What is your pay structure?

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Shimmy8

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Not actual numbers, but structure.

Salary with OT? Base pay plus call pay? Extra for weekends? Point system? Hourly? RVUs? Hourly?

How would you design the perfect pay structure for our field?

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Equal salary amongst all with opportunity to "pay ourselves overtime" if you have to work post call. Call and number assignments are all assigned as equal as possible throughout the year.

I would argue there is no perfect pay structure because they can all be gamed differently.
 
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0.5 public (think academics/VA?): salary + overtime, with lots of perks.
0.5 private: RVU with 10% to group (not bought in)
 
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Base pay with call pay. Overtime after certain hours on weekdays, and overtime pay for voluntary weekend shifts
 
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Every week a guy comes by....he usually wears a knit cap pulled down low.....his eyes are constantly shifting back and forth...he has a large burlap sack with a crudely drawn "$" on it....he tosses it at my feet and scurries away.
 
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Shift work/hourly rate. Certainly the best system from a peace of mind point of view. No need to game the schedule or worry about units. Just come in and do the job.
 
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Academics: It’s starts off kinda complicated but basically boils down to base + call. (Different call assignment are paid different amounts and may or may not come with additional perks).
 
Used to be academics on hourly rate. Hated it cause the old guys stopped working around 1pm and watched the clock til 3. Plenty young uns did that too. Awful

Now eat kill, love it
 
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I've always thought ours was pretty slick. I'm sure it's changed some since we're now hospital owned, but the basics are the same.

Ours are paid by the shift. The docs determine the value of a given shift. A weekday day shift has a value of 1, and everything else relates to that. The range is from 1 to 4.5, with nights and holidays compensated at the high end, and longer or evening shifts somewhere in between. Days off after call are all figured into those shift values. Shifts are scheduled via Qgenda so they even out through the year, so in theory everyone is scheduled about the same number of a given shift over the year. Swapping shifts and locations is voluntary and frequent, so someone who wants to make more money picks up shifts with higher values. When we were strictly private practice, the value for "1" was determined each month according to revenues and deductions for overhead. So simply multiply the $ amt for that value times the total value of the shifts worked each month and that gives you the compensation for the month. That value would change from month to month. My guess is now that value is set and doesn't vary since we are no longer an independent practice. I'm sure there are particulars I'm not aware of, but from an outsider perspective it seems a pretty fair and straightforward way of doing things.
 
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Used to be eat what you kill (which i like)
Now it’s based on shift.
If you are working outside of your shift (past 3 on non-call days) it’s 275/hr.
Different shifts generate different stipends.
 
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We go by units, eat what you kill with a pooled unit value. The scheduling is done fairly so everyone has same number of high and low days, and everything averages out over the year. A multiplier is added for nights, weekends and holidays.
 
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We go by units, eat what you kill with a pooled unit value. The scheduling is done fairly so everyone has same number of high and low days, and everything averages out over the year. A multiplier is added for nights, weekends and holidays.
I have been an employee my whole career. I can’t even imagine working under a unit based system. If you supervise CRNA’s how are your units calculated? The inevitable room delays, case cancellations, profitable cases being moved around would drive me up the wall. I was born to punch a clock I guess….
 
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I have been an employee my whole career. I can’t even imagine working under a unit based system. If you supervise CRNA’s how are your units calculated? The inevitable room delays, case cancellations, profitable cases being moved around would drive me up the wall. I was born to punch a clock I guess….


Unit based compensation would be exponentially more complicated in a practice that uses CRNAs. I think that’s part of the reason why it’s more common in MD only practices where it is quite simple.
 
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I have been an employee my whole career. I can’t even imagine working under a unit based system. If you supervise CRNA’s how are your units calculated? The inevitable room delays, case cancellations, profitable cases being moved around would drive me up the wall. I was born to punch a clock I guess….

I don’t supervise so can’t speak to how a unit-based system would work in that setting.

I don’t mind it though since it all tends to work itself out. Sometimes I get screwed, and other times I get lucky. But at the end of the day, I know that if I’m working then I’m being compensated appropriately for it. It helps numb the pain of being called in from home.
 
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Well I’m salary. I call it the VA model on steroids. State job. Healthcare is essentially free. No lawsuits. So have immunity.

So pays in mid 400s. No overnight calls. Peel off system. 1:2 or 1:3 max coverage. I don’t remember cover 1:4 except when I’m late doc.

