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Democratic Group Buy-In With "Sweat Equity"

EctopicFetus

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    I would be very careful taking a big haricut today. I see further consolidation of groups, partnerships selling out etc. Too much risk to get screwed. If you make a decent wage of 160+ then thats fine. But to work for under 150 is foolish. Also, consider what the payoff would be just to break even. As I said my buyin was monstrous. It worked out for me. If I had that same opportunity today there is a 0% chance I would take 1/2 market with the promise of making a lot. One woulld have to be really careful. Now its one thing to say that after working for a few years and saving and getting used to living on a normal paycheck. I can say this at $140/hr I would have a hard time paying my mortgage, paying my student loans, savings 50+k for retirement, saving for kids college and living well. Thats just me though.
     

    Makati2008

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      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.

      I know of one place in Texas doing even worse-70ish
       
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      deleted109597

        I know of one place in Texas doing even worse-70ish
        That's odd. I have yet to see a single community hospital that isn't hiring. None are advertising $70. The FM trained guys in Laredo are making nearly $300. The lowest I've seen is $200.
        There are peds ED slots paying $275/hr right now. I know people making $5K/shift on the regular, and not just Veers.
         
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        Makati2008

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          That's odd. I have yet to see a single community hospital that isn't hiring. None are advertising $70. The FM trained guys in Laredo are making nearly $300. The lowest I've seen is $200.
          There are peds ED slots paying $275/hr right now. I know people making $5K/shift on the regular, and not just Veers.

          Very small critical access hospital volume of maybe 3.5k a year, probably less. They get the local guys to cover it and they mostly sleep. All FM no EM.
           

          emergentmd

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            I know of one place in Texas doing even worse-70ish
            Again... Ignorance is not bliss. They may get residents at that rate or old FM docs who just want to sit around seeing 1 pt every 5 hrs but No way are they sniffing any competent doc at that rate. As we get cold calls all of the time, I tell the recruiters that my Locums rate is 400/hr within 1 hr and 550+/hr if I have to get on a plane.
             
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            GeneralVeers

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              Generally, the best paying locums jobs have the following criteria (in my experience):

              - Located in South/Southeast
              - Small to medium sized city with poor "desirability".
              - Usually underserved by all medical specialties.
              -Contract is held by a large CMG who can afford to pay the high rates. Smaller groups and hospital-employee models pay less.

              Things I look for:
              - Area with multiple sites/groups I can work with
              - Within 1 hour drive of commercial airport
              - Decent chain hotels
               

              GeneralVeers

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                So from what I am reading here it's very reasonable to supplement ones income to get into the 450k+ range.

                Very reasonable. Assume your regular job pays about $300K. Supplement that with 4 locums shift/month at $12K extra income. That would easily bring you to the $450K range.
                 

                emergentmd

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                  Generally, the best paying locums jobs have the following criteria (in my experience):

                  - Located in South/Southeast
                  - Small to medium sized city with poor "desirability".
                  - Usually underserved by all medical specialties.
                  -Contract is held by a large CMG who can afford to pay the high rates. Smaller groups and hospital-employee models pay less.

                  Things I look for:
                  - Area with multiple sites/groups I can work with
                  - Within 1 hour drive of commercial airport
                  - Decent chain hotels

                  I am sure I know you. Most locums only docs do this. For stability, I elect to have a regular 120hr/month job and cherry pick big shifts. I worked 20 Locums shifts last year and banked over 120k.

                  If I had great flexibility and didn't have a family to care for, I would just cherry pick shifts. Last year I would easily have made 500k working 8 shifts a month working only days I wanted.

                  In fact, if i can get financially independent in 2 yrs and the EM landscape has not changed, I am going Locums without any shift commitments. Work around my family schedule would be great.
                   
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                  Interpolfanclub

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                    I am sure I know you. Most locums only docs do this. For stability, I elect to have a regular 120hr/month job and cherry pick big shifts. I worked 20 Locums shifts last year and banked over 120k.

