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

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Yossarian Lives

Yossarian Lives

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Ok, so I'm a new grad on a pre-partnership track with, what I thought was a secure group in the Midwest (1 site, not West Michigan). I did not realize the situation this group was in until I had already moved here and started the job. We are working more hours than I anticipated, but more importantly, the group is in negotiations with the hospital and it's clear that they want to make us hospital imployed.

I don't really have any geographic links to this area, my family is farther east. I'm on the hook for 50k if I leave during the prepartner period, but I'm worried that even if they negotiate a 1 year contract, the group will still be finished before I ever get the benefits of being a partner.

Hoping to get advice from the collective wisdom here. Do I hold tight and hope that things work out long enough for me to make partner (I only make low 400s pre partner), should I take the 50k hit and move on to something more secure, or should I wait and see what happens with this round of negotiations (even though the contract wouldn't last until I'm a partner).

I feel like I have 3 bad choices. I have no connections to this state, so it's purely a financial choice.
 
For other soon-to-be grads that are reading this, this is why the recommendation is to not join a partnership track unless everything is equal day 1 and you are just getting voting rights.

Idk the specifics but it is normal to renegotiate contracts every couple of years. If you like the area stay and see what happens. If you don’t then get out. 50k isn’t going to make or break you in the current environment. And CRNAs are making 400k with less hours then what it sounds like you’re working
 
Yossarian Lives said:
Ok, so I'm a new grad on a pre-partnership track with, what I thought was a secure group in the Midwest (1 site, not West Michigan). I did not realize the situation this group was in until I had already moved here and started the job. We are working more hours than I anticipated, but more importantly, the group is in negotiations with the hospital and it's clear that they want to make us hospital imployed.

I don't really have any geographic links to this area, my family is farther east. I'm on the hook for 50k if I leave during the prepartner period, but I'm worried that even if they negotiate a 1 year contract, the group will still be finished before I ever get the benefits of being a partner.

Hoping to get advice from the collective wisdom here. Do I hold tight and hope that things work out long enough for me to make partner (I only make low 400s pre partner), should I take the 50k hit and move on to something more secure, or should I wait and see what happens with this round of negotiations (even though the contract wouldn't last until I'm a partner).

I feel like I have 3 bad choices. I have no connections to this state, so it's purely a financial choice.
Click to expand...
IMO- stick it out and see how it goes. If everyone becomes hospital employee, then might be best case scenario for you.

And just become locums/per diem and do 1099. You will be much happier.
 
Yossarian Lives said:
Ok, so I'm a new grad on a pre-partnership track with, what I thought was a secure group in the Midwest (1 site, not West Michigan). I did not realize the situation this group was in until I had already moved here and started the job. We are working more hours than I anticipated, but more importantly, the group is in negotiations with the hospital and it's clear that they want to make us hospital imployed.

I don't really have any geographic links to this area, my family is farther east. I'm on the hook for 50k if I leave during the prepartner period, but I'm worried that even if they negotiate a 1 year contract, the group will still be finished before I ever get the benefits of being a partner.

Hoping to get advice from the collective wisdom here. Do I hold tight and hope that things work out long enough for me to make partner (I only make low 400s pre partner), should I take the 50k hit and move on to something more secure, or should I wait and see what happens with this round of negotiations (even though the contract wouldn't last until I'm a partner).

I feel like I have 3 bad choices. I have no connections to this state, so it's purely a financial choice.
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If you don't have any family obligation, etc, You better start looking for other jobs. If the so-called negotiation works out you get your partnership and if it doesn't then you will have some idea about your next job by then.
 
gasdoc2025 said:
If you don't have any family obligation, etc, You better start looking for other jobs. If the so-called negotiation works out you get your partnership and if it doesn't then you will have some idea about your next job by then.
Click to expand...


Can also reach back to groups they already know from the recent job hunt.
 
