and I made the stupid mistake of not asking my attendings. Also, I had some friends who were also initially earning low salaries, but then they were given very significant raises at their institutions each year. My institution never did that. Luckily I got out of there. I was very surprised to later learn what the "normal" is for critical care.

 

[Giic]

And regarding women... I can attest to that. My female friend was quoted a much lower figure than her male co-fellow when they both applied to the same job. Both were 3rd year fellows from the same institution.

 

[NurWollen]

I can tell you some numbers I have seen in that context. These were for someone fresh out, and they certainly don't speak for everyone or everything.
Hospitalist (which included 14-16 shifts a month, 12 hours each): Offers around $140k (the academic center in the same town was offering 100k for hospitalist position, which I thought was ridiculously low).
Pure outpatient: $120k, but I have definitely seen higher, closer to $150k. Some will depend on whether you are salaried or whether you 'eat what you kill.'
Inpatient plus call and ER consulting: no idea.

That's criminal. Family docs doing pure outpatient are starting at
200k+ for M-F with no nights or weekends. IM or FM hospitalist jobs are making 230k+ starting.

I know a lot of docs tell med students to "do what you love" and "don't follow the money because "no matter what you'll make enough to be comfortable." I'm not sure of that's true... with the amount of debt my generation is graduating with, I'm not sure I could support a family and pay back my loans, even living frugally.

 

[Stitch]

That's criminal. Family docs doing pure outpatient are starting at
200k+ for M-F with no nights or weekends. IM or FM hospitalist jobs are making 230k+ starting.

I know a lot of docs tell med students to "do what you love" and "don't follow the money because "no matter what you'll make enough to be comfortable." I'm not sure of that's true... with the amount of debt my generation is graduating with, I'm not sure I could support a family and pay back my loans, even living frugally.

Most of us manage it. Remember that these salaries still put us in the top income percentages. But it's definitely frustrating when you do the adult comparison and see how much less our work is valued. I certainly wouldn't have been happy doing anything else, though I wish I had received a greater exposure to anesthesia during my med school years. It took me a while to realize all the cool physiology they knew and all the procedures they did.

Also remember that there are definitely private practice pediatricians making 250K. You can make a very good living in peds if you pick the right practice and location.

 

[Stitch]

That's exactly what it is. Noone ever told me what to expect after PICU fellowship. I had NO CLUE. So I accepted the first salary I was offered because it was 3x my fellowship salary. I remember being SO HAPPY (I thought it was a lot of money).

I later found out that I was severely low-balled. My fellowship classmates at other jobs were making up to 100K more than I was (granted it was private practice, but still.....). I sincerely had no clue, and I made the stupid mistake of not asking my attendings. Also, I had some friends who were also initially earning low salaries, but then they were given very significant raises at their institutions each year. My institution never did that. Luckily I got out of there. I was very surprised to later learn what the "normal" is for critical care.

I also think that many big institutions have vague contracts. They don't talk about number of shifts, they don't talk about raises or career advancement. So you're often stuck with something and not in a position to renegotiate. You often don't even know you should renegotiate. When my wife worked for Pediatrix, her contract was very clear: you will work x number of shifts and make x number of dollars. If you work more shifts we will pay you x dollars per hour extra.

 

[NurWollen]

Most of us manage it. Remember that these salaries still put us in the top income percentages. But it's definitely frustrating when you do the adult comparison and see how much less our work is valued. I certainly wouldn't have been happy doing anything else, though I wish I had received a greater exposure to anesthesia during my med school years. It took me a while to realize all the cool physiology they knew and all the procedures they did.

Also remember that there are definitely private practice pediatricians making 250K. You can make a very good living in peds if you pick the right practice and location.

Thanks for your input. Speaking of private practice, I've noticed based on nothing but my own half-hearted observations that there seem to be more independent, private peds practices around still than there are for FM or outpatient IM. Is there any truth to this? Or is it just wishful thinking? Have large healthcare organizations been slower to buy up peds practices than they for have other primary care specialties?

 

[Obnoxious Dad]

If you want a good deal then you should market yourself to those areas that have a pediatrician shortage. Go to Wisconsin, Minnesota or Iowa and forget about getting a job in San Francisco or Boston. The newly minted peds docs who insist on living in the northeast or on the Pacific Coast are setting themselves up for a lifetime of penury. You'll make lousy pay, get taxed to death, take forever to pay off loans and will be unable to afford a home large enough for your own kids. Recently, I was channel surfing and saw this pair of imbeciles who bought a 500 square foot converted storage shed as their principal residence in San Francisco. They paid $500,000 for it. Absolutely stupid.

If you want leverage, go where there's a shortage. If you want to be a slave, follow the herd.

