Have we reached peak AMC (Anesthesia Management Company)?

[pgg]

I agree with some of what you've written, but

Those countries tend to outperform us in many indicators, including population health.

is a total red herring.

Those countries might (or might not) outperform us on population health metrics[1] but concluding that's due to their admissions system selecting better doctors-to-be, and not their diets making them less fat, is a stretch.


[1] I don't believe metrics from data collected and reported by most of those countries anyway.

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[dannyboy1]

Count me in the camp who is unimpressed by these “TopCoders.” All these nerds do is figure out ways to quantify data so that they can find better ways to advertise to us to get us to buy cr@p we don’t need. Amazon, Facebook, and Google are nothing but advertising firms. The other savants find ways to game the financial system. Maybe that’s where the money is right now, but these so-called “beautiful minds” are not really contributing to the advancement of the species at the moment. I’ll take the social community organizer or the guy still making chairs by hand any day over these nerds.

Maybe in fields like radiology, pathology, and research oncology. Anesthesia... hell no. The ones that can’t get along with people are a disaster in our line of work.

 

[deleted171991]

Count me in the camp who is unimpressed by these “TopCoders.” All these nerds do is figure out ways to quantify data so that they can find better ways to advertise to us to get us to buy cr@p we don’t need. Amazon, Facebook, and Google are nothing but advertising firms. The other savants find ways to game the financial system. Maybe that’s where the money is right now, but these so-called “beautiful minds” are not really contributing to the advancement of the species at the moment. I’ll take the social community organizer or the guy still making chairs by hand any day over these nerds.

You do realize that you are just spewing marxism, no offense? I am sorry that you have a personal reason to hate these people. This entire world (including this forum we enjoy) would be nowhere without mathematics, and that wasn't invented by social community organizers or the guys making chairs by hand.

Btw, the marxists hated highly intelligent people. They were typically among the first exterminated when the marxists came to power. Speaking about "the advancement of the species" (80% of IQ is inherited).

 

[BorntobeDO?]

Count me in the camp who is unimpressed by these “TopCoders.” All these nerds do is figure out ways to quantify data so that they can find better ways to advertise to us to get us to buy cr@p we don’t need. Amazon, Facebook, and Google are nothing but advertising firms. The other savants find ways to game the financial system. Maybe that’s where the money is right now, but these so-called “beautiful minds” are not really contributing to the advancement of the species at the moment. I’ll take the social community organizer or the guy still making chairs by hand any day over these nerds.

The social community organizer? I find it hard to believe any attending would want more of that after the last decade and ACA. A made up name for doing nothing but raising trouble IMO. Give me teachable people who are smart over the ones padding the CV with bogus 'humanistic' activities.

 

[deleted171991]

Medicine is just another natural science, one based on probabilistic thinking (which is derived from population statistics) and logic (math again). Yes, it has a social component (people are not lab rats), but, unless we want our doctors to be just glorified midlevels (AKA monkey see monkey do), we should recruit much less based on social skills/sciences and EC, and much more based on proven performance in exact sciences (including math). Scores on relevant standardized tests should matter more.

Also, while some specialties are based on manual or social skills, any large group has more than enough people with various talents. It's not like countries where selection is more objective lack good surgeons or other specialists.

I am not naive. Things are the way they are not because it's right or scientific, but mostly because that's what the elites want and society accepts.

 

[mmag]

Investment firm KKR to acquire Envision Healthcare in $9.9B deal | FierceHealthcare
KKR signed deal with Envision.
And the shareholder lawsuits commence
SHAREHOLDER ALERT: Levi & Korsinsky, LLP Notifies Investors of an Investigation Regarding Whether the Sale of Envision Healthcare Corporation to KKR is Fair to Shareholders

 

[Notorious T.E.E.]

American Medical Association to investigate whether private-equity-owned practices put profits over patients

This is from MarketWatch today. I wondered if/when the public (and therefore PR conscious hospital administration) would become upset about more of their healthcare expenses going to Wall St.

 

[Twiggidy]

American Medical Association to investigate whether private-equity-owned practices put profits over patients

This is from MarketWatch today. I wondered if/when the public (and therefore PR conscious hospital administration) would become upset about more of their healthcare expenses going to Wall St.

You may get this a lot.....but Best. SDN Name. Ever.

 

[anbuitachi]

American Medical Association to investigate whether private-equity-owned practices put profits over patients

This is from MarketWatch today. I wondered if/when the public (and therefore PR conscious hospital administration) would become upset about more of their healthcare expenses going to Wall St.

