Different types of practices in Anesthesiology

[dhooppi]

---

Members don't see this ad.

Hi,
I was wondering if someone could explain to me how partnership in private practice anesthesia work? I hear about partnership-track and non-partnership-track jobs but don't really understnd the difference

thanks

 

[Pilot Doc]

Hi,
I was wondering if someone could explain to me how partnership in private practice anesthesia work? I hear about partnership-track and non-partnership-track jobs but don't really understnd the difference

thanks

First concept: an anesthesia practice is a business like a carwash or a Burger King. It offers a service for which it's customers pay money. It uses that money to pay expenses (electicity, employees, etc). What's leftover is profit and goes to the owner.

As and MD, you can either be an employee or an owner.

As a general rule, you always start as an employee. You go to work, you put people to sleep, the owner gives you a paycheck. You might be straight salary or have some production incentives, you might get benefits or not. But in theory, your paycheck has nothing to do with the profitability of the business.

When you become a partner (let's assume there are 10 partners) you get 1/10 of the profit per year. Typically this is done by drawing a monthly salary similar to what your MD employees earn and every so often (monthly, quarterly, etc) you see how much profit has been made and divide it up. Again, there are lots of ways to do this. Some partnerships divide call, cases and $$ completely evenly. Others have some production based system. There are as many ways to run it as you can imagine.

One variation to watch out for is a setup where there are one or more superpartners who have special powers. These typically involve somehow working less or making more. I know these exist but don't have any good advice on how to see and avoid them.

So how do you become partner? Well, you're getting a share in a business. It's just like buying 10% of any other business (e.g. Dell, GM). You'll be expected to compensate the person who currently owns your 10%. Typically, this is done by spending a year or two or three working hard and making the group more money than you earn. After a period of time, that profit you generate is counted toward your share of the business and you become partner. It's also possible to have a straight buy-in where you pay $X00,000 (typically borrowed) for a share of the group. My imrpession is that this is uncommon in anes compared to other specialties (typically ones where a practice will have a valuable patient base and/or buildings/equipment.)

Other pitfalls to watch out for here - groups who have a habit of firing employees just before they make partner. There are no guarantees here - it will involve a degree of trust. There's a good post somewhere about how to sniff out groups and see if they have this habit. It's harder in anes compared to other specialites because anes leaves fewer tracks (phonebook listings, patients who remember them, etc.)

Hope that helps.

 

[Dr Serenity]

Thanks for the educational post!

 

[nociceptor]

First concept: an anesthesia practice is a business like a carwash or a Burger King. It offers a service for which it's customers pay money. It uses that money to pay expenses (electicity, employees, etc). What's leftover is profit and goes to the owner.

As and MD, you can either be an employee or an owner.

As a general rule, you always start as an employee. You go to work, you put people to sleep, the owner gives you a paycheck. You might be straight salary or have some production incentives, you might get benefits or not. But in theory, your paycheck has nothing to do with the profitability of the business.

When you become a partner (let's assume there are 10 partners) you get 1/10 of the profit per year. Typically this is done by drawing a monthly salary similar to what your MD employees earn and every so often (monthly, quarterly, etc) you see how much profit has been made and divide it up. Again, there are lots of ways to do this. Some partnerships divide call, cases and $$ completely evenly. Others have some production based system. There are as many ways to run it as you can imagine.

One variation to watch out for is a setup where there are one or more superpartners who have special powers. These typically involve somehow working less or making more. I know these exist but don't have any good advice on how to see and avoid them.

So how do you become partner? Well, you're getting a share in a business. It's just like buying 10% of any other business (e.g. Dell, GM). You'll be expected to compensate the person who currently owns your 10%. Typically, this is done by spending a year or two or three working hard and making the group more money than you earn. After a period of time, that profit you generate is counted toward your share of the business and you become partner. It's also possible to have a straight buy-in where you pay $X00,000 (typically borrowed) for a share of the group. My imrpession is that this is uncommon in anes compared to other specialties (typically ones where a practice will have a valuable patient base and/or buildings/equipment.)

Other pitfalls to watch out for here - groups who have a habit of firing employees just before they make partner. There are no guarantees here - it will involve a degree of trust. There's a good post somewhere about how to sniff out groups and see if they have this habit. It's harder in anes compared to other specialites because anes leaves fewer tracks (phonebook listings, patients who remember them, etc.)

Hope that helps.

There goes my perfect world view, where everything works out right once I finish residency.

 

[Pilot Doc]

Adding on a bit about non partner track jobs. These are a little more straightforward in that you will always remain an employee (or independent contractor, but that's another discussion.)

In these cases you show up to work and you get a paycheck (and perhaps benefits). That's it. Very simple and clear. You can do it for 1 year or 40. Kaiser, VA and most academic jobs fit this model. There is less potential upside and downside in this compared to a partnership track job.

 

[core0]

Where does an AMC fit into these models. Ownership? Salary? or Other?

