IkeBoy18

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Will AMCs ever corner the market and offer current PP level salaries because hospitals dont have a choice as AMCs can set the rate. Or will they just take the profit without sharing the wealth.
I'm exercising every bit of restraint I have here IkeBoy18, and will assume your naivite is based on inexperience with life in general and simply reply: the latter. Most definitely the latter.
 

IkeBoy18

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I'm exercising every bit of restraint I have here IkeBoy18, and will assume your naivite is based on inexperience with life in general and simply reply: the latter. Most definitely the latter.
Just trying to be as optimistic as possible. I am aware of how unrealistic and unconventional it would be if AMCs turned out to offer those kinds of salaries.

What exactly happens after the take over of PP groups by these companies in regards to salaries? The partners immediately take a paycut after a buyout and then each subsequent hire starts off substantially lower until everyone in the group eventually makes significantly less?
 

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All you are to an AMC = a body. You don't share your profits with people you don't really care about. Same for the hospitals. Your value is the cost of replacing you with somebody of similar talents.

Get used to the idea that you will be a "grey" collar employee, and be happy while you're still called "doctor". If you can survive self-employed or as part of a small and nice private practice, kudos to you; you will be part of the 1% (happiness-wise, not income-wise).
 

cognitus

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What's the pay difference between PP and AMC? And by pay, I mean salary + share of practice income
 

norwood

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AMCs are not the future they are the present
If I'm reading this correctly, it sounds like you see AMCs as sort of a fad. Do you mean that you think the AMCs' cavalier staffing will lead to enough annoyed surgeons (and enough lawsuits from avoidable complications) that at least some hospitals will eventually not renew the AMCs' contracts?
 

countingdays

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If I'm reading this correctly, it sounds like you see AMCs as sort of a fad. Do you mean that you think the AMCs' cavalier staffing will lead to enough annoyed surgeons (and enough lawsuits from avoidable complications) that at least some hospitals will eventually not renew the AMCs' contracts?
No. He's saying they're not the future because they are already here, in the present, right now.
 

Hamhock

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Is this not the great "free-market captialism" that everyone so desires?

HH
 

pgg

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Is this not the great "free-market captialism" that everyone so desires?
Healthcare in the US is about as free-market as a 6-year-old at the dinner table who is "free" to choose either the brussel sprouts or the tofu.

Are you really suggesting that we should celebrate insurance company and hospital manager freedom when we as physicians aren't free to unionize, collectively bargain, refuse service retaurant-style to anyone not wearing shoes and shirt? You're a smart guy, are you trolling?
 

Hamhock

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Healthcare in the US is about as free-market as a 6-year-old at the dinner table who is "free" to choose either the brussel sprouts or the tofu.

Are you really suggesting that we should celebrate insurance company and hospital manager freedom when we as physicians aren't free to unionize, collectively bargain, refuse service retaurant-style to anyone not wearing shoes and shirt? You're a smart guy, are you trolling?
Yes, I am fully aware that health-care is not "free-market".

No, not trolling...just poking fun at the folks in this forum who are often exclaiming their individualism and support of aggressive economics (if you will), but in this thread (and some others, including CRNA threads) seem to be crying at their misfortune, decrying the situation as "unfair" and "unbalanced" due to more powerful forces, and sulking away with defeatist attitudes.

I should have been more clear or at least not so short. The analogy and irony were clear in my mind but not clear on paper.

HH
 

norwood

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when we as physicians aren't free to unionize, collectively bargain
This was really interesting - I had always assumed there wasn't a union because docs were too disorganized to form one, until your comment led me to do a Google search for it. Wow.
 

pgg

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just poking fun at the folks in this forum who are often exclaiming their individualism and support of aggressive economics (if you will), but in this thread (and some others, including CRNA threads) seem to be crying at their misfortune, decrying the situation as "unfair" and "unbalanced" due to more powerful forces, and sulking away with defeatist attitudes.
So you're poking fun at people (capitalists? libertarians? conservatives? 1%ers?) who value free markets and individual effort/achievement, because they're griping about difficulties and hardships caused by artificially restricted un-free markets and unrewarded effort because lobbyists bought favors?

Regarding the CRNA issue. I've written many times here that I would have absolutely no problem at all with completely unrestricted independent CRNA practice (let them run ICUs and practice pain too!), if the public made the decision to accept higher risk in return for some level of cost savings. That would be a free market. But that's not the option that's being falsely advertised and lobbied by the AANA; there is no cost savings to independent practice, there is no improved access in underserved areas, and there is the everpresent lie of equal care and equal risk. It's the AANA lie we object to. None of us are worried about our ability to compete on merit.
 

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I've written many times here that I would have absolutely no problem at all with completely unrestricted independent CRNA practice (let them run ICUs and practice pain too!), if the public made the decision to accept higher risk in return for some level of cost savings. That would be a free market.
It would be a free market as long as I am allowed to ignore APRNs and their so-called "competence"; let them deal with each other only in an HMO network kind of way.

