Enfolded Fellows - How r they viewed?

[Guest]

Ancillary income can vary widely. Not sure about everywhere, but I found that ASC or hospital ownership was far and away the most lucrative thing. I wont get into the numbers, but the academic and hospital employed jobs I looked at weren't even in the same ballpark financially after factoring that in. Its important to note however this is very specific to the practice or area and reimbursement from those endeavors can fluctuate dramatically.

[Guest]

How does one get involved in hospital ownership? Haven't heard much about that before

[Guest]

Obama and congress made physician-owned hospitals very rare now. Can’t make new ones and can’t expand existing ones. Thanks Obama.

ASC ownership is the main route to wealth at this point, until someone decides it violates Stark or some bullshit..

[Guest]

(responding as the person who posted the 500-750k range of offers)

Base pay does vary widely, but as another poster said, your total compensation can be very different from your base pay. One thing I left out of the above numbers is that the 550k offer came with a ~$65/RVU compensation. The two 750 offers had mid-high $80/RVU compensations. Meaning the magic number to make $1mil/year is ~11,600 RVUs. As a spine surgeon that is a very easy threshold to meet. A busy spine surgeon could realistically be making >$1.5mil/year at these places. I think that's a lot of money. Depends on your expectations, I suppose.

I was also geographically limiting myself to the Pacific Northwest and a few other big cities across the country. If you don't have any geographic preferences and just want to maximize income you could make much more in a small town in the south.

There are a lot of factors you should consider in your first job. I would not recommend money one of your top three priorities. It's a little cliche, but there are more important things than money. As a neurosurgeon coming out of training, you want to be a place that you will succeed. That means having senior partners you trust and who are invested in your success and not out to get you. That means having a hospital administration that is invested in your success and is willing to spend money to get what you need. It means taking a realistic amount of call (the 1:2 you did in residency is not sustainable in the long term, unless you're one of those weirdo neurosurgery masochist monk types, and hey if you are more power to you, just not me).

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Oh and by the way, salaries are dramatically lower on average in cities like New York, Boston, LA, San Francisco, etc. One of those jobs I mentioned had another position in a major west cost city where the salary offer was $400k. Again, it depends on your priorities.

[Guest]

Could you explain how you got 11,600 RVUs in order to make $1mil/year?

[Guest]

The previous poster is correct that money should not be the only factor, but I do think it is vitally
Important. I would also caution for the Med students and residents that frequent this site, that 11,600 RVU to reach 1 million per year is not particularly good. At least in terms of my practice’s contract, for example, the number of RVUs needed to hit 1 million per year is nearly 2000 less, and the base pay is nearly 400k more.

[Guest]

Simple math from 2 posts above. $1,000,000 / 11,600 wRVUs = $86.2/wRVU so that's within their "mid to high 80s per RVU."

I've seen offers similar to what the poster above wrote, but only in North/South Dakota at a level 1 trauma center. I'm sure it's possible but not very common.

[Guest]

$1mm early in the career is worth a lot more early on than even mid career. Those offers may have been reasonable a few years ago, but the last data I saw said 750 is below median now.

11-12k RVU is totally doable…if your hospital can give you 2-3 blocks per week, which some hospitals have real trouble with. The other surgeons all want more block time, too, and you’re the new surgeon without volume at first. There are a ton of variables that go into whether you’ll make production. Keep in mind, half of all surgeons fall below the median. Worst case you are paid based on collections and you find yourself seeing the Medicaid chronic pain patients while your partners take the private insurance ACDF consults.

[Guest]

"The previous poster is correct that money should not be the only factor, but I do think it is vitally
Important. I would also caution for the Med students and residents that frequent this site, that 11,600 RVU to reach 1 million per year is not particularly good. At least in terms of my practice’s contract, for example, the number of RVUs needed to hit 1 million per year is nearly 2000 less, and the base pay is nearly 400k more."

I'm curious what your total compensation package is based on? Do you get base pay plus RVU? And are you making >$100 per RVU?

That seems like an exceptionally good financial package, congrats on landing that. Based on the MGMA 2023 (using 2022 data), median total compensation was $875k and median RVU compensation was $68. The first two years I'm in practice I'll make a minimum ~$960K between base salary and call, with the possibility of making more if my production is higher than base pay.

Another poster above mentioned collections based and that is an excellent point to clarify with your negotiations, as payor mix becomes extremely important in that situation. Honestly there's enough here to justify a whole other thread about first contract negotiations and practice evaluations.