7-Figure Anesthesia Salaries?

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That would be true if alternative jobs didn't offer the same rip off.

No. If you can't find a better job, than by definition it isn't a rip off. It's a market. If nobody is offering something, then don't complain about not getting it from any particular job. Wishing things could be like the good old days is just pointless.

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How does partnership work? Is it something that is offered in other specialities like IM/FM/Psych etc...? What are the pros and cons?


I cant speak for IM/FM....but certainly not psych typically. Psych is very much(in private practice) an eat what you individually kill model....and there isn't a heck of a lot to kill.
 
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I cant speak for IM/FM....but certainly not psych typically. Psych is very much(in private practice) an eat what you individually kill model....and there isn't a heck of a lot to kill.
Really? I thought there were hoards of ppl just waiting to get in with a psych? Where I practice, getting someone a psych appointment is second in difficulty only to derm... and maybe neuro.
 
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When physicians become owners of something, even if it is just a stupid piece of paper signed by the CEO of a hospital, they somehow magically transform into sharks or elitists, and their next step would be to screw and victimize the newcomers and suck their blood.
This interesting phenomenon becomes even more pronounced in an unfavorable job market, the predators become bolder and all shame simply disappears.
The explanation of this phenomenon is that people who go to medical school stop evolving on the human level for the duration of their school and residency, and in general they are very competitive and have an insatiable desire to be ahead of their peers. Being in control of another physician's livelihood and career is very satisfying and fulfilling to that constant itching to be better.
 
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It's also a convenient view if you aren't a communist.

I don't believe anybody is entitled to anything when it comes to a job. If you go looking for a job, you go looking. You will hopefully get some interviews and some job offers and then decide which is best for you. Bitching about what you get offered is just stupid IMHO. A job offer is a take it or leave it proposition. If you choose to accept the offer, don't go whining that the employer is stealing from you.


And keep in mind, I'm in a group where everybody is a partner. We don't even have anybody on a partnership track since we haven't hired anybody in years. I'm more likely to be looking for a job in the future than I am to be hiring a non partner. But if I took a job somewhere else as an employee or on a prolonged partnership track, I sure wouldn't have animosity towards my bosses so long as they treated me fairly according to my contract.

I also agree that what you get offered depends on the job market. That's the whole point. As a physician, you are essentially a commodity. Your value may go up or down over time. If you need a job when your value is at a low point, don't complain about what the going rate is.
No. If you can't find a better job, than by definition it isn't a rip off. It's a market. If nobody is offering something, then don't complain about not getting it from any particular job. Wishing things could be like the good old days is just pointless.

It's not a free market because monopolies aren't broken up. I can't get a different job because the same couple of groups control everything. A 'going rate' requires competition which is absent in anesthesia.
You guys are kidding yourselves if you think there is a viable alternative to taking a lousy job, and you are just bad people if you think control of an exclusive contract gives you the right to take income from my labor.
 
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It's also a convenient view if you aren't a communist.
Or if you have control over a monopoly.

You are throwing big words very easily; brainwashed you much they did. Growing up in this country, you have no idea what "communism" looks like. Next time when you're out their searching for a job and all you get are crappy offers, please remember this conversation.

And, yeah, I don't really give a damn about anesthesia "partners", since most of them did/do not assume significant risks when starting/running their group, and don't bring anything special that their physician employees wouldn't. It's not like starting most other types of businesses in a free market; 90+% of the value of their business is the monopoly over a contract, being at the lucky place at the lucky time. They are just gatekeepers/monopolists, another form of crony capitalists, about as far from the kind of humans I like as... communists.
 
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Or if you have control over a monopoly.

You are throwing big words very easily; brainwashed you much they did. Growing up in this country, you have no idea what "communism" looks like. Next time when you're out their searching for a job and all you get are crappy offers, please remember this conversation.

And, yeah, I don't really give a damn about anesthesia "partners", since most of them did/do not assume significant risks when starting/running their group, and don't bring anything special that their physician employees wouldn't. It's not like starting most other types of businesses in a free market; 90+% of the value of their business is the monopoly over a contract, being at the lucky place at the lucky time. They are just gatekeepers/monopolists, another form of crony capitalists, about as far from the kind of humans I like as... communists.

Don't worry. soon all the workers will get sick of it, they'll throw out those crony capitalists, secure their capital, and all will be well. Only a few hundred more years...
 
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Or if you have control over a monopoly.

You are throwing big words very easily; brainwashed you much they did. Growing up in this country, you have no idea what "communism" looks like. Next time when you're out their searching for a job and all you get are crappy offers, please remember this conversation.

I find it odd that you claim to know anything personal about my life or experience. I've spent several months in Russia and China so I know exactly what communism is and what it looks like.

