‘EPs are Dumber than Pro Athletes’

[Birdstrike]

An interesting article with a catchy title: ‘EPs are Dumber than Pro Athletes' by McNamara, Robert MD

http://mobile.journals.lww.com/em-n...ewer.aspx?year=2013&issue=03000&article=00014

"It is my firm belief that if all emergency physicians saw exactly what was billed and paid in their names, we would have a much different structure to the practice of emergency medicine today."

He's 100% correct with this quote. As far as the title, you be the judge.


I would only add this: Lose control of how you are paid, and lose control of your specialty as a whole.

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[GeneralVeers]

An interesting article with a catchy title: ‘EPs are Dumber than Pro Athletes’ by McNamara, Robert MD

http://mobile.journals.lww.com/em-n...ewer.aspx?year=2013&issue=03000&article=00014

"It is my firm belief that if all emergency physicians saw exactly what was billed and paid in their names, we would have a much different structure to the practice of emergency medicine today."

He's right.

Exactly right. A large CMG, for example takes 42% off the top for overhead, not including 401K, or CME. Where does all that money go?

- Billing/Coding
- Malpractice
- Human Resources
- Marketing
- Travel for officers
- Rent/overhead for the office building
- Salaries for non-clinical board members and officers

If we were really smart we'd get rid of these guys, work as 1099 employees with the hospital. Our hourly would probably be $100/hour more. IMO after seeing the operations at one of these head offices, a lot if it (marketing, salaries, travel) is wasted spending that could be going to the EP.

 

[Hercules]

If we were really smart we'd get rid of these guys, work as 1099 employees with the hospital. Our hourly would probably be $100/hour more. IMO after seeing the operations at one of these head offices, a lot if it (marketing, salaries, travel) is wasted spending that could be going to the EP.

How would this plan be different than a well run small democratic group?

 

[GeneralVeers]

How would this plan be different than a well run small democratic group?

The large CMG has many expenses that are irrelevant to the local site:

- Marketing
- Office expenses (they rent two whole office buildings)
- Vice presidents
- Executives
- Travel to all the sites in the company

 

[Hercules]

Sorry, I was just referring to the part in the quotes I used. A well-run small Democratic group essentially functions the way you've described as an independent contractor with the hospital. And you're right l--it cuts out all the expenses of the contract management group. This lets you take home more pay per doctor, and also gives you more of a say in the way things are run. I have heard contract management groups claim that their economy of scale allow them to decrease the expenses of a site. In my experience, I have not found that to offset the amount of money they will skim off of their physician labor.

 

[GeneralVeers]

Sorry, I was just referring to the part in the quotes I used. A well-run small Democratic group essentially functions the way you've described as an independent contractor with the hospital. And you're right l--it cuts out all the expenses of the contract management group. This lets you take home more pay per doctor, and also gives you more of a say in the way things are run. I have heard contract management groups claim that their economy of scale allow them to decrease the expenses of a site. In my experience, I have not found that to offset the amount of money they will skim off of their physician labor.

They are partially right. They can reduce malpractice and billing/coding costs through economy of scale. In my experience that does not compensate for the amount they spend on marketing (which doesn't help the local site), and the large salaries COO, CEO, and VPs who have to run the company. Furthermore, the "management fees" often are a percentage, rather than a flat fee, so if you work at a profitable site, you are funding more of the company overhead than a less-profitable one. It's a form of socialism that I disagree with.

 

[Hercules]

They are partially right. They can reduce malpractice and billing/coding costs through economy of scale. In my experience that does not compensate for the amount they spend on marketing (which doesn't help the local site), and the large salaries COO, CEO, and VPs who have to run the company. Furthermore, the "management fees" often are a percentage, rather than a flat fee, so if you work at a profitable site, you are funding more of the company overhead than a less-profitable one. It's a form of socialism that I disagree with.

Agree completely. I am a staunch supporter of true small democratic groups. I wish there were more of them. My group is one of only a few in my state.

 

[DreamingTheLive]

good democratic group > mega-group. Don't need an MD to know that mega-groups ultimately de-value EM docs.

Personal opinion. Feel free to learn-me in hopes of changing my mind...

 

[GeneralVeers]

Agree completely. I am a staunch supporter of true small democratic groups. I wish there were more of them. My group is one of only a few in my state.

Unfortunately the small group is dying. At this point to go to one, or become a hospital employee would require moving out of state. The large CMGs have so infiltrated the lucrative markets that they have a virtual monopoly.

