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deleted547339
Yea. They’re a behemoth. I’m shocked they didn’t already do this.
Envision screwing doctors again!!!!
- Thread starter EctopicFetus
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Yea. They’re a behemoth. I’m shocked they didn’t already do this.
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Nothing to worry guys. Just got off a conference call with a high chain of command and everything is fine. The Bloomberg article is not correct and there is no talk of bankruptcy. They are just adjusting to the current environment like any other proactive company.
So don't worry, no need to find another job, no need to worry about your pay.
This is code for- "send the msg to keep the line docs quiet while we figure out how to pay them less"
So don't worry, no need to find another job, no need to worry about your pay.
This is code for- "send the msg to keep the line docs quiet while we figure out how to pay them less"
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So they going to be hospital employees? Not sure how great this is. Seems like another master while cutting out the middle man. Atleast with a CMG, you can negotiate and they pay for travel expenses.
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I think the problem with that is that in certain states EM docs can't be hospital employees.
"Adversity introduces a man to himself."
"Adversity introduces a man to himself."
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If they are contracting with the entire group than that sounds like an SDG does it not? An employer-employee is an arrangement on an individual basis.
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Nope. If they do the billing, collect the $$$, makes the Staffing decisions but not holding my breath.
Hospital paying a rate means they r no better than being w a cmg
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Fun times ahead.. BTW the CMGs still suck. The math is complex for envision. So unless someone came in with a large amount of cash it is hard to imagine they arent in trouble.
The $650M in cash.. MOnthly payroll of 500M which doesn't include rent, equipment etc. $175M in cash they cant touch.. oh and $7B in debt and no one is gonna loan them money for a low rate. Slow burn... that's my guess. They are screwed and I cant say I am sad about it.
Next step is obvious.. which is to cut pay where they can. I imagine a 10% or $20/hr cutin situations where they can cut. Dont think they can? Check USACS in Denver.
The $650M in cash.. MOnthly payroll of 500M which doesn't include rent, equipment etc. $175M in cash they cant touch.. oh and $7B in debt and no one is gonna loan them money for a low rate. Slow burn... that's my guess. They are screwed and I cant say I am sad about it.
Next step is obvious.. which is to cut pay where they can. I imagine a 10% or $20/hr cutin situations where they can cut. Dont think they can? Check USACS in Denver.
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So just heard through the grapevine that INOVA out in Virginia are making big cuts to “nonclinical staff”, Hopkins system is taking away their 403 benefits and other possible benefits. Curious since that area had been hit hard as well, any news on Medstar and their solvency?!
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Who staffs Inova?
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I am always an optimist. this is a great opportunity for EM docs to retake control. Get the nursing Jenny's out of the way of physician care. Retake our jobs. I am hopeful that some of these orgs bleed bad and we return to a system whereby the captain of the ship also has control of the steering wheel.
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Is this actually a thing? And if so, what can I do about it to maintain coverage of my butt? I am an Envision IC.
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Well that goes back to my much earlier comment. HCA and Envision are a shared entity in Florida. So *can* florida HCA hospitals terminate their contracts even if envision itself goes bankrupt since the HCA+Envision dual entity is definitely still financially viable. e.g. could HCA pull out of that deal, or does them still being above water mean they have to keep envision in florida alive while envision as a whole tries to figure out their next moves.
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deleted109597
They'll restructure, rename themselves as "EmFuture" or something, and continue doing what they're doing.
I promise.
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When a company truly goes bankrupt their assets are sold and a judge decides how the creditors are paid based on the structure of liabilities.
So the portion of emcare that owns the hca hospitals or those shares of ownership would
Be sold off.
Probably is a thing. The bill has to be paid for the coverage...
Usually when a new group takes over a contract they finance the tail coverage for the docs they take on board...
but that is never 100% guaranteed. If it does not happen, you need to be prepared to pay a hefty sum to keep that coverage for yourself...
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Again not what happened at Legacy Physician partners. usually the new group doesnt cover the Tail. Envision self insures so it is akin to your med mal carrier going bankrupt if this happens.
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It depends. Some states have laws that they must have reserves to handle insurance claims.
Legacy got taken over by Progressive Emergency Physicians, Another shady group run by a shady character...
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Yep. Of course he is a former ACEP president.
