Unionizing EM

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JumpingThroughHoops

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Why do EM docs not simply form a labor union to protect ourselves going forward? Wouldn't going all-in now give EM docs the upper hand and avoid physicians being labeled as the evil bad guys with any disruption to patient care?

It's been done in healthcare with nurses in NY so why not for EM? It seems like a better idea than bickering here or on facebook and watching a slow demise to emergency medicine. I'm probably being naive to the rules and extent to which a union could help but maybe someone could explain it...or provide an alternative?
 
I think it has something to do with being employees vs IC vs other modes of employment. I know employees of an organization can form unions, but not sure if independent contractors can.
 
EctopicFetus said:
Laziness.
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See above.

As birdstrike and others have noted, for all the birching that goes on in this forum re: CMG’s, they exist out of necessity. Fewer and fewer docs want the hassel/time/headaches that comes with running a practice, and thus opt for the employee / contractor gig. Happened many years ago with Physicians being replaced by nursing and mba’s at the executive level, happening now at the practice management level, and developing at the legislative level (see midlevel independent practice laws). You cant set the rules to the game if you don’t play. We’ve opted for comfort at the expense of sovereignty
 
John Red said:
See above.

As birdstrike and others have noted, for all the birching that goes on in this forum re: CMG’s, they exist out of necessity. Fewer and fewer docs want the hassel/time/headaches that comes with running a practice, and thus opt for the employee / contractor gig. Happened many years ago with Physicians being replaced by nursing and mba’s at the executive level, happening now at the practice management level, and developing at the legislative level (see midlevel independent practice laws). You cant set the rules to the game if you don’t play. We’ve opted for comfort at the expense of sovereignty
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That hassle of owning versus hospital employed in my area is a difference of about $80k per year. I'd assume CMG is about the same.

New grads, that's $1.6 million over a 20 year career. Money taken from you to fuel the ADMIN machine if you choose to go the easy route.
 
TooMuchResearch said:
That hassle of owning versus hospital employed in my area is a difference of about $80k per year. I'd assume CMG is about the same.

New grads, that's $1.6 million over a 20 year career. Money taken from you to fuel the ADMIN machine if you choose to go the easy route.
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When i was job hunting last year, the SDG groups were paying significantly less than what I'm making at the CMG. In fact, my patient volume is less too. It really comes down to a particular hospital basically.

Literally right now doing a shift at a chill rural place, $200/hour. Seen 3 patients in 9 hours so far. The CMG i believe pays more than it collects at a lot of these rural places. A democratic group i doubt could take a loss at some of these sites.

Even my full time gig, I'm roughly averaging $160/patient based on my average number of patients seen and my compensation. I believe that is more than the average reimbursement, and doesn't even take into account the overhead costs.

So i don't know about you guys, but so far I'm satisfied with my CMG. They probably barely break even on me.
 
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thegenius said:
I think it has something to do with being employees vs IC vs other modes of employment. I know employees of an organization can form unions, but not sure if independent contractors can.
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Correct. Traditionally, most doctors were in some form of private practice. The government has made it illegal for doctors who are not employees to unionize and strike. That's let to a widespread misconception among doctors that "it's illegal for any doctor to unionize and go on strike."

As more and more doctors take employed positions, unionization is increasingly possible, since it's legal for employed MDs to unionize. But that prevailing defeatist attitude is still out there, something like, "It's illegal for us to strike, so we're screwed." But it's no longer always true.

The other factor that other people have mentioned is many physicians have rule following personalities and want to be viewed as the "good guy." Many doctors also like to project the image they don't care at all about money and only care about patient care. Someone accuses them of going rouge, or being greedy, and they immediately surrender and forfeit all their cards.

Also, another big factor is that things haven't gotten bad enough. Doctors love, love, LOVE nothing more than too complain, but if you push anyone too far enough, even rule-following self-proclaimed altruist doctors, they'll revolt. But it just hasn't gotten bad enough. It's gotten bad enough to turn the complaining up to 11, but not bad enough to do anything about it. The most dissatisfied docs will say it's bad enough, but ask they what they're going to do about it, and the answer is usually a jumbled mess of disgruntledness that add up to a whole lot of nothing.
 
cyanide12345678 said:
When i was job hunting last year, the SDG groups were paying significantly less than what I'm making at the CMG. In fact, my patient volume is less too. It really comes down to a particular hospital basically.

