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[richnathan]

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Hey everyone, just out of curiousity, are there possibilities of working in rural hospitals for a week straight (168 hours) and then having the rest of the month off while being able to make 250K/year? Thanks!

 

[RustedFox]

Whaaa ?!

 

[richnathan]

Sorry if I wasn't clear. I've seen jobs advertised in rural areas where physicians work 24 hours and are generally able to sleep at night b/c the patient volume is low. I was wondering if anyone knew if it would be realistically possible to work seven 24 hour shifts straight each month and be able to earn 250k/year. I apologize in advance if it's a stupid question.

 

[winkleweizen]

So youd basically be working 168 straight hours? I doubt theres a place that would let you do that, and I doubt youd want to do that.

 

[Makati2008]

Agree with other posters about facilities not letting you work 7days straight(although in most rural settings you would sleep a good chunk but probably not enough to be fully rested). I would think they would share some blame if a bad outcome came about due to exhaustion/fatigue on your part?

I have worked at one facility where a Provider comes on at 5p Friday and ends 8am Monday. Some weekends there is very few patients(and you sleep a ton) and other weekends its hell on Earth.

 

[Apollyon]

So youd basically be working 168 straight hours? I doubt theres a place that would let you do that, and I doubt youd want to do that.

No, there are places that do this. I think (although not sure) that on Catalina Island, they do something like that (it might be fewer, like 4 days - 96 hours - on), for example.

The bigger question in my mind is the $250K. 10 patients a day, at $1000/crack, is $3650000. $250K x 4 docs = $1000000/year. However, that is billed. So, what are they bringing in - $2M/year? And I don't think that even a hospital subsidized by the state as being a critical access hospital is going to consent to $250K/year for docs.

You might find the job. You might find the money. However, it is quite, quite unlikely that you will find that job with that money.

 

[bad virus]

here is a twist on that question.

Let us say you are the type of person that would be happy with 60-80k a year after all is said in done. This means 60-80k in your pocket after malpractice, taxes, etc . . .

How much do you need to work if you don't really care about the setting. Traveling and international work are of supreme importance for my spouse and I and I will only have 20k to pay off after med school. She basically just wants to work half the year with NGO's and half the year off (all scattered through the year, not one 6 month chunk off). She does not want to work at home as I will be the primary bread winner. I know many people say your standards change after residency, but 60k in my pocket is lavish for our family.

Getting back to the point. How much of the year will I need to work for money to earn that kind of pay?

Thanks guys in advance. Don't worry about responding in regards to lifestyle advice and how my expectations will change as everyone knows their own personality and what they want in life.

Take care guys and sorry for the thread jack. I really did not want to overburden the board with my clutter.

 

[EM_Rebuilder]

here is a twist on that question.

Let us say you are the type of person that would be happy with 60-80k a year after all is said in done. This means 60-80k in your pocket after malpractice, taxes, etc . . .

How much do you need to work if you don't really care about the setting. Traveling and international work are of supreme importance for my spouse and I and I will only have 20k to pay off after med school. She basically just wants to work half the year with NGO's and half the year off (all scattered through the year, not one 6 month chunk off). She does not want to work at home as I will be the primary bread winner. I know many people say your standards change after residency, but 60k in my pocket is lavish for our family.

Getting back to the point. How much of the year will I need to work for money to earn that kind of pay?

Thanks guys in advance. Don't worry about responding in regards to lifestyle advice and how my expectations will change as everyone knows their own personality and what they want in life.

Take care guys and sorry for the thread jack. I really did not want to overburden the board with my clutter.

3-4 days per month and you can easily make that after taxes...

Again, I know it sounds good as a pre-med. I came from a family that did not make 60K/year and figured I would be more than happy with twice that...

Then you get out, and then you want a bigger house, you want the prime dry aged steak, the more aged wine, the corner suite on a cruise, the first class flight upgrade, the nicer car, nice clothes, buy your wife bigger earrings... and it all continues to snowball. I think you deserve to live well since we do well, but its still uber important to NOT go too big of a grand scale to where you are only working to support your habits.. Its all in the balance...



The other poster talking about working a week straight... Crazy, unhealthy, you would be ignorant to even consider doing that... I have worked some 48 hours moonlighting in residency where I slept much of the night but it SUCKED. I quickly moved onto busy places with 12 hour shifts. I could not imagine spending a week straight in a hospital.

