Advice needed: Time to leave or stick it out?

[HoustonDreaming]

I'd really appreciate some advice, especially from some of the more experienced members of the board, regarding my current employment situation: I'm currently a hospital-employed physician in TX in a group with more than a dozen other MDs. We operate in a high-stress but highly-specialized area that the hospital relies on for its overall revenue stream, but that requires subsidy for our specific group to support salaries (high amount of Medicare, etc). Over the last few months the group has been attempting to have civil conversations with our hospital employer to renegotiate individual contracts that are at the end of their five-year term. These contracts expired Dec 31st with no meaningful response from the hospital besides telling us that the terms would be honored indefinitely until they were "ready" to renegotiate. Now several months later, and still without any real discussions, the overall coverage agreement has expired between the hospital and our group (this contract provides for our exclusive coverage of services within the hospital). Again, the hospital has been very nonchalant about the contract lapse, stating that coverage defaults to us under same terms until a new contract is in place.

My specific situation is slightly different than the rest of the group's, in that I still have 2 years on my contract until expiry. In addition, due to some bad 'gut feeling' about the way we were being handled by hospital administration, I have been circulating my resume since last October with at least a couple good leads. However, I feel I'm now at a crossroads where I need to make the choice to either 'stick it out' with the current group and possibly go down with the ship (but best-case I would get to keep seeing the types of patients I love with partners I trust), or move forward with my other leads (worst-case same problems at new place after having to move).

To complicate things, my wife landed what she considers a 'dream job' about 2 months ago, and a move would force her to have to change industries altogether. We don't rely on her salary but she gets great joy in her job and is a rising star in the company. For those that have been faced with similar situations, especially in medicine, is it worth it to jump ship and start over somewhere where you are considered a valuable asset to the hospital? Or is it generally better to 'stick it out' and see what happens since we are comfortable where we live and with the wife's career. I know no one here has a crystal ball, but I'm interested in hearing perspectives.

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[pjl]

With a new job comes risk of the same or worse. If you feel the comp is adequate for the work you do, you have less to worry about than the rest. Keep the contacts and have money saved if you were to be replaced, which is unlikely. More likely you would be told you have new management if you are going to stay.
Get your partners to sort the issue over the next year, so when it is your turn it is solved.


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[deleted171991]

Happy wife, happy life. End of story. If you are not happy with your current job, find another in the area. I would definitely not move, unless I have no choice.

 

[IlDestriero]

This sounds like what happened to one of my relatives in radiology in a stable group for >20 years with the hospital. They failed to renew the contract as was allowed 2/2 the hospital supposedly having financial problems. The contract went into 6 month auto renewal. They told them that they were going to renew, no problem, renegotiated a couple minor issues, then 14 days before the contract was going to auto renew again, and while they were saying a new 3 or 5 year contract was imminent, they were told they contracted to a new group that was expanding into that city. They were just deliberately stringing them along while they were negotiating with the new group. Then bam! All out of work with 2 weeks notice.
I'd be a little worried about that going on.


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Il Destriero

 

[HoustonDreaming]

This sounds like what happened to one of my relatives in radiology in a stable group for >20 years with the hospital. They failed to renew the contract as was allowed 2/2 the hospital supposedly having financial problems. The contract went into 6 month auto renewal. They told them that they were going to renew, no problem, renegotiated a couple minor issues, then 14 days before the contract was going to auto renew again, and while they were saying a new 3 or 5 year contract was imminent, they were told they contracted to a new group that was expanding into that city. They were just deliberately stringing them along while they were negotiating with the new group. Then bam! All out of work with 2 weeks notice.
I'd be a little worried about that going on.


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Il Destriero

Thanks for the replies -- that's exactly what I'm trying to avoid. I obviously want to stay in the area, but the other options are either large-private-equity-controlled group, grossly under-compensated, or unhealthy work environment. Remember, we are currently working under an expired coverage agreement (between hospital and group practice plan) and expired individual contracts (between group practice plan and each MD). If I'm simply over-reacting and making more out of this situation than actually exists, then fine, I'll hold on and see what happens (that's actually easiest anyways). But, I don't want to look in hindsight when we've been given official notice of losing the coverage agreement and regret the chance I had to separate unhurriedly. Not to mention, searching for jobs alongside my out-of-work and vastly-experienced partners would be infinitely more challenging.

 

[Noyac]

I agree with FFP here.
But one question I have is, if your employer decides to go with a different group at some point before the new contract what sort of notification do they need to give 30 day, 90 day, or 1 day? That may be the insecurity I would have y not having a contract. If they are just carrying over the previous contract then I would hope this part would carry over as well. But I would verify this.
As a point of reference, this sort of thing went on at my facility as well. It didn't involve my group but others were involved and admin just carried the old contract over until they could convince corporate that they needed to change some things. So in other words, my admin actually wouldn't go through with a new contract until they could get one that benefitted the group they were dealing with. It wasn't to screw them. Don't think all delays are necessarily bad. But be cautious.

