Doom, Gloom and career selection

[militarymd]

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no one has to "deep six" anyone, if they hire the right person in the first place. apparently you've had to do this more than once. i think that speaks volumes.

Have not had to do this ONE single time...per above post.....but if what you say is true....then why EVER bother with a termination clause???

I assume your contract has a termination clause....right?

Or did your experience and superior negotiation skills allow you to get a contract without a termination clause?

 

[VolatileAgent]

I assume your contract has a termination clause....right?

Or did your experience and superior negotiation skills allow you to get a contract without a termination clause?

of course it has a termination clause, and a moral turpitude clause, and a covenant not to compete and a bunch of other standard stuff that will never get invoked unless i just stop showing up for work or start sleeping with 14-year-olds. the point is, it's not so lopsided as to let them do whatever they want without cause. it's not so vague as to be openly interpretable. and, even "at will" contracts can be fought in court if you're terminated without due process. i know this because i've been involved in litigation (my company in the past) in such a scenario... and had to settle big time to get it resolved.

i do have experience dealing with contracts, probably more so than most going into this, and i can only tell people this again and again: do not get emotionally involved in this process. if you don't like what they say, smile and walk away. if you've got the goods, they'll bend. if they don't, someone else will want you.

and, the point is that you terminated people. it doesn't matter the circumstances. and, by your choice of language, it's clear you took pleasure in it. i'm not sure of the exact details around your firings, but i know that there are many owners like you who are readily and willingly able to fire someone - and use the contract like a shield - instead of trying to make it work.

 

[militarymd]

i do have experience dealing with contracts, probably more so than most going into this, and i can only tell people this again and again: do not get emotionally involved in this process. if you don't like what they say, smile and walk away. if you've got the goods, they'll bend. if they don't, someone else will want you.

and, the point is that you terminated people. it doesn't matter the circumstances. and, by your choice of language, it's clear you took pleasure in it. i'm not sure of the exact details around your firings, but i know that there are many owners like you who are readily and willingly able to fire someone - and use the contract like a shield - instead of trying to make it work.

In the coming years....with the renewed interest....and according to you....a plethora of highly motivated trainees....as opposed to the slackers in my generation of anesthesiologists......There will the be PLENTY of job searchers with the GOODS....as you put it.....The readers (upcoming MDAs) won't be able to walk...as you put it.

Where in my language did I show pleasure in terminating unacceptable employees???? Quote if you can.....

As a business man, with business experience (as you claim) then you should be the first the realize that decisions need to be made for the BUSINESS....and not for the individual.

It is not the responsbility of the BUSINESS owner to "work with" employees who are a liabilities to the BUSINESS.....Small businesses are not charities for the kind of people who I have fired.....

 

[mille125]

In the coming years....with the renewed interest....and according to you....a plethora of highly motivated trainees....as opposed to the slackers in my generation of anesthesiologists......There will the be PLENTY of job searchers with the GOODS....as you put it.....The readers (upcoming MDAs) won't be able to walk...as you put it.

Where in my language did I show pleasure in terminating unacceptable employees???? Quote if you can.....

As a business man, with business experience (as you claim) then you should be the first the realize that decisions need to be made for the BUSINESS....and not for the individual.

It is not the responsbility of the BUSINESS owner to "work with" employees who are a liabilities to the BUSINESS.....Small businesses are not charities for the kind of people who I have fired.....

i hate to say it....but military is right in this debate

 

[mille125]

why you ask??? guys like myself and military have taken an extreme risk in going out and starting a new practice. Most people would be unwilling, unable, or unqualified to do this. Then a new guy on the block wants to join the practice and fills that he deserves the same as the guy that took the risk. I am all for being fair but get real.

 

[VolatileAgent]

As a business man, with business experience (as you claim) then you should be the first the realize that decisions need to be made for the BUSINESS....and not for the individual.

