Buy in still a thing in current market?

[propadex]

Straightforward question. Do groups nowadays still have a buy in/partnership track? Or is that mostly a relic of the past? What about your group?

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[caligas]

Straightforward question. Do groups nowadays still have a buy in/partnership track? Or is that mostly a relic of the past? What about your group?

We dumped it 2 years ago. No way I’d do a long partnership track or major buy in in todays market.

 

[Howard888]

Don’t ever do that in this climate. It still exists though, and ironically and even worse even still exists at USAP sites…..not worth it. Too many high paying jobs to start not to mention that group who has a buy in has a solid chance of earning even less by the time you have “bought in” as expenses continue to rise

 

[Status Sciaticus]

its still a thing in several groups. Interestingly, those groups are the ones struggling to hire people. Some think the two might be related.

 

[Coffee PRN]

There’s a group here that still starts partner track people around 250k last I heard

 

[midazzoler]

Been out 10 years. Been part of 3 groups with buy ins. None of them exist anymore…

 

[amyl]

We have a partnership track. I wish it was shorter but our hands are tied by our board of doctors.

 

[ans2021]

We have a buy in. Can't hire all the people applying for a job with us.

 

[DG51]

my recent experience reaching out to groups and interviewing...all groups had a 1.5-3 year partnership period before you were granted voting rights. 1 group had equal pay between partners and pre-partners with no buy in. 1 group had equal pay with "small" buy in ~ under $30k. Final group had flat salary for pre-partners before becoming eligible for profit sharing (probably equated to a very large buy in ~$150k+ but I couldn't get exact numbers).

 

[Howard888]

A few attractive locations may still get new grads to drink the koolaid but as soon as they find out the numbers they resent the buy in…especially when they hear their classmates made twice as much as them for working less with the past two years.

I suspect all buy ins will become one year and only slightly less money in the future and it’s more of a vetting period vs a buy in. The economic return of not doing a buy in has surpassed and is surpassing more the return of doing a buy in. Especially if you have flexibility in location

 

[NICMAN]

A few attractive locations may still get new grads to drink the koolaid but as soon as they find out the numbers they resent the buy in…especially when they hear their classmates made twice as much as them for working less with the past two years.

I suspect all buy ins will become one year and only slightly less money in the future and it’s more of a vetting period vs a buy in. The economic return of not doing a buy in has surpassed and is surpassing more the return of doing a buy in. Especially if you have flexibility in location.

Some hospital C-suite administrators appreciate when physician leaders who are capable business people can manage large and otherwise mercenary human capital resources. We run a great company and make a profit based on our quality of services and the fact that they (the parent hospital corporation) can’t seem to do it any cheaper or as efficiently at their other hospitals in the system. Thus our physician-owned private practice group makes a tidy profit for the partners (which is everybody who stays with the group for over a year). Partnership track people make close to what other anesthesiologist in the area make on day 1 which is less than what partners make.

It is still possible to run a business and get paid to administer the business. It takes more stipend than in the old days and it is harder to make huge profits but it can still be rewarding. Partnership/ownership in a multimillion dollar business enterprise is not something that should be given away for free. Sorry but it is worth something. You don’t want to run a businesss, but rather be paid as an hourly clock worker then by all means—go work for somebody. For me it is much more satisfying and interesting to run a business that can become the lowest cost but highest quality anesthesia provider in a hospital system while still making more then the hospital employees at the hospitals down the street.

 

[Silo004]

A few attractive locations may still get new grads to drink the koolaid but as soon as they find out the numbers they resent the buy in…especially when they hear their classmates made twice as much as them for working less with the past two years.

This. Starting bonuses make more sense than buy-ins.

Plus they never let you see the books.

 

[TheLoneWolf]

There’s a group here that still starts partner track people around 250k last I heard

Yep. We have one in my city. PP group. 230 base pay for partners plus quarterlies, 8 weeks vacation. Offers 325 and 6 weeks vacation for day docs. Mostly ACT with 1:3 or more. I struggle to believe they can find suckers in the current market.

