Stuck in between rock and hard place

[BoardingDoc]

People who choose to work for usacs are those who are administrators and people with no geographic choice. The pay is below market, the staffing is terrible and their culture is bad. As dbag rolls around like a don with a bit of booze in one hand and hairy chest sticking out and big gold chain swinging around.

My buddy used to work for usacs when they were emp and said they nicknamed dom “the big gold chain”.

Little napoleon is watching his serfs make money for him.

Yep. I have 2 friends who have worked for USACS. One formerly, one currently. Both do/did so either because USACS had a regional monopoly or because no other group was hiring.

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[namethatsmell]

Of course not. Even I know the answer to that. Why would any employer allow themselves to be sued while dropping the employee. It will always be the opposite

Actually, employers who self-insure have lots of reasons to do this. By self-insuring the employer wins by gaining more control and usually lowering costs, and the doc benefits since their interests are actually aligned with the employer’s interests since the policy $ all comes from the same place.

Some specific reasons: increased doc productivity (rather than being preoccupied on a case you’re named in), ensuring a group’s docs don’t run into potentially costly/time consuming issues with licensing/credentialing, and breeding loyalty and improving physician retention.

I know of several places that do this. Look for a physician-run non-profit entity/hospital system that self-ensures and there’s a decent chance they do this. That said, the place I know that do this only do so in cases where the doc acted within reasonable standard of care (which turns out to be the vast majority Med-Mal claims)—for cases where the doc did something wild then they’re staying named, and appropriately so.

So in USACS’s case, I’m skeptical if they use their power to do what I’ve described. But if they do, that would be laudable and hopefully encourage other groups/employers to do the same to try to compete for talent.

 

[thegenius]

Actually, employers who self-insure have lots of reasons to do this. By self-insuring the employer wins by gaining more control and usually lowering costs, and the doc benefits since their interests are actually aligned with the employer’s interests since the policy $ all comes from the same place.

Some specific reasons: increased doc productivity (rather than being preoccupied on a case you’re named in), ensuring a group’s docs don’t run into potentially costly/time consuming issues with licensing/credentialing, and breeding loyalty and improving physician retention.

I know of several places that do this. Look for a physician-run non-profit entity/hospital system that self-ensures and there’s a decent chance they do this. That said, the place I know that do this only do so in cases where the doc acted within reasonable standard of care (which turns out to be the vast majority Med-Mal claims)—for cases where the doc did something wild then they’re staying named, and appropriately so.

So in USACS’s case, I’m skeptical if they use their power to do what I’ve described. But if they do, that would be laudable and hopefully encourage other groups/employers to do the same to try to compete for talent.

What I'm getting at is the employer will always throw the employee under the bus. All things considered

 

[namethatsmell]

What I'm getting at is the employer will always throw the employee under the bus. All things considered

I understand what you’re getting at.

Employers are not mother Theresa. But sometimes an employer’s and an employee’s interests can align. This is one of those sometimes.

 

[sylvanthus]

Hah I saw the USACS slimy admin post and was not disappointed in everyones responses. This is the way.

 

[NYEMMED]

This is a new SDN account because my original one from when SDN started was archived - I haven't been on here in some time. Full transparency - I’m a doc and high level leader with USACS and have been with the group through my legacy company since 2010. I have worked in multiple states and with multiple divisions within USACS - I’ve served at all levels of our group and I believe in our perpetual physician owned model and our ability to create programs that support our people. I also started my career as an Asst. Prof in a very well-regarded EM program in Philly, so USACS is not all that I have known.

While I’m not here to get in the mud, I do want to correct some facts about our programs and the math about an RVU model. I do not know which site the OP is looking at, but am happy to connect with anyone about our company here or privately.

This fall we launched a Physician Loan Payback (PLP) program at over 80 sites. As a physician owned company, we recognized that our current owners and newest partners were coming out of residency with tremendous debt coupled with an exceptionally unfavorable refinance environment - which we all know has gotten worse in the past few months. We are not PSLF eligible, so we chose to invest in our people. The PLP is open to our current team members at these sites as well as our new hires.

