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My bad we can't own the hospital but still unfair
555 EM spots did not fill in Match
- Thread starter calvinhobbes
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You can own mpw or some other REIT at an incredible discount to book value and become the landlord of hundreds of hospitals instead.
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I looked at MPW years ago but stopped tracking it when it was in the 20s. Is hospital rent dropping thus income thus probably dividend cut?
I get higher interest and macro issues are down pressures but 70% drop seems out of the norm compared to other REITs.
I might jump in with an option play but what is causing this oversell? Obviously the dividends are not sustainable.
I get higher interest and macro issues are down pressures but 70% drop seems out of the norm compared to other REITs.
I might jump in with an option play but what is causing this oversell? Obviously the dividends are not sustainable.
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A few things has caused the recent drop.
1) macro situation with rate hikes, they currently have fixed rate debt averaging 3.5 percent. A lot of this will get refinanced at higher rates. 10-20 percent of their debt is due and will require refinancing in the next 2 years.
2) steward health which is their largest tenant, ~25 ish percent of revenue was struggling financially in some hospitals. Mpw has already dealt with these issues but having the largest tenant struggling to pay definitely caused massive downside. A lot of the hospitals where steward health was struggling have actually been taken over by spirit health which is a high quality tenant with a stronger credit rating, however the rental rate for spirit was lower than what steward was paying. So even though they brought on a higher quality tenant for the hospitals where the tenant was struggling, wallstreet didn’t like the few percentage drop in rent.
3) while management has been dealing with the above, one of their other top 3 tenants, prospect health really started to struggle financially as well. Last earnings they announced that they were letting prospect defer their rent for 12-18 months, and gave guidance of funds from operations ranging from a low end of 1.5 FFO to 1.65 ffo per share. The 1.5 low conservative end of guidance assumes that prospect pays $0 all year. It’s also a yoy decline of about 10 percent. So literally that number assumes that 11 percent of their portfolio, which is prospect health, makes 0 revenue. So wallstreet wasnt too happy about it. But they are actively resolving these issues too and have a pretty solid plan in place and anticipate to eventually recover all of their money including deferred rent. One part of the solution is through an already agreed upon sale where prospect sells their hospital operations to yale, and mpw sells the buildings to yale. It’s a 400 million dollar deal or something that’s already penciled and supposed to go through in summer. Regardless, this is another cause of drop.
4) lastly the stock has been heavily shorted >20 percent shorts right now. So essentially a bunch of people have sold stock that they don’t even own, increasing selling pressure, whenever there is a reversal, there will be significant buying from the shorts as well
Regardless, there is definitely a chance the dividend will drop, but financially they are actually more than able to cover the dividend from their funds of operation. Their current dividend yield is 15-16 percent and 1.16 per share, which their FFO and adjusted funds from operation more than covers that number. However, they may preserve cash flow by dropping dividend. This will create millions of excess cash which allows those funds to be used to pay down debt, or do stock buy backs, so essentially help the fundamentals of the business - so if they do drop dividend, it’s going to give the firm a lot of liquidity for doing what’s best for the business. So while the dividend is sustainable, the question is if they do something better with it - i mean they didn’t even drop their dividend in 2008 and paid 0.8 per share in a year then as well while the stock traded around 2-3 dollars a share (30-40 percent dividend lol).
Lastly the fact of the matter is they have 19B of real estate assets, 10 billion in debt. A book value of 9 billion. They are currently trading with a market cap of 4.5 ish billion, so 0.5 of book value. This is an incredible opportunity for a company that is regardless highly profitable, solid funds from operations, huge discount compared to peers, and has a 23 year record of managing tenant issues without major losses. They have gone through previous tenant bankruptcies and have squeezed their deferred rents out of these companies as a first in line creditor as a landlord. Plus they have some very well structured master leases that have even held up in courts during tenant bankruptcies
Full disclosure: i have sold 100 contracts for July expiration for $6 strike price. It’s a naked put requiring $250/contract as margin maintenance. So $25000 is my cash buying power being used to get $5800 premium in 4 months aka 23 percent return in 4 months on my cash. I will continue to sell premium on this and keep milking this fairly under valued opportunity. My worst case scenario is acquiring a company with real estate of 19 billion and a book value of 9 billion for $6 a share ($5.42 per share cost basis accounting for premium) which is essentially 3.5 billion market cap.