Literally right now doing a shift at a chill rural place, $200/hour. Seen 3 patients in 9 hours so far. The CMG i believe pays more than it collects at a lot of these rural places. A democratic group i doubt could take a loss at some of these sites.

Even my full time gig, I'm roughly averaging $160/patient based on my average number of patients seen and my compensation. I believe that is more than the average reimbursement, and doesn't even take into account the overhead costs.

So i don't know about you guys, but so far I'm satisfied with my CMG. They probably barely break even on me.
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My experience is that democratic groups don't frequently divulge how much partners make. Even if somewhat less than some CMG, at least they get to eat what they kill.

Lets be real about that chill rural place - they're subsidized. They aren't paying you 200/hr out of the kindness of their hearts. They take money from the hospital (who may get extra money from the gov't if they're critical access). They are also taking money from the docs at busier departments (you get to the privilege to pay yourself at another department). Despite whatever you're getting paid, you're being cheated and unwittingly helping the CMG to cheat other docs. Hey, you gotta do what you gotta do to make a living, but they prey on that sort of attitude and it is that attitude that has allowed them to flourish and plunder the specialty.
 
carbonizedeyesockets said:
My experience is that democratic groups don't frequently divulge how much partners make. Even if somewhat less than some CMG, at least they get to eat what they kill.

Lets be real about that chill rural place - they're subsidized. They aren't paying you 200/hr out of the kindness of their hearts. They take money from the hospital (who may get extra money from the gov't if they're critical access). They are also taking money from the docs at busier departments (you get to the privilege to pay yourself at another department). Despite whatever you're getting paid, you're being cheated and unwittingly helping the CMG to cheat other docs. Hey, you gotta do what you gotta do to make a living, but they prey on that sort of attitude and it is that attitude that has allowed them to flourish and plunder the specialty.
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Well the problem is that most SDGs screw their prepartners.

However, back to the main point of the thread. The issue isn't as simple as employees can unionize, and private physicians can't. the issue is that, historically, under labors laws, even employed physicians would be classified as independent contractors (since we retain sufficient flexibility regarding scheduling and medical practice), and thus prohibited from unionizing (I think a similar prohibition against residents unionizing would hold as well, under the guise that they're "students"). Private practitioners (ie owners) obviously can't unionize since that would entail forming a cartel.

Currently, however, with the increased control that hospitals, CMGs and other employers are placing on us, regarding the need to follow treatment and evaluation protocols, as well as some recent court decisions, I think one could easily argue that we are best classified as employees and thus have the right to unionize.
 
Where is your evidence that most SDGs screw their pre-partners?
turkeyjerky said:
Well the problem is that most SDGs screw their prepartners.

However, back to the main point of the thread. The issue isn't as simple as employees can unionize, and private physicians can't. the issue is that, historically, under labors laws, even employed physicians would be classified as independent contractors (since we retain sufficient flexibility regarding scheduling and medical practice), and thus prohibited from unionizing (I think a similar prohibition against residents unionizing would hold as well, under the guise that they're "students"). Private practitioners (ie owners) obviously can't unionize since that would entail forming a cartel.

Currently, however, with the increased control that hospitals, CMGs and other employers are placing on us, regarding the need to follow treatment and evaluation protocols, as well as some recent court decisions, I think one could easily argue that we are best classified as employees and thus have the right to unionize.
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carbonizedeyesockets said:
My experience is that democratic groups don't frequently divulge how much partners make. Even if somewhat less than some CMG, at least they get to eat what they kill.

Lets be real about that chill rural place - they're subsidized. They aren't paying you 200/hr out of the kindness of their hearts. They take money from the hospital (who may get extra money from the gov't if they're critical access). They are also taking money from the docs at busier departments (you get to the privilege to pay yourself at another department). Despite whatever you're getting paid, you're being cheated and unwittingly helping the CMG to cheat other docs. Hey, you gotta do what you gotta do to make a living, but they prey on that sort of attitude and it is that attitude that has allowed them to flourish and plunder the specialty.
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Trust me, the SDG jobs for my area were MUCH worse. One paid 150/hr for 3 years, which increased slightly, and then another 2 years until full partner. They could deny you partnership at any point within these 5 years, then all you did was slave labor for the SDG. Plus not to mention every site of theirs averaged 2.5 pph.

