HCA Healthcare

[namethatsmell]

Completely agree with Ectopic. I've worked in CMG, quasi-SDG, SDG, and hospital employed gigs. The most toxic setup, by far, is the CMG. Begin rant:

When somebody 1000 miles away is ultimately in charge of things like your EDs staffing levels and determining how the midlevels will function, it's much easier for decisions to be made the favor profit over patients.

They have one revenue stream: you. Their continual goal is to find ways to maximize it. The most aggressive billing I've ever seen, by far, was with the CMG.

As mentioned, the CMG is somewhat shielded from the public eye since most to realize they even exist. As such, they're less of a target from the constant barrage of crap and complaints their docs on the front lines deal with. They're happy to let their docs get hammered for things the individual doc of course has no control over.

If there's a lawsuit, the CMG is almost never named and they know it. So again, their C-suite folks have far less reason to care about the conditions on the front line and they have x number of suits written into the bottom line (which again, you create for them). If you work for a hospital you're all on the same team so you can be less exposed. SDGs fall in the middle.

With a CMG it's often not a doc but a bean counter driving these decisions. The framework by which CMGs make decisions is the most slippery of slopes.

If I had a CMG offer and a hospital employed offer that were at all similar, I'd pick hospital employed over CMG in a second.

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[miacomet]

Completely agree with Ectopic. I've worked in CMG, quasi-SDG, SDG, and hospital employed gigs. The most toxic setup, by far, is the CMG. Begin rant:

When somebody 1000 miles away is ultimately in charge of things like your EDs staffing levels and determining how the midlevels will function, it's much easier for decisions to be made the favor profit over patients.

They have one revenue stream: you. Their continual goal is to find ways to maximize it. The most aggressive billing I've ever seen, by far, was with the CMG.

As mentioned, the CMG is somewhat shielded from the public eye since most to realize they even exist. As such, they're less of a target from the constant barrage of crap and complaints their docs on the front lines deal with. They're happy to let their docs get hammered for things the individual doc of course has no control over.

If there's a lawsuit, the CMG is almost never named and they know it. So again, their C-suite folks have far less reason to care about the conditions on the front line and they have x number of suits written into the bottom line (which again, you create for them). If you work for a hospital you're all on the same team so you can be less exposed. SDGs fall in the middle.

With a CMG it's often not a doc but a bean counter driving these decisions. The framework by which CMGs make decisions is the most slippery of slopes.

If I had a CMG offer and a hospital employed offer that were at all similar, I'd pick hospital employed over CMG in a second.

Not only that, but hospitals that employ docs are at least minimally invested in their ED. Those that employ CMGs (unless it's a really undesirable area and there are no alternatives) tend to simply not be interested.

 

[gamerEMdoc]

Not only that, but hospitals that employ docs are at least minimally invested in their ED. Those that employ CMGs (unless it's a really undesirable area and there are no alternatives) tend to simply not be interested.

This is definitely true, I've always felt this was the biggest difference in the work environmentment between being a hospital employee or a CMG employee. Both are profiting off you more than if you were in a SDG, but as a hospital employee, the hospital is more invested in you, and you in it, compared to a CMG. That and a portion of the profit that the CMGs make goes to their gigantic recruiting efforts, as opposed reinvested in the work of their docs. Then again, same can be said for the salaries and bonuses for hospital administrators.

 

[DocRPP]

"Emergency Medicine exists because the public demands it" - someone notable on twitter circa this week

Yes, but why do we do it? At least at these terrible jobs?

Loved his keynote and most of the reasons he mentioned in the "why Emergency Medicine" were highly relatable. And not one of them was the pay.

 

[miacomet]

Loved his keynote and most of the reasons he mentioned in the "why Emergency Medicine" were highly relatable. And not one of them was the pay.

Personally, and YMMV, I work because I have to eat and pay the mortgage and save for retirement. I don't see that many independently wealthy folks working in medicine, and particularly not in EM. It's not the worst way to make a living, and I do enjoy the flexibility and blocks of time off. But I'd happily do something easier for the same salary, and if I can earn $125 an hour reviewing charts or working in an urgent care, nights in the ED would certainly be less appealing for the same hourly.

If I'm going to work for a low hourly or none at all, clinical EM in an American hospital would not be it.

 

[GeneralVeers]

Personally, and YMMV, I work because I have to eat and pay the mortgage and save for retirement. I don't see that many independently wealthy folks working in medicine, and particularly not in EM. It's not the worst way to make a living, and I do enjoy the flexibility and blocks of time off. But I'd happily do something easier for the same salary, and if I can earn $125 an hour reviewing charts or working in an urgent care, nights in the ED would certainly be less appealing for the same hourly.

