Physician Compensation Plan

Pradeep V. Kadambi, MD, MBA, FASN, FASTProfessor of Medicine

Senior Associate Dean, UFCOM—JPresident and CEO, UFJPI

Principles of our Compensation Plan

• Market Competitive • Retain and Recruit talent to fulfil the Institutional Mission

• Performance Based• Correlates with clinical, academic and value based metrics

• Affordable• Can we afford the initial cost to start the plan?

• Sustainable and Flexible• Flexing components of the plan to address changing needs

• Transparent• Simple, consistent, objective and equitable

• Compliant• With applicable laws and regulations including fair market value

What are the chances of achieving this?

“Zero”

The Committee

• Dr. Alan Berger (Neurology)• Dr. Kelly Best (ObGyn)• Dr. Tirbod Fattahi (OMFS)• Dr. Leon Haley (Dean & CEO)• Dr. Mark Hudak (Pediatrics)• Dr. Igor Ianov (Anesthesiology)• Dr. Lisa Jones (Medicine)• Dr. Arshag Mooradian (Medicine)• Mr. Tim Reinschmidt (UFJPI)• Mr. Eric Conde (UF Admin Affairs)

• Dr. Ashley Norse (Faculty Council)• Dr. Nipa Shah (CHFM)• Dr. Paul Mongan (Anesthesiology)• Dr. Chandana Lall (Radiology)• Dr. KC Balaji (Urology)• Dr. Paul Dougherty (Orthopedics)• Dr. Andy Kerwin (Surgery)• Dr. Shahla Masood (Pathology)• Mr. Rick Scanu (UFJPI)• Mr. Dean Cocchi (UF Health)

What are the sources of our revenue?

65.2%

12.7%

12.5%5.1% 2.5% 1.9%

Clinical Revenue

Academic Support

UPL

Grant Revenue

State Based

Other

UFJPI Revenue Sources FY 2018 ($284 M)

What are our expenses?

49.1%

26.3%

2.8%

4.9%

11.7%5.2%

Physician Salary & Benefits

Clinical Staff Salaries &BenefitsOccupancy Costs

Other Clinical Costs

Non-Clinical Admin Costs

Deans Fund

UFJPI Costs FY 2018 ($300M)

Academic Support Agreement

• The hospital is the economic engine of a health system• The annual support (~$36M) that the hospital provides to the practice plan

• Medical Directorship• Program Support• Call obligations• Personnel• “Other”

• The hospital has endured $31M in cuts from the State over the past 3 years and is expecting $12M Federal cuts this year (~7%)

• A hospital with a healthy margin = a fully supported practice plan• Annual negotiation with the hospital

Assessment

• We are an academic practice with a heavy clinical footprint• Clinical dollars are allocated for most non-revenue generating activities

• Residencies• Fellowships• Students• Teaching• Administrative time• Protected time

• Clinical dollars are allocated for non-revenue generating positions• Nurse navigators• Clinical coordinators

• The Hospital needs to be financially sound for it to continue its current support

How do we move along?

Basic Principles

• We are an academic institution, and hence need to benchmark ourselves to the AAMC salary scale

• We want to target the 50th percentile salary for subspecialty and academic rank

• Faculty productivity will be assessed using the FPSC/AAMC/Vizient benchmarks for work RVUs

• For us to sustain, generally the benchmark for work RVUs are 12 to 17 percentile higher than the salary benchmark

• How do we value research/scholarship/teaching/quality• The next set of work will be on Call Pay and Incentives

Which is a better model and why?

Opportunity (20%)

Base (80%)

Opportunity (10%)

Base (90%)

Models

• What are the opportunities to earn incentives?• wRVUs• Quality Metrics• Scholarship• Unfunded research• Good citizenship• Being on call

• What is the weightage for different metrics?

Example (80/20 split)

• AAMC Median Salary benchmark: $200,000• Base is $160,000 (biweekly paycheck)• Incentives (given out either once or twice a year)• Clinical (50% of $40,000)• Quality (20%)• Access to care (10%)• Research and scholarship (20%)

• The Opportunity will be Department/Division specific• The threshold for clinical incentives will be set prior to the academic

year

Group 2

Concept of Protected Time

• Funded almost entirely by clinical revenue• Examples include:

• Department Leaders• Division Leaders• GME faculty• Medical Directors (hospital funds flow)

• 10% of the faculty time (other than CHFM) is “funded” by the practice plan

• Group benchmarks should also be considered

Potential Model for Protected time

Practice Plan

Department

Division

Individual

• A (1- ) approach is common with many compensation plans

• The clinical time can be offset by the actual funding for a certain position (clinical target will be adjusted downward)

• The clinical time can be preserved and the actual funding could supplement the compensation (clinical target will not be adjusted)

• Division or Department will still have to meet its overall targets

Group 3

Department Specific Plans

• Non Unitized• Medicine• OMFS

• Unitized• ED• Radiology