HCA vs USACS

[RustedFox]

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Because a one-bedroom sh!box apartment with no bathrooom will cost you eleveteen thousand dollars a month.
I played that game in North Jersey because I had to.
I was a student in the area.
I'm never playing that game again.

Overpopulated.

Mother Earth is screaming that we can't keep this nonsense up.

 

[southerndoc]

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🙄

Mountains? Oh yea, you're right. It's the "mountains" for the reason to practice in Colorado. 😉

 

[ShockIndex]

Mountains? Oh yea, you're right. It's the "mountains" for the reason to practice in Colorado. 😉

I did notice that everyone was hitting that snack table pretty hard at the ACEP exhibit hall...

 

[Fox800]

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.

$200/hr is nothing to boast about as a “good job”, unfortunately. I guess everything is relative compared to Denver.

 

[Alvarez13]

Really?! It's this high here? How is this possible?

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To offset cost of living. CA income taxes are some of the highest in the country, probably 11+% for your bracket. The 2 bd shacks are $1mil+. After taking care of the basics you're probably back down to <$200/hr. Again, it's like CO. Yah you get sun, near great landscape, good coffee, etc. It's just not were financially smart people live.

 

[thegenius]

Really?! It's this high here? How is this possible?

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Because I work in Northern CA!!

 

[thegenius]

To offset cost of living. CA income taxes are some of the highest in the country, probably 11+% for your bracket. The 2 bd shacks are $1mil+. After taking care of the basics you're probably back down to <$200/hr. Again, it's like CO. Yah you get sun, near great landscape, good coffee, etc. It's just not were financially smart people live.

I suppose that is true, if your #1 goal is to maximize wealth. CA is not a good place to live.

 

[TheSingularity]

$200/hr is nothing to boast about as a “good job”, unfortunately. I guess everything is relative compared to Denver.

200/hr is totally fine for a nice practice environment

To offset cost of living. CA income taxes are some of the highest in the country, probably 11+% for your bracket. The 2 bd shacks are $1mil+. After taking care of the basics you're probably back down to <$200/hr. Again, it's like CO. Yah you get sun, near great landscape, good coffee, etc. It's just not were financially smart people live.

Would totally work in NoCal for 250-300/hr

 

[Fox800]

200/hr is totally fine for a nice practice environment



Would totally work in NoCal for 250-300/hr

Well below national average in a super high COL area, in a state with income tax...okay. To each their own.

 

[MSmentor018]

Can anyone tell me why Gainesville, yes, Gainesville FL needs another residency program? UF is a fantastic institution. How the hell does HCA justify opening a residency at North Florida? That hospital is absolute garbage. Does ACGME have any standards left? My God.

$$$ and greed that’s why. Does Tampa Florida really need 5 more programs?


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[RustedFox]

$$$ and greed that’s why. Does Tampa Florida really need 5 more programs?


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I know a lot of those hospitals.
I wouldn't bring my wife to a lot of them.

ACGME seems to not care.
Or (and I bet), they've got an Envision member or two on their board.

 

[alpinism]

Looks like HCA has moved on to DFW Texas.

Wouldn't be surprised if we see 150/hr rates within the next 5 years.

Jobs on PracticeLink

www.practicelink.com

Jobs on PracticeLink

www.practicelink.com

 

[MSmentor018]

I know a lot of those hospitals.
I wouldn't bring my wife to a lot of them.

ACGME seems to not care.
Or (and I bet), they've got an Envision member or two on their board.

There’s a rumor that the gov Rick Scott former owner of hca redesigned em as a primary care speciality therefore the rrc allowed it. What better way to have residents work for your hospitals for cheap, get the fed to pay, and flood the market driving down our power


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[EctopicFetus]

There’s a rumor that the gov Rick Scott former owner of hca redesigned em as a primary care speciality therefore the rrc allowed it. What better way to have residents work for your hospitals for cheap, get the fed to pay, and flood the market driving down our power


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Rick scott doesnt own HCA. they are a public company. He ran the company for a while. EM has long been looped into primary care just like OB. Yes he is a snake and yes HCA sucks.

