AMC lesson learned

[anes121508]

Hope the young people can learn from my mistake....

I choose a job with an AMC who had very recently bought out what most residents considered the best group in the city over two other pp groups in the same city.

I was skeptical of the AMC based on all the stuff I had heard about amc jobs. However, I really liked the hospital, the clinical opportunity, and the people in the group. Rumor on the forums and amongst others I knew said this AMC wasn’t quite as bad as North Star and was one of the “more benign” amcs.

What really clinched it for me was the fact that the group president explained to me that the original pp group put into place protections in the contract like staffing agreements, call schedule , a board made up of majority docs in the group, ect. Seemed like they really did it the right way and the place was a good fit. Coverage, call limits, ect even built into the individual employee contract.

Fast forward and the pp groups in town are still churning and the amc just started firing docs without cause, are going to change the staffing model to 4:1, adding significantly more call, making physicians clock in and out despite no hourly pay, ect. The amc claims they are not profitable and have to make changes. Hard to beleive without evidence.

I’ve shown a close family friend who is a lawyer with experience in this realm my employment contract and he says the amc has clearly violated terms of contract the way they have handled things, especially the firing of docs without cause and no consultation with the board.

Many lessons and insights into how the private equity firm based amcs work, but I’d say take the risk with a private practice vs the amc. Seems the like risks are the same and the upside is far better with the pp if you pick a fair and truthful practice.

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[dannyboy1]

Hope the young people can learn from my mistake....

I choose a job with an AMC who had very recently bought out what most residents considered the best group in the city over two other pp groups in the same city.

I was skeptical of the AMC based on all the stuff I had heard about amc jobs. However, I really liked the hospital, the clinical opportunity, and the people in the group. Rumor on the forums and amongst others I knew said this AMC wasn’t quite as bad as North Star and was one of the “more benign” amcs.

What really clinched it for me was the fact that the group president explained to me that the original pp group put into place protections in the contract like staffing agreements, call schedule , a board made up of majority docs in the group, ect. Seemed like they really did it the right way and the place was a good fit. Coverage, call limits, ect even built into the individual employee contract.

Fast forward and the pp groups in town are still churning and the amc just started firing docs without cause, are going to change the staffing model to 4:1, adding significantly more call, making physicians clock in and out despite no hourly pay, ect. The amc claims they are not profitable and have to make changes. Hard to beleive without evidence.

I’ve shown a close family friend who is a lawyer with experience in this realm my employment contract and he says the amc has clearly violated terms of contract the way they have handled things, especially the firing of docs without cause and no consultation with the board.

Many lessons and insights into how the private equity firm based amcs work, but I’d say take the risk with a private practice vs the amc. Seems the like risks are the same and the upside is far better with the pp if you pick a fair and truthful practice.

Yup. The business exists to make money. Period. As for the contract violation, guess what, it only matters if you have the time and resources to fight the AMC. since most of us don’t your only real leverage is to leave....

 

[anes121508]

Yup. The business exists to make money. Period. As for the contract violation, guess what, it only matters if you have the time and resources to fight the AMC. since most of us don’t your only real leverage is to leave....

Overall, I’d say the amc job is not the safe predictable low risk play insulated from economic powers. It’s likely worse.

My mommy was always right...”life’s tough kid, get an f***ing helmet.”

 

[anes121508]

Yup. The business exists to make money. Period. As for the contract violation, guess what, it only matters if you have the time and resources to fight the AMC. since most of us don’t your only real leverage is to leave....

Exactly what the amc uses.

Funny you mention then leave part...

Is taking another job and leaving a threat to be leveraged or the obvious move? Why even try to leverage? Doesn’t matter what they agree to or promise. They will just go back on their word.

So....why even get involved in the first place? Even leaving and finding another job isn’t really leverage.

Finding another job is the right move. Still no guarantee people operate in good faith...

But hell, at least a smaller pp group is less likely to violate an employment contract and has less resources to fight you than the amc

 

[dchz]

What is the name of the AMC and the region of the country?

 

[IMGASMD]

Hubris..... for all of us. I can do it better. My contract is better than yours.

