HCA vs USACS

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad.
emergentmd said:
Wait Wait Wait. let me get this straight.

I can be an owner with USACS but I have no voting rights, I can't look at the books, I can't make any decisions, I can't cash out, I have nothing tangible?

Man those guys set up one of the best ownership structure I have ever seen. No liability while hooking up servants.

I think I am going to start a investment syndication tomorrow. It will be called EmergentMD care. Just give me $100K and You will get ownership in the group. You can even pick how much shares you want for the 100K. Why do I care, as they are essentially worthless. Opps... I didn't mean to mention that.
Click to expand...

Yep, you just eat crow...and hope that you don't have a non-compete thrown in your contract, too.

Residents and medical students: don't work for this abomination. Just look at the job markets in Austin and Denver (which USACS laid waste to), and do your research on what happened to the Summa residency program. Just say no.
 
GeneralVeers said:
I find it interesting that not one person who's worked for USACS will defend them or their tactics on here. Their higher-ups are so bad at their jobs that they can't even make an alias to come online and support their company. They have to realize that tons of new grads read this forum.
Click to expand...
No options so they dont give a F. when you are a monopoly in some desirable places people will work for you, work environment be damned. Jobs are tightening up like crazy. I can't believe the horrid pay some people will work for. Honestly people wtf.
 
Fox800 said:
Yep, you just eat crow...and hope that you don't have a non-compete thrown in your contract, too.

Residents and medical students: don't work for this abomination. Just look at the job markets in Austin and Denver (which USACS laid waste to), and do your research on what happened to the Summa residency program. Just say no.
Click to expand...
And what they are doing in Texas with the purchase of ESP.
 
Fox800 said:
One of my mentors is a USACS doc in the TX. She can't cash out her "shares" because the company won't let her. How's that for ownership?
Click to expand...

Isn't this illegal? Sounds like sham shares... i.e., a pyramid scheme. They keep taking docs money for investments but won't pay anyone.

At least with my group you can get out anytime.
 
southerndoc said:
Isn't this illegal? Sounds like sham shares... i.e., a pyramid scheme. They keep taking docs money for investments but won't pay anyone.

At least with my group you can get out anytime.
Click to expand...

Back when I was with them you used to be able to buy shares and it paid a guaranteed rate of interest, which I believe was 5% back then. I bought a couple shares, pocketed the 5% interest then cashed out. At the time you could sell back to the company whenever. Funny thing was the next year they were performing so poorly financially that they had to cut the dividend to 0.
 
southerndoc said:
Isn't this illegal? Sounds like sham shares... i.e., a pyramid scheme. They keep taking docs money for investments but won't pay anyone.

At least with my group you can get out anytime.
Click to expand...

I don't think they are preventing anyone from selling shares. All they need to do is value it at 1cent/share. You can sell if you want but if you think you are going to cash out, then you are mistaken.

That is their hook.

Come join. Largest doctor owned group. Get shares. Stay 2 yrs and your shares will be vested. Sell when you want. Buy more if you want. Just take a 50k paycut. The dividends and ownership is worth it.

They just don't tell you what the value of the shares are when you sell.
 
Selling at 1c/share is still being able to sell. I gathered from the previous post that people were unable to redeem their shares. That's a totally different story.

Which is it?

I have never been affiliated with USACS so I have no idea how they operate.
 
About a year after I left a part time gig that was taken over by USACS, I got a random check for something like $770. It was some sort of "retirement plan" cashout, but I just rolled it over, so I don't remember exactly what it was for, although I don't think it was clear at the time. This was now several years ago, and since I was part time, I never expected any sort of retirement contribution, but that might be what it was?
 
southerndoc said:
Selling at 1c/share is still being able to sell. I gathered from the previous post that people were unable to redeem their shares. That's a totally different story.

Which is it?