 

[Druggernaut]

They are partially right. They can reduce malpractice and billing/coding costs through economy of scale. In my experience that does not compensate for the amount they spend on marketing (which doesn't help the local site), and the large salaries COO, CEO, and VPs who have to run the company. Furthermore, the "management fees" often are a percentage, rather than a flat fee, so if you work at a profitable site, you are funding more of the company overhead than a less-profitable one. It's a form of socialism that I disagree with.

What is it that stops a small democratic group from approaching a hospital and undercutting the big CMG? Shouldn't they be able to offer their employees equal or greater pay while being able to offer the hospital a better deal, since they don't have to worry about paying all those executives and marketing fees? Or is it that they've taken over entire hospital systems and it would be a tall order for an upstart group to hire enough physicians to staff them all?

The only things I can see as benefits toward the CMG is that they can probably get better rates on health and malpractice insurance (but I can't see that offsetting the expense of paying so many administrators), and perhaps that they'd be doing advertising that the hospital would otherwise be paying for (but again, the methods I typically saw in my city were billboards, with the occasional radio commercial or TV commercial for the big players, none of which should be expensive to the point of being dealbreakers).

It's a shame. It seems like the same situation facing the anesthesiologists except for there being less of a midlevel threat in EM, and there's an awful lot of doom-and-gloom over in their forum. I know everyone says a medical student should pick their specialty based on what work they enjoy most, but it's troubling when it seems like much of what's appealing is also facing a more economically uncertain future.

 

[Old_Mil]

The only things I can see as benefits toward the CMG is that they can probably get better rates on health and malpractice...

The vast majority of CMG jobs not only do not offer health insurance to their physicians, they don't even offer access to payroll deducted group health. This is really important to recognize because frankly if you or anyone in your immediate family has a medical condition emergency medicine is not a career you should be considering.

Lets look at dollars and cents. You, the 1099 Ed doc with a CMG makes 200k a year. By virtue of your title you are in essentially ineligible for most forms of student loan repayment. Post tax you are getting 130k give or take. Now figure with the rate increases coming in the retail marketplace and the recent estimate of a bronze family plan at 20k a year say a gold family plan is 30k. Down to 100k. Pull off another 17k in student loan payments and another 3000 in disability premiums. Down to 80k.

Meanwhile your FM colleague is pulling 150k a year and has his loans and insurance handled by his w2 employer. That is the depressing reality of this CMG dominated field.

It's a shame. It seems like the same situation facing the anesthesiologists except for there being less of a midlevel threat in EM, and there's an awful lot of doom-and-gloom over in their forum. I know everyone says a medical student should pick their specialty based on what work they enjoy most, but it's troubling when it seems like much of what's appealing is also facing a more economically uncertain future.

Actually it is a bit worse. I suspect that in many instances, MD-As are going to end up as midlevel managers for CRNAs. But there are only so many medical director jobs to go around and the DNPs are going to be looking to replace us.

 

[deleted109597]

What is it that stops a small democratic group from approaching a hospital and undercutting the big CMG?

Undercutting what?
I can't think of any hospital in my area that subsidizes the groups in the ED. They eat what they kill, which is why they staff both the rural and the city hospitals.

Small groups can't promise PG scores. Small groups can't fly people in from other parts of the state that are already credentialled in case of emergency.

Even the big groups shuffle periodically. There are plenty of hospitals that used to be TeamHealth, that are now EMP, and are probably going to be Schumacher, etc. It's the "what can you do for me right now" model many hospital admins want. Faster times. Happier patients. Who cares about the docs.

 

[docB]

Exactly right. A large CMG, for example takes 42% off the top for overhead, not including 401K, or CME. Where does all that money go?

- Billing/Coding
- Malpractice
- Human Resources
- Marketing
- Travel for officers
- Rent/overhead for the office building
- Salaries for non-clinical board members and officers

If we were really smart we'd get rid of these guys, work as 1099 employees with the hospital. Our hourly would probably be $100/hour more. IMO after seeing the operations at one of these head offices, a lot if it (marketing, salaries, travel) is wasted spending that could be going to the EP.

You make some really valid criticisms but I strongly disagree with your conclusion. I would be truly frightened to be a direct independent contractor to a hospital (any of mine and any of yours). They have no interest in hospital based docs other than how hard they can flog us to meet metrics. If there is $100/hr more to be had I will guarantee you they will keep that for them selves along with 50% of what we make now.

At the very least a CMG is in business to make money by employing physicians. For hospitals we would be afterthoughts they work like rented mules.

It is also likely that a transition from contract groups (be they CMGs or indies) to direct contractors would end EM board certification as a desirable commodity. Boarded docs is something a group can be required to provide by the hospital. Once the hospital is paying docs itself that premium would fall by the wayside in favor of being able to pay less.

