I’m a pgy 3 derm resident and I have a moonlighting opportunity, but I’m not sure what to ask for pay. None of the previous residents here wanted to moonlight so I have no idea what the average is. I assume taking a percentage of collections would be the way to go but idk. I’ve heard attendings usually get 40-45% of collections so would a resident get 30-35%? Any advice would be great, thanks.
Derm moonlighting pay
- Thread starter zinger89
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I don’t have a good answer but am curious (also derm resident but pgy-2 so asking for the future) what type experience is it? Is it derm related?
Yes it’s with a derm attending. (Out of his office)
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My moonlighting was a sweet deal, no attending, 40%, crazy looking back on it
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I think our moonlighting in residency paid about $100/patient (less after taxes obviously).
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That’s the best I’ve ever heard. You’d be doing well to make that as an attending.
30 pt day is 3k? 50k a month for 4 day workweek? I’m gonna quit my job and go back to moonlighting.
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I got about $200/hr for derm moonlighting shifts as a resident
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Yeah.... given the disease mix around here, seeing 60 a day is not terribly challenging. 4 day weeks, 48 weeks a year, pre tax of 1.1m....
I think I'm tired of cutting and sewing now.
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60 a day is suicidal. Even if just bread and butter, that’s just too much humanity to churn through. It’s the 2-3% of patients who are just nuts that make the job difficult, you’d almost be assured one outright delusional patient daily with this model. But those Teslas aren’t going to buy themselves, lol. I take my hat off to anybody who can sustain 60 pt a day, even at 4 days a week I could never do that.
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Really? I'd have thought that would not be much more than average.
Do you happen to track wRVUs? It's an interesting thing to follow (even if it's not really actionable) over time; my wRVUs have plateaued since the practice is fairly mature, but an interesting trend has jumped out over time -- wRVUs go up as surgical mix goes up, but collections per wRVU goes down. It's not a battery powered deathbox that I work for (it's that Montana ranch). Heh.
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Really? I'd have thought that would not be much more than average.
It's not a battery powered deathbox that I work for (it's that Montana ranch). Heh.
Most of my gen derm colleagues are in the 30-40 pts/day range. I would also agree that 60 is probably not sustainable for the long term unless the physician had a never ending stream of patience.
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Huh. Interesting -- I cannot remember a time when I did not have 30 general appointments in the morning -- at least not after the first couple of months of practice. For years I did 4-5 MMS and 30-40 gen derm a day, then went to referral only, 7-9 MMS a day and 15-20 gen derm, then the easy MMS cases evaporated, backed it down to 7-8 MMS, 2 excisions, and 12-15 gen derm a day (not counting s/r or wound checks). Maybe I am leaving a lot of money on the table (or maybe the fee schedules are just that poor here) but I don't see how people can make the average derm incomes seeing 30-40 a day?
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Yes, 30-40 is norm. Mohs1, you are a God among men. Kudos to you. Truly. I’d lose my marbles in 6 mon with that schedule. I’ll look for you at the next AAD rollin up in your Bugatti, lol.
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Really? I'd have thought that would not be much more than average.
It's not a battery powered deathbox that I work for (it's that Montana ranch). Heh.
No, I don’t. I have no idea where I’d even find this info. I’ve heard of RVUs, but we don’t use them that I’m aware.
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They are good for benchmarking; they're the only reproducible quantification of work between settings and across platforms that exists. If you're in private practice (eat what you kill), they don't matter much beyond their benchmarking. It is nice to know how well you're being compensated for the amount of work you do. For example, I am well above the 90th percentile in wRVU production, but I'm right at or below 75th percentile for compensation. I have a collections / revenue per unit work problem, one of the banes of living in a broke ass state. Nice to know, but there really isn't **** I can do about it....
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I’d rather not know, there’s enough bs I can’t change that I worry about daily.
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Who has time for meetings???? lol
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If you’re doing all that and making 75th percentile, get the hell out of dodge my friend!
