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When they propose a worse contract than you already have....

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  • When they propose a worse contract than you already have....

    This post is for my partner who is at the 30 month point in his first attending job as an obgyn. Things have gone great so far. This is a large multi-clinic group of various specialties, so management is not on site. There were originally two other providers in the group, but they both left in the last six months, so now it's just him. The practice is very busy. They have been trying to recruit new providers, but it isn't going well, so it will be just him for quite some time it appears, and there is a drastic obgyn shortage in our area.

    Management just presented my partner with a new contract that is actually worse than his old contract, and would like him to sign it. The base pay is the same (mediocre, but acceptable), the stipend pay for call shifts is the same (makes up for the mediocre base pay), and they've added a new "backup call" pay feature for when the hospitalist takes his call, but if the hospitalist is swamped and can't do it, my partner would be the backup and would need to come in.

    The pay for that is really a joke, something like $100 per "backup call shift" but that still means you can't leave town, you have to be available just in case, etc. So it's effectively CALL in our minds. If he does get called in during the backup call period, he gets paid per delivery, which is fine. If he were to take "backup call" instead of real call every single day for a year (he's the only doctor so we think he would have to), that would only bump his base by $36,500, plus whatever he would make in deliveries which remains to be seen, but that would mean 0 vacations or drinking, etc..

    They have also reduced his ability to earn additional PTO, which used to be earned based on how much call you take, but now simply doesn't exist anymore. They have also indicated that they want to switch to the hospitalist doing most deliveries, meaning less or even zero regular call shifts for him - however his call pay at 1:3 really adds up to something like 25% of his overall compensation. To lose ALL of that would be a dealbreaker.

    He's had a soft offer with a new group at another hospital nearby, but hasn't really gotten to the details on it, and would prefer to stay where he is simply because it's closer to where we live.

    He sent an email to his immediate supervisor and said 1) You're effectively reducing my compensation by taking away earned PTO and not replacing it with anything 2) if you take away my call and give it to the hospitalist, but expect me to be on backup for the hospitalist, you're effectively keeping me on call (can't leave town, can't drink, etc.) but paying me way less. They responded with "this is the contract" and claim they are trying to standardize the contracts at all their locations.

    This location is a harder location to staff, so we think they need to take that into account. If he leaves they literally would have no doctor, none on the horizon, and they are already way overstaffed with MA's, scribes, etc., as they haven't let any go that worked for the two providers that already left. His performance numbers are among the best in their system, he always sees more patients than scheduled, etc., so we are really at a loss for what their thought process is in asking for this, especially since he's all they have.

    Neither of us can think of how to move forward, since there is no way he's signing this new contract as it sits, and I can't imagine they're going to fire him if he doesn't since it would effectively close down this clinic. Should he just negotiate with this other group to see what their offer would look like? How do we negotiate this existing situation when we really feel like he's got them over a barrel, but they don't seem willing to negotiate so far? It's kind of crazy to us that they are wanting this, but I think it's one of the problems you have when management isn't local and is spread over too many locations.
    Last edited by jfoxcpacfp; 02-03-2020, 12:13 PM. Reason: split into paragraphs

  • #2
    If he can truly walk, he is holding all the cards. A bureaucrat is not going to take call.

    And regarding the title of your post: "In other news, the sun rose in the east this morning...."

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    • #3
      First of all, he's not a provider, he's a physician. An immensely valuable and difficult to replace one at that. You should correct your partner if he calls himself a provider.

      If they need him more than he needs them, he should certainly talk to the other group before doing anything. If he has a trump card of a better offer the worst case scenario is to not sign their new contract. Until then, he should just let them sweat.

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      • #4
        Are you talking about an OB hospitalist or an IM/FP hospitalist ? "Backup call" sounds pretty stupid.

        It sounds like you are confident they wont fire him. So simply tell them he will honor his current contract. Call their bluff and see what happens.
        I would definitely be talking to the other group in the meantime.