My problem has always been they treat you like an hourly employee, at the same time telling you have to behave like a owner/partner, so you need to cover all the cases. There is a thread in EM sub about no relief after a 24 hour shift. I think we may see that too in anesthesia. We also have our own problems with CRNAs.

At the end of the day AMC is a company that the primary objective is to make money. When money is good, everyone is happy. When “they” are making cuts without consulting “physician/ former owners”, it makes a bitter pill hard to swallow.

I think this should be a stickie.

 

[DM27]

This is one of the main hazards of AMCs. The general concept and design of an academic/teaching medical center is not compatible with being a profitable clinical investment. The second it starts to be run like a business or someone looks to actually generate some form of substantial profit from it everything rapidly goes down the toilet.

 

[anes121508]

Hubris..... for all of us. I can do it better. My contract is better than yours.

My problem has always been they treat you like an hourly employee, at the same time telling you have to behave like a owner/partner, so you need to cover all the cases. There is a thread in EM sub about no relief after a 24 hour shift. I think we may see that too in anesthesia. We also have our own problems with CRNAs.

At the end of the day AMC is a company that the primary objective is to make money. When money is good, everyone is happy. When “they” are making cuts without consulting “physician/ former owners”, it makes a bitter pill hard to swallow.

I think this should be a stickie.

Amc sort of pitches this income preservation thing. Like don’t worry about forces that impact your income as a pp group...we the big amc will shoulder that weight and give you a guarantee salary.

I’d say that’s not true. Pay can be cut, hours and workload will increase, benefits will go down in order to keep profit margins.

So I guess I’d say I’d rather just be hourly vs salary. They may reduce the hourly rate but at least when the hours go up, you can be paid for it. Allowing yourself to Get squeezed on both ends is bad.

 

[Mikkel]

Thank you for sharing your story, and good for you for leaving.

You don't need a lot of resources to fight it, just a bunch of disgruntled former employees who hire a big law firm which just takes at the end but doesn't require money upfront. Especially if there are clear contract violations.

Hit these bastards where it hurts: the profit.

 

[Consigliere]

"I choose a job with an AMC who had very recently bought out what most residents considered the best group in the city over two other pp groups in the same city."

Mistake #1

 

[Consigliere]

"I was skeptical of the AMC based on all the stuff I had heard about amc jobs."

Mistake #2 was ignoring your intuition.

 

[Consigliere]

"What really clinched it for me was the fact that the group president explained to me that the original pp group put into place protections in the contract like staffing agreements, call schedule , a board made up of majority docs in the group, ect."

Mistake #3 was believing this unbelievable load of horsesh_it.

 

[Consigliere]

Mistake #4 would be pursuing any legal actions against this AMC. Cut your losses, learn your lessons, and GTFO of there.

 

[Mikkel]

Mistake #4 would be pursuing any legal actions against this AMC. Cut your losses, learn your lessons, and GTFO of there.

He wouldn't, but those who were wrongfully terminated certainly should consider.

The company has deep pockets, and the annual salary lost is substantial. 1-2 million payoff each for wrongful termination is easily worth it.

 

[BLADEMDA]

AMCs lie. Lesson 1. AMCs will always try to understaff the practice. Lesson 2. AMCs typically have terrible benefits and rarely give pay raises. Lesson 3. AMCs rarely value your talents or abilities as a professional. You are cog in the machine. A body to work for them as much as necessary for the good of the practice. Lesson 4. When a colleague quits or the AMC expands the workload they will resist hiring locums. Instead, they will expect the remaining providers to suck up the additional work and call burden.

 

[Mman]

wrongful termination laws differ drastically from state to state. I live in a right to work state and here you can fire somebody for no reason at all. In fact, it's preferable to fire them for no reason so that they cannot contest the reason in a lawsuit.

 

[TrojanGopher]

Hope the young people can learn from my mistake....

I choose a job with an AMC who had very recently bought out what most residents considered the best group in the city over two other pp groups in the same city.

I was skeptical of the AMC based on all the stuff I had heard about amc jobs. However, I really liked the hospital, the clinical opportunity, and the people in the group. Rumor on the forums and amongst others I knew said this AMC wasn’t quite as bad as North Star and was one of the “more benign” amcs.

