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[Mman]

The private anesthesia group in Asheville, North Carolina decided to sell out to something called Surgery Partners. I'm not sure what their model is, but assume it's similar to other AMCs. Well apparently the hospital was not exactly pleased and decided to end their contract and place ads for everybody's job to be a hospital employee.

From what I know of the group it was/is a pyramid with various levels of superpartners so they must've been inline for a big pay day while screwing the lesser partners/nonpartners. While I'm sad for the physicians and CRNAs that worked for this group in what they probably all assumed was a stable model going forward, I'm not sad to see the losers that were looking to profit off their employees get this swift kick in the balls from the hospital.

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Members don't see this ad.

 

[chocomorsel]

Wow. I think I saw that online somewhere.
Problem for me would be that model would be all supervision all the time. No thanks.
I am sure there are some who would be interested though.

 

[BLADEMDA]

The group in Asheville got renewed in 2012 by the hospital. They had a 3-4 year contract. The time to sell was right after they inked that deal in 2012. Mission hospital provides a large subsidy to the anesthesia group as most of the patients are CMS (75 percent) or no pay (5-10 percent).

Mission hospital is trying to cut costs due to the fact that NC did not expand Medicaid under Obamacare. They are expected to lose millions of dollars in revenue as a result.

Mission said "no" to the Allcare deal because they didn't get a big reduction in subsidy (that's my guess).

 

[BLADEMDA]

http://www.citizen-times.com/story/...-risk-mission-eyes-deep-budget-cuts/13340991/

 

[BLADEMDA]

 

[Scotty_G]

They already put an ad on gasworks.

 

[BLADEMDA]

They already put an ad on gasworks.

My hunch is that the existing group, Allcare/Asheville Anesthesia, will agree to a substantial cut in subsidy thereby averting the need for Mission hospital to hire any anesthesia providers.

Mission's CEO wants that subsidy cut in half (or more) before signing off on any deals.

Everyone will keep their jobs and the super partners may have to settle for $6-$7 million apiece rather than $10 million after the sale to the new Wallstreet AMC.

 

[urge]

Goes to show how much a contract is worth. Today you have it, tomorrow you don't.

 

[Mman]

edit: nevermind

 

[IlDestriero]

The problem with taking that job as an employee is that the hospital is in financial trouble and had a poor payer mix. That's not the job you really want. You want to align yourself with a profitable hospital that's got a good patient population. Hell would freeze over before my shop shuttered.

 

[caligas]

Also, it's kind of a bull**** job ad, it's a local political move to try to gain leverage more than a job ad.

 

[Hiram Coggin]

My hunch is that the existing group, Allcare/Asheville Anesthesia, will agree to a substantial cut in subsidy thereby averting the need for Mission hospital to hire any anesthesia providers.

Mission's CEO wants that subsidy cut in half (or more) before signing off on any deals.

Everyone will keep their jobs and the super partners may have to settle for $6-$7 million apiece rather than $10 million after the sale to the new Wallstreet AMC.

The super partners get nothing. There is no buy out. What in the world are you talking about?

The anesthesia group signed a new contract with the hospital and then turned right around an sold to the management group. Except that the contract wasn't finalized and the hospital system has gone nuclear on the group. They are all going to be hospital employees. The only "buyout" is the groups outstanding AR.

 

[BLADEMDA]

The super partners get nothing. There is no buy out. What in the world are you talking about?

The anesthesia group signed a new contract with the hospital and then turned right around an sold to the management group. Except that the contract wasn't finalized and the hospital system has gone nuclear on the group. They are all going to be hospital employees. The only "buyout" is the groups outstanding AR.

The hospital system went "nuclear" on the group because of the sale to a management company. The hospital is likely subsidizing the group heavily and wants to save money by reducing that subsidy. A large AMC would have purchased the group and reduced the hospital subsidy. These large AMCs are actually more efficient in terms of billing insurance companies than hospital systems and can usually meet or beat hospital owned/run anesthesia departments.

Mission hospital is bleeding money and wants to reduce costs in all areas. This means a sale to an existing mega-AMC with cost savings to the hospital CEO was far more likely to be tolerated than one which resulted in no savings at all.

