Subspecialists Compensation Structures - Peds/Cardiac

[rp218]

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What ways do groups compensate their subspecialists (Peds,cardiac) who end up taking more pager call than rest based on hospital requirement for 24/7 coverage?
If there is a hospital stipend for the speciality, how is that distributed within a group of general, peds, and cardiac? Assuming peds/cardiac are also part of the general call pool given low volume of specialty cases.

 

[deleted126335]

These discussions usually take place In a calm, collegial, open, organized, friendly, manner.

 

[Mman]

What ways do groups compensate their subspecialists (Peds,cardiac) who end up taking more pager call than rest based on hospital requirement for 24/7 coverage?
If there is a hospital stipend for the speciality, how is that distributed within a group of general, peds, and cardiac? Assuming peds/cardiac are also part of the general call pool given low volume of specialty cases.

we pay everyone the same and our peds and cardiac docs do not take any more call than anybody else. The only thing the fellowship changes is if/when we offer jobs depending on need of those particular specialties.

 

[kidthor]

I can speak to peds anesthesia only - but I've seen all kinds of compensation and load strategies for call. I've actually seen several places who pay the peds anesthesiologists less than the adult generalists for a similar workload (noting the billable income is less in peds). I can't imagine anywhere paying cardiac less (high billables).

It ends up being a supply/demand thing mixed with ability for the group to negotiate hospital stipends well.

The most coherent structures I've seen give a slight bump to peds and cardiac for their base pay and associated call, but only slightly - maybe 5-10%. Those people tend to then only take peds/cardiac call. Units are blended or the day is paid as a day rather than by productivity. The stipends go into the group's general coffers and help sustain what would other be a money-losing activity (e.g. 24/7 call - which is inherently unproductive from a financial standpoint).

 

[Hoya11]

Our cardiac guys make 20k per year more, and have an extra week of vacation. They take extra cardiac call from home which involves staying late, coming in on weekends sometimes to do cases..

Nothing different for peds trained people as we all do peds on call and there is nothing extra necessary

 

[D P356]

Where I trained, cardiac folks were paid 10% more, but their call burden was higher. I’d like to think if the generalists took similar call, the pay would be about the same.

 

[sleepallday]

What ways do groups compensate their subspecialists (Peds,cardiac) who end up taking more pager call than rest based on hospital requirement for 24/7 coverage?
If there is a hospital stipend for the speciality, how is that distributed within a group of general, peds, and cardiac? Assuming peds/cardiac are also part of the general call pool given low volume of specialty cases.

Who is taking the in house call (if any)? Are you RVU based?

 

[AdmiralChz]

Who is taking the in house call (if any)? Are you RVU based?

I’m not aware of anyone taking required in-house call for Cardiac. Some stay there for convenience/distance but it’s not a service mandated to have immediate coverage (same for the surgeons). Unless you are cross-covering trauma/OB it would be very uncommon I’d wager.

Probably a little more common in pediatrics - the kids hospital in town is a “Level 1” pediatric trauma center that I imagine requires in-house coverage at night.

 

[sleepallday]

I’m not aware of anyone taking required in-house call for Cardiac. Some stay there for convenience/distance but it’s not a service mandated to have immediate coverage (same for the surgeons). Unless you are cross-covering trauma/OB it would be very uncommon I’d wager.

Probably a little more common in pediatrics - the kids hospital in town is a “Level 1” pediatric trauma center that I imagine requires in-house coverage at night.

Yea, true groups that cross cover do it.

But my question was more so directed to the OP stating peds/cardiac take more pager call. So how is the in house call divided? Are the generalist in house more frequently?

 

[rp218]

Yea, true groups that cross cover do it.

But my question was more so directed to the OP stating peds/cardiac take more pager call. So how is the in house call divided? Are the generalist in house more frequently?

The group all takes a similar salary with peds/cardiac getting roughly 10-20k more. Not RVU based

In house call numbers are the same for all (general, peds, cardiac) - we do pretty high volume OB.

Peds/cardiac have additional pager call burden of covering 365/x docs - it has been fluctuating lately with turnover/retirement.
Callbacks generate an hourly rate, but the low volume makes this pretty infrequent(10-20% of the time, more common on the weekends; most peds/cardiac cases are usually done during daylight hours on weekdays). Peds usually infants/toddlers for callback, most of the group is comfortable with peds >4 years of age. We do all neonatal cases, besides congenital hearts. Hearts are bread and butter, but the hospital is probably doing away with cardiac very soon.

Group has been very successful for a while, but with the changing environment, we are looking to revamp compensation. Don't currently receive a stipend from the hospital, but contemplating if thats an avenue we should pursue to make the books work.

Appreciate all the input.

 

[WholeLottaGame7]

In-house overnight call (generalists, OB) make one hourly rate, though since it's a shift it's essentially a flat rate. Home/pager call makes a substantially lower hourly rate which gets bumped up when called in. Generally subspecialists take more call, but it's from home, so *mostly* evens out. The highest earners at our place are the OB/generalists who gobble up the extra in-house shifts. The base is the same for everyone, though, which is where the acrimony comes in. The people who take loads of overnight call still get the same base as if they are working full daytime hours, which they obviously are not. Also showing it is skewed is the fact that the OB/generalists fight hard to keep specialists from being able to take the in-house overnight call.

Hard to design a perfect system. As they say, our system is the worst one, except for all the other ones out there...

 

[pjl]

Our cardiac people take the same call and are paid the same as our noncardiac people.
The only time there is a pay difference is if they get called in for an emergency heart on the weekend or at night, when they wouldn't have already been there as primary call. Then they get $450 per hour.

The last time we paid anyone that was a few years ago since we are not really into doing emergency hearts off hours.

About once a year we end up with 2 non-cardiac people on call/backup, and add in a cardiac backup. That is worth ~$1000/24 hours for being available.

All those things added together have netted me ~5-10k over the past 10 years. Hearts are worth it though because you can do a nice case instead of supervising.

 

[kidthor]

Then they get $450 per hour

Whoa that's a lot. What do your generalists get when called back for a weekend case?

 

[pjl]

Whoa that's a lot. What do your generalists get when called back for a weekend case?

Nothing