The other offered 185/hour, 2 years to partnership. Partners roughly made another $50/hour.

I wasn't impressed honestly. The SDG is basically screwing the younger less experienced doc in favor of the partners, how is that better?
 
The rural hospital can still be profitable these CMGs are making money staffing this place with no liability. If anything that place subsidizes the hospitalist group they are making money trust me.
 
cyanide12345678 said:
When i was job hunting last year, the SDG groups were paying significantly less than what I'm making at the CMG. In fact, my patient volume is less too. It really comes down to a particular hospital basically.

Literally right now doing a shift at a chill rural place, $200/hour. Seen 3 patients in 9 hours so far. The CMG i believe pays more than it collects at a lot of these rural places. A democratic group i doubt could take a loss at some of these sites.

Even my full time gig, I'm roughly averaging $160/patient based on my average number of patients seen and my compensation. I believe that is more than the average reimbursement, and doesn't even take into account the overhead costs.

So i don't know about you guys, but so far I'm satisfied with my CMG. They probably barely break even on me.
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No CMG barely breaks even on anyone. They are definitely making a profit. CMG's only goal is to generate free cash flow to pay debt to increase PE owner's equity stake. The idea they would take a loss on any contract is foolish to think. If they ever found themselves losing money or breaking even, they wouldn't hesitate to just cut the contract.
 
Don't be naive guys. Remember @NinerNiner999's post as a CMG partner going over the economy of EM? We should resurrect that thread. Here's a quote:

NinerNiner999 said:
To begin, there is really only one number that you need to know. $150. That's right, $150. This is the average amount of money COLLECTED per patient across the board, across the country. Not billed, not in accounts receivable, not cash only, ACROSS THE BOARD for ALL PATIENTS. Remember this number. This is after 1/3 of your patients (self pay) don't ever pay you, 1/3 of your medicare and medicaid patients pay you at reduced rates, and 1/3 of those with private insurance pay you what they decide to pay you. Payor mix (the ratio of these three components) may vary from place to place, but $150 averaged per patient is fairly reliable.
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All CMGs (and most SDGs pre-partner) are raping you but are very skilled at selling you on the "We're barely breaking even guys...but you know, we think the right thing to do is to add $5/hr to your pay in spite of the decreasing profitability. We're barely staying afloat here but wanted to show some appreciation for all your hard work. Also, remember....your compensation formula is clearly shown on the CMG portal if you guys have any questions about how it works."

Translation: We normally make about $80-100/hr off you guys but last month we only made $70/hr and are "in the red". Meanwhile, some of you are getting sick of seeing 2.6pph and have left for greener pastures so we're going to incentivize you with a "fat raise" in the form of an extra $5/hr to keep more people from leaving since hiring you guys is a major pain in the ass. The compensation formula "technically" is on the CMG portal, this much is true, but we've made it so confusing that it now looks like alien hieroglyphics and we will be quick to make you feel like an idiot for not understanding the "crystal clear math" in case you decide to ask any questions about it during quarterly meetings while we are doing site visits.
 
citymd1234 said:
No CMG barely breaks even on anyone. They are definitely making a profit. CMG's only goal is to generate free cash flow to pay debt to increase PE owner's equity stake. The idea they would take a loss on any contract is foolish to think. If they ever found themselves losing money or breaking even, they wouldn't hesitate to just cut the contract.
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The CMGs generally don't make much money from doctor's fees. They make money from billing, coding and "management fees". Typically they just use the surplus from the better-paying sites to subsidize doctor's fees at lower paying ones. The whole point is to get doctors to see patients and generate all of those tasty per patient management fees.
 
cyanide12345678 said:
Trust me, the SDG jobs for my area were MUCH worse. One paid 150/hr for 3 years, which increased slightly, and then another 2 years until full partner. They could deny you partnership at any point within these 5 years, then all you did was slave labor for the SDG. Plus not to mention every site of theirs averaged 2.5 pph.

The other offered 185/hour, 2 years to partnership. Partners roughly made another $50/hour.

