Family Medicine and " Teaser Salaries"

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

psychMDhopefully

Full Member
7+ Year Member
Joined
Jan 1, 2016
Messages
659
Reaction score
791
I have a question for the experienced here, on the AAFP article "Salaries Climbing" there were a few people in the comments saying it is common for places desperate for Docs to offer higher salaries to new grads ~ 240k for the first couple of years, then switch to a production method where salaries are usually lower - 160-180k. I could see this being the case in places that really need doctors but have a low volume of patients, but not in places where there is high demand and high volume. Anywho, is bait and switch common in FM???

Members don't see this ad.
 
First off, let's get one thing straight: if you're on production, you're not salaried. A salary is a guaranteed wage. People need to stop using the term "salary" as a synonym for "income."

That being said, it's not unusual for health systems to use high salary guarantees as a recruiting tool. The guarantee period typically only lasts for 1-3 years, however, after which you're paid on production (typically based on RVUs). Bottom line, know what you're getting into.
 
Last edited by a moderator:
  • Like
Reactions: 7 users
You get a clear idea what your salary will be by the end of year 2 based on your RVUs. If you see 100 patients a week, if you do injections, i&ds, counsel on things, bill 99214s when you should be I really see low-mid 200s as a realistic thing. People in group practices also do well as they have economies of scale and more negotiating power.

I read the article and the comments afterwards, but Ive heard only one instance of this and it could partially have to do with someone wanting a 4 day workweek. I work for Kaiser and the guaranteed salary actually has gone from 205 - 250 from 2013 - 2016 and there might be an increase again this year.

I wonder if those comments were by solo docs with a 3-4 person staff who really should be looking to narrow down what insurances they accept and maybe pare down the staff. Maybe its a coding issue.

I could also be wrong and there is a lot of bait and switch going on.

Are you in psych looking to get into FM?
 
  • Like
Reactions: 1 user
Members don't see this ad :)
First off, let's get one thing straight: if you're on production, you're not salaried. A salary is a guaranteed wage. People need to stop using the term "salary" as a synonym for "income."

That being said, it's not unusual for health systems to use high salary guarantees as a recruiting tool. The guarantee period typically only lasts for 1-3 years, however, after which you're paid on production (typically based on RVUs). Bottom line, know what you're getting into.

Know what you're getting into and hire a good contract lawyer, preferably one that specialises in physician employment. I can't believe the number of doctors who sign on the dotted line with zero clue about what they're signing. Even basic things like bonus repayment, tail coverage, handling breach of contract, etc. "Bait and switch" can easily be foreseen with a good lawyer, who can also help negotiate things like good-faith low productivity as a term of separation. Oh, and tax. An extra word here or there can make a difference.

It's also common to be both salaried and be on production, like in the ACO model, which, on average, has a 50:45:5 mix (with 5 being KPI-based or other bonuses).
 
Last edited:
It's also common to be both salaried and be on production, like in the ACO model, which, on average, has a 50:45:5 mix (with 5 being KPI-based or other bonuses).

But that's still not salary. That's production with a base+bonus. The bonus is what matters.
 
  • Like
Reactions: 1 users
Anyone else have input on this? Im a heavily indebted MS-3 strongly considering family med, and making $175k vs $225k number that is getting thrown around these days makes a huge difference.
 
Anyone else have input on this? Im a heavily indebted MS-3 strongly considering family med, and making $175k vs $225k number that is getting thrown around these days makes a huge difference.
Full time FM shouldn't be making less than 200k these days. More is fairly easy.
 
  • Like
Reactions: 2 users
I wrote about the kaiser salaries above and its increased this year as well (I believe they're openly advertising 260k now starting salary). The VA pays 190k now from what I understand and that should be your minimum.
 
I was in your position 10 years ago. I'm doing ok now, but could be doing much, much better had I done a few things differently.

1. Strongly consider the National Health Sciences Services Corp. Tax free payments towards your loan. Yes, you'll likely be in a place that you wouldn't want to live long term, but it's only temporary.

