Update: Young Attending Neurohospitalist

[ChristopherMD20]

Thank you all for the advice. A little bit after the original thread I wrote up a proposal for salary adjustments and reworking my contract to be compensated for the work I do. It has been a few weeks and I have not gotten a response. My wife and I have had a discussion and I am willing to walk if a reasonable reconciliation cannot be met. Thank you all for the advice.

New Questions:
1. When should I ask for an answer and what tact should I use?
2. What would be a professional and amicable way to terminate my contract early?

[Zaphod]

You should have had some kind of response by now, at least acknowledgement.

Whatever the contract says you should do.

[MPMD]

The answer to this depends on how serious your negotiating position is.

First step should be a follow up email with all the important parties saying you need a response. It's the first week of the month so the end of the month is more than reasonable. If they don't get back to you give notice and move on.

If I remember correctly you're being asked to be med director for no comp? I hope you have stopped doing that already and referring issues up to your supervisor.

[wonka31]

When is your contract up/how long of notice do you need in order to leave? I’d take this time frame and add at least three months to it. Given the time it takes to find a new position, credential, etc this should be taking place sooner rather than later.

[q-school]

you haven't heard anything at all from your one up leader?  not even, we received your letter, we are working on some of your requests?  that's unusual.

a few weeks for most organizations is a short time frame for a response.  they often have multiple priorities.  it also sounded (to me) like your organization is run more top down and likes things to be very consistent (right way, wrong way, and my way).   i think you have a few options.  it sounded like you liked your job.  if that remains the case, give them a call and find out when a response can be expected.  make it clear that you are looking forward to a healthy conversation.  i think when i was your age, i wanted a quick yes.  even a quick no would be better than nothing.  come to find out that most things are a qualified maybe and take months to run through.  often the only way to expedite the process is to hand in walking papers, which automatically force the issue to top priority.

if you are going to walk, it is professional to have a verbal discussion with administration and then hand in written notice with whatever notice is required.   you may consider finding a new job before you do that however.  sometimes in looking for a new job, it is possible to realize the job market has shifted and your job actually is better than you thought.  or vice versa.

good luck to you.

i know from your posts that you are a thoughtful young man, and i'm sure this has been an agonizing time for you.

 

 

[ChristopherMD20]

Hello. I met with my boss and we had a verbal discussion so it was acknowledged that they heard my position. The next steps were to talk among the board of directors and whatever governing panel. There was some comments made that the budget was already set for this fiscal year but no definitive response to my proposal.

I have 1 year remaining on my contract. Per my understanding, I would have to give them 90days notice for early termination and 6 months if I do not plan to renew my contract. If it comes to that I think I’d better consult my lawyer.

I have not vacated my medical director responsibility at this point. I am willing to give them a bit more time to respond. There are some big hospital wide changes that will be initiated soon so I feel like I would burn bridges if I just stopped cold. Also I do not think I could sleep without seeing this big change through.

My negotiating position- I am confident that I am a vital part of the care there and I help many other service lines. I do not want to come off as arrogant, but the quality that I bring is not easily replaceable at that hospital. I do think I am top-tier for my age/experience level and will get much better with more time and experience.

[q-school]

ChristopherMD20 wrote:

Hello. I met with my boss and we had a verbal discussion so it was acknowledged that they heard my position. The next steps were to talk among the board of directors and whatever governing panel. There was some comments made that the budget was already set for this fiscal year but no definitive response to my proposal.

I have 1 year remaining on my contract. Per my understanding, I would have to give them 90days notice for early termination and 6 months if I do not plan to renew my contract. If it comes to that I think I’d better consult my lawyer.

I have not vacated my medical director responsibility at this point. I am willing to give them a bit more time to respond. There are some big hospital wide changes that will be initiated soon so I feel like I would burn bridges if I just stopped cold. Also I do not think I could sleep without seeing this big change through.

My negotiating position- I am confident that I am a vital part of the care there and I help many other service lines. I do not want to come off as arrogant, but the quality that I bring is not easily replaceable at that hospital. I do think I am top-tier for my age/experience level and will get much better with more time and experience.

