Yes, physician compensation varies both in terms of total cash compensation and in the risk profile (guaranteed salary versus incentives) between school of medicine–employed faculty and those employed in community medical groups or within private practice. In general, private practice can often offer the highest compensation packages, especially after an initial term. This is because private practice compensation plans usually have the most money at risk, tied to factors such as clinical production and quality. Most private practice groups have a margin distribution model, wherein members have a base salary, but much of the compensation is paid as a year-end bonus after associated practice costs are deducted from professional revenue.
Employment in nonacademic medical groups represents a midpoint on the risk/reward scale, with higher salaries but less money at risk and usually less upside. ID physicians employed in these settings are often offered a base salary, with additional dollars per work relative value unit, or WRVU, offered above a certain production threshold.
Academic medical centers tend to offer lower salaries, but those salaries are associated with lower clinical expectations because faculty are expected to pursue other mission-oriented endeavors, which are recognized through academic rank progression. Academic faculty compensation is largely influenced by the funding enjoyed by the division and will vary for clinicians, clinician scientists and researchers. Even among ID physicians employed by academic medical centers, while total cash compensation can be lower, compensation per hour of patient-facing time is reasonably consistent across the industry.
This will vary by employer, but it helps to remember it never hurts to ask. This can pertain to the base salary, the term of the initial guarantee, the signing bonus and even the start date. For many large employers, the salary is somewhat preset as employers seek greater consistency and equity in their compensation plans. However, even at relatively rigid places like academic medical centers, elements such as signing and relocation bonuses, CME allotment, start dates and the protected time and funding associated with clinical leadership roles can be open for discussion, especially when the candidate is informed about market norms or has other offers.
Many offer letters will provide an initial guaranteed term, which typically ranges from one to two years, or three years for J-1 visa recipients, that is associated with guaranteed funding. This funding is intended to cover a typical ramp-up period during which new physicians pass their boards, get settled within the medical staff and become more proficient with electronic health records and the requisite documentation. At the end of that term, compensation is often allowed to float, in most cases up but in some cases down, to align compensation with production. This is why clarity on clinical expectations is so important for new faculty, even during their guarantee period, to ensure there are no unpleasant surprises.
For those employed in private practice, the end of a probationary period can potentially result in becoming a shareholder in the group, although this practice is slowly becoming less common as more groups adopt a more egalitarian mindset.
It is at academic medical centers where this discussion is most important. Many academic medical centers do not have a formal policy for salary adjustments, especially while the faculty remain at the same rank. Some have a years-of-experience adjustment, a cost-of-living adjustment or a merit-based increase, but they are not always consistent or transparent across faculty in their criteria. It is always good to ask about the availability of these planned and unplanned adjustments during the recruitment process.
Some sort of sign-on or relocation bonus is common across the industry. However, a material sign-on bonus is often associated with a payback period or a stringent noncompete agreement, so it always helps to understand the “strings attached.” Loan forgiveness, unfortunately, is less common, but not unheard of, so again, it always helps to ask.
For most entry-level offers, the language in the employment contract is very standardized, so a formal legal review isn’t usually necessary. However, you should always read it carefully, because it should establish many of the compensation components mentioned above, including policies for future salary adjustments, production thresholds, clinical expectations, FTE definitions, call requirements, etc. The more clarity you can get on these elements before signing anything, the better off you will be.
While the future of noncompete agreements is ambiguous, with the Federal Trade Commission actively reviewing the legality of such restrictions, you should read through your employment contract for this language. This is the one area where having a lawyer review your agreement can be especially helpful. The use of noncompete agreements varies greatly across regions, but an overly stringent noncompete agreement, especially in a dense urban setting, can hinder future job opportunities unless carefully navigated.
Most medical groups, no matter how big or small, are constantly thinking about their succession planning for various leadership roles, so expressing your interest in a role is not only acceptable, it is highly encouraged! While a formal role may not be immediately available, expressing your interest can result in informal mentorship opportunities, and your group or division leaders may appreciate being able to plug you into a leadership pipeline.
We publish annual aggregated industry benchmarks, accessible from our ID Physician Compensation Initiative landing page. These benchmarks, while aggregated, are commonly used to set compensation across the country. In addition, our own proprietary survey and findings can be used to inform more nuanced compensation elements, such as subspecialty adjustments, regional variations, funding for leadership roles and commonly accepted clinical expectations for faculty and nonfaculty ID physicians.
