Reimbursement for additional work/teaching

[wareagle726]

PGY-3 here

I have signed with a CMG once I graduate and need your advice on a topic. It may seem trivial at first glance but one of my interests(**not passions RustedFox**) has been ultrasound guided IVs. I started a training course for EDTs and nurses in residency and it has had good reception and results. My question is how do I present this and capitalize on it when I am in the real world and under a standard contract. I would like to think I could negotiate an extra stipend for doing this but I am fearful this will fall under the "it helps you to help them" umbrella. All thoughts would be greatly appreciated.

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[DeadCactus]

I would talk to your medical director, once you've worked there a bit and have the lay of the land, about starting a program and ask for compensation. Put together a pitch and some supporting evidence for how it will help. If they decline, you either:
a) Find a new hobby and enjoy life
b) Start an outside company to do the training and look for opportunities in other hospitals
c) Be a chump and do it for free hoping one day they'll pay you

In academics and SDGs, I can see getting into doing things like this for free. In a CMG gig, I would be hard-pressed to do anything beyond show-up to my scheduled shifts without some sort of additional compensation. If I'm hired to be a cog, I'm going to be a cog...

 

[GonnaBeADoc2222]

LOL.

The CMG will not give one **** about this. Nice try!

 

[Arcan57]

Yeah, that’s going to be a hard pass. Stipends from CMGs are going to be of the director/scheduler/nocturnist variety. Most CMGs expect some engagement from their FT docs with a hospital committee. You may we able to substitute your skill for sitting through a Bariatrics meeting but you’re not getting money out of CMG for US guides IVs. If you’re RDMS you May be able to try for a director of US for a system but you’d likely need fellowship. Remember, nothing pays like seeing patients.

 

[Groove]

 

[EctopicFetus]

As said your CMG doesn't care.. not 1 bit. If you want to do it for free they will heap praise on you like they would for any ***** who improves their look for no $$. reality is your passion doesn't make them money. You are better off approaching the hospital and doing it as a 1 off but honestly I wouldn't count on making any money doing this. Eventually the RNs or PICC team will just train everyone and no one will need you. Putting IVs in isn't an MD skill. The use of US sort of is but PICC teams aren't MD run. Sorry bro. even sorrier you took a CMG job but I know options are limited.

 

[MechEDoc]

PGY-3 here

I have signed with a CMG once I graduate and need your advice on a topic. It may seem trivial at first glance but one of my interests(**not passions RustedFox**) has been ultrasound guided IVs. I started a training course for EDTs and nurses in residency and it has had good reception and results. My question is how do I present this and capitalize on it when I am in the real world and under a standard contract. I would like to think I could negotiate an extra stipend for doing this but I am fearful this will fall under the "it helps you to help them" umbrella. All thoughts would be greatly appreciated.

I am pretty good at ultrasound guided peripheral IVs. I have worked for CMG's for several years. Many of the sites will have nurses that are wildly incapable of competently placing a peripheral ultrasound guided IV. Your skills will come in handy. You will not get paid a cent for it. Your benefits will be: improve patient throughput versus central line (although the latter will pay more) and some credibility with nurses. The downside will be that you will be placing IVs on every difficult stick. Not only that, but you will get to meet them after 5 nurses have tried 3 times each...

 

[AlmostAnMD]

I stopped doing US IV's. I was getting good at them towards the end of residency and noticed that nurses saw when I was assigned a patient they would suddenly not be able to get the IV. Then I started doing a LOT of US IV's......now I don't do any.

 

[RuralEDDoc]

I stopped doing US IV's. I was getting good at them towards the end of residency and noticed that nurses saw when I was assigned a patient they would suddenly not be able to get the IV. Then I started doing a LOT of US IV's......now I don't do any.

This. If you build it, they will come.

 

[thegenius]

LOL.

The CMG will not give one **** about this. Nice try!

Our crappy CMG pays one of our ED docs to do regional ER simulation stuff. The doc works less shifts and does simulation stuff.

 

[BoardingDoc]

I stopped doing US IV's. I was getting good at them towards the end of residency and noticed that nurses saw when I was assigned a patient they would suddenly not be able to get the IV. Then I started doing a LOT of US IV's......now I don't do any.

I had this happen briefly as a new attending. I just started asking the RN how many times they tried and if the person in the dept who was the best at getting an IV had tried at least once. If a real effort had been made, I would go do it. If not, I made them try more. One time a travelling nurse lied and said she tried twice but couldn't get an IV. The patient told me that no one had stuck her yet. She no longer works at that hospital.

 

[gro2001]

Perhaps if you could organize an accredited CME course for which you charge a fee (either through your CMG or as a side gig), you can pay yourself (or whoever is doing the teaching) an honorarium. If you don't have someone helping you who is familiar with the accreditation process for these things it can be a challenging thing to pull off though. If you do this as a side gig, it might be worth hiring someone with the right background for the paperwork. Either way, this is not going to be a super lucrative thing either way and might be more trouble than it's worth.

If you wanted academic recognition rather than money, the way to go would be to submit the workshop to conferences and to partner with a local residency program. This would only be worthwhile if you plan to be an academic though. And even then, it's unlikely to result in a publication (unless you are doing something innovative, curriculum wise), so the academic returns would be slim.

 

[wareagle726]

Well damn

 

[Brigade4Radiant]

Our crappy CMG pays one of our ED docs to do regional ER simulation stuff. The doc works less shifts and does simulation stuff.

That’s regional and that’s for the CMG the CMG does not employee the nurses the hospital doesn’t care about the CMG in fact the hospital CEO has weekly calls and emails from CMGs wanting to staff their ER. Same as you getting all those calls and emails from CMGs.

 

[Arcan57]

Our crappy CMG pays one of our ED docs to do regional ER simulation stuff. The doc works less shifts and does simulation stuff.

Yeah, in the same way an US director does QI and teaches US around the system. TBH, these gigs can be worth it. The benefit isn't in the money (which isn't worth it) but that like FMDs you can usually dictate your schedule due to travel, mandatory meetings, etc. Doesn't matter as much early on, but it's not nothing once you start accruing responsibilities outside of work. As mentioned previously, teaching nurses US-guided PIVs isn't going to activate this perk.