Hourly rate

[miacomet]

Here are real world numbers from 10 yrs ago when we were a SDG, open book for all partners so we all saw the real numbers. I would guess the numbers are alittle worse given insurance headwinds, but lets assume they are unchanged. I would say this is typical so not including all the niche areas with extraordinary insurance/stipend, etc.

Background - above avg payer mix. All MD group, No NP. Docs saw about 2pph. 70% of the group were partners, 2 yr partnership track with same pay rate/nights/weekends as Partners with only difference being about a typical 50K partner distribution yearly.

Partner pay was about $230/hr + 50K SEP contribution + 50K partner distribution + 25K in benefits (med mal/insurance/etc). Most docs worked 140hrs/mo. This put Partners right at $300/hr all in or about 280/hr assuming all were partners. So full time docs pulled in about 500K working 140hrs/mo, Non partners 450K.

Adding 1 APC 10 hr shift typically boosted MD pay about $10/hr if my memory was correct vs hiring an MD.

Before we became a democratic group, the few owners essentially took all of the distribution so they made about 2.1M for just being the owners.


The avg pay above of $300/hr was after billing expense 12% of collections ($35/hr) with very little other administrative costs/medmal so about $50/hr all in for non physician pay.

So we collected about $350/hr at 2pph so the $200/pp seems about right.

I stand by my statement that a decent above avg hospitals system with above avg payer mix will pull in about $200/pp.

So if you are seeing 3pph and making $300/hr, your owner/CMG/employer is making $300/hr.

I have to say, I really admire the career you have put together for yourself. Very impressive- SDG, FSED, real estate. You should give a seminar, it's so amazing.

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[EctopicFetus]

I have to say, I really admire the career you have put together for yourself. Very impressive- SDG, FSED, real estate. You should give a seminar, it's so amazing.

Agreed. He has kicked butt.

 

[pollyspockets]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

 

[bravotwozero]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

$210/hr nocturnist at full partner?

Terrible, even with benefits.

 

[emergentmd]

I have to say, I really admire the career you have put together for yourself. Very impressive- SDG, FSED, real estate. You should give a seminar, it's so amazing.

Actually some luck, made plenty of mistakes on the way, and nothing special that many EM docs could not do with the high income/plenty of off days.

Many docs I know have done just as well and some better. Most just do not say anything either b/c they do not want competition or want to be the "successful one". Good thing with an anonymous board is I can hopefully help the younger generations without outing myself in small community where many probably know me.

 

[emergentmd]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

Full partner making 210/hr seeing 3pph as a nocturnist? Either you have the worse payer mix, or some other higher partner is making all the money. How do you even find non partners seeing 3pph + APCs making less than 210/hr.

 

[RustedFox]

Full partner making 210/hr seeing 3pph as a nocturnist? Either you have the worse payer mix, or some other higher partner is making all the money. How do you even find non partners seeing 3pph + APCs making less than 210/hr.

The sole "SDG" in my area has a lower rate, a 2-year buy-in track, and no guarantee of partnership.
Oh, and you'll work mostly nights.

 

[JacobMcCandles]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

As we've shown, a lot can go into this. If you're a full partner then you should have access to the books so you can answer your own question. I'm never surprised at the number of partners who couldn't tell you the first thing about their group's (in which they are an owner) finances.

 

[Rekt]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

Put your notice in today.

 

[pollyspockets]

Put your notice in today.

Got a job for me

 

[BoardingDoc]

As we've shown, a lot can go into this. If you're a full partner then you should have access to the books so you can answer your own question. I'm never surprised at the number of partners who couldn't tell you the first thing about their group's (in which they are an owner) finances.

Agreed. If you are actually a full partner, you should be able to see where every cent that comes into the practice goes. This includes being able to see exactly how much all the other partners are getting paid as well.

 

[cyanide12345678]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

100% getting screwed if you are truly averaging 3 pph. That’s just absolutely terrible. If i ever saw that much, i would at least want 350 per hour bare minimum. Probably still won’t do it for $350/hr honestly because money is becoming less and less important the more i have it.

If i were you, id be job hunting while there are still plenty of jobs.

Though at the same time, depends on the area. Some cities in Colorado have been completely taken over by Usacs and are paying $150/hr i hear. For all you know, your 210/hr could be great for your area if you live in a terrible EM market.

 

[GonnaBeADoc2222]

$210/hr nocturnist at full partner?

Terrible, even with benefits.

