Another good SDG bites the dust

[ERMudPhud]

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Looks like Eugene Emergency Physcians just got thrown out in favor of Apollo. They were a long standing democratic group.

Dozens of PeaceHealth emergency physicians to be impacted by management shakeup

Nearly 50 emergency physicians at PeaceHealth hospitals in Lane County will be impacted by a change in the emegency physicians group responsible for providing c

kval.com

I actually came here to see if anyone knew any more about this but it looks like nobody has mentioned it yet.

30 or so docs and about a dozen APP's

Sad to hear

If you are part of an SDG do everything you can to keep it that way and enjoy it while you can but realize in the end its out of your control. All it takes is one person in the C-suite having lunch with a CMG. And they call them with lunch invites every day.

 

[southerndoc]

Unfortunately, SDGs are finding it hard to survive with the conglomerate insurance companies. I found it odd that one article I read stated that the ER docs couldn't talk because of non-compete agreements, which would be under their current contract (the SDG) and not Apollo that hasn't taken effect yet.

I have no idea what the story is behind their departure, but something wasn't making administration happy... either demanding too much in subsidies, not meeting metrics, or something. There is another side to the story that we probably won't hear about.

and yes, I am part of ApolloMD (for full disclosure). However, I do not have intimate awareness of this particular group and am only speaking on behalf of myself and not Apollo. I will say this: I've been very happy with Apollo. I don't get "corporate overlords" telling me what to do, and they partner with a lot of companies for various benefits for independent contractors. The most important part, however, is they will stand behind you during litigation and they do not want to settle unless you ask them to. I've been with them for 17 years and likely will be with them when I retire.

 

[EMdoc235]

I work for a couple of Apollo sites and they’re fine. I’d never work in Oregon with their crazy taxes.

 

[WhatJobDoIPick]

Physicians should own their practices.

Corporate groups and hospital employment is the scourge of medicine.

 

[AlmostAnMD]

Physicians should own their practices.

Corporate groups and hospital employment is the scourge of medicine.

Corporate, yes

Hospital, less sure. At least hospital leadership is INVESTED in the hospital functioning/not getting siphoned off and sold off.

 

[WhatJobDoIPick]

Corporate, yes

Hospital, less sure. At least hospital leadership is INVESTED in the hospital functioning/not getting siphoned off and sold off.

The hospital is invested in itself functioning to the extent that the C suite the bonused out.

 

[WhatJobDoIPick]

Unfortunately, SDGs are finding it hard to survive with the conglomerate insurance companies. I found it odd that one article I read stated that the ER docs couldn't talk because of non-compete agreements, which would be under their current contract (the SDG) and not Apollo that hasn't taken effect yet.

I have no idea what the story is behind their departure, but something wasn't making administration happy... either demanding too much in subsidies, not meeting metrics, or something. There is another side to the story that we probably won't hear about.

and yes, I am part of ApolloMD (for full disclosure). However, I do not have intimate awareness of this particular group and am only speaking on behalf of myself and not Apollo. I will say this: I've been very happy with Apollo. I don't get "corporate overlords" telling me what to do, and they partner with a lot of companies for various benefits for independent contractors. The most important part, however, is they will stand behind you during litigation and they do not want to settle unless you ask them to. I've been with them for 17 years and likely will be with them when I retire.

I work for a couple of Apollo sites and they’re fine. I’d never work in Oregon with their crazy taxes.

This is bootlicking.

 

[Janders]

This is bootlicking.

If nothing else, I think we ALL know of times SMGs lost their contracts to CMGs based NOT based on demanding subsidies, failure to meet reasonable metrics, etc.

I know groups who had no or very minimal subsidies, who beat most local/regional competition in metrics, who got forced out by CMGs for reasons like "we need the ED group to subsidize the hospitalists because we are tired of doing that and CMG XYZ offers that" or "you guys do well at the metrics, but CMG XYZ promises they can do BETTER for free" (of course they can't...).

 

[emergentmd]

If nothing else, I think we ALL know of times SMGs lost their contracts to CMGs based NOT based on demanding subsidies, failure to meet reasonable metrics, etc.

I know groups who had no or very minimal subsidies, who beat most local/regional competition in metrics, who got forced out by CMGs for reasons like "we need the ED group to subsidize the hospitalists because we are tired of doing that and CMG XYZ offers that" or "you guys do well at the metrics, but CMG XYZ promises they can do BETTER for free" (of course they can't...).

