Another job thread

[Apples to oranges]

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Hey all,

Looking for any opinions at all to help make a decision...

Considering leaving AMC job for pp.

I like my current job. Like the guys in the group, like the surgeons, don’t work too much (almost feel like I should work more). Pp group sold out few years ago and contract is up in a year or so. We started clocking in and out a week ago. Feels a bit too cushy and overstaffed.

Pp gig with solid reputation across town contacted me due to expansion. 5 year track. Compared to current job the non partner track is 40k more/yr (also w2), 42k retirement after year 1, 1 week less vacation, 5-10 hrs/week more, 10 more calls a year, cover 4:1 and solo cardiac vs 3:1 now. Partners are 10 weeks vacation, 600s w/benefits on top including the 401k contribution and cash balance plan. Nobody has been denied partner. Not much hiring in recent years. 5 year contract with hosptal.

Overall, workload is more but not terrible , income is better even in non partner even though if I worked more with amc it’s probably be a wash, retirement is huge, have faith in the group, upside is much more. Buyin seems large and long track but Upside is a major increase to current situation (for increased workload of course). Overall, believe in the direction of the pp group.

Opinions?

 

[rakotomazoto]

How hard would it be to return to your current gig if you tried out this PP group and things didn't go as well as hoped/planned? I would feel even more motivated to go for if I felt like I could leave in a way that left the back door open, just in case...

 

[Apples to oranges]

How hard would it be to return to your current gig if you tried out this PP group and things didn't go as well as hoped/planned? I would feel even more motivated to go for if I felt like I could leave in a way that left the back door open, just in case...

I’m biting my tongue as to not get in trouble

 

[Apples to oranges]

Was that intentional?

 

[anbuitachi]

Need some details about current AMC job

 

[Apples to oranges]

Need some details about current AMC job

I tried to make it relative in the post above.

What specifics can I give? Q18 in house call 24 hrs w/post call off, crnas do epidurals over night, no trauma, 35-45 hrs, 390k, no retirement, 9 weeks vaca, couple of late shifts a month till 5pm or so, 3:1 coverage, nice people, no pedi, clock in and clock out but not paid for overtime, not too much oversight by amc at this point on site. It’s a nice easy cushy job, just doesn’t seem sustainable and I really have this odd feeling of wanting to work more and be part of a pp.

 

[Shimmy8]

That’s a great job overall in the AMC world.

But the other gig doesn’t sound bad either as long as call isn’t increased a ton.

If you want to work more/make more can you pick up extra at current gig?

 

[Apples to oranges]

That’s a great job overall in the AMC world.

But the other gig doesn’t sound bad either as long as call isn’t increased a ton.

If you want to work more/make more can you pick up extra at current gig?

Yeah it is a great job. Just feel like it’ll change here soon.

I can definately work more and have so I’m above 390 mark. Hourly rate isn’t that great for the extra work though. Call is like q20 now and would be q14 on the new job. Hard to leave easy job with decent income, but just feel like I could do more

 

[deleted162650]

The lack of retirement at AMC is atrocious. There's really no opportunity cost with switching. The 5 year track is a bit excessive though. Any chance the other group sells out in that time? I don't see a lot of down side to switching though.

 

[Apples to oranges]

The lack of retirement at AMC is atrocious. There's really no opportunity cost with switching. The 5 year track is a bit excessive though. Any chance the other group sells out in that time? I don't see a lot of down side to switching though.

What clause would you ask for in non partner track to give yourself insurance against sale?

 

[Apples to oranges]

The lack of retirement at AMC is atrocious. There's really no opportunity cost with switching. The 5 year track is a bit excessive though. Any chance the other group sells out in that time? I don't see a lot of down side to switching though.

5 years is linger than any of my friends in pp but My assumption is that the group made non partner salary slightly better to directly compete with the amc. Same buyin total just over longer period.

 

[deleted162650]

What clause would you ask for in non partner track to give yourself insurance against sale?

I would ask for one of two options:

1) in the event of a sale before you're partner, you get the buy-in money back that you have paid in up to that point.

2) you get a proportion of buy-out equal to the percentage of the track you have competed (i.e. you have been there for 39/60 months into the track when they sell so you get 0.65% of the partner buy-out amount

 

[Shimmy8]

I mean you’re an experienced anesthesiologist already working and they know you somehow, I’d ask for 3 years to partner and switch if they say yes.

I’d agree that the AMC job is too good now. They’ll tighten that belt.

 

[anbuitachi]

Reminds me of Teamhealth. Anyway i would totally take the pp job. They pay more and have retirement and similar vacation. 430k w 8 weeks vacation and 42k retirement for 5 years is liveable.

