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Employer contract disputes with hospital
Just looking for some advice in the best way to handle this from a negotiating perspective to get the best outcome.
Hospital system wants us to cover IR call services some third tier hospital they acquired an hour away from our other hospital coverage. They dont want to subsidize us or pay extra for this added service. Our employment contract explicitly states that we cover call services for only the hospitals we normally staff during the day. Their chances of getting a FTE or locums coverage seem slim to none or extremely cost prohibitive in this job market.
Anyone in a similar situation and what would be the best way to handle this so we get compensated fairly for the added call coverage? My partners and I could engage a employment contract attorney and go nuclear but that seems like a last resort. -
31 Replies
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Tell them you can’t unless you hire an additional IR doc. If they can acquire a hospital they can pay you all 750k more a year for IR coverage.
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Just to clarify:
– You are W2 employees of the hospital ?
or
– You are a corporation that contracts with the hospital to provide coverage ?-
Yeah W2 employed positions. It would be way easier if it was the later case.
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Quote from Gotham
Yeah W2 employed positions. It would be way easier if it was the later case.
Does your employment contract specify a work location or does it say something like ‘a location directed by employer’.
It is the nature of an employee relationship to perform work at a job site determined by the employer according to his business needs. Unless you have something that specified where you work in your agreement you go where they tell you to go.
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You’re employees. Hospitals systems taking on new facilities is a part of normal business practice. And yes, you’re going to end up having to do *something* to provide services to this St. Elsewhere hospital in BFE.
IR coverage of a hospital 60 minutes away is indeed a big ask. That is onerous. It deserves support from the administration.
In our group, due to short staffing, we don’t have nearly enough IR bodies to successfully cover night call at every hospital in our system.
Instead we have put in place transfer arrangements from the smaller hospitals to the main medical center in case of true emergencies.
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That said, imho, there is very little that you have to gain by going the legal route unless all other avenues have been exhausted. Negotiate firmly with data.
Is there *some* level of call compensation that would get your current IRs to be willing to pick of this coverage? $500 / night plus $300/hr per call including drive time or something like that? If so, propose it.
If not, just ask the hospital to pay for the locums coverage and tell them you will start soon as that new staff is credentialled, etc.
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Yeah we all agree that legal hardball has little upside.
Regarding your transfer agreements, do you guys get a subsidy from the sending facility or added comp from the health system. Just trying to get gauge of what is market and fair.-
Good advice above.
The easiest thing for admin is have you go there; I bet they would settle for a transfer arrangement. That is what most big system do. In fact most of the ir overall is best to go to one well staffed ir service.
Come up with a plan as above and sell it to them.
Also, get numbers as to how many overnight cases there are; although that wouldnt change my solution. Transfer.
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Hospitals are all part of the same system.
I have no idea what (if any) back end monetary arrangements exist.
I know that a lot of the docs at the BFE hospitals don’t like it b/c they lose patients and control … but welcome to the new world.-
We faced a similar situation and our groups position was that we never wanted to be the rate-limiting step. In our case, the hospital was only 7 miles away, so certainly much more doable than the OPs.
Instead of telling them we wouldn’t do it, we told them we’d be glad to staff it with an entire call team also on call. Then we simply reminded them that they are already paying for an entire IR call team of techs/nurses.etc to be on call at the main hospital 7 miles away but if they want to pay for another call team, we would have an IR doc available.
Needless to say, they never required call at the second hospital once they realized that the only call wasn’t the wear and tear on an IR doc but that it also hit their bottom line.-
I love how we have a severe rads shortage and hospitals admins are still walking all over rads like it was 2015. This is a failure of leadership and the inability of rads to just say no. Everyone is so scared and clutching their pearls when they should be standing up for themselves, no questions asked.
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Kind of wonder if hospital administrators look at these forums and are like- yep confirmed what I thought, radiologists will just fall into line and fold like a house of cards. Just another example of radiologists shaking in their boots because too afraid to lose the status quo. Imagine hospitals having essentially zero leverage yet still doing whatever they want.
