USACS share scam.

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- Can anyone elaborate as to why precisely the USACS "shareholder" idea is a giant scam. I can remember it being said on here not long ago. I have zero experience or knowledge of the offer/structure; so I'd like to hear from someone who knows just why it's a worthless deal.

Thanks in advance.

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Because they could just pay you more without handcuffing you to the company? (I remember the thread but not the details). In general, phantom stock programs are there to simulate ownership while really just maintaining control by management.

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- Can anyone elaborate as to why precisely the USACS "shareholder" idea is a giant scam. I can remember it being said on here not long ago. I have zero experience or knowledge of the offer/structure; so I'd like to hear from someone who knows just why it's a worthless deal.

Thanks in advance.
Here you go.

US Acute Care Solutions
 
Because they could just pay you more without handcuffing you to the company? (I remember the thread but not the details). In general, phantom stock programs are there to simulate ownership while really just maintaining control by management.

Sent from my Moto G (5) Plus using SDN mobile

You summed it up. It's all about keeping you an indentured servant to the company as long as possible. The truth is that the 100K, really only ads up to 20K per year (or $30K including annual bonus) when I was there. My current job I get $30k more PER MONTH than what I got working for USACS without having to be a slave.
 
You summed it up. It's all about keeping you an indentured servant to the company as long as possible. The truth is that the 100K, really only ads up to 20K per year (or $30K including annual bonus) when I was there. My current job I get $30k more PER MONTH than what I got working for USACS without having to be a slave.

Quick math. Assuming you work 40h/wk, that means you're consistently getting $187.5/hr more than USACS was offering? Even more if you work fewer hours. That's impressive.
 
Quick math. Assuming you work 40h/wk, that means you're consistently getting $187.5/hr more than USACS was offering? Even more if you work fewer hours. That's impressive.
I've seen jobs in NV approaching 350/hr and can totally see USACS paying their docs 170/hr after billing for 400+/hr. Own by doctors my a$$.
 
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When I worked for them in Nevada, the average hourly some months was ~$130/hour. At the time they were paying their firefighters $175/hour. I hear that it is up to $200/hour now, which is worth about $240/hour if you include the benefits. Still a lot less than what you can make working at other places.
 
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When I worked for them in Nevada, the average hourly some months was ~$130/hour. At the time they were paying their firefighters $175/hour. I hear that it is up to $200/hour now, which is worth about $240/hour if you include the benefits. Still a lot less than what you can make working at other places.

I'm sorry, did you say a firefighter was making $175/hour?!?!?!?!? :wow:
 
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I'm sorry, did you say a firefighter was making $175/hour?!?!?!?!? :wow:

correct, however that was with benefits. Unfortunately the downsides are you can't make your own schedule, and are still locked into the 120 hours/month. As I said, I think they have raised to $200/hour, but still doesn't have the flexibility of of locums.
 
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As of 6 months ago, they were in the process of changing firefighter pay. It was 180/hr for first 120 hrs and then 280/hr for hrs over that. Working 140 per month and a slew of benefits got you up to 260/hr.

Last I heard, I think they were at 200/hr and they upped it to 140 hrs at that rate then switched to 300/hr.

Might as well do locums on your own and get full ctrl of your schedule and pocket all the travel benefits. That and the feeling of not destroying the specialty of emergency medicine.
 
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As of 6 months ago, they were in the process of changing firefighter pay. It was 180/hr for first 120 hrs and then 280/hr for hrs over that. Working 140 per month and a slew of benefits got you up to 260/hr.

Last I heard, I think they were at 200/hr and they upped it to 140 hrs at that rate then switched to 300/hr.

Might as well do locums on your own and get full ctrl of your schedule and pocket all the travel benefits. That and the feeling of not destroying the specialty of emergency medicine.

Even with the bump in pay over 140 hrs, I don't understand who the hell would take it. Your average hourly rate is still crap. My read of this isn't: "if you work 130 hours, you get 180/hr, and if you work 150 hours, you get 280/hr", it's "if you work 130 hours, you get 180/hr and if you work 160 hours, you get 140 hours at 180/hr and 20 hrs at 280/hr." Congratulations, you're working 45 hours a week in EM at a ****ty site that noone else wants to work at and you're getting paid $192.50/hr on average. Screw that.

Even if they give you the new terms with 200/hr and 300/hr, it averages out to $212.50/hr for 160 a month....

