I know I have been stupid---rheumatology

[rheumforawhile]

I am in a bit of a quandry. I have practiced rheumatology for over 30 years and still really enjoy it (most of it anyway). I have many patients (with very high patient satisfaction), have been subspecialty recertified twice, get my charts done on time, etc. Unfortunately, when I started working at my practice 14 years ago, it was a period of duress--my husband had lost his job during the recession (2009) and we had to move quickly. Anyway, my current practice didn't pay well--175K increased to 200K in 2012. However, I was only seeing about 50 to 60 patients a week (4.5 days). However, the hospital basically ignored me and high patient satisfaction. Well, they told me that
didn't need to renegotiate my contract and about the same time my son was diagnosed with cancer that returned as GBM when he was in med school. So, I kind of neglected things contract-wise. I cut my hours to 30 hours/wk when he was near the end and never returned to full time. I figured I was being a bit underpaid, but liked the hours. Meanwhile, I was able to recruit 2 other rheumatologists, who obviously make more than I do as their base. My original contract calls for 40 hours/wk including "patient record keeping"--easily doing that. RVUs are not mentioned in my contract. So, our hospital recently has a new CEO and they gave me 2 weeks to accept a new contract with a 50% pay cut. All RVU-based now. They are doing the same thing to the other rheumatologists (pretty much). They are also going to pay one of the newer rheumatologists more than they will pay me for the same percent time worked--my schedule is packed and that doesn't seem fair (I am retirement age, so likely want to force me out). To not have a pay cut, I will have to work 11 hour days and never take a vacation (by my math). I was told that I should be double-booking patients and to work thru lunch (do anyway). They don't acknowledge the time I spend ordering infusions (e.g., 25 patients on Saphnelo), which I think adds value. I really want to work for another 2 years or so (trying to fund a scholarship to honor my late son)--otherwise financially definitely could retire.
What do you recommend? Thanks for any insights, Anne

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[rokshana]

I am in a bit of a quandry. I have practiced rheumatology for over 30 years and still really enjoy it (most of it anyway). I have many patients (with very high patient satisfaction), have been subspecialty recertified twice, get my charts done on time, etc. Unfortunately, when I started working at my practice 14 years ago, it was a period of duress--my husband had lost his job during the recession (2009) and we had to move quickly. Anyway, my current practice didn't pay well--175K increased to 200K in 2012. However, I was only seeing about 50 to 60 patients a week (4.5 days). However, the hospital basically ignored me and high patient satisfaction. Well, they told me that
didn't need to renegotiate my contract and about the same time my son was diagnosed with cancer that returned as GBM when he was in med school. So, I kind of neglected things contract-wise. I cut my hours to 30 hours/wk when he was near the end and never returned to full time. I figured I was being a bit underpaid, but liked the hours. Meanwhile, I was able to recruit 2 other rheumatologists, who obviously make more than I do as their base. My original contract calls for 40 hours/wk including "patient record keeping"--easily doing that. RVUs are not mentioned in my contract. So, our hospital recently has a new CEO and they gave me 2 weeks to accept a new contract with a 50% pay cut. All RVU-based now. They are doing the same thing to the other rheumatologists (pretty much). They are also going to pay one of the newer rheumatologists more than they will pay me for the same percent time worked--my schedule is packed and that doesn't seem fair (I am retirement age, so likely want to force me out). To not have a pay cut, I will have to work 11 hour days and never take a vacation (by my math). I was told that I should be double-booking patients and to work thru lunch (do anyway). They don't acknowledge the time I spend ordering infusions (e.g., 25 patients on Saphnelo), which I think adds value. I really want to work for another 2 years or so (trying to fund a scholarship to honor my late son)--otherwise financially definitely could retire.
What do you recommend? Thanks for any insights, Anne

You and the other rheumatologists should go start a new practice… take all your pts with you.

Or go do locums to raise that money. So so sorry for your loss…I can’t even begin to imagine your grief.

 

[anonperson]

I am in a bit of a quandry. I have practiced rheumatology for over 30 years and still really enjoy it (most of it anyway). I have many patients (with very high patient satisfaction), have been subspecialty recertified twice, get my charts done on time, etc. Unfortunately, when I started working at my practice 14 years ago, it was a period of duress--my husband had lost his job during the recession (2009) and we had to move quickly. Anyway, my current practice didn't pay well--175K increased to 200K in 2012. However, I was only seeing about 50 to 60 patients a week (4.5 days). However, the hospital basically ignored me and high patient satisfaction. Well, they told me that
didn't need to renegotiate my contract and about the same time my son was diagnosed with cancer that returned as GBM when he was in med school. So, I kind of neglected things contract-wise. I cut my hours to 30 hours/wk when he was near the end and never returned to full time. I figured I was being a bit underpaid, but liked the hours. Meanwhile, I was able to recruit 2 other rheumatologists, who obviously make more than I do as their base. My original contract calls for 40 hours/wk including "patient record keeping"--easily doing that. RVUs are not mentioned in my contract. So, our hospital recently has a new CEO and they gave me 2 weeks to accept a new contract with a 50% pay cut. All RVU-based now. They are doing the same thing to the other rheumatologists (pretty much). They are also going to pay one of the newer rheumatologists more than they will pay me for the same percent time worked--my schedule is packed and that doesn't seem fair (I am retirement age, so likely want to force me out). To not have a pay cut, I will have to work 11 hour days and never take a vacation (by my math). I was told that I should be double-booking patients and to work thru lunch (do anyway). They don't acknowledge the time I spend ordering infusions (e.g., 25 patients on Saphnelo), which I think adds value. I really want to work for another 2 years or so (trying to fund a scholarship to honor my late son)--otherwise financially definitely could retire.
What do you recommend? Thanks for any insights, Anne

How many other rheumatologists are in the practice other than you? Two or three?

