Stuck in between rock and hard place

[Major]

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.

****!

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[Mount Asclepius]

$150/patient. 2 pph. $300/hour.

Hours worked variable. For hypothetical’s sake choose a fairly reasonable 14 8-hour shifts/month. $300 x 8 x 14 x 12 months = $403,200.

Trust me. Plenty of jobs are out there currently that pay >$400K/year. Some will get $500K+/year. That may not be the case forever. I don’t know.

You’ll have to decide how much your specific location matters when you accept a $100K+/year pay-cut. Over 10 years that could be $1M+ difference and FIRE or not.

You also don’t have to live in a completely undesirable location to have reasonable compensation. You may not get LA, NYC or Denver. You just can’t be tied to only 1 location. If you are, realize that is your opportunity cost. Your choice.

Points less directed towards the OP’s specific situation and more so to people selecting jobs in general.

 

[Major]

$150/patient. 2 pph. $300/hour.

Hours worked variable. For hypothetical’s sake choose a fairly reasonable 14 8-hour shifts/month. $300 x 8 x 14 x 12 months = $403,200.

Trust me. Plenty of jobs are out there currently that pay >$400K/year. Some will get $500K+/year. That may not be the case forever. I don’t know.

You’ll have to decide how much your specific location matters when you accept a $100K+/year pay-cut. Over 10 years that could be $1M+ difference and FIRE or not.

You also don’t have to live in a completely undesirable location to have reasonable compensation. You may not get LA, NYC or Denver. You just can’t be tied to only 1 location. If you are, realize that is your opportunity cost. Your choice.

Points less directed towards the OP’s specific situation and more so to people selecting jobs in general.

.

 

[NYEMMED]

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 wouldn’t touch the USACS offer with a 10 foot pole. Low pay, they will likely “flex” your hours down, which results in less pay as well.
The USACS unofficial motto is “underpaid, understaffed, overworked” and that is a bad offer to start with.

 

[VisionaryTics]

What is average yearly RVU of EM doc? In the ENT surgical world, ~4-8k RVU is the 25-75th percentile yearly for my region.

 

[Mbekweni]

Another part of my frustration. My area isn’t like freakin Pismo Beach or San Diego. It’s freakin lower midwest region.

I have friends who work at both of those places and make around $300/hr. Isn’t Midwest supposed to be the land of high pay, low COL and “geographic arbitrage”?

 

[Major]

I have friends who work at both of those places and make around $300/hr. Isn’t Midwest supposed to be the land of high pay, low COL and “geographic arbitrage”?

.

 

[BoardingDoc]

What is average yearly RVU of EM doc? In the ENT surgical world, ~4-8k RVU is the 25-75th percentile yearly for my region.

According to this website, it's around 7k. Numbers are going to vary wildly based on staffing models and how busy a dept you work in.

 

[namethatsmell]

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.

Here's another dirty secret about USACS not yet mentioned: 8 hour shifts.
They probably play it off as "yeah hey it's better for your work-life balance rah-rah"...but:
1) they run notoriously bare-bones staffing and
2) with their dismal hourly rate they're setting you up to sweat and scavenge every RVU you can touch
1+2= 0% chance of you getting out on time.
Let's say on average you're staying 1 hour past your shift. This equates to an extra 5hrs per month of uncompensated time vs having 12hr shifts. That's an extra 10k out of your pocket and into theirs each year. If they have 10 docs at the site that's an extra 100k/yr to the company...you get the idea. This doesn't even account for all the extra uncompensated time at home you'll need to chart and "sign off" on midlevel charts (that won't be sent to you until well after your shift).

 

[Major]

Here's another dirty secret about USACS not yet mentioned: 8 hour shifts.
They probably play it off as "yeah hey it's better for your work-life balance rah-rah"...but:
1) they run notoriously bare-bones staffing and
2) with their dismal hourly rate they're setting you up to sweat and scavenge every RVU you can touch
1+2= 0% chance of you getting out on time.
Let's say on average you're staying 1 hour past your shift. This equates to an extra 5hrs per month of uncompensated time vs having 12hr shifts. That's an extra 10k out of your pocket and into theirs each year. If they have 10 docs at the site that's an extra 100k/yr to the company...you get the idea. This doesn't even account for all the extra uncompensated time at home you'll need to chart and "sign off" on midlevel charts (that won't be sent to you until well after your shift).

I didn’t even think about that. At first I thought, “oh yeah 8 hr shift, that seems better and more sustainable.” But you raise some good points. And it also means I have to drive to work more times to get the same amount of hours compared to my other two offers.

