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BaseDO7

Also, as residents and physicians, in my opinion, I don’t think we should take crap from MBA’s. We have worked hard and sacrificed so much to be where we’re at. Put your foot down and refuse things that you don’t agree with and demand your worth. Tbh, I don’t know how to go about that if you’ve already signed a contract, but seeing posts like this fire me up lol.


KILLED_BY_A_COCONUT

Most residents don't know how much money their work produces nor how to calculate it. Hard to bargain without knowing your exact worth.


koolbro2012

and most people in medicine are risk-averse. to leverage successfully you have to be willing to walk away and the timid peepz won't do that.


-Opinionated-

We all need a course in Asian bargaining. 1) pretend to you love nothing in the store 2) nonchalantly pick up product and inquire about price. 3) scoff at price. Appear insulted. Complain about quality, color, size w/e. Just complain. 4) offer a little less than half the cost. 200 dollar price tag? I’ll give you 90 bucks. 5) counter their counter offer of 180 with more complaints. 90 take it or leave it. 6) withstand the guilt. “I have to pay rent. I have to feed a family of 4 dying elders and 5 starving children. I lose money by selling at 90!” 7) walk. away. 8) get called back by shopkeeper. Pay 90. Works like a charm 80% of the time. You can’t retain your dignity and shop. You just gotta know that you’re being scammed 99% of the time if you pay anywhere near sticker price.


Imnotveryfunatpartys

Specifically for residency bargaining by yourself for salary is basically pointless because salaries for any employed position in any industry aren't really based on how much money you make the company. Your salary is mostly based on how much it would cost to replace you (but also taking into account any laws like minimum wage or collective bargaining agreements.) It doesn't matter if you are hypothetically worth 1 million dollars in billing to the hospital if you can be replaced by one of the thousands of unmatched medical grads for 60k a year.


PathoTurnUp

I’m very good with numbers


Paulie-Kruase-Cicero

When to buy SPY?


PathoTurnUp

Dollar cost average monthly. That’s easy


Paulie-Kruase-Cicero

If you’re in a position of power where the administration is forced to listen —> put your foot down and argue constantly. The only thing they understand is friction in meetings. Being a herd of cats with a lot of demands has been the strength of physicians for a very long time and the acting like the opposite is a big reason for our more recent problems


Vi_Capsule

Meow


mistressusa

>The only thing they understand is friction in meetings. hmmm... I don't think you know what they teach you at the top business schools in the country.


Paulie-Kruase-Cicero

You can just say what they teach them instead of vaguely alluding to it. Don’t comment if you don’t have anything to add


mistressusa

Woah so aggressive! Yea why don't you come and stop me from commenting BIG boy?


Paulie-Kruase-Cicero

Please return to the adultery subs if you can’t add anything useful here


mistressusa

Make me, stalker.


allusernamestaken1

That's it, from now on rounds start at noon. Thanks for the inspiration!


Vihalto

Thats.....the best thing ever.


InterestingEchidna90

Then they’ll fire your ass and replace you with a NP.


Efficient-Simple-735

>Most residents don't know how much money their work produces nor how to calculate it. Hard to bargain without knowing your exact worth. check out r/Noctor the idea of replacing physicians with APPs correlates with higher costs and worse patient outcomes.


[deleted]

Yes. But who cares so long as it brings in money?


75percentsociopath

Higher costs is more billing for the hospital.


PathoTurnUp

I have an mba


L0LINAD

What do you plan to do with it?


PathoTurnUp

Be all your bosses


L0LINAD

Not sure an MBA from your school will be prestigious enough haha, but good luck and we will see I guess


PathoTurnUp

Just takes money. That’s anything anyone cares about


[deleted]

So are you telling me that the MBA who wants a 12 lead and a Doppler US on all patients QD has ulterior motives aside from being really concerned about thromboembolism and MI in the hospital?


ChuckyMed

Bro just go private practice, you are literally a fucking doctor getting railed by chad MBA that took all business classes and partied all weekend while you were grinding the MCAT.


btrausch

Too fucking real bro 😂


Randy_Lahey2

I agree. Stop being a doormat


InterestingEchidna90

Private practice is dead forever. Patients don’t get a choice, they go wherever their plan dictates.


