Advice for physician asking for a raise

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financial.freedom
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Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 1:58 pm

My wRVUs are consistently 90th to 95th percentile however my pay is about median to 60th percentile for my specialty. I have been at the group for about 5 years, W2 employee, and my pay is the lowest in the group as far as I can gather from discussion with others in the group. I have scheduled a meeting to discuss a raise. This is the first time in my career asking for a raise.

Do you have any suggestions/advice?

My main points are going to be:

1. High production
2. Positive annual reviews
3. New procedures I brought to the group
4. New responsibilities I have taken on since joining the group

Thank you in advance!

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6miths
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Re: Advice for physician asking for a raise

Post by 6miths » Wed Mar 09, 2016 2:09 pm

Do you have a way to walk away if they refuse. Sounds like you are relatively underpaid. Have seen many MDs accept far less than they generate. It can go many different ways. One thing is for sure, if you don't ask they are unlikely to call you in and say, 'hey, take this money you earned it!'
'It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so!' Mark Twain

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 2:31 pm

6miths wrote:Do you have a way to walk away if they refuse. Sounds like you are relatively underpaid. Have seen many MDs accept far less than they generate. It can go many different ways. One thing is for sure, if you don't ask they are unlikely to call you in and say, 'hey, take this money you earned it!'
I have received offers with less pay but better hours. If I took one of those jobs, I'd have to do some side work to make the same income. But I'd prefer to stay if they are willing to negotiate. Not sure if I should bring up the other offers since they pay less.

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bertie wooster
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Re: Advice for physician asking for a raise

Post by bertie wooster » Wed Mar 09, 2016 2:41 pm

Are you on a partner track or has the group just hired you as an employee?

If so I'd do nothing but since you didn't indicate it a partner track seems unlikely. Are you hoping the group offers you a partnership?

I think you've got a great case but they've got no incentive to give you a raise since you don't have other offers. Can you do work elsewhere to supplement your income or does your contract forbid that?

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 2:47 pm

bertie wooster wrote:Are you on a partner track or has the group just hired you as an employee?

If so I'd do nothing but since you didn't indicate it a partner track seems unlikely. Are you hoping the group offers you a partnership?

I think you've got a great case but they've got no incentive to give you a raise since you don't have other offers. Can you do work elsewhere to supplement your income or does your contract forbid that?
I am foundation W2 employee shareholder (A little different from partnership track. There is no profit sharing.) There is a non-compete for the surrounding counties. However, non-compete is illegal in CA and I could do outside work for more distant counties -- something I've considered but the hours can be pretty intensive where I work.

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 3:05 pm

PS - Several of my colleagues have RVUs much lower -- below the national average. If I were to work at the same level as my colleagues they might have to hire another physician. But I'm not sure that I should bring that up in the meeting.

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White Coat Investor
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Re: Advice for physician asking for a raise

Post by White Coat Investor » Wed Mar 09, 2016 3:08 pm

Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
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Re: Advice for physician asking for a raise

Post by kenner » Wed Mar 09, 2016 3:20 pm

White Coat Investor wrote:Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
Absolutely agree.

Different profession here, same philosophy. Deal from a position of strength. And often you are only as strong as your options.

Probably no one on this forum has a precise feel for the ethos of your employer and the competitive forces you face.

letsgobobby
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Re: Advice for physician asking for a raise

Post by letsgobobby » Wed Mar 09, 2016 3:20 pm

are you salaried or paid on production?

In general, highly productive docs should look for production based compensation.

We are a production based comp model. As a result, most everyone we hire is pretty productive. Sometimes we make a mistake and hire less productive docs. They don't tend to stick around.

If you are salaried you can imagine your group will resist paying you more. After all, they can work less than you and make more than you so why would they want to change that?

Like EmergDoc says, you will want to start looking for a better situation and don't be shy about sharing that info with your group.

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dm200
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Re: Advice for physician asking for a raise

Post by dm200 » Wed Mar 09, 2016 3:57 pm

Different profession, but do you know (or have any idea) why your compensation is low? It can often be helpful, when planning a strategy for increased compensation, to have an understanding of why you are being compensated as you are.

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gasman
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Re: Advice for physician asking for a raise

Post by gasman » Wed Mar 09, 2016 4:04 pm

A key question is how replaceable are you? What is the supply of your specialty in your area?

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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 4:11 pm

letsgobobby wrote:are you salaried or paid on production?

In general, highly productive docs should look for production based compensation.

We are a production based comp model. As a result, most everyone we hire is pretty productive. Sometimes we make a mistake and hire less productive docs. They don't tend to stick around.

