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97t

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Hi guys,
I've Been out a few years and am restricted geographically. Not totally happy but not miserable with my current gig and am considering a job with team health. They are offering slightly above the going rate in my area and was wondering if this is a gimmick that's going to change after a year or two or if from experience they keep paying what the say for the long haul.

Thanks!

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I've worked for team health for a few years, and I've not known them to change pay structure after a short time. I suppose they could if the market changes, but it hasn't been my experience. There are some extra bonuses such a significant amount of free CME and a few negatives (increased corporate oversight, required risk management online classes are kinda boring), but they've always seemed pretty up front about everything in my experience.
 
TH varies depending on region, but the 2 regions I've worked in have been upfront about pay and job expectations. The employment contract is horribly one-sided which seems to be the standard for a CMG. I think your experience is going to be more shaped by the particular shop/FMD than being "employed" by TH.
 
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I've had 3 TH gigs. They have always done what they said they would.

You can expect them to act like a for profit, publicly owned business. They don't make any bones about it. They 'd be happy to pay me $5 an hour if they could. Conversely, I'd have no guilt taking $1,000 an hour from them if I could. Honestly, I find it a little comforting. There's no pretension of "we're a family, we'll look out for you even if it means losing the contract, etc." It's simply a mutually beneficial relationship.

They definitely care almost solely about whatever the hospital administrators care about. But, that is likely true of every successful contract holder (SDG or otherwise).

As far as the pay goes, I can't find anybody to give me any actual evidence that it doesn't line up with partner pay at a SDG. The party line on SDN is that CMGs will pay you far less than partner pay at a SDG. Nobody seems to have the numbers to back it up. Every SDG I've looked at (n=4) had roughly equivalent pay (+/- $5/hr) for partners after you did the buy in or sweat equity. I've asked folks to put up the $/RVU they're seeing at SDGs and only got anecdotal replies of "much higher than the CMGs." No one either knows the $/RVU of their "open book" group or they won't say.

I don't personally think CMGs are great for EM but I don't think it has to do with them "stealing our money." I just rather see SDGs where partners have due process, stay as part of a community, and have open books.
 
. They don't make any bones about it. They 'd be happy to pay me $5 an hour if they could.

Why so much? Hurry up and delete this post, because that's 5 times more than $1 per hour.
 
I think TH is the worst of the worst, due to the stockholders. When they bought the group with which I was working (which was already big), the word was pay would go up. It didn't. TH is the devil, and, well, I guess, the better the devil you know, but, screw them. If you are geographically limited, well, that's what you get - if you were going to work there, you were, so what we say doesn't even matter.
 
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I hope you weren't expecting to come on here and find a lot of love for Team Health.

I was trained to hate Team Health as the devil. When you go to ACEP people make a point to use different lanyards that don't have the TH name on it and it's "cool" to bash them. I bought into this completely during residency. I figured anybody who didn't work for a SDG was a fool or had little options.

This definitely limited my first job search and is a little humorous looking back. During my first job search I looked at 3 SDGs and wasn't super happy with one aspect or another of them (location, buy in, compensation, set up, consultants, happiness level, etc). I ended up looking at a TH job in an area I liked and while it wasn't perfect, it was more perfect for me than the other jobs. But, I thought I was about to sell my soul to the devil.

Everybody has bad things to say. I started to realize that it fell into a few categories:

1. 2nd hand knowledge - "my buddy said his cousin got screwed over real bad by them" I didn't find that many people with actual first hand complaints - maybe they'll post up here. Everybody who I talked to was neutral to positive. I decided I wasn't going to base my decision on what was essentially gossip.

2. Contract takeover chaos - I did hear a fair bit of first hand stuff about these situations. I definitely think CMGs promote this environment at the complete expense of the physicians and patients. This sucks, but it wasn't the situation I was looking at. Honestly, I was more worried about this at one of the SDGs I was looking at that looked like they might lose the contract. It'd probably be more of something to worry about if I wasn't with TH.

3. Small contracts in the middle of nowhere being staffed by travelers - I don't personally care for this model either, but it wasn't the situation I was looking at.

4. They have a bunch of non BC/BE docs working for them - this is probably true at the smaller sites. At the ones I've been at they're all BC/BE or >50 yo and have tons to teach me.

