Negotiating with an academic pain group- all advice welcome!

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cameroncarter

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I always wanted to go back to my home residency program to join the pain group.With recent departures in their pain group and two new neurosurgery spine attendings, I know they are quite interested in recruiting me and I feel certain that I can generate the department a lot of money.

However, the contract offer was very underwhelming with regard to base salary (10%ile in my area), productivity bonus (they placed a ceiling on how much I can earn- a low ceiling), an expectation to work 5 days per week (I previously expressed interest to work 4-4.5 days).

How much room do I exactly have to negotiate? The brief early answer I got was that “this isn’t a private practice” and I shouldn’t consider this contact to be like a private practice contract.
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cameroncarter said:
I always wanted to go back to my home residency program to join the pain group.With recent departures in their pain group and two new neurosurgery spine attendings, I know they are quite interested in recruiting me and I feel certain that I can generate the department a lot of money.

However, the contract offer was very underwhelming with regard to base salary (10%ile in my area), productivity bonus (they placed a ceiling on how much I can earn- a low ceiling), an expectation to work 5 days per week (I previously expressed interest to work 4-4.5 days).

How much room do I exactly have to negotiate? The brief early answer I got was that “this isn’t a private practice” and I shouldn’t consider this contact to be like a private practice contract.
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Academic places always have fresh fodder. They don't need or want to negotiate.

If they want you, they can offer things such as non-clinical time, a one-time bonus for moving/etc, and in rare circumstances things like protected time for research or a startup find. In general though, academic places offer less contractual protection or flexibility as they often hide behind "boilerplate language" or verbal agreements.

You should realize the structure and who has control limits your ability to negotiate greatly unless you're something super special.

I would ask your mentors in the division or other residents that stayed there for other stuff about their first contract.

Realize you can't go home again and things are often different when you're not a trainee, so there's probably a good reason they're looking for people.
 
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What incentivizes the other docs to stay?
 
So the other 2 docs there seem content with their salary structure and are fairly shy with offering procedures and do minimal advanced procedures (SCS, Kypho, etc).

Given that I want to get busier (the others don’t do too much) with clinic and procedures, I know I’ll generate far more and am hoping to get compensated a bit more fairly.
 
Possibly they don’t offer more advanced procedures or are shy with procedures as a result of the poor bonus structure/lack of incentive to do so. I think that it’s unlikely you are going to come in and get a contract is better than that of the more senior guys.
 
I'm not sure you understand this yet but the system doesn't pay you because you make it money. This isn't real world finances. After you sign that contract, you'll be locked into a noncompete and no matter what you produce, they really don't care to improve the contract.

If this was important to them, the admin would've restructured the incentives to promote more clinical work, but it's not.

The system gets what it wants, and you're going to get paid the same if you kill it or if you relax.

Will you be happy doing what the other two are doing?
Will the other two docs enjoy and support the new guy doing all the stuff?
Will the neurosurgeons like it?

There's a reason most of the high volume people are in private practice.
 
Orin said:
I'm not sure you understand this yet but the system doesn't pay you because you make it money. This isn't real world finances. After you sign that contract, you'll be locked into a noncompete and no matter what you produce, they really don't care to improve the contract.

If this was important to them, the admin would've restructured the incentives to promote more clinical work, but it's not.

The system gets what it wants, and you're going to get paid the same if you kill it or if you relax.

Will you be happy doing what the other two are doing?
Will the other two docs enjoy and support the new guy doing all the stuff?
Will the neurosurgeons like it?

There's a reason most of the high volume people are in private practice.
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I’m learning this, that the pay gap is fairly minimal between laying back and staying busy. I’m not asking for PP money, just a bit more so that it’s a bit more fair.

I don’t get it- wouldn’t it be a win-win for me to be productive?
 
cameroncarter said:
I always wanted to go back to my home residency program to join the pain group.With recent departures in their pain group and two new neurosurgery spine attendings, I know they are quite interested in recruiting me and I feel certain that I can generate the department a lot of money.

However, the contract offer was very underwhelming with regard to base salary (10%ile in my area), productivity bonus (they placed a ceiling on how much I can earn- a low ceiling), an expectation to work 5 days per week (I previously expressed interest to work 4-4.5 days).

