US Acute Care Solutions

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jack128k

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Hi,

I'm wondering if anyone has experience working for USACS?

What has your experience been? I've heard mixed things ranging from good to bad and then with the negative Summa Health press they've gotten this past year, I'm just not sure how to feel about them.

I'm sure some of it is related to the site you work at, but I'm wondering more about if there are unreasonable/unreachable metrics that you are forced to try and reach, how much of compensation is tied to these metrics, how much they take into account physician concerns/complaints, any emphasis on wellness, etc. Does it seem to be a good job for longevity?

Feel free to PM me if you don't feel comfortable posting it publicly on here. Thanks.
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jack128k said:
Hi,

I'm wondering if anyone has experience working for USACS?

What has your experience been? I've heard mixed things ranging from good to bad and then with the negative Summa Health press they've gotten this past year, I'm just not sure how to feel about them.

I'm sure some of it is related to the site you work at, but I'm wondering more about if there are unreasonable/unreachable metrics that you are forced to try and reach, how much of compensation is tied to these metrics, how much they take into account physician concerns/complaints, any emphasis on wellness, etc. Does it seem to be a good job for longevity?

Feel free to PM me if you don't feel comfortable posting it publicly on here. Thanks.
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What more do you need to know than what the Summa Health deal revealed? You really want to work with them after that? Or anyone dumb enough to work for them after that? They're on my list with EmCARE for groups I'll never work for. TeamHealth is probably going to get added to that list at some point as well.

When docs refuse to work for CMGs, CMGs will go away and docs will own their jobs again. The rare commodity is not the contract, it's the docs. Remember that.
 
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If you work for USACS you are funding your own demise.
 
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It makes me sad to see that USACS has spread like a cancer to a lot of really great areas. Just don't work for them.

I don't care how many full-page ads they run in the ACEP mailer. Screw 'em.
 
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I heard USACS took over Denver. Denver EM docs want to explain?
 
I currently work for USACS. My original group was merged approx. 6 months into my contract. While my situation is somewhat unique, at the moment I don't have any feelings, good or bad.

The location I chose to live (my original home) has only one decent sized hospital I would consider working in for a 60-80 mile radius. So choice was obviously limited for me.

The pay was decent (225/hr) and hours are nice. It is a very low cost of living area. And I get to live in my home town close to all my family and friends. So overall it has been a great job. But again a lot to this doesn't have to do with USACS in particular. Much to this was the same before the merger.
 
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Thanks to replies so far.

So, clearly there are many negative feelings towards the group. Is this because they're large and taken contracts at many hospitals or because of how they treat empolyees? I think everyone would prefer to be in an SDG with partnership opportunity if it was available, but many areas don't have this option.

I agree with WCI, I would never work for EmCare or Team Health, but I always viewed these differently since they are publicly traded companies that aren't physician run. USACS seems to advertise itself as physician-owned and run with a 'partnership' track of some sort (similar to CEP, which I think is one of the more benign large groups).

I've never worked for any of these though, so perhaps I'm wrong. I just certainly wouldn't want to leave my current job for something that is intolerable.
 
jack128k said:
Thanks to replies so far.

So, clearly there are many negative feelings towards the group. Is this because they're large and taken contracts at many hospitals or because of how they treat empolyees? I think everyone would prefer to be in an SDG with partnership opportunity if it was available, but many areas don't have this option.

I agree with WCI, I would never work for EmCare or Team Health, but I always viewed these differently since they are publicly traded companies that aren't physician run. USACS seems to advertise itself as physician-owned and run with a 'partnership' track of some sort (similar to CEP, which I think is one of the more benign large groups).

I've never worked for any of these though, so perhaps I'm wrong. I just certainly wouldn't want to leave my current job for something that is intolerable.
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You hit the nail on the head for most family oriented ED docs like me. There just wasn't any other options available to me that had as good of a balance between compensation and quality of life.

I would certainly love for a SDG to open its doors in my area. But for now that is looking less and less likely anywhere in the USA.

But I entered this game knowing all well that the "ownership" in EM is basically all but gone. Especially in the area I was looking to live and work. So if you are looking for true ownership and partner opportunities, I do not think USACS will fulfill this.
 
