Pain jobs at Kaiser

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Your overhead is not 450k, and keeping everything after you overhead is a joke. That's an unbelievable statement.

If you start your own practice, you will have an entirely different opinion after a few yrs. I hope you do, and I hope you're extremely successful.

I like PP and everything with it, but I'm not an entrepreneur know my limitations.
What is the typical overhead then?
Maybe youre right that I will feel different in a few years.
But this is precisely why most grads are looking for HOPD or JVs

Very few practices have their own MRI. X-ray doesn’t pay anything.
UDSs and DMEs are quite profitable though, but I do understand your point about it being tied to the physician itself.

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What is the typical overhead then?
It depends. If your practice has 5 locations, physical therapy, multiple doctors, a ton of staff, etc., expect your overhead to be higher than a standalone facility with two other doctors, a midlevel, 5 MAs and a small front desk staff.

The overhead is more than just your salary and benefits. I also believe partners should profit off employed doctors. If you collect 1.5M, the partners should profit more off you than if you collect 980k or 1.25M. The more you collect, the more you make in bonuses and the more money you bring into the practice that the partners will use as they see fit.

Don't take an adversarial stance against the partners. You're benefitting from them. They bought your C-Arm and ultrasound machine, paid for the PT gym whose profits you want a piece of and they paid for the lawsuit 2 yrs ago, the flood damage and bought that EMR you can't stand.

Consider this - As an employed doctor you WILL get paid what you signed in your contract, meanwhile the partners may go 2 quarters with no paycheck other than ancillary monies or ASC dividends.

You WILL get paid full salary, benefits and bonuses per your contract.

Maybe youre right that I will feel different in a few years.
If you go out on your own, and if that's what you do I applaud your entrepreneurial spirit, it will 100% change.

You're advocating for yourself, and you're not completely wrong dude. Just negotiate when it comes time to sign anything.
 
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HOPD is a great place to start your career for the majority of physicians. Lots of money, get fed patients, protected place to work, moderate sedation to help cover up sloppy technique.

Patients ask me if I like being on my own more than the hospital. I always reply, “Not necessarily. Different problems at each job, but there are still always problems.”
 
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Today, I have helped my wife create multiple “scripts” to narrow down, refine what the staff are doing. Making it as easy as possible for them and to provide a reference for them as well. We changed block times for the new physician. We discussed and created some caps on the amount of my follow ups that would be put on his schedule to allow him the opportunity to develop his own practice. We moved his patients around (to my schedule) to accommodate travel for a training trip that I paid for. Someone has to do all of this and things like this happen every week which is why you can’t get paid as a partner without a real partnership and being also completely personally and professional invested in the growth of the practice.
 
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You can go from that to pp. I did it going from the VA to pp. collected 1 mil my first year in practice. Ultimately left that job bc I was paying an exorbitant overhead (75%) and went back to the VA to make substantially more with less work. Eventually left that job to HOPD and now make double what I did. So it’s all doable
 
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Today, I have helped my wife create multiple “scripts” to narrow down, refine what the staff are doing. Making it as easy as possible for them and to provide a reference for them as well. We changed block times for the new physician. We discussed and created some caps on the amount of my follow ups that would be put on his schedule to allow him the opportunity to develop his own practice. We moved his patients around (to my schedule) to accommodate travel for a training trip that I paid for. Someone has to do all of this and things like this happen every week which is why you can’t get paid as a partner without a real partnership and being also completely personally and professional invested in the growth of the practice.

You're doing it right. Welcome to the 5-9 club.
 
This thread is a good example of why I say nobody should take a job because of the prospect of partnership. Partnership may never happen.
 
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This thread is a good example of why I say nobody should take a job because of the prospect of partnership. Partnership may never happen.
Partnership is not always advisable.
 
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Would any PM&R pain providers working at Kaiser be able to comment on their general pay range for new hires and projected increases with experience?
 
