Production based compensation

[cyanide12345678]

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What are the important questions to ask to fully understand a production based compensation bonus?

I was negotiating a contract, and was offered a production based compensation bonus in addition to base rate. I've been told that the other docs average at 20/hr for the production. Base is 205/hr. What do i need to know about the production bonus?

 

[USCDiver]

Assuming this is RVU based, how do they handle patients who are signed out at shift change or mid level supervision?

 

[cyanide12345678]

Update and advice needed:

The contract i have received has a vague clause about production based compensation. I have had a lot of difficulty trying to get more information from the recruiter.

I have asked 3 times in 3 separate emails if there is a minimum threshold of productivity required to receive the productivity incentive, no answer on this. I have asked what equation is used to determine this, no answer yet. I don't understand why i have received vague responses to my very direct questions. In response to my questions, i have received 3 pieces of information so far: productivity incentive is rvu based, patient per hour based, 20/hr median. I have not been given specifics of how Rvus determine this.

Also, A l friend who works at the facility doesn't know of any other doc at that facility who has a productivity based compensation.

Any suggestions on what my next step should be? I feel weird about asking the same question the 4th time, but i think it's essential to know if the productivity incentive kicks in after a certain threshold. Talk to the medical director instead of the recruiter? Opinions on getting a contract lawyer to review the contract ? Opinions on having a contract lawyer negotiate on my behalf?

 

[BoardingDoc]

Update and advice needed:

The contract i have received has a vague clause about production based compensation. I have had a lot of difficulty trying to get more information from the recruiter.

I have asked 3 times in 3 separate emails if there is a minimum threshold of productivity required to receive the productivity incentive, no answer on this. I have asked what equation is used to determine this, no answer yet. I don't understand why i have received vague responses to my very direct questions. In response to my questions, i have received 3 pieces of information so far: productivity incentive is rvu based, patient per hour based, 20/hr median. I have not been given specifics of how Rvus determine this.

Also, A l friend who works at the facility doesn't know of any other doc at that facility who has a productivity based compensation.

Any suggestions on what my next step should be? I feel weird about asking the same question the 4th time, but i think it's essential to know if the productivity incentive kicks in after a certain threshold. Talk to the medical director instead of the recruiter? Opinions on getting a contract lawyer to review the contract ? Opinions on having a contract lawyer negotiate on my behalf?

Just tell the recruiter that you want the details of your salary and productivity bonus stipulated in any contract that they offer you and that it must contain details on exactly how that bonus is calculated. Otherwise, you obviously wouldn't feel comfortable taking the job as they're basically saying "yeah, don't worry we'll pay you, we just aren't going to say how much. Sign here." If the recruiter knows that all of this work getting a commission from you might be for naught, I suspect you'll get the answer you want.

 

[cyanide12345678]

Just tell the recruiter that you want the details of your salary and productivity bonus stipulated in any contract that they offer you and that it must contain details on exactly how that bonus is calculated. Otherwise, you obviously wouldn't feel comfortable taking the job as they're basically saying "yeah, don't worry we'll pay you, we just aren't going to say how much. Sign here." If the recruiter knows that all of this work getting a commission from you might be for naught, I suspect you'll get the answer you want.

I'll try again and tell them that. Right now the contract says that ill be entitled to a production based compensation based on their production based program, and that the program may change at any point. Literally that's all it says.

Obviously there is a separate clause for the base of 205/hr which is very clear. I will ask for clarity a 4th time -_-

 

[GonnaBeADoc2222]

So they say the other docs average $20/hr, but your friend who works there says no other doc there has such a productivity based compensation model.....

Sounds pretty damn sketch to me.

 

[cyanide12345678]

So they say the other docs average $20/hr, but your friend who works there says no other doc there has such a productivity based compensation model.....

Sounds pretty damn sketch to me.

Agreed, it is sketch. It was never mentioned before until after a few rounds of negotiations. Right now looking into getting the contact reviewed by a lawyer.

