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Neurohospitalist Part III: The Saga Continues [Administrator shell game?]

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  • #46





    When their one job is to “manage” the staff, you can never let them look like a patsy our make it appear that they’ve been out negotiated. 
    Click to expand…


    I certainly think that it was a fair agreement for both sides.

     

    I truly appreciate everyone’s guidance. Effectively I got 10% in base clinical pay, payment for directorship, modest decrease in productivity bonus threshold and a moderate retention bonus. Never would have been able to maneuver without all your help. I am very grateful.
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    Hooray.  Are you the first person in the hospital to get paid for medical directorship?

     

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    • #47
      Congrats.

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      • #48
        “They only have 2 options now, fold or call.”
        Hmmm. What happened to the “playing field “?
        •They made a verbal offer.
        •You countered in writing (basically reset the agenda).
        •Then IN PERSON you negotiated from your agenda and reached an agreement.

        The only thing not specifically addressed was the call pay. As you stated, the total comp was your primary focus. Better to accept the retention bonus . Sure am glad the word “Stark” wasn’t an issue.

        My guess is you probably felt you could have pressed for more, but simply decided it wasn’t worth it from a relationship standpoint (being the nice guy you are). That is not being weak, it’s judgement.
        Well played.

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        • #49
          This was better than watching a novela, except I did not learn any new spanish words

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          • #50
            Great job and thanks so much for sharing. It's so educational when someone goes through this and shares with other physicians.

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            • #51


              •Then IN PERSON you negotiated from your agenda and reached an agreement.
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              Yes. Pretty much they accepted my written counter. The in-person meeting was the admin trying to see how real I was. I think I made it clear there was not much wiggle room. The play completely changed the tone of this whole situation. Very interesting.


              My guess is you probably felt you could have pressed for more, but simply decided it wasn’t worth it from a relationship standpoint (being the nice guy you are). That is not being weak, it’s judgement. Well played.
              Click to expand...


              Yes. I think I did ruffle some feathers after I met with them in person. I wanted to smooth over some things over and not nickel and dime over some trivial things.


              Are you the first person in the hospital to get paid for medical directorship?
              Click to expand...


              Haha I am sure I am not. I did not ask that question though specifically.


              The only thing not specifically addressed was the call pay.
              Click to expand...


              Actually. I negotiated my 4 weeks of call required for my base pay down to 0. So now I get paid $500/night for call without having to hit any threshold.

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              • #52


                Great job and thanks so much for sharing. It’s so educational when someone goes through this and shares with other physicians.
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                Well it was very helpful to crowdsource a lot of this. I would have never done any of this alone. Yet another benefit of the WCI site. Not only giving docs a fair shake on wallstreet, but also the negotiation table.

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                • #53
                  Negotiate and dominate

                   

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                  • #54
                    This might be one of the first successful negotiation threads I've read. Good job. Its hard to actually buckle down and say this is it or nothing in real life. Takes guts.

                    Benefit of FI and having an EF and a back up plan. Can negotiate more thoroughly and seriously for what you deserve.

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                    • #55
                      congrats again!  very pleased to see you go through the experience and successfully conclude your first real negotiation.

                       

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                      • #56




                        This might be one of the first successful negotiation threads I’ve read. Good job. Its hard to actually buckle down and say this is it or nothing in real life. Takes guts.

                        Benefit of FI and having an EF and a back up plan. Can negotiate more thoroughly and seriously for what you deserve.
                        Click to expand...


                        While its always preferable to go in at a rate that you are happy with in the real world I have seen many successful negotiations particularly if the person didn't wait until they were so burned out that nothing was going to soothe the situation. I don't think it is generally that difficult to obtain the actual increase as much as it is uncomfortable to deal with the devaluing process it entails. The OP also is quite smart in that he set his life up in a way that afforded the option to walk which unfortunately many "can't" or haven't done.

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                        • #57
                          Sorry if I am resurrecting a concluded thread. But as a neurologist and neurohospitalist, I feel I could have provided some useful tips to the OP at the time of your contract negotiation about 1 yr ago. But since there is no such things as unbreakable contracts, my advice here may still be useful to you or anyone in similar situation.

                          Since I just began reading about your saga tonight, I copied and pasted some of your key postings summarizing your situations:

                          "I have been employed for 11 months. I have seen ~1020 inpt new consults, ~1100 intpt follow ups [ Did about 100 new outpt consults and 100 outpt follow up, but shut down my clinic]. I am not sure what a high volume is but I work as hard as I can. I do not have typical 7-on-7off schedule either, I work on average 22 days/month. I am having trouble finding out averages for neuro-hospitalists specifically... Despite the volumes I am well under the median for neurologists. I am not sure I am capable of working much harder than I am now. I do not think I am a "lazy millennial," but I recognize that I may be blind to my own faults/laziness. I often put in 12-16 hour days when including documentation I just want to understand who to be the best advocate for myself. I may be just inefficient (I do spend a lot of time talking with families, reviewing their imaging with them, participating in family meetings) which is generally not billable work since I use E&M coding. I feel like I provide a ton of value, but I have no hope of extra compensation since my productivity numbers suck.

