Call Sales by full partners

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GA8314

Regaining my sanity
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Hello,

Just trying to get a feel for various PP groups' policies on selling calls. It's a slippery slope, it seems.

On the one hand, surely, selling a call or two for important life events or whatever, should be allowed. But, at what point do you transition someone from partner to employee when they start selling a LOT of call???

25% of call, 50%, 75%??? How do you guys handle this in your PP equal partner groups?

Thanks in advance. This is something which is coming up in our group.
 
Hello,

Just trying to get a feel for various PP groups' policies on selling calls. It's a slippery slope, it seems.

On the one hand, surely, selling a call or two for important life events or whatever, should be allowed. But, at what point do you transition someone from partner to employee when they start selling a LOT of call???

25% of call, 50%, 75%??? How do you guys handle this in your PP equal partner groups?

Thanks in advance. This is something which is coming up in our group.

It is a slippery slope. Definitely above 50% and probably closer to 66%-75%.
 
Honestly, what difference does it make unless they are forcing someone to do call for free? As long as the call is covered and the person taking it is getting compensated, and not complaining, does it and should it really matter? Because I suspect they are making less than the person taking full call and their "call responsibility " is taken care of.
 
But, at what point do you transition someone from partner to employee when they start selling a LOT of call???



Are you crazy? You cannot kick someone out of their partnership because they are trying to get rid of their calls.

Let the market decide what is the fair value of a call and let him pony up the money until the value is so high that he would only try to get rid of a few calls.

Somewhere between 4 and 6k is not unheard of.
 
But, at what point do you transition someone from partner to employee when they start selling a LOT of call???



Are you crazy? You cannot kick someone out of their partnership because they are trying to get rid of their calls.

Let the market decide what is the fair value of a call and let him pony up the money until the value is so high that he would only try to get rid of a few calls.

Somewhere between 4 and 6k is not unheard of.
 

Are you crazy? You cannot kick someone out of their partnership because they are trying to get rid of their calls.

Let the market decide what is the fair value of a call and let him pony up the money until the value is so high that he would only try to get rid of a few calls.

Somewhere between 4 and 6k is not unheard of.
Agreed, lose the douchey mentality
 
Keep em coming. Interested in opinions.

To shed light on my "douchey mentality", these are of course the older guys who seem to want their cake and eat it too, who are slowing down, who can't run more than 2 or 3 rooms, who can't or won't learn additional skills (so we have to "hide" them in certain locations), who we need to track down to see patients....... etc. etc.

It just seems that the above is tantamount to someone who just needs to retire. But, I don't want to digress from the simple question in the thread.
 
This is so odd to me. Plenty of EM docs sell their night shifts or groups give night shift differentials. (Practically) no one wants to do these shifts. Figure out what dollar amount it takes to have someone else do it.

Why do people in medicine always care so much about what other people are doing??
 
Depends whose calling the shots is the answer. In other words how democratic is the process?
What are the demographics of the group? We had one partner who was giving away almost all his calls and maintained his partnership status. Thee group didn't have a problem with it. The group did have a problem with a 75% partner who took 75% of calls but only worked 75% of the weeks of full partners. He retained a full partnership vote was the objection we had.
 
Keep em coming. Interested in opinions.

To shed light on my "douchey mentality", these are of course the older guys who seem to want their cake and eat it too, who are slowing down, who can't run more than 2 or 3 rooms, who can't or won't learn additional skills (so we have to "hide" them in certain locations), who we need to track down to see patients....... etc. etc.

It just seems that the above is tantamount to someone who just needs to retire. But, I don't want to digress from the simple question in the thread.
Those are two different things.
And you need to address them separately. As a group, you leadership needs to address the laziness of the normal day to day. That may be something to go after their partnership for.
Leave the selling call out of it. Some people hate call and just do whatever is necessary to get it covered.
 
Keep em coming. Interested in opinions.

To shed light on my "douchey mentality", these are of course the older guys who seem to want their cake and eat it too, who are slowing down, who can't run more than 2 or 3 rooms, who can't or won't learn additional skills (so we have to "hide" them in certain locations), who we need to track down to see patients....... etc. etc.