 

[NYEMMED]

Rick scott doesnt own HCA. they are a public company. He ran the company for a while. EM has long been looped into primary care just like OB. Yes he is a snake and yes HCA sucks.

Rick Scott after becoming a law firm partner, he co-founded Columbia Hospital Corporation. Columbia later merged with another corporation to form Columbia/HCA, which eventually became the largest private for-profit health care company in the United States.[7] Scott was pressured to resign as chief executive of Columbia/HCA in 1997. During his tenure as chief executive, the company defrauded Medicare, Medicaid and other federal programs. The Department of Justice ultimately fined the company $1.7 billion in what was at the time the largest health care fraud settlement in U.S. history.[8] Scott was not charged with a crime.[9] Following his departure from Columbia/HCA, Scott became a venture capitalist and pursued other business interests.

-- Wikipedia



Which also proves, when you are caught doing shady things in business, just go into politics.

 

[RustedFox]

There’s a rumor that the gov Rick Scott former owner of hca redesigned em as a primary care speciality therefore the rrc allowed it. What better way to have residents work for your hospitals for cheap, get the fed to pay, and flood the market driving down our power


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This still wouldn't absolve the RRC of their duty to ensure quality GME at their accredited sites.

 

[EctopicFetus]

Rick Scott after becoming a law firm partner, he co-founded Columbia Hospital Corporation. Columbia later merged with another corporation to form Columbia/HCA, which eventually became the largest private for-profit health care company in the United States.[7] Scott was pressured to resign as chief executive of Columbia/HCA in 1997. During his tenure as chief executive, the company defrauded Medicare, Medicaid and other federal programs. The Department of Justice ultimately fined the company $1.7 billion in what was at the time the largest health care fraud settlement in U.S. history.[8] Scott was not charged with a crime.[9] Following his departure from Columbia/HCA, Scott became a venture capitalist and pursued other business interests.

-- Wikipedia



Which also proves, when you are caught doing shady things in business, just go into politics.

NO where is there a higher concentration of scum than in politics. Not prison, not lawyers (though many of them make up politics). Politics is the most disgusting and worst parts of our society.

 

[Old_Mil]

Are they the same type of entity? Should I be lumping them together when considering the quality and evaluating future residency options? Thanks!

Do you want to learn how to practice medicine as Hippocrates would have you practice it (non HCA/CMG) or a Hedge Fund would have you practice it? Your choice.

 

[hundreddaysoff]

Do you want to learn how to practice medicine as Hippocrates would have you practice it (non HCA/CMG) or a Hedge Fund would have you practice it? Your choice.

Hippocrates would've rectalized and panscanned all the traumas

 

[miacomet]

No thank you.

 

[thegenius]

Hippocrates would've rectalized and panscanned all the traumas

Hippocrates would have written a damn good chart too. Impervious to liability!

 

[Emdocinabox]

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.

I’m a usacs doc for past 5 years...happy to answer any questions. I’m not going to defend the company, but some things are great like 40k in 401k, paid paternity leave, salary paid if deployed (military), productivity incentive pay etc. Some things suck like reducing scribes and push on coverage. Shares to be revalued this year with distribution also this year. Everyone knows that the PE firm needs to exit with cash in next 2 to 5 years. Same thing happened with US oncology and US Anesthesia. Everyone got a nice payday when this occurred so we are hoping for same. You get free shares and also have option to buy more when they do capital raise for large acquisition. Locations of the hospitals are in mostly nice areas. My previous SDG was a hundred times better, but my friends at other companies are saying Usacs is a 10 times better than where they are...so nobody really knows. I bring home 300k with great benefits and 12 shifts a month so don’t complain, but I do miss the old days of when I was partner in a small group where I knew the CEO’s name!

 

[oldtown]

Hi Dominic!

I kid. Couldn’t resist.