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        • #5
          Originally posted by childay View Post
          Are you talking about an OB hospitalist or an IM/FP hospitalist ? "Backup call" sounds pretty stupid.

          It sounds like you are confident they wont fire him. So simply tell them he will honor his current contract. Call their bluff and see what happens.
          I would definitely be talking to the other group in the meantime.
          OB hospitalist, so we think it's unlikely they would ever call him in for backup....But it does get busy up there with random walk-ins.

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          • #6
            I suppose he could also consider taking the paycut in order to not have to go deliver babies in the middle of the night. The "backup" call is also Q3?

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            • #7
              He is a Doctor not a provider. He needs to be clear on this. I am confused. He is the only OB/GYN but yet there is a hospitalist service. Did the others docs leave to become hospitalists? Really confusing about the money. In general back up call if you take your responsibility seriously is no different than call. It would depend on the work ethic of the hospitalists.

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              • #8
                Originally posted by Hatton View Post
                He is a Doctor not a provider. He needs to be clear on this. I am confused. He is the only OB/GYN but yet there is a hospitalist service. Did the others docs leave to become hospitalists? Really confusing about the money. In general back up call if you take your responsibility seriously is no different than call. It would depend on the work ethic of the hospitalists.
                Yes, and what happens when the hospitalist(s) leave for another job...

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                • #9
                  Originally posted by childay View Post
                  Are you talking about an OB hospitalist or an IM/FP hospitalist ? "Backup call" sounds pretty stupid.

                  It sounds like you are confident they wont fire him. So simply tell them he will honor his current contract. Call their bluff and see what happens.
                  I would definitely be talking to the other group in the meantime.
                  I like this approach. “I will continue to work per the terms of the current contract. Otherwise, let’s open up negotiations. I already have an offer from the competitor down the street.”

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                  • #10
                    Admins know that physicians typically feel uncomfortable negotiating but he has all the cards in this situation so I would 100% call their bluff. I mean, he's their only OB. My big question is, why did the other two quit/leave?

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                    • #11
                      this is definitely time to stand up for yourself.
                      you have to be OK losing and moving on.

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                      • #12
                        Get an offer from the competitor that you guys are happy with. Then, if he wants to try to stay at his current position, give the current place your requests. If they say no, move on. You guys have all the power in this situation.

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                        • #13
                          Without knowing what else is going on in the practice, it is possible that they really would let him go if he does not sign the contract. It would be a stupid and irresponsible decision for an administrator to make without anyone to cover OB. Anyone here ever see administrators make stupid and irresponsible decisions? The group already knows it has a big problem holding on to OB's. It already knows it cannot hire, if it is even really trying.

                          Your partner should definitely look elsewhere. If there is a good job nearby, then great. If not, look farther afield. The very best they are offering is 365/365 call at a reduced income, which is crazy. Find a better job, which should not be hard, given what the new job would be, then make them a reasonable counter offer. That counter should include a realistic amount of call, a competitive salary, market based payment for taking call and incentives for them to hire enough OB's and pay for locums people to help with coverage until.the new people are in place.

                          It is possible the group has bigger problems than an inability to staff OB at this site and you are seeing desperate cost cutting. It is possible the management is just incompetent. In either case, your partner cannot fix this by taking on an abusive and unsustainable contract.

                          Depending on what else is going on, staying there may not be an option. The gap between the substantially increased pay and coverage to take call to 1:3 and want they are offering is so great that staying is impossible.

                          Look around under the assumption your partner will leave. If the current employer comes up with a decent offer and you believe they will honor it, then maybe stay.

                          Look around local and farther away.

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                          • #14
                            Under those circumstances and in consideration of the ridiculous offer they had the nerve to propose I would require a much nicer deal then the current contract in order to stay.

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                            • #15
                              Still not sure that I totally understand the situation. I would check who pays the tail and any non-competes. Polish up the resume.

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