If I'm going to work for a low hourly or none at all, clinical EM in an American hospital would not be it.

I feel the same. I don't mind working nights, weekends, and Holidays because the pay is good. Cut that pay significantly and I think there will be a lot less people interested in the "EM lifestyle".

 

[EctopicFetus]

Loved his keynote and most of the reasons he mentioned in the "why Emergency Medicine" were highly relatable. And not one of them was the pay.

Says you are a med student. Fact or fiction.

As mentioned few wealthy em docs still pulling shifts. I know a few but the reason is more related to serving their community/ hospital. Cut em pay by 25% and lets talk. Also, he took a sabbatical and works very little. I like the guy. His educational program is better than anything i have ever seen from ACEP or AAEM but.....its easy to cheerlead from the sideline when its not your ass on the line.

 

[namethatsmell]

Personally, and YMMV, I work because I have to eat and pay the mortgage and save for retirement. I don't see that many independently wealthy folks working in medicine, and particularly not in EM.

Yup haven’t met anybody wealthy doing this either.



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[EctopicFetus]

These inspirational talks are good. I like this type of stuff but to be frank it speaks more to the med student resident early attending types.

I’m PGY-13, I love my job but I am open and honest about what’s bad. Not all warm and fuzzy EM. I used to review complaints for the state board in AZ. The stuff was ridiculous. People mad they had to wait to get results for strep in an upright chair. Not a complaint to the Medical director or hospital but the state medical board.

We do plenty of good but there is plenty of room to improve. Metrics, PG, CMGs all this BS harms us. Not just financially but but professionally. YOu know burnout is an issue? Do you think if you got paid more and could work less you could limit burnout issues? Do you think if you could control your work environment that would help? Do you think if you could run the hospital that would be better? Oddly, physician run hospitals do better. No one seems to care.

Thats the issue young padawan. I love my job for more than just the income but its not all sunshine and daisies.

 

[gamerEMdoc]

In defense of Mel Herbert's speech, it wasn't a pep talk saying EM is a great lifestyle. I saw it live. He talked about how EM changed his life, how it gave him a purpose, but also, how hard the job truly is, and how many people can't do it until retirement, including himself. Its why he kept saying "you are f'ing superheroes" for the people that do the job day in and day out. He acknowledges how hard it truly is to do this job.

I think anyone that thinks EM is a lifestyle field doesn't understand how the job psychologically affects you, and how that may not be worth the few less days of work compared to other specialties. It may be worth it to some, it may not be worth it to others.

Whether it is worth it to you and you can keep on working in EM, or whether you can't and you have to step away, there is no doubt in my mind, Herbert is right, anyone who has done this job out on their own is truly the closest thing we have in medicine to "a F***'ing superhero".

 

[DocRPP]

Says you are a med student. Fact or fiction.

As mentioned few wealthy em docs still pulling shifts. I know a few but the reason is more related to serving their community/ hospital. Cut em pay by 25% and lets talk. Also, he took a sabbatical and works very little. I like the guy. His educational program is better than anything i have ever seen from ACEP or AAEM but.....its easy to cheerlead from the sideline when its not your ass on the line.

Just to clarify, and trying desperately not to come out like a "med student advising the attending what is good about the job that they have been doing since a very long time", I quoted his keynote as an answer to a previous comment, coming from a guy who has been an EM practitioner for many years. In addition, I didn't mean to give out the impression that financial gains aren't important. But often, there are many interesting reasons than "money" and "lifestyle" to go into EM, and it was great to hear someone articulate them so well.

 

[GeneralVeers]

My main issue is control. I'm okay with seeing tons of patients, with high stress, with unpredictability. What burns me out are the things I have no control over: Nursing staffing levels, BS patient complaints, specialists who don't call back, and lack bed space. I could fix all these things if I was in charge.....but I'm not.

 

[EctopicFetus]

Just to clarify, and trying desperately not to come out like a "med student advising the attending what is good about the job that they have been doing since a very long time", I quoted his keynote as an answer to a previous comment, coming from a guy who has been an EM practitioner for many years. In addition, I didn't mean to give out the impression that financial gains aren't important. But often, there are many interesting reasons than "money" and "lifestyle" to go into EM, and it was great to hear someone articulate them so well.

