The Insanity of Vituity

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A lot of corporate buzzwords in that "About" section. They know they couldn't have gotten a better yes-man.

Also, why did he do a 4 year 11 month residency? I assume some kind of leave of absence?
 
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also look at rest of his schtick:

It was all before his residency. A born administrator. Lots of things to nitpick in the world, this guy was gunning for admin from the start. Good for him I guess?

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alpinism said:
So apparently nowadays brand new EM residency graduates are being offered jobs as EM medical directors.

Linkedin for Medical Director at St Joe's in Joliet Illinois
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Poor youngling.. that being said was 6 months out of residency and was assistant and then 6 months later he is the boss. I will say Envision offered me an assistant director role right out of residency. These companies other than USACS abuse these poor saps. While I think USACS is the worst they treat their medical directors generally well. They just poop on the rank and file.
 
This is what happens when hospitals go to the corporate model and MBA's are put in charge of hiring, with out medial input.
 
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I don't know anything about this dude, but based on the link, it seems his main sins according to the posters here are:
  • Accepting an admin position when offered
  • Using CV language in their virtual CV (LinkedIn)
  • Not following this board's mandated career path: 3 year residency followed by unicorn SDG partnership and early retirement/burnout
I can't say this merits making a whole thread just to single out the one guy.
 
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I am finding that the ER doc with 6-15 year experience is getting more rare. They seem to be leaving the field for other areas. Now, I still see a decent number of docs with 15 year+ experience.

Maybe the 15 year+ group is so close to retirement they are white knuckling the job? The younger group seems to want to take the risk to leave.

This could be why there are very few experienced docs wanting to take the medical director role. The CMGs have to have a medical director so they can be the rotating fall guy for the contract.
 
Porfirio said:
I am finding that the ER doc with 6-15 year experience is getting more rare. They seem to be leaving the field for other areas. Now, I still see a decent number of docs with 15 year+ experience.

Maybe the 15 year+ group is so close to retirement they are white knuckling the job? The younger group seems to want to take the risk to leave.

This could be why there are very few experienced docs wanting to take the medical director role. The CMGs have to have a medical director so they can be the rotating fall guy for the contract.
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I think some of this is likely that those with the 15+ years of experience are less likely to need the money or job so they can ignore a lot more BS whereas those who are younger still really need that paycheck and are more worried about ignoring stuff. You can typically ignore A LOT of emails, etc. As long as you’re not the worst physician and last in every single metric then you can typically keep your head down, ignore all the BS, and know that there is minimal chance anything of substance is going to happen.
 
Franzd'Epinay said:
I don't know anything about this dude, but based on the link, it seems his main sins according to the posters here are:
  • Accepting an admin position when offered
  • Using CV language in their virtual CV (LinkedIn)
  • Not following this board's mandated career path: 3 year residency followed by unicorn SDG partnership and early retirement/burnout
I can't say this merits making a whole thread just to single out the one guy.
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More power to the guy that can wake up in the morning and look himself in the mirror and be ok with their CMG-induced brown nose.
 
Franzd'Epinay said:
I don't know anything about this dude, but based on the link, it seems his main sins according to the posters here are:
  • Accepting an admin position when offered
  • Using CV language in their virtual CV (LinkedIn)
  • Not following this board's mandated career path: 3 year residency followed by unicorn SDG partnership and early retirement/burnout
I can't say this merits making a whole thread just to single out the one guy.
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Personally its not so much this dude but about vituity who its obvious doesn't care about their docs.

I mean this might sound really harsh but there is literally zero reason to hire someone right out of residency with literally zero attending experience for a leadership position unless they just want a mindless puppet to do whatever hospital administration wants even if it screws over their docs.

I'll add this is not some middle of nowhere rural site but a 400+ bed level 2 trauma center and tertiary hospital in the suburbs of a major city.
 
alpinism said:
Personally its not so much this dude but about vituity who its obvious doesn't care about their docs.

I mean this might sound really harsh but there is literally zero reason to hire someone right out of residency with literally zero attending experience for a leadership position unless they just want a mindless puppet to do whatever hospital administration wants even if it screws over their docs.

