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I worked at Vohra Wound Physicians full-time (more than 3 years)Pros
No call, no weekends, good pay, intellectually challenging. If you like wound care (and that's a big if), this is a great job, with predictable hours and very good pay.Cons
You have to be willing to work in multiple facilities, you have to be willing to work in nursing homes, you have to be OK with wound care, and corporate is far away (I was fine with these things, but for some they are negatives.)Advice to ManagementAdvice
An MD friend of mine was recently between jobs and tired of the rat race of every fourth night call, every other weekend on call, declining revenue, increasing demands, etc., or as I like to call it, the usual MD job in our current crazy health care system. I told him to check out Vohra Wound Physicians, since I thought it might be a good fit for him. I worked for them for about 4 years. I had a good experience, and left because I moved into another field. But before he ever called the contact I gave him, he called me back in a panic, telling me about this site Glass Door and what some reviewers had to say. I had never heard of GD, so I checked it out, and I'm shocked at what some people are saying, so I'm going to give a detailed summary of my experience.
First of all, this review is about working as a Wound Physician at Vohra Wound Physicians. Some of the reviewers griping about VWP seem to have held non-MD jobs with VWP, like sales rep or data entry. As for as those jobs go, I haven't a clue. I didn't spend much time in South Florida at the corporate mother ship, so I can't speak for them. All I can say about that is, the few times I was down there (once for my interview and twice for conferences), all the non-MD employees seemed very pleasant, and no one had anything bad to say.
The bulk of the people who work for VWP are MDs. They have something like 200 docs working in about 30 states. Each MD has his or her own territory, with the more urban territories being more vague and more likely to overlap and the more rural territories being much more spread out.
The first complaint of every physician I ever talked to in the company is the driving. Unlike in a traditional clinic or hospital, you don't have just one location you go to, you have several. The way the company is set up is this: You get hired for a particular region. The person who is your Practice Manager is a non-MD salesperson who is responsible for getting you a full load of patients. This person is incentivized (via some weird bonus method I could never figure out) to get you up to full time. They consider full time work to be at least 100 patients per week. Most of their docs can see at least 25 patients in a 9 hour day, so at least four days a week x 25 patients per day is what they aim for. Many of the docs (myself included during my time there) see a lot more than that. My own load was about 150, and my typical hours were 6:30 a.m. to 4:30 p.m., Monday through Friday. You are expected to see each patient once a week, and thus you go to each facility once a week. The facilities are rehab centers, what used to be called nursing homes. Some of these places have very high turnover, because they cater to the better-paying short-term patients, and some have lower turnover, with more long-term patients. Each center will have a variable number of patients, with some small facilities averaging only 5 patients for you to see, others as many as 25. So to have a full day, you might go to one or two facilities or four or five. Average for the company seemed to be about 3 facilities per day. The amount of driving for each doc for each day varied a lot, but it seemed to me that if you were willing to drive, they would find a big patient load for you quickly, and over time your area would shrink as they got new facilities and your seniority within the company increased. If you don't like driving, this job is definitely not for you. I didn't mind it, especially since I was able to schedule my facilities such that I was always going against traffic.
The size of your region, the amount of driving you will have to do, and the ramp up from your start date to a max load of patients is somewhat determined by luck and how good your practice manager is, but also by how willing you are to take whatever they give you at first. They have a specified ramp up period they will give you when you are hired, but this is the minimum. Your own might be faster, depending on many factors, some under your control, some not. As i said, some of it is luck. I was hired for a doc who quit, so I had 80 patients my first week. I spoke to another doc at one of the conferences who was hired for an area that had never had a wound MD, and the nursing homes in his area were so happy to have one, he was ramped up from 10 encounters his first week to 130 by his fourth week. On the other hand, other areas are slower to build, and if the doc is very picky about how far he or she is willing to drive, the ramp up will be slower. (To put that another way, if you take the first four facilities they offer you, you are likely to get a full load quickly. But if you turn down three of the first four because they are too far, or the wrong side of town, or you refuse to drive on Interstate highways, you are going to build very slowly.)
