Announcement

Collapse
No announcement yet.

Coming up with a .75 FTE proposal for my practice

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

  • #16
    We're a big group.  Difficulties are always around money and crumby shifts.

    Money/benies are proportional since it comes out of our own pocket.  No benefit to crumby shifts til you drop below .5 FTE.

    It is amazing how few people drop to PT (for a variety of reasons); understand that this engenders strong opinions/feelings from some people: tread lightly.

    Comment


    • #17




      @mpmd

      “this isn’t exactly my world but… i think i would sort of decline to do this.”

      — And the partners, in turn, may decline your request to work less than full-time. The OP is the one who wants a modified schedule, it should be incumbent upon the OP to show the rest of the group what that means and how that works.

      “i would like to not work full time and be paid proportional to what i work. /end manifesto.”

      — To which the partners pay respond, “we don’t want to work extra nights, weekends, and holidays to cover for you going part time. /end discussion of part-time role”

      As Tim pointed out, the details matter, different story if it’s a 100 doc practice vs. and 8 doc practice. OP hasn’t provide those useful details, but I’d venture to guess it’s a smaller practice, hence the request for ‘show us how think this works for you, and for us.’

      It’s not a weird request at all. It’s actually good for the OP and the practice, better to sort through the proposed schedule and compensation changes and ensconce them in a contract.
      Click to expand...


      How exactly can someone decline to let someone work fewer hours than they want to work? Fire them? Is that going to happen? A group is going to fire a doc who wants to go to 0.75 FTE? A doc tells their partners they want/need to cut back to 0.75 FTE and the partners say "you can't." Doesn't that vastly increase the chance that said doc is going to look to get o 0.00 FTE?

      Nights, weekends, holidays: see above, but feel free to hire up.

      I would nearly guarantee you that any partner who found this request to be unreasonable would immediately switch their position if they suddenly needed to go to 0.75 FTE and demand that accommodations be made.

      It's pretty clear that if there is some kind of profit sharing or money being passed around and one person's FTE means that others are working more that they can expect reasonable compensation for doing so. I just don't see why the OP should need to create some kind of grand justification to decrease their workload by 25%.

      Comment


      • #18
        “just be fair, if you are 0.75 FTE you should get that ratio of anything there is to share.”

        So a shift is 12 hrs, you work 9.
        •Who has to come in and work the last 3?
        • Do you pick which 3?
        Brings new meaning to 50/50. It’s now 62.5/37.7 split.
        Fair then you take every holiday weekend and nights. It’s not just math. One is taking close to 2/3’s of the workload. Basically, because you want to cruise you want someone that already cranking as much as possible to take on more. The math shifts more than time, it shifts responsibilities that weren’t previously agreed to and can cause serious damage and be unsustainable.

        If a resident wanted to do a four year program, but personally wanted to only commit to .75 , would you approve them stretching it to 5 years? You could always fill that .25 slot or let the other residents fill it.
        Not sure that works. Flexibility is not always math, even if you adjust the residents pay.

        MDPD, you are an expert, I am not. Simply a humble attempt to illustrate that there is more involved than just compensation and benefits as percentages.

        Your manifesto is an opening talking point. Framed in the context, how can “we” make this happen.
        It won’t be smooth.




        Comment


        • #19







          @mpmd

          “this isn’t exactly my world but… i think i would sort of decline to do this.”

          — And the partners, in turn, may decline your request to work less than full-time. The OP is the one who wants a modified schedule, it should be incumbent upon the OP to show the rest of the group what that means and how that works.

          “i would like to not work full time and be paid proportional to what i work. /end manifesto.”

          — To which the partners pay respond, “we don’t want to work extra nights, weekends, and holidays to cover for you going part time. /end discussion of part-time role”

          As Tim pointed out, the details matter, different story if it’s a 100 doc practice vs. and 8 doc practice. OP hasn’t provide those useful details, but I’d venture to guess it’s a smaller practice, hence the request for ‘show us how think this works for you, and for us.’