                    If I had great flexibility and didn't have a family to care for, I would just cherry pick shifts. Last year I would easily have made 500k working 8 shifts a month working only days I wanted.

                    In fact, if i can get financially independent in 2 yrs and the EM landscape has not changed, I am going Locums without any shift commitments. Work around my family schedule would be great.

                    This has been a very enlightening thread. I currently work at 2 hospitals in the SE for very good hourly rates. If I didn't have a family I think it would be a blast flying out to different EDs around the country and making a killing. I would love to work some shifts in south Texas, the midwest and areas in the SE at my choosing. Get someone else to pay my travel, rack up the FF miles...
                     

                    emergentmd

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                      This has been a very enlightening thread. I currently work at 2 hospitals in the SE for very good hourly rates. If I didn't have a family I think it would be a blast flying out to different EDs around the country and making a killing. I would love to work some shifts in south Texas, the midwest and areas in the SE at my choosing. Get someone else to pay my travel, rack up the FF miles...

                      I have a friend that did this. He had over 1 Mil FF miles. Last Christmas, I did a few Locums shift b/c of family/work commitment. But if I was single without a job, I could have worked 15 shifts easily at 8k/shift.

                      This month, I picked up 6 shifts and Making $525/hr. Love the EM flexibility
                       

                      The White Coat Investor

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                        Some pretty crazy numbers being thrown out in this thread. $400, $500, $525 an hour. I doubt you're actually generating that much, so I assume these are "loss leaders" for the CMGs.

                        On another note, keep in mind those high rates aren't free. There's a reason these guys have to pay this much for some shifts. There is a good thread on Sermo right now that explains why:

                        A few months ago, I started working a few shifts per month for a "Contract Medical Group" with a contract in AZ. One of my scheduling requirements that I stated in writing to the CMG Medical Director was that I only work 12 hour shifts (one of the facilities covered by the contract still had physicians working 24 hours), and that I have no night to day turnarounds in the 5-6 days I would be working each month.


                        The first month I was scheduled appropriately. The second month I had a 24-hour shift followed by a 24-hour PM to AM turnaround. The CMG Medical Director "assured" me that this was an unintentional oversite and would not happen again.


                        The 3rd month - this month - I was scheduled for 5 day shifts. I noticed on the schedule that no physician was scheduled to relieve me at 7pm on the last 2 days that I worked. I contacted the CMG Med Director who assured me that arrangements had been made for physician coverage and that I need not worry - in fact I was told that the physician was going to come early (around 4 pm) the first shift to acquaint himself with the EMR and the hospital routine.


                        4pm arrived but the scheduled night doc did not..... 7pm arrived and the night doc still had not arrived. No one had the night doc's phone number or way to contact him. Calls to the CMG Med Director (who prepares the schedule) and the facility medical director (local physician) all went to voice mail. However, Nursing supervisor told me that she had called the CMG MedDir who texted her that the night doc "was running late" but "should be at the ER by 9 pm.


                        At 10:15pm with night doc still absent, I texted the CMG Med Director and reminded him that I was scheduled to work the following day shift and that the night shift doc scheduled for this night was also scheduled for the following night. if I had no relief I would be looking at 36 and potentially 48 hours of continuous ER duty in a relatively busy and moderate acuity ER. I advised via text message that this was not healthy for me or safe for the patients. No response to text - calls all went to voice mail immediately.


                        At 2 AM I receive a response from CMG Med Director that stated "...What? Dr. ******* didn't show? I have NEVER had a doctor fail to show for his first shift! I am really upset about this and you must also be very upset......" The text response failed to articulate any plan to relieve me however. I immediately called the CMG MedDir back and....... call went immediately to voice mail. Another call 1 hour later also went to voice mail. Several of the nurses commented that this scenario had happened several times since the new CMG had taken over the hospital contract and several of the docs had been forced to work 36 hours shifts even though only scheduled for 12.