How much room do I exactly have to negotiate? The brief early answer I got was that “this isn’t a private practice” and I shouldn’t consider this contact to be like a private practice contract.
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I've negotiated above offer with a few academic places. You need to a) make them realize why they want you specifically vs another doc and b) show them evidence of better offers with numbers described. Most recent time I got a 10% bump above their "standard" offer and scheduling concessions. This tends to work if they don't have a trillion applicants for the spot (and you know this) or you are in a position to somehow make their lives significantly easier/better and highlight this.

Orin said:
Academic places always have fresh fodder. They don't need or want to negotiate.

If they want you, they can offer things such as non-clinical time, a one-time bonus for moving/etc, and in rare circumstances things like protected time for research or a startup find. In general though, academic places offer less contractual protection or flexibility as they often hide behind "boilerplate language" or verbal agreements.

You should realize the structure and who has control limits your ability to negotiate greatly unless you're something super special.

I would ask your mentors in the division or other residents that stayed there for other stuff about their first contract.

Realize you can't go home again and things are often different when you're not a trainee, so there's probably a good reason they're looking for people.
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Agree the verbal agreements are dangerous -- anything meaningful that you want needs to be in writing.
An easy fix for the "boilerplate language" BS is to recommend an appendix be added to contain what you need and which supersedes the otherwise "standard" contract language for those issues. This way the people hiring you/HR gets to save face and continue on with the mantra that everybody has the same contract and you get what you need.
 
cameroncarter said:
I’m learning this, that the pay gap is fairly minimal between laying back and staying busy. I’m not asking for PP money, just a bit more so that it’s a bit more fair.

I don’t get it- wouldn’t it be a win-win for me to be productive?
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Stop thinking logically

Unfortunately, i agree with Orin.

They really dont care enough to offer you what you are looking for.

Only sign on if this is a stepping stone to somewhere else or it they make major concessions in writing (unlikely)
 
It doesn’t hurt to ask for more. The worst they can do is say No. They’re not going to come to your house and slap you. If multiple people left at the same time they were unhappy with something. They need to fill the gap because everyone else’s schedule sucks when you’re short on doctors. Just ask and see what happens.
 
cameroncarter said:
I’m learning this, that the pay gap is fairly minimal between laying back and staying busy. I’m not asking for PP money, just a bit more so that it’s a bit more fair.

I don’t get it- wouldn’t it be a win-win for me to be productive?
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No.

Some of this is ego, and some of this comes down to finances/contracting. You crushing volume could make the folks there already look worse. It may generate further administrative burden that they don't want to support. It may generate ripples in the competing departments whose physicians who are doing those procedures. You also have to appreciate that sometimes financial productivity in the hospital system doesn't always equate to doing high volume or high RVU procedures. They may prefer you to be a visit monkey, generating 20-30 E&M visits. Do they even have block time at an ASC or OR for procedures? Who would lose if you were to get that time or is there just empty time waiting for you to step in?

au bon pain said:
I've negotiated above offer with a few academic places. You need to a) make them realize why they want you specifically vs another doc and b) show them evidence of better offers with numbers described. Most recent time I got a 10% bump above their "standard" offer and scheduling concessions.

Agree the verbal agreements are dangerous -- anything meaningful that you want needs to be in writing.
An easy fix for the "boilerplate language" BS is to recommend an appendix be added to contain what you need and which supersedes the otherwise "standard" contract language for those issues.
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Great advice regarding the appendix/addendum. Realize though that if the chair or division chief changes, even written agreements can be worthless. Many academic institutes are run at the whim of the dean/chair/etc and are happy to painfully drag things through court despite being morally/legally in the wrong.

It's sometimes easier to discuss this with the finance person directly rather than the division chief as they're more aware of the finances and options for flexibility. They generally tend to be more business and contractually oriented, but there's little transparency into the finances/bonuses of most academic departments.

I realize this is coming across as negative, but it's better to go in expecting the worst. It could be a great jolt to their system and if they have a fellowship, a boon to their learning, but at the end of the day, you'll have to understand that this is part of the cost of working in academics rather than the land of milk and honey. There are problems on both sides, but you've got to step back and objectively understand the metrics that drive the academic people as it is not what you might equate with a successful/strong/productive career and not the business metrics that drive private practice.
 
cameroncarter said:
I always wanted to go back to my home residency program to join the pain group.With recent departures in their pain group and two new neurosurgery spine attendings, I know they are quite interested in recruiting me and I feel certain that I can generate the department a lot of money.
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Before you sign, I would also take the time to talk to the device reps that cover cases in that region. They can likely tell you more about the business/practice side of things there. I suspect they've seen a few doctors come in ready to light the world on fire and then move onto more tractable problems. They can help you understand if it's just an incentive issue which could be fixed by the contract negotiations, or deeper systemic issues that would require a longer approach.