At this point the entire situation is hostile and it is likely too late to involve a Sheridan/Amsurg or Mednax/American Anesthesiology in the negotiations. With the billing power of these mega AMCs there would have been a buy-out and a large reduction in costs to the hospital. This is a good lesson to others about how NOT to go about the sale of a group which receives a hospital subsidy (most likely a substantial one).

With the non-compete clauses in place AllCare/Asheville super partners may need to release all the employees prior to employment by the hospital. Obviously, I do not know the specifics of that non-compete clause the employees have with Surgery Partners/AllCare.

 

[caligas]

How could the partners have screwed this up so bad, seems obvious to have contract secured before sale to AMC.

 

[BLADEMDA]

http://wcqs.org/post/updated-over-100-jobs-mission-hospital-question#stream/0

Listen to the CEO discuss the situation. You can bet your life savings that the super partners were going to make mega bucks ($6 million plus each) until the CEO blocked the deal.

I applaud the CEO for his "balls" in blocking this deal. AllCare got greedy when they could have slashed the subsidy by more than half while still getting their buyout ($3-4 million each).

 

[BLADEMDA]

Although Mission had been in discussions with AllCare Clinical Associates, PA, to provide anesthesiology services, we were just recently notified by them that they had been acquired by a for-profit competitor. Subsequently, we made a determination that it is in the best interests of our patients and Mission to explore all alternatives, including bringing the service in-house. Accordingly, we have posted positions. We truly value and greatly appreciate AllCare's clinicians and staff, and to ensure continuity for our patients we have entered into an interim agreement that runs through April 30, 2016.

We do not anticipate any interruption in services while we continue to consider all options for meeting our service needs by identifying partners who share our values and are able to contribute to the caring and safe environment we provide to our patients and community.

Mission Hospital

 

[BLADEMDA]

Original Post - Wednesday 12/23/15:

More than a hundred doctors and nurses at Mission hospitals in Asheville are unsure about their jobs after Mission indicated it could sever ties with the company that employs them. Mission told the workers they were looking at alternatives to extending a contract with the company AllCare. The action was taken swiftly after the non-profit Mission was made aware that AllCare would be acquired by Surgery Partners. Both of the latter are for-profit entities. In a statement provided to WCQS, Mission Health President and CEO Ron Paulson says the company is looking at alternatives, including employing its own doctors and nurses, sidestepping AllCare altogether. He says the company is posting the jobs and that an existing contract with AllCare has been extended through the end of April to ensure continuity of service. Here is a link to one of the online job postings. The workers that are affected include 25 physician anesthesiologists, 96 certified registered nurses, and about 20 additional people.

http://www.citizen-times.com/story/...eement-anesthesia-services-provider/77883838/

 

[BLADEMDA]

How could the partners have screwed this up so bad, seems obvious to have contract secured before sale to AMC.

Greed.$$$. They should have cut the hospital in on the deal by reducing the subsidy. A mega-AMC would improve revenue by 50-75% via their contracts with insurance companies allowing the mega-AMC to cut the hospital subsidy.

 

[BLADEMDA]

Mission has a nonsolicitation agreement with AllCare and can’t approach AllCare workers about working for Mission. AllCare employees can apply for the recently posted Mission positions.
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So, can some of the Docs and CRNAs jump ship from Surgery Partners to Mission hospital? Typically, any sale of a group to a management company involves strong "non-compete" clauses to prevent providers from jumping ship and then competing against the management company.

 

[Mman]

1) I have good reason to believe they did not have a commercially insured surgical population as low as the 15-20% number implied in the article. They have a low unemployment rate and healthy local economy. Sure there are some retirees propping up the medicare number, but not to that degree. Failure to expand Medicaid also doesn't hurt anesthesia groups since we collect so little from medicaid in the first place.
2) I don't think a subsidy had anything to do with the hospital ending the contract. They ended it because they got blindsided by the sale to a for-profit corporation that the hospital didn't want to deal with.
3) I suspect employees and partnership track people will end up better off employed by the hospital than by the super partners that were so willing to screw them in the first place.

 

[BLADEMDA]

1) I have good reason to believe they did not have a commercially insured surgical population as low as the 15-20% number implied in the article. They have a low unemployment rate and healthy local economy. Sure there are some retirees propping up the medicare number, but not to that degree. Failure to expand Medicaid also doesn't hurt anesthesia groups since we collect so little from medicaid in the first place.
2) I don't think a subsidy had anything to do with the hospital ending the contract. They ended it because they got blindsided by the sale to a for-profit corporation that the hospital didn't want to deal with.
3) I suspect employees and partnership track people will end up better off employed by the hospital than by the super partners that were so willing to screw them in the first place.

