part of the reason I strongly suggest 12+ month emergency funds for physicians. If you unexpectedly lost a job, it can be a prolonged process to find the right next job and not just sign up for the first thing you find if desperate.
AMC lesson learned
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part of the reason I strongly suggest 12+ month emergency funds for physicians. If you unexpectedly lost a job, it can be a prolonged process to find the right next job and not just sign up for the first thing you find if desperate.
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None of this is really exclusive to anesthesiology though. this is good advice for just about any "service-related" field in medicine. ER, pathologist, radiologists, etc....you have to be ready when the hospital/amc/whatever decides to cut it's cord. It also means that more and more fields are becoming "jobs" instead of careers and I would argue why fellowships and academic jobs are becoming competitive. As Blade has mentioned, probably the most stable job in anesthesia is a fellowship trained academic anesthesiologist.
agreed and that's why I specifically said physicians and not just anesthesiologists
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I hope people re-read what you posted.
In this case though, the initial term is not up and the AMC is jumping the gun and violating the terms and saying too bad what you gonna do about it
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The amc is not the devil you know IF it’s still in the early phase and the original partners are still there. The original guys wanna keep it nice and cushy for their transition and are in line fighting about who can retire first cuz they all know what happens after the initial term.
So the sell out of the original partners goes beyond just money. Ensuring their own comfort with their AMC days happens as well. “I’ll sell out and stick around as long as I keep my vacation , cover 2:1, don’t take more call ect”.
Is it coincidence that majority of the original partners have gradually retired during the initial term?
And that that retired first were the most senior folks and still received the same payout.
So they knew what the future beyond the initial term would bring. So let’s all structure it so we can retire before the hammer drops.
And let’s claim to new hires that we have preserved the good quality nature of the practice.
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If they can string it out longer than I last they know they have even more leverage.
Unless of course I just move out of town. Living a couple hours away from immediate family isn’t the worst thing in the world . Maybe move then do locums and return to the area or find a devil you know and try to negoate a more protective contract.
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Even worse
You’re the new chief??? Or are you the new chief of one of their latest “acquisitions”??
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deleted500612
"Right to work" State refers to Union laws, I think what you are referring to is "At will employment".
Well, if they aren’t keeping up THEIR end of the contract, that could PERHAPS be grounds for you not having to keep up YOURS. You signed expecting them to limit your hours/call/etc (you said there were limitations in the contract). If they are violating that, before the term of the contract has ended, you MAY have grounds for getting out from under the non-compete. MAY....
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probably yes, my legalese is failing me
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deleted162650
The non-competes are really there to protect the AMC's contract. The AMC is trying to prevent you from either taking the contract back yourself, or working for whoever takes the contract at that facility from the AMC, i.e. the Charlotte fiasco.
If the AMC terminated you without cause and you went to the group 30mins down the road at a different hospital system, I'm not sure how the AMC would even know. Even if they did find out, in order to sue you they would have to show damages. There are literally zero damages incurred on the part of the AMC by you going to work for the group across town. You aren't taking any patients or revenue with you, and this is especially true if they are the ones that fired you. They've got no civil case against you.
Disclaimer: I am not an attorney, nor an attorney spokesman. Nothing in this post should be construed as legal advice. Prices subject to change without notice. No purchase necessary. Void where prohibited.
If the AMC terminated you without cause and you went to the group 30mins down the road at a different hospital system, I'm not sure how the AMC would even know. Even if they did find out, in order to sue you they would have to show damages. There are literally zero damages incurred on the part of the AMC by you going to work for the group across town. You aren't taking any patients or revenue with you, and this is especially true if they are the ones that fired you. They've got no civil case against you.
Disclaimer: I am not an attorney, nor an attorney spokesman. Nothing in this post should be construed as legal advice. Prices subject to change without notice. No purchase necessary. Void where prohibited.
My suspicion is that the contract your group negotiated is different in some way from the vast majority of TH contracts. Maybe HR doesn't understand? Maybe their legal hasn't actually read the contracts.
