Support the AMA - a group actually trying

[DebtRising]

Medicare physician pay fell 26% since 2001. How did we get here?

Medicare’s unsustainable pay system threatens access to care. The failure to update physician pay for inflation is a huge part of the problem.

www.ama-assn.org

For all of you who have had an on and off AMA relationship, I ask you to reconsider.

They are pushing to tie Medicare payments with inflation and blasting out how reimbursement has decreased significantly while education costs, practice costs, complexity, have all increased. Doximity similarly had a good article based on their annual MDsurvey https://press.doximity.com/reports/doximity-physician-compensation-report-2023.pdf
(if you read it, can you believe they actually highlighted the concerns responds markers on there survey? Take some notes ASTRO)

Also a great contrast to how ASTRO “represents” us. The AMA is not perfect, but the best organized group championing a just cause through good data. Consider taking those ASTRO dues and instead donate to AMPAC.

I have no leadership or formal role at AMA or its PAC.

---

Members don't see this ad.

 

[Rad Onc SK]

AMA is interesting. It's an organization that has reinvented itself through younger leadership, many of whom I know from my time in RFS and YPS. We all were together during the 2000's. Those who stayed did well. Many Board members, including the past president, are 55 or less. This would have been unheard of just 10 years ago.

AMA still has a perception problem that is going to take them a while to shake, however. You noted that.

AMA wants to link updates to MEI, which I think is smart.

This is what ROCR is proposing for PC, as an FYI.

 

[CaesarRO]

AMA is interesting. It's an organization that has reinvented itself through younger leadership, many of whom I know from my time in RFS and YPS. We all were together during the 2000's. Those who stayed did well. Many Board members, including the past president, are 55 or less. This would have been unheard of just 10 years ago.

AMA still has a perception problem that is going to take them a while to shake, however. You noted that.

AMA wants to link updates to MEI, which I think is smart.

This is what ROCR is proposing for PC, as an FYI.

Is there a glossary somewhere for all the health policy acronyms? My head is spinning.

 

[Neuronix]

I will support the American Medical Association when they come out against non-compete agreements as the American Bar Association has for lawyers.

Rule 5.6: Restrictions on Rights to Practice

Law Firms And Associations | A lawyer shall not participate in offering or making: (a) a partnership, shareholders, operating, employment, or other similar type of agreement that restricts the right of a lawyer to practice after termination of the relationship, except an agreement concerning...

www.americanbar.org

 

[grenz]

I will support the American Medical Association when they come out against non-compete agreements as the American Bar Association has for lawyers.

Rule 5.6: Restrictions on Rights to Practice

Law Firms And Associations | A lawyer shall not participate in offering or making: (a) a partnership, shareholders, operating, employment, or other similar type of agreement that restricts the right of a lawyer to practice after termination of the relationship, except an agreement concerning...

www.americanbar.org

This is more complex IMO because in law it’s illegal for anyone but lawyers to own a law firm.

Restrictive covenants protect physician-owned practices that may be competing with bigger hospital systems. Getting rid of non-competes would help employed docs but hurt independent docs

 

[NotMattSpraker]

This is more complex IMO because in law it’s illegal for anyone but lawyers to own a law firm.

Restrictive covenants protect physician-owned practices that may be competing with bigger hospital systems. Getting rid of non-competes would help employed docs but hurt independent docs

Majority are employed now and even more will be in the future.

I am all for maneuvers that help independent doctors and increase competition, but don't agree that non-competes should stay for that hypothetical reason.

 

[Neuronix]

This is more complex IMO because in law it’s illegal for anyone but lawyers to own a law firm.

Not a bad idea that only doctors should own a medical practice while we're at it.

Restrictive covenants protect physician-owned practices that may be competing with bigger hospital systems.

and yet the bigger hospital systems have restrictive covenants too. Everyone does here. It's impossible for a rad onc to be employed in this state without one.

