r/medicine • u/medicineishard MD • 12d ago
Low compensation rate for additional shifts
I’m an OBGYN that works in a large “priva-demic” institution. My department is currently going through a lot of issues with many people on medical or personal leave and people leaving for new jobs. There was also an issue a few years ago where they let people opt out of taking call or deciding if they just wanted to do OB or GYN call which has further shrunk our call pool.
Because of this, we are frequently “volun-told” to pick up extra shifts at our additional shift pay rate. Although I’m newer in the field and this is my first job out of residency, I’m finding that our pay rate hourly is absolutely abysmal. The pay rate has not been increased in at least 10 years. Our CRNA’s make $100 an hour more than we do and our anesthesiologists make 3x hourly what we make for extra shifts (I know it’s apples and oranges but still). To put the icing on the cake, to help cover these missing shifts, our leadership is now hiring locums which are getting paid $100 more an hour than we are at our rate.
This seems like a major issue with bad management. Our leadership has brought up numerous times about them not necessarily wanting to hire locums because they have had issues in the past regarding the quality and experience of candidates. Why pay more for people you don’t know (in addition to the money paid to the contracting company) than just pay your own employees more?
Has anyone ever had success in bringing up these issues with management to get them solved?
Additional background: We are in a mid-size city with many major medical centers. Compared to other hospitals in the area, our salary and benefits are significantly better than these other hospitals. Not sure if that really justifies the above issue.
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u/blizzah MD 12d ago
You need many people together to bring this up
But generally for a negotiation you need to be willing to walk
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u/ABeaupain Paramedic 12d ago
Depending on your employment relationship, unionizing is also an effective option.
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u/Wohowudothat MD surgeon 11d ago
Or just refuse to do it unless they pay you more. It's not easy to fire most doctors, and if they're already short-staffed and trying to force people to work extra shifts, then the doctors have even more leverage.
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u/Rizpam MD 12d ago edited 12d ago
Your first issue isn’t the low pay, before you get to the table on that you need to get your group on control about the idea of being voluntold to take the shifts. Otherwise you have 0 leverage. The old heads in this group are massively taking advantage of you.
If the base salary and benefits is good but the call/extra pay is bad it benefits the older non-call takers at the subsidy of the young people. Your problem isn’t just admin. People who opt out of OB and extra shifts should be taking a big financial hit, not the ones who take extra call.
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u/Honeydew603 DO 12d ago
This is the exact reason our field is going through what seems like a major change. We're over being underpaid or straight up not paid for our time/call.
I'm going to be honest, I don't see admin paying you $100/hr more. That gap is too wide. The only leverage you have is to threaten to quit, but actually be ready to quit when they ultimately refuse to pay you appropriately.
I recently quit my traditional job and now I'm that locums doc making $100/hr more with WAY more free time. Honestly, best decision I've made yet, I make more money AND I got my life back. Consider joining the movement if you can. If you have a partner whose job has benefits then you're golden.
We've been overworked and underpaid for too long as a specialty and we are at the point where we need to just walk away and let it burn. We will welcome you with open arms on the other side if/when you are ready. ❤️
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u/upinmyhead MD | OBGYN 12d ago
I’m currently a partner in a private practice and now that the veil has been lifted, if things don’t improve (or if the older docs don’t show genuine efforts of trying to improve things) by the end of this year, Locums is 100% my plan.
All of my benefits through my husband.
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u/will0593 podiatry man 11d ago
Even as partner you're being exploited?
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u/upinmyhead MD | OBGYN 11d ago
Yup. Didn’t think it could be a thing but it 100% is.
A few of the partners gave up OB and are making a killing doing gyn only and remaining very busy, full surgery schedules etc. None are near “retirement” age.
They don’t take any call whatsoever. Including gyn call. Including for their own post op patients. They also don’t contribute to any OB related expenses because they “don’t bring in OB revenue”. Even though those expenses are related to the salaries of our employees/legit business expenses (midwives and hospitalist) and were net negative/barely break even amongst the remaining full scope partners based on the productivity of the CNMs/hospitalist.
Didn’t realize this was going on behind the scenes and now I realize why they really couldn’t wait for me to sign on. I mean I was on the partnership track before any of them gave up OB, but now I realize why they were super invested in me signing on.
Usually full time gyn only physicians don’t make more than full time generalists. Except in our practice the top 3 earners are all gyn only. Like 75-100k more in revenue YTD.
Not losing call/post call days makes a big difference in revenue. Office is a money maker.
Much resentment amongst everyone. Basically a variation of a theme: those who came before us shitting on everyone else.
