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  • Asking for salary raise

    I’m a family medicine/sports medicine doctor in practice for one year. A private practice orthopedist who was one of my rotation mentors during fellowship invited me to his group which was a large orthopedic surgeon-only practice. The group offered me a starting family med physician salary which is on average 30-40k lower than a starting non-surgical sports medicine salary in my area. I was contemplating on negotiating but the mentor said it was a take it or leave it situation. At the time due to COVID there were no other sports medicine jobs anyways so I took it (plus there is no term and no non compete so I didn’t feel locked).

    Fast forward to present. I enjoy my job a lot. The practice is like a constellation of independent practices so there is a lot of autonomy. The group encourages more of an “eat what you kill” model however rather than salary. The overhead cost is quite high. My practice and revenue is growing, but not as fast enough for me to adopt an eat what you kill model yet. CEO said I was young and impatient (but added that’s a good thing).

    I have student loans that I’ll need to refi soon and it may be a bit difficult for me financially then (non-working spouse & child). I’m wondering if it be reasonable now to approach the practice for raise (at least closer to a starting sports medicine salary)? I feel like I was more of an experiment back then since I’m their first non-surgical doctor but now I think I’ve shown I’m eager to work and proven some value to the practice (or so I hope), despite not making enough to switch to eat what you kill model yet. Or would this leave a bad taste to the practice?
    Last edited by kev777zero; 07-25-2021, 11:34 PM.

  • #2
    “I’m a family medicine/sports medicine doctor in practice for one year.”
    ”not as fast enough for me to adopt an eat what you kill model yet.”

    Not familiar with the financial details, but a non-operative sports medicine doc is “complimentary” to the “operative” sports medicine docs. The “eat what you kill” model assumes an equitable split of overhead. I think it is reasonable to have a discussion about the model as it relates to covering costs. If you aren’t covering your direct comp and benefits, the question is quantifying the complimentary services. There is value there.
    Some larger use non-operative sports medicine docs and trainers. The total business is better when the operative focus on that and subsidize the others. Just a guess, you won’t complete with a direct “eat what you kill model”.
    You provide service to the practice as well as to the patients. That could be the disconnect with the difference in comps. That discussion with the CEO regarding the business plan should not
    leave a bad taste. There is a market for non-operative sports med docs. You may be short volumes or not. That is available too. Know your value and make your choices.

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    • #3
      Prideful perhaps but I don't ask for a raise unless I'm prepared to walk if they refuse. It is unfortunate that you went in low although I totally get it with the state of affairs at the time. I don't like working for less than I feel I'm worth however since you are not at the Eat What You Kill phase I would not ask for a raise at this time because essentially you haven't proven yourself to be a producer yet. It is kind of a unique situation and I'm interested to see what other physicians advise.

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      • #4
        Does your practice have ancillaries (PT and MRI)? If so, you’re contributing to the owners bottom line by sending your patients. You’re also seeing patients while the partners operate. I think it would be good to have a discussion with the CEO about your value to the group and a possible raise.

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        • #5
          Are you bringing in more than you're paid? If not, I would hope they don't notice and I certainly wouldn't bring it to light. If so, I would be cautious given the original 'take it or leave it' offer and make sure I had a backup plan because even if you're denied an increase and stay on, the relationship may be changed for the worse.

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          • #6
            Originally posted by CordMcNally View Post
            Are you bringing in more than you're paid? If not, I would hope they don't notice and I certainly wouldn't bring it to light. If so, I would be cautious given the original 'take it or leave it' offer and make sure I had a backup plan because even if you're denied an increase and stay on, the relationship may be changed for the worse.
            I am bringing in more than my salary. I'm covering my direct costs already (rent, my own and my MA's salary), but not covering all the indirect costs on a monthly basis yet (EMR, Admin fees, shared front desk, etc...)

            I can and I am willing to see 30+ patients a day which would easily beat out these costs, but it's been harder than I thought to establish enough of a patient population. My clinic can vary from 10 patients a day to 35 patients a day.

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            • #7
              Originally posted by kev777zero View Post

              I am bringing in more than my salary. I'm covering my direct costs already (rent, my own and my MA's salary), but not covering all the indirect costs on a monthly basis yet (EMR, Admin fees, shared front desk, etc...)
              If you aren't covering your share of total costs then you're not bringing in more than what you cost them.