Yossarian Lives said:
Ok, so I'm a new grad on a pre-partnership track with, what I thought was a secure group in the Midwest (1 site, not West Michigan). I did not realize the situation this group was in until I had already moved here and started the job. We are working more hours than I anticipated, but more importantly, the group is in negotiations with the hospital and it's clear that they want to make us hospital imployed.

I don't really have any geographic links to this area, my family is farther east. I'm on the hook for 50k if I leave during the prepartner period, but I'm worried that even if they negotiate a 1 year contract, the group will still be finished before I ever get the benefits of being a partner.

Hoping to get advice from the collective wisdom here. Do I hold tight and hope that things work out long enough for me to make partner (I only make low 400s pre partner), should I take the 50k hit and move on to something more secure, or should I wait and see what happens with this round of negotiations (even though the contract wouldn't last until I'm a partner).

I feel like I have 3 bad choices. I have no connections to this state, so it's purely a financial choice.
Click to expand...
You probably will never get the benefits of being a partner. Most likely, but not certain- the partners will get a buyout that you will not participate in. Going forward you will then be equal in terms of pay/hours. It is unlikely but not impossible that if they like you and they are decent people that they will make you whole in some way. Wouldn’t hold my breath though. How many partners and how many people in your position? It is easier to do the right thing if it doesn’t cost them too much. I would start looking.
 
Gator7 said:
For other soon-to-be grads that are reading this, this is why the recommendation is to not join a partnership track unless everything is equal day 1 and you are just getting voting rights.
Click to expand...

This is good advice but to put it another way anticipate working at several practices during your career. The days of staying at one hospital for your whole career are over. Factor that in when purchasing a house. You want something you can unload quickly without taking a major hit.

We’re mostly interchangeable. It’s one of the best and worst things about anesthesiology
 
Lab Lover said:
You probably will never get the benefits of being a partner. Most likely, but not certain- the partners will get a buyout that you will not participate in. Going forward you will then be equal in terms of pay/hours. It is unlikely but not impossible that if they like you and they are decent people that they will make you whole in some way. Wouldn’t hold my breath though. How many partners and how many people in your position? It is easier to do the right thing if it doesn’t cost them too much. I would start looking.
Click to expand...
Not sure how frequently hospitals actually "buy out" an anesthesia group. I would think it more likely that the group just folds and divides its assets among the partners (accounts receivables, etc. IF they have any), and the hospital offers individual contracts or employment agreements with each doc or anesthetist.

The hospital is not typically under any obligation to hire ALL of the providers in a group, so there may not be a guarantee of employment, partner in the old group or not.
 
jwk said:
Not sure how frequently hospitals actually "buy out" an anesthesia group. I would think it more likely that the group just folds and divides its assets among the partners (accounts receivables, etc. IF they have any), and the hospital offers individual contracts or employment agreements with each doc or anesthetist.

The hospital is not typically under any obligation to hire ALL of the providers in a group, so there may not be a guarantee of employment, partner in the old group or not.
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Correct

Hospitals may give some incentives for pre existing providers to stay. But hospitals anesthesia only contracts are valued at zero in 98% of the country.
 
jwk said:
Not sure how frequently hospitals actually "buy out" an anesthesia group. I would think it more likely that the group just folds and divides its assets among the partners (accounts receivables, etc. IF they have any), and the hospital offers individual contracts or employment agreements with each doc or anesthetist.

The hospital is not typically under any obligation to hire ALL of the providers in a group, so there may not be a guarantee of employment, partner in the old group or not.
Click to expand...


Correct. This isn’t the old PE buy out where an unsubsidized practice had a great payer mix. That by and large is extinct. Typically, the contract has an end date and is allowed to expire.

Most of the time, all the current anesthesiologists will be offered (due to the large attrition during the transition), and the hospital will often heavily incentivize them to join (especially in this market). Not getting a contract would be due to pretty extenuating circumstances.

Gator7 said:
For other soon-to-be grads that are reading this, this is why the recommendation is to not join a partnership track unless everything is equal day 1 and you are just getting voting rights.

