New Grads: What Type of EM Job Do You Want?

Jeff Pinnow, MD

Disclosures

March 19, 2012

In This Article

Contract Management Groups

Corporate groups are those that are managed by corporations as opposed to being run by the physicians in the group. A contract management group (CMG) holds contracts with individual hospitals with the promise to provide physician services, and it, in turn, employs physicians to fulfill those contracts. From a hospital perspective, because of the large network of contracts, billing services and physician employees, CMGs may be able to offer lower contract costs to smaller hospitals, which are also looking at the bottom line. The contract management group deals with all the financial management and human resources aspects and subsequently pays the physicians for their work within the contracted ED. The physician may either be employed directly by the group or work as an independent contractor on behalf of the group. Traditionally, the physician provides clinical care and has little input as to the finances of the group and how they are to be managed. Physician employees of CMGs typically work for a salary, with bonuses tied to patient satisfaction and resource utilization. Often, CMGs may take a disproportionately large part of the emergency physician’s billed and collected professional fees as remuneration for administrative services provided by the group.

As with smaller democratic groups, the need to maintain the contract still exists, and physicians still must maintain strong relationships with hospital administration. As an employee of the CMG, the physician must also maintain good relationships with the CMG administration, thus adding an additional layer of responsibility on the emergency physician. The physician thus functions as an employee of two entities and may have difficulty in keeping both employers satisfied. The fact that CMGs are corporately run places an emphasis on the bottom line and profits. This emphasis may alter patient management practices on the part of the physician. This is part of the reason that many states have laws against the corporate practice of medicine. The advantage of belonging to a CMG is the ability to work at multiple locations while still being employed by the same employer. This may be attractive to young physicians unsure about what size or type of ER they want to work in or what location a physician wishes to live in.

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