In regards to the accusations of shady business practices and sordid backgrounds, I'm really at a loss. First of all, does this site have any vetting of posters? I use Yelp a lot, and at Yelp, there's a lot of information about posters, so you get an idea of integrity; you can see, for example, that a reviewer has been around for X years and has posted Y number of reviews. Seems like at this site one pissed-off person could post the same baseless accusations from 20 separate IP addresses and get away with it. In any case, the sordid background thing has no specifics, so it's probably just a random insult, but maybe someone who once worked for the company had a bad history. It's a company with 200 docs, and yes some people wash out; wound care is not for everyone, and the business model works for some not for others. So I guess it's possible the reviewer met someone who said they used to work for la cosa nostra or whatever, but the claim that their management has sordid backgrounds is nonsense. The management chain, on the MD side, while I was there at least, was that each clinician reported to a clinician field manager (who was also a full time wound MD but was a company veteran and served as kind of middle management to corporate HQ), and that person reported to the Chief Medical Officer (Dr. Bird when I was there, I think he's still there), who reported to Dr. Vohra, the owner of the company. That's the entire MD management chain. Dr. Bird and Dr. Vohra are squeaky clean, you can Google them and check out their medical profiles easily enough.
The business model is not for everyone. When I was there, most of the docs were 1099, meaning they got paid a lump sum, then filed their own taxes etc. My understanding now is that everyone is an employee. Maybe some people saw the 1099 thing as "sordid" because you had to keep you own books, but I loved it, because of all the tax advantages. In any case, everyone is a W2 employee now, so that point is moot. Your "salary" is entirely based on production. You are paid for seeing each patient, but what you get paid depends on what you do. It's an exact replica of the CMS Fee For Service schedule, because they are billing CMS and private insurers based on that system and then giving you a percentage. They say that your portion is about 40%. Actually, I found mine was more like a third. Maybe some people think that's unfair, but Medicare never intended the Fee for Service reimbursements to be pure salary. The MD's salary, in fact, is considered one of the smaller parts of the payment, the rest going for the office, the personnel, malpractice insurance, supplies, and "overhead," meaning all the people you have to pay to support your practice, which these days, is mostly the people it requires to actually collect that payment. I worked for several years as a hospital-employed physician. Any idea how much the hospital in the US collects from all sources for the average hospital-employed internist? I'll save you the clicks, it's about $1.2 million. And the average salary of that same internist? About $200K. Add in malpractice, training reimbursement, health insurance, and vacation and retirement, it bumps up close to $300K. Works out to about 25%. Suddenly 33% doesn't sound so bad.
The simple fact of modern medicine is this: If you want to set up your own shop, get certified with every insurance company yourself, direct bill the insurance, and keep all the money for yourself, go right ahead. Good luck paying your mortgage when all your charts get reviewed and your payments get held up for six months. In all seriousness, only a very few docs these days manage to run their own show, and even fewer than that make a success of it. Most of us have realized that the costs and risks are too high, and join up with a big company. Why? Because if I as a lone doc gripe to an insurer about not getting paid, they tell me to f off. But large companies can afford lawyers and lobbyists and can make sure they get paid. They don't get paid if I don't, so they make darn sure I get paid, and on time every time.
When I started my own practice fresh out of residency many years ago, i got my first reimbursement check from an insurer (Medicare, as it turned out) exactly 13 months after I started seeing patients. It was fully 2 years before most of the insurers were current on payments, most of them refusing the claims of the first 3-6 months because the claims were too old, never mind it was their fault the claims were that old. When I joined VWP, I started in the first week of the month, and got paid in full for every patient I had seen during that calendar month, on the 15th of the following month. No denials, no waiting to see when or if the insurer would pay, there was my entire amount 39 days after I saw my first patient, and 15 days after the patients I saw on the last day of the calendar month. And now, I understand from friends of mine still with the company, they pay on the 12th or earlier!
