Call Sales by full partners

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nimbus said:
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.
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I think if you give your call to the same partner every month and some other "new" partner wishes to have that same opportunity cuz he's up to his neck in debt then you are creating resentment between partners. Say I don't take any call and give all my call away to the same guy every month and that guy ends up making 200k more than the average partner- yet you have 15 other guys who want that same opportunity.

IMO opinion, everyone should have a crack at making extra cash by taking extra call on a rotating basis. Again, we prioritize fairness in our group and continually revisit policies to ensure this very important aspect of our practice.
 
nimbus said:
Maybe "Peter" gets first dibs because he always says yes while the others are less reliable??
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It may have started out that way but it had evolved into something a little less innocent. A couple times I mentioned to the guy giving up his call that I would be happy to take a few off his hands. "Oh ya definitely. . ." was the response I got and then month after month "Peter" mysteriously ended up with all of it.

nimbus said:
Doubt they are buddies outside of work if one is working all the time while the other is not.
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They were absolutely good buddies outside of work. Both late 50's kinda oddball dudes. Both single, never married types. I think they were each other's only friends. Hell you may know or have at least heard of one of these characters.
 
We are eat-what-you-kill, pooled RVU. Everyone is assigned their schedule monthly, with only full time partners and 1/2 time partners in the system. No employees. If you want to give up call, or unwanted shifts, which most partners > 50 do, they find a young gun to take it. It typically goes to the same people every month, and it tends to be the young guns who are reliable and consistent as opposed to those who want a call here, or a call there, but the old guys can't consistently count on them. If unwanted call were put into a 'community pool' which was assigned evenly amongst all interested parties, it probably wouldn't work as there aren't enough young guns to soak up all of the unwanted work.

I can see resentment growing in a system like sevo or Salty mentioned, but it'd have a be a group much larger than mine. We don't have enough young guns clamoring for extra work, in fact we could probably use another young gun or two if you asked the older partners.

The same qualities that make an anesthesiologist good in the OR make one good within a private practice group. And it isn't magic. Be courteous, consistent, hard working, and provide good care.

With regards to the OP's situation, you really need good, solid senior leadership willing to keep issues like those described at a minimum, and squashed pretty quickly. If you don't have that, the issues can be tough to sort out, especially in a small democratic group.
 
GA8314 said:
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....
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P

I left and the group was booted out about a year after that. The surgeons didn't do much to stop it. There were many issues that led to dysfunction, and this was one of them. We made it work for a long time though, so if this is the only issue you can make it work. Just sucks when people get lazy and entitled and expect everyone else to pick up the slack.
 
SaltyDog said:
It may have started out that way but it had evolved into something a little less innocent. A couple times I mentioned to the guy giving up his call that I would be happy to take a few off his hands. "Oh ya definitely. . ." was the response I got and then month after month "Peter" mysteriously ended up with all of it.



They were absolutely good buddies outside of work. Both late 50's kinda oddball dudes. Both single, never married types. I think they were each other's only friends. Hell you may know or have at least heard of one of these characters.
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I don't know them. But anyway, things depend on how busy the OR is overall. We have 3-4 people who are always giving away calls and 2-3 who are always picking them up. For now everybody gets what they want and are reasonably happy. That could change if volume drops but even when things are slow it's funny how many people who complain that "things are slow" still don't want to work evenings and weekends.
 
sevoflurane said:
I think if you give your call to the same partner every month and some other "new" partner wishes to have that same opportunity cuz he's up to his neck in debt then you are creating resentment between partners. Say I don't take any call and give all my call away to the same guy every month and that guy ends up making 200k more than the average partner- yet you have 15 other guys who want that same opportunity.

IMO opinion, everyone should have a crack at making extra cash by taking extra call on a rotating basis. Again, we prioritize fairness in our group and continually revisit policies to ensure this very important aspect of our practice.
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Sounds like people are fighting for calls. I would say call is overvalued. Why don't you start offering money to the call shedder?
 
sevoflurane said:
I think if you give your call to the same partner every month and some other "new" partner wishes to have that same opportunity cuz he's up to his neck in debt then you are creating resentment between partners. Say I don't take any call and give all my call away to the same guy every month and that guy ends up making 200k more than the average partner- yet you have 15 other guys who want that same opportunity.

IMO opinion, everyone should have a crack at making extra cash by taking extra call on a rotating basis. Again, we prioritize fairness in our group and continually revisit policies to ensure this very important aspect of our practice.
Click to expand...
Also, let's assume there are a husband and wife couple who are both partners in your group. They have a couple of kids and they want to transfer all calls from the wife to the husbad.

