More proof cmgs can be unscrupulous

[FetchThePliers]

So I was employed at a hospital that brought in a new group called Legacy Physician Partners, I was let go as an employee when this group came in. I signed on to work for LPP while I sought a new job. As a new grad, I no longer trusted the hospital (owned by Prime Healthcare) and its leadership (no options for admitting as observation, directing physicians to make everything full admission no matter what), and ultimately left, but kept in contact with folks working there.

Legacy was a new group, CMG-like and based in Nashville, that was taking on contracts at a few hospitals in my area and in other states. They certainly had some red flags. For one, the CEO was a lawyer, and there were no physicians within the corporate structure (not that it would have made much of a difference). They also initially offered 24 hour shifts at a nearby hospital with around 65 visits per day, which to me showed blatantly how little they knew about emergency medicine.

Anyways, long story short, they just went bankrupt without warning and NONE of the docs got paid for their work in October. NONE. And they will not be paid. The company also did not pay its malpractice premium and the 30 day grace period for finding a new carrier expired leaving all the physicians at multiple hospitals uninsured for a brief period. Fortunately, the tab got picked up very quickly either by the new group or the hospital. The new group has taken over and slashed pay and are cutting staffing.

A lot of lessons here, some of which speak for themselves. Part of this post is to make other physicians aware of this happening, but also as a reminder to save up at least 3 months of income in case your are suddenly without a job or put in a situation where leaving ASAP is the best option. I jumped ship early on, fortunately. But, I really feel bad for my colleagues who were led on by the previous group and ultimately screwed, some of whom who are faced with being out of work for 3 months or so, or signing on with another unknown group for less pay and less coverage.

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[namethatsmell]

They also initially offered 24 hour shifts at a nearby hospital with around 65 visits per day, which to me showed blatantly how little they knew about emergency medicine.

Thank you for alerting us about these jokers. If they’re still staffing like this I hope somebody has alerted the hospital admins, state health board, the local lay press, etc as this is simply dangerous.


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[Brigade4Radiant]

Yep my group with legacy is not paying to doctors for their work. Its a good thing I have two jobs so it is just six shifts. I would recommend that unless absolutely can't get credentialed nearby at least get credentialed at two nearby hospitals with different groups.

PRN part-time because these things happen also unless you really need it dont take a sign on bonus.

24 shifts for 65000 visits or literally a critical access hospital that sees 65 patients a day?

 

[EctopicFetus]

ER doctors worked without pay for weeks as three Philly area hospitals changed management : Money : WHYY

This guy who was the ceo tried other shady business to make money.

Now the new guys offered the docs who just lost 6 weeks of pay a 20% pay cut.

It’s why real ownership matters. Not usacs bs ownership.

 

[alphaholic06]

ER doctors worked without pay for weeks as three Philly area hospitals changed management : Money : WHYY

This guy who was the ceo tried other shady business to make money.

Now the new guys offered the docs who just lost 6 weeks of pay a 20% pay cut.

It’s why real ownership matters. Not usacs bs ownership.

Also offered them their back pay as a retention bonus only if they signed a long term contract. WTF?

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[Backpack234]

This is why physicians should be able to form unions.

 

[deleted480308]

Day the checks don’t show up.

“You owe me money, your ED is on diversion, let us know when our checks are printed”

 

[Angry Birds]

It's time to bounce.

 

[emergentmd]

Pay back as retention Bonus. Is this even Legal? WTF is this?
Talk about creating a very lowly motivated group of docs. If I had to stay in this hellhole for some reason, you would see me sipping coffee and slow rolling my shifts. What are they going to do? Fire me? No one in their right mind would sign up for this job.

 

[Brigade4Radiant]

Yeah this happened to all Legacy hospitals. It was legal to offer a retention bonus because the other CMG is paying you not the one that declared bankruptcy. It happened to my hospital but I always have two jobs and our doctors are not pushovers so we refused to sign whenever they came up with unless it was the same pay and same hours.

Uhh that has got to suck working 12 hour shifts and being payed 20% less. This is what happens when you live paycheck to paycheck and don't have two jobs.

