here's the latest garbage i'm dealing with

[VolatileAgent]

so the healthcare system i work in just recently hired a new director to coordinate and align care (whatever that means) across all of its surgical care areas. this person believes all entities should be 'fully aligned' with with the mother ship. basically it's my hospital, which is the 120 bed community based, and the large main referral facility which is over 500 beds that i like to call the deathstar and 9 other facilities that provide surgical services. we are the only group of anesthesiologists left that aren't either employed by the system's group or working for a national anesthesia group

our hospital functions just fine. we are a small independent private group. i am one of the owners. the CRNAs work for the hospital. we get along peachy. there are no issues with flow, billing, adverse outcomes, etc. we are a churn-and-burn machine where the surgeons are happy and the numbers they show me are good. no complaints. quite the opposite, at least locally.

i am, along with my other senior co-owner, supposed to meet with this joker next week. at the system level, there's a lot that's broken. i have been in a few zoom meetings with this guy already and he is just rah-rah-sis-boom-bah bull*** spewing meaningless corporate-speak nonsense machine

and i know why he's calling this meeting...

they want our practice. period. that's it. they've been jerking us around for the past 6 months with a services agreement extension and made it clear they won't re-sign for longer than 1 year.

here's what i'm going to tell the guy:

- i'm not coming to work for you
- if you force this, i'm gone
- good luck finding other capable qualified anesthesiologists willing to come here and do what i do on such an already-meager subsidy

about a year-and-a-half ago we brought another guy in who was a bad fit. after some discussion, we mutually came to an agreement that he should go work elsewhere. the departure was on friendly terms. this was after numerous complaints from surgeons, delays in his rooms, inability to perform blocks in a competent manner, and a host of other complaints from local managers. he was a good guy, but that's the way it works. when you're in a small group, you are on the front lines. you solve your own problems. you hire a contractor or outside group with no ties to the community and guess what? you get what you get

this new director does not believe any of that. and if he forces things he's going to pay the price. if he breaks our group up, i'm gone. i'm going to make that very clear to him.

stand your ground. this is a hill i'm willing to die on. i'm sick of administrators ****ing up medicine and our profession. stop letting these ****heads take control of your life and career. this is a damning trend in medicine that needs to stop.

more to come.

/rant

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[nimbus]

I’ve been through a similar situation and witnessed many others. The meetings are just kabuki theater. It’s done and the decision was probably made before the new director was hired. You are not going to stop this. Best to find your next opportunity. It’s a good time to switch. In my case it worked out for the best.

 

[dabears505]

Good luck.

 

[deleted126335]

so the healthcare system i work in just recently hired a new director to coordinate and align care (whatever that means) across all of its surgical care areas. this person believes all entities should be 'fully aligned' with with the mother ship. basically it's my hospital, which is the 120 bed community based, and the large main referral facility which is over 500 beds that i like to call the deathstar and 9 other facilities that provide surgical services. we are the only group of anesthesiologists left that aren't either employed by the system's group or working for a national anesthesia group

our hospital functions just fine. we are a small independent private group. i am one of the owners. the CRNAs work for the hospital. we get along peachy. there are no issues with flow, billing, adverse outcomes, etc. we are a churn-and-burn machine where the surgeons are happy and the numbers they show me are good. no complaints. quite the opposite, at least locally.

i am, along with my other senior co-owner, supposed to meet with this joker next week. at the system level, there's a lot that's broken. i have been in a few zoom meetings with this guy already and he is just rah-rah-sis-boom-bah bull*** spewing meaningless corporate-speak nonsense machine

and i know why he's calling this meeting...

they want our practice. period. that's it. they've been jerking us around for the past 6 months with a services agreement extension and made it clear they won't re-sign for longer than 1 year.

here's what i'm going to tell the guy:

- i'm not coming to work for you
- if you force this, i'm gone
- good luck finding other capable qualified anesthesiologists willing to come here and do what i do on such an already-meager subsidy

about a year-and-a-half ago we brought another guy in who was a bad fit. after some discussion, we mutually came to an agreement that he should go work elsewhere. the departure was on friendly terms. this was after numerous complaints from surgeons, delays in his rooms, inability to perform blocks in a competent manner, and a host of other complaints from local managers. he was a good guy, but that's the way it works. when you're in a small group, you are on the front lines. you solve your own problems. you hire a contractor or outside group with no ties to the community and guess what? you get what you get

this new director does not believe any of that. and if he forces things he's going to pay the price. if he breaks our group up, i'm gone. i'm going to make that very clear to him.

stand your ground. this is a hill i'm willing to die on. i'm sick of administrators ****ing up medicine and our profession. stop letting these ****heads take control of your life and career. this is a damning trend in medicine that needs to stop.

more to come.