All I am saying is money is but one part. Most ed docs feel they are fairly compensated. I would say simply most don’t know their worth.

On top of that like veers who has been on here as long as me so well articulated it is control. I would work in a fsed I owned for 20% less than what I make now. My job would be way better.

That being said I control my staffing levels of docs and pas. I don’t mind pas cause I can fire them and they fund my retirement and then some.

On top of that I decide who they can and can’t see.

It’s control. I would also caution you listening to someone who barely works anymore. I like Mel. I know him personally but when you have the time and money to do YouTube videos about the latest Tesla you bought while no longer pulling shifts I think it’s important to be cautious about the message. I think he believes it. I also think the further away you get from the pit the less meaningful your message about the pit.

 

[MechEDoc]

I also think the further away you get from the pit the less meaningful your message about the pit.

I personally found it less than fulfilling when the regional medical director for when the large contract management groups came out with a series of video messages for the minions noting how much management cares about the pit docs, how mental health was a primary issue for the firm, and how he had really taken this to heart after one of his emergency medicine colleagues had recently killed himself. I'm not here to crap on the death of his friend or the pain that he felt. However there was zero change in the trenches. Physicians were being given a constant **** sandwich and patients were being hurt due to poor staffing. Burnout is a continuum, with a high stress job, low control, and all the other factors that go into this work it is understandable that there is a higher suicide rate.

 

[EctopicFetus]

Those of us in the game for a while understand. I think the enthusiasm of the young folks is great. But it’s foolish to go in without your eyes wide open and assuming you are so different than the rest.

I always said I can do what any average ed doc or person can do. If 90% of people say it can’t be done there is a chance I could do it but I wouldn’t bet my life or health on it.

This isn’t high school

 

[GeneralVeers]

On a positive note I am offically done with my HCA job this week! The Texas market has gotten tough, and the bonus shifts which made it worthwhile to tolerate HCA's nonsense are all but gone. I'm going on a vacation, then I'm going to work at home full time.....but at two part time jobs so that no one owns me.

 

[miacomet]

On a positive note I am offically done with my HCA job this week! The Texas market has gotten tough, and the bonus shifts which made it worthwhile to tolerate HCA's nonsense are all but gone. I'm going on a vacation, then I'm going to work at home full time.....but at two part time jobs so that no one owns me.

Cool. Telehealth?

 

[miacomet]

Yes, once my unicorn job is done, I'll be out of the game. Not sure whether it will be UC, HPM, occmed, telehealth, or a nonclinical gig, but no vale la pena with these corporate gigs. I just don't understand how it's worth it. I'm sad because, well, I was trained as an EM doc, but if society values us this little, and more importantly if WE value ourselves this little, clearly the message is to move on.

I advise each and every student and resident I have that clinical EM is a 10 year career for most, to have an exit strategy, and that no, ultrasound is NOT an exit strategy. We are lucky, at the very least, that ABEM has made several exit strategies possible via clinical fellowship and that nonclinical jobs seem to be increasing.

 

[gamerEMdoc]

Telehealth is going to be a new frontier that will gain widespread acceptance by the insurance industry (because like UC, it will keep people away from coming to the ED). I definitely foresee that becoming an avenue for ED docs who want to get out of the ED.

I also foresee a day where insurance companies would require a telehealth screening with one of their providers for their patients to "approve" and ED visit for non-emergent conditions.

 

[miacomet]

Telehealth is going to be a new frontier that will gain widespread acceptance by the insurance industry (because like UC, it will keep people away from coming to the ED). I definitely foresee that becoming an avenue for ED docs who want to get out of the ED.

I also foresee a day where insurance companies would require a telehealth screening with one of their providers for their patients to "approve" and ED visit for non-emergent conditions.

I also foresee the day when telehealth is all midlevels.

 

[GeneralVeers]

Cool. Telehealth?

No, unfortunately. There is no Telehealth I know of that can replace my EM income at the moment. I'll be part-time with two CMGs.

 

[Birdstrike]

Opinion: HCA sucks to work for. And I don't mean it sucks like "all jobs suck" because they're jobs, but it really blows, like "gaslight-you-make-you-think-you're-insane-losing-your-mind" blows. Unless of course you're one of the guys at the top making all the money, then it's probably great, but if you're just staff or a grunt doc, run. I mean run like you're going to blow both achilles, run. End of story.

PS: Send your notes "thank you" notes for writing this post directly to my inbox, because you will thank me for it someday.

