Stuck in between rock and hard place

[Major]

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[Janders]

It is unlikely I would commute 4hr round trip for a typical job. A side-gig / locums that pays well and maybe I do 3x12hr shift in a row and get a cheap hotel? We could discuss. But personally I wouldn’t be interested in a typical FT job doing 13-16 shifts a month with that commute. Depending on the geography you could perhaps live in between jobs, but then you both have 1hr commutes and may be living somewhere neither of you like, so likely a poor solution. YMMV.

I assume you value your marriage and want to live with your wife. This being assumed, sounds like you need to dig what dirt you can on the various groups in reasonable distance to your home and pick the best option. The rest of the board may have more useful knowledge on said particular groups.

 

[NYEMMED]

Long time lurker first time poster in this subforum. Current PGY2 in the job hunt.

My wife is a general surgeon and just signed with a great group at a great hospital. I’d love to work at the same hospital as her, but the issue is that it’s staffed by USACS.

The next problem. All the other ERs in our hometown are staffed by either Teamhealth, Envsion, Or Ascension.

Nearest SDG staffed ER is about 2 hours away, then next 4 hours away.

Not sure what to do. I know working with USACS is making a deal with the devil.

Thanks for the input and advice

I am assuming ascension is a hospital employed gig.

I don’t really know ascension but making an assumption

Ascension> Teamhealth> envision> dog poop> USACS

 

[bravotwozero]

I’d go with ascension. TH envision and usacs will all likely go bankrupt soon enough.

 

[Major]

It is unlikely I would commute 4hr round trip for a typical job. A side-gig / locums that pays well and maybe I do 3x12hr shift in a row and get a cheap hotel? We could discuss. But personally I wouldn’t be interested in a typical FT job doing 13-16 shifts a month with that commute. Depending on the geography you could perhaps live in between jobs, but then you both have 1hr commutes and may be living somewhere neither of you like, so likely a poor solution. YMMV.

I assume you value your marriage and want to live with your wife. This being assumed, sounds like you need to dig what dirt you can on the various groups in reasonable distance to your home and pick the best option. The rest of the board may have more useful knowledge on said particular groups.

Thanks for the reply. I definitely agree with that. Freakin sucks what has happened to this field of medicine

 

[GonnaBeADoc2222]

Yeah I’ve reached out to the recruiter. What freakin sucks also is that my wife’s hospital is physically awsome and best staffed/equipped. Unfortunate that the hospital admin decided to sell out the EM docs to USACS

Your experience with a CMG is usually very dependent on the site itself. If it is well staffed on the nursing/tech end and has good payor mix, USACS will likely give more resources to it.

As a side note, why does your wife's professional career take priority over your's (she gets to sign with great group while you get poop)? I don't ask this to be a dick, just as a fellow man who made the same mistake in the past. Be careful mate.

 

[Groove]

I don't see that it really matters. All your practical options are CMGs. It's like comparing STDs...HIV vs syphilis vs HPV....they are all STDs in the end. 2 hours is way too far for an SDG. Just go with your wife's hospital. If the CMG goes bankrupt, it doesn't really matter as the docs usually stay on regardless. I would consider your situation to be an exception to most situations because it's your hometown and you guys are really invested in the location. All that is assuming that the pay is equal. If not...then just go with the best gig unless the money isn't important. I can never tell with new grads these days... Good luck.

 

[Dr Mantis Toboggan]

My wife is a general surgeon and just signed with a great group at a great hospital. I’d love to work at the same hospital as her, but the issue is that it’s staffed by USACS.

The next problem. All the other ERs in our hometown are staffed by either Teamhealth, Envsion, Or Ascension.

Nearest SDG staffed ER is about 2 hours away, then next 4 hours away.

Not sure what to do. I know working with USACS is making a deal with the devil.

Two words:

House. Husband.

