Man o War

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looks like they are offering 400k (450 max) w 8 weeks vacation
PLEASE if you are reading this, only take this job if they spell out your call burden in the contract, as well as expected work hours for this 400K.
You need to negotiate a rate past a certain time (5:00 for example). Do not take any call beyond what is explicitly spelled out in your contract. If you do, make them pay handsomely for it.
These AMCs are notorious for running short on docs and making the rest pick up the slack. That 400k is measly for what they will make you do if you have no protections in your contract and they run this site like I’ve seen these companies run others....
 

dr doze

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PLEASE if you are reading this, only take this job if they spell out your call burden in the contract, as well as expected work hours for this 400K.
You need to negotiate a rate past a certain time (5:00 for example). Do not take any call beyond what is explicitly spelled out in your contract. If you do, make them pay handsomely for it.
These AMCs are notorious for running short on docs and making the rest pick up the slack. That 400k is measly for what they will make you do if you have no protections in your contract and they run this site like I’ve seen these companies run others....
+1000. Offering to punch a time clock and be paid hourly might be worth exploring.
 

aneftp

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looks like they are offering 400k (450 max) w 8 weeks vacation
So works out to around $200/hr. Assuming 45 plus hours a week.

but if it’s close to 52-55 hours. Than that brings average down to closer to $175/hr which isn’t good.
 
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aneftp

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The major private group sold to American anesthesiology in 2011, who controlled 3 of Beaumont’s hospitals (royal oak, Troy, Grosse pointe). Since then, American was sold to mednax, who then was sold to NAPA. Beaumont has employed the CRNAs directly through all of that until now with Northstar being awarded the contract starting January 2021. This portion of Beaumont entails about 70 anesthesiologists.

the other parts of Beaumont were acquired via mergers etc over the past decade, and includes places like Dearborn. Those hospitals were most recently staffed by A4, but Beaumont became upset with that group reportedly due to threat of balance billing Blue cross. North Star was awarded this contract and they take over in August. A4 will be enforcing non competes on their existing 28 anesthesiologists.

So now Northstar needs to replace these 28 doctors, and also may have to replace the 70 anesthesiologists at the royal oak/troy/Grosse pointe campuses in January if NAPA enforces their non competes too.
In a nut shell. These (mednax buyout) practices are the same as the current usap practices who sold out. It’s been 8-9 years since the buyout.

let this be a lesson for those who preach the Usap koolaid. Usap is currently in year 5of this creation. Who knows what the future holds. Big hospital systems can elect to get rid of all the anesthesia docs in Usap as well. No one is safe. I just wouldn’t commit more than 2 years max into any “partnership” track.

just depends on how much the hospital system squeezes anesthesia to be in network. A ceo of big hospital system can tell insurance like united or Aetna “we can save you on anesthesia cost by demanding they take only $80/unit” but we can keep the all the current hospital fees the same. So hospital still keeps profits. Anesthesia billing is squeeze.

Any ceo can read these boards and save millions for insurers. Make anesthesia the bad guy. Kick usap to the curb. Cause Napa or North Star more than willing to take $80/unit as long as private payor mix is good.
 

ERRES2288

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PLEASE if you are reading this, only take this job if they spell out your call burden in the contract, as well as expected work hours for this 400K.
You need to negotiate a rate past a certain time (5:00 for example). Do not take any call beyond what is explicitly spelled out in your contract. If you do, make them pay handsomely for it.
These AMCs are notorious for running short on docs and making the rest pick up the slack. That 400k is measly for what they will make you do if you have no protections in your contract and they run this site like I’ve seen these companies run others....
Yes but would they ever actually do this? I thought most of these contracts where pretty set and if you don’t like it then can take a hike.
 

aneftp

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Yes but would they ever actually do this? I thought most of these contracts where pretty set and if you don’t like it then can take a hike.
U can add it to the contract. People aren’t stupid these days. If they don’t want to add it. Don’t take the job.
 

Man o War

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Yes but would they ever actually do this? I thought most of these contracts where pretty set and if you don’t like it then can take a hike.
Depends how desperate they are....
I wouldn’t work for an AMC without this language- seen enough to know better.
You’re better off working locums for them per hour otherwise
 
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ERRES2288

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Alright good to know, will be interesting to see how this plays out.
 

