McPoyle

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Hey all, anyone know anything about working for Sound Critical Care? I’m considering a position at one of their locations. Feel free to PM if not comfortable using the public forum.



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CCM-MD

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In general these staffing companies suck. They love midlevels, especially Sound.

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Working for a hospital directly is probably better.
 
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chocomorsel

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If you look in the EM forum, it’s described as one of the worst staffing companies.
I would stay away. They seem to be in desirable location probably because they can lowball people like you.

I have done some locums for them. I don’t think the docs were happy.

Agree with above. Work for the hospital instead.
 
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Southpaw

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Anytime you see the words ‘top of their license’ you know to take a direct 180 and walk away. Sad to see physicians pulling this bull****.
 
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psychbender

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I have no experience with Sound CC, but I have worked with Sound Hospitalists, and have been less than impressed. Part of that may be because they severely understaff the wards, so its easier for the hospitalists to just try to turf anyone that causes more than one phone call to the unit.
 
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FFP

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Anytime you see the words ‘top of their license’ you know to take a direct 180 and walk away. Sad to see physicians pulling this bull****.
Top of the license means top of (i.e. maximum) incompetence.

It's textbook Dunning-Kruger and it doesn't apply just to midlevels, but to everybody. None of us should be performing duties at the upper tail-end of our competence. Those are the kind of things I call a consult for (even something as simple as giving calcitonin to a patient with hypercalcemia for the first time in my life).
 
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FFP

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Another pointer to the huge potential for mid-level incursion in critical care
Only where human lives don't count.

A good intensivist will run circles around a good midlevel for anything that gets to the level of intubation or shock (and many others). Critical care is one the specialties where basic science knowledge is a fundamental requirement for good care. Exactly that basic science knowledge that's so minimized in nursing education of all levels. I am not buying and reading books about patho(physio)logy for nothing.

Half of what I do that's game-changing for the patients is usually counter-intuitive, even to some physicians. If one practices critical care by a book, any one book or source, even UpToDate, one will kill some patients, period. Every patient in the ICU is different.

Now I can see why hospitals love bad intensivists, regardless of their education level. A bad intensivist will order a ton of unneeded tests, and that's how the hospitals make their money, a lot of it. Somebody like me who thinks twice about that, who uses free bedside ultrasound before/instead of the CT scan, will not be highly popular, regardless of lives saved. That's the sad state of American medicine: what's right for the patient is quite the opposite of what's right for the hospital systems.
 
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ERCC

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Don’t much about them but their CCM Medical Director has one of the best CC podcasts out.
 

CCM-MD

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Only where human lives don't count.

A good intensivist will run circles around a good midlevel for anything that gets to the level of intubation or shock (and many others). Critical care is one the specialties where basic science knowledge is a fundamental requirement for good care. Exactly that basic science knowledge that's so minimized in nursing education of all levels. I am not buying and reading books about patho(physio)logy for nothing.

Half of what I do that's game-changing for the patients is usually counter-intuitive, even to some physicians. If one practices critical care by a book, any one book or source, even UpToDate, one will kill some patients, period. Every patient in the ICU is different.

Now I can see why hospitals love bad intensivists, regardless of their education level. A bad intensivist will order a ton of unneeded tests, and that's how the hospitals make their money, a lot of it. Somebody like me who thinks twice about that, who uses free bedside ultrasound before/instead of the CT scan, will not be highly popular, regardless of lives saved. That's the sad state of American medicine: what's right for the patient is quite the opposite of what's right for the hospital systems.

I had assumed hospitals like less testing given the change to payment via DRG. More palliative care, early discharge etc.
 
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FFP

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I had assumed hospitals like less testing given the change to payment via DRG. More palliative care, early discharge etc.
If only the DRG counted, hospitals would encourage everybody to cut down on useless labs and non-invasive diagnostic procedures, and would not hire midlevels left and right. Midlevels order useless studies all the time.

I am 100% sure that hospitals are strongly incentivized to do diagnostic studies at least on certain (non-Medicare) patients.
 
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CCM-MD

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If only the DRG counted, hospitals would encourage everybody to cut down on useless labs and non-invasive diagnostic procedures, and would not hire midlevels left and right. Midlevels order useless studies all the time.

I am 100% sure that hospitals are strongly incentivized to do diagnostic studies on at least certain patients.

**** midlevels.
 

sluggs

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Imagine a work setting where everything you learned about intelligent, compassionate, patient centered care did not exist; the hippocratic oath did not count, and a good chunk of your work went to pay "physician-administrators" who were working hard tro sell out the profession every day. Add in gross mis-incentives. Sound....
 
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Splenda88

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I have a friend who works for Sound as hospitalist and always says it's a good company...
 

jthedestroyr

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glad this is brought up. Im looking at a sound ccm job in the south. 15shifts, 215$ an hr and 225$ for nights. They have bad reviews online.

The problem is the job thats the best fit for me personally is in a part of the country I dont want to live in nor think I can (including significant other stating she won't come).

Current situation ticking time bomb.
 
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sloh

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glad this is brought up. Im looking at a sound ccm job in the south. 15shifts, 215$ an hr and 225$ for nights. They have bad reviews online.