 

[Major]

I don't see that it really matters. All your practical options are CMGs. It's like comparing STDs...HIV vs syphilis vs HPV....they are all STDs in the end. 2 hours is way too far for an SDG. Just go with your wife's hospital. If the CMG goes bankrupt, it doesn't really matter as the docs usually stay on regardless. I would consider your situation to be an exception to most situations because it's your hometown and you guys are really invested in the location. All that is assuming that the pay is equal. If not...then just go with the best gig unless the money isn't important. I can never tell with new grads these days... Good luck.

That is how my gut is feeling/leaning also. Thanks so much for the advice!

 

[Arcan57]

That is how my gut is feeling/leaning also. Thanks so much for the advice!

Unsure what if any liability the whole USACS ownership thing exposes you to, but I’ll second that if there isn’t a well run SDG with open books and a reasonable partnership track job available (and there won’t be for most of us) then hospitals factors >> CMG flavor in determining job satisfaction. Personally I’d jump at the shop that has you seeing the majority of patients in rooms compared to a WR only shop due to inpatient holds.

 

[bravotwozero]

If the CMG goes bankrupt, it doesn't really matter as the docs usually stay on regardless.

You know, it didn’t occur to me until now, but that’s a good point. It’s one thing If a CMG simply loses a contract, and the docs can get screwed if there was a non compete in their contract clause.

If the CMG goes bankrupt and ceases to exist, then any non competes, if there, should become irrelevant.

 

[Mount Asclepius]

I’ll dissent and stake a position that you should find a job in a SDG or secondarily in a hospital employed position even if it means moving and not living in your preferred location. I refuse to work for a CMG. I’d move before doing so. Now that financially secure (not idependent), I’d quit EM if CMG jobs were the only option. For you it might mean not living close to family or in your home town. It might mean your spouse doesn’t get the perfect job. In the long run, it won’t be at all sustainable, even for a short while, if your job is miserable. An EP has the average medical career of the average NFL player. I believe most will regret choosing the convenient path of the local CMG option over the adventure of a new location and a better job with ownership. Another option if you play your cards right is to aim for being a stay at home Dad with lots of diverse extracurriculars. That’s pretty rewarding too. Good luck as your decision isn’t easy.

 

[Rekt]

I don't see that it really matters. All your practical options are CMGs. It's like comparing STDs...HIV vs syphilis vs HPV....they are all STDs in the end. 2 hours is way too far for an SDG. Just go with your wife's hospital. If the CMG goes bankrupt, it doesn't really matter as the docs usually stay on regardless. I would consider your situation to be an exception to most situations because it's your hometown and you guys are really invested in the location. All that is assuming that the pay is equal. If not...then just go with the best gig unless the money isn't important. I can never tell with new grads these days... Good luck.

I'd rather have syphilis than HIV.

 

[alpinism]

In your situation it honestly depends on the quality of the local job options.

If we're talking about your typical USACS sweatshop paying 150/hr to manage 5 PPH with midlevels it might be preferable to commute for shifts versus having to work long hours for horrible pay. There's a reason why most Denver people don't work in the city since you can easily make the same total monthly salary at midwest hospitals working 5 shifts versus at rockies hospitals working 10 shifts.

 

[Major]

I’ll dissent and stake a position that you should find a job in a SDG or secondarily in a hospital employed position even if it means moving and not living in your preferred location. I refuse to work for a CMG. I’d move before doing so. Now that financially secure (not idependent), I’d quit EM if CMG jobs were the only option. For you it might mean not living close to family or in your home town. It might mean your spouse doesn’t get the perfect job. In the long run, it won’t be at all sustainable, even for a short while, if your job is miserable. An EP has the average medical career of the average NFL player. I believe most will regret choosing the convenient path of the local CMG option over the adventure of a new location and a better job with ownership. Another option if you play your cards right is to aim for being a stay at home Dad with lots of diverse extracurriculars. That’s pretty rewarding too. Good luck as your decision isn’t easy.

