Salary and FP

[MexicanDr]

What is the starting Salary for someone starting up in FP? I know this depends on demographics, but on an average what it is? What about for the Central Valley, Fresno California area?

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[deleted87716]

$120,000-$150,000 depending on location and type of practice.

 

[MedicineDoc]

You won't catch mw working for that low a salary. Most the residents I know are starting closer to 200 if not 200.

 

[thethom]

"One million dollars." (pinkie in mouth)

 

[deleted87716]

Most the residents I know are starting closer to 200 if not 200.

Just answering the question. I know people who started well above the average, too. That doesn't change the average.

Any unusually high starting salary should raise another question...why?

 

[MedicineDoc]

One of our residents was making over a hundred thousand a year as a resident with just er and care center shifts. A former resident just left with a deal for two hundred thousand at a seattle urgent care center. Another is working as a hospitalist at our hospital for close to two hundred if not over. I haven't heard of anyone going that low.

 

[deleted87716]

A former resident just left with a deal for two hundred thousand at a seattle urgent care center. Another is working as a hospitalist at our hospital for close to two hundred if not over. I haven't heard of anyone going that low.

Well, you'd have to pay me at least that much to do any of those jobs, too.

Hospitalist will generally pay more than outpatient (hours, malpractice risk, etc.) Urgent care is a mixed bag, but usually pays better because of the hours and volume.

Also, remember we're talking about starting salary. There's usually a considerable upside for non-salaried (production-based or partnership) positions.

Furthermore, beware of independent contractor jobs that require you to pay your own malpractice, health insurance, retirement, and/or other benefits out of your own pocket. Some of these salaries look great at first, but the take-home reality is far different.

 

[deleted6669]

I work in several systems that utilize family medicine md's in urgent care or em settings.
the low end of the salary scale at these places is 140k/yr + production bonus.
several places pay around 170k.
the high end is > 275k/yr(for fp docs essentially working as em docs).

 

[deleted87716]

the high end is > 275k/yr(for fp docs essentially working as em docs).

I know people making more than that working four days/week in the outpatient setting.

Of course, that doesn't have anything to do with the average starting salary that the OP asked about, either.

 

[RGMSU]

Well, you'd have to pay me at least that much to do any of those jobs, too.

Hospitalist will generally pay more than outpatient (hours, malpractice risk, etc.) Urgent care is a mixed bag, but usually pays better because of the hours and volume.

What's wrong with urgent care Blue? I thought most FP's found those to be pretty desirable positions?

 

[deleted87716]

Urgent care blows. Anyone who thinks otherwise either doesn't know any better, or has already done something worse.

 

[RGMSU]

Urgent care blows. Anyone who thinks otherwise either doesn't know any better, or has already done something worse.

So it seems from your posts that I've read that your favored practice arrangement is outpatient only non-urgent?

 

[deleted87716]

So it seems from your posts that I've read that your favored practice arrangement is outpatient only non-urgent?

 

[dangit]

in other words, urgent care is boring?

 

[RGMSU]

in other words, urgent care is boring?

That's my read of it, bud. What I want to know is who the hell made that graphic? I knew an FP who left urgent care to do occupational med. I wondered why because he seemed to be making a ton of bread in his urgent care setting.

I like old Blue's approach - always right to the point.

 

[lowbudget]

Urgent care blows. Anyone who thinks otherwise either doesn't know any better, or has already done something worse.

Urgent care is fun once in a while. But it gets old quickly. And then, you're only doing it for the money. And then, you hate it and resent it and all of your patients. And then, you stop taking shifts. And then you miss it. And then it's fun again.

 

[lowbudget]

Hospitalist will generally pay more than outpatient (hours, malpractice risk, etc.) Urgent care is a mixed bag, but usually pays better because of the hours and volume.

Yea... you better ask questions. FP colleague of mine took a hospitalist job for 200-250+ out of residency. Her butt rounds at 5 hospitals... 2 or 3 hospitals per day depending on where her partner is (who has the other 3 or 2 hospitals).

