Summa Health System/NEOUCOM Residency Reviews

Discussion in 'Emergency Medicine' started by icymd, Feb 24, 2008.

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  1. emergentmd

    emergentmd 7+ Year Member

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    In All seriousness. What SDG asks for a 15 yr contract with a subsidy? I have not seen anything north of 3 years. And even if they had a 100 yr contract, most have clauses for a 90 dy termination so why does it matter if its 15 or 3 yrs?

    Who knows if they needed a subsidy. Most EM groups that is well run and decent payer mix should not need a subsidy. And if they do need a subsidy, they are a big target for a CMG to come in without a subsidy.

    Looks like all parties tried to bluff and in Poker, if you don't have the Nuts then you can very well lose. No SDG have the Nuts or even close to the Nuts. Most are lucky to have a weak pair.
     
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  3. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

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    Right. Why does it matter? They want 15 years. Give em 15 years. What does it matter if you have your 90 day out? That's an easy point to give away in a negotiation.

    They were forced by the hospital at risk of their contract to staff FSEDs where the hospital made money but they did not. After several years of subsidizing the hospital's business decisions, they said no more without a subsidy. This is where the real point of negotiation came in. Nobody cared all that much about the length of the contract. It was about the subsidy. Bagnoli's wife says, "Bagnoli will do it without a subsidy. Give it to him." Hospital CEO says, "Okay, how can we do this without looking bad?" And the rest is history. Bagnoli convinced him it could be pulled off even though he really didn't have any way to do it without the hospital looking bad. Then the hospital looked bad, CEO got canned, and Bagnoli and USACS ran off with the contract. Everyone is a loser in this situation except USACS. Both parties in the negotiation are now gone.
     
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  4. emergentmd

    emergentmd 7+ Year Member

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    I am all behind SDG and hate CMGs, but SEA asking for 15 yrs immediately tainted the waters. That is like going through a divorce and asking for something ridiculous right off the bat. That just painted SEA in a poor light from the hospital standpoint. Your idea of just give them 15 yrs b/c SEA wants it as it doesn't matter is not valid when Large Egos are involved. We all know the CEO had a big ego but SEA's negotiator also had a Big Ego. Problem is SEA had very little bargaining power.

    If I was a CEO negotiating in good faith and had all the intentions to renewing the contract, I would be Pissed if SEA demanded a 15 yr contract and whatever poison pill that came along with it.

    Off course they were asked to take on poor contracts. That is what a good business does. They squeeze profit if they can. And if the current SDG can't, then they will find a group that can take on the poor contract without a stipend. All for profit business seek ways to maximize income.

    I am sure the hospital CEO had a nice severance package and will land another CEO job very soon.

    SEA's negotiator screwed his partners and now have many families in disarray.
     
  5. sum dude

    sum dude MD 7+ Year Member

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    I don't think you can say SEA negotiated well--at very least, they could have asked for extension and re-grouped, but they stuck to the nuclear option, which was the Jan 1 2017 walkout. Now they damaged the hospital but blew themselves up and cease to exist, and the residents are collateral damage (and let's not pretend that they didn't bank on the residency as their strongest bargaining chip). Props for having stones and sticking to it, but just like marriage, sometimes its better to coexist than to be right.

    I'm w/ Emergent MD on this one--SEA misplayed their hand and made a bad business decision. Leverage is everything, and unfortunately, hospitals have become so powerful that they will always have leverage in negotiations for contracts.

    FWIW, EPMonthly probably had the most in depth coverage on it
    http://epmonthly.com/article/deal-breakers-summa-story/
     
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  6. littlejuan

    littlejuan 10+ Year Member

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    I hope all the residents can be absorbed somewhere, that is a decent amount of residents who will be left out in the cold. That really sucks.
     
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  7. shoal007

    shoal007 2+ Year Member

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    i spoke with an apd, cord listserv is going nuts. all the residents should get absorbed with financial help for relocation it sounds. Good luck

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  8. littlejuan

    littlejuan 10+ Year Member

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    That's good to hear. I can't imagine being in their position.
     
  9. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

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    I'm definitely not saying they negotiated well. They clearly didn't as they didn't get their desired outcome.