 

[Xcellerator]

When I was interviewing just a few years ago, buy-ins were still a thing. A few gigs in OR and WA had like 50k-100k buy in for 2-3 years partnerships with only $250k starting for full call taking people. Thought that was ridiculous at the time, now it is even more ridiculous considering what OAG and WA have crumbled down to now.

 

[neutro]

Some hospital C-suite administrators appreciate when physician leaders who are capable business people can manage large and otherwise mercenary human capital resources. We run a great company and make a profit based on our quality of services and the fact that they (the parent hospital corporation) can’t seem to do it any cheaper or as efficiently at their other hospitals in the system. Thus our physician-owned private practice group makes a tidy profit for the partners (which is everybody who stays with the group for over a year). Partnership track people make close to what other anesthesiologist in the area make on day 1 which is less than what partners make.

It is still possible to run a business and get paid to administer the business. It takes more stipend than in the old days and it is harder to make huge profits but it can still be rewarding. Partnership/ownership in a multimillion dollar business enterprise is not something that should be given away for free. Sorry but it is worth something. You don’t want to run a businesss, but rather be paid as an hourly clock worker then by all means—go work for somebody. For me it is much more satisfying and interesting to run a business that can become the lowest cost but highest quality anesthesia provider in a hospital system while still making more then the hospital employees at the hospitals down the street.

I mean if you’re asking for a stipend then by definition you’re not profitable…

 

[Howard888]

I mean if you’re asking for a stipend then by definition you’re not profitable…

Correct. That’s not to say you can’t make a profit asking for a higher stipend then your costs and call it a “management fee”, but be very careful as administrators books are very tight right now and if they ever think they can do it cheaper they will pull that stipend and employ you.

There are still some profitable groups without stipends, particularly in areas where hospital systems employ the CRNAs. Perhaps these might be worth a buy in still but not a steep one and not more than 2 years tops.

But the ability to get a job at 600k or higher to start with 75-100k sign on bonuses has never been easier…if you’re flexible on location.

Making 300 for 3 years and no sign on bonus to just make the same 640-700 is crazy

 

[Simba1711]

I wouldn’t take a buyin in this market. Too much uncertainty it’s not what it was in the past.

 

[neutro]

Correct. That’s not to say you can’t make a profit asking for a higher stipend then your costs and call it a “management fee”, but be very careful as administrators books are very tight right now and if they ever think they can do it cheaper they will pull that stipend and employ you.

There are still some profitable groups without stipends, particularly in areas where hospital systems employ the CRNAs. Perhaps these might be worth a buy in still but not a steep one and not more than 2 years tops.

But the ability to get a job at 600k or higher to start with 75-100k sign on bonuses has never been easier…if you’re flexible on location.

Making 300 for 3 years and no sign on bonus to just make the same 640-700 is crazy

Also, many groups I talked to who offer partnership - I was never satisfied with their answers in terms distributions or what partnership actually means.

Even after you’re able to tolerate the time to buy in- what really matters is annual yearly compensation - partnership or no partnership.

recently I asked one of the partners how they do partnership distributions, and he said - we do “lump and divide” model.

The only thing was - the older partners were 0.3-0.5 fte and also did the schedule and assignments. They had full control of revenue generation.

So that’s unfair.

The new/ non partners are doing the heavy lifting and if you’re 0.3-0.5 FTE, because you’re a partner - you’re getting full benefit yourself while reducing pay for the younger non partners.

Also, partnership was built on anesthesia billing being a profitable endeavor and surgeon recruitment and solicitation. Those things have changed a lot. It was built on surgeon - anesthesiologist relationships, discussion on payor mix etc etc.

Hospitals have all the money. Surgeons are employed as well.

Idk.

It’s a rapidly changing landscape. Groups are coming and going. AMCs are “managing” but essentially wanting a commission.

 

[NVO]

I've seen several groups with buy-ins however base salaries much higher than whats posted here. 2 year partnership track Year 1 500k fixed Year 2 550k fixed. Most partners make 600k+ so effectively ~150k buy-in. Still with 10+ weeks vacation.

