In today’s competitive market, physician compensation can vary based on a variety of factors. The Affordable Care Act has created an increased need for physicians in all specialties, but knowing what to expect when it comes to compensation can be difficult. Of course experience affects what you’re worth to an employer, but there are other factors, too, including location and demand. And you have factors to consider beyond salary—signing and performance bonuses will also affect your overall compensation.
Physician compensation in high-demand specialties
Based on a national sample of physician and advanced practitioner searches, Merritt Hawkins’ 2015 Review of Physician and Advanced Practitioner Recruiting Incentives provides an indication of the types of physicians currently in greatest demand, along with the types of medical settings in which they are recruited.
The chart below shows the average compensation package for physicians for that survey’s top four most in-demand physician specialties, not including production bonuses or benefits.
As you can see, compensation ranges vary widely, even within specialties. For example, a family practice physician can expect an annual salary range between $130,000 and $330,000, with an average of $198,000 per year. The upper and lower limits of this model differ by more than 250 percent, further demonstrating that other factors are in play when determining overall compensation.
Other factors that affect compensation
What are those other factors? To varying degrees, all of the following developments have had an impact on the recruiting incentives offered to physicians:
Continued expansion of the Affordable Care Act
The accelerating closure of rural hospitals
The implementation of population health management through integrated organizations, such as accountable care organizations
The expansion of telemedicine, with one third of physicians now using some form
Increased scope of practice and demand for advanced practitioners, such as PAs and NPs (NPs can now practice independently in more than 20 states.)
The health care system continues to evolve, but whether care is delivered in small, independent and unconnected silos, orin vast, integrated health systems, and regardless of whether volume or value is rewarded, physicians will be the paramount providers of care and drivers of health care economics.
According to the Boston University School of Public Health, physicians receive or direct 87 percent of all personal spending on health care in the current volume-driven system through hospital admissions, test orders, prescriptions, procedures, treatment plans and related activities. The total combined economic output of patient care physicians in the U.S. is $1.6 trillion, and each physician generates a per capita economic output of $2.2 million while supporting approximately 14 jobs, according to the American Medical Association’s 2014 Economic Impact Study.
As a practicing physician, you have lots of options regarding your career. Keep in mind that your skills are in high need, and compensation will vary. The key takeaway is to make sure that you are informed on the recruiting incentives that are being offered in the area where you would like to practice.
There is always room for negotiation, and benefits—including longer vacation time and performance bonuses—can also be factors in determining which type of positions are more in line with not only your career aspirations, but also your specific lifestyle.
During the course of your career, you will make many changes: finishing training and taking that first job, advancing within an organization, switching jobs, moving to a different town or, eventually, retiring.
You may initiate many of these changes. Family situations may cause some. Your employer may precipitate others. Still others may result from mergers, acquisitions, affiliations or consolidation as health care continues to evolve. Regardless of the cause of a change, when it is about to occur, you will need to evaluate and compare multiple opportunities.
Comparing opportunities by weighing the costs and benefits of various options is critically important. And crucial to a proper cost/benefit analysis is the understanding of what is most important and viable to you in both the short- and long-term. Which job will protect your future and provide you the flexibility you need for the next opportunity you’ll pursue down the road?
Weigh it: Familiarity
The road through residency and fellowship can be long and winding with an uncertain future. After finishing training, you might weigh the option of staying at the same academic medical center.
There are benefits to staying in the same environment: continuity, familiarity, and the opportunity to teach junior residents whose strengths and weaknesses are known. There are also potential costs to staying at the institution where you trained. You may struggle to be seen as a peer rather than a trainee. You may find upward advancement difficult in a crowded division or department. And you may be more accepting of less compensation in exchange for the comfort of staying at a familiar institution.
To help you evaluate
If you’re considering whether to stay in your current program or not, ask yourself:
What is my relationship like with my mentors here? How long will they practice here?
What are the growth opportunities?
Will I always be viewed as a resident or fellow, or will I be able to be viewed as a colleague?
Would I be better off in a different environment that would broaden my professional experiences?
Geographic location, quality of life and benefits were most important to Caren Kirschner, M.D., as she evaluated opportunities. · Photo by Colin Lenton
Caren Kirschner, M.D., had three primary considerations when comparing opportunities after completing residency at St. Christopher’s Hospital for Children in Philadelphia: geographic location, quality of life and benefits. Each was of equal priority, and more important to her than other criteria such as starting salary or advancement opportunities.
Kirschner chose to join a private practice, but familiarity still played a role. “I grew up in the Philadelphia area and went to medical school and completed my residency in Philadelphia. I knew I wanted to stay in the immediate Philadelphia area, and I really wanted to avoid an unpleasant commute,” she says.
Weigh it: Geography
As in Kirschner’s case, geographic location is a top consideration for many physicians comparing job options. Geographic preferences are mostly personal, but there are also practical and legal issues regarding the area in which you choose to work.
Professional liability insurance costs vary among regions largely because of each region’s reputation of being provider-friendly in legal matters and because of its history of suits, judgments and settlements. If the cost of professional liability insurance is significantly more in one community than another, that may affect the salary that can be offered by an employer—and your choice to practice there.
Practice comparing offers with these sample scenarios
Comparing markedly different offers can be daunting. Here are a few sample employment terms to help you see how different options stack up.
Offer 1: Independent contractor
Offer 2: Employed position
Offer 3: Partner
If you receive an offer as an independent contractor, you should expect an above-average salary, fewer benefits, and fewer strings attached if and when you decide to leave. If the offer is for an employed position, you should expect a lower salary than an independent contractor, a full slate of benefits, and more strings attached—but also more protections if either party terminates the agreement. A partnership opportunity should bring greater risk and reward in the forms of variable income, shared liabilities, bonuses, etc.
