compensation ratio thoughts

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Looking at revamping our compensation. We have the usual infighting. Would like to hear some opinions.

Currently partners have 4 in house calls/month 4 back up call per month. Very rare call back once q 3months. work on average about 50-55 hrs per week with typical high variance in hours/week depending on number in the call system and surgery schedule. Off after post in house call. Usually called off post back up call. Usually, but not always can lay down for a few hours on call.

Long term guy wants to get out of call system work M-F 40ish/hrs per week days only, no nights, weekends, holidays. Same number of weeks per year. Same case mix. Same case load 3-4 rooms every day all day. Side by side. Days only partner will never get an early day if schedule is light.

What should the salary ratio be for the "days only guy" as compared to the "call taking guy?"
 
I would think about it in terms of how much more work the other partners will have to pick up, longer days and more call to be shared with less people.. what’s the price tag for the partners to pick up these extra hours?

for example, if he is giving up 4 calls a month and each call would be worth about 2g, then his monthly pay should be about 8g less? Also he’s working 10hrs less a week, so some people will be sticking around later to get him out every day.
 
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nimbus said:
How are you paid now?

It is easy to do in a pure productivity model.
Click to expand...

Presumably most of the income is from day cases? And if you’re doing 3-4 rooms during the day, what’s the incentive to do calls at night? To get 2 appys? Maybe a few epidurals?

The day only guys will need to subsidize calls. Or someone has to.

If straight salary then maybe easier. Base salary for people who are day doctors, and calculate out how much each call is worth and multiple that by the year.

But I will say this was the downfall started for us, one guy got out of call schedule, and another one wanted to do it. the group wouldn’t/couldn’t allow the partner to do it.....
 
nimbus said:
How are you paid now?

It is easy to do in a pure productivity model.
Click to expand...

We are paid based on availability. Not productivity. Day time hours are more productive. But night time hours are more soul sucking.
 
dr doze said:
Looking at revamping our compensation. We have the usual infighting. Would like to hear some opinions.

Currently partners have 4 in house calls/month 4 back up call per month. Very rare call back once q 3months. work on average about 50-55 hrs per week with typical high variance in hours/week depending on number in the call system and surgery schedule. Off after post in house call. Usually called off post back up call. Usually, but not always can lay down for a few hours on call.

Long term guy wants to get out of call system work M-F 40ish/hrs per week days only, no nights, weekends, holidays. Same number of weeks per year. Same case mix. Same case load 3-4 rooms every day all day. Side by side. Days only partner will never get an early day if schedule is light.

What should the salary ratio be for the "days only guy" as compared to the "call taking guy?"
Click to expand...

We had this same situation and what we ended up doing is assigning a lower base salary and paying out for call shifts. This has been too long ago at this point for the numbers to still be relevant I believe, over 10 years ago in my old group. Our call nights were pretty painful between OB and vascular so call was paid out at $2000 per night.
 
Day doc should make 75%-80% of call taker. However, if you’re in a small group the increased call burden needs to be accounted for. Call sucks. It’s the worst part of our jobs. But without the day doc the post call guys are working and working longer post call days.
 
nimbus said:
How are you paid now?

It is easy to do in a pure productivity model.
Click to expand...

Productivity based is fine, but in many places the night guy is penalized as there’s less work (fewer units to churn) at night. Day work is generally much more efficient in a productivity based model.
 
IMGASMD said:
What do you mean by this? Can you be a little more specific?
Click to expand...

Everybody is assigned the same number of call shifts, low call number, and high call number days. Salaries are identical.

If I sleep all night I make exactly the same as the guy who got killed the night before.
 
Southpaw said:
Productivity based is fine, but in many places the night guy is penalized as there’s less work (fewer units to churn) at night. Day work is generally much more efficient in a productivity based model.
Click to expand...

Most productivity-based practices try to even this out by providing a stipend for the night call. The stipend plus average productivity of a night shift should ideally make up for two days worth of work.
 
dr doze said:
Everybody is assigned the same number of call shifts, low call number, and high call number days. Salaries are identical.

If I sleep all night I make exactly the same as the guy who got killed the night before.
Click to expand...

Would you guys consider doing it the same way still, make it the partner or the person’s own responsibility to sell his/her own calls?

thinkorswim said:
Most productivity-based practices try to even this out by providing a stipend for the night call. The stipend plus average productivity of a night shift should ideally make up for two days worth of work.
Click to expand...

@Twiggidy And I had sort of similarly discussion just today. He is of opinion that he wouldn’t be happy to pay someone post call.

How would you pay it? If my day rate is 1600/8 hrs. What do you think is a fair rate for a 24 hour call?