5. Their contracts are one sided - this is as true for TH as every single other CMG. Show me a CMG contract without waiver of due process. I hate this part more than any other, but I think this is as much our fault as theirs. If all of us refused to sign contracts without due process the market would force them to change. What they pay you and how they treat you is driven by supply and demand. Luckily, there's a fair bit of demand and its darn hard to get BC docs to some of these sites. Once they get you, if you are decent, they will try hard to keep you.

In the end, I decided a perfect SDG was better than any CMG. Find me a perfect SDG somewhere I want to live and I'm in. I'm guessing yours isn't perfect or you wouldn't be looking. A bad contract with any CMG or SDG is just bad on all levels. I ended up taking a job with Team Health at a location I like a lot and have been happy. None of the jobs I've had has been perfect but I still talk to my friends in private groups and academics (and I work a few shifts a month for a smaller CMG) and I don't think the grass is really greener at any of these places (or mine).

My main point is: Don't let 2nd hand complaints or things that don't apply to your situation keep you from working for Team Health. Try to find people who have actual experience with TH (good or bad) to talk with. I'm sure some of the guys at the job you're looking at would be happy to talk with you (or PM me).

You could always tell TH you want to get credentialed and pick up a few shifts a month and see how it goes. Try that with a SDG.
 
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As a corollary, is it okay to go into one of these CMG's straight out of residency with nothing to compare it to? We're kind of unofficially told that Team Health and these other groups are the devil. A Team Health representative called me the other day to talk about options and honesty, it's the first time I'd considered going with one of those groups (Granted I'm very much in the early stages of thinking about the next step).
 
Hopefully some other folks will chime in.

If you find a job with a CMG that fits everything else that you want then you should consider it. I think it's totally reasonable to first look for an open book democratic group that is in a location you like and has the practice you want. If you don't find it, then consider CMGs. I don't say this because I think CMGs are all bad deals. I just think the ideal setting is a SDG with open books, no restrictive covenants and due process (no clause that says you can be fired without notice if a hospital administrator asks).

That being said, you also want to try to go somewhere with enough acuity, peds, leadership options, equitable scheduling for non partners, good pay and a good location. I'd put SDG vs CMG at the end of that list in terms of importance.

I'd start asking people specifically why they think CMGs are the devil.

I thought this book from EMRA was helpful in comparing jobs early on:
Career Planning Guide for Emergency Medicine, 2nd Edition (2007)
by Gus M. Garmel, MD, FACEP
http://www.emra.org/publications/books/
 
I didn't find that many people with actual first hand complaints - maybe they'll post up here. Everybody who I talked to was neutral to positive. I decided I wasn't going to base my decision on what was essentially gossip.

Right above you, I DID post. I guess I wasn't clear enough with my first hand complaints. I don't want to post up the personal details, though, because I can't tell the horror stories without divulging that. I experienced it - it's not "essentially gossip".
 
Appollyon, I don't want you to think I didn't see it before I posted, I did.

I just don't think "the pay was supposed to go up and it didn't" qualifies as "TH is the devil"

I think it just falls more in the #2 category - contract takeover chaos. I'm sure there's some other things left unsaid about what happened when they took over. I haven't meet anyone whose group was taken over by ANY CMG who didn't have legitimate complaints about the CMG or the transition process. I'm not trying to belittle your very real, and very sucky experience as "essentially gossip" at all. I think it sucks every time a physician group loses their contracts for things that almost universally have nothing to do with patient care. As I mentioned, I do think the CMGs are the main driver in contract takeovers and our resultant job insecurity. Nonetheless, he is at equal or more risk for having "contract takeover chaos" if he stays where he is.

I'm not trying to be a cheerleader for any of the CMGs. I'm just trying to get the OP to separate the real concerns about CMGs from what is fed to most of us (at least me) from our peers. Blindly taking these complaints as unequivocal fact limited my first job search. Those "unequivocal facts" didn't turn out to be true for me. The OP is not happy in his SDG, I'm just trying topoint out that there's a bunch of docs working for TH who don't all think they're the devil.

I am not pro-CMG. I just didn't find the party line of "any SDG is better than Team Health" to be true in my situation. People get reputations for reasons, they may be overblown but there's usually some facts there. That being said, people get mad at old employers in almost any field. We have to be able to look at it as objectively as possible to try to make the right decisions for each of us.
 
thanks for the replies. my current gig is not a sdg. in my area either you work for a private group owned by a few or are a hospital employee. One of the reasons I'm not happy is the incentive pay has been dramatically decreased because 'our collections are down" Team health is offering a healthy wage and I want to make sure they aren't doing a bait and switch. If the pay was the same I probably would not switch. My current job is tolerable, just not great.
 