I'll add this is not some middle of nowhere rural site but a 400+ bed level 2 trauma center and tertiary hospital in the suburbs of a major city.
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Hey, even in the rural sites my SDG runs, our medical directors (all elected, not appointed by management) are all 8-15 or so years out of residency.
 
alpinism said:
Personally its not so much this dude but about vituity who its obvious doesn't care about their docs.

I mean this might sound really harsh but there is literally zero reason to hire someone right out of residency with literally zero attending experience for a leadership position unless they just want a mindless puppet to do whatever hospital administration wants even if it screws over their docs.

I'll add this is not some middle of nowhere rural site but a 400+ bed level 2 trauma center and tertiary hospital in the suburbs of a major city.
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You hit it out of the park on this one. Spot on.

Often this is a move by the higher-ups to shake things up at a site where admin is looking to heavily tighten the belt (lest that CMG lose the contract). That newly installed director:

1) Has ZERO relationships with the established physicians there, making it easier to cut their hours and effectively remove them from the schedule (i.e. delicately "fire" them)
2) Allows them to put in various policies that will receive the ire of anybody who values quality and safe patient care (the established docs there who are likely from the area and may need to use that ER for their own families). It's much easier to screw over a community hospital when it's NOT your own home community
3) Eventually change the entire culture of that site as the newly minted medical director advances in their career

It's a very effective playbook and I've seen quite a few sites destroyed over my relatively short career this way
 
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I was a medical director of my SDG for 6 years. When we got taken over by a CMG, I was out the door within 6 months. I could never be a Yes man so they let me go within 6 months. The only way to move up the ladder is to be a Yes man. They need these people to play the blame game and isolate the docs from the higher ups.

It is a miserable job that will not last if you are not a Yes man and sell your soul. You literally have to sell your soul and drink the kook aid to do this job.

There were about 5 medical directors in our group. I was the 1st to be let go and maybe in record time. I believe 3 more eventually left that job in 3 years. The only one who stayed and climbed the corporate ladder was the biggest butt kisser in our SDG. It does not shock me that that she kept climbing the ladder.

Ironic because I got an email from them about 2 years ago asking me to apply to be medical director at my OLD job. They must have been desperate or forgot that they fired me.

If you are a new doc who is going to take this job just realize that you need to be a Yes man and sell your soul. My soul is worth more than any $$$ they can give me.
 
emergentmd said:
I was a medical director of my SDG for 6 years. When we got taken over by a CMG, I was out the door within 6 months. I could never be a Yes man so they let me go within 6 months. The only way to move up the ladder is to be a Yes man. They need these people to play the blame game and isolate the docs from the higher ups.

It is a miserable job that will not last if you are not a Yes man and sell your soul. You literally have to sell your soul and drink the kook aid to do this job.

There were about 5 medical directors in our group. I was the 1st to be let go and maybe in record time. I believe 3 more eventually left that job in 3 years. The only one who stayed and climbed the corporate ladder was the biggest butt kisser in our SDG. It does not shock me that that she kept climbing the ladder.

Ironic because I got an email from them about 2 years ago asking me to apply to be medical director at my OLD job. They must have been desperate or forgot that they fired me.

If you are a new doc who is going to take this job just realize that you need to be a Yes man and sell your soul. My soul is worth more than any $$$ they can give me.
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One of the things I learned is that CMGs have no institutional knowledge when it comes to recruitment. We once hired, fired, and paid a doc for a month of unworked shifts to make them go away. Twice in the span of 4 years.
 
Arcan57 said:
One of the things I learned is that CMGs have no institutional knowledge when it comes to recruitment. We once hired, fired, and paid a doc for a month of unworked shifts to make them go away. Twice in the span of 4 years.
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Leeches all of them.
 
alpinism said:
Personally its not so much this dude but about vituity who its obvious doesn't care about their docs.