 

[deleted206819]

Is this a democratic group, hospital owned group or CMG?

 

[Hercules]

Agreed, it is sketch. It was never mentioned before until after a few rounds of negotiations. Right now looking into getting the contact reviewed by a lawyer.

Is this an unbelievably desirable job for you? In all honesty, I tell residents that smokescreens like this are usually an indication that you should walk. If an SDG can’t explain very simply the cost and path to partnership, then walk. If a large CMG can’t explain with crystal clear clarity what your compensation and scheduling will look like, then walk. There are a lot of really bad jobs in EM, but there are also some fantastic jobs/groups if you’re willing to do your homework. The recruiting/interviewing phase is the group putting their best foot forward. If you’re already seeing red flags at this point, then you can’t be surprised if it turns out to be a terrible job plus you’ll be kicking yourself for ignoring the signs.

None of this may apply to you, but it seems like a common scenario for many.


Sent from my iPhone using SDN mobile

 

[cyanide12345678]

Is this a democratic group, hospital owned group or CMG?

CMG.

 

[cyanide12345678]

Is this an unbelievably desirable job for you? In all honesty, I tell residents that smokescreens like this are usually an indication that you should walk. If an SDG can’t explain very simply the cost and path to partnership, then walk. If a large CMG can’t explain with crystal clear clarity what your compensation and scheduling will look like, then walk. There are a lot of really bad jobs in EM, but there are also some fantastic jobs/groups if you’re willing to do your homework. The recruiting/interviewing phase is the group putting their best foot forward. If you’re already seeing red flags at this point, then you can’t be surprised if it turns out to be a terrible job plus you’ll be kicking yourself for ignoring the signs.

None of this may apply to you, but it seems like a common scenario for many.


Sent from my iPhone using SDN mobile

It is one of the better jobs in the area. I am extremely location restricted, and in the 1 hour radius, I think this is one of the more desirable jobs compared to the other positions in the area. There are potentially 4 different employers in the area, I've talked to everyone and done multiple site visits, everything was extremely smooth until the whole idea of productivity based compensation was added in response to negotiations. I was attempting to increase the base rate in my negotiations, and instead they offered a productivity incentive. It sounded great, better than what I was asking for, but they haven't given any concrete formulas that determine this.

I am willing to walk away, but the next best job in the area has the same salary but worse staffing and higher patient loads (2.5 pph vs 2.0 pph).

 

[dadaddadaBATMAN]

It is one of the better jobs in the area. I am extremely location restricted, and in the 1 hour radius, I think this is one of the more desirable jobs compared to the other positions in the area. There are potentially 4 different employers in the area, I've talked to everyone and done multiple site visits, everything was extremely smooth until the whole idea of productivity based compensation was added in response to negotiations. I was attempting to increase the base rate in my negotiations, and instead they offered a productivity incentive. It sounded great, better than what I was asking for, but they haven't given any concrete formulas that determine this.

I am willing to walk away, but the next best job in the area has the same salary but worse staffing and higher patient loads (2.5 pph vs 2.0 pph).

Sounds stressful. If I was signing this contract what would make me nervous is that if they're potentially fos on my compensation then what else are they stretching the truth on?

Hopefully it's just a annoying recruiter that is giving you a bad vibe, but if you can't get it crystal clear in writing I would probably not sign.

I guess I am curious why another job in the same area pays the same for a supposedly worse job? Does the cmg have a better payer mix somehow, or questionable billing practices? Are you signing more midlevel charts? Why haven't the docs there walked for the "better" job seeing less patients for the same pay and better staffing?

 

[cyanide12345678]

I guess I am curious why another job in the same area pays the same for a supposedly worse job? Does the cmg have a better payer mix somehow, or questionable billing practices? Are you signing more midlevel charts? Why haven't the docs there walked for the "better" job seeing less patients for the same pay and better staffing?