Just today I had an ASA 3+ patient with a worthless pre-op clearance from a "cardiac specialist APRN". What does she know about what anesthesia entails, when her understanding of physiology is at handbook level, when compared to a physician? In this case, this was not a big deal, since I can override her "recommendations", but there are many cases when their incompetence creates a dangerous paper trail, that leads to unnecessary consults, testing and CYA.
 
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BLADEMDA

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There are no free markets and no competition where there are exclusive contracts.
Maybe you all don't fear competition from nurses, but partners might fear competition from call-taking non-shareholder-track board certified anesthesiologists, if it existed. Especially since we'll work for half as much as you.

You will be working for "half as much as me" but your employer will be an AMC who won't ever cut you in on partnership and will keep reducing your salary in order to maintain profitability.

The future is an "ACO" type model where the "team approach" to health care delivery maintains quality while reducing costs. Allowing random non team members to float into the system without the same accountability as team members doesn't benefit the ACO or the patient.
 

dr doze

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You will be working for "half as much as me" but your employer will be an AMC who won't ever cut you in on partnership and will keep reducing your salary in order to maintain profitability.

The future is an "ACO" type model where the "team approach" to health care delivery maintains quality while reducing costs. Allowing random non team members to float into the system without the same accountability as team members doesn't benefit the ACO or the patient.
Quality is being redefined. I would change the word quality to "perception of quality".
 

nimbus

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Absolutely!
All these metrics (PQRS, SCIP...) hospitals and AMCs are focussed on don't measure quality they just provide an illusion of quality.[/quote

Quality is easy to see but difficult to quantize. That's why we use all those surrogate markers.

Everyone in the OR knows who are the quality surgeons and who are not. But there is no measure able difference if they both stop the perioperative antibiotics on time.
 

dr doze

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"Not the Best, but the Most."
-Nate Zock.
 

BLADEMDA

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Perhaps some of you need hearing aids?
 
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BLADEMDA

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Sell and take the money or hold on and wait for ObamaCare to make your current Group worthless. Hmmm.... I know which decision the largest providers of anesthesia in the USA are making every day. The current model of Anesthesia Groups is doomed in a few years. Almost everyone in this specialty for more than 15 years knows this and are selling/merging as fast as possible.
 

ProRealDoc

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And some here are still asking questions about joining 3-yr partnership track. :nono:
Make as much as you can now before it's too late.

I never imagined anesthesia would change so much so fast. Wow! Just wow!
 

BLADEMDA

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The Sun is setting on the current practice model of anesthesia. Guys like JPP can hold out for a few more years (probably at least 5) and make a bundle more; the rest of us aren't as fortunate and the scenery resembles the picture above.
 

BLADEMDA

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The largest Groups in the USA are selling/merging or have s


The Sun is setting on the current practice model of anesthesia. Guys like JPP can hold out for a few more years (probably at least 5) and make a bundle more; the rest of us aren't as fortunate and the scenery resembles the picture above.






This chart could very well represent your anesthesia group's stock price/value over the next few years. When would be a good time to sell sir? There will always be those who hold on to the bitter end.
 

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Wow. Maybe the military route is the best way to a financially rewarding career in anesthesiology for med students today.
 

cognitus

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I have a question. I heard that some pediatric dentists hire anesthesiologists to put their patients under. These anesthesiologists get $1100 for a 90 min procedure. Anyone look into this?
 

dr doze

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images.jpeg
Hurry it's Closing.
 
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anes121508

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And some here are still asking questions about joining 3-yr partnership track. :nono:
Make as much as you can now before it's too late.

I never imagined anesthesia would change so much so fast. Wow! Just wow!
If you were a new grad would you turn down a 3 year track these days? Is there anything that would convince you to take a track that long? City you want to be in, people you believe you can trust, a clause in your contract in the event of a buy out, ect?
 
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Consigliere

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If you were a new grad would you turn down a 3 year track these days? Is there anything that would convince you to take a track that long? City you want to be in, people you believe you can trust, a clause in your contract in the event of a buy out, ect?
I would. Nothing could convince me to take a track any longer than a year. 3 years? Hell, an AMC will buy that contract out well before then.
 

anes121508

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The largest Groups in the USA are selling/merging or have s








This chart could very well represent your anesthesia group's stock price/value over the next few years. When would be a good time to sell sir? There will always be those who hold on to the bitter end.
If you work Pinnacle, who has divisions that seem to operate independently, and USAP goes public....what would be the ramifications?
 

anes121508

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I would. Nothing could convince me to take a track any longer than a year. 3 years? Hell, an AMC will buy that contract out well before then.
Take for example a partnership track making a base salary for 2 years, then partner at year 3 with ownership and voting rights but a buy in spread over the course of 1-2 years....seems like a financial 4 year track right? ...what if they were to put a clause in your contract giving you a portion of the buyout if they were to sell prior to you becoming partner?
 