Offer 1: Guaranteed salary
Offer 2: Production-based
Offer 3: Draw
If you are offered a guaranteed salary, you will have the consistency of knowing what you will be paid, but you also won’t have as much income growth potential. An offer with a production-based salary (RVUs, net collections, per shift) comes with uncertainty but also higher income growth potential. A draw is basically a salary that is paid to you over a certain time period that will be altered based on your production—supplemented if your production creates more income than expected and debited if it creates less.
Offer 1: 2 years and 10 miles in New York City
Offer 2: 2 years and 10 miles in rural Kentucky
Offer 3: 10 years and 100 miles anywhere
Noncompete clauses are also called restrictive covenants. They are intended to ensure that you can’t directly compete with your previous employer upon termination. In these sample scenarios, Noncompete A is reasonable since it would be possible to find employment outside of a 10-mile radius of a location in New York City. Noncompete B, on the other hand, is not as reasonable considering the location. In rural Kentucky, a 10-mile radius might force you to move a considerable distance to the next population center. In almost every location and situation, Noncompete C is not reasonable and should be negotiated.
Matt Wiggins is the lead advisor and partner at OnCall Advisors, which helps physicians educate themselves on the non-clinical aspects of their lives.
Noncompete clauses prohibit physicians from practicing within a certain distance from their previous employer for a certain amount of time after they leave that employer. A clause’s scope may vary depending upon your specialty, employment setting and the competition in an area. If you know you want to be in a specific community for a long time, a noncompete stipulation may be the most important section of your contract. In states that prohibit noncompetes, you may find that employers include a liquidated damages clause to ensure that physician employees pay damages if they practice within a certain radius during a certain time frame after their employment ends.
Cost of living is another consideration tied to geography. How much of your salary will go toward housing, property taxes, groceries and transportation? Will you need to budget for private school tuition in one practice location and not another?
To help you evaluate
Plan to talk with realtors, local school district officials, leaders in the local hospital and others who will provide objective information. Ask about anything that’s particularly important to you: cost of housing, school options, athletics and other recreational activities, and turnover of other physicians.
Knowing the standard of living that your base salary would provide in a community is also important, particularly when you are considering relocating to an area with which you have limited familiarity. Get a clearer picture of the areas you’re considering with help from these websites:
CNN Money (cnnmon.ie/28PPyEd): A straightforward online calculator.
Sperling’s Best Places (bit.ly/1wO6KTN): A calculator that factors in food, housing, utilities, transportation and health costs.
Bankrate (bit.ly/1gTzoZ0): Detailed cost comparisons for a few dozen common cost-of-living items, from ibuprofen to tennis balls.
The U.S. Department of State (1.usa.gov/1RrNOPI): A list of helpful resources regarding salaries, cost of living and relocation, including links to various chambers of commerce as well as realtor and retirement information.
Weigh it: Compensation
Two jobs that both pay $150,000 annually may result in very different standards of living depending on where each is located. But there are also other factors to consider as you compare compensation. The salary in the contract is just the beginning.
A fundamental premise that you must understand as you compare compensation offers is that your total pay (base salary, bonus, benefits) will be based upon some variation of return on investment—the return you provide on the investment employers make in you. Employers will pay you less than what you generate in revenue because the resulting margin will help fund their other operations, which may include less profitable practices. Your responsibilities—whether clinical, administrative, research or a mix—also affect your compensation.
Employers typically pay physicians based on one of three models: straight salary (with or without bonus opportunities), productivity, or profit-centered.
Straight salary. The straight salary model guarantees you a specific amount of pay for a defined period of time. No matter how hard you work, how many patients you see or how many procedures you perform, your salary remains the same.
Productivity. Under this model, you are paid according to your personal productivity. This may be measured as cash in the door, work relative value units (wRVUs), patient encounters, number of call shifts, overnight shifts or another standard. This model often includes a lower base salary or draw, but the more productive you are, the more money you can make.
The wRVU measurement eliminates bias based on the payer mix of a physician’s patients. For instance, a physician who treats only uninsured patients likely generates far less cash in the door than a physician who treats only privately insured patients. But if they work the same number of hours and see the same number of patients, they should have the same number of wRVUs.
Profit-Centered. A profit-centered model bases your salary on both your productivity and your expenses. Your compensation depends on both the opportunities you have to generate revenue and your ability to keep expenses to a minimum.
If you’re considering an opportunity with this payment model, it is important to understand the approximate revenue you can generate and how expenses are calculated. Are expenses determined pro-rata (for example, if there are five physicians in the profit center, they are each responsible for 20 percent of the expenses), or are they based on some other formula?
For some employers, the compensation model may be negotiable. If you’re more comfortable with one model over another, it’s worth asking your potential employer if their model is flexible. The response will likely depend on the size of the practice and how developed its infrastructure is. Other employers may start you with a straight salary that shifts to a productivity model at some pre-determined point in time.
To help you evaluate
When evaluating offers, “having an objective, unbiased resource to help you set compensation expectations is very important,” advises pediatrician Diane Godorov, D.O. · Photo by Kelly Giarrocco
Diane Godorov, D.O., is a pediatrician who has worked in several different settings including private practice and urgent care. “It is important to know what you are supposed to earn and how realistic it is that you can attain proposed bonuses,” she says. “Having an objective, unbiased resource to help you set compensation expectations is very important.”
One source of objective data is the Medical Group Management Association (MGMA), which publishes several reports compiling annual compensation data for physicians. MGMA data shows how salaries are affected by factors such as specialty, years of experience, size of practice and geographic location and can help you understand the physician marketplace.
For physicians pursuing academic medicine, the Association of American Medical Colleges (AAMC) publishes physician compensation data. AAMC reports include detailed information about how compensation is affected by faculty level, departments and specialties, and the mix of clinical work, teaching and research.
