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Dermatology, new job search, what should we be looking for?

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  • Dermatology, new job search, what should we be looking for?

    My wife and I will be moving soon from HCOL area to LCOL area, and she is looking for a new job in dermatology (MD). I am wondering if anyone is willing to comment on pay structure upon joining new groups. It seems like most dermatology groups offer a standard salary and incentive once benchmark/goals are met with a set percentage over this mark. For example, base salary of 280k plus 40% of net collections over 275k. My understanding was that overhead in dermatology was pretty low unless there was expensive equipment such as lasers, so it seemed like incentive pay should be higher than other specialties (cardiology, etc.) in many practices. What is the WCI experience? Any tips on finding a new job in dermatology? We do have the ability to start a practice with loans, but my wife is hesitant to invest more of her time with work. Additionally, if she takes an employee position, she will likely deal with a non-compete, which will be tough to deal with if the job doesn't pan out. Thanks for any input!

  • #2
    BUMP. I am sure there are dermatologists on this forum who can give some advice to Redwings13.
    Our passion is protecting clients and others from predatory and ignorant advisors. Fox & Co CPAs, Fox & Co Wealth Mgmt. 270-247-6087

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    • #3
      PM me - also, there are tons of groups on FB for her (sorry you can't join).

      But, every group is different.

      Some will offer base + incentive like you said. 40% is low IMO, more like 45%. 50% is high but not unheard of. The overhead is staff, benefits, all the supplies.

      Also,  highly recommend against "private equity" derm groups.

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      • #4
        edit: duplicate

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        • #5




          My wife and I will be moving soon from HCOL area to LCOL area, and she is looking for a new job in dermatology (MD). I am wondering if anyone is willing to comment on pay structure upon joining new groups. It seems like most dermatology groups offer a standard salary and incentive once benchmark/goals are met with a set percentage over this mark. For example, base salary of 280k plus 40% of net collections over 275k. My understanding was that overhead in dermatology was pretty low unless there was expensive equipment such as lasers, so it seemed like incentive pay should be higher than other specialties (cardiology, etc.) in many practices. What is the WCI experience? Any tips on finding a new job in dermatology? We do have the ability to start a practice with loans, but my wife is hesitant to invest more of her time with work. Additionally, if she takes an employee position, she will likely deal with a non-compete, which will be tough to deal with if the job doesn’t pan out. Thanks for any input!
          Click to expand…


          Both base salary and % of collections seem low for a LCOL area.

          Word of mouth is still the best way to find a job. I would be wary of groups that advertise and/or use a recruiter and haven’t filled for months/years.

          Assuming your wife is gen derm, if you don’t find a job you like, starting your own practice (while scary) is an excellent way to go. As you’ve noted, the downside is more time invested in work than as an employee.

          Non-competes are negotiable and vary based on location (mine is based on miles as I work in the middle of nowhere. I used to work in NYC and my non-compete was measured in city blocks)




          PM me – also, there are tons of groups on FB for her (sorry you can’t join).

          But, every group is different.

          Some will offer base + incentive like you said. 40% is low IMO, more like 45%. 50% is high but not unheard of. The overhead is staff, benefits, all the supplies.

          Also,  highly recommend against “private equity” derm groups.
          Click to expand…


          I agree with the numbers, 40% is low. 45% is average. 50% is great.

          I disagree with the recommendation against private equity. I share some of the same concerns about what private equity will do to our specialty long term. That being said, I currently do work for one (I did not sell my practice to them, I joined as an employee from day 1). I think you have to take a look at each individual scenario and see if it makes sense. I have a contract where % of collections is > 45%. I started with 6 weeks vacation from day 1. I don’t work nights. I don’t work weekends. I don’t work holidays. I don’t work Fridays. I am primarily surgical so a private equity platform that funnels the lucrative surgical cases to me meant starting much further ahead then if I had pursued a solo practice or joined another group private practice (like my last job). I do worry about the long term future of dermatology under these PE models (and whether it is even sustainable at my current rate of pay). But from a selfish viewpoint, I am killing it and plan on being FI very shortly.

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          • #6
            Just went through this myself. Agree with above with percentages. However, the threshold for when the bonuses start seems very good. So take that into consideration. Most jobs I saw started bonus at 2-2.5 base salary so yours at about 1x salary seems awesome. Some of my peers had bonuses starting at 3+ base which were not feasible at all.

            When I was comparing jobs, I just made a spreadsheet that showed me the amount of income based upon your expected collections. Made things very easy to compare financially. That doesn’t take into account all the other factors though: staff, EMR, partnership, how long to get busy, benefits, retirement plans, etc...

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            • #7
              I used to work for private equity in LCOL and it wasn't all bad other than I made about 30% due to their Byzantine compensation formula.

              I'm now with a large multi-specialty group and make straight 50% net billed, plus benefits on top of that. Couldn't be happier.

               

              I would say the best option is to practice geographic arbitrage and find a place that will treat you well like I did. You can always have a kick-****************** vacation home on the coast, mountains or wherever.

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              • #8
                your mistake is that you think physician pay has to do with cost.  profit to the owner has to do with cost.  money you pay employees, even physician employees, reduces owner profit.  incentive pay is the lowest amount you think provides the incentive to keep doing more profitable work.  possibly retaining MDs might be desirable, but also may not be a priority.  see how do you hide a dollar from a doctor joke.



                 

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                • #9
                  Hi,
                  I was wondering if I could get some advice on dermatology salary. Saw your reply to a post recently. I’m a gem Derm in Houston. I know you’re more surgical and working for PE based on your reply.

