Vituity vs Schumacher

[kenjixshadow]

Hello everyone,

Currently looking for a job between those two companies. I ignored TH, USACS, and Envision at ACEP. Any thought of which one is better for long term? I could not find more information about Schumacher aside from one post in 2019.

Thank you

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[Groove]

I think you'll find CMG shops to vary depending on the particular market. For instance, I work for TH but it's a hybrid base +RVU system. Others have worked for TH and report 100% RVU structures though that seems to be pretty rare in my experience. I've been pretty happy with TH so far and much happier than I was with Apollo so don't necessary overlook TH jobs simply because of the name.

I used to work for Schumacher about....8 years ago or so. From what I remember, compensation structure was very similar to TH in my region. ~75% base with 25% RVU. We'd get monthly score cards with metrics but it was blinded and wasn't shoved down your throat like at my last job. Otherwise, it was pretty much just like any other CMG gig. You get the typical corporate culture and incentives to focus on metrics and core measure type stuff, etc.. They never told me how to practice and I had a fairly positive experience. Pay was fair, etc.. Again, though...a lot probably depends on your location.

 

[Rekt]

If that's realistically your only options then Vituity.

Both are like having to eat dog ****. But the Vituity feces comes from a dog that eats puppy chow from Walmart. Whereas with Schumacher it's feces from a dog fed McDonald's everyday.

But Both are better than USACS and Envision which is feces from a dog that lives off 2 week old refried beans covered in chipotle hot sauce and e coli lettuce.

Overall, you're still eating ****, but maybe one is more palatable.

 

[TheComebacKid]

^ Literally the post of the year on this forum.

 

[wendalltwolf]

^ Literally the post of the year on this forum.

I thought that would have been the powerhouse program guy. Or at least he would have been meme of the year.

 

[RustedFox]

1. Rekt's dog$hit post above is up there for sure.

2. OMG... "Powerhouse Residency". Someone find that thread.

 

[BoardingDoc]

2. OMG... "Powerhouse Residency". Someone find that thread.

Ask and ye shall receive: Competitive Market - Denver CO or Souther California - Advice

 

[HemorrhagicShock]

All the vituity docs I know seem incredibly happy with their choice, so there's that. I think their version of "partnership" is fairly superficial, but you still get a K1/1099 income, and given the state you live in and your own personal finances, it might be more lucrative overall.

 

[turkeyjerky]

I also know someone who works for Vituity and he's happy. We worked at a $****hole before though, so the comparison might not be that accurate. But compare that to pretty much universal hatred for every other cmg people work for, schumacher included.

 

[bravotwozero]

Veers was with vituity but left. Said it was something resembling a pyramid scheme. Too bad we can’t get his perspective…

 

[RustedFox]

Veers was with vituity but left. Said it was something resembling a pyramid scheme. Too bad we can’t get his perspective…

Yeah, total shame.
It's like he had a lot of experience at multiple levels and insightful things to say to contribute to a forum of EM physicians on a number of topics all intrinsically related to EM in one fashion or another...

 

[Apollyon]

Yeah, total shame.
It's like he had a lot of experience at multiple levels and insightful things to say to contribute to a forum of EM physicians on a number of topics all intrinsically related to EM in one fashion or another...

I think you're the first person to call him "insightful". Just sayin'.

 

[RustedFox]

I think you're the first person to call him "insightful". Just sayin'.

Experience brings insight.

 

[Apollyon]

Experience brings insight.

You know the way just because it's old doesn't mean it's valuable? Same thing.

 

[Mbekweni]