2. Do as much as you can to pay at least the interest on your loans through residency. When they capitalize, you are SCREWED. I've been paying since I graduated in 2012 and I have only recently just gotten some back to their original principal.

3. Yes, teaser salaries do exist. You'll be guaranteed a great starting salary for 1-3 years then will transition over to a production based or base + bonus. Hopefully, by the time this occurs, you have a full practice or else you WILL be in for a shock.

4. Be prepared to work HARDER than you did in residency if you plan on paying aggressively towards your loans. DO NOT be in a rush to get a house/new vehicle/boat since you have come up and now 'deserve it.'

5. I know I'll be escorted outside the FM compound gates and have acid thrown in my face, shot, drawn, quartered, hung then burned for this one, but bottom line, urgent care docs make bank. In my area they pull at least $250k a year. A friend of mine this past fiscal year will do a little over $300k working about 1600 hours (that's about 40 weeks work). Minimal paperwork, no PCMH headaches

6. Lawyers may know the gotchas that can get you in legal issues (early termination, tail, restrictive covenant, etc) but from my experience, few are able to tell you if this is a good deal or not, which is pretty much what you really want to know. In general, organizations will offer contracts in THEIR own best interest. They will take advantage of the fact that you likely have little financial savvy, and have an altruistic bend since you didn't exactly go to in FM to become a billionaire. You are at the mercy of the people keeping your books. If they say you made X and you say that no, I made Y, you better have some documentation to show otherwise. That takes time, effort and energy that will likely be in short supply, especially more so if you have a life outside of work. They know this too. Be wary of wanting to do your financial meetings over lunch at a restaurant. It's distracting. Request a copy of your monthly report BEFORE meeting. Keep tract of the number of patients you see every day.

7. This is my candid observation but I swear it holds true. Wherever you're recruited, make sure you spend some time in their Walmart and a grocery store. It's my unofficial way to check the pulse on the town. People watch. Do people seem generally friendly? How many people look like they actually take any interest in their health. Do you generally see people who have done a lot of 'hard livin?' Do you see cart after cart filled with sodas and junk food? These are the people who will be your patients.

There's more, but it's lunch time and I've gotta get home and get the crock pot started. It's potroast night.
 
  • Like
Reactions: 1 users
I know I'll be escorted outside the FM compound gates and have acid thrown in my face, shot, drawn, quartered, hung then burned for this one, but bottom line, urgent care docs make bank. In my area they pull at least $250k a year. A friend of mine this past fiscal year will do a little over $300k working about 1600 hours (that's about 40 weeks work).

You should be able to do the same in primary care.

Minimal paperwork, no PCMH headaches

Maybe not, but urgent care has its own headaches.
 
  • Like
Reactions: 1 users
You should be able to do the same in primary care.



Maybe not, but urgent care has its own headaches.
No kidding. I'll take most of primary care's headaches over the terribleness that is Urgent Care.

With rare exceptions, the only way to make a career out of it is to not care if you practice good medicine.
 
  • Like
Reactions: 1 user
I was in your position 10 years ago. I'm doing ok now, but could be doing much, much better had I done a few things differently.

1. Strongly consider the National Health Sciences Services Corp. Tax free payments towards your loan. Yes, you'll likely be in a place that you wouldn't want to live long term, but it's only temporary.

2. Do as much as you can to pay at least the interest on your loans through residency. When they capitalize, you are SCREWED. I've been paying since I graduated in 2012 and I have only recently just gotten some back to their original principal.

3. Yes, teaser salaries do exist. You'll be guaranteed a great starting salary for 1-3 years then will transition over to a production based or base + bonus. Hopefully, by the time this occurs, you have a full practice or else you WILL be in for a shock.

4. Be prepared to work HARDER than you did in residency if you plan on paying aggressively towards your loans. DO NOT be in a rush to get a house/new vehicle/boat since you have come up and now 'deserve it.'

