Productivity Bonus Subject to Overhead as Associate?

[Jummy Biffett]

I am a second year Associate at a multi-specialty group which includes mostly vascular/general surgery and some podiatry. In meeting with my CEO the other day I was informed that although I am close to reaching my wRVU-based quarterly bonus, I actually will not receive any further compensation until I've 'become profitable' for the practice. Essentially, I am being charged overhead expenses as if I were a partner/owner, despite only being an associate with no equity. As of now, the practice has "lost" well over six figures by employing me (highly doubtful). Has anyone else encountered this? Surely this is not normal...

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[icebreaker32]

You can contact an attorney to review your contract, but not sure that would go over well If you bring that up to them.

I would try to nicely ask for what defines profitabIe and ask for it in writing so you know.
The partners are probably upset they are down a little (probably a combination of many factors not just you). They are probably still doing well, but looking for ways to cut expenses. Many partners no matter how much they make, often throw tantrums if they are down even a little from the previous year in their meetings.

It is a tough situation because if you are hitting goals you should be profitable for them long term and they should not want to give you a reason to leave. If you have the possibility of partnership eventually and want to remain in the area it is in your best interest to be as diplomatic as possible.

If you do not have good long term feeling about the situation, you can start applying for other jobs and may even have an out with your contract based on what they did If you want to give less notice.

 

[dtrack22]

What part of your contract allows them to withhold compensation for production benchmarks that were established elsewhere in that same contract?

 

[icebreaker32]

What part of your contract allows them to withhold compensation for production benchmarks that were established elsewhere in that same contract?

Yah you really need review your contract thoroughly and maybe even hire a good attorney for some advice. Odds are it will not be worth pursuing legally even if you want to leave, but is nice to know your options. Also you need to know your options for breaking your contract and how this would affect things.

For now try to be as diplomatic as possible and get something in writing about the changes they just have made without your consent. Play it off as you need to know what being profitable entails so you know what goals to aim for etc.

 

[podwho]

Sounds like a power move by the CEO to make you feel grateful for having a job and you don't ask for a raise considering your reaching bonus wRVU levels of production.
Play it safe and just ask for transparency in an honest attempt to be more valuable to the company.

 

[NobodyDPM]

LOL, that's a pile of horse manure.

Your productivity bonus already has the overhead calculated within it. And then you still aren't getting 100% of what you made over and above what you needed to make to get a bonus.

So let's say you have to cover 200% of your current salary, plus benefits before your bonus kicks in, and then you're only getting 30% of the over and above, you think they aren't making a HUGE profit on you? They think you're stupid. That's why medicine is such a scam now.

Do you think you would still be employed if you lost a company that much money? Again, they are playing you for a fool.

It is up to THEM to make sure you are busy. If there was that severe a loss of revenue, that's on them. Which is total BS. Honestly, this early in your career, move on. Find somewhere else to go, or start up on your own. If they are treating you like this so quickly, it can only go downhill.

 

[Feli]

It all depends what your contract says. As mentioned, consult an attorney.

It depends if you're on % collections of $ or on RVUs and what the language states. As you said, you are "close to reaching my wRVU bonus," so they haven't technically done anything wrong yet regardless of what the deal is. Find out exactly what you signed with a professional who does contract review. It is impossible to say without knowing the contract, though.

Find a good attorney who charges per hour and specializes in employment law or medical law. Once you know, you are better prepared to see if things can be amicable or if you need to start leaving. For all you know, you simply got some canned CEO spiel that they give to all new hire docs to make them know their place and keep building volume and productivity?

It's not a bad idea to look for new job options also. If the attorney concludes you are clearly not getting monies owed, then that is usually a way out of the deal and voiding any non-compete and/or ending early without possible claw back by them. Contracts are ultimately only as good as the ppl signing them. Good luck.

 

[Jummy Biffett]

Thanks for all the input. I had an attorney review it when I signed and will ask them to review again under these new circumstances. The other complicating factor is I don't actually know how many wRVUs I've earned to date because the CEO 'hasn't been able to run that report yet'...clearly BS. My sense is I have not earned a significant bonus but I know for a fact that I've generated almost 3x my salary in revenue for the practice last year. So its total crap for them to claim they've lost over 6 figures on me. The bigger problem is my potential future earnings would clearly be significantly hampered if I'm being held to 'paying off this debt' before getting a dime more than my base salary.

Sad to see that it's not just the old TFP groups that are screwing over young associates. I work at a respectable MSG in my city...

 

[619]

Sad to see that it's not just the old TFP groups that are screwing over young associates. I work at a respectable MSG in my city

Sorry to hear what you are going through. Just my input, I hope you can work things out with your MSG. Even if you did not hit the bonus, I am sure your MSG is paying you a very good base and you have benefits like health insurance, 401K etc. Your other option is obviously finding another job but if you are settled down in the city and love the city then the other choices are hospitals or pod private practice.

I am sure you are aware that your MSG base salary (without bonus) is way way way higher than any amount a pod practice can offer you even with a promise of bonus. So my advice is to work things out with your MSG (except if you can get a hospital job). You said it's your second year as an associate so we are all just recovering from the COVID hit and that's why the CEO is throwing a tantrum but I think if you stick around longer, then you will sure begin to bonus on top of your large base salary.

I think it's over the top for those saying to quit. It's not like there is a basket full of MSG jobs to cherry pick from. I hope you work things out. Stay and fight diplomatically instead of running away.

