Why are we not discussing this? CMGs gobbling up SDGs

[TrumpetDoc]

I know several SDG's that lost or gave up their contract over this exact issue. Team and Emcare both run hospitalist divisions specifically for this reason so they can dangle that carrot in front of the CEO's. Give us your contract and never worry again about having to pay for your hospitalists. Many hospitalist programs even at hospitals with good payer mixes seem to lose money.

This is HUGE. I've seen this first hand as well.

I have yet to see any non hospital owned hospitalist service not need a subsidy.
The will continue unless Medicare decides to make physician reimbursement for them a priority (yeah right)

This will certainly open the door for ALL SDGs to be in danger if their hospitalists get taken over.

I think this is a huge place where ACEP and the IM colleges need to focus and make VERY public. The corporate bastardization of medicine should be highlighted with this very thing.
I fear it's a lost cause anyhow barring some legislation limiting corporate influence...even more of a pipe dream.

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[VA Hopeful Dr]

This is HUGE. I've seen this first hand as well.

I have yet to see any non hospital owned hospitalist service not need a subsidy.
The will continue unless Medicare decides to make physician reimbursement for them a priority (yeah right)

This will certainly open the door for ALL SDGs to be in danger if their hospitalists get taken over.

I think this is a huge place where ACEP and the IM colleges need to focus and make VERY public. The corporate bastardization of medicine should be highlighted with this very thing.
I fear it's a lost cause anyhow barring some legislation limiting corporate influence...even more of a pipe dream.

I have. The hospitalist group my residency hospital used was privately owned and got no subsidy.

Now that said, those guys worked their asses off like I've never seen since...

 

[bravotwozero]

AAEM Statement on USACS Replacement at Summa Health

AAEM Members,

By now most of you have heard about Akron-based Summa Emergency Associates (Akron City Hospital EM Residency) and their sudden termination and replacement by US Acute Care Solutions at all of the Summa Health System EDs. This literally overnight transition to a new group of physicians most of whom, to the best of our understanding, are unfamiliar with the hospitals, the EDs, their staffs, the EMS systems and the EMR/CPOE, creates a potential patient safety issue in the short term. The displaced group is physician owned and has been in existence for 40 years.

As you know it is a major concern of the AAEM to preserve physician owned practices in EM. The new group, USACS, while having physician ownership, also has a major private equity partner which creates lay influence over their operations, something the AAEM is opposed to. Although the state of Ohio recently nullified its prohibitions on the corporate practice of medicine, AAEM remains concerned when lay corporations have an ownership stake in an EM practice. Additionally, this summary termination of over 60 EM physicians clearly violates physician practice rights delineated in the AAEM, AMA and ACEP policies on due process.

The AAEM mission statement and those of other EM organizations supports residency education and unfortunately an EM residency is caught up in this business matter. The Summa Emergency Medicine residency program has lost its leadership and academic faculty, disrupting established mentoring and teaching relationships right in the midst of resident recruitment season. This is distressing to the current residents and this event will impact the future of this program.

AAEM and AAEM-PG have been in contact with the SEA Leadership and are collaborating on the best options to address this situation. Please let us know if you have specific ideas or input regarding this distressing state of affairs.

AAEM Board of Directors
AAEM Past-Presidents Council
[email protected]


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[BAM!]

I know several SDG's that lost or gave up their contract over this exact issue. Team and Emcare both run hospitalist divisions specifically for this reason so they can dangle that carrot in front of the CEO's. Give us your contract and never worry again about having to pay for your hospitalists. Many hospitalist programs even at hospitals with good payer mixes seem to lose money.

Although CEP is one of the better CMG's, they're doing this same thing. It seems that some of the CMG's are also tying anesthesia groups into the mix. Perhaps this will help lessen the burden of EM subsidies of hospitalists?

 

[sum dude]

Here's a fun fill in the dots...

Envision (EMCare) owns both Hospitalists and Anesthesia. Besides HCA, they're like the Walmart of EM...take small, rural contracts, supplement salaries with other campuses in order to pay them. It's a boom on paper for hospitals, for reasons noted above. Until they see the quality of doctors is often (though not always) lacking. To compensate, they're now paying for ED Residnency programs w/ HCA (a future big trend, given that CMS is stuck in 1991 dollars to fund residencies)
TeamHealth same. They're owned by one of the largest private equity firms in the world.
For fun, see who owns share (though not majority) USAntesthesia Partners. See if you can notice a link between them and another group noted throughout this thread (besides eerily similar name). Also note emergency medicine is not in name...prob. not an accident.