Me, me, me. We got screwed but in life when one door closes, another opens. Best decision forced on me in my life.

 

[southerndoc]

This is just the nature of the game. Five years from now they may not be happy with ApolloMD or they may get a better offer from someone else.

 

[EctopicFetus]

Will be interesting to see how many of the docs stay. The smart thing for that group is to hold their ground and none of them stay on. Will cause total disaster for ApolloMD and may help them get their contract back. Let’s be honest, there arent a ton of people just dying to go to Eugene. This is the name of the game if they want to have any chance of getting that contract back. Imagine the pain for Apollo if they have to replace the 30 ED docs.. thats not a simple nor cheap situation to be in. I am fairly neutral on ApolloMD but in this instance i hope they fail.

@southerndoc looks like Valorbridge is out of their ownership piece. Can you provide any details/ clarity?

 

[WhatJobDoIPick]

Will be interesting to see how many of the docs stay. The smart thing for that group is to hold their ground and none of them stay on. Will cause total disaster for ApolloMD and may help them get their contract back. Let’s be honest, there arent a ton of people just dying to go to Eugene. This is the name of the game if they want to have any chance of getting that contract back. Imagine the pain for Apollo if they have to replace the 30 ED docs.. thats not a simple nor cheap situation to be in. I am fairly neutral on ApolloMD but in this instance i hope they fail.

@southerndoc looks like Valorbridge is out of their ownership piece. Can you provide any details/ clarity?

Does Apollo have a scab team that they can send in to staff the ED?

 

[JacobMcCandles]

Will be interesting to see how many of the docs stay. The smart thing for that group is to hold their ground and none of them stay on. Will cause total disaster for ApolloMD and may help them get their contract back. Let’s be honest, there arent a ton of people just dying to go to Eugene. This is the name of the game if they want to have any chance of getting that contract back. Imagine the pain for Apollo if they have to replace the 30 ED docs.. thats not a simple nor cheap situation to be in. I am fairly neutral on ApolloMD but in this instance i hope they fail.

I, too, am interested. 30 ED docs in Eugene is a lot. That’d be very tough for Apollo to overcome although I’m sure cutting coverage will be one of the first temporary measures.

 

[EctopicFetus]

Does Apollo have a scab team that they can send in to staff the ED?

Of course they do.. but eventually the money becomes painful. Look at the USACS site in California. Similarly there are some other groups out there that have suffered due to taking on sites in equally less desireable cities. How long can they afford to pay for travel, extra rates etc. Not to mention the disorder of the med staff at the hospital. If I were them this is the approach, I would sow discord, i would not work there and would work locums elsewhere until this blew over. I would maintain a good relationship with hospital admin since you need them to take you back.

 

[EctopicFetus]

I, too, am interested. 30 ED docs in Eugene is a lot. That’d be very tough for Apollo to overcome although I’m sure cutting coverage will be one of the first temporary measures.

They took over an APP contract around me. Its been an unmitigated disaster. I know people who worked there and wont go back. Some shifts are 5 MLPs to 1 MD. Big busy hospital with non EM trained people.. to say it is not going well would be an understatement. I hope its an equal disaster in Eugene.

 

[southerndoc]

Does Apollo have a scab team that they can send in to staff the ED?

Yes, our strike team can staff it without issue for quite a while.

 

[southerndoc]

They took over an APP contract around me. Its been an unmitigated disaster. I know people who worked there and wont go back. Some shifts are 5 MLPs to 1 MD. Big busy hospital with non EM trained people.. to say it is not going well would be an understatement. I hope its an equal disaster in Eugene.

That does not seem like the Apollo model I am familar with. I've never seen them utilize that many APPs.

 

[southerndoc]

Will be interesting to see how many of the docs stay. The smart thing for that group is to hold their ground and none of them stay on. Will cause total disaster for ApolloMD and may help them get their contract back. Let’s be honest, there arent a ton of people just dying to go to Eugene. This is the name of the game if they want to have any chance of getting that contract back. Imagine the pain for Apollo if they have to replace the 30 ED docs.. thats not a simple nor cheap situation to be in. I am fairly neutral on ApolloMD but in this instance i hope they fail.

