CMG Employed and Enjoying It?

[theblueswede]

I would love to someday be a part of a small democratic group of emergency medicine physicians. If I choose to pursue EM, I will try to make this a reality. But, given the trends, I'm interested to hear the perspective of EM docs that are employed by a CMG and have had a positive experience. Much has been said of the negatives on this forum, so I am looking for the other side of things.

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[namethatsmell]

Having worked for a CMG, the happiest folks tend to be: 1) the new grads who think the job is awesome as they have nothing to compare it to and 2) the physicians admins. Once you work for the CMG for awhile you realize there's no real path for things to get better for you over time, other than trimming hours or trying to become an admin yourself if you can stomach it. Along the way, the CMG will slowly demand more from you and your time without giving you extra resources or compensation--rather, they'll try to cut these things. Every year will be like groundhog day in this regard. It will become painfully clear you're essentially a cash machine for non-clinical people who really couldn't care less about you or your patients.

That said, the daily life of working for a CMG really boils down to the site you work at. There are EDs in the Team, USACS, and Envision portfolios that aren't terrible to work at. Then there are sites that are raging dumpster fires with a seemingly endless supply of fuel.

In my opinion, if you have to work for a CMG, the best way to protect yourself is to work at one of their sub 20k visit sites. Generally, they have decent staffing and the metrics are a bit less of an issue. Or work at one of the major tertiary sites the CMG highly values -- at these places the CMG knows if they pull major shenanigans they'll lose the contract. Working at these two ends of the CMG extreme will make your life easier on many levels.

The worst place to work for a CMG are their 40-60k sites with limited specialty support and where the ED is outsized for the hospital and you have to transfer frequently. You'll hear about metrics but have no resources to satisfy them. These are the places where the CMGs will most readily cut MD staffing and replace them with midlevel hours. Your liability and work load will increase and your pay will not. The CMGs will do other things without regard to you or your patients' well-being if it improves their short-term bottom line since they don't really care as much about these sites.

 

[Osteoth]

Having worked for a CMG, the happiest folks tend to be: 1) the new grads who think the job is awesome as they have nothing to compare it to and 2) the physicians admins. Once you work for the CMG for awhile you realize there's no real path for things to get better for you over time, other than trimming hours or trying to become an admin yourself if you can stomach it. Along the way, the CMG will slowly demand more from you and your time without giving you extra resources or compensation--rather, they'll try to cut these things. Every year will be like groundhog day in this regard. It will become painfully clear you're essentially a cash machine for non-clinical people who really couldn't care less about you or your patients.

That said, the daily life of working for a CMG really boils down to the site you work at. There are EDs in the Team, USACS, and Envision portfolios that aren't terrible to work at. Then there are sites that are raging dumpster fires with a seemingly endless supply of fuel.

In my opinion, if you have to work for a CMG, the best way to protect yourself is to work at one of their sub 20k visit sites. Generally, they have decent staffing and the metrics are a bit less of an issue. Or work at one of the major tertiary sites the CMG highly values -- at these places the CMG knows if they pull major shenanigans they'll lose the contract. Working at these two ends of the CMG extreme will make your life easier on many levels.

The worst place to work for a CMG are their 40-60k sites with limited specialty support and where the ED is outsized for the hospital and you have to transfer frequently. You'll hear about metrics but have no resources to satisfy them. These are the places where the CMGs will most readily cut MD staffing and replace them with midlevel hours. Your liability and work load will increase and your pay will not. The CMGs will do other things without regard to you or your patients' well-being if it improves their short-term bottom line since they don't really care as much about these sites.

What is it the process like to become an admin of a CMG?

 

[Rekt]

What is it the process like to become an admin of a CMG?

Chapped lips.

 

[deuist]

What is it the process like to become an admin of a CMG?

In many instances, becoming a site director is as simple as applying. TeamHealth and Envision regularly advertise on their websites and in the back of throwaway journals. The thing about CMG admin is that the jobs are thankless tasks with little upward mobility. You get to look forward to always being on call, getting paid less, and hearing 360 degrees of complaints.