 

[Brigade4Radiant]

ER doctors worked without pay for weeks as three Philly area hospitals changed management : Money : WHYY

 

[alphaholic06]

Day the checks don’t show up.

“You owe me money, your ED is on diversion, let us know when our checks are printed”

Exactly!

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[EctopicFetus]

Yeah this happened to all Legacy hospitals. It was legal to offer a retention bonus because the other CMG is paying you not the one that declared bankruptcy. It happened to my hospital but I always have two jobs and our doctors are not pushovers so we refused to sign whenever they came up with unless it was the same pay and same hours.

Uhh that has got to suck working 12 hour shifts and being payed 20% less. This is what happens when you live paycheck to paycheck and don't have two jobs.

No. This is what happens when you work for someone else.

 

[GonnaBeADoc2222]

Unbelievable. Or maybe perfectly believable.

This illustrates two important points:

1) You need to have an emergency fund. As soon as something like this happens, you need to have the liquidity to GTFO yesterday if needed, and support yourself financially for 3-6 months while you find alternative work.

2) Get credentialed at another area ED. Gives you an escape hatch, even if it's just per diem. If nothing else, might give you leverage with shi**y place you are trying to leave.

PLEASE new grads and senior residents - pay attention to this!

 

[miacomet]

These hospitals sound super sketch and physician unfriendly, and Andy Sama's Progressive Emergency Physicians is unlikely to improve things per my sources.

Save and get out of the game.

 

[RustedFox]

Unbelievable. Or maybe perfectly believable.

This illustrates two important points:

1) You need to have an emergency fund. As soon as something like this happens, you need to have the liquidity to GTFO yesterday if needed, and support yourself financially for 3-6 months while you find alternative work.

2) Get credentialed at another area ED. Gives you an escape hatch, even if it's just per diem. If nothing else, might give you leverage with shi**y place you are trying to leave.

PLEASE new grads and senior residents - pay attention to this!

So important.
I have my main gig, and also a small "bullpen" of jobs that I can call-up or "bench" if they start to suck.

 

[EMPertinent]

This is why physicians should be able to form unions.

There isn't any prohibition on physician labor unions, as far as I'm aware. As to why they don't exist in any meaningful form for EM, I don't know - I'm only a resident.

 

[bravotwozero]

you can unionize if you're w-2, not IC.

 

[miacomet]

you can unionize if you're w-2, not IC.

Lots of ER docs are W2

 

[Brigade4Radiant]

Too bad unions have been demonized and now we are at the mercy of corporate overloads whose goals are antagonistic to their employees.

Also it is hard for unions to form. As many corporations squash any mention of a union.

 

[TheComebacKid]

I think there should be some sort of "accreditation" process by ACEP. If you are not an ACEP "accredited" CMG, you should have to disclose this so people who work for that group are aware. When there is funny business going on, like in this case, ACEP can launch an investigation and withhold/suspend accreditation of that particular organization and hopefully uphold some standards. Similar to board certification for EM docs.

Oh wait, ACEP is completely bought out/owned by CMGs, silly me.

 

[Angry Birds]

in an ideal world would it have been possible to ban CMG’s?

 

[Dr Mantis Toboggan]

in an ideal world would it have been possible to ban CMG’s?

Several states have laws against corporate ownership of medical practices. As I recall AAEM tried to fight on that front some years back but I don’t think it got anywhere.

 

[theseeker4]

Day the checks don’t show up.

“You owe me money, your ED is on diversion, let us know when our checks are printed”

Problem is too many physicians feel like they are ethically obligated to work, and hospitals play off of that, saying that it is bad for patients if you actually expect to be paid for your work, and that you CAN'T possibly NOT work, or the patients will suffer. Sadly too many physicians believe that reasoning and will willingly bend over if you start to question their dedication to the patients. Strangely that same logic never bothers administrators when they are screwing over the doctors and nurses and techs etc. who actually take care of patients.....

 

[TheComebacKid]

Several states have laws against corporate ownership of medical practices. As I recall AAEM tried to fight on that front some years back but I don’t think it got anywhere.

While I think AAEM's heart is in the right place and they are on the right side of many issues, they unfortunately do not have the political clout or financial backing to really move mountains on issues like this.

