Northstar Anesthesia

[Gm1]

Anyone know anything about this group? Is it a good company to work for? Do they treat their MD's well?

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[sevoflurane]

Isn't this an AMC? Co-founded by a CRNA?

 

[goosegas]

Founded by an anesthesiologist and a CRNA. Now a private equity group owns the majority. They are big in Texas but are in several other states as well.

 

[sethco]

Highly considered them as they are big in TX. Good salary and benefits, but staffing/supervision model (even when doing cardiac) turned me off.

 

[ScaleneDoc]

Stay away... Far away, friends. They make big promises to the facilities they take over and (as predicted) under deliver. Working conditions and hours unfortunately dictated by share holders who sleep whole you suffer... They are the epitome of marginalizing physicians to a commodity. Typical AMC is this day and age.

 

[gasdoc77]

Stay away... Far away, friends. They make big promises to the facilities they take over and (as predicted) under deliver. Working conditions and hours unfortunately dictated by share holders who sleep whole you suffer... They are the epitome of marginalizing physicians to a commodity. Typical AMC is this day and age.

 

[BuzzPhreed]

Stay away... Far away, friends.

I'd take it further and suggest you stay away from any group that has a CRNA as an owner.

 

[gasdoc77]

I'd take it further and suggest you stay away from any group that has a CRNA as an owner.

an equal partner at that. I have no doubt that the two of them see MD heavy groups as ripe for the picking and work in conjunction to underbid those practices.

 

[BuzzPhreed]

an equal partner at that. I have no doubt that the two of them see MD heavy groups as ripe for the picking and work in conjunction to underbid those practices.

I have no doubt either. That CRNA-partner singing the "I'm on your team" and "the ACT model works" tune will quickly change tenor if that state opts out.

If one is forced to consider such a job (for whatever reason) theres no way in hell I would join as an MD/DO without a rock-solid guarantee of partnership. Or I'd at the very least high-ball the crap out of them, make hay while the sun shines, and then fly straight and make nice while trying to find something else. Quickly.

 

[cb3221]

Ive worked for them. they bent over backwards to get the contract, said they'd Keep the all MD model. good benefits Now the ACT is expanding and half of us will be forced out in the next 3 years or so. its the typical AMC, number crunchers that look at bottom line above all else. Agree w/ buzz.If the deal is sweet, milk it until it's dry.

 

[gasdoc77]

Just took over another practice that is nearby in a neighboring state (Owensboro KY). I knew some people there. No warning. Established practice. Came to work one day and a notice was hanging. Perhaps no other AMC will cannibalize our field more than this 50-50 venture between an "MD" (and I use the term loosely) and a CRNA. New grads, don't walk but run from these guys. The first deal they offer will be the best you will ever get and from that day forward they look to make deeper cuts and/or increase your responsibilities. May start with medical direction, will later be medical supervision, then to collaboration, them boom you are toast. Truly a trojan horse. And spreading like a virus. That is all.

 

[nycitygas]

Probably the worst AMC out there

 

[BuzzPhreed]

When are we going to say "enough is enough"? Don't work for these types of practices. Period. If it changes suddenly to this arrangement, suck it up and leave.

 

[anbuitachi]

When are we going to say "enough is enough"? Don't work for these types of practices. Period. If it changes suddenly to this arrangement, suck it up and leave.

I'm guessing some ppl need to stay in the region and don't got any other options... Fed kids is better than starving kids

 

[BuzzPhreed]

What? They don't have food in other parts of the country?

This is precisely the type of psychological warfare and manipulation they use to keep you in your place. I saw this firsthand in the practice I left. It's all about what you are willing to tolerate, I guess. Suck it up and stay then.

 

[anbuitachi]

What? They don't have food in other parts of the country?