I’m a usacs doc for past 5 years...happy to answer any questions. I’m not going to defend the company, but some things are great like 40k in 401k, paid paternity leave, salary paid if deployed (military), productivity incentive pay etc. Some things suck like reducing scribes and push on coverage. Shares to be revalued this year with distribution also this year. Everyone knows that the PE firm needs to exit with cash in next 2 to 5 years. Same thing happened with US oncology and US Anesthesia. Everyone got a nice payday when this occurred so we are hoping for same. You get free shares and also have option to buy more when they do capital raise for large acquisition. Locations of the hospitals are in mostly nice areas. My previous SDG was a hundred times better, but my friends at other companies are saying Usacs is a 10 times better than where they are...so nobody really knows. I bring home 350k with great benefits and 12 shifts a month so don’t complain, but I do miss the old days of when I was partner in a small group where I knew the CEO’s name!

 

[MechEDoc]

I bring home 350k with great benefits and 12 shifts a month so don’t complain, but I do miss the old days of when I was partner in a small group where I knew the CEO’s name!

Is that 350k a year including the benefits or excluding them?

 

[Emdocinabox]

Is that 350k a year including the benefits or excluding them?

My apologies, I just edited original post...it’s 300k excluding benefits ($210-215/hr incentive based comp). I would definitely not recommend this group if you have a SDG option where you can become a real partner

 

[NYEMMED]

My apologies, I just edited original post...it’s 300k excluding benefits ($210-215/hr incentive based comp). I would definitely not recommend this group if you have a SDG option where you can become a real partner

What is the true hourly base rate?
USACS is known to have base rates of 150/hour or less

 

[BoardingDoc]

but some things are great like 40k in 401k,

Does USACS use a matching formula? OR
Do they simply dump 40k into your 401k annually? OR
Is 40k the total amount going into your 401k/yr (e.g. you put in the max of 19.5k and they put in 20.5k?)

Also, are you including this 40k in your 300k annual comp number?

Finally, you said you work 12 shifts/mo. Length? 12s? 9s?

 

[B52forU]

Does USACS use a matching formula? OR
Do they simply dump 40k into your 401k annually? OR
Is 40k the total amount going into your 401k/yr (e.g. you put in the max of 19.5k and they put in 20.5k?)

Also, are you including this 40k in your 300k annual comp number?

Finally, you said you work 12 shifts/mo. Length? 12s? 9s?

it is 40k unconditional, not matching. 215/hr is high for a USACS job but I guess it depends on location. I did residency at a few USACS sites in the Midwest and only one dedicated nocturnist that they brought on was being paid 220 minus the firefighters they used initially. That said the benefits (before) were solid

 

[Emdocinabox]

it is 40k unconditional, not matching. 215/hr is high for a USACS job but I guess it depends on location. I did residency at a few USACS sites in the Midwest and only one dedicated nocturnist that they brought on was being paid 220 minus the firefighters they used initially. That said the benefits (before) were solid

For 401k it’s 10% of your salary up to whatever IRS defines for profit sharing (typically ~25k) so the 40 includes my contribution (I guess it’s total around 43k)
10 hour shifts
Base 180, but I do work in a more rural-ish location. About an hour drive to decent town.

 

[Emdocinabox]

401k not included in total comp of 300
Each hospital has a different base, so it’s possible there are locations with lower. My place is kinda ****ty so the base is higher and RVU threshold is lower, but that’s not the case everywhere of course.
Volumes range, but I see anywhere from 1.8-2.2 pts/hr depending on the shift. There is unfortunately large NP use but hard to recruit docs to a location like mine. Fortunately they are decent, but still not thrilled with how usacs uses PA and NP so heavily throughout.

 

[EctopicFetus]

IMO $185-215 is standard EM pay (total comp). In the end many SDGs are in the 275+ range. that $60/hr is 100k+/yr plus autonomy and control. Its not all sunshine and rainbows but it saddens me that this is the reality for EM Docs.

 

[GeneralVeers]

For 401k it’s 10% of your salary up to whatever IRS defines for profit sharing (typically ~25k) so the 40 includes my contribution (I guess it’s total around 43k)
10 hour shifts
Base 180, but I do work in a more rural-ish location. About an hour drive to decent town.

The salary doesn't tell us too much without knowing the geographic area. $200-$210 in Los Angeles? That's great! The same amount in TX is rather pathetic. I know that in Austin, TX for example USACS is paying well below $200/hour and the same with Denver. Do you feel it's okay that they are making $200-$300/hour off your back while only paying $200?