I've had 3 TH gigs. They have always done what they said they would.

You can expect them to act like a for profit, publicly owned business. They don't make any bones about it. They 'd be happy to pay me $5 an hour if they could. Conversely, I'd have no guilt taking $1,000 an hour from them if I could. Honestly, I find it a little comforting. There's no pretension of "we're a family, we'll look out for you even if it means losing the contract, etc." It's simply a mutually beneficial relationship.

They definitely care almost solely about whatever the hospital administrators care about. But, that is likely true of every successful contract holder (SDG or otherwise).

As far as the pay goes, I can't find anybody to give me any actual evidence that it doesn't line up with partner pay at a SDG. The party line on SDN is that CMGs will pay you far less than partner pay at a SDG. Nobody seems to have the numbers to back it up. Every SDG I've looked at (n=4) had roughly equivalent pay (+/- $5/hr) for partners after you did the buy in or sweat equity. I've asked folks to put up the $/RVU they're seeing at SDGs and only got anecdotal replies of "much higher than the CMGs." No one either knows the $/RVU of their "open book" group or they won't say.

I don't personally think CMGs are great for EM but I don't think it has to do with them "stealing our money." I just rather see SDGs where partners have due process, stay as part of a community, and have open books.
Do you believe that TH pays similar to SDGs? If you do you have been brainwashed. I wont come on here and tell you what I make. but.. look at the stern salary survey. Oh an I can tell you if TH pays you $200/hr or the most I heard for a CMG at a steady rate is $235/hr. I know guys at groups here in town where the non-partner CMG pay is in the 160-200 range. Every group I know the partners are making a minimum of 25% more with benefits.

Oh and when it comes to getting what you can from the CMGs I worked for them briefly.. I milked them for all I could.
 
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Simply put I am of the opinion that you have to understand what you are getting into and why. For me I really needed a SDG. A CMG is little more than a parasite. Now a poorly run or unequal SDG can be similar. From speaking to people there are MANY poorly run SDGs out there. I think this is due to physicians having poor business sense.

When groups are forced to sign contracts docs get screwed hard. The insurance companies are a ruthless lot and docs often dont bargain hard or come from positions where they can not bargain effectively.

In the end I dont believe the CMG is good for EM. I also dont think having to complain to some regional manager who hasnt worked a shift in 7 years is a great way for me to enjoy my career. If you want to not be involved and "just punch the clock" the CMG might be the best option. If you do a bunch of extra work for the CMG and arent getting comped my opinion is that you are a complete and utter fool. (and im not saying anyone on here is)
 
What is a partner level hourly rate with and without benefits?
 
What is a partner level hourly rate with and without benefits?


That is very hard to say as many groups pay bonuses that account for large portion of income. When you break these down over the year by hour it's a crap ton more than any CMG offer I have entertained, aside from TH's west region "special ops" rate


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Do you believe that TH pays similar to SDGs? If you do you have been brainwashed. I wont come on here and tell you what I make. but.. look at the stern salary survey. Oh an I can tell you if TH pays you $200/hr or the most I heard for a CMG at a steady rate is $235/hr. I know guys at groups here in town where the non-partner CMG pay is in the 160-200 range. Every group I know the partners are making a minimum of 25% more with benefits.

That is very hard to say as many groups pay bonuses that account for large portion of income. When you break these down over the year by hour it's a crap ton more than any CMG offer I have entertained, aside from TH's west region "special ops" rate

We clearly have had different experiences. I doubt either of us are brainwashed, but objective data is the only way to really answer this. This question of CMG vs SDG pay is very important to me as I was told I'd be giving up tons of money if I went with the CMGs. So I've spent a lot of time looking at it with objective data.

Ectopic, you and trumpet both gave the typical response, which is CMG pay a "crap ton" less. Sounds like you've based that on your experience. I think that's fair. But, I've looked at 4 offers from SDGs and each of them had pay +/- 5 dollars/hr from my lowest paying CMG job. The funny thing is, each of them said "you'll make tons more as a partner here than with any CMG." My experience is different than yours or theirs. Maybe rather than say that all SDGs pay way more than CMGs, we should just say that some pay more than others.

I do pay close attention to the Stern survey. For this year the 10th percentile was $120/hr (240k/yr) and 90th was $240/hr (500k/yr). The 50th percentile was $185/hr (313k/yr) for SDG partners and $200/hr (352k/yr) for CMG independent contractors. In other words Ectopic, the objective data from Sterns isn't consistent with your experience. The CMG folks made MORE than the SDG partners. Of course, after you count benefits they're possibly equal to less, but not by tons. I can tell you that I've never made less than the 50th percentile and am above the 75th percentile. I'm not a traveler and don't have admin duties.