4800+1600?
4800?
Less than 4800? Because I “usually” get a few hours of shut eyes?

@Arch Guillotti will say I over-analyze for nothing....
 
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IMGASMD said:
@Twiggidy And I had sort of similarly discussion just today. He is of opinion that he wouldn’t be happy to pay someone post call.

How would you pay it? If my day rate is 1600/8 hrs. What do you think is a fair rate for a 24 hour call?

4800+1600?
4800?
Less than 4800? Because I “usually” get a few hours of shut eyes?
Click to expand...

I agree that you shouldn't pay someone for post-call, but you need to incentivize the night call enough to make it fair to the whole group, otherwise you'll run into problems with gaming the schedule too much. At my practice, you typically have the pre-call and post-call days off, so I can't really translate our structure into how a full 24 hours would be compensated. Using the numbers you listed above, my vote for a fair 24 hour call compensation would be closer to the $4,800 than the $6,400 number.
 
IMGASMD said:
Would you guys consider doing it the same way still, make it the partner or the person’s own responsibility to sell his/her own calls?



@Twiggidy And I had sort of similarly discussion just today. He is of opinion that he wouldn’t be happy to pay someone post call.

How would you pay it? If my day rate is 1600/8 hrs. What do you think is a fair rate for a 24 hour call?

4800+1600?
4800?
Less than 4800? Because I “usually” get a few hours of shut eyes?

@Arch Guillotti will say I over-analyze for nothing....
Click to expand...
thinkorswim said:
I agree that you shouldn't pay someone for post-call, but you need to incentivize the night call enough to make it fair to the whole group, otherwise you'll run into problems with gaming the schedule too much. At my practice, you typically have the pre-call and post-call days off, so I can't really translate our structure into how a full 24 hours would be compensated. Using the numbers you listed above, my vote for a fair 24 hour call compensation would be closer to the $4,800 than the $6,400 number.
Click to expand...


I dont think you should let them do it. Call in my opinion is the bigger factor. Much easier to replace a M-F day only person, than the same with 4+ calls.

I would lean towards in between 4800 and 6400 depending on when your ORs usually end by. Is the 24 hr call person doing 3-4 rooms all day until when? 10pm? At some point it gets less busy. I dont think it should be below 4800 since that would go under the 200$/hr mark you pay normally for a day person. 4800 would be minimum in my opinion. Otherwise people will just all want to be M-F with no calls
 
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The value of call also depends on the demographics of your group and the call burden. If you have a lot of younger members, it is easier to give away call. If the baseline call burden is low, it is easier to give away call.

In my group we are all assigned an equal amount of call by our schedule maker/Qgenda but you can literally give away any call within minutes by sending out a group email announcing it is up for grabs. We have a couple of people who give away almost all their call and late shifts and all their weekends. If our baseline call burden was high or we had a disproportionate number of older doctors, it would be more difficult to give away call.
 
You have a lot of call damn. You should have a system of buying/selling calls. I think a mix of stipend for being on call/pay per case should be good. For example, being given 1k for being on call and paying 500 per case or something like that and set up a market for buying/selling. That should keep people reasonably happy.
 
dr doze said:
Looking at revamping our compensation. We have the usual infighting. Would like to hear some opinions.

Currently partners have 4 in house calls/month 4 back up call per month. Very rare call back once q 3months. work on average about 50-55 hrs per week with typical high variance in hours/week depending on number in the call system and surgery schedule. Off after post in house call. Usually called off post back up call. Usually, but not always can lay down for a few hours on call.

Long term guy wants to get out of call system work M-F 40ish/hrs per week days only, no nights, weekends, holidays. Same number of weeks per year. Same case mix. Same case load 3-4 rooms every day all day. Side by side. Days only partner will never get an early day if schedule is light.

What should the salary ratio be for the "days only guy" as compared to the "call taking guy?"
Click to expand...

We have had similar scenarios in our group, the exact scenario actually, and we paid 350 for 5 10hr shifts, 300 for 4 10 hr shifts..

At that time partners made about 500 so that would be about 70%, but why make it a percentage? Define the hours (7-3, 7-5) and define the number of days and then make a set salary offer..

I start thinking "percentage" when the person is taking a fraction of the usual number of calls. only then are they are a fractional partner, no call in my book is no partner which means no percentage..
 
Why can't the guy who doesn't want call just write a check to pay other partners to cover? He can start by offering $1000 or whatever, and if no one takes it, he can offer more and more until it's worth someone's while to take it.

Why does this problem require redoing the whole group's compensation model?
 
dr doze said:
Everybody is assigned the same number of call shifts, low call number, and high call number days. Salaries are identical.

