How to pay partners for working your call

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gasdoc
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How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 5:18 pm

For those of you in medical groups, how do you compensate each other for calls taken or shifts worked on your behalf? In other words, If I want to pay a partner to take my Saturday call, and we are paid a straight salary from our employer, what is the best way to pay each other? Some of the group members have a hard time understanding after-tax payments so that doesn't seem to work (they don't really get how much they pay in taxes!), so I am trying to find a way to compensate them pre-tax. I am guessing it is necessary to fill out and send 1099 MISC's to each of them and to all of the tax entities. Is that what people do? Is there something I might be missing? Thanks in advance.

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sport
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Re: How to pay partners for working your call

Post by sport » Thu Feb 22, 2018 5:21 pm

Can you just exchange calls for each other? Then, it seems no paperwork would be necessary.

Archimedes
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Re: How to pay partners for working your call

Post by Archimedes » Thu Feb 22, 2018 5:40 pm

I would suggest you ask this same question on whitecoatinvestor.com in the forum. There are many docs and other professionals who post there. Your answers will likely be quite helpful over there. This bogleheads forum is for all kinds of folks, although there are some physicians on this site as well.

jacoavlu
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Re: How to pay partners for working your call

Post by jacoavlu » Thu Feb 22, 2018 6:07 pm

cash, if you can't figure out some way to run it through the practice (this is what we do, but we own and run the practice)

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dm200
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Re: How to pay partners for working your call

Post by dm200 » Thu Feb 22, 2018 6:12 pm

No experience in this field, but I would wonder about various kinds of risks associated with one "employee" being paid by the employer for work/time done by another.

Sure seems like the employer could just pay the one doing the hours/work.

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 6:52 pm

sport wrote:
Thu Feb 22, 2018 5:21 pm
Can you just exchange calls for each other? Then, it seems no paperwork would be necessary.
Sometimes that is done. Other times, a more senior member (me) pays a more junior member (everyone except me) to work the senior member's weekend calls.

gasdoc

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 6:53 pm

jacoavlu wrote:
Thu Feb 22, 2018 6:07 pm
cash, if you can't figure out some way to run it through the practice (this is what we do, but we own and run the practice)
Thanks, jacoaviu, Do you deal in pre-tax cash or post-tax cash? Do you deal with 1099's if it is pre-call cash?

gasdoc

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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 6:54 pm

dm200 wrote:
Thu Feb 22, 2018 6:12 pm
No experience in this field, but I would wonder about various kinds of risks associated with one "employee" being paid by the employer for work/time done by another.

Sure seems like the employer could just pay the one doing the hours/work.
Thanks, dm200. Not sure what kind of risks you would be referring to above.

gasdoc

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 6:56 pm

jacoavlu wrote:
Thu Feb 22, 2018 6:07 pm
cash, if you can't figure out some way to run it through the practice (this is what we do, but we own and run the practice)
Thanks, jacoaviu. To this point, we have been running these schedules through the practice, but our ability to do that may end soon. We are employed by a national company (since 2009) and have very little choice in the matter.

gasdoc

jacoavlu
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Re: How to pay partners for working your call

Post by jacoavlu » Thu Feb 22, 2018 7:01 pm

gasdoc wrote:
Thu Feb 22, 2018 6:53 pm
jacoavlu wrote:
Thu Feb 22, 2018 6:07 pm
cash, if you can't figure out some way to run it through the practice (this is what we do, but we own and run the practice)
Thanks, jacoaviu, Do you deal in pre-tax cash or post-tax cash? Do you deal with 1099's if it is pre-call cash?

gasdoc
we don’t deal with cash

We divide our practice income based on days worked, so if we trade around, we change it on the schedule and the payment ultimately works itself out when we split the pot at the end of the year. Make sense?

