Avoiding the same fate as emergency medicine

[PainDrain]

Ironically I just got a call from a large national AMC this morning looking for locums coverage and permanent positions at a practice I know sold out about 5 years back. I imagine what is happening is those older docs who sold out have all retired and those younger guys filled their commitment then bailed. Now the AMC is looking for any warm body.

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[chocomorsel]

This is what we do. After one year we give you a notice in writing that you have made partner or not. You do have to complete your buy in after that, however. You get voting rights after that one year mark.

This sounds fair.

 

[chocomorsel]

Nowadays anything more than a two year track is onerous. 3 years at the max, only for a great group. You are right things can change, starting salary can go up, length to partnership can go down. But for those of us still living the private practice "dream" it, it only changes so much. I didn't get a free ride, why should the next guy get one?

Pick your poison, you can't have it all these days.

I am not talking of giving people a "free ride." However, if you are having a difficult time recruiting this is something that needs to be looked at. Are reimbursements going up or down? Are people in general making more money or less? When you made partner, maybe three years wasn't too bad a deal because the money was real good then, but since then, maybe the numbers have gone down. I am just playing devils advocate here. Were that to be the case and you were looking for people who didn't want to sign up, then there is nothing wrong with decreasing the track time if potentials are telling you it's too long. Obviously, get some feedback. How much money are the partners really going to lose off one year shaved? Something so significant enough as to not have enough help and be working really lean and possibly lose the contract? I don't know. Forest for trees.
Continuing to do the same thing just because it's always been done this way even as the landscape around is changing around seems stupid to me. It's like "I was abused and so you must be as well" just to be doing it.
To each their own. Let's agree to disagree on that.

 

[Man o War]

This is the honest way to do things and probably one of the best deals I have heard. I commend you guys for having some integrity.

People are motivated to do their best when they feel they’re being treated fairly. We don’t want the headaches of unmotivated people who just want to get their check and do the bare minimum. Not worth it to us.

 

[maxxor]

People are motivated to do their best when they feel they’re being treated fairly. We don’t want the headaches of unmotivated people who just want to get their check and do the bare minimum. Not worth it to us.

I wish you’d talk some sense into the partners at my hellpit.

 

[Arch Guillotti]

I am not talking of giving people a "free ride." However, if you are having a difficult time recruiting this is something that needs to be looked at. Are reimbursements going up or down? Are people in general making more money or less? When you made partner, maybe three years wasn't too bad a deal because the money was real good then, but since then, maybe the numbers have gone down. I am just playing devils advocate here. Were that to be the case and you were looking for people who didn't want to sign up, then there is nothing wrong with decreasing the track time if potentials are telling you it's too long. Obviously, get some feedback. How much money are the partners really going to lose off one year shaved? Something so significant enough as to not have enough help and be working really lean and possibly lose the contract? I don't know. Forest for trees.
Continuing to do the same thing just because it's always been done this way even as the landscape around is changing around seems stupid to me. It's like "I was abused and so you must be as well" just to be doing it.
To each their own. Let's agree to disagree on that.

Who said anything about abuse? There seems to be a narrative perpetuated that all private practices are predatory. Not true at all. Those of us still left standing are here because we refused to sell out. Snowflakes want the keys to the castle but don't want to put in the time and effort? Too bad. We will find someone who can be fully vested in the practice. If anyone were to ever get canned before they made partner, it would be because they deserved it.

 

[chocomorsel]

Who said anything about abuse? There seems to be a narrative perpetuated that all private practices are predatory. Not true at all. Those of us still left standing are here because we refused to sell out. Snowflakes want the keys to the castle but don't want to put in the time and effort? Too bad. We will find someone who can be fully vested in the practice. If anyone were to ever get canned before they made partner, it would be because they deserved it.

Defensive much? There’s a reason I put in “It’s like... before the rest of the sentence. Was just using it as an example. Whether or not you abuse your associates, no one knows. And again, like I said, if you were having a difficult time recruiting which you don’t seem to want to read or comprehend. Clearly you are golden and have a fabulous non abusive group. I didn’t say they weren’t out there. I have been in one.
Whatever the case, abuse and exploitation of all sorts is rampant in medicine starting all the way from medical school. People are just ingrained to think it’s normal when it’s not. This is nothing new. And that’s what some people are weary of.
One of the many reasons I stay locums.

