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HCA Healthcare
Started by kcm1984
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Do you really want to work at a place where there is a nurse standing over you, breathing down your neck to monitor door to doc times, and asking you ten times 'why haven't you seen the new patient' when you're already at a pace of 2.5 pph?
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deleted547339
Just tell em to put the next patient in the bathroom and you can see them while you take a dump.
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deleted547339
Awesome.
A....doctor....winning....money?????
omg
omg
Envision is pure crap. USACS is worse. No system lets you know that you are their bitch like HCA. $$$ over care.
Well there are Emcare / HCA residencies. They are expanding. Future will be ******ed docs who trained at places not worthy of a residency who only exist to provide cheap labor to the CMGs. Thats what you will train in, learn in and expect.
I shudder in fear for the education they will receive and that they will be forced into a career that is unforgiving whilst their corporate overlords reap in riches.
I blame the doctors who agree to teach these residents. Don't they realize they are killing their own specialty? I've already seen reimbursement go down a lot in TX with far fewer job openings. This is going to get worse as Freestanding EDs go bankrupt (like Neighbors) and they churn out more ED docs.
I'm working prn at an HCA hospital. I can see working for Envision as its a CMG and older docs have already sold the profession. But I can't see working full-time at an HCA hospital The hospital I'm at wants to start a new residency in a place with no trauma and only have one sight that has about 50k with 10 residents in the next few years. When the residency starts I'm gone.
"Emergency Medicine exists because the public demands it" - someone notable on twitter circa this week
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deleted109597
Sir Mel Herbert
Yes, but why do we do it? At least at these terrible jobs?
Because EM pays a lot more? Or maybe it's because those other specialties require a fellowship?
My place has also announced that it is starting a residency program next year. We are not a trauma center and no one on staff is fellowship trained. There are no other residency programs at this hospital. I am wondering how we could ever make it through the accreditation process.
You make a good point about the fellowships, but HPM is only a year. EM may pay more in undesirable parts of the country, but Denver pays $125 an hour, and NYC is even less. Many midlevels make more! I don't know if EM really pays that well if you look, as the recruiters like to say, at the total package. You have to work nights, weekends, and holidays and take on a ton of risk. The workplace is violent and occasionally dangerous. I don't think it's particularly well compensated for the actual job.
Someone please post a "Low Score Board" (instead of a High-Score Board) for these jobs that are so low paying that being an MLP is more lucrative.
So, I know at least one midlevel who makes $150 an hour, and that's not nights, so that will be my benchmark. I'll start:
Basically anything in Denver. All CMGs. $125 an hour is not unheard of.
Columbia-Presbyterian in NYC. Pays ~220k for a ~1500 hour year, not including extra academic responsibilities, yielding less than $144 an hour.
Highly regionally variable. I did my M4 EM rotation at an HCA hospital near Overland Park and the physicians there were saying in KC average EM job in the city paid well over 200/hr and if you're willing to drive 30 minutes out of the city you can find some larger "rural" paychecks. The hospital I was at made initial offers to their teams of $300k for twelve 10-hour shifts/mo, so a little over $208/hr. That's without benefits and without negotiation. The guys I talked to said they were all making more than what they were initially offered, likely because they had the power to negotiate.
Can't speak to national rates or rates in other regions, but I know where I went to med school EM was considered a pretty sweet gig from the financial/time aspect of it (if working nights and the ED environment isn't a big deal).
How much is well over? $220 an hour does not impress me for an undesirable area of the country (that's you, Kansas) unless there is a hefty, hefty night/weekends/holiday differential. You are getting robbed at $208 an hour unless you are seeing less than 2 pp/hr and not dealing with midlevels.
Also, nights, weekends, and holidays become a big deal for EVERYONE eventually.
Just to be clear, I'm not EM. Just sharing my experience from my rotation during med school as I had an interest in the field at the time.
Average patients per 10 hour shift was highly variable. Had shifts where we saw 6-7 pp/shift and had others where there were 25. I'd guess the average would be 12-15 per shift. Only time they dealt with midlevels was if the triage people at the front of the ED weren't sure if someone should come back and see the docs, which was maybe 1-2x/shift. If they got sent back then physician took full control, midlevels no longer involved. Level 1 trauma center, additionally a huge percentage of patients were psych holds/intoxications, so basically came in to sober up then cut loose. Did see some crazy traumas, which was really cool, so it felt like a true ED experience and not like some of my other experiences where 90% of your cases are grandpa felt out of breath today or little jimmy is running a 101 fever, help.
