Another One Goes Down

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BuzzPhreed said:
No. This is not entirely true.

The partnership groups do pay peanuts to the new hires. But the payout should come in a year or two (at most) when you make partner.

However having talked to a few of those more junior just-outta-residency docs at the last ridiculous gig from which I recently extricated myself, there is no real promise or guarantee of partnership anymore. I think this all started in the Atlanta groups back about 10-12 years ago and has slowly spread like a cancer up the east coast. It's like a carrot dangled in front of the jackass. Probably permanently. The difference is that at an AMC you know up front you will never make partner but the pay is better from the start. Psychologically you also don't feel like there is ever a chance you will make partner so you don't feel compelled to kiss the other "partner's" asses. You're all in the same boat.

The true AMC and the true hospital-owned practice is far more "pure" than the new trend in PP to not directly offer a partnership track up front. I've heard this up and down the east coast that this is the new standard. You just hire a doc and, if it works out, someday you may be offered a partnership. Think about the mind-**** in that. It puts you in a position where you simply do what you're told and take your lumps and practice their way - whether it's right or wrong - because you hope someday they'll let you in the club. When the reality is that it's an illusion.

**** that ****. These ****ing greedy ***holes are more interested in lining their pockets than building a future. And they are doing it while breaking your back.

If they are a PP group and they are not willing to offer you a clear, written, and defensible-in-court partnership track from day 1 then walk. Don't sign. Telling them to go **** themselves. You're better off in an AMC or a hospital-owned group. Trust me. If I'd done this I would have saved myself a lot of hassle and heartache.
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Where is the part where you disagree with me?
 
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urge said:
Where is the part where you disagree with me?
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I don't entirely disagree with you. It's a subtle difference.

You are likely to make more money initially working for an AMC. You are likely to make less money working for a PP group with a false promise of future partnership. Given the current model, the PP group is jerking your chain. You're never going to make partner, at least over the next probably 5-7 years. So you will be leaving a lot of money on the table in that timeframe if you take the PP job with the false hope and co-requisite *** kissing that you will endure.

Get it in writing. "A wise man learns from the mistakes of others, a fool from his own."
 
Let me put it another way, you basically said both partnership groups and AMC groups pay peanuts up front. I think AMCs generally pay better than partnership groups who try to lure you in with a false promise of partnership. And you have to kiss more tookus at the PP group than you do the AMC where you're all in the same boat.

You're leaving more money on the table if you take the false-partnership PP job over the AMC job. And you will have more hassle. Most PP groups are trying to run like AMCs now with a huge inequity of partners vs. non-partners. It's just not worth it.

Get them to offer you a partnership track. Get it in writing. Or don't sign the contract.
 
BuzzPhreed said:
Let me put it another way, you basically said both partnership groups and AMC groups pay peanuts up front.
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Find me a quote where I said AMCs pay peanuts upfront.
 
https://www.google.com/url?sa=t&sou...u2h10gINf4iQBAtAlxPNGvA&bvm=bv.64542518,d.cWc

Maybe I'm a little late in reading "the rape of emergency medicine", but it is still very relevant to our current situation with the "suits" (AMCs) looking for "scrubs" so that they can "kitchen schedule" and reap tons off of management fees whiling throwing us bones.

Mix that it with desperate new mds looking to pay down that debt, or start a family and mid levels willing to fill that void, is a recipe for disaster....
 
