What’s your ideal solution - if you could have changed the model of your former place. Clearly there are admin jobs in any dept that has to be done by someone. More of these in some settings than others, but not at all exclusive to academics.
How do you design a compensation model that accounts for that?
Yea, so this is all just my opinion and I've never been a chair. I also think that there are so many local factors that it's unlikely there is one solution for departments across the country. The problem is also very broad. If you talk about admins, I suspect my authorization admin needs are very low compared to some departments because I work in a friendly payer environment (I do very few P2P).
I was really just talking about physician compensation in an academic department that is expected to generate a lot of clinical revenue. I suspect that in some places Ortho and Radiology and other fields have similar problems.
My ideal solution there is for departments to be much more transparent and intentional about priorities and pay. Assume a department is going to hire an academic clinical rad onc that will carry 10K RVU. This person could be paid national non-academic median and generate enough money to cover their own salary plus have some left over. Its just that its not enough to cover the chair making 800K, the lab RO being paid a clinical salary but while grant pay is capped at half that, the "deans tax", etc.
If you ever want to make a lab RO
really mad, just float the idea that these individuals should be paid as researchers not clinicians, consistent with the NCI salary cap.
The SCAROP data really drives home the size of the financial burden of these non-clinical physicians. There is a single graph in there (clinical pay versus RVUs, its flat) that is so damning I am not at all surprised they continue to illegally conduct and conceal this survey.
I do think some of these folks provide value to our society and medical system that outweighs their financial burden, but honestly I think they are relatively few in Rad Onc. It also doesn't matter as we could wax philosophical about what pay SHOULD be, but the facts are the facts. There is a clinical RO somewhere doing 15K RVU for 300K so that their partner RO can do 5000 RVU and publish database research on inclusion and make the same salary "so its fair".
Except thats not fair at all. I talk to soooo many junior faculty that are 12-24 months out, waking up to these realities, and searching to leave academics.
If people were transparent about their priorities an pay, the market would put some pressure on the "high burden" academic departments. The one I worked in, the amount of money that went to non-clinical doctors was incredibly high.
In my new gig, we just have way less of these people and pay is transparent and perceived as fair (of course, given the caveats of "fair pay" in Rad Onc). Also, the non-clinical time more directly impacts the clinic. I am paid 1 day a week to do non-clinical stuff for my network and a lot of it is making the work of our other doctors more efficient or "valuable".
@MidwestRadOnc has a good idea, but I think we are so far away from employee owned hospitals today! THAT would be awesome.