I'll add this was not KS, this was in KC which is a decent sized metro (~500k), so not all that undesirable (though certainly not in-demand like NYC) and the 208/hr was initial offer. Most of the guys I talked to were making between 250-280/hr (per my attending) working in the city. Different strokes for different folks as well. You'd legit have to pay me 7 figures to live in a "desirable" location like NYC or LA. I'll take my mid-sized city with half the COL and higher pay any time.
Sure. EM is a great gig if you want to live in flyover. It's a terrible gig in LA, SF, NYC, DC, Boston, and Denver, and one is unlikely to have any gig at all in Salt Lake, Portland, or Austin. For those happy in Indianapolis or KC, yes, it's a fine gig, but so are most other fields of medicine.
You are unlikely to have any gig at all in other fields of medicine in those cities. Lol at being an orthopedic surgeon and moving to Denver. With other fields of medicine you can't just pick a city and live there. Even in those hard to staff cities you can have a job making a 1.5 hour commute you can't say the same with other fields of medicine.
It's pretty easy to move around in most non subspecialty positions as most docs are employed these days. Sure, it's always pretty hard to join up with an ortho group. But it's pretty easy to find a job in psych, PM and R, peds, IM etc. And I do think it's pretty easy to pick a city and live there. I know plenty of docs in SF, SLC, and NYC who simply refused to live anywhere else and they universally found places to practice there.
Many other specialties also pay less in desirable areas where the supply of physicians across specialties is greater. There may be some cities that are particularly difficult in this regard for EM as we tend to gravitate towards certain areas that support certain interests such as mountain towns like Denver and Salt Lake City, which have nearby mountain sports.
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If they don't have a surgical and an internal medicine residency they wont be able to open one. I don't think its an explicit requirement (it may be), but I do know it to be a well understood implicit requirement that ACGME EM residencies be in locations that already support other residencies as a surrogate marker for sufficient medical and surgical pathology and volume.
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deleted547339
I’m almost certain it used to be an explicit statement (and I think more than just IM and gen surg) but I don’t see it in the curren acgme requirements.
I initially wrote that it was a requirement because I was totally certain - but couldnt find it either when I went to look. I figured I'd better be more cautious with how I phrase it before someone tells me I'm wrong.
I'm a peds resident, not an EM resident, but I can name at least one recently accredited EM residency at a hospital with only EM and FM programs.
I think it's interesting that HCA is expanding in to GME so suddenly and so strongly. A few of their GME programs are at actual academic centers (Tulane) but most are not. I wonder if those that are are shielded from some of the HCA pitfalls by a long-standing academic culture.
Either way, it's cool to see GME expansion from the perspective that medical education is an interest of mine, but not necessarily a good thing based on oversaturation and questionable clinical exposure. Some of the new HCA programs (not EM afaik, but FM and IM) were going to be DO programs but now have ACGME accreditation with the merger. I thought ACGME accreditation was a pretty good indicator of sufficient training but maybe not?
I interviewed at an HCA hospital and something seemed off. Kind of a disorganized interview, although the residents were really nice. I think I'm much better served at the place I ended up matching to.
I think it's interesting that HCA is expanding in to GME so suddenly and so strongly. A few of their GME programs are at actual academic centers (Tulane) but most are not. I wonder if those that are are shielded from some of the HCA pitfalls by a long-standing academic culture.
Either way, it's cool to see GME expansion from the perspective that medical education is an interest of mine, but not necessarily a good thing based on oversaturation and questionable clinical exposure. Some of the new HCA programs (not EM afaik, but FM and IM) were going to be DO programs but now have ACGME accreditation with the merger. I thought ACGME accreditation was a pretty good indicator of sufficient training but maybe not?
I interviewed at an HCA hospital and something seemed off. Kind of a disorganized interview, although the residents were really nice. I think I'm much better served at the place I ended up matching to.
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deleted547339
It is definitely NOT cool to see GME expansion in this way. This is the inmates running the asylum.
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deleted547339
It would be analogous to us inviting big pharma to teach our pharmacology classes in med school. I think you understated how bad this actually is.
Once again, while I know GamerDoc's heart is in the right place, I don't understand why we are encouraging people to go into EM. The future looks bleak as we are increasingly enslaved by our corporate overlords.
Some folks are getting the message- the HPM match is apparently full of EM grads fleeing CMG hell.
Some folks are getting the message- the HPM match is apparently full of EM grads fleeing CMG hell.
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deleted109597
N.
Most of the new ones are at hospitals with FM or literally nothing.
