Mr. Hat

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So I have a potential job offer from a democratic group that I could see really enjoying working for, in an area where I would really like to live.

However, there is one concern I have and I would value some advice.

The way the group works is that you work for them for three years as a non-partner at an hourly rate. This rate happens to be about $50 an hour less than what other groups in the area offer and is pretty low in terms of national percentile. However, at the end of three years, you become a partner and your "sweat equity" from those years is your buy-in. (This as opposed to the model where you work as an employee at a normal hourly rate for however long, and then when/if the group decides to offer you partnership you have to pay a large sum of money to the group).

The group can of course terminate you anytime in the first three years or you could quit, but they assure me that this is extremely rare and I think are even willing to open the books on this.

Nonetheless, a concern remains for me: If I fail to make partner for any number of reasons (they terminate me, I quit, the group gets bought out, a CMG woos the hospital away, etc), then I have just spent months or years working at an extremely low hourly rate, all for nothing. (As opposed to working at a normal hourly rate and having to pay in to get partnership - at least if I don't make partner I have all the $$$$ I was saving to buy in. No harm no foul).

Is this "sweat equity" thing something that should be a red flag, or is it fairly common among democratic groups? Am I just making a big deal out of nothing?
 
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GeneralVeers

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Before doing it, I would make sure to find out what you are making once you hit the three years. Honestly if you're only getting $200-$300/hour after 3 years of being a slave, then it's not worth it. There are plenty of jobs nationally that will pay close to that, however you may not get your desired living situation.

In general I would stay away from any group that requires sweat equity for low pay.
 

Birdstrike

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So I have a potential job offer from a democratic group that I could see really enjoying working for, in an area where I would really like to live.

However, there is one concern I have and I would value some advice.

The way the group works is that you work for them for three years as a non-partner at an hourly rate. This rate happens to be about $50 an hour less than what other groups in the area offer and is pretty low in terms of national percentile. However, at the end of three years, you become a partner and your "sweat equity" from those years is your buy-in. (This as opposed to the model where you work as an employee at a normal hourly rate for however long, and then when/if the group decides to offer you partnership you have to pay a large sum of money to the group).

The group can of course terminate you anytime in the first three years or you could quit, but they assure me that this is extremely rare and I think are even willing to open the books on this.

Nonetheless, a concern remains for me: If I fail to make partner for any number of reasons (they terminate me, I quit, the group gets bought out, a CMG woos the hospital away, etc), then I have just spent months or years working at an extremely low hourly rate, all for nothing. (As opposed to working at a normal hourly rate and having to pay in to get partnership - at least if I don't make partner I have all the $$$$ I was saving to buy in. No harm no foul).

Is this "sweat equity" thing something that should be a red flag, or is it fairly common among democratic groups? Am I just making a big deal out of nothing?
I don't think the "sweat equity" thing by itself is a red flag at all. If they have a history of dumping people before the three years are up and there's a revolving door for non-partners, that's the big red flag. You have to weigh the risks of taking lower pay for 3 years for the promise you'll possibly get a higher rate thereafter.

You need to know how high that rate is.

You need to know the likelihood you'll get there.

You need to know the likelihood this group will keep the contract that allows it, after you make partner, and for how long.

You need to weigh the dollar amount your giving up for three years versus the amount you will get thereafter, multiplied by the likelihood you'll ever get that money and for how long.

A group where you pay for a buy in isn't without risk either. In fact, there is calculable risk. You could pay your dollar sum for the buy in and three weeks later the hospital could come in and say, "Sorry. We terminate your group without cause. After 90 days, you're out. Bye." Then you're working for the cme that took over and I guaran-f-ing-tee you the group you bought into is not giving you your buy in back.

There are way too many variables to say which is better. It all depends on various factors.

Also, focus on the people in the group you're joining. If your gut tells you these are solid, good, honest and trustworthy people, the rest will likely sort out for the good. However, if you get the sense you'd be getting in bed with people who are questionable or untrustworthy then, there may be more risk than you think, in either scenario.

Do your homework. Weigh the facts. And then make a decision. Go with your gut, your heart, feel good about it and dive in. There's only so much you can control. Remember that "perfect" doesn't exist. (The only exception to that is Donald Trump's hair).

Good luck.
 
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LaBusqueda

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With all the changes in healthcare reimbursement and such...my thoughts are there is a little more risk for these types going fwd, in terms of estimating future income. Granted, all EM jobs are vulnerable, but would hate to sacrifice three years, that seems like a long buy in these days.
 
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RustedFox

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I'd be careful for the exact reasons that Veers/Bird state. I recently interviewed with a demo group and everything seemed cool and rosy, then I talked to a couple of their old docs (whom I just happened to meet at other job sites, small world and all) - their "sweat-in" was three years of nights, and being told that they "had" to work that eighth shift in a row when there was no partner that "could work that shift".

Needless to say, I didn't take the job.
 
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BoardingDoc

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I'd be careful for the exact reasons that Veers/Bird state. I recently interviewed with a demo group and everything seemed cool and rosy, then I talked to a couple of their old docs (whom I just happened to meet at other job sites, small world and all) - their "sweat-in" was three years of nights, and being told that they "had" to work that eighth shift in a row when there was no partner that "could work that shift".

Needless to say, I didn't take the job.
I feel like the scheduling is something that should be apparent from the initial discussion with the hiring group. Did they not tell you what your schedule/sick call would be like?
 

bikERdoc

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I'll weigh in from the experiential side.

Recent residency graduate. 6 weeks into my new job in a brand new city. I joined a democratic group that sounds eerily similar to the setup you described. I know we're hiring, so it's possible we're even chatting about the same group. Who knows.

