Physicians lack independent data to counter hospital FMV calculations
Hospital employees, particularly physicians and specialists, are experiencing frustration and powerlessness when negotiating contracts. They face externally imposed 'fair market value' calculations, restrictive non-compete agreements, and a system where executive compensation appears prioritized over frontline staff compensation. This creates a sense of unfairness and limited agency in their professional lives.
SOURCES (60)
“Has anybody matched into pain from FM? Is it worth it time wise and compensation? submitted by /u/WhiteTdLyfter [link] [comments]”
“My little rant of the day: I genuinely get side-eyes when I say that falling in love with a specialty isn't enough for me to choose it. I also want to be profitable in that specialty. And then I hear, “Oh, so you're just in it for the money?” Guys… money is obviously part of it. 😭 You spend thousands just preparing and applying to medical school, then potentially hundreds of thousands getting through it. You sacrifice years of your life. Why are we pretending financial compensation shou”
“I’m a medical student and eventually hope to own my own practice. I recently learned about provider-based departments while trying to understand what happens when an established physician practice is acquired by or becomes affiliated with a hospital system. I understand the Medicare requirements on paper, but I’m having a harder time understanding what makes these arrangements complicated in real life. Say a hospital acquires an existing practice with its own employees, management structure, con”
“Has anyone been received an offer or been employed by Fox Rehab and been given Employment Agreement a few dozen pages long? I feel like the non-compete is VERY restrictive, given the nature of the bulk of their business. This is for a very limited hour PRN position. Anyone here seen this? Thoughts? A lot of it seems borderline or flat out questionable with laws regarding non-competes in my state. I like the prospects of the position. But this is sending some red flags. submitted by /”
“I'm MIGS surgeon and Department Chair in NYC. I teach residents, early career-physicians, NPs and PAs on compensation and RVUs. I am trying to learn what topics are the most critical to address. If you have questions, I am happy to address them and share online information on these topics Thank you. submitted by /u/BrunoCasanovaMD [link] [comments]”
“Like someone else said, the COGS thing is a yellow flag. It could be something like an insurance provider increasing what they pay for DME or it could be a change in how they are categorizing things to make it more attractive to a buyer. I have no idea what the cost would be, but you could have a CPA firm do a review to see if their financials are reasonable. My firm even has a group specializing in M&A. I don’t work in that group so I can’t give any specifics on it though.”
“Do any of you formally supervise NPs with a signed practice agreement? If so, how does it work in your state? Are you compensated at all? How many are you expected to supervise? Do you actually review and sign off on their notes or is it more of a formality where you’re just available? Any additional admin time for reviewing notes? Any legal / liability concerns? This topic was never remotely mentioned in residency and some jobs are expecting the role supervision completely remote NP/PAs, no add”
“Thoughts? Rural California, high desert north of LA. $0.725/mi, and base pay of $23/hr for all non-treat time, such as driving and calling patients. They have an ambient AI system that cuts doc time roughly in half. It will involve a lot of driving due to it being such a rural area. I thought the SOC and treat rates were low. Driving half an hour each way for $70 + $23 isn’t great. I was going to counter 180 SOC, 80 treat, 110 DC. submitted by /u/Shot_Leadership9169 [link] [com”
“Signed already overbooked/overpaneled FM resident who just clicked some buttons in Epic to assign himself PCP and routed the chart to the schedulers for new patient plus ED follow up visit on patient’s who have never been seen by our clinic who is now asking for forgiveness and not permission. Apparently this is unhinged behavior. submitted by /u/just_premed_memes [link] [comments]”
“New rule at my hospital. What’s even the point of a primary team? Just admit all chest pain to the cardiologists, all the abdominal pain to the GIs, all of the coughs to Pulm. What are we even doing here? submitted by /u/brownmamba1015 [link] [comments]”
“6 yrs experience, located in Raleigh NC through large healthcare system Sleep medicine Tele-health $130k base. Will not budge on salary. $10k sign on bonus. no other bonuses 20 patients daily (all patients 20mins) only for sleep apnea. Other sleep complaints are referred out M-F 8-4pm. 1 hr admin time daily with 1 hr lunch $2k CME, 5 CME days. 24 days PTO a year thoughts? submitted by /u/theanxiousPA [link] [comments]”
“I am currently a PA student set to graduate in December. I have submitted a few applications over the summer (about 7-8) and I have heard back from 2 of them. I had a series of interviews and was offered a job in rural MN. The job is family medicine / wound care with hospital calls. Clinic hours are 8-5 Monday-Friday (my FTE would be 1.0). The on- call schedule is once every 6 weeks. Regular clinic hours are worked while being on call. Hospital acuity is low - about 5-6 patients admitted at a ti”
