Ethan A. Nkana (00:00):
When I sat down with their CEO, CEO said exactly what I knew he was going to say, which is, "We cannot pay these doctors a single dollar more or we'll go to jail."
From Spaugh Dameron Tenny, it's The Prosperous Doc podcast, real stories, real inspiration, real growth, a show for doctors who are ready to improve their overall wellness in every aspect of life. Now here's your host, Shane Tenny.
Shane Tenny (00:32):
All right, welcome back to The Prosperous Doc podcast. My name is Shane Tenny and glad to have you with us today for our conversation. In a recent independent survey of physicians from a variety of specialties, the medical network, Doximity found that although excited about their new career, over 72% of residents had negative feelings about negotiating, including feeling stressed and concerned, anxious or lost. The survey also showed that only 31% of physicians feel prepared to network and less than 10% feel comfortable negotiating at all. Well, my guest today is a sports agent for docs. He represents and negotiates with hospital systems on behalf of physicians. Ethan Nkana runs the Rocky Mountain Physician Agency. He's got an MBA and a law degree from the University of Dayton, but before starting his sports agency for physicians, he worked as a hospital administrator. And when in physician contracting, he just saw how often docs leave money and value on the table during their contract and salary negotiations with hospital executives.
So he's with me today to talk about the tips and tricks of negotiation. Ethan Nkana, thanks so much for joining me on The Prosperous Doc podcast.
Ethan A. Nkana (01:59):
Shane, I am delighted to be here with you today. And your opening really set the stage for the challenge facing doctors. I didn't realize the numbers were as stark as what you shared at how few doctors feel comfortable going into those negotiations. I'm not surprised, but I didn't realize the numbers were that staggering.
Shane Tenny (02:21):
Well, I like to tee it up high for you because that, in fact, has created the opportunity for you to be able to help so many. So let's just start there. Give us the broad level of what the myths or the challenges are around compensation negotiation for physicians.
Ethan A. Nkana (02:40):
The first thing that I often have to do for people is contextualize why doctors need an advocate. Because I think we all tend to think of doctors as these multimillionaires and super high earners. And if they are that, well, why do they need someone to advocate for them? And the fact of the matter is the numbers that you shared when we started the conversation really indicate that doctors have no training or education in contracts and salary negotiation. So what that means is when they go into those situations, they are completely unprepared. They are used to clinical training, in-classroom training for decades, and then they come out and have no experience or training in how to negotiate those deals. So you or I might feel uncomfortable in a completely foreign and new situation, and that's how doctors feel. And so it's important first to set the table.
And then I think the next layer of it is there are very vast disparities between doctors' pay, not just within specialties, but within a certain specialty, even beyond having no training, it even amplifies the reasons why it's so important for doctors to advocate for their value because you and I don't want to make 30% less than the person next to us for doing the same work. And doctors don't want to do that either. And so I think that's a really important contextual consideration for why doctors need an advocate.
Shane Tenny (04:15):
Excellent way to tee up and frame the conversation. I know from just our preparation for today that your work with doctors kind of falls into two broad categories. There's those who are coming straight out of residency or fellowship and are new and looking for or getting their first contract, in contrast to those who are mid-career and wanting to exit private practice and negotiate with a hospital system or relocate or something like that. So I thought it might be helpful to break our conversation down along those lines. Talk a little bit, maybe we'll tackle kind of the new physician scenario first, what's helpful to know for someone who's kind of approaching their first job?
Ethan A. Nkana (04:56):
I like how you broke it down between experienced physicians and first-time attendings. I think that's a really natural line of demarcation and it also amplifies how we think differently. At RNPA we think differently about how we advocate for first-time attendings relative to how we advocate for established attendings. So it's a really natural and nice delineation. For first-time attendings, the information that I think is most important for them to know, and this comes back for me, I'm digging back into my life as a hospital executive. Most hospital executives want their first-time attending doctors to be as busy as possible as fast as possible for as cheap as possible. And if doctors understand that that's the context in which they are negotiating, I think they would take a little bit more of a self-advocacy approach when they go into those conversations.
And I think the primary challenges that I see first-time attending doctors fall victim to is comparing their salary that's offered in their employment agreement to what they're making as a resident. And that's just not relevant. I get it, you're making 50, 60, 70,000 maybe as a resident and that first contract is four, five, six X of what you were making. So it's a lot of money, but it's so important to know that it's not about what you're making relative to what you were making as a resident, it's about what you should be making relative to the market. And so if I could give one piece of advice to first-time attendings that would really help give them the best chance for success, get more than one offer.
