May 21, 2024 • 42 mins
Welcome to another episode of the Med School Minutes podcast by Saint James School of Medicine! In this episode, the host Kashik Guha sits down with Ethan Nkana, a specialist in physician contract negotiations, to uncover the secrets to maximizing doctor salaries. Ethan, the founder of Rocky Mountain Physician Agency, shares invaluable insights into the disparities in physician compensation, particularly affecting women and minority doctors.
Learn how Ethan helps rookie and seasoned physicians negotiate better contracts, achieve fair pay, and gain more time with their families and patients. Discover the importance of having multiple job offers and how doctors can use this leverage to secure better deals.
0:00 - Introduction to Med School Minutes
0:35 - Welcoming Ethan Nkana
1:20 - Overview of Physician Contract Negotiation
2:45 - Ethan's Background and Inspiration
3:50 - The Role of a Physician Agent
5:10 - Addressing Misconceptions About Doctor Salaries
7:00 - The Business of Medicine
9:30 - The Importance of Fair Pay for Doctors
11:15 - Ethan's Journey in Hospital Administration
13:00 - Founding Rocky Mountain Physician Agency
15:00 - How Doctors Can Benefit from Contract Negotiations
17:10 - The Power of Multiple Job Offers
19:00 - Helping Rookie Doctors Navigate Job Offers
21:15 - Addressing Salary Inequality Among Physicians
23:20 - Understanding the Market Value for Doctors
26:00 - Strategies for Negotiating Better Contracts
29:45 - Ethan's Unique Approach to Doctor Advocacy
32:30 - The Impact of Fair Compensation on Doctor Well-being
35:00 - Closing Remarks and Contact Information
36:00 - Conclusion and Call to Action
#PhysicianSalary #DoctorPay #MedicalCareer #ContractNegotiation #MedSchoolMinutes #SaintJamesSchoolOfMedicine #PhysicianCompensation #MedicalPodcast #HealthcareIndustry #EthanNkana #RockyMountainPhysicianAgency #MedicalStudents #ResidencyAdvice #HealthcareEquity #DoctorLife #MedicalEducation #NegotiationTips #HealthcareProfessionals #IMGDoctors #CareerAdvice
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Hello and welcome to another episode of the Med
School Minutes podcast, where wediscuss what it takes to attend
and successfully complete amedical program.
This show is brought to you bySt James School of Medicine.
Here is your host, kaushik Guha.
Speaker 2 (00:19):
Thank you so much for joining another episode of Med
School Minutes where we talkabout everything MD related,
with the focus on internationalstudents, specifically students
from the Caribbean.
Today we have a veryinteresting guest, and this
podcast is not just pertainingto IMGs or international
(00:40):
students.
This actually pertains to anyphysician.
We have a very special guestwho actually does the
negotiation for higher contractsfor physicians.
This is not residency, mind you, but this is a post-residency
negotiation.
So a rookie doctor, a seasonedphysician, seasoned surgeons
(01:01):
this particular person hasfounded a company that helps
physicians maximize their networth or maximize their salaries
, and we're going to have a veryinteresting conversation with
him and I really hope that ourviewers, our alumni we have
(01:22):
nearly 800 practicing physiciansin the US and Canada.
I hope you guys tune in and takeadvantage of this, because this
is something that we've talkedabout internally but again, it's
kind of out of our purviewbecause most of our students are
gone by then.
But once you become a physician, apparently there's a lot of
disparity in pay, and this iswhat Ethan Inkana and his's pay
(01:47):
by up to 30 to 40 percent.
So, anyway, have a listen and Ihope you really find this
(02:14):
podcast helpful, ethan.
Well, thank you so much forjoining us on our podcast, med
School Minutes.
Podcast Med School Minutes.
I just wanted to you know.
I saw your background andyou're such an interesting
person, generally speaking andeven in the field that you're
working.
I think our students and notjust our students, but our
(02:36):
general audience and medicalstudents absolutely need to know
about the kind of work that youdo.
So can you give us a little bitabout yourself and then your
company and what it is youactually do?
Speaker 3 (02:47):
Yeah, first and foremost, thank you for having
me.
I am delighted to be here.
I think the most importantthing about my background is
that my mom is a doctor.
Speaker 2 (02:59):
Okay.
Speaker 3 (02:59):
So this business, to me, is more than just a business
.
It's my way of honoring her asa physician and, you know, kind
of leaving my imprint onmedicine in a way that I
couldn't intellectually by beinga doctor.
And so the work that I do mostbasically is very similar to
(03:22):
like a talent agent for a moviestar or a professional athlete.
I represent doctors in contractnegotiations, surgeons,
surgical groups, and I help themget more time with their
patients, more time with theirfamilies, better support in
their practices so that they canperform care at the highest
(03:44):
level, and then, lastly, fairpay for their work.
Speaker 2 (03:48):
Okay, and why do you think that that's needed?
I mean because you know thegeneral impression is that
doctors make buku bucks.
Like you know, they graduatefrom med school.
And then the salaries that likeat least, if social media is
any indicator, you're looking atnearing seven-figure salaries.
(04:09):
Why would somebody need you forthat?
Speaker 3 (04:11):
though.
That's a fabulous question, andI often have to explain to
people outside of medicine thatwhile doctors make buku bucks,
they have buku debt right, andso that six figures for most
doctors in America.
They have six figures ofstudent loan debt that they need
(04:32):
to work off or pay down.
Or you have other doctors whohave other obligations that need
to be met after graduating.
I have a client right now witha J-1 visa, and so there's
certain accommodations that shehas to make for her practice.
So it's not just that doctorsneed to be paid more, it's the
(04:54):
fact that doctors are not paidfairly, and that's most evident
when you get into the pay gapsthat are well-pub published
between women physicians as wellas physicians of color.
Speaker 2 (05:07):
Okay, so unpack that for me a little bit.
What do you mean by doctors arenot paid fairly?
Because from the standpoint ofmost average earners, where in
the United States, I think, theper capita income is $45,000 or
$48,000, something like betweenless than 50,000.
How, why would you say that adoctor making so much money is
(05:29):
not paid fairly?
Speaker 3 (05:32):
For two primary reasons.
When I was in hospitaladministration, one of my jobs
was to quantify how valuable adoctor is to our hospital.
Okay, and sometimes people willsay, well, you work for a
for-profit.
Nope, I only work for nonprofit, faith-based institutions and I
(05:54):
knew down to the dollar howmuch revenue Dr Smith made for
us.
Here's where doctors often arenot aware of the numbers of the
economics of hospitals.
As a hospital, I'm going to make$1 million plus minimum off of
(06:14):
the effort of a doctor on anannual basis.
What I pay the doctor is theexpense side of that.
So the gap as a business person, person, that gap is what I
call my roi, or return oninvestment.
So while doctors get intomedicine to care for patients,
to do no harm, to cure illnesses, I as a healthcare executive
(06:38):
got into medicine for differentreasons, for different reasons,
and so doctors get caught in thecrosshairs of.
Medicine is a business and themore money I can make off of a
doctor, the more money that goesinto my pocket and the more
(06:59):
money that goes into ourshareholders pocket.
So what doctors are oftenmissing is that, yes, you're
making 300, 400, 500,000.
But what you don't know is howmuch I'm making as a hospital,
off of that effort, which isusually five, six, seven, x what
you're being paid.
Okay.
Speaker 2 (07:16):
And do you have internally, from your experience
, a particular benchmark?
That might be this is fair, orthis and above, or this and
below is fair.
So if it would you say 2x isfair or 3x is fair or, you know,
5x, do you have a certainbenchmark or does it vary from
(07:40):
region to region, geography togeography?
Speaker 3 (07:45):
region to region, geography to geography yes,
that's a fabulous question andit does vary geographically.
But we do use a statisticalbenchmark which is the gold
standard in the United States,which is MGMA, the Medical Group
Management Association.
So, we rely on that data to tellus what is the 10th all the way
up to the 90th percentile ofdoctors within that certain
(08:06):
specialty.
And then, of course, you adjustfor your care setting.
You adjust for how busy you areand maybe you take some
leadership responsibilities, butwhat that does is it helps us
get a market value for thatdoctor's skill set and training.
And as you progress as aphysician, you become busier,
(08:26):
more proficient, which happensreally quickly.
You should also be paidaccordingly, and I think the
important thing to call out hereis I've talked to doctors who
are five, six years into theircareers and are still being paid
the same as they were theirfirst year.
