TeamHealth VS USACS

[Brioche]

Hello everyone,

New Grad soon to be Looking at jobs with these groups.

Highly desirable area (only two groups around)

Teamhealth is offering 180/hour base plus some RVUs as an independent contractor, 2.2 PPH

USACS is offering 160/hour as an employee plus benefits. 2.5pph


Just trying to see which company would be better from a compensation and happiness perspective

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[bravotwozero]

Both jobs seem terrible, but i suppose not everyone has options to move. I’d go with TH, employee benefits are overrated.

In Texas, $180/hr (flat) is what they pay for working at freestanding EDs, where you often see 1pph or less. At least they do for the ones staffed by our group.


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[Brioche]

Both jobs seem terrible, but i suppose not everyone has options to move. I’d go with TH, employee benefits are overrated.

In Texas, that’s what they pay for working at freestanding EDs, where you often see 1pph or less. At least they do for the ones staffed by our group.


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I understand that. I just have no ability to move my family right now. Since both companies have a market monopoly, the pay rates are horrible, just trying to see which is a better offer

It would be nice not to allow CMG monopolies over markets...

 

[Mbekweni]

Those are terrible rates. Fair market value is usually around $150 per patient in terms of collections minus 10-20% for overhead including admin, billing, malpractice etc. That of course has wide variability. My group is in the $160-200/pt collection range as a very good site, I have friends in groups seeing more Medicaid/uninsured and low acuity groups that are in the $90 per patient range. On average though, that means you should be expecting $260-300 per hour for those jobs. Since you aren't getting it, that is of course why TeamHealth, USACS etc are worth billions of dollars for shareholders. On average "benefits" are worth $15-20 per hour in my estimation. If you can't move I would look at Team Health as a better option from your two examples.

 

[Brioche]

Those are terrible rates. Fair market value is usually around $150 per patient in terms of collections minus 10-20% for overhead including admin, billing, malpractice etc. That of course has wide variability. My group is in the $160-200/pt collection range as a very good site, I have friends in groups seeing more Medicaid/uninsured and low acuity groups that are in the $90 per patient range. On average though, that means you should be expecting $260-300 per hour for those jobs. Since you aren't getting it, that is of course why TeamHealth, USACS etc are worth billions of dollars for shareholders. On average "benefits" are worth $15-20 per hour in my estimation. If you can't move I would look at Team Health as a better option from your two examples.

Thank you.

I agree the rates are terrible, I’m guessing that with 180/hour plus some RVUs I can at least get it to 200/hour with team health

 

[Psai]

Recent grad like midlevel school? Cause those are midlevel rates.

 

[alphaholic06]

Thank you.

I agree the rates are terrible, I’m guessing that with 180/hour plus some RVUs I can at least get it to 200/hour with team health

Have seen the RVU fomula? I wouldn't count on that getting that bonus for long.

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[Brioche]

They claim it’s a pot of RVUs generated by all providers over the month and we are paid the % out of that pot of the RVUs were generated (if you generated 15% of the RVUs you get 15% of the pot)

 

[bravotwozero]

That is exactly how it works at my shop. Our base pay/floor is $180/hr, plus night shift differentials that are also paid out of the RVU pot. That said, our docs average well above $180/hr with rvus, the median being ballpark $250/hr in a place with scribes, MLP coverage, and 1.8-2.2 patients per hour.

 

[Brioche]

That is exactly how it works at my shop. Our base pay/floor is $180/hr, plus night shift differentials that are also paid out of the RVU pot. That said, our docs average well above $180/hr with rvus, the median being ballpark $250/hr in a place with scribes, MLP coverage, and 1.8-2.2 patients per hour.

TeamHealth recruiter did mention the majority make in the 220-240 range after RVUs. I just find it hard to believe recruiters.
I imagine the Teamhealth spot would in theory pay more over the USACS spot. But would the increased taxes and expenses as an independent contractor not make it worth it?

 

[bravotwozero]

That's not too bad, assuming you're not being lied to. See if you can press for some kind of documentation/figures to prove it, though I doubt you'll get anywhere. IC is still worth it imo, the higher hourly usually more than makes up for any missed benefits, for most people. Also, don't take the sign on bonus if you can, and see if you'll get a 1 year contract instead of two, so you're not trapped if it turns out to be a terrible place to work.