/rant

If you really are willing to die on this hill...Let him know what you believe will be the consequences of not continuing with your group on efficiency, productivity, patient care, surgeon satisfaction, financials, etc. Let him know that you will memorialize this in writing and send to all senior administrative leadership. If your prediction is accurate, you will do your best to make sure that this bad decision follows him for the rest of his career. You need to put his skin in the game somehow. Do it with the assistance of counsel.

 

[nimbus]

If you really are willing to die on this hill...Let him know what you believe will be the consequences of not continuing with your group on efficiency, productivity, patient care, surgeon satisfaction, financials, etc. Let him know that you will memorialize this in writing and send to all senior administrative leadership. If your prediction is accurate, you will do your best to make sure that this bad decision follows him for the rest of his career. You need to put his skin in the game somehow. Do it with the assistance of counsel.

I believe this new director was hired to implement a decision made by the systemwide CEO/board of directors. That person is not the decision maker.

 

[deleted126335]

I believe this new director was hired to implement a decision made by the systemwide CEO/board level.

Very possible. Some person(s) made this decision. All you can do is try to make sure that they own it and it is memorialized.

 

[coffeebythelake]

Is this going to be qn Advocate Sherman like situation? **** like this can backfire on admin and put a hospital in a much worse financial situation.

 

[Southpaw]

so the healthcare system i work in just recently hired a new director to coordinate and align care (whatever that means) across all of its surgical care areas. this person believes all entities should be 'fully aligned' with with the mother ship. basically it's my hospital, which is the 120 bed community based, and the large main referral facility which is over 500 beds that i like to call the deathstar and 9 other facilities that provide surgical services. we are the only group of anesthesiologists left that aren't either employed by the system's group or working for a national anesthesia group

our hospital functions just fine. we are a small independent private group. i am one of the owners. the CRNAs work for the hospital. we get along peachy. there are no issues with flow, billing, adverse outcomes, etc. we are a churn-and-burn machine where the surgeons are happy and the numbers they show me are good. no complaints. quite the opposite, at least locally.

i am, along with my other senior co-owner, supposed to meet with this joker next week. at the system level, there's a lot that's broken. i have been in a few zoom meetings with this guy already and he is just rah-rah-sis-boom-bah bull*** spewing meaningless corporate-speak nonsense machine

and i know why he's calling this meeting...

they want our practice. period. that's it. they've been jerking us around for the past 6 months with a services agreement extension and made it clear they won't re-sign for longer than 1 year.

here's what i'm going to tell the guy:

- i'm not coming to work for you
- if you force this, i'm gone
- good luck finding other capable qualified anesthesiologists willing to come here and do what i do on such an already-meager subsidy

about a year-and-a-half ago we brought another guy in who was a bad fit. after some discussion, we mutually came to an agreement that he should go work elsewhere. the departure was on friendly terms. this was after numerous complaints from surgeons, delays in his rooms, inability to perform blocks in a competent manner, and a host of other complaints from local managers. he was a good guy, but that's the way it works. when you're in a small group, you are on the front lines. you solve your own problems. you hire a contractor or outside group with no ties to the community and guess what? you get what you get

this new director does not believe any of that. and if he forces things he's going to pay the price. if he breaks our group up, i'm gone. i'm going to make that very clear to him.

stand your ground. this is a hill i'm willing to die on. i'm sick of administrators ****ing up medicine and our profession. stop letting these ****heads take control of your life and career. this is a damning trend in medicine that needs to stop.

more to come.

/rant

what's funny is they have no reason to mess with you.....but they will anyway. Because they can. Power and control. If you're willing to die on the hill then tell the surgeons what's going on, have them go to bat for you/your quality/your efficiency, and tell them exactly how it will play out if they force your hand. and then......watch them do it anyway. good luck.

 

[Southpaw]

I believe this new director was hired to implement a decision made by the systemwide CEO/board level. That person is not the decision maker.

I agree with this

 

[deleted941485]

what's funny is they have no reason to mess with you.....but they will anyway. Because they can. Power and control. If you're willing to die on the hill then tell the surgeons what's going on, have them go to bat for you/your quality/your efficiency, and tell them exactly how it will play out if they force your hand. and then......watch them do it anyway. good luck.

I’d start looking. These guys eventually win.