It just seems that the above is tantamount to someone who just needs to retire. But, I don't want to digress from the simple question in the thread.


We run a free market. Sell whatever shift you want to whoever wants it and negotiate between yourselves. Why would anybody else care? It's not making me work any harder and it isn't costing me money. I mean the more shifts that are being sold (in general), I'd say the better. Why? Because it means there is demand for that money/shift from other partners. If you are lazy and want to get rid of call, you need someone else that wants the work/money for their to be a sale. As long as you aren't forcing someone else to work against their will I just don't care.
 
We run a free market. Sell whatever shift you want to whoever wants it and negotiate between yourselves. Why would anybody else care? It's not making me work any harder and it isn't costing me money. I mean the more shifts that are being sold (in general), I'd say the better. Why? Because it means there is demand for that money/shift from other partners. If you are lazy and want to get rid of call, you need someone else that wants the work/money for their to be a sale. As long as you aren't forcing someone else to work against their will I just don't care.

Do you do anything to keep it a free market and prevent "insider" deals where Partner Bob always sells calls to his buddy Partner Bill at a discounted rate?
 
No insider trading here. If you are a 24 hr call position you can only trade 24 hour call positions... same goes for late calls.
If you can't get someone to trade with you it goes out to the whole group. We get a list of available calls every single day from our office.
You pick what you want. If you are high up on the list, then you get it and get moved to the bottom (for that particular call).
This is THE best practice I have seen thus far. Open to EVERYBODY and no insider trading.
If someone wants to give up all their calls then great. They will make A LOT less in our system... but if they can't get rid of their call they are stuck with it.
Super fair.
 
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Some of our calls are extremely brutal and require 24 hr. in house coverage. Sucks but... $$$$
 
No insider trading here. If you are a 24 hr call position you can only trade 24 hour call positions... same goes for late calls.
If you can't get someone to trade with you it goes out to the whole group. We get a list of available calls every single day from our office.
You pick what you want. If you are high up on the list, then you get it and get moved to the bottom (for that particular call).
This is THE best practice I have seen thus far. Open to EVERYBODY and no insider trading.
If someone wants to sell all their calls then great. They will make A LOT less in our system... but if they can't get rid of their call they are stuck with it.
Super fair.
It sounds like the calls have a set amount of money established by the group.

If that is the case I would not call it free market.

Free market would be if John takes it for 1k, Peter takes for 2k and Edwin takes it for 3k. Of course all of us would give our calls to John. That is until he gets fed up and then you have to pay the Peter rate of 2k to either John or Peter, and so forth.
 
Correct. Your scenario is exactly what we don't want.

OB comes with a $1200 stipend plus whatever you bill after 3 on weekdays or whatever you bill on weekends.
Trauma comes with $1000 stipend and you get whatever comes after 3 during weekdays and whatever you bill on weekends.
1st call gets whatever you bill after 3 on weekdays and whatever you bill on weekends.
etc, etc....

No competition between partners and no insider trading. The price is set.
 
Of course... if you are SUPER busy you take home more vs. having a 1st call where you are home at 8pm.

Peronally, I like this system better because I'm getting paid for time spent in the hospital.

I've never been a fan for: "It works out in the end"
 
Do you do anything to keep it a free market and prevent "insider" deals where Partner Bob always sells calls to his buddy Partner Bill at a discounted rate?
Why would you want to interfere and strong arm the guy into paying more for his calls when someone will take it for less? Seems like harassment to me.
 
The beauty of the system is that some people just don't want to take the brutal calls any more. I will probably be there before too long. Heck, some people don't want to take any call at all. It allows for those who are cruising through their later years to do exactly that- cruise along. Those young padawans who want to work and make the big bucks have that opportunity if they want to put in the work.

Flexibility within a group is key IMO.
 
Correct. Your scenario is exactly what we don't want.

OB comes with a $1200 stipend plus whatever you bill after 3 on weekdays or whatever you bill on weekends.
Trauma comes with $1000 stipend and you get whatever comes after 3 during weekdays and whatever you bill on weekends.
1st call gets whatever you bill after 3 on weekdays and whatever you bill on weekends.
etc, etc....

