Another One Goes Down

[Consigliere]

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Residents take heed...this is your future. You will be working for an AMC. So what you say? Well, if they are the only game in town, you best toe the line, take your paltry salary, say "thank you sir, may I have another?", and do it with a smile or else you will be unemployed. Glad you chose anesthesia?

http://online.wsj.com/article/PR-CO-20140128-905503.html

 

[IlDestriero]

Who wants to work a some hospital in Baltimore? (JH included BTW). I think a lot of the expansion is to low hanging fruit and groups who see the writing on the wall in struggling hospitals. Are either of these locations premium hospitals? The big premier groups selling out gets my attention more than a small Baltimore group that looked top heavy with MDs to begin with. Maybe if they right sized and changed their model they would be making more money, which is the driver of this change. Money and fear.

 

[cognitus]

The senior management of that anesthesia group had MBAs in addition to their MDs. They probably knew how to make money and saw the buyout as a way to maximize value

 

[deleted171991]

The senior management of that anesthesia group had MBAs in addition to their MDs. They probably knew how to make money and saw the buyout as a way to maximize value

Or they weren't truly good at either business administration or anesthesia, which is more probable. 😛

 

[countingdays]

 

[waitwhat]

Are Interventional Pain docs fall under the umbrella of the merger? Or are they typically a separate entity?

 

[kazuma]

Are Interventional Pain docs fall under the umbrella of the merger? Or are they typically a separate entity?

I don't know about this case, but they are usually their own separate groups from what I've seen. Pain has it's own set of issues to deal with, particularly with CMS reimbursement.

 

[aneftp]

Mednax general takes/buys out more successful groups.

Greater Baltimore anesthesia group was/is one of the more desirable groups to work for.

You also have to remember most groups in bigger metro areas get no subsidies. Case loads have been down 15-20%.

Your time requirement in the hospital doesn't change even if no cases cause there ends up being huge gaps in the scheduling.

 

[cognitus]

Or they weren't truly good at either business administration or anesthesia, which is more probable. 😛

What's more probable is that this post is misguided.

 

[gasdoc77]

Residents take heed...this is your future. You will be working for an AMC. So what you say? Well, if they are the only game in town, you best toe the line, take your paltry salary, say "thank you sir, may I have another?", and do it with a smile or else you will be unemployed. Glad you chose anesthesia?

http://online.wsj.com/article/PR-CO-20140128-905503.html

I regret my choice of specialty almost daily. In private practice the surgeons dictate the anesthetic and the crna's deliver it. Anyone who implies otherwise is an ostrich with their head in the sand. Alas, I have a wife and children so I'll ride this pony until it collapses, which will likely be soon. I will retrain before doing this job (and tolerating the injustices that come along with it) for a cent less. Welcome to the world of anesthesia, where we are well paid to permit behavior we would otherwise steamroll a man for.

 

[chmd]

That's not true everywhere. As a new attending in PP I frequently run things by surgeons and ask if they have preferences. They mostly say "whatever you want as long as they're still" or something to that effect.

Can't really imagine what you're referring to. Example?

 

[deleted126335]

That's not true everywhere. As a new attending in PP I frequently run things by surgeons and ask if they have preferences. They mostly say "whatever you want as long as they're still" or something to that effect.

Can't really imagine what you're referring to. Example?

There are both strong and weak anesthesia departments. Quite a few where the surgeon calls the tune. If one doesn't go along with that practice, One starts to look like you have quality issues, maybe labeled as not a team player, disruptive physician, you get to be the first one voted off the island unless you are measurably more skilled than the rest of your department. I have seen it happen to a quality doc.
The motto in these departments is stay under the radar, don't hurt anybody, acquiesce, collect your paycheck, race everybody else for the door at 2pm because it was so unfulfilling. I worked in such a practice in the past. Couldn't wait to get out for this and other reasons.