 

[Tony C anesthesia]

so the healthcare system i work in just recently hired a new director to coordinate and align care (whatever that means) across all of its surgical care areas. this person believes all entities should be 'fully aligned' with with the mother ship. basically it's my hospital, which is the 120 bed community based, and the large main referral facility which is over 500 beds that i like to call the deathstar and 9 other facilities that provide surgical services. we are the only group of anesthesiologists left that aren't either employed by the system's group or working for a national anesthesia group

our hospital functions just fine. we are a small independent private group. i am one of the owners. the CRNAs work for the hospital. we get along peachy. there are no issues with flow, billing, adverse outcomes, etc. we are a churn-and-burn machine where the surgeons are happy and the numbers they show me are good. no complaints. quite the opposite, at least locally.

i am, along with my other senior co-owner, supposed to meet with this joker next week. at the system level, there's a lot that's broken. i have been in a few zoom meetings with this guy already and he is just rah-rah-sis-boom-bah bull*** spewing meaningless corporate-speak nonsense machine

and i know why he's calling this meeting...

they want our practice. period. that's it. they've been jerking us around for the past 6 months with a services agreement extension and made it clear they won't re-sign for longer than 1 year.

here's what i'm going to tell the guy:

- i'm not coming to work for you
- if you force this, i'm gone
- good luck finding other capable qualified anesthesiologists willing to come here and do what i do on such an already-meager subsidy

about a year-and-a-half ago we brought another guy in who was a bad fit. after some discussion, we mutually came to an agreement that he should go work elsewhere. the departure was on friendly terms. this was after numerous complaints from surgeons, delays in his rooms, inability to perform blocks in a competent manner, and a host of other complaints from local managers. he was a good guy, but that's the way it works. when you're in a small group, you are on the front lines. you solve your own problems. you hire a contractor or outside group with no ties to the community and guess what? you get what you get

this new director does not believe any of that. and if he forces things he's going to pay the price. if he breaks our group up, i'm gone. i'm going to make that very clear to him.

stand your ground. this is a hill i'm willing to die on. i'm sick of administrators ****ing up medicine and our profession. stop letting these ****heads take control of your life and career. this is a damning trend in medicine that needs to stop.

more to come.

/rant

Sorry if I sound bitter but if they want your contract, they'll get it sooner than you think. This is how it works in anesthesia world nowadays.

 

[NICMAN]

DM me if you would like to move to a nice Atlantic coastal town and become an owner/partner of a solid group.

 

[ambiturner]

How many docs do you have? If you’re running 4:1 and they get to keep the crnas, it won’t be difficult for them to find a few docs to run a small hospital. If you have bigger numbers a fair system would at least offer a buyout.

 

[DirtDocMD]

This goofball is looking to get promoted/transferred to another position in the next 2-3 years. He doesn’t care about you or the hospital or the patients.

Pay is continuing to go up, providers are getting harder to find, and inflation is boosting pay numbers, as well.

If there’s only 2-4 of you, he’ll be able to replace you, somehow. A number of 6-10 is much harder, in the current environment.

Give him some corporate-speak (“we need to review these numbers”, “we’ll get back to you”), and simply drag your feet. Get a line on some other jobs, and make sure everyone is willing to walk.

When the “deadline” does come, have a number, the number of vacation weeks you want, and the stipulation that you guys cover THAT hospital only (no cross-coverage). Be ready for them to take it or leave it.

Maybe you’ll luck out, and this guy will be gone in the next 6-12 months. Maybe, if he’s staying, he accepts your salary/vacation demands. Otherwise, bye-bye.

As I’ve heard before, “You’re not gonna find a good job, if you’re afraid to leave a bad one.”.

 

[NICMAN]

The best way to negotiate as others have said is to strengthen your best alternative to no agreement (BATNA). Do this by lining up a job that you can sign. I saw this at several hospitals in my system and the executives paid a very heavy price in terms of locum anesthesiologist and CRNAs. Also they will use time to their advantage by stringing you along on a meager stipend. You can use time to your advantage as well (just look at the striking Chicago Public Schools). Give them a shorter deadline with a credible threat to walk. A crippled anesthesia department will result in surgeons walking and a very difficult recovery if the surgery market is competitive (eg lots of hospitals); but perhaps not as much if they are the only hospital in town.

