Derm, southeast. Have two job offers. Trying to compare between the two.
"PE" 435 K year one guaranteed base. Will guarantee 90% for year two then collections. 3K CME, Lousy 401k match. Clinic 4 days a week. 6 weeks vacation. 44% collections up to 1 mil then 45% thereafter. 2-3 MAs depending on volume (2 up to 35 then "flex" 3rd MA), 3 rooms. Expect to see 35 to 40 pts/day.
"Privademic". 350 K base, RVU threshold for bonus 9300. 403b, 457 and 5% match in a state retirement plan. 7 weeks vacation. 1 FTE = 90% clinical, 10% other activities. I am waiting for them to confirm wRVU conversion (not in offer letter). Will also have 2-3 MAs, 3 rooms, expectation is 30 pts per day. They offered 4.5 days but open to 4 days of clinic. Cheaper insurance (family of 3 is like 400 a month). Academic Non tenure track job (No current residency affiliated with hospital but there is some expectations for limited teaching of med students, rotating residents from other departments and minor research - case reports)
Commute is similar between the two.
I can add any details that may be helpful. Just trying to boil things down. Any insight would be appreciated. Thanks!
Edited to add more details (which I bolded).
Do you think the $7k per month pre tax difference between the jobs will make or break your ability to pay off your loans as quickly as you'd like?
Early career access and time in the market for 8% match of $350k puts you at the $23k per year limit. Does that mean that your employer will also put in $23k for the year for $46k total? If so that is really hard to pass up in addition to 7 weeks of vacation and the opportunity to interact with students/residents to keep yourself out of monotony.
I feel like it's worth a shot taking the Privademic job... I feel like if you start with PE and hate your work environment, you'll resent switching to a lower paying job that is more satisfying and thus be less satisfied. If you hate your privademic job setting, you will receive a pay raise to leave for a different enviroment and this may make the decision to switch less frustrating if you need to God forbid.
In my last year of residency, not Derm, but making similar decision and taking the equivalent of your Privademic job. No experience to prove whether it's the right call I'm in the same boat with you.
I made an error. It is 8% total (with 5% employer contribution) to a state plan. So about 17.5K from them, 10.5K from me. I then have access to contribute to the 403b (up to 14K) and a 457. So about 42K between the first two account not including 457.
That's still a great deal!
If it were me, I’d look past year-one comp pretty quickly and focus on who controls your future.
The PE offer wins on paper early, but it’s the usual story: higher upfront guarantee, weaker retirement, and you’re betting that collections stay favorable once the guarantees fade. You’re also exposed to staffing changes, schedule creep, and metric pressure you don’t fully control yet. Derm does great in PE until it doesn’t.
The privademic offer is boring in a good way. Lower base, but much better long-term benefits, real retirement contributions, more vacation, and some built-in protection against burnout. The 403b + 457 + 8% match combo is no joke, especially if you’re thinking 10–20 years out. And derm + RVUs in the Southeast usually means you’ll close some of that gap anyway.
If your priority is maximizing short-term cash and you’re comfortable with PE dynamics, the first one makes sense. If you care about stability, autonomy, and not having the goalposts moved on you in 2–3 years, the privademic job is probably the better “sleep at night” choice.
Personally, I’d take slightly less money for better alignment and fewer surprises. PE risk feels underpriced in a lot of these offers right now.
This is what I was looking for! I did make an error it appears to be a 5% match. Nonetheless, the benefits at the privademic job seem much better (better health insurance too). I care about stability and autonomy for sure long term over short term dollars. However, I do want invest as much upfront to have the ability to leave full time clinical medicine earlier than traditional retirement age. I suppose this is where more money early on helps...
Curious when you’re looking to retire and what your planned strategy will be? I’m in a similar mindset, and will likely looking for jobs (gen derm) on the East coast in a couple of years.
Private equity is ass lol. Their only goal is to squeeze docs til nothing is left. I’d go with option #2
Also, consider anything that they tell you about that job either isn't true, or won't be true 6 months after you take the position.
They are only about short term profit. And I mean at most the coming fiscal year, more like fiscal quarter. As such, they will do things that are utterly non sensical and counter productive long term in order to make things look good, right now.
