ER physician pay cut at Beth Israel Deaconess

[wamcp]

Cutbacks for some doctors and nurses as they battle on the front line - The Boston Globe

These financial cutbacks, coming in response to sudden shortfalls during the coronavirus outbreak, have triggered an outcry from doctors and nurses who are already working grueling shifts in demanding working conditions.

www.bostonglobe.com

Emergency room doctors at Beth Israel Deaconess Medical Center have been told some of their accrued pay is being held back.

“This is at a time when many of us have moved out to live like lepers separate from family to prevent spreading infection, and have already been working huge extra hours trying to scrape together [personal protective equipment] and otherwise brace for COVID-19,” said Dr. Matt Bivens, an ER doctor at Beth Israel Deaconess Medical Center and St. Luke’s Hospital in New Bedford.


“Like many other health care and physician organizations, the economics of the care we provide has changed quickly and dramatically,” wrote Dr. Alexa B. Kimball, chief executive of the Harvard Medical Faculty Physicians group practice at Beth Israel Deaconess Medical Center, in an e-mail Thursday to doctors that was obtained by the Globe. “I wish I had better news to convey as I know all of you are making sacrifices every day in all sorts of ways.”

In that e-mail, the physicians group announced that effective April 1, it is suspending employer contributions to the retirement plan for doctors in the group, as well as at an affiliated group that staffs many other hospitals in the state, Associated Physicians of Harvard Medical Faculty Physicians at BIDMC. There are 1,600 doctors in both groups, and the majority of them are affected by the cutback, according to a company spokesperson.

The physicians group also told ER doctors this week that it is withholding and deferring half of their quarterly “bonuses” scheduled for March 30, according to another e-mail shared with the Globe. Those payments, which can reach tens of thousands of dollars per quarter, are based on extra shifts or additional patients the ER doctors took on months earlier, according to the doctors.

“The bonus is just pay we’ve earned,” Bivens explained. “It’s analogous to re-branding ‘overtime pay’ as ‘your bonus.’" Meanwhile physicians in other specialties in the group will not be receiving bonuses at all on March 30, according to the e-mail.

Several ER doctors from the BIDMC-affiliated physicians groups, who requested anonymity out of concern for potential career consequences, spoke vividly about how the financial hit was one more strain as they step up to combat the pandemic at work, all while trying to keep their families safe.

“It’s a privilege and an honor to have this job,” said one ER doctor. “It seems crazy that we’ll be compensated less as we work more and put ourselves in harm’s way.”

“We’re human, too,” another ER doctor said simply. “It’s just blow after blow after blow, on top of showing up for work and feeling potentially like I could not come home, too.”

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[wamcp]

Anyone know if administrative and executive pay at Harvard Medical Faculty Physicians also slashed too? Or just cutting those working on the frontlines, FFS

 

[Money-Moniker]

They should just walk out. I'm serious. This isn't a "paycut," this is literally theft of money already earned.

 

[Old_Mil]

Yeah, sorry. Not doing that.

 

[bravotwozero]

What about CEO bonuses? did they cut those? Did anyone even bother to ask? If not, WHY?

 

[deleted480308]

Yeah, sorry. Not doing that.

Just to clarify, not walking or not showing up if they are holding back pay?

 

[deleted480308]

What about CEO bonuses? did they cut those? Did anyone even bother to ask? If not, WHY?

Yeah, if I’m a ceo announcing that it doesn’t leave my office without a joint statement about the csuite also taking a hit. That’s basic leadership, you take care of the frontline

 

[namethatsmell]

This is disgusting and unfortunately not the only instance of stuff like this.

As frontline docs' pay is being cut/withheld (rather than increased as it probably should be), check out the 2nd to the last paragraph of an email below that was just sent out by the CEO of Delta.

Dear Congress, thank you for having the backs of all the EM docs, ICU docs, hospitalists etc out there putting themselves and their families at risk by continuing to show up to work...yeaaahhh rightttt...

 

[erdoc00]

Lol. Meanwhile nurses are getting offers for $5k/week.

If this was me I'd offer to help them save even more money and walk out door.

Harvard is flush with cash btw.

 

[kaygeebee]

this is absolutely insane wtf.

 

[Brigade4Radiant]

I mean if you wanna cut pay you do my other shops are doing and cut down on the amount of hours. But to just retroactively cut your paycheck like that?

