-
Hospital stipend
Does your hospital provide stipends to your group? And for what services?
-
63 Replies
-
Any group not getting a stipend for IR and call should immediately give notice on their contract. Should also get something for admin duties related to the hospital.
-
I have taken part in 3 hospitals with call stipends. Per night rates were 600, 800, and 1000. The 600/night hospital was a very very quiet place. The 1000 place was busy and included stroke call.
-
Agree. They need to step up. Recently learned a small community hospital was paying general surgeons 10K/weekend just to take call. They got to bill separately for procedures when they came in. We need to be taken seriously.
-
There really wasn’t a good opportunity for many years. Things have changed quite rapidly. Better get it done before they change back, although I am bullish on how long that will take.
-
Hospitals pay other specialties nicely for coverage.
-
Yes, because they control the patients. Now we have control because of the market for radiologists. Temporary (hopefully quite long) but powerful at the moment.
-
Our hospital system paid for radiology coverage for the last 15-20 years.
-
Our hospital system paid for radiology coverage for the last 15-20 years.
Much probably depends on the local market and quality of service provided by the group. In house presence, including an interventional and stroke service makes it fairly easy to get a stipend.-
Stipends are a reasonable expectation for many practices.
It’s all in the details, how you negotiate.
It is rarely enough, they will not pay market value.
If you can get them to pay for a nighthawk service, that would at least be a binary decision.
Anyway, you have to present you proposal in a professional and unemotional manner, with lots of data. Probably not the strength of many radiologists leaders. You need to provide the solution; and they need to finance it. Just asking for a blind subsidy is not how it works.-
Yes, if it turns out that all that is necessary/utilized/de facto medicine is radiology, then we should obviously be compensated to a greater degree, for the greater demand.
-
Quote from boomer
Stipends are a reasonable expectation for many practices.
It’s all in the details, how you negotiate.
It is rarely enough, they will not pay market value.
[b]If you can get them to pay for a nighthawk service, that would at least be a binary decision. [/b]
Anyway, you have to present you proposal in a professional and unemotional manner, with lots of data. Probably not the strength of many radiologists leaders. You need to provide the solution; and they need to finance it. Just asking for a blind subsidy is not how it works.
Tremendous leverage for whatever groups still cover overnights in-house.-
“Tremendous leverage for whatever groups still cover overnights in-house.”
Wow jd4540…only place where I see this are academic institutions with poor, slave labor radiology residents and fellows covering deep nights. Even the bigger groups in metropolitan areas don’t cover onsite. Maybe until 10-11 PM at the most, but later than that — no way.
-
Quote from PirateRad
“Tremendous leverage for whatever groups still cover overnights in-house.”
Wow jd4540…only place where I see this are academic institutions with poor, slave labor radiology residents and fellows covering deep nights. Even the bigger groups in metropolitan areas don’t cover onsite. Maybe until 10-11 PM at the most, but later than that — no way.
I hear you. I’m in a small/mid-sized non-private equity PP mid-west. We still cover our overnights. -
Large mid atlantic PP. We still cover 1200 bed hospital in house as well as 2 other smaller ones via tele. No stipend. No way the hospital would give it to us now if we asked. they’ve picked who gets a stipend, even excluding some surgical specialties.
-
holy smokes — 1200 bed behemoth. I wonder if as a group you really put your cards on the table the next time the contract is up for renewal, what would be offered or not offered or what would be a “deal breaker.” Who else realistically will the hospital find to cover their 1200 bed hospital (plus all their ancillary clinics/imaging centers/satellite mini-ERs, etc.) — especially these days.
-
hah great point. problem lies with group leadership. their main concern is to minimize unpleasant interactions with hospital admin and maybe hope for an admin job when they leave clinical work. plus there’s always the threat of “you can be replaced easily” which scares enough people who don’t want to consider looking for new work or leaving a hospital based practice, especially neuro and IR folks.
regardless, i don’t think it’s a battle worth fighting since it won’t be a significant financial amount. at least not until another group of hospital admins cycles in. -
Is the contract good enough that you can pay yourselves market rates? No reason to rock the boat if it is. The only reason to demand a stipend would be if you are losing docs and cant recruit.
-
Quote from Thread Enhancer
Is the contract good enough that you can pay yourselves market rates? No reason to rock the boat if it is. The only reason to demand a stipend would be if you are losing docs and cant recruit.