 

[StevieStud]

Agree with other posters about facilities not letting you work 7days straight(although in most rural settings you would sleep a good chunk but probably not enough to be fully rested). I would think they would share some blame if a bad outcome came about due to exhaustion/fatigue on your part?

I have worked at one facility where a Provider comes on at 5p Friday and ends 8am Monday. Some weekends there is very few patients(and you sleep a ton) and other weekends its hell on Earth.

Back in the day, I did a few of those "here are the keys, see ya Monday AM" jobs.


Not so much rural as just a small population area far from the big city. Most likely 50 or 100 miles from the big city. If you count Bismark as a big city.

Might be the only hospital servicing a pretty good physical size catchment area.... because the next nearest hospital is 30 miles alway and they don't have an all night doc.

Expect volunteer EMS bringing in farm tractor roll-overs and granny broke her hip. You won't know about the tractor roll-over until it hits your doors. Granny will be accompanied by 7 fire trucks and every sheriff's deputy in the county.

A good amount of urgent care stuff because... there ain't a 24hr urgent care clinic for 200 miles.

Actually Urgent Care is going to be your bread and butter. And a lot of FP chronic aliments that lack a PCP. The hospital won't care... that is why they hired you.

The trivial/minor stuff that gets "consulted" in many big city teaching hospitals {and a lot of big suburb community hospitals (dental, optho, ortho etc) is yours to handle simply because there may not be overnight/weekend coverage for all those specialities. Even if there is coverage from the specialty, you will be expected to handle 95% of the minor cases because they hired your arse to do just that.

Usually you are the only doc in the house. Forget overnight hospital coverage in most locations. Maybe an OB will come in to handle a private patient, but otherwise you handling the breech birth at 3AM with the help of the L&D nurse.

There isn't going to be a lot of ICU/CC stuff to worry about because, except for the tractor roll-over somehow making it through surgery and granny's post-op complications, most of the serious stuff is not going to remain/stay local.... remember, most likely there is no overnight hospitalist coverage.

Nursing/support is going to be spotty at best. Not faulting the nurses, because the issue is not them.... it is the staffing levels. Remember, this is a hospital that has 5 patients... FIVE... on the average Friday Night. How many nurses do you think the hospital is going to staff if the average patient is a treat and street urgent care type?

Worse case crap?

Don't worry about it..... when the grain silo explodes.... or a row boat of 4 teens overturns on the lake.... you will have every off shift nurse/doc plus the entire rest of the hospital helping the best they can.


It is the inbetween.

Between the Friday night with 5 treat and streets and the other end of the scale.

To the "rest of the hospital", the ED is an inconvience. The few times you handle an admission the ED staff will take the patient to the floor. There are no transport staff on the weekend and the floor nurses most likely don't even know where the ED is located. Ask the floor mother (nursing supervisor) for some additional hands and you manhood/MD etc is going to be questioned.... you might not even be hired back because any decent ED Doc should be able to handle TWO patients at once. Even if the "code" alarm goes off, the likelihood of a pair of hands showing up to help in the ED is slim at best.

The regular ED Docs? They are gone fishing. That is why they hired your arse.

Other specialities? Just like the big city. If it is interesting we will charter a helicopter to make the trip faster, otherwise tell the patient to call our clinic on Monday.

And there are NO residents. Maybe if you are lucky (sarcasm) you will have a nursing student tagging along and trying to not get in the way.

So it is 11PM. Breech Baby in L&D. Granny with the broke hip that throws a PE. Gramps has a stroke sitting in the waiting room. And the volunteer EMS screaming on the phone about all the blood from the 17yr old that fell on his fish fileting knife.

And you got 2 nurses, 1 tech and a 19 yearold clerk that just went AWOL.

Oh what fun it is to work in a rural ED.

PS: Your shift ends in 55 hours.

 

[Dane07MD]

I know of a place in Eastern Washington (Ritzville) that has a very small hospital. The contractors for their hospital hire docs to come in for 168 hours at a time. There is a small cabin/house across the street where you stay, with a small office, internet, what have you. You go there when you want to sleep or get out of the ED if you're not needed. They pay about $100/hr, so you go for a week, make $17,000 gross pay and you're off for 3 weeks. Come back and do it again. at this rate, you make about $220k before taxes (13 weeks). If you took 20 days off instead of 21, you could squeeze another week in and get to $240k almost. Ritzville sucks. Look it up. It is however a slow ass ED and I think you average about 0.33 patients/hour.

