Career Guidance Needed

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WhatJobDoIPick

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I am early-mid career Emergency Medicine, currently W2 employed by a large hospital system and have been given the opportunity to join an independent democratic group. Their partnership track seems fair (2 years; minimally more hours than I work now). Their pre-partner pay is essentially the same as I make now (maybe even a little more), which makes the financial risk of joining essentially zero. Obviously, there are significant benefits once you make partner.

Current job: I've stagnated, professionally and financially. My pay has risen 7% since 2020. Really no opportunity for growth. It's obvious that there's no culture of change or improvement here. I've tried to get involved with leadership, but it seems like they're looking only for "yes men" and I do not fit their mold. The BIG pro is that I do not work any overnight shifts as there are nocturnists (this is a benefit that could go away if group composition changes). I've become increasingly frustrated and bitter in this job as there are people who have been there a long time, who get paid much more than I do (hundreds of thousands), who are less productive (pay is based on time served NOT production, but read on). I was able to tolerate this when I thought the same income would eventually be attainable for me, but the hospital scrapped the previous compensation system, and what was attainable before will never be attainable now.

Many people have "sweetheart" deals:

1) One nocturnist works an extreme number of shifts, although does not work on said shifts. They grossed 1 million last year. This is not an exaggeration. They disappear on shifts / scroll on phone, leaving the swing doc to see all the patients. They have been banned from working at one of our sites because of a huge nursing rebellion. Admin is aware, and takes no action, because they rely on this person to stabilize night coverage.

2) Multiple "boomer" types that work only day time weekdays, never swing or nights, never weekends or holidays, never high acuity shifts

3) An admin group that works minimal shifts (chair worked 2 shifts all summer), never swing / nights / holidays / high acuity. Disappear for "meetings" while on shift.

All of the above make more money than I do, and it is extremely frustrating.

New Job: Group is expanding. They currently staff a handful of hospitals across a few systems. They seem successful and that they "get it." There will be higher expectations in terms of metrics and patient satisfaction (this will be an adjustment). The major con is I will have to work about 3 overnights a month. The commute is also longer: about 45 minutes compared to my 20 now, which to be honest, doesn't bother me (I can decompress post shift, listen to pods, etc.).

I feel somewhat disappointed and nostalgic regarding the current job: I joined thinking it would be my last job and knew a lot of the leadership and group members previously. I had high hopes. However, COVID happened, and everything changed. It's obvious the hospital system regards the ED as a loss leader, and there is no respect from either departmental or hospital leadership. I've gone through cycles of relative frustration w this job before, but stuck it out thinking things would somehow improve or change...it hasn't. Many people have left (docs and midlevels...it's the typical EM carousel I guess).

Any pearls or words of wisdom would be appreciated!

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This sounds very obvious to me. 3 night shifts a month is a joke. If you can’t handle 3 nights no idea why you thought you’d fit EM. Take the SDG job.
 
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It sounds like you’ve got bad leadership, and that’s really what I think you should try and figure out for the next job; what’s the quality of the leadership there?

Bad leadership at your current job has allowed for inequality (I.e. in pay, scheduling, etc.) and has misaligned the goals of the physician group by allowing a bad nocturnist to stay, believing that the goodwill of maintain a nocturnist group and not having the majority of the group work nights makes up for keeping a bad colleague. It sounds like you have little hope for change occurring in your group, since the compensation structure is now such that you won’t benefit from the former pay inequality and who knows if you’d get to take advantage of the schedule inequality one day either (when you’re the boomer attending).

Nights stink. Working 3 night shifts a month is manageable, however. Working at a place you feel like you have no future at is not manageable.
 
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I’ve worked with those “warm body” types in the past and it’s honestly excruciating if there’s not an RVU or productivity system. Like if you’re gonna staff the ED with someone who isn’t going to do the job just pay me double and I’ll see everyone since that’s basically what’s happening anyway.

One doc saw 11 pts on a 12 hour shift, only dispod 6 of them and signed out the other 5. I can’t imagine paying someone for a whole shift at that level of productivity.

Get out of that place man, sounds like you’re working in a clown factory.
 
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No brainer, take the new job. Pay inequality within a group without productivity or partnership track sounds like a disaster. Once settled in the new job you can set up a nocturnist program.
 
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I'm a little perplexed about how your current pay structure. Is it just hourly pay? Where does the money come from for these people? Sounds insane. What is the chair doing to earn their pay?

Get out.
 
Update:

Signed with the SDG.

Put in notice with dystopian nightmare shop.

Here's hoping for a bright future!
 
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Does anyone have a good resource for learning about the economics of modern EM billing / SDG type operations?
 
Congrats on your new job. Ask the billing company for your SDG. Most of them should have a powerpoint on coding, billing, economics etc... If they do their own billing in house they should still have some resources for new hires. Also AAEM has their "Rules of the road for young physicians"
 
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