That is the single most valuable piece of advice for first-time attendings because now when I'm having a conversation about my salary and compensation, it's not about how good of a doctor Dr. Tenny is. Now we're having a conversation about, "Well, I have an offer from this other hospital. I really want to be here with you all and I'm hoping that you can close the gap between the base salary offer that you've presented and what they've shared." And now you're having a conversation about the offers, not about how good of a doctor Dr. Tenny is. So first-time attendings, go get more than one offer. That will vastly improve your bargaining position. Because if I were a guessing person, Shane, I would guess that most of your first-time attending clients or colleagues likely say, "I don't have leverage because I don't have experience." And that's just simply not true.
Shane Tenny (07:38):
Which brings up, I think perhaps the clear follow-up question, and that is the belief or the notion that, here's little old me up against big old hospital system. Is this even negotiable at all?
Ethan A. Nkana (07:53):
I have a doctor who I'm working with right now, I won't say her name because I don't want to embarrass her, she doesn't love attention, but she is the prototypical first-time attending in the way that she's approached her job search and contract negotiation. First and foremost, she has three offers. And so that gives her the leverage to be able to say, "I prefer this offer over that offer." And so what we've done is we've gone to each of the employers and said, "We like this offer and hoping you can make some reasonable changes. We also like this offer, hope you can make some reasonable changes." And just to give you some high level numbers, her initial offer came in at a certain number. All we did was say, "Thank you for the offer. Would you be willing to consider this salary number?" That increased her salary number, her base salary guarantee by $50,000.
And so for a doctor, just would it be worth it to you to send an email if it meant you could get an additional $50,000 a year? And the answer, I think, for most doctors is yes. And so it's so important for doctors to know, you must get more than one offer. And once you do that, now you're in control. Now you can say what you like and what you don't like. And think about this. If, as a physician, if you say, "This offer is good, but it's missing some major components of what I need for my practice or my lifestyle," let's say that the employer's not willing to make changes, then what do you do? You have to start the process all the way over from scratch as opposed to when you have three offers, if one or two of your employers or prospective employers is not willing to accommodate your requests, you can simply move on to another employer.
So you don't have to start from scratch, it's not as daunting a proposition to decline an offer as well. And I think that's a problem that my doctors get to have is, now you have the challenge of turning down offers.
Shane Tenny (09:55):
You bring up the example of negotiating on the base salary or the guarantee portion. What are some of the things that can be negotiated and are there areas that are generally kind of the unmovable parts? Because contracts are not one-page documents, there's generally a lot of different pieces to them.
Ethan A. Nkana (10:15):
I am of the belief, and I know I'm speaking out against my industry, I am of the belief that contracts are written intentionally convoluted and complex so that only a certain few people can read them and you have to go through them to have them interpreted. It's a racket in my mind. But on a more serious note, I do think it's important for doctors to understand that when you go into those conversations, everything is negotiable. Yes, there may be certain things that with an employer you cannot move, but that does not mean that it's a non-negotiable item.
So when we think about compensation for doctors, yes, we love that big sexy six figure number because that's the number the doctor can count on to live and for their lifestyle. But we think about compensation holistically in three parts. Your base, your bonus, and your benis. Your base is the compensation that you are guaranteed just by showing up and doing your job. Do no harm, as they say. Your bonus is the compensation that you earn for taking an action or completing a goal. So it can be something as simple as signing a contract and you get a signing bonus or something more involved like a clinical quality bonus where you can help improve clinical quality outcomes or ER readmission rates, things like that. You can earn compensation, $12,000 to $15,000 generally, so not huge numbers, but also not peanuts, at least to me and the doctors I get to work with.
And then lastly, benis or your benefits, tremendous amount of value, but you may not necessarily be able to deposit into a bank account. So think about things like your paid time off, who covers your malpractice insurance? Your health benefits? All of those things that are extremely important, but maybe don't get the headline press that big six figure number gets.
As it relates to the immovable objects, I think the things that doctors tend to have a little more of a challenge moving is hospital policies or employer policies. Sometimes, I have one doctor who has a bonus compensation policy that in no way aligns with the industry standard and it's highly disadvantageous to her, but because that's the policy for the organization, it's almost impossible to say, "Change the policy for this singular doctor."