Many employers use national surveys such as the above to set salary and bonus caps at the median or 75th percentile. By creating this cap, an employer can ensure that compensation is based on fair market value and balanced among peers. Ensuring there is a salary floor, too, can ease your anxiety of switching from a job with a guaranteed salary to one that may be variable and based on factors outside your control.
Another compensation factor to be aware of is that, if your practice includes clinical or academic research, your employer may expect you to secure grant dollars to cover part of your own compensation. If the grant dollars are eliminated or reduced, your compensation may be adjusted accordingly. In many instances, receiving additional grants may not increase your compensation, but it can allow additional research to be performed by hiring additional staff.
Weigh it: Benefits
Benefits are an often-overlooked piece of the compensation package, but they can make a significant difference both in dollars and in quality of life.
Q: How open should I be about my other offers to potential employers?
A: Very open. Some physicians think that disclosing information about other offers will cost them money because they are hoping that my group will throw out a much higher number if we don’t know anything about the other offer. That might have been true in the Wild West days of physician recruitment when employers could just “buy” doctors they wanted. In today’s environment with Stark Law, compensation is less of a black box, and more of an open fish bowl. We all have to comply with rules about Fair Market Value, and we all are accessing the same national compensation data. There will still be huge differences between markets based on the reimbursement levels, job structure and the level of difficulty of the search. But I can save you a lot of time by letting you know right away if I can be in that ballpark.
Stop short of sharing actual documents because that makes us a little queasy about integrity issues. Tell me that you are holding a competing offer with a base salary of X, a sign on bonus of Y and projected first year compensation of Z. We also want to know where the other offers are located and whether the offer is an income guarantee from a hospital, a salary from a private practice or a hospital-employed position. That will help us talk you through the apples-to-oranges comparison. We can point out that our offer is lower on X, but has a much higher upside in future earning years and explain why.
Therese Karsten is director of physician recruitment for HCA in the hospital system’s Continental Division.
For Kirschner, “maternity leave was an important consideration of any job offer.” As a pediatrician and a hopeful mother, she prioritized this benefit as part of her job search.
It’s important to understand how the benefits you’re offered compare both monetarily and toward your quality of life. What is the value of the health insurance and vacation time offered, or the funds available for CME? How about the value of the retirement program or the professional insurance coverage offered?
An opportunity with a lower base salary but excellent benefits may actually be better than one with a higher base salary and few or no benefits.
Weigh it: Family Fit
Stuart Ort, M.D., was a successful otolaryngologist in California for eight years. He practiced with one other physician and had no employment-based reason to switch jobs. But as he weighed his happy job situation with a desire to be closer to family in the New York City area, family took the higher priority.
In his search for a new practice, Ort says his “major consideration was finding a non-academic institution or group where I would be able to focus the vast majority of my time and energy on clinical work.”
Ort reached out to friends in the New York City area and ultimately identified a large single-specialty ear, nose and throat practice. Even though it is a much larger practice than his former employer, Ort reports that he is “very happy with how transparent the practice is and the fact that no one feels like they are missing out or are getting unfairly treated.” Despite moving cross-country to a very different practice environment, Ort says his new practice is a “great fit.”
To help you evaluate
To help ensure your new practice and community meet you and your family’s needs, ask these questions:
What is the real estate market and school district like?
Does the community offer access to my and my family’s religious, educational and extracurricular needs?
How close would I be to family and friends?
How is the climate and environment?
What community do most physicians live in? What is the commute like?
What do physicians in the area do when they’re not working?
What do other physicians and their families like best about living and working there?
Comparing your options
Some physicians compare the job-search process to a dating game: you meet a lot of different people interested in getting to know you better, and they all want to see if you are compatible with them. Once you are interested, the employer prepares a contract to make the relationship official.
Mike Srulevich, D.O., who recently changed jobs, was philosophical as he considered a new opportunity. A change in jobs “can be transformative on several levels,” he says. “You may have been doing the job for years, but all of a sudden it’s a new culture, a new schedule and a lot of different personalities.”
Taking a new job, he says, is “like buying a new house: Finding it might be the easiest part.” Once you sign the employment contract, you must “navigate the paperwork, coordinate schedules and unpack life as it formerly was [in order to] start a new and different professional life.”
Just as in house-hunting or dating, physicians who are comparing options must understand and prioritize their own short-term and long-term goals. Choosing among multiple options is never easy. As you weigh the costs and benefits of opportunities, make sure you have carefully defined your own objectives. Additionally, make sure that the language of your final contract is consistent with these objectives and matches your impression of the opportunity. Identifying what matters most to you will help you make the choice that is most professionally and personally gratifying.
Bruce Armon is chair of the health care practice group at Saul Ewing LLP and frequently speaks to physician audiences and other health care audiences. He has helped hundreds of physicians and practices over the years with contractual, compliance, reimbursement and regulatory issues.
The northwest Arkansas area has experienced a growth spurt in the past 10 years; the population has grown, as have cultural offerings and job opportunities. Still, one thing remains the same: a devotion to the Razorbacks, the University of Arkansas’ beloved sports program.
“I moved here in 1987 after my residency training. Since 1990, there are 24 net new people living in northwest Arkansas every day. There is no prediction that that’s going to slow down any,” says Stephen Goss, M.D., president of Mercy Clinic Northwest Arkansas.
Goss was born and raised in southeast Arkansas. Inspired by his upbringing on a farm, he initially planned to become a veterinarian. He attended Ouachita Baptist University in Arkadelphia, Arkansas, where he pivoted onto a medical science track and met his wife. “The college was in my wife’s hometown, and both of her parents were professors at the university.” Goss attended medical school at the University of Arkansas for Medical Sciences, and trained in internal medicine and pediatrics.
Finished in 1875, Old Main is a well-known symbol of higher ed throughout Arkansas.