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urge said:
Find me a quote where I said AMCs pay peanuts upfront.
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FFP said:
Unless enough of us refuse to work for peanuts (and rather work as locums), nothing will change.
urge said:
That applies to partnership groups as well as AMCs. However, we all know that partnership groups are the ones paying peanuts to the new hires. So, your message is basically to join AMCs.
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The way you phrased it your implication was that both pay peanuts compared to locums. But whatever dude. I'm on your side. Not interested in getting into a pissing match with you.
 
k12balla said:
https://www.google.com/url?sa=t&source=web&cd=2&cad=rja&uact=8&ved=0CCcQFjAB&url=http://www.aaem.org/UserFiles/file/The_Rape_of_Emergency_Medicine.pdf&ei=J9pJU8SPNojNsQS7mIHIBQ&usg=AFQjCNHWcqUu2h10gINf4iQBAtAlxPNGvA&bvm=bv.64542518,d.cWc

Maybe I'm a little late in reading "the rape of emergency medicine", but it is still very relevant to our current situation with the "suits" (AMCs) looking for "scrubs" so that they can "kitchen schedule" and reap tons off of management fees whiling throwing us bones.

Mix that it with desperate new mds looking to pay down that debt, or start a family and mid levels willing to fill that void, is a recipe for disaster....
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Wow. Sounds exactly like anesthesia. What exactly do AMC suits or ' PP partners' offer other than kitchen scheduling? There are answers, but none of them justify the amount they skim off the top.
 
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And to further clarify, my message is to join PP if you can get a clear partnership track in writing. One you can enforce if push comes to shove. Or walk. Nothing else. **** the ***holes who won't give you this because they don't think they have to anymore. In that case, yes, go work for the AMC. You'll have one less layer of bull**** to deal with, believe it or not.
 
Well, Blade my simple point too to the new grads was that you still can and should try to join a PP group but only if they promise and guarantee you a partnership despite being paid peanuts at first. This is where I slightly disagreed that you should choose an AMC over them (which apparently pissed off urge because it wasn't clear to me what he meant). But I also see the fact that the value of a board certified anesthesiologist is becoming less valuable to the bean counters who equate anesthesia with "anyone can do it why should I pay you extra" mentality.

Here is a great blog post and well worth the read: http://www.kevinmd.com/blog/2013/04/anesthesiologists-victims-success.html

An academic anesthesiologist, posting recently on the physician-only website Sermo, bemoaned the fact that an excellent resident accepted a job offer for pay that was barely above that of a nurse anesthetist. Anesthesiologists who want to work in desirable locations like the Bay area, work part-time, or work in surgery centers with no call and no weekends, appear to be willing to accept pay that no one would have considered competitive just a few years ago.
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Another big problem I have is that corporations are starting to dictate how we can and should practice medicine regardless whether or not it's safe. For instance the big AMC are expecting stretching to 4:1 ratios for care and a lot of these cases may involve marginally competent or freshly trained CRNAs where you just can't really supervise. If PP models adopt this way of thinking and offer you no real partnership track - and pay you peanuts to boot - there's no real incentive to join them. It's the worst case scenario for the new residency grad.
 
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The best job would be a pp group with a delineated partnership track, with periodic evaluations, and with decent pay to begin with. I couldn't find one during my active interview days. The closest I got was 20% below market pay with 4 years partnership in a group that looked solid and honest. I didn't take it because they were looking for a general person only. Their offer wasn't that good to turn my back on my fellowship.

Guess what? They also got taken over by another company. Now they are all employees.
 
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I know of three people at my last gig who came out of the woodwork and told me they felt the exact same way I did. Some of them are actively looking to go elsewhere. The others I don't know if they'll show that they have grapes to up and leave.

Point is that such practices are going to be a revolving door. The surgeons hate it. It's extra paperwork and hassle for the credentialing committees. And everyone starts to scratch their collective heads about whats wrong with the practice. The only ones who stay are the mommy trackers and the degenerates who you wouldn't want giving anesthesia to your pet gerbil.

I asked a senior guy at the practice I just left whether or not he thought treating the new guys like **** while they're purchasing their second beach home was a honest way to do business. He told me that it was the only way. That they are trying to defend themselves from what is essentially a hostile take over.

I told him that that didn't matter. The way they were running their business it was inevitable. We'll see. I'm keeping my eye on that place. My bet is that they're gone in less than two years. Sold out to an AMC. And all the juniors there who are eating **** and taking it in the *** for the senior partners are going to get a new contract. We'll see what happens then.

