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