Goss has two adult sons, both of whom were raised in northwest Arkansas. Goss says the area was a great place to raise kids and that virtually everyone who grows up in the area is a fan of the Razorbacks. “I have season tickets to the Razorback football and basketball games. It’s hard to grow up in Arkansas and not be a Razorback fan. Win, lose or draw, we’re for Arkansas.” Goss says that the University of Arkansas is undergoing a stadium expansion, in part to accommodate the growing number of locals who want to go to games.
This population growth has been great for Mercy Clinic Northwest Arkansas. “We have robust recruitment for Mercy in NWA. We still have plans for much more over the next several years. We’re becoming a really vibrant area in the Midwest. We’re the only community where they have seen a 25 percent growth rate. The closest place to that, in terms of growth, is Austin, Texas,” says Goss. In fact, Fayetteville’s growth appears to mirror the transformation that Austin has undergone, with new housing developments, more restaurants and young professionals moving there every day.
“Our town used to have a small-town feel, but now there are lots of new restaurants, lots of biking trails and many more amenities,” says Goss.
The bike trails are hugely popular among locals, according to Kym Hughes, the executive director of Experience Fayetteville. “The city trails really inspire people to live a healthy lifestyle. Many people are avid cyclists, and they enjoy the system here.” The Experience Fayetteville office is quick to mention the many accolades that Fayetteville has earned from national media, including Best Affordable Place to Live in America and the No. 3 Best Place to Live in America according to U.S. News and World Report in 2016. The city was also ranked No. 23 on Forbes’ 2015 Best Places for Business and Careers.
Dayna Pangle, a physician recruiter for Mercy, says that northwest Arkansas is widely known for its local economic growth. This certainly applies to her organization: “We are in the process of a $250 million expansion; we’re looking at adding 100 physicians in the next five years.”
Says Pangle, “Mercy Hospital Northwest Arkansas is currently 220 beds. We have approximately 135 integrated physicians and 60 advanced practitioners.” Pangle says that her main recruiting focus is primary care, and she is actively looking for primary care physicians. Mercy also has 10 clinics within the health system.
“We offer the opportunity to be part of a larger health care system,” says Goss. “Being part of a larger system lets you be a part of more things than if you were a stand-alone. We’re truly an integrated group of physicians. It’s not a hospital employment model. We have the whole organization integrated. We work together between hospital and clinic. We’re often looking at how we can solve health care issues as a system. We get lots of good traction and more robust programming as a result of that.”
For example, Goss describes their hybrid lab, where surgeons are able to perform a new procedure for the replacement of aortic valves. “Another thing we’ve gotten started is what we call our heartburn treatment center. We’re doing a better job diagnosing and giving better treatment for people with heartburn,” says Goss.
Pangle has another powerful talking point to use when she is selling job candidates on Mercy Hospital: “The University of Arkansas in Fayetteville—and the beloved UA Razorback football team—is just 20 minutes away.”
Al Gordon, M.D., is a family physician at FirstCare Family Doctors-North, part of the Medical Associates of Northwest Arkansas (MANA), a multispecialty group that provides an umbrella for about 75 physicians in private practice to share common administration, marketing and billing offices. Gordon not only helped start MANA, but he also was on the first primary care team for the University of Arkansas athletic department.
Gordon’s relationship with the Razorbacks started in 1994; today he is the head team physician for the University’s Department of Athletics and medical director of the graduate program in athletic training.
“As far as University of Arkansas sports, it’s almost like everyone in the state supports them, no matter who you might be supporting otherwise,” Gordon says. “To be an integral part in that, there’s a lot to be said for that. …The relationships that are formed with these student-athletes, that’s also a big part of why I do it. I have student athletes who participated 20 years ago who are still in contact with me. That means more to me than anything.”
An Arkansas native who grew up in the eastern part of the state, Gordon headed north to Fayetteville for residency after completing medical school in Little Rock.
“In Northwest Arkansas, we’re rather spoiled,” he says. “There are so many things to do, whether you’re a music, art or sports enthusiast. It’s just one of those kinds of areas, and we’re fortunate to have that.”
Another employment option for physicians looking in northwest Arkansas in the Fayetteville Diagnostic Clinic, also part of MANA. The Fayetteville Diagnostic Clinic offers a wide spectrum of specialties at one location, including internal medicine, gastroenterology, rheumatology and sleep medicine.
Or, consider Washington Regional Medical Center, a nonprofit hospital in Fayetteville that’s part of the locally governed health system Washington Regional. The system also operates several specialty clinics in the northwest Arkansas area.
“This is an area where there is a lot of opportunity, and we are recruiting a lot,” says Goss. “A lot of people think, ‘Arkansas?’ But they owe it to themselves to do a little research and see all that we have to offer. It’s a very unique place. We have a nice regional airport, and we’re well-located geographically. We’re not that far if you want to take a drive to Dallas, St. Louis or Tulsa. We have a great public school system, all four seasons, and lots of outdoor activities. It’s a great community, it has good people, and it’s a good place to grow your life.”
Says Gordon: “I like to visit areas all around this great country, but I’m always glad to be going home.”
Having a major university in town helps make Madison a thriving cultural center in the Midwest, with eclectic restaurants, a variety of arts and culture offerings and, of course, sports.
Brad Schmidt, M.D., would be the first to tell you about Madison’s full range of entertainment options. He lives in Madison with his family and is the Medical Director of Inpatient Specialties at SSM Health St. Mary’s Hospital – Madison. SSM Health, an integrated delivery network, operates more than 55 medical group locations and three hospitals across south central Wisconsin.
“I have always been interested in science. I enjoyed combining the biology and science of medicine with connecting with people. I had done a little bit of research, but I missed the interactions with people. Working in a hospital was a way to put it all together. I started as a hospitalist, and (back) then it was a much newer and different field than it is currently,” says Schmidt.