 

[GeneralVeers]

I was talking with one of the other docs at my new job (used to be a TeamHealth contract) and he said when TeamHealth took over, payroll didn't pay him for 2 months. He kept asking them where his money was, and not getting any answers. Finally he booked a flight to TeamHealth headquarters and showed up demanding his check. They paid him, but were shocked and astonished that anyone would do that.

 

[RustedFox]

I was talking with one of the other docs at my new job (used to be a TeamHealth contract) and he said when TeamHealth took over, payroll didn't pay him for 2 months. He kept asking them where his money was, and not getting any answers. Finally he booked a flight to TeamHealth headquarters and showed up demanding his check. They paid him, but were shocked and astonished that anyone would do that.

I'd absolutely do that. Isn't the HQ in Knoxville, TN?

 

[medschoolzombie]

Problem is too many physicians feel like they are ethically obligated to work, and hospitals play off of that, saying that it is bad for patients if you actually expect to be paid for your work, and that you CAN'T possibly NOT work, or the patients will suffer. Sadly too many physicians believe that reasoning and will willingly bend over if you start to question their dedication to the patients. Strangely that same logic never bothers administrators when they are screwing over the doctors and nurses and techs etc. who actually take care of patients.....

For some reason physicians seem to be easily guilted into this stuff with the “but think about the patient!” Quips. Nurses have a fantastic union. Not sure why doctors can’t follow suit. They’re letting themselves be exploited for profit

 

[GeneralVeers]

For some reason physicians seem to be easily guilted into this stuff with the “but think about the patient!” Quips. Nurses have a fantastic union. Not sure why doctors can’t follow suit. They’re letting themselves be exploited for profit

I have no guilt at all. Administration doesn't give a crap about patient care, patient safety or "quality". They refuse any requests to improve patient care with more nurses, techs, resources or space. So why should I feel guilty when a CMG or hospital treats physicians like crap? Sure I'd show up for a little while, but I would only see emergencies, and make everyone else wait. Physicians tend to be altruistic and their inherent guilt is what has led to the destruction of our specialty and the relinquishing of the financial controls.

 

[emergentmd]

Unbelievable. Or maybe perfectly believable.

This illustrates two important points:

1) You need to have an emergency fund. As soon as something like this happens, you need to have the liquidity to GTFO yesterday if needed, and support yourself financially for 3-6 months while you find alternative work.

2) Get credentialed at another area ED. Gives you an escape hatch, even if it's just per diem. If nothing else, might give you leverage with shi**y place you are trying to leave.

PLEASE new grads and senior residents - pay attention to this!

This!!!! I have 4 systems I am credentiled at and a total of like 20 sites.

If I was missing a check, I would show up 1 or 2 more shifts and see only emergencies. If not paid by then, I would not show up on the 3rd day.

But I have savings I can live on and back up sites.

 

[bravotwozero]

I'd absolutely do that. Isn't the HQ in Knoxville, TN?

Ditto. What’s a flight/hotel stay vs two month salary?


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[medschoolzombie]

I have no guilt at all. Administration doesn't give a crap about patient care, patient safety or "quality". They refuse any requests to improve patient care with more nurses, techs, resources or space. So why should I feel guilty when a CMG or hospital treats physicians like crap? Sure I'd show up for a little while, but I would only see emergencies, and make everyone else wait. Physicians tend to be altruistic and their inherent guilt is what has led to the destruction of our specialty and the relinquishing of the financial controls.

Then why not unionize or do something about the current situation? Maybe I’m being naive but physicians have a lot of respect in the community and if they pushed for changes to the current system, it’s more likely to happen. At this rate, it looks like they’ll lose all Autonomy within a few decades

 

[VA Hopeful Dr]

Then why not unionize or do something about the current situation? Maybe I’m being naive but physicians have a lot of respect in the community and if they pushed for changes to the current system, it’s more likely to happen. At this rate, it looks like they’ll lose all Autonomy within a few decades

Unions only work because they can threaten (or actually go on) strike. How well do you think doctors going on strike would play out in the court of public opinion?