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This was the non compete lawsuit with mednax in Michigan a few years ago. The courts ruled there is non harm for the doctor to do anesthesia practices in Michigan. So I wouldn’t be concern with napa/mednax non compete. They lost the contract already. You are employee. U are not causing them irreparable harm for a contract they no longer have

That guy went to work at a surgical center 3 miles or so away. For a different anesthesia practice. In this case, it would be NAPA enforcing those docs not to take employment at the hospitals they are currently at, with NorthStar. So, it's different, but who knows how this will pan out.
 
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ERRES2288

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So sounds like they will be increasing supervision ratio and risks to the residency program. What a shame. How are they going to find 80 anesthesiologists to work there?
 
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dr doze

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They won't need to find 80 bodies.
Caveat: I don't know anything about the local market.

The displaced A4 docs may be able to go to the NAPA (northstar) sites.
The displaced NAPA docs may be able to may be able to go to the A4 (Northstar) sites.
If there is any MD Anesthesia---> go to 100% ACT.
If it is a medical direction practice---> go to medical supervision. Maybe even CRNA only for some sites.
Lose the residency? Bye Bye to the 1:2 teaching rule. Save a few FTEs that way.
Cut vacation and increase work hours, lose post call or early days. Save a few FTEs that way.
Northstar is a big national organization. Parachute some docs from other sites into this market for a few months till they can recruit. Give them a carrot of premium pay for a few months.
The suburbs of Detroit is a desirable metro area.
 

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They won't need to find 80 bodies.
Caveat: I don't know anything about the local market.

The displaced A4 docs may be able to go to the NAPA (northstar) sites.
The displaced NAPA docs may be able to may be able to go to the A4 (Northstar) sites.
If there is any MD Anesthesia---> go to 100% ACT.
If it is a medical direction practice---> go to medical supervision. Maybe even CRNA only for some sites.
Lose the residency? Bye Bye to the 1:2 teaching rule. Save a few FTEs that way.
Cut vacation and increase work hours, lose post call or early days. Save a few FTEs that way.
Northstar is a big national organization. Parachute some docs from other sites into this market for a few months till they can recruit. Give them a carrot of premium pay for a few months.
The suburbs of Detroit is a desirable metro area.
Between the non-compete clauses docs in those areas are not going to simply go from NAPA to Northstar and vice versa. I almost joined a NAPA practice a few years back and their non-compete was very strict. While people say they are unenforceable, I know NAPA has more resources than any doctor to try and enforce the non-compete. Also, the locums docs and CRNAs these AMCs hire to fill random spaces around the country are typically not superstars and/or come with baggage. There are countless stories on here about locums docs coming in and screwing up or pissing off surgeons to the point the AMC loses their contract.
 

dr doze

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Between the non-compete clauses docs in those areas are not going to simply go from NAPA to Northstar and vice versa. I almost joined a NAPA practice a few years back and their non-compete was very strict. While people say they are unenforceable, I know NAPA has more resources than any doctor to try and enforce the non-compete. Also, the locums docs and CRNAs these AMCs hire to fill random spaces around the country are typically not superstars and/or come with baggage. There are countless stories on here about locums docs coming in and screwing up or pissing off surgeons to the point the AMC loses their contract.
Agree that it is unlikely that if I work for hospital A for NAPA, it is unlikely that I will be able to work for Northstar at hospital A.
But I might be able to work for hospital B for Northstar if it was a previously A4 hospital that is now Northstar. That may be possible.
 

Man o War

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Those hospital execs better start looking for jobs. When heavyweight service lines like cardiology and CT surgery leave the board of trustees won’t be to happy and will likely vote no confidence.
Yep.
Our cardiac surgeons and high volume ICs have single handedly kept CRNAs out of the ORs. If the hospital shows any signs of push back on us during contract negotiations they set up meetings and make phone calls. They are by far the pickiest surgery sub specialty as far as anesthesia goes.
 

