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  • Considering Private Democratic EM group, need help

    Hi,
    This academic doc needs help; absolutely new to this.
    I am 4 years post-Pediatric EM fellowship practicing academics (poor pay) on the East coast and considering moving to TX for a private EM group. I am okay giving up on academia for a while, and my family would be okay with the move.
    - Track to partnership in 12-16 mo
    - Group has reportedly been stable for >15 years, expanding
    - Slightly more shifts and busier shifts in pts per hour
    - Minimum + RVU. Median pay for current group members is substantially more than my current salary.

    What do you recommend I ask as I interview and negotiate?
    Share any items you have/wish you had asked as I build up for my meeting in a couple of days.
    Thanks!

  • #2
    "Private Democratic EM group"
    If it is truly a PP democratic EM group, what you are asking for is what everyone else gets.
    You might get some relo etc. that will be funded by the other partners since they need to recruit another doc.
    I would focus on the if they are willing to make the path to partnership work and what is expected of you until partnership.

    Comment


    • #3
      1) Make sure that the path to full partner is measurable and achievable. It should be very clear to all involved when you have paid your dues
      2) Make sure you are aware of what it takes to be a full partner. Majority vote, unanimous vote of existing partners? Avoid the latter as a single person who doesn't like you could cost you a lot of money.
      3) Who has left the group in the last 5 years or so and why?

      Likely same comp among all in the group, expected full partner vs pre partner difference though.

      Comment


      • #4
        Make sure it's 1 partner, 1 vote (i.e. no seniority, all partners equal).

        Who has left the group in the last 5-10 years and why? Will they give you their contact information?

        Will they let you see the books? Some will and some won't.

        Stability in EM doesn't mean much these days. It's good they've been there for a while but the pressure from CMGs is always there. Trust me, CMGs are always trying to pitch their product to the admins.

        It sounds like pay will be a bit variable amongst partners since there is an RVU component. How are profit sharing/distributions handled? Divided equally among partners?

        Ask if they meet with you during your partnership track to make sure there are no surprises on your end that you aren't aware of that could affect you getting partnership.

        Honestly, if their partnership track is 12-16 months then they're probably pretty reasonable.

        Comment


        • #5
          Also what happens if you are not made a partner.

          Any non-compete? Is it enforceable if they don't offer you a partnership.

          Comment


          • #6
            democratic group and 12 month partner track sounds kind of weird
            not mutually exclusive but worth asking about
            are you peds-->PEM or EM-->PEM?

            Comment


            • #7
              What happens if group is bought out by PE before making partner? You’ll want an easy release from a non-compete clause if any.

              Comment


              • #8
                Non-complete clauses in EM are likely going to be something along the lines of you can't individually take over the group's contract or quit and then open an urgent care right across the street from the group's facilities or something like that. We don't have patients in EM and any long-term patient relationships you develop in EM aren't typically positive ones.

                Comment


                • #9
                  Originally posted by CordMcNally View Post
                  any long-term patient relationships you develop in EM aren't typically positive ones.
                  So buying back the narcotics you just prescribed for non-existent pain isn’t a positive relationship 😉?

                  Comment


                  • #10
                    Are you going to be doing General EM or is this practice large enough to have a dedicated Peds ED?
                    How is the scheduling done, and how are nights distributed? I think it’s fine if you can age out of nights but it should be applied fairly.
                    How many physicians in the history of the group have not made parter? Should be very few.
                    What is the payer mix? Does the group depend on the Hospital for a significant stipend? If it does it makes it more susceptible to underbidding?
                    Who owns the Hospitalist contract? If it’s a CMG with a big ER footprint the fox is already in the hen house.
                    How is the coverage. Are there APPs. If there are APPs how are they supervised?
                    What is the malpractice carrier and does the group cover the tail when you leave?
                    Is there a buy in other than sweat equity from a lower salary before partner. Once a partner do you own a piece of the AR and do you get it when you leave?
                    12-16 months seems short for full partnership. Is there another pathway after you are a partner until you reach full income?
                    Why is it 12-16 months. I’d think it would be a set timeline, ie 12 months or 16 months
                    How long is the tenure of the average partner? How much turnover. If it’s a lot. That’s a red flag.