If you are salaried you can imagine your group will resist paying you more. After all, they can work less than you and make more than you so why would they want to change that?

Like EmergDoc says, you will want to start looking for a better situation and don't be shy about sharing that info with your group.
Paid on salary. The RVU incentive is very little, about 5%. I have thought about asking for changing the contract to production based. For instance, same base salary to median RVU level, and then a set amount per RVU above that. But I'm not sure if I should bring that up in the meeting.

The folks in the group who do less and make more are not involved in the decision to increase my salary, as far as I can tell.

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 4:12 pm

dm200 wrote:Different profession, but do you know (or have any idea) why your compensation is low? It can often be helpful, when planning a strategy for increased compensation, to have an understanding of why you are being compensated as you are.
I was a new hire a few years back, so they hired me for less back then since the others had already been at the group awhile.

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 4:13 pm

gasman wrote:A key question is how replaceable are you? What is the supply of your specialty in your area?
My skill set would be difficult for them to replace. But I don't think those who do the hiring/firing know that, so may not matter.

letsgobobby
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Re: Advice for physician asking for a raise

Post by letsgobobby » Wed Mar 09, 2016 4:42 pm

You're clearly underpaid. That's the bottom line. You may need to change jobs to get what you are owed, in fact I understand that is common in many industries. But the data you've accumulated is pretty clear.

In my group you'd be paid 90-95% ile because your production is 90-95%ile. So if this doesn't work out, and you're looking for a job, send me a PM. :beer

staythecourse
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Re: Advice for physician asking for a raise

Post by staythecourse » Wed Mar 09, 2016 4:49 pm

My opinion, it has nothing to do with showing data to prove your worth, but all to do with the situation of your employment and the culture.

What is your restrictive covenant? Is restrictive covenants in your state even enforceable? How long of notifcation do you have to give before leaving? Is this a corporate medicine gig? Is there another group in the same city you can go join? Do you have any competing offers that you can use as a frame of reference to what someone else is offering you for your abilities and level of experience? Do they have the ability to recruit someone else easily to replace you? Do they know if you are too eager to stay in the current community or don't care about moving on?

The truth of ALL employment salaries is NOT what you think you are worth, but what someone else will pay you to do the same job. If there isn't another job out there that is offering more then what you are getting now it is hard to make "case" for higher pay.

If you are in corporate medicine I will give you the same advice I give my wife who is in corporate medicine and that is the frame of thinking is NOT how much money can I make, but how little of work can you do without getting fired. You might not get more money, but just start scaling back work hours where they are making less money on you. In private practice this is hard to do as the "extra revenue" you are making now is divided among the senior guys and they will not be happy losing their free handout. Now you can see why in a private practice they are LESS likely to give you any more money as it means it is less money they will see in their own bank accounts. It isn't fair, but doctors are not the most ethical in business relationships.

Good luck.
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6miths
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Re: Advice for physician asking for a raise

Post by 6miths » Wed Mar 09, 2016 5:40 pm

White Coat Investor wrote:Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
This is what I was angling at. Need to have teeth in the 'or else' statement. And the other side of the coin as was pointed out was how replaceable are you and also how do you fit with the group. Too put it less subtly, would the be glad to be rid of you!
'It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so!' Mark Twain

am
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Re: Advice for physician asking for a raise

Post by am » Wed Mar 09, 2016 5:55 pm

W2 physician and raise don't mix. Perhaps if the organization really needs you and tough to recruit your specialty. Otherwise it will not work. You will just make other docs and administrators angry with you. Best to either look for a new job or dial down your productivity (although they will know you are slacking).

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Re: Advice for physician asking for a raise

Post by leonard » Wed Mar 09, 2016 5:58 pm

OP - Interview. Even if you don't get a new job, you will have a good sense of exactly what the market will pay for someone of precisely your skillset. This will give you a baseline to understand your value to your current employer.

However, do not use this as direct leverage with your employer - where you say "I've been offered a job here - you need to match/beat it." The HR stats indicate that whenever an existing company makes a counter offer and the employee chooses to stay - it only works for a short time. And, you could come across as disloyal. Simply use your interview process and offers as setting a baseline.

On negotiating with your current employer - drop any "Or else" or ultimatum type language. It shuts down communication at a time when exactly what you want is communication with your manager/employer. You want to try to find alternatives that can make both sides happy. Any doubt on this point? Read the book "Getting More" by Stuart Diamond. One of the most useful books I have ever read on negotiating - or anything else for that matter.