David Carpenter, PA-C

 

[Pilot Doc]

Where does an AMC fit into these models. Ownership? Salary? or Other?

David Carpenter, PA-C

Kind of unclear.

In some cases it is straight salary.

In others, there offer something called partnership which, best I can tell, is really a profit sharing or production incentive plan. It's not partnership in the traditional fashion where all profits (and losses) as well as significant operational control and increased job security go along with partnership. In this case there is definitely a superpartner, perhaps on site full or part time who is making more $$.

The degree to which what AMC's say they do and what they actually do is a matter of hot debate that would probably be better suited to another thread.

 

[huron]

Where does an AMC fit into these models. Ownership? Salary? or Other?

David Carpenter, PA-C

There are good partnerships out there that will treat you honestly and pay you fairly where all the partners carry their fair share and you don't end up supporting some older partner who does very little work but gets the lion's share of the money.

The best situation is where you do your own cases and get to bill for them if you have to join a partnership you are very likely propping up someone else salary. You are getting paid less for doing more or the same amount of work as someone else for the empty promise of "making partner and finally getting paid "fairly and equally"

Unfortunately there are many bad partnerships out there. Places that will pay you little work you hard for three or more years without offering partnership then fire you and find a new graduate. Places where even when you make partner you find out there are two levels of partners and you are only eligible to do the crappy cases and get paid less.

You need to learn as much as you can about the group that you are joining, You need to go into that job knowing whether you will be offered partnership or be cast off like the last new grad they hired who worked for very little for three years and then got the boot.

AMC's are as bad or worse as the bad partnerships groups because if you choose to work for an AMC you will never get paid fairly. The AMC owner is going to take the lion's share of the money and feed you the table scraps. AMC owners are smooth talking lairs who job is to con you into working for far less than you could be paid anywhere else. They will pretend to be a partnership group, but you will always be a poorly paid employee of the AMC owner never an equal partner.

The other common AMC payment scam is the Bonus scam. AMC will promise that if you work hard, do more cases, take more call, your productivity will be rewarded with a big bonus that will offset the meager salary they pay. The AMC owner's have dreamed up hundreds of excuses for why they can't pay you the bonus this time but of course if you keep working hard next year you will get that big bonus. Just like a malignant group if you complain or confront the AMC owner about their lies you will get the boot and a bad recommendation to make finding a new job difficult.

So do your self and your career a favor don't work for crooks, whether they are AMC owners or malignant groups.

 

[polkadotcap]

As a near-future resident who will be dealing with this in four short years, my question is...how do you go about "sniffing out" the truth about a particular group? How does one go about getting the dirt, so to speak? It seems to me to be kind of like asking residents if they like their program....probably not gonna get the most honest answer if they work for one of those malignant groups out of fear of "making waves". Thoughts?

 

[2ndyear]

If you're looking in the area of your residency, then there will likely be grads from your program in a group. Possibly even CA2's and 3's that you know from residency. Also word just gets around. Attendings leave academics to go to private practice and vice-versa. I've gotten lots of 'word on the street' type advice from all of these. It's pretty well known what the good groups are near your residency and what ones to stay away from. If there has been a big shakeup around town you'll hear about it.

 

[johankriek]

There are good partnerships out there that will treat you honestly and pay you fairly where all the partners carry their fair share and you don’t end up supporting some older partner who does very little work but gets the lion’s share of the money.

The best situation is where you do your own cases and get to bill for them if you have to join a partnership you are very likely propping up someone else salary. You are getting paid less for doing more or the same amount of work as someone else for the empty promise of “making partner and finally getting paid “fairly and equally”

Unfortunately there are many bad partnerships out there. Places that will pay you little work you hard for three or more years without offering partnership then fire you and find a new graduate. Places where even when you make partner you find out there are two levels of partners and you are only eligible to do the crappy cases and get paid less.

You need to learn as much as you can able the group the you are joining, You need to go into the place knowing whether you will be offered partnership or be cast off like the last new grad they hired who worked for very little for three years and got the boot.

AMC’s are as bad or worse then the bad partnerships groups because an AMC you will never get paid fairly. The AMC owner is going to take the lion’s share of the money and feed you the table scraps. AMC owners are smooth talking lairs who job is to con you into working for far less than you could be paid. They will pretend to be a partnership group but you will always be a poorly paid employee of the AMC owner never an equal partner.

The other common AMC payment scam is the Bonus scam. AMC will promise that if you work hard, do more cases, take more call, your productivity will be rewarded with a big bonus that will offset the meager salary they pay. The AMC owner’s have dreamed up hundreds of excuses for why they can’t pay you the bonus this time but of course if you keep working hard next year you will get that big bonus. Just like a malignant group if you complain or confront the AMC owner about their lies you will get the boot and a bad recommendation to make finding a new job difficult.

So do your self and your career a favor don’t work for crooks, whether they are AMC owners or malignant groups.

Unfortunately, the way i see it. its going the way of amc. Soon that will be everyones only option. working as an employee for an amc.