Are you saying that the SDG guys in your group make 25% more than $235 an hour and get benefits? That would be $280 an hour plus benefits. Sounds awesome.

Trumpet, I don't think this question is that hard to answer. Anybody who has looked at a IC job vs Employee (of SDG or Hospital) has had to do this calculation. You just have to add up all the benefits (including average partner bonus) to your expected other pay per year and divide by your expected hours. You then have apples and apples. Dental and Health insurance isn't hard to estimate, go to ehealthinsurance.com and they give you a quote. Everything else usually has an easily defined value (401k, CME, etc).

The very best way to answer this (ie the question of overhead) is to look at your groups $/RVU collected and then look at what you make per RVU. The difference would be the overhead. Every group is essentially compensated solely on RVU's collected (unless there's a stipend). I have yet to met a SDG person who has these numbers despite being in an "open book" group. It'd be the best way to answer this question. I couldn't tell you my groups $/RVU collected bc no CMG would ever tell me this. But, if I knew a similar groups $/RVU I could probably estimate whether CMGs are making a ton of money from me or not.

I've looked up the profits from some of these publicly traded companies and divided by the number of physicians to get a rough idea of profit. The numbers I got were between 5k-30k per physician per year. This is just the profit, so the overhead is higher (VPs, parties, recruitment). That's definitely more of my check than I'd like to give up but I suspect half of that is money they've made by economy of scale that's not available to SDGs (cheaper malpractice insurance, better billing capture, etc). Most of them also have PAs, anesthesia, hospitalist and urgent care docs they're profiting from that make up some of this number. Maybe this is just something I tell myself to feel better. But if it's true, and they're making an extra 2.5k-15k off me and I have little responsibility to them and no sweat or financial buy in - that seems pretty fair.

If I'm presenting a BS argument and being brainwashed, please tell me. I definitely want to know (no sarcasm meant here at all). People are able to rationalize all kinds of things. I don't think I'm doing so. I will say I've paid closer attention to this thread than most others in my 14 years lurking here. I don't know if I have a chip on my shoulder about it, or was just so surprised to find out something I took as fact wasn't true. I don't care strongly about how much I make but I definitely care if what I'm making is fair compared to my peers. As hard as we've worked, the last thing I want is to let someone not seeing patients siphon off my earnings.
 
We clearly have had different experiences. I doubt either of us are brainwashed, but objective data is the only way to really answer this. This question of CMG vs SDG pay is very important to me as I was told I'd be giving up tons of money if I went with the CMGs. So I've spent a lot of time looking at it with objective data.

Ectopic, you and trumpet both gave the typical response, which is CMG pay a "crap ton" less. Sounds like you've based that on your experience. I think that's fair. But, I've looked at 4 offers from SDGs and each of them had pay +/- 5 dollars/hr from my lowest paying CMG job. The funny thing is, each of them said "you'll make tons more as a partner here than with any CMG." My experience is different than yours or theirs. Maybe rather than say that all SDGs pay way more than CMGs, we should just say that some pay more than others.

I do pay close attention to the Stern survey. For this year the 10th percentile was $120/hr (240k/yr) and 90th was $240/hr (500k/yr). The 50th percentile was $185/hr (313k/yr) for SDG partners and $200/hr (352k/yr) for CMG independent contractors. In other words Ectopic, the objective data from Sterns isn't consistent with your experience. The CMG folks made MORE than the SDG partners. Of course, after you count benefits they're possibly equal to less, but not by tons. I can tell you that I've never made less than the 50th percentile and am above the 75th percentile. I'm not a traveler and don't have admin duties.

Are you saying that the SDG guys in your group make 25% more than $235 an hour and get benefits? That would be $280 an hour plus benefits. Sounds awesome.

Trumpet, I don't think this question is that hard to answer. Anybody who has looked at a IC job vs Employee (of SDG or Hospital) has had to do this calculation. You just have to add up all the benefits (including average partner bonus) to your expected other pay per year and divide by your expected hours. You then have apples and apples. Dental and Health insurance isn't hard to estimate, go to ehealthinsurance.com and they give you a quote. Everything else usually has an easily defined value (401k, CME, etc).

