No group is safe

[bthings]

For the past 6 years I have worked in a private practice, all MD, community hospital doing the gamut of cases (except for hearts and trauma). We were a very egalitarian, transparent group. Financials were available to me my first month of employment and for every month there after until becoming a partner three years in.

We worked well with the surgeons, covered the hospital's inane schedule in the OR and all the satellite locations they could dream up. Most important we asked for nothing. No stipends, no benefits, no remuneration of any kind from the hospital (in a locale with 60% Medicare/Medicaid/self-pay.) Meds and machines, that's all we got.

So what could a stable group like this possibly have to worry about in this time of upheaval? Everything. In the past 9 months my group has gone from hospital fixture of over 30 yrs to any other replaceable item.

Administration basically presented a contract that made us indentured servants. Servants without any guarantee of income, benefits, or even employment. Things like 90 day release without cause, call coverage as the hospital sees fit, complete control over hiring and firing and even deciding who will be department chair.

When we resisted they threatened. When we pleaded they scoffed. When we offered solutions they denied. When finally the only option left was to sell our souls to an AMC they smiled and handed us a RFP (put the contract up for bid). "We hope you will participate in the process," they said.

As I write this I am thinking about the newest members of my group and the CA3 residents looking for jobs. This is a wonderful specialty, necessary, and appreciated by those who truly know what it is that we do. As a group we have to do a better job of letting administration know and more importantly see how valuable our services are.

-scorned B

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Members don't see this ad.

 

[emergentmd]

For the past 6 years I have worked in a private practice, all MD, community hospital doing the gamut of cases (except for hearts and trauma). We were a very egalitarian, transparent group. Financials were available to me my first month of employment and for every month there after until becoming a partner three years in.

We worked well with the surgeons, covered the hospital's inane schedule in the OR and all the satellite locations they could dream up. Most important we asked for nothing. No stipends, no benefits, no remuneration of any kind from the hospital (in a locale with 60% Medicare/Medicaid/self-pay.) Meds and machines, that's all we got.

So what could a stable group like this possibly have to worry about in this time of upheaval? Everything. In the past 9 months my group has gone from hospital fixture of over 30 yrs to any other replaceable item.

Administration basically presented a contract that made us indentured servants. Servants without any guarantee of income, benefits, or even employment. Things like 90 day release without cause, call coverage as the hospital sees fit, complete control over hiring and firing and even deciding who will be department chair.

When we resisted they threatened. When we pleaded they scoffed. When we offered solutions they denied. When finally the only option left was to sell our souls to an AMC they smiled and handed us a RFP (put the contract up for bid). "We hope you will participate in the process," they said.

As I write this I am thinking about the newest members of my group and the CA3 residents looking for jobs. This is a wonderful specialty, necessary, and appreciated by those who truly know what it is that we do. As a group we have to do a better job of letting administration know and more importantly see how valuable our services are.

-scorned B

Sorry to hear this. This is happening to all hospital based medicine. Independent groups in ER, Anesth, Rad, Pathology, etc will slowly get bought out. It has nothing to do with how well you are doing, it has to do with $$$$$. If you don't think the Hospital CEO's have close relationships with the CMG CEOs, then you have your head in the sand. Back room private deals are made all of the time. CMG $$$ handshake to hospital CEO = private group out.

If I were a private group, I would look for a buyout and get as much money as you can. Wait too long, and your contract will go out for bid for Nothing.

Good luck to all in medicine. You still will make alot of $$$, but the days of insane $$$ and independence is coming to an End. Look for a way out of medicine. You don't want to have to work to pay the bills. Save some money, look for income producing businesses.

I know I am and hope to be independent of my Doc income in 5 yrs.

 

[Man o War]

Administration is going to screw the pooch on this one. In time that will be apparent. Let them bring in the AMC. It will cost them more money in the long run and they will get crappier service to boot. I think it's going to take a few years for this notion to actually become accepted amongst administrators. By that time, the AMC will make their profit and run. For as smart as many administrators think they are, they so easily fall for the smooth talking sales pitches these guys offer. I will tell you from experience, it's hilarious to sit back and laugh as you watch the volumes go down and surgeons bail because they can't stand the anesthesia providers because they are dangerous and quite frankly, suck.

 

[gasp]

Administration is going to screw the pooch on this one. In time that will be apparent. Let them bring in the AMC. It will cost them more money in the long run and they will get crappier service to boot. I think it's going to take a few years for this notion to actually become accepted amongst administrators. By that time, the AMC will make their profit and run. For as smart as many administrators think they are, they so easily fall for the smooth talking sales pitches these guys offer. I will tell you from experience, it's hilarious to sit back and laugh as you watch the volumes go down and surgeons bail because they can't stand the anesthesia providers because they are dangerous and quite frankly, suck.

