Hospital Stipend Negotiation

[Respira_Profundo]

I recently joined a small physician only group that works primarily at a mid-size community hospital. Since this group has been there, they have not had a stipend of any kind, and have always provided 24/7/365 in-house coverage, including covering main ORs and OB. We have recently broached the topic of the stipend and admin seem very receptive and understanding. Our contract is up for renegotiation, and we will be including a request for a stipend.

I was hoping to get some advice and pointers from those who have dealt with this issue, and how we should go about coming up with an appropriate number. Is it as simple as coming up with an hourly rate and multiplying that out to cover for nights and weekend coverage? Would it be prudent to bring a consulting group on board to help with market research in order to back up our proposal with data? Does anybody have any links or knowledge as to current market rates and averages for hourly pay and stipends for private groups? Any insight at all would be appreciated. Thanks!

---

Members don't see this ad.

 

[nimbus]

In general, the stipend is inversely proportional to the group collections from insurance companies. A busy, well insured OB unit might offer no stipend. Conversely a trauma center with a bad payor mix and hit or miss cases at night might offer a large stipend. Anyway time spent inhouse needs to be financially worthwhile.

 

[Hoya11]

I recently joined a small physician only group that works primarily at a mid-size community hospital. Since this group has been there, they have not had a stipend of any kind, and have always provided 24/7/365 in-house coverage, including covering main ORs and OB. We have recently broached the topic of the stipend and admin seem very receptive and understanding. Our contract is up for renegotiation, and we will be including a request for a stipend.

I was hoping to get some advice and pointers from those who have dealt with this issue, and how we should go about coming up with an appropriate number. Is it as simple as coming up with an hourly rate and multiplying that out to cover for nights and weekend coverage? Would it be prudent to bring a consulting group on board to help with market research in order to back up our proposal with data? Does anybody have any links or knowledge as to current market rates and averages for hourly pay and stipends for private groups? Any insight at all would be appreciated. Thanks!

You need a consulting group to come up with a figure. They take care of all of that.

Initially the hospital will say no big deal yes let’s work together.

It will more than likely end in your group losing the contract in the next couple of years.

 

[Respira_Profundo]

You need a consulting group to come up with a figure. They take care of all of that.

Initially the hospital will say no big deal yes let’s work together.

It will more than likely end in your group losing the contract in the next couple of years.

What makes you think this would lead to losing the contract? I don't have exact numbers but I'd say the overall payer mix is about 50% Medicare/Medicaid, so not exactly a lucrative contract, in which the hospital requires 24/7/365 in house coverage. Wouldn't improving a contract with us be much cheaper than shopping around for another group who will most likely immediately ask for this stipend?

 

[nimbus]

What makes you think this would lead to losing the contract? I don't have exact numbers but I'd say the overall payer mix is about 50% Medicare/Medicaid, so not exactly a lucrative contract, in which the hospital requires 24/7/365 in house coverage. Wouldn't improving a contract with us be much cheaper than shopping around for another group who will most likely immediately ask for this stipend?

You should be getting a stipend.

 

[Southpaw]

What makes you think this would lead to losing the contract? I don't have exact numbers but I'd say the overall payer mix is about 50% Medicare/Medicaid, so not exactly a lucrative contract, in which the hospital requires 24/7/365 in house coverage. Wouldn't improving a contract with us be much cheaper than shopping around for another group who will most likely immediately ask for this stipend?

And yet the locums market is on fire precisely because so many hospitals have not negotiated with their local group or abruptly cancelled the contract.

any group that provides inpatient services is likely looking at at least 50% Medicare/Medicaid. You’re not alone though I know you never implied you were.

I hope you get a fair stipend and I hope you keep your contract for the entirety of your career. All I’ll say is, read the room, and look around and see what else is going on with the anesthesia market across the country.

 

[Hoya11]

What makes you think this would lead to losing the contract? I don't have exact numbers but I'd say the overall payer mix is about 50% Medicare/Medicaid, so not exactly a lucrative contract, in which the hospital requires 24/7/365 in house coverage. Wouldn't improving a contract with us be much cheaper than shopping around for another group who will most likely immediately ask for this stipend?

Your justified in asking for a stipend.

