Hiring Anesthesiologist in Iowa

[staple]

Well established private practice group in Des Moines looking to hire due to growth and retirement. Well above 50% MGMA, 18 months to partner with no buy in. 8 weeks vacation plus sick time. Family friendly group with equality of call schedule starting day 1. Cover 2 hospitals and 3 surgery centers. We do every case except transplants and have separate cardiac, pediatric, and ped heart teams. 90% own cases, 10% medical direction of employed CRNAs.

Low cost of living, best public schools in the nation, plenty of entertainment in the city, and a great total package compensation. Hiring established anesthesiologists, new grads, and residents/fellows interested in the Iowa market.

Visa spot open to ideal candidate

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[staple]

We have had some solid interest and hires recently, but we are looking to hire a couple more due to upcoming retirements. Our job is a solid, true PP job. Iowa is a great place to live and raise a family. If you’re interested, send me a message.

 

[Iso4ane]

Is it possible to join the cardiac team? What benefits are there to being part of that team?

 

[nimbus]

Is it possible to join the cardiac team? What benefits are there to being part of that team?

If it’s anything like my practice, more call, more money, and the opportunity to “practice at the top of your license”

 

[staple]

Is it possible to join the cardiac team? What benefits are there to being part of that team?

We have separate cardiac, sick pediatric, and pediatric heart teams, which includes additional specialty call. As you can imagine, you get paid more to be on these teams. If you are on one of these specialty teams, you still cover general cases as well, so it wouldn't be 100% specialty coverage. We do the most hearts in the state.

 

[nimbus]

From latest MGMA

 

[sethco]

From latest MGMA

View attachment 355925View attachment 355926

Funny how half of the regions went down in median income from 2021 to 2022. The problem with MGMA data has always been the number of reporting (The "n"). It makes it hard to see actual trends. Alas, this is the best we got 😔

 

[nimbus]

Funny how half of the regions went down in median income from 2021 to 2022. The problem with MGMA data has always been the number of reporting (The "n"). It makes it hard to see actual trends. Alas, this is the best we got 😔

I was also surprised to see there was a downtrend in some regions, given that the ASA survey showed increases in commercial unit value everywhere. The downward pressure must be coming from..

1. Increased proportion of public payers…Medicare/Medicaid.

2. Decreased hospital stipends.

3. Increased grifting by middlemen.

4. Sampling bias as you alluded to.

 

[staple]

We are starting our push for new hires again.

True PP group, equality in work from day 1
18 months to partner with prepartner total package 400k+
~40hrs a week average
LCOL city shy of a million people
New grads w/wo fellowship welcome

 

[theslicknerd]

We are starting our push for new hires again.

True PP group, equality in work from day 1
18 months to partner with prepartner total package 400k+
~40hrs a week average
LCOL city shy of a million people
New grads w/wo fellowship welcome

so prepartner is well below 50% MGMA?

 

[staple]

so prepartner is well below 50% MGMA?

Great question. Pre partners are reimbursed less but there is no financial buy in for partnership. The 18 months is considered the “buy in” for partners.

 

[UnoMas]

Great question. Pre partners are reimbursed less but there is no financial buy in for partnership. The 18 months is considered the “buy in” for partners.

Why prepartners are reimbursed less?

 

[Volatile]

Why prepartners are reimbursed less?

If you have to ask this, you probably shouldn’t join a private practice. I’m sure you’ll be much happier working for an AMC where everyone makes the same from day 1.

 

[UnoMas]

If you have to ask this, you probably shouldn’t join a private practice. I’m sure you’ll be much happier working for an AMC where everyone makes the same from day 1.

I don’t want to derail the thread but there are private groups that start their prepartners equal from day 1 with a modest 15-17k token buy-in once they qualify for partnership.

If prepartners make less than partners by a percentage then there is a financial buy-in.

If the pay commesurates with the work, I would not mind going with an AMC. Why not? As long as the checks clear.

