Residents Beware!

[Consigliere]

Your future:

http://online.wsj.com/article/PR-CO-20140224-904557.html

Employment by an AMC. If you are okay with that, then your future looks bright.

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Members don't see this ad.

 

[countingdays]

The press releases make the AMC's sound so wonderful you have to wonder why the partners need a buyout at all.

 

[LeverArm]

What's the issue here? Is it a pay cut or something more than that?

 

[BLADEMDA]

Anesthesiology used to be a great specialty for private practice. No longer. Now a PGY-1 is most likely looking at an employment model rather than ownership after residency. Hence, the specialty is no longer the lucrative field it once was and likely will never be again.

Money aside (the field is undergoing major salary reduction every year) we must also contend with the most militant nurses in the world who view "anesthesia" as a nursing level duty unworthy of a physician.

 

[gasdoc77]

I agree that the future looks bleak. I relocated my family across the country for a position that (I was told) would offer partnership after a year. It was the only such offer I found, seemed more than fair due to the short track, and they needed someone with my fellowship experience. Now, as the first year has passed, I apparently was "a vote" shy of partnership (this time around, of coarse). They say they may vote again, but I am left in limbo in the meantime. I still have the job (for now) but that too could change with little notice. I have gone above and beyond from day one, have fantastic working relationships with the surgeons and (I thought) with my colleagues, and was given no specifics in terms of feedback, despite inviting input. I have to believe this is a reflection of uncertainties in the field and market forces since by any objective measure I have by far exceeded the output of most if not all others in the group from day one. Admitting bias, I have to say that if this can happen to me it can, will, and likely often does happen to others (perhaps more so every day).

 

[BobBarker]

Go to a small hospital where doctors are still respected and work for the hospital. W2 with a production bonus for collections above base salary. It's out there and better than working for an AMC.

 

[deleted126335]

Go to a small hospital where doctors are still respected and work for the hospital. W2 with a production bonus for collections above base salary. It's out there and better than working for an AMC.

Collections won't be above salary. The hospital frequently controls the insurance product, or negotiates a lower professional service fee and a higher facility fee from the payor.

 

[BobBarker]

Better description would be a negotiated blended unit rate to calculate productivity. If productivity above base, then returned to physician at blended unit rate. So base of 350k, blended unit rate of $35/unit. 12,000 units billed, then receive a bonus of 70k.

 

[BuzzPhreed]

Go to a small hospital where doctors are still respected and work for the hospital. W2 with a production bonus for collections above base salary. It's out there and better than working for an AMC.

Agreed. 100%.

Negotiate a good salary. The production bonus (if you get any) will just be gravy.

 

[BuzzPhreed]

Collections won't be above salary. The hospital frequently controls the insurance product, or negotiates a lower professional service fee and a higher facility fee from the payor.

This is also true.

 

[BuzzPhreed]

Better description would be a negotiated blended unit rate to calculate productivity. If productivity above base, then returned to physician at blended unit rate. So base of 350k, blended unit rate of $35/unit. 12,000 units billed, then receive a bonus of 70k.

You will never see this no matter how you try to negotiate. That's the only downside to working in a hosptial system. "Mushroom syndrome" will apply. You'll never see the books. Who cares? Just negotiate a good base and be in control of what you do on a day-to-day basis.

 

[imfrankie]

I agree that the future looks bleak. I relocated my family across the country for a position that (I was told) would offer partnership after a year. It was the only such offer I found, seemed more than fair due to the short track, and they needed someone with my fellowship experience. Now, as the first year has passed, I apparently was "a vote" shy of partnership (this time around, of coarse). They say they may vote again, but I am left in limbo in the meantime. I still have the job (for now) but that too could change with little notice. I have gone above and beyond from day one, have fantastic working relationships with the surgeons and (I thought) with my colleagues, and was given no specifics in terms of feedback, despite inviting input. I have to believe this is a reflection of uncertainties in the field and market forces since by any objective measure I have by far exceeded the output of most if not all others in the group from day one. Admitting bias, I have to say that if this can happen to me it can, will, and likely often does happen to others (perhaps more so every day).

You should talk to the hospital admin then walk

 

[deleted126335]

I agree that the future looks bleak. I relocated my family across the country for a position that (I was told) would offer partnership after a year. It was the only such offer I found, seemed more than fair due to the short track, and they needed someone with my fellowship experience. Now, as the first year has passed, I apparently was "a vote" shy of partnership (this time around, of coarse). They say they may vote again, but I am left in limbo in the meantime. I still have the job (for now) but that too could change with little notice. I have gone above and beyond from day one, have fantastic working relationships with the surgeons and (I thought) with my colleagues, and was given no specifics in terms of feedback, despite inviting input. I have to believe this is a reflection of uncertainties in the field and market forces since by any objective measure I have by far exceeded the output of most if not all others in the group from day one. Admitting bias, I have to say that if this can happen to me it can, will, and likely often does happen to others (perhaps more so every day).