 

[AlmostJesus]

Talk to cabinbuilder in the FM forum. She does locum work where its single coverage for a week in places like Nevada and Alaska.
I also know of a place in western Minnesota that has their ER docs do a week at a time although I don't know how much they make. I believe they do 1 in 3 weeks.

 

[docB]

I know of a place in CA that had 96 hour shifts. IIRC it paid in the $80/hr range. Annual census was ~1000. There was no inpatient. It was kind of a cross between a free standing ER and Battalion Aid Station and a clinic. I considered it as it sounded relaxing but it specified that you would be expected to do primary care as well which I was uncomfortable with.

 

[DrMom]

I recently got an email for a 0.6/hr low pay/hour ED that included an extra $25/hr to cover the hospitalist service over the weekend. Really? $25/hr? They're trying to promote that as a bonus since you can make more during the weekend. No thanks!

 

[gutonc]

I recently got an email for a 0.6/hr low pay/hour ED that included an extra $25/hr to cover the hospitalist service over the weekend. Really? $25/hr? They're trying to promote that as a bonus since you can make more during the weekend. No thanks!

Well...with that kind of an ED census, they probably only have about 10 beds.

 

[docB]

I recently got an email for a 0.6/hr low pay/hour ED that included an extra $25/hr to cover the hospitalist service over the weekend. Really? $25/hr? They're trying to promote that as a bonus since you can make more during the weekend. No thanks!

We have one where there's a similar differential to cover the inpatient side at night.

 

[dchristismi]

... kind of a cross between a free standing ER and Battalion Aid Station and a clinic...

Now, that is an image. Not exactly an image where I'd want to work, but an image.
Thank you, DocB, for that.

 

[DrMom]

Well...with that kind of an ED census, they probably only have about 10 beds.

Probably. And probably low acuity admissions, but I still don't want to play hospitalist and the $25/hr is somewhat insulting (or should be insulting to any hospitalist).

 

[8654Marine]

Probably. And probably low acuity admissions, but I still don't want to play hospitalist and the $25/hr is somewhat insulting (or should be insulting to any hospitalist).

Agree.

Very insulting to hospitalist.

Very few specialties I have empathy for. Hospitalist is one of 'em. Damn hard work they do.

 

[Groove]

Hey everyone, just out of curiousity, are there possibilities of working in rural hospitals for a week straight (168 hours) and then having the rest of the month off while being able to make 250K/year? Thanks!

The short answer...

You don't want to do this. You "think" you do, but you really don't. Technically possible? Maybe... by doing a lot of last minute position fills with some sort of HIT type positions for a mega staffing firm, but even then.. I kind of doubt it. Even if you could, you'd be miserable.

 

[docB]

Probably. And probably low acuity admissions, but I still don't want to play hospitalist and the $25/hr is somewhat insulting (or should be insulting to any hospitalist).

Agree.

Very insulting to hospitalist.

Very few specialties I have empathy for. Hospitalist is one of 'em. Damn hard work they do.

I never thought of it that way before but you guys are right. They're saying that hospitalists are work $25/hr.

 

[StevieStud]

I never thought of it that way before but you guys are right. They're saying that hospitalists are work $25/hr.

I think they are looking at the issue of pay as $25 ABOVE the fantastic.... cough, cough... wages they are already paying you to babysit a shop with 0.6 patients per hour.... besides the likelihood of you actually needing to "do" something as a hospitalist is really remote becasue the patient's private physician does all the heavy lifting during the normal business hours workweek so the $25 should more than cover any long term malpractice liability you acquire from spending taking 30 seconds to write a 'script or ask for a consult.

Conversely, the same hospital is offering $15.95 per hour to all hospitalist candidates if they will take a shift or 4 down in the ED above and beyond their hospitalist duties, 'cause they are already in the hospital so it makes sense they cover the ED and they might as well add the responsibility of handling the patient from triage through admissions and do it right the first time.


PS: that line of "you are already in the hospital" and its variant "you are already treating the patient" is used by a lot of insurance companies and hospital administrators.

 

[8654Marine]

Does anyone know the real cost/benefit in terms of dollars for this practice?

Sounds like the hospital is trying to get 2 FTE's for the price of a 1.25 FTE for that day.

Maybe the CEO, CFO could clean the rooms during the day cause "they're there anyways"?

