Home > Physician Start Salary Survey - Data Entry
Physician Starting Salary Survey - Data Entry



Survey Submitted By: New Hire Information:
Name: Employer Information:
Company: Other:
Address Line 1: Practice Location:
Address Line 2: City/State/Zip:
City/State/Zip: Number of doctors including new doctor:
Phone Number: Practice telephone area code:
Email Address: Start Date (year):
Employee Physician Information:
Dr. Specialty: Dr. Subspecialty:
Training Residency: Fellowship:
Years in Practice: Board Certified:

COMPENSATION: PRODUCTION-BASED ONLY
Year 1 Compensation:
% of collections over $ OR Other:
Year 2 Compensation:
% of collections over $ OR Other:
Year 3 Compensation:
% of collections over $ OR Other:

First Year Perks:
Signing Bonus: Moving Expenses: Other (specify):

CALL OBLIGATION
Weeknights: Weekends:
1 every days; or 1 every days; or





BENEFITS PAID BY EMPLOYER
Health Insurance:
Yes No Unknown Yes No Unknown
Disability insurance Dental insurance
Life insurance Journal subscriptions
Medical society dues Company car/reimbursement
Hospital staff fees Vacation: weeks
Sick leave: days CME absence: weeks
Other:
Retirement plans - Entry Date: after other:

Malpractice Insurance:
Type:
Annual premium paid by:
"Tail" premium paid by:

OWNERSHIP
Restrictive Covenant:
Co-ownership Potential:


Not Before months of employment
No co-ownership
To be negotiated
Not stated
Equity Cost:
(co-ownership percentage of) Other (specify):
Compensation Plan after co-ownership:
"Partnership" Year 1: % of full income share, or
% of full income share (reduced by ownership share of accounts receivable), or
Other (please explain):
If applicable:
"Partnership" Year 2: % of full income share
"Partnership" Year 3: % of full income share
"Partnership" Year 4: % of full income share
"Partnership" Year 5: % of full income share


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