Thoughts?

[emergentmd]

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I am not saying his job, my job, your job is better or worse. I am not saying an owner or a worker is any better than the other. I am just saying that if you work for someone, you are a widget and eventually most will find out that they are a widget.

I have been in management from line doc, Medical director at a large receiving hospital. Been through too many MECs and meetings to count. No one who works for the hospital (actually any business) eventually find out they are a widget. Do you think I made any material changes when I was a medical director? Went to bunch of meetings, gave my opinions, and they did what they want and typically ended up what made them more money. Yeah they threw us a few bones to make us feed good but bottom line is $$$ and hospital reputation.

Knew of a specialist surgeon who came in doing everything the hospital wanted, followed the company line, brought bunch of $$$. He thought he could do no wrong until he crossed the wrong person and was out the door quite quickly.

My only point is that unless you own something, your job security is at the whim of the next CEO of the hospital. Our SDG thought we were some unicorn b/c he did "aligned" with the hospital and didn't cost them any stiped with great metrics. New C suite guy came and thought it was a great idea to bring in a CMG strictly for financial reasons.

 

[EctopicFetus]

Ill say the majority of docs arent surgeons either. Ill admit on the happy spectrum of work. I find meaning in my admin stuff and honestly, more importantly to me is that i am well compensated for my clinical and non clinical work. If that disappears truly i think my work satisfaction will go down.

I am fully aware thatthat may seem shallow to some on here. My take is this. If someone wants to pay me $200/hr for 0.5pph its a job I would consider if I could do a 72 hour shift. If someone offers me 300/hr to see 2 pph im laughing in their face. All that to say my compensation is very directly tied to the job that I want and will be happy with. There are hospital level issues we deal with. If I owned the hospital or ED I would have 0 tolerance for this. But im a cog and we all are in the ED. I may be a "leader" in my group but that only means I bang my head against the wall when interacting with hospital admin.

They like me, I like them. I have to decide when to make a big fuss about things. Cant complain about everything to the high level folks. I think as humans it is important we find meaning in our work. For some thats clinical medicine. I still legit enjoy it. I work 10-14 clinical shifts a month. I still view myself as a clinician unlike the fake CMG leaders who say they are doctors but work 50 clinical hours a year.

In the end my main point to the young people on here. Get your finances in order. You will be so much happier at your clinical work. You can and should invest wisely. It can be the stock market, it can be real estate, really anything that will get your 10% returns annually. Its the only way to grow your wealth. I think almost any EM doc can be FI in 15 years. For many folks that puts you in your mid 40s and you can be out. Obviously this depends on your spending / needs. There is no downside to FI.

 

[EctopicFetus]

I am not saying his job, my job, your job is better or worse. I am not saying an owner or a worker is any better than the other. I am just saying that if you work for someone, you are a widget and eventually most will find out that they are a widget.

I have been in management from line doc, Medical director at a large receiving hospital. Been through too many MECs and meetings to count. No one who works for the hospital (actually any business) eventually find out they are a widget. Do you think I made any material changes when I was a medical director? Went to bunch of meetings, gave my opinions, and they did what they want and typically ended up what made them more money. Yeah they threw us a few bones to make us feed good but bottom line is $$$ and hospital reputation.

Knew of a specialist surgeon who came in doing everything the hospital wanted, followed the company line, brought bunch of $$$. He thought he could do no wrong until he crossed the wrong person and was out the door quite quickly.

My only point is that unless you own something, your job security is at the whim of the next CEO of the hospital. Our SDG thought we were some unicorn b/c he did "aligned" with the hospital and didn't cost them any stiped with great metrics. New C suite guy came and thought it was a great idea to bring in a CMG strictly for financial reasons.

If no stipend why did the SDG lose their contract for "financial reasons". What were those?

 

[emergentmd]

Hospitalist group had a stipend and wanted a bigger stipend. I think they were at $2M/yr and wanted more. They offered us to take over the hospitalist group or have a CMG do it with no stipend.

Always about $$$$

 

[EctopicFetus]

Hospitalist group had a stipend and wanted a bigger stipend. I think they were at $2M/yr and wanted more. They offered us to take over the hospitalist group or have a CMG do it with no stipend.

Always about $$$$

Yep.. this was a major concern/risk years ago. I am sure it still is in certain areas.

 

[emergentmd]

Yep.. this was a major concern/risk years ago. I am sure it still is in certain areas.

Every time I hear on here how secure a SDG is, they don't realize the security can be gone with a new CEO. SDGs do not own anything tangible even though they think they do.