No competition between partners and no insider trading. The price is set.
That sort of works but sort of doesn't. Imagine you want to get rid of all your calls but cannot get rid of all of them. You would be willing to double the price to get rid of all of them but the group doesn't allow. I'm sure there would be others that will take the call for the right amount of money. Lose-Lose scenario.
 
That sort of works but sort of doesn't. Imagine you want to get rid of all your calls but cannot get rid of all of them. You would be willing to double the price to get rid of all of them but the group doesn't allow. I'm sure there would be others that will take the call for the right amount of money. Lose-Lose scenario.

Yeah, I guess I did leave out the fact that once it goes out to the ENTIRE group, you can start to incentivize it monetarily or by adding vacations days if no one picks it up. Eventually, you can get rid of any call with enough effort.
 
Correct. Your scenario is exactly what we don't want.

OB comes with a $1200 stipend plus whatever you bill after 3 on weekdays or whatever you bill on weekends.
Trauma comes with $1000 stipend and you get whatever comes after 3 during weekdays and whatever you bill on weekends.
1st call gets whatever you bill after 3 on weekdays and whatever you bill on weekends.
etc, etc....

No competition between partners and no insider trading. The price is set.
Just thinking what a group led free market would be:

Make all calls voluntary. Have people sign up for them if they want.

Tell them you will pay them nothing extra: nobody will sign up.
Tell them you will pay 1k: maybe 1 or 2 calls get taken.
Tell them you will pay 2k: half of them get taken.
Tell them you will pay 3k: most of them taken
Let's say at 4k all calls get taken.

4k times 30 days = 120k.

There are 10 partners. Thus, everyone will have a salary cut of 12k/month to pay for the call.

Partner who doesn't take call will make 144k/year less than what he makes now.

Partner who takes 10 calls every month will make an extra 480k/yr in call plus whatever the other guy who doesn't take call makes.

These are imaginary numbers. Weekend call will likely pay more than weekdays.

But you get the idea.
 
Yeah, I guess I did leave out the fact that once it goes out to the ENTIRE group, you can start to incentivize it monetarily or by adding vacations days if no one picks it up. Eventually, you can get rid of any call with enough effort.
Before it goes to the ENTIRE group, to whom does it go?
 
Do you do anything to keep it a free market and prevent "insider" deals where Partner Bob always sells calls to his buddy Partner Bill at a discounted rate?
Why do you care? The work and pay for everyone but Bob and Bill stays the same in this case. Letting it go through, everyone is happy.
 
You can only "swap" 24 hour calls or late calls.
Anything outside of that, it goes to the entire group in order to give everyone a chance to pick up a particular call depending on what number you are on the list.
 
Those are two different things.
And you need to address them separately. As a group, you leadership needs to address the laziness of the normal day to day. That may be something to go after their partnership for.
Leave the selling call out of it. Some people hate call and just do whatever is necessary to get it covered.

Has anyone ever done this? We have some guys that we are really struggling to "hide" and we are not that large a group. Can't put Doc X here, but oh no, can't put him there either. Can put them HERE, but that's a 4 room assignment and they are just going to piss off the surgeons by not keeping up.......... It makes schedule making very hard, and the fact is that the "doers" are the ones picking up the slack.

It's not an age thing per se, because we have awesome older guys that get the job done, but to be totally honest all of the people in question are more senior (we are equal owners however) guys in age. It wouldn't be as big a deal if we were a bigger group.

But, we are all hands on deck but it's not manifesting that way. How to address?? It's a tough problem.
 
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Why would you want to interfere and strong arm the guy into paying more for his calls when someone will take it for less? Seems like harassment to me.

Not trying to strong arm anyone - just trying to prevent back door crony capitalism deals that end up preventing everyone who wants to pick up extra calls from getting them.

everyone is happy.

Not quite. Here's the problem.

