Daily reminder to do the bare minimum

[GonnaBeADoc2222]

-admin doesn't care about your well being

-nursing wants path of least resistance , regardless of how it harms you or patients

Therefore:

1) take good care of your patients

2) do the right thing

3) don't do any extra work

4) all charts done at work

5) go home on time

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[RustedFox]

Good post is good.

 

[ScepticSkeksis]

Also:
- No non-emergent procedures on patients that aren't yours, especially if they are upstairs.
- Don't "eyeball" EKGs that are admitted patients who just happen to still be in the department
- No, I won't put an EJ in a patient because one nurse gave up
- No, I won't grab a patient pre-triage and do vitals signs for the nurse (have one medical director who wants us to do this).

 

[BoardingDoc]

- No, I won't put an EJ in a patient because one nurse gave up

I know it's tomato tomato, but are you really putting an EJ in someone these days and not an US guided PIV? I haven't placed an EJ in years.

And before this starts another side discussion on US PIVs, yes I know this can get abused by nursing if you don't make it painful for them to ask you. If 3 different RNs stick the patient and can't get access I'll do an US PIV. Whether or not others think that's reasonable for them is certainly open to debate.

 

[GonnaBeADoc2222]

I know it's tomato tomato, but are you really putting an EJ in someone these days and not an US guided PIV? I haven't placed an EJ in years.

And before this starts another side discussion on US PIVs, yes I know this can get abused by nursing if you don't make it painful for them to ask you. If 3 different RNs stick the patient and can't get access I'll do an US PIV. Whether or not others think that's reasonable for them is certainly open to debate.

I like doing EJs when I can. Quicker than US, less likely to become dislodged.

 

[RustedFox]

Daily reminder to do the bare minimum.

 

[BoardingDoc]

I like doing EJs when I can. Quicker than US, less likely to become dislodged.

Interesting. I find that the amount of time I need to spend getting a patient to cooperate with getting an IV in their neck is similar or greater than throwing a US PIV in. That said, I clearly haven't done so in a while so maybe I simply haven't honed my "you're getting an IV in your neck" talk.

 

[FiremedicMike]

You guys don’t allow nurses to do US PIV sticks?

 

[Mount Asclepius]

Our techs and nurses do US PIV and EJs. I never get involved for either. Rarely do I place a central line for access. Sometimes just do a quick fem stick for blood if we have an IV, but doesn’t draw well to obtain laboratory analysis.

I’ll take the opposite stance. When you work hard for your team, they’ll work hard for you.

 

[BulgeDaTwine]

Our techs and nurses do US PIV and EJs. I never get involved for either. Rarely do I place a central line for access. Sometimes just do a quick fem stick for blood if we have an IV, but doesn’t draw well to obtain laboratory analysis.

I’ll take the opposite stance. When you work hard for your team, they’ll work hard for you.

That the team of… revolving door Traveller nurses you’re talking about? Healthcare is a business now and corporatized in every way unless you’re in a unicorn SDG and the team working hard for you actually translates.

Do the bare minimum, spit the corporate kool aid

 

[Mount Asclepius]

That the team of… revolving door Traveller nurses you’re talking about? Healthcare is a business now and corporatized in every way unless you’re in a unicorn SDG and the team working hard for you actually translates.

Do the bare minimum, spit the corporate kool aid

Nope. Team of solid in house nurses and techs. Pandemic was rough with lots more turnover. We’re back to decreased turnover though closer to only 10%. Traveling nursing market drying up. I’ve been working with a core group of night nurses for years. They make my life way easier as others have come and gone. Yes I’m in a SDG. That’s by choice.

 

[JacobMcCandles]

Doing the bare minimum is kind of a self-fulfilling prophecy. Doing the bare minimum won’t fly with a SDG. If you work for a CMG then doing the bare minimum may feel like the right decision but nurses will do the bare minimum making your job harder and things continue to spiral ultimately repeating this vicious cycle until you quit from frustration and burnout.

 

[GonnaBeADoc2222]

Our techs and nurses do US PIV and EJs. I never get involved for either. Rarely do I place a central line for access. Sometimes just do a quick fem stick for blood if we have an IV, but doesn’t draw well to obtain laboratory analysis.

I’ll take the opposite stance. When you work hard for your team, they’ll work hard for you.

Lol tone deaf response from the unicorn SDG guy.