 

[anbuitachi]

so the healthcare system i work in just recently hired a new director to coordinate and align care (whatever that means) across all of its surgical care areas. this person believes all entities should be 'fully aligned' with with the mother ship. basically it's my hospital, which is the 120 bed community based, and the large main referral facility which is over 500 beds that i like to call the deathstar and 9 other facilities that provide surgical services. we are the only group of anesthesiologists left that aren't either employed by the system's group or working for a national anesthesia group

our hospital functions just fine. we are a small independent private group. i am one of the owners. the CRNAs work for the hospital. we get along peachy. there are no issues with flow, billing, adverse outcomes, etc. we are a churn-and-burn machine where the surgeons are happy and the numbers they show me are good. no complaints. quite the opposite, at least locally.

i am, along with my other senior co-owner, supposed to meet with this joker next week. at the system level, there's a lot that's broken. i have been in a few zoom meetings with this guy already and he is just rah-rah-sis-boom-bah bull*** spewing meaningless corporate-speak nonsense machine

and i know why he's calling this meeting...

they want our practice. period. that's it. they've been jerking us around for the past 6 months with a services agreement extension and made it clear they won't re-sign for longer than 1 year.

here's what i'm going to tell the guy:

- i'm not coming to work for you
- if you force this, i'm gone
- good luck finding other capable qualified anesthesiologists willing to come here and do what i do on such an already-meager subsidy

about a year-and-a-half ago we brought another guy in who was a bad fit. after some discussion, we mutually came to an agreement that he should go work elsewhere. the departure was on friendly terms. this was after numerous complaints from surgeons, delays in his rooms, inability to perform blocks in a competent manner, and a host of other complaints from local managers. he was a good guy, but that's the way it works. when you're in a small group, you are on the front lines. you solve your own problems. you hire a contractor or outside group with no ties to the community and guess what? you get what you get

this new director does not believe any of that. and if he forces things he's going to pay the price. if he breaks our group up, i'm gone. i'm going to make that very clear to him.

stand your ground. this is a hill i'm willing to die on. i'm sick of administrators ****ing up medicine and our profession. stop letting these ****heads take control of your life and career. this is a damning trend in medicine that needs to stop.

more to come.

/rant

Nice ! full support here. best of luck. like what others said, make sure this guy gets the consequences. even if its like 4 anesthesiologists, it'll take time to replace. the hospital will lose volume . surgeons may leave etc. if you lose, make sure that guy loses too

 

[Velefunt]

If you end up needing a job, DM me. Private all-MD group on the west coast.

 

[sevoflurane]

Jobs are plentiful right now and the housing market is a sellers market.
Don’t put up w/ this type of crap.
Move to where you will be happy.

 

[sevoflurane]

*preferably a big group entrenched in a hospital system = safety in numbers.

 

[ValentineD]

How many docs do you have? If you’re running 4:1 and they get to keep the crnas, it won’t be difficult for them to find a few docs to run a small hospital. If you have bigger numbers a fair system would at least offer a buyout.

On paper they probably think this. My hospital went through a similar change as OP is describing. Had an entrenched anesthesia group that got sacked in an effort to unite everything under one banner. Lost most of the anesthesiologists and contrary to what many may think, if you have a healthy ACT model, the anesthetists get very very angry. Lost most of the anesthetists as well. If they're starting fresh they might as well go someplace new and get top-dollar.

Edit: I will also say that the result is dumpster fire, for those curious. The people responsible probably got promoted.

 

[OptionOffense]

Hate to break it to you. There is tons of precedence already of them axeing pvt groups en masse on a moments notice. You will be NO different. Start looking for another job. There is precendence for that too. I

 

[deleted126335]

Hate to break it to you. There is tons of precedence already of them axeing pvt groups en masse on a moments notice. You will be NO different. Start looking for another job. There is precendence for that too. I

Don't take advice from somebody who doesn't know the difference between precedence and precedent.

 

[Blockit]

Don't take advice from somebody who doesn't know the difference between precedence and precedent.

or precedex.

 

[deleted126335]

so the healthcare system i work in just recently hired a new director to coordinate and align care (whatever that means) across all of its surgical care areas. this person believes all entities should be 'fully aligned' with with the mother ship. basically it's my hospital, which is the 120 bed community based, and the large main referral facility which is over 500 beds that i like to call the deathstar and 9 other facilities that provide surgical services. we are the only group of anesthesiologists left that aren't either employed by the system's group or working for a national anesthesia group

our hospital functions just fine. we are a small independent private group. i am one of the owners. the CRNAs work for the hospital. we get along peachy. there are no issues with flow, billing, adverse outcomes, etc. we are a churn-and-burn machine where the surgeons are happy and the numbers they show me are good. no complaints. quite the opposite, at least locally.

