Every time a practice asks physicians to take on something new (e.g., more clinic hours, call coverage, administrative responsibilities, etc.) or to help fix a problem, one topic always seems to dominate the conversation:
Compensation.
Sometimes physicians will bring it up immediately. Sometimes administrators raise it because they assume it will be the physicians’ biggest concern. Either way, if pay enters the conversation too early, the entire discussion becomes transactional and progress stalls.
Over the years, I’ve found it much more productive to make compensation the last conversation, not the first one. When the topic of pay comes up early on, I typically say something like:
We’ll get to pay. But let’s not put the cart before the horse. Let’s make sure this idea actually works first.
Before you talk about compensation, there are several more important questions to answer.
First: How does this fit into physician effort?
Physician time is precious, so it’s important that to be clear:
Are you going to carve out time on the physicians’ schedules, or are you asking them to add more time on top of their current workload?
That distinction matters. A lot.
Second: Is this temporary or permanent?
Some initiatives are short-term experiments. Others are long-term expectations. Those are very different situations, and they should be treated differently, when it comes to the time, effort, and resources required.
Third: Does the practice actually have the capacity to support the change?
Do you have enough exam rooms or O.R. time? Enough medical assistants, nurses, or other support staff? Does the scheduling template make this feasible?
Even well-intentioned ideas fall apart when the operational support isn’t there.
Fourth: Have we made it as easy as possible for physicians to succeed?
Sometimes physicians are asked to “do more” when the real opportunity is in removing obstacles that keep them from providing the best care to as many patients as they reasonably can—inefficient workflows, documentation burdens, scheduling friction, or staffing gaps.
When you address these four questions before you start talking about pay, something interesting happens. Physicians see that the practice is really trying to support them, not just extract more effort, and they become more willing to engage. Or, on the flip side, you might discover that your well-intentioned idea won’t work in practice. Either way, you’ll make important progress before you get into a heated compensation debate.
Now, you won’t be negotiating in the abstract. You’ll be aligning pay with work that everyone understands.