1. AllCare's payer mix was better than Mission Hospitals because they had surgi-centers. Mission Hospital was bleeding money and Medicaid pays hospitals much better than Anesthesia in terms of reimbursement rates.

2. Subsidy did have something to do with it as the CEO would be much more inclined to deal with a "for-profit" AMC if the hospital benefited from that relationship. The way things went down Mission Hospital got ZERO benefit from the AMC while AllCare reaped a windfall deal.

3. We agree here. Employees should jump ship in droves if permitted. and become hospital based providers.

 

[BLADEMDA]

http://www.surgerypartners.com/

Looks like a small "AMSURG" type company. They own/partner in surgi-centers throughout the USA.

 

[BLADEMDA]

"Surgery Partners has made an excellent partner for Vanderbilt University Medical Center in development and management of a freestanding outpatient surgery center. Their seasoned team of professional healthcare surgery center managers has allowed us to expand into community based surgery arena in which health systems generally do not have a great deal of experience. With their skill at surgery center management and in developing positive physician and community relations, we have been able to collaborate to create a highly successful surgical environment co‐mingling both Vanderbilt faculty physicians as well as community based surgeons and physicians. This environment has been a quality, cost effective enterprise appealing to patients, surgeons, and staff."

David R. Posch, M.S.
CEO, Vanderbilt University Hospital and Clinics
Executive Director, Vanderbilt Medical Group

 

[BLADEMDA]

My source tells me that Surgery Partners/AllCare is currently enforcing the non-compete clause which means that the employees can not work for Mission hospital.

 

[caligas]

Bumping. Any updates?

 

[Mad Jack]

My source tells me that Surgery Partners/AllCare is currently enforcing the non-compete clause which means that the employees can not work for Mission hospital.

That's senseless and brutal. I guess they're hoping they can strongarm the hospital by starving them of employees...

 

[caligas]

That's senseless and brutal. I guess they're hoping they can strongarm the hospital by starving them of employees...

I assume they feel that their business model requires them to have and enforce the non compete. This is the problem with mixing Wall Street with small community medicine.

 

[criticalelement]

That's senseless and brutal..

It's senseless and brutal but legal...

 

[painstop]

Depends how enforceable it is in North Carolina...there might be some libertarian judges on their Supreme Court

 

[Consigliere]

I've got a spot on source that informs me they were contacted by a recruiter offering a locums rate of $1200/day. WTF!? They're looking for 25 heads and they have the audacity to lowball anesthesiologists!? Eff them. $1500/day MINIMUM for The Kid.

 

[BLADEMDA]

I've got a spot on source that informs me they were contacted by a recruiter offering a locums rate of $1200/day. WTF!? They're looking for 25 heads and they have the audacity to lowball anesthesiologists!? Eff them. $1500/day MINIMUM for The Kid.

Skip the middle man and call the hospital yourself. I'm sure if the agency is paying you $1200 per day plus expenses the hospital is paying the agency over $2K per day. Hence, $1500 per day plus $100 for lodging ($1600) would likely be lower than the agency rate.

 

[gasmark]

I am interviewing there next month, I already have a decent job but i like asheville. What are the right questions to be asking? In my conversations with them, I have already been pretty upfront about how this isn't an ideal situation, do they have surgeon buy-in, are they setting up a group to fail, their contingency plan if they can't hire enough docs etc... But how would you guys go about evaluating the opportunity?

 

[caligas]

I am interviewing there next month, I already have a decent job but i like asheville. What are the right questions to be asking? In my conversations with them, I have already been pretty upfront about how this isn't an ideal situation, do they have surgeon buy-in, are they setting up a group to fail, their contingency plan if they can't hire enough docs etc... But how would you guys go about evaluating the opportunity?

You are brave. If you already have a good job be very cautious about entering such a potentially unstable/hostile situation. Have a good contract lawyer read the contract. My view is that if they are hiring so many now they will likely still be hiring in a year or so. Good luck.

 

[gasmark]

You are brave. If you already have a good job be very cautious about entering such a potentially unstable/hostile situation. Have a good contract lawyer read the contract. My view is that if they are hiring so many now they will likely still be hiring in a year or so. Good luck.

