Firefighter position with Team Health

[UnderwaterDoc]

Hi there everybody, I was wondering if anybody has inside knowledge about the firefighter positions with team health. Yes I know that I can contact them and they will give me all their corporate approved info but I am looking for unbiased information, from docs that either are or have worked as firefighters for team health.

Any info would be greatly appreciated. Muchas gracias!

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[Birdstrike]

I've got a great, great, story about a couple guys that went to be "firefighters" for this group. I'm laughing just thinking about it. It'll be in my book, if I ever get around to writing it. LOL. Awesome. I wish I could post it right now. It's got nothing to do with this group, but everything to do what happened in these guys lives when they took off to be "firefighters." Sorry, wish I could help.

 

[UnderwaterDoc]

I've got a great, great, story about a couple guys that went to be "firefighters" for this group. I'm laughing just thinking about it. It'll be in my book, if I ever get around to writing it. LOL. Awesome. I wish I could post it right now. It's got nothing to do with this group, but everything to do what happened in these guys lives when they took off to be "firefighters." Sorry, wish I could help.

Holy cryptic answer Batman.

 

[TooMuchResearch]

Holy cryptic answer Batman.

Well, at least you figured out Birdstrike's non-ED career move.

 

[UnderwaterDoc]

Well, at least you figured out Birdstrike's non-ED career move.

I wonder who his Robin is.

 

[gro2001]

Rusted Fox.

 

[jbar]

Sorry, what's a "fire fighter?" I assume that it's not a dude who puts the wet stuff on the hot red stuff, but some sort of locum job. But for those of us still in residency could you expand on what these jobs generally entail?

 

[deleted109597]

Sorry, what's a "fire fighter?" I assume that it's not a dude who puts the wet stuff on the hot red stuff, but some sort of locum job. But for those of us still in residency could you expand on what these jobs generally entail?

Locums for big groups at places with issues. Thus, you go to put out fires. It can be a little demanding.

 

[GeneralVeers]

Locums for big groups at places with issues. Thus, you go to put out fires. It can be a little demanding.

I never figured out why people do this. The Firefighters with EMP were paid $150/hour, which is less than most locums contracts pay. For the privilege of that mediocre salary you get to fly out to rurual/depressed contracts that have low morale and are losing money.

 

[UnderwaterDoc]

I never figured out why people do this. The Firefighters with EMP were paid $150/hour, which is less than most locums contracts pay. For the privilege of that mediocre salary you get to fly out to rurual/depressed contracts that have low morale and are losing money.

I didn't expect to be the one knowing a bit more about this. Locally where I'm at (northeast) firefighters make 250/h, and full time is 120h per month which is significantly more money and less hours than the average community gig here, although you also have to factor in travel time if they send you out of state. All travel expenses would be covered including rental vehicle and meals. You are paid as an IC and get no benefits so you have to set all that up on your own, they do cover malpractice. I know a single person doing it and he bunches his shifts together in blocks of 5 so he ends up working almost as a hospitalist with one week on and one off, he swears by it and tells me it is the best thing since sliced bread.

I can think of a lot of cons of a set up like that, hence why I posted to see if anybody had some inside knowledge to share. I think I could do a year or two tops, definitely not a long term gig.

 

[GeneralVeers]

I didn't expect to be the one knowing a bit more about this. Locally where I'm at (northeast) firefighters make 250/h, and full time is 120h per month which is significantly more money and less hours than the average community gig here, although you also have to factor in travel time if they send you out of state. All travel expenses would be covered including rental vehicle and meals. You are paid as an IC and get no benefits so you have to set all that up on your own, they do cover malpractice. I know a single person doing it and he bunches his shifts together in blocks of 5 so he ends up working almost as a hospitalist with one week on and one off, he swears by it and tells me it is the best thing since sliced bread.

I can think of a lot of cons of a set up like that, hence why I posted to see if anybody had some inside knowledge to share. I think I could do a year or two tops, definitely not a long term gig.