 

[RickyScott]

Majority are employed now and even more will be in the future.

I am all for maneuvers that help independent doctors and increase competition, but don't agree that non-competes should stay for that hypothetical reason.

actually a super-majority.

 

[StIGMA]

They can move out of their “AMA Plaza” skyscraper in Chicago instead of harassing me for pocket change

 

[Mandelin Rain]

They can move out of their “AMA Plaza” skyscraper in Chicago instead of harassing me for pocket change

You don't think a medical organization should have the "Wayne Enterprises" in the Dark Knight building located in downtown Chicago named for it? Come on. Live a little.

 

[Mandelin Rain]

From what I can tell, AMA spent 21 million on rent, 15 million on travel, and 235 million on total comp for their 1750 employees last year. In total, they spent 400 million dollars. What that got physicians, is uncertain.

CPT codes are big business.

 

[DebtRising]

AMA is interesting. It's an organization that has reinvented itself through younger leadership, many of whom I know from my time in RFS and YPS. We all were together during the 2000's. Those who stayed did well. Many Board members, including the past president, are 55 or less. This would have been unheard of just 10 years ago.

AMA still has a perception problem that is going to take them a while to shake, however. You noted that.

AMA wants to link updates to MEI, which I think is smart.

This is what ROCR is proposing for PC, as an FYI.

Appreciate you taking the time to reach out.

In terms of advocacy the AMA in my opinion has done an excellent job of direct communication about goals and focusing on issues important to physicians. I know what I am getting with the AMA, it's not perfect, but it's a heck of a lot better than it was. Maybe all that young blood is running hot!

This is where ASTRO could learn some lessons if it wants to represent the field. Without rehashing the other thread, I have no idea what ASTRO gets me on advocacy. The ROCR was done secrecy. We have had significant cuts, and overexpansion has magnified all of this. You have made some posts in the other thread about what ASTRO has done. Well, no one knows these things! And the silence on overexpansion also seems intentional - there can be legitimate concerns about comments on programs (obvious question mark is why relative to other organizations), but if a study is commissioned and finds in a worst-case scenario, we are already overtrained by 1600 residents prior to the 2030 cliff, surely at least ASTRO can (or could have) provided a better platform to highlight this. Many of us, respectfully, find it hard to believe the line of 'anti-trust' is that big and so terrible to cross that even fostering a discussion would run afoul of these lurking lawyers just waiting to waylay us. And you know what, if I am wrong, why not have the ASTRO counsel have a discussion about what they feel is off limits? I am truly not planning on having a job in 10 years. It won't be because I retire to my private island. I hope many people at the younger spectrum in this field are planning and living the same. And if ASTRO is fighting against that, I just don't see it. The AMA, I see it.

Respect your time and congratulations on your victory.

 

[sirspamalot]

Nah, I'll save my ASTRO and AMA dues (haven't been a member of the latter since after med school) and direct them to where it matters and pays dividends. ACRO, yes.. as should every pp radonc in the USA.

 

[vm26]

Medicare physician pay fell 26% since 2001. How did we get here?

Medicare’s unsustainable pay system threatens access to care. The failure to update physician pay for inflation is a huge part of the problem.

www.ama-assn.org

For all of you who have had an on and off AMA relationship, I ask you to reconsider.

They are pushing to tie Medicare payments with inflation and blasting out how reimbursement has decreased significantly while education costs, practice costs, complexity, have all increased. Doximity similarly had a good article based on their annual MDsurvey https://press.doximity.com/reports/doximity-physician-compensation-report-2023.pdf
(if you read it, can you believe they actually highlighted the concerns responds markers on there survey? Take some notes ASTRO)

Also a great contrast to how ASTRO “represents” us. The AMA is not perfect, but the best organized group championing a just cause through good data. Consider taking those ASTRO dues and instead donate to AMPAC.

I have no leadership or formal role at AMA or its PAC.