I started my job hunt up about a year ago. I was looking mostly in the west and a couple spots in the mid west. I got a handful of offers from some great groups. The midwest groups were transparent, nice people, and paid a lot of $$$ with some sweet benefits. The groups I looked at in the west either had buy ins or "sweat equity." I ended up signing with the a 3 year "sweat equity" group (ok, hate using that term...)

At 6 weeks in, so far I can say that I am first and foremost extremely happy. The group dynamics are solid, I'm working with some super smart people, and I'd say about 85% of the partners genuinely care about how I'm doing and adjusting to the new setup. The transition from residency to attending has been smooth, and all the nursing/ancillary staff has been truly awesome.

My after tax paychecks are in the 11-12k range. That, combined with my SO's paychecks gets us to around 15k per month.

I think the most important thing you need to figure out right now is how much money do you really NEED. Everyone is going to be different here. I'm in my early 30's, have no kids, and my student loans are not off the charts. Plus, I was able to refi and my rates are super low. I feel like I'm getting by fine on combined 15k per month (WAY more than residency!). No, I'm not putting massive amounts away for retirement yet, but I'll be maxing it hopefully within the next 6 months. I have a bad biking/skiing addiction, and I feel like I can buy some toys. Fortunately I don't have a bad Ferrari addiction, at least not yet. Money is a plenty.

For anyone that tells you the money isn't enough and you should look elsewhere, I call BS. Figure out what your financial needs will be like over the next few years, read WCI's book, chat with as many people as you can from your group, both partners and associates. Then go from there. No matter how much money I was making in the midwest, there was no way I could wake up and look at mountains every day. Money doesn't matter if you're not enjoying it. We trained WAY too long to settle on anything else.

The last point I will make is that most of my residency class is making a bit more than me. We all chatted about our sign ons over the last year. If I was really determined during my associate days, there are ways to increase income without killing myself. My group requires minimum of 12 eight hour shifts per month. After chatting with one of the partners, it sounds like some guys go out and do locums to help supplement. 3 twelve hour shifts done in one weekend in a place like TX put him well over the 50 percentile for ER docs. In addition, my group pays night differential. I've been contemplating picking up a few more nights, as I don't mind them so much. At least not yet. Something to consider if the money is really that bothersome.

That's my rant. Feel free to ask more questions. This topic hits close to home for me. Cheers
 

traxus

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I'm working currently as an independent contractor at an SDG in Texas with a sweat equity buy-in of 2 years. I'm making anywhere from 18-21K after corporate taxes. I'm also working 15-17 shifts per month and anywhere from 135-160 hours. I joined the group 1 year and 2 months ago. My wife and I are perfectly happy where I've ended up and are able to enjoy our money while pudding off my education loan which tops > 300k. I agree with bikERdoc that money is everything at this point in my life. It has allowed me to purchase a home while squirreling money away for retirement, able to help family, and all the while enjoying life.
 

RustedFox

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I feel like the scheduling is something that should be apparent from the initial discussion with the hiring group. Did they not tell you what your schedule/sick call would be like?
Ehh, it was a bit of an "unusual" interview to begin with. I don't want to go into details. Its a small world, and a smaller town. We had other things to discuss.
 

Groove

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It's not a red flag, per say, but should only be expected in very popular and desirable locations. I've never ran across a 3yr partnership track in the South though extended tracks of this length are not uncommon in places such as Denver, CO, etc...

You are right on the money with inherent risk in a lengthy "sweat equity" track, but then again... it's an calculated risk. You just have to do your due diligence. Personally, I don't believe in 3 yr tracks, period. I'm just too risk averse. I don't care if they've had the contract 30 years and promise the world. 1-2 is doable, but 3? It's like residency all over again. No thanks.

Also, I think partnership track buy ins, of any sort, should be avoided by all graduating residents unless they have their loans paid off and have an extremely high level of confidence in the location/group. If you end up leaving after 2 years at 50% pay, you really screwed yourself over.
 

NinerNiner999

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Been there, done that. Make sure of several things:

1) The books are transparent and you can see the K-1/1099 statement for each partner before you sign. You need to know what you're getting.
2) Contract the exact definition of partnership and what the criteria are.
3) **Most important** Contract an accounts receivable clause for you to retain your accounts receivable in the case your group gets bought out, sells out, or loses a contract. If the group you are joining is reasonable, and is willing to give you protection for loss of partnership not caused by you or them (i.e. the hospital), they will honor this protection for you. The should be willing to meet you half way and refund your sweat equity for reasons beyond either of your control.
4) check the debt/income ratio of the group. Are they carrying several loans? do they take loans for payroll? Where is the group invested? Is there any pending litigation for the group?
5) What is your responsibility when you become a partner? If the group is renting an office, has a few urgent care centers, advances payroll, and has a loan note, are you signing onto their debt as a partner of the company? Are you inheriting years of bad mistakes that the group needs to dilute?
6) How many of your future partners are near retirement, and what are their terms? Do they have golden parachutes? Have they negotiated their own retirement buyouts? Are you going to be paying more "sweat equity" after you become partner in the form of advancing your group's savings and principle to fund their retirement?
7) Again - make sure the books are open ask for a profit/loss statement.

I agree with some other posters about rate not being enough, I can say there is validity to what they say. Assume a 25% loss of income for the 3 highest liability years of your practice. Better yet, imagine investing in your retirement/paying off loans only to know that you are taking a 25% loss each year for 3 years. That a hard pill to swallow. at 1800 hours/year (typical "sweat equity" type of load), your "buy in" of "sweat equity" will cost you $90k per year - $270,000 over three. Assuming conservative 6% rate of return, compounded annually, for the first three years of your job, this equates to a total of $303,715 that you have lost from the prime years of your life. Figure out how much your hourly rate would need to be to catch you up, and generate wealth after that.

