Part 4 Donnelly Elinsky Contract

Hi all you BTK fans, it's Scott here and we are super pleased to have the final episode in our series on physician compensation, salary, HR benefits, hospital side of things, you name it, we brought it to you here. And today I'm super excited to have two guests on for this. First is Matt Donnelly, who's the Vice President of Professional Staff Affairs here at the Cleveland Clinic.

And also Mark Olinsky, who's the Director of Staff Analytics and Compensation also here at Cleveland Clinic. Gentlemen, thanks so much for joining us. Thank you. Thank you, Dr. Steele. Matt, I'll start with you. So, You got to tell me a little bit. We always like to get to know our guests. So, you know, where are you from?

How'd you train? And tell me a little bit about what is a vice president of professional staff affairs. All right. So I was I was born and only in New York and I went to school at a state university in New York at Fredonia. I played baseball there and I went to law school. So I'm a lawyer by trade.

I went to law school at the university of Dayton. Then I went to

a law firm in Cincinnati for about five years, and then I came to the Cleveland Clinic 18 years ago. I just had my 18 year anniversary. Started in the in the litigation section of the law department. I was in charge of litigation for a little over a decade.

I was also a deputy chief legal officer where I maintained my day job over litigation, but also helped run the law department and got involved in a few other things on the law department side. And then I came to the chief of staff's office Close to six years ago and I run an office called the Office of Professional Staff Affairs, and it's a fairly unique office to the Cleveland Clinic because of our heritage of physician leadership and our physician based culture.

We manage the employment environment for all of our physicians and professional staff at the Cleveland Clinic. So it's a little bit of a legal office, a little bit of HR, some strategy anything that touches the the environment of of our physicians things like recruiting, compensation, privileging, and credentialing, conflict of interest, institutional review board,

physician alignment staff governance I also get involved in some professionalism and disciplinary types of issues.

So really anything that touches the lives of our physician me and my expert staff handle those types of things. Yeah, I got to say from living in it on a daily basis, it is truly unique, but I actually think it's an incredible resource and we're lucky to have that and have you here, Mark. Let's switch over to you.

So tell us a little bit. Same thing. Where are you? Where are you from? Where did you train in and tell us a little bit about your job now? Yeah. Thanks a lot. So I have lived in Cleveland, Ohio, my whole life. I went to college at Miami University in Oxford, Ohio where I actually had two majors there.

I majored in both marketing and decision sciences. A lot of people ask me what decision sciences is. It covers many different things. A little bit of computer programming database type stuff, but primarily it's business statistics. So a lot of math background, statistical analysis that sort of thing.

Right out of school, I had a job at a small community

bank. I worked in their commercial lending department for a few years. And then I joined the Cleveland Clinic back in 2010 in their staff compensation office. And, you know, worked there for a few years. I ended up being promoted to the director at the end of 2016, and that's where I still am today.

So I've been doing this at the Cleveland Clinic for a while now, coming up on 15 years, and basically what my job entails is I get involved in all sorts of issues related to staff compensation. So, I'm helping out some of our physician leaders with recruitment and retention needs. I work with, pretty closely with our legal department on some issues with our contracts for for some of our physicians.

But our primary function is to facilitate the process for our annual compensation reviews for the professional staff. So as we go through our annual reviews, I meet with our physician leaders in each department being reviewed. And I work with them to take the dollars that have been

budgeted for staff salary adjustments, and we do the best we can to make the necessary merit and equity and market adjustments for the staff.

And then we take all those recommendations to various levels of leadership at the organization, the chief of staff, the CEO, our board of directors. And you know, we get everything reviewed by all of them at those levels and approved before we process. So, I get very involved with many different people here working on the staff compensation needs.

That's great. And we're glad to have both of you here and we'll jump right in. So today we're going to talk a little bit about a few different topics. First one is compensation and the different types of compensation, a little bit about approaches to your initial contract, and then we're going to wrap it up with some human resources or HR type issues.

