Interpreting salary data ie MGMA, Sullivan-Cotter, et al

[Superior]

What's to say the next hospital won't be the same way or worse? Every CEO is able to make the job look sparkly on an interview or visit. These are our first attending jobs (spouse and I), but from discussions with our peers from training and colleagues, nearly all hospital admin are slimy and have different goals entirely than physicians. We told ourselves that if they're all crooked, at least we get to negotiate face to face with the CEO instead of some HR rep for a big hospital chain who REALLY doesn't care a thing about us.

Our offers aren't objectively bad, and we certainly aren't asking for the moon, but feel that even a moderate amount of give on their part to offer two young, well-liked, productive physicians a more peachy (or at least above average) situation would go a long way. Instead we feel they are trying to nickel and dime us to the lowest possible amounts we will accept. And there certainly aren't folks beating down the door to work here unless COVID has changed that. I feel strongly that it would hurt them substantially if we left, yet they have essentially offered zero compromise in negotiations so far. Maybe they know something we don't?

One of us has the opportunity to go to a physician owned PP group and I think that is the correct move, even if it nets less money (probably won't). Just seems like the right thing to do.\

[childay]

What's to say the next hospital won't be the same way or worse? Every CEO is able to make the job look sparkly on an interview or visit. These are our first attending jobs (spouse and I), but from discussions with our peers from training and colleagues, nearly all hospital admin are slimy and have different goals entirely than physicians. We told ourselves that if they're all crooked, at least we get to negotiate face to face with the CEO instead of some HR rep for a big hospital chain who REALLY doesn't care a thing about us.

Our offers aren't objectively bad, and we certainly aren't asking for the moon, but feel that even a moderate amount of give on their part to offer two young, well-liked, productive physicians a more peachy (or at least above average) situation would go a long way. Instead we feel they are trying to nickel and dime us to the lowest possible amounts we will accept. And there certainly aren't folks beating down the door to work here unless COVID has changed that. I feel strongly that it would hurt them substantially if we left, yet they have essentially offered zero compromise in negotiations so far. Maybe they know something we don't?

One of us has the opportunity to go to a physician owned PP group and I think that is the correct move, even if it nets less money (probably won't). Just seems like the right thing to do.\

What prompted this negotiation? Did you just decide to ask for a raise in the middle of COVID or what? What's your leverage? How much $$ do you make for the hospital?

[Lordosis]

What's to say the next hospital won't be the same way or worse? Every CEO is able to make the job look sparkly on an interview or visit. These are our first attending jobs (spouse and I), but from discussions with our peers from training and colleagues, nearly all hospital admin are slimy and have different goals entirely than physicians. We told ourselves that if they're all crooked, at least we get to negotiate face to face with the CEO instead of some HR rep for a big hospital chain who REALLY doesn't care a thing about us.

Our offers aren't objectively bad, and we certainly aren't asking for the moon, but feel that even a moderate amount of give on their part to offer two young, well-liked, productive physicians a more peachy (or at least above average) situation would go a long way. Instead we feel they are trying to nickel and dime us to the lowest possible amounts we will accept. And there certainly aren't folks beating down the door to work here unless COVID has changed that. I feel strongly that it would hurt them substantially if we left, yet they have essentially offered zero compromise in negotiations so far. Maybe they know something we don't?

One of us has the opportunity to go to a physician owned PP group and I think that is the correct move, even if it nets less money (probably won't). Just seems like the right thing to do.\

I see your point that every admin can suck. But if you know the guy you are dealing with sucks that is different then assuming. It s good to assume they are out to get you but if you catch them and let them screw you over anyway who is to blame.

I do not mean to be overly harsh but if you show good data and they continue to deny that it is correct it might be time to fly.

[Superior]

What prompted this negotiation? Did you just decide to ask for a raise in the middle of COVID or what? What's your leverage? How much $$ do you make for the hospital?

Contracts are up later this year otherwise I wouldn't bring up the subject at all. The hospital does well by having us. In-demand specialties which each generate a lot of downstream hospital revenue, growing practice volumes, certainly not deficient in any metric of physician work, well settled in a generally not-desirable location. Points to their side are COVID, weak payer mix in the area, "you can't make as much as all the old guys who have been here for years." Another point that I think gets overlooked on here and WCI Facebook (where people hem and haw about squeezing an extra $200 into 1099 expenses to write off on taxes or hot stock tips) is that getting stuck in a less valuable contract than you deserve for several years has waaaaay more impact on finances and retirement.

At the end of the day, our offers are not shamefully low and we are wildly thankful to be in a position of bargaining to the better as compared to many who are making less or not working at all in these times(a discussion for another day about how admin handle that issue). The hospital began the discussions saying they live and die by published salary data in making offers but either intentionally misconstrued or misinterpreted the data to reflect a lower reimbursement per amount of work. Further, any consolation on a number of contractual points we brought would have been enough to show some good will but they refused on all accounts (even small things like increasing a CME allowance that is lower than we even got as residents). I am not convinced a lot of the other staff here know their worth and aren't just happy to be making a little more than their buddies in big cities.

[Superior]

I see your point that every admin can suck. But if you know the guy you are dealing with sucks that is different then assuming. It s good to assume they are out to get you but if you catch them and let them screw you over anyway who is to blame.

