Admin jobs with Team Health

[brabbit2222]

Does anyone know the pay structure for medical directors at Team Health facilities, and assistant medical directors? Do they get paid a certain amount extra per month, in addition to whatever the make clinically, if the shop is RVU-based? Do they get benefits of any sort, like retirement?

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[southerndoc]

Yes. You get a monthly stipend. Ranges anywhere from $10k-25k for medical directors and $2k-10k for AMDs.

 

[Rekt]

Yes. You get a monthly stipend. Ranges anywhere from $10k-25k for medical directors and $2k-10k for AMDs.

Small price to pay for selling your soul and destroying the profession of emergency medicine.

 

[RustedFox]

My old director at my old shop got 15k a month to be director.

Of course, it meant that he had to work all the shifts that nobody else would or could work, or if they had a last minute call-off, or whatever.

He came to me one day and asked if I wanted to be the next director, couching the pitch in the fact that he "believed in term limits".

I laughed hard before I said: "M-me?! What's wrong with you? Ohhh, I'm the LAST person you asked. Lol."

 

[emergentmd]

I was underpaid 5 k/mo director and 2k/mo AMD for a 50kER

I’d be all over 25 k/mo

 

[Groove]

Admin is for chumps in most CMG gigs. I'd think long and hard before doing it. Apollo paid me 4K/mo as AMD and I thought that was worth it considering my only real obligations were the schedule, an occasional meeting and I was first up to fill any gaps in the schedule or last minute emergency shifts. I didn't like having to field all the last minute shifts but I liked having control over the schedule. I'm not sure what the FMD was getting paid, I thought it was around 16K for our 55K ED but I could be wrong.

TH in my area pays much less. They offered me an AMD position twice and I turned it down both times. It was $2500/mo which is completely not worth it to me.

CMGs tends to condition docs (especially new ones) to glamorize positions in leadership but it's really a dead end street unless you really enjoy administration and is the antithesis of what most ED docs were originally attracted to about the specialty. As FMD, you can never really turn your phone off. You are fielding calls all day long from docs, nursing, c-suite. Always at their beck and call. Always putting out fires. Always the one to blame for anything that went wrong in the ED. If you like no privacy, micro management and kissing ass to c-suite then go for it. Most of us got into this field because there was no call and we wanted to turn our phones off after each shift and go home. You can give up that dream if you go into administration.

I did about 7 years of AMD and I'll never do admin again.

The secret when you join a new group is to avoid the admin roles at all costs and don't be "that guy" that is always available to admin to fill last minute shifts. Don't answer the phone immediately if admin calls you because chances are...they've got a last minute emergency shift they are trying to fill and "you filled it last time" so they have you on speed dial. Wait about an hour or two before responding. That way, it's plausible that you were busy and didn't see the call and by that time....they've typically found someone else. Do that a few times and they won't call you immediately every time and put you in an awkward position to turn down a shift. They'll start calling the docs that answer right away as well as the ones that can't say "no".

Oh, and turn off “read receipt” on your phone or at least turn it off for all admin.

 

[Kryptocoin]

My site offered $3k and wasn't worth it at all. If you're gonna sell your soul, $25k seems like a good number to be a well-paid corporate fluffer.

 

[Angry Birds]

Small price to pay for selling your soul and destroying the profession of emergency medicine.

well, you get a nice fleece out of it too

 

[NYEMMED]

What is the typical sign on bonus for these jobs at TH?

 

[RustedFox]

What is the typical sign on bonus for these jobs at TH?

Bwah-hah-ha-ha

 

[sloh]

Admin is for chumps in most CMG gigs. I'd think long and hard before doing it. Apollo paid me 4K/mo as AMD and I thought that was worth it considering my only real obligations were the schedule, an occasional meeting and I was first up to fill any gaps in the schedule or last minute emergency shifts. I didn't like having to field all the last minute shifts but I liked having control over the schedule. I'm not sure what the FMD was getting paid, I thought it was around 16K for our 55K ED but I could be wrong.

TH in my area pays much less. They offered me an AMD position twice and I turned it down both times. It was $2500/mo which is completely not worth it to me.