And yes, if I'm ever looking for a job, I'll remember this because it's simple and truthful. Why would I ever be mad at somebody for offering me a job? Either I like the offer or don't. That's it. In other words, don't hate the player, hate the game. I've lived happily on less than 20K a year so I find it hard to call a 6 figure job offer to be "crappy".
 
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It's not a free market because monopolies aren't broken up. I can't get a different job because the same couple of groups control everything.

You realize a "couple of groups" isn't a monopoly, right? Oligopoly is perhaps more appropriate but still not technically correct for what you are describing.

But anyways, your job search isn't limited to a geographic area. I can probably find 1000+ entities hiring anesthesiologists in the continental US. You could work for any of them that are hiring. And if they aren't getting together and colluding to hold down wages, it isn't illegal (or immoral).
 
And, yeah, I don't really give a damn about anesthesia "partners", since most of them did/do not assume significant risks when starting/running their group, and don't bring anything special that their physician employees wouldn't. It's not like starting most other types of businesses in a free market; 90+% of the value of their business is the monopoly over a contract, being at the lucky place at the lucky time. They are just gatekeepers/monopolists, another form of crony capitalists, about as far from the kind of humans I like as... communists.

PS, no group has a "monopoly over a contract". It's a contract and is subject to periodic renewal. We renegotiate ours every 2 years. Any group is free to bid on the same services. Our hospital is extremely happy with our service so they aren't looking to change anything but if you were so super awesome I'm sure you could start a group to kick us out.
 
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I find it odd that you claim to know anything personal about my life or experience. I've spent several months in Russia and China so I know exactly what communism is and what it looks like.
No, you don't. Otherwise you wouldn't be so fast in calling me a communist just because I don't admire the concept of physician employees, where the employer takes most of the profits, while the employees assume most of the (malpractice) risks. I believe that returns should be proportional to the risks taken, so I am a big fan of capitalism, just not in the oligopoly version.
 
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You realize a "couple of groups" isn't a monopoly, right? Oligopoly is perhaps more appropriate but still not technically correct for what you are describing.

But anyways, your job search isn't limited to a geographic area. I can probably find 1000+ entities hiring anesthesiologists in the continental US. You could work for any of them that are hiring. And if they aren't getting together and colluding to hold down wages, it isn't illegal (or immoral).
Yes, I realize that. I think monopoly gets my point across.

You can find a long list of jobs at AMCs or non-partnership groups or partnerships in terrible little towns in the middle of nowhere. You can't find any partnership tracks in any major city in my state because people use the monopoly control of their exclusive contracts at a monopoly-like percentage of local hospitals to take money from people who are kept out of their partnership.

Yes I could move to someplace I would hate and join a fair group, but I shouldn't have to. I should be able to either get equal treatment from my coworkers or I should have the right to compete.

Even if I agreed with everything you said, you have to admit that these are terrible people who will just take the income that you earned just because they can get away with it.
 
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Yes, I realize that. I think monopoly gets my point across.

You can find a long list of jobs at AMCs or non-partnership groups or partnerships in terrible little towns in the middle of nowhere. You can't find any partnership tracks in any major city in my state because people use the monopoly control of their exclusive contracts at a monopoly-like percentage of local hospitals to take money from people who are kept out of their partnership.

Yes I could move to someplace I would hate and join a fair group, but I shouldn't have to. I should be able to either get equal treatment from my coworkers or I should have the right to compete.

Even if I agreed with everything you said, you have to admit that these are terrible people who will just take the income that you earned just because they can get away with it.
The future of medicine is very clear... everyone will work for a corporation of some sort, the time of small or midsize groups is over and most of them are either selling or being forced out by bigger entities.
All the pseudo private groups who are still in existence and pretending to be stable will disappear within the next 5 years.
 
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A super Senior partner in a large group may take home $1.3 million per year. That super senior partner has 4 junior track employees working for him. Still, he is doing cases, taking call and dealing with the business.

The CEO or CFO of a large AMC Is making mega millions (net worth well over $50 million), doesn't do cases, no call and has dozens of employees to deal with the business.

The day of the super senior partner is coming to a close while the CEO/CFO or founding CRNA owner continues to rake in millions each year while he stays home watching the price is right.

So my friends, which of these two models is the real monopoly of this field.
 
Yes, I realize that. I think monopoly gets my point across.

You can find a long list of jobs at AMCs or non-partnership groups or partnerships in terrible little towns in the middle of nowhere. You can't find any partnership tracks in any major city in my state because people use the monopoly control of their exclusive contracts at a monopoly-like percentage of local hospitals to take money from people who are kept out of their partnership.

Yes I could move to someplace I would hate and join a fair group, but I shouldn't have to. I should be able to either get equal treatment from my coworkers or I should have the right to compete.