This is precisely the type of psychological warfare and manipulation they use to keep you in your place. I saw this firsthand in the practice I left. It's all about what you are willing to tolerate, I guess. Suck it up and stay then.

thats like saying why dont they go to australia.. job is one thing but there are many factors to why someone may not want to move. maybe your wife/husband can't find a job at the new location, or he/she has a very stable job and doesn't want to leave. or maybe the city you are in has great schools and you dont want to leave cause your kids are loving it.. etcc
Moving to a new location often times means starting over. Got to make brand new friends, build new connections, etc etc, i dont think it is as simple as, hey if you dont like your job, just move

 

[gasdoc77]

thats like saying why dont they go to australia.. job is one thing but there are many factors to why someone may not want to move. maybe your wife/husband can't find a job at the new location, or he/she has a very stable job and doesn't want to leave. or maybe the city you are in has great schools and you dont want to leave cause your kids are loving it.. etcc
Moving to a new location often times means starting over. Got to make brand new friends, build new connections, etc etc, i dont think it is as simple as, hey if you dont like your job, just move

Case in point. This was a large established group rooted in a small town for generations. The hospital could care less if you did a fellowship. They want Wal-Mart and they will hand you your walking papers. As I've said, its a race to the bottom and it's growing exponentially.

 

[Arch Guillotti]

Just took over another practice that is nearby in a neighboring state (Owensboro KY). I knew some people there. No warning. Established practice. Came to work one day and a notice was hanging. Perhaps no other AMC will cannibalize our field more than this 50-50 venture between an "MD" (and I use the term loosely) and a CRNA. New grads, don't walk but run from these guys. The first deal they offer will be the best you will ever get and from that day forward they look to make deeper cuts and/or increase your responsibilities. May start with medical direction, will later be medical supervision, then to collaboration, them boom you are toast. Truly a trojan horse. And spreading like a virus. That is all.

Do you have any more information? Had the contract run the cycle? Surely someone in the anesthesia group knew about this beforehand unless they were hospital employees.

 

[risnwb]

Just took over another practice that is nearby in a neighboring state (Owensboro KY). I knew some people there. No warning. Established practice. Came to work one day and a notice was hanging. Perhaps no other AMC will cannibalize our field more than this 50-50 venture between an "MD" (and I use the term loosely) and a CRNA. New grads, don't walk but run from these guys. The first deal they offer will be the best you will ever get and from that day forward they look to make deeper cuts and/or increase your responsibilities. May start with medical direction, will later be medical supervision, then to collaboration, them boom you are toast. Truly a trojan horse. And spreading like a virus. That is all.

If it really happened this way the group should have turned around and walked out the door.

 

[2ndyear]

I know nothing of them other that they've started to make inroads in my state as well now. Started with a nice suburban hospital in a nice town. Now they took over a not so nice place in a not great city. But the ads on gaswork (both MD and CRNA) look to be on the high side of the local market range. It looks as though the truth is less than advertised by this thread.

 

[risnwb]

I know nothing of them other that they've started to make inroads in my state as well now. Started with a nice suburban hospital in a nice town. Now they took over a not so nice place in a not great city. But the ads on gaswork (both MD and CRNA) look to be on the high side of the local market range. It looks as though the truth is less than advertised by this thread.

Look carefully at those offers. I talked to them when looking for a job a year ago about a position that seemed good. Turned out the salary was 1099, call was rigorous, and it was a really sketchy setup with CRNA's and docs doing cases at the same time, but I was to be responsible for supervising them somehow. Basically the offer looked good but the details showed how crappy and dangerous it actually was

 

[anbuitachi]

Look carefully at those offers. I talked to them when looking for a job a year ago about a position that seemed good. Turned out the salary was 1099, call was rigorous, and it was a really sketchy setup with CRNA's and docs doing cases at the same time, but I was to be responsible for supervising them somehow. Basically the offer looked good but the details showed how crappy and dangerous it actually was

I see a lot of permanent full time 1099 anesthesia jobs listed on gaswork. Are these even legal... Don't the feds crack down on hiring 1099 when its supposed to be W2..

 

[risnwb]

I see a lot of permanent full time 1099 anesthesia jobs listed on gaswork. Are these even legal... Don't the feds crack down on hiring 1099 when its supposed to be W2..

It's not illegal, w2 jobs will generally come with benefits, malpractice, etc, whereas 1099 jobs will require you to fund that stuff yourself. The total benefit package is frequently worth upwards of 60-70k/year, so you have to take that in to account when considering a "higher than market value" salary...

 

[norwood]

RUN, do not walk.

If the choice is Northstar or unemployment, I'll take unemployment.

It's that bad.