The problem is you cant sit back and laugh or say I told u so because 1) you are losing your job 2) yes the hospital will start to go downhill eventually way after youre gone 3) yes surgeons will bail out but nobody cares 4) patients will suffer but nobody cares 5) you will join another group and live in fear of it happening again. In the end, its a lose lose situation for everyone except some guy who doesnt even deserve the win. So what do u do? Nothing. This is the reality of any medical field in this day and age, you become stronger in not letting it bother you and you go with the flow. Easier said than done? Absolutely. Impossible? No.

 

[sevoflurane]

These series of events can be very cyclical.

Someone mentioned Vail Anesthesia earlier this week. I knew some pretty good guys in that group. Very sad the way things turned out.

 

[urge]

For the past 6 years I have worked in a private practice, all MD, community hospital doing the gamut of cases (except for hearts and trauma). We were a very egalitarian, transparent group. Financials were available to me my first month of employment and for every month there after until becoming a partner three years in.

We worked well with the surgeons, covered the hospital's inane schedule in the OR and all the satellite locations they could dream up. Most important we asked for nothing. No stipends, no benefits, no remuneration of any kind from the hospital (in a locale with 60% Medicare/Medicaid/self-pay.) Meds and machines, that's all we got.

So what could a stable group like this possibly have to worry about in this time of upheaval? Everything. In the past 9 months my group has gone from hospital fixture of over 30 yrs to any other replaceable item.

Administration basically presented a contract that made us indentured servants. Servants without any guarantee of income, benefits, or even employment. Things like 90 day release without cause, call coverage as the hospital sees fit, complete control over hiring and firing and even deciding who will be department chair.

When we resisted they threatened. When we pleaded they scoffed. When we offered solutions they denied. When finally the only option left was to sell our souls to an AMC they smiled and handed us a RFP (put the contract up for bid). "We hope you will participate in the process," they said.

As I write this I am thinking about the newest members of my group and the CA3 residents looking for jobs. This is a wonderful specialty, necessary, and appreciated by those who truly know what it is that we do. As a group we have to do a better job of letting administration know and more importantly see how valuable our services are.

-scorned B

It is just business. The hospital thinks they can get away with more. Maybe they can, maybe not. You should put a value to yourselves and be done with it. If the hospital wants cheaper let them hire the cheaper anesthesiologists. When there is a critical mass of anesthesiologist who value themselves things will get better.

There is no reason to be scorned.

 

[IlDestriero]

It sounds like someone gave them a sales pitch or the CEO went to a conference to learn how they were losing money on these hospital based services. They can now be seen as a source of income, and they decided to just try to take over your group and make you employees. Be glad it didn't work out, an AMC would probably be a more stable arrangement. At least they understand how they should manage an anesthesia group. When things got bad for the hospital, and they may already be sliding off the cliff, they'd squeeze you until you have to quit anyway. As you noted in your OP they already mismanage things.

 

[aneftp]

Again guys. If you can drag it out to where you are day to day in your anesthesia contract.

Put firewalls in credentialing process.

Say as a group bail on a Friday and F the hospital.

That's how you roll and take care of business. Hospital ceo will be fired immediately once you sucker him/her into that.

I really don't understand why groups don't do this. Go day to day in ur contract and bail. Be united.


They will lose $$$ quickly.

 

[deleted126335]

Again guys. If you can drag it out to where you are day to day in your anesthesia contract.

Put firewalls in credentialing process.

Say as a group bail on a Friday and F the hospital.

That's how you roll and take care of business. Hospital ceo will be fired immediately once you sucker him/her into that.

I really don't understand why groups don't do this. Go day to day in ur contract and bail. Be united.


They will lose $$$ quickly.

lack of unity. fear. hospital strategy of divide and conquer.

 

[deleted50478]

Again guys. If you can drag it out to where you are day to day in your anesthesia contract.

Put firewalls in credentialing process.

Say as a group bail on a Friday and F the hospital.

That's how you roll and take care of business. Hospital ceo will be fired immediately once you sucker him/her into that.

I really don't understand why groups don't do this. Go day to day in ur contract and bail. Be united.


They will lose $$$ quickly.

Every CEO will also learn to steer clear of your group.

 

[emergentmd]

Easier

Again guys. If you can drag it out to where you are day to day in your anesthesia contract.

Put firewalls in credentialing process.

Say as a group bail on a Friday and F the hospital.

That's how you roll and take care of business. Hospital ceo will be fired immediately once you sucker him/her into that.

