The Great Resignation is producing tremendous challenges for physicians. In particular, many “senior” physicians (some as young as 50 years old) are simply throwing in the towel and resigning rather than continue with the brutal schedules imposed by many employers. As physicians leave, it is becoming increasingly difficult to recruit new talent, so in many cases the remaining physicians are forced to take up the “slack.” That “slack,” of course, represents the patient contact hours and call coverage schedule that burned out the physician or physicians who left.
As the burden on physicians increases, the value of these physicians should also increase. That would be the case in any rational system. However, the U.S. health care system is anything but rational, so in most cases physicians are forced to accept incredible burdens as “part of the job.”
As a physicians’ attorney with 40 years of experience, I never cease to be amazed by the resilience of physicians. However, I must admit that I also become discouraged by the unwillingness of most physicians to look after their own welfare as well as they look out for their patients.
No other professional would require this advice, but physicians should realize that the Great Resignation, in addition to imposing incredible burdens upon them, also presents the perfect opportunity to consider renegotiating their employment agreements. Employers know that recruiting physicians is expensive and time-consuming. Physicians are in massive demand, so finding a new position will not be difficult. Employers have to worry that losing yet another physician will so overburden the remaining physicians that a mass exodus may result.
Accordingly, the position of physicians right now could hardly be stronger. The question to me is not if you should negotiate – it is more appropriate to ask what should be negotiated. The simple answer to that question is “everything.”
If you have not compared your current compensation to Medical Group Management Association (“MGMA”) benchmarks recently, now would be an excellent time to do so. Note that MGMA benchmarks in many specialties can be filtered for years of experience, as well as minor geographical areas. Your compensation may be close to median nationwide for physicians at all levels of experience, but it may be below median for physicians with your experience in your current practice setting.
A retention bonus seems like the minimum that should be requested. If you are performing administrative duties, perhaps a medical directorship should be considered (with appropriate additional compensation). MGMA has benchmarks for medical directorships, and also has benchmarks for call coverage and compensation for excess call coverage. As more physicians leave, it is likely that the call coverage currently performed by the remaining physicians is in excess of MGMA benchmarks. Now might also be the time to request a limitation on call (e.g., no more than 1:5).
Now would also be a good time to request appropriate staffing. A scribe would not only make your life easier, but would certainly be less expensive for the employer than replacing a burned-out physician spending countless hours at night maintaining the EHR. Productivity compensation also seems appropriate to compensate physicians for the increased workload they are facing.
Does your contract discuss patient contact hours? It should. Now is the time to request a maximum of 32 patient contact hours per week, to give you adequate time for charting and other administrative duties. Even if the employer only meets you halfway, 36 patient contact hours would at least give you some time to update the EHR during working hours.
Most hospitals give starting physicians a cell phone and usage plan. Do you have one? In addition, you might request board recertification fees and payment of professional society dues separate from your CME allowance. You might also request payment of the AOA or AMA dues, as well as state and local medical society dues outside of your CME allowance.
New physicians frequently get medical school debt assistance. Is there a reason that you should not get that too?
Now might be the time to request limitations on where you can be assigned. If tail coverage is not addressed in your contract, perhaps the employer could agree that tail coverage will be paid under all circumstances when you leave.
If you are in a private practice, you may want to consider asking for accelerated consideration of partnership.
There are numerous ways your contract (and your life) can be made better. If you do not want to do it for yourself, do it for your patients. A burned-out physician will not give those patients the same quality of care as a reasonably rested physician would give. For the sake of your patients, please renegotiate your contract!
Dennis Hursh is a veteran attorney with over 40 years of experience in health law. He is founder, Physician Agreements Health Law, which offers a fixed fee review of physician employment agreements to protect physicians in one of the biggest transactions of their careers. He can also be reached on Facebook and LinkedIn.
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