 

[BuzzPhreed]

I see a lot of permanent full time 1099 anesthesia jobs listed on gaswork. Are these even legal... Don't the feds crack down on hiring 1099 when its supposed to be W2..

I depends:

http://www.irs.gov/Help-&-Resources...rs/Form-1099-MISC-&-Independent-Contractors-1

It could be interpreted that a supervisor is assigning your cases and thus controlling how you do the work in such circumstances. It might also depend on who collects your fee and how exactly you're paid (i.e. the business part of the work). It could also be interpreted that you are required to respond to the normal responsibilities expected of all other employees (i.e. your relationship with the business and behavioral control).

If you're not truly "independent", then you may be skirting the law and doing such potentially illegal things like allowing your employer to avoid paying the FICA tax. If you're full-time, I think it becomes much harder to argue that you are not an actual employee of whichever entity is utilizing your services... if they investigate, that is.

 

[Hockeyguy]

The problem is plain old economics. Supply and demand. If we (Anesthesiologists and CRNAs) didn't work for these companies they would go away. People will treat exactly the way you allow them to.

 

[anbuitachi]

The problem is plain old economics. Supply and demand. If we (Anesthesiologists and CRNAs) didn't work for these companies they would go away. People will treat exactly the way you allow them to.

if only that were possible with the thousands of anesthesiologists/crnas available... that'd be awesome though

 

[deleted50478]

The problem is plain old economics. Supply and demand. If we (Anesthesiologists and CRNAs) didn't work for these companies they would go away. People will treat exactly the way you allow them to.

The problem is failed government. These monopolies should be broken up.

 

[deleted126335]

The problem is failed government. These monopolies should be broken up.

Doubt they qualify as monopolies.
Arise ye starvelings...

 

[Triple AAA]

The problem is plain old economics. Supply and demand. If we (Anesthesiologists and CRNAs) didn't work for these companies they would go away. People will treat exactly the way you allow them to.

What do you suggest? Go on strike? Form a union? Good luck with that. We don't get to ask for rights, like nurses.

Let's face it. The people who make the rules don't care about safety. The govt, the management companies, the AANA, I imagine in the next couple of decades, most private groups will be bought out and our field will either be AMCs or academia. Pick your poison.

 

[anbuitachi]

What do you suggest? Go on strike? Form a union? Good luck with that. We don't get to ask for rights, like nurses.

Let's face it. The people who make the rules don't care about safety. The govt, the management companies, the AANA, I imagine in the next couple of decades, most private groups will be bought out and our field will either be AMCs or academia. Pick your poison.

that is troubling

 

[deleted50478]

that is troubling

Don't be troubled, just choose a different specialty.

 

[anbuitachi]

Don't be troubled, just choose a different specialty.

hahah i dont think im going to withdraw all my apps now...

 

[deleted50478]

hahah i dont think im going to withdraw all my apps now...

It's your funeral...

 

[gasdoc77]

http://www.prnewswire.com/news-rele...sence-in-southeast-and-midwest-300011964.html

 

[BLADEMDA]

Med Students should examine Northstar and AMCs as proof that the field is in big trouble.

1. NorthStar is growing by using a 1:6 or 1:8 medical supervision model. CRNAs are essentially unsupervised.
2. NorthStar is expanding its base and acquiring more contracts. Hospitals CEO want the LOWEST cost services.
3. AMCs are taking market share every day and cutting salaries. You will likely be employed by these guys at $250-$275K.
4. AMCS are successful because they control costs, utilize higher CRNA ratios or even unsupervised CRNAs and negotiate higher reimbursement rates from insurance companies.
5. Everyone here believes in "free markets" until it affects them personally. Guess what? AMCs utilize the free market principle to gut your salary and hire cheap labor.
6. Northstar is an example of the AANA agenda coming to fruition. Soon Northstar may offer "CRNA only" contracts at a huge cost reduction to the poorest hospitals.
7. Anesthesia will end up with Family practice type income with three times the stress, 30% more work hours and lots of night time/weekend call.

 

[BLADEMDA]

Blog by William Hass, MD, MBA:



Some anesthesiologists suspect there is a conspiracy by duplicitous certified registered nurse anesthetists (CRNAs) to displace them and or disrupt the anesthesia care team model. There are culprits all right, but they are called capitalism, competition, and technology.