The PLP program has you refi/consolidate to a 15 year loan or you can bring a current loan with you. We have a rate reduction with Laurel Road, but the doc is free to use any bank. The doc pays for 7 years and we then pay them the balance PLUS gross-up the estimated tax burden for that payment. No cap to the amount of student loan debt that can be brought into the program. The commitment is 4 years at the initial site (or transfer to another included site during that time), then if life changes, they can transfer to any one of our 500+ sites nationwide for the final 3 years of the commitment. Leave before 7 years? No handcuffs - we wish you well.

If the PLP program doesn’t fit your needs, we are offering $150K sign-on bonus for the same sites with a 3 year commitment.

As for comp rates - our busy sites on a hybrid hourly/RVU model typically make at least twice the hourly as an average. I don’t know the site the OP has interviewed at, so cannot really comment if the rate of $170/hr is accurate, but that sounds low to me with that acuity level. I wonder if that is the lowest person at the site or a part-time doc?? Would always recommend asking what the range is at the site between high and low performers.

The comp change the OP described absolutely is a RAISE - they are decreasing hourly by $4/hr and increasing RVUs by $3/RVU. OP stated that there is a 40% admit rate at this site - so we can assume a high acuity - lets assume 4.5 RVU/pt - could even be higher with that acuity level.

At 1 pt/hr that is a $9.50/hr raise - 4.5 RVU/hr * $3/RVU = $13.50/hr - $4/hr = $9.50/hr
At 2 pt/hr that is a $23/raise - 9 RVU/hr * $3/RVU = $27/hr - $4/hr = $23/hr

They likely see 1.8-2.1 pt/hr. So unless I am missing something - this site is getting a pretty significant raise of > $20/hr.

OP - you should ask what the RVU/pt and RVU/hr at the site is to help you determine comp - as well as asking for the range of team members. The director should easily be able to show you each doc's monthly productivity as we openly share this online. Each member of a team can see their own patients/coding as well as the entire groups productivity each month.

Additionally, our compensation includes $45-50K/year in pre-tax benefits - we like our pre-tax dollars:

* 10% company contribution to 401K (not a match) up to $33K/yr in 2023 - increases each year with the increase in IRS limits
* Low cost health/dental/vision with good coverage
* STD/LTD own occupation paid for by the group
* Business expense account $4K/yr with additional $4K in the first year out of residency
* Fully paid military leave
*.Fully paid parental leave open to all new parents including adoptive (up to 12 weeks for birth moms)
* $75K equity grant at 2 year anniversary with no buy-in (yes - the IRS has you pay the taxes on this)
* Stock price has more than doubled in the past 7 years and we have at least annual opportunities to buy/sell

And our docs are SUED LESS THAN HALF the national average for EM because we focus on hiring high quality BCEM and actively manage our own risk.

I wish the OP the best of luck with their decision and am happy to connect if I can be of help.

Stop spouting the corporate nonsense.

There is a reason that USACS has such a horrible reputation among EM physicians, and why EM docs only want to work for USACS if there is absolutely no other choice.


If you are a “high level leader” I suggest you take a hard look at why your company has such a bad reputation and is hated by EM docs….

 

[ScepticSkeksis]

It's great that a corporate schill for USACS can say with a straight face how great the company is. Question for USACS schill: Why are rates in Austin (where you guys have a monopoly) $100/hr below market in Texas? Why do you target all these new grads with illusory promises of bonuses, when you could just return that money to the hardworking physicians you already have as higher pay? Do you have any swelf-awareness as a leader in your company as to why you are universally despised on SDN? I'd wager you'd rank lower than Envision or Teamhealth because of your business practices. Can DB or your leadership ever admit fault?

 

[RustedFox]

I guarantee that @EM_Disney_Doc doesn't have the cojones to reply, let alone give an honest and direct answer.

 

[alpinism]

So if you look at the USACS Dell Austin residency website only about 10 of 60 grads signed with the company.

You know you're a horrible employer when most of your own residency grads leave for other companies.

 

[BoardingDoc]

So if you look at the USACS Dell Austin residency website only about 10 of 60 grads signed with the company.

You know you're a horrible employer when most of your own residency grads leave for other companies.

Well, our corporate overlord here did say that they only hire quality EM docs. Maybe their residency program only produces 1 competent doc for every 6 they churn out?

 

[Neopolymath]

SDN aggressively moderates a lot of weak stuff. Why not add an insta ban for anyone who states that a corporate practice (in any specialty) is physician owned in the sense we all mean it or that uses the term partner for corporate practice employees?