    The question is whether the hospital was ever seriously negotiating with SEA. My opinion is they probably never were but covered that up well enough that no one can prove it.

    Bagnoli basically says that if you read between the lines:

    “I am married to the CMO, who trained there, who worked there, who was the Chair of Women’s Health for eight years; who had the highest quality metrics in the State and was on the Board of Directors and then applied for the CMO job and started it six months ago. That’s fact. We never talked about business. She was not involved in any of the [USACS] negotiations. The only interaction I had with her around this contract was on the 24th, where she said: Tom’s going to call you. I hung up that phone call and started to say, “can you believe…” and then she goes, “I’m not talking to you about it.” And that’s the way our discussions went because she is the most principled, ethical person. I mean, she’s way better than anyone I know. And she’s getting dragged through the mud because why? Because she’s a female and she has a job and she happens to be married to a guy who runs a big business. Okay, but that’s all she’s done wrong. And it’s unfair to her. And these people, there’s been an outside counsel investigation of conflict of interest, that has been completely shown: no conflict, no impropriety. The Board is doing a second one. I mean, they are looking at all of this. There is nothing there. They’ve looked at all the emails. There’s nothing. There’s nothing to show that and there was nothing.”

    They're no dummies. They're smart enough not to put anything in writing. But the ethical thing to do would be to tell the Summa CEO "I can't take that contract as it would be unethical because my wife is the CMO." Could you do that Dom? Nope. You couldn't. Because money is more important to you than emergency physicians.
     
    Last edited: Feb 11, 2017
  10. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor 10+ Year Member

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    Summa called their bluff alright, and now that bluff is having major repercussions to Summa. Next up is the Joint Commission and CMS investigations if the rumors are to believed about attendings not seeing patients. EMS and even patient seem to be choosing to go elsewhere. Long-term staffing is not a sustainable option for USACS unless they get more docs to sign up. There's no way they can sustain losing that much money.

    Someone posted on Gruntdoc that this should be a lesson in the Harvard Business Review. I agree with him/her. This is an epic failure on multiple fronts.
     
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  11. bikERdoc

    bikERdoc 2+ Year Member

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    SEA definitely misplayed their hand. But so did Summa, and so did USACS. This is publicity that no one wants. Some contracts are not worth it, and I'm sure everyone would've played this one differently, if they had the chance. Hindsight is a bitc&. This will play out in the courts for a long time to come.

    The issues I see with the negotiation are all the delays. Summa gave SEA an 80 pg contract on 11/28, which seems to be way shorter than industry standard. They also wanted to CUT reimbursements for residency faculty, and do nothing to address the failing sites. SEA countered on 12/12 with the 15 yr contract, knowing "it was a stretch." That was 12 days before Dominic got the stated heads up that USACS was possibly taking over.

    SEA could've taken the extension offered to get the deal hammered out. They thought it was disingenuous and that the deal could get done before 1/1. Summa seemed to think otherwise. This is where both sides F'd it up for each other, and I think looking back they realize that. Careers have been tainted and plenty of collateral damage has been done as a result.

    Bob Mcnamara from Temple suggested that USACS give the contract back to SEA on EM Docs. Thought this seemed interesting. Unfortunately don't think this would change the ACGME decision, nor correct a ship that went way off course. But it would put a ton of docs back to work in the community they've enjoyed serving over the last 40 years...


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  12. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

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    Give me a break. The extension was to give Dominic enough time to have a smoother transition. This decision was made long before 12/31 at 5 pm when Dominic "got the call." Who has enough emergency docs sitting around that you can staff 5 EDs 7 hours from now? Nobody. That doesn't pass the sniff test. Licensing, credentialing etc etc etc take months, weeks, at least days. No 7 hours on New Years Eve. This was planned at least weeks before then.
     
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  13. bikERdoc

    bikERdoc 2+ Year Member

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    Not disagreeing. The whole thing looks and smells like nepotism. You have to admit negotiations got started later than they should have. More time may have made this deal go through. I can't read the mind of Thomas Malone, but I have a feeling he likely didn't want to resign at the demand of his entire medical staff voting him out.


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  14. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

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    What I'm saying is that there was never a real negotiation to start with it. It was all a pretend negotiation.

