Fair compensation for 4 day work week?

[Dr Grant]

I am about to likely sign on for a PP job on the west coast. It's Mon-Thurs 8-5 with 420k base or 40% collections month-to-month, whatever is higher year one and 450k base or 40% collections year two. After that point, there's the option for buy-in to the practice at fair market value, including buying into any ASCs or real estate if wanted. They have one ASC currently, lots of goals for future expansion. Probably 2 procedure days and 2 clinic days a week. I'm guessing 30 ish patients a day. Just from going through posts on this forum, I'd guess many will say that I'd be underpaid...although it's the west coast, so I think that's kind of expected? It's a necessary move for our family, so that factors heavily into the decision. I've looked at a lot of jobs in the area, and this is the best I've seen (struck out on finding any hospital gigs nearby), as I'm looking to angle more toward lifestyle, and the 4 day work week is huge as well. I've been in practice 5 years out of fellowship, and I've been grinding to pay down most of my debt in a higher paying job in the meantime. I don't know that I have much more room to negotiate, as I've already negotiated the % collections part from 35 to 40%, as well as more PTO and better hours etc for the LOI. I'm just curious if I'm getting a fair shake for the area and schedule. I see many posts on here with people making 700-800k, etc without killing themselves. Browsing this forum makes it seem like you're a chump for taking anything less

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[GoBeers]

working only 4 days for 450k base west coast is more than fair.
i'm shocked you're able to get 2 days worth of procedures from 2 clinic days unless there's plenty of midlevels helping you.
to me this is a great deal
is this california?

 

[Dr Grant]

working only 4 days for 450k base west coast is more than fair.
i'm shocked you're able to get 2 days worth of procedures from 2 clinic days unless there's plenty of midlevels helping you.
to me this is a great deal
is this california?

PNW. I'm used to a very high volume at my current job so they agreed to truncate 10 hour work days into 8 hour days for my schedule. There is help from midlevels as well. I'd say I'm unlikely to see much higher than the base year one or two. My guess is if I can stay fairly busy I could make ~500k ish total give or take a year.

 

[RoloTomassi]

How much of the ASC will you be able to buy, and how much income does that translate to currently/projected to?

 

[Dr Grant]

How much of the ASC will you be able to buy, and how much income does that translate to currently/projected to?

That's a great question and something I'll have to look into. I've just been an employee since fellowship with a fairly simple base/bonus structure, so all of these buy-in/partnership issues are pretty foreign to me.

What are some other good questions to ask regarding this?

 

[callmeanesthesia]

Sounds pretty good to me for PNW.

 

[mid|ine]

Don't feel bad about other numbers you see. You have to go to BFE to get $700K+ / year and not hustle, and even then, that usually take a few years. Numbers look fair.

 

[RoloTomassi]

That's a great question and something I'll have to look into. I've just been an employee since fellowship with a fairly simple base/bonus structure, so all of these buy-in/partnership issues are pretty foreign to me.

They state "After year 2 the employee with have the option to buy-in to the practice at fair market value based on a 3rd party appraisal of the practice. Buy-in percentage to be decided upon prior to the 2 year buy-in clause. The employee will also have the option to buy into any associated real estate at fair market value based on a 3rd party appraisal of the real estate."

What are some other good questions to ask regarding this?

Better to get more details, like percentage, in the contract upfront, because if not, they can always pull the rug out when 2 years hits.

If you're happy with the 450/40% you don't have much to lose, but if you're not and the prospect of ASC ownership is the redeeming quality of the deal, then you need to ask more about what that would look like. Sounds like you should hire a healthcare transaction attorney and possibly a CPA as well to vet the deal. Same goes for the real estate portion.

 

[Dr. Ice]

Better than 90% of deals in the northeast. I’d say it’s pretty damn good

 

[jsaul]

There are paindocs here in the big city seeing about 30 patients a day 5 days a week who make no more than 400k

 

[bedrock]

There are paindocs here in the big city seeing about 30 patients a day 5 days a week who make no more than 400k

Exactly. The OP has a great potential gig.

I Know many pain docs working themselves to the bone 5 days a week to make 400-450.

 

[DrMDAware]

Looks great!

 

[SC Tian]

it seems to me 40% of the revenue refers to professional part Only, in the first two years you will have no earned facility fee from using ASC. The ancillary part is easily to reach 6 digits a year. In a very desirable location, it is probably difficult to negotiate this part. It will be great if you can get part of facility fee to buy in ASC, imo.

 

[PainApp2021]

With regard to fair compensation... Should a doc who trained in PMR for residency but did an anesthesia based pain fellowship be paid significantly less than a doc who trained in anesthesia for residency and also and an anesthesia based pain fellowship? I'm unclear if this is the distinction that the MGMA is making in their reports. Thanks!