SDG's are a dying bread. On paper, an SDG can't compete with a large, private equity run managment firm. If you don't have a multiple-hospital group with a kick-ass billing/management, chances are your SDG will either eventually (1) lose contract or (2) be bought out (eg for the pseudo-SDG's which are actually owned by groups' senior partners, see FEP). Hospital employment is equally bad--if you think admin is hard on your group, wait till they are your actual employer. Soon to be grads take note--be very wary of doing multiple years of sweat equity, as the risk increases on a yearly basis and you probably won't get the difference in pay back. Forget that "40 year history with hospital" non-sense, as this example shows. Corporate america is taking over medicine.

I could see a situation where groups that own FSED's can survive, but otherwise, small SDG's are in big trouble, as they just can't compete with the fire-power that the big groups bring. Skills count for something, but administrators think dollars/sense, not relationships, and management firms with links to Wallstreet will bring bazookas to your knife contract fight.

Welcome to the corporate raid of medicine. It was only a matter of time b/4 they figured out there's lot of money to be made in medicine

 

[hypnix]

The above post was a very dark post.

 

[Arcan57]

The above post was a very dark post.

He's not wrong. They're aren't a lot of poorly run businesses that have the potential for profit that currently exists in healthcare. You see an aging population burdened with multiple chronic diseases and wonder how we're going to take care of all of them. They see an expanding market that has ridiculous profit margins if you're able to carve out the right segment.

 

[GeneralVeers]

He's not wrong. They're aren't a lot of poorly run businesses that have the potential for profit that currently exists in healthcare. You see an aging population burdened with multiple chronic diseases and wonder how we're going to take care of all of them. They see an expanding market that has ridiculous profit margins if you're able to carve out the right segment.

On the benefit side for us, our new corporate masters bring huge resources that allow them to subsidize EM contracts that they want to keep. I work at one such site, which is why the pay is higher. Prior to becoming USACS, EMP never paid $300/hour for anyone, and in fact never broke $200/hour at any of their sites. Let's take some of the Wall Street money being pumped into the system for ourselves while we can. We can't change the situation, but at least we can profit from it ourselves, and rape them as much as we can.

 

[EctopicFetus]

GV is right. Get what you can. Let me step back and say this. I have worked for 2 SDGs. The one that didnt want to pay physicians to "run the business" was a hot mess when I joined. No one looked at payer contracts for a while, chargemaster neglected etc. Some business savvy docs came in and cleaned it up to the tune of $100k per partner per yr. The SDGs are still out there but I would tell anyone to be careful that the buy in isnt too steep and I would flat out ask after an offer if the group has considered selling.

When I left my last job I looked at a few, one was an ok job where I had a close friend who told me they would probably sell before I ever became a partner. It was easy to not consider that job but I know they hired after me. Be wise but dont fall prey to the CMG crap.

Many of those issues were as MudPhud mentioned. Overpaying MedMal, poor billing practices, etc. With the overhead of the CMGs your contracts dont have to be as good as the CMGs. You just have to be in the ball park.

 

[emergentmd]

Here's a fun fill in the dots...

Envision (EMCare) owns both Hospitalists and Anesthesia. Besides HCA, they're like the Walmart of EM...take small, rural contracts, supplement salaries with other campuses in order to pay them. It's a boom on paper for hospitals, for reasons noted above. Until they see the quality of doctors is often (though not always) lacking. To compensate, they're now paying for ED Residnency programs w/ HCA (a future big trend, given that CMS is stuck in 1991 dollars to fund residencies)
TeamHealth same. They're owned by one of the largest private equity firms in the world.
For fun, see who owns share (though not majority) USAntesthesia Partners. See if you can notice a link between them and another group noted throughout this thread (besides eerily similar name). Also note emergency medicine is not in name...prob. not an accident.

SDG's are a dying bread. On paper, an SDG can't compete with a large, private equity run managment firm. If you don't have a multiple-hospital group with a kick-ass billing/management, chances are your SDG will either eventually (1) lose contract or (2) be bought out (eg for the pseudo-SDG's which are actually owned by groups' senior partners, see FEP). Hospital employment is equally bad--if you think admin is hard on your group, wait till they are your actual employer. Soon to be grads take note--be very wary of doing multiple years of sweat equity, as the risk increases on a yearly basis and you probably won't get the difference in pay back. Forget that "40 year history with hospital" non-sense, as this example shows. Corporate america is taking over medicine.

I could see a situation where groups that own FSED's can survive, but otherwise, small SDG's are in big trouble, as they just can't compete with the fire-power that the big groups bring. Skills count for something, but administrators think dollars/sense, not relationships, and management firms with links to Wallstreet will bring bazookas to your knife contract fight.

Welcome to the corporate raid of medicine. It was only a matter of time b/4 they figured out there's lot of money to be made in medicine

I preach this to all docs I see. I have been through it all. From Director in SDG, Director in CMG, Med Exec Committee. Everyone can paint a pretty picture. Everyone cares about the doctors. Everyone wants doctors to have freedom to Practice.

