Tag: doctors

Doctors need to understand their worth

Doctors need to understand their worth

There was a recent news brief stating that the average internist generates about $2.4 million annually for the hospitals that they work for.  While it’s no surprise that doctors help others make money, seeing a figure to your worth hammers home how much we sustain the healthcare system, often at our own expense.

This basically means that a Hospitalist making $240,000 a year doing average work for the hospital is working with a 90% overhead!  This is not just a matter of robbing Peter to pay Paul—this is robbing Peter, Paul, and their  children to pay the king!  I certainly wouldn’t want to be running a business with a 90% overhead.  Those of you who are hospitalists probably know of the various incentive programs that your hospital offers to its doctors for good work:

  • A $10,000 annual bonus for twelve consecutive months of good patient satisfaction scores.
  • A $5,000 quarterly bonus for handling more admissions from the ER.
  • An invitation-only steak dinner catered by the hospital for a year of prompt charting.

Now this article is not intended to get all doctors to strike, but we do have to sit back and realize that we’re getting moldy carrots for a whole lot of work.  In case you were wondering, those fat cats occupying the C-suite are getting steak dinners more than once a year.

How does a Hospitalist bring in $2.4 million to the hospital?

This is more of a thought exercise, but I’ve had colleagues tell me that their RVUs amount to a fraction of this $2.4 million figure.  Sometimes, hospitals show doctors their RVUs simply to shame them into working harder—maybe comparing them to each other or showing that a particular doctor isn’t meeting the baseline number of admissions.  Not all RVUs are created equal, but that will be a discussion in another article.
In order to follow the dollar signs, you have to look at what can happen with every hospital admission:

Even though the primary doctor only brings in direct revenue from daily exams, labs, and diagnostics, all of the consultants downstream generate even more money for the hospital.  Remember that revenue comes both in the form of professional and technical charges.  The technical and facilities charges bring in serious amounts of money into the system. Just look at some of the bigger hospitals in metropolitan areas—they are all renovating their facades and public spaces in order to attract more patients.  The money is coming in somewhere, and doctors play an integral role in capturing that revenue for the hospital.

The conundrum of the doctor

Unfortunately understanding the money trail isn’t going to get your hospital to pay you more.  The issue has to do with numbers.  Just as hospitals are trying to supplant M.D.’s with physician extenders who can follow protocols at a lower salary, the more doctors of your “type” there are, the easier it is for the hospital to hire.  In the medicine world, internists are a dime a dozen—you can always be replaceable if there is someone out there willing to do your job for less pay.  More specialized doctors may have more leverage in the health system, they are still replaceable.  I’ve seen highly trained specialists in metropolitan areas become replaced by hospitals when they gripe about work hours or inadequate salaries.

The more work for less pay issue doesn’t sit well with me—we all obviously have different thresholds on our worth, but the lack of uniformity among our profession contributes to our downfall.  I’d imagine that starting debt after our training contributes to our willingness to negotiate higher salaries, as does our starting net worth.
Until we find a more unified front to combat the system, I simply continue to tell my trainees to learn as much about the healthcare system as they can if they intend to practice medicine. 

What would you suggest doctors should do to qualify our worth?

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Negotiating Pitfalls for the young doctor

Negotiating Pitfalls for the young doctor

In an ideal world, we should all be compensated fairly for our services and skills.  The reality, as we all experience, is an amalgam of mistakes and victories.  One hopes that with time our skills will translate to a greater number of victories.  Most greenhorns entering the workforce are unfortunately poorly equipped to assess their worth.  I certainly was.  

Greenhorn doctors stand to lose a financial lot from mistakes simply because doctors tend to experience a significant jump in income after they finish their formal training.  Seemingly inconsequential mistakes can end up costing us a lot of green and sleep over time.

The significant jump in salary signals a well-deserved reward at the end of the rainbow, but what doctors frequently fail to recognize is how big or small that pot of gold ought to be.  In some ways it is difficult to believe that relatively intelligent, hard-working people who become doctors can have so little clue about our worth.  When I was in my training, business sense certainly wasn’t in the medical school or residency curriculum.  I doubt that much has changed over time either.