That’s sound logic. I suppose a counter point would be that hospitals/HC systems have no trouble using a bad market against physicians/rads to minimize costs, so why not use leverage to maximize income. Of course there’s inherent risk in losing a contract, however there’s also the threat of losing a handful of rads who are getting better offers, which could cause group implosion. It’s a tightrope. -
I think people over-estimate the amount of stipends that is available. So great, you got a couple 100k a year to defray the cost of nighthawk or to pay call differentials for your IRs, in the overall picture of a multi FTE group covering not only the hospital practice but also their outpatient business they are a rounding error.
-
The “free market” is deciding the going rates for rads is what the locums are getting (or what any “internal moonlighting” rate is)…why does it some majority of radiologist salaries are much less than this?? I would argue, internal moonlighting and locums are the only true “free markets”.
What has happened with nursing and nursing locums is finally rolling over into radiology. Nurses can give 14 day notice and jump ship to make 2x as travel nurse. Rads are locked down longer, this will play out longer than it has for nurses…hopefully in the end will mean much higher salaries all around. Inertia (and non completes) are unfortunately a powerful force for keeping salaries low for docs. -
Quote from radstudent12345
The “free market” is deciding the going rates for rads is what the locums are getting (or what any “internal moonlighting” rate is)…why does it some majority of radiologist salaries are much less than this?? I would argue, internal moonlighting and locums are the only true “free markets”.
What has happened with nursing and nursing locums is finally rolling over into radiology. Nurses can give 14 day notice and jump ship to make 2x as travel nurse. Rads are locked down longer, this will play out longer than it has for nurses…hopefully in the end will mean much higher salaries all around. Inertia (and non completes) are unfortunately a powerful force for keeping salaries low for docs.
Not too mention techs…they have been making out like bandits, often with subpar work -
Quote from fw
I think people over-estimate the amount of stipends that is available. So great, you got a couple 100k a year to defray the cost of nighthawk or to pay call differentials for your IRs, in the overall picture of a multi FTE group covering not only the hospital practice but also their outpatient business they are a rounding error.
You know more about this than I do. With this said, its my understanding that hospitals/HC systems routinely shuffle money around as needed (eg.I’ve heard that Hospitalists do not generate enough wRVU to cover their compensation)
Why can’t a PP group approach a hospital and say we are at X wRVU and want to be at X+20% wRVU?
-
Quote from jd4540
Quote from fw
I think people over-estimate the amount of stipends that is available. So great, you got a couple 100k a year to defray the cost of nighthawk or to pay call differentials for your IRs, in the overall picture of a multi FTE group covering not only the hospital practice but also their outpatient business they are a rounding error.
You know more about this than I do. With this said, its my understanding that hospitals/HC systems routinely shuffle money around as needed (eg.I’ve heard that Hospitalists do not generate enough wRVU to cover their compensation)
Why can’t a PP group approach a hospital and say we are at X wRVU and want to be at X+20% wRVU?
Thats the gist of it. However, it cant be want. You have to sell them in the idea that you cant recruit and there is no other option for them. Its a lot easier to convince admin of this these days but it rarely happens unless the group is willing to walk.In fws world we may be talking about rounding errors. In many places its up to 20% and the difference between keeping radiology functioning and not.
-
Quote from jd4540
You know more about this than I do. With this said, its my understanding that hospitals/HC systems routinely shuffle money around as needed (eg.I’ve heard that Hospitalists do not generate enough wRVU to cover their compensation)
Why can’t a PP group approach a hospital and say we are at X wRVU and want to be at X+20% wRVU?
And I WANT a pony !
I would never want to approach the hospital under the angle of what I want income wise. For them, we are already overpaid do-nothings.
The areas where I have seen stipends are:
– IR after-hours coverage. The argument being that that drainage or dialysis catheter after hours pays X but the rad costs us Y. So if you want 24/7 coverage for this service, you have to make some compromise.
– Nighthawk coverage. This is the after hours ER volume. We collect X due to poor payor mix but we pay Y to our telerad provider.
– On-site coverage for hospital owned outpatient facilites, for the group to put an an actual person on site. -
Quote from fw
Quote from jd4540
You know more about this than I do. With this said, its my understanding that hospitals/HC systems routinely shuffle money around as needed (eg.I’ve heard that Hospitalists do not generate enough wRVU to cover their compensation)
Why can’t a PP group approach a hospital and say we are at X wRVU and want to be at X+20% wRVU?