The AMA launched a campaign (last year I believe) called "AMA Recovery Plan for America's Physicians". One of the key objectives being CMS payment reform-mainly eliminate budget neutrality (zero-sums game), and incorporate annual COL increases similar to what Hospitals already have. As a radiologist I joined the AMA for the 1st time. Apparently there is a large coalition of professional societies (Such as ACR, unsure about ASTRO) that is participating with the AMA with CMS payment reform. I had been encouraged with the AMA's efforts thus far and have listened to several of their webinars. Latest one was last night which dealt with August recess and some grass-roots strategies for physicians to utilize. I'm not totally giving up hope but last night was a buzz-kill. To start with, 500 physicians registered and only a small portion actually listened in. The pipe dream of getting a chunk of politicians on board is also extremely challenging. They are getting hit left and right with requests, particularly from lobbyists that have much deeper pockets than our lobbyists do. The CBO has estimated this fix costing something ridiculous over the 10 years (can't recall the #s). Finally the AMA was giving pointers/tips/talking points etc for physicians to use once they secure an appointment or site visit with their reps. I get this but c'mon man. I'm FT in a busy PP with a family and young children. I am not a polished speaker that would be able to engage in a meaningful conversation with a politician...I am becoming to think this is a lost cause and race to the bottom. ACR/ASTRO etc have extremely limited power in really doing much. Most physicians are oblivious and unengaged. It seems to me this is a PP physician issue and CMS/govt would be perfectly content if PP was dead and we were all hospital employees...Next years CMS cuts will apparently be worse. 2023 cuts were -3% but closer to -6% when inflation is factored in.

 

[DebtRising]

This is what lobbying is. Fighting for our rights against other, bigger interests. The AMA is firmly setting out an agenda to increase MD pay in an era when our pay has fallen in inflation adjusted dollars over 20 years while hospitals and pharma execs roll in it on the backs of our hard work.

It will take effort - this is the first coordinated campaign to do this in decades

You don’t have to be a polished speaker, you just have to speak. Especially if you are a community provider in a not so populated area, your voice matters.

Engage the plan if you feel up for it. This is our largest MD lobby and actually is fighting for… MDs. Speciality societies are on board. But if you give up, you give up on yourself.

Even ASTRO I haven’t totally given up hope on, but ASTRO is clearly out to benefit the previous generation of rad onc, not the last 10 years of rad onc grads and upcoming graduates. AMAs push here is to help all physicians. Period. Get everyone on board and expect it to take time

 

[deleted1111261]

I’m getting more and more convinced that AMA makes more sense for us.

It’s hard to get over how blindly they have followed the political winds over the years, though.

 

[DebtRising]

They have, they lost their way and we (as MDs) were politically pimped further as other lobbys pitted MD vs MD, mainly primary care versus specialities.

This is a universal effort to benefit all MDs. It shows me, at least, the AMA understands its mission and trying to rebuild. And both the hospital and pharma lobby want to rip us apart for their benefit. As SK noted, there is also some new blood. The old blood doesn’t understand because they had it so good, or because they can keep having it so good on our backs.

 

[vm26]

I’m getting more and more convinced that AMA makes more sense for us.

It’s hard to get over how blindly they have followed the political winds over the years, though.

Yeah I always got the sense that they were anti-physician (particularly anti-specialist) in some warped way...It does seem however that they have turned things around. They are now also heavy in the fight against mid-level (or mid-level lobby), to blur the lines between physicians and other...All of this will take time so I suppose patience and persistence are necessary

 

[grenz]

 

[sirspamalot]

Yeah I always got the sense that they were anti-physician (particularly anti-specialist) in some warped way...It does seem however that they have turned things around. They are now also heavy in the fight against mid-level (or mid-level lobby), to blur the lines between physicians and other...All of this will take time so I suppose patience and persistence are necessary

I would prefer to just have a direct mechanism.. Ie a PAC focused solely on getting physician pay and control of medicine back to physicians.