I do not mean to be overly harsh but if you show good data and they continue to deny that it is correct it might be time to fly.

I agree, and I think we can see that writing on the wall. I think one of us will definitely leave for other options. Call their bluff, if you will.

I am familiar with the statistic that often gets thrown around that X% of physicians don't keep a first attending job past Y years (typically recited as a majority). In your experience: does any stigma develop of docs who change jobs more frequently? I don't mean every few months , but can there be an inference that they were problematic? Or is that really just the norm in this age of physicians as interchangeable employees? I know that in the business world there can be upward mobility in switching companies serially, but at some point we have to settle and build a practice. Not to mention, a community like ours would be hurt (medically) and sad for us to leave.

[familydocPA]

Another point that I think gets overlooked on here and WCI Facebook (where people hem and haw about squeezing an extra $200 into 1099 expenses to write off on taxes or hot stock tips) is that getting stuck in a less valuable contract than you deserve for several years has waaaaay more impact on finances and retirement.

Ain't that the truth. I see myself being guilty of this as well. I can get caught up in the credit card bill being $1000 higher this month, even though that is only $12k per year. Meanwhile, I know that I could easily switch jobs right now and make $50k per year more (I haven't because I truly enjoy my job). Expenses need to be optimized, but once the big stuff is out of the way, the rest just becomes distracting.

Good luck to you in your negotiations. It sounds like you are not in the most physician-friendly environment. I second the other posters' suggestion that I would at least look at some other jobs. That advice was given to me by a mentor earlier in my career -- he said even if you think you would never take the position, just see what else is out there, and you might be surprised. That advice has earned me hundreds of thousands over the first years of my career.

[Sundance]

Yes, a pattern of switching can be an issue or a red flag.. but 1-2 in the first few years is fine imo.

main problem is each future employer will contact all your past employers so you’re increasing the number of potentially jaded people that can sabotage your career

[braindoc]

Base salary typically means guaranteed compensation. It usually applies to incoming physicians or for W2 physicians and those that work at hospital systems. It may only be guaranteed for a short period of time, even less than the contract length. Total comp is base + any production, other bonuses and a sign-on. IMO stop worrying about the surveys. Find out what your colleagues make and try to get that or more. If you see a recruiter add saying "$X income potential" don't even bother. Salary is always significantly lower.

[PCA]

Overall, benefits aren’t included in the base or total compensation figures for MGMA, AMGA, or SullivanCotter. One small caveat would be that the survey respondents may include some independent contractors who get their “benefits” through higher compensation. Although, I don’t think this is something material to worry about as I doubt this greatly affects the survey data

Arguing over survey data can be nebulous and even different appraisal firms approach valuations a bit differently. I speak from experience coming from a fair market value background


I think what braindoc says emboldened below is valuable advice to consider in this particular situation in addition to using the other offers you have

Base salary typically means guaranteed compensation. It usually applies to incoming physicians or for W2 physicians and those that work at hospital systems. It may only be guaranteed for a short period of time, even less than the contract length. Total comp is base + any production, other bonuses and a sign-on. IMO stop worrying about the surveys. Find out what your colleagues make and try to get that or more. If you see a recruiter add saying "$X income potential" don't even bother. Salary is always significantly lower.

Lastly, SullivanCotter data can be a bit lower than MGMA and AMGA. So, if this is the only survey the admin folks are using, I'd definitely ask to see MGMA numbers

[Zaphod]

Yes, a pattern of switching can be an issue or a red flag.. but 1-2 in the first few years is fine imo.

main problem is each future employer will contact all your past employers so you’re increasing the number of potentially jaded people that can sabotage your career

This is now just plain normal. And yes all admin will take you for a ride if any way possible. Sure its covid time, but your hospital should have gotten massive grants/cares/etc...to bridge or make up even more than the gap.

Lets not pretend admin stick around long enough to be there when the call comes in, and frankly have never heard of a hospital or other practice even contacting references personally, they send a standardized form letter which for legal reasons they will usually give you glowing remarks on.

Honestly many of these rural places dont give enough of a premium to come close to the difference in a city, and most is probably imaginary now given all the standard contracts and using of same salary consulting groups. The only huge gain is better pace of life and much lower cost of living, which isnt even huge outside a few select places.

[childay]

This is now just plain normal. And yes all admin will take you for a ride if any way possible. Sure its covid time, but your hospital should have gotten massive grants/cares/etc...to bridge or make up even more than the gap.

Lets not pretend admin stick around long enough to be there when the call comes in, and frankly have never heard of a hospital or other practice even contacting references personally, they send a standardized form letter which for legal reasons they will usually give you glowing remarks on.

Honestly many of these rural places dont give enough of a premium to come close to the difference in a city, and most is probably imaginary now given all the standard contracts and using of same salary consulting groups. The only huge gain is better pace of life and much lower cost of living, which isnt even huge outside a few select places.

I suspect rural premium varies some by specialty. And how rural. Amazon prices are the same everywhere true. Housing costs / taxes can be rather dramatic. No need to keep up with the Joneses here. And I would have to drive a good way to drop some cash at a Michelin starred restaurant etc..

[Tim]

Compensation, job, and location.
It will cost more or be discounted based upon location. In discussions here, many times it’s called competitive or saturated. Maybe there isn’t a premium but most call it discount for urban desirable locations.