Envision (formerly Sheridan) acquired by KKR

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Isn’t this perhaps a sign that AMCs backed by private equity have reached a point where they have squeezed the care and the providers to a point where perhaps it isn’t as profitable as they expected. Perhaps it isn’t profitable at all when you start losing contracts and getting sued for not delivering on promises. The more these companies fold like this the better.
 
PainDrain said:
Isn’t this perhaps a sign that AMCs backed by private equity have reached a point where they have squeezed the care and the providers to a point where perhaps it isn’t as profitable as they expected. Perhaps it isn’t profitable at all when you start losing contracts and getting sued for not delivering on promises. The more these companies fold like this the better.
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If that were true, why KKR wants to be the sucker?
 
FFP said:
They must be profitable if they keep being bought.
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Or more likely someone thinks they could be profitable.

A primary care group I used to work for got bought by some VCs. If they were that profitable to begin with, the parent company wouldn't have sold them...
 
FFP said:
They must be profitable if they keep being bought.
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The article has a very telling line: “The sale is the culmination of a seven-month strategic review by the board following disappointing third-quarter 2017 earnings. Envision, which offers physician and post-acute services and owns hundreds of surgery centers, has struggled since its 2016 merger with AmSurg, which made it one of the largest health care providers in the country.”


They apparently think they can turn it around but maybe they don’t realize it’s a failing business model to begin with.
 
narcotics999 said:
Greed is good, per Gorden Gekko

We need to be greedy too. Don't work for AMC full time. Do locum, ask 300/hr, 8 hours minimum, 1.5 after that, 3 month minimum and 3 month advance notice.
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I doubt it holds true everywhere, but the graduating seniors in my class primarily opted for locums
 
IMGASMD said:
Not necessarily.... just realized this KKR is the same company that bought ToysRus. See where they are now.
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Quoting myself is that an dingus move? My SO is in business, was very fascinated with Toys R Us rise and fall. From what I gathered from her, KKR really squeezed the business and more about giving dividends than making the business grow and thrive.

Reminds me of how AMCs promise great profit and only focus on the business side, but have no interest in the clinical practices. But what do I know?
 
d9sccr said:
I doubt it holds true everywhere, but the graduating seniors in my class primarily opted for locums
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The locums market is better than the perm market right now. It's like every administrator has the same idea:
1. I'm spending too much on anesthesia
2. Cut anesthesiologist pay and/or hire amc
3. Oh crap all my anesthesiologist are leaving and I don't have enough MDs to keep my ORs going
4. Pay locums company almost double what I was paying my anesthesiologist
5. Rinse/repat

The $300/hr mentioned earlier in this thread is not unreasonable if you cut out the middle man. I guarantee you locums companies are routinely charging that much and more.
 
Top Reddit post currently...



Be interesting to see if they do the same thing with Sheridan/Envision. I'm not sure how they would offload assets like they did with Toys R' Us. Sell practices back to hospitals? Parcel groups out to other AMCs?
 
d9sccr said:
Top Reddit post currently...



Be interesting to see if they do the same thing with Sheridan/Envision. I'm not sure how they would offload assets like they did with Toys R' Us. Sell practices back to hospitals? Parcel groups out to other AMCs?
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Can’t see the video. Is there anything to offload from anesthesia practices? No equipment, no real estate?

Sell back to hospital sounds like an interesting idea; didn’t Atrium get slap on the wrist for taking on IM practice for monopolize the market?

It continues.

Edit: saw the toy R us poster. Probably what you wanted to show.
 
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ryanjmy said:
The locums market is better than the perm market right now. It's like every administrator has the same idea:
1. I'm spending too much on anesthesia
2. Cut anesthesiologist pay and/or hire amc
3. Oh crap all my anesthesiologist are leaving and I don't have enough MDs to keep my ORs going
4. Pay locums company almost double what I was paying my anesthesiologist
5. Rinse/repat

The $300/hr mentioned earlier in this thread is not unreasonable if you cut out the middle man. I guarantee you locums companies are routinely charging that much and more.
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What if the Anesthesiologists who are leaving formed their own little locums company to contract back with the hospital? They could pay better salaries and demand better working conditions. All the Anesthesiologists would jump ship to this locums company. Life would be good again.

