How Much PTO Should Physicians Get? | Physician Vacation
Written by Robert Chelle
Spelling out the details of your job is crucial to avoid contract conflicts during the term of your employment.
Written by Robert Chelle
Spelling out the details of your job is crucial to avoid contract conflicts during the term of your employment.
Paid Time Off (PTO) refers to the amount of time a person has for taking off from work without being penalized. This typically includes vacations, holidays, and sick days. Physician PTO policies vary greatly as they are determined by employer discretion and union agreements which are a key part of the benefits package.
There are some key factors that all physician PTO policies should include: how much paid time off you get per year; what happens when you take a day or more of your paid time off; what happens if you’re using up your allotted days then go on vacation; and whether or not unused days carry over into other years.
While some have paid leave through the government or state law such as Workers’ Compensation, this type of pay is administered by the employer.
Paid time off (“PTO”), is several days (within a calendar year) that an employee is entitled to be absent from work. PTO refers to the time off accrued by an employee. The more hours they work, the more PTO hours they get paid for.
Most larger hospital network employers will offer accrual-based PTO. Meaning the physician does not receive a chunk of paid time off at the beginning of each contract year; they accrue a set amount each pay period. Private practice employers generally give time off without accrual factored in.
Continuing medical education (CME) is a type of continuing professional development that helps physicians stay up to date with the latest developments in their field. Continuing medical education can be done online, on site, or through other means such as books and journals.
In the medical field, it is crucial for physicians to continue their education by attending Continuing Medical Education (CME) courses. The cost of these courses can be a burden on an individual physician’s wallet. To reduce this burden, many employers will cover some or all of the cost of CMEs for their employees.
Continuing medical education (CME) is a type of continuing professional development that helps physicians stay updated with the latest developments in their field. Continuing medical education can be done online, on-site, or through other means such as books and journals.
Continuing medical education is not just for physicians; it also includes nurses, pharmacists, dentists, physical therapists, and other professionals in healthcare fields. Continuing medical education can help people keep up-to-date on new treatments and technology while keeping them out of trouble regarding ethical issues within their profession.
Continuing Medical Education can help physicians keep up to date on new treatments and technology while keeping them out of trouble regarding ethical issues within their profession. Continuing Medical Education has many benefits, so read this article to learn more!
As a doctor, you know the importance of continuing medical education to stay current with the latest advancements in your field. Continuing medical education can be done online, on-site, or through other means such as books and journals; some people might take college courses where they can earn credits towards getting a degree if they want one. This is important not just for physicians but also nurses, pharmacists, dentists, physical therapists, and other professionals in healthcare fields.
The requirements are variable but typically require 20 hours per year, with many employers requiring more than 40 hours annually.
A sponsoring organization often provides credit for completed CME activities. For example, a medical association will provide credit for time spent listening to presentations at their annual meeting – and the physician can use this information on their CV or seeking new employment opportunities with other organizations.
At a CME conference, the physician will see many lectures and posters on different topics in their field. Continuing medical education is an opportunity to hear from experts about a topic that can be difficult to stay up-to-date with without reading extensively.
A conference may also have networking opportunities, sharing experiences, and discussing new developments in one’s practice area with other physicians who specialize in the same type of care.
Most CME conferences offer more than just talks and posters:
Continuing medical education is typically offered in a number of formats, including live events, online courses or webinars, journal articles, books, and conference proceedings. CME hours are reported on Continuing Medical Education (CME) certificates that can be printed and shared with employers.
Each state licensing board requires certain Continuing Medical Education credits to be completed yearly in order for a physician’s license to stay valid. To get these Continuing Medical Education credits, physicians might have to do things like take courses on new medical developments or participate in activities that are supervised by the board of directors at their place of employment or volunteer work.
CME hours are reported on Continuing Medical Education (CME) certificates that can be printed and shared with employers. Continuing medical education is typically offered in a number of formats, including live events, online courses or webinars, journal articles, books, conference proceedings.
