Is moonlighting right for you

The pros and cons of working extra shifts.

By Karen Edwards | Fall 2019 | Feature Articles

 

Moonlighting gave Justin Smith, M.D., experience in clinical decision-making. – Photo by Lindley Battle

Moonlighting isn’t a new practice, but lately, it’s become increasingly common. The physicians choosing to do it span a wide variety of specialties and settings. Some begin moonlighting as early as their second year of residency, while others pick up additional shifts even after they’ve officially retired.

Physicians’ reasons for moonlighting vary, but the increasing trend can be traced, at least in part, to a shortage of physicians. In 2016, the Association of American Medical Colleges predicted that the U.S. will face a deficit of 61,700 to 94,700 physicians by the year 2025. No wonder more and more opportunities to moonlight are becoming available. Here’s what you should know as you consider whether or not those opportunities are right for you.

Internal vs. external moonlighting

“There are two types of moonlighting,” explains Richard Williams, M.D., residency program director at the University of Nevada, Reno. Internal moonlighting means picking up extra shifts with your current employer or, if you’re in residency, within your residency program under faculty supervision. External moonlighting means working for a different hospital or employer altogether.

Since many residents are working with a limited license, external moonlighting isn’t an option for them. However, some residency programs, including the University of Nevada, do offer internal moonlighting opportunities. “The faculty supervision and moonlighting within the residency program is why internal moonlighting can be done with a limited license,” says Williams.

Behind the moonlighting controversy

Before you sign up for extra shifts, it’s important to recognize that the practice is sometimes controversial, especially for residents. Some residency programs won’t allow moonlighting, period. Others only allow third-year residents to moonlight. Most require residents interested in moonlighting to receive written approval from a supervisor or program director.

At the University of Nevada, for example, moonlighting by residents is permitted but not necessarily encouraged. “Any discussion of moonlighting in our program is driven by the residents,” says Williams. “It’s not something we bring up. The university’s moonlighting policy is published on our website, so if a resident wants to see what it is, there’s that option.”

Beyond program-specific rules, residents must obey the Accreditation Committee for Graduate Medical Education’s guidelines. The ACGME has capped the number of educational and work hours for residents at 80 hours per week. “The 80 hours applies to all work the resident performs, whether the extra shifts are internal or external,” explains Catherine McCarthy, M.D., professor of family and community medicine at the University of Nevada. Picking up extra shifts runs the risk of putting residents over that limit.

As for hospitals, most consider staffing moonlighting shifts “a necessary evil,” according to Dan Bensimhon, M.D., who moonlighted as a cardiology fellow. Keeping a hospital staffed at all hours is a logistical nightmare. A flu epidemic or mass emergency could strike at any time, but a lull could leave them overstaffed with full-time doctors—at the expense of a hospital’s bottom line.

“Many hospitals will typically staff toward their average census for a given season and fill the gaps with part-time physicians or doctors looking to pick up extra shifts,” explains Bensimhon. “Others will contract with locum tenens groups to fill those slots.”

This may explain the increasing number of physician-founded, physician-owned companies picking up the moonlighting baton. Suneel Dhand, M.D., for example, cofounded DocsDox, an online resource that connects moonlighting physicians and health care facilities, and Bensimhon formed Moonlighting Solutions to help physicians find moonlighting opportunities and help hospitals understand their staffing needs.

Some of these companies cater specifically to non-hospital employers. CrowdRx, founded by Andrew Bazos, M.D., an orthopedic surgeon specializing in sports medicine, provides medical services to concerts, sporting events and other large events. Its chief operating officer, Connor Fitzpatrick, says that while these setting are different from a hospital, the same skill sets are required.

The advantages of moonlighting

Financial benefits

For residents especially, the extra money moonlighting provides is alluring. “You’re restricted by what you can make as a resident,” says Daniela Lamas, M.D., a pulmonary and critical care physician. When she began to moonlight, the extra paycheck gave her more money than she was making as a resident—and her first taste of the future.

“I saw it was possible to make good money at something I love doing,” she says. The extra shifts also helped with student debts and the high cost of living during her residency at Columbia University College of Physicians & Surgeons in New York City.

Paying down debt is a powerful motivator for many physicians, but there are other ways to generate income outside of moonlighting shifts. “I never moonlighted as a resident,” says Joel Schofer, M.D., although he now does so in addition to serving as a military emergency care physician. During residency, he earned extra cash by writing articles for professional publications.

Of course, residents aren’t the only ones who enjoy the financial benefits of moonlighting. “Traditionally, there were two main groups who moonlighted: Physicians at the beginning of their careers, including residents and fellows, who moonlighted to supplement their income and pay off debt,” says Dhand. “The second group included physicians at the end of their careers who were looking to wind down their practices but also continue their income stream.” Schofer notes that more and more physicians lately have turned to moonlighting to supplement stagnant income levels.

Increased independence

Justin Smith, M.D., is an electrophysiology fellow at Wake Forest Baptist Health and a hospitalist for Cone Health Medical Group and several locations of Novant Health. He saw moonlighting in residency as a chance to “test the waters in making clinical decisions.”

Similarly, Bensimhon says it helps residents develop decision-making skills. “In residency, you make decision by committee,” he explains. “Moonlighters learn to trust their own judgments and become more confident in their skill sets.”

