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100 miles can be a huge deal but in this case the two jobs are similar....not urban vs rural or anything else like that. The distance merely references that one wasn't in Moline and one in New York. In the end, an apples to apples comparison must mean that the CMG is underpaying you because the money to support all that non physician infrastructure has to come from somewhere. This is not to say that a bad local group isn't going to try and screw you as bad or worse if they are of that mindset.

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While I personally would do all I could to avoid working for a CMG I just feel as long as you know what you are getting yourself into its not a big deal.

I took a significant pay cut up front as part of my buy in to my group. Now as a partner it is paying off handsomely.

Our admin overhead is under 5%.

The one thing thats scared me more than anything away from the CMGs is simple. The one I moonlit at the docs were getting beat down and bad with the volumes. They wanted to add coverage and nothing happened for months because the decision was being made 600 miles away.
 
EctopicFetus said:
While I personally would do all I could to avoid working for a CMG I just feel as long as you know what you are getting yourself into its not a big deal.

I took a significant pay cut up front as part of my buy in to my group. Now as a partner it is paying off handsomely.

Our admin overhead is under 5%.

The one thing thats scared me more than anything away from the CMGs is simple. The one I moonlit at the docs were getting beat down and bad with the volumes. They wanted to add coverage and nothing happened for months because the decision was being made 600 miles away.
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This. I work for a big CMG. There's so much kvetching over "the times, the TIMES!" I was being hustled along to go see patients that "hadn't been timestamped yet" by the charge nurse the other day. I stood back and said - "Listen. The sore throat will have to wait. This guy with the chest pain and the difficult EKG... he deserves at least 180 seconds of my expertise, making sure that I don't miss something critical here."

We needed more coverage months ago. We finally got it. No; not more providers... just longer shifts for everyone already there.
 
Not meant to brag but when we have problems things are solved quickly. The reason is we elect our medical directors and they have to work those same shifts. I just dont like coming to work and taking a beating. It helps that my speed is above avg so when changes are made it makes my job easier.
 
i work for a "megagroup" mentioned - each local area is locally run. some things are "corporate" but stuff like scheduling is done locally. if volumes go up, shifts change, etc
 
I too work for one, as it would seem from earlier threads, the same one as many here.
I am very disenfranchised with the whole deal. I see our pay steadily going down with no plans to address it. It's just accepted. There are groups in my local market, also employed with bennies, whose pay is lapping is regularly, and we have a great payor mix comparatively. So the whole it's going down everywhere may be true but we are taking a disproportionate slide. Something is fishy and we cannot get a straight answer as to why besides "it's complicated". "just see more pts (already at 2.5-3) and work more shifts"
I've checked out personally.
 
no place is perfect... it's all about what's important to you. i'm not saying i wouldn't consider other options, but after having had 2 gigs in different markets and hearing stories from friends/colleagues, there are warts everywhere. luckily most of us can pick what warts we want to tolerate (location, $$, small vs large group, pace, pt population).
 
la gringa said:
no place is perfect... it's all about what's important to you. i'm not saying i wouldn't consider other options, but after having had 2 gigs in different markets and hearing stories from friends/colleagues, there are warts everywhere. luckily most of us can pick what warts we want to tolerate (location, $$, small vs large group, pace, pt population).
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Very true...
I guess I will be a statistic but I'm all good with that 🙂 being my first gig I too will change.
 
EctopicFetus said:
While I personally would do all I could to avoid working for a CMG I just feel as long as you know what you are getting yourself into its not a big deal.

I took a significant pay cut up front as part of my buy in to my group. Now as a partner it is paying off handsomely.

Our admin overhead is under 5%.

The one thing thats scared me more than anything away from the CMGs is simple. The one I moonlit at the docs were getting beat down and bad with the volumes. They wanted to add coverage and nothing happened for months because the decision was being made 600 miles away.
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I'm a little confused. I thought your group was 5 year partnership track.
 
