EM docs that left medicine

[The White Coat Investor]

I know lots of people who have done this. One went into pain. One went into functional medicine. Others went on the mommy/daddy track. I know a two doc couple who both left for a year to be dive instructors. I know a doc who went to New Zealand to do EM for a year.

I went to half-time so I had time to type crap into the internet.

Medical students don't think about employee/ownership issues so I don't buy the argument that people are getting out because most emergency docs are just employees punching the clock. You don't go to medical school if your primary goal is to be an entrepreneur and own a business.

I would submit that if you want to punch out within the first decade out of residency that you picked the wrong career/specialty. Not totally your fault, we're all different people at 35 than we were at 21, but I think that's probably the truth. The OP should have picked finance. Too many of us had some weird idea that medicine was the most prestigious, best-paid, most-appreciated, most fulfilling job out there and then when it turns out that's not the case AND it isn't what they want to do they blame medicine.

Wake up. There wasn't ever a golden age of medicine. If there was ever a golden age of emergency medicine, this is it. We've never had such a high inflation-adjusted hourly wage.

Take some ownership for your life and your decisions. You had to take a guess at 25 what you wanted to do with your life at 40 and you guessed wrong. Deal with it. Either go into another career or save up all your pennies and punch out and retire completely or suck it up buttercup. It's not supposed to be a blissful beach vacation. They call it work because somebody has to pay you to do it. Your job sucks? Join the club. There are tens of millions of people in the US who also hate their jobs and those jobs don't pay anywhere near $400K.

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[iish]

I know lots of people who have done this. One went into pain. One went into functional medicine. Others went on the mommy/daddy track. I know a two doc couple who both left for a year to be dive instructors. I know a doc who went to New Zealand to do EM for a year.

I went to half-time so I had time to type crap into the internet.

Medical students don't think about employee/ownership issues so I don't buy the argument that people are getting out because most emergency docs are just employees punching the clock. You don't go to medical school if your primary goal is to be an entrepreneur and own a business.

I would submit that if you want to punch out within the first decade out of residency that you picked the wrong career/specialty. Not totally your fault, we're all different people at 35 than we were at 21, but I think that's probably the truth. The OP should have picked finance. Too many of us had some weird idea that medicine was the most prestigious, best-paid, most-appreciated, most fulfilling job out there and then when it turns out that's not the case AND it isn't what they want to do they blame medicine.

Wake up. There wasn't ever a golden age of medicine. If there was ever a golden age of emergency medicine, this is it. We've never had such a high inflation-adjusted hourly wage.

Take some ownership for your life and your decisions. You had to take a guess at 25 what you wanted to do with your life at 40 and you guessed wrong. Deal with it. Either go into another career or save up all your pennies and punch out and retire completely or suck it up buttercup. It's not supposed to be a blissful beach vacation. They call it work because somebody has to pay you to do it. Your job sucks? Join the club. There are tens of millions of people in the US who also hate their jobs and those jobs don't pay anywhere near $400K.

Maybe one of the best posts I've ever read on here. I think the biggest reason most docs don't leave is the sunk cost fallacy, one of the most illogical ways to make a career decision. The one thing 90% of people ask me is "you left after all that training??" Of course I did. Why would I keep on a track that wasn't taking me in the right direction just because I put 8 years of my life into it?

 

[Brigade4Radiant]

Exactly. More docs in admin roles, greater involvement in hospitals and communities means people willing to give up some money/hours to do these things. CMGs know exactly how much to pay us so that doing anything else becomes illogical. They essentially pay us well to keep us on the sidelines.

No many corporate mega groups are started by physicians they become admisnistrators to better serve their business. Also it means doctors doing uncompensated work while juggling clinical duties.

This will just lead to more burnout especially since you are doing uncompensated work.

Administrators work for corporations justo like HCA medical directors are metric crazy because they are required to.

To be honest even with the nights and weekends this is an amazing job I’m able to live frugally and save and provide for my family. I’m able to have adequate me time and have great job security and I can work anywhere and will make at least 200k.

EM has it pretty good

 

[Birdstrike]

It's said that the average person will change careers 5-7 times in their lifetime. So if you've made a career change along the way, or are considering doing so, congratulations, you're normal. Change does not equal failure. Change is often difficult, but also normal, necessary and healthy.

 

[Apollyon]

It's said that the average person will change careers 5-7 times in their lifetime. So if you've made a career change along the way, or are considering doing so, congratulations, you're normal. Change does not equal failure. Change is often difficult, but also normal, necessary and healthy.

Careers, or jobs?

 

[Birdstrike]

Careers, or jobs?

Careers, not jobs. People change jobs even more.

