Envision Services

[ans2021]

Anyone have any experience working for Envision? I'm starting to look for jobs on gasworks and trying to get a feel for what different practices offer.

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[IMGASMD]

Sheridan and Emcare it was known as. So you can look for other discussions before. Typical AMC, strong foothold in Florida and south.

It’s “practice dependent.”

 

[aneftp]

Get it in writing. Every envision place is different. Envision is like Comcast cable.m (xfinity cable). They are Sheridan and just took on envision name.

but always have whatever you want in writing.

expected call 1:6 (whatever per month). Force them to write any additional calls above 1:6 should should be compensated X amounted (depending on beeper vs in-house call)

do not believe what they say verbally. Get it in writing. Envision is fine to work for once all the ground work is laid out.
The real issue with envision is once you become short staff. It’s like the “downward death spiral” with “hey. Hang in there we are recruiting and will get the open position filled quickly “. That stuff gets old quickly as the calls pile on and you are working for free extra hours.

1. what is expects hours ?
2. WhAt is expected calls
3. How will I be compensated if I do more than the expected calls

all the ground work needs to be written out

they will purposely write a vague contract that COVERS THEM. You have to force them to write a contract THAT COVERS YOU

Saying that. I have friends who work with envision who are happy. But that’s because they are fully staffed. I have friends who hate envision (that’s because they are short staff).

 

[PieOHmy]

Just make sure you get paid for the hours you work. Thats with any of the management companies.
Youre not there giving away free hours. If they put you on salary, make sure they specify how many hours of work that it is for. THen divide that # by the # of hours they want you to work. If its acceptable to you, take the job

 

[deleted899865]

I have a friend who works for envision and likes it. My other friends don't mind the work but do not like the pay. PTO is 8 weeks I believe. Pay low 300-350 with no growth potential. And then I knew several people in San Antonio who quit once Envision took over their practice. So mixed bag

 

[aneftp]

It’s all about workload folks. What’s fair and what’s reasonable. There is a big difference working 40-45 hours a week (including calls/post call days off) working 55-60 hours.

That’s an extra 20% of workload.

If they are paying you 400k high pace for 55-60 hours of workload with fewer fringe benefits.

And a academic job pays 330k for 40-45 hours plus fringe state benefits.
I’d rather take the at the academic place

I dunno Two of my buddies got really screwed with sheridan/envision a few years ago. He was literally working 68 hours in house for 375k/8 weeks. Plus beeper time

. He logged his time and showed it to them after they said “show us the proof”. They didn’t believe him. Than believed Him after it was electronically logged. Still they didn’t pay him for all the free work he did.

Keep in mind. A lot of Sheridan places that have high turnover also have rogue chiefs and vice chiefs. So that doesn’t help. If you have a fair Chief who is equitable with the schedules. It can be decent place because staffing should be adequate cause left turnover. Sheridan gives the chiefs a lot of leeway how to run a practice locally.

hint hint: If the chiefs are not doing equal calls that’s a big red flag. Especially if place is short staff.

 

[PieOHmy]

It’s all about workload folks. What’s fair and what’s reasonable. There is a big difference working 40-45 hours a week (including calls/post call days off) working 55-60 hours.

That’s an extra 20% of workload.

If they are paying you 400k high pace for 55-60 hours of workload with fewer fringe benefits.

And a academic job pays 330k for 40-45 hours plus fringe state benefits.
I’d rather take the at the academic place

I dunno Two of my buddies got really screwed with sheridan/envision a few years ago. He was literally working 68 hours in house for 375k/8 weeks. Plus beeper time

. He logged his time and showed it to them after they said “show us the proof”. They didn’t believe him. Than believed Him after it was electronically logged. Still they didn’t pay him for all the free work he did.

Keep in mind. A lot of Sheridan places that have high turnover also have rogue chiefs and vice chiefs. So that doesn’t help. If you have a fair Chief who is equitable with the schedules. It can be decent place because staffing should be adequate cause left turnover. Sheridan gives the chiefs a lot of leeway how to run a practice locally.

hint hint: If the chiefs are not doing equal calls that’s a big red flag. Especially if place is short staff.

Solution to the above problem:
1)Negotiate an hourly wage
2) They can keep me working til the cows come home. The longer they have me work the longer my car will be.
3) Solved.
4) Thank you!

 

[ans2021]

I heard that it's salary plus time after like 3 or 5? Maybe each state is different with different contracts. I wonder if it's nice to have someone take care of your overhead plus getting benefits where some private practice you're paying for both out of pocket.