i am, along with my other senior co-owner, supposed to meet with this joker next week. at the system level, there's a lot that's broken. i have been in a few zoom meetings with this guy already and he is just rah-rah-sis-boom-bah bull*** spewing meaningless corporate-speak nonsense machine

and i know why he's calling this meeting...

they want our practice. period. that's it. they've been jerking us around for the past 6 months with a services agreement extension and made it clear they won't re-sign for longer than 1 year.

here's what i'm going to tell the guy:

- i'm not coming to work for you
- if you force this, i'm gone
- good luck finding other capable qualified anesthesiologists willing to come here and do what i do on such an already-meager subsidy

about a year-and-a-half ago we brought another guy in who was a bad fit. after some discussion, we mutually came to an agreement that he should go work elsewhere. the departure was on friendly terms. this was after numerous complaints from surgeons, delays in his rooms, inability to perform blocks in a competent manner, and a host of other complaints from local managers. he was a good guy, but that's the way it works. when you're in a small group, you are on the front lines. you solve your own problems. you hire a contractor or outside group with no ties to the community and guess what? you get what you get

this new director does not believe any of that. and if he forces things he's going to pay the price. if he breaks our group up, i'm gone. i'm going to make that very clear to him.

stand your ground. this is a hill i'm willing to die on. i'm sick of administrators ****ing up medicine and our profession. stop letting these ****heads take control of your life and career. this is a damning trend in medicine that needs to stop.

more to come.

/rant

So how did your meeting go?

 

[VolatileAgent]

So how did your meeting go?

oh, this guy was good.

so he first tells us that it's just a "meet and greet" to start to understand our practice. then he shares his vision of what he's trying to accomplish across all sites. as advertised, it's just a bunch of new agey feel-good mumbo jumbo. he follows that up by saying that he hopes to meet with us several times over the next few months to assess our needs.

here's the kicker...

he tells us that he wants us more involved in the coordination of the day-to-day operations. i respond telling him that i'm already in enough meetings and that as a full-time clinician it is hard to find time in the day away from patient care. then he says, basically, that our ongoing subsidy is dependent on us "stepping up" (his words) into being more involved in the operations and ostensibly reporting to him what's going on.

i will tell you this. by industry standards our stipend is a joke. our OB census is spotty and yet we are expected cover 24/7/365 for OR emergencies, c-sections, pain consults, etc. this is all in the face of a growing overall surgical census as they continue to hire surgeons and increase block time. they also asked us to hire another person in anticipation of more ORs opening in the next two years. we're not bringing in another person until we're sure all of that is going to happen.

bottom line is this guy is just another academic dip**** who should have stayed at his previous job at university hospital medical center as a low-level director. because that's all he is. i'm satisified that he's already pissed enough people off that he won't be here in 2 years time. seems to be his pattern. but our group just has to survive until then. and right now unfortunately he's holding the reins on our contract. he's been on a firing spree lately and replacing people from his prior job who are loyal to him and happy to drink his koolaid.

this is the **** they don't teach you in residency, residents. everyone who matters locally is happy with the service we provide. but that doesn't matter to some ***hole sitting in a office somewhere that doesn't understand the relationships you have with the surgeons, the CRNAs, and ultimately the patients in the local community.

more to come i'm sure. i will never direcly work for this idiot. that much i will certify to you now.

 

[VolatileAgent]

so, it is done. as predicted, they are f***ing us.

i'm outta here.

 

[dabears505]

What is happening

 

[IMGASMD]

so, it is done. as predicted, they are f***ing us.

i'm outta here.

Moving is a bitch.
I hope you get to something good soon.
Or like one of my co-owner, stick around, buy some popcorn, get through the non-compete, watch them burn.

 

[DirtDocMD]

There are jobs everywhere, right now. Find you something good, and don’t be afraid to do some pushing on contract details. May look worse, next year, but for now, it’s a great time to be looking for a job.

 

[CubsDynasty]

Sorry to hear that, you called it. But it couldn't happen at a better time in our field, jobs open everywhere and compensation at the highs

 

[Hoya11]

Sorry to hear that, you called it. But it couldn't happen at a better time in our field, jobs open everywhere and compensation at the highs

The academic department will take over for this group. Cost of anesthesia to the hospital will be much much more than the current stipend. Care will be worse. CEO will get a bonus. We’ve all seen it before ..

 

[IMGASMD]

The academic department will take over for this group. Cost of anesthesia to the hospital will be much much more than the current stipend. Care will be worse. CEO will get a bonus. We’ve all seen it before ..