Sounds really hard to actually do a study and be able to produce result with significance

 

[chocomorsel]

I am not naive. Things are the way they are not because it's right or scientific, but mostly because that's what the elites want and society accepts.

You really think the "elites" want to mingle with a bunch of affirmative action "charity" cases? Somehow, I highly doubt that. Maybe it's because that's what's expected of society. But not the "elites"

 

[patriot6]

Abbott Northwestern switching anesthesia service

Abbott Northwestern will start using Minneapolis Anesthesia Partners by mid-2020.

m.startribune.com

AMCs still losing steam?

 

[skypilot]

Abbott Northwestern switching anesthesia service

Abbott Northwestern will start using Minneapolis Anesthesia Partners by mid-2020.

m.startribune.com

AMCs still losing steam?

Maybe having management in the same building as the hospital, and a high ratio of dedicated, committed Physicians actually makes a difference? Hmmm
The AMC only lasted a couple of years per the article.

 

[B-Bone]

Maybe having management in the same building as the hospital, and a high ratio of dedicated, committed Physicians actually makes a difference? Hmmm
The AMC only lasted a couple of years per the article.

Hell to the yeah.

 

[AdmiralChz]

Abbott Northwestern switching anesthesia service

Abbott Northwestern will start using Minneapolis Anesthesia Partners by mid-2020.

m.startribune.com

AMCs still losing steam?

Nearly the exact same story as Mednax in Charlotte.

Also, if you are asked to help out around the hospital from time to time and you have the staff... do it.

 

[IMGASMD]

Is this a reflection on Mednax or AMCs tho? Haven’t see envision (or whatever they are now) make any news, other than now they are private?

 

[PieOHmy]

Medicine is just another natural science, one based on probabilistic thinking (which is derived from population statistics) and logic (math again). Yes, it has a social component (people are not lab rats), but, unless we want our doctors to be just glorified midlevels (AKA monkey see monkey do), we should recruit much less based on social skills/sciences and EC, and much more based on proven performance in exact sciences (including math). Scores on relevant standardized tests should matter more.

You will get nowhere as a physician if you dont have "outstanding" social skills. Especially as an Anesthesiologist/
One's EQ has to be off the charts and the ability to parallell process has to be excellent to be truly successful in practice and avoid the many landmines and pitfalls.

 

[dannyboy1]

Nearly the exact same story as Mednax in Charlotte.

Also, if you are asked to help out around the hospital from time to time and you have the staff... do it.

My hospital does the same crap. They want coverage whenever, wherever, regardless of the time of day or acuity of the patient. Guess what, salaried employees are not interested in bending over to accommodate every request if we are not getting paid more to do it. What do I care if the practice ( run by the AMC) implodes. Plenty of jobs out there. I get treated like an employee so I sure as hell will act like one.....

 

[B-Bone]

My hospital does the same crap. They want coverage whenever, wherever, regardless of the time of day or acuity of the patient. Guess what, salaried employees are not interested in bending over to accommodate every request if we are not getting paid more to do it. What do I care if the practice ( run by the AMC) implodes. Plenty of jobs out there. I get treated like an employee so I sure as hell will act like one.....

Except when the AMC implodes and you have a brutal non-compete clause, you have to pick up your family and move out of state. These things really suck for the people working there. I definitely didn't want an AMC in my market and am not sad to see them go, but I still feel bad for the people there. Charlotte was the same deal.

 

[deleted941485]

Except when the AMC implodes and you have a brutal non-compete clause, you have to pick up your family and move out of state. These things really suck for the people working there. I definitely didn't want an AMC in my market and am not sad to see them go, but I still feel bad for the people there. Charlotte was the same deal.

Yeah the south is pretty employer friendly and will enforce it. You really take a risk when it implodes. At any rate, AMCs are here to stay. Will these new surprise billing ban proposals making their way through PPs and AMCs are gonna have a tough go. Apparently the last people who should be paid for services are the physicians actually rendering the service.

 

[dannyboy1]

Except when the AMC implodes and you have a brutal non-compete clause, you have to pick up your family and move out of state. These things really suck for the people working there. I definitely didn't want an AMC in my market and am not sad to see them go, but I still feel bad for the people there. Charlotte was the same deal.

My non compete is 5 miles. One advantage of being in the northeast is that there are hundreds of jobs to choose from. From what I have seen the non compete is not really enforced. Plenty of people leave, go down the block and nobody seems to care....