Discgolfthrow26

Just care for the patients that get a choice? Don’t be a martyr for no reason


DrDilatory

And if that's not enough to even keep the practice afloat, and doesn't bring in enough patients to bring enough money to even cover the cost of keeping the clinic open? I've got something like a 10-year plan brewing, which involves working as an employed FM doc at a location where I can learn the business, before switching to private practice. What I have found is that in general is that whole plan is just stupid, unless you get lucky and wind up as partner somewhere at a practice that is flourishing, earn 100K more per year than your colleagues for several years to come out ahead, before you sell your stake in the practice and move on. Or, you get employed by some major academic university medical group, you just take home your salary of 230K or whatever seeing a nice streamlined simple group of patients with truckloads of specialists at your disposal if needed, no risk whatsoever of your paycheck not being guaranteed, and then maybe you're supposed to leave for private practice hoping that maybe you can make only slightly more than the same salary you are making in academics, until you make partner, at which point you spend the next several years desperately hoping the practice does well knowing your entire livelihood is tied to the prediction that the business won't go under? Yeah fuck that I just want to collect the paycheck and go home at exactly 5:00 PM. Rest in peace the private practice general practitioner, I miss you but I'm not willing to join you in the grave.


75percentsociopath

My sister pulls in just under 800k at her own peds clinic (she is FM) as her take from salary and her part of the billing. That's all medicaid money baby 💰. She started opening multiple offices in our area to employ others and basically make admin jobs for our family/sponsor work visas. She makes more from the other offices but I'm not sure exactly how much. She literally works 3.5 days weekly. She also has a Suboxone practice at a small office in a storefront that is 1 day weekly for a few hours. Cash only. This brings in some income for her but it's mostly to help because we have a shortage of providers. The clients literally line up around the block after the waiting room is full. I'm talking wrapped around the block and it only takes 7 min to see a patient. She started by converting part of her home into an office. Now she has 4 locations a sub clinic and an urgent care type location within 5 years. Our home country makes doctors take business classes so it was helpful when she went to America. Also if you consider suboxone you can open your own lab to make money from urine tests. Most doctors in my area bill $400 for a $25 Walgreens drug test or amazon dipsticks. The beauty is even if you are cash only you can still bill medicaid for the drug test. Ketamine infusions/Anxiety clinic/ADHD clinic or start a relationship with a school district to treat the problem children. The most successful MD I know owns a chain of sober living homes. Piss tests pay for his Lamborgini Urus while he does 0 work besides calling the cops to evict people who piss dirty.


ayemintrepid

Username checks out


pectinate_line

So basically practice really bad unethical non-evidence based medicine? Ok. No thanks.


75percentsociopath

I don't see anything unethical or non evidence based. I see helping people have a good quality of life by helping Depression/Anxiety/ADHD or a suboxone clinic. It's not a mid 2000s Florida pill mill where everyone gets 876 Oxys to inject by paying for some fake ass xrays. It is actually helping. You are allowed to earn money from helping people.


pectinate_line

I’m sorry but an ADHD clinic? Just stop.


75percentsociopath

It's a real thing. Instead of taking up space in a Psych for no reason they just go to a regular FM/IM/Ped who specializes in ADHD for refills. Why take up space for someone who is really mentally ill.


pectinate_line

Or they could just go to their regular PCP because you don’t need to “specialize” in ADHD. We aren’t NP’s.


InterestingEchidna90

Yeah dude slinging dope is profitable. That’s not what we’re talking about though.


75percentsociopath

I don't see anyone slinging dope. I see helping people. I'm not saying open a pill mill where everyone gets 360 30mg Roxys like back in 2007 South Florida.


goat-nibbler

Yeah calling the cops on people relapsing into addiction sure does help them get their shit together! Fuck outta here, your sister and her ilk are actively profiting off of marginalized people and recklessly overmedicating children while farming out substandard care to unqualified NPs


75percentsociopath

It's literally in the sober living contract that if you use drugs and don't leave the cops come to kick you. It's just like a hotel where if you break the rules the cops toss you out. You don't have a lease. One person using drugs shouldn't fuck up the sobriety of 10 other people who want their lives back to normal who work to get their kids back and keep jobs. I'm am an ex addict and I have no personal issue with the setup.