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Physicians should not refer to Physicians as providers. This is what they want us to do
 
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Where I work the midlevels actually refer to themselves as midlevels. I refer to them as NPs and PAs since that’s their actual title, but not hearing the stupid “APP” or “we are all providers” noise is so damn refreshing
 
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I dont mean to go too left field with this question. However when I see some comments about seeing a ton of patients a day is good for you and seeing less will ruin you. I am stil relatively new attending, however I have done 25-30 patient a day and 10-15 patints a day which is my new job. Do the people who are doing 25-30 or even more feel like they can truly talk to patients about a procedure inlcuding risks/benefits. Or are you basically like hey i can do an injection to help with arthritis pain, or i can do an epidural and if they say yes you give them a handout and walkt out. I woud guess most poeple seeing 25-30 a day are doing the later.
 
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I saw 47 and I talked a huge amount to each patient today. Went back and did a fluoroscopic exam for lead placement on a new to me patient myself. Told the rep how I wanted it programmed. Started at 7:30 and worked through lunch though.
 
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I dont mean to go too left field with this question. However when I see some comments about seeing a ton of patients a day is good for you and seeing less will ruin you. I am stil relatively new attending, however I have done 25-30 patient a day and 10-15 patints a day which is my new job. Do the people who are doing 25-30 or even more feel like they can truly talk to patients about a procedure inlcuding risks/benefits. Or are you basically like hey i can do an injection to help with arthritis pain, or i can do an epidural and if they say yes you give them a handout and walkt out. I woud guess most poeple seeing 25-30 a day are doing the later.
I'm able to talk to people in as much depth as required, and I don't feel rushed at that volume. I used to think it was too hard to see 30 and actually do a good job until I started critically evaluating myself and my time. I was wasting tons of time in many areas.
 
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If I saw 10-15, not only could I do their office visit, I could get a full groom in on all of the service animals also with my free time.
 
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I saw 47 and I talked a huge amount to each patient today. Went back and did a fluoroscopic exam for lead placement on a new to me patient myself. Told the rep how I wanted it programmed. Started at 7:30 and worked through lunch though.
Respect..lol I feel like 30-35 is my limit, I would struggle with 40+.
 
40 is easy if it's a lot of stable med mgmt
Cruious out of 40 how many are new were you looking at imaging, prior records, examinign patient, talking to them about options for tx, and risks benefits of procedures.
 
Cruious out of 40 how many are new were you looking at imaging, prior records, examinign patient, talking to them about options for tx, and risks benefits of procedures.
oh i'm like you, my comfortable range for a busy day is 30-32, with 6 being new. switch out 2 follow-ups for every new patient.

it all depends on your set up, staffing, room availability. And if most of your referrals are tee'd up sports and spine pathology with referrers setting the patients' expectations of injections before seeing you, it's easy to bang out new patient consults easily and thoroughly.

if you see all comers, including headache, pelvic, autoimmune, etc, then probably not as fast and easy.
 
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I dont mean to go too left field with this question. However when I see some comments about seeing a ton of patients a day is good for you and seeing less will ruin you. I am stil relatively new attending, however I have done 25-30 patient a day and 10-15 patints a day which is my new job. Do the people who are doing 25-30 or even more feel like they can truly talk to patients about a procedure inlcuding risks/benefits. Or are you basically like hey i can do an injection to help with arthritis pain, or i can do an epidural and if they say yes you give them a handout and walkt out. I woud guess most poeple seeing 25-30 a day are doing the later.
you dont. they dont.

and what is sacrificed is listening to the patient.

in a pure spine practice, this probably doesnt matter a great deal. patients just recently started hurting, they are optimistic that they will get better, and there is little pain psychology due to chronic pain in play, and they are there for their injection.

i definitely can see 3 acute radics in the time it takes me to see one of these chronic pain patients with more medical problems than moons around jupiter...
 
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I’m 14 years of clinical practice next month. At my first job based on the culture of el hefe at the time, even though it was a surgical practice which even though non op, means you are ultimately hired to do procedures, I felt that the energy was more so of a hand holding one. Was there for 5 years. Fast forward, the pain doc that hired me at my current practice had a very broad skill set and was able to provide a comprehensive service line. He saw upwards of 40 patients a day and spend adequate time with each patient and did notes when he could. He was gen x. I learned from him a lot, I taught myself ultrasound, encorporated orthobiologics, to this day see 40+ per day and my patient reviews continue to say that I’m the only one that actually spent “time” with the patients and they didn’t feel rushed. I will wake up at 5am, come in early and do charts.

