Any Kaiser (TPMG) docs here?

[ROdoc13]

Thanks. If what you are saying is true, then Kaiser would only have to have offered him only $300K for that to have been financially better than the $400K he ended up taking (all else being equal, which is probably isn't). Surely they offer more than that? What's the starting salary for a Kaiser starting EM doc these days?

It also sounds like you are saying that there are jobs out there that offer even more than $400K starting, which would be even better. This guy was somewhat geographically constrained. He was only going where either his family lived or his wife's family lived.

Perhaps just ask your friend what the offer was rather than speculate? As a radiation oncologist, I have no idea what ER docs make at TPMG. The fringe is certainly more valuable that average employed group, but whether that is worth other downsides is of course subjective.

[AR]

Perhaps just ask your friend what the offer was rather than speculate? As a radiation oncologist, I have no idea what ER docs make at TPMG. The fringe is certainly more valuable that average employed group, but whether that is worth other downsides is of course subjective.

I don't think he made it to the offer stage. He just talked to a recruiter and maybe informally talked to a couple of docs that worked there.

So, he didn't get a formal offer. His decision was based on what approximately what he thought the "standard" offer was. Also unknown is how much room he had to negotiate. I figure someone here would be guessing less than he would be.

[ROdoc13]

I don't think he made it to the offer stage. He just talked to a recruiter and maybe informally talked to a couple of docs that worked there.

So, he didn't get a formal offer. His decision was based on what approximately what he thought the "standard" offer was. Also unknown is how much room he had to negotiate. I figure someone here would be guessing less than he would be.

Gotcha. I suspect your friend was referencing the benefits in that case, which are certainly among the best / most valuable, often called the “golden handcuffs.” I suspect the base compensation is around median to just above median for EM, which is generally what the compensation committee aims for. Keep in mind, however, as a prior poster noted, that EM at TPMG apparently works more shifts in a month than typical EM physician would.

[AR]

Gotcha. I suspect your friend was referencing the benefits in that case, which are certainly among the best / most valuable, often called the “golden handcuffs.” I suspect the base compensation is around median to just above medicine for EM, which is generally what the compensation committee aims for. Keep in mind, however, as a prior poster noted, that EM at TPMG apparently works more shifts in a month than typical EM physician would.

Is it the same number of patients per shift? Given what I know about Kaiser (I looked into a job there myself over a decade ago), most Kaiser docs will see fewer patients per unit time compared to a non-Kaiser setting. I wonder if it is the same in EM.

Of course, that doesn't make it that much better. I'd rather do fewer shifts and be a bit busier.

Also completely unrelated to the original question, but this topic got me thinking about something else I always wondered about. In most cases, Kaiser docs can only see Kaiser patients. But federal laws make it so that ERs can't turn anyone away. So do Kaiser ERs see non Kaiser patients? I'd think they would have to. But what happens if a non-Kaiser patient needs admission. It seems like the reimbursement issues could get messy really quick both for Kaiser and the patient.

[ROdoc13]

Is it the same number of patients per shift? Given what I know about Kaiser (I looked into a job there myself over a decade ago), most Kaiser docs will see fewer patients per unit time compared to a non-Kaiser setting. I wonder if it is the same in EM.

Of course, that doesn't make it that much better. I'd rather do fewer shifts and be a bit busier.

Also completely unrelated to the original question, but this topic got me thinking about something else I always wondered about. In most cases, Kaiser docs can only see Kaiser patients. But federal laws make it so that ERs can't turn anyone away. So do Kaiser ERs see non Kaiser patients? I'd think they would have to. But what happens if a non-Kaiser patient needs admission. It seems like the reimbursement issues could get messy really quick both for Kaiser and the patient.

I'm uncertain about the former, as I'm not an EM physician.

KP is subject to EMTALA, like all hospitals. In the event a non-KP member is seen in ER, they are triaged and stabilized, and then once stable, may be transferred to another local facility (although not in every circumstance). Similarly, for KP members presenting to a non-KP ER, they are triaged, stabilized, and when stable attempt is made to transfer them to a KP facility.

[Tim]

I'm uncertain about the former, as I'm not an EM physician.

KP is subject to EMTALA, like all hospitals. In the event a non-KP member is seen in ER, they are triaged and stabilized, and then once stable, may be transferred to another local facility (although not in every circumstance). Similarly, for KP members presenting to a non-KP ER, they are triaged, stabilized, and when stable attempt is made to transfer them to a KP facility.