PainDrain

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Yep.
Our cardiac surgeons and high volume ICs have single handedly kept CRNAs out of the ORs. If the hospital shows any signs of push back on us during contract negotiations they set up meetings and make phone calls. They are by far the pickiest surgery sub specialty as far as anesthesia goes.
And rightfully so.
 

nimbus

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Those hospital execs better start looking for jobs. When heavyweight service lines like cardiology and CT surgery leave the board of trustees won’t be to happy and will likely vote no confidence.
“Fox put up his Bloomfield Hills estate up for sale months ago and multiple sources say he’s building a house in his native Atlanta.”

He will move on to the next gig with his 7 figure golden parachute in tow. Changing jobs is normal course of business for high level executives. They accept their role as fall guy to cut costs for the system, then they move on.
 
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There are lots of fall guys in the hospital corp hierarchy. Layers of (un)accountability.

“Fox put up his Bloomfield Hills estate up for sale months ago and multiple sources say he’s building a house in his native Atlanta.”

He will move on to the next gig with his 7 figure golden parachute in tow. Changing jobs is normal course of business for high level executives. They accept their role as fall guy to cut costs for the system, then they move on.
 
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DirtDocMD

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Sounds like Fox needs to shut the hell up, before NAPA and Ann Arbor slap him with a suit for tortious interference.

He can award the contract to whoever he wants, but encouraging the Docs to jump ship (against contract) is a big no-no...
 
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cks33

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Lots of CRNAs posting in the comments with the AANA agenda at the forefront.

Would love for some MDs to add to the comment board.

We all have to fight this fight, and do it respectfully and truthfully. Let patients pick who they want.
 

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The CRNA's in the Detroit area can be rather militant.....
 

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The lawsuits are beginning. This will
Continue for a while.

What does it say? No access.... :(
 

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Cliff Notes version from Becker’s ASC:

“Irving, Texas-based NorthStar Anesthesiologists was ordered July 27 to temporarily stop recruiting providers from Anesthesia Associates of Ann Arbor to staff four Beaumont Health hospitals in Michigan, Crain's Detroit Businessreported. Southfield, Mich.-based Beaumont hired NorthStar to replace Anesthesia Associates of Ann Arbor at seven hospitals.

Beaumont provided the following statement to Becker's ASC Review:

"Regardless of any dispute between A4 and NorthStar, Beaumont has and will continue to have highly qualified anesthesiologists to provide care to Beaumont patients seamlessly and without interruption. Beaumont is not a party to these legal maneuvers. The judge acted after hearing only A4's side and before giving NorthStar a chance to respond.

"We fully anticipate that NorthStar will respond and clarify assertions made by A4. The temporary order issued by the judge limits NorthStar's ability to engage with the A4 employed physicians who currently staff Beaumont's Dearborn, Taylor, Trenton and Wayne hospitals."

When asked for comment, a NorthStar representative said the following:

"Through this lawsuit, A4 is seeking to prevent doctors from providing much-needed anesthesia care to the Detroit community. Not only is A4 trying to prevent the doctors from becoming employed by NorthStar, but also prevent them from working at the Beaumont hospitals where they have provided much needed patient care during our current healthcare crisis. NorthStar is confident that our position will prevail."
 

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“Northstar is hopeful they’ll be able to hire all the anesthesia staff out from under A4 (which likely took years to recruit), while providing little of substance, other than a cheap contract, a computer program, and some “metrics”.....”

What it should say....

I hope all these AMC’s sue each other into the poor house...
 
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coffeebythelake

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bump. CRNAs taking over the whole messaging board in that Detroit article, trying to get unsupervised model
These militant CRNAs must think they are hot **** when both anesthesiologists and surgeons are demanding a safe, supervised ACT model at reasonable ratios. Training matters. Safety matters.
 
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“Northstar is hopeful they’ll be able to hire all the anesthesia staff out from under A4 (which likely took years to recruit), while providing little of substance, other than a cheap contract, a computer program, and some “metrics”.....”

What it should say....

I hope all these AMC’s sue each other into the poor house...
So north star is arguing that a standard non compete used in the industry is invalid. Wouldn’t a ruling in their favor essentially destroy their business model?
 

dr doze

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So north star is arguing that a standard non compete used in the industry is invalid. Wouldn’t a ruling in their favor essentially destroy their business model?
Translation: Each situation is unique. We fall on the side of enforcing non-competes when it is in our interest to do so. We fall on the side of voiding the existing non-compete if it is in our interest to do so. Either way we are always on the side of the angels and have the best interest of the patients and the community at heart.
 

