u/Urology_resident

I’m a surgical sub specialist five years out from finishing residency and I’m considering moving to a different region of the country with a higher cost of living/real estate than where I currently live.

I’ve had some preliminary conversations with several of the groups in the region. They only have experience with bringing on a new grad and provided the starting salary they gave that person. My concern is that this is about $200,000 less than what I’m currently making. Maybe I’m overthinking this, but it seems a little awkward to negotiate a higher salary as an employee for a group that you will want to be a partner at within a year or two of beginning employment. There’s no set partner timeline, basically as soon as you are productive enough to support yourself, you can become partner.

I don’t want to poison the relationship at the outset by asking for more money which I know is coming from the business but I also don’t want to take a significant pay cut in a location where cost-of-living is higher in real estate is more expensive.

TLDR: is it reasonable to ask for a higher starting salary joining a physician owned group if you have experience at a residency compared to a new grad?

ETA: I am currently an employee of a multispecialty specialty group owned by a larger national organization without an opportunity for partnership currently. But I am in an eat what you kill model and I am quite busy and productive. I am aware that high cost of living places also typically pay less.

At the group, I’m talking to the current partners make as much as me or more depending on productivity and there is a very straightforward path to partnership. So there definitely is some deferred economic benefit.

When I ski with my preschool age kids I use a hunting chest pack to hold all their snacks and water bottles in front for easy access.

This looks interesting but maybe overkill?

Question for fellow rural sub specialists, subspecialty surgeons, proceduralists and/or anyone who’s also overwhelmed by referrals many of which involve cancer or other organ threatening pathology. Our practice covers a large Tri state catchment area and currently has about 2000 unscheduled referrals and a 3-6 month wait.

We are looking for ways to restrict access (yes downvote away) and lower our volume since we are currently drowning. Our options are to restrict by diagnosis to only cancer and organ threatening complaints or geographically restrict to just our city/county region.

ETA: I’m more inclined to geographically restrict to keep more variety.

Has anyone else been in this situation and instituted any changes? Thanks in advance.

This may be a niche question but I’m a urologist in community private practice. We are very busy and drowning in semi urgent surgical volume while on call. We have OR time M-F and usually do 3-4 add ins every day. On the weekends we usually do 5-6 cases or more Saturday and Sunday. Patients routinely spend several days in the hospital waiting for us to operate on them. We are paid for call thankfully but we all agree the pace and volume is not sustainable.

My question has anyone in this situation (not employed by the hospital) worked with their hospital system to create a surgical hospitalist partnership? Like you pay me some fractional FTE and give me a room every day and I just do add ons? During that week or on that day I wouldn’t do any clinic or scheduled cases.

ETA: To clarify I’m the urologic hospitalist, kind of like emergency general surgery but like 0.2 FTE and I do my regular job 0.8 FTE.

Asking for a friend.