The very best way to answer this (ie the question of overhead) is to look at your groups $/RVU collected and then look at what you make per RVU. The difference would be the overhead. Every group is essentially compensated solely on RVU's collected (unless there's a stipend). I have yet to met a SDG person who has these numbers despite being in an "open book" group. It'd be the best way to answer this question. I couldn't tell you my groups $/RVU collected bc no CMG would ever tell me this. But, if I knew a similar groups $/RVU I could probably estimate whether CMGs are making a ton of money from me or not.

I've looked up the profits from some of these publicly traded companies and divided by the number of physicians to get a rough idea of profit. The numbers I got were between 5k-30k per physician per year. This is just the profit, so the overhead is higher (VPs, parties, recruitment). That's definitely more of my check than I'd like to give up but I suspect half of that is money they've made by economy of scale that's not available to SDGs (cheaper malpractice insurance, better billing capture, etc). Most of them also have PAs, anesthesia, hospitalist and urgent care docs they're profiting from that make up some of this number. Maybe this is just something I tell myself to feel better. But if it's true, and they're making an extra 2.5k-15k off me and I have little responsibility to them and no sweat or financial buy in - that seems pretty fair.

If I'm presenting a BS argument and being brainwashed, please tell me. I definitely want to know (no sarcasm meant here at all). People are able to rationalize all kinds of things. I don't think I'm doing so. I will say I've paid closer attention to this thread than most others in my 14 years lurking here. I don't know if I have a chip on my shoulder about it, or was just so surprised to find out something I took as fact wasn't true. I don't care strongly about how much I make but I definitely care if what I'm making is fair compared to my peers. As hard as we've worked, the last thing I want is to let someone not seeing patients siphon off my earnings.
The answer is typical because it is true. Your average SDG pays more than the avg CMG. Not every SDG pays better. I interviewed at one and I was appalled at how low their pay was. My conclusion was that they were poorly run.

Now regarding your premise based on pay I will use my groups demographics as an example. We have a slew of docs who are older, they barely work so their annual income is lower as such. Now I think you have to look at hourly wage which is all that matters because annual salary depends on hours and as we all know they vary widely. In my SDG we have guys who work literally almost 2x as many hours as others.

Also not everyone who works at a CMG is an IC (keep in mind increased costs of being an IC) but some are employees. This may not be true in your part of the US but here in the southwest we have both models.

As such... lets look toward the higher end and compare to say an average of the employed doc and the IC doc. at the 90th %ile the partner is making $300/hr the employed doc is making 225 and the IC is at 258.

at the 75th% the employee is at 200 the IC at 235 and the partner at 230. The IC has increased costs which put them below the 230 (medicare and SS paying both sides). At the 50th, 25th and 10th the delta between the avg of non-partner docs and partners is pretty equal.

you said "Are you saying that the SDG guys in your group make 25% more than $235 an hour and get benefits? That would be $280 an hour plus benefits. Sounds awesome." It is awesome. I can also tell you that I know of partners in 4 other separate groups in town that do the same.

You also said " I have yet to met a SDG person who has these numbers despite being in an "open book" group.". We havent met but I have stupidly detailed numbers from my group going back 3 years including how much I billed per month for those years.. Same for every other person in my group.

Regarding profit you are way way low. http://finance.yahoo.com/q/is?s=tmh

in Q1 2014 their gross profit was 120M. They say they have 9,000 FT employees per yahoo finance. Many of these are not docs and are PAs, admin etc but thats 13K for the quarter. for 2013 their gross profit was 441.5M. so just under 50k per. I dont know nor will I scour the internet to find out if the 9k is right but it seems pretty close.

I believe the 50k per number. It makes sense.

Im not here trumpeting the CMG or SDG but maybe the jobs you looked at werent well run shops or had some other issue as to why the comp wasnt good but its obvious TH is profiting off of you which is fine as long as you accept that as fact.
 
Pretty solid response Ectopic, thanks.

I think you're saying that the reason the Stern average for Independent contractors is higher than the average for Employee partners is that the employee partner category includes some people who work for CMGs as employees or are employed by hospitals. That seems pretty reasonable.

I'll eat my previous words and go ahead and say it: The SDG partners in your area make a crap ton more money than the CMG (or SDG) guys in my area. That type of difference in pay would likely fix any buy-in after 5 years. It also sounds like the CMG guys don't do very well over there (CMG guys here make a crap ton more than them). If I lived where you lived and had the choice between more money, more say so, open books, and due process it would be a no brainer. Heck, I'm happy where I am in terms of job and location but that would almost be a situation worth moving for. Congrats, seriously.