Wow, are your expenses the same?
Speaker 2 (08:46):
Wow, Are you?
Speaker 3 (08:47):
still performing at a rookie level six years out.
No, you're contributing waymore, and it's important that
your compensation iscommensurate with your efforts
and contribution.
Speaker 2 (08:59):
Okay, so before we dive more into this compensation
part, okay, so before we divemore into this compensation part
, I really would like ourviewers to know exactly how you
became an authority in thisparticular field.
So why don't you tell us alittle bit about your background
and what it is you do, and howdo you do what you do?
Speaker 3 (09:20):
Yeah, that's a great question.
This is the only thing I'veever done in my career.
So when my mom doing that, Iwas working on the executive
side of hospitals, financeoperations, physician
contracting.
So I was the guy.
When Dr Smith comes into theCEO's office and says, hey, ms
(10:04):
CEO, I would like to make moremoney, I was the one next to the
CEO saying, well, here's howmuch Dr Smith makes us and
here's how busy they are and allthe analytics.
So I knew what my CEO would sayto a doctor before they even
said it.
And now I use that to doctor'sadvantage to say, look, here's
what they're going to tell you.
(10:25):
It's a standard contract, wedon't have the budget, blah,
blah, blah.
Those are all things that Isaid.
And eventually, because doctorsdon't have any training or
preparation for contracts, theyjust believe it and they think
that we're all in medicine forthe same reasons.
Speaker 2 (10:42):
But what we?
Speaker 3 (10:43):
don't fully appreciate and embrace is
medicine is a business and myrevenue has to exceed expenses
in order for my business toremain in operation.
Speaker 2 (10:52):
Okay, and you know.
So how many years have you beendoing this from the hospital
side?
Speaker 3 (11:01):
So I spent 15 years working as a hospital executive
Wow, so it was literally myfirst job out of college.
I was an intern in a hospitalHR department, so I was doing
all the onboarding of nurses andstaff progressively grew in my
leadership responsibility.
I wanted to be a hospital CEO.
(11:24):
That's why I went to law school.
I didn't go to law school tobecome an attorney.
I went to law school because Iwanted to become a CEO and I
felt as though that would be agood skillset to kind of help
lead a hospital work withdoctors.
What I didn't appreciate,speaking of the business of
medicine, is I got laid off in2019.
(11:44):
And in that moment of justcomplete loss professionally, I
had this question why don'tdoctors have agents like
professional athletes?
And that question spiraled into.
Now, four years later, I'verepresented over 50 doctors in
(12:06):
contract negotiations with theiremployers and spoiler alert, we
get them.
Like you were saying before, wewere recording $50,000, $60,000
, $70,000, and even, in somecases, almost $200,000 per year
increased compensation, and soit begs the question not well,
how good are we that we can dothat?
(12:28):
How do we do that?
That question's ancillary why dohospitals have that money to
pay in the first place.
If you couldn't give me a payraise six months ago, why can
you now pay me $186,000 more?
Because Ethan's in the room?
What's the difference now?
And so it demonstrates thatdoctors are so focused and tied
(12:53):
to the Hippocratic oath that alot of times they end up
suffering because they don'twant to take away from their
focus on patients by having togo to another job or ask for a
pay raise.
So I encourage doctors when youare happy and fulfilled, your
patients get the best version ofyou, and that's what they
(13:15):
deserve.
Okay.
Speaker 2 (13:17):
So you, obviously, after undergrad you went to law
school and then you got an MBA.
So, Ethan, I have to say this Idon't think you weren't smart
enough to be a doctor.
With all those degrees, Igenuinely think you're probably
just as smart, if not smarterthan, any physician I've met and
(13:38):
I've dealt with a ton of them.
And then after that, you moveto Colorado.
Is that right?
Speaker 3 (13:47):
Yeah, so now we're based out of Denver.
I lived here with my wife.
We got married about six monthsago.
Speaker 1 (13:54):
Oh, congratulations.
Yeah, thank you.
Speaker 3 (13:56):
So we have two old dogs.
Usually one of them is in herehanging out with me for a
podcast, but not today.
But I've lived in Denver for 11years.
We serve doctors nationally, soit just so happens that this
weekend I'll be in the mountainsdoing education for the
National Medical Association onhow black doctors can be
(14:18):
successful in the business ofmedicine.
Speaker 2 (14:21):
Awesome and generally speaking, you basically moved
and then you started a company.
Is that right?
Speaker 3 (14:29):
You know, it didn't happen quite like that.
So I lived here for about sixor seven years, got laid off,
and that was when I started tohave this crisis of conscience
like what do I even want to bewhen I grow up if I'm not going
to be a hospital CEO?
And then that's when so I'd sayprobably 2019, about five years
(14:51):
ago I had the idea, and thenover the last four years,
literally, when the pandemicbrought us all to working from
home, that was about the timewas July 2020, where I
officially launched, and thenthree months, four months later,
I quit my job and said I'mgoing to give this thing my
(15:12):
full-time effort.
Speaker 2 (15:14):
Oh, that's amazing.
So, um, and what?
And it's called.
Can you tell us the name?
Speaker 3 (15:21):
Yeah, it's Rocky mountain physician agency, okay.
Yeah, the reason I chose thatis because we're based.
I have loved denver, right therocky mountain region of the
united states, and I wanted toalso bring in this idea of
agency, like actors and athletes, which is why included the
physician agency piece okay, um,and generally speaking, so.
Speaker 2 (15:46):
So it's almost a happy coincidence that Denver,
if I'm not mistaken, is thehealthiest city in the United
States, isn't it?
We're up there.
We're usually more about thehospital or the doctor
(16:09):
compensation field.
So the reason I ask this isbecause, as you know, we're a
school, we're one of the oldestCaribbean medical schools, we're
the largest family-ownedCaribbean medical school and we
have over 800, or almost 800,practicing physicians right now,
and we get this a lot, thisquestion a lot.
Hey, compensation, you know,med school?
(16:32):
Because we don't.
I mean, we don't have abusiness course, we don't have a
negotiations course.
What we are recentlyintroducing is a networking
course.
Not a course, but like a seminar, where students come and we're
trying to help them network,because some of our older
physicians or older alum havecome and said you know what?
We met some of your kids andthey don't know how to talk.
(16:54):
They don't know how to do all ofthis.
So obviously you know, I meannegotiations is obviously a
skill.
Now, when a student finishesresidency, residency is kind of
set in stone, right.
That's where you won't be ableto come and make much of a
difference there, because thisis coming from the government.
Post-residency, I've heard alot of our physicians come and
(17:19):
say you know what?
I didn't have any room fornegotiation.
When would a physician actuallyengage you?
Or when should they engagesomebody like you?
Speaker 3 (17:29):
The moment you are thinking about your job after
training is when you should callme Okay.
The reason for that is becauseI can give you the roadmap.
I can say you don't have towork with me, but here's exactly
what you should expect and howyou can prepare yourself for
success.
You should expect and how youcan prepare yourself for success
(17:51):
.
I think you brought up a reallygood point where a lot of
rookie doctors will go intotheir first job and say well,
I'm making $200,000.
That's way more than I made asa resident.
How could I say no my first job?
I went from making $12 an houras an intern to $60,000.
I didn't negotiate.
That was an ungodly amount ofmoney to me.
(18:13):
But now that I have a littlemore skill in this space, I
understand that it's not amatter of well.
I need to ask for more, to beaggressive.
It's the market is a certainnumber for your skillset and you
need to make sure that you'repaid fairly for your work.
So for rookie doctors, there'sone key that will help you get
(18:35):
what you deserve in your firstcontract and it's getting
multiple job offers.
I don't care if you have J1.
I don't care if you have towork for an FQHC underserved.
You need to get more than onejob offer.
That way you have the abilityto walk away from the offer,
which is a superpower incontract negotiation.
(18:59):
But I tell everyone, my clients,even my experienced orthopedic
surgeons, who I'm talking tohere in about 20 minutes.
I tell every one of thoseclients if you go into your
employer and ask for more money,better schedule, more support,
you will not get it.
I'm just going to spoil it foryou.
(19:20):
You're not going to get it Ifyou have a competing offer.
Now you have leverage.
I don't care how good of adoctor you are, I work with the
best.
None of them can walk intotheir boss's office and ask for
a salary raise and get itwithout having a competing offer
.