 

[Mman]

Yeah the south is pretty employer friendly and will enforce it. You really take a risk when it implodes. At any rate, AMCs are here to stay. Will these new surprise billing ban proposals making their way through PPs and AMCs are gonna have a tough go. Apparently the last people who should be paid for services are the physicians actually rendering the service.

Mednax is just going to fade out of the anesthesia business over the next 5-10 years. I suspect other AMCs won't be too far behind. We are past peak AMC and their share of the market will keep decreasing. The newest model will just be hospital employed.

 

[Lurch]

Mednax is just going to fade out of the anesthesia business over the next 5-10 years. I suspect other AMCs won't be too far behind. We are past peak AMC and their share of the market will keep decreasing. The newest model will just be hospital employed.

These are exciting times. I followed these threads with angst as a med student and resident wondering if I had made the right decision. Now you see the larger corporations showing some vulnerability by losing major contracts in major metropolitan areas. Their system is cracking. It can go the other way: a hardworking private practice group with a good relationship with hospital administration can take a contract from the AMCs. There is now precedent x2.

This should be a wake-up call for pp docs everywhere. Hospital employment is certainly an option but a well-run pp group will always be the preferred model. Demonstrate value: sit on committees, do the cases, help find process improvements and save money for perioperative arena, be available and amiable. These things position your group for success and make you an asset rather than a headache.

This is what we have done in Minneapolis/St. Paul for years and winning this contract proves that philosophy is a good one in the eyes of hospital administration and physician executive leadership.

Our group will be hiring. We want applicants that are cut from a similar mold. New grads or established docs. Feel free to PM me for further discussion and details.

 

[dannyboy1]

These are exciting times. I followed these threads with angst as a med student and resident wondering if I had made the right decision. Now you see the larger corporations showing some vulnerability by losing major contracts in major metropolitan areas. Their system is cracking. It can go the other way: a hardworking private practice group with a good relationship with hospital administration can take a contract from the AMCs. There is now precedent x2.

This should be a wake-up call for pp docs everywhere. Hospital employment is certainly an option but a well-run pp group will always be the preferred model. Demonstrate value: sit on committees, do the cases, help find process improvements and save money for perioperative arena, be available and amiable. These things position your group for success and make you an asset rather than a headache.

This is what we have done in Minneapolis/St. Paul for years and winning this contract proves that philosophy is a good one in the eyes of hospital administration and physician executive leadership.

Our group will be hiring. We want applicants that are cut from a similar mold. New grads or established docs. Feel free to PM me for further discussion and details.

Do you think it’s possible to turn back the clock? I get the feeling that most new docs (myself included) have come to accept the employment model. PP can have its own headaches, the aforementioned sitting on committees and attending meetings, responsibilities for practice overhead, fighting with partners for “good” cases. Ect. I think most docs graduating today expect to show up, cash a check, and go home....

 

[skypilot]

My non compete is 5 miles. One advantage of being in the northeast is that there are hundreds of jobs to choose from. From what I have seen the non compete is not really enforced. Plenty of people leave, go down the block and nobody seems to care....

Yes, and non competes are not even legal for Physicians in several New England states. See if your State Anesthesiology and Medical societies lobbying arm or Political Action Committee can lobby to copy the law in Massachusetts, Connecticut in Rhode Island that makes non compete agreements for Physicians illegal.

 

[PieOHmy]

Demonstrate value: sit on committees, do the cases, help find process improvements and save money for perioperative arena, be available and amiable. These things position your group for success and make you an asset rather than a headache.

YOu mean Bend over for the man to have his way.

 

[kidthor]

Yes, and non competes are not even legal for Physicians in several New England states. See if your State Anesthesiology and Medical societies lobbying arm or Political Action Committee can lobby to copy the law in Massachusetts, Connecticut in Rhode Island that makes non compete agreements for Physicians illegal.

Unfortunately they are legal in my east coast state. If they were illegal/unenforceable, I bet my wages and our collective happiness would go way up. Many of my colleagues wish they could jump ship but can't due to the common 10 mile non-completes (coupled with their house, their spouse having a local job, kids in school, etc). Or they want to moonlight somwhere else but again the non-competes restrict that too. If my shop knew that people could leave tomorrow to get a better job, they'd feel the pressure to make things much better. But with no threat of compensation, we are treated like trash all too frequently.

Doctors are in a funny spot these days as we are relatively highly compensated hourly workers without any of the associated protections. Don't get me wrong - we're comfortable and living well compared to much of the world. But still we're still being exploited by the man.