 

[dchristismi]

I also worked a TH gig with a similar setup. I left for a variety of reasons, but they did pay the RVUs. Some months were better than others, but I stayed there longer than I did with USACS... Being an IC was incredibly liberating for me, and the business deductions help considerably although it does make your taxes more complicated.

 

[EctopicFetus]

Both are trash but the sticky bottom of the waste basket is DBag and usacs.

 

[doctalaughs]

I paid my plumber 160 an hour the other day. And when he f-ed up and my sink leaked all over the floor he came back and said “oops, my bad,” and shrugged his shoulders.

Sad... this is what medicine has become.

 

[thegenius]

the TH one sounds like a better job. Make a little more and don't see as many patients/hr.

Just keep looking for jobs though. Don't settle for one of these and give up. Always look, you'll find better than the shhiitt CMG jobs out there.

 

[miacomet]

Since TH and USACS are both a gateway for evil, I would probably go with TH because (as the ever-wise Christismi points out), it's better to be an IC when dancing with the devil. As an exempt employee with USACS, you can be asked/forced to work unpaid overtime, have your schedule changed at the last minute, and get stuck with a 90 day out clause. As an IC, you can gently remind TH that legally you make your own schedule and have to be paid for when you work and you won't have an out clause and can leave at anytime. I think employed jobs with the CMGs are the WORST gigs around.

In a desirable area, >$200 an hour is a decent gig as long as the working conditions and patient/staff safety concerns are OK. If both jobs turn out to be nasty and neither reaches at least $200 an hour, I would recommend doing some IC work for TH (like a shift a week) and then supplementing with telehealth, urgent care etc where you can make a similar wage with less liability and fewer headaches. You'll keep your skills, earn the same, and minimize stress.

 

[GTP]

What if the IC job is $275 per hour and w2 is 265$ an hour ? All other things being equal

 

[miacomet]

What if the IC job is $275 per hour and w2 is 265$ an hour ? All other things being equal

Then you have two well-paying options and should be delighted!

 

[gamerEMdoc]

2.5 pt/hr for $160/hr as a new grad? Seems like high expectations for a new graduate, and very little incentive to work like that.

 

[deleted547339]

Dude. I’m in academics and I make more than that....

 

[miacomet]

2.5 pt/hr for $160/hr as a new grad? Seems like high expectations for a new graduate, and very little incentive to work like that.

Sounds like they make more than that with RVUs. I agree the structure is screwy and that the base should be higher, esp for 2.5 pph.

 

[emergentmd]

Has ER medicine really gone this low? Why would anyone take such a job?

For $160/hr, I would expect to see at most 1 pph. I knew that HI was about this low, so hopefully you are on the beach enjoying life with this type of stressful job.

 

[miacomet]

Has ER medicine really gone this low? Why would anyone take such a job?

For $160/hr, I would expect to see at most 1 pph. I knew that HI was about this low, so hopefully you are on the beach enjoying life with this type of stressful job.

It sounds like it's really the mid 200s per hour with RVUs, but I agree that the structure is annoying with such a low base.

 

[cyanide12345678]

TH is the better job for sure. IC does mean you pay your own FICAA but you can have some extra deductions (think mileage, home office, home internet, health insurance premiums, disability insurance premiums, and you can place a significantly higher portion of your salary towards retirement (upto 55k annually). If you have a spouse that works, then the benefits are hardly worth 10/hr.

Usacs job sounds absolutely terrible. Does it come with a sign on at least? Just to give you context of how terrible 160/hr for 2.5 pph ($64/pt seen), I moonlight at a place with 170/hr and see about 1 pph. And another place on average I see 10 pts in 24 hours at $130/hr ( ~ 0.4 pph). USACS probably pockets about $85 and pays you $64 for every patient you will see and do all the work for and take all the liability for.

Team job of seeing 2.3 doesn't sound all that great either, but it's better. I'd pick that over the USACS job option any day.