 

[staple]

Why prepartners are reimbursed less?

This is a very standard practice in competitive and quality private practice groups, especially in our market.

I promise any group worth working at will be structured similar to this.

 

[Volatile]

I don’t want to derail the thread but there are private groups that start their prepartners equal from day 1 with a modest 15-17k token buy-in once they qualify for partnership.

If prepartners make less than partners by a percentage then there is a financial buy-in.

If the pay commesurates with the work, I would not mind going with an AMC. Why not? As long as the checks clear.

Yes those groups are out there, they often have trouble hiring/keeping people and have to “sweeten” the deal with $$. You are also correct that there are a few AMC’s that pay well, but they are not common, and you now have a boss that likely under-appreciates you. I’m not speaking in absolutes, just what I’ve seen over the years. Good luck!

 

[Status Sciaticus]

If you have to ask this, you probably shouldn’t join a private practice. I’m sure you’ll be much happier working for an AMC where everyone makes the same from day 1.

Nah. There’s definitely groups that pay the same for everyone from day 1. I am in one and it’s definitely not a hiring/sweetening the pot issue here.

 

[UnoMas]

Nah. There’s definitely groups that pay the same for everyone from day 1. I am in one and it’s definitely not a hiring/sweetening the pot issue here.

Yeah I don't understand the whole "Pre partners are reimbursed less but there is no financial buy in for partnership." If a certain percentage is taken off the associates' pay for the first 18 months, that IS the financial buy-in. Plenty of good groups (by SDN standards) have no buy-in

 

[Volatile]

Nah. There’s definitely groups that pay the same for everyone from day 1. I am in one and it’s definitely not a hiring/sweetening the pot issue here.

Like I said before, I’m not saying they don’t exist, but I don’t think it’s the norm. Poster is welcome to do some geographic arbitrage to find a group like yours if he wishes

 

[Status Sciaticus]

Like I said before, I’m not saying they don’t exist, but I don’t think it’s the norm. Poster is welcome to do some geographic arbitrage to find a group like yours if he wishes

I agree, however, as the above poster also mentioned, its disingenuous to say that there is no financial buy-in when the associate only nets a portion of his/her collections. That by definition is a buy-in cost. OP is trying to pull a fast one with that.

 

[GravelRider]

I wouldn’t write the job off completely. It’s sounds reasonable to me, but the difference in income should be explained to a potential new hire. It could be that the group is fronting you money for income and benefits until your collections catch up and they figured that it takes about 18 months at the reduced pay to do that (total guess). My point is groups need to be completely open and transparent to potential hires on where money is going.

 

[staple]

Our groups pay structure for pre partners and partners is not only completely transparent, it is actually more fair than you guys are making it out to be. I explain everything to new hires in private, not in a public forum open to anyone.

I appreciate the general discussion on whether or not pre partners should get paid less or equal. This is a fairly standard practice in PP, similar to how a junior associate would get paid less than a professor in academics. We aren't eat what you kill. Our pre-partner phase is 18 months, not 2 or 3 years compared to some jobs in large cities.

This job is one of the most competitive jobs in the region in terms of pay and work life balance. We have very little turnover except for retirements.

If anyone has any questions I'm more than open to private discussions. There is full financial transparency of our books during interviews.

 

[ERRES2288]

People confuse the “buy in” a lot on this forum.

If you are making less than partners while on the track then yes that is a buy in BUT you can’t really compare it to partner money because you don’t have easy access to that. Your true buy in is what you could make from day one as a w2 employee minus what you’re paid on track.

So for example if partners are making 600k and you 300k for 2 years but the w2 jobs in area paying 425k for equal work.

You’re buy in (opportunity cost) is really 250k and not 600k.

 

[kidthor]

Your true buy in is what you could make from day one as a w2 employee minus what you’re paid on track.