          It’s not a weird request at all. It’s actually good for the OP and the practice, better to sort through the proposed schedule and compensation changes and ensconce them in a contract.
          Click to expand…


          How exactly can someone decline to let someone work fewer hours than they want to work? Fire them? Is that going to happen? A group is going to fire a doc who wants to go to 0.75 FTE? A doc tells their partners they want/need to cut back to 0.75 FTE and the partners say “you can’t.” Doesn’t that vastly increase the chance that said doc is going to look to get o 0.00 FTE?

          Nights, weekends, holidays: see above, but feel free to hire up.

          I would nearly guarantee you that any partner who found this request to be unreasonable would immediately switch their position if they suddenly needed to go to 0.75 FTE and demand that accommodations be made.

          It’s pretty clear that if there is some kind of profit sharing or money being passed around and one person’s FTE means that others are working more that they can expect reasonable compensation for doing so. I just don’t see why the OP should need to create some kind of grand justification to decrease their workload by 25%.
          Click to expand...


          see my note above, I agree that happy docs are important.  but keep in mind that even though I am 0.6 FTE, I'm still 100% pain in the arse for office work (payroll, insurance, etc), opinion at group meetings, a full vote in the democracy, etc.  plus how to account for intricacies such as scheduling (much easier to have a circadian flow when you're working 10 days a month as opposed to 16); and I still have certain schedule preferences--do these carry the same weight.

          there are nuances to consider.

          Comment


          • #20
            @MPMD

            You're an academic ER doc, right? While it may be easy in your shift based specialty with interchangeable docs and a academic employer to let someone ramp down or pick how much they want to work, think about how that may not be the case in other situations. The OP hasn't provided enough info regarding his own situation, but consider the following:

            A group of 4 orthopods with a hospital contract with a busy clinic and q4 call. Now one guy wants to go 3/4 time. The group has never had someone do that, so there's no precedent for how to handle it. So instead of taking his proportionate 91 nights of call a year, he only wants to do 68. Well, there's no magic call fairy to do the 23 nights the group is now short, so the other three guys are now needing to do 100 nights each. Well, they don't want to take more call -- at any price (or, maybe there is a price, that's the reason it needs to be discussed). They don't love call, but realize it's part of the deal, but they don't want to do more. And there's not enough work to add a 5th doc without dramatically depressing their own income (not every practice can just 'hire up'). But one of them has a buddy from training that's looking for a new job and would love to join the practice as a full timer -- so yeah, maybe they'd rather the guy go to 0 FTE and hire a motivated replacement as opposed to covering a 4 man practice with 3.75 guys.

            Or maybe the guy that wants to go to 0.75 FTE is an invaluable rainmaker and they'd pay him 0.75x salary plus full benefits because he's that valuable to the group that they'll bend over backward to keep him happy.

            Or maybe the guy that wants to go to 0.75 FTE is unproductive and often irritates referring docs and while he doesn't do anything bad enough that they'd have legal grounds to kick him out of the group and they really don't want to go through a messy divorce, they certainly aren't going to accommodate him in hopes that he'll just leave the group on his own volition.

            It's best for the OP and his group for him to explicitly state:

            - what he wants his work schedule to look like, and how that will impact the other partners

            - what his compensation will look for doing that amount of work, such that the rest of the partners can use those expectations and balance them against their own to come to an understanding that's agreeable to all parties.

            - For how long is he allowed to work a reduced schedule, under what circumstances could he be asked to work more, etc.

            OP, I suspect you and your group can come to a reasonable agreement. That'll be best facilitated by you communicating your expectations to the group and offering up reasonable solutions to any identified friction points. It might be as easy as 0.75 work = 0.75 total comp, but I bet there's more to it than that -- you know your group dynamics best, proceed accordingly.

            Comment


            • #21
              I am employed but came into a practice with 2 part timers. It is a pain the the rear. Compensation is only part of it. It is the increased work that sucks.

              So and so was seen yesterday and is not improving.
              Well I never met the guy and the note isn't done so I guess I should see them again today.
              They do not want to come in again.
              Too bad so sad.
              Calls our admin and complains about me.