I really don't understand why groups don't do this. Go day to day in ur contract and bail. Be united.


They will lose $$$ quickly.

Easier said than done. Of course you could do this and it would work. Try getting 50+ docs to go along with this. People have family, homes, kids in school, bills. If they are out of the job for a few months, many would be in a world of hurt.

BUT it would WORK for about 3 months. The CEO would give in, put on his happy face, and then make a quick call to a CMG. Your private group would be out in 6 months. You would be living in fear every day of your life.

Our group went through this, talked alot about every options. Key is to band together, get your buyout, and move on. No way you can fight this if the CEO wants a CMG in

 

[criticalelement]

Again guys. If you can drag it out to where you are day to day in your anesthesia contract.

Put firewalls in credentialing process.

Say as a group bail on a Friday and F the hospital.

That's how you roll and take care of business. Hospital ceo will be fired immediately once you sucker him/her into that.

I really don't understand why groups don't do this. Go day to day in ur contract and bail. Be united.


They will lose $$$ quickly.

not sure anyone has the balls to work day to day. especially if you have kids and a family in the area. BUt you are right, that is the way to go. We will never be united. But once we are united, and present a united front our salaries can jump almost double I bet. Look at nurses in NYC. They make almost 100K working 36 hours.

It is partly about the money, mostly about CONTROL!!

 

[Planktonmd]

It is just business. The hospital thinks they can get away with more. Maybe they can, maybe not. You should put a value to yourselves and be done with it. If the hospital wants cheaper let them hire the cheaper anesthesiologists. When there is a critical mass of anesthesiologist who value themselves things will get better.

There is no reason to be scorned.

Unfortunately with the current job market conditions the value you put on yourself has to be flexible and realistic.

 

[Arch Guillotti]

Again guys. If you can drag it out to where you are day to day in your anesthesia contract.

Put firewalls in credentialing process.

Say as a group bail on a Friday and F the hospital.

That's how you roll and take care of business. Hospital ceo will be fired immediately once you sucker him/her into that.

I really don't understand why groups don't do this. Go day to day in ur contract and bail. Be united.


They will lose $$$ quickly.

This would be a little too much for me and my guess is that it would backfire.

 

[aneftp]

This would be a little too much for me and my guess is that it would backfire.

Yes. And like the other poster said.

Hospital admin rely on the divide and conquer technique.

And in a way it's bad that physicians are not unionized. They should especially if 70-80% of us become employees of the hospital or AMCs.

And it's not just private groups feeling increased hospital demands.

My brother in law large hospital emoloyed anesthesia dept (45 plus Md plus 65-70 Crnas/aa).

Hospital wanted to cut back on anesthesia staffing.

9 MDs immediately threatened to leave. You think 9 would hurt. But it hurts. Just the threat made the hospital up to salary up to low 400s (with generous hospital benefits like paid short and long term disability). It takes min 3 months to get credentialed at this hospital.

So being united is what it will take to make the hospitals listen.

 

[urge]

My brother in law large hospital emoloyed anesthesia dept (45 plus Md plus 65-70 Crnas/aa).

Hospital wanted to cut back on anesthesia staffing.

9 MDs immediately threatened to leave. You think 9 would hurt. But it hurts. Just the threat made the hospital up to salary up to low 400s (with generous hospital benefits like paid short and long term disability). It takes min 3 months to get credentialed at this hospital.

So being united is what it will take to make the hospitals listen.

Don't get it. Didn't they want to downsize? Why would they yield when people threatened to leave? I would be like "don't let the door hit you......"

 

[IlDestriero]

Yes. And like the other poster said.

Hospital admin rely on the divide and conquer technique.

And in a way it's bad that physicians are not unionized. They should especially if 70-80% of us become employees of the hospital or AMCs.

And it's not just private groups feeling increased hospital demands.

My brother in law large hospital emoloyed anesthesia dept (45 plus Md plus 65-70 Crnas/aa).

Hospital wanted to cut back on anesthesia staffing.

9 MDs immediately threatened to leave. You think 9 would hurt. But it hurts. Just the threat made the hospital up to salary up to low 400s (with generous hospital benefits like paid short and long term disability). It takes min 3 months to get credentialed at this hospital.

So being united is what it will take to make the hospitals listen.

You think it takes 3 months to get credentialed, but they may have emergency credential process (we do at our bloated academic center) and someone can walk the paperwork around to everyone that needs to sign off on it. Things can be sent for review by email, voted electronically, etc. as well.
Even if the bylaws have a set process, there are ways around these things that may or may not be in place.

