tag:blogger.com,1999:blog-5393996338560944889.post1610062574065245661..comments2024-03-02T02:26:00.928-05:00Comments on bleakonomy: An odd fight to picktetracontadigonhttp://www.blogger.com/profile/04604381739383227553noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-5393996338560944889.post-17611362353362647642009-09-04T07:51:14.063-04:002009-09-04T07:51:14.063-04:00Thanks. I look forward to your observations and c...Thanks. I look forward to your observations and criticisms.Gadfly Johnnoreply@blogger.comtag:blogger.com,1999:blog-5393996338560944889.post-80633738126526971422009-09-03T08:46:31.637-04:002009-09-03T08:46:31.637-04:00Ohhhhhhhhh. So, you're basing your comments o...Ohhhhhhhhh. So, you're basing your comments on some imagined future reality of your creation. Gotcha.<br /><br />I'm still reading the Atlantic article. When I finish it, I'll probably post something.Danhttps://www.blogger.com/profile/11213051268392108382noreply@blogger.comtag:blogger.com,1999:blog-5393996338560944889.post-90867497298806852852009-09-02T13:48:27.422-04:002009-09-02T13:48:27.422-04:00I'm saying that the Feds may well have a great...I'm saying that the Feds may well have a greater say in your employer's ability to fire you if the Feds start writing more of the checks. That's all. Remember the NEA.<br /><br />If/When we get back to 10% inflation per year, you might not be so happy with those 5 year deals.<br /><br />The Atlantic article I cited in another post asks a reasonable question: most ER physicians are salaried (all the ones I know are), and the buying power of the entire hospital is there to keep equipment and supply costs down, so why is ER care such an expensive thing?Gadfly Johnnoreply@blogger.comtag:blogger.com,1999:blog-5393996338560944889.post-86828491340414186972009-09-01T15:14:42.339-04:002009-09-01T15:14:42.339-04:00"You'll need a professional grievance boa..."You'll need a professional grievance board to handle those "concerns" that will inevitably arise about the competency and work ethic of fellow physicians but fail to be resolved over coffee or by the medical director (who surely cannot fire physicians without a lengthy paper trail and due process). The seniority part is good, the Union will love that, as it will keep patients from bypassing the lazy old curmudgeon who fails to keep up with the times in favor of the bright young bundle of energy with the nice bedside touch."<br /><br />Uhhhhh... John, I fail to see why it would be harder to fire me if I were salaried than it currently is when I am paid using a revenue-based model. Please explain to me what the difference would be.<br /><br />And, re: salary renegotiation every five years, pray tell how often you think my pay increases based upon the flux of how many patients I see. <br /><br />Finally, what is this "career progression" of which you speak? What kind of career progression do you think exists for physicians in hospital-owned practice? The area of medicine that offers the clearest path to a progressive career is in academia... which tends to be salaried.Danhttps://www.blogger.com/profile/11213051268392108382noreply@blogger.comtag:blogger.com,1999:blog-5393996338560944889.post-5797051646548361092009-09-01T13:57:30.512-04:002009-09-01T13:57:30.512-04:00Salary adjustments every 5 years? You certainly a...Salary adjustments every 5 years? You certainly are not expecting the return of old Demon Inflation, despite President Scary-Smart's stunning deficits. I think you'll need a better contract to retain talent. I'm also not sure what the career progression is from reading your ideas.<br /><br />One more point. I would expect this to turn out much like Teacher's Unions, since there is a significant Federal aspect to the funding. Those omniscient Members will want to have their say about how the money is handed out!<br /><br />You'll need a professional grievance board to handle those "concerns" that will inevitably arise about the competency and work ethic of fellow physicians but fail to be resolved over coffee or by the medical director (who surely cannot fire physicians without a lengthy paper trail and due process). The seniority part is good, the Union will love that, as it will keep patients from bypassing the lazy old curmudgeon who fails to keep up with the times in favor of the bright young bundle of energy with the nice bedside touch.<br /><br />All in all, it is nice to see such idealism remaining in the medical profession.Gadfly Johnnoreply@blogger.comtag:blogger.com,1999:blog-5393996338560944889.post-50197925230513800862009-09-01T08:47:23.187-04:002009-09-01T08:47:23.187-04:00"Greetings, Dr. X. We are delighted that you..."Greetings, Dr. X. We are delighted that you have decided to join one of the affiliated practices of the Mid-Maine Medical Co-operative and Lobster Pound. We pride ourselves on our delivery of competent, compassionate care, as well as the best lobster roll in northern New England.<br /><br />As per your contract, your starting salary is [xxx,xxx], which is commensurate with national and regional trends for members of your specialty. (Please see attached informational sheets.) We feel that this salary is competitive, and represents a reasonable approximation of what the local market can sustain. You will receive additional compensation for additional services provided (eg. attending high-risk deliveries, taking additional call, etc.) if you opt to participate in that provider pool. Further, should your practice hit certain quality benchmarks (eg. a threshold number of asthmatic patients receiving flu immunizations yearly), third-party quality care payments will be disbursed to you and your colleagues in the practice.<br /><br />Revenue data for your practice will be aggregated before being reported to Co-op administration. It is assumed that you and your colleagues will structure your schedule in keeping with your collective professional expectations. It is further assumed that any concerns about any individual provider pulling his or her own weight in the practice will first be addressed by your colleagues in conversation with that provider. Your medical director will arbitrate any long-standing grievances, and concerns will be communicated to Co-op administration only if these preliminary steps prove fruitless.<br /><br />Every five years, salaries are open for renegotiation. Cost of living and changes in national and regional benchmarks for your specialty will be taken into consideration, as well as provider seniority. We are confident that we will be able to keep your salary competitive.<br /><br />We look forward to a long and mutually beneficial professional relationship."Danhttps://www.blogger.com/profile/11213051268392108382noreply@blogger.comtag:blogger.com,1999:blog-5393996338560944889.post-40058680476856437132009-08-31T19:49:22.383-04:002009-08-31T19:49:22.383-04:00How can you decouple salary from revenue generatio...How can you decouple salary from revenue generation? At company X, the salary of the employees depends upon how well Company X does revenue-wise. Revenues up, salary pool up, pay raises happen, everyone happy. Revenues down, salary pool down, pay cuts possible, no happiness. It is especially interesting when individuals can be measured in impact to the bottom line; sales is a great example. Sales employees have quotas to meet.<br /><br />OK, so, you are running the Maine physicians cooperative 134. How do you set salaries? Wouldn't the temptation be to look at the revenue generated by each physician? Surely there must be some link between money brought in and salary.Gadfly Johnnoreply@blogger.com