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Yes precisely. I mean, as an example, eat what you kill with the same overhead % for each person, not some special “partners get a $150k bonus no one else gets” deal.
Another good SDG bites the dust
Started by ERMudPhud
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Right I can make a 10 page list of rules the but the basic premise of radical transparency is the root. Open books. Fair scheduling. Fair income split. Scheduler needs a fair stipend. Director needs a fair stipend and some schedule adjustments. But openly. Honestly.
It’s a lovely show. Highly recommended. I didn’t find the tone shift as jarring but… look what we do for a living.
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It should be pretty easy even for a new grad to tell the difference between a democratic group and a group that's private but owned by a few people. And if you can't, well you're just kinda dumb.
Correct, it's comp structure. Equal income per work done is what janders is getting at. If you see on average 20 patients per shift, you will make (within a margin of error based on collections) the same amount per shift as anyone else seeing 20 patients per shift, regardless of how long they've been there.
When you get to the poker table, if you can't identify the sucker, the sucker is you.
Credit to those docs.. they are not going out without a fight. They are working on making it incredibly ugly which is the move. I find it hard to imagine after they try to take down the hospital they will be welcomed back but kudos for the effort and playing the game the CMG way.
AAEM put out a statement backing the local Eugene group over the corporate group.
www.kezi.com
American Academy of Emergency Medicine extends support for EEP amidst PeaceHealth changes
PeaceHealth is ending its contract with Eugene Emergency Physicians (EEP) and hiring ApolloMD to manage emergency services; all 41 EEP clinicians have chosen not to work for ApolloMD, and the
Meanwhile acep is focused on issues that only tangentially touch em. Busy with social issues as our specialty burns with a CMG goon leading the broken organization.
Wouldn't 100% agree with that. Tony isn't a bad guy. The org has definitely swung left, but they are very focused on improving Medicaid and Medicare rates for EPs. Unfortunately it's tough to outspend the insurance lobby. And not shockingly, too many EPs don't put their money where their mouth is. People should be donating to NEMPAC, but probably don't even know what that is. AAEM is nice and all, but they're a nobody - old man screaming at the clouds vibes.
And I hope they succeed. But they're not getting any clout on the national stage for CMS compensation. I support for AAEM and acep, but EPs need to put up some money.
AAEM > ACEP and it isn’t even close.
I agree I like their policies more.
You can say it as many times are you want, but AAEM does not have the lobbying power of ACEP.
I've never met him but he was top leadership at USACS when they partnered with PE firms, went after SDG contracts, decimated local EM markets, severely reduced pay, cut staffing to dangerous levels, and let midlevels work shifts completely unsupervised in all their emergency departments.
I know he advocates for ACEP for increased reimbursement from private insurance companies but I wouldn't call him one of the good guys.
I don't think he's good or bad.
These things are often nuanced
Insurance / CMS is the Dominion and CMGs are the Romulans.
Sometimes the enemy of your enemy is your friend.
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It's not nuanced when you're one of the top brass at USACS. Just because he advocates for some things that could benefit you doesn't make him a friend. He'd take your contract in a second if he could.
Okie. Don't give any money to the org has hat has national power. Give it to the one with zero.
Logical
AAEM actually cares about physicians, and thus does not have CMG backing
ACEP is a CMG shill
As someone else said here, physicians would need to actually pony up some money to do some decent lobbying because TeamHealth isn't gonna back AAEM
I was AAEM only until leaving the field. Refused to give ACEP another dime once I found out they were a wolf in sheeps clothing. ACEP can indeed lobby, but keep in mind they're gonna lobby for things that matter to their CMG overlords. So that's why you'll never hear them talk about residency expansion or midlevel encroachment. It's all billing billing billing....the only shared interest they have with pit docs
Residency expansion and midlevel encroachment don't really matter if you own your job. Billing is much more proximal.
That’s exactly what I do. AAEM can’t get bigger without support.
I like it. Rare to see an EP put their money where their mouth is.