 

[pgg]

You think it takes 3 months to get credentialed, but they may have emergency credential process (we do at our bloated academic center) and someone can walk the paperwork around to everyone that needs to sign off on it. Things can be sent for review by email, voted electronically, etc. as well.
Even if the bylaws have a set process, there are ways around these things that may or may not be in place.

Yep, one can get credentialed by tomorrow afternoon anywhere, if they want you to start tomorrow. Nonessential machine cogs can wait until the third Thursday next month when the credentials committee meets.

 

[aneftp]

You think it takes 3 months to get credentialed, but they may have emergency credential process (we do at our bloated academic center) and someone can walk the paperwork around to everyone that needs to sign off on it. Things can be sent for review by email, voted electronically, etc. as well.
Even if the bylaws have a set process, there are ways around these things that may or may not be in place.

Temp privileges still take 2-4 weeks.

We are in an age where credentialing is getting more scrutinized.

Like the idiot 17 year old who faked his way to being credentialed as PA. Makes hospital system look bad.

 

[urge]

Temp privileges still take 2-4 weeks.

We are in an age where credentialing is getting more scrutinized.

Like the idiot 17 year old who faked his way to being credentialed as PA. Makes hospital system look bad.

There are emergency privileges also. Takes just minutes.

The biggest hurdle is not the privileges. It is finding someone who can be privileged on a short notice. I would say it takes a month to find an anesthesiologist.

 

[Twiggidy]

Every CEO will also learn to steer clear of your group.

This should have been quoted by everyone. Let's say you pull out and administration says, "Peace!" How are you with a straight face going to show up at another hospital asking for a job? You don't think anyone is going to call the former hospital CEO

You'll more likely look like this...

 

[aneftp]

This should have been quoted by everyone. Let's say you pull out and administration says, "Peace!" How are you with a straight face going to show up at another hospital asking for a job? You don't think anyone is going to call the former hospital CEO

You'll more likely look like this...

1. You aren't breaking any legal contracts when you are literally on a week to week basis. This does happen. It happened in 2 hospital out in California that I am aware. Both times CEO's were out of jobs. Somnia took over one of them. Another was used by temp locums (like those emergency 2 week privileges). Guess what happened? They had a patient death and it freaked out the community. Blamed it on anesthesia obviously cause the locums person was "new".

Even my group in florida was operating on a 7 day temporary contract (IE monday to monday morning) for 1 month back with their last renewal end of 2012.

2. What's the other hospital CEO going to say? MD F us over? How?

It's not like you have a 90 day contract and leave abruptly here guys.

You negotiate in good faith. Negotiations can get stalled at times.

 

[criticalelement]

They will lose $$$ quickly.

No the won't. There is something called locums. While you are day to day in your contract, the ceo has already contacted every locum agency in the country with the need for temp docs. It will depend on the location whether or not it will be easy or difficult to get docs. So when you do bail, they've got a back up.... Ive been in a situation like this before.

 

[Mman]

For the past 6 years I have worked in a private practice, all MD, community hospital doing the gamut of cases (except for hearts and trauma). We were a very egalitarian, transparent group. Financials were available to me my first month of employment and for every month there after until becoming a partner three years in.

We worked well with the surgeons, covered the hospital's inane schedule in the OR and all the satellite locations they could dream up. Most important we asked for nothing. No stipends, no benefits, no remuneration of any kind from the hospital (in a locale with 60% Medicare/Medicaid/self-pay.) Meds and machines, that's all we got.

So what could a stable group like this possibly have to worry about in this time of upheaval? Everything. In the past 9 months my group has gone from hospital fixture of over 30 yrs to any other replaceable item.

Administration basically presented a contract that made us indentured servants. Servants without any guarantee of income, benefits, or even employment. Things like 90 day release without cause, call coverage as the hospital sees fit, complete control over hiring and firing and even deciding who will be department chair.

When we resisted they threatened. When we pleaded they scoffed. When we offered solutions they denied. When finally the only option left was to sell our souls to an AMC they smiled and handed us a RFP (put the contract up for bid). "We hope you will participate in the process," they said.

As I write this I am thinking about the newest members of my group and the CA3 residents looking for jobs. This is a wonderful specialty, necessary, and appreciated by those who truly know what it is that we do. As a group we have to do a better job of letting administration know and more importantly see how valuable our services are.

-scorned B

I don't quite understand your situation. You describe a private group with a hospital contract but then the contract you got offered related to things like hospital being in control of hiring/firing, benefits, etc. Are you saying the hospital offered you a new contract for anesthesia services that was much more onerous than your previous one (in terms of things like call coverage)?