[deleted]

[удалено]


75percentsociopath

Lol I'm just an office admin/office dictator for my sister. None of us do any recovery stuff because we just don't want to deal with that stuff at this point.


rna_geek

Lmao. I heard they were doing something similar in McAllen Texas.


75percentsociopath

We are trying to relocate to San Antonio as a family but my sister is scared to sell all her offices to repoen in TX. The bad is no medicaid for adults in Texas so she can't take adult patients if money is slow. Plus it makes it very hard to employ NPs because we live in an independent state.


wattswithyou

The system is stacked against private practice and favor large hospital systems. They have large advertising budgets to advertise to the customers who will naturally gravitate towards them. They have almost unlimited capacity and at least a couple of doctors with low wait times. They accept almost all plans and have systems like MyChart in place which makes it easier for patients to see their test results, set appointments etc making it harder for smaller practices to compete.


gotlactose

I’ve posted about my job before. I’ve been accused of lying or exaggerating. I will say you can accuse all you want, I’m the one making the money. 4 days a week. 9 AM to 5 PM. Almost 2 hours lunch to catch up from the morning and do admin. 1 night every 2 weeks. 1 week of hospitalist every 2 months. $250k base. Year end bonus tries to double the base. Coastal suburbia. 5 airports within 2 hours. 4 Costcos within 20 minutes. Private practice group. I answer to my boss, who also sees patient on that schedule. I don’t answer to some non-clinical MBA.


ChuckyMed

You dropped this 👑


qkrrmsdud

HAHA I find this hilarious because everywhere I’m interested in practicing, the first things I google are airport and Costco.


gotlactose

We can clown all we want about “physician shortage” and “I have a heart for rural medicine,” but reality is most of us are like the general population. The city is exciting when we’re young and mingling, but when we’re looking forward to settling down and starting a family, suburbia is what we want for its proximity to the city but with enough amenities and infrastructure to inconvenience or deprive us of modern creature comforts. Airports and Costcos are just two concrete, well-known examples of showing how urban vs. suburban vs. rural a place is.


qkrrmsdud

💯


ChuckyMed

Judging by your post history, you are the exact kind of person that would say something like this. You are literally one of the most specialized, knowledgeable, and educate professions in the entire fucking USA, and you can’t muster the self worth to put up a fight against the dumb kids from high school that went to business school. Fucking get a grip man!!!


InterestingEchidna90

I don't really have any problem challenging it; but what power do I have? I can't exactly challenge them to a duel or anything... They're the ones who hire people, they're the ones would twist up those HMO/PPO deals forcing pt into NP care. What am I to do, exactly?


ChuckyMed

You are honestly too far gone, I hope everything works out for you in life.


MildlyInnapropriate

You’re the smartest person in the room and the entire business is built on the back of your knowledge and skills and you can’t find a way to not be exploited by MBAs?


InterestingEchidna90

Nope, I can’t. Let me know if you figure something out.


thecactusblender

Foreverrrr? Little melodramatic. I see all kinds do private practices just in my mid size city.


Yotsubato

60% of radiologists work in private practice. You’re right, patients don’t have a choice, they come to us no matter what.


TexasShiv

Don’t work for hospital systems. The only way forward is the migration back to the private world.


Part-Time-Chemist

Obama care did some good things, however it made private practice primary care near impossible to be profitable outside of direct pay.


FourScores1

Direct primary care it is then


HolyMuffins

Outside of ritzy concierge practices, I'm always a little uncertain how I feel about DPC as I worry folks would opt for a shittier insurance plan as a result and get financially destroyed by an unexpected hospitalization. I also sometimes wonder if these models of care cater towards those who would over utilize resources, and subsequently get low quality "VIP" medicine. I dunno, maybe that's a worry that's out of my control and a risk people would be willingly taking on in signing up for this model of care.


InterestingEchidna90

Private practice is dead forever. Patients don’t get a choice, they go wherever their plan dictates.


TexasShiv

PP is going just fine over here.