I mean this might sound really harsh but there is literally zero reason to hire someone right out of residency with literally zero attending experience for a leadership position unless they just want a mindless puppet to do whatever hospital administration wants even if it screws over their docs.

I'll add this is not some middle of nowhere rural site but a 400+ bed level 2 trauma center and tertiary hospital in the suburbs of a major city.
Click to expand...
This is it right here. What makes someone think someone with 0 experience (aka right out of residency) can run a big ED. They are the pin cushions for the higher ups and will be molded to be puppets. All the big CMGs do this. I think at a minimum you are looking at 5 years overall experience post residency and that person should have been involved in QI/process improvement/committees before doing so. My SDG has 9 medical directors. I think none has been with the group / at their site less than 7 years.. a bunch have ~10-15 years experience. This is the way.

If we took a new grad and made them medical director it would be considered an April’s Fool joke. All elected.. all on a cycle.
 
Porfirio said:
They have a CEO. They have a board of directors. There is a hierarchy.

Leeches all of them.
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JacobMcCandles said:
Of course. It’s a CMG who tries to market themselves as not a CMG.
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I think these are bad takes. That CEO and board of directors are all MDs who still have hospital assignments and work. Being in the top echelon of senior leadership there is much more fluid than other places and while there is a ceo and multiple VPs, that board has legitimate openings for people to enter those top ranks and isnt just a cup shuffle of MBAs and lawyers like other companies. I had a brief 6 month assignment with them and worked with one prior board member who was back down to being regional director because his time on the board was over, met another guy who was just a rank and file employee (not even director of anything) who ran for the board like 10 years ago and was elected, served, and went back to being a shift worker afterwards, and watched a director of a random site run for the board (not sure if he won or not). This is not the entrenched heirarchy you suggest it is.

The only thing that is true about them is that their pay structure if very much based on seniority.... not seniority on the corporate ladder but just number of years logged.... but thats a super reasonable way to organize a massive company and they're super upfront about that. On a very real way their structure is different than CMGs, even if they do literally manage contracts.
 
DocEspana said:
I think these are bad takes. That CEO and board of directors are all MDs who still have hospital assignments and work. Being in the top echelon of senior leadership there is much more fluid than other places and while there is a ceo and multiple VPs, that board has legitimate openings for people to enter those top ranks and isnt just a cup shuffle of MBAs and lawyers like other companies. I had a brief 6 month assignment with them and worked with one prior board member who was back down to being regional director because his time on the board was over, met another guy who was just a rank and file employee (not even director of anything) who ran for the board like 10 years ago and was elected, served, and went back to being a shift worker afterwards, and watched a director of a random site run for the board (not sure if he won or not). This is not the entrenched heirarchy you suggest it is.

The only thing that is true about them is that their pay structure if very much based on seniority.... not seniority on the corporate ladder but just number of years logged.... but thats a super reasonable way to organize a massive company and they're super upfront about that. On a very real way their structure is different than CMGs, even if they do literally manage contracts.
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Once a group gets to be a certain size then they almost have to operate like a CMG. You can say they’re not as bad as the rest but they’re not a SDG.

Also, pay based on seniority isn’t a reasonable structure in the ED.
 
JacobMcCandles said:
Once a group gets to be a certain size then they almost have to operate like a CMG. You can say they’re not as bad as the rest but they’re not a SDG.

Also, pay based on seniority isn’t a reasonable structure in the ED.
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Pay is based on the rates for where you work and everyone (in that area) makes the same. I sort of assumed people were familiar with their model and cut corners on the explanation. They decided how to split any profits made by the whole company as a end of year (technically like February) bonus based on your number of years accrued and that bonus starts out insignificant but gets to be very hefty after not all that long of a commitment. Was referring to that. Also (though this doesn't apply to all sites) if your site itself is profitable you get quarterly bonuses of whatever the excess profit of the site is.

Youre right that given it size there are certain elements of it that are going to be CMG like (focusing on numbers that lead to more profits, for one). It is inherent at a certain size. But it's probably a way move even blend of democratic features and CMG elements than people are giving it credit for.