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So north star is arguing that a standard non compete used in the industry is invalid. Wouldn’t a ruling in their favor essentially destroy their business model?
Same strategy Mednax used in Charlotte.
 

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Same strategy Mednax used in Charlotte.
No. Mednax enforced the non compete and made the hospital hire a bunch of unaffiliated docs. This is one AMC, NAPA (formerly MEDNAX) being kicked out and trying to avoid being kicked out by enforcing the non compete. The competing AMC (North Star) is making the argument that non competes are invalid...
 

DrZzZz

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No. Mednax enforced the non compete and made the hospital hire a bunch of unaffiliated docs. This is one AMC, NAPA (formerly MEDNAX) being kicked out and trying to avoid being kicked out by enforcing the non compete. The competing AMC (North Star) is making the argument that non competes are invalid...
You're right, I had that mixed up.

Edit: What I more meant was that publicly, they tried to use the non-compete to bash Scope and Atrium, suggesting that changing out all of those anesthesiologists in one fell swoop was dangerous for the people of Charlotte. Which in essence, just suggests that non-competes are a bad idea for the healthcare system (even though that's important to their model).
 
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DirtDocMD

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Northstar-“Non-competes are bad (unless we put them in our contract, then they’re good and need to be enforced).”

Basically....
 
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The Northstar model is 4:1 supervision, basically all the time. This is the plan for at least one of the hospitals they have acquired in Metro Detroit that I know for sure.
 

dr doze

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impressive any MD want to be in that situation.. 1:4 is just awful. they better be paid 1m a year
4:1 does suck. But it is manageable. Some really ugly days. It is more “tolerable” if the docs are the owners and thus a top decile pay package.

Sounds like this will be a top decile work intensity job with an average pay package.
 

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4:1 does suck. But it is manageable. Some really ugly days. It is more “tolerable” if the docs are the owners and thus a top decile pay package.

Sounds like this will be a top decile work intensity job with an average pay package.
It’s actually very easy if you don’t give a $hit. Just sign those charts .....
 

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4:1 does suck. But it is manageable. Some really ugly days. It is more “tolerable” if the docs are the owners and thus a top decile pay package.

Sounds like this will be a top decile work intensity job with an average pay package.
For those in PP doing 4:1 are u preopping patients like crazy? How many patients per day?
 
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dr doze

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For those in PP doing 4:1 are u preopping patients like crazy? How many patients per day?
Like anything else, it depends. We try to balance number of preops with intensity of cases. Two cataract rooms can have 20 cases in them. Pair that with something like a total joint room and an all day breast reconstruction.

Maybe another doc gets staggered open heart rooms and with two slow as sh1t general surgeon rooms, etc. 10-12 cases for the day.

The surgery center has one doc four rooms. Virtually all LMA GAs or MAC cases. Routinely 20+ cases.

The crappy days are when you have an unexpectedly sick patient for a routine procedure or a case goes to hell or everything goes off at once instead of being staggered, etc. It can work. But everybody is working hard.

Those who don’t give a crap and just sign the charts don’t last in our practice.
 

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Like anything else, it depends. We try to balance number of preops with intensity of cases. Two cataract rooms can have 20 cases in them. Pair that with something like a total joint room and an all day breast reconstruction.

Maybe another doc gets staggered open heart rooms and with two slow as sh1t general surgeon rooms, etc. 10-12 cases for the day.

The surgery center has one doc four rooms. Virtually all LMA GAs or MAC cases. Routinely 20+ cases.

The crappy days are when you have an unexpectedly sick patient for a routine procedure or a case goes to hell or everything goes off at once instead of being staggered, etc. It can work. But everybody is working hard.

Those who don’t give a crap and just sign the charts don’t last in our practice.
Sounds like a very challenging balance. I fear that is the way all ACT models are leading to, 4:1 or even higher ratios.
 
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nimbus

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Reading the above comments, I can’t see how a 4:1 supervision practice can match the quality and attention that can be delivered in an MD only stool sitting model. Doing 20-30 preops alone would make my head spin, let alone taking care of intraop issues and complications. 2:1 would be the most I’d want to do.
 
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