So the deal is: get paid poorly and in exchange you get to work too many hours, fly to an unstaffable hospital, sleep in a hotel and help damage the profession of emergency medicine? I'm good thanks.
 
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correct, however that was with benefits. Unfortunately the downsides are you can't make your own schedule, and are still locked into the 120 hours/month. As I said, I think they have raised to $200/hour, but still doesn't have the flexibility of of locums.

120 hours/month, locums, are you sure you aren't talking about an emergency physician instead of a firefighter?!? I find it hard to believe that a firefighter would make $175-200/hr and work 120 hours/month.
 
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120 hours/month, locums, are you sure you aren't talking about an emergency physician instead of a firefighter?!? I find it hard to believe that a firefighter would make $175-200/hr and work 120 hours/month.
I think its a metaphor.
 
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Can someone PM me, how exactly is the CEO of USACS making out so well? I understand that the shares, are not real entitlements to cash flow. Does a private company owned by the CEO own USACS? How does the details of the scam work?
 
120 hours/month, locums, are you sure you aren't talking about an emergency physician instead of a firefighter?!? I find it hard to believe that a firefighter would make $175-200/hr and work 120 hours/month.
I think it's EmCare that calls their in house locums "firefighters". I, personally, find that insulting to real firefighters.
 
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They prey on new grads.

USACS recruits heavily from programs in the midwest.

Lots of "free" dinners, concerts, and sporting events for residents and their families.
 
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USACS has their own "firefighter" program


Meet Dr. Deepika Singh, a USACS Traveling “Firefighter” and a Mom
March 16, 2017

It’s the most counter-intuitive thing you could possibly expect to hear from a physician whose job is to travel, but it’s true: Dr. Deepika Singh spends more time with her family, and more quality time, than when she worked locally at only one site.

Now an Assistant Medical Director with US Acute Care Solutions (USACS), Singh has made permanent an arrangement she initially thought would be temporary. “I decided to become a Firefighter for a year and after that our plan was to move back to a local place and I’d keep being a local doc,” she said.

Singh is part of a group of traveling emergency physicians known as Firefighters. Rather than rely on locums when there are unmet staffing needs, these physicians bring with them USACS training, culture and trademark camaraderie wherever they go.

The surprising thing is that since taking the job, Singh says she spends more time overall, and importantly more quality time with her two young kids, a 4-year-old girl and 6-year-old boy.

Singh came to work for USACS directly out of residency at one of its sites in Connecticut. After three years, her husband got a one-year position in Rochester, NY, and they decided to move. Rather than look for a job locally, Singh said she loved the USACS culture so much that she decided her best option was to take a temporary position on the Firefighter team.

She decided to travel despite being pregnant at the time. Not only was she about to give birth to her daughter, she also had a one-and-a-half-year-old at home. “I ended up just loving the whole vibe of the group. They clearly cared about me as a person; not just as a physician. I wanted to stay with them even if that meant traveling,” she said.

Amazingly, within a few months of the change, Singh found her lifestyle had dramatically changed for the better. When she was a local doc, her schedule was more unpredictable, and usually consisted of shifts interspersed throughout the week. The problem is that she would often return home exhausted after long overnight shifts. Either her kids wouldn’t be home, or if they were, she would be catching up on sleep.

In stark contrast, now Singh works 4 or 5 days in a row somewhere away from home, and then returns for sometimes nearly three weeks of total freedom. “I can sleep like a normal person, eat dinner at a normal time with my family. Your circadian rhythm can just be normal,” Singh said. “When I come home the quality time is really quality.”

Whereas in her previous position it was rare, if not impossible, to get three days in a row off, now she has weeks at a time with no shifts: “Instead of trying to cram in everything a parent does before going back to work, I can sleep in, work out and spend time with the kids. It’s like I’m a stay-at-home-mom for those days.”

At USACS, the current requirements for being a Firefighter are pretty straightforward, and Singh said they weren’t a problem for her:

  • A minimum of 108 hours a month (same as for local docs)
  • Work two weekends a month (or 2.5 weekends on a 5-weekend month)
  • Work either Thanksgiving or Christmas (including the Eve’s)
  • If you fly somewhere, work a minimum of four days in a row
“Outside of those requirements you have total control over your shifts. The flexibility is amazing,” she said.

