USUKS has burned it to the ground

[Boatswain2PA]

Worked a shift at a USUKS shop. Used to be a GREAT place, stable docs with PAs who have been there a long time. Then "merged" with USUKS.

Benefits cut, but bonuses promised. Buuuuuut...looks like nobody qualifies for bonuses so group of us walks. That leaves shop short handed PAs for a month so most days only one PA not two. USUKS throws us a benny and says will increase our pay (back to what the bonus used to be)!!!!....but....since we have been making due with only one PA shift that's what they expect now.

So the stable FT docs walk. Now down to the medical director (who I would bleed for) and a newbie who are working themselves to death trying to save the ship (along with a usuks firefighter and a couple of prn docs).

USUKS.

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[Arcan57]

It's sad that with all of the intelligent people that go into business that whenever they take over a new business, their first and only idea is to take things away until it breaks and then slowly add back until it becomes minimally function again. It's even sadder that almost all the existing incentives encourage this mindest.

 

[EctopicFetus]

Worked a shift at a USUKS shop. Used to be a GREAT place, stable docs with PAs who have been there a long time. Then "merged" with USUKS.

Benefits cut, but bonuses promised. Buuuuuut...looks like nobody qualifies for bonuses so group of us walks. That leaves shop short handed PAs for a month so most days only one PA not two. USUKS throws us a benny and says will increase our pay (back to what the bonus used to be)!!!!....but....since we have been making due with only one PA shift that's what they expect now.

So the stable FT docs walk. Now down to the medical director (who I would bleed for) and a newbie who are working themselves to death trying to save the ship (along with a usuks firefighter and a couple of prn docs).

USUKS.

Yeah buddy.. thats the game.. literally 0 surprise in anything thats said in here. USUCS is the toilet water post diarrhea.

 

[EctopicFetus]

It's sad that with all of the intelligent people that go into business that whenever they take over a new business, their first and only idea is to take things away until it breaks and then slowly add back until it becomes minimally function again. It's even sadder that almost all the existing incentives encourage this mindest.

This is what business is. They imagine seeing patients in an ED is like working a factory. It’s dumb. TeamHealth will fold next. That will be major.. I am hopeful USACS isnt too far behind but hey have til 2026 i imagine.

 

[emergentmd]

Worked a shift at a USUKS shop. Used to be a GREAT place, stable docs with PAs who have been there a long time. Then "merged" with USUKS.

Benefits cut, but bonuses promised. Buuuuuut...looks like nobody qualifies for bonuses so group of us walks. That leaves shop short handed PAs for a month so most days only one PA not two. USUKS throws us a benny and says will increase our pay (back to what the bonus used to be)!!!!....but....since we have been making due with only one PA shift that's what they expect now.

So the stable FT docs walk. Now down to the medical director (who I would bleed for) and a newbie who are working themselves to death trying to save the ship (along with a usuks firefighter and a couple of prn docs).

USUKS.

This is the classic practice management that is not unique to EM.

Nurses get pissed when they are short staff, then they hire contract nurses at 2x rate. These are smart MBAs so I must be missing something.

 

[EctopicFetus]

This is the classic practice management that is not unique to EM.

Nurses get pissed when they are short staff, then they hire contract nurses at 2x rate. These are smart MBAs so I must be missing something.

I think this is a fallacy most of these decision makers have BS degrees from online universities. The Harvard, Wharton MIT Stanford MBAs aren’t screwing around with this bs.

 

[oldtown]

This is the classic practice management that is not unique to EM.

Nurses get pissed when they are short staff, then they hire contract nurses at 2x rate. These are smart MBAs so I must be missing something.

They think that if you set regular/FT wages at a competitive level and/or staff at a safe level, then the employees will come to expect that as the norm. Better to weather the storm and pay locums/travellers extra and hope that is a temporary need, so they can go back to the dogs&*t staffing/ pay level baseline.
It works enough for them, obviously, that they continue to do this all over the country.

 

[Arcan57]

This is the classic practice management that is not unique to EM.

Nurses get pissed when they are short staff, then they hire contract nurses at 2x rate. These are smart MBAs so I must be missing something.

You’re missing how they’re incentivized. Just like Dom lives life a quarter mile at a time, MBAs live life a quarter at a time. You cut to the bone to exceed your productivity/cost goals, collect your bonus and move up to the next rung. Continue until you’re at the top or the ladder collapses out from under you. In either of those cases you just move laterally or bounce to a different industry.

 

[medninja]

I think this is a fallacy most of these decision makers have BS degrees from online universities. The Harvard, Wharton MIT Stanford MBAs aren’t screwing around with this bs.

Dude, amongst hospital administrators half are nurses, the same people getting B-‘s in the prerequisites we were aceing. After a few years of mediocre pt facing care, they get an MBA online and at night. It’s a terrible way to select for excellence. It also partially explains why hospitals are constantly going broke.