 

[Mman]

Residents take heed...this is your future. You will be working for an AMC. So what you say? Well, if they are the only game in town, you best toe the line, take your paltry salary, say "thank you sir, may I have another?", and do it with a smile or else you will be unemployed. Glad you chose anesthesia?

http://online.wsj.com/article/PR-CO-20140128-905503.html

In 20 years every specialty in medicine will be this way. I've already seen plenty of private surgical groups that are now employees of hospitals and same thing with medicine subspecialties.

In 20+ years, we will all work for somebody else.

 

[BLADEMDA]

If Obamacare remains the law of the land it won't take 20 years for the destruction of private practice in Anesthesiology. 5 years looks likely and 7 years looks quite probable for the demise of 95 percent of private practices.

If yours survives for longer than 7 years consider yourself one of the fortunate few.

 

[ProRealDoc]

80% of surgeons at my gig are employed. The trend for employment will apply to everyone. The AHA will see to that.

 

[aneftp]

Over 2 million per partner from Xxx group. Total scam by private equity. They immediately resold package to private pension plan who probably has re insurance.

It's like AIG credit default swaps all over again
Scam. Private equity just took the commission without any risks

 

[BuzzPhreed]

I regret my choice of specialty almost daily. In private practice the surgeons dictate the anesthetic and the crna's deliver it. Anyone who implies otherwise is an ostrich with their head in the sand. Alas, I have a wife and children so I'll ride this pony until it collapses, which will likely be soon. I will retrain before doing this job (and tolerating the injustices that come along with it) for a cent less. Welcome to the world of anesthesia, where we are well paid to permit behavior we would otherwise steamroll a man for.

Agree with BLADEMDA.

I think the PP owned group is a dying breed overall. If my current experience is any indication they are so afraid of losing the contract that they allow an anything goes attitude where every anesthetic is cookie-cutter and the CRNAs rule the roost. Good news for me is I'm going back to a job that is a hospital-owned practice for more money and they are going to cover my tail. They want me back that badly. So there is hope. At my former and soon to be again job, the surgeons don't dictate anything. They truly collaborate. As a hospital owned practice they don't really have any power over us other than threatening not to bring business to the hospital, which is often a hollow threat (and the administrators know it).

So I think working for the hospital owned group is far better (at least for me) than working in a group that has neither promised me a real future nor offered to listen to my input. It essentially already functions like an AMC. It's just not worth it. Ask the tough questions before you take a job anywhere. I'm going back to a nice job albeit in a less desirable location for more money, but where I'm truly appreciated. I was there for almost 5.5 years and will ride this for as long as I can. Sometimes better to be a big fish in a small pond. In that environment you can make a difference.

Also get educated. In business. In subspecialty. Choose one or both. And work on diversifying yourself so you are an invaluable member to whatever team you join. My current (soon to be ex-) situation, I'm just another spoke in the wheel. Easily replaced. And they know it.

 

[turnupthegas]

These threads are a little discouraging to those interested in anesthesia. It seems that most of grads entering residency now have missed boat in regards to reimbursement and practice culture. Would one recommend surgery as a better option as far as career outlook? Or is that field threatened with the same changes as far as practice culture?

 

[deleted171991]

Medicine is changing, all of it. Get an MBA, or some backup plan, if you can. Otherwise, just do a specialty that you (mostly) like. If you're attracted, surgery will probably be a better option than anesthesia for the future (a surgeon is much more difficult to replace with nurses - the public will resist big time).

Our biggest mistake was to sell anesthesia as "sleep", instead of "coma".

 

[aneftp]

These threads are a little discouraging to those interested in anesthesia. It seems that most of grads entering residency now have missed boat in regards to reimbursement and practice culture. Would one recommend surgery as a better option as far as career outlook? Or is that field threatened with the same changes as far as practice culture?

It's hard to find a job in radiology as well.

It's not just anesthesia.

 

[sevoflurane]

Agree with BLADEMDA.

I think the PP owned group is a dying breed overall. If my current experience is any indication they are so afraid of losing the contract that they allow an anything goes attitude where every anesthetic is cookie-cutter and the CRNAs rule the roost. Good news for me is I'm going back to a job that is a hospital-owned practice for more money and they are going to cover my tail. They want me back that badly. So there is hope. At my former and soon to be again job, the surgeons don't dictate anything. They truly collaborate. As a hospital owned practice they don't really have any power over us other than threatening not to bring business to the hospital, which is often a hollow threat (and the administrators know it).

