Mid-career changes - is it all about money?

[Fullhouse11]

My husband is a specialist in a multi-specialty clinic.  He has built his practice over the past 14 years and was compensated well for his efforts.  Ever year providing more revenue for the clinic (and himself) and better patient satisfaction than the last.  With 4 docs in his specialty department, he is producing the most revenue and has the most patients waiting to get in with him.  He has rarely gotten involved in the politics of the practice and attended few shareholder meetings.  This past year administration brought in a consultant to revamp compensation.  My husband's understanding of why this happened was that there were primary care departments that were not happy with their compensation and there was difficulty recruiting.  The new comp plan means that my husband will receive an approx 25% pay cut, working the same amount.  The way that he was told of his specific compensation proposal was in a letter, not in person.  It was voted on by all shareholders and passed.

He is hot.  Mostly because he worked really hard to build this practice, in growth and reputation, and now it is being fleeced by departments that do not want to take call and who are leading committees instead of seeing patients.  He immediately reached out to a group in another town that has wanted him for years.  He now has an offer at a single specialty group with 14 docs.  The compensation would be the same as in his current practice (new comp) the first two years and then increase to the level that he was previously.  Moving kids (teens) and schools is involved if we leave, but they are all on board with a new adventure and are not upset either way.  We are completely numb on what to do.  It's not all about the money, we follow all the advice of WCI with a paid off house, significant retirement (6x previous comp) and full college funds.  It's a bit of a pride thing and he has lost confidence in the leadership.  Two of the other docs in his specialty will be gone in a year due to retirement and the other doc has said that he would give it a year.  Because of our kids' ages, the best time to move would be now and not in 1 or 2 years.  If he sticks it out, he sticks it out for the rest of his career and that could mean a practice where it is hard to recruit new docs under this comp plan.  We never expected to leave this community and have developed roots here.

He loves his patients and his job is the center of who he is.  He is an oncologist and we have been to patient's weddings, held their babies and attended funerals.  There is no better job for him.  Leaving everyone would be really hard, but he plans to work another 15 years and he could build relationships where we would be moving.  We have family in the other town and none here.

What to do??  We feel greedy making it about the money when he has been compensated well in the past and this new plan does not change our lifestyle.

[Zaphod]

So, there have been shareholding meetings of which your husband is a shareholder, and he has not gone to these meetings? If you're not at the table, youre on the menu. If you dont take the time to speak up on your own behalf of course you look like you dont care as much as those that are present, so obviously you're more likely to be the one taking a hit. Thats dangerous, but its in the past so cant be changed except going forward of course.

Now for recourse. If he truly is the one making the most production and some are leaving then that puts him at quite the leverage advantage holding a lot of the cards. However, you have to be able to stick to whatever demands or consequences you're talking about, be it leaving or whatever. There is of course always issues with a new place as well, as these types of concerns are ubiquitous.

[Golfing Doc]

Sounds like a pretty tough decision with no easy answer.

It seems it's about more than just the money though and although it sounds like you can afford the pay decrease, who knows if they won't bring in another consultant in another few years and decrease it further, or have your husband take more call, etc. Trust in leadership (or being your own boss) is at least as important as pay, probably more. If moving isn't the end of the world for your kids, it sounds like it is the better option.

You shouldn't feel greedy. Would leaving for more money (even though that may not be the main reason) in any other profession be seen as greedy? No way.

[Fullhouse11]

The encouragement from this this forum is very helpful.   My husband did go to the meetings leading up to the consultant and vote, he wrote letters to the comp committee and executive board before the vote to say it was a mistake for his department to survive.  But prior to that he was not active at all, believing that the best people were leading the organization and seeing his value as a hard working doc.

He has since let some of the executive board know that he has another offer in hopes that they will come back with something.  A meeting with the CFO after the vote and discuss that he had another offer sounded like it went nowhere.  Colleagues have reached out asking him to please not go.  He is definitely a guy who excels at the doctor part.  I follow this group diligently because I am the money manager of the income/savings.   I sometimes worry that he thinks that less money would be a disappointment to me as well, even though I tell him that I like counting our savings and creating spreadsheets for our retirement, it's not everything!

This would be an interesting conversation to have one day:

http://www.healthline.com/health-news/policy-ten-administrators-for-every-one-us-doctor-092813#1

[CM]

It's hard to imagine that your husband will ever agree that his 25% pay cut is fair or justified. If that is the case, then you should leave.

Moving closer to family makes the decision even easier.

[Zaphod]

Fullhouse11 wrote:

The encouragement from this this forum is very helpful.   My husband did go to the meetings leading up to the consultant and vote, he wrote letters to the comp committee and executive board before the vote to say it was a mistake for his department to survive.  But prior to that he was not active at all, believing that the best people were leading the organization and seeing his value as a hard working doc.