Firefighters are usually assigned to the same place for a few months, or even longer, so they aren’t bouncing around to a different hospital every time they work. In that way, when Singh walks into an emergency department, she knows most of the people. She’s not constantly learning new systems or dealing with foreign environments. “The culture is already there in the ED, and within the hospital.”

Singh has now been a Firefighter for four years, and she and her family are thinking about making Rochester – what was supposed to have been a one-year pit stop – their permanent home, and Firefighting her permanent job.
 
Ah, for some reason I thought the Las Vegas Fire Department was paying their firefighters $175/hr, which I thought was totally BS. I didn't realize that the docs were called "firefighters."
Yeah, I'll say it a third time - BS, man, BS!!

I don't recall - were you FF/PM, or "just" EMT-P?
 
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USACS has their own "firefighter" program


Meet Dr. Deepika Singh, a USACS Traveling “Firefighter” and a Mom
March 16, 2017

It’s the most counter-intuitive thing you could possibly expect to hear from a physician whose job is to travel, but it’s true: Dr. Deepika Singh spends more time with her family, and more quality time, than when she worked locally at only one site.

Now an Assistant Medical Director with US Acute Care Solutions (USACS), Singh has made permanent an arrangement she initially thought would be temporary. “I decided to become a Firefighter for a year and after that our plan was to move back to a local place and I’d keep being a local doc,” she said.

Singh is part of a group of traveling emergency physicians known as Firefighters. Rather than rely on locums when there are unmet staffing needs, these physicians bring with them USACS training, culture and trademark camaraderie wherever they go.

The surprising thing is that since taking the job, Singh says she spends more time overall, and importantly more quality time with her two young kids, a 4-year-old girl and 6-year-old boy.

Singh came to work for USACS directly out of residency at one of its sites in Connecticut. After three years, her husband got a one-year position in Rochester, NY, and they decided to move. Rather than look for a job locally, Singh said she loved the USACS culture so much that she decided her best option was to take a temporary position on the Firefighter team.

She decided to travel despite being pregnant at the time. Not only was she about to give birth to her daughter, she also had a one-and-a-half-year-old at home. “I ended up just loving the whole vibe of the group. They clearly cared about me as a person; not just as a physician. I wanted to stay with them even if that meant traveling,” she said.

Amazingly, within a few months of the change, Singh found her lifestyle had dramatically changed for the better. When she was a local doc, her schedule was more unpredictable, and usually consisted of shifts interspersed throughout the week. The problem is that she would often return home exhausted after long overnight shifts. Either her kids wouldn’t be home, or if they were, she would be catching up on sleep.

In stark contrast, now Singh works 4 or 5 days in a row somewhere away from home, and then returns for sometimes nearly three weeks of total freedom. “I can sleep like a normal person, eat dinner at a normal time with my family. Your circadian rhythm can just be normal,” Singh said. “When I come home the quality time is really quality.”

Whereas in her previous position it was rare, if not impossible, to get three days in a row off, now she has weeks at a time with no shifts: “Instead of trying to cram in everything a parent does before going back to work, I can sleep in, work out and spend time with the kids. It’s like I’m a stay-at-home-mom for those days.”

At USACS, the current requirements for being a Firefighter are pretty straightforward, and Singh said they weren’t a problem for her:

  • A minimum of 108 hours a month (same as for local docs)
  • Work two weekends a month (or 2.5 weekends on a 5-weekend month)
  • Work either Thanksgiving or Christmas (including the Eve’s)
  • If you fly somewhere, work a minimum of four days in a row
“Outside of those requirements you have total control over your shifts. The flexibility is amazing,” she said.

Firefighters are usually assigned to the same place for a few months, or even longer, so they aren’t bouncing around to a different hospital every time they work. In that way, when Singh walks into an emergency department, she knows most of the people. She’s not constantly learning new systems or dealing with foreign environments. “The culture is already there in the ED, and within the hospital.”

Singh has now been a Firefighter for four years, and she and her family are thinking about making Rochester – what was supposed to have been a one-year pit stop – their permanent home, and Firefighting her permanent job.

You all are right. "Firefighter" probably isn't the right term. "Scab" would be better. I mean, let's honestly look at what these guys (and gals) are doing most of the time- they're facilitating USACS taking contracts away from democratic groups, ensuring that the next generation of emergency physicians doesn't even have the option to own their job in many areas of the country.
 
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So do all the execs just make a ton and keep the salary and bonus pay low, or is their some deeper opaque ownership structure that no one knows about?