 

[Giic]

If you want a good deal then you should market yourself to those areas that have a pediatrician shortage. Go to Wisconsin, Minnesota or Iowa and forget about getting a job in San Francisco or Boston. The newly minted peds docs who insist on living in the northeast or on the Pacific Coast are setting themselves up for a lifetime of penury. You'll make lousy pay, get taxed to death, take forever to pay off loans and will be unable to afford a home large enough for your own kids. Recently, I was channel surfing and saw this pair of imbeciles who bought a 500 square foot converted storage shed as their principal residence in San Francisco. They paid $500,000 for it. Absolutely stupid.

If you want leverage, go where there's a shortage. If you want to be a slave, follow the herd.

Some people would rather earn less but live in San Fran. .....To each his own, I guess....
The whole picture involves a lot more than $$$.

 

[BigRedBeta]

I also think that many big institutions have vague contracts. They don't talk about number of shifts, they don't talk about raises or career advancement. So you're often stuck with something and not in a position to renegotiate. You often don't even know you should renegotiate. When my wife worked for Pediatrix, her contract was very clear: you will work x number of shifts and make x number of dollars. If you work more shifts we will pay you x dollars per hour extra.

My mother is a corporate attorney, and so spends lots of time reading contracts of all sorts...she was beside herself at how terribly written my letters of intent were from academic medical centers and the contract I eventually got from Pediatrix. While she understood that some financial numbers weren't listed for things like bonuses, there wasn't even language that spelled out that I was entitled to a bonus, even though the division heads spent a lot of time telling me about their bonus structures, which in my mother's mind left me very exposed. And it was difficult to get any changes added, even for things that were simply poor grammar.

And while I understand the sentiment of students looking for more compensation, I agree with @Stitch - I would have been miserable having to take care of adults, even if I had done something like anesthesia followed by a peds fellowship. In the end, while I'm not making the same as my adult colleagues I'm going to manage.

 

[VA Hopeful Dr]

Thanks for your input. Speaking of private practice, I've noticed based on nothing but my own half-hearted observations that there seem to be more independent, private peds practices around still than there are for FM or outpatient IM. Is there any truth to this? Or is it just wishful thinking? Have large healthcare organizations been slower to buy up peds practices than they for have other primary care specialties?

Because hospitals like owning us adult PCPs, we generate a bunch of money from labs, imaging, and consults. Peds practices don't do that nearly as much. I'd guess that a good 15% of my practice is diabetic adults who get q3 month a1c, yearly TSH, CMP, CBC, lipid panel, and urine microalbumin. Women over 40 get yearly mammograms at the hospital machine. Lots of skin biopsies and paps to hospital pathology. Colonscopies to the hospital-owned GI doctors.

You get the idea.

That said, more and more adult PCPs are getting fed up with hospital ownership and becoming jealous of all the independent pediatricians out there. More money is all well and good, but there is a lot to be said about not having 4 layers of administration telling you how to practice.

 

[Stitch]

My mother is a corporate attorney, and so spends lots of time reading contracts of all sorts...she was beside herself at how terribly written my letters of intent were from academic medical centers and the contract I eventually got from Pediatrix. While she understood that some financial numbers weren't listed for things like bonuses, there wasn't even language that spelled out that I was entitled to a bonus, even though the division heads spent a lot of time telling me about their bonus structures, which in my mother's mind left me very exposed. And it was difficult to get any changes added, even for things that were simply poor grammar.

Excellent point. It's a good idea before joining any practice to have an attorney look over the contract. There are people who specialize in this for physicians. It may cost $500 or more, but it's worth it to know what you're getting into. If more of us were willing to walk away from crappy contracts, we'd force practices to take us seriously. Also, if you're joining a private practice, you have the right to ask to see the accounting books. You want to make sure they are billing honestly. If you become partner and then the practice gets hit with a fraud suit, you can't claim ignorance. You'll be part of it and dragged down with it.

 

[ysunflowermd]

I am a pediatrician in private practice about 45 miles from a big town and from what I have seen, most young current generation pediatricians would rather make $120,000 or less and live in a bigger town than earning $160,000 and be about 45 miles away.

The pediatricians that are interested, they neither want to do calls nor the evenings, want their weekends free and yet they want $150+

With the current reimbursement rates, a PCP needs to see at least 25-30 patients to justify a salary of $130+ which is not happening.

Having said that, our pediatricians are making $160,00 + along with generous benefits and they seem pretty content at the moment.

Hope that helps

 

[jlm013085]

I am a pediatrician in private practice about 45 miles from a big town and from what I have seen, most young current generation pediatricians would rather make $120,000 or less and live in a bigger town than earning $160,000 and be about 45 miles away.

The pediatricians that are interested, they neither want to do calls nor the evenings, want their weekends free and yet they want $150+

With the current reimbursement rates, a PCP needs to see at least 25-30 patients to justify a salary of $130+ which is not happening.

Having said that, our pediatricians are making $160,00 + along with generous benefits and they seem pretty content at the moment.

Hope that helps

1st yr peds resident and I am going these opportunities will be available when I'm done. I don't mind working in small town either!

 

[NurWollen]

I am a pediatrician in private practice about 45 miles from a big town and from what I have seen, most young current generation pediatricians would rather make $120,000 or less and live in a bigger town than earning $160,000 and be about 45 miles away.