And again, I no longer have any skin in that game. I'm WITH a SDG (where it's not sunshine and rainbows at all because the pay structure is pyramidal in a way that would make TeamHealth blush - but I digress). But I really came to respect vituity during my time there, getting to actually see who is in senior leadership and them just being other locums/traveler guys like me.
 
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DocEspana said:
Pay is based on the rates for where you work and everyone (in that area) makes the same. I sort of assumed people were familiar with their model and cut corners on the explanation. They decided how to split any profits made by the whole company as a end of year (technically like February) bonus based on your number of years accrued and that bonus starts out insignificant but gets to be very hefty after not all that long of a commitment. Was referring to that. Also (though this doesn't apply to all sites) if your site itself is profitable you get quarterly bonuses of whatever the excess profit of the site is.

Youre right that given it size there are certain elements of it that are going to be CMG like (focusing on numbers that lead to more profits, for one). It is inherent at a certain size. But it's probably a way move even blend of democratic features and CMG elements than people are giving it credit for.

And again, I no longer have any skin in that game. I'm WITH a SDG (where it's not sunshine and rainbows at all because the pay structure is pyramidal in a way that would make TeamHealth blush - but I digress). But I really came to respect vituity during my time there, getting to actually see who is in senior leadership and them just being other locums/traveler guys like me.
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Sounds as I suspected, at best they’re one of the better CMGs but still a CMG, nonetheless. I give them props for senior leadership still working.

The longer I’m in EM the more I see that I think the best model is local SDGs. Once things start becoming more regional (outside of a metro area or more multi-state) then it gets too big to be a true SDG and it starts becoming a CMG. There are benefits to group size but there are downsides, too.
 
Something about vituity has Struck me as being very off. Why are they taking over SDG contracts? (See my new thread). They have gone after and taken a bunch of SDG contracts. What’s the benefit? It makes no sense to me if it really is a true partnership. Perhaps they make a bunch on the MSO and dont share that. I dont know.

I simply look at an sdg and wonder what would want this group to grow. I know they arent an SDG but they want to market themselves as a giant DG.

Why take over the headaches of 4 contracts.. for no money? Makes no sense. Similarly, if you take over a contract and make $1m and it is split amongst 1000 senior partners it just isnt that much money per partner. I cant seem to understand the move.
 
EctopicFetus said:
Something about vituity has Struck me as being very off. Why are they taking over SDG contracts? (See my new thread). They have gone after and taken a bunch of SDG contracts. What’s the benefit? It makes no sense to me if it really is a true partnership. Perhaps they make a bunch on the MSO and dont share that. I dont know.

I simply look at an sdg and wonder what would want this group to grow. I know they arent an SDG but they want to market themselves as a giant DG.

Why take over the headaches of 4 contracts.. for no money? Makes no sense. Similarly, if you take over a contract and make $1m and it is split amongst 1000 senior partners it just isnt that much money per partner. I cant seem to understand the move.
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We all know the true answer and it’s that the money gets funneled towards the top. Maybe they don’t funnel as much as TeamHealth or Envision but if their ultimate goal was to promote democratic groups and wanted to further that pursuit then maybe it’d make sense to try to get more contracts under one umbrella for negotiating purposes with respect to insurance contracts, benefits, etc. but they’d still let that group be independent and be otherwise completely hands off and if size ultimately didn’t matter for negotiations then they’d leave that contract be.
 
Any group of sufficient size becomes CMG-like because CMGs are the way they are because that's what the market has molded them into.
 
TooMuchResearch said:
What size
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Sufficient.


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I've been an observer on this forum for over a decade, but since this thread isn't about quitting medicine or politics I thought I might hop in. Vituity "takes over" so many democratic groups largely because if the SDG is forced financially or otherwise to join a larger group, they join Vituity by choice. That's what happened to mine at least. There are significant financial benefits to scale in terms of managing a group and retaining a contract in the current environment especially if you started with a borderline payer mix to begin with. Vituity sites locally have near complete autonomy as long as they remain financially solvent and the contract remains secure.