Another FP colleague turned down a hospitalist job for 200-250+ because they had this "long call short call" system covering 4 hospitals, with 2 hand-offs per day, and there's a 3 hour window where 1 hospitalist is cross-covering the entire groups' patients (which would be in the hundreds), and doing admits. Jacked up system.

Just remember, in the real world, you need to make your keep. No one is going to pay you 200k if you don't bring in that much in collections. There ain't no 80 hour rule, no post-call days, no protected noon conferences, no let me check it out with the attending, no sorry we're over the cap.

 

[RGMSU]

I found my own graphic.

http://www.leftnewsandviews.com/wp-content/uploads/2009/07/blue-dog-dems.jpg

 

[andwhat]

occ med may sound "boring" but its a sweet gig any day in my opinion. no long nights, super sick patients, er call. Hospitalist pays well, above average plus two weeks or more off per month, but it is mentally and physically tough. Urgent care is ok. It pays well, perhaps because you are billing new patient visits every time, which can generate more revenue than routine office visits sometimes. Pure Urgent Care, yeah agreed its not the best gig. Ultimate gig is no weekends no nights no call, no holidays, outpatient only, 8 to 4p.m. with an hour and a half lunch break, a touch over $200 K with benefits, 401 K, etc. Possible? Better believe it.

 

[MexicanDr]

I will not go into medicine (MD/DO) for the money, but its kind of crazy that FP MDs do not make much more than a PA in FP. I mean, ~90K for a PA compared to ~120-130K for an MD/DO is not a big difference compared to the years of school and residency the Doctor has to do.

 

[deleted6669]

I will not go into medicine (MD/DO) for the money, but its kind of crazy that FP MDs do not make much more than a PA in FP. I mean, ~90K for a PA compared to ~120-130K for an MD/DO is not a big difference compared to the years of school and residency the Doctor has to do.

120-130K is on the low side for an fp md.
150k or so is the avg. most of the jobs that pay less also have some kind of loan repayment of 25k/yr or so.
most pa's make around 50% of what the docs they work with make. in an hmo setting pa's may make 2/3 or so what the docs make or under some circumstances(union contracts) a senior pa may make more due to seniority step scales than a new md who is not a partner yet.
I work a per diem job a few days/mo (and have for > 10 yrs) in such a setting. I'm at the top of the pay scale there so make $5/hr more than a non-partner physician. as soon as they have been there for 2 yrs though they become partners and make $10/hr more than I do.

 

[RGMSU]

From a student's perspective, there will be a real problem attracting people to medical school, irrespective of intended field of specialization, if it is perceived that the pay gap between mid-levels and physicians is closing significantly. This would seem to be common sense. I can't tell you how many times I have heard bright students say, "Why would I want to go to medical school when I can go to pharmacy school? It's shorter, the hours are better, and the pay is almost as good." How long will it be before people are saying the same thing about PA school versus medical school? Especially if it is perceived that you can be an orthopedic PA and make more than a family med MD. Not a very bright thing to allow to happen to our medical workforce. I don't know when we'll wake up and realize that good primary care physicians are a cornerstone to a decent healthcare system (like every other civilized medical system in the world has done) and start incentivizing the field rather than coming up with endless alternatives to cheapen it. It may have been a while since some of you sat in a medical school class, or maybe you never did or haven't yet, but I can tell you that the seats are full of people there for the money. And, the best and brightest ones are the ones who compete viciously and mercilessly to get into the highest paid specialties. As someone considering family med, it's a bit disturbing that many students almost break into a giggle when you mention family medicine. Shoving an NP or PA in every urgent care clinic in America and driving the prices down isn't exactly helping that stereotype either.

 

[digitlnoize]

How long will it be before people are saying the same thing about PA school versus medical school?

It's already happening. Before med school, I was an ER scribe. Many of the scribes I worked with, most of whom I'd consider far smarter than me, went to PA school for exactly those reasons.