So I think working for the hospital owned group is far better (at least for me) than working in a group that has neither promised me a real future nor offered to listen to my input. It essentially already functions like an AMC. It's just not worth it. Ask the tough questions before you take a job anywhere. I'm going back to a nice job albeit in a less desirable location for more money, but where I'm truly appreciated. I was there for almost 5.5 years and will ride this for as long as I can. Sometimes better to be a big fish in a small pond. In that environment you can make a difference.

Also get educated. In business. In subspecialty. Choose one or both. And work on diversifying yourself so you are an invaluable member to whatever team you join. My current (soon to be ex-) situation, I'm just another spoke in the wheel. Easily replaced. And they know it.

Nice post. Congrats. 👍

 

[gasdoc77]

That's not true everywhere. As a new attending in PP I frequently run things by surgeons and ask if they have preferences. They mostly say "whatever you want as long as they're still" or something to that effect.

Can't really imagine what you're referring to. Example?

It's simply a matter of $$. Hospitals view surgeons as assets and anesthesia as a liability. By the transitive property, the surgeons will basically be your boss. A very very seasoned older anesthesiologist once told me there are two types of anesthesia: bad anesthesia and anesthesia. Maybe it's my own fault, but my disposition is far too alpha to have to check with "the Dr" if I want to deviate from the cookie cutter approach. Private practice is service based and every 2-3 years the hospital may choose to go with a different provider if they feel so inclined.

 

[Mman]

It's simply a matter of $$. Hospitals view surgeons as assets and anesthesia as a liability. By the transitive property, the surgeons will basically be your boss. A very very seasoned older anesthesiologist once told me there are two types of anesthesia: bad anesthesia and anesthesia. Maybe it's my own fault, but my disposition is far too alpha to have to check with "the Dr" if I want to deviate from the cookie cutter approach. Private practice is service based and every 2-3 years the hospital may choose to go with a different provider if they feel so inclined.

And a smart surgeon will recognize that you are only trying to prevent bad outcomes from happening. When they have 1 or 2 patients drop dead postop when they pushed to get something done, you'll see them keep their head down in the future.

We all want what is best for the patient. In a future with bundled payments, any bad outcome will be a huge money loser for everybody.

 

[Random Anesthesiologist]

It is my dream to open a fair-market price surgicenter. Kind like the Surgery Center of Oklahoma.

Yes, I hear the snickers behind the monitors, but it's something I've always wanted to do. I have so far to go in my training, I know this. I do have an option to get an MBA at my residency program. But it's an ambition I hold on to. Who knows where that will go.

Also, yes, I'm glad I chose anesthesiology. So glad.

 

[Silent Cool]

It is my dream to open a fair-market price surgicenter. Kind like the Surgery Center of Oklahoma.

Yes, I hear the snickers behind the monitors, but it's something I've always wanted to do. I have so far to go in my training, I know this. I do have an option to get an MBA at my residency program. But it's an ambition I hold on to. Who knows where that will go.

Also, yes, I'm glad I chose anesthesiology. So glad.

I think your ambition is perfectly reasonable and is one that everyone should have. Look for opportunities to OWN something so that you control the money flow, you are self-employed. I wouldn't waste time with an MBA. It's not going to help you much. Just educated yourself in the basics of business on your own and look at various published case studies.

 

[BuzzPhreed]

And a smart surgeon will recognize that you are only trying to prevent bad outcomes from happening. When they have 1 or 2 patients drop dead postop when they pushed to get something done, you'll see them keep their head down in the future.

We all want what is best for the patient. In a future with bundled payments, any bad outcome will be a huge money loser for everybody.

I disagree that we all want what's best for the patient. Surgeons just want to cut and don't want the patient to move or die. Few actually care. A surgeon was railing at me one time not that long ago about a bad outcome (his fault) and I simply told him to remember that it's nice to have a friend in court. That's a good one to remember.