If TeamHealth is paying 250/h for its firefighters, then it definitely has a lot of the other companies beat. I will say that EMP's 150/h is WITH benefits, so it's about equivalent to a 190/h IC job. I'm getting about 250/h plus malpractice and travel for my own IC job, so Teamhealth seems comparable to market rates.

 

[UnderwaterDoc]

If TeamHealth is paying 250/h for its firefighters, then it definitely has a lot of the other companies beat. I will say that EMP's 150/h is WITH benefits, so it's about equivalent to a 190/h IC job. I'm getting about 250/h plus malpractice and travel for my own IC job, so Teamhealth seems comparable to market rates.

How far do you travel?

 

[GeneralVeers]

How far do you travel?

Usually two flights on a major airline (stop in a hub).

 

[Hercules]

I never figured out why people do this. The Firefighters with EMP were paid $150/hour, which is less than most locums contracts pay. For the privilege of that mediocre salary you get to fly out to rurual/depressed contracts that have low morale and are losing money.

The firefighter gig you describe sounds terrible. But I can say the firefighter jobs that I have encountered have paid more similar to what was quoted for teamhealth here. In general they pay a premium over what they normally would. 250 an hour sounds about right

 

[GeneralVeers]

The firefighter gig you describe sounds terrible. But I can say the firefighter jobs that I have encountered have paid more similar to what was quoted for teamhealth here. In general they pay a premium over what they normally would. 250 an hour sounds about right

I told them it was terrible, but EMP has a culture of nevery talking about money, or salary. I brought up the terrible, uncompetitive firefighter salary with some of the VPs, and they just gave me a blank look as if I was speaking a different language.

 

[UnderwaterDoc]

I told them it was terrible, but EMP has a culture of nevery talking about money, or salary. I brought up the terrible, uncompetitive firefighter salary with some of the VPs, and they just gave me a blank look as if I was speaking a different language.

I moonlight for EMP, and I have to agree that their salaries are on the low side for full time community gigs, although their benefit package partially makes up for that.

 

[The White Coat Investor]

$250? That's it? I assumed these gigs would pay $400 an hour. I'm not going anywhere for $250. Makes me appreciate my regular job in a functional ED in a functional hospital with great partners.

 

[la gringa]

we've had to use firefighters where i am, and i wouldn't say morale is "low"... but when people leave for any reason mid-year and/or you add coverage, or a freestanding ED... you need more docs.

i live in a nice city with reasonable COL, hospitals are not malignant, but people still come and go. plus, it's a BIG group with 7 ED's. most who have left have family reasons to leave, or stayed as PT and are doing non-clinical work.

i will say that EMP's benefits are quite good -- the retirement contribution is quite significant and not common in physician groups.

 

[UnderwaterDoc]

I guess that firefighters don't frequent SDN

 

[Joriel]

Does anyone have any updates regarding the TH Traveling positions (now called Special Ops, I think)? Do the TH traveling/locums people work at 1-3 sites for several months or longer like the firefighters with EMP? Or do they bounce from hospital to hospital every few days like the float docs with EmCare? Any input is greatly appreciated. Thanks!

 

[Arcan57]

Our division has envoys that are free-floaters that cover shops in the city on an as-needed basis, which sounds like your description of the EMCare set-up. We have docs that fly in from other states to work, but as far as I can tell they're not getting a stipend to do so.

 

[The White Coat Investor]

Sorry, what's a "fire fighter?" I assume that it's not a dude who puts the wet stuff on the hot red stuff, but some sort of locum job. But for those of us still in residency could you expand on what these jobs generally entail?

Some people may not understand this, but a firefighter is a "scab." When a large contract management group steals a contract from a small democratic group, they need a bunch of bodies all at once to staff that ED. If the members of the small group won't sign on with the CMG who now owns the contract (due to a non-compete, because they have better options, or just out of spite) then they need to get a bunch of guys in a hurry, hopefully a bunch of good docs who can impress the hospital who just booted a bunch of good docs after falling for the line the CMG sold them (higher quality, a subsidy for the hospitalist service, fewer complaints, more revenue etc). Then a few months later as they fill those positions with long term guys, the firefighters move on to the next stolen contract.