If I sleep all night I make exactly the same as the guy who got killed the night before.
Click to expand...
This is the argument for straight productivity model
 
The secret is to make night work/less desirable work so lucrative that it’s easy to give away. There’s always a partner or two who are purely motivated by money so you have to make it so they’re actually soliciting people for calls
 
GassYous said:
Eat what you kill! People still try to game the system but it is relatively fair.
Click to expand...
It’s true though. You’ll have much more instability as far a group dynamics if people doing less work are making the same money as people who get rocked on call. If you get rocked your paycheck should reflect it, same as it should be reflective if you do nothing. I do think there should be a base pay for being parked in the hospital.
 
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My sister group the partner non call doc makes about 50 percent less than the partner call docs. All md in house based. Partners make 500-700k. Daytime doc works 50 hours and makes 320k. Required 10 hour days.
 
dr doze said:
Looking at revamping our compensation. We have the usual infighting. Would like to hear some opinions.

Currently partners have 4 in house calls/month 4 back up call per month. Very rare call back once q 3months. work on average about 50-55 hrs per week with typical high variance in hours/week depending on number in the call system and surgery schedule. Off after post in house call. Usually called off post back up call. Usually, but not always can lay down for a few hours on call.

Long term guy wants to get out of call system work M-F 40ish/hrs per week days only, no nights, weekends, holidays. Same number of weeks per year. Same case mix. Same case load 3-4 rooms every day all day. Side by side. Days only partner will never get an early day if schedule is light.

What should the salary ratio be for the "days only guy" as compared to the "call taking guy?"
Click to expand...
If he wants a mommy track, pay him for a mommy track. Around here it would be ~$300k plus basic benefits, no bonus, no partner perks, no fancy deferred compensation, no profit sharing, no vote, 4-6 weeks vaca, etc. Whatever else he brings in the partners split for their trouble. Buy back his share and give him a new contract as an employee.
My friend who has partners and employees in his group is a little over 50% as well. Though the employees don’t know that. Might be a harder sell for someone who already knows how the sausage is made. They also lose all the owner perks. That can be a big deal.
(And the employees all take equal call so they are really taking it from the back without a reach around, not even a kiss after.)
 
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Twiggidy said:
The secret is to make night work/less desirable work so lucrative that it’s easy to give away. There’s always a partner or two who are purely motivated by money so you have to make it so they’re actually soliciting people for calls
Click to expand...

I agree with Twiggidy. Pay enough and there is a fair market of buyers and sellers and the problem takes care of itself.
 
pgg said:
Why can't the guy who doesn't want call just write a check to pay other partners to cover? He can start by offering $1000 or whatever, and if no one takes it, he can offer more and more until it's worth someone's while to take it.

Why does this problem require redoing the whole group's compensation model?
Click to expand...

This is the way to figure out the true value of call within your group. It will probably settle out at a particular number.
 
nimbus said:
This is the way to figure out the true value of call within your group. It will probably settle out at a particular number.
Click to expand...

When my daughter was part of a gymnastics team in high school the team ran bingo nights to raise money for travel. Every weekend a few parents had duty at this dive bingo hall, from 8 PM to 1 AM or so, full of smoke, happy people, and cranky people. The team made a bunch of money off the local community of gamblers, enough to mostly fund team trips all over the country (and one meet in the Bahamas), but the parent duty was miserable. You basically spent the night breathing cancer fog and went home smelling bad.

The cash price to get someone else to cover your shift settled out under $100. I would've paid a lot more ...

Sometimes free markets work out.
 
pgg said:
When my daughter was part of a gymnastics team in high school the team ran bingo nights to raise money for travel. Every weekend a few parents had duty at this dive bingo hall, from 8 PM to 1 AM or so, full of smoke, happy people, and cranky people. The team made a bunch of money off the local community of gamblers, enough to mostly fund team trips all over the country (and one meet in the Bahamas), but the parent duty was miserable. You basically spent the night breathing cancer fog and went home smelling bad.

The cash price to get someone else to cover your shift settled out under $100. I would've paid a lot more ...

Sometimes free markets work out.
Click to expand...

Ha! That’s like the Jesuit’s at my old high school. One of my friends got in trouble for writing an editorial in the school newspaper denouncing bingo. Bingo was apparently a big money maker for the school.
 
pgg said:
The cash price to get someone else to cover your shift settled out under $100. I would've paid a lot more ...

Sometimes free markets work out.
Click to expand...

Your group either has some very good cases overnight or people who hate their home lives.
 
Different specialty but I saw the “senior partner no call” scenario ultimately destroy a group. It’s not just about this partner. What happens if 4 other partners suddenly want the same thing? The age distribution of your group probably isn’t smooth and when a cluster hits that threshold all at once, what will you do?