I would argue that if you are comfortable living off of $50/hr less, you should take a job paying market rate ($50/hr more), live off of $50/hr less, and invest the 25% you would otherwise pay in sweat equity for hat group. The odds of landing a full-time job for you to see huge returns over several years in the same small democratic group are very much against you. Especially with decreasing insurance reimbursement...

Put another way, if you work 3 years and save as above, over a 25-year career, your $303,715 could be worth $1.1 million in 22 years if you never invested another cent in a balanced portfolio...
 
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emergentmd

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I will be blunt. For ED Docs, during the current EM environment...... this group is PREDATORY.

If they were not, just pay you what you market rate. When you are ready to buy in, make the buy in 300K. If being a partner is worth it, then pay the 300K at that time.

Put the 90k a year, and if its worth it, then jump in. If not, then you have 300k and walk away.

There is WAY too much uncertainty for me to put in the "predatory" equity. Let me tell you what you could happen in 3 yrs

1. Hospital cancels contract
2. CMG takes you over
3. Life changes and you move
4. Partners gets greedy and do not offer you partnership
5. Reimbursement goes down and what partners make now is much less.

To me, its just not worth it. Its definitely not be worth it in 3 yrs.
 

emergentmd

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My after tax paychecks are in the 11-12k range.
I am glad that you are happy. Money is not everything, we all understand this. But 11-12k/mo means someone is stealing from you. The reason you will not believe this is b/c you just graduated and ignorant about the business of medicine. Remember medicine is just business. You may think everything is peaches now, but trust me... The business of medicine will hit you like a ton of bricks b/f you become partner.

I see docs around me settling for $160/hr IC, and I just can't believe any Boarded EM doc would settle for this. The only reason would be ignorance. I work in the same environment and I would not settle for anything close to this. But when you are ignorant, people can take advantage of you.

CMGs/SDGs all have the same goals. Maximize profits. If they can find someone to work for $160/hr, they will pay $160/hr.

I understand how to leverage EM shortage to my advantage. Just had a conversation to cover shifts today. I picked up two shifts at $525/h b/c I knew they were desperate. I am sure some other young docs would have jumped at $250/hr. And they were not too desperate and I know they were not desperate yet given that the shift is 3 wks away. If it was in the next 2-5 dys, I would have asked for $700/hr.
 
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Makati2008

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I am glad that you are happy. Money is not everything, we all understand this. But 11-12k/mo means someone is stealing from you. The reason you will not believe this is b/c you just graduated and ignorant about the business of medicine. Remember medicine is just business. You may think everything is peaches now, but trust me... The business of medicine will hit you like a ton of bricks b/f you become partner.

I see docs around me settling for $160/hr IC, and I just can't believe any Boarded EM doc would settle for this. The only reason would be ignorance. I work in the same environment and I would not settle for anything close to this. But when you are ignorant, people can take advantage of you.

CMGs/SDGs all have the same goals. Maximize profits. If they can find someone to work for $160/hr, they will pay $160/hr.

I understand how to leverage EM shortage to my advantage. Just had a conversation to cover shifts today. I picked up two shifts at $525/h b/c I knew they were desperate. I am sure some other young docs would have jumped at $250/hr. And they were not too desperate and I know they were not desperate yet given that the shift is 3 wks away. If it was in the next 2-5 dys, I would have asked for $700/hr.
I am wondering if any other posters are getting near these rates for last min coverage?
 

Arcan57

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I am wondering if any other posters are getting near these rates for last min coverage?
Depends on region. I know a doc that pulls in similar rates for going out to the smaller cities in southeast Texas (hell, it may be emergentMD). In other areas of the south you may get $500 for covering Christmas but the "I need a shift covered" rate is going to be 2/3 to 1/2 of that. From a group standpoint paying that high of an emergency rate just guarantees you'll always have holes in your schedule but if you can't recruit then it's the only way to keep the contract.
 
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Dakota

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Agree with the sentiments as well as the math above. $50 per hour less than the going rate for three years is more of a risk than I would be willing to take. Even if you make $100 more per hour as a partner due to the time value of money you have not broken even at the 6 year mark (3 years prepartner and 3 years partner).

Planning on six more years of stability to come close to breaking even is a definite gamble especially in the current environment.
 

emergentmd

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Depends on region. I know a doc that pulls in similar rates for going out to the smaller cities in southeast Texas (hell, it may be emergentMD). In other areas of the south you may get $500 for covering Christmas but the "I need a shift covered" rate is going to be 2/3 to 1/2 of that. From a group standpoint paying that high of an emergency rate just guarantees you'll always have holes in your schedule but if you can't recruit then it's the only way to keep the contract.
It is true that these rates are more readily available in out of the way places and typically seasonal. I have been there and done it. When I initially started doing locums, I worked for $325/hr per contract. This was an out of the way place that was a 4 hr drive but I opted for them to pay for my flight into the big city and drive 1 hr away. For the 12 hr shift, I made close to 4K. A good deal of money but that took 2 days out of my life (fly in , work, fly out). Not worth it IMO. It took me 2 months to figure out how the game works and how to leverage the shortage. I prob did this gig for 3 months (6 shifts) until i figured it out.

I now make my 1 hr drive into a big city (yes its well over 1 million people) and work my shift at a minimum $500/hr. Well worth it for me as I can drive to work and back the same day.

