How to handle colleagues not pulling their weight

[emergentmd]

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Again, all theoretically possible but something I've never seen in practice. Those 4 patients would all still be actively managed by the primary MD until the signout became: 1 had a stroke and is being admitted. 2 has a benign workup. Still hasn't peed. Needs to be admitted either way as they're old and failing at home. Click admit once UA back. 3's shoulder is back in place and they're discharged on the board. Tech is busy getting them a sling. Patient 4 is better with nitro and is being admitted.

We have enough coverage that the doc who's leaving would either 1: have decided to pick all of these up in the last hour because they know they're likely going to stay late to dispo them and will get a bunch of money, or 2: would not have picked them up and the other doc would have.

People who try to give the signout you posited would not be with our group for very long. If you wanna make a bunch of extra money, go ahead and be option 1 above. If you want to leave on time, you can do that too. I almost always pick option #2 unless the fam is out of town or something and I have literally nothing else to do except make an extra $500-$1000.

I interviewed at a place like this and it was a no go for me. So I asked one of the docs, what happens if you have a slow doc having 10 WTBS and a fast doctor sipping coffee? They said they would move some over, which defeats the purpose or they just wait, another poor option.

Unless there was a carrot for higher output, I would just be as fast or slow as the doc I am working with. Be a hero and see pts fast will result in slower docs just letting you do everything

 

[WhatJobDoIPick]

I interviewed at a place like this and it was a no go for me. So I asked one of the docs, what happens if you have a slow doc having 10 WTBS and a fast doctor sipping coffee? They said they would move some over, which defeats the purpose or they just wait, another poor option.

Unless there was a carrot for higher output, I would just be as fast or slow as the doc I am working with. Be a hero and see pts fast will result in slower docs just letting you do everything

Non-productivity based EM compensation results in a race to the bottom.

When I joined the hospital employed pyramid scheme that was my last job I quickly became the first or second most productive, yet in bottom third of compensation.

Me to chair "now if you look at my numbers you'll see that I am very very productive. I would like a raise."

Chair "Aw shucks. We don't compensate based on productivity."

Guess what happened to my productivity afterwards.

 

[EctopicFetus]

I’m 100% rvu based. Love it. I love being on with the slow docs. Have to staff at 40th or so percentile of your docs. Have to leave some room for busy days. Still it works. On a “slow” shift I make enough on a
Busy shift I’m happy cause I made good dough. Key is behaving and sharing charts.

I would rather incentivize people to work hard than to be lazy. Would rather create a system that is desirable to people who work hard than one that encourages people to be lazy.

 

[Janders]

I’m 100% rvu based. Love it. I love being on with the slow docs. Have to staff at 40th or so percentile of your docs. Have to leave some room for busy days. Still it works. On a “slow” shift I make enough on a
Busy shift I’m happy cause I made good dough. Key is behaving and sharing charts.

I would rather incentivize people to work hard than to be lazy. Would rather create a system that is desirable to people who work hard than one that encourages people to be lazy.

There are downsides to 100% RVU (or any close relative).

But I 100% prefer it to my former position which was 99% hourly and 1% “bonus” partially based on productivity.

Talk about walking into a bunch of charts in the rack for 2-3hrs, angry patients, angry nurses and frankly suboptimal care…

 

[WhatJobDoIPick]

There are downsides to 100% RVU (or any close relative).

But I 100% prefer it to my former position which was 99% hourly and 1% “bonus” partially based on productivity.

Talk about walking into a bunch of charts in the rack for 2-3hrs, angry patients, angry nurses and frankly suboptimal care…

Yup, nothing is perfect, and there should be a floor to protect against uncharacteristically low volumes, because after all we should be paid for our time.

Old job was essentially as you describe 99/1. I can't tell you how badly this breeds laziness. If people see 1.6 PPH it's a ton. Wait times through the roof. Lots of LWBS (oh wait it's "eloped" cause they were seen by a provider in triage 6 hours ago LOL). Angry patients, lazy nurses. Admins solution is to throw more physician hours at an already backlogged system, because they can't comprehend that the systems issues are non-physician factors (consultants, delays, radiology etc)

While we're at it, let's tie nursing compensation to productivity too. Time from orders to collection, time to urine, time from med orders to administration, time from DC order placed to discharge. Let them feel the burn.

 

[s/p epilepticus]

While we're at it, let's tie nursing compensation to productivity too. Time from orders to collection, time to urine, time from med orders to administration, time from DC order placed to discharge. Let them feel the burn.

DTU or "Door to Urine" time is a nursing metric I can get behind.

 

[Janders]

While we're at it, let's tie nursing compensation to productivity too. Time from orders to collection, time to urine, time from med orders to administration, time from DC order placed to discharge. Let them feel the burn.