Even if I agreed with everything you said, you have to admit that these are terrible people who will just take the income that you earned just because they can get away with it.


Are you familiar with the auto/home insurance business? The local agent who simply opened up a store on a great block rakes in hundreds of thousands of dollars per year doing relatively little work. That person has an exclusive on that block/street and a future employee of his will be generating money for that owner for many years. When that owner hires a second employee that scheme Continues on.

I know a guy who has 14 agents now working for him. All he did was open that BRAND NAME INSURANCE FIRM on a block somewhere. But, that owner is now making a fortune off those 14 agents while he himself works less than 10 hours per week. Is this fair? Did the original owner actually do anything so special? No. But, he has an exclusive deal with the Insurance company for that prosperous block/neighborhood.

I know a Beer Distributor "owner" who makes millions from others work as well. He inherited the distributorship from his Father. This Beer guy doesn't do much either but since the Company restricts competition in his area the profits are huge. He hires "employees" to do all the work while he watches ESPN and CNBC all day. If you try to sell Beer cheaper than him (same major national Beer line) the Lawyers will sue you out of existence. A local Bar owner told me the Beer is cheaper at Walmart than the Distributor most of the time but he is forbidden to sell any of that Brand Beer unless he buys it from the certified Distributor.

Tesla has been barred from selling its cars in certain states because they don't have a dealership. If a customer wants to buy a car Tesla can't legally sell it to them unless they agree to open a dealership. Tesla offers "mobile van" repair to all its customers but the OLD AUTO ELITE like the current system where dealerships mark up the cars; hence, these politically connected dealership owners convinced govt. officials to ban direct sales of cars.
http://www.cbsnews.com/videos/tesla-barred-from-selling-cars-in-michigan/


The world is NOT FAIR; deal with it and learn to succeed in spite of it.
 
Are you familiar with the auto/home insurance business? The local agent who simply opened up a store on a great block rakes in hundreds of thousands of dollars per year doing relatively little work. That person has an exclusive on that block/street and a future employee of his will be generating money for that owner for many years. When that owner hires a second employee that scheme Continues on.

I know a guy who has 14 agents now working for him. All he did was open that BRAND NAME INSURANCE FIRM on a block somewhere. But, that owner is now making a fortune off those 14 agents while he himself works less than 10 hours per week. Is this fair? Did the original owner actually do anything so special? No. But, he has an exclusive deal with the Insurance company for that prosperous block/neighborhood.

I know a Beer Distributor "owner" who makes millions from others work as well. He inherited the distributorship from his Father. This Beer guy doesn't do much either but since the Company restricts competition in his area the profits are huge. He hires "employees" to do all the work while he watches ESPN and CNBC all day. If you try to sell Beer cheaper than him (same major national Beer line) the Lawyers will sue you out of existence. A local Bar owner told me the Beer is cheaper at Walmart than the Distributor most of the time but he is forbidden to sell any of that Brand Beer unless he buys it from the certified Distributor.

Tesla has been barred from selling its cars in certain states because they don't have a dealership. If a customer wants to buy a car Tesla can't legally sell it to them unless they agree to open a dealership. Tesla offers "mobile van" repair to all its customers but the OLD AUTO ELITE like the current system where dealerships mark up the cars; hence, these politically connected dealership owners convinced govt. officials to ban direct sales of cars.
http://www.cbsnews.com/videos/tesla-barred-from-selling-cars-in-michigan/


The world is NOT FAIR; deal with it and learn to succeed in spite of it.

If you don't like the insurance guy's deal you can open a brach of another insurance company next door and compete directly for customers on both the quality and price of your product. There are only so many hospitals and competition for anesthesia is not permitted. I would gladly compete head to head with partners. I provide at least as good a service at half the price!

Anyway, listing other injustices doesn't make this one any better.
 
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How is that an injustice? Two of my friends both started companies with a couple partners based on an idea they had but couldn't implement. Both companies started with them bringing in subject matter expert partners, developing the concept and then hiring outside employees to do the bulk of the work for them for a salary. Fast forward 20 years. One sold for $900m and the other has a market cap over 3 billion.
The few visionaries that started the companies and the initial angel investors made 8 and 9 figures off their ideas and the employees that built the brands made their salary and maybe some modest incentive compensation.
Was that fair? Of course it is.
 
How is that an injustice? Two of my friends both started companies with a couple partners based on an idea they had but couldn't implement. Both companies started with them bringing in subject matter expert partners, developing the concept and then hiring outside employees to do the bulk of the work for them for a salary. Fast forward 20 years. One sold for $900m and the other has a market cap over 3 billion.
The few visionaries that started the companies and the initial angel investors made 8 and 9 figures off their ideas and the employees that built the brands made their salary and maybe some modest incentive compensation.
Was that fair? Of course it is.
Of course, but anesthesia is nothing like that AT ALL. No partner anywhere in America came up with jack. They just have exclusive contracts. It's not like they invented propofol or sevo. They didn't create or develop or invent anything.