Bob doesn't like call and when the schedule comes out he has 5 calls he wants to shed. Bill, Ted, Jim, John, and Joe are all hungry and looking to pick up more calls. Bill happens to be long time buddies with Bob, and they have an unwritten deal worked out where Bob gives all his calls to Bill right off the bat. Ted, Jim, John, and Joe are all left in the dust. They just see the new amended schedule with Bill taking all the call and think "WTF? I woulda liked to pick to pick up some of those." This ends up breeding resentment within the group. That sorta thing happened at my first gig. It was straight blended unit eat what you kill so there was no buying/selling of calls, but it wasn't fair as not everyone had equal opportunities to pick up the unwanted call. My current gig operates a little more like Sevo's. Unwanted calls are relayed to our secretary who then sends out a group wide email. It's essentially first come first serve but the high dollar calls are tracked to ensure everyone who wants them ends up having a fair shot. If no one wants to pick up a given call, the original owner can then start to add value to it, but again - everyone gets a shot at it. No back room deals.
 
Not trying to strong arm anyone - just trying to prevent back door crony capitalism deals that end up preventing everyone who wants to pick up extra calls from getting them.



Not quite. Here's the problem.

Bob doesn't like call and when the schedule comes out he has 5 calls he wants to shed. Bill, Ted, Jim, John, and Joe are all hungry and looking to pick up more calls. Bill happens to be long time buddies with Bob, and they have an unwritten deal worked out where Bob gives all his calls to Bill right off the bat. Ted, Jim, John, and Joe are all left in the dust. They just see the new amended schedule with Bill taking all the call and think "WTF? I woulda liked to pick to pick up some of those." This ends up breeding resentment within the group. That sorta thing happened at my first gig. It was straight blended unit eat what you kill so there was no buying/selling of calls, but it wasn't fair as not everyone had equal opportunities to pick up the unwanted call. My current gig operates a little more like Sevo's. Unwanted calls are relayed to our secretary who then sends out a group wide email. It's essentially first come first serve but the high dollar calls are tracked to ensure everyone who wants them ends up having a fair shot. If no one wants to pick up a given call, the original owner can then start to add value to it, but again - everyone gets a shot at it. No back room deals.

Another way to look at it is, those are Bob's calls to do with as he pleases. He has the obligation to see that they are covered and the right to cover them as he sees fit. If he wants to give them all to Bill, so be it.



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Another way to look at it is, those are Bob's calls to do with as he pleases. He has the obligation to see that they are covered and the right to cover them as he sees fit. If he wants to give them all to Bill, so be it.



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I understand where you're coming from. That sorta thing does lead to resentment within the group though, and ultimately leads to group dysfunction. I guess it just depends on the whole group dynamic, but having experienced both systems, I can definitely tell you which setup fosters more comraderie, more teamwork, and an overall better working environment.

I think that's something that's lost on you East Coast guys, and a big reason why all the disgruntled people on this board live East of the Mississippi.
 
Has anyone ever done this? We have some guys that we are really struggling to "hide" and we are not that large a group. Can't put Doc X here, but oh no, can't put him there either. Can put them HERE, but that's a 4 room assignment and they are just going to piss off the surgeons by not keeping up.......... It makes schedule making very hard, and the fact is that the "doers" are the ones picking up the slack.

It's not an age thing per se, because we have awesome older guys that get the job done, but to be totally honest all of the people in question are more senior (we are equal owners however) guys in age. It wouldn't be as big a deal if we were a bigger group.

But, we are all hands on deck but it's not manifesting that way. How to address?? It's a tough problem.

Yes this is a crappy problem to have. My old group never figured out a good solution.
 
Do you do anything to keep it a free market and prevent "insider" deals where Partner Bob always sells calls to his buddy Partner Bill at a discounted rate?

I don't get why that would be a problem? If Bill wants to work it for less money than anybody else would be willing to, why would anybody else be mad?

We all get assigned the same amount of call and we all get paid the same. If you want to pay someone else to work a shift for you, that's a negotiation between the 2 of you. Most of the time people just work out a deal between themselves. Occasionally a groupwide email goes out soliciting a bid for a shift. Nobody really cares. 80% of partners don't want to work any extra shifts. 20% occasionally want the money. More commonly people will just trade shifts (no money) because they have something else to do that they need out of work.

But if you have a shift you really want to get out of, everybody has a price you can pay to get somebody to do it for you. And we all like having that system.
 