 

[pgg]

I mean if you’re asking for a stipend then by definition you’re not profitable…

Well, they're surely profitable. Whether or not they're profitable enough to retain or recruit is a separate question.

 

[coffeebythelake]

Most hospitals make money from surgery services. Unless they are completely terrible in their management. Now how they silo and divvy up the money is the big question. They call anwsthesia a "cost center" but they can't run cases or generate their fat facility fees without us.

 

[ucladoc2b]

Most hospitals make money from surgery services. Unless they are completely terrible in their management. Now how they silo and divvy up the money is the big question. They call anwsthesia a "cost center" but they can't run cases or generate their fat facility fees without us.

Well, they could theoretically.

The bite block and whiskey approach may not go over so well with patients.

 

[neutro]

Most hospitals make money from surgery services. Unless they are completely terrible in their management. Now how they silo and divvy up the money is the big question. They call anwsthesia a "cost center" but they can't run cases or generate their fat facility fees without us.

Yes.
It’s an intellectual deficit.

Anesthesia is cost of doing business. It’s a necessary service.

To put all the risk on anesthesia billing while the hospital takes the cream is unfair.

No one criticizes the pathologist that runs in the middle of surgery to discuss results. Yes that costs too.

 

[neutro]

Well, they're surely profitable. Whether or not they're profitable enough to retain or recruit is a separate question.

I look at profit = revenue minus expenses

Subsidy isn’t a part of it

The fact that you have to rely on a subsidy means that anesthesia billing by itself is no longer generating enough revenue to manage business and affairs without external help.

What happens when the next CEO comes in and goes no more subsidy and offers employment directly?

 

[medicine2wallstreet]

Your fair market value is too much in today's market to tolerate financial abuse from old boomer partners. Anesthesia contracts are fleeting anyways, it's not like anyone comes to get anesthesia they come to get surgery. So old anesthesiologist partners have an inflated sense of value to the system.

I turned down a 4 year buy in to go with an AMC where I'd make over half a million guaranteed from the start. With the private group I would be down 640k in lost wages versus an AMC over the 4 year buy in.

It's time for this poor pyramid business model to die.

I can understand a 2 year buy in in today's market if someone desires it but anything more is legal financial abuse.

 

[medicine2wallstreet]

Some hospital C-suite administrators appreciate when physician leaders who are capable business people can manage large and otherwise mercenary human capital resources. We run a great company and make a profit based on our quality of services and the fact that they (the parent hospital corporation) can’t seem to do it any cheaper or as efficiently at their other hospitals in the system. Thus our physician-owned private practice group makes a tidy profit for the partners (which is everybody who stays with the group for over a year). Partnership track people make close to what other anesthesiologist in the area make on day 1 which is less than what partners make.

It is still possible to run a business and get paid to administer the business. It takes more stipend than in the old days and it is harder to make huge profits but it can still be rewarding. Partnership/ownership in a multimillion dollar business enterprise is not something that should be given away for free. Sorry but it is worth something. You don’t want to run a businesss, but rather be paid as an hourly clock worker then by all means—go work for somebody. For me it is much more satisfying and interesting to run a business that can become the lowest cost but highest quality anesthesia provider in a hospital system while still making more then the hospital employees at the hospitals down the street.

Yeah stipend means you are not profitable. Not sure if you know the maths well.

 

[agammaglobulin]

Increasing market rates for anesthesiologists/CRNAs and declining reimbursement from insurers mean more and more hospitals will have to provide/increase stipends for anesthesiology practices. Anesthesia pay tied only to billing will no longer be sustainable for a majority of anesthesia practices. This is simple supply and demand. Yes, there is a risk of the hospital management deciding to try to provide care at a more affordable price either with employment or a different group, but I think the market has shown repeatedly this is usually a disaster (especially going to national group). Below is a link to a hospital management consultants essentially saying this. If you're a private group making below 50% MGMA or are supervising 3-4:1, you should be negotiating for a (higher) stipend.

Stipends for private practices.