It is not the responsbility of the BUSINESS owner to "work with" employees who are a liabilities to the BUSINESS.....Small businesses are not charities for the kind of people who I have fired.....

wrong! you are arguing my point. if you are hiring "liabilities" as you put it, that's your fault. no one else's. if you have a great organization, people will want to come work for you - and you will get the people who'll make your organization better. draconian contract language scares good people away, and you are left with chaff.

you illustrate a common problem with people who simplistically reflect business-for-business's sake mentality. this especially does not translate well into the healthcare profession. this is about primary business philosophy, and there are those of us who do not adhere to that paradigm.

the biggest challenge for an organization is to develop and retain highly qualified employees. this goes for any business. actually, businesses pay a premium to hire those who already have experience. a company with high turnover usually has low morale, as new hires are often recruited in at premium salaries. in the late 1990's in the high tech job market, the average length of employment for a programmer per job was 8 months. most of those companies are no longer in existence and, i believe, this is in large part due to their inability to take a good idea to fruition because of high employee turnover. there was no continuity to their product.

i prescribe to the model proposed by gordon bethune, now-retired chairman of continental airlines. he is one of the true iconoclastic ceo's, similar to howard schultz of starbucks or jim senigal of costco, who took a different business approach in rebuilding continental. he truly understood that any organization is ultimately about its people. in his book, "from worst to first", bethune details how many organizations - in pursuit of the bottom line - forget that it really is all about the people they have working for them. i highly suggest that you read this book, mil. you stand to gain a new perspective on what you do.

those who don't understand this simple fact will continue to struggle with recruiting and retaining quality employees. unfortunately, this is currently the rampant and prevalent negative attitude in the healthcare world. it is a rare leader who understands and engenders an employee-centered organization. this is mostly because there are very few people who actually know how to and are good at managing others.

 

[militarymd]

I've read the book....given to me by my mentor.

And your paradigm is not accurate.

You're comparing new hirees....with little or no skills to......highly trained physicians.

You're applying human resource models that DO NOT apply to highly trained physicians.

Read my previous post on the paradigm of my group....pay structure, work structure, etc.etc....

It is ALL about the right people....except I don't make them the right people.....they either will fit in or not......

We're not talking college grads or even freshly minted MBAs here.....we're talking FULLY TRAINED physicians.

You can disagree ...as I'm sure you will, but I hate to say it....I own a group...

a group that I turned from a laughing stock in our community to "the best anesthesia group" as quoted from the Chief of surgery....based largely on firing the folks that don't "fit" and hiring folks that I personally chose.....

You have business experience ....experience in a time era and medicoeconomic landscape that no longer exists...and you're working on finishing your residency.....

I don't think you're correct or accurate in your beliefs.

 

[militarymd]

wrong! you are arguing my point. if you are hiring "liabilities" as you put it, that's your fault. no one else's. if you have a great organization, people will want to come work for you - and you will get the people who'll make your organization better. .

Your inability to read my posts...makes me wonder how you could ever interpret any type of contracts....let alone negotiate for one.

Go back to my earlier posts.....I did not hire any "liabilities"....they were there for years before me.....not my fault...

I fixed the fault that existed by firing them.

I now have a great organization based on the folks that I personally chose to replace the slots vacated by the liabilities....and people WANT to come work IN (not for me) my group....

and let's not fool ourselves here.....in the business of anesthesiology (medicine) ....it's about the money.....if the economic base crumbles (ie collections)......the good people will leave....along with me.

 

[VolatileAgent]

I've read the book....given to me by my mentor.

And your paradigm is not accurate.

You're comparing new hirees....with little or no skills to......highly trained physicians.

again, mil, i hate to say it but you are wrong. if you actually did read the book, then you'd know that bethune did not blanketly fire people and bring in brand new employees with no experience. he restructured the organization from the ground up, and did so by engendering a employee-centered philosophy. now, he did bring in some new people and told certain others "this is the way it's going to be". i'm sure more than a few left. but, this is a far cry from "deep sixing" people.

i'm disheartened that you appear to believe that you have nothing to learn from this, that your "winner take all" attitude should prevail. this is exactly the problematic attitude that is rampant in the healthcare world, and why we have so many issues from the top down. as long as you continue your dog-eat-dog ways, there will be many other bureaucrats and administrators out there to exploit you. and, it's equally sad that you only see a different perspective as "experience in a time era and medicoeconomic landscape that no longer exists".

you, in no other terms, are part of the problem, not the solution. it is you who are antiquated, and you will eventually get swallowed.

