Navigating job offer/sign on bonus

[STEMI_voy]

Long time lurker.

Received a job offer that I’m planning to take. Very solid compensation with hospital employed group. Sign on bonus is 45K but for 3 years (!) Payback before 3 years is prorated. The length makes me cautious.

Would you just sign contract and not spend the money until some amount of time like 6 months - year when you feel more comfortable that you’ll stay? Try to negotiate a lower term, say 2 years? Not take the bonus and try to negotiate a higher base compensation?

The rest of the contract is great.

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[EctopicFetus]

Long time lurker.

Received a job offer that I’m planning to take. Very solid compensation with hospital employed group. Sign on bonus is 45K but for 3 years (!) Payback before 3 years is prorated. The length makes me cautious.

Would you just sign contract and not spend the money until some amount of time like 6 months - year when you feel more comfortable that you’ll stay? Try to negotiate a lower term, say 2 years? Not take the bonus and try to negotiate a higher base compensation?

The rest of the contract is great.

So let me offer you some perspective. Your contract is likely for 1500 or so hours a year. This bonus is $10/hr. Meh. If it is prorated there is no reason not to take it and use it. If. You want to store the money somewhere safe go for it. Your taxes will never be lower than in 2022 and 2023. So better to take it and save on those taxes.

 

[Brigade4Radiant]

Long time lurker.

Received a job offer that I’m planning to take. Very solid compensation with hospital employed group. Sign on bonus is 45K but for 3 years (!) Payback before 3 years is prorated. The length makes me cautious.

Would you just sign contract and not spend the money until some amount of time like 6 months - year when you feel more comfortable that you’ll stay? Try to negotiate a lower term, say 2 years? Not take the bonus and try to negotiate a higher base compensation?

The rest of the contract is great.

How do you like the city? Do you think you'll move in a few years. I would take a lower term so 15k for one year. Do you have the ability to work extra shifts? To put it into perspective 7 shifts equal this bonus if you get paid around 200 an hour (which is pretty low lol). So working one more shift or two more shifts a month will have a bigger impact on your salary.

 

[valianteffort]

As above posters said, this offer is minimal when spread out over your shifts and hourly. There is no reason not to accept a prorated shift bonus. I ended up breaking a similar contract, had a 60k for 3 years. I left after year 2. I had to pay 20k back when after taxes I only recieved like 13k initially so it was a pain to go back and fix this tax wise. But either way, you should come out on top in the end. USACS is offering 150k sign on bonus, not sure the terms but I'm sure they are lowballing the hourly.

 

[Brigade4Radiant]

if this is an offer they only give to new grads think very carefully about it. Only do a year bonus also what happens if that group loses the contract?

 

[cyanide12345678]

Just take the bonus. Try to negotiate it up though maybe 75k for 3 years would be a good starting point. Don’t take the first or the second offer. Also negotiate the hourly at the same time.

If it’s prorated, it really doesn’t matter if you left early. Tax returns can be fixed up to 3 years. If you had to pay back a portion of your income, you’ll just have to have your tax person send in an amendment to a previous year and get s refund. No biggie.

Don’t worry about paying back if needed. I mean people don’t leave jobs immediately, you would give a 3 month notice or something. You can save that 45k with 3-4 months of paycheck.

 

[LChristmas]

As above posters said, this offer is minimal when spread out over your shifts and hourly. There is no reason not to accept a prorated shift bonus. I ended up breaking a similar contract, had a 60k for 3 years. I left after year 2. I had to pay 20k back when after taxes I only recieved like 13k initially so it was a pain to go back and fix this tax wise. But either way, you should come out on top in the end. USACS is offering 150k sign on bonus, not sure the terms but I'm sure they are lowballing the hourly.

USACS is offering $150k for a 7-year commitment. You have to stay at your initial site for 3 years and then you can transfer to another USACS site.

They have a similar offer for student loan "forgiveness" that requires 7 years too. They sell it as "saving" 3 years compared to PSLF.

Per their website.

 

[Old_Mil]

Long time lurker.

