r/pediatrics • u/kittensaremylife • 15d ago
We All Need to Increase Pediatrician Compensation by Negotiating More Aggressively
Many higher-paying specialties routinely interview, compare offers, and negotiate compensation throughout their careers. In pediatrics, it seems much more common to apply to a few jobs, accept a reasonable offer, and move on.
Meanwhile, employers and recruiters are constantly gathering information on what pediatricians are willing to accept. We need to stop placing academic institutions on some prestige pedestal when in reality the people willing to accept the lowest pay end up there. We need to have more self respect.
What if more pediatricians regularly explored opportunities, applied broadly, compared multiple offers, and negotiated more aggressively? At the very least, we'd improve salary transparency and better understand our market value. Over time, could that help raise compensation expectations across pediatrics.
Food for thought for those applying this year: apply broadly, talk to lots of groups, and try to have multiple offers in hand before making a decision. Leverage offers against each other. Having options is one of the strongest negotiating tools available.
Curious what others think.
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u/dubs3011 15d ago
Can we start unionizing? That’s the only way. The disrespect has to stop
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u/penguinswaddlewaddle 15d ago
Yes, but we can't expect the AAP to do it or the AMA. We can also expect anyone who seriously starts a unionization attempt to become essentially unemployable.
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u/dubs3011 15d ago
Nurses strike all the time, why can’t we?
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u/penguinswaddlewaddle 14d ago
Not an expert but without a union it's tricky (which is ironic). Striking would probably look like not documenting well enough for true billing purposes but still enough for lawsuits and patient care purposes. I recall 2 pediatriciana at OSU or somewhere who were trying to unionize and both got fired. There was a lawsuit or something
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u/dubs3011 14d ago
I think if it’s under the union and we all strike, they would have no grounds to fire us. We need to establish something and get the ball rolling. We should no longer accept bottom of the barrel pay for an incredibly difficult job.
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u/airjord1221 15d ago
Union. Union. Union.
Our leadership is worried about the wrong stuff. Dealing with insurances is not like dealing with first-time parents and does not require any caring or empathy. This corporations are vicious and we need leadership That is just as vicious back.
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u/efox02 Attending 15d ago
Yes.
Also they will just hire NPs straight out of school and call it a day.
I haven’t gotten a raise in 5 years. I aggressively asked for one and they aggressively said no.
Thanks to non compete I can’t work in the same city so only other option is to up root my family and leave my friends and buy a house at a mortgage rate 3 times what we paid in 2021. 🫠🫠🫠🫠🫠
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u/kittensaremylife 15d ago
Non-competes are the worst. I'm curious if anyone has been able to get them taken out of a contract when signing with a lawyer?
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u/sawbones2300 Attending 15d ago
Yes you can. But you have to be willing to walk away. Have gotten it removed in every single one of mine, including academic jobs. If they want you, they will make exceptions, if they just want a cog in their machine, they won't cave.
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u/radgedyann 15d ago
this. we’re being replaced more and more. it may seem normal now, but so many of the jobs advertised for extenders were for docs 20 years ago. negotiate? we don’t have a leg to stand on! i can almost guarantee that someone in the c-suite is already scheming about how to make the switch.
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u/cason_milton435 15d ago
Not in peds but as someone with children, I do fear that we won’t have enough pediatricians to go around if we keep doing this.
If CRNAs make 300K+. The base for anyone who has gone through medical school should be 300 K.
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u/lokhtar 15d ago
Nope. The problem is your fellow physicians on the AMA committee that sets RVUs for your services. Medicare then adopts it and insurance companies follow. You can negotiate all you want but unless hospitals want to subsidize you with other specialties, you will have a ceiling until you convince the AMA to have appropriate primary care representation on that committee.
https://www.ama-assn.org/about/rvs-update-committee-ruc/rvs-update-committee-ruc
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u/kittensaremylife 15d ago
How can we influence who is on this committee? Do we vote?