I respectfully disagree, the true buy in is whatever money is taken off the top of your work and then redistributed to the group/partners. If money flows away from you and into the pockets of someone else, that's the buy in.

 

[ERRES2288]

I respectfully disagree, the true buy in is whatever money is taken off the top of your work and then redistributed to the group/partners. If money flows away from you and into the pockets of someone else, that's the buy in.

Yes technically but I feel it’s not the right way to evaluate a partnership track which is what we are really asking.

 

[tdub878]

Why not pay everyone the same for the same work?

 

[Status Sciaticus]

Why not pay everyone the same for the same work?

"because that's how pp works" is the canned answer you get to hide the fact that partners want to make money off other peoples backs just as much as private equity does.

 

[UnoMas]

"because that's how pp works" is the canned answer you get to hide the fact that partners want to make money off other peoples backs just as much as private equity does.

But the thing is if the group is big enough, the money each partner gets from this is almost negligible. It's more of a power move to 'initiate' the new guys, who are the new grads saddled with student loans and need every penny they can keep. It really leaves a bad taste in my mouth interviewing with private groups like these.

 

[Status Sciaticus]

But the thing is if the group is big enough, the money each partner gets from this is almost negligible. It's more of a power move to 'initiate' the new guys, who are the new grads saddled with student loans and need every penny they can keep. It really leaves a bad taste in my mouth interviewing with private groups like these.

You're describing hazing. You need to do it because we all went through it is a BS answer. Just because you were abused doesn't mean you need to continue the abuse.

 

[staple]

I appreciate your feedback, but wholeheartedly disagree with your assessment on how private practice anesthesia jobs actually function. I truly wish you the best of luck finding a job up to your standards and expectations after your fellowship.

There are predatory jobs out there and this is very much not one. While you assume it to be standard to make equal pay for “equal work” you also neglect the millions of dollars of overhead often it takes to run a successful small business and the amount of time it takes partners to operate a business.

It is a very naive expectation that you become an equal partner on day 1, Without question, to hold equal shares and permanent ownership and decision making capacity into a business without having set foot in an OR. An 18 month partnership track is one of the lowest you’ll see. It sounds like your expectations are of private equity where you are an employee from day 1 with no growth potential. Not an owner. Or an academic physician with a tiered pay structure, again no ownership.

If you would like to discuss the different types of jobs and employment structures, I encourage you to kindly discuss it on the main forum and we could have a riveting discussion.

I want to reiterate that all financials are transparent to new hires and this job is a fair, democratic, and top and desirable job In the area.

 

[abolt18]

I appreciate your feedback, but wholeheartedly disagree with your assessment on how private practice anesthesia jobs actually function. I truly wish you the best of luck finding a job up to your standards and expectations after your fellowship.

There are predatory jobs out there and this is very much not one. While you assume it to be standard to make equal pay for “equal work” you also neglect the millions of dollars of overhead often it takes to run a successful small business and the amount of time it takes partners to operate a business.

It is a very naive expectation that you become an equal partner on day 1, Without question, to hold equal shares and permanent ownership and decision making capacity into a business without having set foot in an OR. An 18 month partnership track is one of the lowest you’ll see. It sounds like your expectations are of private equity where you are an employee from day 1 with no growth potential. Not an owner. Or an academic physician with a tiered pay structure, again no ownership.

If you would like to discuss the different types of jobs and employment structures, I encourage you to kindly discuss it on the main forum and we could have a riveting discussion.

I want to reiterate that all financials are transparent to new hires and this job is a fair, democratic, and top and desirable job In the area.

I didn't get the impression that anyone was suggesting having voting rights day 1. Rather, they suggested equal pay.

 

[Gator7]

But the thing is if the group is big enough, the money each partner gets from this is almost negligible. It's more of a power move to 'initiate' the new guys, who are the new grads saddled with student loans and need every penny they can keep. It really leaves a bad taste in my mouth interviewing with private groups like these.