Specialty/practice agnostic. Just get us our stuff.

Anyone else feel the same way?

 

[thecarbonionangle]

Yeah I always got the sense that they were anti-physician (particularly anti-specialist) in some warped way...It does seem however that they have turned things around. They are now also heavy in the fight against mid-level (or mid-level lobby), to blur the lines between physicians and other...All of this will take time so I suppose patience and persistence are necessary

It is very interesting to hear this. I have also always heard negative things about AMA and never joined. Online physician groups on social media are always bashing it as basically an anti physician coorporatist shill which constantly is on wrong side of issues. Their monthly mail goes straight to trash. If they do something positive i will reconsider.

 

[elementaryschooleconomics]

I would prefer to just have a direct mechanism.. Ie a PAC focused solely on getting physician pay and control of medicine back to physicians.

Specialty/practice agnostic. Just get us our stuff.

Anyone else feel the same way?

Yup.

Stay tuned.

 

[thecarbonionangle]

I would prefer to just have a direct mechanism.. Ie a PAC focused solely on getting physician pay and control of medicine back to physicians.

Specialty/practice agnostic. Just get us our stuff.

Anyone else feel the same way?

Physicians need to learn from nurses and PAs who constantly get a pay raise. The brain washing and guilt enshrined into our brains from early that good compensation is “greedy” has the house of medicine in current condition. This should be the top issue for the AMA.UPS union just basically doubled their pay. We need to lobby and unionize.

 

[vm26]

It is very interesting to hear this. I have also always heard negative things about AMA and never joined. Online physician groups on social media are always bashing it as basically an anti physician coorporatist shill which constantly is on wrong side of issues. Their monthly mail goes straight to trash. If they do something positive i will reconsider.

Completely agree. They are saying the right things. I joined last year and will give them another 2-3 years to get something done.

AMA Recovery Plan for America’s Physicians​

You took care of the nation. It’s time for the nation to take care of you. It’s time to rebuild. And the AMA is ready.

• Fixing prior authorization
• Reforming Medicare payment
• Fighting scope creep
• Supporting telehealth
• Reducing physician burnout

 

[vm26]

Physicians need to learn from nurses and PAs who constantly get a pay raise. The brain washing and guilt enshrined into our brains from early that good compensation is “greedy” has the house of medicine in current condition. This should be the top issue for the AMA.UPS union just basically doubled their pay. We need to lobby and unionize.

At this point, I think its illegal for physicians to unionize/strike?...If the current status quo continues however, hard to see a scenario where physicians do not form some type of union

 

[Neuronix]

At this point, I think its illegal for physicians to unionize/strike?...If the current status quo continues however, hard to see a scenario where physicians do not form some type of union

I'm all in for unions. I'm slated for a $150k pay cut at my shop this year because of how they are changing the clinical bonus structure. Why? Because **** you, that's why.

 

[NotMattSpraker]

At this point, I think its illegal for physicians to unionize/strike?...If the current status quo continues however, hard to see a scenario where physicians do not form some type of union

I hadn’t heard that. I’m from Chicago and have seen the pros and cons of unions growing up.

I joined one as a resident and was weary at that point.

Then I more thoroughly understood the average behavior of administrators. I am very happy that residencies are unionizing, much needed.

This narrative from a UK oncologist was going around a few weeks ago. It thought it was a good read.

My reasons for striking. - Lucy Gossage

lucygossage.com

 

[dieABRdie]

At this point, I think its illegal for physicians to unionize/strike?...If the current status quo continues however, hard to see a scenario where physicians do not form some type of union

Its illegal for private contractor physician's to unionize and strike (i believe...). Essentially you work for yourself and would be abandoning your patients. Employed physicians.... absolutely can. They just don't do it often.