I worked 25 hours this week.
I worked 35 hours last week.

I Probabiy average 35 hours a week.

It’s not bad at this stage in my career.
 
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Well I’m salary. I call it the VA model on steroids. State job. Healthcare is essentially free. No lawsuits. So have immunity.

So pays in mid 400s. No overnight calls. Peel off system. 1:2 or 1:3 max coverage. I don’t remember cover 1:4 except when I’m late doc.

I worked 25 hours this week.
I worked 35 hours last week.

I Probabiy average 35 hours a week.

It’s not bad at this stage in my career.

That is great
 
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Well I’m salary. I call it the VA model on steroids. State job. Healthcare is essentially free. No lawsuits. So have immunity.

So pays in mid 400s. No overnight calls. Peel off system. 1:2 or 1:3 max coverage. I don’t remember cover 1:4 except when I’m late doc.

I worked 25 hours this week.
I worked 35 hours last week.

I Probabiy average 35 hours a week.

It’s not bad at this stage in my career.
Any opportunity to earn more by working more?
 
Well I’m salary. I call it the VA model on steroids. State job. Healthcare is essentially free. No lawsuits. So have immunity.

So pays in mid 400s. No overnight calls. Peel off system. 1:2 or 1:3 max coverage. I don’t remember cover 1:4 except when I’m late doc.

I worked 25 hours this week.
I worked 35 hours last week.

I Probabiy average 35 hours a week.

It’s not bad at this stage in my career.


Are you a triathlete and a master carpenter? ;)
 
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I've always thought ours was pretty slick. I'm sure it's changed some since we're now hospital owned, but the basics are the same.

Ours are paid by the shift. The docs determine the value of a given shift. A weekday day shift has a value of 1, and everything else relates to that. The range is from 1 to 4.5, with nights and holidays compensated at the high end, and longer or evening shifts somewhere in between. Days off after call are all figured into those shift values. Shifts are scheduled via Qgenda so they even out through the year, so in theory everyone is scheduled about the same number of a given shift over the year. Swapping shifts and locations is voluntary and frequent, so someone who wants to make more money picks up shifts with higher values. When we were strictly private practice, the value for "1" was determined each month according to revenues and deductions for overhead. So simply multiply the $ amt for that value times the total value of the shifts worked each month and that gives you the compensation for the month. That value would change from month to month. My guess is now that value is set and doesn't vary since we are no longer an independent practice. I'm sure there are particulars I'm not aware of, but from an outsider perspective it seems a pretty fair and straightforward way of doing things.
We have a similar system, but calculate the point value quarterly. We give ourselves a base monthly rate, then perform a reconciliation at the end of each quarter, so total pay ends up being "point value x number of points earned."
 
Any opportunity to earn more by working more?
Yes. Weekends are essentially open for extra pay. Though we have 3 docs gonna to switch to night float system to cover all the weekends. You can work 8 hours extra/12 hours extra or do the entire 24. They will pay you extra if they short crna’s if you have to work your post late day as well. You get post late day off (and honestly late doc is really 7-5pm coverage than beeper) plus potential to get called back in but it’s rare. Happens like 4x-5x a year the backup doc has to be called in.

It’s not bad like I said. I’d do an 7-3pm for extra on a Saturday on weekend if my kid has his baseball game at 5pm so I’m still there for the game.

It all depends what you want want. I tell guys if they want to make 700k and up. It’s not the job for them. If they want to sleep in their own bed almost every night of the year. And home by 4pm 95% of the time. Than that’s the job for them.

Half the docs do the extra weekend duties for extra so they make an extra 50-130k on top of the base. The other half won’t do any weekends.
 
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Yes. Weekends are essentially open for extra pay. Though we have 3 docs gonna to switch to night float system to cover all the weekends. You can work 8 hours extra/12 hours extra or do the entire 24. They will pay you extra if they short crna’s if you have to work your post late day as well. You get post late day off (and honestly late doc is really 7-5pm coverage than beeper) plus potential to get called back in but it’s rare. Happens like 4x-5x a year the backup doc has to be called in.

It’s not bad like I said. I’d do an 7-3pm for extra on a Saturday on weekend if my kid has his baseball game at 5pm so I’m still there for the game.