They may also be used in places that are difficult to attract a decent doc. In short, it is highly likely to be a hostile or even dysfunctional work environment. Thus the reason it seems silly to do it for a relatively standard $250 an hour, notwithstanding all the travel.

 

[gman33]

Some people may not understand this, but a firefighter is a "scab." When a large contract management group steals a contract from a small democratic group, they need a bunch of bodies all at once to staff that ED. If the members of the small group won't sign on with the CMG who now owns the contract (due to a non-compete, because they have better options, or just out of spite) then they need to get a bunch of guys in a hurry, hopefully a bunch of good docs who can impress the hospital who just booted a bunch of good docs after falling for the line the CMG sold them (higher quality, a subsidy for the hospitalist service, fewer complaints, more revenue etc). Then a few months later as they fill those positions with long term guys, the firefighters move on to the next stolen contract.

They may also be used in places that are difficult to attract a decent doc. In short, it is highly likely to be a hostile or even dysfunctional work environment. Thus the reason it seems silly to do it for a relatively standard $250 an hour, notwithstanding all the travel.

I'll give you the scab part.
It's not the type of job that would appeal to me.

Where I live and will be practicing, $250 an hour is no where near standard.
$150 - 170 is normal.

Some people who take these jobs may live in a similar area, but want to make more than the local market pays.

 

[TysonCook]

Agree with White Coat. Nothing personal, but IMHO this is a very glorified name for a Scab (and demeans what firefighters do in reality)...

 

[The White Coat Investor]

I'll give you the scab part.
It's not the type of job that would appeal to me.

Where I live and will be practicing, $250 an hour is no where near standard.
$150 - 170 is normal.

Some people who take these jobs may live in a similar area, but want to make more than the local market pays.

So if you have to go work somewhere else as a scab to make a good salary, why not just go somewhere else and work a regular job? You can do locums without being a big CMG "firefighter."

 

[Capgras]

I think there are a lot of generalizations being made by people who haven't been in the position ... usually the case on most forums.

I work as a "Firefighter" "Traveler" "Internal Locums" for a medium sized contract management group (CMG) currently and can give you my opinion / experience.

Pros:
You get paid a premium over the current full-time rate for that group. Why are people comparing random numbers around the country? If EMP pays their docs $130 then they pay more to the "Firefighters" and the difference between the base rate and the premium rate is what matters. I think $50/hour is a fair difference

My job offers full benefits and the same incentive and bonus structure as full time. So I am like a local full time doc with $60/hour premium. Travel expenses are covered (This actually adds up to ton of frequent flier miles and cashback $ on the credit card).

You get exposure to multiple hospital systems, EMRs and people. Some people will tell you adaptability is the best quality to have and this is fellowship in adaptability.

Compared to Locums you are part of a Company and get exposure to the same leadership opportunities within the company. I am currently the Medical Director at my department and got the role through the program.

Cons:
You have to travel - which should be understood before you even explore the option.

The sites are usually understaffed. There are several reasons for this (location, turnover, new contract) and you used as a temporary fix. Scab is not a horrible description and I don't take offense to it because Scabs offer a very important function in wound healing in real life. I would caution against listening to the stories above of big evil group kicking out the good small group. Usually the hospital looks for a replacement for a reason and most of the time it is the hospital that want the old docs out rather than the old docs not wanting to stay. There are always exceptions but just caution you to not think extremes are norms.

The worst part is leaving a site - if you are a good doc and work hard you start to build a relationship with the nurses and house staff. When they hear you are leaving they start to have separation anxiety and it takes a toll on you as well because you grow to like them as well

I am more than happy to give my insight or help to anyone considering this role.

 

[deleted128562]

.

 

[GeneralVeers]

I'm a "scab" for a large hospital system, not a CMG. All of their hospitals are located in the plains states, and almost all of them have a shortage of BCEM docs, which is why there is a need.