There's definitely part of me that wants to argue that the guys in your town are in the top 1% and it doesn't have anything to do with CMG vs SDG. But, I think your experience is probably better data the the Stern survey. 4 groups is 50-200 docs. That's a lot to consider them an outlier. I don't know anybody making that kind of hourly. I looked across three states and I think most people in my area would consider the SDGs I got offers from to be of high quality (although 1 definitely had some financial burdens of hospital expansion into other rural hospitals and lost some money staffing those).

Ectopic, I'll press you a little more to try to figure out what your groups overhead is. You don't have to post it here, you can send me a PM. If you can figure out what your groups $/RVU collected and $/RVU paid is I'll happily buy you a drink at ACEP or something.

For anyone who thinks this stuff doesn't matter or we shouldn't talk about compensation, I strongly disagree. The more we can inform each other, the more power we have as a group and the less power CMGs and privately owned small groups have. Their entire profit is in the difference between what we expect to be paid and what they collect. The less we know about others pay, the more we give away. Also, the more SDGs know about each others structure the better they can all run. I certainly didn't find any SDGs who could beat the CMG pay in my area. Why is that? Maybe they should be talking to SDGs in Ectopics town to try to figure out where they're dropping the ball. If a CMG can pay more and turn a profit than a SDG than there's some room for improvement.
 
I don't have a tremendous amount of insight but saw all the books for a SDG I almost went with last year before deciding to go with a CMG. The pay about $20-$30/hr more with the CMG though it's difficult to make a statement about annual income because of the profit sharing component of most SDG models. There were also more benefits with the SDG which probably equalled out the pay with the CMG. Personally, I'm not set on staying in a certain area long term at this stage in my life and enjoy my potential mobility which makes CMG much more attractive. SDG would be my preferred model once I figure out where I want to live long term. Most SDGs have enough strings attached, especially after partnership that make it difficult to leave. Which is...of course, the point.
 
If you take a hospital and replace replace a CMG with a Democratic group, your total compensation will go up at least 25%. That's reality. That would be going from $200 up to $250 per hour (we can all do the math, but at 30 hours per week, that is $75000 per year). If you are a doc who is aggressive about seeing patients and wants to see more patients, your pay will go up significantly more with a democratic group (since everyone more or less makes the same working for a CMG, but democratic groups usually reward productivity much better). I was in an eat what you kill group in an area with a slightly below average payer mix, and I made $350/hr. I moved for my wife's work (she finished fellowship) and to be closer to family to a one contract-holder group. Will make $300-350/hr. I expect EmCare to take the contract at some point (the longer the better obviously), and I expect my pay to plummet to $200/hr. If this job lasts 5 years (pre Emcare) I will hopefully gave made enough money that I'm ok to kick back and work my current hours and not worry about it. Almost like retiring to 1.7 patients per hour.
 
Interested to hear what peoples thoughts are on where hospital employed EM physicians would fit into this spectrum, assuming that these might generally be smaller-t0-medium sized community hospitals.
 
Pretty solid response Ectopic, thanks.

I think you're saying that the reason the Stern average for Independent contractors is higher than the average for Employee partners is that the employee partner category includes some people who work for CMGs as employees or are employed by hospitals. That seems pretty reasonable.

I'll eat my previous words and go ahead and say it: The SDG partners in your area make a crap ton more money than the CMG (or SDG) guys in my area. That type of difference in pay would likely fix any buy-in after 5 years. It also sounds like the CMG guys don't do very well over there (CMG guys here make a crap ton more than them). If I lived where you lived and had the choice between more money, more say so, open books, and due process it would be a no brainer. Heck, I'm happy where I am in terms of job and location but that would almost be a situation worth moving for. Congrats, seriously.

There's definitely part of me that wants to argue that the guys in your town are in the top 1% and it doesn't have anything to do with CMG vs SDG. But, I think your experience is probably better data the the Stern survey. 4 groups is 50-200 docs. That's a lot to consider them an outlier. I don't know anybody making that kind of hourly. I looked across three states and I think most people in my area would consider the SDGs I got offers from to be of high quality (although 1 definitely had some financial burdens of hospital expansion into other rural hospitals and lost some money staffing those).

Ectopic, I'll press you a little more to try to figure out what your groups overhead is. You don't have to post it here, you can send me a PM. If you can figure out what your groups $/RVU collected and $/RVU paid is I'll happily buy you a drink at ACEP or something.

