TeamHealth Contract Negotiations and Revisions

[Groove]

I haven't had a bad experience with TH yet. Our hourly is the highest in the region and state. We used to have a larger RVU component that got paid every quarter but now it's been switched to pure hourly at one site and a very small monthly RVU component at another site. After miserable experiences with RVU centric Apollo (especially during COVID), I welcomed the increased stability in a more fixed hourly rate but I also question whether it will breed increased clinician laziness. Luckily, we've got a fairly motivated younger crew but the only real reason to hustle these days would be job security I suppose. Which is a valid reason to produce in this day and age...

In my experience, none of the major CMGs will negotiate very much on the contracts and you never want to be the problem doc that has a million requests for change on your contract. They are more likely to just cut you loose and hire some other new grad that wants the job. Honestly, it's the CMG contracts that are fairly standard and I don't worry about as much. I'd be more apt to spend money on a good contract attorney for a bizarre hospital employee contract and/or SDG contract. Those can be very unique and obfuscated with strange clauses and wording. The CMG contracts are fairly straightforward. Like someone said earlier, you're more likely to be successful negotiating incentive bonuses with the CMG or hourly rate as a nocturnist or locums than with anything else.

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[GonnaBeADoc2222]

I haven't worked in an hourly position yet. Don't you find it challenging to work with other lazy docs who won't see their fair share?

Yup. That component sucks.

 

[emergentmd]

Only place I would work strictly rate is single coverage or Locums. Even with single would suck if I walked into a place with 10 people every time and when I leave its empty.

 

[cyanide12345678]

Recent negotiation that happened with team health.

I asked for 280/hr for 2 shifts a month at a critical access with 14k volume and 9 hours of mlp support.

They said they can only give 280/hr if i do 4 shifts. And 260/hr if i do 2.

I said no thank you.

Will see if they change their mind. Otherwise life moves on.

Though the point is - they definitely negotiate.

 

[emergentmd]

If you are happy $280/hr, you should have have asked for $325-350/hr. They have a maximum they don’t want to go over, don’t give them the opportunity to lower the maximum.

Desperate sites have rates all over the place. I remember when I was in the locums game, their max bonus was never their max bonus.

 

[NYEMMED]

If you are happy $280/hr, you should have have asked for $325-350/hr. They have a maximum they don’t want to go over, don’t give them the opportunity to lower the maximum.

Desperate sites have rates all over the place. I remember when I was in the locums game, their max bonus was never their max bonus.

Best Locums rate Ive ever got was $1,000 per hour. The company was desperate, they had nobody to fill shifts and were about to lose their contract.
Then COVID hit....

 

[dchristismi]

Some TH recruiter some some major cohones just TEXTED me. At 5:20 pm. With an overtly cheerful "Welcome to TeamHealth Messaging..." And proceeded to invite me to enjoy full benefits and a newly increased sign-on bonus for coming onboard at their Advent sites in Orlando.

I managed to refrain from cursing, but made it clear I wouldn't be working for a company who'd ripped me off and didn't pay me the RVUs they'd rightly owed me that I'd only partially recovered through a lawsuit.

Same recuiter sent me the same very cheery email earlier today. And obviously, she can go to hell.

We went live with a new EMR today, so I'm in a VERY good mood. Not. (F-bombs raining down all day. And I'm touchy feely at baseline.) You all know the feeling.

 

[thegenius]

Some TH recruiter some some major cohones just TEXTED me. At 5:20 pm. With an overtly cheerful "Welcome to TeamHealth Messaging..." And proceeded to invite me to enjoy full benefits and a newly increased sign-on bonus for coming onboard at their Advent sites in Orlando.

I managed to refrain from cursing, but made it clear I wouldn't be working for a company who'd ripped me off and didn't pay me the RVUs they'd rightly owed me that I'd only partially recovered through a lawsuit.

Same recuiter sent me the same very cheery email earlier today. And obviously, she can go to hell.

We went live with a new EMR today, so I'm in a VERY good mood. Not. (F-bombs raining down all day. And I'm touchy feely at baseline.) You all know the feeling.

I'm getting similar emails and texts. F TH. Such a crummy company. They will lower your pay as much as possible. They have no desire for doctors to make what they earn, like all CMGs.

 

[alphaholic06]

Some TH recruiter some some major cohones just TEXTED me. At 5:20 pm. With an overtly cheerful "Welcome to TeamHealth Messaging..." And proceeded to invite me to enjoy full benefits and a newly increased sign-on bonus for coming onboard at their Advent sites in Orlando.

I managed to refrain from cursing, but made it clear I wouldn't be working for a company who'd ripped me off and didn't pay me the RVUs they'd rightly owed me that I'd only partially recovered through a lawsuit.

Same recuiter sent me the same very cheery email earlier today. And obviously, she can go to hell.

