Anesthesia Private Equity News Article

[lane]

Look. I understand every practice is different. Every partnership track is different even within the same metro area.

But why would anyone get involved in a track with no guarantees these days giving up 30-40-% of their billing rights for 3 plus years.

Partners eventually age out. They do. And partners give up calls a lot. That’s why I said I don’t believe equal calls scheduled. Partners actually prefer employees or partnership track employees take their calls for extra money because it’s an uneven trade. And the employees are dumb even to do it. Because a partner call earned doesn’t go into the pot with most Usap practices. The employees call earn percentage goes into the pot for the partners to split. But partners will always find someone to work cause everyone does need some extra money.

Just the cycle of life.

Why would someone work for Northstar or any other employed model where they would give up their “billing rights” indefinitely?
Many folks also have little interest in eat-what-you-kill practices. There seems to be much greater opportunity for abuse in those models as well.
Physicians come in as employees with set salary, benefits, 401k, and stability without dealing with billing issues off the bat. As they grow with the group they are offered the opportunity to become partners where they take on a more significant role with the business aspects of the practice and are able to participate in the variable economics of the practice, good and bad, as partners.
On the flip side I would be very suspicious of any group guaranteeing partnership after a set time without ever stepping foot in the door.

---

Members don't see this ad.

 

[crash2500]

Potentially, yes. But our stated goal is to make partners. We do have partners slowing down and retiring, and we have significant growth that requires new partners for the health of the practice. We also have a stated goal that, absent significant issues, those who go on the partner track become partners according to the track schedule. We don’t drag people along with the dangling carrot or cut bait just before their anticipated partnership… which does happen in private practices.

Yes, but you do drag people along before they even get on the partner track if you won't tell them when they're partner track will start definitively.

 

[lane]

Yes, but you do drag people along before they even get on the partner track if you won't tell them when they're partner track will start definitively.

Historically that was an issue with one of the legacy divisions in our practice. We have since reconciled that issue as we all operate as one large platform.

 

[lane]

Idk why everyone focuses so much on the stock shares. It’s a negligible part of one’s income and at least it’s an asset.

The scrutiny should be on the instability and changing economics of doing billing for yourself and the rising cost of crnas.

All I’ve ever seen from PE practices is that theyre always trying to expand and pad their payor mixes. The problem is the rising cost of crna labor and insurance companies always chipping away at the payouts.

Agreed

The issues you raise with increasing overhead and pressure from payers to decrease rates is universal. If you aren’t aware of BCBS and United kicking groups and facilities out of network unless they take significant cuts you aren’t paying attention. Cigna cutting QZ rates will be a nice trial for every other payer to quickly follow suit. While significant efforts toward the arbitration process have been made, the time and cost are not negligible. Say what you will about the corporate aspect of USAP, but having the scale and resources to fight against insurance companies and their significant political interests provides benefits that carry beyond our practice.

 

[epidural man]

Why would someone work for Northstar or any other employed model where they would give up their “billing rights” indefinitely?
Many folks also have little interest in eat-what-you-kill practices. There seems to be much greater opportunity for abuse in those models as well.
Physicians come in as employees with set salary, benefits, 401k, and stability without dealing with billing issues off the bat. As they grow with the group they are offered the opportunity to become partners where they take on a more significant role with the business aspects of the practice and are able to participate in the variable economics of the practice, good and bad, as partners.
On the flip side I would be very suspicious of any group guaranteeing partnership after a set time without ever stepping foot in the door.

I have never worked for ASMG (large San Diego group) - but have been in this town a long time.

I have always thought their eat what you kill model was excellent as they use blended units. They don’t rape the new guy (something all partnership tracts do). It has always seemed ideal to me. And it used to be the ideal job in town.

I suspect now that reimbursements have dropped, it isn’t the case anymore. I know several people who have left, and many who went to Kaiser.

Now I believe employee model works best.

I have done some per diem hourly, some eat what you kill (hated it), and salaried. I have never done the partnership track thing so I guess my opinion on that is pointless.

 

[DirtDocMD]

Agreed

Say what you will about the corporate aspect of USAP, but having the scale and resources to fight against insurance companies and their significant political interests provides benefits that carry beyond our practice.

If only there was a “society” of Anesthesiologists, that was really trying to look out for the non-academic members…..