My nurses never do USPIV or EJ, always falls on us.

"Team" lol. When the hospital starts profit sharing with me I'll be a great team leader.

 

[GonnaBeADoc2222]

In before "its your fault! Just work for a rockstar SDG!"

Btw I'm totally down w the SDG mindset. I would love to be be an owner and team player and all that jazz.

I was recently offered a position by an SDG. Their partner track was 2.5 years at 170/hr, more hours and nights than I currently work, restrictive scheduling and work at 3 sites.

I calculated a breakeven of 5 yrs.

This is the same deal they offer a new grad. You expect an ABEM doc with many years attending experience to accept same deal?

The math doesn't math.

 

[JacobMcCandles]

In before "its your fault! Just work for a rockstar SDG!"

Btw I'm totally down w the SDG mindset. I would love to be be an owner and team player and all that jazz.

I was recently offered a position by an SDG. Their partner track was 2.5 years at 170/hr, more hours and nights than I currently work, restrictive scheduling and work at 3 sites.

I calculated a breakeven of 5 yrs.

This is the same deal they offer a new grad. You expect an ABEM doc with many years attending experience to accept same deal?

The math doesn't math.

Just for my own curiosity, what do you feel would be fair with regards to someone fresh out of residency and someone that has already been practicing?

 

[Mount Asclepius]

In before "its your fault! Just work for a rockstar SDG!"

Btw I'm totally down w the SDG mindset. I would love to be be an owner and team player and all that jazz.

I was recently offered a position by an SDG. Their partner track was 2.5 years at 170/hr, more hours and nights than I currently work, restrictive scheduling and work at 3 sites.

I calculated a breakeven of 5 yrs.

This is the same deal they offer a new grad. You expect an ABEM doc with many years attending experience to accept same deal?

The math doesn't math.

Narrow sighted. That partnership track isn't much different from what I went through. I made <$150/hour for my partnership track. I have now made 90th+ percentile EM income for years as a partner. I don't think it's a unicorn even if it's close. You wouldn't realize that based upon our pre-partnership track though. We're hiring. Not listing on this site, but our information is out there. You'll have to give sweat equity too. It's totally worth it.

 

[Kryptocoin]

Gen Z has a term for that : Quiet quitting.

 

[CoolDoc1729]

Lol tone deaf response from the unicorn SDG guy.

My nurses never do USPIV or EJ, always falls on us.

"Team" lol. When the hospital starts profit sharing with me I'll be a great team leader.

I’m at a soulless cmg site (actually I can’t say that anymore since the cmg imploded.. still not sdg tho) and I still agree with the sentiment. Most of our nurses will do more for me than for my colleagues because i help them too. Intubate the icu boarders so they don’t have to call a stupid rapid response; home meds for the Geri psych boarders; etc etc. At least at my site it makes sense to lead by example. I still either leave on time or bill for extra time, ok by me either way if I don’t have something to do after work.

 

[ERMudPhud]

In before "its your fault! Just work for a rockstar SDG!"

Btw I'm totally down w the SDG mindset. I would love to be be an owner and team player and all that jazz.

I was recently offered a position by an SDG. Their partner track was 2.5 years at 170/hr, more hours and nights than I currently work, restrictive scheduling and work at 3 sites.

I calculated a breakeven of 5 yrs.

This is the same deal they offer a new grad. You expect an ABEM doc with many years attending experience to accept same deal?

The math doesn't math.

This is why 5 years from now you will still be doing what you are doing now but 5 years older and 5 years more bitter. And one of those new grads will be working with Mount Asclepius at the rockstar SDG

And why should they cut you a different deal because you've been out for a few years? You aren't necessarily any more valuable to them then a fresh residency grad. The new grad is probably going to work more hours and hang around for more years so in a way they are a better investment for the SDG.

 

[GonnaBeADoc2222]

This is why 5 years from now you will still be doing what you are doing now but 5 years older and 5 years more bitter. And one of those new grads will be working with Mount Asclepius at the rockstar SDG

And why should they cut you a different deal because you've been out for a few years? You aren't necessarily any more valuable to them then a fresh residency grad. The new grad is probably going to work more hours and hang around for more years so in a way they are a better investment for the SDG.

In most industries you're compensated for experience. Only in medicine do we allow ourselves to be devalued.

