HOPD Contract help

[Inygma]

Hi all. Appreciate any feedback/information especially you guys hospital employed.

I am getting an offer from one of the main hospitals in my area. I am in the Southwest. Cheap COL - I own my house for about $1500/mo for a 2800sf 5br.

Offer is around $400k base guarantee for 2 years. 3rd year and beyond is strictly wRVU. wRVU around $52. Sign on bonus around $30k. Good benefit package (35 days vacation). The two current full time pain docs are my friends (1x is on his 3rd year out, 1x on his first year out). They both enjoy the place, and have pretty good lifestyle. Big draw is that it qualifies for PSLF, which i'll be 60/120 payments in when I start and I owe $500k+. I really don't know what/if to negotiate, as I'd like to work there. Any suggestions/thoughts?

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[SgtThunderfistMD]

52 is bad particularly in a non-competitive market (? southwest)

mgma shows median closer to 63 i believe

southwest should trend higher

 

[cowboydoc]

Not hard to find pslf qualifying job. $52 is terrible. See PM for a guide.

 

[drusso]

Swipe left.

 

[Baron Samedi]

Ah, the high base salary. Like the lure of the siren's song. Never what it seems to be, but who among us can resist?

 

[Inygma]

Thank you all.. I didn't realize the wRVU was so low, thought the average was $55, going to negotiate and see. I have other options in the same location. I can get an academic gig for 4x days a week for $350k straight salary which would also be pslf

 

[cowboydoc]

Thank you all.. I didn't realize the wRVU was so low, thought the average was $55, going to negotiate and see. I have other options in the same location. I can get an academic gig for 4x days a week for $350k straight salary which would also be pslf

solid part time job. Live like a resident and have a nice quiet life or find a side hustle. Sounds ok either way.

 

[Ducttape]

You could negotiate. After 2 years, get in writing guaranteed wrvu of at least $60.

See if they bite...

 

[paindoc007]

Even $60 is low for that area. 65 minimum

 

[Ronin1]

You should buy the data from resolve.com. It’s cheap. Last guy we hired in our HOPD group started at 475. 50k signing and 2 year guarantee. 65/unit over the base. He should exceed the guarantee during year 2.

 

[Inygma]

You should buy the data from resolve.com. It’s cheap. Last guy we hired in our HOPD group started at 475. 50k signing and 2 year guarantee. 65/unit over the base. He should exceed the guarantee during year 2.

I was looking at that... there are no contracts in my specialty and in my state. I am wondering if its worth the $199 knowing that.

 

[afob100]

MGMA national median $/wrvu in 2020 was $68.49. I think the latest is around $75, but I don't have the data

 

[Status Sciaticus]

Not hard to find pslf qualifying job. $52 is terrible. See PM for a guide.

Could I get that PM too?

 

[mdo1738]

Way too low. Need an absolute minimum of $60 per RVU. Base salary a bit low too.

 

[GoBeers]

Way too low. Need an absolute minimum of $60 per RVU. Base salary a bit low too.

have you seen any southwest jobs with better RVU and higher base salary?

 

[SSdoc33]

Wait a minute…..

How do you fit 5 bedrooms into 2800 square feet?

 

[BobBarker]

Your ability to negotiate is going to be severely hampered due to they have just successfully on boarded two comparable physicians who likely were presented the same deal.

 

[drusso]

Your ability to negotiate is going to be severely hampered due to they have just successfully on boarded two comparable physicians who likely were presented the same deal.

This is how we screw each other. We keep taking crap jobs.

 

[Ronin1]

Why would anyone take a lesser rate than their associates are getting? That’s the first question I would ask in a hopd job. I.e. what’s your rate

 

[clubdeac]

Why would anyone take a lesser rate than their associates are getting? That’s the first question I would ask in a hopd job. I.e. what’s your rate

Yeah stupid. Apparently they didn’t know what the other docs were getting. Ours are all in the mid 70s

 

[Ronin1]

Yeah stupid. Apparently they didn’t know what the other docs were getting. Ours are all in the mid 70s

Mid 70s. Good for you guys

 

[GatorCHOMPions]

They’re cutting it though while they roll in the 2021 e/m rvu increases. They say it will come out a wash. Still pissed

We’re still on 2020, it seems criminal. Moving to 2021 should boost you 15-20%.

 

[cowboydoc]

We’re still on 2020, it seems criminal. Moving to 2021 should boost you 15-20%.

