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  • Too Many Providers

    I work at a clinic that has a fairly unusual problem. We have too many providers. I just hit year three in my contract. Like many contracts, my base salary dropped, and I am much more dependent on RVUs. I didn't anticipate that the clinic I worked for would keep adding providers despite not filling our schedules, and my contract only states that if they add providers AFTER year two, they would possibly change my compensation structure to compensate for the lower volume. They added two providers while I was still within the first two years, and they still have a position posted online. I have days where I see 20 patients, and I have days where I see ten. My patient surveys are consistently very strong, I make sure to schedule follow-ups. I feel like I'm doing everything I can on my end. It seems extremely short sighted on the clinic's part. We are in a rural area, with a very high turnover rate. I'm the first physician who actually lives in the same town as the clinic. If they actually can find another physician, they are just going to have to pay another large sign on bonus, a higher salary for two years, and benefits. Wouldn't it be smarter to maximize capacity for their current providers?! Interestingly the clinic in the city closest to us, that has a larger population than our entire county, has less providers... and they aren't hiring. The town up the road from us that has double the population has 1/3 the providers. How does this make sense? Has anyone been in a similar situation? How did you handle it? I hate to cut and run.

  • #2
    It sounds like they are used to the high turnover and that they’ve been burned before with people leaving. So they are in a perpetual hunt for more providers to plug the inevitable gaps.

    I would go sit down with the senior partner and/or administration and tell them that you are in for the long haul (you actually live in the town) and that you want them to recognize this and that you want them to work with you to make your arrangement mutually beneficial.

    Filling your schedule should be priority before hiring anyone else. If they don’t agree then you have some thinking to do about moving on. Why commit to a clinic that won’t commit to you?

    Comment


    • #3
      How about the other physicians in your group, what are their feelings about this? If you are all on the same page, have you spoken to whoemever is planning staffing and figure out why they are over hiring? First step is communication and seeing why they are doing what they are doing.

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      • #4
        It is expensive to hire a new provider, besides the recruiting costs, they are usually subsidizing them the first few months to years until their patient panel is established.   Presumably, someone in the business administration has calculated that the clinic would make more money in the long run by hiring a new provider rather then trying to over-fill your guys schedules and give you more of an rvu bonus.  Maybe your partners don't want more patients and want the relief from their schedule?   Or they are worried about losing their patient base and revenue when they have gaps due to provider turnover.  I suspect that your problem could be solved if you met with the administrator responsible for hiring and running the clinic.   It is almost always cheaper to pay you more in the rvu bonus then it is to hire a new provider, that's why they have rvu bonuses, both sides profit from generating more work for you.  If that fails, maybe try to get more days off/fewer clinic hours with the agreement that you will be paid the same if you are generating the same number of rvu's if you really just want more patients per hour and they can't seem to find you more patients per hour.

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        • #5
          Sounds like you need to just take it to them

          Start marketing.. reach out to patients to spread word that your open for more business.. tell other providers. Hit up other local towns.

          A good MD pcp who lives in a rural town and not moving is a god to those people. I have a hard time seeing you won’t get busier by being more aggressive or just with time unless you’re really saturated.

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          • #6
            It sounds like they actually dont need to add more physicians. Do you have a non compete?

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            • #7
              Who owns the practice? Are some of the physicians partners? Will you be one at some point? I think that would play into my decision making too - and maybe tell you how/who to approach with your observations and suggestions.

              Comment


              • #8




                It sounds like they are used to the high turnover and that they’ve been burned before with people leaving. So they are in a perpetual hunt for more providers to plug the inevitable gaps.

                I would go sit down with the senior partner and/or administration and tell them that you are in for the long haul (you actually live in the town) and that you want them to recognize this and that you want them to work with you to make your arrangement mutually beneficial.

                Filling your schedule should be priority before hiring anyone else. If they don’t agree then you have some thinking to do about moving on. Why commit to a clinic that won’t commit to you?
                Click to expand...


                That sounds like really good advice.

                The question will be if the people making what sounds like odd hiring decisions are going to have the vision to see this. I find that many administrators really can't see stuff like this, they just see a line on the spreadsheet. The generally terribly overestimate their ability to replace you.

                I think you have a really easy ask though, you want your schedule filled and your pay to reflect that. Let's reassess in 6 months. If they can't commit to that then I agree with @Ghetto's last line for sure.