The Hospital Employed gig pays me to finish notes, clock out after my notes are finished for the day.

I had a long talk with my attorney today, who is also an EP. He reviewed the usacs contract. He said lots of red flags, and is strongly advising against me signing.

 

[RustedFox]

Eff USACS, for ever. And ever.

 

[emergentmd]

Also NO mid levels for me to manage

I will say that when we had APPs I was against it for the obvious reasons. But when we had them, I was thankful to not do another suture, abscess, constant Viral URI turnstile.

 

[emergentmd]

Let's say on average you're staying 1 hour past your shift. This equates to an extra 5hrs per month of uncompensated time vs having 12hr shifts. That's an extra 10k out of your pocket and into theirs each year

This is why you game the system. Once figured out, I stopped working for free.

Be efficient with charting, see the avg 2 pph. Never pick up anything you can not dispo when your shift ends.

Very unusual for me to stay more than 30min after shift ends. I for sure will never bring charting home.

 

[turkeyjerky]

This is why you game the system. Once figured out, I stopped working for free.

Be efficient with charting, see the avg 2 pph. Never pick up anything you can not dispo when your shift ends.

Very unusual for me to stay more than 30min after shift ends. I for sure will never bring charting home.

This can be hard to pull off depending on patient flow, sign out culture, availability of low acuity patients to see at the end of your shift, etc

 

[Mount Asclepius]

The problem isn’t 8 hour shifts. The problem is not being paid for your hours worked.

I prefer a scheduled 8 hour shift that lasts about 10-10.5 hours. Beyond 10 hours you start losing the ability to be productive. Working a busy 12 hour shift results in 2 hours of decreased productivity and decreased pay when your are compensated based upon productivity. If you are paid hourly then who cares, but that’s the problem with being paid hourly. You never have incentive to work hard with the potential of creating a bad culture. I also think you’ll never maximize income in a hourly position. If you are end of career or looking for a more relaxed position that can be okay, but not when compensation is a priority.

 

[emergentmd]

This can be hard to pull off depending on patient flow, sign out culture, availability of low acuity patients to see at the end of your shift, etc

I have always worked in busy referral centers and trauma centers. If you want to leave on time, you just have to make adjustments.
1. Be top 1/4 of pph. This means see pts quickly, get them out quickly. No one will complain that you are not pulling your weight esp if you stop seeing work ups 2 hrs before shift
2. If you must see a work up, sign it out. If everyone loves to stay 2-3 hrs late waiting on a belly work up then that culture stinks. More reason not to pick them up and just order basic labs then hand it off
3. Don't chase RVU and need to squeeze out the extra dollar.
4. Learn to chart fast, there always are tricks. I typically chart half the time most docs can and my charts paints a better picture.

We typically did 8 hr shifts. 1st 6 hrs I picked up as many pts as possible, typically 3pp/h, b/c our ER was always busy. Last 2 shifts was for disposition/charting. End of the day, my pph was 1st or 2nd out of 15 docs. No one will complain that you are not picking up pts.

 

[VisionaryTics]

The problem isn’t 8 hour shifts. The problem is not being paid for your hours worked.

I prefer a scheduled 8 hour shift that lasts about 10-10.5 hours. Beyond 10 hours you start losing the ability to be productive. Working a busy 12 hour shift results in 2 hours of decreased productivity and decreased pay when your are compensated based upon productivity. If you are paid hourly then who cares, but that’s the problem with being paid hourly. You never have incentive to work hard with the potential of creating a bad culture. I also think you’ll never maximize income in a hourly position. If you are end of career or looking for a more relaxed position that can be okay, but not when compensation is a priority.

I would absolutely try to maximize productivity if I were being paid $90/hr (which is insane to me), but if being productive only nets me $8/RVU, kind of stuck between a rock and a hard place.

This job from the outside looking in sounds horrible. It is insane to me that MDs in the United States are being paid such **** wages for such difficult work. Your academy leaders should be tarred and feathered for allowing this to happen.

 

[Mount Asclepius]

I would absolutely try to maximize productivity if I were being paid $90/hr (which is insane to me), but if being productive only nets me $8/RVU, kind of stuck between a rock and a hard place.

This job from the outside looking in sounds horrible. It is insane to me that MDs in the United States are being paid such **** wages for such difficult work. Your academy leaders should be tarred and feathered for allowing this to happen.

In my opinion the best paid positions in the US are at SDGs where you can control your practice environment and productivity. If you make on average $150/patient there is going to be incentive to see another patient.

You might be able to make a decent amount in locums or as a firefighter, but those positions aren’t sustainable. Nor am I sure they are going to last in the future when we are looking at an oversupply of EPs.