EDIT: I'll throw in one more issue - how well does your company fill vacancies? What will the cost be to fill your position - in terms of interview time, resume screening, lost productivity, etc.? If that cost is high in you particular company, you may have a bit more leverage.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

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Re: Advice for physician asking for a raise

Post by leonard » Wed Mar 09, 2016 6:03 pm

am wrote:W2 physician and raise don't mix. Perhaps if the organization really needs you and tough to recruit your specialty. Otherwise it will not work. You will just make other docs and administrators angry with you. Best to either look for a new job or dial down your productivity (although they will know you are slacking).
If the OP's boss openly discusses private salary negotiations with other "docs and administrators" then the OP has bigger problems than salary. It would be very unethical for the boss to go to anyone with this that wasn't need to know in their chain of command.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 6:14 pm

leonard wrote:OP - Interview. Even if you don't get a new job, you will have a good sense of exactly what the market will pay for someone of precisely your skillset. This will give you a baseline to understand your value to your current employer.

However, do not use this as direct leverage with your employer - where you say "I've been offered a job here - you need to match/beat it." The HR stats indicate that whenever an existing company makes a counter offer and the employee chooses to stay - it only works for a short time. And, you could come across as disloyal. Simply use your interview process and offers as setting a baseline.

On negotiating with your current employer - drop any "Or else" or ultimatum type language. It shuts down communication at a time when exactly what you want is communication with your manager/employer. You want to try to find alternatives that can make both sides happy. Any doubt on this point? Read the book "Getting More" by Stuart Diamond. One of the most useful books I have ever read on negotiating - or anything else for that matter.

EDIT: I'll throw in one more issue - how well does your company fill vacancies? What will the cost be to fill your position - in terms of interview time, resume screening, lost productivity, etc.? If that cost is high in you particular company, you may have a bit more leverage.
Thank you for the advice.

It is helpful to have suggestions that involve looking for another job. I will start that process right now. I'm always keeping an eye out, but have not been actively searching.

The more immediate concern is how I should approach this upcoming meeting for negotiating a raise. I agree, will not use any ultimatums during the meeting. I want to just focus on my productivity and other things I have brought to the group since joining.

It will be difficult for them to fill the vacancy if I leave, but again I don't think the administrators (non-physicians) who do the hiring/firing realize that. Others in my group do.

leonard
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Re: Advice for physician asking for a raise

Post by leonard » Wed Mar 09, 2016 6:18 pm

financial.freedom wrote:
leonard wrote:OP - Interview. Even if you don't get a new job, you will have a good sense of exactly what the market will pay for someone of precisely your skillset. This will give you a baseline to understand your value to your current employer.

However, do not use this as direct leverage with your employer - where you say "I've been offered a job here - you need to match/beat it." The HR stats indicate that whenever an existing company makes a counter offer and the employee chooses to stay - it only works for a short time. And, you could come across as disloyal. Simply use your interview process and offers as setting a baseline.

On negotiating with your current employer - drop any "Or else" or ultimatum type language. It shuts down communication at a time when exactly what you want is communication with your manager/employer. You want to try to find alternatives that can make both sides happy. Any doubt on this point? Read the book "Getting More" by Stuart Diamond. One of the most useful books I have ever read on negotiating - or anything else for that matter.

EDIT: I'll throw in one more issue - how well does your company fill vacancies? What will the cost be to fill your position - in terms of interview time, resume screening, lost productivity, etc.? If that cost is high in you particular company, you may have a bit more leverage.
Thank you for the advice.

It is helpful to have suggestions that involve looking for another job. I will start that process right now. I'm always keeping an eye out, but have not been actively searching.

The more immediate concern is how I should approach this upcoming meeting for negotiating a raise. I agree, will not use any ultimatums during the meeting. I want to just focus on my productivity and other things I have brought to the group since joining.

It will be difficult for them to fill the vacancy if I leave, but again I don't think the administrators (non-physicians) who do the hiring/firing realize that. Others in my group do.
I suggest going to the library and getting a copy of "Getting More". Even if you only employ 3 or 4 of these techniques, it could pay off.

If your manager is responsible - they will weigh the cost of filling the position. They're responsible for delivering - so they'll feel it if they are having to stretch to cover your work for 3 months while they hire a replacement.
Leonard | | Market Timing: Do you seriously think you can predict the future? What else do the voices tell you? | | If employees weren't taking jobs with bad 401k's, bad 401k's wouldn't exist.

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gasdoc
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Re: Advice for physician asking for a raise

Post by gasdoc » Wed Mar 09, 2016 6:40 pm

1. What specialty are you? Is your productivity directly related to how well you attract patients, or are you dependent on others in the group for referrals?

2. Are you in a single specialty group, or a multi specialty group?

I am trying to gauge how useful your RVU's are to your worth to the group.

