Salary/Benefits

Society for Academic Emergency Medicine Goals of This Talk u Help you see what is out there u Pros and cons of certain situations u Discuss Salary options u Explain Benefits available u Help you compare apples to apples and oranges to oranges

Society for Academic Emergency Medicine Choices, Choices u Location is key when first choosing a job u Once you know your city, then time to choose your setting u Then you can compare ERs and work environment u Then you can compare salaries and benefits

Society for Academic Emergency Medicine Location Ultimately, most people’s #1 factor when looking for a job

Society for Academic Emergency Medicine Types of Jobs PrivateSemi-Private Quasi-Academic Academic

Society for Academic Emergency Medicine Job Setup Independent Contractor or Locum Tenens Hospital/ University Employee Private Group

Society for Academic Emergency Medicine Type of Jobs u Private *You see all the patients (no residents) *Can have all 3 job setups *Usually best pay u 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 u 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

Society for Academic Emergency Medicine Work Environment If you hate the ER you work in, no amount of money or benefits will make up for your overall happiness

Society for Academic Emergency Medicine 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)

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

Society for Academic Emergency Medicine Independent Contractor / Locum Tenens u 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

Society for Academic Emergency Medicine Independent Contractor / Locum Tenens u Cons *No firm roots in a group or hospital *Very limited benefits u No health, disability, life, dental, eye insurance u 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

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

Society for Academic Emergency Medicine Hospital/University Employee u 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

Society for Academic Emergency Medicine Private Independent Group u Pros *Partnership available *Usually highest paying jobs *If group does well, you do well u Profit Sharing *Usually an employee of the group with benefits

Society for Academic Emergency Medicine Private Independent Group u 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

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

Society for Academic Emergency Medicine $$$$$$$$ u Median Salary by Experience *1-2 years $200,344 *3-7 years $226,963 *8-17 years $233,788 *18+ years $225,639

Society for Academic Emergency Medicine $$$$$$$$ u Median Salary by Region *Eastern $203,046 *Midwest $249,841 *Southern $228, 435 *Western $225,799

Society for Academic Emergency Medicine $$$$$$$$ u Academic Median Salary by Position *Instructor$168,539 *Assistant Professor$181,888 *Associate Professor$204,389 *Professor$221,452 *Department Chair$306,445

Society for Academic Emergency Medicine Contract u Don’t get screwed *Make sure it is all written down *Get a contract lawyer to review ($500) u 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

Society for Academic Emergency Medicine Partnership/Tenure u 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

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

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

Society for Academic Emergency Medicine Health Insurance u Don’t forget COBRA and don’t let it lapse u This is quite expensive especially for family coverage u $ a month depending on situation, health, etc u Most employers with pay a portion leaving $ for you to pay u Usually not provided for Independent Contractors

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

Society for Academic Emergency Medicine Ophtho Insurance u Does your Health Insurance cover? u Do you need u Usually not provided for Independent Contractors

Society for Academic Emergency Medicine Prescription Insurance u Does your Health Insurance cover? u Different levels u Depends on need and remember you will get older u Usually not provided for Independent Contractors

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

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

Society for Academic Emergency Medicine Disability Insurance Most Important Thing to do BEFORE Residency Ends!!!

Society for Academic Emergency Medicine Disability Insurance u 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 u 50%, 60%, 66 2/3%, 70%, 80% u There are upper limits *Minimal if any cost to you *Usually not provided as Independent Contractor *$ a month for $10,000 monthly coverage

Society for Academic Emergency Medicine Disability Insurance u 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

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

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

Society for Academic Emergency Medicine Retirement u 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

Society for Academic Emergency Medicine Retirement u 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

Society for Academic Emergency Medicine CME u Money *The more the better *$1000-$5000 *Travel, Dues, Conference, CME, etc *Independent Contractors have to deduct from taxes u 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

Society for Academic Emergency Medicine Vacation u Paid Vacation *2-6 weeks while maintaining income *Usually not provided as Independent Contractor

Society for Academic Emergency Medicine Leave u Sick/Maternity/Paternity Leave *2 weeks-3 month while maintaining income *Usually not provided as Independent Contractor

Society for Academic Emergency Medicine Pension Plan u Nice if you have it u Be careful with it as it can change at any time u New laws make it more difficult to keep pension plans so may start dissolving u Can make your own as an Independent Contractor

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

Society for Academic Emergency Medicine Other Benefits u Rarely Stock Options (but possible) u Night differential u Who pays your license, DEA, Narcotic Drug license renewal u Who pays your dues u Hospital give free food

Society for Academic Emergency Medicine Independent Contractor vs. Employee Choose One $270,000 Independent Contractor Vs. $200,000 Employee with Benefits

Society for Academic Emergency Medicine Independent Contractor vs. Employee u When comparing, remember to take into consideration all costs and benefits u Make a column of yearly cost and benefits

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

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

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

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

Society for Academic Emergency Medicine Apples to Apples and Oranges to Oranges

Society for Academic Emergency Medicine Independent Contractor vs. Employee u Remember that Benefits generally make up 35% more of salary* $200,000 with benefits is equivalent to $270,000 for Independent Contractor *In this scenario!!!

Society for Academic Emergency Medicine Take Home Points Find a Job You WANT to Work At $20,000 is NOT Worth Your DAILY Happiness

Society for Academic Emergency Medicine If You Have Many Attractive Job Offers u Compare Apples to Apples and Oranges to Oranges u Don’t overlook Benefits u Don’t overlook Contracts and Partnership u Try to Enjoy Your Job and Career (You can change Jobs and 50% of graduating residents do within 2 years) u Max Out Retirement

Society for Academic Emergency Medicine Author Credit-Salary/Benefits: Armando Hevia MD Questions

Society for Academic Emergency Medicine 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