It may be true a few years ago where these rates were only available during the holidays but It is now available to me 5-7 times a month. I have my reg job where I commit 12-14 shifts so I can't cover all of these shifts. But I can squeeze in 2-3 easily. Its is definitely not seasonal anymore and definitely not only Night shifts. In fact, my $500+/hr rate is only offered to the CMGs for daytime shifts and if they want me to work an overnight shift, I am asking for atleast $550/hr and I have to have nothing to do.

Its there. Learn the game. Learn how to leverage it. Know that these shifts has to be covered and rates keeps going up until it gets covered.

This may not last very long but I am here to take advantage of the shortage.
 
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Makati2008

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It is true that these rates are more readily available in out of the way places and typically seasonal. I have been there and done it. When I initially started doing locums, I worked for $325/hr per contract. This was an out of the way place that was a 4 hr drive but I opted for them to pay for my flight into the big city and drive 1 hr away. For the 12 hr shift, I made close to 4K. A good deal of money but that took 2 days out of my life (fly in , work, fly out). Not worth it IMO. It took me 2 months to figure out how the game works and how to leverage the shortage. I prob did this gig for 3 months (6 shifts) until i figured it out.

I now make my 1 hr drive into a big city (yes its well over 1 million people) and work my shift at a minimum $500/hr. Well worth it for me as I can drive to work and back the same day.

It may be true a few years ago where these rates were only available during the holidays but It is now available to me 5-7 times a month. I have my reg job where I commit 12-14 shifts so I can't cover all of these shifts. But I can squeeze in 2-3 easily. Its is definitely not seasonal anymore and definitely not only Night shifts. In fact, my $500+/hr rate is only offered to the CMGs for daytime shifts and if they want me to work an overnight shift, I am asking for atleast $550/hr and I have to have nothing to do.

Its there. Learn the game. Learn how to leverage it. Know that these shifts has to be covered and rates keeps going up until it gets covered.

This may not last very long but I am here to take advantage of the shortage.

So what's the least you would take as a new grad in EM in the southeast? 250k? 300k?
 

The White Coat Investor

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I don't think the "sweat equity" thing by itself is a red flag at all. If they have a history of dumping people before the three years are up and there's a revolving door for non-partners, that's the big red flag. You have to weigh the risks of taking lower pay for 3 years for the promise you'll possibly get a higher rate thereafter.

You need to know how high that rate is.

You need to know the likelihood you'll get there.

You need to know the likelihood this group will keep the contract that allows it, after you make partner, and for how long.

You need to weigh the dollar amount your giving up for three years versus the amount you will get thereafter, multiplied by the likelihood you'll ever get that money and for how long.

A group where you pay for a buy in isn't without risk either. In fact, there is calculable risk. You could pay your dollar sum for the buy in and three weeks later the hospital could come in and say, "Sorry. We terminate your group without cause. After 90 days, you're out. Bye." Then you're working for the cme that took over and I guaran-f-ing-tee you the group you bought into is not giving you your buy in back.

There are way too many variables to say which is better. It all depends on various factors.

Also, focus on the people in the group you're joining. If your gut tells you these are solid, good, honest and trustworthy people, the rest will likely sort out for the good. However, if you get the sense you'd be getting in bed with people who are questionable or untrustworthy then, there may be more risk than you think, in either scenario.

Do your homework. Weigh the facts. And then make a decision. Go with your gut, your heart, feel good about it and dive in. There's only so much you can control. Remember that "perfect" doesn't exist. (The only exception to that is Donald Trump's hair).

Good luck.
This might be the best post I've ever read from Birdstrike. I'm copying it before it becomes a "."
 

The White Coat Investor

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In my relatively highly desirable and competitive area filled with SDGs and no CMGs, partnership tracks tend to be 2 years long and rates tend to be $100-150 an hour + benefits. Take from that what you will. I think $160/hr is pretty good for a pre-partnership position.

But if you're willing to work anywhere with anyone, then sure, work the system for $500 an hour. Not what I'm looking for in life, but can't blame you for doing it.
 
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emergentmd

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So what's the least you would take as a new grad in EM in the southeast? 250k? 300k?
This question is difficult to answer. It all depends on what you want, what risks/uncertainty you can deal with.

If I were single with no one to depend on me, I would sit back and do all locums. Pick up only the big money shifts but again who knows how long this would lasts.

If you have a family that depends on you, then its hard to travel. Difficult to deal with times when there may not be any big money shifts. But at worse, you could work for 300/hr.

Southeast is a big area. Unless you need to be in a sought after place, I would not work for less than $225/hr.
 

emergentmd

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In my relatively highly desirable and competitive area filled with SDGs and no CMGs, partnership tracks tend to be 2 years long and rates tend to be $100-150 an hour + benefits. Take from that what you will. I think $160/hr is pretty good for a pre-partnership position.

But if you're willing to work anywhere with anyone, then sure, work the system for $500 an hour. Not what I'm looking for in life, but can't blame you for doing it.
I have no clue what your area is and I am sure it is very sought after but if non partners are only making $100-150/hr, WHO is pocketing all of the rest? Are partners fleecing the nonpartners?

I ask this in all seriousness. I have been with SDGs and know what billings are. We pulled in about $200/hr for income on a bad month. On a good month, we pulled in $250+/hr.

Unless your area have poor reimbursement, are partners making 100-150/hr off from the new docs? Seems alittle unfair.
 

Janders

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Its all economics.