Sincerely,
gasdoc

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 6:43 pm

So much for the meeting. I was called and notified there will be no raise. The person on the phone said they pushed for me and felt I really deserved a raise but that the hospital administration said they lost a lot of money this year and cannot give raises.

financial.freedom
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Re: Advice for physician asking for a raise

Post by financial.freedom » Wed Mar 09, 2016 6:44 pm

The irony is that in the same conversation, they told me that they are looking into hiring another physician for my group and that will lessen my burden in terms of productivity.

staythecourse
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Re: Advice for physician asking for a raise

Post by staythecourse » Wed Mar 09, 2016 8:37 pm

financial.freedom wrote:The irony is that in the same conversation, they told me that they are looking into hiring another physician for my group and that will lessen my burden in terms of productivity.
All you had to say was corporate medicine and that would have simplified the discussion. This is common approach for admin. If you say I am seeing x amount and I want y pay for that work their countermove is ALWAYS to just hire another person and pay them poorly as well to lighten your load and have you make the same salary.

Not saying it is logical, but the common approach from corporate medicine. As I said in my advice the better approach in this situation is to change your way of thinking from "I'll work hard and prove I deserve more" to "How little can I work and not get fired". It is change of thinking, but is the truth. This attitude of corporate medicine is why there will always be money for private practice docs as they are willing to work harder to make the money.

Good luck.
Last edited by staythecourse on Wed Mar 09, 2016 9:23 pm, edited 1 time in total.
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Compound
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Re: Advice for physician asking for a raise

Post by Compound » Wed Mar 09, 2016 8:51 pm

financial.freedom wrote:So much for the meeting. I was called and notified there will be no raise. The person on the phone said they pushed for me and felt I really deserved a raise but that the hospital administration said they lost a lot of money this year and cannot give raises.
Sounds like you are clearly working for the wrong employer -- better double down on that job search.

Good luck!

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Re: Advice for physician asking for a raise

Post by DireWolf » Wed Mar 09, 2016 8:59 pm

staythecourse hit the nail on the head. Corporate medicine is like a Soviet collective farm. It transforms the brightest and hardest working into slugs whose sole purpose is to work as little as possible to get that paycheck.

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Re: Advice for physician asking for a raise

Post by desiderium » Thu Mar 10, 2016 12:10 am

Do the administrators take any interest in your production? Is there any interest in your contribution to the business model? If so, then they might take notice if you were to deliberately back off on the intensity of your work. You don't have to be obnoxious, just stop saying yes all the time and slow down your hustle. If they don't notice, then at least you can have more time for personal pursuits. Working at the 95th percentile is a recipe for burnout

toofache32
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Re: Advice for physician asking for a raise

Post by toofache32 » Thu Mar 10, 2016 1:03 am

White Coat Investor wrote:Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
This. Your only bargaining chip is the ability to walk away. Although it's a little different, my group of 4 docs recently met with our local hospital CEO requesting that they pay us to take call at their hospital. We NEVER get paid by their patients and end up sending all of them to collections. Most are Medicare/insured and the hospital gets paid well for these patients. The CEO essentially told us to go to hell. Since we also cover their competing hospital that pays us to take call, we faxed over our letter to terminate our status as active hospital staff. We got a call the next day to talk about it more and now they are paying us. You have to be able to call their bluff and walk away.

WL2034
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Re: Advice for physician asking for a raise

Post by WL2034 » Thu Mar 10, 2016 2:56 am

Does the pay have something to do with where you live? I'm curious because it seems based on RVUs that you deserve higher compensation, but the other offers you've come across in your area have been for even less than you are making now. Are those corporate medicine jobs as well?

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Re: Advice for physician asking for a raise

Post by ks289 » Thu Mar 10, 2016 8:17 am

It sounds like you are working hard and are justified in seeking more compensation.
Unfortunately, your practice sounds fairly rigid with regard to compensation, particularly right now as you are under contract and your practice may have a standard process for determining compensation without a great deal of flexibility. It is likely no accident that your colleagues' productivity is below average and their compensation is minimally impacted by that.
I agree with the other posters who suggest looking for another job which meets your needs better.

I agree to a small degree about dialing it back, but I do believe that you may have more leverage in your future negotiations not only by having another offer but also by your present high level of productivity.

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8foot7
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Re: Advice for physician asking for a raise

Post by 8foot7 » Thu Mar 10, 2016 9:29 am

I would never accept a blanket "no" to a raise request.

Acceptable answers to me include:

1. "No, but we will revisit in six months." "No, but let's have a conversation about how to get you to a raise."
2. "No, but here are n active priorities for us and if you can deliver on z of them, then you will have earned it."
3. "You just got one."

