compare these jobs...

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
That is true... but with a well structured group, the guy who just bought in will be getting a lot more time off per dollar earned than the guy who is going though partnership. I wouldn't focus on exact numbers.

Members don't see this ad.
 
That is fine... but with a well structured group, the guy who just bought in will be getting a lot more time off per dollar earned rthan the guy who is going though partnership. I wouldn't focus on exact numbers.

In a stable group the numbers probably won't change a lot but income has been on the downslide at some places.
 
In a stable group the numbers probably won't change a lot but income has been on the downslide at some places.

If you sign the contract, then that is what you do... it doesn't matter if your group reimbursements go up or down. It's a business.
 
Members don't see this ad :)
If you sign the contract, you are an employee for x amount of years. No promises afterwards.

It all depends on what your contract actually says. If it says you are a partner from day one, but need to pay 50K in "buy in" over the next 5 years then you are golden. :artist:

Nevertheless, you need to know what your partners make NOW. Full disclosure, otherwise YOU are to blame for what happens afterwards.
 
It all goes back to transparency. Even if a partnership is a little more taxing... the transparency says a lot about who you will be working with for possibly 20-30 years.

You want that feeling of being part of a group that you can be proud of.
 
Last edited:
  • Like
Reactions: 1 user
If you sign the contract, you are an employee for x amount of years. No promises afterwards.

I have a colleague in Phoenix that started a 3 year partnership tract with 2 other junior partners. He was the only one to make it and was sweating bullets 'till the very end. Those are the exact type of shadows you need to try and see through. It is not easy. But if you have time on your side... things become much more clear.

Don't rush the job.
 
If you are able to represent the group (and not follow your personal interests) , negotiate higher reimbursements, avoid takeovers, position your group into a safe foothold in the hospital... then ABSOLUTELY! That is a tough job my friend. Easily worth 60-100K. At least that is what I've seen in my practice with successful negotiator anesthesia directors/chiefs. ;)
Dude can you talk to my group then? I think I'm getting ripped off!
 
Administrative work does not get reimbursed like clinical work. YOu dont have any of the liability that you have like clinical work. You can pay any practice manager 20 bucks an hour to do what YOU do in those 20 hours. SO you should make 4oo bucks extra per month to do you administrative work. You cant expect anesthesiologist pay to sit in the office making phone calls and attending meetings.

Same thing with the academic chairmen. They dont spend ANY time in the OR yet they make 500 plus per year. WTF... If you are doing admin work. YOu should be paid as such. SO those chairmen should make 120K per year.
Well I'm going to have to disagree wholeheartedly.
I will tell you that it is much much easier to show up to work, take care of pts and then go home. I would rather that any day. But I have a vested interest in this practice surviving. I was voted the most fit for this job by my group. So you think I should take less income because of this? Thats crazy. We would have had an AMC here 5 yrs ago if I didn't do this job (with the help of others of course).
The chairmen are a different story sort of. But still it isn't a glorious job in my opinion and it must be compensated well. If not you will get total F'ups in the position. That does nobody any good. I think chairmen are important and a good one can make great things happen. I also think they lose touch with the everyday OR stuff but that's where they should consult others.
It's easy to sit in the OR and criticize the members that are out in mtgs or doing other administrative duties but until you are in their shoes please try to understand the job they are doing or at least trying to do.

The OR is easy.
 
  • Like
Reactions: 3 users
It's easy to sit in the OR and criticize the members that are out in mtgs or doing other administrative duties but until you are in their shoes please try to understand the job they are doing or at least trying to do.
The OR is easy.

Truth. :thumbup:

I did my stint of 6pm meetings... What I've learned is that I'm clearly a foot soldier that enjoys taking care of patients while contributing a positive piece to a much bigger organism.
 
  • Like
Reactions: 1 user
Truth. :thumbup:

I did my stint of 6pm meetings... What I've learned is that I'm clearly a foot soldier that enjoys taking care of patients while contributing a positive piece to a much bigger organism.
And there is nothing wrong with that.
Some people are cut out for politics and some aren't. I don't consider myself one of these people but interestingly enough others think I do fairly well in these situations. I must say tho, there was a time that I wasn't very good at it. With time comes experience. And once you have committed enough time and effort into a group you will do what it takes to keep things the way you see fit.
Some things I have learned:
Always keep your cool ( this took me some time to learn)
Use your resources, other members have important points to consider
Make sure everyone feels they have a voice that is heard, everyone, not just your group members.

