Medical director pay

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nexus73

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I’m looking for some ballpark ideas on medical director pay as I may be taking over for my hospital group. We have inpatient adult/child/addiction a small outpatient clinic and starting a primary care integration program. The current director bills for his time hourly and gets paid in the $130-140 range per hour. He’s told me he often goes over his monthly alottment of 30 hours devoted to medical director so doesn’t get paid for that time. This is a situation I would refuse to accept.

I’m just curious about what is a reasonable amount per hour, or what is a reasonable monthly or yearly stipend, as I go into negotiate with administration.
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REALLY depends on the facility. At a large facility, if you don't want to do it, someone else will, so you pretty much have to take the offer they give you.

At a community facility, I think it's not unusual to have a medical director who gets a 100k+ supplement depending on the performance of the group.

Admins at nonprofits generally make a lot less than their private counter parts, if you do apple to apple comparisons (i.e. organization of a similar size/budget). I'd say the variation on the salary for this type of work can go 100-300% depending on the facility. In negotiations, it's important to never start naming your price as an anchor. Using national benchmark is IMHO generally not useful.
 
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Most places that I’ve talked to are wanting a medical director on paper only. Meaning that they want you to sign off for liability purposes and keep your mouth closed otherwise. They believe that you shouldn’t put in many hours and accept a low rate because it’s “free money” in their eyes. Sadly many doctors accept this.

A true medical director will spend ample time on policies, quality improvement, and increasing revenue. They should be paid well for the valuable knowledge. Anything less than $170/hr is an insult.
 
I'm aware of a health system paying $160/hr, which I believe was converted into some formula for FTE status, like 0.1, 0.15, 0.2FTE etc. Not sure what the final dollar lump some amount equated for that employed person. A different private entity gave $200/hr for 50-60/hrs month for independent contractor. Lesser directors got $165/hr which was as Texas Physician pointed out, an insult. Also factor into the hourly rate evaluation, are you employed or independent contractor? If employed, than $160 could be reasonable, if independent contractor, than unlikely.

Med directors also need a separate liability insurance rider, that gets farmed out to different insurance companies. If employed, make sure the contract states med director duties are covered. The extra policies can be like 2-5K extra for psych per year.
 
Thanks for the responses. I've tentatively accepted the position, pending hospital agreeing to pay $200/hour with at least 40 hours authorized each month. I get about $70 per RVU and can easily generate 3 RVUs per hour, often more with therapy, so figured the medical director pay should be at least similar to two 99214 followups I could do in clinic. I'll definitely make sure my insurance specifically covers medical director responsibilities.

Dealing with admin is very frustrating. Mostly because they seemed to be downplaying the amount of time the medical director puts towards administrative tasks each month. They tried to claim it's a 5-10 hour per month position...when I know the current medical director does at least 30 hours a month, if not more. 5-10 hours/month is ridiculous on the surface because this is an entire behavioral health service line, not just an outpatient clinic or just a single inpatient unit. And because we're understaffed this creates persistent scheduling challenges and frustration from other hospital departments when we can't see consults quickly enough. We'll see....I actually wouldn't be surprised if the hospital balks at the hourly rate I'm insisting on.
 
In my limited experience, the function of a "medical director" is not to represent the interests of the doctors contra the administration, it's to act as a face for the administration to tell the doctors to fall in line and do the kind of thing administration wants doctors to do (e.g., lengthen the grace period by which patients can be late and still be seen, see more patients, extend hours beyond normal business hours, double-book, not fire patients, etc.) Do you get the impression that is the kind of function you will be serving?
 
Trismegistus4 said:
In my limited experience, the function of a "medical director" is not to represent the interests of the doctors contra the administration, it's to act as a face for the administration to tell the doctors to fall in line and do the kind of thing administration wants doctors to do (e.g., lengthen the grace period by which patients can be late and still be seen, see more patients, extend hours beyond normal business hours, double-book, not fire patients, etc.) Do you get the impression that is the kind of function you will be serving?
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The main issue for us is on inpatient and pressure to see more patients per day. Admin seems to have this fantasy that because some psychiatrists in some hospitals see 18-20 per day (providing unsafe care) it means we should all do this everyday.

My main concern about getting this offer is I’m fairly agreeable so the admin may want me because they think I’m a pushover. But when it comes to my work/life balance, my income, and the income of my colleagues I’m very aggressive. Which may not be well received but I’m not at work for accolades or to make administration’s life easier. I’m here to provide good patient care and get paid. And at least right now there aren’t enough psychiatrists so they can’t demand too much or we’ll just all quit and go to work elsewhere.
 
Best wishes Nexus. Hope it works out.

Very much agree with Trismegistus4 above. And in reflection that's also what Chief Residents are. A resident advocating to be the voice of the residents, won't be selected for a Chief position.
 
nexus73 said:
The main issue for us is on inpatient and pressure to see more patients per day. Admin seems to have this fantasy that because some psychiatrists in some hospitals see 18-20 per day (providing unsafe care) it means we should all do this everyday.