If you are in a private group in a really desirable location, it makes fiscal sense to fill any openings you have with pre-partners willing to work for 50 cents on the dollar and pocket the rest as profit. As long as you can find people willing to sign up for it, you and the other partners get bonus $ AND you get to truly audition the new guy/gal and make sure you want them to be a long-term player on your team.

In a non-desirable location, you're filling your gaps with privateers for $600 an hour and losing money on them... the other side of the same coin.

Personally, 3 years of significantly lower pay to "buy in" would concern me, primarily because I don't trust the current system to be stable enough to ensure i'll get to be a partner in that group for the 3-6 additional years I'd need to make up for that initial deficit. That said, it wouldn't be a 100% non-starter... depends on what else is available, how transparent the group was with me, and most importantly the recon I could do on them.

I know around here some of the stable, nice private groups have 2 year buy in periods where you get the same hourly as the partners, but get none of the bonus/profit-share... which can easily be 10-25% additional cash per year. My own group doesn't do a fiscal buy in-- you get your share from day 1, open books and all. But we HAVE selected new hires willing to do less-desirable shifts for a year or two (extra nights / weekends), though they are fairly compensated for those...
 

emergentmd

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Let me contrast two groups in a highly desireable city. Both of these SDGs were in the same city, had about the same amount of doctors, with similar geographic footprint. In essence, both made very similar income.

Group A (mine) as extremely difficult to get a job with. We maybe hired 1-2 new docs a year. We may have lost 1-2 and usually to retirement.
The Nonpartners pulled in about $225/hr while partners pulled in about $250/hr. Both with full benefits. All docs worked their fair share of bad/good shifts. Other than getting the partners bonus, you could not tell the difference b/t the two.

Group B paid their new hires $160/hr IC with the "Promise" of partnership. These new hires had to work in the undesirable hospitals with the promise of getting into a "good" hospital and thus better rates. The few docs that was lucky enough to get in with our group told me they never got into the Desirable hospitals. Thus they were stuck with long drives, crappy hospitals, crappy schedules. If these new hires were making $160/hr IC, then the partners were sucking $100/hr off of these guys with just promises. This group is having a real hard time finding docs given the shortage of EM docs even in our desirable city. I consider this PREDATORY.

Good luck to any new doc willing to risk making $50-100/hr less prepartner working crappy shifts just with the promise that they will make partner. If I was in this situation and made partner, I would not be able to sleep at nights knowing that I am screwing some new grad b/c seasoned EM docs would never settle for such a contract.
 

Birdstrike

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I feel like the scheduling is something that should be apparent from the initial discussion with the hiring group. Did they not tell you what your schedule/sick call would be like?
Groups love to tell you the schedule will be awesome then when you're hired, its, "Sorry, dude we're short all of a sudden. Two docs left, volume has shot up and wait times needs to come down. Hope you brought lube and if not I promise it'll be quick."

Then a year goes by, the three new guys are about to start ( 2 to replace those that left, 1 for higher volume) life just might get okay again, and then.....two of your best guys give 120 day notice and they're quitting. And one of 'em's an all night guy.

"F--k!"

And the cycle repeats.

Repeat after me, 1000 x's, "Board certified/Board eligible Emergency Physician shortage..Board certified/Board eligible Emergency Physician shortage..."
 

EctopicFetus

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I find some of the new grad posts on here funny.

Ill chime in.. I was a partner in an SDG, we paid our non partners (me included) less than 1/3 of what the partners made, also fewer benefits (e/g/ no paid vacation no long term disability and lack of access to all retirmeent options). This is on top of everything else. Starting pay was $110/hr. I termed this punitive pay when I became partner. Once a partner it took 3 more years for a full financial bonus. Ill admit the group made top end money, everyone made partner and it was a pretty sweet setup. Fast forward to me being a full partner and our group sells to a large CMG in a monstrous deal. The old farts are out, they were going to leave with 0.. They got a lot more.. I got a nice check...

Working for a CMG isnt my thing and therefore I start to look for a new job. I took my job near where I did residency and knew people all around town in every democratic group. I poke around. I knew who had the "2nd best job", and got the offer. I have a long discussion with my buddy, its another long buyin 3..5-4.5 years at a rate under $150/hr. He tells me the group may become employees or sell out before I make partner. I therefore choose to move.

To the new grads.. $150/hr is plenty and "more than enough".. Thats not the point. Once you figure out how much money you "need" then ask yourself, would I prefer to earn the 15k per month by working 150 or 75 hours per month.. If you are bored and dont need more money do me a favor. Work ask much as you feel you need to and send the extra money in to sallie mae to pay off my loans.

The take home here is I have money, more than I need, I could live on $150/hr easy.. but if I generate $300/hr why do I want to pay off someone elses loans when I surely could find better ways to spend my money?

To those willing to work for little. Thats up to you. I hope you dont get burned. I have had a locums inquiry at least 2/week for quite some time. I tell them my rate, they tell me its high. I simply let them know I dont care and dont need to work. I am working about 120 hrs / month now after doing about 160/ month for 6 years. I could afford to work probably about 80.. Its irrelevant. I hope you guys figure that out. Maybe it takes having kids to understand.
 

The White Coat Investor

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I have no clue what your area is and I am sure it is very sought after but if non partners are only making $100-150/hr, WHO is pocketing all of the rest? Are partners fleecing the nonpartners?

I ask this in all seriousness. I have been with SDGs and know what billings are. We pulled in about $200/hr for income on a bad month. On a good month, we pulled in $250+/hr.