I wasn't impressed honestly. The SDG is basically screwing the younger less experienced doc in favor of the partners, how is that better?
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From 185 to 235 may equate to an addition 77k per year, assuming 1532 hours per year.

That’s significant.

I do have concerns about how some democratic groups function. And some may be just as predatory as the CMGs, for sure. But while you “slave” for a few years to make partner, it’s better than slaving for your whole career for a CMG. The SDG is likely not lobbying to undermine you and replace you with midlevels. Or at least if the SDG uses MLPs, you have say in hiring, firing, and may be able to reduce your workload to allow better oversight. I know of a few SDGs wher they staff heavily with MLPs, but you see 1-1.5 an hour yourself so that you can see all the MLP patients, too, and actually provide adequate oversight.

So, yes, some SDGs may be bad. And, I will admit that some CMG sites may actually be pretty good. But, at the end of the day, the CMGs have it in their interest to screw you, and screw you they will. Their shareholders EXPECT it and will DEMAND it.
 
If they can deny partnership at any point, it's SDG in name only. If they're seeing 2.5 pph, that's their choice, not because they're SDG, but because they're nuts.

True, my partnership track cost me nearly $100k compared to local hospital employed jobs, but it will take one year of partnership to make that back. We see roughly 1.5-1.6 pph at our busiest place. Unless everyone I know in the group lies, we don't deny partnership to anyone (i.e. we take the hiring process very seriously).

Maybe our local market is just good? No predators around that I know.
cyanide12345678 said:
Trust me, the SDG jobs for my area were MUCH worse. One paid 150/hr for 3 years, which increased slightly, and then another 2 years until full partner. They could deny you partnership at any point within these 5 years, then all you did was slave labor for the SDG. Plus not to mention every site of theirs averaged 2.5 pph.

The other offered 185/hour, 2 years to partnership. Partners roughly made another $50/hour.

I wasn't impressed honestly. The SDG is basically screwing the younger less experienced doc in favor of the partners, how is that better?
Click to expand...
 
CMGs has many financial advantages that SDGs just do not have. All of these advantages may not seem like alot but they sure add up.

They save money on administrative costs, recruiting, better insurance negotiated rates, better billing, etc.

If all things were equal, the SDG would be way more profitable b/c all the profits goes to the Docs. But it is not. Its not black and white.

When we ran a SDG, there were alot of inefficiencies that just could not be avoided.

1. If a SDG has a disgruntled doc who sued the group, then the SDG has the choice of getting a lawyer at $200+/hr to fight the suit or just give in. Many times its just better to just give in and give the doc back his money. The CMG just grabs one of their lawyers to fight it and doesn't really cost much
2. CMGs have much better leverage to negotiate better rates than SDGs.
3. They spend way less on HRs than a SDG per doc
4. CMGs can give more benefits at lower costs due to scale
5. The SDG has to pay 10+% of income to the biller. The CMGs have this in house and essentially keeps all the profits

These are the reasons the SDG may pay less than the CMG in town eventhough the CMG is taking 50+/hr from the docs working.

Think walmart vs a mom/pop store. Eventually the mom/pop gives up bc they can't compete at the economies of scale.
 
cyanide12345678 said:
When i was job hunting last year, the SDG groups were paying significantly less than what I'm making at the CMG. In fact, my patient volume is less too. It really comes down to a particular hospital basically.

Literally right now doing a shift at a chill rural place, $200/hour. Seen 3 patients in 9 hours so far. The CMG i believe pays more than it collects at a lot of these rural places. A democratic group i doubt could take a loss at some of these sites.

Even my full time gig, I'm roughly averaging $160/patient based on my average number of patients seen and my compensation. I believe that is more than the average reimbursement, and doesn't even take into account the overhead costs.

So i don't know about you guys, but so far I'm satisfied with my CMG. They probably barely break even on me.
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Foolish to think this. Think subsidy, think with a good payer mix they collect way more. It is like stockholm syndrome to think you are the special one. They profit off of you. If they didnt they would replace you with someone cheaper. Many SDGs are so greedy they screw their pre partners. I think that model is gone.
 
emergentmd said:
CMGs has many financial advantages that SDGs just do not have. All of these advantages may not seem like alot but they sure add up.

They save money on administrative costs, recruiting, better insurance negotiated rates, better billing, etc.