Brad Schmidt, M.D., was born and raised in Wisconsin and is happy to call Madison home. “Our experience has been great,” he says. · Photo by Ueda Photography
Schmidt has enjoyed raising a family in Madison. He and his wife have three children, and they take advantage of the full range of entertainment options in the area. “With the university here there are many sporting events and cultural events. It’s a very high quality of life with a very engaged city. We like that, even though we have so many options, it has a smaller town feel.”
Appropriately, the Schmidt family members are sports fans. “We are diehard Packers fans. We also have season basketball tickets, which has been great over the past few years.” The Badgers are the University of Wisconsin’s Big Ten NCAA men’s basketball team. Schmidt says that there is strong local devotion to the team and that virtually everyone can get tickets to see them play: “In Madison, it’s generally pretty easy to get tickets.”
SSM Health physician recruiter Christopher Kashnig says that Madison’s attractiveness piques physicians’ interest, but what seals the deal is the culture at SSM Health Dean Medical Group, which has been around since 1904. “We tend to be innovative as an employer. We try new things. We try to be state-of-the-art. We pilot a lot of projects and we try to be cutting-edge,” says Kashnig.
For example, SSM Dean Medical Group was an early adopter of the patient-centered medical home. “We received a large grant from a major philanthropic organization to pilot a patient-centered medical home. We chose six of our primary care clinics for a pilot study; we looked at how to structure staffing and workflow.”
In total, SSM Health Dean Medical Group has more than 55 locations in 18 counties across Wisconsin. “We have four big clinics in the city of Madison, five clinics in suburbs of Madison, and the rest are in small towns across Madison. In Madison, we admit to St. Mary’s Hospital.” St. Mary’s is a full-service hospital with 440 beds.
“We are competitive financially with other offers around the country and around the city. We have Madison, and Madison sells itself. Madison has culture, it has sports, it has theater. When you have a big college campus and a state capital, there is a lot to do,” says Kashnig.
Judy Frankel, director of public relations and communications at the Greater Madison Convention and Visitors Bureau, moved to Madison from Long Island, in New York. She was pleasantly surprised by the extent to which Madison is a busy and bustling area. “I’ve been here for 15 years. Madison is an amazing place to raise a family. It has great public schools, and the university is world-class. The university brings in a lot of opportunities for families whether it’s lectures or performances, music and theater.”
For those interested in potential employment opportunities in Madison, another employer of physicians in the area is UnityPoint Health System, which operates a clinic in Madison, called UnityPoint Health-Meriter. UnityPoint operates a number of clinics across Wisconsin, providing family care, urgent care and emergency medical care.
The Wisconsin Office of Rural Health, which serves as a linchpin for a number of state-wide health promotion initiatives, runs a 25-year-strong physician recruitment program to place talented physicians in jobs across Wisconsin. Their nonprofit physician placement program works with clinics, hospitals and other health care providers to recruit physicians who are a match. According to the website, “Physicians placed into these sites promote and sustain a high quality of life, especially in rural, underserved areas.”
Schmidt was born and raised in Wisconsin, and feels good about his decision to stay in the state and build a life in Madison. “Madison has a state-of-the-art performing arts theater at the Overture Center. A family donated $250 million, so we have Broadway shows come through, everything from The Lion King to Stomp. We have a great farmers market with local food products; it’s fun to have those kinds of options and know where you’re getting your milk. That’s what creates the feeling that you have many choices with regard to restaurants, theater, comedy, performing arts, and still feel connected to the local community.”
This applies when it comes to sports, too. The University of Wisconsin basketball team may have the biggest fan base, but the university’s large sports program has something for everybody. “There are ways to enjoy sports beyond the high-profile teams you read about. I can take my daughter to a volleyball meet at the University of Wisconsin. I can take my son to soccer games at the University of Wisconsin.”
Says Schmidt, “Our experience has been great. We feel like our kids get a great education. There are lots of things in Madison that we can choose to have our kids experience. Overall, we love it.”
Whether you “bleed blue and gold” or you’re more of a casual sports fan, you’ll find scores of opportunities in Morgantown to enjoy the West Virginia University athletics program. For physicians, building a career with WVU Medicine offers flexibility and room for upward growth.
“I’ve always had an affinity for college towns,” says Taylor Troischt, M.D., the medical director of a pediatric clinic operated by WVU Medicine. “I like the vibe, I like the variety of culture. You get the amenities without the stress or expense of a big city. My wife’s family lives in Hagerstown, Maryland. We knew we wanted to be closer to her family. When we were looking for jobs, we started by looking at college towns within a two- to three-hour radius of where her family lives. WVU Medicine seemed to be the best situation; we could both find a job in the same field in the same area. It’s not always that easy.”
“I like the vibe, I like the variety of culture. You get the amenities without the stress or expense of a big city,” says Taylor Troischt, M.D., of living in a college town. · Photo by Rebecca Devono
“WVU Medicine offers a really good blend of career opportunities and a good lifestyle,” says Troischt. “We’ve had plenty of opportunities to relocate with other jobs and other areas; the fact that we’re still here says a lot.”
Troischt and his wife, who is also a pediatrician in the same office, had a fairly specific idea of what they were looking for in a community. In Morgantown, they feel they’ve hit the jackpot.
“I love college sports and college athletics. I don’t ‘bleed blue and gold’ like a lot of people who grew up here, but it’s always fun to see the teams do well,” says Troischt. “I love football. I love basketball. We love going to the games. It’s a lot of fun being part of a major athletic conference for basically every sport. It’s great that WVU is part of the Big 12.”
“The sports scene is huge,” says Katie Webster, the visitor services specialist at the Greater Morgantown Convention and Visitors Bureau. “Football season in the fall is an awesome time. Football is the pride of the school and the state. Around the whole state, you see people wearing WVU stuff. Whether or not they went to school there, everyone is supportive of the college.”