Although you'll find different estimates on this depending on the source, none of them say, "1" is the average number of careers people have in a lifetime. Therefore, our idea in Medicine, that at age 18 we set our sites on a career in Medicine, go through pre-med, medical school, residency and practice, and will never even be tempted to change anything, is a little bit unrealistic. Then, on top of that, for those in Medicine to act as if even thinking of a career change is some sort of a failure, is sort of ridiculous, if you think about it. Sometimes even people thinking of doing a fellowship, or changing specialties within Medicine, are assumed to be having some sort of a "mid-life crisis" or labeled with a pejorative such as being "burned out," implying they failed or couldn't handle "it." As if handling "it" means having to stay in a career that makes one miserable for a lifetime.

Change is the norm. Staying laser focused on one career since a decision at age 18 is not the norm. If people can accomplish that, and it works for them, and continues to work for them their whole life, then great. But if not, that's no failure. In fact, often it is change which reinvigorates us and allows us to recharge for a next phase in our lives. As much as moving out of a career in Emergency Medicine into something else may be what a given person needs, moving out of something else into Emergency Medicine might be what is right for someone entirely different.

 

[DeadCactus]

I would submit that if you want to punch out within the first decade out of residency that you picked the wrong career/specialty...

Take some ownership for your life and your decisions. You had to take a guess at 25 what you wanted to do with your life at 40 and you guessed wrong. Deal with it. Either go into another career or save up all your pennies and punch out and retire completely or suck it up buttercup. It's not supposed to be a blissful beach vacation. They call it work because somebody has to pay you to do it. Your job sucks? Join the club. There are tens of millions of people in the US who also hate their jobs and those jobs don't pay anywhere near $400K.

Your thoughts reflect my own, but I have two additional points I would throw out there for medical students and residents. One, along the lines of your second point above, I think medicine attracts people who are perpetually dissatisfied. You have to be in order to pass up the number of perfectly satisfying and financially stable career opportunities you could divert to on the way to medical school and beyond. You have to learn to take a step-back and realize how good things are as a physician in the grand scheme of life and not get caught up in the facebook envy and pity-party drama that's common in medicine.

But I also think there is a fallacy in how we look and talk about medicine or even a specialties within medicine as if it is a single career. Rural EM, academic EM, community EM, research, teaching, administration, entrepreneurial endeavors, global health, consulting, medico-legal work, writing, etc: the reality is that even within EM, there are radically different ways a career can look. Physicians have been trained off of checking boxes and multiple choice tests. Pre-med? Get this grade, this MCAT, this many research experiences, and this much volunteer time. Medical student? Repeat the process, check the boxes for your specialty of choice. Time to pick a specialty? Pick the right one and a lifetime of happiness will follow! Then people finish residency and get out into a suddenly open ended world and they have no check box to guide them or plan for what to do so they take a job at random and mindlessly grind through each day with no 5 year, 10 year, or career-long plan for where they want to go and how to get there. If you don't manage your career, someone else will and their only goal is going to be to make you the specific cog they need in their specific machine. Get 10 years into being a cog for someone and it's no surprise that they're burned out and they start scrambling for ways to jumpship.

You have to figure out what a satisfying life looks like to you, and this goes way beyond picking a particular specialty or subspecialty, and work toward it. Medicine is a skill set, not any one specific job you're locked into. The vast majority of physicians will always have some component of clinical care in their career but there are so many flavors of how to apply that skill-set, and so much financial freedom that comes with the EM skill-set, that it's a shame there are people out their miserable in their careers after they spent so much effort to get there.

 

[Birdstrike]

Your thoughts reflect my own, but I have two additional points I would throw out there for medical students and residents. One, along the lines of your second point above, I think medicine attracts people who are perpetually dissatisfied. You have to be in order to pass up the number of perfectly satisfying and financially stable career opportunities you could divert to on the way to medical school and beyond. You have to learn to take a step-back and realize how good things are as a physician in the grand scheme of life and not get caught up in the facebook envy and pity-party drama that's common in medicine.

But I also think there is a fallacy in how we look and talk about medicine or even a specialties within medicine as if it is a single career. Rural EM, academic EM, community EM, research, teaching, administration, entrepreneurial endeavors, global health, consulting, medico-legal work, writing, etc: the reality is that even within EM, there are radically different ways a career can look. Physicians have been trained off of checking boxes and multiple choice tests. Pre-med? Get this grade, this MCAT, this many research experiences, and this much volunteer time. Medical student? Repeat the process, check the boxes for your specialty of choice. Time to pick a specialty? Pick the right one and a lifetime of happiness will follow! Then people finish residency and get out into a suddenly open ended world and they have no check box to guide them or plan for what to do so they take a job at random and mindlessly grind through each day with no 5 year, 10 year, or career-long plan for where they want to go and how to get there. If you don't manage your career, someone else will and their only goal is going to be to make you the specific cog they need in their specific machine. Get 10 years into being a cog for someone and it's no surprise that they're burned out and they start scrambling for ways to jumpship.