 

[deleted547339]

Chapped lips.

No no no. It’s most along the lines of carpet layers knee.

 

[Birdstrike]

What is it the process like to become an admin of a CMG?

 

[TooMuchResearch]

What is it the process like to become an admin of a CMG?

Self loathing.

 

[Ceez]

I've worked for a few of the large CMGs and a small democratic group. They are all capable of taking advantage of you.

 

[AlvinKamara]

How do you mitigate being taken advantage of? Is it possible to find a good equilibrium, see patients, make money without being bothered by too many parties if you keep your head down?

 

[GonnaBeADoc2222]

How do you mitigate being taken advantage of? Is it possible to find a good equilibrium, see patients, make money without being bothered by too many parties if you keep your head down?

No.

Being facetious here. Yes, it's pretty easy to just show up, do your work, and go home.

 

[deuist]

How do you mitigate being taken advantage of? Is it possible to find a good equilibrium, see patients, make money without being bothered by too many parties if you keep your head down?

Yes, I only see patients. I serve on no committees. I delete every email that I get saying that our metrics need to be improved. At the end of the day, the hospital needs me a lot more than I need the hospital.

 

[GeneralVeers]

I actually love just being able clock in, collect my hourly, and clock out. No admin, no committees, and no extra work. CMGs aren't all that bad to work at if you approach it like this.

 

[dchristismi]

A CMG ate my main group about 4 years ago. At that time I was the asst director, and I told them point blank that I hated doing admin, and would quit on the spot if they made me. And that's how they left me alone for quite some time. I was really burned out.

I got to do as Veers - show up, collect my hourly and RVUs and leave, although I was a 1099 IC and got to dictate that I didn't want to work more than 10 shifts a month. (That control was huge - being able to dictate what I would and wouldn't do was incredibly liberating.) In any case, I ended up leaving, but had good friends step into leadership positions. And for the most part, it's a lot of unpaid work and responsibilities.

If you look at it as a job that pays the bills, it's as tolerable as many non-medicine jobs. If you want it to be your overarching passion, well, maybe not?

 

[southerndoc]

I'm an associate medical director and core faculty of a residency. I get a stipend for my administrative time. Nobody should do administrative duties for free.

 

[Osteoth]

In many instances, becoming a site director is as simple as applying. TeamHealth and Envision regularly advertise on their websites and in the back of throwaway journals. The thing about CMG admin is that the jobs are thankless tasks with little upward mobility. You get to look forward to always being on call, getting paid less, and hearing 360 degrees of complaints.

So if the job sucks so bad why did OP say that the people who do the jobs are happier than just the rank and file pit docs?

 

[GeneralVeers]

I'm an associate medical director and core faculty of a residency. I get a stipend for my administrative time. Nobody should do administrative duties for free.

That's my issue with Vituity. Although the site directors get paid a stipend, there isn't reimbursement for being on a committee. The old group used to pay $900 for being on the Trauma committee and I'd gladly go back to doing that, however I'm not getting up for an early morning meeting where they bash ED docs for free.

 

[deleted497653]

I'm an associate medical director and core faculty of a residency. I get a stipend for my administrative time. Nobody should do administrative duties for free.

About how much is the stipend? I’ve always wondered about this. The position seems to draw a certain kind of personality based on my experience. They are people who like leadership roles wherever they go whether with cmg or sdg or church or neighborhood association president

 

[Groove]

I’m also AFMD for CMG and receive a stipend. I think it’s honestly probably the best admin position compared to FMD. Less responsibility, fewer requirements, less malpractice exposure. AFMD is primarily responsible for scheduling, filling sudden gaps in coverage due to emergencies and some committee stuff. Most do admin to reduce clinical shifts and because they enjoy leadership. FMD can get a sizeable stipend at a larger site. Most AFMD stipends are much less and equate to about 2 fewer shifts/mo give or take.

