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Comparing salaried vs private positions


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I am hoping to get some tips from the more financially savvy residents or staff, for those of us that’ll be graduating soon.

As a graduating R2, I have been getting few offers for locuming, partnering and salaried positions. The main two that I am considering is a semi-permanent locuming position (6-8mos) vs a salaried hospital position.

My main question is how to compare an office based gig (as new grad I’ll probably see 4-5 pts/hr so I’d guess around $130-140/hr income with 25% overhead) vs a hospital salary based position that probably comes to something around $115/hr but comes with health benefits and pension (I am still waiting to get the full package for details on remuneration).

I know that there are opportunities for added income in the clinic with the occasional more lucrative chronic disease/annual exam/etc billing codes as well as some private billings, and of course there is the opportunity for incorporation in private practice.

I am wondering about the cost of not being able to incorporate as a hospital employee, and if it’d be generally balanced out by the benefits/pension plan that one would get? 

Thanks guys!

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Numbers aside, I'd encourage you to think about your long-term goals and how each position might set you up accordingly. Would you want to take the opportunity to locum first and learn about the business side of medicine, and then move into a salaried, or another type of position if you want? It's often valuable to gain experience working in a number of different settings, unless an ideal position is currently available. 

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salaries look ok on their face but you become subject to the whims of your employer. to enjoy the pension and benefitsyou have to stay at that location long term which penalizes you significantly for walking away to a better one.

 

if salary was so great youd see radiologists and optho take it but they dont because its not great.

 

pathologists are forced to be salaried employees and they arent happy

 

id go with FFs

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On 1/6/2019 at 7:26 PM, GrouchoMarx said:

salaries look ok on their face but you become subject to the whims of your employer. to enjoy the pension and benefitsyou have to stay at that location long term which penalizes you significantly for walking away to a better one.

 

if salary was so great youd see radiologists and optho take it but they dont because its not great.

 

pathologists are forced to be salaried employees and they arent happy

 

id go with FFs

I agree that the loss of freedom with salary is a huge issue.

I would never want to be an employee of a health authority. It has all the disadvantages of being an employee of a regular company plus you get the absolute incompetence and unprofessional behaviour of healthcare administration on top of it. 

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Don’t drink the koolaid...start FFS....the issue is you don’t know your actual earning potential while still a resident which makes salary and its associated benefits more attractive then they likely are. 

Believe me, salaried jobs will still be there later, and perhaps that is what works best for you in the end but as others point out, there are lots of downsides that aren’t readily apparent right now. 

I have been having this conversation with several staff right now and they have given me the above advice.

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  • 2 weeks later...
21 hours ago, blacktowel said:

I have a question regarding this. If you are a salaried (whether for an academic position, or purely clinical), is incorporation totally off the table? Can you only incorporate fees billed outside of a salary (FFS, blended capitation, etc.)?

That is my understanding. If you are pure salary, you are an employee and therefore cannot incorporate. 

You could ask an accountant if you wanted a definitive answer. 

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