"In years past, patients were more likely to bear the burden of high anesthesia costs. Many anesthesia groups chose a strategy of not contracting with payers and instead balance billing their patients; the No Surprises Act put an end to that in 2022. The act also established an out-of-network ratesetting methodology that was very slanted in favor of payers. This has effectively negated anesthesiologists’ ability to use contract termination as a negotiation tactic, seriously undermining their ability to obtain better rates. As a result, payers get the benefit of keeping the anesthesiologists in their network, and at low rates.However, since the hospital cannot survive without anesthesia, it often finds itself with no alternative but to make a major financial commitment to supporting its anesthesia providers"

 

[nycitygas]

When I was interviewing just a few years ago, buy-ins were still a thing. A few gigs in OR and WA had like 50k-100k buy in for 2-3 years partnerships with only $250k starting for full call taking people. Thought that was ridiculous at the time, now it is even more ridiculous considering what OAG and WA have crumbled down to now.

What happened with OAG? Thought they were a well paying MD only geoup

 

[james775]

I am currently a fellow and interviewed at many different types of places. I also took a lot of phone calls. In South Carolina and North Carolina private practices are still paying people less for 2-3 years. Even hospitals where you are a w-2 try to pay you less the first couple years.

Partners are making out like bandits but it’s unsustainable. Every group that has a buy in still has their ad on gasworks and keep updating it. These older docs are completely out of touch. One group told me “you make the same exact as I do but you just aren’t eligible for the quarterly bonus until after three years” the quarterly bonus was 50-75k… like does this guy think I’m stupid or ignorant? I wanted to speak my mind but I just politely said no thank you. It’s insane what these groups are trying to get away with. One group was 40 percent of what the partners make the first year and the 60 percent year 2. It’s in an undesirable city as well.

I took a w2 job and got pay equity day one. I am extremely excited to start my job and it seems like everyone in the group is very happy. Going and doing the same job while being paid half and having half the amount of vacation can’t be good for morale.

 

[BLADEMDA]

Yeah stipend means you are not profitable. Not sure if you know the maths well.

Some groups would be earning $500K each without the stipend and $750K+ with a stipend so be careful when stating "not profitable" because of a stipend.

 

[DG51]

I look at profit = revenue minus expenses

Subsidy isn’t a part of it

The fact that you have to rely on a subsidy means that anesthesia billing by itself is no longer generating enough revenue to manage business and affairs without external help.

What happens when the next CEO comes in and goes no more subsidy and offers employment directly?

This is another great argument against large buy-ins and unfavorable pre-partnership tracts in this market. The possibility of a hospital terminating the group's contract is simply too high to justify sacrificing $50k+ per year in the hopes that the boomers will eventually make you a partner.

 

[caligas]

Needing or not needing a stipend doesn’t determine profitability, it may determine independent VIABILITY, i.e. can the practice survive without a source of income beyond collections. My group was independently viable AND profitable for many years. We paid a physician wage and shareholders received a distribution of profits. Payor mix declined, national salaries increased, and the group was not paying salaries and distributions that kept up with MGMA. But we were still a profitable corporation, still booking corporate profits and paying shareholders distributions of those profits. Now we receive, as part of our corporate revenue, funds from the hospital IN EXCHANGE FOR SERVICES such as covering additional anesthetizing locations and call obligations. We remain as always profitable by any formal definition. We are NOT however independently viable with billing collections alone. If you have a different definition of profitable that precludes a stipend, so be it, but it’s not how profitably is defined by any business or accounting professional.

 

[neutro]

Some groups would be earning $500K each without the stipend and $750K+ with a stipend so be careful when stating "not profitable" because of a stipend.

I don’t understand this math.
We are talking about inherent profitability of a group due to billing.

 

[neutro]

Needing or not needing a stipend doesn’t determine profitability, it determines independent VIABILITY, i.e. can the practice survive without a source of income beyond collections. My group was independently viable AND profitable for many years. We paid a physician wage and shareholders received a distribution of profits. Payor mix declined, national salaries increased, and the group was not paying salaries and distributions that kept up with MGMA. But we were still a profitable corporation, still booking corporate profits and paying shareholders distributions of those profits. Now we receive, as part of our corporate revenue, funds from the hospital IN EXCHANGE FOR SERVICES such as covering additional anesthetizing locations and call obligations. We remain as always profitable by any formal definition. We are NOT however independently viable with billing collections alone. If you have a different definition of profitable that precludes a stipend, so be it, but it’s not how profitably is defined by any business or accounting professional.