58b60830d26ef5b1f63fd4edb732fe5c220cba41465f207836d5bf861c5ece40.jpg
 
Of course, but anesthesia is nothing like that AT ALL. No partner anywhere in America came up with jack. They just have exclusive contracts. It's not like they invented propofol or sevo. They didn't create or develop or invent anything.
They didn't even risk much money. They basically just showed up.

What other job in America requires the employee take all the risks, even of bankrupting one's family, while the employers take the cream of the profits? It's usually the other way round: the owners who risk(ed) their existence reap the benefits, while the employees who don't risk much get much less. I am perfectly fine to be just an employee in the latter case, and I find it fair. But not in the former.

Rather than work as an employee for some dinguses, I am a lowly-paid academic. At least (most of) the money they take goes for a good cause, and the malpractice coverage is at least double.
 
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PS, no group has a "monopoly over a contract". It's a contract and is subject to periodic renewal. We renegotiate ours every 2 years. Any group is free to bid on the same services. Our hospital is extremely happy with our service so they aren't looking to change anything but if you were so super awesome I'm sure you could start a group to kick us out.
It is anti competitive. If one has credentials one should have privileges to provide anesthesia at multiple hospitals and let the patients and surgeons decide who is best and consult them. The exclusive contract in my opinion violates the stark laws and anti kickack laws.
 
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Are you familiar with the auto/home insurance business? The local agent who simply opened up a store on a great block rakes in hundreds of thousands of dollars per year doing relatively little work. That person has an exclusive on that block/street and a future employee of his will be generating money for that owner for many years. When that owner hires a second employee that scheme Continues on.

I know a guy who has 14 agents now working for him. All he did was open that BRAND NAME INSURANCE FIRM on a block somewhere. But, that owner is now making a fortune off those 14 agents while he himself works less than 10 hours per week. Is this fair? Did the original owner actually do anything so special? No. But, he has an exclusive deal with the Insurance company for that prosperous block/neighborhood.

I know a Beer Distributor "owner" who makes millions from others work as well. He inherited the distributorship from his Father. This Beer guy doesn't do much either but since the Company restricts competition in his area the profits are huge. He hires "employees" to do all the work while he watches ESPN and CNBC all day. If you try to sell Beer cheaper than him (same major national Beer line) the Lawyers will sue you out of existence. A local Bar owner told me the Beer is cheaper at Walmart than the Distributor most of the time but he is forbidden to sell any of that Brand Beer unless he buys it from the certified Distributor.

Tesla has been barred from selling its cars in certain states because they don't have a dealership. If a customer wants to buy a car Tesla can't legally sell it to them unless they agree to open a dealership. Tesla offers "mobile van" repair to all its customers but the OLD AUTO ELITE like the current system where dealerships mark up the cars; hence, these politically connected dealership owners convinced govt. officials to ban direct sales of cars.
http://www.cbsnews.com/videos/tesla-barred-from-selling-cars-in-michigan/


The world is NOT FAIR; deal with it and learn to succeed in spite of it.

Your analogy is ridiculous. The rules in medicine are quite different from the rules in the insurance and beer business.
 
DId you write this with a straight face?
Yes. Although it's probably more like "some of", not "most of".

I once interviewed at an ASC group which had 2 owners and a number of employees. Nobody had been made partner, ever, in 5+ years. Just disgusting.
 
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I literally cannot believe someone can be smart enough to graduate medical school and dumb enough to believe that a business they've never met anybody at or been a part of owes them something. Just astounding. They didn't make you go to medical school or do a residency in anesthesia, yet you hold bitterness towards them for offering you a job that you think doesn't pay enough?

Oh, and the next time anybody thinks the profits that are "taken" from them in an academic setting are for a noble cause, please go look up the salaries of the CEO and upper level execs of that health system.
 
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I provide at least as good a service at half the price!

Here's the thing, you don't and you don't. Groups have contracts because the hospitals are HAPPY with the service. And our service doesn't "cost" the hospital anything as they aren't paying us so not sure how you cost less than nothing.
 
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It is anti competitive. If one has credentials one should have privileges to provide anesthesia at multiple hospitals and let the patients and surgeons decide who is best and consult them. The exclusive contract in my opinion violates the stark laws and anti kickack laws.

Exclusive contracts for services are unrelated to Stark and kickback laws. Not even close. Hospitals have all sorts of exclusive contracts, some of which are with physician groups and some of which are with non physician groups (food vendors, etc).