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deleted547339
I got screwed out of tail insurance before. Thankfully, the hospital that contracted with a sketchy group picked it up so we didn’t sue them.
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I believe progressive took over the contract but not the assets (and liabilities of Legacy)
ER physicians at 3 Pennsylvania hospitals work weeks without pay
At the end of October, Ontario, Calif.-based Prime Healthcare ended its contract with the staffing firm that employed the physicians who worked in the emergency rooms at its three Pennsylvania hospitals. Last week, the staffing firm failed to pay the ER physicians, according to The Philadelphia...
They offered to help if the docs who were there took the ****ty terms of the new contracts.
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Did the Team Health ER physicians have a non compete? If so, how did MH break it?
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Envision has a large amount in a separate account to cover malpractice liability per Federal laws as they are self-insured. This amount likely could not be touched in any bankruptcy proceeding.
New York apparently has plenty of local EM docs willing to help, but they are using out-of-state "volunteers" instead. This is why I never do anything for free medically.
slate.com
“For the First Time in My Life, Going to Work Scares Me”
“And coming home scares me even more.”
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Don't know exactly. Non-competes are allowed in Texas. All I can say is that the same docs stayed on as 1099s as before, but just under a different name, contracted from Memorial Hermann directly.
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I'm no expert in this; but I do recall someone saying that non-competes are essentially unenforceable if x-and-y.
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New York apparently has plenty of local EM docs willing to help, but they are using out-of-state "volunteers" instead. This is why I never do anything for free medically.
“For the First Time in My Life, Going to Work Scares Me”
“And coming home scares me even more.”
Had the exact same experience as the article. Signed up to work for NYC Health and Hospitals back in March when they were getting hit hard. Currently only working 10 shifts per month so I had offered to do an extra 5 shifts at my hospital in April. When I heard the public hospitals were getting hit even harder I gave away the shifts and signed up to work at Lincoln Hospital instead. They did emergency credentialing in a week and stated they'd get me started immediately. Its been almost 4 weeks now and I still haven't been given any shifts. From talking to friends it sounds like they chose to give the shifts to MDs from out of town instead of the local docs. Never heard why but honestly I wouldn't be surprised if that was their reasoning that it might lead to us getting higher long term salaries. Its unfortunate but most NYC hospitals don't respect their EM docs.
Do you work in NYC (@alpinism doesn't exactly fit with NYC)? I'd say you are being too generous- none of the hospitals in NYC respects their EM docs, with the possible exception of Northwell. Terrible hospitals, terrible medical care, uniquely corrupt hospitals, and awful salaries. I don't know how they staff them now, or how they will in the future.
Looks like H and H has openings...everywhere: PAGNY - Careers | Physician Affiliate Group of New York. You also can work insane clinical hours while underpaid with terrible benefits.
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Denver Health asks its frontline employees to voluntarily take leave without pay or reduce their hours/pay because you know "hard times"....yet 1 week later the executives all get bonuses ranging from 50k to 230k.
denver.cbslocal.com
How tf do you justify yourself getting a bonus if you are telling the people who make the hospital $$$ that they are getting their hours and pay cut?
and seriously wtf does an "Experience Officer" do that justifies her 220k salary and 40k bonus.....
Denver Health Executives Get Bonuses 1 Week After Workers Asked To Take Cuts
Top executives at Denver Health received significant bonuses one week after frontline hospital workers were asked to voluntarily take leave or reduce their hours.
denver.cbslocal.com
How tf do you justify yourself getting a bonus if you are telling the people who make the hospital $$$ that they are getting their hours and pay cut?
and seriously wtf does an "Experience Officer" do that justifies her 220k salary and 40k bonus.....
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deleted547339
Denver Health asks its frontline employees to voluntarily take leave without pay or reduce their hours/pay because you know "hard times"....yet 1 week later the executives all get bonuses ranging from 50k to 230k.
Denver Health Executives Get Bonuses 1 Week After Workers Asked To Take Cuts
Top executives at Denver Health received significant bonuses one week after frontline hospital workers were asked to voluntarily take leave or reduce their hours.
How tf do you justify yourself getting a bonus if you are telling the people who make the hospital $$$ that they are getting their hours and pay cut?
and seriously wtf does an "Experience Officer" do that justifies her 220k salary and 40k bonus.....
