Teamhealth vs EMcare/Envision vs Schumacher vs USACS vs Vituity

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cyanide12345678

cyanide12345678

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Whose the worst CMG to work for in your opinion? Are they all the same, or is one worse than the others? How would you guys rank them in order of ascending awfulness?
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I haven't worked at all of them so unable to rank. I will say the compensation with Schumacher has been reasonable at all 3 sites that I've worked PRN. Same staffing issues as everyone else with you cosigning midlevel charts. No weird administrative pressures to work in a questionable way. Sites have all been more rural ones. EMRs have varied from good to terrible. Current CEO's annual speech centered on value based care, but was framed in a way that made me think my compensation would be decreasing (IMHO).
 
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Vituity is technically a large physician owned group. Individual sites get a lot of autonomy and can set their own pay structures, and if they are more profitable then hourly rates go up. No big shareholders or private equity firms that need to be fed on the backs of physician workers. Open books throughtout the group which is better than a lot of private groups. I work for them currently, have worked for a private small group with about 20 doc, as well as Team Health and academics. I like Vituity a lot, sort of feels like a small SDG with our 23 people locally but with some good central institutional support. A bit of administrative bloat, but many other SDGs have that as well and your admin contribution shrinks considerably as a portion of your overall production once you make it to full partner after 4 years. Team Health was also reasonable to work for due to a good medical director and pretty hands off approach but they had closed books and more top down structure and I kept feeling like I was missing out on reimbursement and wasn't paid all that well considering how busy it was at the shop. Team Health was 1099 at the time with little opportunity for advancement out of per diem pit doc role and I didn't like the feel overall and I do consider them a true CMG. Ironically I got screwed worst by the small group which has closed books, missed bonuses as soon as it became clear I was going to leave the group, obtuse partnership advancement structure with a few needless roadblocks to keep full partner numbers lower and maximize their profit sharing.

Overally Vituity>Team Health. I have some peers with BAD USACS experiences but not sure how representative those were.
 
Just started with Vituity at a new contract. So far I've only worked 3 shifts, but it will be interesting to compare with Envision and USACS. I'm optimistic, as I do know people who have worked with them for years, and have good things to say.
 
Mbekweni said:
Open books throughtout the group which is better than a lot of private groups. I work for them currently, have worked for a private small group with about 20 doc, as well as Team Health and academics. I like Vituity a lot, sort of feels like a small SDG with our 23 people locally but with some good central institutional support. A bit of administrative bloat, but many other SDGs have that as well and your admin contribution shrinks considerably as a portion of your overall production once you make it to full partner after 4 years.
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Interesting. Don't know much about Vituity. So the company is solely owned by the docs without any umbrella/shell set ups?

So you see open books from the whole group or just your site? What do you have to do to make partner? By what percent does your pay increase after you make partner? Are there different levels of partners? Does your local group have control over your own staffing and scheduling changes?
 
namethatsmell said:
Interesting. Don't know much about Vituity. So the company is solely owned by the docs without any umbrella/shell set ups?

So you see open books from the whole group or just your site? What do you have to do to make partner? By what percent does your pay increase after you make partner? Are there different levels of partners? Does your local group have control over your own staffing and scheduling changes?
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Excellent and important questions! Vituity (formerly CEP) is definitely the most democratic of the groups listed, with at least a well-defined partnership track and ownership. Don't know the answers to your questions, and don't know how it translates to the docs on the ground.
 
Real issue is vituity lacks the ability currently to benefit from site specific set ups. I met their chairman and he acknowledged this issue.

Their chargemaster and contract are all based on California rates which are pretty bad. They are by all accounts the fairest of the ones listed.

I think USACS is the biggest POS of all the EM groups. Summa, stuff I know of in Texas, etc. They are pure trash.

USACS, TH, Envision are all private equity owned. APP is all debt financing but tons of non - ED docs as owners including their president. Note the leader of USACS now is no longer DBag but some business goon.

Vituity is the best BIG democratic group. That being said the pay isnt great for partners. I know a bunch. They are happy but their pay is not great. That being said they dont have debt and they dont bow to a private equity firm.

EFs list from crappiest to least crappy (Ill say vituity is acceptable).