A flat "no" is a flashing orange neon sign that says to me, look for another job.

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Re: Advice for physician asking for a raise

Post by bandaidman » Thu Mar 10, 2016 10:43 am

For most of my career I have been employed by non profit academic centers. In many ways they are just as bad if not worse than corporate groups in compensating clinical productivity fairly.

Many years ago, when our salaried pay was probably in the bottom 5% in the country , faculty complaints fell on deaf ears, that is until several of us presented contracts nearly tripling our pay.

That was met with about a 30% increase. Financially it was probably not wise to remain in academics, but I enjoy the work milieu.

Since that time much more attention is paid to compensation issues and that is nice.

For the business managers this is purely a business matter. If they can get more work out of you for less they will always do so. Demonstrating how your productivity should warrant higher compensation should spur action, but often does not. As said before, being willing to walk is a powerful bargaining chip. You have to be careful wielding it though, as they may take you up on it

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Re: Advice for physician asking for a raise

Post by TT » Thu Mar 10, 2016 11:16 am

If I am understanding this correctly "my pay is about median to 60th percentile for my specialty" this refers to the range for your specialty including salaries at other organizations. More importantly is where does your salary fall within the range of the organization you currently work. With your performance as stated after 5 years you should be at least in the 60-65 % range of salaries for your specialty in your organization. If you indeed are within this range and your salary is not compensating you at the level you feel you are deserving of then the alternative would be to seek employment at another organization with higher compensation levels.

malabargold
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Re: Advice for physician asking for a raise

Post by malabargold » Thu Mar 10, 2016 11:21 am

Find a partnership job. Period.

My guess is that if you could see how much more
Your colleagues who have profit-sharing are receiving
You would be sickened.

staythecourse
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Re: Advice for physician asking for a raise

Post by staythecourse » Thu Mar 10, 2016 7:36 pm

toofache32 wrote:
White Coat Investor wrote:Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
This. Your only bargaining chip is the ability to walk away. Although it's a little different, my group of 4 docs recently met with our local hospital CEO requesting that they pay us to take call at their hospital. We NEVER get paid by their patients and end up sending all of them to collections. Most are Medicare/insured and the hospital gets paid well for these patients. The CEO essentially told us to go to hell. Since we also cover their competing hospital that pays us to take call, we faxed over our letter to terminate our status as active hospital staff. We got a call the next day to talk about it more and now they are paying us. You have to be able to call their bluff and walk away.
Personally, not all that advisable. You may see this as a win, but it may be short lived. I can guarantee one thing and that is the CEO is currently trying to line up another group to service their patients in TOTALITY. He/ she in the end will likely eliminate your group from seeing their patients and just refer within. If you group needs those patients to be profitable you may have shot yourself in the foot down the road.

Moves like this I respect (I am as much a capitalist as ANYONE), but when you make a move like this there will be untoward payback down the road. If you were the CEO would you like it? Medicine (I'm sure is the same as many jobs) are filled with big egos and long memories and have seen this story fireback the other way in a couple of years MANY, MANY, MANY times. Living your work life is all about avoiding land mines and trying to win the WAR and not so much the smaller battles.

To the OP, the best move is to look for another job. Not as a trump card, but as an attempt to find a situation that is more equitable for you. Many years ago someone said something that has ALWAYS stuck: (paraphrasing) "If one is making a million dollars, but taking a thousand from you you will be more unhappy if you are making a 1/2 million and not getting screwed." There is just something unsettling for ANYONE to know that someone is reaching in your back pocket and taking money from your hard work and almost always not appreciating your hard work in the process.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

toofache32
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Re: Advice for physician asking for a raise

Post by toofache32 » Thu Mar 10, 2016 8:22 pm

staythecourse wrote:
toofache32 wrote:
White Coat Investor wrote:Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
This. Your only bargaining chip is the ability to walk away. Although it's a little different, my group of 4 docs recently met with our local hospital CEO requesting that they pay us to take call at their hospital. We NEVER get paid by their patients and end up sending all of them to collections. Most are Medicare/insured and the hospital gets paid well for these patients. The CEO essentially told us to go to hell. Since we also cover their competing hospital that pays us to take call, we faxed over our letter to terminate our status as active hospital staff. We got a call the next day to talk about it more and now they are paying us. You have to be able to call their bluff and walk away.
Personally, not all that advisable. You may see this as a win, but it may be short lived. I can guarantee one thing and that is the CEO is currently trying to line up another group to service their patients in TOTALITY. He/ she in the end will likely eliminate your group from seeing their patients and just refer within. If you group needs those patients to be profitable you may have shot yourself in the foot down the road.