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Give them an inch and theyll perhaps take a mile. Maybe one inch at a time but before you know it a chasm has developed and you realize youve slowly let administration crush you under their boot too many times
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Quote from sartoriusBIG
Kind of wonder if hospital administrators look at these forums and are like- yep confirmed what I thought, radiologists will just fall into line and fold like a house of cards. Just another example of radiologists shaking in their boots because too afraid to lose the status quo. Imagine hospitals having essentially zero leverage yet still doing whatever they want.
This thread illustrates why it is important to practice radiology as part of a well run diversified private practice.
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Quote from sartoriusBIG
I love how we have a severe rads shortage and hospitals admins are still walking all over rads like it was 2015. This is a failure of leadership and the inability of rads to just say no. Everyone is so scared and clutching their pearls when they should be standing up for themselves, no questions asked.
This.
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Agree with Biggie. First off, how is any hospital system comfortable with its current rad staffing, especially IR? They should be scared of losing rads and be hesitant to force new obligations that might lead people to leave.
My own experience has been that working in a place where the rads are complacent and the admin thinks they can do whatever they want is not sustainable. Ironically, I think the best opportunities now are with health systems that have learned their lesson and dealt with rad shortages. They are more likely to create a compensation structure and support staff designed for radiology retention.
Who cares about threats and lawyers? Just bend the ear of admin and say they are taking a huge gamble which could lead to losing current staff. If they follow through and screw it up have the courage to seek out a better gig.
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Please allow me to use a wife beater or kidnapper for ransom as an example of why you shouldnt just give in to admin.
What do you think a disgusting wife beater does if a wife tolerated being beaten. Never tries to leave, never calls police, never tries anything. Do you think they will stop beating their wife on their own? Do you think they will stop if asked nicely? The answer is no. A wife beater is scum and will never learne their lesson until they are punished. Even then they may not but you still have to punish them.
What do you think a kidnapper for ransom does if you always pay the ransom and never involve the cops etc? They will continue to kidnap for ransom. They too have to be punished. No amount of money will make them stop as long as they continue to get away with it.
Similarly, most hospital admin just arent going to learn their lesson unless you make it clear that taking advantage of radiology is not the answer to their problem and even more so in the current market. Sure they may go nuclear and cause the radiology dept to implode if they are stupid enough. But they will quickly have a crisis on their hands and have to backtrack. Sure the above analogies are extreme but the mindset is of a similar vein. Bad behavior always almost always continues if it goes unpunished or unchallenged.
So stand up for yourselves. We are your support group to seek justice and leave your wife beater husband or at the very least to tell him that you wont touch me again or I am leaving. Admin will do whatever they can get away with. They could care less about your quality of life if they can do something to pad their bottom line. Human nature at its finest.
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We can do it if is a great technique.
In this case the if is quite large
1) it is a real IR emergent case which we will provide a list for (no bs lumbar puncture, para/thoras, etc).
2) full IR team trained by us is in place at the 3rd tier place
3) you hire 2 more IRswe will now have to have a backup IR to our current IR on call as the the hour away means we will not be able to cover what we are currently covering safely. That hour could mean death and lawsuit.in writing/legal paperwork.
4) the new place has adequate procedure room.
5) appropriate anesthesia/surgical coverage is there in case of complication. -
Just tell them to fark off. If you say no will they fire you? Doubtful
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Quote from sartoriusBIG
Just tell them to fark off. If you say no will they fire you? Doubtful
I get that such a sentiment *feels* good …
But there’s not a lot of upside to hostile relations with admin, whether you’re employees or a contracted PP.
You will have better standing and more leverage if you are perceived as working in good faith to help solve problems.
Yes, when you’re an employee the relationship is fundamentally one of the management v labor. But a big ask like this is an opportunity for the department.
And this is where good leadership inside the department pays off. You need a group leader/s with the soft skills to build positive relationships with administrators over, who are diplomats and negotiators.
Revisit the compensation structure for more $/RVU, ask the hospital to pay for internal moonlighting, get more FTEs hired, get funding for ancillary staff, etc.