I’m probably making mgma much less than any hospital employed doc as a private practitioner but at least I respect my own comprehensive skill set and know what I can offer. At a certain point, you have to know who you are as a doc, recognize what you can and cannot do and what you won’t settle for. People touting that they can only see x amount of people per day and others who see more are not “spending time” with patients are def not of my generation.
 
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I'm able to talk to people in as much depth as required, and I don't feel rushed at that volume. I used to think it was too hard to see 30 and actually do a good job until I started critically evaluating myself and my time. I was wasting tons of time in many areas.
Like what?
 
I am PM&R / Pain. Left academics in 2011 and joined SCPMG. I am in a department with 10 PM&R physicians; 3 of us practice pain medicine.

Monday: Clinic AM 8:30 am to noon. Fluoro PM 12:30 to 4:00 PM (generally finish about 3:30)
Tuesday: Home virtual clinic 8:30 AM to noon. Consists of video and telephone follow-ups mostly. 4th Tuesday of every month I lead a fibromyalgia video group class with 15-20 patients. PM is my educational time.
Wednesday: Same as Monday. Clinic AM 8:30 am to noon. Fluoro PM 12:30 to 4:00 PM (generally finish about 3:30)
Thursday: AM clinic or electrodiagnostic studies (alternating each week) 8:30 to noon. Department meeting over lunch. 1:30 to 5:00 pm clinic
Friday: Full day clinic 8:30 to noon and 1:30 to 5:00 pm.

New pain consults 45 min. New pm&r consults 30 min. Follow-ups 20 min for pm&r and 30 min for pain. NCV only studies 40 min. NCV and EMG 60 min. We have a Cadwell Sierra Summit and three Natus Vikings. We have two ultrasound machines for clinic. I use Abridge to help with documentation. It is an AI program that gets the notes 95% done. We cover inpatient PM&R consults a week at a time, basically 4 or 5 times per year since there are 10 of us. We rarely get called in on the weekends, but we get callback pay if we come in. We perform the full gamut of procedures in our outpatient procedure suite time. SCPMG provides me with a home computer for my virtual clinic and a new iPhone every 2-3 years (currently iPhone 14).

My physician colleagues are my work family. We are a super close department. My MA is amazing. We have two very helpful NPs and two incredible pain psychologists. We have an 8 week CBT program led by our psychologists.

I get 33 days of vacation per year and 5 days of education leave. $37,500 per month distribution = $450k per year. Then there are little quality of care awards, access awards, and profit sharing if we have a good year. It boosts the pay up another $10-20k per year.

Overall I am happy with the decision to leave my “dream job” in academics. Nothing is ever perfect, but I have been more than satisfied with my career with SCPMG.
 
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As another data point for the OP, I work at a place that has Kaiser-like qualities (pt volumes, appt length, etc), though likely more dysfunctional and with less admin support. Unlike Kaiser, I have excellent schedule flexibility and pretty good control of my clinic set up. I get paid less than Kaiser though I have more admin/project time, no call, and something like ~10 weeks of PTO. It’s not a gig I would necessarily suggest for their first attending job, but if that happens to be your situation I wouldn’t let it stop you if there are otherwise no better options in the location you need to be. I only came into this job after the place I was going to start working at pulled the contract during the 2020 Covid lockdown. At all my other jobs until then, I took pride in moving the meat quickly and efficiently. I didn’t think I would stay in this job very long, but honestly the work-life balance has been amazing (I have young kids) and I’m a much happier person outside of work. Several local more traditional practices have approached me to join them, but I have passed as their overall deals are just not as good for what I’m looking for at this point in my life. That’s not to say I wouldn’t leave if something better came along…but my definition of “better” has changed.

IMHO, the only real deal breakers for pain jobs are gigs where there’d be any sort of pressure to prescribe things or do procedures you don’t want to do/think are reasonable…after that, it’s just about balancing the aspects of what’s important for you in job with whatever place offers you the best deal. At the end of the day, we are all highly replaceable and hopefully your work is not your whole life.
 
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I am PM&R / Pain. Left academics in 2011 and joined SCPMG. I am in a department with 10 PM&R physicians; 3 of us practice pain medicine.