 

[EctopicFetus]

The eyes do not see what the mind does not know.

That’s the goal for cmgs. No option but an employed model. They are almost there.
They will collude and keep pay down or drive it down.

I am seriously worried about the future of em.

I see hope in the pendulum swinging away from the cmgs. But $$ talks.

 

[southerndoc]

I’m also AFMD for CMG and receive a stipend. I think it’s honestly probably the best admin position compared to FMD. Less responsibility, fewer requirements, less malpractice exposure. AFMD is primarily responsible for scheduling, filling sudden gaps in coverage due to emergencies and some committee stuff. Most do admin to reduce clinical shifts and because they enjoy leadership. FMD can get a sizeable stipend at a larger site. Most AFMD stipends are much less and equate to about 2 fewer shifts/mo give or take.

This varies by facility. I don't do scheduling. The other docs probably appreciate that.

 

[Arcan57]

@Groove is correct. AFMD is the sweet spot in terms of CMG administration. Have a hand in things but generally not excessive responsibility for factors outside your control. Main danger is FMD quits/is fired and then you’re doing their job without their salary or their protected time. That’s less fun.

 

[deleted109597]

The flip side is also true. Those surgeons, cardiologists, and internal medicine docs? They are eat what they kill FFS. Being on a committee prevents them from working those hours. It might still help their bottom line though. in EM, the patients beat down the doors no matter what we do. I'm not sure making the department more efficient wouldn't mean I would have to simply work harder, and with a CMG, I wouldn't get paid better for the most part.

 

[southerndoc]

One of the benefits to serving on those committees is developing relationships with consultants that is outside the ER. So when I call a neurosurgeon at 2 am with an admission, I don't have to go into as much detail as some of the other docs. I'm less likely to get resistance to things because they're going to see me once/month.

I've became friends with some of the surgeons and physicians I serve with on committees. It gives a sense of ownership of the hospital. It's not for everyone though. Some people are just worker bees. If it makes them happy, then great.

 

[TheComebacKid]

Just out of curiosity... when you work for a CMG that is affiliated with a residency program, other than your teaching/supervision that you perform on shift, is there really any difference compared to a standalone CMG site? Do you get compensated for your teaching role? Are you still held to the same metrics? Is resident education really a priority in these places, or are residents really just there to help you move the meat and increase the bottom line?

Vitiuity staffs a handful of EDs that are associated with what appear to be fairly decent residency programs. I am curious about what it's like to work as an attending in one of those places.

 

[deleted109597]

It depends. Are you core faculty or clinical faculty? The CMG may or may not pay for the academic time, it would depend on the contract. But yes, you can get paid for your time.
But usually not for committees.
Yes, the metrics don't change. You also get new metrics.

 

[Groove]

This varies by facility. I don't do scheduling. The other docs probably appreciate that.

Lucky goose. Virtually every shop I've been at required scheduling as part of AFMD duties. How'd you rig that one? Maybe it's different in academic land. I can't say I mind it that much at this point as I can knock out the schedule relatively quickly these days and run a tight ship in the requests/preferential treatment department so I get minimal whimpering below deck.

 

[deuist]

Do you get compensated for your teaching role?

We have a medical school affiliated with my hospital. The University pays me when students rotate through.

 

[emergentmd]

Unless you really like the admin stuff, being a Med director really sucks especially at a CMG. Much worse at a CMG where it is difficult to staff.

I was Med director when we were a private group. Not a bad gig. Went to more meeting than I like but atleast I had some control from the doctor's side. I was never had any illusion that I had any say from the admin side.

Once we were bought out by a CMG, I had no control from the admin and very little from the doctor side.

Now I work at a CMG that is difficult to staff and the director gets zero say b/c every doc knows that they can't find someone to replace them.

 

[MechEDoc]

Now I work at a CMG that is difficult to staff...

Masochist? Dropped as a child? Not trying to be an ass, but please tell me why you do this? It seems like such a raw deal that I'd rather take care of fibromyalgia patients all day than be a director with a CMG.