The opportunity to understand the full medical experience is what drove Ameeth Vedre, M.D., to start moonlighting during his cardiology fellowship. “I learned what it’s like to act as the cardiologist of the day. It gives you a huge advantage over those who don’t moonlight,” he says. “You have the ability to pick up the ropes faster and to build your confidence level.”

“When you’re a resident, you’re under certain constraints you don’t have on a moonlighting shift,” says Lamas. “There’s a greater sense of autonomy when you moonlight.” Even seasoned physicians experience a sense of freedom from moonlighting. “Physicians at all stages of their careers—increasingly frustrated with modern-day clinical practice—are also moonlighting as a way of regaining some autonomy and control over their schedule,” says Dhand.

Exposure to new situations

Moonlighting can also expose you to patients you might not otherwise see as a resident or in your daily practice. That helps build confidence and knowledge. For example, Schofer says military physicians outside of combat zones “are working primarily with a young and healthy population.” In order to see the full scope of patients, these physicians need to practice outside the military. “It’s something I’d encourage,” he says. “It helps put military physicians on par with their colleagues.”

Military physicians aren’t the only ones who need additional exposure. “These days, especially in the area of primary care, a physician will diagnose a problem, then a specialist is brought in to treat it,” says McCarthy. At rural clinics, residents who moonlight are able to both diagnose and treat the problem, so they learn and do more than their non-moonlighting colleagues.

Matt Friedman, M.D., an emergency physician and medical director at CrowdRx, says that pay is a tertiary concern for many of the residents who work the company’s events. They’re primarily interested in the learning experience. “You can make more money working in the ER,” he says. “We even have some medical students who do research for us. They find it’s an eye-opening experience as well.”

Experience working with and managing a team

Moonlighters also learn how to work alongside other medical personnel. Fitzpatrick says, “At our events, residents learn and experience what it’s like to be on the other side of the hospital run. They experience what it’s like to work with first responders onsite. For many, it’s their first opportunity to do so.”

It’s not just learning to work with hospital teams, says McCarthy. She has worked with University of Nevada residents at a Burning Man concert and explains, “Yes, you learn what it’s like to supervise, but you also learn how to work with patients from all over the world.” That’s an opportunity that these residents only were able to experience through moonlighting.

A chance to test drive without commitment

External moonlighting offers yet another advantage: the chance to test drive a job or hospital without making a commitment. “By working a few moonlighting shifts, you can determine if the hospital’s culture, position and personnel are going to be a good fit for you,” Schofer says.

Vedre agrees: “It’s a benefit for you and an employer to judge how the relationship will work. And it gives a moonlighter an opportunity to look at a variety of different systems to find the best fit.” Some physicians even like moonlighting so much that they look into locum tenens arrangements.

Having a trial period can be a major benefit to residents who aren’t sure what setting they want to practice in. “Nearly half of physicians will leave the first job they take after training within two years,” says Bensimhon. “By moonlighting with a hospital or practice during their fellowship, moonlighters get a chance to sample different jobs and hospital settings, and they are more likely to find the right job the first time around.”

It’s also a major benefit to the hospitals. Williams says family medicine residents at the University of Nevada, Reno who take the opportunity to moonlight in rural emergency rooms often decide to locate to rural areas to practice. This is a huge plus for these communities, which are often notoriously short of physicians.

The downsides of moonlighting

An increased risk of burnout

Practicing physicians and residents have demanding schedules as it is. If you’re not careful, adding hours to your workweek is a quick way to wear yourself thin. However, moonlighters say this can be avoided by setting hours that work for you and your lifestyle. “I never experienced burnout,” says Smith. “If I was getting close, I adjusted my hours.”

Moonlighting terms differ, but the arrangement usually involves contracting for a block of time, such as an entire weekend, or spreading the time throughout the week, such as a few hours in the evenings.

No matter how you choose to moonlight, McCarthy says to remember: “Sleep is important.” That’s one of the major reasons residents are capped at 80 hours of work a week, and it’s easy to neglect rest if you’re not careful.

At one point, Lamas was moonlighting at two different hospitals in addition to her full-time research fellowship. “I realized I was becoming exhausted, and I cut down from as many as five shifts a month to two or three. Eventually, I gave up one of the moonlighting jobs,” she says. “The money is great, but you can’t afford to drop the ball on your health or on the work you do in your current position.”

Less time for family life

Many physicians are drawn to moonlighting because it offers the opportunity to provide more for their families. However, there are two sides to that coin. If you’re working more, you have less time to spend with your family, which can wreak havoc on quality time.

This is especially true because of the times of day and year when moonlighters tend to work. Vedre says opportunities to supplement income usually come from working odd hours, including weekends and holidays.

To ensure that extra shifts don’t put a damper on your family life, Vedre recommends keeping an open dialogue with your loved ones. “Discuss your moonlighting opportunities with your family, and decide together what will work best for everyone,” he says.

Increased responsibility

Increased independence is one of the reasons physicians decide to moonlight in the first place, but this autonomy is a double-edged sword. “Moonlighting can be empowering,” says Lamas, “But it comes with a huge responsibility.

“Anything can happen at night,” says Bensimhon. If you do decide to moonlight, you will still have access to more experienced physicians, but you have to be ready to handle whatever comes up. That can be trickier at some locations than others.

On a hectic night, this can quickly place you outside your comfort zone. “Moonlighting in a high-risk area can also expose you to potential legal risks,” adds Schofer.