 

[aneftp]

Why would someone work for Northstar or any other employed model where they would give up their “billing rights” indefinitely?
Many folks also have little interest in eat-what-you-kill practices. There seems to be much greater opportunity for abuse in those models as well.
Physicians come in as employees with set salary, benefits, 401k, and stability without dealing with billing issues off the bat. As they grow with the group they are offered the opportunity to become partners where they take on a more significant role with the business aspects of the practice and are able to participate in the variable economics of the practice, good and bad, as partners.
On the flip side I would be very suspicious of any group guaranteeing partnership after a set time without ever stepping foot in the door.

What I’m saying if X partner gets $9000 per 24 hour weekend call.

But employee is getting $6000 per 24 hour call in house

If partner gives up their $9000 call and employee does extra work. And take the call. They are compensated at $6000 and the spread difference is $3000 that goes back to the revenue sharing pot of the partners.

So it’s an unequals trade. Partners actually encourage employees partner track to take extra calls from them. You know the game. I know the game. It has continued well before AMCs.

Just a lot of partnership track people fail to realize it. So that’s why I called BS on equal call scheduled and work load as older partners age out of full call schedule.

I know how much the Houston Usap practices make. I’m not gonna to disclose stuff. But it’s the usual. You needs juniors to step up to the plate. The seniors do work hard. But they must rely on partnership track to keep up more than their share and more. If the juniors did the same exact work as the seniors. Same schedule. Same exact call load and the same exact hospitals. I would believe u. But I don’t.

So let’s be real.

There is nothing wrong with that like I said. but Saying juniors do the same amount of work and case load with same acuity is incorrect.

 

[lane]

What I’m saying if X partner gets $9000 per 24 hour weekend call.

But employee is getting $6000 per 24 hour call in house

If partner gives up their $9000 call and employee does extra work. And take the call. They are compensated at $6000 and the spread difference is $3000 that goes back to the revenue sharing pot of the partners.

So it’s an unequals trade. Partners actually encourage employees partner track to take extra calls from them. You know the game. I know the game. It has continued well before AMCs.

Just a lot of partnership track people fail to realize it. So that’s why I called BS on equal call scheduled and work load as older partners age out of full call schedule.

I know how much the Houston Usap practices make. I’m not gonna to disclose stuff. But it’s the usual. You needs juniors to step up to the plate. The seniors do work hard. But they must rely on partnership track to keep up more than their share and more. If the juniors did the same exact work as the seniors. Same schedule. Same exact call load and the same exact hospitals. I would believe u. But I don’t.

So let’s be real.

There is nothing wrong with that like I said. but Saying juniors do the same amount of work and case load with same acuity is incorrect.

The practice you described happens in every private practice. It’s not unique to USAP in any of its platforms. When call schedules are made in Houston the partner track docs and partners are assigned the same number of calls, weekday, weekend, and holiday alike. Daily departures are dictated on who is pre- or post-call; all others are randomized. So yes, believe it or not, parter track docs and partners are treated the same. Partners and partner track docs both work side by side in high acuity hospitals. Associates work with partners at ASCs.
It sounds like you’re projecting your own experience in other practices on ours in Houston. I can only share what I know. Whether you choose to believe it is up to you.

 

[lane]

If only there was a “society” of Anesthesiologists, that was really trying to look out for the non-academic members…..

Ideally, yes. But it takes far more than just the ASA to move the needle against the millions of lobbying dollars the insurance carriers throw around.

 

[nimbus]

The float is defined, but a new partner’s shares are not predicated on another partner in one of numerous platforms across multiple states selling his or her shares

I have no idea what that means. But since USAP stock is very expensive, the basic question I have is, “can you get your money back in a timely way when you retire or leave to join another practice?”

 

[nimbus]

Idk why everyone focuses so much on the stock shares. It’s a negligible part of one’s income and at least it’s an asset.

The scrutiny should be on the instability and changing economics of doing billing for yourself and the rising cost of crnas.

All I’ve ever seen from PE practices is that theyre always trying to expand and pad their payor mixes. The problem is the rising cost of crna labor and insurance companies always chipping away at the payouts.

It’s always sunshine and rainbows when the buyout first starts. Over time, in every single regional practice group of USAP, their workloads have increased, overhead has increased, and pay per hour has gone down.

They have the exact same problem as other private groups, except it’s dressed up in a corporate entity. They are not more powerful than the people controlling payouts, and the work environments for their people all over the country are deteriorating and stretching their physicians and crnas thinner all the time.

If you’re employed or locums, your work is what it is. It’s so much harder to just dump on a huge academic group when they can’t really be compelled to go to different sites and commute an hour away to pick up new work. They’ll never allow supervision ratios to go up consistently because the older faculty will outright refuse it, and they aren’t beholden to payors like usap is.