And I WANT a pony !
I would never want to approach the hospital under the angle of what I want income wise. For them, we are already overpaid do-nothings.
The areas where I have seen stipends are:
– IR after-hours coverage. The argument being that that drainage or dialysis catheter after hours pays X but the rad costs us Y. So if you want 24/7 coverage for this service, you have to make some compromise.
– Nighthawk coverage. This is the after hours ER volume. We collect X due to poor payor mix but we pay Y to our telerad provider.
– On-site coverage for hospital owned outpatient facilites, for the group to put an an actual person on site.
Point taken…at some point being an employed rad (even by PE) may be more lucrative than being a PP rad requesting subsidies. Look at anesthesia, always subsidized and now in demand. Though recent events may have changed things, recently saw an Envision ad for a North NJ hospital for anesthesiologist at 600K with 9 weeks vacation. Clearly don’t know the details but those #s at face value seem pretty good given close proximity to NYC -
jd the things fw mentions just might add up to X+20% in some practices. Always better to stay independent if one can negotiate in a manner Boomer describes.
-
Quote from fw
Quote from jd4540
You know more about this than I do. With this said, its my understanding that hospitals/HC systems routinely shuffle money around as needed (eg.I’ve heard that Hospitalists do not generate enough wRVU to cover their compensation)
Why can’t a PP group approach a hospital and say we are at X wRVU and want to be at X+20% wRVU?
And I WANT a pony !
I would never want to approach the hospital under the angle of what I want income wise. For them, we are already overpaid do-nothings.
The areas where I have seen stipends are:
– IR after-hours coverage. The argument being that that drainage or dialysis catheter after hours pays X but the rad costs us Y. So if you want 24/7 coverage for this service, you have to make some compromise.
– Nighthawk coverage. This is the after hours ER volume. We collect X due to poor payor mix but we pay Y to our telerad provider.
– On-site coverage for hospital owned outpatient facilites, for the group to put an an actual person on site.
Yeah. Framing matters.
The argument to admin isn’t “We want more money!”
The argument has to be framed in “getting adequate resources to care for patients, satisfy the referrers, and serve the system mission.” Framing around recruitment and retention radiologists is key. And, as fw noted, around the services the group provides that are poorly compensated/non-compensated but meet critical needs of the hospital.
It’s OK for you to *think* you want to get to X +20% comp … but that’s not the way you argue it if you want to be successful. -
We were recently able to negotiate a fairly significant stipend for IR coverage. Our approach was essentially, look we just want to break even on this coverage, we arent even trying to make money on it. Daily procedure volume was not enough to support 1 FTE, was fairly easy to show that. Since we were already losing money on the service it was easy for us to say take it or leave it.
-
Quote from tigershark06
We were recently able to negotiate a fairly significant stipend for IR coverage. Our approach was essentially, look we just want to break even on this coverage, we arent even trying to make money on it. Daily procedure volume was not enough to support 1 FTE, was fairly easy to show that. Since we were already losing money on the service it was easy for us to say take it or leave it.
Curious, does this stipend exclusively go to the IR rads taking call or does it get dispersed evenly?
-
Quote from jd4540
Quote from tigershark06
We were recently able to negotiate a fairly significant stipend for IR coverage. Our approach was essentially, look we just want to break even on this coverage, we arent even trying to make money on it. Daily procedure volume was not enough to support 1 FTE, was fairly easy to show that. Since we were already losing money on the service it was easy for us to say take it or leave it.
Curious, does this stipend exclusively go to the IR rads taking call or does it get dispersed evenly?
I would be very surprised if it was direct payment to IRs …. that’s the kind of the thing that becomes poison within a group. Then *everyone* wants individual support directly into their paychecks.
-
Quote from dergon
Quote from jd4540
Quote from tigershark06
We were recently able to negotiate a fairly significant stipend for IR coverage. Our approach was essentially, look we just want to break even on this coverage, we arent even trying to make money on it. Daily procedure volume was not enough to support 1 FTE, was fairly easy to show that. Since we were already losing money on the service it was easy for us to say take it or leave it.
