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bambamy

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I'm starting to think about jobs (graduate in 1.5 years). One of the areas I am really interested is predominately staffed by the megagroups (teamhealth, EMP, apollo etc). Given location restraints I may end up needing to work for one of these groups. Does anyone have any experiences working for these groups - good or bad? Also does taking a job with one of these groups hurt your employment opportunities down the road (ie a democratic group might be turned off by someone froma megagroup?
 
It's good that you're getting ahead on this. Fall/winter of 2nd year is when residents need to start on the job trail.

I work for EmCare. I will say that I have found that the big CMGs are not evil as some say they are. They are also not the place where you rise through the ranks predictably enjoying more perks for your seniority as you go. There is some self management at the local level but it's not as extensive as you have with an independent group.

You last question is the most provocative. I've never heard it asked before but it's an excellent question. Does a history of working with a big CMG make you less desirable for an indie job? My first inclination was to say no. I know guys who have moved on to indie gigs. I've gotten offers for indie gigs as well. But maybe I'm too biased to answer. I don't want to think that I'd be looked at as having a CMG taint. I suppose someone could think I'm coming in as a plant to steal a contract. I've never heard of that happening but it would make a good story.

So what does everyone else say. Does working for a CMG make you a less desirable candidate down the road?
 
docB said:
It's good that you're getting ahead on this. Fall/winter of 2nd year is when residents need to start on the job trail.

I work for EmCare. I will say that I have found that the big CMGs are not evil as some say they are. They are also not the place where you rise through the ranks predictably enjoying more perks for your seniority as you go. There is some self management at the local level but it's not as extensive as you have with an independent group.

You last question is the most provocative. I've never heard it asked before but it's an excellent question. Does a history of working with a big CMG make you less desirable for an indie job? My first inclination was to say no. I know guys who have moved on to indie gigs. I've gotten offers for indie gigs as well. But maybe I'm too biased to answer. I don't want to think that I'd be looked at as having a CMG taint. I suppose someone could think I'm coming in as a plant to steal a contract. I've never heard of that happening but it would make a good story.

So what does everyone else say. Does working for a CMG make you a less desirable candidate down the road?
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Should! Hooray smallish-to-mid sized independent groups! Boo mega groups!

Fourth year here. Feel pretty strongly that mega-groups ultimately de-value EM physicians. Agree/Disagree, whatever. I'm an EM physician-to be who loves this field! Power to the individual EM docs! 🙂
 
DreamingTheLive said:
Should! Hooray smallish-to-mid sized independent groups! Boo mega groups!

Fourth year here. Feel pretty strongly that mega-groups ultimately de-value EM physicians. Agree/Disagree, whatever. I'm an EM physician-to be who loves this field! Power to the individual EM docs! 🙂
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mo_eyeroll_130121c.gif
 
I'm not very bright. Please interpret video response for me.
 
RustedFox said:
It looks like Michelle Obama is blowing off (President Sarkozy?)
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Not sure if you're being sarcastic or not. Its Michelle Obama rolling her eyes at boehner. It's from the inauguration and linked on drudge.

Yes, I'm a political junkie much to my wife's shagrin.
 
FSU2013 said:
Not sure if you're being sarcastic or not. Its Michelle Obama rolling her eyes at boehner. It's from the inauguration and linked on drudge.

Yes, I'm a political junkie much to my wife's shagrin.
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Yes.. Ha.. hilariious.. Im a political junkie too. Its like a train wreck. I hate those clowns but man are they amusing.

Anyways my opinion to the OP (as someone who works for a indie group)..

It would depend how long you were there and what you did. One of the things about the indie groups is the extra work that needs to be done for no money to keep the contract going.

If you were there for 15 yrs and just showed up for shifts and then left it wouldnt make you a desirable candidate. OTOH if you worked for one for 2-3 years, did some committee work etc that would make you more desirable than most.
 
bambamy said:
I'm starting to think about jobs (graduate in 1.5 years). One of the areas I am really interested is predominately staffed by the megagroups (teamhealth, EMP, apollo etc). Given location restraints I may end up needing to work for one of these groups. Does anyone have any experiences working for these groups - good or bad? Also does taking a job with one of these groups hurt your employment opportunities down the road (ie a democratic group might be turned off by someone froma megagroup?
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I really don't consider ApolloMD a megagroup. Nonetheless, Apollo's sites are pretty autonomous.
 