Don't take those PP jobs unless they promise you a partnership because it's not really a PP job if they don't. Do I sound like a broken record yet?
 
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I'm not aware of any promised partnerships. Guaranteed in the contract? Is that a new thing? Defined path to partnership is the standard. If you take a non partner track job, ask for a market wage. They'll still be making plenty more.
 
IlDestriero said:
I'm not aware of any promised partnerships. Guaranteed in the contract? Is that a new thing? Defined path to partnership is the standard.
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Me either. I would be surprised if any group gave someone a contract that "promised" partnership.
 
Arch Guillotti said:
Me either. I would be surprised if any group gave someone a contract that "promised" partnership.
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Exactly. So when is the ASA going to start the legal fight to ban non-competes and prevent the exploitation of its members?
 
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BuzzPhreed said:
Let me put it another way, you basically said both partnership groups and AMC groups pay peanuts up front. I think AMCs generally pay better than partnership groups who try to lure you in with a false promise of partnership. And you have to kiss more tookus at the PP group than you do the AMC where you're all in the same boat.

You're leaving more money on the table if you take the false-partnership PP job over the AMC job. And you will have more hassle. Most PP groups are trying to run like AMCs now with a huge inequity of partners vs. non-partners. It's just not worth it.

Get them to offer you a partnership track. Get it in writing. Or don't sign the contract.
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Question,
I am trying to move back to my home state of TX and in the two cities I am looking at, all the partnership tracks are 3 years!!!!! In this day and age. I mean, that sounds like way, way too long for me. However, due to family being there, I am sort of limited. I'd rather be an employee and make more money up front than do a 3 year partnership track. That's all they have in San Antonio I believe(at least One of the big groups there), although it's MD/DO only. I honestly don't care too much about partnership considering it's going by the wayside in this day and age with the AMC's taking over everything.

What's your advice?
 
In my limited inexperience, in this day and age, it's a miracle they actually offer you a partnership track.

Anyway, 3 years means basically zero chances for partnership. You will be denied partnership, and they will hire another sucker for another 3 years (if not taken over). Rinse and repeat.

You do not bring patients. You don't have super-duper connections to be able to get them business in another hospital. What's so special about you anyway, that you deserve to be a partner?
 
You get them to put verbiage in the contract that states you will be given a review at the end of the contract you sign regarding whether or not you will be offered a buy in (or however they structure it) for ownership on renewal. Ask to see the partner contract and the books. If they are willing to show you this, they're probably on the up and up. If not, caveat emptor.

Chocomorsel, keep your letters of intent (a.k.a. offer letter). They are legal documents. There's a legal maneuver called "detrimental reliance". Get them to put the offer in writing. Basically if they don't pony up at the end of three years, your options are don't renew and walk or have them show cause. They will not fail to renew you unless they give you some sort of for-cause finding. Being able to have a shot at a physician-only practice is hard these days. Worth a gamble in my opinion. Just negotiate a good starting salary. Fortunately in Texas you can live pretty large on less money.
 
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FFP said:
In my limited inexperience, in this day and age, it's a miracle they actually offer you a partnership track.

Anyway, 3 years means basically zero chances for partnership. You will be denied partnership, and they will hire another sucker for another 3 years (if not taken over). Rinse and repeat.
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Partnership tracks are still around, they are just hard to find. You are taking a risk if you sign on to a track though. Not all groups are out to screw you over.
 
FFP said:
In my limited inexperience, in this day and age, it's a miracle they actually offer you a partnership track.

Anyway, 3 years means basically zero chances for partnership. You will be denied partnership, and they will hire another sucker for another 3 years (if not taken over). Rinse and repeat.