Monday: Clinic AM 8:30 am to noon. Fluoro PM 12:30 to 4:00 PM (generally finish about 3:30)
Tuesday: Home virtual clinic 8:30 AM to noon. Consists of video and telephone follow-ups mostly. 4th Tuesday of every month I lead a fibromyalgia video group class with 15-20 patients. PM is my educational time.
Wednesday: Same as Monday. Clinic AM 8:30 am to noon. Fluoro PM 12:30 to 4:00 PM (generally finish about 3:30)
Thursday: AM clinic or electrodiagnostic studies (alternating each week) 8:30 to noon. Department meeting over lunch. 1:30 to 5:00 pm clinic
Friday: Full day clinic 8:30 to noon and 1:30 to 5:00 pm.

New pain consults 45 min. New pm&r consults 30 min. Follow-ups 20 min for pm&r and 30 min for pain. NCV only studies 40 min. NCV and EMG 60 min. We have a Cadwell Sierra Summit and three Natus Vikings. We have two ultrasound machines for clinic. I use Abridge to help with documentation. It is an AI program that gets the notes 95% done. We cover inpatient PM&R consults a week at a time, basically 4 or 5 times per year since there are 10 of us. We rarely get called in on the weekends, but we get callback pay if we come in. We perform the full gamut of procedures in our outpatient procedure suite time. SCPMG provides me with a home computer for my virtual clinic and a new iPhone every 2-3 years (currently iPhone 14).

My physician colleagues are my work family. We are a super close department. My MA is amazing. We have two very helpful NPs and two incredible pain psychologists. We have an 8 week CBT program led by our psychologists.

I get 33 days of vacation per year and 5 days of education leave. $37,500 per month distribution = $450k per year. Then there are little quality of care awards, access awards, and profit sharing if we have a good year. It boosts the pay up another $10-20k per year.

Overall I am happy with the decision to leave my “dream job” in academics. Nothing is ever perfect, but I have been more than satisfied with my career with SCPMG.
Amazing. What are some starting salaries or contracts for a new fellow joining Kaiser with a similar set up or in your department? Additionally, are most of the contracts for everyone else in your group similar or are some contracts more production based?
 
I am PM&R / Pain. Left academics in 2011 and joined SCPMG. I am in a department with 10 PM&R physicians; 3 of us practice pain medicine.

Monday: Clinic AM 8:30 am to noon. Fluoro PM 12:30 to 4:00 PM (generally finish about 3:30)
Tuesday: Home virtual clinic 8:30 AM to noon. Consists of video and telephone follow-ups mostly. 4th Tuesday of every month I lead a fibromyalgia video group class with 15-20 patients. PM is my educational time.
Wednesday: Same as Monday. Clinic AM 8:30 am to noon. Fluoro PM 12:30 to 4:00 PM (generally finish about 3:30)
Thursday: AM clinic or electrodiagnostic studies (alternating each week) 8:30 to noon. Department meeting over lunch. 1:30 to 5:00 pm clinic
Friday: Full day clinic 8:30 to noon and 1:30 to 5:00 pm.

New pain consults 45 min. New pm&r consults 30 min. Follow-ups 20 min for pm&r and 30 min for pain. NCV only studies 40 min. NCV and EMG 60 min. We have a Cadwell Sierra Summit and three Natus Vikings. We have two ultrasound machines for clinic. I use Abridge to help with documentation. It is an AI program that gets the notes 95% done. We cover inpatient PM&R consults a week at a time, basically 4 or 5 times per year since there are 10 of us. We rarely get called in on the weekends, but we get callback pay if we come in. We perform the full gamut of procedures in our outpatient procedure suite time. SCPMG provides me with a home computer for my virtual clinic and a new iPhone every 2-3 years (currently iPhone 14).

My physician colleagues are my work family. We are a super close department. My MA is amazing. We have two very helpful NPs and two incredible pain psychologists. We have an 8 week CBT program led by our psychologists.

I get 33 days of vacation per year and 5 days of education leave. $37,500 per month distribution = $450k per year. Then there are little quality of care awards, access awards, and profit sharing if we have a good year. It boosts the pay up another $10-20k per year.