A lot of this could be explained by TH assuming contractual obligations are in their favor when they actually aren't.
I have no other way to explain how a large AMC would flagrantly violate the terms of their contract, when doing so opens them up to substantial liability (like multi million dollar payouts to physician terminated when it didn't go through the contractually-required panel).
I think you should get legal involved on contingency.
A lot of this could be explained by TH assuming contractual obligations are in their favor when they actually aren't.
I have no other way to explain how a large AMC would flagrantly violate the terms of their contract, when doing so opens them up to substantial liability (like multi million dollar payouts to physician terminated when it didn't go through the contractually-required panel).
I think you should get legal involved on contingency.
When did the private group sell out?
what is the time period. I want to know.
I’ve known at least 10 friends who have sold out to amc (friendly buyout). And never has their staffing changed in the 2-3 years like you described. But than again. They were at 1:3 and 1:4 already. So not much to change.
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The exception to the "right to work" law is if one has an employment contract and the terms of that contract have not been followed.
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Oh come on, stop teasing me! At least PM me what happened.
That’s 3 years. The money ball answer. So it wasn’t bait and switch.
like I said. With friendly take over. It’s usually 2-3 or even 5 years (in one of the first mega buyouts) where it’s business as usual.
So 3 years and things changing isn’t that surprisingly.
One of the mega recent buyout in the South happens in late 2014 and by early 2018 Original partners people leaving or cutting Back hours. And the new grads who came into the newly merged amc 2015/2016 (fed similar story how things will be the same). But 2018 they found themselves working like dogs and many of them looking for new jobs like u. 2 of them have left already that I know of.
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The sky hasn’t fallen since they sold. I wonder if people have regret about selling and losing control of their practice.
Mednax, Atlanta?
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.... and this is why I have done full-time locums for AMCs.
I lay out my terms. Pay, days I want to work, and if and when I want to take call.
If you are in the northeast like me, you can have a home, family and base and just contract out to the AMCs. You can empower yourself and get some of that autonomy back.
These AMCs are so desperate I have friends who now work part-time for AMCs and rake in the benefits yet at the same time have it in their contracts to work at other non-AMC sites or locum companies.
My advice dealing with ALL AMCs- pay that $400-500 for a contract lawyer. Its the best $$$ you will have ever invested 🙂
I lay out my terms. Pay, days I want to work, and if and when I want to take call.
If you are in the northeast like me, you can have a home, family and base and just contract out to the AMCs. You can empower yourself and get some of that autonomy back.
These AMCs are so desperate I have friends who now work part-time for AMCs and rake in the benefits yet at the same time have it in their contracts to work at other non-AMC sites or locum companies.
My advice dealing with ALL AMCs- pay that $400-500 for a contract lawyer. Its the best $$$ you will have ever invested 🙂
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On the surface I totally agree with this, but is an AMC contract in any way negotiable? Ours in independent PP is not - it’s a take-it-or-leave-it for all. We are very open about that fact when we offer a position. We have a thorny non-compete which would basically force me out of the area if I ever left, but there was no negotiating that point - thankfully I don’t see myself leaving. Has anyone had any luck changing specific verbiage?
Edit: As I type this, I realize if a group is desperate enough for a hire then more is negotiable.
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I've had friends negotiate parts of AMC contracts. It's a good thing too, because one of them negotiated a narrower area on her non-complete - and then the AMC later got terminated from that hospital and she lost her job. If she hadn't negotiated on her contract she'd be non-competeted out in her entire state. Now she just has a bit of an in state commute to another (different AMC) job.
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I guess it’s the same exact playbook.
I’m wondering if the money buyout happened over 3 years.
And the 5 year thing is just the hospital contract.
