Disadvantages of HCA EM residencies?

[stemi8]

Hello all, does anyone have any insight on the disadvantages of doing an EM residency at an HCA hospital?

Thank you

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[TooMuchResearch]

HCA.

 

[Fox800]

Mediocre experience. There's a reason these places didn't have a residency until just now - trying to crank out a legion of underpaid EM docs to work for them.

 

[The Knife & Gun Club]

Applying this cycle - I plan on using a few HCA residencies as my fall back plan. I guess an ACGME accredited program working for an evil company is still an accredited program

 

[deuist]

The chance that all of your attendings could be fired and replaced by another CMG comes to mind.

 

[EctopicFetus]

Applying this cycle - I plan on using a few HCA residencies as my fall back plan. I guess an ACGME accredited program working for an evil company is still an accredited program

If your application is that bad........

In the end your education will likely be subpar, you will be trained to be a sheep. When someone puts profit over your education thats enough reason to be worried. HCA and envision arent putting up all these residencies out of the goodness of their hearts.

Interestingly enough in many smaller cities jobs that were ubiquitous are now scarce. When we pump out an extra 30% of EM trained docs a year it doesnt take a genius or a lot of time to figure out the future. Many EM docs (good), with few good job options (bad), with a huge amount of debt (bad) which will require them to work a lot to pay off debt but with supply/demand curves the hourly rate can easily and quickly go down.

Dont believe me? Check the other threads about vituity asking people to take a $10 pay cut. one shop in town was run by a national group, pay was high. New group coming in and will cut pay by $30/hr.

Old group was doing well and making good money. As more and more HCA residencies pop up your attendings will be the dumb ones who think this is a decent job (self selection) and will teach you the same. You also will graduate from a residency where you will have a hard time finding anything other than a market rate job.

 

[deuist]

I can't imagine any other career fields out there in which the national leadership thought to itself, let's intentionally destroy our own marketability and decrease the salaries for everyone.

 

[Brigade4Radiant]

Having the CEO call the ER and asking why no one has signed up for a patient that has been there for 20 min.

 

[southerndoc]

The chance that all of your attendings could be fired and replaced by another CMG comes to mind.

Highly unlikely. SummaHealth's experience is now a case-study in healthcare management programs nationwide. CMG's with residency programs will have careful discussions before getting rid of core faculty members.

 

[EctopicFetus]

I can't imagine any other career fields out there in which the national leadership thought to itself, let's intentionally destroy our own marketability and decrease the salaries for everyone.

Unless said leadership is already a bunch of CMG ******. parker, Friedman, rodgers etc etc etc.

 

[EctopicFetus]

Highly unlikely. SummaHealth's experience is now a case-study in healthcare management programs nationwide. CMG's with residency programs will have careful discussions before getting rid of core faculty members.

You realize they wanted to keep those people. Those people told USACS and Summa to eat dirt.

It was SEA that made the decision. Summa and USACS would have loved to keep those docs.

 

[GonnaBeADoc2222]

Man. The more I read about this stuff, the more thankful for my highly academic training program that gave me amazing training.

 

[The Knife & Gun Club]

If your application is that bad........

In the end your education will likely be subpar, you will be trained to be a sheep. When someone puts profit over your education thats enough reason to be worried. HCA and envision arent putting up all these residencies out of the goodness of their hearts.

Interestingly enough in many smaller cities jobs that were ubiquitous are now scarce. When we pump out an extra 30% of EM trained docs a year it doesnt take a genius or a lot of time to figure out the future. Many EM docs (good), with few good job options (bad), with a huge amount of debt (bad) which will require them to work a lot to pay off debt but with supply/demand curves the hourly rate can easily and quickly go down.

Dont believe me? Check the other threads about vituity asking people to take a $10 pay cut. one shop in town was run by a national group, pay was high. New group coming in and will cut pay by $30/hr.

Old group was doing well and making good money. As more and more HCA residencies pop up your attendings will be the dumb ones who think this is a decent job (self selection) and will teach you the same. You also will graduate from a residency where you will have a hard time finding anything other than a market rate job.

