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Large contract management EM groups

Discussion in 'Emergency Medicine' started by LightMD, 02.24.12.

  1. LightMD

    LightMD

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    SDN Members don't see this ad. (About Ads)
    I've been considering working for a large group (EMP, EMCare, etc.) when I finish residency, but don't know enough about any of them to make an educated decision. I was hoping to start a thread that reviews the larger groups and their reputations, pro/cons, benefits, starting salaries if known, etc. Any input would be appreciated.

    Thanks
  2. TysonCook

    TysonCook Senior Member

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    not to be too negative, but do a search, it has been discussed ad nauseam :)
  3. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    Also, most don't offer benefits for independent contractors. Salaries are regional.
  4. EctopicFetus

    EctopicFetus Keeping it funky enough

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    Simply put you have to consider what are your goals? Is this a 1-2 year job? I have worked for EmCare as a moonlighter. I got what was promised. I learned the game and played it. I would personally be miserable working for someone else my whole life knowing they profit off my labor while flying around in private jets.

    If you check the Daniel Stern salary survey those guys make less, have few if any benefits and from my experience are quite unhappy in their jobs. Others who are on here work for them and seem happier.

    Another factor is do you want to be involved in committees etc.? This is more of a requirement in democratic groups.
  5. richse

    richse

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    Does anyone have a link to the "Daniel Stern salary survey?" I've never heard of it but it sounds useful.
  6. la gringa

    la gringa Senior Member

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    EMP is a large group with a track to have financial stake and shareholder status. full timers have pretty good benefits.

    it's not an independent contractor contract management group.

    worked for a smaller but still large "democratic" group that had a vague and very political path to "partner", and a huge buy-in. no longer w/ them... they had a lot of turnover in the younger docs in the 2 yrs i was there.

    can't speak for others other than 2nd hand info.
  7. cyclohexanol

    cyclohexanol No, no. Doggie afuera.

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  8. EM_Rebuilder

    EM_Rebuilder Member

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    I do not work for one of said jobs as my primary job but do still moonlight on occasion with one and worked with several when I was a resident.

    One of the huge 'positives' to me of working with such a company (and often not mentioned) is that there are TONS of opportunity to 'move up' on the administrative side of things (if thats your thing). If you work hard and show interests, those companies will utilize you as medical directors, regional directors, divsion directors, recruiting directors, etc etc...even if its sticking you as director at a smaller satellite hospital nearby for a while. Also, although its not too hard to find a 'new job', it is super easy to move around within one of thse companies to different locations and perhaps 'try out a place' before committing.

    I am in an uber stable group that is only on its second medical director in probably 20 years. It would be another 20 years before I could even think of stepping into that job. I can do the committee thing in the meantime (and do), but I have started turning to state/local organzations to become more involved with leadership type stuff.
  9. LastMinEMROLQs

    LastMinEMROLQs

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    i really hate when people do sh*t like this.

    1) its a thread killer
    2) i don't care if there are other threads. even if this is a repeat topic, you still get new answers from different people with different perspectives
    3) if you had the time to type "go search for it", you probably had the time to just add your input instead and move on.
  10. Khaos

    Khaos I beat the game, now what

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    Just to make a point...you didn't add anything to the OP either...what he said was true.
  11. EMFreakz

    EMFreakz New Member

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    re: leadership/admin. this is very true. I've found this true as well. lots of admin/leadership stuff that helps prevent burn out. You can end up with good stipends and work less clinical hours if that's your thing. More opportunities.
  12. EctopicFetus

    EctopicFetus Keeping it funky enough

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    6 posts by u nuff said..
  13. LastMinEMROLQs

    LastMinEMROLQs

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    wasn't trying to add anything, as I don't have insight into this issue. hence, why i am very interested in hearing thoughts on it. my post's purpose was an indirect way to bump the thread rather than see it die due to some SDN long timer on his/her high horse kill a thread by saying "do a search". its annoying when people do that. its pretty stupid to have an issue with repeat topics. how else are we going to keep getting new insight and perspectives on issues if all we do is "search" into past threads and read what people said years ago.

    and just to add to your point, you didn't add anything to the OP either. thanks anyways
  14. LastMinEMROLQs

    LastMinEMROLQs

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    ....whats your point?

    are you trying to imply that you are The Ectopic Fetus and your posts therefore are more valuable/respected/important than anyone else's? i've been on SDN for years, i don't care what the post count is. please get off your high horse. :thumbup:
  15. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    "High horse" for suggesting a search? Hyperbole much? And your personal animus does not seem very collegial. Oh dear, though - I also did not contribute to the thread topic!
  16. EctopicFetus

    EctopicFetus Keeping it funky enough

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    Since you are bringing it up .... my posts are def more respected than yours. No one knows you and one of your 6 posts is some garbage bashing posters on here.