Of course, now the hospital will be affiliated with a name brand ivory tower…. CEO did a great job selling out everybody.

 

[deleted1147063]

The academic department will take over for this group. Cost of anesthesia to the hospital will be much much more than the current stipend. Care will be worse. CEO will get a bonus. We’ve all seen it before ..

I'm sorry for your loss. Hope you found a better job.

 

[VolatileAgent]

The academic department will take over for this group. Cost of anesthesia to the hospital will be much much more than the current stipend. Care will be worse. CEO will get a bonus. We’ve all seen it before ..

so employment is becoming the trend. i've done that before. it sucks. the problem is this a-hole is about $75k/yr under the current market. and, by the way, did i mention he's an a-hole. can't even stand to hear his voice. to me that makes the situation untenable.

yeah, i'm just looking forward to all of us leaving and him taking the blame for ORs shutting down. looks like at least two (possibly 3) of us are going to say "eff you" and move on. they will not be able to replace us at the current rate and they're going to get sh*tty locums to come in that they're going to pay an outrageous amount for. then the CRNAs (with whom we have a lot of solidarity) are going to start jumping ship.

i don't think this bag of dicks has yet realized what he's done.

 

[VolatileAgent]

Moving is a bitch.
I hope you get to something good soon.
Or like one of my co-owner, stick around, buy some popcorn, get through the non-compete, watch them burn.

we are a private group. i own the professional goodwill. the noncompete is only enforceable if i say so. i can go work anywhere else in town that i want to. they can't do anything about it. in our drivable region there are currently 22 anesthesiologist openings. this idiot did not do his homework.

 

[VolatileAgent]

What is happening

they are cancelling our service agreement and offering to employ us at a far less than market rate. they also understood that we were trying to hire 2 additional FTEs which they were not going to support. so they said "join us or pound sand". then the "join us" part was insulting.

they will not be able to both replace us and hire additional help for their expanding service lines. they are going to very quickly realize this over the next several months. nothing short of an apology and a fair market value offer will make me stay. both are requirements. plenty of other jobs in the area. my wife is motivated to stay local for family reasons. i'm ready to go scorched earth here. sick of this SOB's b.s.

 

[Arch Guillotti]

they are cancelling our service agreement and offering to employ us at a far less than market rate. they also understood that we were trying to hire 2 additional FTEs which they were not going to support. so they said "join us or pound sand". then the "join us" part was insulting.

they will not be able to both replace us and hire additional help for their expanding service lines. they are going to very quickly realize this over the next several months. nothing short of an apology and a fair market value offer will make me stay. both are requirements. plenty of other jobs in the area. my wife is motivated to stay local for family reasons. i'm ready to go scorched earth here. sick of this SOB's b.s.

burn it down

 

[ambiturner]

they are cancelling our service agreement and offering to employ us at a far less than market rate. they also understood that we were trying to hire 2 additional FTEs which they were not going to support. so they said "join us or pound sand". then the "join us" part was insulting.

they will not be able to both replace us and hire additional help for their expanding service lines. they are going to very quickly realize this over the next several months. nothing short of an apology and a fair market value offer will make me stay. both are requirements. plenty of other jobs in the area. my wife is motivated to stay local for family reasons. i'm ready to go scorched earth here. sick of this SOB's b.s.

Have you had disagreements about ‘strategic alignment’ or the like? I’ve seen this scenario with hospitals that want to use anesthesia on inefficient service lines for our billing but profitable ones for the hospital but aren’t willing to support it. Ultimately they want to just be able to tell you what to do and skip the haggling over subsidies, which will be accomplished with what they’re doing, but they will likely have to overpay for it in the near term. Leaving is a good idea if you have the option, the people that stay will be overworked in the short term, and will likely end up with better salaries in the end. And from his perspective, the obstructionist troublemakers will be gone.

 

[VolatileAgent]

The best way to negotiate as others have said is to strengthen your best alternative to no agreement (BATNA). Do this by lining up a job that you can sign. I saw this at several hospitals in my system and the executives paid a very heavy price in terms of locum anesthesiologist and CRNAs. Also they will use time to their advantage by stringing you along on a meager stipend. You can use time to your advantage as well (just look at the striking Chicago Public Schools). Give them a shorter deadline with a credible threat to walk. A crippled anesthesia department will result in surgeons walking and a very difficult recovery if the surgery market is competitive (eg lots of hospitals); but perhaps not as much if they are the only hospital in town.

just looking back through this thread. yes, nicman, this is exactly correct. listen to this, youngsters. this is the way it is.