                        At 6 AM nursing staff began calling several local ER docs and one was reached who agreed to come in to relieve me by mid-morning. Later I talked with the Facility Med Director who had been out of town the night before. He was really pissed and also confirmed that this pattern of not filling uncovered shifts and dumping responsibility to the doc presently working had happened several times - in fact he stated that because of holes in the schedule he had been forced to work 61 straight days without a day off filling in for missing docs. After a moderate amount of vulgar commentary(appropriate from my perspective) on the CMG and it's Med Dir, the FMD confirmed that I would be relieved and not required to work 36 hours and the schedule would be covered. I suppose the scheduled night doc might have gotten sick, or involved in an MVA, or perhaps a massage parlor sting operation in Phoenix on his way to our hospital..... I should, I suppose, be generous until all the facts are known.


                        I ended my "prolonged" shift with a STEMI and just enough time to email my letter of resignation to the CMG MedDir - fortunately my contract specified 30-days notice only and I was not scheduled to work again until 31 days later. I thought briefly about staying on the schedule and giving the CMG and its Med Dir one more chance, but then reasoned that the best case scenario was that the CMG MedDir was incompetent while the worse case scenario was that he was a liar and a sociopath. In either case, a medical director with either attribute was not one that I wanted to work for under any circumstances.


                        Later after flying home I received an email from the CMG MedDir stating that "...if only you had contacted me the night before and made me aware" of the no-show doc, "I would have fixed the problem." He finshed his email with the comment..." You know, I am on call 24/7 365 and my phone is ALWAYS on..." This resolved any confusion over which attribute to attach to his behavior - clearly the worst case scenario applied.

                        I'm not sure how much money I want to be paid to deal with crap like that, but $525 isn't enough.
                         
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                        emergentmd

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                          One thing I love about EM is there is always someone up at night with me.

                          I am sure there are places like this and I agree that $600/hr is not worth it. Actually, if it was me, I would have sat back and just saw sick pts and let the waiting room rot.

                          I have worked at 5 different big city/busy hospitals doing Locums and I can tell you that the work is not any different than my Main Job. I actually see less pts/hr but feel like I work just as hard as these hospitals are not as efficient as my home base. If they were, then it would be a cakewalk.

                          Word of wisdom is check these places out, never commit to any long term contract. My style is to pick up the droppings (ie open shifts) after the regulars fill the schedule. I take 0-3 shifts a month if it fits my home live/home base schedule. Some months I pick up zero shifts (no biggie). Some I pick up more if the rate is worth my while. This month, I will be picking up alot b/c there happens to be a large amount of openings. Next month who knows.

                          But at the end of the day, I make my 350+k a year from my stable job, and tack on 100-150k a yr doing 20 locums a year.
                           

                          GeneralVeers

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                            I'm not sure why any doctor would stick around after 24 hours. I would simply tell nurses that I am leaving at 7 AM, and if no doctor shows, then they need to close down the ER. It's not reasonable to make anyone work 36 hours straight, and it would be entirely defensible in court.

                            Unfortunately doctors are pushovers, and will often bend to unreasonable nonsense. I would never tolerate this on a locums job, and certainly wouldn't return to a job at which it's commonplace.
                             
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                            NinerNiner999

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                              In those cases, I would have contacted hospital administration on call. If no response on house supervisor not willing, I would call the CEO first thing in the morning. Nothing gets the CMG/regional/local director on the phone faster than an unhappy hospital administrator who is told his/her department will not be covered. This is how contracts end - and in this case probably should have...
                               
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                              Docinthetrenches

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                                Well I can say for sure I would probably be interested in such a scenario when I was right out of residency, unmarried with no kids. First however, I would try to find out like others have said from those who left - were they put into an awful schedule? Tons of nights, weekends, and holidays? Etc. But seriously, now as a married father out for 13 years, I am loving my salaried, flexible schedule, no pressure job. Back then when I was bursting with energy, I would consider such an arrangement - worse case is that you leave and start anew before you are heavily invested in anything (house, spouse, kids, etc).
                                 