Yeah.
In order to stay in business, you’re needing a subsidy, ie anesthesia billing is non viable independently.
Got it. we’ve established that.

If you didn’t have the subsidy - you’d lose the contract or people would leave.

It’s semantics really.

I don’t consider subsidy income. You may do. But any other group will also obtain that subsidy. It’s not especially for your company.

 

[neutro]

Profit is revenue minus expenses; for anesthesia it’s collections - overhead - salaries

 

[agammaglobulin]

I think you’re looking at a subsidy too negatively. Recognize almost all departments of the hospital are not net positive. The OR, OB and (I think?) ED are generally the only areas that make money. All other departments receive a subsidy and by your definition are “non viable”.

 

[Silo004]

Correct. That’s not to say you can’t make a profit asking for a higher stipend then your costs and call it a “management fee”, but be very careful as administrators books are very tight right now and if they ever think they can do it cheaper they will pull that stipend and employ you.

There are still some profitable groups without stipends, particularly in areas where hospital systems employ the CRNAs. Perhaps these might be worth a buy in still but not a steep one and not more than 2 years tops.

But the ability to get a job at 600k or higher to start with 75-100k sign on bonuses has never been easier…if you’re flexible on location.

Making 300 for 3 years and no sign on bonus to just make the same 640-700 is crazy

It's not being profitable that's driving the better market. It's the lack of anesthesiologists. They need to pay the stipend to raise pay to get people through the door. Yes, I understand that's a part of costs. But when there were more anesthesiologists around, the older partners had no incentive to pay incoming docs. Instead, tax them with buy ins, higher overhead and crap cases.

Put another way, the group can be as profitable as it wants, if it's not able or willing to pay it's going to eventually lose contracts.

"The talent always supposed to get paid" -- Floyd Mayweather.

 

[neutro]

I think you’re looking at a subsidy too negatively. Recognize almost all departments of the hospital are not net positive. The OR, OB and (I think?) ED are generally the only areas that make money. All other departments receive a subsidy and by your definition are “non viable”.

i have no issue against a dept obtaining subsidy or income guarantee whatever or stipends for call or additional points of service

I was just saying that attention should be paid to stability of groups that are obtaining subsidies and are also offering partnership tracks esp with buy ins. Since they aren’t intrinsically profitable…

 

[Xcellerator]

What happened with OAG? Thought they were a well paying MD only geoup

Some quick reads if you're not in the Anesthesia Club where this was posted as well:
Providence Portland and St. Vincent hospitals to reduce surgeries due to anesthesiologist shortage

 

[NICMAN]

I mean if you’re asking for a stipend then by definition you’re not profitable…

That is just business ignorance. You think subsidies are to cover clinical services only—bless your heart.

All I am saying is that some locations with certain partnerships can be profitable and even lucrative since the management of personnel and the provision of value-added operational efficiency and economies of scale of a single system-wide service line can provide massive benefits to hospital administrators who have very little capacity to manage such a workforce as a bunch of mercenary anesthesiologist and CRNAs. That service is worth something.

Here’s the kicker—as an employee you are probably forced to provide much of those benefits for free by being roped into “community service” positions of medical directorships or chief/chair positions—now who is the sucker?

You want to be a shift worker and be told when and where to work? To be told you can’t take off 6 months for a family emergency? To have defined benefits that are not fully tax advantaged? Now is a good time to be an employee. Good for you! But for those who can leverage the labor shortage as part of the business plan and who can take ownership of the process of service line operations there are some marginal benefits to be had. That is worth something. My W2 says so.

 

[NICMAN]

Profit is revenue minus expenses; for anesthesia it’s collections - overhead - salaries

Did they teach you that in business school? When you negotiate your salary would you accept a hospital executive saying “well, this is what insurance companies say you are worth so that is what we are going to pay you”.