You have to figure out what a satisfying life looks like to you, and this goes way beyond picking a particular specialty or subspecialty, and work toward it. Medicine is a skill set, not any one specific job you're locked into. The vast majority of physicians will always have some component of clinical care in their career but there are so many flavors of how to apply that skill-set, and so much financial freedom that comes with the EM skill-set, that it's a shame there are people out their miserable in their careers after they spent so much effort to get there.

Well said

 

[iish]

Your thoughts reflect my own, but I have two additional points I would throw out there for medical students and residents. One, along the lines of your second point above, I think medicine attracts people who are perpetually dissatisfied. You have to be in order to pass up the number of perfectly satisfying and financially stable career opportunities you could divert to on the way to medical school and beyond. You have to learn to take a step-back and realize how good things are as a physician in the grand scheme of life and not get caught up in the facebook envy and pity-party drama that's common in medicine.

But I also think there is a fallacy in how we look and talk about medicine or even a specialties within medicine as if it is a single career. Rural EM, academic EM, community EM, research, teaching, administration, entrepreneurial endeavors, global health, consulting, medico-legal work, writing, etc: the reality is that even within EM, there are radically different ways a career can look. Physicians have been trained off of checking boxes and multiple choice tests. Pre-med? Get this grade, this MCAT, this many research experiences, and this much volunteer time. Medical student? Repeat the process, check the boxes for your specialty of choice. Time to pick a specialty? Pick the right one and a lifetime of happiness will follow! Then people finish residency and get out into a suddenly open ended world and they have no check box to guide them or plan for what to do so they take a job at random and mindlessly grind through each day with no 5 year, 10 year, or career-long plan for where they want to go and how to get there. If you don't manage your career, someone else will and their only goal is going to be to make you the specific cog they need in their specific machine. Get 10 years into being a cog for someone and it's no surprise that they're burned out and they start scrambling for ways to jumpship.

You have to figure out what a satisfying life looks like to you, and this goes way beyond picking a particular specialty or subspecialty, and work toward it. Medicine is a skill set, not any one specific job you're locked into. The vast majority of physicians will always have some component of clinical care in their career but there are so many flavors of how to apply that skill-set, and so much financial freedom that comes with the EM skill-set, that it's a shame there are people out their miserable in their careers after they spent so much effort to get there.

Brilliant!

 

[enalli]

Take some ownership for your life and your decisions. You had to take a guess at 25 what you wanted to do with your life at 40 and you guessed wrong. Deal with it. Either go into another career or save up all your pennies and punch out and retire completely or suck it up buttercup. It's not supposed to be a blissful beach vacation. They call it work because somebody has to pay you to do it. Your job sucks? Join the club. There are tens of millions of people in the US who also hate their jobs and those jobs don't pay anywhere near $400K.

You've listed all the non-suicide options that people have to dealing with jobs they don't enjoy (keep doing it forever, retire early, or change jobs). I'm not sure what you're suggesting here--that people quietly do this without talking about it? Isn't discussion the whole point of this forum?

 

[Mr.S]

Really?

Because for this past match, there were 438 applicants for 335 positions, or 1.3 applicants per spot. Worked out for a 75% match rate which put it right at halfway between GI (65%) and endocrine (84%) on the IM spectrum, equal to peds EM for y'all, or the same as colo-rectal for the surgeons. To compare to the other main multi-disciplinary fellowship, sports med had a match rate of 65% this year.

Sure its not the 95% of child psych, but its also not the <50% of peds surgery.

I would think an EM resident who can get good LORs would have a decent shot at a fellowship (the data I could find doesn't break down results by specialty).

is that anesthesia pain?

DO ER docs do pain fellowships now?

 

[nimbus]

Careers, not jobs. People change jobs even more.

Although you'll find different estimates on this depending on the source, none of them say, "1" is the average number of careers people have in a lifetime. Therefore, our idea in Medicine, that at age 18 we set our sites on a career in Medicine, go through pre-med, medical school, residency and practice, and will never even be tempted to change anything, is a little bit unrealistic. Then, on top of that, for those in Medicine to act as if even thinking of a career change is some sort of a failure, is sort of ridiculous, if you think about it. Sometimes even people thinking of doing a fellowship, or changing specialties within Medicine, are assumed to be having some sort of a "mid-life crisis" or labeled with a pejorative such as being "burned out," implying they failed or couldn't handle "it." As if handling "it" means having to stay in a career that makes one miserable for a lifetime.