You do not bring patients. You don't have super-duper connections to be able to get them business in another hospital. What's so special about you anyway, that you deserve to be a partner?
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I don't know what you're talking about. Partner tracks have been around forever. 2-4 years is common. Though they should know after 12 months if you have the skills and are a good fit. Look at the partner track history. If its 90+% you should be fine. All the partner track jobs I looked at were 2-4 years and had a >90% partner success rate. I would have felt comfortable with all save one who had a low track pay and >95% income for partners. Someone else can be their bïtch for >$1M "buy in". They, of course, defended it as reasonable. They were 10 for 10 in their track though. It's a pay to play scam.
 
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We are probably in different markets. Plus you have a fellowship.
 
IanMcGalt said:
Exactly. So when is the ASA going to start the legal fight to ban non-competes and prevent the exploitation of its members?
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You seem to be under some impression that there is some magic person or group of persons that can just change the law. Each state determines the extent and enforceability of these clauses. Secondly it will be very odd to say the least since anesthesia groups have been using these against both MD's and CRNA's for quite some time, thus exploiting both for quite some time.
 
007livesforever said:
You seem to be under some impression that there is some magic person or group of persons that can just change the law. Each state determines the extent and enforceability of these clauses. Secondly it will be very odd to say the least since anesthesia groups have been using these against both MD's and CRNA's for quite some time, thus exploiting both for quite some time.
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Nope. Just think they're worth fighting against.
 
MEDNAX Announces Acquisition of Anesthesiology Practice in Virginia
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FORT LAUDERDALE, Fla., Apr 21, 2014 (BUSINESS WIRE) -- MEDNAX, Inc., /quotes/zigman/536802/delayed/quotes/nls/md MD +0.56% today announced the acquisition of Fredericksburg Anesthesia Associates, Inc., a private practice physician group based in Fredericksburg, Va. The practice will become part of MEDNAX’s American Anesthesiology division and is the third Virginia-based anesthesia practice to join the division.
Fredericksburg Anesthesia Associates employs 16 anesthesiologists who provide anesthesia services as part of a care team model that includes anesthetists at Mary Washington Hospital, Stafford Hospital and Fredericksburg Ambulatory Surgery Center. Their services include general surgery, orthopedic, cardiovascular, thoracic, neurosurgery (including spine), pediatric, obstetric and gynecological, as well as acute pain management. The practice’s founding physicians began providing anesthesia services to Fredericksburg and surrounding communities in 1965 and the practice was incorporated in 1992.
“We chose to partner with American Anesthesiology to ensure that our group can continue to focus on patient care and outcomes in an increasingly competitive and complicated healthcare environment,” said W. Scott Brosche, M.D., who will serve as medical director for the practice. “The company’s proven integration process ensures that we will have strong support in the areas of practice management, clinical quality initiatives, research and education, yet maintain clinical autonomy so we can do what we do best – take care of our patients.”
MEDNAX’s American Anesthesiology division consists of more than 1,950 anesthesia providers, including more than 825 physicians and 1,125 anesthetists practicing in Florida, Georgia, Maryland, Michigan, New Jersey, New York, North Carolina, Tennessee, Texas, and Virginia.
This was a cash transaction, and it is expected to be immediately accretive to earnings. No additional terms of the transaction were disclosed.
 
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Planktonmd said:
One day we will all be working for one giant corporation and we won't have names anymore... just numbers!
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SSN ring a bell? The name is just an alias for your and your coworkers' comfort. For the bean counters running healthcare, you are already less than a number.
 
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You wanted to know about what happens when Mednax takes over?