Moves like this I respect (I am as much a capitalist as ANYONE), but when you make a move like this there will be untoward payback down the road. If you were the CEO would you like it? Medicine (I'm sure is the same as many jobs) are filled with big egos and long memories and have seen this story fireback the other way in a couple of years MANY, MANY, MANY times. Living your work life is all about avoiding land mines and trying to win the WAR and not so much the smaller battles.
You assume much because it depends on the specialty. My specialty is one that avoids hospitals at all costs because we LOSE money every time we go to the hospital. We are based mainly on cash. And our fees are very reasonable because we stay in business this way and actually do very well. This hospital situation is community service. I made it very clear to the hospital suits that they need us but we do NOT need them. There are ZERO hospitals that hire their own doctors in my specialty because they cannot afford them ([removed] insurance rates are not acceptable to anyone in my specialty). Healthcare exists outside of hospitals. There is a reason that we have over 30 doctors in my specialty in our city but only 1 group (mine) puts up with the hospital and deadbeat patient [removed]. It's because we enjoy helping these patients with their complex problems. But charity only lasts for so long. [OT comments removed by admin LadyGeek] I welcome any advice here from anyone else that agrees that nobody should be asked to work for free. Lincoln outlawed slavery many years ago.

staythecourse
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Re: Advice for physician asking for a raise

Post by staythecourse » Thu Mar 10, 2016 9:19 pm

toofache32 wrote:
staythecourse wrote:
toofache32 wrote:
White Coat Investor wrote:Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
This. Your only bargaining chip is the ability to walk away. Although it's a little different, my group of 4 docs recently met with our local hospital CEO requesting that they pay us to take call at their hospital. We NEVER get paid by their patients and end up sending all of them to collections. Most are Medicare/insured and the hospital gets paid well for these patients. The CEO essentially told us to go to hell. Since we also cover their competing hospital that pays us to take call, we faxed over our letter to terminate our status as active hospital staff. We got a call the next day to talk about it more and now they are paying us. You have to be able to call their bluff and walk away.
Personally, not all that advisable. You may see this as a win, but it may be short lived. I can guarantee one thing and that is the CEO is currently trying to line up another group to service their patients in TOTALITY. He/ she in the end will likely eliminate your group from seeing their patients and just refer within. If you group needs those patients to be profitable you may have shot yourself in the foot down the road.

Moves like this I respect (I am as much a capitalist as ANYONE), but when you make a move like this there will be untoward payback down the road. If you were the CEO would you like it? Medicine (I'm sure is the same as many jobs) are filled with big egos and long memories and have seen this story fireback the other way in a couple of years MANY, MANY, MANY times. Living your work life is all about avoiding land mines and trying to win the WAR and not so much the smaller battles.
You assume much because it depends on the specialty. My specialty is one that avoids hospitals at all costs because we LOSE money every time we go to the hospital. We are based mainly on cash. And our fees are very reasonable because we stay in business this way and actually do very well. This hospital situation is community service. I made it very clear to the hospital suits that they need us but we do NOT need them. There are ZERO hospitals that hire their own doctors in my specialty because they cannot afford them ([removed] insurance rates are not acceptable to anyone in my specialty). Healthcare exists outside of hospitals. There is a reason that we have over 30 doctors in my specialty in our city but only 1 group (mine) puts up with the hospital and deadbeat patient [removed]. It's because we enjoy helping these patients with their complex problems. But charity only lasts for so long. [OT comments removed by admin LadyGeek] I welcome any advice here from anyone else that agrees that nobody should be asked to work for free. Lincoln outlawed slavery many years ago.
I stand corrected. In your situation it really doesn't seem you need the hospital or their patients. I just wanted to let the OP and other readers know the flip side of a move like this which I have seen play out several times.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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Re: Advice for physician asking for a raise

Post by mac808 » Fri Mar 11, 2016 3:20 am

toofache32 wrote:
staythecourse wrote:
toofache32 wrote:
White Coat Investor wrote:Start looking for another job. The best way to get a big raise is to say I'm leaving unless you give me a big raise and mean it.
This. Your only bargaining chip is the ability to walk away. Although it's a little different, my group of 4 docs recently met with our local hospital CEO requesting that they pay us to take call at their hospital. We NEVER get paid by their patients and end up sending all of them to collections. Most are Medicare/insured and the hospital gets paid well for these patients. The CEO essentially told us to go to hell. Since we also cover their competing hospital that pays us to take call, we faxed over our letter to terminate our status as active hospital staff. We got a call the next day to talk about it more and now they are paying us. You have to be able to call their bluff and walk away.
Personally, not all that advisable. You may see this as a win, but it may be short lived. I can guarantee one thing and that is the CEO is currently trying to line up another group to service their patients in TOTALITY. He/ she in the end will likely eliminate your group from seeing their patients and just refer within. If you group needs those patients to be profitable you may have shot yourself in the foot down the road.