Idk the specifics but it is normal to renegotiate contracts every couple of years. If you like the area stay and see what happens. If you don’t then get out. 50k isn’t going to make or break you in the current environment. And CRNAs are making 400k with less hours then what it sounds like you’re working
Click to expand...

Buy-ins should be gone except in very limited circumstances (for example, paying into a self-insured malpractice fund or extremely high partner pay NOT due to associate buy ins).

Unsure if the bonus is repayable if the practice essentially folds.
 
jwk said:
Not sure how frequently hospitals actually "buy out" an anesthesia group. I would think it more likely that the group just folds and divides its assets among the partners (accounts receivables, etc. IF they have any), and the hospital offers individual contracts or employment agreements with each doc or anesthetist.
Click to expand...
This 100%. There's nothing to buy out. The hospital just terminates the contract and that's it.

And the legacy mindset of the value of "the contracts" being some high value thing warranting a buy in - this notion should be nullified these days. The contract can be terminated in short order. See the recent thread on CAAMG/LB Memorial for example.
 
kidthor said:
This 100%. There's nothing to buy out. The hospital just terminates the contract and that's it.

And the legacy mindset of the value of "the contracts" being some high value thing warranting a buy in - this notion should be nullified these days. The contract can be terminated in short order. See the recent thread on CAAMG/LB Memorial for example.
Click to expand...
Yup. Partnership tracks are largely useless these days.

Depending on the timeline, buy in amount,etc, it can take 5-10 years before you come out ahead on a partnership track. So the chance that you stick around that long, and the group doesn't implode, are small
 
I think most groups would hear your story and think nothing of your short stay. If anything, I’d maybe think you were more appealing because you were smart enough to read the tea leaves and get out.
 
Yossarian Lives said:
Ok, so I'm a new grad on a pre-partnership track with, what I thought was a secure group in the Midwest (1 site, not West Michigan). I did not realize the situation this group was in until I had already moved here and started the job. We are working more hours than I anticipated, but more importantly, the group is in negotiations with the hospital and it's clear that they want to make us hospital imployed.

I don't really have any geographic links to this area, my family is farther east. I'm on the hook for 50k if I leave during the prepartner period, but I'm worried that even if they negotiate a 1 year contract, the group will still be finished before I ever get the benefits of being a partner.

Hoping to get advice from the collective wisdom here. Do I hold tight and hope that things work out long enough for me to make partner (I only make low 400s pre partner), should I take the 50k hit and move on to something more secure, or should I wait and see what happens with this round of negotiations (even though the contract wouldn't last until I'm a partner).

I feel like I have 3 bad choices. I have no connections to this state, so it's purely a financial choice.
Click to expand...
Are you at an academic center?

I went through a similar situation as a junior attending at an academic center. We were a private totally equitable group, and hospital was negotiating with us for terms of employment. It was messy because the hospital was negotiating with other groups behind our back, and we were also approaching other groups to see what terms of a buyout would be. Finalizing everything was supposed to take 6 months but ended up taking almost 2 years. In the end, hospital took us and salary and terms of employment basically stayed the same (but again this was a totally equitable group).

I decided to leave, but most of my former partners are still there in the new arrangement and happy. The horizon on closing this deal may be longer than you think. Alternatively it may not matter bc you won't get "bought out," you'll just get new reimbursement arrangements. Just stay involved and make sure it's fair to your situation.
 
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Discuss with a contract lawyer. Your contract may be void upon sale of the original entity unless there’s some sort of succession clause.
 
Yossarian Lives said:
Ok, so I'm a new grad on a pre-partnership track with, what I thought was a secure group in the Midwest (1 site, not West Michigan). I did not realize the situation this group was in until I had already moved here and started the job. We are working more hours than I anticipated, but more importantly, the group is in negotiations with the hospital and it's clear that they want to make us hospital imployed.