 

[bravotwozero]

@Boatswain2PA , when are you walking away from this apparent dumpster fire?

 

[Boatswain2PA]

@Boatswain2PA , when are you walking away from this apparent dumpster fire?

I pretty much have. Four reasons I still pull a shift or two every couple of months or so:

1. Immense respect for the medical director.
2. It makes me better. The numbers, acuity, working alongside EPs and other specialists make me better at my other jobs.
3. Nurses are good.
4. I somehow am still able to contribute to my 401K there so I put max amount there (in addition to maxing my 457b at primary gig and then topping solo 401k).

 

[emergentmd]

#1-3 will be gone in about 6 months.

 

[hundreddaysoff]

It's sad that with all of the intelligent people that go into business that whenever they take over a new business, their first and only idea is to take things away until it breaks and then slowly add back until it becomes minimally function again. It's even sadder that almost all the existing incentives encourage this mindest.

And true in many fields other than medicine.

My understanding is also that this is the mindset taught as routine in pretty much any business school. I hope someone with an MBA will correct me if I am wrong.

There's a theory that these incentives were put in place by intentional but complex changes to the legal and business education curricula in the 1980s. The theory is laid out in a book called Econned by Yves Smith. Not sure I buy it but I haven't heard any explanations more convincing yet.

 

[Boatswain2PA]

#1-3 will be gone in about 6 months.

#4 will be too as soon as they see I am listed as PT instead of PRN.

 

[Arcan57]

And true in many fields other than medicine.

My understanding is also that this is the mindset taught as routine in pretty much any business school. I hope someone with an MBA will correct me if I am wrong.

There's a theory that these incentives were put in place by intentional but complex changes to the legal and business education curricula in the 1980s. The theory is laid out in a book called Econned by Yves Smith. Not sure I buy it but I haven't heard any explanations more convincing yet.

My (significantly limited) understanding is that the Friedman and his cohort in Chicago laid the theoretical foundation for "a company is only responsible to its shareholders" and then Welch at GE popularized it as he was able to turn GE from a company that makes things (which is hard) to a company that could manipulate profit/loss statements through acquisitions and mass layoffs (which had not been a significant thing in financially healthy companies previously) thus ensuring the stock price was whatever GE needed it to be at any given time. This ushered in the era of the budget slashing celebrity CEO which combined with a significant loosening of regulations in using things that aren't banks as banks led to a clear model for what an executive should be.

 

[DeadCactus]

It's sad that with all of the intelligent people that go into business that whenever they take over a new business, their first and only idea is to take things away until it breaks and then slowly add back until it becomes minimally function again. It's even sadder that almost all the existing incentives encourage this mindest.

I can't think of a single time I've ever talked to a PhD, engineer, or other highly educated and intelligent professional who didn't immediately make it clear they have literally no understanding or respect for the nuanced difficulties of practicing medicine. I have no hope an MBA is going to get it. They all live in a homogenous bubble of highly educated people speaking the same language and working toward the same goal and assume that it's how everyone else's work goes.

 

[emergentmd]

Doctors are just as bad. I have seen it countless times, when they run a successful medical business, they turn into MBAs seeking to max profit until the site runs to the ground.

 

[dieABRdie]

This is the classic practice management that is not unique to EM.

Nurses get pissed when they are short staff, then they hire contract nurses at 2x rate. These are smart MBAs so I must be missing something.

Another reason is that full time employees count as "recurring" expenses which form the basic operational costs of the business.... while temp workers count as "non-recurring"... so they can artificially inflate their profits by leaving them out of the costs.

Worked great for PE in the era of free money. Buy practice, fire permanent staff and replace with temp workers; restructure the business and instant profit! Just as long as you can unload it to some other sucker before things fall apart.

 

[Arcan57]

Plot twist, rumor is that USACS is going to take over the Houston Methodist contracts after Schumacher fell through.

 

[bravotwozero]

Not a rumor at this point.

 

[RustedFox]

Not a rumor at this point.

 

[EctopicFetus]

USACS gonna ruin Methodist. Those docs have no idea the poop show coming their way. Good luck homies.

 

[RoyBasch]

I think this is a fallacy most of these decision makers have BS degrees from online universities. The Harvard, Wharton MIT Stanford MBAs aren’t screwing around with this bs.

Agreed. The Wharton/Sloan/HBS crowd aren’t in healthcare, they’re in tech/finance. The business people who run us are the bargain bin MBAs of the world.

 

[hundreddaysoff]

Agreed. The Wharton/Sloan/HBS crowd aren’t in healthcare, they’re in tech/finance. The business people who run us are the bargain bin MBAs of the world.