                                docdragon

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                                  Well I can say for sure I would probably be interested in such a scenario when I was right out of residency, unmarried with no kids. First however, I would try to find out like others have said from those who left - were they put into an awful schedule? Tons of nights, weekends, and holidays? Etc. But seriously, now as a married father out for 13 years, I am loving my salaried, flexible schedule, no pressure job. Back then when I was bursting with energy, I would consider such an arrangement - worse case is that you leave and start anew before you are heavily invested in anything (house, spouse, kids, etc).
                                  I'm kind of glad somebody finally said something like "I have a job that I like and it doesn't involve flying every week."
                                   
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                                    Bump

                                    I am finally approaching the completion of training and looking at several different opportunities. One is a solid SDG in a desirable location that has a 3 year "sweat equity" to partnership set-up. Group is very stable and several people I trust vouch for the strength of the group and the docs. Salary is low <$150/hr until partnership is reached. Opinions still the same?
                                     

                                    GeneralVeers

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                                      Bump

                                      I am finally approaching the completion of training and looking at several different opportunities. One is a solid SDG in a desirable location that has a 3 year "sweat equity" to partnership set-up. Group is very stable and several people I trust vouch for the strength of the group and the docs. Salary is low <$150/hr until partnership is reached. Opinions still the same?

                                      Don't do it unless you have no options on geographic area.
                                       
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                                      coachB

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                                        Bump

                                        I am finally approaching the completion of training and looking at several different opportunities. One is a solid SDG in a desirable location that has a 3 year "sweat equity" to partnership set-up. Group is very stable and several people I trust vouch for the strength of the group and the docs. Salary is low <$150/hr until partnership is reached. Opinions still the same?

                                        If anything, I would be even more cautious. The big CMGs are buying up everything in site. Hard for partners to pass up the immediate gratification of a seven figure pay-day even if it means destroying the long term strength of the group and specialty.
                                         
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                                        GeneralVeers

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                                          If anything, I would be even more cautious. The big CMGs are buying up everything in site. Hard for partners to pass up the immediate gratification of a seven figure pay-day even if it means destroying the long term strength of the group and specialty.

                                          Exactly right. And when (not if) that happens you lose your "sweat equity" and any buy-in money that you've given. Usually not all partners are equal in these setups and the senior partners are the ones who determine if it is sold, and get the big payout.
                                           

                                          emergentmd

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                                            Bump

                                            I am finally approaching the completion of training and looking at several different opportunities. One is a solid SDG in a desirable location that has a 3 year "sweat equity" to partnership set-up. Group is very stable and several people I trust vouch for the strength of the group and the docs. Salary is low <$150/hr until partnership is reached. Opinions still the same?

                                            Lets just forget how the partners will and can screw you with scheduling, holidays, etc and just concentrate on pay. Lets assume the SDG and CMG down the street are equivalent jobs so we can focus on money.

                                            Let assume the partners make 100/hr more than you. That difference comes out to 168k for a 140h/mo job. So you make 252k and they pull in 420k.

                                            Lets assume the CMG job down the road pulls in 200/hr or 336k/yr.

                                            So by taking the SDG job, you will lose out on 252k over 3 yrs.

                                            Now in year 4, you are a partner. It will take you 3 yrs to get back to even, or 6 total yrs before you get ahead. You actually would take more than 6 yrs b.c of the loss of capital use, so I would say it would take 6.5 yrs to get even.

                                            WHY anyone would take this deal knowing your environment is crazy.