Per DocEspana, it is true the C suite, board and regional/medical director hierarchy works clinical shifts, which even if symbolic, still seems meaningful. What I think is more meaningful is the fact that unlike many other players in the large CMG space, Vituity has no debt and no private equity involvement. Thus, the cuts that PE and debt interest take out of the pie in a traditional CMG are instead returned to the partners ie pit docs.

No model is perfect. Vituity is still subject to the ebbs and flows of battles with hospital c suites over metrics, battles with problem payers over reimbursement and the somewhat harsh realities of modern medical capitalism. Of course I would love to fix these issues, but since in the meantime I need to make a living and feed my family, I'd rather deal with these issues in a group that is transparent with finances and seems to value the people actually putting hands on patients instead of some of the alternatives out there.

In conclusion, yeah this kid is way too young to be a medical director lol
 
arbalest1165 said:
I've been an observer on this forum for over a decade, but since this thread isn't about quitting medicine or politics I thought I might hop in. Vituity "takes over" so many democratic groups largely because if the SDG is forced financially or otherwise to join a larger group, they join Vituity by choice. That's what happened to mine at least. There are significant financial benefits to scale in terms of managing a group and retaining a contract in the current environment especially if you started with a borderline payer mix to begin with. Vituity sites locally have near complete autonomy as long as they remain financially solvent and the contract remains secure.

Per DocEspana, it is true the C suite, board and regional/medical director hierarchy works clinical shifts, which even if symbolic, still seems meaningful. What I think is more meaningful is the fact that unlike many other players in the large CMG space, Vituity has no debt and no private equity involvement. Thus, the cuts that PE and debt interest take out of the pie in a traditional CMG are instead returned to the partners ie pit docs.

No model is perfect. Vituity is still subject to the ebbs and flows of battles with hospital c suites over metrics, battles with problem payers over reimbursement and the somewhat harsh realities of modern medical capitalism. Of course I would love to fix these issues, but since in the meantime I need to make a living and feed my family, I'd rather deal with these issues in a group that is transparent with finances and seems to value the people actually putting hands on patients instead of some of the alternatives out there.

In conclusion, yeah this kid is way too young to be a medical director lol
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As I mentioned earlier, if Vituity really cared that much and wanted to support the SDGs then they’d help with insurance contracts and pooling for benefits and be completely hands off otherwise but they aren’t.
 
Yeah that would be nice. I'd imagine it probably varies site to site and by how the site is performing prior to them stepping in
 
JacobMcCandles said:
As I mentioned earlier, if Vituity really cared that much and wanted to support the SDGs then they’d help with insurance contracts and pooling for benefits and be completely hands off otherwise but they aren’t.
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I know of a few specific cases where they are competing for contracts against the sdg that is currently there. Including shmoozing the ceo. Essentially trying to undercut / steal the contract. Hard to love that behavior.
 
In my experience, a site with a very young attending who is the medical director is a place that either has only young attendings or has a small number of more experienced attendings that have less than zero interest in doing the work of the medical director.
 
EctopicFetus said:
I know of a few specific cases where they are competing for contracts against the sdg that is currently there. Including shmoozing the ceo. Essentially trying to undercut / steal the contract. Hard to love that behavior.
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Can’t be. Someone already told us they’re just helping and rescuing these SDGs…
 
DocEspana said:
And again, I no longer have any skin in that game. I'm WITH a SDG (where it's not sunshine and rainbows at all because the pay structure is pyramidal in a way that would make TeamHealth blush - but I digress). But I really came to respect vituity during my time there, getting to actually see who is in senior leadership and them just being other locums/traveler guys like me.
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The buy in for some SDGs are pretty wild/predatory. Sure, if it works out, you can do well in the long run. Gambling away a few years for <$200/h in hopes of someday getting that sweet partner $$ is interesting.
 
Emapp20177 said:
The buy in for some SDGs are pretty wild/predatory. Sure, if it works out, you can do well in the long run. Gambling away a few years for <$200/h in hopes of someday getting that sweet partner $$ is interesting.
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Some buy ins and partnership tracks can be predatory but it’s pretty unusual to get ownership in a business for free.
 