I'm sure there's a little of that, but the vast majority of the fee skimmed off the backs of the docs is going to the owners- i.e private equity or the public shareholders depending on the company.
 
Can someone PM me, how exactly is the CEO of USACS making out so well? I understand that the shares, are not real entitlements to cash flow. Does a private company owned by the CEO own USACS? How does the details of the scam work?

No need for PM. The way the company works is that the CEO (and some of the board members) own the "Holdings" company which owns the billing, coding and HR sub-companies for which USACS grants exclusive contracts. Often they pay the doctors at a loss from other sites, but the sub-companies always get paid regardless of whether or not a site is making a profit. They aren't making money directly off of physician services, but they get paid a ton through the management fee, and profit from the sub-companies they own.

For example, If I work at a losing site and collect $50/patient, the Holdings company gets their $30 piece of the pie first, before the docs are paid out. That leaves $20 for the docs. Obviously that isn't enough to pay the docs, so it indirectly comes out of another site which is making a profit. They do this by moving the money around. The "management fee" is typically a percentage, so it allows them to move money from a highly profitable site to pay docs at losing site. All the while they still keep collecting their $30/pt at EVERY site.
 
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Yeah, "firefighter" is bull****. "In house locums" would be much more apropos.
But "Firefighter" invokes a desire to rush in and help where it's needed.And this facilitates USACS' manipulation of docs.
 
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As of 6 months ago, they were in the process of changing firefighter pay. It was 180/hr for first 120 hrs and then 280/hr for hrs over that. Working 140 per month and a slew of benefits got you up to 260/hr.

Last I heard, I think they were at 200/hr and they upped it to 140 hrs at that rate then switched to 300/hr.

Might as well do locums on your own and get full ctrl of your schedule and pocket all the travel benefits. That and the feeling of not destroying the specialty of emergency medicine.
What sorts of locums companies let you do this?
 
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Any time you are working locums you are helping to destroy emergency medicine. As for shedule and travel most companies will give you free reign.

Really? Some rural ERs just can’t staff fully. Seems like working occasionally there as an EP helps the field, not hurts it.
 
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This is why General Veers is one of my favorite posters on SDN, because he has this wearied, jaundiced outlook on these modern times while at the same time minting cash doing locums in the Golden Age of EM and sipping mojitos at exotic locales. That is honorable! That is noble! Whereas being a jaundiced, poor cynic is simply depressing and for losers. lol

That is all I aspire to in life, to cast my yellowed eye upon a world going rapidly to dogsheit but secure in the knowledge that I was able to make some hay while the sun still shone. Sadly, as a lowly M2 I may have to satisfy myself with a future of being a most cashless of cynics the way things in medicine are going. Will I, too, get my time under the sun? Cue the violins. +pity+
 
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You all are right. "Firefighter" probably isn't the right term. "Scab" would be better. I mean, let's honestly look at what these guys (and gals) are doing most of the time- they're facilitating USACS taking contracts away from democratic groups, ensuring that the next generation of emergency physicians doesn't even have the option to own their job in many areas of the country.
Exactly.

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Any time you are working locums you are helping to destroy emergency medicine. As for shedule and travel most companies will give you free reign.
I disagree. I know plenty of places using locums and trying to hire up to stop using them. I'm getting credentials at a few sites now. They would rather have someone from (or close to) the community than deal with locums. None of these places are CMG run.

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I disagree. I know plenty of places using locums and trying to hire up to stop using them. I'm getting credentials at a few sites now. They would rather have someone from (or close to) the community than deal with locums. None of these places are CMG run.

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What part of the country? Texas?
 
I disagree. I know plenty of places using locums and trying to hire up to stop using them. I'm getting credentials at a few sites now. They would rather have someone from (or close to) the community than deal with locums. None of these places are CMG run.

I forgot where I heard it whether it was on here or another doc was telling me, but supposedly pt satisfaction scores are better where there are SDG's and local doctors practicing rather than corporate employees. That person correlated it to better physician motivation and patient ownership rather than working for a huge corporate company. Hospital CEOs were said to be taking notice too.
 
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I forgot where I heard it whether it was on here or another doc was telling me, but supposedly pt satisfaction scores are better where there are SDG's and local doctors practicing rather than corporate employees. That person correlated it to better physician motivation and patient ownership rather than working for a huge corporate company. Hospital CEOs were said to be taking notice too.