Do you still have open books? Back when it was EMP they used to show us the books with collections at least locally.

Their 401K match used to be really great. They had good health insurance, but honestly the 401K, HSA, and BEA are the only benefits of real value.

 

[Emdocinabox]

The salary doesn't tell us too much without knowing the geographic area. $200-$210 in Los Angeles? That's great! The same amount in TX is rather pathetic. I know that in Austin, TX for example USACS is paying well below $200/hour and the same with Denver. Do you feel it's okay that they are making $200-$300/hour off your back while only paying $200?

Do you still have open books? Back when it was EMP they used to show us the books with collections at least locally.

Their 401K match used to be really great. They had good health insurance, but honestly the 401K, HSA, and BEA are the only benefits of real value.

Yes, the director does share avg collections/pt. We are in a crappy area, so no way they’re generating 200-300 of the docs. If they did, the company would be paying a lot of dividends/distributions. I do feel for the PA’s who get much less pay but are seeing a lot of similar patients. In the end, I feel the benefits are good, but that’s about it. Would I work for them if I moved—only if there was no SDP available and no hospital based jobs either.

 

[GeneralVeers]

Yes, the director does share avg collections/pt. We are in a crappy area, so no way they’re generating 200-300 of the docs. If they did, the company would be paying a lot of dividends/distributions. I do feel for the PA’s who get much less pay but are seeing a lot of similar patients. In the end, I feel the benefits are good, but that’s about it. Would I work for them if I moved—only if there was no SDP available and no hospital based jobs either.

They should at least show you total collections for the site, and then a breakdown of site costs. If you aren't getting at least $125/pt on average for collections, then there's a problem even in a crappy area. It's always revealing to see how much a CMG is skimming off the top. Back when it was EMP that number was a 21% "management fee" then an inflated $7/pt for malpractice insurance through the group-owned company. In total about 40% was going out the door to Ohio every month. I'd be curious to see if USACS is more streamlined, though I doubt it since now they have to give a portion back to the private investment firm.

 

[EctopicFetus]

They should at least show you total collections for the site, and then a breakdown of site costs. If you aren't getting at least $125/pt on average for collections, then there's a problem even in a crappy area. It's always revealing to see how much a CMG is skimming off the top. Back when it was EMP that number was a 21% "management fee" then an inflated $7/pt for malpractice insurance through the group-owned company. In total about 40% was going out the door to Ohio every month. I'd be curious to see if USACS is more streamlined, though I doubt it since now they have to give a portion back to the private investment firm.

It is more streamlined. Streamlined to profit the private equity gods. Lol.

 

[Not Pudding]

I’ve been at EMP/USACS since before the transition.

I don’t know what world this guy emdocinabox is in.

1) He is correct about the paid maternity, paternity, an military leave. 8 weeks full pay, 4 weeks half pay for moms. 2 weeks full pay for dads. Military pay is your past 12 month’s average pay minus your month’s LES statement.


2) 401k has been severely neutered. While you “may” get 10%, it is guaranteed. You have to work 1000 hours to get it. Most people won’t hit that mark until 8 months in. Once you hit 1000 you get the 7% that was withheld as a lump sum. While you are below 1000 hours you get 3%. If something happens, like an emergency or needing a medical leave, you’ re SOL. Also, the market hits a big boom in the first half of the year, you’re SOL.

3) There has been no official word about an evaluation made. I haven’t seen anything about getting the private equity firm out via official channels. So he either has some knowledge that isn’t public to the rest of USACS or is FOS.

4) No profit sharing of the stocks since Oct 2016.

5) My director has been trying to get a breakdown of our site performance in relation to revenue for years. USACS has refused.

6) USACS has massively cut Doc hours while not touching Midlevel hours at my place. Any hour changes always is from the Docs, even though the primary change in our volume has been in out quick care area. The quick care is staffed my the midlevels.

 

[GeneralVeers]

I’ve been at EMP/USACS since before the transition.

I don’t know what world this guy emdocinabox is in.

1) He is correct about the paid maternity, paternity, an military leave. 8 weeks full pay, 4 weeks half pay for moms. 2 weeks full pay for dads. Military pay is your past 12 month’s average pay minus your month’s LES statement.

