Emcare Anesthesia

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Typical, predatory AMC. If they are sniffing around your neck of the woods, prepare to become an EmCare employee.
 
Standard package for new hires is quite nice. I have the numbers posted in the club in a recent "job" thread.
 
one of my attendings was a partner in a robust PP group before they decided to cash out and sell the group to EmCare. He stayed on briefly but hated it thereafter, and left to join on as an attending at my program.
 
Doctor4Life1769 said:
one of my attendings was a partner in a robust PP group before they decided to cash out and sell the group to EmCare. He stayed on briefly but hated it thereafter, and left to join on as an attending at my program.
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The money eases the pain of seeing a sellout in the mirror every morning.
 
If you are in a group that they are considering to take over, they will significantly lower your salary and you will lose ALL autonomy. If you are considering joining from the outside, you may have to work with one of their recruiters who are dishonest snakes.
 
should new graduates embrace the fact that majority of practices will eventually become AMC run? I would like to hear some good stories from those who started their career in an AMC, or do they not exist?
 
buntatog said:
should new graduates embrace the fact that majority of practices will eventually become AMC run? I would like to hear some good stories from those who started their career in an AMC, or do they not exist?
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Join a group with YOUNG docs. The oldies don't care how bad things will get because they'll just retire and avoid the negative impact of their actions. Young docs who have to work for more than 5 more years are less likely to become sell outs.
 
GypsySongman said:
Join a group with YOUNG docs. The oldies don't care how bad things will get because they'll just retire and avoid the negative impact of their actions. Young docs who have to work for more than 5 more years are less likely to become sell outs.
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Exactly, don't think for a second that the oldies are watching your back. They only watch your back in order to stab you. Sell outs....
 
GypsySongman said:
Join a group with YOUNG docs. The oldies don't care how bad things will get because they'll just retire and avoid the negative impact of their actions. Young docs who have to work for more than 5 more years are less likely to become sell outs.
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👍 Voting control is everything.
 
buntatog said:
should new graduates embrace the fact that majority of practices will eventually become AMC run? I would like to hear some good stories from those who started their career in an AMC, or do they not exist?
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Yes

They do not exist.

I've said it a million times - we will all eventually be employees of an AMC or a hospital. Just take a recent 10 year period....say 2000 - 2010 and look at the drastic increase in the number of anesthesiologists who are employees of an AMC or hospital. Wait another 10 years and that number will be much higher, etc.
 
how about compared to an employed position in a private group. I've seen employed position offers from private groups. Call schedule comparable but less attractive fringe benefit packages. Can you say that working as an employee for a private group is the same as in an AMC?
 
I'd like to hear from recent grads or graduating residents what practice kind they've entered, as well as their experiences. I've been given alot of insight from seasoned attendings, mostly doom and gloom. Its hard to believe that majority of anethesiologists who are employees are also the majority of unhappy/unfulflilled ones.
 
Private practice is in many respects a victim of its own success. There are far too many private groups run by lazy and self serving "partners" who will capitalize on the drive of young anesthesiologists to enrich themselves under the guise that everyone has to "pay their dues."

It is this very mentality that has allowed AMC's to fluorish, and it is the very thing that will in the end squeeze out private practice.

Don't get me wrong, there are still some hidden gems out there, but they are few and far between. Many "partners" will not think twice about chewing up a talented doc for an extra 50k and 2 more weeks vacation.

You know who you are out there.
 
OffPiste said:
Private practice is in many respects a victim of its own success. There are far too many private groups run by lazy and self serving "partners" who will capitalize on the drive of young anesthesiologists to enrich themselves under the guise that everyone has to "pay their dues."

It is this very mentality that has allowed AMC's to fluorish, and it is the very thing that will in the end squeeze out private practice.

Don't get me wrong, there are still some hidden gems out there, but they are few and far between. Many "partners" will not think twice about chewing up a talented doc for an extra 50k and 2 more weeks vacation.