 

[NinerNiner999]

How about 7 12-hour shifts, days, nights, or both, $250 per hour? That's over 250k per year for one week of work each month (21k per month).

And yes - we are hiring...

 

[Groove]

How about 7 12-hour shifts, days, nights, or both, $250 per hour? That's over 250k per year for one week of work each month (21k per month).

And yes - we are hiring...

Niner, what state? Hire me buddy. I'll work your nights.

 

[deleted109597]

Niner, what state? Hire me buddy. I'll work your nights.

Umm, his sig says Naples, Fl. So I'm guessing Italy.

 

[Apollyon]

Umm, his sig says Naples, Fl. So I'm guessing Italy.

[YOUTUBE]WDy9S8dxsE8[/YOUTUBE]

(And this was not on an age-restricted page on YouTube, so it is not in any violation. See also "Be Cool".)

 

[Rendar5]

How about 7 12-hour shifts, days, nights, or both, $250 per hour? That's over 250k per year for one week of work each month (21k per month).

And yes - we are hiring...

That's a long commute for me, lol. what type of gig? 🙂

 

[po' boy]

This is absolutely, 100% correct and exactly what my brief experience working similar jobs in the past was like. You'd think it'll be low-key/low-stress, but the combination of high expectations with minimal control or backup makes these gigs not worth the money. That's why these jobs have to turn to recruiters/ads in the throwaways to get docs.

Back in the day, I did a few of those "here are the keys, see ya Monday AM" jobs.


Not so much rural as just a small population area far from the big city. Most likely 50 or 100 miles from the big city. If you count Bismark as a big city.

Might be the only hospital servicing a pretty good physical size catchment area.... because the next nearest hospital is 30 miles alway and they don't have an all night doc.

Expect volunteer EMS bringing in farm tractor roll-overs and granny broke her hip. You won't know about the tractor roll-over until it hits your doors. Granny will be accompanied by 7 fire trucks and every sheriff's deputy in the county.

A good amount of urgent care stuff because... there ain't a 24hr urgent care clinic for 200 miles.

Actually Urgent Care is going to be your bread and butter. And a lot of FP chronic aliments that lack a PCP. The hospital won't care... that is why they hired you.

The trivial/minor stuff that gets "consulted" in many big city teaching hospitals {and a lot of big suburb community hospitals (dental, optho, ortho etc) is yours to handle simply because there may not be overnight/weekend coverage for all those specialities. Even if there is coverage from the specialty, you will be expected to handle 95% of the minor cases because they hired your arse to do just that.

Usually you are the only doc in the house. Forget overnight hospital coverage in most locations. Maybe an OB will come in to handle a private patient, but otherwise you handling the breech birth at 3AM with the help of the L&D nurse.

There isn't going to be a lot of ICU/CC stuff to worry about because, except for the tractor roll-over somehow making it through surgery and granny's post-op complications, most of the serious stuff is not going to remain/stay local.... remember, most likely there is no overnight hospitalist coverage.

Nursing/support is going to be spotty at best. Not faulting the nurses, because the issue is not them.... it is the staffing levels. Remember, this is a hospital that has 5 patients... FIVE... on the average Friday Night. How many nurses do you think the hospital is going to staff if the average patient is a treat and street urgent care type?

Worse case crap?

Don't worry about it..... when the grain silo explodes.... or a row boat of 4 teens overturns on the lake.... you will have every off shift nurse/doc plus the entire rest of the hospital helping the best they can.


It is the inbetween.

Between the Friday night with 5 treat and streets and the other end of the scale.

To the "rest of the hospital", the ED is an inconvience. The few times you handle an admission the ED staff will take the patient to the floor. There are no transport staff on the weekend and the floor nurses most likely don't even know where the ED is located. Ask the floor mother (nursing supervisor) for some additional hands and you manhood/MD etc is going to be questioned.... you might not even be hired back because any decent ED Doc should be able to handle TWO patients at once. Even if the "code" alarm goes off, the likelihood of a pair of hands showing up to help in the ED is slim at best.

The regular ED Docs? They are gone fishing. That is why they hired your arse.

Other specialities? Just like the big city. If it is interesting we will charter a helicopter to make the trip faster, otherwise tell the patient to call our clinic on Monday.

And there are NO residents. Maybe if you are lucky (sarcasm) you will have a nursing student tagging along and trying to not get in the way.