I've worked for them for years. The benefits are great and it's probably the best group to work for in my area. The SDG groups in my area are pretty predatory. Overall I'm pretty happy with them.
 
jack128k said:
Thanks to replies so far.

So, clearly there are many negative feelings towards the group. Is this because they're large and taken contracts at many hospitals or because of how they treat empolyees? I think everyone would prefer to be in an SDG with partnership opportunity if it was available, but many areas don't have this option.

I agree with WCI, I would never work for EmCare or Team Health, but I always viewed these differently since they are publicly traded companies that aren't physician run. USACS seems to advertise itself as physician-owned and run with a 'partnership' track of some sort (similar to CEP, which I think is one of the more benign large groups).

I've never worked for any of these though, so perhaps I'm wrong. I just certainly wouldn't want to leave my current job for something that is intolerable.
Click to expand...

I would say go to ACEP and just see how much EMP(USACS)/TH/Emcare all spend to keep the party going. I'll let you have a guess where that money is coming from....


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They mislead and outright lie. They are "physician-owned" however the ownership is by one physician, Dominic Bagnoli. Although they claim the pit docs own a piece of the company, in reality it is smoke and mirrors, and they have nothing.
 
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I feel for those that are limited in their choices. This is getting all too common.
these groups put on a hell of a "show" for hospital admins...in particular with the ACA USACA pounced on all the ACO, cost saving, observation, BS and used this as a huge tool for marketing to hospitals. I remember quite well as I used to work for them and did their little director training fellowship program.

But I think a lot of blame need to fall on the greed of many SDGs. There are many predatory ones out there and new grads are rightfully turned off and go for the path of least resistance.
I am lucky that I found an open SDG with a short, reasonable, work-in time.
But the attitude of so many groups really soured the taste of the SDG for a lot of young physicians. We saw this while recruiting for USACS back in the day.
In the end, you are a cubicle-working EM doc. And your pay will be a fraction of what you are worth and what you are truly billing. You are no safer with them "owning" their malpractice company. You see none of the benefits of the "owning" of the billing company, etc.
You get a benefit package if you stay the course but compare that dollar for dollar over time if you were freelancing or a partner in a "good" SDG and...wow.

Granted, I know the choices are limited for you so just know what's up and what you're looking at with these groups.
 
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I was one of those "new grads following the path of least resistance."

Had bigger things to worry about at the time, and after interviewing with 1-2 SDGs and having them tell me lies about turnover, schedule, etc, I just said "eff it, I'll sort this out later if I have to."
 
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Bunch of new grads = large percentage of uninformed = easy prey for CMGs who have large presence. They don't need to pluck a large percentage of docs, just a decent percentage. Plus most docs are fundamentally poor money managers and see the $175/hr and they think they got a good deal.

I mean..... $175/hr (WOW thats more than I ever made) x 40hr/wk (WOW... a cakewalk compared to residency) = 360K (Wow, that's a lot and better than average), plus they are paying me a stipend or relocation or these great benefits.

What they don't realize is a seasoned mature doc is making Much more sitting right next to them doing the same amount of work without any administrative responsibilities.
 
RustedFox said:
I was one of those "new grads following the path of least resistance."

Had bigger things to worry about at the time, and after interviewing with 1-2 SDGs and having them tell me lies about turnover, schedule, etc, I just said "eff it, I'll sort this out later if I have to."
Click to expand...

As was I.
I really feel those reaping $$$ in SDGs, that really do prey on any new blood have a lot of blame too.
Granted there are great, open, honest SDGs, but they are hurt by the stigma of predatory groups too. I mean, if you have s family, gambling on a group is probably not going to fly.
And the freaking CMGs know this and milk the crap out of it too. Just sad.
 
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I always like to mention dollars/hr isn't the only comparison you need to do.
Making 210/hr seeing 1.7 Pt/hr is a nice job compared to 260/hr seeing 3.0 Pt/hr.
Lots of new grads see this big hourly rate but don't realize you are going to get hammered in the amount of Pt/hr they see. And for example above seeing 3pt/hr they are literally taking over 100/hr off the top.
The last and maybe more important thing is control. In your own group you control schedule, adding or subtracting hours. This is important for pt safety and quality of life issues.
 