@southerndoc looks like Valorbridge is out of their ownership piece. Can you provide any details/ clarity?

I believe so. ValorBridge is a capital management company that was founded by one of our leadership team, his ApolloMD shares rolled into it, and then a number of physicians invested in ValorBridge.

 

[WhatJobDoIPick]

Yes, our strike team can staff it without issue for months. Standing their ground will leave a lot of docs out of jobs probably. Would not be advised.

Ah yes, the strike force / special ops / embassadors / fire fighters / alpha squadron.

AKA...scabs.

 

[Cauchy]

Looks like all the local ER doctors and APPs signed an agreement not to work for Apollo. I'm not too familiar with the company, but in this case, I tend to lean towards supporting the local physician group.

PeaceHealth’s split with local emergency physicians sparks disappointment, resolve

PeaceHealth will end its 35-year contract with Eugene Emergency Physicians and replace the local group with Atlanta-based ApolloMD to staff ERs in Springfield, Florence, and Cottage Grove. Local doctors cite rising wait times and worsening conditions at RiverBend. All 41 EEP providers have...

www.klcc.org

 

[southerndoc]

Ah yes, the strike force / special ops / embassadors / fire fighters / alpha squadron.

AKA...scabs.

Whatever you want to call them, ApolloMD has a team that can staff.

Not sure why I'm even commenting here. People already have their minds made up which side they support, and I have no intention of ever working in Oregon so I have no skin in the game.

 

[WhatJobDoIPick]

Looks like all the local ER doctors and APPs signed an agreement not to work for Apollo. I'm not too familiar with the company, but in this case, I tend to lean towards supporting the local physician group.

PeaceHealth’s split with local emergency physicians sparks disappointment, resolve

PeaceHealth will end its 35-year contract with Eugene Emergency Physicians and replace the local group with Atlanta-based ApolloMD to staff ERs in Springfield, Florence, and Cottage Grove. Local doctors cite rising wait times and worsening conditions at RiverBend. All 41 EEP providers have...

www.klcc.org

I mean unless you're ready to hold out for months or maybe a year I don't see how they can win. I don't think most ER docs have the stomach.

 

[emergentmd]

I applaud these docs for uniting and holding out, but how long will they be able to do this unless there is a viable system in the area? It is hard to uproot your family and most will suck it up until they find a better option.

This reminds me of our SDG. We were at many leadership positions in the system. We had a similar long run, well liked throughout the system by specialists who advocated for us. We had specialists across the board and at MEC who threw their weight around. This was likely the only reason we were offered a buyout and I hope these guys get some small parachute. But even if we did not get a buyout, I think the vast majority would have stuck it out with TH especially when they offered us and equivalent pay package.

 

[EctopicFetus]

I mean unless you're ready to hold out for months or maybe a year I don't see how they can win. I don't think most ER docs have the stomach.

You can work.. just work elsewhere.. just like the replacement scabs. honestly, good for those docs for having some balls. There is literally no reason to make it easy for the new contract holder. What may be an unpopular opinion is that most of those scabs are subpar physicians with minimal work ethic. I get that may be unpopular. I said what i said and i stand by it. Yes 25% of them are good competent docs.. 75% cant last at single site due to laziness, lack of competence, poor interpersonal skills etc. Im not here to fluff any docs. Thats been the way I have seen it from these types for the past decade.

Throw in poor relationships with other docs and there is a chance it falls apart. It might be small but this is their only hope. Let them go work at sites around there. I fully commend them for doing what is hard and standing up for themselves. If my group lost its contract I would hope we would do the same.

 

[EMdoc235]

You can work.. just work elsewhere.. just like the replacement scabs. honestly, good for those docs for having some balls. There is literally no reason to make it easy for the new contract holder. What may be an unpopular opinion is that most of those scabs are subpar physicians with minimal work ethic. I get that may be unpopular. I said what i said and i stand by it. Yes 25% of them are good competent docs.. 75% cant last at single site due to laziness, lack of competence, poor interpersonal skills etc. Im not here to fluff any docs. Thats been the way I have seen it from these types for the past decade.

Throw in poor relationships with other docs and there is a chance it falls apart. It might be small but this is their only hope. Let them go work at sites around there. I fully commend them for doing what is hard and standing up for themselves. If my group lost its contract I would hope we would do the same.

