Good Job offer?

[dermdoc2612]

This one is for practicing dermatologists on here regarding a contract and if it sounds reasonable to you:

Background: I am Derm/dermpath trained and only been out a couple years.

Looking at signing with PE group for 3 days a week clinical derm job ( I already have dermpath job taken care of two days a week elsewhere, more academic setting, lower volume, close to where I will live).

They are offering 360 k base first year with 25 k sign-on bonus for 3 days a week with first year incentive of 40-45% net profits > 900K ( doubt I will get near that first year). After the first year I go to only Net profits at 40-45% depending on office I am at based on distance. Also keep in mind, I want to be in area for personal reasons and likely will not be in this specific area for > 3 years so this location will likely not be long term. The no cause out is 180 days. Benefits like health insurance, 401k match, and malpractice included. They have MA's that write notes.

The Catch:

All of the clinics are in rural areas ( which I don't really dislike because I like rural medicine but just to keep in mind) > 30 min from suburban areas in cold weather climate. The clinic I go to twice a week is about 40 min away in smaller rural area. They want 9 hour days at 55 patients in contract ( seems like a lot to me). The other clinics are farther away and depending on site are 1-2 hours away and they rotate each week which one I go to. At the father clinics they want me to work 8 hours and see 45 patients. They say they will reimburse for mileage for driving.

-Does this seem like a reasonable deal or am I making a mistake?
-Do you think I could push to cut patient load down by 10/day first year ( so 45 during 9 hours and 35 during 8 days) for same base and increase as comfortable during second year on for net profits?
- Should I be asking for more if I see 55/day for two days and 45/day for one day. I will be doing mix of surgery and general derm so those numbers will change depending on mix).
- Ask for bigger bonus due to undesirable location?


Any advice greatly appreciated!!

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[Skindoc83]

Traveling to a clinic that is over an hour away is a deal breaker for me, especially if you live in an area with inclement weather. I am mohs so I can’t speak to seeing 6 patients an hour, but unless your MAs are excellent at scribing and you have three exam rooms to rotate out of, I think you will be having very long days And running an hour behind schedule. If You do an excision, does that count as just one patient? Would you still need to see another 5 in that hour? If so, that’s a recipe for disaster. I also hesitate with going to full collections in the future since if it’s a rural area, the payor mix could be atrocious. I think the base salary is solid but that’s not a gift, that job sounds exhausting and a recipe for burn out and unhappiness, but to each their own.

 

[dermdoc2612]

Thank you for the advice. Do you think it would be reasonable to keep base the same and negotiate for 45 patients for 9 hours and 35 patients for 8 hours. Yes the excisions have special block so I would not have to see 6/hr in those situations.

 

[PhillyMed777]

Mind you im still a resident but how do you actually see 55 patients a day? Sounds super hard. Even if 5-10% of those end up being tricky, could very much throw the entire day off time wise. Not to derail the point of this thread, but i think a discussion in the feasibility of 55 patients is reasonable. That could generate a lot of inbox work as well, and I'm curious how others have or have not handled it.

 

[MOHS_01]

Mind you im still a resident but how do you actually see 55 patients a day? Sounds super hard. Even if 5-10% of those end up being tricky, could very much throw the entire day off time wise. Not to derail the point of this thread, but i think a discussion in the feasibility of 55 patients is reasonable. That could generate a lot of inbox work as well, and I'm curious how others have or have not handled it.

Rural clinic, likely largely actinic disease mix, seeing 6 an hour would not be a problem. Been there, done that, have the chart count and disdain for Karens and hair loss BS to show for it. It will make for long days -- especially at first when you are not as efficient as you (or your employer) would think, you're learning new systems, training new staff, etc.

360k base for a 3 day work week.... no one should scoff at that. Remember, your marginal value (what determines your earning potential) does not enjoy a linear relationship with your productivity; you make more of the last dollar collected than you did the dollar before that or the one before that, on and on.

 

[MOHS_01]

Thank you for the advice. Do you think it would be reasonable to keep base the same and negotiate for 45 patients for 9 hours and 35 patients for 8 hours. Yes the excisions have special block so I would not have to see 6/hr in those situations.

You don't want to work 9hr days, even at 3/week. As for volume: your compensation is based upon your expected collections at a given volume, so if you decrease your productivity by 20%, you've decreased your expected collections by 20%, and can expect that to translate into a greater than 20% reduction in base. It's practice finance, can't get around it.

 

[OraclePL]

360 for three days from a private equity group is a great offer in terms of numbers. But clearly they’re going to work you to the bone for the offer. Seeing that many patients as a fresh grad is not easy.

If you’re going to decrease your request to 45 max and 35 on eight hour days, then I would expect your base salary to decrease as well. You probably have a little wiggle room but not much, they still want to make money off of you.

I personally wouldn’t take the job offer unless those were the only three days I was working. All that driving, the long days, and working five days a week sounds like a recipe for burnout. But everyone has to make an individual decision knowing themselves

 

[doctalaughs]

This one is for practicing dermatologists on here regarding a contract and if it sounds reasonable to you:

Background: I am Derm/dermpath trained and only been out a couple years.

Looking at signing with PE group for 3 days a week clinical derm job ( I already have dermpath job taken care of two days a week elsewhere, more academic setting, lower volume, close to where I will live).

They are offering 360 k base first year with 25 k sign-on bonus for 3 days a week with first year incentive of 40-45% net profits > 900K ( doubt I will get near that first year). After the first year I go to only Net profits at 40-45% depending on office I am at based on distance. Also keep in mind, I want to be in area for personal reasons and likely will not be in this specific area for > 3 years so this location will likely not be long term. The no cause out is 180 days. Benefits like health insurance, 401k match, and malpractice included. They have MA's that write notes.

The Catch:

All of the clinics are in rural areas ( which I don't really dislike because I like rural medicine but just to keep in mind) > 30 min from suburban areas in cold weather climate. The clinic I go to twice a week is about 40 min away in smaller rural area. They want 9 hour days at 55 patients in contract ( seems like a lot to me). The other clinics are farther away and depending on site are 1-2 hours away and they rotate each week which one I go to. At the father clinics they want me to work 8 hours and see 45 patients. They say they will reimburse for mileage for driving.

-Does this seem like a reasonable deal or am I making a mistake?
-Do you think I could push to cut patient load down by 10/day first year ( so 45 during 9 hours and 35 during 8 days) for same base and increase as comfortable during second year on for net profits?
- Should I be asking for more if I see 55/day for two days and 45/day for one day. I will be doing mix of surgery and general derm so those numbers will change depending on mix).
- Ask for bigger bonus due to undesirable location?


Any advice greatly appreciated!!

Not worth it. 55/day is high unless you are only doing skin checks and lesions checks. If you are doing rashes and allowing multiple complaints than it’s hard to practice high quality, even if that’s 9 clinical hours.

Also, what’s your support situation? Running 3 rooms, 2 assistants and a scribe that’s feasible (although still a very long day). 2 rooms and 1 staff unsustainable.

To put it another way, the volume they are asking in “3 days” is really your average private practice volume in 4 or 4 1/2days (seeing 35-40/day). They should be paying you accordingly, especially to run their rural clinics where it’s harder to find a dermatologist.

They are likely making a big margin on that deal.

 

[dermie1985]

Not really impressed with that offer.
(1) Commute is terrible
(2) 360k is probably under market value for that number of patients. I work in an urban market area (Top 10 metro) and see about 120 patients/week over 4 days. You'd be seeing 165 patients over 3 days in a rural area and getting paid less than me.