It all depends what you want want. I tell guys if they want to make 700k and up. It’s not the job for them. If they want to sleep in their own bed almost every night of the year. And home by 4pm 95% of the time. Than that’s the job for them.

Half the docs do the extra weekend duties for extra so they make an extra 50-130k on top of the base. The other half won’t do any weekends.
you got openings??
 
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you got openings??
They filled every thing quickly after they switched to this model

It’s very simple. Either continue paying one MD locums 900k when u factor in agency fees or pay daytime doc 450k. And get 2 docs.
 
They filled every thing quickly after they switched to this model

It’s very simple. Either continue paying one MD locums 900k when u factor in agency fees or pay daytime doc 450k. And get 2 docs.

What region are you? Metro or more rural?
 
Salary + roughly quarterly distributions. All shifts and calls spread evenly. Some older partners frequently put weekends up for sale, usually gobbled up pretty quick as the agreed upon rate is pretty good.
 
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Currently salaried at an academic gig. Pay isn't bad, time off is great. But will be moving to PP that is straight hourly pay with 100% home call and an in house CRNA. Make as much or as little as you'd like. Looking forward to that. These Locums gigs are wearing me out on my weeks off now.

I should add, one of my main complaints of my current job is the inefficiencies of daily practice. It's not just the trainees in a teaching hospital, it's a large machine of a place that has constant turn over. I'll get called in to do an emergent case on a Saturday morning and we're supposed to cut within 1 hour of notification. The scrub tech will show up 50 minutes later, start to open the room, break scrub for a smoke break, etc. Patient transport won't answer the phone so I'll typically go get the patient while my resident sets up the room. Circulator nurse shows up late. Surgeons sometimes show up 90 minutes later. Then they do a gallbladder that will take them 3 hours. It's maddening. The support staff are paid hourly so they want to stretch it as much as they can. I've seen it cause actual patient harm (although this is rare - most of the time our surgeons call dumb things like healthy gallbladders emergencies). I complain and run it up the ladder only for all these people to be replaced by new staff 3 months later, rinse and repeat.

At the pp job, you get a call for an emergency, I drive in from home and we're in the OR 10 minutes later. Patient is brought to me, consented for me (I still go over it but nice to not have to wait for patient to sign and find a witness) and things run smooth. These people are all paid by the day for their call so they make the same whether they're in the OR or at home with family, so they hustle to be in the OR as little as possible.

Anyway, end rant. I'm tired of 45 minute cases taking up 5 hours of my day. Excited to be done with that.
 
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Yes. Weekends are essentially open for extra pay. Though we have 3 docs gonna to switch to night float system to cover all the weekends. You can work 8 hours extra/12 hours extra or do the entire 24. They will pay you extra if they short crna’s if you have to work your post late day as well. You get post late day off (and honestly late doc is really 7-5pm coverage than beeper) plus potential to get called back in but it’s rare. Happens like 4x-5x a year the backup doc has to be called in.

It’s not bad like I said. I’d do an 7-3pm for extra on a Saturday on weekend if my kid has his baseball game at 5pm so I’m still there for the game.

It all depends what you want want. I tell guys if they want to make 700k and up. It’s not the job for them. If they want to sleep in their own bed almost every night of the year. And home by 4pm 95% of the time. Than that’s the job for them.

Half the docs do the extra weekend duties for extra so they make an extra 50-130k on top of the base. The other half won’t do any weekends.
PM me if hiring
 
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how much your salary go up w inflation?
The docs hired before me get inflation index raises. But it’s always a year behind real time inflation. So they got 2%? Around $9000.

This year it’s looking like 4% which is big around 18k

But I get a metric bonus around 15k. All a zero sum game. No inflation pay raise for me.

At least the state , they’re better than the federal system. The federal pay raises is a scam for docs. It’s based on the base which for docs is like 100k. Their locality pay is 200-250k. So even though Biden gave them 4–4.5% pay raises. The docs only got $4000 pay raise cause it’s based on the base (100k) While the mid levels pay raises are based on their “base”

Which is their entire salary of 200k. So the mid levels got $8000-9000 pay raises. Double the docs pay raises.
 
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Currently salaried at an academic gig. Pay isn't bad, time off is great. But will be moving to PP that is straight hourly pay with 100% home call and an in house CRNA. Make as much or as little as you'd like. Looking forward to that. These Locums gigs are wearing me out on my weeks off now.