 

[dannyboy1]

Unfortunately they are legal in my east coast state. If they were illegal/unenforceable, I bet my wages and our collective happiness would go way up. Many of my colleagues wish they could jump ship but can't due to the common 10 mile non-completes (coupled with their house, their spouse having a local job, kids in school, etc). Or they want to moonlight somwhere else but again the non-competes restrict that too. If my shop knew that people could leave tomorrow to get a better job, they'd feel the pressure to make things much better. But with no threat of compensation, we are treated like trash all too frequently.

Doctors are in a funny spot these days as we are relatively highly compensated hourly workers without any of the associated protections. Don't get me wrong - we're comfortable and living well compared to much of the world. But still we're still being exploited by the man.

At my shop the CRNA’s all have the same non compete as the physicians yet plenty of them work per diem locally. Seems that the AMC only tries to enforce it when they are under threat of losing the contract ( like what happened with mednax in North Carolina), individual docs and CRNAs going their own way not so much....

 

[IMGASMD]

Unfortunately they are legal in my east coast state. If they were illegal/unenforceable, I bet my wages and our collective happiness would go way up. Many of my colleagues wish they could jump ship but can't due to the common 10 mile non-completes (coupled with their house, their spouse having a local job, kids in school, etc). Or they want to moonlight somwhere else but again the non-competes restrict that too. If my shop knew that people could leave tomorrow to get a better job, they'd feel the pressure to make things much better. But with no threat of compensation, we are treated like trash all too frequently.

Doctors are in a funny spot these days as we are relatively highly compensated hourly workers without any of the associated protections. Don't get me wrong - we're comfortable and living well compared to much of the world. But still we're still being exploited by the man.

Before AMC, you have the (some) senior partners who slave you away too. Just there was a promise for a piece of the pie. Now you just work for a pretty stagnant (standard) salary.

I for one, rather be being “taken advantage”of by one of my own, with possible of better future, than working for a faceless “man” who’s running an operation that they have no clue about other than how much dollars coming in and going out.

 

[kidthor]

At my shop the CRNA’s all have the same non compete as the physicians yet plenty of them work per diem locally. Seems that the AMC only tries to enforce it when they are under threat of losing the contract ( like what happened with mednax in North Carolina), individual docs and CRNAs going their own way not so much....

CRNAs at my shop have no non-competes, while the physicians do. The CRNAs regularly work per diem elsewhere to make extra money and mix things up. And they regularly jump ship to something better with no barriers. Yet we can't. Very weird.

 

[Lurch]

Do you think it’s possible to turn back the clock? I get the feeling that most new docs (myself included) have come to accept the employment model. PP can have its own headaches, the aforementioned sitting on committees and attending meetings, responsibilities for practice overhead, fighting with partners for “good” cases. Ect. I think most docs graduating today expect to show up, cash a check, and go home....

I'm not sure how most new grads see things now. I wanted more for myself and my profession than to be a clock puncher. Maybe today's new grad sees things differently. It's hard for me to understand not wanting to sit in on a meeting where decisions are being made that directly affect you and your practice. That's just lazy. I matched myself with a group that did more and I am glad I did. We have the respect of our physician colleagues and the administration as a result. It's a collaborative effort and a symbiotic relationship. I hate sounding cliche but it works. Everyone benefits.

Not sure what you mean by fighting with partners for "good" cases. As in eat what you kill? There are obviously plenty of systems for dividing up cases fairly (one of which we use).

I will be interested to see how the new grads respond here. It takes more than the bare minimum to get into and through medical school and residency. Why would a new grad think that the bare minimum is enough when they finally land a job? Maybe I will be surprised. Based on our most recent hires though, I would disagree with your assessment. That being said, we will be offering employed positions as well to try to accommodate those that want this track.

 

[B-Bone]

At my shop the CRNA’s all have the same non compete as the physicians yet plenty of them work per diem locally. Seems that the AMC only tries to enforce it when they are under threat of losing the contract ( like what happened with mednax in North Carolina), individual docs and CRNAs going their own way not so much....