"1%-er doctors refusing to see gravely ill patients in argument over money"

 

[TheComebacKid]

Then why not unionize or do something about the current situation? Maybe I’m being naive but physicians have a lot of respect in the community and if they pushed for changes to the current system, it’s more likely to happen. At this rate, it looks like they’ll lose all Autonomy within a few decades

We already have lost autonomy. That ship has already sailed a long time ago.

The physician "respect" that you speak of is a thing of the past. Now the physician is more of a checkbox for a corporation to return dividends to their shareholders.

Nurses run healthcare in this country. NPs/PAs will be running medicine in this country in the near future. While some think this is a bleak outlook on things, just look at hospital leadership for any big organization, the number of individuals who have ZERO medical training will blow your mind. As I've stated multiple times in this forum, physicians are the only ones to blame for this because we thought we were immune to being taken over.

Physicians have spent their careers trying to "do the right thing" for patients, being noble, and taking the high road. It paid off when your grandfather was a physician. Today it means you get taken advantage of. Welcome to the healthcare conglomerate machine of which you are a tiny little cog in the wheel.

To quote Ray Liotta in Good Fellas:
"Everybody had their hands out. Everything was for the taking. And now it’s all over. And that’s the hardest part. Today, everything is different. There’s no action. I have to wait around like everyone else. Can’t even get decent food. Right after I got here I ordered some spaghetti with marinara sauce and I got egg noodles and ketchup. I’m an average nobody. I get to live the rest of my life like a schnook."

See you guys in the academic EM world where I'll make far less money but at least will have some pride by not working for any of these scumbags.

 

[namethatsmell]

I was talking with one of the other docs at my new job (used to be a TeamHealth contract) and he said when TeamHealth took over, payroll didn't pay him for 2 months. He kept asking them where his money was, and not getting any answers. Finally he booked a flight to TeamHealth headquarters and showed up demanding his check. They paid him, but were shocked and astonished that anyone would do that.

Did they pay for his time and travel required to get the check due to their inability to function?


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[Angry Birds]

I gotta be honest. I throw a hissy fit when I don’t get paid for the extra hour due to daylight savings time. Can’t imagine working weeks without pay. F that

 

[medschoolzombie]

Unions only work because they can threaten (or actually go on) strike. How well do you think doctors going on strike would play out in the court of public opinion?

"1%-er doctors refusing to see gravely ill patients in argument over money"

Well no one likes strikes, regardless of what profession. The court of public opinion was against teachers striking with their “ but think about the children” signs but eventually shifted to favor teachers when it became apparent how overburdened and screwed over they were by the system. No reason why it can’t happen for doctors too. It can be for anything really. Every step of the way pretty much sucks these days. Medical students don’t get to do much on rotations and pay a bunch of loan money to basically self study for classes/boards. Residents are over worked and paid essentially minimum wage while NPs/other mid levels rake in the dough with a lot less training. Physicians are not getting paid due to administrative setbacks or being pushed out of fields due to mid levels etc etc

We already have lost autonomy. That ship has already sailed a long time ago.

The physician "respect" that you speak of is a thing of the past. Now the physician is more of a checkbox for a corporation to return dividends to their shareholders.

Nurses run healthcare in this country. NPs/PAs will be running medicine in this country in the near future. While some think this is a bleak outlook on things, just look at hospital leadership for any big organization, the number of individuals who have ZERO medical training will blow your mind. As I've stated multiple times in this forum, physicians are the only ones to blame for this because we thought we were immune to being taken over.

Physicians have spent their careers trying to "do the right thing" for patients, being noble, and taking the high road. It paid off when your grandfather was a physician. Today it means you get taken advantage of. Welcome to the healthcare conglomerate machine of which you are a tiny little cog in the wheel.

See you guys in the academic EM world where I'll make far less money but at least will have some pride by not working for any of these scumbags.

I guess you’re right. Corporations/insurance and people with MBAs basically run hospitals right now. I still don’t understand why nurses were able to form a union but doctors didn’t? Was it really becuase they lacked the foresight to see that their jobs weren’t immune? I hear nurses complaining about these same issues all the time too. Are their situations really that different?

 

[GonnaBeADoc2222]

See you guys in the academic EM world where I'll make far less money but at least will have some pride by not working for any of these scumbags.