JacobMcCandles said:
Some buy ins and partnership tracks can be predatory but it’s pretty unusual to get ownership in a business for free.
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Our break even vs local health system employers is around 5 years or was last time I did the math. There are 1-2 predatory "small groups" in the area so I don't count them.
 
JacobMcCandles said:
As I mentioned earlier, if Vituity really cared that much and wanted to support the SDGs then they’d help with insurance contracts and pooling for benefits and be completely hands off otherwise but they aren’t.
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At my Vituity site that’s basically what they do. One SDG 30 min down the road joined Vituity and had a 16% increase in collections same year due to improved negotiating power with payers and better contracts. Billing, malpractice costs are all competitive. We never see Vituity central meddling in staffing decisions - for example my main site pays around $240/hr and sees 1.6-1.7 pts/hr. Out of residency I was chomping at the bit and wondering why we couldn’t staff to 2.0-2.3 pts/hr and be well above $300/hr but the group voted against it at a meeting we all were at and was very transparent, same for limiting APP coverage to help some, but be around 30% of coverage. Transparent comp for medical directors and admin which is on a siteline presented at a monthly meeting to all partners.

Yeah, there is a sweat equity buy in with lower bonus for the first 4 years and should work out to $200-250k at most sites. When I was job shopping out of residency that was about equal to the SDG buy in same town (that later joined Vituity) and much less than a super lucrative site an hour away that was also much more opaque and honestly super predatory partnership structure.

Vituity is pretty active in my region of CA and I think all of our local sites are really functional and happy. I hear horror stories of some hard to staff sites in the middle of nowhere or a terrible culture that took a bad contract without enough subsidy and can’t pay the $$ to entice people but they seem few and far between. With a large organization and hundreds of sites there is of course going to be a spectrum of culture, compensation etc.

In the last 7 years talking to people at various meetings I have seen several different reasons that Vituity seems to be expanding and SDG contracting. A few examples:

1) Better contracts and reimbursement. See 16% increase with Vituity compared to single site SDG example above. A struggling site might reach out to Vituity.
2) A group of docs want to take over a contract but don’t have the organizational capacity to do it. Ie a number of docs who love their community and hospital but hate working for USACS etc. it’s a rare group where someone knows how to manage all the new contracts, can negotiate them favorably, and then work for 90-120 days for free before the $$$ come in vs take out a multi million dollar loan (this is where ER private group buy in goes - existing share of pending billing accounts receivable or other assets). It might be overwhelming but manageable for a single doc practice but I can’t even imagine someone trying it these days with a 10-30 doc practice.
3) SDG or CMG group isn’t performing well and so the hospital shops the contract. If LWBS is 8%, patient sat is in the toilet and the CEO and board members don’t want to use the hospital then there is going to be a change one way or another. Sometimes it’s musical chairs and after a decade of different players Vituity gets a swing. Reputation of private equity in medicine is poor so Vituity has been getting first pass at a number of contracts lately.
4) Hate to say it but subsidy. If performance is good and subsidy is 0 then no SDG would ever lose a hospital contract. A lot of contracts that went to Vituity happened after SDG went to the hospital and asked for an extra $$$/yr. The standard business response to that is say maybe, but shop around. Same with any vendor. If my car insurance stays the same I’ll likely renew. Big jump and I’m calling around to test the market. Free service that performs well (Gmail?) and I’ll use it forever. Vituity is not operating a charity and if they can pay market rate and staff a site with their proposal (usually blind do what the situation was with other group) then the chips fall. Vituity is known for not being cheap either and makes each site stand on their own financially.

Overall, I’m happy enough with Vituity, sometimes a bit burnt out on emergency medicine overall and just tired, but that’s nobody’s fault except for just our dysfunctional American medical system.
 