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No. It's all the same. You only own your job until PE backed CMG tells your friendly neighborhood health system leadership that they can staff your hospital better using HCA grads willing to work for half pay supervising a grossly unsafe level of inexperienced NPs.
Sounds like an AcEP apologist. Tony may not be a bad guy but i have it on good word that he thinks EM docs are too stupid to run their own groups. It’s fine.. but Ill keep saying this til im blue in the face.. Medicaid and medicare rates have little to no impact on what a CMG will pay their EM docs. On top of that specific to ACEP.. EM has done worse than any other specialty when it comes to a pay bump post covid. So while AAEM is the little dog and imo have their direction often pointed in a misguided manner they always stand for the actual doc unlike ACEP who stands for the PE backed organization.
I wouldnt donate to NEMPAC nor any other ACEP run item. ACEP needs a harsh truth. Fortunately, the financial strain of CMGs has made it less common where the CMGs would pay ACEP dues for their docs. Ming Lin also knew acep would suck and he got his support from AAEM. The NES docs as well.. ACEP rarely if ever takes a difficult stance that supports EM docs. At best they oppose insurance. Thats not a difficult position. But they consistently support the envisions, TH, USACS types. Screw ACEP.
As said above and this matters a lot. ACEP lobbies for things that benefit CMGs. If on the side it also benefits SDGs and pit docs.. great.. but thats not the intent and in this case it matters.
Good thing I don't work for a CMG then.
You can take a principled stance and not donate to NEMPAC and instead to AAEM. Just know that it's not doing anything for you.
You know those 500k/yr salaries people here love to brag about? That doesn't happen without private insurance being kept at bay.
Yep. I agree. That’s pretty shortsighted though. I’m in an SDG. We do well. But if the goal is just personal you may be right but I do advocacy as well. Congress sees acep as equal to PE. Again, our specialty has done the worst of any specialty post covid. That falls on acep incompetence. Additionally, CMGs run EM. ACEP represents CMGs. If I can make 500k that’s great but I’m at the point in life where it doesn’t matter that much to me. It’s about looking out for everyone. That’s been my focus for a long time. I do whatever I can to not give a single penny to acep. I tell docs I know that they shouldn’t donate or join. I don’t care. It’s self destruction for our specialty. If you believe acep has done such a kick ass job why have we sucked the last 5 years as a specialty financially as compared to our peers.
Probably because of EMTALA. We don't have a choice, and they (the government) knows it. Why would they pay us more...to be nice? EMTALA has destroyed this field. This won't change until rich/powerful people start dying in ERs secondary to boarding etc. we all know this won't happen because the second a "VIP".shows up, all resources are diverted to them.
I also didn't say they've done a kickass job. I support both ACEP and AAEM. To have such a black and white perspective regarding ACEP is impractical.
EPs are great at complaining about their jobs, but few leverage their money and time to try to change things.
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I have no dog in this particular fight, but I'd say this is a near universal truth among physicians in general. And the ones who complain the loudest are typically the ones who do the least to actually effect change.
My previous statements are clear i think aaem leaves much to be desired but they stand with EM docs.. ACEP stands with cmgs or more accurately bend over for cmgs.
ftfy
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If that's your choice, then yes.
ApolloMD is in full on disaster mode apparently.
Reportedly offering 400+ hr but can't find locums docs.
Yogin is writing news articles in the local papers and pleading with the local docs to join his newly created lane emergency physicians which
he then claims will be a new locally run practice of emergency physicians even though the company is registered in Atlanta Georgia and
lists its principal location of business in Atlanta Georgia which just so happens to be the location of their ApolloMD headquarters.
Reportedly offering 400+ hr but can't find locums docs.
Yogin is writing news articles in the local papers and pleading with the local docs to join his newly created lane emergency physicians which
he then claims will be a new locally run practice of emergency physicians even though the company is registered in Atlanta Georgia and
lists its principal location of business in Atlanta Georgia which just so happens to be the location of their ApolloMD headquarters.