 

[ExperiencedDPM]

There is more to the story that you don’t know. Maybe the CEO has his/her head on the chopping block and is looking for ways to increase profits. So the CEO takes the path of least resistance and takes a shot at you.

This is a bad sign and a look into the future there of things to come. These scenarios rarely end up getting better.

The CEO is getting pressure and shi- rolls downhill. And you’re presently at the bottom of that hill.

 

[619]

For all you know, you simply got some canned CEO spiel that they give to all new hire docs to make them know their place and keep building volume and productivity?

This could be correct. OP could just be thinking too much as the CEO just gave his canned spiel in an effort to motivate the young docs. In every new practice or organization, you have to earn your tiger stripes. OP said he has made the practice 3 times over which is good to hear. Anyway I wish OP the best.

 

[CutsWithFury]

Thanks for all the input. I had an attorney review it when I signed and will ask them to review again under these new circumstances. The other complicating factor is I don't actually know how many wRVUs I've earned to date because the CEO 'hasn't been able to run that report yet'...clearly BS. My sense is I have not earned a significant bonus but I know for a fact that I've generated almost 3x my salary in revenue for the practice last year. So its total crap for them to claim they've lost over 6 figures on me. The bigger problem is my potential future earnings would clearly be significantly hampered if I'm being held to 'paying off this debt' before getting a dime more than my base salary.

Sad to see that it's not just the old TFP groups that are screwing over young associates. I work at a respectable MSG in my city...

You are just in a bad private MSG. MSG associated with hospitals or hospital medical groups would never be able to pull this crap. Get a new job.

 

[GreenHousePub]

Time.....for a new job?

Or stay and then you can brag to everyone about working for a MSG on SDN.

 

[Steveington]

This suggestion may be too late for your current issue, but hopefully it will help in the future or help other readers. I recommend getting your RVU report each month. Figure out how to run to the report or who to talk to so you can get it. Make it like clockwork so you get the previous month's report every 15th, or something like that. By doing this, you will know where you stand. I have a monthly meeting with admin where the first bullet point of the agenda is just to confirm that we have the same RVU number and are both on the same page.

 

[air bud]

This suggestion may be too late for your current issue, but hopefully it will help in the future or help other readers. I recommend getting your RVU report each month. Figure out how to run to the report or who to talk to so you can get it. Make it like clockwork so you get the previous month's report every 15th, or something like that. By doing this, you will know where you stand. I have a monthly meeting with admin where the first bullet point of the agenda is just to confirm that we have the same RVU number and are both on the same page.

This is the way. Remember nobody cares how much you get paid more than you do.

 

[heybrother]

Its a little trite to hear this a 3rd time in a row, but hospitals/organizations botching RVU counts is more common than you'd think. During my residency I worked with a few different groups of doctors employed at different hospitals in the same system. One group was supplied their RVU/code totals etc and they tore it to pieces every month. They literally started keeping a daily count of codes and procedures because of how off the hospital was. The other group couldn't get the hospital to surrender their RVUs. They ultimately sued and found the hospital had massively botched and miscoded their work for years. The hospital coded so poorly that nothing was being paid for and therefore the hospital was demanding pay cuts claiming the revenue was poor.

Be your own advocate. Keep tabs on your own production. Good luck.

 

[HardRoadPaved]

Be your own advocate. Keep tabs on your own production. Good luck.

Do this even in PP. I never trust other people with my own money.

 

[heybrother]

Do this even in PP. I never trust other people with my own money.

PP is this on steroids. Did the insurance adjust it appropriately. Did the insurance ever pay. You see the patient through an enormous global checking at each visit to see if its been processed yet and the insurance still hasn't paid. Then you find out the insurance doesn't actually communicate to your EHR so you have to do remittance. You get the EOB from the insurance company, submit it to your EHR, who then processes the claim and ultimately passes the balance to the patient to pay - 6 months later etc. And then hopefully you set up a process in your office to recognize all the insurances that don't communicate so you can start this process 3 months sooner next time.

Or - worse still. You do this process and send the EOBs. Then you do a billing check back through time and realize the EHR misunderstood the EOBs and returned 6 months of patients $60 copays. So the plantar fascial injections that were supposed to be paid at 165% of Medicare (basically best insurance I accept) were set to be paid at like $90, but your EHR gave the $60 copay back and now they are worth $30 and you spend months sending an excel of all the screwed claims back to the EHR but in another audit you find they still didn't fix all of them.

 

[wakaflocka88]

This suggestion may be too late for your current issue, but hopefully it will help in the future or help other readers. I recommend getting your RVU report each month. Figure out how to run to the report or who to talk to so you can get it. Make it like clockwork so you get the previous month's report every 15th, or something like that. By doing this, you will know where you stand. I have a monthly meeting with admin where the first bullet point of the agenda is just to confirm that we have the same RVU number and are both on the same page.

I’m new to the MSG game but yes do this. I’m able to generate a RVU/wRVU report anytime to make sure they’re charging and billing the same number of patients I saw on a given day and also allows me to see what procedures carry more wRVU and so on.

 

[NobodyDPM]

You should be asking for a monthly report of your own revenue regardless of what type of work environment you're in. The CEO is full of crap if you ask and he tells you it hasn't been run yet. He's lying to you. In a situation like yours, there are bean counters there that can tell you exactly what your revenue stream is and how it has fluctuated, virtually daily.

Like I said earlier, get out of there. Not only are you currently getting the brunt of the BS, but it's bound to only snowball.