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Placing a Value on " On Call" responsibilities

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  • kingsnake
    replied
    Well, it's in the 80's and sunny here in the Midwest...and I have 7 on call procedures to do plus 3 more consults...and our senior guy wants to take 25% less call and go part time. We agreed that he could if he paid the person that covers him $1,000 per call. I volunteered to take 0 of his calls. Call sucks. Not worth it. Some others bit though.

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  • q-school
    replied
    on call responsibilities for us get worse and worse as the hospital system aggressively expands.

    at some point, we will be primarily 'on call' and do some niggling amount of clinic and hospital rounds and procedures on the side.

    we have a hard time dealing with part time since the call is such a big part of the work everyone hates.

    we have a terrible age distribution with a ton of docs who are roughly same age and have same age kids.

    hard to envision a situation where we can allow part time/reduced call,  and it doesn't impact our ability to hire new physicians.

     

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  • NJDoc
    replied
    So just a follow up to our negotiations. It has been a bit frustrating, but we ultimately decided that at age 60 you can opt to be off call for a market based reduction. Of course, the market rate is highly subjective as we are a small group and have limited people to poll within our specialty. It comes out to a small number, around $36K per annum. My personal plan is to go to half call at age 55, when we agreed that is allowed, and then retire at 60. But, ya never know maybe working 2 days a week with no call from 60 to 62?? is something I would enjoy.

     

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  • High Income Parent
    replied
    We are trying to decide the same thing right now. We have a couple members wanting to take half call. The younger members threw out some numbers where we would take their call. The older members weren't willing to pay that yet so everybody is still taking full call.
    I imagine the older members will just retire completely before they pay us what we said we would take.

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  • TheGipper
    replied
    Be careful.  I do not think it is healthy for a group to allow older docs to sell too much of their call, even if there is a free market call/buy mechanism.

    Not easy to say out loud or to a colleague, but the driving force for retirement and getting in new blood is usually call burden.  Do you want to have more docs working into their 70s in your gorup.  Would this be healthy?  I'd submit, probably not.

    We only allow partners to sell a small percentage of their call, because we view it as a shared burden that is a responsibility for everyone in the group.

    An even more controversial issue is if whether dept chiefs and admins should do less call.........

     

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  • Benjamin
    replied




    It all depends on the culture of your practice and what feels is right. I recall about 16 years ago when the the senior partner offered that he would not take call anymore and offered to pay the other partners $ 6000  to take all his call for the year. This was a “partner’s meeting” and I was facetious ( i has seniority over the other partners) and  I stated would out bid him for $ 25,000 and that was the beginning of the end. I actually thought I was funny at the time. It cost me me a fortune in litigation.

    Our group blew up. I still took call up to 11 years later. I should not have if I had any sense.

    If I could play it again, I would have said that the senior partner had a point and that since I was not the senior partner if anybody wanted to take me my call I would pay double.

    Do not take call call unless the hospital makes it worth your while.

     

     

     

     
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    That is a crazy story.  Too bad it went to litigation.  It's frustrating when reasonable discussions about business issues, such as call for "sale," are taken personally.

     

    I hope things are better for you now.

     

    That type of situation is one I will keep in mind, as my practice situation could/will change in the future (employed now).

     

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  • Benjamin
    replied
     

    see below (cant delete)

     

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  • VagabondMD
    replied


    to the other posters, i’m curious how payments for the $2000 are made.  this is after tax money, i hand you 2000 cash my post tax $ to you?  or pretax adjustments are made, meaning net the covering doctor receives 1200?



     

    thanks

     
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    In our group, I instruct the bookkeeper to take $2000 of my pre-tax salary and transfer to the other member who is taking my call. Yes, the net transfer is in the $1100 range for us. At one time, there was cash changing hands, but this was frowned upon and eventually made against the rules. Obviously, $2000 pre-tax is not the same as $2000 post-tax, and all parties understand the difference.

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  • q-school
    replied
    in my first practice, we auctioned it off to determine market value.

    but the problem is if the second guy wants to stop taking call, the price for getting out of call is higher.  is that fair for the second guy?

    anyhow, to answer your question, it was determined to be $100,000 was the cost of getting out of call.  his salary would be cut and the calls would be spread out evenly among the remaining partners.  nobody wanted to take any extra call but the guy had built the practice and been there forever.  it was crazy, i think there were 20 partners or associates, so everyone only got 5k gross.  of course everyone only ended up taking a couple more calls.  he also had to agree to give up voting privileges and retire in two years.  he retained the right to work essentially locums for the group at the groups discretion.

     

    to the other posters, i'm curious how payments for the $2000 are made.  this is after tax money, i hand you 2000 cash my post tax $ to you?  or pretax adjustments are made, meaning net the covering doctor receives 1200?

     

    thanks

     

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  • pulmdoc
    replied
    In regards to a partner wanting to give up call, let the market decide. He can offer up whatever he thinks is fair to pay someone for his call, and either he will get takers or he won't.

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  • Dreamgiver
    replied
    I agree with you in theory. However, the risk of that might be that the head person becomes more of a dictator and the other partners loose interest and investment in what is going on and the group takes a dive. I guess it all depends on what kind of people you are dealing with.

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  • The White Coat Investor
    replied




    One model I have often seen in several groups in my specialty (anesthesiology) is to have a rotating “president” who takes care of the admin stuff. No stipend for this, every partner is expected to do it, and it is one year at the time (best to stick with a heavily enforced rotating basis).
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    The problem with that is you lose continuity and you get people in there who have no interest or are not good at it. It's fine for a position that doesn't matter as much (our department chair position rotates every 2-3 years) but for something like medical director and especially managing partner, a long term seems advantageous.

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  • Zaphod
    replied
    I wouldnt do it for 125k, and our place sounds even more complicated though you mention a practice manager. Its pretty impressive what a single move at that level can value add or subtract. If youre really involved in all the day to day thats a full time job.

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  • Dreamgiver
    replied
    One model I have often seen in several groups in my specialty (anesthesiology) is to have a rotating "president" who takes care of the admin stuff. No stipend for this, every partner is expected to do it, and it is one year at the time (best to stick with a heavily enforced rotating basis).

    Leave a comment:


  • The White Coat Investor
    replied
    Again, let the market decide. I'll bet our managing partner gets something like that, but our reimbursement scheme is ridiculously complicated. He's willing to do it for less than I am, that's for sure.

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