Using Another Job Offer as Leverage for Current Job

[EastCoastPain]

Regular poster but want to keep anonymity.

Title says it all. I started my first job out of fellowship 4-5 months ago and knew I was being slightly underpaid but the market at the time forced my hand. Aside from money and a couple other minor things I am happy there. Hospital employed, base is 300k with $60/RVU above 5000 RVUs. It’s been slow building a patient panel and will probably be at least another year, maybe more, before I get to 5000 RVUs.

Office manager at another hospital employed job reached out because I had sent a CV there several months prior and supposedly they hired someone who backed out last minute. Currently there is one pain doc who plans to go part time in a few months and exit sometime in the not distant future. Will plan to investigate further. Offer is 375k base until 6500 RVU then get 40k bonus then $58/RVU after 7000 RVUs. I might try to negotiate more $/RVU.

Is there a way to use the second offer as leverage for the first? Has anyone tried and succeeded or failed at this? It could potentially backfire epically. I’d like to stay at the first one because I’m just getting used to it and generally like the staff and patient population. Second job is outside non-compete and actually closer to home by 10-15 minutes.

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[callmeanesthesia]

Unless my math is off, aside from the lower base your current job is better once you build up your volume.
I guess you could try emailing the admin and say “Hey, I’m getting recruited for another job with a higher base. This job isn’t building up as fast as I was led to believe despite my best efforts. What can you do to increase my base salary?”

 

[EastCoastPain]

Yes once I build up it’ll be fine and equivalent, but in the 1-2 years it’ll take I’m losing out on 75-150k.

 

[Analgesia108]

These are troubling:
1. they hired someone who backed out last minute.
2. Currently there is one pain doc who plans to go part time in a few months and exit sometime in the not distant future'
Once you investigate, your choice will be clear..& the time and effort you already spent are not coming back

Like the above idea to discuss diplomatically with your current admin how they can take your compensation plan closer to the 'market'

 

[drrosenrosen]

If you like where you are, and already know all the pros and cons, I would be hesitant to jump ship. But it's definitely in bounds to speak with admin about adjusting your salary. I'd be sure to emphasize that this other job contacted you, which both indicates that you are in demand, and also that you are not out hunting for a better job.

 

[Ducttape]

you should be > 5000 wRVU after year one if you are building from scratch.

i wouldnt jump ship. you would probably be trying to build up the other program from root level also. doesnt look good to jump after one year and not because of job dissatisfaction.

would agree in letting admin know that someone else offered you a job that is better paying. one option would be to tell senior admin that you are staying, but this is what another place offered, and the pay at this other place is better up... until you get to 6499 wRVU.

the difference is kind of a toss up.

the other job has higher base pay which would be good until you hit 6250 wRVU.

from 6251 until 6499, you slightly better off at your current job.

from 6500 until 6917, you are slightly better at the other job.

above 7000 wRVU, its $2/wRVU change, which is not much difference.

literally, the pay at both places is almost identical. and there is nothing to say that you would build up a practice any faster at the other place, with the exception that you have had 4-5 months in to your current location. so factor that in.


however, you should consider health of the heathcare system and the clientele of each. if one is an urban primary medicaid hospital and the other one is suburban (not rural) with high private insurance, then this could be a factor in to relocating - for job security and financial stability.

 

[Ferrismonk]

however, you should consider health of the heathcare system and the clientele of each. if one is an urban primary medicaid hospital and the other one is suburban (not rural) with high private insurance, then this could be a factor in to relocating - for job security and financial stability.

and sanity.

 

[BobBarker]

Less than 5000 a year? You just see a handful of patients a day and don’t see that improving?

 

[EastCoastPain]

If you like where you are, and already know all the pros and cons, I would be hesitant to jump ship. But it's definitely in bounds to speak with admin about adjusting your salary. I'd be sure to emphasize that this other job contacted you, which both indicates that you are in demand, and also that you are not out hunting for a better job.

Great suggestion, thanks.

Less than 5000 a year? You just see a handful of patients a day and don’t see that improving?

Right now I see about 40 patients per week doing about 3.5 days at their main clinic with an established pain doc and referral network in place. Shortly after I began they decided to send me to a new, unestablished site 1 day per week that is dragging down my productivity a lot. There I see 0-5 patients per week thus far and I’m not sure how it will be much different any time soon.

