Group in negotiations... how concerned should I be?

[Lab Lover]

---

Members do not see this ad.

I would say it is more stable than it has ever been. There is far less competition trying to get into the anesthesia business. When nobody knows how much money you make, nobody is coming for it.

I mean I understand people whining about how their job sucks and they don't see anything good advertised and whatever. But there are good (and even great) private groups still out there.

I was talking about prevalence. You are talking about desirability.

 

[Mman]

I was talking about prevalence. You are talking about desirability.

you underestimate the prevalence

15 years ago there were a lot of private jobs about to get bought out. That is no longer the case.

 

[Yossarian Lives]

No offense, but you are simply uneducated at what jobs are possible. The great ones never advertise. I never really "sacrificed" anything. Our partnership track docs make a reasonable salary, get equal pick of vacation, equal assignments during the day, and equal call. After a few years they then get a big pay bump. Nobody has ever left during their partnership track so I assume it is not terribly onerous.

lol no way we are paying a new hire what we make. Sorry. My group’s risk of losing our contract is very very slim. There are still some decent partner track jobs out there.

In fairness to my group, this has historically been the situation here. The call schedule is the same and the payoff once you hit partner is worth the below market pay of the pre-partner years. I was promised on the interview trail that the group was very secure.

I guess things changed. I'm not sure when they knew there would be problems with the contract negotiations, so I don't know if they hid things from me when I interviewed. I know I would not have signed if I knew about it. The worst thing is, they are still interviewing for partnership positions with all of this going on.

 

[PainInTheAnes]

I was promised on the interview trail that the group was very secure.

Pretty common discussion on here that there's no security, no matter what is promised or said. Lesson learned unfortunately.

They do not care about you, your family, or your livelihood. Full stop.

 

[ucladoc2b]

Pretty common discussion on here that there's no security, no matter what is promised or said. Lesson learned unfortunately.

They do not care about you, your family, or your livelihood. Full stop.

With almost all groups subsidized, this is mostly the case. Maybe some will have better luck. But for the most part, groups are only secure for the length of their contract.

All it takes is a new CEO, CMO or even a new OR manager.

 

[aneftp]

No offense, but you are simply uneducated at what jobs are possible. The great ones never advertise. I never really "sacrificed" anything. Our partnership track docs make a reasonable salary, get equal pick of vacation, equal assignments during the day, and equal call. After a few years they then get a big pay bump. Nobody has ever left during their partnership track so I assume it is not terribly onerous.

If it’s a top 5-6 city. (Within 20/30 min of airport) and not boonies. U are one of the rare ones left.

 

[NPJR]

The way to succeed in this market is to be mobile….

1000%. Not great on having a nice stable family life. If you want that you have to make SERIOUS concessions.

 

[NPJR]

When nobody knows how much money you make, nobody is coming for it.

I mean I understand people whining about how their job sucks and they don't see anything good advertised and whatever. But there are good (and even great) private groups still out there.

The management of your organization is ALWAYS looking for solutions: one of those solutions is to solve the problem of your big salary. They are looking for someone or people to undercut you and eventually they will find that person(s).

 

[NPJR]

My group’s risk of losing our contract is very very slim.

That's what many people have said before relocating. What makes your organization different?

 

[aneftp]

That's what many people have said before relocating. What makes your organization different?

There are practices where admin has looked for other management companies. The good administrators will see the current group is stable and the grass is not greener on the other side.

That’s a good hospital administration.

The bad ones think they can save money by going with an amc that over promises and under delivers

 

[PainInTheAnes]

That's what many people have said before relocating. What makes your organization different?

They mix the lidocaine IN the propofol, not BEFORE the propofol.

Hospitals know the difference, it comes in their patient reviews. That technique is worth millions to them.

 

[ERRES2288]

you underestimate the prevalence

15 years ago there were a lot of private jobs about to get bought out. That is no longer the case.

I’m curious. Do you get a large subsidy from hospital or just have incredible payer mix? Has to be one or the other to be making the big bucks.