The Stark law has to do with referring patients covered by CMS to a facility you have a financial relationship with. Anesthesiologists don't have patients to refer to a facility. We just work at the facility and get whatever rolls in the door.
 
Virtually all small to medium size groups who are still holding exclusive contracts with hospitals will be gone within a few years, they are no longer compatible with the new system, especially those who are not getting any subsidy from the hospital.
 
Here's the thing, you don't and you don't. Groups have contracts because the hospitals are HAPPY with the service. And our service doesn't "cost" the hospital anything as they aren't paying us so not sure how you cost less than nothing.

Yeah they're happy with the service, which I provide!
 
I literally cannot believe someone can be smart enough to graduate medical school and dumb enough to believe that a business they've never met anybody at or been a part of owes them something. Just astounding. They didn't make you go to medical school or do a residency in anesthesia, yet you hold bitterness towards them for offering you a job that you think doesn't pay enough?
Of course I would hold bitterness for being well underpaid, while doing exactly what the partners are doing, without any real chance of advancement. Every normal human being would, in any business, especially in one where we take most of the risks and they reap most of the benefits. I don't see what's so complicated to understand or extraordinary. It's absolutely normal human psychology. Equal pay for equal work (and equal risk) has nothing to do with socialism or communism, just with what's fair.

Of course you are free to do as you want as a business owner. And I am free to despise you for employing physicians long-term. They both go with my libertarian-leaning philosophy, but neither can change human psychology.
Oh, and the next time anybody thinks the profits that are "taken" from them in an academic setting are for a noble cause, please go look up the salaries of the CEO and upper level execs of that health system.
I won't comment on this. I'll just say that my salary has nothing to do with those.
 
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I literally cannot believe someone can be smart enough to graduate medical school and dumb enough to believe that a business they've never met anybody at or been a part of owes them something. Just astounding. They didn't make you go to medical school or do a residency in anesthesia, yet you hold bitterness towards them for offering you a job that you think doesn't pay enough?

Oh, and the next time anybody thinks the profits that are "taken" from them in an academic setting are for a noble cause, please go look up the salaries of the CEO and upper level execs of that health system.

Is being treated fairly being owed something?

Groups can:
1) Not need any more help and not be hiring- no opportunity.
2) Need some help in the daytime but not need call or weekend help- mommy track offer.
3) Need help with a full call-taking MD- partnership track opportunity.
4) Need help with a full call-taking MD- not offering partnership.

1,2, and 3 are all okay.
The problem is when 4 needs another partner but doesn't allow partnership because they are greedy bastards.
 
Your analogy is ridiculous. The rules in medicine are quite different from the rules in the insurance and beer business.


The rules in Medicine are in general different than the Beer Business; but, a few specialties are EXACTLY like the Beer Business:

1. Anesthesiology
2. Radiology
3. Pathology
4. EM

Hospitals are like major beer corporations and they offer EXCLUSIVE contracts for these areas. That is why I recommend you go into the WINE BUSINESS which is analogous to Orthopedics or ENT.

If you choose this type of specialty (see 1-3) then you are stuck with the concept of Exclusive contracts.
 
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Courts Reject Antitrust Challenges to Hospital Exclusive Provider Contracts
Client Alert
January 12, 2004
Hospital-based physicians, such as radiologists, anesthesiologists and emergency room physicians, who are excluded from practice at a hospital when that hospital enters into an exclusive contract with a physician group often look to the courts for relief. In these cases, physicians have claimed that antitrust law provides them with a right to practice at the hospital despite the exclusive contract. Such claims have been rejected by the courts. BCB Anesthesia Care v. Passavant Memorial Area Hospital, 36 F.3d at 664, 667-68 (7th Cir. 1994) (listing overwhelming number of cases that have rejected challenges to exclusive contracts on antitrust grounds).
A physician is not a proper party to bring a claim of antitrust violation; he or she merely seeks recovery of an alleged loss of personal income. Antitrust law serves to protect important public policy considerations concerning the structure of the marketplace; it does not serve to provide a mechanism to recover for personal injury. The class of allegedly injured parties who can bring an antitrust claim as limited. See e.g. Greater Rockford Energy & Technology Corp. v. Shell Oil Co., 998 F.2d 391, 395 (7th Circuit 1992) (antitrust actions are limited to those who are in the best position to vindicate the antitrust policy concern).