 

[BobBarker]

When you are seeing 0-5 patients it is your job to explore that community, meet other doctors, and find more patients. You have been working for over 6m. You have to take responsibility to improve it or you will be fired. You are closer to being fired than getting a raise.

 

[EastCoastPain]

When you are seeing 0-5 patients it is your job to explore that community, meet other doctors, and find more patients. You have been working for over 6m. You have to take responsibility to improve it or you will be fired. You are closer to being fired than getting a raise.

Appreciate the input, but that is far from the vibes I’m getting from the administration. They are actively trying to get me more time back at the main site. They see it as a failure on their part and have apologized for what’s transpired so far.

 

[BobBarker]

Why would more time at the main site matter? You aren’t seeing any patients there either.

 

[GoBeers]

When you are seeing 0-5 patients it is your job to explore that community, meet other doctors, and find more patients. You have been working for over 6m. You have to take responsibility to improve it or you will be fired. You are closer to being fired than getting a raise.

Being transferred to an offsite location with no heads up, likely no planning, no marketing ahead of time means his productivity will be in the hole for the next 3 to 6 months. It takes time to set up meetings, lunches, figure out which insurance networks these referral sources are in, getting your name high on the preference list, getting contracts in the first place.

I agree he should be doing boots on the ground marketing now but the reality is this site wont be fully operational for awhile.

 

[BobBarker]

He has plenty of time to do these things. He has about 32 hours of downtime per week.

 

[BobBarker]

You can not ask for a raise period. They have lost a huge amount of money on you so far. They will lose at least $500k this first year.

 

[EastCoastPain]

When you are seeing 0-5 patients it is your job to explore that community, meet other doctors, and find more patients. You have been working for over 6m. You have to take responsibility to improve it or you will be fired. You are closer to being fired than getting a raise.

Slow your roll just a little bit. During the application and hiring process this job was sold as a no outside effort needed type of setup, both by the current pain doc who’s doing 9000 RVUs in 4 days/week and the administration. I’ve reached out to the administration on what I can do to market myself better and there has just been crickets.

And it’s been just over 4 months total on the job, 3 at new site.

 

[jsaul]

I agree with bob barker... asking for a raise when you are losing big time money for your employer is something george costanza would do.
Seriously, thinking you should get paid more where you are currently at and losing the amount of money that you are currently doing is just entitlement attitude. You want guaranteed 375k for what amounts to working 1.5 days per week???? Sign me up for that. Thats the best job in the world.

Don't always depend on your "admin" Show some initiative and go out and market on your own, You don't need some magic words from the "administration" to do this. It's not that complicated. You've got the time, now go out and meet with doctors.

 

[callmeanesthesia]

Appreciate the input, but that is far from the vibes I’m getting from the administration. They are actively trying to get me more time back at the main site. They see it as a failure on their part and have apologized for what’s transpired so far.

Jeez, lighten up guys, they’re straight out of fellowship and this place sold a turn-key operation and instead shunted them off to a satellite clinic. Probably made it sound like they’d be making bonus the first year. I’d be looking at other options too.

Still, OP, recognize it as a potential opportunity both for growth and to learn how to market yourself. Assess the area. If the hospital put a clinic there, did they do some sort of market analysis?
Are there Spine surgeons in the area? If so that’s your best but most difficult target. Otherwise go for the big PCP groups. Make it clear you aren’t willing to take their opioid dumps but you will be responsive and thorough. Give them your cell number in case they have an urgent patient. Let them know your calendar is wide open. Hammer the admin every week for a budget for marketing. If the clinic has a website with a blog, write blog posts (use ChatGPT to generate most of the content) which can help drive search engines your way.
Make them condense your schedule so you can spend some good chunks of time hitting up local offices. Hold a seminar for patients. If you do stims, have the local reps help with your outreach.

 

[hyperalgesia]

Your current job sounds like a really good place to learn how to build a practice. No admin can do that for you and you wouldn't want them to try.

To answer your question, I've seen people try to negotiate higher salaries based on other job offers. The only time I've seen it work is when they demonstrate the productivity to justify it to the finance people. That is the KEY element, not the other job offers.

I've also seen people who aren't particularly productive, jump from job to job, increasing salary as they go. This lasts for a couple of years max before they lose their contract, are completely burnt out, and have nothing to show for it.