 

[johankriek]

As a near-future resident who will be dealing with this in four short years, my question is...how do you go about "sniffing out" the truth about a particular group? How does one go about getting the dirt, so to speak? It seems to me to be kind of like asking residents if they like their program....probably not gonna get the most honest answer if they work for one of those malignant groups out of fear of "making waves". Thoughts?

all you have to do to find out if a group is fair is ask the following question, "Do I have access to the books and financial statements?" If a group is fair and Im your partner, I should know how much you make and vice versa. Its not a partnership if you know what i make and I have no clue what you make. IF a group doesnt allow you to peruse the financial statements at will.. go elsewhere..

 

[Planktonmd]

Unfortunately, the way i see it. its going the way of amc. Soon that will be everyones only option. working as an employee for an amc.

Or be hospital employees.

 

[huron]

As a near-future resident who will be dealing with this in four short years, my question is...how do you go about "sniffing out" the truth about a particular group? How does one go about getting the dirt, so to speak? It seems to me to be kind of like asking residents if they like their program....probably not gonna get the most honest answer if they work for one of those malignant groups out of fear of "making waves". Thoughts?

Chesterfield lists some ways to look into groups to see how they plan to treat you.

You also need to look at the new section of gaswork.con. The "request for proposals" then "Search - Anesthesia Groups" which will show a list of most of the AMC you want to avoid. A number of the worst AMC's are playing games with their names and trying to pretend to be a partnership group and to trying to hide their past from their new employees. So you need to figure out if you are about to join a real partnership group or an AMC posing as one.

The UPIN number info is getting old soon there should be a NPI look up site that hopefully will show some good information. This site gives some NPI info and other good directory info.

http://www.hmedata.com/npi.asp

If anyone know of other good physician directory information web sites please post them to help the rest of us.

Keep a copy of every communication you have with the group. Record or immediately write a summary of all oral conversation with any group members.

Use this opportunity to investigate the practice. Before you go check out the hospital web site for the names of the Anesthesia doctor who work there. Your goal is to find the names of all the doctors who have left the practice in the last few years. Google all of those names along with the names of the corporation. Asking for this information from the group will get you labeled as a malcontent but to take a job with out an investigation the backgrounds of your employers is a recipe for disaster.

When you get there try to get as many months of the call schedule as possible. Old call schedules often have phone number of recently departed members of the group, plus they tell you how fair the call schedule is.

While you are in town go to the county court house and look up the names of all of the members of the group looking for lawsuits.

If your interview goes well and you are seriously considering the group you need to contact the people who have left to get the real information about how he group treats its employees.

How to find old employees of a group;

Look up all the anesthesiologist in that town with the state licence database,
http://www.docboard.org/docfinder.html

Look up all the anesthesiologist in that town with the AMA directory, ASA Directories for the last three or four years.

Look up all the anesthesiologist in that town with UPIN number search, great for towns with more than one hospital since it lists the billing address with the name separating out different practice locations.
http://upin.ecare.com/
or
http://www.upinregistry.com/provider_form.asp

Another good database dr-411 since it gives some info not seen elsewhere,
http://www.dr-411.com/default.asp


With all the names you have found you should be able to find a few former employees to contact about the group since this is your best source of unbiased information.

These databases will help you get current names and addresses of former employees.

Google is often helpful.

Searching for current phone number and addresses
http://www.zabasearch.com/

or your favorite directory search database.

Doc board is good for finding some one who has moved;
http://www.docboard.org/docfinder.html
which may give a current address.

If you have no luck you might want to invest a few buck and ask your local detective to search for people you can't locate. They also can search for lawsuits more broadly than the court house.

Now call your names and politely ask them to tell you about there experience at your potential employer.

While this is just the basics, your hospital credential application probably will be ten to twenty pages of invasive questions, many of which will be verified. Why shouldn't you know as much about your potential employer?

If you do not find any skeletons in the closet or areas of concern you need to find a competent lawyer and some trusted friends to look at your contract. Finding a lawyer who knows anything about anesthesia contacts is very difficult many attorneys will claim to be able to review a contact. So just because your buddy and fellow resident used that attorney does not say much about his competence in reviewing anesthesia contacts and providing relevant feedback.

Lastly don't ever buy a house until you have been there at least a year or made partner.
But don't say that to the realtor they force you to take a "tour of the town" with, you can be sure that everything you say to her will funnel back the anesthesia group.

 

[jwk]

Unfortunately, the way i see it. its going the way of amc. Soon that will be everyones only option. working as an employee for an amc.

Jeez, are you just a total pessimist?

 

[militarymd]

Unfortunately, the way i see it. its going the way of amc. Soon that will be everyones only option. working as an employee for an amc.

We're on the way there already.....Working Locums is one step away from working for an AMC....

and it appears to be the trend of what everyone is doing already...and it is also what you advocate.

Self-fulfilling prophecy.....

I'll stick with groups...thank you.