How Much are Fellowship Physician Salaries? | Physician Fellowship

What is the average salary for a physician in fellowship? At the basic level, after a physician graduates from medical school, they go into an internship and then into a residency program in their specialty, and some specialties require extra training. And that’s what’s called a fellowship. Depending on the specialty, most fellowships last between one and three years. And after that, they can then move on and have an employment relationship where they can practice in their specialty. 

Average Physician Resident and Fellowship Salary

Is there a huge difference between residents and fellowship salaries? The answer is no. There isn’t. The average resident salary is around 63,000 a year. Now, that’s the average. So, there will be some lower than that and some higher. It’s specialty-dependent.

I think the average for family medicine, the physician in training in the residency makes around 51,000, and then maybe some of the surgical specialties can be in the high 60s. But you logically would think, alright, if I’m going to get through residency and move on to my fellowship, I’ll make more money. And the answer is not really. The average fellowship salary is about the same as the average resident salary. Now, the fellowships, anyone who must move into a fellowship is on the higher end of a specialty. So, if the range is between 50 to 70, they’ll be higher towards the 70 range. But there will not be a significant jump between the money you make as a resident and the money you make as a fellow.

Moving Expenses and Bonuses

One word of advice if you are coming out of a residency or fellowship. When you have a new job offer after you are either done in your PGY-3 or your fellowship, people in training are not flush with cash. And so, almost any employer will offer the physician a signing bonus, relocation assistance, or both. But most of them will have language in the contract that states they will either reimburse the physician once they start or they will offer the signing bonus with their first paycheck after they’ve begun providing care. That can burden some physicians who don’t have $10,000 to $15,000 to move. 

A Physician’s Contract Must Have This Written in Their Agreement.

Suppose a physician has a family and they’re living in New York. If they get a job in California, it can easily be $15,000, and sometimes having to pay that out of pocket at the beginning can be an enormous financial burden. So it would be best if you made sure that any of these languages are in your contract:

• Your contract will state that the employer will pay the moving expenses directly to the moving company before the move.
• You will get that money before moving so that you can use that for the moving expenses.
• You can use a portion of the signing bonus to do that.
• And then most contracts will have language that states that if the physician leaves within the initial term, they’ll have to pay back a prorated amount of those bonuses, which I think is fair.

If they’re going to outlay the cash up front, they certainly don’t want a physician to leave after a few months and take all the bonuses with them. A physician in fellowship is around mid $60,000. I think 47% of physicians have over $200,000 in student loan debt. And then, if you think that they’re working 70 to 80 hours a week, which some of them are, it works out to be like $15 an hour, which is tough to support a family at that point.

Other Blogs of Interests

• What to Know Before Signing Your First Physician Contract | Contracts
• Will I Be Paid My Bonus if I Terminate the Physician Contract Early?
• What Can You Negotiate in a Physician Contract? | Doctors Contract Negotiations
• Are Physicians Eligible for Student Loan Forgiveness?
• Physician Loans: Physician Recruitment Forgivable Loan Explained

Physician Contracts Negotiating Tips

Do you want to know how to negotiate hospitalist contracts? I have some good and some bad news. The good news is that there are certain areas within the employment contract that a hospitalist can negotiate. The bad news is that one of the main areas where it’s difficult to negotiate is the base salary or hourly rate. There are two ways a hospital can be staffed. Either the hospital employs them, or there’s a staffing company/physician group that contracts with that hospital to staff the hospital with hospitalists. I find that most companies want to keep the rates standard, especially if there’s an hourly rate involved. I mean, the variables for any hospitalist job are the base salary. And the shift expectations per year, month, or hourly rate, usually with the shift differential.

Main Areas of Hospitalist Employment Contract That You Can Negotiate

When the hospitalist negotiates, the company will typically push back and say, “Look, we want to keep the rate standardized.” The physician is going to talk. There will most likely be friction if one person makes $20 more than another. So, suppose it’s an hourly rate position. In that case, getting the organization to move off that is challenging. Contract negotiation can be complex in this case. Some movements and contract agreements are reachable if it’s just a base salary. However, there will be a narrow range of what the action could be on a base salary. 

