HCA hospitals

[tdittyx2x3]

As a new EM grad this year, should I be staying away from all HCA hospitals for my first job?

I have been running into what seems like good hospitals, compensation, area, etc, but the one thing holding me back is HCA and the corporate push to meet metrics.. should I be so averse to these hospitals?

I've been hearing a lot of negative things and wondering if there are comments from those who have actually worked at these sites in the last few years..

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[Danbo1957]

HCA is for profit. Period.

 

[TexBoundEMDOC]

Ive personally heard to stay away from HCA. Theyre all about metrics (although to some degree most hospitals/groups take metrics into consideration of compensation) but apparently HCA often have in their contracts that they can fire you if you do not meet the metrics... I interviewed with one group who covered only HCA hospitals and this was definitely in there...

 

[coachB]

As a new EM grad this year, should I be staying away from all HCA hospitals for my first job?

I have been running into what seems like good hospitals, compensation, area, etc, but the one thing holding me back is HCA and the corporate push to meet metrics.. should I be so averse to these hospitals?

I've been hearing a lot of negative things and wondering if there are comments from those who have actually worked at these sites in the last few years..

Have never worked at an HCA hospital, but I wouldn't even consider it. There is nothing inherently wrong with metrics. If they are accurately measured and reasonably thought out, they can be a positive thing. The issues with HCA go toward profit above all else, most importantly the patient's best interest. Don't fool yourself into thinking that a "non-profit" isn't about profits either though. The distinction is mostly just about what taxes get paid. However, the history of multiple lawsuits in multiple locations with common threads involving inappropriate admissions, testing, etc. are certainly suggestive of some underlying problems if your duty to patients is important to you. Hey, for many it just doesn't seem to matter much anymore.

 

[Arcan57]

Preface: I have no affiliation with HCA and have been a frequent recipient of docs from the local HCA hospitals that were looking to find a place to work that didn't suck.

Now truth bomb time:
1) Everyone cares about metrics now. The EM CMS core-measures now include multiple time-stamped measures and we have entered into the phase where failure to comply with the core measures is going to cause a noticeable drop in Medicare reimbursement for year 2017. There are plenty of hospitals that can shrug off a competitor that was advertising a 10 min door-to-doc ED time. There are substantially fewer hospitals that can take a 3% hit to total Medicare reimbursement without drastic changes. If you're at a hospital that doesn't care about metrics then: prepare to have your c-suite overhauled, have you hospital acquired by HCA or the like, or have the doors close entirely.

2) Non-profit hospitals are all about profit, they just roll it into massive warchests, real estate speculation, and executive compensation. All while enjoying the advantages of avoiding certain taxes. I've seen non-profit hospitals that have had to selectively write off patient bills because they needed to meet a minimum amount of charity care to stay non-profit. Just because you trained in an inner-city teaching hospital that teetered on the edge of financial ruin while trying desperately to serve as a safety net for the disenfranchised, don't think that's the typical non-profit.

3) Most CMG-hospital contracts are going to include a clause that the hospital can decide that a physician can no longer work at their ED for any reason. Most CMG-physician contracts are going to have a clause that if the hospital tells them to, the CMG can fire you immediately. Thus most physicians working for CMGs can be fired at any time for any reason. There is nothing specifically in my contract that specifies termination if I don't meet metrics x,y, and z, but I could be dismissed for any reason including metrics. For SDGs that have due process in the contract, the threat to meet metrics tends to be at the group level. While it is rare for an individual to be fired for not meeting metrics (at least in the environments I've worked), it's very common for a group (CMG, SDG, etc) to lose the contract due to metrics.

4) Kudos on identifying hospital level factors as being a crucial component of your working conditions. In my experience, your job satisfaction tends to have relatively little to do with who signs your paycheck and almost everything to do with the conditions inside your shop. There are places that are amazingly metric conscious but still good places to work because of robust nursing/ancillary staff resources and a hyper-efficient back door (look for hospitals that: routinely implement swoop teams, board admitted patients in the hallways of inpatient units, have stringent rules regarding physician responsiveness to the ED, etc.). There are other places that have no systems in place to support the EP and rely on a steady stream of docs that sprint until they fall down from exhaustion and are replaced by a fresh set of new grads who can't afford to pay back the signing bonus or litigate out of the 2 yr deal they signed.

 

[Old_Mil]

There are other places that have no systems in place to support the EP and rely on a steady stream of docs that sprint until they fall down from exhaustion and are replaced by a fresh set of new grads who can't afford to pay back the signing bonus or litigate out of the 2 yr deal they signed.

I am only familiar with one HCA facility because I know people there, but it absolutely falls into this category.

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[emergentmd]

Every shop is the same to varying degree. Metrics, protocols, etc.

15 yrs ago, door to doc time was 1 hr. now its 10 min even in super busy days. Atleast from this standpoint, it has been beneficial tot he pts.