I can think of about 100 other dumb things the mods outside the anesthesiology forum get bent out of sorts about.

 

[BoardingDoc]

SDN aggressively moderates a lot of weak stuff. Why not add an insta ban for anyone who states that a corporate practice (in any specialty) is physician owned in the sense we all mean it or that uses the term partner for corporate practice employees?

I can think of about 100 other dumb things the mods outside the anesthesiology forum get bent out of sorts about.

Interesting. I am not inherently opposed to enforcing a policy like that, but it isn't the route I would personally choose. I think that a policy like that would be useful if it got to the point where a corporation were spreading enough misleading information that it became objectively difficult for the average user here to see that they were full of crap.

In this particular instance, I happen to love this interaction. Someone makes an offhand comment about how bad USACS is, some corporate monkey jumps in to say how great they are and how we should really drink the kool-aid, and then EVERYONE just dogpiles on top of him with pointed questions or concise explanations as to why this guy is completely full of crap.

That sort of interaction is 1: great for residents and young attendings reading this who could use specific details about why this convoluted "generous comp package" is in fact utter garbage, and 2: great for my schadenfreude.

If people feel differently and think this sort of thing should get an outright ban, either shoot me a DM or reply here as I'm more than happy to discuss with the other mods.

 

[Major]

Interesting. I am not inherently opposed to enforcing a policy like that, but it isn't the route I would personally choose. I think that a policy like that would be useful if it got to the point where a corporation were spreading enough misleading information that it became objectively difficult for the average user here to see that they were full of crap.

In this particular instance, I happen to love this interaction. Someone makes an offhand comment about how bad USACS is, some corporate monkey jumps in to say how great they are and how we should really drink the kool-aid, and then EVERYONE just dogpiles on top of him with pointed questions or concise explanations as to why this guy is completely full of crap.

That sort of interaction is 1: great for residents and young attendings reading this who could use specific details about why this convoluted "generous comp package" is in fact utter garbage, and 2: great for my schadenfreude.

If people feel differently and think this sort of thing should get an outright ban, either shoot me a DM or reply here as I'm more than happy to discuss with the other mods.

.

 

[thegenius]

Interesting. I am not inherently opposed to enforcing a policy like that, but it isn't the route I would personally choose. I think that a policy like that would be useful if it got to the point where a corporation were spreading enough misleading information that it became objectively difficult for the average user here to see that they were full of crap.

In this particular instance, I happen to love this interaction. Someone makes an offhand comment about how bad USACS is, some corporate monkey jumps in to say how great they are and how we should really drink the kool-aid, and then EVERYONE just dogpiles on top of him with pointed questions or concise explanations as to why this guy is completely full of crap.

That sort of interaction is 1: great for residents and young attendings reading this who could use specific details about why this convoluted "generous comp package" is in fact utter garbage, and 2: great for my schadenfreude.

If people feel differently and think this sort of thing should get an outright ban, either shoot me a DM or reply here as I'm more than happy to discuss with the other mods.

KEEP THIS GUY AND THREAD ON!

 

[thegenius]

It also concerning that the user hasn’t replied to my specific questions, that I thought we’re fair and reasonable.

Of course they could be super busy with work

Of course he isn't going to respond. if he does he will get peppered with 10 other questions. He will be answering questions non stop. There is nothing he can really say that we will believe because there is a mountain of evidence that doesn't support his positions.

 

[GonnaBeADoc2222]

"And then we told them that we're physician owned!!!!!"

 

[Neopolymath]

Interesting. I am not inherently opposed to enforcing a policy like that, but it isn't the route I would personally choose. I think that a policy like that would be useful if it got to the point where a corporation were spreading enough misleading information that it became objectively difficult for the average user here to see that they were full of crap.

In this particular instance, I happen to love this interaction. Someone makes an offhand comment about how bad USACS is, some corporate monkey jumps in to say how great they are and how we should really drink the kool-aid, and then EVERYONE just dogpiles on top of him with pointed questions or concise explanations as to why this guy is completely full of crap.

That sort of interaction is 1: great for residents and young attendings reading this who could use specific details about why this convoluted "generous comp package" is in fact utter garbage, and 2: great for my schadenfreude.

If people feel differently and think this sort of thing should get an outright ban, either shoot me a DM or reply here as I'm more than happy to discuss with the other mods.

I was mostly saying that in jest. You are absolutely correct on the benefits of the open dialogue.