Thanks for the response. I am certainly not naivete and have my eyes open to what could potentially be a very tough situation. My current job is decent but by no means perfect. But they would still have to do a good job of convincing me.

 

[caligas]

Thanks for the response. I am certainly not naivete and have my eyes open to what could potentially be a very tough situation. My current job is decent but by no means perfect. But they would still have to do a good job of convincing me.

I will say that Asheville is a GREAT city of you like to do stuff outdoors. Their downtown and festival scene is great too. And you can get to the Atlanta airport in about 2 hours to fly anywhere. Good luck.

 

[IlDestriero]

Thanks for the response. I am certainly not naivete and have my eyes open to what could potentially be a very tough situation. My current job is decent but by no means perfect. But they would still have to do a good job of convincing me.

Leverage your experience and their situation to your maximum benefit. Some kind of signing bonus to make up for your risk and relocation expenses, nose/tail coverage, maybe a 3 year guarantee, loss of contract pay out, etc. be creative. This is one time a contract attorney might actually help you get something of value.
Spin whatever collateral duties you have as evidence of proven leadership, etc.
Good luck.

 

[gasmark]

Leverage your experience and their situation to your maximum benefit. Some kind of signing bonus to make up for your risk and relocation expenses, nose/tail coverage, maybe a 3 year guarantee, loss of contract pay out, etc. be creative. This is one time a contract attorney might actually help you get something of value.
Spin whatever collateral duties you have as evidence of proven leadership, etc.
Good luck.

Thanks for the thoughtful response. I was thinking similarly of making sure there was some sort of 3 yr guarantee, along with moving, tail coverage. I think that they definitely need me more than I need them, and thus hold some negotiating power. Will definitely report back after the interview. I missed out on the good partnership days and work for an AMC now, figure it might not be too different to be an employee of a hospital vs corporation. It also gives me a little bit of leverage with my current employer hopefully

 

[sifidawkins]

Edited

 

[sifidawkins]

Edited

 

[gasmark]

I feel bad for the young docs and CRNAs who likely saw no benefit from the acquisition. But feel no pity for the "partners" who sold out and now have to deal with the repercussions. I agree that it doesn't sound like a great situation and the rubber will meet the road come May. This seems to be the way anesthesia is heading unfortunately, it certainly wasn't my doing, and all there is left to do is what's best for each individual.

 

[projectpat]

WOW.

 

[IlDestriero]

Watching these deals fall apart publicly with the associated bad press, etc. might actually help some of us in the long run. These aren't the first places to have problems with AMCs, etc. Time will tell.

 

[caligas]

AllCare (formerly Asheville Anesthesia Associates) has provided anesthesia services at Mission for over 40 years. The docs and CRNA's love their job and where they work, but do NOT want to become hospital employees for a number of reasons (The administration treats staff very poorly and freezes PTO hospital wide on several occasions while CEO makes his paltry $900K base salary. The new OR manager is not well liked by her staff and has gained a reputation of being difficult to work with. OR management have done away with RN's "no call" positions earned after 20+ years of service. There has been greater than 75% of faculty turnover due to such a bad work environment, then mandatory overtime is enforced because OR's are so understaffed that it is the only way to get cases done...etc.)

Anyhow AllCare (AC) sold to Surgery Partners (SP) in a deal that would allow AC to stay in tact in Asheville and continue to run the same model that allows them to succeed in area with a terrible payer mix (numbers quoted earlier seem pretty accurate). Surgery Partners benefits by getting the billing office and its model for anesthesia services that was highlighted by MGMA best practices. SP's goal is to implement that anesthesia billing model throughout their many surgery centers while leaving AllCare as its own entity to continue at its current practice sites. SP also gets to use AllCare's NC tax ID for their 2 centers in NC giving them an immediate return on their investment.

So Mission would be dealing with the SAME anesthesia practice that it had been for 40+ years, but now is backed by publicly traded company. What would this mean for Mission? Lower stipend to AllCare (quoted as likely lowering the stipend by 25% in 1-2 years) while working with the same anesthesiologists and CRNA's! Win- win, right?