 

[Rendar5]

When I was full time for HCA I witnessed the following things:

encouragement to sign in and essentially say that I saw patients AND put in orders to say that u treated them to make metrics look good. We were to do this the instant the patient came in

3 doc firings without cause and no 30day notice given in violations of their contracts

Active encouragement (as in it was implied that you would get in trouble unless the parents specified otherwise) to transfer peds cases to another county 45 minutes away instead of to the press facility 10 minutes away

As a new EM grad this year, should I be staying away from all HCA hospitals for my first job?

I have been running into what seems like good hospitals, compensation, area, etc, but the one thing holding me back is HCA and the corporate push to meet metrics.. should I be so averse to these hospitals?

I've been hearing a lot of negative things and wondering if there are comments from those who have actually worked at these sites in the last few years..

 

[tdittyx2x3]

Kind of what I expected to hear... bummer really because a lot of the hospitals in the Tampa Bay area are HCA. It's drastically reducing the opportunities and we are very excited about this area of FL..

If anyone has any positive comments then please feel open to leave them here. Likewise if there are personal horror stories, I think they should be told so that new grads can hear it imo.

 

[The White Coat Investor]

The problem with HCA is the vast majority of their EDs are in with corporate emergency medicine/ CMGS, particularly EMCARE, one of if not THE worst CMG to work for.

They still have a few hospitals staffed with democratic EM groups, but there is heavy pressure on them. Trust me, I just spent 2 hours in a meeting about this last night.

As far as the metrics, you'll get that at any hospital, maybe a bit more at for-profit hospitals. Just gotta deal with that. But working for a CMG where you don't get to control your own fate and someone else is skimming off the profit, that's a far bigger issue in my view. But if you just want to punch a timecard, make 25% less, and not control who you work with and how you staff, that's your choice.

 

[Apollyon]

The problem with HCA is the vast majority of their EDs are in with corporate emergency medicine/ CMGS, particularly EMCARE, one of if not THE worst CMG to work for.

I call TeamHealth the worst, because they have stockholders that do the skimming.

 

[coachB]

I call TeamHealth the worst, because they have stockholders that do the skimming.

So does EmCare. Ticker EVHC.

 

[Apollyon]

So does EmCare. Ticker EVHC.

No kidding? Straight dope, man, I didn't know that. Bummer.

 

[RustedFox]

No kidding? Straight dope, man, I didn't know that. Bummer.

As a "former" (still PRN) EmCare/HCA employee... yeah - we all knew this was coming, and "teh (sic) suck" came with it.

Here's the pisser: I have taken care of the C-crew's family in the ED. Metrics ? Lolz. "Those are for little people".

Poison.

Poison.

Poison.

 

[GeneralVeers]

I work at an HCA hospital. It is true they are all about metrics, but as long as you "fake it" by signing up for patient even if you aren't going to see them for a bit, the hospital doesn't care. As long as the numbers on the screen stay in in the green, the C-Suites are fine and you don't have to worry. Is this unethical? Certainly. But this is modern medicine, and it's going to get worse as the Federal government takes a greater role in delivery and payment.

I have to disagree with EMCare. I"ve worked off and on with them for about 8 years now, and they've always treated me fairly. I know where I stand with them, and that I'm just a replaceable cog in the machine. I'm completely okay with that, provided they are up front and don't lie to me. I nominate EMP as the WORST group, along with all of he other fake democratic CMGs. They lie and say you're a physician "owner" all the while paying you pathetic wages, and giving non-clinical executives huge salaries and taking them to expensive dinners.

 

[deleted109597]

Worked for TH, EmCare, and Schumacher in the past, as well as a non-democratic small group.
Of them, the small group was the worst. Inbred, not open books, no incentives to work hard or hardly work.
Schumacher has the best "perks", in that I could see my statistics from each shift, as well as free access to UptoDate. TH and EmCare, I wouldn't have been able to tell you who was my boss except for the signature lines on the emails for contracts every year. They're pretty hands off.
Caveat, I do not work at an HCA facility.

 

[Arcan57]

A major determinate of how good a company/group is to work for is going to be the health of their contracts. Is the contract with a hospital that partners with the group to provide patient safety and staffs appropriately for the desired level of metrics while treating a patient population that is mostly privately insured? You're probably going to be in good shape barring some massive pyramid scheme partnership track. Or until the hospital puts out an RFI for any of the myriad reasons corporate marriages break up. If the contract is with a crap hospital that has a mandate to change but no one on the hospital side with the political will to make it happen, it's probably going to be a suck job (albeit with higher pay during the initial and final parts of the relationship).

 

[emergentmd]

I have been an owner of a open book dem group. Worked for TH, EMCARE.

They all have their plus and minuses. To be honest, I like Locums with emcare the best bc they leave me alone and I can care less about fake metrics.

Fake metric - pt signs in. APC jumps on the chart and puts in orders/signs up. Back to waiting room. Back to ER in 2 hrs. I see pt and out the door in 2hr2 min.

Guess what? metric looks great. Pt still in ED for over 2 hrs even if the APC didnt sign up.

 

[GeneralVeers]

I have been an owner of a open book dem group. Worked for TH, EMCARE.

They all have their plus and minuses. To be honest, I like Locums with emcare the best bc they leave me alone and I can care less about fake metrics.