 

[Apollyon]

Of course they could be super busy with work

Understaffed. Checks out.

 

[Major]

Understaffed. Checks out.

.

 

[WorkNoteEmergency]

I would ask the private group what the partner bonus/profit share has been for the past couple years, or maybe 2021 and 2019 since Covid screwed things up. It’s been a while for me but used to not be a big deal for them to “show you the books”. I think that offer, working at one of the closer sites sounds most intriguing, especially if you plan on staying in the area for awhile.

Other thoughts:

Kind of touched on earlier - 8 hour shifts are nice, especially now as I’m older and I find I’m losing interest around hour 6 (unfortunately working 10 shifts tho) but that will mean working more frequently.

Shift coverage - do they overlap? My 8 hour shift job (a USACS site, quit after 9 months) I would stay 1-2 hours after each shift finishing charts, etc. My 2 other jobs have had overlapping shifts so last 1+ hour I can wrap up, pick up an easy patient if I’m up for it, go home on time. My night shifts I usually leave a little early.

IMO, first job out residency should have some different goals. I love me some 1.2 pts/hr but if that’s all you know, when the day comes that you have to take a job at a busy shop, there will be some angst involved. It wasn’t particularly intentional on my part but my first job was high volume, high acuity ER with a lot of staffing. It’s nice to have friends available for the hard cases the first few times. That being said, if your option #1 USACS is the busy ER choice, still a hard pass.

 

[Major]

I would ask the private group what the partner bonus/profit share has been for the past couple years, or maybe 2021 and 2019 since Covid screwed things up. It’s been a while for me but used to not be a big deal for them to “show you the books”. I think that offer, working at one of the closer sites sounds most intriguing, especially if you plan on staying in the area for awhile.

.

 

[southerndoc]

I don't think an autoban is possible.

 

[Dr Mantis Toboggan]

I talked with the SDG some more. Actually 3 years of full time until they vote yes or no for partnership. Then it becomes graduated payout 60% first year, then 70% next year, etc.

That’s pretty bad.

 

[Major]

That’s pretty bad.

Is that typical of SDGs with partnership route?

 

[EctopicFetus]

Is that typical of SDGs with partnership route?

The buyins vary especially as more and more of them have to get bigger to keep the SDGs at bay.
i think the days of terribly low pay are long gone for SDGs though some may try that. Overall I think it was a terrible approach. My first group my buy in was like $2m. (Not a typo). That’s the difference between my hourly and what the partners got. My pay was stupid low and we had so many partners that it didn’t move the needle for any of them but it did royally screw me.

 

[emergentmd]

I talked with the SDG some more. Actually 3 years of full time until they vote yes or no for partnership. Then it becomes graduated payout 60% first year, then 70% next year, etc.

I am not sure what this means. So you become a partner, but still make less than other partners? What kind of Ponzi scheme is this? Are you now a junior partner? This USACS just gets worse and worse.

Again, I have yet to meet anyone Pit doc that likes USACS. So why are you even entertaining this? Do you think you are some special snowflake who will get better treatment than 99% of the docs? I mean, does anyone even know of A USACS doc who left and got paid $$$ for their shares, and if so may I ask how much it was?

 

[emergentmd]

The buyins vary especially as more and more of them have to get bigger to keep the SDGs at bay.
i think the days of terribly low pay are long gone for SDGs though some may try that. Overall I think it was a terrible approach. My first group my buy in was like $2m. (Not a typo). That’s the difference between my hourly and what the partners got. My pay was stupid low and we had so many partners that it didn’t move the needle for any of them but it did royally screw me.

Wait, your buyin was actually about 2M. Were you working for free or were partners making 3x the scut docs.

20 yrs ago, I signed a contract. At 2 yrs, 95% of the docs were offered partnership and most accepted. Buy in was 125K I believe. Once partner, you made about 50-75k/yr more. All partners/non partners did the same weekend/nights. Pay difference was about 50-75k which is about a 50% return on investment which seemed quite fair.

I think I lucked into one of the least predatory group.

 

[Dr Mantis Toboggan]

Is that typical of SDGs with partnership route?

No, 8 years until full profit sharing is not typical in my experience.

 

[Major]

I am not sure what this means. So you become a partner, but still make less than other partners? What kind of Ponzi scheme is this? Are you now a junior partner? This USACS just gets worse and worse.