I will say that $250/hour is not typical pay for a "scab". Most of the time it is in the range of $160 to $200.

 

[The White Coat Investor]

Pros:
You get paid a premium over the current full-time rate for that group. Why are people comparing random numbers around the country? If EMP pays their docs $130 then they pay more to the "Firefighters" and the difference between the base rate and the premium rate is what matters. I think $50/hour is a fair difference.

If EMP is paying their docs $130 an hour and the docs are happy to take it the battle is already lost. CMGs use all kinds of underhanded ways to get contracts, and I doubt any significant percentage of lost contracts is due to bad doctors. I know of at least one group now subsidizing the hospital in order to keep their contract because that's what the CMG was offering to do (by paying its docs less.)

If doctors wouldn't work for CMGs, they wouldn't exist. I believe The Rape of Emergency Medicine used the term "kitchen schedulers." Sign up to work for them at your peril. You simply cannot make more in the long run as an employee than as an owner. If the employees were paid what they are really worth then where is the profit for the business?

http://www.aaemrsa.org/resources/rape-of-em
Mahoney’s Commandments of Emergency Medicine

The more states a physician is licensed in, the more incompetent he
usually is.

Corollary one: Multi-licensed incompetent physicians are equally
incompetent in all states in which they work.

There’s a bigger fortune in emerge
ncy medicine “management” than
there is in ****.

The competence of physicians working in an emergency department
is inversely proportional to the
number of promotional “products”
and “services” merchandised by
the emergency medicine “manage-
ment” group.

The crips and the bloods with the mo
st extensive “quality assurance”
programs assure the lowest-quality physicians.

The more money and time a “suit” spends on risk management, the
more he increases the risk.

Taking a sick child to a non-owner-occupied “doc in the box” is a
form of child abuse.

Corollary one: Always ask about th
e owner of a “doc in the box.”

“Suits” of whatever stripe should not run for public office at any
level.

“The business of America is Business.” (Uncle Calvin)

Corollary One: The business of organized emergency medicine is
business.

 

[Capgras]

I agree with your dislike for for CMGs but its hard to just say "don't work for them". There are several areas of the country where it is impossible to find a job if you didn't join a CMG. The next part is that most good democratic groups eventually evolve to the CMG structure without realizing it because they keep getting offered more contracts. I wish we lived in a world where we had our pick of democratic groups but the trend is more towards the opposite.

Our world of EM is going to take some dramatic turns in the near future and we can't predict which way it will go. Large hospital groups (equally evil as CMGs) are partnering with specific CMGs to staff all the hospitals. Tenent Health recently partnered with ApolloMD to staff all its EDs in the Carolina region. Tenent then went and bought out Vanguard group to expand its footprint and I'm guessing Apollo will be next in line to take over those EDs as well. Eventually ApolloMD can be bought out by Tenent making all of those contracts hospital employees. There are several other examples of hospital systems incorporating ED groups into the system and making them hospital employees.

 

[Birdstrike]

This simply comes down to economics. We are all replaceable parts, in a huge industry....unless, you can manage to survive in outpatient private practice, in some form. Then you work for your patients. That of course, is getting increasingly more difficult, in Medicine in general. It's all but impossible in hospital-EMTALA-based EM (free standing ECC and urgent care would not be included in that).

Pejorative terms like "scabs" certainly have meaning (implying resentment) but people will do what's best for their situation. People will take the best offer on the table. If it's a "scab" job, they'll do it. If not, they won't. Implying that any "non-scab" jobs is any higher on some sort of ethical metaphysical plain of existence, is I think, a little bit of a stretch. One mans "scab" is the next man's hero rushing in to help an "undeserved" hospital.

I've never worked one of these "firefighter" jobs, but let's face it, everyone of us is a "scab" or a squirrel trying to get a nut, in this insane post-Obamacare world of forced adaptations. We're all just trying to survive the uncertainty, hoping we all have jobs in five years, and aren't all replaced by cheaper mid-levels or some Google-Doctor-formula that can answer all clinical questions much quicker, and for free.