I do believe there will be a huge rise in these independent contracting or locums arrangements. You can only push intelligent, hard working, financially independent people so far before they will say: "Fine, here are my terms, here is my rate, call me when you need me."
 
skypilot said:
What if the Anesthesiologists who are leaving formed their own little locums company to contract back with the hospital? They could pay better salaries and demand better working conditions. All the Anesthesiologists would jump ship to this locums company. Life would be good again.

I do believe there will be a huge rise in these independent contracting or locums arrangements. You can only push intelligent, hard working, financially independent people so far before they will say: "Fine, here are my terms, here is my rate, call me when you need me."
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Locums are excellent for people who already have their FU money, and can dictate terms. For around $200/hour (which many of these agencies want to pay), they are not worth the headache over the hourly 150 plus benefits long-term job.
 
Anyone have an explanation for why private practice groups sell out to AMC's versus merging into large physician-owned groups? I feel like it would be better to have an oligopoly of 2-3 very large physician-owned groups per state, rather than selling to an AMC. It would also allow for significant more clout with hospitals.
 
resp228 said:
Anyone have an explanation for why private practice groups sell out to AMC's versus merging into large physician-owned groups? I feel like it would be better to have an oligopoly of 2-3 very large physician-owned groups per state, rather than selling to an AMC. It would also allow for significant more clout with hospitals.
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Lump sum of money? Each share is 2 mil? So Sheridan/Mednax pay 100-200 millions at the time of buying them out....

it is a finite insurance money, i don’t understand economics enough to see how these companies can make it back any time soon.

skypilot said:
What if the Anesthesiologists who are leaving formed their own little locums company to contract back with the hospital? They could pay better salaries and demand better working conditions. All the Anesthesiologists would jump ship to this locums company. Life would be good again.

I do believe there will be a huge rise in these independent contracting or locums arrangements. You can only push intelligent, hard working, financially independent people so far before they will say: "Fine, here are my terms, here is my rate, call me when you need me."
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Non-compete probably have you out of the same market for years.
 
IMGASMD said:
Non-compete probably have you out of the same market for years.
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Not necessarily. Docs jump ship from Sheridan. Sheridan is now desperate. Docs offer to work for Sheridan on a locums basis. No violation of the non-compete because you are still working for Sheridan.
 
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skypilot said:
Not necessarily. Docs jump ship from Sheridan. Sheridan is now desperate. Docs offer to work for Sheridan on a locums basis. No violation of the non-compete because you are still working for Sheridan.
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And what if Sheridan gets another doc to take your spot? Then no need for locums = you out of a job with the non-compete still enforceable = you now needing to uproot your family to move to another location for a new job.
 
FFP said:
Locums are excellent for people who already have their FU money, and can dictate terms. For around $200/hour (which many of these agencies want to pay), they are not worth the headache over the hourly 150 plus benefits long-term job.
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Yes, but not so good for those looking to put some roots down in an area. You might have some warning (3-6 months max), but it’s not uncommon for a permanent guy to get hired and your gig be up.

Just happened to those us of us who covered a local ED. They finally contracted with a local group and within a month we were out.
 
AdmiralChz said:
Yes, but not so good for those looking to put some roots down in an area. You might have some warning (3-6 months max), but it’s not uncommon for a permanent guy to get hired and your gig be up.