I have never been affiliated with USACS so I have no idea how they operate.
Click to expand...
When you buy shares for 1k a share and can sell for a penny that’s not reasonable. Especially when they internally say it’s worth more.
Also physician owned is a joke. 35% owned by Carson welsh private equity trash.
Usacs sucks so bad they couldn’t even get a real private equity company to buy them. At least kkr and black stone are legit private equity firms.
Usacs was making no profit before they went private. They needed the private equity money to buy up profitable ed groups and then drive down md pay I’m desireable places.
 
I have never worked for USACS. But in life and business, never believe what people tell you. Read the contract.

The problem is most people don't read contracts and even when they do they don't understand it and even if they understand it there is always fine print that allows them to get out of the contract.
 
I was a scribe in the ED at a HCA site for about a year before starting medicsl school. During that time, it was already passed along to the ED that a residency would be created -- I never directly asked, but it seemed that the edict came from the hospital admin. Anyways, on more than a few occasions the attendings not only lambasted the decision ("If I wanted to teach, I would have gone to a teaching hospital"), but also genuinely felt a residency at the ED would invariably be inferior to that of a university hospital or other well-established programs. I had made it known to a few of the docs my interest in pursuing EM, so they were candid in their assessment with me. I recently looked up the residency on the hospital website, and those who were on faculty ended up being the attendings I remember who at least even enjoyed teaching scribes stuff, so take that for what it is. Regardless, it was interesting to see so much disdain or indifference from the EPs about the impending program. Last I checked, though, there had been quite a bit of turnover among the attendings. My opinion really hasn't changed since then that that resident education and learning at HCA sites will likely be a teach-yourself-style.
 
Doctor_Strange said:
I was a scribe in the ED at a HCA site for about a year before starting medicsl school. During that time, it was already passed along to the ED that a residency would be created -- I never directly asked, but it seemed that the edict came from the hospital admin. Anyways, on more than a few occasions the attendings not only lambasted the decision ("If I wanted to teach, I would have gone to a teaching hospital"), but also genuinely felt a residency at the ED would invariably be inferior to that of a university hospital or other well-established programs. I had made it known to a few of the docs my interest in pursuing EM, so they were candid in their assessment with me. I recently looked up the residency on the hospital website, and those who were on faculty ended up being the attendings I remember who at least even enjoyed teaching scribes stuff, so take that for what it is. Regardless, it was interesting to see so much disdain or indifference from the EPs about the impending program. Last I checked, though, there had been quite a bit of turnover among the attendings. My opinion really hasn't changed since then that that resident education and learning at HCA sites will likely be a teach-yourself-style.
Click to expand...
A teach yourself style. LOL. If only medicine was so simple. your post is spot on though. Those people will be incredibly inferior to those coming from real residencies. I think I saw somewhere that there are just about 1k more EM residency spots as compared to 2011. Thats insanity. Nearly doubled the amount of spots. Good luck to those new in their career. Glad FI has been a goal from day 1.
 
EctopicFetus said:
A teach yourself style. LOL. If only medicine was so simple. your post is spot on though. Those people will be incredibly inferior to those coming from real residencies. I think I saw somewhere that there are just about 1k more EM residency spots as compared to 2011. Thats insanity. Nearly doubled the amount of spots. Good luck to those new in their career. Glad FI has been a goal from day 1.
Click to expand...

I'm actually trying to go and shadow for a day at the site merely out of morbid curiosity to see if any of the same attendings are still there or not. I do not expect to rotate there or try to match there since I think I have competitive enough stats to go to a university-affiliated hospital (Step 1 243, but am a DO so who knows...).

I am sympathetic to medical students who want to go into EM, and if they are left w/ going to a HCA site or go into IM/FM, that then is an easy choice. However, I am also not surprised that attendings who have a strong disdain towards CMGs and the increased # of residencies oppose the existence of HCA residencies -- I can understand that frustration and have followed this forum long enough to agree even with the prevailing opinion. Either way, as a med student I really don't think I can change anything anyways, so I try to focus on what I can control and what I like.
 
