Questions for the hospital employed

[cowbydoc]

With decreasing reimbursement coupled with increasing salaries it is getting harder and harder for private practice groups to stay afloat. An ever increasing stipend has some hospitals saying “screw this, we will just employ the group”. I have only worked in a private practice model so I’m curious what some of the details of hospital employment looks like. For us, the motivation to do some of the day to day tasks is because we are running our own business, want it to succeed and therefore reap the benefits. In an employee model I can imagine a lot of that motivation goes away.

Who does all the admin work previously done by group physicians?

What happens if there is a call out/sick call? Basically how does the hospital cover a spot that is unexpectedly now vacant?

Do you have hours stipulated in your contract and if you go over is there overtime?

With the current labor shortage what happens when the group is short staffed?

Do you feel any autonomy or are you beholden to someone holding a clipboard locked away in the c suite?

How do you handle wage disputes especially in this environment of skyrocketing salaries?

I’m mainly curious about the differences in employment models since I’ve only worked for one type in my career.

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[nimbus]

Our circulators and scrub techs are hospital employed. We have 2-3 call out sick every single day. Use it or lose it.

 

[Lecithin5]

Private practice has its challenges. I’ve only ever known private practice. But please strongly consider before signing on that dotted line with the hospital. You will be beholden to the hospital. Yes we are all beholden to somebody, but you still have a little bit more control in PP. I’ve spoken to countless folks who tell me they regret signing with the hospital when they had an opportunity to either form a PP, or merge with another PP, etc. And now, because there is such a shortage of anesthesiologists, and a strong demand for their services, your bargaining power is as strong as it will ever be (such as for asking for stipends, although ideally as a private practice, you want to minimize those.)

Think very long and hard before you make that decision- many regret it. I know I’m not answering your specific questions, and when I get a chance, I will.

 

[ambiturner]

With decreasing reimbursement coupled with increasing salaries it is getting harder and harder for private practice groups to stay afloat. An ever increasing stipend has some hospitals saying “screw this, we will just employ the group”. I have only worked in a private practice model so I’m curious what some of the details of hospital employment looks like. For us, the motivation to do some of the day to day tasks is because we are running our own business, want it to succeed and therefore reap the benefits. In an employee model I can imagine a lot of that motivation goes away.

Who does all the admin work previously done by group physicians?

I worked for a group that transitioned to employed.

Still some work done by physicians, we get each other out for meetings. The hospital can choose to offset FTEs for admin time if they desire, since they’re writing the checks anyway. The first few years are the most painful as they will expect the same level of service and sweat and will have to accept they aren’t going to get it from employees.

What happens if there is a call out/sick call? Basically how does the hospital cover a spot that is unexpectedly now vacant?

You will have to hire more people and people will call out sick a lot more. Invariably, stipends INCREASE with employment but they get the control they want.

Do you have hours stipulated in your contract and if you go over is there overtime?

We have overtime and weekend rates. This is critical since otherwise there is no incentive to stop doing late cases and you would see no money for them.

With the current labor shortage what happens when the group is short staffed?

Locums or temporarily consolidate rooms, another reason you need the overtime rate. If the shortage is chronic the hospital is usually willing to increase compensation after hiring consultants for large sums of money.

Do you feel any autonomy or are you beholden to someone holding a clipboard locked away in the c suite?

You can give your opinion and it is usually heeded but at the end of the day an unpopular change can go through without your blessing. This can be done via mandate from the csuite or laundered through committees so then they can say you participated, but if that’s the case they usually will give you a bone to get you to vote yes and not show dissent. Only way to make it hurt is if MULTIPLE people leave, just 1 or 2 leaving is the cost of doing business and won’t stop bad ideas.

How do you handle wage disputes especially in this environment of skyrocketing salaries?

Hire consultants, look at salary surveys, and pay whatever they say to ‘recruit and retain top talent’. This will never be enough to make you happy but will typically not make you resign in protest.

I’m mainly curious about the differences in employment models since I’ve only worked for one type in my career.

Feel free to PM if you have specific questions.