Until if affects the bottom line. When money is involved, no one cares about the doctors regardless of specialty. EM is affected but it goes across all specialty.

Do you really think all of the Sepsis, Cath Time, Pneumonia metrics are pushed b/c it affects patient care? These only started b/c it began to affect the hospital's bottom line.

Its all about money.

EM is a hot and very profitable profession at this time. It may last another 5 yrs or another 30 years. No one knows. Seek your money now while it is hot.

 

[FreddieH]

The one that didnt want to pay physicians to "run the business" was a hot mess when I joined. No one looked at payer contracts for a while, chargemaster neglected etc. Some business savvy docs came in and cleaned it up to the tune of $100k per partner per yr.

Forgive my upfront and candid ignorance as a 4th year going into EM, but how much of this "gobbling up" is a factor of non-business savvy docs? Are there just not enough MD/MBA's or maybe insufficient entrepreneuraliasm? Though anecdotal, WCI's group seems to run a well-oiled group (at least it appears this way on these forums and I know it's been asserted that their future in by no means guaranteed). He, himself, seems very entrepreneurially savvy.

As I said, my understanding of this problem is limited and I'm trying to learn more about this problem every day as my future lies firmly in its grips. Anybody else see this lack of business savvy as a larger problem or is just small potatoes compared to the general economics of the whole poop-storm?

Thanks team!

 

[The White Coat Investor]

Forgive my upfront and candid ignorance as a 4th year going into EM, but how much of this "gobbling up" is a factor of non-business savvy docs? Are there just not enough MD/MBA's or maybe insufficient entrepreneuraliasm? Though anecdotal, WCI's group seems to run a well-oiled group (at least it appears this way on these forums and I know it's been asserted that their future in by no means guaranteed). He, himself, seems very entrepreneurially savvy.

As I said, my understanding of this problem is limited and I'm trying to learn more about this problem every day as my future lies firmly in its grips. Anybody else see this lack of business savvy as a larger problem or is just small potatoes compared to the general economics of the whole poop-storm?

Thanks team!

It's a factor but not a large one. The big factor is the consolidation of health care into fewer but large entities.

 

[emergentmd]

Forgive my upfront and candid ignorance as a 4th year going into EM, but how much of this "gobbling up" is a factor of non-business savvy docs? Are there just not enough MD/MBA's or maybe insufficient entrepreneuraliasm? Though anecdotal, WCI's group seems to run a well-oiled group (at least it appears this way on these forums and I know it's been asserted that their future in by no means guaranteed). He, himself, seems very entrepreneurially savvy.

As I said, my understanding of this problem is limited and I'm trying to learn more about this problem every day as my future lies firmly in its grips. Anybody else see this lack of business savvy as a larger problem or is just small potatoes compared to the general economics of the whole poop-storm?

Thanks team!

WCIs group may very well be so great that the hospital will never let a CMG take over. I highly doubt this. If they are in a nice/big city, they will be gobbled up and partners will be bought out. If they are in a small town where the CMGs have no interest, they very well could flourish until reimbursement continues to diminish at which point, the partners will hire more midlevels/decrease staffing/hope a CMG buys them out.

The bottom line is medicine is no different than any other business. No one/company can defy the law of economics. There is a breaking point where larger groups have more avenues to generate money that small groups (no matter how business savvy) will not be able to overcome.

WCI may have a very profitable group and he best keep it quiet. Otherwise a CMG will come in, offer the hospital a financial incentive, and his group will be offered a buyout vs some poor economic alternative.

 

[Vandalia]

Well, some economic theory:

In the same way that a black hole sucks in everything around it (not really, but go with the analogy), in a free market system everything naturally ends up with one, single, dominant entity that controls the market. (See, for example, Rockefeller and Standard Oil.)

With the elimination of restrictions on the physician market such as the prohibitions against "corporate practice of medicine", we have essentially a free market for physician services. In those specialties where there is not a barrier to entry (read physicians are replaceable widgets as in EM, Anesth, Path, Radiology) everything will naturally move of its own accord to one "trust" that controls the market. In the primary care market, and a few specialties like Cards and GI that have long term patient relationships, it is a bit harder for companies to do this since patients will not tolerate "their" physician changing every two months.

I know a lot of physicians who keep saying they want a "free market" for medicine. Well, a "free market" means you will end up working as an employee for a mega-corporation that controls the entire market for your specialty. The era of the independent small businessman existed precisely because it WAS NOT a free market. Ages ago the guilds strictly limited who could and who could not practice the trade and/or specialty. There were strict laws that regulated businesses and the professions. As an example, state restrictions on alcohol distribution, and food distributors kept your independent grocery store open. As soon as those were removed, Wal-Mart controlled the local market. There were many small, privately owned airlines in the era of airline regulation. As soon as that went away, we ended up with a few mega-carriers.

