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Southpaw said:
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.
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Also, for my specific situation, the logic doesn’t make sense. A group can’t say “hey come work with our stable pp and leave the amc”...yet turn around and refuse to put a claus in the contract. That shows they don’t believe in the stability or longevity of the practice. You can’t have it both ways. Sure refuse, but only because they can hire another person willing to sign it.
 
Apples to oranges said:
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?
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Your current job sounds OK and I would be leery to leave for something that might turn out better. I agree with you also that they approached you, so it's worth trying some negotiation. If it were me, I would ask for a shorter partner track, reimbursement for my buy in if there is a buy out, and no non-compete in my contract during the partnership track. Then see what they say. It does sound reasonable other than the 5 year process.

I don't really agree with the thought that if everyone has done something regarding a partnership track in the past then everyone else has to do it in the future. They can have that thought, but at the end of the day you have to do what the market does if you want a reasonable candidate. Maybe they have more applicants than positions and can maintain their approach, I really have no idea. You should have a better handle on the local market.
 
Apples to oranges said:
Also, for my specific situation, the logic doesn’t make sense. A group can’t say “hey come work with our stable pp and leave the amc”...yet turn around and refuse to put a claus in the contract. That shows they don’t believe in the stability or longevity of the practice. You can’t have it both ways. Sure refuse, but only because they can hire another person willing to sign it.
Click to expand...

Sometimes I don't understand this mindset. Maybe I'm misunderstanding you. I'm not trying to be rude here. You work for an AMC and are an employee. You have NO SAY in how the business is run. You show up, work, go home, and get your check. You benefit MINIMALLY (you do help your AMC) by going the extra mile (the hospital via committees and meetings, your group via committees and meetings, etc) unless it's in your contract.

There's a group across town offering you OWNERSHIP. You will become a part OWNER. You'll cast your vote on how the day to day is run, nights, weekends, schedules, CRNAs (if they work for your group), etc. You will DIRECTLY BENEFIT by helping the hospital solve problems, serve on committees, go to meetings, etc.

I just want to be clear as you feel entitled to something they haven't offered you. At least that's what I'm reading in your posts. Maybe I'm off base, but when you say 'a group can't say yada yada yada....' you're wrong. They own the business. They can say whatever they want. They're already offering you a better package as an EMPLOYEE than you're currently receiving working for an AMC, for marginally more work from what I understand. If they are a solid private practice in good standing with the hospital (s) they contract with, then I bet there's a line to get in the door. You can accept it or not. You can ASK for whatever you feel you want. Shorter partnership, part of the buyout, more vacation, sign on bonus, etc. Just don't be shocked when they say NO. But, if they say yes then good for you.
 
Also, to those who say a new hire is deserving of a clause for protection in case of a buyout, I don't necessarily disagree but I also don't wholly agree either. A new hire on a partner track needs to prove worth to become part owner. Just walking in the door and clocking in isn't enough. They haven't developed trust relationships with surgeons or the hospital. They haven't served on committees, negotiated contracts, etc. In short, they haven't run the business. In fact, they know literally nothing about the business. They know anesthesiology, and for that they're being offered ownership, but at a cost.

A business does not need to offer clauses to prove they believe in themselves. They exist, and if they are thriving (this should be easy to tell), then that is proof enough. You either trust them or you don't. And if you don't, then move on. But again, you ask for whatever you want, but just because they say NO doesn't mean anything with regards to their valuation of themselves as a business.
 
Southpaw said:
A new hire on a partner track needs to prove worth to become part owner. Just walking in the door and clocking in isn't enough.
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Where I work you just have to be average. Basically if you get hired and you do an average job and not stick out for being stupid or malignant or corrupt, you’ll make partner.
 
Apples to oranges said:
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.
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Don't leave
 
Apples to oranges said:
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.
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i quite honestly like what i hear. do you take in house call? does the PP take in-house call? OB? i would really evaluate quality of life between the two. no retirement blows but you can also put in some more work with the AMC and maybe discuss some options with a good financial planner.

With a lot of these jobs, especially in PP, the grass can seem greener.
 