If the increased responsibility worries you, you’re not alone. “Not all residents are ready to moonlight,” says Smith. But if you decide to start as a resident, it’s best to ease yourself in. “Start moonlighting internally first,” Smith recommends. “If you moonlight externally, be careful with where and how much you moonlight. You don’t want to be in a position where you’re over your head in terms of the kind of patient care you can deliver.”

Before you moonlight

If you decide to moonlight externally, you’ll be an independent contractor, not an employee. That means there are a few additional factors to consider.

1 Ask about liability insurance

It will be up to you to determine who pays for your liability insurance. “If you are moonlighting externally, you are no longer working as a resident and no longer under any supervision,” Williams says. “That means you need to make sure your malpractice insurance is provided for.”

Bensimhon agrees, adding that it’s best to confirm these details ahead of time: “Ask [prospective employers], ‘What kind of coverage will I have?’ If it’s occurrence-based coverage, that’s fine. Everything is covered. But if it’s a claims-made policy, make sure it comes with a tail.”

Military physicians are covered by the government’s tort claims act as long as they are treating patients as part of their duties. But the same may not be true for military physicians who moonlight at a veteran’s center or event. Schofer says, “They think they’re covered because they are treating veterans, but they’re not.” Just like civilian physicians who moonlight at outside facilities, military physicians should also ask what kind of coverage they will receive.

2 Get the right licensure and certifications

Before you begin moonlighting, it’s important to know what your hospital’s moonlighting policy is and then make sure you’re following it down to the letter. You don’t want to get caught violating a contract or a residency policy.

You also need to be sure you have all of the required licenses and certifications. This can be especially tricky if you’re near state lines.

3 Prepare for salary negotiations

As an external moonlighter, you’re functioning as an independent contractor. That means you are free to negotiate any payment structure that both you and the employer can agree to. PracticeLink.com offers a wide variety of resources on negotiating, and it’s best to read up beforehand.

4 Leave enough time for your job search

If you’re considering moonlighting while in residency or while actively looking for your next position, realize that the extra hours might interfere with your job search. “Moonlighting will cut into your personal time,” Williams warns.

Since residents generally start their job search efforts a year out, moonlighting may eat into the time you have to find an employer. On the flipside, a moonlighting position may lead to a full-time job—especially if you are moonlighting in order to test drive a position or facility.

5 Wait for the right opportunity

There are plenty of moonlighting opportunities out there. That means you can afford to be picky. Make sure the opportunity involves the type of work you want to be doing. “Moonlighters like to feel good about the work they do,” Bensimhon says. “Although the money is important to help make ends meet, making a difference for patients is what really makes the extra work worth it for most of us.”

You should also make sure you know who you’ll be working with and for. “Research the hospital or company you will moonlight for, and make certain it is a bona fide company,” says Fitzpatrick. “Verify who exactly you will work for.”

Is moonlighting right for you?

All of those interviewed here would recommend moonlighting to colleagues. But ultimately, Vedre says, “It’s an individual decision—and one that should be made thoughtfully.”

Smith adds that one lesson he learned as a moonlighter is that medicine is not as clear-cut as it’s often presented in residency. “I discovered nuance,” he says. That’s the kind of lesson that comes usually after years of experience.

Finally, Lamas says that while moonlighting isn’t a good fit for everyone, the benefits outweighed the downsides for her. “Everything is a trade-off,” she says. “But I consider every incremental experience I’ve had as a physician, whether moonlighting or on my regular job, as increasing my education. All of it has made me a better physician.” 

 

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What’s in a compensation package?

Before you can negotiate, understand how your offer was created.

By Debbie Swanson | Fall 2019 | Feature Articles

 

“Consider what you bring to the position,” recommends Rose Berkun, M.D. “Assess your own self-worth.” – Photo by IHNY

You may be focused on salary when you’re job hunting, but salary alone isn’t an accurate portrayal of compensation. Other elements of a benefits package have significant monetary implications, and even benefits without dollar signs attached can make a major difference when it comes to work/life balance. If you don’t take these into account as you negotiate and consider offers, you could be leaving something on the table.

“Upwards of 25 to 35 percent of a comp package is the benefits,” says Richard Roberts, M.D., JD, professor emeritus of family medicine at the University of Wisconsin School of Medicine and Public Health. “Newer doctors don’t often think about benefits. It’s their first time evaluating this. As a resident, you just got what you got. But now, you can negotiate.”

Here’s some inside information on holistically evaluating your compensation package.

Part 1: Understanding salary

In many other professions, employees earn a set annual salary, but that’s not always the case for physicians. “Forms of compensation vary greatly between specialties and practice types,” explains Roberts. “The most common salary model for a new doctor is often straight salary, which may include some productivity-related bonuses.”

You may be offered a traditional fixed salary or one that depends on other factors. Understanding the different models can help you decide which suits your financial and personal preferences.

COMMON SALARY MODELS

A straight or fixed salary is most familiar: comply with the terms of employment and receive a pre-determined sum, delivered incrementally over the year. This model is attractive for planning and budgeting, but it may leave ambitious physicians hungry for more motivation.

Some things to consider with a fixed salary: Is the salary adequate to meet your financial needs? Do you believe it’s a fair amount in terms of your specialty—and on par with what your peers are receiving, regardless of gender or race? When will you be eligible for a raise? How frequently will you get paid: weekly, bi-monthly or monthly?

A variation on the salary model is salary plus incentives or bonuses, which provides a fixed yearly sum plus the opportunity to earn additional financial rewards. These rewards are contingent on certain pre-defined measures, such as productivity, quality, performance, adherence to non-clinical obligations and other factors. This model’s appeal is that it offers the security of a steady paycheck along with the opportunity to earn more.