5. I know I'll be escorted outside the FM compound gates and have acid thrown in my face, shot, drawn, quartered, hung then burned for this one, but bottom line, urgent care docs make bank. In my area they pull at least $250k a year. A friend of mine this past fiscal year will do a little over $300k working about 1600 hours (that's about 40 weeks work). Minimal paperwork, no PCMH headaches

6. Lawyers may know the gotchas that can get you in legal issues (early termination, tail, restrictive covenant, etc) but from my experience, few are able to tell you if this is a good deal or not, which is pretty much what you really want to know. In general, organizations will offer contracts in THEIR own best interest. They will take advantage of the fact that you likely have little financial savvy, and have an altruistic bend since you didn't exactly go to in FM to become a billionaire. You are at the mercy of the people keeping your books. If they say you made X and you say that no, I made Y, you better have some documentation to show otherwise. That takes time, effort and energy that will likely be in short supply, especially more so if you have a life outside of work. They know this too. Be wary of wanting to do your financial meetings over lunch at a restaurant. It's distracting. Request a copy of your monthly report BEFORE meeting. Keep tract of the number of patients you see every day.

7. This is my candid observation but I swear it holds true. Wherever you're recruited, make sure you spend some time in their Walmart and a grocery store. It's my unofficial way to check the pulse on the town. People watch. Do people seem generally friendly? How many people look like they actually take any interest in their health. Do you generally see people who have done a lot of 'hard livin?' Do you see cart after cart filled with sodas and junk food? These are the people who will be your patients.

There's more, but it's lunch time and I've gotta get home and get the crock pot started. It's potroast night.


Mark, you mentioned that you still have student loans. You finished in 2012. In my opinion you should have zero loans by now. Here is an example.

200K after taxes is around 130 to 140 K. Take 70 K of that and pay off loans over 3 to 5 years. Done. Live on the other 60 to 70 K. That should be easy because you were living on less as a resident. Want more money at the start? Pick up one of those urgent care shift once or twice a month.
 
  • Like
Reactions: 1 user
Members don't see this ad :)
Mark, you mentioned that you still have student loans. You finished in 2012. In my opinion you should have zero loans by now. Here is an example.

200K after taxes is around 130 to 140 K. Take 70 K of that and pay off loans over 3 to 5 years. Done. Live on the other 60 to 70 K. That should be easy because you were living on less as a resident. Want more money at the start? Pick up one of those urgent care shift once or twice a month.

Unfortunately that entirely depends on what you've accrued in loans. I have around $350k at 6-7% interest. Paying like you've mentioned will not get mine paid off in 5 years. But I do agree about paying them off as aggressively as possible.


Sent from my iPhone using SDN mobile
 
Unfortunately that entirely depends on what you've accrued in loans. I have around $350k at 6-7% interest. Paying like you've mentioned will not get mine paid off in 5 years. But I do agree about paying them off as aggressively as possible.


Sent from my iPhone using SDN mobile

350K in loans???
 
350K in loans???
Not a shock. Guy in my residency (graduated in 2013) had 275k in loans. I mean heck, Tufts right now tuition alone is 56k/year which is 224k total. Let's be optimistic and say that you can live in Boston on 30k/year. That puts us right at 350k by my math.
 
Not a shock. Guy in my residency (graduated in 2013) had 275k in loans. I mean heck, Tufts right now tuition alone is 56k/year which is 224k total. Let's be optimistic and say that you can live in Boston on 30k/year. That puts us right at 350k by my math.

Wow.
 
350K in loans???

Yep. About 20k from undergrad. About 55k per year in tuition, alone. Plus taking out additional $ above tuition to help with cost of living. Not to mention that 6-7% interest in all unsubsidized loans means I've also already accumulated a large chunk in interest on top of that.


Sent from my iPhone using SDN mobile
 
Yep. About 20k from undergrad. About 55k per year in tuition, alone. Plus taking out additional $ above tuition to help with cost of living. Not to mention that 6-7% interest in all unsubsidized loans means I've also already accumulated a large chunk in interest on top of that.