So, Let's start it out in front, a lot of information out there. And to be honest with you, a little bit of confusion talking about the different compensation models, whether it's salary, hybrid fee for service, can you talk a little bit about each of these different

types and then maybe what is some of the perceived, at least strengths in maybe some of the downsides of each of the different models.

Yeah, absolutely. I'll get started here, Dr. Steele. I will start with salary. That is the model that I'm most familiar with. It's probably the easiest one to understand. And basically you, it's exactly what it sounds like. You have a flat salary, which is based on your FTE, which is defined by the organization based on the amount of work that you're doing, a number of days per week or number of shifts.

And the salaries are derived by looking at various resources that are out there. You know, primarily we're using benchmarking tools from consultants that we work closely with in the form of, salary and productivity surveys with many different organizations across the country submitting data to these surveys so that we can see what other organizations out there are paying and how our salaries fit in compared to all of them.

You know, I'll warn you that. Not every

single source that has benchmarking data in it is trustworthy or something that we want to use in our reviews. A lot of the time I get requests from people saying, Hey, you know, I have this He's a paper from a society that I'm a member of, or, you know, I found this benchmarking report.

We think you could use those to take a look at my salary and it's not quite that easy. There are many different things to consider but, you know, mainly we want to make sure that these are organizations that are totally unbiased. that are providing the data. We want to make sure that we really understand their data validation process to make sure that we're looking at good data that we can trust.

And you know, for that reason, we have a few different consultants that we work with who we really trust and we feel strongly that they have data that we can use. So, so when we go through our compensation reviews or when we're setting Somebody who is new to the organization.

We're looking at these various surveys. We have data for different years of experience. We have a starting salary

benchmark. We look at benchmarks for those first few years out of training so that we can see how people ramp up early on in their career. And then we have benchmarks for more of the mid and late career staff where we have different percentiles.

Maybe we want to position people around a certain percentile, maybe at the median, maybe for some people based on their role up closer to the 75th percentile, or anywhere in between, or, you know, even above or below those for various reasons. But I mean, that's really how the salary model works is you just look at all sorts of different factors what their specialty is, their years of experience their maybe their productivity, their quality, and you just pick a salary that seems to make sense based on both the internal comparators and that external data, and you just set that until the next time it's reviewed.

That's fantastic, Mark. So, you know, in terms of you mentioned some of the strengths of this model, like you have a set understanding of what you're going to do, what you're going to get paid for. Can you think of any downsides of the salary model or anything that, you know, you need to be aware of to our

listeners out there to think about?

Yeah. So, no, I think that what can be perceived as a downside, you know, it's a lot of it is based on the culture of the organization or the mindset of the individual. But, if you have a salary that. Is your salary until it has changed. So, you know, sometimes you get people who are very committed to working hard, just cranking out the patients doing tons of procedures, and they feel like they're working above what they're being paid for.

And, that's something that we can look at. As you bring that to our attention or when we go through our next review to see if your pay actually is compensating you for the work that you're doing. But there could be a little dissatisfaction there if somebody feels that they're being paid for less work than they're actually doing.

You know, on the flip side, there's a lot of security in the salary. You know, if you have to miss a few days of work or if things slow down for you for whatever reason, you're not going to be I don't want to say penalize. You're not going to be hurt financially for that. You're going to maintain that salary.

So,

you know, you don't have to be as concerned about hitting those targets to make sure that you're getting the money that you expect. Fantastic. Matt, let's switch over. Dr. Steele, just before we, before we move on to other models, I think we really saw the benefit of the salary model during COVID when the Cleveland Clinic kept everybody whole.

People still got their salaries despite, you know, the government shutting down the O. R. S. And things of that nature. So that was really that security blanket that people really appreciated being on the salary model as opposed to the other models we're going to get into, you know, that that paycheck was coming to help support your family and and your future.

So that was definitely a benefit of the salary model. Yeah, absolutely. No question. And again, great points brought up by your mark in terms of both. But Matt, let's switch it over to you and talk a little bit about some of the things I mentioned early in the onset. So, you know, maybe hybrid fee for service with some of the other compensation models.

