Physician Compensation

When exploring new job opportunities, salary is often one of the determining factors that a physician considers when evaluating a position. It's also a delicate issue, calling for self-restraint during early communications with a potential employer or partner.

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It's imprudent to raise the issue of compensation too early in communication, but there is disagreement about raising the matter when considerable travel is involved to make a site visit. It has been suggested that there is no point in agreeing to travel for an interview, only to learn that the position pays considerably less than you are willing to accept. I disagree with that idea. A salary quoted by a recruiter may be artificially low. It may change during an actual interview, after they have perceived your interest, and you have represented yourself well.

There may be other jobs within the same institution which may be available to you and which are aligned with your salary expectations. A faculty position with a teaching hospital may not offer a salary acceptable to you, but there are often hospital-employee opportunities or a practice with an open position for a partner at the same institution. Although you may believe there is little to be gained by travel to an unlikely future job, be sure that you always learn something and present yourself well. Networking is priceless. If the hospital or institution is willing to pay travel expenses, use that opportunity. You should take care, though, to give the hospital a clear picture of your intentions and lower the expectation of acceptance, should they offer you a position. That candor increases their respect and promotes the image of a conscientious team player. In such conversations, I've never had a recruiter or institution withdraw their invitation to interview.

Ideally, the practice's representative will volunteer information about compensation. If you have a compelling reason to address the issue in early communications, you can bring it up by saying, "Tell me about this position's compensation package." Don't fall for the trick question, "How much would you like to earn?" The representative is probably trying to get you to quote a figure that is less than they are willing to pay. Respond that you would like to be paid fairly for the work you will be doing, considering your experience and the local market.

As your discussions progress, understand how the practice’s compensation plan works, and how much you might earn. Ask how you’ll build your practice, especially if your productivity will affect your compensation.

If you’re considering a position with a private practice, ask about future partnership, or shareholder status. When would you be eligible to buy into the practice? What would you be buying? What will it cost? How will you pay for it?

Health systems frequently offer physicians financial incentives to join an independent practice or start a new one. The incentive is presented as an income guarantee, but it’s really a loan guaranteed by the physician. During the first one or two years of the guarantee period, when the physician collects less than the guarantee amount, the institution makes up the difference. At the end of the guarantee period, the physician repays the loan, or, to have it forgiven, continues practicing in the area.

Previous: Evaluating a Practice

For information on current compensation, trends and practice management issues:

National Center for Biotechnology Information, National Institutes of Health: Physician Compensation, Cost, and Quality; http://www.ncbi.nlm.nih.gov/pubmed/20716745

New England Journal of Medicine Career Center: Physician Compensation Update 2013; http://www.nejmcareercenter.org/article/physician-compensation-update-big-picture-shows-stability

Medscape 2013: http://www.medscape.com/features/slideshow/compensation/2014/public/overview

National Center for Biotechnology Information, National Institutes of Health: Primary Care Physician Compensation; http://www.ncbi.nlm.nih.gov/pubmed/22786738