 

[Brigade4Radiant]

I have always worked in busy referral centers and trauma centers. If you want to leave on time, you just have to make adjustments.
1. Be top 1/4 of pph. This means see pts quickly, get them out quickly. No one will complain that you are not pulling your weight esp if you stop seeing work ups 2 hrs before shift
2. If you must see a work up, sign it out. If everyone loves to stay 2-3 hrs late waiting on a belly work up then that culture stinks. More reason not to pick them up and just order basic labs then hand it off
3. Don't chase RVU and need to squeeze out the extra dollar.
4. Learn to chart fast, there always are tricks. I typically chart half the time most docs can and my charts paints a better picture.

We typically did 8 hr shifts. 1st 6 hrs I picked up as many pts as possible, typically 3pp/h, b/c our ER was always busy. Last 2 shifts was for disposition/charting. End of the day, my pph was 1st or 2nd out of 15 docs. No one will complain that you are not picking up pts.

Yeah this is the way except we do 10 hours. Often I try to supervise the midlevel charts and introduce myself. That way you get out on time. The last two hours you do charting. If its hourly there is no incentive to work hard and you see doctors cherry pick patients.

 

[namethatsmell]

I have always worked in busy referral centers and trauma centers. If you want to leave on time, you just have to make adjustments.
1. Be top 1/4 of pph. This means see pts quickly, get them out quickly. No one will complain that you are not pulling your weight esp if you stop seeing work ups 2 hrs before shift
2. If you must see a work up, sign it out. If everyone loves to stay 2-3 hrs late waiting on a belly work up then that culture stinks. More reason not to pick them up and just order basic labs then hand it off
3. Don't chase RVU and need to squeeze out the extra dollar.
4. Learn to chart fast, there always are tricks. I typically chart half the time most docs can and my charts paints a better picture.

We typically did 8 hr shifts. 1st 6 hrs I picked up as many pts as possible, typically 3pp/h, b/c our ER was always busy. Last 2 shifts was for disposition/charting. End of the day, my pph was 1st or 2nd out of 15 docs. No one will complain that you are not picking up pts.

Sure, I do those too except for 3 (I never took a contract with an RVU component). Still, several of these suggestions are not relevant to OP.

1) OP is going to be a brand new attending...they will come into their next job with minimal self-confidence and experience. They of course will get better with time, but even then your tips won't work for some folks depending on their personality, practice style, local group practice patterns, and staffing etc.

2) You've described working in hell-holes before in your prior posts. Have you ever worked a Monday swing as the sole attending in a 60k shop while "supervising" 5 midlevels (2 of those were less than 6 months out of their schooling)? I worked in such a hellscape, and they are not quite as uncommon as you would think. And this sounds like the USACS job the OP is describing. If you have a CVA in the window, an MI you're trying to transfer a few rooms over, and there's a peds code en routhe when the new attending is coming on...are you leaving on time?

Don't get me wrong. There's a lot to like about 8 hour shifts and reasons why anything longer than 10 hours isn't ideal. But if you don't work at a place were your group has control over the reimbursement model as well as staffing levels, than 8 hour shifts carry a lot of risk.

 

[TysonCook]

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.

Offer 1: Hard no. No way, no how, no time would I work for USACS. Sooooo many horror stories (from multiple sources, for multiple years).
Offer 2: Meh
Offer 3: SDG is what I'd take. Partners will definitely get paid more. Probably looking at a 25-33% income boost once partner. Obviously ask a partner what they're ballpark making. Also read the multiple threads here about partnership tracks and what to ask about (i.e. how many have NOT made partner, is it guaranteed, is it a "all or none" situation, is it calendar years, or shifts worked, or hours worked, any chance for acceleration, partner with buyout, etc.

Yes, you may drive 3hr and pull 3-7 shifts in a row, once a month, but eventually that will likely peter-out as you become partner, plus you have the control of a SDG.

 

[NYEMMED]

Those are some great points. I need to speak with the SDG group again and find out more. They are offering $10K sign on bonus.

The hospital employed gig is offering $20K sign on bonus. $40K if I work exclusively full time at one of their rural ERs about 50mins away from my house.

I’m definitely cutting the usacs offer out now. I just received an email from the usacs recruiter stating they are updating their compensation stating Jan 1st. Decrease in per hour by $4 and increase in RVU by $3. And somehow tried to sale it as a benefit. Wtf…

So, now it’s between the hospital employed gig and the SDG gig.

USACS switched to RVU at many sites during COVID, when no patients were moving. If you don’t dispo patients, you don’t make money.