Am I wrong?

 

[@JackShephard]

let's face it, everyone of us is a "scab" or a squirrel trying to get a nut, in this insane post-Obamacare world of forced adaptations.

This is quote worthy.

 

[Arcan57]

If EMP is paying their docs $130 an hour and the docs are happy to take it the battle is already lost. CMGs use all kinds of underhanded ways to get contracts, and I doubt any significant percentage of lost contracts is due to bad doctors. I know of at least one group now subsidizing the hospital in order to keep their contract because that's what the CMG was offering to do (by paying its docs less.)

If doctors wouldn't work for CMGs, they wouldn't exist. I believe The Rape of Emergency Medicine used the term "kitchen schedulers." Sign up to work for them at your peril. You simply cannot make more in the long run as an employee than as an owner. If the employees were paid what they are really worth then where is the profit for the business?

There's a start-up cost to getting a new contract and there's some risk involved also. Very few people are willing to endure the cost and risk without some expectation of benefit beyond that which they'd get just showing up for their shifts. In addition, no doc is taking home what they're billing without something coming off the top. Whether you're a CMG or a SDG, certain functions are necessary to keep the contract and are going to require money to fund. Malpractice insurance, billing, compliance/quality assurance, scheduling, liaising with admin, and recruiting all require money and that money is coming out of what you're billing. Once you've accepted that, it just becomes a matter of figuring out what percentage is being skimmed and whether you can live with that.

 

[Joriel]

Thanks for the info guys, I really appreciate it.

 

[GeneralVeers]

There's a start-up cost to getting a new contract and there's some risk involved also. Very few people are willing to endure the cost and risk without some expectation of benefit beyond that which they'd get just showing up for their shifts. In addition, no doc is taking home what they're billing without something coming off the top. Whether you're a CMG or a SDG, certain functions are necessary to keep the contract and are going to require money to fund. Malpractice insurance, billing, compliance/quality assurance, scheduling, liaising with admin, and recruiting all require money and that money is coming out of what you're billing. Once you've accepted that, it just becomes a matter of figuring out what percentage is being skimmed and whether you can live with that.

It's easy to figure out. Any CMG that says they are "Democratic" should show you the P&L sheet for that site. At my site in EMP, we were paid a pro-rated fee of 52%. That means that 48% of the money was going to the CMG to provide "services" and 52% was paid out to the local docs as salary. We were paid $160 an hour, so it's easy to see how much we could have made if we got rid of the overhead.

Why do docs take $130/hour to work with a CMG? It's easy, doctors are complacent and tend not to ask questions. As has been mentioned the CMGS have a lock over a lot of geographic areas. In Vegas for example with 12 major hospitals, it's impossible to work there without being part of a CMG. There are no hospital employees, or small groups left.

CMGs keep doctors happy with platitudes:
- They would tell us how fantastic our benefits were
- They would tell us how low our malpractice costs were
- They would tell us how they were looking out for us
- I routinely heard how awful the hospital employee model is

But the bottom line is that we were underpaid relative to our colleagues in the city and in other geographic areas. I blame the low pay squarely on huge, unecessary overhead designed to keep the "old boys network" that started all of these groups well-salaried despite lack of any ongoing clinical work.

 

[The White Coat Investor]

It's easy to figure out. Any CMG that says they are "Democratic" should show you the P&L sheet for that site. At my site in EMP, we were paid a pro-rated fee of 52%. That means that 48% of the money was going to the CMG to provide "services" and 52% was paid out to the local docs as salary. We were paid $160 an hour, so it's easy to see how much we could have made if we got rid of the overhead.

Why do docs take $130/hour to work with a CMG? It's easy, doctors are complacent and tend not to ask questions. As has been mentioned the CMGS have a lock over a lot of geographic areas. In Vegas for example with 12 major hospitals, it's impossible to work there without being part of a CMG. There are no hospital employees, or small groups left.