It just helps to understand what you're getting into, as I suspect that system like many other academic places is not failing due to the lack of an individual capable of doing things.

I also highly encourage people to talk to the faculty that have recently left or are leaving. They're often the most honest, although everyone tries to play nice.
 
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You can always ask for more compensation/benefits.
As far as getting a productivity incentive, I really wouldn’t put that much weight on it. billing gets screwed everywhere and in academics the teams have no reason to do a good job. Just focus on base salary. Academics don’t have the same realities for overhead and profit a smaller more nimble practice has to deal with.
In general, if you want money and autonomy you have to do your own thing. If your priorities are lifestyle. academics may be better suited for you- but don’t be surprised if you get lowballed. Somewhere in between those two realities is joining a private group
 
au bon pain said:
I've negotiated above offer with a few academic places. You need to a) make them realize why they want you specifically vs another doc and b) show them evidence of better offers with numbers described. Most recent time I got a 10% bump above their "standard" offer and scheduling concessions. This tends to work if they don't have a trillion applicants for the spot (and you know this) or you are in a position to somehow make their lives significantly easier/better and highlight this.



Agree the verbal agreements are dangerous -- anything meaningful that you want needs to be in writing.
An easy fix for the "boilerplate language" BS is to recommend an appendix be added to contain what you need and which supersedes the otherwise "standard" contract language for those issues. This way the people hiring you/HR gets to save face and continue on with the mantra that everybody has the same contract and you get what you need.
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This is sound advice. A few items to maybe build upon

1) always always have multiple offers in the same market. Even if you have no interest in working for the “guys across town”, dropping that system’s name, casually mentioning you have an interview or pending offer will pique their interest. From a service line perspective, the only thing worse than losing a good candidate (especially one with expertise in advanced procedures that the incumbent doctors don’t practice) is the threat that a neighboring program will be “winning” the recruitment battle. This creates leverage for you

2) You are not privy to the discussions the AMC is having behind the scenes about you. Maybe the Chair really likes you but the service line lead is pinching penny’s or is being obstinate about enhancing the offer. Meet with both of them separately to discretely probe. Say their program is your top choice but can’t sign for that low of an offer. Say you know new grads getting offers 20% higher (I usually target the 25th percentile for new docs between base and sign on. I’m really surprised to hear that are going that low). If you know which one of them is in your corner, leverage that relationship.

3) I’m not totally privy to your skills vs the two other docs but if you do offer a more advanced skilllset you should be paid as such. Maybe if they can’t wiggle your base upward, your wrvu rate or bonus structure could be modified in your favor (what wrvu rate are their offering you by the way?) They probably have a contribution margin of about 700 per epidural but a stim or more kypho or some of the other more complicated ones could be upwards of $10k. Hospitals do pay attention to that stuff. The service line administrator should know that but if not, remind him of your 1:1. They can’t set pay based on that downstream example I just cited, but a smart administrator would structure the offer accordingly. It’s not totally uncommon with proceduralists but very tight lipped

4) surprised to see a low cap on your bonus. That sets all the wrong incentives…point out that you are covering more overhead the busier you get and could make the case for a tiered wrvu structure for super high production levels. You are likely taking a cut in salary to go there…they should meet you in the middle and increase or eliminate that cap. If you do rock it with them, all parties win including them

5) as others mentioned, you should try to negotiate a relocation and sign on up to 10% of your base. I’m sure they have that in their back pocket (maybe not that high or an amount) in their back pocket as a negotiating item

Hope that helps! Good luck
 
you cant think of academics the same way you think of private practice. there are goals outside of how much you can make.

i might guess that the other docs do a lot of nonclinical stuff such as teaching or research.

teaching probably brings in a lot of revenue.

research - in other subspecialties - can drive more revenue than patient care. i dont see that as much for pain, though.

they will be more interested in retaining your services in academia if you provide these other skills. they feel they can always hire former residents/fellows for a year or two (while they transition to more training/wait for spouses to finish etc.)


in exchange, they do eliminate some of the heinous responsibilities those in non-academia have to put up, and i would highly suspect they leave/go home a lot earlier and have more "protected time"...
 