It was beneficial for USACS to not pay docs when the ED was full.

Slimy….

 

[NYEMMED]

Those are some great points. I need to speak with the SDG group again and find out more. They are offering $10K sign on bonus.

The hospital employed gig is offering $20K sign on bonus. $40K if I work exclusively full time at one of their rural ERs about 50mins away from my house.

I’m definitely cutting the usacs offer out now. I just received an email from the usacs recruiter stating they are updating their compensation stating Jan 1st. Decrease in per hour by $4 and increase in RVU by $3. And somehow tried to sale it as a benefit. Wtf…

So, now it’s between the hospital employed gig and the SDG gig.

How long are you locked in for those sign on bonuses?

Can you negotiate the 10k higher? Kinda low

 

[emergentmd]

Those are some great points. I need to speak with the SDG group again and find out more. They are offering $10K sign on bonus.

The hospital employed gig is offering $20K sign on bonus. $40K if I work exclusively full time at one of their rural ERs about 50mins away from my house.

I’m definitely cutting the usacs offer out now. I just received an email from the usacs recruiter stating they are updating their compensation stating Jan 1st. Decrease in per hour by $4 and increase in RVU by $3. And somehow tried to sale it as a benefit. Wtf…

So, now it’s between the hospital employed gig and the SDG gig.

I love the nebulous RVU makes the bulk of your pay. Its just another barrier to actually understanding how you are paid.

 

[Major]

I love the nebulous RVU makes the bulk of your pay. Its just another barrier to actually understanding how you are paid.

Amazing they are touting this as a “pay raise”

 

[emergentmd]

Amazing they are touting this as a “pay raise”

I have never seen a move to RVU raising anyone's pay.

 

[Old_Mil]

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

Are you SURE you'd love to work at the same hospital as her? Aside from what your lawyer told you, going home to a consultant isn't what I consider to be a good quality of life.

Go to the SDG ER 2 hours away. Or go to something not named USACS. But if you insist on working there, you may include something in your contract that you can't work a shift the same nights she is on call so at least you won't generate the liability - and grief after your shift ends - involved in transferring a patient to her care.

 

[EM_Disney_Doc]

This is a new SDN account because my original one from when SDN started was archived - I haven't been on here in some time. Full transparency - I’m a doc and high level leader with USACS and have been with the group through my legacy company since 2010. I have worked in multiple states and with multiple divisions within USACS - I’ve served at all levels of our group and I believe in our perpetual physician owned model and our ability to create programs that support our people. I also started my career as an Asst. Prof in a very well-regarded EM program in Philly, so USACS is not all that I have known.

While I’m not here to get in the mud, I do want to correct some facts about our programs and the math about an RVU model. I do not know which site the OP is looking at, but am happy to connect with anyone about our company here or privately.

This fall we launched a Physician Loan Payback (PLP) program at over 80 sites. As a physician owned company, we recognized that our current owners and newest partners were coming out of residency with tremendous debt coupled with an exceptionally unfavorable refinance environment - which we all know has gotten worse in the past few months. We are not PSLF eligible, so we chose to invest in our people. The PLP is open to our current team members at these sites as well as our new hires.

The PLP program has you refi/consolidate to a 15 year loan or you can bring a current loan with you. We have a rate reduction with Laurel Road, but the doc is free to use any bank. The doc pays for 7 years and we then pay them the balance PLUS gross-up the estimated tax burden for that payment. No cap to the amount of student loan debt that can be brought into the program. The commitment is 4 years at the initial site (or transfer to another included site during that time), then if life changes, they can transfer to any one of our 500+ sites nationwide for the final 3 years of the commitment. Leave before 7 years? No handcuffs - we wish you well.

If the PLP program doesn’t fit your needs, we are offering $150K sign-on bonus for the same sites with a 3 year commitment.

As for comp rates - our busy sites on a hybrid hourly/RVU model typically make at least twice the hourly as an average. I don’t know the site the OP has interviewed at, so cannot really comment if the rate of $170/hr is accurate, but that sounds low to me with that acuity level. I wonder if that is the lowest person at the site or a part-time doc?? Would always recommend asking what the range is at the site between high and low performers.

The comp change the OP described absolutely is a RAISE - they are decreasing hourly by $4/hr and increasing RVUs by $3/RVU. OP stated that there is a 40% admit rate at this site - so we can assume a high acuity - lets assume 4.5 RVU/pt - could even be higher with that acuity level.