My main concern about getting this offer is I’m fairly agreeable so the admin may want me because they think I’m a pushover. But when it comes to my work/life balance, my income, and the income of my colleagues I’m very aggressive. Which may not be well received but I’m not at work for accolades or to make administration’s life easier. I’m here to provide good patient care and get paid. And at least right now there aren’t enough psychiatrists so they can’t demand too much or we’ll just all quit and go to work elsewhere.
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So do you think in this new role administration is going to put pressure on you to put pressure on the other docs to see more patients?

The reason I ask is that I'm not really sure how things are "supposed" to work in my current place of work. When I interviewed for and accepted the position, there actually was no medical director over my particular area, so I didn't think I would have a "boss" per se; it would just be me and the other docs interacting directly with the administration to hash out how we wanted to/were willing to do things. Sure, I thought we might butt heads over some things, but at the end of the day we'd have some negotiating power. Then when I showed up on my first day, they said "oh, by the way, we're hiring this medical director." Then once she came on board, she started acting like she was our "boss:" announcing that our vacation day requests had to go through her, any changes to our schedules have to go through her, handing down decisions about some logistical/workflow issues without any discussion or input from us, etc. And I've never been sure whether that's how things are "supposed" to work (i.e., someone higher up told her to do those things) or whether she's just on some kind of power trip.
 
Trismegistus4 said:
So do you think in this new role administration is going to put pressure on you to put pressure on the other docs to see more patients?

The reason I ask is that I'm not really sure how things are "supposed" to work in my current place of work. When I interviewed for and accepted the position, there actually was no medical director over my particular area, so I didn't think I would have a "boss" per se; it would just be me and the other docs interacting directly with the administration to hash out how we wanted to/were willing to do things. Sure, I thought we might butt heads over some things, but at the end of the day we'd have some negotiating power. Then when I showed up on my first day, they said "oh, by the way, we're hiring this medical director." Then once she came on board, she started acting like she was our "boss:" announcing that our vacation day requests had to go through her, any changes to our schedules have to go through her, handing down decisions about some logistical/workflow issues without any discussion or input from us, etc. And I've never been sure whether that's how things are "supposed" to work (i.e., someone higher up told her to do those things) or whether she's just on some kind of power trip.
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That sucks. I know at a hospital I did residency the docs were fed up with the medical director basically not advocating for them and they somehow were able to all cast a “no confidence” vote and he was ousted.

In my situation I assume they’ve grown frsutrated with past medical directors who resisted unreasonable changes and may hope I’ll be more flexible. The problem is I have no problem being just as difficult. The only reason I’m even willing to do this job is nobody else wants it and I’d prefer the docs to have a point person to deal with pressure from administration. My concern if there is no medical director is that changes will be made by admin, without physician input, and if we disagree we won’t have an organized way to challenge it.
 
I just started a PT 1099 med director role a few months ago at $225 /hr, submitting time similarly at a Medicaid-type clinic. My contract is maxed at 4 med dir hours /wk. This is in addition to my part time clinical job at the same place.
 
nexus73 said:
Just to complete the story here. I ended up getting about $200/hour for medical director time. I track hours and submit them at the end of each month.
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how many hours per month are they allowing you to bill at 200/hr? Can’t you just say you’re working 80 hours per month if you’re tracking your own hours?
 
I am alway perplexed as to why physicians take these jobs when we can work 1 extra day every two weeks and make the same amount or even more sans the headache.
 
oldiebutgoodie1211 said:
how many hours per month are they allowing you to bill at 200/hr? Can’t you just say you’re working 80 hours per month if you’re tracking your own hours?
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Good question. I have up to 40 hours per month, so about 10 hrs per week. They tried to reduce it to 30 hours this year, but I insisted it stay at 40 and it did. And it is a big headache; I would only wish this job on my worst enemy. And it's actually 40 hours per month average, so there are 40x12 months = 480 hours per year I can use, so if one month is over, like 46 hours, I can still get paid for that time, but other months are less so it all averages out. It's actually a lot of potential money, $96,000/year...but again the headache makes me want to give it up at times.
 
Splenda88 said:
I am alway perplexed as to why physicians take these jobs when we can work 1 extra day every two weeks and make the same amount or even more sans the headache.
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I don't imagine it's about the money. It's trading one type of headache for another. Some might do it for the prestige. Others might genuinely want to have a say in the functioning of a program.
 
nexus73 said:
Good question. I have up to 40 hours per month, so about 10 hrs per week. They tried to reduce it to 30 hours this year, but I insisted it stay at 40 and it did. And it is a big headache; I would only wish this job on my worst enemy. And it's actually 40 hours per month average, so there are 40x12 months = 480 hours per year I can use, so if one month is over, like 46 hours, I can still get paid for that time, but other months are less so it all averages out. It's actually a lot of potential money, $96,000/year...but again the headache makes me want to give it up at times.
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you say you have up to 40 so I’m assuming you just put 40 hours for every month right? I can’t imagine you would just throw away a few hours without reporting them, 100k per year for director sounds decent
 
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