So for rookie docs, gotta havemultiple offers in order to have
(19:41):
leverage and make changes so II'm going to be honest.
Speaker 2 (19:45):
A lot of our physicians during residency
aren't looking for multiple jobs.
They're like, okay, I'mfinishing residency here, I
probably am going to work here,and that's kind of an
understanding that they havewith their program director.
Program director is very happyand again they get one offer.
Can you help such rookie docsget multiple offers even?
Speaker 3 (20:12):
help such rookie docs get multiple offers, even
Absolutely.
We work with doctors in kind ofone of two phases.
Some doctors bring us offersand say we want you to help
review, analyze and negotiatethese for us from behind the
scenes or your employer doesn'tsee us.
And then other doctors say sowhen they call us up front.
They say we want your expertisein identifying opportunities
that fit in, helping me find joboffers, opportunities, create
(20:36):
leverage and then in turnnegotiate those opportunities
for the most value to the doctor.
And also it's not just the StJames thing.
(20:56):
I've talked to the Universityof Michigan, at Stanford, all of
these training programs, andit's not unique to you.
Every doctor is coming out oftraining with this, this feeling
of like I'm exhausted.
It's, I often say, yourcontract is like the last 0.2
(21:18):
miles of a marathon.
You run the 26 miles and thenyou're ready to cross through
the tape.
A lot of doctors just collapseand say I'm not going to go the
last 0.2 and cross the tape bygetting multiple offers, by
negotiating those offers.
It is like giving up on thelast 0.2 miles to not negotiate
(21:42):
your offer and find multiple joboffers because you've spent how
many years and hundreds ofthousands of dollars and hours
on your education.
And now the last point twoyou're going to phone it in yeah
, wow, you know, I mean you.
Speaker 2 (21:59):
You bring this up.
This is a very interestingpoint because we've had a couple
of residents who, postresidency, have matched into big
university hospitals in Chicago, you know, there are two
massively dominant medicaluniversities and then there's
another one that has a hugehospital associated with it and
it is funny because thesehospitals pay notoriously low
(22:27):
amounts, like I'm talking about.
As much as you know, a post-MBA22, 23-year-old will probably
make in an entry-levelconsulting job that low and for
that situation, and you know,when we talk to the students,
they're like and I was like youknow, that's really really low.
(22:47):
I mean again students they'relike, oh, and I was like you
know that's really really low.
I mean, again, I don't reallystudy the market like you do,
but I have a general idea howmuch a hospitalist should make
because we place students acrossthe globe uh, not just in the
united states.
We have students who've gone tothe caribbean, like the cayman
islands even, and they'reworking there and they're making
a lot of money.
(23:09):
These other smaller economiesare actually paying more than
these big university hospitalsand these students are like well
, or I shouldn't say students,but these physicians are like
well, you know?
I mean, I don't know, it's abig name I can work there for a
couple of years and then I'lljust move and probably go
somewhere else.
What would you say to aphysician like that?
Speaker 3 (23:31):
I don't think it's an either or situation.
So a lot of times what happensis doctors suffer in silence.
Speaker 2 (23:40):
Okay.
Speaker 3 (23:41):
Doctors may be frustrated and you don't talk to
somebody about it.
They're fortunate to have you,but a lot of times doctors
aren't talking to anyone aboutthe fact that I know I'm
underpaid, but I'm underpaidbecause I love my patients, I
love my work, I love thispopulation and I often share
(24:01):
that.
Doctors sometimes feel tensionbetween doing good doing the
good work you do and doing well.
Okay, and it's okay to do both.
It's okay to do good and dowell.
So In that situation, lock armswith your fellow doctors.
Talk about your salary at work.
(24:22):
Someone in the room is going toraise their hand Hopefully it's
not you, but someone in theroom is going to raise their
hand and say wait, that's notfair.
Why is everyone else paid thatway and I'm not?
Lock arms together.
It's like when I was a kidgrowing up, there was the Power
(24:43):
Rangers and they would all cometogether and bring their powers
together.
That's how it is.
When doctors lock arms together, it is impossible I can tell
you from experience on thehospital side it is impossible
to ignore a group of doctors.
That magic number is usuallybetween three and four doctors.
When you lock arms together, Iguarantee you you can do amazing
(25:07):
things.
But you come in one-on-one andsay hey, ethan, I'm frustrated
with my salary.
Can I get a salary raise?
Oh, dr Smith, you know, it'sjust not in the budget.
Maybe next year.
And, by the way, I actuallyneed you to see patients more
quickly, so those 15 minuteappointments need to be 12.
(25:27):
And did you go on vacation lastmonth because it looks like your
rvs were a little low?
So they're gonna.
Not only are you gonna say Ideserve more, they're gonna flip
it on you and try to make youhave even less.
So I guarantee you medicine isa business and once you're in it
, you understand it.
It's the rookie doctors, Ithink, that have this idealized
(25:52):
version of what being a doctoris Not fully understanding the
context that you're walking into.
So I want you to have all theenergy and time to focus on what
you do best, which is caringfor patients, and my job is to
help alleviate the stress ofbeing paid fairly, having a
schedule that you enjoy, thathonors your lifestyle goals and
(26:18):
that allows you to spend timewith the people that you care
most about.
Speaker 2 (26:20):
Okay, and so that means, essentially, even rookie
doctors have a scope fornegotiation, generally speaking,
because, I'm going to be honest, most of our rookie doctors
don't.
I mean, they just don't.
They're like oh, I got an offer, look at me, I'm so great, I'm
making a lot of money, I'm happy, that's it.
But one thing I did want totouch upon was something that
(26:42):
you pointed out is that we'vealso noticed that in the last
decade at least, physiciansalaries haven't changed, at
least beginning physiciansalaries.
I mean, is that true or falsein your opinion, since you've
seen this from the other end,you've seen this from the other?
Speaker 3 (26:58):
end.
The gap between cost of livingand physician salaries gets
wider and wider and wider, wow.
Speaker 2 (27:22):
And I know, when we were talking about this, you
actually mentioned that there isa lot of disparity and
unfairness in doctor'scompensation, even within
physician groups.
Can you elaborate on that alittle bit more?
Speaker 3 (27:27):
This is not my opinion.
If you go to Medscape MerrittHawkins, this data is publicly
available.
I have distilled it down intowhat I think are some key
highlights.
I have distilled it down intowhat I think are some key
highlights, but often when Ipost some of these findings,
people will try to rationalizeWell, that's because of
(27:54):
irrelevant reasons and my beliefis that, for whatever reasons
these disparities exist, my roleis resolving them.
So I often stay out of theacademics of like well, why does
this exist and what are therationale?
The numbers are generalistpositions where women, on
average, are going to make about$60,000 less than their male
(28:15):
counterparts.
So from a percentageperspective, that's about 25%,
and that's from Medscape's 2022report.
They just published on theirlatest report about a week and a
half ago.
The same goes for doctors ofcolor.
So if you are a black doctorspeaking of the doctors, I'm
going to educate this weekendwith the National Medical
(28:37):
Association the average salaryfor all doctors is $339,000.
The average salary for whitedoctors $346,000.
So it's above the nationalaverage.
Now, when you go to blackdoctors, who are the lowest
among all minority groupsreported, they make $313,000.
(29:01):
So that's about $26,000 less onaverage than all doctors across
the board, wow, wow.
Yeah same work, right?
Speaker 2 (29:12):
So if you and I were in your past life, if you and I
were economists, sitting incubicles next to each other and
I was paid less than you for thesame work, I would be
frustrated by that, yeah, Idon't even think a lot of people
know that, because when I talkto our students, the light at
(29:32):
the end of their tunnel isgetting a residency residency
and at the residency I don'teven think like because I keep
hearing this on a regular basisthat once I'm into residency
it's utopia for us.
Like everybody's equal, thereare pretty standard salaries
across the board, but what I'mhearing from you is that's
(29:53):
totally not the case and evenafter finishing residency for,
uh, seasoned professional, therestill might be inequalities
that exist.
That's pretty amazing.
So, as you know your services,how much does it cost the
(30:16):
physician to hire somebody likeyou?
Speaker 3 (30:24):
cost the physician to hire somebody like you.
What I started out with when Iinitially started the business
is I wanted for doctors to nothave to worry about paying us,
and so we've done two things tomake the payment completely
painless.
One instead of charging doctorsa flat fee, painless One.
Instead of charging doctors aflat fee, our fee is tied to
their compensation.