 

[cowbydoc]

Thanks ambiturner. This is the sort of perspective I’m looking for. My motive for asking this question was not because I’m considering changing practices. I’m trying to estimate what our replacement cost would be if the hospital ever tried to replace us. In most instances the cost is more and in the majority a LOT more. If that is the case are we, as private practice groups leaving a lot on the table? All the admin, organization, billing, committees, etc, etc, etc. we do for free that you just wouldn’t do as an employee but we do it in the name of maintaining our own business. I think we as doctors are too willing to just put our heads down and work ever so harder when we would be better off putting our foot down and demanding better working conditions or higher pay.
With our group I’m trying to reframe the conversation so we can get a better deal for ourselves. To try and rethink what our value is to the hospital and system as a whole.

 

[ambiturner]

Thanks ambiturner. This is the sort of perspective I’m looking for. My motive for asking this question was not because I’m considering changing practices. I’m trying to estimate what our replacement cost would be if the hospital ever tried to replace us. In most instances the cost is more and in the majority a LOT more. If that is the case are we, as private practice groups leaving a lot on the table? All the admin, organization, billing, committees, etc, etc, etc. we do for free that you just wouldn’t do as an employee but we do it in the name of maintaining our own business. I think we as doctors are too willing to just put our heads down and work ever so harder when we would be better off putting our foot down and demanding better working conditions or higher pay.
With our group I’m trying to reframe the conversation so we can get a better deal for ourselves. To try and rethink what our value is to the hospital and system as a whole.

Our subsidy has tripled or quadrupled since the time we were private. Our working conditions are better and our pay is slightly lower, adjusted for inflation, although less pyramidal than a partnership track. What the hospital got in return for their money was the ability to direct our group’s resources into their preferred service lines via call stipends and hiring directives and the ability to try some of their bad ideas without negotiation. Think about some of the bad ideas the hospital has had that they wanted your practice to do and then imagine you were less able to resist.

 

[Arantius]

Serious question. If we all end up hospital employed then what is the incentive to hustle and keep everyone moving (like the hospital employed surgeons, nurses, etc). Will everyone just move at a snails pace? Frequently I feel like I am the one pushing the schedule to keep moving, and I feel like I'm the ONLY ONE.

 

[GassYous]

Our subsidy has tripled or quadrupled since the time we were private. Our working conditions are better and our pay is slightly lower, adjusted for inflation, although less pyramidal than a partnership track. What the hospital got in return for their money was the ability to direct our group’s resources into their preferred service lines via call stipends and hiring directives and the ability to try some of their bad ideas without negotiation. Think about some of the bad ideas the hospital has had that they wanted your practice to do and then imagine you were less able to resist.

I don't understand what's the problem with having drs just sit in the room doing cases. Why do people need to try to reinvent the wheel and then whoops now there's a "provider shortage" because you want people sitting around for "pain service" or whatnot.

 

[IMGASMD]

I don't understand what's the problem with having drs just sit in the room doing cases. Why do people need to try to reinvent the wheel and then whoops now there's a "provider shortage" because you want people sitting around for "pain service" or whatnot.

Because they all have to perform to their audiences…. Show they’re doing “something” to justify their pay.

 

[nimbus]

Serious question. If we all end up hospital employed then what is the incentive to hustle and keep everyone moving (like the hospital employed surgeons, nurses, etc). Will everyone just move at a snails pace? Frequently I feel like I am the one pushing the schedule to keep moving, and I feel like I'm the ONLY ONE.

We’ll all have the VA spa life

Sometimes my days are like this except it’s 7pm…..

 

[aneftp]

We’ll all have the VA spa life

Sometimes my days are like this except it’s 7pm…..

View attachment 374013

Not all VA places are the same. There are VA that are always understaffed.

VA lifestyle fits those with family issues (like young kids at home needing to call out sick anytime) or older docs ready for retirement or docs with clinical/mental issues or military docs.

Or docs hoping for advancement in VA system into non clinical roles

 

[nimbus]

Not all VA places are the same. There are VA that are always understaffed.

VA lifestyle fits those with family issues (like young kids at home needing to call out sick anytime) or older docs ready for retirement or docs with clinical/mental issues or military docs.

Or docs hoping for advancement in VA system into non clinical roles

I’ve only had experience at 2 VAs as a medical student and as a resident. At both places, the pace was…..relaxing.

 

[IMGASMD]

I’ve only had experience at 2 VAs as a medical student and as a resident. At both places, the pace was…..relaxing.

Had a partner who left and joined a va. He is bored out of his mind, and would come back at least a few times a month just to “do” something.