Voluntary pay cut?

[Angry Birds]

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So, a friend of mine, a fellow ER doc, was sent a letter from his hospital saying that they are requesting pay cuts across the board... They are asking everyone to take a voluntary pay cut. What is the downside to say no (in a respectful manner)?

 

[VA Hopeful Dr]

So, a friend of mine, a fellow ER doc, was sent a letter from his hospital saying that they are requesting pay cuts across the board... They are asking everyone to take a voluntary pay cut. What is the downside to say no (in a respectful manner)?

Getting fired when things go back to normal?

That's the most drastic, but its very possible.

 

[Fox800]

I would only agree to this if the hospital deferred your salary due, and you had an ironclad contract that said you would be paid your normal amount when times get better. Effectively, a loan to the hospital. Otherwise I would refuse.

 

[Angry Birds]

Getting fired when things go back to normal?

That's the most drastic, but its very possible.

I told him that I would tell them to shove it. But yeah, I guess that is the concern. But, really, he can easily get another job (outside of COVID freezes, etc.)

 

[VA Hopeful Dr]

I told him that I would tell them to shove it. But yeah, I guess that is the concern. But, really, he can easily get another job (outside of COVID freezes, etc.)

I tend to agree with your sentiment, however if the hospital invokes the 90/120-day out no-fault clause that most contracts have, will things be normal enough in 3-4 months to make getting that new job easy?

 

[RustedFox]

Great post. I put some thoughts in italics where they fit:

A lot of the answer depends on where the hospital is, and how hard it would be for them to attract new doctors. But on the whole, sadly, your friend probably doesn't have much leverage and would find himself out of a job if he told them no. EM is becoming quite saturated (as has been thoroughly discussed on this forum), and the current state of affairs has accelerated the problem/ made it worse.

Yep, you're right. I don't know what we can do to fix this besides holding the residency credentialing folks' feet to the fire.

Most places right now are overstaffed and would have no problem getting rid of a few people. Will volumes eventually return to normal? Maybe. Or maybe a certain percentage of the population now realizes they don't need the ED for everything and will never return.

Speaking from my (n=1) experience, our volumes are quickly climbing back to "normal". I saw 29 in 8 hours yesterday, none of whom were COVID-related. There are a few factors that make me think that the population "doesn't" realize that they don't need the ED for everything:

1. The medicaid crowd will always return, because its free and convenient.
2. The medicare crowd will always return, because its free and convenient.
3. Those seeking care at "Urgent Cares" are being transferred/referred to us in ever-increasing numbers.

In any case, a hospital can easily afford to lose a couple of ED docs right now and when/if volumes return it won't be hard to cover their shifts with a bit of OT for a while (which the remaining docs will be desperate to pick up), while easily hiring from the large EM applicant pool in the meantime.

I don't understand this. There's no OT in our world.

 

[Fox800]

A lot of the answer depends on where the hospital is, and how hard it would be for them to attract new doctors. But on the whole, sadly, your friend probably doesn't have much leverage and would find himself out of a job if he told them no. EM is becoming quite saturated (as has been thoroughly discussed on this forum), and the current state of affairs has accelerated the problem/ made it worse. Most places right now are overstaffed and would have no problem getting rid of a few people. Will volumes eventually return to normal? Maybe. Or maybe a certain percentage of the population now realizes they don't need the ED for everything and will never return. In any case, a hospital can easily afford to lose a couple of ED docs right now and when/if volumes return it won't be hard to cover their shifts with a bit of OT for a while (which the remaining docs will be desperate to pick up), while easily hiring from the large EM applicant pool in the meantime.

I keep a couple of locums contacts, and right now the "best" offers they're making that I'm seeing are for jobs paying between $150-$180 an hour for horrible places with terrible support and mostly nights. One of my former residents who lost their locums gig (hospital didn't need them any more) just took a desperation job at a sleepy rural place for $90/hr because that's all she could find to offer FT hours. It's really hard out there, and this isn't the time to put your job at risk. I'd like to give you a different answer, but unless EM docs come together as a whole (which let's be real, isn't happening), then this is not the time to do anything but bend over and take it.

Full disclosure, my hospital has now taken about $50,000 away from me for this year and I've bent over and taken it. So my money (or lack thereof) is where my mouth is.