I guess Harvard thinks the prestigious is enough to make up the pay difference.

 

[ShockIndex]

I was wondering how long this would take to happen. Most hospitals cancelled elective procedures a couple of weeks ago, and out-patient clinic volumes have likewise plummeted. That eliminates the two major sources of operating revenue. Most hospitals operating in the 2-5% margin range will quickly find themselves in the red. That means they will be dipping into reserves since investments (probably the largest source of non-operating income) vanished with the markets.

Like other forum members I’m interested in what is happening to admin bonuses and salaries. Of course, the reporter forgot to ask that question - typical for the crap that comes out of the Globe and NYT these days.

 

[WilcoWorld]

Yeah, if I’m a ceo announcing that it doesn’t leave my office without a joint statement about the csuite also taking a hit. That’s basic leadership, you take care of the frontline

I agree with you.

And while I'm no fan of the admin creep in healthcare, we've got to listen to facts. It looks like the CEO is having 50% of his pay withheld: Furloughs, Retirement Cuts And Less Pay Hit Mass. Doctors And Nurses As COVID-19 Spreads

Of course, the reporter forgot to ask that question - typical for the crap that comes out of the Globe and NYT these days.

WBUR is still good in my book (see above link).

 

[turkeyjerky]

I'm sure the orthopods are all chilling in their vacation homes since their cases are canceled, and the cardiologists are mostly at home waiting for the rare stemi since unnecessary angios and TAVRs can mostly wait.

And I'm sure the C-suite are all working from home, or maybe telecommuting from St Barts.

While we're hosing ourselves down after work or living in a hotel to avoid getting our families sick.

Yup, makes sense. Yay for unsocialized medicine!

I agree with you.

And while I'm no fan of the admin creep in healthcare, we've got to listen to facts. It looks like the CEO is having 50% of his pay withheld: Furloughs, Retirement Cuts And Less Pay Hit Mass. Doctors And Nurses As COVID-19 Spreads

WBUR is still good in my book (see above link).

My guess is that 50% of his salary is still far more than any of us make. Looks like Atrius had a $39M operating surplus in 2018 (not profit, lol). What no rainy day fund? Also, since 75% was from full risk contracts, shouldn't they be pocketing even more w/ the decrease in provided services?

You guys think European countries are cutting doctors hours and pay right now?

 

[docB]

I am not complaining but the reality is that most of us paid based on productivity will take a pay cut due to the low volumes.

See this thread by Porfirio about the low volumes - Patient Volumes

I definitely don't think it's right to hold back money that was scheduled to be paid out now due to possible future decreases in revenue but we all all likely to see a hit on this one.

 

[namethatsmell]

Cash is king. Especially right now. Hospitals that keep enough on hand to cover months of their expenses and payrolls in tough times like this are going to look like geniuses right now and their staff will remember it.

I'm primarily at two places these days. Rumor is that one has enough dough in their coffers to cover their expenses for 4-6 months. The other one doesn't and is already doing stupid things. Staff morale between the two places is palpable.

 

[WilcoWorld]

I'm sure the orthopods are all chilling in their vacation homes since their cases are canceled, and the cardiologists are mostly at home waiting for the rare stemi since unnecessary angios and TAVRs can mostly wait.

And I'm sure the C-suite are all working from home, or maybe telecommuting from St Barts.

While we're hosing ourselves down after work or living in a hotel to avoid getting our families sick.

Yup, makes sense. Yay for unsocialized medicine!



My guess is that 50% of his salary is still far more than any of us make. Looks like Atrius had a $39M operating surplus in 2018 (not profit, lol). What no rainy day fund? Also, since 75% was from full risk contracts, shouldn't they be pocketing even more w/ the decrease in provided services?

You guys think European countries are cutting doctors hours and pay right now?

Fair questions, I don't know the answers.

 

[GeneralVeers]

Probably 50% pay cut here as our volumes are down. I don't mind making less, as long as my hours are less, and workload is less. More work for less pay? Not a chance.

 

[bikERdoc]

2 shifts cut from the schedule at one of my sites, and 1 shift at the other site. Partners paid on RVUs, associates paid hourly. I'm about to make less than our associates, and that's after a fairly long partnership track.

I feel my morale approaching all time low at the moment. Sole bread winner in house of 3, soon to be 4. Paycut right now just seems like a swift kick to the balls, after already being down.

