- Joined
- Nov 27, 2002
- Messages
- 7,890
- Reaction score
- 752
A big question that faces each EM resident is what kind of job they want to get upon graduation. You'll likely hear a lot of talk about corporate EM groups vs. independent groups. What is this distinction all about?
Corporate groups are those that are managed by corporations as opposed to being run by the physicians in the group. EmCare is one of the prototypical corporate EM groups. Others include EPMG, Team Helth and the defunct PhyAmerica. EmCare is a large company that manages over 300 ER contracts. In other words >300 hospitals have agreements with EmCare to staff their ERs. It is based in Dallas but holds contracts in many states.
Independent groups exist all over the place. They are made up of a group of doctors who have formed some sort of partnership and staff ERs (usually a small number like one or two but sometimes more). Often there is one or a few primary contract holders and everyone else is technically a sub contractor. Most indie groups have members who are partners and others who are not, usually the newer guys.
So how do these types of groups really differ? Let's break it down along some specific areas:
Money
First and foremost the differences revolve around money. Indie groups bill for their services and everything they make that doesn't go to overhead (admin costs, billing costs, etc.) goes to the docs. Bear in mind that indie groups may not distribute this money evenly across the docs. For example the senior partners may take the lion's share.
With corporate groups the money from billing is collected by the corporation and then money is paid to the physician groups. The company takes more than just the cost of overhead and keeps it as profit. This profit is then distributed among stockholders in the corporation.
Finances
By this I mean the economic standing and practices of the group. Not just the compensation. With corporate groups you don't get to see the books. The company could be wasting money which affects what's left over for you (after they take their profits which don't tend to go down).
Indie groups usually open the books to the partners.
Malpractice
In general the corporate groups provide malpractice for their docs.
For indie groups some provide it and some don't. It's highly variable.
Autonomy
In a corporate group you can have some input at the local level but it's really difficult to have any serious pull at the corporate level. You are much more of a worker bee in a corporate group.
In an indie group, once you have achieved partner status, you have a voice in the decisions of the group. This is the reason for the frequently used term democratic group.
Administrative Responsibilities
Corporate groups have many of the admin areas handled for the local group. It makes it more likely that you can be free from any admin responsibilities if you want to.
Most indie groups require some admin work from their docs because they have to do it all locally. This usually takes the form of having to do CQI, EMS, compliance, utilization review and so on.
Buy In
Most indie groups require new docs to buy into the group with cash or with lower pay and crappy hours for some length of time. The length of time and general pain of the buy in vary dramatically from group to group. Once you achieve partner status then you often become eligible for the profit sharing in the group.
Corporate groups don't do this as much. Some do to some degree but as a rule not as much as the indies.
So what about AAEM and their strong anti-corporate EM stance?
AAEM has some very good points. They argue that it is morally and ethically wrong for any EP to have their fees taken by a corporation and paid to stockholders. They argue that all docs should get all of their fees less overhead and have full access to their books. They also are rabidly opposed to the anticompetitive clauses put into contracts by the corporate groups. The frequently said things like if you leave the group you can't work within 100 miles of the contract site for 2 years.
Disclaimer: I work for EmCare. In general I like it but you've got to understand what you give up by working for a corporate group. My feeling is that corporate groups are not evil, they're just different with a whole set of plusses and minuses.
Corporate groups are those that are managed by corporations as opposed to being run by the physicians in the group. EmCare is one of the prototypical corporate EM groups. Others include EPMG, Team Helth and the defunct PhyAmerica. EmCare is a large company that manages over 300 ER contracts. In other words >300 hospitals have agreements with EmCare to staff their ERs. It is based in Dallas but holds contracts in many states.
Independent groups exist all over the place. They are made up of a group of doctors who have formed some sort of partnership and staff ERs (usually a small number like one or two but sometimes more). Often there is one or a few primary contract holders and everyone else is technically a sub contractor. Most indie groups have members who are partners and others who are not, usually the newer guys.
So how do these types of groups really differ? Let's break it down along some specific areas:
Money
First and foremost the differences revolve around money. Indie groups bill for their services and everything they make that doesn't go to overhead (admin costs, billing costs, etc.) goes to the docs. Bear in mind that indie groups may not distribute this money evenly across the docs. For example the senior partners may take the lion's share.
With corporate groups the money from billing is collected by the corporation and then money is paid to the physician groups. The company takes more than just the cost of overhead and keeps it as profit. This profit is then distributed among stockholders in the corporation.
Finances
By this I mean the economic standing and practices of the group. Not just the compensation. With corporate groups you don't get to see the books. The company could be wasting money which affects what's left over for you (after they take their profits which don't tend to go down).
Indie groups usually open the books to the partners.
Malpractice
In general the corporate groups provide malpractice for their docs.
For indie groups some provide it and some don't. It's highly variable.
Autonomy
In a corporate group you can have some input at the local level but it's really difficult to have any serious pull at the corporate level. You are much more of a worker bee in a corporate group.
In an indie group, once you have achieved partner status, you have a voice in the decisions of the group. This is the reason for the frequently used term democratic group.
Administrative Responsibilities
Corporate groups have many of the admin areas handled for the local group. It makes it more likely that you can be free from any admin responsibilities if you want to.
Most indie groups require some admin work from their docs because they have to do it all locally. This usually takes the form of having to do CQI, EMS, compliance, utilization review and so on.
Buy In
Most indie groups require new docs to buy into the group with cash or with lower pay and crappy hours for some length of time. The length of time and general pain of the buy in vary dramatically from group to group. Once you achieve partner status then you often become eligible for the profit sharing in the group.
Corporate groups don't do this as much. Some do to some degree but as a rule not as much as the indies.
So what about AAEM and their strong anti-corporate EM stance?
AAEM has some very good points. They argue that it is morally and ethically wrong for any EP to have their fees taken by a corporation and paid to stockholders. They argue that all docs should get all of their fees less overhead and have full access to their books. They also are rabidly opposed to the anticompetitive clauses put into contracts by the corporate groups. The frequently said things like if you leave the group you can't work within 100 miles of the contract site for 2 years.
Disclaimer: I work for EmCare. In general I like it but you've got to understand what you give up by working for a corporate group. My feeling is that corporate groups are not evil, they're just different with a whole set of plusses and minuses.