IMO, call is the worst part of the job. Let him (and future “senior” partners) sell it for whatever it’s worth to the rest of you. If there are more sellers, it will be a buyers market.
 
Why should you penalize a senior anesthesiologist for not taking calls. Hospitals will have to subsidize and pay for services. Night call will get takers when you offer 1200-1500 per night. Some places it is 1000 plus whatever you bill Is yours( productivity)+ lodging. If it is in-house call and busy place one has to negotiate more as you will not be able to work next day.
once you start penalizing physicians who have served the group for a long time, they quit and you may not be able to recruit leading to locums getting a foothold and worse AMC getting involved.
 
inquisitiveanes said:
Why should you penalize a senior anesthesiologist for not taking calls. Hospitals will have to subsidize and pay for services. Night call will get takers when you offer 1200-1500 per night. Some places it is 1000 plus whatever you bill Is yours( productivity)+ lodging. If it is in-house call and busy place one has to negotiate more as you will not be able to work next day.
once you start penalizing physicians who have served the group for a long time, they quit and you may not be able to recruit leading to locums getting a foothold and worse AMC getting involved.
Click to expand...

It’s not a penalty. It’s equal pay for equal work, less pay for less work.
 
nimbus said:
It’s not a penalty. It’s equal pay for equal work, less pay for less work.
Click to expand...

Exacrly. If they aren’t taking call, then somebody else is. So somebody else is working more. Also screws up the schedule the next day.
 
dhb said:
If the call person is off post call and the no call person works every day then they are not working much less...
Click to expand...
Call is a burden. Why do you think there is such a discussion about how much to get paid for it. Two 8 hour days is 16 hours. Call is (usually) 24 hours.
 
Arch Guillotti said:
Call is a burden. Why do you think there is such a discussion about how much to get paid for it. Two 8 hour days is 16 hours. Call is (usually) 24 hours.
Click to expand...

Even if it isn’t. Let’s assume we do a night float like our shift working EM/hospitalist colleagues. It would break the productivity compensation model. Unless it’s MD only and you have busy overnight OB/OR/Trauma service.

I understand the partners senioritis, as well as I believe they do deserve “more” consideration when making schedule. As a company it will be very hard to spin anything when there are tiered partners. Then you created different levels of partnership. In this instance I actually don’t mind a “real” buy-in and buy-out. Give the seniors an incentive to get out. However, then you may run into problems with those who “believe” they can still do it like they’re 30s in their 70s bodies.

It’s not a simple thing. It needs to be considered carefully..... maybe should be agreed upon, long before it happens. Just like your code status/POA way before you need it.
 
Again, I’m a fan of internally subsidizing call to the point where there is a full market of buyers and sellers.

My last gig, a busy call weekend (1st/2nd/1st call F/Sa/Su) was probably around $10-12k between internal subsidies and production. Please believe if someone wanted to get rid of a call, they had no problem finding a taker.
 
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okayplayer said:
Again, I’m a fan of internalizing subsidizing call to the point where there is a full market of buyers and sellers.

My last gig, a busy call weekend (1st/2nd/1st call F/Sa/Su) was probably around $10-12k between internal subsidies and production. Please believe if someone wanted to get rid of a call, they had no problem finding a taker.
Click to expand...

I'll take that call.
 
Arch Guillotti said:
Call is a burden. Why do you think there is such a discussion about how much to get paid for it. Two 8 hour days is 16 hours. Call is (usually) 24 hours.
Click to expand...
You always answer me like i'm ******ed but ok...
2 x 10h days is as i said not much less than a 24. (Specially when you have a short pre-call day)
My point is sometimes having a day off is valuable. And at my hospital i almost never work at night (some of my collegues do though).
When you are in a relatively large group +- 15 you have 2 call a month with a high chance of sleeping the whole night with a day off post call. In that setting it's hard to cut back 25 or 50% pay for non call takers.
 
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okayplayer said:
Again, I’m a fan of internally subsidizing call to the point where there is a full market of buyers and sellers.

My last gig, a busy call weekend (1st/2nd/1st call F/Sa/Su) was probably around $10-12k between internal subsidies and production. Please believe if someone wanted to get rid of a call, they had no problem finding a taker.
Click to expand...
So if you are the taker, how do you account for being postcall on Monday when you would normally have a normal workday, which might be a call?
 
Arch Guillotti said:
So if you are the taker, how do you account for being postcall on Monday when you would normally have a normal workday, which might be a call?
Click to expand...
Give up whatever your shift is that day to the person whose weekend you took. We had a peel off system so it could be an early or late day depending...
 
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