Southpaw said:
They exist, and if they are thriving (this should be easy to tell), then that is proof enough
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I don't disagree with what you say in general but a thriving group has probably more to do with the quality of the surgeons that the quality of the anesthesiologists.
 
dhb said:
I don't disagree with what you say in general but a thriving group has probably more to do with the quality of the surgeons that the quality of the anesthesiologists.
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There’s definitely truth in that as the surgeons are the ones bringing in the patients. But, if the anesthesia group sucks, the surgeons will take those patients across town. A good anesthesia group takes care of the surgeons and vice versa. It’s a symbiotic relationship. The recent history of my group includes multiple instances of surgeons and GI docs asking us to provide anesthesia at their outlying ASC’s, offices, and GI clinics.
 
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SaltyDog said:
There’s definitely truth in that as the surgeons are the ones bringing in the patients. But, if the anesthesia group sucks, the surgeons will take those patients across town. A good anesthesia group takes care of the surgeons and vice versa. It’s a symbiotic relationship. The recent history of my group includes multiple instances of surgeons and GI docs asking us to provide anesthesia at their outlying ASC’s, offices and, GI clinics.
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This is the part that really needs to be hit home.
 
Southpaw said:
Sometimes I don't understand this mindset. Maybe I'm misunderstanding you. I'm not trying to be rude here. You work for an AMC and are an employee. You have NO SAY in how the business is run. You show up, work, go home, and get your check. You benefit MINIMALLY (you do help your AMC) by going the extra mile (the hospital via committees and meetings, your group via committees and meetings, etc) unless it's in your contract.

There's a group across town offering you OWNERSHIP. You will become a part OWNER. You'll cast your vote on how the day to day is run, nights, weekends, schedules, CRNAs (if they work for your group), etc. You will DIRECTLY BENEFIT by helping the hospital solve problems, serve on committees, go to meetings, etc.

I just want to be clear as you feel entitled to something they haven't offered you. At least that's what I'm reading in your posts. Maybe I'm off base, but when you say 'a group can't say yada yada yada....' you're wrong. They own the business. They can say whatever they want. They're already offering you a better package as an EMPLOYEE than you're currently receiving working for an AMC, for marginally more work from what I understand. If they are a solid private practice in good standing with the hospital (s) they contract with, then I bet there's a line to get in the door. You can accept it or not. You can ASK for whatever you feel you want. Shorter partnership, part of the buyout, more vacation, sign on bonus, etc. Just don't be shocked when they say NO. But, if they say yes then good for you.
Click to expand...
A 5-year track is just an AMC in disguise.
 
FFP said:
A 5-year track is just an AMC in disguise.
Click to expand...

I wouldn't sign on for a 5-year track and I'm curious (and suspicious) of how that came to be. But the market is the market. The decision makers for that 5 year track are physicians/anesthesiologists, not business cronies in another state telling you whether or not to clock in/out and what your hourly rate is. I'm not defending the 5-year track, but there is a difference between that and an AMC. If no one signed up for the 5 year track, it wouldn't be 5 years....
 
If you're doing advanced cardiac, regional and livers but are still bored, what kind of cases is the PP going to offer to stimulate you? Particularly when you're supervising 4:1 and just signing charts.
 
Southpaw said:
Sometimes I don't understand this mindset. Maybe I'm misunderstanding you. I'm not trying to be rude here. You work for an AMC and are an employee. You have NO SAY in how the business is run. You show up, work, go home, and get your check. You benefit MINIMALLY (you do help your AMC) by going the extra mile (the hospital via committees and meetings, your group via committees and meetings, etc) unless it's in your contract.

There's a group across town offering you OWNERSHIP. You will become a part OWNER. You'll cast your vote on how the day to day is run, nights, weekends, schedules, CRNAs (if they work for your group), etc. You will DIRECTLY BENEFIT by helping the hospital solve problems, serve on committees, go to meetings, etc.

I just want to be clear as you feel entitled to something they haven't offered you. At least that's what I'm reading in your posts. Maybe I'm off base, but when you say 'a group can't say yada yada yada....' you're wrong. They own the business. I just want to be clear as you feel entitled to something they haven't offered you. solid private practice in good standing with the hospital (s) they contract with, then I bet there's a line to get in the door. You can accept it or not. You can ASK for whatever you feel you want. Shorter partnership, part of the buyout, more vacation, sign on bonus, etc. Just don't be shocked when they say NO. But, if they say yes then good for you.
Click to expand...