What really clinched it for me was the fact that the group president explained to me that the original pp group put into place protections in the contract like staffing agreements, call schedule , a board made up of majority docs in the group, ect. Seemed like they really did it the right way and the place was a good fit. Coverage, call limits, ect even built into the individual employee contract.

Fast forward and the pp groups in town are still churning and the amc just started firing docs without cause, are going to change the staffing model to 4:1, adding significantly more call, making physicians clock in and out despite no hourly pay, ect. The amc claims they are not profitable and have to make changes. Hard to beleive without evidence.

I’ve shown a close family friend who is a lawyer with experience in this realm my employment contract and he says the amc has clearly violated terms of contract the way they have handled things, especially the firing of docs without cause and no consultation with the board.

Many lessons and insights into how the private equity firm based amcs work, but I’d say take the risk with a private practice vs the amc. Seems the like risks are the same and the upside is far better with the pp if you pick a fair and truthful practice.

So did you end up leaving?

 

[nimbus]

Effectively there is no difference between leaving and being terminated.

 

[deleted162650]

I would like to think that if you are terminated, the non-compete should be null and void.

Maybe wishful thinking on my part.

 

[Twiggidy]

I would like to think that if you are terminated, the non-compete should be null and void.

Maybe wishful thinking on my part.

i feel like that's true, but may also be wishful thinking

 

[deleted126335]

i feel like that's true, but may also be wishful thinking

It is almost certainly wishful thinking unless it is specifically negotiated in the contract.

 

[DirtDocMD]

Surprise!! AMC’s often have a contractual agreement with the hospital that includes “transition” costs being covered for the first 1-2 years. The hospital bears the cost for locums, overages, etc. In addition, the new AMC doesn’t want to run off too many folks during the initial transition.

After about 1-2 years of this(when the hospital money runs out), the “nice” AMC has a “come to Jesus” meeting with the Docs and the CRNA’s, to let them know they need to “cut costs”...

 

[dannyboy1]

Surprise!! AMC’s often have a contractual agreement with the hospital that includes “transition” costs being covered for the first 1-2 years. The hospital bears the cost for locums, overages, etc. In addition, the new AMC doesn’t want to run off too many folks during the initial transition.

After about 1-2 years of this(when the hospital money runs out), the “nice” AMC has a “come to Jesus” meeting with the Docs and the CRNA’s, to let them know they need to “cut costs”...

Amazing that hospital still fall for this crap.

 

[GravelRider]

I would like to think that if you are terminated, the non-compete should be null and void.

Maybe wishful thinking on my part.

Definitely wishful thinking. The worst one I’ve heard of recently (*cough* Northwell *cough*) effectively prevents you from working in an entire state and the language is such that if you part ways for any reason, the non-compete goes into effect.

The biggest lesson from these AMC stories should be to have a very clear understanding of what the potential repercussions are of a contract’s non-compete and refuse to sign anything beyond a site specific non-compete (and only for a smaller private practice in those situations).

 

[deleted162650]

A non-compete that goes into effect if they fire you has got to violate labor laws (at least in some states) I would hope.

 

[GravelRider]

A non-compete that goes into effect if they fire you has got to violate labor laws (at least in some states) I would hope.

Ah, in many of those same contracts there is language where you waive those rights...such as the right to use collective bargaining. Whether any of this is actually legal or not doesn’t matter and is not the point. Most of the non-competes are probably not enforceable, but it’s a scare tactic designed to make you hesitant to take up the fight with both time and legal fees.

It is totally worth paying a lawyer a few hundred bucks to spell out every sentence of a contract in normal human speak...even if the contract is “the standard one we give everyone.”

 

[sevo00]

what AMC was this?

 

[anes121508]

"I choose a job with an AMC who had very recently bought out what most residents considered the best group in the city over two other pp groups in the same city."

Mistake #1

Yes, that is why I posted this. Don’t make the same mistake. Maybe some amcs don’t have reputations as bad as north star but at the end of the day they are driven by profit and you are an expense. Nothing else matters.