 

[Apollyon]

On a positive note I am offically done with my HCA job this week! The Texas market has gotten tough, and the bonus shifts which made it worthwhile to tolerate HCA's nonsense are all but gone. I'm going on a vacation, then I'm going to work at home full time.....but at two part time jobs so that no one owns me.

No, unfortunately. There is no Telehealth I know of that can replace my EM income at the moment. I'll be part-time with two CMGs.

Oh, when you said "work at home", I thought you literally meant "work at home". I believe you just mean not having to travel.

 

[MechEDoc]

I'm a little at a loss regarding HCA facilities. I have never heard anything positive about them (nurses or docs). However I've worked at one HCA facility with totally different experience. TeamHealth had the contract (strangely not EmCare/Envision). The emergency department was friendly, labs and imaging were resulted quickly, patients were admitted or discharged quickly, and I never felt pressured with metrics other than keeping the door to doc time low. With regards to the door to doc time, there is very little pressure as we had enough capacity to see patients. However, nurses had poor support, many of which were relatively green, lacked good attention to detail/professionalism from a medical perspective (sloppy with vital signs, poor at resuscitating patients, etc.). There was moderate nursing turnover, and the nurses were largely a product of their environment. Some of the consulting physicians (who had been there since Osler's time) were a real pain in the neck, otherwise the place was relatively decent to work at.

I guess I got lucky.

 

[MechEDoc]

...but at two part time jobs so that no one owns me.

I think this is the key part.

 

[Arcan57]

I personally found it less than fulfilling when the regional medical director for when the large contract management groups came out with a series of video messages for the minions noting how much management cares about the pit docs, how mental health was a primary issue for the firm, and how he had really taken this to heart after one of his emergency medicine colleagues had recently killed himself. I'm not here to crap on the death of his friend or the pain that he felt. However there was zero change in the trenches. Physicians were being given a constant **** sandwich and patients were being hurt due to poor staffing. Burnout is a continuum, with a high stress job, low control, and all the other factors that go into this work it is understandable that there is a higher suicide rate.

You must have not gotten the book on physician burnout written by a primary care doc that solved burnout by creating a career out of counseling doctors about burnout. They bought thousands of them.

 

[hundreddaysoff]

I'm a little at a loss regarding HCA facilities. I have never heard anything positive about them (nurses or docs). However I've worked at one HCA facility with totally different experience. TeamHealth had the contract (strangely not EmCare/Envision). The emergency department was friendly, labs and imaging were resulted quickly, patients were admitted or discharged quickly, and I never felt pressured with metrics other than keeping the door to doc time low. With regards to the door to doc time, there is very little pressure as we had enough capacity to see patients. However, nurses had poor support, many of which were relatively green, lacked good attention to detail/professionalism from a medical perspective (sloppy with vital signs, poor at resuscitating patients, etc.). There was moderate nursing turnover, and the nurses were largely a product of their environment. Some of the consulting physicians (who had been there since Osler's time) were a real pain in the neck, otherwise the place was relatively decent to work at.

I guess I got lucky.

Yeah, this basically sounds like my current HCA/TH job. I do think HCA is generally evil but I don't really mind my job and plan to stick around a couple years.

My HCA admins do harp on Press-Ganey as well as door to doc times. The RNs/ED staff are mostly great people and become awesome at their jobs if they stick around long enough. But HCA makes it hard for them to stick around by (eg) paying the RNs even less than the RNs made at my big cheapskate academic residency hospital.

OTOH, I was recently told to put my coffee on the drink station by a random admin person in a white coat. Hope that doesn't become a trend.

 

[gamerEMdoc]

OTOH, I was recently told to put my coffee on the drink station by a random admin person in a white coat. Hope that doesn't become a trend.

The appropriate response to bs like this:

"When I quit here and take all the money I make for this place to another hospital, I'll make sure to tell the CMO you were the reason I was leaving".

 

[deuist]

Telehealth is going to be a new frontier that will gain widespread acceptance by the insurance industry (because like UC, it will keep people away from coming to the ED).

Telemedicine companies were all over ACEP this year. I looked into a few of them. I listened example audio clip from one of their websites touting how an interaction should be. In it the physician interrupts the patient, does not get a full history, and then inappropriately prescribes an antibiotic for a viral illness. I don't have much hope for telemedicine if this encounter is the best example that the company could come up with.

 

[VA Hopeful Dr]

Telemedicine companies were all over ACEP this year. I looked into a few of them. I listened example audio clip from one of their websites touting how an interaction should be. In it the physician interrupts the patient, does not get a full history, and then inappropriately prescribes an antibiotic for a viral illness. I don't have much hope for telemedicine if this encounter is the best example that the company could come up with.

