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Salary/Benefits

Salary/Benefits. Goals of This Talk. Help you see what is out there Pros and cons of certain situations Discuss Salary options Explain Benefits available Help you compare apples to apples and oranges to oranges. Choices, Choices. Location is key when first choosing a job

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Salary/Benefits

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  1. Salary/Benefits

  2. Goals of This Talk • Help you see what is out there • Pros and cons of certain situations • Discuss Salary options • Explain Benefits available • Help you compare apples to apples and oranges to oranges

  3. Choices, Choices • Location is key when first choosing a job • Once you know your city, then time to choose your setting • Then you can compare ERs and work environment • Then you can compare salaries and benefits

  4. Location Ultimately, most people’s #1 factor when looking for a job

  5. Types of Jobs

  6. Job Setup

  7. Type of Jobs • Private *You see all the patients (no residents) *Can have all 3 job setups *Usually best pay • Semi-Private/Quasi-Academic *You have help seeing patients *Can have all 3 job setups (usually hospital/university employee or private group) *Benefits of teaching with usually better pay • Academics *You have lots of help seeing patient *Can teach residents *Usually get a pay cut but sometimes less shifts with more academic responsibilities *Usually Hospital/University Employee

  8. Work Environment If you hate the ER you work in, no amount of money or benefits will make up for your overall happiness

  9. Time to Compare Once you have chosen location, job type, and work environment down, now you can compare jobs offers (if more than one job exists)

  10. Dare to Compare • An independent contractor job for a contract group at a salary of $300,000 • An academic job at a salary of $160,000 with benefits and 7 shifts a month with protected research time • A private group at a salary of $200,000 with great benefits and full partnership, raise, and profit sharing after 2 years of nights • A hospital employee at a production based pay with great benefits

  11. Independent Contractor / Locum Tenens • Pros *Not tied down to one job/city *Usually higher pay *Can make yourself a corporation to protect assets *Different but higher retirement benefits available (SEP IRA) *Can deduct business expenses from taxes *ER financial status not that important

  12. Independent Contractor / Locum Tenens • Cons *No firm roots in a group or hospital *Very limited benefits • No health, disability, life, dental, eye insurance • No vacation, sick leave, maternity leave, CME, HSA, DCSA *Some offer malpractice insurance *Have to pay all Social Security benefits *Could lose contract at any time *Someone has to prepare your papers/legal stuff

  13. Hospital/University Employee • Pros *Part of the hospital/University *All Benefits offered by hospital *Have the power of being a large employer • Decreased costs *Some shielding from finances • Less dependant on payor mixes *If academic, more free time for research and teaching

  14. Hospital/University Employee • Cons *Hospital politics *Since you are an employee, less freedom to move *Important that your hospital make a profit so you can make more in some situations *If academics, usually less well paid

  15. Private Independent Group • Pros *Partnership available *Usually highest paying jobs *If group does well, you do well • Profit Sharing *Usually an employee of the group with benefits

  16. Private Independent Group • Cons *Group could be asked to leave hospital *If payor mix changes, could see decrease in pay *May have to buy into group *Benefits available but more expensive because smaller group *Since you are a partner, less freedom to move

  17. $$$$$$$$$ • Different ways to get paid *Salary • $150,000-$350,000 for 12-17 shifts a month *Per Hour • $80-$200 per hour • Usually regardless of production *Fee for Service • RVU based $25-37/RVU • Billing based • Percentage of amount billed (similar to RVU) • Percentage of amount collected (payor mix very important) *Profit sharing (divide left over pot, usually among partners) • Many combinations of above

  18. $$$$$$$$ • Median Salary by Experience *1-2 years $200,344 *3-7 years $226,963 *8-17 years $233,788 *18+ years $225,639

  19. $$$$$$$$ • Median Salary by Region *Eastern $203,046 *Midwest $249,841 *Southern $228, 435 *Western $225,799