Thanks so much. This is difficult. And I was completely ignorant about cmgs, private equity, usacs, etc during med school and first year of residency.

 

[Groove]

You know, it didn’t occur to me until now, but that’s a good point. It’s one thing If a CMG simply loses a contract, and the docs can get screwed if there was a non compete in their contract clause.

If the CMG goes bankrupt and ceases to exist, then any non competes, if there, should become irrelevant.

It's always easier to keep the docs that are already working in the ER and have hospital privileges than it is to bring in new ones. It gives you time to identify the bad apples and you can throw them out of the barrel a few months down the line. I've been part of CMG contract buyouts/changes and know docs still working at one of my old hospitals that has now changed CMG hands twice in the past 5 years. I don't recall any non competes ever being an issue and even if it was in our contracts, nobody cares to enforce it once they lose the ED contract. (At least not in my area.)

When a new CMG comes in, they always schedule a big meeting and assuage exiting doc's anxiety because they don't want to have everyone running for the hills and suddenly have to worry about credentialing 10-20 new docs, bringing in travelers with emergency credentialing, etc... It's a gigantic headache.

If OP truly has an intention of staying in this city long term and putting down roots, the safest thing to do is stay away from administration roles and just be a regular worker bee. Chances are the ED could change contracts 5 times in the next 20 years and he'd still be there. Administration roles expose too much of your neck to the sacrificial chopping block of the rotating c-suite/CMG execs. Better to bury himself in with the rest of the galley-slaves.

The craziest non-compete I had was actually in a hospital employee contract (CMG cancelled the contract and hospital wanted to take over) that said I needed express written permission from hospital admin to work in any other ER in the entire country. I s**t you not, lol. It was insane. The hospital lawyer was beyond obtuse and I could never reason with him on why this clause was a terrible idea for the ED doc contracts. He was such an idiot. 90% of us walked away from that one.

 

[Mbekweni]

Your wife could also make herself indispensable, get on hospital admin roles and push to get USACS canned. CMGs are losing sway nationally and I feel like all hospital admin knows how bad they are. They just may not want the risk of an unstaffed schedule and extra headache to make a change happen.

 

[The Knife & Gun Club]

As a side note, why does your wife's professional career take priority over your's (she gets to sign with great group while you get poop)? I don't ask this to be a dick, just as a fellow man who made the same mistake in the past. Be careful mate.

Being married to a surgeon comes with its own set of challenges and one of the biggest ones is that they have far worse professional flexibility than we do in EM.

While some ACS/trauma people can just pick up shop and move, the vast majority of surgeons need to set up shop with a group/hospital where they can build a practice, referral base, and fill out a patient panel. This takes years and once established can’t really be easily shut down (it can take 1-2 years to close a general surgery practice based on some states laws). Good/fair offers in surgery are also tough to come by.

The end result is the EM half of the couple has to be pretty flexible…or at least that’s what I tell myself lol. The flip side though is EM is rarely gonna be the major breadwinner of the household so the pressure to keep the job isn’t as “scary.”

 

[turkeyjerky]

I'm not sure what working at the same hospital as your wife gets you, unless it's an issue of being able to live very close to the hospital so you both have a short commute (not a small consideration). So I'd throw that out, and evaluate each hospital on its own merits. Personally, in general, I wouldn't put much stock into the name of each particular CMG, evaluate positions w/ each hospital on their own merits. (only exception, not applicaple in this case, is vituity) Hospital-employed is likely better than CMG employed at this stage of the game (some semblance of job security, admin *slightly* more invested in day-to-day affairs, and less future downward pressure on pay).

I wouldn't commute 2 hrs each way for a job in an SDG unless you thought it was more likely than not that you'd be relocating to that area w/in the near future.

Begin preparing your wife now for the eventual liklihood that you'll be working part-time w/in a few years.