I'm assuming your locums offers are in your region, and you aren't looking nationally. It's still easy to find $225-300/hr LT gigs, though the days of >$300/hr LT spots are basically gone.

I feel your pain - local gigs here top out at about $220/hr for a busy shop. Most places around here are $150-200/hr.

I'm about to get on a plane for $285/hr to a spot that saw 6 patients in 10 hours on my last shift. Granted, I have to fly to the Midwest.

 

[southerndoc]

I went a shift the other day with only seeing 1 COVID patient. I had 5 that were COVID positive yesterday (2 done last week, returned with their ARF/SARS).

We're predicting 75-85% return of patient volume by this fall. There aren't many models I've seen that predict 100% return to volume for at least 2 years (based on population aging/growth and other factors). As much as we complained about things needing to go to urgent care instead of the ER, well guess what? It's happening. People are going to and will continue to go to urgent cares and use telemedicine in the future. We should've been careful what we wished for when we were complaining about that little old lady with an asymptomatic blood pressure of 180 being sent to us.

 

[RustedFox]

I went a shift the other day with only seeing 1 COVID patient. I had 5 that were COVID positive yesterday (2 done last week, returned with their ARF/SARS).

We're predicting 75-85% return of patient volume by this fall. There aren't many models I've seen that predict 100% return to volume for at least 2 years (based on population aging/growth and other factors). As much as we complained about things needing to go to urgent care instead of the ER, well guess what? It's happening. People are going to and will continue to go to urgent cares and use telemedicine in the future. We should've been careful what we wished for when we were complaining about that little old lady with an asymptomatic blood pressure of 180 being sent to us.

I get your sentiment; but this is what needs to happen altogether.
Nonsense shouldn't come to the ER.
I'll happily work in higher-acuity shops doing higher-acuity work if (and only if) the nonsense visits stop and admins get on board and out of our way.
More people are going to be sicker, faster.

 

[VA Hopeful Dr]

I get your sentiment; but this is what needs to happen altogether.
Nonsense shouldn't come to the ER.
I'll happily work in higher-acuity shops doing higher-acuity work if (and only if) the nonsense visits stop and admins get on board and out of our way.
More people are going to be sicker, faster.

You'll need a lot fewer EPs if that happens.

 

[thegenius]

I went a shift the other day with only seeing 1 COVID patient. I had 5 that were COVID positive yesterday (2 done last week, returned with their ARF/SARS).

We're predicting 75-85% return of patient volume by this fall. There aren't many models I've seen that predict 100% return to volume for at least 2 years (based on population aging/growth and other factors). As much as we complained about things needing to go to urgent care instead of the ER, well guess what? It's happening. People are going to and will continue to go to urgent cares and use telemedicine in the future. We should've been careful what we wished for when we were complaining about that little old lady with an asymptomatic blood pressure of 180 being sent to us.

Why 2 years? I think we will get there much sooner than we think.

I think the bigger challenge for ER doctors, and for health care in general, is seeing 30 million new uninsured patients for the next several months (if not longer) and having them enrolled in state insurance plans which pay at par, or subpar, to CMS reimbursement rates. That will definitely it everyone's salary.

 

[thegenius]

You'll need a lot fewer EPs if that happens.

I have the general belief that less people should go to the ER. It's a position that would anger many ER docs as that is our livelihood. But I believe that overall ER congestions delivers needed care away from sick patients onto patients who are not sick and that causes two things: 1) wasteful $$ spending practices and 2) less quality care.

Now the opposite of this is that if we see less people, we will staff less, so the ratios will be the same. We should not be seeing 2.5-3 / pt's hour, and if less patients come to the ER, we will just hire less ER docs and keep that ratio intact.

 

[RustedFox]

You'll need a lot fewer EPs if that happens.

But will we?
The old folks are retiring.
The young folks are burning out.
People aren't getting any healthier or younger.

I would like to see a small contraction in our volume that reflects a shift towards: "dumb things no longer come to the ER; they can go to UC or PMDs or whatever".

Hell, I myself would take a bit of a haircut if it meant that I didn't have to deal with "I woke up and took my blood pressure; because that's what seniors do at 5:15 AM, and it was high for me, so I came right away!" for me to do absolutely nothing and send them right back home.