I got my act together to apply for jobs in September of senior year. That was plenty early. Signed a contract in early January. Plenty of senior residents don't finalize their jobs until Jan, Feb, or later...
 
Dakota said:
I'm curious what you mean by this. Start thinking about where you want to go/what sort of work environment you're interested in? Start sending out resumes and interviewing? Do places really know their staffing needs 18 months out?

Most of the residents in my program appear to start applying /interviewing Fall of their final year.

As a 3rd year at a 4 year program, I'm already getting antsy to start looking.
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Don't know whether its too early to start looking for a specific job, but it is never too early to start networking - attend conferences, talk to people in your program about where previous residents have gone, find out what connections your attendings may have, and so on. It's hard on those of us who hate the whole smoozing thing, but those who do it well have a definite advantage.
 
Daiphon said:
Oh no! Will the jerseys have to wait another paycheck????

😀😀😀

-d

Sent from my DROID BIONIC using Tapatalk
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Haha - Nah. This thing is under warranty. I'm missing around 45 pixels in various spots around the screen, though. Aggravating.
 
Talk **** about macs all you want.... I used to do the same.... but I've never had a laptop that I've liked more than my MacBook Air. I installed windows on it too 🙂
 
RandomHero117 said:
Talk **** about macs all you want.... I used to do the same.... but I've never had a laptop that I've liked more than my MacBook Air. I installed windows on it too 🙂
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Ditto. Expensive, but so luxury cars. People crack me up when they say they won't spend the money on a Mac yet they drive a luxury car.
 
southerndoc said:
Ditto. Expensive, but so luxury cars. People crack me up when they say they won't spend the money on a Mac yet they drive a luxury car.
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Pretty sure a new MacBook Air would retail higher than the car I'm driving...#medstudentpoverty
 
Akail said:
Pretty sure a new MacBook Air would retail higher than the car I'm driving...#medstudentpoverty
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Haha. Sucker, I could buy 2 MacBooks for the price of my car!!!! Boom! I'm rich!!!!

Oh, wait......
 
Dakota said:
I'm curious what you mean by this. Start thinking about where you want to go/what sort of work environment you're interested in? Start sending out resumes and interviewing? Do places really know their staffing needs 18 months out?

Most of the residents in my program appear to start applying /interviewing Fall of their final year.

As a 3rd year at a 4 year program, I'm already getting antsy to start looking.
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I say you're better off starting early. You need to have an idea of what you want, location, population, density, academic or not, etc. Then you want to do some interviews. You also have to take into account that getting a license in a lot of places takes time, sometimes 3+ months then you have to get credentialed. You can start late and get a job as an afterthought but you may get stuck waiting to start and hurting for money. Most EPs change jobs in their first 2 years. Don't let it be because you didn't put in the effort to make sure you weren't signing on to a turkey. If you have a word of mouth awesome job you can slide into then good for you. It's like getting to the airport. Are you happier getting there an hour and a half early and waiting with low stress or do you get there with 20 minutes to go and pray security works out?
 
southerndoc said:
Ditto. Expensive, but so luxury cars. People crack me up when they say they won't spend the money on a Mac yet they drive a luxury car.
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The day the Mac elite can run a presentation without starting "Did anyone bring their expensive proprietary cable to connect my Mac to: Ethernet/projector/USB/Wall plug" then I'll consider it.
And I'll still probably buy a cheaper Windows product.

What's the point of buying a Mac and then installing Windows on it?
Oh, right, you want to use some actual programs like the rest of us.
 
Dr.McNinja said:
The day the Mac elite can run a presentation without starting "Did anyone bring their expensive proprietary cable to connect my Mac to: Ethernet/projector/USB/Wall plug" then I'll consider it.
And I'll still probably buy a cheaper Windows product.

What's the point of buying a Mac and then installing Windows on it?
Oh, right, you want to use some actual programs like the rest of us.
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Haters gonna hate.
 
lol, fascinating how divisive apple products are.
 
Dr.McNinja said:
The day the Mac elite can run a presentation without starting "Did anyone bring their expensive proprietary cable to connect my Mac to: Ethernet/projector/USB/Wall plug" then I'll consider it.
And I'll still probably buy a cheaper Windows product.