 

[RGMSU]

It's already happening. Before med school, I was an ER scribe. Many of the scribes I worked with, most of whom I'd consider far smarter than me, went to PA school for exactly those reasons.

Welcome to America, where laziness is second only to greed. I've said before that the MD is becoming like the academic PhD - prestigious and useless. Basically, we've chosen a profession that is at the same time one of the best yet one of the most frustrating. C'est la vie, I guess. I wouldn't be at all surprised if NPs, PAs, and MDs soon have the same pay rates, unless the MD is performing a "supervisory" role. Someday, we may have NPs and PAs supervising MDs. Seems like MDs have totally and utterly lost control of their own profession to me.

 

[digitlnoize]

Welcome to America, where laziness is second only to greed. I've said before that the MD is becoming like the academic PhD - prestigious and useless. Basically, we've chosen a profession that is at the same time one of the best yet one of the most frustrating. C'est la vie, I guess. I wouldn't be at all surprised if NPs, PAs, and MDs soon have the same pay rates, unless the MD is performing a "supervisory" role. Someday, we may have NPs and PAs supervising MDs. Seems like MDs have totally and utterly lost control of their own profession to me.

It's not quite there yet...MD's still have a decent amount of lobbying power...for now. With the malpractice situation like it is, all it will take is a couple serious mistakes by an unsupervised mid-level to bring that house of cards crashing down.

And it'll be a cold day in hell before I let a mid-level perform a serious procedure on me. A couple sutures, sure...but there's no way I'm letting one do my appy or my kids.

Also, there are plenty of diseases that are far out of the mid-levels understanding. Are there enough for all the docs? Not so sure.

Fortunately, we're predicted to have a 100,000+ pcp shortage by 2020. I think docs are mostly hoping that there will be enough to go around...

Also, the numbers tell a different story :

Median PA salary: $80,356
Median FP salary: $156,010

Sources: http://www.bls.gov/oco/ocos081.htm#earnings
http://www.bls.gov/oco/ocos074.htm

That's pretty much double. I think that certainly justifies the extra years of training.

Consider this: PA school is 2-3 years. Med school is 4 years. Okay, so I have 2 extra years in school. But, a new PA grad makes $69,517. A resident makes ~$50k give or take. So, for 2 years, they're making money and I'm paying for school. Then, for 3 years, they're making ~20k more than me. Then, I get a big fat raise and start making double their salary. It's not so bad. Except for the loans, but that's another story.

If course, this is just the finances. The real story is much more complicated. You want to know why I didn't go to PA school? It's because I wanted to have at least some modicum of control over my patients' care. PA's are ultimately assistants of their doc, and I wanted to be the one in charge. Guess that makes me a control freak or something, huh?

 

[RGMSU]

True. My vote is that it's just time to stop the slippery slope though before the line between mid-level and physician gets blurred beyond recognition.

 

[deleted6669]

your source is old.
here are the current #s:

In its 2008 census report, the American Academy of Physician Assistants reported mean total income (MTI) from primary employer for clinically practicing PAs working at least 32 hours per week. ADVANCE compiled this chart using data from AAPA's individual specialty reports.

Specialty MTI
Cardiovascular/Cardiothoracic surgery $110,468
Dermatology $104,474
Emergency medicine $99,635
Neurosurgery $98,024
Critical care medicine $96,984
Radiology $95,214
Orthopedics $94,916
Anesthesiology $93,370
Plastic surgery $92,633
Occupational medicine $92,323
Trauma surgery $91,417
Urology $90,462
General surgery $90,094
Pain management $89,059
Cardiology $87,812
Hospital medicine $87,550
Otorhinolaryngology $86,856
Geriatrics $85,973
Psychiatry $85,361
General internal medicine $85,076
Addiction medicine $84,627
Oncology $84,336
Gastroenterology $84,268
Family medicine $84,173
Pediatrics $83,021
Neurology $81,762
Allergy/Immunology $81,557
Public health $81,387
Rheumatology $81,224
Nephrology $80,842
Obstetrics/Gynecology $79,229
Endocrinology $78,956

 

[RGMSU]

A lot of those are actually quite a bit lower than I would have thought. It would be interesting to see what happened in terms of physician salaries in those fields over the same time period comparing to PA salaries.

