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florida cool groups
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Watch out in Florida
There are a lot of garbage jobs in Florida. Very Heavy Penetration by Absentee owner groups and Anesthesia Management Companies. My Friend just got caned, fired for no reason invoking the contact's one month notice provision by a national Anesthesia Management company that decided not to pay him for his last month of work, after he fulfilled the terms of the contract and worked the entire notice period.
P.M. me for the people to avoid, Anesthesia Management Companies have piles of money, stolen from their hard working employees saved up to sue anyone who dares to tell the truth about how they screwed their ex-employees.
Chester Field
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I'm not sure about south florida (I hear it's not as nice to practice there) and I don't know of any groups per se. A newbie to the "attending" gig from my old program got what I think of as a sick job in the florida panhandle. >300,000, 7 weeks, 1:6, 40-50/week, partnership in uh.... 10 more months. Probably not as good as 3-4 years ago... but I'd certainly be having a code brown as I signed the papers.
Chester brings out some very important points....namely the concept of middlemen taking C-notes out of your back pocket.
Almost unheard of in smaller cities, like my old gig, or Mil's current gig.
That concept pisses me off to this day.
Theres a group like that in New Orleans right now.......docs are salaried, albeit pretty good salaries....but thats not the point....the point is that the doctors in the trenches doing the days, nights, weekends, holidays, would be making more $$ if they had worked out their own contract with whatever hospital.
Guess if you know that going in and are fine with it...so be it.
But realize while you're up at 2am on Christmas Eve putting in labor epidurals, some owner-dude is at home sipping Cabernet, doing his wife and making money off you at the same time. Money that should be yours, going towards your kid's private school tuition. Or your waterfront condo. Or your next thousand-shares of Garmin (GRMN).
Shoot for groups that offer equal equity within 24 months. Or look elsewhere.
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an anesthesia management company just took over a group about 1 hour from where I practice.
Immediately fired one of the anesthesiologists....no notice.
I'm not sure why hospital's would go for these contracts....it is a lose/lose/lose scenario for all involved except for the management company.
My mentor's explanation is that hospital administrators are kind of dim witted.
Immediately fired one of the anesthesiologists....no notice.
I'm not sure why hospital's would go for these contracts....it is a lose/lose/lose scenario for all involved except for the management company.
My mentor's explanation is that hospital administrators are kind of dim witted.
I'm not sure about south florida (I hear it's not as nice to practice there) and I don't know of any groups per se. A newbie to the "attending" gig from my old program got what I think of as a sick job in the florida panhandle. >300,000, 7 weeks, 1:6, 40-50/week, partnership in uh.... 10 more months. Probably not as good as 3-4 years ago... but I'd certainly be having a code brown as I signed the papers.
Sounds like a pretty nice gig, Sevo.
But let me offer some perspective for my CA-3 colleagues out there who will be searching for a job soon. And I'll offer said-perspective by a true story from my med school days.
I was working out in the archaic gym of U of Miami circa 1992 (once a gym rat, always a gym rat) with an anesthesia resident...I was a MS-4 at the time..we started talking about the anesthesia biz, and I said something like..
"Dude, if I can make 200K a year I'll be good."
...to which the anesthesia resident replied..
"Dude, why would you be satisfied with 200K if you can make 600K?"
Simple, passing conversation. But its a conversation I still remember 14 years later.
Unfortunately very few residents emerge from residency with any clue of what to look for in a contract..or what the current market is offering..something that needs to change in residency training...you've sacrificed your twentieth decade and 100-200 large to get where you're at...and yet most of you, like me back in 1996, are ready to sign just about anything. And I understand that. I've been where you are financially.
So learn from my experience/mistakes:
Are you location bound? Do you or your wife/significant other NEED to be in a certain location? Very well. Take the best contract you can find in that location. Money isnt everything. I took my current gig because my boss (wife) "needed" to be here. So I took a pay cut for location. I understand the location gig. But understand BEFORE I took the location gig I enjoyed eight years at a location-unattractive (read: nice C notes) gig.
Are you NOT LOCATION BOUND? Are you in a position where it doesnt really matter where you live? .....uhhhhhh......guess what? You mine as well be a low NFL draft pick, cuz there are deals out there that are in the 500-700-large range as partner...
...so back to what that anesthesia resident told me in U of Miami's gym back in 1992....
If you are debt-ridden and not location-restricted, there is a plethora of very lucrative deals out there right now. From a pure business standpoint, why would you not look for the highest paying job? We are doctors, not businessmen. And thats a problem. You need to think not only medically, but business savvy as well.....when you emerge from residency.