At 1 pt/hr that is a $9.50/hr raise - 4.5 RVU/hr * $3/RVU = $13.50/hr - $4/hr = $9.50/hr
At 2 pt/hr that is a $23/raise - 9 RVU/hr * $3/RVU = $27/hr - $4/hr = $23/hr

They likely see 1.8-2.1 pt/hr. So unless I am missing something - this site is getting a pretty significant raise of > $20/hr.

OP - you should ask what the RVU/pt and RVU/hr at the site is to help you determine comp - as well as asking for the range of team members. The director should easily be able to show you each doc's monthly productivity as we openly share this online. Each member of a team can see their own patients/coding as well as the entire groups productivity each month.

Additionally, our compensation includes $45-50K/year in pre-tax benefits - we like our pre-tax dollars:

* 10% company contribution to 401K (not a match) up to $33K/yr in 2023 - increases each year with the increase in IRS limits
* Low cost health/dental/vision with good coverage
* STD/LTD own occupation paid for by the group
* Business expense account $4K/yr with additional $4K in the first year out of residency
* Fully paid military leave
*.Fully paid parental leave open to all new parents including adoptive (up to 12 weeks for birth moms)
* $75K equity grant at 2 year anniversary with no buy-in (yes - the IRS has you pay the taxes on this)
* Stock price has more than doubled in the past 7 years and we have at least annual opportunities to buy/sell

And our docs are SUED LESS THAN HALF the national average for EM because we focus on hiring high quality BCEM and actively manage our own risk.

I wish the OP the best of luck with their decision and am happy to connect if I can be of help.

 

[GonnaBeADoc2222]

You are not physician owned. Stop pretending you are.

7 year commitment for loan repayment Lulz.

If you want to "invest in your people" pay them correctly.

 

[bravotwozero]

USACS corporate shill gonna USACS shill.

I wonder how much student loan repayment they’ll offer after becoming financially insolvent, declaring bankruptcy and losing all of their contracts.

 

[southerndoc]

I wonder how much student loan repayment they’ll offer after becoming financially insolvent, declaring bankruptcy and losing all of their contracts.

100% this. I'd be very reticent about signing a long-term commitment with any CMG that has even a remote possibility of failing.

 

[GonnaBeADoc2222]

Username checks out....living in a fantasy land

 

[RustedFox]

Dissolve yourself, USASSKISSER.
Did you not see the OP where he straight says your docs are miserable?

Wonder why that is?

 

[namethatsmell]

This is a new SDN account because my original one from when SDN started was archived - I haven't been on here in some time. Full transparency - I’m a doc and high level leader with USACS and have been with the group through my legacy company since 2010. I have worked in multiple states and with multiple divisions within USACS - I’ve served at all levels of our group and I believe in our perpetual physician owned model and our ability to create programs that support our people. I also started my career as an Asst. Prof in a very well-regarded EM program in Philly, so USACS is not all that I have known.

While I’m not here to get in the mud, I do want to correct some facts about our programs and the math about an RVU model. I do not know which site the OP is looking at, but am happy to connect with anyone about our company here or privately.

This fall we launched a Physician Loan Payback (PLP) program at over 80 sites. As a physician owned company, we recognized that our current owners and newest partners were coming out of residency with tremendous debt coupled with an exceptionally unfavorable refinance environment - which we all know has gotten worse in the past few months. We are not PSLF eligible, so we chose to invest in our people. The PLP is open to our current team members at these sites as well as our new hires.

The PLP program has you refi/consolidate to a 15 year loan or you can bring a current loan with you. We have a rate reduction with Laurel Road, but the doc is free to use any bank. The doc pays for 7 years and we then pay them the balance PLUS gross-up the estimated tax burden for that payment. No cap to the amount of student loan debt that can be brought into the program. The commitment is 4 years at the initial site (or transfer to another included site during that time), then if life changes, they can transfer to any one of our 500+ sites nationwide for the final 3 years of the commitment. Leave before 7 years? No handcuffs - we wish you well.

If the PLP program doesn’t fit your needs, we are offering $150K sign-on bonus for the same sites with a 3 year commitment.

As for comp rates - our busy sites on a hybrid hourly/RVU model typically make at least twice the hourly as an average. I don’t know the site the OP has interviewed at, so cannot really comment if the rate of $170/hr is accurate, but that sounds low to me with that acuity level. I wonder if that is the lowest person at the site or a part-time doc?? Would always recommend asking what the range is at the site between high and low performers.

The comp change the OP described absolutely is a RAISE - they are decreasing hourly by $4/hr and increasing RVUs by $3/RVU. OP stated that there is a 40% admit rate at this site - so we can assume a high acuity - lets assume 4.5 RVU/pt - could even be higher with that acuity level.