                                            I have never made less than 400k a year since I became a partner. I can make that working 6-8 shifts a month doing locums and not ever working abot losing the contract, metrics, pt complaints. In fact, I am moving towards part time soon and will make my 400k doing about 90 hrs/month.
                                             
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                                            Psai

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                                              Lets just forget how the partners will and can screw you with scheduling, holidays, etc and just concentrate on pay. Lets assume the SDG and CMG down the street are equivalent jobs so we can focus on money.

                                              Let assume the partners make 100/hr more than you. That difference comes out to 168k for a 140h/mo job. So you make 252k and they pull in 420k.

                                              Lets assume the CMG job down the road pulls in 200/hr or 336k/yr.

                                              So by taking the SDG job, you will lose out on 252k over 3 yrs.

                                              Now in year 4, you are a partner. It will take you 3 yrs to get back to even, or 6 total yrs before you get ahead. You actually would take more than 6 yrs b.c of the loss of capital use, so I would say it would take 6.5 yrs to get even.

                                              WHY anyone would take this deal knowing your environment is crazy.

                                              I have never made less than 400k a year since I became a partner. I can make that working 6-8 shifts a month doing locums and not ever working abot losing the contract, metrics, pt complaints. In fact, I am moving towards part time soon and will make my 400k doing about 90 hrs/month.

                                              This is how life should be
                                               

                                              MSmentor018

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                                                Some pretty crazy numbers being thrown out in this thread. $400, $500, $525 an hour. I doubt you're actually generating that much, so I assume these are "loss leaders" for the CMGs.

                                                On another note, keep in mind those high rates aren't free. There's a reason these guys have to pay this much for some shifts. There is a good thread on Sermo right now that explains why:

                                                A few months ago, I started working a few shifts per month for a "Contract Medical Group" with a contract in AZ. One of my scheduling requirements that I stated in writing to the CMG Medical Director was that I only work 12 hour shifts (one of the facilities covered by the contract still had physicians working 24 hours), and that I have no night to day turnarounds in the 5-6 days I would be working each month.


                                                The first month I was scheduled appropriately. The second month I had a 24-hour shift followed by a 24-hour PM to AM turnaround. The CMG Medical Director "assured" me that this was an unintentional oversite and would not happen again.


                                                The 3rd month - this month - I was scheduled for 5 day shifts. I noticed on the schedule that no physician was scheduled to relieve me at 7pm on the last 2 days that I worked. I contacted the CMG Med Director who assured me that arrangements had been made for physician coverage and that I need not worry - in fact I was told that the physician was going to come early (around 4 pm) the first shift to acquaint himself with the EMR and the hospital routine.


                                                4pm arrived but the scheduled night doc did not..... 7pm arrived and the night doc still had not arrived. No one had the night doc's phone number or way to contact him. Calls to the CMG Med Director (who prepares the schedule) and the facility medical director (local physician) all went to voice mail. However, Nursing supervisor told me that she had called the CMG MedDir who texted her that the night doc "was running late" but "should be at the ER by 9 pm.


                                                At 10:15pm with night doc still absent, I texted the CMG Med Director and reminded him that I was scheduled to work the following day shift and that the night shift doc scheduled for this night was also scheduled for the following night. if I had no relief I would be looking at 36 and potentially 48 hours of continuous ER duty in a relatively busy and moderate acuity ER. I advised via text message that this was not healthy for me or safe for the patients. No response to text - calls all went to voice mail immediately.


                                                At 2 AM I receive a response from CMG Med Director that stated "...What? Dr. ******* didn't show? I have NEVER had a doctor fail to show for his first shift! I am really upset about this and you must also be very upset......" The text response failed to articulate any plan to relieve me however. I immediately called the CMG MedDir back and....... call went immediately to voice mail. Another call 1 hour later also went to voice mail. Several of the nurses commented that this scenario had happened several times since the new CMG had taken over the hospital contract and several of the docs had been forced to work 36 hours shifts even though only scheduled for 12.


