Vituity Partnership question

[vagabondattending]

Thinking about signing with vituity. Does anyone know if you can advance up the partnership ranking only doing 100 hours a month instead of the full time 125 hours per month??
Seems like 1500 hours + 12 months is necessary for advancement. Just couldn’t get a straight answer if you have to be over the 125 monthly hours to qualify.
It’s the weekend and can’t talk to anyone with vituity directly.
Thanks

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[JacobMcCandles]

“Partnership.”

 

[Mbekweni]

I’ve been a happy member of the Vituity partnership now 6 years out of residency. You have to pass 1500 hours AND 12 months to advance to the next level of partnership. So if you work 100 hours a month it would take you 15 months to hit the 1500 hours and next level of partnership bonus. That happened to me on one year when I was working less and seems fair as this is essentially a sweat equity buydown.

The opposite seems less fair and is a quibble I have with Vituity especially if they ask a young attending to push hard and support a struggling understaffed site. Assume you work a ton and generate a lot of extra revenue, say 2000 hours a year. You still have to wait 12 months to achieve your next level of partnership and can’t do it in 9 months at that rate.

You have to work 900 hours minimum to stay on the partnership track (about 75 hours a month but this is assessed annually), though once you are a senior partner (aka 10 years of full service) you can drop to 600 hours and not lose your place in the partnership. It’s pretty flexible though and if you want to take a break you just submit a leave of absence request and almost all I know have been granted - such as wanting to spend more time with a new baby, travel the world, start a company and maybe come back etc.

 

[TooMuchResearch]

Wtf is a level of partnership? Fails the definition, right?

 

[JacobMcCandles]

I’ve been a happy member of the Vituity partnership now 6 years out of residency.

though once you are a senior partner (aka 10 years of full service)

10-year partnership sounds awesome.

 

[Mbekweni]

Wtf is a level of partnership? Fails the definition, right?

In the broad world of private practice groups there are a ton of different models towards achieving partnership. I can’t say which is best but felt that the Vituity model was at least reasonable and palatable for me. Vituity has 5 different levels with level one being just starting out and level 5 is full partner. In total there is about a 20% pay gap between full partner and level 1 with the difference being the sweat equity buy in. However as you put another year in you start to collect more of the end of the year bonus so the pay differential starts to shrink. Of the approximate 20% target end of the year bonus you get 5% of that year 1, 17.5% year 2, 33% year 3, 50% year 4 and in year 5 get all of it. Essentially a 4 year partnership track.

I wouldn’t say this is the best model, just that the math will depend on each individual person and the jobs they are shopping for. I liked that there was a max 20% income differential and then shrinking with a defined measurable path to partnership so if I left in 1-2 years and the job didn’t work out it wasn’t a massive sunk cost especially if I kept working within Vituity but at a different site. I also got a 30k signing bonus (10k from Vituity available to all as early sign on bonus, 20k from the hospital) which made the startup hit even smaller.

For comparison the other SDG private group I was considering other than Vituity had only pre partner and full partner with about a 40% pay differential over about 2 years. That was too much risk and a rather low exploitative income until the “promised land”. Also risk of the group losing their single contract. Another group out of state advanced to full partner after a total number of patients seen but only after a vote from the group that wasn’t guaranteed and was a bit vague when it would happen. Also about 30-50% difference with about 2 year path to partnership.

The net sweat equity buy in was about 150-200k for all groups that made my final jobs list including the Vituity gig. YMMV in other comparisons.

 

[TooMuchResearch]

In the broad world of private practice groups there are a ton of different models towards achieving partnership. I can’t say which is best but felt that the Vituity model was at least reasonable and palatable for me. Vituity has 5 different levels with level one being just starting out and level 5 is full partner. In total there is about a 20% pay gap between full partner and level 1 with the difference being the sweat equity buy in. However as you put another year in you start to collect more of the end of the year bonus so the pay differential starts to shrink. Of the approximate 20% target end of the year bonus you get 5% of that year 1, 17.5% year 2, 33% year 3, 50% year 4 and in year 5 get all of it. Essentially a 4 year partnership track.