USACS>Envision>TH>APP>Vituity
 
EctopicFetus said:
Vituity is the best BIG democratic group. That being said the pay isnt great for partners. I know a bunch. They are happy but their pay is not great. That being said they dont have debt and they dont bow to a private equity firm.

EFs list from crappiest to least crappy (Ill say vituity is acceptable).

USACS>Envision>TH>APP>Vituity
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Their pay seems decent actually, otherwise I wouldn't bother. I work with Envision in the same market and am paid ~ $300/hr. Vituity is very close to that, and say they will potentially raise it based on collections.
 
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I’m looking for a change of groups. How is Teamhealth to work for?
 
GeneralVeers said:
Their pay seems decent actually, otherwise I wouldn't bother. I work with Envision in the same market and am paid ~ $300/hr. Vituity is very close to that, and say they will potentially raise it based on collections.
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People I know seem happy enough working for them. Regarding the above.. They at this point have one chargemaster nationally and one agreement per insured nationally. California rates are generally bad and therefore the vituity contracts are generally bad. Veers, I obviously wish everyone the best. Would be curious if rates stay strong or if they drop.

Also obviously interested in what Envision had to say on their call. Last I heard they want to cut rates to the ED docs. Unsure if this is national or more regional.
 
EctopicFetus said:
Also obviously interested in what Envision had to say on their call. Last I heard they want to cut rates to the ED docs. Unsure if this is national or more regional.
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I'll get to this tomorrow. Exhausted. It was all about the "cost-containment measures" that "needed to be rolled out immediately".
We were all turbo-pissed.
 
RustedFox said:
I'll get to this tomorrow. Exhausted. It was all about the "cost-containment measures" that "needed to be rolled out immediately".
We were all turbo-pissed.
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I'd be pissed too. My last CMG used this as a lame excuse to slash doc staffing and up midlevel coverage. It was of course a lie and our site went from being in the black to just being more in the black to the benefit of none of us working stiffs.

While I hope they don't touch your guys pay, if they do perhaps a massive walkout of envision docs would offer clarity to the suits. Let the mba work the pit.
 
RustedFox said:
I'll get to this tomorrow. Exhausted. It was all about the "cost-containment measures" that "needed to be rolled out immediately".
We were all turbo-pissed.
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Makes me glad I quit my main Envision gig. The bonuses have certainly dried up in this past year, and the EMbassador new contracts are laughable and pathetic compared to what they offered 3-4 years ago. Unfortunately this is the future of EM as we get more and more grads competing for the same jobs.
 
GeneralVeers said:
Makes me glad I quit my main Envision gig. The bonuses have certainly dried up in this past year, and the EMbassador new contracts are laughable and pathetic compared to what they offered 3-4 years ago. Unfortunately this is the future of EM as we get more and more grads competing for the same jobs.
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Yes. I don't understand why students are choosing this field, and I think we all need to figure out our exit strategies. Open to suggestions on the latter...
 
RustedFox said:
I'll get to this tomorrow. Exhausted. It was all about the "cost-containment measures" that "needed to be rolled out immediately".
We were all turbo-pissed.
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If they have a ton of docs that quit, they may have to pay double what they're paying now.
 
southerndoc said:
If they have a ton of docs that quit, they may have to pay double what they're paying now.
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At least for 1-2 years, then there will be more grads from all the new programs to fill slots at $150 per hour supervising 4-5 midlevels at a time.
 
Exactly.

Envision isn't stupid.

There's been a total of 10 new EM residencies open in FL over the past 5 years. When they all start graduating residents its going to flood the market and they'll have no problem staffing their hospitals with Colorado rates of $150 per hour because it's Florida and you can live on the beach!
 
alpinism said:
Exactly.

Envision isn't stupid.

There's been a total of 10 new EM residencies open in FL over the past 5 years. When they all start graduating residents its going to flood the market and they'll have no problem staffing their hospitals with Colorado rates of $150 per hour because it's Florida and you can live on the beach!
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This is not the time to go into, or be in, EM.
 
Veil said:
+1 from a SDG partner.

EM is far from perfect. Unsure if would choose again. That said, you could do so, so much worse. Every rose has its thorn(s), pick your poison, etc.
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There are many parts of the country without any SDGs, and many parts of the country with only toxic SDGs. Prospective EM docs should look into the situation in their desired location BEFORE deciding on EM.
 