 

[VolatileAgent]

Your inability to read my posts...makes me wonder how you could ever interpret any type of contracts....let alone negotiate for one.

Go back to my earlier posts.....I did not hire any "liabilities"....they were there for years before me.....not my fault...

I fixed the fault that existed by firing them.

I now have a great organization based on the folks that I personally chose to replace the slots vacated by the liabilities....and people WANT to come work IN (not for me) my group....

and let's not fool ourselves here.....in the business of anesthesiology (medicine) ....it's about the money.....if the economic base crumbles (ie collections)......the good people will leave....along with me.

this all occurred within the past two years? how long have you been there? i ask because i believe that you are now lying and trying to reinvent yourself. (we can go back and dig up those posts where you previously admit that you hired and then had to fire someone, if we have to...)

everything else in your post is the sad truth. unless and until people are willing to start doing things differently...

 

[militarymd]

Once again....

business of medicine (anesthesiology) is not the same as the rest of the business world.

We deal with highly trained physicians...not some pimple faced MBA....

If you want to do it your way ..that's fine....if you become a partner...rather than receiving that dreaded talk 6 months before making partnership.

In the last 2 years I have been doing it my way...and it is successful.

You can ask the Sensei..he knows me....We've met in real life....he knows the deal.

All I can say....is I've been there...I'm doing it.

All you can say...is I've read the book...and i'll do it when I get done with training....and make partner.

 

[VolatileAgent]

business of medicine (anesthesiology) is not the same as the rest of the business world.

well, actually, again you are just wrong. anesthesiology especially is an end-service provider model that fits very nicely with many other fee-for-service consultant/outsourcing models.

We deal with highly trained physicians...not some pimple faced MBA....

you will be forced to be dealing more and more with such "pimple faced" mba types in the future, because your business model is out of date and out of touch with the changing healthcare delivery model.

i said this already, but a large part of the reason why i ended-up going to the practice i'm going to (which worked out better for me in the long run) is that we have a strong, sensible long-term business plan. they appreciated the ideas i offered to them, and my spidey-sense (that told me to discontinue negotiations with the first organization) is strongly positive for this group. the real irony is that, i expect in about 4-5 years, the practice i initially accepted an offer from will probably no longer exist at least as is in its current form. there are many reasons for this that i will not divulge here (part of a longview business plan), but suffice it to say that i have a few unique ideas concerning business development that are neither traditional private practice paradigm nor classic anesthesia practice management type set-ups. stay tuned...

so, milmd, in a few years when you're attending practice management seminars offered by the ASA, i'd be willing to bet there'll be a good chance that you'll be paying money to listen to me speak.

 

[militarymd]

I'm glad some residencies get blessed with residents who know all the answers.....AND is so humble.

For you lurkers...I'm just a small time part business owner with 2 partners who hold MBAs and 1 with a CPA.......with combined healthcare business experience in excess of 60 years (not counting mine because I was in the Navy)....but we're just learning.

 

[urgewrx]

You're comparing new hirees....with little or no skills to......highly trained physicians.


We're not talking college grads or even freshly minted MBAs here.....we're talking FULLY TRAINED physicians.

You are full of contradictions regarding recent graduates. Fully trained vs. little or no skills? Humph? Regardles, letting people go is not wrong as long as you gave them adequate warning and time to change.

 

[mille125]

Volatile,


You will probably make a great businessman/physician someday. You may revolutionize the field. However, at the present time what you say is just rhetoric. Until you finish residency, pass your boards, and establish yourself as a center of excellence, your soliloquies are just empty prose. You should value your employees especially those that work hard for you. You still need to be smart. Allowing someone to destroy the business that you worked hard to set up is not smart. That is why various contract language exists. I have very little turnover with my employees. They will never work for anyone else. However, they all had to sign a contract with termination clauses, restrictive covenants, etc. I make it a point to sit down with them and discuss why these things need to be in place. I have had no objections to date. I would like to hear your theories when you have more experience in the real world. Until then it is just empty prose.

