The 7-Figure Urologist: Origin Story

Last summer, an enterprising urologist reached out to me with an interesting story to share, and he offered to write up his story for me to share.

I often quote or paraphrase Henry Ford’s saying: “Whether you believe you can do a thing or not, you are right.”

And as my Dad says, “If you don’t ask, you don’t get.”

Today’s guest author believes he can and he’s not afraid to ask. Five years into his career, he’s worked his way up to a million-dollar-plus annual income. Today, he shares his origin story and how he arrived at this lofty annual income.

He has shared his identity with me, but prefers to remain anonymous on this public post.

The 7-Figure Urologist: Origin Story

 

My story begins in the rust belt during the blizzard of 1978. I was the fifth child born to second generation American parents in their late forties. I ended up losing my father to suicide when I was 11 years old and my mother to health issues when I was 13.

My father worked on the railroad and my mother never worked outside the home. I was 13-year old orphan plunged into the world with an inheritance of $8,000 dollars. My older sister became my guardian but needless to say I was as much of an adult by 13 as I am today at 41.

While not having parental guidance, I was blessed with intellect and a ferocious work ethic. I did carry financial scars with me after this ordeal as my mother and I lost all income when my father passed. We eventually were able to receive a modest railroad pension which is roughly equivalent to social security but times remained tough before and after my mother passed.

 

7 figure urologist

An Entrepreneurial Mindset

 

Fast forward: I ended up attending a prestigious undergrad institution and then on to medical school. I always thought that Doctors were financial titans and a substantial portion of their financial prowess came from owning their practices.

I went into medicine expecting to be a small business owner after training. I did well during medical school and choose Urology as a specialty. I chose Urology not only for the work but also found the business end of the specialty to be appealing.

It was after choosing Urology that I made a few realizations. First, the age of the solo Doc owning his own practice was quickly becoming extinct. Second, my professional aspirations still included business ownership.

It was during my intern year when a rural hospital about an hour from my training expressed interest in having me practice there after training. I had rotated there during my medical school OB/GYN clerkship.

I quickly dismissed this idea but after considering my family, which started during my 4th year of med school with my first child, I began to think that this could be the place for me. After all, this position was about 15 miles from my mother-in-law, which is where we all end up anyway.

I had an exceptional time negotiating my contract. I used websites, blog sites, and personal conversations to develop my package. It was very early in my training which allowed me a lot of wiggle room. I signed a deal to practice there after residency.

I was able to negotiate a $50,000 signing bonus, $25,000 per year stipend during residency, and $125,000 of student loan repayment. My deal was to start a solo private practice where I would be guaranteed the 50th percentile salary and full practice support.

This period would last for 2 years and then I would need to stay for an additional 4 years, which ends in August of 2019. After negotiating this deal, I became known as an “expert negotiator” and have helped several colleagues in several areas of medicine navigate the contracting process.

 

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Business Cards

Starting Clinical Practice

 

I started into private solo practice right out of residency. I hired an office manager and full complement of staff including an advanced practice provider (APP). I was able to build out my office during residency have the hospital rent it from me prior to graduation for the retiring urologist to practice.

Private practice is tough; private solo practice right out of residency is as tough as it gets. At the end of my two years of practice and income guarantee, I had to decide whether to remain in private practice or become employed.

I used several accountants, other physicians, and hospital administrators in my analysis of the two roads. After two years of private practice, I sold my practice and became hospital employed.

I had some colleagues who looked up to me in the private practice world very disappointed in my “selling out” and going against everything that I preached. These same folks were also very anxious to hear the details and learn more of how I came to this conclusion.

For my employment recipe, I needed to understand RVU’s that were, up until now, a mythical beast to me. My mantra was always “how do you spend an RVU?” and never really took the time to understand RVU’s.

It was during my second year of my income guarantee that I had heard some of the dollar per RVU numbers that my colleagues were getting. I then converted my practice into RVU counts. I did the math and was blown away.

I went to the negotiating table, where I am very comfortable, and I was able to negotiate a better rate than my colleagues and a few other perks. I was able to have the hospital lease my office for me to work in, effectively becoming the landlord netting about $30,000 per year.

I was able to maintain two additional Urology positions outside of the health system. I was able to keep my surgery center and lithotripsy ownership. I was also able to create a unique financial relationship with my APP that has recently been adopted by the entire 45+ hospital system.

 

Multiple Income Streams

 

Current situation: I have been hospital employed for three years now and am happy. I am able to make about $700,000 in my main employed position. I make about $150,000 per year working in a second hospital system on Fridays; I average about 2-3 per month and cover consults.

I also take one weekend of call per month at the hospital where I live and make an additional $50,000 per year doing that.

My ancillary income reaches about $250,000 per year between building, surgery center, and lithotripsy. My wife is a Dentist and makes about $250,000 per year working three days per week.

We make between $1.3 to $1.5 million per year in household income. This high stable income and my Midwestern residence have afforded me the ability to enter the side hustle game and satisfy my want of business ownership.

I literally closed my first non-medical side hustle on the same day that I became employed.