And then, as long as the shifts are required, they can move them. In some places, the longer the physician has been with that company or hospital, the more their expectations may change over time. And that’s a place that we can sometimes negotiate. 

The areas of the employment contract that you do have some movement on would be:

• the signing bonus, 
• relocation assistance, 
• non-compete scope, 
• and nose coverage, 
• or whether they pay for your tail when you’re leaving.

What Is a Fair Signing Bonus for a Hospitalist?

I’d say those are the main areas where there is some movement. Now, how does a physician determine what’s a fair signing bonus for a hospitalist? Well, it depends on who you are in the country. Suppose you’re looking into a facility that’s in a difficult location to staff. More rural communities without large cities around them are always harder to staff.

That’s just the reality. And so, the hospitalist has more leverage in asking for a higher signing bonus. Some communities will not only provide a signing bonus. But they can also offer student loan assistance where they’ll pay a particular portion to the company that has the student loans. Usually, that can be substantial, somewhere between fifty to a hundred thousand. But as far as the signing bonus goes for a hospitalist, I’d say anywhere between 10,000 and 50,000 could be a normal range. And then you certainly want to ensure that the organization is also paying for your move.

Can The Bonuses Be Negotiated?

One thing to remember, especially for hospitalists coming out of training, is that the timing of those bonuses can also be negotiable. You’re in residency, and you don’t make a ton of money. Some people don’t have $15,000 to put down for action because, most of the time, they’ll state that they will reimburse you. One of our negotiating points is having them pay the cost directly to the moving company. And have them provide the signing bonus upon executing the document and signing it, and not just when the hospitalist starts the job. A non-compete can be necessary as well. Now, if you’re in a one-hospital town, a non-compete has almost no effect on you because it needs to be reasonable. Something reasonable is usually somewhere between 5 to 15 miles and one year. 

But if you’re in a large metropolitan area, and you want to stay in that city, decreasing the radius of the geographic restriction certainly is something that we would look to do as well. And then, as I mentioned before, with malpractice insurance, sometimes you can work on if the organization provides tail insurance or not. A good rule of thumb in tail insurance is that it’s usually about twice your annual premium. For hospitalists, it’s probably somewhere between 7,000 to 10,000. So, your tail insurance cost would be 14,000 to 20,000, something like that. So, is it possible to negotiate points in a hospitalist contract? Obviously, yes. Getting any movement, base salary, or maybe a little action is strict. Still, the signing bonus, and non-compete, which pays for tail insurance, are the areas that I think you should focus on.

How Should a Resident Physician Look for a Job?

How should resident physicians look for a job? Literally, what steps should they take to find a position they’ll be satisfied with? The timing certainly is important. Most physicians generally start looking for positions early in their PGY-3 year. Some specialties will even sign contracts in their PGY-2 year if they’re not going into fellowship. If a physician is moving from residency into fellowship, they usually won’t start looking until the end of their last year of residency, or maybe it’s a multiple-year fellowship. Maybe at the beginning of the last year of their fellowship as well. There are several ways physicians can find jobs.

How Physicians In Residency Can Look For A Job

The easiest way I’ve found is through colleagues. If you’ve trained with somebody, usually, they’ll know of, a place that’s recruiting, or maybe they joined a practice. And they say it’s a great environment that we’re looking to add another physician in a specialty. Maybe you should look at it. Now, that can vary wildly in location, and location is very important to some while not important to others. So, it can go all over the place if you’re getting some leads from fellow residents or fellows. One way is to talk to colleagues, mentors, or other people you’ve met in training. And that’s also a great way of determining the market value at the time. The MGMA data is like an annual physician compensation survey across the nations broken up into geography, specialty, and physician-owned versus hospital-based physicians. In some specialties, the sample size is so tiny.

I don’t think it’s a great tool. Other specialties can usually be a pretty good gauge if there are hundreds and hundreds of responses. I don’t think any physician should base a job search solely on compensation. I think that’s shortsighted. Anyone coming out of training needs to be in an environment where they can learn. Or they’re going to have mentors where they’ll feel safe and have an opportunity to grow.