The power of a non-compete in practical terms doesn't really rest with its enforceability. Depending on your state's laws, it usually goes something like this:

-you sign non-compete when you're hired
-you quit/get fired/employer loses contract and you want to start a new job
-if can be tough to get a new employer to hire you within the terms of the non-compete (geography/timeline) because they (as well as you) can be sued by your former employer for "tortious interference with contractual relations" and be liable for damages and legal fees. Why would a new employer take this risk?
-if you want to challenge the non-compete, your former employer sends a cease/desist letter, which is usually followed by an injunction and restraining order preventing you from working while the suit is litigated
-litigation usually takes 12-18 months and your legal fees will typically be $30-50k through the injunction phase, and possibly >$100k if it goes to trial
-if you lose, you can be reponsible for the former employer's legal fees as well

Based on this, who is willing to spend the time/money and incur the risk of additional legal fees? Even if you "win", it took over a year and cost you six figures. That's the power of the non-compete and why everybody in Charlotte was screwed. AMCs will defend their non-competes to the death, because their business model depends on them. Their non-competes don't have to be particularly valid or enforceable, they just have to be willing to use their (already paid-for) in-house counsel to bleed you dry/waste your time litigating it. Huzzah for American jurisprudence!

 

[BLADEMDA]

Mednax is just going to fade out of the anesthesia business over the next 5-10 years. I suspect other AMCs won't be too far behind. We are past peak AMC and their share of the market will keep decreasing. The newest model will just be hospital employed.

I'm not so sure USAP or Envision will be going out of business anytime soon. Envision is deeply in bed with HCA at multiple ( 2 dozen) hospitals and USAP markets itself as Physician run/led.

 

[dannyboy1]

The power of a non-compete in practical terms doesn't really rest with its enforceability. Depending on your state's laws, it usually goes something like this:

-you sign non-compete when you're hired
-you quit/get fired/employer loses contract and you want to start a new job
-if can be tough to get a new employer to hire you within the terms of the non-compete (geography/timeline) because they (as well as you) can be sued by your former employer for "tortious interference with contractual relations" and be liable for damages and legal fees. Why would a new employer take this risk?
-if you want to challenge the non-compete, your former employer sends a cease/desist letter, which is usually followed by an injunction and restraining order preventing you from working while the suit is litigated
-litigation usually takes 12-18 months and your legal fees will typically be $30-50k through the injunction phase, and possibly >$100k if it goes to trial
-if you lose, you can be reponsible for the former employer's legal fees as well

Based on this, who is willing to spend the time/money and incur the risk of additional legal fees? Even if you "win", it took over a year and cost you six figures. That's the power of the non-compete and why everybody in Charlotte was screwed. AMCs will defend their non-competes to the death, because their business model depends on them. Their non-competes don't have to be particularly valid or enforceable, they just have to be willing to use their (already paid-for) in-house counsel to bleed you dry/waste your time litigating it. Huzzah for American jurisprudence!

I understand that it is hard for the little guy to fight a large corporation. What I was saying is that I don’t see companies going after individual violators of these non competes. We had a doc leave and take a job down the block. It was not a secret where she was going. CRNA’s with non competes regularly work per diem ( we know about it too. It will say on the schedule CRNA X unavailable Tuesdays due to per diem commitments) maybe the AMC doesn’t want to litigate due to the risk of a precedent setting loss? Maybe no one from corporate is keeping track of people coming and going ? This is just my experience with this sort of thing. Maybe others have different experiences.

 

[deleted171991]

I'm not sure how most new grads see things now. I wanted more for myself and my profession than to be a clock puncher. Maybe today's new grad sees things differently. It's hard for me to understand not wanting to sit in on a meeting where decisions are being made that directly affect you and your practice. That's just lazy. I matched myself with a group that did more and I am glad I did. We have the respect of our physician colleagues and the administration as a result. It's a collaborative effort and a symbiotic relationship. I hate sounding cliche but it works. Everyone benefits.

Not sure what you mean by fighting with partners for "good" cases. As in eat what you kill? There are obviously plenty of systems for dividing up cases fairly (one of which we use).

I will be interested to see how the new grads respond here. It takes more than the bare minimum to get into and through medical school and residency. Why would a new grad think that the bare minimum is enough when they finally land a job? Maybe I will be surprised. Based on our most recent hires though, I would disagree with your assessment. That being said, we will be offering employed positions as well to try to accommodate those that want this track.

If you're not sitting at the table, you're on the menu.

 

[B-Bone]

I understand that it is hard for the little guy to fight a large corporation. What I was saying is that I don’t see companies going after individual violators of these non competes. We had a doc leave and take a job down the block. It was not a secret where she was going. CRNA’s with non competes regularly work per diem ( we know about it too. It will say on the schedule CRNA X unavailable Tuesdays due to per diem commitments) maybe the AMC doesn’t want to litigate due to the risk of a precedent setting loss? Maybe no one from corporate is keeping track of people coming and going ? This is just my experience with this sort of thing. Maybe others have different experiences.