EctopicFetus said:
When you buy shares for 1k a share and can sell for a penny that’s not reasonable. Especially when they internally say it’s worth more.
Also physician owned is a joke. 35% owned by Carson welsh private equity trash.
Usacs sucks so bad they couldn’t even get a real private equity company to buy them. At least kkr and black stone are legit private equity firms.
Usacs was making no profit before they went private. They needed the private equity money to buy up profitable ed groups and then drive down md pay I’m desireable places.
Click to expand...

Not reasonable, but still possible. SEC won't find fault in selling at a substantial loss (as long as it is valued properly, and if someone complains they'll go through the books), but if they refuse to allow you to sell your shares I believe that's illegal. I'm no securities expert, but I'm almost 99% sure it is.
 
EctopicFetus said:
No options so they dont give a F. when you are a monopoly in some desirable places people will work for you, work environment be damned. Jobs are tightening up like crazy. I can't believe the horrid pay some people will work for. Honestly people wtf.
Click to expand...

What's the lowest you've heard people working for with these losers?
 
southerndoc said:
Not reasonable, but still possible. SEC won't find fault in selling at a substantial loss (as long as it is valued properly, and if someone complains they'll go through the books), but if they refuse to allow you to sell your shares I believe that's illegal. I'm no securities expert, but I'm almost 99% sure it is.
Click to expand...

not true. Shares in privately held companies can be incredibly restrictive. With private companies the managing partner has incredible control.
 
Dr.McNinja said:
They could charge $60k per year and it would fill.
Click to expand...

I point the finger of blame at the ACGME.
But I'm also willing to bet that just like ACEP, that the CMGs have infiltrated the ACGME.
This is just spectulation, but I wouldn't be surprised at all if it fleshed out.

I remember my first job...

*FLASHBACK*

I met the other four guys that were the full-timers.

One was the medical director. We'll call him Joe McJersey.
One was an old, vasculopathic, curmudgeon. We'll call him Brian McButtery
One was a dude in his mid 40s who was hip to the CMG game. We'll call him Manny McMutey (because he was smart enough to keep his mouth shut.)
One was a fresh grad from Baltimore. We'll call him Black Steve, because he liked to be called Black Steve. He had a great sense of humor.

In less than two years...

Manny McMutey left because he couldn't stand the CMG nonsense anymore and had a better gig. We're still good buddies.
Black Steve and his wife had a baby, and went to live and work back in Baltimore back with the family. I miss him. Last I heard, he had triplets with their next pregnancy. No joke. I miss him.
Brian McButtery "retired" and took a C-suite job at the same hospital in an ultimate example of crony-ism.
Joe McJersey was exposed as the corporate lapdog that he was, and left to go do locums work.

And then, there was me.

I remember getting 2-3 calls a week from Dick McDickerson, the regional vice-dicker-around-er for the dickstrict.
Note that Dick McDickerson is NOT a physician.

"Hey, buddy! You're going to be the flag-carrier for the NEW ERA of docs for this hospital!"

Nah. I'm out.

Manny and I are still buddies. We talk about every month.
I still miss Black Steve.
I don't miss Joe McJersey. Neither does anyone else.

But you know what?

Brian McButtery.

I still have all his emails... from when he was the loudest voice in the room crying out against the CMG and all their underhanded nonsense and their impossible metrics and their expectations that were otherworldly and couldn't be met.

Then... Brian McButtery found himself a cushy corporate job.
He became a DINO... Doctor In Name Only.

His tune changed instantly.

"WELL, these people are our PARTNERS, and we need to COLLABORATE and CORPORATE DOUBLESPEAK and EURASIA has ALWAYS been at war with EASTASIA. Now, let me rub this stick of butter all over my manboobs and lick my fingers when it melts. Oops! the butter is running down my CABG scar towards my belly button, so I'll have to suck it out with a long straw."