Sent from my Pixel 3 using Tapatalk

 

[deleted547339]

2 shifts cut from the schedule at one of my sites, and 1 shift at the other site. Partners paid on RVUs, associates paid hourly. I'm about to make less than our associates, and that's after a fairly long partnership track.

I feel my morale approaching all time low at the moment. Sole bread winner in house of 3, soon to be 4. Paycut right now just seems like a swift kick to the balls, after already being down.

Sent from my Pixel 3 using Tapatalk

Not trying to put salt in the wound, but when you are eat what you kill, this is the obvious other side of that.

 

[bikERdoc]

Not trying to put salt in the wound, but when you are eat what you kill, this is the obvious other side of that.

Not disagreeing. Many reasons why I'm not a fan of 100% RVU pay. Global pandemics happen to be one of those...

Sent from my Pixel 3 using Tapatalk

 

[docB]

Probably 50% pay cut here as our volumes are down. I don't mind making less, as long as my hours are less, and workload is less. More work for less pay? Not a chance.

Agree. I think we are understaffed at baseline. Now that the volume dropped I feel like our staffing is about right. So far we haven't cut staffing because it's either going to get crazy or go back to normal. That said I understand that fewer RVUs = less $. When I ask for more staffing I understand it isn't free. That's what's always been so annoying. I'm essentially saying "Let me slow down and pay me less so I can do a better job for you." I can't believe that falls on dead ears. It's like the UAW saying slow the assembly line and cut my pay so I can make sure the cars get built right. If you want me to spend extra time with the patients and families, sit down in the room for 20 minutes, pass out cards, recite scripting, call discharges with my "extra time" and basically do everything short of performing sexual favors to get PGs it can't happen at 5/hour. [end rant]

 

[gamerEMdoc]

If the hospital breaks the contract, is that not illegal? It's a contract. Wouldn't that give the physicians their the right to just quit without any 90 day out or whatever is stated in the contract? IDK, I'm not a lawyer, but it would seem that if a hospital just decided they were going to violate the terms of your contract, you'd have every right to quit on the spot.

 

[Fox800]

 

[deleted547339]

If the hospital breaks the contract, is that not illegal? It's a contract. Wouldn't that give the physicians their the right to just quit without any 90 day out or whatever is stated in the contract? IDK, I'm not a lawyer, but it would seem that if a hospital just decided they were going to violate the terms of your contract, you'd have every right to quit on the spot.

Is that really quitting? Sounds more like being fired. “Hey - you don’t have your job anymore, that’s gone.......soooooo, want to stay ok for the same work but less pay?”

 

[deleted109597]

Yep. We are getting hit on all sides.
Who is more essential, nurses or docs?
Why can an NP suddenly demand $50K a month when they want us to volunteer?

Because they know docs will. Hell, some were talking about it in the other thread.

 

[docB]

If the hospital breaks the contract, is that not illegal? It's a contract. Wouldn't that give the physicians their the right to just quit without any 90 day out or whatever is stated in the contract? IDK, I'm not a lawyer, but it would seem that if a hospital just decided they were going to violate the terms of your contract, you'd have every right to quit on the spot.

Interesting question. Strategically the hospital is by far in the power position on this one. Assuming they have violated the contract by failing to pay and there's no other language in the contract about grievances, arbitration and so on, which there usually are, I can't see any long term win for a group of doctors who just quit in the face of a pandemic. No jury would ever side with that group.

 

[gamerEMdoc]

Interesting question. Strategically the hospital is by far in the power position on this one. Assuming they have violated the contract by failing to pay and there's no other language in the contract about grievances, arbitration and so on, which there usually are, I can't see any long term win for a group of doctors who just quit in the face of a pandemic. No jury would ever side with that group.

I'd imagine its in the contract. Most of the time there is going to be an option to quit with some time frame notice, usually 90 days. But I'd imagine any lawyer could get you out of that if the contract terms were violated. If they for instance are contractually obligated to pay you and they can't, you shouldn't be contractually obligated to give 90 days notice. I can't imagine an attorney couldn't help get you immediately out of that contract.

I'm not saying that anyone SHOULD do that and abandon their hospital, but it may be nice to know if this is the case, because it would give ED docs a ton of leverage to say to their hospital if you do this, you will need locums tomorrow. Good luck.

 

[Spikebd]

Are physicians getting the pink slip first before Midlevels? If so that seems really worrisome for a lot of specialties in the USA. Yikes. Corona looks to have massive consequences for a lot of us.