Hospital CEOs often don’t operate logically.

They’ll pay more for bad service from an AMC. Happens all the time.

Once you ask for a stipend your relationship changes. Hospital feels like anesthesia getting rich and sitting around. You can’t staff this new location with the money we gave you ? You’ll see. Hopefully your group will be an exception. But this is often the beginning of the end

 

[NeedleJockey]

These admins think they know something everyone else missed, when the happy hospital turns into a raging dumpster fire they just step over the rubble with a promotion. A consultant is warranted.

Hours coverage per year / 2000 = FTE multiply times FMV and subtract collections to get the stipend number.

 

[Howard888]

Md only is where youll use this battle unless the stipend is minimal.

Even though CRNAs pretty expensive these days both consulting firms and other groups/amcs will show a cheaper direction model.

 

[Respira_Profundo]

Md only is where youll use this battle unless the stipend is minimal.

Even though CRNAs pretty expensive these days both consulting firms and other groups/amcs will show a cheaper direction model.

We are 100% direction, but hospital employs CRNAs.

 

[Lochmoor]

We are 100% direction, but hospital employs CRNAs.

How does that arrangement work? Does the anesthesia billing go through the hospital and then the money is taken out to cover the CRNA salary and benefits with the rest going to the anesthesiologists?

 

[abolt18]

How does that arrangement work? Does the anesthesia billing go through the hospital and then the money is taken out to cover the CRNA salary and benefits with the rest going to the anesthesiologists?

Typically anesthesiologists bill for 1/2 the anesthetic while crna (hospital) bills half.

 

[Arch Guillotti]

How does that arrangement work? Does the anesthesia billing go through the hospital and then the money is taken out to cover the CRNA salary and benefits with the rest going to the anesthesiologists?

Not for us. We have a billing firm that handles it all.

 

[LivetoTell]

Not for us. We have a billing firm that handles it all.

So how does the hospital recoup the CRNAs/AAs salaries, If they don’t get to bill for the anesthesia services?

 

[Howard888]

Sounds like you already have a stipend then???? That’s a massive benefit. Good luck asking for more money if they employ the CRNAs.

 

[IMGASMD]

My first job, we had our own crna. Hospital provides subsidies. It was called “call stipends”. Because we weren’t making money taking calls, since we were also “trauma 2” and have OB in house 24/7. It was mid-high 6 figures. We also received “cardiac stipends”. Covid came. We left, because we didn’t have “any” income for about 3 months, while taking airway calls 24/7. They did try to make us whole; however, they called out for a RFP, many AMCs came and said they can do it for cheaper….. The hospital picked one. As a side note, that AMC lasted about 2 years.

My second job, hospital provided a stipend by employing X doctors from the group. Our obligation to the hospital is to sent X to the hospital, while we had 2X of physicians. Hospital also employs CRNAs. They kept all the billings. It worked well until it didn’t. Come 2022, when this hot market started. We started to lose physicians, because there are now plethora of jobs out there, which either offered higher pay and/or less work. We don’t really have the means to recruit anymore. The old partners also doesn’t want to work calls also started to cut back. AMC came, and chaos ensued.

OP, you need to ask for above market value to be able to recruit, especially if you’re not at a desirable area or you’ve already had problem recruiting new blood to come. I also hate to say it, it’ll be a uphill battle. Admins sees us as replaceable cogs in the system. We are an expense on their balance sheet. They don’t know what we do day in and day out to keep the ORs running well. All they see if how much they have to spent on anesthesia. They also believe they and themselves alone will be immune to all the failures of AMCs around them.

But it’s something that you have to do to give yourself a chance. The alternative is that they will have to experience the shlt show before they can even fathom how under-delivered most of these AMCs will be.

Above accounts are just hypothetical discussions. I may or may not have been in any of those situations.

 

[Anesthesia_Guy]

You need a consulting group to come up with a figure. They take care of all of that.

Initially the hospital will say no big deal yes let’s work together.

It will more than likely end in your group losing the contract in the next couple of years.

This all day. Completely accurate.

 

[Anesthesia_Guy]

What makes you think this would lead to losing the contract? I don't have exact numbers but I'd say the overall payer mix is about 50% Medicare/Medicaid, so not exactly a lucrative contract, in which the hospital requires 24/7/365 in house coverage. Wouldn't improving a contract with us be much cheaper than shopping around for another group who will most likely immediately ask for this stipend?

