Need input on hospitalist contract

[gutonc]

So they would rather have you on as a locums and pay through the nose for that. Plus, as a locums, you could do whatever length you want with no financial penalty.

Is this correct?

The stupidity of hospital administration in full effect.

100% this.

Note that most of you would consider me "hospital admin" since I'm a physician group director within a large academic hospital setting. I am tasked with recruiting physicians under the limitations imposed by the hospital "powers that be". I can't negotiate salary, or benes, or sign-on/relo (other than a narrow window) or really anything other than schedule.

But then I get the "why are we having to use locums, why haven't you filled these positions yet?" question and my answer is "because you're too cheap to pay people what they're worth." I kept that last answer to myself for the past 4 years, but I've already announced my exit date so I'm letting it fly these days. It hasn't changed a lot, but they finally got rid of the non-compete clauses because I kept red-lining them in the contracts I sent to new hires.

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[DrMetal]

What about doing locums in the Inland empire or working there how much does a hospitalist make I’m willing to work out in riverside etc

I did, through CompHealth (good locums company, very organized). $160/hr. not bad. The same position at the same location used to make $200/hr, 10 years ago, but whatevaah! If you're interested in Riverside/Loma Linda/Inland Empire, get it on it quickly. It's getting flooded too (with both physicians and mid levels).

 

[Nocturnist]

I'm sadly reminded of our EM colleagues, many of whom swore (not less than 10 years ago) that they'd all forever make $300/hr or $500k/year, even if working in non-trauma centers and seeing only low acuity colds/sniffles. As soon as that mid-level faucet was turned on, the flooding began and those salaries dropped (if the EM physician job wasn't eliminated entirely).

I'm a cheerful guy, I know.

But hey, prove me wrong. This is a debate I'd love to lose.

I dont know anything about the EM market but the more midlevels we hire, the more I've made and the more I'm satisfied with my job.

When I started we had two nocturnists and no midlevels. We split crosscovering a census of 200-300 patients, doing codes/rapid responses and triage. It frankly sucked.

6 years later we have 4 nocturnists and midlevel support crosscovering nearly 100% of the service. They also each do a couple easy admits that I can go say hi to, briefly examine, drop a quick note and bill. I'm able to focus on the purely RVU generating and cerebral aspects of my work, while they do the soul sucking non rvu generating cross coverage.

Per diem shift rates have also been increased by $50/hr for any shift the rest of 2022 because they can't find enough physicians to fill them.

I mean if I was making $300-500 an hour I'd probably be drinking from that firehose knowing it's here for a good time, not a long time. That said hospitalist salaries have consistently trended up 3-7% a year for the past 15 years without a sign of slow down.

 

[DrMetal]

I mean if I was making $300-500 an hour I'd probably be drinking from that firehose knowing it's here for a good time, not a long time. That said hospitalist salaries have consistently trended up 3-7% a year for the past 15 years without a sign of slow down.

No they haven't, in what state? We don't generate that much money for the hospital. We don't do procedures, we certainly don't do elective surgeries. In fact, strong arguments have been made that we're too costly.

So they hired mid-levels to relieve some pressure off of you, that's great. And they didn't fire or replace you quickly. And they won't. Physicians aren't getting let go (yet).

But heres the difference: the next time they need to hire some more hospitalists---since the midlevel model you described worked out so well, and you praised it---they may just decide to hire one or two less MDs in favor of hiring twice as many midlevels. Or, they'll offer crap contracts to the MDs (see the plethora of posts on this forum), and wont think twice about it when the MD rejects it.

Look, it's happening now. See the Original post here? See the 230K nocturnist posts?! I ain't making this up.

 

[Nocturnist]

No they haven't, in what state? We don't generate that much money for the hospital. We don't do procedures, we certainly don't do elective surgeries. In fact, strong arguments have been made that we're too costly.

So they hired mid-levels to relieve some pressure off of you, that's great. And they didn't fire or replace you quickly. And they won't. Physicians aren't getting let go (yet).

But heres the difference: the next time they need to hire some more hospitalists---since the midlevel model you described worked out so well, and you praised it---they may just decide to hire one or two less MDs in favor of hiring twice as many midlevels. Or, they'll offer crap contracts to the MDs (see the plethora of posts on this forum), and wont think twice about it when the MD rejects it.