Perhaps an unpopular take, but the sellout of physicians, especially to PE, is making medicine worse. I get the money is tempting, but we’ve gone from a mostly independent profession to one dominated by hospitals, corporations, and PE, and consolidation is only accelerating.
PE turns care into a transaction, strips physician autonomy, and prioritizes margins over patients, but hey the paycheck is huge so who cares? Then when productivity pressure rises, visits shrink, and burnout hits, the same physician wants out and everyone asks why the burnouts are so high.
I’m not trying to villainize older physicians or pretend the practice environment hasn’t been squeezed to death. Reimbursement cuts, admin bloat, and regulation have made independent practice brutally hard. But pretending PE is a neutral option or worthy of a consideration as a job offer, regardless of the exorbitant pay, is worrisome.
Please, we need to stand up to these guys. They are ruining medicine, and people are suffering.
An unpopular take?
You must be new around here.
Sure am. I commented because I saw PE. I certainly hope this is not an unpopular take, but if this sentiment is not unpopular, why are so many physicians now working for / selling out to PE? I wish I saw this sentiment everywhere in medicine, but I don't.
I'm not a doctor, but when I recently had to look for a new GI, I specifically looked for a non-PE practice. I can tell you that, from my research during the process, my case is not unique. Patients, too, are taking notice.
That’s encouraging to hear, honestly.
How is this an unpopular take? I feel like this is THE take lol. I haven’t met anyone in my field who is pro PE, even the ones who take those jobs 🤷🏼♀️
I don't think anyone is "pro-PE." That's not my take. My take is that everyone is selling out to them, because it is the easier thing to do. My biff is with the people you know who took those jobs anyway. That is a problem. I believe it is unpopular to call out fellow physicians out for being cowards.
Ok, being pedantic doesn’t really change anything. It’s very very easy to avoid PE. I don’t personally know anyone who is in a PE group (I was speaking colloquially in my prior comment as of course, I’ve encountered them in passing and online). The people who join those practices usually have good reasons to do so; reasons that you may not be privy to or relate to. Typically very early or very late in their career and want to be an employee, not a partner etc. Unfortunately, many independent private practices (mine included) do not have non-partner positions, so PE fills this void for those who “need” that kind of job in a pinch. But your comment said “unpopular take” regarding something that is the popular take. It’s semantics. That’s why people are offering their retort.
Interesting. Where I am at almost all private practice gigs are non partnered. I interviewed at several the first go around and partnership was only available at like one place.
Please also consider if you have to pay any tail coverage if you leave either job for malpractice. This can be hefty, and a nasty surprise when you change jobs. Have seen this a lot recently with folks who left PE owned practices
Great catch! If I stay 3 years with PE they pay tail, if I leave before it's on me. No tail needed for privademic job.
Everyone should be shouting this from the rooftops for all new grads who take jobs. I got lucky and my group pays it regardless of time spent employed
Tails are not that expensive in derm. What about penalty for Leaving before your 3 year term ends? This is where it can get very expensive really quick.
Yeah I have to repay sign in bonus (25k) prorated and 10 mile non compete for 2 years + liquidated damages if unenforceable
Good luck. If you decide on PE just do your homework and negotiate your contract well. You may have to bail if job goes bad for you which is true for any job not just PE. Def have your lawyer look at the liquidative damages language and out clauses closely
Yeah my group tried to essentially name an unspecified amount of liquid damage and my lawyer about had an MI. Make sure this is specified - and worth every penny to have a lawyer take a look.
Thanks! Yeah I have an and will have to push for this to be removed from the contract.
Is that 7 weeks paid vacation? That only is worth it. I’m a PP derm and not having paid vacation has been really challenging. Offer two seems better for long term
Yes, it’s paid.
That is an amazing deal. Think of it this way, in PE/PP it’s unusual for derms to get paid vacation. I’m in PP and make around $10k per week, so 7 weeks paid vacation would be worth $70k. Not to mention not having the mental burden of feeling guilty for taking time off. Plus a 5% match with good benefits means better retirement. Good luck with your choice but B sounds like a dream coming from a burnt out private practice derm. Feel free to msg me if you want to chat more!
Yes, I will PM you. Thank you!!
