NAPA in trouble in NJ

[natethegreat22]

You heard it here first. the same situation that happened with NAPA in Nevada, is happening at RWJ Barnabas health, the largest system in New Jersey. They took over this practice from Mednax in 2020 and, as is typical, tried to underpay and understaff. The $hit hit the fan when all the legacy partners initial contracts were up and none of the Docs would resign with NAPA. Hospital got fed up and offered direct employment with much more favorable terms and full indemnification. NAPA is going scorched earth, pulling multiple providers to other sites and leaving a skeleton crew at the hospital, but the hospital is determined to see this through. Stay tuned
New account for obvious reasons.

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[Dr. Rude]

You heard it here first. the same situation that happened with NAPA in Nevada, is happening at RWJ Barnabas health, the largest system in New Jersey. They took over this practice from Mednax in 2020 and, as is typical, tried to underpay and understaff. The $hit hit the fan when all the legacy partners initial contracts were up and none of the Docs would resign with NAPA. Hospital got fed up and offered direct employment with much more favorable terms and full indemnification. NAPA is going scorched earth, pulling multiple providers to other sites and leaving a skeleton crew at the hospital, but the hospital is determined to see this through. Stay tuned
New account for obvious reasons.

 

[Gator7]

Yep this is true. Very familiar with the group.

 

[sevo00]

Good. Let the ****ers burn. I hate NAPA

 

[residency2010]

I was offered to cover weekends at 310/hr at one of their facilities in NJ as a locum. Is it a good deal or even locum is a no-no with NAPA?

 

[chocomorsel]

I was offered to cover weekends at 310/hr at one of their facilities in NJ as a locum. Is it a good deal or even locum is a no-no with NAPA?

Ask for more. Never take what they offer.
And you are now on a mercenary mission to help patients. Who cares?
As long as you don’t sign for a permanent deal with them let them bleed and fill your pockets.

 

[2Fast2Des]

Why that group even sold out to begin with is puzzling. Those guys were raking in moola and in an affluent payor mix area. They went short sighted, took the nice buyout and turned an MD only group into a 1:4 CRNA **** show that is constantly rotating cast of characters. This is what greed does.

 

[narcotics999]

I was offered to cover weekends at 310/hr at one of their facilities in NJ as a locum. Is it a good deal or even locum is a no-no with NAPA?

Solo or supervision? If supervision, ratio?

Weekend rate should be OT rate. Get 400/hr.

 

[IMGASMD]

I was offered to cover weekends at 310/hr at one of their facilities in NJ as a locum. Is it a good deal or even locum is a no-no with NAPA?

Depends on workload and hours. Is it W2 or 1099? With them directly or third party agency?
Also how long you think this kind of market/rate can go on.

I happen to know it’s very hard to negotiate a different rate than what’s offered with NAPA. They have came back to me “this is our company/region rate, we want to be ‘consistent’ ”. You’d think beggars cannot be choosers, you’d be wrong. They can drag their feet and you continue to not be working…..

 

[coffeebythelake]

If solo work I would do it for 400 an hour.
If 4:1 then **** them no way

 

[Mman]

You heard it here first. the same situation that happened with NAPA in Nevada, is happening at RWJ Barnabas health, the largest system in New Jersey. They took over this practice from Mednax in 2020 and, as is typical, tried to underpay and understaff. The $hit hit the fan when all the legacy partners initial contracts were up and none of the Docs would resign with NAPA. Hospital got fed up and offered direct employment with much more favorable terms and full indemnification. NAPA is going scorched earth, pulling multiple providers to other sites and leaving a skeleton crew at the hospital, but the hospital is determined to see this through. Stay tuned
New account for obvious reasons.

this is close to happening at several other large NAPA locations. Hospitals hate them with a passion.

 

[IMGASMD]

this is close to happening at several other large NAPA locations. Hospitals hate them with a passion.

I am just waiting for LIJ and Northwell to fall….