Narrow sighted. That partnership track isn't much different from what I went through. I made <$150/hour for my partnership track. I have now made 90th+ percentile EM income for years as a partner. I don't think it's a unicorn even if it's close. You wouldn't realize that based upon our pre-partnership track though. We're hiring. Not listing on this site, but our information is out there. You'll have to give sweat equity too. It's totally worth it.

Nah I don't like nights (I don't work them now) and I'd rather spend more time with my family than pull extra shifts in the name of the "team." More to life than money.

Gen Z has a term for that : Quiet quitting.

Lol generational shaming. "Quiet quit" is the label the corporations have given "show up and do precisely the amount of work you are compensated to do, and don't let yourself be taken advantage of."

 

[hoot504]

Lol tone deaf response from the unicorn SDG guy.

My nurses never do USPIV or EJ, always falls on us.

"Team" lol. When the hospital starts profit sharing with me I'll be a great team leader.

I don't work in a unicorn SDG. Standard CMG urban site. I haven't had to do either of these in the 5 years I've been out of residency. This probably has more to do with your particular hospital system and the quality of nurses they're hiring.

Now I have had a nurse approach me every once in a blue moon telling me that they're having a difficult time getting access. Know what I do? I ask them what RNs are around that are better at IVs/more adept at US IVs, and tell them to go get them. I don't leave it even remotely ambiguous that I will not be performing an EJ or US IV. Peripheral access is the nurse's job. In the overwhelming majority of cases, this has resulted in a line materializing on my patient. If the patient is crashing a central line will do (either RT or myself). Otherwise, I suspect you need to get better at telling the nurse 'no'.

 

[Siggy]

Gen Z has a term for that : Quiet quitting.

Blue collar boomers have a term for that as well... work to rule.

 

[ERMudPhud]

In most industries you're compensated for experience. Only in medicine do we allow ourselves to be devalued.

In most industries you are compensated based on the value you are perceived to bring to the organization. In some cases experience adds value. But a fresh grad from residency(or even better fellowship) is going to be clinically very up to date, as fast as you within a very short period of time, wanting to work more hours than you, and going to contribute to the SDG for more years.

Nah I don't like nights (I don't work them now) and I'd rather spend more time with my family than pull extra shifts in the name of the "team." More to life than money.

And that is a completely reasonable decision for you but you can see that it adds no value to the SDG so the members of that group are unlikely to give you some sort of sweetheart deal over their standard deal to fresh grads

 

[Brigade4Radiant]

Working for a SDG can be nice however, you can easily be taken advantage of, and they could also lose the group to a CMG

A seasoned attending can often move more patients and has a better lay on their worth, and a newly graduated resident

I know being five years out I wouldn’t do a partnership track that is five years long

A person working a a decent paying CMG can be their own partner by living like a resident and investing and paying off debt in five years

 

[WorkNoteEmergency]

It still really bugs me to have patients in the treatment area not having seen a doc but I don't jump on those as quickly as I used to. Big thing for me now is the waiting room is for waiting. I don't order stiff for people in the WR and I don't pluck people out to stick in a chair and get a quick d/c. I'm not going to cover for the bossman's inefficiencies anymore.

I will put out effort for nursing though. Most of them work hard for me, so I reciprocate and I don't complain. I effing hate doing US IV's though.

 

[deleted206819]

This is why 5 years from now you will still be doing what you are doing now but 5 years older and 5 years more bitter. And one of those new grads will be working with Mount Asclepius at the rockstar SDG

And why should they cut you a different deal because you've been out for a few years? You aren't necessarily any more valuable to them then a fresh residency grad. The new grad is probably going to work more hours and hang around for more years so in a way they are a better investment for the SDG.

The chance of the contract being lost in those 2.5 years is greater and riskier for a seasoned emergency physician than a new grad. Tell me how I know.

Let’s break down the hourly rate for a partnership track position vs a soulless CMG.

At 1560 clinical hours, the salary differential for being in the partnership track at $170/hr vs CMG IC at $220/hr for 2.5 years is $195,000.

You would need to work another 1.5-2 years or more depending on the CMG hourly rate to breakeven.

If the contract gets pulled while you are still in the partnership track, then you get $0. You would have lost money, time and experience an inflexible schedule.

I’m not saying it isn’t worth it but in today’s climate of hospitals being stupid and shortsighted, the chance of losing the contract is not negligible.

Keep your eyes open and ask questions from every entity!