Are they similarly dissatisfied with the new contract offer?

Since the new contract is RVU based, are they paying that other rheumatologist a higher conversion rate?

Your main leverage in this situation is to walk. If you can rally the troops and leave them high and dry, even better. Otherwise, you may be stuck with a bad contract if you are set on funding the scholarship, which is a very noble thing to do.

Would strongly consider locums work as well.

Unfortunately, situations like this can occur with a CEO on a power trip.

I'm in a different specialty but had a similar situation. Initial contract was expiring and the newly offered contract was a 10% pay cut.

Hospital refused to budge even presenting the alternative that several would leave. Eventually I resigned along with several other partners. Unfortunately not enough resigned to dissolve the group. Just enough stayed so they could limp along. They still haven't recovered but it's best to be out of that environment. ( Everyone who left found better jobs with a happier work environment and better pay).

 

[bronx43]

I am in a bit of a quandry. I have practiced rheumatology for over 30 years and still really enjoy it (most of it anyway). I have many patients (with very high patient satisfaction), have been subspecialty recertified twice, get my charts done on time, etc. Unfortunately, when I started working at my practice 14 years ago, it was a period of duress--my husband had lost his job during the recession (2009) and we had to move quickly. Anyway, my current practice didn't pay well--175K increased to 200K in 2012. However, I was only seeing about 50 to 60 patients a week (4.5 days). However, the hospital basically ignored me and high patient satisfaction. Well, they told me that
didn't need to renegotiate my contract and about the same time my son was diagnosed with cancer that returned as GBM when he was in med school. So, I kind of neglected things contract-wise. I cut my hours to 30 hours/wk when he was near the end and never returned to full time. I figured I was being a bit underpaid, but liked the hours. Meanwhile, I was able to recruit 2 other rheumatologists, who obviously make more than I do as their base. My original contract calls for 40 hours/wk including "patient record keeping"--easily doing that. RVUs are not mentioned in my contract. So, our hospital recently has a new CEO and they gave me 2 weeks to accept a new contract with a 50% pay cut. All RVU-based now. They are doing the same thing to the other rheumatologists (pretty much). They are also going to pay one of the newer rheumatologists more than they will pay me for the same percent time worked--my schedule is packed and that doesn't seem fair (I am retirement age, so likely want to force me out). To not have a pay cut, I will have to work 11 hour days and never take a vacation (by my math). I was told that I should be double-booking patients and to work thru lunch (do anyway). They don't acknowledge the time I spend ordering infusions (e.g., 25 patients on Saphnelo), which I think adds value. I really want to work for another 2 years or so (trying to fund a scholarship to honor my late son)--otherwise financially definitely could retire.
What do you recommend? Thanks for any insights, Anne

First off, condolences to you regarding your son. Truly tragic.

I don't completely understand the contract situation you are in now. So, you are part time, but NOT on wRVU productivity model, but you think you are currently underpaid (but like it due to part time status). Do you mind sharing how many patients you see per week now, and what your salary is? Do you know your wRVU production?
If your schedule is packed, then I would find it hard to believe that it'll be a big paycut, unless they are paying you a pittance per wRVU generated. Just for reference, the median wRVU these days is somewhere in the 40s to 50s blended. So, if you are seeing 18 return patients 3 days a week for 48 weeks, that comes out to just under 5000 wRVUs. And if you're making low end of the wRVU conversion at $40/wRVU, then you're looking at around 200k.

 

[dozitgetchahi]

I wouldn’t put up with what sounds like a horrible work situation with this new CEO. Time to go. If the other rheums feel similarly, you could start a new practice. Or if you have the money to retire, just let yourself be done and retire. But don’t put up with the BS of abusive hospital management. I’m at a very different point in my career (5 years in as a rheumatologist), but I’ve already been there, done that with abusive hospital leadership and I personally will never tolerate it ever again.

If I was in your shoes and I had the money to retire and be done with medicine, I’d do it.

 

[Residentdoc86]

This is a ****ty situation to be in, compounded by the tragic loss you just experienced. If i was in your shoes i'd call it a career, and use the time left to grieve, celebrate your late son and perhaps enjoy life.

if you miss the medicine, then you can always consider locums as previously recommended or volunteer at a free clinic.