 

[dannyboy1]

I am just waiting for LIJ and Northwell to fall….

Rumor has it that is in the works. Also that Fairfax in Virginia is kicking them out. Hospitals have figured out a cheap and easy way to acquire anesthesia groups. Just indemnify and litigate later. NAPA, envision cannot keep up with market rates. They are Fu(ked.

 

[aneftp]

NAPA is notorious at enforcing non compete. So in order to retain docs. Hospitals loath to use in house w2 models but that’s the only way to can claim safe harbor.

So that’s their only way out. They cannot switch to another company for anesthesia services

Believe it or not. Hospitals generally do not want to employ anesthesia (rads or EM). Because it’s like fight club. They don’t want surgeons complaining about anesthesia coverage. It’s like fighting themselves so they rather place the blame on someone else.

 

[Fpg1245]

I am just waiting for LIJ and Northwell to fall….

My guess is they’ll probably just not renew their contract. They already employ anesthesiologists at certain hospitals. Probably just seeing how well they can run it before they cut completely.

I think despite all the sites they’ll lose. Plenty of hospital systems they can scam in other parts of the country. They probably have another 15 years or so.

 

[IMGASMD]

My guess is they’ll probably just not renew their contract. They already employ anesthesiologists at certain hospitals. Probably just seeing how well they can run it before they cut completely.

I think despite all the sites they’ll lose. Plenty of hospital systems they can scam in other parts of the country. They probably have another 15 years or so.

It has been in the works for a while. They’ve been bringing anesthesia in house for their smaller hospitals. I am just mystified by all these hospitals who rather work with AMCs. If they really lose LIJ, where it all started, I wonder if C-suite will still see them in the same light.

Who knows. There’s a lot of consolidation going on in healthcare.

 

[dannyboy1]

At least private equity gets cut out. They do nothing/own nothing so why should they get paid?
Initially the hospital will be a nicer employer. Long term????

 

[aneftp]

Rumor has it that is in the works. Also that Fairfax in Virginia is kicking them out. Hospitals have figured out a cheap and easy way to acquire anesthesia groups. Just indemnify and litigate later. NAPA, envision cannot keep up with market rates. They are Fu(ked.

Very complicated in northern Virginia with another national company in competition to try to take over for Napa at inova facilities. There is no way out for inova unless they got savvy lawyers to switch companies. And inova is a very affluent hospital system there. They will figure a way out.

 

[amyl]

I have to disagree that being hospital employed is better than at least my amc, USAP. When I was hospital employed the ceo always told me I was his favorite anesthesiologist because he never heard my name. We are just checked boxes to them… they’d all replace us with crnas if they could get away with it. They don’t care if you’re well trained or not… provide good care or not. They just want money and silence.

My old partners at that hospital had been there for years and found out I was being given a bigger bonus then they were - ceo just pays what he HAS to…. Hospital administrators whole job is to get you for as cheap as they can….

 

[2Fast2Des]

How do hospital gigs run compared to private or AMC? Does the scheduling and day to day logistics have to be approved by the hospital? Or does the hospital leave it to the group leaders to run things as they see fit? Like being in private we can be flexible with changing vacation time, asking to be out early if things come up, have call requests, etc. Does being a hospital employee change all that and do whatever they tell you?

 

[Dr. Rude]

I have to disagree that being hospital employed is better than at least my amc, USAP. When I was hospital employed the ceo always told me I was his favorite anesthesiologist because he never heard my name. We are just checked boxes to them… they’d all replace us with crnas if they could get away with it. They don’t care if you’re well trained or not… provide good care or not. They just want money and silence.

My old partners at that hospital had been there for years and found out I was being given a bigger bonus then they were - ceo just pays what he HAS to…. Hospital administrators whole job is to get you for as cheap as they can….

Hospitals that employ docs and AMCs are both predators that look at us as antelopes to feed on. AMCs are just more effective predators in general.