 

[Apples to oranges]

I would ask for one of two options:

1) in the event of a sale before you're partner, you get the buy-in money back that you have paid in up to that point.

2) you get a proportion of buy-out equal to the percentage of the track you have competed (i.e. you have been there for 39/60 months into the track when they sell so you get 0.65% of the partner buy-out amount

So this is exactly what I was getting at...which is better?

 

[Apples to oranges]

Reminds me of Teamhealth. Anyway i would totally take the pp job. They pay more and have retirement and similar vacation. 430k w 8 weeks vacation and 42k retirement for 5 years is liveable.

I think both are great options. Hard giving up a known happiness for unknown but good on paper. No matter how much you ask around you never really know till you are in the job.

 

[AdmiralChz]

A LOT can happen in 5 years, that’s an eternity for partnership track. Has that hurt their recruiting?

 

[Apples to oranges]

A LOT can happen in 5 years, that’s an eternity for partnership track. Has that hurt their recruiting?

Agree, 5 years a lot can happen. Hence the insurance against buyout and relative wages comment. Recruiting has been fairly successful recently judging by recent hires.

 

[Apples to oranges]

I mean you’re an experienced anesthesiologist already working and they know you somehow, I’d ask for 3 years to partner and switch if they say yes.

I’d agree that the AMC job is too good now. They’ll tighten that belt.

In terms of 3 years vs 5. I believe it’s a set buyin that all partners have done. Buyin is 10 dollars and you can spread that over 3 or 5 years , but since we all paid 10 bucks to get in here, you can’t come in acting like you are better. Ya know? Hard to argue for more than the guys that came before you and paid their dues. Any partners in pp with opinions on this? Maybe I’m wrong

 

[deleted162650]

So this is exactly what I was getting at...which is better?

I think they are both totally acceptable. I'd be happy with whichever they are willing to go along with.

 

[Southpaw]

So pp job does 4:1 other than cardiac which is solo? Does everyone do cardiac, because otherwise if I were a 4:1 person I’d be pretty resentful of another colleague getting to sit their 2-3 cases every day. 4:1 is freaking busy.

I wouldn’t be comfortable with 5 years these days without a clause like @SaltyDog mentioned. I’d also want to know why they need 5 years to partner. They know you already. Nothing will suddenly become obvious that wasn’t already after your first year or two of practice there.

The lack of retirement offered by AMCs is atrocious.

 

[AdmiralChz]

Those guys aren’t going to give you a percentage of the buyout, just not how it rolls in private practice. You can definitely ask but don’t be surprised if you get laughed at. A more reasonable request is getting the amount you’ve put in back - putting both options out there would be a good move, in my opinion.

Just to let you know what my practice said... “sorry, no” Either work for us or not. But you never know unless you ask.

 

[Apples to oranges]

So pp job does 4:1 other than cardiac which is solo? Does everyone do cardiac, because otherwise if I were a 4:1 person I’d be pretty resentful of another colleague getting to sit their 2-3 cases every day. 4:1 is freaking busy.

I wouldn’t be comfortable with 5 years these days without a clause like @SaltyDog mentioned. I’d also want to know why they need 5 years to partner. They know you already. Nothing will suddenly become obvious that wasn’t already after your first year or two of practice there.

The lack of retirement offered by AMCs is atrocious.

Lack of retirement is driving a lot of this.

All do hearts.

5 years to partner is apparently only to smooth out the pay as non partner. Buyin of X amount can be done over 3 or 5 years. I think it’s just to compete with the AMC, which makes sense as along as you give someone the percentage of partner buyout correct?

 

[chocomorsel]

Reminds me of Teamhealth. Anyway i would totally take the pp job. They pay more and have retirement and similar vacation. 430k w 8 weeks vacation and 42k retirement for 5 years is liveable.

Livable?
Wow, sometimes I think that I must be living in
another world. Cuz that’s more than livable to me.
Downside would be the long partner track and the 4:1 nurse coverage.

 

[Arch Guillotti]

Just to let you know what my practice said... “sorry, no” Either work for us or not. But you never know unless you ask.

Same here.

 

[Apples to oranges]

Those guys aren’t going to give you a percentage of the buyout, just not how it rolls in private practice. You can definitely ask but don’t be surprised if you get laughed at. A more reasonable request is getting the amount you’ve put in back - putting both options out there would be a good move, in my opinion.

Just to let you know what my practice said... “sorry, no” Either work for us or not. But you never know unless you ask.

I’ve had that offer in writing before when I was originally looking for a job out of fellowship so it does roll like that at some places I guess. I’d assume that’s because they had no intention of selling and didn’t see that happening in the near future.

