SDG Hiring in Houston

[EM Junkie]

Recent expansion of our ED from 30-50 beds, plus the addition of 2 freestanding EDs that our group has been asked to cover has us in the unfamiliar position of having to hire more physicians. Most be board certified or board eligible in EM.

We have a very stable group of docs, and have hired 5 more from graduating residency classes and those who have come to us via word of mouth, but we still need two more in the April-July 2016 timeframe.

Our ED sees 65,000 annually, about 25% pediatrics, with in house ICU Intensivist and OB Hospitalist coverage. We also offer a robust call schedule (only lacking ENT, which is covered 1/2 the time).

Paid CME, health/vision/dental, and retirement match but at independent contractor pay rates.

We're located in far NW Houston with an easy commute into the city or many of the surrounding bedroom communities (Katy, Cypress, Tomball, Klein, and The Woodlands).

This is a great group to be a part of, and I think my partners would agree (average doc has been here 5 years).

If you're looking for something different from the standard CMG-gig, send me a PM and we can talk!

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[GeneralVeers]

Just saw your message. As you probably knowI do locums in TX. I'm fully scheduled right now, so the only thing that would make me change is a better location at equal/higher pay. Do you have a range of what your group would be offering for part time?

 

[EM Junkie]

Looking for full time only at this point. We have a pretty good stable of part time folks. Let me know if you're looking to "settle down"!

 

[emergentmd]

Looking for full time only at this point. We have a pretty good stable of part time folks. Let me know if you're looking to "settle down"!

Houston is a market with shortage of EM docs. I assume you guys are private AND offer partnership. Otherwise, your rate better be competitive to the CMGs high rates. Its getting harder and harder to get EM boarded docs and SDG are always endangered of being taken out.

 

[EM Junkie]

We don't believe in the games of partnership. There is one owner who is paid the same as everyone else (not me). All open books. The guys that start here on day one make 5% less for two years, then after two years get that additional 5%. This basically covers onboarding costs associated with malpractice policies, and encourages loyalty to the group. Many of our docs as new grads make more than the President of the group.

He's offered to let us buy in, but nobody is interested (why buy the cow when you can get the mild for free)?

The existing groups in Houston are all pretty secure in their contracts.

 

[The White Coat Investor]

Only a 5% difference? Weird. What would you buy into if not a higher hourly? The only other thing you have is the accounts receivable. How is it a "democratic group" if most folks aren't owners? There are more questions than answers in your post! Doesn't mean it's not a great gig, but it seems odd compared to most SDGs, not to mention the short average time of the docs. I mean, I'm now the second most recent partner in the group, and I've been here 6 years.

 

[EM Junkie]

We're definitely a different group, that's for sure. We started in 2003, the original owners (except one) left 2005-2008 to start a freestanding empire, and the current docs have mostly 5-8 years in. We've already hired a few new docs to cover our (forced) freestanding expansion, lowering our average years to the 5 I quoted.

The 5% was never intended to be a partnership incentive. Our philosophy has always been that the brand new doc has he same pull as the 10 year guy, and often makes more money (due to productivity). We have had some bad apples over the years come in, only intended to stay for 6 months to a year, then leave us stuck with covering their tail policies. The 5% was meant to account for (and discourage) that behavior.

 

[The White Coat Investor]

We're definitely a different group, that's for sure. We started in 2003, the original owners (except one) left 2005-2008 to start a freestanding empire, and the current docs have mostly 5-8 years in. We've already hired a few new docs to cover our (forced) freestanding expansion, lowering our average years to the 5 I quoted.

The 5% was never intended to be a partnership incentive. Our philosophy has always been that the brand new doc has he same pull as the 10 year guy, and often makes more money (due to productivity). We have had some bad apples over the years come in, only intended to stay for 6 months to a year, then leave us stuck with covering their tail policies. The 5% was meant to account for (and discourage) that behavior.