Change is the norm. Staying laser focused on one career since a decision at age 18 is not the norm. If people can accomplish that, and it works for them, and continues to work for them their whole life, then great. But if not, that's no failure. In fact, often it is change which reinvigorates us and allows us to recharge for a next phase in our lives. As much as moving out of a career in Emergency Medicine into something else may be what a given person needs, moving out of something else into Emergency Medicine might be what is right for someone entirely different.

Does this also apply to spouses?


I was being a wiseass but then realized relationships do change over time. And sometimes people move to entirely new relationships or join a monastery.

 

[bravotwozero]

I went to half-time so I had time to type crap into the internet.

Dude, don't be so hard on yourself!

 

[VA Hopeful Dr]

is that anesthesia pain?

DO ER docs do pain fellowships now?

There isn't technically "anesthesia pain", there's just pain medicine.

Anesthesia, PM&R, EM, psych, neuro, and FP are all eligible.

I'm sure certain programs only take graduates from certain specialties, but that's not going to be universal or an official policy.

 

[Birdstrike]

DO ER docs do pain fellowships now?

Yes, they can. I did and I know a handful of others who have. Pain is as much an official subspecialty of EM as it is anesthesiology (see ABEM website and list of fellowships).

is that anesthesia pain?

Yes, it's the same fellowship that anesthesiologists do, but no, there isn't technically anything called an "anesthesia pain" fellowship anymore. There used to be separate "anesthesia pain, PM&R pain, neurology pain" fellowships, in the past. They've all merged now. As of 2014, the specialties that can do an accredited Pain fellowship and be board certified are: Anesthesia, PM&R, Neurology, EM, FM, radiology and psych. Technically any specialty can do an accredited fellowship, but only those can take the boards, currently. That's the current state of things regarding Pain fellowships (unless things have changed since 2014 and I'm unaware.)

Now, which specialties are most likely to get accepted to these fellowships, is an entirely different story.

Edit: Just saw @VA Hopeful Dr 's post, which covered most of this.

 

[EctopicFetus]

Corporations work for their bottom line employees and contractors cut into this other than maybe google most corps treat their corps rather poorly like Amazon. Nytimes did an article about corporate life there no thanks.

In regards to finance.. see how much Goldman brings in revenue wise per employee. It’s astoudning. I have friends who work there. Their pay is equally astounding. The people who manage Goldman are “one of them”. Meanwhile the guy running USACS and a bunch of CMGs isnt “one of us”. You answer to a bunch of suits who dont know an app from a chole. They dont know what a butthole looks like other than when they look at a mirror.

 

[EctopicFetus]

Yes. It doesn't matter if a doc works 20 hours/month or 200 hours/month, his/her malpractice and administrative costs are the same. It's cheaper for the company to have people work more hours.

This depends on your med mal policy. The admin costs is true though the more you work the cheaper the total admin cost is cause it is cheaper to manage 4 F docs than 8 PT ones.

 

[EctopicFetus]

My point exactly. If some EM docs gave up some salary/time to fight those forces instead of worrying how to work as little as possible while still making good money, maybe we'd have some power.

These guys have figured it out. Pay us well enough that doing anything else seems implausible. Silence us while making us think we are getting a good deal.

Join AAEM, dump ACEP and make a difference.

 

[EctopicFetus]

Eek. Physicians giving up salary is absolutely not the answer to fighting these forces. Maybe giving up big paydays and selling out to large corporations would be an answer, but salary is one of the big things we're fighting for.

I didn't practice 20 years ago, but I don't imagine the goal back then was to work as little as possible to make the most money (although I'm sure 99% of humanity would love to work less for more money). It seems that back then, physicians were invested in their groups, benefitting their community while also pulling in big numbers. Now that they've sold to the corporations, we're one of the main expenses that these corporations have. Translation: Their goal is profit. Their expense is us. They achieve more profit by spending less on us. That's the formula now and why you see our fight is for our piece of the pie.

With that said, does an increase in EM doc salary of 50% nationwide solve the problems that EM is facing? Absolutely not. Personally, I'd argue that more docs in administrative roles, less rule by mega-corp, and a return to greater involvement by ED docs in their hospitals and their communities. (Cue plug for AAEM)

The reality is that an SDG is a more profitable model for docs AND provides the community involvement you mention.

Giving up money sounds good but its a problem we all want solved by someone else. A good SDG has folks who all step up to go to meetings and be involved for no pay. The trade off is much higher clinical pay. There are and always will be the free loaders but the expectation and recruitment centers among those who we believe will be contributors.

My group has an insane amount of guys on committees, board and chairs of those boards and committees. Our hospital CEOs know probably half the group by name. Those relationships are our security.