 

[deleted547339]

I'd imagine its in the contract. Most of the time there is going to be an option to quit with some time frame notice, usually 90 days. But I'd imagine any lawyer could get you out of that if the contract terms were violated. If they for instance are contractually obligated to pay you and they can't, you shouldn't be contractually obligated to give 90 days notice. I can't imagine an attorney couldn't help get you immediately out of that contract.

I'm not saying that anyone SHOULD do that and abandon their hospital, but it may be nice to know if this is the case, because it would give ED docs a ton of leverage to say to their hospital if you do this, you will need locums tomorrow. Good luck.

Whoa. Theyre not abandoning their hospital, they’re not working for a hospital which isn’t keeping their word. The hospital abandoned them.

 

[Birdstrike]

The hospital I'm on staff at just spent $1 million on a "COVID overflow tent" in their parking lot. They currently have 1 COVID-19 positive patient. I'm sure administration will take that $1 million loss out of every hide they can, other than their own.

 

[GeneralVeers]

Doctors are stupid. We allow ourselves to be treated like automatons by the ruthless businesses that employ us, but then allow ourselves to be guilted into working for free.

I'd have no compunction about leaving any group or hospital that refused to pay me, regardless of the external factors.

 

[gamerEMdoc]

Whoa. Theyre not abandoning their hospital, they’re not working for a hospital which isn’t keeping their word. The hospital abandoned them.

Yeah that was a poor choice of words on my part.

 

[southerndoc]

The hospital I'm on staff at just spent $1 million on a "COVID overflow tent" in their parking lot. They currently have 1 COVID-19 positive patient. I'm sure administration will take that $1 million loss out of every hide they can, other than their own.

Man I wish we had 1 COVID-19 patient. We had 30 positive results in one day!

 

[Splenda88]

Man I wish we had 1 COVID-19 patient. We had 30 positive results in one day!

That is a lot...

Is there a dedicated floor for COVID-19 patients? Also, for the ones that need ICU care, do they put them together in one ICU wing?

 

[TooMuchResearch]

In the past few days I've seen enough probable COVID-19 patients to be about 25% of the total confirmed number in the county. And this week I haven't worked the section where most of them are seen.

Man I wish we had 1 COVID-19 patient. We had 30 positive results in one day!

 

[ShockIndex]

Here is the joint statement from multiple critical care societies about multiple patients per ventilator. Bottom line - don’t do it.

Joint Statement on Multiple Patients Per Ventilator

The Anesthesia Patient Safety Foundation (ASPF), Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American

www.apsf.org

 

[deuist]

Here is the joint statement from multiple critical care societies about multiple patients per ventilator. Bottom line - don’t do it.

Easy to say when you're not the one staring at dying patients and have no ventilators. Imagine telling a family, "I decided his life wasn't worth saving because society that I do not belong to told me not to share the ventilator."

 

[Old_Mil]

Just to clarify, not walking or not showing up if they are holding back pay?

Not showing up. It's constitutes a unilateral abrogation of the contract I hold with them.

I'd recommend that any physician in such a situation simply finish your shift, walk away, and take a three week vacation.

By then, there will be plenty of demand for your services at other facilities without such short-sighted leadership.

...and while there is an attempt by the for-profit entities involved in emergency medicine to cause a deliberate oversupply of labor and reduce pay, we're still at a place where voting with your feet is the best solution for malignant management practices.

 

[Mad Jack]

They should just walk out. I'm serious. This isn't a "paycut," this is literally theft of money already earned.

The hospital I'm on staff at just spent $1 million on a "COVID overflow tent" in their parking lot. They currently have 1 COVID-19 positive patient. I'm sure administration will take that $1 million loss out of every hide they can, other than their own.

Give it time. Peaks are going to vary by region

 

[radsisrad]

View attachment 300228

Damn.

If I were a young NP or PA, I'd be all over this.

 

[Brigade4Radiant]

Well the C suite is seeing that of there is less threat of malpractice why not just employ NPs and PAs hell they do scopes now and they take call for the urology service at large academic hospitals

 

[deleted547339]

That is a lot...

Is there a dedicated floor for COVID-19 patients? Also, for the ones that need ICU care, do they put them together in one ICU wing?

One icu wing? Lol. We can’t house them in one icu.