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Re: How to pay partners for working your call

Post by N10sive » Thu Feb 22, 2018 7:03 pm

gasdoc wrote:
Thu Feb 22, 2018 6:54 pm
dm200 wrote:
Thu Feb 22, 2018 6:12 pm
No experience in this field, but I would wonder about various kinds of risks associated with one "employee" being paid by the employer for work/time done by another.
Sure seems like the employer could just pay the one doing the hours/work.
Thanks, dm200. Not sure what kind of risks you would be referring to above.
gasdoc
I think dm200 is referring to risks involved giving medical advice to a patient while supposedly off and someone else is giving such advice or similar. Say a person needs surgery and the person is covering someone elses shift that is being paid in cash etc and something happens..

Again I have no idea how this works but unless these calls are just say administrative things then okay but if it were to involve some kind of liability......Although judging buy others posters this seems to be common?

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Re: How to pay partners for working your call

Post by daveydoo » Thu Feb 22, 2018 7:11 pm

sport wrote:
Thu Feb 22, 2018 5:21 pm
Can you just exchange calls for each other?
Only way I've ever heard of.

If one individual is buying his/her way out of call to reduce overall call exposure, seems like something that the whole group or leadership or management (if an employed model) should be aware of, imo.
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 7:12 pm

jacoavlu wrote:
Thu Feb 22, 2018 7:01 pm
gasdoc wrote:
Thu Feb 22, 2018 6:53 pm
jacoavlu wrote:
Thu Feb 22, 2018 6:07 pm
cash, if you can't figure out some way to run it through the practice (this is what we do, but we own and run the practice)
Thanks, jacoaviu, Do you deal in pre-tax cash or post-tax cash? Do you deal with 1099's if it is pre-call cash?

gasdoc
we don’t deal with cash

We divide our practice income based on days worked, so if we trade around, we change it on the schedule and the payment ultimately works itself out when we split the pot at the end of the year. Make sense?
I get it. That is what we do now, and they may be taking away our ability to do that. Looking for ways to do it "internally."

gasdoc

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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 7:15 pm

daveydoo wrote:
Thu Feb 22, 2018 7:11 pm
sport wrote:
Thu Feb 22, 2018 5:21 pm
Can you just exchange calls for each other?
Only way I've ever heard of.

If one individual is buying his/her way out of call to reduce overall call exposure, seems like something that the whole group or leadership or management (if an employed model) should be aware of, imo.
The group is aware, and it impacts only those involved in the trade. The only thing that is changing is that the national company is considering no longer supporting the changes and resulting payroll changes.

gasdoc

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kingsnake
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Re: How to pay partners for working your call

Post by kingsnake » Thu Feb 22, 2018 7:16 pm

Our accounting department just takes the money from Dr. Senior's paycheck and adds it onto Dr. Junior's, all pretax. On our pay stub is a separate column called call pay.

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Re: How to pay partners for working your call

Post by DocSleepy72 » Thu Feb 22, 2018 7:23 pm

We just trade shifts/calls to avoid a lot of the headache. As long as it isn't a frequent issue, I would consider paying cash for a call or a shift if trading wasn't possible.

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 7:23 pm

kingsnake wrote:
Thu Feb 22, 2018 7:16 pm
Our accounting department just takes the money from Dr. Senior's paycheck and adds it onto Dr. Junior's, all pretax. On our pay stub is a separate column called call pay.
Thanks, kingsnake. We will have to see what this company decides to do. I'll have to push hard to keep it clean by doing the accounting within the company.

gasdoc

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Re: How to pay partners for working your call

Post by daveydoo » Thu Feb 22, 2018 7:28 pm

gasdoc wrote:
Thu Feb 22, 2018 7:15 pm

The group is aware, and it impacts only those involved in the trade. The only thing that is changing is that the national company is considering no longer supporting the changes and resulting payroll changes.
Kinda makes sense; you're sorta hiring a subcontractor to do your own contracted work.

I know "pay call" was/is big in Anesthesia (I'm inferring that's the genesis of gasdoc) -- presumably because it's all in-house (?). It's just evenly-shared "call" almost everywhere else so there is no monetary value attached. You roll the dice -- sleep like a baby or get killed. It's all baked in...
"I mean, it's one banana, Michael...what could it cost? Ten dollars?"