So it is 11PM. Breech Baby in L&D. Granny with the broke hip that throws a PE. Gramps has a stroke sitting in the waiting room. And the volunteer EMS screaming on the phone about all the blood from the 17yr old that fell on his fish fileting knife.

And you got 2 nurses, 1 tech and a 19 yearold clerk that just went AWOL.

Oh what fun it is to work in a rural ED.

PS: Your shift ends in 55 hours.

 

[EctopicFetus]

9er.. not for me but curious if your partnership is open or are you just hiring employees?

 

[Old_Mil]

Hey everyone, just out of curiousity, are there possibilities of working in rural hospitals for a week straight (168 hours) and then having the rest of the month off while being able to make 250K/year? Thanks!

There is a very small staffing company (the one that holds the previously mentioned Ritzville contract - some hard feelings in that town BTW regarding how the well loved local docs split with the hosital and were replaced in the ED with contract guys) that has a few contracts with some low volume rural hospitals that allows you to do this. You show up for the week and you are "the guy". You see whatever walks into the ER, you round on inpatients, and you see patients in the clinic as workload permits. Also, I'm not entirely sure that training in Emergency Medicine is a good background for this sort of practice - FM plus an ED fellowship would probably be better.

There is another somewhat larger but still small regional staffing company that has some more contracts with low volume rural hospitals where you see the ED patients and round on inpatients on weekends and holidays (no clinic duties).

I don't think that 250k a year is reachable in either of the scenarios as the pay rates are pretty low (think $60-$80 an hour, and $90-$100 an hour would be unusually good). You only see a handful of patients a day to get that money, but you will have to sell a lot of your time if you want a big paycheck. Also keep in mind that these are all independent contractor positions. You are responsible for not only buying but medically qualifying for your health insurance, your disability insurance, paying for both halves of social security, both halves of medicare, etc so they aren't as good as employed or partnership positions to begin with.

Oh, and as far as visit volumes. What is advertised may or may not be accurate. If it is inaccurate (either deliberately, or because volume has increased since the ad was published) in quiet departments it may be off by a factor of 100%. That is, the ED that is advertised as 1200 a year may actually be seeing 2400 a year. This may not be a big deal normally, but it may be if you plan working a 60 or 72 hour shift in a shop with 2000 that turns out to actually have 3500 or 4000 visits a year. I would not recommend attempting anything longer than 24 hours if your visit volume is over 3500-4000. That isn't that many patients a day, but the odds that a few of them are going to interrupt your sleep on a regular basis increases. Somewhere between 9000-10000 and you want to start looking at moving to 12 hour shifts. I wouldn't recommend working more than 60 hours at a stretch, ever, for any reason.

 

[NinerNiner999]

We are not looking for employees, but equal partners day one. If you would like to learn more, PM me...

 

[sweetsweetlax]

Are there limitations in practicing EM after an AOA residency vs an ACGME residency? Do groups / hospitals regard the ABOEM differently than the ABEM?

I realize this may vary by location and many other factors, but just wondering if anyone had any input?

 

[gman33]

Went to a local ER with my wife the other day.
Started talking to the doc about job opportunities etc.

Private group that covers 4 very nice community hospitals.
Had the contract 20+ years.

Best community hospital in the area in which I grew up and I'd like to stay.

Here's the part I'm not so sure about.

New hires start by working all nights. 3 years to make partner. Even then you can't get out of the all night part until they hire somebody else to fill your spot. A lot of the current docs are getting pretty close to retirement so it's probably not a lifetime of working nights.

Not sure about shift length, but they do 5 nights in a row followed by 9 days off.
There is a diff for working nights that I think is pretty significant.
I'd probably be ok with doing this for 3-5 years if it sets me up with a job that will be good for the next 20.

 

[AmoryBlaine]

I knew a guy who did 36s in a pretty rural ER. Pretty decent money, low volume.

When things went how they were "supposed" to (<1 pt/hr, low acuity) it was nice, he would read and watch TV, sleep, etc.

When they didn't it sucked very, very hard.

I'm not that far out of training, but these "legit" experiences where you are all by yourself are not nearly as fun you think they will be when you hear about them in medical school. Having a ****ty airway, a big fat drug addict ready to deliver her preemie, or a crumping kid in front of you is pure unadulterated stress when you have no resources.

 

[NinerNiner999]

Went to a local ER with my wife the other day.
Started talking to the doc about job opportunities etc.

Private group that covers 4 very nice community hospitals.
Had the contract 20+ years.