What's the point of buying a Mac and then installing Windows on it?
Oh, right, you want to use some actual programs like the rest of us.
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The only reason I installed windows was the use OneNote. You are a fool if you think that any of the ultra books on the market can hold water to a MacBook Air. They are well crafted machines. Apple may be a bunch of pretentious asses, but they make good stuff.
 
I have a Mac and a PC.



Oooh.....livin' on the E D G E....
 
RandomHero117 said:
Apple may be a bunch of pretentious asses, but they make good stuff.
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Other people make good stuff too.
And they costs less. And they use the same standard connections for video as the devices themselves. And they have user serviceable parts (such as the battery). And....
 
Dr.McNinja said:
Other people make good stuff too.
And they costs less. And they use the same standard connections for video as the devices themselves. And they have user serviceable parts (such as the battery). And....
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I got an iPhone because I was told that I just "had to have one." Went to BestBuy trying to get a spare charger to travel with. 20bucks for a usb cord and another 20 for an ac adapter. wtf? Anyone know of a place that'll take my iPhone and give me a droid?
 
I drank the kool-aid and gave up Windows a couple years ago. Never looked back.

Oh, and back to the OP, I'm the medical director of a democratic-academic-community group (yeah, it's weird, but it's cool), and our group doesn't discriminate against people who've worked for big groups. They're everywhere. More importantly is what you've done - as above, did you just show up for your shifts, or did you get involved?
 
DreamingTheLive said:
Should! Hooray smallish-to-mid sized independent groups! Boo mega groups!

Fourth year here. Feel pretty strongly that mega-groups ultimately de-value EM physicians. Agree/Disagree, whatever. I'm an EM physician-to be who loves this field! Power to the individual EM docs! 🙂
Click to expand...

There's a better than average chance that your first job is going to be with a CMG. New grads are a distinct gamble (see any of the numerous posts on what residency teaches vs. what is required for success in the community). Many independent groups (especially in desirable areas) don't need to risk that gamble.

Every group regardless of size has certain things that must be done in order to service the contract. The group has to bill patients, attend administrative meetings to keep C-suite and the med staff happy, and perform QA on their docs. There are definitely other tasks that I'm forgetting, but failing to do any of those things consistently will result in losing the contract.

All of those things require overhead (you could argue about the admin stuff but not having a shift buy-down or compensation for meetings is inherently unstable) and that overhead is going to come out of the group's collections. CMGs always have an additional overhead component which is going to be shareholder profits. Many non-CMG groups are also going to have something equivalent in terms of increased payments to the contract holder (non-democratic) or contract holders (democratic with distinction between partners and non-partners).

In markets where there isn't much competition, CMGs can depress pay to increase shareholder profit and still keep their contracts. This tactic is also available to the other types of groups except for democratic groups that don't have non-partner MDs. In markets where there is competition, CMGs offering below market pay are going to hemorrhage their docs to better paying places. Their replacements, crappy or brand new docs, can't keep metrics at the level needed to maintain the contract. At risk of losing the contract, the CMG starts offering competitive pay to get quality docs. The various CMGs can't collude with each other because of anti-trust regulations, so this effect works even in markets dominated by CMGs as long as there are multiple CMGs in the market.

Now where things get interesting is that the core functions for maintaining a group are constantly increasing in cost. At some point, the economies of scale for CMGs in terms of billing, CME, core measure reporting, etc. are going to largely offset the profit that gets skimmed off by the shareholders. In some markets this is laughably far in the future, in others (Houston for one) the pay between CMG and non-CMG groups is roughly similar.
 
Arcan57 said:
There's a better than average chance that your first job is going to be with a CMG. New grads are a distinct gamble (see any of the numerous posts on what residency teaches vs. what is required for success in the community). Many independent groups (especially in desirable areas) don't need to risk that gamble.

Every group regardless of size has certain things that must be done in order to service the contract. The group has to bill patients, attend administrative meetings to keep C-suite and the med staff happy, and perform QA on their docs. There are definitely other tasks that I'm forgetting, but failing to do any of those things consistently will result in losing the contract.

All of those things require overhead (you could argue about the admin stuff but not having a shift buy-down or compensation for meetings is inherently unstable) and that overhead is going to come out of the group's collections. CMGs always have an additional overhead component which is going to be shareholder profits. Many non-CMG groups are also going to have something equivalent in terms of increased payments to the contract holder (non-democratic) or contract holders (democratic with distinction between partners and non-partners).