Why a group of Allina Health Mercy Hospital doctors wants to unionize

Physicians at Allina Health Mercy Hospital are unionizing. They filed a petition for representation through Doctors Council SEIU, which already represents other healthcare workers at Allina Mercy, Unity and other hospitals throughout the state.

www.mprnews.org

 

[thecarbonionangle]

I'm all in for unions. I'm slated for a $150k pay cut at my shop this year because of how they are changing the clinical bonus structure. Why? Because **** you, that's why.

So what are you going to do? That is a dramatic paycut WTF

 

[Neuronix]

So what are you going to do? That is a dramatic paycut WTF

 

[deleted1111261]

There is a lovely center in Garden City, MI with an opening.

So much biryani, kebab and haneeth

 

[elementaryschooleconomics]

Its illegal for private contractor physician's to unionize and strike (i believe...). Essentially you work for yourself and would be abandoning your patients. Employed physicians.... absolutely can. They just don't do it often.

Well, that's the tricky thing...is it really illegal? By definition, can an independent contractor unionize and/or strike? Is there a way to bridge care for patients safely while cutting off the profits to a hospital or system? Or is it all impossible/illegal?

I'll stop short of saying "that's what they WANT you to believe", because it sounds like it's a conspiracy.

There's no conspiracy. It's just that medicine is insanely complex (duh). But so is the structure of our country, with state and federal rules/regulations/laws, then Medicare/Medicaid with private payors, and individual hospital credentialing and privileges etc etc.

Without any formal mechanism for education about "the system", mostly because it takes borderline inhuman effort to become a physician fit for independent practice - a murky system at baseline remains an even murkier system for American doctors.

It's gotten significantly worse with consolidation. When you're a medical student, the only people you can learn soft skills from are the people "in the system".

While some residency programs are community-based at independent hospitals, absolutely none of the Radiation Oncology programs are. So we're stuck, for our entire career, "in the system", until we finally graduate.

The "advice" I was given about jobs and the wider world from the "lifers" academic faculty during residency...just...completely irrelevant and often wrong. Over the last few years, I've had multiple interactions with well-known RadOncs at name-brand places, RadOncs who I would go to if I had cancer, tell me point-blank and very plainly that they don't understand even the most basic aspects of the administrative side.

Heck, it's even in the literature. If you go read a lot of the financial-related papers our colleagues have been publishing, it's clear they don't understand. And the reviewers and editors allowing these papers to be published don't know enough to catch it.

Anyway, the point being that @Neuronix should go to war.

 

[sirspamalot]

You just have to know that saying NO means you may walk out the door.

Be prepared to do so. And in doing so.. free yourself from geographic shackles and W2 RVU black boxes.

This is the way.

#

 

[deleted1111261]

Unions and medicine go together like tuna and cigarettes.

There is enough groupthink already out there. Imagine paying dues to a union and then they go out of their way to make statements on being pro / anti Ukraine, or abortion or whatever, that has nothing to do with radiation oncology AND they continually do nothing to help the specialty or your own personal situation.

We already effectively have a very useless union. If we start paying another group to look out for us, it will inevitably end up as a clusterf*ck. Unions are best for unsafe jobs (don’t equate burnout with being a roughneck off the coast), power dynamic issues (nurses, for example), jobs requiring less formal education (working at Meijer’s).

From working PA, docs don’t realize that they have the power. Medicare ratings are a BFG. Enough reversals and that payor (and third party) will get hurt much more than you will. I fear an appeal more than fear allowing a few extra fractions go (thanks for your wisdom on the ‘gus palliation!). We have power and don’t need to collectively bargain to do so.

Now, what happens is that in academics, they structure it in a way leads to far more infighting then fighting the admins. If one of these places where a bunch of people left at once - if all of them went to the boss and said, “we are walking in 90 days if we can’t get to median salary for our experience” - well, you young ones are seeing the patients. If 5 faculty leave in 90 days, the institution will hurt more than any of the individual docs will. But, it’s catty.