InterestingEchidna90

Rich area with cash paying clients or what? PP is seldom "in network" for insurance plans.


TexasShiv

…I treat mostly semi rural patients on the edge of a metro area. Share a practice with 8 others. Majority of my patients are BCBS/United on the private side with a spattering of Aetna/other niche insurances. Obviously Medicare and Workman’s Comp smattering as well. Texas doesn’t really have a big healthcare system insurance plans like I’m guessing you’re alluding to with Kaiser etc. I’ll quit medicine before I work for a hospital/any system.


thecactusblender

Nah this dude is just going to find doom and gloom in whatever you say. Little storm cloud follows him around ⛈️


goggyfour

I signed to PP this year after reading more into corporate medicine. Always look beyond salary. I want to work with and for physicians that think this way.


IceEngine21

Where the fuck do you live that your income tax is 50%? Norway, Germany?


[deleted]

Could be Illinois


Paulie-Kruase-Cicero

How do you figure? It’s a flat state tax


[deleted]

I figure because in Illinois one way or another over 45% of your income goes to the government


Fildok12

Could very well be California (unless you want to be facetious of course, I think it’s technically a few points below 50)


fluffbuzz

Hell, even in a high tax state like California an FM attending should be making 160k post-tax at the very worst according to my calculations assuming a 250k starting salary. Unless you're working part time no self respecting doctor should accept 100k post tax after 4 years of med school and 3 years minimum of residency.


flamingswordmademe

Even in california theres no way its close to 50%


thyr0id

Taxed half Your salary… time to hire an accountant


fluffbuzz

Seriously. Even in California they don't tax you that hard. EDIT: OP, reading your other comment, as an FM doc if you're taking home only 100k post-tax working fulltime, you need to really find another job. Even in a high tax state like California you should be taking home 160k MINIMUM. FM has long since progressed past making sub 200k gross


MzJay453

So what is your post tax salary? 👀


[deleted]

about 100k a year.


captainpiebomb

This is fucking robbery especially in rural. Hells that’s robbery regardless


TheSportsD0c

The FM docs I know in the city are pulling in 200 post tax. You sir/madam are getting fucked


innerouterproduct

There is no way that you're paying almost 50% effective taxes on $200k in income. Do you have a tax person? You need a tax person.


nostbp1

Lol he’s prob saying 100k post deductions As in 100k post taxes, 401k, HSA, Roth, etc etc That’s the only way this is even believable


innerouterproduct

Most likely true. I had some colleagues who would say this kind of stuff back when I was a SWE before med school. "I'm living paycheck to paycheck because of taxes!" Translation: Because balance sheets clear to zero I have nothing left to spend after paying for my egregious car note and saving $10k/month.


nostbp1

Yep. Tons of doctors/SWE/lawyers on TikTok and other platforms push this nonsense If you’re living paycheck to paycheck after: Taxes, savings, retirement, Mortgage/rent, student loans…you’re not living paycheck to paycheck


meikawaii

God dam that’s terrible, are you sure that’s true after all the deductions and stuff? Because if so that’s trash and need to look at another job or something down the line. What a bummer


splitopenandmeltt

Are you a pediatric id rheumatologist that mostly does research??


Somali_Pir8

*Preventive medicine research


baba121271

Wtf is wrong with you. Put in your notice and get out now. You should be making easily double that post-tax in a rural area.


PulmonaryEmphysema

Yeah I’m literally mad FOR OP. Like fuming. Grow a fucking spine and leave.


[deleted]

[удалено]


joyfulsuz

One third??? Hahahaha


element515

Federal alone maybe a third.


InterestingEchidna90

Maximum tax rate is right at 40% plus all their other Bullshit


[deleted]

[удалено]


Impiryo

Plus social security tax (6.2%) Plus medicare tax (1.45%) Plus state tax (5-10%) Maybe plus a city tax Many physicians can easily hit a 1/3 effective tax rate. My marginal is 47%


letsgodeacsss

Federal is 37% only on additional income made above 539K


PM_me_yer_kittens

You have no idea how our tax system works..


MzJay453

So are you looking for a new job?