For anyone who thinks this stuff doesn't matter or we shouldn't talk about compensation, I strongly disagree. The more we can inform each other, the more power we have as a group and the less power CMGs and privately owned small groups have. Their entire profit is in the difference between what we expect to be paid and what they collect. The less we know about others pay, the more we give away. Also, the more SDGs know about each others structure the better they can all run. I certainly didn't find any SDGs who could beat the CMG pay in my area. Why is that? Maybe they should be talking to SDGs in Ectopics town to try to figure out where they're dropping the ball. If a CMG can pay more and turn a profit than a SDG than there's some room for improvement.

Tell me what the CMG guys make where you are? That’s of course on an hourly basis. If someone works 2500 hours per yr I don’t care what their income is.

According to stern the numbers I am pitching overall are in the top 10%. The job market here is good. Partners do well and IMO deserve it.

FWIW the 4 groups are somewhere in the 150 doc range.

Lastly, regarding my group overhead. I know exactly what it is. Our costs are what we pay our admin folks and billing. Obviously malpractice and benefits. Our overhead is 15%. That means 85% of our income goes to our partners.

I can figure out our numbers. When I tell you I have the numbers I don’t mean some email with some data. I mean detailed excel files. I can tell not just $/RVU billed vs collected. I mean that data per payer per month plus % paid and how long our money is in AR.

Ill agree we should talk about this. It is sensitive though and as a whole people in all industries don’t talk about their pay.
 
I agree its sensitive, I won't be shocked if this whole thread ends up Birdstriked at some point. But for the time being, it is probably as useful or more than the Stern numbers and helps us help each other as a group rather than have the CMGs and private SGs benefit from our squeamishness.

CMG guys here make between 200 and 245/hr with most falling around $210. There's a few sites with good payer mix and productivity system where everybody is between 225 and 245/hr. The other ones really stay between 200 and 220/hr. This is malpractice and tail paid, nothing else. Most of them get a one time signing bonus that raises their pay 10-15 bucks an hour for one to two years. The travelers make 250-300/hr but I think pay for it in the end with time spent in the car/plane/hotel.

The SDGs I looked at all ended at around $220/hr once you made partner (this was using their average bonus from the previous year). They all had benefits worth about 60-70k for me. They all started out in the 130-170/hr range and had various paths to partnerships and penalties for leaving early (lose vestment in 401k or have to pay some portion of the tail). A few didn't have a mechanism for reducing hours in your 50's and on (not to mention nights). They all worked more hours than I wanted to be obligated to (140-150/month - I get there most months but am not required to break 120 and when I need a break I back down in picking up extra shifts). These were all in places I'd like to live as much or more than where I am now. Two of them had what looked like might be better practice fits for me in terms of acuity, peds, etc. For me, it wasn't worth it to work for a reduced rate for a few years with the hope of eventually making the same I make now. When I added in the benefits, it looked like I would make slightly more once a partner at a SDG but not by more than 10k/year (and after working 2 years at reduced rates).

I understand what you're saying about the numbers. There's not a reason for you to need to know $/RVU since you know overhead. For those of us who don't work in open book groups, this would be a useful number. We all know the CMGs are making money off of us - its a business and they wouldn't do it if it weren't profitable. The question is how much and is that worth the trade off. My guess is that you generate about 9-10 RVUs per hour and y'all collect 29.5/RVU and you get 28 after overhead. That would be a pretty substantial (15%) increase over most CMG $/RVU. I wouldn't be too upset over that, but if it turns out that your collecting $35/RVU I would feel slightly raped by my CMG.
 
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FWIW I have spoken to some of the midle to large CMG types. They are taking just under 30% as overhead. Thats not from 1 group or 2. There is some variability but those parties, recruiters, schedulers, middle managers, regional managers, VPs all cost money.. Oh and not a little bit. Plus a nice office, travel all add up. You are paying for that.

Take your income add 20% and thats at a minimum what you are giving up as compared to a decent SDG job. The ones by you might be poorly run.

Also, you have to keep 2 things in mind.. 1) Mid levels are not your friend when you work at a CMG. They are huge profit centers at SDGs. 2) The quality of your contracts with insurance companies makes a huge difference. CMGs contract at 100%, few if any SDGs do.
 
Just took a job with TeamHealth right out of residency. I guess I don't have much to compare it to, but its one of the highest paying groups in town (unless your partner somewhere), has great resources online, and the FMD's have been fantastic.
 