This is a great conversation and I truly believe that no matter the partnership arrangement, if everyone feels they are getting a fair shake then things usually will work out for the better.

But if nothing else, this thread goes a long way into describing the various types of group arrangements out there.
 
  • Like
Reactions: 2 users
Well I'm going to have to disagree wholeheartedly.
I will tell you that it is much much easier to show up to work, take care of pts and then go home. I would rather that any day. But I have a vested interest in this practice surviving. I was voted the most fit for this job by my group. So you think I should take less income because of this? Thats crazy. We would have had an AMC here 5 yrs ago if I didn't do this job (with the help of others of course).
The chairmen are a different story sort of. But still it isn't a glorious job in my opinion and it must be compensated well. If not you will get total F'ups in the position. That does nobody any good. I think chairmen are important and a good one can make great things happen. I also think they lose touch with the everyday OR stuff but that's where they should consult others.
It's easy to sit in the OR and criticize the members that are out in mtgs or doing other administrative duties but until you are in their shoes please try to understand the job they are doing or at least trying to do.

The OR is easy.
I understand your point of view and i dont doubt for one second that you are integral in your practice. BUt to say it should be compensated on par with clinical work.. CMON... The guywho packages the placentas on OB works hard. SHould he get paid as much as the obstetrician?

IF you want the administration to understand and appreciate you, Just screw up an anesthetic. Just once. BIG TIME!!! They will get the message.. ( im kidding of course)
 
  • Like
Reactions: 1 user
Members don't see this ad :)
I understand your point of view and i dont doubt for one second that you are integral in your practice. BUt to say it should be compensated on par with clinical work.. CMON... The guywho packages the placentas on OB works hard. SHould he get paid as much as the obstetrician?

IF you want the administration to understand and appreciate you, Just screw up an anesthetic. Just once. BIG TIME!!! They will get the message.. ( im kidding of course)
Well actually, if I manage to increase the insurance rates and collection or negotiate a better contract with a raise and more time off for everyone, then how much is that worth to you?
 
I understand your point of view and i dont doubt for one second that you are integral in your practice. BUt to say it should be compensated on par with clinical work.. CMON... The guywho packages the placentas on OB works hard. SHould he get paid as much as the obstetrician?

IF you want the administration to understand and appreciate you, Just screw up an anesthetic. Just once. BIG TIME!!! They will get the message.. ( im kidding of course)


This sounds like a new-b comment. Sorry critical. It seems you are not seeing the big picture.

Say that as the groups anesthesia director your "clinical" day... ends at 1pm... hurray!

But... :arghh:... you get to hang around for a meeting that starts @ 6pm and doesn't end until 8:45 pm... and for this meeting you have to be on your best game...???? After all your groups future depends on it. o_O

What if as the anesthesia director you are overseeing 4 hospitals and 12 surgery centers....? Easy job....?

Think again.
 
  • Like
Reactions: 1 user
Well said Sevo.
Crit, don't take this wrong because I mean no disrespect at all. I'm just wondering if you would share with us your years out of training and what type of practice setting you are in. If you would rather not, I understand. But I think it would help the conversations tremendously. Not for you and I but for everyone.

On a separate note entirely:
To everyone, don't underestimate how much your job depends on others in your group. I'm not just talking about the ones that go to meetings but also on the ones that delay cases, cancel cases, look to leave early, gobble up the high paying cases, look to add labs at the last minute knowing that any delay will bump the case to the next guy, get poor pt comments, get complaints from surgeons/staff, the list goes on. All these actions will impact your practice. Take ownership but don't be a dictator. Lead by example and you will more than likely end up on top.

Oh and most importantly, don't bad mouth your partners.
 
Last edited:
  • Like
Reactions: 3 users
I applaud all of the guys who have no interest in the business and politics side of things but step up and do them for the good of their group.

To abdicate these roles is exactly what got this specialty (and much of medicine in general) in the mess we're in now, with the professional administration species (who have no clinical experience) running the show.