You aren’t being rude. You are right on multiple points however I disagree on key portions of what you said that I think matter.

1. I am currently an employee and have no say whatsoever. You are 100% correct. I hate that.

2. “There's a group across town offering you OWNERSHIP. You will become a part OWNER.”
- the key here is that they are offering a CHANCE to become owner. This is not a guarantee and we wouldn’t be having this discussion at all if they were offering me ownership. Leaving my current job for the chance to become owner has risk. Consider the downside where after 1.5 years the group sells to an AMC and the salary is set lower and the AMC has a more malignant style of running things. I’d be working more for less money and would have burned bridges. That is a real risk.

3. “I just want to be clear as you feel entitled to something they haven't offered you.”
- if I were a partner and someone came asking for this I would initially have the same feeling so I understand why you might say this...I challenge you to get beyond the initial feeling of “who the hell does entitled POS think he is” and appreciate someone aware of and accepting of the climate of or field today. This has ZERO to do with feeling entitled. It has everything to do with minimizing risk and is a product of the countless stories of “I was just a couple months away from becoming partner and all of the sudden I’m forced to either work for AMC or leave town”. Minimizing risk and protecting yourself against real possibilities is probably the same way most good private practices go about negotiating their business with the hospital or whomever they deal with. I would hope they would view such a request as savvy rather than insulting.

4. “solid private practice in good standing with the hospital (s) they contract with, then I bet there's a line to get in the door. You can accept it or not”
- you are right on point

5. “Just don't be shocked when they say NO“
- totally agree and I won’t be. Probably has to do with the line at the door. I get it, why agree to things when you can just bring in the next guy/gal who is more willing to take a chance
 
Southpaw said:
Sometimes I don't understand this mindset. Maybe I'm misunderstanding you. I'm not trying to be rude here. You work for an AMC and are an employee. You have NO SAY in how the business is run. You show up, work, go home, and get your check. You benefit MINIMALLY (you do help your AMC) by going the extra mile (the hospital via committees and meetings, your group via committees and meetings, etc) unless it's in your contract.

There's a group across town offering you OWNERSHIP. You will become a part OWNER. You'll cast your vote on how the day to day is run, nights, weekends, schedules, CRNAs (if they work for your group), etc. You will DIRECTLY BENEFIT by helping the hospital solve problems, serve on committees, go to meetings, etc.

I just want to be clear as you feel entitled to something they haven't offered you. At least that's what I'm reading in your posts. Maybe I'm off base, but when you say 'a group can't say yada yada yada....' you're wrong. They own the business. They can say whatever they want. They're already offering you a better package as an EMPLOYEE than you're currently receiving working for an AMC, for marginally more work from what I understand. If they are a solid private practice in good standing with the hospital (s) they contract with, then I bet there's a line to get in the door. You can accept it or not. You can ASK for whatever you feel you want. Shorter partnership, part of the buyout, more vacation, sign on bonus, etc. Just don't be shocked when they say NO. But, if they say yes then good for you.
Click to expand...

One other very important point you brought up:

“They're already offering you a better package as an EMPLOYEE than you're currently receiving working for an AMC,”
- this definately is true and makes me willing to take on more risk. However, it is a real possibility that after a sale of the group 16 months into my track the partners strike a deal that results in a lower salary that what I have now with a more malignant AMC. You can not deny that this is a real possibility.
 
Southpaw said:
Also, to those who say a new hire is deserving of a clause for protection in case of a buyout, I don't necessarily disagree but I also don't wholly agree either. A new hire on a partner track needs to prove worth to become part owner. Just walking in the door and clocking in isn't enough. They haven't developed trust relationships with surgeons or the hospital. They haven't served on committees, negotiated contracts, etc. In short, they haven't run the business. In fact, they know literally nothing about the business. They know anesthesiology, and for that they're being offered ownership, but at a cost.

A business does not need to offer clauses to prove they believe in themselves. They exist, and if they are thriving (this should be easy to tell), then that is proof enough. You either trust them or you don't. And if you don't, then move on. But again, you ask for whatever you want, but just because they say NO doesn't mean anything with regards to their valuation of themselves as a business.
Click to expand...