Yeah telemedicine is basically turning us into antibiotic vending machines. Well, more of one than we already are.

 

[sum dude]

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.

Ha that's not even close to true anymore. Here in FL they are opening residencies in hospitals w/ nothing else w/ censuses so small (and no trauma), that you'd think it's a mistake. Tiny hospitals that you wouldn't even want outpatient surgery at, let alone your doctor trained there. ACGME is cart-blanche allowing these woefully underqualified places to start residencies--it's a perfect storm of Osteopathic residencies combining with Allopathic, HCA trying to flood market, and FL all to happy to help supplement an oversupply of EM doctors.

 

[miacomet]

I don't want to be a downer, but in all seriousness students REALLY need to look elsewhere. It's not just the salaries, but the liability and quality of care that's making this field crap.

 

[gamerEMdoc]

I don't want to be a downer, but in all seriousness students REALLY need to look elsewhere. It's not just the salaries, but the liability and quality of care that's making this field crap.

There is liability in every field. My salary is more than I ever thought I'd make in medicine, and double what I thought I would make when I was considering FP and Peds going into medical school. I'm not saying EM is all sunshine and roses, it isn't. But I don't think its nearly as bad as you make it out to be. Almost every other specialty in medicine deals with burnout and stress as well.

In the most recent survey on Depression and Burnout EM ranked as one of the happiest specialties outside their job, and was about middle of the pack in terms of happiness with their job. They were middle of the pack with depression and burnout as well.

Physician burnout: It’s not you, it’s your medical specialty
Medscape: Medscape Access

The fact of the matter is, medicine is tough, and this is true across many specialties. Being a physician in 2018 means dealing with constant administrative pressures, protocols, patient satisfaction, payer issues, etc. Its not fun, its constanly changing, and never for the better. But I can tell you, in my dealing with consultants, I routinely see way more burnout hospitalists and on call specialists than I do my EM colleagues.

This isn't to diminish the burnout of EM. Believe me, I've struggled with it during my career. It's a real issue. I just don't think its inherent to EM, and unless you are going to go do Dermatology, its a struggle out there.

I've said this before. There is no "lifestyle" field in medicine, other than to recognize being a physician is your lifestyle. It defines who you are. It will consume your life. Its kind of always been this way in medicine. There are some people that come to terms with that, or even seek that out. It's the people that go to medical school and gun for a specialty thinking it will give them a high paying great lifestyle that find misery. Because that's not medicine. Medicine is about the art of being a physician, perfecting your craft, teaching it to others, relieving peoples suffering, and furthering the field for the next generation of workaholics. It's never been about finding the easiest job.

 

[miacomet]

There is liability in every field. My salary is more than I ever thought I'd make in medicine, and double what I thought I would make when I was considering FP and Peds going into medical school. I'm not saying EM is all sunshine and roses, it isn't. But I don't think its nearly as bad as you make it out to be. Almost every other specialty in medicine deals with burnout and stress as well.

In the most recent survey on Depression and Burnout EM ranked as one of the happiest specialties outside their job, and was about middle of the pack in terms of happiness with their job. They were middle of the pack with depression and burnout as well.

Physician burnout: It’s not you, it’s your medical specialty
Medscape: Medscape Access

The fact of the matter is, medicine is tough, and this is true across many specialties. Being a physician in 2018 means dealing with constant administrative pressures, protocols, patient satisfaction, payer issues, etc. Its not fun, its constanly changing, and never for the better. But I can tell you, in my dealing with consultants, I routinely see way more burnout hospitalists and on call specialists than I do my EM colleagues.

This isn't to diminish the burnout of EM. Believe me, I've struggled with it during my career. It's a real issue. I just don't think its inherent to EM, and unless you are going to go do Dermatology, its a struggle out there.

I've said this before. There is no "lifestyle" field in medicine, other than to recognize being a physician is your lifestyle. It defines who you are. It will consume your life. Its kind of always been this way in medicine. There are some people that come to terms with that, or even seek that out. It's the people that go to medical school and gun for a specialty thinking it will give them a high paying great lifestyle that find misery. Because that's not medicine. Medicine is about the art of being a physician, perfecting your craft, teaching it to others, relieving peoples suffering, and furthering the field for the next generation of workaholics. It's never been about finding the easiest job.