Do you as a hospital employee only make what you generate in collections. How far are you willing to push this narrative that anesthesia services are only worth what private and government insurance pay and the rest is basically charity and not “profit”. This is a very ill-informed line of argument from a business and accounting perspective.

 

[NICMAN]

i have no issue against a dept obtaining subsidy or income guarantee whatever or stipends for call or additional points of service

I was just saying that attention should be paid to stability of groups that are obtaining subsidies and are also offering partnership tracks esp with buy ins. Since they aren’t intrinsically profitable…

You are making an assumption/argument that hospital employed positions are more stable than a large and diversified anesthesia group that has contracts across several hospitals. The argument simply doesn’t make sense to me.

Just wait, when the labor shortage gets a little more loose, a lot of these hospital-employed positions will be handed over to corporations that will take advantage of your employeed-mindset and you might even be working for a CRNA.

 

[neutro]

That is just business ignorance. You think subsidies are to cover clinical services only—bless your heart.

All I am saying is that some locations with certain partnerships can be profitable and even lucrative since the management of personnel and the provision of value-added operational efficiency and economies of scale of a single system-wide service line can provide massive benefits to hospital administrators who have very little capacity to manage such a workforce as a bunch of mercenary anesthesiologist and CRNAs. That service is worth something.

Here’s the kicker—as an employee you are probably forced to provide much of those benefits for free by being roped into “community service” positions of medical directorships or chief/chair positions—now who is the sucker?

You want to be a shift worker and be told when and where to work? To be told you can’t take off 6 months for a family emergency? To have defined benefits that are not fully tax advantaged? Now is a good time to be an employee. Good for you! But for those who can leverage the labor shortage as part of the business plan and who can take ownership of the process of service line operations there are some marginal benefits to be had. That is worth something. My W2 says so.

Interesting yet weird take.
It is your assumption that only a private anesthesiology group can manage staff, affairs, and operations of an anesthesia department for a hospital. I guess then docs from Kaiser, LVHN, and other in-house anesthesia departments must be failures in running large scale, successful practices. What about academic center chairs and many other community hospitals?

Eventually, the hospitals will get smart and bring anesthesia in house. It's happening at a lot of places already. I don't see the reverse - where the hospital had their in-house anesthesia department and got rid of it. Good or bad, I don't know. But they will have a better say in staffing, case addition etc.

You may think that you're important as an anesthesiologist - but you're really not. You dont have your own census of patients and depend on the graces of surgeons and hospital.
Your worth is less than a PCP or a surgeon where the hospital can reliably benefit from downstream revenue. Anesthesia will always be on the chopping block for that reason.

I am not an employed physician and I am also fellowship trained in pain mgt and have had my own practice - so I will ignore majority of your tirade about my career. And yes, I fully exercise the benefits of tax advantaged retirement plans, autonomy and ability to say no.

 

[neutro]

Did they teach you that in business school? When you negotiate your salary would you accept a hospital executive saying “well, this is what insurance companies say you are worth so that is what we are going to pay you”.

Do you as a hospital employee only make what you generate in collections. How far are you willing to push this narrative that anesthesia services are only worth what private and government insurance pay and the rest is basically charity and not “profit”. This is a very ill-informed line of argument from a business and accounting perspective.

Man, you are just justifying the need for "management fee" that are put on bids and routinely rejected by hospitals.
Does a surgeon pay himself a "management fee" for running his practice? No.

Laughable assertion.

 

[neutro]

You are making an assumption/argument that hospital employed positions are more stable than a large and diversified anesthesia group that has contracts across several hospitals. The argument simply doesn’t make sense to me.

Just wait, when the labor shortage gets a little more loose, a lot of these hospital-employed positions will be handed over to corporations that will take advantage of your employeed-mindset and you might even be working for a CRNA.

lol "employeed-mindset".
You dont know anything.

Bless yo heart.

 

[medicine2wallstreet]

Did they teach you that in business school? When you negotiate your salary would you accept a hospital executive saying “well, this is what insurance companies say you are worth so that is what we are going to pay you”.