Hope they’ve made some locums plans for the next year. The bills will have to be paid. But then again, if you’ve been working for 22 years you should be able to retire.

 

[EctopicFetus]

Yep. I assume a mix of people. They can find alternative gigs. Inflict maximum pain.. i hope they do. I hope peace health feels the pain

 

[EctopicFetus]

Hope they’ve made some locums plans for the next year. The bills will have to be paid. But then again, if you’ve been working for 22 years you should be able to retire.

I dont know what it is like in Oregon but seemingly there is a monster need for locums in the SE USA.

 

[DocEspana]

Can we also talk about the fact that sometimes the SDG is.... bad. There is so much money moving around that the temptation to be super greedy about it definitely exists.

I currently work for one that is, objectively, a pyramid scheme with some REALLY sharp inclines. 80 (exactly) providers. about evenly split between 40 doctor and 40 midlevels. I think the full time group is like 20 and 20 but there are about 20 part timer in both the APP and physician category who *do* get work pretty regular. We staff 5 hospitals, so that is why. Anyway.... the leadership is 3 people (CEO, CFO, CMO more or less) and there are 3 physician "site directors" and 1 APP director. The physicians and APPs get massively underpaid ($217/hr with part timers only making $208 an hour) everything I hear the 4 site directors + APP director get a decent stipend that brings them *almost* up to the going rate in this area of 250/260ish per hour. The group is massively massively massively successful and the site directors are open (with me) about the fact that the three people at the top are just swimming in money to a level that is not even funny. And despite them having their own personal yacht fund each, they are still massively underpaying the people here because they mostly hire new graduates who just want to be in a major city and don't want to do the leg work that is necessary (and that I had to do ) to get "in" the old fashioned way. And its not like the job is super easy either.... its easy... but not $217/hr easy. Thankfully it's not my only job, it's just my easy job

a CMG moving in over there would be, in many ways, a blessing for that site. Thats not the only place like that either. There is a second private group over here with a similar "mega pyramid" design. And a third group that is actually treating their people very well and there is no complaints there, just... you know... its still not truly equitable.

 

[RustedFox]

Can we also talk about the fact that sometimes the SDG is.... bad. There is so much money moving around that the temptation to be super greedy about it definitely exists.

I currently work for one that is, objectively, a pyramid scheme with some REALLY sharp inclines. 80 (exactly) providers. about evenly split between 40 doctor and 40 midlevels. I think the full time group is like 20 and 20 but there are about 20 part timer in both the APP and physician category who *do* get work pretty regular. We staff 5 hospitals, so that is why. Anyway.... the leadership is 3 people (CEO, CFO, CMO more or less) and there are 3 physician "site directors" and 1 APP director. The physicians and APPs get massively underpaid ($217/hr with part timers only making $208 an hour) everything I hear the 4 site directors + APP director get a decent stipend that brings them *almost* up to the going rate in this area of 250/260ish per hour. The group is massively massively massively successful and the site directors are open (with me) about the fact that the three people at the top are just swimming in money to a level that is not even funny. And its not like the job is super easy either.... its easy... but not $217/hr easy.

a CMG moving in over there would be, in many ways, a blessing for that site. Thats not the only place like that either. There is a second private group over here with a similar "mega pyramid" design. And a third group that is actually treating their people very well and there is no complaints there, just... you know... its still not truly equitable.

True story:

/b/ (nobody does this anymore, because /b/ is totally dead, but okay. Nostaglia FTW>)

Be me.
I was at a Walgreens sometime in 201X.
Gal in front of me said something into her phone that gave her away as an ER nurse.
I get to yapping, because I'm a yapper. Yap. It's wild what you'll learn just by being a yapper.
Don't try and change me.
Make instant friends. Some talk about The Stooges (band) and early punk music that I also noticed from her generalized demeanor.
"Loose". Iggy pop. "Search and Destroy" being used to sell Windows95. LOOK OUT HONEY, CAUSE I'M USING TECHNOLOGY!
I am the world's forgotten BOY! The one who SEARCHES and DESTROYS! *BA-du-WAH-du-WAHH-du-WAH*
"You're an ER doc?! Where do you work? We need HELP!"
I take interview with the only SDG in five counties or more around these parts.
"Do you have any questions?"
"Sure! What happened to Doctor Stacy? I worked with her at Community General."
[Lies]: Uhhh. UhHhH, Doctor StAcY wanted to go do locums before she settled down to have kids."
Me, to myself: (No. You guys effed Doctor Stacy six ways to Sunday.)
"What about Doctor Albert? He said some nice things about you guys."
[Lies]: (See above, except replace locums and family with [whatever lies they wanted to tell].)
Okay.
Ohh-kay.
I never got a callback, because they knew that I knew the truth.
Some SDGs need to die because they are vile.