To each their own. CMGs aren't just an EM phenomenon. I find EM incredibly rewarding, and incredibly flexible so if some doomsday scenario hits where every EM job is horrible (it won't) I'm sure I'll find something I can do. I'm still in the first half of my career, and I don't lose a second of sleep about having to work for a CMG. I make more money than I ever thought I would, doing a job that is more rewarding than anything I thought I would do in medicine. If people don't want to go into EM (or another field of medicine) based on CMGs being part of the staffing model, so be it. I hope they find success elsewhere. Everyone has the right to find what they think is rewarding about their chosen field. I personally find no field more exciting than EM, more rewarding than EM, and more flexible than EM. We will be just fine.
GD makes excellent points as always, and it's great that he, and hopefully many of his residents, are happy.
Maybe I should put it differently- EM may be great for many, but others really aren't adequately informed as to what they are signing up for, and may have less autonomy, less flexibility, higher liability, and more stress than they had anticipated. It's hard for a medical student to envision what any field entails and where they will want to be in ten, much less twenty, years, but we need to do our best not just to sell our students on certain fields, but tell them the negatives.
I have made EM work for me, but I would have picked a different field had I been aware of CMGs, how much the schedule would affect me with every year, the questionable salaries in many parts of the country, and the complete lack of autonomy. I've worked all over and I've found these issues to be universal. With what appears to be an increasing number of young docs going straight to pain, HPM, and urgent care, I think we need to do better at counseling students and also addressing the issues that make the field hard to sustain. Then the folks that DO go into EM will all be as happy as Gamer 🙂
One of the questions I almost always ask candidates is what they perceive to be the downsides of EM. I definitely think that to be happy in any field, you have to go into it knowing the worst parts of it. You can't go into General Surgery because you like the OR if you aren't ok with the work hours for five years of residency. You shouldn't go into FM if you don't like the monotony of managing DM and HTN in noncompliant patients. Etc. Every field has its perceived downsides, and the people that enjoy what they do recognize those downsides early on and either they don't bother them or they come to peace with them as something that are outweighed by the benefits.
I'm happy when I work a job with excellent pay, so that I can only work 10-12 days per month. Then on shift it's like a giant widget factory for me. I clock in, see and dispo my 20 or so widgets, then clock out ON TIME, go home and turn my brain off and not worry about it.
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Gosh. It's a job. That means they have to pay you do do it. It's never going to be all fun and games and happy times.
I am more than fine seeing 2 pph with a scribe. Lots of shifts, I'm moving fast and working hard. Some shifts, I'm sitting on my a** for an hour at a time and getting PAID.
I make ~400k/yr to work 1440 hrs. I travel for a CMG. Cue all the hate about how I'm a scab, etc. I know the deal, and right now it's a a mutually beneficial arrangement for my family and me given my current circumstances. In the future I'll likely do something else.
I max out my solo-401k, aggressively pay my loans, and am saving for a house without really noticing it at all.
Am I in love with work? No. But it's tolerable and if I make a difference in one patient a shift I'm cool with that.
I take 3-4 vacations a year.
I don't get the "the sky is falling" sentiment. Yes, I get the corporate medicine concern. We still make more than most specialties per hour. If you value frequent skiing over high pay, then live in Denver. If you don't, then don't. It's pretty simple.
I am more than fine seeing 2 pph with a scribe. Lots of shifts, I'm moving fast and working hard. Some shifts, I'm sitting on my a** for an hour at a time and getting PAID.
I make ~400k/yr to work 1440 hrs. I travel for a CMG. Cue all the hate about how I'm a scab, etc. I know the deal, and right now it's a a mutually beneficial arrangement for my family and me given my current circumstances. In the future I'll likely do something else.
I max out my solo-401k, aggressively pay my loans, and am saving for a house without really noticing it at all.
Am I in love with work? No. But it's tolerable and if I make a difference in one patient a shift I'm cool with that.
I take 3-4 vacations a year.
I don't get the "the sky is falling" sentiment. Yes, I get the corporate medicine concern. We still make more than most specialties per hour. If you value frequent skiing over high pay, then live in Denver. If you don't, then don't. It's pretty simple.
I think you have to figure out how to make EM work for you and frankly that has everything to do with knowing yourself. I left the corporate world because I didn’t want to travel or be away from my kids and family.
I also wanted to find a high paying job where I didn’t have to work much yet still be around people I liked and had values similar to mine which are CMGs are evil and we will do whatever we can and have to keep our SDG going and we will be fair to all.
I amazingly found this 2x in great cities. What’s sad is that the number of these jobs that are around are shrinking at a dizzying pace.
Recruiters call me nonstop and tell me about amazing jobs 2 hours from my house for $165/hr seeing 1.8pph. I tell them to look at my profile and tell me what it says.
Simply I wont leave my house for under $300/hr. I wont see more than 1.4 pph at that rate and the drive better be short. For a 2 hour drive I’m asking for 500/hr if the volume is normal. Ill cut my ask for 24s.