Look, it's happening now. See the Original post here? See the 230K nocturnist posts?! I ain't making this up.

Key trends in hospitalist compensation from the 2020 SoHM Report - The Hospitalist

Hospitalist compensation continues to rise compared to previous years, despite relatively flat trends in total patient encounters.

www.the-hospitalist.org

43% rise from 2010 to 2020 across the country. That's 2.5x the rate of inflation.

 

[rokshana]

They are very busy and are a doc owned private practice. They clear at least 700 a year working 12-14 a month. Idk man a great strategy to gut your supply is spell doom. Look how great anesthesia is now.

You mean 20 years later?

 

[rokshana]

I did, through CompHealth (good locums company, very organized). $160/hr. not bad. The same position at the same location used to make $200/hr, 10 years ago, but whatevaah! If you're interested in Riverside/Loma Linda/Inland Empire, get it on it quickly. It's getting flooded too (with both physicians and mid levels).

Have you worked with CompHealth before? Worked with the once and never again… tried to change my contract mid assignment to take less money… and always fighting about accommodations… they tell you there is a cap… but when you talk to the facility…they are surprised by that…frankly I think they tell physicians there is a cap and take the full amount from the facility and pocket the difference… and made you pay for the difference… shdy

 

[DrMetal]

Have you worked with CompHealth before? Worked with the once and never again… tried to change my contract mid assignment to take less money… and always fighting about accommodations… they tell you there is a cap… but when you talk to the facility…they are surprised by that…frankly I think they tell physicians there is a cap and take the full amount from the facility and pocket the difference… and made you pay for the difference… shdy

I did, once, for one assignment, one location. It was a positive experience, although I'm sure opinions may vary from job to job.

 

[DrMetal]

Key trends in hospitalist compensation from the 2020 SoHM Report - The Hospitalist

Hospitalist compensation continues to rise compared to previous years, despite relatively flat trends in total patient encounters.

www.the-hospitalist.org

43% rise from 2010 to 2020 across the country. That's 2.5x the rate of inflation.

No way I believe this.
a). The data is too linear. Nothing fits a line that nicely. Such nice fitting is often indicative of data fraudulence or cherry-picking, probably the latter.
b). this is the Hospitalist, our own self-tooting publication that's way too optimistic for my taste. It reminds me of Guitar World, another publication that I subscribe too, praises every Guitar brand out there, never a bad thing to say, but alas there's a lot of crappy guitars out there.
c) and most importantly, it just doesn't match what we're seeing "out in the field", "experimentally". The evidence? again, many crappy offers posted here and that we here of anecdotally.

 

[Splenda88]

No they haven't, in what state? We don't generate that much money for the hospital. We don't do procedures, we certainly don't do elective surgeries. In fact, strong arguments have been made that we're too costly.

So they hired mid-levels to relieve some pressure off of you, that's great. And they didn't fire or replace you quickly. And they won't. Physicians aren't getting let go (yet).

But heres the difference: the next time they need to hire some more hospitalists---since the midlevel model you described worked out so well, and you praised it---they may just decide to hire one or two less MDs in favor of hiring twice as many midlevels. Or, they'll offer crap contracts to the MDs (see the plethora of posts on this forum), and wont think twice about it when the MD rejects it.

Look, it's happening now. See the Original post here? See the 230K nocturnist posts?! I ain't making this up.

There are data out there that show we generate as much as general surgeons (will look for these data) . We order more imaging that the hospital can bill for.

 

[Splenda88]

Key trends in hospitalist compensation from the 2020 SoHM Report - The Hospitalist

Hospitalist compensation continues to rise compared to previous years, despite relatively flat trends in total patient encounters.

www.the-hospitalist.org

43% rise from 2010 to 2020 across the country. That's 2.5x the rate of inflation.

I am getting 2k+/day locum offers almost qweek. Hoping this trend continues for the next 10 yrs

 

[DrMetal]

I am getting 2k+/day locum offers almost qweek. Hoping this trend continues for the next 10 yrs

so am I. The locums situation is a very weird one. As pointed out above, can't figure why hospitals would rather pay a higher locums rate than offer better contracts for permanent staff. Maybe they like the attrition of locums, that it can be turned off right away.