                                                At 6 AM nursing staff began calling several local ER docs and one was reached who agreed to come in to relieve me by mid-morning. Later I talked with the Facility Med Director who had been out of town the night before. He was really pissed and also confirmed that this pattern of not filling uncovered shifts and dumping responsibility to the doc presently working had happened several times - in fact he stated that because of holes in the schedule he had been forced to work 61 straight days without a day off filling in for missing docs. After a moderate amount of vulgar commentary(appropriate from my perspective) on the CMG and it's Med Dir, the FMD confirmed that I would be relieved and not required to work 36 hours and the schedule would be covered. I suppose the scheduled night doc might have gotten sick, or involved in an MVA, or perhaps a massage parlor sting operation in Phoenix on his way to our hospital..... I should, I suppose, be generous until all the facts are known.


                                                I ended my "prolonged" shift with a STEMI and just enough time to email my letter of resignation to the CMG MedDir - fortunately my contract specified 30-days notice only and I was not scheduled to work again until 31 days later. I thought briefly about staying on the schedule and giving the CMG and its Med Dir one more chance, but then reasoned that the best case scenario was that the CMG MedDir was incompetent while the worse case scenario was that he was a liar and a sociopath. In either case, a medical director with either attribute was not one that I wanted to work for under any circumstances.


                                                Later after flying home I received an email from the CMG MedDir stating that "...if only you had contacted me the night before and made me aware" of the no-show doc, "I would have fixed the problem." He finshed his email with the comment..." You know, I am on call 24/7 365 and my phone is ALWAYS on..." This resolved any confusion over which attribute to attach to his behavior - clearly the worst case scenario applied.

                                                I'm not sure how much money I want to be paid to deal with crap like that, but $525 isn't enough.
                                                [email protected]#in wow
                                                 

                                                EctopicFetus

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                                                  Food for thought. Depending on the democratic group the partners may be making much more than $100/hr more than you. I would say that break even longer than 4 years as compared to a CMG you should avoid the democratic group.

                                                  As to the thread above, I would have left and put the CMG contract at risk and had them shut down the ED. Thats how you handle locums work.

                                                  The CMGs never screwed me but one time. That was more a matter of me "being a good citizen" while I was moonlighting as a resident.

                                                  I would give 30 mins for someone to show after that I would leave unless I spoke with the medical director and they agreed to my terms. Likely 1k per hour.
                                                   
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                                                  GeneralVeers

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                                                    Food for thought. Depending on the democratic group the partners may be making much more than $100/hr more than you. I would say that break even longer than 4 years as compared to a CMG you should avoid the democratic group.

                                                    As to the thread above, I would have left and put the CMG contract at risk and had them shut down the ED. Thats how you handle locums work.

                                                    The CMGs never screwed me but one time. That was more a matter of me "being a good citizen" while I was moonlighting as a resident.

                                                    I would give 30 mins for someone to show after that I would leave unless I spoke with the medical director and they agreed to my terms. Likely 1k per hour.

                                                    Exactly. You're under no legal obligation to stay. I might call the director or corporate and give them an hour to get someone else in. After that hour I'd be out and they could close down.
                                                     

                                                    Makati2008

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                                                      Exactly. You're under no legal obligation to stay. I might call the director or corporate and give them an hour to get someone else in. After that hour I'd be out and they could close down.

                                                      Sorry for my ignorance in this matter, but could you explain how you could just leave the ED? A slow, low acuity one I could understand but a moderate paced one I couldn't imagine leaving since there are almost always patients in the waiting room? Would you truly have no responsibility for them from a legal sense? I'm interested in locums down the line and this will be helpful information.


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                                                      GeneralVeers

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                                                        Well you'd likely have to see the patients already in the waiting room but would close the ED to new arrivals.

                                                        You could also arrange for them to be transferred to another hospital.