Curious, does this stipend exclusively go to the IR rads taking call or does it get dispersed evenly?
I would be very surprised if it was direct payment to IRs …. that’s the kind of the thing that becomes poison within a group. Then *everyone* wants individual support directly into their paychecks.
I imagine the group was already subsidizing the IR call from the DR revenue which is its own kind of poison but the right thing to do for the pain and suffering. Appropriate that the hospital cover the cost of the stipend. So yes, it should go to the group, not the individual directly. -
Quote from tigershark06
We were recently able to negotiate a fairly significant stipend for IR coverage. Our approach was essentially, look we just want to break even on this coverage, we arent even trying to make money on it. Daily procedure volume was not enough to support 1 FTE, was fairly easy to show that. Since we were already losing money on the service it was easy for us to say take it or leave it.
Have you seen any (additional) unreasonable requests from admin since you started receiving the stipend ?
4:45pm requests for STAT lung biopsies with a indication of ‘discharge pending’ or ‘Dr X requests’ ? -
Quote from tigershark06
We were recently able to negotiate a fairly significant stipend for IR coverage. Our approach was essentially, look we just want to break even on this coverage, we arent even trying to make money on it. Daily procedure volume was not enough to support 1 FTE, was fairly easy to show that. Since we were already losing money on the service it was easy for us to say take it or leave it.
I agree, this needs to be more common place. If anything, a stipend to hire PAs who are beat down with 17 thora/para each day because no one if the hospital seems to remember how to do them. When the hospitalists complain that you aren’t getting to them timely, use this as an opportunity to request more stipend from admins. We see the big employed surgeons walking around with teams of PAs, paid for by the hospital. -
Sounds exactly like my gutless group.
-
Ditto to gutless group. Too many rads in my group close to retirement who dont care much about the future and too many others afraid of confrontation to demand the changes needed to stay competitive with other jobs.
-
I would float the idea of call pay for IR/NIR. Educate the admin about the nationwide trends. Its very common to pay for stroke call and its changing for IR call too. If you don’t ask then you never did.
-
-
-
-
-
Quote from vonbraun
Hospitals pay other specialties nicely for coverage.
Only if they have to and if there is a regulatory requirement to have a certain service on call. You need a NS and an Ortho to be Trauma II, you need a neurologist for primary stroke etc. If there is no such requirement they just get 24h consult coverage out of specialists who have to maintain privileges for some reason.
-
-
-
-
-
-
In a big institution with lots of layers and an employee model the $$ get fungible real fast.
The money might be coming from base salary, MSAs, clinical productivity bonuses, quality and value bonuses, call support, internal moonlighting supplemental pay …
… I tell the rads that it’s an administrative game of 3-card monty and you just have to keep your eye on the final important stat … $/RVU
A few years ago I want rad total comp (not including benefits) to come in at around $50/RVU (because that’s about where our large local competitor sits) …
Stipend or base pay or whatever … just keep the $/RVU as high as possible.
-
Quote from dergon
In a big institution with lots of layers and an employee model the $$ get fungible real fast.
The money might be coming from base salary, MSAs, clinical productivity bonuses, quality and value bonuses, call support, internal moonlighting supplemental pay …
… I tell the rads that it’s an administrative game of 3-card monty and you just have to keep your eye on the final important stat … $/RVU
A few years ago I want rad total comp (not including benefits) to come in at around $50/RVU (because that’s about where our large local competitor sits) …
Stipend or base pay or whatever … just keep the $/RVU as high as possible.
Who subs ped and IR and nuc salaries?
They will lose money paying 50 per wrvu unless they can get 180% of medicare from insurers- not likely in a big city-
Its fungible you cant put a finger on a specific who
Closest you can probably get is what not who and that what is the technical revenue
-
Quote from dergon
Its fungible you cant put a finger on a specific who
Closest you can probably get is what not who and that what is the technical revenue
Of course, you know dipping into technical is walking on thin ice. A radiologist doesn’t want to make powerful enemies, group may get thrown to the dogs, i.e. RP.
-
Quote from drad123
Quote from dergon
Its fungible you cant put a finger on a specific who
Closest you can probably get is what not who and that what is the technical revenue
Of course, you know dipping into technical is walking on thin ice. A radiologist doesn’t want to make powerful enemies, group may get thrown to the dogs, i.e. RP.