 

[Twiggidy]

Practices aren't going to change their entire model just because a few people have decided to not sign up for the deal. While 2 years to partner is perfectly fine, Im sure there are defensible answers while a longer period may be better for a group. Partnerships are a big deal and that vetting process is important because one someone is a partner, everything they say and do has impact to the group, especially in smaller practices.[ As far as money, it's a tough sell to tell someone who's used to making a certain wage for a certain amount of time and to take less just so some fresh grad or transplant will sign up for a gig. The are multiple reasons why practices that are even in great location have problems recruiting.

 

[gasdoc77]

Practices aren't going to change their entire model just because a few people have decided to not sign up for the deal. While 2 years to partner is perfectly fine, Im sure there are defensible answers while a longer period may be better for a group. Partnerships are a big deal and that vetting process is important because one someone is a partner, everything they say and do has impact to the group, especially in smaller practices.[ As far as money, it's a tough sell to tell someone who's used to making a certain wage for a certain amount of time and to take less just so some fresh grad or transplant will sign up for a gig. The are multiple reasons why practices that are even in great location have problems recruiting.

Therein lies the beauty of the free market. If practices choose to not budge and positions don't fill, partners are defacto choosing to work that many more hours and pay that much more in taxes... it's always time vs money. All positions will fill if the incentives suit all parties. Refusal to adapt is simply ego, which is always bad business.

 

[nimbus]

I think the job market is very good for new grads right now. My buddy says his group is so desperate that they’ve hired alcoholics who need to submit to random testing. He jokes that if you’re not a pedophile, you can get hired. They do have a high call burden and mediocre pay but in a desirable area.

 

[BLADEMDA]

I think the job market is very good for new grads right now. My buddy says his group is so desperate that they’ve hired alcoholics who need to submit to random testing. He jokes that if you’re not a pedophile, you can get hired. They do have a high call burden and mediocre pay but in a desirable area.

Tons of MEDIOCRE jobs out there with very mediocre pay. The good jobs are rare birds unlike just 10 years ago. The field continues to separate into the haves (30%) and the have nots (70%).

 

[deleted126335]

I think the job market is very good for new grads right now. My buddy says his group is so desperate that they’ve hired alcoholics who need to submit to random testing. He jokes that if you’re not a pedophile, you can get hired. They do have a high call burden and mediocre pay but in a desirable area.

Can you work for them if you are a pedophile and just agree to stay out of pediatric cases?

 

[chocomorsel]

Tons of MEDIOCRE jobs out there with very mediocre pay. The good jobs are rare birds unlike just 10 years ago. The field continues to separate into the haves (30%) and the have nots (70%).

Just like all of America. Capitalism at its best.

 

[chocomorsel]

Therein lies the beauty of the free market. If practices choose to not budge and positions don't fill, partners are defacto choosing to work that many more hours and pay that much more in taxes... it's always time vs money. All positions will fill if the incentives suit all parties. Refusal to adapt is simply ego, which is always bad business.

Nah, you are just a snowflake who can't handle the pressure of a three year track. I mean, what's wrong with you? Everyone else before you did it why should you get special treatment even if we are drowning in work and surgeons and admin aren't happy that we can't find work?

 

[chocomorsel]

I think the job market is very good for new grads right now. My buddy says his group is so desperate that they’ve hired alcoholics who need to submit to random testing. He jokes that if you’re not a pedophile, you can get hired. They do have a high call burden and mediocre pay but in a desirable area.

I am sure the Superstar paying jobs are getting their doors beaten down by superstar chief residents. They have no problems finding potential partners while others have to settle for pedophiles. SMH.
Reminds me of when I go to the rural/small towns and they are having a difficult time finding docs and yet in the city people are fighting over work and complaining about decreasing paychecks. The inequity is everywhere. Free market I guess.

 

[Greenbayslacker]

Really? Where are these groups? Or do you gotta know the right people? Or be stellar applicant? Or some other BS. Are they advertising?

I have a job like this but it’s in upstate NY

 

[chocomorsel]

I have a job like this but it’s in upstate NY

Is this an AMC? Or a private group? And how did you get it? Just curious for all the rest of us without the proper connections to all these sweet jobs.

