Any Kaiser (TPMG) docs here?

[Tim]

"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."

"Our more than 9,000 physicians and 35,000 nurses and staff"

https://permanente.org/the-permanente-medical-group-inc/

This could be a question of governance and still be a perfect democratic process. I certainly does not fit your view of a much smaller organization, whether employed or a partnership or shareholder..It is big. 1 vote of 9000 is not a lot of influence.

[StarTrekDoc]

AR-
-don't know how it's calculated. In the past, if not voted in -- you're off the island. -- I suppose per diem pool is possible; but I've never seen that happen.

-ownership stake - not sure if opportunities to gain more or not. There was a bond buyback style program started, kind of like self funding programs, but not shares (we've been 8 years removed from Kaiser direct)

-like Tim said ; 1 vote is meager. I'm sure a proxy vote can be done but typically any advocacy is done locally at department then PIC (local political head doc leader).

[AR]

AR-
-don't know how it's calculated. In the past, if not voted in -- you're off the island. -- I suppose per diem pool is possible; but I've never seen that happen.

-ownership stake - not sure if opportunities to gain more or not. There was a bond buyback style program started, kind of like self funding programs, but not shares (we've been 8 years removed from Kaiser direct)

-like Tim said ; 1 vote is meager. I'm sure a proxy vote can be done but typically any advocacy is done locally at department then PIC (local political head doc leader).

Assuming you work at Kaiser, when you got your offer, how much extra value did you attribute to share appreciation? Did you even consider it at all? Should a prospective hire consider it?


Who does the voting on new owners? Is it all the other existing owners? Is it one vote per owner, or do you get votes proportionally based on your share value. How does this even work. How is one doc at one location going to be able to make an informed decision about a doc in another location, in a different specialty, who he has probably ever met?

If you're considering a job at Kaiser, do you really need to worry about not being voted in?

[StarTrekDoc]

-We didn't take shareholder value into account.
-I believe initial vote is local, then to the group at large -- really don't recall it's been awhile.

-No, we didn't worry. Very few were NOT offered partnership and the ones not offered had clear deficiencies that would put the group at risk as a whole.

[AR]

-We didn't take shareholder value into account.
-I believe initial vote is local, then to the group at large -- really don't recall it's been awhile.

But haven't you been periodically voting on others over the years?

-No, we didn't worry. Very few were NOT offered partnership and the ones not offered had clear deficiencies that would put the group at risk as a whole.

Thanks for all the responses. One more

How do you view yourself: Employed Physician or Owner-Physician. It sounds you are technically both of those things, but which do you feel more like? I've always viewed TPMG as more like a union than a business, but maybe I had it wrong all along.

[wally world]

Hi AR-
Current TPMG doc here. The info you’ve received thus far from StarTrekDoc and others is good. I’ll try and add some additional details.


Re: partnership: New physicians become eligible for participant status at 2 years & senior status at 3 years. You get some additional perks and benefits at each level (expanded sick leave, LTC insurance, more life insurance, etc) & opportunity for share purchase/ownership at the senior level.


The voting occurs at the local medical center level. I know of a couple of people that had their election postponed for some time (to encourage more collegial behavior… not sure it totally worked, though they did get voted in eventually) and a couple of people that were told that the job wasn’t going to work out for them & they should plan on finding another gig (this typically after trying performance improvement type interventions). Most of the time the vote is just a formality (“click here to vote yes on all candidates” button exists on the voting page). If you have the support of your chief and department, you’ll get the necessary votes.


Re: shares: Being a shareholder at TPMG is really nowhere close to being a shareholder/owner in a private practice group (at least in my experience having been in both of these situations). Yes, you get to vote on who becomes a fellow shareholder & some of your local leadership (the elected rep, for example). The medical center’s Physician-In-Chief is selected by the big boss (ie the TMPG CEO picks the PICs). With regards to selecting the CEO, you only get to vote yea or nay on the Board’s selection. So really limited input there.


You asked: “How do you view yourself: Employed Physician or Owner-Physician?” Employed physician. No question. I’m pretty confident this would be the same answer (if you asked anyone in my department, anyway.)