Wow I thought I was getting screwed lol.

I make this as w2 employee seeing 1.5 pph and working no nights.

 

[Dr Mantis Toboggan]

210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

Do you have a like an amazing defined benefit retirement plan or something?

 

[alpinism]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

Honestly even with a horrible payer mix you should be getting at minimum 250/hr not including a differential for night shifts.

 

[CliveStaples]

It's probably worth quantifying benefits in the context of hourly rate.

Physician A works for a CMG and makes 250/hr, working 120 hours per month for 12 months, making 360k per year.

Physician B is a W2 for a hospital and makes 210/hr, working 120 hours per month for 12 months, but receives a retirement match that comes out to 25k per year, 5k per quarter on incentive bonuses, 5k of CME spending that can be used pretty liberally, 2 weeks (I.e. 60 hours) of paid vacation per year, a health insurance plan through work that saves him or her 500 a month on health insurance premiums, dental and vision insurance that saves 50 dollars a month, disability insurance to save 5k per year, and life/accidental disability insurance saving them 1k per year, and you end up with a physician that actually makes about 375k per year, or about 260/hr and that's before accounting for the savings on payroll taxes.

 

[emergentmd]

Just for context. Our SDG of yesteryear paid our nocturnist $65/hr extra and discussions at our Board mtgs were to increase it as much as they wanted. They just didn't know this so was happy with the $65/hr. I am sure they would have gotten $100/hr extra.

 

[namethatsmell]

Some other #s for context...all of which are accessible to a BCEM...

Things like occ med, addiction med, disability exams all pay in the higher 100s/hr or sometimes in the lower 200s/hr if you find the right setup.

HPM guys can make 300k+ a year depending on the hustle.

Crit care (great job market but rougher lifestyle) and pain guys (crappier job market but better lifestyle) have a tremendous range of incomes, but can make into the 7 figures depending on location and hustle.

All (except cc) have no nights/weekends/holidays. Nobody should feel trapped in EM.

 

[mancub]

Question for the hive. Current PGY3 interviewing at multiple SDG’s. Every group is pretty coy about post partner earnings but very up front about partner tracks, hourly pay. What sort of bump in pay could I reasonably expect per hr/month/year after partner? Okay with low estimates I just honestly have no idea and can’t get straight answers. Let’s say base average is ~220 per/hr for discussion sake

 

[Mount Asclepius]

Question for the hive. Current PGY3 interviewing at multiple SDG’s. Every group is pretty coy about post partner earnings but very up front about partner tracks, hourly pay. What sort of bump in pay could I reasonably expect per hr/month/year after partner? Okay with low estimates I just honestly have no idea and can’t get straight answers. Let’s say base average is ~220 per/hr for discussion sake

A true SDG should always be willing to tell you what the average partner makes hourly. If they won’t, then it’s a red flag.

 

[mancub]

A true SDG should always be willing to tell you what the average partner makes hourly. If they won’t, then it’s a red flag.

Point taken. All three groups come well vetted by my program leadership, former employees since moved, and current program grads so I feel risk of predatory SDG is low.

 

[EctopicFetus]

Point taken. All three groups come well vetted by my program leadership, former employees since moved, and current program grads so I feel risk of predatory SDG is low.

Ask one of the people who left. They should tell you how much. Imo a decent sdg partner is making at least $300/hr but some make way less. Usually due to a mix of being poorly run and/bad payer mix.

In general your program leadership especially if a real academic center aka “U of In n out medical center ” are far removed from any concept of how these groups work or the $$ they make.

You should have a decent idea of what they make. Some sdgs won’t tell you partner income. Many of these are the ones who make a lot. Usually if they will tell you it’s $300/hr or less.

 

[JacobMcCandles]

I agree with Ectopic. It isn’t necessarily a red flag. Many of the ones who won’t say do very well and want to keep some of that information private rather than tell 10 interview candidates when they’re only hiring for 1 spot.

 

[Arcan57]

Man, am I just getting screwed?
210/hr dedicated nocturinst
Group pays all benefits (no premiums for me)
Full partner
Mid-Atlantic
Frequently see 3+ pph including mid levels (many of whom are useless and the amount of supervision they require does not benefit me at all)

$210/hr seems pretty good for the Mid-Atlantic. Do you get to set your own schedule? Typically nocturnists either get a pay bump or get to assign their own shifts. If you're not getting either, than you probably are being screwed.

 

[hundreddaysoff]

I'm a nocturnist.