That’s the difference. Forget money. Forget autonomy. It’s the fact that you have no say as a physician what your workload is, only the dollar signs matter to the larger structure and leadership. Hence the ever present “our practice is growing soooo fast we are just doing soooo well” schtick that every AMC peddles

Mostly agree with this post.

However, if a share of stock is $15-20k, that is negligible and a nonissue. But if the stock is $150-250k and illiquid with promises of some vague future payout at an unknown future date, then it becomes a bigger factor.

 

[Howard888]

The issue is what happens when a large payer goes out of network with USAP now that arbitration is on.

The United fight was pre arbitration. I’ll agree USAPs resources helped them win.

However arbitration is a different animal. Even if you’re winning arbitration it costs a ton in FTEs to fight it.

Lastly, this news article is a piece to be used by payers in arbitration.

At bare minimum no commercial payer will ever raise their rates to USAP again. They’ll challenge USAP to go out of network and to arbitration.

Basically they’ve price capped USAP. Game of chicken.

For welsh Carson and private equity it’s not as big of a deal. They don’t have to raise rates if going to arbitration will cost more. They get their 25-30%.

This is a much bigger deal for the MDs who live off the 70-75%. With capped rates and booming expenses they have no choice but to make less or works more-as someone already mentioned. Or you can milk junior parters-as someone also mentioned

 

[linkin06]

Float is defined…others not required to sell. Sounds like dilution to me

 

[UTMB2014]

I wonder how much non-call taking doctors and partner track doctors make per year. I’m sure it’s much below National averages.

Is it true USAP is trying to give CRNAs more autonomy? Allowing them to induce by themselves as well as placing arterial lines if indicated. Is USAP sponsoring courses for CRNAs to learn nerve blocks? Very interested to hear from people working at Usap.

Make no mistake about it. This doesn’t seem like a group that values physicians.

 

[aneftp]

The practice you described happens in every private practice. It’s not unique to USAP in any of its platforms. When call schedules are made in Houston the partner track docs and partners are assigned the same number of calls, weekday, weekend, and holiday alike. Daily departures are dictated on who is pre- or post-call; all others are randomized. So yes, believe it or not, parter track docs and partners are treated the same. Partners and partner track docs both work side by side in high acuity hospitals. Associates work with partners at ASCs.
It sounds like you’re projecting your own experience in other practices on ours in Houston. I can only share what I know. Whether you choose to believe it is up to you.

What I’m saying is if u have 2-3 people on partnership track. And none of them want to do more than their required calls and schedules. Then you are screwed in your projected revenue sharing. The partnership track methods especially with money already going to the parent company dictates (assumes) the partnership tracks people want to work more therefore flowing money into the pot for the partners to share.

I’ve seen another Usap tell people (and they are super fair practice) tell someone to take a hike/it’s not working after 4 months- 2 years working them like dogs when the 3 year the partnership track person doesn’t want to work extra. They work their required calls. They are a team player. But the scheme requires those making paying up to 40% into the pot to work more than their fair share. The system simple doesn't work if everyone partner and non partners work equal share/calls. It's simple math especially when the parent company is already taking a 20% cut (this is well known from court records/divorce records).

So what happens when younger docs don't want to take on extra calls?….bam you tell the young docs it’s lot working out if they are consisntely asked to work more and do not want to.

That’s my point. People aren’t stupid. Especially the generation

Usap will end up like mednax American anesthesiology division where there high flying payor mixed changes. Especially with the out of network no surprises bill. Add to the factor parent company is taking roughy a 20% cut already. Even with very good payor mix (commercial and medicare advantage). You guys are 8 plus years into the game. Mednax American Anesthesiology division was super profitable for the first 7-8 years and started the decline as USAP formed taking the rest of the profitable practices.

Texas is the wild wild west. I've mentioned before out of network rates were up to $400/unit. And insurers would just settle for a still ridiculous $250/unit. In network units are $150/unit. There will be increase pressure with the no surprises act that will drive down those units.

The shell game ends in around 3-4 years. It won't matter to most of the original USAP partners, they will be long gone, or close to hitting their magic number. That's why it's incredible risky to take a 3 plus year commitment on a partnership track that may not exist in 3-4 years.

Just look what USAP Houston has had to pay for starting wages for partnership track these days (2023) compared to 2020. That eats into their operating profits. The partners are still raking in almost 2x as much as a starting wages which is why I said it's still a very good deal if you can assume the money train is still going to continue.