We went live with a new EMR today, so I'm in a VERY good mood. Not. (F-bombs raining down all day. And I'm touchy feely at baseline.) You all know the feeling.

Got the same email about a week ago. Then she texted me to make sure I saw the email.

 

[RustedFox]

Some TH recruiter some some major cohones just TEXTED me. At 5:20 pm. With an overtly cheerful "Welcome to TeamHealth Messaging..." And proceeded to invite me to enjoy full benefits and a newly increased sign-on bonus for coming onboard at their Advent sites in Orlando.

I managed to refrain from cursing, but made it clear I wouldn't be working for a company who'd ripped me off and didn't pay me the RVUs they'd rightly owed me that I'd only partially recovered through a lawsuit.

Same recuiter sent me the same very cheery email earlier today. And obviously, she can go to hell.

We went live with a new EMR today, so I'm in a VERY good mood. Not. (F-bombs raining down all day. And I'm touchy feely at baseline.) You all know the feeling.

1. Whoa.
2. What EMR?

 

[Brigade4Radiant]

Best Locums rate Ive ever got was $1,000 per hour. The company was desperate, they had nobody to fill shifts and were about to lose their contract.
Then COVID hit....

What state was this?

 

[Boatswain2PA]

Finally they will frequently update the way they calculate your RVU pay. It usually always benefits Teamhealth when they do…

USUKS does the same thing.

 

[dchristismi]

1. Whoa.
2. What EMR?

1. Yeah, I know.
2. An obscure ancient one that doesn't integrate with pharmacy. That is backwards and demands nurse ordering. It's so 20 years ago. Hence it was kind of nice to have a TH recruiter to unload on. It's a "pilot." Hopefully when upper management realizes it's an utter disaster (I've already found mismatched ICD codes), they will realize their error and not subject other regions to it.

But I'm just drinking tonight.

 

[thegenius]

🍹🍻

 

[NYEMMED]

What state was this?

Oklahoma

 

[collegestud2013]

My advice is the following. Get together with your group. None of you sign the contract as-is. All of you begin working on part-time/PRN credentialing elsewhere. Split the cost of a good contract lawyer. After review, you all submit the contract back to your employer with your recommended changes, with the intention to work elsewhere if they do not concede.

This is the only way to get them to make changes. It is very effective, but the most difficult part is getting your group on the same page.

This. Physicians can have a good deal of leverage in these situations when there is a change in employer. Clinical care doesn't stop during these transitions, and it's very hard to have a smooth transition if everyone leaves and they have to recruit a whole new group of people from scratch. At many hospitals, the credentialing would not even get done fast enough in 3 months, let alone the rest of the recruiting process. The last thing the new CMG and the hospital wants is to have a major understaffing problem and having to close part of the ED if most of the group doesn't sign and leaves for somewhere else. This is especially the case in a high-demand specialty or in an geographic area that's difficult to recruit, but might be harder in EM given that the job market is more saturated now.

 

[JacobMcCandles]

This. Physicians can have a good deal of leverage in these situations when there is a change in employer. Clinical care doesn't stop during these transitions, and it's very hard to have a smooth transition if everyone leaves and they have to recruit a whole new group of people from scratch. At many hospitals, the credentialing would not even get done fast enough in 3 months, let alone the rest of the recruiting process. The last thing the new CMG and the hospital wants is to have a major understaffing problem and having to close part of the ED if most of the group doesn't sign and leaves for somewhere else. This is especially the case in a high-demand specialty or in an geographic area that's difficult to recruit, but might be harder in EM given that the job market is more saturated now.

This is great in a theoretical world. In the real world, many physicians can't go without a paycheck for very long. It only takes one for the dominoes to start falling. People talk pretty tough about these kinds of situations but when the cards are on the table you'll find that it was nothing but talk.

 

[Mount Asclepius]

In the real world, many physicians can't go without a paycheck for very long.

This is what people often say, but I haven’t ever encountered it to be truth. I’ve had 3+ (and now vastly more) years of savings/liquidable emergency fund since the day I graduated from residency. Our group is very FIRE/retirement focused so perhaps I’m biased. Within just a few short years though we all have significant savings. If you can’t go very long without a paycheck (more than 1-2 years), then you are doing something wrong and living well beyond your means. I don’t doubt this happens. However, I haven’t seen it in the countless emergency physicians that I know.

 

[JacobMcCandles]

This is what people often say, but I haven’t ever encountered it to be truth. I’ve had 3+ (and now vastly more) years of savings/liquidable emergency fund since the day I graduated from residency. Our group is very FIRE/retirement focused so perhaps I’m biased. Within just a few short years though we all have significant savings. If you can’t go very long without a paycheck (more than 1-2 years), then you are doing something wrong and living well beyond your means. I don’t doubt this happens. However, I haven’t seen it in the countless emergency physician that I know.

You're also going to have a selection bias. Do you think docs who are living paycheck to paycheck are going to be very vocal about it?