Who is opposed to that?

Are you going to prevent them from making the same salary as 2 partners because the other guys want more for themselves?

Why would the legal relationship have any implication on how call transfer is viewed?
 
sevoflurane said:
I think if you give your call to the same partner every month and some other "new" partner wishes to have that same opportunity cuz he's up to his neck in debt then you are creating resentment between partners. Say I don't take any call and give all my call away to the same guy every month and that guy ends up making 200k more than the average partner- yet you have 15 other guys who want that same opportunity.

IMO opinion, everyone should have a crack at making extra cash by taking extra call on a rotating basis. Again, we prioritize fairness in our group and continually revisit policies to ensure this very important aspect of our practice.
Click to expand...

What's stopping a third guy from approaching the call shedder and offering to do his call for less?


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Wiscoblue said:
What's stopping a third guy from approaching the call shedder and offering to do his call for less?


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He has 75 other eyes looking at the call schedule on a daily basis + it needs to go through the office in order for it to be official.
 
Wiscoblue said:
What's stopping a third guy from approaching the call shedder and offering to do his call for less?


Sent from my iPad using Tapatalk
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In a system like Sevo's or mine, call is not bought and sold. You're increased compensation from taking call comes from the work you do while on call (either directly in Sevo's case, or a little more indirectly in my practice set-up).
 
SaltyDog said:
In a system like Sevo's or mine, call is not bought and sold. You're increased compensation from taking call comes from the work you do while on call (either directly in Sevo's case, or a little more indirectly in my practice set-up).
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I work in a similar setup but there is very little money to be made on call. Call is not traded very often, only for special occasions, and it is often hard to find someone to take your call.
 
When you guys buy and sell calls to each other, does the group make you do it through your billing office (pre-tax money) or you just give each other cash or a check?
 
Write a personal check


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I'm all for selling and buying call. As long as everyone agrees, don't see the harm. However, payment via cash or check rather than through the group could get your group into some deep crap with the IRS. I wouldn't recommend that.
 
facted said:
I'm all for selling and buying call. As long as everyone agrees, don't see the harm. However, payment via cash or check rather than through the group could get your group into some deep crap with the IRS. I wouldn't recommend that.
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The IRS will never find out if it is done off the books.
 
ZzzPlz said:
Careful! If I worked for the IRS, first thing I'd do would be a google search for "the IRS would never find out if"
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Billionaires (*cough* Trump *cough*) are not paying taxes and the IRS is going to go after a few anesthesiologists buying and selling call? If that's the case then I quit America.
 
Arch Guillotti said:
The IRS will never find out if it is done off the books.
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Are you serious? If you get audited, the first thing the IRS will do is look at your bank statements. If you received a check, they can obviously track where it came from. If it's one check for the year, you might be able to make something up. If it's 10 or 20 checks of a few thousand, you're going to have a lot of explaining to do. If it's cash and it never sees your bank, maybe you can get away with it...who knows.

If the IRS audit finds you hid income and your group knew about it, that could bring some serious consequences for the whole group. I'd be SUPER wary. My old group outlawed partner to partner cash transactions for that exact reason. Everything had to go through the group and you had your taxes taken out.
 
facted said:
Are you serious? If you get audited, the first thing the IRS will do is look at your bank statements. If you received a check, they can obviously track where it came from. If it's one check for the year, you might be able to make something up. If it's 10 or 20 checks of a few thousand, you're going to have a lot of explaining to do. If it's cash and it never sees your bank, maybe you can get away with it...who knows.

If the IRS audit finds you hid income and your group knew about it, that could bring some serious consequences for the whole group. I'd be SUPER wary. My old group outlawed partner to partner cash transactions for that exact reason. Everything had to go through the group and you had your taxes taken out.
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What do they care? Someone paid taxes on the money as it was paid out.
 
GravelRider said:
Billionaires (*cough* Trump *cough*) are not paying taxes and the IRS is going to go after a few anesthesiologists buying and selling call? If that's the case then I quit America.
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Unfortunately, we can't usually afford high priced lawyers and accountants like they can. They can definitely go after us and I know quite a few colleagues who got audited.
 
Raryn said:
What do they care? Someone paid taxes on the money as it was paid out.
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That's looking at it only in terms of the group's books. It would still be "unreported income" for the call taker. To be fully kosher the call shedder is technically supposed to 1099 the call taker. We had an attending in residency who would sell call to the "pre-tending" regional fellows and 1099 them.
 