You know who you are out there.
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Yes, yes, yes. This is what I heard verbatim when I finished my residency and looked to get a job at a small community hospital near family:

"We (the partners making 5+) could get a monkey to do this job for $90k a year."

After that and similar I said to myself, I will NEVER pay a buy-in.
 
OffPiste said:
Private practice is in many respects a victim of its own success. There are far too many private groups run by lazy and self serving "partners" who will capitalize on the drive of young anesthesiologists to enrich themselves under the guise that everyone has to "pay their dues."

It is this very mentality that has allowed AMC's to fluorish, and it is the very thing that will in the end squeeze out private practice.

Don't get me wrong, there are still some hidden gems out there, but they are few and far between. Many "partners" will not think twice about chewing up a talented doc for an extra 50k and 2 more weeks vacation.

You know who you are out there.
Click to expand...


That's not why AMCs are flourishing. They are flourishing because of uncertainty. When you have a large number of docs in mid to late career who are uncertain about the future reimbursement of the specialty, taking a guaranteed hunk of cash in exchange for selling your practice sounds a little more appealing.

But the older docs in our group say there has always been uncertainty in medicine (and anesthesia in particular). We hear the same dire predictions now they were dealing with 30 years ago. That's why when we've been contacted by AMCs to offer us a buyout, we told them no thanks. The way I see it they have a lot of smart people crunching numbers and they are making a bet that anesthesia reimbursement will continue to be profitable in the future so we decided why should we sell them our future profit for a comparatively small chunk of change?
 
Mman said:
But the older docs in our group say there has always been uncertainty in medicine (and anesthesia in particular). We hear the same dire predictions now they were dealing with 30 years ago. That's why when we've been contacted by AMCs to offer us a buyout, we told them no thanks. The way I see it they have a lot of smart people crunching numbers and they are making a bet that anesthesia reimbursement will continue to be profitable in the future so we decided why should we sell them our future profit for a comparatively small chunk of change?
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👍 +2
 
I don't think they are so smart. The profit is in commoditizing the profession, owning the contract, getting someone to do the work cheaper, then skimming the difference. It's what many anesthesiologists have been doing for years.
 
imfrankie said:
I don't think they are so smart. The profit is in commoditizing the profession, owning the contract, getting someone to do the work cheaper, then skimming the difference. It's what many anesthesiologists have been doing for years.
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They are smart because that model only makes money for them if the reimbursement remains comparable in the future.

If the reimbursement is drastically slashed, say cut by 50-70% over 5-10 years then they will not be making money on the deal. Because there isn't much difference to skim. And if that's the case laying out millions of dollars up front is a terrible move.

So either you think those several hundred million to several billion dollar corporations are making a dumb bet financially or you think small groups should be selling out to them to look out for their own self interest.
 
Mman said:
That's not why AMCs are flourishing. They are flourishing because of uncertainty. When you have a large number of docs in mid to late career who are uncertain about the future reimbursement of the specialty, taking a guaranteed hunk of cash in exchange for selling your practice sounds a little more appealing.

But the older docs in our group say there has always been uncertainty in medicine (and anesthesia in particular). We hear the same dire predictions now they were dealing with 30 years ago. That's why when we've been contacted by AMCs to offer us a buyout, we told them no thanks. The way I see it they have a lot of smart people crunching numbers and they are making a bet that anesthesia reimbursement will continue to be profitable in the future so we decided why should we sell them our future profit for a comparatively small chunk of change?
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That's right. Its the same logic as to why you should not buy extended warranties or pet health insurance. They have done the math and and know they will take in more money than they pay out.
 
Mman said:
They are smart because that model only makes money for them if the reimbursement remains comparable in the future.

If the reimbursement is drastically slashed, say cut by 50-70% over 5-10 years then they will not be making money on the deal. Because there isn't much difference to skim. And if that's the case laying out millions of dollars up front is a terrible move.