“Started working for a group practice in November 2025. I was told it would say 3-6 months for insurance credentialing. At about the 6 month mark, my employer told me that they are “negotiating” fees and will be delayed in getting credentialed until July. July is past and my paychecks have been continuously low. I am seeing 10-15 patients a day and producing a good amount per month. My office is PPO. I recently checked to see if my name was credentialed with different insurances and still do not”
“What should be negotiated as a new grad if we are offered up to 22 PPD, work four days/32 hours, function without a dedicated MA, use a new EMR (NextGen), unsure about onboarding, and pay rate $140/hour at an FQHC clinic in an unsafe neighborhood? Can I negotiate a cap of 18 PPDs, since I know that managing the inbox and paperwork, complex patients, and rooming delays, may require me to take work home? How would you address overtime, double-booking, last-minute add-ons, and delays in rooming? Wh”
“Hey all, I see posts here and people talk about buying into a practice, or becoming partners, etc. What are you actually getting when you do this? From what I can initially see, the most profitable model for a private practice doctor is "eat what you kill" minus overhead, and do everything you can to minimize overhead. You get your share from an ACO, maybe you are doing RPM/CCM. If you can hire a NP, you can pay them a salary and take the profit off the top. But like what magical money”
“would be really interested in more details re: how private equity blew up your old practice”
“I mean, they can, they just make the bonus enough money so that it ends up as $250 after the taxes are deducted”
“Interviewed for a rheumatology position in southern CA. Got the job offer but pretty disappointed with contract offered. I have rheumatology experience already and will be going into my 3rd year as a PA starting this October. Base salary: $125,000 for 40 hours per week with potential bonus of up to $4,000 every quarter (if seeing more than 2.3 patients per hour) PTO: 10 days CME: 4 days with only $550 No on call or inpatient. I also will not be in just 1 clinic, will be at 2 max 3 if needed thro”
“Non compete are usually for a limited time and location. Have you looked for ad locum work?”
Rates will vary depending on where in California. Where are you looking?
“You already knew the bigger academic hospital had this culture before signing up for a second contract with them. What are the repercussions with your agency if you don’t finish the contract? But… Just take your assignments in more peaceful locations”
“I am a first year attending and I am pretty sure I am interested in a private practice. I was wondering where is a good place to start to learn more? How do you find out demographic statistics on places that would be good to open a practice? Any other tips? Ty! submitted by /u/Rare-Regular4123 [link] [comments]”
“Joined a practice years ago, worked hard, long hours. Salary grew to 1M. Paid off loans, married, 2 young kids, sole income. Practice fell apart (private equity), quit, non-compete, legal fight, in limbo, no job for 1 year. Started own practice, no income for another 2 years. Back to long hours, can’t afford to fail, burned out, but record revenue last month. If I can keep this up, may get back to 1M salary. 2M brokerage 1M retirement 1M CRE (modest revenue) 15-20k monthly spend (includes 6k mor”
“Joined a practice years ago, worked hard, long hours. Salary grew to 1M. Paid off loans, married, 2 young kids, sole income. Practice fell apart (private equity), quit, non-compete, legal fight, in limbo, no job for 1 year. Started own practice, no income for another 2 years. Back to long hours, can’t afford to fail, burned out, but record revenue last month. If I can keep this up, may get back to 1M salary. 2M brokerage 1M retirement 1M CRE (8k monthly net, on hold indefinitely due to recent bi”
“My hospital used to do a 2.5k annual bonus but switched to a $2.50 per hour differential for having a certificate and that's way better. Also, they pay for testing, study materials, and a retest if you fail, and CEUs to maintain it. We're kinda spoiled”
“Working in the ER and feel like I need a raise. I’m one of the most productive PAs at this shop seeing around 2 pph usually ESI 3-5, sometimes ESI 2. I have received positive feedback from several attendings and my director. I want to ask for a raise but issue is that I have been at this shop for less than a year. I want to ask for a 10% raise which I know is significant. I don’t know how to start this conversation without just spitting out numbers and saying pay me more lol. Not too many other”
“I currently work for a profit hospital making 162-175k/year with RVU quarterly bonuses and overtime as a nocturnist (hospitalist & critical care). I perform procedures at bedside such as arterial/central lines and intubations. I am ATLS/ACLS/BLS certified. I am locked in at this salary. There will be no more raises. Got an offer for an inpatient cardiology position at another non-profit large hospital system that is well known and highly rated. My dream specialty, daytime schedule, but longe”
“About $220k right now, so certainly viable but as mentioned elsewhere, my future may include full-time care due to MS... So that's a bit of a curveball.”