But at the rate we're going, you soon won't even have a say anymore. You'll just sign the chart, take the risk and the CRNA will do all the work. Including the blocks. Like it or lump it. It's coming. Unless anesthesiologists grow a spine and start standing up for their profession instead of their bank accounts. Most of the ones who've allowed this are checking out in a few years. I'm 37 years old. I'd like to still have a future in my chosen field.

 

[Consigliere]

It is my dream to open a fair-market price surgicenter. Kind like the Surgery Center of Oklahoma.

Yes, I hear the snickers behind the monitors, but it's something I've always wanted to do. I have so far to go in my training, I know this. I do have an option to get an MBA at my residency program. But it's an ambition I hold on to. Who knows where that will go.

Also, yes, I'm glad I chose anesthesiology. So glad.

Talk to me in 10 years and let's see how glad you are. How glad.

 

[Consigliere]

I disagree that we all want what's best for the patient. Surgeons just want to cut and don't want the patient to move or die. Few actually care. A surgeon was railing at me one time not that long ago about a bad outcome (his fault) and I simply told him to remember that it's nice to have a friend in court. That's a good one to remember.

But at the rate we're going, you soon won't even have a say anymore. You'll just sign the chart, take the risk and the CRNA will do all the work. Including the blocks. Like it or lump it. It's coming. Unless anesthesiologists grow a spine and start standing up for their profession instead of their bank accounts. Most of the ones who've allowed this are checking out in a few years. I'm 37 years old. I'd like to still have a future in my chosen field.

You won't. Anesthesiology is dead. Just sign the chart you overpaid, tube monkey.

 

[LeverArm]

Talk to me in 10 years and let's see how glad you are. How glad.

Who is this nurse troll? It seems like you definitely have a chip on your shoulder. Youve been posting the doom of anesthesiology for years but the field is growing. Its taking on more roles in academic centers and itll only be a matter of time itll expand its role in pp. unlike 30-40 years ago, today some of the smartest and most ambitious young docs are going into the profession who recognize the potential

 

[gasdoc77]

Who is this nurse troll? It seems like you definitely have a chip on your shoulder. Youve been posting the doom of anesthesiology for years but the field is growing. Its taking on more roles in academic centers and itll only be a matter of time itll expand its role in pp. unlike 30-40 years ago, today some of the smartest and most ambitious young docs are going into the profession who recognize the potential

Over the years I have met many anesthesiologists that are disenchanted with the profession. We have always had to play a secondary role to the surgeon, but lately we have become little more than a commodity whose only value is in the cost to replace us. Anyone who goes into medicine is by default an achievement oriented individual who likely takes pride in his accomplishments. When entering anesthesia, one quickly realizes that his achievements will largely go unrecognized for the remainder of his working career. The only blips on the radar will be if you delay a case or (perish the thought) cancel one altogether. AMC's will continue to gain foothold and will reduce their coverage to the lowest common denominator that can provide a service, maximizing profits, all while pushing the limits of practice standards for that respective location. Therefore, their natural tendancy will be to continue trying to dilute the workforce. Starting with an MD heavy practice, move it to 4:1 medical direction, then perhaps medical supervision (greater than 4:1), then collaborative (a single MD possibly doing complex cases alongside CRNA's doing independent practice), then strictly independent practice and MDA's better go hang your shingle somewhere. I have lived in many places and seem many models and it's already here. I just shake my head at the suggestion of making the residency an additional year. Somebody somewhere is completely unaware of what's happening on the front lines, market forces, and the business side of medicine. They are too busy dictating policies from their ivory tower.

 

[Mman]

The way to change the future is to change the paradigm. We are working towards that. Don't be a cog in the wheel, be the engine driving the entire machine. At many places anesthesiologists pre-op patients, keep them alive in the OR, and get them out of PACU to be someone else's problem. Gotta get your fingers into the entire machinery to make the whole thing run better.

Hospitals want ORs that are efficient and safe and the anesthesiologist knows more than anybody about how to do that. More than the administrator, more than the surgeon, more than the OR nurses.

