USACS share scam.

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shoal007 said:
Wow total control? You must be locums. I have almost no control or it seems that way.

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You must be full time. It sucks, and I would never go back to full time. If all EM docs did locums, demanded control over their own schedule, and took vacations we would have a lot more control. Any time you work full time, especially for a CMG you are selling your autonomy and keeping THEM in power.
 
GeneralVeers said:
You must be full time. It sucks, and I would never go back to full time. If all EM docs did locums, demanded control over their own schedule, and took vacations we would have a lot more control. Any time you work full time, especially for a CMG you are selling your autonomy and keeping THEM in power.
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Quoting for truth. It's taken me years to appreciate the realities of the major opportunity costs to signing on FT that you allude to. At this point I'd probably only consider it for a) a true SDG with some sort of contingency clause if they sell out or b) an academic/hospital/government employed position.
 
GeneralVeers said:
Exactly how it was when I was there. But Dominic, and the rest of the braintrust at the top still get paid out their salaries, plus any bonuses profits from the Holdings corp (is it still EMP Holdings?). The Holdings corp gets paid out first for billing/coding/HR and other administrative stuff before any pit doc sees $1 of salary.
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hardly matters now...heard today that he was leaving and his entire staff quit
 
Not Pudding said:
So what are the details you are hearing?
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they introduced a new ceo and he's not moving from dallas...HR, Ops and Finance chiefs all quit and more to come. everyone I talked in leadership is panicking or have already been looking
 
Well being headquartered in Canton Ohio never made much sense. Relatively high taxes, terrible weather, poor location, and closest major airport is CLE, which is a 1 hour drive. Akron airport only had regional flights to a few destinations. It was definitely not fun to commute to leadership meetings in the middle of Winter. Had to fly through CLE or ORD to get there.

When I was in EMP leadership I told them repeatedly to move to Texas for all of the above reasons. All of the head guys were from Ohio, and had their families there, so of course didn't want to move.
 
I have two former residents that are looking to sign at one of their sites. I wonder if this will influence the "feet on the ground" or more of a reshuffling of the admin levels.
 
The rank and file within the organization haven't been told a thing.
 
Crusader59 said:
they introduced a new ceo and he's not moving from dallas...HR, Ops and Finance chiefs all quit and more to come. everyone I talked in leadership is panicking or have already been looking
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Sounding pretty confident there. Internet hearsay or actually happening?

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What's prompting this exodus and turnover? I'm sure whoever replaces these guys will be an even bigger scumbag than their predecessors.
 
Doctor Feelbad said:
It sounds like the new CEO may not even be a doctor? So much for physician ownership...
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No no, you have it all wrong! See..the physicians own the company in their "vested shares" which are worth whatever Dominic says they are worth, and can't be sold or traded. They can also be confiscated at any point arbitrarily by the company if you are fired "for cause". Sounds great, right?
 
Why do you guys all harp on "physician ownership" and #ownershipmatters? Please don't be under any illusion that any physicians owns USACS. There is no such thing. They are owned by WCAS. Plain and simple.

It's just something they say to get more naive docs on board. They will be sold in a few yrs and WCAS will make the money and a few other equity partners. None of whom are the docs. It's the way most healthcare services work.
 
Doctor Feelbad said:
It sounds like the new CEO may not even be a doctor? So much for physician ownership...
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Not to sound overly pragmatic, but who cares? CEOs for Team and Envision are non docs, as far as Google was able to tell me with a quick search. USACS and the other groups mentioned are not physician groups, they're corporations. They have investors and share holders who are non docs, and therefore there is an obligation to those entities to fill their pockets with money. Perhaps a CEO with a business background is better suited for that?

There's nothing right about that idea, but it's the crappy professional world that we as docs have allowed to grow. Until a powerful lobbying group is willing to limit the growth of these corporations, things will continue to spiral.

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I don't care about physician ownership. In USACS the physicians "own" the company, but get none of the profit. I'd rather get paid for my work, and paid what I'm worth than have "ownership" which is worth nothing.
 
GeneralVeers said:
No no, you have it all wrong! See..the physicians own the company in their "vested shares" which are worth whatever Dominic says they are worth, and can't be sold or traded. They can also be confiscated at any point arbitrarily by the company if you are fired "for cause". Sounds great, right?
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You forgot to mention that they also pay taxes ahead of time on property that hasn’t vested yet and can’t trade to pay for the taxes once it vests!
 
bikERdoc said:
Not to sound overly pragmatic, but who cares? CEOs for Team and Envision are non docs, as far as Google was able to tell me with a quick search. USACS and the other groups mentioned are not physician groups, they're corporations. They have investors and share holders who are non docs, and therefore there is an obligation to those entities to fill their pockets with money. Perhaps a CEO with a business background is better suited for that?

There's nothing right about that idea, but it's the crappy professional world that we as docs have allowed to grow. Until a powerful lobbying group is willing to limit the growth of these corporations, things will continue to spiral.

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If pay is low and the docs on the front line are grumbling when a doc is leading it, do you think things will get better when a non-doc CEO (probably beholden to that hedge fund) is in charge? Bet USACS moves toward an RVU-heavy model...
 
Doctor Feelbad said:
If pay is low and the docs on the front line are grumbling when a doc is leading it, do you think things will get better when a non-doc CEO (probably beholden to that hedge fund) is in charge? Bet USACS moves toward an RVU-heavy model...
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Whether it's run by a doc or non-doc is irrelevant in my opinion. It's a big company, should be run a strong executive. After all the BS last year at Summa, I think it should probably be someone other than Dom. Even better, it shouldn't be run at all and all these CMGs can implode on themselves. Make EM Great Again.