 

[deleted6669]

If course, this is just the finances. The real story is much more complicated. You want to know why I didn't go to PA school? It's because I wanted to have at least some modicum of control over my patients' care. PA's are ultimately assistants of their doc, and I wanted to be the one in charge. Guess that makes me a control freak or something, huh?

I understand why that might be your perception and initially that would be true.
new grads( like md interns) require supervision and teaching.
a pa who has been out of school for a few yrs and working in 1 specialty consistently has far more control over their practice environment(if they want it). for example I staff an 11 bed 28k/yr emergency dept by myself on night shifts without any other provider on site. we staff pa's 24/7 and have a double coverage md on day shift only.
sure, someone can second guess me the next day but the initial decisions, treatments, dispositions, admissions, transfers, etc were all my decision. I see every pt who comes in the door regardless of acuity so I run the codes, do the procedures, see the MI's/cva's/traumas, etc as well as see the minor stuff. I'm kind of a "control freak" myself which is why I have worked my way into this type of position. anything else just wasn't interesting or challenging enough. it's taken me a while to get here as you might have guessed. january 2010 marks my 23rd yr working in emergency medicine starting at the very bottom and working my way up.

 

[deleted6669]

A lot of those are actually quite a bit lower than I would have thought. It would be interesting to see what happened in terms of physician salaries in those fields over the same time period comparing to PA salaries.

keep in mind those take into account folks only working 32 hrs/week as well as those working 40+. they also average in new grads( a very lg % of the total with the recent increase in the # of pa programs) with folks with lots of experience. when I went to pa school there were 50 programs. there are now 150 so the % of folks with less than 5 yrs of experience is large..
the em and surgery #s listed here are very low. I don't know any em or surgical pa's making less than 125k for full time work if they have a few yrs of experience. this also varies quite a bit with location as you might imagine. I work in a metro area. if I did my exact job in a rural location I would make less because for what I make now they could afford to staff a doc instead.

 

[RGMSU]

I had thought earlier that, in my experience, supervision of mid-levels is a joke. If you're going to really supervise thoroughly, you'd might as well be doing it yourself, from the physician's perspective. If you're just going to review a few charts, you will only perceive something if there is an egregious, chronic problem, in which case the person shouldn't be working there anyway. I suspect future divisions in the workforce will fall more along the lines of class, socioeconomics, underserved/affluent, and so forth. That's the real direction American medicine is heading, and everybody knows it - one type of medical system for the wealthy and connected, another type for everybody else. There are some people who will walk in and see whatever provider is there. There are others who will insist on seeing a provider with a certain type of credentials. It's really just that simple.

 

[deleted6669]

There are some people who will walk in and see whatever provider is there. There are others who will insist on seeing a provider with a certain type of credentials. It's really just that simple.

there is some truth to this but it works both ways. there are pts in my dept who would rather see me than some of the docs I work with and have made this choice vocally and with their feet, refusing to be seen until I show up on night shift and the doc goes home.
most people want competence and really could care less about initials.
there are providers of all types (md/do, pa/np) who I like to have caring for my family and members of each group that I wouldn't let near them to apply a bandaid.

 

[RGMSU]

there is some truth to this but it works both ways. there are pts in my dept who would rather see me than some of the docs I work with and have made this choice vocally and with their feet, refusing to be seen until I show up on night shift and the doc goes home.
most people want competence and really could care less about initials.