“Lots of institutions have bonus structures, [which] are highly variable,” says Jennifer Hunt, M.D., chair of the department of pathology and laboratory services in the College of Medicine at the University of Arkansas for Medical Sciences. “More and more, I think, are relying on RVU-productivity-type bonuses, where if an M.D. has a productivity at a certain benchmark level then they will get a bonus after that level.”

Some things to consider with salary plus bonuses: What is the breakdown of salary versus bonuses and incentives? Is the salary alone enough to meet your financial needs? Are the incentives clearly defined, or are they subjective? Can you satisfy the incentive criteria by yourself, or will you have to rely on other individuals or departments to reach your goals? Are the requirements fixed or subject to change?

Other salary models are productivity-based, meaning your salary is calculated using your contributions to the practice. This model may appeal to physicians highly focused on improving the practice or bringing in new business, yet it is sometimes criticized for fostering a competitive work environment. A variation on this model is a conversion plan, which allows you to earn a fixed salary for the first few years then change to a productivity-based model.

Some things to consider with a productivity-based arrangement: Are earnings based on RVUs, total amount billed or total amount collected? If earnings are based on collections, what percent of billings does the group typically collect? What is the breakdown of patient insurance types (commercially insured, Medicaid or uninsured)?

A different type of model is the equal shares arrangement, which is common in group practices. After deducting expenses from yearly earnings, the remaining funds are divided among the physicians. This incentivizes everyone to work toward a productive year, but some downfalls include a lack of tangible recognition for high performance, skill level or experience.

Some things to consider with equal shares: Does the physician group have a wide range of skills within the physicians employed? Are there any additional incentives to compensate high producers?

The capitation model has dropped in popularity since its peak in the late 1980s and early 1990s, but some regions of the United States still use it today. With this model, your salary is based on the number of patients enrolled with a health plan for a certain amount of time. This model is often praised for delivering efficient care, as there are no incentives for tests or additional procedures. However, some physicians criticize capitation for a lack of control over salary because it’s dependent upon enrollment rather than care provided.

Some things to consider with capitation: Are there any modifications in place to adjust for patients who require extensive services? Are there any bonuses in place?

WHAT SALARY MODEL IS BEST FOR YOU?

When interviewing, you should research what compensation methods are common in your region and your specialty, but choosing the best one for you is a personal decision. Consider the following questions:

  • What hours are you able to work? What hours do you prefer?
  • What are your fixed financial obligations?
  • What are your long-term financial goals?
  • Are you comfortable with a variable income?
  • Do you enjoy marketing your services and promoting your business?
  • Do you want the potential to earn more?
  • Do you work better when presented with incentives?
  • What is your work style? Are you more comfortable with a defined workload, or do you like to control your own productivity?

FIXED OR VARIABLE?

Variable physician salaries allow you to earn more by increasing productivity or meeting other goals. This model has obvious upsides, especially if you’re highly motivated by financial incentives. However, you should take time to consider all the aspects involved.

“If the M.D. relies on hospital systems, ancillary staff whom they don’t manage, or advertising and market share for the institution (not the practice), productivity could suffer as a result of executive decisions,” explains Hunt. “For example, if a surgeon cannot book cases because the hospital is always full and there are ER diversions, then they might not meet productivity targets, through no fault of their own.”

She adds that compensation models based heavily on productivity can present some challenges, explaining, “Although incentives and bonuses based on added productivity can be great, I think it is also strategic to get as much in guaranteed base compensation as possible, especially if the M.D. is going to rely on the hospital or system for the functioning of their practice.”

BE AWARE OF WHAT’S FAIR

In a perfect world, salaries would be consistent across the board, and any differences would be based upon measurable factors, such as experience or performance. But in reality, inequities exist. The best way to protect yourself is with knowledge.

“Do your research ahead of time,” says Rose Berkun, M.D., clinical assistant professor of anesthesiology at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences. “Medscape’s [annual physician compensation report] is a good place to turn.” You can also ask your alma mater or specialty associations for any studies or data they have on current physician salaries.

Once you’ve determined what’s typical for your personal situation, specialty and geographic area, reflect on your past accomplishments, education and training. “Consider what you bring to the position,” Berkun encourages. “Assess your own self-worth. Have you done research, been published or volunteered somewhere, such as at Doctors Without Borders?”

“Be aware of the gender pay gap,” recommends Berkun. “Women should be offered the same salary as their male counterparts.” However, this isn’t always the case. Medscape reports that male physicians earned 18 percent more than female ones in 2018, compared with 16 percent more in 2017.

Don’t be afraid to speak up, whether that means making a case for your own worth, questioning inequality, or simply requesting a higher starting figure. “If you start at a disadvantage, the gap only increases,” Berkun says.

Don’t forget to consider call, lifestyle and even commute time, recommends Jennifer Hunt, M.D. – Photo by Ashley Sanders

Part 2: What else do you need?

Salary is only a starting point. Dig deeper into the details of your package to tally up the impact of benefits. For example, a relocation allowance can help during a move, while an attractive family health plan can ease your finances throughout the year.

“The total compensation package is more involved than you’d imagine,” says Roberts. “Classically, the focus of a package is the two Cs: cash and call. Physicians look for a lot of cash and less of call. However, the importance of those issues fades after the first few years as other parts become more important: disability, life insurance, time off, continuing education, as well as the people you’re treating and the community you’re working with.”