At 1 pt/hr that is a $9.50/hr raise - 4.5 RVU/hr * $3/RVU = $13.50/hr - $4/hr = $9.50/hr
At 2 pt/hr that is a $23/raise - 9 RVU/hr * $3/RVU = $27/hr - $4/hr = $23/hr

They likely see 1.8-2.1 pt/hr. So unless I am missing something - this site is getting a pretty significant raise of > $20/hr.

OP - you should ask what the RVU/pt and RVU/hr at the site is to help you determine comp - as well as asking for the range of team members. The director should easily be able to show you each doc's monthly productivity as we openly share this online. Each member of a team can see their own patients/coding as well as the entire groups productivity each month.

Additionally, our compensation includes $45-50K/year in pre-tax benefits - we like our pre-tax dollars:

* 10% company contribution to 401K (not a match) up to $33K/yr in 2023 - increases each year with the increase in IRS limits
* Low cost health/dental/vision with good coverage
* STD/LTD own occupation paid for by the group
* Business expense account $4K/yr with additional $4K in the first year out of residency
* Fully paid military leave
*.Fully paid parental leave open to all new parents including adoptive (up to 12 weeks for birth moms)
* $75K equity grant at 2 year anniversary with no buy-in (yes - the IRS has you pay the taxes on this)
* Stock price has more than doubled in the past 7 years and we have at least annual opportunities to buy/sell

And our docs are SUED LESS THAN HALF the national average for EM because we focus on hiring high quality BCEM and actively manage our own risk.

I wish the OP the best of luck with their decision and am happy to connect if I can be of help.

Regarding your comment on risk, can you elaborate on what "actively" managing it means? Does USACS self-insure so your docs can be removed from cases?

Regarding everything else you wrote re: compensation, I just posted a response to a question re: EM doc comp at the VA. When comparing what the VA was offering to the compensation package you describe, it seems that the VA comes out around or ahead in terms of overall compensation--and when considered in terms of $ per unit of pph+liability it comes out way ahead. Food for thought.

 

[EM_Disney_Doc]

Regarding your comment on risk, can you elaborate on what "actively" managing it means? Does USACS self-insure so your docs can be removed from cases?

Regarding everything else you wrote re: compensation, I just posted a response to a question re: EM doc comp at the VA. When comparing what the VA was offering to the compensation package you describe, it seems that the VA comes out around or ahead in terms of overall compensation--and when considered in terms of $ per unit of pph+liability it comes out way ahead. Food for thought.

Yes, we are self-insured so we get to determine how our cases are managed. We have significant focus on education and CME for our teams, and have a 24/7 hotline to speak with another doc for difficult cases.

Our malpractice cases are far below national average. See attached - AON rates vs USACS rates of non-$0 (paid out) cases per 100,000 patients. EM data for the entire company in 30 states.

VA is a great choice too! Lot's of practice options in our field.

 

[EctopicFetus]

Yes, we are self-insured so we get to determine how our cases are managed. We have significant focus on education and CME for our teams, and have a 24/7 hotline to speak with another doc for difficult cases.

Our malpractice cases are far below national average. See attached - AON rates vs USACS rates of non-$0 (paid out) cases per 100,000 patients. EM data for the entire company in 30 states.

VA is a great choice too! Lot's of practice options in our field.

Dude. This isnt some c suite you are trying to impress here. This is a bunch of em docs and we know you are full of 🐮 💩

are you DBag? I mean you can’t truly believe the drivel you spout. Your cme. Hiring high quality people. Gtfooh. No one wants to work for you. Don’t pretend like you get the skim the cream. You take who you can get cause your company and the jobs in it suck.

 

[BoardingDoc]

Leave before 7 years? No handcuffs - we wish you well.

What does this even mean? Of course there are no handcuffs. You haven't given the doctor anything. Or do you simply realize how absurd this deal is and you're trying to make it sound like a an actual good deal which has a clawback agreement? Because this ain't that.

Seriously. This entire post reads like a snake oil ad. You may as well have been twirling your moustache while writing it.

 

[JacobMcCandles]

Our docs are SUED LESS THAN HALF the national average for EM because we focus on hiring high quality BCEM and actively manage our own risk.

Yes, we are self-insured so we get to determine how our cases are managed. We have significant focus on education and CME for our teams, and have a 24/7 hotline to speak with another doc for difficult cases.

Our malpractice cases are far below national average. See attached - AON rates vs USACS rates of non-$0 (paid out) cases per 100,000 patients. EM data for the entire company in 30 states.