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thorg12 said:
I always like to mention dollars/hr isn't the only comparison you need to do.
Making 210/hr seeing 1.7 Pt/hr is a nice job compared to 260/hr seeing 3.0 Pt/hr.
Lots of new grads see this big hourly rate but don't realize you are going to get hammered in the amount of Pt/hr they see. And for example above seeing 3pt/hr they are literally taking over 100/hr off the top.
The last and maybe more important thing is control. In your own group you control schedule, adding or subtracting hours. This is important for pt safety and quality of life issues.
Click to expand...

I had no control with EMP/USACS. I had to submit a request for 10 days off a month if I wanted the, and there was no guarantee it would be granted. I was also forced to work most Holidays (could request one off per year). Now I work when I want, and how much I want.
 
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GeneralVeers said:
I had no control with EMP/USACS. I had to submit a request for 10 days off a month if I wanted the, and there was no guarantee it would be granted. I was also forced to work most Holidays (could request one off per year). Now I work when I want, and how much I want.
Click to expand...

Are you doing locums full-time?
 
In theory, when we all decide to stop working for USACS then they cease to exist but I just dont see that happening to be honest. But what it we could all unify and no one worked from them for under $400? Maybe its a pipe dream but it could be another way of forcing them out.
 
OccupyTheED said:
In theory, when we all decide to stop working for USACS then they cease to exist but I just dont see that happening to be honest. But what it we could all unify and no one worked from them for under $400? Maybe its a pipe dream but it could be another way of forcing them out.
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Do partners of SDG average $400/hr? I am curious and not trying to challenge you any way. Genuinely curious
 
@hypnix I'll let you know if I ever find one and become a partner lol. But check out @NinerNiner999 's thread about how much you are worth and how much you're actually generating as a competent and productive EP. I would imagine that thats on the high side even for an SDG partner, but when it comes to the scum of the earth, I mean USACS, I would have no qualms about it if we all tried to extract our pound of flesh for what they do to our specialty as a whole and to new and naive EPs in particular.
 
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hypnix said:
Do partners of SDG average $400/hr? I am curious and not trying to challenge you any way. Genuinely curious
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No, but $300 is pretty doable. If you want $400 an hour you're going to need to be a gunslinger "Call me when you're paying $400 an hour" type doc doing locums kind of stuff.
 
OccupyTheED said:
In theory, when we all decide to stop working for USACS then they cease to exist but I just dont see that happening to be honest. But what it we could all unify and no one worked from them for under $400? Maybe its a pipe dream but it could be another way of forcing them out.
Click to expand...

In theory this would be great. In practice it won't work because of jerks like me. I easily found a $300/h new attending job with decent metrics with a CMG of the lesser-evil variety (eg, not USACS on principle). I talked with a few SDGs in the same area, and their entry-level pay was more like $200/h with similar metrics, various partner buy-in schemes, and no guarantees they would still be independent before I made partner. All for partner-level pay of ~$300/h at most.

Will the CMGs win in a few years and make the bottom fall out for everyone? Damned if I know. That's why I'm gonna make hay while the sun shines now and hopefully practice the way I really want in a few years when I'm more financially independent.
 
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hundreddaysoff said:
In theory this would be great. In practice it won't work because of jerks like me. I easily found a $300/h new attending job with decent metrics with a CMG of the lesser-evil variety (eg, not USACS on principle). I talked with a few SDGs in the same area, and their entry-level pay was more like $200/h with similar metrics, various partner buy-in schemes, and no guarantees they would still be independent before I made partner. All for partner-level pay of ~$300/h at most.

Will the CMGs win in a few years and make the bottom fall out for everyone? Damned if I know. That's why I'm gonna make hay while the sun shines now and hopefully practice the way I really want in a few years when I'm more financially independent.
Click to expand...
Here's hoping.
 
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GeneralVeers said:
I had no control with EMP/USACS. I had to submit a request for 10 days off a month if I wanted the, and there was no guarantee it would be granted. I was also forced to work most Holidays (could request one off per year). Now I work when I want, and how much I want.
Click to expand...

This is exactly the type of thing that scares me when thinking about working for them or a similar group.
My current job is in a very high COL area and the pay is relatively low (<200/hr) but I otherwise feel valued and treated well. There are definitely other benefits with my current gig and definitely don't have the above issue.

Just trying to figure out if it's worth the pay cut and staying in this area vs. a higher income in absolute and relative dollars.
 
