The group or the hospital?

[SolidGold]

I'm a senior resident set to graduate in June and I've interviewed at a few places now and I was wondering what others who have recently gone through this process or recently changed jobs thought about this.

I've interviewed with a democratic group with a very fair partnership track that seems to have great people in it and all are very happy with their jobs but the hospitals they staff are smaller than I what I envisioned working in. Another is with a large national corporate staffing company but the hospital it staffs that I interviewed with is everything I'm looking for, but I never got a great sense that others working there were as happy as those in the democratic group.

Since the hospital would be my work environment, should that be what I weigh more in my decision, or will the group I work for make a bigger difference if I know I would enjoy working for that group more than the corporate group? Let say everything else including compensation is equal.

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[kungfufishing]

I'd go where the docs are happier - there is a lot of unspoken commentary made on the general work environment that you pick up in your gestalt assessment.

 

[deleted109597]

I'd go where the docs are happier - there is a lot of unspoken commentary made on the general work environment that you pick up in your gestalt assessment.

How do you do this? On the few site visits so far, there are at most 2-3 docs working at a time, and the groups are 20 or more. And since my next job philosophy (read: anywhere but here) precludes me from just "stopping by", I don't think I can spend the entire day getting a feel.
This is almost harder than residency apps, except that every single place I've been has started with "What can we do to get you to work here?" It's nice to be wanted.

 

[cach]

Why would you choose to be a poorly paid employee of a large management company, whose goal is to enrich a few out of state absentee owners who are far better paid than you, yet do little or no work. Management companies take 40% or more of the practice revenues. That means you will have to work 40% more (an extra 4 months and 25day per year) to cover the money taken by the out of state absentee owners.


The choice is simple if you join a small democratic group, after a year or two you could become and equal partner and share in the practice revenues, you also will have the opportunity to be a leader of the group and learn about the business side of medicine. Why would you chose to be a poorly paid employee of a large management company with little or no opportunity to become one of the few out of state absentee owners who run the group. You will have little or no say in the operation of the group or the ED, you also will have little or no job security since Management company will fire you for the slightest imagined infraction.

 

[Groove]

Does a contract at a smaller hospital with a democratic group typically exclude you from say... working 3-4 shifts/mo at a busier trauma center staffed by a management group within the same city? Is something like that possible?

 

[cach]

Does a contract at a smaller hospital with a democratic group typically exclude you from say... working 3-4 shifts/mo at a busier trauma center staffed by a management group within the same city? Is something like that possible?

Most contacts comes with a non compete clause for the entire county or 25 miles. Most contacts also prohibit moonlighting or any other sources of income. The Contract may say that all income from your medical practice shall belong to the group.


You need to try to modify your contracts with both groups so you are able to work when and where you want. Unfortunately the groups may refuse to modify their contract.

 

[Dwindlin]

So I know of some who split time between ICU/ED. How would this work if most places have clauses such as this? Are places willing to forgo these clauses if your practicing outside of the ED (thus not really competing with your group)?

Most contacts comes with a non compete clause for the entire county or 25 miles. Most contacts also prohibit moonlighting or any other sources of income. The Contract may say that all income from your medical practice shall belong to the group.


You need to try to modify your contracts with both groups so you are able to work when and where you want. Unfortunately the groups may refuse to modify their contract.

 

[deleted109597]

Noncompete clauses rarely stand up in court. I wouldn't sweat it.

The argument that democratic groups are the end all be all and corporate groups aren't is amusing. Each has their own pros and cons. I have interviewed at a place where I make more starting day one than a friend will make at partner in year 4. They need medical directors at each facility, and most if not all are hired from within. There are plenty of democratic groups that are effectively pyramid schemes. Also, not everyone wants to manage.
I think everyone needs to be exposed to each type of job, but for someone here to tell people that they're wrong is just comical.

 

[tkim]

Noncompete clauses rarely stand up in court. I wouldn't sweat it.

The argument that democratic groups are the end all be all and corporate groups aren't is amusing. Each has their own pros and cons. I have interviewed at a place where I make more starting day one than a friend will make at partner in year 4. They need medical directors at each facility, and most if not all are hired from within. There are plenty of democratic groups that are effectively pyramid schemes. Also, not everyone wants to manage.
I think everyone needs to be exposed to each type of job, but for someone here to tell people that they're wrong is just comical.

Almost as comical as advising that non-compete clauses 'rarely stand up in court':

http://www.metrocorpcounsel.com/current.php?artType=view&artMonth=March&artYear=2004&EntryNo=296

 

[deleted109597]

That article shows no precedents and gives no cases. It does correctly state that

Physician-Noncompete Agreements Are Void Per Se In Some States

I bet I can find more cases where they fail than you can where they succeed.