The pediatricians that are interested, they neither want to do calls nor the evenings, want their weekends free and yet they want $150+

With the current reimbursement rates, a PCP needs to see at least 25-30 patients to justify a salary of $130+ which is not happening.

Having said that, our pediatricians are making $160,00 + along with generous benefits and they seem pretty content at the moment.

Hope that helps

What would you say to someone interested in pediatrics but with ~350k in debt? IBR? PAYE?

 

[Obnoxious Dad]

What would you say to someone interested in pediatrics but with ~350k in debt? IBR? PAYE?

I would say, "Take a job in the Midwest, pay off your debt and live like a school teacher for five years."

I have serious doubts that the feds are going to hand out billions in loan forgiveness to physicians without capping it, taxing it and means testing it. If you are counting on a loan bail out, you've got a lot of hope.

 

[BigRedBeta]

Have large healthcare organizations been slower to buy up peds practices than they for have other primary care specialties?

Corporate ownership of pediatrics is nowhere near the level of other fields, in large part because peds outside of NICU is rarely seen as a moneymaker, as previously mentioned. This might be changing in the future though. HCA (Hospital Corporation of America) one of the largest healthcare corporations in the US is supposedly moving into pediatrics. I interviewed for a PICU job at one of their facilities last year and was admittedly very skeptical of their motivation and commitment. It was explained to me that largely this entry into the market is an offshoot of their investments in OB, high risk OB, and Neonatology. Their feeling is that they have invested significant money on getting the mother into the system, only to generate business for the academic children's hospital down the road when that baby develops the typical preemie problems and needs outpatient subspecialists. Apparently, a large enough portion of families then end up transferring care to a facility that can meet the needs of the entire family and HCA feels they are losing out on not only the subsequent pediatric care but more importantly the care of the adults on down the line. So in a sense kids are sort of the healthcare anchor for many families.

Now, I don't know how long this experiment is going to last, or how widespread it's going to be. Certainly building a complete, full service, pediatric healthcare delivery system is an uphill battle. So few pediatric subspecialties are able to sustain private practice models except in the biggest of cities, that I think most people going on to peds fellowships just assume they're going to be in academic medicine. Getting them to believe that private practice is sustainable is going to require some selling. HCA seems to be starting with Peds EM first, then adding PICU's, and using those to attract subspecialists and assure them that there will be people around to take care of their patients when they get sick...but as a PICU person, I was stuck saying "where are all my consultants?", so there's definitely some chicken/egg stuff going on. Where general pediatrics plays a role in all of this, I have no idea. Obviously it's made sense for other primary care fields, so maybe for the sake of completeness, general pediatricians will get swept up as well, but who knows.

For the record, HCA did seem pretty committed. They were clearly willing to use their profits to subsidize the building of this concept. The salary they were offering was not possible based on the patient volumes they were going to generate. I generally feel that 250k is the very upper limit for base salary for PICU jobs and that is for those with experience (I'm not counting bonuses here) and they were offering $325k. Now, I'm sure the next question is why didn't I take the job given that it was such a high salary, and it came down to the fact that as someone just out of fellowship, it wasn't the right job for my career development and growth. Yes the salary would have been phenomenal, but it probably would have left me unemployable anywhere else in the future had I decided to move on.

 

[ysunflowermd]

What would you say to someone interested in pediatrics but with ~350k in debt? IBR? PAYE?

Sorry for the delayed reply.

When I moved to my current location 15 years ago, I had paid $350,000 for the practice rather than being an employee as I wanted to be my own boss and wanted the autonomy of doing what ever I wanted to. I worked hard, started doing out of the box office practice, IV therapy, allergy practice etc and was able to pay off my loan in 8 years.

The key is to have love for kids, join the right practice and to have some entrepreneurial aptitude/skills or at least have a partner that could guide you in that role.

Hope that helps.

 

[PikminOC]

Much harder to get loans now

 

[deleted109597]

Every place is different. My wife earns more as a private practice pediatrician than I did as an academic emergency physician.
They're paid in the top 1%ile, but they also see 40+ a day, have a night clinic, and take their own call without a nurse line. There are 18 of them, so it's not a terrible call schedule. They also do inpatient rounds 4 weeks a year, and have a weekend morning sick clinic.

 

[pritz786]

Does anybody have the latest MGMA deep dive salary data?

Thanks

 

[W19]

I can tell you some numbers I have seen in that context. These were for someone fresh out, and they certainly don't speak for everyone or everything.
Hospitalist (which included 14-16 shifts a month, 12 hours each): Offers around $140k (the academic center in the same town was offering 100k for hospitalist position, which I thought was ridiculously low).
Pure outpatient: $120k, but I have definitely seen higher, closer to $150k. Some will depend on whether you are salaried or whether you 'eat what you kill.'
Inpatient plus call and ER consulting: no idea.

This is crazy! One might as well become a pediatric NP...