                Comment


                • #9
                  OP: Felt like I could have written this post. I'm in a similar situation, except my base was only for one year. While talking to them is helpful, I'm skeptical as to how much of a difference it'll make. They've already hired the extra physician.

                  I'm introducing myself to PCPs in the areas and trying to build up my referral base. Opened up late evening and Saturday hours to attract more patients due to convenience. And volunteered to work in a satellite clinic 1 hour away where they have fewer providers and more need. But the main clinic has a new doc who just started last week, and I (the most recent hire) wasn't close to full prior to them starting.

                  I don't know if any of those ideas will help you/apply in your situation. Not even sure they'll work in mine. But I want to give it a fair shot to make it work.

                  To be honest, I've already created a list of job openings in more rural areas with higher pt demand as backup options. I'm only willing to put up with a few months of low income before I leave. The administrators have their heads up their asses. They won't hire scribes but they're fine shelling out 6 figures in base salary to a superfluous physician.

                  So do everything you can do to make it work, but curate backup options at the same time. If your salary drops precipitously, you don't want to then have to apply for a new state license and credential and be stuck for 8 months with low income waiting for the new job to kick in. Have a backup plan ready to go in case it doesn't work out.

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                  • #10
                    Stop calling yourself a provider. With that kind of mentality, these bosses will continue to eat you up. Demand respect for actually bringing dollars to the table, or walk and set up shop as a physician.

                    Comment


                    • #11




                      I work at a clinic that has a fairly unusual problem. We have too many providers. I just hit year three in my contract. Like many contracts, my base salary dropped, and I am much more dependent on RVUs. I didn’t anticipate that the clinic I worked for would keep adding providers despite not filling our schedules, and my contract only states that if they add providers AFTER year two, they would possibly change my compensation structure to compensate for the lower volume. They added two providers while I was still within the first two years, and they still have a position posted online. I have days where I see 20 patients, and I have days where I see ten. My patient surveys are consistently very strong, I make sure to schedule follow-ups. I feel like I’m doing everything I can on my end. It seems extremely short sighted on the clinic’s part. We are in a rural area, with a very high turnover rate. I’m the first physician who actually lives in the same town as the clinic. If they actually can find another physician, they are just going to have to pay another large sign on bonus, a higher salary for two years, and benefits. Wouldn’t it be smarter to maximize capacity for their current providers?! Interestingly the clinic in the city closest to us, that has a larger population than our entire county, has less providers… and they aren’t hiring. The town up the road from us that has double the population has 1/3 the providers. How does this make sense? Has anyone been in a similar situation? How did you handle it? I hate to cut and run.
                      Click to expand...


                      the administration either don't care, are incompetent, or are sure you won't leave.  it is extremely unlikely you won't fill up in a few years, the question is whether the financial hit and the free time is of enough value to you now to stay.  even if they hire more physicians, likelihood of them staying is low, so they would essentially be helping leverage your long term success when they leave.  for your twenty five to thirty five year career, you may have a quiet period for a few years.  as the years go by, you may remember this time fondly. 

                       

                       

                      Comment


                      • #12
                        How big is your patient panel now?
                        How many new patients do you see a day?
                        When your schedule is full and a patient calls in with an acute concern do you see them? What about the next one?
                        Do you take off either Monday or Friday?

                        Comment


                        • #13
                          This somewhat happened to me.  I was young and eager to see more patients.  I was concerned on declining salary if I do not ramp up my panel by year 2. In my case, they allowed me to extend my base salary for another year since they moved me to a busier location clinic. I didn't need year 3 to go to RVU since I was consistently going beyond the base.  My few suggestions: meet with them and see what is a realistic goal of number of patients/provider eg, 1500-2000patient /internist.  how many patients are in your clinic?  does the volume in your clinic justify the number of doctors they are hiring? if they are planning to expand, what are their marketing efforts? Try to design your template on what is really needed- follow ups, new patients, same day sick.   I was talking to a pediatrician, who is well established.  He said, they almost never send people to urgent care. they have extended hours 7 days a week except holidays.  I personally try to have 1 late day to accommodate working patients.  I also am more accepting even if a patient comes in late, it is like throwing away business when they are already on my front door. If they value you, they will make efforts for you to stay.  However, I will also see if I can get other job options and can use it as negotiating power.   I also agree to try to rest and enjoy this time. Read, get CMe's done.  Once you are fully established, there is almost no downtime.

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                          • #14
                            I agree, time to renegotiate that contract.
                            Helping those who wear the white coat get a fair shake on Wall Street since 2011

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