“F*ck off!” takes all of that off the table.
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You dont think admin tells rads to fark off? Of course Im speaking with hyperbole. You dont actually tell them to fark off. But you basically do say it without saying it, in a polite way of course. Ill give you an example of a clinician friend. Their hospital system basically told them they have to meet certain metrics or their comp goes down 10%. These metrics are very hard to meet and depend on patient compliance which as you may know are often out of the clinicians control. It was basically just told to the clinicians- this is how it is. What Im advocating for is the same. You tell admin this is how it is. In a polite way no doubt but all the same it isnt a negotiation. You tell them how it is and thats that
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I have been in situations where negotiations with admin werent going anywhere. Our points were very valid. For one situation, we stopped the service at a moments notice as it just had to be done for our group to be functional.
That would have been a good reason to kick our group out. Didnt happen. They ended up doing what our group suggested for a long time. Cost them a small amount of money, but the revenue still generated blew that cost out of the water. Turns out we were right. This may have ended up getting a VP fired.
Putting their feet to the fire to wake them up has to be done from time to time. Admin would love to disregard your requests or prolong the issue as long as possible. Gotta wake them up!
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I’ll bet that 95% of what they consider “IR” is routine stuff like para, thora, LP, central line placement.
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This is the problem with IR. A luxury once obtained becomes a necessity (ie. Once hospitals get IR, they think that they CAN NOT live without it).
How about just transfer the patients from this new, remote facility who need IR care 1 hour to your hospital for IR procedures; instead of completely upending/altering your IR docs and their IR call rotation to benefit the newly acquired hospital?
The other thing you can say is ‘NO,’ as was stated above, and see what happens. I mean, you could say ‘F off’ too (like Big says), but it might not look too good – so what?. In this market, you can get away with it.
You ALWAYS need to have a backup job/plan too anyway, so now would be a good time to hedge your bets for another option as well.
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All good advice above. Thanks!
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Btw there is no ‘group’. If admin wants to push this, there is little risk to them. They just tell one of the IRs when he has to cover St Longwaytodrive. If he refuses, they take action against him individually according with with his contract. Letter in the personnel file followed by dismissal for cause or suspension of medical staff privileges. It’s radiology, once you execute one, the rest falls in line.
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Sometimes I wonder if the advice given here is from experience/what works or from building anger at the medical-industrial complex.
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Quote from ChuckI
Sometimes I wonder if the advice given here is from experience/what works or from building anger at the medical-industrial complex.
My statement on ‘only having to execute one’ is based local experience (outside of rads). The hospital can always make do with one less of anything. -
Quote from xraygiggles
We can do it if is a great technique.
In this case the if is quite large
1) it is a real IR emergent case which we will provide a list for (no bs lumbar puncture, para/thoras, etc).
2) full IR team trained by us is in place at the 3rd tier place
3) you hire 2 more IRswe will now have to have a backup IR to our current IR on call as the the hour away means we will not be able to cover what we are currently covering safely. That hour could mean death and lawsuit.in writing/legal paperwork.
4) the new place has adequate procedure room.
5) appropriate anesthesia/surgical coverage is there in case of complication.
I’ve seen this work. It speaks the language of the admin reptiles. -
Feel free to send this article to your admins in case they want to know which way the market is heading –
[link=https://irq.sirweb.org/clinical-practice/9-5-ir/]9-5 IR[/link]
Can a revised workflow model prevent burnout, improve efficiency, and get IRs home by 5?
How Stanfords new workflow structure improves efficiency and prevents delays
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Doing IR at a new small hospital without established IR sounds like a recipe for prolonged procedures, unskilled techs and more complication risks. If their PA or docs can’t do the procedures there, then the patient should be transferred. How is this even a debate?
It’s not like all you need is tool kit like neurologists to do these IR procedures. Just show them what you actually do and need for a competent IR service.
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Yes the contract does specify that about location but only during day shifts. Our call coverage agreement is separate and we have named facilities that we cover. I inserted a clause to protect us from situations like this so the health system couldn’t just screw us over with increasing call coverage for multiple facilities.
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