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This is the rate for EM now in FL. This is horrible.
Hi Dr. XXXXX,
FYI. The hourly rates are somewhat negotiable for several of the locations below, depending on experience etc.
Look forward to hearing from you! Full details and locations are listed below.
Emergency Medicine (Full-Time and Part-Time) Positions Available in Florida!!
Seeking Emergency Medicine Physicians to Staff Emergency Departments throughout Florida
Full-Time and Part-Time Openings Available!!
Physicians Must be Board Certified or Eligible:
ABEM or AOBEM certification/eligibility OR At least 2 years ER experience plus ABIM/AOBIM, or ABFM/ABOFM certification/eligibility.
ACLS/ATLS Required
1099 Status with covered malpractice with tail
The following locations are available for Full-Time or Part-Time. Please note that some hourly rates are negotiable and can be slightly higher than listed:
1) Tavernier, FL (Florida Keys) - Pay is $190/hour, ER Volume is 12000, 9 beds, Shifts: 7a-7p; 7p-7a, EMR is Cerner
1099 positions, Full-Time or Part-Time, FREE Lodging available
2) Lehigh Acres, FL (Ft. Myers) - Pay is $210/hour ($220/hour nights), ER Volume is 24000, 12 beds Shifts, 7a-7p; 7p-7a, EMR is Epic
1099 positions, Full-Time or Part-Time
3) Marianna, FL (FL Panhandle) - Pay is $200/hour, ER Volume is 25000, 17 beds, Shifts, 6a-6p; 6p-6a, EMR is Epower Doc
*Note, for Full-Time (10+ shifts/month) will be Hospital Employed W2 position with Full Benefits. Also, hospital has Sovereign Immunity. FREE Lodging near the Hospital if needed.
4) Arcadia, FL (rural South Florida) - Pay is $200/hour, ER Volume is 15000, 15 beds, Shifts, 7a-7p; 7p-7a, EMR is Meditech
1099 positions, Full-Time or Part-Time
5) Marathon, FL (Florida Keys, near Key West) - Pay is $190/hour, ER Volume is 10000, 11 beds, Shifts, 7a-7p; 7p-7a, EMR is Cerner
1099 positions, Full-Time or Part-Time, FREE Lodging available.
Thank you,
Jarrett Alman, President
Doctor's Choice Placement Services, Inc.
6640 NW 101 Terrace
Parkland, FL 33076
Phone: 954-825-0975
E-mail: [email protected]
Or: [email protected]
Website: www.doctorschoiceplacement.com
Hi Dr. XXXXX,
FYI. The hourly rates are somewhat negotiable for several of the locations below, depending on experience etc.
Look forward to hearing from you! Full details and locations are listed below.
Emergency Medicine (Full-Time and Part-Time) Positions Available in Florida!!
Seeking Emergency Medicine Physicians to Staff Emergency Departments throughout Florida
Full-Time and Part-Time Openings Available!!
Physicians Must be Board Certified or Eligible:
ABEM or AOBEM certification/eligibility OR At least 2 years ER experience plus ABIM/AOBIM, or ABFM/ABOFM certification/eligibility.
ACLS/ATLS Required
1099 Status with covered malpractice with tail
The following locations are available for Full-Time or Part-Time. Please note that some hourly rates are negotiable and can be slightly higher than listed:
1) Tavernier, FL (Florida Keys) - Pay is $190/hour, ER Volume is 12000, 9 beds, Shifts: 7a-7p; 7p-7a, EMR is Cerner
1099 positions, Full-Time or Part-Time, FREE Lodging available
2) Lehigh Acres, FL (Ft. Myers) - Pay is $210/hour ($220/hour nights), ER Volume is 24000, 12 beds Shifts, 7a-7p; 7p-7a, EMR is Epic
1099 positions, Full-Time or Part-Time
3) Marianna, FL (FL Panhandle) - Pay is $200/hour, ER Volume is 25000, 17 beds, Shifts, 6a-6p; 6p-6a, EMR is Epower Doc
*Note, for Full-Time (10+ shifts/month) will be Hospital Employed W2 position with Full Benefits. Also, hospital has Sovereign Immunity. FREE Lodging near the Hospital if needed.