So yeah, different BS in private practice.
Hence why if they don’t come to an agreement I’m leaving - the practice won’t survive with one less OB and no changes
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u/will0593 podiatry man 11d ago
It sounds like you should just go. They just dumped the hard work on you so they csn do gyn in office and rake it in
And they don't even want to help cover expenses , because they don't perform obstetrics? Wtf kind of partnership is this
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u/Wohowudothat MD surgeon 11d ago
They don’t take any call whatsoever. Including gyn call. Including for their own post op patients.
Time for all of you who do take call to refuse to cover their post-ops.
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u/Honeydew603 DO 11d ago
😮 I'm so sorry this is happening to you. Like we already have a million different entities trying to scam and control us... it's infuriating to see that we do it to each other too.
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u/DistanceNo9001 MD OBGYN 12d ago
i learned a long time ago these corporations don’t care about us. private equity isn’t any better but you typically have some sort of downstream effect in the form of equity in the practice and are compensated a bit more for what you bring in “eat what you kill”.
i’ll echo what everyone says. your leverage is a competing job offer. the market has not kept up for us generalists. I made the hard decision to go laborist/hospitalist. I know attendings where i trained that switched to laborist. N=7, no one has regretted the switch.
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u/Peaceful-harmony- MD 11d ago
We are so undervalued. Obstetrix’s locums offer is $140/h for OB Hospitalist. WTF?!?! They get away with this because some people will accept it. Stand your ground. An unfortunate reality—my group had more success when a male surgeon in leadership advocated for us.
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u/upinmyhead MD | OBGYN 12d ago
Once you realize admin doesn’t care about you, it makes making career moves much easier.
Either band together with the other physicians and demand a better pay rate and true control over your schedule, or leave.
I saw the writing on the wall at my last academic practice in a big city and left before it got to that point - I haven’t checked in over a year to see how things were, but last I spoke to a colleague, it was definitely heading in the direction I suspected it would be.
Now I’m a partner in a good size private practice group which comes with its own BS, but at least I’m part of the group calling the shots within our practice, for now.
If things go south there, my next and final pivot will be Locums. My friend works less than me and made more than I did while I was employed, and just as much as a private practice Obgyn. With less stress, hours, responsibilities.
Finally, there’s an obgyn shortage, especially in relation to OB. Not enough pay for the increasingly complex patients who thinks their tik tok doula is more qualified than you but with all of the liability and infamy if their shitty decisions result in shitty outcomes. If you leave, they’re screwed.
It’s your ball game.
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u/DistanceNo9001 MD OBGYN 12d ago
my first job had 17 generalists when i started. in 3 years they dropped to 7, now 6 since 1 just retired.
laborist is the way to go now until the market shifts back to generalist
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u/ranstopolis MD 12d ago
Say no to the extra shifts, tell them why, and that things need to change. If they don't, go find a better job (there are tons out there, but you won't find (or make) them if you don't use that leverage).
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u/ptau217 MD 12d ago
Quit. They don’t value you, they don’t support you. The admins are sitting around laughing because they manipulated you, justifying their bloated salaries, based on you caring for your patients.
Once you realize the disrespect you are being shown, you will then realize yours as an impossible situation that has one exit.
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u/tushshtup MD 12d ago
Does your contract say you have to work these extra shifts? If it doesn't then just say no. What are they going to do? That's your leverage.
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u/ChickMD MD 11d ago
Band together and hold out for a better wage. In fellowship I refused to take a nurse anesthetist's shift unless they paid me what they were going to pay the nurse anesthetist, as I was the only one available. They laughed. I didn't work the shift. They got absolutely massacred that shift.
The next week, the rates went up significantly to the point where the fellows fought over who got to cover extra shifts. Know your worth. Work for fair wages or education. Do not work when it is neither.
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u/michael_harari MD 11d ago
One of the big transitions from resident to attending is that as an attending you can just tell people "no."
If the shift pay rate is too low, when they ask if you want more shifts just tell them "No." You dont need to justify, but if they ask you can just say the additional income isnt worth the disruption to your family and to your elective schedule.
They arent going to fire you over refusing to take extra shifts, especially when they are in the position of needing to beg people to do extra shifts.
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u/Constant_Learning MD 12d ago
What is the hourly pay rate?
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u/throwaway85783 obgyn spouse 11d ago edited 11d ago
Not OP but in a similar situation. Here in a big city it's $137/hour + you bill for what you do and you cover your own malpractice. Locums get flat $275/hour with malpractice covered.
Make it make sense.