Doctors not only need a seat at the table, they also have to fill the chair when offered.
 
ASGM (the big group here in San Diego) uses pooled units - a brilliant idea. There isn't a buy-in and I am not saying there shouldn't be.

But why not do pooled units - and the longer you work, the more your pay percentage and time off. That seems reasonable and mirrors EVERY OTHER profession (other than medical) in the world.

A blended unit isn't necessarily incompatible with a partner track/buy-in. Some groups have their new hires work on a fraction of a blended unit as the "buy-in." i.e. your first year every unit you produce is worth 0.8 units of compensation. Thus your buy-in is still production based and a set fraction of what the partners are making.

Although I was lucky enough to join an "equal from the start group", I'm still in the camp that thinks a partner-track is reasonable if done correctly/fairly. This means clearly defined length of time and clearly defined $$ involved (either by explicitly saying what partners make or what percentage of partners income you will be making during the buy-in period). If the track is greater than 1yr then I think it's right that you should have an increased salary each year until partner. Over 2yrs is excessive but 3yrs is acceptable if the group is truly excellent in other regards and is reputable and fair to their new hires. As others have said, if there is a bad history of cutting people loose just before partnership you should run.

From the group's perspective, although you can tell if someone is a good fit within the first year, having a 2-3yr track helps ensure group stability. A new hire is more likely to stick around long term if they have 2-3 years invested in the practice before making partner. This is important to a high quality lucrative practice that doesn't want a revolving door of people coming through to make a buck and then moving on.


And don't think ASMG is some holy beacon of how an anesthesiology practice should be structured. I'll admit that it is essentially a fair practice (and certainly as stable a job as you're gonna find due to their sheer size), but it's not entirely equal, it's very restrictive, and there is A LOT of fat built into that model.
 
Since it can take several months for accounts to settle, isn't it reasonable for a buy in to be a reduced salary the first year (since they are effectively subsidizing you the first 2-3 months anyway) or a purchase of the equivalent of 3 months of accounts receivable before you are a fully vested partner? If you start making equal pay to the partners from day one, they are actually losing money on you until your billing were to roll in.
 
Well actually, if I manage to increase the insurance rates and collection or negotiate a better contract with a raise and more time off for everyone, then how much is that worth to you?

Did you do the negotiation yourself with the insurance carriers?
 
Since it can take several months for accounts to settle, isn't it reasonable for a buy in to be a reduced salary the first year (since they are effectively subsidizing you the first 2-3 months anyway) or a purchase of the equivalent of 3 months of accounts receivable before you are a fully vested partner? If you start making equal pay to the partners from day one, they are actually losing money on you until your billing were to roll in.

Some practices will float you a low interest loan at the start to make up for the lag time in A/R.
 
Did you do the negotiation yourself with the insurance carriers?
I have had various roles in this over the past 10+ yrs. I am not the best in our group at negotiating insurance contracts therefore, I prefer to moderate these types of events. That's the best answer I can give you. Since we are employed the contracts are mainly negotiated by the Hosp administration.

When I said "i" it was meant as a general statement for anyone that accomplishes these tasks for their group.
 
Buy in should be paid after partnership is offered and accepted. Underpaying you for 3 years encourages groups to take your money, not offer partnership, and find another sucker to screw over.

When you buy something you either get it or you get a refund.
 
  • Like
Reactions: 1 user
I have had various roles in this over the past 10+ yrs. I am not the best in our group at negotiating insurance contracts therefore, I prefer to moderate these types of events. That's the best answer I can give you. Since we are employed the contracts are mainly negotiated by the Hosp administration.

When I said "i" it was meant as a general statement for anyone that accomplishes these tasks for their group.

So you didn't do the negotiation but you are taking credit for it?:whistle::)

In all seriousness, since you are a hospital employee what benefit do you gain from getter a better rate from the payers? Is your salary tied to the increase somehow? Or does it just put you in the good graces of the hospital?
 
Last edited:
g
This sounds like a new-b comment. Sorry critical. It seems you are not seeing the big picture.

Say that as the groups anesthesia director your "clinical" day... ends at 1pm... hurray!