              Comment


              • #22




                @mpmd

                You’re an academic ER doc, right? While it may be easy in your shift based specialty with interchangeable docs and a academic employer to let someone ramp down or pick how much they want to work, think about how that may not be the case in other situations. The OP hasn’t provided enough info regarding his own situation, but consider the following:

                A group of 4 orthopods with a hospital contract with a busy clinic and q4 call. Now one guy wants to go 3/4 time. The group has never had someone do that, so there’s no precedent for how to handle it. So instead of taking his proportionate 91 nights of call a year, he only wants to do 68. Well, there’s no magic call fairy to do the 23 nights the group is now short, so the other three guys are now needing to do 100 nights each. Well, they don’t want to take more call — at any price (or, maybe there is a price, that’s the reason it needs to be discussed). They don’t love call, but realize it’s part of the deal, but they don’t want to do more. And there’s not enough work to add a 5th doc without dramatically depressing their own income (not every practice can just ‘hire up’). But one of them has a buddy from training that’s looking for a new job and would love to join the practice as a full timer — so yeah, maybe they’d rather the guy go to 0 FTE and hire a motivated replacement as opposed to covering a 4 man practice with 3.75 guys.

                Or maybe the guy that wants to go to 0.75 FTE is an invaluable rainmaker and they’d pay him 0.75x salary plus full benefits because he’s that valuable to the group that they’ll bend over backward to keep him happy.

                Or maybe the guy that wants to go to 0.75 FTE is unproductive and often irritates referring docs and while he doesn’t do anything bad enough that they’d have legal grounds to kick him out of the group and they really don’t want to go through a messy divorce, they certainly aren’t going to accommodate him in hopes that he’ll just leave the group on his own volition.

                It’s best for the OP and his group for him to explicitly state:

                – what he wants his work schedule to look like, and how that will impact the other partners

                – what his compensation will look for doing that amount of work, such that the rest of the partners can use those expectations and balance them against their own to come to an understanding that’s agreeable to all parties.

                – For how long is he allowed to work a reduced schedule, under what circumstances could he be asked to work more, etc.

                OP, I suspect you and your group can come to a reasonable agreement. That’ll be best facilitated by you communicating your expectations to the group and offering up reasonable solutions to any identified friction points. It might be as easy as 0.75 work = 0.75 total comp, but I bet there’s more to it than that — you know your group dynamics best, proceed accordingly.
                Click to expand...


                as others have noted, there are many considerations.  overhead is not always reduced proportionately.  if there are coverage issues outside of call, someone has to take care of those-patient calls, lab results, specialists communications, urgent visits- that previously were covered by the 1.0 FTE.  retirement due to mandated call coverage is historically what thinned the herd and allowed new partners to be hired in many groups.

                i'm a little surprised by the question-how can you make someone work more than they want to?   they signed an agreement to do so.  you are just holding them to that agreement.  you are not allowing a requested change.  sure they might quit, but if there is a significant noncompete, they might not want to do so.  sometimes, it isn't only about the one person reducing time, it is what happens if everyone reduces time?  there is no question that running full benefits on bunch of part timers is more expensive than fewer full time employees.  just depends on how the cake is divided and how much everyone wants.  every practice is different.

                Comment


                • #23




                  So a shift is 12 hrs, you work 9.
                  •Who has to come in and work the last 3?
                  • Do you pick which 3?

                  If a resident wanted to do a four year program, but personally wanted to only commit to .75 , would you approve them stretching it to 5 years? You could always fill that .25 slot or let the other residents fill it.
                  Not sure that works. Flexibility is not always math, even if you adjust the residents pay.
                  Click to expand...


                  I don't think anyone would suggest that part time work should play out at the level of the individual shift.

                  The resident analogy makes no sense. Residency training times are set by national governing bodies. There is no negotiation to be had.