Sent from my iPhone using SDN mobile

Was it worth it?
 
350K in loans???
I'm going to have 400k by the time I'm done with residency. Between them killing subsidies for graduate student loan interest while still in school a few years back and the increase in tuition over the past few years, many of us have crippling debt. Even if I throw 70k at my loans, I'm still accruing 24k in interest per year, hampering my ability to pay things down efficiently. Realistically at that rate it would take 7-8 years to pay down, and during that time I'd be living on about the same income I had as a freaking respiratory therapist. The only way to do things efficiently would be to work tons of hours and make as much money as possible to pay down the loans faster- at 300k of income, my after tax pay would be around 175k, and throwing 105k a year at something makes a massive difference.
Mark, you mentioned that you still have student loans. You finished in 2012. In my opinion you should have zero loans by now. Here is an example.

200K after taxes is around 130 to 140 K. Take 70 K of that and pay off loans over 3 to 5 years. Done. Live on the other 60 to 70 K. That should be easy because you were living on less as a resident. Want more money at the start? Pick up one of those urgent care shift once or twice a month.
Oh, and if you're saving for retirement, that 200k comes to around 122k after taxes (in my state at least), so if you're throwing in 70k you've got around 52k left. Not poverty mode, certainly, but there's a big difference between 70k and 52k for someone with a family.
 
  • Like
Reactions: 1 user
I'm going to have 400k by the time I'm done with residency. Between them killing subsidies for graduate student loan interest while still in school a few years back and the increase in tuition over the past few years, many of us have crippling debt. Even if I throw 70k at my loans, I'm still accruing 24k in interest per year, hampering my ability to pay things down efficiently. Realistically at that rate it would take 7-8 years to pay down, and during that time I'd be living on about the same income I had as a freaking respiratory therapist. The only way to do things efficiently would be to work tons of hours and make as much money as possible to pay down the loans faster- at 300k of income, my after tax pay would be around 175k, and throwing 105k a year at something makes a massive difference.

Oh, and if you're saving for retirement, that 200k comes to around 122k after taxes (in my state at least), so if you're throwing in 70k you've got around 52k left. Not poverty mode, certainly, but there's a big difference between 70k and 52k for someone with a family.


Fair enough. But you did know that when you went into Family Medicine, right? Or even in medicine. I know it sucks but what choice do you have. 52 K per year plus your wife (if you are married) working is not bad for a few years while allowing you to save for retirement and pay off debt. You can find high paying (work to the bone) FM jobs and pay them off faster. Don't burn out. Perhaps 2 -3 years.
 
Fair enough. But you did know that when you went into Family Medicine, right? Or even in medicine. I know it sucks but what choice do you have. 52 K per year plus your wife (if you are married) working is not bad for a few years while allowing you to save for retirement and pay off debt. You can find high paying (work to the bone) FM jobs and pay them off faster. Don't burn out. Perhaps 2 -3 years.
Yeah, my girlfriend makes around 15k a year, so that's not exactly going to keep us afloat in the northeast :laugh: Compared to a physician salary, her take home pay looks like a rounding error.
 
  • Like
Reactions: 1 user
Was it worth it?

Absolutely. Although I'm currently a resident and haven't started those massive loan payments just yet. I'm accruing close to $30k per year in interest so by the time I'm done with residency my total will be well above $400k.
Thankfully a lot of rural FM jobs offer large sign on bonuses and loan repayment. I'm hoping that will help me pay these off before I'm 80.


Sent from my iPhone using SDN mobile
 
Absolutely. Although I'm currently a resident and haven't started those massive loan payments just yet. I'm accruing close to $30k per year in interest so by the time I'm done with residency my total will be well above $400k.
Thankfully a lot of rural FM jobs offer large sign on bonuses and loan repayment. I'm hoping that will help me pay these off before I'm 80.


Sent from my iPhone using SDN mobile

Fair enough. Have you thought about how you are going to set up a retirement in the event you get burnt out or just want to retire earlier than the usual 65 years old or even at 65. I'm not trying to be downer but 400K is a house.