4) Arcadia, FL (rural South Florida) - Pay is $200/hour, ER Volume is 15000, 15 beds, Shifts, 7a-7p; 7p-7a, EMR is Meditech
1099 positions, Full-Time or Part-Time
5) Marathon, FL (Florida Keys, near Key West) - Pay is $190/hour, ER Volume is 10000, 11 beds, Shifts, 7a-7p; 7p-7a, EMR is Cerner
1099 positions, Full-Time or Part-Time, FREE Lodging available.
Thank you,
Jarrett Alman, President
Doctor's Choice Placement Services, Inc.
6640 NW 101 Terrace
Parkland, FL 33076
Phone: 954-825-0975
E-mail: [email protected]
Or: [email protected]
Website: www.doctorschoiceplacement.com
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SW FL checking in.
That rate at Arcadia is actually UP from what it was last I checked.
I avg 240-250 at my shop.
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Idk man, I think several specialities are safe:
Neurosurgery, ENT, Urology, IR, GI, heme/onc, IC, plastic surgery, transplant surgery, and other specialized surgical fields.
There are academic centers now that are training NP/PA how to scope and do LHC.
Specialties that are surgical in nature are safe for now.
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Yeah I agree but these are very far and in between. Besides, there’s a lot more to cardiology and GI than these two routine procedures
You know that because you are a physician, but the bean counter does not care.
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what other GI procedures are there? Not every GI does ercp. It’s basically two major endoscopies. If you mean the cognitive side of GI, then they’re about as safe as any “cognitive” specialty.
Cardiology at least has the echo and ekg as a soft barrier against encroachment.
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Even NSG is sort of safe. The MLPs will do some of the work the physicians dont want to do. It might seem like a win but that means you now need 0.9 NSGs and not 1.0. So instead of 10 on staff you need 9.
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Ironically, I had considered cold calling these 2 hospitals in the past to find out who staffed their ED's. Would love to live in the Keys, but not at those rates. I wonder what the actual non-headhunter rate is?
The rate can be a little higher based on the email. You might want to talk to the recruiter if you are still interested. I probably talked to that recruiter lin 2021 when I ws hunting for hospital medicine gig and seems to be a reasonable person.
They’re both Baptist Health hospitals, which is a system that’s generally well run.
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IDK what it is currently, but those *were* the rates pre-covid for full time directly employed. Baptist famously (again, in early 2020) pays pretty crappy but benefits are great and the actual experience is as pleasant as one can ever hope for. It sucks to be a part timer there because they wont negotiate on the rate at all but will also not give benefits below a certain number of hours.
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250-270 in Miami, which just means these places are shortchanging you because Miami is *not* supposed to be where the big bucks are, the rural places are supposed to be where the money is.
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Some months have been over 300.
My shop is HIGHLY seasonal.
No snowbirds = radically less volume.
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yeah my place is still.... 66-75% hourly pay with the RVUs just being sort of dangled out there but not being a big enough chunk of income to change our final numbers much. Plus we function at full "always someone else to see" volumes probably 90% of day shifts and 66% of nightshifts. A bit less seasonal than your side of "america's dangling penis state"
This is surprisingly a good rate for Miami. Did you negotiate that rate 4+ years ago?
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Nope. We got a raise (to $250 flat rate) about 4 years ago and another (to the current) about 1 year ago. Only place I know that has consistently gotten *better* for docs since covid. We got to work extra shifts during covid because administration was terrified that the Miami Herald would plaster us on the front page as bodies piled up, so they okayed extra coverage.
Not sure if the powers that be knew switching us to a 70/30 flat rate/rvu system would be a raise, but it was.