 

[JacobMcCandles]

Can we also talk about the fact that sometimes the SDG is.... bad. There is so much money moving around that the temptation to be super greedy about it definitely exists.

I currently work for one that is, objectively, a pyramid scheme with some REALLY sharp inclines. 80 (exactly) providers. about evenly split between 40 doctor and 40 midlevels. I think the full time group is like 20 and 20 but there are about 20 part timer in both the APP and physician category who *do* get work pretty regular. We staff 5 hospitals, so that is why. Anyway.... the leadership is 3 people (CEO, CFO, CMO more or less) and there are 3 physician "site directors" and 1 APP director. The physicians and APPs get massively underpaid ($217/hr with part timers only making $208 an hour) everything I hear the 4 site directors + APP director get a decent stipend that brings them *almost* up to the going rate in this area of 250/260ish per hour. The group is massively massively massively successful and the site directors are open (with me) about the fact that the three people at the top are just swimming in money to a level that is not even funny. And despite them having their own personal yacht fund each, they are still massively underpaying the people here because they mostly hire new graduates who just want to be in a major city and don't want to do the leg work that is necessary (and that I had to do ) to get "in" the old fashioned way. And its not like the job is super easy either.... its easy... but not $217/hr easy. Thankfully it's not my only job, it's just my easy job

a CMG moving in over there would be, in many ways, a blessing for that site. Thats not the only place like that either. There is a second private group over here with a similar "mega pyramid" design. And a third group that is actually treating their people very well and there is no complaints there, just... you know... its still not truly equitable.

What part of that is supposed to be a democratic group? It doesn’t sound like it functions as one so I wouldn’t call it that. It’s just a CMG on a lesser scale.

 

[DocEspana]

What part of that is supposed to be a democratic group? It doesn’t sound like it functions as one so I wouldn’t call it that. It’s just a CMG on a lesser scale.

Two answers I guess.

1) we have sort of blurred what a SDG really means. Its just sort of become a synonym for "private" group, perhaps even "benign private", when that is not actually what the words mean. Why isn't vituity an SDG.... because its not small? Its definitely democratic and if we are using 'group' to mean 'not a private equity monster' its definitely just a bunch of doctors running it with no secret corporate overlord. But no one here is going to accept that it should be an SDG.... because its not small? No, it is because its distinctly not private, its very much a national organization despite being democratic and a "group" as I am choosing to define it. Also, it is because SDG has taken on some amorphous idea that its benevolent, which isn't in any of the letters - and you can decide what group you think are benevolent or not. I think "private" is the casual usage of SDG to enough of a level where private groups that look at all like a formal SDG should count since clearly we are all being a bit loosey goosey with it

2) With that said, this group is, in the most literal sense small, democratic, and a group (ownership is everyone but, really, we can see its the three at the top making all the calls). And we share profits and adjust the hourly pay for each year after looking at the profit - you know - after the bosses take an undisclosed massive salary that leaves about $215 an hour left. So its just not benign.

 

[JacobMcCandles]

Two answers I guess.

1) we have sort of blurred what a SDG really means. Its just sort of become a synonym for "private" group, perhaps even "benign private", when that is not actually what the words mean. Why isn't vituity an SDG.... because its not small? Its definitely democratic and if we are using 'group' to mean 'not a private equity monster' its definitely just a bunch of doctors running it with no secret corporate overlord. But no one here is going to accept that it should be an SDG.... because its not small? No, it is because its distinctly not private, its very much a national organization despite being democratic and a "group" as I am choosing to define it. Also, it is because SDG has taken on some amorphous idea that its benevolent, which isn't in any of the letters - and you can decide what group you think are benevolent or not. I think "private" is the casual usage of SDG to enough of a level where private groups that look at all like a formal SDG should count since clearly we are all being a bit loosey goosey with it

2) With that said, this group is, in the most literal sense small, democratic, and a group (ownership is everyone but, really, we can see its the three at the top making all the calls). And we share profits and adjust the hourly pay for each year after looking at the profit - you know - after the bosses take an undisclosed massive salary that leaves about $215 an hour left. So its just not benign.