You can't blame anesthesia management companies ("AMCs") and physician practice management companies ("PPMCs") for acting like private equity companies because some are backed by bigger private equity companies. The process used by private equity firms large and small is something like this:

• Evaluation the process
• Improve the processes
• Cut costs (in anesthesia cases this almost always staff costs)
• Continue to improve process and reduce costs
• Provide a return to investors

In this process some workers, in this instance anesthesia professionals, have lost their jobs and some companies, in this instance anesthesia groups, have closed, but that my friends is what we call capitalism.

Good old All-American competition is a culprit too. If you haven't been paying attention, there has been a focus replacing physicians services with advanced practice nurses ("APNs") and physicians' assistants ("PAs"). In the anesthesia APNs are called CRNAs and PAs are called AAs. We can debate the studies done to compare the equivalency of the care provided by the physician centric vs extender centric models, but they must look pretty good to someone because the acceptance of the concept continues to grow. The role of the AMCs and PPMCs for anesthesia professionals seems to follow this slippery slope:

• anesthesiologist only practices (no CRNAs/AAs); become
• anesthesia care team model practices (fewer anesthesiologists, more CRNAs/AAs); become
• collaborative anesthesia practices (fewer and fewer anesthesiologists, more and more CRNAs/AAs); become
• CRNA only practices (no anesthesiologists); become
• anesthesia professional light practices (fewer anesthesiologists, CRNAs, AAs, and more technology)

If done properly, each rung down this later comes with lower staff costs. The effect on overall costs is unclear.

There is also the competition between larger groups and medical service organizations ("MSOs") to lower "back office costs" like billing, administration, human resources, and performance improvement. AMCs and PPMCs can have higher non-staff costs because of the need to provide a return to investor over and above administrative costs. Again, the overall effect on costs are unclear.

The another culprit is technology. Anesthesiologists have felt immune to replacement by other anesthesia professionals (CRNAs and AAs) because the presence of preoperative catastrophes required advanced airway and/or anesthesia skills possessed by anesthesiologists were needed for the best possible results. With the introduction of the videolaryngoscopy, ultrasound guidance, and improvements in monitoring as well as telecommunications, there is an assumption by some that CRNAs and/or AAs could replace anesthesiologists.

There is an elephant in the room. Are CRNAs and AAs the winners? Not by a long shot. Who or what is being replaced in the “New World Order” should confuse no one. There will be continuing efforts to replace higher cost anesthesia professionals with lower cost staff or technology.

 

[BLADEMDA]

Again, Anesthesiology=Family practice in terms of income but with 3 times the stress, considerably more work and horrendous Call. Where do you sign up?

I can envision a scenario where AMCs start staffing their hospitals with newly minted Anesthesiologists instead of CRNAs because they cost the same per hour. The Anesthesiologist gets a $200K salary but 60 hours per week of work. Welcome to the new paradigm where you are just another body in the O.R.

 

[deleted126335]

I agree with your projections IF the current trend lines are unbroken. At some point before your prediction comes to pass, the trend lines will (probably) break. Not sure what will cause it, e.g., significant numbers of docs saying "f&ck it" and going part time or retiring or leaving the specialty, the RNs staying away from CRNA training programs, etc.

 

[anbuitachi]

I agree with your projections IF the current trend lines are unbroken. At some point before your prediction comes to pass, the trend lines will (probably) break. Not sure what will cause it, e.g., significant numbers of docs saying "f&ck it" and going part time or retiring or leaving the specialty, the RNs staying away from CRNA training programs, etc.

I imagine that will take a while since we have like almost 2000(?) New anesthesiologists graduating every year and only increasing.. Idk if old anesthesiologists can say Fk it fast enough for demand to > supply. If we really are going to a 1:6 model then the # of anesthesiologists would be signfiviantly fewer

 

[GaseousClay]

This all comes down to all these academic chairmen/faculty who train CRNAs alongside residents or even without residents. That right there is the biggest problem we face. All that money that comes in from CRNA schools is just too much for these departments to stop but there needs to be a stand somewhere. Its these same academic anesthesiologists that show their faces at ASA and want us to somehow do things to differentiate ourselves from CRNAs and that is because they themselves are responsible for churning these mid levels out like butter. The academic physician cares not about the private marketplace, as they know their jobs are secure. There needs to be more push to end CRNA training especially at places where residents are being trained. That itself marginalizes our field and our training.