Physicians generally do not have standing to assert antitrust claims because they are not efficient enforcers of the antitrust laws. Only those who suffer a direct antitrust injury - - hospital patients and their payors - - have standing to bring such claims. Hospital "patients, their insurers or the government, all of whom are interested in ensuring that consumers pay a competitive price" are the ones to bring an antitrust claim. Mid-Michigan Radiology Associates P.C. v. Central Michigan Community Hospital, 1995 WL 239360 at 5 (E.D. Mich. 1995) (no standing for doctor excluded from the market) (quoting and relying upon Todorov v. DCH Healthcare Authority, 921 F.2d 1438, 1455 (11th Cir. 1991); Kurshin v. Benedictional Hospital, 34 F. Supp. 2d 133, 140 (N.D.N.Y. 1999) (same) (citing Addis v. Holy Cross Health System Corp., 1995 WL 914278 at *8 (N.D. Ind. 1995) and Rooney v. Medical Center Hospital of Chillicothe, 1994 WL 854372 *6 (S.D. OH 1994)).

Antitrust claims by physicians also have been rejected because they have not suffered any "antitrust injury." The exclusion of a particular doctor from a hospital does not constitute an antitrust injury; the replacement of one doctor with another doctor does not adversely change the competitive circumstances in the claimed market. Antitrust laws were enacted for "the protection of competition, and not competitors" and harm to individual doctors does not constitute a violation of the antitrust laws. Integraph Corp. v. Intel Corp., 195 F.3d 1346, 1356 (Fed. Cir. 1999) (citing Mr. Furniture Warehouse, Inc. v. Barclays Am./Commercial Inc., 919 F.2d 1517, 1522 (11th Cir. 1990); Independent Milk Producers Co-op v. Stoffel, 102 Wis. 2d 1,7-8, 298 N.W.2d 102 (Ct. App. 1980) (to be unlawful, the restraint must have a significant impact on competition in the relevant market). For example, Coffey v. Healthtrust, Inc., 955 F. 2d 1388 (10th Cir. 1992) addressed a situation where a radiologist worked for a medical group that had an exclusive contract with the local hospital, but later resigned from the group and sought to contract with the hospital individually. When his approach was rebuffed, the doctor sued, seeking to void the exclusive contract by claiming that it violated antitrust laws. The Tenth Circuit rejected his claim and held that there was no antitrust injury because patients receiving medical services before the doctor left the group still were receiving medical services after he was denied access to the hospital.

Other courts that have addressed the issue of a doctor excluded from the hospital because of an exclusive medical provider contract have reached the same conclusion: that the doctor's alleged injury is not an antitrust injury and the doctor therefore cannot state a valid antitrust claim. See e.g. Bakalaw v. Lovell, 14 F.3d 793 (2d Cir. 1994) (even if anesthesiologist was excluded from practice because of an exclusive contract, there is no antitrust injury from the consumer's point of view since the consumers, before and after implementation of the exclusive contract, still received medical services; only the name of the medical service providers changed); Kurshin, 34 F. Supp. 2d at 139 (no antitrust injury resulting from exclusive contract at hospital since only the providers changed);Davies v. Genesis Medical Center, 994 F. Supp. 1078, 1093 (same) (listing cases where doctors who were excluded from practicing at hospitals could not allege antitrust injury); Mid-Michigan Radiology, 1995 WL 239360 at *4 (same); Howerton v. Grace Hospital, Inc., 1995 WL 787529 #7 (W.D. N.C. 1995) (same); Salaman v. Our Lady of Victory Hospital, 1999 WL 955513 (W.D. N.Y. 1999) (same).

While physicians continue to file lawsuits seeking to have the courts overturn decisions by hospitals to enter into a exclusive provider contracts, the courts for the most part have upheld the decisions of hospital administration to enter in such contracts. Hospitals are given wide deference by the courts to handle their administrative affairs.
 
http://law.case.edu/studentLife/organizations/healthmatrix/files/Forrest.pdf

Hereare some Legal cases which has established the ground rules in Anesthesiology. If SCOTUS were to revisit their 1984 ruling in Jefferson Parish Hospital District vs Hyde then those bitching about this field's exclusive contract would have standing. As of today those Med Students entering into Anesthesiology, EM, Rads or Pathology are stuck with the Beer Distributorship model of medicine.
 
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California anesthesiologists should know by now that an exclusive contract to provide anesthesia services doesn’t provide the same level of job security as a tenured professorship or a seat on the Supreme Court.

As CSA Legal Counsel Phillip Goldberg, Esq., has reminded us more than once, “hospital administrators have extremely broad discretion in selecting the group to staff the hospital’s anesthesia department.”

signing_contract.jpg
Yet many anesthesiologists were surprised to learn recently that Dallas-based Tenet Healthcare is considering a contract with a national management company that would replace current contracts with the anesthesiology, emergency, and hospitalist departments in its 11 California hospitals.