I wouldn’t say this is the best model, just that the math will depend on each individual person and the jobs they are shopping for. I liked that there was a max 20% income differential and then shrinking with a defined measurable path to partnership so if I left in 1-2 years and the job didn’t work out it wasn’t a massive sunk cost especially if I kept working within Vituity but at a different site. I also got a 30k signing bonus (10k from Vituity available to all as early sign on bonus, 20k from the hospital) which made the startup hit even smaller.

For comparison the other SDG private group I was considering other than Vituity had only pre partner and full partner with about a 40% pay differential over about 2 years. That was too much risk and a rather low exploitative income until the “promised land”. Also risk of the group losing their single contract. Another group out of state advanced to full partner after a total number of patients seen but only after a vote from the group that wasn’t guaranteed and was a bit vague when it would happen. Also about 30-50% difference with about 2 year path to partnership.

The net sweat equity buy in was about 150-200k for all groups that made my final jobs list including the Vituity gig. YMMV in other comparisons.

We have employed (i.e. partner track) and partner. Our employed docs get a substantial annual pay bump and bonus, but they're still not partners. The vituity definition defies my understanding of the word partner.

Also unclear to me if vituity docs are equal shareholding partners in the legal entity, which is what is meant by partner.

 

[ScepticSkeksis]

I looked at a Vituity site, and though the 20% bonus for Level 5 partner does seem good, for the first 5 years you are making significantly less than if you worked at Envision, TH or other groups. Vituity is only worthwhile if you plan to stay there for a minimum of 10 years, otherwise the salary lost up front won't make up for bonuses on the back end. I'm not sure any contract is really stable enough to take the 10 year risk.

 

[EctopicFetus]

Bunch of horse**** how they

In the broad world of private practice groups there are a ton of different models towards achieving partnership. I can’t say which is best but felt that the Vituity model was at least reasonable and palatable for me. Vituity has 5 different levels with level one being just starting out and level 5 is full partner. In total there is about a 20% pay gap between full partner and level 1 with the difference being the sweat equity buy in. However as you put another year in you start to collect more of the end of the year bonus so the pay differential starts to shrink. Of the approximate 20% target end of the year bonus you get 5% of that year 1, 17.5% year 2, 33% year 3, 50% year 4 and in year 5 get all of it. Essentially a 4 year partnership track.

I wouldn’t say this is the best model, just that the math will depend on each individual person and the jobs they are shopping for. I liked that there was a max 20% income differential and then shrinking with a defined measurable path to partnership so if I left in 1-2 years and the job didn’t work out it wasn’t a massive sunk cost especially if I kept working within Vituity but at a different site. I also got a 30k signing bonus (10k from Vituity available to all as early sign on bonus, 20k from the hospital) which made the startup hit even smaller.

For comparison the other SDG private group I was considering other than Vituity had only pre partner and full partner with about a 40% pay differential over about 2 years. That was too much risk and a rather low exploitative income until the “promised land”. Also risk of the group losing their single contract. Another group out of state advanced to full partner after a total number of patients seen but only after a vote from the group that wasn’t guaranteed and was a bit vague when it would happen. Also about 30-50% difference with about 2 year path to partnership.

The net sweat equity buy in was about 150-200k for all groups that made my final jobs list including the Vituity gig. YMMV in other comparisons.

I am not sure the % is what matters. My overacting view of vituity is they try to pay “market rate” day 1. The % difference doesnt matter as much as the actual $$. Vituity day 1 200 but upside is to 240/hr vs day 1 in another group is 200/hr but upside is 600/hr.. im taking the non vituity gig. Smart to be worried about a group losing its single site contract. That can happen for sure.

In my mind you have to get $$ day 1 and then again when you make partner. The days of very low pre partner pay i think are gone.

 

[Brigade4Radiant]

when I was in residency vituity was CEP it didn’t sit well with me since if you are not in California if your place lost the contract you would have to move to another site

 

[Mbekweni]

I looked at a Vituity site, and though the 20% bonus for Level 5 partner does seem good, for the first 5 years you are making significantly less than if you worked at Envision, TH or other groups. Vituity is only worthwhile if you plan to stay there for a minimum of 10 years, otherwise the salary lost up front won't make up for bonuses on the back end. I'm not sure any contract is really stable enough to take the 10 year risk.