A good benefit, but totally worthless if you don't have kids, and aren't in the military. What about people who don't take 8 weeks maternity leave? Do they get a 50K check?

2) 401k has been severely neutered. While you “may” get 10%, it is guaranteed. You have to work 1000 hours to get it. Most people won’t hit that mark until 8 months in. Once you hit 1000 you get the 7% that was withheld as a lump sum. While you are below 1000 hours you get 3%. If something happens, like an emergency or needing a medical leave, you’ re SOL. Also, the market hits a big boom in the first half of the year, you’re SOL.

This has definitely worsened. When I was there it was 12% of your gross contributed to the 401K, and then that 12% came back every pay period as extra cash once you maxed out the ~30 employer component.

3) There has been no official word about an evaluation made. I haven’t seen anything about getting the private equity firm out via official channels. So he either has some knowledge that isn’t public to the rest of USACS or is FOS.

I doubt the line doctors will get anything. The best they can hope for is their "equity" gets paid out.

5) My director has been trying to get a breakdown of our site performance in relation to revenue for years. USACS has refused.

Some things never changed. While we got generic numbers, we would never get a complete breakdown. One of my colleagues accidentally got a full spreadsheet from one of the office peons, and it was eye-water how much they were skimming off the top

6) USACS has massively cut Doc hours while not touching Midlevel hours at my place. Any hour changes always is from the Docs, even though the primary change in our volume has been in out quick care area. The quick care is staffed my the midlevels.

Vituity did the same while I was there. The docs already didn't have enough hours, but they kept cutting anyway, while maintaining a ton of MLP coverage. It made sense so that they could continue skimming the 20% necessary to pay the partners.

 

[Emdocinabox]

I’ve been at EMP/USACS since before the transition.

I don’t know what world this guy emdocinabox is in.

1) He is correct about the paid maternity, paternity, an military leave. 8 weeks full pay, 4 weeks half pay for moms. 2 weeks full pay for dads. Military pay is your past 12 month’s average pay minus your month’s LES statement.


2) 401k has been severely neutered. While you “may” get 10%, it is guaranteed. You have to work 1000 hours to get it. Most people won’t hit that mark until 8 months in. Once you hit 1000 you get the 7% that was withheld as a lump sum. While you are below 1000 hours you get 3%. If something happens, like an emergency or needing a medical leave, you’ re SOL. Also, the market hits a big boom in the first half of the year, you’re SOL.

3) There has been no official word about an evaluation made. I haven’t seen anything about getting the private equity firm out via official channels. So he either has some knowledge that isn’t public to the rest of USACS or is FOS.

4) No profit sharing of the stocks since Oct 2016.

5) My director has been trying to get a breakdown of our site performance in relation to revenue for years. USACS has refused.

6) USACS has massively cut Doc hours while not touching Midlevel hours at my place. Any hour changes always is from the Docs, even though the primary change in our volume has been in out quick care area. The quick care is staffed my the midlevels.

Not sure we are too far apart here...it was announced in the CFO video last year that we will have stock price re-evaluated in 2020 (plus discussed at Assebly). I never said we received a distribution since 2016. As for the budget, the director sees it monthly...at least in my region. Agree about the 1000 hours before you can get 401k...that’s a new change this year which I forgot about.
Doc cuts are painful and at my place it’s more mid levels getting cuts because we only have 24 doc hours, so nowhere to cut them.

 

[NYEMMED]

Not sure we are too far apart here...it was announced in the CFO video last year that we will have stock price re-evaluated in 2020 (plus discussed at Assebly). I never said we received a distribution since 2016. As for the budget, the director sees it monthly...at least in my region. Agree about the 1000 hours before you can get 401k...that’s a new change this year which I forgot about.
Doc cuts are painful and at my place it’s more mid levels getting cuts because we only have 24 doc hours, so nowhere to cut them.