Okay, so our fee is apercentage of the doctor's base
(30:50):
salary, so that way they knowthat we're incentivized to help
make them more money.
Okay.
Secondarily, we negotiate ourfee into the doctor's contract.
So, we just had a generalsurgeon who signed her first
contract.
Her salary caused us to have afee of about $15,000.
And then what we did is wenegotiated a $50,000 5-0 signing
(31:12):
bonus into her contract.
She's part of that to pay us,and then the rest of it goes to
her and we also make her waymore money than those initial
offers.
So, one, we want to increaseyour salary and then, two, we
get a signing bonus that's niceand big, so it covers our fee,
so you don't have to worry abouthow we get paid.
Speaker 2 (31:34):
Wow, that's pretty awesome.
So one thing I did want tocover is that you know, as you
mentioned there's, you should bearmed with multiple offers,
right, that makes your jobeasier.
That makes the physician a lotmore desirable, so to speak, to
the employer.
However, you know, we've heardabout locums.
(31:55):
I've heard about locums, but alot of our students don't have
no idea what locums is.
Do you think getting a locumsoffer would constitute a second
offer, so to speak, becauselocums offers are relatively
easy to get?
Again, I don't know if this istrue or not.
(32:16):
Maybe you can shed some lighton that.
Speaker 3 (32:18):
Yeah, that's a really interesting question.
I tend to think of locums as analternative or a supplement to
a doctor's job full-time job.
So mainly the doctors that I'veencountered who work with
locums are doing one of twothings Either they are
moonlighting, so I'm doinglocums in addition to my
(32:41):
full-time gig.
So, as an easy example,hospitalists tend to have a
seven on, seven off schedule, soI'll have some hospitalists who
will use that seven off as sometime for locums, so it will
supplement their full-timeemployment.
I have others who say I'm burnedout of being an employee.
(33:03):
I don't like how much controlthey have.
I want an alternative toworking full-time for this one
conglomerate employer, and sodoctors will go work locums
because they have more controlover their earning potential.
They have more control overtheir schedule, where they work,
when they work, and in thosesituations the primary
(33:28):
considerations would be you needto understand your pay, your
taxes, your benefits, becauseyou're a contractor.
Now there's a few differentthings to consider, but I often
say locums is a good supplementto your main gig as a side
hustle, or it's a goodalternative for doctors who are
(33:48):
just not really enthusiasticabout where they are now and
maybe want to consider adifferent opportunity.
Speaker 2 (33:55):
Okay.
So would you consider locums tobe another job offer, so to
speak?
If somebody gets a locums offer, can they go back to their
principal employer and say hey,I got locums.
If I do this for the stipulatedtime, or if I were to do this
full time, I'm actually makingmore, so I'm going to leave.
(34:15):
Do you think that that's apossibility?
Speaker 3 (34:20):
I'm going to leave.
Do you think that that's apossibility?
Absolutely.
I think your ability to walkaway as a physician really is
your power in a contractnegotiation.
Now here's the nuance that Iwould include in that statement
is I always encourage my doctorsif you were going to negotiate,
you can only negotiate withoffers you would accept.
(34:42):
So just as an easy example, Ihad a neurosurgeon who was
looking in California and Texasand then, out of the blue, he
had a buddy reach out who had anopportunity in Oklahoma, and he
said oh, ethan, can I now usethe Oklahoma offer to negotiate
against the California offer?
And I said unless you wouldaccept the Oklahoma offer, do
(35:05):
not include it in yournegotiation.
The reason for that is becauseit's this idea that if you bring
it into the conversation, youmust be willing to accept it,
because the employer that you'renegotiating with may say, oh,
okay, cool, well, good luck, allthe best.
I think there is thisirrational fear that doctor's
(35:28):
offers will get pulled.
I've never seen that happen.
I'm sure it does happen, but itdoesn't happen because a doctor
is asking for reasonableupdates to the employment
contract.
That's not why offers getpulled, and so I often say if
you're going to use a secondoffer, locums could be that you
(35:50):
must be willing to accept thatoffer in order to use it with
leverage.
Speaker 2 (35:54):
I think that makes complete sense.
I mean, you know, if you'remaking a power play, you need to
be able to live with theconsequences, so to speak.
I think that makes completesense, all right, well, I mean,
I think that you know theservices that you're providing.
I'm going to be very honestwith you I've never heard
anybody really provide theservices that you're providing.
(36:17):
This is a very unique area.
I know a lot of people who areworking for companies that do
like a staffing agency forphysicians, that do locums and
not just locums but full-time.
But what you're doing iscompletely different.
I mean, you know, is this avery competitive field that
you're in, or is this acompletely niche that you're
(36:39):
creating right now?
Speaker 3 (36:41):
There are a ton of contract attorneys and companies
that say we do contract reviews.
I think that has done adisservice to physicians,
because it's the same as goingto the doctor for a diagnosis.
You go in, they tell you you'vegot 16 things wrong with you.
(37:02):
Okay, well, how do I fix them?
Well, we don't do that.
We just point out the thingsthat are wrong.
We are really focused on onemaking sure we identify the
things that are wrong, thediagnosis, but also the
treatment.
So how can we get you paidfairly?
How can we get you a schedulethat honors your lifestyle goals
(37:24):
?
And we're not just going to say, well, cool, good luck on those
offers, we're going to go getthose for you.
So I don't believe there'sanybody else doing what we do.
But I also think that doctorshave been so accustomed to these
contract review factories thatjust churn and burn oh, it looks
good, dr Smith, nothing illegal, you're good to sign.
(37:46):
Now Dr Smith's underpaid by$50,000, and they don't even
know it.
Speaker 2 (37:52):
Wow, I mean, you know , ethan, again, you said this
before that you kept saying thatyou're not smart enough to be a
physician.
I completely disagree with that.
I I mean you, literallysingle-handedly are creating a
brand new industry and I thinkthat's needed because you know
doctors, at the end of the day,I want them to be uh, paid, uh,
(38:14):
you know fairly, because I wanta happy physician looking at me
and my family, because, at theend of the day, there are very
few professions that is life anddeath and physicians are
definitely that.
I always have the notion thatthere are four major
civilization buildingprofessions, and it's teachers,
(38:38):
it's farmers, it's engineers andit's doctors.
Unfortunately, it's not likeconsultants or lawyers.
Speaker 3 (38:45):
Lawyers will have something to say about that,
that's for sure.
Speaker 2 (38:49):
Probably, but I'm just saying like if there was a
zombie apocalypse, you would be-.
Speaker 3 (38:54):
I think that's spot on.
I think, it's spot on Lawyers,I think often overestimate how
important we are.
Speaker 2 (38:59):
So, but I think that the service that physicians are
providing and I do also thinkthat the way you know, the hours
, hours are crazy for physiciansnowadays because of the rigor,
and you know a lot of we keephearing this again.
We're we're a school, right, sowe keep talking to students on
a regular basis and they saidthat you know what the juice is
(39:21):
really not worth the squeeze.
I can get a CPA and makeprobably just as much as a
physician.
Probably in one fourth of thetime a physician makes Same
thing with law.
To a certain extent, why wouldI want to be a physician?
And that's why we have thiscrazy acute shortage of
physicians.
(39:46):
And you know, the laws aren'tchanging as quickly as they
should and you know, to acertain extent, I hope and I
wish physicians get paidcompetitively so that some of
the political scenarios that areplaying out in today's world
can be averted and prevented,because physicians will have the
time and the energy to raisetheir voice to make sure that we
(40:08):
are going in the rightdirection.
And I think the role that you'replaying in the big picture of
things is amazing and it'sremarkable.
So you know, thank you fordoing what you're doing what I
would like to do, ethan, is that, as I said, we have a pretty
big alumni base.
I'd like to share yourinformation, if that's okay,
(40:30):
with our physicians we have inour alumni directory, as well as
our current physicians who havejust matched into residency.
Just stay in touch with you toget some advice and then you
know, possibly at some point ifyou wouldn't mind doing a
webinar for some of our alumniand see if they can benefit from
your services, because I cantell you this much that they are
(40:53):
not getting, in my opinion,competitive salaries that they
should be getting.
I agree, yeah.
Speaker 3 (41:00):
First and foremost, let's keep the conversation
going about that webinar.
I will be more than happy tomake myself available, because
that education piece is just soimportant for doctors to know.
One that you do deserve better.
And two, how do I go get thatfor myself?