The physicians will need to report their CME credits earned according to the guidelines set forth by their state board. A physician may choose from one format for completion such as attending two lectures at an annual meeting while another might prefer completing twelve three-minute videos over six months time period; these options reflect different levels of learning intensity, but both would qualify as reporting 12 hours for this example year since they represent equivalent academic value.
In the wake of COVID-19, many employers are struggling with how to keep their employees working amid pandemic fears. We have covered some possible options for avoiding layoffs or furloughs: The Families First Coronavirus Response Act (FFCRA), the Coronavirus Aid, Relief and Economic Security (CARES) Act, and local/state laws that provide incentives for employers who want to retain workers during a time when it is not clear if there will be any new cases in this area. No one knows what might happen once we get out of this terrifying pandemic, but hopefully, these measures can help us ride through until things settle down again!
In the event of COVID-19 pandemic, employers need to remain mindful that a time will come when they’ll have no choice but to let employees go. As such, it’s crucial for companies and organizations not only to plan so sufficient funds are in place during this challenging period. We also encourage them to put together an employee retention strategy before any layoffs or furloughs take effect later.
Employers must account for both financial issues relating to funding. And also, consider how best to handle their workforce should one be forced into dismissing staff due to foreign contracts drying up from being canceled. All because of COVID-19 pandemic fears sweeping through society like wildfire.
Some employers worry about how their policies will be affected by the pandemic. Employers should consider whether they can and should make adjustments to account for post-pandemic business needs, such as a shorter work week or taking more time off than usual in case of illness. While an employer may not feel comfortable giving employees additional paid leave right now. It is worth considering what changes need to happen if your company survives the outbreak without being too negatively impacted financially, on top of potentially losing many human resources due to illness during that period.
Contracts are a pervasive and obligatory part of nearly all business and legal transactions. Well-drafted contracts help to enumerate the responsibilities of the involved parties, divide liabilities, protect legal rights, and ensure future relationship statuses. These touchstones are even more crucial when applying their roles to the case of a physician employed by a hospital, medical group, or other health care provider.
While contract drafting and negotiation can be long and arduous, legal representation is necessary to protect your rights.
The present-day conclusion is simple: a physician should not enter into any contract without having the physician contract reviewed by legal counsel.
There is simply too much risk for physicians to take contract matters into their own hands. In addition to the specific professional implications, contract terms can significantly impact a physician’s family, lifestyle, and future. There are many important contract terms and clauses which can present complex and diverse issues for any physician, including:
Additionally, often the most influential terms and clauses in any employment contract are the ones that are not present. With the advent of productivity-based employment agreements, any physician must review an employment agreement before they execute it. Attorney Robert Chelle has practical experience drafting and reviewing physician contracts for nearly every specialty.
New residents, attending physicians, doctors entering their first employment contract or established physicians looking for new employment can all benefit from a thorough contract review. By employing an experienced attorney for your representation, you can ensure that you will be able to fully understand the extensive and complex wording included in your contract. By fully understanding the contract, you will be in a better position to make your own decision on whether or not you want to enter into the agreement, which will affect your career life for years to come.
The financial benefits gained from having your contract reviewed and negotiated by an experienced healthcare attorney far outweigh the costs associated with a review. You are a valuable resource, and you should be treated and respected as such. Attorney Robert Chelle will personally dedicate his time to ensure that you are fully protected and assist you in the contract process so that your interests are fairly represented.
Every physician’s contract is unique. However, nearly all contracts for health care providers should contain several essential terms. If the contract does not spell out these crucial terms, disputes can arise when there is a disagreement between the parties regarding the details of the specific term. For instance, if the doctor is expecting to work Monday through Thursday and the employer is expecting the provider to work Monday through Friday. Still, the specific workdays are absent from the agreement. Who prevails?