Another loss for us on that would be that we would no longer get to choose our colleagues. If the hospital is paying they hire and fire. Your collection of doctors would have little real power, other than in an advisory role, to get rid of a doc who leaves bad sign outs, can't pull their weight, etc.

How would this plan be different than a well run small democratic group?

A physician group exists to make money by staffing EDs with physicians. A hospital exists to make money by running a hospital. Any physicians it employs would be an afterthought. We would be like housekeeping or nursing except that as ICs we could be "fired" without cause or process.

They are partially right. They can reduce malpractice and billing/coding costs through economy of scale. In my experience that does not compensate for the amount they spend on marketing (which doesn't help the local site), and the large salaries COO, CEO, and VPs who have to run the company. Furthermore, the "management fees" often are a percentage, rather than a flat fee, so if you work at a profitable site, you are funding more of the company overhead than a less-profitable one. It's a form of socialism that I disagree with.

These are legitimate criticisms. Still don't throw out the baby with the bathwater. I'm not talking about CMGs here. I'm talking about the whole concept of physician groups.

What is it that stops a small democratic group from approaching a hospital and undercutting the big CMG? Shouldn't they be able to offer their employees equal or greater pay while being able to offer the hospital a better deal, since they don't have to worry about paying all those executives and marketing fees?

Undercutting what?
I can't think of any hospital in my area that subsidizes the groups in the ED. They eat what they kill, which is why they staff both the rural and the city hospitals.

This is correct. The environments in which physician groups are subsidized by hospitals are shrinking rapidly. CMGs are always able to undercut other groups where a subsidy is being paid. They do this by foregoing the subsidy and supporting the group during the building phase with outside resources. Outside resources is what CMGs have that indie groups don't. But ultimately it's the metrics. An indie group can say "We'll get our PGs up." while the CMG can stride in with data and consultants that say they can do it better and faster and guarantee it. Administrators love data and consultants. This may be a lot of crap but it's reality.

 

[GeneralVeers]

DocB, your criticism about hospital-based employees only utilizing you as cannon-fodder is the exact same concern I have about CMGs.

The CMG I have worked for has one goal only: To acquire more contracts in order to generate patient visits, to make money for themselves.

They are perfectly happy to hire new graduates out of residency and brainwash them (hence the marketing I pay for), then see them leave after 2-3 years and hire fresh ones. They don't really care about the existing docs or longevity. They make their money off of billing/coding, salaries and various other ways they have of funneling the money to themselves.

THAT is what I have a problem with.

 

[Druggernaut]

The vast majority of CMG jobs not only do not offer health insurance to their physicians, they don't even offer access to payroll deducted group health. This is really important to recognize because frankly if you or anyone in your immediate family has a medical condition emergency medicine is not a career you should be considering.

Lets look at dollars and cents. You, the 1099 Ed doc with a CMG makes 200k a year. By virtue of your title you are in essentially ineligible for most forms of student loan repayment. Post tax you are getting 130k give or take. Now figure with the rate increases coming in the retail marketplace and the recent estimate of a bronze family plan at 20k a year say a gold family plan is 30k. Down to 100k. Pull off another 17k in student loan payments and another 3000 in disability premiums. Down to 80k.

Meanwhile your FM colleague is pulling 150k a year and has his loans and insurance handled by his w2 employer. That is the depressing reality of this CMG dominated field.

Yikes. I feel like you're laying out a worst case scenario rather than describing the average arrangement, but I am beginning to wonder if the environments I've seen have been some sort of EM paradise yet untouched by the changing times. At least I don't have to make a decision just yet.

Undercutting what?
I can't think of any hospital in my area that subsidizes the groups in the ED. They eat what they kill, which is why they staff both the rural and the city hospitals.

Small groups can't promise PG scores. Small groups can't fly people in from other parts of the state that are already credentialled in case of emergency.

Even the big groups shuffle periodically. There are plenty of hospitals that used to be TeamHealth, that are now EMP, and are probably going to be Schumacher, etc. It's the "what can you do for me right now" model many hospital admins want. Faster times. Happier patients. Who cares about the docs.

I know subsidies aren't the norm, but I assumed there has to be some sort of financial benefit to the hospital in opting for one group over the other, and that the group without a bloated administrative payroll would be best equipped to deliver that (even to the point of giving the hospital a small percentage of the billing rather than to some MBA who's giving you orders). The ability to bring in people from surrounding areas during a staffing crisis is a plus, but is that really an issue in most markets? And wouldn't an appealing democratic group be able to draw in employees to avoid that, and be selective in choosing the ones who will hopefully satisfy whatever satisfaction metric or door to doctor time the hospital is after? I would expect that better jobs would draw better candidates, and they'd be more likely to keep the hospital happy. I don't think many physicians feel that the CMGs are the best practice environment.