Yeah. So when you talk about hybrid people hear of different things called hybrid, maybe an incentive based model or productivity model. And there's a lot of different ways to build them,

but generally what happens is they will set your base compensation at maybe it's at the 20th percentile of pay.

And then. You'll have to do as so much work in order to earn that base compensation. But then when you work above and beyond that is when you you're incentivized or bonus to you'll earn more income as you create, you see more patients or do more procedures or, you know, higher RVUs are generated and things of that nature.

So that's one incentive model or productivity model. Another one is take that same the same model I just gave you but add a third layer and what we call the trident model so on top of your base on top of any RVU bonuses. There's also potential to earn more money, based on your quality scores based on your patient satisfaction.

Your citizenship, are you a good citizen, so to speak do you come to meetings when you're supposed to, do you follow all the rules, do you close your charts on times, things of that nature. So there's that quality bucket that that we can layer on for that as

well. And then the chance to earn more money sometimes that quality metric, okay.

Can actually be a guardrail where if you don't hit certain quality metrics, you don't even qualify for the your WR view bonus, no matter how hard you work. If your quality isn't there, you shouldn't earn those, you know, the quality the. So, there's a lot of different ways that you can structure these, but those are basically how the incentive or productivity model is is generated.

And then the other thing you mentioned was fee for service that is just exactly what it says you might get paid a certain fee for, you know, for the service that you provide whether it's. per patient seen or whether it's per per surgery or whatever the case is you're strictly paid for the services that you provide.

It's a contract and you understand what you're paid in return for what you're providing. That's fantastic. And so For those who haven't listened to the other in podcasts in these series, I want to set some standard definitions just off the bat. And so

you mentioned RVUs and you mentioned FTEs.

Can you just tell our listeners out there what these are? Yeah, I'll take the FTE. I think that's an important piece, and then I'll hand it over to Mark for the RVUs, but FTE, full time equivalent, is what how most people say it. That's really defining your job, and I think it's important when you take a job, what, what is my expectation?

So if you're an anesthesiologist, for example, what does my day look like? I come in at what time, and what do I, what time do I reasonably expect to be out? How many ORs am I supposed to cover? What is What, what am I working for that salary? You're paying me or for the, whatever model it is.

I think it's very important to know what you're getting into. So you want to have that FTE defined. If you're a primary care physician, for example, how many patient facing hours per month or how many patients do I see a day? What are my slots look like? Are they 20 minute slots? Are they 40 minute slots?

Are they 60 minute or things of that nature? You really want to define what your FTE is so you understand.

What you're being paid for, what the expectations are. And if you're weighing different offers at different organizations, you want to be able to, it's not just, you're not just weighing your salary or the money, but what does my work like life look like?

And can I compare the two? Are the, am I comparing like jobs? So I think defining that FTE is very important. It's not just looking at the money, but what, what's expected of you and what is your day to day look like? Mark, how about the RVUs? Yeah, so RVUs, or relative value units, are the values given to services or procedures by CMS.

So essentially what they're doing is they're saying what your time is worth as you do these procedures or provide some sort of service. And everything is relative to all other services and procedures. So based on the work that's being done, the resources needed the expertise required for the service, you'll receive a certain number of RVUs.

And to simplify it, if you are doing something

that generates 10 RVUs, essentially what that's saying is that that is worth 10 times what something that generates one RVU is worth. So, so everything that you do as a physician does generate a certain number of RVUs for the most part. And, you know, we have RVU based contracts where you are being paid for the RVUs that you generate.

So, as you see more patients, as you spend more time in the OR, as you do anything that you do as a doctor, you are generating more RVUs based on the work that you are doing. And that is how you would be compensated, by being paid for those RVUs that you generate for the different things that you do. Yeah, I think that's important to note.

And as I got into practice, I can say to the listeners that, you know, having an understanding of which of these particular procedures that you do is associated with our view that could be tied into your contract or could just be tied into expectations from your Boss or your chair, depending on what

organization you work for that, you know, it may not be hand in hand with a payment, but it may be a certain expectation that you meet 5, 000 or a certain benchmark in terms of productivity.