If all things were equal, the SDG would be way more profitable b/c all the profits goes to the Docs. But it is not. Its not black and white.

When we ran a SDG, there were alot of inefficiencies that just could not be avoided.

1. If a SDG has a disgruntled doc who sued the group, then the SDG has the choice of getting a lawyer at $200+/hr to fight the suit or just give in. Many times its just better to just give in and give the doc back his money. The CMG just grabs one of their lawyers to fight it and doesn't really cost much
2. CMGs have much better leverage to negotiate better rates than SDGs.
3. They spend way less on HRs than a SDG per doc
4. CMGs can give more benefits at lower costs due to scale
5. The SDG has to pay 10+% of income to the biller. The CMGs have this in house and essentially keeps all the profits

These are the reasons the SDG may pay less than the CMG in town eventhough the CMG is taking 50+/hr from the docs working.

Think walmart vs a mom/pop store. Eventually the mom/pop gives up bc they can't compete at the economies of scale.
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This is some of the most commonly BS stuff I hear.

Yes they generally have better insurance contracts and recruiting mechanism but thats it. Neither of the SDGs I was a part of spent a nickel in recruiting beyond a dinner to meet candidates who paid their own way to talk with us. Why? We didnt need to. We have/had great jobs people came to us. Why? Cause we were a solid SDG.

SDGs are way more profitable. They run way leaner. total costs including billing and coding and med mal runs in the 10-15% range. No CMG is under 20-30% and most are way more than that as they play games on the billing/coding side. What no one mentions in here is much of their profit is from the overuse of MLPs.

Re #1. If a person sues depending on the size of your SDG its not a huge deal. If you have 20 partners and you rack up 200k in lawyer fees thats 10k a person. the person who sued (the plaintiff) better have a damn good case to get a lawyer as the fees will be similar with the lawyer often at risk. CMGs dont use one of their lawyers. they outsource. Their lawyers arent licensed / passed the bar in all 50 states, hence they outsource which isnt cheap.
2. Yes they do get better rates than most SDGs.
3. They spend way more on HR. Thats insane to think otherwise. If you roll recruiting into HR its not even remotely close. Shrimp dinners, shiny post cards, recruiters, calls, email, etc. Herding a bunch of disinterested docs costs way more than herding engaged partners.
4. This is another lie. Which benefit can they give at a lower cost? Maybe health insurance? Maybe they save $100/month. No other cost. This is a joke.
5. SDGs dont spend 10% of their income on billing and coding. If you did you got screwed. First job was under 4% and current one is about 5%. This is with 2 different large EM billing companies. The CMGs do this in house for a high cost and keep the profit. I pay less and I keep the profit. No games.

The CMGs are taking way more than $50/hr. If I remember when envision was public their profit was about 25%. So I assume we can agree most EM docs make over 200/hr, you do the math. Obviously the profit is higher on MLPs. I keep my MLP profit in my sdg

The economies of scale dont work out as you say in EM. The advantages of an SDG are highly enagaged docs who require little to no herding. The exorbitant cost and loss at CMGs due to poor charting, not billing procedures doesnt exist in a FFS SDG.
 
In other news did anyone see the article in the financial times about the debt TH and envision have and the lack of appetite in the public markets to buy it. Doesnt give a rosy picture of the future of EM in general.
 
EctopicFetus said:
In other news did anyone see the article in the financial times about the debt TH and envision have and the lack of appetite in the public markets to buy it. Doesnt give a rosy picture of the future of EM in general.
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Didn't find it with a quick search. Can you post the link?
 
Groove said:
Don't be naive guys. Remember @NinerNiner999's post as a CMG partner going over the economy of EM? We should resurrect that thread. Here's a quote:



All CMGs (and most SDGs pre-partner) are raping you but are very skilled at selling you on the "We're barely breaking even guys...but you know, we think the right thing to do is to add $5/hr to your pay in spite of the decreasing profitability. We're barely staying afloat here but wanted to show some appreciation for all your hard work. Also, remember....your compensation formula is clearly shown on the CMG portal if you guys have any questions about how it works."