Unless your area have poor reimbursement, are partners making 100-150/hr off from the new docs? Seems alittle unfair.
Depends on your definition of "fleecing." I pay your malpractice ($16K a year), your health insurance ($12K a year for my family), your board costs, some CME costs etc, plus the employer half of the payroll taxes ($14K a year.) Meanwhile, I have to take the trouble to interview 5 people just like you, hire you, fire you, perform the group's administration duties, take the risk of the business disappearing (we opened a new hospital recently and don't have the volume to pay the guaranteed hourly rate of those we've hired as pre-partners for instance) etc etc etc. When that volume eventually grows (we hope) will we be making something off our current batch of prepartners? I certainly hope so. I don't think it's fleecing, but if you do, feel free to go work for a CMG for that awesome $200 an hour for 3 pph and no control over your job in some crappy area of the country and I'll continue to climb, ski, and canyoneer 10 days a month while seeing 1.3 pph and making good money.

Meanwhile, 3/4 of prepartners make partner, the others know they're in trouble within 3-6 months and are usually gone within 12, and partners never leave for another emergency medicine job....ever. Didn't feel predatory to me as a prepartner and doesn't now.

Ectopic Fetus used to have the best job in EM, but his group sold out to a CMG, so now I think I've got it. Maybe it will last, maybe it won't. I'll enjoy it while it lasts, but doubt if it doesn't that I'd go through another partnership track. I'd probably stay right where I am, do the WCI thing, and maybe go do locums for 5 days a month for crazy money.
 

emergentmd

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It sounds like we all have had great jobs. Getting a great job has very little to do with skill. It has all to do with who you know, alot of luck, and good timing.

I was fortunate to get into EM right when money started to Pick up, right when most big hospitals required EM boarded docs, right when Free standing started to pop up. I became a rare commodity.

I was also in a private group. Also made alot of money. We also were bought out by a CMG for much more than I could have imagined. We could have easily been Taken over for Nothing. As a partner, we had the same "risks" that you had. We paid for full benefits, full malpractice with tail, full health, funded EVERYONE's SEP IRA (yes.... on your first day you step in the group), plus 1/2 payroll tax. We didn't pay for CMEs/Boards but that is pennies.

We carried the same risks. We just happened not not feel that this was worth paying a new grad (yes read new b/c seasoned ones would never work for 150/hr) $100/hr less than partners. And Yes, we all had to put money up to Buy in.

Could we find New grads to come in and work at a rate of $150/hr? Absolutely.

Would I feel guilty making $300/hr while my fellow line doc was making $150/hr knowing that I am sucking $75/hr from his work? Absolutely.

EM docs need to understand that they are valuable and a rare commodity. This very well could change but you should not allow someone to make twice as much as you doing the same work.

I get calls and emails weekly, with cold calls at work. I will take their calls but I tell them I would not work for less than $450/hr.
 

GeneralVeers

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I love my current job (full time locums). Paycheck last month was 60K.

- I get to make my own schedule
- I can work as much or as little as I like
- My travel is all paid for (free airmiles are a little known tax-free benefit)
- I am paid a lot of money to do it.

I wouldn't give it up for full time with any CMG, SDG, or other setup. I worked with a well-known large CMG for 5 years, and can attest that they do indeed steal about 40-50% of YOUR money.
 

docdragon

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Is this "sweat equity" thing something that should be a red flag, or is it fairly common among democratic groups? Am I just making a big deal out of nothing?
The sweat equity itself is not a big deal if you contrast it with a buy-in. Three years is a big deal. My first job was a 2-year buy-in, and there were several people who were very unhappy when the CMG deal was announced.
If you take the perspective that you are unlikely to stay in your first job more than 1-3 years, the low pay rate is still a ding.
If everybody was willing to fill Texas, then pay rates there would drop and other states would have to start paying competitively. If you're somewhat geographically tethered, then look at your negotiating options. As a democratic group, they CAN change their partnership track and make it a better deal if they want. If there is a red flag or a specific concern early in the interview/negotiation process but you like the group & location, it's worth sharing your positive impression and your significant concerns regarding the red flags. If reasonable people hear the same feedback from enough people and maybe lose a couple good candidates for said reason, then many reasonable people would consider changing the problem.
 

The White Coat Investor

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Would I feel guilty making $300/hr while my fellow line doc was making $150/hr knowing that I am sucking $75/hr from his work? Absolutely.
Do you feel guilty making $300 an hour while internists and FPs are making $80 an hour? Why not? I think it's silly to feel guilty for stuff like this.

If you think no one should make any money off you ever, think about how much work, time, effort, and money it takes to start and maintain a group and that awesome job that you're just walking into a department and having handed to you. Good groups in awesome locations don't just magically appear. They are built over decades. There is a price to join them. That price is $50-100 an hour for 1-3 years. If it is too high for you, don't pay it. Go work for a crap group somewhere else.

Is there risk there (that you're either fired or that a CMG gets the contract?) Sure. I think it's worth it to eventually make more money and to have control over your job.

Is this all ignores the fact that a new residency grad is NOT worth the same as someone 4 or 10 years out. Why should he get paid the same?
 

EctopicFetus

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FWIW I left and joined another SDG. What I wouldnt do again and I would caution anyone else is joining a group with a steep buy-in. The reason isnt because it is steep but it is because there is no guarantee that it will be there when you become a partner. In the past 12 months, I know of 4 groups in arizona and 1 in texas who have all gone the way of the Dodo bird and sold out and became CMG jobs. Now as a partner in one of those, I did really well (should have been better, but thats another story).