These are excellent points. But I think we are so constrained, at least in EM, by outside factors that we can't perfect our craft, nor can we relieve people's suffering with so much administrative crap and so much time pressure.

EM's primary advantages are a short residency with high pay. Maybe that's enough- you can work a decade and call it quits. If salaries drop, though, I'd say it's attraction is much less.

 

[gamerEMdoc]

These are excellent points. But I think we are so constrained, at least in EM, by outside factors that we can't perfect our craft, nor can we relieve people's suffering with so much administrative crap and so much time pressure.

EM's primary advantages are a short residency with high pay. Maybe that's enough- you can work a decade and call it quits. If salaries drop, though, I'd say it's attraction is much less.

Yes an no. I mean, we are absolutely constrained by outside factors, no doubt, but I think most specialties who work in a hopsital or for a hosptial system are. We have "door to doc time" and disposition metrics... they have readmission metrics, discharge metrics, etc. We as physicians are all being squeezed by corporate medicine, its universal. Physicians either need to unionize (will never happen) or we need a complete govt takeover of medicine and to become govt employees (unfortunately will get paid as such) or the business of medicine will just continue to get worse across the board.

You would think that we can't escape it and just open a private practice like an FP doc. But many of the primary docs and specialists can't afford the overhead of a primary practice either, and outpatient medicine is becoming more and more corporation driven as well. But I honestly think, if you want to be a "private practice doc", you may have a better chance of that in EM than you do in other fields. Because in other fields, to have a private practice you need to deal with a ton of overhead. As an EM doc, its just you. We had a few of our faculty a few years back decide to leave and form their own private locums group, a very democratic small group of docs who were legit good EM docs. The rake in the cash, with little overhead and love their job. When they get a contract, no one gives them up, because unlike other locums groups, they actually see patients effectively and aren't problem docs. They have one administrator. That's their overhead. Locums is basically our version of "private practice" IMO.

 

[miacomet]

Yes an no. I mean, we are absolutely constrained by outside factors, no doubt, but I think most specialties who work in a hopsital or for a hosptial system are. We have "door to doc time" and disposition metrics... they have readmission metrics, discharge metrics, etc. We as physicians are all being squeezed by corporate medicine, its universal. Physicians either need to unionize (will never happen) or we need a complete govt takeover of medicine and to become govt employees (unfortunately will get paid as such) or the business of medicine will just continue to get worse across the board.

You would think that we can't escape it and just open a private practice like an FP doc. But many of the primary docs and specialists can't afford the overhead of a primary practice either, and outpatient medicine is becoming more and more corporation driven as well. But I honestly think, if you want to be a "private practice doc", you may have a better chance of that in EM than you do in other fields. Because in other fields, to have a private practice you need to deal with a ton of overhead. As an EM doc, its just you. We had a few of our faculty a few years back decide to leave and form their own private locums group, a very democratic small group of docs who were legit good EM docs. The rake in the cash, with little overhead and love their job. When they get a contract, no one gives them up, because unlike other locums groups, they actually see patients effectively and aren't problem docs. They have one administrator. That's their overhead. Locums is basically our version of "private practice" IMO.

The golden age of medicine is certainly past. As a third generation doc, I guess I have a hard time accepting and working within said constraints. You may be right- nothing in medicine (aside from perhaps nursing and being a ML or admin) is really golden right now.

Nice with the locums group. We definitely need more situations and initiatives like that.

 

[Birdstrike]

The golden age of medicine is certainly past.

I suppose it is, so the old timers say. But we can still do pretty damn well, if you play your cards right.

 

[bravotwozero]

And in this so-called ‘golden age’ docs made less money than they do now...


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[EctopicFetus]

And in this so-called ‘golden age’ docs made less money than they do now...


Sent from my iPhone using Tapatalk

Doubt it’s true when adjusted for inflation. Check what an rvu paid in 2008.

My old group got paid 100% of charges by the hospital for all patients. For cmgs I’m guessing you are right. For decent gigs I doubt it.

 

[88222]

We had a few of our faculty a few years back decide to leave and form their own private locums group, a very democratic small group of docs who were legit good EM docs. The rake in the cash, with little overhead and love their job. When they get a contract, no one gives them up, because unlike other locums groups, they actually see patients effectively and aren't problem docs. They have one administrator. That's their overhead. Locums is basically our version of "private practice" IMO.

Can you elaborate on this practice model a bit? Do they only staff hospitals who require locums docs to fill shifts that the SDG/CMG/hospital can't? What would the terms of the contract be in this case: "Fill X number of shifts/month" or "Be on call for X number of shifts max?" How would the scheduling work? Etc. Thanks!