My feeling is that what’s the point of leaving amc for pp if the group ends up selling anyways. Then all is lost because who knows how bad it could be with the new amc. I don’t know how buyouts work but I’m assuming since the price is based on a multiple it would be better than getting back that fraction of the buyin.

 

[Apples to oranges]

Same here.

So for real, here is my feeling and please tell me if I’m being unreasonable...I’m happy and in an AMC job that I like. These guys ask if I’d like to join and sell the idea of a major upside as partner and a stable long lived private practice and being an owner. Unless they are selling false dreams, why would they not agree to a fair percentage based on years or amount bought in? Tells me they aren’t confident in the future of their group or that they may have plans to sell. So why join?

 

[Apples to oranges]

How can you defend that?

 

[Apples to oranges]

Livable?
Wow, sometimes I think that I must be living in
another world. Cuz that’s more than livable to me.
Downside would be the long partner track and the 4:1 nurse coverage.

Agree 100%

 

[Apples to oranges]

Those guys aren’t going to give you a percentage of the buyout, just not how it rolls in private practice. You can definitely ask but don’t be surprised if you get laughed at. A more reasonable request is getting the amount you’ve put in back - putting both options out there would be a good move, in my opinion.

Just to let you know what my practice said... “sorry, no” Either work for us or not. But you never know unless you ask.

I’m 35. Long way to go...So let’s say I join and two years later they sell to amc. They give me 350k or so to make up for what I missed out on as partner And now my boss is Sheridan and the salary is 300k, 6 weeks vacation, less staffing and more weekly hours. Now I’ve left a nice AMC job for a bad AMC job working more and making 90k less per year than I was before. The 350k I received as part of the buyout doesn’t compare to what I just gave up over the course of a career.

 

[Southpaw]

5 years to partner is apparently only to smooth out the pay as non partner. Buyin of X amount can be done over 3 or 5 years. I think it’s just to compete with the AMC, which makes sense as along as you give someone the percentage of partner buyout correct?

They’ll see life through their eyes, not yours. If no one before you got such a clause then why should you ? Not saying it’s fair, but it’s what they’ll say.

 

[deleted162650]

I say go for door #C. Move to a location without AMC’s and without 4:1 supervision. You’ll be much happier in the long run.

 

[Apples to oranges]

They’ll see life through their eyes, not yours. If no one before you got such a clause then why should you ? Not saying it’s fair, but it’s what they’ll say.

I’m not the one who asked for a job though. That’s the thing. They said come join us, it’s a better future here. So my feeling is they put it to writing or admit that they don’t believe what they are telling me by refusing to put it in a contract.

And the landscape has changed compared
to some of the earlier partners who joined when AMC buyout was not as prevalent. Therefore it should be considered fair.

 

[Arch Guillotti]

I’m 35. Long way to go...So let’s say I join and two years later they sell to amc. They give me 350k or so to make up for what I missed out on as partner And now my boss is Sheridan and the salary is 300k, 6 weeks vacation, less staffing and more weekly hours. Now I’ve left a nice AMC job for a bad AMC job working more and making 90k less per year than I was before. The 350k I received as part of the buyout doesn’t compare to what I just gave up over the course of a career.

Find a better group to join😵

 

[Apples to oranges]

I say go for door #C. Move to a location without AMC’s and without 4:1 supervision. You’ll be much happier in the long run.

I wish it was possible but My wife and I are close with our families and I don’t think you could put a price on being in our hometown. So I gotta work with what I’ve got here.

 

[Apples to oranges]

Find a better group to join😵

I’m confused ...Find a pp with shorter buyin or pp that gives a claus?

 

[Arch Guillotti]

I’m confused ...Find a pp with shorter buyin or pp that gives a claus?

One that you feel confident will not be bought out. Although I think the AMC craze is over for a while.

 

[Hoya11]

I’m 35. Long way to go...So let’s say I join and two years later they sell to amc. They give me 350k or so to make up for what I missed out on as partner And now my boss is Sheridan and the salary is 300k, 6 weeks vacation, less staffing and more weekly hours. Now I’ve left a nice AMC job for a bad AMC job working more and making 90k less per year than I was before. The 350k I received as part of the buyout doesn’t compare to what I just gave up over the course of a career.

Being a young guy, do you find your current job a little sleepy? 35-40 hrs, no trauma, no pedi, crnas doing the epidurals.... how does the case acuity factor in? Both are good jobs financially, what makes you more happy day to day? I wouldnt be afraid to invest the 5 years if the cases are more engaging and no other red flags, i would try to negotiate the number of years tho

 

[Southpaw]

I’m not the one who asked for a job though. That’s the thing. They said come join us, it’s a better future here. So my feeling is they put it to writing or admit that they don’t believe what they are telling me by refusing to put it in a contract.

