MORE WORK. LESS MONEY. |
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"Psst, I've got a deal for you. Want to work harder, but for the same money?"
If I asked you that, you'd look at me as if I were nuts. But, chances are, if you're a physician in a hospital-based group, your group has jumped to accept that same deal, perhaps even more than once. A classic example is the situation in which a hospital seeks to expand its O.B. service line from the current level of a handful of deliveries each week, even though its market is such that the expectant mothers are likely to be heavily from the Medicaid population. The hospital "asks" (you can read this as "demands") its anesthesia group to provide 24/7 in-house coverage in order to attract obstetricians to use the facility. The group is now faced, at a minimum, with having one of its physicians stay overnight in the hospital, when he or she might be doing only a few cases a week and generating very few dollars. Yet groups often agree to these demands due to the mistaken belief that voluntarily providing more services will endear the group to the hospital's administration. Although I counsel that hospital-based groups need to create unique experiences for their referral sources, patients and hospitals (see my article on creating an experience monopoly http://www.advisorylawgroup.com/experiencemonopoly.html), they should not take on new coverage obligations without a concomitant financial reward. If sufficient reward does not come from patient services, it must come from the hospital.
Failing to obtain a quid pro quo leads to two unfavorable results: 1. The group works harder for the same money, destroying morale and making it harder to recruit and retain.
2. The group creates a new, coverage/stipend status quo level in the mind of administration. In other words, if the hospital later adds additional service requirements, the entire preexisting level of both compensated and uncompensated services will be thought of by the hospital as the baseline for discussing new financial support. This is simply another factor in a widening Workload-Reimbursement Gap™ that further exacerbates the inability to recruit and retain. Groups must be proactive in defending against any variant of what I've described here as the O.B. coverage scenario (note that the situation is the same for any hospital-based group, the specific type of increased service demanded is not what is important ... the fact that there's an increase is). This requires a coordinated strategy in respect of many elements of the group's operations. Among other things, the group must be vigilant in defending its workload obligations, and it must work, in advance, to gather data, and frame the issues, to support higher end fair market valuations.
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DOES YOUR MEDICAL GROUP HAVE A FUTURE?
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In the course of speaking to residents I'm often queried as to what questions they should ask when on an interview.
Of course, they're interested in knowing things like how much they will be paid, what's the work schedule generally like, and what the call obligations are. But they rarely think of asking the basic question, one so basic that not only every resident and other prospective physician employee or subcontractor should ask, but one with which every member of every medical group should be concerned: Does this medical group have a future? Here are a few of the specific questions I tell the residents to ask to ferret out the true state of affairs: 1. Can you tell me where the group sees itself being in five years?
2. Is there someone, not a committee, in charge?
3. Does the group have a strategic plan?
4. How often is it updated?
5. Is there someone in the group's leadership who manages the plan? May I speak with him or her?
6. Are there substrategies in place for each area of the group's business and are they coordinated with the group's overall business strategy? What are some of the substrategic areas that the group has focused on?
7. Does the group coordinate its tactics with its strategy? Can you give me some examples?
8. (If the group is hospital-based) Do you have an exclusive contract? If so, how long have you held it? How long does it run? What leverage have you created to help assure its continuation? What leverage have you created to help assure the group's continued existence in the event the exclusive contract is terminated? These are just a few of the questions you should be asking yourself. Once they and the others are asked, one question still remains: If your group does not have a future, what are you doing to change its circumstances . . . or your own?
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THE 6 GOLDEN RULES OF CRAFTING PHYSICIAN EMPLOYMENT AGREEMENTS AND SUBCONTRACTS
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RECENTLY PUBLISHED ARTICLES |
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THE IMMEDIATE LEADER EXPERIENCE™
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You're a physician who wants to form a medical group and, among other things, subcontract with or employ other physicians, enter into exclusive contacts, obtain significant stipend support money, create related entities to increase protection and the like. And you want to come up to speed on all of this immediately.
Or, you're the new leader of an existing group with complex practice and business operations -- you need to understand how to master the group's organizational, operational and leadership issues -- and you need to be brought up to speed immediately.
After having regularly dealt for many years with physicians in both of these contexts, we've designed a process to deliver immediate results: The Immediate Leader Experience™.
The Immediate Leader Experience™ takes place over a weekend in Santa Barbara, California and includes two nights accommodation at the Four Seasons Santa Barbara Biltmore Hotel.
In two short days, you'll be entirely up to speed, totally prepared and confident. You'll be armed with tools and sample documents.
Due to the nature of this program, admission is upon interview only -- there is extremely limited availability.
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THE WISDOM. APPLIED. BLOG |
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