The hospital knows we make above average pay and are fine with it as we support the hospital and its mission.

Let’s call it what it is. The current generation of docs 50+ have sold out the rest. While in a business sense they “owned “ their group what they did is sell off future revenue and profit that wont affect them and screwed the younger generation of docs. I see the pendulum starting to swing back but it is much tougher for a new SDG to start than it is for a CMG to take one over. Every doc should be squeezing the CMGs hard, going to local ceos to start up an SDG. The timeline i great is short as a new batch of young, dumb and broke docs from CMG residencies will need to work and they will drive the price and leverage way down.

 

[Birdstrike]

I see the pendulum starting to swing back but it is much tougher for a new SDG to start than it is for a CMG to take one over. Every doc should be squeezing the CMGs hard, going to local ceos to start up an SDG. The timeline i great is short as a new batch of young, dumb and broke docs from CMG residencies will need to work and they will drive the price and leverage way down.

The pendulum does swing back and forth on this kind of thing, depending on the era you're in.

 

[miacomet]

The reality is that an SDG is a more profitable model for docs AND provides the community involvement you mention.

Giving up money sounds good but its a problem we all want solved by someone else. A good SDG has folks who all step up to go to meetings and be involved for no pay. The trade off is much higher clinical pay. There are and always will be the free loaders but the expectation and recruitment centers among those who we believe will be contributors.

My group has an insane amount of guys on committees, board and chairs of those boards and committees. Our hospital CEOs know probably half the group by name. Those relationships are our security.

The hospital knows we make above average pay and are fine with it as we support the hospital and its mission.

Let’s call it what it is. The current generation of docs 50+ have sold out the rest. While in a business sense they “owned “ their group what they did is sell off future revenue and profit that wont affect them and screwed the younger generation of docs. I see the pendulum starting to swing back but it is much tougher for a new SDG to start than it is for a CMG to take one over. Every doc should be squeezing the CMGs hard, going to local ceos to start up an SDG. The timeline i great is short as a new batch of young, dumb and broke docs from CMG residencies will need to work and they will drive the price and leverage way down.

Agreed. I wish residency directors would counsel new grads not just about the evils of CMGs, but about the particular evil of the CMG "firefighter" gig. It was a ton easier to squeeze high locums rates from desperate CMGs before they suckered new grads into in-house locums.

 

[nimbus]

The reality is that an SDG is a more profitable model for docs AND provides the community involvement you mention.

Giving up money sounds good but its a problem we all want solved by someone else. A good SDG has folks who all step up to go to meetings and be involved for no pay. The trade off is much higher clinical pay. There are and always will be the free loaders but the expectation and recruitment centers among those who we believe will be contributors.

My group has an insane amount of guys on committees, board and chairs of those boards and committees. Our hospital CEOs know probably half the group by name. Those relationships are our security.

The hospital knows we make above average pay and are fine with it as we support the hospital and its mission.

Let’s call it what it is. The current generation of docs 50+ have sold out the rest. While in a business sense they “owned “ their group what they did is sell off future revenue and profit that wont affect them and screwed the younger generation of docs. I see the pendulum starting to swing back but it is much tougher for a new SDG to start than it is for a CMG to take one over. Every doc should be squeezing the CMGs hard, going to local ceos to start up an SDG. The timeline i great is short as a new batch of young, dumb and broke docs from CMG residencies will need to work and they will drive the price and leverage way down.

Ask the former Summa guys about security. They were equally involved.

And the thing about some CEO’s is that they will smile, be cordial, and work with you while simultaneously cutting a back room deal with someone else. They are players.

 

[Apollyon]

Business is sociopathic. Just, ALWAYS, remember that.

 

[VA Hopeful Dr]

Ask the former Summa guys about security. They were equally involved.

And the thing about some CEO’s is that they will smile, be cordial, and work with you while simultaneously cutting a back room deal with someone else. They are players.

That CEO did lose his job over that though

 

[DeadCactus]

That CEO did lose his job over that though

But what did his severance package look like?

 

[thegenius]

I can see why things appear that way but I think you have it backwards. The attitudes you see are the result of the current state, not the cause of it. I think most went into medical school/residency with the goal of giving good patient care, while having a reasonable amount of control over their work environment and practice. I think the current attitude you see on the forum is the result of realizing the good fight is lost. These guys are just trying to get out with as little damage as possible. Once you realize your business is going bankrupt, you just try to sell off as much as you can. Trying to maintain your vision of a good business model is no longer relevant.

It should not be that hard to do the right thing for patients.

Good patient encounters, good results, and having the system work the way it should gets harder and harder.