CMGs keep doctors happy with platitudes:
- They would tell us how fantastic our benefits were
- They would tell us how low our malpractice costs were
- They would tell us how they were looking out for us
- I routinely heard how awful the hospital employee model is

But the bottom line is that we were underpaid relative to our colleagues in the city and in other geographic areas. I blame the low pay squarely on huge, unecessary overhead designed to keep the "old boys network" that started all of these groups well-salaried despite lack of any ongoing clinical work.

Exactly, when the books are open, you know what your management costs are. 5% for management, 5% for billing, 5% for malpractice. You ought to be getting about 85% of what you're collecting, not 52%.

I agree that many areas of the country don't offer democratic jobs. I also agree that truly small democratic groups have already almost completely disappeared. Democratic groups have learned they must grow to survive (and often incorporate other specialties like hospitalists, intensivists, radiologists, anesthesia, even cardiologists). The best ones still make all the most important decisions (how the money and shifts are split up) on a local basis with the 5-20 guys actually working in that ED and just band together with other small groups to deal with insurance companies, do benefits, and fight off the CMGs. But the difference between a large group where the doctors, all the doctors, are the owners and one where the kitchen schedulers are the owners is dramatic. Looks like about $81 an hour by the figures above.....

But hey, if you like to work for $130 an hour and just punch a clock, go sign up for the EmCares of the world. Just don't be surprised when you're feeling burnt out after 5 or 10 years because you're underpaid and have no control over your job.

 

[Arcan57]

Exactly, when the books are open, you know what your management costs are. 5% for management, 5% for billing, 5% for malpractice. You ought to be getting about 85% of what you're collecting, not 52%.

I agree that many areas of the country don't offer democratic jobs. I also agree that truly small democratic groups have already almost completely disappeared. Democratic groups have learned they must grow to survive (and often incorporate other specialties like hospitalists, intensivists, radiologists, anesthesia, even cardiologists). The best ones still make all the most important decisions (how the money and shifts are split up) on a local basis with the 5-20 guys actually working in that ED and just band together with other small groups to deal with insurance companies, do benefits, and fight off the CMGs. But the difference between a large group where the doctors, all the doctors, are the owners and one where the kitchen schedulers are the owners is dramatic. Looks like about $81 an hour by the figures above.....

But hey, if you like to work for $130 an hour and just punch a clock, go sign up for the EmCares of the world. Just don't be surprised when you're feeling burnt out after 5 or 10 years because you're underpaid and have no control over your job.

Agree with a lot of this post. 48% overhead is high for CMGs in the parts of the country I've been in. I've been seeing 25-30%.

 

[GeneralVeers]

Agree with a lot of this post. 48% overhead is high for CMGs in the parts of the country I've been in. I've been seeing 25-30%.

I will defend the 48% to some extent by saying it includes health insurance, employer 401k match, disability, life insurance, and CME. I think the "correct" number given all of these services and the actual overhead should be about 30%.

 

[EctopicFetus]

Im with whitecoat.. i work for an sdg, our overhead is under 15%. IMO even in a "bad payer" place the doc should be pulling in $200/hr. The number I have heard from the heads of the CMGs is "about 30%" for overhead. Remember all those suits need to make their money. That money is coming right off your back. On top of that they need to generate profit.

 

[Arcan57]

I will defend the 48% to some extent by saying it includes health insurance, employer 401k match, disability, life insurance, and CME. I think the "correct" number given all of these services and the actual overhead should be about 30%.

Which would be right in line with what I've seen. The best non-CMG offer I've had took 25% off the top, but I've also been in places dominated by CMGs or by a single doc that has a bunch of contracts.

 

[GeneralVeers]

T

Which would be right in line with what I've seen. The best non-CMG offer I've had took 25% off the top, but I've also been in places dominated by CMGs or by a single doc that has a bunch of contracts.

There is incredible wastage at the top. Why do you need a CEO, CFO, COO, 6 VPs and 4 regional directors? All of these people are pulling down more than 400K, for minimal clinical activity. They are like parasites feeding off the working doctors. I don't believe they add value to the sites. They just exist to perpetuate themselves and all of their cronies.