CMGs tends to condition docs (especially new ones) to glamorize positions in leadership but it's really a dead end street unless you really enjoy administration and is the antithesis of what most ED docs were originally attracted to about the specialty. As FMD, you can never really turn your phone off. You are fielding calls all day long from docs, nursing, c-suite. Always at their beck and call. Always putting out fires. Always the one to blame for anything that went wrong in the ED. If you like no privacy, micro management and kissing ass to c-suite then go for it. Most of us got into this field because there was no call and we wanted to turn our phones off after each shift and go home. You can give up that dream if you go into administration.

I did about 7 years of AMD and I'll never do admin again.

The secret when you join a new group is to avoid the admin roles at all costs and don't be "that guy" that is always available to admin to fill last minute shifts. Don't answer the phone immediately if admin calls you because chances are...they've got a last minute emergency shift they are trying to fill and "you filled it last time" so they have you on speed dial. Wait about an hour or two before responding. That way, it's plausible that you were busy and didn't see the call and by that time....they've typically found someone else. Do that a few times and they won't call you immediately every time and put you in an awkward position to turn down a shift. They'll start calling the docs that answer right away as well as the ones that can't say "no".

Oh, and turn off “read receipt” on your phone or at least turn it off for all admin.

Cmoooon

“Be a team player!”

“All hands on deck!”

 

[southerndoc]

You can sell or soul or you can stand up for what you think is right. The choice is yours. You can be an AMD/MD and stand your ground. Not all of us are corporate sellouts.

 

[bravotwozero]

. You can be an AMD/MD and stand your ground. Not all of us are corporate sellouts.

No you can’t because they’ll just replace you with someone else.

 

[emergentmd]

Anyone who stays as MD FOR many years have sold their soul. They are not looking for someone to run an efficient/well like doctor group, they are looking for someone able to be the hated point person for admins whims.

They need someone who the docs will eventually dislike; but like enough to follow the rules.

But eventually you have to sell ur soul.

I did MD for 6 yrs of our private group without any issues , once TH took over the contract, I was out in 6 months. They knew I would not follow the rules or go to all the stupid useless meetings.

 

[hundreddaysoff]

No you can’t because they’ll just replace you with someone else.

My suspicion is that, like another EMS director I knew in residency, southerndoc is a bit different from us JAFERDs. He appears to have a special set of skills that make him especially valuable to his employer, and it gives him some headroom to be authentic. These skills also allow him to walk away from his ER gig if stuff got real and still make a nice living.

He may or may not realize this. I agree that this particular piece of advice of his does not apply to us JAFERDs, in my experience.

(I mean this with the utmost respect to him, of course. He has taught me many things in my time on here over... wow... almost 10 years now!)

 

[thegenius]

The secret when you join a new group is to avoid the admin roles at all costs and don't be "that guy" that is always available to admin to fill last minute shifts. Don't answer the phone immediately if admin calls you because chances are...they've got a last minute emergency shift they are trying to fill and "you filled it last time" so they have you on speed dial. Wait about an hour or two before responding. That way, it's plausible that you were busy and didn't see the call and by that time....they've typically found someone else. Do that a few times and they won't call you immediately every time and put you in an awkward position to turn down a shift. They'll start calling the docs that answer right away as well as the ones that can't say "no".

What about just drinking on your days off? We do it anyway! Maybe we should it more.

 

[Groove]

What about just drinking on your days off? We do it anyway! Maybe we should it more.

I like the way your brain works! 🍻🥃

 

[southerndoc]

No you can’t because they’ll just replace you with someone else.

At least I've stood my ground if that happens. I fight for what I believe in, not for a title or paycheck.

 

[alpinism]

Speaking of admin jobs I've noticed quite a few places have started hiring new residency grads straight into medical director positions.

For example a friend interviewed with a group recently where the actual director had just graduated within the past couple years.

 

[RuralEDDoc]

Speaking of admin jobs I've noticed quite a few places have started hiring new residency grads straight into medical director positions.

For example a friend interviewed with a group recently where the actual director had just graduated within the past couple years.

That makes sense. New grads are cheap since they don’t know the value of their own time and will do a lot of things for free. Not good for the medical group, but great for a regional director who wants to keep admin costs low and still maintain control through puppet leadership.