Interesting. I thought I’d bump by about 10% with the migration to 2021 scale and spent a fair amount of energy being pissed when they decided to renege on the plan. Our director of finance (who is my patient) tells me she is having to get creative to make sure I don’t take a pay cut with the pending update to the new scale. More to come…

 

[GatorCHOMPions]

Interesting. I thought I’d bump by about 10% with the migration to 2021 scale and spent a fair amount of energy being pissed when they decided to renege on the plan. Our director of finance (who is my patient) tells me she is having to get creative to make sure I don’t take a pay cut with the pending update to the new scale. More to come…

99214 which is probably our most commonly used code went up 28%. 99213 went up 34%. 99203 up 13% and 99204 up 10% based on what I’ve seen. Anyone else know differently?

 

[Inygma]

I'm basically sending a counter offer with an increase in everything offered. I have the academic job as a backup if they decide to rescind the original offer... Also a lot of great people have messaged me if I am looking to relocate (thank you all).

 

[clubdeac]

99214 which is probably our most commonly used code went up 28%. 99213 went up 34%. 99203 up 13% and 99204 up 10% based on what I’ve seen. Anyone else know differently?

Here are the new wRVUs for each code

 

[clubdeac]

We’re still on 2020, it seems criminal. Moving to 2021 should boost you 15-20%.

Agree completely

 

[sevo00]

Yeah stupid. Apparently they didn’t know what the other docs were getting. Ours are all in the mid 70s

How would they know what you’re getting. If anything you should be letting them know what to expect as the more senior colleague at the group. They can’t just guess what your conversion factor is without you explicitly telling them

 

[RoloTomassi]

Hi all. Appreciate any feedback/information especially you guys hospital employed.

I am getting an offer from one of the main hospitals in my area. I am in the Southwest. Cheap COL - I own my house for about $1500/mo for a 2800sf 5br.

Offer is around $400k base guarantee for 2 years. 3rd year and beyond is strictly wRVU. wRVU around $52. Sign on bonus around $30k. Good benefit package (35 days vacation). The two current full time pain docs are my friends (1x is on his 3rd year out, 1x on his first year out). They both enjoy the place, and have pretty good lifestyle. Big draw is that it qualifies for PSLF, which i'll be 60/120 payments in when I start and I owe $500k+. I really don't know what/if to negotiate, as I'd like to work there. Any suggestions/thoughts?

Ask your friends what their wrvu rates are

 

[sevo00]

True, but they interviewed with all of us. They could’ve asked

Someone fresh out of fellowship might not be smart enough to ask this question yet. Or they might consider it taboo. It falls on the employer to give all the information needed and not try to hide information from the new interviewee

 

[Inygma]

Ask your friends what their wrvu rates are

Its the same, $52sh. AKA terrible.

 

[RoloTomassi]

Its the same, $52sh. AKA terrible.

Yeah going to be hard for the new guy to demand more than the two existing. But there is an intangible element to working with your friends. In the spirit of Thanksgiving I'm very thankful my partners are my friends who I respect and trust personally and professionally

 

[clubdeac]

Someone fresh out of fellowship might not be smart enough to ask this question yet. Or they might consider it taboo. It falls on the employer to give all the information needed and not try to hide information from the new interviewee

Agree, employer was not forth coming and transparent on purpose

 

[IYKYK]

We’re still on 2020, it seems criminal. Moving to 2021 should boost you 15-20%.

I may be misunderstanding, but are you saying you're getting paid based on 2020 wRVU values? Is that legal?

 

[GatorCHOMPions]

I may be misunderstanding, but are you saying you're getting paid based on 2020 wRVU values? Is that legal?

Yes 2020 values for the whole hospital system. I know at least one neighboring hospital is still using 2020 as well. I’m going to ask for an RVU conversion raise if it’s still this way deep into 2024.

 

[DOctorJay]

Agree, employer was not forth coming and transparent on purpose

Will that come back to bite the established docs? Pressure to decrease the $/wRVU value? Make you guys miserable til you leave and replace you with cheaper new grads? Or simply piss off the new grads and they leave after a year or 2?

 

[clubdeac]

Will that come back to bite the established docs? Pressure to decrease the $/wRVU value? Make you guys miserable til you leave and replace you with cheaper new grads? Or simply piss off the new grads and they leave after a year or 2?

yeah that's my fear. I guess we'll see what happens

 

[Status Sciaticus]

True, but they interviewed with all of us. They could’ve asked

You could've also volunteered that information. Something something about rising tides lifting all boats and all.

Yes 2020 values for the whole hospital system. I know at least one neighboring hospital is still using 2020 as well. I’m going to ask for an RVU conversion raise if it’s still this way deep into 2024.

