Why are we not discussing this? CMGs gobbling up SDGs

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Send me that lead for Hawaii, lol. That's awesome for Hawaii, last time I checked there it was something atrocious along the lines of $120/hr though that was a few years back. If I had all my loans paid off and a bit more in retirement, I'd probably consider working there for $200/hr.
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Alvarez13 said:
I've signed on with a midwest SDG and will start July. Like the people and nice big city, 135 hrs/mo. With all the benefits (CME, disability, health, etc) and everything combined it's $235/hr year 1, $265/hr year 2, and $285/hr year 3 when you're a full partner. The hourly is like $140 but when you add the bonus and 401k it's like $210/hr for the new guys and then the bonus ramps up. I thought this was pretty good, but you guys are making me feel self conscious. I've worked so hard this last year, just don't want to get screwed.
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You're making more than my group would pay you as a pre-partner. The key is the people. Get in with the right people. Then every other issue can usually be fixed, including contract threats.
 
The White Coat Investor said:
You're making more than my group would pay you as a pre-partner. The key is the people. Get in with the right people. Then every other issue can usually be fixed, including contract threats.
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Usually being operative word. It's difficult for an SDG to rapidly ramp up coverage. With the temporal trend being merger of hospital systems and those systems having a preference for dealing with a single service line vendor for providers, I think more SDGs are at risk then think they are. Stable populations and geographic isolation slow this trend but don't seem to completely halt it.
 
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Dr.McNinja said:
I would love to see a benefits package that ends up at $100/hr.
$210/hr is nothing to shake a stick at. If you like the city, you'll be fine as long as the cost of living is ok.
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Our package, which I consider excellent, is equivalent to $45/hr. Not sure where they get the rest!
 
I doubt it's even close to $100/hr in benefits. 401k maxed out + health insurance + other various stuff including yearly CME and professional fees will only be in the $40-50/hr range. Also remember the less you work the more this $/hr will be and the more you work the less it will be per hour.
 
Remember they artificially bump up the value of the benefits. For example they might add $20hr for maternity leave. That doesnt matter if you have a penis. I am all for this but they use that sort of crap to inflate their numbers. The only benefits that matter are those you might tap.
 
From my perspective the only worthwhile benefits are health insurance and retirement plan where they match your contributions - these actually result in significant savings than if you were to fund them on your own. The rest is just fluff that most people don't use ...


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Siggy said:
Hospitalist work, pay wise, is a lot like EM, just a little lower. The places where everyone wants to live can absolutely suck (South Florida tends to be low to mid-200k with hospitalists seeing 25-30 patients/day). On the other hand, the 3rd years are getting offers to staff critical access hospitals in BFE for 300k+ for 1 week on (24/7), 3 weeks off.
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Dafuq? I mean that in 2 ways:

They get paid over 300k for working 1 week a month

and

They work for 168 hours straight ???
 
Brahnold Bloodaxe said:
Dafuq? I mean that in 2 ways:

They get paid over 300k for working 1 week a month

and

They work for 168 hours straight ???
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We're talking about tiny hospitals in the middle of nowhere. This isn't your 200 bed community hospital with 20-30 admits a day... but a 20 bed hospital that normally isn't close to being full.
 
Siggy said:
We're talking about tiny hospitals in the middle of nowhere. This isn't your 200 bed community hospital with 20-30 admits a day... but a 20 bed hospital that normally isn't close to being full.
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Sure, but it's still a mystery to me how someone can work seven 24hr shifts in a row. Do they sleep, shower, and do laundry at the hospital, as if on a submarine?

With that said, I'd jump at this kind of job. Starting a 3-week vacation every other week while still pulling north of $300k is ludicrous.
 
Brahnold Bloodaxe said:
Sure, but it's still a mystery to me how someone can work seven 24hr shifts in a row. Do they sleep, shower, and do laundry at the hospital, as if on a submarine?
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I'm not sure of the specifics. Of course in deals like this you can sleep during your down time. Also not all contracts require you to be physically at the hospital during the entire shift, so it might be that they can leave after a certain time provided they can be back at the hospital in X number of minutes (i.e. 30 minutes).
 