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Mbekweni said:
At my Vituity site that’s basically what they do. One SDG 30 min down the road joined Vituity and had a 16% increase in collections same year due to improved negotiating power with payers and better contracts. Billing, malpractice costs are all competitive. We never see Vituity central meddling in staffing decisions - for example my main site pays around $240/hr and sees 1.6-1.7 pts/hr. Out of residency I was chomping at the bit and wondering why we couldn’t staff to 2.0-2.3 pts/hr and be well above $300/hr but the group voted against it at a meeting we all were at and was very transparent, same for limiting APP coverage to help some, but be around 30% of coverage. Transparent comp for medical directors and admin which is on a siteline presented at a monthly meeting to all partners.

Yeah, there is a sweat equity buy in with lower bonus for the first 4 years and should work out to $200-250k at most sites. When I was job shopping out of residency that was about equal to the SDG buy in same town (that later joined Vituity) and much less than a super lucrative site an hour away that was also much more opaque and honestly super predatory partnership structure.

Vituity is pretty active in my region of CA and I think all of our local sites are really functional and happy. I hear horror stories of some hard to staff sites in the middle of nowhere or a terrible culture that took a bad contract without enough subsidy and can’t pay the $$ to entice people but they seem few and far between. With a large organization and hundreds of sites there is of course going to be a spectrum of culture, compensation etc.

In the last 7 years talking to people at various meetings I have seen several different reasons that Vituity seems to be expanding and SDG contracting. A few examples:

1) Better contracts and reimbursement. See 16% increase with Vituity compared to single site SDG example above. A struggling site might reach out to Vituity.
2) A group of docs want to take over a contract but don’t have the organizational capacity to do it. Ie a number of docs who love their community and hospital but hate working for USACS etc. it’s a rare group where someone knows how to manage all the new contracts, can negotiate them favorably, and then work for 90-120 days for free before the $$$ come in vs take out a multi million dollar loan (this is where ER private group buy in goes - existing share of pending billing accounts receivable or other assets). It might be overwhelming but manageable for a single doc practice but I can’t even imagine someone trying it these days with a 10-30 doc practice.
3) SDG or CMG group isn’t performing well and so the hospital shops the contract. If LWBS is 8%, patient sat is in the toilet and the CEO and board members don’t want to use the hospital then there is going to be a change one way or another. Sometimes it’s musical chairs and after a decade of different players Vituity gets a swing. Reputation of private equity in medicine is poor so Vituity has been getting first pass at a number of contracts lately.
4) Hate to say it but subsidy. If performance is good and subsidy is 0 then no SDG would ever lose a hospital contract. A lot of contracts that went to Vituity happened after SDG went to the hospital and asked for an extra $$$/yr. The standard business response to that is say maybe, but shop around. Same with any vendor. If my car insurance stays the same I’ll likely renew. Big jump and I’m calling around to test the market. Free service that performs well (Gmail?) and I’ll use it forever. Vituity is not operating a charity and if they can pay market rate and staff a site with their proposal (usually blind do what the situation was with other group) then the chips fall. Vituity is known for not being cheap either and makes each site stand on their own financially.

Overall, I’m happy enough with Vituity, sometimes a bit burnt out on emergency medicine overall and just tired, but that’s nobody’s fault except for just our dysfunctional American medical system.
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Ill say this as a semi apologist for vituity and a strongly pro SDG person.. so im coming in with this lens. 90% of the docs dont care about vituity or not and are happy with relatively avg pay. There is they buy in until you become a senior partner. Their “partner” at day 1 model is interesting marketing. IMO they are the best of the huge companies. I dont think they are super predatory but they are in some small ways like their medical insurance which you are forced to pay into (which of course will help the old guys). The pay is fine but usually not much better than the local CMGs.. maybe $20-30.

My fear is vituity is operating with a narrow margin. I could see complete collapse at some point. No debt helps but people quitting en masse is an issue, it might not be with the workforce issues ahead.

At vituity you will never earn top notch SDG type income. The “good” SDGs are paying at or near market right now during the associate/pre-partner phase. The upside though is huge.