When the "private practice" physician was thriving, there were things like "certificate of need" in almost every state that regulated hospitals and regulated healthcare. No ASCs, no FSED. An old, old-timer who was on his state board of medicine 60+ years ago told me many years ago that they controlled medical licensing based on the local medical market. "Hmm. This surgeon who wants a KY license and is coming in from Tennessee wants to go to Smithtown. We already have too many surgeons in Smithtown. Deny his application."

In medicine, things like relaxing the restrictions on "corporate practice of medicine" and lawsuits that eliminated the ability of hospital credentials boards to regulate the local physician market created the environment that inevitably results in mega-corporations controlling a specialty. In a "free market" everyone competes on an equal playing field. But that doesn't mean that everyone is equal. As posted previously, the big groups already have a tremendous advantage in lower costs in areas such as billing, HR, malpractice, etc.. Yeah, NFL games are (probably) fair, but that also means the Patriots beat the Browns 100 times out of 100.

So if you want physicians to be able to control their own practices and own their own groups.... pray for a single-payer healthcare system. In the absence of strong regulation in a capitalistic society, every trade and profession inevitably evolves to one mega-corporation controlling the trade or specialty.

Ever hear of the saying "be careful of what you wish for because you might just get it?" That is exactly where emergency medicine and a lot of other specialities are at right now.

(In case you are wondering, I am not in a CMG, but rather what is essentially a private group... for now, at least.)

 

[FreddieH]

In those specialties where there is not a barrier to entry (read physicians are replaceable widgets as in EM, Anesth, Path, Radiology) everything will naturally move of its own accord to one "trust" that controls the market.

This is an interesting take. It has always been my understanding that the opposite is true. This understanding is taken from Ronald Coase's (https://www.nobelprize.org/nobel_prizes/economic-sciences/laureates/1991/coase-facts.html) ideas espoused in his essay "The Nature of the Firm" (http://onlinelibrary.wiley.com/doi/10.1111/j.1468-0335.1937.tb00002.x/pdf), for which he won a Noble Prize. In this essay he states that independent economic actors coalesce into firms in order to overcome transactions costs, synonymous with the very "barriers" that you discuss. Given such a theory, one would expect barriers to entry which increase transactions costs, such as Certificate of Need laws and other costly regulations, to increase consolidation; the antithesis, or the case of decreased transactions costs (ie "free markets"), then, would decrease consolidation.

It would also be prudent to acknowledge that while Standard Oil controlled more than 90% of the market, Rockefeller was also bringing oil to the masses at prices >70% less than it was previously offered. Wal-Mart shares a similar story of innovation, relying on price reduction as a strategy to obtain market share (and those prices remain low as any poor 4th yr student knows).

While I see the temptation to favor guild-like labor market protections for physicians, I can't help but remain suspicious of the fundamental inconsistencies (those stated above) in such an argument.

 

[bravotwozero]

Ok, so now that those regulations are gone by the wayside, then consolidation shouldn't happen anymore then, according to that guys theory? Is that really happening right now? NOPE...it's now even more than when those regulations existed.


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[The White Coat Investor]

WCIs group may very well be so great that the hospital will never let a CMG take over. I highly doubt this. If they are in a nice/big city, they will be gobbled up and partners will be bought out. If they are in a small town where the CMGs have no interest, they very well could flourish until reimbursement continues to diminish at which point, the partners will hire more midlevels/decrease staffing/hope a CMG buys them out.

The bottom line is medicine is no different than any other business. No one/company can defy the law of economics. There is a breaking point where larger groups have more avenues to generate money that small groups (no matter how business savvy) will not be able to overcome.

WCI may have a very profitable group and he best keep it quiet. Otherwise a CMG will come in, offer the hospital a financial incentive, and his group will be offered a buyout vs some poor economic alternative.

We're definitely well-known to the CMGs and fighting the good fight.

 

[TrumpetDoc]

Can we even be considered to be in a "free market" system right now? We have ridiculous government control "price controls" on how we can get paid. We cannot innovate increase pay as reimbursement is not only fixed but the goal is to reimburse less via asinine documentation requirements. (we can diversify with FSEDs/do non clinical stuff, it that isn't the same).

 

[Zebra Hunter]

ACEP finally released a statement:

“We are deeply concerned about the continuity and stability of training for the emergency medicine residents working in the Summa Health System following the abrupt shift in contracted emergency physician services from Summa Emergency Associates to U.S. Acute Care Solutions. Hospitals and health systems change staffing contracts routinely, but what is not routine at Summa Health is the abruptness of the change. Typically, it takes 90 to 120 days for a transition to be completed, to allow for adjustments to personnel, schedules and infrastructure. We are concerned about what plans Summa Health has to ensure smooth transition for the residency program and the residents directly involved.