 

[Frazier]

A 2-hour commute each way is not setting yourself up for long-term success, IMO.
Sure there are scenarios where some random ED doc makes it happen with a smile on their face for years... but the average bird is going to find it tiring and more fuel for burnout driving 4 hours on top of whatever your shift is.

Take your hourly wage, add it up for whatever the shift... recalculate with the added 4 hours to the denominator [you spend driving to your job]
If you are making $225 hour and dedicate 4 hour of your life driving to that 10-hr shift... your wage is really like $160/hr. Many docs will be thinking about work (or dreading it) the whole way in, then ruminating or thinking about it on the way home.
Are you happy with that?

I am a fan of keeping my commute 15 min or less -- and that is coming from someone who really enjoys their job.

 

[Mount Asclepius]

I have commuted 35-40 minutes to my partnership SDG job for many years. Would prefer not to, but worth it for my job and have found a little bit of a commute can be nice for decompression. The cap though I think is a 1 hour one way commute. We’ve had folks try to commute 1.5-2 hours one way for our job. Some have even lasted quite a while going on multiple years. Most though didn’t last long and all eventually found it unsustainable.

 

[EctopicFetus]

You know, it didn’t occur to me until now, but that’s a good point. It’s one thing If a CMG simply loses a contract, and the docs can get screwed if there was a non compete in their contract clause.

If the CMG goes bankrupt and ceases to exist, then any non competes, if there, should become irrelevant.

Unless your tail becomes uncovered and you miss a month or more of pay.

I ageee all cmgs are basically the same and the overall quality is region dependent. However, all things being equal usacs is the bottom of the barrel.

 

[p1acebo]

Work at the largest place with the most resources so you rarely have the headache of trying to transfer a patient out.

 

[Major]

Work at the largest place with the most resources so you rarely have the headache of trying to transfer a patient out.

That would definitely be the usacs staffed hospital and one my wife will be working at. It’s also the best staffed, best nurses, and resource rich hospital/ED in town.

 

[RoyBasch]

Look, the bottom line is you have to pick the location that will work best for your entire life, not just your "work life."

A lot of the debates on this board about jobs are made in a vacuum of other life concerns. If you have no other constraints in life, you can try to find the "unicorn" SDG in a small town in the Southeast that pays 600k a year. But the reality is unless you are a single unattached person with no other geographic constraints, you can't simply seek out the "best" job, it will have to be balanced against other life concerns.

Pick a location where you and your spouse will be happy, and then find the best ER job you can within 45 mins of your house. I agree with above posters surgical jobs are actually less portable. I know a lot of people that have been compelled to move to markets that essentially only have CMGs. Usually the compulsion is their spouse, their family, the area, etc. Optimizing those categories contributes a lot to overall happiness even if you don't have the best job.

I agree with posters above 60 mins commuting one way is the absolute upper limit I would consider for a regular job (not an occasional PRN shift or locums with high pay). Beyond that is not sustainable.

 

[RoyBasch]

That would definitely be the usacs staffed hospital and one my wife will be working at. It’s also the best staffed, best nurses, and resource rich hospital/ED in town.

These are important considerations.

At this point in my career I would probably trade less pay, less control, to work at a generally more functional/well staffed hospital. A lot of the worst stress originates from difficult transfers, dysfunctional staff, and inadequate resources.

 

[Major]

Look, the bottom line is you have to pick the location that will work best for your entire life, not just your "work life."

A lot of the debates on this board about jobs are made in a vacuum of other life concerns. If you have no other constraints in life, you can try to find the "unicorn" SDG in a small town in the Southeast that pays 600k a year. But the reality is unless you are a single unattached person with no other geographic constraints, you can't simply seek out the "best" job, it will have to be balanced against other life concerns.

Pick a location where you and your spouse will be happy, and then find the best ER job you can within 45 mins of your house. I agree with above posters surgical jobs are actually less portable. I know a lot of people that have been compelled to move to markets that essentially only have CMGs. Usually the compulsion is their spouse, their family, the area, etc. Optimizing those categories contributes a lot to overall happiness even if you don't have the best job.