 

[EastCoastPain]

Good points so far with some opposing views. I do hear the part about them losing money and how could I expect a raise. It’s just I was given all these assurances, always felt my base wasn’t fair market value, and now have some evidence from the other offer. Some of it is also always hearing on various physician forums to “know your worth” and how hospitals and corporations are making huge money off of docs so why not ask for a raise. Maybe I’m really worth -500k this year like BB suggested in which case I should just shut up and cog on, or seriously consider this other offer since my current one has been unexpectedly slow. I also hear the part about boots on the ground marketing myself. Like I mentioned I have repeatedly asked hospital leadership about contacts and meet ups, and I know I could do more leg work myself, but that’s not what I thought I signed up for. As you can see I am conflicted and don’t know how to proceed. Thanks to everyone for contributing.

 

[Ducttape]

how much do people want to bet that the new job did a little research, found out what you are getting paid, and then decided to up the ante...


you may not want to trust admin, but definitely do not trust recruiters. definitely in the top 5 list of people not to trust.

===

Some of it is also always hearing on various physician forums to “know your worth” and how hospitals and corporations are making huge money off of docs so why not ask for a raise.

prove to admin that you are worth the money. then ask for a raise.

in terms of how to proceed, talk to admin about you getting out to do some marketing to improve your volumes. spend extra time contacting referring doctors to encourage them to give you more referrals. ask to go to the spine surgery conferences so that they can see you in person. (bone up on your MRI reading skills before you show up).

 

[Analgesia108]

Good points so far with some opposing views. I do hear the part about them losing money and how could I expect a raise. It’s just I was given all these assurances, always felt my base wasn’t fair market value, and now have some evidence from the other offer. Some of it is also always hearing on various physician forums to “know your worth” and how hospitals and corporations are making huge money off of docs so why not ask for a raise. Maybe I’m really worth -500k this year like BB suggested in which case I should just shut up and cog on, or seriously consider this other offer since my current one has been unexpectedly slow. I also hear the part about boots on the ground marketing myself. Like I mentioned I have repeatedly asked hospital leadership about contacts and meet ups, and I know I could do more leg work myself, but that’s not what I thought I signed up for. As you can see I am conflicted and don’t know how to proceed. Thanks to everyone for contributing.

At the end of the day, its how much money one can make .....but it is also about happiness. If you feel like you are not valued and wd rather try your luck with the closer opportunity, it would not be wrong - but have clarity on expectations - most corporates make it attractive during the interview process while reality will certainly be different - if the other gig is closer, pays more & u see yourself working hard to build your practice & there are no (corporate) obstacles as you can see now, consider it. However, do proper diligence & decide where you will be 'happy'

All the above suggestions for marketing and growing 'your' practice are from your well wishers

 

[DOctorJay]

presumably you signed a contract for 1-2 years. this is the risk you took by accepting a low base. that being said once you get busy you'll do better in the current job. it doesn't sound like you're getting much pressure from admin so your work life balance may be better here if you stick it out, put in some initiative to really grow this thing on your own accord and get rewarded down the line.

don't focus so much on where you are 1-2 years into the practice, look at where you'll be in 5-10 years. I mean without this other offer that popped up would you really be thinking about your base? if you can do 9,000-10,000 wRVUs per year with this current set up you're clearing 540-600k. A $2 difference in $/wRVU is $20k at 10,000 wRVUs - that's some nice vacation money in my book.

if you really want to push for a higher base you could mention that things aren't building up as quickly as you had expected and you're willing to put some time in yourself and maybe they could show some good will be increasing your base but I'd be really careful about this if you think you possibly want to stay here long term.

 

[Gauss]

For anyone fresh out of fellowship: stop looking for the perfect job, a good enough job is just fine when you're starting out.

 

[MitchLevi]

I traveled around to 15-20 different MD clinics when I started at my current job.

Despite the fact my practice has been around since the 1960s.

Referral network already in place.

I still managed to grab new referring doctors though.

Face to face will always yield new referrals. ALWAYS.

I got another ortho MD to send me ALL of his spine pts. From his solo shop I get a lot of business.

OP - Go meet some local docs. They'll send you pts.

Also...Go meet a few chiropractors. They will love you.

 

[cowboydoc]

Face to face will always yield new referrals. ALWAYS

Spoken like someone who doesn’t understand the power of ugly.