Maximize your returns if at all possible.
You've earned it.
Now its time to earn it for real.
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Why the Administration likes the Anesthesia Management Company.
1> The owner of the Anesthesia Management Company shows up once a month and takes the Administrators to the best restaurant in town and gives them an envelope full of 100 dollar bills.
2> The administrators do not have to deal with the concerns of an independent group of doctors. The Administrators can call to the Anesthesia Management Company head Liar for any complaint no matter how small and the Absentee owners will jump through hoops to fix it instantly. If a surgeon or nurse complains about an anesthesiologist the Anesthesia Management Company head Liar makes sure they are disciplined or are gone instantly. Administrators hate having to do any real work to get an OR running smoothy or having to deal with "problem" physicians credentialing or medical staff privileges issues. The Anesthesia Management Company will handle all of that for the Administration since they have the exclusive contract and will fire or remove any physician the administration does not like instantly.
3> The Anesthesia Management Company will step into any problem situation and promise to fix everything. They can by the nature of their predatory dishonest relationship with their employees make good money in place where a traditional group would not be able to make a fair income for its employees. The Anesthesia Management Company owners will not be doing any of the work so they will promise to do anything the administrators want.
From an Anesthesia Management Company web site one of the service they provide is "Retention of selected current providers," perhaps the fired anesthesiologist was not luck enough to be "Selected for Retention," due to his "attitude" i.e. he cared about patient safety over the administration or the surgeons desire to get case done quickly or perhaps he was well like by the administration and surgeons but challenged Anesthesia Management Company or their practices.
Anesthesia Management Companies are growing like wildfire and represent one of the greatest threats to our profession.
Well put, Special-K.
And many times ya get whatcha pay for....high attrition and undesirable MDs commensurate with the I-work-for-the-anesthesia-management-company contract.
There are better ways to cover operating rooms, both from a hospital standpoint and from a clinician's standpoint.
But, again, very well put, Ketamine.
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Jet... Interesting how you mentioned learning from "experience/mistake". I know how easy it is to search out sweat locals in the US- I've been looking at gaswork.com for years. For me it would be the rockie mountains (idaho, wyoming, montana) as well as the US virgin islands. Regarding the contract issue... you are right on. I wish there was some sort of time set aside during residency to learn more about "negotiating contracts". At this point I don't have a clue about contracts and subcortically I know I need to be wise to this subject.
Sounds like you really think there are job opportunities in BFE that pay $500-700 right out of residencty? Wow... That's enough to put my dream on hold for a good while. It's hard to wrap my head around that one. It almost sounds like 80's medicine. I'm under the impression, by talking to current graduating seniors of last year and this year, that things are tightening up out there. Myabe they were looking in the wrong spots. Clearly, you have a better perspective of what is going on in the field. For those jobs you mention... are you like the only anesthesiologist in a 50 mile area?
Not right outta residency. Didnt mean to imply that. But there are jobs with reasonable partnership tracks that offer equal equity within 1-3 years, with partners making in the above range.
Not all are in BFE either, but most are in smaller cities, say 50-75,000 population.
Dallas/Las Vegas are a couple of the higher paying metropolitan areas I can think of off the top of my head....
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Is there any way to find out (e.g. a website) that shows what locations are ran by an AMC? I am a third year and interested in anesthesia. Knowing this kind of information before I schedule rotations would help me focus my rotations in places that I would be able to practice in and avoid these groups. Of course, in two years, maybe those AMCs will have taken over EVERY practice, which is part of their goal I am sure.
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Anesthesia Management companies can exist anywhere. You just have to call the hospitals where you are interested and ask.
As for these companies taking over.....well, as long as there are folks who come out looking for jobs that pay an hourly rate, regardless of cases done, there will be a market for anesthesia management companies.
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As am MS3 you should work on getting into the best residency that you can. You may also want to consider if you want to choose another specialty where you have your own patients and bring money to the hospital thus giving you more power in dealing with the three thousand pound gorilla, the hospital administration. I like anesthesia but it would be nice to seen, by the administration as more that just furniture for the OR but as a source of profitable patients for the hospital like plastics, ENT or ortho. Even better would be to have the power to direct those patients to my favorite hospital or surgery center thus having some power over the administration.
I have never seen a list of location on an anesthesia management company's web site. Information is intentionally compartmentalized in an Anesthesia Management Company, you only know if it serves the boss for you to know. When I had the misfortune of working for an AMT, the owners would brag about getting new locations but only tell the state never the town name. Asking the town name provoked the lie, "We got so many opportunities there we will have work on finding the best fit for you." I.E. we do not want you to know that info, you know to much about our operation that you might tell the poor saps down there what they are in for before the AMT has totally locked up that location.