This is correct. The environments in which physician groups are subsidized by hospitals are shrinking rapidly. CMGs are always able to undercut other groups where a subsidy is being paid. They do this by foregoing the subsidy and supporting the group during the building phase with outside resources. Outside resources is what CMGs have that indie groups don't. But ultimately it's the metrics. An indie group can say "We'll get our PGs up." while the CMG can stride in with data and consultants that say they can do it better and faster and guarantee it. Administrators love data and consultants. This may be a lot of crap but it's reality.

If the CMG can deliver better metrics, I understand why the hospital would prefer them. But again, I don't get how they're automatically more able to do that, aside from possibly taking the short term hit and spreading the cost of hiring consultants over all their business ventures to cook up some unique scheme to do things more quickly or better, or at least finess the numbers into appearing that way. And as distasteful as it might be, if they can produce the data, they deserve to win.

 

[la gringa]

many of can't do 1099 due to need for benefits... i know i'm not the only one w/ pre-existing conditions who has trouble with obtaining reasonable, if any, individual health and disability insurance. also has an excellent retirement plan and most of us are behind due to residency and whatnot

in my area there are a couple of smaller groups and one larger CMG (it is at least physician owned and run, and not publicly traded, which is the main reason i tolerate its size). one of the smaller groups lost 2 contracts (one mainly for not moving to HMA's computer system that was recently "featured" on 60 minutes) and their docs had to take fewer hrs or leave.

there's no perfect setup, each of us has to take what is important to us and make the best decision one can. i know that McNamara has been the most vocal via AAEM and i don't entirely disagree w/ their stand, but it's hard to listen to those who lived their entire lives in academia spout so much about what we in "the trenches" should be doing... it just isn't that simple!

 

[deleted109597]

I know subsidies aren't the norm, but I assumed there has to be some sort of financial benefit to the hospital in opting for one group over the other, and that the group without a bloated administrative payroll would be best equipped to deliver that (even to the point of giving the hospital a small percentage of the billing rather than to some MBA who's giving you orders).

Nope. It's satisfaction and numbers through the door. If you want to make a small group and offer to pay a hospital for the privilege of working there, I'm sure the hospital would love you. I just don't think you would be able to do it.

If the CMG can deliver better metrics, I understand why the hospital would prefer them. But again, I don't get how they're automatically more able to do that, aside from possibly taking the short term hit and spreading the cost of hiring consultants over all their business ventures to cook up some unique scheme to do things more quickly or better, or at least finess the numbers into appearing that way. And as distasteful as it might be, if they can produce the data, they deserve to win.

They're able to do it because of a bigger pool of doctors. Bad guy in the group? He's gone. No sweat off everyone's back, as there is someone else to replace him, especially while you're looking for the new full time guy. In a small group? You suck it up until you find a new guy, because otherwise everyone works more to fill in the gaps.

I'm not defending CMGs, but they obviously have a pretty well working machine.

 

[GeneralVeers]

They're able to do it because of a bigger pool of doctors. Bad guy in the group? He's gone. No sweat off everyone's back, as there is someone else to replace him, especially while you're looking for the new full time guy. In a small group? You suck it up until you find a new guy, because otherwise everyone works more to fill in the gaps.

I'm not defending CMGs, but they obviously have a pretty well working machine.

They work well for the hospitals and for the guys lucky enough to be on top of the CMG company period. For the average pit doc you are just a cog in the machine to generate revenue.

 

[TrumpetDoc]

They work well for the hospitals and for the guys lucky enough to be on top of the CMG company period. For the average pit doc you are just a cog in the machine to generate revenue.

Ding ding!

Our group touts, incessantly, the "great benefits, etc". And frankly it's getting old.
We are getting letters in the mail telling us how we can all expect to bring in less, we just need to see more patients, we hold all just be "happy we are in a high tax bracket" etc.
I have friends who are truly happy as hospital employees. They are payed approaching "double" what I am and have benefits. They don't live in the l
Big City, but not BFE either...
Sign me up!

 

[DreamingTheLive]

They work well for the hospitals and for the guys lucky enough to be on top of the CMG company period. For the average pit doc you are just a cog in the machine to generate revenue.

Ding ding!