I agree with posters above 60 mins commuting one way is the absolute upper limit I would consider for a regular job (not an occasional PRN shift or locums with high pay). Beyond that is not sustainable.

You make some very solid points, and so has everyone else. Given me a lot to think about.

I feel a little less stressed wirh making a deal with the devil now haha

 

[wareagle726]

Knee jerk reaction. Let her work on her career in what sounds like a good place. You work part time for whoever. 6-8 shifts/mo is doable in crappy situations straight out of training. Do that until a better opportunity arises. Her job probably has more opportunity at really making a long-term career. Advantage to you is as EM you can move around without much change in pay/status(theoretically). Don't kill your marriage in the first few years out.

 

[GonnaBeADoc2222]

Knee jerk reaction. Let her work on her career in what sounds like a good place. You work part time for whoever. 6-8 shifts/mo is doable in crappy situations straight out of training. Do that until a better opportunity arises. Her job probably has more opportunity at really making a long-term career. Advantage to you is as EM you can move around without much change in pay/status(theoretically). Don't kill your marriage in the first few years out.

Why should he table his career for hers?

 

[DeadCactus]

Dual physician income living exactly where you want to live with a good opportunity for your wife's significantly less flexible career and multiple employers for your own career including a well run and well staffed hospital (and reading between the lines it sounds like a relatively well paying area too). Honestly, sounds like a pretty good situation to me. Corporate medicine is a flawed concept on multiple levels but that doesn't mean a job is inherently bad because it's a corporate job. Check out the local groups, choose the best fit and go in with the comfort that there are several other games in town and you can always find a viable way to work somewhere farther away if you really need to.

If you check out the local options and realize, either during the interview phase or after working there for a bit, that the options are all miserable then sure sit down with your wife and figure out a viable path forward even if it means moving. Don't torpedo your life and marriage getting caught up in other people's ideologic war or post-divorce traumatization.

 

[PianoMedic]

I think key to any of these jobs will be trying to make sure that the contracts do not contain a non compete clause. If they will not remove a non compete clause entirely, you could counter with a “non interference clause”. One of the cmgs you mention already does this. Non competes don’t make sense in emergency Medicine, it’s not like you take patients with you if you switch hospitals. But, you could in theory interfere with the cmgs contract with the individual hospitals, which would be detrimental to their business. So, provided you are willing to sign that type of clause, you could offer up a clause that essentially says “I will not interfere with the ability of cmg A to obtain or maintain the emergency department contract at hospital X while employed by cmg A and for two years after terminating employment with cmg A”. Gives you both an out and my guess is also what you both want.

I’d echo most other sentiment here: work at the hospital where it seems least crappy if you don’t want to move for any reason. I personally despise cmgs so I took a job in middle of bfe making decent money with a SDG and now family is moving to us. Not everyone has that luxury however.

 

[NITRAS]

Why should he table his career for hers?

Grown up married adults make deliberate decisions on what is best for the family. It is also ok to make a plan and reevaluate it in a year.

The OP and his wife know each other best. I always push back on the idea that people “need” to stay in a location.

Good luck!

 

[forchinet121]

Why should he table his career for hers?

Because she’s a surgeon

 

[emergentmd]

I really do not see what the big dilemma is. Most couples go through this many times in their marriage. There are many instances where a decision positively impacts one and negatively impacts another.

You guys are in a great position. She makes 3-600K/yr. You make 3-500K/yr. If her job is a unicorn, then I would suck it up and work the min 120 hrs and make 300K/yr. If thats too much, work 6 shifts a month, and you would have a unicorn job.

She took the job already, so just pick the best option. If you hate USACS that much, then work another CMG.

 

[Tenk]

Damn I should have married a doctor and had this problem too.