 

[amyl]

Genuinely curious. Would dividends to "shareholders" not also mean the physician owners/those with equity got a share of that? According to article it's 45% physician stock ownership (thought it was a little bit higher than that).

I read that as $1.3B was paid out to equity/stock holders, which included a large number of physicians. Could be wrong.

Yes. Doctor shareholders got a dividend- I know as I was one. I got a dividend on the shares I was gifted when I made partner

 

[amyl]

I wonder how much non-call taking doctors and partner track doctors make per year. I’m sure it’s much below National averages.

Is it true USAP is trying to give CRNAs more autonomy? Allowing them to induce by themselves as well as placing arterial lines if indicated. Is USAP sponsoring courses for CRNAs to learn nerve blocks? Very interested to hear from people working at Usap.

Make no mistake about it. This doesn’t seem like a group that values physicians.

Every USAP platform is different so I’ll speak about my group In dallas only. We have every intention of making someone a partner when we hire them. We have passed on likely good anesthesiologists because disposition, thought process, approach to the business of anesthesia wasn’t a fit for us. Could I have coached them through and made them see they aren’t a fit with their current mindset? Maybe but we won’t offer partner track on too big of a project because we don’t want to operate that way or have a bad reputation.
In my group non call day docs make significantly less yes. We all share call equally - partner and partner track until the age of 60… when everyone CAN opt out of call if they want to. We pay on time so they make less… but hey work when you are 40 and you’ll be able to opt out at 60 too.
Our partner track drs start at 80% of production and go up every year. I know you may not think that’s enough but it’s a big change from the market a few years ago and that’s as far as I’ve been able to move the needle in my group. Actually we have hired some really amazing people so it must be working and competitive… dallas has only gotten more and more desirable In The past few years.
When you retire you sell your stock - I know several who have done so without event. The gifted stock takes 5 years to vest so you can’t sell that if you leave before 5 years.
USAP just added Nashville, indiana, and Montana, just got a new contract in baltimore - so it’s not fair to say we are not expanding.
I know it’s popular to bash USAP on this forum but it’s the best job I’ve ever had by far. I’m thankful for it every day… well maybe not today bc I had a ****ty OB shift last night…. But every other day

 

[Status Sciaticus]

The practice you described happens in every private practice. It’s not unique to USAP in any of its platforms. When call schedules are made in Houston the partner track docs and partners are assigned the same number of calls, weekday, weekend, and holiday alike. Daily departures are dictated on who is pre- or post-call; all others are randomized. So yes, believe it or not, parter track docs and partners are treated the same. Partners and partner track docs both work side by side in high acuity hospitals. Associates work with partners at ASCs.
It sounds like you’re projecting your own experience in other practices on ours in Houston. I can only share what I know. Whether you choose to believe it is up to you.

So would a non-partner make less taking a call shift than a partner would for the same call?
Also Ill ask the question again, does the dividend pay out on a regular basis such as every quarter or every year, or is it sporadic and whenever the group feels like paying it out?

 

[lane]

So would a non-partner make less taking a call shift than a partner would for the same call?
Also Ill ask the question again, does the dividend pay out on a regular basis such as every quarter or every year, or is it sporadic and whenever the group feels like paying it out?

non-partners receive a salary that includes their assigned calls; additional calls are paid a premium beyond their salaried amount. Partners are on a completely different compensation system based upon profit sharing.
The stock-based dividend is assessed annually. Some years a dividend is issued and others it is not. It seems you’re fishing for a discussion on why a dividend isn’t released every year. Relative to the regular expected income of the partners it’s a minor portion of total compensation.

 

[Status Sciaticus]

non-partners receive a salary that includes their assigned calls; additional calls are paid a premium beyond their salaried amount. Partners are on a completely different compensation system based upon profit sharing.
The stock-based dividend is assessed annually. Some years a dividend is issued and others it is not. It seems you’re fishing for a discussion on why a dividend isn’t released every year. Relative to the regular expected income of the partners it’s a minor portion of total compensation.

So basically a partner working the same call shift will get compensated more than a non-partner. They may work equally hard, but clearly one gets paid more than the other for the same amount of work. Regarding the dividend question, I'm not fishing for anything. I'm pointing out that unlike a real stock that pays out dividends regularly (quarterly or annually), the forced purchase of USAP "stock" is just a buy-in.