The last time I interviewed a high school student from New Jersey for college, I asked her if she knew how to pump gas.  The response was an overwhelmed deer in the headlights look.  (New Jersey law still doesn’t permit people to pump their own gas)  It really isn’t that difficult to find voids in one’s fund of knowledge, no matter how intelligent anyone is.

When I was a fledging greenhorn coming out of my training, I made plenty of mistakes in looking for a job.  Some of factors I overlooked were so egregious that I probably deserved to fumble.  Live and learn, as they say.  January and February are the typical months of year that graduating trainees start looking for jobs.  This is also the time I start getting questions about job hunting. 

I figured it was time to distill some of my impressions about rookie mistakes into a post.  

Underestimating your worth

Medical trainees provide way too many services pro bono.  In my training, I moved gurneys, waited for up to an hour over the phone for health insurance companies, cleaned up excrement, and performed many duties that didn’t require busting my ass.  When trainees enter the workforce, life suddenly becomes easier in most respects.  

What do you say when you’re offered this to take call on Christmas eve?

Sometimes if life becomes easier no matter how you spin it, we may be more willing to take anything we are given.  Maybe your potential employer intends to give you a signing bonus of $5,000.  Great!  Would you think any differently if they gave your coworker an $8,000 signing bonus instead? That’s where doing your research will pay off.  Most medical graduates do a good job in their sleuthing skills, because that’s what medicine is all about. 
The key is actually going to the right sources.  Your friends who are several years into practice can give you pointers.  But relying solely on their experience can only give you a certain picture into the situation.  Your friends might share similar views that you do, or even think like you do.  They are likely to provide the information that you want to hear, but there is also a possibility that their mindset leads them to overlook certain aspects of the job world that you’d miss too. 

Pro tip: Ask doctors who may be in a different generation as well as other maybe even in another specialty about their wisdom.  Get the advice of others who have worked for the employer that you’re considering, or those who have paved a career similar to what you envision your career to be.

Overestimating your worth

Not understanding your skill level can lead doctors to ask for too much as well.  There are statistics out there that include median starting salaries along with median mid-career salaries of all the specialties.  The problem is that these are median numbers, and you have to be able to extrapolate the statistics.  

For instance, if you plan to join a bustling medical practice that is drowning with patients you will be busy very quickly.  However, most new doctors fail to recognize that they still need time to ramp up their practice patterns. Just because the retiring doctor who touch-typed was seeing 100 patients a day doesn’t mean that you could see 120.  In fact, as someone learning the ropes you might only be capable of doing a fraction of the work and maybe even at a fraction of the quality!  There may be reasons why the employer would consider starting you at a much lower salary as someone else with a decade of practice under their belts.

Pro tip: Go into your negotiations with the facts, and make your potential employer give you good reasons why they think that you’re worth what they’re offering you. If you can prove them wrong, you can command a better arrangement. Just be aware of your own limitations too. Gray hair does come with some benefits.

Overestimating what the employer can afford

This is a touchy subject.  Financially and business savvy new doctors can make very informed decisions about their qualifications and practice goals to potential employers.  The problem arises when everything is a great fit except that the potential employer isn’t actually able to financially afford what you’re asking.  Sometimes this happens.  

Pro tip: You cannot earn more than your boss. If you do, then they are in either a horribly desperate situation to bring you on board or a situation to make you work like a dog.  Neither situation is sustainable long-term.

You have to set realistic expectations in any situation. I have known plenty of doctors who calculate how much they should be earning based on professional charges, negotiate based on expected overheads, and anger many potential employers.  The reason? Many of these doctors don’t realize that there is give or take. They may have underestimated the costs of running a business.  

Pro Tip 2: Do your homework. Go into your negotiations with reasoning. But don’t forget that you could be wrong too.

What other tips do you have for new doctors?