So either you think those several hundred million to several billion dollar corporations are making a dumb bet financially or you think small groups should be selling out to them to look out for their own self interest.
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My measure of smarts isn't ability to turn a profit. The companies are making a profit now, just like the anesthesiologists now and in the past who employ others for a profit. Tomorrow is of little concern to those that have little to lose and plenty to gain.
 
Mman said:
They are smart because that model only makes money for them if the reimbursement remains comparable in the future.

If the reimbursement is drastically slashed, say cut by 50-70% over 5-10 years then they will not be making money on the deal. Because there isn't much difference to skim. And if that's the case laying out millions of dollars up front is a terrible move.

So either you think those several hundred million to several billion dollar corporations are making a dumb bet financially or you think small groups should be selling out to them to look out for their own self interest.
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They're taking money off the top. There'll always be a difference to skim. They'd rather make 15% of 50 million than 15% of 30 million, but either way they're making money.
The only way they lose is losing the contract. I hope hospitals pull the contracts and hire employee docs. The investment bankers trying to take our income deserve to get ****ed just as badly as the older docs selling the future labor of younger docs as if it's theirs to sell, *******s.
 
GypsySongman said:
They're taking money off the top. There'll always be a difference to skim. They'd rather make 15% of 50 million than 15% of 30 million, but either way they're making money.
The only way they lose is losing the contract. I hope hospitals pull the contracts and hire employee docs. The investment bankers trying to take our income deserve to get ****ed just as badly as the older docs selling the future labor of younger docs as if it's theirs to sell, *******s.
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No, they can lose because they are shelling out millions of dollars up front to buy out the current partners. They need revenue to remain high so that their 15% or whatever in the future is enough net present value to more than cover the up front buy out.


Paying out 25-50 million up front to purchase the group becomes a lot less worthwhile if their annual revenue is drastically slashed 3 years from now.
 
GypsySongman said:
They're taking money off the top. There'll always be a difference to skim. They'd rather make 15% of 50 million than 15% of 30 million, but either way they're making money.
The only way they lose is losing the contract. I hope hospitals pull the contracts and hire employee docs. The investment bankers trying to take our income deserve to get ****ed just as badly as the older docs selling the future labor of younger docs as if it's theirs to sell, *******s.
Click to expand...

And if you become a hospital employee, do you think for a moment that the hospital will not be making money off you? With more and more power and money going to the hospitals thanks to the AHA, we will all be hospital employees in the future and the CEO will get a big paycheck.

http://healthland.time.com/2013/02/20/what-makes-health-care-so-expensive/
 
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Unfortunately, I have spoken to alot of CA3s who either are oblivious of the current and evolving landscape of anesthesiology or quite frankly don't care. Fact of the matter is, for the vast majority of grads, there are loans to be paid for, and have their eyes set on making the paper to pay those off. so partnership tracks are hard to swallow, especially with the uncertainty of the future coming years. any advise to the new generation of anesthesiologists who care to fight the devaluation of the field, or is it futile to continue to fight the inevitable?
 
Worked for EmCare and also for 2 private practice groups so here's my 2 cents.

EmCare - 1099 strait salary regardless of units generate worked both full time and part time for them

Overall impression - EmCare has been very good at honoring exactly what they put into the contract no more no less. Working in this type of situation in the right hospital can actually be very profitable. EmCare hospital I've worked at has very slow, academic like turnover and surgeons who love to show up late. This is the perfect salary type situation because more often then not, my salary is greater than my billing. OB is also a huge moneymaker for me at this hospital given the flat rate for a 24hr call and relatively low volume of procedures (<5) and poor insurance mix. In the long run I don't think this is a sustainable situation because if you pay people more than you bill you're gonna go broke real quick but in the right situation working for an AMC can be profitable for you the independent anesthesia provider and a good 2nd gig to supplement some income
 
It's not that you can't have a fine job working for EmCare, Sheridan, GHA, NAPA, etc. It's that increasing outside control of our specialty will make it less likely that any of us will have good jobs in the future.
 