I somehow didn’t realize any docs are unpaid for their allotted vacation time. That’s insane. In my field, I’ve never seen that come up at all, so I feel very fortunate with my 8 weeks!
$350k for 9300 rvu is ~$38/wrvu which is super low. That's below the 10th percentile. Look up the average wrvu for dermatology
Yes, I appreciate you pointing that out. I am trying negotiate the target rvu down
This ^
Are you thinking of doing PSLF, privatemic may qualify. PE will not. That swayed my decision. All-in-all I wouldn’t work for PE. The concept is to squeeze for what you are worth. It guides every admin decision. That’s not a model I want to be a part of.
Fair enough. Unfortunately my neck of the woods PE dominates. I am not doing PSLF (I have 165K i plan to knock out in the next year or 2)
Fuck, $165 is a dream. I did my residency with attendings in privademics and they seemed very happy. Definitely a “best of both worlds” situation and I’d absolutely go for that option.
Yeah I’m leaning towards this if I can make the numbers work.
And I paid my loans down from 240 originally.
wRVU threshold is way too high for such a low base salary. #2 is a bad deal and disincentives you from being productive.
Thanks for chiming in. This will a strong negotiation point for deal 2. Seems like if I can bring that down (plus whittle it 4 clinic days) I may come out ahead long term.
Pls keep us updated on how #2 negotiation goes! Thanks!!
Haven’t factored in the taxes (pretax). Pretax retirement savings in the Privademic are huge.
You have a state mandatory + a voluntary. Those two are limited to $70k (2025). Plus $23500 in the 457b. Everyone of these can be rolled into any future plan. $93k pretax deferring tax at the highest marginal rate. Throw in a BD Roth and a little taxable.
Make no mistake. Privademic will still have volume pressures, but it won’t be “eat what you kill”. PE can change on a dime and be sold. Returning to Privademic or academic will be difficult if not impossible. Lots of reasons to try the Privademic first.
Missing the two most important pieces.
What’s the collections for offer 1?
What’s the wRVU conversion factor for offer 2?
Also how many MAs/scribes at each job? How many pts can you reasonable expect to see per day at each job? Unless you’re looking to be a one and done, those factors matter way more than the initial base
You are correct, I edited my post to include these important details. Still waiting on wRVU conversion factor from offer 2 (this was not disclosed).
44% collections for a PE group is not bad. In general, it’s better to avoid PE when you can. However, the academic model has its flaws, namely they tend to be less efficient and allow you to see less patients a day. This is often a function of less support staff or an EMR that is less conducive to efficient charting. 30 patients a day in an academic model is not bad, but you really have to calculate out if you think you would hit your bonus. $350,000 is pretty low for derm unless you’re a true academic. I don’t love either of these job offers, if it were me, I would still be on the hunt for a true private practice offer where there is more room to grow. It ultimately comes down to how many RVUs you think you will generate. If you generate 1.8 wRVUs per patient, see 30 a day four days a week, you can expect to generate over 10,000 wRVUs. In a straightforward system, if your conversion factor is $55, that’s a very respectable $570k a year. That’s assuming it’s a running total of your yearly RVUs. If instead, they are just taking the number you generate over 9300, that’s a much less impressive bonus. 10,300 RVUs with a 9300 threshold is an additional $55,000 a year, which added to a 350K base is solid but not as spectacular.
So ultimately, you will have to decide at what level of income you will be happy with, and what your goals are. If it were me, I would generally try to avoid PE. But I would make sure that offer 2 is set up in a way that I can easily surpass the 9300 RVU threshold.
The latter has huge upside for building retirement wealth early. You should check to see when the match vests. I have a similar setup and we only vest 50% match at 5 years and fully at 10. But the rest for tax advantaged accounts is unrivaled. We also have a 401a which adds another $70k per annum.
I don’t know derm well, but 9300 threshold seems high for a modest base.
Vested immediately. 5% match.
Is there any back end profit sharing or opportunity to buy in with PE? I know some PE owned groups offer “partnership”
what's the % collections? That's probably more important and will you be able to hit the #s? What is your support staff like? PE is a solid grind.
If you're gen derm, may be difficult to hit that 9300 RVU threshold for bonus. Do it if you really enjoy teaching and more interesting cases.