As others have posted ad nauseum...We as doctors tend to dramatically underestimate how valuable a commodity we are. I am almost two years out from residency and have gotten a little perspective on this issue.
When I was interviewing I wanted to stay in a particular part of the country (mid-Atlantic) so my experience is limited to this area.
I began interviewing pretty early because I wanted to make sure I had the chance to see various practices. The variation in remuneration, practices, groups, styles, etc. astounded me. It's actually kinda cool when you think about it but it does mean that newly minted EM docs have to do some serious homework and some serious soul searching.
In my third year, one of my buddies from residency and I (along with our wives) went to one of those lavish recruitment dinners the big managed groups put out. The spread was amazing with a brief lecture to highlight the group's strengths, etc, etc. They began telling us how much $ they would front us...30k sign-on bonus, 8k for moving, 10k per year for exenses (phone, computer, pda, board fees, etc.). It all sounded amazing. Quaint beach town, lots of friendly EM docs, all EM trained, and...$95/hr for 12-14 12 hr shifts/mo. Well, the hourly rate is kinda low but with all of these perqs and an decent benefit package it seemed like a pretty good job. So we both went to interview. They rolled out the red carpet, man. Beautiful, expensive dinner, gift baskets for our wives, new hospital, idyllic southern coastal town.
Well you know where this is going, right? My buddy took the job and walked into the biggest snake pit of his life. No one mentioned the complete lack of support or the fact that the group had lost 4-5 docs that year. No one mentioned that the new recruits were now working 16-18 12/hr shifts/mo and because that ED saw it's volume triple over the past 2 years those shifts were really 15-16 hrs long. No one mentioned that the groups director was a complete charlatan. He was replaced within 6 months but by then more docs had jumped ship, so everyone was working more and more. So here is my friend stuck in a cute small southern town with a pretty hefty mortgage and school age children. What can you do? You can't just bail, because you signed a contract and that lovely signing bonus is now an albatross, not to mention your new car (come on, who didn't buy a new car when they graduated?) and you new mortgage.
Luckily for me I wanted to stay a little closer to home so I didn't really consider the above position. So I kept looking. I found a small democratic group on the outskirts of our geographic radius and was immediately impressed. Great salary, partners were pulling in ~300k/yr. Stable, democratic group. Busy place but good back-up, close referral tertiary care, PCI in house. We went to the interview and loved the whole gang. Young, dynamic group, had a great time at the informal dinner, got chided for not drinking enough. You get the picture. We're thinking about signing the contract when I get a call from the director, who tells me the hospital's reviewing our contract so I can't offer any positions right now. "This is just a formality", he says, "give me a month and we'll get you down here. BTW we're going on a fishing trip next month and we want you and your wife to come along". Next month the group is disbanded and completely reorganized and are now hospital employees. Still a pretty good gig but kinda hard to jump in while the place is still in flux...so I keep looking.
Multiple sucky interviews ensue. I look and find an ad in one of the journals. I call, talk to the recruiting partner who seems pretty funny. We arrange an interview. I am offered a lunch interview and a tour. We go to a dumpy Chineses restaurant but there are 12 partners there. The group is laughing, insulting each other, completely at ease. I ask about a signing bonus, they laugh. I ask about moving expenses, they say "sure, we'll take em out of your first check". I ask about coverage, back up, democracy. The laughing stops and they say if you work here you work the same schedule, nights, weekends as the director. You will live within a certain radius of our hospital becuase we want our docs for the long haul and we want you to put down roots in the community. Other than that it's a fee for service model and you collect what you collect. Our director is also an MBA and our billing, coding is designed so we max our collections and you are reimbursed as well as can be. Busy, busy place but excellent back up. Have to transfer PICU only. During my interview I saw the books, they made sure I saw them. Phenomenal income potential. Avg partner salary was >400K. They work 14-16 8's a month. Benefits are up to you, you can pick the group's plan or go on your own. Group is a mix of wildly divergent docs. All of them are committed to providing excellent care in a democratic FFS model. Busy place, lots of sick people but wonderful support from hospital and ancillary staff.
Any way I signed on and really lucked into one of the best jobs around in my opinion. My buddy finally left that first job and is now part of our group.
This isn't meant as a recruiting tool (although we are looking for 1-2 docs) I swear but just as a cautionary tale to really look at a group before committing. FFS is great but so are big, managed groups (for some), independent contracting, locums, etc. You have all worked extremely hard to make yourselves so marketable. Take advantage of your skills and find the best job you can. Ask hard questions, don't tolerate evasive answers. Really grill the partners about what it's like to work there. Try to observe the ED in action if possible. Find out where the $'s going. Too many groups have an old guard of fat cat EM docs skimming off the top. That shouldn't, in my opinion, be allowed to persist.
Man, this was long. I'm just coming off nights and am still fired up from my shift. Again, if the tone of this is all wrong I apologize, just one man's opinion.
Good luck, feel free to PM me if you have any q's.