    Imagine this potential scenario. Dom and his wife are chatting up the CEO at a social occasion in September, 2 months after she became the CMO. Dom talks about how awesome USACS is and how much they'd love the contract. The CEO starts moaning about how those darn emergency docs are talking about getting a subsidy for the FSEDs. They decide, that maybe we'll just make sure the negotiation doesn't result in anything by making the terms so onerous those pesky SEA docs won't take them or they'll be giving me so much I can't tell them no. A handshake and they're off and running. Dom starts licensing docs for Ohio. The CEO starts looking in to how to credential a couple dozen docs in 7 hours. They delay the negotiation. They ignore a few emails. They make a few gestures that seem like negotiations. SEA smells a rat. A mole tells them Dom and the CEO have something up their sleeve but need a little more time for credentialing. Then "all of a sudden" negotiations break down and at midnight on the 1st, a residency program is nuked and 65 docs are out on the street with their jobs transferred into corporate medicine. Dom goes on a PR blitz to try to convince the world he's swooping in to save the patients and the residency program and never talks business with his wife.

    Not saying that's how it happened. Just saying I wouldn't be surprised to learn that's how it happened. Given my interactions with CMGs, I think that's the most likely scenario.
     
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  15. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    This is exactly what happened. The internal leadership academy that USACS/EMP runs for their physicians stresses the importance of "making connections". In this case the connection was already there, and they were just using it. Dominic is never one to admit a conflict of interest, or pass up an opportunity to make money or inflate his ego.
     
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  16. southerndoc

    southerndoc life is good Moderator Emeritus Lifetime Donor 10+ Year Member

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    I don't know why people keep bringing up USACS has trouble staffing because of credentialing process. Nearly every hospital has a clause that allows the CEO to give emergency credentials to a provider. I know this from sitting on a credentials committee. If the need is there -- such as in this case -- the CEO can grant credential privileges on a temporary basis (up to 60 or 90 days depending on bylaws). Licensure, however, is a totally different time frame and can take months. However, most large CMG's will have docs from multiple states licensed. Given that USACS is based out of OH, I'm sure they had quite a few Ohio-licensed docs to pull from.
     
  17. Petypet

    Petypet 7+ Year Member

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    They did. Also have some affiliated with residencies and they pulled faculty from those places too. However, they were all temporary and ACGME recognized it.
     
  18. MSmentor018

    MSmentor018 Hooah! SDN Advisor 10+ Year Member

    nice....the lesson is to wear plastic pants and to keep it in your pocket
     
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  19. MSmentor018

    MSmentor018 Hooah! SDN Advisor 10+ Year Member

    yeah good luck with that, I didn't know the galveston program closed when I applied back then. here's what they told me on the phone when I asked for my money back.

    "click"
     
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  20. doctalaughs

    doctalaughs Member 10+ Year Member

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    Seems to be that the docs were not totally powerless - after all, other docs in the system stood up a little for them and got the CEO fired. While they wont likely get their jobs back wouldn't this story give other CEOs pause?


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  21. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    The first and second year class probably has a viable class action lawsuit....
     
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  22. NYEMMED

    NYEMMED Member 7+ Year Member

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    Probably has a mandatory arbitration clause in their contracts which bans class action lawsuits...
     
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  23. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    Not really possible. A lawyer would require a retainer, and take 30-50% of damages. What were the actual monetary damages to residents? Assuming they all find new residency spots and don't lose training time, their monetary damage is minimal. I doubt moving/relocation expenses would cost more than the $100K it generally costs to go to litigation like this.
     
  24. RustedFox

    RustedFox We're all stars now. In the GOAT RODEO. 10+ Year Member

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    Land of Eternal Summer

    - Sorry ?

    Haven't followed this story in a touch.
     
  25. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    3-5k moving. 2-4K first, last month and security deposit. Anyone who lost money on a home they bought. Plus any non-monetary damages - picking summa for family reasons and having to pick up and move to a different part of the country.

    I don't know, if just try to find a way to screw the guys who screwed them over.
     
  26. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner SDN Moderator 10+ Year Member

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    You let me know when another group that's screwed over by a CMG wins their suit first.
     