Moves like this I respect (I am as much a capitalist as ANYONE), but when you make a move like this there will be untoward payback down the road. If you were the CEO would you like it? Medicine (I'm sure is the same as many jobs) are filled with big egos and long memories and have seen this story fireback the other way in a couple of years MANY, MANY, MANY times. Living your work life is all about avoiding land mines and trying to win the WAR and not so much the smaller battles.
You assume much because it depends on the specialty. My specialty is one that avoids hospitals at all costs because we LOSE money every time we go to the hospital. We are based mainly on cash. And our fees are very reasonable because we stay in business this way and actually do very well. This hospital situation is community service. I made it very clear to the hospital suits that they need us but we do NOT need them. There are ZERO hospitals that hire their own doctors in my specialty because they cannot afford them ([removed] insurance rates are not acceptable to anyone in my specialty). Healthcare exists outside of hospitals. There is a reason that we have over 30 doctors in my specialty in our city but only 1 group (mine) puts up with the hospital and deadbeat patient [removed]. It's because we enjoy helping these patients with their complex problems. But charity only lasts for so long. [OT comments removed by admin LadyGeek] I welcome any advice here from anyone else that agrees that nobody should be asked to work for free. Lincoln outlawed slavery many years ago.
Derm? Optho? Psych? Very curious what specialty this is.

toofache32
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Re: Advice for physician asking for a raise

Post by toofache32 » Fri Mar 11, 2016 9:19 am

mac808 wrote: Derm? Optho? Psych? Very curious what specialty this is.
Oral maxillofacial surgery. Our hospital stuff is mainly trauma and infections. My point is that the specialties that will thrive in the future are those that don't have to rely on being a cog in a bigger wheel. There is a very disturbing trend over the past 5 years where the rate of employed physicians has gone from around 30% to 65%. I didn't catch the OP's specialty but if there is a way to NOT be an employee, then the situation can be helped. Otherwise, you're an employee and no different from the nurses, lab techs, custodians, etc.

buckstar
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Re: Advice for physician asking for a raise

Post by buckstar » Fri Mar 11, 2016 9:23 am

mac808 wrote: Derm? Optho? Psych? Very curious what specialty this is.
From username, I'm guessing oral maxillofacial surgery :)

The biggest raise I was offered was when I told my academic administrator that I was leaving for a private practice job. You do have to be willing to walk away...

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Re: Advice for physician asking for a raise

Post by thirdman » Fri Mar 11, 2016 2:00 pm

Years ago I was in a corporate medicine job. I had responsibility upon responsibility piled on me. Fortunately I had been investing for years, and really didn't need a job. I spoke with my department chair, but got nowhere. Finally, I resigned, although I didn’t have a job lined up. I did consult an attorney familiar with contracts and physician employment to make certain I would not have legal problems. My boss shook my hand and basically said don’t let the door hit you…

I thought I might do locums for a while. A month after I left I got a call from the administrator. They would like me to come back. I came back as an independent contractor. I had no benefits, but I was paid very well, and it was understood that if I was not happy I would leave. I stayed another year.

When I got back, I found the practice had not been able to replace me, and they were really backed up. I had given two weeks notice when I resigned.

Also, in the month I had off, I stayed at the beach and went diving every day. Actually after a month, that got old.

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Re: Advice for physician asking for a raise

Post by LadyGeek » Fri Mar 11, 2016 5:21 pm

I removed some off-topic comments. As a reminder, see: General Etiquette
We expect this forum to be a place where people can feel comfortable asking questions and where debates and discussions are conducted in civil tones.
Also, we maintain a family-friendly environment - things you can say in front of the little ones.

State your comments in a factual manner and focus on helping the OP ask for a raise.
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Re: Advice for physician asking for a raise

Post by ram » Sat Mar 12, 2016 1:48 am

In general physician salaries are lower on the coasts and better in the middle of the country. (Assuming all other things remaining equal). Salaries are better in rural areas than in urban areas.

When compensation is all or predominantly a fixed salary amount the employer attracts a particular type of physician employee. Such an employee physician is seldom interested in a workload substantially above the median and usually tends to move towards the lowest quartile of productivity as the years go by. This doesn't necessarily mean that the employee physician is 'lazy'. This simply is an employee physician who wants a better work- life balance.