“One of Summa Health’s top priorities must be to preserve the integrity of the training and support of its emergency medicine residents. Residency is a critical part of any physician’s education, and a clear plan, executed quickly, by Summa Health, is crucial to its residents’ education, training and well-being. The three years of residency are intensely focused on putting into practice, under stable supervision, the skills that are essential to a lifelong career in emergency medicine. Disruptions to that training can have damaging reverberations.

“We look forward to hearing about a more detailed plan from Summa Health on a seamless transition while continuing to provide a first-rate education to their emergency medicine residents of today and for the years to come.”

 

[Mad Jack]

CMGs buying up SDGs is the first phase. The second phase will consist of CMG mergers leading to total regional market dominance by one or two groups.

I think you all know what happens to wages under a monopsony.

That's pretty much what went down (and is currently going down) with AMGs in anesthesia. If there's gravy to be had, you'd better bet there's some venture capitalist or investment banker wondering how they can steal it from the people working to earn it.

 

[GeneralVeers]

Though anecdotal, WCI's group seems to run a well-oiled group (at least it appears this way on these forums and I know it's been asserted that their future in by no means guaranteed). He, himself, seems very entrepreneurially savvy.

As I said, my understanding of this problem is limited and I'm trying to learn more about this problem every day as my future lies firmly in its grips. Anybody else see this lack of business savvy as a larger problem or is just small potatoes compared to the general economics of the whole poop-storm?

Thanks team!

There are two factors at work which could allow a CMG to take over which are out of the average doctor's control:

1. The hospital Contract. The hospital administration can and will change groups once a contract is up. This is regardless to the quality of physicians, metrics etc. My own site underwent a contract change because a scandal involving one of our ED medical directors in collaboration with the Hospital which made it to the papers. Despite being mostly at fault, the hospital wanted to wash their hands of the group and brush it under the rug:

http://lasvegassun.com/news/2013/may/31/st-rose-hospital-wrongly-sending-patients-umc-stat/

2. Money. If you are a partner in a SDG, and a big contract management group comes in and offers every partner, including yourself $1 million to buy the contract, would you refuse? In fact, it would be bad business NOT to accept the offer. SDGs selling out to CMGS actually represents good business sense.

 

[deleted109597]

ACEP made a statement. It's not all that brutal. But EMRA (you know, idealistic residents without real jobs) gave theirs and it was pretty rough.
I'm not sure how much withering fire Summa can tolerate. USACS will simply move on to greener pastures.

 

[southerndoc]

People seem to be confusing a termination clause and expiration of contract.

The contract wasn't terminated for SEA. It was completed. I've never seen a contract state that you must be given 90 days notice if you don't plan to renew the contract at its completion. Contracts routinely state that if either party wants to terminate the contract, they must give 30-90 days notice. If either party doesn't want to renew the contract at its completion, then notice isn't required.

 

[GeneralVeers]

People seem to be confusing a termination clause and expiration of contract.

The contract wasn't terminated for SEA. It was completed. I've never seen a contract state that you must be given 90 days notice if you don't plan to renew the contract at its completion. Contracts routinely state that if either party wants to terminate the contract, they must give 30-90 days notice. If either party doesn't want to renew the contract at its completion, then notice isn't required.

Correct, but if SUMMA didn't intend to automatically renew the contract, they should have started the RFP process 90 days from termination, in time to negotiate with the physicians, and to make sure USACS had enough time to get the requisite number of staff credentialed. The fact that the termination was made so suddenly suggests a shock & awe approach. After knowing Dominic personally for a few years, I can say that he was probably overconfident that enough docs would be desperate and sign up with the new group to make his bid work.

 

[deleted109597]

After knowing Dominic personally for a few years, I can say that he was probably overconfident that enough docs would be desperate and sign up with the new group to make his bid work.

Hell, I've met him, but the persona he projects on Facebook and in the comments of gruntdoc's forum show that he was overconfident. This will end either his or his wife's position, mark my words.

 

[The White Coat Investor]

Hell, I've met him, but the persona he projects on Facebook and in the comments of gruntdoc's forum show that he was overconfident. This will end either his or his wife's position, mark my words.

Hopefully both. How can anyone possibly feel good about wiping out a residency program? It's one thing to steal a contract from a group of attending docs, especially if they get a nice buyout. Hosing a bunch of residents is totally different.

 

[GeneralVeers]

Hopefully both. How can anyone possibly feel good about wiping out a residency program? It's one thing to steal a contract from a group of attending docs, especially if they get a nice buyout. Hosing a bunch of residents is totally different.