                   




                  @mpmd

                  You’re an academic ER doc, right? While it may be easy in your shift based specialty with interchangeable docs and a academic employer to let someone ramp down or pick how much they want to work, think about how that may not be the case in other situations. The OP hasn’t provided enough info regarding his own situation, but consider the following:

                  A group of 4 orthopods with a hospital contract with a busy clinic and q4 call. Now one guy wants to go 3/4 time. The group has never had someone do that, so there’s no precedent for how to handle it. So instead of taking his proportionate 91 nights of call a year, he only wants to do 68. Well, there’s no magic call fairy to do the 23 nights the group is now short, so the other three guys are now needing to do 100 nights each. Well, they don’t want to take more call — at any price (or, maybe there is a price, that’s the reason it needs to be discussed). They don’t love call, but realize it’s part of the deal, but they don’t want to do more. And there’s not enough work to add a 5th doc without dramatically depressing their own income (not every practice can just ‘hire up’). But one of them has a buddy from training that’s looking for a new job and would love to join the practice as a full timer — so yeah, maybe they’d rather the guy go to 0 FTE and hire a motivated replacement as opposed to covering a 4 man practice with 3.75 guys.

                  Or maybe the guy that wants to go to 0.75 FTE is an invaluable rainmaker and they’d pay him 0.75x salary plus full benefits because he’s that valuable to the group that they’ll bend over backward to keep him happy.

                  Or maybe the guy that wants to go to 0.75 FTE is unproductive and often irritates referring docs and while he doesn’t do anything bad enough that they’d have legal grounds to kick him out of the group and they really don’t want to go through a messy divorce, they certainly aren’t going to accommodate him in hopes that he’ll just leave the group on his own volition.

                  It’s best for the OP and his group for him to explicitly state:

                  – what he wants his work schedule to look like, and how that will impact the other partners

                  – what his compensation will look for doing that amount of work, such that the rest of the partners can use those expectations and balance them against their own to come to an understanding that’s agreeable to all parties.

                  – For how long is he allowed to work a reduced schedule, under what circumstances could he be asked to work more, etc.

                  OP, I suspect you and your group can come to a reasonable agreement. That’ll be best facilitated by you communicating your expectations to the group and offering up reasonable solutions to any identified friction points. It might be as easy as 0.75 work = 0.75 total comp, but I bet there’s more to it than that — you know your group dynamics best, proceed accordingly.
                  Click to expand...


                  Yes I'm an academic ER doc, what are you?

                  Well I don't think that we should assume the worst case for an arrangement like this, maybe the op is a member of a multi specialty group with 60 docs in 4 fields?

                  But to respond to you, again, life happens and people go part time all of the time. We have multiple members of this forum and the WCI community who have gone part time. I don't think anyone should be vilified for doing so or asked to provide some crazy level of justification.

                  If you are a member of a 4 partner ortho group that is on call q4 (your analogy) then your job already is kind of busy and it is VERY VERY poorly prepared for illness, death, disability, family emergencies etc. Something is almost inevitably going to upset this apple cart. If that's your setup and it's working at the moment good on you but it's inherently unstable. Quiet honestly a request to go to 0.75 FTE by one member is probably one of the better things that could happen to a group like this.

                   










                  @mpmd

                  “this isn’t exactly my world but… i think i would sort of decline to do this.”

                  — And the partners, in turn, may decline your request to work less than full-time. The OP is the one who wants a modified schedule, it should be incumbent upon the OP to show the rest of the group what that means and how that works.

                  “i would like to not work full time and be paid proportional to what i work. /end manifesto.”

                  — To which the partners pay respond, “we don’t want to work extra nights, weekends, and holidays to cover for you going part time. /end discussion of part-time role”

                  As Tim pointed out, the details matter, different story if it’s a 100 doc practice vs. and 8 doc practice. OP hasn’t provide those useful details, but I’d venture to guess it’s a smaller practice, hence the request for ‘show us how think this works for you, and for us.’