The record tends to establish the following facts: Dr. John Fontana (“plaintiff”) received a letter dated 29 August 2006 which detailed an offer of employment from SAC. The letter contained, inter alia, the compensation package plaintiff was to receive, a benefits summary, a non-compete clause, and the following statement: “You will be eligible for consideration as a shareholder solely of Southeast Anesthesiology Consultants, PA after six (6) years.” Plaintiff claimed in his complaint that he discussed the six-year “partnership track” in detail with Drs. Gilbert, Gillette, and Yevak prior to receiving the 29 August letter. Plaintiff asserted that he was assured that SAC would not be sold before he became a partner. The 29 August letter was signed by plaintiff, Dr. Gillette, and Dr. Gilbert on 17 September 2006. Plaintiff refers to this letter as the “letter agreement.” In his complaint, plaintiff also refers to a “partnership agreement” that was entered into in August 2006. However, the partnership agreement was an oral agreement.
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Plaintiff contends that SAC began negotiations in 2008 to sell SAC contrary to assurances made to him that SAC would not be sold before plaintiff achieved partner status. Plaintiff claims that he was not informed in 2008 or 2009 that SAC may be sold and that his ability to achieve partner status was in jeopardy. In 2010, SAC entered into an agreement with MSI and MDX for the sale of 100% of the shares of SAC.2 The sale was approved by the SAC Board of Directors in August 2010. On 16 September 2010, AAS and MDX sent plaintiff a letter stating that it would be “assuming” plaintiff's employment contract. Plaintiff was asked by AAS to sign a new employment contract under which he would receive a fixed salary, unlike the original contract which provided for a six-year graduated salary. On 28 September 2010, plaintiff sent a letter to MDX stating:
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Your proposal is basically unfair to a 4th year partnership track physician such as myself and is contrary to the representations by SAC which led me to join the practice in 2007 and to remain there for the last three and a half years. As a result, I will not be signing anything that changes my and SAC's obligations to each other.
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By an undated letter mailed on 6 October 2010, SAC informed plaintiff that his employment with SAC was terminated effective 1 October 2010. The letter did not state the reason for termination. Plaintiff contends that he did not receive 90 days notice and that his “termination was not discussed or approved by SAC's Executive Committee and was never approved by SAC's Board of Directors as was required by Article V, Section I of SAC's Bylaws.”
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http://caselaw.findlaw.com/nc-court-of-appeals/1606326.html#sthash.Zuexf1iW.dpuf

It's a good read. And what you can expect if you sign a sh*tty contract. Long story short they wanted to arbitrate this as opposed to go to court. And the defendants won that point.
 
That guy is owed a 2/3 partnership buyout which is over $2 million. In fact, the only discussion should have been whether to pay him 2/3 or a full buyout. I know some of these players personally and it's disgusting that greed overtakes fairness/ethics when it comes to money.
 
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BLADEMDA said:
That guy is owed a 2/3 partnership buyout which is over $2 million. In fact, the only discussion should have been whether to pay him 2/3 or a full buyout. I know some of these players personally and it's disgusting that greed overtakes fairness/ethics when it comes to money.
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I hope they all drive off a cliff.
 
BLADEMDA said:
That guy is owed a 2/3 partnership buyout which is over $2 million. In fact, the only discussion should have been whether to pay him 2/3 or a full buyout. I know some of these players personally and it's disgusting that greed overtakes fairness/ethics when it comes to money.
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The guy got hosed and so did everybody else in a similar position I would imagine. I didn't read the whole summary but it sounds like he didn't get what he was "promised" in writing, so I hate to say it but I am not sure he is "owed" anything. One of the defendants is now VP and CMO of Mednax. He didn't get there by playing nice.
 
Even worse hosing occurred when Sheridan took over MAC in the Bay Area. 18mo partnership track was extended to 36mo just before buyout.

Folks on the cusp were SOL.
 
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Arch Guillotti said:
The guy got hosed and so did everybody else in a similar position I would imagine. I didn't read the whole summary but it sounds like he didn't get what he was "promised" in writing, so I hate to say it but I am not sure he is "owed" anything. One of the defendants is now VP and CMO of Mednax. He didn't get there by playing nice.
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I disagree with you here. The guy who got screwed over has the Courts for remedy. A Jury may not be so sympathetic to the ultra rich Gilbert who was making $600K plus as a partner then got a $3 million buyout while leaving the "employee" who was promised partnership SOL. 4 years into the partnership track (2/3) should have counted for something and good faith means giving the guy his due. He was promised partnership prior to the sale of the group so Gilbert lied to him. Hence, he has a decent case for damages and attorney's fees.
 