 

[EastCoastPain]

I traveled around to 15-20 different MD clinics when I started at my current job.

Despite the fact my practice has been around since the 1960s.

Referral network already in place.

I still managed to grab new referring doctors though.

Face to face will always yield new referrals. ALWAYS.

I got another ortho MD to send me ALL of his spine pts. From his solo shop I get a lot of business.

OP - Go meet some local docs. They'll send you pts.

Also...Go meet a few chiropractors. They will love you.

Taking this and some other constructive feedback to heart. Today I started going door to door to some local PCPs and surgeons.

 

[MitchLevi]

Taking this and some other constructive feedback to heart. Today I started going door to door to some local PCPs and surgeons.

This works 100% of the time, if you give it time...It takes awhile for those pts to cycle through those clinics, get the referral placed and land in your clinic.

This is especially true in pain management, where those docs have referred to other guys for a long time with mediocre success (bc it's pain).

Do a good job and they'll return to those referring docs and thank them for the referral.

Send those referring doctors your clinic notes and don't take a dump where you eat. Be careful with verbiage in your notes. If the referring doctor is a *****, take care not to come out and say it. I need to remember that myself.

 

[hyperalgesia]

This works 100% of the time, if you give it time...It takes awhile for those pts to cycle through those clinics, get the referral placed and land in your clinic.

This is especially true in pain management, where those docs have referred to other guys for a long time with mediocre success (bc it's pain).

Do a good job and they'll return to those referring docs and thank them for the referral.

Send those referring doctors your clinic notes and don't take a dump where you eat. Be careful with verbiage in your notes. If the referring doctor is a *****, take care not to come out and say it. I need to remember that myself.

My biggest problem was the quality of patients. PCPs might send 2 decent pts and one guy demanding oxy to support his drug habit. They really expected a place to dump everyone. I think it depends a lot on the competition in the area. If it's highly competitive, you just need a place to disposition EVERYONE.

 

[MitchLevi]

My biggest problem was the quality of patients. PCPs might send 2 decent pts and one guy demanding oxy to support his drug habit. They really expected a place to dump everyone. I think it depends a lot on the competition in the area. If it's highly competitive, you just need a place to disposition EVERYONE.

You tell them you're a minimal prescriber and prefer physical therapy approaches supplemented by occasional injxns. Works for me.

 

[SeniorWrangler]

Be aware that some administrators will regard any statement from you that you're looking at offers from other sites as a betrayal and they will start looking to replace you. No, this is not logical behavior, but it happens.

 

[deleted131481]

Be aware that some administrators will regard any statement from you that you're looking at offers from other sites as a betrayal and they will start looking to replace you. No, this is not logical behavior, but it happens.

My experience has been different. Physicians are costly to replace. From what I've seen admin don't really care if docs leave, and it's pretty rare for a physician to get pushed out for non-clinical reasons.

I would not hesitate to ask for what I want, but should be reasonable within the market.

 

[deleted875186]

I traveled around to 15-20 different MD clinics when I started at my current job.

Despite the fact my practice has been around since the 1960s.

Referral network already in place.

I still managed to grab new referring doctors though.

Face to face will always yield new referrals. ALWAYS.

I got another ortho MD to send me ALL of his spine pts. From his solo shop I get a lot of business.

OP - Go meet some local docs. They'll send you pts.

Also...Go meet a few chiropractors. They will love you.

Chiropractors! I’ve talked to a couple over the phone, they were very appreciative, got the impression most PCPs or specialists don’t ever communicate with them. Also, patients go to a chiropractor themselves without a referral, the chiros get imaging, so probably a very high yield referral source for you.

 

[Ducttape]

vet your chiropractors.

some are con artists and grifters. i have yet to find any indication for someone post MVC to have to be seen by a chiropractor every day for 3 months until funds run out.

some are legitimate knowledgable professionals that should have gone in to PA school instead. .

 

[EastCoastPain]

I want to bump my old post and get some opinions on productivity. I peaked at 550 RVU’s a few months ago but the last few months have been like 400. I’m now over 15 months out. My practice is mostly bread and butter procedures with some med management sprinkled in, not more than like 20%. Should I be more busy by this point? Does this speak to some weakness in my referral network?