You are correct in that employers with scruples who treat their employees like human beings would be unlikely to litigate a non-compete. That is not who we are talking about. Think about why an anesthesia group would even have a non-compete clause. We don't have patients that we can take with us. We don't have trade secrets that will ruin a business if shared. An anesthesia non-compete doesn't make sense for traditional reasons.

Here's why they have a non-compete, using Charlotte as an example. AMC comes in and takes a hospital service contract from a private group (or buys out a private group). They get these contracts because they pitch that they can cover the contract without a subsidy and will save the hospital money. Their ability to lower or eliminate a subsidy is based on their preferential billing rates that they get due to their large size and ability to negotiate with insurers. They come in, cut MD/CRNA salaries (which is frequently tolerated in the case of a buyout cuz the docs got PAID), increase supervision ratios, and generally make the job worse. Now the job is worse and the employees start to get squirrely, especially after the contractually-required commitment from the "bought-out" docs. People start to retire, move away for different jobs, etc (but NOT work locally due to their non-competes). Now the AMC has trouble recruiting because the salaries have been cut and word gets around about how crummy the job is. So the job gets worse (more call, more supervision, etc without increasing pay), and now the AMC is having trouble covering its service commitments. The docs who have to stay local for family reasons or whatever are stuck because of their non-compete. Hospital gets fed up and wants a new group i n there. The real crux if the situation is that (especially in larger groups), there is no real alternative for the hospital to go with, becasue where are you going to find 100 docs in a market (like Charlotte) that just doesn't have them? The non-compete means that if the AMC loses the contract, all the employees currently working there are off-limits to the new group. It's kind of a "too big to fail" situation.

It's that fear of being unable to replace the current workforce in a reasonable timeframe (based on the enforced-to-the-death non-compete) that forces the hospital to keep working with the AMC no matter how bad things get. That is why AMCs non-competes are non-negotiable and will be enforced/litigated no matter what. Even if their non-compete is unenforceable, they avoid precedent by dropping the suit just before it goes to trial. Still costs the defendant almost as much time and money with no pesky precedent set.

The cases with Mednax in Charlotte and now Minneapolis represent how fed-up with AMCs hospitals are getting and the risks they are willing to incur (service disruptions, lack of coverage, toxic TV/radio/newspaper ads by the AMC) to stop dealing with them.

 

[PieOHmy]

Before AMC, you have the (some) senior partners who slave you away too. Just there was a promise for a piece of the pie. Now you just work for a pretty stagnant (standard) salary.

I for one, rather be being “taken advantage”of by one of my own, with possible of better future, than working for a faceless “man” who’s running an operation that they have no clue about other than how much dollars coming in and going out.

i disagree. seeing someone daily thats screwing you.. Not ok with me.

 

[PieOHmy]

You are correct in that employers with scruples who treat their employees like human beings would be unlikely to litigate a non-compete. That is not who we are talking about. Think about why an anesthesia group would even have a non-compete clause. We don't have patients that we can take with us. We don't have trade secrets that will ruin a business if shared. An anesthesia non-compete doesn't make sense for traditional reasons.

Here's why they have a non-compete, using Charlotte as an example. AMC comes in and takes a hospital service contract from a private group (or buys out a private group). They get these contracts because they pitch that they can cover the contract without a subsidy and will save the hospital money. Their ability to lower or eliminate a subsidy is based on their preferential billing rates that they get due to their large size and ability to negotiate with insurers. They come in, cut MD/CRNA salaries (which is frequently tolerated in the case of a buyout cuz the docs got PAID), increase supervision ratios, and generally make the job worse. Now the job is worse and the employees start to get squirrely, especially after the contractually-required commitment from the "bought-out" docs. People start to retire, move away for different jobs, etc (but NOT work locally due to their non-competes). Now the AMC has trouble recruiting because the salaries have been cut and word gets around about how crummy the job is. So the job gets worse (more call, more supervision, etc without increasing pay), and now the AMC is having trouble covering its service commitments. The docs who have to stay local for family reasons or whatever are stuck because of their non-compete. Hospital gets fed up and wants a new group i n there. The real crux if the situation is that (especially in larger groups), there is no real alternative for the hospital to go with, becasue where are you going to find 100 docs in a market (like Charlotte) that just doesn't have them? The non-compete means that if the AMC loses the contract, all the employees currently working there are off-limits to the new group. It's kind of a "too big to fail" situation.