 

[anbuitachi]

This all comes down to all these academic chairmen/faculty who train CRNAs alongside residents or even without residents. That right there is the biggest problem we face. All that money that comes in from CRNA schools is just too much for these departments to stop but there needs to be a stand somewhere. Its these same academic anesthesiologists that show their faces at ASA and want us to somehow do things to differentiate ourselves from CRNAs and that is because they themselves are responsible for churning these mid levels out like butter. The academic physician cares not about the private marketplace, as they know their jobs are secure. There needs to be more push to end CRNA training especially at places where residents are being trained. That itself marginalizes our field and our training.

or end our training and reduce residents..

one thing i dont quite get is if the whole business model is so profitable for companies like northstar, why dont the individual hospitals adopt the model and kick them out? that would give the hospital the profit isntead wont it?

 

[criticalelement]

This all comes down to all these academic chairmen/faculty who train CRNAs alongside residents or even without residents. That right there is the biggest problem we face. All that money that comes in from CRNA schools is just too much for these departments to stop but there needs to be a stand somewhere. Its these same academic anesthesiologists that show their faces at ASA and want us to somehow do things to differentiate ourselves from CRNAs and that is because they themselves are responsible for churning these mid levels out like butter. The academic physician cares not about the private marketplace, as they know their jobs are secure. There needs to be more push to end CRNA training especially at places where residents are being trained. That itself marginalizes our field and our training.

I agree with you that the chairmen of academic departments are the problem but for different reasons.

 

[criticalelement]

or end our training and reduce residents..

one thing i dont quite get is if the whole business model is so profitable for companies like northstar, why dont the individual hospitals adopt the model and kick them out? that would give the hospital the profit isntead wont it?

Very astute comment. It is my contention that , this is exactly what will happen in the next 10 years. Perhaps even earlier. YOu will see the large anesthesia companies dissolve everyone will go to hospital employment.

 

[BuzzPhreed]

Cross-posting on the "Another One Goes Down" thread.

 

[deleted126335]

Very astute comment. It is my contention that , this is exactly what will happen in the next 10 years. Perhaps even earlier. YOu will see the large anesthesia companies dissolve everyone will go to hospital employment.

Disagree. Very few people outside of those those that work in anesthesia management have a real understanding how it works. It is why these companies not only survive, but thrive.

 

[BLADEMDA]

Disagree. Very few people outside of those those that work in anesthesia management have a real understanding how it works. It is why these companies not only survive, but thrive.

I agree with Doze. Hospitals do a poor job at anesthesia billing and reimbursement. In addition, hospitals overpay and get less work out of their employees.

 

[deleted171991]

IMO, it would be much cheaper for a hospital to hire a competent well-paid chief of anesthesia, who can build a proper anesthesia department (including billing etc.), then to give these AMCs all that profit. I think the reason this is not happening is that the US has almost destroyed the private for-profit hospitals.

 

[BLADEMDA]

IMO, it would be much cheaper for a hospital to hire a competent well-paid chief of anesthesia, who can build a proper anesthesia department (including billing etc.), then to give these AMCs all that profit. I think the reason this is not happening is that the US has almost destroyed the private for-profit hospitals.

AMCs can bill 30 percent more per unit for insurance cases vs the hospital. AMCs can fire at will and pay less than fair wage. Hospitals must pay fair wages and have HR departments. Hence, the vast majority of hospitals (over 80 percent) are better off with an AMC vs hiring their own providers.

Until we get a radical change in billing/reimbursement the AMC is here to stay.

 

[kazuma]

AMCs can bill 30 percent more per unit for insurance cases vs the hospital. AMCs can fire at will and pay less than fair wage. Hospitals must pay fair wages and have HR departments. Hence, the vast majority of hospitals (over 80 percent) are better off with an AMC vs hiring their own providers.

Until we get a radical change in billing/reimbursement the AMC is here to stay.

Wow, I understood that they could negotiate a better per unit rate but I had no idea it was 30% more.