    FWIW the list is long but those with a post count in the double and triple digits are more valuable/respected/important than yours.
  17. NEATOMD

    NEATOMD Senior Member

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    Let's move on...
    Your best bet is to actually talk to those groups. They tend to put you into contact with smooth talkers who can seem a lot like used car salesmen so I recommend actually talking to people in those groups. While it would require you to have a specific location in mind, many people recommend that you talk to the most recent hire and fire (last person to leave anyway) at any job you're looking at.

    As mentioned above, the contract management groups are each a bit different and location to location you will see huge differences in pay and schedule, etc.

    I signed with a group called MEDS (Midwest Emergency Department Specialists). Highly competetive starting salary (highest initial salary I interviewed at). We work two years with full benefits beginning on full time start date. It revieved an average sized sign on bonus. I have life, dental, optical, health, disability insurance. I can contribute to a 401k after 1000 hours. After 2 years you can apply for partnership into the group. The group splits the profits for the year and cuts it between each of the partners. Usually ends up being a very significant amount of money. Many of the new docs out of my residency in the past 5 years that are started with that group are now ED directors at nearby hospitals.

    Here's some additional reading on the topic: EMRA: Emergency Medicine Contract Management Groups
    and here: More information
    Last edited: 02.25.12
  18. MRSAful Fate

    MRSAful Fate

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    I just read "The Rape of Emergency Medicine" this week then looked up the two hospitals in the city where I want to work in a million years when I'm done with my training and found out their ED's are both contracted out to big CMGs :scared:. The dystopia presented in the book has to be a bit overblown, but it was enough to freak me out a bit.
  19. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    So, what are the options? Stay an employee, or "apply for partnership". What happens if you get turned down for partner - out on your ass? I find it unlikely that you just continue on as an employee.
  20. NEATOMD

    NEATOMD Senior Member

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    Well, it's a yearly contract until you are a partner. So, it is case dependent. If you aren't someone they would be interested in as a partner then they're not going to want to hire you for another year. That said, the partner vote goes before the whole group and the decision to hire for another year would go to the ED director. So, I guess if the group hated you and the director liked you it would be possible for you to stay without becoming a partner but I can't imaging why you would want to. Since changing to this setup, the hospital I signed with has made everyone who has been able to keep their contract for 2 years a partner.
  21. la gringa

    la gringa Senior Member

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    that's how it worked in my first job out of residency... and fastest track to partner was 4 yrs w/ a big buy-in.

    needless to say, i am no longer there.
  22. EctopicFetus

    EctopicFetus Keeping it funky enough

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    Gotta find the right job. La gringa wasnt happy with her private democratic job. Some of them out there are shady as can be. For this reason research is important. My group is 2 years to partnership. No one has been turned down in a very long time. I am very very happy with my decision (and yes I made partner already).
  23. GeneralVeers

    GeneralVeers Globus Hystericus

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    Florida Emergency Physicians had a similar shady scheme when I interviewed 4 years ago.

    Question: How long does it take to reach partner?
    Answer: 2 years and then we vote you in.

    Question: Is there any guarantee that after putting in 2 years at the lower non-profit sharing wage I would become partner?
    Answer: No

    Question: If I'm elected to be partner what is the buy-in?
    Answer: We can't tell you that, but it's "substantial"

    Question: If I am elected partner and pay the buy-in, what would my salary be?
    Answer: We can't tell you that either.

    Needless to say I didn't return their calls at that point.
  24. la gringa

    la gringa Senior Member

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    i chose that first group for geography.... once i decided i didn't want to live there anymore, it was easy to decide to leave.

    they're the only decent sized democratic group in a large east coast city. seemed a lot of the people who were there long term needed to be there for spouses, or had gotten themselves into a life they couldn't just relocate. i'm still single/childless and took my cue to move on to greener pastures ;)
  25. EctopicFetus

    EctopicFetus Keeping it funky enough

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    I might be too dumb but here is what I dont get.. My group only has a buy in of sweat equity. I work for 2 years making less and they keep the money as my buy in. I never cut them or anyone else a check..

    For groups with financial buy-ins.... whats the sense? I get paid, pay taxes, give you the money and then you pay taxes.. Just stupidity.. can someone explain this to me. What am i missing?

    On another note when I interviewed with another group they had a 20-40k buy in (I cant remember), so I asked why not just let me work at the lower wage for another 6 months and then I dont have to cut you a check. They looked at me like I just solved a complex calculus problem with an abacus.