The points you make on this front are great and I absolutely can not argue with you on anything you said here. This is exactly the other side I was hoping to hear when I brought this up. Your perspective is much appreciated and has changed the way I view this a little

However, I still don’t think it changes my position involving risk.
 
Twiggidy said:
i quite honestly like what i hear. do you take in house call? does the PP take in-house call? OB? i would really evaluate quality of life between the two. no retirement blows but you can also put in some more work with the AMC and maybe discuss some options with a good financial planner.

With a lot of these jobs, especially in PP, the grass can seem greener.
Click to expand...

Both in house call. Both have OB. PP job is definately an increase in workload, however as those have recently pointed out....at least you are working for yourself
 
FFP said:
A 5-year track is just an AMC in disguise.
Click to expand...

No, this does not seem to be that. I guess I could be wrong but that’s not what i think.

5 year track is a commitment yes, but to become part of a thriving group and have ownership it’s worth it to me. Especially since the pay for the work load is similar to where I am now. The risk associated with a 5 year track though, could be minimized by a buyout claus. I may sound stupid here but the duration of the track is a non issue for me. I think that asking for a shorter track as opposed to a claus that protects against buyout is less “entitled” sounding
 
Southpaw said:
I wouldn't sign on for a 5-year track and I'm curious (and suspicious) of how that came to be. But the market is the market. The decision makers for that 5 year track are physicians/anesthesiologists, not business cronies in another state telling you whether or not to clock in/out and what your hourly rate is. I'm not defending the 5-year track, but there is a difference between that and an AMC. If no one signed up for the 5 year track, it wouldn't be 5 years....
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Well we clearly agree on this part
 
Every AMC contract I've heard of contains a non-compete. You should check. There's some pretty specific information about the PP gig you're considering in this thread.
 
Ezekiel2517 said:
Every AMC contract I've heard of contains a non-compete. You should check. There's some pretty specific information about the PP gig you're considering in this thread.
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I was curious about this as well; what is your non-compete in your current contract?
 
Apples to oranges said:
One other very important point you brought up:

“They're already offering you a better package as an EMPLOYEE than you're currently receiving working for an AMC,”
- this definately is true and makes me willing to take on more risk. However, it is a real possibility that after a sale of the group 16 months into my track the partners strike a deal that results in a lower salary that what I have now with a more malignant AMC. You can not deny that this is a real possibility.
Click to expand...

I don't blame you for wanting to minimize your risk. I'd do the same. I'm sure you realize there's only so much risk you can minimize while at the same time accepting some strangers on their word. So talk to the partners. Has anyone not made partner in the last 5 years? What's the track record for partnership? If someone hasn't made partner, why? Can you talk to them to dig deeper? This should be an easy part of the equation to tease out with regard to risk management. Try to look yourself as objectively as possible. Do you get along with others? Are you a team player, generally willing to go out of your way, within reason, to help others on your team? If the group is solid and fair, you hold up your end of the bargain, everyone around you says 'hey I like this guy!!' including nurses and surgeons, then you'll make partner.

With regard to an AMC buyout, this rightly seems your biggest fear. Talk to the partners. Ask them their thoughts on AMCs and buyouts. I'm sure they've already been approached and have discussed it as a group, so they should know. They should also understand your fears and be willing to give you honest answers to pointed questions with regard to AMCs. But you need to ask the questions and to multiple people. If they seem wishy washy, or aren't giving you good vibes, then you know your answer. You can tell a lot about a person by looking them directly in the eye, asking a pointed question, and seeing their response. If they reply with confidence in a straight forward manner, either you should trust them on their word or they're a good liar. If they squirm or try to give you some PC response while weaseling out of the conversation, then there you go.
 
OP, if you were looking for this level of mental masturbation, you should have posted this in the IM forum. It’s time get your hand out of your pants, put on your big girl panties, drive across town, and ask them about adding a buy-out clause. There’s no point in continuing the conversation until that happens.
 
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SaltyDog said:
OP, if you were looking for this level of mental masturbation, you should have posted this in the IM forum. It’s time get your hand out of your pants, put on your big girl panties, drive across town, and ask them about adding a buy-out clause. There’s no point in continuing the conversation until that happens.
Click to expand...

Probably a pull-up would be best for me as opposed to big girl panties for obvious reasons
 
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