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Let's face it, solo practice isn't for everyone. Some people want to just join a group, go into academics, or take a job at a large healthcare organization (HCO). There's nothing wrong with any of these career paths, and you should do what you think has the greatest chance to make you happy. I've had some frank discussions with people in each of these work environments and want to give you the benefit the this group's collective experience. We'll focus on the salary and bonus component for now.
Please keep in mind that the salary and bonus ranges are very dependent on practice location and your subspecialty. The numbers below come primarily from the urban South and Midwest for comprehensive ophthalmologists. For anterior segment subspecialists, add about $10,000 - 25,000 to the starting salary. For retina, add about $50,000 to the starting salary. For competitive markets (e.g. NYC, SF, LA, DC), subtract about $20,000 - $30,000 from the starting salary. If you're looking at a job in a rural market, add at least $50,000 (and likely more, depending on the exact location) to the starting salary.
All of these job offers should include some form of: signing bonus, health insurance, CME stipend, production incentive, moving stipend, etc. When evaluating a job offer, keep in mind that everything is negotiable. This includes the base salary, production incentives, and all of your benefits. I'll get into the specifics of contract negotiations in a separate post, but keep in mind that your salary is just one part of the equation.
Joining a Group
Reasonable starting salary: $200,000 - $250,000
Typical bonus structure: After making 2.5-3x your starting salary, keep 25-33% of additional collections
Growth opportunity: high if partnership track
Typical initial contract length: 1.5 - 2 years to partner. 3 years is too long, and should raise a red flag for a "churn and burn" situation
Notes: You have to be super careful about your group selection. I personally know 3 people who have joined group practices who realized that they made a mistake partway into their 2-3 year junior associate contract. Some groups might be looking to churn through junior associates (make a lot of money off their hard work then not offer partnership and instead hire another one) or increase their practice's value in preparation for a private equity buyout. I know people who have had both of these experiences, and it's a huge bummer to put in all that work and then be told that you have to find another job.
Academics
Reasonable starting salary: $180,000 - $225,000
Typical bonus structure: Varies wildly by the individual institution.
Growth opportunity: Moderate
Typical initial contract length: 2 years
Notes: Additional income from speaking engagements, industry consulting, etc are easier to obtain if you publish frequently and shake a lot of hands. See dollars for docs to see what you can be making (or just to look up people you know).
HCO
Reasonable starting salary: $250,000 - $300,000
Typical bonus structure: Typically a fixed amount if you hit a relative value unit (RVU) target. I've heard anywhere from $20,000 to $50,000 annually. The actual amount is highly variable depending on the HCO.
Growth opportunity: None
Typical initial contract length: 2-3 years
Notes: You are an employee of a large organization. This means that you never have to worry about scheduling, billing, etc but you have no control over your schedule and have to ask permission for things like vacation days.
Solo Practice
Reasonable starting salary: $100,000 - $300,000
Typical bonus structure: 100% of profits
Growth opportunity: High.
Notes: You're reading a blog by a solo practitioner, so you know I'm biased toward solo practice. I know solo practice ophthalmologists that have made anywhere from $100K to $400K in their first year in practice. It's all about being judicious in your practice setup and meticulous overhead control.
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