True. I am a firm believer that people should choose their own provider. And, also true that credentials alone don't indicate competence. Again, though, there are some patients who still value the MD, and those are the ones I plan on treating. A lot of things vary from state to state too. In Texas a PA must have the support of a physician to be attached to their license, so it's the physician's decision whether or not to have the PA around in the first place. I suspect there will be enough work for everybody. I plan on being pretty selective about my future practice arrangement anyway. I'm not just going to set up shop and see everybody unless I feel like it, especially after I've built up some seniority. I think it would be nice to have coworkers to help lighten the load who you felt like you didn't even have to supervise, and I've certainly met some PAs who fall into that category. It didn't take me very long in medical school to figure out I wasn't the smartest person in the room, so I kinda lose a little more of the ego thing every day. I USED to think being an MD would make me special. Now, I just want to make a living. Let everybody else do whatever the hell they want to I guess.

 

[deleted6669]

In Texas a PA must have the support of a physician to be attached to their license, so it's the physician's decision whether or not to have the PA around in the first place.

this is true in all 50 states and everywhere else pa's practice actually. pa's have their own licenses and dea#s but are by definition "dependent providers requiring supervision" but that supervision can vary considerably based on state law. for example in NC supervision= 2 thirty min discussions/yr about pa practice patterns without any requirement for chart review or md presence on site so a pa can own and run their own clinic and have their md of record come by for coffee twice/yr.. other states require 100% chart review and md physically present at all times when the pa works.
senior pa's are typically afforded more latitude with how stringent supervisory requirements are. for example some states say 100% chart review for first yr then 50% next yr then 10% thereafter, etc
at my current job "supervsion" per the state is md available by phone for consult as needed and presence on site 4 hrs/week. the hospital requires 100% cosignature of charts within 1 week but this is not a state requirement.

 

[RGMSU]

I'm sure most MDs feel like the less supervision needed, the better. That's the way I would feel. I wouldn't feel so great with the 100% cosignature bit. I would have to really get compensated well to go for that one. I'm sure a lot of it has to do with trust. When you build that up with an MD "supervisor," I'm sure it changes things for both parties.

 

[deleted6669]

I'm sure most MDs feel like the less supervision needed, the better. That's the way I would feel. I wouldn't feel so great with the 100% cosignature bit. I would have to really get compensated well to go for that one.

and most pa's don't like that kind of arrangement either so tend not to work in states that require that unless they absolutely have to. I think within the next decade or so we will end up with a set of universal supervisory requirements as part of the "streamlining of healthcare" so when you move from state A to state B you don"t feel like you are going to mars.
the places that have that kind of arrangement the docs tend to review each note with a fine tooth comb until they are comfortable then after that only read certain charts with high risk complaints(abd pain, worst h/a ever, etc) and just rubber stamp the rest.
docs are well paid for supervision in most places. at one of my jobs the doc gets 40 dollars/chart of mine he reviews...and we have worked together for 10 yrs so a chart review takes less than 1 minute.....

 

[RGMSU]

Universal standards would probably be wise. At the moment, I would say that I feel more comfortable with the PA movement than the NP movement. The outright belligerence of the leaders of the NP movement toward physicians doesn't really bode well for them, I think. But, I honestly haven't had as much contact with NPs as PAs.

 

[RGMSU]

the places that have that kind of arrangement the docs tend to review each note with a fine tooth comb until they are comfortable then after that only read certain charts with high risk complaints(abd pain, worst h/a ever, etc) and just rubber stamp the rest.

I can see where that would make sense.

docs are well paid for supervision in most places. at one of my jobs the doc gets 40 dollars/chart of mine he reviews...and we have worked together for 10 yrs so a chart review takes less than 1 minute.....

Hah, I bet he likes the hell out of you bud. That sounds like the kind of arrangement I'd like to have.