Our group touts, incessantly, the "great benefits, etc". And frankly it's getting old.
We are getting letters in the mail telling us how we can all expect to bring in less, we just need to see more patients, we hold all just be "happy we are in a high tax bracket" etc.
I have friends who are truly happy as hospital employees. They are payed approaching "double" what I am and have benefits. They don't live in the l
Big City, but not BFE either...
Sign me up!

Vote with feet. GTFO.

 

[GeneralVeers]

Vote with feet. GTFO.

Working on it. Trust me.

 

[la gringa]

Ding ding!

Our group touts, incessantly, the "great benefits, etc". And frankly it's getting old.
We are getting letters in the mail telling us how we can all expect to bring in less, we just need to see more patients, we hold all just be "happy we are in a high tax bracket" etc.
I have friends who are truly happy as hospital employees. They are payed approaching "double" what I am and have benefits. They don't live in the l
Big City, but not BFE either...
Sign me up!

if you hate it that much then you SHOULD leave! if you're unhappy at work then it is probably showing, and your patients and staff likely know it.

the letter was odd.

(btw, the benefits thing does hold a good bit of validity unless you're independently wealthy. take it from someone who had to learn the hard way what it's like to have no disability coverage and limited ability to save for retirement, then have a catastrophic injury/illness where one can't work... not saying they're angels but that point does hold water)

 

[Druggernaut]

Nope. It's satisfaction and numbers through the door. If you want to make a small group and offer to pay a hospital for the privilege of working there, I'm sure the hospital would love you. I just don't think you would be able to do it.

[...]

I'm not defending CMGs, but they obviously have a pretty well working machine.

It sounds crazy to pay them so you can work there, but given the option between giving (per Veers' estimate) $100 an hour to a CMG's pencil-pushers or giving a fraction of that to the hospital, keeping the change, and doing what you can to ensure that physicians are the ones governing medical practice, it doesn't sound quite so bad.

I'm sure there'd be something that would gum up the works, otherwise CMGs would be less successful, but I'd love to see something done. Is there anyone out there in academic medicine doing research to show the pitfalls of Press-Ganey and all these management schemes that take power and clinical decision making away from the people best trained to be at the helm? Or is that not noble enough or an efficient use of all this education, so it's just patient care and occasionally blowing off a little steam now and then with articles like that in the OP? If it's money and data that the CMGs are bringing to the table, then we need to beat them on at least one of those fronts to turn back the tide.

And before I get labeled a preachy med student (not at all my intention, I'm genuinely curious), I would be interested in pursuing research on management and the business of emergency medicine if there was a way to get involved, and I was a little further down this road.

Ding ding!

Our group touts, incessantly, the "great benefits, etc". And frankly it's getting old.
We are getting letters in the mail telling us how we can all expect to bring in less, we just need to see more patients, we hold all just be "happy we are in a high tax bracket" etc.
I have friends who are truly happy as hospital employees. They are payed approaching "double" what I am and have benefits. They don't live in the l
Big City, but not BFE either...
Sign me up!

This was another point I intended to make. The CMGs are middle-men. You'd make more as an independent contractor, and you and the hospital both make more when you cut them out and are employed directly (though with all the risks highlighted by docB). There must be room to maneuver, or it wouldn't be profitable for your friends' hospitals to take on physicians as employees.

 

[Birdstrike]

All this is secondary to the fact that most EPs don't really value their skills as much as other "specialists." They considered themselves "owned," either by a group, hospital or government (EMTALA), and therefore are treated as such.

Do spine surgeons just take what's handed to them and let others define what they're worth, or do they demand to be in control of their worth?

When's the last time you heard of an EM group taking contract negotiations to the 11th hour, demanding an end to Press Ganey, an increase in pay, more staffing, call the hospitals bluff and then...

WALK

being fully prepared to not work for 6 months, while poised to open up an armada of urgent cares to take control of their own careers?

That's what surgeons would do.

That's what surgeons have done (ASCs).

Who's in control of their career, specialty, compensation and professional life?

 

[TrumpetDoc]

if you hate it that much then you SHOULD leave! if you're unhappy at work then it is probably showing, and your patients and staff likely know it.

the letter was odd.