Are they getting paid on the 2020 values as well? If not, this could be considered wage theft.

 

[GatorCHOMPions]

You could've also volunteered that information. Something something about rising tides lifting all boats and all.

Are they getting paid on the 2020 values as well? If not, this could be considered wage theft.

Yes everyone is on 2020 values in the whole system. When I said I’ll ask for a raise I meant the $/RVU not to be on 2021 when everyone else is still 2020.

 

[SC Tian]

Imo, two parameters determine compensation: $ per wRVU, the amount of wrvus the hopd can support. Some hopd system are very efficient to support 10k wrvus or so, some others are not that efficient, average wrvus are only 5k, they use $/wrvu to adjust total compensations so that it is not too far from median.

 

[clubdeac]

You could've also volunteered that information. Something something about rising tides lifting all boats and all.

Are they getting paid on the 2020 values as well? If not, this could be considered wage theft.

They’ve kept all of us on the 2020 values as well

 

[Status Sciaticus]

They’ve kept all of us on the 2020 values as well

Right, I understand that. However, they are being reimbursed 2023 values. So theyre screwing you in two ways, not just one.

 

[CleanUp]

Imo, two parameters determine compensation: $ per wRVU, the amount of wrvus the hopd can support. Some hopd system are very efficient to support 10k wrvus or so, some others are not that efficient, average wrvus are only 5k, they use $/wrvu to adjust total compensations so that it is not too far from median.

This is spot on.

Instead of everyone arguing dollar per rvu I suggest working from the final comp and going from there.

In my experience I was offered an above market dollar per rvu. Digging a little deeper though I was limited by possible rvus per year given the staff was slow and OR space was limited. The dollar per rvu didn’t tell the entire story.

I ultimately took an offer that had a very low rvu but I realized the total comp was much much higher because of the clinic and OR staff, ancillary support and OR availability. And this was not even including ancillaries like PT, MRI and other bonuses for things I was already doing.

 

[DOctorJay]

This is spot on.

Instead of everyone arguing dollar per rvu I suggest working from the final comp and going from there.

In my experience I was offered an above market dollar per rvu. Digging a little deeper though I was limited by possible rvus per year given the staff was slow and OR space was limited. The dollar per rvu didn’t tell the entire story.

I ultimately took an offer that had a very low rvu but I realized the total comp was much much higher because of the clinic and OR staff, ancillary support and OR availability. And this was not even including ancillaries like PT, MRI and other bonuses for things I was already doing.

How are you being bonused from ancillaries in an HOPD setup?

 

[SC Tian]

There different types of HOPD: for profit, physician owned, private not for profits, state owned etc.

 

[clubdeac]

Right, I understand that. However, they are being reimbursed 2023 values. So theyre screwing you in two ways, not just one.

Agree 100%. Question is do we physicians have any recourse other than to just look for other employment

 

[Status Sciaticus]

Agree 100%. Question is do we physicians have any recourse other than to just look for other employment

class action?
Ill bring up the point again of wage theft. Of course, an attorney would be able to give you the over/under that threatening action would yield a benefit.

 

[DODOCSS]

Imo, two parameters determine compensation: $ per wRVU, the amount of wrvus the hopd can support. Some hopd system are very efficient to support 10k wrvus or so, some others are not that efficient, average wrvus are only 5k, they use $/wrvu to adjust total compensations so that it is not too far from median.

100% wrong

 

[CleanUp]

Will that come back to bite the established docs? Pressure to decrease the $/wRVU value? Make you guys miserable til you leave and replace you with cheaper new grads? Or simply piss off the new grads and they leave after a year or 2?

I’ve been involved with three large healthcare systems. Two out of the All three have gone through a period of cutting costs. The themes I see when it comes to the pain departments are as follows
1. Hire IMGs.
2. Hire DOs
3. Hire PMR.
4. Hire new grads.
5. Hire someone desperate to move to the area

In essence the system always has the upper hand in these negotiations then.

How are you being bonused from ancillaries in an HOPD setup?

I’m not in an HOPD set up

 

[BobBarker]

I’ve been involved with three large healthcare systems. Two out of the All three have gone through a period of cutting costs. The themes I see when it comes to the pain departments are as follows
1. Hire IMGs.
2. Hire DOs
3. Hire PMR.
4. Hire new grads.
5. Hire someone desperate to move to the area

In essence the system always has the upper hand in these negotiations then.

I’m not in an HOPD set up

I think it is more the hospital has no bias against the individuals in these categories but the private spine hospital/neurosurgery group does.