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Brahnold Bloodaxe said:
Sure, but it's still a mystery to me how someone can work seven 24hr shifts in a row. Do they sleep, shower, and do laundry at the hospital, as if on a submarine?

With that said, I'd jump at this kind of job. Starting a 3-week vacation every other week while still pulling north of $300k is ludicrous.
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The smaller critical access volume hospitals often have hospitalist at home at night unless they need to be there for something.
 
Brahnold Bloodaxe said:
Sure, but it's still a mystery to me how someone can work seven 24hr shifts in a row. Do they sleep, shower, and do laundry at the hospital, as if on a submarine?

With that said, I'd jump at this kind of job. Starting a 3-week vacation every other week while still pulling north of $300k is ludicrous.
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I had an opportunity (which I declined) to moonlight as a hospitalist at a place like this. It wasn't a full week, Thurs 5p-Mon 8a. Hospital owned house for my use 1 block from the hospital. Rural, 30 bed, critical access hospital that was usually half full or less and most of those were really SNF patients. No specialty support. 1 General Surgeon who was on call when he wanted to be. 90 minutes to the nearest other hospital of any size, 2.5h by ground to the nearest hospital that would accept anyone in transfer.

I don't remember what it paid (this was 7 or 8 years ago) but it was pretty good for the area at the time.
 
TooMuchResearch said:
The smaller critical access volume hospitals often have hospitalist at home at night unless they need to be there for something.
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That's tight. 300k for 1 week a month means you're making 25k a week for every week you actually work. Damn!
 
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If I were one of the old docs I would try and squeeze the new group for $500 an hour. To do something like that on 36 hours notice is insane.
 
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OccupyTheED said:
If I were one of the old docs I would try and squeeze the new group for $500 an hour. To do something like that on 36 hours notice is insane.
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I'm sure USACS has a group of firefighters who are credentialed already.

I'm more interested in the residency. I know this has happened before, but it seems pretty hard on the training program. The residents can't leave the hospital. They're employed by it. If the faculty can't work there clinically, they probably can still work as teachers. But I'm sure it's bizarro world over there.
 
OccupyTheED said:
If I were one of the old docs I would try and squeeze the new group for $500 an hour. To do something like that on 36 hours notice is insane.
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USACS will have enough docs willing to cover, then they'll offer the previous group a 30% pay cut to keep a sh*tty version of their old jobs.
 
TooMuchResearch said:
USACS will have enough docs willing to cover, then they'll offer the previous group a 30% pay cut to keep a sh*tty version of their old jobs.
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I'm sure you're right. But the sooner we all wise up, the sooner it'll become impossible for these CMG's to keep on pulling that kind of crap. Probably wishful thinking on my part though.
 
OccupyTheED said:
I'm sure you're right. But the sooner we all wise up, the sooner it'll become impossible for these CMG's to keep on pulling that kind of crap. Probably wishful thinking on my part though.
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Sooner we rise up.

But... what do we do?

Here are my choices for employment within a reasonable driving distance:

1. EmCare
2. TeamHealth
3. Locums (yeah, right)
4. Predatory SDG that I interviewed with with full knowledge of what they were doing to their "washouts". Homeboy about **** his pants when I dropped ThatDocs! name.
 
So once all of the EM groups are swallowed up, the corporations can pay EM physicians whatever they want right? Doesn't look good..
 
I was part of a group that gobbled up this year. Sucks big time. For anyone who feels like they're immune to this, well you're naive. I had no intention of starting my career with Walmart, but sure as hell is starting to feel like that.

While I'm not happy my group got bought out, it's 100 times better than them losing the contract and watching this BS go down. At least partners walked out with some serious money in their pockets. This summa group looks like they walked out with their thingies in their hands. I feel for those guys, and kudos to them for not taking the usacs offer. At least so far...

As long as stronger business minds rest at the helm of these companies, we will forever be losing out on these contracts.

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RustedFox said:
Sooner we rise up.

But... what do we do?

Here are my choices for employment within a reasonable driving distance:

1. EmCare
2. TeamHealth
3. Locums (yeah, right)
4. Predatory SDG that I interviewed with with full knowledge of what they were doing to their "washouts". Homeboy about **** his pants when I dropped ThatDocs! name.
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Exactly, it's only an option for many of they're willing to move and many are not.