Click to expand...

good to see them respond.

i am not sure the hospital administration actually thinks any doctor is not replaceable however.  they don't really get more money for high quality.  they prefer to live with 75% of quality if the volume/profitability make up for it.   and in the end, the metric that usually matters most for administration is $.  however your comments do remind me of when i was young, so that's a positive, at least from my perspective.   as good as you are now, i agree you will be even better in 5 years.  both administratively and clinically.

best to you.



 

[wonka31]

I would also start networking with colleagues/putting out feelers to see if you are being undercompensates and if so, by how much. This may also give you a feel for the job market in your desired areas if things don’t work out with your current employer.

[CordMcNally]

ChristopherMD20 wrote:

There was some comments made that the budget was already set for this fiscal year but no definitive response to my proposal.

Click to expand...

This sounds like administrators using the budget to hide behind an upfront answer. I can guarantee that there are going to be multiple line items on their budget that they are going to go over for the year due to various reasons. Salaries are no different. A budget isn't set in stone like they're going to pretend it is.

[MPMD]

ChristopherMD20 wrote:

 

My negotiating position- I am confident that I am a vital part of the care there and I help many other service lines. I do not want to come off as arrogant, but the quality that I bring is not easily replaceable at that hospital. I do think I am top-tier for my age/experience level and will get much better with more time and experience.

Click to expand...

You are not coming off as arrogant at all but you need to understand a few things:

1. The admin may have a shockingly poor understanding of your actual value

2. Even if they recognize it they may wildly overestimate their ability to replace you

3. Age and experience are going to be seen by some hospital admins as at best a mixed bag.

4. If you want them to understand your value the only thing that is going to work is data and that's going to be hard to generate unless it's RVUs. The intangibles will not translate in negotiation.

[MPMD]

CordMcNally wrote:

ChristopherMD20 wrote:

There was some comments made that the budget was already set for this fiscal year but no definitive response to my proposal. 

Click to expand…

This sounds like administrators using the budget to hide behind an upfront answer. I can guarantee that there are going to be multiple line items on their budget that they are going to go over for the year due to various reasons. Salaries are no different. A budget isn’t set in stone like they’re going to pretend it is.

Click to expand...

"I understand that issue on your end, my timeline is unfortunately not influenced by that factor."

[Zaphod]

Agree with the above. Remember what you see as quality care they will view as inefficient and nonproductive, since it doesnt pay.

[ChristopherMD20]

Those are good factors to consider.

I have access to the wRVU by my other hospital employed colleagues. I produced 1500 and 1000 more wRVU than my colleagues respectively and I worked 1 month less. I am not trying to throw them under the bus, but is there a way to tactfully bring that up without “screwing them?”

[q-school]

ChristopherMD20 wrote:

Those are good factors to consider.

I have access to the wRVU by my other hospital employed colleagues. I produced 1500 and 1000 more wRVU than my colleagues respectively and I worked 1 month less. I am not trying to throw them under the bus, but is there a way to tactfully bring that up without “screwing them?”

Click to expand...

sure.  just tell them-here are the production numbers.  but they likely are going to tell you, the medical director,  that you need to get them up to speed.  they may whip out the national averages and tell you all three of you are under the desired range, based on your previous post.

good luck!  welcome to the ugly side of medicine.

 

 

[MPMD]

ChristopherMD20 wrote:

Those are good factors to consider.

I have access to the wRVU by my other hospital employed colleagues. I produced 1500 and 1000 more wRVU than my colleagues respectively and I worked 1 month less. I am not trying to throw them under the bus, but is there a way to tactfully bring that up without “screwing them?”

Click to expand...

This is another junior physician mistake. We assume that increased productivity or citizenship translates to increased influence.

I wouldn't quite say that the opposite is the case, but I would say you will see some upsetting things as you move forward. Low production and whining are often rewarded as those docs can be vocal and admin will sometimes give them what they want to get them out of their office. The high producers are often the most flexible as well.

I would also say to be fair to them that a spot check of RVUs doesn't give them much to work with. If you consistently beat out everyone else on RVUs over 10 years that's a different story albeit still doesn't give you what it should give you.