 

[Mount Asclepius]

The chance of the contract being lost in those 2.5 years is greater and riskier for a seasoned emergency physician than a new grad. Tell me how I know.

Let’s break down the hourly rate for a partnership track position vs a soulless CMG.

At 1560 clinical hours, the salary differential for being in the partnership track at $170/hr vs CMG IC at $220/hr for 2.5 years is $195,000.

You would need to work another 1.5-2 years or more depending on the CMG hourly rate to breakeven.

If the contract gets pulled while you are still in the partnership track, then you get $0. You would have lost money, time and experience an inflexible schedule.

I’m not saying it isn’t worth it but in today’s climate of hospitals being stupid and shortsighted, the chance of losing the contract is not negligible.

Keep your eyes open and ask questions from every entity!

And the differential is significant when a SDG pays $250-400/hour as partner while local CMGs pay $125-225/hour. Your 2-3 year partnership money loss is quickly recouped.

 

[GonnaBeADoc2222]

Who is getting paid 125/hr lol

And the differential is significant when a SDG pays $250-400/hour as partner while local CMGs pay $125-225/hour. Your 2-3 year partnership money loss is quickly recouped.

 

[Brigade4Radiant]

The chance of the contract being lost in those 2.5 years is greater and riskier for a seasoned emergency physician than a new grad. Tell me how I know.

Let’s break down the hourly rate for a partnership track position vs a soulless CMG.

At 1560 clinical hours, the salary differential for being in the partnership track at $170/hr vs CMG IC at $220/hr for 2.5 years is $195,000.

You would need to work another 1.5-2 years or more depending on the CMG hourly rate to breakeven.

If the contract gets pulled while you are still in the partnership track, then you get $0. You would have lost money, time and experience an inflexible schedule.

I’m not saying it isn’t worth it but in today’s climate of hospitals being stupid and shortsighted, the chance of losing the contract is not negligible.

Keep your eyes open and ask questions from every entity!

True a hospital can break a contract at anytime or if the hospital gets a new CEO or another group offers to cover xyz also

 

[Mount Asclepius]

Who is getting paid 125/hr lol

You, by not working for a SDG as massive amounts of new grads flood the market and CMGs continue to depress pay nationally like they have done in some markets to appease PE.

 

[Mount Asclepius]

True a hospital can break a contract at anytime or if the hospital gets a new CEO or another group offers to cover xyz also

They can. Not all do though. I’m on my 3rd hospital CEO. You maintain a SDG by not doing the bare minimum, and by showing the hospital your value as a group. We’ve been with our hospital for over 20 years and our group is occasionally lauded by the hospital as being one of its bright spots. Our group’s leadership meets on a regular basis with the hospital CEO. We have former partners scattered throughout hospital leadership positions. Our partners serve on the vast majority of hospital committees. Our presence is felt. That’s how you maintain a contract.

 

[deleted206819]

Here's a spreadsheet to show you the exact break-even numbers. If anyone wants the spreadsheet, let me know.

The difference between $300 and $400 / hr definitely makes the SDG the better proposition. The question is whether it will deliver at that rate every month or average to that hourly rate over the year.

I’m not suggesting that a SDG is bad by any means but when you have experienced contract lose due to change in CEO and them being buddy buddy with the CMGs it colors your experience.

I joined a SDG that was at this hospital for 30 years. I put in my two years as an IC and joined as a partner in year 3. Lost the contract after 1 year as a partner. Longevity means nothing. Involvement in hospital committees means nothing. Being entrenched in the community means nothing. It’s $$$ to the very end.


SDG at $300 / hr

SDG at $400 / hr

 

[Brigade4Radiant]

They can. Not all do though. I’m on my 3rd hospital CEO. You maintain a SDG by not doing the bare minimum, and by showing the hospital your value as a group. We’ve been with our hospital for over 20 years and our group is occasionally lauded by the hospital as being one of its bright spots. Our group’s leadership meets on a regular basis with the hospital CEO. We have former partners scattered throughout hospital leadership positions. Our partners serve on the vast majority of hospital committees. Our presence is felt. That’s how you maintain a contract.

It also depends on location are you close to a major metropolitan area?

 

[Fox800]

Doing the bare minimum is kind of a self-fulfilling prophecy. Doing the bare minimum won’t fly with a SDG. If you work for a CMG then doing the bare minimum may feel like the right decision but nurses will do the bare minimum making your job harder and things continue to spiral ultimately repeating this vicious cycle until you quit from frustration and burnout.