Exactly. Speaking as someone not too far out of residency this is the main reason myself and many classmates did not join private practices.

For example one of my partners is in his first year out of fellowship and is on track to make nearly $1 million for the year. While private practices are trying to offer $250-350k to new grads. And also trying to include benefits as part of the offered salary so you are really making even less.

Most new grads don’t desire to work for AMCs but we are talking huge gaps in income potential here.

 

[nimbus]

Nah. There’s definitely groups that pay the same for everyone from day 1. I am in one and it’s definitely not a hiring/sweetening the pot issue here.

I’m in one too. I think it’s gaslighting to say we don’t exist.

 

[UnoMas]

I appreciate your feedback, but wholeheartedly disagree with your assessment on how private practice anesthesia jobs actually function. I truly wish you the best of luck finding a job up to your standards and expectations after your fellowship.

There are predatory jobs out there and this is very much not one. While you assume it to be standard to make equal pay for “equal work” you also neglect the millions of dollars of overhead often it takes to run a successful small business and the amount of time it takes partners to operate a business.

It is a very naive expectation that you become an equal partner on day 1, Without question, to hold equal shares and permanent ownership and decision making capacity into a business without having set foot in an OR. An 18 month partnership track is one of the lowest you’ll see. It sounds like your expectations are of private equity where you are an employee from day 1 with no growth potential. Not an owner. Or an academic physician with a tiered pay structure, again no ownership.

If you would like to discuss the different types of jobs and employment structures, I encourage you to kindly discuss it on the main forum and we could have a riveting discussion.

I want to reiterate that all financials are transparent to new hires and this job is a fair, democratic, and top and desirable job In the area.

I am not saying your group is predatory, my whole point is it's disingenuous to say 'NO FINANCIAL BUY-IN' but the pay is reduced for 18 months.

I never said the associates should have voting rights from day 1. Just equal pay from day 1. I don't think I am naive. It would be naive of me to not question these things. The job market is very different now and honestly what you are offering is not appealing at all.

the millions of dollars of overhead often it takes to run a successful small business and the amount of time it takes partners to operate a business.

Take whatever you need off the top for operating cost, the same way you do for all your partners.

What are they buying in anyway? Contracts? The success of your contracts depend on whether or not you can hire enough people to staff your sites so you need the new hires as much as they need you. If you sell your group in 18 months, do associates on the track get anything? There's literally a thread in the Private Forum talking about how uncertain the future of private practice is right now.

Do you give the associates back the money you took from them for 18 months in the event they don't make partners?

It sounds like your expectations are of private equity where you are an employee from day 1 with no growth potential.

I don't care about growth potential when it is artificially applied by the group. You can't artificially reduce someone's income to 70-80% then bring it back to 100% and call it 'growth potential.'

I would ask you to explain to me how 'private practice anesthesia jobs actually function,' but I know I am derailing your recruitment thread so I'll stop. Nimbus is correct, I feel gaslit.

Like I said before, I’m not saying they don’t exist, but I don’t think it’s the norm. Poster is welcome to do some geographic arbitrage to find a group like yours if he wishes

I don't know if you are OP's partner but moving to Iowa is geographic arbitrage and 400k+ including benefits isn't attractive enough these days. A university job in a good location I talked to pays more than that, AMC pays more than that. Honestly, I'd rather work for an AMC knowing some corporate suits 4 states over are eating off my back than having Bob, the senior partner sitting 3 ORs down the hallway, eating off my back.

I’m in one too. I think it’s gaslighting to say we don’t exist.

I talked to your group. Super fair and transparent! Associates get paid what they earn from day 1. In fact, that's the group I alluded to prior. SD is appealing but not feasible right now as a new grad. Maybe a few years down the road.

 

[staple]

Many groups not only have a pre partner time track with reduced salary, but also a financial buy into partnership. It is farily common in private practices which is why I have phrased this as no financial buy in. Under intense scrutiny, you are technically correct in my exact phrasing.