 

[thegenius]

The regional directors (on the West Coast) at TH allegedly make over a million dollars. What a great deal. You take no personal risk and make a million dollars/year flying to meetings, responding to pissed off doctors, and letting other people take on legal risk while you live in a big fat house.

 

[emergentmd]

Masochist? Dropped as a child? Not trying to be an ass, but please tell me why you do this? It seems like such a raw deal that I'd rather take care of fibromyalgia patients all day than be a director with a CMG.

I lasted about a yr after our SDG was "bought out" by a CMG. I could have played the game, collected my director pay, and called it a day but wasn't worth it.

 

[deuist]

The regional directors (on the West Coast) at TH allegedly make over a million dollars. What a great deal. You take no personal risk and make a million dollars/year flying to meetings, responding to pissed off doctors, and letting other people take on legal risk while you live in a big fat house.

Do they advertise for these jobs?

 

[MechEDoc]

Do they advertise for these jobs?

If that's what they're paying, then they are definitely overpaying the last two RMDs I knew.

 

[GonnaBeADoc2222]

If that's what they're paying, then they are definitely overpaying the last two RMDs I knew.

I am very skeptical of this

 

[EctopicFetus]

The regional directors (on the West Coast) at TH allegedly make over a million dollars. What a great deal. You take no personal risk and make a million dollars/year flying to meetings, responding to pissed off doctors, and letting other people take on legal risk while you live in a big fat house.

The regional guys at emcare make 450k plus stock and other benefits. No way RMDs get $1M maybe a few who are actually good but most of them are sleaze balls who no one likes.

 

[deleted109597]

The regional guys at emcare make 450k plus stock and other benefits. No way RMDs get $1M maybe a few who are actually good but most of them are sleaze balls who no one likes.

They're like those bad nurses. The ones that get transferred to other units rather then disciplined.
CMG has a doc who is terrible. Horrible PPH numbers. Might get decent PG because they're so slow they talk to the family. Lots of complaints to MEC about their care. So what do they do? Promote them up out of patient care into management. You think the CMGs are going to take their golden goose (good, fast physicians) and slay that for management?

 

[emergentmd]

I have been offered by CMGs directorship ever few years. I might have to reconsider if I can make 1 Mil a year.

 

[Arcan57]

They're like those bad nurses. The ones that get transferred to other units rather then disciplined.
CMG has a doc who is terrible. Horrible PPH numbers. Might get decent PG because they're so slow they talk to the family. Lots of complaints to MEC about their care. So what do they do? Promote them up out of patient care into management. You think the CMGs are going to take their golden goose (good, fast physicians) and slay that for management?

1) RMD is a suck job that’s making no where near a million a year. At that level you’re looking at division president who probably got the job by selling their SDG to the CMG. From what I’ve seen that’s a pretty sweet gig, but it comes at the price of having worked a succession of sick jobs for 15-20 yrs.

2) Plenty of good, fast docs become FMDs or AFMDs. The skill set is completely different than being a good clinical doc. Being management has some fairly significant downsides. A doc that’s very good clinically but only ok at management is going to have less incentive to stick it out.

3) It’s very difficult to be director and maintain clinical efficiency because people (docs, nurse managers, c-suite) see you in the ED and assume you have the bandwidth to deal with whatever issue they currently have with the ED. So you find yourself being pulled into conference calls on shift, spending 20 min soothing an entitled consult that got their feather’s ruffled, calling back a patient who’s complaint is deemed “emergent”. You can avoid some of that by working at night but then you have to represent at meetings which is tough to do on no sleep.

tl;dr FMDs aren’t selected for sucking clinically, they’re just less penalized for it

 

[deleted547339]

They're like those bad nurses. The ones that get transferred to other units rather then disciplined.
CMG has a doc who is terrible. Horrible PPH numbers. Might get decent PG because they're so slow they talk to the family. Lots of complaints to MEC about their care. So what do they do? Promote them up out of patient care into management. You think the CMGs are going to take their golden goose (good, fast physicians) and slay that for management?