 

[chocomorsel]

Oh thank God. You finally got rid of him!
Halleluyer!!!!

 

[deleted162650]

I wonder if it's nice to have someone take care of your overhead plus getting benefits where some private practice you're paying for both out of pocket.

SMH

Some people just don’t get it.

 

[Leinie]

SMH

Some people just don’t get it.

It's why these AMCs can get a foothold. Too many docs today don't want to think about "business".

 

[Mikkel]

I wonder if it's nice to have someone take care of your overhead plus getting benefits where some private practice you're paying for both out of pocket.

"Overhead" is AMC-speak for "profit".

 

[mmag]

I heard that it's salary plus time after like 3 or 5? Maybe each state is different with different contracts. I wonder if it's nice to have someone take care of your overhead plus getting benefits where some private practice you're paying for both out of pocket.

If you bring in $100 of billing and get paid $100 - employer taxes/office costs/billing - benefits/retirement = $80 on W2, would you be less happy than if a AMC pays you a $60 salary and takes care your overhead+ benefits with a $10 bonus for work after 5pm (with the tagline we take care of the yucky business side of medicine so you can focus on patients)?

Sure you can win a hand or two but statistically over the long haul the house always wins.

 

[Status Sciaticus]

If you bring in $100 of billing and get paid $100 - employer taxes/office costs/billing - benefits/retirement = $80 on W2, would you be less happy than if a AMC pays you a $60 salary and takes care your overhead+ benefits with a $10 bonus for work after 5pm (with the tagline we take care of the yucky business side of medicine so you can focus on patients)?

Sure you can win a hand or two but statistically over the long haul the house always wins.

This would depend on how many hours per week it took you to take care of the managerial side of your business. If its automated and youre a quick study, then going it without an AMC helps, but if youre routinely adding 5 hours per week to get that extra $20, it may just be more feasible to work those hours (if theyre less than the hours it takes you to do the finances) in the OR.

FWIW, I agree with you on physicians needing to learn the business side of anesthesia management.

 

[deleted162650]

This would depend on how many hours per week it took you to take care of the managerial side of your business. If its automated and youre a quick study, then going it without an AMC helps, but if youre routinely adding 5 hours per week to get that extra $20, it may just be more feasible to work those hours (if theyre less than the hours it takes you to do the finances) in the OR.

FWIW, I agree with you on physicians needing to learn the business side of anesthesia management.

The AMC is never providing their managerial services "at cost." They are always extracting their pound of flesh over and above any dubious "service" they are providing.

 

[mmag]

This would depend on how many hours per week it took you to take care of the managerial side of your business. If its automated and youre a quick study, then going it without an AMC helps, but if youre routinely adding 5 hours per week to get that extra $20, it may just be more feasible to work those hours (if theyre less than the hours it takes you to do the finances) in the OR.

FWIW, I agree with you on physicians needing to learn the business side of anesthesia management.

If you are 1099/K1 then yes you will spend time on the paperwork and managerial side but this is would be reflected in lower office and billing costs as well as balanced out by the huge number of deductions and other tax advantaged things you can do with retirement.

Typical medium to large sized PP will take care of the managerial side (reflected in overhead) so the average partner spends maybe 20 min a month filling out paperwork to get reimbursement for CME and what not. No funding of multi levels of nonclinical VPs, directors of X, and the c suite.

 

[Mikkel]

If you bring in $100 of billing and get paid $100 - employer taxes/office costs/billing - benefits/retirement = $80 on W2, would you be less happy than if a AMC pays you a $60 salary and takes care your overhead+ benefits with a $10 bonus for work after 5pm (with the tagline we take care of the yucky business side of medicine so you can focus on patients)?

Sure you can win a hand or two but statistically over the long haul the house always wins.

You don't need a mega corporation to figure out how to run your anesthesia group.

It's one of the simplest businesses to run. You can have a few people within the group get a stipend to help run things, and pay others some to do oversight.

This would depend on how many hours per week it took you to take care of the managerial side of your business. If its automated and youre a quick study, then going it without an AMC helps, but if youre routinely adding 5 hours per week to get that extra $20, it may just be more feasible to work those hours (if theyre less than the hours it takes you to do the finances) in the OR.

Taking a few hours a week to manage the finances is much much better than giving a faceless AMC 30-40% of your revenue every year till the day you die.

Going with an AMC is NEVER the smart business decision.