Again, I have yet to meet anyone Pit doc that likes USACS. So why are you even entertaining this? Do you think you are some special snowflake who will get better treatment than 99% of the docs? I mean, does anyone even know of A USACS doc who left and got paid $$$ for their shares, and if so may I ask how much it was?

.

 

[Rekt]

What? No I am talking about the SDG. I’ve already eliminated the USACS offer.

The SDG group offer is 3 yrs working for them full time then the partners will vote whether or not to offer me partnership.

Then it becomes a graduated system of profit sharing. Starting at 60%. Then next year 70%, etc.

However, each partner and non-partner makes the same hourly rate.

That's awful and not normal. Predatory SDG. Plus a two hour drive? I would not take that job.

 

[Major]

That's awful and not normal. Predatory SDG. Plus a two hour drive? I would not take that job.

.

 

[emergentmd]

That's awful and not normal. Predatory SDG. Plus a two hour drive? I would not take that job.

Yeah, this you are a partner but not really sucks. That is some serious goal post moving.

 

[sylvanthus]

What? No I am talking about the SDG. I’ve already eliminated the USACS offer.

The SDG group offer is 3 yrs working for them full time then the partners will vote whether or not to offer me partnership.

Then it becomes a graduated system of profit sharing. Starting at 60%. Then next year 70%, etc.

However, each partner and non-partner makes the same hourly rate.

Sounds terrible.

 

[TooMuchResearch]

Run away.

 

[EctopicFetus]

Wait, your buyin was actually about 2M. Were you working for free or were partners making 3x the scut docs.

20 yrs ago, I signed a contract. At 2 yrs, 95% of the docs were offered partnership and most accepted. Buy in was 125K I believe. Once partner, you made about 50-75k/yr more. All partners/non partners did the same weekend/nights. Pay difference was about 50-75k which is about a 50% return on investment which seemed quite fair.

I think I lucked into one of the least predatory group.

The setup sucked. but the job WAS great. great resources, great location and partners making well over $400/hr. My first year I made $110/hr. To make it even more predatory nights were optional but if you did 96 hours a month of nights those night hours were paid at an extra $40/hr. Needless to say almost all the younger docs did this. Pay was around $160-180/hr at local CMG sites.

Partners made about $300/hr more than the new hires. I knew what I was getting into. you made partner at 2 years but they continued to bleed you for 3 more years (graduated bonuses) so 5 years total. Schedule was square and fair otherwise. Nights, weekends, holidays etc. While the night setup was coercive it was truly optional.

 

[TooMuchResearch]

What is average yearly RVU of EM doc? In the ENT surgical world, ~4-8k RVU is the 25-75th percentile yearly for my region.

I'm not really sure. If I only worked at our tertiary care facility and about the number of shifts I work, I think it would be somewhere between 7,500-10,000. But if I only worked there, I would hate everything. I do as much as possible at our smaller/rural sites where we're paid a set rate and I don't pay attention to RVUs.

 

[TooMuchResearch]

Sure, I do those too except for 3 (I never took a contract with an RVU component). Still, several of these suggestions are not relevant to OP.

1) OP is going to be a brand new attending...they will come into their next job with minimal self-confidence and experience. They of course will get better with time, but even then your tips won't work for some folks depending on their personality, practice style, local group practice patterns, and staffing etc.

2) You've described working in hell-holes before in your prior posts. Have you ever worked a Monday swing as the sole attending in a 60k shop while "supervising" 5 midlevels (2 of those were less than 6 months out of their schooling)? I worked in such a hellscape, and they are not quite as uncommon as you would think. And this sounds like the USACS job the OP is describing. If you have a CVA in the window, an MI you're trying to transfer a few rooms over, and there's a peds code en routhe when the new attending is coming on...are you leaving on time?

Don't get me wrong. There's a lot to like about 8 hour shifts and reasons why anything longer than 10 hours isn't ideal. But if you don't work at a place were your group has control over the reimbursement model as well as staffing levels, than 8 hour shifts carry a lot of risk.

Re: 2. Wtf. No. Why would I work in such a place. Anyone paying attention: That is not normal. Do not agree to work in such conditions.

 

[RustedFox]

Re: 2. Wtf. No. Why would I work in such a place. Anyone paying attention: That is not normal. Do not agree to work in such conditions.