 

[RustedFox]

Speaking of admin jobs I've noticed quite a few places have started hiring new residency grads straight into medical director positions.

That makes sense. New grads are cheap since they don’t know the value of their own time and will do a lot of things for free. Not good for the medical group, but great for a regional director who wants to keep admin costs low and still maintain control through puppet leadership.

Yep. I was straight up a neanderthal when I first graduated.

But even I wasn't dumb enough to do anything administrative.

 

[CajunMedic]

With TH, you may not have a job very long. I sold my soul to them after match day for a sign-on and stipend. Got a phone call a couple of months ago from the RMD that said "Sorry, didn't plan on a pandemic when we signed you. We don't have a place for you in the state. Your contract will end in 90 days and you don't have to pay back what we've paid you." Landed in an employed position at an SDG with benefits and growth potential. From what I've heard, I got lucky. One of the places I was supposed to go to work turned into a dumpster fire, and the Director got fired. Their recruiter asked me at state ACEP if I was interested in that position. I politely told them what had happened and gave them a Hell, No.

 

[thegenius]

We are currently suing TH for lost wages. Probably shouldn't say much more until it's concluded. I can't stand TH.
Have you guys ever looked at the leadership for USACS? It's got about 50 MD's. I'm sure they all make 350-650K each. And I'm sure just a fraction of those come from their own RVU generation. Meaning the other docs are supporting their salaries. That's 30M in money that is coming from other doctors working in the pit.

 

[emergentmd]

Here is my Admin history.

#1 - Physician owned SDG 1st job - MD for 6 years. Was a pretty good job, pay was like 5k/mo so money was commensurate with amount of work.
#2 - CMG #1 took over, MD for another 6 months. Didn't like the mandates, ignored meeting requests b/c they were just dumb. They wanted me to go schedule a mtg with the CEO who could care less, so I never pushed it. They wanted me to go to market private practices for more pts when we were one of the busiest site in the City was a big no go. CMG didn't like it among other things, then I was out. Interviews were done, and they hired a doc that everyone universally disliked but was a good puppet who to this day is still MD.
#3 - Did Locums at a dumpster fire but made $500/hr. Again, a fast and strong clinical doc. If I am getting paid $500/hr, I will work hard. I literally saw 2x the amount of pts, never complained, staff loved me, Waiting room typically decompressed after a few hours on shift. Literally 3 months in doing the locums job, I was asked to be the MD. It was a CMG #2and it was a no go. No one wanted the job that took 2 yrs to fill. The sucker who took the job lasted about 6 months and was fired for incompetance.
#4 - Did Locums at a outlying site for CMG #3 and literally did 3 shifts. Got an email from their recruiter asking me to be the MD at a larger site for 10k/mo and they were fine with me living 2 hrs away from the site. Big no go there.

Long story short, the MD job typically sucks. No one wants to do it. They will hire anyone willing to take the job. If you have any sense of doing the right thing, you will last a very short period of time.

The tight rope of doing what is medically/clinically/ER site appropriate vs what the hospital/CMG wants is non existent. Sure there may be some outliers but I would say for 95% of the sites in major cities it is not existent.

Good doctors who did the right thing early on in my career who stayed on with CMGs eventually changed to a corporate cog.

 

[RuralEDDoc]

One issue is that the stipend for these jobs tend to be directly related to ED volume. So a 100k annual volume site will be 3x the medical director pay of a 33k site. Which is the harder job? At the 100k site you have a full call panel, 24 hour US, MRI access, and a functional EMR. At the 33k site you have - none of those things, plus single coverage overnight.
Medical director of a small-mid sized ED might be the toughest admin job in medicine.

 

[EctopicFetus]

One issue is that the stipend for these jobs tend to be directly related to ED volume. So a 100k annual volume site will be 3x the medical director pay of a 33k site. Which is the harder job? At the 100k site you have a full call panel, 24 hour US, MRI access, and a functional EMR. At the 33k site you have - none of those things, plus single coverage overnight.
Medical director of a small-mid sized ED might be the toughest admin job in medicine.

Depends on what this role does. Having all those consultants also means dealing with their moaning and bitching. Not all sunshine and rainbows.