Speaker 2 (41:20):
I would love to support, right, awesome.
But, ethan, again, thank you somuch for being on our show.
I know you have an appointmentin about 10 minutes, if I'm not
mistaken.
Yeah, it's coming up here.
Thank you so much, ethan, forwonderful insights.
There were so many things Ijust really didn't know about
(41:40):
the economics of physiciancompensation and I really
appreciate you shedding somelight on that.
Again, I truly hope that ouralumnus or our alumni have found
this particular podcast helpfuland I hope they reach out to
Ethan in Ghana for his services.
(42:02):
But again, if you like thecontent of this podcast, please
give us a like, follow and share, download more episodes of our
podcast on any of the platformsthat you prefer, and remember
there's never a shortcut tobecoming an MD.
Speaker 1 (42:17):
Thank you so much for tuning into our show.
We hope you enjoyed anotherepisode of Med School Minutes.
If you like our content, pleasefollow us and receive
notification when a new show isposted.
This podcast is brought to youby St James School of Medicine.
For a video version of thispodcast, please check us out on
sjsmorg slash video.
Hello and welcome to another episode of the Med
School Minutes podcast, where wediscuss what it takes to attend
and successfully complete amedical program.
This show is brought to you bySt James School of Medicine.
Here is your host, kaushik Guha.
Speaker 2 (00:19):
Thank you so much for joining another episode of Med
School Minutes where we talkabout everything MD related,
with the focus on internationalstudents, specifically students
from the Caribbean.
Today we have a veryinteresting guest, and this
podcast is not just pertainingto IMGs or international
(00:40):
students.
This actually pertains to anyphysician.
We have a very special guestwho actually does the
negotiation for higher contractsfor physicians.
This is not residency, mind you, but this is a post-residency
negotiation.
So a rookie doctor, a seasonedphysician, seasoned surgeons
(01:01):
this particular person hasfounded a company that helps
physicians maximize their networth or maximize their salaries
, and we're going to have a veryinteresting conversation with
him and I really hope that ourviewers, our alumni we have
(01:22):
nearly 800 practicing physiciansin the US and Canada.
I hope you guys tune in and takeadvantage of this, because this
is something that we've talkedabout internally but again, it's
kind of out of our purviewbecause most of our students are
gone by then.
But once you become a physician, apparently there's a lot of
disparity in pay, and this iswhat Ethan Inkana and his's pay
(01:47):
by up to 30 to 40 percent.
So, anyway, have a listen and Ihope you really find this
(02:14):
podcast helpful, ethan.
Well, thank you so much forjoining us on our podcast, med
School Minutes.
Podcast Med School Minutes.
I just wanted to you know.
I saw your background andyou're such an interesting
person, generally speaking andeven in the field that you're
working.
I think our students and notjust our students, but our
(02:36):
general audience and medicalstudents absolutely need to know
about the kind of work that youdo.
So can you give us a little bitabout yourself and then your
company and what it is youactually do?
Speaker 3 (02:47):
Yeah, first and foremost, thank you for having
me.
I am delighted to be here.
I think the most importantthing about my background is
that my mom is a doctor.
Speaker 2 (02:59):
Okay.
Speaker 3 (02:59):
So this business, to me, is more than just a business
.
It's my way of honoring her asa physician and, you know, kind
of leaving my imprint onmedicine in a way that I
couldn't intellectually by beinga doctor.
And so the work that I do mostbasically is very similar to
(03:22):
like a talent agent for a moviestar or a professional athlete.
I represent doctors in contractnegotiations, surgeons,
surgical groups, and I help themget more time with their
patients, more time with theirfamilies, better support in
their practices so that they canperform care at the highest
(03:44):
level, and then, lastly, fairpay for their work.
Speaker 2 (03:48):
Okay, and why do you think that that's needed?
I mean because you know thegeneral impression is that
doctors make buku bucks.
Like you know, they graduatefrom med school.
And then the salaries that likeat least, if social media is
any indicator, you're looking atnearing seven-figure salaries.
(04:09):
Why would somebody need you forthat?
Speaker 3 (04:11):
though.
That's a fabulous question, andI often have to explain to
people outside of medicine thatwhile doctors make buku bucks,
they have buku debt right, andso that six figures for most
doctors in America.
They have six figures ofstudent loan debt that they need
(04:32):
to work off or pay down.
Or you have other doctors whohave other obligations that need
to be met after graduating.
I have a client right now witha J-1 visa, and so there's
certain accommodations that shehas to make for her practice.
So it's not just that doctorsneed to be paid more, it's the
(04:54):
fact that doctors are not paidfairly, and that's most evident
when you get into the pay gapsthat are well-pub published
between women physicians as wellas physicians of color.
Speaker 2 (05:07):
Okay, so unpack that for me a little bit.
What do you mean by doctors arenot paid fairly?
Because from the standpoint ofmost average earners, where in
the United States, I think, theper capita income is $45,000 or
$48,000, something like betweenless than 50,000.
How, why would you say that adoctor making so much money is
(05:29):
not paid fairly?
Speaker 3 (05:32):
For two primary reasons.
When I was in hospitaladministration, one of my jobs
was to quantify how valuable adoctor is to our hospital.
Okay, and sometimes people willsay, well, you work for a
for-profit.
Nope, I only work for nonprofit, faith-based institutions and I
(05:54):
knew down to the dollar howmuch revenue Dr Smith made for
us.
Here's where doctors often arenot aware of the numbers of the
economics of hospitals.
As a hospital, I'm going to make$1 million plus minimum off of
(06:14):
the effort of a doctor on anannual basis.
What I pay the doctor is theexpense side of that.
So the gap as a business person, person, that gap is what I
call my roi, or return oninvestment.
So while doctors get intomedicine to care for patients,
to do no harm, to cure illnesses, I as a healthcare executive
(06:38):
got into medicine for differentreasons, for different reasons,
and so doctors get caught in thecrosshairs of.
Medicine is a business and themore money I can make off of a
doctor, the more money that goesinto my pocket and the more
(06:59):
money that goes into ourshareholders pocket.
So what doctors are oftenmissing is that, yes, you're
making 300, 400, 500,000.
But what you don't know is howmuch I'm making as a hospital,
off of that effort, which isusually five, six, seven, x what
you're being paid.
Okay.
Speaker 2 (07:16):
And do you have internally, from your experience
, a particular benchmark?
That might be this is fair, orthis and above, or this and
below is fair.
So if it would you say 2x isfair or 3x is fair or, you know,
5x, do you have a certainbenchmark or does it vary from
(07:40):
region to region, geography togeography?
Speaker 3 (07:45):
region to region, geography to geography yes,
that's a fabulous question andit does vary geographically.
But we do use a statisticalbenchmark which is the gold
standard in the United States,which is MGMA, the Medical Group
Management Association.
So, we rely on that data to tellus what is the 10th all the way
up to the 90th percentile ofdoctors within that certain
(08:06):
specialty.
And then, of course, you adjustfor your care setting.
You adjust for how busy you areand maybe you take some
leadership responsibilities, butwhat that does is it helps us
get a market value for thatdoctor's skill set and training.
And as you progress as aphysician, you become busier,
(08:26):
more proficient, which happensreally quickly.
You should also be paidaccordingly, and I think the
important thing to call out hereis I've talked to doctors who
are five, six years into theircareers and are still being paid
the same as they were theirfirst year.
Wow, are your expenses the same?
Speaker 2 (08:46):
Wow, Are you?
Speaker 3 (08:47):
still performing at a rookie level six years out.
No, you're contributing waymore, and it's important that
your compensation iscommensurate with your efforts
and contribution.
Speaker 2 (08:59):
Okay, so before we dive more into this compensation
part, okay, so before we divemore into this compensation part
, I really would like ourviewers to know exactly how you
became an authority in thisparticular field.
So why don't you tell us alittle bit about your background
and what it is you do, and howdo you do what you do?
Speaker 3 (09:20):
Yeah, that's a great question.
This is the only thing I'veever done in my career.
So when my mom doing that, Iwas working on the executive
side of hospitals, financeoperations, physician
contracting.
So I was the guy.
When Dr Smith comes into theCEO's office and says, hey, ms
(10:04):
CEO, I would like to make moremoney, I was the one next to the
CEO saying, well, here's howmuch Dr Smith makes us and
here's how busy they are and allthe analytics.
So I knew what my CEO would sayto a doctor before they even
said it.