I want to print out all of his emails and hand them to him as a Christmas present, with a card that says something like: "Hey, Judas! Remember THIS? Good times. Merry Cholesterol!"

Last I had heard, he "retired" from his C-suite gig... to take a job as a "consultant", which means that he doesn't have to come to work anymore - but still takes money from the work that the grunt docs make.

I imagine he douses 100 dollar bills in A1 Steak Sauce and rubs them on his jowls in his "spare time", which is... all day.

DINO.

Its time for the DINOs to die.

There is no role for the DINO in modern American healthcare.

If you want to trade scrubs for suits, then be sure to spend some time back in scrubs.

If not... expect no quarter.
 
Last edited:
RustedFox said:
"WELL, these people are our PARTNERS, and we need to COLLABORATE and CORPORATE DOUBLESPEAK and EURASIA has ALWAYS been at war with EASTASIA. Now, let me rub this stick of butter all over my manboobs and lick my fingers when it melts. Oops! the butter is running down my CABG scar towards my belly button, so I'll have to suck it out with a long straw."



I imagine he douses 100 dollar bills in A1 Steak Sauce and rubs them on his jowls in his "spare time", which is... all day
Click to expand...


The imagery this conjures up is one part work of art and another part absolutely disgusting. Well done
 
NYEMMED said:
No it’s more like 2.5-3.5 per hour supervising 3-4 midlevels.

USACS is pushing to staff with midlevels and 1-2 supervising attendings.
Click to expand...
APP which is a growing cancer in EM is doing the same.
 
EctopicFetus said:
Couldnt find your post about this. give it time.
Click to expand...

Heard.


This was actually one of the sticking points with TH and not APP.
If we have a MLP hole in the schedule, it is filled with a physician, and the physician is paid the physician rate.

This is in stark contrast to Envision.

I work at an FSER once a month or so that is seriously less than a pop song away from my home.
We got word that the FSER needed "surge" help one day last week.
We never need "surge" help at my primary gig, because APP lets us staff it appropriately.
They could have called me. I could have been there in 10 mins or less after a quick shower and brush of my teeth.
I seriously have a "scrub-roll-up" at the ready at any time. Just gotta grab it and go.
But; they spent 2-3 hours calling all of the MLPs first to help (which they, in turn, declined to come in) because they didn't want to pay the physician rate.
Meanwhile, that poor doc drowned for another 2-3 hours.

I hope HCA/Envision (which is one in the same) dies in a fire.
 
Mr. Hat said:
USACS in Denver pays as low as $125/hr. I think that’s what I made moonlighting when I was in residency
Click to expand...
Reality they would be happiest paying as little as possible. That’s true for any business when it comes to employees. Also, their duty is simply not to you the physician. It’s to their shareholders. These 2 facts should not be a foreign concept to anyone smart enough to become a physician.
Hence it would be good if we owned our jobs.
 
EctopicFetus said:
Reality they would be happiest paying as little as possible. That’s true for any business when it comes to employees. Also, their duty is simply not to you the physician. It’s to their shareholders. These 2 facts should not be a foreign concept to anyone smart enough to become a physician.
Hence it would be good if we owned our jobs.
Click to expand...

Yep. It’s called supply and demand - another foreign concept to many physicians.
 
TheSingularity said:
No way. Are you sure about this? Part of me wants to call one of their stupid recruiters just got the lulz.

Sent from my Pixel 3 using SDN mobile
Click to expand...

Give it a try. You’ll probably get a busy signal due to all of the physicians calling to sign up...you know...because mountains...yay🙄
 
TheSingularity said:
No way. Are you sure about this? Part of me wants to call one of their stupid recruiters just got the lulz.

Sent from my Pixel 3 using SDN mobile
Click to expand...
I interviewed with them 2 yrs ago and that's about right. After 2 yrs with them you'd be 140s, 150s at night. But you got to be an "owner" or some bull.