I don't really have any geographic links to this area, my family is farther east. I'm on the hook for 50k if I leave during the prepartner period, but I'm worried that even if they negotiate a 1 year contract, the group will still be finished before I ever get the benefits of being a partner.

Hoping to get advice from the collective wisdom here. Do I hold tight and hope that things work out long enough for me to make partner (I only make low 400s pre partner), should I take the 50k hit and move on to something more secure, or should I wait and see what happens with this round of negotiations (even though the contract wouldn't last until I'm a partner).

I feel like I have 3 bad choices. I have no connections to this state, so it's purely a financial choice.
Click to expand...

i would see what else is out there, and then see what the hospital offers you guys.

if you find something else out there that is great, you can tell your current guys to make you partner immediately or your out, especially if the process is taking forever and your missing out on bigger money - probably somewhere cooler
 
Thank you to all of the replies so far. Hoping my experience can help some future resident picking their first job.

jwk said:
Not sure how frequently hospitals actually "buy out" an anesthesia group. I would think it more likely that the group just folds and divides its assets among the partners (accounts receivables, etc. IF they have any), and the hospital offers individual contracts or employment agreements with each doc or anesthetist.

The hospital is not typically under any obligation to hire ALL of the providers in a group, so there may not be a guarantee of employment, partner in the old group or not.
Click to expand...

It wouldn't be a buyout. My understanding is that they want us to become hospital-employed or somehow cost less money.


ucladoc2b said:
Correct. This isn’t the old PE buy out where an unsubsidized practice had a great payer mix. That by and large is extinct. Typically, the contract has an end date and is allowed to expire.

Most of the time, all the current anesthesiologists will be offered (due to the large attrition during the transition), and the hospital will often heavily incentivize them to join (especially in this market). Not getting a contract would be due to pretty extenuating circumstances.



Buy-ins should be gone except in very limited circumstances (for example, paying into a self-insured malpractice fund or extremely high partner pay NOT due to associate buy ins).

Unsure if the bonus is repayable if the practice essentially folds.
Click to expand...

For the "buy-in period" I make considerably less than our partners, but with the "promise" of a significant bump in pay once I make partner. It seemed like a good deal if I were to spend my career here. The reality is, it's hard for me to imagine this group still being here in 5-10 years, even if we survive this round of contract negotiations. I was more or less blindsided by this right as I started in July or I wouldn't have chosen this job.


ace_inhibitor111 said:
Assuming OP does want to switch is doing it so soon after starting a bad look? When would be a good time to jump ship
Click to expand...

This is one of my biggest worries. I never would have imagined I would be thinking of leaving so soon into my first job.

UscGhost said:
Yup. Partnership tracks are largely useless these days.

Depending on the timeline, buy in amount,etc, it can take 5-10 years before you come out ahead on a partnership track. So the chance that you stick around that long, and the group doesn't implode, are small
Click to expand...

I wish I had read this as a resident.


secretasianman said:
If you are unable to complete the prepartner period , ie if the group falls apart and loses the contract with the hospital, would you be liable to pay the $50k back?
Click to expand...

I will talk to a lawyer if it gets to that point.
 
Hoya11 said:
i would see what else is out there, and then see what the hospital offers you guys.

if you find something else out there that is great, you can tell your current guys to make you partner immediately or your out, especially if the process is taking forever and your missing out on bigger money - probably somewhere cooler
Click to expand...

Is there a downside in exploring other jobs before I know if I'm going to jump ship?
 
DolphinVA said:
Are you at an academic center?

I went through a similar situation as a junior attending at an academic center. We were a private totally equitable group, and hospital was negotiating with us for terms of employment. It was messy because the hospital was negotiating with other groups behind our back, and we were also approaching other groups to see what terms of a buyout would be. Finalizing everything was supposed to take 6 months but ended up taking almost 2 years. In the end, hospital took us and salary and terms of employment basically stayed the same (but again this was a totally equitable group).