Unless you threaten to leave they will likely never give you a partnership. Don't threaten unless you are prepared to have them say "go ahead". Even mostly honorable people will do dishonorable things when facing a hit in their income.

 

[BuzzPhreed]

I relocated my family across the country for a position that (I was told) would offer partnership after a year.

Sounds familiar.

I apparently was "a vote" shy of partnership (this time around, of coarse).

Wonder how many times this is going to happen?

I have gone above and beyond from day one, have fantastic working relationships with the surgeons and (I thought) with my colleagues, and was given no specifics in terms of feedback, despite inviting input.

They don't care. They expect this. This is baseline. This isn't part of anything out of the ordinary or special. And as far as administrators are concerned you'd better provide this or you'll be gone quicker than lightning on an oil slick.

I have to believe this is a reflection of uncertainties in the field and market forces since by any objective measure

No, this is reflection of greed.

I have by far exceeded the output of most if not all others in the group from day one.

Who cares? Obviously not these guys. I say do what I did: vote with your feet. There is no longer a PP track. You are basically already working for an AMC. Find a place you really want to live and go work for one there. The bar is much lower and there are no expectations. Takes the pressure off. Or go work for a small hospital somewhere where you're paid directly like I mentioned above (and like I did and am doing). Either way you will have a much better and more gratifying practice life.

The days of wine and roses are gone in this profession. If you're in it for the money and thinking about the good life as a partner, I'd recommend choosing a different field.

 

[norwood]

What's the issue here? Is it a pay cut or something more than that?

It's a few things.

1. Pay cut, in the mid-to-long term if not the short term.
2. Dramatic decrease in benefits, in both recent AMC takeover cases I've seen.
3. Dramatic increase in work expected for the pay. Instead of supervising two or three rooms' worth of CRNAs (2:1 or 3:1 ratio), AMCs often expect 4:1.
4. Working at 4:1 means you often won't be there for induction or emergence, but the AMC will expect you to sign the chart to indicate that you were. Apart from the dishonesty involved, this means you are taking on all of the liability for the AMC's unsafe staffing. What happens when the CRNA can't intubate and you're off doing yet another preop?
5. Untrustworthy management - in both of the cases where AMCs took over something local, they promised the sun, the moon, and the stars, only to have a final arrangement that looked nothing like they promised. I talked to one on the phone, and their recruiter was quite a slippery character... took 10+ minutes of him beating around the bush before, on about the 5th time I asked, he finally admitted that yes, he'd be asking me to run 4:1 and sign as present for induction/emergence on every case.

Finally, although this may change as AMCs take over more and more of the landscape, the aforementioned five points mean that they often get people who don't have any other choice, and manage to keep them only until a better choice becomes available to them. This leads to a high-turnover environment and low morale.

So that's pretty much the issue with AMCs.

 

[LeverArm]

It's a few things.

1. Pay cut, in the mid-to-long term if not the short term.
2. Dramatic decrease in benefits, in both recent AMC takeover cases I've seen.
3. Dramatic increase in work expected for the pay. Instead of supervising two or three rooms' worth of CRNAs (2:1 or 3:1 ratio), AMCs often expect 4:1.
4. Working at 4:1 means you often won't be there for induction or emergence, but the AMC will expect you to sign the chart to indicate that you were. Apart from the dishonesty involved, this means you are taking on all of the liability for the AMC's unsafe staffing. What happens when the CRNA can't intubate and you're off doing yet another preop?
5. Untrustworthy management - in both of the cases where AMCs took over something local, they promised the sun, the moon, and the stars, only to have a final arrangement that looked nothing like they promised. I talked to one on the phone, and their recruiter was quite a slippery character... took 10+ minutes of him beating around the bush before, on about the 5th time I asked, he finally admitted that yes, he'd be asking me to run 4:1 and sign as present for induction/emergence on every case.

Finally, although this may change as AMCs take over more and more of the landscape, the aforementioned five points mean that they often get people who don't have any other choice, and manage to keep them only until a better choice becomes available to them. This leads to a high-turnover environment and low morale.

So that's pretty much the issue with AMCs.

I can see how that would suck. Thank you for giving an honest answer.

 

[IkeBoy18]

I can see how that would suck. Thank you for giving an honest answer.

it does suck. I really dont want to supervise.

 

[Consigliere]

it does suck. I really dont want to supervise.

Then you shall be unemployed. When the bills start piling up, you'll change your tune.

 

[BuzzPhreed]

It's a few things.

1. Pay cut, in the mid-to-long term if not the short term.
2. Dramatic decrease in benefits, in both recent AMC takeover cases I've seen.
3. Dramatic increase in work expected for the pay. Instead of supervising two or three rooms' worth of CRNAs (2:1 or 3:1 ratio), AMCs often expect 4:1.
4. Working at 4:1 means you often won't be there for induction or emergence, but the AMC will expect you to sign the chart to indicate that you were. Apart from the dishonesty involved, this means you are taking on all of the liability for the AMC's unsafe staffing. What happens when the CRNA can't intubate and you're off doing yet another preop?
5. Untrustworthy management - in both of the cases where AMCs took over something local, they promised the sun, the moon, and the stars, only to have a final arrangement that looked nothing like they promised. I talked to one on the phone, and their recruiter was quite a slippery character... took 10+ minutes of him beating around the bush before, on about the 5th time I asked, he finally admitted that yes, he'd be asking me to run 4:1 and sign as present for induction/emergence on every case.