Have a role in the process of working up a patient for surgery with the surgeon. Devise protocols to eliminate needless pre-op tests, streamline referrals for cardiology consult way before the patient gets into the hospital on day of surgery, make sure the CRNAs/AAs are either working for you or scheduled by you and get the OR staff in that same plan, work on protocols for improving satisfaction with pain control, work out plans to fast-track surgical patients and get shorter hospital length of stays, etc.

You already know more than anybody else in the hospital about all those things. You are the one that can make it happen better than anybody else. It requires a complete paradigm shift in many places, but it's not impossible.

When a surgeon sees a patient in a clinic that they determine needs an operation, that's really the extent of anything the surgeon should be involved in the process of until the patient is in the OR. As long as they have the studies completed they need to operate, the rest of the pre-op workup and tests should be dictated 100% by the anesthesiologist. CBC? Coags? CXR? Unless the surgeon isn't cutting skin without seeing a particular result, it's up to the anesthesiologist to decide if they need it to go to sleep. In the OR having 1 person/group in charge of the entire staffing of the operation from preop nurses to PACU nurses to OR staff to anesthetists ensures that a shortage in 1 area doesn't slow down the whole process on a given day.


and on and on and on and on


Hospitals want we are good at. Some might not recognize it yet, but the smart ones that will be growing and making money will need your help to do it.

 

[Consigliere]

Who is this nurse troll? It seems like you definitely have a chip on your shoulder. Youve been posting the doom of anesthesiology for years but the field is growing. Its taking on more roles in academic centers and itll only be a matter of time itll expand its role in pp. unlike 30-40 years ago, today some of the smartest and most ambitious young docs are going into the profession who recognize the potential

LOL! Ok sport.....wait until you try and find a job post-residency. The AMC down the street will be glad to hire you; and control you.

 

[BuzzPhreed]

LOL! Ok sport.....wait until you try and find a job post-residency. The AMC down the street will be glad to hire you; and control you.

You're right. And what's worse is that many PP groups are now adopting the AMC model. In effect they are functioning like an AMC already. This means 4:1, glorified preop doc, no real partnership track or promise of partnership track and the list goes on and on. This is the model that puts profit above the patient and fills the pockets of the secret senior partners who are getting rich off of you risking your medical license.

Just the other night I took care of a sick as crap patient in the PACU for over three hours. I could only do this because I was on call and nothing else was going on. What would've happened if I had not been able to resuscitate her post op (perfed duodenal ulcer) and had sent her tubed to the ICU. Who knows. But my bet is that she would have ended up on three pressors and renal replacement instead of just getting the TLC she needed. And a substantially higher chance that she might have died. If this had occurred during the day when I'd been 4:1 and couldn't give her or the other patients my attention demanded this is probably what would have happened.

We just don't have the capacity in our data collection to be able to see the difference in this type of patients care. If she'd died then it would have been chalked up to being inevitable. As it is she is doing fine in the ICU and another life saved. That's the difference that no one normally sees.

 

[BuzzPhreed]

The consolidation and "Walmarting" of our profession continues...

http://napaanesthesia.com/north-ame...and-foaa-anesthesia-services-announce-merger/

My advice to the soon-to-be residency grads? Demand they pay you what you're worth.

 

[BLADEMDA]

The consolidation and "Walmarting" of our profession continues...

http://napaanesthesia.com/north-ame...and-foaa-anesthesia-services-announce-merger/

My advice to the soon-to-be residency grads? Demand they pay you what you're worth.

Sorry. But, if you won't take $300 then I'm sure there will be someone else who gladly will. Over time these guys will keep ratcheting down the salary until nobody takes the job. However, if the salary falls to $250 will new graduates without fellowships and $200K in student loans NOT accept the lower pay? I doubt it.

The AMCs will eventually dominate and control the market in anesthesia. Resistance is futile.

 

[aneftp]

The consolidation and "Walmarting" of our profession continues...

http://napaanesthesia.com/north-ame...and-foaa-anesthesia-services-announce-merger/

My advice to the soon-to-be residency grads? Demand they pay you what you're worth.