 

[amyl]

Our partner track docs are production based so paid differently. Yes, in final effect, a partner track person is paid 20% less per call in the first year and 10% less in second year and same in the third year. I prefer this to a salary where you aren’t paid more if you get stuck late or want to pick up extra calls. I think it’s the fairest system and control over how much you work and make optimizes satisfaction.
Whether dividends are paid or not depends on the macroeconomics of the market. For example, dividends were not paid when we were using capital to fight United health care. When interest rates were down we got a nice dividend. From the outside it may look like we can do what we we want because we are a private company, but that is not at all the case and naive. We have third party evaluations and answer the market like everyone else. Public stock is also worth something because everyone agrees on its value - not entirely different from public just the audience is bigger. Lol our US dollar is the same.
Within the company there is always a desire to give dividends, but only is so much as it reflects the market. My dividend on my free stock was 25k…. Not an appreciable part of my income at all.
Personally I look at my stock as nice to have, not have to have - it’ll pay for itself - over my career the dividends will be nice but I’m not counting on the stock every being worth millions.

 

[amyl]

Also I’ll add that we (north Texas) just revamped the buy in program allowing for a wide variation in tolerances for stock speculation. You can buy 50-125k over the first 5 years and will get a free match up to 100k.
Of course, becoming a shareholder is an option. In my group at least you could not buy in if you wanted 🤷‍♀️

 

[lane]

So basically a partner working the same call shift will get compensated more than a non-partner. They may work equally hard, but clearly one gets paid more than the other for the same amount of work. Regarding the dividend question, I'm not fishing for anything. I'm pointing out that unlike a real stock that pays out dividends regularly (quarterly or annually), the forced purchase of USAP "stock" is just a buy-in.

You’re describing the benefit of partnership in any group, not just USAP. And this is after you mentioned that the compensation of non-partner physicians has increased in response to the market. So what’s the point? Just the same blah blah USAP bad blah blah blah

 

[Status Sciaticus]

You’re describing the benefit of partnership in any group, not just USAP. And this is after you mentioned that the compensation of non-partner physicians has increased in response to the market. So what’s the point? Just the same blah blah USAP bad blah blah blah

Nope. Youre referring benefits of 'partnership' in USAP. Several MD groups that pay people the same rate day 1. I was in a group that paid the same call pay to me as a partner that was there for 10 years because they don't believe in leeching off their associates/future partners.

I assume that youre in Houston. I was pointing out the fact that the starting pay and the sign-on bonus has increased quite a bit in response to market forces, which is a totally different tune than what the recruiters/interviewers were playing just a year ago.

 

[lane]

Nope. Youre referring benefits of 'partnership' in USAP. Several MD groups that pay people the same rate day 1. I was in a group that paid the same call pay to me as a partner that was there for 10 years because they don't believe in leeching off their associates/future partners.

I assume that youre in Houston. I was pointing out the fact that the starting pay and the sign-on bonus has increased quite a bit in response to market forces, which is a totally different tune than what the recruiters/interviewers were playing just a year ago.

What, then, would be the benefit of pursuing partnership in such a group?

 

[aneftp]

Usap model is sustainable for the original big 3 for now only because their payor mix has been incredible. We will see what the future entails if the commercial insurers force per unit billing down with the no surprise billing act.

It’s not a sustainable model if commercial rates go down to say $90/unit In California where many smaller private practices think $70-80 unit for commercial is a good deal. That’s why AMCs have very little wiggle room with increasing labor costs out there.

The long term practice model of 20% to private equity 20% to Usap partners physicians won’t work if they are taking a 30-40% hit on their commercial insurance payments. Because private equity will always want their 20% first.

 

[epidural man]

Partnership-track, in any form, is such a load of crap.

It is unjustifiable in my mind - and the excuses…I mean reasons…that people use to continue the slave trade are laughable.

I would know in two weeks, maybe two days…if the hired hand is “compatible” with our business.

 

[BLADEMDA]

The biggest issue I see with USAP is the income going forward. If one starts a 2 year track what will the income be in 2 years? I suspect 10-20% lower than today based on market forces of rising costs for CRNAs and capped insurance reimbursement due to the No Surprise Act. USAP will need to get and ask for higher subsidies to maintain the income or the employees/partners will suffer an income reduction. The natural tendencies for AMCs is to increase the workload on the workers to maintain profits. I state all this so the future USAP employee knows what he/she is buying into over 2-3 years.

 

[Status Sciaticus]

What, then, would be the benefit of pursuing partnership in such a group?

The specific group only let partners have voting rights on group decisions. Call, holidays, vacations, pay all equal amongst partners/nonpartners.

