Income Guarantees as Compensation for Doctors

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Question: What Is an Income Guarantee? How Does an Income Guarantee Work?

I am a physician finishing up my residency and currently starting my search for new practice opportunities. Several hospitals have described an "income guarantee" as being the core component of their compensation plan. How does an income guarantee work? Is it the same thing as receiving a base salary?

An Income Guarantee is Not a Salary

An income guarantee is a way for hospitals to attract physicians to their community to practice in the hospital's service area.

An income guarantee is not a salary! An income guarantee is more like a loan, or an advance, that is forgiven over time, to help a physician get started in his or her own private practice.

As a recipient of an income guarantee plan, you are not an employee of the hospital, but you may have to meet a few key requirements. The terms of an income guarantee allow you to build your practice the way you want to build it, as long as you become self-sufficient by the end of the guarantee allowance period, which is usually 12 months, or 18 months at the most, depending on your medical specialty.

The income guarantee amount is set ahead of time. For example, you may be offered a guarantee of $20,000 per month. If your income guarantee were set at $20,000, you would receive a check each month for an amount equal to the difference between $20,000 and the amount you collected that month. At the end of the 12 months, if that is the guarantee period, you would neither accrue any further debt or have to pay anything back, as long as you remain in the community practicing medicine.

An average forgiveness period is about three years after the end of the guarantee period.

Two Types of Guarantees

There are two types of income guarantees: a net income guarantee, and a gross income guarantee. A net income guarantee covers your salary only. Your overhead expenses would be expensed, approved, and reimbursed as a separate entity.

A gross income guarantee would include your salary and overhead expenses all in one flat monthly guaranteed rate. If you run your practice lean, and have money left over from the expense budget, you would get to keep that extra money that was saved.

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