group with potential takeover before i start

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anezthezia

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hello, i would like some advice. i have been offered a job with a group that is currently a democratic partnership group. i was informed that they are in talks to be bought out by an AMC.

I'm told it is not a done deal that they will sell the practice but they would not give me a 'likelihood' percentage. I was not offered a partnership track position due to the unknown future of the group. I was offered an employed position with increasing and above average salary for the area. When I asked what my future with the group would be should there be no sellout (i.e. would I be eligible to be a partner in the future) I was told that that question 'can't be answered at this time'. My concerns are that I will be joining a job that is a complete unknown -- if taken over the landscape of the job is up in the air. Would my contract even be honored by the AMC? (I'm thinking this is an obvious NO or at best a who knows situation and why enter into it). Also that should it not go well the older guys will retire leaving the remains and inevitable locums to pick up the call/work until the group expands again -- leaving a disaster in the wake. This job is close to family which is why it is still being considered.
 
anezthezia said:
hello, i would like some advice. i have been offered a job with a group that is currently a democratic partnership group. i was informed that they are in talks to be bought out by an AMC.

I'm told it is not a done deal that they will sell the practice but they would not give me a 'likelihood' percentage. I was not offered a partnership track position due to the unknown future of the group. I was offered an employed position with increasing and above average salary for the area. When I asked what my future with the group would be should there be no sellout (i.e. would I be eligible to be a partner in the future) I was told that that question 'can't be answered at this time'. My concerns are that I will be joining a job that is a complete unknown -- if taken over the landscape of the job is up in the air. Would my contract even be honored by the AMC? (I'm thinking this is an obvious NO or at best a who knows situation and why enter into it). Also that should it not go well the older guys will retire leaving the remains and inevitable locums to pick up the call/work until the group expands again -- leaving a disaster in the wake. This job is close to family which is why it is still being considered.
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Run, don’t walk.
You’d likely make more money doing locums, but not sure what they offered you. Assuming it’s not good considering their answers to you.
 
Huge amount of unknowns. However, they do get points for being honest with you. If you take it, don't buy a house till things settle out. The reality is that there is far less certainty and security out there.
 
Forrest_Gump_running_alabama_jenny-2556.jpg
 
Too much uncertainty. They are being honest, which is becoming more of a rarity these days, so that is a plus. However, uncertainty would make me uncomfortable. I would decline this job. Plus you have the added benefit of telling the group that their decision to possibly sell to an AMC was the reason. Let them get a taste of the instability that this decision could bring.
 
Is the first year income the best you can do? How does it compare to your other offers?
 
These group sellouts not infrequently result in several million dollars for partners- money the AMC must recoup over a period of years by lowering income for everyone.
 
If it's an all MD group. I would definitely pass. If the AMC converts an MD group to ACT you'll be fired, no fault of your own. If it's already an ACT practice then it's just a question of whether or not you are willing to be an AMC employee after the buyout, assuming that's an option which is uncertain but likely.

Also, your future with the group should there be no sellout CAN be answered at this time. You future is to stay on as an employee indefinitely as they continue to try to sell the group and avoid cutting you in on any future deal.
 
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Yeah agree with the above, what part of the country is this? Is there anything else around in the vicinity?
 
What about working some sort of protection into the contract?

Such as: if there is a buyout and you don’t stay for whatever reason, they compensate you something to move, get a new job etc. If the clause is fair and reasonable and they want you, they might agree to it.
 
nimbus said:
Is the first year income the best you can do? How does it compare to your other offers?
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Year 0-1 is 300k
Year 1-2 is 375k
Year 2+ is 450k

nolagas said:
Also, your future with the group should there be no sellout CAN be answered at this time. You future is to stay on as an employee indefinitely as they continue to try to sell the group and avoid cutting you in on any future deal.
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This is word for word what I was thinking as well.

AdmiralChz said:
Yeah agree with the above, what part of the country is this? Is there anything else around in the vicinity?
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There are other groups in the vicinity but not in the same town. The entire reason to move back to this area is to be with family. I'm not too interested in moving closer but not in the same city because that's basically the situation I'm in now with residency. I'd rather stay where I am because I have decent offers here rather than move to a new city that is closer, if that makes sense.
 
this group has traditionally been a sought after group to work for with low turnover, happy docs, democratic partnership etc. i think the younger the group gets the more its leaning towards sellout as the younger guys don't want to take over managerial roles. that is just my thought though, don't know for sure obviously. but thinking this makes me worry about the older guys retiring if the group is bought out, especially if they get a fat check to do so. or if not retiring right away having a low threshold for shenanigans.
 
alternatively i have a 2 year partnership track offer in my residency city, buy in is low salary in year 0-1 (low 200's :bored:), high 200's year 1-2, and low 400's once partner. this job is hours from family (car travel though).

