comparing offers

[Smallmelon]

Long story in my job hunting as graduating fellow. Now with 3 offers to compare, all from the same city in midwest

- my first offer is with a satellite practice with an university system. 4.5 days a week, $400k guarantee salary for 2 years, bonus structure is not well-defined and likely at discretion of my boss. $25k sign on bolus. Benefit is soso. Call 1:4. Unfortunately this practice fell apart overnight in the process of hospital merging. End of story.

- now got an offer from another big name in the city, satellite, group of 12, 4.5 days a week, call is very light, compensation is unrelated to your productivity, $350k written in stone, no sign-on bonus, no room for negotiation. Benefit cannot be better. Yearly contract. A lot of docs in the pool are mid 30s to mid 40s with small kids. I personally know several of them, they are all happy.
Pro-it functions very close with academic main campus, colleagues are well-trained and friendly, hence it might build a solid foundation for my career trajectory;
Con-I don't quite like their compensation structure

- the other offer is from the same brand name but recently acquired and still functions like private practice. A group of 7, soon to be 6, as one or two docs are retiring. 5 days a week (they claim to be flexible with scheduling knowing that I have small kids and a working husband). $380k base salary as long as I meet 4250 wRVU, $25k bonus as long as I meet quality metrics, $88.7 per wRVU above 5000. $100k sign-on bonus. Benefit is great. 5-year contract; hospital and physician may terminate without cause providing 90 day notice.
Pro-better compensation, still room to negotiate;
Con-5-year contract, no guarantee first-year salary though I did not ask yet, things are still in movement as the practice being integrated into the big name system, a few older docs choose to retire at once, shall I consider it as a red flag?

Thanks for sharing your thoughts

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[robellis]

Long story in my job hunting as graduating fellow. Now with 3 offers to compare, all from the same city in midwest

- my first offer is with a satellite practice with an university system. 4.5 days a week, $400k guarantee salary for 2 years, bonus structure is not well-defined and likely at discretion of my boss. $25k sign on bolus. Benefit is soso. Call 1:4. Unfortunately this practice fell apart overnight in the process of hospital merging. End of story.

- now got an offer from another big name in the city, satellite, group of 12, 4.5 days a week, call is very light, compensation is unrelated to your productivity, $350k written in stone, no sign-on bonus, no room for negotiation. Benefit cannot be better. Yearly contract. A lot of docs in the pool are mid 30s to mid 40s with small kids. I personally know several of them, they are all happy.
Pro-it functions very close with academic main campus, colleagues are well-trained and friendly, hence it might build a solid foundation for my career trajectory;
Con-I don't quite like their compensation structure

- the other offer is from the same brand name but recently acquired and still functions like private practice. A group of 7, soon to be 6, as one or two docs are retiring. 5 days a week (they claim to be flexible with scheduling knowing that I have small kids and a working husband). $380k base salary as long as I meet 4250 wRVU, $25k bonus as long as I meet quality metrics, $88.7 per wRVU above 5000. $100k sign-on bonus. Benefit is great. 5-year contract; hospital and physician may terminate without cause providing 90 day notice.
Pro-better compensation, still room to negotiate;
Con-5-year contract, no guarantee first-year salary though I did not ask yet, things are still in movement as the practice being integrated into the big name system, a few older docs choose to retire at once, shall I consider it as a red flag?

Thanks for sharing your thoughts

Wow that seems really good pay per wrvu

 

[bobsmith]

So it seems like Option 1 was good until it wasn't really an option anymore?

Option 3 with 5 days/week (big gulp) + that wRVU minimum + no guaranteed salary for the first year(s) is really rough (though the sign on bonus is nice). Claiming to be flexible is nice (p.s. basically no employer admits to being inflexible), but the details of your actual patient contact hour requirements would be really important, as would the details of what happens if you don't hit the wRVU minimum (or if you're between 4250 and 5000?)

Also maybe I'm missing something, but what is the benefit of a 5 year contract (other than them betting that $/wRVU goes up over this time period and they're locking you in at a lower level)?