 

Related: He Earns $1,800,000 a year. He spends $70,000. Holy Stealth Wealth!*
*not the same physician, by the way

 

Physician on FIRE, thank you for sharing a part of my journey. I will be sharing further posts on medical side hustles, non-medical side hustles, personal finance, tax strategy, and potentially how to maximize an APP in practice.

 


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What else would you like to hear about from the 7-figure urologist? Have you negotiated well for yourself? Let us know in the comment box below!

16 comments

  • I’d love to learn what books or resources he used to study negotiation tactics.

    Very impressive story, although how you resisted titling it something like, “Goodness Gracious Great Balls Of FIRE” speaks to your better angels, PoF.

    Fondly,

    CD

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  • Agree with Crispy Doc. Tell me more about these masterful negotiation skills.

    Incredible work, and an impressive story.

    TPP

  • That is remarkable of being so financially savvy with the negotiation skills you possess while still in residency. Most docs never get to that level and know their true worth even decades out of practice.

    I certainly did not bring much negotiation skills to the table and just went with what was offered. This is part of the lack of financial training that docs are subjected to throughout their education. Basic finance and negotiation should be a mandatory course in med school or residency.

    Congratulations on creating a very impressive business resume early on. The fact that you negotiated the hospital to rent out your building for you to practice is such a win-win situation for you.

    • AnonRad

      I’ve always felt handicapped in my negotiations or lack thereof when it came to contracts. Being in radiology as well and come out at one of the most difficult times (2012-2013) when the market was very depressed. Friends who tried to negotiate contract terms, let alone salary, where just having there offers pulled. It was very much a take or leave it market for newly minted rads.

      I’ve always felt that the one part on the keys to negotiation is being able to walk away if needed. Feel like this example would be useful to those in surgical specialities. Specialties who bring patients to a facility.

      In radiology, we have become commoditized and we are easily replaceable with a click of a button.

  • ReFinDoc

    Maybe you could give a presentation on contract negotiation at the WCI conference next year.

  • Zac

    I’m in awe of what you have accomplished!

  • Amazing story. Thanks for sharing. Great job working your way up to this level.

  • LizOB

    The RVU system is VERY friendly to urologists. Unfortunately there is significant gender discrepancy when it comes to procedures on male vs female patients. For example, biopsy of a scrotum is worth 5.72 wRVUs whereas a vulvar biopsy is worth 1.1 wRVU. Biopsy of the prostate is 4.61 wRVUs, biopsy of the endometrium is 1.53 wRVU. And don’t get me started on how little CMS values my time when it comes to managing labor patients.
    Congratulations on your success, however it is unlikely to be translated to other specialties nearly as well.

  • Ether to FI

    My mind is blown. I read a lot of articles on PoF, but this was my favorite. It motivates me to work smarter because you are absolutely crushing the game. Well done.

  • Interesting perspective on how leaving private practice to work for the hospital was actually more lucrative and I would imagine far less burdensome on the business side. I have worked in startups for quite some time and done pretty well, however, I know a couple of long term corporate friends who get very lucrative benefits in addition to nice big salaries and have carved out low stress roles over time. I think the lesson is that it can seem like the shiny prize to want to start your own practice and eventually get a few younger physicians working under you so you have some great financial stream or starting the next big startup and exit big. However, perhaps sometimes with work as with investing, the less flashy path carefully taken can yield great steady returns that get you to your goal better than the alternative

  • Oceanmaster

    Excellent job! You should definitely be proud of taking the bull by the horns and cultivating a practice setting that works for you.

    I realize this is the “origin story”, so just more of an overview. Maybe a follow up article or two on actionable items? Setting up a successful APP? Keys to negotiation? Anything besides go back and do urology (or maybe 3 day a week dentistry)…

  • Kristi

    I would love to hear more about the unique financial arrangement with APPs.

  • Stephen

    Love the story! I’m a new FP grad in a city that’s saturated. My contract is $225K guaranteed for two years with a 20K sign on bonus for 36 patient contact hours per week, after which I’ll be production. I started moonlighting in rural sites as a resident. I also just started moonlighting at the VA for a total of 180-220K in side gig income per year. My clinic shares space with an urgent care. In clinic I try to focus on in-office procedures as well as moving complicated urgent care patients to my schedule that are more than they’re comfortable with, but not quite sick enough for the ER.

    I’m branching into aesthetic procedures, which is new for my clinic. I’d love to hear more about negotiating and how to best utilize APPs. Thanks!

  • Brandon

    How did your employment contract address your ability to practice outside the system? Many employment agreements I have seen prohibit moonlighting.

  • GU in the SE

    Wow! I’m also a practicing urologist 95th percentile of RVU production (12K RVU per yer). As a sole urologist, how do you have the time to also have a second practice on Fridays at another hospital?

    Also, doesn’t “fair market value” limit the amount a hospital pays you for your service?

    Further, if you have partial ownership of an ambulatory surgery center, do the procedures you perform there count as production for your hospital employment?

    As a sole urologist in your community, what types of procedures do you perform? Nephrectomy, robotic prostatectomy, etc? Or mainly stones/outpatient procedures?

    My situation is as follows:

    Hospital employment: 335K/year at 40% percentile RVU production (6000 RVU per year);
    Lithotripsy owner: 85k/year

    Someone please tell me if I’m getting screwed!

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