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First Academic Job (Neurology) workweek negotiation

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  • First Academic Job (Neurology) workweek negotiation

    I'll be finishing fellowship this summer in a non-procedural Neurology subspecialty, and will likely be staying on with the institution v. going to private, multistate group. I'm inclined to stay in academics due to the diversity of career that I see for myself (teaching, multidisciplinary clinics, other opptys, but not necessarily research) and hopefully not quite as much straight clinic which I feel could burn me out in the long term.

    The private institution would have me do 8 half-days of clinic, with 1 weekday off a week (can be used for anything, don't have to stay in the institution). As part of my discussions for the academic job prior to any offer letter being sent out, the "agreement" was that I would have between 6-7 half-days of clinic. I got the offer letter back- it says 8 half-days, although over time that might be reduced (filled by tele-neuro, covering inpatient, multidisciplinary clinic, resident clinic). With the academic job 0.75 days is used for conferences and the sort which I am basically expected to attend, which leaves me one morning where I could start at 1030 or so, ie 2.5-3 hrs "off".

    I guess this is a little bit of a stream of consciousness moment and maybe I'm being a bit whiny and unrealistic, but part of me thinks I should at least ask for 1 half-day of admin/chart completion/preparing lectures,etc. time right off the bat instead of growing into it. Especially newly minted attendings in similar fields (IM subspecialties, etc.), or those who still remember starting, how much admin time did you have and what were your expectations for that time? I feel like where I did residency, several attendings had at least 1.5 days of admin time that I for sure know they were not spending in the hospital or doing "work" with, but otherwise I have no comparison.

    If it helps, the proposed criteria is based of 1.0 FTE, 90% clinical, 5% education, 5% investigation. Base and total comp are slightly under the median benchmarks, but not by much. Thanks!

  • #2
    Nothing wrong with asking for admin time off the bat, but the reason that they may have not wanted to give you any admin time off the bat is because your clinic is usually much slower when you first start so you may have time just sitting around even in your clinic time. My wife is an academic surgical subspecialists and uses her admin time to come home early to pick up the kids or go into work late to drop off the kids when needed. It is definitely helpful, I know that she works on lectures and finishes charts or schedules meetings when she is actually doing admin work on her admin time. If they don't schedule you any admin time, you may just end up doing that work at home. Not the end of the world, you may want that time doing clinical work if you are trying to meet some production bonus, but obviously not idea either.

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    • #3
      “As part of my discussions for the academic job prior to any offer letter being sent out, the "agreement" was that I would have between 6-7 half-days of clinic.”
      When you add in the .75 day on top the 4 days of clinic that leaves you .25 days of admin time. The reality is you will not be able to control the .75 day for conference. Your 2 hrs admin will be whatever is left. That is not what you expected.
      Realistically, what you want is one day admin with the meetings/clinic in the 4 days. No meetings, 8 1/2 day clinics. If they schedule .75 day meetings, 6.25 clinic.
      It’s perfectly reasonable to attempt 1 day admin time. The clinics and meetings get the 4 days.
      The point of contention is the required meetings, subtracted from clinic or admin. Advantage them or you. You do have one advantage, it was previously discussed. Discuss again, is there a way to protect one admin day? Of course they may say no. The 8 1/2 days clinics will put admin time on you whenever they use the meeting time.

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      • #4
        In part it depends on how busy you will be in clinic. If you have to build your practice and there is a concrete schedule of how you get more time off as you get busy then it might be ok. At our place a new Neurology attending would be booked up in general Neurologist clinic right away. It would take time to build a practice in their subspecialty and use that to replace general Neuro. But there would be no time twiddling their thumbs with empty clinic slots.

        If you are in academic practice but not doing research, what would your longer term career look like? Are there people who are happy and successful in that sort of position?

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        • #5
          If you are paid on production then it becomes an issue with how much you want to be paid. I would be willing to skip the admin time if I was well compensated for it. However if it would be the same either way then of course snag some admin time. You know that you will be doing a ton of work off the clock and 4 hours of admin time would not likely even make up for that.

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          • #6
            Thanks for the perspective! I'll be trying to at get down to 7 half-days. We'll see what that does to the base. In hindsight, I wonder if they came up with that number expecting I would negotiate schedule, and not ask for more base.

            Benchmark (total comp, which they use) from AAMC 2018-2019 Asst Prof: median $222K https://www.aamc.org/system/files/20...arydata-md.pdf

            Given that since 2013, $ has been going up yearly, I got the mean projected change (from past data) to next year of +4.65%. So I would feel comfortable asking for up to 232K total comp to get to 50%

            Offer: 200k base + 15k bonus + 10k startup cost + 3k CME = 228K, so not much below what I project the mean to be.
            "Total comp includes fixed/contractual salary, medical practice supplement, bonus/incentive pay, and uncontrolled outside earnings and excludes fringe benefits"

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            • #7
              The main reason I wanted some admin time in addition to chart completion, is to spend some time working on education and perhaps a small amount of research. For some efficient clinicians, there is potential production bonus, and inpatient time is additionally compensated-- need to learn more about these (usually worth more than the opportunity cost of not doing clinic that week).

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              • #8
                Comp will change by geographic area. Is stroke coverage part of the deal? That can really change things. Have one of the recommended contract services on WCI review your offer and get a compensation and benefits analysis. They should give you MGMA data so you can see where the offer stands.

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                • #9
                  Originally posted by braindoc View Post
                  Comp will change by geographic area. Is stroke coverage part of the deal? That can really change things. Have one of the recommended contract services on WCI review your offer and get a compensation and benefits analysis. They should give you MGMA data so you can see where the offer stands.
                  Only will be seeing stroke followups inpatient to a limited degree; stroke team covers acutes. Good point about the contract services, will either do a local attorney or contract diagnostics mainly for legalese-- I already know their benchmark data (AAMC), so I'm not sure an updated MGMA 2019 info would be that beneficial (2018 MGMA Academic base median 207K; 238K total for my region-- which seems a tad higher than AAMC)

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                  • #10
                    Originally posted by Pupsicle View Post

                    Only will be seeing stroke followups inpatient to a limited degree; stroke team covers acutes. Good point about the contract services, will either do a local attorney or contract diagnostics mainly for legalese-- I already know their benchmark data (AAMC), so I'm not sure an updated MGMA 2019 info would be that beneficial (2018 MGMA Academic base median 207K; 238K total for my region-- which seems a tad higher than AAMC)
                    A healthcare attorney might be worth it.

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