LOL!! Wow, no offense but you are very naive. If the hospital can save a nickel by having an AMC there, you're gone.

 

[Anesthesia_Guy]

We are 100% direction, but hospital employs CRNAs.

The ABSOLUTE worst situation to be in. CRNA's with a chip on their shoulders and a "you're not my boss" attitude.

 

[Dr. Rude]

LOL!! Wow, no offense but you are very naive. If the hospital can save a nickel by having an AMC there, you're gone.

Given the blow ups they have been going on in the current environment, that is far less true than it used to be.

 

[Arch Guillotti]

The ABSOLUTE worst situation to be in. CRNA's with a chip on their shoulders and a "you're not my boss" attitude.

Far from the truth.

 

[pgg]

Given the blow ups they have been going on in the current environment, that is far less true than it used to be.

Yeah, maybe I'm just whistling past the graveyard, but 5 or 7 years ago there hadn't been a bunch of high profile, catastrophic AMC detonations. The last few years have seen a lot.

Hospital administrators may be cynical, and they may be dollar-obsessed, and they may not have a clue what we do to facilitate their cash cows, and there are no friends or loyalties in business - but one thing they're not is stupid. They talk amongst themselves. By this point, I think there's some broad awareness on their side that AMCs and venture capital aren't going to save them money, even in the short term, and may very well result in 8 figure losses and long term damage to their systems.

Of course, my subsidy-receiving group might get stabbed and bid out next Thursday, and I might be unemployed next Friday, but I doubt it.

 

[thinkorswim]

Of course, my subsidy-receiving group might get stabbed and bid out next Thursday, and I might be unemployed next Friday, but I doubt it.

At least you know by Monday you can be right back at that same job making much more as a locums. These are very interesting times.

 

[IMGASMD]

At least you know by Monday you can be right back at that same job making much more as a locums. These are very interesting times.

Or more without ever taking calls….. while you wonder, don’t they know how to do arithmetic. We asked for much less than what you are giving AMCs. Unavoidably, AMC will come back and ask for more money. The hospital now is dealing with a multimillion company, and held hostage by their army of lawyers. Tale as old as time.

it is interesting time indeed.

 

[thinkorswim]

Or more without ever taking calls….. while you wonder, don’t they know how to do arithmetic. We asked for much less than what you are giving AMCs. Unavoidably, AMC will come back and ask for more money. The hospital now is dealing with a multimillion company, and held hostage by their army of lawyers. Tale as old as time.

it is interesting time indeed.

I’m just curious if anyone in the board room even thinks to ask these companies if they have the bodies to keep the ORs running. It seems every new contract change is promptly followed by numerous locums and job postings for that location.

AMCs these days seem to be proverbial dog that caught the car.

 

[IMGASMD]

I’m just curious if anyone in the board room even thinks to ask these companies if they have the bodies to keep the ORs running. It seems every new contract change is promptly followed by numerous locums and job postings for that location.

AMCs these days seem to be proverbial dog that caught the car.

They (AMC) promised they have a whole platoon of workers (both crna and docs) to staff this place.

The allocation chart they (AMC) provided makes so much sense. The presentation they came in to razzle and dazzle us looks so pretty and professional. While you anesthesiologists can’t even work the excel.

 

[USCTrojan11]

You need to find a consulting group that has access to all the data and provide them yours.

You need to balance financial reward with stability. If you're rural, know there's no way they find X number of anesthesiologists to replace you and definitely not within 90 days. You are emboldened by your competition or lack thereof. You need to present them all the data in a comprehensive and transparent manner, give them 14 days to decide while your 90 day notice is in. They will go through the stages of grief, then make the calculated decision for your stipend request and based on what anesthesia coverage they want/afford/can offer.

 

[Dr. Rude]

I’m just curious if anyone in the board room even thinks to ask these companies if they have the bodies to keep the ORs running. It seems every new contract change is promptly followed by numerous locums and job postings for that location.

AMCs these days seem to be proverbial dog that caught the car.