I love the Denver area but it takes a truly special kind of idiot to do a 4 year residency in a 3 year residency specialty then take a job at 50% market value.
 
Alvarez13 said:
I interviewed with them 2 yrs ago and that's about right. After 2 yrs with them you'd be 140s, 150s at night. But you got to be an "owner" or some bull.

I love the Denver area but it takes a truly special kind of idiot to do a 4 year residency in a 3 year residency specialty then take a job at 50% market value.
Click to expand...

That IS market value in Denver.

There are tons of people with a romanticized view of Denver - mountains, progressive, restaurants, entertainment, you name it. That generally lasts until they sit in traffic for 3 hours on I-70 and really get a chance to contemplate the $300/sq foot they’re paying in mortgage. If that doesn’t bring’em back to reality, then the pothead that comes crashing into the back of their Prius will...

Many of us who went to this past ACEP in Denver were reminded why we would never live in that city when it was 20 degrees and snowing...2 days before Halloween.
 
The other problem with Denver that people don't seem to get is that it's still a 2 hr drive from the ski mountains
ShockIndex said:
That IS market value in Denver.

There are tons of people with a romanticized view of Denver - mountains, progressive, restaurants, entertainment, you name it. That generally lasts until they sit in traffic for 3 hours on I-70 and really get a chance to contemplate the $300/sq foot they’re paying in mortgage. If that doesn’t bring’em back to reality, then the pothead that comes crashing into the back of their Prius will...

Many of us who went to this past ACEP in Denver were reminded why we would never live in that city when it was 20 degrees and snowing...2 days before Halloween.
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
I was excited to go to Denver a few years ago for ACEP (actually 8 years ago since I no longer go) and was disappointed with the city. Almost as dull as the other large Midwestern cities, but with more potheads and homeless. No thanks.

On a related LOLZ moment got a text from a locums company that they were hiring for a rural contract in my state at $250/hr. It was hilarious as Envision pays $350 as their standard rate without a recruiter. That locums company was trying to pocket the $100/hr. I sent a text basically basically stating the facts, and saying "good luck with that". The recruiter wasn't thrilled.
 
Colorado is an interesting place.

The market in Denver is horrible but outside the city you can actually find good jobs.

The group in Aspen was offering 200/hr to staff their 8000/yr hospital.
 
Last edited:
ShockIndex said:
That IS market value in Denver.

There are tons of people with a romanticized view of Denver - mountains, progressive, restaurants, entertainment, you name it. That generally lasts until they sit in traffic for 3 hours on I-70 and really get a chance to contemplate the $300/sq foot they’re paying in mortgage. If that doesn’t bring’em back to reality, then the pothead that comes crashing into the back of their Prius will...

Many of us who went to this past ACEP in Denver were reminded why we would never live in that city when it was 20 degrees and snowing...2 days before Halloween.
Click to expand...

There are other desirable places to live in the US too but don't pay terrible prices. Northern California / Bay Area is paying $250 - 300/ hr and more in one area that I know of.

It is market economics, yup.
 
Really?! It's this high here? How is this possible?
thegenius said:
There are other desirable places to live in the US too but don't pay terrible prices. Northern California / Bay Area is paying $250 - 300/ hr and more in one area that I know of.

It is market economics, yup.
Click to expand...

Sent from my Pixel 3 using SDN mobile
 
You must log in or register to reply here.

Similar threads

FlaminHotER
US Senator Investigating USACS
Replies
1
Views
2K
FlaminHotER
FlaminHotER
W
U Maryland USACS takeover
Replies
16
Views
4K
EctopicFetus
EctopicFetus
EctopicFetus
Usacs leader arrested for ……
Replies
20
Views
5K
Birdstrike
Birdstrike
Groove
HCA Mission Hospital & TeamHealth Lawsuit
Replies
7
Views
2K
RustedFox
RustedFox
BoardingDoc
USACS Shenanigans
Replies
19
Views
6K
Fpg1245
F
Top