  20. $$$$$$$$ • Academic Median Salary by Position *Instructor $168,539 *Assistant Professor $181,888 *Associate Professor $204,389 *Professor $221,452 *Department Chair $306,445

  21. Contract • Don’t get screwed *Make sure it is all written down *Get a contract lawyer to review ($500) • You’d be amazed at the stuff they try to put into the contract *Make sure that time, cost, benefits, and method of partnership is clearly written *Make sure all benefits are clear

  22. Partnership/Tenure • Make sure you know what it takes to become a partner/tenured!!! *Buy in money (how much?) *Time (how many years, what shifts) *Responsibilities (hospital committees, publishing, etc) *Voting (what percentage, who votes, what percentage do not get offer, what if you don’t get offer) *Talk to people who did not get offer—Are they using you to do nights and see you later? *What is the benefit of Partnership—raise, profit sharing, stocks, better shifts

  23. Malpractice Health Insurance Dental Insurance Ophtho Insurance Prescription Insurance Life Insurance *Term, Whole and Variable Disability Insurance *Short term *Long term Profit Sharing Stock Options Dependant Care Spending Account Licensure CME *Time *Money Paid Vacation Sick Leave Maternity/Paternity leave Retirement *401k *403b *SEP IRA *Matching Pension Plan Flexible Spending Account Unemployment Compensation Benefits

  24. Malpractice • Usually paid by hospital or company • ? Legality for Independent Contractors • Make sure it is Occurrence Based • Claims-Made needs Tail Insurance • At least make sure they pay the tail in writing and up front

  25. Health Insurance • Don’t forget COBRA and don’t let it lapse • This is quite expensive especially for family coverage • $300-700 a month depending on situation, health, etc • Most employers with pay a portion leaving $200-400 for you to pay • Usually not provided for Independent Contractors

  26. Dental Insurance • Most companies provide at a small cost to you ($15-20 a month) • You decide if it is worth it to you • Usually 2 yearly cleanings with no problems breaks you even • Usually not provided for Independent Contractors

  27. Ophtho Insurance • Does your Health Insurance cover? • Do you need • Usually not provided for Independent Contractors

  28. Prescription Insurance • Does your Health Insurance cover? • Different levels • Depends on need and remember you will get older • Usually not provided for Independent Contractors

  29. Life Insurance • Need some amount for catastrophe in early career especially with dependents • $1-3,000,000 total coverage early • Most companies will provide $500,000-$1,000,000 coverage at minimal or no cost to you (sometimes can purchase more) • Usually Accidental Death and Dismemberment Provision that essentially doubles benefit • Some offer Spouse and Child Life Insurance

  30. Life Insurance • Good to probably have some mixture of term and permanent life insurance • Remember Variable Life Insurance *Provides another place to stow away money tax deferred • Can decrease you life insurance as you get older and amass more wealth • Usually not provided as Independent Contractor • ~$500 a year for $1,000,000

  31. Disability Insurance Most Important Thing to do BEFORE Residency Ends!!!

  32. Disability Insurance • Long Term Disability Insurance *Kicks in at 3-9 months after accident *Most companies give this benefit *Different levels and you can pay for more • 50%, 60%, 66 2/3%, 70%, 80% • There are upper limits *Minimal if any cost to you *Usually not provided as Independent Contractor *$400-600 a month for $10,000 monthly coverage

  33. Disability Insurance • Short Term Disability *Kicks in once you get sick *Usually some percentage of your pay *Usually increases in amounts as you are with the company for longer *Gaps time until Long Term Disability kicks in *Most companies provide *Usually not provided as Independent Contractor

  34. Health Care Spending Account or Flexible Spending Account • Allows you to put up to $5000 a year into an account to pay for medical expenses • Money is pretax so saves up to $1750 in taxes • Can use all OTC med, RXs, Deductibles, Eyeglasses, Contacts, Dental, anything not covered by insurance • Usually not provided as Independent Contractor