Just happened to those us of us who covered a local ED. They finally contracted with a local group and within a month we were out.
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Wow. That’s rough. Bye bye within 10 mile radius.
 
d9sccr said:
I doubt it holds true everywhere, but the graduating seniors in my class primarily opted for locums
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Yea. here most graduating residents who went on to jobs went to work for AMCs, since that's what is mostly available here. Annoying part is they think their 300k salary is amazing. They are still too used to their resident mentality.. i guess it's still better than working 75 hrs a week and making 65k
 
anbuitachi said:
Yea. here most graduating residents who went on to jobs went to work for AMCs, since that's what is mostly available here. Annoying part is they think their 300k salary is amazing. They are still too used to their resident mentality.. i guess it's still better than working 75 hrs a week and making 65k
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Most of us took AMC jobs. Most lucrative PP still wants 5 years, and some starts in low 200s.
I just don’t know if anyone can really promise that they will still exist in five years.
 
Seems like there are decent PP jobs in gaswork in smaller towns, is everyone that hot to be in a big city?
 
IMGASMD said:
Most of us took AMC jobs. Most lucrative PP still wants 5 years, and some starts in low 200s.
I just don’t know if anyone can really promise that they will still exist in five years.
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So it's better to get raped for the next 30 years than the next 5?? 😕

You should work in a clause whereby if the practice you've been buying into is sold or absolved, your buy-in is either repayed or you receive a proportional sum of the buy-out. Unwillingness to entertain either of these options would be a big red flag.

Aside from money, you have to accept the lack of control if you're gonna work for an AMC instead of a PP. AMC wants you to take more call, wants to change supervision ratios to 12:1, wants more locations covered everyday?? You have no control over these things. Be a good cog and keep grinding.
 
SaltyDog said:
So it's better to get raped for the next 30 years than the next 5?? 😕

You should work in a clause whereby if the practice you've been buying into is sold or absolved, your buy-in is either repayed or you receive a proportional sum of the buy-out. Unwillingness to entertain either of these options would be a big red flag.

Aside from money, you have to accept the lack of control if you're gonna work for an AMC instead of a PP. AMC wants you to take more call, wants to change supervision ratios to 12:1, wants more locations covered everyday?? You have no control over these things. Be a good cog and keep grinding.
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Read this closely.
 
SaltyDog said:
So it's better to get raped for the next 30 years than the next 5?? 😕

You should work in a clause whereby if the practice you've been buying into is sold or absolved, your buy-in is either repayed or you receive a proportional sum of the buy-out. Unwillingness to entertain either of these options would be a big red flag.

Aside from money, you have to accept the lack of control if you're gonna work for an AMC instead of a PP. AMC wants you to take more call, wants to change supervision ratios to 12:1, wants more locations covered everyday?? You have no control over these things. Be a good cog and keep grinding.
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Had this explicitly written into my 3yr-track contract.
1st year - 1/3 of partner buyout if sold
2nd year - 2/3 partner buyout
3rd year - full partner buyout

If they agree, you have at least some financial security and also a pretty good notion that the group doesn't have any plans to sell anytime soon.
If they balk (a favorite bulls hit excuse is "everybody before you signed the same contract"), be wary...
 
FFP said:
S/he has a point though. If people stopped working for AMCs except as expensive locums, we would get rid of them pretty fast.
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The problem is, as you know, is that people still have to eat, pay bills, and have some ones left over for the strip club. We graduate so many residents that there will always be a desperate body out there. It's the same reason the NFL still doesn't have guaranteed contracts. They can't hold out long enough for the owners to hurt because they have bills to pay.
 
The fantasy world that is this thread is pretty silly.

First, we’re going to have boycott-like work stoppages for AMCs so they are forced to pay expensive locums agencies. In the meantime the 300k student debt at 7% interest is going to pay itself and the family will just learn to live off the land?

Next, we’re going to leave the current job and force them to hire us back as an independent locums agency. That non-compete clause you signed is just going to be forgotten, right?