The problem is more that if someone told me I can go to an HCA evil residency or go unmatched, I'll go to HCA. Im couples matching, so a non-match or getting split from my fiance (and possibly future kids) would be a disaster an entire order of magnitude higher than having to do residency at an HCA hospital.

Sadly, a lot of med students are in the same position. If given the choice between a non-match and a ****ty match, theyll take the $hitty match.

 

[Avalanche19]

I'm a PGY2 at an HCA EM program and I honestly think this is all overblown. As residents, we are shielded from most of the metric-driven nonsense. Maybe my program is an exception rather than the rule but an HCA logo alone should not stop applicants from looking into each individual program.

 

[southerndoc]

You realize they wanted to keep those people. Those people told USACS and Summa to eat dirt.

It was SEA that made the decision. Summa and USACS would have loved to keep those docs.

I understand what you're saying, but a lot of hospitals are afraid of canceling contracts for fear docs will do what SEA did and walk. They're not willing to take the chance. Likewise, high turnover of faculty leads to problems. Therefore, CMG's are less likely to fire docs.

 

[KGflyboy]

I personally would consider ranking an HCA hospital as a backup, but it would not be high on my list. I gave HCA and CMGs a fair shake when looking for grown up jobs, but ultimately I just prefer a solid, stable, well run SDG or academic job over any HCA job.

My general rank from least preferable to most preferable is HCA > any other CMG job > academic > SDG.

Of course there are bad SDG jobs and awesome academic jobs that don't fit this order precisely.

My reasoning for disliking HCA is no different than all the reasons other people already stated on this thread and others.

 

[deleted109597]

The chance that all of your attendings could be fired and replaced by another CMG comes to mind.

Hahahaha.
The chance of that is zero.
The CMG could be replaced, but all the docs will remain the same, except maybe upper middle management.
I know one site that's been 3 at this point. All of the faculty save a couple are still the same.

 

[deleted109597]

Having the CEO call the ER and asking why no one has signed up for a patient that has been there for 20 min.

Or getting dinged for "double dipping" because two residents sign you up for a patient within 5 minutes of each other.

 

[deleted109597]

It was SEA that made the decision. Summa and USACS would have loved to keep those docs.

At a much lower rate. And without the same protections they had as the SDG.
It was bad all around, but not the first time it's happened. There was a DO residency in Kansas/OK/Missouri (I forget) that had the same problem, and the faculty and residency had to move hospitals.

 

[Brigade4Radiant]

I'm a PGY2 at an HCA EM program and I honestly think this is all overblown. As residents, we are shielded from most of the metric-driven nonsense. Maybe my program is an exception rather than the rule but an HCA logo alone should not stop applicants from looking into each individual program.

It depends there are some ones in Florida that are decent but there are others that are just popping up so they can get the money which is why there are so many new recent HCA programs

 

[miacomet]

Highly unlikely. SummaHealth's experience is now a case-study in healthcare management programs nationwide. CMG's with residency programs will have careful discussions before getting rid of core faculty members.

Would love to hear more about how Summa is used as a case study and what lessons they are drawing from it.

 

[deleted547339]

I'm a PGY2 at an HCA EM program and I honestly think this is all overblown. As residents, we are shielded from most of the metric-driven nonsense. Maybe my program is an exception rather than the rule but an HCA logo alone should not stop applicants from looking into each individual program.

The greatest trick the devil ever pulled was convincing people he didn’t exist.

 

[TooMuchResearch]

Don't ruin the ending.

The greatest trick the devil ever pulled was convincing people he didn’t exist.

 

[Porfirio]

I work for an Envision/HCA job right now. The pay is the best in the area. The metrics are so easy to game. The complaints on this board have not been my experience.

 

[TooMuchResearch]

"Best in the area."

I work for an Envision/HCA job right now. The pay is the best in the area. The metrics are so easy to game. The complaints on this board have not been my experience.

 

[Birdstrike]

I can't imagine any other career fields out there in which the national leadership thought to itself, let's intentionally destroy our own marketability and decrease the salaries for everyone.

It's more common than you think. If a leadership can enrich itself by destroying that which it leads, often it will.

"Power corrupts. Absolute power corrupts absolutely."- Lord Acton, 1887.

 

[Birdstrike]

If you want to find out how community EM is, and is becoming in the real world, I suppose there's no better place to learn that, than an HCA residency.