                  I’m an employee in private practice with 45% compensation. Not private equity. I only get one MA, Med insurance, malpractice, 3 weeks vacation, and $1000 CME. I see about 30 patients a day. I want to negotiate because I feel like my benefits are not good. I’ve only been there for 1 year. Any thoughts? For the amount of work I put in, I feel I should be compensated more. Would love to hear your thoughts.

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                  • #10
                    You don’t get what you deserve, you get what you negotiate.

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                    • #11




                      Hi,
                      I was wondering if I could get some advice on dermatology salary. Saw your reply to a post recently. I’m a gem Derm in Houston. I know you’re more surgical and working for PE based on your reply.

                      I’m an employee in private practice with 45% compensation. Not private equity. I only get one MA, Med insurance, malpractice, 3 weeks vacation, and $1000 CME. I see about 30 patients a day. I want to negotiate because I feel like my benefits are not good. I’ve only been there for 1 year. Any thoughts? For the amount of work I put in, I feel I should be compensated more. Would love to hear your thoughts.
                      Click to expand...


                      I'm assuming this question was targeted to me.

                      A couple of items I would ask for:

                      - definitely more rooms and more MAs. When I did do gen derm, I required a minimum of 2 MAs, quickly moved up to 3, and was on the verge of asking for 4 before transitioning to an all surgical practice. It definitely makes seeing higher volume a more manageable task. The drawback is that they would usually ask me to see more volume to accommodate the increased overhead. If you are seeing 30+ patients a day, I still think 2 MAs is a more than reasonable request.

                      - vacation seems a little light. If I recall correctly, I'm fairly certain I got 4 weeks vacation as a resident and 1 week for CME. Negotiations for me would have to start at least at 5 weeks (so ask for 6+). On a productivity model, I don't take all my vacation anymore but I want it written in my contract that I have the option to do so if I desire. I don't have separate CME time but you may want to negotiate vacation time and CME time separately.

                      - CME fund seems a little light too. I'd ask for at minimum $3000 for CME (if you go to 2 conferences, the registration fees usually burn through the $1000 already) AND coverage for other expenses (e.g. medical license renewal, society fees/dues, MOC nonsense, etc)

                      If you are seeing 30+ patients per day and doing a good job with it, that's fairly high volume for general derm. The general derm market is robust enough that you shouldn't have to settle for a job where you feel underpaid.

                      I don't like threatening my current employer with another offer as I feel it only leads to a poor work relationship. I'd quietly search out another job opportunity as a Plan B, ask for the items I wanted at my current practice, and if they decline to play ball, I'd walk (especially in general derm). I would expect they should meet or at least be willing to work towards most of your requests: a 2nd MA, 4+ weeks of vacation, and a slightly larger CME fund is definitely not anywhere close to unreasonable.

                      Best of luck

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                      • #12




                        Hi,
                        I was wondering if I could get some advice on dermatology salary. Saw your reply to a post recently. I’m a gem Derm in Houston. I know you’re more surgical and working for PE based on your reply.

                        I’m an employee in private practice with 45% compensation. Not private equity. I only get one MA, Med insurance, malpractice, 3 weeks vacation, and $1000 CME. I see about 30 patients a day. I want to negotiate because I feel like my benefits are not good. I’ve only been there for 1 year. Any thoughts? For the amount of work I put in, I feel I should be compensated more. Would love to hear your thoughts.
                        Click to expand...


                        45% is fine as an employed private practice derm.  As long as the group collects well and doesn't have a horrible payer mix, compensation should be reasonable for whatever amount of work you do.

                        Will they get you more staff if you want to see more patients?

                        Maybe you could get a little more CME or vacation.  That seems a little low.

                        If this is a partnership track position, it's really not bad at all.  If it's not, I still think it's OK.  You could easily do worse.

                         

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                        • #13
                          Thanks for everyone's input. Sorry for hijacking this post but I think it will be good for your wife to know these things as well. What to negotiate for.

                          I am going to ask for more CME, vacation time and MA's.

                          My MA situation isn't so good because getting a second MA will be tough for lots of reasons. First, we have a high turnover. The other 2 physicians only get one MA as well. How can this work? While the three of us work at the same time in the clinic, we all share 2 rooming MAs at the same time. So, it is as though we all get 1.5 MA. This slows us down but the other physicians seem not to care as much about this inefficiency. They have been there for more than 10 years.

                          It makes me want to leave the practice unless some things start to shape up.

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                          • #14
                            What would be a reasonable percent collections for a derm that works as an independent contractor (no base salary)?

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                            • #15




                              Thanks for everyone’s input. Sorry for hijacking this post but I think it will be good for your wife to know these things as well. What to negotiate for.

                              I am going to ask for more CME, vacation time and MA’s.

                              My MA situation isn’t so good because getting a second MA will be tough for lots of reasons. First, we have a high turnover. The other 2 physicians only get one MA as well. How can this work? While the three of us work at the same time in the clinic, we all share 2 rooming MAs at the same time. So, it is as though we all get 1.5 MA. This slows us down but the other physicians seem not to care as much about this inefficiency. They have been there for more than 10 years.

                              It makes me want to leave the practice unless some things start to shape up.
                              Click to expand...


                              Why is this sort of thing constantly a problem for practices and physicians?

                              It just makes no sense. If the return is indeed positive enough to pay for them and account for anything else, its really short sighted to worry about the nearly lowest paying addition you can do in a drs office.

                              Gather some data on productivity now, get a probationary MA for a quarter, compare the data again so you have some hard numbers to use. If it shows revenues increased more than costs, you're done.

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