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Re: How to pay partners for working your call

Post by goodenyou » Thu Feb 22, 2018 7:32 pm

Just cut a check on Monday morning. The one taking the call takes more income (call cost) and pays the extra taxes as income. The one paying expenses it and deducts it. More W-2 for the call-taker. Less W-2 for the call-avoider. We own our own practice, so it's easy.
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Re: How to pay partners for working your call

Post by anil686 » Thu Feb 22, 2018 7:34 pm

Not easy in my experience unless it is a permanent cutback (such as 50% or no call) in which salary can be adjusted. We had floated an idea (when we were 3 and not 2) - of contributing to a pot and paying whoever was on call from the pot every weekend - so if somebody wanted to do more - they could and be compensated for it while being paid by those who did not. the problem arose when we all did not want to work more :)

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 7:35 pm

daveydoo wrote:
Thu Feb 22, 2018 7:28 pm
gasdoc wrote:
Thu Feb 22, 2018 7:15 pm

The group is aware, and it impacts only those involved in the trade. The only thing that is changing is that the national company is considering no longer supporting the changes and resulting payroll changes.
Kinda makes sense; you're sorta hiring a subcontractor to do your own contracted work.

I know "pay call" was/is big in Anesthesia (I'm inferring that's the genesis of gasdoc) -- presumably because it's all in-house (?). It's just evenly-shared "call" almost everywhere else so there is no monetary value attached. You roll the dice -- sleep like a baby or get killed. It's all baked in...
Yes, but ours is a brutal 24 hour ordeal that results in a higher than average salary but is a bit much as you get to the point in your life where you might want to actually enjoy living in the world a bit. The younger guys in the group are very hungry- that is why they work here rather than somewhere else. They like the salary, and the facility likes the fact that they don't have to hire additional providers. I have worked here for twenty-seven years, and would rather work out a call reduction than change jobs. Thanks for the interest.

gasdoc

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 7:40 pm

goodenyou wrote:
Thu Feb 22, 2018 7:32 pm
Just cut a check on Monday morning. The one taking the call takes more income (call cost) and pays the extra taxes as income. The one paying expenses it and deducts it. More W-2 for the call-taker. Less W-2 for the call-avoider. We own our own practice, so it's easy.
Goodenyou, please elaborate. It seems that you are writing a personal check to the call taker, and it is pretax money (needs to be claimed by one and deducted by the other. Do you also send out 1099's? How does it end up on the W2 if you are writing the check yourself? Or is "the group" the entity that is actually writing the check?

gasdoc

bi0hazard
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Re: How to pay partners for working your call

Post by bi0hazard » Thu Feb 22, 2018 7:50 pm

Easy. We do this ALL the time. Salary transfer for standard/pre-determined rate (NO-negotiation needed).

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 7:57 pm

bi0hazard wrote:
Thu Feb 22, 2018 7:50 pm
Easy. We do this ALL the time. Salary transfer for standard/pre-determined rate (NO-negotiation needed).

biOhazard, is this pre-call or post-call? Handled person to person, or does the group manage it and pay for it like we have been doing until recently?

gasdoc

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Re: How to pay partners for working your call

Post by bi0hazard » Thu Feb 22, 2018 8:02 pm

gasdoc wrote:
Thu Feb 22, 2018 7:57 pm
bi0hazard wrote:
Thu Feb 22, 2018 7:50 pm
Easy. We do this ALL the time. Salary transfer for standard/pre-determined rate (NO-negotiation needed).

biOhazard, is this pre-call or post-call? Handled person to person, or does the group manage it and pay for it like we have been doing until recently?

gasdoc
It goes like this. Email goes out to the group before an upcoming shift. First one to accept gets it. The doc getting rid of the shift emails accounting with details. Accounting dept subtracts from original doc salary to the new doc. It's validated on pay stub at the end of the month.

We do this with day shifts, night shifts, vacations, extra-shifts/internal moonlighting, hourly, etc.

Hope this helps.