Because if they were never paying you a dime for anything in the past, then they cannot exert any control over things like your benefits or how your contract within your group works unless you became a hospital employee. The only way I can see a private group being offered a contract "that made us indentured servants" was if they drastically increased the call coverage they wanted. Because they don't do your billing or collections so they money you make is not part of their equation in their contract.

Am I misunderstanding because I can't reconcile your description of a completely private and unsubsidized group and being offered a contract that drastically alters your group structure/pay/function with the exception of call coverage?

 

[bthings]

I don't quite understand your situation. You describe a private group with a hospital contract but then the contract you got offered related to things like hospital being in control of hiring/firing, benefits, etc. Are you saying the hospital offered you a new contract for anesthesia services that was much more onerous than your previous one (in terms of things like call coverage)?

Because if they were never paying you a dime for anything in the past, then they cannot exert any control over things like your benefits or how your contract within your group works unless you became a hospital employee. The only way I can see a private group being offered a contract "that made us indentured servants" was if they drastically increased the call coverage they wanted. Because they don't do your billing or collections so they money you make is not part of their equation in their contract.

Am I misunderstanding because I can't reconcile your description of a completely private and unsubsidized group and being offered a contract that drastically alters your group structure/pay/function with the exception of call coverage?

Our group operated without a formal contract for its lifetime (30 plus yrs). When admin would come to us with a contract we would always sit at the table with them and negotiate (this happened several times). Every time they would ultimately move on to bigger and better concerns ( what health system to merge with next etc...)and leave us sitting at the table holding our @&);s. We were happy to enter into a contract for our security and we were realists with the hospitals concerns.

But yes to your question this was the first time we saw a contract that was as absurdly punitive as the current iteration. Here are a few more "required provisions" of the contract.
-1600 square mile restrictive covenant for 1 year.
-no individual indemnity (pt slips on water you spill, sues hospital, you are responsible for legal fees and judgement personally.)
-90 day no cause termination at "the discretion of the hospital president."
-all 3rd party contract negotiations ( ie insurance rates) go through the hospital and you are bound to accept whatever they get you with no recourse.
- in-network with all payers regardless of the rate
- all hiring and in some cases firing must be run through the admin.
- expansion of services/coverage at hospitals discretion without notice or compensation.
- no outside clients, ie new ASC opens and wants you to staff it......SOL!


Just a few of the pearls "offered" to us as non-negotiable for the right to exclusivity with the hospital.


-B

 

[Mman]

Our group operated without a formal contract for its lifetime (30 plus yrs). When admin would come to us with a contract we would always sit at the table with them and negotiate (this happened several times). Every time they would ultimately move on to bigger and better concerns ( what health system to merge with next etc...)and leave us sitting at the table holding our @&);s. We were happy to enter into a contract for our security and we were realists with the hospitals concerns.

But yes to your question this was the first time we saw a contract that was as absurdly punitive as the current iteration. Here are a few more "required provisions" of the contract.
-1600 square mile restrictive covenant for 1 year.
-no individual indemnity (pt slips on water you spill, sues hospital, you are responsible for legal fees and judgement personally.)
-90 day no cause termination at "the discretion of the hospital president."
-all 3rd party contract negotiations ( ie insurance rates) go through the hospital and you are bound to accept whatever they get you with no recourse.
- in-network with all payers regardless of the rate
- all hiring and in some cases firing must be run through the admin.
- expansion of services/coverage at hospitals discretion without notice or compensation.
- no outside clients, ie new ASC opens and wants you to staff it......SOL!


Just a few of the pearls "offered" to us as non-negotiable for the right to exclusivity with the hospital.


-B

I don't even know where to begin.

--30+ years and you never once had a signed contract with the hospital?????????? That's the biggest red flag imaginable.

--Restrictive covenant? Unless they are making you a hospital employee, I'm not sure how that even works. I can't see how what is essentially an indepedent contractor through a private group could have limits placed on where else they could work. I suspect this is just a ploy to see how far they can get you to bend over for them.

--90 day no cause termination??? unless you work for the hospital and not the group, not sure how that is even applicable.

--insurance negotiations going through the hospital? Huh? that's called working for the hospital and not being a private group.




As far as I can tell it sounds like your group for some reason never had a contract with the hospital and the hospital now wants to make you hospital employees, albeit in some weird half ass way that makes it sound like you are still a private group. If I was the group, I'd start negotiating to actually be hospital employees. No point in submitting to their demands without them guaranteeing your salary.

 

[caligas]

Our group operated without a formal contract for its lifetime (30 plus yrs). When admin would come to us with a contract we would always sit at the table with them and negotiate (this happened several times). Every time they would ultimately move on to bigger and better concerns ( what health system to merge with next etc...)and leave us sitting at the table holding our @&);s. We were happy to enter into a contract for our security and we were realists with the hospitals concerns.