It is the first link on google. But a more recent (ie not 2004) titled "Recent Developments in Physician Non-Compete Agreements" states

These cases illustrate that, although physician non-compete agreements are not against public policy in this state, great care must be exercised in drafting and attempting to enforce them under Wisconsin law.

From a separate legal firm

Because noncompete agreements interfere with a person's ability to pursue his or her livelihood and constitute restraints of trade, courts are often loath to enforce them.

Importantly, you don't have to sue to work in an area they have a non-compete. They have to sue you for breach of contract, and as mentioned, they almost always lose.

 

[tkim]

That article shows no precedents and gives no cases. It does correctly state that

I bet I can find more cases where they fail than you can where they succeed.

You made a blanket statement based on ... what? And the article clearly lists states where the non-compete is enforceable. Stop talking out of your ass.

 

[deleted109597]

You made a blanket statement based on ... what? And the article clearly lists states where the non-compete is enforceable. Stop talking out of your ass.

Blanket statement based on legal advice. Nothing more, nothing less.
It clearly lists states where they aren't null and void automatically. It does not list one case where it was actually enforced. Once again, show me a case where the non-compete was upheld and I'll show you 50 where it wasn't.

 

[danielmd06]

Noncompete clauses rarely stand up in court. I wouldn't sweat it.

This is dangerous advice.

Please, talk to a lawyer.

 

[tkim]

Blanket statement based on legal advice. Nothing more, nothing less.
It clearly lists states where they aren't null and void automatically. It does not list one case where it was actually enforced. Once again, show me a case where the non-compete was upheld and I'll show you 50 where it wasn't.

http://www.beckersasc.com/news-anal...p-on-physicians-practice-upheld-by-court.html

Get cracking.

 

[deleted109597]

Sorry, I didn't know you were family medicine. I apologize, I must be in the wrong forum. Try again.

 

[tkim]

Sorry, I didn't know you were family medicine. I apologize, I must be in the wrong forum. Try again.

I'm sorry, I didn't see you mention anything about the non-compete being speciality-dependant. Does the practitioner being family practice have any bearing on the non-compete, or is this just a not-so-subtle attempt to wriggle out of your blowhard statement.

 

[deleted109597]

Here's an EM specific loss for you, with appeals loss.
http://caselaw.findlaw.com/in-court-of-appeals/1372845.html

And yes, specialty does make a large difference. People go to see Dr. Family Practice because he always cares for him. If people come to your ED asking for you, it's because you give out too many pain medicines.

 

[tkim]

Here's an EM specific loss for you, with appeals loss.
http://caselaw.findlaw.com/in-court-of-appeals/1372845.html

And yes, specialty does make a large difference. People go to see Dr. Family Practice because he always cares for him. If people come to your ED asking for you, it's because you give out too many pain medicines.

49 more ...

 

[SolidGold]

Why would you choose to be a poorly paid employee of a large management company, whose goal is to enrich a few out of state absentee owners who are far better paid than you, yet do little or no work. Management companies take 40% or more of the practice revenues. That means you will have to work 40% more (an extra 4 months and 25day per year) to cover the money taken by the out of state absentee owners.


The choice is simple if you join a small democratic group, after a year or two you could become and equal partner and share in the practice revenues, you also will have the opportunity to be a leader of the group and learn about the business side of medicine. Why would you chose to be a poorly paid employee of a large management company with little or no opportunity to become one of the few out of state absentee owners who run the group. You will have little or no say in the operation of the group or the ED, you also will have little or no job security since Management company will fire you for the slightest imagined infraction.

The large management group for this site (in a great location in FL) actually pays extremely well, in fact I would make much more with them during my time in the pre-partner stage than I would as a partner with the democratic group. But as a partner in the democratic group, I'd make a decent amount more than with the large corporate management group.

I've mulled it over the last few days and I'm leaning toward the democratic group because I think it will provide for a much better long term career experience, even though its not near a beach.

Also, interestingly, the democratic group does not have a non-compete clause so if I really wanted to I could work part time elsewhere but I don't have the desire to do that as of right now.

 

[deleted109597]

49 more ...

So, since reading and comprehension still evade you, there are only 48 more, since that, as mentioned, was the original and the appeal, so two wins for the doc.