                                                        I would give the house supervisor, and CMG a 1 hour warning. I would advise them to immediately close to any ambulance traffic. I would do an MSE on anyone waiting in the waiting room. Anyone critical, I would immediately call 911 to transfer them out. Everyone else I would advise that there was no ED doctor after a certain time, and they could seek medical care elsewhere. Then I would leave at the time I had chosen.
                                                         
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                                                        emergentmd

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                                                          WCI's quote is an extreme exception to the rule. I don't know why that doc even stayed past the first shift. I just would not show back up. I have done Locums at 5 different hospitals and I ALWAYS Leave right when the new doctor comes. There is no reason to be a hero. Everyone knows that I am Locum, most are Locum, so the culture dictates leaving right on time. I see less pts/hr at my locums than my regular job. My typical Locums shifts has a scribe and I see between 20-25 pts in a 10 or 12 hr shift. So I avg right at 2pt/hr which is not that busy esp when given a scribe. These places are hard to staff either by location or poorly run ED. But its nothing like WCI quoted.

                                                          I have no problem working at a dysfunctional ED if they are paying 2x my reg job rate.
                                                           

                                                          emergentmd

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                                                            Food for thought. Depending on the democratic group the partners may be making much more than $100/hr more than you. I would say that break even longer than 4 years as compared to a CMG you should avoid the democratic group.

                                                            As to the thread above, I would have left and put the CMG contract at risk and had them shut down the ED. Thats how you handle locums work.

                                                            The CMGs never screwed me but one time. That was more a matter of me "being a good citizen" while I was moonlighting as a resident.

                                                            I would give 30 mins for someone to show after that I would leave unless I spoke with the medical director and they agreed to my terms. Likely 1k per hour.

                                                            I would NEVER leave the ED without a Doc. Its against every fiber of my body. They way I would handle WCI's example (and this is extremely rare) is ONLY see true medical emergencies. Everyone gets a screening exam and sent on their way.

                                                            If the CMG/Hospital wants to put me in that position, I can trash the ED while having a safe pt environment.
                                                             

                                                            EctopicFetus

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                                                              I would NEVER leave the ED without a Doc. Its against every fiber of my body. They way I would handle WCI's example (and this is extremely rare) is ONLY see true medical emergencies. Everyone gets a screening exam and sent on their way.

                                                              If the CMG/Hospital wants to put me in that position, I can trash the ED while having a safe pt environment.
                                                              Lets say your kid or spouse was sick and you were 10 hours after your shift was *supposed* to end? You did say NEVER. I would force a shutdown of the ED as per veers. 1 hour notice, dispo everyone, no one who hasnt checked in yet and call 911 and send them up the road.
                                                               

                                                              emergentmd

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                                                                Lets say your kid or spouse was sick and you were 10 hours after your shift was *supposed* to end? You did say NEVER. I would force a shutdown of the ED as per veers. 1 hour notice, dispo everyone, no one who hasnt checked in yet and call 911 and send them up the road.

                                                                Never is a strong word, but there would be very few reasons for me to leave. I would only see sick patients. If after 6 hrs, a satisfactory outcome did not happen, I would call the news and declare safe harbor and have every news station in the ED. The threat of this would get the CEO to see patients.

                                                                And they better pay me 500+/hr for those 6 hrs or I am going to press.
                                                                 
                                                                Mar 17, 2011
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                                                                  Lets just forget how the partners will and can screw you with scheduling, holidays, etc and just concentrate on pay. Lets assume the SDG and CMG down the street are equivalent jobs so we can focus on money.

                                                                  Let assume the partners make 100/hr more than you. That difference comes out to 168k for a 140h/mo job. So you make 252k and they pull in 420k.

                                                                  Lets assume the CMG job down the road pulls in 200/hr or 336k/yr.

                                                                  So by taking the SDG job, you will lose out on 252k over 3 yrs.

                                                                  Now in year 4, you are a partner. It will take you 3 yrs to get back to even, or 6 total yrs before you get ahead. You actually would take more than 6 yrs b.c of the loss of capital use, so I would say it would take 6.5 yrs to get even.