That is remarkable. Envision was offering $75/hr plus their complicated RVU scheme as a hospitalist. I believe it was at Baptist if my memory serves me well.
I know EM rate is much higher than hospital medicine rate, but I did not expect for any place in Miami to have a rate of $200+/hr for EM.
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For years I’ve looked on and off a little further north in Broward and PB counties. I haven’t found any job sniffing 270/hour, it’s usually been ballpark of 220/hour. What’s unique about the Miami area?
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**** if I know. I always assumed everyone else was making $300 if I was making 250 then 260-270. It's only in the last year or two that I realized Miami breaks the "major cities get paid less" trend.
But as I wrote on a different post, baptist system doesn't count. They do pay poorly but with excellent benefits.
In the famous words of an IM doctor where I trained: "is the pay good? Yes. Do I like it? Yes. Would I quit immediately if they paid me even $1 less? Also yes."
$220/hr is not bad for Broward and Palm Beach counties. I actually thought rate in south FL was < 200. You guys make bank.
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Absolutely agree.
I’m pretty astounded at how quickly the train can go off the rails with regard to specialty saturation. When I applied to residency (IM) in 2013, EM was one of the hip/trendy specialties that was “becoming more competitive”. I remember people trying for EM at my school and not matching, and some of my classmates were really thinking they were red hot **** for matching EM. I remember some perception of EM being a “lifestyle specialty”, which never made sense to me given the neverending circadian rhythm changes and the like (when I did my month of EM as an IM resident I can remember feeling so zonked at the end of that month that it took months to recover - like even worse than an overnight call floor month. How do you guys manage to do this for years on end?). I can remember lots and lots of new EM residencies opening up to “meet demand”. Hell, I can remember EM docs on this very board talking **** about other specialties. I can definitely remember seeing folks on this board trash IM residents and hospitalists over and over.
Hell, rad onc, at the time, was tippy top in terms of competitiveness, up there with derm, neurosurgery, plastics, and the like.
My, how things have changed. EM is now experiencing a crisis on the level of what nephrology and (to a lesser extent) ID have been dealing with - massive numbers of unfilled positions, garbage training programs, etc etc. Now I come to this board and people are saying “for the love of god match IM/peds/FM” which is never something I would have expected to hear just a few years ago.
Right, and the worst part is that the glut can’t be corrected. The programs will fill anyways, there anre armies of IMGs/FMGs who will do anything for a spot.
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All programs will have the same fate but the very select painful few like NSG. So the hundreds of top EM candidates will look elsewhere to Rad, Anesth, etc. Pain always flows downhill and these other sought after specialities will be much more competititive.
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I made a post a year or two back.
The solution for EM is to become a fellowship for IM/FM - 2 years.
Or make EM all 4 year programs with dual cert in FM/EM right from the start.
This will allow an exit.
The solution for EM is to become a fellowship for IM/FM - 2 years.
Or make EM all 4 year programs with dual cert in FM/EM right from the start.
This will allow an exit.
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Any post in this thread not focused on how to shut down the recent influx of subpar residencies is a waste of time and best left for other threads.
EM is a legitimate, essential specialty. Far and away the primary reason we are in this mess is because of the insane rate of residency expansion. So, let’s focus on that.
EM is a legitimate, essential specialty. Far and away the primary reason we are in this mess is because of the insane rate of residency expansion. So, let’s focus on that.
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IM doesn't want more competitors for its own fellowships so EM was set up explicitly to avoid that path.
Ideal for us, but bad for IM folks. Easy to see both sides of it. I'd jump ship for cards or something if I could.
Ideal for us, but bad for IM folks. Easy to see both sides of it. I'd jump ship for cards or something if I could.
We are trying to have a system that makes sense and is fair for everyone. I am an internist and I don't care about turf war.
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Most internists would disagree with you on that.
If we want to break down all barriers to training and certification then ok whatever. Then IM should be allowed to do a 2 year fellowship in radiology or derm. And guess what rads or derm would say?