Yeah, fortunately that’s not really a threat for us. We’re a huge and complex system at an academic center with massive grants funding, research labs, big residency programs and radiologists throughout the institutional leadership.
Also, it’s been pretty well appreciated in most university hospital departments that you won’t have a fully staffed quality radiology department if comp is dependent solely on pro fee. There’s just too much intrinsic inefficiency in academics and too sh*tty of a payor mix.
I’ve personally never seen the down side to pushing the administration as hard as we can on compensation until we somehow become the best paid rads in town. (We’re not … we’re not even the best paid academics)
-
Quote from dergon
I’ve personally never seen the down side to pushing the administration as hard as we can on compensation until we somehow become the best paid rads in town. (We’re not … we’re not even the best paid academics)
How do you know who is the best paid in academics? Not exactly public knowledge. I don’t know who is the best paid in pp.
-
drad there you go again with not understanding how Medicare pays. Flat Medicare allows paying $50 per wRVU.
-
Quote from drad123
Quote from dergon
I’ve personally never seen the down side to pushing the administration as hard as we can on compensation until we somehow become the best paid rads in town. (We’re not … we’re not even the best paid academics)
How do you know who is the best paid in academics? Not exactly public knowledge. I don’t know who is the best paid in pp.
Unless you work for a state institution where salaries are public record.-
It’s a small town.
-
The disclosed salaries at many public institutions are commonly restricted to base pay. Many do not include the clinical bonus which can be substantial. So its not as transparent as you may think.
-
Quote from boomer
The disclosed salaries at many public institutions are commonly restricted to base pay. Many do not include the clinical bonus which can be substantial. So its not as transparent as you may think.
Plus no public records of wRVU so hard to figure out $/wRVU without actually knowing someone on the inside or interviewing -
Quote from jd4540
Quote from boomer
The disclosed salaries at many public institutions are commonly restricted to base pay. Many do not include the clinical bonus which can be substantial. So its not as transparent as you may think.
Plus no public records of wRVU so hard to figure out $/wRVU without actually knowing someone on the inside or interviewing
When we went into our initial discussions with admin about a new comp plan in 2019 I activated my network. I asked pretty much everyone I knew to ask anyone they knew at the other major Cleveland area groups and asked them to press as hard as they could to get detailed numbers on compensation, productivity expectations, etc
I was able to piece together a half-way decent graphic that showed our $/RVU at Case/UH compared to that at MetroHealth, CCF, Summa, and the VA… and we were the lowest …by a fair bit.
The hospital did its own work (well, hired a consultant) and in a year came back with more money. It was about 30% of what I thought it should be, but it was a start.
We’re on better terms now, but I don’t see any reason not to keep asking for more to get to fair local market rates. -
Quote from dergon
Quote from jd4540
Quote from boomer
The disclosed salaries at many public institutions are commonly restricted to base pay. Many do not include the clinical bonus which can be substantial. So its not as transparent as you may think.
Plus no public records of wRVU so hard to figure out $/wRVU without actually knowing someone on the inside or interviewing
When we went into our initial discussions with admin about a new comp plan in 2019 I activated my network. I asked pretty much everyone I knew to ask anyone they knew at the other major Cleveland area groups and asked them to press as hard as they could to get detailed numbers on compensation, productivity expectations, etc
I was able to piece together a half-way decent graphic that showed our $/RVU at Case/UH compared to that at MetroHealth, CCF, Summa, and the VA… and we were the lowest …by a fair bit.
The hospital did its own work (well, hired a consultant) and in a year came back with more money. It was about 30% of what I thought it should be, but it was a start.
We’re on better terms now, but I don’t see any reason not to keep asking for more to get to fair local market rates.
Why not just take a job at CCF if they pay more? Seems easier to me.
-
I’ve got a life and career here. I’m section chief, my Chair is a friend of colleague of 25 years who let me go part time while remaining in leadership. I’ve personally chosen every person in my section and we have a great professional relationship. I know all the techs and can chat and laugh. I have a nice big office window natural sunlight on the 5th floor.
I don’t see much logic in making a lateral move (actually a downward move since I wouldn’t be section head) for an 8-10% salary bump when I can earn that and more back easily with internal moonlighting.
I think my best play is to remain here and continue to advocate for better comp internally.