I have historically seen some distrust for Vituity on this forum in the past but not a clearly spelled out reason why. I have worked for them at 4 sites in the past 5 years (all in one local region so have a primary site and help out here and there at others). Overall very happy. I wouldn't consider it a pyramid scheme or CMG in any way. Similar to a SDG there is a partnership structure so when you first start out you make less than a full partner (the earned hourly) which is based on collections. More patients, better run site, leaner, and you make more overall. It's open books which is about as good as you can get in terms of transparency. The "pyramid" occurs with partnership structure. You get a tiny end of the year profit sharing bonus to start, and up to around 20% of income as an end of the year bonus as a full partner. So you trade sweat equity and make a bit less for a few years and then make more long term if you build a career. I found that in general Vituity was about market rate maybe a touch below a CMG to start out of residency and then above market rate as full partner. 4 years working up that structure and then 20 years above market rate sounded like a good trade off to me. Most sites are run really locally so you forget it's a big group and have a lot of autonomy, but our negotiated rates are pretty good with insurance so that helps with profitability (we just merged with a local SDG here and their collections per patient went up $15 or so per pt with better Vituity billing and contracts which I feel are above board and not full of balance billing and other nonsense I have heard about with some CMG shops). Overall I wouldn't be afraid of Vituity as a company, but like any place there are great well run contracts and some that are struggling either as a difficult hospital or maybe medical director/group culture issue so YMMV. I know some Vituity sites with earned hourly in the $180/hr range and others above $300/hr before bonus so again really depends on the site and finances.

 

[BAM!]

did Veers leave?

 

[BAM!]

I worked at a hospital when it was CEP, then I think it somehow became a "Med America" / CEP blend briefly, then after I left it became Vituity. That said, all the CEP sites were dependent on the actual hospital's payor mix. Some had a bad mix, like mine, and others were good. So.... it really just depends on the hospital. CEP's partnership track was 4 years back then, which seemed a little long. But the docs who were working there longer than me got all these bonuses off my work which they certainly enjoyed. 🙁

 

[turkeyjerky]

I have historically seen some distrust for Vituity on this forum in the past but not a clearly spelled out reason why. I have worked for them at 4 sites in the past 5 years (all in one local region so have a primary site and help out here and there at others). Overall very happy. I wouldn't consider it a pyramid scheme or CMG in any way. Similar to a SDG there is a partnership structure so when you first start out you make less than a full partner (the earned hourly) which is based on collections. More patients, better run site, leaner, and you make more overall. It's open books which is about as good as you can get in terms of transparency. The "pyramid" occurs with partnership structure. You get a tiny end of the year profit sharing bonus to start, and up to around 20% of income as an end of the year bonus as a full partner. So you trade sweat equity and make a bit less for a few years and then make more long term if you build a career. I found that in general Vituity was about market rate maybe a touch below a CMG to start out of residency and then above market rate as full partner. 4 years working up that structure and then 20 years above market rate sounded like a good trade off to me. Most sites are run really locally so you forget it's a big group and have a lot of autonomy, but our negotiated rates are pretty good with insurance so that helps with profitability (we just merged with a local SDG here and their collections per patient went up $15 or so per pt with better Vituity billing and contracts which I feel are above board and not full of balance billing and other nonsense I have heard about with some CMG shops). Overall I wouldn't be afraid of Vituity as a company, but like any place there are great well run contracts and some that are struggling either as a difficult hospital or maybe medical director/group culture issue so YMMV. I know some Vituity sites with earned hourly in the $180/hr range and others above $300/hr before bonus so again really depends on the site and finances.

Thank you for this post. It's really quite useful and appreciated. But a few followup questions:
--Do you know how much national admin takes off the top of collections? Is it a certain %, a flat amount, and does it differ between sites?
--Are you able to be a little more specific about 'run locally'? Say, for instance, could the docs get together tomorrow and change the schedule?
--Do local docs dictate midlevel practice? Many people were concerned about the memo circulated last year about how midlevels would be credentialed for advanced procedures group-wide.

 

[Mbekweni]

Thank you for this post. It's really quite useful and appreciated. But a few followup questions:
--Do you know how much national admin takes off the top of collections? Is it a certain %, a flat amount, and does it differ between sites?
--Are you able to be a little more specific about 'run locally'? Say, for instance, could the docs get together tomorrow and change the schedule?
--Do local docs dictate midlevel practice? Many people were concerned about the memo circulated last year about how midlevels would be credentialed for advanced procedures group-wide.