Most non compete at least with Sheridan and team health are hospital specific these days. Which is fair. U are welcome to work right across the street at non affiliated surgery center if u want. That’s in their language. It’s very specific hospital language u work with them. Plus u can have clarification via email with them if u aren’t sure of the language. At least the contracts I have seen from Sheridan and team health.
usap and Mednax seem to encompass way too much of an area like 30 miles which I recommend no one ever agree to
No. Mednax hasn’t purchase any Atlanta area groups that i know of in the last 3-4 years. Most of their spending/acquisition was from 2009-2013
Sheridan did buy northside end of 2015 in Georgia. ......what a deal those guys got. Cash. Let’s just say it was better than the mythical usap stock hybrid cash deal cause it was guarantee cash deal from Sheridan.
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Maybe, but at least they have their buyout money. I think the youngest guys who received money are just annoyed they have to find a new job. But they also have a cushion to work with.
Even though the other pp group is flourishing, I bet the older guys are still happy. They sold and timed it as close to their retirement as possible. It’s hard to blame them.
Really makes me think age of the partners is a huge driving factor.
If I had to find a new job I’d look for a pp group with middle age docs, limited stipend, docs integrated with leadership positions within the hospital, short track, transparency with the books, and a back end insurance clause (ie if I’m 1/2 years into track and group sells I get half).
Unicorn? I’m sure the older guys on the board will tell me to take a hike. But then again, why leave one bad situation only to find myself in another?
Hopefully the younger folks looking for jobs realize that you really can’t trust people and what they say unless it’s in a contract. Even then, if the other side has enormous resources, like the amc, they may not even respect the contract.
I want to emphasize that the point of my post is not to complain and say poor me, but rather to share the knowledge so the younger folks can take pieces from this scenario and others on sdn, put them together, and try their best to protect themselves or at least realize the risks when they look at different jobs.
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Oh yeah that’s another good point.
Amc tell you “this is standard everyone signs it”. That’s false.
I negotiated that if hospital and the amc no longer play nice in sand box, they can’t leverage me and keep me out of the hospital. I also negotiated that if my pay or vacation changed by any amount for the worse, the non compete is not enforced. I wanted to include work hours and call duties but that would be tricky.
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The AMCs like to play hard ball and say they don't negotiate.
Most of the time from what I have heard is they will cave in but you have to stand firm and be prepared to walk away.
Also it is in your interest to point out why those same AMC jobs haven't been filled for years as part of your leverage.
See as physicians we have been conditioned to think we have no leverage when in fact we have ALOT of the leverage.
I can't really comment on PP because I have dealt with AMCs for years. I am one of those who loves taking advantage of AMCs.
The only leverage you have is if they are desperate to fill the position and have nobody else that wants it. For jobs in desirable locations, that is rarely true.
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So what's the group doing about it? Is the hospital ok with all the changes (the firings, going to 4:1)? That's a fundamental change....the surgeons are probably going to notice if you're 2:1 now going to 4:1.
How many people are leaving because of the changes (voluntarily I mean)?
How many people are leaving because of the changes (voluntarily I mean)?
Good luck finding the 2 groups in the entire country that meet this criteria.
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deleted126335
Yes. We are the "talent." It is not easy to find a talented, productive Physician. Every time an AMC creates an environment that sucks, there is a mass exodus of "talent!" It is becoming more like the corporate world where you have to change jobs every few years to advance. Except in this case you have to change jobs to find an environment where you are not eaten alive. Eventually we should all just go to an hourly rate and work, like locums docs, for the highest bidder that offers a decent working environment. Free agents.
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People and the AMC are hoping that the hospital/surgeons save the model. I won’t hold my breath though.
What else can we do other than walk away?
Nobody has electively left yet. The scary thing is what happens when they fire 3 more people and then 4-5 guys turn in notice. Then we will really be hurting.
Any of you guys ever been successful on fighting changes imposed on the group by the AMC?
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Hence the sarcastic unicorn part.
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This is so relevant. I would not sign on with an AMC if I had greater than 10 yrs left to practice. Go Locums and see where the cards lay.
But if you are looking at retirement then you may want to sign on and cruise to the finish line. Unfortunately, you may not be able too. If the youngsters leave as they should then you will need to leave as well.