Why do they keep saying these are "mergers". They are full or partial buyouts. Pure and simple.

The fair oaks main guy is a very notorious md/MBA business guy. Even he sees the writing on the wall.

 

[BuzzPhreed]

Sorry. But, if you won't take $300 then I'm sure there will be someone else who gladly will. Over time these guys will keep ratcheting down the salary until nobody takes the job. However, if the salary falls to $250 will new graduates without fellowships and $200K in student loans NOT accept the lower pay? I doubt it.

The AMCs will eventually dominate and control the market in anesthesia. Resistance is futile.

Then I think people need to 1099 these guys and work as contractors. Just refuse to sign their contract and offer instead to work as locums. They pay you $2500/day whether you do 15 cases or 1 case. If enough people had the sack to do this then it would put an end to this forced labor market.

 

[BuzzPhreed]

Why do they keep saying these are "mergers". They are full or partial buyouts. Pure and simple.

The fair oaks main guy is a very notorious md/MBA business guy. Even he sees the writing on the wall.

Yeah this was a huge coup. Not really a merger. Others will follow or get gobbled-up. It's only a matter of time until they infiltrate Roanoke, Va Beach and Richmond areas. And take over.

 

[deleted171991]

The consolidation and "Walmarting" of our profession continues...

http://napaanesthesia.com/north-ame...and-foaa-anesthesia-services-announce-merger/

My advice to the soon-to-be residency grads? Demand they pay you what you're worth.

Unless enough of us refuse to work for peanuts (and rather work as locums), nothing will change. And trust me: there aren't enough anesthesiologists (and doctors in general) with both nest eggs and balls.

The stupid recent ABA-candidate grads are the biggest problem in tighter markets. Don't be surprised if your corporation hires a bunch of them in your place, if you refuse to accept a pay cut.

 

[BuzzPhreed]

Unless enough of us refuse to work for peanuts (and rather work as locums), nothing will change. And trust me: there aren't enough anesthesiologists (and doctors in general) with both nest eggs and balls.

The stupid recent ABA-candidate grads are the biggest problem in tighter markets. Don't be surprised if your corporation hires a bunch of them in your place, if you refuse to accept a pay cut.

There are not enough anesthesiologist and doctors in general. Period. Stand up for yourself. That's my point.

If you allow yourself to be compromised someone else (not you) will make a killing off of your medical license. You're supporting a whole cadre of people who benefit from your ability to bill CMS and insurance companies. And you personally are indirectly paying them a lot of money when you allow this. They don't care about what it took to get your medical license. They are just more than willing to exploit it though with no personal exposure to themselves. These are the true vultures in our profession. And if you get sued they're not going to be there to get your back.

Recognize this before you take that job, soon to be grads.

 

[deleted171991]

They are playing divide and conquer; they will win.

They are already winning. One can try to ride it out with better-paid locums and 1099 jobs, but long-term the writing is on the wall. 30% increase in anesthesia grads over the last years?

They don't need more doctors. They need more bodies.

 

[Mman]

There are not enough anesthesiologist and doctors in general. Period. Stand up for yourself. That's my point.

While you might be right, on an individual basis it's hard for people to voluntarily go months without income at a time when they have student loan bills and mortgages and the like. In a game of chicken on a local level, they can always find another doctor to replace you but you can't always find another job in the area and you suffer more than they do if neither side gives in. That's why their game works for them.

 

[aneftp]

Most crnas aren't willing to work for less than $150k 3-4 days a week no calls no weekends.

That's going to be the rate limiting step.

I know someone personally who is part owner one of these "management companies". That's the money ball answer. What will crnas be willing to work for? And for what type of hours?
She had an extremely hard time finding crnas for less than 150k


And that's what's ultimately going to determine the anesthesiologist salary. You rate adjust for calls and more hours, right now 250k is the low end the market will bare in urban areas and around $200k for md without call (That's what my sisters all MD group pays their weekday no nights no call MD) in major urban areas.