Share value increases at around 10% per year. This has been pretty much true every year that I have been here. How it's calculated, I don't know. We just receive a letter at the beginning of the year telling us the new collective value of our shares. There’s a maximum amount of shares you can own (totaling around 158k this year… max value was 143k last year) & you can’t go above this ceiling. You need to purchase a minimum of 40k once you make senior physician (though you can buy up to the max amount as well). I’m certain that there are other posts in this thread about the difference between A, B, C shares (having made them some of them myself in the past :-)), so I won’t repeat all that here.


Anyway, hope the additional info is helpful!


WW

[AR]

Hi AR-
Current TPMG doc here. The info you’ve received thus far from StarTrekDoc and others is good. I’ll try and add some additional details.


Re: partnership: New physicians become eligible for participant status at 2 years & senior status at 3 years. You get some additional perks and benefits at each level (expanded sick leave, LTC insurance, more life insurance, etc) & opportunity for share purchase/ownership at the senior level.


The voting occurs at the local medical center level. I know of a couple of people that had their election postponed for some time (to encourage more collegial behavior… not sure it totally worked, though they did get voted in eventually) and a couple of people that were told that the job wasn’t going to work out for them & they should plan on finding another gig (this typically after trying performance improvement type interventions). Most of the time the vote is just a formality (“click here to vote yes on all candidates” button exists on the voting page). If you have the support of your chief and department, you’ll get the necessary votes.


Re: shares: Being a shareholder at TPMG is really nowhere close to being a shareholder/owner in a private practice group (at least in my experience having been in both of these situations). Yes, you get to vote on who becomes a fellow shareholder & some of your local leadership (the elected rep, for example). The medical center’s Physician-In-Chief is selected by the big boss (ie the TMPG CEO picks the PICs). With regards to selecting the CEO, you only get to vote yea or nay on the Board’s selection. So really limited input there.


You asked: “How do you view yourself: Employed Physician or Owner-Physician?” Employed physician. No question. I’m pretty confident this would be the same answer (if you asked anyone in my department, anyway.)


Share value increases at around 10% per year. This has been pretty much true every year that I have been here. How it's calculated, I don't know. We just receive a letter at the beginning of the year telling us the new collective value of our shares. There’s a maximum amount of shares you can own (totaling around 158k this year… max value was 143k last year) & you can’t go above this ceiling. You need to purchase a minimum of 40k once you make senior physician (though you can buy up to the max amount as well). I’m certain that there are other posts in this thread about the difference between A, B, C shares (having made them some of them myself in the past :-)), so I won’t repeat all that here.


Anyway, hope the additional info is helpful!


WW

Great post! Thanks a lot.

[AmCanKor]

Hi all,

As an incoming TPMG doc, I just wanted to thank everyone on this thread for your insight/opinion. This thread has been very helpful during my recruitment process. I am excited to join the group.

One question... What to the current TPMG docs make of the single payer efforts in California? It looks like the latest version failed to gain traction very recently. Is this something that gets discussed amongst TPMG docs or Kaiser in general? Since the insurance, hospital and TPMG are so interdependent, if the insurance arm was to go away, I'd guess that will have a significant impact on TPMG recruitment, salaries or pension???

I'm coming from out of state and learned about this recently. I didn't know how realistic that something like this could happen during our working lives, next 20-30 yrs.....

Thanks,

[StarTrekDoc]

To the single payor issue - you know if it gets pulled in CA with a super majority in place -- not going to get there anytime soon. Makes good headlines but little appetite to see it through the finish line.

[Yancantcook]

Can someone clarify this health benefits in retirement, is this a all or none benefit so if you are not working at TPMG at say age 55, then you won't get any of the healthcare benefits at all at retirement? Do you need to be working at TPMG at age 60 regardless of your years of service to get the healthcare benefit?

[barelybarefoot]

Yes, that’s why we all stick it out until 60yo. It’s all or none.

[Yancantcook]

Yes, that’s why we all stick it out until 60yo. It’s all or none.

Thanks for clearing that up, do many partners goto 0.8, 0.6 FTE before that typically

[fatlittlepig]

Can someone put a dollar value on this benefit?

[Hank]

Can someone put a dollar value on this benefit?

The prodigal porcine has returned!

[StarTrekDoc]

The gold card is priceless.