 

[Porfirio]

"Best in the area."

1099 IC at $309.25 per hr for 120 hr per month, time and half for holidays (Memorial Day/Labor Day/independence day/thanksgiving/Christmas/New Years), med mal (with tail) paid for by Envision

This was $25-$35 higher per hour compared all other gigs in my area. Granted there is one SDG left in my area but the buy in was 2 years hard time with bread and water while working on the chain gang. But they only offered $5-$25 per hour more than what I am making now (once partner), and the scheduling would be a “night”mare.

I think the key to finding a good gig is to not limit yourself and to explore all options while being able to walk away from offers.

 

[EctopicFetus]

1099 IC at $309.25 per hr for 120 hr per month, time and half for holidays (Memorial Day/Labor Day/independence day/thanksgiving/Christmas/New Years), med mal (with tail) paid for by Envision

This was $25-$35 higher per hour compared all other gigs in my area. Granted there is one SDG left in my area but the buy in was 2 years hard time with bread and water while working on the chain gang. But they only offered $5-$25 per hour more than what I am making now (once partner), and the scheduling would be a “night”mare.

I think the key to finding a good gig is to not limit yourself and to explore all options while being able to walk away from offers.

Ill exclude the working at an HCA site for a moment.

I have a buddy of mine. Was able to fill a role for envision, a site about 90 mins from a major metro area. He got $370/hr and going rate “in-town” was $250. As I told him.. you are the first one to be chopped. He got a few good months in and then came the “we need to cut your pay”. He was the highest paid doc at that site.

The point is if they can find cheaper labor they will. The advantage of an SDG is that isnt the case. Ill say that $300/hr is good pay. Plenty of SDGs make more but that’s definitely above “market” for a CMG job. Why wouldn’t you work more?

Here locally there is a site that pays about 275/hr and recently they have overhired so docs cant get their hours. So they are working extra at other places to fill in their hours/income (at a lower rate).

I would take the fact that so many have bad things to say about HCA/Envision as more of a statement on how things are. Your experience seems different but that makes you the exception and not the rule.

I assume most SDG docs on here make more that the number you quoted.

 

[namethatsmell]

1099 IC at $309.25 per hr for 120 hr per month, time and half for holidays (Memorial Day/Labor Day/independence day/thanksgiving/Christmas/New Years), med mal (with tail) paid for by Envision

So they're too cheap to just pay $310/hr?

 

[MechEDoc]

1099 IC at $309.25 per hr for 120 hr per month, time and half for holidays (Memorial Day/Labor Day/independence day/thanksgiving/Christmas/New Years), med mal (with tail) paid for by Envision

This was $25-$35 higher per hour compared all other gigs in my area. Granted there is one SDG left in my area but the buy in was 2 years hard time with bread and water while working on the chain gang. But they only offered $5-$25 per hour more than what I am making now (once partner), and the scheduling would be a “night”mare.

I think the key to finding a good gig is to not limit yourself and to explore all options while being able to walk away from offers.

What general part of the country is Envision paying $309.25/hr? Asking for a friend...

 

[GonnaBeADoc2222]

I don't think it's fair to criticize another doc for the taking a high paying job with a CMG/HCA.

Now if someone is gonna be a sheep and take 170/hr from U-SUCK citing their "amazing profit sharing opportunities" that's a different story.

In the end, everyone has to make the best life/financial decisions for them and their families. As a young attending, it totally makes sense to maximize income at whatever practice environment you feel comfortable at. Older attendings who have been working for awhile have the financial flexibility to "fight the good fight" and take a moderate paycut and avoid CMGs/HCA if they choose. Don't pretend you're taking a moral high road and "fighting for EM." You merely have more financial freedom to take the other job.

If the SDG wants to recruit strong docs and survive against the CMG they should treat pre partners fairly and not subject them to 2 years of night shift slavery.

In the end, we have become mercenaries. If the balance billing prophecies shared on this forum are true, this level of compensation is headed towards the end times. Might as well make hay while the sun shines.

 

[EctopicFetus]

I think we all need to get our money. if a CMG is gonna pay you $310/hr I sure as poop wont criticize you. I think its pure bs to say fight the good fight and take a paycut. I fought the good fight but I surely didnt take a paycut.