 

[RustedFox]

Every time I hear on here how secure a SDG is, they don't realize the security can be gone with a new CEO. SDGs do not own anything tangible even though they think they do.

One of the best lines I've ever read here on SDN was: "Your Unicorn job is just one administrative tantrum away from being a dumpster fire at any time."

 

[emergentmd]

One of the best lines I've ever read here on SDN was: "Your Unicorn job is just one administrative tantrum away from being a dumpster fire at any time."

I have a friend who is President of a CMG. He gets calls often from CEOs wanting to know if he can send proposals over to take over the contract. He asks if there are issues with the group. The answer most often is, "No, they are fine. We have a budget shortfall and want to get rid of the stipend or want the CMG to supplement something to reduce costs".

The best advice is to be your own boss and I don't even mean owning something. Get to Fire or at least close, so you can make the best decision for your family.

 

[TooMuchResearch]

Ill say the majority of docs arent surgeons either. Ill admit on the happy spectrum of work. I find meaning in my admin stuff and honestly, more importantly to me is that i am well compensated for my clinical and non clinical work. If that disappears truly i think my work satisfaction will go down.

I am fully aware thatthat may seem shallow to some on here. My take is this. If someone wants to pay me $200/hr for 0.5pph its a job I would consider if I could do a 72 hour shift. If someone offers me 300/hr to see 2 pph im laughing in their face. All that to say my compensation is very directly tied to the job that I want and will be happy with. There are hospital level issues we deal with. If I owned the hospital or ED I would have 0 tolerance for this. But im a cog and we all are in the ED. I may be a "leader" in my group but that only means I bang my head against the wall when interacting with hospital admin.

They like me, I like them. I have to decide when to make a big fuss about things. Cant complain about everything to the high level folks. I think as humans it is important we find meaning in our work. For some thats clinical medicine. I still legit enjoy it. I work 10-14 clinical shifts a month. I still view myself as a clinician unlike the fake CMG leaders who say they are doctors but work 50 clinical hours a year.

In the end my main point to the young people on here. Get your finances in order. You will be so much happier at your clinical work. You can and should invest wisely. It can be the stock market, it can be real estate, really anything that will get your 10% returns annually. Its the only way to grow your wealth. I think almost any EM doc can be FI in 15 years. For many folks that puts you in your mid 40s and you can be out. Obviously this depends on your spending / needs. There is no downside to FI.

I can probably find you that first job but you'll have to move [emoji16]

 

[EMdoc235]

I’m totally fine being a widget. Unless you’re a billionaire you’re pretty irrelevant and I know I’ll never be that, so I’m pretty happy with what I’ve got.

 

[TooMuchResearch]

I’m totally fine being a widget. Unless you’re a billionaire you’re pretty irrelevant and I know I’ll never be that, so I’m pretty happy with what I’ve got.

I'm only so many NW doublings away from billionaire. Surely I can do it!

 

[EctopicFetus]

Every time I hear on here how secure a SDG is, they don't realize the security can be gone with a new CEO. SDGs do not own anything tangible even though they think they do.

I am aware. That being said I have surfed the good luck wave for a while. any contract isnt all that secure. It’s what it is. I’ll keep making hay while the sun is shining. Been a bright career so far.

 

[EctopicFetus]

I can probably find you that first job but you'll have to move [emoji16]

I have a great gig.. I’ll be honest i enjoy my time away from work too much. I did push for a 72 hour shift at a spot that was 0.5pph but the pay was $275 or so. They wouldnt do it so i said no. I figure i could buy a new car if i did a 72.

 

[emergentmd]

I am aware. That being said I have surfed the good luck wave for a while. any contract isnt all that secure. It’s what it is. I’ll keep making hay while the sun is shining. Been a bright career so far.

SDG and some CMGs are great gigs. Its all in the eye of the beholder. We had a great SDG that was completely fair/democratic including everyone shared in the same amount of holidays/nights/weekends including everyone had the same pay from day #1.

Got the rug pulled out from under us and CMG took over. Best thing to happen to me as when one door closes, another opens. Talked to some old doc friends who stayed with the CMG and they are all miserable with 80% eventually leaving.

Save your $$ so you can have a good exit plan. The ones who stayed are all tied to the $$$ and have little choice with all of their financial responsibilities.

 

[Groove]

Ill say the majority of docs arent surgeons either. Ill admit on the happy spectrum of work. I find meaning in my admin stuff and honestly, more importantly to me is that i am well compensated for my clinical and non clinical work. If that disappears truly i think my work satisfaction will go down.

Quote of the thread goes to Honey Badger!