Most of us don't live somewhere with multiple good SDGs and hospital employee jobs.
 
One realistic hope is for hospitals to start employing us directly. Not an amazing alternative, but at least it'd create more competition.


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Hospital employee jobs are out there but they don't pay well - so much for competition !


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bravotwozero said:
Hospital employee jobs are out there but they don't pay well - so much for competition !


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i get paid very fairly as a hospital based doc (280/hr) or so if you include benefits. it does exist -- certainly better than the $150 some of these cmg are paying

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RustedFox said:
Sooner we rise up.

But... what do we do?

Here are my choices for employment within a reasonable driving distance:

1. EmCare
2. TeamHealth
3. Locums (yeah, right)
4. Predatory SDG that I interviewed with with full knowledge of what they were doing to their "washouts". Homeboy about **** his pants when I dropped ThatDocs! name.
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Choices in my area are similar, + another CMG that I wont name (mainly because I only have awful things to say about them). Why the aversion to locums @RustedFox ? I'm considering doing it full time if my new SDG gig doesn't workout.
 
Dakota said:
I would like to be in a SDG, but am not sure I could tolerate the risk of loss of contract.
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Why are you afraid of that? Don't you know what happens when a contract is lost? You become a hospital or CMG employee. I mean it sucks, but it's not like you're out of a job. You're out of a business.
 
The White Coat Investor said:
Why are you afraid of that? Don't you know what happens when a contract is lost? You become a hospital or CMG employee. I mean it sucks, but it's not like you're out of a job. You're out of a business.
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Loss of thousands, potentially hundreds of thousands of dollars in income via sweat equity?


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For those of us lucky enough to have family flexibility and long term geographic certainty, finding a stable, non-predatory SDG filled with good people, good consultants, good pay and a short/fair pre-partnership track is a luxury that is worth striving for I think. For the rest of us who do not know where they will be living long-term or have familial obligations that tie them to a certain locale, CMGs may be the only option, and actually may be a very viable one at that. I don't think solutions like "just move to Texas (or another 0% tax state with a great malpractice environment and a severe physician shortage)" or "just find an amazing SDG" are practical for some of these individuals - I think they would do this if they could. If you don't know where you will be long term, you have no incentive to be a pre-partner and put in the sweat, just to move again and lose out on partnership benefits. Loss of contract is always a concern and it appears obvious from the above discussion that even stable, long-term contracts aren't as stable as we think. The CMG contracts I've seen tend to be fairly straightforward - I have a pretty clear idea of what's expected of me and I know what I can expect of them. Some of their opportunities are fairly lucrative - especially their travel team options which give people tied to one living location an opportunity to earn high pay and gain a fairly diverse breadth of experience if they are not comfortable with totally stepping out on their own into a pure locums set-up.
 
TooMuchResearch said:
That's a load of BS. I interviewed there are really liked the attendings, residents, and hospital.

I hope the hospital staff hate working with USACS so much they beg the Summa group to come back.

I'm sorry for the attendings and residents this affects.
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http://www.ohio.com/lifestyle/healt...a-health-system-emergency-room-plans-1.737312

I trained here and truly feel it is one of the underrated EM residencies out there, the attendings are fantastic and truly sad to see that these administrators do not care at all about education. It was one of the unique spots that as a resident exposed you to a democratic group and obviously unique that a democratic group actually had residents. At my current democratic group because of it. Tom Malone is the hospital CEO and penny pincher. I feel so bad for the residents.
 