I often see it, especially in rural environments, where they need a specialty. They’re willing to throw a bunch of cash at somebody. But they’ll be the only ones in their specialty out there. Like there’ll be no others, no one to learn from, train with, or pick someone’s brain, at least locally. Those scenarios are tough. Some physicians can thrive in that environment, but it’s more complicated for others. So, I think they need to consider that. 

Physician Employment Recruiters 

Any physician contract is going to have without-cause termination. If a physician is unhappy in their practice, they usually provide 60- or 90-days’ notice. And they can move on. Even if you’re in a job at the beginning, you’re not stuck there forever. You can find something better. I mean, I find a lot of physicians coming out of residency or fellowship will take the first job. And then they’d say, alright, now I know what I don’t want. So, they can look for work more appropriate to the practice they’re looking for. 

Another way is through physician recruiters. There are two types of them. You have in-house recruiters. Many big hospital networks employ physician recruiters who attend different residency programs. Maybe there’s a job fair, something like that. Or they’ll specifically reach out to people in training, saying, hey, I have this opportunity in this place. Would you be interested? They’re free to physicians. You do not have to pay the recruiter or anything. The employer is the one that pays the recruitment fees.

So, physician recruiters. Both in-house and those that are just a private group where they just go out and broker these deals. Typically, they would get a percentage of the first-year salary of the physician, or maybe a flat fee. Something like that. But there’s absolutely no harm in discussing positions with recruiters. It’s a usual way of doing business nowadays. They usually have their ear to the ground and know many different opportunities that could be exciting for physicians. 

Physician Job Search 

Another way is if you have a specific region in mind. It is just job searches for practices in your specialty in one area. Most places will have job posts on regular job sites if they’re looking. Then you can search for those in the city you want, find that, and contact them from their work listing.

That’s another way. So, those are the three biggest ways. Word of mouth through colleagues, doing it through a physician recruiter or searching in specific cities through job search websites. Now, for those who are maybe J-1 or something like that, that’s like an entirely different kind of job search. And I can do a separate video about that. But this is more geared towards those looking for the normal position just coming out of training.

Can a Physician Negotiate After Signing a Letter of Intent?

Can a physician negotiate after signing a letter of intent? The letter of intent is also known as an offer letter. The normal recruitment process would be close to the end of their residency or fellowship. And then, most people find a job in one of three ways: either word of mouth amongst colleagues or mentors. A physician recruiter can reach out to them. And say here’s a position that might fit your needs. Then initiate the process that way, or the physician can always find job opportunities through job listings on the internet. Once initiated the process, the physician discusses it with the physician recruiter. Such as the terms of the relationship, salary, bonus opportunity, locations, and that type of thing. Many employers will then ask the physician to sign the letter of intent.

Physician Salary, Compensation, and Other Basics in an Offer Letter

The letters of intent are just the basic structure of the employment relationship: start date, location, and contract length. Which is known as the term, how both parties can terminate the contract, compensation. So what’s the base salary? Is it RVU production? What are the thresholds? Is it a collection? What’s the net collection percentage? And then, the restrictive covenants, non-solicit, what are the terms of the non-compete? And then usually, the basic benefits, so what do they offer in terms of health, vision, dental, life, disability, retirement? What does the employer pay for continuing medical education, licensing fees, DEA registration, association, and societies?

Just basic things. These are all the things we’re going to provide to you. Now, some letters of intent are more detailed than others. Suppose a physician is okay with the general terms of the offer letter. The employer will say, we need you to sign the offer letter. And then, at that point, we will get the employment agreement drafted, and then they’ll offer the physician the employment agreement. Is the offer letter or letter of intent binding? The answer is no unless a language there says it is binding. You rarely find a letter of intent stating this is a binding document. For several reasons, it doesn’t make sense for a physician to sign that under any scenario.

When to Decline a Physician Employment Agreement?