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Wish I could, wish I could.... wife and kids all have anchors buried here so... but, yeah, I would not recommend anyone to practice in this state.
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I think I know which one, totally understand the desire to stay anonymous though.
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What accounts for the discrepancy? Poor payor mix?
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It's basic economics; if the state is at the geographic floor for MC adjustment -- and 1/3 of your non-MC population qualify for Medicaid -- and those who do not have an average household income at the 33rd percentile nationally (and a high deductible) -- you might have plenty of work to do, just won't have anything to show for it.
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A toxic mix of contributors, really. Marked private insurance market consolidation, higher than average Medicare population, higher than average Medicaid population, high deductibles in a low earning populace, and, now, a ballooning QMB (qualified medicare beneficiary) population all translate into lower collections per unit work. It costs more to work more, so there is significant margin compression as a result.
...but yes, many people seem to believe that the answer to our woes is single payer. I invite them to witness and experience the glories of having a high government payer presence, just think of all the joy that will result from extrapolation of the experience to everyone!!!!
So you were contracted directly with the insurance company?
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Yes, truly you are rare if you can see the same number of genderm patients I see a day and do 4-5 MMS a day on top of that!
Out of curiosity, how do you keep people happy? I could do 60 a day and keep the medicine quality, but it would involve not allowing the patients to speak. I thought I was pretty efficient but a certain large percentage of my patients would probably throw a fit if I don’t give them at least a few minutes to talk before the exam (and of course keep prattling on during the exam and procedures)... unless you are a Superman doing 12 hour days year in and out....
Regarding the genderm averages I’m guessing that I’m probably 80th+ percentile MGMA and see 35-40 (albeit 5 days a week). It’s about payor mix and ancillaries.
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A lot to unpack in this -- I'll try.
Rare? I don't know, guess that being well above the 90th in wRVU production does make one rare by definition -- but it's mostly out of necessity, at least in my mind. It is no secret that I work like a dog while I'm at work, nor is it much of a secret that I do 40% more work now compared to 7 years ago yet net 40% less, and that is almost exclusively due to living in a very poor state and its corresponding poor fee schedules.
As for patient happiness -- it's a two way street. I'm just a normal local country boy who happened to do okay in school, and it comes across as such. We can chat about the normal life around here while I'm looking them over, cry-ac is already in the room, shave biopsy tray is already set up, etc, with each room change. The vast, vast majority of my visits are for specific problems: growth on nose, bleeding spot on scalp, rough spots on hands, etc. I don't treat hair loss, don't do biologics or medications that require monitoring, etc -- I have excellent working relationships with colleagues in town who are frankly better at it, more up to date on it, etc. I am a big believer in division of labor; one cannot be great at all things, and systems cannot be efficient at all things. We have to pick and choose our battles, I don't do routine maintenance, believe that people need a general dermatologist that can see them more regularly, etc. I have very few patients that I follow primarily, predominantly those poor souls with horrible actinic disease or transplant patients, and they all understand the business like nature of get in, get out, see ya next time.
If you really want to know how happy I keep them, PM me -- I'll divulge who I am and you can check out my reviews. We are salesman and educators as much as we are technicians; we need to sell what they need to do, educate them to that end, and make them feel good about it. If you can do that quickly and leave them smiling, all the better!
Prior to the forced EMR adoption, I got out a full hour earlier -- I could, on any given day, drop the kids off to school at 7:50am and pick them up at 3:15-3:30pm; this require working through lunch and doing most of the charting after hours. Now, with EMR, it's the rare day that I'm done before 4pm -- and that's still with doing the lion's share of charting after dismissing the staff.
I have no ancillaries and my payer mix is largely beyond my control thanks to the dependence on a referral only practice; it's the demographics that truly F me. Poor people, poor state, high Medicare aged disease prevalence, at the geographic floor for Medicare. I should not complain as I still do okay, but my compensation per wRVU is at the 10th percentile for specialty. It's not that I don't have enough work per se, it's that I'm compensated for **** for all that I do.