GypsySongman said:
It's not that you can't have a fine job working for EmCare, Sheridan, GHA, NAPA, etc. It's that increasing outside control of our specialty will make it less likely that any of us will have good jobs in the future.
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Isn't Sheridan owned by anesthesiologists?

Not sure about the others.
 
urge said:
Isn't Sheridan owned by anesthesiologists?

Not sure about the others.
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Don't know. If they don't all have some anesthesiologist ownership, I would bet that they atleast have strong consulting advice from anesthesiologists on how to be more effective at acquiring practices. We prey on our own. Just like other specialties and professions. It is not unique to anesthesia. It is human nature.
 
urge said:
Isn't Sheridan owned by anesthesiologists?

Not sure about the others.
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I don't know the specifics of the ownership of any of those groups.

By outside control I meant owners who you'll rarely or never see at work, don't know or care about you as a person, and often live far away.

Doesn't really matter if they are MDs. If they are owners first and doctors second, they're part of the problem.
 
This article is long but it is interesting to see what business people think they can do with anesthesia. At one point he mentions having the hospitalists preopping and then supervising the crnas and then taking care of the patient afterward. If they already own the hospitalist, they take the anesthesiologist right out of the equation.

http://www.anesthesiallc.com/compon...ion-and-the-theory-of-the-anesthesia-business

Hopefully the link works. i'm not saying this is the future or that those theories would work, its just a wake up call that others are thinking about how to reshape our field to profit from it. We need to be the ones who provide a better product.
 
climbingak said:
This article is long but it is interesting to see what business people think they can do with anesthesia. At one point he mentions having the hospitalists preopping and then supervising the crnas and then taking care of the patient afterward. If they already own the hospitalist, they take the anesthesiologist right out of the equation.

http://www.anesthesiallc.com/compon...ion-and-the-theory-of-the-anesthesia-business

Hopefully the link works. i'm not saying this is the future or that those theories would work, its just a wake up call that others are thinking about how to reshape our field to profit from it. We need to be the ones who provide a better product.
Click to expand...

Absolutely fabulous read. Thanks so much.
 
climbingak said:
This article is long but it is interesting to see what business people think they can do with anesthesia. At one point he mentions having the hospitalists preopping and then supervising the crnas and then taking care of the patient afterward. If they already own the hospitalist, they take the anesthesiologist right out of the equation.

http://www.anesthesiallc.com/compon...ion-and-the-theory-of-the-anesthesia-business

Hopefully the link works. i'm not saying this is the future or that those theories would work, its just a wake up call that others are thinking about how to reshape our field to profit from it. We need to be the ones who provide a better product.
Click to expand...

Interesting theory. Let's just say that when somebody who can write "cleared for anesthesia" on a consult form and then supervise a CRNA providing crappy anesthesia there will be a lot of dead and/or seriously injured patients. The entire realm of IM is unfamiliar with how to care for an anesthetized patient.

Patient is hypotensive? Let's give a liter of fluid over the next 2 hours and then send some labs!
 
Mman said:
Interesting theory. Let's just say that when somebody who can write "cleared for anesthesia" on a consult form and then supervise a CRNA providing crappy anesthesia there will be a lot of dead and/or seriously injured patients. The entire realm of IM is unfamiliar with how to care for an anesthetized patient.

Patient is hypotensive? Let's give a liter of fluid over the next 2 hours and then send some labs!
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👍
 
Btw the ******* who runs emcare was an anesthesiologist and doesn't think we're needed, or maybe even If a crna is needed. No one screws doctors more than other doctors.
 
I finished residency in 2009 and joined my training private practice group. In 2010 my private practice contract was not renewed and given to AnesthesiaCare. All members of my group were hired by AnesthesiaCare. I had a great deal of exposure to their upper level management, including Dr. Hicks, the author of the above quoted article.. I have to say, they were extremely fair to work for. I honestly have nothing bad to say about them. They fulfilled everything that they promised us as employees. At the end of the 15 months, the hospital decided to give the contract back to myself and my 2 partners for multiple reasons. However, I would work for AnesthesiaCare again if my small private group were taken over.
 
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