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[rufio79]

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[EctopicFetus]

I’m looking into EM attending jobs in a new city and wanted to get feedback regarding an SDG job that I’ve come across.

Medium cost of living city with a stable private democratic group that has had the hospital system contract for 30+ years. They have a stable contract with a specific health system staffing 3 of their hospitals in the metroplex.

Partnership track: sweat equity buy-in for 2 years with a base salary of $220k for 1620 hours/year. W2 with subsidized health insurance, fully funded HSA, $3k CME.

Once partner you change to productivity pay with partners earning $250-330/hr with the average partner making $280/hr. Partners also will get fully funded retirement ($66k this year and will max out every year), health insurance premiums will be fully covered, fully funded HSA, CME increased to $5k, and a share of the year end profits (ranges from $50k-$200k historically but this was pre No-surprises act). They estimate the conservative “break even” point is 2-3 years after you become partner to make up for the “loss” you have for working at less than market rates for 2 years as your sweat equity buy-in.

Partners all genuinely seem happy and it’s a nice hospital system to work for.

Other options in the city are CMGs that pay more from the start (roughly $225-265/hr) but cap out at that rate with no additional upside.

My big hesitation is with the 2 year sweat equity buy-in at such a low salary. I’m told that once you’re asked to join the partnership track you’re guaranteed unless there are some egregious issues. The group is vehemently anti-CMG so I’m not as fearful about them selling out and they renewed their hospital contract recently so that risk of losing their contract during my partnership track is essentially nil, but I hate the idea of being exploited as a cheap new hire while doing the same exact work as the partners. Unfortunately, this buy-in process has been the way the group has done it for several years and I don’t see them changing it anytime soon as it wouldn’t be fair to the current partners that had to go through it.

Most other SDGs I’ve encountered elsewhere seem to have a more fair partnership track with a nominal buy-in fee or nominal reduced hourly rate for 1-2 years or reduced profit sharing for a few years while making the same hourly rate as partners. This group is the first where it clearly seems like you’re being exploited for 2 years but reap the benefits afterwards. Is this pretty common for some SDGs or is this predatory?

A few things.. you have to consider the all in $/hr. If the avg partner is making 280/hr does that include them funding your retirement? You have to be able to compare apples to apples. I assume the CMG jobs are 1099 so the 225-265/hr are all in.

Are the year end profits (huge range) of 50-200k included in the hourly? Make a spreadsheet to get an hourly partner compensation and then decide. If the retirement 66k and bonus (50-200k; avg 125k) arent included then there is 200k in compensation that isnt in the 280/hr which would bring your real avg partner hourly comp to 400/hr (if you include insurance premiums HSA etc).

The associate pay is quite low, there is no doubt. While the break even is 2-3 years that means you wont be at break even for 5 years. While the group may be strongly anti CMG hospitals change their staffing on a whim sometimes.

The group wont need to change their partnership track as long as they have people willing to take what is offered.

Other pro/con to consider.

1) The workforce issues are very very real and with that the CMG jobs will start to lower pay. I have seen/heard this locally and regionally. It will accelerate every year. On the other hand the SDG is fairly insulated from this.

2) Quality of hospital / job. How is staffing, do you leave on time? Do people help each other out? use of MLPs? All these things matter to various extents.

3) there is more to consider but this is a start

 

[Porfirio]

Depends.

1) Is this your forever location?
2) Is scheduling for the 2 years mostly overnights?
3) Can you work more hours to off set the 2 year sweat equity?
4) How many have not made partner in the last 5 years?
5) How many retirements/moves of current partners can you expect? It seems a large part of your future partner bonus will be dependent upon turn over because after 2 years (when you make partner) you will be exploiting the new guy
6) Are you going to be at the crappy hospital location for all 2 years? Long commute, terrible working conditions, etc
7) Are you forced to do a ton of extra hour work? Committees, meetings, etc?

 

[Mount Asclepius]

That is certainly substantial sweat equity. I don't think it's necessarily predatory though. I similarly made less than $150/hour during the pre-partnership period for my SDG. During that time I also worked Locums to help offset the decreased pre-partner income. People cautioned me regarding the sweat equity then just like plenty will do to you now. I agree it's worth carefully evaluating and considering. For me, a low paying pre-partnership at a great SDG was the best decision I could have made. I've subsequently reaped the rewards as a partner both financially and in job satisfaction. In my opinion, it's well worth the risk.

 

[JacobMcCandles]

Every group is a bit different. Some do sweat equity. I know others that do decreased profit sharing for 'x' number of years. Some make you work all nights for a few years.

Don't be fooled by 'doing the same exact work as the partners'. I suspect most (but maybe not all) put in a lot more time and effort than you realize. It's typically like that for every SDG. While the contract is usually the only asset for an EM SDG, a lot of people have put in a lot of time to keep that in place and in good standing. I can almost guarantee that as long as you're going to be in that location for at least 4-5 years then it will almost always be better than your alternatives in that location.