I would join a group like WCI assuming they arent about to sell out. I dont feel guilty profiting off of others. The reason is simple, its not like its bait and switch. On the interview we would tell people here is what you will be making. If they take the job and I am making 3.5x what they made is that wrong? As WCI said, I put in a LOT of uncompensated work to keep the group great. The new grad has contributed nothing. Now that being said, I thought what we did was punitive and I did work to change it. I think making $100/hr or more as long as the wage is decent is fine.

Serious scenario, someone joins group A partners are making $500/hr and non partners get $250/hr, contrast with Partners make $240, non partners $200. I am taking job A all day.. I dont care that they are profiting more off of me. DO you?
 

TooMuchResearch

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FWIW I left and joined another SDG. What I wouldnt do again and I would caution anyone else is joining a group with a steep buy-in. The reason isnt because it is steep but it is because there is no guarantee that it will be there when you become a partner. In the past 12 months, I know of 4 groups in arizona and 1 in texas who have all gone the way of the Dodo bird and sold out and became CMG jobs. Now as a partner in one of those, I did really well (should have been better, but thats another story).

I would join a group like WCI assuming they arent about to sell out. I dont feel guilty profiting off of others. The reason is simple, its not like its bait and switch. On the interview we would tell people here is what you will be making. If they take the job and I am making 3.5x what they made is that wrong? As WCI said, I put in a LOT of uncompensated work to keep the group great. The new grad has contributed nothing. Now that being said, I thought what we did was punitive and I did work to change it. I think making $100/hr or more as long as the wage is decent is fine.

Serious scenario, someone joins group A partners are making $500/hr and non partners get $250/hr, contrast with Partners make $240, non partners $200. I am taking job A all day.. I dont care that they are profiting more off of me. DO you?
Can you pm me the location of job A? I can probably sell Sh*tsville, New H*llsberg to the wife for that rate.


Our local SDGs have some buy in time, but even new grads tend to stay with these groups long term.
 

emergentmd

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Do you feel guilty making $300 an hour while internists and FPs are making $80 an hour? Why not? I think it's silly to feel guilty for stuff like this.

If you think no one should make any money off you ever, think about how much work, time, effort, and money it takes to start and maintain a group and that awesome job that you're just walking into a department and having handed to you. Good groups in awesome locations don't just magically appear. They are built over decades. There is a price to join them. That price is $50-100 an hour for 1-3 years. If it is too high for you, don't pay it. Go work for a crap group somewhere else.

Is there risk there (that you're either fired or that a CMG gets the contract?) Sure. I think it's worth it to eventually make more money and to have control over your job.

Is this all ignores the fact that a new residency grad is NOT worth the same as someone 4 or 10 years out. Why should he get paid the same?
WCI, I find many of your posts enlightening and respect your position on this thread. I have no problems with doctors making more than others even in the same group. I firmly believe that the docs who takes a job that is 150/hr less than a partner have no clue about the EM environment and have no clue what the books look like. Most groups never show the books to Nonpartners, just vague promises. Yours may be different. Your group could very well open the book to all new docs but I highly doubt this b/c its no beneficial to the group.

I have seen it over and over where SDGs make great promises. Partners in 2 yrs, equality in 2 yrs, Make 6 figures more as a partner,etc. This very well happens but in many cases, I see doctors being taken advantage of. I see many not making partners, groups loosing the contract, and downright lies to keep the docs with the group b/c they are needed to work for alot less than market and do crappy shifts.

I have been at this for 15 yrs. I have been with SDG, CMGs, IC, etc..... I can tell you will complete certainty that under no circumstance am I taking $100-150/hr less in sweat equity with the promise that I will be partner after 2 yrs.

I would rather get paid 200/hr and save the extra 50/hr for buy in after 2 yrs, then to be paid 150/hr with no buy in after 2 yrs. B/c the latter has absolutely no leverage when the 2 yr comes.

Good luck to all of the new grads. before you jump into a contract, research.... research... research. Ask, get knowledgeable, and if after you vetted everything and willing to make 150/hr less than a partner for the promise of partnership, then by no means go ahead.

Every CMG, SDG, locums job has their advantages and disadvantages.

Knowing what I know now, I would never work for a SDG unless my rate is atleast 80% market value. I would rather do a CMG/Locums and make >100% market with the freedom to do whatever I want.

I will pick up 4 Locums shifts this month putting me at 14 shifts total. I get paid 225/hr at my CMG job and will make more working my 40 hr locums as I do my 100 hr CMG job. And my CMG pay is greater than 100% market. Hopefully in the next 2 yrs, I will go full Locums and get to make my own schedule, work only day shifts, and hit my 100% CMG pay working 5 days a month.
 

Birdstrike

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I find some of the new grad posts on here funny.
.
I think back to what a dumba$$ I was when I first got out of residency and its laughable. Lol. I wonder how naive I'll think I was now, in twelve more years. Lmao. Smh
 

GeneralVeers

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I think back to what a dumba$$ I was when I first got out of residency and its laughable. Lol. I wonder how naive I'll think I was now, in twelve more years. Lmao. Smh
I agree completely. I worked right out of residency with a CMG for almost 5 years. Our salary was anywhere between $130-$180/hour plus benefits. We were told over and over how great we were doing, how much money we were making, and about how many wonderful things the company did for us. All the while they were pocketing nearly 50% of the gross right off the top. Now I make more working 4-5 days as a locums than I made working 18 shifts for the CMG.
 

emergentmd

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We actually do have open books to the pre-partners. My raise when I made partner was about 40-50% I believe. The difference is more now.
I applaud your group for opening the books to pre-partners. If they walk in knowing that they are taking a large haircut and willing to risk this in order to become partner with a 40% raise, then I have no problem with your structure. I can tell you that your group is rare.