VA is a great choice too! Lot's of practice options in our field.

So, where's the data that USACS physicians are sued less? Your chart (as you later state) shows the number of paid out cases, not the frequency of lawsuits. Since you self-insure and have a legal team on retainer it likely costs you nothing to fight these in court where most other malpractice carriers would just settle. Just another example of a CMG presenting less than truthful facts and benefits. The only thing that correlates to getting sued in EM is the number of patients you see. Nothing more, nothing less.

I'm impressed if you continue to stick around but you're part of the problem, not a solution.

 

[namethatsmell]

What does this even mean? Of course there are no handcuffs. You haven't given the doctor anything. Or do you simply realize how absurd this deal is and you're trying to make it sound like a an actual good deal which has a clawback agreement? Because this ain't that.

Seriously. This entire post reads like a snake oil ad. You may as well have been twirling your moustache while writing it.

What's amazing is that USACS is, again, a worse deal than the VA. I'm not here to pump up the VA and said my piece about them in the other thread, but....

I just looked and the VA offers 200k in loan repayment over 5 years w/o requiring an agreement to stay. Apparently if you leave before 5 years you still get the proportional amount at 40k/yr with no strings attached.

Can USACS not even keep up with the fed?

 

[Major]

Are you SURE you'd love to work at the same hospital as her? Aside from what your lawyer told you, going home to a consultant isn't what I consider to be a good quality of life.

Go to the SDG ER 2 hours away. Or go to something not named USACS. But if you insist on working there, you may include something in your contract that you can't work a shift the same nights she is on call so at least you won't generate the liability - and grief after your shift ends - involved in transferring a patient to her care.

.

 

[Major]

At 1 pt/hr that is a $9.50/hr raise - 4.5 RVU/hr * $3/RVU = $13.50/hr - $4/hr = $9.50/hr
At 2 pt/hr that is a $23/raise - 9 RVU/hr * $3/RVU = $27/hr - $4/hr = $23/hr

They likely see 1.8-2.1 pt/hr. So unless I am missing something - this site is getting a pretty significant raise of > $20/hr.

.

 

[namethatsmell]

Yes, we are self-insured so we get to determine how our cases are managed. We have significant focus on education and CME for our teams, and have a 24/7 hotline to speak with another doc for difficult cases.

Our malpractice cases are far below national average. See attached - AON rates vs USACS rates of non-$0 (paid out) cases per 100,000 patients. EM data for the entire company in 30 states.

VA is a great choice too! Lot's of practice options in our field.

So I do give your company kudos for self-insuring, it can be a powerful tool for good (and a wise business decision). But the stat you quote isn't relevant for the doc in the pit.

Pit docs want to know if their group will actually have their back and get their names removed from cases while leaving the organization as the remaining defendant. Does USACS do this?

 

[JacobMcCandles]

So I do give your company kudos for self-insuring, it can be a powerful tool for good (and a wise business decision). But the stat you quote isn't relevant for the doc in the pit.

Pit docs want to know if their group will actually have their back and get their names removed from cases while leaving the organization as the remaining defendant. Does USACS do this?

I imagine they would because if they self-insure then it would be to their benefit to fight it and minimize (or completely eliminate) any payout. But again, this has nothing to do with them supposedly hiring quality physicians. I imagine they have many locations where they'll hire anyone that can fog a mirror.

 

[JacobMcCandles]

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.

Job 1: Sucks something awful. Even if you see 1 pph you're going to be underpaid. If it's a high acuity place then you'll be underpaid and burnt out. USACS won't be around in their current form in 7 years would be my bet so I wouldn't commit to anything long term with them.

Job 2: May not be terrible if you're seeing 1 pph. Hospitals can't typically run their own departments very efficiently so I wouldn't be surprised if they let the physicians do most of the logistics of running a department.

Job 3: An SDG probably has the highest ceiling but there are always risks with SDG's that aren't going away any time soon. No way I'd routinely commute 3 hours.

 

[Dr Mantis Toboggan]

What's amazing is that USACS is, again, a worse deal than the VA. I'm not here to pump up the VA and said my piece about them in the other thread, but....

I just looked and the VA offers 200k in loan repayment over 5 years w/o requiring an agreement to stay. Apparently if you leave before 5 years you still get the proportional amount at 40k/yr with no strings attached.

Can USACS not even keep up with the fed?

Yeah I worked at the VA for 7 years and they were supposed to pay off part of my loans.
They didn’t pay any of it. What was advertised was not delivered in my case.

 

[emergentmd]

First, I have never talked to a doctor that said USACS was a great but many that told me it ruined their group when they were taken over. Facts don't lie.