It's that fear of being unable to replace the current workforce in a reasonable timeframe (based on the enforced-to-the-death non-compete) that forces the hospital to keep working with the AMC no matter how bad things get. That is why AMCs non-competes are non-negotiable and will be enforced/litigated no matter what. Even if their non-compete is unenforceable, they avoid precedent by dropping the suit just before it goes to trial. Still costs the defendant almost as much time and money with no pesky precedent set.

The cases with Mednax in Charlotte and now Minneapolis represent how fed-up with AMCs hospitals are getting and the risks they are willing to incur (service disruptions, lack of coverage, toxic TV/radio/newspaper ads by the AMC) to stop dealing with them.

the current group in charlotte the docs dont have a non compete from what im told

 

[chocomorsel]

CRNAs at my shop have no non-competes, while the physicians do. The CRNAs regularly work per diem elsewhere to make extra money and mix things up. And they regularly jump ship to something better with no barriers. Yet we can't. Very weird.

Why do physicians allow this? What is wrong with this profession? Have some back bone.

 

[IMGASMD]

I'm not sure how most new grads see things now. I wanted more for myself and my profession than to be a clock puncher. Maybe today's new grad sees things differently. It's hard for me to understand not wanting to sit in on a meeting where decisions are being made that directly affect you and your practice. That's just lazy. I matched myself with a group that did more and I am glad I did. We have the respect of our physician colleagues and the administration as a result. It's a collaborative effort and a symbiotic relationship. I hate sounding cliche but it works. Everyone benefits.

Not sure what you mean by fighting with partners for "good" cases. As in eat what you kill? There are obviously plenty of systems for dividing up cases fairly (one of which we use).

I will be interested to see how the new grads respond here. It takes more than the bare minimum to get into and through medical school and residency. Why would a new grad think that the bare minimum is enough when they finally land a job? Maybe I will be surprised. Based on our most recent hires though, I would disagree with your assessment. That being said, we will be offering employed positions as well to try to accommodate those that want this track.

It really depends on how long the partnership track is and how big of the reward it is, isn’t it?

I can make 450 “punch clock” vs I make 225, get paid extra for calls and still working post call for 5 years and “maybe” touch 600.

Yes that partnership track salary is real and very “sought after” which currently doesn’t even have an “opening.” So that can be easily turn into a 7 year partnership track.

The amount of work to make that extra 150 may not worth it for me. But if that difference becomes 250, 350? I don’t know what the right answer should be.

i disagree. seeing someone daily thats screwing you.. Not ok with me.

You’ll be working at the main hospital, the face that ask you to bend over is at the surg center giving prop. So you won’t see the face.

But are you okay to be “managed” by someone with a MBA who has zero, zippo, big fat ZERO idea what we do on a daily basis?

 

[PieOHmy]

It really depends on how long the partnership track is and how big of the reward it is, isn’t it?

I can make 450 “punch clock” vs I make 225, get paid extra for calls and still working post call for 5 years and “maybe” touch 600.

Yes that partnership track salary is real and very “sought after” which currently doesn’t even have an “opening.” So that can be easily turn into a 7 year partnership track.

The amount of work to make that extra 150 may not worth it for me. But if that difference becomes 250, 350? I don’t know what the right answer should be.



You’ll be working at the main hospital, the face that ask you to bend over is at the surg center giving prop. So you won’t see the face.

But are you okay to be “managed” by someone with a MBA who has zero, zippo, big fat ZERO idea what we do on a daily basis?

Again, I would rather be screwed by someone else other than my colleague. It enrages me to no end watching someone consistently getting more favorable assignments than me

 

[Lurch]

Again, I would rather be screwed by someone else other than my colleague. It enrages me to no end watching someone consistently getting more favorable assignments than me

What do you mean by more favorable assignments? You get gov't payers in an eat what you kill practice every day? You get ear tubes when you would rather do hearts? You get an all day case and get no relief? You get the surgeon that plays katy perry and you prefer pantera? Help me out.

Sorry if you're being screwed but you sound completely jaded with your current gig and in denial about other prospects. Consider this your awakening.

 

[Lurch]

It really depends on how long the partnership track is and how big of the reward it is, isn’t it?

I can make 450 “punch clock” vs I make 225, get paid extra for calls and still working post call for 5 years and “maybe” touch 600.

Yes that partnership track salary is real and very “sought after” which currently doesn’t even have an “opening.” So that can be easily turn into a 7 year partnership track.