Our partner track docs are production based so paid differently. Yes, in final effect, a partner track person is paid 20% less per call in the first year and 10% less in second year and same in the third year. I prefer this to a salary where you aren’t paid more if you get stuck late or want to pick up extra calls. I think it’s the fairest system and control over how much you work and make optimizes satisfaction.
Whether dividends are paid or not depends on the macroeconomics of the market. For example, dividends were not paid when we were using capital to fight United health care. When interest rates were down we got a nice dividend. From the outside it may look like we can do what we we want because we are a private company, but that is not at all the case and naive. We have third party evaluations and answer the market like everyone else. Public stock is also worth something because everyone agrees on its value - not entirely different from public just the audience is bigger. Lol our US dollar is the same.
Within the company there is always a desire to give dividends, but only is so much as it reflects the market. My dividend on my free stock was 25k…. Not an appreciable part of my income at all.
Personally I look at my stock as nice to have, not have to have - it’ll pay for itself - over my career the dividends will be nice but I’m not counting on the stock every being worth millions.

Also I’ll add that we (north Texas) just revamped the buy in program allowing for a wide variation in tolerances for stock speculation. You can buy 50-125k over the first 5 years and will get a free match up to 100k.
Of course, becoming a shareholder is an option. In my group at least you could not buy in if you wanted 🤷‍♀️

This model definitely is better than Houston's compensation.
What happened to the 2 year partnership track that PAP was advertising?
Do you get paid for your availability in between turnovers, case delays, etc? Or is it just time of Anes Start to Anes Stop?
Do you get paid the 'synergy' your third year?
Regarding your comment about owning shares being optional.. are you saying you are made partner even if you dont buy the shares at all?

 

[epidural man]

Partnership-track, in any form, is such a load of crap.

It is unjustifiable in my mind - and the excuses…I mean reasons…that people use to continue the slave trade are laughable.

I would know in two weeks, maybe two days…if the hired hand is “compatible” with our business.

When residents who I have never worked with come to the pain clinic, I know within a half of day what kind of resident they are-will be. They can know next to nothing. Their skills can be horrible. But that doesn’t matter. It’s all the other things that define it.

 

[lane]

Partnership-track, in any form, is such a load of crap.

It is unjustifiable in my mind - and the excuses…I mean reasons…that people use to continue the slave trade are laughable.

I would know in two weeks, maybe two days…if the hired hand is “compatible” with our business.

“Leeching”… “slave trade”… it’s almost hysterical

The compensation provided to non-partners is competitive in each local market.

 

[aneftp]

The Usap model is very dependent on how much they can strong arm commercial insurers like united healthcare who won’t budge. Now I don’t blame usap. They gotta do what’s best for the their business. Same with United healthcare. Hospital systems are far worst these days with their mega mergers jacking up fees themselves on insurers just like usap.

My good buddy had to abandon his fee for service anesthesia business in Texas last year because he’s just a small player and the no surprise bill hit his business by 50%. So he went from 1 mil to 500k projected (work load around 35 hours) (he left mid year) That’s what I mean by if insurers start pounding on the big players like Usap with the no surprise act. It’s no sustainable model.

A 20% hit on commercial reimbursement for in network would make profit margins incredibly thin for Usap partners to survive with the parent company taking an additional 20%. It will come to a head soon.

 

[UTMB2014]

One of my buddies that works for Houston Usap was telling me how much they pay the non- partner docs.

275k for non-call taking (40 hr) docs
430k for call taking.

These numbers are atrocious, especially when considering the hourly rate.

 

[nimbus]

One of my buddies that works for Houston Usap was telling me how much they pay the non- partner docs.

275k for non-call taking (40 hr) docs
430k for call taking.

These numbers are atrocious, especially when considering the hourly rate.

If you start with a 700k job, deduct 20% for Welsh Carson, and then deduct another 20% for your local “partners”, that is roughly what you end up with.

Few years ago, someone told me starting pay at another VERY busy USAP division was even worse. The starting pay worked out to about $20/unit. Hopefully they increased that in the interim.

 

[BLADEMDA]

One of my buddies that works for Houston Usap was telling me how much they pay the non- partner docs.

275k for non-call taking (40 hr) docs
430k for call taking.

These numbers are atrocious, especially when considering the hourly rate.

you left out that partner income is almost double the non partner income; that's why they still get applicants.

 

[Arch Guillotti]

Whether dividends are paid or not depends on the macroeconomics of the market.

This is nonsense. Unless it's something like COVID when we all took a hit, you should be getting a regular dividend.

 

[aneftp]

you left out that partner income is almost double the non partner income; that's why they still get applicants.