Wow, and they argue that it’s to keep salaries in line with other administrators make around the country - what about keeping the doctors and nurses lay in line?
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All depends on the language. MH may have paid them some money to keep those docs or they told those docs they would cover the lawsuit costs. Either way unlike when one CMG takes a contract from another the CMGs suing hospitals wont look good for their desire to expand.
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Denver Health asks its frontline employees to voluntarily take leave without pay or reduce their hours/pay because you know "hard times"....yet 1 week later the executives all get bonuses ranging from 50k to 230k.
Denver Health Executives Get Bonuses 1 Week After Workers Asked To Take Cuts
Top executives at Denver Health received significant bonuses one week after frontline hospital workers were asked to voluntarily take leave or reduce their hours.
How tf do you justify yourself getting a bonus if you are telling the people who make the hospital $$$ that they are getting their hours and pay cut?
and seriously wtf does an "Experience Officer" do that justifies her 220k salary and 40k bonus.....
Special place in hell, I say.
I'll post it again.
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actually apparently the benefits are amazing.
but everything else you said appears to be correct.
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It could be similar to what Michigan has going on. Recruiters working michigan contracts have been told they cannot accept anyone who already works in Michigan under the premise that the hospital they are already credentialed at may need them to give more shifts at their home site and whomever made this stupid rule did the math already and decided that they wont have a shortage of out of state people willing to come in - so they didnt want any chance of their recruiting causing a different hospital to end up understaffed if coverage is needed.
I do think NYC is particularly worrisome since they have people volunteering for it. From HHC's perspective they'd be fools to not milk that for all its worth. But they may have done some mental calculus like Michigan did and decided they wont use anyone in-state. I dont *think* thats the case, but it might be partially at play.
The benefits are not amazing. Terrible 401k match, no pension (nurses get pensions), average health insurance. What benefits are amazing?
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They do get pensions (at least harlem and met do). And particularly robust ones at that. I am aware that pay can vary from site to site, but I didn't know pension varied site to site - but possibly thats why we are disagreeing? Thats the appeal of working in those two
They do not get pensions. The physicians are employed by PAGNY, and have been for several years. It's true the city hospitals used to offer pensions, but PAGNY, the awful group that staffs all the city hospitals now, does not offer pensions. The last holdout was Kings County, but even they hire all new physicians through PAGNY, which is pensionless.
This is a description of a PAGNY contract from a recruiter. I calculated the hours and it comes to about 1450 clinical a year, plus academic responsibilities:
"Attendings are employed by the physician group PAGNY (Physician Affiliate Group of New York).
Starting salary is $235,000 when you are Board Certified. An additional $2,000 if you have completed a fellowship.
If you are interested in a night position, there is a $15,000 additional stipend for all nights.
There is potential for bonuses in both an annual PI distribution and as either part of a faculty practice or a retention bonus. (This past year the retention bonus was $20,000 for Emergency Physicians at XXXX hospital after 1 full year of service and the PI bonus was over $10,000).
Benefits are described as attached. Pay particular attention to the section on the 401K employer contributions that PAGNY makes. The 401K vests after 3 years of service.
Below is a description of the different types of Benefit days that you would be entitled to (Vacation, CME, Holiday and Sick). Vacation, Holiday, CME and Sick time is very generous as noted below.
The clinical hours are at XXXXX including the Urgent Care / ExpressCare areas at XXXXX
Clinical hours start at 33 hours per week. However, you must log at least 40 hours / week on your timesheet (80 hours every 2 weeks) for all of your educational, administrative & clinical activities; this would be in your offer letter.
Attendings take an average of 2 sick calls per month, some months it is more."
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Well as of three years ago everyone at met and most (only saying that because I cannot confirm if the new hires they made a few years ago have them) at harlem had pensions. And not all of them were old hires, many were new.
But Ive been out of the area x3 years so things may very well have changed and I can accept that. but PAGNY was definitely around back then. So I'm just surprised they went ahead and took it away.
and I think we are in full agreement that work over there without a pension is.... wow.... just not worth it unless you have a loyalty to one of these places.