You are comparing one aspect of a west coast job to one aspect of a midwest job. I would caution residents who are graduating to look at the larger picture - hours worked, case load, call schedule, +/- supervision, power hierarchy, financials, etc. Life isnt always just about money. Some people are OK making less for a year and a half when a 25 year career will have much higher total earnings in the long run and high overall job satisfaction. If you find offense with our structure, you may be appalled by other jobs out there.

Im not saying we are perfect. In a perfect world, I would prefer to get rid of "pre partners" all together. But in a real world, the world we live in, a pre partnership track has its own merits which may be above discussion to this hiring thread. This is not an "eat what you kill" model.

Since you continue to push for information, which is a good thing, I will mention one of our fair measures is that our group pays partners the difference in (partner minus prepartner) pay over a three year span when they retire/leave to make up the initial discrepancy.

Our pre partners also don't take call right away, including weekday and weekend call. Many Anesthesiologists who have worked in a real job can appreciate how this is worth financial consideration.

I appreciate your insights as a resident searching for a job, but I stand by every word I have written and I will state that private practice is not meant for everyone. For those who are looking for a career of high income potential in a fair group, working ~40 hrs a week, limited call, in a great city, with a great mix of cases, I would be more than happy to talk about what we can offer.

 

[UnoMas]

Many groups not only have a pre partner time track with reduced salary, but also a financial buy into partnership. It is farily common in private practices which is why I have phrased this as no financial buy in. Under intense scrutiny, you are technically correct in my exact phrasing.

You are comparing one aspect of a west coast job to one aspect of a midwest job. I would caution residents who are graduating to look at the larger picture - hours worked, case load, call schedule, +/- supervision, power hierarchy, financials, etc. Life isnt always just about money. Some people are OK making less for a year and a half when a 25 year career will have much higher total earnings in the long run and high overall job satisfaction. If you find offense with our structure, you may be appalled by other jobs out there.

Im not saying we are perfect. In a perfect world, I would prefer to get rid of "pre partners" all together. But in a real world, the world we live in, a pre partnership track has its own merits which may be above discussion to this hiring thread. This is not an "eat what you kill" model.

Since you continue to push for information, which is a good thing, I will mention one of our fair measures is that our group pays partners the difference in (partner minus prepartner) pay over a three year span when they retire/leave to make up the initial discrepancy.

Our pre partners also don't take call right away, including weekday and weekend call. Many Anesthesiologists who have worked in a real job can appreciate how this is worth financial consideration.

I appreciate your insights as a resident searching for a job, but I stand by every word I have written and I will state that private practice is not meant for everyone. For those who are looking for a career of high income potential in a fair group, working ~40 hrs a week, limited call, in a great city, with a great mix of cases, I would be more than happy to talk about what we can offer.

Appreciate the explanation! With the additional info that sounds very fair and a great setup.

 

[2019medstudent]

I think you paint a much fairer picture of your practice than most groups I’ve seen.

The typical in large groups in North Carolina or other coastal areas is a 3 year partner track with backbreaking call burdens that are not compensated regardless of difficulty or production.

These groups then continue to skim with maximum income being around 650000, when the true production value for the hospital in the days of inflation is probably closer to 1.2 million.

Where I disagree with your presentation is the concept of “ownership”. As someone who knows several true partnership track/true partner private practice surgeons, the idea of anesthesia practices “owning” anything is pretty absurd.

What is there to own exactly? A contract that is at the hospitals pleasure? How do you value that exactly?

A buy in is not supposed to be for the physician giving money to the practice. A real “buy in” is an investment.

I emphasize the investment aspect, because a true surgical private practice buys its new hires a ton of stuff. They buy you equipment, a scheduler, office space, a billing infrastructure, contracts with hospitals, real estate, and equity in other investments that the practice keeps money in. You WOULD be making that money if you weren’t spending it on yourself and your future infrastructure.