Here’s a rundown on some of the benefits most important to a physicians.

CALL EXPECTATIONS

For most physicians, being available to respond to patients during off hours is just part of the job. This is especially true for newer physicians. Your comp package should outline the frequency, compensation and logistics of call.

“Usually with larger groups, you’ll have less frequent call,” says Berkun, adding that call requirements also vary by specialty. “For example, I’m in anesthesia and have to be physically present for calls. With other specialties, such as pediatrics, you may be able to take some calls from home.”

Understand your employer’s expectations upfront and be realistic about the impact call will have on your personal life. Be mindful of your family and others important to you. If you aren’t at home often—or are frequently interrupted during your free time—everyone’s happiness is affected.

Compensation for call is also important. According to Becker’s Hospital Review, the four most common methods are: a daily stipend (36% of respondents), an hourly rate (27%), a per-shift stipend (14%), and an annual stipend (12%). Each of these has its pros and cons, and you need to keep in mind that additional earnings from call may be offset by the need to hire household support or childcare.

MALPRACTICE INSURANCE

Everyone needs insurance . Typical benefit packages include medical, vision, dental, life and disability policies. But for physicians, there’s one more potentially career-saving benefit to consider: malpractice insurance. Before signing a contract, you need to understand what kind of malpractice insurance your employer offers and how much it will cost you.

The cost to you varies greatly from employer to employer. A hospital, academic institution or large practice group may contribute to your premiums, while a smaller group or practice may expect you to pay it all yourself. Some employers take regular contributions from your salary, while others require a lump sum upon termination of employment. Additionally, premiums for some policies vary over time or are based on years of service, so it’s important to understand how they are calculated.

As for the type of policy, malpractice insurance falls into two categories: occurrence-based and claims-made. Occurrence-based policies cover you for any claim made against you while you were working on behalf of the employer, regardless of when the claim is raised. If a patient files a claim 10 years after you changed employers, you are still covered. Claims-made policies only cover you while you are an active employee. If a claim is raised post-termination, the policy will not cover you—even though you were an active employee when the event in question took place.

If your contract offers a claims-made policy, you’ll want to add an extended reporting endorsement, also known as tail insurance. This critical yet costly addition extends claims-made malpractice coverage after termination. And no matter what else is in your contract, make sure that a lawyer reviews the malpractice terms and that you understand any limits or maximums.

PAID TIME OFF

You may be expecting to work long hours, but even so, everyone needs time away from the office. Your compensation package should detail an amount of paid time off. According to SullivanCotter, physicians’ annual PTO benefits typically range from 25 to 35 days. This may be presented as a bundle, or the days may be designated for specific types of leave, such as:

PAID VACATION TIME

Vacation supports a healthy family life and a good work/life balance. Having more of it may help prevent burnout, while having too little may leave you stressed. According to the 2017 Medical Group Management Association Provider Compensation Survey, physicians typically receive three to seven weeks of vacation time.

PAID SICK LEAVE

Some employers require you to accrue sick days by working a certain length of time, while others offer an allotted number per year or even unlimited sick days. It’s helpful to know what you can and can’t use these sick days for and if you’re allotted any personal days. These allow you to take paid days off without dipping into your vacation days.

FAMILY LEAVE

You should also discuss plans regarding family leave and understand what your employer offers. “Maternity and family leave is important to negotiate ahead of time,” says Berkun. “Some states have a mandate for time off, [which means] you won’t lose your job but no mandate for it to be paid. Negotiate for both the number of weeks off and if it’s paid.”

Similarly, the Family and Medical Leave Act of 1993 requires that any employers with more than 50 employees maintain a job for any employee who must take time off due to a family obligation. However, there is no requirement that this time be paid.

EDUCATION AND PROFESSIONAL ENRICHMENT

To keep your knowledge current and renew your medical license, you’ll need to continue learning by taking courses, attending conferences and maintaining professional organization memberships.

“Continuing education benefits have shrunk greatly over the years,” says Roberts, adding that an allowance for this can mean sizable savings for a physician. “Things like a membership to a specialty society can run anywhere from $750 to $1,500.

In addition to coverage for courses or events, you’ll want to make sure you’ll receive your salary while you’re away from work, as well as a stipend to cover expenses related to travel, educational supplies and food.

According to SullivanCotter, annual allowances for CME typically range between $3,500 and $5,000 with paid time off between five and 10 days.

While it’s possible to save money by meeting educational requirements online, Roberts points out that there are benefits to gathering in person with colleagues.

“Attending a conference or class is a useful form of networking and helps to avoid becoming disconnected from other physicians,” he says. “I’ve always come away feeling energized and with new ideas.”

APP COMPENSATION

Advanced practice providers (APPs) are skilled medical professionals qualified to extend or provide patient care, such as nurse practitioners, physician assistants, behavioral health specialists and more. The use of APPs is widespread; however, most states require some level of physician supervision or direction.

Your package should explain how much time you’ll spend overseeing APPs, and your compensation may depend partially on how much time you spend with APPs. This might be measured by hourly rate or patient encounter, or your employer might apply a revenue-less-expenses model.

According to the 2017 SullivanCotter Physician Compensation and Productivity Survey, approximately 71% of hospitals surveyed have physicians who supervise APPs. Of these, 48% provide compensation for APP supervision in addition to a physician’s base salary.