Another thing that I think doctors often see as immovable, although it's quite movable, is non-competes, also called restrictive covenants. That is the boogeyman. And hospitals will use it to say, "Well, Dr. Tenny, you better not go down the street because you have a non-compete in your contract and we don't want to have to use that." And I can tell you from experience, non-competes are much more akin to air turbulence in an airplane or a speed bump on a road. It wouldn't stop you from getting on a plane or getting in a car, but you would notice it if you drove over it or fly through it. So I often characterize it in that way because it shouldn't be seen as an impediment, understanding though that it is a consideration when you go into a contract negotiation.
Shane Tenny (13:39):
With new attendings, often coming out of training, what part does debt and student loan, those sorts of things play in salary negotiations?
Ethan A. Nkana (13:51):
Huge, huge, huge, huge. I'm going to nerd out a little bit, so bear with me. Most doctors, the overwhelming majority, as we all know, have six figures in student loan debt. That number can range anywhere from 200 to 400. By the time that debt has fully matured and there's interest and it's paid off, that number is closer to 400 to 500,000 for most doctors. So what that means is on average, it's going to take you 13 years to pay that debt back. So that means that for 13 years, you have to delay or defer the lifestyle of a doctor. And so my job is to, one, help you pay that debt down ASAP and secondarily, for the doctor to pay as little of that as possible.
So the way we accomplish that is through three primary strategies. The first strategy is what we call PSLF or public service loan forgiveness. So anytime our doctors, our first-time attendings are interviewing, looking for jobs, one question we always coach them to ask is, is the employer PSLF eligible or are they a 501C3? If you don't know what those are, that is a nonprofit designation, and typically academic institutions and religious-based hospitals or medical centers will fall under that umbrella. What that means is after 10 years of employment and 10 years of on-time payment, you can have your entire balance forgiven. It doesn't mean you have to live in poverty either. So it means you can be employed by a community hospital system, make a salary commensurate with your colleagues, and then after 10 years working there making a good living, have that debt completely forgiven. So, huge value for doctors, again to the tune of six figures.
The second strategy we use is called education loan debt assistance. This is a program whereby the employer will pay money directly towards the physician's medical education loan balance. The lowest amount that I've seen negotiated into one of our doctor's contracts is $45,000 a year on a three-year contract, so that was about 135,000 total. And the highest amount I've seen is about $65,000 a year. So these are not peanuts, and you'll get that money typically for the duration of your employment with that employer. So, extremely valuable for doctors to always ask, "Do you offer education loan debt assistance?" in an interview.
And then lastly, if we encounter an employer who says, "We don't offer education loan debt assistance, we are for-profit, so you're not eligible for PSLF." Cool, well then put that money into my base salary guarantee and I'll pay my debt off as fast as possible. So, you can increase the base salary to say, "Well, option B is offering education loan debt assistance to the tune of 100,000. Would you be willing to consider putting a portion of that into my guarantee so that I can still pay down my debt aggressively?" And I think the key to this, Shane, is that you can use all three strategies in tandem. You don't need to say, "Well, only education loan debt systems or only PSLF," you can use all three, pay that debt down as fast as possible and get to live in a lifestyle you worked so hard for.
Shane Tenny (17:11):
All great points because it also just introduces one of the top concerns of new physicians; their student loan debt and the awareness that in fact can be something that they introduce to the employment contract regardless of whether or not the hospital system offers it first.
Ethan A. Nkana (17:30):
Always, always, always ask for it.
Shane Tenny (17:32):
Yeah. Yeah. So before we take a break, I just maybe wrap up this section of talking about new physicians. What are kind of your top tips? And you already laid one out there, which is look, if nothing else, whether they engage with you, work with a physician advocate or agent, or not, get multiple, even if you don't want to move to Cincinnati or you don't want to move to Houston or you don't want to move there, at least get offers so that you feel empowered. Are there any other top tips that come to your mind to point out to people?