Purely a health insurance question: what facilities accept “uninsured transfers”?

[AR]

Purely a health insurance question: what facilities accept “uninsured transfers”?

County hospital?

[Tim]

County hospital?

Might be my ignorance. I know there are some rules for NOT diverting uninsured to county vs nonprofit ED’s. Transfers were limited to qualified facilities (level 1,2,3,4). Even ambulance coverage gets tangled. Stablilized and transfer do to lack of insurance would imply transfer vs release for nonpayment.

[AR]

Might be my ignorance. I know there are some rules for NOT diverting uninsured to county vs nonprofit ED’s. Transfers were limited to qualified facilities (level 1,2,3,4). Even ambulance coverage gets tangled. Stablilized and transfer do to lack of insurance would imply transfer vs release for nonpayment.

Oh, I have no idea. I was just throwing a guess out there.

Where I trained, every single resident of the county was eligible to get care through the county hospital system. If you are uninsured, then a social worker will help get you a card while you are in the hospital. I'm pretty sure (but not completely sure) that it was means-tested in some way. So if you weren't indigent, you would be paying as much, if not more than you would if you just bought insurance (or had it through your employer).

[cawa84]

For those who have utilized the TPMG home loan program, the paperwork states that the loan "is considered subordinate financing, typically a second mortgage with favorable interest terms, and is not considered a down-payment by lending institutions." Does that mean that it can be put towards a down payment (i.e. 50% KP loan + 50% cash for down payment) but that mortgage lenders won't factor in the KP amt when setting terms of the primary mortgage ?

[emergencysavings]

For those who have utilized the TPMG home loan program, the paperwork states that the loan "is considered subordinate financing, typically a second mortgage with favorable interest terms, and is not considered a down-payment by lending institutions." Does that mean that it can be put towards a down payment (i.e. 50% KP loan + 50% cash for down payment) but that mortgage lenders won't factor in the KP amt when setting terms of the primary mortgage ?

depends on your lender. It’s for the most part considered a second mortgage, so most banks won’t accept it as a down payment or even part of it. I have a colleague who worked with a lender that did allow some of the down payment to be paid from the TPMG home loan. You’ll have to ask. Most prominent lenders out there have run across the TPMG home loan purely because of the volume of TPMG docs.

US Bank allowed us to put down 10% on a jumbo loan. My other half is also TPMG doc and we both qualified for home loan, so we covered 20% of home purchase with TPMG loan (basically a 2nd and 3rd) and financed the remaining 70%.

[cawa84]

depends on your lender. It’s for the most part considered a second mortgage, so most banks won’t accept it as a down payment or even part of it. I have a colleague who worked with a lender that did allow some of the down payment to be paid from the TPMG home loan. You’ll have to ask. Most prominent lenders out there have run across the TPMG home loan purely because of the volume of TPMG docs.

US Bank allowed us to put down 10% on a jumbo loan. My other half is also TPMG doc and we both qualified for home loan, so we covered 20% of home purchase with TPMG loan (basically a 2nd and 3rd) and financed the remaining 70%.

Thanks for the info. How long ago did you get the loan? Sounds like US Bank was the best option at the time?

[emergencysavings]

Thanks for the info. How long ago did you get the loan? Sounds like US Bank was the best option at the time?

I bought my home in June of 2020. I worked with a guy at US Bank who does nothing but physician loans and has ample experience with TPMG secondary loan. Let me know if you’d like his info. He is Based out of Sacramento but I worked with him over the phone 120 miles away.

If you’re in the north bay there is another trustworthy guy at Wells Fargo I can connect you with based out of Santa Rosa.

[ROdoc13]

Thanks for the info. How long ago did you get the loan? Sounds like US Bank was the best option at the time?

We worked with Patelco, who allowed us to use as part of the 20% down payment. Patelco was a bit annoying to work with as they were slow, but they still pulled through with a 21-day close...and glad we went with them given we got a rate of 2.75% on a 30-year jumbo in 2021.

[Bthom86]

Thanks. If what you are saying is true, then Kaiser would only have to have offered him only $300K for that to have been financially better than the $400K he ended up taking (all else being equal, which is probably isn't). Surely they offer more than that? What's the starting salary for a Kaiser starting EM doc these days?

It also sounds like you are saying that there are jobs out there that offer even more than $400K starting, which would be even better. This guy was somewhat geographically constrained. He was only going where either his family lived or his wife's family lived.

Starting salary for a 10/10 full-time ER doctor runs around $360k for base salary.