Sometimes I feel best when a complex patient arrives, I make a diagnosis that really doesn't require admitting. All they need is a repeat blood draw a few days later to make sure they are improving with my therapy. I call their PMD, maybe another doc, get everything all set up, and they can go home. They don't need to sit in the hospital so they can get an antibiotic infused for 30 minutes. The other 23.5 hrs of their time they are sitting in the hospital looking at the walls taking up a needed bed. When I'm able to set that stuff up, I really feel like I'm helping the patient, their doctors, and the health care system. I'm saving everyone time, money, and hassle. All it requires is a little more work on my part.

These types of "wins" only happen a few times a month, unfortunately.

 

[Paperman]

It should not be that hard to do the right thing for patients.

Good patient encounters, good results, and having the system work the way it should gets harder and harder.

Sometimes I feel best when a complex patient arrives, I make a diagnosis that really doesn't require admitting. All they need is a repeat blood draw a few days later to make sure they are improving with my therapy. I call their PMD, maybe another doc, get everything all set up, and they can go home. They don't need to sit in the hospital so they can get an antibiotic infused for 30 minutes. The other 23.5 hrs of their time they are sitting in the hospital. When I'm able to set that stuff up, I really feel like I'm helping the patient, their doctors, and the health care system. I'm saving everyone time, money, and hassle. All it requires is a little more work on my part.

These types of "wins" only happen a few times a month, unfortunately.

Agree wholeheartedly. But it takes (at least) 2 to tango and many of our FPs are fanatically protective of their schedules and arranging for prompt follow-up in an FP office to re-evaluate in 48-72 hours is often a Herculean task. Which is really unfortunate as it’s often “the right thing to do.”

TPM

 

[EctopicFetus]

Ask the former Summa guys about security. They were equally involved.

And the thing about some CEO’s is that they will smile, be cordial, and work with you while simultaneously cutting a back room deal with someone else. They are players.

That’s true. Do you think when we negotiated our newest contract that didn’t get brought up. Oh and what happened to the ceo? What happened to the ed volumes? What happens to their residency? What happened when they tried to get the residency back.

I feel bad for what happened to the summa guys. To think it didn’t hurt the hospital a ton is foolish.

That’s the lesson as a non summa doc. That’s the lesson for the CEOs.

What happened to the summa docs was atrocious.

Other lesson get a long term no out contract. Protect ya neck as wu-tang would say.

 

[nimbus]

That’s true. Do you think when we negotiated our newest contract that didn’t get brought up. Oh and what happened to the ceo? What happened to the ed volumes? What happens to their residency? What happened when they tried to get the residency back.

I feel bad for what happened to the summa guys. To think it didn’t hurt the hospital a ton is foolish.

That’s the lesson as a non summa doc. That’s the lesson for the CEOs.

What happened to the summa docs was atrocious.

Other lesson get a long term no out contract. Protect ya neck as wu-tang would say.

Completely agree with all your points. I only brought it up because I wanted to point out that even if you have a seat at the table you can still be lunch because some of the decisions that affect you are being made at the super secret unofficial table. These meetings are not part of any official committee, not publicized on the hospital calendar, have no written agenda, and no minutes. But they are where some of the most important decisions get made. Then the administration pushes them through even at a high cost to themselves.

 

[emergentmd]

I was part of a SDG with 100+ docs, ran 10+ sites. MEC, committee members everywhere. We likely had the most committee members of any group by far. CMO at 2 hospitals. Name it, we were involved. Bought out with not choice.

Hospitalist group at same system. Most respected and rated group throughout the system. All of the specialists loved working with them bc they were top notch doctors and easy to work with. Group wanted a stipend, CMG didn't. They were gone.

Anyone who thinks that it is not all about money is delusional. There may be a unicorn where admin actually cares about legacy/longevity but it rarely trumps the bottom line.

 

[EctopicFetus]

Completely agree with all your points. I only brought it up because I wanted to point out that even if you have a seat at the table you can still be lunch because some of the decisions that affect you are being made at the super secret unofficial table. These meetings are not part of any official committee, not publicized on the hospital calendar, have no written agenda, and no minutes. But they are where some of the most important decisions get made. Then the administration pushes them through even at a high cost to themselves.

Not if they know it will cost them a lot. Let’s be honest. Hospital admins are like politicians.. Their #1 goal is to maintain their jobs. Do you think the Summa President thought he would lose his job if he brought in USACS? Do you think he would have still done this if he knew the consequences?

Have your hands in deep places and you will know of the super secret meetings too. Self preservation is their game. Make it a key part of what you offer.

 

[EctopicFetus]

I was part of a SDG with 100+ docs, ran 10+ sites. MEC, committee members everywhere. We likely had the most committee members of any group by far. CMO at 2 hospitals. Name it, we were involved. Bought out with not choice.