I have always wanted to figure a way to offer RN staff (and the techs too while we are at it) with bonus pay for productivity. There is a massive difference between the nurse that is in there churning quickly with you, a competent one that does the job as expected and one that disappears for times, plays on their phone 20 minutes before hanging meds, dodges assignments and holds discharges for 30min to avoid an empty bed space.

Yes the poor ones often are eventually drummed out, but I wish the superstars could get $x bonus a shift because THEY are moving meat, improving satisfaction and decreasing LWBS by working extra hard (and often skipping their "breaks").

 

[EctopicFetus]

I have always wanted to figure a way to offer RN staff (and the techs too while we are at it) with bonus pay for productivity. There is a massive difference between the nurse that is in there churning quickly with you, a competent one that does the job as expected and one that disappears for times, plays on their phone 20 minutes before hanging meds, dodges assignments and holds discharges for 30min to avoid an empty bed space.

Yes the poor ones often are eventually drummed out, but I wish the superstars could get $x bonus a shift because THEY are moving meat, improving satisfaction and decreasing LWBS by working extra hard (and often skipping their "breaks").

I also agree here. The RVU issue can be managed by leveling it over time. For example some groups do a running 12 months. Others do it over a quarter.

There is cherry picking as a problem but you hope you don't have a ton of turds. Need people who will behave or have a system where you can spank someone.

I have my few RNs I love.. they get things done, no excuses and move the meat. others its like I want to claw my eyes out.

 

[Janders]

You know how some docs have scribes?
In the dark times of so many patients and so few nurses, I had this pipe dream of coming to work with my personal side kick nurse.

Get one of the ones I love working with, pay them cash $100/hr, give them two gurneys and two chairs in a corner somewhere, and we churn patients in our personal miniPod while I also continue to see patients in the slogged in Ed. Basically start converting all those lwbs and 5hr waits to revenue.

 

[DOswag]

True, but statistically you will be "the other guy" half the time that imbalance happens.

To reiterate though, this isn't my preferred solution. Keep what you kill in a busy dept is the only way to go in my mind. Turns out, if you incentivise people to work harder, they frequently do! And if you don't, they don't. Who woulda thought?

Non-productivity based EM compensation results in a race to the bottom.

When I joined the hospital employed pyramid scheme that was my last job I quickly became the first or second most productive, yet in bottom third of compensation.

Me to chair "now if you look at my numbers you'll see that I am very very productive. I would like a raise."

Chair "Aw shucks. We don't compensate based on productivity."

Guess what happened to my productivity afterwards.

I’m 100% rvu based. Love it. I love being on with the slow docs. Have to staff at 40th or so percentile of your docs. Have to leave some room for busy days. Still it works. On a “slow” shift I make enough on a
Busy shift I’m happy cause I made good dough. Key is behaving and sharing charts.

I would rather incentivize people to work hard than to be lazy. Would rather create a system that is desirable to people who work hard than one that encourages people to be lazy.

Ah this is America and I love it, although there are some systems in place that do incentivize laziness (not trying to get into any sort of political discussion or debate). But by and large we like to try to incentivize hard work and productivity because that tends to produce better results in the long run for everyone. I love coming to visit the ER forum from time to time.

 

[xaelia]

Non-productivity based EM compensation results in a race to the bottom.

I'm not sure how common RVU- or productivity-based compensation is outside of the U.S./Canada. The rest of the world's societies have not collapsed.

 

[thegenius]

Yup, nothing is perfect, and there should be a floor to protect against uncharacteristically low volumes, because after all we should be paid for our time.

Old job was essentially as you describe 99/1. I can't tell you how badly this breeds laziness. If people see 1.6 PPH it's a ton. Wait times through the roof. Lots of LWBS (oh wait it's "eloped" cause they were seen by a provider in triage 6 hours ago LOL). Angry patients, lazy nurses. Admins solution is to throw more physician hours at an already backlogged system, because they can't comprehend that the systems issues are non-physician factors (consultants, delays, radiology etc)

While we're at it, let's tie nursing compensation to productivity too. Time from orders to collection, time to urine, time from med orders to administration, time from DC order placed to discharge. Let them feel the burn.

And that's where hybrid models come in, which is probably the best model out there. About 60% of our pay is RVU protected (e.g. salary) and 40% is RVU. We have a pretty wide variation of pay in our group, over $100/hr from most productive to least productive.

 

[WhatJobDoIPick]

I'm not sure how common RVU- or productivity-based compensation is outside of the U.S./Canada. The rest of the world's societies have not collapsed.

Up to you if you want to be paid your worth or not.

 

[EctopicFetus]

Up to you if you want to be paid your worth or not.

Half the people don’t want to be paid their worth n they want to be paid the worth of the other half.