 

[DG51]

I’m curious. Do you get a large subsidy from hospital or just have incredible payer mix? Has to be one or the other to be making the big bucks.

Skimming millions of dollars off their pre-partners likely helps as well!

 

[ambiturner]

I’m curious. Do you get a large subsidy from hospital or just have incredible payer mix? Has to be one or the other to be making the big bucks.

Based on previous posts I think their group makes a lot on non-anesthesia billing, ie surgicenters/pain/real estate/etc related to the practice. If so, that’s something with a real value that’s worth a real buy in.

 

[aneftp]

Skimming millions of dollars off their pre-partners likely helps as well!

yup. My sister first practice
120/140/160/180/200k (1998-2003)

While partners made 500-550k

That’s 1.5 million skimmed off one doc. And they did it to multiple docs.

It takes around 5-7 years just to break even after becoming a partner (that’s assuming u even become a partner)

That stuff doesn’t work these days. Paying employee partnership track docs 2.5x less than what partners make

That’s why the usap partnership fiasco imploding in most parts of the usap buyout area. The partners are not making 2.5 x the employees partnership tracks are making. Per hours wise. The partners are making LESS than the employees. That’s when you gotta bail.

The employees have figured it out.

Successfully partnership models only work when there is money to be spread around for the partners while they sleep at night or on the boat on weekends and while their employees work and slave away.

 

[PainInTheAnes]

yup. My sister first practice
120/140/160/180/200k (1998-2003)

While partners made 500-550k

That’s 1.5 million skimmed off one doc. And they did it to multiple docs.

It takes around 5-7 years just to break even after becoming a partner (that’s assuming u even become a partner)

That stuff doesn’t work these days. Paying employee partnership track docs 2.5x less than what partners make

That’s why the usap partnership fiasco imploding in most parts of the usap buyout area. The partners are not making 2.5 x the employees partnership tracks are making. Per hours wise. The partners are making LESS than the employees. That’s when you gotta bail.

The employees have figured it out.

Successfully partnership models only work when there is money to be spread around for the partners while they sleep at night or on the boat on weekends and while their employees work and slave away.

They only work when there wasn’t competition for workers. Partnerships are only necessary when there’s less job security elsewhere. It’s the carrot. Now everywhere has plenty of carrots due to competition for bodies. Otherwise just go be your own partnership as a locums or get paid and benefits with better schedule as a hospital employee

 

[NPJR]

Skimming millions of dollars off their pre-partners likely helps as well!

There used to be a steady stream of suckers to take the "partnership track", not so much anymore.
Edit: I wouldn't call them suckers, because that's how it was back then. Every hospital had their partnership scheme. And it was all greasy.

 

[Arch Guillotti]

That's what many people have said before relocating. What makes your organization different?

Longstanding group.
Hospital employs CRNAs.
No stipend.
Long term admin.
Admin who understand that the OR is a cash cow and screwing up anesthesia group isn’t worth the hassle.
Only picking important battles.

 

[ERRES2288]

There used to be a steady stream of suckers to take the "partnership track", not so much anymore.
Edit: I wouldn't call them suckers, because that's how it was back then. Every hospital had their partnership scheme. And it was all greasy.

There were certainly fair partnerships around. Had a family member in one before selling to Mednax (one of the early deals). Year 1/2 350/400 then partners making 650ish. This was in 2010 so big bucks. Fair and everyone equal. Everyone made partner. In fact recruiting was hard. Not a desirable location and they worked hard.

 

[ERRES2288]

Longstanding group.
Hospital employs CRNAs.
No stipend.
Long term admin.
Admin who understand that the OR is a cash cow and screwing up anesthesia group isn’t worth the hassle.
Only picking important battles.

Without a stipend I would guess you are making less than many employed docs on a per hour basis. Certainly locums.

 

[ucladoc2b]

Longstanding group.
Hospital employs CRNAs.
No stipend.
Long term admin.
Admin who understand that the OR is a cash cow and screwing up anesthesia group isn’t worth the hassle.
Only picking important battles.