Ok all, thanks for your advice! I’m meeting with a contract review team. One of the services they offered was to directly negotiate on my behalf. Their going rate is 10% compensation for the total increase in my base salary. What are your thoughts? Seems weird to not be present for my own contract negotiation but I fully believe in their experience more than mine.
 
cameroncarter said:
Ok all, thanks for your advice! I’m meeting with a contract review team. One of the services they offered was to directly negotiate on my behalf. Their going rate is 10% compensation for the total increase in my base salary. What are your thoughts? Seems weird to not be present for my own contract negotiation but I fully believe in their experience more than mine.
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i can think of a lot of reasons why this is not a good idea.

most important of which is that they will only care about a 1-time base salary increase. what about bonus? future compensation? growth? CME? time off? 401k? disability insurance? malpractice?

only you will know what you really want.

it seems daunting if you are young, but your only real leverage is your willingness to walk. otherwise they will tell you to go pound sand
 
cameroncarter said:
I always wanted to go back to my home residency program to join the pain group.With recent departures in their pain group and two new neurosurgery spine attendings, I know they are quite interested in recruiting me and I feel certain that I can generate the department a lot of money.

However, the contract offer was very underwhelming with regard to base salary (10%ile in my area), productivity bonus (they placed a ceiling on how much I can earn- a low ceiling), an expectation to work 5 days per week (I previously expressed interest to work 4-4.5 days).

How much room do I exactly have to negotiate? The brief early answer I got was that “this isn’t a private practice” and I shouldn’t consider this contact to be like a private practice contract.
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LOL

Tell them to F off.
 
cameroncarter said:
Ok all, thanks for your advice! I’m meeting with a contract review team. One of the services they offered was to directly negotiate on my behalf. Their going rate is 10% compensation for the total increase in my base salary. What are your thoughts? Seems weird to not be present for my own contract negotiation but I fully believe in their experience more than mine.
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I'm not confident this makes sense if they've already clarified their unwillingness to negotiate.
 
cameroncarter said:
Ok all, thanks for your advice! I’m meeting with a contract review team. One of the services they offered was to directly negotiate on my behalf. Their going rate is 10% compensation for the total increase in my base salary. What are your thoughts? Seems weird to not be present for my own contract negotiation but I fully believe in their experience more than mine.
Click to expand...

Do not do this. It will be viewed as a sign of weakness and will make it more challenging for you to negotiate for anything there in the future. There's tons of easily digestible stuff out there on negotiating. Start now, your future self will thank you.
 
Academics can be a mixed bag. Some places are more "privademic" where they don't expect you to do research, and want you to be productive in a WRVU environment.

You are not going to be lighting the world on fire as a new grad, financially or otherwise. It takes a long time to build a practice, establish a reputation, and generate self referrals. 5-10 years in, if you're successful, you'll have some leverage, even in an academic system.

Realize that many academic shops may be low procedure volume and low complexity because they are seeing Medicaid train wrecks who are not (ethical) candidates for procedures. They may not be properly incentivized to be productive, and don't look at every patient as a walking $$$$

Academic places tend to be conservative with fixed referral patterns, which discourages innovation. The NSGY group, for example, may be dead set against MILD, Minuteman etc.

Academics can be attractive for pain for a few reasons:

Generally you don't have to do opioid management. In a private group- especially anesthesia based- you will probably do a lot of it until they assign you midlevel opioid pez dispensers so you can radiate yourself 4 days a week. The other option is to call yourself a "spine specialist" and go work for an ortho spine group, where the surgeons often have their own midlevel opioid pez dispensers and just need you to do the injections to justify the fusion and then they "refer to pain management" at the 2nd postop follow up visit.

You can get clinical buy down roles, such as Division directorships, program directorships etc. if that's your bag

You may genuinely enjoy working with trainees.

Academics may not be a bad place to start, especially for pain, but it's not for everyone in the long run.
 
You’re either punch the RVU time-clock or not. there’s no middle ground anymore …
 
cameroncarter said:
Ok all, thanks for your advice! I’m meeting with a contract review team. One of the services they offered was to directly negotiate on my behalf. Their going rate is 10% compensation for the total increase in my base salary. What are your thoughts? Seems weird to not be present for my own contract negotiation but I fully believe in their experience more than mine.
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This third party will certainly have less marketing ability than you have.
 
