Supporting Physicians: An Operational Perspective

Physician dissatisfaction is not primarily a pay problem. It’s an operational and transparency problem, and the financial stakes for health systems are significant.

Brett Pinnix draws on his tenure as a Director and VP of Provider Compensation inside a major health system, and makes the case that administrative burden, unclear compensation structures, and the absence of real-time performance data are significant drivers of burnout and turnover. For health system leadership, this matters directly: replacing a single physician costs an estimated two to three times their annual salary, with compounding revenue loss while the role sits vacant. The organizations winning on retention are those investing in compensation clarity and physician trust, not simply increasing base pay.

The complete conversation with Brett Pinnix — from his background in healthcare administration to the strategic case for physician compensation transparency.

A: I got into healthcare by accident — and you’re going to hear that term a few times here. My background is in exercise science and nutrition. Most professional pathways from that go into clinical work: cardiac rehab, medical school, physical therapy. But something in me said that’s not for me.

I always had a passion for helping the people doing the work. I would watch my classmates in clinical rotations and just saw the inefficiency. What they had to put up with, what they had to persevere through, in order to take care of patients. It felt a little ridiculous. So, I thought, healthcare administration helps those people, right? Healthcare is the place to keep people healthy.

My first internship really flipped that on its head. I’ll never forget the very first day. I had an amazing mentor named Melissa. She asked me what I knew about the revenue cycle, which is how health systems and doctors’ offices get paid. I had nothing. We spent the next four hours mapping it out on a whiteboard.

I walked away from that interaction, just flabbergasted at what the healthcare system actually was and what people had to persevere through. I realized that provider contracting and pay were an area of real frustration for clinicians and admins alike. It really created a passion for me to say: any part of this I can have a small influence over to make better, I’m here to do it. That lit a fire.

That kicked off what is now, more or less, my career — focusing in provider contracting and compensation. Again, completely by accident.

A: It really does. I remember my classmates saying, “They taught me how to treat a patient, that’s not the hard part. It’s everything around treating a patient, that’s the real problem.” And that’s only grown to be more true the more I’ve learned about healthcare.

A: When a provider is seeing a patient, what’s on their mind is: “what’s best for that patient?” I believe most providers have an innate sense of goodness to take care of the people in front of them. But they also have to focus on maintaining the right documentation, because just being honest in your documentation doesn’t mean you’re going to get paid the way you should. It is a gamification of what a provider needs to do just to get paid for work they’ve already done.

So, you’ve got their best intentions for the patient, but then they’re having to think about all of this in the background — documenting everything, considering their insurance and costs, submitting it in the EMR, going through a million different clicks and if-then statements and questions. A lot of their energy gets diverted just to getting that bill out the door, hopefully correctly, to get paid anywhere from four to twelve weeks later.

And the last thing I’ll add: all this pressure affects how much money the provider brings home to their family. For doctors, the number of patients they see, the acuity of patients they treat — all of that directly affects their take-home pay, supporting their family, paying off half a million dollars in student loans from medical school.

The people are the product in healthcare, which is why it keeps people coming back. They know they’re doing good for the community. But the divide between providers and everyone else is that their pay is on the line, significantly, for each patient they see. I think that’s a very pressure-ridden environment we’ve created for them.

A: That’s right. But the reason they’re taking notes in the first place isn’t by choice. It’s how they survive. It’s how they get paid. And if they don’t do it, one, they may not capture everything correctly and may not get paid to the extent they should and two; they’re going to have to do all that documentation after hours anyway.

Closing charts is typically two to three hours a day for a doctor outside of the patients they see.

And a big output of all of this is provider burnout because of administrative burden and the constant split between billing frameworks and patient care.

A: Providers spend four years in undergrad, four years in med school, then four to eight years in residency and fellowship. So, you could be talking about nearly 16 years of training. In all that schooling, they focus on medical knowledge and clinical expertise.

There is very little, if any,  training about how doctors get paid throughout that entire process.

When they start seeing what a typical provider contract looks like — if I see this many patients and I can get paid this much, and then if I see this many it’s this much, but it’s not counting patients, it’s counting work RVUs — what is a work RVU? What’s a work RVU for an E&M? — it is a whole new language. It’s difficult for anyone to understand, much less a person who’s supposed to be focusing on something much more important like treating patients.

And the fact that it affects their livelihood creates this internal consternation of — I know this matters, and I need to understand it, but how?

A: Simplicity is valuable for a lot of reasons, and first and foremost, it gives peace and confidence to the provider that they can understand what’s going on.

Simplicity also helps align incentives. If you give a provider ten metrics, they’re going to be paid on there’s no focal point. That is a fatal flaw.

And then even if you get those first two right — a simple contract with a finite number of aligned incentives — the third piece is where most health systems fall flat: the transparency of measuring performance. They don’t have the technology or integration capabilities to tie it all together and show the provider real-time feedback of what they’re doing compared to how they’re paid.

Laying it out for the provider, letting them see in real time, I saw more patients yesterday, I get more wRVUs, I got paid more; my quality metrics went up or down, here’s how it relates to my pay — that is arguably most important element of a high-performing physician compensation program. Because otherwise all that work is for nothing if providers can’t see and react to real-time data.

A: Absolutely. I think about it like offense and defense.

The offense is directly trying to improve the provider experience — being proactive in laying out contract terms in a way they can understand, showing them the data, giving it to them not just on a desktop but in a mobile app, coherent and easy to understand. That transparency is a positive experience, and you’re trying to be proactive about building it.

The defense is when something goes wrong — because healthcare is too complex an ecosystem for perfection. You’re going to have to rely on the trust you’ve built with that provider to work through it in a meaningful way.

Before software, so many resources go into just understanding and identifying the problem, then coming back with what ends up being a defensive message. These are people working 70, 80-hour weeks. They just want to get paid correctly.

A: Yes, exactly. And this brings us back to retention.

On average, losing a provider and backfilling that role is going to cost anywhere from two to three times their annual salary. For a physician making $500,000 a year, you’re talking potentially about millions of dollars to re-recruit, plus lost revenue while that role sits open. It is financially critical to retain providers.

And on top of that, there’s a shortage, you’re fishing in a pond that has a low volume of fish.

Retention of the provider’s workforce is at an all-time critical level.

You obviously have to pay sufficiently. But past the point of being competitive, I truly don’t think money is the answer. The most critical element I’ve seen actually work is aligning your workforce – top to bottom – to the organization’s mission.

Whereas if you’re printing PDF spreadsheets and just trying to get the financial numbers right every month, there is no time or space for the more important conversation — what we’re actually trying to accomplish as a mission for our patients.

A: I really appreciate the opportunity to talk about this. Bringing to light some of the issues they’re dealing with — what’s contributing to burnout and stress — just gives a better understanding of where we’re all coming from.

Providers are passionate about their communities, and it is a pleasure to get to talk about that.