 

[hundreddaysoff]

The tight rope of doing what is medically/clinically/ER site appropriate vs what the hospital/CMG wants is non existent. Sure there may be some outliers but I would say for 95% of the sites in major cities it is not existent.

Good doctors who did the right thing early on in my career who stayed on with CMGs eventually changed to a corporate cog.

This. "ER site appropriate."

I suspect for any enterprise to be sustainable, it needs someone to make decisions that make sense for the local population of workers and customers (clients, patients, whatever). Ie, for those of us who actually want to live in a particular location and get along with each other and don't just see the location as abstracted numbers on a spreadsheet.

Ie, someone who has skin in the game and is not (just) a sociopathic instrumentalist.

In my experience, TH and especially USACS have absolutely no sense of this skin in the game. The USACS higher-ups (ie the MDs' bosses and above) just crack the whip of national metrics/secret holding-company cash cows, write ridiculous Powerpoints that no one pays attention to at monthly meetings (if docs show up at all), and take our money via fiat "equity," fiat "productivity-based pay" that wasn't in the original contract, 83(b) scams, and other such.

Not the soldier MDs so much... as you and others write, these days either they are just duped or they have another side racket they are hustling. In my n=1, TH was a little better at picking MDs than USACS, but that may speak to my personal situation more than these institutions.

The incentives are not aligned. Never have been at any big organization where I've ever worked. Top-heavy creates its own evil little universe of bureaucracy and Number Go Up.

So it has been everywhere since the start of civilization, I suspect. Seeing Like A State is a great read about this that I am still trying to get through.

</rant>

 

[Brigade4Radiant]

Lol they have people doing the ED schedule for 2k a month that is an entire job. But people get used to doing all this stuff when they are chief resident

 

[emergentmd]

AMD essentially do the schedule which is a PIA.

but u have the added responsibility of going to some mtgs, run the show the MD not in town, etc.

It’s really not worth 2K/mo thus most won’t take it

 

[Arcan57]

I think the toughest thing about being an FMD for a CMG is realizing that you are firmly middle management and that every step above you on the ladder is also middle management until you get to the vice presidents who are typically docs that sold big multihospital contracts to the CMG. Director sounds lofty until you realize that the entirety of the job is absorbing negative feedback caused by systemic issues that you don't have control over. The majority of long-lasting medical directors develop a state of tranquil inaction that is monk-like. They learn not to get attached to anything because everything eventually goes away. They invest little to nothing of themselves into the role. They realize it's all a rigged game, but the only way to truly lose is to start acting like what you do matters.

Occasionally you'll meet a director that just has amazing leadership skills and genuinely makes the job of the docs in the ED better. They universally get promoted into the structure of the hospital system (think CMO,etc.) or get made regional director where their life takes on a level of suck that has to be seen to be believed.

 

[dchristismi]

I was an AMD when my site (a hybrid community site of an academic group) was eaten by TH. Beware.

I was already pretty crispy, and was in the middle of moving, and actually was getting married (just eloping really) the weekend when TH wanted to meet to find out "what I loved about administration." I told them point blank I hated it, I didn't want to do it, and if they made me, I'd quit on the spot.

Needless to say, I was treated with kid gloves for a bit, gradually cut my hours back over the next couple years, quietly moved eggs into different baskets, and then they decided they didn't want any part timers. Their loss, I figured, so I bowed out gracefully to "retire" to HPM.

Got a call about 6 months later asking if I'd consider coming out of retirement because they'd had some docs quit.
I happen to really like the poor guy who had to call me, so I didn't laugh, but no, I'd found my calling, but good luck.

 

[Arcan57]

I was an AMD when my site (a hybrid community site of an academic group) was eaten by TH. Beware.

I was already pretty crispy, and was in the middle of moving, and actually was getting married (just eloping really) the weekend when TH wanted to meet to find out "what I loved about administration." I told them point blank I hated it, I didn't want to do it, and if they made me, I'd quit on the spot.

Needless to say, I was treated with kid gloves for a bit, gradually cut my hours back over the next couple years, quietly moved eggs into different baskets, and then they decided they didn't want any part timers. Their loss, I figured, so I bowed out gracefully to "retire" to HPM.

