Job Negotiations after Fellowship

[Spine Specialist]

Friends-

I am a PMR-based ACGME/Anes Pain fellow who is applying for jobs in academic practice Vs group practice in academic setting. How do i negotiate for percentage in procedures i am going to do after regular base salary? I hope you understand my question.

Any suggestions or advice from practicing pain folks or others will be really appreciated. Thanks!

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[paz5559]

Friends-

I am a PMR-based ACGME/Anes Pain fellow who is applying for jobs in academic practice Vs group practice in academic setting. How do i negotiate for percentage in procedures i am going to do after regular base salary? I hope you understand my question.

Any suggestions or advice from practicing pain folks or others will be really appreciated. Thanks!

I am not yet in practice, but my understanding, having spoken to both recruiters and potential employers, is that your productivity bonus is typically a percentage of collections or gross revenues, over some multiple of your salary. If, for instance, you were being paid a salary of 200K, the bonus might be 25% of collections in excess of 400K.

The other relevant point regarding a collection-based bonus is the status of accounts receivables if you were to chose to leave the practice. Clearly, you take the hit up front while the practice is waiting for collections. Yet the default seems to be that the practice owns the ARs upon separation, unless you are able to negotiate otherwise.

Hope that helps.

 

[PainDr]

I'll be job hunting next year (ACGME Anes Pain Fellow starting in July), so what's the market like? I'm interested in private practice...not academics. Would prefer So Cal but am not limited to that area.

 

[Spine Specialist]

Thanks paz.

 

[PainDr]

Bump...anyone have any insights? Thanks!

 

[Aether2000]

Typically the first year, there will be little bonus because
1. Unless a person is licensed in the state to practice medicine, there is a significant delay in licensure
2. Unless a licensed person has a street address of practice, they may not be able to enroll in all insurers and therefore there is a significant delay (3-4 months) before any collections are received.
3. Start up costs require the employer to subsidize the cost of malpractice insurance even before any revenue is generated
4. The physician may not be as busy as other physicians already in the practice due to embedded referral patterns, patient preference, etc. Also the practice may not be able to suddenly provide the amount of referrals to fill a practice.

Ultimately there may be a possibility of partnership and this should be discussed up front with the potential employer. Definitely not longer than 3 years to partnership.... Most are now 1-2 years. Partnership or employee status should include a definitive bonus formula and not some nebulous calculation. Also, if the bonus is to be a percentage of overall income you generate minus office expenses, the books should be available to you and should be transparent.
Check out "Starting a Practice" in www.algosresearch.org

 

[DrBarna]

The most important factor in negotiating any employment contract is to understand what it is that you want, what is fair, and understand what the personal offering the contract wants/expects. A great book to read prior to any negotiation is "Getting to Yes", written by some Harvard professors. I also highly recommend enlisting a healthcare, medical contract attorney, ideally in the state where you hope to practice. This is probably the most important thing you can do, and will be worth every penny. There are many pitfalls in negotiating...and ultimately incentive pay or even overall salary may be one of the less important, believe it or not. There are also great articles for free at medical economics (online at www.medicaleconomics.com) which may prove helpful. So, to answer your question, there is no real answer...it is the entire deal that needs to be carefully weighed, and not just one component. Bottom line, make sure that you enter a deal where you will be happy with the first year and also see a future as a happy partner (not just simply a partner...but a happy partner).

 

[C Fiber]

If a certain location is preferred, how does one approach job hunting in that area? Phone calls to all that's listed in the yellow pages? Send CVs? Have someone else call for you? How does one begin this job hunt? Negotiation?

 

[Spine Specialist]

I need info about signing in bonus. How much are they paying as signing in bonus for pain specialists? Do they pay initially or after six months? How much they pay bonus in the first year?
Is signing in bonus only for rural practices?
Please share information. Thanks!

 

[DigableCat]

AlgosDoc has prepared a well put together article on PainRounds entitled

What should I know before signing a contract?

I would suggest it as a reading.

 

[Epidural]

I need info about signing in bonus. How much are they paying as signing in bonus for pain specialists? Do they pay initially or after six months? How much they pay bonus in the first year?
Is signing in bonus only for rural practices?
Please share information. Thanks!

I've heard of fellows getting $25,000-$35,000 as a signing bonus. I don't think the signing bonus itself means that much. Employers know how much they want to pay you so if you get a large signing bonus, they'll take away money elsewhere. I think it's more important to be happy with your overall contract and as Dr. Barna mentioned, you should hire a medical contract attorney.