Hospitalist group at same system. Most respected and rated group throughout the system. All of the specialists loved working with them bc they were top notch doctors and easy to work with. Group wanted a stipend, CMG didn't. They were gone.

Anyone who thinks that it is not all about money is delusional. There may be a unicorn where admin actually cares about legacy/longevity but it rarely trumps the bottom line.

Stipends are the Achilles of all groups. The CMGs exploit this as most EM groups do not require a subsidy but hospitalists do. They bundle this to a no subsidy agreement. Hospital saves money. I understand that game. Groups have to make sure they make it exquisitely painful to get rid of them. The summa Roadmap was a starting point. It can and should be uglier.

 

[Birdstrike]

I was part of a SDG with 100+ docs, ran 10+ sites. MEC, committee members everywhere. We likely had the most committee members of any group by far. CMO at 2 hospitals. Name it, we were involved. Bought out with not choice.

Hospitalist group at same system. Most respected and rated group throughout the system. All of the specialists loved working with them bc they were top notch doctors and easy to work with. Group wanted a stipend, CMG didn't. They were gone.

Anyone who thinks that it is not all about money is delusional. There may be a unicorn where admin actually cares about legacy/longevity but it rarely trumps the bottom line.

This sounds a lot like my group. Same presence. Same result. EM and Hosp contracts, canceled. Critical care, next to go. Only outpatient practices survived (now thriving). The hospital businessmen will slit our throats to save $1 if they can find a way get away with it, I have no doubt.

 

[deleted109597]

Join AAEM, dump ACEP and make a difference.

That's like saying join the Green Party and dump the Democratic party and make a difference. It's expensive to do both, but ACEP has waaaaaaay more power.

 

[miacomet]

I just don't get why the kids are picking this specialty, or frankly any other hospital-based specialty. CMGs are the future, and it's only going to get worse, IMHO much worse, before it gets better. Look at the United/Envision deal in the works. If that doesn't make you shudder, it should.

 

[VA Hopeful Dr]

I just don't get why the kids are picking this specialty, or frankly any other hospital-based specialty. CMGs are the future, and it's only going to get worse, IMHO much worse, before it gets better. Look at the United/Envision deal in the works. If that doesn't make you shudder, it should.

Because they enjoy the work?

 

[alphaholic06]

I just don't get why the kids are picking this specialty, or frankly any other hospital-based specialty. CMGs are the future, and it's only going to get worse, IMHO much worse, before it gets better. Look at the United/Envision deal in the works. If that doesn't make you shudder, it should.

What's the deal in the works? Last I heard United was out.

Sent from my SM-T830 using SDN mobile

 

[Paperman]

I just don't get why the kids are picking this specialty, or frankly any other hospital-based specialty. CMGs are the future, and it's only going to get worse, IMHO much worse, before it gets better. Look at the United/Envision deal in the works. If that doesn't make you shudder, it should.

Your posts seem to indicate you are beyond burned out. I am truly sorry for that. Like any field (medicine or not), there are good gigs and bad gigs within a respective industry. Good finance, bad finance. Good law, bad law. Good teaching, bad teaching. Good plumbing, bad plumbing.

EM is still a great specialty and I fully understand its appeal. Move with your feet, there are still good jobs to be had.

TPM

 

[miacomet]

Your posts seem to indicate you are beyond burned out. I am truly sorry for that. Like any field (medicine or not), there are good gigs and bad gigs within a respective industry. Good finance, bad finance. Good law, bad law. Good teaching, bad teaching. Good plumbing, bad plumbing.

EM is still a great specialty and I fully understand its appeal. Move with your feet, there are still good jobs to be had.

TPM

I have a really good job. A job so good it has a waiting list of applicants. Doesn't mean I don't see the future of the field.

There are parts of the country (NYC, for example) without a single tolerable job. Hard to be happy living where you don't want to be.

 

[EctopicFetus]

That's like saying join the Green Party and dump the Democratic party and make a difference. It's expensive to do both, but ACEP has waaaaaaay more power.

But if they use their power to harm EM why should I support them? ACEP does some good for all but typically only when it benefits the CMGs. See the long list of recent presidents and you will appreciate the CMG power. Look at who is on the speaker circuit.

I would say its like Dump the KKK and join the ACLU. (FWIW I dont like either of those 2 options). ACEP has scale but it is bought and paid for with CMG money.

 

[EctopicFetus]

Ill say I haven’t heard anything about an update on UHC Envision. Remember it is united dumping envision. And in our small view of the world we think envision has the power but remember United is a 250B company and envision is $5b (or less when they went private). One company is literally 50x the worth of the other.