One potential issue I identified is my colleague who’s been there for years has begun to see more new consults than before. And looking back over the last year there were only 2 months where I saw significantly more new consults, both when he was away on vacation. He’s generating like 750-850 RVU’s monthly. Do I have any grounds to bring this up to management? Did I have a “fair” start?

To the previous posters who said do more marketing yourself, I did go around to various referral sources months ago. I’ll probably stop by them again. But to reiterate, I was sold that this job was more or less cruise control from a referral network standpoint. My colleague never did any marketing.

 

[Ducttape]

dont complain that you are being treated unfairly.

do complain that your schedule is not being filled and especially not being filled with new patients and that you are looking to get busier.

your colleague probably complained to admin saying that he wasnt getting fed enough. you will look bad and admin will not be as likely to make changes. (yes yes i do know the squeaky wheel gets the grease etc., but you attract more bees with honey than vinegar)

you might be able to surreptitiously check and see how they are dividing the referrals. the secretaries may have been "reminded" to fill up his schedule first, leaving you with scraps. (be nice to them, they are gatekeepers but they dont make decisions).

change your schedule around to make sure there are plenty of openings for new patients.



btw, market yourself. make sure you send a message to the docs on patients from these docs you would like more referrals from. if you do talk to them in person, remind them to put the referral directly to you, so the secretaries know to do that.

 

[Agast]

How do referrals work in your group if you are both being “fed?”

One of our guys was giving the schedulers donuts and treats and getting more referrals that way, the partners put a stop to that. But if that other guy has been there for years it stands to reason he’s the known quantity. Also possible he has a higher patient satisfaction rating.

 

[MitchLevi]

IMO, every referral should go to the guy with the next availability. In my practice, there are two pain docs, and I saw 2k more visits last yr than the other guy.

OP needs to see the volume of his partners and make an informed decision if he's competitive in that work flow.

 

[EastCoastPain]

How do referrals work in your group if you are both being “fed?”

One of our guys was giving the schedulers donuts and treats and getting more referrals that way, the partners put a stop to that. But if that other guy has been there for years it stands to reason he’s the known quantity. Also possible he has a higher patient satisfaction rating.

IMO, every referral should go to the guy with the next availability. In my practice, there are two pain docs, and I saw 2k more visits last yr than the other guy.

OP needs to see the volume of his partners and make an informed decision if he's competitive in that work flow.

When I started I was told I’d get everyone unless the patient specifically requested to see my colleague. I looked back over the last year and it’s been a fairly even split at the main site, but over the last few months he has had significantly more. He doesn’t really go to a couple of other sites that I do, but both the quality and quantity of referrals there are very weak.

He seems like a fine doctor and I know ratings aren’t everything but they are below a 3 on Google so it’s not that. We see a pretty heavy Medicaid population, possibly upwards of 50% (confirmed his mix is similar to mine), and I find it hard to believe all these patients must see him and only him. I approached my manager and she insisted I am offered to the patient first. I am a little skeptical because she has worked with him for over 10 years and he brought her over from his prior practice, but I can only confront her so much. I also approached my colleague and he said he did tell the staff that he will open up a couple more days per month to accommodate more patients, but insists I am still getting first dibs. He was quick to ask if I think there’s some conspiracy going on. Obviously it sounds a little suspect but again what is my recourse. He does do a little more med management than I do. Perhaps 40% of his practice vs 20% for me, and I am a little stricter overall. Productivity was trending in the right direction until recently so I don’t think it’s just med related.

Anyway, I realize at this point I have to take control as much as I can and plan to market myself more directly to referral sources. Any other specific ideas? I am beginning to regret not pulling the trigger on the other job referenced in the first post!

 

[Ducttape]

1. location location. if he is at the main site closer to higher population density, he is going to get more referrals.
2. make sure your schedule is conducive to new patients, if it is different than his. for example, i used to insist on not scheduling back to back new patients, and there was a sizeable decrease in evals for a few months until i changed back. also, having differing time slots for new vs follow ups can make it challenging and secretaries dont want to go through hassles. make it simple.
3. "He does do a little more med management than I do. Perhaps 40% of his practice vs 20% for me, and I am a little stricter overall." could be a reason you are seeing fewer. and if you voice complaints about med management patients, the secretaries will subconsciouly not put patients on your schedule.

it sounds like your colleague is being very cordial to you. personally, id take them at their word and not think there is a conspiracy. but then again, i am not the kind of person that believes in conspiracies...