the thing I'm wrestling with is that i really think i will ultimately end up where my family is. everything else feels a bit temporary. i don't want to take the financial hit to do the above partnership track if I'm not going to work there long term. but, it is a stable job that will work out well for me if i do end up staying long term (10+ years).

so far looking for jobs has been way more stressful than i envisioned it to be.
 
anezthezia said:
this group has traditionally been a sought after group to work for with low turnover, happy docs, democratic partnership etc. i think the younger the group gets the more its leaning towards sellout as the younger guys don't want to take over managerial roles. that is just my thought though, don't know for sure obviously. but thinking this makes me worry about the older guys retiring if the group is bought out, especially if they get a fat check to do so. or if not retiring right away having a low threshold for shenanigans.
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It was the opposite in my group. The younger partners were vehemently opposed because we realized we’d be giving up $5x over our careers for $x now. The people close to retirement were just getting an advance on a portion of their next 5 years’ income and were more open to considering a sale. If the group is tilted toward younger doctors I think a sale is less likely.

anezthezia said:
alternatively i have a 2 year partnership track offer in my residency city, buy in is low salary in year 0-1 (low 200's :bored:), high 200's year 1-2, and low 400's once partner. this job is hours from family (car travel though).

the thing I'm wrestling with is that i really think i will ultimately end up where my family is. everything else feels a bit temporary. i don't want to take the financial hit to do the above partnership track if I'm not going to work there long term. but, it is a stable job that will work out well for me if i do end up staying long term (10+ years).

so far looking for jobs has been way more stressful than i envisioned it to be.
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Even if the first group sells out, you’ll probably come out ahead compared to the second job and be living where you want. I’d take my chances with the first.
 
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thanks for the replies.

does anyone have first or secondhand experience with a situation like this? how did it turn out?
 
anezthezia said:
thanks for the replies.

does anyone have first or secondhand experience with a situation like this? how did it turn out?
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I was in a very similar situation not too long ago, although I was being offered a partnership track even in midst of a buyout. I went with 2nd option (numbers were significantly higher than yours) and the partnership group did end up selling out. In the end, I am very happy with my decision (did significantly better financially and work/family balance)
 
Yes nimbus is right the younger the group/partners are the less chance of the group selling out. Talk to the first group some more. See what they are willing to put in the contract. I'm a young attn, but 100% against AMC's so I would advise against the first group. It's only November now, you can still interview for more jobs for summertime 😛 Now to the second group with all due respect to them they can go f%# themselves. Low 200's for first yr anesthesia attn? The only way that one should do that is if the partners were making way more than low 400s.
 
mostwanted said:
I was in a very similar situation not too long ago, although I was being offered a partnership track even in midst of a buyout. I went with 2nd option (numbers were significantly higher than yours) and the partnership group did end up selling out. In the end, I am very happy with my decision (did significantly better financially and work/family balance)
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so did you end up going with an employed position over partnership? i have a new offer that is pretty geographically close. its an employed position, less money than the group that might sell out. but if they sell out who knows what the money would be.

the new position starts mid 300's and will end up after a year in the 370's. significantly better lifestyle, less hours. thinking its better, at least for now.
 
anezthezia said:
so did you end up going with an employed position over partnership? i have a new offer that is pretty geographically close. its an employed position, less money than the group that might sell out. but if they sell out who knows what the money would be.

the new position starts mid 300's and will end up after a year in the 370's. significantly better lifestyle, less hours. thinking its better, at least for now.
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I went with the employed position. I think the main advantage of a partnership will be pretax savings or possible being part of a buyout later. The partnership offer you listed might make sense, if they can raise the first year salary or they can reduce the partnership track to 1 year. Is it low 400s plus 53k in retirement? Employed position tax savings are tougher, but still has worked out well for me.
 
GA8314 said:
Stop exaggerating. You know darn well our average here is much closer to $750k (W2) geez.
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Doesn’t include the $100K Christmas bonus, 16 weeks vacation, no call, regional and cardiac master from residency, model on both arm bad mofo. Trained at a second to none program of course!

Happy Thanksgiving!
 
All joking aside, I recently found out that one of my neurosurgeon colleagues makes $1.6 million.

Obviously can’t totally confirm but pretty reliable source.
 
Most neurosurgeons I know make over 7 figures
 
I'm looking for opinions on taking a bread and butter position straight out of residency. I have the option to take a very busy trauma center job or a cushy b & b practice. The b & b job pays more per hour worked (around 160) vs the trauma center job (around 130). Also, I'm realizing these numbers are kind of depressing. The trauma center job seems to be as busy as my residency program. What is everyone making an hour?
 
anezthezia said:
I'm looking for opinions on taking a bread and butter position straight out of residency. I have the option to take a very busy trauma center job or a cushy b & b practice. The b & b job pays more per hour worked (around 160) vs the trauma center job (around 130). Also, I'm realizing these numbers are kind of depressing. The trauma center job seems to be as busy as my residency program. What is everyone making an hour?
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Keep looking
 
AdmiralChz said:
How many jobs are you looking at, exactly?
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Three. Two in the same region. One in my residency city, though I'm pretty sure I'm not taking that position. I started to reconsider a job that is closer to family (bread and butter). The trauma center job is the possible buyout place.
 