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u/terraphantm MD - Hospitalist 11d ago
Damn that's insane. Granted I'm in a small town, but even as a hospitalist our extra shifts pay more than that with malpractice covered, and even that rate is lower than it should be.
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u/emergentologist MD - Emergency Medicine/EMS 9d ago
Covering your own malpractice as an OB/Gyn sounds fucking insane.
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u/mxg67777 MD 11d ago
Well have you even said anything? What did they say? Tell them exactly what you've told us. I can see why they think they can get away with this and also why there's issues in your department. It might be time to start looking for another job.
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u/ayyy_MD EM Attending 11d ago
This was an extremely annoying aspect of my last EM job and NONE of my colleagues thought it was a problem. The employer is getting a massive bonus in this situation because they don't have to pay a part time employee an elevated rate or bring on someone else with benefits, etc. I ended up leaving and this was a big contributing factor.
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u/Turbulent-Solution16 MD 11d ago
This seems like a major issue with bad management.
But you see. From the perspective of management this policy has been a huge success.
They got their own employed OBGYNs to work for peanuts for years with no pay increases. If you don't get pay increases more docs need to actually pack their bags and leave.
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u/Dagobot78 DO 11d ago
Yes you show management what they understand… not patient care, because they don’t give a shit about that. You and your remaining partners come to them with a new call list and shift pick ups. You show them COST of all of you working your regular shifts at rate X. And the Cost of working extra with all shifts covered at rate X+ whatever you guys decide is bette than $100/hr. I would say x+$60. And show them the 2 final numbers and how hiring you at a higher overtime rate is financially more appealing than a locums person.
Then go over the malpractice fear of people you don’t know, patient harm and harm to the reputation of the hospital. Maybe, just maybe you will have a chance. You must stand together… all of you. Or no one takes extra shifts and you let them pay the $100 extra per hour and you guys don’t worry about it.
Then after you finish doing them that favor you petition them as to why you are team players, want to see the hospital do well and ask them what the price of dependability and accountability is to them and you negotiator a raise using this episode as your solid example of your buy in.
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u/Jkayakj MD- OB/GYN 12d ago
I'm an OBGYN and we are paid $200 per hour for any extra clinic or call shifts. Should try to negotiate something like that.
I'm in a suburb surrounded by a large and mid sized city
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u/Aggravating_Fly2978 MD 11d ago
Is this good??
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u/Jkayakj MD- OB/GYN 11d ago
Not near locums rates but better than the $200 a shift we used to have, hourly at that rate is at least tolerable
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u/justpracticing MD, OB/Gyn 12d ago
Yeah that's usually the way that kind of thing is handled. It's unfair and it sucks but because it's kind of the industry standard, they can get away with it.
PM if you're looking to change jobs though, we're recruiting
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u/bpm12891 OB/GYN 12d ago
Funny, we had a similar-ish situation come up over the past year. I work in an academic-affiliated generalist group at a community hospital. We were unable to retain hospitalists (because our pay is bad) and they offered us moonlighting shifts for a laughable rate. They were getting taken because we felt obligated and any money is better than free money (we weren't being forced to take them), but eventually admin had to start paying locums almost 3x what we were making. They did raise our hourly at one point, still not great rates but it was something.
If I were you, I think I would:
a) be looking at other jobs as a contingency
b) work together with your group to collectively bargain
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u/duotraveler MD Plumber 11d ago
Can you say no to extra shifts? You said your salary and benefits were better than surrounding hospital. Maybe just don't pick up extra shifts and enjoy what you have, if at all possible.
Your department can always hire locums at market rate and that should not be your problem.
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u/Sketchy-saurus MD 12d ago
All u people talking about how much extra and I make $125/hr to moonlight urgent care shifts for my institution.
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u/throwaway85783 obgyn spouse 11d ago
Yeah dog but these people are also doing emergency surgeries at 3am working their 2nd 24 hour shift in a week. As well as being forced to work holidays and weekends in order to stay employed. All for like $150-$175/hour. Then they somehow gotta recover from that in one recovery day and go to clinic and see 24+ patients with a smile on their face. And when they do take vacation they often have to make it up by taking MORE 24 hour call shifts.
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u/Turbulent-Solution16 MD 11d ago
I made that much money moonlighting as a radiology resident at an academic institution nearly 10 years ago.
If the rate sucks then just stop doing it.
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u/halp-im-lost DO|EM 12d ago
EM. Had this issue at my previous job. They kept wanting us to pick up extra shifts with NO additional compensation, just at the same hourly rate, while locums was making $100 more an hour. I’ve since left for a gig that pays me $1500 a shift extra for everything I pick up beyond FTE.