The Tribune newspaper in San Luis Obisporeported that Tenet is reviewing proposals from three national companies to provide anesthesiology and other services at the 11 hospitals, and may choose one of them by December. This news has sparkedpushback from the medical staff at Sierra Vista Regional Medical Center among other hospitals, and a letter of protest from the CMA that accused Tenet of acting “unilaterally and without regard to the varying needs and unique circumstances of each Tenet hospital.”

But Tenet’s action proves that having an “exclusive” contract means only one thing: You are the only one that can lose it.

From Tenet’s point of view, costs must be controlled. Apparently, Tenet has made it clear to the large contract management groups that it is looking for a no-subsidy arrangement for all its contracts. It’s nothing personal; it’s just business. But it ispersonal for many patients and physicians.

To its credit, Tenet is discussing the situation with local hospital medical staffs. Score one for establishing relationships with your facility. As Mr. Goldberg advised us last year, “Since anesthesiologists have limited legal bases for challenging decisions on anesthesia contracts, anesthesiologists should adopt a strategy ofreducing hospital administrations’ inclination to replace one anesthesia group with another.”

However, the risk to the Tenet anesthesiology groups is very much alive.
 
I will say it again. If you choose Anesthesiology, Radiology, EM or Pathology you will likely be someone's EMPLOYEE. You will be their lackey while they rake in the profits. If you want a better deal AVOID those fields or hope SCOTUS reverses their 1984 decision in Jefferson Parish Hospital vs Hyde.
 
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Every hospital based group is at risk of replacement by a Management company. The Management company can use the profit from Anesthesia to fund the ER or the ICU. A full service management company could save your hospital's CEO millions per year. Even if your group doesn't require a subsidy you are at risk of losing out to a Management company.

http://www.aaem.org/UserFiles/SepOct14PresidentsMessage.pdf
 
An exclusive contract at a hospital that prevents you from just applying for privileges is not an antitrust violation according to the court.

Exclusive contracts at the majority of hospitals in a city or region that allows the group to receive higher billing from insurers/patients and which prevents competition from less expensive groups IS an antitrust violation. Jefferson Parish has nothing in common with today's megagroups.
 
An exclusive contract at a hospital that prevents you from just applying for privileges is not an antitrust violation according to the court.

Exclusive contracts at the majority of hospitals in a city or region that allows the group to receive higher billing from insurers/patients and which prevents competition from less expensive groups IS an antitrust violation. Jefferson Parish has nothing in common with today's megagroups.


Good luck with your legal case against the AMCs and hospitals. Such a case will cost millions in legal fees and I don't share your view that today's megagroups are necessarily an Anti-Trust Violation because there at least a half-dozen of them competing against one another. Consolidation in an industry is perfectly legal and not Anti-Trust provided there are enough competitors left in place.
 
Consolidation in an industry is perfectly legal and not Anti-Trust provided there are enough competitors left in place.
And that (my emphasis) is exactly what the backdoor is in American antitrust law. Americans seem to think that having just 2-3 players in a market is not a monopoly, as long as the players don't actively cooperate to fix prices. (They just do it passively, based on easy to obtain information about the pricing structure of the other companies, live and let live.)

That's OK, as long as it's easy for any other company to enter the market and disrupt it. But when it's not, just 2-3 players in a market are a monopoly. And the way to break it is to regulate the companies as utilities, like the FCC is trying to do with ISPs.

Unfortunately, based on case law, I also tend to believe that antitrust law does not apply when anesthesiologists try to sue hospitals for not allowing them hospital privileges separately from the group that has the exclusive contract.
 
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And that (my emphasis) is exactly what the backdoor is in American antitrust law. Americans seem to think that having just 2-3 players in a market is not a monopoly, as long as the players don't actively cooperate to fix prices. (They just do it passively, based on easy to obtain information about the pricing structure of the other companies, live and let live.)

That's OK, as long as it's easy for any other company to enter the market and disrupt it. But when it's not, just 2-3 players in a market are a monopoly. And the way to break it is to regulate the companies as utilities, like the FCC is trying to do with ISPs.


Nothing is stopping you from starting or buying your own AMC. There are at least a dozen players in this industry right now. WallStreet is active in this area and they are funding the growth of the sector.
 
A future foretold? As has been suggested in this blog for some time, investors' time frames differ from anesthesia professionals and facilities. Consider the recent announcement below, the private equity investors (who I must assume are fine people, upright citizens, and excellent businessmen) are selling NAPA Management Services (who I must assume are fine people, upright citizens, and excellent at what they do) after an investment of Four (long) Years. How long is an anesthesia career again? NOT 4 years, how about 30 years? How long do the facilities these anesthesia professionals serve hope to be in business? Not 4 years, how about 100 years? The timeframes don't match. Do you have a sense of the long-term problems for anesthesia professionals and facilities in this model of transient ownership of AMCs?

