PracticeLink Magazine

FALL 2018

The career development quarterly for physicians of all specialties, PracticeLink Magazine provides readers with feature articles, compensation stats, helpful job search tips—as well as recruitment ads from organizations across the U.S.

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Practice l ink.com F A ll 2018 49 the C ontra C ts & C ompensation issue Winds at selective backs Even within a specialty, your ability to command top dollar is still a mixed bag depending on other forces. Being a pediatric neurologist, for instance, may increase your compensation into the medical subspecialty realm, but not into the procedural realm. As to other specialties, supply and demand is the focus. Pathologists, for instance, have been harmed lately by a difficult market. Appino can only speculate as to the reasons — perhaps technology has improved efficiency or training has produced too many. Yet with fewer job openings now than in the past, employers have the upper hand. On the other hand, rheumatologists and other short-supply specialists such as neurologists and urologists are definitely seeing an uptick in their financial outlook. With an aging population demanding their skills, in many cases they can write their own tickets. And what about primary care? You're likely still bringing up the compensation rear, even with promises since RBRVS originated in the 1990s that your field would one day be rewarded equal to that of procedural- based groups. Citing AMGA survey comparisons of 20 specialties between 2009 and 2017, Horton notes that orthopedic surgery still holds the top place with family medicine, internal medicine and pediatrics anchoring the bottom. "Basically, they haven't moved at all," he says. "The wealth hasn't really been redistributed as promised." That doesn't mean, however, that there aren't promising exceptions. As a residency program faculty member with Jacksonville, Florida's St. Vincent's Family Medicine Center, Robert Raspa, M.D., is in charge of 30 family medicine physicians, with 10 not only graduating each year, but also heavily recruited for their skills. New physicians may need to be assertive about their worth even as they're being wooed. Theresa Rohr-Kirchgraber, M.D., preaches the value of assertiveness to her residents and fellows as the executive director of the Indiana University National Center of Excellence in Women's Health. Rohr-Kirchgraber, who is also the Barbara Kampen Scholar in Women's Health, doesn't have to look further than her own experience as an example. Board certified in both internal and adolescent medicine, she went to bat for herself after discovering that her primary clinical appointment in pediatrics was costing her thousands of income dollars. Although she held a secondary appointment in internal medicine and saw mostly adult patients, administrators weren't keen on upsetting the parity applecart with her pediatric colleagues by just changing her status but keeping her in the adolescent division. 5 mantras for negotiating With a hefty number of nuances with any compensation negotiation, it's worth your while to take these tips to heart. All in the formula. Selecting a specific compensation plan likely isn't in the cards for any physician, let alone a new kid on the block. Your package will likely reflect what your future colleagues with similar backgrounds are earning. A different lens. n o matter who's paying your compensation, you'll likely see your package through a different lens than your employer. You're focusing generally on the net amount of your monthly check; administrators may be picturing every cost associated with hiring you and ensuring that the figure fits reasonably into the business picture. Fair is fair. r egardless of the creative ways organizations find to appropriately pay physicians, the final package must meet fair market value standards. Whatever an organization pays you has to be reasonable in light of the marketplace. The sky is not the limit. Health systems, hospitals and independent practices have limited pools of money for compensating their providers. So, if you're angling for a sign-in bonus, relocation stipend, loan forgiveness or other attractive goodies, the money for your singular salary bucket may have to be divvied up into several smaller buckets to accommodate your request. Be cautious going it alone. If your goal is to become an independent contractor rather than an employee, make sure that you understand the financial pros and cons of essentially freelancing your skills. Specialty, practice type and geography have already shaped your final offer in ways that you might or might not have suspected. How do they move the dial up or down?

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