 

[Prehealth1011]

Even with the higher salaries, are the things you're expected to do now more than they used to be?

When I browse around practicelink, doccafe, indeed etc, the gigs that pay near 300k almost always comes with "open icu", "procedures required" "must be comfortable with intubations". The last one in particular is terrifying. Where do people find these jobs that are 250k with a reasonable workload?

 

[Nocturnist]

No way I believe this.
a). The data is too linear. Nothing fits a line that nicely. Such nice fitting is often indicative of data fraudulence or cherry-picking, probably the latter.
b). this is the Hospitalist, our own self-tooting publication that's way too optimistic for my taste. It reminds me of Guitar World, another publication that I subscribe too, praises every Guitar brand out there, never a bad thing to say, but alas there's a lot of crappy guitars out there.
c) and most importantly, it just doesn't match what we're seeing "out in the field", "experimentally". The evidence? again, many crappy offers posted here and that we here of anecdotally.

-The data is more or less congruent with MGMA, med scape, etc. Pick a survery, the trend is up.
-data is an average. For every crappy offer there is a baller offer that either doesn't come on here to b*tch about or (like my scenario) you choose to toss out because it doesn't fit your narrative that everything is doom and gloom and some NP is coming for your job.
-If anything, I've mostly heard some people here complain the anecdotes here skew too much the other way and that only nocturnists pulling 400-500k+ are posting here.
-not sure which 230k nocturnist offers you're talking about. Even the original one here is 285, and with benefits/ loan forgiveness easily exceeds 300k

 

[CCM-MD]

There are data out there that show we generate as much as general surgeons (will look for these data) . We order more imaging that the hospital can bill for.

This is false. The same quoted article mentions hospitals are shelling out 200k out of their pockets per hospitalist to support their salaries and that generated wRVUs have not changed.

“Ordering more imaging” is a money loser in the inpatient world of bundled and DRG based payments.

 

[VA Hopeful Dr]

so am I. The locums situation is a very weird one. As pointed out above, can't figure why hospitals would rather pay a higher locums rate than offer better contracts for permanent staff. Maybe they like the attrition of locums, that it can be turned off right away.

That's an easy one. Better for the bottom line to pay a couple people 200/hr and the majority 150/hr then pay everyone 200/hr.

 

[Nocturnist]

That's an easy one. Better for the bottom line to pay a couple people 200/hr and the majority 150/hr then pay everyone 200/hr.

+1.
Also, unparalleled flexibility.
Locums shifts can all be canceled for no cause with 30 day notice.
Once they've booked my shifts, they're set in stone no matter how low volumes are.

 

[Splenda88]

This is false. The same quoted article mentions hospitals are shelling out 200k out of their pockets per hospitalist to support their salaries and that generated wRVUs have not changed.

“Ordering more imaging” is a money loser in the inpatient world of bundled and DRG based payments.

View attachment 352402

these-10-physician-specialties-generate-the-most-revenue-for-hospitals-051519.html


Not sure how accurate these are.

1. Cardiovascular surgery

• Average revenue: $3.7 million
• Average salary: $425,000

2. Cardiology (invasive)

• Average revenue: $3.48 million
• Average salary: $590,000

3. Neurosurgery

• Average revenue: $3.44 million
• Average salary: $687,000

4. Orthopedic surgery

• Average revenue: $3.29 million
• Average salary: $533,000

5. Gastroenterology

• Average revenue: $2.97 million
• Average salary: $487,000

6. Hematology/Oncology

• Average revenue: $2.86 million
• Average salary: $425,000

7. General surgery

• Average revenue: $2.71 million
• Average salary: $350,000

8. Internal medicine

• Average revenue: $2.68 million
• Average salary: $261,000

9. Pulmonology

• Average revenue: $2.36 million
• Average salary: $418,000

10. Cardiology (noninvasive)

• Average revenue: $2.31 million
• Average salary: $427,000

 

[Nocturnist]

This is false. The same quoted article mentions hospitals are shelling out 200k out of their pockets per hospitalist to support their salaries and that generated wRVUs have not changed.