Oops just saw iL's post. I guess we are saying the same thing.

 

[HoustonDreaming]

I agree with FFP here.
But one question I have is, if your employer decides to go with a different group at some point before the new contract what sort of notification do they need to give 30 day, 90 day, or 1 day? That may be the insecurity I would have y not having a contract. If they are just carrying over the previous contract then I would hope this part would carry over as well. But I would verify this.
As a point of reference, this sort of thing went on at my facility as well. It didn't involve my group but others were involved and admin just carried the old contract over until they could convince corporate that they needed to change some things. So in other words, my admin actually wouldn't go through with a new contract until they could get one that benefitted the group they were dealing with. It wasn't to screw them. Don't think all delays are necessarily bad. But be cautious.

Oops just saw iL's post. I guess we are saying the same thing.

Believe me, the wife's happiness is paramount to me -- but she will also be more-than-a-little miffed should I be terminated and we lose my income while searching and/or end up moving anyways To answer your question: Individual contracts specified 90 days, but there is no requirement within the coverage agreement. In other words, if hospital decides to employ the local mega-group it could enact a coverage agreement almost immediately. Individual contract terms would then be nullified since the existing practice plan is not the contracted service provider and thus we individuals cannot fulfill contracted clinical responsibilities. Not to mention TX is an at-will employment state and we are operating under no actual current contract (just a good-will extension of terms), so that's also worrisome.

 

[Ignatius J]

Believe me, the wife's happiness is paramount to me -- but she will also be more-than-a-little miffed should I be terminated and we lose my income while searching and/or end up moving anyways To answer your question: Individual contracts specified 90 days, but there is no requirement within the coverage agreement. In other words, if hospital decides to employ the local mega-group it could enact a coverage agreement almost immediately. Individual contract terms would then be nullified since the existing practice plan is not the contracted service provider and thus we individuals cannot fulfill contracted clinical responsibilities. Not to mention TX is an at-will employment state and we are operating under no actual current contract (just a good-will extension of terms), so that's also worrisome.

What does your wife do?

 

[deleted50478]

Believe me, the wife's happiness is paramount to me -- but she will also be more-than-a-little miffed should I be terminated and we lose my income while searching and/or end up moving anyways To answer your question: Individual contracts specified 90 days, but there is no requirement within the coverage agreement. In other words, if hospital decides to employ the local mega-group it could enact a coverage agreement almost immediately. Individual contract terms would then be nullified since the existing practice plan is not the contracted service provider and thus we individuals cannot fulfill contracted clinical responsibilities. Not to mention TX is an at-will employment state and we are operating under no actual current contract (just a good-will extension of terms), so that's also worrisome.

I hate to say it but you should probably join the megagroup now if they'll let you be partners. Better to bring something to the table than to go to them hat in hand when they take over your site.
It might not work out since your lack of a contract makes it where you are not bringing much to the table, but might be worth a shot. The downside would be putting your hospital on their radar as a site ripe for takeover.
The hospital is probably going to screw you anyway, so what do you have to lose?

 

[GravelRider]

So you have an employment contract with the hospital for 2 years? Doesn't that give you a margin of safety for 2 years? I suppose they could terminate you without cause, but your partners are in a worse position than you. Are any of your partners also sniffing around for job offers?

 

[dmk5n]

FWIW, stick it out for however long you can...but don't ever trust the suits. They have zero ethics. Shore up the CV and browse gasworks just in case. Texas has tons of locums if in a bind...

 

[Man o War]

This exact scenario happened in my old group. Hospital kept delaying and we went on automatic extensions. I followed my gut and got out of there. 6 months later they ousted my old group. Turns out they were shopping around that entire time. Always follow your gut. If it feels like they're getting ready to screw you, get out.

 

[HoustonDreaming]

So you have an employment contract with the hospital for 2 years? Doesn't that give you a margin of safety for 2 years? I suppose they could terminate you without cause, but your partners are in a worse position than you. Are any of your partners also sniffing around for job offers?

No not exactly. There are two levels of contracts. The first is the coverage agreement between the hospital and the practice plan (essentially a business entity with several hospital suits on the board so that the hospital does not directly employ us physicians), the second is the contract with each individual MD and the practice plan. The coverage agreement and most of the individual contracts have expired. My individual contract has 2 more years, but won't matter if the practice plan doesn't continue to hold the coverage agreement for anesthesia services.

 

[BLADEMDA]

No not exactly. There are two levels of contracts. The first is the coverage agreement between the hospital and the practice plan (essentially a business entity with several hospital suits on the board so that the hospital does not directly employ us physicians), the second is the contract with each individual MD and the practice plan. The coverage agreement and most of the individual contracts have expired. My individual contract has 2 more years, but won't matter if the practice plan doesn't continue to hold the coverage agreement for anesthesia services.