The problem is the job thats the best fit for me personally is in a part of the country I dont want to live in nor think I can (including significant other stating she won't come).

Current situation ticking time bomb.

Location notwithstanding, 215/hr for CCM is already a bad deal.
 

CCM-MD

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Location notwithstanding, 215/hr for CCM is already a bad deal.

It’s actually not bad compensation wise. $215/h comes out to $465k/year, plus whatever 401k and benefits, PTO etc. The bigger question is how hard are you gonna work for it - not worth it if you’re gonna be twerking all day seeing 18-20+.

MGMA mean for 2020 is like 450k.
 
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CCM-MD

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I've heard the census is capped at 16 since there are only 16 beds in your unit ha!

16 bed ICU can easily be 20+ encounters in a day depending on the turnover. Census matters less than the number of encounters. I wouldn’t be too excited about that. Especially if you are going to be primary on all of them and covering patients waiting in the ER for unit beds. The set up is everything. Don’t make the mistake of being too easily pleased, as most fellows are when looking for their first job. Companies like Sound exists for one reason only = to make money off your work.
 
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chocomorsel

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16 bed ICU can easily be 20+ encounters in a day depending on the turnover. Census matters less than the number of encounters. I wouldn’t be too excited about that. Especially if you are going to be primary on all of them and covering patients waiting in the ER for unit beds. The set up is everything. Don’t make the mistake of being too easily pleased, as most fellows are when looking for their first job. Companies like Sound exists for one reason only = to make money off your work.
Do you work for a hospital or an independent group?
What’s a good hourly rate for CCM full time?
 

CCM-MD

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Do you work for a hospital or an independent group?
What’s a good hourly rate for CCM full time?

I work for a hospital. Honestly I think it all comes down to how much work you are doing and how crappy the location is... and also how much night call/in-house coverage. I don’t know about hourly but for a permanent gig I think 450k total cash comp for 12-14 patient encounters/day would be pretty decent. More than 14 is doable but busy and one should try to get 75th percentile or more at that point. We were just able to negotiate an RVU based productivity bonus which is nice, since we have been working our asses off during COVID, if you work your ass off during a shift you get rewarded for it.
 
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jthedestroyr

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From what I've heard is 2 physicians on a day then one on at night with APP. (32 beds)

Avg encounters are 7-12 per night shift which includes responding to codes (they count codes and lines are encounters also).

7on and 7 off. To me this much better than my current gig which pulls me 3 different directions including kids thrown at you.
 

CCM-MD

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From what I've heard is 2 physicians on a day then one on at night with APP. (32 beds)

Avg encounters are 7-12 per night shift which includes responding to codes (they count codes and lines are encounters also).

7on and 7 off. To me this much better than my current gig which pulls me 3 different directions including kids thrown at you.

What about days? Nights honestly aren't that bad usually, except for the fact that you have to be there at night. Some new consults, some procedures, some cross cover. Days on the other hand, can be rough.

I honestly wish you the best. I hope you like it. Like you said earlier, there's more to it than just $ and type of work. Location, family, all that factors in. There are obviously people that work for Sound and don't mind it. You should share with us how it is, after you start.
 

jthedestroyr

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well its hands down better then the situation I'm in currently tbh!

Location is good for me as its close to significant others family.
 

turkeyjerky

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I'm EM, not CCM so my experience may or may not be relevant. I've been doing some per-diem work for Sound for almost a year, and I would say its dismal reputation is well deserved. Poorly organized, dishonest, incessant gaslighting, overuse of midlevels (and encouraging them to practice far outside their scope). The hospitalists don't seem to mind them though. The EM docs who've been there seem like the most beat-down, burnt group I've ever seen.
 
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jthedestroyr

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I'm EM, not CCM so my experience may or may not be relevant. I've been doing some per-diem work for Sound for almost a year, and I would say its dismal reputation is well deserved. Poorly organized, dishonest, incessant gaslighting, overuse of midlevels (and encouraging them to practice far outside their scope). The hospitalists don't seem to mind them though. The EM docs who've been there seem like the most beat-down, burnt group I've ever seen.

Thats good to know.
 

leviathan

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So is it normal to be paid an hourly rate for ICU in the US? In Canada it's mostly fee-for-service, and ICUs generally have a comprehensive billing code for each patient that covers all of their care/procedures etc per day, with the highest reimbursement on the first few days.
 

CCM-MD

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So is it normal to be paid an hourly rate for ICU in the US? In Canada it's mostly fee-for-service, and ICUs generally have a comprehensive billing code for each patient that covers all of their care/procedures etc per day, with the highest reimbursement on the first few days.

It’s usually either per shift or a combination of per shift plus productivity. The productivity piece is usually based on billing. 99291-99292 are the billing codes for critical care and they are time based, and have specific requirements for a patient/service provided to qualify. If they don’t qualify, then it’s usually an inpatient visit that’s billed. CVC, art lines, bronchs, chest tubes etc is all separate from the time codes.

If crit care was 100% FFS here, few would be practicing it due to the number of uninsured, who you would get $0 to take care of. Even on the insured patients, collections are typically 30-35% of the amount that’s billed due to how broken the medical billing system is here. Good portion of an intensivists salary is subsidized by the hospital.
 
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