Not sure if you're a resident or attending, but there's nothing inherently wrong with an RVU heavy model. If you're a productive doc, you should be paid accordingly. Plain and simple. Eat what you kill. Slower docs can enjoy a more leisurely shift, but they shouldn't be paid the same as the docs who are truly running the department and creating numbers for the group.
 
bikERdoc said:
Whether it's run by a doc or non-doc is irrelevant in my opinion. It's a big company, should be run a strong executive. After all the BS last year at Summa, I think it should probably be someone other than Dom. Even better, it shouldn't be run at all and all these CMGs can implode on themselves. Make EM Great Again.
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I'm curious: why do you think this is irrelevant?

Do non-clinical CEOs have any priorities high on their list other than profit?

Can they really empathize with how their decisions will impact the patients and docs on the front line like a physician can (granted, there are doctor CEOs who suck at this)?

Are they able to realize when they're being penny wise pound foolish with decisions to squeeze out a little extra profit at the cost of alienating their staff while increasing risk and worsening performance and retention?

There's evidence that hospitals do better when run by physicians and it may be reasonable to extrapolate this out to physician staffing groups as well: Why The Best Hospitals Are Managed by Doctors

I agree that having the CMGs fade away would be an overall win for our specialty.

bikERdoc said:
Not sure if you're a resident or attending, but there's nothing inherently wrong with an RVU heavy model. If you're a productive doc, you should be paid accordingly. Plain and simple. Eat what you kill. Slower docs can enjoy a more leisurely shift, but they shouldn't be paid the same as the docs who are truly running the department and creating numbers for the group.
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Just my opinion, but an RVU-heavy system does more harm than good. It over-incentives folks to rush to pick up the shoulder dislocation over the old dizzy (as if we needed more incentive for that). It can encourage people to do things that are at best borderline necessary. It's easier for a group to skim money off the top with fuzzy math RVU calculations and underpay the doc. In the right conditions, I can see the benefit of a small RVU component (5-10% of salary) to help balance out the very fast from the very slow.
 
I agree that it doesn't really matter Doc CEO or not. We've all heard of the Doc's that have been convicted of fraud, child molestation, mutilation, etc, and conversely CEO's that take great care of their company AND employees. In the end the CEO profits by a profitable company, a happy employee makes for a happy customer = revenue. That being said regardless of ?potential? changeup at the admin level, WCAS has a business that I suspect they want to keep profitable and on the uptick as they are venture capitalist - by nature they want to buy low, sell in 5-7 years for a profit. It serves them no good in any regard to bring in an admin that ruffles the feathers thus decreasing the interest of potential future suitors.

In regards to RVU-heavy, it falls apart in many regards. After being in this game for 10 years as an attending and being a part of a 100% RVU based model, and a 0% based model, I think that the area is probably a 25% RVU'ish +/-, and a PPH multiplier. There are literally a 1000 ways to skin that cat... mostly benefiting those that are making the decisions.
 
I personally don't care if it's an MBA or an MD running the company. I know that they are going to under-pay me, and skim off the top for the "real owners" of the company at the expense of the doctors.

If ACEP wanted to regain relevance for its members, they would push for billing and pay transparency. Every doctor should know exactly how much a CMG collects in their name, and what percentage of that is paid back to the doctors. True measures of fairness in pay would be a "percent of collections" paid back to providers.
 
TysonCook said:
I agree that it doesn't really matter Doc CEO or not. We've all heard of the Doc's that have been convicted of fraud, child molestation, mutilation, etc, and conversely CEO's that take great care of their company AND employees. In the end the CEO profits by a profitable company, a happy employee makes for a happy customer = revenue. That being said regardless of ?potential? changeup at the admin level, WCAS has a business that I suspect they want to keep profitable and on the uptick as they are venture capitalist - by nature they want to buy low, sell in 5-7 years for a profit. It serves them no good in any regard to bring in an admin that ruffles the feathers thus decreasing the interest of potential future suitors.

In regards to RVU-heavy, it falls apart in many regards. After being in this game for 10 years as an attending and being a part of a 100% RVU based model, and a 0% based model, I think that the area is probably a 25% RVU'ish +/-, and a PPH multiplier. There are literally a 1000 ways to skin that cat... mostly benefiting those that are making the decisions.
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Agreed on the CEO part.

I work in an RVU based model. I'm sure there's another thread this could go into (and already has). I don't think it's as bad as people make it out to be. Yes, there are some gunners. But in general, they get called out for it and I don't work with a bunch of sharks (just a couple). In a 0% RVU model, you get partners sitting on their asses while the associates get crushed. I don't think that's right either. If you're a partner, act like it and run the department to set the model for your future partners. In general, I would say some kind of hybrid works best too.
 
GeneralVeers said:
I don't care about physician ownership. In USACS the physicians "own" the company, but get none of the profit. I'd rather get paid for my work, and paid what I'm worth than have "ownership" which is worth nothing.
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How do you figure that in USACS the physicians "own" the company? They have 0% ownership, no matter what you are told.
 
Anything new since last week about the fate of the USACS C-suite or the Old Gold Chain, Crusader59? +pity+
 
Looks likes USACS issued a press release on their website.

As a new poster (but long-time lurker), I apologize that I cannot post links (yet). ;-)
 
TooMuchResearch said:
Wait...SUMMA went so well they want him to focus on taking over groups? Eff that.
-TooMuchResearch, FAAEM
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