April 1, 2021


I joined a small democratic group 4 years ago. One year into my time with the group, I joined the executive committee, which consisted of a managing partner, treasurer, secretary, and an at-large member. The first three positions were paid, but the at-large position was not. Of course, I got on as the at-large member. There were significant pay disparities between the managing partner and other two positions; the managing partner made 85% more than the treasurer and the secretary. As a result, the majority of the work was done by the managing partner. This put all of our eggs in one basket with little oversight, which lead to some poor employee contract management and decreased transparency to the rest of the partners. It also burned out the managing partner.

When I joined the committee, they were stuck. They needed a driving force to organize meetings and push our group forward. Our group had been talking for years about finding new accountants and pulling our 401ks together under one plan (at the time we each put together individual plans), but the group was sure it would be too difficult to switch accountants find cheaper ones, and there was resistance to leaving our personal 401k managers. However, I decided to organize meetings with accountants and 401k providers, which led to us hiring accountants for half of the base price we were paying with much better access and counseling from the accounting firm. We also moved our 401k to a local bank, dropping our average annual fee from 1% to .25%. I did this work while not receiving a stipend.

After my success of pushing the executive committee forward, my group felt I should get a stipend, too. I got 33% of the amount the treasurer and secretary got; however, through the above endeavors, I realized I would like to be the managing partner. So, I stuck with the job, picking up tasks that would have otherwise fallen to the managing partner and continuing to support the managing partner and push the group forward. I saw my time as sweat equity and learning the ropes for my future position. Six months later, at the next partner meeting, my stipend was increased to the same level of the secretary and the treasurer.

Along the way, our group became divided about picking up an additional contract in a town about 75 minutes from our primary location. The executive committee — particularly myself, the treasurer and the managing partner — put a lot of effort into exploring the new contract. Ultimately, in an 8-to-9 vote, we decided not to take the contract. The division created during this process lead to our treasurer stepping down. I had seen this coming, and started learning the payroll process 4 months prior to his departure. As you can imagine, when it was time to vote on the new treasurer, there was no one else who wanted the onerous job of payroll. So, I added payroll to my plate without decreasing any of my other responsibilities. There was not a change in my stipend, but I still felt I was learning, and perhaps even earning the position of managing partner.

This past December, we transitioned from an LLP to an LLC. The organization of meetings with lawyers, accountants, and numerous small-group discussions with the partners, as well as editing the new operating agreement, was all done by me. The LLC extended the executive committee’s terms to 2 years. Our managing partner decided to step down, and my opportunity to become the managing partner had arrived! I was prepared; I knew our business like no one else. I was the most qualified and willing candidate, and I was ready to finally get paid appropriately for all the time I had been putting into the company.

BUT — you knew there was a “but” coming, right? — I made a mistake. I believed that I could earn an elected position.

I was not elected to the position of managing partner. In a 9-to-8 vote, a partner that had joined the executive committee 6 months earlier, who had not produced much of a work product while on the committee, was elected. Through the company grapevine, I had heard that those who voted against me agreed that I was a qualified candidate and probably in a better position to take over the job, but they felt I was a dictator, less approachable, and not transparent in my actions.

Wow! Those are not words that have ever been used to describe me before. In the past, people had used words like “nice,” “team player,” “dependable,” and “knowledgeable.”

I was elected to stay on in the treasurer position with no change in stipend. Shortly after the vote, we started to pay our accountants to do payroll. We agreed to pay the accountants 3 times more than what I was getting paid to do payroll.

I attempted to decrease the number of hours I was working on executive committee projects to just 10 hours a month. My monthly stipend divided by 10 hours would then put my hourly admin rate at near the national average for EM doctors doing administrative work. But we had a brand-new managing physician who was not as knowledgeable as I was about the company, the accountants needed to be taught how to do payroll and invoicing, and we had projects that needed to be completed, including changing a product vendor that would save our group over $120 thousand a year and possibly add another $100 thousand of revenue to the group (spearheaded by yours truly). Therefore, I have continued to work 20 hours a month.

BUT, I am learning to become Audacious.

This past week, I sent an e-mail to the rest of executive committee asking that at the May partnership meeting we discuss executive committee pay. I detailed my value to the committee and explained that for the last 2.5 years, I have been paid one-third of the national average payment rate for EM physicians doing administrative work in democratic groups. I have accepted that it is unlikely there will be continued career growth for me outside of clinical work with this group, and I have determined that I will be paid appropriately for my time. I understand that this demand may lead to my replacement on the executive committee, or that in order to value my time, I may need to resign from the position.

But gosh darn it…I have the Audacity to make a new path with new career growth opportunities!

Sarah Hoper, MD, JD

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