If you take a hospital and replace replace a CMG with a Democratic group, your total compensation will go up at least 25%. That's reality. That would be going from $200 up to $250 per hour (we can all do the math, but at 30 hours per week, that is $75000 per year). If you are a doc who is aggressive about seeing patients and wants to see more patients, your pay will go up significantly more with a democratic group (since everyone more or less makes the same working for a CMG, but democratic groups usually reward productivity much better). I was in an eat what you kill group in an area with a slightly below average payer mix, and I made $350/hr. I moved for my wife's work (she finished fellowship) and to be closer to family to a one contract-holder group. Will make $300-350/hr. I expect EmCare to take the contract at some point (the longer the better obviously), and I expect my pay to plummet to $200/hr. If this job lasts 5 years (pre Emcare) I will hopefully gave made enough money that I'm ok to kick back and work my current hours and not worry about it. Almost like retiring to 1.7 patients per hour.

Can you please tell me where I can make 300-350/hr? I have never even heard of such numbers. Is there something undesirable about the hospital or ED? I'm sure they are in less than popular places to live, though that's all up to the individual.
 
I was in middle tennessee. I'm moving to southern Louisiana, but I don't start until later this month. Honestly, I made even more than $350 when you factored in signing PAs charts and associate distribution (it was only a two year buy in). I had zero benefits, but I could have paid for them. My wife's fellowship took care of that. It was a great job, but I busted my ass working. I made an average of $146 per chart. At the end I was seeing over 2.5/hr, so those numbers went up. To be be fair, I averaged 23 patients per 8 hours shift, but stayed for an extra hour. Then I had to pay my own medmal (about $17/hr), but at least that was tax deductible.
 
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Can you please tell me where I can make 300-350/hr? I have never even heard of such numbers. Is there something undesirable about the hospital or ED? I'm sure they are in less than popular places to live, though that's all up to the individual.
Look at the job searches. These jobs come across me not infrequently. Look in Texas and NC.
 
I apologize for still being a bit vague. If you want to know the details of our shop PM me.

I have worked for two large CMGs and no where even close to what I make with the SDG as a partner.

To echo others, overhead is VERY small for us. Billing, and PAs. That's it. Each doc gets their own med mal, but it's a write of and dirt cheap in NE.

Our books are open and hilariously simple. :) we can all contact our billing co, who's rep we know as a friend pretty much, and get any metric we ask for on demand.


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Trumpet.. are you in NE.. meaning nebraska?
 
Yes. Sorry.


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I appreciate the PMs I got. I'll keep them confidential as requested. I'll say that there's more than a few folks who make significantly more than what I make at my CMG or at any of the SDGs I've seen. I'm not sure why the SDGs I looked at were equivalent in pay to the CMGs. What I've heard from folks is that this is not always the case and that there's some SDGs who keep considerably more of the revenue they generate and have considerably lower overhead. I know this has always been the generalization but the numbers I've experienced didn't fit that generalization. Having heard from enough folks with specific experiences, I'd say the generalization is true.
 
2 guys.. like you said. I mentinoed as well i got an offer from an SDG that paid what the local CMG paid. I think it is important to look around. I also believe that word of mouth is the best way to find these jobs. I know our SDG and some others dont tell applicants our partner compensation without using some ranges (i.e. we make the top x% of income in EM). This really limits those outside from looking at our group but we have been very successful when it comes to recruiting docs.
 
I've posted about our model before, but we're open-book, eat-what-you-kill, with no "buy in" to have access to your full billings.

We keep overheads well under 20%... I think well under 15% soon.

So, of course, how much you actually make depends on how many hours you do, how many patients you see, how well they reimburse, etc. However it feels very FAIR, which is important to me. You work your butt off on Christmas Eve seeing a bunch of sick people? You deserve the great great majority of your billings.
 
Has anyone been successful in negotiating a higher hourly rate then team health's initial rate offer?
 
I don't know of anyone that initially negotiated a higher hourly rate from TH. There are things that can be done to raise the hourly rate (locums, only-nights, etc) but in general what you're offered is what you're offered.
 
Look at the job searches. These jobs come across me not infrequently. Look in Texas and NC.

if anything pays that much in NC, it's not worth the money... in risk, questionable staff, etc.
 
if anything pays that much in NC, it's not worth the money... in risk, questionable staff, etc.
might be true but I had a friend who worked outside of charlotte. Found the job to be fine and manageable and that geroup made 380k. Not too bad.
 
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