As long as they get a guaranteed profit and locum tenens costs are a complete pass through, they don’t care.

 

[Beeftenderloin]

I recently joined a small physician only group that works primarily at a mid-size community hospital. Since this group has been there, they have not had a stipend of any kind, and have always provided 24/7/365 in-house coverage, including covering main ORs and OB. We have recently broached the topic of the stipend and admin seem very receptive and understanding. Our contract is up for renegotiation, and we will be including a request for a stipend.

I was hoping to get some advice and pointers from those who have dealt with this issue, and how we should go about coming up with an appropriate number. Is it as simple as coming up with an hourly rate and multiplying that out to cover for nights and weekend coverage? Would it be prudent to bring a consulting group on board to help with market research in order to back up our proposal with data? Does anybody have any links or knowledge as to current market rates and averages for hourly pay and stipends for private groups? Any insight at all would be appreciated. Thanks!

Our group literally just played this out. PP no stipend, multi-decade exclusive stable relationship with hospital, including 24/7 in house OR/OB coverage including peds and cardiac teams. Asked for a stipend given we effectively couldn’t hire anymore without one. Fast forward 8 months and we’re all employed.

 

[Anesthesia_Guy]

Far from the truth.

Spot on brah.

 

[pgg]

Our group literally just played this out. PP no stipend, multi-decade exclusive stable relationship with hospital, including 24/7 in house OR/OB coverage including peds and cardiac teams. Asked for a stipend given we effectively couldn’t hire anymore without one. Fast forward 8 months and we’re all employed.

Bummer

How many of your group left?

Are you getting paid more now than you were as a private group? More predictable hours?

Less administrative work? I mean there are a LOT of things my partners do for the hospital for the purpose of promoting efficient work, good will, and other things the hospital values. I don't think any of us would devote even a 10th of the effort to any of that if we were just employees.

 

[GassYous]

Our group literally just played this out. PP no stipend, multi-decade exclusive stable relationship with hospital, including 24/7 in house OR/OB coverage including peds and cardiac teams. Asked for a stipend given we effectively couldn’t hire anymore without one. Fast forward 8 months and we’re all employed.

Sorry to hear that. Vote with your feet

 

[Status Sciaticus]

The ABSOLUTE worst situation to be in. CRNA's with a chip on their shoulders and a "you're not my boss" attitude.

Far from the truth.

Could be much worse. CRNAs with a chip on their shoulders employing the anesthesiologists to sign the charts and a "I am your boss" attitude.

 

[DesiredMemberName?]

Our group literally just played this out. PP no stipend, multi-decade exclusive stable relationship with hospital, including 24/7 in house OR/OB coverage including peds and cardiac teams. Asked for a stipend given we effectively couldn’t hire anymore without one. Fast forward 8 months and we’re all employed.

Has the compensation/work ratio improved significantly? How is hiring going now?

Although it’s not the ideal setup imo, going in-house might not be the worst outcome. Either people get paid more for the work and hiring picks up or people continue to leave and staffing is now the hospital’s problem. This is assuming you have language protecting you from being forced to work more for no/minimal increase in pay.

 

[Beeftenderloin]

Bummer

How many of your group left?

Are you getting paid more now than you were as a private group? More predictable hours?

Less administrative work? I mean there are a LOT of things my partners do for the hospital for the purpose of promoting efficient work, good will, and other things the hospital values. I don't think any of us would devote even a 10th of the effort to any of that if we were just employees.

Sorry to hear that. Vote with your feet

Has the compensation/work ratio improved significantly? How is hiring going now?

Although it’s not the ideal setup imo, going in-house might not be the worst outcome. Either people get paid more for the work and hiring picks up or people continue to leave and staffing is now the hospital’s problem. This is assuming you have language protecting you from being forced to work more for no/minimal increase in pay.

We were around 50. Only lost about 10%. Compensation is considerably better employed. Everyone got at minimum a 6 figure raise. Work load TBD. Call schedule is a little more onerous since we’re down some people, but admin has stressed (even after the ink dried) they intend to hire well above our previous staffing level. Work load should improve. They’ve already brought in some locums docs to lighten the day to day work load in the short term. In the process of interviewing people. It’s all pretty fresh.