  27. GeneralVeers

    GeneralVeers Globus Hystericus 10+ Year Member

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    Revenge lawsuits are pointless. Want to spend 2 years, and tons of work to go through the process for minimal gain? When contemplating one of these suits it is probably better just to suck it up, move on, and think about other things.
     
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  28. Wolff313

    Wolff313 7+ Year Member

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    Are there any interviewees that are a little perplexed as to "Continuing Accreditation," title there?
     
  29. EKGdoc

    EKGdoc 2+ Year Member

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    Summa PD notified us on CORD (Council of EM Residency Directors) listserve today that they are withdrawing from the match this year. Right thing to do but difficult decision.
     
  30. Wolff313

    Wolff313 7+ Year Member

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    Thanks for the quick response. I interviewed there for IM and recently received a letter discussing the status. I posted in this particular thread because there hasn't been an discussion in IM, although people have interviewed there (per the IM interview thread). It stated that the EM department and Summa Health (sponsoring instutition) were filing an appeal to prevent being on probation. Although the other programs remain, I was just wondering what the ultimate status would be if they lose the appeal and are on probation long term.
     
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  31. shoal007

    shoal007 2+ Year Member

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    i would rank this program low on my list. although the IM program is less likely to go under, its certainly a risk not worth taking.

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  32. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    If you're asking what impact it will have on you as an IM resident there, the answer is "little to none, other than likely mediocre teaching during your EM month(s)".
     
  33. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    Yes and no. It probably means nothing - but if your hospital politics are that screwed up, there may be systemic dysfunction.
     
  34. Petypet

    Petypet 7+ Year Member

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  35. filhodeinferno

    filhodeinferno 7+ Year Member

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    Could this be any more similar to what is described in the book 'The Rape of Emergency Medicine'?
     
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  36. TimesNewRoman

    TimesNewRoman 2+ Year Member

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    "Sorry we ruined your career plans, but here's three types of popcorn - you'll probably only give away one of them!" Lolz

    Also, shouldn't there be a divider between the three types of popcorn? What type of God-forsaken heathen mixes butter, cheddar and caramel corn?
     
  37. shoal007

    shoal007 2+ Year Member

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    people from chicago

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  38. HooliganSnail

    HooliganSnail 5+ Year Member

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    This is the deep dark problem with the ACGME. It acts like it wants to look out for the residents, but it's only actions are to completely screw those same residents over.

    Problem....staff turnover about an ED contract. ACGME is concerned it may not represent a "great learning environment" for those residents.

    Solution: End the residency.

    Result: Old group loses contract....they are all BC attendings and will find another job next week. They may have to move, but they will be fine. The 1st and 2nd year residents are completely screwed over. No one else has the funding to take them on, they are completely screwed. Huge debt, can't make any damn money, and likely very few prospects to actually complete their training.

    Thanks ACMGE. I am sure the program would have been just fine if they gave them time to sort it out, but NOOOOOOOO, they have to completely F*ck everyone over.
     
  39. Bouddha

    Bouddha 7+ Year Member

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    I'm not sure you understand the situation. If the ACGME believes the resident as it exists now is inadequate, it shuts down the residency, but the residents aren't left jobless.

    Apparently dozens of residencies have offered to help these residents, and with "orphan" status, they are effectively a free resident with funding, for any program willing to take them.

    How is allowing the residents to transfer to a stable program "screwing" them over?
     
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  40. Old_Mil

    Old_Mil Senior Member 10+ Year Member

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    While I feel bad for the residents, this was really the only realistic move for the ACGME to make. After all, Summa basically fired all the attendings.

    If they hadn't acted in this way, it would have called into question the validity of postgraduate medical training in general, and EM training specifically.

    As for the residents - and those of you going through the match process right now - let this be a lesson about how the world of Emergency Medicine really works. Reconsidering your options may be in order. Certainly you should think twice before ranking a residency program that corporate medicine or a CMG has its fingerprints on.

    For medical students considering a residency outside of Emergency Medicine, this is a window to the soul of how Summa works in general. Do you want to risk all the time and effort you have put into become a doctor in this sort of an environment?
     
  41. pkwraith

    pkwraith 5+ Year Member

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    How is the old group losing contract the result of the probation/suspension? It's completely backwards.
     