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Re: How to pay partners for working your call

Post by CppCoder » Thu Feb 22, 2018 8:10 pm

Interesting. In my line of work, if you are salaried, you don't get paid for doing extra things like being on call. It's part of your job. If they wanted to pay by the call, they'd put you on an hourly wage. If the work can be traded, you trade (or ask for favors). If this is simply part of your salary and the expectation for receiving the salary, is it possible for you to ask for a lower salary and commensurately fewer on call days? It sounds like others in the practice would gladly pick up the extra work for more money.

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 8:25 pm

CppCoder wrote:
Thu Feb 22, 2018 8:10 pm
Interesting. In my line of work, if you are salaried, you don't get paid for doing extra things like being on call. It's part of your job. If they wanted to pay by the call, they'd put you on an hourly wage. If the work can be traded, you trade (or ask for favors). If this is simply part of your salary and the expectation for receiving the salary, is it possible for you to ask for a lower salary and commensurately fewer on call days? It sounds like others in the practice would gladly pick up the extra work for more money.
Yes, that would be another way to do it. But that would require a permanent solution, and the others in the group are not willing to permanently pick up extra calls. On a case by case basis, they will take the weekends when they want the money and when they have no serious weekend plans.

gasdoc

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Re: How to pay partners for working your call

Post by raddoc101 » Thu Feb 22, 2018 8:37 pm

We always do it pretax, but have a small partnership and it’s easy for us to arrange payments.

I’ve always wondered if doing it post tax and not reporting it would be considered illegal - can any lawyers/ cpas weigh in? It also could affect what tax rate those dollars are being earned at if the buyers and sellers of call are at different rates - seems like it could be abused and/or considered tax evasion.

Does your national group allow part time? It’s ridiculous they’re considering not facilitating call sales... it really can’t take all that much effort on their part. Did they say why?

Personally, I hope all National corps fail miserably though, so I hope it encourages docs to leave.

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Re: How to pay partners for working your call

Post by jacoavlu » Thu Feb 22, 2018 8:43 pm

super common

Heck we even did this in residency. Those were quiet cash deals of course. Took lots of nights and weekends as a sophomore resident for three figure checks, so the juniors and seniors could go moonlight for four figure checks.

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Thu Feb 22, 2018 8:55 pm

raddoc101 wrote:
Thu Feb 22, 2018 8:37 pm
We always do it pretax, but have a small partnership and it’s easy for us to arrange payments.

I’ve always wondered if doing it post tax and not reporting it would be considered illegal - can any lawyers/ cpas weigh in? It also could affect what tax rate those dollars are being earned at if the buyers and sellers of call are at different rates - seems like it could be abused and/or considered tax evasion.

Does your national group allow part time? It’s ridiculous they’re considering not facilitating call sales... it really can’t take all that much effort on their part. Did they say why?

Personally, I hope all National corps fail miserably though, so I hope it encourages docs to leave.
raddoc101, you make an interesting point about tax evasion, but I am sure it is done. The national corps sure do break the spirit of a group, in my experience of N=1. Again, the problem with the part time solution is that the rest of the docs in the small group of ours would have to agree to permanently take the extra calls and they are not ready to do that. I have to sell the calls on an individual basis to whomever wants them that particular month. It is amazing how there isn't that much difference group to group how this is done. I thought maybe there was some method of buying and selling that might be unique.

gasdoc

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Re: How to pay partners for working your call

Post by arsenalfan » Thu Feb 22, 2018 9:15 pm

Private practice gas passer here. I don't have any solid advice for you - our system wouldn't fit a national group. If I were you, I'd just sell it for a fixed rate to all. E.g. every Sat 24hr call is $XX cash, first-come, first-served. Up to you if you want to file a 1099 for that - I'm sure some here will opine you must, others that you won't get audited, etc.