Good joke. Academic centers are acquiring hospitals all over the place and their C-suite have salaries pushing 1 mil. You're seeing 3 or more pph with your residents, but still responsible for everything. If anything you're getting screwed more.

 

[Brigade4Radiant]

Lol at academics being safe say that to the academic hospitals that were owned by Tenet then SSM.

HCA is opening residencies like crazy.

The hospitals are run the same the only difference is the physician is employed by the school of medicine you may have a bit more job security but less pay and more responsiblities.

 

[TheComebacKid]

Good joke. Academic centers are acquiring hospitals all over the place and their C-suite have salaries pushing 1 mil. You're seeing 3 or more pph with your residents, but still responsible for everything. If anything you're getting screwed more.

I highly doubt that.

I could be wrong, but academic physicians not being paid for several weeks and working for free is not something that I've heard of. All of the issues with CMGs gutting their physicians is really not the same in the academic environment.

I'd happily see 3 pph with an EM resident who actually received something resembling medical training as opposed to an NP/PA staffed by TeamHealth where I'm expected to just sign off on their chart without physically ever seeing the patient.

I'm not denying the fact that hospital executives at academic medical centers still get paid ridiculous salaries. Academic physicians still have certain metrics and sepsis bundles and all these other stupid things to do in order to qualify for reimbursement, however, it is nowhere as bad as it is at the community site. There really is not much in terms of RVU based compensation at the academic center I'm at, I don't know about other places, but regardless, our attendings seem extremely happy, have a decent schedule, great benefits and don't feel like they are being taken advantage of by the chairman or hospital they work for. That may be an n=1 but still, if you think academic hospitals are getting away with the stuff that USACS and other atrocious CMGs are, you are mistaken.

 

[GeneralVeers]

Also to the OP...."ducking sick" isn't all that bad.

 

[GeneralVeers]

Lesson to all of us. As soon as a group/company declares bankruptcy, quit and stop working.

 

[namethatsmell]

In terms of day to day life on the front lines, the best group to work with is one where the people who have decision-making power about things like scheduling, staffing, budgets etc are working weekends, nights, and holidays like everybody else.

If that's a truly equitable SDG, great.

If it's an academic group, super.

It won't be a CMG.

If the people "in power" are out of touch with the reality in the trenches then the quality of your job will suffer.

 

[thegenius]

I have no guilt at all. Administration doesn't give a crap about patient care, patient safety or "quality". They refuse any requests to improve patient care with more nurses, techs, resources or space. So why should I feel guilty when a CMG or hospital treats physicians like crap? Sure I'd show up for a little while, but I would only see emergencies, and make everyone else wait. Physicians tend to be altruistic and their inherent guilt is what has led to the destruction of our specialty and the relinquishing of the financial controls.

Even that is too nice. I would not show up to work under any circumstance if I was not going to be paid.

Well...maybe I would show up if there was an MCI (like what happened in Las Vegas), but the moment everything was under control, I'm out.

 

[miacomet]

Even that is too nice. I would not show up to work under any circumstance if I was not going to be paid.

Well...maybe I would show up if there was an MCI (like what happened in Las Vegas), but the moment everything was under control, I'm out.

It sounds as though they were told they would be paid. I mean, my job could conceivably not pay me next month, but I wouldn't know while I'm slaving away.

 

[emergentmd]

It sounds as though they were told they would be paid. I mean, my job could conceivably not pay me next month, but I wouldn't know while I'm slaving away.

If they are late a few days or even a wk is one thing. If they are late for a few weeks, they better have a GOOD reason not just "payment is coming"

 

[VA Hopeful Dr]

Well no one likes strikes, regardless of what profession. The court of public opinion was against teachers striking with their “ but think about the children” signs but eventually shifted to favor teachers when it became apparent how overburdened and screwed over they were by the system. No reason why it can’t happen for doctors too. It can be for anything really. Every step of the way pretty much sucks these days. Medical students don’t get to do much on rotations and pay a bunch of loan money to basically self study for classes/boards. Residents are over worked and paid essentially minimum wage while NPs/other mid levels rake in the dough with a lot less training. Physicians are not getting paid due to administrative setbacks or being pushed out of fields due to mid levels etc etc

First, I'm one of the lowest paid doctors out there (family med) and my first year out I still made 5X what a teacher in the same area does. So you really can't compare the 2. Teachers make significantly less than median salary in this country. Most doctors make enough to put us in the 1% quite frequently.