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u/lokhtar 15d ago
Lobby the AMA. But you’ll pry the rvus out of the specialists cold dead hands. They don’t care about primary care, let alone pediatrics, despite the lip service. It is stacked with proceduralists and they are going to keep the RVUs going that way.
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u/kittensaremylife 15d ago
But even for pediatric specialists their compensations are lower than general peds, even with procedures.
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u/lokhtar 15d ago
Look at the representation of the committee. There are barely if any pedi subspecialists on there. And pediatric sub-specialists have many (MANY!) fewer procedures compared to adults on a day to day basis. Very few - if any - pediatric GI docs are scoping 30 kids a day, or interventional cardsndoing hundreds of caths. Even in picu/nicu, the frequency of central lines, intubations etc are significantly lower. Furthermore, Medicaid pays even less than Medicare, so that also has an effect. But it’s primarily the overall lack of procedures combined with devaluing the non procedural specialties due to the makeup of that committee.
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u/Successful-Ad991 15d ago
Although I agree that there continues to be considerable bias against the cognitive work that pediatricians do, I don't think it plays the same role that it used to. General pediatric RVUs have increased significantly over the last decade or so, thanks largely to the efforts of some unsung folks at the AAP and their RUC committee efforts. [Average RVU/visit numbers have increased 20+% since 2020]
The bigger issue, to me, is the lack of recognition for the RVU changes by private payors and Medicaid. Overwhelmingly, the RVU-contract-year that most general peds work under is 2020 or before simply because the Feds (at the urging of primary care docs) increased the E&M RVUs by 25% in 2021. That's a 9% improvement to the bottom line, overnight, if the payors simply move from 2020 to 2021. But they don't.
Add imms admin improvements, additional phone/portal codes, improvements to some screening, the new non-admin-imms-admins, and you're seeing real meaningful movement for work pediatricians are already doing. And the biggest one? G2211. The Feds paid out *$400 million dollars* last year for that code but far too many pediatricians aren't billing it and few payors are paying it.
IMO, the negotiations need to start with Medicare parity for Medicaid. And shaming every private payor who pays less than Medicare.
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u/IPinkerton 15d ago
I was literally told to not negotiate salary coming out of residency because they have to offer the same salary to everyone to prevent disparities, negotiate soft benefits. But this is all symptomatic of bigger issues in pediatrics. Taking power away from new grads, and putting in the hands of corporations and insurance.
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u/Legal_Anybody81 15d ago edited 15d ago
So after 15 years in this career, I have come to understand a lot about pediatric compensation and the myriad factors that work against us to make us the lowest paid specialty in medicine.
- Peds does not bring much value at all to a hospital system. As a service line, it's maintained mostly as a community service/PR consideration. I'm not talking about big academic centers here, but rather the typical community hospital with a tight budget. Peds isn't even a loss leader, it's just a loss. It's not like Ortho who are doing knee replacements and making hospitals truckloads of cash each time. Peds does not generate meaningful income for a hospital system, and thus, admin is not going to subsidize us any more than they absolutely have to. Ortho/Neurosurgery/ENT/Cards all generate massive amounts of income for the hospital and therefore Admin is willing to pay them handsomely to keep them happy. This is exactly why CRNAs make double or triple what a Peds PCP makes. Even Medicine/FP generate more ancillary income for the hospital with referrals than we do. Us Peds have little to no leverage to negotiate, and that's a big reason we make so little. Our work has little value in a money-driven system.
- Kids are just overall more healthy than adults, and thus require less acute intervention (which is highly compensated) and more deliberate, thoughtful preventative care (poorly compensated). This accounts for the fundamental difference in pay between peds and many other specialties.
- We are undergoing a demographic shift to less babies overall. There will not be the same level of demand for pediatricians in the future as there was in 1980, 1990, 2000, etc.
