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Tuesday Jun 21, 2016

FP Salaries Increasing, But How Much?

Editor's Note: Physician search and consulting firm Merritt Hawkins and the Medical Group Management Association recently released their annual reports on physician salaries. Both groups noted sizable increases in compensation for primary care. A few family physicians who are regular contributors to this blog changed jobs in the past year, so we asked them to offer their opinions on those reports and their insights on the job market.

Peter Rippey, M.D., Bluffton, S.C.
The most intimidating thing I had to do during my residency and fellowship training had nothing to do with patient care. It was negotiating my first employment contract.  

Of course, one of the most important parts of the contract for new physicians, who often have $200,000 or more in student debt, is the starting salary. Merritt Hawkins recently announced that for the first time in the history of the search firm's annual report on physician salaries(www.merritthawkins.com) the average starting salary for family physicians eclipsed $200,000. In fact, based on the thousands of search and consulting assignments Merritt Hawkins conducted on behalf of its clients from April 1, 2015, to March 31, 2016, the firm said the average starting salary for family physicians increased 13 percent to $225,000.    

The Medical Group Management Association recently released similar findings in its annual survey(www.mgma.com), stating that median primary care physician compensation rose more than 4 percent to $250,000.

Family medicine was Merritt Hawkins' most requested specialty for the 10th consecutive year. It's no secret there is a shortage of primary care physicians. Add the fact that a well-trained family physician can fill virtually any primary care void and you have a recipe for high demand, which is one driver of higher compensation.  

But before all of our third-year residents start salivating over these numbers, this is where I put an important asterisk.

* Individual results may vary.  

I would love to tell you that all new FPs can expect these high salaries. However, this was not my experience when I changed jobs last year. We have to mind the demographics of Merritt Hawkins' sample. The majority of the settings involved were hospital-based, employed positions and in communities with populations of more than 100,000. Salaries also vary by region and practice setting.  

Also keep in mind that Merritt Hawkins is a recruitment firm, so employers using these services may have more resources, which could translate to higher salaries. It's also possible that using a recruiting service could indicate more trouble hiring or retaining physicians, which may cause salaries to skew higher.

Personally, I am not making anywhere close to the average Merritt Hawkins is reporting, and I have a certificate of added qualifications in sports medicine to boot. I think these reports can give us a starting point for negotiating a fair salary, but I would be careful about doggedly expecting to start out making that kind of coin.

Also keep in mind there is more to a job than a salary. I have worked jobs where no amount of money could have made me stay. For me, considerations such as location and type of practice are just as important as the salary. Let's also not forget that job benefits -- including insurance, retirement and bonuses -- are not created equal.   

However, it is promising that salaries are trending up given the increased demands and responsibility of primary care physicians. I think this breeze is indicative of larger winds of change where increasingly primary care is stepping up responsibility for coordinating patient care, improving health care outcomes and increasing the efficiency of health care delivery.

The importance of primary care's central role in a vibrant health care system is finally starting to be recognized, respected and valued.  

Natasha Bhuyan, M.D., Phoenix
The shortage of primary care physicians is expected to reach 31,100 by 2025, according to the Association of American Medical Colleges(www.aamc.org). There isn't a magic bullet to alleviate this shortage; it will require health care delivery reform, incorporation of technology into health care, increased funding for residency training, and team-based care with more advanced clinical practitioners. In the meantime, groups desperate for physicians are responding to market demand with vigorous recruitment.

As a resident in search of employment last year, I was pleasantly surprised to see how aggressively family physicians are recruited. Of course, there are the standard recruitment techniques of endless mass mailings and targeted headhunters. However, with increasing primary care demand, recruitment strategies are growing more sophisticated and responsive to physicians. The most obvious recruitment tool is a competitive salary with impressive signing bonuses (an average of $40,000 in Phoenix) or loan repayment.

Many places I interviewed offered high base salaries with reasonable quality performance bonuses as well. Each interviewer offered $10,000 more than the last. I also quickly learned employers are flexible in all areas of contract negotiations, including non-compete clauses, CME and even paying for examinations/licensing and professional membership dues.

Non-financial aspects also are used as recruitment tools: better call schedules, sophisticated electronic health record systems and minimized administrative burdens. I was particularly glad to see that many places I interviewed valued primary care physicians through leadership and governance. Some have compensated committee roles for physicians -- a move that shows our ability to transform care delivery is valued as well as our direct clinical skills.

With the trends in health care, I anticipate family physician salaries will continue to increase. However, job satisfaction isn't dictated simply by money. Rather, the structure of health care delivery will have to change for primary care physicians to truly deliver on the quadruple aim of better health, better delivery, lower costs and higher physician job satisfaction.

Helen Gray, M.D., Kirkland, Wash.
In November, I wrote about my move from Nevada to Washington in this blog. I learned a lot about changes to costs of housing and living. Keeping this in mind, I made sure that when I negotiated my contract my salary would be fixed and guaranteed for the first two years, and that I would be receiving compensation commensurate to the increase in spending I would experience in a different state and bigger city.

Although the numbers are available, I had a difficult time finding data on average compensation for the location I was moving to. Eventually, after Googling for what felt like days and asking numerous colleagues in the area, I felt like I had a good idea of what I should ask for without getting laughed at when it came time to negotiate.

Negotiating and contracts are not things I'm fond of, though it's worth noting that the AAFP has resources that can help. So imagine my relief when my initial offers from the potential employers I was considering were actually comparable to the community's market. My salary increased 20 percent with the new job.

I will say, however, the starting salary offered to me as a physician now four years removed from residency in an urban area with a high cost of living is not the number noted by Merritt Hawkins.

I was involved in recruiting for my Nevada practice prior to relocating, and I can say that the starting salaries there were even lower than those here in Washington. The Merritt Hawkins numbers were a little surprising to me and my colleagues with whom I discussed the results.

It is great, though, that family medicine is becoming more desirable and that salaries are going up. This could help to address the primary care shortage.

Posted at 10:05AM Jun 21, 2016 by Peter Rippey, M.D.

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