Things I have been told in life that sure sounded great until you really look into the details.

1. Military option - Join, its great, you get to do whatever field you want, go essentially where you want, we pay for everything. They never said Iraq was an option.
2. Whole/variable life - put your money in, you can get millions in death benefits, and your money keeps growing. They never said anything about high fees or your cash value disappearing at death.
3. Gov Loan repayment - Work in under served area and you will get loans paid off in 7-10 yrs. Look up the actual % who got loan forgiveness
4. Work for USACS for 7 yrs and we will repay your loans. Don't like your spot, you can go to another. I am sure if you want to move, then your choices are crappy places or crappier places that they can't staff. Places with crappy locums who are making 100-200/hr more than a full timer. Sure they would be happy for u to move. What if they go bankrupt. What if you need to move and the choices are Alaska, Mississippi, or Detroit? What if they fired you at year 6 to save that 200K in repayment? I mean what could go wrong?

What a joke. I wonder how USACS admin would like it if they were given a 7 yr contract for 5M/yr but only get $50k/yr then a whopping 343+M at the end of the 7th yr. I wonder if he would take it. Think about it.

 

[thegenius]

So I do give your company kudos for self-insuring, it can be a powerful tool for good (and a wise business decision). But the stat you quote isn't relevant for the doc in the pit.

Pit docs want to know if their group will actually have their back and get their names removed from cases while leaving the organization as the remaining defendant. Does USACS do this?

Of course not. Even I know the answer to that. Why would any employer allow themselves to be sued while dropping the employee. It will always be the opposite

 

[southerndoc]

This fall we launched a Physician Loan Payback (PLP) program at over 80 sites. As a physician owned company, we recognized that our current owners and newest partners were coming out of residency with tremendous debt coupled with an exceptionally unfavorable refinance environment - which we all know has gotten worse in the past few months. We are not PSLF eligible, so we chose to invest in our people. The PLP is open to our current team members at these sites as well as our new hires.

The PLP program has you refi/consolidate to a 15 year loan or you can bring a current loan with you. We have a rate reduction with Laurel Road, but the doc is free to use any bank. The doc pays for 7 years and we then pay them the balance PLUS gross-up the estimated tax burden for that payment. No cap to the amount of student loan debt that can be brought into the program. The commitment is 4 years at the initial site (or transfer to another included site during that time), then if life changes, they can transfer to any one of our 500+ sites nationwide for the final 3 years of the commitment. Leave before 7 years? No handcuffs - we wish you well.

If the PLP program doesn’t fit your needs, we are offering $150K sign-on bonus for the same sites with a 3 year commitment.

So the doc refinances his/her loan preferably with a bank that USACS chooses AND repays half his/her loan before you pay the remainder. It's either the loan "forgiveness" program which only forgives half your loan or the sign-on bonus.

I noticed you didn't comment on their debt commentary with USACS.

 

[CoolDoc1729]

Those are some solid points. My attorney again iterated to me the legal, financial trouble, and emotional stress that could happen if we are tied to case with a poor outcome together. It could lead to my attorneys against her attorneys blaming the opposite for the poor outcome, etc.

The other 3rd option is the hospital employed gig, 50minutes away. They do 11 hr shifts. They just had a pay raise to 178 hr day/ 198 hr night shift. Always 2 docs on. See about 1.2 pph. $20K bonus every year. Also qualify for PSLF. But 50 minute drive from my house, which kinda sucks.

I work at a site 20 minutes from my house and my main site is 35. Ymmv of course but I don’t feel like I have enough time to decompress when I work at the 20 minute place and I prefer the longer commute because I don’t snarl at my kids when they talk to me when I get home lol. I use the drive to work to talk to family and the drive home to listen to music and relax. People do podcasts. Etc. if you work 12 shifts a month then the difference between 35 and 50 minute commute is what, 6 hours? A significantly better job to me would be worth 6 hours a month. JMTC

 

[EctopicFetus]

I imagine they would because if they self-insure then it would be to their benefit to fight it and minimize (or completely eliminate) any payout. But again, this has nothing to do with them supposedly hiring quality physicians. I imagine they have many locations where they'll hire anyone that can fog a mirror.

People who choose to work for usacs are those who are administrators and people with no geographic choice. The pay is below market, the staffing is terrible and their culture is bad. As dbag rolls around like a don with a bit of booze in one hand and hairy chest sticking out and big gold chain swinging around.

My buddy used to work for usacs when they were emp and said they nicknamed dom “the big gold chain”.

Little napoleon is watching his serfs make money for him.