 

[gamerEMdoc]

CMGs try to use traveling docs employed by their company, basically someone like a locums that works all over the place, but is employed by the CMG. Otherwise, yes, locums companies staff hospitals where there aren't enough docs. It's a big business, popular in EM because we are so transient and adaptable, but there is locums for just about every on call specialty.

Locums companies get contracts with hospitals that are short looking for docs. Many hospitals use multiple locums companies, because each one can only give a few shifts. The locums companies aren't under any obligation to guarantee to fill all of the shortage a place has in a given month unless they specifically contract to do so, and the hospital isn't under any obligation to have any work for the company. Typically the hospitals would contact the company saying they need X amount of shifts in a given month they expect to be short, and the locums company would dole out those shifts for the docs interested in the work. Each doc decides how much they want to pick up. When the locums company has a contract at multiple hospitals, some docs may only choose to work at some hospitals but not others. The rates can vary from the baseline rate the company asks for. For instance, if a hospital has a shortage they can't fill, and its like only a few days out and they still cant fill it, they will jack the rate WAY UP until someone takes the shift.

That's the best I can explain it, but I've never done any locums work myself personally so forgive me anyone who has done locums if I didnt explain that right. I've been on the other end trying to deal with locums companies to schedule back when I was in the Navy during peak deployment times, because we used locums heavily for staffing.

 

[Brigade4Radiant]

Couldn't stomach my prn HCA gig anymore don't think i'll work there again unless 500+

 

[Old_Mil]

A hospital system I’m looking Was recently bought out by HCA

So you should start looking for a new job right about now.

 

[Old_Mil]

Agreed. I don't understand why medical schools aren't advising students against EM.

Medical schools do a terrible job advising their students about the realities of medical practice.

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?

CMG: 1099 independent contractor, no benefits, paying both halves of medicare, paying both halves of social security, questionable due process based on the tenuous nature of your hospital privileges, and the CMG maintains a stable of replacement physicians and firefighters which allows them to throw you under the bus for a variety of reasons.

Hospital employed: W2 employee, benefits, paying your half of medicare and social security, actual hospital privileges and due process, if they decide to get rid of you, they have to do the calculus of "can I find an equal or better replacement."

The latter is a much more secure environment to work in, and if you build the right relationships and sit on the right committees, you may actually have a tiny bit of influence on your work environment. Not much, but more than the zero you will have as a CMG doc.

 

[RustedFox]

Couldn't stomach my prn HCA gig anymore don't think i'll work there again unless 500+

I recently reached this same conclusion.

I accepted a shift at my HCA prn gig in October only because OtherDoc (who is a good dude) has tickets for a concert that night, and needs coverage.

Every week, I get an email from a doc or MLP at my HCA gig that asks if my non-HCA gig is hiring. They all think that they have the inside track and that nobody else has asked this before them.

Pssst.


Here's the dirt: My present full-time, home-base, non-HCA gig just kicked out TeamHealth in favor of (xxx).
We're in the process of purging the dead weight.

We "lost" (READ: Ditched) two docs and three MLPs in the transition.

One doc was a 42 year-old goddamned nightmare, and is a disgrace to EM. I got tired of taking sign-outs including MRI of everything and serum porcelain levels.

One doc was a great doc, but is (no joke) 82 years old, and just couldn't work with the computer system.

The 82 year old is a better doc than the 42 year old. If my wife had belly pain, and I was legit worried... I would take her to the 82 year old doc, and not the 42 year old doc.

Those slots are open.

We had one MLP leave for another health system because he/she was upset with the level of oversight at the home-base. We had another leave because he/she had family obligations and wanted to work in a cushy derm practice. The third said: "I don't feel that this is an environment conducive to my professional development."

My reaction (which is echo'ed by the majority of FT docs at home base):

1.) Byeeee sucka' ! You want to work independently? Try the wasteland that is primary care, or... something else. Want respect? There's that thing called medical school and residency. Yes, we understand that "you were in the military". Your average patient is a 66 year old female with plenty of comorbidities, not a 26 year old recruit who is HOO-RAHH!' If your 26 year-old dies, its easy to say they were a "heat casualty" or whatever. When you kill a fifty-something cardiac patient because you gave them 20mg of Reglan for their headache... not so easy to explain.

2.) Derm practice? Good luck. Yeah, we all thought you would do this eventually, given your inability to consider a DDx beyond two items and your subscription to Glamazon.Com. This is where you belong. Thankfully, we don't have to fire you. Byeeee.