ApolloMD Calls It a Homecoming. The Public Record Tells a Different Story.
A Warm Letter From Atlanta That Answers Nothing
martywilde.substack.com
It really amazes me how people speak with such authority when they have absolutely no clue what they're talking about. Many ApolloMD sites are in the $300-350+ per hour range. $400/hr is not that unheard of. It's the way ApolloMD does things -- they do not take a large portion off the top.
The article written by AAEM showed just how ignorant they are of ApolloMD structure. ValorBridge was founded by one of ApolloMD's founders, and the majority of people behind ValorBridge are in fact physicians (I personally know five physicians who are investors of ValorBridge). Unless something has changed in the past two years, the only debt ApolloMD has is the building in Atlanta, which was structured at <2% APR.
For the record, ValorBridge is a capital/asset management fund and not a private equity fund. Although people may think they are the same thing, they are not. Capital management firms invest in things without seeking to gain control of their investments. Private equity firms not only seek to gain control of their investments, but they also divest things by selling off portions of the investment's assets. Take a look at what Golden Gate Capital did with Red Lobster. It sold off its real estate and then turned around and leased it back to Red Lobster. Although named Golden Gate Capital, it is, in essence functioning as a private equity firm.
Lane Emergency Physicians may be registered in Atlanta (which is odd considering the majority of LLCs are registered in Delaware), but once a local medical director is secured, it will be run by that medical director without corporate oversight. In my 17 years with ApolloMD, I have not had corporate telling me how to practice locally. Physician leadership are still required to work clinical shifts. Presidents, CEO, they all work clinical shifts still so they are not out of touch with the "boots on the ground."
As I've said before, I have been very happy with ApolloMD and will likely retire with them. Everyone thinks the SDG is always the good guy, but that's not every case. There is a reason the local group didn't retain the contract. That information is not being written about in the articles. Just like the SDG lost the contract, if ApolloMD can't perform, it too will lose the contract.
I implore anyone who speaks about this actually validate the facts before making claims such as ApolloMD being private equity owned, loaded with debt, or in "disaster mode." It is far from the truth.
In the end, ApolloMD will survive.
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ApolloMD can kick rocks back to Atlanta. Hopefully, this bleeds them for a long time. CMGs are just as bad as predatory SDGs but to have 41 dos/midlevels from this SDG stand up to ApolloMD/hospital would suggest it is not a predatory SDG.
Also, how does it make you feel to know they are skimming from you right now to pay for $locum$ in OR?
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They aren't skimming from me to pay for locums in Oregon. We have a strike team that is staffing it. AFAIK, we have never used outside locums.
On another note, SDG's also "skim" to pay for their administrative staff, collections, etc.
The fact of the matter is that most SDGs have difficulty surviving in today's insurance climate because it is hard to negotiate with insurers when you're the little guy.
At any rate, we'll revisit this in one to two years and see where things play out.
AAEM doesnt matter? Here it is..ApolloMD Calls It a Homecoming. The Public Record Tells a Different Story.
A Warm Letter From Atlanta That Answers Nothing
The American Academy of Emergency Medicine tells a different story. AAEM President Robert Frolichstein publicly noted that ApolloMD was backed until recently by ValorBridge Partners, a private equity firm, and called on Oregon regulators to review the arrangement under Oregon’s SB 951, which restricts corporate ownership of medical practices.⁶ Tracxn, a venture capital data platform, lists ValorBridge Partners as ApolloMD’s sole institutional investor across $10.9 million in funding.⁷
What did ACEP do? Maybe Apollo wins out.. but its ugly. It hurts Apollo. Maybe the regulators will take a peak into the law that AAEM helped foster. Maybe nothing comes of it. But ACEP is standing by idly with its USACS leader as the mouthpiece. I dont know a single doc in that group (as far as I am aware) but man im proud of them making this messy, ugly and torching the system and apollo and the typical PE/CMG lies for all to see.