RECRUITMENT INCENTIVES AND BONUSES

The United States is headed toward a significant physician shortage, which is good news for physicians on the job hunt. According to a 2017 study commissioned by the Association of American Medical Colleges, the deficit is estimated to reach a shortage of 8,70043,100 for primary care physicians, 19,80029,000 for surgeons and 18,60031,800 for specialty physicians by 2030.

With employers eager to recruit talent, incentives are a common part of the compensation package. Look for relocation reimbursement, student loan payments, a signing bonus or other pre-determined bonuses. Don’t be afraid to consider these issues when negotiating.

As with any part of your package, read the terms carefully and ask questions. For example, with any bonus money delivered at the start of your employment, find out if you incur a penalty if you do not remain employed for a set period of time. Similarly, make sure a bonus is truly additional money, not a front-loaded portion of your salary.

RETIREMENT

It’s never too early to think about retirement, even if you’re fresh out of residency. Retirement contributions equate to money in your pocket, as well as peace of mind, and they’re a key piece of any compensation package. SullivanCotter reports that the average employer retirement contributions range from 3 to 7% of salary. This may be paid through an employer contribution, a matching program or a salary deferral.

Part 3: Pulling it all together

You’ve thought about salary, considered benefits and arrived at a fair approximation of the financial worth of your package. But you’re not finished yet. There are a few other factors that may not be spelled out on paper but will influence your financial situation and personal satisfaction nonetheless.

REGIONAL ISSUES

Housing, groceries, transportation, taxes and other expenses vary depending on where you live. In an area with a high cost of living, even a large paycheck may quickly disappear. Conversely, you may live quite comfortably on a mediocre salary in an affordable area. Before making decisions, research a region’s cost of living and run your salary through a cost of living calculator.

Malpractice insurance premiums also vary by region, since there are different laws and coverage requirements in different states. A lawyer in the area is usually the best source of information on what’s required and how much you should expect to pay for it.

Finally, physician supply and demand can be wildly different from city to city and state to state, and your specialty makes a difference. “It’s a market economy,” says Roberts. “Be aware of the market rates in your area. For example, central and southeastern United States is the highest salary for a family M.D.

SUPPORTING A HEALTHY LIFESTYLE

Financial security is important, but so is your happiness and that of your family. Keep potential burnout in mind as you evaluate your compensation package, especially since 44% of responding physicians reported feeling burned out in Medscape’s 2019 report.

Job factors that can add to or prevent burnout include call hours, paid time off and insurance benefits, but sources of stress or comfort are different for every individual. For example, if student debt is a major area of personal worry, a loan repayment benefit may add to your peace of mind and reduce your risk of burnout.

Scheduling also has a huge impact on personal contentment. You may be full of focus and dedication as you head into your new job, but even so, you need to be realistic about your need for rest and relaxation.

An all-work-and-no-play approach is never successful.

“Things I often see people forget to account for are commuting time, excessive call requirements, mandatory extra duty (particularly for short-staffed services), and whether a group or department is family-friendly,” says Hunt.

Measure your commute time carefully. A good schedule may not be as great as it seems if you have to spend a long time in transit.

“Your commute never comes out of your work time,” says Hunt. “It comes out of your home life time. Carefully factor how much time you will be at home, versus not at home.”

Other benefits that support a healthy lifestyle include wellness programs, onsite gyms or membership reimbursement, opportunities for sabbatical leave, flexible work schedules, physician lounges, family and/or spouse support groups and mentorship programs.

Understanding and selecting a compensation package is a major endeavor, particularly early in your career when the terminology and expectations may be fairly new to you.

For the best outcome, seek the expertise of seasoned physicians as well as a health care attorney. Remember that your happiness is closely tied to that of your loved ones, so you should listen to their needs and concerns.

Finally, be flexible and don’t stray too far from your established priorities with your final decision. 

 

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Live & Practice: Sports Towns 2019

By Liz Funk | Fall 2019 | Live & Practice

 

Virtually every town or small city has a local flavor and a sense of regional pride. For towns and small cities home to major universities with well-known sports programs, that local spirit is amplified.

In Syracuse, New York, the Syracuse University college basketball program makes the snowy winters something to look forward to. In Lexington, Kentucky, in addition to the equestrian sports that the city is famous for, the University of Kentucky sports fans take their teams seriously. In Lawrence, Kansas, the enthusiasm over The University of Kansas sometimes calls for city streets to be closed during the NCAA playoffs. And in Storrs, Connecticut, the University of Connecticut women’s basketball program is king—or rather, queen.

Living in an area with a large university sports program usually involves scores of other benefits for physicians: diversity, culture, arts and entertainment.

Lawrence, Kansas

Dr. James Naismith, known as “the father of basketball,” was also the first basketball coach at The University of Kansas. The fervor for sports in this college town—particularly KU basketball—is deeply ingrained in the culture.

Steven Stites, M.D., attended medical school at the University of Missouri-Columbia. He completed a fellowship at The University of Kansas Hospital and built a career there. The two schools are rivals—but Stites has found a happy compromise. “I am a rare breed,” he says. “I’m a ‘TigerHawk,’ cheering for both KU and MU!”

Stites is a pulmonary and critical care specialist as well as the interim executive vice chancellor for the KU School of Medicine. “I specifically treat patients with cystic fibrosis or those who have had a lung transplant,” says Stites.

Choosing his specialty came easily: “This is something I truly enjoyed and loved to do from the first day of residency,” he says. This specialization also brought him to The University of Kansas Hospital for a fellowship in pulmonary and critical care medicine.