The amount of work to make that extra 150 may not worth it for me. But if that difference becomes 250, 350? I don’t know what the right answer should be.

I hear you but this sounds like a partnership track on the coasts. Not reflective of our market. One of the advantages of the Midwest I suppose. I feel the pain of those that have to live in NYC for instance because this is the best they can hope for. Geographical arbitrage is real; use it to your advantage if you can.

 

[IMGASMD]

I hear you but this sounds like a partnership track on the coasts. Not reflective of our market. One of the advantages of the Midwest I suppose. I feel the pain of those that have to live in NYC for instance because this is the best they can hope for. Geographical arbitrage is real; use it to your advantage if you can.

I hear you. I’ve only worked with nurses for a short while, not sure how I feel about it still. AFAIK, team model is the standard practice model out there.

 

[GravelRider]

CRNAs at my shop have no non-competes, while the physicians do. The CRNAs regularly work per diem elsewhere to make extra money and mix things up. And they regularly jump ship to something better with no barriers. Yet we can't. Very weird.

It could be that your physician contract is an executive contract vs a simple employee contract for the CRNAs. It could also be that the CRNAs are not employees and are true contractors without benefits. I’ve seen the latter arrangement a lot in the northeast.

 

[Notascab]

the current group in charlotte the docs dont have a non compete from what im told

Why would they need a non compete... the hospital system controls 60-80% of the market and the there are plenty of former Mednax docs to compete at Novant.... They are defacto hospital employees with an invisible non compete... the real question is how many are still locums working at Atrium (they magically don't publish the current providers on their website... been over a year and they still list former MD's that haven't practiced since last June 30....) doing locums still the only way to control your own destiny... The Firm encourages children, large mortgages and depends on what form the "The Firm " takes.... AMC's, large PP groups or hospital systems..... nice thing is on average 1/3 of the group at Abbott got a chunk of change in the buyout from Mednax and now either can retire or work 12 weeks of the year which only creates a void somewhere else in the country...

 

[PieOHmy]

Why would they need a non compete...

Because there is still a middleman there that the hospital system can eliminate without a problem. They have nothing the hospital wants. Scope? whats that?

 

[Arch Guillotti]

Because there is still a middleman there that the hospital system can eliminate without a problem. They have nothing the hospital wants. Scope? whats that?

Scope is the company that poached the contract.

 

[Direct Laryngoscopy]

There are cracks presently. I know that NAPA is not on solid footing in LI and there's a massive tug of war going on to get them out of the big shops. Northwell has started their own anesthesia departments at a couple of hospitals. A buddy of mine and his buddies were given the task of forming their anesthesia group at a hospital 90 minutes or so from me after an AMC was booted out. So far so good for his group and their expanding services.

Like others have said, I think the crest of AMCs may have peaked a couple of years ago. Things might be changing (for the good). I think the administrators that are making decisions on these AMCs realizes that if it doesn't work out, they themselves maybe on the chopping block.

 

[GravelRider]

There are cracks presently. I know that NAPA is not on solid footing in LI and there's a massive tug of war going on to get them out of the big shops. Northwell has started their own anesthesia departments at a couple of hospitals. A buddy of mine and his buddies were given the task of forming their anesthesia group at a hospital 90 minutes or so from me after an AMC was booted out. So far so good for his group and their expanding services.

Like others have said, I think the crest of AMCs may have peaked a couple of years ago. Things might be changing (for the good). I think the administrators that are making decisions on these AMCs realizes that if it doesn't work out, they themselves maybe on the chopping block.

I wouldn’t count on Northwell being the savior of physician independence. Northwell is just one of the few big dogs that can push NAPA around, but I doubt they will bring about a Renaissance for physicians. I have a couple of friends that work for Northwell in other specialties and it’s certainly not the greatest working arrangement. They just have no other options when they are in a Northwell area because if you even attempt to open up a practice in the vicinity of a Northwell practice they will choke you out until you have no choice but to join them.

 

[PieOHmy]

I wouldn’t count on Northwell being the savior of physician independence. Northwell is just one of the few big dogs that can push NAPA around, but I doubt they will bring about a Renaissance for physicians. I have a couple of friends that work for Northwell in other specialties and it’s certainly not the greatest working arrangement. They just have no other options when they are in a Northwell area because if you even attempt to open up a practice in the vicinity of a Northwell practice they will choke you out until you have no choice but to join them.

True enough.
Tfhey are not kicking AMCs out and saying " geez let the physicians take over". They are kicking AMCs out so THEY can take over.