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Employment incentives may help hospitals retain orthopedic surgeons
When hospital leadership includes clinically active orthopedists, hospital employment may be favorable for orthopedic surgeons.
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Hospitals may increase their orthopedic department’s faculty retention rate when they integrate programmatic leadership and compensation leadership incentives and provide a stable, long-term opportunity for their employees, according to two presenters.
“One of the things I do is, when I sit with the residents, I explain to them that there are both excellent and flawed opportunities working for hospitals and there are both excellent and flawed opportunities out in the private sector,” Nicholas A. Sgaglione, MD, said. “We try to put together what we think is a list of red flags for those settings.”
Leadership, employee retention
Sgaglione, who is an Orthopedics Today Editorial Board member, explained that employment in the hospital setting tends to be better when the leadership includes a clinically active orthopedist rather than an administrator.
“If the leadership point person of your hospital employment opportunity or engagement or gain sharing or joint venture is limited to only an administrator, that is not as optimal as if the person you are dealing with is a physician, and more importantly another orthopedist,” Sgaglione said.
He said orthopedists in these leadership roles should also be clinically active. Of note, all the leadership at Sgaglione’s department are “orthopedic surgeons who spend at least 50% of their time in clinical practice,” he said.
Incentives may help
When incentives are provided to new physicians and when marquee orthopedists are recruited to a hospital’s orthopedic department, this also helps maintain and foster faculty satisfaction, according to Sgaglione. Incentives can range from academic productivity incentives to relative value unit (RVU) incentives and, in some cases, to administrative incentives, he noted.
“What we try to do, from a department standpoint, is provide incentive compensation and we do that when appropriate through administrative and programmatic opportunities,” Sgaglione said. “It is all with duties, responsibilities, deliverables [and] expectations.”
He explained that retaining orthopedic surgeons is just as important as recruiting them. This can be done by providing them with stability and a long-term commitment.
Three keys to departmental retention in a hospital setting are regular communication with physicians, consensus and coordination, Sgaglione said.
“Probably the largest area of dissatisfaction we find for those who have joined hospital systems from the private practice world, where you can manage whether you want to ... hire another secretary or have another assistant, is that you are told, well, you cannot have a [physician assistant] PA or you cannot have that extra assistant that you need,” Sgaglione said.
Understand salary surveys
Salary is another factor to consider when comparing employment in the private sector vs. in a hospital.
According to David M. Glaser, JD, hospitals often use salary surveys to determine the amount of compensation an orthopedic surgeon should receive.
“If you are in private practice, no one looks at how much you make,” Glaser said. “When you are employed by a hospital, the hospital is all worried that if they overcompensate you they could get in trouble for either violating Stark [Law] or, if it is a nonprofit hospital, the tax exemption rules. They are going to use salary surveys.”
However, salary surveys are not accurate, Glaser said.
He noted an example where the 90th percentile RVU production fell by 20% from one year to the next and then increased by a similar amount the next year.
“While it is theoretically possible this occurred, it seems far, far more likely that the sample was inaccurate,” Glaser said.
“If you are employed and someone is using these salary surveys, you need to understand — I am quite certain — that they underestimate reality,” Glaser said. – by Casey Tingle
- Reference:
- Real-life case presentations involving private practice and hospital employment scenarios. Presented at: Orthopedics Today Hawaii 2017. Jan. 8-12, 2017; Lahaina, Hawaii.
- For more information:
- David M. Glaser, JD, can be reached at Fredrikson & Byron, PA, 200 S. 6th St., Suite 4000, Minneapolis, MN 55402; email: dglaser@fredlaw.com.
- Nicholas A. Sgaglione, MD, can be reached at North Shore – Long Island Jewish Medical Center, Northwell Health, University Orthopaedics Associates at Great Neck, 611 Northern Blvd., Suite 200, Great Neck, NY 11021; email: nas@optonline.net.
Disclosures: Glaser reports he performs legal services for medical device manufacturers. Sgaglione reports he receives royalties from Zimmer Biomet and Wolters Kluwer.