    To this day I use that group as an example of business ineptitude. If someone has insight on this please share.
  26. EM_Rebuilder

    EM_Rebuilder Member

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    I am not associated with either type group, but I certainly follow what you are saying and have thought the same thing. The ONLY thing I can see is that if you have the cash to 'buy in' right away; if you make more money from the get go, yes you lost the taxes, BUT it might be better off in the long run. It would all depend on how the numbers fall.

    For folks coming fresh from residency, a cash buy in would often be near impossible without lucrative moonlighting... but if you are a few years at least into practice, the buy in would be easy and might actually work out better.


    Thats the only advantage I can see to it... All depends on 'how much more the partner makes' and how the numbers end up falling...
  27. tkim

    tkim D-d-d-dilaudid

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    my shop 18 months/2400 hrs sweat equity no buy in. unless you outright behead someone in the er and wave the head around the waiting room, you make partner.

    during residency was offered job with a 3 year sweat equity with no guarantee making partner. no wonder the partners at that group were so happy. the ones that made it, that is.
  28. EctopicFetus

    EctopicFetus Keeping it funky enough

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    But... its not just a cash buy in.. you also have 1-3 years (depending on the group) of reduced income on top of it. I get the straight financial buy in.. dont get why you would work at a reduced income for a few years and then have to give these clowns 40k of post tax money.
  29. NEATOMD

    NEATOMD Senior Member

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    What do you mean? It all makes sense:
    You work hard and make them money. You get taxed on that money. You pay part of it back to them. They get taxed on the money. Now that you are partner, you make it back over time with your new partner salary. You now get taxed on the money again. See! Complete sense.:thumbup:
  30. GeneralVeers

    GeneralVeers Globus Hystericus

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    It makes perfect sense. Have you ever heard of a pyramid scheme?
  31. NinerNiner999

    NinerNiner999 Senior Member

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    Actually, you buy in usually as a partner, which becomes a capital contribution toward your group, which is a partnership (corporation). They then pay your buy-in amongst themselves as a distribution, which after write-offs is pretty close to tax-free. You're actually paying them three years worth of "buy in" if you look at it that way when you include the first two years of reduced pay plus your lump sum.

    Some other groups might take your buy-in and add it to the partner bonus pool, which might be paid quarterly, which means you (as a new partner) will get a portion of your money back in the form of a bonus.

    Greed can be a motivating factor even with small groups. The more physicians they add, the more it dilutes their bonus pool. Be weary of groups that require more than one year of a partnership track - it usually means they are hoarding as much as they can. The typical accounts receivable (the amount the group has billed from your work but not collected) is 6 months behind, which means after a year of time, you should be generating them revenue even if you were paid at their same salary. Your lower salary accounts for their short-term loss which they keep anyway in the form of your AR.

    They benefit from people not making partnership in two ways 1) you work two years for a lower salary and leave, and 2) after you leave they get to keep all of your AR. When shopping for a partnership job, it can be fun to see how they react to your question about who keeps the AR. If you are an independent contractor, you might have a claim to it. This is one reason the employee model can be popular with partnership track physicians.

    CMG's are not without their pitfalls, but they infrequently pay a higher rate than someone on the partnership track, even as an employee. I would guess that for a five-year period, for those on a partnership track versus those who are strict CMG workers, it's pretty close to a wash for net income.

    The groups that don't tell you what you will make as a partner usually have four things they are hiding:

    1) The fact that they don't plan on making you a partner
    2) That partnership bonus is not much and will actually put you slightly above or just at market average for your area after your buy-in period
    3) There are many tiers to partnership level, and they are accompanied with many additional responsibilities (i.e. reduced clinical hours PLUS mandatory administrative work or committee service). Only the top three holders of the corporation make the big bucks and control the show.
    3) The group is in trouble.

    Be weary and run the numbers. Also, call around the other groups in the area where you want to work. Use them as references for your potential group's reputation. Directors and groups have local history, and often you will learn more about the "partnership" from those who are local and outside of the group. There is a group local to my practice that is known for voting on "partners" and actually using a fraternal type of "black ball" system. If one partner blackballs any physician at any time during their partnership track, they will never be offered partnership - even if it is your first shift working with that partner. They have let numerous people go at the two-year mark and in the past 7 years, and after countless "partnership track" physicians, have never added a partner. They continuously market themselves as 99th percentile for pay. Wonder why...
  32. danzman

    danzman The Ace of Spades

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    So how much, in real numbers, does ones income really go up after becoming a partner?
  33. tkim

    tkim D-d-d-dilaudid

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    Many different numbers.
  34. danzman

    danzman The Ace of Spades

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    ?

