Inpatient negotiation penny for your thoughts

[nexus73]

My hospital inpatient unit is hemorrhaging providers left and right, to the point we'll likely have to contract the service line down to inpatient unit only, and no med consults or ED coverage. We are located in an area that has proved very challenging to recruit psychiatrists, rural ish, uber conservative politically, schools aren't that great, but good outdoor recreation activities.

Does anyone have experience with this scenario, where it feels like the docs have a lot of leverage to negotiate good salary due to bad staffing getting worse...and better compensation for call, vacation/sick leave. Does this ever actually work out for the physicians negotiating excellent total comp/benefits? Up until now it seems our hospital has been content letting people leave and paying through the nose for locums doctors to fill in gaps. Pretty soon it may be all locums. Is there a best way to frame negotiations to achieve the most favorable agreement.

I assume saying "you're screwed because we're all you have left, pay us or pay locums" may not get the best response.

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[Monocles]

Yes.

No matter how happy you are with your current gig, you should always have transparent salary conversations with peers/colleagues to make sure your compensation is keeping up with the market forces. I always speak with recruiters to get a sense of the types of jobs that are available at any given time, and then use it as leverage for annual salary renegotiations.

Hospitals can take advantage of you assuming the default of "information asymmetry". This is why it's important to talk about pay. If you start off the bat and let your employer know you are being undercompensated, it skips a lot of the dance and goes directly into the negotiation part.

OP it sounds like you can throw your dart at your local region and get a job with better pay and/or working conditions. Have you considered interviewing at what's available nearby and going back to your employer to ask for a comparable matching offer?

 

[Monocles]

I assume saying "you're screwed because we're all you have left, pay us or pay locums" may not get the best response.

You actually DO want to say this... but frame the message in a more diplomatic and collaborative way. I would phrase it along the lines of fair value "cost of living" adjustments, positioning yourself as a "known factor who will provide ongoing quality work" as opposed to the hospital having to pay more for uncertainty, and "coming up with a solution that is mutually beneficial" etc

It always helps to demonstrate some basic understanding of economics because most hospitals assume that docs are purely naive, idealistic clinicians who have no understanding of the markets and therefore easy mark to hustle.

Bonus points if you can pre-emptively pull up your hospital's fiscal reports. They are usually public record (ex: propublica which has replaced open 990 Nonprofit Explorer - ProPublica) and allows you point out objective YoY asset gains (ex: hospital revenue increase of 17% vs staff compensation increase of 3%, etc) and immediately shuts down any "welllll we dont have the budget" excuses. I would be surprised if you can't straight up google your hospital's balance sheets.

 

[Sushirolls]

I've been in a similar position in the past.
The Big Box shop is in a race to be the worst on a national level.
They just didn't care, and even since my exodus years ago, continue to hemorrhage money on locums not just for Psych but GI, surg, etc
A pure gold mine for locums, and when you see the recruiters post what the pay is for that job. Its sad to see the money spent is well in excess of the complete salaried benefits and employer portions of payroll. How this Big Box shop keeps things sustainable, I just don't know.

I am not optimistic negotiations will go well. Evidenced by the fact that the place is already losing staff as you pointed out. Rural places can and do recruit people and keep them. But its about the subculture of the department, and the leadership. I recently interview truly in the middle of nowhere, and was quite surprised by the leadership. They were truly doing things right and they have staff retention of all their specialties. Partly because they know they have to be good to get people to stay, and to seize any opportunity of any docs that reach out to them.

Has your admin learned this? Do they embrace this? Do they say, how can we help you and actually mean it? Or they still dictating form top down?

Take stock of what you want, present it to them, and if they don't come to the table, you got your answer. Time to walk.

Could always look into your contract and staff priviliges. Might be able to drop them, keep your hospital privilieges, do your own billing, and build up your own IP/OP gig? If they can't admin right, take that role from them, form your own independent group, and show them how its done.

As you've seen, they can't recruit. They can't retain. Any independent group you form to run things, stands a better chance at longevity without being under cut by their resurgence of employed docs or competing groups coming in, like you see in EM or Anesthesiology.

 

[whopper]

This may be out of your hands.

I've been in organizations where the leadership is terrible and won't listen and allow obvious and easy answer to fix problems.

If this is the case just avoid that place entirely. Some organizations really need to fail. IT's not your job to work 10x harder because some idiot above you isn't doing their job.

I brought up this analogy before. People think Amazon doesn't pay their workers well (whether or not this is the case let's not debate that, but let's just assume that is the case).

IF this is the case should you then go to the Amazon warehouse and start giving out your own hard-earned money to the workers? No. It doesn't solve the underlying problem, let's Amazon off the hook, and in fact rewards them cause now some idiot made themselves a martyr, made their own workers happier when it really was Amazon's responsibility.

I used to happily fix broken areas of an organization. While in state hospitals I used to fix units, and once fixed they'd have me fix another unit. While in a university hospital same thing. My second university I worked for wouldn't let anything broken be fixed. IF the organization won't let you fix something broken, the organization is broken. Get out. Said organization just a few months ago imploded yet again. Implosion meaning almost all of it's attending doctors leaving in disgust. This is the 3rd implosion within that organization in 8 years.

Seriously it's not unlike one of those bar or restaurant rescue shows. The places that follow the advice sometimes get fixed. The places that don't listen always fail.

 

[nexus73]

Has anyone ever shifted directly from employed to locums at the same place.

 

[wolfvgang22]

I had this situation. So I interviewed for and was offered a position in a much more desirable location with much less work for the same pay. I advised my current employer that I was giving 3 months notice to wrap up my outpatient clinic (also privately I needed time to sell my home and move, wait for kids to finish the school year, etc.) I was fortunate in that the clinic chief desired I stay and talked the organization into giving me an even better offer (less work, more pay) to stay, so I stayed. My patients were relieved. I was 100% not bluffing, the clinic saw me clean out my office and put my house up for sale and move into temporary lodging.

So yeah, it depends on leadership and what they want.

 

[Jules A]

I had this situation. So I interviewed for and was offered a position in a much more desirable location with much less work for the same pay. I advised my current employer that I was giving 3 months notice to wrap up my outpatient clinic (also privately I needed time to sell my home and move, wait for kids to finish the school year, etc.) I was fortunate in that the clinic chief desired I stay and talked the organization into giving me an even better offer (less work, more pay) to stay, so I stayed. My patients were relieved. I was 100% not bluffing, the clinic saw me clean out my office and put my house up for sale and move into temporary lodging.

So yeah, it depends on leadership and what they want.

And the fact that you meant what you said. Well played.

 

[Sushirolls]

Dang. Moved into temporary housing...
Having already done that much moving, they had better have offered a sweet deal to have to undo that. At that point I don't know if I could go back to a job. Moving always sucks, but once you got kids, spouse, more junk, etc, its just worse.