I decided to leave, but most of my former partners are still there in the new arrangement and happy. The horizon on closing this deal may be longer than you think. Alternatively it may not matter bc you won't get "bought out," you'll just get new reimbursement arrangements. Just stay involved and make sure it's fair to your situation.
Click to expand...

I'm not sure I can handle 2 years of uncertainty. Especially if that is 2 years of pre-partnership pay for a partnership that doesn't exist.
 
Gator7 said:
this is why the recommendation is to not join a partnership track unless everything is equal day 1 and you are just getting voting rights.
Click to expand...

I mean that might be your personal recommendation, but it isn't everyone's. Every single partnership track doc we have hired has ended up better financially than they would have in any non partnership track job they could have taken instead of joining us.

The devil is in the details. IMHO most of the top heavy pyramid shaped bad partnership track places that looked to screw young people over have gone by the wayside over the last 10-15 years.
 
Mman said:
I mean that might be your personal recommendation, but it isn't everyone's. Every single partnership track doc we have hired has ended up better financially than they would have in any non partnership track job they could have taken instead of joining us.

The devil is in the details. IMHO most of the top heavy pyramid shaped bad partnership track places that looked to screw young people over have gone by the wayside over the last 10-15 years.
Click to expand...
What region of the country are you in? The market is definitely not equal across the country.
 
Yossarian Lives said:
For the "buy-in period" I make considerably less than our partners, but with the "promise" of a significant bump in pay once I make partner. It seemed like a good deal if I were to spend my career here. The reality is, it's hard for me to imagine this group still being here in 5-10 years, even if we survive this round of contract negotiations. I was more or less blindsided by this right as I started in July or I wouldn't have chosen this job.
Click to expand...

You ended up with essentially a very below market call-taking job. You may end up doing better if you end up going in house.
 
Hoya11 said:
i would see what else is out there, and then see what the hospital offers you guys.

if you find something else out there that is great, you can tell your current guys to make you partner immediately or your out, especially if the process is taking forever and your missing out on bigger money - probably somewhere cooler
Click to expand...

Mman said:
I mean that might be your personal recommendation, but it isn't everyone's. Every single partnership track doc we have hired has ended up better financially than they would have in any non partnership track job they could have taken instead of joining us.

The devil is in the details. IMHO most of the top heavy pyramid shaped bad partnership track places that looked to screw young people over have gone by the wayside over the last 10-15 years.
Click to expand...
Those top heavy practices got the heck out of dodge 10 years ago. They all took the cash.
 
Here’s a crazy idea, feel free to shoot me down everyone:

Write out a thoughtful, kindly worded letter about what brought to the group, what you like about it and the people, yada yada. Explain that you were misled about the status of the group’s standing with the hospital and that you would have looked elsewhere if this had been honestly conveyed, and now you are in a position of making under market rates with likely no payoff. Ask them to do the right thing and move up your partnership status so that you can at least make a fair income in the meanwhile.

Ok, flame on.
 
Mman said:
I mean that might be your personal recommendation, but it isn't everyone's. Every single partnership track doc we have hired has ended up better financially than they would have in any non partnership track job they could have taken instead of joining us.

The devil is in the details. IMHO most of the top heavy pyramid shaped bad partnership track places that looked to screw young people over have gone by the wayside over the last 10-15 years.
Click to expand...
There are still many top heavy groups out there that take advantage of the newcomers for their own benefit: the most important is financially, but it happens in other ways such as vacation picks, case selection (partners seem to be in all the easy, less challenging cases or the highest reimbursed cases) if that is the case ya gotta get outta dodge toot sweet. DO not wait to GTFO!
 
You may have more leverage than you think. Let the group know you will be participating in any buyout, or you will simply leave. Demand is very high for our services. There are very few practices fully staffed.
 