 

[Hamhock]

Here is the joint statement from multiple critical care societies about multiple patients per ventilator. Bottom line - don’t do it.

Joint Statement on Multiple Patients Per Ventilator

The Anesthesia Patient Safety Foundation (ASPF), Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American

www.apsf.org

With respect (we face similar populations and we are in similar or identical sub-specialties):

Please acknowledge, not just that 2-4 patients on a single ventilator is a horrible idea, but that in true catastrophe, that this MAY be a viable option.

For our society (notably SCCM), to toss bedside physicians under the bus, is unacceptable. Did they offer alternatives? Did they consider the doc with two patients who could survive with a vent for a few more days vs. the doc who wastes a vent on the TBI without exam or prospect for recovery?

Did they offer putting two hypertensive ICH patients with "easy" vent management on the same vent (before they go to an LTAC)?

Or did they just say, "No!"? Screwing us all. Tell the NYP intensivist to not consider dual-patient ventilation, when he must either commit two people to death or try something "nuts"?

HH

 

[Birdstrike]

In the past few days I've seen enough probable COVID-19 patients to be about 25% of the total confirmed number in the county. And this week I haven't worked the section where most of them are seen.

What's your conversion rate for PUI's (persons under investigation) locally? Nationally, 83% of those suspected test COVID-19 negative. Some places are as high as 97% negative. On the other hand, New York is 64%. "Probable COVID-19" means "not COVID-19" the majority of the time.

These could (probably will) change, but for your location's current numbers, check here.

 

[Birdstrike]

With respect (we face similar populations and we are in similar or identical sub-specialties):

Please acknowledge, not just that 2-4 patients on a single ventilator is a horrible idea, but that in true catastrophe, that this MAY be a viable option.

For our society (notably SCCM), to toss bedside physicians under the bus, is unacceptable. Did they offer alternatives? Did they consider the doc with two patients who could survive with a vent for a few more days vs. the doc who wastes a vent on the TBI without exam or prospect for recovery?

Did they offer putting two hypertensive ICH patients with "easy" vent management on the same vent (before they go to an LTAC)?

Or did they just say, "No!"? Screwing us all. Tell the NYP intensivist to not consider dual-patient ventilation, when he must either commit two people to death or try something "nuts"?

HH

When the "bad option" is your only option, didn't it just become your best option?

 

[TooMuchResearch]

Most of our admitted probably COVID have lab findings and x-ray findings. Even if the test is negative, I don't think I'd buy it

What's your conversion rate for PUI's (persons under investigation) locally? Nationally, 83% of those suspected test COVID-19 negative. Some places are as high as 97% negative. On the other hand, New York is 64%. "Probable COVID-19" means "not COVID-19" the majority of the time.

These could (probably will) change, but for your location's current numbers, check here.

 

[Birdstrike]

Most of our admitted probably COVID have lab findings and x-ray findings. Even if the test is negative, I don't think I'd buy it

Ultimately that comes down to the false negative rate of the test and I don't think any of us, and probably even the labs, have a good feeling for what the false positive/false negative rates of these brand new COVID-19 tests are. So, you're correct to hedge your bets in that way. It's just like the, pale, diaphoretic 75-year-old guy with HTN/DIAB/Chol and crushing substernal chest pain that happened to have a normal stress test a few days ago. It's critical to have an idea in our heads of the false negative and false positive rates of all the tests we order and interpret. Because they're never 0% and often they're higher than we're lead to believe.

 

[Dr Mantis Toboggan]

we have seen some RSV ARDS back in Feb before the covid really hit. Had a guy like that who looked rough this weekend. Maybe he was a false covid neg, coinfection with RSV.

I haven’t sent a lot of resp panels before this on older admitted patients. Seems viral pneumonia of any kind in these patients is pretty terrible.

Most of our admitted probably COVID have lab findings and x-ray findings. Even if the test is negative, I don't think I'd buy it

 

[gro2001]

When the "bad option" is your only option, didn't it just become your best option?

Its not the only option. Another way of looking at this problem is you have two options:

1) One ventilator, one patient. The one on the ventilator probably lives because we know how to treat ARDS with lung protective ventilation. The other probably dies.
2) One ventilator, two patients. Now the chances of either patient living are unknown because we don't know how well the vent splitting will work with rapidly changing compliance.

It's not about saving 1 vs saving 2. Its about saving 1 vs risking more and maybe saving 2 and maybe killing 2. That's a harder choice.