Ex clinical Anesthesiologists and CRNAs are far more effective at exploiting us than non anesthesia administrators. They know us better because they used to be us.

 

[dannyboy1]

Depends on workload and hours. Is it W2 or 1099? With them directly or third party agency?
Also how long you think this kind of market/rate can go on.

I happen to know it’s very hard to negotiate a different rate than what’s offered with NAPA. They have came back to me “this is our company/region rate, we want to be ‘consistent’ ”. You’d think beggars cannot be choosers, you’d be wrong. They can drag their feet and you continue to not be working…..

That is my experience with NAPA. they refuse to negotiate directly with doctors. Doesn’t matter how short they are. For some reason they have no qualms about negotiating with locums companies.

 

[IMGASMD]

That is my experience with NAPA. they refuse to negotiate directly with doctors. Doesn’t matter how short they are. For some reason they have no qualms about negotiating with locums companies.

I’ve been trying to talk to some “agents” from locum companies to figure out their process. Some of the smaller companies can get the cold shoulders too.

That’s one of my criticism of big national groups….. it moves too slow…. The rate change will have to go through 5 layers. By the time they finally approve the rate, they’re already behind. But what do I know. I am only “anesthesia” right?

 

[chocomorsel]

Why that group even sold out to begin with is puzzling. Those guys were raking in moola and in an affluent payor mix area. They went short sighted, took the nice buyout and turned an MD only group into a 1:4 CRNA **** show that is constantly rotating cast of characters. This is what greed does.

This is often the case. They see the quick money they will make right away instead of over the long haul and bite.
So stupid.

 

[TheLoneWolf]

Good to hear. I had interviewed and was considering signing with Napa at an amazing location for above average pay but something didn't feel right.

 

[aneftp]

How do hospital gigs run compared to private or AMC? Does the scheduling and day to day logistics have to be approved by the hospital? Or does the hospital leave it to the group leaders to run things as they see fit? Like being in private we can be flexible with changing vacation time, asking to be out early if things come up, have call requests, etc. Does being a hospital employee change all that and do whatever they tell you?

It’s very tricky. My old practice (private) went to an AMC who maintain same salary structure and paid vacation. Than hospital took over w2 (benefits better) salary slightly better. Looked better on paper. At least while they were fully staffed for a while.

Now 2 plus years later. They are short staff. This is where LARGE AMC do really do better. The large amc have a large pool of locums docs they can immediately plug in if short staff. While the previous amc managed the practice. Staffing was adequate and locums could be used to fill in the gap usually with less than 4 weeks notice for temp privileges.

Now the hospital based practice is very slow to respond to staffing shortages. They simply do not have that large of base of locums to pull from and they too cheap to pay the middle man recruiters 20-30% fees to get locums in quicker.

 

[GassYous]

Good to hear. I had interviewed and was considering signing with Napa at an amazing location for above average pay but something didn't feel right.

Tons of call. Busy af. Crappy crnas.

It’s very tricky. My old practice (private) went to an AMC who maintain same salary structure and paid vacation. Than hospital took over w2 (benefits better) salary slightly better. Looked better on paper. At least while they were fully staffed for a while.

Now 2 plus years later. They are short staff. This is where LARGE AMC do really do better. The large amc have a large pool of locums docs they can immediately plug in if short staff. While the previous amc managed the practice. Staffing was adequate and locums could be used to fill in the gap usually with less than 4 weeks notice for temp privileges.

Now the hospital based practice is very slow to respond to staffing shortages. They simply do not have that large of base of locums to pull from and they too cheap to pay the middle man recruiters 20-30% fees to get locums in quicker.

Really doesn't make sense when you think about how much they make in facility fees per case.

 

[IMGASMD]

Tons of call. Busy af. Crappy crnas.



Really doesn't make sense when you think about how much they make in facility fees per case.

Just very short sighted, but it sure looks good on paper for a short while. Kept the same volume with less….