 

[rheumforawhile]

Hi, Thank you for the advice above. There are actually 4 people in our group--one just started and should be protected by a 3 year contract. One of the others would be working 80% time for evidently 110K and states that she doesn't want to even negotiate--trying to get a new job (she is much younger and she does see at least 14 patients/day). We have no real support in our practice--just MA's. Very harsh if charts/labs not completed on time--problem because some labs (eg ANCA, cryos) can take a while. Anyway, the employment attorney I spoke with said that I am actually protected until 9/24. My original contract is from 2009 and I was told repeatedly that I did not need another contract. The term "RVU" does not appear in my contract--just 40 hours total seeing patients and maintaining medical records. It automatically renews every Sept. 4th and they have to notify me 90 days before 9/4 to change contract. So, what they are proposing is an impending breach of contract (since was notified in August). I am going to pursue this and hopefully be able to work for another year at the same salary. Evidently our group is the 1st group where contracts are being "updated". I am doing this both to make certain that my patients are situated well and also to hopefully make the powers that be think twice about doing this to the other doctors. I have a lot of patients receiving infusions (26 getting Saphnelo alone) and need to make certain there is a good transition. I am lucky in that I could retire. Could do locums, but don't think my husband would enjoy being stuck some place away from home. Thanks again, Anne
P.S. Am diverting some of my income to set up fund to support neuro-onc research. In our will, we have trusts set up for same, but would like to do this also while I'm still around.

 

[Crayola227]

Hi, Thank you for the advice above. There are actually 4 people in our group--one just started and should be protected by a 3 year contract. One of the others would be working 80% time for evidently 110K and states that she doesn't want to even negotiate--trying to get a new job (she is much younger and she does see at least 14 patients/day). We have no real support in our practice--just MA's. Very harsh if charts/labs not completed on time--problem because some labs (eg ANCA, cryos) can take a while. Anyway, the employment attorney I spoke with said that I am actually protected until 9/24. My original contract is from 2009 and I was told repeatedly that I did not need another contract. The term "RVU" does not appear in my contract--just 40 hours total seeing patients and maintaining medical records. It automatically renews every Sept. 4th and they have to notify me 90 days before 9/4 to change contract. So, what they are proposing is an impending breach of contract (since was notified in August). I am going to pursue this and hopefully be able to work for another year at the same salary. Evidently our group is the 1st group where contracts are being "updated". I am doing this both to make certain that my patients are situated well and also to hopefully make the powers that be think twice about doing this to the other doctors. I have a lot of patients receiving infusions (26 getting Saphnelo alone) and need to make certain there is a good transition. I am lucky in that I could retire. Could do locums, but don't think my husband would enjoy being stuck some place away from home. Thanks again, Anne
P.S. Am diverting some of my income to set up fund to support neuro-onc research. In our will, we have trusts set up for same, but would like to do this also while I'm still around.

I regret not being the one to say, consult a lawyer in this thread. This was the perfect example of when that is the right move and it seems it will pay for for you.

 

[AlbinoHawk DO]

I am in a bit of a quandry. I have practiced rheumatology for over 30 years and still really enjoy it (most of it anyway). I have many patients (with very high patient satisfaction), have been subspecialty recertified twice, get my charts done on time, etc. Unfortunately, when I started working at my practice 14 years ago, it was a period of duress--my husband had lost his job during the recession (2009) and we had to move quickly. Anyway, my current practice didn't pay well--175K increased to 200K in 2012. However, I was only seeing about 50 to 60 patients a week (4.5 days). However, the hospital basically ignored me and high patient satisfaction. Well, they told me that
didn't need to renegotiate my contract and about the same time my son was diagnosed with cancer that returned as GBM when he was in med school. So, I kind of neglected things contract-wise. I cut my hours to 30 hours/wk when he was near the end and never returned to full time. I figured I was being a bit underpaid, but liked the hours. Meanwhile, I was able to recruit 2 other rheumatologists, who obviously make more than I do as their base. My original contract calls for 40 hours/wk including "patient record keeping"--easily doing that. RVUs are not mentioned in my contract. So, our hospital recently has a new CEO and they gave me 2 weeks to accept a new contract with a 50% pay cut. All RVU-based now. They are doing the same thing to the other rheumatologists (pretty much). They are also going to pay one of the newer rheumatologists more than they will pay me for the same percent time worked--my schedule is packed and that doesn't seem fair (I am retirement age, so likely want to force me out). To not have a pay cut, I will have to work 11 hour days and never take a vacation (by my math). I was told that I should be double-booking patients and to work thru lunch (do anyway). They don't acknowledge the time I spend ordering infusions (e.g., 25 patients on Saphnelo), which I think adds value. I really want to work for another 2 years or so (trying to fund a scholarship to honor my late son)--otherwise financially definitely could retire.
What do you recommend? Thanks for any insights, Anne

They are trying to pay more for a younger person for the same work? Sounds like an age discrimination case. It will be taken by the lawyers

Also, call their bluff

 

[Old_Mil]

Could do locums, but don't think my husband would enjoy being stuck some place away from home. Thanks again, Anne

Not a Rheumatologist (EP), so I'm not entirely sure how locums works in your specialty but I know of an EP who rented out his house, he and his wife moved into a nice Class A motorhome, and followed the locums. It worked out well for them.

Sorry for your loss, best wishes.