Ethan A. Nkana (18:05):
Absolutely. I do think it's important for first-time attendings to get the salary insights and the salary data for their specialty in the region of the country they will be in, and lastly, for their care setting. So I kind of laid out a couple of caveats there, but the important thing to know is a neurosurgeon is paid very differently in Dayton, Ohio than they are in Palo Alto, California, well, you suggested it, than they are in Houston. And so for doctors who are looking around the country for jobs, it's important to know what the salary ranges are for your specialty in that region of the country, which can vary widely.
Secondarily, the care setting that you're in. Doctors who work in single specialty private practice or multi-specialty private practice tend to make the highest salaries because those physicians have the lowest amount of overhead between the doctor providing care and the insurance provider who's paying the doctor for that care. When you move over to large healthcare systems, which represents where most doctors are employed, that's where you start to see more overhead, executives and directors and people like myself, like the suits who used to think that hospitals existed because of us, that is a cost. And so consequently, doctors who work in large healthcare systems tend to make less than their private practice counterparts just because there's so much more overhead that consumes that reimbursement.
And then lastly, doctors who work in safety net settings, whether that is a community hospital, a county hospital, what's called an FQHC, a federally qualified health center. Those doctors typically, because they're working in typically a vulnerable population of patients and an underserved community, those doctors will typically earn less than doctors in large healthcare systems and who earn less than doctors in private practice. So I think getting the salary data and insights is first and foremost.
A few places that I get data from; Medscape, the one you mentioned earlier, Doximity is a really good one. Physicians Thrive and Merritt Hawkins. For doctors who have the disposable income to afford it, they may also decide that they want to buy salary data insights. SullivanCotter sells salary data insights as well as MGMA, which is a Medical Group Management Association. And MGMA's data, which is probably familiar to your audience, is the industry standard or the gold standard as it relates to doctors' salary insights. Every hospital that I've worked in has used MGMA to establish their physician's salary levels.
Shane Tenny (20:57):
Excellent information. So at the outset I said I wanted to talk about new docs and their negotiation. Right after this quick break, I want to talk a little bit about those that are transitioning to a new location or a new practice structure. So we'll be right back.
Do you understand your personal cash flow? Do you know the combination of your monthly income and monthly expenses? Do you ever think about how much money you made last year and wonder, where did it all go? Understanding where your money goes today is essential to creating an actionable plan to achieve your financial goals for tomorrow. Take control of your finances by downloading the free personal cash flow worksheet. The Prosperous Doc podcast is underwritten by the financial planning firm of Spaugh Dameron Tenny, and you can download this free personal cash flow worksheet at sdtplanning.com, and click on financial resources. Don't let another month of money confusion go by when you have access to free help. Again, the website is sdtplanning.com. Click on financial resources to download the free personal cash flow worksheet.
All right, so Ethan, before the break, we were talking about some of your observations and approach to helping new attending physicians understand the scope of contracts and what's movable and how to approach that. What about for those physicians who've been practicing, they're mid-career, and for one reason or another, they're now finding themselves wanting to or needing to negotiate the salary? What are some of the unique considerations there?
Ethan A. Nkana (22:50):
The doctors who are established attendings have an appreciation for the harsh reality of the business of medicine, and as much education as I do with residents and fellows all over the country helping illuminate some of the pitfalls that doctors often experience, there's something to be said of experiencing it firsthand. When I work with established attendings, I see doctors who have seen the harsh reality of that, the business side of medicine. It's a lot easier for established doctors to get a salary raise. The way that I think about established attendings is, I want you to be paid the absolute most right where you are today. I don't want you to have to leave. And so I think that underpins why 90% of my clients, who are established docs, they stay with their current employer and get a salary raise where they already are.
Here's how we do it. And I think this is a good example for any attending who's listening who wants to do this for themselves. You don't need me. I do this every day, so obviously I could do it at a high level, but these principles are not proprietary. A doctor could take this and do it tomorrow, and I advise them to do that. So we worked with a group of six OBGYN doctors, this is the summer of '21, and the doctors were referred to me by an attorney who said, "My physician clients want to go private practice from employee." And I thought, wow, that's a really major shift from being an employee and having all of your resources and support structure.
And so when I met with the doctors, I asked them, "Well, what is your rationale or what's the reason to go private practice?" And it really boiled down to three primary challenges that they were having relative to the support they needed to run their practice at the level they felt they needed. And so when they hired me, my goal was, one, to help remedy their daily life at work and some of the issues they raised, but also to help them make more money.
