Question for all neurologists/neurohospitalists regarding contracts, models, etc.

[Hockeyfan23]

Hey all,

Currently in my pgy-3 year of residency and currently in the process of locking down a neurohospitalist job post residency. i have actually just received an offer and contract for a position with a small group practice near my hometown. They are mixed outpatient inpatient practice. I would be seeing inpatient consults for hospitals they have contracts with. I did have a few questions for anyone with experience. Any help would be greatly appreciated.

1. This is a base salary + production model. The base salary is very generous and the production model is as follows and is based on keeping a percentage of
“physician net receipts”: 0-750k=no bonus, 750k-1mil=50%, 1 mil-1.25mil=60% and so on....my question is really regarding what a reachable and attainable “physician net receipts” would be based on billing. This is a M-F gig with occasional weekend coverage (1/4). Any suggestions are welcomed as I am clueless on billing.

2. The contract is a 3 year deal. There is a 2 year and 20 mile non compete agreement. I feel this may be overly aggressive but was not sure what the standard is in the industry as this is my first “real“ job post residency.

I’m sure I will have more questions but this is a good start. Thank you everyone!

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[dramw]

I’m currently a pgy2. May I ask how good is the base salary and what is the patient census? Is it in the 300’s? And do you only see inpatient patients, strokes? And what does weekend coverage consist of?

 

[deathmerchant]

Hey all,

Currently in my pgy-3 year of residency and currently in the process of locking down a neurohospitalist job post residency. i have actually just received an offer and contract for a position with a small group practice near my hometown. They are mixed outpatient inpatient practice. I would be seeing inpatient consults for hospitals they have contracts with. I did have a few questions for anyone with experience. Any help would be greatly appreciated.

1. This is a base salary + production model. The base salary is very generous and the production model is as follows and is based on keeping a percentage of
“physician net receipts”: 0-750k=no bonus, 750k-1mil=50%, 1 mil-1.25mil=60% and so on....my question is really regarding what a reachable and attainable “physician net receipts” would be based on billing. This is a M-F gig with occasional weekend coverage (1/4). Any suggestions are welcomed as I am clueless on billing.

2. The contract is a 3 year deal. There is a 2 year and 20 mile non compete agreement. I feel this may be overly aggressive but was not sure what the standard is in the industry as this is my first “real“ job post residency.

I’m sure I will have more questions but this is a good start. Thank you everyone!

Im not sure what "physician net receipts" are or how they are calculated, most physicians are paid using RVU model. If you know your RVU targets, we can look at it.

 

[Telamir]

In my experience you want to be careful with jobs offering an unusual amount of money. Make sure you know what your guaranteed base is. Does it change from year to year depending on production? Regarding RVU targets...ask how many RVUs someone doing your job typically makes. If it's below the "targets" then they're pretty much just setting you up to fail and hoping you're blinded by the $$$.

 

[Hockeyfan23]

So I will be getting guaranteed base $350k first year then $400k year two.

so per contract, net receipts is defined by gross receipts - related billing fees.

gross receipts is defined as medical services rendered by physician on an inpatient and outpatient basis (less refunds) including but not limited to patient fee receipts, pharmaceutical receipts, infusion fee receipts, and lab receipts (each net of direct expenses, including but not limited to payroll expense, taxes, employee benefits, and costs of lab tests/supplies) and any other medical services receipts generated by physician.

Related Billing fees is defined as any expense incurred by the group to generate process and receive physicians gross receipts.

 

[Postictal Raiden]

So you get to keep ~50% of total collections up to 1M.

if we assume each encounter nets you an average 4 total RVU's (could be less if you aren't doing EEGs/EMGs/Injections), and if we say the rate of RVU reimbursement is $40, you'd need 6250 collectable encounters to get to 1M of net collections. If you work 47 weeks/year, 5 days a week, that comes out to be 27 patients a day. Not sure how doable it is. I certainly know people seeing a lot more than that number of patients a day, but the vast majority of neurologists see less than 25 a day.

Doing the above calculation for your "guaranteed" 350k shows that you'd need to see 20 pts a day to pull your weight. That's a much more reasonable number of patients to see a day imo, specially for someone fresh out of training.

BTW, I was once told by a PP neurologist that if I'm offered to keep *only* 50% of collections I should turn my back on the offer. No way the practice costs measure up to 350k-400k per neurologist seeing 20 pts a day unless the practice very inefficiently run.

 

[Hockeyfan23]

So you get to keep ~50% of total collections up to 1M.

if we assume each encounter nets you an average 4 total RVU's (could be less if you aren't doing EEGs/EMGs/Injections), and if we say the rate of RVU reimbursement is $40, you'd need 6250 collectable encounters to get to 1M of net collections. If you work 47 weeks/year, 5 days a week, that comes out to be 27 patients a day. Not sure how doable it is. I certainly know people seeing a lot more than that number of patients a day, but the vast majority of neurologists see less than 25 a day.