I agree you need policies to discourage that behavior. And if you're not on occurrence, one of the best ways is to make them buy the tail if it is their choice to leave. But there is way more that sucks about someone leaving in 6 months than covering their tail, like covering their shifts.

What I can't figure out is why the difference between pre-partner pay and partner pay is only 5%. The real incentive I have to not leave my group is that I'd be working for a lot less and have a lot less control over my job anywhere else. I mean, if my group offered pay that was 5% less than we were making to pre-partners we'd have 1000 applications a year because we'd be offering the best employee job in emergency medicine.

 

[EM Junkie]

Like I said, we're different. People don't want to leave because they like their jobs. Most of us have worked for the other groups in Houston at one point or another, and yet chose to come here. That says something I think.

Occurrence wasn't available in Texas until recently, and we've since made the switch for our new hires.

 

[Janders]

I think one of the better ways for an outsider to judge a group is not just to look at how many people have left, but WHERE they have left to. If you lose 3-4 docs in 3 years but they all moved cross country, its different than losing 3 docs to other groups in your metro area...

We have a somewhat similar structure to EM Junkie, in that from day 1 you get equal voice and there isn't a moment 1-2-3 years in where you become "partner" and get 25% more money. Instead you are entitled to all your collections from day 1... but for the first year or so you will make 15-20% less than the established guys as you pay off your startup costs. Once you clear that debt, you make equal % as the guys who've been here 10 years.

I suppose we could tax the new guys heavily for 2 years and let the old hands have the money, but frankly we don't need to buy more loyalty that way, and we don't like fleecing new grads. That said, it is COMPLETELY reasonable to ensure the new hire is set up in a way to pay their malpractice, tail, overhead, etc so that them leaving in 6mo isn't a massive burden to the group.

 

[The White Coat Investor]

Instead you are entitled to all your collections from day 1... but for the first year or so you will make 15-20% less than the established guys as you pay off your startup costs. Once you clear that debt, you make equal % as the guys who've been here 10 years..

How's that any different? You make less money for a year or two.

 

[GeneralVeers]

EM Junkie, why would the "owner" of your group want to be an owner? Sounds like he's taking on the liability for the group, as well as administrative headaches for little or no extra compensation. The only reason to "own" a group is to skim off the top from the productivity of the other docs.

 

[The White Coat Investor]

EM Junkie, why would the "owner" of your group want to be an owner? Sounds like he's taking on the liability for the group, as well as administrative headaches for little or no extra compensation. The only reason to "own" a group is to skim off the top from the productivity of the other docs.

Unless you all own it. Then you own it so no one else is skimming off of you. But I see little benefit to that particular set up. No wonder he can't get anyone to buy in.

 

[emergentmd]

Seems like a very odd set up.
1 Owner who gets paid as much as everyone else.
Everyone can't be an owner and thus pay will go down given the downward pressures.
New Grads makes as much as everyone else. Doesn't seem like there is much incentive to taking on additional responsibilities that would make the group stronger.

Seems no different than any CMG to me.

To me, this job would only be great if the workplace is great or the pay is great. Otherwise, i might as well work for a CMG.

I have been part of a very successful SDG and almost everyone made partner. The reason it was successful, stable, and there was very little turnover was b/c once you made partner, you made more than anyone in town. That is what kept everyone in.

now if everyone made the same from day one, then the pay would be no better than everyone else. People would jump ship. Group would not be stable. No different than any CMG.

 

[Janders]

How's that any different? You make less money for a year or two.

Quick answer--> when you leave our group you get your collections tail, minus overhead (assuming your startup debt is paid off, otherwise it is applied to that first).

So yes, you might make $60k less the first year while your collections ramp up, and thus you don't get a bonus, just like a "buy-in" group... but our "partners" didn't take your money. When you decide to move cross country after 8 years of service to our group, you'll get a check 3mo and another smaller one 6m0 after you leave... your money, basically what you DIDN'T get your first year. Same when you decide to retire.

 

[Gastrapathy]

The owner is the only one to get paid if they get bought out. Seems like a recipe to get eaten.