Moelis Plans Sale of NAPA Anesthesia, Aims to Raise $600M
Amy Or
January 09, 2015
(c) 2015 Dow Jones & Company, Inc.
Moelis Capital Partners plans to put up for sale NAPA Management Services Corp., an anesthesia and perioperative management company it has backed for almost four years.
People familiar with the situation said Moelis Capital has engaged investment banks Moelis & Co . and Harris Williams & Co . to handle the sale process, which is slated to kick off as soon as next week. Moelis Capital is the private equity operation of Moelis & Co....

The smart investors (fine people, upright citizens, and excellent businessmen to be sure) must now look for a buyer. You can wonder as much as you like why they are selling, but the real question is who are they going to sell to? If history is an indicator, there is a chance that the sale will be to “a bigger fool,” or someone who milks the finances for all it's worth, disregarding the consequence to the anesthesia professionals or the facilities they serve.
 
Here's the thing, you don't and you don't. Groups have contracts because the hospitals are HAPPY with the service. And our service doesn't "cost" the hospital anything as they aren't paying us so not sure how you cost less than nothing.
They are happy with your service because you are the cheapest and it saves them money. That in and of itself is a form of a kickback in my opinion.
 
They are happy with your service because you are the cheapest and it saves them money. That in and of itself is a form of a kickback in my opinion.
No. That's just market economy. One can choose the cheapest supplier of goods or provider of services.

The question that's debatable (and where the 5th Circuit ruled opposite to SCOTUS) is whether an anesthesia provider should be able to ask for hospital privileges outside of the exclusively-contracted anesthesia group. IMO this entire hospital privilege thing should go the way of the Dark Ages. If one is licensed in a state and board-certified in a specialty, one should automatically have hospital privileges in any facility in the state (for exactly the same facility fees). That (meaning healthy competition) would really decrease healthcare costs, while conserving the patients' right to choose both their facility and providers.

Of course, it would exclude a lot of middlemen, who would go the way of the dinosaurs, together with all the fees they steal from the patients.
 
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And that (my emphasis) is exactly what the backdoor is in American antitrust law. Americans seem to think that having just 2-3 players in a market is not a monopoly, as long as the players don't actively cooperate to fix prices. (They just do it passively, based on easy to obtain information about the pricing structure of the other companies, live and let live.)

That's OK, as long as it's easy for any other company to enter the market and disrupt it. But when it's not, just 2-3 players in a market are a monopoly. And the way to break it is to regulate the companies as utilities, like the FCC is trying to do with ISPs.

Unfortunately, based on case law, I also tend to believe that antitrust law does not apply when anesthesiologists try to sue hospitals for not allowing them hospital privileges separately from the group that has the exclusive contract.

Yeah. Insurance companies should sue anesthesia groups for raising costs.

What should really happen is hospitals start AMC-wings. It's amazing to me that there isn't an HCA AMC (for example) that makes millions for HCA with negligible added costs. They'd have secure contracts and profit off of anesthesia instead of letting AMC jerkoffs take money while providing nothing but an unnecessary middle man and empty promises AND NO BUYOUT would be required for the sellouts, they just don't renew you MFs' contracts.
 
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No. That's just market economy. One can choose the cheapest supplier of goods or provider of services.

The question that's debatable (and where the 5th Circuit ruled opposite to SCOTUS) is whether an anesthesia provider should be able to ask for hospital privileges outside of the exclusively-contracted anesthesia group. IMO this entire hospital privilege thing should go the way of the Dark Ages. If one is licensed in a state and board-certified in a specialty, one should automatically have hospital privileges in any facility in the state (for exactly the same facility fees). That (meaning healthy competition) would really decrease healthcare costs, while conserving the patients' right to choose both their facility and providers.

Of course, it would exclude a lot of middlemen, who would go the way of the dinosaurs, together with all the fees they steal from the patients.


You can wait for this to happen... which will likely never occur, or, you can choose a different medical specialty altogether.
 
You can wait for this to happen... which will likely never occur, or, you can choose a different medical specialty altogether.

I wish I had! and I would discourage anyone else from boarding this sinking ship.
 
You can wait for this to happen... which will likely never occur, or, you can choose a different medical specialty altogether.
Absolutely it won't. I am not fooling myself.

That's one of the reasons I am discouraging everybody, but the most obsessed, to enter this field. Once you are in it, there are basically no exits. Even pain, which used to be one, is sinking fast, because of declining reimbursements.
 
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Virtually all small to medium size groups who are still holding exclusive contracts with hospitals will be gone within a few years, they are no longer compatible with the new system, especially those who are not getting any subsidy from the hospital.

Why do you think lack of a subsidy isn't compatible?
 
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