There’s nothing democratic about the group you’re in. A democratic group’s goal should be to basically have all full-timers as partners. There shouldn’t be various levels of partners. I agree that those who do extra work should be compensated but that compensation is set and agreed upon by the partners. You’re telling me a majority of the partners agree that these 3 should get an inordinate amount of compensation while everyone else gets screwed? You say everyone is an owner but nobody can see the books to see what “undisclosed massive salary” these 3 are taking? Something doesn’t add up.

 

[TooMuchResearch]

Two answers I guess.

1) we have sort of blurred what a SDG really means. Its just sort of become a synonym for "private" group, perhaps even "benign private", when that is not actually what the words mean. Why isn't vituity an SDG.... because its not small? Its definitely democratic and if we are using 'group' to mean 'not a private equity monster' its definitely just a bunch of doctors running it with no secret corporate overlord. But no one here is going to accept that it should be an SDG.... because its not small? No, it is because its distinctly not private, its very much a national organization despite being democratic and a "group" as I am choosing to define it. Also, it is because SDG has taken on some amorphous idea that its benevolent, which isn't in any of the letters - and you can decide what group you think are benevolent or not. I think "private" is the casual usage of SDG to enough of a level where private groups that look at all like a formal SDG should count since clearly we are all being a bit loosey goosey with it

2) With that said, this group is, in the most literal sense small, democratic, and a group (ownership is everyone but, really, we can see its the three at the top making all the calls). And we share profits and adjust the hourly pay for each year after looking at the profit - you know - after the bosses take an undisclosed massive salary that leaves about $215 an hour left. So its just not benign.

A democratic group does not have undisclosed, massive salaries. I can lookup, right now, in spreadsheets sent to my company email, the amount every partner in my group made every year since I became a partner. I can see their hours, including billed administrative hours, breakdown by hospital, shift (day, evening, night), pph, RVU/hr, etc.

 

[TooMuchResearch]

There’s nothing democratic about the group you’re in. A democratic group’s goal should be to basically have all full-timers as partners. There shouldn’t be various levels of partners. I agree that those who do extra work should be compensated but that compensation is set and agreed upon by the partners. You’re telling me a majority of the partners agree that these 3 should get an inordinate amount of compensation while everyone else gets screwed? You say everyone is an owner but nobody can see the books to see what “undisclosed massive salary” these 3 are taking? Something doesn’t add up.

One level of partner: Equal.

 

[DocEspana]

There’s nothing democratic about the group you’re in. A democratic group’s goal should be to basically have all full-timers as partners. There shouldn’t be various levels of partners. I agree that those who do extra work should be compensated but that compensation is set and agreed upon by the partners. You’re telling me a majority of the partners agree that these 3 should get an inordinate amount of compensation while everyone else gets screwed? You say everyone is an owner but nobody can see the books to see what “undisclosed massive salary” these 3 are taking? Something doesn’t add up.

A democratic group does not have undisclosed, massive salaries. I can lookup, right now, in spreadsheets sent to my company email, the amount every partner in my group made every year since I became a partner. I can see their hours, including billed administrative hours, breakdown by hospital, shift (day, evening, night), pph, RVU/hr, etc.

my point being thats an idealized and (conveniently) strict definition for a term people fling around with reckless abandon to describe anything not belonging to the meat claws of about 6 major groups. Not that I disagree with your comment on its face, only that I'd assume the other 364 days out of the year you'd describe a WIDE variety of places that function nothing like the description above as an SDG under the auspices of "well its not TeamHealth/Envision/Apollo etc." But because this one suffers from the same malignancy that infects CMGs (namely greed at the top) 'this one isnt a SDG.'

or maybe I'm being overly judgy. But its all we got in this area. Corporate groups and a few extremely lopsided partnerships.

 

[Janders]

One level of partner: Equal.

Open books equal income equal overhead from day one. Radical transparency.

