Last year, it was all about sign-on bonues, debt assistance, and free housing. This year, I'm dubbing it the “Eat What You Kill” season. There is major transition in all-sized groups, in hospital and direct employers, and in RVU-based compensation models.
Direct employers tend to go with a partial program, providing a guaranteed base plus an RVU-based bonus system. Some groups are offering the full RVU-based model being demanded by physicians who have heard about rates topping $200 an hour in some locations. Texas, California, Wisconsin, Ohio, Florida, Illinois, and the Carolinas are leading the country in RVU-based incomes. The Northeastern states have the slowest momentum, while the west and Midwest are coming on strong. This presents a problem to job-hunting young physicians. With employers advertising big dollars based on RVUs, less experienced physicians, particularly graduating residents, can be misled about what they can earn in the first year.
“It's been our experience that new grads who were producers in residency will be producers at or above average by the sixth month on the job,” said Steve Maron, MD, the president of Valley Emergency Physicians Medical Group in Walnut Creek, CA. “Those who were slower as residents will be slower to produce the big numbers.”
It's important that young physicians looking at total fee-for-service opportunities obtain realistic numbers before signing on. Sign-on bonuses are still abundant, some as high as $50,000, and loan assistance is still a strong potential perk, but the more extravagant perks have dropped off. Employers appear to be accepting that the actual cash earnings are the key to winning a top doctor's heart.
These figures are based on incomes from employee and fee-for-service (RVU) models. The annual package includes an average benefit value of $25,000 (excluding malpractice and tail premiums). The numbers are based on an average 1,600 clinical hours a year, and don't include any perks. These are entry-level numbers for new hires and first-year earnings.
The West/Southwest leads the way in top hourly compensation, but only because of the big bucks to be found in Texas. The highest package I found was in the $490 range, and the highest hourly rate was $300, both based on RVUs. Several groups such as Schumacher are offering $200 an hour or more depending on location and credentials. The rate is as high as $210 in Laredo. The highest income in the state is with a group outside Dallas starting at $225 an hour and going to $300 an hour as a partner. Average hourly compensation in Texas is $180, and the annual package is $325,000.
In California, TeamHealth West has a few openings in RVU sites averaging $190 to $240 an hour, and Valley Emergency Physicians can average $200 an hour and higher the first year at its various sites. EMP is staffing in Sacramento with first-year packages at $300,000 including base, profit-sharing, full benefits, and a significant pension contribution. Averages in California are $162 an hour and a first-year package of $300,000.
Colorado, Nevada, Hawaii, and Utah provided no information, but Arizona has an average hourly rate of $145 and package of $280,000. Look for higher dollars in Oklahoma, with some hourly incomes also at the $200 level, but averaging closer to $165. New Mexico is averaging $160 an hour with the Schumacher Group offering a director's salary as high as $190 to $200 an hour in Carlsbad.
The lead for annual packages goes to the Midwest with a big push from Wisconsin where the average annual package is in the $350,000 range. A private group in southern Wisconsin is offering $300 an hour as a partner. A larger, regional group in the eastern part of the state seems to have misunderstood the concept of sign-on bonuses, offering a $46,000 “advance.”
Ohio is a mega-location this year, and the compensation figures back it up. Look for packages in the $320,000 to $350,000 range from Premier Health Care Specialists, including quarterly bonuses and sign-ons with some loan assistance. The Apollo MD group has RVU-based compensation in the $365,000 to $400,000 range, and a democratic group in Cleveland is offering that range, too. Ohio's average is $165 an hour and $340,000 for a first-year package.
Missouri comes in at $200 an hour in Branson, $170 to $175 an hour in Joplin, and $190 an hour in St. Charles, with average annual package of $330,000 for the state. Illinois and Iowa average around $150 an hour and $300,000 annually. There's a $40,000 sign-on bonus in northwest Illinois, $300,000-plus in south Chicago, and a western Iowa group offering “close to” $200 an hour. Kendall and Davis physician recruiting represents a group offering $160 an hour in Illinois with a raise to $178 an hour in the second year, plus benefits. They are also representing a client in Iowa with a starting salary of $160 an hour, plus comprehensive benefits including paid leave.