Regarding admin I think it's collections minus billing (7%) minus malpractice (fixed $/chart for the region) so overall overhead is around 10% which is pretty competitive. The tricky part comes with Vituity contribution which is 21.45% of collections. This fund also goes into the bonus which at the end of the year will range from 18-23% or so with target of 20%. So as a full partner there is very little going to national admin, practice support, contract negotiations with insurers, innovation projects etc. As a new partner you are giving up good chunk of that 21.45% which goes to support both the operations and extra bonus of the partners (vs your $$ partnership buy in as another perspective). Again, that's how all private groups work, with more of the profits going towards the full partner, which works out great if you stay for the 4 years of partnership track so all the efficiencies of scale come "free," but if you want to stay at a place and know you will leave in 1-2 years you should look around for other options for sure. This is all public information and comes up in the interviews so it's just a math problem involving how much you like a site, whether you can see yourself there long term. For good reason, I think that the financial model does encourage people to commit to a site long term. For me the 20% difference (made up by the different end of the year bonus) between new hire and full partner didn't seem that bad. I interviewed at 2 other small SDG shops on the West Coast out of residency and they had a 2 year path to partnership but a differential that was 30-40% in pay, so I took the smaller delta figuring that if I changed my mind it wouldn't have been quite as painful of an initial financial commitment. Another 2 had no well defined path to partner with easily measured metrics, huge full partner pay bump (expected and implied but not fully open books)...so that was a hard pass. I also got a modest 10k new hire sign on bonus, and additional hospital sign on bonus which helped a lot to close the gap the first few years as well.

Regarding locally run process: The group can change the schedule and jack up coverage, cut or raise paid hourly, start or end an APP program with a vote. It's all open book and you are paid essentially with proffit/hours worked at the end of the day, so staffing always has hourly pay implications but you can design schedule for a lifestyle site or a "work your ass off and make a lot of money" site. There are always a few partners on either end of the spectrum in a group but in a democratic vote you need the majority to move the needle. One of my main sites tries for a 1.7 pph schedule and some want to make more $/hr and push towards 2.1 pph but they haven't won out. I was hungry right out of residency and resented that a little but now I'm so damn tired after the past few years I'm very happy for the extra support on shift. APP program and supervision is all derived locally. Implemented well can earn the group more money. They are employees with different labor law, fixed hourly, benefits etc so can also end up being an extra cost the vast majority of which is born locally. This is another area where Vituity central is super helpful with guidance. Local docs dictate APP supervision and practice to their comfort. One site I work with uses midlevels for very low acuity ESI 4/5 and scut work like splints and lacs. Another site is ESI 2 through 5 with much more experienced APP providers who are super independent but seem to do a good job of coming to you with questions. I've never had an issue with the relationship and for all new APPs I supervise I want to hear about all of their patients for a few shifts until I get comfortable then I rarely care. I do sign their charts but I think that requirement comes from the hospital contract and not from Vituity (though I don't know of any sites in independent APP practice).

 

[Groove]

4 year partnership track? Assuming at least a $60/hr deficit for 4 years @ 1728hr/yr ~ over 400K lost. It takes you 5-6 years to "recoup" once partner once you factor in returns it could have generated if invested in the market. So, you have to take a job right out of residency and have enough confidence that the contract is stable enough that it's going to be there for at least 8-10 years and double assume that you're actually going to like the job/hospital. Or...you can take a CMG job that pays you almost exactly what you'd make as partner. Better be some killer benefits as "partner". Do you own true equity in the company? Probably not. More than likely, the "equity" is being sold as the opportunity to work for them at a higher rate in the future while other docs and execs benefit off your sweat "equity" which isn't really any equity at all in the end.

That's the definition of a pyramid scheme.

1. a form of investment in which each paying participant recruits further participants, with returns being given to early participants using money contributed by later ones.

I can't imagine taking a job and having long term confidence that the contract is stable enough to be there for 10 much less 20 years. Maybe 20-30 years ago but definitely NOT today.

 

[Groove]

I've seen some primo SDG gigs with one of the nicest being in CO several years ago and it had the longest partnership track at 3 years. 4 year partnership track for a "hybrid CMG" makes me want to LOL.