 

[deleted6669]

Universal standards would probably be wise. At the moment, I would say that I feel more comfortable with the PA movement than the NP movement. The outright belligerence of the leaders of the NP movement toward physicians doesn't really bode well for them, I think. But, I honestly haven't had as much contact with NPs as PAs.

there are good and bad np's just like pa's and docs. I work with one NP who is brilliant. the guy runs the county infectious dz clinic and knows everything there is to know about HIV, TB, HEP B/C, std's, etc including all the most recent meds, studies, etc
he is a great resource when he moonlights in our dept.
he has been an NP for > 20 yrs and has no desire to get his DNP.

 

[RGMSU]

One of the best lectures I have had in medical school was given by a nurse over H1N1. I believe she does epidemiology for Scott and White in Temple, TX. I don't believe she was an NP, but I'm not sure.

 

[digitlnoize]

I understand why that might be your perception and initially that would be true.
new grads( like md interns) require supervision and teaching.
a pa who has been out of school for a few yrs and working in 1 specialty consistently has far more control over their practice environment(if they want it). for example I staff an 11 bed 28k/yr emergency dept by myself on night shifts without any other provider on site. we staff pa's 24/7 and have a double coverage md on day shift only.
sure, someone can second guess me the next day but the initial decisions, treatments, dispositions, admissions, transfers, etc were all my decision. I see every pt who comes in the door regardless of acuity so I run the codes, do the procedures, see the MI's/cva's/traumas, etc as well as see the minor stuff. I'm kind of a "control freak" myself which is why I have worked my way into this type of position. anything else just wasn't interesting or challenging enough. it's taken me a while to get here as you might have guessed. january 2010 marks my 23rd yr working in emergency medicine starting at the very bottom and working my way up.

Yeah...I know it's possible...but being 30 years old, I didn't want to wait 23 years for it. Also, I don't want to be confined to nights only...

I'm not trying to get down on you or anything...I know alot of very good PA's who could handle pretty much anything, and if I ever have an FP office, I plan on hiring a couple, but it just wasn't for me.

 

[deleted6669]

Yeah...I know it's possible...but being 30 years old, I didn't want to wait 23 years for it. Also, I don't want to be confined to nights only...

I'm not trying to get down on you or anything...I know alot of very good PA's who could handle pretty much anything, and if I ever have an FP office, I plan on hiring a couple, but it just wasn't for me.

fair enough.
there are day jobs for solo em pa's but they are all rural gigs. that's probably what I will do after I'm done with this.

 

[TheFamilyDoc]

$140,000-$175,000. $120,000 on the low end.

 

[Narcan1]

Have not received any offers below $175 yet.

 

[JaggerPlate]

Have not received any offers below $175 yet.

What region of the country?

 

[MLT2MT2DO]

Have not received any offers below $175 yet.

To add onto Jagger's question: Hours a week you've been looking at?

 

[deltamed]

Have not received any offers below $175 yet.

So why are family med people complaining so much about compensation?
Most ROAD specialties start only a bit higher than that with more years of training (maybe except radiology which admittedly is overcompensated now). Most complaints seem to exaggerate the difference in compensation between primry care and specialists it seems.

 

[deleted87716]

So why are family med people complaining so much about compensation?

Again...those figures are higher than average.

 

[jdig]

I have the 2008 mgma physician salary survey in front of me:
Family Medicine, (w/o OB) Mean = $187,953

This is for ALL providers, regardless of length of time in practice.
The 25 percentile is $140,000

I can speak from experience, all the offers residents in my program are getting this year are from 160k to 200k, depending on location anc dall, and inpatient vs OP.
Its not GREAT money, but very solid, and with a pretty stress free schedule.

 

[JaggerPlate]

I have the 2008 mgma physician salary survey in front of me:
Family Medicine, (w/o OB) Mean = $187,953

This is for ALL providers, regardless of length of time in practice.
The 25 percentile is $140,000

I can speak from experience, all the offers residents in my program are getting this year are from 160k to 200k, depending on location anc dall, and inpatient vs OP.
Its not GREAT money, but very solid, and with a pretty stress free schedule.

$188?? That's not too shabby.