Got a call about 6 months later asking if I'd consider coming out of retirement because they'd had some docs quit.
I happen to really like the poor guy who had to call me, so I didn't laugh, but no, I'd found my calling, but good luck.

The problem (among many) with funding CMGs via a combo of private equity and publicly traded stock is that it puts the CMG on this treadmill of quarterly profit statements that doesn’t really fit with how doctors move around and react to stimuli.

CMGs want this just in time staffing that maximizes productivity while minimizing expense. Want to hire a new doc? You’ve got to prove that your current volume already justifies it. Unless you’ve got a part timer that suddenly wants to go full time (which is largely the opposite of how it usually happens), you’re looking at 6-9 months of being short staffed. That’s if they already have a license and your hospital credentialing is well greased. During that time volumes may go up even more, or you may have docs that were cruising along at 12 shifts a month decide that half a year of 14-15 shifts/month has soured them on the concept of being responsible for fixing your staffing shortage.

The only time you’re not short is when volumes fall, and then everyone freaks the f$@“ out and starts cutting hours or pay. Which further emphasizes to the docs that they’re not highly trained professionals respected and guided by a benevolent entity that’s just taking care of all the unpleasant paperwork-ey things but instead cogs in a machine designed to transmute their time and talent into profits that go to someone else.

 

[bravotwozero]

If you really want a good admin job, consider moving to Lansing, Michigan, and get a job with ABEM. That's about as cush as it gets, with your salary being paid for with board exam fees. Guys at the top make at least $400k without having to work a single clinical shift.

 

[thegenius]

I think the toughest thing about being an FMD for a CMG is realizing that you are firmly middle management and that every step above you on the ladder is also middle management until you get to the vice presidents who are typically docs that sold big multihospital contracts to the CMG. Director sounds lofty until you realize that the entirety of the job is absorbing negative feedback caused by systemic issues that you don't have control over. The majority of long-lasting medical directors develop a state of tranquil inaction that is monk-like. They learn not to get attached to anything because everything eventually goes away. They invest little to nothing of themselves into the role. They realize it's all a rigged game, but the only way to truly lose is to start acting like what you do matters.

Occasionally you'll meet a director that just has amazing leadership skills and genuinely makes the job of the docs in the ED better. They universally get promoted into the structure of the hospital system (think CMO,etc.) or get made regional director where their life takes on a level of suck that has to be seen to be believed.

So they make $500K/year listening to problems, offering high level solutions, not really following through on everything...being mute...and just raking in the money. I can't stand them.

 

[thegenius]

If you really want a good admin job, consider moving to Lansing, Michigan, and get a job with ABEM. That's about as cush as it gets, with your salary being paid for with board exam fees. Guys at the top make at least $400k without having to work a single clinical shift.

Makes me puke.

 

[southerndoc]

AMD essentially do the schedule which is a PIA.

but u have the added responsibility of going to some mtgs, run the show the MD not in town, etc.

It’s really not worth 2K/mo thus most won’t take it

Thankfully I don't do the schedule.

 

[Arcan57]

So they make $500K/year listening to problems, offering high level solutions, not really following through on everything...being mute...and just raking in the money. I can't stand them.

Most FMDs aren’t making anywhere close to $500k for the FMD portion of the job. I think I topped out around $12.5/month for a job that was around 25-30hrs/wk on top of around 10 clinical shifts a month.

There are reasons to hate FMDs but then being overpaid isn’t typically one of them. It’s more that one of the easiest ways to do the job is to just dump everything that comes your way onto your docs while only telling the C suite what they want to hear. I couldn’t figure out how to turn off that “my job is to make this ED a great place to work for my docs” switch which is a large part of why I’m no longer an FMD.

 

[thegenius]

Most FMDs aren’t making anywhere close to $500k for the FMD portion of the job. I think I topped out around $12.5/month for a job that was around 25-30hrs/wk on top of around 10 clinical shifts a month.

There are reasons to hate FMDs but then being overpaid isn’t typically one of them. It’s more that one of the easiest ways to do the job is to just dump everything that comes your way onto your docs while only telling the C suite what they want to hear. I couldn’t figure out how to turn off that “my job is to make this ED a great place to work for my docs” switch which is a large part of why I’m no longer an FMD.