I agree that we all need to do whats best for our families and ourselves. With crippling debt you better chase the money. Just dont spew the typical CMG BS. those jobs are bad and shame on SDGs for abusing pre partners and shame on them if they dont make more money than the local CMG. its honestly inexcusable. Your payer mix can be atrocious but your income should not be.

 

[southerndoc]

For those reading this who are considering SDG's, I would have second thoughts of joining them with the intention of making partner in 2-5 years. At the rate they are getting bought up, chances are you won't have time to become partner before they sell. This happened to a friend of mine.

The SDG's are quickly becoming a dinosaur in the landscape of emergency medicine. I don't see them around in 10 years because of the need to be large to compete with insurers. Small groups don't have the muscles that the big groups do.

 

[Porfirio]

What general part of the country is Envision paying $309.25/hr? Asking for a friend...

It’s not:

LA
San Fran
San D
San Jose
Anywhere CA
Boston
New York
Houston
Austin
Philly
Chicago
Dallas
Atlanta
Miami
Portland
Charleston
Richmond
DC
Cincinnati
Tampa
San Antonio
West Coast
East Coast

Where else is a hot spot for desirable area/city?

Plenty of jobs out there pay good money. You just have to look for them and be willing to live there.

 

[Porfirio]

Why wouldn’t you work more?

This is just my full time HCA/Envision job. My locum gigs pay more. Besides, if I keep them hungry for hours they keep me fed.

People for some reason in this business think you should work more hours at one place. That does nothing for you and nothing for our side of the industry. We have to keep the CMGs hungry. The way to do that is give them the least amount of guaranteed hours for the job and pick up shifts all around when CMGs are starving. This is what drives up our salary.

 

[EctopicFetus]

It’s not:

LA
San Fran
San D
San Jose
Anywhere CA
Boston
New York
Houston
Austin
Philly
Chicago
Dallas
Atlanta
Miami
Portland
Charleston
Richmond
DC
Cincinnati
Tampa
San Antonio
West Coast
East Coast

Where else is a hot spot for desirable area/city?

Plenty of jobs out there pay good money. You just have to look for them and be willing to live there.

It’s not nashville.

 

[EctopicFetus]

This is just my full time HCA/Envision job. My locum gigs pay more. Besides, if I keep them hungry for hours they keep me fed.

People for some reason in this business think you should work more hours at one place. That does nothing for you and nothing for our side of the industry. We have to keep the CMGs hungry. The way to do that is give them the least amount of guaranteed hours for the job and pick up shifts all around when CMGs are starving. This is what drives up our salary.

Aware. Having more than 1 job is smart. In the end though the target is on your back. If you are in an undesirable city it might work indefinitely.

 

[EctopicFetus]

For those reading this who are considering SDG's, I would have second thoughts of joining them with the intention of making partner in 2-5 years. At the rate they are getting bought up, chances are you won't have time to become partner before they sell. This happened to a friend of mine.

The SDG's are quickly becoming a dinosaur in the landscape of emergency medicine. I don't see them around in 10 years because of the need to be large to compete with insurers. Small groups don't have the muscles that the big groups do.

This is some of the biggest bs the CMGs spew. I do agree that it would not be wise to do a steep buy in. That being said the associates in my group make over 50% more than local CMG rates. Hence no risk.

SDGs are the opposite of dinosaurs. I would argue that while CMGs do overall have better contracts they have to be so much better to pay for the bloat that those days are gone. The insurers aren’t playing those antiquitated games. Don’t believe me. See what United did to envision and now to team health. They aren’t dong that to give those guys better rates.

My hourly pay is far and beyond any local CMG.

The idea that CMGs are the future is what CMG folks say. I see hospitals dumping their CMGs slowly but surely. If this BB thing passes and my income goes down 30% I’ll still make more than the CMG guys locally make now. Their pay will have to go down. I can both control my situation and I have something cmgs and pe is willing to buy. CMG docs have neither.

 

[TooMuchResearch]

How small is small though? Maybe a better model going forward is a physician owned equal partner DG.