Bob is miserable and leaving and he was vice chief of wellness. Kathy is miserable, but she really wanted to be vice chief of wellness. She figures if Bob goes and she gets the position she wants, life will improve. We all know what happens - things still stay awful and Kathy will eventually leave, too.

If Bob and Kathy and Vijay and Feng all say “hey, we are in 25th percentile of pay, while producing at 75th percentile. Get us a raise, or we are going to bounce in 90 days” - there is power in that. I know of a situation where that happened, and pay structure was revamped.

We don’t have trust in our peers because of the information as currency that is parceled out by leadership. We should do what they do to us. These people just aren’t as powerful as you think. They want to weaponized HR and professionalism? Guess what - at most institutions, they are separate from the clinical management and you can escalate and weaponize (if you have the stomach for it - I didn’t).

I think people presume those above us are in stable positions and those at our level are not. But here’s, the secret … They have way more to lose than you. Because they have more. And are more scared than you of losing it.

 

[sirspamalot]

Unions and medicine go together like tuna and cigarettes.

There is enough groupthink already out there. Imagine paying dues to a union and then they go out of their way to make statements on being pro / anti Ukraine, or abortion or whatever, that has nothing to do with radiation oncology AND they continually do nothing to help the specialty or your own personal situation.

We already effectively have a very useless union. If we start paying another group to look out for us, it will inevitably end up as a clusterf*ck. Unions are best for unsafe jobs (don’t equate burnout with being a roughneck off the coast), power dynamic issues (nurses, for example), jobs requiring less formal education (working at Meijer’s).

From working PA, docs don’t realize that they have the power. Medicare ratings are a BFG. Enough reversals and that payor (and third party) will get hurt much more than you will. I fear an appeal more than fear allowing a few extra fractions go (thanks for your wisdom on the ‘gus palliation!). We have power and don’t need to collectively bargain to do so.

Now, what happens is that in academics, they structure it in a way leads to far more infighting then fighting the admins. If one of these places where a bunch of people left at once - if all of them went to the boss and said, “we are walking in 90 days if we can’t get to median salary for our experience” - well, you young ones are seeing the patients. If 5 faculty leave in 90 days, the institution will hurt more than any of the individual docs will. But, it’s catty.

Bob is miserable and leaving and he was vice chief of wellness. Kathy is miserable, but she really wanted to be vice chief of wellness. She figures if Bob goes and she gets the position she wants, life will improve. We all know what happens - things still stay awful and Kathy will eventually leave, too.

If Bob and Kathy and Vijay and Feng all say “hey, we are in 25th percentile of pay, while producing at 75th percentile. Get us a raise, or we are going to bounce in 90 days” - there is power in that. I know of a situation where that happened, and pay structure was revamped.

We don’t have trust in our peers because of the information as currency that is parceled out by leadership. We should do what they do to us. These people just aren’t as powerful as you think. They want to weaponized HR and professionalism? Guess what - at most institutions, they are separate from the clinical management and you can escalate and weaponize (if you have the stomach for it - I didn’t).

I think people presume those above us are in stable positions and those at our level are not. But here’s, the secret … They have way more to lose than you. Because they have more. And are more scared than you of losing it.

Great. So who is ready to play "Risk. That. Paycheck!"

Today's game is sponsored by: ABC Moving Company. When you need to move fast they're ready for you.

 

[deleted1111261]

That’s interesting.

Your whole negotiating strategy is #750orGTFO.

Doesn’t GTFO mean if the deal isn’t good for you, then you walk?
There is more than just asking for more money. There is more than just unionizing and expecting things to get better. There are many moving parts.

And yes, I’ve had the moments of terror of not having a job after quitting another one. Feels way way way better than day-in, day-out feeling like you’re trapped. I’m no stronger willed than anyone else in this field. But, I think with age and experience, I’m getting much better at risk assessment.