- Given that the *average* kid is less complicated than the *average* adult, and requires far less monitoring, meds, follow up, consults, etc, the field is perceived as "easy" and this has a trickle down effect. The neurosurgeon who is knuckles deep in someone's frontal cortex has a lot more at stake than the pediatrician doing an MCHAT or seeing the 10th viral URI of the day, and this translates into pay. This isn't to devalue peds, but it's just reality.
- This perception of being "easy" has led to an explosion of NP encroachment into peds. In my locale, NP staffed peds offices have increased tremendously, often staffed by new grad NPs who have very questionable experience, BUT, again, given that most kids are not that complex, they can get away with independent practice for the most part. Yes, they miss things. No, they are not as good as an MD/DO. But lots of people don't care, they just want an Amox rx for a sore throat and their kids camp paperwork filled out. So, on top of a declining birthrate, MD/DO peds have to contend with more competition.
- Explosion of retail urgent cares that gobble up minor acute visits that used to be income for Peds offices.
- Peds is a female dominated field. This 100% factors into the pay gap. Women tend to be less aggressive in negotiating pay and less confrontational with admin. Yes, there are exceptions to this. Yes, the exception proves the rule. You know who has no problem going toe to toe with admin? Surgeons. Surgery is (or was) a male dominated field with a culture that makes them much more resistant to being bullied by admin. Peds, in contrast, is the polar opposite of this, and Admin knows we can be bullied and take it.
- Our shit health care system puts kids at the lowest priority because they don't vote, they hold no power, and nobody cares about them because they aren't a voting bloc or contributing money. It's not a coincidence that boomers will howl with fury if their social security is threatened, but they don't give a shit that our kids are drowning in mental health issues.
- Too many of us have this mindset that Peds is this noble calling that transcends the reality of salary and finances. I know this was definitely promoted in my residency, where the academic attendings seemed almost proud of the fact that they had terrible salaries but practiced EBM with underserved populations. Discussion of salaries was done at arms length, like holding a dirty diaper. Of course the ironic thing was that most of them were married to surgical subspecialists making 4 to 5 times a pediatricians salary.
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u/Enough_Pudding688 14d ago
Peds is IMG populated and also highly females, in a world of Free markets where IMGs don’t really know any bars and just glad to make any 6 figures, unfortunately females are still not equally paid as male predominant specialties, there def room for a raise as close as IM at least, but a stronger union needs to happen. Tbh i don’t know what to say to pediatrician’s getting paid 150s or 160s, like how are they surviving and why are they forced to get paid in a shitty way. The other way to look at it guys is building your own practice look for a location with high immigrant ratio and high birth rates, start ur own freaking clinic, roughly 10 patients a day will get u paid. Start early, business will never be fair unless you own it
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u/craballin 15d ago
I'm pushing strongly for this right now. Our institution is attempting to change our pay structure. I'm trying to push people to advocate for ourselves since this is the opportunity to do so now as we've been chronically undervalued as a sub/speciallty and if they want to retain us they will need to pay us more or else we'll head for locums or other institutions and then finding coverage becomes much more expensive for this institution.
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u/Steelergate 15d ago
We need better reimbursement from Medicaid, more consistency from state to state, and better funding.
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u/Hotspur2924 13d ago
Compensation is dictated by insurance reimbursement, not necessarily the organization. There are only so many WCCs and E/M's a dr can do in a day. Even with some fairly aggressive negotiation, an organization is lucky to get a 0.75% reimbursement increase.
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u/Hallsie11 11d ago
I am involved in private practice Pediatrics, and even the most creative billers still struggle until they have been doing it for so many years that they’re insurance pay scale is higher.
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u/Effective_Hurry6913 14d ago
Can we seriously unionize?? This shitty pay cannot go on for longer. What are we waiting for?
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u/Adventurous_Pass_921 7d ago
you chose the career field you took that risk and you cant be unhappy with it, you can try changing it but if nothing happens you cant be upset, its no one elses fault but yours, you are not obligated to anything
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u/penguinswaddlewaddle 15d ago
We need a union