“Ordering more imaging” is a money loser in the inpatient world of bundled and DRG based payments.

View attachment 352402

Never understood this argument.

So bottom line, salaries have increased while hospital stipends have too?
It's almost like it has nothing to do with productivity and just correlated with supply and demand like any other job in this country.

Look no further than the 6-8k/week travel nursing covid contracts. Not to mention the very few RVUs they bring in, but are nurses suddenly caring for three times as many patients to justify paying them as much as a physician?
Yet half of sdn would have us believe they're all going to be replaced with nursing assistants..

 

[Splenda88]

Hospitalists in 2022: Demand, Salaries, Trends │ Merritt Hawkins

Hospitalist medicine physicians have endured tough times during COVID, affecting work, salaries and recruitment. Get the latest insights for hospitalists in 2022.

www.merritthawkins.com

Let's hope this trend continues for the next 10 yrs.

 

[CCM-MD]

So bottom line, salaries have increased while hospital stipends have too?
It's almost like it has nothing to do with productivity and just correlated with supply and demand like any other job in this country.

Look no further than the 6-8k/week travel nursing covid contracts. Not to mention the very few RVUs they bring in, but are nurses suddenly caring for three times as many patients to justify paying them as much as a physician?
Yet half of sdn would have us believe they're all going to be replaced with nursing assistants..

Agree. Based on that article the compensation has gone up because of increased stipends. Supply/demand seems like it would make the most sense as a possible reason.

@Splenda88 those numbers for Internal Medicine are likely referring to outpatient docs who generate a lot of downstream revenue for hospitals, not hospitalists.

I think the better argument for physician hospitalists is - more appropriate utilization of resources, less unneeded testing, better throughput etc. that’s how they bring a lot of value to the table and why hospitals are willing to shell out so much money to have them. Perhaps this is why midlevel encroachment hasn’t exploded yet.

 

[Splenda88]

Agree. Based on that article the compensation has gone up because of increased stipends. Supply/demand seems like it would make the most sense as a possible reason.

@Splenda88 those numbers for Internal Medicine are likely referring to outpatient docs who generate a lot of downstream revenue for hospitals, not hospitalists.

I think the better argument for physician hospitalists is - more appropriate utilization of resources, less unneeded testing, better throughput etc. that’s how they bring a lot of value to the table and why hospitals are willing to shell out so much money to have them. Perhaps this is why midlevel encroachment hasn’t exploded yet.

Perhaps...

The survey was not clear but it seems like more IM hospitalists than outpatient docs

 

[CCM-MD]

Hospitalists in 2022: Demand, Salaries, Trends │ Merritt Hawkins

Hospitalist medicine physicians have endured tough times during COVID, affecting work, salaries and recruitment. Get the latest insights for hospitalists in 2022.

www.merritthawkins.com

Let's hope this trend continues for the next 10 yrs.

“Hospitalists made our list of the top 20 specialties in demand for 2020/2021 (coming in at No. 19), but the number of search requests was significantly less than prior years.”

This is consistent with what my residents are experiencing. Many want to be hospitalists and it has not been as easy as prior years to find a job.

 

[Osteoth]

What’re the best locums agencies?

 

[DrMetal]

 

[scoopdaboop]

View attachment 352455

meme really should be the other way around, no cap.

 

[stayinalive]

I declined it. I tried for a compromise, used many ideas from here I even said 6 months notice instead of 3. Hard no.

They said try it with a locum assignment, if you think like it agree to the clause in the full time contract!

The search continues

You definitely made the right choice. Future you is thanking you for not screwing him over in a year or two.

 

[stayinalive]

This! I’m in this exact same situation, job sounded great on paper so I didn’t think too much about the liquidated damages ($250k) when I signed. Now I badly need to leave less than a year…so now I have to deal with that.

Thanks for sharing this publicly. Hearing other people's examples is very useful. The liquadated damages/penalty clauses (and I am not speaking of loan repayment to be clear) should be an instant non-starter for anyone reading this, particularly for the first job.

 

[Giovanotto]

Sorry to revive an old threat, but I am looking at a contract now and am worried about similar language. Contract is for 3 years, salary guaranteed.
Regarding termination they mention:

This Agreement may be terminated as follows:
a) Termination With Cause. This Agreement may be terminated with cause by either party with thirty (30) days written notice...
b) Immediate Termination. Employer may immediately terminate....