Old job: 1040 1099 as S-corp for USACS, rural CA shop, 1.5--2pph, $200/h nominal but actual $180/h for past 6 months due to USACS RVU skimming, no benefits

New job: W-2 hospital-employed, small Northeastern city, 2pph, $250/h plus benefits

 

[Mount Asclepius]

I should clarify. If you are offered a position and they still won't tell you what partners make, then I think that is a red flag. It's not truly democratic if group compensation isn't transparent. It's concerning for a malignant non-democratic group. Well compensated groups likely won't want to fully disclose group finances to all prospective applicants and make publicly available. Very similar to how private companies aren't open book to the public.

 

[GonnaBeADoc2222]

I'm a nocturnist.

Old job: 1040 for USACS, rural CA shop, 1.5--2pph, $200/h nominal but actual $180/h for past 6 months due to USACS RVU skimming, no benefits

New job: W-2 hospital-employed, small Northeastern city, 2pph, $250/h plus benefits

Old job = WOOF.

Did you mean "1099" when you said "1040?

If so, even more WOOF.

 

[EctopicFetus]

I should clarify. If you are offered a position and they still won't tell you what partners make, then I think that is a red flag. It's not truly democratic if group compensation isn't transparent. It's concerning for a malignant non-democratic group. Well compensated groups likely won't want to fully disclose group finances to all prospective applicants and make publicly available. Very similar to how private companies aren't open book to the public.

This is tough for sure. Many of the higher paying groups don’t want people to know what they make and keep this as a secret. My old group had in our contract that they would fine you 25k if you discussed what we made to anyone but your spouse. Had your spouse sign the same fwiw.

 

[alpinism]

I mean I get the desire not to advertise your income but I don't see a reason to hide it from potential new partners.

To be honest those aren't the kind of people I'd want for partners if I had the chance to choose between multiple jobs.

 

[EctopicFetus]

I mean I get the desire not to advertise your income but I don't see a reason to hide it from potential new partners.

To be honest those aren't the kind of people I'd want for partners if I had the chance to choose between multiple jobs.

Lets make up a job.. You are in a city and maybe there are 2 SDGs and 5 CMG jobs.

One SDG is "normal" pay with all the stuff is $300/hr as partner before that it they pay $220/hr.
The other SDG pays $200/hr but the partners make $500/hr.

The CMGs are standard pay is $225/hr.

If I was making $500/hr and way more than anyone else in town why would I want that to get out? There are a million people for that $500//hr sdg gig. I dont need to convince someone to go there. Word of mouth is enough.

My first SDG job it was super secret what the partners made (was over $300/hr). The pre partner pay was like 60% of CMG jobs. I took the job cause I knew people in the group and they told me what the partner money was.

 

[Rekt]

When I interviewed, it was about 50/50 for SDGa giving me pay figures. I understood why. I agree with Ectopic. If you're making ridiculous money, it's no one's business. Typically they would quote percentile for MGMA. "You'll make 99th percentile for MGMA" which was more than adequate. I don't think our compensation should be out in the wild willy nilly.

 

[EctopicFetus]

When I interviewed, it was about 50/50 for SDGa giving me pay figures. I understood why. I agree with Ectopic. If you're making ridiculous money, it's no one's business. Typically they would quote percentile for MGMA. "You'll make 99th percentile for MGMA" which was more than adequate. I don't think our compensation should be out in the wild willy nilly.

It does put you at risk. It’s not just the CMG who will know you may have a great grasp on your contract. But if the hospital hears this they could ask you to help them with the hospitalists which would be both a financial nightmare as well as a HR disaster.
do you see people coming on here saying hey I make 750k a year in EM? No. You know why? Cause why would you?

 

[Mount Asclepius]

@EctopicFetus makes valid points. Makes me think about my position for sure. Ultimately though I think I agree most with @alpinism. I was readily told what the average partner made prior to signing on to the partnership track for my current SDG job. I was also told privately by a former grad from my residency program what some of the most productive partners made. I was given enough information through different sources to feel very comfortable taking the job and trusting my potential future partners. I was proven right. Perhaps connections were important to my circumstance in landing a position, but we still are very open when hiring what compensation looks like. We don't advertise and flaunt our compensation publicly, but when we do hire we are pretty transparent with people who we are considering. The vast majority of our hires end up becoming future partners and should know what to expect. There is a little trust that goes both ways, which ultimately contributes to a non-malignant SDG.