But... :arghh:... you get to hang around for a meeting that starts @ 6pm and doesn't end until 8:45 pm... and for this meeting you have to be on your best game...???? After all your groups future depends on it. o_O

What if as the anesthesia director you are overseeing 4 hospitals and 12 surgery centers....? Easy job....?

Think again.

I understand the value of noyacs role. I hate sitting at the table with a bunch of clipboard nurses and some b level administrator trying to argue with me about why I want to do spinals in the room and not the holding area or why patients consistently go in the room at 737 vs 730 AM. I dont have time to explain why we practice the way we practice to some dumb ass clipboard nurse in a meeting at 6 pm when i could be waging war with gravity at that time. They wont understand anyway no matter how many times i repeat myself.

At any rate, a full time practice manager can go to all those meetings for you. One with impressive credentials from ivy league schools for 100 k. 4 weeks vacation.
No need to get anesthesia pay
 
  • Like
Reactions: 1 user
g


I understand the value of noyacs role. I hate sitting at the table with a bunch of clipboard nurses and some b level administrator trying to argue with me about why I want to do spinals in the room and not the holding area or why patients consistently go in the room at 737 vs 730 AM. I dont have time to explain why we practice the way we practice to some dumb ass clipboard nurse in a meeting at 6 pm when i could be waging war with gravity at that time. They wont understand anyway no matter how many times i repeat myself.

At any rate, a full time practice manager can go to all those meetings for you. One with impressive credentials from ivy league schools for 100 k. 4 weeks vacation.
No need to get anesthesia pay

Note that this is how it's done in academics. Every department worth its place in the organization has a business manager (many with the credentials you mention, though not quite at that price...) to buffer these interactions, and who have the business credentials so desired by administrators (note the seething rage under this last phrase).

The key, if you're going to follow this model in PP, is to ensure that your business manager is properly incentivized to act in the group's long-term best interest. It is very easy for them to "go native" and work at cross purposes if they're put in the wrong environment with the wrong compensation structure.
 
g


I understand the value of noyacs role. I hate sitting at the table with a bunch of clipboard nurses and some b level administrator trying to argue with me about why I want to do spinals in the room and not the holding area or why patients consistently go in the room at 737 vs 730 AM. I dont have time to explain why we practice the way we practice to some dumb ass clipboard nurse in a meeting at 6 pm when i could be waging war with gravity at that time. They wont understand anyway no matter how many times i repeat myself.

At any rate, a full time practice manager can go to all those meetings for you. One with impressive credentials from ivy league schools for 100 k. 4 weeks vacation.
No need to get anesthesia pay

No offense Critical...but would you trust a 10-40 million dollar business to an individual who has "IV league credentials and then give him 4 weeks vaca and 100K"?
That sounds shallow to me.

You get what you pay for... and you get whatever comes afterwards.

The way I see it, I need someone at the round table that knows exactly what my group members have to endure in the trenches on a day to day basis. Someone who knows what it feels like to take care of a massively f'd up MVC patient at 3AM, or a night of 16 epidurals and then goes on to do cases the next day due to staffing issues.... or someone who understands when you say... man those old dex-ohmeda vents really suck. Someone who at least can listen to other colleagues and FULLY understand their concerns. You get me? I also need a person who gets the whole picture and is able to negotiate effectively.

In essence... I need to have confidence in an anesthesia administrator who understands the fabric of their own group not by omission but by hard earned sweat.

You are unlikely to get that from an "ivy league" MBA. Furthermore, you are risking transfer of power to a non-anesthesiologist partner.

If you are willing to pay out 100K and 4 weeks of vaca to some "ivy league with great credentials"... why not give it to someone in your OWN group who has a piece in the game yet has proven themselves as effective leaders? Someone who the group trusts, votes on... Someone who can get things done for the better of the group.

You are a foot soldier that is "too busy" to deal with clipboards.... I get it.

Someone needs to be there sacrificing time in an effort for the whole.
 