Translation: We normally make about $80-100/hr off you guys but last month we only made $70/hr and are "in the red". Meanwhile, some of you are getting sick of seeing 2.6pph and have left for greener pastures so we're going to incentivize you with a "fat raise" in the form of an extra $5/hr to keep more people from leaving since hiring you guys is a major pain in the ass. The compensation formula "technically" is on the CMG portal, this much is true, but we've made it so confusing that it now looks like alien hieroglyphics and we will be quick to make you feel like an idiot for not understanding the "crystal clear math" in case you decide to ask any questions about it during quarterly meetings while we are doing site visits.
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It's based on Niner's post that I don't think the CMG is making 80-100/hour off of me. Maybe they are? Who knows, but this is why I don't think they are.

In one 12 hour shift, I gross $3180. That's $265/hr. I'm a nocturnist, so after 1 am, I'm hardly seeing 1/hour.

I'm usually seeing between 18-20 patients in a 12 hour shift. So lets say I average 19 patients a day. Busy days I'm seeing around 24, slow days I'm seeing 13-14 in a 12 hour day.

So thats about $167/patient I see. Based on the post by niner, which I've read multiple times, that's actually pretty good if average reimbursement is $150/patient.

I have about a 3 hour overlap with the MLP, usually I'll co sign about 5 notes of theirs for the last few hours that they are there.

So as delusional as you guys think I might be, as a nocturnist, I get paid more, I see less patients, so I don't think I'm being raped by the CMG. based on the numbers
 
TooMuchResearch said:
If they can deny partnership at any point, it's SDG in name only. If they're seeing 2.5 pph, that's their choice, not because they're SDG, but because they're nuts.

True, my partnership track cost me nearly $100k compared to local hospital employed jobs, but it will take one year of partnership to make that back. We see roughly 1.5-1.6 pph at our busiest place. Unless everyone I know in the group lies, we don't deny partnership to anyone (i.e. we take the hiring process very seriously).

Maybe our local market is just good? No predators around that I know.
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This particular group, which is the largest SDG group in the area that staffs 7-8 hospitals now, has denied many people in the past from partnership.

So yea...its mostly SDG only in name.
 
My residency attendings are being absolutely raped by the CMG group.

They see around 3.5 patients per hour with the residents.

They get paid $185-200/hour.

That my friends is a real CMG rape.
 
cyanide12345678 said:
It's based on Niner's post that I don't think the CMG is making 80-100/hour off of me. Maybe they are? Who knows, but this is why I don't think they are.

In one 12 hour shift, I gross $3180. That's $265/hr. I'm a nocturnist, so after 1 am, I'm hardly seeing 1/hour.

I'm usually seeing between 18-20 patients in a 12 hour shift. So lets say I average 19 patients a day. Busy days I'm seeing around 24, slow days I'm seeing 13-14 in a 12 hour day.

So thats about $167/patient I see. Based on the post by niner, which I've read multiple times, that's actually pretty good if average reimbursement is $150/patient.

I have about a 3 hour overlap with the MLP, usually I'll co sign about 5 notes of theirs for the last few hours that they are there.

So as delusional as you guys think I might be, as a nocturnist, I get paid more, I see less patients, so I don't think I'm being raped by the CMG. based on the numbers
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YOU might be doing ok. And yes, it is possible that for your 9 hours as single coverage overnight, they lose money on you. But, they make it up elsewhere. They're screwing your fellow EM docs in the day to pay you 265/hr and they're doing it in addition to what they're already skimming for themselves. You are unwittingly helping to facilitate the "rape" of your fellow EM docs.
 
I think the first step in getting EM unionized will be to file lawsuits against all the CMGs to reclassify EM docs as employees rather than independent contractors. Looking at the IRS definitions for ICs, there’s absolutely no way EM docs are truly ICs in CMGs. That’s the first step in the battle.
 
carbonizedeyesockets said:
YOU might be doing ok. And yes, it is possible that for your 9 hours as single coverage overnight, they lose money on you. But, they make it up elsewhere. They're screwing your fellow EM docs in the day to pay you 265/hr and they're doing it in addition to what they're already skimming for themselves. You are unwittingly helping to facilitate the "rape" of your fellow EM docs.
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I'm doing okay because i know my worth and refused to take any crap offer. There were plenty of those. My fellow EM docs who accept low ball offers are actually the ones screwing the field. So many of my co residents fell for the, "everyone gets paid the same" crap. As a whole we need to say no to low ball offers.
 