Pretty sure most CMGs spend months planning annual expensive "leadership conferences" at swanky hotels so they can do a couple days of intense brain washing in order to produce a few AFMD/FMDs that will write something like that down on their end of conference survey. LOL. That's awesome. I wish I knew how to feel that way when I did admin but I most assuredly did NOT. Prob why I didn't last.

 

[AlmostAnMD]

I think it depends on what your "admin work" is. If it's complaints and press-ganey yeah kill me

My projects all involve developing strategies to reduce denial rates across the system, decreasing downstream admin work by decreasing # of appeals and p2ps even needed because the denial rates are dropping. Also increases hospital revenue and lowers obs rates.

And, as a big benefit, by decreasing denial rates the overall UM work gets easier since UM is built around denials. My fantasy goal is cutting denials 90% across all medicaid/MA plans and just cruising

It's also really fun taking payors to state fair hearings and watching them eat crow and get a 25k fine/overturn. They're starting to fear me and I love it

 

[RustedFox]

I think it depends on what your "admin work" is. If it's complaints and press-ganey yeah kill me

My projects all involve developing strategies to reduce denial rates across the system, decreasing downstream admin work by decreasing # of appeals and p2ps even needed because the denial rates are dropping. Also increases hospital revenue and lowers obs rates.

And, as a big benefit, by decreasing denial rates the overall UM work gets easier since UM is built around denials. My fantasy goal is cutting denials 90% across all medicaid/MA plans and just cruising

It's also really fun taking payors to state fair hearings and watching them eat crow and get a 25k fine/overturn. They're starting to fear me and I love it

Hire me. I'm really good at being a d!ckhead to those who genuinely deserve it.

 

[AlmostAnMD]

Hire me. I'm really good at being a d!ckhead to those who genuinely deserve it.

Tempting! The line is like 15 deep from people reaching out from my ****ty old SDG sadly

Working in the interspace between medicine and law is fun, if your definition of fun is policy

But every large system has a UM department...they have to or else they would otherwise hemorrhage 10-100+ mil a year depending on system size. Reach out to your UM department and ask to be an advisor! You never know

 

[Groove]

Nah, I'm talking typical FMD stuff. I'm just not used to seeing people talk about finding personal fulfillment with admin work, lol. At least, not in the CMG world. (I'm sure SDG world is different as well as UM.) Most docs are trying to escape clinical work for the same compensation and a little less stress. But it always seemed like a merry go round of ass kissing. Schmoozing the pit docs to placate their concerns, Jedi mind tricks to get them to implement c-suite level policies. Ass kissing c-suite, minimizing their headache load, alignment of ED policy with whatever their administrative whim is for the month. Available to them at all hours. Constant tweaking physician/APC coverage, ED policies, blah blah blah in an effort to maximize each ounce of blood you can squeeze out of operations only to see all the policies reverse in about 2-3 years when a new FMD steps in and/or everyone forgets about the old policies. Constantly having to worry about not pissing off the right hospital exec that might want to have you fired and replaced with someone else. Having to call up your tantrum doc each month who went off on nursing and generated a complaint. Countless hiring interview dinners. Having to call up disgruntled patients who got pissed off for X, Y, Z. I just can't imagine a worst nightmare than having to juggle all that stuff all day long. Let's face it....there will never be a hospital auditorium named after the ED FMD.

My greatest joy is being able to shut my phone off when I leave work and not be expected to answer it for anything.

 

[AlmostAnMD]

Yeah that sounds gross

The UM world 100% shuts down after close of business. There are no UM emergencies. **** that happens on Saturday I'll deal with on monday. **** that happens at 2a I'll deal with at 9a.

I completely understand not wanting to be bugged all hours of the day. Or worse, ass kissing patients. No thanks, you're a goddam hero for doing that at all.

What a broken mess.

 

[EctopicFetus]

Quote of the thread goes to Honey Badger!

Pretty sure most CMGs spend months planning annual expensive "leadership conferences" at swanky hotels so they can do a couple days of intense brain washing in order to produce a few AFMD/FMDs that will write something like that down on their end of conference survey. LOL. That's awesome. I wish I knew how to feel that way when I did admin but I most assuredly did NOT. Prob why I didn't last.

Oh to be clear.. it’s SDG admin work. I also have a role within the hospital system which I find less fulfilling but i still like it some. I couldnt feel good about myself being a stooge for a CMG. I’ve been lucky to avoid that in my career. I dont do patient complaints, i dont do too many meaningless meetings. Most of what I do is protect my colleagues from hospital stupidity and find ways to make sure we do $$ well.