“Our academic flagship hospital sits adjacent to the WVU Football stadium and in close proximity to our baseball, soccer, swimming and basketball venues, so sports are never far away from reach and the minds of WVU Medicine employees,” says Deveran George, director of talent management and physician recruitment for WVU Medicine. The WVU Medicine flagship academic hospital and Level I trauma center is Ruby Memorial Hospital in Morgantown. “However, we are also part of a system with more than 12,000 employees and nearly $2 billion in annual revenues, the WVU Medicine – West Virginia United Health System,” says George. WVU Medicine – West Virginia United Health System also operates eight other hospitals and numerous clinics throughout the Morgantown area as well as the state of West Virginia and surrounding region.
Ruby Memorial Hospital is currently 532 beds, but an upcoming expansion, a 10-story tower addition, will bring the count to 646. Other hospitals and associated clinics in the WVU Medicine – West Virginia United Health System include Potomac Valley Hospital, Camden Clark Medical Center, St. Joseph’s Hospital, WVU Medicine Children’s Hospital, the WVU Cancer Institute, and the WVU Eye Institute.
Says George, “It is a time of unprecedented growth at WVU Medicine, so we are expanding and growing our footprint throughout the state and region to meet the needs of our patients, state and surrounding region. … As a result of this growth and demand for our services, we are recruiting for every department—primary care and specialty. Some of the needs and focus include heart and vascular, orthopedics, pediatrics, neurology, oncology, rheumatology and digestive diseases, to name a few.”
For Troischt and his wife, building careers with WVU Medicine and raising their children in Morgantown is a choice they’re very happy with. “It’s a good community where people look after each other. My kids make cracks at me about this: When we’re out, they’ll see me saying hi to four or five families. When you’re a pediatrician in a small town, you’re going to get to know a lot of people.”
Webster says that the Morgantown population tends to be outdoorsy and takes advantage of local outdoor activities. “During the summer it’s especially great, because there is so much to do outdoors. We’re right on a lake and a river, so there’s boating, fishing and water rafting.”
For those interested in a day trip, the great outdoors is just beyond Morgantown.
“Morgantown is surrounded by forests and parks. Within a couple of hours you can get to so many parks, waterfalls and caves. People like to hike and bike on the trails, especially,” says Webster.
Troischt’s son and daughter are both athletes, which increases the family’s affection for where they live. “My kids love Morgantown,” says Troischt. “They have a great peer group. If you put time and effort in, you’ll be amazed what kind of opportunities there are here.”
Troischt says, “My daughter is in the ninth grade; she does track, and she does ballet. She has been busy with her dance career. She’s had amazing opportunities to train with professional dancers downtown at the Metropolitan Theatre. My son is a swimmer and participates in a swim league organized by WVU. His coach is going to the Olympic Trials, and he does lessons one-on-one.”
“It’s really amazing what opportunities a small town like Morgantown can have,” says Troischt. “There is opportunity, charm, safety. You’re not going to find all that in a lot of places.”
Education: Medical school: New York University School of Medicine (2005)
Residency: Yale University, Primary Care Internal Medicine Program (2008)
Blackburn enjoys traveling, exploring new culinary delights, dancing, and spending time with her husband, Tyson Davila.
What surprised you about your first post-residency job search? Many of the academic medicine positions would not even respond back unless my residency program director or chair of the department of medicine initiated the inquiry. This surprised me because I thought a competitive CV, experience and good qualifications were all that were needed to land a dream job. In the end I realized I still needed an advocate to help get past the barriers.
What’s your advice for residents beginning the job search? Don’t rule out opportunities right away. You may have the idea to go into academic medicine in an urban center, but perhaps private practice, rural medicine or hospital medicine may be a better fit. Be open-minded and explore your options.
Anything particularly unique about your job search? I searched websites such as PracticeLink.com, ads posted at national conferences and ads in journals for a few months to get a general overview as to what was out there before doing a more active search. I also spoke to colleagues to elicit their experience in working with different organizations.
How did PracticeLink help you in your job search? It allowed me to search for jobs online without pressure from recruiters calling me all the time. On the other hand, if I wanted to be contacted directly, I could post my CV and have it distributed to recruiters. If I wanted more information, I could click on the request form or call the recruiter. I also enjoyed the articles published in PracticeLink Magazine on writing an effective CV, interviewing and reviewing contracts. Finally, I went to a regional job fair that offered a seminar on the basic steps to the job search.
Med School: Michigan State University, East Lansing, Michigan
Residency: Botsford General Hospital, Farmington Hills, Michigan
Federally Qualified Health Centers (FQHCs) like Family Health Care (FHC) in Baldwin, Michigan, are vital to rural areas. Health centers must meet specific criteria to qualify as FQHCs, including serving underserved populations, offering sliding fee scales, providing comprehensive services, having ongoing quality assurance programs and having governing boards of directors. Physicians who have federal loans may be particularly interested because FQHCs are able to help with the loan repayment of their employed physicians. Baldwin FHC, where Bow practices, is the third-oldest FQHC in the country. The National Health Service Corps, which connected Bow with Baldwin FHC, offers tax-free loan repayment to health care providers who choose to go where they are most needed including NHSC-approved FQHCs.
How did you become an FQHC physician? There are different routes to be taken. For me, I found Baldwin Family Health Care while I was a student at Michigan State. I joined the National Health Service Corps, and they connected me with Baldwin. So the National Health Service Corps paid for some of my schooling. At Baldwin, money has been provided to pay back my student loans while I am working. I believe the state of Michigan has a similar program.
What is your workweek like? I work [a] set workweek, [and] there’s a call schedule to be available to patients after hours to answer questions. There are two other physicians at the center in addition to a physician assistant and a nurse practitioner. [Among] all of us, we handle the call schedule. We rotate for a full week [among] the five of us.