In markets where there isn't much competition, CMGs can depress pay to increase shareholder profit and still keep their contracts. This tactic is also available to the other types of groups except for democratic groups that don't have non-partner MDs. In markets where there is competition, CMGs offering below market pay are going to hemorrhage their docs to better paying places. Their replacements, crappy or brand new docs, can't keep metrics at the level needed to maintain the contract. At risk of losing the contract, the CMG starts offering competitive pay to get quality docs. The various CMGs can't collude with each other because of anti-trust regulations, so this effect works even in markets dominated by CMGs as long as there are multiple CMGs in the market.

Now where things get interesting is that the core functions for maintaining a group are constantly increasing in cost. At some point, the economies of scale for CMGs in terms of billing, CME, core measure reporting, etc. are going to largely offset the profit that gets skimmed off by the shareholders. In some markets this is laughably far in the future, in others (Houston for one) the pay between CMG and non-CMG groups is roughly similar.
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Awesome post. Thank you. Lol, but apparently you posted this in the wrong thread as this is the Mac vs. PC thread.😀
 
I just evaluated two jobs roughly 100 miles apart. Similar volumes, acuity. The CMG job is (of course) independent contract with no benefits. The employed position comes with benefits and pays 25 an hour more. I think many EPs underestimate just what working for a CMG is costing you. AAEM exists for a reason.

Sent from my A110 using Tapatalk 2
 
Old_Mil said:
I just evaluated two jobs roughly 100 miles apart. Similar volumes, acuity. The CMG job is (of course) independent contract with no benefits. The employed position comes with benefits and pays 25 an hour more. I think many EPs underestimate just what working for a CMG is costing you. AAEM exists for a reason.

Sent from my A110 using Tapatalk 2
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100 miles is a huge distance in terms of EDs. Even 45 miles out of almost any major city is going to lead to a huge jump in pay due to loss of desirability in living there. If you need benefits and can't get decent rates due to pre-existing issues then CMGs are indeed the devil. Otherwise each job offer needs to be evaluated on its own merits. Figure out how much being an IC costs compared to employed and use that as your basis for comparison. But not taking a job simply because it's with a CMG if everything else is better is idiocy.
 
I'm not defending CMGs. You guys know that my attitude is that the are what they are and you have to decide what you want.

That said, just for perspective, my group is part of a CMG and we have a lot of autonomy. We are paid as W2 employees (which has its own drawbacks) and med mal is covered through the company's self insurance program. We have health coverage and dental. We pay for it but it covers preexisting conditions. So not all CMG jobs are created equal. This applies across my CMG nationally and across the job market in general.
 
arcan, thanks for that post. obviously its several years away for me, but its nice to get insight from people "in the know."
 
I do locums work (or part-time, whatever you want to call it) for a hospital that utilizes TeamHealth for their regular staff. While I can't attest to benefits, etc, I can say that it's a big corporation. They lose things frequently, ask you to send them another copy, then send another copy back to you "for your records." I SENT IT TO YOU! I DON'T NEED IT FOR MY RECORDS!! There's a lot of paperwork that seems excessive and I didn't need to do for my full-time academic job. They also have a program that is mandatory where you go thru 'modules' to review practice standards. You do get some CME for it, but it's interesting that they mandate your education.

I'm probably considered one of those damn liberals, but I do like my locums' paychecks, so I'll suck it up for the possibility of a good down-payment for my future house. :whistle:
 
Apollo's corporate office has some great people working for it. Never lost paperwork, they are always on top of the credentialing process/renewals, etc. They will send out emails to you when your licenses are close to expiring.

Our groups are all autonomous from each other.
 
Not a fan of CMGs. But if that were all there were in a place I really wanted to live.....might have to compromise.

Lots of indie groups won't hire you later not because you worked for a CMG, but because you aren't a new grad. You can often get a grad for less money than an experienced doc, especially one coming out of a partnership situation.
 
i worked for one large regional group and now am w/ a large national group - no issues w/ paperwork and the like. they are on top of EVERYTHING... i'm fairly anal but it's nice to know someone else is keeping track of that mountain of paperwork that keeps the paychecks flowing!!

as for me - good health insurance and a non-individual DI policy, with short-term disability, are priceless. i've learned my lesson at a young age for that sort of thing 😉

working in my hometown means a CMG for the most part - i find it funny that a big hospital system uses small groups AND CMG's to staff their ED's but they do...
 
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