 

[VolatileAgent]

Have you had disagreements about ‘strategic alignment’ or the like? I’ve seen this scenario with hospitals that want to use anesthesia on inefficient service lines for our billing but profitable ones for the hospital but aren’t willing to support it. Ultimately they want to just be able to tell you what to do and skip the haggling over subsidies, which will be accomplished with what they’re doing, but they will likely have to overpay for it in the near term. Leaving is a good idea if you have the option, the people that stay will be overworked in the short term, and will likely end up with better salaries in the end. And from his perspective, the obstructionist troublemakers will be gone.

i can tell you this (without doxxing myself)... they see the future as us as interchangeable parts throughout the system. this is one person's vision. it's been presented as "i can't understand why you don't think this is a great idea".

fine. okay. that's your vision. pay up.

our service line is not inefficient. exact opposite. we are the only group in the system that is making it work. they've essentially offered us a lateral move. and everything i now see goes behind the veil. i've done this before. then "mission creep" eventually comes around and people become like fleeing cockroaches when the light is turned on. what's left are the lazy complainers. i won't be there that long this time.

the moral of the story here is that these so-called corporate geniuses do not understand the market. i can literally go down the street and work for more pay, less call, and more vacation. what's kept me in this job was being my own boss. take that away and there's zero incentive for me to stay.

 

[HemeOncHopeful19]

we are a private group. i own the professional goodwill. the noncompete is only enforceable if i say so. i can go work anywhere else in town that i want to. they can't do anything about it. in our drivable region there are currently 22 anesthesiologist openings. this idiot did not do his homework.

This is probably the most important part and sadly for that reason the hardest to negotiate these days

 

[Southpaw]

the moral of the story here is that these so-called corporate geniuses do not understand the market. i can literally go down the street and work for more pay, less call, and more vacation. what's kept me in this job was being my own boss. take that away and there's zero incentive for me to stay.

For a long time I’ve felt the deck is stacked against us. Hospitals will bring our service in house if and when they want. Our only recourse is to get angry and leave. The admins who we meet with are really just acting on the orders of the higher ups. It’s not like they’re gonna get fired if anesthesia is in the dumps a year later.

There’s a group not far from me who was recently taken in house, against their desire, by a big hospital corporation. This group was private but had stopped hiring partnership track physicians. Before they stopped they didn’t allow partnership for their physicians on track until another partner retired. I’m not upset that they’ve been taken over.

There are plenty of hospital employed positions that are more desirable or at minimum equal to partnership jobs. And yeah some hospital employed jobs suck and the hospital deserves to feel some pain when they’ve taken over a private group. Regardless, sorry for what happened to your group.

 

[chessknt]

so employment is becoming the trend. i've done that before. it sucks. the problem is this a-hole is about $75k/yr under the current market. and, by the way, did i mention he's an a-hole. can't even stand to hear his voice. to me that makes the situation untenable.

yeah, i'm just looking forward to all of us leaving and him taking the blame for ORs shutting down. looks like at least two (possibly 3) of us are going to say "eff you" and move on. they will not be able to replace us at the current rate and they're going to get sh*tty locums to come in that they're going to pay an outrageous amount for. then the CRNAs (with whom we have a lot of solidarity) are going to start jumping ship.

i don't think this bag of dicks has yet realized what he's done.

I know you're upset right now but absolutely do not bet against them ultimately succeeding. I have seen this play out--even if they have ****ty locums they have to pay through the nose for at far above your costs they will continue to do it until they can find enough suckers to take their full time gigs. Even if this takes years of them slowly increasing the rates at astronomical losses to locums (out of a different pool of money of course so it doesn't really count) they will never ever go back to you because the boss has made sure everyone in hospital admin understands that the reason they are losing so much money is because you aren't team players or want too much or whatever other nonsense he/she needs to conjure up to cast the blame elsewhere. You and your group are now poisoned goods and nobody in charge of decisions at that hospital will ever consider anything you have to say seriously again.

 

[VolatileAgent]

For a long time I’ve felt the deck is stacked against us.

southpaw, we've both been here on this forum for a long time. the one thing i've learned in that time is that the game is forever changing. everything we were talking about 15 years ago is now slowly happening. the real enemy is the protected and sanctioned collusion between the big payers and the big healthcare systems. they just don't want to negotiate with individual practices anymore. they want to negotiate bundled payments directly with the systems who are overseeing the care. everyone has to fight for their piece of that. for some reason, the Stark regulations only screw the little guy and somehow it's okay for them to do exactly what they forbid us from doing.

the only thing you can do anymore is look out for yourself and vote with your feet. but there is currently a nationwide shortage of anesthesiologists. long story short, i'm not going to educate administrators about what I do, what the current market is, and i'm certainly not going to take their lousy pay and bust my ass for their year-end bonus. i'm going to vote with my feet.

this all goes in cycles. this current generation of administrators think they know better than those who preceded them. they'll learn. eventually.