So another discussion that you should have, Matt, I'd like to, just as before we close out the different compensation models, you know, I've heard a lot about free fee for service that, you know, depending on your personality out there, you may like, man, I can't take any time off. Cause if I do, then it's just, you know.

The quote unquote eat what you kill type of thing that mentality out there. Is there any other perceived maybe strengths or weaknesses that are associated with any of these different hybrid models? I know that as Mark said, we use a salary model here. I can tell you that I, you know, I grew up in that when I was in the army.

Having a salary model. I do a lot of these cases that may be longer cases and understand that it's not maybe has the highest RVU, but they take a long time or they're multi panel type cases. So having that salary, you know, may fit my lifestyle, but any thoughts there. Yeah, you highlight an important piece where

if you're based, if you're paid based solely on RVUs and you might do a grueling surgery takes you all day, but you might not get the credit, the RVU credit that you feel you deserve for putting in that time.

Therefore, your pay is not going to reflect that or other procedures have a lower RVU value. And you might be busy all day long servicing and providing great service to patients, but again, you're not going to get paid the value that you're providing to the patients. If you're looking just at the RVUs.

On the flip side, if you are generating RVUs and you are being paid pursuant to your production, I think you do feel like you're being rewarded. The harder I work, the more I'm going to get paid. Like Mike, Mark was saying, if you're on a salary model and you think you're going above and beyond, but your pay doesn't change, you feel kind of shortchanged by that salary model when you're on the incentive based.

And you are providing a great service to your patients. You have great quality and you're extremely busy

and you're generating a lot of our views. You're going to get paid and you're going to feel like I worked hard but I also got paid and I got rewarded for that hard work. So there is a, there's a balance you have to strike I think with that.

I think you also have to be careful in the incentive model. You don't want to incentivize the wrong behavior. You don't want to incentivize, you know, Just seeing as many patients as I can just doing as many surgeries as I can so that I get paid more. But you also want to make sure you're keeping your quality high.

You're keeping your patient satisfaction high, and you're not just turning patients just for the sake of a paycheck. So, all of this comes with balance. All of it comes with thinking through why you're doing things. Hopefully everyone does it for the right reasons and you can get into, you can get into regulatory problems you know, if you're providing services for the wrong reasons as well.

So, so. That's such great points and important to consider. So let's switch gears just a little bit right now. And let's talk about maybe some approaches or things to think about in terms of your initial contract. We talked about FTEs, we talked about

RBUs a little bit and what that looks like.

But any thoughts about other factors or other things that might go into consideration, even to have a discussion with your potential employer about. Things to ask for things to think about in terms of that initial contract or changing jobs, or if you're in a contract and want to get to the next one.

Yeah, a couple things that are pretty standard. And again, everything I think everything we're talking about is relative to your specialty to your market supply and demand, all those sorts of things, but a lot of the typical discussions might involve sign on bonus. Maybe loan forgiveness a retention bonus after so many years.

So you might not be given a sign on bonus when you sign up, but you might want to say, Hey, If I'm here for five years, can you give me a retention bonus to reward me for staying and not leaving after a couple of years. Other

things that you might think out of the box, will they pay for your MBA, maybe you want to be a girl go on to be a physician leader, and maybe after a couple of years and you get your feet under your in your practice, you might want to get an MBA or some other type of schooling.

Take other courses that might be something that you can negotiate into your contract as well. Are there other resources you may want, you may need teaching? Do you want to teach trainees? So there are a lot of other things that aren't necessarily tied to money, but things that might be tied to your job satisfaction or your your goals and professional development that you might think about including into your contract negotiations as well.

I know that you both had talked a little bit about in the salary model that it gets reassessed. So just, and it may differ between institution to institution, but the salary to, is it regulation that salary is going to change over time or evolve a certain factor over time? Or how does that all work?