My point is that no matter where these people got their MBAs, in my understanding, the "successful" ones tend to have the same prime directives of maximizing short-term profit and getting the hell out in a few years while they still can.

IOW, all the business schools have followed the lead that HBS and the other big boys pioneered starting in the 1970s and 80s.

In the worst case, following this blueprint leads to outright looting. In less bad cases, it's a slow burn.

Do we believe that our system of healthcare would suck less if we had more HBS suits around and fewer Southwestern Kansas University suits? If so, why?

 

[MechEDoc]

I can't think of a single time I've ever talked to a PhD, engineer, or other highly educated and intelligent professional who didn't immediately make it clear they have literally no understanding or respect for the nuanced difficulties of practicing medicine. I have no hope an MBA is going to get it. They all live in a homogenous bubble of highly educated people speaking the same language and working toward the same goal and assume that it's how everyone else's work goes.

We should talk, I could be the N of 1 that screws up your world view (PhD in engineering before medicine)...

 

[dozitgetchahi]

I can't think of a single time I've ever talked to a PhD, engineer, or other highly educated and intelligent professional who didn't immediately make it clear they have literally no understanding or respect for the nuanced difficulties of practicing medicine. I have no hope an MBA is going to get it. They all live in a homogenous bubble of highly educated people speaking the same language and working toward the same goal and assume that it's how everyone else's work goes.

On the contrary, when I’ve previously dated lawyers, engineers, etc, all of them seemed to be really surprised at the amount of time, energy and training that goes into working as a doctor.

MBAs, on the other hand, work from a separate mindset…

 

[GassYous]

Agreed. The Wharton/Sloan/HBS crowd aren’t in healthcare, they’re in tech/finance. The business people who run us are the bargain bin MBAs of the world.

That's not true. My friend went to school at Wharton and HBS and they are in healthcare.

 

[JacobMcCandles]

That's not true. My friend went to school at Wharton and HBS and they are in healthcare.

I don’t think they meant literally everyone.

 

[EctopicFetus]

I have a handful of friends, HBS, wharton, NYU Michigan Duke etc biz school, not the online or e-mba the real deal. None are directly in medicine, Bain capital, running a VC, a CFO of a biotech, a CFO type in a non medical company. They dont get into running hospitals, clinics etc.

The guys and gals I know are looking for major major upside. One of my buddies who is a partner at a large consulting firm. He told me he got 500k in the bank for a quarterly bonus. he believed he would make 800k a year forever but things have been good and he is asmart and personable dude and told me he is making over $2m a year. I have known this guy since we were 10. We went to HS and college together. These dudes (he went to HBS) arent hoping to be hospital CEOs.

 

[emergentmd]

One of my buddies who is a partner at a large consulting firm.

Curious, does he work/travel his A$$ off? I know a partner in a big 4 accounting firm and the time/travel is insane.

 

[RoyBasch]

My point is that no matter where these people got their MBAs, in my understanding, the "successful" ones tend to have the same prime directives of maximizing short-term profit and getting the hell out in a few years while they still can.

IOW, all the business schools have followed the lead that HBS and the other big boys pioneered starting in the 1970s and 80s.

In the worst case, following this blueprint leads to outright looting. In less bad cases, it's a slow burn.

Do we believe that our system of healthcare would suck less if we had more HBS suits around and fewer Southwestern Kansas University suits? If so, why?

Fair point.

 

[EctopicFetus]

Curious, does he work/travel his A$$ off? I know a partner in a big 4 accounting firm and the time/travel is insane.

for sure. Works a ton, travels a ton, Calgary, vegas etc. IMO its not any worse than what i know a bunch of locums docs do.

 

[GatorCHOMPions]

Anyone see Dom’s post on EM Docs a few hours ago? Seems like it has been well received so far, most comments in support of USACS.

 

[bravotwozero]

Bots. All of ‘em

 

[ScepticSkeksis]

Bots. All of ‘em

Is there anything AI can't do?

 

[vm26]

I pretty much have. Four reasons I still pull a shift or two every couple of months or so:

1. Immense respect for the medical director.
2. It makes me better. The numbers, acuity, working alongside EPs and other specialists make me better at my other jobs.
3. Nurses are good.
4. I somehow am still able to contribute to my 401K there so I put max amount there (in addition to maxing my 457b at primary gig and then topping solo 401k).

Had to look up USUKS to figure out its US Acute Care. They cover our ED and recently took complete control of hospitalists (was a mix of hospital based group and USAC)...On their site they offer "Industry-leading 10% company funded 401(k)". I'm probably misunderstanding but that would seem low (typical PP is maxed out match + profit sharing/year for 401K)

 

[emergentmd]

Had to look up USUKS to figure out its US Acute Care. They cover our ED and recently took complete control of hospitalists (was a mix of hospital based group and USAC)...On their site they offer "Industry-leading 10% company funded 401(k)". I'm probably misunderstanding but that would seem low (typical PP is maxed out match + profit sharing/year for 401K)

USACS is a leader in physician owned/directed management group. You are being short sighted about the 10% company funded 401k. 10% might seem small, but if you factor in how the stock has outpaced the market then its an amazing benefit. There are docs literally retiring on the 10% USUCKS stocks when they leave the company.