 

[VolatileAgent]

I know you're upset right now but absolutely do not bet against them ultimately succeeding.

you're right, but i don't care. they will f*** themselves in the short term, but i'll be gone. all i'm asking is for them to ensure they hire another FTE and that they pay us fair market value. if they could assure that, i'd stay. but they can't even commit to doing that.

so, off i go (along with a couple of others). yes, this is spiteful. and I will enjoy the schadenfreude of watching this a***hole sweat while paying out the nose to cover what i was already happily doing. we gave them a chance. they said we were being 'disrespectful'. that's what we've been dealing with.

 

[IMGASMD]

you're right, but i don't care. they will f*** themselves in the short term, but i'll be gone. all i'm asking is for them to ensure they hire another FTE and that they pay us fair market value. if they could assure that, i'd stay. but they can't even commit to doing that.

so, off i go (along with a couple of others). yes, this is spiteful. and I will enjoy the schadenfreude of watching this a***hole sweat while paying out the nose to cover what i was already happily doing. we gave them a chance. they said we were being 'disrespectful'. that's what we've been dealing with.

“Disrespectful” is not knowing the market price and not doing their homework. Go find a recruiter and find out what the next door hospital is paying, and you can have a “fair market” comparison.

In a way all of them are the same, AMCs, hospitals. You’re employees, do your work and shut up. Let the “big boys/gals” take care of everything else. They don’t see what’s happening after you hire all these locum/travelers for all the different departments. Quality suffers, morale suffer, on top of that when the long timers find out how much locums are getting, they simply lose all motivations to work hard.

I know I am preaching to the choir….

 

[VolatileAgent]

I know I am preaching to the choir….

preach, brother. others need to hear it too.

 

[abolt18]

preach, brother. others need to hear it too.

I know this royally sucks for you, but I want you to know I am grateful for you sharing it so we can learn from your experiences.

 

[DrNut]

Hospital administrators know absolutely nothing about the business of anesthesia. Theyll pay heavily for this mistake. They'll have even worse staffing issues and pay more for less. The CEO might not get fired but someone will take the fall. Someone will get blamed for it.

Our group went from private practice to hospital employees in 2014. The salaries were similar to how much we were making and they offered better benefits (403b, 457, and traditional pension). At the time there wasn't any buyout. We were struggling to hire CRNAs and likely would have folded the group. we asked the hospital to take us as employees. we couldn't compete with the other anesthesia group who had a large stipend from their hospital and the group didn't pay crna salaries (the crnas were employed by the hospital).

As employees it was less stressful. we managed our own call schedules. We were always understaffed from 2014 to pandemic but we didn't stay any longer than 40 hours per week. we closed down sites as the day progressed so we can get staff home. Surgeons and Administrators werent happy and asked us to run more cases without adequate staff.

In 2022, hospital administration surprised us by transitioning all their anesthesia to NAPA. The reasoning was to streamline anesthesia and better recruiting. They wanted a single entity delivering anesthesia in all 17 hospital locations. No input from any of their anesthesia employees.

The transition was utter failure. Multiple C suite administrators resigned or forced to resign. Every anesthesia site had to decrease and only offered on certain days of the week. The hospital I was at lost 50% of their docs and >60% CRNA staff right away. Another satellite hospital lost all their staff. NAPA/hospital admin were so scared of losing everyone that the remaining anesthesia staff wrote their own contracts. negotiated 20% more salary (>600k/year), every single call is voluntary and pays >300/hr, post call day off, 6 figure sign on bonus.

Then a continuous trickle of people continued to leave once the stress and burn out began. The locums they brought in did only day shift work (we are a tertiary center and flag ship hospital. anyone taking call needs to comfortable doing hearts) and were paid even more than our current staff. The people we lost went to do locums work full time.

When this happened I went through all 5 stages of grief in early 2022. But it was such a blessing in disguise. Hospital administrators had no idea the current market and were under paying us. Every one of us are doing better financially whether they stayed on with NAPA or went elsewhere.

 

[DrNut]

If a group is happy, leave them alone. Especially in this market. Anyone that threatens this balance will lose their shirt. I bet the CEO will get removed by the board of directors.