What do you like best about working for an FQHC? That’s easy to answer: mainly the patients. They’re basically hardworking people who live in underserved areas. A lot of them don’t even have the resources that would possibly be available to them elsewhere. I feel like I’m making more of a difference to the people living in an underserved area.
Is there anything you don’t like? The commute. … I don’t live in the same area due to family constraints. That, in a way, can be a challenge, but it can also be mind-cleansing. The commute is the biggest thing—just getting there. However, that’s the whole point of the health center. It’s sometimes a difficult area to get to. That’s why there can be difficulty recruiting. Yet that shouldn’t sway anybody because I think the benefits far outweigh the bad.
What advice do you have for physicians interested in FQHCs? Regarding this or any other job, I would say to visit and do your footwork, investigate and make sure that where you are going is where you want to be. When I teamed up with NHSC, Baldwin FHC was not the only FQHC that I was able to visit. There are other places that are HPSA-qualified [Health Professional Shortage Areas]. I visited all of the places and went to the Upper Peninsula of Michigan, which is pretty remote. I decided on Baldwin FHC because of the benefits the practice offers.
Would any specialty be able to work for an FQHC? It’s mostly primary care. When I say primary care, I’m talking about family practice. I believe pediatrics, internal medicine, gynecology and psychiatry are applicable. I don’t think it applies to orthopedics or surgeons.
What surprised you? Being in an area where I thought there wouldn’t be resources, I was surprised at the number of resources that were actually available. For instance, we actually have a dental center in the same building. So if a patient has a dental need, it’s just down the hall. The resources are a little more than if I were in a private practice. In the U.S., the funding for mental health has really been cut back over the years. In our clinic, because of a grant and the work of the CEO and CMO, we have a behavioral health specialist on site. They’ve been working very hard to foster this because there are a lot of mental health issues out there. It’s a nice bonus to have those specialties readily available for patients. We also provide pharmacy, radiology and laboratory services on-site—kind of one-stop shopping for our patients’ health care needs.
Anything else? If a physician is looking to make a difference, this is the type of facility he or she would want to work in. Most of us go into medicine to help others, and this is a great opportunity to do just that.
In this edition of Tech Notes, we’ll cover three great medical apps that can make you into a more efficient physician: MDCalc, Ottawa Rules and SmartIntern Sepsis. Each of these apps is focused on helping health care providers practice evidence-based medicine. In addition to providing a wealth of information, these apps can be used quickly at the point of care. All of these apps are also free to download and use.
MDCalc: Medical Calculators, Scores, and Clinical Decision Support
Price: Free. App Store Link: apple.co/1Lm4Nac Android Link: Currently not available
It’s hard to find a practicing physician who hasn’t been to MDCalc.com. The popular physician-run website is a go-to for finding medical calculators and clinical decision tools. Thanks to a recent release, the website is now available as an app, also called MDCalc.
This app is now a must-have for any physician; it provides access to nearly every type of medical calculator or decision tool. Although popular clinical decision apps such as Medscape, UpToDate and DynaMed also have their own calculators, MDCalc makes the process much easier because it lets you enter data into decision tools with just one click.
What further separates MDCalc from other medical calculator apps is the amount of evidence-based medicine it teaches. Every clinical decision tool within the app has a section dedicated to the evidence behind the actual equation. Some clinical decision calculators within the app—such as Wells’ Criteria—even have direct quotes from the tool’s creators.
The app is currently free, but in the past the developers have mentioned in its App Store description that they may charge for it in the future.
Ways the app could improve. Unfortunately this app is currently unavailable on Android.
Key ways to use the app. You will no longer need to search for decision tools on Google or on the actual MDCalc.com website. The app loads quickly, and you can use its search function to find the clinical decision tool or medical calculator you want. I would also recommend using this app to learn more about clinical decision tools. If you’re a physician new to the iPhone, this is definitely the most important medical app to download.
In medical school every physician gets taught the decision tools related to the Ottawa rules, which include C-spine, knee and ankle rules. Instead of having to look up these clinical decision tools online, you can now access the Ottawa rules from this free app provided by the Ottawa Hospital Research Institute itself.
Though the app can be used simply to access the tools, it’s much more than that. The app also has videos and commentary that provide a wealth of information about the rules. The videos in particular are a great touch because they explain in great detail the nuances behind the rules.
Ways the app could improve. Overall the app is slick, but it would be helpful if it gave you access to the criteria more quickly. Right now it’s faster to use the MDCalc app or another medical calculator’s decision tools at the point of care. The Ottawa Rules app does, however, contain a wealth of valuable information that still makes it a critical download for those who use these tools.
Key way to use the app. At this time the best way to use this app is for educational purposes. The app is free to download. There are some great figures and algorithms included, and the videos, though not flashy, provide contain great content.
Earlier this year a consensus group published changes to the definition of sepsis in the Journal of the American Medical Association (JAMA), calling for a move away from systemic inflammatory response syndrome criteria in favor of the sequential organ failure assessment score. Also known as “Sepsis 3.0,” this is the first set of new guidelines since 2003.
The SmartIntern Sepsis app takes the new sepsis guidelines and puts them into easily understandable formats. It also has built-in calculators. In addition, the app has educational aspects to it, helping health care providers better understand the new guidelines. There is some controversy surrounding the Sepsis 3.0 guidelines, so it would be prudent for health care providers to read the JAMA study in detail.
Ways the app could improve. Though this app isn’t as popular as MDCalc, it, too, is not available for Android devices.
Key ways to use the app. If you are trying to implement the new Sepsis 3.0 guidelines, this app will help you calculate scores and learn the new algorithms. This app is focused on emergency medicine physicians, critical care physicians and hospitalists.
Iltifat Husain, M.D., is the editor-in-chief and founder of iMedicalApps.com, the leading physician publication on digital medicine, and an assistant professor of emergency medicine at Wake Forest University School of Medicine.
