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fair for all to take a paycut if specialties bring in $0 and others bring in more?

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  • fair for all to take a paycut if specialties bring in $0 and others bring in more?

    I was curious to get people's thoughts on the following scenario. My wife is an internist at an outpatient clinic associated with a university and a separate group and earns a bit less than your average IM doc (most of her pay is from the group but she gets some $$ from the university too). Her group is very generous with the 401k match which is one reason we're okay with earning less than the average IM doc. With the latest economic issues, they have temporarily done away with their match for 3 months. A bummer but we can live with it.

    The group now needs to cut costs. The group also has many other specialties in it, including ortho, pediatrics, plsatics, radiology, etc. The specialties of course all get paid more than my wife in general, and they aren't billing anything now since elective procedures can't happen. BUT the IM docs are doing telemedicine. Sure they'd bill more with in-patient visits but telemedicine brings in something vs those in the specialties who as far as we can tell are doing nothing and thus bringing in nothing. So the group is looking to make an across-the-board salary cut of 25% to everyone. This seems hugely unfair, no? Shouldn't those who are doing actual work and billing suffer less than those who aren't doing anything? Further, while those in the specialties will have a larger raw dollar amount of their pay cut, they're still getting more money than my wife while she works and they do not. This doesn't seem fair at all. I realize we're all in this together but if we expect the CEO admins to take a paycut if doctors do too, shouldn't those not working take a bigger paycut than those not working?

  • #2
    I'm a eat what I kill type person, even in a pandemic no apologies, so this would not appeal to me but it doesn't sound like she is being offered an option. I also have to wonder if part of the additional rub is that you have felt she is underpaid all along? It seems like the caveats people convince themselves make something worth the sacrifice often aren't when actually put into practice. It might be worth reconsidering if this is the place she wants to work after this crisis has resolved.

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    • #3
      Expecting something similar in my department where half of faculty including me are still working fairly hard (urgent surgeries) and other half are basically on vacation at the golf course right now because they only do elective things at baseline.

      Been thinking about what my response will be to an across-the-board pay cut. Probably not great. But the optics of asking for people you work with to take a draconian paycut or be furloughed so you can keep full salary would be less great. My strategy is to ask that those who aren't working take more call or take on other responsibilities I don't want to do in exchange for me taking a pay cut.

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      • #4
        Originally posted by JBME View Post
        I was curious to get people's thoughts on the following scenario. My wife is an internist at an outpatient clinic associated with a university and a separate group and earns a bit less than your average IM doc (most of her pay is from the group but she gets some $$ from the university too). Her group is very generous with the 401k match which is one reason we're okay with earning less than the average IM doc. With the latest economic issues, they have temporarily done away with their match for 3 months. A bummer but we can live with it.

        The group now needs to cut costs. The group also has many other specialties in it, including ortho, pediatrics, plsatics, radiology, etc. The specialties of course all get paid more than my wife in general, and they aren't billing anything now since elective procedures can't happen. BUT the IM docs are doing telemedicine. Sure they'd bill more with in-patient visits but telemedicine brings in something vs those in the specialties who as far as we can tell are doing nothing and thus bringing in nothing. So the group is looking to make an across-the-board salary cut of 25% to everyone. This seems hugely unfair, no? Shouldn't those who are doing actual work and billing suffer less than those who aren't doing anything? Further, while those in the specialties will have a larger raw dollar amount of their pay cut, they're still getting more money than my wife while she works and they do not. This doesn't seem fair at all. I realize we're all in this together but if we expect the CEO admins to take a paycut if doctors do too, shouldn't those not working take a bigger paycut than those not working?
        I suspect it is reasonable for the folks making money to pay for the overhead. Otherwise...Two months ago, were the other specialties subsidizing your wife? If not, I would tell them to pound sand.

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        • #5
          In salaried position and academic center hasn't approached medical group on paycuts to anyone here nor any rumblings on the RVU based specialities on pay adjustment anticipated this quarter despite the clear loss of elective surgeries/procedures over the past 3 weeks. System is hemorrhaging dollars, but can't really do surgeries when PPE is at a premium

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          • #6
            Originally posted by G View Post

            I suspect it is reasonable for the folks making money to pay for the overhead. Otherwise...Two months ago, were the other specialties subsidizing your wife? If not, I would tell them to pound sand.
            I dont know her groups situation, but I imagine the other specialties were subsidizing your wife's pay, benefits, overhead, etc when they were fully functional. At least, thats how I imagine many groups work.

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            • #7
              Argument #653 for self employment. Top of the food chain in your own business. She wouldn't have been replaceable.

              It may look like she's being involved in the decisions. But in reality she's likely being told what will happen. Primary care is most easily replaceable from a bureaucratic standpoint.

              The severity of the cut in conjunction with the loss of the 401k match suggests this group's finances are not very good despite already relatively suppressed physician salaries, or they're possibly taking advantage of the current economic circumstances. Looking elsewhere may not be a bad idea. I'm getting many more emails these days from headhunters with what appears to still be healthy offers (but not relative to my reward as business owner).