-
Quote from dergon
I’ve got a life and career here. I’m section chief, my Chair let me go part time while remaining in leadership. I’ve personally chosen every person in my section and we have a great professional relationship.
I don’t see much logic in making a lateral move (actually a downward move since I wouldn’t be section head) for an 8-10% salary bump when I can earn that and more back easily with internal moonlighting.
I see, but what about when the salary was 30% lower. You wouldn’t have to move to another town. Why didn’t you leave then?
What does CCF pay per wrvu. MGMA? -
I haven’t checked their exact package in couple of years now. But I’d bet it’s about $500-550k for 11-12k RVUs.
It’s an employee salaried gig … it’s not structured as pay per RVU… none of the local big groups are. -
As for what’s the salary differential that makes a person jump ship or not?
It seems to be about 20% for established people … maybe 10-15% for those starting off (all other things equal)
-
Quote from dergon
I haven’t checked their exact package in couple of years now. But I’d bet it’s about $500-550k for 11-12k RVUs.
It’s an employee salaried gig … it’s not structured as pay per RVU… none of the local big groups are.
That’s quite a range 41-50 wrvu. Sounds like where you are at now or below.
Cleveland seems to be one of the better large cities to work in. -Perks of being in a town dominated by not for profits.
-
“”Cleveland seems to be one of the better large cities to work in”????
You are kidding? You have to walk around there with a bullet proof vest.
Carjackings are as common as petty theft was in the 90’s
Look at below article for relatively recent statistics.
Cleveland, OH Reported One of the Highest Murder Rates in the US
-
-
-
-
-
-
-
Negotiated a stipend many years ago with the assistance of an experienced consultant and a health care attorney. Used connections throughout the medical staff to smooth things over during tense times. It was drawn out, and we worked without contract for a while; but was successful. Without outside help, we couldn’t have pulled it off.
Had another time where we presented great data justifying subsidy from technical for IR support without success, despite a clear benefit to the system. They clearly made an irrational decision, and I don’t know where it went wrong. C’est la vie.
Bottom line, don’t throw your “neuroradiologist president” into the fray with some RVU numbers and try to wing it, or have a placeholder leader read demands developed at an executive board meeting. You need data and professional support, which is of course presented to the radiologists, as you develop a position. Many colleagues will have overly aggressive and entitled positions which need to be tempered. You want a good fair deal, don’t shoot the moon. Ultimately it’s a dance. Your negotiators need to understand that, have appropriate professional support, and have enough gravitas and likability amongst the hospital staff, medical and administrative, to pull it off.
-
There are also of course natural consequences. I dont think any of us know where to find a consultant for these issues if such a person/entity even exists. But if you work for a hospital or entity that chooses not to adapt and the radiologists dont have what it takes to take a unified stance, then the able bodied rads will simply leave for greener pastures once the job is no longer competitive with the market.
-
Quote from boomer
Negotiated a stipend many years ago with the assistance of an experienced consultant and a health care attorney. Used connections throughout the medical staff to smooth things over during tense times. It was drawn out, and we worked without contract for a while; but was successful. Without outside help, we couldn’t have pulled it off.
Had another time where we presented great data justifying subsidy from technical for IR support without success, despite a clear benefit to the system. They clearly made an irrational decision, and I don’t know where it went wrong. C’est la vie.
Bottom line, don’t throw your “neuroradiologist president” into the fray with some RVU numbers and try to wing it, or have a placeholder leader read demands developed at an executive board meeting. You need data and professional support, which is of course presented to the radiologists, as you develop a position. Many colleagues will have overly aggressive and entitled positions which need to be tempered. You want a good fair deal, don’t shoot the moon. Ultimately it’s a dance. Your negotiators need to understand that, have appropriate professional support, and have enough gravitas and likability amongst the hospital staff, medical and administrative, to pull it off.
Who are these who can find ways where others find no ways? Radiology meet “consultants” or modern day sophists. You pay them to whisper sweet nothings into administrative ears.
Hospitals are well aware of MGMA rates. No consultant needed there.-
Negotiating with hospitals can be quite silly. They look at salaries or $/wrvu. Whichever one is cheaper.
They say, look, your rads are making $600k/yr and thats more that MGMA or whatever data average, so we wont give a stipend. We tell them, the average yearly wrvus/rad is 17,000, much more that MGMA avg, and we are very short staffed. We need some extra dollars to make the $/wrvu more competitive for recruits. That somehow gets them confused. Cant get past the $600k part. Fake numbers of course, but you get the gist.