Or you just, you get a salary and you're good to go for the next several years on that salary.

How does all this work? Yeah, I was actually going to bring this up to respond to your last question as well, Dr. Steele. I think an important thing to make sure that you understand, or at least consider, is the evolution of your salary when you're signing that contract.

Are you joining an organization that brings you in high and keeps you flat or relatively flat for the next five, seven years? Or are you joining a place that brings you in at a certain level and maybe bumps you up after one year, two years, three years until you reach that mid career level salary. So that, that is a very key thing to consider.

And that could vary based on the organization that you're dealing with. It could vary based on the department that you're going into or the leader that you're working with. But yeah it's definitely there, there are different ways that that could go and you want to make sure you understand what to expect when you're signing that initial contract.

You know, other things that I think you might want to consider are just how much you want to put into this because while we do have on the salary model

anyway, your salary does ramp up at least in most cases, it will ramp up from that starting salary through those first few years. We're not always going to position you along with everybody else with similar experience.

It's going to depend on. You know, are you going above and beyond, or are you just kind of clocking in and clocking out at the end of your day? Are you going to be a part of the call pool, or are you going to not take call? So when you are joining an organization, setting that salary, signing that initial contract, these are the things that you want to consider.

So I kind of answered two questions in one with that, but I think that's great. And it's something that many people out there may be so excited that they got a job and signing a contract after years of debt, they may not feel the free or even be worried about asking that. So I think these are important take home points to go, Matt, can you talk a little bit, whether it be sports or medicine or anything, there's a lot about equity and payments.

Can you talk a little bit about your thoughts on that and maybe your approach to that? Sure. That's obviously a hot topic and something that people monitor

pretty closely. And what we do at the Cleveland Clinic is we're pretty transparent about our process. Because we don't want people feeling like somebody is making up salaries or other, or other hiring or pay decisions in a back room somewhere and nobody knows what's going on.

So, Mark actually gives a presentation several times a year to different groups in the organization about what our salary process looks like. How does it start on day one? Who evaluates it, who's involved in the process how do we evaluate it, what are the factors that go into those evaluations how he runs analyses in the background as to make sure that people are paid fairly with respect to to gender and race and ethnicity and specialties and all different things of that nature.

So that when our staff walk out of that meeting, they say, wow, that was. That was really, it's really clear to me how our salaries are generated, how they're decided, who's making the decisions. And we also walk them through the different steps, how it starts at the department level,

goes to the institute, goes to the chief of staff's office.

And then ultimately, we have a board of directors compensation committee that approves this. And these are individuals that understand compensation, they understand fairness, they understand equity. So our process is very transparent and it's it's very thorough. And it's something that, that we gladly tell people about because because we're proud of it and it is transparent.

So I think another thing to evaluate when people are looking at jobs, you know, what is the process? To evaluate salary, how often do you do it? And what are the factors that go into that? To add to that, you know, one thing to be totally clear about is equity does not mean that everybody has paid the same thing, right?

You know, people have different responsibilities. They you know, they may have different levels of productivity. They may have different quality. There are all sorts of reasons why people may be paid different things. So when we're talking about equity, we want to make sure that what we have makes

sense and is fair, and most importantly, that we're being consistent in how we apply our approach.

So that is what it means to be equitable in compensation, not to make sure everybody is being paid exactly like everybody else. Absolutely great points. And as we round out this episode, let's switch gears a little bit to maybe some other things that you may not think about asking for, and that's some of the HR benefits that may go into it.

So thoughts there and all what goes into that and what can be the expectation and maybe what are some things that are some wiggle room for maneuver there? Yeah, I think, you know, probably the big benefits are given at all the institutions that people that are listening to this are looking for health insurance, dental vision you know, a 403 B match things of that nature.

Life insurance, short term disability, long term disability, but there are differences among the plans that you might want to compare if you're deciding on competing offers time off is one that people can really get fooled by though, because it comes in all different shapes and sizes.