Centurion38 said:
Academics can be a mixed bag. Some places are more "privademic" where they don't expect you to do research, and want you to be productive in a WRVU environment.

You are not going to be lighting the world on fire as a new grad, financially or otherwise. It takes a long time to build a practice, establish a reputation, and generate self referrals. 5-10 years in, if you're successful, you'll have some leverage, even in an academic system.

Realize that many academic shops may be low procedure volume and low complexity because they are seeing Medicaid train wrecks who are not (ethical) candidates for procedures. They may not be properly incentivized to be productive, and don't look at every patient as a walking $$$$

Academic places tend to be conservative with fixed referral patterns, which discourages innovation. The NSGY group, for example, may be dead set against MILD, Minuteman etc.

Academics can be attractive for pain for a few reasons:

Generally you don't have to do opioid management. In a private group- especially anesthesia based- you will probably do a lot of it until they assign you midlevel opioid pez dispensers so you can radiate yourself 4 days a week. The other option is to call yourself a "spine specialist" and go work for an ortho spine group, where the surgeons often have their own midlevel opioid pez dispensers and just need you to do the injections to justify the fusion and then they "refer to pain management" at the 2nd postop follow up visit.

You can get clinical buy down roles, such as Division directorships, program directorships etc. if that's your bag

You may genuinely enjoy working with trainees.

Academics may not be a bad place to start, especially for pain, but it's not for everyone in the long run.
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This is pretty much dead on.

Pros of academics: non-clinical time for teaching/research, manageable patient workload, limited to no opioid management

Cons of academics: average to below average pay, limited time off (4 weeks), lag period in adopting new technological advances

It is very difficult to be productive clinically in a place that historically does not have the infrastructure for this style of practice.
 
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Dawkter said:
This is pretty much dead on.

Pros of academics: non-clinical time for teaching/research, manageable patient workload, limited to no opioid management

Cons of academics: average to below average pay, limited time off (4 weeks), lag period in adopting new technological advances

It is very difficult to be productive clinically in a place that historically does not have the infrastructure for this style of practice.
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Are academic institutions giving out non clinical FTE freely now?

At my old shop, you had to get a grant or publish in NEJM before they would even hand out 20%.
 
Ducttape said:
you cant think of academics the same way you think of private practice. there are goals outside of how much you can make.

i might guess that the other docs do a lot of nonclinical stuff such as teaching or research.

teaching probably brings in a lot of revenue.

research - in other subspecialties - can drive more revenue than patient care. i dont see that as much for pain, though.

they will be more interested in retaining your services in academia if you provide these other skills. they feel they can always hire former residents/fellows for a year or two (while they transition to more training/wait for spouses to finish etc.)


in exchange, they do eliminate some of the heinous responsibilities those in non-academia have to put up, and i would highly suspect they leave/go home a lot earlier and have more "protected time"...
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Most of the innovation in our field occurs in the private sector, not the Academic realm. If you want to make a difference in advancing the specialty, being leading edge, and doing game-changing research--go private and establish your own research program. Fewer headaches and politics in the long run.

The academic health centers will never love you back.
 
Having recently left academics for the private sector, here are my two cents:
  • With rare exceptions, most academic departments will not be high productivity places. This is as noted above, because many times there are poor patient populations in terms of procedure appropriateness, and also because the finances are set up completely differently.
  • Non-clinical time varies widely. Some places will be stingy with it, as bronx notes above, and some will use it to justify paying you less.
  • Expectations for academic productivity vary widely. Some places have "clinical educator" tracks, where if you are involved in teaching and clinical work, that's good enough. This may put you on a non-tenure promotion track, which is sometimes but not always an easier road to promotion.
  • Promotion (asst->assoc->prof) can mean a lot to your finances, or almost nothing. There can also be a wide variation in requirements for promotion from place to place.
  • Expectations for administrative work, committee membership, etc, are usually higher than in non-academic settings. These are usually not seen as "extras," but as something that you're expected to do for your salary.
  • Opioids can vary widely. I came from a place with much higher amounts of prescribing than I had done previously, and although they were trying to change, there were a lot of legacy patients. Other places don't prescribe at all.
  • Petty politics in academia truly is next level, as Hyperalgesia says. That said, some places are more collegial than others.
  • The bigger the place, the more likely that there will be ossified processes and referral patterns. For example, if there is a PMR interventional group under the Ortho department, and a separate pain group under the anesthesia department
  • Working with trainees can be very rewarding. It was far and away my favorite part of academics, and the only part I miss now. It was almost enough to make me consider staying in a place I was otherwise unhappy.
So, ultimately, it really depends on the individual place, their culture and policies. The above points can give you some things to consider. In most circumstances, though, you will not convince them to change to a high productivity model and compensate you according to your increased clinical production, if that's not already their way of operating. You're more likely to find that in a hospital employed model. If however, you're willing to trade productivity and higher income for other metrics of success and satisfaction, you might find it's right for you if it's otherwise a good place to work.
 