Spelling out the details of your job is crucial to avoid contract conflicts during the term of your employment.
Coming into a new organization with a favorable contract can put the physician in a positive financial situation for years to come. Before you sign the most important contract of your life, turn to Attorney Robert Chelle for assistance.
If you have questions about your current medical malpractice policy or are interested in having your employment agreement reviewed contact Chelle Law today.
What is a physician incentive bonus? It can be calculated in several ways, and we’ll walk through each. Some physician contracts are just a base salary, meaning you make $200,000 a year. There is absolutely no productivity bonus, and there’s no way to make any more money. You get this money; you do the work, and that’s it. Then there are other models which I think are smarter—incentivizing the physician to be more productive means having more encounters or maybe doing higher acuity cases. It depends, but the two usual ways of giving a physician an incentive bonus are either through a percentage of net-collections or RVU production.
Let’s kind of hit both of those. In some physician contracts, there will be an incentive if the physician takes in. The practice collects a certain amount of money from the physician’s health services. The physician will get a percentage of that. A few usual ways of doing it is for the physician to make $240,000 a year. The practice will state that once the physician has collected 20,000, covering their base salary, they will get a percentage of what’s collected after that.
In that scenario, it would generally be somewhere between 20% to 30%. I would say 25% is probably the average amount in that scenario. And that would be a monthly way of doing it. The employer could also do it quarterly, or they could do it semi-annually. It’s rare to do it annually. Most physicians don’t want to wait until the end of the year to receive a giant bonus check. They would prefer to have it doled out throughout the year. That’s a usual way of doing a net-collections bonus incentive.
With an RVU model, the employer will set a base threshold of RVUs. If you don’t know what an RVU is, it’s a relative value unit. I do have a few videos that you can investigate, but each specialty has an average annual RVU production. And let’s say the employer says you must produce 6,000 RVUs in a year. They would then likely move that down to monthly or quarterly production. So, if they had to do 6,000 a year, that’s 1,500 a quarter. Then, they would say, alright, any RVU produced over 1,500 in a quarter.
You would multiply the RVUs above that times a compensation factor number. That’s specialty-dependent. It can be anywhere from $35 up to $80. Let’s say the physician was to produce 2,000 in a quarter. Then you would take the 500 RVUs above that threshold times the compensation factor. And then, the physician would receive that as a bonus. Once again, usually, I’d say the most common way of doing it is quarterly. And then there may be reconciliation at the end of the year.
But those are the two most common ways for a physician to receive a bonus incentive. There are hybrid models that you could do as well. Some physicians get paid on production, so they get a net-collections percentage or the RVUs they produce. I think a hybrid may be the best way to do it for morale. The physician has kind of the security of, alright, this is the minimum amount that I will make. However, if I am either productive or ultra-productive, I can receive much more. And it just makes sense. Incentivizing employees in any business is just an intelligent way of handling things. It’s a good business model; I find most employees also appreciate it.
How are physicians paid in a productivity model? First, there are multiple ways of calculating productivity for a physician. And then, of course, there are multiple ways to compensate them for that. I think there are four main areas, and we’ll hit all of them. You have just a straight net collections-based contract, a straight RVU production contract, a hybrid of base salary plus net-collections, and then a hybrid of base salary plus RVU production. We’ll go over the basics of all four of those.
First, straight net-collections contract. That would mean that the physician would get a percentage of anything that is collected by the practice for the physician services. The general percentages are between 35% to 45% of their net-collections if it’s a pure net collections-based agreement. 45% is on the high side, but I’ve seen from 35% up to 45% if it’s only based on net-collections percentage. Some of the downsides are that the physician will see almost no compensation for a period at the beginning of the agreement.
The average accounts receivable cycle for an insurance claim is somewhere between 30 to 90 days. And so a physician just being paid on net-collections could be working for a month, but none of that money is collected for two months afterward. So, the physician could theoretically make $0 in the first couple of months of the agreement. In that situation, sometimes we’ll have a base draw, maybe for the first three to six months.