We can only hope they notice it in time.
 
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I disagree. I know plenty of places using locums and trying to hire up to stop using them. I'm getting credentials at a few sites now. They would rather have someone from (or close to) the community than deal with locums. None of these places are CMG run.

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I agree. Locums is different than a CMG. In fact, in a lot of ways locums (and physician-owned FSEDs) are giving emergency physicians their specialty back.
 
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I'm sorry, did you say a firefighter was making $175/hour?!?!?!?!? :wow:
I am out of medicine now but am pulling $167 an hour Without benefits (14 percent employer contribution for my 401k health, disability) doing a job that doesn't require a college degree.

I wouldn't touch a 2/pph EM job for less than 300 an hour.
 
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This is why General Veers is one of my favorite posters on SDN, because he has this wearied, jaundiced outlook on these modern times while at the same time minting cash doing locums in the Golden Age . Will I, too, get my time the sun? Cue the violins. +pity+

You will... But not if you get involved in a hospital based speciality. A rising tide floats all boats. The converse is also true. The tide in medicine in the US is absolutely receding.
 
I am out of medicine now but am pulling $167 an hour Without benefits (14 percent employer contribution for my 401k health, disability) doing a job that doesn't require a college degree.

I wouldn't touch a 2/pph EM job for less than 300 an hour.

What are you doing now?
 
He’s a lumberjack in British Columbia.


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What are you doing now?
I sell shower caps to hotels (OK, not really) . I only share this to try and shed light on just how badly CMGs and management teams are screwing physicians.
 
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All physician "ownership" schemes are all scams at large staffing groups. Most of these groups are owned by investors. No actual ownership is being give to the docs. You are just given a little extra money and told that you are a "partner". In reality you're not a partner or an owner. You have no real corporate voting power that typically comes with ownership. Just a little extra cash.

Most investors and large staffing companies know that doctors are not savvy enough to really understand any of this, but will flock at a few extra bucks.
 
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All physician "ownership" schemes are all scams at large staffing groups. Most of these groups are owned by investors. No actual ownership is being give to the docs. You are just given a little extra money and told that you are a "partner". In reality you're not a partner or an owner. You have no real corporate voting power that typically comes with ownership. Just a little extra cash.

Most investors and large staffing companies know that doctors are not savvy enough to really understand any of this, but will flock at a few extra bucks.
It’s like the BS they float about it being “physician owned”.

Um what does that mean? USACS says this.. But about 30% of the company is owned by a PE company Carson Welsh I think.

Team Health is owned by private equity as well and EmCare well their stock got destroyed and are looking at getting bought up.

Using what I think is their criteria, Apple, Tesla, Smith & Wesson, Bank of America are all physician owned.

So was Enron.. how did that turn out.
 
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All physician "ownership" schemes are all scams at large staffing groups. Most of these groups are owned by investors. No actual ownership is being give to the docs. You are just given a little extra money and told that you are a "partner". In reality you're not a partner or an owner. You have no real corporate voting power that typically comes with ownership. Just a little extra cash.

Most investors and large staffing companies know that doctors are not savvy enough to really understand any of this, but will flock at a few extra bucks.

I find it comical and pathetic when the CMGs try to shovel this BS.

There are basically two types of jobs in our field: ones where you have an equal vote in making the vast majority of group decisions as an actual partner...and every other job (where you’re an employee).

Being in some faux partner position is the worst of both worlds. You’re bound monetarily to the company without any ability to control the shop in which you work. Even better (for the CMG), you may not have a clear path for getting your $ out of the group. Yet, they’ll have more leverage to foist things on you (committees, extra shifts, etc) without pay since you’re a “partner.”

If my job options are fake partner vs employee, than I’ll take the employee gig any day. There’s much less BS and clear boundaries as an employee. You want me to work more? Cool, you’re going to pay me more. You want me to work shifts at a new shop “our” group just took over? Sure, give me a bonus or find somebody else. Why do some people love locums? It’s being an employee on steroids and allows you a measure of control in your life.

Am I the only person who also finds it insulting that these partner-lite shenanigans exist? By offering me that job you’re implying that I’m probably stupid. After all, who on earth would feel a sense of “ownership” for a group that won’t let them: see what they bill, have a say in who they hire, provide oversight over midlevels, discuss how to use PG data, and the list goes on.



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