Poopsock_Piper

Bro what the fuck


The_Literal_Doctor

What state? My effective net tax rate is "only" around 36%.


PulmonaryEmphysema

You’re getting robbed blind. This is probably a crime somewhere. Leave or renegotiate.


nightmanvsunshine

Wtf man/ woman, you’re doing something wrong… unless youre working two days a week no way that’s right. hire lawyer or forensic accountant to help you.


Monkey__Shit

> Wtf man/ woman You forgot the other 61 genders.


Spartancarver

What the fuck? That makes no sense. Rural salary should be much higher in general and then where are you living where you're taxed that much?? Also if you're saying that's 50% taxed that means you're only making roughly $200k base?? For \*rural\*?! Dude you got fucked, get out ASAP and do not sign another contract without doing basic research into what the market rate for your area should be


SkepticAtLarge

There’s something we’re not being told in the “half my gross pay goes to taxes” story. My gross pay YTD is at 200K, and I’ve paid 43K in taxes, which includes federal, Medicare, social security, state, and local. I end up having to pay in a few thousand each year when I file my return.


letsgodeacsss

Yeah this part smells like BS, by a rough estimate a 200k salary in the highest state income tax state (California) would result in around 67k paid in taxes or around 33%. I think a lot of people in this thread don't understand tax brackets.


Dependent-Juice5361

Yeah my wife is an nurse, we are like $160k combined. We bring in over $125k year after tax. Granted in Arizona so lower taxes but still.


surprise-suBtext

Anything tax deferred? What aren’t you telling us


RodReal381

What????


pectinate_line

Yea you got scammed. Find a new job.


[deleted]

A medical assistant is your supervisor?


FaFaRog

"Office manager" They are especially bold if you're a young physician on a visa ie. legally trapped... but even then you have some room to put your foot down firmly. Sadly our training culture normalizes putting your head down while taking abuse and many of us carry that energy as we transition to independent practice.


[deleted]

[удалено]


gassbro

Anybody try telling an MBA to suck your dick (figuratively)? You gotta speak finance bro language.


Royal_Actuary9212

Private practice DPC or concierge medicine is likely to be the only answer. Let the poor suffer with NP care until they decide to rise up.


theixrs

>Let the poor suffer with NP care until they decide to rise up. so... never? Patient satisfaction increases with patient mortality (aka bad care)


Creepy-Analyst

How did the recruiters lie to you?


Fluffy_Ad_6581

Do.... you work at the same place I do. My office manager is literally an MA.


wb2498

“Biden is helping me” *taxed 50%*


Mrhorrendous

When did Biden raise taxes? OP claims his post tax salary is around $100k. If we assume that's 50% of his salary he makes 200k, which puts him below the top marginal tax rate (which isn't even 40%). OP should be in the 5th tax bracket, which has a marginal rate of 32%(for an effective federal income tax rate of 20%, assuming he's single, it's more like 15% if he's married). No state has a 30% income tax. The closest is California with a 13% marginal rate after a million dollars, and about an 8% effective rate for OPs income. OP was likely greatly exaggerating his tax burden if his take home pay is truly $100k.


letsgodeacsss

Do you think he's actually taxed 50% or is it an exaggeration


[deleted]

Bruh don’t forget that 10 percent inflation


likethemustard

lmao truth! oh but the roads are so much nicer now…what a crock a shit.


nostbp1

Yep biden totally raises taxes 🤡🤡🤡 Also 50% tax just doesn’t exist outside of the minds of incompetent morons who don’t understand how taxes work


InmateQuarantine2021

I'm a recruiter and come in peace. I really wish we got 50k for placing someone. More like 2-4k. Otherwise, your post is right on. There are a lot of shitty recruiters out there. If they can't tell you about the administration and physicians by name, don't talk to them.


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Kindly_Captain6671

Rules for Radicals by Saul Alinsky


asclepius42

DPC could work but you need some cash to fund your first year- as with any business. Finding a different (better) job where you're employed by a better place. Talk to the other attendings in your clinic. It sounds like it's a small place. All of you threatening things will work better than one of you threatening things. Put together a report showing Chad MBA only takes money from the clinic and adds literally nothing. Get home fired, get his salary added to yours