Friends at Sheridan, team health, napa, and kaiser don't have the option to split shifts or formally dump shifts. They work the 40hr dayshift, or the call pool for more $$$. My understanding is these national firms want the most RVU production with the least FTEs; they also don't see the reason to spend more for an accounting system that lets you swap calls internally - why bother with that, when you can fill the roster with new grads who don't demand it? The older MDs transition to dayshift - or they move to another hospital in the system that isn't as busy/high acuity/has more home call. No graceful deceleration option.

I do have friends at mednax/aa who, so long as they remained financially successful, basically have been left alone to run the group internally as they did pre-buyout. They're pretty happy, as folks can dump shifts at will/overwork themselves at will, based on need, capacity, and desire to do so. The one mednax/aa group who didn't hit targets had a lot of their workforce reshuffled/hours increased.

Good luck! Also, love to hear from national chain MDs who DO have flexibility to trade time for money, and how that works - guess that's the point of this thread!

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Re: How to pay partners for working your call

Post by uclalee » Thu Feb 22, 2018 9:27 pm

We just do a salary transfer on the next paycheck. The person selling the call likes that this income is removed from their W2 and it avoids the whole post tax confusion. We also chose a set price for taking calls to eliminate any need to negotiate rates. In the past some colleagues would pay others via 1099 from their side business but this universally rubbed people the wrong way.

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Re: How to pay partners for working your call

Post by ImaBeginner » Thu Feb 22, 2018 10:19 pm

If you are bonused for production, is there a way to adjust that?
We assign points for days worked and calls. At the end of the quarter our bonuses are split based on yearly ratio of points. It adjusts on the fly, so there sometimes are big shifts at the end of the year if there were a lot of swaps and you end up half a percent higher or lower.
Before we switched to that method we had Wild West of varying dollar payments which worked, but was confusing. Much easier now.

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Re: How to pay partners for working your call

Post by White Coat Investor » Thu Feb 22, 2018 10:40 pm

A good reason for docs to own their jobs. This all seems nutso compared to what we do- a simple market based system assigning a value to each of the 5 shifts- you pick the mix you work. If the shifts aren't covered, the values are adjusted until they are. If there are too many available shifts, we hire and split up what's left until the person shows up. If there are too few available shifts, you deal with it. But everyone is working the number of shifts they want (within 1 a month) and the exact mix of shifts they desire. And nobody has to mess with paying each other on the side.
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Re: How to pay partners for working your call

Post by mt » Thu Feb 22, 2018 10:45 pm

We changed the way we pay ourselves. Original compensation system was production based using ASA units (half base and all time multiplied by the blended unit value). The change involved taking roughly 25% of revenue out and putting a stipend on call. This did drop the value of the blended unit, but in theory if one took all one's calls one should come out roughly equal. Pay is still production based, but now the production aspect includes production for generating units as well as for taking call.

This has created a flurry of call swapping. The younger docs with massive debt love it because by picking up weekend calls they make more and can pay off loans. More senior docs love it because call is now a tradable commodity and they can easily get rid of call. The middle career docs do not care because they make the same as under the old system.

Before making this change, nobody took call for someone else unless they took a similar call in return. Now, if I have a Saturday call I want to get rid of I send out an email and it will be gone in 15 minutes. Literally. Young docs with $350K in debt are very hungry for call that has a stipend associated with it (they get production for doing cases on call as well).

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Re: How to pay partners for working your call

Post by blueman457 » Thu Feb 22, 2018 11:04 pm

In my previous job, we'd pay 50% of the pre-tax value in cash. It wasn't perfect, but it was good enough.

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toofache32
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Re: How to pay partners for working your call

Post by toofache32 » Thu Feb 22, 2018 11:19 pm

I don't understand why it's so difficult.
In the old days when we were not paid to take call, we would simply trade calls. If I wanted to get rid of a call night, I would ask my group if anyone could take it and I would take one of theirs later.

Now that we get paid to cover call, it's even more simple. The hospital pays me X dollars to take call per 24 hours. If one of my partners covers call for me, the hospital pays him instead of me. So simple. This makes it easy for a more established surgeon like me who would rather not treat a bunch of non-paying patients to give the chance for younger docs in the practice who are simply happy to have the measly hospital stipend. Not worth it for me.