The one guy I know who moved up a CMG rapidly was a guy who would routinely see 4+pph. Basically, “Hi, I’m doctor malpractice. Yea, you’re admitted.”

 

[jw3600]

The one guy I know who moved up a CMG rapidly was a guy who would routinely see 4+pph. Basically, “Hi, I’m doctor malpractice. Yea, you’re admitted.”

If the hospitalist is down, why not I guess?

 

[deleted109597]

The one guy I know who moved up a CMG rapidly was a guy who would routinely see 4+pph. Basically, “Hi, I’m doctor malpractice. Yea, you’re admitted.”

I said good and fast. Not just fast. Otherwise regional managers would be NPs.
Of course, I bet that happens pretty soon anyway.

 

[jw3600]

I said good and fast. Not just fast. Otherwise regional managers would be NPs.
Of course, I bet that happens pretty soon anyway.

They already manage ICUs. Seems like natural progression.

 

[EctopicFetus]

I said good and fast. Not just fast. Otherwise regional managers would be NPs.
Of course, I bet that happens pretty soon anyway.

Like usacs. It’s happened.

 

[thegenius]

Just heard news that our hospital is cancelling our TH contract in the winter. All the ER docs will now be independent contractors under our Hospital Foundation's group. We are having a meeting with them soon to talk about details. Our group is generally excited, although a little nervous. I can say with certainty, however, that just about all of us really despised TH. They made regular errors with our payroll every year, happened 3-4 times. I simply cannot trust them at all, I trust nothing that they do.

Anyway...EctopicFetus I'll be PM'ing you shortly about some questions. We are going to become a pseudo SDG and I'm excited about that.

 

[MechEDoc]

Just heard news that our hospital is cancelling our TH contract in the winter. All the ER docs will now be independent contractors under our Hospital Foundation's group. We are having a meeting with them soon to talk about details. Our group is generally excited, although a little nervous. I can say with certainty, however, that just about all of us really despised TH. They made regular errors with our payroll every year, happened 3-4 times. I simply cannot trust them at all, I trust nothing that they do.

Anyway...EctopicFetus I'll be PM'ing you shortly about some questions. We are going to become a pseudo SDG and I'm excited about that.

I've seen multiple errors with Team Health pay / compensation. Some were willful with Team Health intentionally short changing physicians. Sometimes it was hidden behind a non-disclosed RVU formula change ("Sorry! Work harder now."). Some lawyered up and recovered some money. It took me about 8 months of nagging to recover about $50,000 that I was being shorted. Never trust Team Health, double check all their pay.

 

[Arcan57]

The RVU sites for Team tend to f&$! up payroll periodically. I’ve never seen them fail to issue a check right away when notified but you do need to keep a close eye on things.

 

[thegenius]

I've seen multiple errors with Team Health pay / compensation. Some were willful with Team Health intentionally short changing physicians. Sometimes it was hidden behind a non-disclosed RVU formula change ("Sorry! Work harder now."). Some lawyered up and recovered some money. It took me about 8 months of nagging to recover about $50,000 that I was being shorted. Never trust Team Health, double check all their pay.

We've tried double checking their pay, and at the end of the day we only have access to the data they send us. We can't peer into their bank accounts. They are 100% not trustworthy. So sad I will never say a good thing about them again.

 

[emergentmd]

How can you tell when TH spits out the RVU? There is no way to make sure they don't short change you. Its like a magic wand they can wave and put out any number they want.

 

[thegenius]

Really energetic people who have a lot of time to kill can keep a log of all the patients they see, then compare it to a log of the patients TH says you see and the RVUs generated. I did that for several months. It didn't lead to much. Sometimes I wasn't sure why I got a 99284 and not a 99285 for a chart, but it's too much work to inquire about that. Plus, they could just gie you less RVUs. They could credit you for 99284 even though they billed for 99285. They can do whatever they want. They do not, as most CMGs that I have gathered, give you insight into the billing process.