And now I use that to doctor'sadvantage to say, look, here's
what they're going to tell you.
(10:25):
It's a standard contract, wedon't have the budget, blah,
blah, blah.
Those are all things that Isaid.
And eventually, because doctorsdon't have any training or
preparation for contracts, theyjust believe it and they think
that we're all in medicine forthe same reasons.
Speaker 2 (10:42):
But what we?
Speaker 3 (10:43):
don't fully appreciate and embrace is
medicine is a business and myrevenue has to exceed expenses
in order for my business toremain in operation.
Speaker 2 (10:52):
Okay, and you know.
So how many years have you beendoing this from the hospital
side?
Speaker 3 (11:01):
So I spent 15 years working as a hospital executive
Wow, so it was literally myfirst job out of college.
I was an intern in a hospitalHR department, so I was doing
all the onboarding of nurses andstaff progressively grew in my
leadership responsibility.
I wanted to be a hospital CEO.
(11:24):
That's why I went to law school.
I didn't go to law school tobecome an attorney.
I went to law school because Iwanted to become a CEO and I
felt as though that would be agood skillset to kind of help
lead a hospital work withdoctors.
What I didn't appreciate,speaking of the business of
medicine, is I got laid off in2019.
(11:44):
And in that moment of justcomplete loss professionally, I
had this question why don'tdoctors have agents like
professional athletes?
And that question spiraled into.
Now, four years later, I'verepresented over 50 doctors in
(12:06):
contract negotiations with theiremployers and spoiler alert, we
get them.
Like you were saying before, wewere recording $50,000, $60,000
, $70,000, and even, in somecases, almost $200,000 per year
increased compensation, and soit begs the question not well,
how good are we that we can dothat?
(12:28):
How do we do that?
That question's ancillary why dohospitals have that money to
pay in the first place.
If you couldn't give me a payraise six months ago, why can
you now pay me $186,000 more?
Because Ethan's in the room?
What's the difference now?
And so it demonstrates thatdoctors are so focused and tied
(12:53):
to the Hippocratic oath that alot of times they end up
suffering because they don'twant to take away from their
focus on patients by having togo to another job or ask for a
pay raise.
So I encourage doctors when youare happy and fulfilled, your
patients get the best version ofyou, and that's what they
(13:15):
deserve.
Okay.
Speaker 2 (13:17):
So you, obviously, after undergrad you went to law
school and then you got an MBA.
So, Ethan, I have to say this Idon't think you weren't smart
enough to be a doctor.
With all those degrees, Igenuinely think you're probably
just as smart, if not smarterthan, any physician I've met and
(13:38):
I've dealt with a ton of them.
And then after that, you moveto Colorado.
Is that right?
Speaker 3 (13:47):
Yeah, so now we're based out of Denver.
I lived here with my wife.
We got married about six monthsago.
Speaker 1 (13:54):
Oh, congratulations.
Yeah, thank you.
Speaker 3 (13:56):
So we have two old dogs.
Usually one of them is in herehanging out with me for a
podcast, but not today.
But I've lived in Denver for 11years.
We serve doctors nationally, soit just so happens that this
weekend I'll be in the mountainsdoing education for the
National Medical Association onhow black doctors can be
(14:18):
successful in the business ofmedicine.
Speaker 2 (14:21):
Awesome and generally speaking, you basically moved
and then you started a company.
Is that right?
Speaker 3 (14:29):
You know, it didn't happen quite like that.
So I lived here for about sixor seven years, got laid off,
and that was when I started tohave this crisis of conscience
like what do I even want to bewhen I grow up if I'm not going
to be a hospital CEO?
And then that's when so I'd sayprobably 2019, about five years
(14:51):
ago I had the idea, and thenover the last four years,
literally, when the pandemicbrought us all to working from
home, that was about the timewas July 2020, where I
officially launched, and thenthree months, four months later,
I quit my job and said I'mgoing to give this thing my
(15:12):
full-time effort.
Speaker 2 (15:14):
Oh, that's amazing.
So, um, and what?
And it's called.
Can you tell us the name?
Speaker 3 (15:21):
Yeah, it's Rocky mountain physician agency, okay.
Yeah, the reason I chose thatis because we're based.
I have loved denver, right therocky mountain region of the
united states, and I wanted toalso bring in this idea of
agency, like actors and athletes, which is why included the
physician agency piece okay, um,and generally speaking, so.
Speaker 2 (15:46):
So it's almost a happy coincidence that Denver,
if I'm not mistaken, is thehealthiest city in the United
States, isn't it?
We're up there.
We're usually more about thehospital or the doctor
(16:09):
compensation field.
So the reason I ask this isbecause, as you know, we're a
school, we're one of the oldestCaribbean medical schools, we're
the largest family-ownedCaribbean medical school and we
have over 800, or almost 800,practicing physicians right now,
and we get this a lot, thisquestion a lot.
Hey, compensation, you know,med school?
(16:32):
Because we don't.
I mean, we don't have abusiness course, we don't have a
negotiations course.
What we are recentlyintroducing is a networking
course.
Not a course, but like a seminar, where students come and we're
trying to help them network,because some of our older
physicians or older alum havecome and said you know what?
We met some of your kids andthey don't know how to talk.
(16:54):
They don't know how to do all ofthis.
So obviously you know, I meannegotiations is obviously a
skill.
Now, when a student finishesresidency, residency is kind of
set in stone, right.
That's where you won't be ableto come and make much of a
difference there, because thisis coming from the government.
Post-residency, I've heard alot of our physicians come and
(17:19):
say you know what?
I didn't have any room fornegotiation.
When would a physician actuallyengage you?
Or when should they engagesomebody like you?
Speaker 3 (17:29):
The moment you are thinking about your job after
training is when you should callme Okay.
The reason for that is becauseI can give you the roadmap.
I can say you don't have towork with me, but here's exactly
what you should expect and howyou can prepare yourself for
success.
You should expect and how youcan prepare yourself for success
(17:51):
.
I think you brought up a reallygood point where a lot of
rookie doctors will go intotheir first job and say well,
I'm making $200,000.
That's way more than I made asa resident.
How could I say no my first job?
I went from making $12 an houras an intern to $60,000.
I didn't negotiate.
That was an ungodly amount ofmoney to me.
(18:13):
But now that I have a littlemore skill in this space, I
understand that it's not amatter of well.
I need to ask for more, to beaggressive.
It's the market is a certainnumber for your skillset and you
need to make sure that you'repaid fairly for your work.
So for rookie doctors, there'sone key that will help you get
(18:35):
what you deserve in your firstcontract and it's getting
multiple job offers.
I don't care if you have J1.
I don't care if you have towork for an FQHC underserved.
You need to get more than onejob offer.
That way you have the abilityto walk away from the offer,
which is a superpower incontract negotiation.
(18:59):
But I tell everyone, my clients,even my experienced orthopedic
surgeons, who I'm talking tohere in about 20 minutes.
I tell every one of thoseclients if you go into your
employer and ask for more money,better schedule, more support,
you will not get it.
I'm just going to spoil it foryou.
(19:20):
You're not going to get it Ifyou have a competing offer.
Now you have leverage.
I don't care how good of adoctor you are, I work with the
best.
None of them can walk intotheir boss's office and ask for
a salary raise and get itwithout having a competing offer
.
So for rookie docs, gotta havemultiple offers in order to have
(19:41):
leverage and make changes so II'm going to be honest.
Speaker 2 (19:45):
A lot of our physicians during residency
aren't looking for multiple jobs.
They're like, okay, I'mfinishing residency here, I
probably am going to work here,and that's kind of an
understanding that they havewith their program director.
Program director is very happyand again they get one offer.
Can you help such rookie docsget multiple offers even?
Speaker 3 (20:12):
help such rookie docs get multiple offers, even
Absolutely.
We work with doctors in kind ofone of two phases.
Some doctors bring us offersand say we want you to help
review, analyze and negotiatethese for us from behind the
scenes or your employer doesn'tsee us.
And then other doctors say sowhen they call us up front.
They say we want your expertisein identifying opportunities
that fit in, helping me find joboffers, opportunities, create
(20:36):
leverage and then in turnnegotiate those opportunities
for the most value to the doctor.
And also it's not just the StJames thing.
(20:56):
I've talked to the Universityof Michigan, at Stanford, all of
these training programs, andit's not unique to you.
Every doctor is coming out oftraining with this, this feeling
of like I'm exhausted.