(btw, the benefits thing does hold a good bit of validity unless you're independently wealthy. take it from someone who had to learn the hard way what it's like to have no disability coverage and limited ability to save for retirement, then have a catastrophic injury/illness where one can't work... not saying they're angels but that point does hold water)

I agree, and I am in the process. For the exact reason that it IS showing up at work...and at home which was the last straw.
The bennies "are" important, don't get me wrong. But if you look at the numbers, their actual worth is less than what mission control play them up to be. It's really quite a modest IC pay, an nothing compared to some employed positions.
Since I've been out looking I've gotten more frustrated with my situation, total buyers remorse

 

[la gringa]

I agree, and I am in the process. For the exact reason that it IS showing up at work...and at home which was the last straw.
The bennies "are" important, don't get me wrong. But if you look at the numbers, their actual worth is less than what mission control play them up to be. It's really quite a modest IC pay, an nothing compared to some employed positions.
Since I've been our liking, IV gotten more frustrated with my situation, total buyers remorse

my last employed position (first out of residency) paid LESS with fewer bennies, AND in a higher COL city... guess it's the price i pay for wanting to live in decent places and needing employed status benefits. this gig on the whole is actually better...

i also work in a totally different environment and city and have been able to work a lot of my hours in a lower stress (in some ways, more in others) environment. has done wonders for my work satisfaction... if i couldn't have left my first "site" as my "core", i would have left at 1 year due to what i'll call culture issues at the site where i started.

 

[DreamingTheLive]

All this is secondary to the fact that most EPs don't really value their skills as much as other "specialists." They considered themselves "owned," either by a group, hospital or government (EMTALA), and therefore are treated as such.

Do spine surgeons just take what's handed to them and let others define what they're worth, or do they demand to be in control of their worth?

When's the last time you heard of an EM group taking contract negotiations to the 11th hour, demanding an end to Press Ganey, an increase in pay, more staffing, call the hospitals bluff and then...

WALK

being fully prepared to not work for 6 months, while poised to open up an armada of urgent cares to take control of their own careers?

That's what surgeons would do.

That's what surgeons have done (ASCs).

Who's in control of their career, specialty, compensation and professional life?

Just to continue my man-crush on Birdstrike posts lol. But couldn't have said it any better.

 

[EMPD]

McNamara is the Ralph Nader of the EM world. He has lots of ideas but he has never been able to rally the masses. I agree with everything he said. Now when someone can mobilize the profession behind such ideas, then we will have a leader.

 

[Birdstrike]

McNamara is the Ralph Nader of the EM world. He has lots of ideas but he has never been able to rally the masses. I agree with everything he said. Now when someone can mobilize the profession behind such ideas, then we will have a leader.

What we need is not a "leader," but a cat herder.

 

[Akail]

McNamara is the Ralph Nader of the EM world. He has lots of ideas but he has never been able to rally the masses. I agree with everything he said. Now when someone can mobilize the profession behind such ideas, then we will have a leader.

I will lead us.

Mark my words, Mr. Program Director.

 

[GiraffeKickTx]

I will lead us.

Mark my words, Mr. Program Director.

Tough talk, I like it.

 

[DreamingTheLive]

I will lead us.

Mark my words, Mr. Program Director.

Haha nice. Count me in as well. Starting Day 1 of residency (and hopefully I can directly get involved after the match) I plan on doing everything in my power to advocate directly for EM PHYSICIANS (NOT just EM, big difference IMO). Citizens, hospital admin, businessmen, fellow residents/physicians, politicians...I will "help" them understand.

Can't f*cking wait!

 

[docB]

McNamara is the Ralph Nader of the EM world. He has lots of ideas but he has never been able to rally the masses. I agree with everything he said. Now when someone can mobilize the profession behind such ideas, then we will have a leader.

Bob McNamara embodies the best ideals of EM. Ed Panacek once told me that he is "the conscience of EM." I have to agree.

Bob has actually excelled at rallying EPs to his cause. The evidence is the ongoing import of the AAEM.

If he has not yet been able to unite the entire specialty it simply speaks to the difficulty of the cause. Many if not most of us have big financial incentives to continue the status quo. ACEP continues to dominate and it does a lot of good but it does incorporate and represent a lot of CMG interests.

I don't think it's lack of leadership here. I think it's trying to get self-interested physicians to sacrifice for a possible better future. How many of us are willing to see the specialty thrown into turmoil, lose a lot of money and possibly lose the gains we have made in the past to fight the good fight and maybe, just maybe prevail so that future EPs can have it better than we do?

EPs (and doctors in general) have a biological clock ticking loudly. We have to make enough for our retirement fast enough to make up for the time we spent in training. How many of us plan to work until we're 65? Most of us want out or to at least slow down way before that. So rocking the boat is a real risk. That's why our profession is so willing to tolerate what ever we have to to get by. We're hoping we can escape before it gets really bad.

 

[Birdstrike]

Bob McNamara embodies the best ideals of EM. Ed Panacek once told me that he is "the conscience of EM." I have to agree.

Bob has actually excelled at rallying EPs to his cause. The evidence is the ongoing import of the AAEM.