SaltyDog said:
That's looking at it only in terms of the group's books. It would still be "unreported income" for the call taker. To be fully kosher the call shedder is technically supposed to 1099 the call taker. We had an attending in residency who would sell call to the "pre-tending" regional fellows and 1099 them.
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I have heard of similar stories. The call taker did not know the call shedder was going to 1099 them, otherwise they would have asked for double the money to take it.
 
Arch Guillotti said:
A personal audit and a corporate audit are entirely different.
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Sure, but if you have 10 checks in your personal account showing you get paid by a coworker under the table for work done under your corporation, you don't think they're going to come for your corporate books?

In essence, your practice is knowingly allowing untaxed compensation. That's not going to go over well.
 
facted said:
Sure, but if you have 10 checks in your personal account showing you get paid by a coworker under the table for work done under your corporation, you don't think they're going to come for your corporate books?

In essence, your practice is knowingly allowing untaxed compensation. That's not going to go over well.
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small f***'n potatoes. Not worth the IRS time. Please.
 
dr doze said:
small f***'n potatoes. Not worth the IRS time. Please.
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If only the IRS really thought like that. My dad is a self employed attorney in a solo practice. He got audited a couple years ago. IRS agent spent 3-4 full days at his office and in the end calculated that my dad owed an extra $800. Seriously.

If the IRS happens to pull your number for whatever reason they are gonna throw all their resources at it making it a huge pain in the ass for you even if it's only over chump change. Real effective use of resources but I guess what else do you expect from a government agency.
 
facted said:
If that's your tax strategy, you're in for a rude awakening.
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Dr. X and Dr. Y are employees of the same practice. Maybe partners in a private practice. Maybe W2 employees of AMC or hospital.
Dr. X doesn't want to work next Saturday 24 hrs in house. Dr. Y says "I'll work the call". In house Saturday call is worth 5K pre tax. Dr. X says let's keep our employer out of it because their payroll and compliance office are a pain in the ass and incompetent and there is no contractual provision for this and they will be obstructionists. Dr. X writes Dr. Y a check for $2,500 or hands him $2,500 in cash. Their employer pays Dr. X the $5K on his W2 or 1099.
Is it completely Kosher? Nope. Does anybody, including the IRS give a F%ck? Nope. On the off chance the IRS does look into it the penalty is likely to be small because Dr. X is paying taxes on the income. Are all the taxes owed being paid? Nope. Dr. X should give Dr Y a 1099 and deduct the income off his taxes. Doesn't quite come out even. Unlikely to be caught even if audited because their is no paper. The employer doesn't care because it doesn't cost them anything. It keeps the employees happy and they can claim they didn't know **** if the IRS does for some unknown reason choose to look into it. Plausible deniability whatever.
This stuff is widespread. This is a common way of doing things and you are naive.
 
Last edited by a moderator:
dr doze said:
Dr. X and Dr. Y are employees of the same practice. Maybe partners in a private practice. Maybe W2 employees of AMC or hospital.
Dr. X doesn't want to work next Saturday 24 hrs in house. Dr. Y says "I'll work the call". In house Saturday call is worth 5K pre tax. Dr. X says let's keep our employer out of it because their payroll and compliance office are a pain in the ass and incompetent and there is no contractual provision for this and they will be obstructionists. Dr. X writes Dr. Y a check for $2,500 or hands him $2,500 in cash. Their employer pays Dr. X the $5K on his W2 or 1099.
Is it completely Kosher? Nope. Does anybody, including the IRS give a F%ck? Nope. On the off chance the IRS does look into it the penalty is likely to be small because Dr. X is paying taxes on the income. Are all the taxes owed being paid? Nope. Dr. X should give Dr Y a 1099 and deduct the income off his taxes. Doesn't quite come out even. Unlikely to be caught even if audited because their is no paper. The employer doesn't care because it doesn't cost them anything. It keeps the employees happy and they can claim they didn't know **** if the IRS does for some unknown reason choose to look into it. Plausible deniability whatever.
This stuff is widespread. This is a common way of doing things and you are naive.
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You can gift anyone 14k a year without paying taxes or raising questions.

If you keep any money exchange below this limit you should be ok.

More than that you might have to answer for it.

https://turbotax.intuit.com/tax-too...ing-and-Checklists/The-Gift-Tax/INF12036.html
 
dr doze said:
Technically that is still not kosher since it is not a gift. Dr. X would not be "gifting" if Dr. Y did not do his call for him.
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He is gifting you for doing him a favor.

Semantics.
 
SaltyDog said:
So then can my patients gift me my fees for doing them the favor of taking care of them, and I can avoid income taxes? I just won't bill anyone over 14K and I'm cool right?
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You might be stretching it but if you can convince the IRS, go ahead.
 
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