Thank you all so much- I learned a ton and your advice makes this exhausting decision a bit easier. I’m learning that I may most enjoy a privademics model of care. But that’ll be in the future.
 
I do not recommend starting your career like this, but if you're good with it obviously do it.

If you have a plan in the future of being a doctor capable of managing volume efficiently while providing high quality care, this is likely to stymie that development and you could potentially struggle later on if you make the switch.

Academic doctors are often inexperienced bc they've never had their feet to the fire.

I can't believe there are ppl who accept these jobs.
 
as someone who has had a taste of both, those in academics find it equally distasteful to work with the primary goal to make money by seeing more/doing more. i feel i give up some moral perspective when i focus on my wRVUs and how to improve efficiency.

then my next 5 medicaid patients no show and that goes out the window.


and there is some truth to the adage that those who cannot do, teach.

but most people who leave academics and go in to private practice seem to be do quite fine. im sure there is a transition period, but i would defer to drosenrosen on that.
 
Ducttape said:
as someone who has had a taste of both, those in academics find it equally distasteful to work with the primary goal to make money by seeing more/doing more. i feel i give up some moral perspective when i focus on my wRVUs and how to improve efficiency.

then my next 5 medicaid patients no show and that goes out the window.


and there is some truth to the adage that those who cannot do, teach.

but most people who leave academics and go in to private practice seem to be do quite fine. im sure there is a transition period, but i would defer to drosenrosen on that.
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I started in private, decided to try academics for a while, and went back to private. I think if you're good, you can certainly get back up to speed after leaving academics, but it is the difference in mindset that's harder to overcome. I think in general, people are just either academic style doctors or private style doctors. Although I love teaching, in all other ways, I confirmed to myself that I am the latter
 
drrosenrosen said:
I started in private, decided to try academics for a while, and went back to private. I think if you're good, you can certainly get back up to speed after leaving academics, but it is the difference in mindset that's harder to overcome. I think in general, people are just either academic style doctors or private style doctors. Although I love teaching, in all other ways, I confirmed to myself that I am the latter
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which is why we should not be disparaging those who choose academic employment.

or hospital based employment.
 
drusso said:
Except HOPD site of service arbitrage is ruining our profession.
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except its not

this isnt some new thing that just reared its ugly head.

you've been bitching about it for a decade now
 
SSdoc33 said:
except its not

this isnt some new thing that just reared its ugly head.

you've been bitching about it for a decade now
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Prove me wrong.

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"At the heart of the bargain between patients and non-profit hospitals is a promise that a nonprofit hospital will spend a portion of its revenue on meaningful community services. Consider it a way of directing your taxes to activities that local community members, rather than the government, believe benefit the community as a whole. Oregon has outdated infrastructure and faces a looming public employee retirement system shortfall and a chronically underfunded K-12 education system."

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"Thus, a key driver of consolidation has been “reimbursement arbitrage--” schemes to extract higher payment for services that could be delivered in lower cost or less resource-intensive settings. We’ve seen many, many times that when independent physician practices are acquired by hospitals, three things happen: Prices go up after the acquisition, total spending goes up, and referral patterns change. Hospitals pay the physicians and their staff the same salaries, but charge more for these services in their Hospital Outpatient Departments (HOPD’s), and pick up this additional revenue without adding value."
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did i say anything about HOPD reimbursement or facility fees? this is classic diversion.


your all out effort to denigrate HOPD SOS arbitrage not inadvertently denigrates physicians who choose to practice in a HOPD environment. we - well, at least, I - practice there because it suits my goals in medical, ethical and financial aspects
 
Ducttape said:
did i say anything about HOPD reimbursement or facility fees? this is classic diversion.


your all out effort to denigrate HOPD SOS arbitrage not inadvertently denigrates physicians who choose to practice in a HOPD environment. we - well, at least, I - practice there because it suits my goals in medical, ethical and financial aspects
Click to expand...