 

[maxxor]

Nah, you are just a snowflake who can't handle the pressure of a three year track. I mean, what's wrong with you? Everyone else before you did it why should you get special treatment even if we are drowning in work and surgeons and admin aren't happy that we can't find work?

This sounds so familiar.

 

[deleted126335]

Just like all of America. Capitalism at its best.

 

[chocomorsel]

Bald head looks like classic douchery at its best. As someone earlier maybe in this thread or another stated, unchecked capitalism is the problem.

 

[chocomorsel]

This sounds so familiar.

I meant to say “we can’t find help”, but what is so familiar?

 

[nimbus]

Bald head looks like classic douchery at its best. As someone earlier maybe in this thread or another stated, unchecked capitalism is the problem.

Yeah this board is filled with rants about how AMCs are ruining anesthesia. That is capitalism. Those with capital (the owners on Wall Street) get to rule over those who don’t (us).

 

[Mman]

Where are these groups paying 500K/year for pre-partner pay?

500K is total package including benefits, midwest and southeast. Honestly plenty of employees and partner track physicians don't really know how much their benefits are worth. It's usually > $50K per year.

 

[pgg]

Bald head looks like classic douchery at its best. As someone earlier maybe in this thread or another stated, unchecked capitalism is the problem.

Every word he said was 100% true and correct. And your only rebuttal is a pair of ad hominem attacks?

 

[chocomorsel]

Every word he said was 100% true and correct. And your only rebuttal is a pair of ad hominem attacks?

Like I said. Unchecked capitalism is a problem. Lack of social networks in this country while we claim to be “the best country in the world” and the “world superpower” annoys me. This country is all about survival of the fittest and to hell with the weak.

And all the other stuff I said. I didn’t realize this was out there for me to debate him.

He gives me the creeps. People who’s whole purpose and life is about more, more, money, money, typically do.

It’s all I got buddy. Sorry you are disappointed.

 

[sethco]

500K is total package including benefits, midwest and southeast. Honestly plenty of employees and partner track physicians don't really know how much their benefits are worth. It's usually > $50K per year.

I'll take it a little further. When you count employer paid Social Security/Medicare, Medical, Dental, Disability, Malpractice, PTO, Retirement, Credentialing/Licensing and so on it can come close to (and maybe in some places exceed) 100k in benefits in a good practice

 

[chocomorsel]

I'll take it a little further. When you count employer paid Social Security/Medicare, Medical, Dental, Disability, Malpractice, PTO, Retirement, Credentialing/Licensing and so on it can come close to 100k in benefits in a good practice

So now we are talking more like 600k total package? As an employee?
I don’t count the SS/Medicare since everyone has to pay that.

 

[sethco]

So now we are talking more like 600k total package? As an employee?
I don’t count the SS/Medicare since everyone has to pay that.

No, I'm saying that this is how a 400k salary can be 500k in "total compensation" as an employee. SS/Medicare had both employer and employee portions to be paid. If you are an independent contractor, you pay both yourself but if you are a W2, their employer pays half of the charge while the employee picks up the other half. Don't know why you wouldn't count this as there is definitely monetary value

 

[Status Sciaticus]

No, I'm saying that this is how a 400k salary can be 500k in "total compensation" as an employee. SS/Medicare had both employer and employee portions to be paid. If you are an independent contractor, you pay both yourself but if you are a W2, their employer pays half of the charge while the employee picks up the other half. Don't know why you wouldn't count this as there is definitely monetary value

Everybody pays the tax, it shouldnt be counted in how much you take home. In fact, if you are talking about total compensation, you should exclude all taxes paid on your end to see what your true take-home compensation is.

Lets not pretend that a 400k salary is actually 500-600k compensation. The employer paying their share is the cost of doing business, same as it is for the employee.

 

[Mman]

I don’t count the SS/Medicare since everyone has to pay that.

The thing is if someone asks a "partner" somewhere how much they make, they count everything. I have to pay my own employee and employer portions of SS/Medicare. I have to pay my match to my 401K contributions. I have to pay my health insurance. I have to pay my disability insurance. I have to pay my malpractice insurance.

Employees usually state their income as the W2 gross income and that's it. Partners somewhere would state their income as the paycheck + all the costs of benefits since they directly see those costs subtracted from their total income. So when I ask a friend that is a partner somewhere else what they made last year, I know that is the total of everything including benefits, not their salary.