If he has not yet been able to unite the entire specialty it simply speaks to the difficulty of the cause. Many if not most of us have big financial incentives to continue the status quo. ACEP continues to dominate and it does a lot of good but it does incorporate and represent a lot of CMG interests.

I don't think it's lack of leadership here. I think it's trying to get self-interested physicians to sacrifice for a possible better future. How many of us are willing to see the specialty thrown into turmoil, lose a lot of money and possibly lose the gains we have made in the past to fight the good fight and maybe, just maybe prevail so that future EPs can have it better than we do?

EPs (and doctors in general) have a biological clock ticking loudly. We have to make enough for our retirement fast enough to make up for the time we spent in training. How many of us plan to work until we're 65? Most of us want out or to at least slow down way before that. So rocking the boat is a real risk. That's why our profession is so willing to tolerate what ever we have to to get by. We're hoping we can escape before it gets really bad.

No, you're right, it's not a lack of leadership, it's a refusal to follow lead. It's always been an epic failure of the physician community; "Every man for himself."

That's why I said, "We don't need a leader, we need a 'cat herder.'" There's no lack of leaders amongst us, there's a lack of followers. Physicians would rather be fall divided, than stand united.

Auto factory workers stood so united, for so many years, and fought so hard for their workers "rights," and were so successful, in fact too successful, to the extent that they brought down the largest company in the world (at the time), General Motors. Yet we cry and whine about the fact that after decades of training, and thousand of hours of clinical experience we are powerless to the fact that we are told we could lose our jobs, not for lack of heroic emergency care, but for lack of proper busboy skills. "Do you take cream in your coffee?"

"That Doctor didn't offer me any Splenda! 'F' this place!"

Rather than saying, "Enough is enough!" off we go with our tail between our legs, convinced we did a bad job because we allowed them to convince us we are burger flippers first, and life savers second. We could do a lot by learning from factory workers (and pro athletes.)

United we stand, divided we fall.

 

[FMtoEM]

...Rather than saying, "Enough is enough!" off we go with our tail between our legs, convinced we did a bad job because we allowed them to convince us we are burger flippers first, and life savers second. We could do a lot by learning from factory workers (and pro athletes.)

United we stand, divided we fall.

I agree and respectfully disagree on some points...Since it takes so much risk for us as individuals to get to where we are today it is hard to think of making things better for future EPs that did not help us get through college, med school, and residency. I lost income and sacrificed years fo my life to become an EP today. I cannot sacrifice myself twice (the clock is ticking to play catchup)...Indeed it may be harder to fall united but falling united is a possibility thus as physicians we stand back and watch. I think as physicians it is difficult to sacrifice our careers without seeing the fruits of our labor yet...we can be easily replaced. This is what I believe is making it hard to herd the cats.

I'm not sure how much factory workers sacrificed (years, potential income, etc) to become a factory worker. I'm not sure if pro athletes can be replaced easily.

 

[DreamingTheLive]

I agree and respectfully disagree on some points...Since it takes so much risk for us as individuals to get to where we are today it is hard to think of making things better for future EPs that did not help us get through college, med school, and residency. I lost income and sacrificed years fo my life to become an EP today. I cannot sacrifice myself twice (the clock is ticking to play catchup)...Indeed it may be harder to fall united but falling united is a possibility thus as physicians we stand back and watch. I think as physicians it is difficult to sacrifice our careers without seeing the fruits of our labor yet...we can be easily replaced. This is what I believe is making it hard to herd the cats.

I'm not sure how much factory workers sacrificed (years, potential income, etc) to become a factory worker. I'm not sure if pro athletes can be replaced easily.

Respectfully disagree. I don't think anyone is asking all EPs to accept 75K for full-time salary in the hopes that their great-grandchildren EMers will have a good life 80 years from now. Plus, who is to say that YOU won't directly benefit from the sacrifices for a significant time as well. When I think of sacrifices, I think of EPs shying away from mega-groups who ***** EPs out so that a few share-holders/fat cats make uber-dough.

Using your logic, we might as well just quit conserving water, oil, electricity, recycling, food, etc. because f*ck everyone and everything that isn't the here and now.

 

[FMtoEM]

DTL if you shy away from mega-groups that in most cases own almost entire states as far as EM jobs go where do you work? Most of us at this point need an income with all the education debt we have, and that is a higher priority. I definitely will benefit just like everyone else but that is a huge risk to jump on the wagon before seeing results.

Using your logic, we might as well just quit conserving water, oil, electricity, recycling, food, etc. because f*ck everyone and everything that isn't the here and now.