That’s the distinction. The practice reduces your pay because they’re investing in YOU. YOU end up getting the money back and then some.

Anesthesia buying in is nothing more than a tax on your earnings because you’re the young guy. You leave the practice after 10 years, and there is no return on your investment. No shares to sell back.

The 5% of overhead in an anesthesia practice isn’t enough to justify the 3 year partnerships at 50% pay that comprise most private practices in the country. Any savvy new grad steers far from these unless they’re geographically locked permanently for some reason

How do the groups skim after partnership? Senior partners?

 

[Southpaw]

Does the group employ the CRNAs or the hospital? If they employ - what have the past couple of years been like?

Is the group stipend dependent for salary? Personally this is a tough question to answer and one I wouldn’t answer on a public forum, but any prospective hire should ask in private.

Honestly, if anyone cares, I think this is most likely a great job - because it’s in Iowa. There just aren’t as many people looking at this job compared to the coasts.

I’ll post more later as a have time. I have thoughts on the last post from @PainInTheAnes

 

[staple]

I really appreciate so much discussion from all angles.

Our group employs all crnas and a very effective large in house billing staff.

 

[BLADEMDA]

For anyone willing to relocate to Iowa, this job is a gem. It is the type of job any new grad should definitely interview for if he/she is willing to live there. The COL is low, the partner pay is high and the workload is below average. Sweet gig and 18 months in NOTHING in terms of a career plus they give the money back to you when you retire. The Only question is after you make partner, if you decide to relocate to Florida after 5 years do you get that pre partner money back over the next 3 years.

 

[teacher2md]

I am not saying your group is predatory, my whole point is it's disingenuous to say 'NO FINANCIAL BUY-IN' but the pay is reduced for 18 months.

I never said the associates should have voting rights from day 1. Just equal pay from day 1. I don't think I am naive. It would be naive of me to not question these things. The job market is very different now and honestly what you are offering is not appealing at all.


Take whatever you need off the top for operating cost, the same way you do for all your partners.

What are they buying in anyway? Contracts? The success of your contracts depend on whether or not you can hire enough people to staff your sites so you need the new hires as much as they need you. If you sell your group in 18 months, do associates on the track get anything? There's literally a thread in the Private Forum talking about how uncertain the future of private practice is right now.

Do you give the associates back the money you took from them for 18 months in the event they don't make partners?


I don't care about growth potential when it is artificially applied by the group. You can't artificially reduce someone's income to 70-80% then bring it back to 100% and call it 'growth potential.'

I would ask you to explain to me how 'private practice anesthesia jobs actually function,' but I know I am derailing your recruitment thread so I'll stop. Nimbus is correct, I feel gaslit.

I don't know if you are OP's partner but moving to Iowa is geographic arbitrage and 400k+ including benefits isn't attractive enough these days. A university job in a good location I talked to pays more than that, AMC pays more than that. Honestly, I'd rather work for an AMC knowing some corporate suits 4 states over are eating off my back than having Bob, the senior partner sitting 3 ORs down the hallway, eating off my back.


I talked to your group. Super fair and transparent! Associates get paid what they earn from day 1. In fact, that's the group I alluded to prior. SD is appealing but not feasible right now as a new grad. Maybe a few years down the road.

Here are my thoughts about this, after going through the job-hunt process a few times. This is geared toward new grads mostly:

The thing that makes a private-practice group successful or not is how much they are paid by insurers. This is the blended unit value. (see this: ASA Survey Results: Commercial Fees Paid for Anesthesia Services – 2021 | ASA Monitor | American Society of Anesthesiologists). (caveat, there is also the hospital stipend)

How do you think it is that some groups have great work-life balance and still get paid very well, while others work a ton and get paid so-so? It because of how much they are paid by insurers. All this discussion about "how much you should be earning" doesn't mean much, because if you set up shop as a new solo anesthesiologist working with your surgeon buddy, and you go to UHC or BCBS and ask for $100/unit contract, they'll give you $25/unit while telling you to go f*ck yourself.