Received a job offer that I’m planning to take. Very solid compensation with hospital employed group. Sign on bonus is 45K but for 3 years (!) Payback before 3 years is prorated. The length makes me cautious.

Would you just sign contract and not spend the money until some amount of time like 6 months - year when you feel more comfortable that you’ll stay? Try to negotiate a lower term, say 2 years? Not take the bonus and try to negotiate a higher base compensation?

The rest of the contract is great.

If there are no other red flags, take the bonus and divide it up in a CD ladder with half @ 6 months and the balance @ 3 years. You're unlikely to make a decision to leave prior to 6 months to 1 year, and subsequent to that you should be in a position to pay the whole thing off from savings even with it locked into a CD.

 

[EM_Disney_Doc]

USACS is offering $150k for a 7-year commitment. You have to stay at your initial site for 3 years and then you can transfer to another USACS site.

They have a similar offer for student loan "forgiveness" that requires 7 years too. They sell it as "saving" 3 years compared to PSLF.

Per their website.

Just clarifying - USACS currently has 80+ sites with a $150K sign-on for a 3 year commitment or a 7 year program for physician loan payback (PLP). Cross-posted from another thread by me:

The PLP program is open to new hires and our current docs at 80+ sites. It has you refi/consolidate to a 15 year loan or you can bring a current loan with you. We have a rate reduction with Laurel Road, but the doc is free to use any bank. They pay for 7 years and we pay them the balance PLUS gross-up the estimated tax burden for that payment. No cap to the amount of student loan debt that can be brought into the program. The commitment is 4 years at the initial site (or transfer to another included site during that time), then if life changes, they can transfer to any one of our 500+ sites nationwide for the final 3 years of the commitment. Leave before 7 years? No handcuffs - we wish you well.


If the PLP program doesn’t fit your needs, we are offering $150K sign-on bonus for the same sites with a 3 year commitment.

And for the past 7+ years, we have offered an interest rate buy-down program for new grad hires who refi with Laurel Road. This is available for ALL of our sites.

For the OP - completely reasonable to ask for more money, a shorter term, or even to have it paid in multiple payments ($15K/yr). They may not say yes, but you don't get what you don't ask for.

 

[emergentmd]

45K is really nothing when you making 300K/yr. If this is a good job, take it. For me the 45k would have almost no bearing on accepting or not.

Now to the USACS benefits above, they must be in some dire straights to be trying to lure docs in. I mean, if its a good job, there are plenty of docs willing to take it. Kind of sad that some docs will actually think its a great deal.

 

[JacobMcCandles]

Now to the USACS benefits above, they must be in some dire straights to be trying to lure docs in. I mean, if its a good job, there are plenty of docs willing to take it. Kind of sad that some docs will actually think its a great deal.

Typical goal of making promises today for benefits tomorrow. I imagine there will be some fine print that will allow them to contractually back out if USACS is still functioning in its current capacity.

 

[thegenius]

USACS is offering $150k for a 7-year commitment. You have to stay at your initial site for 3 years and then you can transfer to another USACS site.

They have a similar offer for student loan "forgiveness" that requires 7 years too. They sell it as "saving" 3 years compared to PSLF.

Per their website.

7 year commitment! Ridiculous. One wouldn’t even commit to a hot girlfriend who like sex for 7 years. Maybe 6 months

 

[cyanide12345678]

Just clarifying - USACS currently has 80+ sites with a $150K sign-on for a 3 year commitment or a 7 year program for physician loan payback (PLP). Cross-posted from another thread by me:

The PLP program is open to new hires and our current docs at 80+ sites. It has you refi/consolidate to a 15 year loan or you can bring a current loan with you. We have a rate reduction with Laurel Road, but the doc is free to use any bank. They pay for 7 years and we pay them the balance PLUS gross-up the estimated tax burden for that payment. No cap to the amount of student loan debt that can be brought into the program. The commitment is 4 years at the initial site (or transfer to another included site during that time), then if life changes, they can transfer to any one of our 500+ sites nationwide for the final 3 years of the commitment. Leave before 7 years? No handcuffs - we wish you well.