Best community hospital in the area in which I grew up and I'd like to stay.

Here's the part I'm not so sure about.

New hires start by working all nights. 3 years to make partner. Even then you can't get out of the all night part until they hire somebody else to fill your spot. A lot of the current docs are getting pretty close to retirement so it's probably not a lifetime of working nights.

Not sure about shift length, but they do 5 nights in a row followed by 9 days off.
There is a diff for working nights that I think is pretty significant.
I'd probably be ok with doing this for 3-5 years if it sets me up with a job that will be good for the next 20.

Run! Run as far away from this as possible and don't look back. First it's the nights, then the nights and weekends, then it's the carrot of partnership that looms over your head. Then it's a partner leaving, or getting pregnant, or one of your co-workers on the "partnership track" leaving for greener pastures leaving you with (you guessed it) more nights to cover.

A LOT will happen your first 2-3 years out, and being a green attending on the night shift without the routine back-up coverage and seasoned veterans to help you will significantly increase your liability, let alone the sleep deprivation you will have. You'll be making mistakes you don't even know you are making and your liability will soar. God forbid you pick up a lawsuit along the way (which they may use to disqualify you from partnership). That is, if you don't raise eyebrows with administration and they ask the group to take you off the rotation.

There are more red flags with this model than I can even list in this post.

If you like the hospital and the area, plan on going back for another look in a few years - after the current group has lost it's contract and you can work humane hours.

 

[DeadCactus]

Tangential question: how do medical licenses work with locum tenems? Do you need to hold a normal license in each state you want to do locum tenems in or do you get some sort of temporary permit?

 

[gman33]

Run! Run as far away from this as possible and don't look back. First it's the nights, then the nights and weekends, then it's the carrot of partnership that looms over your head. Then it's a partner leaving, or getting pregnant, or one of your co-workers on the "partnership track" leaving for greener pastures leaving you with (you guessed it) more nights to cover.

A LOT will happen your first 2-3 years out, and being a green attending on the night shift without the routine back-up coverage and seasoned veterans to help you will significantly increase your liability, let alone the sleep deprivation you will have. You'll be making mistakes you don't even know you are making and your liability will soar. God forbid you pick up a lawsuit along the way (which they may use to disqualify you from partnership). That is, if you don't raise eyebrows with administration and they ask the group to take you off the rotation.

There are more red flags with this model than I can even list in this post.

If you like the hospital and the area, plan on going back for another look in a few years - after the current group has lost it's contract and you can work humane hours.

Thanks for the input.
I hadn't really thought about being stuck without backup all the time.
That's probably the worst part.

 

[8654Marine]

Heed what 999 says.

Those types of places use the bones of the young/new to keep the "partners" afloat. That's why they are continually looking for new flesh. Like vampires.

 

[gutonc]

Tangential question: how do medical licenses work with locum tenems? Do you need to hold a normal license in each state you want to do locum tenems in or do you get some sort of temporary permit?

Yes, you need a license in any state in which you want to practice, locums or no. Some locums companies will help out by paying for "rapid review" in some places where it exists but you can't practice w/o a license.

 

[Apollyon]

Yes, you need a license in any state in which you want to practice, locums or no. Some locums companies will help out by paying for "rapid review" in some places where it exists but you can't practice w/o a license.

That was not the question asked. Of course, you need a license. His question was of a "normal" license, which I took to be a full, unrestricted, permanent license, and, from what I'd heard, some states do indeed have a "limited license" sort of thing. I don't know which are the states that have such a thing, but, on the other hand, that would mean that locums places would have great, great difficulty with states like NY, California, and Texas, considering how long it takes to get a license in one of these.

Oh, here's something I found that Davita had collated. (I notice, though, that American Samoa and the Northern Marianas Islands are not listed.)

 

[AmoryBlaine]

Heed what 999 says.

Those types of places use the bones of the young/new to keep the "partners" afloat. That's why they are continually looking for new flesh. Like vampires.

I would never work for a group when a substantial part of the job is working for (not with) old guys who don't work nearly as hard as I can/do.

Seen plenty of groups like this even in my short time. The old basterds justify it to themselves by pretending they saw 3.5 pts/hour when they were 30 and that this is some sort of post-residency residency.

Even where I work now we have some issues with the senior people in the group not working as hard on shift.

This seems like the kind of group that would get a little skittish if you asked them to let you talk to the last guy who left the group.