Recruiters understand that you have very little, if any, education about physician compensation packages as you enter the job search. Even if this is not your first job out of training, chances are still high that you are looking at an entirely different set of circumstances from the last contract you signed.
Hospital employment contracts are very different from private practice employment, and the differences among markets can mean that the vocabulary you need for one city is useless for a market with a markedly different payer mix.
Stark Law throws a unique set of handcuffs into contract construction if hospital financial support is involved. The growth of large national employers now drives alignment of local contract structure and verbiage with national physician services agreements.
Bottom line…There really isn’t any point in reading up on every type of structure you might encounter. So what can you do to prepare?
1. Determine if you can live there
First, control one element that only you can control: Determining whether or not the community is a viable fit for you and your household.
Have an idea of the compensation range for your specialty in the area.
Ask your program coordinator for names of physicians from your program who have settled in this market in recent years. Reach out to them and ask for an appointment to ask what they see happening in the area. Ask recruiters the same questions.
Even if it is too early to ask about salary and sign-on bonus for the job you clicked through, it’s never too early to ask questions about the market compensation.
- What do you the think is the compensation range is going to look like in the market in 2020?
- Have recent recruits ramped up quickly? Are they on track to earn bonuses as projected?
- What factors explain the low- and high-end outliers?
- Where does this metro area fall relative to Medical Group Management Association (MGMA) benchmarks?
- Are base salaries increasing or decreasing?
- Are sign-on bonuses typical? If so, how much?
- Do you have an education loan payback program?
Research the cost of living in the area
Enter “cost of living calculators” in any search engine and compare that market with one you know, like where you grew up or where you are training. Talk with your spouse about his/her absolute must-haves so that you are on the same page about minimum number of bedrooms, size of lot and commute time.
Do you have a special needs child? Will you need to budget for private school for a gifted/talented child if the group puts you in site A, but there is a great magnet public school convenient to site B?
Perhaps the realtor’s pre-qualification process projects that you will need $20,000for a down payment and you will need that money at closing, several weeks before your start date.
The recruiter needs to know that before any draft contracts are developed. Be ready to discuss your progress in assessing how your needs fit with your household’s projected cost of getting settled in the community during the compensation discussion.
Know what your monthly education loan payment will be
You do not need to share this with the recruiter, but your realtor needs to know.
That number is not what you hope it will be after you get it restructured, or what you dream it might be after a generous loan repayment deal, or what your spouse thinks it will be based on original paperwork you completed years ago. Use realistic numbers.
These activities will give you a general idea of whether or not you can afford to live in a particular market. That is an important step in narrowing your focus to the one or two offers that make sense.
Physicians withdraw from discussions all the time, at whatever point they feel certain there will not be a meeting of the minds. Withdrawals are a perfectly normal part of the process. Employers do not stop interviewing and do not expect you to stop exploring until there is a mutual decision to move forward.
The scenario everyone wants to avoid is the heartbreaking realization that you, the physician, have burned interview days and spent many hours of precious time negotiating a contract that you cannot sign because you and your spouse will never have peace of mind with the tradeoffs that will have to be made.
By then, the employer has lost other candidates and may lose patients and miss budget targets if they were counting on the start date for which you were interviewing.
2. Talk compensation
Good questions are the key to a productive compensation talk. “What is the pay?” is not going to get you disqualified, but it does not cast you in a flattering light.
The conversation will naturally lead to discussion of the potential range of first-year compensation and a better understanding of how compensation is structured. Follow, rather than lead, the discussion.
Ask how the compensation structure reflects the employer’s values
The explanation will help you understand what the group prioritizes. Hundreds of management and physician leadership hours have been expended on developing and tweaking the compensation structure.
Let them explain how it works. Ask how long the structure has been in place and ask them if they and the physicians feel it is working for the practice. Are any major changes coming soon?
Ask where they expect you to be in year one in terms of production
Year two? Year three? In order to hit those targets, how many patients a day will you be seeing? Ask physicians when they typically arrive and leave.
Is a day off really a day off, or do physicians use half of it to catch up on calls and charting? How many PTO days will you have, and how do they calculate holidays? What happens if you underperform?
If you intend to work part time or need more PTO than normal due to mission trips, introduce this parameter early in the talk.
Employers feel manipulated when they learn about limitations after compensation for a full-time, full-bore position is on the table.
The answers to these will help you know if this job is going to be the right fit in terms of practice style and pace. If getting to the expected threshold to support the salary level is going to entail a lot more hours per week or a pace much faster than is comfortable for you, this job is simply going to be too stressful to be sustainable.
If the practice is slower paced or more of a “lifestyle-focused” group of physicians, it won’t be long before you’re chafing at carrying more than your fair share of the load.
Your recruiter’s job is to consult, educate and explore the fit with you. Asking questions is your most important job as a candidate. The more you ask, the better we understand your situation and can help you get into the right fit for you and your family.