Yes this is a crappy problem to have. My old group never figured out a good solution.

Did things go o.k.? We have probably 2 guys that are really really hard to staff for reasons stated.

O.k. so there is a clear consensus to allow call sales, so long as the process is fair. Do the younger guys agree?? I can see the synergy. Some lose money and gain lifestyle and others gain money for a hit on lifestyle. Makes sense and we do allow it.

It's just that if a full partner becomes a daytime person, in all essence, then when will he/she retire? There is not incentive because even if they sell ALL call at market value, it's an income which is still FAR above employee status. I suspect many groups struggle with this. I wouldn't have a problem with it were it not for our group being smallish and we have at least 2 guys to whom this applies.

Again, incidentally, the guy that sells most call (and gets the most takers) is an older guy that shows up and rocks it every day. He's also the guy that gave a 2 year retirement date once this has happened. But, we have another guy quoting 5-7 years, who is a real weight on our group. No incentive to retire in my eye....
 
It's just that if a full partner becomes a daytime person, in all essence, then when will he/she retire? There is not incentive because even if they sell ALL call at market value, it's an income which is still FAR above employee status.
Your call is undervalued. Jack up the price and the issue is gone.
 
It sounds like you want to force him out for issues other than this call selling. Deal with those issues and everyone will be happy.
Taking calls are not what makes a partner. Like it or not he's an owner. Buy him out if everyone has a problem with him.
Hopefully your bylaws have some system to remove a partner for cause. Give him the assignments he "can't" do and there's your cause. Can't do the job as required.
Anyone can learn blocks, or whatever. Cardiac is a different beast though. If he's not been doing that, I don't think you can just drop him in there. I bet he's capable of doing a lot more than he seems to be able to do.
We have one piece of dead weight, but he likes to do a particular thing that the rest of us generally don't, it's not very efficient either so it's a good fit. He's an easy assignment.


--
Il Destriero
 
I understand where you're coming from. That sorta thing does lead to resentment within the group though, and ultimately leads to group dysfunction. I guess it just depends on the whole group dynamic, but having experienced both systems, I can definitely tell you which setup fosters more comraderie, more teamwork, and an overall better working environment.

I think that's something that's lost on you East Coast guys, and a big reason why all the disgruntled people on this board live East of the Mississippi.
I sense entitlement when you believe call must be sold to your liking rather than to the liking of the owner of the call.
 
Your call is undervalued. Jack up the price and the issue is gone.

is the call undervalued if there are people willingly taking the money to work it? Seems to them that it is appropriately valued if they are willing to do the work for the money.

In our group, you couldn't sell all your call because there wouldn't be enough buyers. In reality for us the most anybody sells in a given year is about 10% of their calls.
 
is the call undervalued if there are people willingly taking the money to work it? Seems to them that it is appropriately valued if they are willing to do the work for the money.
I was thinking about that. Perhaps the employees are underpaid.

Depends on who is taking the call. Are employees taking the call because they are underpaid and hence the calls end up selling for a lower price?

Are only partners allowed to take call? What you say might be correct then.
 
I was thinking about that. Perhaps the employees are underpaid.

Depends on who is taking the call. Are employees taking the call because they are underpaid and hence the calls end up selling for a lower price?

Are only partners allowed to take call? What you say might be correct then.

I was referring to my situation which is partners taking other partners call. As a neutral 3rd party, as long as I'm not there I don't care who is working.
 
I sense entitlement when you believe call must be sold to your liking rather than to the liking of the owner of the call.

😵🙄

If I'm coming across as entitled then perhaps I'm not explaining my POV very well. All I'm really advocating is a fair free market system where everybody who wants to pick up extra calls has an opportunity to do so. The system you describe here would be totally fine with me:

Free market would be if John takes it for 1k, Peter takes for 2k and Edwin takes it for 3k. Of course all of us would give our calls to John. That is until he gets fed up and then you have to pay the Peter rate of 2k to either John or Peter, and so forth.