With a lot of doom and gloom going on here, I still think there are plenty of areas with excellent compensation, as long as someone is willing to move around and is open to location. But there is a surprising number of people willing to settle down for lower compensation. From my calculations my current residency attendings probably generate ~500-600/hr for a particular CMG based on the volume that they see (3.5-4.0 pph with every patient being seen by a resident). The CMG that runs this place pays like ~ 185/hr base rate. I can't believe how some of these guys with 10-40 years of experience don't ask for more.
 
cyanide12345678 said:
With a lot of doom and gloom going on here, I still think there are plenty of areas with excellent compensation, as long as someone is willing to move around and is open to location. But there is a surprising number of people willing to settle down for lower compensation. From my calculations my current residency attendings probably generate ~500-600/hr for a particular CMG based on the volume that they see (3.5-4.0 pph with every patient being seen by a resident). The CMG that runs this place pays like ~ 185/hr base rate. I can't believe how some of these guys with 10-40 years of experience don't ask for more.
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1. Those areas of the country are decreasing- look at Texas
2. Location is generally really important to people, and people with families generally want to settle down in one area

Caveat emptor, med students.
 
miacomet said:
1. Those areas of the country are decreasing- look at Texas
2. Location is generally really important to people, and people with families generally want to settle down in one area

Caveat emptor, med students.
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They are decreasing, agreed. But I think physicians generally suck at negotiation and sign for crappy rates. So even in these crappy areas with low salaries, you have individuals with significantly better contracts. Most of these places need docs. while these CMGs may keep saying "everyone's contract is the same", it's really now. If they are desperate enough, they'll pay a lot more. For example: I signed for 265/hr. I know docs at the same site signed up for 210-220/hr. That is where they started negotiations. They were desperate though.

I saw on a post here someone willing to work a 2.5 pph job for 150/hr. I mean that's ridiculous. I moon light at a 1 pph place for 170/hr. The places with high rates are decreasing, but some people are just not smart enough to know their worth and settle for less.
 
cyanide12345678 said:
They are decreasing, agreed. But I think physicians generally suck at negotiation and sign for crappy rates. So even in these crappy areas with low salaries, you have individuals with significantly better contracts. Most of these places need docs. while these CMGs may keep saying "everyone's contract is the same", it's really now. If they are desperate enough, they'll pay a lot more. For example: I signed for 265/hr. I know docs at the same site signed up for 210-220/hr. That is where they started negotiations. They were desperate though.

I saw on a post here someone willing to work a 2.5 pph job for 150/hr. I mean that's ridiculous. I moon light at a 1 pph place for 170/hr. The places with high rates are decreasing, but some people are just not smart enough to know their worth and settle for less.
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Once again, I just don't get the $150 an hour in the current market. You can make that as a nurse. You can make that at a government job. You can just about make that doing chart review. You can make that in UC or telehealth. All of these are lower liability. All of these are easier. It makes no sense, and it does show what terrible negotiators physicians are. Crazy.
 
miacomet said:
Once again, I just don't get the $150 an hour in the current market. You can make that as a nurse. You can make that at a government job. You can just about make that doing chart review. You can make that in UC or telehealth. All of these are lower liability. All of these are easier. It makes no sense, and it does show what terrible negotiators physicians are. Crazy.
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But it's like Denver MAAAN, marijuana is legal and they have mountains.
 
miacomet said:
Once again, I just don't get the $150 an hour in the current market. You can make that as a nurse. You can make that at a government job. You can just about make that doing chart review. You can make that in UC or telehealth. All of these are lower liability. All of these are easier. It makes no sense, and it does show what terrible negotiators physicians are. Crazy.
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It also comes down to area. If they have to be in one area due to various reasons, and that area is monopolized by one CMGs, then the rates will be low in that market
 
NYEMMED said:
It also comes down to area. If they have to be in one area due to various reasons, and that area is monopolized by one CMGs, then the rates will be low in that market
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Agreed. But I still don't see the point of accepting $150 an hour when there are easier, less stressful, lower-liability alternatives that are not place-dependent.
 
BoardingDoc said:
So does Canada. Plus you'll get paid better and have to chart less and worry less about getting sued.