                                                                  WHY anyone would take this deal knowing your environment is crazy.

                                                                  I have never made less than 400k a year since I became a partner. I can make that working 6-8 shifts a month doing locums and not ever working abot losing the contract, metrics, pt complaints. In fact, I am moving towards part time soon and will make my 400k doing about 90 hrs/month.

                                                                  This is really a great illustration to point out the flaws in pursuing such an arrangement. With my family, student loans, and time already spent in training this makes this job near untenable. For family reasons the location is ideal but I am not sure this is enough anymore. I will have to do some serious soul searching. I appreciate the insight from you and everyone else.



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                                                                  emergentmd

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                                                                    This is really a great illustration to point out the flaws in pursuing such an arrangement. With my family, student loans, and time already spent in training this makes this job near untenable. For family reasons the location is ideal but I am not sure this is enough anymore. I will have to do some serious soul searching. I appreciate the insight from you and everyone else.



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                                                                    Making a decision is always tough but with EM, you usually can get out in 2-3 months. So its not much more than a 3 month inconvenience.


                                                                    I will tell you that I would Never work for anyone for 150/hr. I have a surgical Hospital job that I get 165/hr with a close to guarantee of a no hitter every shift.

                                                                    I could not imagine working 3 yrs knowing that in year 3, you could not make partner for a slew of reasons. 3 yrs is a long time where you could decide to move, takeover of contract, get fired, decreased reimbursement, etc.

                                                                    And to think a 6.5 yr break even? I would have to LOVE this city for 150/hr. Someone is making serious bank from you. I am guessing they are billing at 300+/hr.
                                                                     

                                                                    Groove

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                                                                      This is really a great illustration to point out the flaws in pursuing such an arrangement. With my family, student loans, and time already spent in training this makes this job near untenable. For family reasons the location is ideal but I am not sure this is enough anymore. I will have to do some serious soul searching. I appreciate the insight from you and everyone else.



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                                                                      If you have loans, it's just not worth it. If you're finishing now, then you are of the generation that incurred 100% of their debt at 7% interest. Unless you refi that for 3-3.5% with SOFI, etc.. then you don't have an option. Think about the interest accruing while you are on your path to partnership. It's crazy not to take a job with a CMG paying you almost twice that from day 1 and allowing you to aggressively pay off your loans. I love the idea of SDGs but you have to be really invested in the location with ultimately no plans to move anytime in the next several years. You also take a risk that partnership equity will still be there when you read the end of your track (and that your contract won't have gone up for bid). It will take you years to break even on the money lost during sweat equity tenure and I don't know anyone who can feel confident enough in their contract to project status quo 6-7 years down the line. Don't consider anything less than $200/hr and that would be a bare minimum. Oh, and I think 3yr partnership tracks are ridiculous these days. I wouldn't even consider a contract with a 3yr track. I don't care where it's located. Those are some fat cat senior partners milking some serious cheddar off your back.

                                                                      Oh and props to myself for paying $280K in 7% interest loans over past 2 yrs, $20K more to go! Woot woot!
                                                                       
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                                                                      emergentmd

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                                                                        This is really a great illustration to point out the flaws in pursuing such an arrangement. With my family, student loans, and time already spent in training this makes this job near untenable. For family reasons the location is ideal but I am not sure this is enough anymore. I will have to do some serious soul searching. I appreciate the insight from you and everyone else.



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                                                                        Good luck on your decision.

                                                                        Even if this group is great, honest, has a great track record, in an areas where CMG will never come in..... I would still not take it.

                                                                        3 yrs is a long time. You never know what will happen with reimbursement and payer mix. If in 3 yrs, most are on obamacare or some gov insurance, the SDGs current income will go down. You may be a partner in 3 yrs but every partner could be making 200/hr.

                                                                        EM is great right now b/c rates are high. Take advantage of it, pay off your debt, and then you can work if you want rather than work b/c you have to.
                                                                         
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