 

[pgg]

Like I said. Unchecked capitalism is a problem. Lack of social networks in this country while we claim to be “the best country in the world” and the “world superpower” annoys me. This country is all about survival of the fittest and to hell with the weak.

And all the other stuff I said. I didn’t realize this was out there for me to debate him.

He gives me the creeps. People who’s whole purpose and life is about more, more, money, money, typically do.

It’s all I got buddy. Sorry you are disappointed.

Of course. It's widely agreed that unrestrained capitalism is bad - at the extreme you've got robber barons, company towns, child labor, etc. The extent of what regulation is appropriate and what sort of teeth it should have are worth discussing.

I just thought it was sort of funny that someone who frequently comments on how she's been judged by her appearance, led off with judgement of that guy's appearance. Without a single mention of the substance of his argument, which is that capitalism has lifted more people out of poverty than any other economic system.

 

[dhb]

Bald head looks like classic douchery at its best. As someone earlier maybe in this thread or another stated, unchecked capitalism is the problem.

Made me think about this:

 

[thinkorswim]

Yeah this board is filled with rants about how AMCs are ruining anesthesia. That is capitalism. Those with capital (the owners on Wall Street) get to rule over those who don’t (us).

But isn’t is truly ironic that the loudest voices on this forum against AMCs and their predatory practices (the result of capitalism) are also the same voices who think taking the capitalism out of medicine (e.g. Medicare for all) would be the end of the world?

 

[deleted126335]

But isn’t is truly ironic that the loudest voices on this forum against AMCs and their predatory practices (the result of capitalism) are also the same voices who think taking the capitalism out of medicine (e.g. Medicare for all) would be the end of the world?

Where you stand depends on where you sit. I liked capitalism more as a partner (co-owner) of a private practice group than I did as an employee.

 

[chocomorsel]

Of course. It's widely agreed that unrestrained capitalism is bad - at the extreme you've got robber barons, company towns, child labor, etc. The extent of what regulation is appropriate and what sort of teeth it should have are worth discussing.

I just thought it was sort of funny that someone who frequently comments on how she's been judged by her appearance, led off with judgement of that guy's appearance. Without a single mention of the substance of his argument, which is that capitalism has lifted more people out of poverty than any other economic system.

When I said that he looks like a total douche, I didn’t actually mean his look alone. I meant more so the words he was speaking. That I why I said he gave me the creeps. He sounded greedy to me and his argument to me is very much about greed. He compares two extremes as you stated and one of those extremes is the USA. Otherwise he just looks like an old White man.
Again, sorry to disappoint.

 

[Steve_Zissou]

Like I said. Unchecked capitalism is a problem. Lack of social networks in this country while we claim to be “the best country in the world” and the “world superpower” annoys me. This country is all about survival of the fittest and to hell with the weak.

And all the other stuff I said. I didn’t realize this was out there for me to debate him.

He gives me the creeps. People who’s whole purpose and life is about more, more, money, money, typically do.

It’s all I got buddy. Sorry you are disappointed.

Here’s the thing, I don’t know of any other system that works better than capitalism. A socialist or communist economic system governing medicine would still try to cut costs and would either cut physician cost or hire cheaper options.

What would you suggest as a better system?

 

[We'llBeDoneIn15Minutes]

Having been through this on the radiology side, a lot of boomer dominated practices are just exploitative. Boomers will give you the whole back in my day speech, but neglect to leave out how times have changed and clinical demands actually are much higher for the partner track physicians versus when they did it.

And then like my practice, they fired 3 associates who were 6 months from partner to save money after they lost a contract from their attempts to sell the place to PE. It triggered a mass exodus of the remaining associates (myself included) and killed their deal.

Then you couple this distrust with the huge debt loads people are coming out of school with, and it’s no surprise people will chase the high paycheck because there’s no guarantee they will receive loyalty from the practice.

Have never ever considered a partnership track and have never ever regretted that.

 

[We'llBeDoneIn15Minutes]

I don’t know. I think people shy away from partnership tracks that are long. Like >2 years. Why do they need to be that long? You can’t figure out if someone is a
s hitty partner in 18 months?

No kidding. For the answer just follow the money.

 

[We'llBeDoneIn15Minutes]

I’m sure many of you are probably aware of the **** show that emergency medicine has devolved into over the past decade, with the ACEP meeting on the EM workforce today indicating that there will be an estimated surplus of 9000 EM docs by 2030.