You are comparing apples to oranges... my logic does not apply to that...how much are you sacrificing to not let the water run...not much, thus you conserve water.

 

[The White Coat Investor]

WTH is a 1099 employee?

 

[Apollyon]

WTH is a 1099 employee?

Are you serious? If you are, then that makes me wonder about the balance of your financial advice.

1099 refers to the income statement - 1099 employees are independent contractors, with that name coming from the IRS form which is used. It is "nonemployment compensation". This specific one is a 1099-M.

Did you really not know this?

 

[TooMuchResearch]

Are you serious? If you are, then that makes me wonder about the balance of your financial advice.

1099 refers to the income statement - 1099 employees are independent contractors, with that name coming from the IRS form which is used. It is "nonemployment compensation". This specific one is a 1099-M.

Did you really not know this?

I took it more as 1099 = IC =/= employee and Dr. Duty was calling attention to that.

 

[Apollyon]

I took it more as 1099 = IC =/= employee and Dr. Duty was calling attention to that.

If that was the meaning, then that makes sense. That way, it sounds like jargon. I mean, an employee can be construed as "someone who works". No matter what a business calls the worker, the IRS has a form to fill out that determines if a person is an "employee" or "independent contractor". It is the same as "just because I call you a doctor doesn't mean that you ARE one".

 

[Old_Mil]

Bob McNamara embodies the best ideals of EM. Ed Panacek once told me that he is "the conscience of EM." I have to agree.

Bob has actually excelled at rallying EPs to his cause. The evidence is the ongoing import of the AAEM.

If he has not yet been able to unite the entire specialty it simply speaks to the difficulty of the cause. Many if not most of us have big financial incentives to continue the status quo. ACEP continues to dominate and it does a lot of good but it does incorporate and represent a lot of CMG interests.

I don't think it's lack of leadership here. I think it's trying to get self-interested physicians to sacrifice for a possible better future. How many of us are willing to see the specialty thrown into turmoil, lose a lot of money and possibly lose the gains we have made in the past to fight the good fight and maybe, just maybe prevail so that future EPs can have it better than we do?

EPs (and doctors in general) have a biological clock ticking loudly. We have to make enough for our retirement fast enough to make up for the time we spent in training. How many of us plan to work until we're 65? Most of us want out or to at least slow down way before that. So rocking the boat is a real risk. .

So do something small. Let your ACEP membership expire while continuing in AAEM. That will save you some $ as well...

Sent from my A110 using Tapatalk 2

 

[The White Coat Investor]

I took it more as 1099 = IC =/= employee and Dr. Duty was calling attention to that.

Exactly. An employee is a very specific entity, and is paid on a W-2 form. An independent contractor is a very specific entity, and is paid on a 1099 form. There is no such thing as a 1099 employee. You're either paid on a 1099, or you're an employee.

Cut me a little slack Apollo....you know me better than that.

 

[TooMuchResearch]

Exactly. An employee is a very specific entity, and is paid on a W-2 form. An independent contractor is a very specific entity, and is paid on a 1099 form. There is no such thing as a 1099 employee. You're either paid on a 1099, or you're an employee.

Cut me a little slack Apollo....you know me better than that.

And I intended no disrespect by referring to you as Dr. Duty. I read your posts, check out the blog frequently, and send your piece on financial mistakes for med students to avoid to incoming MS1s.

 

[Apollyon]

Exactly. An employee is a very specific entity, and is paid on a W-2 form. An independent contractor is a very specific entity, and is paid on a 1099 form. There is no such thing as a 1099 employee. You're either paid on a 1099, or you're an employee.

Cut me a little slack Apollo....you know me better than that.

Yeah, you didn't deserve that. I was the dunce. Apologies. I wish I could blame it on being tired.

 

[Dr.Evil1]

Veers posted a figure of 42% off the top, I assume from collections prior to ever getting to the emergency physicians working for the group. Does anyone have any ideas of what a good percentage is "off the top". What does your small democratic group take off the top in collections, administration, recruitment, billing etc.

My current group is a small (one hospital) group that started as just ER but then expanded into hospitalists, outpatient physicians, ICU, nephrology, endocrine etc. We have a moderately desirable location but our entire region has problems attracting and retaining physicians. It is becoming increasingly difficult to maintain staffing due to the inability for us to compete with big groups who advertise lifestyle. Also it is hard to compete on dollars alone if you can ALWAYS make more money by working as locums and whoring yourself out across the country or by just working in a less desirable or more rural area.

PM me if you are in the know and can give me some information on how much a large CMG or your small democratic group takes off the top for expenses.

Thanks
Evil