 

[EctopicFetus]

Dom make be feeling the heat. Soon they will follow with the “Everything is fine financially” like Tony B at APP did just 5 months before they ceased operations.

My guess is it is because no one wants to work for them and they are feeling the heat of premium labor Costs. 2026 can’t get here soon enough.

 

[JacobMcCandles]

Had to look up USUKS to figure out its US Acute Care. They cover our ED and recently took complete control of hospitalists (was a mix of hospital based group and USAC)...On their site they offer "Industry-leading 10% company funded 401(k)". I'm probably misunderstanding but that would seem low (typical PP is maxed out match + profit sharing/year for 401K)

I despise USACS and have no knowledge of their benefits but I would assume it’s 10% of your allowable IRS salary which is like $330k for 2023. Most EM jobs aren’t private practice.

 

[GonnaBeADoc2222]

I'm not in that toxic wasteland that is EMDocs (or Facebook, for that matter)...can anyone post it?

 

[vm26]

USACS is a leader in physician owned/directed management group. You are being short sighted about the 10% company funded 401k. 10% might seem small, but if you factor in how the stock has outpaced the market then its an amazing benefit. There are docs literally retiring on the 10% USUCKS stocks when they leave the company.

Point taken...was looking at the hospital/ED website, and was pretty surprised at the actual overall # of physicians given how busy we are (3 ERs one of which is level 1 trauma, and 2 of which are stroke centers). Staffing is mostly mid-levels and residents. I would imagine the actually physicians get solid compensation but who knows.

 

[FlaminHotER]

Dom make be feeling the heat. Soon they will follow with the “Everything is fine financially” like Tony B at APP did just 5 months before they ceased operations.

My guess is it is because no one wants to work for them and they are feeling the heat of premium labor Costs. 2026 can’t get here soon enough.

Exactly

Apollo is gonna call their note on usucks in 2026

Then boom

 

[EctopicFetus]

Exactly

Apollo is gonna call their note on usucks in 2026

Then boom

Cant come quick enough. Reality is they will have to refinance their debt. Rates will be 12+%. their debt service is gonna be crippling.

There isnt a CMG I hate more than USACS, at least envision and TH and that ilk let you know you are nothing more than a billing widget. The "ownership" matters BS preys on the idiots of which related to business and finance EM is bulging at the seams.

Too many dont want to be bothered with this stuff and want to spend their time with their bike helmet and glasses on.

 

[southerndoc]

Exactly

Apollo is gonna call their note on usucks in 2026

Then boom

For clarification, that is Apollo Global Management and not ApolloMD.

 

[FlaminHotER]

For clarification, that is Apollo Global Management and not ApolloMD.

Correct

Another giant PE group that is running on the same playbook that other PE groups have done to Envision, APP, K-Mart, Sears, Toys R Us, etc.

 

[alpinism]

So for those not in the facebook group they're getting absolutely murdered in the comments section.

Lots of disgruntled former employees have come out and started publicly sharing their personal experience.

 

[alpinism]

The word on the street is that USACS is in bad shape right now with a lot of docs getting fed up and quitting their sites in large numbers requiring corporate leadership to bring in their 250/hr firefighters and even some 350/hr regular locums docs to fill the schedule at multiple hospitals.

In addition word has finally started to get out about their business practices amongst residents and they've been having a lot of trouble lately recruiting new grads that are willing to sign on for their 150/hr jobs compared to prior years.

 

[emergentmd]

I am getting the sense that CMGs have finally hit the fork in the road where their demise will happen.

Insurance payments down, debt increase, no VC money to be found, insurmountable new debt interest rates, increased salary, etc. The numbers just do not make any economic sense.

I get emails/calls/txt similar to 2015 for locums coverage in places that I never thought would have coverage problem. Even Austin is having a hard time getting coverage. Docs are leaving hospitals in droves. They have to money whip docs to cover where there is not money available. Sites are short staffed and the docs who are left are getting fed up/leaving. Its a viscous cycle

 

[FlaminHotER]

So for those not in the facebook group they're getting absolutely murdered in the comments section.

Lots of disgruntled former employees have come out and started publicly sharing their personal experience.

Good!

I don’t have Facebook but glad there are ER Docs on there calling out usuks

 

[Boatswain2PA]

So for those not in the facebook group they're getting absolutely murdered in the comments section.

Lots of disgruntled former employees have come out and started publicly sharing their personal experience.

The EMDocs FB group?