 

[TheComebacKid]

I'm not exactly sure what all the doom and gloom is about. Oh wait, it's SDN, I remember now.

There is going to be pent-up demand in the fall. Numbers will likely go back close to normal. In fact, my state has already started relaxing social distancing guidelines, and this past week our ED volumes are probably back to maybe 75% of normal. ED boarding is back. COVID cases are going up. Nursing homes are burning down to the ground. Who the hell is going to take care of these patients? Not a telehealth provider.

I know we harp on how man unnecessary visits we see (begrudgingly) in normal times which do likely contribute to our incomes. The drop in these unnecessary visits is not going to account for some catastrophic drop in total overall volume going forward.

We have one of the highest burdens of disease of any developed nation in the world. If your outlook on the future is that "COVID is going to drop ED visits for these patients" I think you are missing something here. Primary care clinics will open up. Surgical patients will be back in the ED with complications. In fact, in my area, by the end of the month the majority of hospitals are planning on doing elective cases, some of them 24/7 to make up for lost revenue.

Also, you all give the public WAY too much credit. Social distancing, while important for managing this disease on a public health level, is really just a fad for most individuals. People want to feel like they are making a difference, maybe gain a few likes on Facebook from saying "Stay at home guys!" while posting some shameless selfie of themselves with their cat doing yoga. Once they realize there is no more Tiger King left to watch, they are going to be out on the streets. Similarly, this is not sustainable economically for most Americans. It doesn't matter what health officials say, the vast majority of Americans aren't in a position to choose protecting their health over protecting their livelihood. They will be out and about, and unfortunately will be getting sick, injured, and drunk.

Regardless, EM is probably better prepared to weather the storm than anybody. I can't even imagine what it's like to be a subspecialty surgeon or dermatologist right now.

 

[thegenius]

Regardless, EM is probably better prepared to weather the storm than anybody. I can't even imagine what it's like to be a subspecialty surgeon or dermatologist right now.

Well, probably better than most. I saw a pt yesterday who had a derm problem, and he made an appt to see Derm 3 weeks in the future. Ridiculous. Are they trying to tell me that they are so busy right now that there is a 3 week waiting period? Bollocks.

(I think the guy did have Medicaid which is probably the reason it took so long)

 

[doctalaughs]

Well, probably better than most. I saw a pt yesterday who had a derm problem, and he made an appt to see Derm 3 weeks in the future. Ridiculous. Are they trying to tell me that they are so busy right now that there is a 3 week waiting period? Bollocks.

(I think the guy did have Medicaid which is probably the reason it took so long)

Derm here. Was pretty bad (probably lost 100k-150k per doc in collections over the last 6-7 weeks as we were at less than 5% volume) but I don’t think it’s going to last.

My state just reopened and our volume is already back to 70% (even though we are still restricting to non-cosmetic work which really only comprises 5-10% of the overall practice). Our wait is minimal though still whereas it used to be 4-6 weeks.

Guessing it will be up to normal in a month.

 

[EctopicFetus]

Already discussed to some degree but beyond the 30M who lost their insurance everyone including EM Docs took a hit here. The people that used to be able to afford their 5K insurance deductible now cant. Many who couldnt before are now uninsured. This will also harm us.

I am also gonna call BS on taking 2 years for our volumes to return. I think we will be within 5% of our daily averages in the next 2 months.

As people come out and become more comfortable with being out and the summer decreases transmissibility we will see the volumes go back to where they were (or very close).

Obviously this will depend on your location etc.

 

[GeneralVeers]

Derm here. Was pretty bad (probably lost 100k-150k per doc in collections over the last 6-7 weeks as we were at less than 5% volume) but I don’t think it’s going to last.

My state just reopened and our volume is already back to 70% (even though we are still restricting to non-cosmetic work which really only comprises 5-10% of the overall practice). Our wait is minimal though still whereas it used to be 4-6 weeks.

Guessing it will be up to normal in a month.

You guys did get hit really badly. Went to my derm yesterday, and the office is normally packed. An afternoon appointment is usually especially bad as often they are running behind. This time I was the only one in the clinic the entire time, and in and out in 15 minutes.

 

[TheComebacKid]

Derm here. Was pretty bad (probably lost 100k-150k per doc in collections over the last 6-7 weeks as we were at less than 5% volume) but I don’t think it’s going to last.