Or the typical response that we are all going to move to small towns and join those supposedly competitive lucrative private practices that “find you” through your professional network and not the other way around. I guess all the anesthesia graduates will fit nicely into the less than 20% of jobs out there that are actually fair PPs. Those 80% AMC, hospital employed, predator practice jobs will just sit vacant. That anesthesiologist who grew up in Brooklyn and trained in NYC will fit right in with that small practice in Arkansas.

There is so much impractical advice in this thread. If there is a fair private practice in your desired location, consider yourself one of the lucky few (we’ll call them the Anesthesia one-percenters). For the 99% of you, go into it with eyes wide open. You will be screwed. You will be lied to. You will be taken advantage of. You won’t make $600k+. You will be subsidizing the lifestyle of someone who works a lot less than you. Make the best of whatever situation you find yourself in. Do not grow roots or “strong roots.” Build flexibility into your life both financially and socially. Being willing and able to leave any situation is your only leverage, so aggressively pay down that student debt. Buy a Toyota instead of a Tesla. Figure out the base situation you are willing to accept to do this job and once a job dips below your expectations, it is time to pickup and leave. Locums will always be an option because of these turnstyle types of jobs.

I will also add, you are not special. No one cares about your M.D. or whatever letters you have after your name. You will forever be known as an “FTE” (full time equivalent) in the eyes of those who sign your paycheck. No one cares that you can draw a graph explaining the context-sensitive half time of propofol. You are equivalent to a CRNA. Who cares, get over it.
 
GravelRider said:
The fantasy world that is this thread is pretty silly.

First, we’re going to have boycott-like work stoppages for AMCs so they are forced to pay expensive locums agencies. In the meantime the 300k student debt at 7% interest is going to pay itself and the family will just learn to live off the land?

Next, we’re going to leave the current job and force them to hire us back as an independent locums agency. That non-compete clause you signed is just going to be forgotten, right?

Or the typical response that we are all going to move to small towns and join those supposedly competitive lucrative private practices that “find you” through your professional network and not the other way around. I guess all the anesthesia graduates will fit nicely into the less than 20% of jobs out there that are actually fair PPs. Those 80% AMC, hospital employed, predator practice jobs will just sit vacant. That anesthesiologist who grew up in Brooklyn and trained in NYC will fit right in with that small practice in Arkansas.

There is so much impractical advice in this thread. If there is a fair private practice in your desired location, consider yourself one of the lucky few (we’ll call them the Anesthesia one-percenters). For the 99% of you, go into it with eyes wide open. You will be screwed. You will be lied to. You will be taken advantage of. You won’t make $600k+. You will be subsidizing the lifestyle of someone who works a lot less than you. Make the best of whatever situation you find yourself in. Do not grow roots or “strong roots.” Build flexibility into your life both financially and socially. Being willing and able to leave any situation is your only leverage, so aggressively pay down that student debt. Buy a Toyota instead of a Tesla. Figure out the base situation you are willing to accept to do this job and once a job dips below your expectations, it is time to pickup and leave. Locums will always be an option because of these turnstyle types of jobs.

I will also add, you are not special. No one cares about your M.D. or whatever letters you have after your name. You will forever be known as an “FTE” (full time equivalent) in the eyes of those who sign your paycheck. No one cares that you can draw a graph explaining the context-sensitive half time of propofol. You are equivalent to a CRNA. Who cares, get over it.
Click to expand...

I agree with just about all of this. The one thing that maybe...MAYBE will save some is doing a fellowship. Maybe.
 
GravelRider said:
The fantasy world that is this thread is pretty silly.

First, we’re going to have boycott-like work stoppages for AMCs so they are forced to pay expensive locums agencies. In the meantime the 300k student debt at 7% interest is going to pay itself and the family will just learn to live off the land?

Next, we’re going to leave the current job and force them to hire us back as an independent locums agency. That non-compete clause you signed is just going to be forgotten, right?