He probably assumed that his sales pitch (and he is a salesman), would convince most or all of the Summa staff to sign on with USACS because it's just such a fantastic, physician-owned company with great benefits. He probably convinced the management of Summa that all the docs would sign on and there would be no issues with transition. He probably assured them that the residency would continue with the same residency faculty in place, and there would be no change. USACS in fact actively pursues residencies, because they can get residents to "drink the kool-aid" and hopefully sign on upon graduation.

 

[WilcoWorld]

Hopefully both. How can anyone possibly feel good about wiping out a residency program? It's one thing to steal a contract from a group of attending docs, especially if they get a nice buyout. Hosing a bunch of residents is totally different.

I'll echo your "hopefully both" sentiment and add that there's a good chance that patients were harmed as well. Turning operations upside-down in an ED that sees >100k/yr is highly likely to cause some medical misadventure.

 

[WilcoWorld]

To any BCEPs reading this thread and thinking of taking advantage of that $1000/hr rate that USACS is offering, know that you're stealing it from your future self.

But if you're already working for USACS...

 

[emergentmd]

People seem to be confusing a termination clause and expiration of contract.

The contract wasn't terminated for SEA. It was completed. I've never seen a contract state that you must be given 90 days notice if you don't plan to renew the contract at its completion. Contracts routinely state that if either party wants to terminate the contract, they must give 30-90 days notice. If either party doesn't want to renew the contract at its completion, then notice isn't required.

This might be correct in legal terms but not moral/practical terms. Our SDG always waited til the last minute to sign a new 2 yr contract b/c the hospital was either to lazy or trying to look for a better deal. By last minute, I am talking about in the last few weeks. And when we went over the contract date, it was temporarily extended for 3 months.

Knowing that all of our schedules are out 2 months ahead, it would have been morally wrong for either parties to wait until the last minute and just walk away.

 

[sum dude]

Correct, but if SUMMA didn't intend to automatically renew the contract, they should have started the RFP process 90 days from termination, in time to negotiate with the physicians, and to make sure USACS had enough time to get the requisite number of staff credentialed. The fact that the termination was made so suddenly suggests a shock & awe approach. After knowing Dominic personally for a few years, I can say that he was probably overconfident that enough docs would be desperate and sign up with the new group to make his bid work.

The clusterF*$k was due to SEA, courageously but in the end foolishly, threatening to walk at midnight Jan 1. It was a negotiation tactic--I'm sure they relied on the residency as being their spade, assuming the hospital would never burn their own residency program. The holiday probably also gave them cover--it's much harder to cover Jan 1 than say...August 1. However, they should have accounted for the CMO and the fact USACS is headquartered down the road from their hospital. Also in the end, hospital admin think in cold numbers, and most large groups can give more competitive rates on paper than SDG's

Their tactic took stones, and I admire that, but it was the wrong move to go all in. Unfortunately, they gambled wrong and lost it all on the River.

 

[coachB]

To any BCEPs reading this thread and thinking of taking advantage of that $1000/hr rate that USACS is offering, know that you're stealing it from your future self.

But if you're already working for USACS...

Exactly. I can't really blame people for wanting to take advantage of the current environment and get a piece of the high locums rates. But there will eventually be payback and you are only selling out yourself and the specialty in the long run.

 

[emergentmd]

Exactly. I can't really blame people for wanting to take advantage of the current environment and get a piece of the high locums rates. But there will eventually be payback and you are only selling out yourself and the specialty in the long run.

EM docs taking 1k/hr rate is not selling out the specialty. Someone will cover the shift, if not for 1k, then 1.5k/hr. If I lived in the area and I could make 1k/mo, work 200hrs this month, I take it.

At worse they will hire residents, FP docs to cover the shift short term. Place is a cluster screw up anyways, having a boarded EM vs FP probably means very little to the hospital.

SEA took a risk, lost, and now their docs have to scramble to work other places.

 

[Chromatid]

http://www.ohio.com/news/break-news...en-summa-and-its-longtime-physicians-1.738835

 

[coachB]

EM docs taking 1k/hr rate is not selling out the specialty. Someone will cover the shift, if not for 1k, then 1.5k/hr. If I lived in the area and I could make 1k/mo, work 200hrs this month, I take it.

At worse they will hire residents, FP docs to cover the shift short term. Place is a cluster screw up anyways, having a boarded EM vs FP probably means very little to the hospital.

SEA took a risk, lost, and now their docs have to scramble to work other places.

The whole attitude of working locums, punching the clock, not being involved in the hospital or activities that improve care is selling out the specialty. You can't have it both ways. If you are willing to sell yourself as a replaceable burger flipper, then that is how you will be viewed. Everyone has to make their own decisions, but just because "someone else will do it" doesn't mean you are not selling out. Your actions reflect your values and your priorities. It's fine to say your priority is maximizing your income, but recognize it for what it is.