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When I was a resident, there was an IM guy who went to U Wash for med school. You know, where Harborview had every service for the ED, instead of just EM seeing the pts first. Well, this guy was vocal about MFing EM, and would say that there should be IM, surgery, peds, ob/gyn, and psych in the ED, all respectively seeing the pts that would go with their service (like they did where he came from). When asked who would pay for this redundancy, silence. But, since it was Duke, the egos were large and very well defined and developed. "It should be my way, because I thought of it!"
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You are probably right that these guys/gals would be against it. But I am ok to open the door for fellowships in some of these non-surgical specialties.
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Well then good thing it’s not up to you.
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Even with CC you usually need to go either the surgery or anesthesia route or a place that regularly takes EM graduates
EM can’t do pulm so that heavily limits your job opportunities
EM can’t do pulm so that heavily limits your job opportunities
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I agree with you. I’ve been saying this for over 10 years on SDN EM. Search SDN forums for the word “pigeonholed” by @Birdstrike . That’s what (nearly all) EM physicians are, unless they have a skill-stack that allows a lateral or superior exit. It’s a fatal, congenital flaw in the specialty design. It renders EM physicians nearly powerless other that the ability to vote with you feet or strike.
Add a skill that allows you to maintain your income outside of an Emergency Department, and you’ll feel reborn, bordering on immortal.
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Didn’t you say you were part of the process to get EM eligible for Pain board certification? What was the process like, and what sort of hurdles exist for newer fellowship paths?
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He posted about this. A series of letters.
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Yes I recall that, but wanted to hear it again at least in a concise manner. Also curious about his insights into other potential new fellowship paths for EM docs and why this hasn’t been done already? Was Pain unique because it already had multiple residencies feeding into it (anesthesia, PMR)?
He probably knows about the process in general better than any of us here. Curbing residency expansion is just one part of the EM problem. Fellowship opportunity expansion has significant potential long term benefits for the specialty, particularly with burn out.
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For example another low hanging fruit fellowship which comes to mind is Sleep. There’s already like half a dozen eligible residencies, why not EM? I hear the job market isn’t too hot but lifestyle is pristine, and it’s a step in the right direction overall.
We need more fellowship trailblazers like @Birdstrike. Hoping he can chime in with the how, what, when, why, etc. details to motivate others.
We need more fellowship trailblazers like @Birdstrike. Hoping he can chime in with the how, what, when, why, etc. details to motivate others.
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Agreed. Need trailblazers to create new fellowship paths..
There is no reason a EM doctor cannot learn FM, sleep, sports medicine, addiction medicine, lifestyle medicine, occupational med, stroke? (Every stroke patient seen by a neurologist is seen by an ER doc as well), geriatrics.
Our current fellowship options are so terrible other than pain, palliative, critical care and potentially toxicology. I mean what are you guys doing with an ultrasound or ems fellowship???? Most of the time you end up taking a lower paying university gig. There’s no value of these fellowships in community medicine - that’s how you know there’s really no real world application for these fellowships. These fellowship docs do exactly the same thing in the community as a non fellowship doc. What in this world is a simulation and administration fellowship. That’s just making up fellowships for cheap labor 🤣
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We have a bunch of fellowship trained docs in our non-academic democratic group. Some have a small amount of admin time related to their fellowship (i.e. US trained person does QI for our US studies. Or at least I think they do. Can't remember the last time I heard anything about it.)Agreed. Need trailblazers to create new fellowship paths..
There is no reason a EM doctor cannot learn FM, sleep, sports medicine, addiction medicine, lifestyle medicine, occupational med, stroke? (Every stroke patient seen by a neurologist is seen by an ER doc as well), geriatrics.
Our current fellowship options are so terrible other than pain, palliative, critical care and potentially toxicology. I mean what are you guys doing with an ultrasound or ems fellowship???? Most of the time you end up taking a lower paying university gig. There’s no value of these fellowships in community medicine - that’s how you know there’s really no real world application for these fellowships. These fellowship docs do exactly the same thing in the community as a non fellowship doc. What in this world is a simulation and administration fellowship. That’s just making up fellowships for cheap labor
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Wait what's lifestyle medicine?
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Mounjaro, adipex, wegovy, ozempic.
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