Not when the Mission CEO, though he stated otherwise, had plans to take over AllCare and "bring the anesthesia services in-house". Now his future plan that was to be implemented over the next several years is ruined. So what does he do? Goes NUCLEAR and decides to try to do it all in 4 months instead! He would not even listen to AllCare's and Surgery Partners' plans to reduce the stipend while maintaining the same AllCare group that they currently work with! He would not even listen!!!

Within days his staff places the signs (see above in the original post for an actual picture) posting the jobs of the entire anesthesia department IN THE WORKPLACE...OUTSIDE OF ORs...IN THE HALLWAYS...AT THE OR CONTROL BOARD!!! They also posted the jobs on gaswork.com and other job websites. It was so bad that there were literally people crying. Keep in mind that this all happened three days before Christmas! (Gee I wonder why none of the anesthesia personnel want to be directly employed by this organization)

So currently the plan is for Mission to take over all anesthesia services on May 1. The problem is that the anesthesiologists have non-compete clauses. Surgery Partners is enforcing them. That means Mission can't bring those anesthesiologists in-house as planned and has to REPLACE all 25 of them (brutal way to treat a group that has served the community for the past 45 years). CRNA's don't have non-competes, but many have decided not to sign with Mission (see facebook.com "Asheville CRNA" page or #Asheville96 on twitter). Now surgeons are starting to realize that if Mission carries out their plan, there will be a brand new anesthesia team on the other side of the blood-brain barrier. They are not happy about the disruption in patient care that this would cause and are now starting to let Mission administration know how they feel. At the same time Mission is realizing that it will be harder than expected to hire 25 MDA's and greater than 50 CRNA's in a four month (now down to three month) span, since their plan for all of the AllCare employees to jump ship is not working.

AllCare is still engaging Mission in negotiations. It is very unclear what the outcome will be.

My personal advice is to stay very far away from the operating rooms (as a patient or a provider) at Mission Hospital on May 1 if AllCare is not providing the anesthesia care. The likelihood is that the newly created toxic work environment will carry on for at least several months or more likely a year or more as the revolving door of MDAs and CRNAs and locums providers scramble to cover all the cases. Mission's response will obviously be long hours for low pay (remember that whole payer mix thing) and probably that same mandatory overtime that Mission has already forced on its OR staff (I'll bet you that the Mission MDA package is straight salary with no call or OT hourly pay).
If you have any questions about AllCare, Mission Hospital or Asheville please feel free to PM me. Thank you.

Thank you for the excellent info!!! More questions if you don't mind: So did the partners get enough money to make this hassle worth while for them? What happened to those still in partnership track? Did surgery partners basically just invest millions in an essentially valueless anesthesia group?

 

[Mman]

Anyhow AllCare (AC) sold to Surgery Partners (SP) in a deal that would allow AC to stay in tact in Asheville and continue to run the same model that allows them to succeed in area with a terrible payer mix (numbers quoted earlier seem pretty accurate). Surgery Partners benefits by getting the billing office and its model for anesthesia services that was highlighted by MGMA best practices. SP's goal is to implement that anesthesia billing model throughout their many surgery centers while leaving AllCare as its own entity to continue at its current practice sites. SP also gets to use AllCare's NC tax ID for their 2 centers in NC giving them an immediate return on their investment.

So Mission would be dealing with the SAME anesthesia practice that it had been for 40+ years, but now is backed by publicly traded company. What would this mean for Mission? Lower stipend to AllCare (quoted as likely lowering the stipend by 25% in 1-2 years) while working with the same anesthesiologists and CRNA's! Win- win, right?

Not when the Mission CEO, though he stated otherwise, had plans to take over AllCare and "bring the anesthesia services in-house". Now his future plan that was to be implemented over the next several years is ruined. So what does he do? Goes NUCLEAR and decides to try to do it all in 4 months instead! He would not even listen to AllCare's and Surgery Partners' plans to reduce the stipend while maintaining the same AllCare group that they currently work with! He would not even listen!!!

If I had to guess, I'd say that the fact Surgery Partners owns an orthopedic surgery center and a pain clinic that directly compete with Mission Hospital had something to do with the outrage from the hospital point of view when they were told their in house anesthesia department was selling out to the competition.

Hard to call such a situation a "win-win", especially if you consider that the All Care superpartners had such a good relationship with Mission that they didn't bother to inform them they were considering such a move until after the ink was dry on the contracts.