GravelRider

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I would take an AMC job that often pays 100k more. Preferably one where you can do a lot of your own cases...if you can find it. Get some experience, make some contacts, and have a better understanding of the market. Pay off your loans and then make a decision. Partnerships are a huge financial risk nowadays, and it is more than likely a fake way to pay you less for a few years until you figure out their lies. Staying in academics might even be a better option. Your first job won't be your last in this market.
 

ProwlerturnGas

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I have a question. I heard that some pediatric dentists hire anesthesiologists to put their patients under. These anesthesiologists get $1100 for a 90 min procedure. Anyone look into this?
I do it all the time
 

SaltyDog

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If you were a new grad would you turn down a 3 year track these days? Is there anything that would convince you to take a track that long? City you want to be in, people you believe you can trust, a clause in your contract in the event of a buy out, ect?
Depends. What's the local market like? Have a number of other area groups sold out? Is it a pyramidal group structure were a few super-partners stand make a killing selling out, or is it egalitarian where everyone is an equal and there are just one or two guys in the track at any given time (much less incentive to sell-out this way)? How steep is the buy-in? Do they have a nasty habit of cutting people loose just before making partner? Are they open to clause giving you partial sell-out money if it happens?

For a great group in a safer market I would definitely consider it. For a pyramidal, shady group in AMC country - No F'in way.
 

anes121508

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Depends. What's the local market like? Have a number of other area groups sold out? Is it a pyramidal group structure were a few super-partners stand make a killing selling out, or is it egalitarian where everyone is an equal and there are just one or two guys in the track at any given time (much less incentive to sell-out this way)? How steep is the buy-in? Do they have a nasty habit of cutting people loose just before making partner? Are they open to clause giving you partial sell-out money if it happens?

For a great group in a safer market I would definitely consider it. For a pyramidal, shady group in AMC country - No F'in way.
Local market - this group about 15 docs employing about 60 CRNA's, two other PP similar sized groups who they are affiliated with, one smaller group 15 docs, one academic institution, North Star at a small community hospital 45 min north of the city, one other PP group that I know nothing about

Group structure - equal call, equal hours (at least they try), bonuses split equally amongst partners, partners with 10+ years get extra 1 week vacation, all partners get equal shares, all partners get equal votes, non partners come to meetings just to be a part early on, associated with two other PP for strength in numbers but financially independent

Recent hires and making partner history - they have hired 1 guy in past 3 years, 2 docs have left in past 10 years, 1 person has ever not made partner

Open to giving partial sell out money if it happens prior to becoming partner

Buy in 125K over 2 years
 

anes121508

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They won't. IF they do, it'll be for some miniscule amount.
Let's say they were willing, what would you ask for (within reason of course)....a dollar amount? percentage of partner buy out? what would be a fair reasonable clause?

Anybody ever join a group and have something like this built in during your partnership track years?
 

SaltyDog

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Let's say they were willing, what would you ask for (within reason of course)....a dollar amount? percentage of partner buy out? what would be a fair reasonable clause?

Anybody ever join a group and have something like this built in during your partnership track years?
I would ask for either of 2 options:
1) You get all your buy-in money back if they sell (hey, at least you didn't lose anything)
2) You get a percentage of partner buy-out based on how far into the track you are (1 year into a 2 year track = 50% of partner buy-out).
 

pjl

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There is risk, but it sounds like decent rewards. If they dont sell out (many dont want to) you will be better off by far. It all depends on the rate for years 1-3.


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anes121508

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There is risk, but it sounds like decent rewards. If they dont sell out (many dont want to) you will be better off by far. It all depends on the rate for years 1-3.


Sent from my iPad using SDN mobile app
year 1-3 rate (salary based) is : year 1 = 42% of partner pay, year 2 = 46% partner pay, year 3 = 50% partner pay
 

anes121508

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I would ask for either of 2 options:
1) You get all your buy-in money back if they sell (hey, at least you didn't lose anything)
2) You get a percentage of partner buy-out based on how far into the track you are (1 year into a 2 year track = 50% of partner buy-out).
In order to assign a value to % of partner buy-out I would have to know what potential partner buy out would be right?

That is probably tough to determine?

How do the management company's assess the value of an anesthesia practice? What do they offer to buy the practice for?
 

SaltyDog

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In order to assign a value to % of partner buy-out I would have to know what potential partner buy out would be right?

That is probably tough to determine?

How do the management company's assess the value of an anesthesia practice? What do they offer to buy the practice for?
No, you would just say I want x% of what you guys get paid where x = the % of the partner track you have completed. Obviously you would need to be in the loop with regards to what the buy-out is if that time comes, but you don't need to know that up front when negotiating the clause.

The answer to your 2nd question has been discussed a bit in other threads.