I did a shift where I supervised 3 PLPs because a doc was out sick (broken arm) and we could only get a PLP to come in.

I'll never do that again.

 

[emergentmd]

The setup sucked. but the job WAS great. great resources, great location and partners making well over $400/hr. My first year I made $110/hr. To make it even more predatory nights were optional but if you did 96 hours a month of nights those night hours were paid at an extra $40/hr. Needless to say almost all the younger docs did this. Pay was around $160-180/hr at local CMG sites.

Partners made about $300/hr more than the new hires. I knew what I was getting into. you made partner at 2 years but they continued to bleed you for 3 more years (graduated bonuses) so 5 years total. Schedule was square and fair otherwise. Nights, weekends, holidays etc. While the night setup was coercive it was truly optional.

Just curious how this worked out. If you could swing $400/hr for 3-4 yrs, you would be made whole and have some equity. If you still are a partner, what a great paying gig.

 

[EctopicFetus]

I made partner, made decent money for a bit and then we sold against my preference. I got a decent payout. Left that poop show and found another SDG. Worked out well for me. Apparently prior to me joining they had some amazing years. Hospital was paying them a % of charges and doing all the billing etc. I ended up way ahead of an average EM doc salary.

 

[alpinism]

That's basically how our group functioned where I trained in Detroit.

Sucked for new attendings but old attendings made bank for academics.

Most of the senior docs made 400k-800k salaries before retirement.

 

[WorkNoteEmergency]

What is average yearly RVU of EM doc? In the ENT surgical world, ~4-8k RVU is the 25-75th percentile yearly for my region.

I'm not really sure. If I only worked at our tertiary care facility and about the number of shifts I work, I think it would be somewhere between 7,500-10,000. But if I only worked there, I would hate everything. I do as much as possible at our smaller/rural sites where we're paid a set rate and I don't pay attention to RVUs.

I pulled up some stuff from my old group from a few years ago and I had 9800 rvu and I was probably in top 1/3 of the group. A little under 1500 hours.

 

[namethatsmell]

Re: 2. Wtf. No. Why would I work in such a place. Anyone paying attention: That is not normal. Do not agree to work in such conditions.

Exactly. It is not normal. And in hindsight, I'm glad it happened to me.

Stop reading now if you'd like to skip a long and potentially boring rant...but since you asked "why?"...

I'd been working shifts at that place for awhile with no staffing shenanigans of any kind. It was a great gig until the group (a mid-sized semi-SDG) sold to a CMG who proclaimed "nothing will change unless it's good for you and patients" (lolz what a crock). None of us believed them, but most of the FT docs had been there for years and adored the shop so didn't jump ship. For the first 6 months literally nothing changed. And then all of the sudden the long-time med director left and the company flew in one of their hired guns to take over. And then a number of small changes began to occur. She was a nice enough person and actually a good doc, but her solution for every concern was to commiserate with you a bit and then say something to the effect of "don't worry this too shall pass."

Flash forward a few months--during which several FT docs had jumped ship and I was starting to scale back there--all of the sudden the schedule changed a day before the shift I described to you. It had morphed from something lean for a Monday swing but not insane, into me+5 midlevels. I messaged the med director (notifying her of what I assumed to be a mistake) who didn't get back to me...until I bumped into her in the middle of the dept 10 mins before the shift was supposed to start. She gave vague "reasons" why I was now the only doc scheduled but that "we" were "fortunate to have a full compliment of midlevels to help out." I told her how insanely unsafe it was and she assured me it was just a random perfect storm and not intentional. She herself was trying to go home as she'd worked overnight and had been up all day for meetings and looked exhausted, so I checked by emotions and calmly said that if this ever happened again she could consider that the date I officially give my notice. She said it was all good because it wouldn't happen again and "all will be well" or some BS.

Predictably, that shift was a continuous torrent of acuity. One memorable gem came gift-wrapped by of the midlevels, a nice-enough dudley do-right type and brand new, who apparently got tired of waiting in line to staff a patient with me and blurted out: "hey doc, sorry to interrupt but real quick I have a patient with a nasty head bruise from a fall. Thankfully his CT head doesn't show a fracture, just a subdural hematoma. Should we drain it before d/c or should I tell him to ice it for the next few days and that it'll go down on it's own?"
The big win was that nobody died (at least in the ER).

