Seeking Advice on Re-Negotiating My Salary

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    Anybody have advice on this one:

    I have been employed by a private group for the past year at a low salary (85% less than the usual going rate for my specialty with my experience in my geographic area). I did this partly because there were very few job options here when I was looking for a job, and it’s my old hometown, and I just loved the idea of being a doc in my hometown. It is an easy 15-20 minute commute (other jobs would have been 40 plus minutes away), and it’s pretty close to my elderly mom, whom I’m hoping will help me with childcare for the children I’m hoping to have someday soon. My contract has that after the first year my salary would go up to the usual going rate “at the discretion of the employer”. Since I have only been profitable for the practice in the past few months, and am $50,000 in the red for the practice, they are denying me any raise. I am now seeing more patients than anyone else I did residency with (I’m averaging 28 patients per day in family practice–my residency mates see about 25/day at 2 to 3 years out), but I’m stuck continuing to make 85% of what they make. My numbers far exceed the practice’s budgeted numbers for me. Part of why I’m in the red is the practice did not get me credentialed with several large insurance companies on time (I had all MY paperwork in months before I started; they didn’t do their part), so my numbers were way down the first couple months. After three years, I’m to start buying into a partnership (although even that offer is not guaranteed anywhere in the contract). The partners get a nice bonus from the lab, along with decent salaries (once you’re done buying in of course). I’m told to just wait a few years and I’ll be making good money (meanwhile, they know about my ridiculous student loan debt of $200K and the fact that my husband, also in grad school debt for $100K, just started his own business a few months ago, so we’re really hurting financially and need the money NOW). They feel that until I’m out of the red, I get no raise (at the rate I’m going, that will probably be in a year, maybe more. Although looking at my accounts receivable, if I left the practice now, I’d probably be about $20,000 in the hole after the receipts all came in.)

    I’m also panicking because I secretly want to try to get pregnant this coming year, and if I’m pregnant a year from now and trying to negotiate a decent salary, I’m sure I could forget it. Plus, I want to quit my moonlighting job when I have a baby, but at this rate can’t afford to unless I get a raise at my regular job. For that matter, if I don’t get this raise, I don’t know that I could get pregnant yet–have already put it off for several years now.

    I still have a formal meeting with my two main bosses coming up, so nothing’s set in stone yet. Any advice on how to handle this? I thought employers were to “suck it up” when hiring someone new, and expect to go into debt for a while. Besides, I’d be out of the red eventually even with a raise. I feel they should be ashamed at paying me so little. Or am I expecting too much?

    That’s the main jist of it. Thanks.


    I am so sympathetic to your situation. I so truly wish I could help you out with some concrete advice. The situation you describe is far too common and was the same one I encountered over 10 years ago when I finished with training. The whole scenario stinks and you are being held responsible for circumstances beyond your control. You are far from the only younger physician who has faced much delayed credentialing issues.

    I was located in a large city in CA and there was never a shortage of physicians who could be “abused” by the partners. In one particular group, new doctors turned over every 2 or 3 years. Finally, the partners sold out their interests to a large medical management firm and could care even less about the integrity of the practice.

    Sadly, a number of my family practice “friends” had to endure migrating from one job to another until they found something resembling more tolerable. One friend is most happy at a VA doing outpatient family practice clinic and is a single mother of a school age child. Interest rates were 18% when she was in medical school and she is finally getting the debt paid off.

    After meeting with your two main bosses you really need to have your “antenna” up to pick up on anything that would indicate to you that this present situation would be best short-lived. Sort of a stopping ground for now. Are you able to piece together various moonlighting jobs where you are paid by the hour/shift and forget about contracts that are generally only for the benefit of the management? At the time I last practiced, I had 2 part time urgent care/shift jobs where I could take as many hours as I wanted. Despite the apparent insecurity of the arrangement, the full time contract jobs ended up ironically more insecure in the long run. Because I could be flexible about shifts, I felt sometimes appreciated rather than be told that I was a “financial” drain.

    I wish I could tell you that you are not expecting too much but really, from what I have observed over the past decade, the situation you’re describing is one I’ve encountered by others all too frequently. Maybe things are different in other areas of the country. Are you in a heavily HMO penetrated region like CA?

    Again, I really wish I had answers for you but I hope that it helps a bit to know that you haven’t been the only one and you have my support here.


    Another option you might consider is contacting your admitting hospital and see if they have any program to support start-up practices, then leave your current private practice group and get support from the hospital.
    Or you might think of starting your own private practice, leaving this group now that you’ve seen how it all works, you may have a loyal patient base which will follow and you may end up having a successful private practice on your own. Banks will provide loans for the start-up costs if your local hospital won’t do it.
    Perhaps there is another doctor in the community or in your group that you could join with and set up your own practice together.
    Does that appeal?


    Dr. RebK has a good suggestion unless of course you have a non-competition clause in your contract keeping you from opening a nearby practice with the patients that were “yours” at that group. I had a friend who really got burned on a non-compete clause pretty painfully. Each state varies on that aspect so check into that first before following up on what Dr. RebK suggested. I wish I weren’t so cynical having seen so much “ugliness” toward physicians. 🙁


    Definitely don’t breathe anything about being pregnant…or wanting to get pregnant…noe of thier business until MUCH later anyways….and yes most places SUCK UP your first year losses bc it is expected and of course someday you’ll be out of the hole. DO you know what they did to the other guys in your group back in the beginning?
    PS SOUnds like some of your money is going to the others in the group…indirectly… :ouch:


    My advice: be assertive and confident. You are valuable to them and will eventually be very profitable, especially because you’re a woman. I’m 2.5 years out of residency and in a similar situation. I felt out of residency like I was the lowly new guy and took what they gave me. Now, I’m realizing that I’m valuable and deserve not to get screwed. Glad to hear a least one person has astonomical student loan debt too. :twocents:

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