These are all women physicians and there are well-documented disparities that women physicians experience. And so when I went into the discussions, I knew that these doctors were vastly underpaid relative to the market and most of their colleagues. When I sat down with their CEO, CEO said exactly what I knew he was going to say, which is, "We cannot pay these doctors a single dollar more or we'll go to jail." I've heard that a thousand times, I've said that a thousand times when I was on that side, and so that's how I know it's a bluff. And so that's when I get to work.
So I went around town and I told hospitals about my amazing physicians. And I pulled all of their stats, I had this amazing strategy built for them. Ultimately, they received three offers to move to a new employer, two of which were more lucrative than what they were making currently, but what ended up happening is they didn't go anywhere. The CEO, who said they couldn't spend any more money, ended up paying them $1 million in additional guarantees on an annual basis, $1 million in additional guarantees and about $300,000 in one-time payment for the doctors to re-sign their unemployment agreements to stay with that employer.
And I share that story because those doctors, when we sat down together initially, they said two things were most important; we want to stay with our current employer and we want to stay together. And I said, "If you trust me to go get you an offer to put some pressure on your current employer, I can make that happen for you." And that's what we did. We got them a new deal with their current employer for seven figures more than what they were already making. And of course, all of those other things that we had discussed were remedied, but the headline is seven figure salary raise in guaranteed money. So that way when they go back to their financial advisors and say, "What do I do with this?" Now they can start to have that money working for them long term.
Shane Tenny (27:14):
Your comment about the CEO saying, "We can't pay them more or we'll go to jail," it's my experience, and I'm curious to have you opine on this, but hospitals love to throw out Stark violation and just, here's this giant quagmire of something that you don't understand, so we're going to mention Stark and hope this whole thing goes away. And I think too often, to the point you just sort of humbly acknowledges, it's a bluff.
Ethan A. Nkana (27:46):
You're spot on. And I think this is a really good time to mention how we differ from attorneys. An attorney is very, very competent in negotiating a physician's contract. And typically what they're going to do is exactly what I just did, which is say, that doesn't violate Stark Law to pay these doctors a reasonable amount based on these established thresholds. But the layer to this that RMPA does that nobody else in the industry is doing is when your employer says, "Nope, we can't do it," that's when we say, "All right, we'll see about that." So we go get you offers.
Whereas an attorney may say, and again, this is their job, right? They may say, "Well, Dr. Smith, we pushed hard. We couldn't get the numbers we wanted, so I suggest maybe you consider these alternate approaches." For us, we say, "That when according to plan." They said no, that's when we get to work. That's when we go around town and demonstrate how valuable those physicians are to the market. And that's the piece that hospital executives are counting on doctors not doing is saying, "Hey, I can't get paid more, so I guess I'm up the creek without a paddle." Nope, you have options. We show you how to leverage the value that doctors have.
Shane Tenny (29:11):
Before the break you were mentioning resources to provide insight into competitive physician compensation around the country by specialty, things like that. In your story about the group of OBGYNs, you mentioned and referenced kind of in passing just that the well-documented disparity between compensation for female physicians versus their male counterparts, or for people of color versus their white counterparts. Do you get involved in those type of scenarios as well? Or is that a type of review and negotiation that is better had by a practicing attorney?
Ethan A. Nkana (29:51):
When I started the business, my mother, who's a physician, told me, "Ethan, you need to pay special attention to women physicians." And I said, "Well, what do you mean by that?" She said, "Women physicians experience challenges in the workplace that men don't." I don't know that I fully bought it, Shane, if I'm being honest, but it took about 10 minutes of research to figure out that she was exactly right. There are really discouraging documented disparities between women and men physicians to the tune of 15% to 25%. So for general practice doctors, the gap is between $30,000 and $50,000. For specialists, surgeons, interventional cardiologists, that number can get up to about $100,000. So it's significant.
I wrote an article for Medical Economics just last week about the disparity that black physicians experience, which compared to white physicians, it's about $50,000 a year. So over the course of a 30-year career, which many physicians have, that's about a $1.2 million in lost wealth. And as uncomfortable as it is to talk about those disparities, I think it's so important to be aware, not to blame anybody or point fingers, but to say, you must know the rules of the game in which you're engaging.