Ill say locums companies have been engaged thats for certain for this contract. Similarly, in my local area they have 1 contract and locums recruiters have reached out to me.
I hate to do this but those above statements are not accurate based on their current business model.
Here's an interview in a Wall Street Newsletter with their own investment director Simeon Wallis:
"The ApolloMD organization is ValorBridge’s original portfolio company."
"We can often provide capital as debt, mezzanine securities, or common equity."
"In the capital structure we’re above the ceo and the founders who own common equity."
"We do a back of the envelope IRR calculation, thinking five years out. On the public side, our holding period might be three to five years. It might be on the early side of that five-year IRR. Price will be a component of the process. With the private investments, we actually expect to hold
longer than five years; there’s more opportunity to influence the outcome because we’re going to have more control."
"The value creation in the private equity business model comes from the willingness to engage at a board level and control two key things.
First is having significant influence over capital allocation decisions, and second is having significant influence over the management team, including picking the c suite and the incentives that are implemented."
Newsletter for value investors at Columbia Graduate School
Regardless of what your bosses have told you that is essentially the literal definition of private equity.
Sadly from experience these corporate groups will often mislead or flat out lie to all of their docs.
Of course ApolloMD is ValorBridge's original portfolio company. It was founded by one of ApolloMD's founders.
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Your group is a cancer to EM. Full stop.
Oh you mean like ..the essential functions of a group?
You're a very reasonable person and I agree with you often and you almost always have well thought out takes but, in my opinion, your take on this is clouded by your employer. I'm glad they have treated you well and you feel they have been fair to you but outside money (I don't care if it's PE or a capital/asset management fund) has no business being in medicine and, more specifically, EM.
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Your opinions are noted. Thank you.
I have been out of the SDG vs CMG/PE game and have been through the battle as much/more than most on here. I have no dog left in this game and fortunate to be owning the practice of medicine without fear of anyone influencing our group decisions.
But you can not believe the bold above do you? Do you think any "investment firm" would put a large money into a project and NOT have some say in their investment? They are not a bank who loans at a fixed rate then happy to collect their 6-8%. That is NOT, let me reiterate NOT their model. Their goal is to invest, push up the value, then exit in 3-5 yrs.
If you think they are sitting idle for 3-5 yrs without a large say in operations, then have accepted a bridge someone is selling.
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The founders of ValorBridge have been involved with ApolloMD for almost 40 years, which is outside the 3-5 year model you quote. ValorBridge does not own the majority of shares of ApolloMD. A very large number of physicians (including myself) own shares of ApolloMD.
Without giving out specific information that I would rather not post on a public forum, all I can say is that the majority of forum users above that claim to know how ValorBridge and ApolloMD operate are ignorant of the true structure. AAEM's president is definitely ignorant of how it is structured.
I mean you can say everyone is wrong but then post the truth. I don’t vilify ApolloMD like I would and have USACS but to outsiders it feels very similar and honestly, the opinion piece by yogin was a horrific look for Apollo. It paints them IMO in a worse light than they are.
I'm not sure why he's afraid to post the company info since it's publicly available on their website.
ApolloMD Employee Ownership’s Impact - ApolloMD
Employee ownership is an everyday philosophy that sets ApolloMD apart from other group practices that provide specialty services to partner hospitals.
apollomd.com
The official SEC filing for a new company named ApolloMD Partners inc back in 2018 in Delaware
Pretty funny. All their quotes are from PAs and one even says “I don’t make corporate decisions”. Isn’t that kind of the point? If you have local issues do the local owners not get to vote on how their department is ran?I'm not sure why he's afraid to post the company info since it's publicly available on their website.
ApolloMD Employee Ownership’s Impact - ApolloMD
Employee ownership is an everyday philosophy that sets ApolloMD apart from other group practices that provide specialty services to partner hospitals.
The official SEC filing for a new company named ApolloMD Partners inc back in 2018 in Delaware