Theres a reason some hospitals are hemorrhaging money. Poor leadership from people at high places that dont understand how money works. Throw millions into things that dont bring in money. Fail to invest in those keeping the train moving.
-
Quote from drad123
Quote from boomer
Negotiated a stipend many years ago with the assistance of an experienced consultant and a health care attorney. Used connections throughout the medical staff to smooth things over during tense times. It was drawn out, and we worked without contract for a while; but was successful. Without outside help, we couldn’t have pulled it off.
Had another time where we presented great data justifying subsidy from technical for IR support without success, despite a clear benefit to the system. They clearly made an irrational decision, and I don’t know where it went wrong. C’est la vie.
Bottom line, don’t throw your “neuroradiologist president” into the fray with some RVU numbers and try to wing it, or have a placeholder leader read demands developed at an executive board meeting. You need data and professional support, which is of course presented to the radiologists, as you develop a position. Many colleagues will have overly aggressive and entitled positions which need to be tempered. You want a good fair deal, don’t shoot the moon. Ultimately it’s a dance. Your negotiators need to understand that, have appropriate professional support, and have enough gravitas and likability amongst the hospital staff, medical and administrative, to pull it off.
Who are these who can find ways where others find no ways? Radiology meet “consultants” or modern day sophists. You pay them to whisper sweet nothings into administrative ears.
Hospitals are well aware of MGMA rates. No consultant needed there.
Isn’t that the corporate trope, consultants everywhere accomplishing nothing? But they are there for a reason, I suppose.
Listen, I thought the same. What do we need a consultant for; how insulting…
I soon learned:
-A good consultant supplies extensive detailed data, worldly experience and emotional support. I didn’t know what I didn’t know.
-They were extremely helpful in corralling the group; who had a problem listening to anyone internal, no matter how wise or experienced.
-They helped the group globally in reorganization and reality testing. The power cliques were held accountable to global metrics. Our provincialism was outed. We cleaned up our management team, productivity measures etc. It was not just about negotiation, more about reorganization.
-They provided a “bad cop” in negotiations with the hospital, but also with disruptive partners; “but our consultant said…” Made it less personal for leadership.
-Also, let the hospital know they were dealing with more than a bunch of local naive physicians. Our health system doesn’t sh!t without the advice of a consultant. We were basically following their game plan, and they weren’t very happy about it.
So, I found it very helpful, way more than I anticipated. Of course, it’s dependent on competency. We had a senior health care attorney and senior consultant who were not afraid to give advise and confront dysfunctional partners in the planning stages. I’m sure the less experienced would waffle more and be of less benefit.
There will be basically two types against consultants.
– Those that think they have it under control, and cringe at the need. They see it as a nuisance and weakness. I was in that camp.
– Those that like a provincial status quo. Outside experts will effectively out dysfunctional situations, because it is partly about realigning the group towards sustainability and improved functionality. This benefits most, but not a certain minority who will fight to maintain an inequitable status quo currently bent in their favor. Open the windows; let in some fresh air…
As far as the actual practice of negotiation, don’t tell the hospital your specific salaries. They can infer it, but the real figures will only confuse them. Open ended requests will go nowhere. “We need more money to recruit,” isn’t going get you anything. Any negotiation needs to be binary, close ended, with consequences. We can’t support X service without being paid Y dollars. It needs to be supported in detail, and you can’t make it personal. Be specific, and with identifiable targets. Don’t try to fix everything at once. Don’t threaten or paint the opposition into a corner, but be clear with your needs and choices; with real consequences. It could be IR support, mammography services, overnight. Take your pick. Make it painful and real, but not so much where it becomes all out war. It’s an art, a dance. Not natural to most physicians.
For those practices struggling, how is your current plan working? You have a multimillion dollar business. Don’t be afraid to get help. Think of it as asking a subspecialist for advice; it’s worth a shot, especially if what you are doing is not working. Don’t drown in your own hubris.
-
Boomer I have to say that is probably the most informative post I have read on AM. Thank you for taking the time.
-
Maybe boomer has found a part time gig in retirement as a radiology consultant. Get those stipends boomer!
-
-
-
-
-
-
-