I can't figure out what this has to do with production bonuses, etc. If you take the call, you get the money.
Last edited by toofache32 on Thu Feb 22, 2018 11:30 pm, edited 1 time in total.

jacoavlu
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Re: How to pay partners for working your call

Post by jacoavlu » Thu Feb 22, 2018 11:27 pm

because not everyone is paid by a hospital or external entity to take call, and there may not be a contracted dollar amount for a call or weekend or holiday or otherwise less desirable shift. So the market figures it out.

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Re: How to pay partners for working your call

Post by toofache32 » Thu Feb 22, 2018 11:31 pm

jacoavlu wrote:
Thu Feb 22, 2018 11:27 pm
because not everyone is paid by a hospital or external entity to take call, and there may not be a contracted dollar amount for a call or weekend or holiday or otherwise less desirable shift. So the market figures it out.
In that case it's a shared burden and you simply trade calls. This is what my group used to do when we were suckers and did not get paid by the hospital to take call.

spth
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Re: How to pay partners for working your call

Post by spth » Thu Feb 22, 2018 11:33 pm

Pay in cash. The junior doc tells you how much it costs. If you don’t like it, work the call shift. They hold the cards. If I were a physician and your junior, I’d ask for twice the usual pay, pretax, cash.

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Re: How to pay partners for working your call

Post by jacoavlu » Thu Feb 22, 2018 11:37 pm

toofache32 wrote:
Thu Feb 22, 2018 11:31 pm
jacoavlu wrote:
Thu Feb 22, 2018 11:27 pm
because not everyone is paid by a hospital or external entity to take call, and there may not be a contracted dollar amount for a call or weekend or holiday or otherwise less desirable shift. So the market figures it out.
In that case it's a shared burden and you simply trade calls. This is what my group used to do when we were suckers and did not get paid by the hospital to take call.
so when one person wants less call and is willing to give up some money, and another is willing to take more call in exchange for more money, what would you suggest? Only even trades?

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Re: How to pay partners for working your call

Post by toofache32 » Fri Feb 23, 2018 12:04 am

jacoavlu wrote:
Thu Feb 22, 2018 11:37 pm
toofache32 wrote:
Thu Feb 22, 2018 11:31 pm
jacoavlu wrote:
Thu Feb 22, 2018 11:27 pm
because not everyone is paid by a hospital or external entity to take call, and there may not be a contracted dollar amount for a call or weekend or holiday or otherwise less desirable shift. So the market figures it out.
In that case it's a shared burden and you simply trade calls. This is what my group used to do when we were suckers and did not get paid by the hospital to take call.
so when one person wants less call and is willing to give up some money, and another is willing to take more call in exchange for more money, what would you suggest? Only even trades?
I thought you weren't getting paid for call?
If you're not getting paid then the junior guy has no incentive to take your call if you don't reciprocate and take one of his. This is why I said it's a shared burden. I apologize if I'm not understanding.

EDIT: now I think I understand what you're saying.
When I joined our group as the 4th doctor, we weren't paid to take call. Therefore the contracts stated that the most junior guy took the most call and the most senior guy took the least. Our most senior guy actually took zero call at that time. I took call every other week for my entire first year....that's 50% of the total call burden. Then the 2nd most senior guy said "well I've been taking call for many years and I think I won't to stop taking call also." That's when I said whoa whoa this is a slippery slope and that this is a shared burden among all of us. They agreed and we then negotiated with the hospitals to be paid to take call. Now even our senior guy takes some call, although less than others. If you're not being paid by the hospital to take call, then it means you see paying patients and there is still some financial incentive to take call which a more junior doctor will be more receptive to. If so, then the junior doctor can simply be put on the schedule more often. If this financial incentive does not exist, then you need to re-evaluate why you are taking call in the first place. One of our hospitals stopped paying us to take call, so we said fine we won't take call. It's the way the rest of the world works. I'm not aware of any other industry that agrees to get up at 2am on Saturday night to go to their place of business, to see a customer they have never met, who likely will not pay them, and can still sue them for everything. Certainly not very boglehead.

jacoavlu
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Re: How to pay partners for working your call

Post by jacoavlu » Fri Feb 23, 2018 12:23 am

we actually do get paid by a hospital to take call, but it’s a non-issue. I’d gladly give all night call to my partners (all more senior than me) and they could have all the call pay. I’ll spend some evening time with my wife and kids. As it is I average q3, which is more than my partners, and I’m ok with it.