Last edited:
  • Like
Reactions: 1 user
I agree with Sevo. You need one or more of the physician partners to be involved in the administration crap. I dont know a single anesthesiologist who likes doing this, or who thinks it is worth their time away from making money clinically. It does however give you a much larger role in the organization, protect your group from stupid decisions, allow you to strategically enhance your services and staffing, and provides stability.
And yes, the guy in our group directly negotiates with insurance companies, and we feel that we are in a strong position as a result of that. The work that person has done has likely increased my salary by 15-20%. In addition to that, I dont have to deal with a lot of stuff I hear others on this forum whining about due to stopping nursing initiatives before they have gotten started. Having a presence on every important committee, as well as a strong position politically allows us to just plain say "no, we aren't doing that" when necessary. Our group's "foot soldiers" understand that they must work in the OR a little later to make up for these benefits.
In addition, we actually compensate the admin guy quite well, then he pays back roughly our hourly rate to the person most affected by his absence. This keeps most everybody happy.

All this said, there is a role for a practice manager to offload many of the more mundane tasks that truly dont require insight from a clinical perspective. I just dont feel that it is smart to hand all of these responsibilities off.
 
Arch, are you poking the bear or are trying to be funny?

And since you are not a hospital employee I must assume you nothing of what you ask.
A couple thoughts for you to consider:
1) what do administrators want to do more than anything? Save money for their bonuses. Right? Tell me how I might have managed to keep an all MD group going in this environment to this point? Any thoughts?
2) what do you think would happen to an all MD group that costs more than it generates?
3) if contracts with carriers suck then who suffers?
4) where do you think salaries come from?
5) how do contract negotiations go when you cost more than you bring in? And vice versa.

Look Arch, I could go on but it doesn't do anybody much good.
 
Arch, are you poking the bear or are trying to be funny?

And since you are not a hospital employee I must assume you nothing of what you ask.
A couple thoughts for you to consider:
1) what do administrators want to do more than anything? Save money for their bonuses. Right? Tell me how I might have managed to keep an all MD group going in this environment to this point? Any thoughts?
2) what do you think would happen to an all MD group that costs more than it generates?
3) if contracts with carriers suck then who suffers?
4) where do you think salaries come from?
5) how do contract negotiations go when you cost more than you bring in? And vice versa.

Look Arch, I could go on but it doesn't do anybody much good.
Although I don't doubt your abilities but I think that there are many factors at play here, I mean the fact that you were able to maintain an all MD model so far is at least partially helped by being in a geographic location where this model is still common, and you probably can remain profitable because your payor mix is young and privately insured.
 
Mostly you are correct Plank. But if you remember, My state opted out about 2yrs ago. That immediately opened the door and our administrators had a poor understanding of what that meant. Luckily I was able to explain things well enough to avoid the independent CRNA joining. It wasn't easy when financial people can only see numbers and assume crnas are much cheaper.

Then there was the AMC threat last year. That got squashed quickly.

The payor mix is occasionally young and privately insured. But without giving actual numbers, you would be surprised. And many would think that people are healthy here which for the most part is true but those people don't frequent the OR. I've seen some wild stuff here but still not on the regular bases that i saw back in La.
 
A big problem in medicine is we hate doing the administration work - hired someone to do it - and they have now screwed us.
 
  • Like
Reactions: 2 users
A big problem in medicine is we hate doing the administration work - hired someone to do it - and they have now screwed us.
I don't think it is a bad idea to have a business minded/educated person represent your group. But what is. A bad idea is to have them represent that group alone. If I were to have one of these business goons represent my group it would be in the form of attending these mtgs with me. I would still do the negotiating.
 
  • Like
Reactions: 2 users
I have no problems with buy-ins after a period of time. I think the vast majority of groups have one. Ours represents our AR. Your partnership track is a period of time when you work as an employee of the group. Then you get made partner. The amount of the buy in represents your 1/x share of the partnership's AR the day you become partner. We let you spread the hit out over however long you want (up to 5 years) to smooth out your cash flow. Then when you leave or die, we buy out your share of the AR and you (or your estate) get a lump sum payment to cover what we will get paid over the next several months from your previous work.

Buy in when you start, buy out when you leave. It's basically a loan to/from yourself.
 
  • Like
Reactions: 2 users
I'm taking none of these... Had two other better offers vs stay here... Decisions decisions--- just wanted to hear everyone's thoughts on these atypical jobs
 
  • Like
Reactions: 1 user
Top