The only way to learn about Anesthesia Management Company locations is to look at gaswork to see where they are advertising. Anesthesia Management Companies often change names as people begin to recognize what bad news they are and they use recruiters extensively to hide where they are at. Many Anesthesia Management Company have wholly owned recruitment agencies going under a different name. If some one knows of a list of Anesthesia Management Companies their names and owners please PM me.
As the administration is taking money from the Anesthesia Management Company they many not tell you who has the hospital contract other than the name of the owner of Anesthesia Management Company or his recruiter. You many not learn that it is an Anesthesia Management Company until you sign on or you do some research into the place.
The Anesthesia Management Company I first worked for the owners claimed to work at that location during my interview. The recruited claimed I would be "working along side" the owners. I smelt something fishy but was blinded by the 400K plus per year that was promised. When I left less than a year latter I had only been paid about 180K per year. The owners never worked at the location, they only came up once a month to hand out the pay checks, pay off the administration and lie about how big the year end bonus would be but never put on scrubs and stepped into the OR.
Thanks for your post.
SDN Anesthesia continues to roll out information not available to residents from their residency programs.
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I agree with the above.. But i would go a step further.. the greatest threat to the profession is awarding exclusive contracts to groups period..
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This area is well litigated and would take pure luck to win a very expensive lawsuit and change the law to correct or a powerful member of congress needs to champion the cause to pass a bill through Congess.
from;
http://www.plusweb.org/Downloads/Events/Anti-kickback Article - Final.DOC
2.3.1 Exclusive Contracts
Exclusive contracts are generally recognized as one of the oldest and most accepted forms of economic credentialing, and have been legitimized in the courts for many years. The term refers to the decision by a hospital governing body to grant an exclusive contract to a single provider group to handle all of the hospitals needs in a particular specialty. Such contracts are very typically awarded for the hospital-based services, such as radiology, pathology, anesthesia, and emergency medicine. Obviously, once a hospital has awarded an exclusive contract for a particular hospital department, all other applicants for privileges in that specialty area will be turned down, regardless of their individual competence and professional qualifications.
Although exclusive contracting has been called a form of pure economic credentialing, most courts have recognized that one of the primary reasons hospitals enter into exclusive contracts is to enhance the quality of care in the department. The New Jersey case of Belmar v. Cipolla, gives a comprehensive look at the interplay between economic and quality factors in a hospitals decision to enter into an exclusive contract. In that case, the New Jersey Supreme Court upheld the decision by Community Hospital to grant an exclusive contract for anesthesia services. The court noted, as an initial matter, that a hospitals responsibility is broader than simply providing a place where sick people receive treatment. It must ensure the availability of appropriate personnel and equipment needed to provide that care:
In providing necessary treatment, a hospital must have available numerous doctors, nurses and attending staff. It must provide operating, recovery and patient rooms; as well as medicines, food, beds, and support equipment Payment of hospital bills by third-party payors (private insurance companies or governmental agencies) requires a complicated billing and collection system. State and federal regulations add to the administrative burden. In short, a hospital is a complex business vitally affected with a public interest.
The court then reviewed the benefits, from the hospitals perspective, of having an exclusive anesthesia contract. They included: better use of operating room personnel, the ability to process more operative procedures, the avoidance of fee splitting between surgeon and anesthesiologist, and better 24 hour coverage. These cited benefits have clear quality implications, and the New Jersey high court regarded them as reasonable. The court summarized: the evidence points to the conclusion that the decision to enter an exclusive contract for the provision of anesthesia services was motivated by the hospitals desire to insure a high standard of medical care.
This case illustrates that economic credentialing is not a matter of pure economics: it is a function of a hospitals decision to enter into a business relationship with a specified group of providers for the purpose of providing more efficient and higher quality care.
From;
http://www.mcguirewoods.com/news-resources/publications/commercial_litigation/peer_review.doc
B. Basic Standard.
The more flexible rule of reason, not the per se rule, is the prevailing standard of analysis in the typical privileges case involving the denial or termination of medical staff privileges. The leading case on this issue, while outside the health care field, is Northwest Wholesale Stationers, Inc. v. Pacific Stationery & Printing Co., which involved the expulsion of the plaintiff from a marketing cooperative. There, the Supreme Court held that per se treatment of such group boycotts should be limited to those situations in which the plaintiff proves that the boycotting group possesses market power or exclusive access to an element essential to effective competition. . . . [Otherwise,] the conclusion that expulsion is virtually always likely to have anticompetitive effects is not warranted.