                          I am currently salary. My contract ends in a year and per my contract I have to give them 6 months warning if I am not going to renew so I am trying to gameplan for the fall when I renegotiate. Do I ask for higher base salary? Lower productivity thresholds? Do people only care about productivity numbers or is there any chance at people valuing the quality of my work (and paying me more )

                          I am in the Mid-Atlantic, so saturated market. The hospital is 300 beds. I am very well liked by my colleagues and they seek me out over the private neurologists for the most part. A lot of my new consults are stroke alerts which take up a lot of time especially if I am given tpa or transferred to a local academic center.

                          *** I get paid base pay $260k and I get paid to be on call $500/night *** I made about $300k when combining base pay and call pay which I was told is 55th-percentile per MGMA per my boss. I do not have access to this data and obviously the person who is telling me this is not acting in my best interest.
                          "

                          My guess is you cover day time while the nights are covered by some tele-neurologist. When you do cover the night, you are paid $500 per night. Is that correct? Are there any satellite facilities you cover?

                          First 11 months you saw on average 9.6 patients a day in a 300-bed hospital and most being strokes. That is somewhat above average in terms of volume. I don't know why that hospital told you there is a "cap" of $460k for a neurologist.

                          Typically we get paid about $2000 to 2600 flat fee per 24hrs of inpatient coverage as an employed position with home coverage (phone, tele) after 4:30 to 5pm. Small to mid size hospitals like yours would be around $2000 to 2200 per day although your daily census is on the higher side. As an independent contractor or locum, you can get $2800-3500 per 24 hrs flat fee or $1400-1800 base fee for pager holding plus physician fee collection from each patient visit (about $200 for new consult and $110 for followups for Medicare).

                          For example, while I was employed at a 250-bed Comprehensive Stroke center, I averaged 6-8 visits per day, working 7-on-7-off and took home $420k to 460k per year not including all the benefits (malpractice, insurances, matching 401k, CME, etc.). My wRVU averaged about 4700 per year.

                          So you work 22 days per month instead of 14-15 days and initially even saw some clinic patients. Yet you made less. Also you did not get paid for medical directorship which comes with its own risk and responsibility.

                          Although I was getting paid more than you, I realized I was getting badly underpaid. So I became my own boss and started a private group and contracted with local hospitals. Now I make much much more than that. There are so many opportunities to grow and expand but I am limited by not being able to find good quality neurologists to join. In fact, I actually cut down my work load recently and let go of a very easy $290k/yr contract to that I can focus on the new project of building a clinic. There is no limit to my practice's growth because there are so much works available! I would love to find someone as dedicated to patient care like you and help you earn what you deserve while avoiding all the BS from the hospital managers as much as possible.

                          Remember, managers were initially employed and brought in to hospitals by the older generation of physicians who were too busy seeing patients and increasing revenues to bother themselves with counting. Gradually the roles changed and now these managers became the "boss" and physicians the employed despite the fact that we the physicians are still paying the salaries of these often good for nothing managers. They don't produce any revenue. We do. There is no hospital if there is no physician. There is no medical practice without physicians. This is why these managers will never truly be our "boss" and they know it and hope that we don't realize our true power and continue to bow our heads.

                          Remember that a neurologist brings about $2 to 2.2 millions annually to a hospital by downstream revenues across the nation. Think of all the tPAs, ICU stays, MRIs, CTs, CTAs, endarterectomies, special labs etcs, EEGs. You need to know your market value. There are great shortage of neurologists in general. And there are even worse shortage of neurologists willing to do inpatient works let alone stroke coverage because most neurologists only want less acute outpatient works. So yes we are very highly sought out rare commodity.

                          You should get paid at least $145/hr for your Stroke medical directorship or its equivalent for your every minute spent. Your professional time should be compensated. Plumbers, car mechanics, lawyers all charge for their minutes.

                          To answer your original question: no, you are not lazy or ineffective. You are working above average in terms of daily patient volume. Yet you are underappreciated by the hospital admin. As to speed of seeing each patient, you will get faster.

                          Know your true market value and never fall into the trap of the business managers belittling your true worth.

                          Another thing you need to quickly realize: there is no such thing as job security in employed position. This is a very common myth among new grads. "3 or 5-yr" contract does not mean anything since all contracts can be terminated without cause with 90-days notice and with cause in 30-days by either party. The only job security for physicians is building your own patient base in a community. Hospital admins will be let go and changed every 2-3 years and your contract will be changed often without any warning. Hospitals' financial situation will change especially with current COVID hysteria and will justify your pay cut. But your patients in the community will still be there on your 6-months waiting list. That is your only best job security.

                          Yes, I am happy with my current practice set up and love seeing patients and helping my colleagues with difficult neuro cases. You can do the same.
                          Last edited by Neurologo; 09-20-2020, 04:32 AM.

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