 

[southerndoc]

1) The workforce issues are very very real and with that the CMG jobs will start to lower pay. I have seen/heard this locally and regionally. It will accelerate every year. On the other hand the SDG is fairly insulated from this.

I wouldn't be so certain of this. SDGs don't have the collective bargaining power as CMGs, and we're already seeing insurance reimbursement rates decreasing in contracts. SDGs will also suffer in reimbursements and will be forced to decrease their pay.

 

[EctopicFetus]

I wouldn't be so certain of this. SDGs don't have the collective bargaining power as CMGs, and we're already seeing insurance reimbursement rates decreasing in contracts. SDGs will also suffer in reimbursements and will be forced to decrease their pay.

It may happen. But it will be due to actual cash isssues. Cmgs pay based on supply / demand. If sdg pay drops 10% cmg pay gonna drop 20% imo.

The argument for bargaining with insurance is fairly moot with the nsa. Again imo.

 

[southerndoc]

It may happen. But it will be due to actual cash isssues. Cmgs pay based on supply / demand. If sdg pay drops 10% cmg pay gonna drop 20% imo.

The argument for bargaining with insurance is fairly moot with the nsa. Again imo.

I'm sure some of them do this. Thankfully I work for one that doesn't do this.

 

[watermanMD]

Just purely for comparison: I interviewed at a similar sounding SDG w/respect to #’s and pros/cons for me personally, but in SE. Partnership track had recently changed to 4 years buy-in at ~$210/hr. Those stingy mother****ers. Similar post-partnership. So, it could be worse. Yours seems like a middle of the road job. Personally, I took the job with most pay. Don’t regret it. Piggy bank doesn’t regret it. It ain’t my “forever” but your first isn’t likely to be.

 

[Emapp20177]

Partnership track: sweat equity buy-in for 2 years with a base salary of $220k for 1620 hours/year. W2 with subsidized health insurance, fully funded HSA, $3k CME.

220k/1620 = 135/hr... wtf dont do this.

As an example I work a CMG job and make $330-400/hr (rvu and I'm fast so it varies but personally I avg 360). No bennies but yikes... If I worked that many hours I'd make around $600k/yr. Do what you want but this hourly rate seems sus. Also, partners should be making more than that with this amount of exploitation.

 

[TooMuchResearch]

OP just make sure to really dig into the math and also consider which job is more sustainable long term.

I just did some quick math but I think our first year partner track docs get roughly $190/hr once you factor in all benefits, bonuses, etc. The hourly looks a lot lower unless you actually add in everything else.

 

[HemeOncHopeful19]

Just purely for comparison: I interviewed at a similar sounding SDG w/respect to #’s and pros/cons for me personally, but in SE. Partnership track had recently changed to 4 years buy-in at ~$210/hr. Those stingy mother****ers. Similar post-partnership. So, it could be worse. Yours seems like a middle of the road job. Personally, I took the job with most pay. Don’t regret it. Piggy bank doesn’t regret it. It ain’t my “forever” but your first isn’t likely to be.

Four years is ridiculous in any field IMO and in the long-run will not be viable to keep hiring unless you’re in a super desirable location. 1-2 years to make sure you all like the new guy (or girl) +/- an actual buy-in if justified.

 

[DocEspana]

135ish hours a month is nothing. Just go get a side job at a better paying place for 2 years and then go straight partner once they elevate you.

 

[Ceez]

Not every SDG group job is appealing. You can go to EM Doc Jobs facebook group to see all the low ball offers. I once worked for a SDG that had a 7 year partnership track while paying below market hourly rates. I left after a few months when I noticed they were giving all the new hires below FT hours to delay starting the partnership track.

Due your due diligence.

 

[emergentmd]

7 year partnership? Holy cow, that puts you mid career and headed towards retirement. Why would any group need 7 yrs to decide if you are a fit? They don't and just want cheap labor. 2 years MAX IMO.

 

[Mount Asclepius]

Not every SDG group job is appealing. You can go to EM Doc Jobs facebook group to see all the low ball offers. I once worked for a SDG that had a 7 year partnership track while paying below market hourly rates. I left after a few months when I noticed they were giving all the new hires below FT hours to delay starting the partnership track.

Due your due diligence.

I’m not sure there is much due diligence to be done for this job. Enough there to scare you away before you even started. What made you take a job with a 7 year partnership track at below market rates in the first place? This is by far the exception rather than the norm. You’re being misleading by using this example as a blanket statement on SDGs.

SDGs are rarer anymore, but the vast majority out there aren’t low balling anyone. You’ll pay some sweat equity or buy in just like partnerships in a lot of fields. It’s worth the reward of not having another entity like a CMG skimming off the top of your earnings and having more control and ownership of your practice.