HOPD doctors can not solve the HOPD SOS arbitrage problem. You have "competing commitments."
 
drusso said:
Prove me wrong.

www.statnews.com

Nonprofit hospitals' community benefits should square with their tax exemptions. They often don't

Automatic tax exemption for nonprofit hospitals is a poorly targeted policy that provides no assurance they will fulfill their charitable missions and gives them unfair competitive advantage over for-profit hospitals.
www.statnews.com www.statnews.com

"Automatic tax exemption for nonprofit hospitals is a long-standing but poorly targeted policy that should be reformed. Tax exemption provides no assurance that these hospitals will behave in accordance with their charitable mission, and gives them an unfair competitive advantage against for-profit hospitals. If nonprofit hospitals are unwilling to provide sufficient community benefit to justify the value of their current tax exemptions, local communities should not be deprived of the property tax revenues that allow them to fund local schools, parks, and other public services."

Opinion: Striking A New Bargain for Oregon Hospital Community Benefit Programs | The Lund Report

www.thelundreport.org www.thelundreport.org

"At the heart of the bargain between patients and non-profit hospitals is a promise that a nonprofit hospital will spend a portion of its revenue on meaningful community services. Consider it a way of directing your taxes to activities that local community members, rather than the government, believe benefit the community as a whole. Oregon has outdated infrastructure and faces a looming public employee retirement system shortfall and a chronically underfunded K-12 education system."

Healthcare Reform Creates Provider Monopolies | The Lund Report

www.thelundreport.org www.thelundreport.org

"Thus, a key driver of consolidation has been “reimbursement arbitrage--” schemes to extract higher payment for services that could be delivered in lower cost or less resource-intensive settings. We’ve seen many, many times that when independent physician practices are acquired by hospitals, three things happen: Prices go up after the acquisition, total spending goes up, and referral patterns change. Hospitals pay the physicians and their staff the same salaries, but charge more for these services in their Hospital Outpatient Departments (HOPD’s), and pick up this additional revenue without adding value."
View attachment 353040
Click to expand...
nice hair, paul. 40 year olds shouldnt be allowed to style their hair this way

1649360466120.png
 
Base Salary and wRVU rate/bonus are very important parts of a contract but not the only factor. What are the other benefits like? vacation/CME, retirement match, etc. Most docs make less through a VA gig but like the population, an opportunity for a pension, and all federal holidays off. Call schedule, support staff etc can all make a difference too. Think about the whole picture when trying to decide.
 
I absolutely miss the teaching, but not being able to be critical of office staff who consistently slowed me down was what turned me away.
 
I'm not sure if this has been said already, but do whatever you can to avoid a non-compete at least for the first few years. Once you're locked in, they can screw you as much as they like in the knowledge that you'll have to move away, have your kids change schools etc. to get a new job.

Also, academic positions, no matter how good the compensation to start with, are always going to lag behind and that gets worse the longer you stay in a position, because they have to make at least somewhat competitive offers to new hires but they don't have to give raises to poor bastards like you.
 
drusso said:
Everyone wants to take care of their patients. Some want to not drive up the tax bill on useless "community benefit" and SOS arbitrage.
Click to expand...
yet you yourself commented that HOPD docs cannot solve the HOPD arbitrage problem.

so circling around - there is no need to denigrate HOPD docs who choose to take care of patients and cannot solve the HOPD arbitrage problem.
 
Ducttape said:
yet you yourself commented that HOPD docs cannot solve the HOPD arbitrage problem.

so circling around - there is no need to denigrate HOPD docs who choose to take care of patients and cannot solve the HOPD arbitrage problem.
Click to expand...

I'm committed to HOPD reform and site-neutral payment. It's time to put an end to HOPD greed and those who profit from SOS arbitrage and phony non-profit tax exemptions at the expense of others.
 
The 5X higher SOS differential payment for providing the same service produces perverse economic incentives that only help the MBAs.

I dont see all the amazing medical services others purport that large hospital chains are providing the indigent population with this extra money. In fact I get at least 5 medicaid patient referrals a week from the big box stores as they limit their number of Medicaid patients.
 
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