 

[militarymd]

You are full of contradictions regarding recent graduates. Fully trained vs. little or no skills? Humph? Regardles, letting people go is not wrong as long as you gave them adequate warning and time to change.

Not contradictions.....but different context of description.

New grads DO still have a LOT to learn when it comes to the practice of medicine.....however, the job doesn't change....From day 1 you will practice medicine......on the day you retire...you are practicing medicine.....sure you're adding some administrative stuff along the way, but your JOB is practicing medicine...not learning the corporate organization.....if becoming solely a medical executive is what you want to do (HMO, AMC, etc..) then we're talking about something else altogether....I'm talking about being a doctor in private practice......not an employee of an AMC, or academic center, or HMO.


New business grad....gets hired into a corporation as a junior exec....as you climb the ladder...you're learing the corporation...your job keeps changing...until if you're lucky...you become the CEO....your primary job is business management....not a widget maker...

2 different animals.

 

[swpm]

i'd be willing to bet there'll be a good chance that you'll be paying money to listen to me speak.

Here's a thought, thrown out from the peanut gallery. Of the two awful, patient-killing malpractice disasters I've witnessed thus far in my life, the common thread was a physician whose arrogance was palpable.

I hope your tunnel vision is limited to the trivialities of the business world. Seems like it would be a dangerous trait to carry into the OR.

 

[Gern Blansten]

so, milmd, in a few years when you're attending practice management seminars offered by the ASA, i'd be willing to bet there'll be a good chance that you'll be paying money to listen to me speak.

As a poster who trys to stay out of heated and damaging debates on this forum, I strongly urge you to step back and read your own posts before continuing to respond to this thread. I suggest that you walk away from this thread. There is nothing further to be gained here.

 

[VolatileAgent]

You will probably make a great businessman/physician someday. You may revolutionize the field. However, at the present time what you say is just rhetoric. Until you finish residency, pass your boards, and establish yourself as a center of excellence, your soliloquies are just empty prose.

maybe. and, i certainly cannot make a strong counter-argument to what you say. i do, however (and unlike many highschool->college->med school->residency->real world), have many years of experience in the healthcare industry, prior to becoming a physician, to back it up. so, "rhetoric"... "empty prose"... perhaps. but, i have ideas, based on experience, and that's a lot more than many people who wish to keep doing things the same old way. it's just not going to continue to be tolerated in our field, and we're going to soon be in a position where the bulk of our outside-the-OR-time is spent in meetings, discussions, negotiations, etc., etc.

that is, unless...

You should value your employees especially those that work hard for you. You still need to be smart. Allowing someone to destroy the business that you worked hard to set up is not smart. That is why various contract language exists.

i signed a contract. i am aware of this. i would not expect anyone to be employed, in our profession, without one.

I have very little turnover with my employees. They will never work for anyone else. However, they all had to sign a contract with termination clauses, restrictive covenants, etc.

so did i.

but, i'll give you an example of the something in the contract at the "other place" that resulted (among a few other things) in me not signing. in their non-competition clause, they wanted to restrict me to not taking additional employment in the same city for two years after expiration or termination, regardless of whether i or they initiated cancellation. this would've meant that they could've fired me, and then i couldn't have gone and worked for their competitors across town (whom i didn't even interview with). i basically told them they were smoking dope and that anyone who'd sign such a contract was a *****, not in those exact words of course (which are reserved for my candor here).

now, i understand why they did this and why they want this. but, reading between the lines, it tells me that they've had a problem in the past with such practice, which is a serious red flag that subtly speaks to other potential morale problems there. additionally, the salary wasn't as good as where i ended-up (the offer from my soon-to-be employer came in about 10 days after the first), yet the promised work hours and time off was much better. however, after seeing their rigidity and complete unwillingness to budge in this covenant, i started to believe that maybe they weren't being honest with me about actual work time either. (and, what the kids may want to know is that you are not actually talking directly with the people who are hiring you during this. it's like buying a car. your lawyer is talking with their lawyers. it's like you're standing in the bleachers with binoculars.)