And so for those physicians, those six women, and I will say the overwhelming majority of my clients are women, over 80% of my clients are women, and for those physicians, the disparities and the gap between what they should have been paid and what they were paid was so wide, it was almost criminal. And I know that a doctor who's making $300,000, nobody's crying tears for them or $400,000 or $500,000, I get that. But when you compare that to what their counterparts are making for the exact same work, it's really hard to reconcile that.
Shane Tenny (31:58):
Do you have a guess as to why the majority of people who are engaging you are female instead of male physicians?
Ethan A. Nkana (32:08):
The women physicians that I work with are some of the most impressive people I've ever encountered, and specifically one, I had one moment, this is my first six months on the job, and I was on a call with one of those OBGYNs, I was on a call and we were chatting about some things that she wanted me to keep an eye out for in the contract. And in the middle of the call she said, "Hey, hold on. I have to go deliver a patient. I'll call you back." She calls me back 45 minutes later and I said, "Did you mean you went to go deliver a baby?" She got off the call, delivered a baby, and then called me back as if she went to go have lunch. And the fact that that is just something that didn't even register to her as significant, just part of her day really put into perspective what I get to do on a daily basis because they trust me to advocate for their significant financial interests.
So, really long-winded way around, I feel as though women physicians, at least when it comes to the business, are more willing to ask questions.
Shane Tenny (33:20):
Talk a little bit about your business, RMPA, Rocky Mountain Physician Agency. I want to ask the question, I'm sure there is one of our listeners thinking, and that is, do you only work with docs in the Rocky Mountains?
Ethan A. Nkana (33:33):
We work with doctors nationwide. So the Rocky Mountain comes from where we are founded, which is in Denver, Colorado, in the Rocky Mountain region, but we work with doctors from coast to coast. A big part of our effort is on education. And so we've been fortunate to visit with University of Michigan, Yale, University of Colorado, and many, many, Johns Hopkins among others, to be able to educate those physician trainees on what to expect in their first contract.
And for the doctors who are established attendings, we negotiate deals from coast to coast, and we're really fortunate to be, I've worked in hospitals in California and Ohio and all over the country, and so my knowledge of how to navigate the decision makers and the industry is frankly unparalleled. And so it makes it easy for me to get my doctors into positions where they can be successful because I know exactly how the machine runs.
Shane Tenny (34:39):
Gotcha. And while I highlighted in the intro, your law degree, you're not practicing law in all 50 states, you're acting as a physician advocate.
Ethan A. Nkana (34:49):
That is correct.
Shane Tenny (34:50):
Ethan A. Nkana (34:50):
So we do a lot of referrals to attorneys. Of course, we have an attorney on retainer in Colorado for any local issues that we experience, but anytime a doctor says, "Ethan, I'm experiencing an issue where I might need to sue my employer or I'm being sued by my employer," or if a doctor says, "I just want someone to get eyes on this and make sure that Ts are crossed and Is are dotted," that's where we refer to attorneys because that's a little bit outside of our skillset. Our skillset, one, if you're going to go to court or there's a risk of going to court, you need an attorney, but our skillset is purely on helping you make more money. So if your employer's not going to do it, we're going to get you to a place that will, and that's a little bit different from the offering that attorneys provide.
Shane Tenny (35:42):
The other thing that I just want to take a minute and highlight before we end is, to piggyback off of the point you made about education, and so for the physicians out there that are wrapping up their training, that are in that category that we highlighted at the top of the show as new attendings, and thinking, "I never thought about, I didn't know there was an agent for physicians, but now I want one, but I'm just coming out of residency or fellowship, how do I pay Ethan?"
Ethan A. Nkana (36:15):
I'm glad you asked that. I worked with a doctor a few months ago who I think is the prototype for how painless working with us is when it comes to how much it costs. So I will say the most burdensome part is there is a retainer. We have a retainer of $1,995 up front, which the doctor gets back. The reason we have a retainer is so that we both have some skin in the game. We are working on your behalf and that you've provided some financial consideration so that we're both on the same team and motivated for the same goal.
The way we get paid is only on performance. If we do not win, we do not get paid. In this context, what that means is when a doctor signs a deal, our fee is a percentage of your base salary. The reason I say the retainer is the most burdensome part of our fee is because the hospital pays the balance of our fee. So while we work for the doctor, our fee is negotiated into the physician's contract through a signing bonus or for established physicians through a retention bonus. So I'll just give you two quick examples.
