True Democratic EM groups

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Workingonit

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Hi all,
I am third year EM resident and am starting to think about jobs! Are there any truly democratic groups that offer partnership out there? And if so, where?

I hate the idea of working for cooperate medicine, although I am aware that they are quickly taking over.

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Hi all,
I am third year EM resident and am starting to think about jobs! Are there any truly democratic groups that offer partnership out there? And if so, where?

I hate the idea of working for cooperate medicine, although I am aware that they are quickly taking over.

Talk to the recent grads from your program. If none of them have any advice (something of a red flag), you can always ask on SDN about specific regions you're looking at, but as it stands right now, the answers to your fairly broad questions are: "yes" and "many places across the united states" respectively.
 
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Hi all,
I am third year EM resident and am starting to think about jobs! Are there any truly democratic groups that offer partnership out there? And if so, where?

I hate the idea of working for cooperate medicine, although I am aware that they are quickly taking over.

There are still private groups and if you go this route, I would do very little sweat equity or little buy in. The problem you will get into is there are people in your position that is willing to risk a high sweat or $$$ buy in which I would never do.

Even with Private SDGs, you will have to deal with the same demands from hospitals. So be ready to deal with corporate medicine
 
The one advantage that SDGs have over most CMGs, is that unlike the latter, they are not publicly traded companies that are beholden to shareholders who have an expectation that you will constantly have to increase your profit margins every single quarter, which is why they will implement every draconian policy imaginable to squeeze out every penny. This is an advantage that is underrated, and enough doctor's groups don't realize.
 
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There are still private groups and if you go this route, I would do very little sweat equity or little buy in. The problem you will get into is there are people in your position that is willing to risk a high sweat or $$$ buy in which I would never do.
What would you consider very little buy-in or sweat equity?
 
Its hard to put a number on this b/c every situation is different.

I would not consider anything less than 2 yr til partner but would try to negotiate 1 yr of sweat equity.

I would not do a buy in that is 2x partner distribution. So if partners make an extra $50k/yr, then it would be 100k.
I would never go over 100k cash buy in no matter what.
 
We're hiring one this year. Might be the only position available in the Salt Lake Valley this year. 2 year partnership track with sweat equity buy-in. Too long for you? Too much risk of CMG acquisition? Fine. Go live in the midwest or go work for a CMG. That's basically what it takes to get a job here similar to lots of other "desirable" places. Just be glad you can actually still own your job, unlike lots of other areas of the country.
 
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Just do your research. Only consider a stable group that's been there for a long time. Short history + hospital subsidy + recent hospital admin turnover = at risk for CMG poachers. I used to say SDGs were too high risk with anything near a 2y buy in. I still feel that way somewhat, but my risk tolerance has increased over time. Just remember that an average ball park (based on my experience) is anywhere up to 150K+ loss in income each year during your "buy in". That's a lot of money to give up. That being said, sure... some locations and practices are worth the investment but the risk is undeniable. Plus, it's not like all CMG jobs are crap.

I dunno... I would have never considered one before but lately...now that my loans are almost completely paid off, I'd consider it. But damn, I'd have to be under an hour from ski slopes or a national park and have a high degree of confidence that I would live there for a very long time.
 
We're hiring one this year. Might be the only position available in the Salt Lake Valley this year. 2 year partnership track with sweat equity buy-in. Too long for you? Too much risk of CMG acquisition? Fine. Go live in the midwest or go work for a CMG. That's basically what it takes to get a job here similar to lots of other "desirable" places. Just be glad you can actually still own your job, unlike lots of other areas of the country.

Again, every place is different. SDG has their headaches just as working with CMGs. You got to weigh how much risk you want to take. If you have to be in a certain place, and there are only one option then its worth it to take a big buy in or prolonged sweat equity.

The great thing about EM medicine is there is usually a job that will fit almost every ER personality. Some like working Locums for an CMG in exchange for more money/flexibility but undesirable working condition/instability. Some like more more control over their practice and join a SDG with the caveat of possibly losing the contract and having very little to show for their sweat equity/buy in.

I have done all of that. SDG, CMG, Locums CMG. The SDG was a sweat gig early on in my career and was partner for over 10 years which was a great environment before metrics and had a good income. Locums CMG right now is a great gig for me b/c I make more than I did with the SDG working less hours and avoiding all major holidays/wekend but have instability.

Hopefully I will be at my 3rd stage in my career soon and move into semi retirement working 4 dys a month.
 
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Some SDGs are very undemocratic. I think it all depends. My 2nd SDG had a small buy in and I made more day 1 than I could have at any CMG locally.

Also, keep in mind that while the risk of a sale is real, if you make partner that could be an extra $1m+ which you will never get with a CMG.

ON top of that as a partner you have a lot of control. I think not all SDGs are the bees knees and you have to be smart but 9/10 it is way better than ponying up for emcare, TH, or USACS.
 
Some SDGs are very undemocratic. I think it all depends. My 2nd SDG had a small buy in and I made more day 1 than I could have at any CMG locally.

I think this is key and frequently gets lost in this recurrent discussion. If you make more during your buy-in at an SDG than you would make with a competing CMG job, then there is essentially no risk and potentially a huge upside. The two guys on our partnership track have made significantly more than they would have with either of the CMG gigs in town. They have also had a vote and voice since day 1. I can't see the risk in that scenario.


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Just do your research. Only consider a stable group that's been there for a long time. Short history + hospital subsidy + recent hospital admin turnover = at risk for CMG poachers. I used to say SDGs were too high risk with anything near a 2y buy in. I still feel that way somewhat, but my risk tolerance has increased over time. Just remember that an average ball park (based on my experience) is anywhere up to 150K+ loss in income each year during your "buy in". That's a lot of money to give up. That being said, sure... some locations and practices are worth the investment but the risk is undeniable. Plus, it's not like all CMG jobs are crap.

I dunno... I would have never considered one before but lately...now that my loans are almost completely paid off, I'd consider it. But damn, I'd have to be under an hour from ski slopes or a national park and have a high degree of confidence that I would live there for a very long time.

How about 20 minutes from a ski resort, within a few hours of five national parks, and a group that's been there since the hospital opened in the 80s and nobody has ever left voluntarily for another EM job? We didn't advertise our job opening this year and just got done interviewing 5 excellent candidates.

There's no doubt the buy in will cost you something, but I think it's worth it, and there is a buy out on the other end if the group survives (and maybe even if it doesn't.) And every year that goes by without the contract being lost is one more year where you made the right decision. And besides, if you can't live and pay back student loans even on crappy pre-partner wages, you've probably got a spending problem, not an earning problem. It's way more than I got paid in the military as an attending and many times what you made as a resident.

You get to control who you work with, what pace you work at, how long your shifts are, what shifts you work, how holidays are distributed, what the shift differential is etc. And when the group has a great month, you have a great month.
 
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Hi all,
I am third year EM resident and am starting to think about jobs! Are there any truly democratic groups that offer partnership out there? And if so, where?

I hate the idea of working for cooperate medicine, although I am aware that they are quickly taking over.

If you want my honest opinion, given current trends in medicine in the US either go to work for the VA/military and retire in 20 or get out of the country and go to Australia/New Zealand/Canada. You're graduating about a decade and a half too late to really take advantage of the free standing boom, and will face a job market that is increasingly dominated by 1099 jobs where you pay for your own benefits. Many W2 jobs are moving to this model as well. As an example, I turned down a W2 position in the spring of 2015 that (1) required you to participate in the company's group health policy, (2) payroll deducted $1800 a month for family coverage, and (3) had a $10,000 annual deductible.
 
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