3.http://library.findlaw.com/1999/Jun/1/128901.html
4-6. http://caselaw.findlaw.com/tn-supreme-court/1058188.html Trial, appeals, and state supreme court judgements
7-8.http://caselaw.findlaw.com/mo-court-of-appeals/1020668.html Trial and appeal
9.http://caselaw.findlaw.com/ar-court-of-appeals/1483758.html Reversal of trial court
10.http://caselaw.findlaw.com/la-court-of-appeal/1082953.html Reversal of trial court with monetary damages
11-12.http://caselaw.findlaw.com/in-court-of-appeals/1460451.html Trial court and appeals
13.http://caselaw.findlaw.com/in-court-of-appeals/1232042.html Reversal
14-15.http://caselaw.findlaw.com/ga-court-of-appeals/1227599.htmlTrial and appeals (although reversed for 1 of 5 defendants)
16-17.http://caselaw.findlaw.com/in-court-of-appeals/1086344.html Trial and appeals
18.http://caselaw.findlaw.com/ny-supreme-court/1016721.htmlSC case, but can't find trial or appeals to say if it was overturned or upheld, so I'll only count it as one
19.http://caselaw.findlaw.com/in-court-of-appeals/1259572.htmlReversal of trial court
20.http://caselaw.findlaw.com/ar-supreme-court/1450981.html Trial court judgment that was not addressed at appeal
21-22.http://caselaw.findlaw.com/mo-court-of-appeals/1243990.htmlTrial and appeal
23-24.http://caselaw.findlaw.com/tx-court-of-appeals/1326034.html
25.http://caselaw.findlaw.com/tn-supreme-court/1055855.htmlSC reversal of appeals court
26.http://caselaw.findlaw.com/in-court-of-appeals/1085870.html
27.http://caselaw.findlaw.com/oh-court-of-appeals/1358320.htmlReversal
28-29.http://caselaw.findlaw.com/ga-court-of-appeals/1530846.htmlTrial and appeal
30-31.http://caselaw.findlaw.com/in-court-of-appeals/1041324.htmlTrial and appeal
32-33.http://images.jw.com/ealert/healthcare/2010/0915sm.htmlTrial and appeal
More to come...
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[SolidGold]

I think I'm changing my mind. The large contract group is offering a signing bonus, so now it would take more than 4-5 years to make up the difference I'd lose by going with the democratic group before becoming a partner. The hospital is what I prefer and being next to the beach again in FL would be awesome.

Instead of continuing a non compete law suit thread, anyone else have an experience with a similar decision?

 

[deleted109597]

I would say don't do it for money. If work sucks, no amount of money will fix it.
On the other hand, plenty of both kinds of environments suck.

I've interviewed at megaconglomogroups, medium sized (10 hospital) groups, and talked to a few smaller groups. I moonlight for Schumacher right now as well. In the end, if you work at one place, you don't feel like a pawn in the machine as much as a guy working at that hospital, with your own medical director.

 

[GeneralVeers]

I currently am employed by a democratic group, and a large national corporation and can tell you that the experience with both is different, but one is not necessarily better.

Large Evil corporation
Benefits:
- Can arrange travel for you if you moonlight with them and will pay your expenses.
- Large number of facilities to work through (if you don't like your current hospital you can usually change).
- Good hourly pay, plus RVU (site dependent) on day 1.

Drawbacks
- Somewhat impersonal
- Do not offer good benefits (i.e. health insurance, disability, 401K)
- You are basically an interchangeable cog in a giant machine.


Smaller democratic group
Benefits:
- Potentially more income (mine maxes out after 6 years).
- Good benefits
- Productivity-based pay is the norm
- You typically know your leaders, and they work clinical shifts as well

Drawbacks
- Takes a few years to get good pay (with my group it was about 10 months).
- Often are pyramid schemes, be wary!
- Changing sites, or moonlighting at other facilities is more difficult.
- Often must meet minimum monthly hourly requirements to be "full time".

 

[tkim]

I think I'm changing my mind. The large contract group is offering a signing bonus, so now it would take more than 4-5 years to make up the difference I'd lose by going with the democratic group before becoming a partner. The hospital is what I prefer and being next to the beach again in FL would be awesome.

Instead of continuing a non compete law suit thread, anyone else have an experience with a similar decision?

I'll tell you what I went with. It was a small democratic group of 15, will make partner in 18 months/2400 hours, no buy-in. The group is contracted to the hospital, and has been for the past 25 years. I make an hourly rate, but part of it is held and returned quarterly after malpractice, health insurance, and whatever I claim for business expenses. Anything left over after this is taxed and paid out to me.

After making partner, you also get whatever percentage of the quarterly profit based on the humber of hours you worked that quarter. Not RVU or production based. So 'cherry-picking' charts won't spike your income. As a new employee, I don't work any single-coverage shift for 4-6 months, which includes overnights. They want longevity. No one has been denied partner. No non-compete clause. Very stable group, handful of people leaving over the past ten years - mostly to go to academics or out of the area.

Initially I was drawn to the high hourly rates advertised by the large CMGs, but when you come right down to it, you go to work where you want to live. And this was the hospital closest to where I wanted to live. So there it is.