That’s not the point. It’s about time, and you can’t make more of it. In many fields someone is willing to pay a partner (often more junior) to take their call, and if both sides are happy with the arrangement then all is well.

toofache32
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Re: How to pay partners for working your call

Post by toofache32 » Fri Feb 23, 2018 1:09 am

jacoavlu wrote:
Fri Feb 23, 2018 12:23 am
we actually do get paid by a hospital to take call, but it’s a non-issue. I’d gladly give all night call to my partners (all more senior than me) and they could have all the call pay. I’ll spend some evening time with my wife and kids. As it is I average q3, which is more than my partners, and I’m ok with it.

That’s not the point. It’s about time, and you can’t make more of it. In many fields someone is willing to pay a partner (often more junior) to take their call, and if both sides are happy with the arrangement then all is well.
I'm the same way. I'm the most junior person and the pay for call is minimal and hardly worth it when I could be with my family. The hospital that stopped paying us was only paying us $12.50 an hour and we didn't miss that at all when they stopped. They looked at it as many of those hours we weren't called so they were paying us for nothing. But they refused to recognize that I still have to stay home, I can't go to a Texas Rangers game 30 minutes away, I can't drink, can't take my kids out to dinner, and I have to be able to go in on a moments notice. There is a cost to that.
I do have 2 Fellows who share call and can cover for me but it's rare I ask them because I treat them very well and I don't want to abuse them.

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gasdoc
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Re: How to pay partners for working your call

Post by gasdoc » Fri Feb 23, 2018 6:31 am

White Coat Investor wrote:
Thu Feb 22, 2018 10:40 pm
A good reason for docs to own their jobs. This all seems nutso compared to what we do- a simple market based system assigning a value to each of the 5 shifts- you pick the mix you work. If the shifts aren't covered, the values are adjusted until they are. If there are too many available shifts, we hire and split up what's left until the person shows up. If there are too few available shifts, you deal with it. But everyone is working the number of shifts they want (within 1 a month) and the exact mix of shifts they desire. And nobody has to mess with paying each other on the side.
White Coat Investor, thanks. All I can say is, I wish. Prior to the national boys moving in, we just picked docs that were like minded to be in the group and shared everything equally among the partners. Now....

gasdoc

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sleepysurf
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Re: How to pay partners for working your call

Post by sleepysurf » Fri Feb 23, 2018 7:16 am

gasdoc wrote:
Thu Feb 22, 2018 6:56 pm
...To this point, we have been running these schedules through the practice, but our ability to do that may end soon. We are employed by a national company (since 2009) and have very little choice in the matter...
Have you spoken to your local or national management team about this? The Anesthesia market is pretty tight right now, and will be for the foreseeable future, so being able to internally accommodate "call swapping" and/or "slowdown" and "job-sharing" tracks is a useful recruiting tool. For the national firm, the cost of implementing an accounting system to handle that should be far cheaper (especially when amortized across multiple practices) than dealing with high turnover or needing locum coverage.

My group (one of the major National firms) handled this by paying everybody a "Base" FTE salary, with additional "Call Pay" tallied each month. Mon - Thu Calls were paid equally, with Fri, Sat, and Sun each having an additional premium pay (as agreed to by all partners).
Retired 2018 | ~50/45/5 (partially sliced and diced)

kenoryan
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Re: How to pay partners for working your call

Post by kenoryan » Fri Feb 23, 2018 8:54 am

Assign a cash value to the call. Then pay half of that in cash to the guy taking your call. That would be what he would make if you paid him pretax.