Just because the original group wants to try to maintain the culture of the practice, the amc is the new dictatoe and they don’t even care what the contract says.

 

[anes121508]

What is the name of the AMC and the region of the country?

I’m sure my post history will show this.

But the point is, they are all the same. Even if you think it’s a more physician friendly or less malignant amc

 

[anes121508]

"I was skeptical of the AMC based on all the stuff I had heard about amc jobs."

Mistake #2 was ignoring your intuition.

Incredible you say that.

I’ve said multiple times to some of the others guys...” I should have just trusted my gut”.

 

[anes121508]

"What really clinched it for me was the fact that the group president explained to me that the original pp group put into place protections in the contract like staffing agreements, call schedule , a board made up of majority docs in the group, ect."

Mistake #3 was believing this unbelievable load of horsesh_it.

It’s actually listed in the contract. Clearly though that doesn’t even matter. I think the original guys were truly trying to preserve the next five years they were going to be stuck there. It’d be in their best interest to do so. However, the amc is blatantly violating the terms.

 

[Trollest]

No way, according to a MDs and MD in training on this website, our job security is iron clad! I can't believe this, fired without reason??

/s

You should post this thread in the MD or pre-MD section; this field is only getting worse.

"Fast forward and the pp groups in town are still churning and the amc just started firing docs without cause, are going to change the staffing model to 4:1 "

 

[anes121508]

Mistake #4 would be pursuing any legal actions against this AMC. Cut your losses, learn your lessons, and GTFO of there.

So are you saying that if the amc violates the contract, its not worth fighting against them? Has anyone ever done something like this? As a group?

 

[anes121508]

wrongful termination laws differ drastically from state to state. I live in a right to work state and here you can fire somebody for no reason at all. In fact, it's preferable to fire them for no reason so that they cannot contest the reason in a lawsuit.

You can terminate without clause. However it is clearly spelled out that the amc can not make this decision unilaterally. They must have the support of the board. The board is made up of amc and doc reps with docs having the majority.

 

[anes121508]

I would like to think that if you are terminated, the non-compete should be null and void.

Maybe wishful thinking on my part.

HR person announced that despite termination without clause the noncompete would be enforced by amc.

 

[abolt18]

HR person announced that despite termination without clause the noncompete would be enforced by amc.

I don't even understand how this can be possible.

 

[anes121508]

Surprise!! AMC’s often have a contractual agreement with the hospital that includes “transition” costs being covered for the first 1-2 years. The hospital bears the cost for locums, overages, etc. In addition, the new AMC doesn’t want to run off too many folks during the initial transition.

After about 1-2 years of this(when the hospital money runs out), the “nice” AMC has a “come to Jesus” meeting with the Docs and the CRNA’s, to let them know they need to “cut costs”...

This is precisely the case.

Coverage needs increase. Locums come in. Locums are cut off on a specific date. 6 months later we have the come to jesus meeting.

So did you end up leaving?

I don't even want to say what I did. I'll get tomatoes thrown at me for being a *****.

 

[anes121508]

It is almost certainly wishful thinking unless it is specifically negotiated in the contract.

I would re-read this if I were young people looking for a job.

 

[IMGASMD]

I don't even understand how this can be possible.

From what I have heard, so hearsay, is that AMC can block you from your next job, while you’re in litigation. Even if you’re in the right, they can throw lawyer army at you for the next six months. Can you survive six months without a paycheck. I can’t.
So if they won’t verify for your next job and you cannot work, let’s assume the whole state. They won.

 

[anes121508]

Amazing that hospital still fall for this crap.

are they falling for it though?

or do they just like the amc to be the bad guy?

in this scenario, the hospital knows the group isn't running at maximum efficiency. they know that money will run out. they know they can say no to any more funding to the amc because the amc can simply go 4:1 or whatever they want. seems like pp groups who ask for a subsidy are at risk because amc has given the hospital more to choose from and the amc, unlike pp groups, does not care if the subsidy doesn't come in. they can just chop and chop. i'm getting the feeling that the subsidy to the amc is sort of like the activation fee for cable. cable company is cool if you say you aren't paying the activation fee because they will make their profit one way or the other. it's just a bonus. am i nuts?