Avoid USACS like the plague.

You are nothing more than a widget maker for this company. My group was taken over by them through a series of hospital mergers. Since they took over, our ED has been in decline.

Hour cuts, constant schedule changes, constant under staffing. Push to cut physician hours and staff with more mid levels. Forced us to pay ~$30,000 at the end of last year because they "restructured" the shares you get.
 
I work for them after they took over my SDG (right before I made partner). And yeah, my job has kinda gone to **** about the same time but it's hard to say why.

Problem is, the hospital system itself got taken over the same time that the group got bought out and we changed medical directors and it's hard to suss out really who's to blame for current conditions. Think it's more the hospital administration, personally. USACS has a great 401K and as far as I understand it, they haven't been intervening any in how I practice or pushing higher billing or anything truly awful. My next job, if I move, is still gonna be to a USACS site but that's really cause they got me by the balls a bit with regards to company stock.
 
Redrox said:
My next job, if I move, is still gonna be to a USACS site but that's really cause they got me by the balls a bit with regards to company stock.
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How are they paying you with company stock?
 
BAM! said:
How are they paying you with company stock?
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USACS gives you a "share" of the company. They call you an "owner," but you have no real say or power.

As I mentioned above, in the fall of 2016 they restructured they way award those shares. Everyone had to pay just under $30,000 cash when they did this to cover the tax liability of their decision. There were a couple of options they gave you to cover this, with most of them being a payroll deduction over 1-2 years. They even charged us interest.
 
Not Pudding said:
USACS gives you a "share" of the company. They call you an "owner," but you have no real say or power.

As I mentioned above, in the fall of 2016 they restructured they way award those shares. Everyone had to pay just under $30,000 cash when they did this to cover the tax liability of their decision. There were a couple of options they gave you to cover this, with most of them being a payroll deduction over 1-2 years. They even charged us interest.
Click to expand...

How financially significant are those shares, and do they generate dividend income or solely capital gains?
 
Brahnold Bloodaxe said:
How financially significant are those shares, and do they generate dividend income or solely capital gains?
Click to expand...

Hard to tell. It wasn't capital gains prior to the restructuring. Now it is. That is why they footed us the bill.

The question to "how much is it worth" depends on the market value whenever you cash out once you're vested. I can't answer that with any accuracy. We are told that our share should be worth between $100K - 150K.
 
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Not Pudding said:
Hard to tell. It wasn't capital gains prior to the restructuring. Now it is. That is why they footed us the bill.

The question to "how much is it worth" depends on the market value whenever you cash out once you're vested. I can't answer that with any accuracy. We are told that our share should be worth between $100K - 150K.
Click to expand...
Ah, phantom stock. The magical way corporations make employees feel empowered while also attempting to financially handcuff them to the company.
 
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Not Pudding said:
Hard to tell. It wasn't capital gains prior to the restructuring. Now it is. That is why they footed us the bill.

The question to "how much is it worth" depends on the market value whenever you cash out once you're vested. I can't answer that with any accuracy. We are told that our share should be worth between $100K - 150K.
Click to expand...
How long is the vesting period?

And, before anyone says it, if anyone suggests "what if everyone cashes out all at once? Won't that put them out of business?" No, it won't. It's like Larry Flynt's offer of $1million to 10 different women to be naked in his magazine more than 40 years ago. It wasn't if all of them did - the first one would get the money, and the rest were out. No one did, by the way. I have no first hand knowledge, but I would guess that USACS would space out payouts beyond a certain dollar level, once it reached that.
 
Apollyon said:
How long is the vesting period?

And, before anyone says it, if anyone suggests "what if everyone cashes out all at once? Won't that put them out of business?" No, it won't. It's like Larry Flynt's offer of $1million to 10 different women to be naked in his magazine more than 40 years ago. It wasn't if all of them did - the first one would get the money, and the rest were out. No one did, by the way. I have no first hand knowledge, but I would guess that USACS would space out payouts beyond a certain dollar level, once it reached that.
Click to expand...

5 years for the whole deal.

Random percentages after 2 or 3.
 
Not Pudding said:
Hard to tell. It wasn't capital gains prior to the restructuring. Now it is. That is why they footed us the bill.