Overall I am happy with the decision to leave my “dream job” in academics. Nothing is ever perfect, but I have been more than satisfied with my career with SCPMG.

When you say "distribution" are you talking K1 or W2? Because $500K W2 is causing over half your income to go to taxes in a HCOL state.

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Living on I'll pass on that.


Don’t listen to some of the noise here.
When looking at overall packages for various jobs, try to convert everything as best you can into a 1099 equivalent to give yourself the best apples to apples comparison. I don’t work for Kaiser, but I interviewed with them several years ago and while I ended up taking another job instead I thought pretty highly of their comp. Assuming there haven’t been any major changes, their benefits are arguably the best out there. IIRC, they match 10% of your salary into their 401(k) and maybe 457? and their pension was insanely generous. And I think other perks there too like health insurance for life. I recall my back of the napkin math said their benefits, in my situation, were worth around 25-30% above the stated salary if I had to re-create them as a 1099. The cash value of their retirement plans alone made it so that if you did nothing else other than max out their options and do your 20 years there (I know, a painful thought for some) you’d highly likely be able to live like someone who retired with ~6-8mil in the bank depending returns.

They don’t call them golden handcuffs for nothing.
 
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Don’t listen to some of the noise here.
When looking at overall packages for various jobs, try to convert everything as best you can into a 1099 equivalent to give yourself the best apples to apples comparison. I don’t work for Kaiser, but I interviewed with them several years ago and while I ended up taking another job instead I thought pretty highly of their comp. Assuming there haven’t been any major changes, their benefits are arguably the best out there. IIRC, they match 10% of your salary into their 401(k) and maybe 457? and their pension was insanely generous. And I think other perks there too like health insurance for life. I recall my back of the napkin math said their benefits, in my situation, were worth around 25-30% above the stated salary if I had to re-create them as a 1099. The cash value of their retirement plans alone made it so that if you did nothing else other than max out their options and do your 20 years there (I know, a painful thought for some) you’d highly likely be able to live like someone who retired with ~6-8mil in the bank depending returns.

They don’t call them golden handcuffs for nothing.

Still needs to answer my questions. It's not what you earn, it's what you keep. If Biden and Newsom are picking your pockets to the tune of 50%+ because the comp is characterized as W2 income, you've got to factor that in. And, then the questions becomes, "What kind of shady stuff is going on at Kaiser that they can afford to pay people like that?"
 
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I agree the salary is extremely robust for the work they expect out of their docs. They must know something the rest of us don’t 🤦🏽‍♂️

That being said, as to the other point, even though taxation might be highway robbery, you really should be able to live quite comfortably with 280k in post tax dollars even with a family and kids. I don’t have nearly that, and I’m the sole provider for a family of 4, 2 young kids in a high cost of living state.
 
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As someone in private practice I used to think I had zero PTO. But in reality with ancillary income and side hustles as well as mid levelers I get income even if I take time off.
 
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Their retirement package is great but that's a bit of an exaggeration no?

To clarify, I didn’t mean 6-8mil in the bank just from their retirement stuff. I think my napkin numbers/assumptions were a pension of 200k/yr and their retirement accounts coming to roughly ~3mil. If you follow the 4% rule, that’d yield 320k of cash flow/yr, which is what somebody with a liquid NW of 8mil could similarly withdraw each year.
 
Still needs to answer my questions. It's not what you earn, it's what you keep. If Biden and Newsom are picking your pockets to the tune of 50%+ because the comp is characterized as W2 income, you've got to factor that in. And, then the questions becomes, "What kind of shady stuff is going on at Kaiser that they can afford to pay people like that?"

Nobody is arguing that being your own boss has great tax benefits. But like you said, everything has to be factored in. As a 1099 you’re paying both sides of FICA and for all the benefits and time off. It cuts both ways.

I do agree with you that Kaiser’s total comp is strong and their pensions are wild—so much so that at times I’ve heard they weren’t sustainable (but apparently no longer an issue, at least for the time being). No question that SOS and being able to control their entire ecosystem and the inflow/outflow of dollars gives them a unique advantage, but of course you know that.
 