And the landscape has changed compared
to some of the earlier partners who joined when AMC buyout was not as prevalent. Therefore it should be considered fair.

Fair is a relative term. What’s fair to you isn’t fair to others. Others who put in their five years won’t see it as fair that you don’t have to.

There’s nothing wrong with asking for a 2 or 3 year track, or a clause in case of a buyout. Maybe you’ll get lucky, but I doubt it unless they really need you.

Your location is fixed. Seems to me as if your current AMC job is no more stable than your potential PP job. In many areas hospitals aren’t thrilled with reality AMC relative to what was promised.

 

[deleted162650]

I wish it was possible but My wife and I are close with our families and I don’t think you could put a price on being in our hometown. So I gotta work with what I’ve got here.

Find a different wife.

 

[Apples to oranges]

One that you feel confident will not be bought out. Although I think the AMC craze is over for a while.

The only thing that would give me confidence is if a group had confidence in themselves and said “yeah we will put it in there because it won’t happen”.

 

[Apples to oranges]

Being a young guy, do you find your current job a little sleepy? 35-40 hrs, no trauma, no pedi, crnas doing the epidurals.... how does the case acuity factor in? Both are good jobs financially, what makes you more happy day to day? I wouldnt be afraid to invest the 5 years if the cases are more engaging and no other red flags, i would try to negotiate the number of years tho

100% find it a little sleepy for all things non cardiac. Currently routinely doing vads, arch work, ecmo, significant volume of structural, redo valves, mitral repairs...no transplant or robotic stuff.

Outside of cardiac and high volume
Of regional it’s boring.

 

[Apples to oranges]

Being a young guy, do you find your current job a little sleepy? 35-40 hrs, no trauma, no pedi, crnas doing the epidurals.... how does the case acuity factor in? Both are good jobs financially, what makes you more happy day to day? I wouldnt be afraid to invest the 5 years if the cases are more engaging and no other red flags, i would try to negotiate the number of years tho

I think the day to day happiness is a good question. And that’s why I’m struggling now. I can’t really say I’m unhappy. I feel I’m not developing enough though and slacking.

Would you off to take less money and 3 years as opposed 5 and more $? If buy in is 10$ I gotta pay it sometime ya know? fair to ask for less buyin than those before me?

 

[Apples to oranges]

Find a different wife.

Yeah but my wife is a total babe .

 

[Apples to oranges]

Find a different wife.

And I don’t think I could out kick my coverage again

 

[Apples to oranges]

Being a young guy, do you find your current job a little sleepy? 35-40 hrs, no trauma, no pedi, crnas doing the epidurals.... how does the case acuity factor in? Both are good jobs financially, what makes you more happy day to day? I wouldnt be afraid to invest the 5 years if the cases are more engaging and no other red flags, i would try to negotiate the number of years tho

Feel like you are good mentor for people.

 

[Apples to oranges]

100% find it a little sleepy for all things non cardiac. Currently routinely doing vads, arch work, ecmo, significant volume of structural, redo valves, mitral repairs...no transplant or robotic stuff.

Outside of cardiac and high volume
Of regional it’s boring.

Livers I guess too

 

[Apples to oranges]

One that you feel confident will not be bought out. Although I think the AMC craze is over for a while.

Not to go too off topic, but do you think the AMC craze is over for a while because AMCs aren’t looking to buy as much? Are the AMCs backing off? Are the pp backing off? Or is it the hospital that is realizing that it’s not good?

 

[Apples to oranges]

Fair is a relative term. What’s fair to you isn’t fair to others. Others who put in their five years won’t see it as fair that you don’t have to.

There’s nothing wrong with asking for a 2 or 3 year track, or a clause in case of a buyout. Maybe you’ll get lucky, but I doubt it unless they really need you.

Your location is fixed. Seems to me as if your current AMC job is no more stable than your potential PP job. In many areas hospitals aren’t thrilled with reality AMC relative to what was promised.

I think we are on different pages here. I’m not saying I would have less of a buyin or less of a duration of a track than those before me. I’m only talking about some sort of insurance in the event of an AMC or hospital buyout.

I do agree with you that the AMC is no more stable than the pp. Probably the other way around.

 

[Mman]

Not to go too off topic, but do you think the AMC craze is over for a while because AMCs aren’t looking to buy as much? Are the AMCs backing off? Are the pp backing off? Or is it the hospital that is realizing that it’s not good?

hospitals are starting to regret having AMCs around. Sounded good at the time, but now they have buyers remorse. The Charlotte Mednax/Atrium thing was just the tip of the iceberg.