Yossarian Lives said:
I got a $50k sign on bonus that I would owe back if I were to leave during the pre partnership period. It is not prorated (big mistake on my part).
Click to expand...
They would likely hold you to those terms IF you were to leave prior to the group being dissolved. My guess would be once the group is dissolved, that clause essentially goes away as no further contracts are in force UNLESS this is specifically mentioned with any hospitals with the contracts.
 
caligas said:
Here’s a crazy idea, feel free to shoot me down everyone:

Write out a thoughtful, kindly worded letter about what brought to the group, what you like about it and the people, yada yada. Explain that you were misled about the status of the group’s standing with the hospital and that you would have looked elsewhere if this had been honestly conveyed, and now you are in a position of making under market rates with likely no payoff. Ask them to do the right thing and move up your partnership status so that you can at least make a fair income in the meanwhile.

Ok, flame on.
Click to expand...

The chance of that letter being well received is near zero. It's all about the money. If they can screw you, THEY WILL! What makes it harder pill to swallow is you put yourself in this position.
 
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gator2886 said:
You may have more leverage than you think. Let the group know you will be participating in any buyout, or you will simply leave. Demand is very high for our services. There are very few practices fully staffed.
Click to expand...
Accepting a 2 year partnership track without pay equity (or nearly so) from day one was a mistake.

Buyout? Heh. No group is getting bought out now!
 
Mman said:
I mean that might be your personal recommendation, but it isn't everyone's. Every single partnership track doc we have hired has ended up better financially than they would have in any non partnership track job they could have taken instead of joining us.

The devil is in the details. IMHO most of the top heavy pyramid shaped bad partnership track places that looked to screw young people over have gone by the wayside over the last 10-15 years.
Click to expand...
OP is making low 400s and working excessive hours. Assuming his pre-partner period is 2 years (it may be longer), his "buy-in" is likely over half a million dollars. So yeah...avoiding these types of contracts is good advice.

I know that you would like to see the pre-partners in your group sacrifice as much as you did, but the anesthesia labor market has shifted dramatically in the last 5-10 years. Private practices are dying off, the risk of any group losing their contract is incredibly high. Groups are short staffed and need to higher more anesthesiologists. Prospective partners should not accept ****ty contracts where they are paid less than the partners for equal work.
 
I remember the first day of my previous job. I posted on Facebook “last first day.” My old residency chairman replied “probably not. I said that several times in my career…” wise words from a great man.
The way to succeed in this market is to be mobile…. For some that means very mobile in the locums market or just being willing to up and move. Our day docs make 400k plus benefits with no call no weekends no holidays and 28 weeks of work. You are being underpaid - from the hours it seems considerably so.
You will never see the benefit of the partnership track you started… don’t double down on that mistake. Lots of places will give you a signing bonus and moving allowance so that 50k may not hurt so much.
Start looking kiddo - good luck.
 
DG51 said:
I know that you would like to see the pre-partners in your group sacrifice as much as you did, but the anesthesia labor market has shifted dramatically in the last 5-10 years.
Click to expand...

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.
 
Mman said:
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.
Click to expand...
Historically what you are describing and have was never common-but it was around. You must know that it is very rare today. Add to the fact even if the partners have the best intentions, that a practice like this is fragile given the world in which we actually live.
 
DG51 said:
OP is making low 400s and working excessive hours. Assuming his pre-partner period is 2 years (it may be longer), his "buy-in" is likely over half a million dollars. So yeah...avoiding these types of contracts is good advice.

I know that you would like to see the pre-partners in your group sacrifice as much as you did, but the anesthesia labor market has shifted dramatically in the last 5-10 years. Private practices are dying off, the risk of any group losing their contract is incredibly high. Groups are short staffed and need to higher more anesthesiologists. Prospective partners should not accept ****ty contracts where they are paid less than the partners for equal work.
Click to expand...
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.
 
Lab Lover said:
Historically what you are describing and have was never common-but it was around. You must know that it is very rare today. Add to the fact even if the partners have the best intentions, that a practice like this is fragile given the world in which we actually live.
Click to expand...

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.
 
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