Kansas, Minnesota, Kentucky, and Nebraska all average $150 to $160 an hour with first-year packages in the $300,000 range. Notable numbers are a $325,000 package in Omaha through Premier HC, and the odd RVU-based, $200 an hour in Kansas and Kentucky. Indiana averages $275,000 a year with one or two exceptions including a Kendall and Davis client group offering $165 an hour and a $49,000 retirement contribution starting in the second year. Bringing up the rear in the Midwest are Michigan and the Dakotas with annual averages around $265,000, again with the odd exception of Premier's Battle Creek site at $325,000.
In the Southeast, Mississippi comes out on top with an hourly average of $175 and first year annual package of $345,000. There is a group on the Gulf Coast offering $300 an hour as a partner. North Carolina has some high packages up to $335,000 in the first year, including EMP with multiple opportunities in the Charlotte area. The Apollo MD group has opportunities in the same area on an RVU model also paying in that range. Look for a North Carolina annual package average of $320,000, as well as pockets of $180 an hour and higher along the coast and in the southern part of the state. Georgia and Tennessee come in with average annual packages around $310,000 and $160 to $165 an hour. Apollo has offers over $365,000 in the Atlanta area with an RVU-based income, and another group in the state is offering $400,000 plus benefits.
Highest in Tennessee is $195 an hour via RVU, plus TeamHealth, the state's principal employer, looking for doctors in Knoxville with a base plus RVU package in the $350,000 range, depending on experience. Florida, Alabama, and Louisiana have averages of $160 an hour, but with a few more high-paying spots at $190 to $200 an hour, including those with Schumacher in Miami Beach and Baton Rouge. There's a Cocoa Beach opportunity through Apollo MD paying more than $325,000 and another in Alabama at more than $365,000. Averages in Alabama are around $280,000 the first year. South Carolina will average $300,000 near the coast and inland, and McLeod Health has a package starting at $155 an hour, plus RVU, benefits, and retirement. Lowest in the region are Arkansas and West Virginia at $260,000 to $275,000 on average, except for Premier HC which has a $325,000 package in Bluefield, WV, with a strong bonus structure, and Apollo MD offering more than $365,000 in the Little Rock area. Finally, a group in Parkersburg, WV, offers the country's top sign-on bonus at $50,000.
The Middle Atlantic region is a picture of highs and lows: highs in Pennsylvania, with a south-central hospital offering a package that adds up to $400,000 the first year including salary, benefits, RVU bonus, loan assistance, and sign-on. Income averages in the state are closer to $280,000 annually and $140 an hour, with lots of employers offering loan assistance along with comprehensive benefit packages. New Jersey, Virginia, and Maryland are averaging $280,000 to $290,000 the first year, with a few spots offering more than $300,000 in western Maryland and around Richmond, VA. Delaware and the District of Columbia did not report incomes.
The Pacific Northwest has some significant RVU-based incomes available in Washington and Oregon via NEP/TeamHealth with some incomes at more than $200 an hour. NEP also is offering $160 an hour plus bonuses in a high-tech, economic growth region in the lake district of western Washington. A group in the Rockies of Montana is starting new doctors at $160 an hour plus relocation, sign-on, and loan assistance. In Oregon, CEP America has a position at $190 an hour plus profit-sharing and a sign-on bonus. The region averages $145 an hour and $260,000 in first-year compensation. Wyoming, Idaho, and Alaska did not provide income information.
Lagging behind this year is the Northeast, mostly because New York state employers, who represent more than 30 percent of jobs, average only $130 an hour and $250,000 for the first-year package. The highest paying group I found in New York was MedExcel posting potential earnings of $300,000, higher in Rome, Orange County, and the Adirondacks. I did find a $40,000 sign-on in Albany. Connecticut is hot with averages at $160 an hour and $310,000 first-year. I found a $370,000 package with a group in the center of the state, plus $350,000 in Waterbury, $365,000 in New Haven, and $370,000 in Middlesex, all with direct hospital employers. Massachusetts averages $290,000 the first year and $155 an hour with a surprising $300,000 opportunity in Cape Cod. Highs are a group offering $175 to $200 an hour for pediatric and adult EPs and $330,000 with an RVU-based group north of Boston. Maine averages are identical to those in New York, at $130 an hour and and $250,000 a year, with no remarkable highs or lows.
Thanks to all the groups and employers who contributed their location needs and compensation information for this year's report. Happy hunting!
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The Katz Compensation Top 10
6. North Carolina