 

[Agast]

With regard to fair compensation... Should a doc who trained in PMR for residency but did an anesthesia based pain fellowship be paid significantly less than a doc who trained in anesthesia for residency and also and an anesthesia based pain fellowship? I'm unclear if this is the distinction that the MGMA is making in their reports. Thanks!

MGMA is looking at base specialty, not training. No, it’s not fair to be paid less. Ask for what you think you are worth. I don’t think I’ve come across groups that prefer anesthesia-trained anyway, unless they needed specific anesthesia services.

 

[Aldertonghen]

MGMA is looking at base specialty, not training. No, it’s not fair to be paid less. Ask for what you think you are worth. I don’t think I’ve come across groups that prefer anesthesia-trained anyway, unless they needed specific anesthesia services.

What about neuro/psychiatry backgrounds? Are they considered for most jobs as well?

 

[Status Sciaticus]

how much PTO ?

 

[drusso]

I am about to likely sign on for a PP job on the west coast. It's Mon-Thurs 8-5 with 420k base or 40% collections month-to-month, whatever is higher year one and 450k base or 40% collections year two. After that point, there's the option for buy-in to the practice at fair market value, including buying into any ASCs or real estate if wanted. They have one ASC currently, lots of goals for future expansion. Probably 2 procedure days and 2 clinic days a week. I'm guessing 30 ish patients a day. Just from going through posts on this forum, I'd guess many will say that I'd be underpaid...although it's the west coast, so I think that's kind of expected? It's a necessary move for our family, so that factors heavily into the decision. I've looked at a lot of jobs in the area, and this is the best I've seen (struck out on finding any hospital gigs nearby), as I'm looking to angle more toward lifestyle, and the 4 day work week is huge as well. I've been in practice 5 years out of fellowship, and I've been grinding to pay down most of my debt in a higher paying job in the meantime. I don't know that I have much more room to negotiate, as I've already negotiated the % collections part from 35 to 40%, as well as more PTO and better hours etc for the LOI. I'm just curious if I'm getting a fair shake for the area and schedule. I see many posts on here with people making 700-800k, etc without killing themselves. Browsing this forum makes it seem like you're a chump for taking anything less

Why fair market value for the buy-in? That's where you're going to get screwed. Do you want to buy in at the same price Wall Street private equity guys will pay? I don't think so. You want to pay garage sale prices based upon an assets-based valuation, not Nordstrom prices based upon what "any willing buyer" would pay at an arms-length. Ask for the first right of refusal on any ownership change or a "ride-a-long" me-too clause for any purchase opportunities. If they balk, walk away.

It sounds like these guys are pretty far down the path in conversations for a practice sale already so they could care less what they negotiate with you as it will end up on the new Boss's tab! You might ask them to sign an affidavit attesting that they are not in negotiations with any other party for a change in ownership.

 

[DrSpine]

Why fair market value for the buy-in? That's where you're going to get screwed. Do you want to buy in at the same price Wall Street private equity guys will pay? I don't think so. You want to pay garage sale prices based upon an assets-based valuation, not Nordstrom prices based upon what "any willing buyer" would pay at an arms-length. Ask for the first right of refusal on any ownership change or a "ride-a-long" me-too clause for any purchase opportunities. If they balk, walk away.

It sounds like these guys are pretty far down the path in conversations for a practice sale already so they could care less what they negotiate with you as it will end up on the new Boss's tab! You might ask them to sign an affidavit attesting that they are not in negotiations with any other party for a change in ownership.

If there's anyone to listen to on here - it's this guy. He knows his stuff, and I agree with majority of what he says. It's an uncomfortable truth that no one wants to know, but he's honest.

 

[paindoc007]

With regard to fair compensation... Should a doc who trained in PMR for residency but did an anesthesia based pain fellowship be paid significantly less than a doc who trained in anesthesia for residency and also and an anesthesia based pain fellowship? I'm unclear if this is the distinction that the MGMA is making in their reports. Thanks!

Is it lower? I have the 2022 mgma for pain management non anesthesia. Median is 469 and 75th is 636. Anyone have the anesthesia pain one ??

 

[PainApp2021]

Is it lower? I have the 2022 mgma for pain management non anesthesia. Median is 469 and 75th is 636. Anyone have the anesthesia pain one ??

About 683k for the 75th anesthesia pain

 

[paindoc007]

About 683k for the 75th anesthesia pain

Ahh so there’s a little difference. Thanks

 

[Status Sciaticus]

About 683k for the 75th anesthesia pain

what is the median? thanks!

 

[Ligament]

If you did an anesthesia based pain fellowship, you should be paid at that rate.