TrumpetDoc said:
I too work for one, as it would seem from earlier threads, the same one as many here.
I am very disenfranchised with the whole deal. I see our pay steadily going down with no plans to address it. It's just accepted. There are groups in my local market, also employed with bennies, whose pay is lapping is regularly, and we have a great payor mix comparatively. So the whole it's going down everywhere may be true but we are taking a disproportionate slide. Something is fishy and we cannot get a straight answer as to why besides "it's complicated". "just see more pts (already at 2.5-3) and work more shifts"
I've checked out personally.
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Get a new job ASAP. EM is one of those specialties where "checking out" can quickly lead to medicolegal difficulties. It can get hard to hear the voice in the back of your head above the background of "this job sucks".
 
Arcan57 said:
Get a new job ASAP. EM is one of those specialties where "checking out" can quickly lead to medicolegal difficulties. It can get hard to hear the voice in the back of your head above the background of "this job sucks".
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Man I hear ya!
Luckily, that fact I have put the rubber to the road has given me a bit of a second wind.
 
TrumpetDoc said:
Man I hear ya!
Luckily, that fact I have put the rubber to the road has given me a bit of a second wind.
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Part of the problem is that you may be trapped if you want to stay at in a particular geographic area. Trumpet Doc's and my area is controlled by three CMGs, and unless you want to work with them you need to see work out of state.
 
TrumpetDoc said:
Very true...
I guess I will be a statistic but I'm all good with that 🙂 being my first gig I too will change.
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i've already switched once - was getting paid less for the same # of hrs in a market where rent is 2x where i am now. so i visit there ad lib for a nice weekend, work fewer hrs for the same effective pay... and the buy-in after a variable # of years (min 4) at my first gig was huge. wasn't a "bad" place, but bad for me...

don't get me wrong, i haven't "had the kool aid" or any of that, but there are worse gigs, WAY WAY worse gigs.

i have a friend who works 12's in a 1 hospital county, no consistent MLP support. she sees 3-4 pts/hr consistently. i think she's insane but she thinks the $$ is worth it. she also hates her job...

seems Vegas is a miserable place to work for a lot of reasons. do ya'll have compelling reasons to stay???
 
Yeah, Vegas has a lot of probs, but I'd guess a lot of places do. Schools suck here so we do she'll put a bit for decent schooling.
My wife's family is here, do my reason for being here was that. However, She is now pushing the issue. As the one who keeps the books, she has had it. And we find ourselves arguing about money every month for the last 6 plus months. Not worth it!
 
la gringa said:
seems Vegas is a miserable place to work for a lot of reasons. do ya'll have compelling reasons to stay???
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Remember that the some of the most outspoken Vegas people on this board are pessimists. So we can sometimes accentuate the negative.

The negatives have been well documented but they are mainly:
-Little to no primary care or outpatient services
-All docs are overworked, i.e. the internist on call doesn't want your admit and will fight
-Minimal specialist coverage
-Aggressive hospital admins

Here are the seldom talked about positives:
-Vegas is a great place to live. If you can stand July and August the rest of the year is really nice. The 118 degree summers are really just the flip side of the coin for places where January and February are miserable.
-The cost of living is relatively cheap. No state income tax.
-It's Vegas. There is a ton to do. You have access to all the shows and restaurants. Parking is free. All your friends will come to you. All the big conventions (ACEP, etc.) come to town every few years.
-The airport is great. It's Vegas. You can get a direct flight to anywhere.

As for medicine in Vegas some positives are:
-We have 24/7 real time radiologist reads for everything. This is less uncommon now but we've had this for as long as I've been here.
-My group is a part of a CMG but we are actually a subsidiary so we really run ourselves. We've gotta keep the contracts happy and pay the overlords but beyond that we could pay everyone in beer if we wanted.
-The contracts in Vegas have been relatively stable for years. We have achieved this by creating a feudal system with three powerful barons who demand and receive fealty but this is the price of peace. Seriously, we don't spend too much time fighting amongst ourselves which is nice.
-EM is well represented in all the hospital administrative structures. We aren't a sideshow with no voice. All over the valley EPs are system CMOs, Chiefs of Staff, US Congressmen (Joe Heck), and so on.
-Med mal is better in Nevada than in most places. We got a good tort reform law through in '04. It is under attack again and we may lose it but for now we're ahead of the curve.
-The money is decent. It's good considering this is a big city in the west.
-The hospitals recognize that most of their admits come through the EDs. Most of us have newer physical plants. We can get gear when we need it. The hospitals demand a lot of nursing and the nurses are high quality.
 
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