APP- American Physician Partners

[NYEMMED]

Has anyone heard of or had any experience with the group American Physician Partners (APP)?

Thanks!

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[Ridge_Runner]

Has anyone heard of or had any experience with the group American Physician Partners (APP)?

Thanks!

Company is only 4 years old or so. Recently spoke with them about a contract they have in East TN, but otherwise have no direct experience. Would be interested to hear others thoughts as well.

 

[EctopicFetus]

They are what is called a “roll-up” have been aggressive about buying out groups. Bought the NETEP contract in Northeast Tennessee and bought one in Michigan. unlike most who rely solely on Private equity money they I believe have some of that but are doing a fair bit of debt to fund their purchases. They closed on around 160M in debt in March or so.

The CEO is a hospital Exec. They are hoping to become another CMG. They are in the process of buying a group in Phoenix (Banner Desert) which is a pretty busy ED.

I think they simply rely on being better business people than docs are. Do you have specific questions?

Working for them will be like working for any other CMG.

 

[CajunMedic]

They took over our attending coverage from ApolloMD. No real change that I can tell, got the standard recruiting pitch from them.

 

[Apollyon]

I told them at ACEP that APP was an unfortunate abbreviation, as people might think "advanced practice practitioner". The recruiter acknowledged this.

 

[Groove]

They aggressively bought out the Merit Health contracts in MS I believe but I have yet to hear anything bad about them. I don't work in MS anymore though. Apollyon, I agree... They've got the perfect abbreviation for an MLP staffing firm.

On a side note, funny how MLP was so universally accepted years back and now everyone seems to get their panty's in a bunch if you say MLP. We call them APCs at my current gig. "Advanced Practitioner Clinician". APP, APC, I can't keep up...part of the PC world. Safe places and crying rooms for everyone.

 

[EctopicFetus]

HOnest question.. Does anyone here actually think there is a difference between CMGs? I think the difference is site specific not CMG specific.

 

[RustedFox]

HOnest question.. Does anyone here actually think there is a difference between CMGs? I think the difference is site specific not CMG specific.

There's absolutely a difference between TeamHealth and EmCare/Envision; but I think this is a function of HCA vs. Not HCA.

 

[EctopicFetus]

There's absolutely a difference between TeamHealth and EmCare/Envision; but I think this is a function of HCA vs. Not HCA.

What do you think the difference is. Like I said I think it might be more about the site rather than the CMG. Something I know you noted in the second part.

I honestly think we will all do our best once we walk into a patients room. Better jobs will get better docs. I am open with my disdain for CMGs.

 

[deleted497653]

EmCare is some kind of evil.

However, I have to agree that not all CMGs are equally threatening to traditional ER physician autonomy ...but they are all some kind of terrible

Sorry can't be more eloquent than that....but who is to blame for CMG takeover?

 

[EctopicFetus]

EmCare is some kind of evil.

However, I have to agree that not all CMGs are equally threatening to traditional ER physician autonomy ...but they are all some kind of terrible

Sorry can't be more eloquent than that....but who is to blame for CMG takeover?

1) the blame falls on ED docs. There are 2 main issues. First is greed. Second is poor business acumen and being cheap.

Simply people have sold functioning groups for a quick buck. It’s still happening. This has left young docs in those groups screwed.

In addition, no matter where you fall on the FSED issue this is our only opportunity for freedom. Otherwise we are under the thumb of the hospital CMG. You cant just work wherever. Instead you need an ED and you and your buds cant just make one.

Docs are notoriously bad at business and frankly are notorious at being cheap. SDGs haven’t wanted to pay their admin a decent wage which led to people doing that work out of a sense of duty with no incentive to do a good job. Similarly they haven’t wanted to spend money to figure out how to make more money and be more efficient.

There are more examples of this than I care to share. Penny wise pound foolish.

The CMGs have no issue or qualms about being a business whereby SDGs try to do the right thing and then when they sell they aren’t getting the same premium they thought they were. instead they leave a ton of money on the table.

 

[RustedFox]

What do you think the difference is. Like I said I think it might be more about the site rather than the CMG. Something I know you noted in the second part.

I presently work for both TeamHealth and Envision at multiple job sites each.
In four years with TeamHealth, I have not once had them deploy some clipboard clutching nurse to harass me about unattainable metrics.
Envision loves doing that **** so much. I love it when I hear Veers say "I just nod and ignore them."

 

[GeneralVeers]

I presently work for both TeamHealth and Envision at multiple job sites each.
In four years with TeamHealth, I have not once had them deploy some clipboard clutching nurse to harass me about unattainable metrics.
Envision loves doing that **** so much. I love it when I hear Veers say "I just nod and ignore them."

All of these useless people like to pretend the have power. In reality, there is nothing they can say or do to me to make me change what I want to do. They all pretend that they are very important and that their jobs matter. The easiest way to get them off your back is to let them think that you think they are important, and they will go away. The worst thing to do is argue with them, as these petty people tend to be vindictive, and will escalate up the chain if anyone is being "non-compliant".

BTW I had the word "compliance" also as much as I hate "provider".

 

[Groove]

1) CMG gig earning $250/hr from day 1

2) SDG earning $150/hr for an 18mo buy in partnership track, then earning $310/hr avg after partner.
-140hrs/mo
-$403,200 lost compensation during "buy in"
-6720 hours as partner to break even and recoup pre-partner losses = 48 months = 4 years + 18 months = 5.5 years to truly "break even" and start turning a profit over your CMG comrades

Anyone who can guarantee you the stability of an ED contract 5.5 years into the future is nuts. Therein lies the fundamental risk involved in taking some of these SDG "buy in" partnership tracks which are not uncommon these days in desirable areas.