 

[deleted206819]

The whole attitude of working locums, punching the clock, not being involved in the hospital or activities that improve care is selling out the specialty. You can't have it both ways. If you are willing to sell yourself as a replaceable burger flipper, then that is how you will be viewed. Everyone has to make their own decisions, but just because "someone else will do it" doesn't mean you are not selling out. Your actions reflect your values and your priorities. It's fine to say your priority is maximizing your income, but recognize it for what it is.

We already are replaceable burger flippers in the eyes of the hospital and CMGs. Throw one group out and bring another in. This has recently happened to our SDG behind our backs. We were involved in multiple committees, multiple ED certifications, part of medical staff leadership and none of that helped to cement our contract and keep us there.

I'm actively thinking of going locums due to the simple fact that no one cares about the effort you put into patient care. They all care about the dollar! I don't feel bad at all about punching the clock, making money, and not being involved in hospital policies or politics. I have already been shown that they do not care about patient care, throughput, boarding, and all of the other components of good care. Why should I?

Our specialty has already been sold out prior to most of us going into this field. I now recognize that I'm a hired gun. I recognize my value in all of this and will act accordingly.

 

[SansaStarkMD]

.

 

[coachB]

We already are replaceable burger flippers in the eyes of the hospital and CMGs. Throw one group out and bring another in. This has recently happened to our SDG behind our backs. We were involved in multiple committees, multiple ED certifications, part of medical staff leadership and none of that helped to cement our contract and keep us there.

I'm actively thinking of going locums due to the simple fact that no one cares about the effort you put into patient care. They all care about the dollar! I don't feel bad at all about punching the clock, making money, and not being involved in hospital policies or politics. I have already been shown that they do not care about patient care, throughput, boarding, and all of the other components of good care. Why should I?

Our specialty has already been sold out prior to most of us going into this field. I now recognize that I'm a hired gun. I recognize my value in all of this and will act accordingly.

Fair points, especially the fact that nobody seems to care about what should be the first priority, actually taking good care of patients. And you are right, much of the selling out has already happened. However, I think that the "if I don't do it and take advantage of it, somebody else will" argument is weak. Pick whatever comparison you like, but particularly in a profession that is rooted in principle and altruism, that just doesn't fly. If we were truly principled as a specialty, we would have enormous leverage. But obviously, my over idealistic notions regarding medicine betray me again.

 

[deleted206819]

Fair points, especially the fact that nobody seems to care about what should be the first priority, actually taking good care of patients. And you are right, much of the selling out has already happened. However, I think that the "if I don't do it and take advantage of it, somebody else will" argument is weak. Pick whatever comparison you like, but particularly in a profession that is rooted in principle and altruism, that just doesn't fly. If we were truly principled as a specialty, we would have enormous leverage. But obviously, my over idealistic notions regarding medicine betray me again.

The altruism that you and I believe in has been used against us. No one else believes in these idealistic notions and that is why we always getting the short end of the stick.

They expect us to do the right thing all the while the administration complains about wait times, long LOS, patient satisfaction scores, etc. The fact that patient care or physician wellness or properly staffing the department or hospital is vital goes over their heads.

I came to that conclusion about a month ago when **** hit the fan. No one cares about us or the patients and it became quickly apparent then.

 

[WilcoWorld]

I won't judge others for taking a jaundiced, "if you can't beat 'em, join 'em" view towards the commodification of medicine. It is an entirely rational response.

However it is not the only rational response, and it is not the one that I am choosing to take (yet).

 

[deleted206819]

I won't judge others for taking a jaundiced, "if you can't beat 'em, join 'em" view towards the commodification of medicine. It is an entirely rational response.

However it is not the only rational response, and it is not the one that I am choosing to take (yet).

I may also change my tune in 6 months or so but what other response(s) are you thinking about? I'm willing to give anything else a shot before the jaundice sets in.

 

[NinerNiner999]

"Dr. Thomas Mark, chair of Summa’s department of anesthesiology, said Malone and his leadership have his full support. "

“Part of this is to run a successful hospital, tough decisions have to be made,” said Mark, whose anesthesiology group recently signed a one-year extension with Summa and is negotiating a multiyear contract."

This was the reply of the contracted anesthesia group when asked about the Summa issue by the press. Complete LOL.

 

[coachB]

The altruism that you and I believe in has been used against us. No one else believes in these idealistic notions and that is why we always getting the short end of the stick.

They expect us to do the right thing all the while the administration complains about wait times, long LOS, patient satisfaction scores, etc. The fact that patient care or physician wellness or properly staffing the department or hospital is vital goes over their heads.