United has the power not envision in this deal. While in general the CMGs will tell you that they have scale etc what they aren’t is nimble. Some hospitals require 100% in network for their ED groups. This may be in some of the CMG contracts. United has envision by the balls because they aren’t nimble. They are so big they are getting beat up by the bigger bully. I for one love love love it.

 

[Dr Mantis Toboggan]

Last I saw Envision wanted 600% of Medicare, so they can charge $900 for a midlevel to diagnose pink eye. Ridiculous.

Ill say I haven’t heard anything about an update on UHC Envision. Remember it is united dumping envision. And in our small view of the world we think envision has the power but remember United is a 250B company and envision is $5b (or less when they went private). One company is literally 50x the worth of the other.

United has the power not envision in this deal. While in general the CMGs will tell you that they have scale etc what they aren’t is nimble. Some hospitals require 100% in network for their ED groups. This may be in some of the CMG contracts. United has envision by the balls because they aren’t nimble. They are so big they are getting beat up by the bigger bully. I for one love love love it.

 

[EctopicFetus]

Last I saw Envision wanted 600% of Medicare, so they can charge $900 for a midlevel to diagnose pink eye. Ridiculous.

They know how to make money. I haven’t seen anything official on the latest on United and Envision.

If United goes out of network envision will be harmed.

 

[deleted109597]

BCBS has been a bigger issue to most. United hasn't threatened to not pay non-emergent complaints or withheld payments without chart reviews. Apparently in my neck of the woods, most if not all of the insurers are pulling out of network. I foresee the next legislative session pushing back on them for network adequacy instead of towards the doctors for balance billing. I could be wrong though.

 

[EctopicFetus]

BCBS has been a bigger issue to most. United hasn't threatened to not pay non-emergent complaints or withheld payments without chart reviews. Apparently in my neck of the woods, most if not all of the insurers are pulling out of network. I foresee the next legislative session pushing back on them for network adequacy instead of towards the doctors for balance billing. I could be wrong though.

Doctors suck at PR and lobbying. Look at what the insurance companies spend on lobbying. They also dont just show up with a bunch of randomly interested ED docs once a year to chat.

Want more proof? The ACA, regardless of what you think about it, it has screwed docs and been a big financial win for insurers.

 

[Brigade4Radiant]

Insurance companies are better at lobbying because its a top down issue. CEOs "donate" the money with very specific requests. Also it is false to say doctors are not good at lobbying. Look at ortho for example. They get paid a lot due to their lobbying efforts.

 

[Paperman]

Doctors suck at PR and lobbying. Look at what the insurance companies spend on lobbying. They also dont just show up with a bunch of randomly interested ED docs once a year to chat.

Want more proof? The ACA, regardless of what you think about it, it has screwed docs and been a big financial win for insurers.

As a cohort, physicians are much more comfortable assuming someone else is protecting our best interests. We wrongly assume that the lay public in general and the healthcare industry as a whole (hospitals, insurance, groups, colleagues) wants to protect the 'tip of the spear' of medicine. We couldn't be more wrong.

 

[The White Coat Investor]

You've listed all the non-suicide options that people have to dealing with jobs they don't enjoy (keep doing it forever, retire early, or change jobs). I'm not sure what you're suggesting here--that people quietly do this without talking about it? Isn't discussion the whole point of this forum?

Of course. Not sure I said don't talk about it in there anywhere. I think my point was more "if you need to change, then change, it's okay." But the financial realities of having $400K in student loans hanging over your head are that your choices are more limited. You've either got to suck it up or you've got to change to something that also pays enough to pay off the loans.

I got an email from a burned out resident recently. Imagine hating your job and still being a few years away from even being able to start doing it, much less paying off the cost of getting that job. It's terrible and heartbreaking to see. Without the loans, you could walk away any time and go be a ski instructor if you want. With the loans....options can be very limited.

 

[EctopicFetus]

Insurance companies are better at lobbying because its a top down issue. CEOs "donate" the money with very specific requests. Also it is false to say doctors are not good at lobbying. Look at ortho for example. They get paid a lot due to their lobbying efforts.

But they compete vs other docs. This is historical FWIW. Doctors are not “not good” we are terrible.

 

[miacomet]

Of course. Not sure I said don't talk about it in there anywhere. I think my point was more "if you need to change, then change, it's okay." But the financial realities of having $400K in student loans hanging over your head are that your choices are more limited. You've either got to suck it up or you've got to change to something that also pays enough to pay off the loans.

I got an email from a burned out resident recently. Imagine hating your job and still being a few years away from even being able to start doing it, much less paying off the cost of getting that job. It's terrible and heartbreaking to see. Without the loans, you could walk away any time and go be a ski instructor if you want. With the loans....options can be very limited.

Debt is slavery, yet people sign up for it quite happily. I don't understand.