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  • Originally posted by tonyjerry View Post
    I do the megabackdoor. It's really easy to set up. Just add your after tax contribution and call net benefits to have them turn on the automatic in plan conversion. I'd do it now before the possible new budget proposal is passed.
    It's converted to the in-plan Roth 401k?

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    • As I understand it from the previous posts in this thread, the TPMG contributions to Plan 2 are vested after 5 years. If one were to leave TPMG after 5 years what happens to this money? Can it be rolled over to another account and remain completely under your control? Thx

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      • Yes. When you leave TPMG, Plan 2 can be rolled over. I believe it is mentioned in the plan benefits document. You can find the document on MD People.

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        • Anyone know if you can take the pension as a lump sum if you leave TPMG before retirement age?

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          • Also anyone know if there have been any recent changes to the benefit package for newbies? Im considering coming on board so dont have access to MD people

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            • Originally posted by TBDMD View Post
              Also anyone know if there have been any recent changes to the benefit package for newbies? Im considering coming on board so dont have access to MD people
              Following

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              • I was was listening to someone describe a job search involving a potential position at Kaiser. One thing came up that I'm curious about.

                If I understood it correctly, the docs work for The Permanente Medical Group and not actually for Kaiser. That was news to me.

                Can someone explain this structuring to me? What is the purpose?

                Also she said something about the docs being part-owners of TPMG. What's that all about? I thought that Kaiser docs were just employed docs.

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                • Originally posted by AR View Post
                  I was was listening to someone describe a job search involving a potential position at Kaiser. One thing came up that I'm curious about.

                  If I understood it correctly, the docs work for The Permanente Medical Group and not actually for Kaiser. That was news to me.

                  Can someone explain this structuring to me? What is the purpose?

                  Also she said something about the docs being part-owners of TPMG. What's that all about? I thought that Kaiser docs were just employed docs.
                  That is correct. As a Kaiser doc you are an employee and/or shareholder in the the medical group of which are a few (northern Ca, Southern Ca, etc.). This originally comes from California law making it illegal for hospitals to employ doctors directly. Thus Kaiser is the owner of the facilities and employs the hospital/clinic staff, while TPMG is the group of physicians which exclusively contracts with Kaiser to provide physician services.

                  This is beneficial for the docs in a lot of ways. By being part of the physician group, they negotiate collectively with Kaiser, which puts them in a much stronger position then if they were individual doctors employed by the behemoth that is Kaiser. The two are completely co-dependent, Kaiser can't exist without TPMG and vice versa, so it incentivizes good relationship and good-faith negotiations between the two.

                  This is not unique to kaiser by the way, many big systems are structured in a similar way with a large physician group that provides the physician services to said system.

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                  • The three part system: Hosp/Clinics - owns the buildings and staff; Insurance - contracts with Hosp/Clinics + Med Grp; Med Grp - docs contracts with Hosp/Clinics and insurance.

                    So your pension is uniquely with the med grp; separate from the staff pensions Also why docs get the gold card treatment and supplemental insurance

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                    • Originally posted by TheTodd View Post

                      That is correct. As a Kaiser doc you are an employee and/or shareholder in the the medical group of which are a few (northern Ca, Southern Ca, etc.). This originally comes from California law making it illegal for hospitals to employ doctors directly. Thus Kaiser is the owner of the facilities and employs the hospital/clinic staff, while TPMG is the group of physicians which exclusively contracts with Kaiser to provide physician services.

                      This is beneficial for the docs in a lot of ways. By being part of the physician group, they negotiate collectively with Kaiser, which puts them in a much stronger position then if they were individual doctors employed by the behemoth that is Kaiser. The two are completely co-dependent, Kaiser can't exist without TPMG and vice versa, so it incentivizes good relationship and good-faith negotiations between the two.

                      This is not unique to kaiser by the way, many big systems are structured in a similar way with a large physician group that provides the physician services to said system.
                      Originally posted by StarTrekDoc View Post
                      The three part system: Hosp/Clinics - owns the buildings and staff; Insurance - contracts with Hosp/Clinics + Med Grp; Med Grp - docs contracts with Hosp/Clinics and insurance.

                      So your pension is uniquely with the med grp; separate from the staff pensions Also why docs get the gold card treatment and supplemental insurance
                      Thanks for the responses. Here are some further questions that I was wondering about:

                      1. So it sounds like all the docs are employees of TPMG (or whichever medical group), but only some of them are shareholders. Is that right? Why not everyone? Does it just take sometime before you are eligible to become an owner?