Amazing. What are some starting salaries or contracts for a new fellow joining Kaiser with a similar set up or in your department? Additionally, are most of the contracts for everyone else in your group similar or are some contracts more production based?

We are all on the same pay scale / ladder. There's nothing additional for production. We all have similar schedules. Starting salary for PM&R/Pain is about $30k per month. There is generally a "bonus"/ advance on pay when a new associate starts and for each year as an associate There is a significant bump when making partner after year 3. Then it goes up incrementally each year until pay maxes at year 12.
 
Still needs to answer my questions. It's not what you earn, it's what you keep. If Biden and Newsom are picking your pockets to the tune of 50%+ because the comp is characterized as W2 income, you've got to factor that in. And, then the questions becomes, "What kind of shady stuff is going on at Kaiser that they can afford to pay people like that?"

In So Cal Kaiser, we get a schedule K1. Our compensation committee reviews our compensations yearly. The goal is to have us at the median of our specialties.
 
To clarify, I didn’t mean 6-8mil in the bank just from their retirement stuff. I think my napkin numbers/assumptions were a pension of 200k/yr and their retirement accounts coming to roughly ~3mil. If you follow the 4% rule, that’d yield 320k of cash flow/yr, which is what somebody with a liquid NW of 8mil could similarly withdraw each year.

We set aside tax deferred retirement in Keogh and 401k plans. $69k / year for 30-35 years at 6% growth is about $6-8 million. Then we get the pension at retirement as well. They tell us that our pension is very well funded. Fingers crossed.
 
We set aside tax deferred retirement in Keogh and 401k plans. $69k / year for 30-35 years at 6% growth is about $6-8 million. Then we get the pension at retirement as well. They tell us that our pension is very well funded. Fingers crossed.


Nice, yeah my rough math was based on a 20 year career, rather than 30+ . If you wanna practice for that long, I think that’s great. I’m leaving the door open to cutting down or possibly transitioning to other work once I reach 50. I’ve always been a FIRE guy, but I recently read the book Die with Zero and it partially changed my thinking. If you’re not familiar with that book, it may be worth at least checking out.
 
Nice, yeah my rough math was based on a 20 year career, rather than 30+ . If you wanna practice for that long, I think that’s great. I’m leaving the door open to cutting down or possibly transitioning to other work once I reach 50. I’ve always been a FIRE guy, but I recently read the book Die with Zero and it partially changed my thinking. If you’re not familiar with that book, it may be worth at least checking out.
Looks like a great book rec based on the sample. Thanks!
 


Interesting. Making me want to go on a trip!
 
Nice, yeah my rough math was based on a 20 year career, rather than 30+ . If you wanna practice for that long, I think that’s great. I’m leaving the door open to cutting down or possibly transitioning to other work once I reach 50. I’ve always been a FIRE guy, but I recently read the book Die with Zero and it partially changed my thinking. If you’re not familiar with that book, it may be worth at least checking out.

We can't take early separation until 58. The med group pays the pension and benefits until 65. At 65, the health plan takes over the pension and benefits. At this point, I can't see myself staying beyond 58.
 
We can't take early separation until 58. The med group pays the pension and benefits until 65. At 65, the health plan takes over the pension and benefits. At this point, I can't see myself staying beyond 58.


What happens to the pension, employer retirement contributions, and health insurance if you leave before 58?
Is going PT an option to stay connected to them until 58?
 
We are all on the same pay scale / ladder. There's nothing additional for production. We all have similar schedules. Starting salary for PM&R/Pain is about $30k per month. There is generally a "bonus"/ advance on pay when a new associate starts and for each year as an associate There is a significant bump when making partner after year 3. Then it goes up incrementally each year until pay maxes at year 12.
What people are missing here is LOCATION.

If you are comparing jobs in rural Oklahoma or Nebraska, Kaiser is a hard sell. There are incredible opportunities in those areas to put up your shingle or negotiate with a hospital and become the King of Pain.

But in the typically desirable areas, where there's a lot of competition, Kaiser can be a fantastic deal. Of course it also depends on the individual Kaiser job but financially, it's a great deal.

You don't really appreciate all the benefits until you don't have to deal with trying to get pre-auths and worrying about the next shoe to drop with insurers, trying to appease your referring docs, etc, etc.
 
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