cyanide12345678 said:
I'm doing okay because i know my worth and refused to take any crap offer. There were plenty of those. My fellow EM docs who accept low ball offers are actually the ones screwing the field. So many of my co residents fell for the, "everyone gets paid the same" crap. As a whole we need to say no to low ball offers.
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Are you positive that your day docs are making so much less than you? Have you seen their contracts? Also, are you in TX? Those are terrible rates for you guys. We had a locums guy who worked with us for years and was convinced he had negotiated such a sweet deal with the CMG for a fixed hourly rate. He flew in from a MW state twice a month (I'm in the South). I never had the heart to tell him that I was making $20/hr more than him.
 
cyanide12345678 said:
I'm doing okay because i know my worth and refused to take any crap offer. There were plenty of those. My fellow EM docs who accept low ball offers are actually the ones screwing the field. So many of my co residents fell for the, "everyone gets paid the same" crap. As a whole we need to say no to low ball offers.
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Yep, it's all about the docs taking low ball offers that screw the field. Of course if everyone stopped accepting low ball offers, your pay would drop. Probably quite dramatically.
 
carbonizedeyesockets said:
YOU might be doing ok. And yes, it is possible that for your 9 hours as single coverage overnight, they lose money on you. But, they make it up elsewhere. They're screwing your fellow EM docs in the day to pay you 265/hr and they're doing it in addition to what they're already skimming for themselves. You are unwittingly helping to facilitate the "rape" of your fellow EM docs.
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Oh please.

Everyone has to do what is best for them and their family. I'm not going to take a hospital employed position for $70/hr less than the CMG gig just cause.
 
DO3 said:
I think the first step in getting EM unionized will be to file lawsuits against all the CMGs to reclassify EM docs as employees rather than independent contractors. Looking at the IRS definitions for ICs, there’s absolutely no way EM docs are truly ICs in CMGs. That’s the first step in the battle.
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No way would I support employeeization if it ever came down to that. Losing my IC would screw up the retirement accounts I worked so hard to make and probably subject me to more random UDSes.
 
No way do I want to be an employee you get hammered in taxes and they will make you take surge call lol

Also your health insurance plan will still be a high deductible plan. Your retirement will be a 401k that maybe that vest after 5 years the whole employee vs independent contractor is moot if you make over 300k
 
hundreddaysoff said:
No way would I support employeeization if it ever came down to that. Losing my IC would screw up the retirement accounts I worked so hard to make and probably subject me to more random UDSes.
Click to expand...


More and more jobs are changing up the 401K plans to have proper investment accounts, not just a selection of rip-off, high cost mutual funds. I just took a full time job, and they do offer a 401K where I can buy any ETFs I want.
 
GeneralVeers said:
More and more jobs are changing up the 401K plans to have proper investment accounts, not just a selection of rip-off, high cost mutual funds. I just took a full time job, and they do offer a 401K where I can buy any ETFs I want.
Click to expand...

The fundamental problem with employer based 401Ks vs IC SEP is the sheer amount of money that I can put away tax deferred each year. It more than makes up for any benefit from employer matching or self directed 401K, etc.. At least, for someone like me. 19K vs 56K...it's a no brainer.
 
Groove said:
The fundamental problem with employer based 401Ks vs IC SEP is the sheer amount of money that I can put away tax deferred each year. It more than makes up for any benefit from employer matching or self directed 401K, etc.. At least, for someone like me. 19K vs 56K...it's a no brainer.
Click to expand...

Yea...max employee contribution is 19K. Employers can contribute too to 401K, and can contribute up to 37K (for a total of 56K). The maximum amount of money that can be deposited into a 401K from any source is 56K.

But what employers contribute that much? Hardly any. They might match...or contribute 5% of what you put in, or whatever.

Every year I put in 56K of my own money into a SEP-IRA. Easy peasy.

It's terrible that companies are sitting on record amounts of cash flow...savings are very low....and companies can probably give a tax break to themselves if they contribute some of that money to their employees 401K.
 
That brokerage option is awesome, ours has it too. Plus the group tops off my $19k to get to $56k.
GeneralVeers said:
More and more jobs are changing up the 401K plans to have proper investment accounts, not just a selection of rip-off, high cost mutual funds. I just took a full time job, and they do offer a 401K where I can buy any ETFs I want.
Click to expand...
 