i may be wrong, but again my spidey-sense was pinging. in retrospect, i got a much better deal. i'll have to work a bit harder on the face of contract, but i believe these guys are being straight-up with me. at least, i got (most of) what i wanted in writing. if they kick me out, they pay the tail. if they kick me out in the first two years, the convenant not to compete is expired. no-contigency buy in at the end of the two-year contract guaranteed. those are the big brush strokes. my lawyer has assured me that the rest of the contract is equitable for both parties and contains nothing outrageous or unexpected. i just have to show and do my job, which is expected and what i always intended to do anyway. and my brother, also a lawyer (but not a contracts expert), said it looks fine too.

I make it a point to sit down with them and discuss why these things need to be in place. I have had no objections to date. I would like to hear your theories when you have more experience in the real world. Until then it is just empty prose.

other than the fact that i was a mid-manager at a large healthcare delivery company negotiating and managing service contracts with anywhere from 12-15 employees directly reporting to me at any given time, i just gave it to you. 🙂

 

[VolatileAgent]

New business grad....gets hired into a corporation as a junior exec....as you climb the ladder...you're learing the corporation...your job keeps changing...until if you're lucky...you become the CEO....your primary job is business management....not a widget maker...

is that how you think it works in the "real world"?

in 8 1/2 years, i changed employers three times and moved to two different cities. in that time period, my salary went up 240%. each job i had was not only a different set of characters, but completely different job responsibilities, different employees, different personalities. i was making six figures when i left for med school (and still, to this day, wonder what the hell i was thinking sometimes).

we are uniquely arrogant in the medical profession thinking we can do it all. we think we can take care of patients AND effectively run our business. the fact is, many people lose this game (just ask JPP).

my solution is novel, but will require a major change in the way small to mid-size practices think. if people buy into it, it will protect practices from incursion by management companies as well as hostile bidding by competing contractors. small-to-mid practices are so busy protecting their own little fiefdom that they are usually ill-equipped to defend themselves. they see other practices as the "enemy" who want to horn in on their turf. there is an easy way (on paper, at least) to circumvent this, but it will require trust... and a lot of paperwork. there are so many advantages to the system i've thought up, and to my knowledge (and extensive research) no one is currently practicing this way.

fortunately for me, the midwest (unlike the coasts) is the perfect venue to try this out. stay tuned....

 

[militarymd]

It's been done....we are doing it.

 

[mille125]

maybe. and, i certainly cannot make a strong counter-argument to what you say. i do, however (and unlike many highschool->college->med school->residency->real world), have many years of experience in the healthcare industry, prior to becoming a physician, to back it up. so, "rhetoric"... "empty prose"... perhaps. but, i have ideas, based on experience, and that's a lot more than many people who wish to keep doing things the same old way. it's just not going to continue to be tolerated in our field, and we're going to soon be in a position where the bulk of our outside-the-OR-time is spent in meetings, discussions, negotiations, etc., etc.

that is, unless...



i signed a contract. i am aware of this. i would not expect anyone to be employed, in our profession, without one.



so did i.

but, i'll give you an example of the something in the contract at the "other place" that resulted (among a few other things) in me not signing. in their non-competition clause, they wanted to restrict me to not taking additional employment in the same city for two years after expiration or termination, regardless of whether i or they initiated cancellation. this would've meant that they could've fired me, and then i couldn't have gone and worked for their competitors across town (whom i didn't even interview with). i basically told them they were smoking dope and that anyone who'd sign such a contract was a *****, not in those exact words of course (which are reserved for my candor here).