But yes to your question this was the first time we saw a contract that was as absurdly punitive as the current iteration. Here are a few more "required provisions" of the contract.
-1600 square mile restrictive covenant for 1 year.
-no individual indemnity (pt slips on water you spill, sues hospital, you are responsible for legal fees and judgement personally.)
-90 day no cause termination at "the discretion of the hospital president."
-all 3rd party contract negotiations ( ie insurance rates) go through the hospital and you are bound to accept whatever they get you with no recourse.
- in-network with all payers regardless of the rate
- all hiring and in some cases firing must be run through the admin.
- expansion of services/coverage at hospitals discretion without notice or compensation.
- no outside clients, ie new ASC opens and wants you to staff it......SOL!


Just a few of the pearls "offered" to us as non-negotiable for the right to exclusivity with the hospital.


-B

Reminds me of:

 

[criticalelement]

--30+ years and you never once had a signed contract with the hospital??????????
--.

That's the way it used to be. Anesthesiologist never had contracts with hospital. And every person in the group was separate from the other. And surgeons actually consulted specific people. That is not weird at all.

 

[Mman]

That's the way it used to be. Anesthesiologist never had contracts with hospital. And every person in the group was separate from the other. And surgeons actually consulted specific people. That is not weird at all.

I'm sure that's how it was 30-40 years ago, but I've yet to see a current group (and we frequently meet with private groups in a 500 mile radius to us to discuss mergers and such) that didn't have a formal hospital contract for anesthesia services. Ours has been in place since the late 1980s. The details vary, but it basically says you will provide X amount of coverage for our location (# of ORs, times of day, weekends, holidays, call, ICU, pain, etc) in exchange for being the exclusive provider of this service. It generally specifies a time range from 1 to 5 years with opt out provisions for either side. Sometimes there is a financial stipend attached to it, sometimes there isn't. Sometimes it includes providing CRNA/AA coverage, sometimes it doesn't.

But any sizeable group that was working with just a handshake with administration for the past few decades was just whistling past the graveyard IMHO and like I said, I've never heard of such a thing in present times.

 

[deleted162650]

It's a little location dependent. In my town many of the big hospitals have open staffing and no exclusive contract for anesthesia. A few major hospitals, mine included are covered by 2 separate groups. I've heard this is pretty common in the Denver metro area as well.

 

[Mman]

It's a little location dependent. In my town many of the big hospitals have open staffing and no exclusive contract for anesthesia. A few major hospitals, mine included are covered by 2 separate groups. I've heard this is pretty common in the Denver metro area as well.

But that's different than a group that is the only show in town and operating as if they have an exclusive contract when in reality they have no contract.

 

[urge]

Our group operated without a formal contract for its lifetime (30 plus yrs). When admin would come to us with a contract we would always sit at the table with them and negotiate (this happened several times). Every time they would ultimately move on to bigger and better concerns ( what health system to merge with next etc...)and leave us sitting at the table holding our @&);s. We were happy to enter into a contract for our security and we were realists with the hospitals concerns.

But yes to your question this was the first time we saw a contract that was as absurdly punitive as the current iteration. Here are a few more "required provisions" of the contract.
-1600 square mile restrictive covenant for 1 year.
-no individual indemnity (pt slips on water you spill, sues hospital, you are responsible for legal fees and judgement personally.)
-90 day no cause termination at "the discretion of the hospital president."
-all 3rd party contract negotiations ( ie insurance rates) go through the hospital and you are bound to accept whatever they get you with no recourse.
- in-network with all payers regardless of the rate
- all hiring and in some cases firing must be run through the admin.
- expansion of services/coverage at hospitals discretion without notice or compensation.
- no outside clients, ie new ASC opens and wants you to staff it......SOL!


Just a few of the pearls "offered" to us as non-negotiable for the right to exclusivity with the hospital.


-B

I think this is why partnership tracks are dangerous.

You have to be ready to walk every time the contract negotiations come up, but with the burden of a track, who really wants to walk? Nobody. That's how you get screwed.

 

[bthings]

I don't even know where to begin.

--30+ years and you never once had a signed contract with the hospital?????????? That's the biggest red flag imaginable.

--Restrictive covenant? Unless they are making you a hospital employee, I'm not sure how that even works. I can't see how what is essentially an indepedent contractor through a private group could have limits placed on where else they could work. I suspect this is just a ploy to see how far they can get you to bend over for them.

--90 day no cause termination??? unless you work for the hospital and not the group, not sure how that is even applicable.

--insurance negotiations going through the hospital? Huh? that's called working for the hospital and not being a private group.