 

[Mbekweni]

4 year partnership track? Assuming at least a $60/hr deficit for 4 years @ 1728hr/yr ~ over 400K lost. It takes you 5-6 years to "recoup" once partner once you factor in returns it could have generated if invested in the market. So, you have to take a job right out of residency and have enough confidence that the contract is stable enough that it's going to be there for at least 8-10 years and double assume that you're actually going to like the job/hospital. Or...you can take a CMG job that pays you almost exactly what you'd make as partner. Better be some killer benefits as "partner". Do you own true equity in the company? Probably not. More than likely, the "equity" is being sold as the opportunity to work for them at a higher rate in the future while other docs and execs benefit off your sweat "equity" which isn't really any equity at all in the end.

That's the definition of a pyramid scheme.

1. a form of investment in which each paying participant recruits further participants, with returns being given to early participants using money contributed by later ones.

I can't imagine taking a job and having long term confidence that the contract is stable enough to be there for 10 much less 20 years. Maybe 20-30 years ago but definitely NOT today.

It's not a 0% bonus and then 20% when full partner. It's about 1% year 1, 3.4% year 2, 6.6% year 3, 10% year 4 and then 20% for any work starting after 4 years so not as bad as the math above suggests. But I totally see your point, there is a delayed payback that requires a 10 year mindset where it becomes really worthwhile, and close to break even/grey area at 6-10 years. Before that totally depends on starting pay vs the competition which will vary a lot from local market to market and makes a general comparison almost useless. You're also right in that the "equity" is generally the ability to work with a higher pay rate ie bonus in the long term. Still, I find that these are all rather self evident math problems depending on a person's goals, where they see themself long term etc and are similar with any difficult decision to join a partnership track private group (buy in, hourly differential, years to partner etc).

I would also be very concerned as a potential applicant if comparing CMG pay which has a huge downward market pressures as your labor has to make profit for the shareholders and pay will be pushed as low as the company can get away with in the future while still maintaining staffing. Better comparison would be to the various private groups around, which have a huge variety in compensation/partnership models and share profits. In all honesty, I knew which geographic location I wanted to work, and picked a nice financially stable hospital with a well run group that happened to be Vituity. Happy with that choice personally and nice to know that if I wanted to move or there was a contract issue then the partnership level would follow me to another Vituity hospital/contract. I would not want to be a CMG/locums doc in today's market though, that's for sure.

 

[EctopicFetus]

It's not a 0% bonus and then 20% when full partner. It's about 1% year 1, 3.4% year 2, 6.6% year 3, 10% year 4 and then 20% for any work starting after 4 years so not as bad as the math above suggests. But I totally see your point, there is a delayed payback that requires a 10 year mindset where it becomes really worthwhile, and close to break even/grey area at 6-10 years. Before that totally depends on starting pay vs the competition which will vary a lot from local market to market and makes a general comparison almost useless. You're also right in that the "equity" is generally the ability to work with a higher pay rate ie bonus in the long term. Still, I find that these are all rather self evident math problems depending on a person's goals, where they see themself long term etc and are similar with any difficult decision to join a partnership track private group (buy in, hourly differential, years to partner etc).

I would also be very concerned as a potential applicant if comparing CMG pay which has a huge downward market pressures as your labor has to make profit for the shareholders and pay will be pushed as low as the company can get away with in the future while still maintaining staffing. Better comparison would be to the various private groups around, which have a huge variety in compensation/partnership models and share profits. In all honesty, I knew which geographic location I wanted to work, and picked a nice financially stable hospital with a well run group that happened to be Vituity. Happy with that choice personally and nice to know that if I wanted to move or there was a contract issue then the partnership level would follow me to another Vituity hospital/contract. I would not want to be a CMG/locums doc in today's market though, that's for sure.

The issue is as a CMG you are fairly set. As an SDG you want to believe you are all in it together. Yet Vituity just lost 2 well publicized contracts in SD. Those “partners” are screwed.

Vituity is better than Schumacher but I cant for the life of me understand why you wouldn’t make more money on day 1 at vituity than any cmg. One of the issues with vituity is for a long time (and maybe still) all their contracts are from California where the contracted rates generally suck. Hence their $/pt is fairly low.

 

[Siggy]

If that's realistically your only options then Vituity.

Both are like having to eat dog ****. But the Vituity feces comes from a dog that eats puppy chow from Walmart. Whereas with Schumacher it's feces from a dog fed McDonald's everyday.