For Option 2, I have many friends who work in salaried situations like that - many of them are also very happy, but they are all also wired a certain way and drink the company "kool-aid" of thinking, "it's so great that we just show up and work and don't have to obsess about certain types of productivity"

The downside of jobs like that are (a) when they pile extra work on you [e.g., another physician leaves], you don't get compensated for now doing more work; because of that, (b) there's no incentive for them to NOT pile extra work on you and (c) you can end up in this toxic relationship with work where every extra thing you have to do just feels frustrating because you only get more work as time goes on, and your salary doesn't raise in a commensurate fashion.

But again, if you can drink the kool-aid and ignore all that, you can be very happy. I think my friends who are wired this way are very lucky.

Assuming that Option 1 is totally out, I would probably try to negotiate a better situation with #3 and depending on how that goes, figure out just how much kool-aid I can drink.

 

[Smallmelon]

So it seems like Option 1 was good until it wasn't really an option anymore?

Option 3 with 5 days/week (big gulp) + that wRVU minimum + no guaranteed salary for the first year(s) is really rough (though the sign on bonus is nice). Claiming to be flexible is nice (p.s. basically no employer admits to being inflexible), but the details of your actual patient contact hour requirements would be really important, as would the details of what happens if you don't hit the wRVU minimum (or if you're between 4250 and 5000?)

Also maybe I'm missing something, but what is the benefit of a 5 year contract (other than them betting that $/wRVU goes up over this time period and they're locking you in at a lower level)?

For Option 2, I have many friends who work in salaried situations like that - many of them are also very happy, but they are all also wired a certain way and drink the company "kool-aid" of thinking, "it's so great that we just show up and work and don't have to obsess about certain types of productivity"

The downside of jobs like that are (a) when they pile extra work on you [e.g., another physician leaves], you don't get compensated for now doing more work; because of that, (b) there's no incentive for them to NOT pile extra work on you and (c) you can end up in this toxic relationship with work where every extra thing you have to do just feels frustrating because you only get more work as time goes on, and your salary doesn't raise in a commensurate fashion.

But again, if you can drink the kool-aid and ignore all that, you can be very happy. I think my friends who are wired this way are very lucky.

Assuming that Option 1 is totally out, I would probably try to negotiate a better situation with #3 and depending on how that goes, figure out just how much kool-aid I can drink.

Hey, thanks for your thoughts! Can you please elaborate how can I make option #3 better?
Things that I can think of include:
- ask for 1 year guarantee salary
- ask for $400K for 4500 wRVU, instead of $380k for 4250 wRVU, in order to narrow the loophole between minimum work and bonus threshold. Maybe I miscalculated. I thought roughly 60 visits a week with 15% new will get me to 4250 wRVU safely, which sounds doable, isn't it?

 

[gutonc]

1. All those work weeks are too much. Oncology is emotionally exhausting and a 5d work week is just no bueno for long-term survival. Every single group around here has a 4d work week standard. If 4.5-5 is the standard where you are...that sucks. But try to knock it down.

2. Whenever PP groups are bought by larger health systems it is pretty standard for the older (read - vested as partners and able to cash out on the deal) docs to either cut back their practice or retire completely. Don't be surprised if you see one or more of them popping back up in a few months offering to do locums work for those groups.

3. You need to decide if you'd rather have a chill-ish, reasonably well paying job or one that will compensate you well for busting your hump. Honestly, none of these gigs really seem like that. The third one has a really odd comp structure. 4250 wRVU seems on the high side for starting a bonus structure, it's probably about the 35th %ile for the region, unless they have already decided to factor in new CMS numbers already. And what's the deal with that gap between 4250 and 5000 before you start getting productivity-based compensation? How productive are the docs there now? Is >5K wRVU practical/normal for that group?

 

[Smallmelon]

1. All those work weeks are too much. Oncology is emotionally exhausting and a 5d work week is just no bueno for long-term survival. Every single group around here has a 4d work week standard. If 4.5-5 is the standard where you are...that sucks. But try to knock it down.

2. Whenever PP groups are bought by larger health systems it is pretty standard for the older (read - vested as partners and able to cash out on the deal) docs to either cut back their practice or retire completely. Don't be surprised if you see one or more of them popping back up in a few months offering to do locums work for those groups.