“Trust me, it could be worse. I’m currently at an HCA hospital using the obsolete version of Meditech with all the F-keys. At least expanse lets you click and type!”
“Does anyone have any insight on what it’s like to at a place that does not have RVU requirements? Example: multi-specialty group where some specialties make RVUs and others don’t. Those RVUs are then pooled and distributed amongst the whole group. submitted by /u/DeepHouseDandelion [link] [comments]”
“Hi, please let me know what y’all think of this offer. It’s at a private practice with what seems to be a friendly/supportive team of 3 doctors and 3 medical assistants. - $170,000 base for 33 hr work week, expected to see 90-94 pts/week when fully trained - Eligible for quarterly productivity bonus (1-4k) and annual bonus (5-6k) - 11 paid holidays and 5 days PTO - Health insurance 100% paid, no deductible - CME $1500 annual - 3% non elective contribution 401(k) starts after 12 months - Free dru”
“Alright so have this upcoming interview at this clinic and I’m a new grad. Talked to a PA who works there and said she and another PA are leaving. Don’t have your own patient panel. See patients first, report to doc, doc comes up with treatment and plan and bills for it. If there is a change in treatment, you can’t do anything, only the doc can. PA told me don’t have as much autonomy ever since clinic got bought out. Thoughts on that? submitted by /u/gmons01 [link] [comments]”
“Received an offer from a big name hospital in the metro for $49 an hour as a new grad pharmacist. just wanting to see if anyone is willing to share their new grad offer letters to provide data to my hiring manager that they are below market average for other hospitals in OKC. obviously you can remove your name etc. hiring manager says they might be able to leverage the offer if they can see that other hospitals are offering more. TIA! submitted by /u/No-Sundae4733 [link] [comme”
“Wondering where everyone making good money with good hours and vacation time are finding jobs. I have a broad search area (though looking for sub specialty work +/- primary care) to almost anywhere in the country and yet I can’t find jobs that have pay above $250k. Are we using a specific search program? Google? Word of mouth? Cold calling hospitals? Using a recruiter? What are we doing to find the good jobs out there. Specifically interested in PNW, Maine, northern MI, OH. Thanks! submitt”
“Can anyone speak to what Sutter Health in Northern CA is paying per RVU for FM outpatient? submitted by /u/Even-Bicycle-151 [link] [comments]”
“The ED I applied to is offering a quite low base pay package with full benefits. I need help negotiating. submitted by /u/jetpufff [link] [comments]”
“I'm a provider and you way overpaid for your NP. Lumping all "providers" together when looking at student debt isn't effective because mid levels are not equivalent to the training physicians receive. I hope your NP wasn't from an online diploma mill at least.”