 

[OptionOffense]

Barnabas is a really nice hospital. It rivals the hospitals in Bergen Co. I also think its sad that this is happening. THey had a group of good doctors there. Why they sold out is beyond me. I did just get a call from a recruiter looking to fill barnabas. I told em to go find more crnas for that rate

 

[Twiggidy]

Barnabas is a really nice hospital. It rivals the hospitals in Bergen Co. I also think its sad that this is happening. THey had a group of good doctors there. Why they sold out is beyond me. I did just get a call from a recruiter looking to fill barnabas. I told em to go find more crnas for that rate

Just playing devil's advocate and I mean you no disrespect, but isn't this a little bit part of the problem. You say "go find more crnas for that rate" and suit with an MBA does so. CRNA miraculous don't off anyone and now suit with MBA is like, "Wait sec, this isn't so bad. Why don't we just keep this CRNA thing going?"

 

[maxxor]

NAPA is notorious at enforcing non compete. So in order to retain docs. Hospitals loath to use in house w2 models but that’s the only way to can claim safe harbor.

So that’s their only way out. They cannot switch to another company for anesthesia services

Believe it or not. Hospitals generally do not want to employ anesthesia (rads or EM). Because it’s like fight club. They don’t want surgeons complaining about anesthesia coverage. It’s like fighting themselves so they rather place the blame on someone else.

How long does W2 have to be in effect to avoid getting sued?

Could they form a W2 group for 2 years then spin it out as a private group +/- an RFP?

 

[aneftp]

Tons of call. Busy af. Crappy crnas.



Really doesn't make sense when you think about how much they make in facility fees per case.

It makes sense when the hospital doesn’t know how to manage anesthesia staffing.

You got people learning on the job with admin. That’s why they will out source third party companies.

 

[OptionOffense]

Just playing devil's advocate and I mean you disrespect, but isn't this a little bit part of the problem. You say "go find more crnas for that rate" and suit with an MBA does so. CRNA miraculous don't off anyone and now suit with MBA is like, "Wait sec, this isn't so bad. Why don't we just keep this CRNA thing going?"

They can put a chimp at the stool. It really isn't my problem. If they think they can get away with all crnas and the surgeons and the patients are ok with it who am I to intervene. I can only control ME, I cant control what an MBA, the surgeons and patients at Barnabas do.

 

[Status Sciaticus]

You heard it here first. the same situation that happened with NAPA in Nevada, is happening at RWJ Barnabas health, the largest system in New Jersey. They took over this practice from Mednax in 2020 and, as is typical, tried to underpay and understaff. The $hit hit the fan when all the legacy partners initial contracts were up and none of the Docs would resign with NAPA. Hospital got fed up and offered direct employment with much more favorable terms and full indemnification. NAPA is going scorched earth, pulling multiple providers to other sites and leaving a skeleton crew at the hospital, but the hospital is determined to see this through. Stay tuned
New account for obvious reasons.

I am just waiting for LIJ and Northwell to fall….

Same. Waiting for the locums rate to hit 450/hr, then time to bleed them.

 

[pgg]

Really doesn't make sense when you think about how much they make in facility fees per case.

The hospital system has to use those windfall profits from the OR to subsidize all of their other money losers though, right?

 

[anbuitachi]

my area probably different from most but i like having some NAPA hospitals and AMC here. i feel like they drive up the average pay because their turnover is high and have to pay higher rates. the manhattan hospitals pay not so good

 

[GassYous]

my area probably different from most but i like having some NAPA hospitals and AMC here. i feel like they drive up the average pay because their turnover is high and have to pay higher rates. the manhattan hospitals pay not so good

But your job pays less than crna rate?