You have to check around and weigh the options. One experience means little towards generalizing to over 300 Vituity EM contracts out there. Some are great, and I’ll be the first to admit that others are really challenged by finances, location or culture. Also consider that CMG pay has a lot of downward pressure at the moment while with Vituity or other SDG you get what CMS offers which is at least market rate for better or worse.

Most Vituity sites in my CA region are paying in the $235-260/hr range to start plus bonus as you move up (so 280-315/hr or so full partner) with some in the $300++ camp (well upwards of $400/hr). However money in Emergency Medicine doesn’t grow on trees and these sites are usually good payer mix with super high volume, high acuity and the partners have decided to hustle big time while on shift for the $$. My primary site is around $240/hr and has an excellent payer mix in the $200/pt collections range. At full time that’s about 360k/yr starting and $430k at full partner 4 years later. For me that’s good enough and I think a functional hospital and group, great place to live start to take precedence from here rather than chasing the last dollar.

Group has voted to staff at a 1.6-1.7 pph level for longevity, partner happiness etc. I’m sure we could push well into the $300/hr camp if we jacked up PA hours, cut back MD staffing and all the other levers that exist out there.

I ended up with Vituity by picking a desired location and then shopping around the various jobs that were nearby and found that Vituity was really compelling in my region. I don’t know how things would go if you went to a jobs fair and were pushed towards some rural struggling contract.

 

[JacobMcCandles]

Most Vituity sites in my CA region are paying in the $235-260/hr range to start plus bonus as you move up (so 280-315/hr or so full partner) with some in the $300++ camp (well upwards of $400/hr). However money in Emergency Medicine doesn’t grow on trees and these sites are usually good payer mix with super high volume, high acuity and the partners have decided to hustle big time while on shift for the $$. My primary site is around $240/hr and has an excellent payer mix in the $200/pt collections range. Group has voted to staff at a 1.6-1.7 pph level for longevity, partner happiness etc. I’m sure we could push well into the $300/hr camp if we jacked up PA hours, cut back MD staffing and all the other levers that exist out there.

What percentage of Medicare/Medicaid/self pay are you seeing at your primary site?

 

[EctopicFetus]

If you collect 200/pt and see 1.6pph and use MLPs you should be making more than 240/hr FYI.

 

[Mbekweni]

If you collect 200/pt and see 1.6pph and use MLPs you should be making more than 240/hr FYI.

I don’t make $240/hr. That’s the starting hourly, then end of the year bonus which has ranged from around 17-28% during my time at Vituity and makes up the difference. Collections are one thing but then you have overhead like malpractice and billing and arrive at net operating revenue which is a bit less. Obviously I’m not going to put all group finances online and I’m only posting rounded numbers but the nice thing is that books are open to all partners and I could look all that information, payer mix, trends etc up in a few minutes and do the math. I even built out a spreadsheet to estimate group finances with pivot tables etc and it all adds up, helps with group decision making regarding staffing, income etc.

Anyways, this all started with some snide comments about fairness, exploitation. I realize there are far more lurkers on this site than active posters and mainly I wanted to mention that I have done the math several times over, and do think it’s fair, I don’t feel exploited and I’m happy where I’m at. Some sites will be worse so be sure to run the numbers in your own circumstances but writing off Vituity offhand to me seems like a mistake and I’m glad to be working at my current site. If you work at a Vituity site for 1-3 years then quit you will miss out on the big salary benefit that comes with a full career as a full partner but that’s not a pyramid scheme or exploitation that’s just how partnerships work. If you can find a better model, compensation and culture then by all means go for it. For me it was at least directly competitive and I wanted to live in a certain place so settled down at a Vituity site.

I am more troubled by long term trends in American healthcare and Emergency Medicine in particular with career satisfaction rather than Vituity partnership model.

 

[EctopicFetus]

I don’t make $240/hr. That’s the starting hourly, then end of the year bonus which has ranged from around 17-28% during my time at Vituity and makes up the difference. Collections are one thing but then you have overhead like malpractice and billing and arrive at net operating revenue which is a bit less. Obviously I’m not going to put all group finances online and I’m only posting rounded numbers but the nice thing is that books are open to all partners and I could look all that information, payer mix, trends etc up in a few minutes and do the math. I even built out a spreadsheet to estimate group finances with pivot tables etc and it all adds up, helps with group decision making regarding staffing, income etc.