I should add, one of my main complaints of my current job is the inefficiencies of daily practice. It's not just the trainees in a teaching hospital, it's a large machine of a place that has constant turn over. I'll get called in to do an emergent case on a Saturday morning and we're supposed to cut within 1 hour of notification. The scrub tech will show up 50 minutes later, start to open the room, break scrub for a smoke break, etc. Patient transport won't answer the phone so I'll typically go get the patient while my resident sets up the room. Circulator nurse shows up late. Surgeons sometimes show up 90 minutes later. Then they do a gallbladder that will take them 3 hours. It's maddening. The support staff are paid hourly so they want to stretch it as much as they can. I've seen it cause actual patient harm (although this is rare - most of the time our surgeons call dumb things like healthy gallbladders emergencies). I complain and run it up the ladder only for all these people to be replaced by new staff 3 months later, rinse and repeat.

At the pp job, you get a call for an emergency, I drive in from home and we're in the OR 10 minutes later. Patient is brought to me, consented for me (I still go over it but nice to not have to wait for patient to sign and find a witness) and things run smooth. These people are all paid by the day for their call so they make the same whether they're in the OR or at home with family, so they hustle to be in the OR as little as possible.

Anyway, end rant. I'm tired of 45 minute cases taking up 5 hours of my day. Excited to be done with that.
Unfortunately that’s common in many state/county/federal facilities. Especially nights and weekends. Night and weekend pay differential is anywhere between 10-15% extra for ancillary staff. So the more they milk it. The more they make since they are making extra to began with.
 
Currently salaried at an academic gig. Pay isn't bad, time off is great. But will be moving to PP that is straight hourly pay with 100% home call and an in house CRNA. Make as much or as little as you'd like. Looking forward to that. These Locums gigs are wearing me out on my weeks off now.

I should add, one of my main complaints of my current job is the inefficiencies of daily practice. It's not just the trainees in a teaching hospital, it's a large machine of a place that has constant turn over. I'll get called in to do an emergent case on a Saturday morning and we're supposed to cut within 1 hour of notification. The scrub tech will show up 50 minutes later, start to open the room, break scrub for a smoke break, etc. Patient transport won't answer the phone so I'll typically go get the patient while my resident sets up the room. Circulator nurse shows up late. Surgeons sometimes show up 90 minutes later. Then they do a gallbladder that will take them 3 hours. It's maddening. The support staff are paid hourly so they want to stretch it as much as they can. I've seen it cause actual patient harm (although this is rare - most of the time our surgeons call dumb things like healthy gallbladders emergencies). I complain and run it up the ladder only for all these people to be replaced by new staff 3 months later, rinse and repeat.

At the pp job, you get a call for an emergency, I drive in from home and we're in the OR 10 minutes later. Patient is brought to me, consented for me (I still go over it but nice to not have to wait for patient to sign and find a witness) and things run smooth. These people are all paid by the day for their call so they make the same whether they're in the OR or at home with family, so they hustle to be in the OR as little as possible.

Anyway, end rant. I'm tired of 45 minute cases taking up 5 hours of my day. Excited to be done with that.
wow do we work in the same place?! hahhaa
 
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We are a blended unit value with quarterly distributions in PP. People trade around call to make more or less with time off. Vacation is open to take as much as you want, however its unpaid.. It’s nice to be able to crank it out when you need some extra dough. Our stipend could be higher, but that is being negotiated.
 
Currently salaried at an academic gig. Pay isn't bad, time off is great. But will be moving to PP that is straight hourly pay with 100% home call and an in house CRNA. Make as much or as little as you'd like. Looking forward to that. These Locums gigs are wearing me out on my weeks off now.

I should add, one of my main complaints of my current job is the inefficiencies of daily practice. It's not just the trainees in a teaching hospital, it's a large machine of a place that has constant turn over. I'll get called in to do an emergent case on a Saturday morning and we're supposed to cut within 1 hour of notification. The scrub tech will show up 50 minutes later, start to open the room, break scrub for a smoke break, etc. Patient transport won't answer the phone so I'll typically go get the patient while my resident sets up the room. Circulator nurse shows up late. Surgeons sometimes show up 90 minutes later. Then they do a gallbladder that will take them 3 hours. It's maddening. The support staff are paid hourly so they want to stretch it as much as they can. I've seen it cause actual patient harm (although this is rare - most of the time our surgeons call dumb things like healthy gallbladders emergencies). I complain and run it up the ladder only for all these people to be replaced by new staff 3 months later, rinse and repeat.