You get the gist.

The part that really took me by surprise is that they then have a part about liquidation damages:
In the event that this agreement is terminated for any reason other than a) or b) by either Party, the terminating Party will pay to the other liquidated damages equal to ~40,000 USD.

 

[chessknt]

Sorry to revive an old threat, but I am looking at a contract now and am worried about similar language. Contract is for 3 years, salary guaranteed.
Regarding termination they mention:

This Agreement may be terminated as follows:
a) Termination With Cause. This Agreement may be terminated with cause by either party with thirty (30) days written notice...
b) Immediate Termination. Employer may immediately terminate....

You get the gist.

The part that really took me by surprise is that they then have a part about liquidation damages:
In the event that this agreement is terminated for any reason other than a) or b) by either Party, the terminating Party will pay to the other liquidated damages equal to ~40,000 USD.

That is an exit fee. Market must be completely saturated for them to put that poison pill in there chaining you to them.

 

[Osteoth]

Sorry to revive an old threat, but I am looking at a contract now and am worried about similar language. Contract is for 3 years, salary guaranteed.
Regarding termination they mention:

This Agreement may be terminated as follows:
a) Termination With Cause. This Agreement may be terminated with cause by either party with thirty (30) days written notice...
b) Immediate Termination. Employer may immediately terminate....

You get the gist.

The part that really took me by surprise is that they then have a part about liquidation damages:
In the event that this agreement is terminated for any reason other than a) or b) by either Party, the terminating Party will pay to the other liquidated damages equal to ~40,000 USD.

Hardest of passes, that’s like 6 months salary for some…

 

[dozitgetchahi]

So if you want to quit, you have to pay $71250 ? (Monthly salary x 3).

That's nuts.

Most contracts require anywhere from 60 to 90 days notice but not actually paying anything out.

Who covers your tail if you leave?

Yeah, I agree. This is nuts. I have never seen a physician job contract with that sort of clause…it’s a job, it’s not like you’re breaking a lease when you leave. And what about tail coverage?

(Also, consider that any place that tries to chain you to the job that way probably will engage in all sorts of other unseemly behavior too…run!)

 

[NotAProgDirector]

Is there a termination without cause option? If there is and it has a 90 day notice, then this is much less concerning.

 

[Giovanotto]

Is there a termination without cause option? If there is and it has a 90 day notice, then this is much less concerning.

I do not see one, no.

 

[VA Hopeful Dr]

I do not see one, no.

That would be very unusual.

Is the payback money related to the signing bonus or is that just there without a signing bonus?

If the former, that is not unusual. If the latter, then absolutely do not take this job unless you have no other choice.

 

[Giovanotto]

That would be very unusual.

Is the payback money related to the signing bonus or is that just there without a signing bonus?

If the former, that is not unusual. If the latter, then absolutely do not take this job unless you have no other choice.

Hi, thank you everyone for replying. This is all separate from the pro-rated sign on bonus scheme they have outlined, which I also do not want to accept without negotiating as it requires too many years to get to zero dollars returned.

The only thing I can add is that the pay is appropriate, good. It is in-line with a few other offers I'm considering in less ideal places.

 

[anonperson]

Sorry to revive an old threat, but I am looking at a contract now and am worried about similar language. Contract is for 3 years, salary guaranteed.
Regarding termination they mention:

This Agreement may be terminated as follows:
a) Termination With Cause. This Agreement may be terminated with cause by either party with thirty (30) days written notice...
b) Immediate Termination. Employer may immediately terminate....

You get the gist.

The part that really took me by surprise is that they then have a part about liquidation damages:
In the event that this agreement is terminated for any reason other than a) or b) by either Party, the terminating Party will pay to the other liquidated damages equal to ~40,000 USD.

Terrible.

There should be the ability for either party to leave without cause with proper notice without any penalty.

$40,000 is ludicrous as a penalty.

I would never sign anything like this.

You would have too much too lose. What if they start to create a work environment that you deem unsustainable and unsafe? Your license is on the line and as well as the risk of lawsuit.