Ok. What about those docs who hold positions like "Head of Quality Control" and they work 4 shifts/month. They have to be making 350/450 year, right?

 

[WilcoWorld]

No you can’t because they’ll just replace you with someone else.

Unless you learn to do something no one else knows how to do. Not easy, but possible.

 

[Arcan57]

Ok. What about those docs who hold positions like "Head of Quality Control" and they work 4 shifts/month. They have to be making 350/450 year, right?

Depends on the level and the age of the CMG. If it’s local or regional, they’re probably getting somewhere between afmd-FMD type stipend and are working a lot more than 4 shifts a month.

If it’s national, it’s either one of the aforementioned VPs who’s probably working less than 4 shifts a month or it’s one of those VP’s fair-haired boys who’s probably earning something in the ballpark of what you quoted. I can’t speak to other CMGs but at Team there weren’t really sinecures with the exception of the VPs and to a much lesser extent their highest lieutenant. Everyone else that had stipends was probably being slightly underpaid for the value of their work.

 

[emergentmd]

Our highly functional SDG was "bought out" by TH. I am sure some one here were part of the "buy out". Some of our SDG buy out negotiators suddenly became regional Directors, then a few years more became VP of something. We all were MD of our SDG of 6 fairly large hospitals. 3 went down the TH management group with two being some VP or something. The 3rd became regional director I believe within 3 years. The other 3 MDs, including me, flamed out and I believe I left MD first. I will say that it was the best decision of my life and I have a much better quality of life.

I could not imagine how miserable it would have been if I decided to go down the road of regional VP job. Talk about trying to push directors every day when I didn't believe in it. Some can do this but that was never me. I can't tell docs to do something when my heart knows its not right.

Funny thing was 3 years after leaving MD, a good friend of mine called me out of the blue to be the VP of EM services only reporting to the CEO. I dont think I would have done that for 1M/yr.

 

[RuralEDDoc]

Depends on what this role does. Having all those consultants also means dealing with their moaning and bitching. Not all sunshine and rainbows.

Of course. I think the job mostly sucks regardless of size. But it really sucks as a medical director when you’re paid 1/4 if your clinical salary to be director and yet spend 30+ hours a week on the job. Mostly a word of warning to people who think taking a directorship at a small to moderate sized site is somehow cush - it’s not

 

[random122893]

What about the sites with low volume - say <10k/year total patients. Do those pay at all? I feel like they’d be easy, you’d get to do your own schedule, and how much could there be to do at places like that?

 

[Arcan57]

What about the sites with low volume - say <10k/year total patients. Do those pay at all? I feel like they’d be easy, you’d get to do your own schedule, and how much could there be to do at places like that?
Biggest issue with low volume sites is going to be staffing. In some cases the FMD is just the doc that picks up the shifts they can’t fill. Stipend is going to be pretty small also. Can be an ok gig with stable staffing but losing even 1 fulltime doc can fustigate your life.

 

[RoyBasch]

Director sounds lofty until you realize that the entirety of the job is absorbing negative feedback caused by systemic issues that you don't have control over.

This is the best summary of site medical director position I have ever heard.

 

[random122893]

Infee

What about the sites with low volume - say <10k/year total patients. Do those pay at all? I feel like they’d be easy, you’d get to do your own schedule, and how much could there be to do at places like that?
Biggest issue with low volume sites is going to be staffing. In some cases the FMD is just the doc that picks up the shifts they can’t fill. Stipend is going to be pretty small also. Can be an ok gig with stable staffing but losing even 1 fulltime doc can fustigate your

What about the sites with low volume - say <10k/year total patients. Do those pay at all? I feel like they’d be easy, you’d get to do your own schedule, and how much could there be to do at places like that?
Biggest issue with low volume sites is going to be staffing. In some cases the FMD is just the doc that picks up the shifts they can’t fill. Stipend is going to be pretty small also. Can be an ok gig with stable staffing but losing even 1 fulltime doc can fustigate your life.