BLADEMDA said:
I disagree with you here. The guy who got screwed over has the Courts for remedy. A Jury may not be so sympathetic to the ultra rich Gilbert who was making $600K plus as a partner then got a $3 million buyout while leaving the "employee" who was promised partnership SOL. 4 years into the partnership track (2/3) should have counted for something and good faith means giving the guy his due. He was promised partnership prior to the sale of the group so Gilbert lied to him. Hence, he has a decent case for damages and attorney's fees.
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I don't necessarily disagree with anything you have said. He apparently didn't get it in writing though.
 
Believe it or not the case was about whether or not he was allowed to sue in court or if he had to go to binding arbitration. The appellate court ruled that he should have had to go through arbitration.

It appears that he had what he needed in writing, at least an offer that he would be made partner and that they wouldn't sell the practice. They of course reneged on that offer hence the lawsuit. Either way, they didn't like this guy very much or they didn't care about screwing him out of a lot of money. Probably both. When push comes to shove most people don't care about helping out the next guy. Every man for himself. Especially in a situation like this.
 
Anesthesia Group Acquisition Activity Grows in 2013
Written by Laura Dyrda | December 30, 2013



The anesthesia mergers and acquisitions market has seen a lot of action over the past year, according to a report in The Deal Pipeline.

The anesthesia space is consolidating quickly, according to Dougherty & Co. analyst Brooks O’Neil, and large practice management companies are experiencing competition for acquiring anesthesiology groups. Continental Anesthesia, a private equity-backed company, plans to expand its practice to 150 physicians.

Mednax and Team Health are also actively acquiring small practices and several deals have been announced during the second half of 2013. Private Equity firms are also interested in the anesthesia space, according to the report.
 
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MEDNAX Acquires Anesthesia and Pain Management Group
Written by Anuja Vaidya | May 07, 2014



MEDNAX announced the acquisition of Millburn, N.J.-based Anesthesia and Pain Management Group, a private physician group practice.


The practice employs 14 full-time anesthesia providers providing ambulatory anesthesia and pain management services for outpatient procedures. It will become part of MEDNAX's American Anesthesiology division.
 
http://www.resolutemd.com/news/

July 8, 2014

Resolute Anesthesia and Pain Solutions, LLC (“Resolute”), a leading provider of anesthesia and interventional pain management services, today announced the acquisitions of Perth Amboy Anesthesiology, P.C., based in Perth Amboy, New Jersey and St. Lucie Anesthesia Associates, LLC, based in Port St. Lucie, Florida. Founded in 1994, Perth Amboy Anesthesiology. P.C. (“PAA”) employs 23 physicians who provide anesthesia services at Raritan Bay Medical Center, with locations in Perth Amboy and Old Bridge, NJ, and six Ambulatory Care Surgery Centers.
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Wonder who got screwed in this deal? When is the DOJ going to put a stop to these multi-state deals?
 
And so it continues month by month with AMCs claiming more market share. A new PGY-1 will likely be working for the "man" post Residency.
 
BLADEMDA said:
And so it continues month by month with AMCs claiming more market share. A new PGY-1 will likely be working for the "man" post Residency.
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Most of us will also be working for "the man". Even those who are currently "the man".
 
Mman said:
There is no law against it, that's why they aren't stepping in. Now whether there should be a law against it is another question.
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Well, we actually do have laws and it depends on whether or not the Sherman anti-trust regulations get revisited in the court system. So far they've held up based on 1984 case law in Louisiana that was not even an intrastate issue but a local issue. That was limited to a small practice where there was not felt to be infringement on ability to compete. Now we have large interstate practices that are forming relative monopolies in some regions. I've talked about this before.
 
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