Fake metric - pt signs in. APC jumps on the chart and puts in orders/signs up. Back to waiting room. Back to ER in 2 hrs. I see pt and out the door in 2hr2 min.

Guess what? metric looks great. Pt still in ED for over 2 hrs even if the APC didnt sign up.

Exactly. I do the same thing. The patient isn't really "seen" in 10 minutes however as long as the number looks good no one cares. I still get to largely do what I want and practice how I want, just have to know the tricks to make the numbers good

 

[Birdstrike]

As a new EM grad this year, should I be staying away from all HCA hospitals for my first job?

I have been running into what seems like good hospitals, compensation, area, etc, but the one thing holding me back is HCA and the corporate push to meet metrics.. should I be so averse to these hospitals?

I've been hearing a lot of negative things and wondering if there are comments from those who have actually worked at these sites in the last few years..

Stay away. Stay away. Stay away. Trust me. Stay away.

 

[RustedFox]

Exactly. I do the same thing. The patient isn't really "seen" in 10 minutes however as long as the number looks good no one cares. I still get to largely do what I want and practice how I want, just have to know the tricks to make the numbers good

This used to work, and then they started cracking down on the "door to discharge" times. They want all of those at 2 hours or less; so if you sign up for them, you're on the hook.

Oh, and yes - they're trying to tie your paycheck to this unachieveable metric.

 

[namethatsmell]

Not meaning to hijack this, but while we're at it does anybody have any experience with CEP or EMP (thanks Veers for your comments on them)? Are they the same as the rest of the CMGs? A little better or a little worse? Have heard from my program's alumni about them but would love to hear some more.

 

[MSmentor018]

emcare definitely draws a ton of controversy....and this one made the news
http://www.tampabay.com/news/health...ting-low-staffing-at-brandon-regional/2218497

 

[NinerNiner999]

What Birdstrike said.

 

[The White Coat Investor]

The fact that EmCare would start a joint venture with HCA tells you a lot about both companies.

 

[GeneralVeers]

I'm not sure what a better alternative is. I could work for a CMG which has many of the same issues and make 1/2 as much.

 

[NinerNiner999]

Today there are not better alternatives. We are all in a tremendous race to the bottom.

 

[deleted109597]

Freestandings.
Remember, if you live in a state where they're not legal, it's just like living in a state with terrible malpractice. You always have the ability to move, you just have to decide what's more important. Geography, or quality of life at work.
I realize many people argue that they're bound an area because of family, but that's basically the statement the Occupy Wall St people used. It fails. Now, granted, growing up in the military means that I moved around a fair amount, and thus to me moving doesn't mean much. And while I don't want to move my kids around every 3 years, I'll move in a heartbeat if I think it's an opportunity for me or my family.

 

[emergentmd]

Yup,

I love freestanding.

 

[GeneralVeers]

Freestandings.
Remember, if you live in a state where they're not legal, it's just like living in a state with terrible malpractice. You always have the ability to move, you just have to decide what's more important. Geography, or quality of life at work.
I realize many people argue that they're bound an area because of family, but that's basically the statement the Occupy Wall St people used. It fails. Now, granted, growing up in the military means that I moved around a fair amount, and thus to me moving doesn't mean much. And while I don't want to move my kids around every 3 years, I'll move in a heartbeat if I think it's an opportunity for me or my family.

I've looked at joining one of these groups, and I honestly don't see the benefit vs. what I'm doing now. Usually you "buy in" for a specific number of shifts, then you're working 6 24 hour shifts per month, which is essentially the same workload as I do now. There's a nominal salary of about $100-$120/hour for the time. At 6 months to a year when it's making profit, then you potentially get the payout, however you're taking the risk up front with the buy-in and it could fail. In contrast I could work 6 months at 3X the salary, not have a buy in, and be financially better off after 6 months to year working for myself.

Does anyone know of a better model for physician buy-in to these groups?

 

[deleted109597]

If you're joining one of the "groups" (FirstChoice, etc), then yeah, that's what you get. IMO, those places are just like CMGs, just in different locations.
It's starting your own that is where it's at. If you're not 51% or greater, someone else is simply taking money away from you.

 

[GeneralVeers]

If you're joining one of the "groups" (FirstChoice, etc), then yeah, that's what you get. IMO, those places are just like CMGs, just in different locations.
It's starting your own that is where it's at. If you're not 51% or greater, someone else is simply taking money away from you.

I'm glad my assessment was correct. It would certainly be hard to give up all the free airmiles though.

 

[sum dude]

I call TeamHealth the worst, because they have stockholders that do the skimming.

So does EMCare...no different. Unfortunately, market forces set forth by our government are pushing towards consolidation. Here in Florida, we've had people jump ship from HCA in droves (including lots of directors who leave EMCare to make less per hour but not deal with the BS.)

With that said, every place is different. Might want to talk to the last few hires at the hospital. Also talk up staff and RN's-they like to talk. Also always ask why the position is becoming available--is the group expanding? Or did they just have 10 doctors leave? How long has the director been there? Learn the red flags.