I feel like these places would be the easiest CMGs to work at. Likely able to do 24’s, so just do like 5-6 a month for full time and coast.
-They can’t cut staffing because it’s already low given the census.
-no midlevel charts to co-sign since it’s a 1-man shop
-low chance of losing the job because they’re probably hard to staff anyways so they can’t cut you
-more flexibility of where to live since driving longer is possible if you work so few days
-easy to become FMD and control your schedule
-someone leaves, each remaining doc picks up 1-2 shifts which shouldn’t be that much anyways until you get a replacement

Besides lacking the ‘intensity’ that many crave, what am I missing?

 

[emergentmd]

I feel like these places would be the easiest CMGs to work at. Likely able to do 24’s, so just do like 5-6 a month for full time and coast.
-They can’t cut staffing because it’s already low given the census.
-no midlevel charts to co-sign since it’s a 1-man shop
-low chance of losing the job because they’re probably hard to staff anyways so they can’t cut you
-more flexibility of where to live since driving longer is possible if you work so few days
-easy to become FMD and control your schedule
-someone leaves, each remaining doc picks up 1-2 shifts which shouldn’t be that much anyways until you get a replacement

Besides lacking the ‘intensity’ that many crave, what am I missing?

10K site is about 25ppd. You still have to go to meetings, still have to deal with doctor complaints, deal with admin complaints. You still have the constant emails, still cover open shifts. Docs at these sites know that they will not be replaced so good luck getting rid of anyone.

Prob get paid 5k. You make 5K in a 24 hr shift.

Would you rather work 1 extra day a month seeing 1ppd or perpetually having to deal with any issues that arise?

 

[Brigade4Radiant]

The real tough issue is working academics under a CMG

omg my friend in NY was making 230k working 16 shifts having to go to meetings and clean beds this was all after doing a “sim fellowship”

 

[Arcan57]

Infee


I feel like these places would be the easiest CMGs to work at. Likely able to do 24’s, so just do like 5-6 a month for full time and coast.
-They can’t cut staffing because it’s already low given the census.
-no midlevel charts to co-sign since it’s a 1-man shop
-low chance of losing the job because they’re probably hard to staff anyways so they can’t cut you
-more flexibility of where to live since driving longer is possible if you work so few days
-easy to become FMD and control your schedule
-someone leaves, each remaining doc picks up 1-2 shifts which shouldn’t be that much anyways until you get a replacement

Besides lacking the ‘intensity’ that many crave, what am I missing?

If you're set on doing rural medicine, the last thing I'd want to do is talk you out of it. We need more EM trained docs in rural America.

If you're not deadset on it, there are things to consider-
1)10k is 27 visits per day. That's not facemelting volume but most of that is going to be clustered in the late afternoon/evening so if it's single coverage you're going to be moving for 4-5 hours pretty intensely. Most of your patients will go home, but the ones that don't will be as likely to be transferred as admitted. Which works fine when you can transfer out quickly and becomes it's own horror show when your receiving centers are on diversion.

2)Pay is going to be mediocre to bad. Having superkittyfantastico pay requires 3 things- privately insured patients, high volume/doc, and an employer willing to pass a good part of the collections to you the doctor. It's uncommon to find that mix in most rural shops. You simply can't generate 12-14 RVUs/hr when you're seeing 1 pt/hr with a 7% admit rate. That puts a pretty hard ceiling what you can get paid since most hospitals can't/won't subsidize your pay.

3) Being an FMD that lives 2-3 hrs away from your shop can be tricky, especially when you're the default backup.

4) If you're working 5-6 shifts a month, you probably have a fair amount of control over your schedule anyway, being an FMD is unlikely to significantly enhance this.

5) If someone leaves, that replacement may be 1-2 years away from coming. Check out the ads for medical director in small rural shops and see how long they typically run. Recruiting someone to work in the boonies is tough, although if current residency trends continue that part may be easing up.

 

[Apollyon]

1)10k is 27 visits per day. That's not facemelting volume but most of that is going to be clustered in the late afternoon/evening

Yes, that is TERRIBLE when it's 1pph (literally, for 24 hours) with incompetent staff (which you get, in rural areas). When staff can't do anything, and, the EHR is borderline functionless, it's a grind. And, what happens to things that grind? They burn out.
Ask me how I know.

BTW, UPMC is happy to pay bottom of the scale wages rurally, for all the joy above. There is no cherry on top, or silver lining.