The problem I've seen is where Peter takes all of the available calls due to some back room deal before John and Edwin ever even get a chance to "bid" on them. To me, that sort of stuff is bad for group dynamics and undermines any sort of "free market" capitalistic system. I'm sorta surprised that you think that makes me "entitled." Even Wall Street is governed by laws that prevent insider trading. Why should it then be OK among colleagues/partners within an anesthesia group?

I guess there's also a fundamental difference in how my group views calls than what you describe. Here, call shifts are something that need to be covered by the group, not personal property of each individual partner to be bought and sold. If you decide you don't want to take a call shift that is assigned to you (and in turn want to forfeit the money associated with that shift), then the call can be offered back to the group for whoever wants it on a first come first serve basis.

This system was established way back when all us "entitled" millennials were still in high school.


All that being said, there's no perfect system and if your group is happy with its current set-up then who am I to cry foul?
 
I get it Salty. We see eye to eye on this topic. 👍
 
The problem I've seen is where Peter takes all of the available calls due to some back room deal before John and Edwin ever even get a chance to "bid" on them. To me, that sort of stuff is bad for group dynamics and undermines any sort of "free market" capitalistic system. I'm sorta surprised that you think that makes me "entitled." Even Wall Street is governed by laws that prevent insider trading. Why should it then be OK among colleagues/partners within an anesthesia group?


I guess I don't understand why there would be "some back room deal" where Peter works the call for less than someone else is willing to. I mean if I'm paying someone to take my call, I'm paying whoever will do it the cheapest. I can't imagine there could be some sort of arrangement where I would willing let someone else have me pay them more. It just doesn't make sense, nor can I imagine a scenario where it would make sense. I mean maybe if Peter agreed to take at least 2 calls a month from me for the next 6 months when I knew I'd otherwise have trouble selling them to someone else, but even that is selling to the lowest bidder if he was the only other person that could take all the calls.

Maybe I'm naive. All the docs I know are capitalists and want to pay as little as possible. And while calls are group responsibility to the hospital, they are individual responsibility once assigned to you. And we don't take any extra pay for working calls. They are part of the job.
 
And we don't take any extra pay for working calls. They are part of the job.

This probably has something to do with it. I've always worked in some variant of a pay for production based system (either blended unit or point system). Nobody sold/bought calls - you just got to earn more for taking the additional calls either because you would bill more units by doing the additional cases or by picking up the extra points the call is worth.

I mean maybe if Peter agreed to take at least 2 calls a month from me for the next 6 months when I knew I'd otherwise have trouble selling them to someone else, but even that is selling to the lowest bidder if he was the only other person that could take all the calls.

The issue was that there were plenty of other people who wanted extra calls but they always went to "Peter" because he was your long time buddy. They were "gifted" not sold since it was a blended unit eat what you kill practice.

Anyways, I think the OP's thread has been taken far enough off the rails.
 
We are eat what you kill blended unit plus a trauma stipend overnight. As long as the calls are distributed evenly in the original schedule, I don't care what happens after.

As it is we have people who give away all their calls. We make a good chunk of our money on call so they take a big hit in income. The calls are theirs, they can do what they want with it as long as it gets covered.
 
This probably has something to do with it.

Yeah... it has everything to do with it.

The value of picking up a call in our types of set ups is rarely the monetary bump you may get from a partner selling a call. It's the monetary value you get when at the end of a 24hr. shift when you've clocked in some thoracic cases, a pump run, a hand full of laparoscopies, ex-laps, etc. Or 20 some procedures up on the OB floor.
Some of these calls, if super busy, are extremely lucrative. Just different than a straight salaried position.
 
The issue was that there were plenty of other people who wanted extra calls but they always went to "Peter" because he was your long time buddy. They were "gifted" not sold since it was a blended unit eat what you kill practice.

Anyways, I think the OP's thread has been taken far enough off the rails.


Maybe "Peter" gets first dibs because he always says yes while the others are less reliable?? It's the availability part of the three A's. Doubt they are buddies outside of work if one is working all the time while the other is not.
 
Instead of selling call, you could just create a fake partnership track and assign all the call to the newbie suckers while the partners who are difficult to assign due to incompetence collect all the money off the backs of the guys who think they are working towards partnership. Just another popular option in the few remaining private practices on the east coast.
 
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