It is so much easier when reimbursement is based on production. Saves you the hassle of trying to put a $$ value to the call.

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dm200
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Re: How to pay partners for working your call

Post by dm200 » Fri Feb 23, 2018 9:52 am

gasdoc wrote:
Thu Feb 22, 2018 6:54 pm
dm200 wrote:
Thu Feb 22, 2018 6:12 pm
No experience in this field, but I would wonder about various kinds of risks associated with one "employee" being paid by the employer for work/time done by another.
Sure seems like the employer could just pay the one doing the hours/work.
Thanks, dm200. Not sure what kind of risks you would be referring to above.
gasdoc
Not in the medical field at all - BUT (as a patient) this whole "swapping" scares me for several reasons.

So, as I understand, Dr Jones is scheduled to work and is on the schedule. BUT - Dr Jones wants Dr Smith to work for her. The records show Dr Jones - and I (as a patient) have some kind of "problem" and I then find out that Dr Smith was really there - and maybe they have different qualifications. Or, maybe, Dr Smith (who needs/wants more money) is working 100 hour weeks and is not completely alert. Maybe certain rules are being violated. An analogy would be bus or truck drivers who drive more hours than the records indicate.

There is also, it seems to me, a payroll/tax/reporting "issue" if Dr Jones is paid on the books for working the shift buy Dr Smith was there. This looks like (or is) falsifying time sheets or payroll records. Not good (to say the least)

If swapping or switching or subbing is ok in all other respects, then why not have the records reflect who is on duty?

This whole discussion undermines faith in the medical system.

Katietsu
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Re: How to pay partners for working your call

Post by Katietsu » Fri Feb 23, 2018 10:14 am

dm200 wrote:
Fri Feb 23, 2018 9:52 am
gasdoc wrote:
Thu Feb 22, 2018 6:54 pm
dm200 wrote:
Thu Feb 22, 2018 6:12 pm
No experience in this field, but I would wonder about various kinds of risks associated with one "employee" being paid by the employer for work/time done by another.
Sure seems like the employer could just pay the one doing the hours/work.
Thanks, dm200. Not sure what kind of risks you would be referring to above.
gasdoc
Not in the medical field at all - BUT (as a patient) this whole "swapping" scares me for several reasons.

So, as I understand, Dr Jones is scheduled to work and is on the schedule. BUT - Dr Jones wants Dr Smith to work for her. The records show Dr Jones - and I (as a patient) have some kind of "problem" and I then find out that Dr Smith was really there - and maybe they have different qualifications. Or, maybe, Dr Smith (who needs/wants more money) is working 100 hour weeks and is not completely alert. Maybe certain rules are being violated. An analogy would be bus or truck drivers who drive more hours than the records indicate.

There is also, it seems to me, a payroll/tax/reporting "issue" if Dr Jones is paid on the books for working the shift buy Dr Smith was there. This looks like (or is) falsifying time sheets or payroll records. Not good (to say the least)

If swapping or switching or subbing is ok in all other respects, then why not have the records reflect who is on duty?

This whole discussion undermines faith in the medical system.
There is no problem here from a care perspective. Dr Jones and Dr Smith are both qualified. Your records will reflect the doctor who sees you or speaks with you. When you go to the hospital or call the hospital, you did not know in advance if you were going to see Dr Smith or Dr Jones anyway. The hospital and medical records will reflect who was on duty. The difficulty is only with the payroll system for employed physicians being inflexible. In many cases, no one is being specifically paid to work when everyone keeps their shift. It is just generically part of the job that you will be on call every fourth week, or every eighth day or whatever it is.

It should not undermine your faith in the system. Just the opposite. You have highly trained people who are willing to restrict their personal activities to be ready to come and help you at anytime. They often do this for no additional pay.

jacoavlu
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Re: How to pay partners for working your call

Post by jacoavlu » Fri Feb 23, 2018 10:30 am

gasdoc

I'm curious how the national company comes in? Do they come to your group and make a friendly offer? Or go to the hospital for the contract, and then come to you?

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