As far as I can tell it sounds like your group for some reason never had a contract with the hospital and the hospital now wants to make you hospital employees, albeit in some weird half ass way that makes it sound like you are still a private group. If I was the group, I'd start negotiating to actually be hospital employees. No point in submitting to their demands without them guaranteeing your salary.

Ahh yes. Meeting number one with administration.

Us - "This sounds like you basically want us to take on all the liability and responsibility of an employee without the reward of guaranteed employment or benefits. Why not just employ us?"
Them - We're not in the business of employing in-house groups." ......as they continue to purchase and pick off OB, Vascular sx, General sx, hospitalists, thoracic sx, etc.

And a term you should all become familiar with: CIN "Clinically Integrated Network"
- Obamacare's answer to the obvious anti-trust implications of making hospitals the gatekeepers of bundled payments from government and private insurance. And guess what they base your unit value on......wait for it......X% of Medicare rates. In my hospital that would need to be 400% of the Medicare rate just to equal our blended unit.

As for the other requirements of the contract, no matter how ridiculous they may seem if you voluntarily sign the document you are bound by it. It's the " hospital's price for exclusivity."

B

 

[nimbus]

[QUOTE="bthings, post: 16716772, member: 12946"

And a term you should all become familiar with: CIN "Clinically Integrated Network"
- Obamacare's answer to the obvious anti-trust implications of making hospitals the gatekeepers of bundled payments from government and private insurance. And guess what they base your unit value on......wait for it......X% of Medicare rates. In my hospital that would need to be 400% of the Medicare rate just to equal our blended unit.

B[/QUOTE]

This is the real nightmare for anesthesia. Everyone at the table will look at you as if you are crazy because all the other doctors are happy with 125% of Medicare.

 

[Man o War]

I'd like to add a bullet point to the above: hospital spends millions on outside consultants to say "yes, this group needs a subsidy and is running as lean as they possibly can safely". Hospital hires another set of consultants who concur with the first set. For what they spent on consultants, they could have paid the subsidy we were requesting for FIVE YEARS. I left that dump and will never look back.

 

[Mman]

Ahh yes. Meeting number one with administration.

Us - "This sounds like you basically want us to take on all the liability and responsibility of an employee without the reward of guaranteed employment or benefits. Why not just employ us?"
Them - We're not in the business of employing in-house groups." ......as they continue to purchase and pick off OB, Vascular sx, General sx, hospitalists, thoracic sx, etc.

That's what I thought.

Their problem is they don't have a leg to stand on in negotiations because if your entire group called their bluff, they'd be left employing all the docs or outsourcing contract to an AMC that wouldn't abide by any of their crazy demands.

 

[amyl]

It's not just anesthesia. my bfe hospital just told the rads onc doc here that they "had no problem letting a high rvu generating physician go. You are all replaceable"
I think hospital administrators get so much $ from the government that the little that all of us Drs bring in is a flash in the pan. In the three years I have been here they fired the cards Sx, fired 2 gen surgeons, ran the vascular thoracic guy out of town, lost two anesthesiologists, lost the interventional radiologist, replaced the radiology group with a "service", fired an ortho guy... This is a 185 bed hospital. They make money whether we take care of people or not.... They certainly don't care about the quality of care. The government is in bed with the hospital admin and the joke is on us

 

[criticalelement]

ITs going to take all of the physicians at a big hospital (800 bed) resign and not come into work or do surgeries for a full month for them to understand who isreally important andwho isnt. IF administrators dont come to work , who really cares.

 

[Psai]

I'd like to add a bullet point to the above: hospital spends millions on outside consultants to say "yes, this group needs a subsidy and is running as lean as they possibly can safely". Hospital hires another set of consultants who concur with the first set. For what they spent on consultants, they could have paid the subsidy we were requesting for FIVE YEARS. I left that dump and will never look back.

...i don't understand their priorities

 

[deleted126335]

I'd like to add a bullet point to the above: hospital spends millions on outside consultants to say "yes, this group needs a subsidy and is running as lean as they possibly can safely". Hospital hires another set of consultants who concur with the first set. For what they spent on consultants, they could have paid the subsidy we were requesting for FIVE YEARS. I left that dump and will never look back.

Non profits need cover so they don't get accused of sweet heart deals. Massive civil penalties against institutions and Criminal charges have been made against CEOs who give fat contracts to friends. Rare, but it does happen.