3.) Professional development? You're 53 years old. You have been a PA for 15+ years, and you make mention of that every time we discuss patient care. Its a shame that you seemingly haven't learned anything in those fifteen years, seeing as how you still get c-spine x-rays and treat cellulitis-es with "a slug of rocephin". That's medicine in 1998. Its 20 years later. Keep up, amigo. Or don't. Byeeee.


The purge is on at my home base.
I am Very. Very. Happy.

 

[Brigade4Radiant]

Independent contractor isn’t that bad you aren’t bound by a noncompete and should credential at least two hospitals. You have better tax deductions compared to an employee and can choose better benefits rather than be stuck with what your employee has.

Benefits are just money and you should be maxing out all retirement 53k, 529 and Hsa account to see the tax man take less.

 

[Old_Mil]

One doc was a 42 year-old goddamned nightmare, and is a disgrace to EM. I got tired of taking sign-outs including MRI of everything and serum porcelain levels.

I wonder how one gets to that place in life. How do you get through medical school/residency. Or did you just get burned a couple of times and are paranoid.

 

[namethatsmell]

I recently reached this same conclusion.

I accepted a shift at my HCA prn gig in October only because OtherDoc (who is a good dude) has tickets for a concert that night, and needs coverage.

Every week, I get an email from a doc or MLP at my HCA gig that asks if my non-HCA gig is hiring. They all think that they have the inside track and that nobody else has asked this before them.

Pssst.


Here's the dirt: My present full-time, home-base, non-HCA gig just kicked out TeamHealth in favor of (xxx).
We're in the process of purging the dead weight.

We "lost" (READ: Ditched) two docs and three MLPs in the transition.

One doc was a 42 year-old goddamned nightmare, and is a disgrace to EM. I got tired of taking sign-outs including MRI of everything and serum porcelain levels.

One doc was a great doc, but is (no joke) 82 years old, and just couldn't work with the computer system.

The 82 year old is a better doc than the 42 year old. If my wife had belly pain, and I was legit worried... I would take her to the 82 year old doc, and not the 42 year old doc.

Those slots are open.

We had one MLP leave for another health system because he/she was upset with the level of oversight at the home-base. We had another leave because he/she had family obligations and wanted to work in a cushy derm practice. The third said: "I don't feel that this is an environment conducive to my professional development."

My reaction (which is echo'ed by the majority of FT docs at home base):

1.) Byeeee sucka' ! You want to work independently? Try the wasteland that is primary care, or... something else. Want respect? There's that thing called medical school and residency. Yes, we understand that "you were in the military". Your average patient is a 66 year old female with plenty of comorbidities, not a 26 year old recruit who is HOO-RAHH!' If your 26 year-old dies, its easy to say they were a "heat casualty" or whatever. When you kill a fifty-something cardiac patient because you gave them 20mg of Reglan for their headache... not so easy to explain.

2.) Derm practice? Good luck. Yeah, we all thought you would do this eventually, given your inability to consider a DDx beyond two items and your subscription to Glamazon.Com. This is where you belong. Thankfully, we don't have to fire you. Byeeee.

3.) Professional development? You're 53 years old. You have been a PA for 15+ years, and you make mention of that every time we discuss patient care. Its a shame that you seemingly haven't learned anything in those fifteen years, seeing as how you still get c-spine x-rays and treat cellulitis-es with "a slug of rocephin". That's medicine in 1998. Its 20 years later. Keep up, amigo. Or don't. Byeeee.


The purge is on at my home base.
I am Very. Very. Happy.

This is priceless. Reads like a montage of the last several places I’ve worked.

Glad your shop is getting better.

 

[deleted109597]

Yeah, got an offer from an HCA site. I have respectfully abstained.

 

[doctalaughs]

2.) Derm practice? Good luck. Yeah, we all thought you would do this eventually, given your inability to consider a DDx beyond two items and your subscription to Glamazon.Com. This is where you belong

Don’t send them my way Rustedfox

Seriously, last place I worked as a dermatologist (large system where we didn’t do the hiring) the Midlevels generated 4 missed melanoma lawsuits between the 3 of them... and this was only in the 2 years I worked there. Thank god I was not the supervising doc of record for any of them.

Now in my private practice (where I’m partner) the midlevels see acne, warts, mollusum and light cosmetic stuff... rinse and repeat. No way I let them see anything that requires a differential or knowledge base.