 

[JacobMcCandles]

my point being thats an idealized and (conveniently) strict definition for a term people fling around with reckless abandon to describe anything not belonging to the meat claws of about 6 major groups. Not that I disagree with your comment on its face, only that I'd assume the other 364 days out of the year you'd describe a WIDE variety of places that function nothing like the description above as an SDG under the auspices of "well its not TeamHealth/Envision/Apollo etc." But because this one suffers from the same malignancy that infects CMGs (namely greed at the top) 'this one isnt a SDG.'

or maybe I'm being overly judgy. But its all we got in this area. Corporate groups and a few extremely lopsided partnerships.

I definitely wouldn’t call your group an SDG and I’m not sure who would. Anything that isn’t the known big players isn’t automatically an SDG.

 

[JacobMcCandles]

Open books equal income equal overhead from day one. Radical transparency.

It doesn’t have to be equal income. It doesn’t make sense for partner A to see 1 pph and partner B to see 2 pph and they both get paid exactly the same. The point is that the compensation structure is agreeable and fair to all partners. Maybe you meant the compensation structure is equal for everyone which I agree with.

 

[TooMuchResearch]

Open books equal income equal overhead from day one. Radical transparency.

I'd go several steps further but one obvious one: No weird or unfair scheduling setups. We all work our share of nights and weekends, other than our night or weekend specialists. Some people develop site preferences over time and these get worked in but are fluid and not permanent. Nobody, not even our medical directors, get a Tuesday-Thursday daytime schedule.

 

[AlmostAnMD]

My malignant sdg that frustrated me to death and drove me out of practice had this setup

Non-partner (sweat equity) everyone 3 years
Partner A- no buy in but gets bonuses (non partners dont and made $145/hr)
Partner B- quarter mill buy in, 50% increase in bonus over Partner A. This price apparently rose by 200k over last 10 years to **** new docs

Also there was a secret medical director bonus. They were tight-lipped about the amount but I felt shafted based off the volume I saw so I assume it was substantial

 

[RustedFox]

Words mean nothing anymore.

 

[DocEspana]

Words mean nothing anymore.

10 years ago I would come here and throw a fit when people just named things and diagnosed things as whatever felt right in their heart. I used to say "words either have meanings or they don't" while I pushed for people to stick to the actual meanings.

10 years later?

I'm confident "they don't."

 

[RustedFox]

10 years ago I would come here and throw a fit when people just named things and diagnosed things as whatever felt right in their heart. I used to say "words either have meanings or they don't" while I pushed for people to stick to the actual meanings.

10 years later?

I'm confident "they don't."

It's an SDG.
It's a semi-SDG.
It's a pseudo-SDG.
It's a mixed-SDG.
It's a CMG-SDG.
It's a SDG with private backing.
It's a CMG with "ownership".
It's a ....

I've never seen the anime in question, but it's so ubiquitous on the web that I can't help but post it when it's appropriate.

 

[DocEspana]

It's an SDG.
It's a semi-SDG.
It's a pseudo-SDG.
It's a mixed-SDG.
It's a CMG-SDG.
It's a SDG with private backing.
It's a CMG with "ownership".
It's a ....

View attachment 415330

I've never seen the anime in question, but it's so ubiquitous on the web that I can't help but post it when it's appropriate.

So that's freiren. It has 28 episodes. Apparently the first 18 or so is a cute little slice of life of an elf mage who cant understand humans and their brief fleeting lives trying to understand humans and mortality better by wandering the countryside for years. Very slow. Very contemplative. Apparently the last 10ish episodes involve some insane tone shifts to her just massacring non-human baddies in a way that you don't see coming from an elf spending episodes learning how to cook or crochet. I have no idea if this quote is from the deep zen-like contemplation part or the "force your enemies to commit suicide in front of you because you are an omnipotent being" part.

I couldnt make it past like episode 5 where she is looking for a flower to try to understand what people see in them.

 

[EctopicFetus]

If there are secret bonuses it’s not an SDG. And the owners are not real owners. To me it must be open books to the owners. All owners should have an equal share of ownership. Everyone gets an equal schedule unless you can convince someone to work more undesirable shifts but they can bail whenever. There are other criteria. I would also add you need at least 10+ equal owners. I say this understanding different models exist. But you can’t have 3 kings. Once you hit a critical number like my example of 10 but perhaps some percentage makes more sense.