Lets say you make 250K rural. After taxes that's about 150 net. Consider living on 50K, putting 25 K towards a retirement plan and 75 k to loans until it's paid off. That's about 6 years. Just remember if you make 6% in the market on your investments and pay 6% toward your student loans you are at a negative loss until you pay off all the loans.

The reason I posted about this in here is to show that 250 isn't much if you have massive loans and those loans need to be addressed in an urgent fashion. Most doctor have a very poor understanding of finance. Several reasons for this. They didn't study it. They didn't learn risk tolerance from a business perspective. They don't understand the terminology and historical values of investing. That put you at a significant disadvantage when it comes to money. I suggest you start reading about it. Start with white coat investor and go on to several other books and websites. I don't own white coat investor. If you choose not to do it understand that you could lose your life savings as your net worth increases or you will pay porsche level dollars to financial advisors and walk out with a toyota.

Even if you get those sign on bonuses and loan repayments you will still need to know how to manage your money. Become a student of finance.
 
  • Like
Reactions: 1 users
Yeah, my girlfriend makes around 15k a year, so that's not exactly going to keep us afloat in the northeast :laugh: Compared to a physician salary, her take home pay looks like a rounding error.

So that's 67K per year to live on while you pay off your loans. Are you in the northeast now and living on a resident salary? Why not keep doing that until the loans are gone. Or work your a ss off doing weekend shift to get it done faster. Or choose a higher paying specialty.

Is your girlfriend always going to make 15K per year?
 
So that's 67K per year to live on while you pay off your loans. Are you in the northeast now and living on a resident salary? Why not keep doing that until the loans are gone. Or work your a ss off doing weekend shift to get it done faster. Or choose a higher paying specialty.

Is your girlfriend always going to make 15K per year?
I live on less than a resident's salary, always have. But to give you an idea of what a living wage is in Connecticut (we have some of the highest non-city costs of living in the country):
graphicbudgetjobs.jpg

The gf has no real earning potential, she works for fun and to keep busy more than anything. If we get married it'll actually end up being a tax penalty overall to the point I don't know if her working anymore makes sense, as it'll basically be working for nothing or less care of state taxes, so that might actually be 15k that doesn't exist once I'm a physician. Not saying it's not doable, but just saying it's pretty unpleasant.
 
I live on less than a resident's salary, always have. But to give you an idea of what a living wage is in Connecticut (we have some of the highest non-city costs of living in the country):
graphicbudgetjobs.jpg

The gf has no real earning potential, she works for fun and to keep busy more than anything. If we get married it'll actually end up being a tax penalty overall to the point I don't know if her working anymore makes sense, as it'll basically be working for nothing or less care of state taxes, so that might actually be 15k that doesn't exist once I'm a physician. Not saying it's not doable, but just saying it's pretty unpleasant.

Sounds like you should move out of CT. I can't really comment on your GF working for fun. But, would she work for fun if you were not around?
 
Sounds like you should move out of CT. I can't really comment on your GF working for fun. But, would she work for fun if you were not around?
She got by just fine for seven years of adulthood after she knew me, and pays all of her own bills to this day, so I'd say yeah, she'd still be living the same way. She's like some kind of artist monk, she's happy as long as she's got food and a canvas. And just up and leaving the place you've lived in for as far back as you care to remember isn't exactly easy. I'd rather be poor than give up my friends and loved ones to be rich.
 
Last edited:
  • Like
Reactions: 1 users
She got by just fine for seven years of adulthood after she knew me, and pays all of her own bills to this day, so I'd say yeah, she'd still be living the same way. She's like some kind of artist monk, she's happy as long as she's got food and a canvas. And just up and leaving the place you've lived in for as far back as you care to remember isn't exactly easy. I'd rather be poor than give up my friends and loved ones to be rich.

When do you finish residency? If your last sentence is true and you really mean it then don't worry about it. Just work in CT pay off loans and live.
 
Top