The University of Kansas Health System employs over 1,000 physicians across 200 specialties. The University of Kansas Medical Center is a 773-bed teaching hospital. On the main campus, there are outpatient clinics for nearly every specialty, says Debbie Gleason, a physician recruiter for The University of Kansas Health System. The University of Kansas Health System operates more than 80 inpatient and outpatient facilities in the greater Kansas City area.

“Our featured services include cancer (we have an NCI Cancer Center designation), diabetes and endocrinology, geriatrics, neurology and neurosurgery, urology, cardiology and cardiothoracic surgery, gastroenterology and GI surgery, nephrology and pulmonary,” Gleason says.

Roughly 2 million people live in the greater Kansas City area, which includes Lawrence. The area, says Gleason, “is a breath of fresh air when it comes to the friendly Midwest lifestyle, lower cost of living and a wide variety of smaller communities—everything from downtown loft apartments near the heart of nightlife to quiet suburban neighborhoods.”

Stites agrees with this assessment. “My family and I love Kansas City because it feels much like a small town but has the diversity and opportunities of a larger city. Kansas City is a place to call home.” Stites and his family—he has three children—are active with their church and are outdoors enthusiasts. They like to go fly fishing in the Ozarks.

Lawrence has a tradition of creating big sports fans. “Lawrence is absolutely a sports town. We are a tad fanatical about our sports teams,” says Andrea Johnson, director of marketing and communications at Explore Lawrence. “Our high school squads have a long tradition of state championships. Haskell Indian Nations University has given the world the Olympians Jim Thorpe and Billy Mills. And, of course, this is Jayhawk Nation. The University of Kansas Jayhawks track and field team has gold medal in its blood.”

“Jayhawk basketball” is another source of immense pride for the community in Lawrence. The Jayhawks men’s basketball team has won five national championships. Additionally, more than 80 KU men’s basketball players have played or are currently playing in the NBA. Says Johnson, “It influences the culture all the time, but especially so during the spring when strangers become friends connected by the excitement of March Madness. If the Jayhawks reach the Sweet 16 and beyond in the NCAA tournament, expect impromptu parties downtown… we may even shut down the streets!”

Syracuse, New York

As chief resident, Robert Corona, D.O., discovered a love for leading others. He’s now CEO of Upstate University Hospital. – Photo by Leo Timoshuk

Syracuse University’s dynamic presence brings entertainment, an educated populace, and of course, serious basketball to this small town in central New York. For physicians, the area’s largest employer is Upstate University Hospital, an academic hospital affiliated with the State University of New York (SUNY).

When Robert Corona, D.O., was an undergraduate pre-med major at Ithaca College, he developed a swollen lymph node. “I was told I had Hodgkin’s disease,” says Corona. Corona consulted with his pre-med advisor, who was an osteopathic physician. “He felt the lymph node, and he said, ‘Do you have a cat?’” Corona says. “I did. He said, ‘I think this lymph node is cat scratch fever, not lymphoma.’ When I went to a pathologist, my results were consistent with cat scratch fever. From then on, I was totally hooked on osteopathic medicine.”

Corona was born and raised in central New York. He attended high school in Skaneateles, a town 30 minutes outside Syracuse in the tourist-friendly Finger Lakes region known for its water sports and wineries.

Corona attended the New York Institute of Technology College of Osteopathic Medicine in Long Island. Says Corona, “I got an internship focusing on pathology and neurology, and it really was a monumental moment for me. I was impressed by the approach.”

As chief resident, Corona discovered that he enjoyed leading others in a hospital setting. During his tenure at Upstate University Hospital, he has served as chair of the pathology department up to his current role of CEO.

Upstate Medical University includes the College of Medicine, the College of Nursing, the College of Graduate Studies, and the College of Health Professions. The system’s hospitals include Upstate University Hospital (which has two campuses, one in downtown Syracuse), Upstate Golisano Children’s Hospital, and Upstate Cancer Center.

Upstate’s Downtown Campus is a 425-bed teaching hospital. The Community Campus is a 409-bed facility. The Upstate Family Birth Center is housed at the Community Campus, as is Physical Medicine and Rehabilitation Center.

Another employer of physicians in Syracuse is Crouse Hospital, a 506-bed acute care facility operated by Crouse Health, an affiliate of Northwell Health.

Corona says, “I make rounds with the docs. On Wednesdays, I do my neuropathology work. I teach residents. I look at cases under the microscope. …Working in the trenches with the docs and the nurses helps me keep my balance and feel valued. I also have a senior associate dean role in the medical college. I still do research with my neurosurgery colleagues, and I teach.”

When he is not exercising his passionate nature at the hospital, Corona is literally exercising as a passionate athlete. “I do all kinds of sports. I’m a sports fanatic. I like the summer and the fall; in my opinion, that’s the best season for outdoor sports.”

For sports fans, there are year-round events to enjoy as well. Syracuse University is well-known for its journalism and communications programs and for its Division I sports programs. One could argue that Syracuse’s basketball team—among other indoor sports—makes the central New York winter a little easier for doctors and patients alike.

Storrs, Connecticut

Katherine Coyner, M.D., is a team physician for several UConn teams, including women’s basketball. “I’d go as a fan, but now I get to go as the team doctor,” she says. – Photo by Butler Photography

Storrs, Connecticut, is home to the University of Connecticut, the state’s flagship public university. Twenty minutes south of Storrs is the UConn School of Medicine, as well as the UConn John Dempsey Hospital, a 186-bed academic hospital. UConn Health is home to a robust sports medicine program, where doctors train to specialize and where UConn athletes are treated during training.