Certain hospitals (Jacobi) moved to PAGNY several years ago (I think the group started at Jacobi, but I may be mistaken). The city and H and H moved to have this group contract with all the H and H hospitals including Harlem: Attending - Emergency Medicine Physician - Harlem, New York | Physician Affiliate Group Of New York..
Here is a description of their benefits; no pension mentioned: PAGNY - Careers | Physician Affiliate Group of New York
One of the major reasons for contracting with PAGNY was so the city wasn't on the hook for fancy doctor pensions. And now they have succeeded. They justify it by saying that new hires get a higher hourly (which is true in that a decade ago EM docs in NYC were making 150-180 annually).
But 235k (it is higher at some sites) and no pension work in one of those killing fields? Why do people do this?
Here is a description of their benefits; no pension mentioned: PAGNY - Careers | Physician Affiliate Group of New York
One of the major reasons for contracting with PAGNY was so the city wasn't on the hook for fancy doctor pensions. And now they have succeeded. They justify it by saying that new hires get a higher hourly (which is true in that a decade ago EM docs in NYC were making 150-180 annually).
But 235k (it is higher at some sites) and no pension work in one of those killing fields? Why do people do this?
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Yeah I work in NYC when I'm not in Port Au Prince.
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Its certainly possible and even my hospital took volunteers from SFGH instead of hiring more local docs. They made our ED pods triple coverage with an attending for each resident. They just showed up last week but now that our volume has decreased they're essentially sitting around doing nothing most of their shifts. They should have sent them to the ICUs which still need help because the ED is honestly overstaffed at this point.
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deleted109597
Louisiana did the same.
Bizarro land for sure
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$235k in NYC?????
that’s what the 24-year old new grads from law school make in big law NYC.
however - their salaries in NYC climb quickly to 800-900k (and millions if you are a real partner).
The lawyers know working in a ridiculously expensive, crowded city means they should make 2x more to start (with potential to make 10x any other city).
Not sure why doctors are such suckers their salaries work the opposite way!
that’s what the 24-year old new grads from law school make in big law NYC.
however - their salaries in NYC climb quickly to 800-900k (and millions if you are a real partner).
The lawyers know working in a ridiculously expensive, crowded city means they should make 2x more to start (with potential to make 10x any other city).
Not sure why doctors are such suckers their salaries work the opposite way!
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In general I don't think physicians are very financially literate. Also, the sacrifice of physician ownership of the revenue stream to hospitals and contract organizations has created this supply and demand curve for desirable areas. The amount of revenue generated by emergency physicians in desirable, affluent areas is likely much, much higher than areas with poor payer mixes. If a physician earns less for working in a desirable location its because their earnings are being siphoned off. My hometown is frequently on lists of top 5 places to move to in the United States. From what I've been told, the partners in the local SDG take home significantly more than those who are employed in community sites owned by a large academic health system. The payer mix is identical.
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Exactly right. We don't control the revenue stream. It's supply and demand. Everyone wants to live in NYC, SFO, SAN and AUS, so these companies don't have to pay much to get doctors to work there. Doctors are apparently okay making 30-50% less to live in one of these cities and the supposedly better lifestyle they afford.
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To be fair, those NYC law jobs are likely a rare find, and only open to top ivy league graduates. Most lawyers can't find decent work out of law school these days.
There are plenty of private practice surgeons who make that kind of money... They didn't give their profession away to PAs, CMGs, and insurance companies.
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There are plenty of private practice surgeons who make that kind of money... They didn't give their profession away to PAs, CMGs, and insurance companies.
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It’s very rare that a lawyer that is 24 makes 235k starting out and those are the top jobs less than 1%. Those jobs are not earned by effort
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Doesn't matter.
They're attorneys.
Wretched men and women devoid of moral compasses.
"all the money you made will never buy back your soul"
-'Masters of War'; Bob Dylan.
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Love the Dylan quote. Best lyricist of the past 75 years.
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Someone I know made a comparison of "Eminem" to "Bob Dylan"; making a similar claim that Eminem is as gifted of a wordsmith as Dylan was/is.
A small part of me died inside, at that very instant.
Dylan never cursed or used other verboten words unless he was trying to illustrate a point.
Eminem uses profanity because its profane.
Once upon a time, eloquence carried responsibility and erudition.
Now, its just "who can scream the N-word louder and more often."