There are too many SDGs now that use smoke and mirrors without letting the prepartners look at the books. All they offer is promises which are not close to the truth.
At this moment in EM, I would never join a SDG that doesn't open the books for prepartners. Again, I think this is rare.
If the group has nothing to hide, then they should open their books to prepartners.
 

emergentmd

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I agree completely. I worked right out of residency with a CMG for almost 5 years. Our salary was anywhere between $130-$180/hour plus benefits. We were told over and over how great we were doing, how much money we were making, and about how many wonderful things the company did for us. All the while they were pocketing nearly 50% of the gross right off the top. Now I make more working 4-5 days as a locums than I made working 18 shifts for the CMG.
I am sure things has changed alot in the past 5 yrs with all of the free standings opening up and creating the shortage. If this was true 15 yrs ago when I left residency, I was truly naive. And I was one of the luckier ones. I joined a group with my eyes fully closed just with promises without vetting the group and what they promised was true. I was making 200+/hr plus benefits out of the blocks and never made less than 350K/yr working 140 hrs a month.

But right now, I would laugh at a 200/hr offer from a SDG or a CMG. I too make more working 5 shifts a month than my 200/hr CMG job.
 

winkleweizen

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I want to know where these 400-500 dollar locums jobs are. Im interested if any would PM me. ;)
 

Makati2008

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This question is difficult to answer. It all depends on what you want, what risks/uncertainty you can deal with.

If I were single with no one to depend on me, I would sit back and do all locums. Pick up only the big money shifts but again who knows how long this would lasts.

If you have a family that depends on you, then its hard to travel. Difficult to deal with times when there may not be any big money shifts. But at worse, you could work for 300/hr.

Southeast is a big area. Unless you need to be in a sought after place, I would not work for less than $225/hr.
Thank you so much for the advice. Hoping the bubble doesn't pop for at least another decade.
 

LaBusqueda

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So, for those that seem to have/had awesome paying locums gigs (veers, emergent, others), how generally did you happen upon such opportunities? I ask because I did freelance work for a while and NEVER got hourly rates like you describe. Now, I went on the idea that rural/underserved areas would be more willing to shell out whatever $/hr. However, I was mistaken, at least in the central/west rural areas I searched. They pretty much just offered a very low hourly, sometimes a nice bump for sporadic shifts, but nowhere near 400+.
I was discourage enough to settle down in a FT gig.

Please PM me as well as I am very interested in such work.

Gracias
 

Old_Mil

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Given the level of uncertainty in medicine right now there is no way that I would take a position with a hypothetical payoff in three years.. The others who have posted in here are right: Get paid now and buy in to the partnership later if it seems like a good investment with decent ROI apart from the job.. It sounds like you are getting screwed.
 
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Old_Mil

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Also, keep in mind that there might be hidden gotchas to these high rate jobs...like they are in bad malpractice states.. I don't think I would see patients in Pennsylvania, Illinois, Florida, or Washington regardless of the rate.
 

emergentmd

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So, for those that seem to have/had awesome paying locums gigs (veers, emergent, others), how generally did you happen upon such opportunities? I ask because I did freelance work for a while and NEVER got hourly rates like you describe. Now, I went on the idea that rural/underserved areas would be more willing to shell out whatever $/hr. However, I was mistaken, at least in the central/west rural areas I searched. They pretty much just offered a very low hourly, sometimes a nice bump for sporadic shifts, but nowhere near 400+.
I was discourage enough to settle down in a FT gig.

Please PM me as well as I am very interested in such work.

Gracias
The real rural places with 1 small hospital will never pay that rate. They just get FP docs to staff at 100/hr. You have to go to a place where there is a shortage of EM docs where the hospitals require boarded EM docs to staff. This is where the shortage is created. You find this in big and medium sized cities, not the Small rural ones. Good luck.
 

emergentmd

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Also, keep in mind that there might be hidden gotchas to these high rate jobs...like they are in bad malpractice states.. I don't think I would see patients in Pennsylvania, Illinois, Florida, or Washington regardless of the rate.
Many southern states are medmal friendly. I have met people flying in from Hawaii to work 5 shifts and go back. They make more in that week than they make in Hawaii in 2 months where I am told rates are 125/hr. What a rip
 

emergentmd

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Given the level of uncertainty in medicine right now there is no way that I would take a position with a hypothetical payoff in three years.. The others who have posted in here are right: Get paid now and buy in to the partnership later if it seems like a good investment with decent ROI apart from the job.. It sounds like you are getting screwed.
I completely agree with this sweat equity. If the SDG is solid and people are banging down the doors to be partners, then why not a cash buy in rather than sweat equity. The way I see it is this

1. Sweat - Work 3 yrs at 50/hr less than community rate x 140 hrs or 7k or 84k/yr. In 3 yrs with market appreciation, you are looking at close to 300k
2. Work at market rate, save the 300k, and buy in at 3 yrs if the numbers as partners are worth it. And I only think it is worth it if you can recoup the 300k in 3 yrs. At worse, if the contract diminishes, a CMG is coming in then you can take your 300k and do whatever you want. That is a years worth of work.

I think sweat equity only benefits the partners. It takes ALL of the risks out for them and gives them all of the benefits. Good luck on anyone trying to catch this golden goose. I think it is more like catching a falling knife.
 

Apollyon

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Many southern states are medmal friendly. I have met people flying in from Hawaii to work 5 shifts and go back. They make more in that week than they make in Hawaii in 2 months where I am told rates are 125/hr. What a rip
Then it went up. I got paid less, and there were even more screw jobs that paid less than mine (like, $70/hr in an urban ED in Honolulu).