Family Medicine to Orthopedics

[mgriffiths]

I am in the process of exploring an opportunity to transition from family medicine to orthopedics within the same employer system.  I am curious what people would expect in terms of salary change, if any?

 

I am currently paid a base salary of $110,000 with RVU production bonus.  Would you expect an increase in base salary transitioning to a massive money-making specialty?  If so, what range?

 

I know my employer uses MGMA data, does anyone have any info from there regarding ortho salaries...especially Michigan?

[DarwinStarwin]

I wish I had more insight into this question. Curious, do you have any idea if your hours will change structure? Will you start taking call? Will you spend any time in the O.R? These will all relate to potential salary adjustments as well.

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[AbeTheBabe]

Base salary will probably be about the same but your bonus should increase. I'm 3 years out in ortho with base salary of 108K but I make 10-12% of collections which can be 25-50K depending on how many patients you see, how many surgeries you are first assist, how many post-ops (unpaid), how many injections you do, etc. I make low bonus compared to other PAs because I am second assist often which is unpaid.

[mgriffiths]

12 hours ago, DarwinStarwin said:

I wish I had more insight into this question. Curious, do you have any idea if your hours will change structure? Will you start taking call? Will you spend any time in the O.R? These will all relate to potential salary adjustments as well.

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I don't have all the specifics as nothing is guaranteed and in the beginning steps.  I definitely would be in the OR, but do not believe I would be on call.  As for hours, the "expected" hours would likely be the same, but the actual hours worked would likely be more due to rounding and OR time...currently in FP I work 36 hours of clinic with 4 hours of admin.  This translates into about 40 hours on average due to required meetings every few weeks.  I would expect anywhere 40-50 hours.  

 

11 hours ago, AbeTheBabe said:

Base salary will probably be about the same but your bonus should increase. I'm 3 years out in ortho with base salary of 108K but I make 10-12% of collections which can be 25-50K depending on how many patients you see, how many surgeries you are first assist, how many post-ops (unpaid), how many injections you do, etc. I make low bonus compared to other PAs because I am second assist often which is unpaid.

This is kind of what I was thinking/expecting...unfortunately - sort of.  The key I think that will make or break this potential opportunity for me is how the bonus is calculated.  I have previously interviewed for jobs that didn't include first assist fees in the bonus production, only relying on clinic - those were a HARD no due to pre and post-ops and/or how billing occurs if surgeon sticks their head in to "say hello" (legally should be my billing since I did the work...but we all know how reality works).  I've also interviewed for jobs that paid bonus on combined MD/PA productivity, therefore I would have gotten a piece of every surgery performed whether I assisted or not, because the expectation is if I'm not first-assisting I'm in clinic - passed these jobs for other reasons and there are 2 I kind of kick myself for now...oh well.

[AbeTheBabe]

Ya I think a bonus based on MD/PA productivity could be very lucrative. I have my own patient panel that stays on my panel unless I am literally transferring to the MD and he's doing the note/billing which is nice, he never tried to take credit for my work and we don't even bother with "incident to" billing. 

[SeanPatrick]

I am in a family practice with one physician. I have been in practice 44 years. I see between 21-23 patients a day since that’s all that can be seen with the EMR. My RVU’s average 415 a month and the physician averages 435 a month. My salary is $117,000 and I received a 3% bonus this year because I could not receive a raise because I was at the max for my position. I get 200 hours of vacation, five days CME with $2,500 in fees, malpractice, all license fees (state, DEA, NCCPA, AAPA, state society), 403b with 3% match, sick days) My day starts at 5:30 am when I go on the computer to address the things that came in over night (prescriptions, consults, portal questions, labs, referrals etc.) I then start in the office at 8 am and get home around 5:30. We are being acquired by a corporation and being merged with another practice in town. There will now be 6 providers (3 physician, 2 NP and myself. We will be opened to 8 pm one night a week and opened every Saturday 8-12. These days will rotate between the 6 of us. They pay in RVU’s, there is a base salary, but I have no idea what it is. I am assuming they will be expecting 5000 RVU’s. I do not know when the bonus kicks in (4,000 RVU’s) or the amount per RVU $15.00??) I plan on asking for a base salary of $135,000 to compensate for my lost CME and vacation. What is an appropriate RVU bonus to request? Any comments would be greatly appreciated.

[mgriffiths]

So, I thought I would update as I have learned more.  The job has 100% been offered to me and now just working out details - plus the surgeon I would be working with is a new hire (younger, but not straight from residency/fellowship from what I've been told).  Everything is completely dependent on meeting the surgeon and feeling that we would work well as a team.  Again, this is a transition with the same employer from FM to ortho and where things stay the same I will note:

• Hours: 40hrs/week - this is unchanged, except in FM I have 36 hours of clinic (four 9 hr days).  I start at 7:30am and am home by 5:30pm almost every day (maybe 1-2 days closer to 6pm).  Ortho I would expect that my hours will likely be closer to 45-50hrs/week, but they agreed to keep me at 4 days per week!
• Income: quoted as $115,500 base, I have countered for $120k - current FM base is $110k.  Honestly will probably accept even if they don't increase beyond the $115,500.
• Bonus: wRVU based - $12.97 per RVU produced over 2,539 annually - current bonus is $19.33 per RVU over 3300 annually (looking at historic ortho PA production my bonus potential is MUCH higher in ortho, as expected)
• CME: 40 hours with $2500 (I think) - this is unchanged from FM
• PTO: is accrued per paycheck, but ends up being 32 days TOTAL (except CME) - unchanged
• Benefits: all exact same

 

For me I like the increase in income, even ignoring the change from FM to ortho.  I have been picking up a TON of shifts in our UC clinics, often 2 per week, and honestly am burned out.  Furthermore, while I enjoy FM...it is just soul sucking.  Not that ortho will be perfect, many of my frustrations and causes for burnout will be removed (quality measures, Press Ganey, antibiotic seeking patients, controlled substance seeking patients, etc.).  Plus, I enjoy ortho.  I worked ortho as my first job out of school and enjoyed it, except the employer (really the surgeon I was paired with) was awful.  I left after 6 months, but I miss the hands on nature of clinic, surgery, etc.  I like the "you have a problem and let me fix you" mentality of many (if not most) patients in ortho, as opposed to FM where it is managing chronic diseases that will never get better - or worse, patients do nothing to get better.  Sorry for the bit of a rant if you read this far.

Here's to hoping the details work out and the surgeon is good to work with!