Trends on the D.O. front...

It’s always interesting to see the trends in my line of work…watching changes in who we employ vs who we recruit into communities, looking at how different financial offers change over time by different specialties, etc…

But something I’ve noticed recently in my hospital company? This week alone, I’ve seen 5 contracts for D.O. physicians…and even 2 years ago, I would’ve bet those physicians would be primary care. But this week, I would’ve been wrong! These new docs are all: Orthopedic Surgery, Neurology, Cardio, Bariatric Surgery, and Anesthesia.

It’s cool to see that the lines are getting more and more blurry for the whole MD/DO discussion. It will be interesting to watch in the years to come…We have over 180 hospitals nationwide, and I see more and more DO’s every day.

That’s good news to my ears Carrie

“It’s cool to see that the lines are getting more and more blurry for the whole MD/DO discussion. It will be interesting to watch in the years to come…We have over 180 hospitals nationwide, and I see more and more DO’s every day.”

Yes indeed!

Hey, guys–if this whole med school thing doesn’t work out for me, keep in touch… I’ll try to get you a good job on the flip side. We have hospitals in Georgia, but Bailey–you’ll have to move. LOL

(Or, at the very least, I can tell you what to ask for! So many new doctors leave money on the table because they just didn’t know they could ask for it and get it in their deal! CRAZY!)

Psh, why make us wait! TELL US YOUR SECRETS CARRIE!

I’d be happy to, honestly, except that it won’t be anything helpful for you without the surrounding context of a job offer. Still, a starting synopsis for a little afternoon learning… since you asked…

The biggest mistakes I see new physicians make, fresh out of residency, is that they don’t seem to understand the negotiation process…two doctors with the exact same credentials can have vastly different deals because one of them simply asked for more.

There are two ways my hospitals ‘pay’ physicians. The first, and most easiest to understand, is to outright employ them. W2 income. Biweekly paycheck. We all get this, because we’ve lived in this world. For new physicians, the appeal is that it’s safe and predictable. There are bonus incentives, and there are different things that drive salary… but for the most part, the check comes every two weeks.

The 2nd way, and the one I’ve spent 8 years immersed in, is via a “Recruitment Agreement.” Under these agreements, a hospital can recruit a doctor into a community served by that hospital in order to fulfill a community need. The physician is not employed by the hospital, nor is the physician required to refer patients to the hospital. He/she is required to maintain active privileges at the facility and take call there, and must remain in the community…and they must do that for a set number of years (standard is 4 years.) Typically, the recruit comes in to some existing medical practice in the community and makes their own employment agreement (separate from the hospital one) in order to fulfill that 4 year obligation…

In exchange for the physician agreeing to live and practice in the hospital’s community/patient area for a set time, the hospital agrees to certain financial incentives and reimbursements (ranging from 100% of year 1’s salary, overhead, and startup expenses to just a sign on/student loan/relocation package…depending on the community time requirement).

These deals can vary greatly depending on each situation, but there are basic standard amounts for…say a sign on bonus or student loan reimbursements that you pretty much always see. So I get frustrated when I see a new resident come in with a $10k sign on bonus… but the standard is actually more than twice that.

The thing is…the hospital is legally required to offer the minimum incentive needed to get the recruited doctor into the community (Look up Stark II and anti-kickback laws from some fun reading). So if you’ll come for “X deal,” then that’s what they’ll give you. If you come back and say, “I’ve seen other offers that look like ‘Y’ in terms of sign on or whatever, and I really need at least ‘Y’ to make this happen?” If it’s within the hospital budget, then guess what? Your deal just moved from X to Y.

So when the recruit agrees to the $10k sign on (to stick with my example), that’s what the hospital is legally required to give… no more. It’s nothing to get angry at the hospital about–they are bound by government regulations and a tight fiscal budget. They may have planned to go as high as $25k or $30k, but you said yes to $10k. (Again, just keeping with my sign on example).

See what I mean? It gets crazy… the biggest thing is to do your research, and NEVER be afraid to ask for what you want. You may meet in the middle, but you’ll more than likely wind up with more than you thought.

Right now, I champion the budgets and the financial concerns of our facilities… and I will always be responsible in that regard. You won’t find me trying to gauge a hospital beyond anything that is a fair-market deal for someone with my specialty and my years of experience. In all honesty, physicians rarely do that. But knowing the difference between a starting offer and a fair market offer (for your skill set and geographic area) can mean thousands and thousands and thousands and thousands of dollars in your pocket or left on the table…

Thus concludes today’s lecture.

So it sounds like it would be wise to work with a headhunter?

I HIGHLY recommend it. Our company has their own natl recruiting division just for that reason…

Carrie, I really appreciate that info. This is not so different from hiring a programmer in a large firm. Good stuff to know.

+1 carrie

You are exactly right, Pixie. It’s solid corporate common sense…mingled with the complications of govt regs for hospital/physician relationships.

So many drs are so excited to be done with residency and have offers on the table that they simply neglect to get the facts. Your experience will serve you well!

Thanks, Carrie!

A relative of mine is an example of both the expansion of DOs into specialties formerly reserved for MDs and the benefits of being a good negotiator. She finished up at DO school, did a combined residency with IM and Dermatology, and – being the ambitious gal that she is – got a top-notched position with top-tier pay and a 50K signing bonus at a multispecialty clinic network. In fact, she makes “significantly” more than her office mate, who is an MD dermatologist with years of experience. She used her double qualifications, her background and public health experience, to negotiate her way to her benefit.

+2 carrieliz

This is what we old-farts bring to the table. lol

I understand those who are averse to using a headhunter because of the money. However what I try to explain to a few of the docs I’ve spoken to is if the headhunter got the offer to double of what you were expecting who cares that they made some money. Doctors because of all the education too often behave as though they know everything about everything. I know too many who aren’t making what they could be simply because they jumped at the chance to get $15k sign on. I understand being broke and jumping at the first offer however once you do, you’re done. A bad salary, like bad grades, will follow you. Research and be patient during negotiations.

That’s it exactly, Croooz… Your best shot at a proverbial ‘raise’ is the day you get hired.

If you start out well below market value, it’s going to take a long time to rid yourself of that mistake. If you do your research, know your worth, and negotiate well…you can be well above MGMA medians and working your way up in no time.

Recruiters aren’t evil. I work with amazing ones every day. Yes, they make money… it’s their job!! And well deserved, for the work they do. But again, do your research. Get referrals. Go with the one you feel comfortable with whose record speaks for itself… They swim in negotiations every day. Why try to do something yourself if you aren’t prepared, when you could use an expert to work on your behalf?

Many things to consider… but it comes down to admitting what you know and what you DONT know. You are exactly right…being the most brilliant neurosurgeon in the world doesn’t make you a smart business savy individual. And asking for business guidance doesn’t make you dumb, either.