 

[gamerEMdoc]

I make 185/hr, see about 2.3/hr, and residents see 90% of those patients. I can moonlight at a place that averages about 0.75/hr overnight, sometimes less, for 185/hr. It's frankly robbery that anyone would pay an ED doc 160/hr to see 2.5/hr, I don't care what the rest of the benefits are.

 

[miacomet]

I make 185/hr, see about 2.3/hr, and residents see 90% of those patients. I can moonlight at a place that averages about 0.75/hr overnight, sometimes less, for 185/hr. It's frankly robbery that anyone would pay an ED doc 160/hr to see 2.5/hr, I don't care what the rest of the benefits are.

I agree that $160 an hour is highway robbery, but is that their average hourly, or is there an RVU component like the TH job?

Honestly, unless you work in Hawaii on the beach, like literally on the beach, I just can't wrap my mind around less than $200 an hour for EM (the 0.75 pt an hour job being the exception here), residents or no. It's just not worth it. I'd rather stay home, or prescribe Z-packs at an UC, or do telehealth, or work in Canada or Australia (where they appear to pay a living wage with less liability), or catch up on my Star Trek backlog.

 

[EctopicFetus]

With the proliferation of ED residencies and the scooping up of groups by CMGs they will set the market and you will have no choice. If you are an SDG you can sit back and enjoy the spoils and feel sad for the fools who do a residency at an HCA/CMG site cause they are prepping those suckers for a life of indentured servitude.

 

[cyanide12345678]

How do these new residencies keep springing up? I always thought that Medicare wouldn't be increasing funding for new programs to pay an increasing number of resident salaries.

 

[miacomet]

How do these new residencies keep springing up? I always thought that Medicare wouldn't be increasing funding for new programs to pay an increasing number of resident salaries.

I don't think they are funded by Medicare, are they? Aren't they funded by the CMGs themselves?

 

[thegenius]

Agree with everything being said. You should be making about $100/pt seen (maybe more), and seeing 2.5 pts/hr is very hard to do for anyone, just results in ordering a bunch of needless tests, admitting people that don’t need to be admitted, and working yourself to death.

 

[Dr Mantis Toboggan]

My understanding with Envision/EmCare is that they took a huge number of unprofitable hospitalist contracts to land the ED contracts as well. These are huge anchors on the finances, even with their poor wages and jacked up charges.

 

[gamerEMdoc]

How do these new residencies keep springing up? I always thought that Medicare wouldn't be increasing funding for new programs to pay an increasing number of resident salaries.

The funding is applied for when the hospital starts its gme programs. Once a hospital is given a specific number of gme spots, regardless of program, thats all they get. You cant apply for more funded spots in the future even if you open more programs later.

Many places are therefore well over their medicare funded spots, and fund some of their gme via dept budget.


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[emergentmd]

I suspect it is more financially beneficial to CMGs to open new residencies if they have to fund it themselves, otherwise they will not waste their time.

If it costs X to open a residency and it is cheaper than fighting the shortage, they will continue to open them until it is not financially advantageous. It is just sad how a CMG can affect supply and demand so easily. I bet the could open 100 more, easily fill them all with US grads + Foreign Grads which will flood the market in 10 yrs.

 

[Brioche]

I agree that $160 an hour is highway robbery, but is that their average hourly, or is there an RVU component like the TH job?

Honestly, unless you work in Hawaii on the beach, like literally on the beach, I just can't wrap my mind around less than $200 an hour for EM (the 0.75 pt an hour job being the exception here), residents or no. It's just not worth it. I'd rather stay home, or prescribe Z-packs at an UC, or do telehealth, or work in Canada or Australia (where they appear to pay a living wage with less liability), or catch up on my Star Trek backlog.

For USACS it is a flat rate, no additional bonus. Teamhealth has productivity and RVU bonuses on top of their hourly rate so most are making about $240 per hour if they meet both of those.

Honestly it’s a CMG dominated market so the rates are lower as there is no competition, they know the other groups offer and won’t increase or negotiate.

Also if I was to take another type of job for now I guarantee not doing EM again. Nobody is going to higher somebody with no EM work experience in the last 1-2 years. Not with a constant stream of residency grads to fill the spot

 

[RustedFox]

Nobody work for USASSKISS.
Just forget it.
What they've done and what they do is unforgivable.
Let them die.