It's, I often say, yourcontract is like the last 0.2
(21:18):
miles of a marathon.
You run the 26 miles and thenyou're ready to cross through
the tape.
A lot of doctors just collapseand say I'm not going to go the
last 0.2 and cross the tape bygetting multiple offers, by
negotiating those offers.
It is like giving up on thelast 0.2 miles to not negotiate
(21:42):
your offer and find multiple joboffers because you've spent how
many years and hundreds ofthousands of dollars and hours
on your education.
And now the last point twoyou're going to phone it in yeah
, wow, you know, I mean you.
Speaker 2 (21:59):
You bring this up.
This is a very interestingpoint because we've had a couple
of residents who, postresidency, have matched into big
university hospitals in Chicago, you know, there are two
massively dominant medicaluniversities and then there's
another one that has a hugehospital associated with it and
it is funny because thesehospitals pay notoriously low
(22:27):
amounts, like I'm talking about.
As much as you know, a post-MBA22, 23-year-old will probably
make in an entry-levelconsulting job that low and for
that situation, and you know,when we talk to the students,
they're like and I was like youknow, that's really really low.
(22:47):
I mean again students they'relike, oh, and I was like you
know that's really really low.
I mean, again, I don't reallystudy the market like you do,
but I have a general idea howmuch a hospitalist should make
because we place students acrossthe globe uh, not just in the
united states.
We have students who've gone tothe caribbean, like the cayman
islands even, and they'reworking there and they're making
a lot of money.
(23:09):
These other smaller economiesare actually paying more than
these big university hospitalsand these students are like well
, or I shouldn't say students,but these physicians are like
well, you know?
I mean, I don't know, it's abig name I can work there for a
couple of years and then I'lljust move and probably go
somewhere else.
What would you say to aphysician like that?
Speaker 3 (23:31):
I don't think it's an either or situation.
So a lot of times what happensis doctors suffer in silence.
Speaker 2 (23:40):
Okay.
Speaker 3 (23:41):
Doctors may be frustrated and you don't talk to
somebody about it.
They're fortunate to have you,but a lot of times doctors
aren't talking to anyone aboutthe fact that I know I'm
underpaid, but I'm underpaidbecause I love my patients, I
love my work, I love thispopulation and I often share
(24:01):
that.
Doctors sometimes feel tensionbetween doing good doing the
good work you do and doing well.
Okay, and it's okay to do both.
It's okay to do good and dowell.
So In that situation, lock armswith your fellow doctors.
Talk about your salary at work.
(24:22):
Someone in the room is going toraise their hand Hopefully it's
not you, but someone in theroom is going to raise their
hand and say wait, that's notfair.
Why is everyone else paid thatway and I'm not?
Lock arms together.
It's like when I was a kidgrowing up, there was the Power
(24:43):
Rangers and they would all cometogether and bring their powers
together.
That's how it is.
When doctors lock arms together, it is impossible I can tell
you from experience on thehospital side it is impossible
to ignore a group of doctors.
That magic number is usuallybetween three and four doctors.
When you lock arms together, Iguarantee you you can do amazing
(25:07):
things.
But you come in one-on-one andsay hey, ethan, I'm frustrated
with my salary.
Can I get a salary raise?
Oh, dr Smith, you know, it'sjust not in the budget.
Maybe next year.
And, by the way, I actuallyneed you to see patients more
quickly, so those 15 minuteappointments need to be 12.
(25:27):
And did you go on vacation lastmonth because it looks like your
rvs were a little low?
So they're gonna.
Not only are you gonna say Ideserve more, they're gonna flip
it on you and try to make youhave even less.
So I guarantee you medicine isa business and once you're in it
, you understand it.
It's the rookie doctors, Ithink, that have this idealized
(25:52):
version of what being a doctoris Not fully understanding the
context that you're walking into.
So I want you to have all theenergy and time to focus on what
you do best, which is caringfor patients, and my job is to
help alleviate the stress ofbeing paid fairly, having a
schedule that you enjoy, thathonors your lifestyle goals and
(26:18):
that allows you to spend timewith the people that you care
most about.
Speaker 2 (26:20):
Okay, and so that means, essentially, even rookie
doctors have a scope fornegotiation, generally speaking,
because, I'm going to be honest, most of our rookie doctors
don't.
I mean, they just don't.
They're like oh, I got an offer, look at me, I'm so great, I'm
making a lot of money, I'm happy, that's it.
But one thing I did want totouch upon was something that
(26:42):
you pointed out is that we'vealso noticed that in the last
decade at least, physiciansalaries haven't changed, at
least beginning physiciansalaries.
I mean, is that true or falsein your opinion, since you've
seen this from the other end,you've seen this from the other?
Speaker 3 (26:58):
end.
The gap between cost of livingand physician salaries gets
wider and wider and wider, wow.
Speaker 2 (27:22):
And I know, when we were talking about this, you
actually mentioned that there isa lot of disparity and
unfairness in doctor'scompensation, even within
physician groups.
Can you elaborate on that alittle bit more?
Speaker 3 (27:27):
This is not my opinion.
If you go to Medscape MerrittHawkins, this data is publicly
available.
I have distilled it down intowhat I think are some key
highlights.
I have distilled it down intowhat I think are some key
highlights, but often when Ipost some of these findings,
people will try to rationalizeWell, that's because of
(27:54):
irrelevant reasons and my beliefis that, for whatever reasons
these disparities exist, my roleis resolving them.
So I often stay out of theacademics of like well, why does
this exist and what are therationale?
The numbers are generalistpositions where women, on
average, are going to make about$60,000 less than their male
(28:15):
counterparts.
So from a percentageperspective, that's about 25%,
and that's from Medscape's 2022report.
They just published on theirlatest report about a week and a
half ago.
The same goes for doctors ofcolor.
So if you are a black doctorspeaking of the doctors, I'm
going to educate this weekendwith the National Medical
(28:37):
Association the average salaryfor all doctors is $339,000.
The average salary for whitedoctors $346,000.
So it's above the nationalaverage.
Now, when you go to blackdoctors, who are the lowest
among all minority groupsreported, they make $313,000.
(29:01):
So that's about $26,000 less onaverage than all doctors across
the board, wow, wow.
Yeah same work, right?
Speaker 2 (29:12):
So if you and I were in your past life, if you and I
were economists, sitting incubicles next to each other and
I was paid less than you for thesame work, I would be
frustrated by that, yeah, Idon't even think a lot of people
know that, because when I talkto our students, the light at
(29:32):
the end of their tunnel isgetting a residency residency
and at the residency I don'teven think like because I keep
hearing this on a regular basisthat once I'm into residency
it's utopia for us.
Like everybody's equal, thereare pretty standard salaries
across the board, but what I'mhearing from you is that's
(29:53):
totally not the case and evenafter finishing residency for,
uh, seasoned professional, therestill might be inequalities
that exist.
That's pretty amazing.
So, as you know your services,how much does it cost the
(30:16):
physician to hire somebody likeyou?
Speaker 3 (30:24):
cost the physician to hire somebody like you.
What I started out with when Iinitially started the business
is I wanted for doctors to nothave to worry about paying us,
and so we've done two things tomake the payment completely
painless.
One instead of charging doctorsa flat fee, painless One.
Instead of charging doctors aflat fee, our fee is tied to
their compensation.
Okay, so our fee is apercentage of the doctor's base
(30:50):
salary, so that way they knowthat we're incentivized to help
make them more money.
Okay.
Secondarily, we negotiate ourfee into the doctor's contract.
So, we just had a generalsurgeon who signed her first
contract.
Her salary caused us to have afee of about $15,000.
And then what we did is wenegotiated a $50,000 5-0 signing
(31:12):
bonus into her contract.
She's part of that to pay us,and then the rest of it goes to
her and we also make her waymore money than those initial
offers.
So, one, we want to increaseyour salary and then, two, we
get a signing bonus that's niceand big, so it covers our fee,
so you don't have to worry abouthow we get paid.
Speaker 2 (31:34):
Wow, that's pretty awesome.
So one thing I did want tocover is that you know, as you
mentioned there's, you should bearmed with multiple offers,
right, that makes your jobeasier.
That makes the physician a lotmore desirable, so to speak, to
the employer.
However, you know, we've heardabout locums.
(31:55):
I've heard about locums, but alot of our students don't have
no idea what locums is.