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Uh yeah, I would leave too if they fired a bunch of colleagues for no good reason in a short time period. That could decimate a group...there might not be anyone left!
Can people in your group even leave and still practice in the region? All the AMCs have some sort of non-compete. How restrictive is your group's?
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When the language in the contract explicitly says that you “cannot work for a competitor practice in the entire state” and then goes on to list specific AMCs and PPs, that non-compete clause is not just to prevent the AMC from losing the contract...especially when that contract is written by a hospital system instead of an AMC.
It can be done and should be done. There is absolutely no reason why a PP’s non-compete is anything beyond a site-specific non-compete. If you want to put in an arbitrary 5 mile radius, fine, but anything beyond that is absurd, and a red flag, in my opinion.
I know a few people in the NE who do this as well and they do pretty well for themselves. They don’t go through locums contractors anymore and can basically work whenever they feel like it. They work set hours and take call if and when they feel like it. It’s my recommendation for anyone who wants to be in an area surrounded by AMCs.
All you new grads and old guys need to stop signing these ridiculous non-compete clauses. It is probably more responsible for driving down anesthesia salaries than CRNAs.
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Do you need contract lawyer for locums contracts?
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Well depends.
If you go through an agency, then you get a standard contract that is very straight forward.
If you do locums/ per diem directly with a hospital or AMC, then my recommendation is to get one because they put some really shady language in them esp. when it comes to tail.
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When I finished residency 8 years ago, I am one of the only few "new grad" locums. But over the past 2-3 years I am seeing more and more new attendings jump right into locums. Now the more west you go, this is not so much the case because AMCs havent infiltrated the market but most northeast and florida markets are controlled by AMCs.
IMHO doing locums as a "new grad" is a recipe for disaster. You might end up in a bad situation and be pressured to do things that aren't safe and it is much tougher when you are straight out of residency to deal with that kind of situation.
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So, who would you guess would be in favor of the collective group taking a paycut to avoid further firings?
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You can work anywhere else in the city where the amc doesn’t currently have business.
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Nobody.
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Hey OP, any updates about this AMC issue?? I still can't believe docs got fired from your group to save money, but I guess it shouldn't surprise anyone these days. Academics has its issues but there's something to be said about job security..
Non compete are rarely enforced in anesthesia u going right next door. Even a competitor. The only court cases I hear about is partner who got PAID by the amc as part of their buyout who went to work for another surgery center 2 years later. I guess he was suppose to stay 3 years but he left anyways. And the amc still
Lost the lawsuit.
the only enforceable non compete is if u trying to take over the same place u worked at with amc.
Other than that. It’s game of chicken and simply not worth amc time and effort. They know it.
the team health and Sheridan non compete I have seen recently only has clause for
the current facility u work with them. U are free to work Down the street. That’s fair.
this 30 mile radius. Forget. It. Usap has that in some areas. Stupid. Cross it all out on the contract. If they don’t Agree. Don’t sign. Plain and simple.
Maybe that’s why the big usap place near me the docs are working like dogs. Many in solo cases plus supervising. Working 60 plus hours. Same with Mednax up north. Docs work 50% of rooms solo. That’s what u get for 30 mile non compete. The crnas won’t even sign it. If that tells u something.
Lost the lawsuit.
the only enforceable non compete is if u trying to take over the same place u worked at with amc.
Other than that. It’s game of chicken and simply not worth amc time and effort. They know it.
the team health and Sheridan non compete I have seen recently only has clause for
the current facility u work with them. U are free to work Down the street. That’s fair.
this 30 mile radius. Forget. It. Usap has that in some areas. Stupid. Cross it all out on the contract. If they don’t Agree. Don’t sign. Plain and simple.
Maybe that’s why the big usap place near me the docs are working like dogs. Many in solo cases plus supervising. Working 60 plus hours. Same with Mednax up north. Docs work 50% of rooms solo. That’s what u get for 30 mile non compete. The crnas won’t even sign it. If that tells u something.
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