 

[Birdstrike]

T


There is incredible wastage at the top. Why do you need a CEO, CFO, COO, 6 VPs and 4 regional directors? All of these people are pulling down more than 400K, for minimal clinical activity. They are like parasites feeding off the working doctors. I don't believe they add value to the sites. They just exist to perpetuate themselves and all of their cronies.

I'm sympathetic to this viewpoint, but the smaller "democratic" groups have failed miserably in providing the hospitals what they want at the price they want. Therefore, they have repeatedly gotten steamrolled by the CMGs that are supposedly so inefficient and top bloated. If democratic groups are so competent at staffing ERs efficiently, affordably while providing quality care, then why do they keep getting fired?

I agree with you, in the sense that it's sickening to see some of what's going on, but it's kind of like criticizing any Mouse Trap Company CEO for "making too much money." If you think they make too much money, then why don't you build a better mousetrap and make all that mad cash, if it's so easy?

"Well, because I don't know how to do that. That's sounds really hard."

Well, if only they have the skill set, and knowledge to do something no one else can do.....Then we've come full circle, haven't we?

I agree, it sucks, but the guy that runs the mousetrap company is going to make more that everyone else who doesn't run the company. For some reason, medical residents are brainwashed to think that once they're done with residency, they're "equal parter" in anything, or even deserve such a thing. It's a complete lie, or a myth of wishful thinking. It's equivalent to the new Police Academy grad thinking he's "equal partner" with the Chief of Police, yet we allow our new grads to believe this outrageous feel-good propaganda. I think it breeds burnout and resentment when people realize it's not true, and see others claw, bite and scratch their way to better positions.

If this doesn't sit well with a particular person, my advice is to start your own group, and do it better, cheaper, faster with more 5/5 PG scores. Start your own free standing ED or Urgent Care, and be the boss. Otherwise, get the best job you can and realize you are paying a premium to certain people for what would otherwise be your second 50 hr per week full-time job on top of your current one: Medical Practice and Business Owner.

 

[@JackShephard]

I'm sympathetic to this viewpoint, but the smaller "democratic" groups have failed miserably in providing the hospitals what they want at the price they want. Therefore, they have repeatedly gotten steamrolled by the CMGs that are supposedly so inefficient and top bloated. If democratic groups are so competent at staffing ERs efficiently, affordably while providing quality care, then why do they keep getting fired?

I'm guessing for the same reason anesthesia midlevels (or any midlevels) are getting more jobs.

$$$$$$

Cheaper labor.

Honestly, does Apple build iPads in America or China? Is that because American workers suck or because Chinese labor is cheap?

 

[Birdstrike]

I'm guessing for the same reason anesthesia midlevels (or any midlevels) are getting more jobs.

$$$$$$

Cheaper labor.

Honestly, does Apple build iPads in America or China? Is that because American workers suck or because Chinese labor is cheap?

That's right. It's not good enough to be "better." You've got to be better and cheaper.

Lots of times hospitals will bring in CMGs to replace a quality, stable group and the quality goes way down. Lots of times they're so short they can't even cover the ED or hospitalist services and it's a mess. Does the old group get the contract back? No sir.

I'm not saying it hasn't happened, but despite cheaper, worse service, I've yet to see a CMG thrown out in favor of bringing back the previous, supposedly "better," democratic group. They either stick with the newer CMG, or switch to another CMG that's will claim they can also do the job cheaply, but "better."

Hospital CEOs and administrators only care about one thing: money. It's what they do. All the other stuff you spend 99% of your time focusing on in medical school in residency, such as "science", "medicine," blah blah blah, "standard of care," blah blah blah....it's all good but only if it makes them money.

"Efficiency"

"Throughput"

"Patient satisfaction"

"HCAHPS"

"Metrics"

"Meaningful use"


These are all code words for, "Money."