Anyways, this all started with some snide comments about fairness, exploitation. I realize there are far more lurkers on this site than active posters and mainly I wanted to mention that I have done the math several times over, and do think it’s fair, I don’t feel exploited and I’m happy where I’m at. Some sites will be worse so be sure to run the numbers in your own circumstances but writing off Vituity offhand to me seems like a mistake and I’m glad to be working at my current site. If you work at a Vituity site for 1-3 years then quit you will miss out on the big salary benefit that comes with a full career as a full partner but that’s not a pyramid scheme or exploitation that’s just how partnerships work. If you can find a better model, compensation and culture then by all means go for it. For me it was at least directly competitive and I wanted to live in a certain place so settled down at a Vituity site.

I am more troubled by long term trends in American healthcare and Emergency Medicine in particular with career satisfaction rather than Vituity partnership model.

I dont blame you for not posting the details. having open books makes all the difference. Of the very large groups vituity is at least fair and a true partnership unlike USUCKS. For the sake of the lurkers let’s not pretend some of the overhead costs are that high. Obviously ymmv but it’s fair to assume $5/pt for med mal (maybe lower if they run their own med mal via captive insurance), billing and coding is 7-8/patient. It all adds up but this isnt some monster cost. Simply put most groups will use the MLP profits to cover their overhead plus generate profit. I dont know how your site is using MLPs.

Vituity is a very long path. One other unfortunate aspect of vituity is they force everyone to pay for their health insurance. Again, small money in the grand scheme of things but it’s another way the young are subsidizing the old. I agree with you as far as the large groups go this isnt the end of the world. On the other hand a well run small(-ish) SDG will do better but it is usually gonna be way more secretive About finances.

 

[Fox800]

Vituity rescinded contracts for their entire travel team during COVID. Just straight up nullified legal, binding partnership agreements for several dozen docs who had guaranteed hours and rates of pay during the peak of COVID insanity.

Let that sink in for a minute.

 

[EctopicFetus]

Vituity rescinded contracts for their entire travel team during COVID. Just straight up nullified legal, binding partnership agreements for several dozen docs who had guaranteed hours and rates of pay during the peak of COVID insanity.

Let that sink in for a minute.

Is that true? If so that’s super terrible.

 

[JacobMcCandles]

Vituity rescinded contracts for their entire travel team during COVID. Just straight up nullified legal, binding partnership agreements for several dozen docs who had guaranteed hours and rates of pay during the peak of COVID insanity.

Let that sink in for a minute.

I imagine that all the Vituity partners voted on this, yes?

 

[Fox800]

I imagine that all the Vituity partners voted on this, yes?

Let me rephrase. They basically ignored signed contracts that had guaranteed hours at a guaranteed rate. Folks were depending on that income and stability.

You could remain on as a "partner" you just had no hours or income. What a deal!

 

[TooMuchResearch]

Not trying to defend anyone, but several CMGs and SDGs nulled contracts signed by new grads during covid. Some before 2 months of starting. People had already signed leases/bought houses and were licensed in those states. One particular SDG realized they had hired too many folks, and due to losses, they laid off several docs a couple months into working with them under the guise of "poor performance" (the lowest billers).

My unicorn group kept our new hires (that we didn't need at that point) and everyone cut their hours by a large margin. Nobody got fired, nobody had contracts nullified, and when it was done everyone remembered which local places kept their word and protected their employees and partners i.e. another local player fired as many people as they could get away and cancelled new employment agreements.

Don't work for ****bags.

 

[EctopicFetus]

My unicorn group kept our new hires (that we didn't need at that point) and everyone cut their hours by a large margin. Nobody got fired, nobody had contracts nullified, and when it was done everyone remembered which local places kept their word and protected their employees and partners i.e. another local player fired as many people as they could get away and cancelled new employment agreements.

Don't work for ****bags.

Same here.

 

[Janders]

Same here.

Bingo. We made that call. We also kept our PAs when others laid theirs off after 6wk of decreased volume. Guess who has extremely experienced PAs now?

 

[EctopicFetus]

Also same. No hours or pay cuts. Amazing when you treat people right and aren’t a blood thirsty PE company.

 

[Mbekweni]

Same for all the local Vituity sites I know of. Small pay cut and hours cut initially without letting any docs of PAs go, then once the PPP came through site did really well financially and we were made whole and then some.