“Why is it that so many of us think that compensation is only about numbers?” asked one internal medicine resident recently. I stared, not knowing how to immediately answer. After helping thousands of physicians with their contracts through the years, I should have a great answer. Then it struck me!
My answer: Most doctors are led to believe that their struggles through training are due to a number, their training program salary, and that everything will be solved by a new number, their attending income.
This means that many physicians probably focus on the numbers in their contracts without understanding the legal apparatus around them. After all, won’t it be the attending income number that helps you pay off your debt? Won’t it be the sign-on bonus number that allows you to cover the expenses during your transition into this next (or first) job?
The best place to start is by understanding the different types of compensation.
Sign-On Bonuses. A true sign-on bonus is given to you within a short amount of time after you sign the contract. A commencement bonus is given to you within a short amount of time after starting your work with the new employer. A sign-on bonus is often preferred as it may give you some cash during a period when you may not be earning any money. A commencement bonus is often preferred by employers since they don’t have to pay it until you are actually working. If you find yourself negotiating between the two, you may have to compromise and take half after you sign and half once you start.
Guaranteed Salary. When it comes to physicians and finances, this is one of the all-time favorite word combinations. Think about it: You have the word “salary” preceded by the word “guaranteed.” Both are good words, and both connote “security.” This is simply a number that is guaranteed by the employer to be paid to you over the course of the contract. Once the contract is signed, it typically can’t be altered by performance or changes within the employer for the duration of the contract. As specialization increases, it seems that guaranteed salaries are less prevalent. Family practice and general internal medicine doctors will most likely see this type of compensation while interventional cardiologists and neurosurgeons will most likely see the next type of compensation: productivity-based.
Productivity-Based Salary. This is when compensation gets exciting and scary altogether. If you are or will be working for an employer that pays you based on your production, you may have the ability to make more money than if you were on a guaranteed salary. However, you also have more risk. If your production is higher than expected, you will be compensated for it and earn more than some of your guaranteed-salary counterparts. If your performance lags behind expectations, so will your income. The most common metrics for evaluating performance are net collections and RVUs although other models, such as capitation methods, are also used.
Productivity Bonuses. By now, some of you are probably thinking that productivity-based income sounds scary and complicated and you will be glad to not have to keep up with such a thing. However, even those of you on guaranteed salaries may have bonuses tied to some production metric. These bonuses are similar to the salary formulas above in that you will only be paid a bonus if your production exceeds the expected metric and covers the base guaranteed salary you are being paid.
Traps and Pitfalls to Avoid
Now I’ll share with you some of the frequent compensation traps and pitfalls we find in physician contracts.
Repayment Obligations. Several years ago, a doctor came to us and told us a story that should cause trepidation in every physician. He had signed his first contract out of training and was looking forward to moving back to his hometown and working as an orthopedic surgeon with the only practice in town. His salary was stated as $500,000 a year. He thought it was a fair offer and signed without much analysis. However, during the course of his first year in practice, some unforeseen matters arose, and he was unable to work as much as was expected. He kept getting paid his salary, for which he was very grateful. However, at the end of the year, the practice sent him a notification that he owed them $300,000! His salary had a repayment obligation on it and, at the end of the year, they would pay him or require from him a surplus or shortfall based on his production. He did not have $300,000 in his checking account and had to borrow the money on top of his already burdensome student debt.
This story is not uncommon and applies to salaries, bonuses and other benefits. Anything you receive from the employer could be required to be paid back in part or full if you are unable to satisfy certain terms of your contract. It’s worth noting that this doctor was savvier than most we encounter and still made this mistake.
Not Knowing or Tracking the Metric. One of the necessities of all sporting events is that the score be kept by an impartial observer or equally by a party from each participating person or team. In the case of production-based salaries or bonuses, many doctors allow one team, the employer, to make the point system and keep score without the doctor, or a representative of the doctor (CPA, attorney, etc.), understanding the system or keeping score simultaneously. One of the top reasons physicians leave their current employers is due to unmet expectations. One of the most prevalent unmet expectations is income and comes from physicians not understanding or keeping track of the variable parts of their compensation.
Assuming the Best. We all know what assuming does … and it can be costly when it involves physician compensation. Don’t assume anything when it comes to your compensation. There is much more than just numbers that impact your income. Miss those items, and your bank account may have the right to sue you for financial malpractice.
For job-seekers of all kinds, it can be hard to know. A simple PracticeLink.com search for opportunities in your specialty will give you an indication of the demand for physicians like you, but without knowing who else is vying for those jobs, it’s hard to get an accurate picture of supply.
The Most-Challenging-to-Recruit Specialties
How many other candidates in your specialty are actively looking for jobs at the same time? And how does that number correspond to the number of opportunities available?
That’s where the PracticeLink Physician Recruitment Index comes in. The Index is a relative indication of the ease or difficulty of job searches in various specialties based on supply and demand information gathered by the PracticeLink system quarterly. The larger the “Jobs per candidate” number for your specialty, the better your potential standing in the market.
The change in rank reflects the specialty’s movement since last quarter.
The Most-Challenging-to-Recruit Specialties are those specialties with the highest demand-to-supply ratio in the PracticeLink system. The specialties on this list likely won’t come as a surprise to candidates; they’re often narrow fields.
The Most-In-Demand Specialties
The Most-In-Demand Specialties represent the specialties that have the most jobs overall posted on PracticeLink—specialties for which the demand for physicians is highest. For the Index, we then rank those in‑demand specialties according to the supply. Those at the top represent specialties with the most jobs available and the fewest candidates per job.
After reading these Indexes, ask yourself: Do these Indexes match your experience of searching for a job in your specialty? Do you need to widen or narrow your job-search parameters as a result?
This PracticeLink Physician Recruitment Index was pulled July 6. Candidate ratios include physicians who have registered with PracticeLink.com within the past 24 months.