At the pp job, you get a call for an emergency, I drive in from home and we're in the OR 10 minutes later. Patient is brought to me, consented for me (I still go over it but nice to not have to wait for patient to sign and find a witness) and things run smooth. These people are all paid by the day for their call so they make the same whether they're in the OR or at home with family, so they hustle to be in the OR as little as possible.

Anyway, end rant. I'm tired of 45 minute cases taking up 5 hours of my day. Excited to be done with that.

PM me if hiring
 
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Qgenda scheduling w units compensation. Call is units plus stipend.
Weekends units plus premium stipend.
Satellite locations are paid out with shift pay for volunteers
Multi specialty group bonus at year end (30-50k extra) units are mgma median
All benefits are in addition to comp
2 in house calls per month
2-3 back up calls per month. From home
1 weekend per month. Occasionally 2
 
Anyone have to wait 3 months to get paid after starting ? Awaiting collections to catch up etc
I do not, but I know one private group I interviewed with would "loan" you $7K/month until your collections exceed that amount. Then they continue to pay you 7K/month until your collections above $7K/month were enough to pay back the amount you had been fronted. I don't think you HAVE to do that, but it works well for the doc coming out if residency.
 
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Anyone have to wait 3 months to get paid after starting ? Awaiting collections to catch up etc
At least you presumably collect a few paychecks after you leave. Seems like they would at least float you a few bucks though.
 
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Anyone have to wait 3 months to get paid after starting ? Awaiting collections to catch up etc


I waited. But my old job had the same system so I was still collecting from my old job while my share of collections was ramping up at my new job. We didn’t front money when I joined 20+ yrs ago. Nowadays the group fronts money for the first 3 months if people want it, then it is paid back over the next few months.
 
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Yes. Coming from another PP job to my current gig. Knew it was coming but damn…The first job for me that has this structure and didn’t know how common it was. I don’t like it

I almost didn’t accept but the location is convenient for me.
 
2 weeks on 1 week off, q2 beeper call (extremely light) when on. 450k straight 1099 zero benefits. Malpractice and health insurance eat up 55k of that pre tax. I pick up 3-4 days of locums on my off weeks per month for an additional ~10k per month. Thoughts?
 
2 weeks on 1 week off, q2 beeper call (extremely light) when on. 450k straight 1099 zero benefits. Malpractice and health insurance eat up 55k of that pre tax. I pick up 3-4 days of locums on my off weeks per month for an additional ~10k per month. Thoughts?

Think you should do locums only
 
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2 weeks on 1 week off, q2 beeper call (extremely light) when on. 450k straight 1099 zero benefits. Malpractice and health insurance eat up 55k of that pre tax. I pick up 3-4 days of locums on my off weeks per month for an additional ~10k per month. Thoughts?
14 days in a row, then 7 off? thats tough
 
2 weeks on 1 week off, q2 beeper call (extremely light) when on. 450k straight 1099 zero benefits. Malpractice and health insurance eat up 55k of that pre tax. I pick up 3-4 days of locums on my off weeks per month for an additional ~10k per month. Thoughts?
Horrible:oops:
 
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2 weeks on 1 week off, q2 beeper call (extremely light) when on. 450k straight 1099 zero benefits. Malpractice and health insurance eat up 55k of that pre tax. I pick up 3-4 days of locums on my off weeks per month for an additional ~10k per month. Thoughts?
Thoughts? Only 2 options pal: get another job STAT or commit suicide.
 
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2 weeks on 1 week off, q2 beeper call (extremely light) when on. 450k straight 1099 zero benefits. Malpractice and health insurance eat up 55k of that pre tax. I pick up 3-4 days of locums on my off weeks per month for an additional ~10k per month. Thoughts?
That type of job for $425k-450k ish is 26 weeks on. 26 weeks off

I know that for a fact. Because my pain buddy who’s in mid Atlantic (and another buddy who’s in the south region). They provide coverage 52 weeks out of the year for 900k

Light case facility. 1:3 or 1:4 coverage

Split up the money anyway u want it. So he covers 12 weeks and gets like 200k. The other guy works 40 weeks and takes home 700k

So if you are working 2/3 of the time. Ur pay structure needs to be closer to 650k.
 
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