As mentioned above, what business are you an equal partner day 1 and the pay is great. It just doesnt exist in law, business, medicine, accounting, consulting or in real life.

now comes my old man yelling at the clouds part. The new crop of docs is incredibly entitled, lazy and generally not strong clinicians. Everyone is seeking the easiest path and the push of “wellness” has led not just to crappy “wellness” but also entitlement and laziness and a complete lack of interest in actually being a good clinician. It feeds into what corporate medicine wants which is a bunch of employees who can be exploited so the corporation can bill under the physicians license. They want out to just badge in and badge out so Walden U DNPs can tell you what to do. They want to strip your powers, make you meek and just be the lemming your HCA residency trained you to be.

Thanks for coming to my TED talk.. vituity is fine. If you have a decent SDG option take that. There are SDGs making 4-500/hr.. im confident vituity doesnt have a single site making that consistently.

U should under no circumstance work for the biggest scam of an org out there which is USACS..
 
EctopicFetus said:
Ill say this as a semi apologist for vituity and a strongly pro SDG person.. so im coming in with this lens. 90% of the docs dont care about vituity or not and are happy with relatively avg pay. There is they buy in until you become a senior partner. Their “partner” at day 1 model is interesting marketing. IMO they are the best of the huge companies. I dont think they are super predatory but they are in some small ways like their medical insurance which you are forced to pay into (which of course will help the old guys). The pay is fine but usually not much better than the local CMGs.. maybe $20-30.

My fear is vituity is operating with a narrow margin. I could see complete collapse at some point. No debt helps but people quitting en masse is an issue, it might not be with the workforce issues ahead.

At vituity you will never earn top notch SDG type income. The “good” SDGs are paying at or near market right now during the associate/pre-partner phase. The upside though is huge.

As mentioned above, what business are you an equal partner day 1 and the pay is great. It just doesnt exist in law, business, medicine, accounting, consulting or in real life.

now comes my old man yelling at the clouds part. The new crop of docs is incredibly entitled, lazy and generally not strong clinicians. Everyone is seeking the easiest path and the push of “wellness” has led not just to crappy “wellness” but also entitlement and laziness and a complete lack of interest in actually being a good clinician. It feeds into what corporate medicine wants which is a bunch of employees who can be exploited so the corporation can bill under the physicians license. They want out to just badge in and badge out so Walden U DNPs can tell you what to do. They want to strip your powers, make you meek and just be the lemming your HCA residency trained you to be.

Thanks for coming to my TED talk.. vituity is fine. If you have a decent SDG option take that. There are SDGs making 4-500/hr.. im confident vituity doesnt have a single site making that consistently.

U should under no circumstance work for the biggest scam of an org out there which is USACS..
Click to expand...
I think we could make $400-500 hourly at least at our high volume places but none of us want to staff that thinly. I'll take 1.5 pph and occasionally seeing PA patients with still above market pay.
 
Most of our partners don’t crack $400-500/hour as majority are in the $300-400/hour range, but several do. They certainly work hard for it, but not insanely (~2-2.5 pph). Stay hungry after residency. The financial independence with better than average income in a good SDG setup coupled with aggressive early savings leads to a lot of future options.
 
Mount Asclepius said:
Most of our partners don’t crack $400-500/hour as majority are in the $300-400/hour range, but several do. They certainly work hard for it, but not insanely (~2-2.5 pph). Stay hungry after residency. The financial independence with better than average income in a good SDG setup coupled with aggressive early savings leads to a lot of future options.
Click to expand...
Making that amount depends on the volume and use of a PA and most importantly your collections. If you collect $200/pt and you see 2.2 pph thats 440/hr and if your PAs see 1.5pph thats another 300/hr and lets say the cost of employing them is 120/hr (if you include benefits etc). if you are very doc heavy that PA income can offset expenses fully, if you staff PA heavy it can lead to more profit for docs.

Making 400+ isnt a pipedream but the main factor IMO is your $/pt. It is certainly challenging to collect $200/pt but I know groups (not my own unfortunately that have historically been able to do 250 and another at 300, this makes 200 a possibility tho difficult in this environment.
 
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