 

[anbuitachi]

But your job pays less than crna rate?

yes. but still our rate has gone up significantly in past few years. but yes it still sucks compared to all of you but its comparable to other large academic institutions in the region. but napa and north well are recruiting with salaries 475k to 550k which i believe helps us with negotiation. without them we may still have even lower pay

 

[narcotics999]

yes. but still our rate has gone up significantly in past few years. but yes it still sucks compared to all of you but its comparable to other large academic institutions in the region. but napa and north well are recruiting with salaries 475k to 550k which i believe helps us with negotiation. without them we may still have even lower pay

NYC area academic are paying 500K now? My starting salary was less than 250K a few years ago.

 

[Twiggidy]

NYC area academic are paying 500K now? My starting salary was less than 250K a few years ago.

Closer to 400k per my source

 

[sbmed100]

Beware of worshipping false idols. You’re trashing the AMC, and putting a bunch of old partners on a pedestal who have for years abused their younger and incoming colleagues -as well as engaged in nefarious financial behavior. Some of the tales from years past are the stuff of legend. The younger people without the golden parachute are rightly concerned. The thought that hospital employment is better is frankly laughable…especially once the honeymoon period ends.

 

[nycitygas]

Beware of worshipping false idols. You’re trashing the AMC, and putting a bunch of old partners on a pedestal who have for years abused their younger and incoming colleagues -as well as engaged in nefarious financial behavior. Some of the tales from years past are the stuff of legend. The younger people without the golden parachute are rightly concerned. The thought that hospital employment is better is frankly laughable…especially once the honeymoon period ends.

The SB group was one of the most malignant groups in the country. I am surprised they sold out though bc I heard the "top tier" partners were making an incredible amount of money with minimal work (working 1:1 with a resident each day).

 

[OptionOffense]

The SB group was one of the most malignant groups in the country. I am surprised they sold out though bc I heard the "top tier" partners were making an incredible amount of money with minimal work (working 1:1 with a resident each day).

There were only like 6 residents total there and from what I understand they got a ton of experience. Most of the attendings were/are solo. They just recently brought in some crnas, i do not know to what extent though. Oh, and I believe they were/are malignant. I think most groups in the area were: the groups in manhattan at beth israel and a bunch of defunct groups, Lenox hill, and North Jersey especially. ****, NAPA got their start in NY. That is ground zero

 

[IMGASMD]

There were only like 6 residents total there and from what I understand they got a ton of experience. Most of the attendings were/are solo. They just recently brought in some crnas, i do not know to what extent though. Oh, and I believe they were/are malignant. I think most groups in the area were: the groups in manhattan at beth israel and a bunch of defunct groups, Lenox hill, and North Jersey especially. ****, NAPA got their start in NY. That is ground zero

Someone did mention that they were MD only for a long time, only after AMC took over they started having nurses.

The SB group was one of the most malignant groups in the country. I am surprised they sold out though bc I heard the "top tier" partners were making an incredible amount of money with minimal work (working 1:1 with a resident each day).

1:1 with resident all the time? Must be nice.

 

[OptionOffense]

Someone did mention that they were MD only for a long time, only after AMC took over they started having nurses.



1:1 with resident all the time? Must be nice.

are you working over there now

 

[anesussy]

So if the consensus on here is that Napa sucks, why are people still working for them?

 

[IMGASMD]

are you working over there now

Nah. I have a full time job. If I am locum, I’d probably go and make some dough.

 

[Mman]

So if the consensus on here is that Napa sucks, why are people still working for them?

in some locations, they are currently the only game in town. When it comes to jobs, some people are more flexible in where they can/will work than others.

 

[IMGASMD]

So if the consensus on here is that Napa sucks, why are people still working for them?

Location…. Location… location… Let’s say you need to live around Long Island and don’t want to be in academic and no other PP are hiring. You also don’t believe in working for the hospital.

If you’re making money for the mothership, they tend to leave you alone for a bit. Usually after a few years, if you don’t make enough profit, then you’re constantly short staffed, overworked with locums in and out. It also is based on a “corporate” structure, some people like that stability of a bigger corporation.

 

[Dr. Rude]

So if the consensus on here is that Napa sucks, why are people still working for them?

Least dirty shirt in the closet.