“Anyone has experience working at these two places as a FM physician? I would appreciate any info you have about base pay, RVUs, bonuses, calls, inbox coverage, midlevel supervisions, PPD, overall work life balance, etc. You can also PM if you rather share it privately. I would really appreciate any info or if you can help connect to someone who can share their experince as it will help me make better decision for myself and my family. Thank you submitted by /u/goldenzone786 [link] &#”
“Are any of you currently taking on private consulting or expert witness work outside of traditional platforms? I’ve been looking into independent consulting overhead (managing schedules, direct billing, avoiding massive commission cuts from typical agencies), and I'm curious what setups or platforms you're using to keep things streamlined without drowning in admin work. Would love to hear how others balance independent consulting with clinical schedules. submitted by /u/Charm”
““We definitely need to get rid of the supervising physician requirements if we want to maintain meaningful employment imo.” And “If we don't have autonomy, we won't have jobs before long. Too much administrative headaches and cost if they can hire an NP for less overhead.” I’ve seen this statement echoed but how can we put it into practice. I wish there was a way to make it so NPs and PAs would both need supervision but there’s not going to be any backtracking and we will get left behind”
“Hi! I am a new grad PA-C and was offered a full-time Hospital Medicine PA position with a large health system. $117k annual base ($104k clinical + $6,500 night/weekend + $6,500 call) $5k starting bonus $15k retention bonus ($5k after years 1, 2 & 3) $80/hr moonlighting Eligible for Value-Based + Hospital Medicine Quality Incentives 9pm–7am shifts after training 12 weeks of M–F daytime training I’ll be working alongside 2 physicians overnight — never alone My role overnight is primarily triag”
“I’m in outpatient family medicine and work for a hospital system. Our overlords hired a consulting company to advise on a compensation redesign for the physicians and APPs. Right now, our compensation is a base salary (which is 90 percent of what you netted last year) + RVU bonus + panel bonus + metric bonuses. I’m curious if anyone has went through a compensation redesign and what exactly changed? I like my job (85% of the time) and I’m hoping this new compensation doesn’t force me to leave. &#”
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“I’ve done PC and UC. I love medicine and treating patients, building rapport. But it seems like I’m starting to not like working because quantity over quality values that these companies have. PC patients every 20 mins, get there early, sometimes work thru lunch, maybe leave late… chart after chart. Even with templates and dictation. And then UC, solo provider 12 hr shifts with 60 patients a day, BS complaints, procedures, leaving late- then company wanting notes done in 24 hr. I just want to kn”
“I’m a resident physician making about $96k gross/year , and my wife recently started working and will probably make around $30k/year , so about $126k household gross in a very high cost-of-living city. We currently pay around $3,400/month . This is the first apartment we’ve ever lived in that we genuinely LOVE. Before this, we spent years in tiny apartments while studying/getting our careers started. Our current place is very bright, has tons of natural light and an amazing open view. That hones”
“Hey all I am a DPT in the Atlanta area. I have currently been at my first job out of school for the past 2.5 years. I have recently started job searching to look for better opportunities, and ended up with an offer from a local hospital system. I was wondering if you guys had insight on what seems better? Current job: Outpatient Neuro 85k base (from the 83k I started with) but I also get a ~2k bonus for taking a student, which I have an opportunity to almost every quarter; this year I'll mak”
“Trying to be objective here and not fly off the handle. I’m a DVM at a MedVet location. We have been informed recently that we are expected to charge ourselves an exam fee when we examine our own personal pets. We are also expected to charge ourselves an annual exam to “maintain a veterinary patient client relationship”. While it is discounted at 60%, I am utterly enraged by this concept. What policies do other hospitals have? Is it unreasonable me to be livid about this policy? submitted”
“the state i work in, the appointed HCP is first in line to make medical decision when the patient is deemed unable to make their own. this includes overriding existing decisions like DNRs & MOLSTs. it's very unfortunate in my opinion that decisions like that are able to be taken away from patients who made them when they were deemed capable. i really emphasize with my patients they make sure the person they are appointing will honor their wishes because within my state, the HCP does not”
“So I asked AI on the status of provider status within the next 10 years and it seems it is highly likely but it will start on the state level then move into federal level. Obviously the AMA will oppose but who cares they opposed DO, NP, PA and everyone and it doesn’t really matter. The only question is that we might not see a huge increase in pay .. at least not until the big chains die out and we can open independent pharmacies and bill for those services. On a side I have been seeing so many Y”
“I've known plenty of people working 1 year of experience working in specialties. Some do great. Some dont. So its ultimately how prepared you feel.”
“Looking for advice on a situation I’ve found myself in somewhat inspired by a recent post. I’m a PA with four year experience recently hired to a new practice and been here for about three months. I really enjoy the job and people I work with and our practice is expanding so we hired another PA. I’ve been training him and we get along very well but I’ve recently found out he is making almost 8k more than me and he is a new grad PA. Idk if it matters but he is a second career 40s male and I’m an”