I think this deal went wrong primarily because Surgery Partners doesn't have experience acquiring anesthesia practices. As much as I dislike American, they make sure the hospital is on board with the deal before it happens. No surprises. Considering anesthesia is a service based specialty, a successful group absolutely cannot have anything but the utmost trust of the hospital. This deal would've kept the same people in place, but obviously the trust bridge got torched.

 

[IlDestriero]

They may have not made the loot they were promised if it was contingent on X Years of service. That would really be a lose lose situation.

 

[sifidawkins]

Edited

 

[nimbus]

First off AllCare had partners (majority of the group) and non-partners who were either employed, on partnership track, or former partners that had sold their shares. There were no super-partners and no pyramid set up.

Mission was not bothered by the Asheville Orthopedic Associates surgeons group being part owners of the Orthopedic Surgery Center that directly competes with Mission. They bought that group and happily employ them, including the current Chief of Medical Staff (who just happened to write Mission-biased letters to all of the medical staff about the anesthesia services situation, but somehow managed to not send it to any of the anesthesiologists or their medical staff wives). Something does not add up there. Especially since the administration acted before even hearing what the AllCare/Surgery Partners deal actually meant for the hospital (other than Mission was not going to be the one buying AllCare).

Obviously with hindsight, there are ways that the deal could have gone down smoother and with greater transparency. The fact that it was not an anesthesia super-group (such as American) with experience in these transactions making the purchase led to some of the avoidable problems. In my opinion none of that excuses the unprofessional way that Mission leadership has handled the situation. If lack of trust was truly the main issue, then why didn't the hospital first meet with AllCare/Surgery Partners to determine if the deal was in line with the hospital's goals. If it was determined that AllCare/SP were untrustworthy, then decide to end the contract and employ the anesthesia department themselves?

Sounds like average hospital dirty politics. Backroom deals and alliances driving policy. Unfortunately happens all the time.

 

[Howard888]

Long time reader, never posted, but couldn't hold back on this anymore.

I have no sympathy here at all and have heard of several partners in this group already looking for jobs elsewhere. I doubt a good solution with the current group is reached and nor do I think it should.

Regardless of how the hospital behaved, to go about a sale of a group without some communication with the hospital is such a rookie move and arrogant on the groups behalf.

Also I will mention that in the North Carolina circle, this group hasn't hired partners for quite some time and always gave recent applicants very shady answers about partnership. Bottom line, for years everyone knew in NC they were setting up to sell.

This is on them. While I'll agree the hospital has been a bit over the top in its reaction, I applaud the reaction itself because of how the group handled it.

Me personally, I'm in a good job, and as I said I know these folks are looking for jobs. Not here after how the group was to those looking for partnerships over the past few years, and not after you handled that big of a decision to sell

 

[gasmark]

First off AllCare had partners (majority of the group) and non-partners who were either employed, on partnership track, or former partners that had sold their shares. There were no super-partners and no pyramid set up.

Mission was not bothered by the Asheville Orthopedic Associates surgeons group being part owners of the Orthopedic Surgery Center that directly competes with Mission. They bought that group and happily employ them, including the current Chief of Medical Staff (who just happened to write Mission-biased letters to all of the medical staff about the anesthesia services situation, but somehow managed to not send it to any of the anesthesiologists or their medical staff wives). Something does not add up there. Especially since the administration acted before even hearing what the AllCare/Surgery Partners deal actually meant for the hospital (other than Mission was not going to be the one buying AllCare).

Obviously with hindsight, there are ways that the deal could have gone down smoother and with greater transparency. The fact that it was not an anesthesia super-group (such as American) with experience in these transactions making the purchase led to some of the avoidable problems. In my opinion none of that excuses the unprofessional way that Mission leadership has handled the situation. If lack of trust was truly the main issue, then why didn't the hospital first meet with AllCare/Surgery Partners to determine if the deal was in line with the hospital's goals. If it was determined that AllCare/SP were untrustworthy, then decide to end the contract and employ the anesthesia department themselves?

Do you know why the CRNAs are currently lobbying for the group/docs that just sold them out? Did amsurg somehow get them to sign a non-compete without giving them anything?

 

[caligas]

Do you know why the CRNAs are currently lobbying for the group/docs that just sold them out? Did amsurg somehow get them to sign a non-compete without giving them anything?

Maybe they know that hospital employees are treated poorly?