salary/benefits. society for academic emergency medicine goals of this talk u help you see what is...

Salary/Benefits

Society for Academic Emergency Medicine

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 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


Location

Ultimately, most people’s #1 factor when looking

for a job


Types of Jobs

Private Semi-Private

Quasi-Academic

Academic


Job Setup

Independent Contractor or

Locum Tenens

Hospital/ University Employee

Private Group


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


Work Environment

If you hate the ER you work in, no amount of money or

benefits will make up for your overall happiness


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)


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


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


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


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


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


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


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


$$$$$$$$$ 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


$$$$$$$$

Median Salary by Experience *1-2 years $200,344

*3-7 years $226,963

*8-17 years $233,788

*18+ years $225,639


$$$$$$$$

Median Salary by Region *Eastern $203,046

*Midwest $249,841

*Southern $228, 435

*Western $225,799


$$$$$$$$

Academic Median Salary by Position *Instructor $168,539

*Assistant Professor $181,888

*Associate Professor $204,389

*Professor $221,452

*Department Chair $306,445


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


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


Benefits 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


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


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


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


Ophtho Insurance

Does your Health Insurance cover? Do you need Usually not provided for Independent Contractors


Prescription Insurance

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


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


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


Disability Insurance

Most Important Thing to do BEFORE Residency

Ends!!!



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



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


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


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


Retirement

401k/403b*For Employees

*Matching is very good, the more the merrier

*Max this out to $15,000 a year



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


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


Vacation

Paid Vacation*2-6 weeks while maintaining income



Leave

Sick/Maternity/Paternity Leave*2 weeks-3 month while maintaining income



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


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)


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


Independent Contractor vs. Employee

Choose One

$270,000 Independent Contractor

Vs.

$200,000 Employee with Benefits



When comparing, remember to take into consideration all costs and benefits

Make a column of yearly cost and benefits



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




Independent Contractor $124,000 Take Home $44,000 Retirement

* $6000 Health Insurance

* $300 Dental Insurance

* $500 Life Insurance

* $5000 Disability Insurance


Employee $114,500 Take Home $15,000 Retirement

* $2000 Health Insurance

* $150 Dental Insurance

* Free Life Insurance

* Free Disability Insurance





* No CME (deduction) * No CME time * No Matching * +/- Free Malpractice * No FSA * No DCSA * No vacation



* +$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)





* 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


*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


Apples to Apples and Oranges to Oranges



Remember that Benefits generally make up 35% more of salary*

$200,000 with benefitsis equivalent to

$270,000 for Independent Contractor

*In this scenario!!!


Take Home Points

Find a Job You WANT to Work At

$20,000 is NOT Worth Your DAILY Happiness


If You Have Many Attractive Job Offers

Compare Apples to Apples and Oranges to Oranges Don’t overlook Benefits Don’t overlook Contracts and Partnership Try to Enjoy Your Job and Career (You can change

Jobs and 50% of graduating residents do within 2 years)

Max Out Retirement


Author Credit-Salary/Benefits:Armando Hevia MD

Questions


Postresidency Tools of the Trade CD

1) Career Planning – Garmel

2) Careers in Academic EM – Sokolove

3) Private Practice Career Options - Holliman

4) Fellowship/EM Organizations – Coates/Cheng

5) CV – Garmel

6) Interviewing – Garmel

7) Contracts for Emergency Physicians – Franks

8) Salary & Benefits – Hevia

9) Malpractice – Derse/Cheng

10) Clinical Teaching in the ED – Wald

11) Teaching Tips – Ankel

12) Mentoring - Ramundo

13) Negotiation – Ramundo

14) ABEM Certifications – Cheng

15) Patient Satisfaction – Cheng

16) Billing, Coding & Documenting – Cheng/Hall

17) Financial Planning – Hevia

18) Time Management – Promes

19) Balancing Work & Family – Promes & Datner

20) Physician Wellness & Burnout – Conrad /Wadman

21) Professionalism – Fredrick

22) Cases for professionalism & ethics – SAEM

23) Medical Directorship – Proctor

24) Academic Career Guide Chapter 1-8 – Nottingham

25) Academic career Guide Chapter 9-16 – Noeller

salary/benefits. society for academic emergency medicine goals of this talk u help you see what is...

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