 

[sirspamalot]

That’s interesting.

Your whole negotiating strategy is #750orGTFO.

Doesn’t GTFO mean if the deal isn’t good for you, then you walk?
There is more than just asking for more money.

Yes... I do walk. Run in some cases.

Yes there is more than money. But without the money there is no point in worrying about it.

Sure I could write
#750plus4weeksvacationmustbe1099onlyandnowayinhellarbitrationandtermsofterminationarelimitedasfollows..


But that just isn't as cool. As I tell everyone.. It'd always about the money. And if you're not sure.. Then its DEFINITELY about the money.

#

 

[NotMattSpraker]

This tweet is heading around, it's pretty interesting. I have been watching this topic kind of peripherally, but think we better start paying more attention to scope of practice in radiation oncology. This discussion will become more important and it isn't clear where our societies and advocates stand on the issue.

It sounds like the AMA leads a partnership with many state and specialty medical societies. I was able to find that the ACR participates in the SOPP for AMA. Im not sure what other radiation oncology organizations do, it's hard to find a list.

 

[radoncftw]

Unions and medicine go together like tuna and cigarettes.

There is enough groupthink already out there. Imagine paying dues to a union and then they go out of their way to make statements on being pro / anti Ukraine, or abortion or whatever, that has nothing to do with radiation oncology AND they continually do nothing to help the specialty or your own personal situation.

We already effectively have a very useless union. If we start paying another group to look out for us, it will inevitably end up as a clusterf*ck. Unions are best for unsafe jobs (don’t equate burnout with being a roughneck off the coast), power dynamic issues (nurses, for example), jobs requiring less formal education (working at Meijer’s).

From working PA, docs don’t realize that they have the power. Medicare ratings are a BFG. Enough reversals and that payor (and third party) will get hurt much more than you will. I fear an appeal more than fear allowing a few extra fractions go (thanks for your wisdom on the ‘gus palliation!). We have power and don’t need to collectively bargain to do so.

Now, what happens is that in academics, they structure it in a way leads to far more infighting then fighting the admins. If one of these places where a bunch of people left at once - if all of them went to the boss and said, “we are walking in 90 days if we can’t get to median salary for our experience” - well, you young ones are seeing the patients. If 5 faculty leave in 90 days, the institution will hurt more than any of the individual docs will. But, it’s catty.

Bob is miserable and leaving and he was vice chief of wellness. Kathy is miserable, but she really wanted to be vice chief of wellness. She figures if Bob goes and she gets the position she wants, life will improve. We all know what happens - things still stay awful and Kathy will eventually leave, too.

If Bob and Kathy and Vijay and Feng all say “hey, we are in 25th percentile of pay, while producing at 75th percentile. Get us a raise, or we are going to bounce in 90 days” - there is power in that. I know of a situation where that happened, and pay structure was revamped.

We don’t have trust in our peers because of the information as currency that is parceled out by leadership. We should do what they do to us. These people just aren’t as powerful as you think. They want to weaponized HR and professionalism? Guess what - at most institutions, they are separate from the clinical management and you can escalate and weaponize (if you have the stomach for it - I didn’t).

I think people presume those above us are in stable positions and those at our level are not. But here’s, the secret … They have way more to lose than you. Because they have more. And are more scared than you of losing it.

I totally agree with you.
The devil is non-competes.

I think a lot of people are willing to leave and I can think of 4-5 faculty that have left my large academic training institution in the last year. Non-compete forces you to move. For many that is not feasible and chairs/vice-chairs know that.

 

[deleted1111261]

Yeah, that is a toughie

In the current environment with the federal government moving towards eliminating, I think hospitals will be on edge going too hard.

But, yah, I wouldn’t discount that. Some people feel like they can’t move. I’m not saying they aren’t living their truth - but dude, people move to other continents to improve their life. Sometimes I wonder, what’s a few states away?

(Aside from divorce related purgatory)