The hospital employing the CRNAs is a type of subsidy indirectly. As long as you are able to recruit and retain on this model, you are likely fine.

Non short-sighted, non short time, intelligent admin is probably your key. It’s rare.

 

[Arch Guillotti]

Without a stipend I would guess you are making less than many employed docs on a per hour basis. Certainly locums.

I have no idea. I work a decent amount of hours and have a decent amount of time off. I crush all of them in total compensation though😳

 

[NPJR]

I have no idea. I work a decent amount of hours and have a decent amount of time off. I crush all of them in total compensation though😳

You must be in quite a desirable area (payer mix) to be able to make it without a stipend and your income not suffering.

 

[aneftp]

Longstanding group.
Hospital employs CRNAs.
No stipend.
Long term admin.
Admin who understand that the OR is a cash cow and screwing up anesthesia group isn’t worth the hassle.
Only picking important battles.

That’s the absolute key. The crna salaries are out of control these days.

Hospitals has got to be eating the cost in return of OR facility fee revenues.

So ur admin understands the game unlike other hospital admin who’s ideology is based on prior old thinking that anesthesia needs to support themselves without any hospital help.

 

[CopaceticOne]

So ur admin understands the game unlike other hospital admin who’s ideology is based on prior old thinking that anesthesia needs to support themselves without any hospital help.

Exactly. This comes from the fact that the money has shifted disproportionately from professional fees to facility fees. Hospitals are frequently and willfully myopic in appreciating that they have contributed to the need for subsidizing anesthesia services because of the contract games they played with insurers to ensure those fat facility fees.

 

[aneftp]

Exactly. This comes from the fact that the money has shifted disproportionately from professional fees to facility fees. Hospitals are frequently and willfully myopic in appreciating that they have contributed to the need for subsidizing anesthesia services because of the contract games they played with insurers to ensure those fat facility fees.

Correct. I know this sounds like a broken record. That certain law passed in 2010 I always talk about favored hospitals over physicians. And it gets worse and worse every year. And now the no surprises act is a death blow to small physician private practices.

 

[Arch Guillotti]

And now the no surprises act is a death blow to small physician private practices.

Not necessarilly. For sure it isn’t great you just need to have the resources to fight the big dogs.

 

[Lab Lover]

Correct. I know this sounds like a broken record. That certain law passed in 2010 I always talk about favored hospitals over physicians. And it gets worse and worse every year. And now the no surprises act is a death blow to small physician private practices.

Yup. Send most of the money to hospitals. Let them figure out how to spend it to take care of the patients.

 

[Shimmy8]

Longstanding group.
Hospital employs CRNAs.
No stipend.
Long term admin.
Admin who understand that the OR is a cash cow and screwing up anesthesia group isn’t worth the hassle.
Only picking important battles.

No one is immune to the macro market…but if I had to pick a way to survive for the long haul…this is the way. 🫡

 

[Mman]

I’m curious. Do you get a large subsidy from hospital or just have incredible payer mix? Has to be one or the other to be making the big bucks.

at least 50% of my income is from non clinical activities. Own your own real estate, own radiology, own labs, owning surgicenters, etc.

 

[ryanjmy]

Longstanding group.
Hospital employs CRNAs.
No stipend.

Free CRNA labor is a form of a stipend.

 

[ERRES2288]

at least 50% of my income is from non clinical activities. Own your own real estate, own radiology, own labs, owning surgicenters, etc.

Makes sense and very unique set up. Your partnership is much more valuable than buying into a share of accounts receivable.

 

[NPJR]

Free CRNA labor is a form of a stipend.

Not really, because you split the bill with the CRNA equally. If they were giving that to you w/o you giving away the CRNA fee maybe

 

[Mman]

Makes sense and very unique set up. Your partnership is much more valuable than buying into a share of accounts receivable.

Well I mean AR has an exact and knowable monetary value that can be into and bought out of. If we all get paid on the day of service there would be no AR and no need for the math exercise, but we don't so there is definitely value to that.