Correct blade. That’s from a direct source who is Usap Houston partner. the partners do who work very hard. That part is the truth. Everyone who wants to make big money as a partner will earn a very nice paycheck.

That’s the hanging fruit with the Usap good Payor mix system. 3-10% of the partner pot will rely on the employees generating income. The other 20% from the partner pot relies on the large Usap parent company over charging insurers.

As you can see. If Usap parent is over charging insurers say $150/unit to stay in networks

If that percentage drops to $100/unit. Everyone gets squeeze. Usap the parent company will still get their 20% margins guaranteed. But the partner income will take a 15-20% hit based on current workload

 

[Status Sciaticus]

One of my buddies that works for Houston Usap was telling me how much they pay the non- partner docs.

275k for non-call taking (40 hr) docs
430k for call taking.

These numbers are atrocious, especially when considering the hourly rate.

When I interviewed there, they wouldn't tell me how much they made as partners, which was a huge red flag. If you cant tell me what my projected comp would be, then its obvious that the pay disparity is being hidden. While that wasn't the case at other USAPs, I interviewed at, it definitely is what made me wary of the group as a whole.

 

[Hoya11]

This is the only point that matters. If you work for an AMC, you do not determine your workload or your worksites. Your pay and work environment goes as the winds of reimbursement goes. You may find yourself reassigned with people you don’t know after 5 years working somewhere because “it’s what’s best for the company.”

The stock is negligible. Even the partner track is negligible. If you work consistently for 400k+ in this country almost anywhere you will be extremely wealthy. Your lifestyle, workload, and environment is what’s gonna matter way way more, and that’s what you give up with AMCs forever and ever

in the past if you want to make the most money, you sign up for a full time call taking position. salary is defined. workload is undefined.. could be ok, could be non -sustainable.

i hope as a profession that we will move more towards an hourly rate model, and away from the variability (overloadability) of a nebulous call taking contract..

i wouldnt mind taking a defined period of call for a defined amount of money.. but the idea that hey it might be more calls, more overall hours, same compensation - has to change!

 

[Howard888]

The truth is that USAP is what lead to the no surprises act which has doomed anesthesia.

Just read this article. It’s all accurate. There is nothing USAP is doing clinically that is any better at $150/unit than the $80/unit small group.

All of their quality studies are funded by USAP and USAP sellout authors.

As much as the govt is horrible with health care, the govt is right on this one. While they may never be found guilty, there’s a reason the ftc has investigated them more than once.

It’s monopoly/pyramid economics.

Payers are going to win against them. Just matter of time. And honestly they should

 

[aneftp]

The truth is that USAP is what lead to the no surprises act which has doomed anesthesia.

Just read this article. It’s all accurate. There is nothing USAP is doing clinically that is any better at $150/unit than the $80/unit small group.

All of their quality studies are funded by USAP and USAP sellout authors.

As much as the govt is horrible with health care, the govt is right on this one. While they may never be found guilty, there’s a reason the ftc has investigated them more than once.

It’s monopoly/pyramid economics.

Payers are going to win against them. Just matter of time. And honestly they should

Hospital systems are far worst with insurance strong arming for better rates.

Anesthesia billing a drop in the bucket compared to them. Usap is much smaller entity than envision. Envision did the same thing as USAP.

While USAP has been able to strong arm insurance in places like Texas and Florida initially due to the market share. Usap hasn’t been able to strong arm say in a place in Maryland because it’s presence is much smaller as a pie of the entire dc Virginia Maryland metro area. And the buyout was significantly less than in Texas and Florida. I know couple of them. They regretted it after a country of years. Buyout of MD only partnerships practices were significantly less than heavy ACT models.

 

[lane]

The truth is that USAP is what lead to the no surprises act which has doomed anesthesia.

Just read this article. It’s all accurate. There is nothing USAP is doing clinically that is any better at $150/unit than the $80/unit small group.

All of their quality studies are funded by USAP and USAP sellout authors.

As much as the govt is horrible with health care, the govt is right on this one. While they may never be found guilty, there’s a reason the ftc has investigated them more than once.

It’s monopoly/pyramid economics.

Payers are going to win against them. Just matter of time. And honestly they should

Lol USAP has an in-network strategy. And our group is to blame for the No Surprises Act?

That’s rich. USAP bad blah blah. It’s silly really.

Perhaps you should redirect your attention to the work USAP physicians have done toward making the implementation of the NSA less onerous on everyone (ie fighting the ridiculous QPA and arbitration criteria set forth unilaterally by the payers).