I came to that conclusion about a month ago when **** hit the fan. No one cares about us or the patients and it became quickly apparent then.

You are absolutely right. But that doesn't mean your only option is to give up and become complicit. As WilcoWorld says in the next post, there are many rational and reasonable responses. I sure don't have it figured out, and life is certainly much easier if you just give up and stop caring, but that's not where I'm at either. If you went into medicine because it's a safe, comfortable, secure existence, then it's easier to play along. If you had other reasons, it can be more difficult.

 

[GeneralVeers]

The whole attitude of working locums, punching the clock, not being involved in the hospital or activities that improve care is selling out the specialty. You can't have it both ways. If you are willing to sell yourself as a replaceable burger flipper, then that is how you will be viewed. Everyone has to make their own decisions, but just because "someone else will do it" doesn't mean you are not selling out. Your actions reflect your values and your priorities. It's fine to say your priority is maximizing your income, but recognize it for what it is.

I admire your idealism. CoachB is right, however. We are replaceable burger flippers. Every hospital CEO in the country and every CMG feels the same way. I worked for essentially a medium SDG with a large local control before we were bought by EMP. I spent 5 years being on hospital committees, trying to change the system, and generally bashing my head against the wall in frustration. Nothing ever changed despite the efforts of 30 very talented EPs. In the end, we were replaced at the whim of the CEO. The old adage if you can't beat 'em, then join 'em is apt. We will not win against hospital CEOs or CMGs in the current environment. By playing their game, and exploiting their weaknesses (physician shortage) we can at least get a little bit for ourselves.

 

[WilcoWorld]

"Dr. Thomas Mark, chair of Summa’s department of anesthesiology, said Malone and his leadership have his full support. "

“Part of this is to run a successful hospital, tough decisions have to be made,” said Mark, whose anesthesiology group recently signed a one-year extension with Summa and is negotiating a multiyear contract."

This was the reply of the contracted anesthesia group when asked about the Summa issue by the press. Complete LOL.

I predict some pretty nice rates in Akron for Anesthesiologists in about a year...pity those rates won't last.

 

[emergentmd]

The whole attitude of working locums, punching the clock, not being involved in the hospital or activities that improve care is selling out the specialty. You can't have it both ways. If you are willing to sell yourself as a replaceable burger flipper, then that is how you will be viewed. Everyone has to make their own decisions, but just because "someone else will do it" doesn't mean you are not selling out. Your actions reflect your values and your priorities. It's fine to say your priority is maximizing your income, but recognize it for what it is.

Most ED physicians will not put an extra minute into hospital admin, committees, etc unless they are forced.

I gave 10 yrs of my free time being director at a big SDG hospital, Med Exec committee. You can call me not protecting my profession if you like. I can tell you I have done more free work for my profession than 95% of ED docs in the country.

I also can tell you that all of my/other docs free work had no bearing on us being bought out. It was all about the $$$...

This goes with all professions.

 

[TysonCook]

I'm interested in the minutia of the details when people are getting the bait and switch. So far I've heard of...

1) Scribes that increase "productivity"... but you pay for them out of your check... so it's a wash in the end.
2) "voluntary" (read forced) coverage of new sites that come online (read forced scab for the coporate takeover of nearby hospital contracts)
3) New CMG lost contract after taking over a group, then forced non-compete clauses on the MD's
4) "Income repair" which compared pre to post pay... but didn't include patients per hour (ended up needing to see 3.5pph to match the pre rate)
5) Rate was dependent on how many meetings you made (which was an impossible task as the meetings were set overlaying shifts)

I've heard time and time again re: CMG's and the lies/tricks that get played out.... any other stories out there?

Anyone go from a SDG that was well run, to a CMG and thought it was better?

 

[DissocativFugue]

I'm interested in the minutia of the details when people are getting the bait and switch. So far I've heard of...

1) Scribes that increase "productivity"... but you pay for them out of your check... so it's a wash in the end.
2) "voluntary" (read forced) coverage of new sites that come online (read forced scab for the coporate takeover of nearby hospital contracts)
3) New CMG lost contract after taking over a group, then forced non-compete clauses on the MD's
4) "Income repair" which compared pre to post pay... but didn't include patients per hour (ended up needing to see 3.5pph to match the pre rate)
5) Rate was dependent on how many meetings you made (which was an impossible task as the meetings were set overlaying shifts)

I've heard time and time again re: CMG's and the lies/tricks that get played out.... any other stories out there?

Anyone go from a SDG that was well run, to a CMG and thought it was better?

Scribes really do increase my productivity, in a busy shop. If you see 1-2 extra patients per shift then you've paid for their whole day. Even if I didn't see more patients my overall time charting after shift is significantly reduced or even eliminated because of them. They aren't perfect but I do feel their pros outweigh the cons.