There is a subset of physicians who want to work very hard and are interested in earning a commensurate amount in remuneration. These physicians are best served (financially) by being in solo private practice, a single specialty group practice or a multi specialty practice that pays based predominantly on productivity.

The very same physician may move from one group to the other at different stages of his/ her life. For example a young driven physician may become progressively more financially independent and decide to slow down during mid/ late career.

Reliable physician remuneration data collected from employers in a standardized fashion is available from organizations such as MGMA, AMGA and Sullivan Cotter. This is reported by the employer and is therefore more reliable than the self reported data at Payscale or salary.com.

National means, medians, 10th, 25th, 50th, 75th and 90th percentiles are available for each specialty. For larger specialties regional data with same details is also available. Some of these organizations further split the data for early vs mid stage physicians (classification based on years in practice). Access to this data costs tens of thousands of dollars and it seldom makes sense for an individual physician to purchase this data. However most employers have this data. Uneven access to data puts a physician at a disadvantage during salary negotiation. The employer typically knows the cost of replacing the physician and uses that knowledge to deny or give minimal possible raise.
Ram

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thirdman
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Re: Advice for physician asking for a raise

Post by thirdman » Sat Mar 12, 2016 10:58 am

ram:
National means, medians, 10th, 25th, 50th, 75th and 90th percentiles are available for each specialty. For larger specialties regional data with same details is also available. Some of these organizations further split the data for early vs mid stage physicians (classification based on years in practice). Access to this data costs tens of thousands of dollars and it seldom makes sense for an individual physician to purchase this data. However most employers have this data. Uneven access to data puts a physician at a disadvantage during salary negotiation. The employer typically knows the cost of replacing the physician and uses that knowledge to deny or give minimal possible raise.
ram’s response gave me an idea. An attorney who deals in physician contracts may have access to this data, helping the physician in contract negotiations. Also, an attorney may have other suggestions to help the physician achieve his/her goals.

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Re: Advice for physician asking for a raise

Post by White Coat Investor » Sat Mar 12, 2016 7:12 pm

ram wrote:In general physician salaries are lower on the coasts and better in the middle of the country. (Assuming all other things remaining equal). Salaries are better in rural areas than in urban areas.

When compensation is all or predominantly a fixed salary amount the employer attracts a particular type of physician employee. Such an employee physician is seldom interested in a workload substantially above the median and usually tends to move towards the lowest quartile of productivity as the years go by. This doesn't necessarily mean that the employee physician is 'lazy'. This simply is an employee physician who wants a better work- life balance.

There is a subset of physicians who want to work very hard and are interested in earning a commensurate amount in remuneration. These physicians are best served (financially) by being in solo private practice, a single specialty group practice or a multi specialty practice that pays based predominantly on productivity.

The very same physician may move from one group to the other at different stages of his/ her life. For example a young driven physician may become progressively more financially independent and decide to slow down during mid/ late career.

Reliable physician remuneration data collected from employers in a standardized fashion is available from organizations such as MGMA, AMGA and Sullivan Cotter. This is reported by the employer and is therefore more reliable than the self reported data at Payscale or salary.com.

National means, medians, 10th, 25th, 50th, 75th and 90th percentiles are available for each specialty. For larger specialties regional data with same details is also available. Some of these organizations further split the data for early vs mid stage physicians (classification based on years in practice). Access to this data costs tens of thousands of dollars and it seldom makes sense for an individual physician to purchase this data. However most employers have this data. Uneven access to data puts a physician at a disadvantage during salary negotiation. The employer typically knows the cost of replacing the physician and uses that knowledge to deny or give minimal possible raise.
There are physician contract review firms that purchase this data to use for all their clients.
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staythecourse
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Re: Advice for physician asking for a raise

Post by staythecourse » Mon Mar 14, 2016 9:53 am

thirdman wrote:ram’s response gave me an idea. An attorney who deals in physician contracts may have access to this data, helping the physician in contract negotiations. Also, an attorney may have other suggestions to help the physician achieve his/her goals.
Your are about a decade late in that idea. Any attorney who does this aspect for a living has all that data to use in negotiations, but the question remains does it matter?

For example, if a group or hospital has always given contracts that fall in the 50% of MGMA then guess what they will offer you no matter how productive you are?

The real advantage of using some local attorney who does this for a living is NOT for that data, however. It is for their level of experience of knowing the ins and outs of the LOCAL market of physician salaries. Who cares what MGMA, AGMA, Sullivan-Cotter, etc... have to say on the issue of salary. The only thing that matters is past tendencies of the employers around the area you want to work have done in terms of salary and fringe benefits. Medicine is odd in the fact just because you counterpoint an offering is too low they usually will not budge much even if presented with good data to support your claim.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

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