Or the typical response that we are all going to move to small towns and join those supposedly competitive lucrative private practices that “find you” through your professional network and not the other way around. I guess all the anesthesia graduates will fit nicely into the less than 20% of jobs out there that are actually fair PPs. Those 80% AMC, hospital employed, predator practice jobs will just sit vacant. That anesthesiologist who grew up in Brooklyn and trained in NYC will fit right in with that small practice in Arkansas.

There is so much impractical advice in this thread. If there is a fair private practice in your desired location, consider yourself one of the lucky few (we’ll call them the Anesthesia one-percenters). For the 99% of you, go into it with eyes wide open. You will be screwed. You will be lied to. You will be taken advantage of. You won’t make $600k+. You will be subsidizing the lifestyle of someone who works a lot less than you. Make the best of whatever situation you find yourself in. Do not grow roots or “strong roots.” Build flexibility into your life both financially and socially. Being willing and able to leave any situation is your only leverage, so aggressively pay down that student debt. Buy a Toyota instead of a Tesla. Figure out the base situation you are willing to accept to do this job and once a job dips below your expectations, it is time to pickup and leave. Locums will always be an option because of these turnstyle types of jobs.

I will also add, you are not special. No one cares about your M.D. or whatever letters you have after your name. You will forever be known as an “FTE” (full time equivalent) in the eyes of those who sign your paycheck. No one cares that you can draw a graph explaining the context-sensitive half time of propofol. You are equivalent to a CRNA. Who cares, get over it.
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Well somebody’s glass is half empty.



#1%er
 
Twiggidy said:
I agree with just about all of this. The one thing that maybe...MAYBE will save some is doing a fellowship. Maybe.
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I used to recommend a fellowship as a form of job security, but I don’t anymore. Do a fellowship if doing that particular field brings you some kind of joy or satisfaction. Otherwise, it’s a waste of time and money. It’s one less year of earning money to give you that financial flexibility that is so critical to happiness in this field. Fellowships don’t necessarily get you better jobs, they just get you different jobs. There are plenty of cardiac anesthesiologists out there working for an AMC with Q4 call, 300k, and 4 weeks “PTO.”
 
GravelRider said:
I used to recommend a fellowship as a form of job security, but I don’t anymore. Do a fellowship if doing that particular field brings you some kind of joy or satisfaction. Otherwise, it’s a waste of time and money. It’s one less year of earning money to give you that financial flexibility that is so critical to happiness in this field. Fellowships don’t necessarily get you better jobs, they just get you different jobs. There are plenty of cardiac anesthesiologists out there working for an AMC with Q4 call, 300k, and 4 weeks “PTO.”
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There's truth there too.
 
SaltyDog said:
You should work in a clause whereby if the practice you've been buying into is sold or absolved, your buy-in is either repayed or you receive a proportional sum of the buy-out. Unwillingness to entertain either of these options would be a big red flag.
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Not really possible for some of us to give this guarantee. Just because some of us are unable/unwilling to make this promise or write it into a contract isn't necessarily a red flag.
 
Arch Guillotti said:
Not really possible for some of us to give this guarantee. Just because some of us are unable/unwilling to make this promise or write it into a contract isn't necessarily a red flag.
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How’s that? I’m genuinely curious. Specifically for the deal that I had written into my contract, it would simply require each partner giving up some of their buy-out to cover the doc on the partnership tract.
 
NightNight said:
How’s that? I’m genuinely curious. Specifically for the deal that I had written into my contract, it would simply require each partner giving up some of their buy-out to cover the doc on the partnership tract.
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How would this even work? If partners owe 5 years back of employment to the AMC in exchange for the buyout, would you really take a 1/3 buyout and still have to do 5 years? I wouldn’t.
 
okayplayer said:
How would this even work? If partners owe 5 years back of employment to the AMC in exchange for the buyout, would you really take a 1/3 buyout and still have to do 5 years? I wouldn’t.
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Depending on the job you have to view it as 1/3 of something and a job or all of nothing and no job
 
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