You might say-- "but locums jobs are paying $400/hr! Thats the market value!" Not really, these jobs are more highly reimbursed for a reason-- theyre short-term and involve travelling constantly. Not a fair comparison to a stable job in one location for years.

A good group has spent significant time (years) and resources battling with insurers to get paid more. They have some type of leverage that is giving them the upper hand in these negotiations. Same thing with hospital stipend. The group has a relationship with the hospital that they have leveraged in order to get paid more. This involves meetings with admin, collecting data to show value, etc etc

So in theory, at least, this is what you are buying-in to. The leveraged relationships.

Not all buy-ins are fair, of course. You have to decide for yourself. Especially in the era of the No-suprises act, and impatient hospital admins, you should do your homework to see if you think the terms of the partner position will be the same when you finally 'make it'.

Ask the group "how long have you had this contract? how often is it negotiated? what is keeping a large national group from sweeping in? what is your blended unit value from insurers not including and including hospital stipend? Have the insurers made any noise about reducing reimbursements in the face of the No suprises act? What are the groups plans to address this?"

Hope this helps

 

[Beach bum]

Our groups pay structure for pre partners and partners is not only completely transparent, it is actually more fair than you guys are making it out to be. I explain everything to new hires in private, not in a public forum open to anyone.

I appreciate the general discussion on whether or not pre partners should get paid less or equal. This is a fairly standard practice in PP, similar to how a junior associate would get paid less than a professor in academics. We aren't eat what you kill. Our pre-partner phase is 18 months, not 2 or 3 years compared to some jobs in large cities.

This job is one of the most competitive jobs in the region in terms of pay and work life balance. We have very little turnover except for retirements.

If anyone has any questions I'm more than open to private discussions. There is full financial transparency of our books during interviews.

I do appreciate that you have full disclosure and open Al” your books and accounting. I take it there is also a “buy ou” upon leaving the partnership?

 

[Beach bum]

Here are my thoughts about this, after going through the job-hunt process a few times. This is geared toward new grads mostly:

The thing that makes a private-practice group successful or not is how much they are paid by insurers. This is the blended unit value. (see this: ASA Survey Results: Commercial Fees Paid for Anesthesia Services – 2021 | ASA Monitor | American Society of Anesthesiologists). (caveat, there is also the hospital stipend)

How do you think it is that some groups have great work-life balance and still get paid very well, while others work a ton and get paid so-so? It because of how much they are paid by insurers. All this discussion about "how much you should be earning" doesn't mean much, because if you set up shop as a new solo anesthesiologist working with your surgeon buddy, and you go to UHC or BCBS and ask for $100/unit contract, they'll give you $25/unit while telling you to go f*ck yourself.

You might say-- "but locums jobs are paying $400/hr! Thats the market value!" Not really, these jobs are more highly reimbursed for a reason-- theyre short-term and involve travelling constantly. Not a fair comparison to a stable job in one location for years.

A good group has spent significant time (years) and resources battling with insurers to get paid more. They have some type of leverage that is giving them the upper hand in these negotiations. Same thing with hospital stipend. The group has a relationship with the hospital that they have leveraged in order to get paid more. This involves meetings with admin, collecting data to show value, etc etc

So in theory, at least, this is what you are buying-in to. The leveraged relationships.

Not all buy-ins are fair, of course. You have to decide for yourself. Especially in the era of the No-suprises act, and impatient hospital admins, you should do your homework to see if you think the terms of the partner position will be the same when you finally 'make it'.

Ask the group "how long have you had this contract? how often is it negotiated? what is keeping a large national group from sweeping in? what is your blended unit value from insurers not including and including hospital stipend? Have the insurers made any noise about reducing reimbursements in the face of the No suprises act? What are the groups plans to address this?"