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              • #8
                Originally posted by kev777zero View Post

                I am bringing in more than my salary. I'm covering my direct costs already (rent, my own and my MA's salary), but not covering all the indirect costs on a monthly basis yet (EMR, Admin fees, shared front desk, etc...)

                I can and I am willing to see 30+ patients a day which would easily beat out these costs, but it's been harder than I thought to establish enough of a patient population. My clinic can vary from 10 patients a day to 35 patients a day.
                Are you willing to ask them for your income:expense statement for the year. You billing and net collections and the direct and indirect costs. There might be some value if you are referring ancillary services in house and some portion of the revenue can be assigned to you. But in the end if you are paid more than what you cost, don't ask for a raise yet.

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                • #9
                  You'll probably have to see 30/day to be profitable.

                  We run all our nonop employees through the same overheard model. We know exactly down to the $1 where they stand on a monthly basis.

                  As your value increases, you can negotiate a raise, share of ancillaries, partnership, etc.

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                  • #10
                    if you're only a year in and your know you aren't totally covering your overhead i would treat pretty carefully asking for more money.

                    heard a great reflection on the workplace regarding different employee expectations for compensation:
                    perseverance - "i've been here a long time and i deserve more money"
                    potential - "i can do great things if you give me more money"
                    performance - self explanatory

                    just make sure your argument focuses on #3 not #2.

                    also wonder if there's things you can do to market yourself? buy lunch for PCPs in the area, maybe ask to have coffee w/ your local ED med director etc

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                    • #11
                      If you are at the practice for less than a year, I would bet the majority of your business is patients coming to the practice due to the practice's "goodwill and reputation" not you as an individual. It takes years to build up a good reputation and patient practice. I would be care to make demands unless you have a substantial skill or expertise that can not be easily replaced. Most new physicians underestimate the process , hard work and good business sense it takes to have a long term successful practice. Seeing patients is only a small part of what it takes, in fact that is the easiest part, at least in my opinion. The first order of business in successfully negotiating an increase in wages is to prove you a worth more, which usually translates in medicine into the higher than normal volume of patient encounters or procedures. A 99214 is a 99214 no matter how you slice and dice it.

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                      • #12
                        Originally posted by CordMcNally View Post
                        Are you bringing in more than you're paid? If not, I would hope they don't notice and I certainly wouldn't bring it to light. If so, I would be cautious given the original 'take it or leave it' offer and make sure I had a backup plan because even if you're denied an increase and stay on, the relationship may be changed for the worse.
                        Yeah, I mean they could be allocating a ton of overhead that is unfair, but I'd figure that out before asking for a raise. Make sure you know what you're producing and receiving at least in broad strokes and what the competitive other offers are.

                        Otherwise, please take the above quote so directly to heart you feel it deeply. No one cares how committed or how hard you work if you arent making it into the black. It always feels like you're working hard when you first start out, you're just inexperienced, soon you'll do double and it will feel easier. This is normal.

                        If this happened to me and you were a net cost but just gave the warm fuzzies, well, I'd wish you the best of luck on your new venture, dont steal any pens on the way out.

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                        • #13
                          My understanding is that part of what non-op sports medicine do is to screen patients in part so Ortho can focus more on patients that require surgery. That is hard to put a hard number however. Like hospitalists, a part of their value is so surgeons can do what they do best (including making more money).

                          Also, at least where I practice, non-op sports medicine is very competitive, we had like 50 applicants for 1 opening, so they probably know you are easily replaceable if in a desirable location.

                          I would be very careful about asking for a raise right now, too soon.

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                          • #14
                            What do you collect and what are you paid is what you need to know... What goes into calculating your collections?

                            If you are paid I would venture 40+% of what you collect then the issue is your production.

                            If it's significantly less than that, it might be the groups overhead that's the issue, then you could potentially wander down the argument of how your field just can't generate collections high enough to work in their model... but tread carefully... their response may be 'then we don't need your field'

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                            • #15
                              Thanks for the advice guys. I’ll keep quiet for now.

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