Nah. I have healthy boundaries with work and that helps keep me sane. My shop would have me seeing 4 PPH and keep us picking up patients until right before the end of our shift if they could get away with it.

 

[deleted206819]

They can. Not all do though. I’m on my 3rd hospital CEO. You maintain a SDG by not doing the bare minimum, and by showing the hospital your value as a group. We’ve been with our hospital for over 20 years and our group is occasionally lauded by the hospital as being one of its bright spots. Our group’s leadership meets on a regular basis with the hospital CEO. We have former partners scattered throughout hospital leadership positions. Our partners serve on the vast majority of hospital committees. Our presence is felt. That’s how you maintain a contract.

That’s what our group did as well. Involved up and down in the hospital committees. Chiefs of Medical Staff on multiple occasions and terms. Starting up the trauma service, medical simulation, amongst others.

None of this made a difference to them. We are expendable to them unlike the surgeons and proceduralists.

They can replace us all quickly. Don’t be naive.

 

[Fox800]

Sweat equity buy-ins deter practicing attendings and steer your recruiting toward new-grads. Not to mention being predatory - you're doing the same work and have the same liability, so pay them the same.

Practicing attendings will be faster, more comfortable, and more experienced than a fresh new-grad.

Also doesn't help that many SDGs happen to be in flyover country where most people aren't excited about living.

 

[Brigade4Radiant]

That’s what our group did as well. Involved up and down in the hospital committees. Chiefs of Medical Staff on multiple occasions and terms. Starting up the trauma service, medical simulation, amongst others.

None of this made a difference to them. We are expendable to them unlike the surgeons and proceduralists.

You can replace us all quickly. Don’t be naive.

This is a fact it also depends where Mount practices is it close to a major area? Are they apart of a hospital system?

I saw many SDG lose contracts in Illinois and Missouri and it’s not like those doctors where not spending time with meetings

The CEO at our hospital through is a banquet but it all changed after the pandemic

If a CMG throws in a stipend for the hospital group boom you’re SDG is gone

 

[Fox800]

 

[Fox800]

Don't sign up for committees.

Show up right on time. Leave on time.

Don't chart at home.

Don't pick up extra shifts without a bonus, only if you want to.

Stop seeing patients at a reasonable time. If I have another physician coming on in 30 minutes, I'm not picking up anyone new unless they're crashing. Why have your partner show up and have nothing to do while you're covering the entire department? Some of my older partners want to gobble everyone up and then the new doc is left standing around with nothing to do. RVU greed at its worst.

Stop putting your name on 10 people in the waiting room. Stupid. It's just a farce to "stop the clock" or be an RVU...word that rhymes with "bore". I pick up people when they're roomed and meet EMS when they show up.

If a midlevel is coming on duty, I leave silly/simple things for them to see.

I don't see patients in the last hour of my shift unless it's critical (we have overlap).

I don't see patients in the waiting room unless it's EXTREMELY straightforward, like an ankle sprain. No "dizzy" nonsense, chest pain, abdominal pain, GI/GU complaints, language barriers, etc. Also don't pick up complicated patients like that in the last 90 minutes of your shift. If you don't expect to dispo it or have a clear-cut, simple sign-out like "repeat troponin" or "follow-up CT read, likely negative, anticipate DC home", then don't pick it up.

 

[Brigade4Radiant]

I stop at 2-3 hours I just front load and I see patients in the waiting room so the last 2-3 hours I’m doing charts I’m 2-2.5 an hour and with NP it’s 3-4 an hour

 

[deleted206819]

Some of the “partners” in my CMG just hoover up everything in sight when I still have 3 hours left in the shift. It’s crazy nuts that they are this greedy and want to maximize their income.

 

[Brigade4Radiant]

Some of the “partners” in my CMG just hoover up everything in sight when I still have 3 hours left in the shift. It’s crazy nuts that they are this greedy and want to maximize their income.

Yeah in a CMG RVU you usually need to take in as many patients as possible when you first start working

 

[Fox800]

Some of the “partners” in my CMG just hoover up everything in sight when I still have 3 hours left in the shift. It’s crazy nuts that they are this greedy and want to maximize their income.