Hope this helps

Sounds like what you are describing in what you are “buying in” is essentially “good will” and I can tell you that is hard to value and can be fleeting at best. Over the years I can tell you that a lot of sharp business men woukd have told you that for the most part good will amounts to….bupkis. Just sayin

 

[nimbus]

Here are my thoughts about this, after going through the job-hunt process a few times. This is geared toward new grads mostly:

The thing that makes a private-practice group successful or not is how much they are paid by insurers. This is the blended unit value. (see this: ASA Survey Results: Commercial Fees Paid for Anesthesia Services – 2021 | ASA Monitor | American Society of Anesthesiologists). (caveat, there is also the hospital stipend)

How do you think it is that some groups have great work-life balance and still get paid very well, while others work a ton and get paid so-so? It because of how much they are paid by insurers. All this discussion about "how much you should be earning" doesn't mean much, because if you set up shop as a new solo anesthesiologist working with your surgeon buddy, and you go to UHC or BCBS and ask for $100/unit contract, they'll give you $25/unit while telling you to go f*ck yourself.

You might say-- "but locums jobs are paying $400/hr! Thats the market value!" Not really, these jobs are more highly reimbursed for a reason-- theyre short-term and involve travelling constantly. Not a fair comparison to a stable job in one location for years.

A good group has spent significant time (years) and resources battling with insurers to get paid more. They have some type of leverage that is giving them the upper hand in these negotiations. Same thing with hospital stipend. The group has a relationship with the hospital that they have leveraged in order to get paid more. This involves meetings with admin, collecting data to show value, etc etc

So in theory, at least, this is what you are buying-in to. The leveraged relationships.

Not all buy-ins are fair, of course. You have to decide for yourself. Especially in the era of the No-suprises act, and impatient hospital admins, you should do your homework to see if you think the terms of the partner position will be the same when you finally 'make it'.

Ask the group "how long have you had this contract? how often is it negotiated? what is keeping a large national group from sweeping in? what is your blended unit value from insurers not including and including hospital stipend? Have the insurers made any noise about reducing reimbursements in the face of the No suprises act? What are the groups plans to address this?"

Hope this helps

There are 75 year old groups that have done all these things, cultivated relationships with payors and hospitals for decades, and still pay everyone equally from day 1.

 

[kidthor]

There are 75 year old groups that have done all these things, cultivated relationships with payors and hospitals for decades, and still pay everyone equally from day 1.

That and with NSA, CMS cuts, and hospital pressures - the income streams are so volatile now. I appreciate that groups have maintained good payor rates, but that could all change in a year. So it’s tough to argue that these relationships are worth a “buy in”. In the form of partners skimming off the top.

A few local socal groups have actually changed their buy in scheme to make people paid equally from day 1, because people won’t tolerate an onerous buy in.

 

[nimbus]

we invented anti emetics, etc etc.”

That is pure gold 😂

 

[nimbus]

Ha, you wouldn’t believe how many places see “the sickest patients in the city/state/country/universe”

Hey man! That’s our place!!

 

[DG51]

Ha, you wouldn’t believe how many places see “the sickest patients in the city/state/country/universe”

while also having "the best public schools in the country"

 

[BLADEMDA]

Do you know how much harder it is to replace a group in Iowa than say So Cal or NYC? This is Iowa people. Any AMC promising the world would be looked upon as simply a predator lying to get the contract. 18 months to partner and the group will give you a buyout essentially meaning that your buy-in is very low over the course of a career or anything longer than 5 years.

I recognize quite well the market we are in these days. But solid groups in certain locations like this one deserve a full evaluation by a person prior to rejecting the position simply due to the 18 month track.

 

[dchz]

I’m in one too. I think it’s gaslighting to say we don’t exist.

I interviewed with this group.

+1 plug for asmg in San Diego of all places.

(Beware of cost of living though).