 

[namethatsmell]

I've been in a similar position. Here's what I did:
Made a deal with DW that if I wasn't happy within 3 years we'd look to move elsewhere. And for realsies.
There's a lot to like about the location, but was definitely a mediocre EM market and a much better fit for her for various reasons.
There was no appealing gig within a 45min drive, so I came to the equivalent of a locums deal with a group ~1.5 hrs away. Would have 3-4 shifts in a row and hotel and gas paid by the group. Negotiated hard and made ~1/3 more than the going regional rate at the time.
DW didn't love me being away from home, but was overall much less hassle and time on the road than with a traditional locums gig...and what could she really complain about anyway since we'd made the move for her benefit? Anyway, this was my main gig for awhile. Over time some of the precious few good shops right near me started to hire prn and I was able to get my foot in the door and went from there. I also had non-EM opportunities that I grabbed. If you keep your ear to the ground, there's a good chance you can find your way as well--especially with a high-income spouse and thus less pressure to chase every last dollar. Given the mechanics of EM, there is a very decent chance at least one of the CMGs you mentioned will lose their contract in the next 3-5 years...never know what will grow out of those ashes.

So yes it will start out being a less-than-ideal situation for you...but you are not stuck. In fact, if you have any interests outside of slinging shifts, you'll have a greater license with your spouse to explore other non-traditional work options that will make you happy.

My 2 cents is that marriage is a give and take. If you're not willing to make the first major sacrifice than I'd question how much your spouse and marriage really means to you (not you per se, the royal "you"). It does need to be a 2-way street of course. My wife has made significant sacrifices as well, much to my preference/betterment. Now if I could only get her to take an extra 3 seconds to condense things she puts in the recycling bin so it doesn't overflow in 2 days....

 

[anonperson]

I don't get it. I'm not EM but there are a lot of posts in general about getting out of clinical medicine or being in a situation where you don't have to depend on your income for the survival of the household.

You've got a built-in out. A wife who will theoretically be making an excellent living.

Just work enough to keep your skills up and enjoy life. If the job sucks, tell them to screw off. You don't depend on them in that way.

If you get divorced, you can get some sweet alimony by the judge for sacrificing your career for your spouse.

I've been working for 5 years. If someone told me my spouse could take over and I could either stop working or ease up, I wouldn't hesitate.

 

[emergentmd]

People on here always will be slanted towards unhappy complainers. Most on here would never give up 200+/hr b/c they realize they have lots of free time to spend that 200/hr.

 

[wareagle726]

Why should he table his career for hers?

I'd table mine for my wife's if she had a great career opportunity and I had the flexibility to literally change jobs at will. I don't need that much money and I'd love that time with my little boys as well!

 

[alpinism]

The offer from USACS is about 150/HR for 2PPH which is terrible.

 

[Franzd'Epinay]

quick update.

Offer 1: I interviewed with USACS staffed hospital and received an offer pretty quick. Base pay is $90 per hour then $8per rvu. Shifts are 8 hours. They are also offering a student loan pay back program. I work for them for 7 years and they payoff the remaining balance of my student loans and also cover the tax. I have about $300K in student loans. Have to work 120hrs month for the 7 years. The hospital has 24hr U/S coverage, 2 ct scanners, every specialist available, and in house OB/Gyn hospitalist. They do run lean. Must manage midlevels.

Offer 2; Hospital employee gig. $174 hr for day shift, $20 night shift differential. No midlevels. $25K yearly bonus. Multiple sites need help. Farthest is about 50minutes away. Nearest 20mins away. U/S coverage to midnight. PSLF eligible. Everyone seems pretty happy. Good group of guys. Great benefits.

Offer 3: SDG. Need help at rural ERs, farthest is 3 hours away, but pays $275 hr at that particular site. The other sites pay $185 hr, then $20 night shift diff. They offer partnership track. No buy in. Do the 2 years and partners vote to let me in or not. Partners and non partners get paid the same per hour. I also could work for them as a 1099 if I take one of the other offers.