                    Things for you to consider.
                    Slightly more shifts and busier shifts may sound OK on paper, but can be a recipe for burnout.
                    What percent of the pay is productivity based. If it’s significant and there’s more than single coverage will you feel like you’re competing every shift rather than working together.
                    If most of your pay is RVU based your focus will shift from what you are used to, to “moving the meat” if you want that higher Comp.
                    Likewise if you are doing dedicated Peds EM your RVU per hour will likely be less than those seeing adults.
                    What will your schedule look like and how do you request time off.?
                    Do you want to live in Texas? If this job doesn’t pan out are there other places you can work within a reasonable drive.

                    A general consideration for EM in general. I think the “no surprises” act is really going to hit ED groups in general in the wallet. The rarer private ED groups that depend on “reasonable” rates from insurers will be under pressure. Insurers are now incentivized to cancel contracts and basically send what they want. There is some state to state variability in that I believe state patient protection laws may trump the federal. So you may want to look at how balanced billing is handled in Texas.


                    Comment


                    • #11
                      Thanks for the responses, super helpful!
                      I am curious to know what you think.

                      I got more info and this is what I have -
                      - groups is General + Peds EM (I am Peds > PEM)
                      - 108-144 hrs/mo (less in summer, more in winter)
                      - Eligible for partnership after 2000 hrs (typically 12-14 mo) and $1000 buy-in
                      - until becoming partner, 15% of monthly production goes to the partner pool
                      - everyone in Peds who met eligibility became partner. Couple in gen EM due to personality.
                      - each shareholder gets 1 vote
                      - very little turnover. 2 leaving for family reasons. Most people have been 10+ yrs
                      - transparent with finances
                      - minimum salary but mostly RVU based. 30/RVU.
                      - extra stipend for leadership role

                      Issues -
                      - ageing group
                      - HCA hosp but EM is large, 25+ yrs, and 'has not given in'
                      - no sign-on or relocation bonus

                      I’ve asked to look at the standard contract.

                      Hive - anything else?
                      Thanks again!

                      Comment


                      • #12
                        The trauma level of the specific HCA hospital will impact your transition. HCA in Texas is primarily suburban ED’s. Good for housing.
                        https://www.dshs.texas.gov/emstrauma.../etrahosp.shtm
                        HCA is now committed to providing some residency training. You might be training some residents now or in the future.
                        Both of the above might impact the “job”.
                        Does the group cover more than one HCA hospital? If so, the locations could create a commute/housing issue.
                        The above relate only to HCA in Texas.

                        Balance Billing in Texas is no longer allowed for EDs.
                        https://www.tdi.texas.gov/medical-bi...providers.html

                        None of the above are red flags. Information only.
                        Some ED docs moonlight in Free Standing Emergency Centers. Employment restrictions might come into play.
                        Just food for thought.

                        Comment


                        • #13
                          Originally posted by Tim View Post
                          The trauma level of the specific HCA hospital will impact your transition. HCA in Texas is primarily suburban ED’s. Good for housing.
                          https://www.dshs.texas.gov/emstrauma.../etrahosp.shtm
                          HCA is now committed to providing some residency training. You might be training some residents now or in the future.
                          Both of the above might impact the “job”.
                          Does the group cover more than one HCA hospital? If so, the locations could create a commute/housing issue.
                          The above relate only to HCA in Texas.

                          Balance Billing in Texas is no longer allowed for EDs.
                          https://www.tdi.texas.gov/medical-bi...providers.html

                          None of the above are red flags. Information only.
                          Some ED docs moonlight in Free Standing Emergency Centers. Employment restrictions might come into play.
                          Just food for thought.
                          Good points. Working at 1 hospital location only. Some diff in trauma level but can do. They have a small number of residents already.

                          Comment


                          • #14
                            How long has the hospital been an HCA hospital? HCA and Envision go together like peas and carrots. There’s more to keeping a contract than ‘not giving in’, especially when the hospital can dump the group with no warning.

                            Comment


                            • #15
                              Spend your time getting to know the people. That's the most important part of the partnership. Try to talk to every doc who's ever left the group for any reason and find out if the partners are good people. It doesn't take very many toxic folks to ruin a group.

                              Losing the contract is always a risk, but it's worth running IMHO. I wouldn't spend a lot of time worrying about that.

                              Be sure you know who covers the tail in various circumstances.
                              Helping those who wear the white coat get a fair shake on Wall Street since 2011

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