Thus, the rule of reason has been applied to the vast majority of cases involving the termination or revocation of staff privileges. The rule of reason also has been applied to situations in which physicians have been denied privileges and excluded from practicing at a hospital.
In addition, the courts have declined to apply the per se rule to claims that staff privileges denials constitute illegal tying arrangements. In Jefferson Parish Hospital District No. v. Hyde, the plaintiff characterized a hospitals exclusive contract with an anesthesiology group as a tying arrangement. The Supreme Court held that a tying arrangement is per se illegal only where the defendant has market power over the tying product. In that case, the Court found that there was no evidence of the defendant hospitals market power in the tying product market for hospital services sufficient to force consumers to change their purchasing choice in the tied product market for anesthesia services. Thus, the rule of reason was applied. Similarly, in Scara v. Bradley Memorial Hospital, the court rejected a claim that an exclusive contract between a private anesthesiology group and the hospital was a per se illegal tying arrangement where the hospital had no economic interest in the tied product (anesthesiology services), and did not have sufficient economic power in the tying product (surgical services) to appreciably restrain competition. More recently, in County of Tuolumne v. Sonora Community Hospital, the Ninth Circuit rejected a claim that a hospitals decision to allow only obstetricians to perform C-sections was a per se illegal tying arrangement where the hospital had no economic interest in the tied product (C-section services). The Ninth Circuit also held that the plaintiffs failed to meet their burden of proof to satisfy an illegal tying agreement under a rule of reason analysis.
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Very nice summary. My mentor has formed exclusive groups around the country based on the above.
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im sure there are kickbacks involved
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Nope.
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thats whats in it for the administration.. exclusive contract.. in return .. a kick back they are not gonna tell you that though..
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How do you know?
Have you done one?
Exclusive contracts benefits the members of the group.
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of course i havent done one.. I welcome competition not shun it; its easy to make a lot of money when you shut out all the competition who may be better than you.
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That 's the whole point of exclusive contracts...competition...the best wins the contract, and keeps it ....the losers whine about how they are being screwed ......
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competition does not get you the exclusive contract... kickbacks do... If you really believe its the competition you havent been around much..
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There is something wrong with you....You say you know the business but you say things that make no sense whatsoever...
Kickbacks???? Anesthesia groups PAYING the hospital?
over 70% of anesthesia groups a subsidized by the hospital....meaning we GET money FROM the hospital while getting an exclusive contract....
Anesthesia Management Companies GET money FROM the hospital......
That's competition....the hospitals GIVE money to the GROUPS that provide the best service...
The only people who get screwed are those who can't cut it .....don't play well in sandboxes....or has other personality problems.
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Competition has nothing to do with getting an exclusive contract it is all about more money in the pockets of key hospital administrators.
The only people who get screwed are those who are honest; who don't believe in lying to their employees and who do not feel comfortable breaking the law by bribing hospital administrators to get lucrative contracts.
Anesthesia Management Companies dont pay the hospital they pay the gate keepers the key administrators. The key administrators award the contract which pays the Management Company and pays a fee to manage the anesthesia services. Then the Anesthesia management company pays off the key administrators to keep the exclusive contract.
I have head of private surgery centers that were requesting up front payment for an exclusive anesthesia contract. For example one million dollars to get a five year exclusive contract at a new surgery center.
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Where are you guys working?????
Where are all these crooks????
What am I missing????
My mentor does not do business that way.....Money flows from the hospital to the group...not the other way around....
I have an exclusive contract with my hospital.....and they give us a significant subsidy to keep it that way.
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Why would a hospital CEO/administrator give a subsidy to keep an anesthesiologist. Why not just hire another anesthesiologist on the hospital's terms? As long as the anesthesiologist is board certified and has no "incidents", he would be qualified.
I can see a hospital giving a subsidy to a surgeon who would bring procedures to the hospital.
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The hospital administrators do not want to do their job but would rather pay an Anesthesia Management Company to run the anesthesia department. "Administrators hate having to do any real work to get an OR running smoothy or having to deal with "problem" physicians credentialing or medical staff privileges issues."
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Chesterfield,
Out of curiosity, how many jobs have you had?
What part of the country do you live?
How many years out of residency?
Out of curiosity, how many jobs have you had?
What part of the country do you live?
How many years out of residency?
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Going for the low bid? Is that what you're saying the hospital should do?
It's a little more complex than that....I suppose if there were a glutton of skilled, trusted, affable, and fast anesthesiologist, then I suppose that could happen....but as it stands right now, there are more schmucks out there than ones surgeons would trust with their patients.
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