 

[aneftp]

Only way amc is a benefit if you have 70-80% Medicare plus 10% Medicaid. As private group it’s constant struggle to ask for hospital subsidy. Hospital threatens to cut subsidy often times. That’s the only way I can see an AMC making sense. Let them handle all your overhead

a friend of my practice was taken over my amc. And he’s actually getting paid higher! Than he was in private for last 3 years. But now the amc is leaving lol. Guess they figure they were losing money! Sometimes market share at expense of losing money is not a good thing.

 

[Mikkel]

Only way amc is a benefit if you have 70-80% Medicare plus 10% Medicaid. As private group it’s constant struggle to ask for hospital subsidy. Hospital threatens to cut subsidy often times. That’s the only way I can see an AMC making sense. Let them handle all your overhead

a friend of my practice was taken over my amc. And he’s actually getting paid higher! Than he was in private for last 3 years. But now the amc is leaving lol. Guess they figure they were losing money! Sometimes market share at expense of losing money is not a good thing.

That AMC probably had some other benefit by taking over a loser:

1) As a favor to other facilities in a larger system, building goodwill

2) As a negotiating tactic with insurance companies (our anesthesiologists are in 90% of facilities in a geographic area, you better sign with us or else your insured have nowhere else to go.


The subsidy cut threat is empty now that we're in Post-AMC. Hospitals know they can't just kill their existing group without getting some kind of major blowback. The AMCs have burned enough bridges with their tactics.

 

[dchz]

If you bring in $100 of billing and get paid $100 - employer taxes/office costs/billing - benefits/retirement = $80 on W2, would you be less happy than if a AMC pays you a $60 salary and takes care your overhead+ benefits with a $10 bonus for work after 5pm (with the tagline we take care of the yucky business side of medicine so you can focus on patients)?

Sure you can win a hand or two but statistically over the long haul the house always wins.

See, you think you're smart using that phrase. But I'm not sure you realize who is the house in the situation... 😵

 

[UscGhost]

AMCs tend to become involved in a few typical scenarios

1. Dysfunctional group - if there is fighting and discord amongst the group members, leading to staffing shortages. The C suite will look outside for coverage

2. Poor reimbursement - group members will game the system to make up the difference, leading to scenario #1.

3. Poor reimbursement and the group asks for a subsidy. Hospital refuses...staffing shortages then occur...and scenario #1 follows

Envision and any other AMC simply come in a salvage the situation. They benefit if a variety of possible ways..some of which are not necessarily a benefit for a small group (market leverage, etc).

I doubt most of the groups in these situations are actually nice places to work as they stand prior to AMC involvement. Sure they may be nice for the senior partners who have sold out..but not for the non-partners.

So I dont think the AMCs came in and ruined things in many cases.

 

[nimbus]

AMCs tend to become involved in a few typical scenarios

1. Dysfunctional group - if there is fighting and discord amongst the group members, leading to staffing shortages. The C suite will look outside for coverage

2. Poor reimbursement - group members will game the system to make up the difference, leading to scenario #1.

3. Poor reimbursement and the group asks for a subsidy. Hospital refuses...staffing shortages then occur...and scenario #1 follows

Envision and any other AMC simply come in a salvage the situation. They benefit if a variety of possible ways..some of which are not necessarily a benefit for a small group (market leverage, etc).

I doubt most of the groups in these situations are actually nice places to work as they stand prior to AMC involvement. Sure they may be nice for the senior partners who have sold out..but not for the non-partners.

So I dont think the AMCs came in and ruined things in many cases.

So you’re saying SDA/GCA in Denver, Valley in Phoenix, MAC in NorCal, GHA in Houston, ACI in Vegas, etc were all weak problematic groups?

 

[UscGhost]

So you’re saying SDA/GCA in Denver, Valley in Phoenix, MAC in NorCal, GHA in Houston, ACI in Vegas, etc were all weak problematic groups?

No idea. Have you spoken with the partners and non-partners? Asked them why they sold? Asked them how the new group functions versus the old group? Were there stipends? Was hospital pushing back against them? Hostile take over or was the AMC invited? Who benefited from the buyout?

If the group was an amazing place to work then there would be little incentive to sell. If they sold just for the money then it would be to the advantage of only the old partners to screw over the younger partners (Younger partners and non partners get screwed with lower pay to recoup buyout costs, ie, not a very good group).

Not that I am a particular fan of AMCs...but I have encountered just as many poorly run and predatory groups. Or groups in crap areas that are unstable no matter who would run them.

I just caution against blanket assumptions that all AMCs are terrible and all AMC run groups are terrible and the private groups were all roses and puppies prior to their arrival