 

[suckstobeme]

So can any CMG decide to start a residency? I mean, doesn't ABEM police the number of slots? Can I just start my own residency if I had enough money to get started and then let Medicare funding kick in at some point? If ABEM does have some say so, is there a way to get them to stop approving all these spots? I feel like with all the FSEDs failing, we probably don't need to be expanding EM as rapidly as we are.

 

[miacomet]

For USACS it is a flat rate, no additional bonus. Teamhealth has productivity and RVU bonuses on top of their hourly rate so most are making about $240 per hour if they meet both of those.

Honestly it’s a CMG dominated market so the rates are lower as there is no competition, they know the other groups offer and won’t increase or negotiate.

Also if I was to take another type of job for now I guarantee not doing EM again. Nobody is going to higher somebody with no EM work experience in the last 1-2 years. Not with a constant stream of residency grads to fill the spot

Terrible. NYC, PDX, and SLC all pay more, but you are right- Denver and Boise pay about what you were quoted.

There are other ways to get attending EM experience. If you need to moonlight a few days a month at $160 an hour to keep your toe in the water, so be it, but why not travel a few days a month instead and then do something different closer to home? Honestly, if you are staying in that area long term, EM is not a reasonable choice. If you are moving in a year or two, then do some locums or per diem in your future location, or even a third location.

I should point out that both the VA and the IHS pay more than $160 an hour for EM docs with minimal liability. Do. Not. Work. For. $160. That's a nurse salary.

 

[Jlaw]

We need to start an inter web union....we all want $300 an hour + benefits or we're all quitting and starting urgent cares/FSED's and if you pay us to be in our network we will transfer patients to your hospitalists/surgeons once we've stabilized and diagnosed.

 

[emergentmd]

Hello everyone,

New Grad soon to be Looking at jobs with these groups.

Highly desirable area (only two groups around)

Teamhealth is offering 180/hour base plus some RVUs as an independent contractor, 2.2 PPH

USACS is offering 160/hour as an employee plus benefits. 2.5pph


Just trying to see which company would be better from a compensation and happiness perspective

How are these two jobs even comparable and if these are the two choices, how is it so difficult.

TH puts you well over 200/hr for 2.2 vs USuck at 160/hr for 2.5?

What am I missing and how can two groups with similar PPH have such a disparaging rate? Most cities I work at have very similar rates in order to attrack ER docs.

How is USuck even getting any doc to sign up for 160/hr at 2.5pph? Are they getting the bottom of the barrel docs or non EM trained docs? Why would any EM train doc take such a job?

I have a Job at 275/hr IC seeing 1.8pph and I feel I am underpaid.

 

[namethatsmell]

How is USuck even getting any doc to sign up for 160/hr at 2.5pph? Are they getting the bottom of the barrel docs or non EM trained docs? Why would any EM train doc take such a job?

Oh and it's not just 2.5pp for 160/hr. At that rate you also get the privilege of signing stacks of NP/PA charts after your shift to allow them to "practice at the top of their license."

Now I forget, does USACS stand for "U Serve As Court Scapegoats" or "U Should Anticipate Court Shifts" or something else?

 

[emergentmd]

At 160/hr, what city can be so special? I would rather go to TH, do locums if I had to stay.

Nothing could make me stay for 160/hr at 2.5pph.

25 pts in a 10 hr shift making 1600 which is about 1K after taxes.

Geeeeezzzzzzz

 

[GonnaBeADoc2222]

How are these two jobs even comparable and if these are the two choices, how is it so difficult.

TH puts you well over 200/hr for 2.2 vs USuck at 160/hr for 2.5?

What am I missing and how can two groups with similar PPH have such a disparaging rate? Most cities I work at have very similar rates in order to attrack ER docs.

How is USuck even getting any doc to sign up for 160/hr at 2.5pph? Are they getting the bottom of the barrel docs or non EM trained docs? Why would any EM train doc take such a job?

I have a Job at 275/hr IC seeing 1.8pph and I feel I am underpaid.

It's cause USuck pushes their nonsense "Ownership Matters" slogan hardcore. It's obvious physician ownership didn't mean anything to them pre-private equity and even less now. Most people that I know who have worked for them have drank the koolaid. It's sad.