I cannot believe someone made you that 7-year "loan repayment" offer with a straight face.

 

[Major]

The offer from USACS is about 150/HR for 2PPH which is terrible.

Yeah they said their docs average about $170 hr for very high acuity site. 40% admission rate

 

[Major]

I forgot to mention the hospital employed gig averages about 1.2 pph.

 

[Major]

I cannot believe someone made you that 7-year "loan repayment" offer with a straight face.

Yub. Dead face serious. Actually made it out like they are doing me the favor.

 

[BoardingDoc]

quick update.

Offer 1: I interviewed with USACS staffed hospital and received an offer pretty quick. Base pay is $90 per hour then $8per rvu. Shifts are 8 hours. They are also offering a student loan pay back program. I work for them for 7 years and they payoff the remaining balance of my student loans and also cover the tax. I have about $300K in student loans. Have to work 120hrs month for the 7 years. The hospital has 24hr U/S coverage, 2 ct scanners, every specialist available, and in house OB/Gyn hospitalist. They do run lean. Must manage midlevels.

Offer 2; Hospital employee gig. $174 hr for day shift, $20 night shift differential. No midlevels. $25K yearly bonus. Multiple sites need help. Farthest is about 50minutes away. Nearest 20mins away. U/S coverage to midnight. PSLF eligible. Everyone seems pretty happy. Good group of guys. Great benefits.

Offer 3: SDG. Need help at rural ERs, farthest is 3 hours away, but pays $275 hr at that particular site. The other sites pay $185 hr, then $20 night shift diff. They offer partnership track. No buy in. Do the 2 years and partners vote to let me in or not. Partners and non partners get paid the same per hour. I also could work for them as a 1099 if I take one of the other offers.

USACS is at least wising up in that they are completely obfuscating what your actual compensation is by making you do some math to figure it out. They clearly realize that telling you up front that you will be getting 210k/yr assuming you generate 10k RVUs.... is an insane offer. Even if you factor in your loan deal, that's 300k/7 yrs (assuming you somehow are allowed to make no payments over 7 yrs) which effectively brings it up to 250k for 7 yrs.... before going back to 210k. We also run lean at my shop, and I run very fast. I generated over 10k rvu last year. I also apparently make more than double what I would make at USACS. Seriously, that's not even a bad offer, that's just them insulting you.

 

[p1acebo]

quick update.

Offer 1: I interviewed with USACS staffed hospital and received an offer pretty quick. Base pay is $90 per hour then $8per rvu. Shifts are 8 hours. They are also offering a student loan pay back program. I work for them for 7 years and they payoff the remaining balance of my student loans and also cover the tax. I have about $300K in student loans. Have to work 120hrs month for the 7 years. The hospital has 24hr U/S coverage, 2 ct scanners, every specialist available, and in house OB/Gyn hospitalist. They do run lean. Must manage midlevels.

Offer 2; Hospital employee gig. $174 hr for day shift, $20 night shift differential. No midlevels. $25K yearly bonus. Multiple sites need help. Farthest is about 50minutes away. Nearest 20mins away. U/S coverage to midnight. PSLF eligible. Everyone seems pretty happy. Good group of guys. Great benefits.

Offer 3: SDG. Need help at rural ERs, farthest is 3 hours away, but pays $275 hr at that particular site. The other sites pay $185 hr, then $20 night shift diff. They offer partnership track. No buy in. Do the 2 years and partners vote to let me in or not. Partners and non partners get paid the same per hour. I also could work for them as a 1099 if I take one of the other offers.

So offer 1 is where your wife is going to work correct? Is there residents or just mid levels? Did they tell you they “run lean?”

2 pph with that pay seems rough, however if that’s with residents it’s cake. Is it the main referral center?