As if the field wasn't already God awful enough without a physician glut.

 

[vector2]

Of course. It's widely agreed that unrestrained capitalism is bad

If there was anyone on earth who would've disagreed that unrestrained capitalism is bad, it would've been Milton Friedman.

I also find it hilarious that physicians all over SDN defend the guy considering he was for abolishing all medical licensing as a solution to fighting against quack and alternative medicine. The reason being medical licensing is a constraint on the supply, so if we just flood the field with physicians then even the poorest folks will be incentivized to see a real doctor as the cost comes down.

 

[PainDrain]

I also find it hilarious that physicians all over SDN defend the guy considering he was for abolishing all medical licensing as a solution to fighting against quack and alternative medicine. The reason being medical licensing is a constraint on the supply, so if we just flood the field with physicians then even the poorest folks will be incentivized to see a real doctor as the cost comes down.

Ahh yes. The libertarian argument about everything: “government shouldn’t intervene and the market will figure it out.” I always was curious how exactly the dead and disabled are going to exert market forces to regulate the system. There are enough doctors with poor training and abysmal clinical skills with government intervention; one can only imagine the chaos without it.

 

[Aheadbyacentury]

AMCs and their predatory practices (the result of capitalism

The Flourishing of AMCs is not a result of capitalism, it's the result of crony capitalism.

 

[nimbus]

The Flourishing of AMCs is not a result of capitalism, it's the result of crony capitalism.

What’s the difference?

Citizens United v. FEC - Wikipedia

en.m.wikipedia.org

 

[deleted126335]

The Flourishing of AMCs is not a result of capitalism, it's the result of crony capitalism.

I don’t know. I think most docs would be OK with AMCs- If they owned one.

 

[chocomorsel]

Here’s the thing, I don’t know of any other system that works better than capitalism. A socialist or communist economic system governing medicine would still try to cut costs and would either cut physician cost or hire cheaper options.

What would you suggest as a better system?

An Australian system.

 

[PainDrain]

What’s the difference?

Citizens United v. FEC - Wikipedia

en.m.wikipedia.org

Opinion | The free market rejected Republicans' war on voting rights. They're not taking it well.

The party that once hailed the decision that corporations are people are now showing businesses' political leanings the same disdain as actual people's.

www.nbcnews.com

The hypocrisy is simply amazing.

 

[pgg]

If there was anyone on earth who would've disagreed that unrestrained capitalism is bad, it would've been Milton Friedman.

I also find it hilarious that physicians all over SDN defend the guy considering he was for abolishing all medical licensing as a solution to fighting against quack and alternative medicine. The reason being medical licensing is a constraint on the supply, so if we just flood the field with physicians then even the poorest folks will be incentivized to see a real doctor as the cost comes down.

It's possible for people to be correct about one subject and incorrect about another.

 

[anbuitachi]

i think people arent against AMC or universal health system, personally im against how they are handled.
Im against AMC because of how their system works, maximizing crna to MD ratio to increase profits, so suits can take more money. its solely for profit. doesnt feel like much thought is given to quality care. and the way they are opening up crappy residencies and flooding the market just feels wrong

 

[Aheadbyacentury]

Opinion | The free market rejected Republicans' war on voting rights. They're not taking it well.

The party that once hailed the decision that corporations are people are now showing businesses' political leanings the same disdain as actual people's.

www.nbcnews.com

The hypocrisy is simply amazing.

All politicians are bought and paid for. Period. We need to eliminate this, create term limits of 2 years in the senate 2 years in the house and you are out. Curtail the lobbyists influence significantly and you may start to see some semblance of fairness. We have the answers to solve all of our problems, the stakeholders will buy whomever(politicians) and spend whatever to get things slanted in their favor. How does the little guy stand a chance?

Anyone who thinks corporations buy mostly republican.. Think again.

 

[vector2]

It's possible for people to be correct about one subject and incorrect about another.

The fact that some vague, generalized statement about capitalism lifting people up out of poverty has some degree of correctness isn't a counterargument to the folly contained within Friedman's 60 year catalog of work and his very specific statements about the welfare state, healthcare delivery in this country, deregulation, privatization, and how that relates to the discussion at hand.