Thats the point about the "revaluation" Ive heard it over and over when working for them, and it never happened, didn't have a distribution in years, its a pointless sale tactic/gimmick that the owners really don't want to roll out. They make you pay the ~71k in "Taxes" to receive the phantom "shares" at the end of your second year. Thats the real point of it. They want docs to pay in as they are less likely to leave. Guess how much those "shares" of "ownership" are worth when you leave? ZERO Dollars, but you paid 71k for them.... good Ponzi scheme

 

[Emdocinabox]

Thats the point about the "revaluation" Ive heard it over and over when working for them, and it never happened, didn't have a distribution in years, its a pointless sale tactic/gimmick that the owners really don't want to roll out. They make you pay the ~71k in "Taxes" to receive the phantom "shares" at the end of your second year. Thats the real point of it. They want docs to pay in as they are less likely to leave. Guess how much those "shares" of "ownership" are worth when you leave? ZERO Dollars, but you paid 71k for them.... good Ponzi scheme

Hmmm...this is a good point I hadn’t considered. It is messed up when you look at it like that!

 

[Listen2Savage]

yikes, why would anyone work for these people

are the other cmgs this shady?

 

[RustedFox]

yikes, why would anyone work for these people

are the other cmgs this shady?

TH has no phantom stock program, but just handed everyone a pay cut instead of cutting back on admin fat.

I say: the LEAN model that they apply to physician staffing also needs to be applied to the non clinical staff. Good for the goose? Welp. Good for the Gander, then.

But, of course that will never happen.

Parasites.

 

[NYEMMED]

TH has no phantom stock program, but just handed everyone a pay cut instead of cutting back on admin fat.

I say: the LEAN model that they apply to physician staffing also needs to be applied to the non clinical staff. Good for the goose? Welp. Good for the Gander, then.

But, of course that will never happen.

Parasites.

Docs in general can stick it to Teamhealth by all resigning. TH would have such a panic they would give everything back plus some likely.
The hard part is organizing everyone to give a 90 day notice to force THs hand.
Also the TH leadership is dumb by cutting scribes funding. Most docs aren’t going to pay for scribes. Productivity will decrease forcing more doc hours to open to keep those contracts, thereby costing TH more money

 

[GeneralVeers]

I got a copy of the TeamHealth letter. Essentially a 4% pay cut for physicians, and 5% for non-physician admin staff.

 

[EctopicFetus]

I got a copy of the TeamHealth letter. Essentially a 4% pay cut for physicians, and 5% for non-physician admin staff.

4% in hourly PLUS CME PLUS scribes.. will be closer to 10%. they made the non MD admin look bigger but its a sham.. they arent cutting anything else from them.. thats a true 5% cut for the docs it is 10% or so.

 

[Listen2Savage]

4% in hourly PLUS CME PLUS scribes.. will be closer to 10%. they made the non MD admin look bigger but its a sham.. they arent cutting anything else from them.. thats a true 5% cut for the docs it is 10% or so.

what happens if you guys just slow down on shift lol

 

[EctopicFetus]

They will hire a new grad from whatever low level residency no one heard of to replace you.. those young chaps dont know or understand the game and have 400k in debt. Their world is $200/hr or less.. they dont know how good it should be. As a 1099 they dont need to fire you.. they can simply not put you on the schedule and you have essentially no recourse.

 

[RustedFox]

what happens if you guys just slow down on shift lol

We did just this once EmCare mandated that all charting be done within the same shift, but also mandated that all patients be seen in 15 mins or less. As you could imagine, this became an impossible situation with single coverage. So, we all did charts in series sequence; one at a time.

Then, admin freaked out over the door to doc time, and threatened to fire us.

The eldest one of us (and the most vociferous against EmCare) then went full Judas and became an admin. His tune changed instantly once he didn't have to work clinically anymore.

I still can't stand him.

 

[hundreddaysoff]

4% in hourly PLUS CME PLUS scribes.. will be closer to 10%. they made the non MD admin look bigger but its a sham.. they arent cutting anything else from them.. thats a true 5% cut for the docs it is 10% or so.

In fairness, many TH docs never had a CME fund or scribes in the first place, everyone at my shop included. So should only be a ~4% cut for us.

 

[EctopicFetus]

In fairness, many TH docs never had a CME fund or scribes in the first place, everyone at my shop included. So should only be a ~4% cut for us.

Site dependent. More cuts to come. Blood in the water. Our blood. Sharks circling.