He has since let some of the executive board know that he has another offer in hopes that they will come back with something.  A meeting with the CFO after the vote and discuss that he had another offer sounded like it went nowhere.  Colleagues have reached out asking him to please not go.  He is definitely a guy who excels at the doctor part.  I follow this group diligently because I am the money manager of the income/savings.   I sometimes worry that he thinks that less money would be a disappointment to me as well, even though I tell him that I like counting our savings and creating spreadsheets for our retirement, it’s not everything!

This would be an interesting conversation to have one day:

http://www.healthline.com/health-news/policy-ten-administrators-for-every-one-us-doctor-092813#1

Click to expand...

Well it sounds like he tried to do what he could leading up to it, and is actively fighting for himself in a reasonable way. I think you now sit back and see how it all shakes out and get your responses to the incoming changes ready and settled upon.

[Kamban]

Something similar happened to me 17 years ago. Multispeciality groups do not do well unless it is a huge group like Kaiser.

I found out that over 7 years I was working more and more and not seeing a pay raise. The primary docs wanted to go home at 5 PM and not take calls and have me and few specialists subsidize them for the privilege of them referring patients to me. The two owners of this group did not care and just wanted us to help the PCPs so that their practice kept running.

One fine day I said heck with it - told the owner I was leaving. He thought I was bluffing. I called his bluff. When he saw I had rented a place he knew I was serious. He and his wife begged me to stay and even promised to increase my pay. I knew that if he had not done all these years he will most likely not do in the future except this one. So I said adios.

To the OP, my advice is leave.These consultants and the other docs bank on your husband staying and taking the pay cut, and future cuts. The time to leave is now.

[Dr. Mom]

I'm sorry for this decision being forced on you.  I would go and not because of the money.  The way he has been treated is a good indication of how he will continue to be treated if you stay.  Oncology is hard.  To do it in a practice where they don't support your efforts and you have to fight for yourself can be very self-defeating and can end up affecting his practice and your home life. You are in a position where this decision is not about money but about the best environment for him to work in to flourish for his patients and his family.  I wish you all the best and hope you are happy whatever you decide.

[q-school]

Very sad to hear this.

Commoditization of medicine.  Everyone fighting for their own best interests.

I am encouraged to hear that there are still places where physicians are appreciated by their patients and their colleagues, and that there are still oncologists who love what they do as it obviously can be a tough field.

I echo the thoughts of those who advise you to move.  I'm on my third job and it's the best one yet, although the one where I make the least money and have the most responsibilities.  When we moved before we didn't have kids yet.  Now with kids in school, and my wife with a job that she loves, I am determined to make the best of it.  It's not perfect, but it fits our family needs right now.  I pray that I don't get into a similar situation.   However, I know the landscape of medicare is changing, and that will put pressure on reimbursements for all physicians.  

It sounds like you have a supportive family and you have done well for yourselves financially.  Lots of worse possible situations.  Don't stay in a place where you are not appreciated if you don't have family locally and have options.  Life is too short.

Good luck!

[kingsnake]

I'm a top biller in my multi specialty group of over 100 doctors. If they cut me by 25% I'd be gone. These types of groups and their admin are out for themselves. You need to watch out for number one (yourself). IF you like the location, friends, etc, staying may be reasonable.....but I'd be too pissed off to stay personally. You can't let them walk all over you. If you threaten to leave, and stay....well, you need to talk the talk then walk the walk.

[jfoxcpacfp]

Of course, it's about the money. Your husband's choice is to bring home a fair salary to support his family and your goals or to give up part of what he earns so that others can have more for their families and goals. What is his priority - the good of "the people" or the best for his family?

[Dreamgiver]

Based on your story, I'd leave. Zero tolerance for this treatment and lack or respect and a sign of things to come.

[The White Coat Investor]

Your careful financial planning has put you in a position where this is simply a chance to decide what he wants to do, rather than a true financial catastrophe. if he wants to stay, he can afford to do so. If he wants to go, he has FU money even if the other job wasn't all that good.

Congratulations!

[Hatton]

Autonomy and respect are important.  It sounds like your husband has psychologically bonded with many of his patients.  That might make it harder to leave.  He might find that some of them will follow him to the city if it is not more than an hour away.  Sounds like you should move.  It will be hard to do but self-respect and appreciation are important not just money.

[fasteddie911]

At first read, I would agree with most in that he should leave and that he certainly should look out for himself.  However, it seems like the big issue isn't money, but more so the feeling of disrespect, which is understandable.  For me, I'd find out the details and look at the big picture.  I'd want to know if the paycut is fairly distributed, if it's affecting everyone else in an equitable manner and if the overall system in general is/was fair.  I'd also figure out whether the paycut, and it's end goal (of helping out primary care) is better for the group and me in the long run. Disregarding the impersonal nature of finding this out via letter (maybe he missed the meetings where they discussed this, leaving him emotionally blindsided by the letter?), I could think of a scenario where I could come to terms with the paycut and stay with the group.

As bad as the feeling is, the grass may not be greener elsewhere.