  35. Dependant Care Spending Account • Allows you to put up to $5000 a year into an account to pay for care for dependants • Money is pretax so saves up to $1750 in taxes • Can be for kids, parents, or other legal dependants • Can use for child care, sitters, etc • Usually not provided as Independent Contractor

  36. Retirement • 401k/403b *For Employees *Matching is very good, the more the merrier *Max this out to $15,000 a year *Usually not provided as Independent Contractor

  37. Retirement • SEP IRA *For Independent Contractors *Not available for employees, but can put money in if you moonlight as an Independent Contractor *20% of your salary for a Maximum of $44,000 a year

  38. CME • Money *The more the better *$1000-$5000 *Travel, Dues, Conference, CME, etc *Independent Contractors have to deduct from taxes • Time *The more the better *5-15 days paid *If you don’t have this, if you don’t work you don’t get paid *Usually not provided as Independent Contractor

  39. Vacation • Paid Vacation *2-6 weeks while maintaining income *Usually not provided as Independent Contractor

  40. Leave • Sick/Maternity/Paternity Leave *2 weeks-3 month while maintaining income *Usually not provided as Independent Contractor

  41. Pension Plan • Nice if you have it • Be careful with it as it can change at any time • New laws make it more difficult to keep pension plans so may start dissolving • Can make your own as an Independent Contractor

  42. Profit Sharing • Very nice if available • Usually only to Employees and not to Independent Contractors • This means that your hospital or ER has to make a profit • Can be fickle if payor mix changes for the worse (a.k.a. New Orleans)

  43. Other Benefits • Rarely Stock Options (but possible) • Night differential • Who pays your license, DEA, Narcotic Drug license renewal • Who pays your dues • Hospital give free food

  44. Independent Contractor vs. Employee Choose One $270,000 Independent Contractor Vs. $200,000 Employee with Benefits

  45. Independent Contractor vs. Employee • When comparing, remember to take into consideration all costs and benefits • Make a column of yearly cost and benefits

  46. Independent Contractor * $270,000 Salary * $10,000 Deductions * $44,000 SEP IRA * $216,000 Taxable * $59,000 Taxes * $33,000 SS and Medicare $124,000 Take Home $44,000 Retirement Employee * $200,000 * No Deductions * $15,000 401k * $185,000 Taxable * $52,000 Taxes * $18,500 SS and Medicare $114,500 Take Home $15,000 Retirement Independent Contractor vs. Employee

  47. Independent Contractor $124,000 Take Home $44,000 Retirement * $6000 Health Insurance * $300 Dental Insurance * $500 Life Insurance * $5000 Disability Insurance $110,200 Take Home $44,000 Retirement Employee $114,500 Take Home $15,000 Retirement * $2000 Health Insurance * $150 Dental Insurance * Free Life Insurance * Free Disability Insurance $112,350 Take Home $15,000 Retirement Independent Contractor vs. Employee

  48. Independent Contractor $110,200 Take Home $44,000 Retirement * No CME (deduction) * No CME time * No Matching * +/- Free Malpractice * No FSA * No DCSA * No vacation $110,200 Take Home $44,000 Retirement Employee $112,350 Take Home $15,000 Retirement * +$2000 CME * 1 week CME paid days (+$2600) * +$8000--4% Matching in 401k * Free Malpractice * +$1750 net FSA * +$1750 net HCSA * 3 weeks paid vacation (+$7800) $128,250 Take Home $23,000 Retirement Independent Contractor vs. Employee

  49. Independent Contractor $110,200 Take Home $44,000 Retirement * No sick/maternity leave * Usually no Partnership * Usually no Profit Sharing * Licenses (deduction) * Pension (you pay) $110,200 Take Home $44,000 Retirement + Pension you pay Employee $128,250 Take Home $23,000 Retirement *Sick and Maternity Leave *Partnership (Increased pay) *Profit Sharing (Increased pay) *Pays for All Licenses *Free Pension (retirement) $128,250+ Take Home $23,000 Retirement + Pension paid for you Independent Contractor vs. Employee

  50. Apples to Apples and Oranges to Oranges

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