And then that money given to the physician will be taken out over time so that they’re not working for no income for a period. Is this a fair way of being compensated? Sure. I think it’s also volume-dependent. It would help if you also relied upon the billing and collecting efficiency of your practice. Some specialty, dermatology, comes to mind, where these seem to be much more prevalent than others, but that’s the net-collections productivity.
Second, the RVU production only. I have several videos on RVUs if you don’t know what those are. Still, essentially for every encounter, an RVU value is assigned to it. And then, the physician is paid their RVUs produced times a compensation factor. So, a numerical or monetary value is specialty-dependent, usually between $35 to $80. And whatever the physician would then produce in RVUs, usually monthly, the calculation is simple. That would be RVUs times the comp factor, and that’s how much they would make. The benefits of RVU versus net-collections are that in net collections-based agreements.
It’s only what the practice gets, so insurance write-offs default on patients who don’t pay the bill. As I said before, there is inefficiency in billing and collecting. All those things can affect what the physician makes. If it’s a net collections-based and RVU-based contract, the physicians are only paid for what they do. Collections have nothing to do with it. So, the physician will likely benefit from an RVU-based production model versus collections because all the bad debt doesn’t matter. Now, most private practices don’t use RVUs.
They use net-collections. It’s the hospitals and health networks that would use RVU-based compensation. Keep that in mind. Is one better than the other, meaning net-collections versus RVU? It’s situational dependent, but those are the first just pure product productivity-based agreements. Third, a hybrid of base salary and net-collections. A couple of ways of doing this would be. First, the physicians would get a base compensation, and each month that their net-collections exceed their base salary, they would get a percentage.
That would generally be a smaller percentage, usually between like 20% to 30%. If they’re making $10,000 a month, once their net-collections exceed $10,000, they would get 20% to 25% of what was collected. That’s a usual way of doing a hybrid base salary plus net-collections. They could also just come up with a threshold. Maybe their base salary is less than the amount. Even though their base salary would be $10,000 a month, they may say the net collection threshold is $20,000. Still, they get a much higher percentage, maybe 50% of net-collections after that. Once again, it depends on the situation specialty, but that’s a standard way for a hybrid net-collections model.
And then, the last model would be base compensation plus RVU production. Once again, they would have a base salary, and let’s say it’s $10,000 a month. And then, they would come up with an annual target for their RVU production. Let’s say it’s a family practice; the baseline is 6,000 RVUs per year. They would divide that either by monthly or quarterly and anything that they generate above a certain threshold, so if the expectation is 6,000 a year, then you would divide 6,000 by 12.
Then any RVU generated above that per month, that’s when they would receive the bonus. You would take the RVUs produced above that amount times, whatever the compensation factor is. The benefits of the hybrid model are that there’s less variability, and they will have a base so that there’s a minimum amount that the physician will make. Still, then there are also bonuses on top of that. Once again, it’s specialty-dependent, but most physicians don’t like the potential downside and variability of maybe making much less than a month than others.
For instance, if you’re a physician taking a lot of time off in a month. There is a good chance that, let’s say, someone takes a two-week vacation. Well, if you’re being paid purely on collections or RVUs generated in a month, that month will be much less than you would make in other months. And some people would prefer a steady state; if they outperform, they will get more. So that’s kind of how physicians are paid under a productivity model.
I’m going to talk about some examples of moonlighting for a physician. There are two things to consider. When a physician signs an employment contract, a clause is included and listed as exclusivity or outside activities. This prohibits the physicians from doing any moonlighting, locums, or side work involving the practice of medicine without getting the employer’s written approval. We’re going to get into that in a second.