My state just reopened and our volume is already back to 70% (even though we are still restricting to non-cosmetic work which really only comprises 5-10% of the overall practice). Our wait is minimal though still whereas it used to be 4-6 weeks.

Guessing it will be up to normal in a month.

Thanks so much for sharing. Glad to see things are looking up.

 

[Birdstrike]

Let me translate this for you. When translated from English to administrator, "Please take this optional, voluntary 30% pay cut," translates to, "Either we cut your pay 30% or fire 30% of you. Your choice. Refuse to choose and we fire all of you."

 

[thegenius]

Let me translate this for you. When translated from English to administrator, "Please take this optional, voluntary 30% pay cut," translates to, "Either we cut your pay 30% or fire 30% of you. Your choice. Refuse to choose and we fire all of you."

I will translate it further into different languages, just in case:

Spanish:
O le cortamos el sueldo 30% o disparamos el 30% de ustedes. Tú eliges. Rehúsa elegir y los despidemos a todos.

French:
Soit on a réduit ton salaire de 30%, soit on vous vire 30%. Votre choix. Refusez de choisir et nous vous virons tous.

Hungarian:
Vagy 30%-kal csökkentjük a fizetésed, vagy kirúgjuk 30%-át. A te döntésed. Ha nem akarsz választani, mindenkit kirúgunk.

Maori:
Kua tapahia e mātou tō utu ki 30%, ahi rānei% o koutou. Tō kōwhiringa. E kore e taea te kōwhiri me te ahi i a koe.

Estonian:
Kas me lõikame su palga 30% või tulekahju 30% sinust. Sinu valik. Keeldun valima ja me vallandame teid kõiki.

Swedish:
Antingen sänker vi din lön till 30% eller 30% av dig. Ditt val. Vägra att välja och vi avskedar er alla.

Vietnamese:
Hoặc là chúng tôi cắt giảm 30% của bạn hoặc lửa 30% của bạn. Sự lựa chọn của bạn. Từ chối để chọn và chúng tôi cháy tất cả các bạn.


and the needed Klingon:
vo' vImughta' yIDIl 30 vatlhvI' qul 30 vatlhvI' pagh DIpe'. wIv. wutlh Qujmey Da'ovQo' 'ej Hoch qul maH.

 

[Tenk]

I will translate it further into different languages, just in case:

Spanish:
O le cortamos el sueldo 30% o disparamos el 30% de ustedes. Tú eliges. Rehúsa elegir y los despidemos a todos.

French:
Soit on a réduit ton salaire de 30%, soit on vous vire 30%. Votre choix. Refusez de choisir et nous vous virons tous.

Hungarian:
Vagy 30%-kal csökkentjük a fizetésed, vagy kirúgjuk 30%-át. A te döntésed. Ha nem akarsz választani, mindenkit kirúgunk.

Maori:
Kua tapahia e mātou tō utu ki 30%, ahi rānei% o koutou. Tō kōwhiringa. E kore e taea te kōwhiri me te ahi i a koe.

Estonian:
Kas me lõikame su palga 30% või tulekahju 30% sinust. Sinu valik. Keeldun valima ja me vallandame teid kõiki.

Swedish:
Antingen sänker vi din lön till 30% eller 30% av dig. Ditt val. Vägra att välja och vi avskedar er alla.

Vietnamese:
Hoặc là chúng tôi cắt giảm 30% của bạn hoặc lửa 30% của bạn. Sự lựa chọn của bạn. Từ chối để chọn và chúng tôi cháy tất cả các bạn.


and the needed Klingon:
vo' vImughta' yIDIl 30 vatlhvI' qul 30 vatlhvI' pagh DIpe'. wIv. wutlh Qujmey Da'ovQo' 'ej Hoch qul maH.

Man, Klingons wouldn’t take no 30% pay cut. They’d make you pay them 30% more for even suggesting it.

 

[BoardingDoc]

Man, Klingons wouldn’t take no 30% pay cut. They’d make you pay them 30% more for even suggesting it.

IDK man. You tell them it's for the good of the empire, or it's the honorable thing to do and you've got them over a barrel.

Unless they're on the high council. Those ****ers are slimier than what you'd get combining a Romulan and a Ferengi.