Do you think getting a locumsoffer would constitute a second
offer, so to speak, becauselocums offers are relatively
easy to get?
Again, I don't know if this istrue or not.
(32:16):
Maybe you can shed some lighton that.
Speaker 3 (32:18):
Yeah, that's a really interesting question.
I tend to think of locums as analternative or a supplement to
a doctor's job full-time job.
So mainly the doctors that I'veencountered who work with
locums are doing one of twothings Either they are
moonlighting, so I'm doinglocums in addition to my
(32:41):
full-time gig.
So, as an easy example,hospitalists tend to have a
seven on, seven off schedule, soI'll have some hospitalists who
will use that seven off as sometime for locums, so it will
supplement their full-timeemployment.
I have others who say I'm burnedout of being an employee.
(33:03):
I don't like how much controlthey have.
I want an alternative toworking full-time for this one
conglomerate employer, and sodoctors will go work locums
because they have more controlover their earning potential.
They have more control overtheir schedule, where they work,
when they work, and in thosesituations the primary
(33:28):
considerations would be you needto understand your pay, your
taxes, your benefits, becauseyou're a contractor.
Now there's a few differentthings to consider, but I often
say locums is a good supplementto your main gig as a side
hustle, or it's a goodalternative for doctors who are
(33:48):
just not really enthusiasticabout where they are now and
maybe want to consider adifferent opportunity.
Speaker 2 (33:55):
Okay.
So would you consider locums tobe another job offer, so to
speak?
If somebody gets a locums offer, can they go back to their
principal employer and say hey,I got locums.
If I do this for the stipulatedtime, or if I were to do this
full time, I'm actually makingmore, so I'm going to leave.
(34:15):
Do you think that that's apossibility?
Speaker 3 (34:20):
I'm going to leave.
Do you think that that's apossibility?
Absolutely.
I think your ability to walkaway as a physician really is
your power in a contractnegotiation.
Now here's the nuance that Iwould include in that statement
is I always encourage my doctorsif you were going to negotiate,
you can only negotiate withoffers you would accept.
(34:42):
So just as an easy example, Ihad a neurosurgeon who was
looking in California and Texasand then, out of the blue, he
had a buddy reach out who had anopportunity in Oklahoma, and he
said oh, ethan, can I now usethe Oklahoma offer to negotiate
against the California offer?
And I said unless you wouldaccept the Oklahoma offer, do
(35:05):
not include it in yournegotiation.
The reason for that is becauseit's this idea that if you bring
it into the conversation, youmust be willing to accept it,
because the employer that you'renegotiating with may say, oh,
okay, cool, well, good luck, allthe best.
I think there is thisirrational fear that doctor's
(35:28):
offers will get pulled.
I've never seen that happen.
I'm sure it does happen, but itdoesn't happen because a doctor
is asking for reasonableupdates to the employment
contract.
That's not why offers getpulled, and so I often say if
you're going to use a secondoffer, locums could be that you
(35:50):
must be willing to accept thatoffer in order to use it with
leverage.
Speaker 2 (35:54):
I think that makes complete sense.
I mean, you know, if you'remaking a power play, you need to
be able to live with theconsequences, so to speak.
I think that makes completesense, all right, well, I mean,
I think that you know theservices that you're providing.
I'm going to be very honestwith you I've never heard
anybody really provide theservices that you're providing.
(36:17):
This is a very unique area.
I know a lot of people who areworking for companies that do
like a staffing agency forphysicians, that do locums and
not just locums but full-time.
But what you're doing iscompletely different.
I mean, you know, is this avery competitive field that
you're in, or is this acompletely niche that you're
(36:39):
creating right now?
Speaker 3 (36:41):
There are a ton of contract attorneys and companies
that say we do contract reviews.
I think that has done adisservice to physicians,
because it's the same as goingto the doctor for a diagnosis.
You go in, they tell you you'vegot 16 things wrong with you.
(37:02):
Okay, well, how do I fix them?
Well, we don't do that.
We just point out the thingsthat are wrong.
We are really focused on onemaking sure we identify the
things that are wrong, thediagnosis, but also the
treatment.
So how can we get you paidfairly?
How can we get you a schedulethat honors your lifestyle goals
(37:24):
?
And we're not just going to say, well, cool, good luck on those
offers, we're going to go getthose for you.
So I don't believe there'sanybody else doing what we do.
But I also think that doctorshave been so accustomed to these
contract review factories thatjust churn and burn oh, it looks
good, dr Smith, nothing illegal, you're good to sign.
(37:46):
Now Dr Smith's underpaid by$50,000, and they don't even
know it.
Speaker 2 (37:52):
Wow, I mean, you know , ethan, again, you said this
before that you kept saying thatyou're not smart enough to be a
physician.
I completely disagree with that.
I I mean you, literallysingle-handedly are creating a
brand new industry and I thinkthat's needed because you know
doctors, at the end of the day,I want them to be uh, paid, uh,
(38:14):
you know fairly, because I wanta happy physician looking at me
and my family, because, at theend of the day, there are very
few professions that is life anddeath and physicians are
definitely that.
I always have the notion thatthere are four major
civilization buildingprofessions, and it's teachers,
(38:38):
it's farmers, it's engineers andit's doctors.
Unfortunately, it's not likeconsultants or lawyers.
Speaker 3 (38:45):
Lawyers will have something to say about that,
that's for sure.
Speaker 2 (38:49):
Probably, but I'm just saying like if there was a
zombie apocalypse, you would be-.
Speaker 3 (38:54):
I think that's spot on.
I think, it's spot on Lawyers,I think often overestimate how
important we are.
Speaker 2 (38:59):
So, but I think that the service that physicians are
providing and I do also thinkthat the way you know, the hours
, hours are crazy for physiciansnowadays because of the rigor,
and you know a lot of we keephearing this again.
We're we're a school, right, sowe keep talking to students on
a regular basis and they saidthat you know what the juice is
(39:21):
really not worth the squeeze.
I can get a CPA and makeprobably just as much as a
physician.
Probably in one fourth of thetime a physician makes Same
thing with law.
To a certain extent, why wouldI want to be a physician?
And that's why we have thiscrazy acute shortage of
physicians.
(39:46):
And you know, the laws aren'tchanging as quickly as they
should and you know, to acertain extent, I hope and I
wish physicians get paidcompetitively so that some of
the political scenarios that areplaying out in today's world
can be averted and prevented,because physicians will have the
time and the energy to raisetheir voice to make sure that we
(40:08):
are going in the rightdirection.
And I think the role that you'replaying in the big picture of
things is amazing and it'sremarkable.
So you know, thank you fordoing what you're doing what I
would like to do, ethan, is that, as I said, we have a pretty
big alumni base.
I'd like to share yourinformation, if that's okay,
(40:30):
with our physicians we have inour alumni directory, as well as
our current physicians who havejust matched into residency.
Just stay in touch with you toget some advice and then you
know, possibly at some point ifyou wouldn't mind doing a
webinar for some of our alumniand see if they can benefit from
your services, because I cantell you this much that they are
(40:53):
not getting, in my opinion,competitive salaries that they
should be getting.
I agree, yeah.
Speaker 3 (41:00):
First and foremost, let's keep the conversation
going about that webinar.
I will be more than happy tomake myself available, because
that education piece is just soimportant for doctors to know.
One that you do deserve better.
And two, how do I go get thatfor myself?
Speaker 2 (41:20):
I would love to support, right, awesome.
But, ethan, again, thank you somuch for being on our show.
I know you have an appointmentin about 10 minutes, if I'm not
mistaken.
Yeah, it's coming up here.
Thank you so much, ethan, forwonderful insights.
There were so many things Ijust really didn't know about
(41:40):
the economics of physiciancompensation and I really
appreciate you shedding somelight on that.
Again, I truly hope that ouralumnus or our alumni have found
this particular podcast helpfuland I hope they reach out to
Ethan in Ghana for his services.
(42:02):
But again, if you like thecontent of this podcast, please
give us a like, follow and share, download more episodes of our
podcast on any of the platformsthat you prefer, and remember
there's never a shortcut tobecoming an MD.
Speaker 1 (42:17):
Thank you so much for tuning into our show.
We hope you enjoyed anotherepisode of Med School Minutes.
If you like our content, pleasefollow us and receive
notification when a new show isposted.
This podcast is brought to youby St James School of Medicine.
For a video version of thispodcast, please check us out on
sjsmorg slash video.
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