Also, why would you have 3+ years of liquid savings? Are you counting investments as liquid savings? Taxable is technically liquid but I don't consider it as part of my EF. Or is this a Bogleheads EF thread where people say I've got 3 months expenses of cash, 3 months expenses of treasuries, 18 months expenses of bonds, and so on while counting things that aren't meant to be an EF?

 

[turkeyjerky]

This is great in a theoretical world. In the real world, many physicians can't go without a paycheck for very long. It only takes one for the dominoes to start falling. People talk pretty tough about these kinds of situations but when the cards are on the table you'll find that it was nothing but talk.

Is it 3-6 months w/o a paycheck, or the black mark on your CV from a gap that long? I could easily tolerate (hell, most days would welcome it) the former, but wouldn't risk the latter...

 

[NYEMMED]

Is it 3-6 months w/o a paycheck, or the black mark on your CV from a gap that long? I could easily tolerate (hell, most days would welcome it) the former, but wouldn't risk the latter...

I think you could probably go a year with a good explanation, for the CV

 

[JacobMcCandles]

Is it 3-6 months w/o a paycheck, or the black mark on your CV from a gap that long? I could easily tolerate (hell, most days would welcome it) the former, but wouldn't risk the latter...

If you’re trying to get hired by a CMG and you explain that you hate CMGs and explain the situation honestly then they probably wouldn’t be a fan. If you did the same during an interview with a SDG then you’ll probably get bonus points.

 

[GatorCHOMPions]

I think you could probably go a year with a good explanation, for the CV

I went a year without EM due to fellowship and restarted without a hitch.

 

[turkeyjerky]

I think you could probably go a year with a good explanation, for the CV

If you’re trying to get hired by a CMG and you explain that you hate CMGs and explain the situation honestly then they probably wouldn’t be a fan. If you did the same during an interview with a SDG then you’ll probably get bonus points.

Interesting. Hope you guys are right. However, personally, I wouldn't risk it w/ the current situation and the number of grads coming out ever year. I mean, if I were hiring someone and the choice was someone who'd be unemployed for a year b/c they claim they were sticking it to the man vs a shiny new grad w/ a clean record and good references I'd probably go for the latter.

I went a year without EM due to fellowship and restarted without a hitch.

I think it's a little different w/ regard to completing a fellowship...

 

[JacobMcCandles]

Interesting. Hope you guys are right. However, personally, I wouldn't risk it w/ the current situation and the number of grads coming out ever year. I mean, if I were hiring someone and the choice was someone who'd be unemployed for a year b/c they claim they were sticking it to the man vs a shiny new grad w/ a clean record and good references I'd probably go for the latter.

Here’s my n=1 but I’m not convinced COVID didn’t stunt the learning of those who did residency during the COVID era. As a whole, the new grads I’m familiar with don’t seem as well prepared or comfortable with a busy community ED. Again, just my personal experience. Right now we’d much prefer someone with experience over a new grad.

 

[Mount Asclepius]

You're also going to have a selection bias. Do you think docs who are living paycheck to paycheck are going to be very vocal about it?

Also, why would you have 3+ years of liquid savings? Are you counting investments as liquid savings? Taxable is technically liquid but I don't consider it as part of my EF. Or is this a Bogleheads EF thread where people say I've got 3 months expenses of cash, 3 months expenses of treasuries, 18 months expenses of bonds, and so on while counting things that aren't meant to be an EF?

The income and monthly paycheck of an EP is significantly higher than the average individual. You really should be able to make a single paycheck stretch at least 3 months in comparison to those that truly live paycheck to paycheck. If you can't do that then it's a spending issue.

I don't have 3 years of cash on hand, nor would I want to. Although I could stretch 3-6 months of available cash out to 1-2 years by becoming even more frugal if demanded. I count post-tax investment accounts as liquids savings. I have instant access to those funds if needed. I agree that they're technically not my emergency fund though.

As time goes by on the path to eventual retirement (possibly FIRE) you should have increasing amounts of multiple sources of available funds that are at varying levels of accessibility possibly including cash, CDs, real estate, post-tax investment accounts, IRA, 401K, for our group a CBP, and also eventually SS if still around.

I'll just leave it at that and am thankful for my selection bias as a partner in a SDG. We talk regularly as partners. None are living paycheck to paycheck. Some aren't as well off, primarily due to a prior divorce. Others are better off than I am, primarily due to a spouse also with a high income stream.

 

[Apollyon]

Anesthesiology and EM - one or fewer houses, one or fewer spouses!

 

[emergentmd]

most EM docs should be able to survive. Go telemedicine alittle if you need. Go do UC. Most think they can't miss a paycheck b/c they want to continue to live a 500K lifestyle b/c they can't pull their kids out of privates or cancel their club sports.

But if push came to shove, they could sell their 1M home and live a few yrs.

I typically never had more than 2 months of cash on hand but at worse, I would sell some hard assets.