(And yes, I know you were being sarcastic)
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I know a guy who left Texas for a job in Denver.

He now makes 1/2 of what he was making in Texas. And in Denver he "gets" to see 2.5pph.

I guess if you could live in the mountains and could enjoy them every day I could maybe understand taking a big pay cut (provided the hypothetical ED was uber-low volume). But that's the biggest farce about Denver...it's not in the mountains, it's next to them. And if you want to really access them to go skiing it's a 1.5-2+ drive away.

The cost:benefit ratio of living there is supremely out of wack for EPs.
 
namethatsmell said:
I know a guy who left Texas for a job in Denver.

He now makes 1/2 of what he was making in Texas. And in Denver he "gets" to see 2.5pph.

I guess if you could live in the mountains and could enjoy them every day I could maybe understand taking a big pay cut (provided the hypothetical ED was uber-low volume). But that's the biggest farce about Denver...it's not in the mountains, it's next to them. And if you want to really access them to go skiing it's a 1.5-2+ drive away.

The cost:benefit ratio of living there is supremely out of wack for EPs.
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The narrative matters more than the reality. Honestly I don’t get it. But I also know my view on things isn’t in line with most.
 
It seems like the very existence of CMGs is counter that physician anti-fee splitting laws. A potential fix for all of our problems would be to declare them illegal. Seems like the nuclear option is the only option.
 
TimesNewRoman said:
It seems like the very existence of CMGs is counter that physician anti-fee splitting laws. A potential fix for all of our problems would be to declare them illegal. Seems like the nuclear option is the only option.
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We can hope
They have lobbying power. They have money.
 
EctopicFetus said:
The narrative matters more than the reality. Honestly I don’t get it. But I also know my view on things isn’t in line with most.
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I guess some people also like living in tiny manhatten apartments and pay an exorbitant amount of money for those **** holes. That's something I'll never get either.
 
cyanide12345678 said:
I guess some people also like living in tiny manhatten apartments and pay an exorbitant amount of money for those **** holes. That's something I'll never get either.
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I lived in nyc prior to med school. Fun place. I had no kids.

Why would a sane human being want to live up there with a family is beyond me.

High taxes, cold weather, miserable people.

No offense to you northeastern types. I just totally don’t get it.

California isn’t for me either but I get SoCal and San Francisco.
 
EctopicFetus said:
I lived in nyc prior to med school. Fun place. I had no kids.

Why would a sane human being want to live up there with a family is beyond me.

High taxes, cold weather, miserable people.

No offense to you northeastern types. I just totally don’t get it.

California isn’t for me either but I get SoCal and San Francisco.
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I don't live in NYC, but some people HATE driving, and there aren't a lot of other options in the US. Other people have family in the area. The schools are better than most other places. But yes, it's a PITA.
 
I've never figured out NYC either or Denver. Why people want to live there. Both have terrible weather, and low pay. NYC has outrageous expenses, and taxes. For the amount I save on taxes, I could stay at the Park Hyatt NYC for 1 week every month including flights, and still have money left over for a Malibu beach vacation.
 
GeneralVeers said:
I've never figured out NYC either or Denver. Why people want to live there. Both have terrible weather, and low pay. NYC has outrageous expenses, and taxes. For the amount I save on taxes, I could stay at the Park Hyatt NYC for 1 week every month including flights, and still have money left over for a Malibu beach vacation.
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I have relatives, and grew up in, an expensive coastal city. While I'm miserable in my current location, I have come to the same conclusion re: cost of living. I can fly to said city and stay with my folks for a week or two a month at much lower cost than living there. But it's hard. Very hard. Not a happy situation, but unlike others in that locale, I don't have a trust fund and I'm the breadwinner.
 
Quick thread revival question. Am I correct to assume Vituity does not have 501c tax status, like most physician groups?
 
SDGs are for-profit, too. If you want a nonprofit to work for, you're going to have to do academic (most are employed, and most big academic hospitals are nonprofit), find a hospital that is nonprofit and employs physicians directly (not abundant), or work for the government (VA, military, IHS, etc.) Better option would be to just refinance and aggressively pay down the debt. PSLF doesn't seem to be working out for most people.
 
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