Doing the above calculation for your "guaranteed" 350k shows that you'd need to see 20 pts a day to pull your weight. That's a much more reasonable number of patients to see a day imo, specially for someone fresh out of training.

BTW, I was once told by a PP neurologist that if I'm offered to keep *only* 50% of collections I should turn my back on the offer. No way the practice costs measure up to 350k-400k per neurologist seeing 20 pts a day unless the practice very inefficiently run.

Well the base salary is guaranteed regardless. The 50% is based on billing. Now what the collection of RVU is. Not sure if that is what you’re talking about.

 

[Postictal Raiden]

Well the base salary is guaranteed regardless. The 50% is based on billing. Now what the collection of RVU is. Not sure if that is what you’re talking about.

It seems that even during the guaranteed salary period, your take home income wouldn’t exceed 50% of what you bring in until you cross the 1M threshold. Do they provide you with good benefits? Pay for your malpractice? Vacation and CME time/money?

If they are keeping 50 cents of each dollar you bring in, they are either providing awesome benefits and work environment or they are pocketing a big chunk of your hard earned money.

 

[deathmerchant]

So I will be getting guaranteed base $350k first year then $400k year two.

so per contract, net receipts is defined by gross receipts - related billing fees.

gross receipts is defined as medical services rendered by physician on an inpatient and outpatient basis (less refunds) including but not limited to patient fee receipts, pharmaceutical receipts, infusion fee receipts, and lab receipts (each net of direct expenses, including but not limited to payroll expense, taxes, employee benefits, and costs of lab tests/supplies) and any other medical services receipts generated by physician.

Related Billing fees is defined as any expense incurred by the group to generate process and receive physicians gross receipts.

I still didn’t get it completely but if there is a 350 base pay no matter what And you get production bonus on top of that which includes all the receipts as above, then it might be a very good deal! Because it seems like you are getting paid for labs/tests ordered in addition to patient encounters which doesn’t happen in RVU model! Another advantage might be hospitals charge way more than RVU rate or Medicare rates. Our hospital here charges like $450 for a level 5 new patient and rvu rate is only $55.

Now you should definitely check if they pay you based on YOUR billing or only when the bills come through, because normally insurance companies pay very little of actual receipts!!

I feel if you are scheduling 20 patients a day, 4 days a week, 46 weeks an year- 325-350K plus benefits would be a good deal. Anything over that should be more.

 

[Hockeyfan23]

The productivity is based on billing and not collections as stated above. I was told average billing is around 1-1.2 million for average neurologist but not sure how accurate this is. My contract includes labs and pharmaceuticals. I’m not sure about ct/mri which is something I need to clarify. Benefits are good too. 25 business days vacation, 25k signing, health/life/disability insurance, malpractice, 401k contribution...etc

 

[Postictal Raiden]

The productivity is based on billing and not collections as stated above. I was told average billing is around 1-1.2 million for average neurologist but not sure how accurate this is. My contract includes labs and pharmaceuticals. I’m not sure about ct/mri which is something I need to clarify. Benefits are good too. 25 business days vacation, 25k signing, health/life/disability insurance, malpractice, 401k contribution...etc

Man this is amazing. If they’re looking for another fresh blood in 2022, let me know

 

[dave2626]

Hey all,

Currently in my pgy-3 year of residency and currently in the process of locking down a neurohospitalist job post residency. i have actually just received an offer and contract for a position with a small group practice near my hometown. They are mixed outpatient inpatient practice. I would be seeing inpatient consults for hospitals they have contracts with. I did have a few questions for anyone with experience. Any help would be greatly appreciated.

1. This is a base salary + production model. The base salary is very generous and the production model is as follows and is based on keeping a percentage of
“physician net receipts”: 0-750k=no bonus, 750k-1mil=50%, 1 mil-1.25mil=60% and so on....my question is really regarding what a reachable and attainable “physician net receipts” would be based on billing. This is a M-F gig with occasional weekend coverage (1/4). Any suggestions are welcomed as I am clueless on billing.

2. The contract is a 3 year deal. There is a 2 year and 20 mile non compete agreement. I feel this may be overly aggressive but was not sure what the standard is in the industry as this is my first “real“ job post residency.

I’m sure I will have more questions but this is a good start. Thank you everyone!

I would anticipate to make slightly more than you base - collections over 1 mil would be impossible as a hospitalist. Even when I owned my own EMG and EEG machine and collected global fees from procedures outpatient collecting > 1.25 was tough.

 

[Hockeyfan23]

Yea I’m not too greedy haha. I have not started the job yet but I have a really solid base salary so even without production I would be okay with my setup. At the end of the day not sure how long I will be able to sustain the schedule. Coming straight from residency I feel it will be pretty easy but may eventually end up going to the 7 on/7 off life. Time will tell...

 

[Captain_Falcon]

@Hockeyfan23 any updates on how this job has worked out?