Also $160/hr for 2.5 pph is HILARIOUS.

 

[miacomet]

It's cause USuck pushes their nonsense "Ownership Matters" slogan hardcore. It's obvious physician ownership didn't mean anything to them pre-private equity and even less now. Most people that I know who have worked for them have drank the koolaid. It's sad.

Also $160/hr for 2.5 pph is HILARIOUS.

Sadly, it may not be hilarious, but the future of our field.

 

[cyanide12345678]

At 160/hr, what city can be so special? I would rather go to TH, do locums if I had to stay.

Nothing could make me stay for 160/hr at 2.5pph.

25 pts in a 10 hr shift making 1600 which is about 1K after taxes.

Geeeeezzzzzzz

They are still fairly successful at recruiting, which is surprising! 4 residents from my class have signed with them this year.

 

[miacomet]

They are still fairly successful at recruiting, which is surprising! 4 residents from my class have signed with them this year.

At $160 an hour?

 

[EctopicFetus]

They are still fairly successful at recruiting, which is surprising! 4 residents from my class have signed with them this year.

 

[emergentmd]

I can't see in any circumstance that any Boarded EM doc would sign for $160/hr other than being Ignorant/borderline stupid.

Don't these docs ask their friends, other residents, attendings before signing up? Do they not look on the internet.

Who in their right mind would sign up for 160/hr at 2.5pph?

I have a locums at $275/hr seeing 1.8pph that is in a highly functional/borderline FSER efficient ER an hour from my home. And I still only pick up a few shifts a month at the most b/c this is not an exceptional bargain.

So New Grads and docs wanting to sign up with USuck at 160/hr, WHAT ARE YOU THINKING? If you are looking to be abused, then work in my ER and give me $100/hr and I will reduce your pph to 1.8.

AND

YOU ARE NOT A PARTNER. Let me repeat, You are a minion. Want me to Prove it? Ask USuck

1. Can I look at the books
2. Where do I go to vote
3. Will I get an email to get my input in decisions

 

[cyanide12345678]

At $160 an hour?

Around there, but with large sign on bonuses though, which is not the best way to get paid ofcourse.

 

[miacomet]

Around there, but with large sign on bonuses though, which is not the best way to get paid ofcourse.

Why are your residents doing this? Are they out to destroy the profession? Independently wealthy? Hobbiests?

 

[RustedFox]

Why are your residents doing this? Are they out to destroy the profession? Independently wealthy? Hobbiests?

Probably made the same mistake that I made.

/b/

Be me.
2012. Get outta residency. Finally.
330K+ of debt.
Saved nothing during residency, because life is short and complicated and residency salaries were laughable. 33k. 34k. 35k = Lolz.
Look for jobs.
Find a job that I think I like.
Its low acuity, because I'm sick of the level-1 trauma drama and paperwork that I had to tolerate during residency. Wasn't fun then, shouldn't be fun now. Losers.
Pays 175 an hour. EmCare doesn't seem so bad. After all, its an employed position, and they'll give me and wife-to-be health insurance. Insurance companies otherwise say that we're both "uninsurable" with my ulcerative colitis and my wifey's depression/anxiety. Seriously; that's where these evil insurers are at. ACA isn't a thing yet.
Big signing bonus.
Big signing bonus.
I need that signing bonus to have some small nest egg in case things go bad, because things have gone bad before.
Pack up girlfriend and cats and everything we can fit into two cars and drive from Ohio to Florida.
If it didn't fit, it didn't come.
Abandon furniture.
Sleep on floor of apartment for a few days, shop for mattress.
Start working.
Work seems easy. Pay seems fair. After all, I often slept from 6-8am or sat and sipped coffee.
First paycheck comes. Wifey was out when the check cleared.
Wifey comes home and finds me sitting in boxers on floor with sunglasses on and cigar in mouth. Looks at me confused.
I throw 5K in assorted bills (not the signing bonus, mind you; just an amount that I felt "safe" carrying out of the bank) in cash into the air.
Now I can afford furniture.
Job is job.
Jobbing.
Jobbers.
Job starts to suck.
EmCare does what EmCare does.
I learn the hard way.