Do you as a hospital employee only make what you generate in collections. How far are you willing to push this narrative that anesthesia services are only worth what private and government insurance pay and the rest is basically charity and not “profit”. This is a very ill-informed line of argument from a business and accounting perspective.

How much did you forfeit in wages versus the fair market value while on your buy in track?

Have you calculated that?

My number would have been 640k if I took a dumb private practice partnership track. That is financial abuse by old boomers with all the keys to the anesthesia market.

 

[NICMAN]

I am not an employed physician and I am also fellowship trained in pain mgt and have had my own practice - so I will ignore majority of your tirade about my career. And yes, I fully exercise the benefits of tax advantaged retirement plans, autonomy and ability to say no.

I see, so you don’t even work in a hospital anesthesiologist setting but in more of a surgical/proceduralist model of practice.

Now your confused and baffled business assertions make a little more sense. I felt like I was talking less to a hospital anesthesiologist than I was to an orthopedic surgeon who can’t understand why working until 8PM is a problem when we “should be raking in money from private insurance ortho anesthesia fees”.

Look, it is an argument between being a shift worker and being a physician leader. I view practice management as a core part of my practice as a physician leader. Sure you can do that as a Kaiser department chair but those anesthesiologist don’t work for “only what collections bring in”.

To say that all private practice management/ownership is dead is just not correct. When I retire (after the baby boomer bulge) and sell my stock I suspect things will look radically different and you will be singing a different tune. The key is to position oneself as a PHYSICIAN LEADER and not as a shift worker cuz the latter are going to get slaughtered for the feast once the labor shortage looses a bit. Sure, we have a large subsidy but we also are a revenue multiplier for the hospital. You simply can’t do anesthesia without us and those people who can build and lead large local anesthesia businesses that provide high quality low cost (relatively speaking to inefficient employed corporations) are going to make more money and probably also have greater career satisfaction than those who simply clock in and collect a paycheck.

 

[NICMAN]

How much did you forfeit in wages versus the fair market value while on your buy in track?

Have you calculated that?

My number would have been 640k if I took a dumb private practice partnership track. That is financial abuse by old boomers with all the keys to the anesthesia market.

Our new hires make similar to partners with the sign-on bonus. I paid more. All of us partners also make more while working slightly less than the employed people in our part of the state.

 

[NICMAN]

Man, you are just justifying the need for "management fee" that are put on bids and routinely rejected by hospitals.
Does a surgeon pay himself a "management fee" for running his practice? No.

Laughable assertion.

How does a 6% administrative fee and a percentage “profit” management fee. Yes, “Profit” is written into our hospital contracts as a percentage of total revenue based on calculated MD and CRNA salaries accounting for collections. Our subsidy guarantees a percentage profit. That is new in the last 4 years.

Shows what you know.

 

[neutro]

lol looks like someone woke up wrong side of the bed and is hell bent on babbling over terms he himself is defining and adamant over defending.

Maybe you’re on call and it’s busy lmao and frustrated.

I already told you - by default and all basic business definitions of profit/ income/ revenue - asking for subsidy means that you’re not profitable.
Subsidy is essentially “other income” in addition to collections.

It means that if your company needs to show real profit without subsidy, you’ll need to drop salaries or reduce expenses - which will mean majority of your group will leave.

It means that you’re not market pay without subsidy.

Thats it. I don’t need a 500 page essay countering that.

Thats the reality.

As the subsidy gets larger, the more risky and ubstable you become. Hospital wil, and is always looking for better options on yearly budget meetings. Perhaps not in rural/ non competitive areas where you live, but that’s the reality in my neck of the woods.

Also look up ProMedica / Toledo. They employ their anesthesiologists and CRNAs. Used to be a very successful and profitable company until they decided enough is enough.

So it’s not your decision as anesthesia leadership.

Again you don’t know anything. I’ve already pointed out your multiple fallacies. Im not going to engage with you or defend other anesthesia models and leadership and defend why one is better than other. That depends locally and regionally.

I could care about either of them.

Good luck with your company.