We have a first-time attending physician who signed a deal just about three weeks ago, and our fee is 10% of her $200,000 base salary, and in her contract, we negotiated a $30,000 signing bonus. So that way she gets paid $30,000 from the hospital and then chops off a portion of that to pay RMPA's fee, which is 20,000 minus the retainer.
For the established attendings, it's even more seamless. For those six positions we were just talking about, those doctors ended up making, on average, about $180,000 more annually each. So the way we got paid is we negotiated our fee into the doctor's contract through a retention bonus. So when each doctor signed their contract, they each got $40,000 and then they use less than half of that to pay RMPA's fee. So we don't want you to have to worry about, how much is this going to cost? How many hours are we billing? That doesn't apply to us. Only way we get paid is on performing, and that's by making doctors more money. And then you don't have to worry about paying us because we negotiate our fee into your contract.
Shane Tenny (38:42):
Best part of the whole thing, almost like being a buyer's agent in a real estate transaction.
Ethan A. Nkana (38:47):
Exactly. I use that example all the time.
Shane Tenny (38:51):
Excellent. How can someone get in touch with you?
Ethan A. Nkana (38:54):
The best way to get in touch with us is on our socials. On IG, on Instagram, we are physicianagency, and then on our LinkedIn, it's just my first and last name, Ethan Nkana. We often share tips on a daily basis for how doctors can be successful in contract negotiations. And we also, again, we love to educate financial advisors as well. We know the limitations of our skillset, and so we want to spread the word to folks like you who are trusted advisors of doctors on how you all can help doctors from your positions of trust.
Shane Tenny (39:27):
Ethan, as we wrap up, one of the questions that I forgot to tell you as we were preparing for this, so get ready for quick thinking, but I realize that all of us have come so far because of what others have poured into us, because of what you've learned or been taught or been encouraged by somebody else, either professionally or personally. And I just like to, since you've been gracious enough to give your time and come on The Prosperous Doc podcast, I wanted to give you a couple minutes here at the end, if there's somebody that comes to mind that you'd like to shout out as being just significant in RMPA and what you're doing to help the medical community.
Ethan A. Nkana (40:07):
That is so cool. I didn't anticipate this, but I love it. There are two people who come to mind when I think of this journey of RMPA and what it's become. It doesn't mean that it's only two people who have helped me, there's been many, many people who have supported me along the way, including you, Shane, and your firm. These two people stand out to me because of the time commitment that they put in when I started the business.
The first is my mom and her indoctrination, as it were, started when I was in high school. And she told me, "Ethan, get a job in hospitals and you'll always have a job." And that's where I started my career. I started my career as an HR intern in a hospital. I didn't even know there was a business side to hospitals. And then now here we are 15 years later and that's the only thing I've ever done. And acutely prepared me for the work that I do today.
The second person that comes to mind is a physician friend of my mom's, who's also a physician friend of mine, Dr. Mark McKenzie. The headline for Dr. McKenzie is him working on developing the COVID vaccine. But on a personal level, when I started the business, I asked him to be a strategic advisor for me. And what that meant is he met with me every week for almost a year and he was my physician voice. And when I said, "Well, how do physicians think about asking for a raise? Or how do doctors think about debt?" He was the one who helped give me a lens into the physician mind and how they process things.
And so when I think about what this has become and the sea of people who have helped me and supported me and encouraged me in a variety of ways, those are the two that I would be ashamed if I didn't mention.
Shane Tenny (42:11):
Well then, special shout out to Dr. Mark McKenzie and mom.
Ethan A. Nkana (42:16):
Just mom. Just my mom.
Shane Tenny (42:19):
Thanks so much for giving us part of your day today and sharing your insights and wisdom. Will, as I mentioned before, include in the show notes, links to some of your social channels. And thanks, as always, to you who are listening, because without you, neither Ethan nor I would be here to bring you this conversation. We welcome your reviews and comments wherever you download the podcast. And as always, if you have suggestions for guests, conversations you'd like to hear, please feel free to email me directly, email@example.com. Thanks. We'll see you back here next time.
This episode of The Prosperous Doc podcast is over, but you're not alone on your journey. Spaugh Dameron Tenny has been helping physicians and dentists prosper through financial planning for over 60 years. To connect with us, visit sdtplanning.com today and take your financial wellness to new levels. Join us on the next episode of The Prosperous Doc podcast.