Well, sounds to me that you need to make a pros and cons list for every place you are considering. These are likely things you are weighing now, but doing this exercise helps you to get everything “out in the open”. Then, wait a day and read thru the list. It won’t tell you where to go, but it may help you identify what issue is most important to you.
 
anezthezia said:
I'm looking for opinions on taking a bread and butter position straight out of residency. I have the option to take a very busy trauma center job or a cushy b & b practice. The b & b job pays more per hour worked (around 160) vs the trauma center job (around 130). Also, I'm realizing these numbers are kind of depressing. The trauma center job seems to be as busy as my residency program. What is everyone making an hour?
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That’s CRNA pay. Keep looking, those are awful.
 
GravelRider said:
Not unusual for a neurosurgeon to make well above $1 million. Same goes for busy joint orthopods.
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If a Neurosurgeon isn't making $1 million then he/she has an easy job with a light caseload. Typically, a 40 hour per week neurosurgeon with minimal call (no tramua) can expect to earn around $750-$800K. If the surgeon is busy and takes call at a trauma facility that number should easily exceed $1 million with many earning $1.2 million.

A truly busy, efficient neurosurgeon working 60 hours per week should be earning $1.5 million or he is doing something wrong. Academic Neurosurgeons are a different breed as they earn more in the high 400's/low 500's typically.
 
Blade at my residency program the neurosurg were still doing 750-1 mill each!!!
 
Scotty_G said:
Blade at my residency program the neurosurg were still doing 750-1 mill each!!!
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Really? At mine only the chairman made over $450K.

A couple of my older neighbors back home went into neurosurgery about 10 years ago. One rakes it in but after splitting it with 3 ex wives not much is left. The other just split from his 2nd wife with 3 kids, told me he might have to file bankruptcy. They have a high ceiling for earnings, but it can be exceedingly high stress work. No field is perfect.

Also this is obviously anecdotal, like a Lot of other posters
 
AdmiralChz said:
Really? At mine only the chairman made over $450K.

A couple of my older neighbors back home went into neurosurgery about 10 years ago. One rakes it in but after splitting it with 3 ex wives not much is left. The other just split from his 2nd wife with 3 kids, told me he might have to file bankruptcy. They have a high ceiling for earnings, but it can be exceedingly high stress work. No field is perfect.

Also this is obviously anecdotal, like a Lot of other posters
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I know a few Anesthesiologists in the same boat. Those alimony checks can really eat into your quality of life. Retirement? Better plan on working until age 70 maybe 75.
 
thank you to everyone for your opinions and advice. i have one more thing that i am wrestling with... is it a mistake to take a straight lifestyle friendly bread and butter position including minimal OB (average a few deliveries a day), no trauma, no complex neuro, no vascular right out of residency? i worry about how i will be viewed by future employers (skill atrophy, lack of critical patient experience) should i, for whatever reason, seek another job in a few years. i realize this is mostly a personal preference decision, but i'd still like to hear what you guys think that have been out in the wild for a while.
 
Anezthezia you aren't considering that group with the 200ish starting salary right?
 
not really, i haven't declined it but its low on the list. im trying to make myself not take a cushy job but its hard. my math was wrong previously because i didnt account for vacation time. the bread and butter position hourly rate is around 200/hr. the impending buyout position hourly rate depends on the year and if they sell out, but best case scenario (no sell out) it will be around 175/hr with around 150/hr if they do sell out.

again, my issue is struggling with taking the bread and butter higher paying job and sacrificing the expansion of my skill set vs taking the lower paying significantly harder working job that will challenge me.
 
OP, I'm currently interviewing for residency and wanted to ask you (or anyone else) some relevant questions. How important is the location of your residency to job searching? Is it easier to find a position in the same state/town?
 
It's better to do res near the area you want to work IMO. Of course if you have opportunity to do res at a top 10 etc program then obviously go there!!
 
Neurodelic said:
How important is the location of your residency to job searching? Is it easier to find a position in the same state/town?
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If you plan on working in academics, then not very - program rep and fellowship is more important. If you plan on going PP though, I think it's very important. You don't have to be in the same town, but same region really helps. When the best groups need someone, they don't advertise. There's no gasworks posting, no recruiters, none of that crap. The call up the programs where they trained and asked who the rockstars are. For the most part, these are programs still relatively local to the group. If you wanna really be a ninja about it, look up the hospitals you want to work at someday and see where the anesthesiologists who work there trained, then apply to those programs.
 
I would only agree to join them on a non-partner tract if I didn't have a single other option. Employee tracts in stable groups suck. But being the first ever employee in what was previously a partnership? Fuggetaboudit.
 
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