For those reading this who are considering SDG's, I would have second thoughts of joining them with the intention of making partner in 2-5 years. At the rate they are getting bought up, chances are you won't have time to become partner before they sell. This happened to a friend of mine.

The SDG's are quickly becoming a dinosaur in the landscape of emergency medicine. I don't see them around in 10 years because of the need to be large to compete with insurers. Small groups don't have the muscles that the big groups do.

 

[EctopicFetus]

How small is small though? Maybe a better model going forward is a physician owned equal partner DG.

Like vituity?

 

[Makati2008]

O

This is just my full time HCA/Envision job. My locum gigs pay more. Besides, if I keep them hungry for hours they keep me fed.

People for some reason in this business think you should work more hours at one place. That does nothing for you and nothing for our side of the industry. We have to keep the CMGs hungry. The way to do that is give them the least amount of guaranteed hours for the job and pick up shifts all around when CMGs are starving. This is what drives up our salary.

I will say there was a job in GA that paid close to that rate and I looked at it very briefly. I remembered how crappy working with Meditech was and with HCA being in mix it was a no go.

 

[cyanide12345678]

1099 IC at $309.25 per hr for 120 hr per month, time and half for holidays (Memorial Day/Labor Day/independence day/thanksgiving/Christmas/New Years), med mal (with tail) paid for by Envision

This was $25-$35 higher per hour compared all other gigs in my area. Granted there is one SDG left in my area but the buy in was 2 years hard time with bread and water while working on the chain gang. But they only offered $5-$25 per hour more than what I am making now (once partner), and the scheduling would be a “night”mare.

I think the key to finding a good gig is to not limit yourself and to explore all options while being able to walk away from offers.

I'm curious what the patients per hour is with and without mlp support?

 

[GeneralVeers]

Like vituity?

Vituity is a scam too. As I said in another thread, the level 5 partners in CA take 20% off the top to pay their "partner bonus". If a site isn't making enough money to pay for the 20% bonus, then they will force a pay cut on the docs to get it. They will do so, even if it means losing experienced docs who are super-productive like myself.

I did the math, and after 5 years I'd become level 5 and I'd make $70K year bonus, which comes to just under $50/hour on top of the reduced salary which would put me a the same hourly as the other other two groups in town. Not sure why any docs are willing to work slave wages for 5 years for this nonsense......I just gave my 60 days notice this week.

 

[TooMuchResearch]

I think people here have posted about Vituity. Doesn't seem like an equal partner situation.

How small do you have to be to be considered an SDG?

Like vituity?

 

[deleted109597]

How small do you have to be to be considered an SDG?

Small enough that you don't have the bargaining power of a CMG.
Look at what happened at Summa with SEA. Look at what has happened at any number of other shops.
Sure, you can have your docs be on committees, and be active, and never have an issue with staffing. At the end of the day, only the small hospitals care. Any hospital system will always fall for the "we can cover all of your sites" spiel, even with expansion. Your SDG won't. If you aren't taking money from the hospital, the CMG will come in and offer to pay for the privilege of staffing. They're in it to make money. Period.

 

[miacomet]

Vituity is a scam too. As I said in another thread, the level 5 partners in CA take 20% off the top to pay their "partner bonus". If a site isn't making enough money to pay for the 20% bonus, then they will force a pay cut on the docs to get it. They will do so, even if it means losing experienced docs who are super-productive like myself.

I did the math, and after 5 years I'd become level 5 and I'd make $70K year bonus, which comes to just under $50/hour on top of the reduced salary which would put me a the same hourly as the other other two groups in town. Not sure why any docs are willing to work slave wages for 5 years for this nonsense......I just gave my 60 days notice this week.

I can't keep up with your job situation

 

[GeneralVeers]

I can't keep up with your job situation

I can hardly myself! I'm full-time W2 again for the first time in 6 years. We will see how long that lasts. If the bottom hadn't fallen out on Texas locums I'd probably still be doing that.

 

[GonnaBeADoc2222]

Vituity on paper even looks like a pyramid scheme. 5 levels with varying qualifications to meet each level. They make no effort to even disguise it.

 

[GonnaBeADoc2222]

I remember when vituity was still cep and they were offering some crap like 150/hr for a place in Chicago. I can't stop thinking why do people take jobs like this?!?!?!