If the PLP program doesn’t fit your needs, we are offering $150K sign-on bonus for the same sites with a 3 year commitment.

And for the past 7+ years, we have offered an interest rate buy-down program for new grad hires who refi with Laurel Road. This is available for ALL of our sites.

For the OP - completely reasonable to ask for more money, a shorter term, or even to have it paid in multiple payments ($15K/yr). They may not say yes, but you don't get what you don't ask for.

This sounds a lot like an advertisement.

I’m not sure the sign on bonus justifies the 140-180 per hour salaries.

 

[thegenius]

What I find sad is that these sign-on bonuses of 100K, 150K etc just simply come from other docs hard work. Instead of CMGs taking 10-15% of a docs pay for their services (malpractice ins, practice mgmt, scheduling, scribes, billing/coding, etc.) they take like 25%. Maybe 30%. So docs day in and day out are not making nearly as much as they can. Where does all this money go? Admin takes a big chunk. PE and investors have to get the money back out. Legal stuff. I think when we were under TeamHealth they were taking about 30-35% of our money. I remember that they took, up front, about 10% just for their profit.

So these places like USUCKS take too much money from the docs, and then they have to give schitty sign on bonuses with schitty terms like 150K that ends up being an extra 10/hr. That's your bonus. Whoppee. That money you are getting as a sign on bonus is just coming from your partner you work next to.

I suppose EM_Disney_Doc will come back and say we use economies of scale as one of the ways docs benefit from working at USACS, and then you realize that all the revenue just comes from docs...so don't dock their pay and just pay them accordingly. pay them 87 - 90 cents for every 1.00 they make. The 175-200/hr as an ER doc is crap 90% of the places. Not for the work we do.

So frustrating reading that post above from disney_doc

 

[LabMonster]

The three years is sketchy. I lasted 1 year at my first post-res appointment, but almost 7 at my second. As mentioned, the prorated dollar amount is inconsequential.

 

[ScepticSkeksis]

Just like ETF funds have to publish their expenses per share, CMGs should be forced to disclose to all physicians and applicants their percent overhead they take from each contract.

 

[Rekt]

Also make sure you realize all these fancy numbers you're getting, both for sign on bonuses and loan repayment, is most likely going to be close to half of what they're actually telling you. You still have to pay for your chronic medicaid moms having their 7th kid. So your 45k check turns into 25k and it's a lot less impressive.

 

[RustedFox]

Also make sure you realize all these fancy numbers you're getting, both for sign on bonuses and loan repayment, is most likely going to be close to half of what they're actually telling you. You still have to pay for your chronic medicare moms having their 7th kid. So your 45k check turns into 25k and it's a lot less impressive.

Careful. Godwin's law applies here too. Don't you dare suggest that people be responsible for their decisions.

 

[WildEMDoc]

This sounds a lot like an advertisement.

I’m not sure the sign on bonus justifies the 140-180 per hour salaries.

less than 70/hr in some markets. USACS never worth it.

 

[cyanide12345678]

less than 70/hr in some markets. USACS never worth it.

Whose taking those kind of pays!?!???!?! Are people crazy. There has to be an rvu component, no body is dumb enough to take $70/hr after becoming an ER doctor.

MAYBE if you see an average of 2 patients in 24 hours and don’t care about money. Maybe.

 

[ScepticSkeksis]

less than 70/hr in some markets. USACS never worth it.

Which market? I know West Coast is bad, but I've never seen anywhere less than $150/hr

 

[valianteffort]

Which market? I know West Coast is bad, but I've never seen anywhere less than $150/hr

Denver Hospital Offering Emergency Physicians $21 Per Hour

Emergency physician hospital employment in Denver is competitive. Lutheran Medical Center pushes the envelope by offering doctors $21/hour!

sullivanlegal.us

 

[southerndoc]

Denver Hospital Offering Emergency Physicians $21 Per Hour

Emergency physician hospital employment in Denver is competitive. Lutheran Medical Center pushes the envelope by offering doctors $21/hour!

sullivanlegal.us

I don't care about the minimum (even if there is a $0/hr minimum) as it's very rare to not see enough patients to generate adequate RVUs. I'm concerned that the RVUs don't get the doc above $200/hr. The only way to stop shops from underpaying emergency physicians is simply not take the jobs that pay poorly. People have to eat, pay their loans, etc., so it's almost impossible to leave these jobs unfilled to force CMGs to lower their profits and pay reasonable rates.