Would you work for USAP if push came to shove? That is, would you consider employment with them for 12 months if needed to give you time to find a new job? My hunch is your hospital is already looking for a cheaper alternative group like USAP, Sheridan/Amsurg, Mednax, Northstar, etc to replace you.

 

[leaverus]

any job in which you're not 100% the boss is never a "dream job"

 

[GravelRider]

any job in which you're not 100% the boss is never a "dream job"

A truer statement has never been uttered.

 

[anes121508]

Would you work for USAP if push came to shove? That is, would you consider employment with them for 12 months if needed to give you time to find a new job? My hunch is your hospital is already looking for a cheaper alternative group like USAP, Sheridan/Amsurg, Mednax, Northstar, etc to replace you.

Seems like just about everywhere has some risk built in?

Is USAP any different than Northstar,Sheridan and the others?

 

[urge]

I'd really appreciate some advice, especially from some of the more experienced members of the board, regarding my current employment situation: I'm currently a hospital-employed physician in TX in a group with more than a dozen other MDs. We operate in a high-stress but highly-specialized area that the hospital relies on for its overall revenue stream, but that requires subsidy for our specific group to support salaries (high amount of Medicare, etc). Over the last few months the group has been attempting to have civil conversations with our hospital employer to renegotiate individual contracts that are at the end of their five-year term. These contracts expired Dec 31st with no meaningful response from the hospital besides telling us that the terms would be honored indefinitely until they were "ready" to renegotiate. Now several months later, and still without any real discussions, the overall coverage agreement has expired between the hospital and our group (this contract provides for our exclusive coverage of services within the hospital). Again, the hospital has been very nonchalant about the contract lapse, stating that coverage defaults to us under same terms until a new contract is in place.

My specific situation is slightly different than the rest of the group's, in that I still have 2 years on my contract until expiry. In addition, due to some bad 'gut feeling' about the way we were being handled by hospital administration, I have been circulating my resume since last October with at least a couple good leads. However, I feel I'm now at a crossroads where I need to make the choice to either 'stick it out' with the current group and possibly go down with the ship (but best-case I would get to keep seeing the types of patients I love with partners I trust), or move forward with my other leads (worst-case same problems at new place after having to move).

To complicate things, my wife landed what she considers a 'dream job' about 2 months ago, and a move would force her to have to change industries altogether. We don't rely on her salary but she gets great joy in her job and is a rising star in the company. For those that have been faced with similar situations, especially in medicine, is it worth it to jump ship and start over somewhere where you are considered a valuable asset to the hospital? Or is it generally better to 'stick it out' and see what happens since we are comfortable where we live and with the wife's career. I know no one here has a crystal ball, but I'm interested in hearing perspectives.

I would stay out of consideration for the wife. If the day comes when they send you walking I would take a month off and do locums while you look around.

 

[Pharmado]

Unless you met your wife after residency, she's likely sacrificed a lot to get you to the position that you are in. She deserves the chance to pursue her dream job too. You run risks in staying, but leaving guarantees you cost your wife an opportunity she may never have again. If your wife hadn't found this new job it would be much easier to move on. Trim the fat, save money, prepare for the worst and position yourself as best you can for the future. Perhaps even contact locum groups in the area to see what is available if you are really worried. Remember too that someone has to staff the hospital that you are at. If the hospital turns to a mega-group somewhere, there's always the possibility that you can join that group and stay where you are at, at least until you find something better.

 

[aneftp]

Ok. This is the deal when you are in a "hospital employed situation".

It's called "strength in numbers". The hospital admin don't give a rats about you guys. That's the truth. The only thing they give a rat is about their revenue. Saying this. If there are 12 of you. The critical number is probably 6-7. That means if 6 of you guys join in unison and threaten to walk. Hospital cannot replace that quickly. And I mean do it quickly. What's your out clause? You say u have 2 years left. But if you are on a month to month thing. Than you guys can walk within 30 days?

My sister up North is in hospital employed similar contract situation like u guys. Well 11 of the 35 or so MD threaten to walk after months of the same dealings as u. And 7 of them already had prelim deals with local area hospitals lined up. The threat as to be real here. None of this huff and puff.

Hospital management caught wind of this. Held emergency meeting with entire dept and restructure their contracts. Essentially $50k more for most people. They had been stuck around $350-375k for 5 years. Now most will make $400-450k plus generous hospital benefits.

Now if your collegues don't want to do the strength in numbers. I suggest you secure another job first. Don't quit a job unless it's out right unbearable. Find another job. Than leave. That's my advice.

 

[deleted171991]

With one amendment: the 6 or so who threaten to walk should walk in the end. Because those will be the first 6 fired when the occasion comes, or the first 6 whose salaries are reduced or who don't get a raise etc. Management doesn't like troublemakers; they like sheep.

 

[HoustonDreaming]

Thanks everyone for the replies. I think this all pretty much validates my reasoning. Will stick it out with the group but be ready to pack my bags once things go south. My financial house is in order and I have other employment options in a pinch, so not a terrible situation all considered.