As for the clinical viewpoint, wound care today, in my opinion, is where gerontology was 20 years ago. Early on in my career, the conventional wisdom was that internists who specialized in geriatrics were scammers. Heck, anyone could take care of old people, it's all the same diseases, all the same meds, right? Turned out, of course, the geriatric specialists were right, and there really is a difference in how you care for a bed-bound patient with 10 diseases vs. how you care for 10 ambulatory patients with one disease each. Wound care for many years has been the provenance of nurses, whose entire tool kit was wet-to-dry dressings. When docs finally got in the act, no one did it full time, but just as a little adjunct to their practice. We are now finally starting to see full-time wound docs, and guess what, it turns out that wound care is actually very complex and docs who only dabble in it tend to be bad at it. Far from being a "greedy" company, the service provided to the nursing homes by VWP is offered at a fraction of the cost of treating that patient in a wound clinic or hospital. I've worked in wound clinics and while some are good, some are outright factories for generating revenue, patient care be damned. Look at the incentives: In a wound clinic, they want a full schedule, they could care less how long it takes a patient to heal (heck, the longer the better, more $$$). But in a nursing home, the NH staff has the state reviewers crawling up their rear about healing times and minimizing chronic wounds, so they only want docs in there who are going to heal wounds fast. Any doc that putters around and doesn't do everything possible to heal those wounds will be booted out quick. So VWP's interests are, hire good docs who actually know and care about wounds.
If you're looking at wound care, my advice, the same advice I gave my friend, is this: It's a great job, for some docs. I think the easiest thing to do is to look at facts, not late night rants of crazy people with an agenda. Which docs are right for this job? Obviously, you need to like wound care. That alone rules out a lot of people. I would not advise taking this job just because there's no call or you think you can make a lot money or whatever. Anyone who does that is going to be unhappy, and probably end up posting nasty reviews on the Internet. It's wound care! It's intellectually challenging, involves both medical reasoning and procedural skill, and allows you to be very independent. But it's also gross and smelly. Either you can or can't do the job, you can't force it. Second, you work in nursing homes. Call them rehab centers all you want, they are nursing homes. Again, either you can do it or you can't. Some people get depressed just driving past a nursing home. I loved the challenge, but also the people. Sure some are demented, but many 90-somethings are sharp as a tack and shared their amazing stories with me. Third, you work alone. Not really, because you always round with a wound nurse, and see pretty much the same nurses at the same centers each week, and you will get to know the primary care physicians and see them every week also, but as far as other docs in the company, you will only see them a few times a year. For some, this is a Con. For me, it was a Pro. I loved doing my own thing. I loved the fact that I was FAR away from Florida, and my communications with my regional manager and corporate managers was mostly via email and phone. Fourth, you "eat what you kill." Again, a Pro for some, a Con for others. If your practice style is "Reviewed nurse's note, continue same care," you are a lousy doc, and your payment will be low. If your style is, "Let's fix this," then you'll do well.
As far as salary goes, when I was there, corporate said the average Revenue Per Encounter (your per-patient fee) was about $38. Mine was $40. The range of other docs I talked to was $30-$50. Those at the $30 end were those that, in my opinion, were lazy do-nothing docs with poor healing rates for their patients. Those at the higher end tended to have facilities where the nursing staff only wanted them to see the sickest patients. Most of us were right in the middle, at $38-$42. As for your payment, $40/encounter x 100 patients is $4,000/week x 50 weeks is $200,000. Add in more patients for more revenue. As I said, I was about $40 x 150 patients for $300K/year. My expenses were: gas (about $200/month); supplies such as scalpels and silver nitrate sticks (about $300/month), and malpractice (about $1,000/month). Which meant that my net (before taxes, after expenses) was about $280K a year. For a M-F job with predictable hours, no pager to carry, no night work and no weekend work, I felt very well rewarded. I LOVED that fact that I got paid every month, on the same day, without fail. I highly recommend this job to anyone considering wound care as a career, subject to the caveats above.RecommendsPositive OutlookApproves of CEO
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Vohra Wound Physicians is the premier wound care physician group that provides expert wound and skin care throughout the United States.
We are a physician group comprised of General and Specialist Surgeons, Family Practitioners, and Internists.
Our physicians conduct weekly bedside consultations within long term care, rehabilitation, and skilled nursing facilities with...
Mission: To provide optimal wound management to nursing home residents throughout the United States.