It’s one thing to be a sports fan; it’s another thing to work for a university health system with a Division I sports program.

Katherine Coyner, M.D., is an orthopedic surgeon for UConn Health. She grew up in Ohio with a childhood friend whose father was an orthopedic surgeon—a profession she’d always wanted to pursue.

As a sought-after college basketball recruit, though, Coyner needed to find a coach who supported her academic ambitions as well as her athletic ones. “I had a coach tell me, ‘You can’t play on my team and be a biochemistry and molecular biology double-major,’” says Coyner. It was the coach’s loss; Coyner played basketball for the University of Massachusetts-Amherst and began a fruitful academic career that has come full circle with Coyner practicing at a teaching hospital and working with young athletes.

“For me, it keeps me close to the games I grew up loving. It keeps me around athletes. My experience gives me that connection with athletes; they understand that I played at a high level and that I know what they’re going through.”

Coyner attended Northeastern Ohio University for medical school, then did residency at William Beaumont Hospital in Royal Oak, Michigan. She was their first female resident ever in orthopedic surgery.

Coyner completed a one-year sports medicine fellowship at Duke University and then spent the first five years of her career practicing in Dallas. She came to the University of Connecticut Health System to be part of the organization’s sports medicine program.

“I am one of the team doctors for men’s and women’s basketball, football, ice hockey,” says Coyner. “UConn has an incredible women’s basketball team. I just traveled to the Final Four with them. I’d go as a fan, but now I get to go as the team doctor.”

Coyner enjoys practicing in a smaller market. With Storrs’ population of 15,000, she likes that she sees her patients at the grocery store and around town.

“It’s a vibrant community filled with history, culture and ample recreational opportunities,” says Randy Fiveash, director of the Connecticut Office of Tourism. “Downtown Storrs serves as Mansfield’s downtown, attracting students, residents and visitors from across Connecticut and beyond,” he says.

“There is a whole host of activities to do in the area, from attending major sporting events and hiking in The Last Green Valley—a national heritage corridor—to zip lining through the forest,” says Fiveash. There is even the Mansfield “Pup Crawl,” a guided dog walk through downtown Storrs.

Says Fiveash: “Storrs is a bustling community filled with historic, cultural and natural treasures, as well as thriving businesses, trendy shops and restaurants, making it a great place to live, work or visit.”

Lexington, Kentucky

Lexington, Kentucky, is the second-largest city in Kentucky (second to Louisville). It has a population of 350,000 and a strong sense of community rooted in horse racing tradition and the energy of a college town. There is fierce local pride in the University of Kentucky Wildcats.

I grew up in Louisville and I went to the University of Louisville for medical school, so I’ve always rooted for [the Louisville Cardinals],” says Paige Quintero, M.D. “But now that I live in Lexington, there are some very, very devoted UK fans. So, my family and I say that we cheer for all the Kentucky teams. I pass the UK football field on my way to the hospital. It’s exciting to live in this college town.”

Quintero studied biochemistry at Smith College in Northampton, Massachusetts. She graduated early, went back to Kentucky to study at the University of Louisville Medical School, then did residency at Loyola in Chicago and a one-year fellowship at the University of Missouri (known by football fans as “Mizzou”).

“At Mizzou, the football stadium was right across the street from the hospital. I could go to a game, and if I was on call, I could just walk across the street. It would be faster than driving to the hospital from my home,” says Quintero. After fellowship, she looked for opportunities in bariatric surgery.

She has found Baptist Health Lexington to be especially supportive of her as she builds her practice and sees patients from around the state.

“As a person who struggled with her weight, I can empathize with my patients,” Quintero says. “I had weight loss surgery a year and a half ago, and I lost 90 pounds. That means a lot to patients when you can say, ‘I went through this too. You’ll recover from surgery; it’s going to be all right.” Quintero gave Baptist Health Lexington’s bariatric program potentially the highest praise: she had her surgery there, and her partner performed her surgery. “I told my partner, ‘I chose you; I trust you and I know you’re going to do a great job.’”

Quintero is happy with both her colleagues and patients. “In a larger market, there is more competition, and maybe in a smaller market there wouldn’t be enough business,” she says. “But here, it’s just the right-sized hospital and just the right-sized program, to be recognized and notable. There are two bariatric surgeons, and it provides such a great lifestyle in that we’re not always on call.”

Lexington is a culturally rich place to live with lots of leisure and entertainment activities to enjoy, which is important to Quintero and her family.

“Lexington is a mid-size city that punches way above its weight class,” says Mary Quinn Ramer, director of Visit Lexington. “There is a strong medical community here. …We also have a thriving downtown and an amazing culinary scene.”

Sports are also important to the community. Says Ramer: “We eat, breathe and sleep the Southeastern Collegiate Division, especially basketball. Our football team [at the University of Kentucky] has done just fine recently, so we’re football fans now too. It’s a very social town; people eat out and go to events all the time.”

Quintero is counting her blessings. “I hate to tell people how much I love my job because they’re going to want it,” she says. “I have so much time with family in my position because I don’t do general surgery. I am so thankful here that, in my mid-30s, I’ve achieved a good amount of business, a good lifestyle, and I’m able to see my family.” 

 

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