But Both are better than USACS and Envision which is feces from a dog that lives off 2 week old refried beans covered in chipotle hot sauce and e coli lettuce.

Overall, you're still eating ****, but maybe one is more palatable.

Mind you, you're on a website famous for people professing their love of consuming poop hotdogs.

Would you eat a poop hot dog to gain admission to your first choice school?

I'm talkin' foot long. I know I would.

forums.studentdoctor.net

 

[Little drop of rain]

4 year partnership track? Assuming at least a $60/hr deficit for 4 years @ 1728hr/yr ~ over 400K lost. It takes you 5-6 years to "recoup" once partner once you factor in returns it could have generated if invested in the market. So, you have to take a job right out of residency and have enough confidence that the contract is stable enough that it's going to be there for at least 8-10 years and double assume that you're actually going to like the job/hospital. Or...you can take a CMG job that pays you almost exactly what you'd make as partner. Better be some killer benefits as "partner". Do you own true equity in the company? Probably not. More than likely, the "equity" is being sold as the opportunity to work for them at a higher rate in the future while other docs and execs benefit off your sweat "equity" which isn't really any equity at all in the end.

That's the definition of a pyramid scheme.

1. a form of investment in which each paying participant recruits further participants, with returns being given to early participants using money contributed by later ones.

I can't imagine taking a job and having long term confidence that the contract is stable enough to be there for 10 much less 20 years. Maybe 20-30 years ago but definitely NOT today.

THIS^

ED contracts change hands overnight, especially in today's world with hospitals merging and being acquired nonstop. New C-O on board, everything changes. Just because one group had the contract for the past 20 years doesn't mean that they won't lose it tomorrow.

If you are in a good payer mix area your ED contract is in constant danger because of all the other groups drooling over it....and your group might have to bend over backwards to accommodate the hospital to keep the contract.

If the payer mix is bad the hospital subsidy is all that makes or breaks it. But that usually means the hospital is also financially struggling and constantly looking for ways to save $$$. Another group comes to the CEO asking the ED contract for significantly lower subsidy (while paying the docs "the lowest that market can bear" to keep their margin), the contract might change hands before you know it.

SDG/Vituity reward long career and give you not just a sense of ownership but the financial advantage of profit sharing once you are a full partner, ASSUMING that contract is stable enough. But who can promise? USACS operates W2/employee model using the benefits/stocks as a selling point (...and to justify the low hourly rate...), but when the hospital pulls the contract you will either have to relocate to stay with USACS or signing with the new group/looking for new jobs because you already bought a house and kids are going to school nearby. In my opinion none of these "advantages" is good enough to justify the sacrifice upfront. If you geographically bound to a certain area and like the hospital, I wouldn't put too much emphasis on the name of the ED staffing group, in the end they are all the same, unless you are directly employed by the health system or government/university.

 

[EctopicFetus]

THIS^

ED contracts change hands overnight, especially in today's world with hospitals merging and being acquired nonstop. New C-O on board, everything changes. Just because one group had the contract for the past 20 years doesn't mean that they won't lose it tomorrow.

If you are in a good payer mix area your ED contract is in constant danger because of all the other groups drooling over it....and your group might have to bend over backwards to accommodate the hospital to keep the contract.

If the payer mix is bad the hospital subsidy is all that makes or breaks it. But that usually means the hospital is also financially struggling and constantly looking for ways to save $$$. Another group comes to the CEO asking the ED contract for significantly lower subsidy (while paying the docs "the lowest that market can bear" to keep their margin), the contract might change hands before you know it.

SDG/Vituity reward long career and give you not just a sense of ownership but the financial advantage of profit sharing once you are a full partner, ASSUMING that contract is stable enough. But who can promise? USACS operates W2/employee model using the benefits/stocks as a selling point (...and to justify the low hourly rate...), but when the hospital pulls the contract you will either have to relocate to stay with USACS or signing with the new group/looking for new jobs because you already bought a house and kids are going to school nearby. In my opinion none of these "advantages" is good enough to justify the sacrifice upfront. If you geographically bound to a certain area and like the hospital, I wouldn't put too much emphasis on the name of the ED staffing group, in the end they are all the same, unless you are directly employed by the health system or government/university.