                      2. If you are a shareholder, what are these shares worth? Do you sell them when you leave/retire? Do you purchase them periodically? Do they appreciate? If so, what kind of appreciation have they seen historically?

                      3. If TPMG (for example) is really just a physician group, then why can't they just contract with non-Kaiser hospitals in addition to Kaiser. Or even instead of Kaiser?

                      4. What are some other "big systems" that are structured in this way. Is it just a California thing (because of the weird laws)? Is there any other reason to do it. Does such a system exist anywhere that hospitals are not allowed directly employ physicians.

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                      • Originally posted by fatlittlepig View Post
                        Minimum (I believe) is 1 Class A + 1 Class B = 40K
                        Maximum is 1 Class A + B + 5.2C ~ 143K
                        @AR
                        FLP would have given you better answers.
                        Kaiser has a large HMO customer revenue base that is not present in other hospital systems.
                        I believe the individual contracts for a specific facility, gets benefits from the group and is eligible for partnership after 5 years.
                        This type of arrangement exists in Texas as well , large group employment agreements. Not sure the payoff of the shares. Might be from hospital and HMO operations. The pensions are supposedly pretty generous.
                        Where is FLP when you need him?

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                        • i think the forum banned posting in the third person.
                          “. . . And the LORD spake, saying “First shalt thou take out the Holy 401k. Then shalt thou save to 20%, no more, no less. 20% shall be the number thou shalt save, and the number of the saving shall be 20%. 25% shalt thou not save, neither save thou 15%, excepting that thou then proceed to 20%. 30% is right out . . .””

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                          • Originally posted by blippi View Post
                            i think the forum banned posting in the third person.
                            Last Activity
                            01-25-2022


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                            • He's in a self imposed exile for the 2nd time. Perhaps he'll hit the 'post reply' button in the future but staying in the astral plane for now.

                              @AR

                              -I think a few vertically integrated systems are like this, but rather unique on the insurance exclusiveness. Most Hosp/Clinic will allow other insurances while the hosp/clinic + med group maintain an exclusive relationship.

                              -Med group employs everyone. after 3-5 years vote employee in/out. Most in, some out.

                              -shares while employed. if leave group, must sell. Appreciate yes. How is this tracked/pegged to what? I have no idea. It just went up and after 10 years we had doubled+ our value

                              My perspective is there is a fair amount of churn years 1-3 and they lose their 'buyin/vesting' dollars which the group directly benefits in those forfeitures. Perhaps that's the source of the value appreciation from those who don't make the cut.

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                              • Originally posted by StarTrekDoc View Post
                                He's in a self imposed exile for the 2nd time. Perhaps he'll hit the 'post reply' button in the future but staying in the astral plane for now.

                                @AR

                                -I think a few vertically integrated systems are like this, but rather unique on the insurance exclusiveness. Most Hosp/Clinic will allow other insurances while the hosp/clinic + med group maintain an exclusive relationship.

                                -Med group employs everyone. after 3-5 years vote employee in/out. Most in, some out.

                                -shares while employed. if leave group, must sell. Appreciate yes. How is this tracked/pegged to what? I have no idea. It just went up and after 10 years we had doubled+ our value

                                My perspective is there is a fair amount of churn years 1-3 and they lose their 'buyin/vesting' dollars which the group directly benefits in those forfeitures. Perhaps that's the source of the value appreciation from those who don't make the cut.
                                Thanks for helping to satisfy my curiosity. I've got a few more follow up questions.

                                1. How much does the share appreciation figure into decisions about compensation. For example if you're considering working for Kaiser, how much can you project to get from share appreciation over and above your salary and benefits.

                                2. After the 3-5 years, if someone is voted out, can they still work as a non-shareholding employee. Or if they're out, does it mean they are basically fired.

                                3. Do you just get one allotment of shares when you attain ownership stake, or do you keep getting shares annually

                                4. Can you buy/sell shares from other members.

                                5. Although everyone is an "owner" how much decision-making authority does an indivdual doc have. If someone tells me, "I'm an owner in my physician group", I'd assume they have significant input on hiring, what contracts to accept from hospitals and insurers (although in this case, it's not like they really have a choice), etc. But I have always viewed a Kaiser doc as essentially an employed doc, who doesn't have a whole lot of say in how their practice is run and has to deal with a bunch of admins. So if that view is correct, it would seem to me that this "ownership" is kind of a facade. But if it is more similar to a traditional ownership situation, then that is very different from how I viewed what Kaiser docs are.

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