The question to "how much is it worth" depends on the market value whenever you cash out once you're vested. I can't answer that with any accuracy. We are told that our share should be worth between $100K - 150K.
Click to expand...

So in other words, the equity doesn't entitle you guys to a share of the cash flow the way that being a pertner in a SDG does?
 
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can you sell your stock and still work there?
 
hypnix said:
Do partners of SDG average $400/hr? I am curious and not trying to challenge you any way. Genuinely curious
Click to expand...

It's possible. But like WCI said it's more in the 300-350/hr range if you have the right payor mix and depending if and how much you are taking off the people buying in. Emergentmd always brings up rates in the 400-50o/hr range but those are usually horrible places to work or places in need of coverage with short or no notice or over holidays. If you have a good payor mix and are efficient (scribes, good EMR, good RNs, midlevels, low-mid acuity, etc.) you will generate anywhere from 400-600+/hr. Most docs that work for CMGs will generate that no problem with their billing companies and ability to squeeze insurance companies for everything they have. So next time you see 275/hr, 300/hr, or 325/hr just realize you are still losing 100-200/hr to the suits.
 
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Brahnold Bloodaxe said:
So in other words, the equity doesn't entitle you guys to a share of the cash flow the way that being a pertner in a SDG does?
Click to expand...

What cash flow? There are no real open books. They declare a "bonus" at the end of the year, and the amount you get depends on your percentage vesting. Typically it was about $10K/year for fully vested docs. They claim your share is worth $100K, however when you cash out the amount you get is significantly less. Also if you are fired "for cause" they can take away the equity, and you get nothing. Also cannot sell or cash out equity while still a partner.
 
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USACS, Team, and Emcare are the same thing. Sure, USACS happened to be the one that made the colossal mistake with Summa but rest assured any other CMG would've done the same thing if offered the contract. By working with any of these groups you're simply the laborer making a ton of money for admins and stockholders and financiers. No surprise there. What is surprising though is that they have the nerve to keep peddling that you're an "owner" or "partner" or whatever. It's insulting that they think we'd be duped so easily. If I'm going to be an employee then just tell me I'm going to be an employee and save the glossy handout. At least then I could ask for overtime and a lunch break (which shouldn't I really get anyway since I'm on the same "team" as my nurses?).


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It saddens me how little people understand about all this. Keep in mind USACS is now owned by a private equity company. If you are a shareholder and have no idea of the P/L of your company it isnt worth being a shareholder.

Their scheme is simple and it ties those who are financially interested but have no real understanding how they are getting screwed. A partnership job should be 300 easily.

If you are inflexible with location your options are locums (which I think is hard with a family) or take whatever is around. I think it is foolish for a BCEM to work for $200-225/hr.

Keep in mind that the SDGs generate profit from MLPs. If you work for USACS the MLPs are all work and dont generate any profit for you. I advise those who work for USACS to look for ways to get out and drive the income up for docs who stay and will work. We need to stop being taken advantage of. That being said with the explosion of residencies they will have plenty of easy pickings.
 
So, if the future holds only CMG jobs, maybe all those that are leaving residency looking at SDG 's should push for "no sweat equity" jobs? I see that there lies a great amount of work to be done by SDG's to not only fend off CMG's, but also attract residents, while lowering the risk to them (the new grads) of holding an empty bag come time for partnership (if a buyout occurs).

IMHO if I was a new grad, I would look for a adding a clause to any contract along the lines of "if said group decides to sell before partnership is achieved, applicant will be treated as X% of full partner according to Y stipulations at time of sale"

Sad state of affairs when new grads are excited about $200/hr on a 1099, before CMG deductions...
 
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TysonCook said:
So, if the future holds only CMG jobs, maybe all those that are leaving residency looking at SDG 's should push for "no sweat equity" jobs? I see that there lies a great amount of work to be done by SDG's to not only fend off CMG's, but also attract residents, while lowering the risk to them (the new grads) of holding an empty bag come time for partnership (if a buyout occurs).

IMHO if I was a new grad, I would look for a adding a clause to any contract along the lines of "if said group decides to sell before partnership is achieved, applicant will be treated as X% of full partner according to Y stipulations at time of sale"

Sad state of affairs when new grads are excited about $200/hr on a 1099, before CMG deductions...
Click to expand...

So may I ask if you work for a SDG or CMG? I'm just curious?


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