Anyone else get the email blast from USACS about Summa? If not, here it is:


Two short days ago, US Acute Care Solutions (USACS) was asked to staff Summa Health, Akron, OH area, effective midnight Jan 1, 2017. Unfortunately contract negotiations with the current group broke down leaving the care of 180,000 patients in limbo. As you may have heard, USACS is a national physician-owned group based in Canton, Ohio and when a major local hospital system asked for help, we accepted. To care for patients is our first and foremost value.
We need your help to cover Physician and APP shifts at any of following facilities.
Akron City Hospital- 100,000 visits - Trauma Center
- EM Residency Training program - Akron, OH
Barberton Hospital - 41,000 visits - Barberton, OH
Medina Medical Center - 9,000 visits - Medina, OH
Wadsworth-Rittman Hospital - 10,000 visits - Wadsworth,OH
Green Emergency Department - 21,000 visits - Uniontown, OH
10, 12 & 24 hour shifts are available.
During this critical staffing period, the premium rate for physicians is $300 per hour and for Advanced Practice Providers the rate is $150 per hour.
Interested and want to learn more?
Email Darrin Grella [email protected] or call 330.416.9460 (mobile)
 
OccupyTheED said:
Choices in my area are similar, + another CMG that I wont name (mainly because I only have awful things to say about them). Why the aversion to locums @RustedFox ? I'm considering doing it full time if my new SDG gig doesn't workout.
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Locums won't work for me for several reasons.

1. I hate getting on an airplane. I hate airports. I hate people on airplanes. They smell. They're too fat for the seats. They bring children and animals that don't belong on an airplane. They bring their own smelly food on the plane. I see the sweaty 46 year old with the BMI of 38 in seat 11C gobbling down his McDonalds in his work travel attire and I think: "Good work on rethrombosing those LAD stents, homeboy." Last flight I was on, three screaming brats were dropping awful cabbage based ethnic food all over the place and grinding it into the carpet. My diaphragm hurt just breathing in that recirculated cabbagey air. No joke. It actually hurt. Some toy dog was barking. I love animals, but I wanted to strangle it. "Would you like two swallows of something to drink in an entirely inadequately small cup, sir? It will take me more time to locate the can and pour it than it will for you to drink it and hand me back the wasted plastic cup which won't be recycled." Maybe there's something wrong with me, but I really hate it. Locum'ers need to remember that travel time = work time as well.

2. I will argue that I am one of, if not the most, neurotic charters/documentationists on this forum. I will not tolerate a crappy EMR or order entry system. Paper T-sheets? Might as well ask me to sail the Mayflower back to England. I have all my macros and smartphrases and everything saved, nice and tight, right where I want them. I have most of the MLPs trained to not suck at charting, so when I have to read and sign their charts its not "BACK PAIN. PATIENT HAS TEH LULZ. KTHXBYE." I really, really, really hate (like Grinch-level hate) having to sign an MLP chart where I can't figure out what they were thinking. I won't sign it. I will track down the MLP and have them do it again. I leave my home hospital system and all of this is gone. Now I have to learn a whole new system that I will hate. This will raise my SBP by at least 20-30 points. The MLPs will invariably suck or be lazy, and I don't want to spend time training them. That's 20-30 more mmHg. Now I'm up to 160/90 territory. Do this with a new place every couple weeks? Not good for me.

3. I hate paperwork as much as I hate charting. Here, Dr. RustedFox; return these eleventy pages to us so you can get credentialed. I have to recredential at one of my local shops now. My oppositional defiance score is a 9/10 for this.


Full disclosure: I'm really not all that misanthropic in real life, though the part about the airplanes and tracking down MLPs to have them do it right is true.

I like my gig. 200/hour IC for a CMG. Sure, its on the low end - but the hospital, the patient mix, the location, the PPH, the metrics expectations, everything else about the job... is more than acceptable. Would I love to chase these 300-350 dollar/hour jobs? In theory, yeah - I'd love to get paid that much. In practice, I'm not nearly DIY enough to make it actually happen.
 
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namethatsmell said:
One realistic hope is for hospitals to start employing us directly. Not an amazing alternative, but at least it'd create more competition.


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I work in a hospital employed position. I couldn't imagine not doing this again.

Anyways, I woke up to an email from USACS offering 300/hr for the old Summa job
 
The summa thing needs its own thread. The fourth year Med students need to know about it and the ACGME needs to know about it. This is about the ultimate bait and switch on the poor intern class.
 
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Great to see USACS has to pony up dough to get doctors to work. Their obliviousness was what caused EMP to fail, and have to run to a venture capital company.

Still $300/hour wouldn't get me to Ohio, though it's great for the docs in that market as hopefully it will bring up salaries.
 
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