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              • #8
                Originally posted by CK36 View Post

                I dont know her groups situation, but I imagine the other specialties were subsidizing your wife's pay, benefits, overhead, etc when they were fully functional. At least, thats how I imagine many groups work.
                Absolutely not. That's what multispecialty groups tell you, I used to work for one. Now, with my own primary care small business, earning multiple fold my peers.

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                • #9
                  Originally posted by CK36 View Post

                  I dont know her groups situation, but I imagine the other specialties were subsidizing your wife's pay, benefits, overhead, etc when they were fully functional. At least, thats how I imagine many groups work.
                  I think that this is the crux of the matter.

                  Otherwise, compensation reduction should be inversely proportional to the amount of working being done and billings that are generated.

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                  • #10
                    Procedures pay, that's where the money usually comes from, but some of the specialties in demand right now are some of the lowest paying parts of medicine. Take for example IM and ID. Among the lowest 10% of MD compensation. In the ID case, the surveys show it pays less than IM despite 2 years of Fellowship and the economic opportunities of that. You can't support a hospital system though the current norms of billing though consults for non invasive procedures, you just can't.

                    Non procedure MDs it appears will continue to be paid the least, even if they're still working. Your wife's a perfect example.

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                    • #11
                      Originally posted by EntrepreneurMD View Post

                      Absolutely not. That's what multispecialty groups tell you, I used to work for one. Now, with my own primary care small business, earning multiple fold my peers.
                      Hmmm, interesting. So where is all the $$ going? Asking bc when I was looking at jobs not long ago, the private practice docs were taking home more than the employed. I assumed that was so that the employed docs could subsidize the other specialties in the group/hospital that collected less (fair or not) but were vital to the system's success. Are employed MDs all just paying admins or senior partners a share as a percentage of collections, and this accounts for the decreased compensation, while the private practice MDs take that home as well?

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                      • #12
                        Originally posted by JBME View Post
                        The group also has many other specialties in it, including ortho, pediatrics, plsatics, radiology, etc. The specialties of course all get paid more than my wife in general, and they aren't billing anything now since elective procedures can't happen...
                        I'm surprised no one else would be doing anything. Certainly radiology is still working. Peds should be doing tele visits as well. Ortho fractures etc.

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                        • #13
                          all helpful responses-my first reaction when she told me what was being done was she really needs to look elsewhere after this whole thing is over. She's the in-patient clinic director, so she's "in the know" about what's coming down from the top. She's allowed to state her opinion, and does such, but it really doesn't change the direction that the higher ups probably were already going to take. For instance, she actually took the courage to write a superior several levels above her to complain about this unfairness. She got a response back that she was happy with ("we hear you, it's not fair to those who continue to work, I agree, but if we don't do this there will be a hostile takeover or bankruptcy") just because she feels heard even if it actually means no action. The group has been saying they're losing $4-6m per day and there will be some big problems if this lasts until July-August.

                          I also considered some specialty docs here might suggest that they've been subsidizing my wife all these years. I don't think so-even considering all of the benefits she gets on top of her salary, at least according to medscape surveys, she's still a bit below the average IM pay and average IM benefits for an academic doc 8 years out of training. If she was higher than the average, then maybe one could say she's subsidized but no way is that this case here as she's underpaid slightly. Procedures do bring in the most business, and that's why the docs doing that work get paid more. It's not like those who don't do procedures contribute $0 to the business

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                          • #14
                            Originally posted by aerofreaky11 View Post
                            Procedures pay, that's where the money usually comes from, but some of the specialties in demand right now are some of the lowest paying parts of medicine. Take for example IM and ID. Among the lowest 10% of MD compensation. In the ID case, the surveys show it pays less than IM despite 2 years of Fellowship and the economic opportunities of that. You can't support a hospital system though the current norms of billing though consults for non invasive procedures, you just can't.

                            Non procedure MDs it appears will continue to be paid the least, even if they're still working. Your wife's a perfect example.

                            I am fairly new out of training (<2 years). I am curious about this statement since I am quite naive about the "business of medicine." I am a non-procedural sub-specialty hospitalist. I am employed by the hospital and our department is comprised of neurology and neurosurgery. There are 6 physicians and I am the 2nd highest wRVU (only down by 60 through this fiscal year to one of the neurosurgeons). How can I be doing this as a non-procedural based person who literally just does consults and follow ups in the hospital all day in a hospital with high medicare payer mix? Not being argumentative, I am genuinely curious because I do not understand this.

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                            • #15
                              Originally posted by jacoavlu View Post

                              I'm surprised no one else would be doing anything. Certainly radiology is still working. Peds should be doing tele visits as well. Ortho fractures etc.
                              you could be right-if that was the case and everyone was working at least a bit, then I think it's fair to ask for an across-the board cut. But I'm pretty certain at least a few are doing nothing, and they should be cut to $0 for now. They regularly make 2-3x more than the IMs so they can make it rain when things pick up again

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