Design a perfect group

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BDanes

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So I was curious as to what experienced PP docs would want to change about their groups or what are the best aspects of their groups.

For the following questions assume this is in reference to a hospital based group (600-900 beds) with ability to do outside outpatient cases.

If you could realistically start a new group with partners you trust/enjoy working with how would you structure the group? Mix of doc only with some supervision, maximum supervision model, salary w bonus pay for night calls, some blended unit value with surplus divided by partners? How would partners be compensated for doing non-unit work such as pre-op clinic or post-op rounding?

What about having the ability to have niches within the group-say some want no OB for example, but would be willing to do kids or trauma. Or those who don't do blocks vs those who do. How would the group structure pay for such discrepancies?

For growing the group would you opt for only employees or partnership tract? How long and how would you structure the tract? What size group would you want (# of partners)?

What structure would you have for making group decisions-majority vote vs elected council deciding? Would elected council rotate or stay permanent? How often would your group meet?

How much vacation would you allow? What type of repercussions would be in place for unprofessional behavior (ie chronic lateness, refusing cases, complaints from administration, etc.)?

I am wondering what you'd think is most fair in a group. By this I am not asking for pie in the sky $750k 10 weeks paid vacation w no overnight call BS, but a realistic structuring of a group.

For the record, my current group is an affiliation of independents. We anticipate this model dying out sooner rather than later and will likely restructure in some form. I am trying to get ideas for an equitable future practice. Thanks!
 
1) Strong physician leadership that commands respect and is able to dance and be effective @ negotiations with administration and surgical staff.
2) Decisions via group voting.
3) Transparency and equality with regards to call schedule, vacations, etc. Daily call schedule made by primary call person and based on a number system (no cherry picking). If you are #1 of 30 you are on call. If you are #30 of 30 you are post call. If you are #27, you should be home early in the day.
4) Eat what you kill with a blended unit.
5) Stipend for call, call backs, pre-op clinic, etc. Room for financial negotiations for those who do ICU, pain, cardiac, peds, etc.
6) 1099.
7) Partner from day one. Little or no financial buy in.
8) Vacation and new recruits based on what the group wants. i.e., run lean and take more home OR hire extra hands and have more vacation.
9) Depending on what the group wants, MD only, mix, or supervision. Financial pressures will determine this point. If using CRNA's, they MUST be employed by the group.
10) Recruit those who don't want to take call. Those that do take call can have a good income while those that don't will have a good lifestyle. Everybody is happy if you have a good balance of the young and hungry docs and the older ones. This applies for not only call, but vacation as well.
11) Those who try to cheat the system will be given fair warning and ultimately let go if they can't fit in.

I'm sure I'm missing a lot of points and it's good to realize that no group is perfect.
If you have 1-11, it's a great start.
 
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Somewhere between #2-3:

Anesthesia staff involved in hospital wide committees.
 
3 super partners (inc. me) 2-3 X income + hidden stipend and 5% admin fee.
10 partners 2-3 X income
10 exploited non partner track/mommy track 1.5 X salary
2 really exploited partner track, best one gets in. 2 men enter, one man leaves. 4 years sounds good. X salary
40 CRNAs.

That's almost perfect. Make it no partnership track but the suggestion that at some point there will be a partnership track that may take 4-5 years but won't start for several years, if ever. OR keep the 2 partnership track spots but neither gets in ever.
 
3 super partners (inc. me) 2-3 X income + hidden stipend and 5% admin fee.
10 partners 2-3 X income
10 exploited non partner track/mommy track 1.5 X salary
2 really exploited partner track, best one gets in. 2 men enter, one man leaves. 4 years sounds good. X salary
40 CRNAs.
That's almost perfect. Make it no partnership track but the suggestion that at some point there will be a partnership track that may take 4-5 years but won't start for several years, if ever. OR keep the 2 partnership track spots but neither gets in ever.

The best part, though, is the Thunderdome.
 
3 super partners (inc. me) 2-3 X income + hidden stipend and 5% admin fee.
10 partners 2-3 X income
10 exploited non partner track/mommy track 1.5 X salary
2 really exploited partner track, best one gets in. 2 men enter, one man leaves. 4 years sounds good. X salary
40 CRNAs.

Sounds like you are one of my super partners!!!
 
Curious about this: is it to keep people working hard?
Blending units in an eat-what-you-kill arrangement is mostly intended to reduce the odds of anyone gaming the schedule to do more cases with good insurance vs less charity work. True eat-what-you-kill can screw the people who don't control the schedule. It's not perfect but it removes one source of exploitable bias in the schedule.
 
Curious about this: is it to keep people working hard?
More like keeping people from being lazy. If you are salaried, then you get the same paycheck... weather you work 20 hours or 80 hours. "It will all work out in the end" is a bunch of BS.

Eat what you kill with a blended unit means if you work 20 hours, you get paid for 20 hours. If you work 80 hours you get paid for 80 hours.

Not so easy to be a slug under this system. If you are a slug, then you will get slug pay. If you want to crush it and have an 80 hour work week, then you will get an 80 hour paycheck. Leaves a lot of flexibility for what you want out of the job.

Under my current system, I have partners that don't take call, give up their call, leave at 1pm routinely, etc. Then there are those who take extra weekends, stay late, and pick up extra calls. Then there are some that fall in the middle. Pretty good harmony actually.
 
Blending units in an eat-what-you-kill arrangement is mostly intended to reduce the odds of anyone gaming the schedule to do more cases with good insurance vs less charity work. True eat-what-you-kill can screw the people who don't control the schedule. It's not perfect but it removes one source of exploitable bias in the schedule.

There are others. In the blended unit model, a way of gaming the system is to pick rooms that can generate more units per shift. Maybe a room filled with Ear tubes and tonsils, quickie arthroscopies, etc. A fair way of dealing with this would be a rotation where each of the docs rotate getting first crack at his or her assignment for the day.

Arguing about money and time and bad feelings are often present in groups. It is more the rule than the exception. Things like separate call for hearts, those who have fellowship training or special skills, e.g. TEE, desiring something extra for this. Call at multiple sites where site A is busier at night than site B, If the practice is a mix of MD anesthesia and supervision, resentment for those who supervise more than personally provide. It goes the other way too, the guy supervising is generating more than the guy stool sitting., Resentment for those that have administrative responsibilities who expect to get paid for that time spent, etc., etc.,
 
Blending units in an eat-what-you-kill arrangement is mostly intended to reduce the odds of anyone gaming the schedule to do more cases with good insurance vs less charity work. True eat-what-you-kill can screw the people who don't control the schedule. It's not perfect but it removes one source of exploitable bias in the schedule.

Correct. Which is why the person on call should make the schedule. This way the daily schedule is rotated through all the partners.
 
simplest way is to equally split the money and equally share the call/work hours. If people want to take less call, they can pay another partner to work it for them. Then nobody cares what room they are in or what insurance their patient has as everybody splits the money equally.
 
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