New to the forum. Out of residency now 15 years, all that time in private practice in Connecticut and Colorado and--for the last two years--California. Moved west in search of physician-only anesthesia jobs. But enough about me. I realize this website is mostly for students (and residents), but there's no good place on the Internet (that I know of, anyway), for this sort of discussion. This is the kind of stuff I wish I would have known when I was seeking out my first job. I'm wondering if it's time to call peak AMC. I know that CEP (aka MedAmerica), Envision (formerly Sheridan, formerly Emcare, formerly MAC), and Somnia are still buying up practices--but less publicized is the fact that they are also losing contracts, and that CMOs and CEOs are growing wise to their empty promises. I would welcome input of present and former employees in any of these (or other) management companies to confirm stories. If nothing else, perhaps this thread will stand as a sort of "state of the practice" (in California, anyway) in autumn, 2017. Somnia: Somnia has lost contracts in Kern and Rideout. They are probably going to lose Desert Regional. Their strategy was to sneak into California by way of second- (or third-) tier hospitals and replace the FMGs with CRNAs, but that has proven to be a total disaster. The good news is that the CRNA model was such a disaster under Somnia that nobody else dares try it. Envision: Envision took a different tack, buying up a premier group in San Francisco. They have been able to keep the physician-only model alive because their first acquisition--MAC--has the most favorable payer mix in all of California. Their Northern division is growing slowly and deliberately (and wisely letting CEP overpay for sh***y practices), but their fentanyl-addicted Southern California director is trying to buy up everything in sight, despite the fact that even good old fashioned partnership track positions in the Inland, Apple, San Gabriel, and San Bernadino Valleys and High Desert have not not attracted domestically educated and trained physician anesthesiologists for decades. The latest insult was when they secured a contract at Queen of the Valley, only to lose it 72 hours later when it became apparent they would not be able to retain a single anesthesiologist. Note that they are now on their third company name change as they try to stay ahead of their terrible reputation. CEP: In a misguided case of "me, too" CEP--who had slowly grown its company by sticking to what it knew best: Emergency Room Physicians--decided they needed to get in the AMC game, too. They took over management of a very sad practice in a god-forsaken town in the dismal Central Valley, and when they didn't lose their shirt, they pressed their luck and suckered a decent group to sign up by promising them immediate partnership. What the docs didn't realize was that A) there are five levels of partnership and B) all the board members were ER docs, and they cared very little for anesthesiologists. Out of necessity, CEP then decided that their corporate charter was to "respect the autonomy" of the new anesthesia groups, a strategy that sounded fine until it struck up with the reality that many private practice anesthesiologists would rather look for a new job that have their autonomy respected by CEP brass. Nowhere was this more obvious than at Regional Medical Center, where the old group walked en masse, and CEP has spent now most of a year hemorrhaging cash while being unable to sign even a single FTE. Their original chief has since quit, and the resultant promotion of his second-in-command was such a catastrophe that the hospital CEO was fired in the immediate aftermath. CEP is trying to save face, by saying they didn't really even want the Regional contract, anyway, but that Regional sought them out. They are also proudly touting their new contract at Mercy General in Sacramento, Mercy's flagship. Funny thing, though, lesser Mercy hospitals, including Methodist, San Juan, and even Mark Twain have been able to recruit during the time that CEP has been unable to staunch the bleeding--even though those smaller hospitals warn of worse call schedules. Taking a page from Envision's book, CEP has started to run ads on Gaswork under their pseudonym, MedAmerica. What have I missed? Plenty, I am sure. Please correct me where I am wrong and tell me your experiences, good or bad. Also, I'd like to hear how AMCs are doing elsewhere in the country.