now, i understand why they did this and why they want this. but, reading between the lines, it tells me that they've had a problem in the past with such practice, which is a serious red flag that subtly speaks to other potential morale problems there. additionally, the salary wasn't as good as where i ended-up (the offer from my soon-to-be employer came in about 10 days after the first), yet the promised work hours and time off was much better. however, after seeing their rigidity and complete unwillingness to budge in this covenant, i started to believe that maybe they weren't being honest with me about actual work time either. (and, what the kids may want to know is that you are not actually talking directly with the people who are hiring you during this. it's like buying a car. your lawyer is talking with their lawyers. it's like you're standing in the bleachers with binoculars.)

i may be wrong, but again my spidey-sense was pinging. in retrospect, i got a much better deal. i'll have to work a bit harder on the face of contract, but i believe these guys are being straight-up with me. at least, i got (most of) what i wanted in writing. if they kick me out, they pay the tail. if they kick me out in the first two years, the convenant not to compete is expired. no-contigency buy in at the end of the two-year contract guaranteed. those are the big brush strokes. my lawyer has assured me that the rest of the contract is equitable for both parties and contains nothing outrageous or unexpected. i just have to show and do my job, which is expected and what i always intended to do anyway. and my brother, also a lawyer (but not a contracts expert), said it looks fine too.



other than the fact that i was a mid-manager at a large healthcare delivery company negotiating and managing service contracts with anywhere from 12-15 employees directly reporting to me at any given time, i just gave it to you. 🙂

well congratulations...you actually had the guts to negotiate a fair contract..many in your position would be afraid to do this on fear of passing up a good job...let me tell you, it would not be a good job if you accept those terms....a noncompete should not be in effect if you are fired, only if you leave the group....the tail provision is also fair.........you should also be able to give the same amount of notice as the group (for example you both should have a 30, 60, 90 day termination clause).... you would be surprised at how many contracts I have read which say that the group can give you 30 days notice to terminate but you must give them ninety.....many people sign these contracts to their chagrin.....

 

[The_Sensei]

You can ask the Sensei..he knows me....We've met in real life....he knows the deal.

He's right........I do know the deal - and here it is:

I wanted to accept a job with Mil's group but was unable to since my wife wanted to stay in NJ; fine.......no regrets. There were a bunch of jokers who were there prior to Mil's arrival. We're talking about lazy, unmotivated slugs. Not everyone can be as smart as Mil; as some comedian said "you can't fix stupid" but you do make a conscientious decision whether or not to work hard. Trust me, no one was ever going to accuse these clowns of working too hard. He came in and metamorphisized a failing practice to a very successful one (as detailed in previous posts). As he has explained ad infinatum in previous posts, there were no secrets: everything was explained to me IN DETAIL when I went to interview. This cat is hard-working, fair, ethical, intelligent and does not tolerate mediocrity. These are all qualities I would hope to find in my colleagues - I mean, I'd even accept it if they had MOST of these qualities.

Volatile, your moniker certainly belies your personality; you are a pretty reactionary guy. I'm not going to resort to name-calling but suffice it to say that if you maintain your current mind-set, all your "ideas" will be delusions of grandeur. I really don't see how you are going to achieve any degree of success if how you act here is how you will act in "real life". Good luck.......

 

[Bertelman]

as some comedian said "you can't fix stupid"

That's Ron White. He's hill-air-ee-us.

This thread, not so much.

 

[The_Sensei]

Bump

 

[zippy2u]

Well Volatile, why not interview at Militaryman's "house" and see if ya can land a job? Perhaps he could be your mentor? Roll on over there in a black Lincoln limo with your entourage of employment contract gurus and razzle dazzle that rocket scientist town. Throw a little weight around, show some muscle, some "heat" and paste it on YouTube or something to show us how it's done. The world needs another Donald Trump... Regards, ---Zippy

 

[VolatileAgent]

Well Volatile, why not interview at Militaryman's "house" and see if ya can land a job? Perhaps he could be your mentor? Roll on over there in a black Lincoln limo with your entourage of employment contract gurus and razzle dazzle that rocket scientist town. Throw a little weight around, show some muscle, some "heat" and paste it on YouTube or something to show us how it's done. The world needs another Donald Trump... Regards, ---Zippy

i'd never work for him. of course, the shoe may someday be on the other foot...