Of course a few weeks later it happened again. I immediately sent her and the RMD my notice. They came back at me with "you deserve to be paid more for all your efforts." I reiterated that having a baseline level of safe staffing was non-negotiable. They told me I just needed to be better compensated. The whole exchange and their brazen but even-keeled attempt to basically buy/bribe me was a bit surreal. So I didn't retract my notice. The only immediate "win" I got was that for the remainder of my time there I never had to be the ringleader of a circus shift like that ever again. Not because I was special, but because I told them if they couldn't provide adequate emergency physician coverage in the future I'd call the hospital CMO to come and assist me in the ER.

As I look back, these guys did me a favor by sprinting quickly through the many games that CMGs/PE plays. Having a front-row seat to witness their rapid-fire destruction of a well-functioning ER was a much more powerful motivator for my professional development than if they'd shown me their slow version of CMG death by 1000 cuts.

 

[ScepticSkeksis]

namethatsmell is giving USACS leaders great ideas for cost-savings, "efficiciency" and improved patient satisfaction scores. Supervising a busload of MLPS will be coming to a USACS site near you!

 

[EctopicFetus]

namethatsmell is giving USACS leaders great ideas for cost-savings, "efficiciency" and improved patient satisfaction scores. Supervising a busload of MLPS will be coming to a USACS site near you!

It’s already here. That’s their business model. The naive supervising the unqualified.

 

[Major]

.

 

[EctopicFetus]

Well shoot. My third offer, the hospital employeed gig, is an ascension hospital.

Reality is few good options are out there for docs. The world has changed in the last 5-10 years. Good luck.

 

[namethatsmell]

namethatsmell is giving USACS leaders great ideas for cost-savings, "efficiciency" and improved patient satisfaction scores. Supervising a busload of MLPS will be coming to a USACS site near you!

Bro this has long been their MO

 

[EM_Disney_Doc]

Can you expand on that some more? Why not raise Both the per hour and RVU? I’ve seen first hand the acuity and volume at this hospital. It’s a very high paced/very busy center to work at. Lots of good true EM cases. It’s a real **** show. I think the docs there deserve both a per hour and per rvu raise. Seeing the drop in per hour has made me even more hesitant to sign.

And how does usacs plan to deal with the CMS RVU cut of 4% starting Jan 1 2023? That would surely lead to cuts in physican per rvu pay?

(I am genuinely asking and trying to understand this process better while I make my final decision. Thanks!)

Sorry all… have not been on here and I see you all have been very busy here. All good.

Major - I’m happy to chat offline. And I’m sure the site director can help go over what the comp model change at their site means to their team both hourly and annually. I don’t know if there is a way to DM on here, but feel free to reach out.

As for CMS changes - they go up and down annually. We have not typically adjusted our paid RVU rates with these changes. We also don’t adjust pay rates down when IRS 401K contribution limits and payroll taxes go up. In 2023, our docs will get a pretax $2500 increase in company contribution to their 401K because IRS limits are going up - no change in pay the company is absorbing the cost. We also haven’t seen an increase in our health insurance rates for the last 3-4 years when the overall cost of the plans have gone up. Next year we actually have better options with lower deductibles without a cost increase.

I know some will jump in with the fact that I have not responded to every comment - there were A LOT. Many weren’t exactly kind. Happy to have a collegial discussion - I’m happy with my group and wish everyone well.

 

[RustedFox]

Sorry all… have not been on here and I see you all have been very busy here. All good.

Major - I’m happy to chat offline. And I’m sure the site director can help go over what the comp model change at their site means to their team both hourly and annually. I don’t know if there is a way to DM on here, but feel free to reach out.

As for CMS changes - they go up and down annually. We have not typically adjusted our paid RVU rates with these changes. We also don’t adjust pay rates down when IRS 401K contribution limits and payroll taxes go up. In 2023, our docs will get a pretax $2500 increase in company contribution to their 401K because IRS limits are going up - no change in pay the company is absorbing the cost. We also haven’t seen an increase in our health insurance rates for the last 3-4 years when the overall cost of the plans have gone up. Next year we actually have better options with lower deductibles without a cost increase.

I know some will jump in with the fact that I have not responded to every comment - there were A LOT. Many weren’t exactly kind. Happy to have a collegial discussion - I’m happy with my group and wish everyone well.

Try answering the questions, amigo.
You have a captive audience.
Use it.