Now, moonlighting as a physician means they are working for another employer outside of their main full-time job. Shift work and specialties are probably the ones that do this the most. So, suppose ED and hospitalists work seven-on/seven-off. In that case, it is a regular schedule for emergency medicine physicians or hospitalists. If they have that seven days off, then many times, they’ll want to pick up shifts elsewhere. And in that case, that would be considered moonlight. Now, if a physician is employed, let’s take a hospitalist employed by a hospital.
The physician is employed with a hospital and signs an employment agreement. The employment agreement will state that this is your exclusive full-time employment. And this is the only job you can have without getting our written approval to do something else. If the physicians wanted to work outside the organization, maybe doing some locums or picking up shifts at another local hospital. The employer would have to say, yes, we agree you’re allowed to do this.
And it’s okay. In that scenario, if an employer says the physician can moonlight, then usually, there will be a couple of things the physician must do. First, the employer will likely require that the physician provide proof of professional liability insurance and medical malpractice insurance to their employer. Suppose a physician is working outside of their full-time job. In that case, that employer will say, look, yes, you can work elsewhere. Still, it would help if you showed us that you have medical malpractice insurance for that job specifically.
Medical malpractice insurance is employer-specific for a medical physician. A physician doesn’t just have one medical malpractice policy that covers any practice of medicine anywhere at any time. That’s not how it works. It’s employer specific. So, the medical physician will have a medical malpractice insurance policy for their full-time employer. And then, if they’re going to moonlight, locums, whatever, they would also have another professional liability insurance policy that covered that employer. Many employers don’t want to deal with issues if that physician isn’t insured. Maybe the physician doesn’t even understand that they need insurance for that position. Whoever is hiring them to do moonlighting should also know that they need a different policy.
But that’s one of the main concerns why employers don’t let people moonlight or do locums without having proof that they’re going to be insured in that position. Another consideration is competition. Many employment agreements will state that the employee cannot compete with the employer during the contract term and after the contract terminates. It can say expressly that no matter what, you cannot work with a competitor organization during the term of this agreement. And that could be different than the actual non-compete, which will take effect after the agreement ends. Let’s take the hospitalist as an example as well. The hospitalist works for one hospital. The employment agreement could state that you can’t work as a hospitalist within the county that the hospital is in, within 15 miles, or something like that.
If you think about it, there’s no competition among shift work physicians and people that work in the ED or as hospitalists. It’s not like you’ll steal a patient base from a hospital or anything like that. The biggest concern would be, let’s say, someone was a primary care medical physician employed by a hospital. Their clinic is off campus somewhere. They wouldn’t want to have physicians work at another primary care practice in the area. Maybe on the weekends or something like that, build up at least some patient base.
And then potentially terminate the contract with the employer, move over to whatever job they were moonlighting with, and maybe take the patients with them. Now, there will be other clauses in the contract that prohibit that. There will be a non-solicitation agreement. As I said before, there’ll be a non-compete. Still, in the non-shift work positions, the employer fears that they will establish a presence somewhere else if they moonlight, ultimately taking those patients with them when they leave the original employer.
Moonlighting can also take the form of, once again, let’s say there’s a hospitalist that works at one hospital. However, they’re in a more extensive network. And then there are other hospitals within the network that they could also pick up shifts at. In that scenario, usually, you would not need written approval to do that. Most contracts will state that providers can pick up shifts within the network without needing approval. Because usually, the medical malpractice policy would cover all the networks, not just one hospital.
And so, in that scenario, it would be acceptable that the only reason why, once again, let’s say it’s hospitalists, they would want to pick up shifts elsewhere, outside the network. Let’s say they have an opportunity to pick up additional shifts either at their hospital or maybe in other hospitals in the system. Why would they go outside? Well, it’s money. You’ll generally get paid more if you work in a locum tenant’s position. And maybe you’ll make 1500 a shift within the network, but then if you work a locums job, you’ll earn 2200 shifts, something like that. So, physicians would want to work outside the organization simply because they can make more. Anyway, that are some examples of moonlighting physicians.