Same here. I literally have one that will come in and put their name on 11 patients in the waiting room. And will get sassy about reasonable orders that were put in on waiting room patients before they got to work. Like, we all know you aren't really seeing these people that fast or providing good care out there. Not my style, but whatever.

We have so many "dizzy" elderly train wrecks, language barriers, complex patients that I can't imagine doing a proper exam out there while kids are running around screaming, the WR TV is on, someone is blasting rap music on their speakerphone, ambulances are coming in hot, and their 11 family members are eating McDonald's watching you try to do a neuro exam on meemaw with dementia who speaks English as a second language.

 

[Mount Asclepius]

It also depends on location are you close to a major metropolitan area?

This is a fact it also depends where Mount practices is it close to a major area? Are they apart of a hospital system?

Yes

If a CMG throws in a stipend for the hospital group boom you’re SDG is gone

They’ve come around in the past. We’re still here and they aren’t. Our hospital/system has no interest in CMGs.

Sweat equity buy-ins deter practicing attendings and steer your recruiting toward new-grads. Not to mention being predatory - you're doing the same work and have the same liability, so pay them the same.

Sure, we’ll pay you the same as soon as you pay the same amount of money we all paid into the group to run our business.

Practicing attendings will be faster, more comfortable, and more experienced than a fresh new-grad.

They also occasionally have bad habits engrained into them by prior jobs.

 

[Fox800]

Yes

They’ve come around in the past. We’re still here and they aren’t. Our hospital/system has no interest in CMGs.

Sure, we’ll pay you the same as soon as you pay the same amount of money we all paid into the group to run our business.

They also occasionally have bad habits engrained into them by prior jobs.

There are SDGs without buy-ins that pay full compensation from day one. It's a feature, not a bug.

It also seems toxic/pseudo-paternalistic to think that you would rather "mold" or "train" new-grads to what your group wants them to be instead of hiring an experienced attending.

 

[emperor tamarin]

Narrow sighted. That partnership track isn't much different from what I went through. I made <$150/hour for my partnership track. I have now made 90th+ percentile EM income for years as a partner. I don't think it's a unicorn even if it's close. You wouldn't realize that based upon our pre-partnership track though. We're hiring. Not listing on this site, but our information is out there. You'll have to give sweat equity too. It's totally worth it.

Out of curiosity what is the 90th percentile for em?
I realize I'm indirectly asking you what your income is but I genuinely am not sure at this point

 

[emergentmd]

I found out early on how to game the system. Any system can be gamed and the strong will survive. I can give you endless stories of how I gamed the system.

I have to show/produce more work in less time. Learn the game, be efficient, take advantage holes in the system.

If admin wants me to do something extra, I gauge their seriousness, and then find a way to game it to my advantage.

Survival of the fittest never ends. Learn it early you will succeed. Learn it late, and you will start to see people pass you.

 

[emperor tamarin]

I found out early on how to game the system. Any system can be gamed and the strong will survive. I can give you endless stories of how I gamed the system.

I have to show/produce more work in less time. Learn the game, be efficient, take advantage holes in the system.

If admin wants me to do something extra, I gauge their seriousness, and then find a way to game it to my advantage.

Survival of the fittest never ends. Learn it early you will succeed. Learn it late, and you will start to see people pass you.

Give us some stories of how!

 

[JacobMcCandles]

There are SDGs without buy-ins that pay full compensation from day one. It's a feature, not a bug.

It also seems toxic/pseudo-paternalistic to think that you would rather "mold" or "train" new-grads to what your group wants them to be instead of hiring an experienced attending.

The experienced attending isn’t always better from a productivity standpoint. Also, it’s important to have youth and ages that run the gamut in order to be successful long term.

 

[BoardingDoc]

Out of curiosity what is the 90th percentile for em?
I realize I'm indirectly asking you what your income is but I genuinely am not sure at this point

I don't know what Mount makes, but MGMA data for EM from 2021 showed:
Mean: 368074
Std dev: 98561
10th%: 267054
25th%: 316553
Median: 360771
75th%: 415034
90th%: 468342

I can't speak to the accuracy of these numbers, and it's worth noting that this is the survey for 2021. Data is coming from covid time with crap volume. 90th percentile for the only other MGMA sheet I have shows 90th percentile as being $504298. That's from 2019. (Mean was ~375k, median ~363k)

My gestalt is that the current data from 2023 (if anyone has it, I'd love to see it) would show numbers which are similar to, and possibly higher than 2019.