Basic terms in an offer letter with no context or explanation can change substantially. Once we can see the actual language of the employment agreement. Maybe they will state it in the offer letter. There is a non-compete, but there’s no description of it. Well, perhaps you read the employment agreement, and you’re expecting a one-year non-compete. They say it’s three years, or you’re expecting a 10-mile restriction geographically, but it’s 50. The initial offer letter may look like, okay, a non-compete, well, that’s expected for a physician. But once you read the terms, it goes from being reasonable and okay to be completely unreasonable. In that scenario, although the physician signed the offer letter, they do not need to go through with signing the employment agreement. 

And then, I would also suggest that even though the physician has come to terms with the offer letter. It doesn’t stop them from renegotiating the terms before signing the employment agreement. As I said before, once one reviews the actual language of the contract. It can completely change someone’s perception of a job. I’m willing to make a smaller base salary if the non-compete is not as restrictive when I leave. Or let’s say you have a claims-made malpractice policy and the employer is saying. We will pay for your tail insurance once you go. They might be willing to accept a smaller base because the employer will pay tail insurance. Then when you look and get the employment agreement, the language states the employee must cover their tail insurance.

Physician Negotiating the Terms Before the Employment Agreement

Maybe depending upon specialty, that could be a significant amount of money. And then the physician may say, well, I had no idea I had to pay $50,000 tail insurance. Therefore, I want a more extensive base salary to offset that. So, even after the physician signs the letter of intent, they certainly can continue negotiating once they see the actual terms of the employment agreement. Now, a couple of considerations: it’s not bad form to go back and renegotiate terms. However, some employers may get ticked off when the physician agrees to the offer letter terms and then return to renegotiate those terms. It can be off-putting to some employers. However, if the physician frames it in, well, you said that I would have this, and I expected this to be kind of industry-standard, but once I saw the language, it wasn’t.

For instance, there are normally 60 to 90 days without-cause termination. This means either party can terminate the agreement for any reason, with a certain amount of notice to the other. So, they’re expecting a 60-day without-cause termination notice. And then the employer says, you have to give us a one-year notice. Well, that’s insane! No physician should agree to that. And they absolutely should renegotiate the terms once they see the actual language in the employment agreement. No physician should sign a contract that they’re either unwilling to meet the terms or are significantly unhappy with before starting the job. There will always be push and pull when it comes to a contract. There is no perfect contract. It doesn’t exist. There will be things that the physician has to relent on that maybe they’re unhappy with.

Fair Negotiation

And maybe the employer has to relent as far as compensation goes or have to pay tail insurance. Or any of the things I’ve already discussed. But, if both sides feel relatively bad about the agreement. It usually means it was a fair negotiation. If one side is super happy, it usually means the other side is not. So, don’t sign an offer letter if you’re unhappy with the terms. But even if you sign an offer letter that you’re okay with doesn’t mean you can’t renegotiate the terms after the fact. Now,  lose out on an opportunity if you do that. An employer could theoretically pull a job offer. But in that scenario, I don’t think it’s worth moving forward because you don’t want to tick off an employer. It doesn’t make sense.

Medical Physician Negotiating an Offer Letter in an Agreement

Can you reject a letter of intent? The quick answer is yes, you certainly can, and should, if you’re unhappy with the terms of it. Letters of intent, also known as offer letters, can be provided once negotiations or discussions about a position move forward. Normally, it would work if a potential candidate would find out about a job. Either through a job listing or word of mouth. Or maybe they were reached out through a recruiter. There’s a discussion of the main point of the position: salary, benefits, and location. And once there’s interest on both sides, many employers will offer the letter of intent or the offer letter.

And that is a description of the main points of the employment relationship. Most offer letters will include the contract’s start date, location, and length. This is called the term, maybe a brief discussion on how both parties can terminate the contract, compensation. So is there a base salary? Are there bonus opportunities? Is it net-collections or commission-based RVUs? It would be a brief description. It wouldn’t go into a long four paragraphs about comp. If malpractice insurance is necessary, who pays for that? And then who pays for the tail insurance if that’s necessary? Are there restrictive covenants? The restrictive covenants are normally a non-disparagement, a non-solicit, a non-compete, and it might go through briefly like this is how long go last.