 

[chocomorsel]

It's not just anesthesia. my bfe hospital just told the rads onc doc here that they "had no problem letting a high rvu generating physician go. You are all replaceable"
I think hospital administrators get so much $ from the government that the little that all of us Drs bring in is a flash in the pan. In the three years I have been here they fired the cards Sx, fired 2 gen surgeons, ran the vascular thoracic guy out of town, lost two anesthesiologists, lost the interventional radiologist, replaced the radiology group with a "service", fired an ortho guy... This is a 185 bed hospital. They make money whether we take care of people or not.... They certainly don't care about the quality of care. The government is in bed with the hospital admin and the joke is on us

How many anesthesiologists do you have at this one hospital? How many ORs and and sites do you cover? All that firing leaves a bad taste in people's mouths. I see why you can't wait to leave.

 

[Carbocation1]

New article: http://anesthesiologynews.com/ViewArticle.aspx?d=PRN&d_id=21&i=July+2015&i_id=1203&a_id=32980



Figure. Recent anesthesiology practice acquisitions.

 

[Man o War]

Non profits need cover so they don't get accused of sweet heart deals. Massive civil penalties against institutions and Criminal charges have been made against CEOs who give fat contracts to friends. Rare, but it does happen.

I wish that was the explanation, because that would signify good faith and fairness. In this hospital's case, it's a stall tactic. Group has been asking for subsidy for several years. The guy in charge keeps agreeing to cover expanded services that cost the partners money (because everyone is afraid of losing their jobs), with no subsidy contract signed. Average MGMA at all hospitals in my area is about 75% for anesthesiologists who have less call burden to boot. Partners in my old group are at approximately 40%, and go down every year. This is not typical for my area, so no way I'm accepting that kind of dynamic.

 

[amyl]

How many anesthesiologists do you have at this one hospital? How many ORs and and sites do you cover? All that firing leaves a bad taste in people's mouths. I see why you can't wait to leave.

I am one of 5 anesthesiologists. We have 5 ORs in main, four in our surgery center, OB, endo, cath lab, ir suite n the occasional mri. We staff six brackets as we have a crna.

 

[chocomorsel]

Jesus. That is way too little staffing for that size hospital and what u have to cover.

 

[risnwb]

I am one of 5 anesthesiologists. We have 5 ORs in main, four in our surgery center, OB, endo, cath lab, ir suite n the occasional mri. We staff six brackets as we have a crna.

That sounds like enough staff for either your hospital OR or the surgicenter but how could that be enough for 12-13 rooms ? Seems like a lot of wasted space

 

[urge]

Jesus. That is way too little staffing for that size hospital and what u have to cover.

I imagine not all rooms every day.

 

[Arch Guillotti]

I am one of 5 anesthesiologists. We have 5 ORs in main, four in our surgery center, OB, endo, cath lab, ir suite n the occasional mri. We staff six brackets as we have a crna.

What are brackets?

How many nurses do you staff at a time?

 

[pjl]

Sounds like she means rooms as defined by anesthesia. It is what we do.
Brackets 1 (MD)
Finish 0700 appy in room 1, go to 0800 room 2 for ORIF, go to 0930 room 1 for carotid, etc

Bracket 2 (CRNA)
0700 Cath lab, then 0900 GI lab for 3 cases, then 1100 cath lab

Bracket 3 (MD)
0700 ENT kids x20

Bracket 4...

Works well for staffing more rooms than you have anesthesia personnel, and the scrub techs/nurses can set up complex cases in what would otherwise be empty rooms so you minimize anesthesiologist downtime. (45 minute neurosurg set up can happen during end of previous case, then anesthesiologist just drops off from room 1 and walks back to room 2 with patient instead of waiting for clean up and set up).
Also works well for screwing you over with the second surgeon when the first grossly under schedules case time. We use it so we can flip rooms all day for multiple surgeons with less anesthesia providers, and so that we can keep surgeons on time even if the room they were scheduled to be in goes late on a prior case with different surgeon. Our groups target is to never delay a surgical start time due to other cases running over. The only time this occurs is when we run out of physical rooms.
Adds a bit of organized chaos to the day too for the board runner.

 

[chocomorsel]

They have one CRNA urge. In a 160 bed hospital. 5 Anesthesiologists. Sounds like they work her like a dog. I would leave too.
At my last job, at a 100 bed hospital we had 6 docs and 6 CRNA's, 7 OR's but they highest we ever ran was 6 rooms, plus GI, plus L &D.
We rarely staffed 1:4 with the CRNA's. Maybe we were overstaffed.
I likely would have stayed at that job where it not for the location mostly and the controlling lazy boss who was BFF's with his "best" CRNA, who was completely disrepectful and never disciplined. Heck I probably would have sucked it up and stayed though had it not be the location quite frankly. It was a cush job actually. Post call day off 98% of the time.

Looks like she answered how many brackets in her last post. Six. Everone spread nicely thin.