Finally, although this may change as AMCs take over more and more of the landscape, the aforementioned five points mean that they often get people who don't have any other choice, and manage to keep them only until a better choice becomes available to them. This leads to a high-turnover environment and low morale.

So that's pretty much the issue with AMCs.

Whats more worrisome is that a lot of PP groups are adopting this model. The fat cat partners at the top siphon off your hard work and put you in untenable situations.

Let me give some blanket advice: any job you can find on Gaswork is not a job you want to have. Don't believe anyone's promises. Get it in writing. If they're not willing to put what you want in writing, walk away.

 

[gasdoc77]

Buzz. You mention that Gaswork isn't a worthwhile resource. What do you recommend? Is the good ole boy network the gold standard? I would think a group would want the biggest potential pool of applicants (such as Gaswork) so they could cherry pick. Word of mouth referral is selection bias exemplified.

Whats more worrisome is that a lot of PP groups are adopting this model. The fat cat partners at the top siphon off your hard work and put you in untenable situations.

Let me give some blanket advice: any job you can find on Gaswork is not a job you want to have. Don't believe anyone's promises. Get it in writing. If they're not willing to put what you want in writing, walk away.

 

[jwk]

Buzz. You mention that Gaswork isn't a worthwhile resource. What do you recommend? Is the good ole boy network the gold standard? I would think a group would want the biggest potential pool of applicants (such as Gaswork) so they could cherry pick. Word of mouth referral is selection bias exemplified.

you

There is a reason groups use Gaswork - the same reason they use recruiters - there may be a problem with the group. I have no doubt that some good groups use Gaswork, but anyone that thinks they're the best resource for finding a position is fooling themselves. Only a small fraction of groups and hospitals use Gaswork. Why? Because they don't need to.

Our group has stacks of CV's every hiring season. We have no problem in attracting quality applicants and we're arguably one of the better private practice groups in the country. Don't discount word-of-mouth and networking for a second - in the private practice world, that's how it's done. We draw from anywhere, but especially from both public and private university residency programs all over our region. Assuming you're staying in the region you're in now, are you attending meetings of the state and local anesthesiology societies in that region? ASA annual meeting? ASA Legislative Conference? Better yet, are you actually participating in the activities of your state component society? Anywhere and everywhere that you have a chance to show your face is worthwhile.

 

[Mman]

Gasworks is great for locating part time positions and employee type jobs at small hospitals. It is not the place to go if you are looking for a partnership track position with a large group. Word of mouth works for big groups hiring people because they have large networks of friends. A small hospital with only 2 MDs that essentially each cover 1/2 time obviously will struggle with word of mouth to hire somebody when 1 of their 2 docs retires.

 

[BuzzPhreed]

I recommend being a good stable resident who makes a lot of connections during residency. Choose a geographic area to do your residency where you generally intend to practice when you're done because this is likely where you are going to wind up. All suggestions by jwk are valid too.

The fact is that word of mouth is actually still important in our field like it or not. After a stable job of 5+ years I went off the grid to a place where I was not known and was not really known because my wife desired a geographic change. I did as much homework as I could before I took the job, but there is stuff they just don't tell you until you show up for the first day. Having that network and knowing people in the practice that you can trust and go to is crucial.

A lot of you will get jobs where your now-senior residents or some of your attendings will recruit you too. If you like these people and trust them it's a bonus. Be very wary going into a situation where you don't know anyone in advance.

And most importantly if you have a deal-breaker that they verbally assure you of, don't sign up until they put it in writing. The days of gentleman's agreements are over in this business.

 

[chudat]

Anybody have any experience when it comes to switching out of anesthesia during residency?

Is it even possible to go from anesthesia to general surg? or anesthesia to IM? anesthesia to EM? anything?

 

[secants]

Well I guess you could do your prelim/cby and reapply during that time. I think I recall people saying the cby might count towards a categorical IM position. If you're really crazy you can do a second residency is anesthesia isn't your calling. Resident swap seems like it has potential.

 

[chudat]

....

 

[chudat]

Well I guess you could do your prelim/cby and reapply during that time. I think I recall people saying the cby might count towards a categorical IM position. If you're really crazy you can do a second residency is anesthesia isn't your calling. Resident swap seems like it has potential.

No, honestly I just found out I matched last week; I haven't even begun residency yet.
All these posts of 'beware of anesthesia' by SDN attendings are scaring me though.

 

[Yo GabbaPentin]

The easiest would be anesthesia to .... INVESTMENT BANKING!!!

 

[deleted171991]

More like Investment Tanking. That's what doctors are experts at.