 

[emergentmd]

Offer 1: I interviewed with USACS staffed hospital and received an offer pretty quick. Base pay is $90 per hour then $8per rvu. Shifts are 8 hours. They are also offering a student loan pay back program. I work for them for 7 years and they payoff the remaining balance of my student loans and also cover the tax. I have about $300K in student loans. Have to work 120hrs month for the 7 years. The hospital has 24hr U/S coverage, 2 ct scanners, every specialist available, and in house OB/Gyn hospitalist. They do run lean. Must manage midlevels.

Offer 2; Hospital employee gig. $174 hr for day shift, $20 night shift differential. No midlevels. $25K yearly bonus. Multiple sites need help. Farthest is about 50minutes away. Nearest 20mins away. U/S coverage to midnight. PSLF eligible. Everyone seems pretty happy. Good group of guys. Great benefits.

Offer 3: SDG. Need help at rural ERs, farthest is 3 hours away, but pays $275 hr at that particular site. The other sites pay $185 hr, then $20 night shift diff. They offer partnership track. No buy in. Do the 2 years and partners vote to let me in or not. Partners and non partners get paid the same per hour. I also could work for them as a 1099 if I take one of the other offers.

Man, these 3 offers all have degrees of suckness. Is this some beachy paradise with untold lifestyle benefits.

Offer 1 - 150-170/hr. RVU = they can lower your pay anytime they want. Loan repayment = Handcuffs where most will never reach 7 years. Stock options = imaginary handcuffs. Did they offer you some 100K FTX shares too?

Offer 2 - 275k/yr for 120hrs/mo. What's up with the yearly bonus, what metrics do you have to achieve?

Offer 3 - Long drives, you make about $25-50/hr more. Partnership means little to me anymore. No benefits which equates to about 15-30/hr. Working rural sites, atleast for me, sucks (grouchy old nurses, country way = poor medicine, poor support)

If I had to pick it would be #2 then #3. #1 is not a real offer.

 

[Major]

Man, these 3 offers all have degrees of suckness. Is this some beachy paradise with untold lifestyle benefits.

Offer 1 - 150-170/hr. RVU = they can lower your pay anytime they want. Loan repayment = Handcuffs where most will never reach 7 years. Stock options = imaginary handcuffs. Did they offer you some 100K FTX shares too?

Offer 2 - 275k/yr for 120hrs/mo. What's up with the yearly bonus, what metrics do you have to achieve?

Offer 3 - Long drives, you make about $25-50/hr more. Partnership means little to me anymore. No benefits. Working rural sites, atleast for me, sucks (grouchy old nurses, country way = poor medicine, poor support)

If I had to pick it would be #2 then #3. #1 is not a real offer.

C.

 

[cyanide12345678]

Correct, offer 1 is where my wife is working. Resource rich hospital. No residents. They use PAs. And yes, private conversation with one of the younger guys, he told me “underpaid, understaffed, overworked.” Lmao


However, my attorney is strongly advising me to not work at the same hospital as my wife due to opening us both up to med mal liability. He explained worse case is I manage a Pt in the ED, then she takes the Pt to the OR. If there is a bad outcome then we can lose everything.

Everything? Sounds like an exaggeration. Both of you would have medical malpractice insurance and your it is extremely rare for an above limit lawsuit. The blockbuster lawsuits usually get appealed as well.

You can pay for extra malpractice insurance if you really feel the need to. But usually your malpractice would cover everything and your personal assets will not get touched.

 

[turkeyjerky]

You're in a bad situation. I didn't know the USVI was in Tornado Alley. Best plan is to become a house-husband. That usacs job offer is astoundingly bad.

If you value money, you could take the SDG job and work blocks at the 275/hr site, stay at a hotel or split an apartment w/ someone else. This gets old after a while. I'm assuming that the partners get take a decent amount of money for 'profit sharing' before paying out the "equal" hourly pay. If that's less important or sounds too painful, then take job #2.