 

[GeneralVeers]

1) CMG gig earning $250/hr from day 1

2) SDG earning $150/hr for an 18mo buy in partnership track, then earning $310/hr avg after partner.
-140hrs/mo
-$403,200 lost compensation during "buy in"
-6720 hours as partner to break even and recoup pre-partner losses = 48 months = 4 years + 18 months = 5.5 years to truly "break even" and start turning a profit over your CMG comrades

Anyone who can guarantee you the stability of an ED contract 5.5 years into the future is nuts. Therein lies the fundamental risk involved in taking some of these SDG "buy in" partnership tracks which are not uncommon these days in desirable areas.

Right. And that math gets even worse once you are making $300/hr to $350/hr with a CMG. I've even heard of some partnerships that want a cash buy-in after two years of slave labor in order to become a partner.

 

[Hamhock]

1) CMG gig earning $250/hr from day 1

2) SDG earning $150/hr for an 18mo buy in partnership track, then earning $310/hr avg after partner.
-140hrs/mo
-$403,200 lost compensation during "buy in"
-6720 hours as partner to break even and recoup pre-partner losses = 48 months = 4 years + 18 months = 5.5 years to truly "break even" and start turning a profit over your CMG comrades

Anyone who can guarantee you the stability of an ED contract 5.5 years into the future is nuts. Therein lies the fundamental risk involved in taking some of these SDG "buy in" partnership tracks which are not uncommon these days in desirable areas.

Right.
And it's even worse than that really, as the "value" of that dollar during year one is much "more" than it is five years later...due to maths and such (compounding interest, inflation, loans, security, etc...)

HH

 

[EctopicFetus]

Agreed. It’s all about the setup. My group here I paid in 15% of my collections for 2 years. I kept the rest minus expenses. I made more than any CMG job I could find. The SDGs need to realize the days of monster buy ins are gone because people are selling out.

Also, lets be honest the numbers are never that simple. you have to take into account SDG profits from mid levels which you never will see at a CMG. It is hard to imagine SDGs that aren’t making 300/hr. I imagine plenty are in the 400+ range.

I was offered a job when I left my last one but required another sweat buyin. My buddy was there and I told him. How will I know Ill ever make partner? He said you are right. 18 months later they sold to envision.

Foolish to go work for $$ way below market. 2 of my residents who got SDG jobs last year are getting only 20-30/hr less than the partners and are in line or better than CMG pay.

 

[deleted109597]

Also, as if this didn't need to be mentioned, DO NOT SIGN CONTRACTS WHILE AT ACEP. You want to meet those companies? Sure. Drink all of their red bull vodkas at Omnia (Thanks USACS!)? Feel free.
But don't sign a contract or agree to a pressure sell.

 

[NYEMMED]

They are what is called a “roll-up” have been aggressive about buying out groups. Bought the NETEP contract in Northeast Tennessee and bought one in Michigan. unlike most who rely solely on Private equity money they I believe have some of that but are doing a fair bit of debt to fund their purchases. They closed on around 160M in debt in March or so.

The CEO is a hospital Exec. They are hoping to become another CMG. They are in the process of buying a group in Phoenix (Banner Desert) which is a pretty busy ED.

I think they simply rely on being better business people than docs are. Do you have specific questions?

Working for them will be like working for any other CMG.

I was just wondering how they compare to other CMGs in terms of compensation, physician happiness, and tracking endless metrics

 

[EctopicFetus]

Same BS. They try to pitch that they are better and perhaps they are. They got their start staffing smaller more rural type of EDs. Not a lot of ABEM docs, mostly FP, IM etc. Ohh man do they love their metrics though.. IMO worse than Envision.

 

[alphaholic06]

They're a bunch of ****bags!

 

[namethatsmell]

They're a bunch of ****bags!

I get the sense there’s more to tell here...


Sent from my iPhone using SDN mobile

 

[EM Junkie]

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[NYEMMED]

Bump....

Just got word that our group is being rolled up into American Physician Partners, and wondering if others have insight into their specific business model (scheduling., MD vs midlevel coverage, pay rates compared to prior, etc)?

This is all happening just a little over a year after our SDG was forced to roll up into a much larger group, mostly by forcing our small SDG to take on the staffing of two underperforming FSEDs without any sort of subsidy.


Sent from my iPad using SDN mobile

The contracts through APP are not standardized and are highly negotiable.
Take advantage of that for yourself. Ask for higher pay rate, less nights etc early on

 

[EctopicFetus]

Screw app and all the other cmgs. Get your $$$

 

[thegenius]

Why does a hospital want a contract with a CMG? do they kick back to the hospital more money? I'm naive on this kind of stuff

 

[NYEMMED]

Why does a hospital want a contract with a CMG? do they kick back to the hospital more money? I'm naive on this kind of stuff

Promises and economy of scale.

They take over the ED, the hospital has no financial worries over staffing this themselves. Then The management group offers improved metrics and patient satisfaction.

Large CMGs have economy of scale and can out bid smaller SDGs

In a way I wish Managment groups would be outlawed and we can just be hospital employees

 

[NYEMMED]

Bump....

Just got word that our group is being rolled up into American Physician Partners, and wondering if others have insight into their specific business model (scheduling., MD vs midlevel coverage, pay rates compared to prior, etc)?

This is all happening just a little over a year after our SDG was forced to roll up into a much larger group, mostly by forcing our small SDG to take on the staffing of two underperforming FSEDs without any sort of subsidy.


Sent from my iPad using SDN mobile

What region do you work in?

 

[EctopicFetus]

One other thing. Many of their rmds are fp docs. They are being aggressive I give them that. Over time they will have to cut pay etc.

 

[EM Junkie]

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