    Sure but are we talking ten grand, a hundred, two hundred? I ask because I really don't know. Anyone care to share their before and after ballpark salary? In my area I have been told fresh out of residency 300 is quite doable. If this is the case, just how much more are we talking after a 2 or 3 yr time frame? One hospital I rotated at I asked an attending straight up how much he made, its a large hospital, high volume trauma center. They offer 400k, non partnership track. All he has to do is work 14 shifts a month and go home. That sounded incredible! Another place was in the sticks, 180 to 200/hr, after two years they had more management stuff leading to 10% more pay for a shift or two les.
  35. tkim

    tkim D-d-d-dilaudid

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    As I said, and you've illustrated by example, many different numbers. Ask and you'll get differing numbers from different employment situations.
  36. danzman

    danzman The Ace of Spades

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    The only number I have ever seen has been ten percent. The tone of the discussion above makes me think there must be more to it than this. If the difference between a partner and a non partner is so small, why even consider it?
  37. Apollyon

    Apollyon Screw the GST Lifetime Donor

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    Last group, the cut was $10K/year/partner. Before that, it was $100-200K/year/partner. The second group were money-grubbers - the partner payout was as much as the employee docs were paid.

    So, with a range of 10-200, from one person only, I think that I can safely, easily agree with tkim that there are many different numbers.
  38. tkim

    tkim D-d-d-dilaudid

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    Because most places expect you to want to make partner, not just for the bump in pay, but ability to have a voice in the way the group operates which translates into how you can practice.

    Other places might work you as an employee and give you more money upfront, but you have to ask if that high number includes insurance and benefits in the calculation, which means lower take home pay than the quoted number. You'll never know because you won't be able to see 'the books' to see just how much more money gets taken in.

    Such comparisons are worthless unless you have two places with the same payor mix and volumes, and similar billing successes.
  39. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner

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    I would ask where you're seeing that number. Because, as has been beaten to death, the difference can be as much as 100% to something as simple as fewer hours worked.
  40. GeneralVeers

    GeneralVeers Globus Hystericus

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    In my large group, there is no monetary "buy in" but the new hires have a fixed salary of $130/hour for the first year. After making partner, the hourly jumps between 10-25% depending on the month, as our collections vary month to month.
  41. EctopicFetus

    EctopicFetus Keeping it funky enough

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    All groups vary.. There is a group in town whose bonus is over 200k.. the question is less about what is the bonus in the group.. its all about your total compensation and this will of course vary by collections. There are some groups who make tons of money and the only way to get a figure on income is to talk in percentages. Long story short just look at the daniel stern survey.. some people make 200k others 500k.. find the job that gets you the money you need but make sure you are happy where u r at.

    I am super lucky having found my job.
  42. EctopicFetus

    EctopicFetus Keeping it funky enough

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  43. DreamingTheLive

    DreamingTheLive (something witty here)

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  44. JacobMcCandles

    JacobMcCandles

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    I'm not sure how much information you can gather from that. People in all professions think about doing other things all the time. Did the people that answered yes seriously consider leaving EM or was it just a passing thought that they didn't look into very much?
  45. DreamingTheLive

    DreamingTheLive (something witty here)

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    I simply stated that it gave me pause.

    Outside of mass retirement, yes, I think it is quite interesting that roughly 50% of practicing EM physicians who responded said they've entertained thoughts of leaving. That seems very high, no matter how you try and pretty it up....and I'm drinking the EM kool-aid.
  46. EctopicFetus

    EctopicFetus Keeping it funky enough

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    As an attending now I can say I work in a stable group of 40 docs. I keep hearing things like this is the most unstable things have been in my x years here. People are apprpriately feaful of HC reform. Rightfully so.. I have followed this closely and have heard that we can expect anywhere from no real change to up to a 30% cut in reimbursement. If you believe this.. and say you make a solid living of 300k and now you are looking at the same amount of work for 200k? That uncertainty is stressful esp if you are mid career. You own that nice house, nice car and kids are in private school. Now your house is down 150k from where you bought it and on top of that you have a 100k pay cut forecast in your future.

    Thats just my perception of things. If people knew the job would be stable, our salaries would go up to keep up with inflation.. many people would feel different.

    In the end live below your means until things stabilize.. thats my plan. My house is 1x my salary for this yr. I have no trouble making my payments because I didnt buy a million $ house. I am happier cause my financial stress is known.. my student loans of over 300k are my priority for the next few years.

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