Some organizations might give you a bucket of days off to use as you please. If you get sick, you pull from that pool. If you have to take days off, vacation go on a go to a seminar, that might come from that pool. Whereas other organizations might have different buckets for vacation, for sick time, for business meetings.

For CME travel, all of those types of things. So you want to understand what those offers are and how different organizations are giving you time off because you might get fooled by a big number in one category and that might be the only category you have where there might be triple the amount of time, But categorize differently.

So don't get fooled by the initial, you know, do your homework and do a little bit of digging. So I think that's the biggest advice I'd give is on the vacation or time off comparison. Make sure you understand and you understand all of the options that that are given to you. That's such a good point.

And I know here at the Cleveland Clinic, we do

actually have those several buckets that look at meeting and professional time and vacation and sick days. So really, really good point. Unfortunately, you know, I've seen some statistics that say that 50 percent of people. Leave their job within the first two to three years.

And so things don't always go the way that we expect. And you may need to transition out of jobs or approach that. And so this is a tough time. It's very stressful. You had your hopes up and it, especially if you're earlier in your career. So. Any advice here about when things do go wrong, you know, maybe what's some approach or maybe some things to just think about to make that exit and make sure that it happens you know, is professionally as possible.

Sure. Yeah. Unfortunately I've been involved in a couple of these situations and thankfully nowhere near the 50 percent rate that that, that you had quoted, but sometimes. You're just not a fit for the organization or the organization is not a fit for you. And that's okay. It doesn't mean You're a bad person doesn't mean

you're a bad physician.

It's just not a good fit. And the best way to approach that is professionally and with candor and work with your chair. And say things aren't going things just aren't working out. They know things aren't working out, right? It's not it's usually not just a one sided one sided conversation And when i've been involved in these We're more than happy to help a smooth transition.

We want people to succeed We want them to go to their next job and be happy at that next job And we will help them with that transition Give them some extra time To look for a job, you know, write the right recommendations for them. Because nobody wants anyone to fail. We want everyone to succeed.

And we realize that once in a while, the fits not there but we help people move on. So I think if you're just open and honest and work with your chair, they're more than happy to work with you as well because it's a two way street and the chair doesn't want someone there that's not going to be there and not, it doesn't want to be there and isn't going to

succeed and vice versa.

You don't want to be in a role where you're not happy going to work every day. You have other things on your mind because you can't stand it. So it's mutually beneficial to help a smooth transition. But always maintain your professionalism because you never know with consolidation and the way that, that people move around, you could be working for that company.

Again, your chair could be your chair at another organization. Maybe not the next one, maybe three organizations down the road. It's a small world. So always maintain your professionalism and you can't go wrong maintaining that approach. Yeah, I can tell you that I remember somebody told me once you can work hard as it can be for 99.

9 percent of the time, but people will remember the way that you left. So gentlemen, some quick last minute thoughts any take home messages for the audience out there about any of the things that we talked about today, Mark. I'll start I think it's I think it's an exciting time there is, there's a lot of opportunity in the healthcare world and healthcare space.

Being a physician there's a lot of opportunity to grow

to great organizations to go all over the world. And just my advice would be to Understand what you're getting into. If you're weighing offers, understand the intricacies of all your different offers. Understand the models and all the things that we've talked about and probably, you know, issues you've spoken about on other episodes of this.

And then make the best decision you can and things will work out just fine. Yeah, I mean, I totally echo Matt's comments there. I think it's just, you know, in addition to that, it's important to understand that while obviously, you know, we all want to be compensated for what we do, and you want to get a salary that makes sense for you and make sure that you're getting the most money that you can.

That's only a piece of it. And like Matt was saying, you want to make sure you're a good fit at the organization you go to. You want to make sure you're happy. You know, if you get a big raise, but that's only going to make you happy for a little bit of time. It's, you know, you want to make sure that you're where you're supposed to be and doing the best job that you can and that you're happy doing it, that's

fantastic sage advice.

And so gentlemen, I just want to so much for taking the time out of your busy day to join us here on behind the knife and for all the listeners out there dominate the day. Thank you.