Agreed with everyone above. I love the ability to put in 56k in a solo 401k. I would hate to go to an employed model. Most places I've seen seem to place to much value on the benefits they provide. I'm going to go to a S corp taxation model next year from sole proprietor and further decreased my tax burden next year.
 
Groove said:
The fundamental problem with employer based 401Ks vs IC SEP is the sheer amount of money that I can put away tax deferred each year. It more than makes up for any benefit from employer matching or self directed 401K, etc.. At least, for someone like me. 19K vs 56K...it's a no brainer.
Click to expand...

Right, and that's before we even talk about the cash balance plan that lets me sock away another $90K/y on top of the 401(k).
 
You guys all have to understand that the CMGs/SDGs/employed look at their employee expenses as a flat amount per hour. Whether or not they "top off your retirement" it doesn't matter.

One other thing to consider for you guys is that when you sign those PA charts thats also profit for the CMGs.

In the end there are really bad SDGs. I think most of those have sold at this point. My first job out of residency I made about 30-35% of what the partners made. It wasn't awesome. I took about 30-40/hr less than market. My buy in as compared to what partners made was well into 7 figures. That being said I hit break even after about 3 years. The next 3 years for me were all gravy (plus some extra bonus) and then the group sold for a pretty penny.

Both SDGs I have been a part of told me they never rejected anyone from partnership. My experience is that this has been true with both groups.

I would advise no one take a huge cut compared to market. The world of EM is different today and I know plenty of people who got screwed by the group selling before they made partner (this didn't happen in my old group).

If you think the CMG is paying more than the SDG in town one or more of these has to be true

1) You actually have no idea what the SDG partners are making
2) The SDG is poorly run
3) The SDG partners are so dumb that they would take on the extra work of running an SDG only to make less than the CMG.

I can't think of another option. Most SDGs who use MLPs take this profit to pay off their admin costs.

One other nugget which I will contradict Veers here. I know with 100% certainty that plenty of the CMGs make well over $100/hr (I know of a few sites where it is much higher).

Keep in mind that according to the annual filings of envision and Team (when they were public) their profits were in the range of 25%. So simple math is that if you earn $250/hr they are making $65/hr. Some sites better some sites worse. This is after they pay for all the shrimp at ACEP, their bloated admin etc.
 
EctopicFetus said:
One other nugget which I will contradict Veers here. I know with 100% certainty that plenty of the CMGs make well over $100/hr (I know of a few sites where it is much higher).

Keep in mind that according to the annual filings of envision and Team (when they were public) their profits were in the range of 25%. So simple math is that if you earn $250/hr they are making $65/hr. Some sites better some sites worse. This is after they pay for all the shrimp at ACEP, their bloated admin etc.
Click to expand...

It depends on where the money comes from. Most CMGs own their own billing/coding companies and some even own their own health insurance plan. Just billing/coding is about $15/pt or $30/hr which would be an expense that SDGs would have to pay, but CMGs get to keep as revenue.
 
Birdstrike said:
The most dissatisfied docs will say it's bad enough, but ask they what they're going to do about it, and the answer is usually a jumbled mess of disgruntledness that add up to a whole lot of nothing.
Click to expand...

I feel personally attacked 😀
 
GeneralVeers said:
A union would do nothing at the end of the day except take our money for another layer of non-working physicians. Are doctors REALLY going to walk out and go on strike and put patients in jeopardy? Until the answer to that is "yes" we will remain powerless.
Click to expand...
No they're not and yes, you are correct.
 
EctopicFetus said:
One other nugget which I will contradict Veers here. I know with 100% certainty that plenty of the CMGs make well over $100/hr (I know of a few sites where it is much higher).
Click to expand...

Agreed. Depends on the site, especially true at residency programs.

My residency, although 40+ year old program which is very well established, is staffed by a CMG. Attending salary $185/hr. Attendings average around 3.5-3.8 patients per hour. So they probably generate at least $150 x 3.5 = $525/hour. The rest goes to the pockets of the CMG. Every patient is seen and managed by a resident, attendings do not see their own patients, they only act in a supervisor role.
 
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