 

[cyanide12345678]

Denver Hospital Offering Emergency Physicians $21 Per Hour

Emergency physician hospital employment in Denver is competitive. Lutheran Medical Center pushes the envelope by offering doctors $21/hour!

sullivanlegal.us

There you go. Rvu component. They are probably working like slaves and seeing 2.5-3 pph, and probably generating 8-9 rvus an hour.

So they probably make around 150/hr. Which is what I’ve seen in denver. Plus 24k employer match, and whatever other benefits usacs has, so it’s probably around 180/hr equivalent of a 1099 gig when you account for benefits.

It’s not a great offer and i would never take that because i know my worth, but it’s definitely not $70/hr.

No body is dumb enough to take $70/hr - not today at least.

 

[cyanide12345678]

I don't care about the minimum (even if there is a $0/hr minimum) as it's very rare to not see enough patients to generate adequate RVUs. I'm concerned that the RVUs don't get the doc above $200/hr. The only way to stop shops from underpaying emergency physicians is simply not take the jobs that pay poorly. People have to eat, pay their loans, etc., so it's almost impossible to leave these jobs unfilled to force CMGs to lower their profits and pay reasonable rates.

200/hr shouldn’t be a hard and fast cut off. Really depends on volume. My favorite gig to date was a gig where i moonlighted during residency, 24 hour shifts, ~3000 annual volume, so about 8 patients a day. Almost always 6-7 hours of sleep at night. $130/hr IC was the rate. It was not unusual to see 6-7 urgent care type patients a day and take home $3120 for those patients in 24 hours.

 

[EctopicFetus]

200/hr shouldn’t be a hard and fast cut off. Really depends on volume. My favorite gig to date was a gig where i moonlighted during residency, 24 hour shifts, ~3000 annual volume, so about 8 patients a day. Almost always 6-7 hours of sleep at night. $130/hr IC was the rate. It was not unusual to see 6-7 urgent care type patients a day and take home $3120 for those patients in 24 hours.

I moonlit at a place like this. I did all my chief work and put together my lectures while working. It was amazing. on top of that the cases were almost all super simple. like 1 patient in 2 shifts required any real thinking or problem solving. Was a great way to make money especially when i really needed it.

 

[alpinism]

The lowest I've seen for USACS was about 100/HR at their FSEDs in Texas.

 

[cyanide12345678]

I moonlit at a place like this. I did all my chief work and put together my lectures while working. It was amazing. on top of that the cases were almost all super simple. like 1 patient in 2 shifts required any real thinking or problem solving. Was a great way to make money especially when i really needed it.

I would love to find another job like that even if it means a massive paycut.

The problem with living in a real city is that if the city is big enough (1M+), it’s going to be very hard to find a small enough rural ER nearby at a reasonable commute. The smallest i found near my current home is 8000 volume and quality of life is much better. $200/hr w2 doesn’t feel too bad at my current 8000 annual volume shop. But flu season is reminding me how much i hate high volume days.

 

[cyanide12345678]

The lowest I've seen for USACS was about 100/HR at their FSEDs in Texas.

USACS is excellent with their recruitment. They fly in old grads from residency, their presentation is always impressive, they feed you the coolaid about the 24k employer contribution to your 401k even if you didn’t put in a dime. They really put up an incredible show.

Team health, schumacher, envision recruitment events definitely weren’t as convincing.

 

[EctopicFetus]

USACS is excellent with their recruitment. They fly in old grads from residency, their presentation is always impressive, they feed you the coolaid about the 24k employer contribution to your 401k even if you didn’t put in a dime. They really put up an incredible show.

Team health, schumacher, envision recruitment events definitely weren’t as convincing.

Have to refine the sale so you eat the the harder the sales pitch the harder it is to sell the nonsense. You need to put forth the effort.