I'm not saying medicine shouldn't be a business, because any system that can't support itself financially cannot last. But I think we should be honest about how far science, health and good Medicine have been pushed to the side in the process. Also, students need to be aware of this so they don't because disillusioned when some administrator comes to them and couldn't care less about the nuances of a particular decision making process you went through based on learned "science."

Being a doctor isn't hard because of the Medicine, it's hard because all the other ancillary crap that has metastasized around it.

 

[Janders]

Woof... that 30+% overhead is rough. Rooough.

I'm not philosophically against CMGs, I just see that in real life they skim so much more off the top than a well-run open-book democratic group. In our group we are constantly trying to cut overhead so that the money you earn busting your arse clinically at 2am on Xmas day is yours to keep. Depending on how you calculate it, <20% is certainly reasonable and 15% is a good goal...

 

[GeneralVeers]

Birdstrike, I'd agree with your opinion that they created the company and arguably have a skillset that others lack. My problem is that they continually expand the bloat. We had physicians complaining about their reimbursement and they board voted to create ANOTHER VP position, this time a VP for "Diversity", whatever that means. Additionally they would create new posititions like "Regional Directors" for small 3 hospital systems that had no such position for 20 years and were some of the most productive and functional in the group.

I'd have more respect for management if they kept costs down and tried to pass on savings to the line docs. Instead they just keep spreading their tentacles and take more and more.

 

[Birdstrike]

Birdstrike, I'd agree with your opinion that they created the company and arguably have a skillset that others lack. My problem is that they continually expand the bloat. We had physicians complaining about their reimbursement and they board voted to create ANOTHER VP position, this time a VP for "Diversity", whatever that means. Additionally they would create new posititions like "Regional Directors" for small 3 hospital systems that had no such position for 20 years and were some of the most productive and functional in the group.

I'd have more respect for management if they kept costs down and tried to pass on savings to the line docs. Instead they just keep spreading their tentacles and take more and more.

What is their stated need on why a "VP of Diversity" is needed, and what does this person actually do?

 

[GeneralVeers]

What is their stated need on why a "VP of Diversity" is needed, and what does this person actually do?

I asked that question and got "the look" from those in charge. I asked what "diversity mean". They couldn't give me a defintion, only that this new VP would "Promote Diversity".

 

[EctopicFetus]

I recommend if you are the best and brightest, get a job with a SDG. Learn the business, learn business in general and those skills will serve you well for your career. It isnt enough to simply be an US guru, a grinder, a patient satisfier. If you value earning money and your time (they go together) learn the business of EM.

Keep in mind you can work 2000 hours per yr at $150/hr or make the same income working 1000 hours a yr at $300/hr. Those "extra hours" dont really come for free because IMO being a good SDG partner with your system requires involvement which from most groups I know comes either totally uncompensated or minimally so.

 

[Arcan57]

...IMO being a good SDG partner with your system requires involvement which from most groups I know comes either totally uncompensated or minimally so.

Which is why the CMGs are going to win or force the SDGs to become just like them. While it's unnecessary overheard for a completely secure contract (if such a thing exists), having someone who's main income derives from keeping the contract fosters a certain dedication towards keeping that contract. It's unlikely that someone is going to "volunteer" to be the doc that is in charge of quality for an entire system. Things that can be easily divided up by an SDG at a single hospital like locking down the key committees (med exec, P&T, peer review, +/- trauma/cards) aren't workable at a system level without a heavy subsidy to the person(s) in charge of coordinating things. Now maybe you have a close partnership with the system and they're doing the heavy lifting on quality reporting and compliance. That's going to be at least a potential source of vulnerability because the large CMGs are going to be able to handle that in-house which means less money the system is spending on it.

If you can find a true SDG that's willing to hire you out of residency in a place you want to live with a decent work environment that doesn't require an extended period of indentured servitude then go for it (really, jump on that). But don't sign with what I'll call a quasi-SDG (closed books, only one or a small handful of owners, hx of releasing docs just before making partner, etc) if a true SDG isn't available just because they're not a CMG.