3. You need to decide if you'd rather have a chill-ish, reasonably well paying job or one that will compensate you well for busting your hump. Honestly, none of these gigs really seem like that. The third one has a really odd comp structure. 4250 wRVU seems on the high side for starting a bonus structure, it's probably about the 35th %ile for the region, unless they have already decided to factor in new CMS numbers already. And what's the deal with that gap between 4250 and 5000 before you start getting productivity-based compensation? How productive are the docs there now? Is >5K wRVU practical/normal for that group?

In the region where I am, 4.5 days per week is the norm. I agree with you that 5 days a week seems too much, but is it negotiable? knowing the other docs in the group are all working 5 days a week.

 

[gutonc]

In the region where I am, 4.5 days per week is the norm. I agree with you that 5 days a week seems too much, but is it negotiable? knowing the other docs in the group are all working 5 days a week.

You'll have to tell me if it's negotiable.

I hire people for <1.0 FTE positions all the time. Of course, they make less than 1.0 FTE salary as well. But that's a choice.

 

[bobsmith]

Hey, thanks for your thoughts! Can you please elaborate how can I make option #3 better?
Things that I can think of include:
- ask for 1 year guarantee salary
- ask for $400K for 4500 wRVU, instead of $380k for 4250 wRVU, in order to narrow the loophole between minimum work and bonus threshold. Maybe I miscalculated. I thought roughly 60 visits a week with 15% new will get me to 4250 wRVU safely, which sounds doable, isn't it?

Your calculations seem fine (and I suppose seeing if you're working 5 days a week, then you have more time to see more patients). +1 to gutonc's point that finding out what the baseline productivity numbers / ranges are for the other docs in the practice would be helpful

That being said, no matter how much you try to "hit the ground running," there's typically some sort of "ramp up" period and you ideally would have the ability to learn the ropes properly without feeling like you're being penalized for it by not hitting your wRVU minimum. Getting a guaranteed salary for some time period helps with this, so is worth asking about.

Otherwise, I would probably start by clarifying a few things with them:
- How are the work requirements / days per week outlined in the contract, and how does that mesh with what they told you regarding their flexibility?
- What happens if you only get 3500 wRVU? 4000 wRVU? Depending on what the monetary repercussions are, another way of getting more of a "guaranteed" salary is to diminish the effect of the negative repercussions of not hitting the specified minimum.
- You get paid the same if you hit 4250 wRVU or 4999 wRVU? Agreed that getting to a bonus threshold sooner would be nice.

Depending on the answers to the above, you can then decide which of the above is most important to you and ask for things accordingly, knowing that they might not budge on certain things or could ask for concessions in other ways

 

[gutonc]

I missed the lack of a guarantee for job #3. That tells me their either not doing their homework, or they DGAF about grinding a new doc into the ground. That’s honestly a non-starter for me. You are, of course, free to think differently.

I have “run the numbers” dozens of times over the past couple of years as we’ve been working on completely revamping our compensation plan. For my group, in our region, a full-time doc (4 days a week) seeing 16-20 patients daily, with 2 of them new patients, will land solidly within the MGMA 25-50th %ile range. Any job that doesn’t compensate you appropriately for that level of productivity should be called out and encouraged to pound sand.

 

[Smallmelon]

I missed the lack of a guarantee for job #3. That tells me their either not doing their homework, or they DGAF about grinding a new doc into the ground. That’s honestly a non-starter for me. You are, of course, free to think differently.

I have “run the numbers” dozens of times over the past couple of years as we’ve been working on completely revamping our compensation plan. For my group, in our region, a full-time doc (4 days a week) seeing 16-20 patients daily, with 2 of them new patients, will land solidly within the MGMA 25-50th %ile range. Any job that doesn’t compensate you appropriately for that level of productivity should be called out and encouraged to pound sand.

I did ask some docs in the group about their productivity. Basically, she said that it’s easy to meet the minimal productivity, but she rarely able to hit the bonus line. I did ask for 4.5 days per week, better base salary, and 1 year guarantee salary...maybe I should trust my gut feelings to stay away from this position and just take job #2

 

[gutonc]

I did ask some docs in the group about their productivity. Basically, she said that it’s easy to meet the minimal productivity, but she rarely able to hit the bonus line. I did ask for 4.5 days per week, better base salary, and 1 year guarantee salary...maybe I should trust my gut feelings to stay away from this position and just take job #2

If I'm honest, despite the issues, #1 seemed like the best of the 3 when you initially presented it.