                  It’s not a weird request at all. It’s actually good for the OP and the practice, better to sort through the proposed schedule and compensation changes and ensconce them in a contract.
                  Click to expand…


                  How exactly can someone decline to let someone work fewer hours than they want to work? Fire them? Is that going to happen? A group is going to fire a doc who wants to go to 0.75 FTE? A doc tells their partners they want/need to cut back to 0.75 FTE and the partners say “you can’t.” Doesn’t that vastly increase the chance that said doc is going to look to get o 0.00 FTE?

                  Nights, weekends, holidays: see above, but feel free to hire up.

                  I would nearly guarantee you that any partner who found this request to be unreasonable would immediately switch their position if they suddenly needed to go to 0.75 FTE and demand that accommodations be made.

                  It’s pretty clear that if there is some kind of profit sharing or money being passed around and one person’s FTE means that others are working more that they can expect reasonable compensation for doing so. I just don’t see why the OP should need to create some kind of grand justification to decrease their workload by 25%.
                  Click to expand…


                  see my note above, I agree that happy docs are important.  but keep in mind that even though I am 0.6 FTE, I’m still 100% pain in the arse for office work (payroll, insurance, etc), opinion at group meetings, a full vote in the democracy, etc.  plus how to account for intricacies such as scheduling (much easier to have a circadian flow when you’re working 10 days a month as opposed to 16); and I still have certain schedule preferences–do these carry the same weight.

                  there are nuances to consider.
                  Click to expand...


                  Why do you get a full vote in the process as a 0.6 FTE worker? That doesn't sound fair and it's not something that I'm advocating.

                  Comment


                  • #24
                    MPMD I don't see how being asked to write up a plan for how PT would work for the group equals being villified or asking for crazy justification. In any non-shift work area of medicine there is some level of continuity that has to happen and if someone is not going to be there during regular office hours someone else is going to have to cover in some respect. In the ER you don't have to worry about patients calling a few days later with a question or how to handle messaging inboxes but many other areas do. There are tons of jobs (medical and non-medical) where you can either work full-time or the job isn't yours. Yeah they can't force you to work more hours than you want to but you also can't force them to give you the security and benefits of full time employment if you aren't going to work full time hours. There are plenty of doctors who have gone part time, yes. That does not mean that every job is agreeable to part time employment. The practice didn't say no, it asked OP to spell out how it would work. This seems reasonable, and also wise--better to think through potential issues and figure out how they should be handled so all parties are in agreement beforehand than wait for issues to arise and let one party or other get resentful/feel taken advantage of.

                    The situation that Lordosis described has to be mitigated. If you are a part time doctor (or ever take a day off or go on vacation) in a field where your partners/colleagues need to cover for you and provide continuity of care for your patients, then your notes have to be done and viewable by your colleagues before you leave for the day, and detailed enough to provide that continuity.

                    Comment


                    • #25
                      Unit of measure .
                      The residency example is very relevant.
                      .75 of a 4 year residency program is a 3 yr program.
                      Yes, those 3 year programs are accredited by the national agencies. The fall back on “no negotiation “ is bypassing specific requirements, a different unit of measure. Some programs have a 3 year med school path with a guaranteed residency with 4 year med school if you don’t sign up for the restrictions. Some are 5 years with the same residency requiring 6.
                      You eloquently made the point that some 3 year residencies don’t produce .75 attendings. Different objectives in excess of the minimums, most likely in both paths. It’s not just math. The results and objectives are proportional to a % of a year. Otherwise, 4 year options are rather inefficient. I do not mean to insinuate that by any means. There is more to it that you have illustrated in the past. I was simply pointing out, .75 FTE doesn’t mean .75 x an amount.
                      Partnerships would prohibit moonlighting. Most academics don’t. The economics are basically best efforts are required for the group. Less than best efforts will need to be negotiated. Just like your institution could have both a 3 year and 4 year residency. That would be a strategic decision and take a lot of work.
                      By the way, let’s agree that you win. This is your wheelhouse. But I can understand how complicated things get accommodating individual desires.

                      Comment


                      • #26


                        Why do you get a full vote in the process as a 0.6 FTE worker? That doesn’t sound fair and it’s not something that I’m advocating.
                        Click to expand...