The other job I mentioned is a private democratic group. The partnership docs happily see the extra load because they directly gain from being busier. I think they see more because of scribes as well. The non partnership track, which is what I was interested in (leaving the area in a few years), pays about the same as the CMG. Once a full partner (4 year process for partnership track to be full partner), I believe they make significantly more than the CMG.

 

[BoardingDoc]

Is this a democratic group, hospital owned group or CMG?

This sounds like USACS. I had a similar RVU "bonus" pitch from them when I interviewed which was extremely vague, and they also quoted me an average of 20/hr. Did not take the job.

 

[USCDiver]

Sounds like USACS (née EMP) to me too. In the one year I worked for them just after residency, I never met their threshold for bonusing.

 

[cyanide12345678]

Hopefully it's just a annoying recruiter that is giving you a bad vibe, but if you can't get it crystal clear in writing I would probably not sign.

I am giving the benefit of the doubt so far and assuming this is the case. The recruiter was great, very responsive and easy to work with until this issue of productivity came up and he's beating around the bush in response to my questions. My friend is also pretty happy there, but he his contract doesnt have any productivity stuff in it, just a higher rate.

Sounds like USACS (née EMP) to me too. In the one year I worked for them just after residency, I never met their threshold for bonusing.

It's not USACS. But good to know that this is one way they like to screw us over. Did USACS atleast disclose what their threshold was?

 

[GonnaBeADoc2222]

I am giving the benefit of the doubt so far and assuming this is the case. The recruiter was great, very responsive and easy to work with until this issue of productivity came up and he's beating around the bush in response to my questions. My friend is also pretty happy there, but he his contract doesnt have any productivity stuff in it, just a higher rate.

It's not USACS. But good to know that this is one way they like to screw us over. Did USACS atleast disclose what their threshold was?

So they're f*****g you.

It's the recruiters job to be nice to you. They want to sign you. They are not your friend.

They are being vague because either:
a) The recruiter doesn't know the parameters themselves, or
b) They are so impossibly difficult to meet that you will never see the money

Run, my friend. Run far away.

P.S. Would be helpful to know which CMG this is and what general area of the country.

 

[Arcan57]

I am giving the benefit of the doubt so far and assuming this is the case. The recruiter was great, very responsive and easy to work with until this issue of productivity came up and he's beating around the bush in response to my questions. My friend is also pretty happy there, but he his contract doesnt have any productivity stuff in it, just a higher rate.



It's not USACS. But good to know that this is one way they like to screw us over. Did USACS atleast disclose what their threshold was?

It’s CMG policy not to offer different docs different base rates at same shop. Ruins the whole interchangeable cogs part of Cog Management Group. So you’re not going to get a bump in your base rate. They can offer a productivity incentive (which is opaque by design to make sure they get their dealers’ cut), give you a stipend for some admin task, or bump the whole group (only done if it looks like enough docs are going to walk that the cost to recruit new ones is higher then the outlay for increased base pay). Some CMGs will give you a very precise formula for the productivity bonus but there’s always some fudge factor that decides at the regional director or more commonly CFO level that figures into the calculation. Examples include offering RVU pay but the amount per RVU is substantially less then the CMG collects (on average) or it’s RVUs you generated/RVUs of group X (money group collected - CMG expenses).

 

[USCDiver]

It's not USACS. But good to know that this is one way they like to screw us over. Did USACS atleast disclose what their threshold was?

I honestly don’t remember, it has been a long time. It was definitely pointed out every month at the service meeting though. I just never could reach the productivity OR Press-Ganey benchmarks.

 

[GeneralVeers]

The current scheme is to offer productivity-based pay and give a dollar figure like $30/RVU. It's easy to calculate what your pay is going to be using that formula. They initially offer a very generous amount of $/RVU to get allt he docs to sign on the contract, then later on they reduce it to $25/RVU or worse. Always need to make sure the conditions for changing the productivity are spelled out in writing, and how much advance notice they can give. Always assume that they WILL lower the RVU at whatever time interval that they give. If they don't give a time interval, then don't sign the contract.