You make one assumption that the SDG pay is lower than the cmg pay day 1. Thats not always the case. It used to be but the world has changed. The non partners in my group make way more than any cmg job in town.

Also dont fool yourself that being employed by a hospital is somehow better. Many of them have non competes that are insane (where enforceable) and they too want to drive down what they pay you. You have "stability" sort of. The medical director changes and lots of other changes can follow, most of which are unpleasant.

Just food for thought.

in the end as I tell my colleagues, do what is best for you and your family. If you or I left our jobs tomorrow the world would move on without anyone really noticing. If you died your family would be wrecked. They matter. the job is a job and dont be wed to it. The days of that sort of career in medicine is long gone though many long for it.

 

[Mbekweni]

You make one assumption that the SDG pay is lower than the cmg pay day 1. Thats not always the case. It used to be but the world has changed. The non partners in my group make way more than any cmg job in town.

Also dont fool yourself that being employed by a hospital is somehow better. Many of them have non competes that are insane (where enforceable) and they too want to drive down what they pay you. You have "stability" sort of. The medical director changes and lots of other changes can follow, most of which are unpleasant.

Just food for thought.

in the end as I tell my colleagues, do what is best for you and your family. If you or I left our jobs tomorrow the world would move on without anyone really noticing. If you died your family would be wrecked. They matter. the job is a job and dont be wed to it. The days of that sort of career in medicine is long gone though many long for it.

These are good points and go way beyond Vituity and into SDG vs CMG in general. Contact stability can't be guaranteed and is something that causes me to lose sleep sometimes. I would like to think that if your group does a good job and there isn't a stipend then there isn't much to undercut you on...but time will tell. Fat stipend and you have to work like hell to stand out and It's also worth looking at what the starting pay is between the options. I had one SDG I interviewed at out of residency offer pre-partner $130/hr days and $180/hr nights. That's a huge financial risk until you make partner. Luckily at all the sites I am involved with the day one rates are super solid and I think would make many very happy with the bonus just the icing on top. Add on a signing bonus and it was very easy decision for me. Vituity is well aware that if you have too much of a delta in starting rates vs the competition you can't recruit. Again...case by case based on site and the bigger the delta (if any) the harder it is to justify given the uncertainties in the labor market. But if you can hit a competitive starting rate, add on 20% down the road, and if you lose the contract or decide to move keep your 20% bonus and move, all while you like the hospital and group then you've just struck gold. If not...nobody would blame you for looking elsewhere.

 

[namethatsmell]

in the end as I tell my colleagues, do what is best for you and your family. If you or I left our jobs tomorrow the world would move on without anyone really noticing. If you died your family would be wrecked. They matter. the job is a job and dont be wed to it. The days of that sort of career in medicine is long gone though many long for it.

Most legit advice on this thread.

 

[Groove]

CMGs and Quasi-CMGs during their first interview to hire a new physician trying to sell them on one of these "partnership track" or "company stock" investment models...be like:

 

[Porfirio]

My approach to CMG vs SDG.

A bird in the hand is worth two in the bush.

But my generation of docs don’t have the golden age to look forward to or in the bank.

 

[turkeyjerky]

My approach to CMG vs SDG.

A bird in the hand is worth two in the bush.

But my generation of docs don’t have the golden age to look forward to or in the bank.

I dunno. I think this was rational several years ago, but things are going to look pretty dark at cmg shops in a few years when they're staffing at 120% and people are begging for shifts. Plus the inevitable med mal risk of 'supervising' 4 npps at a time.

 

[EctopicFetus]

I dunno. I think this was rational several years ago, but things are going to look pretty dark at cmg shops in a few years when they're staffing at 120% and people are begging for shifts. Plus the inevitable med mal risk of 'supervising' 4 npps at a time.

I agree. Hard to predict the future but you are right in that we should expect enormous pressure on ER MD income. When that happens pay will drop and drop. Once our rates near the noctor rates they will fire them and hire us. Dark clouds loom. With vituity you dont have this pressure (supposedly).