 

[Status Sciaticus]

Lol USAP has an in-network strategy. And our group is to blame for the No Surprises Act?

That’s rich. USAP bad blah blah. It’s silly really.

Perhaps you should redirect your attention to the work USAP physicians have done toward making the implementation of the NSA less onerous on everyone (ie fighting the ridiculous QPA and arbitration criteria set forth unilaterally by the payers).

On an unrelated note... If USAP is physician-owned, why not just buy out Welsh-Carson's equity and go fully physician owned? I cant be the only one who has brought up this question.

 

[epidural man]

Lol USAP has an in-network strategy. And our group is to blame for the No Surprises Act?

That’s rich. USAP bad blah blah. It’s silly really.

Perhaps you should redirect your attention to the work USAP physicians have done toward making the implementation of the NSA less onerous on everyone (ie fighting the ridiculous QPA and arbitration criteria set forth unilaterally by the payers).

You’ve made some great points.

I’m curious though - why are you defending this private equity group who are overlords of your anesthesia practice?

I mean I love my job but will gladly throw my overlords shade when appropriate.

 

[kidthor]

On an unrelated note... If USAP is physician-owned, why not just buy out Welsh-Carson's equity and go fully physician owned? I cant be the only one who has brought up this question.

Also if it’s “physician-owned” why is the majority of USAP’s board of directors non-physicians? Surely you’d want all, or at least most of the directors of a medical group to be a physician.

You’re also telling me the “physician-owners” actually want a Welsh Carson finance bro being the chair of their board? By the way that guy also had executive positions at Envision and Sheridan, and PE owned dermatology and urgent care groups.

 

[amyl]

The specific group only let partners have voting rights on group decisions. Call, holidays, vacations, pay all equal amongst partners/nonpartners.



This model definitely is better than Houston's compensation.
What happened to the 2 year partnership track that PAP was advertising?
Do you get paid for your availability in between turnovers, case delays, etc? Or is it just time of Anes Start to Anes Stop?
Do you get paid the 'synergy' your third year?
Regarding your comment about owning shares being optional.. are you saying you are made partner even if you dont buy the shares at all?

I think the semantics are somewhat confusing to people- there is a distinction to be made between partnership and shareholder. Partner is a division/group specific term. Shareholder status and track are determined by the board of doctors that runs each platform- the track varies from Houston, to Seattle, to Maryland… each board of doctors determines what they want their track to shareholder to look like.
My group does offer a two year track to financial partnership (contingent on you passing boards) and we also include people at partner meetings and votes after two years.
Yes we pay for availability - case turnover time isn’t carved out.
Yes if a group wanted to make you a partner without buying shares they could do that- each group runs it’s own finances. But you wouldn’t be a USAP shareholder.
It’s great that USAP allows physicians the autonomy to run their own groups and make their own decisions… it sets us apart from other amcs… but that autonomy can complicate things operationally.

 

[amyl]

This is the only point that matters. If you work for an AMC, you do not determine your workload or your worksites.

That’s not true at USAP… my group votes to drop or pick up surgery centers, surgeons, etc all the time…

 

[amyl]

On an unrelated note... If USAP is physician-owned, why not just buy out Welsh-Carson's equity and go fully physician owned? I cant be the only one who has brought up this question.

Lol…. Can I borrrow your Amex black card for my portion. The docs don’t have that kind of money… and I don’t think that we have the political capital that PE firms do. I hate to always blame Washington but..::

 

[amyl]

Also if it’s “physician-owned” why is the majority of USAP’s board of directors non-physicians? Surely you’d want all, or at least most of the directors of a medical group to be a physician.

You’re also telling me the “physician-owners” actually want a Welsh Carson finance bro being the chair of their board? By the way that guy also had executive positions at Envision and Sheridan, and PE owned dermatology and urgent care groups.

National board of directors includes people with experience on national boards, some of which are doctors. The platform/regional boards are all docs. If drs like me ran the National board it would probably be a mess… need some real business minds at the helm

 

[aneftp]

That’s not true at USAP… my group votes to drop or pick up surgery centers, surgeons, etc all the time…

Correct.

I’ve been in the business long enough to know this. Lots of folks confuse AMCs the parent company vs local leadership especially after buyouts

The places that were originally brought out generally run themselves. The amc just writes the checks

The places that have been abandoned or taken over. That’s where the chaos happens most often with staffing and work hours. Like there is a Usap place I know that was given to Usap and it’s literally a mess losing docs (and crna’s left and right). But the Usap that sold out still maintain their autonomy.