 

[IanMcGalt]

Unless enough of us refuse to work for peanuts (and rather work as locums), nothing will change. And trust me: there aren't enough anesthesiologists (and doctors in general) with both nest eggs and balls.

The stupid recent ABA-candidate grads are the biggest problem in tighter markets. Don't be surprised if your corporation hires a bunch of them in your place, if you refuse to accept a pay cut.

Ha ha ha. Seriously? If the older guys didn't do away with partnership tracks and sell out to or 'merge' with AMCs, the new grads wouldn't be looking at AMC jobs except as a last resort.

 

[urge]

Ha ha ha. Seriously? If the older guys didn't do away with partnership tracks and sell out to or 'merge' with AMCs, the new grads wouldn't be looking at AMC jobs except as a last resort.

When I interviewed for jobs out of fellowship, the partnership groups consistently offered substantially less than AMCs. One group offered almost half of the AMC rate with no clear disclosure of partnership salary. It is the groups who are to blame for this debacle, not the new grads.

Of note, the group that offered half pay has been replaced by an AMC. I would have been really screwed if I had joined them.

 

[urge]

Unless enough of us refuse to work for peanuts (and rather work as locums), nothing will change.

That applies to partnership groups as well as AMCs. However, we all know that partnership groups are the ones paying peanuts to the new hires. So, your message is basically to join AMCs.

 

[deleted171991]

Academia is beginning to pay peanuts, too, to the new hires, so they can protect the status quo of the "seniors".

 

[urge]

Academia is beginning to pay peanuts, too, to the new hires, so they can protect the status quo of the "seniors".

Academia has always paid peanuts.

 

[bronx43]

Most crnas aren't willing to work for less than $150k 3-4 days a week no calls no weekends.

That's going to be the rate limiting step.

I know someone personally who is part owner one of these "management companies". That's the money ball answer. What will crnas be willing to work for? And for what type of hours?
She had an extremely hard time finding crnas for less than 150k


And that's what's ultimately going to determine the anesthesiologist salary. You rate adjust for calls and more hours, right now 250k is the low end the market will bare in urban areas and around $200k for md without call (That's what my sisters all MD group pays their weekday no nights no call MD) in major urban areas.

Aren't willing? When the market for CRNAs gets flooded in the near future, they won't be able to dictate $150k for 4 days and no call - or they can go back to wiping poop and giving meds.

 

[BuzzPhreed]

That applies to partnership groups as well as AMCs. However, we all know that partnership groups are the ones paying peanuts to the new hires. So, your message is basically to join AMCs.

No. This is not entirely true.

The partnership groups do pay peanuts to the new hires. But the payout should come in a year or two (at most) when you make partner.

However having talked to a few of those more junior just-outta-residency docs at the last ridiculous gig from which I recently extricated myself, there is no real promise or guarantee of partnership anymore. I think this all started in the Atlanta groups back about 10-12 years ago and has slowly spread like a cancer up the east coast. It's like a carrot dangled in front of the jackass. Probably permanently. The difference is that at an AMC you know up front you will never make partner but the pay is better from the start. Psychologically you also don't feel like there is ever a chance you will make partner so you don't feel compelled to kiss the other "partner's" asses. You're all in the same boat.

The true AMC and the true hospital-owned practice is far more "pure" than the new trend in PP to not directly offer a partnership track up front. I've heard this up and down the east coast that this is the new standard. You just hire a doc and, if it works out, someday you may be offered a partnership. Think about the mind-**** in that. It puts you in a position where you simply do what you're told and take your lumps and practice their way - whether it's right or wrong - because you hope someday they'll let you in the club. When the reality is that it's an illusion.

**** that ****. These ****ing greedy ***holes are more interested in lining their pockets than building a future. And they are doing it while breaking your back.

If they are a PP group and they are not willing to offer you a clear, written, and defensible-in-court partnership track from day 1 then walk. Don't sign. Telling them to go **** themselves. You're better off in an AMC or a hospital-owned group. Trust me. If I'd done this I would have saved myself a lot of hassle and heartache.