 

[anes121508]

I don't even understand how this can be possible.

yeah i agree, if you violate terms of a contract, doesn't that make the entire contract worthless? how can amc violate one part of a contract and fire employee without board support, yet claim they are going to uphold another part?

obviously lawyers are involved at this point so we shall see

 

[anes121508]

From what I have heard, so hearsay, is that AMC can block you from your next job, while you’re in litigation. Even if you’re in the right, they can throw lawyer army at you for the next six months. Can you survive six months without a paycheck. I can’t.
So if they won’t verify for your next job and you cannot work, let’s assume the whole state. They won.

yes I can survive 6 months no paycheck luckily

 

[deleted126335]

I don't even understand how this can be possible.

It is completely possible. Non compete enforceability varies greatly depending on the state. One non-compete I was under was negotiated to apply if i was terminated FOR CAUSE. If terminated without cause, it went away. Things can be negotiated. If both sides are willing.

 

[aneftp]

With friendly buyouts where partners need to stay for 2-3 years to have their money full vested with amc/private equity. Anything goes after that time period.

That seems to be the case with the OP. Those 3 plus years are up. So really no incentive for people to stay with the AMC. People come and go

 

[deleted126335]

With friendly buyouts where partners need to stay for 2-3 years to have their money full vested with amc/private equity. Anything goes after that time period.

That seems to be the case with the OP. Those 3 plus years are up. So really no incentive for people to stay with the AMC. People come and go

Other than comfort and familiarity, the devil you know, etc. Matters a lot to some folks.

 

[IMGASMD]

yes I can survive 6 months no paycheck luckily

Hmmm, what if that goes on for a year? Two? What I was trying to say is that they have tactics that will make you income-less and unmarketable for a long time.

I can probably do it for 3 months, but by the second month, I would start to sht my pants.

 

[TrojanGopher]

I don't even want to say what I did. I'll get tomatoes thrown at me for being a *****.

So you stayed...

 

[B-Bone]

It is completely possible. Non compete enforceability varies greatly depending on the state. One non-compete I was under was negotiated to apply if i was terminated FOR CAUSE. If terminated without cause, it went away. Things can be negotiated. If both sides are willing.

Here's how the law works in my state:

Can the Employer Enforce a Non-Compete Agreement if I Was Fired or Laid Off?

Most non-compete agreements, by their own terms, prohibit the employee from competing against the employer following termination of the employment relationship regardless of whether the employee quit, was fired, or was laid off. Many employees assume that if they were fired, the employer cannot enforce the non-compete agreement. This is simply not true. In many cases, Minnesota courts will enforce a non-compete agreement against an employee even if the employee was terminated. In some situations, however, the circumstances surrounding the employee's termination may influence the court's willingness to enforce the non-compete agreement. For example, if the employee was fired under circumstances that amount to wrongful termination (e.g., unlawful race, sex, or disability discrimination) or in bad faith, the court might refuse to enforce the non-compete agreement. In addition, if the employee was terminated for inability to do the job, this might be used as evidence that the employee will not pose a risk of causing irreparable harm to the employer if allowed to compete.

 

[Twiggidy]

So you stayed...

People need to eat

 

[abolt18]

Here's how the law works in my state:

Can the Employer Enforce a Non-Compete Agreement if I Was Fired or Laid Off?

Most non-compete agreements, by their own terms, prohibit the employee from competing against the employer following termination of the employment relationship regardless of whether the employee quit, was fired, or was laid off. Many employees assume that if they were fired, the employer cannot enforce the non-compete agreement. This is simply not true. In many cases, Minnesota courts will enforce a non-compete agreement against an employee even if the employee was terminated. In some situations, however, the circumstances surrounding the employee's termination may influence the court's willingness to enforce the non-compete agreement. For example, if the employee was fired under circumstances that amount to wrongful termination (e.g., unlawful race, sex, or disability discrimination) or in bad faith, the court might refuse to enforce the non-compete agreement. In addition, if the employee was terminated for inability to do the job, this might be used as evidence that the employee will not pose a risk of causing irreparable harm to the employer if allowed to compete.

Ouch