 

[Dr. Rude]

We were around 50. Only lost about 10%. Compensation is considerably better employed. Everyone got at minimum a 6 figure raise. Work load TBD. Call schedule is a little more onerous since we’re down some people, but admin has stressed (even after the ink dried) they intend to hire well above our previous staffing level. Work load should improve. They’ve already brought in some locums docs to lighten the day to day work load in the short term. In the process of interviewing people. It’s all pretty fresh.

I suspect that they are being accommodating because word is getting around of melt downs of entire anesthesia departments which is financially catastrophic for hospitals. Make hay while the sun shines. It won’t be forever.

 

[abolt18]

We were around 50. Only lost about 10%. Compensation is considerably better employed. Everyone got at minimum a 6 figure raise. Work load TBD. Call schedule is a little more onerous since we’re down some people, but admin has stressed (even after the ink dried) they intend to hire well above our previous staffing level. Work load should improve. They’ve already brought in some locums docs to lighten the day to day work load in the short term. In the process of interviewing people. It’s all pretty fresh.

This sounds pretty good. Hope you guys can maintain a significant amount of autonomy and control, despite hospital employment.

 

[pgg]

We were around 50. Only lost about 10%. Compensation is considerably better employed. Everyone got at minimum a 6 figure raise. Work load TBD. Call schedule is a little more onerous since we’re down some people, but admin has stressed (even after the ink dried) they intend to hire well above our previous staffing level. Work load should improve. They’ve already brought in some locums docs to lighten the day to day work load in the short term. In the process of interviewing people. It’s all pretty fresh.

Well - could be worse.

I do know some really happy people working in employed hospital and academic systems, so it doesn't have to suck.

When I joined my group I accepted less money than was offered by other options I had, because I valued being in a private group and doing a majority of my work solo.

I hope we stay independent forever, and I hope the administration understands that I (and many of my partners) would have to be offered a LOT more money, with very predictable schedules, to stay here if they went to an employed model. If they decided everyone had to be 4:1 all the time I'd quit no matter how much they offered. Here's hoping they leave well enough alone and don't burn it down.

 

[jwk]

Our entire very large group became hospital employed a year ago. Of course there have been a few hiccups but the stability of hospital employment and not dealing with an AMC is worth a lot. Our day to day work hasn’t changed a bit.

 

[DazedWanderer]

And yet the locums market is on fire precisely because so many hospitals have not negotiated with their local group or abruptly cancelled the contract.

any group that provides inpatient services is likely looking at at least 50% Medicare/Medicaid. You’re not alone though I know you never implied you were.

I hope you get a fair stipend and I hope you keep your contract for the entirety of your career. All I’ll say is, read the room, and look around and see what else is going on with the anesthesia market across the country.

It's almost absurd how laughably out of touch some hospitals seem to be with the market. Local private group at one of the busy hospitals in my city tried to negotiate a stipend from the hospital as they had an exclusive contract with this hospital for 30+ years, but their salaries were now below market without stipend and they could not hire a single person since the covid market craze. The hospital figured instead of adding a stipend it would be a good idea to kick out the private practice group and go it on their own. They are now paying per diem MDs and CRNAs truly exorbitant rates trying desperately to keep the ORs running. The old group is laughing their asses off as half of them are now working there per diem making over 50% more money than they would have made if the hospital would have just given their group what they were asking for in the contract negotiation.

 

[IMGASMD]

It's almost absurd how laughably out of touch some hospitals seem to be with the market. Local private group at one of the busy hospitals in my city tried to negotiate a stipend from the hospital as they had an exclusive contract with this hospital for 30+ years, but their salaries were now below market without stipend and they could not hire a single person since the covid market craze. The hospital figured instead of adding a stipend it would be a good idea to kick out the private practice group and go it on their own. They are now paying per diem MDs and CRNAs truly exorbitant rates trying desperately to keep the ORs running. The old group is laughing their asses off as half of them are now working there per diem making over 50% more money than they would have made if the hospital would have just given their group what they were asking for in the contract negotiation.

They do special math that’s beyond my comprehension.

 

[Dr. Rude]

They do special math that’s beyond my comprehension.

They are geniuses.

 

[IMGASMD]

Jeenyus.

I had some of their gears from a long time ago….