Second, yes you can argue that we have to do medical school which sucks and puts us in debt but when all is said and done we're still making at least 4X what the average American does. As for residency, when I was an intern in 2010 the math worked out such that if I did 80 hours every week that I worked my hourly pay was still just over $13/hour. That's almost double minimum wage. And after 3 years I'm essentially guaranteed a 4X increase in yearly income.

If we go on strike all you'll hear is "those rich doctors want even more money" followed closely by every negative interaction someone has had with a physician being told often and loudly. Do people have bad experience with nurses and teachers? Of course. But they seem to be less frequent and again, the money is less of an issue.

Now I'm not saying in certain circumstances it might not work - I think it would if the strike was because you haven't been paid in 2 months. But that's a single issue that is objectively wrong. Most of the things you hear doctors wanting to strike over aren't as clear cut.

 

[GeneralVeers]

First, I'm one of the lowest paid doctors out there (family med) and my first year out I still made 5X what a teacher in the same area does. So you really can't compare the 2. Teachers make significantly less than median salary in this country. Most doctors make enough to put us in the 1% quite frequently.

Second, yes you can argue that we have to do medical school which sucks and puts us in debt but when all is said and done we're still making at least 4X what the average American does. As for residency, when I was an intern in 2010 the math worked out such that if I did 80 hours every week that I worked my hourly pay was still just over $13/hour. That's almost double minimum wage. And after 3 years I'm essentially guaranteed a 4X increase in yearly income.

If we go on strike all you'll hear is "those rich doctors want even more money" followed closely by every negative interaction someone has had with a physician being told often and loudly. Do people have bad experience with nurses and teachers? Of course. But they seem to be less frequent and again, the money is less of an issue.

Now I'm not saying in certain circumstances it might not work - I think it would if the strike was because you haven't been paid in 2 months. But that's a single issue that is objectively wrong. Most of the things you hear doctors wanting to strike over aren't as clear cut.

I'm not in favor of unions or going on strike. We also should never publicly say we want more money. Teachers can show us the way as they constantly talk about "quality education" and "classroom ratios" when what they really want is more money and perks. We can do the same if we demand better nursing ratios to help "patient safety" and we can clamp down on hospitals and CMGs controlling the money that's owed to us. We can say something like: "Removing barriers between doctors and patient care" when discussing financial issues. We are in a situation where we can make more money by not demanding more money if we demand a reduction in CMG overhead costs and fees, as well as transparency in what these companies are billing in our name, and how much they are taking.

Doctor guilt about being well-paid has also contributed to our downfall. I don't feel guilty one bit, and I have no problem going up against hospitals and CMGs to get more of the money I make. Why should it go to fat-cats like Dom Dirtbag, or a hospital C-suite exec who sit in their offices making powerpoint presentations about why we should give a damn about patient satisfaction?

 

[thegenius]

I'm not in favor of unions or going on strike. We also should never publicly say we want more money. Teachers can show us the way as they constantly talk about "quality education" and "classroom ratios" when what they really want is more money and perks. We can do the same if we demand better nursing ratios to help "patient safety" and we can clamp down on hospitals and CMGs controlling the money that's owed to us. We can say something like: "Removing barriers between doctors and patient care" when discussing financial issues. We are in a situation where we can make more money by not demanding more money if we demand a reduction in CMG overhead costs and fees, as well as transparency in what these companies are billing in our name, and how much they are taking.

Doctor guilt about being well-paid has also contributed to our downfall. I don't feel guilty one bit, and I have no problem going up against hospitals and CMGs to get more of the money I make. Why should it go to fat-cats like Dom Dirtbag, or a hospital C-suite exec who sit in their offices making powerpoint presentations about why we should give a damn about patient satisfaction?

I'll vote for ya GeneralVeers. Run. Please run. You'll win and make us a lot more money and happier and you'll go down in history in a glorious way.

 

[Hamhock]

WTF happened to the amusing title to this thread?

OP? Were you coerced? Did the CMGs get to you?

HH