  42. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

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    Of course, neither corporate medicine nor a CMG had its fingerprints on Summa when the residents there applied, interviewed, or started their residencies.

    When emergency docs refuse to work for CMGs, CMGs will cease to exist. Even if only some emergency docs refuse to work for them, at least the ones left behind will be paid some ridiculous amount to work for them. The more emergency docs refuse to work for CMGs, the better the lives of all emergency doctors become. Once the CMGs can't staff EDs, it will be easier for a group of docs to get together, form a small democratic group, and take the contract from the CMG.
     
  43. emergentmd

    emergentmd 7+ Year Member

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    This will only happen when EM docs have options. When the Option is CMG A vs CMG B vs Hospital employee then there isn't much of an option. Its not like 20 EM docs can go into a city and gain the contract.

    We all should work towards giving EM docs options and the only option that is putting fear in CMGs/Hospitals is Freedom for EM docs. The only path is if EM doc owned FSEDs my friends..... All EM docs should lobby and promote this. Otherwise, you are promoting indentured servants.

    You bet that Surgeons would never stand for losing their option for independence and opening their own business.
     
  44. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

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    Sure they can. Why can't they? If a CMG is putting crummy docs in an ED, the patients hate them, the med staff hates them, the hospital's liability is rising, shifts are going uncovered, wait times are going up and a doc strolls in and says "I can bring in a small group of docs, we'll have every shift covered, the med staff will love us, your liability will go down, our patient satisfaction can only go up" then the CEO will go for it. In fact, they can do the same thing CMGs do- cherry pick the good docs and get them to join the group. If you were in a CMG and wanted to stay in the town and had the opportunity to own the group, wouldn't you want to do that? Of course.

    The only way CMGs can stay in business long-term is for them to treat the doctors so well that the doctors would rather work for a CMG than for themselves. Otherwise, eventually, this trend will reverse.
     
  45. emergentmd

    emergentmd 7+ Year Member

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    This is so Unicorn. There are so many barriers for docs to take over a CMG contract, I don't even know where to begin. I can see your point on many of your posts, but this is so far from the truth.

    The Hospital may be sick of the CMG and potentially asks some docs to fill the void, but even then the amount of behind the scene work would be insurmountable.
     
  46. HooliganSnail

    HooliganSnail 5+ Year Member

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    If their funding magically follows them, they will fine.

    That was not how I understood these things to occur.
     
  47. HooliganSnail

    HooliganSnail 5+ Year Member

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    QUOTE="pkwraith, post: 18702806, member: 391939"]How is the old group losing contract the result of the probation/suspension? It's completely backwards.[/QUOTE]


    You misunderstood what I mean. The old group losing the contract is what led to the residency being shut down....

    The attending physicians are going to be just fine. They can work almost anywhere, for lots and lots of money. If need be to make ends meet, they can fly into rural somewhere and make $300/hr while they figure out their next career move. They will be just fine. Hell, most of them will be offered contracts with USACS...

    My point is that the biggest losers here, by far, is the residents. They are the ones whose lives are completely turned upside down. Now, it seems that may be able to be picked up by someone else, so at least they can finish their training, but they still have to move.

    What do they do if they are in the middle of a lease, most buy outs are two months rent. What if they have spouses and children? What if they actually bought a damn house? It is not so easy to just pick up your life, especially when you don't have that much money lying around for moving expenses.
     
  48. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    Then you understood incorrectly. If a program shuts down midway through, any current resident is considered an orphan and any program that picks them up gets their funding as well.

    It's not magical, it's the rules.
     
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  49. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Partner Organization 10+ Year Member

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    While it might not be the overall trend, there are contracts that go CMG --> SDG. It does occur. And if CMGs don't take care of both their employees and their customers (the hospital systems) there could be more. I'm about as pessimistic as you about the trend actually reversing, but it is in the control of the docs. We are the scarce commodity, not the CMG.
     
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  50. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner SDN Moderator 10+ Year Member

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    Yeah, so what other times has it happened and they didn't get funding?
    There was MLK, UTMB, and now Summa.
     
  51. WilcoWorld

    WilcoWorld Senior Member 10+ Year Member

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    Are you saying that funding did not follow residents in all of the above cases?
     

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