 

[RustedFox]

So that's freiren. It has 28 episodes. Apparently the first 18 or so is a cute little slice of life of an elf mage who cant understand humans and their brief fleeting lives trying to understand humans and mortality better by wandering the countryside for years. Very slow. Very contemplative. Apparently the last 10ish episodes involve some insane tone shifts to her just massacring non-human baddies in a way that you don't see coming from an elf spending episodes learning how to cook or crochet. I have no idea if this quote is from the deep zen-like contemplation part or the "force your enemies to commit suicide in front of you because you are an omnipotent being" part.

I couldnt make it past like episode 5 where she is looking for a flower to try to understand what people see in them.

I haven't watched an anime since "Cowboy Bebop" (which my college roommate has a credit on) or "Samurai Champloo" (which was pretty great when it comes down to a "samurai-western"), so I appreciate the synopsis. I see the elf-girl all over the web and can put things together, but I would otherwise have no idea.

Honestly: Cowboy Bebop was amazingly good. Sure, it had it's "this is a cartoon" elements, but it was also a space-mafia-opera, which was genius. I played the soundtrack at work a few years back and people were saying: "Holy smoke; what band IS this?"

 

[Emapp20177]

Not a knock on the Eugene group at all, as I have no info, but in regards to the title, how do we know that the group was "good?"

 

[Mount Asclepius]

Can we also talk about the fact that sometimes the SDG is.... bad. There is so much money moving around that the temptation to be super greedy about it definitely exists.

I currently work for one that is, objectively, a pyramid scheme with some REALLY sharp inclines. 80 (exactly) providers. about evenly split between 40 doctor and 40 midlevels. I think the full time group is like 20 and 20 but there are about 20 part timer in both the APP and physician category who *do* get work pretty regular. We staff 5 hospitals, so that is why. Anyway.... the leadership is 3 people (CEO, CFO, CMO more or less) and there are 3 physician "site directors" and 1 APP director. The physicians and APPs get massively underpaid ($217/hr with part timers only making $208 an hour) everything I hear the 4 site directors + APP director get a decent stipend that brings them *almost* up to the going rate in this area of 250/260ish per hour. The group is massively massively massively successful and the site directors are open (with me) about the fact that the three people at the top are just swimming in money to a level that is not even funny. And despite them having their own personal yacht fund each, they are still massively underpaying the people here because they mostly hire new graduates who just want to be in a major city and don't want to do the leg work that is necessary (and that I had to do ) to get "in" the old fashioned way. And its not like the job is super easy either.... its easy... but not $217/hr easy. Thankfully it's not my only job, it's just my easy job

a CMG moving in over there would be, in many ways, a blessing for that site. Thats not the only place like that either. There is a second private group over here with a similar "mega pyramid" design. And a third group that is actually treating their people very well and there is no complaints there, just... you know... its still not truly equitable.

Not really small. Definitely not democratic. Not a SDG.

 

[WhatJobDoIPick]

Words mean nothing anymore.

No words definitely mean something.

Neither @DocEspana nor @AlmostAnMD are describing democratic groups.

 

[alpinism]

Two answers I guess.

1) we have sort of blurred what a SDG really means. Its just sort of become a synonym for "private" group, perhaps even "benign private", when that is not actually what the words mean. Why isn't vituity an SDG.... because its not small? Its definitely democratic and if we are using 'group' to mean 'not a private equity monster' its definitely just a bunch of doctors running it with no secret corporate overlord. But no one here is going to accept that it should be an SDG.... because its not small? No, it is because its distinctly not private, its very much a national organization despite being democratic and a "group" as I am choosing to define it. Also, it is because SDG has taken on some amorphous idea that its benevolent, which isn't in any of the letters - and you can decide what group you think are benevolent or not. I think "private" is the casual usage of SDG to enough of a level where private groups that look at all like a formal SDG should count since clearly we are all being a bit loosey goosey with it

2) With that said, this group is, in the most literal sense small, democratic, and a group (ownership is everyone but, really, we can see its the three at the top making all the calls). And we share profits and adjust the hourly pay for each year after looking at the profit - you know - after the bosses take an undisclosed massive salary that leaves about $215 an hour left. So its just not benign.

The big problem is that a lot of private groups like to blur the lines and offer fake physician ownership as a way to help attract naive residents.

For the real owners its a quick and easy method to use to justify paying lower salaries to physician empolyees and keep more of the profits.

Remember technically speaking if 5 people own 50% of the stock and 50 people own 50% of the stock then its still "physician ownership."