I had signed with a locums company for 325/hr for 1.8 but never set foot in the hospital because by the time everything got done what i needed went up. It was their fault. Similarly, I know that 325 was the floor and i was gonna work minimally and then hit them hard for more.
In the end if we are individually happy thats what matters. For me that means a race to FI, I am incredibly close. I put over 150k a year away pre tax into retirement. My wife adds more. I save a ton of money post tax as well.
There is a good bit of money in EM and sadly the CMGs are taking it from our graduating residents and others who dont know what’s going on around them.
I agree with miacomet that the key is making sure we let the Em destined med students know the situation in EM.
I know myself in that I went into EM expecting to make 180k/yr. I also know that the thought of someone screwing me over who is a rent seeker is just mentally difficult for me to handle. They add NOTHING and take half of our revenue generated to serve shrimp and booze to the unknowing and unsuspecting.
For those of you who work for CMGs thanks for your work. I enjoy the shrimp and cocktails.
I also wanted to find a high paying job where I didn’t have to work much yet still be around people I liked and had values similar to mine which are CMGs are evil and we will do whatever we can and have to keep our SDG going and we will be fair to all.
I amazingly found this 2x in great cities. What’s sad is that the number of these jobs that are around are shrinking at a dizzying pace.
Recruiters call me nonstop and tell me about amazing jobs 2 hours from my house for $165/hr seeing 1.8pph. I tell them to look at my profile and tell me what it says.
Simply I wont leave my house for under $300/hr. I wont see more than 1.4 pph at that rate and the drive better be short. For a 2 hour drive I’m asking for 500/hr if the volume is normal. Ill cut my ask for 24s.
I had signed with a locums company for 325/hr for 1.8 but never set foot in the hospital because by the time everything got done what i needed went up. It was their fault. Similarly, I know that 325 was the floor and i was gonna work minimally and then hit them hard for more.
In the end if we are individually happy thats what matters. For me that means a race to FI, I am incredibly close. I put over 150k a year away pre tax into retirement. My wife adds more. I save a ton of money post tax as well.
There is a good bit of money in EM and sadly the CMGs are taking it from our graduating residents and others who dont know what’s going on around them.
I agree with miacomet that the key is making sure we let the Em destined med students know the situation in EM.
I know myself in that I went into EM expecting to make 180k/yr. I also know that the thought of someone screwing me over who is a rent seeker is just mentally difficult for me to handle. They add NOTHING and take half of our revenue generated to serve shrimp and booze to the unknowing and unsuspecting.
For those of you who work for CMGs thanks for your work. I enjoy the shrimp and cocktails.
I totally agree with this sentiment. However, I guess where I have never really been able to reconcile is, how is being a CMG employee any different than being a hospital employee? In the end, in either case, some other person is profiting off your work. In either case, you aren't billing directly for the care you provide, and you are being paid a set wage/salary/bonus, which in general, is way lower than the amount you are billing for in physician fees. So to me, I'm not sure its the CMGs themselves that are evil, but rather the way we are reimbursed in general as corporate employees (hospital or CMG), excluding the cases of actually being an employee of a private group that bills for their own care.
Happy to help. Hospitals are way more sensitive to stories in the NYT about price gouging. CMGs dont care cause they are effectively hidden 2 layers deep. First by the hospital then by the ED doc. Hospitals have the right in most states to hire docs. Hospitals charge way less and patients can reliably know if they are in network or not. I personally believe the SDG model is the only acceptable one in EM and it must be transparent, fair and equal. I know it is a pipe dream. I found it twice.
Ill say hospitals except for HCA, tenet and most other for profits are not in the business of screwing patients and squeezing every dollar. That being said I have worked for an academic institution (as a resident) and other than moonlighting for a small and large non profit hospital system. The second of which is a large national company and they have the single most lax patient financial assistance policy I have EVER seen. They aim to provide charity care etc.
Again, my personal belief is we would see the market correct in a big way if FSEDs didn’t have such a strict CON. Hospital based EDs would be dumps with terrible doctors. The good docs would go out on their own with their fellow good docs and run a nice tidy efficient profitable business. This is the true independent practice of medicine. Look at what it did for docs in Texas. I realize they got overstaurated and there were plenty of bad actors but thats to be excepted during a gold rush. What will be left is superior care FSEDs.
In the end hospitals aren’t the nightmare that CMGs are.
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deleted859535
These posts are reaffirming my feeling when I felt put off after talking to Team for one of their HCA hospitals when I was a little unsure of next steps -- and that sticking with my SDG, where I'm now a partner, was the right call.
As has been posted, you pick your poison in basically every respect.
As has been posted, you pick your poison in basically every respect.