                        You're missing the point that is being made.  Managing 10 part-time doctors is more difficult than 6 full time doctors, for numerous reasons.  Even in big groups.  Even in shift-work specialties.  It is totally reasonable to sort out the issues, it is not some "crazy level of justification." I guess we'll have to agree to disagree.

                        Comment


                        • #27




                          Aside from this, I’m really not seeing how it’s much more complicated and requiring of a “manifesto”.  But their use of this term makes me concerned they’re going to make it more difficult than I would like.
                          Click to expand...


                          The OP implied that this would be potentially complex and difficult. That's what I'm reacting to. If everyone agrees that this is going to be simple and the group wants a half-page document they are going to call a "manifesto" then there is nothing to discuss.




                          MPMD I don’t see how being asked to write up a plan for how PT would work for the group equals being villified or asking for crazy justification. In any non-shift work area of medicine there is some level of continuity that has to happen and if someone is not going to be there during regular office hours someone else is going to have to cover in some respect. In the ER you don’t have to worry about patients calling a few days later with a question or how to handle messaging inboxes but many other areas do. There are tons of jobs (medical and non-medical) where you can either work full-time or the job isn’t yours. Yeah they can’t force you to work more hours than you want to but you also can’t force them to give you the security and benefits of full time employment if you aren’t going to work full time hours. There are plenty of doctors who have gone part time, yes. That does not mean that every job is agreeable to part time employment. The practice didn’t say no, it asked OP to spell out how it would work. This seems reasonable, and also wise–better to think through potential issues and figure out how they should be handled so all parties are in agreement beforehand than wait for issues to arise and let one party or other get resentful/feel taken advantage of.

                          The situation that Lordosis described has to be mitigated. If you are a part time doctor (or ever take a day off or go on vacation) in a field where your partners/colleagues need to cover for you and provide continuity of care for your patients, then your notes have to be done and viewable by your colleagues before you leave for the day, and detailed enough to provide that continuity.
                          Click to expand...


                          I am aware of all of this. Again, I was reacting to the OP's implication of complexity and potential conflict.

                           





                          Why do you get a full vote in the process as a 0.6 FTE worker? That doesn’t sound fair and it’s not something that I’m advocating. 
                          Click to expand…


                          You’re missing the point that is being made.  Managing 10 part-time doctors is more difficult than 6 full time doctors, for numerous reasons.  Even in big groups.  Even in shift-work specialties.  It is totally reasonable to sort out the issues, it is not some “crazy level of justification.” I guess we’ll have to agree to disagree.
                          Click to expand...


                          Again, see above. The OP implied complexity and potential conflict. I agree let's leave it here.

                          Comment


                          • #28
                            MPMD is out of his element here. not a big deal just a different type of real world work dynamics in play.

                            ZZZ nailed it.. call burden, the interplay between volume vs call coverage vs work burden can be so tricky.

                            Qschool also makes great points of that inbox and urgent pts if your partner who is out for 10 straight days
                            And how someone is going to have to make up for it.

                            As with many things it usually comes down to call.


                            Comment


                            • #29
                              We have this come up every couple years. It is always emotional and I dislike the process. The part timer to be feels they deserve a "good deal" after x number of years with the group. Younger partners have no guarantee they will have the same treatment when it is our turn.

                               

                              But in the end, it is a negotiation between you and your partners. In my experience, splitting comp and work by 0.75 doesn't work, as there is no incentive to be full time and can lead to early partial retirements and loss of group stability. Taking comp too far below 0.75 doesn't work as you'll feel taken advantage of - most people heading into part time don't need the money as much as the full timers. You'll just quit after a short while. So there is a workay ratio that will make you and the group not happy, but satisfied that it is a good deal for all. Whether that means work 0.75 with pay 0.65-0.70 with benefits, or work 0.75 with additional undesirable shifts (ex: our part timers don't seem to mind evening shifts and overnights since there are no kids to come home to) it is up to you to work out.

                              Comment

                              Working...
                              X