Hospital drops contract, AMC sues hospital, Anesthesiologists sue AMC

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Because he's a good person trying to fight for the younger folks!

Good luck everyone, lots of people around the country watching this...
 
DirtDocMD said:
Lots of people like to “slam” the folks who “sold out” to an AMC. Maybe some of you don’t know how this works.....

A group has a 2-3 year contract with the hospital. In ADDITION, those contracts can be cancelled in as little as 90 DAYS.

Translation??? Even if a group has been at a hospital for DECADES, all it takes is a CEO and a pen to kick you out on your azz.

Knowing this (and the way that hospitals have become more “corporate” over the last 20 years), when someone comes in and waves $1/$2/$3 million in your face to “sell out”, you DO IT.

The other option is to sit around, and a year later, some idiot from Northstar/Envision/Sound/etc comes in, sweet talks the CEO, and THEY take the contract, AND THEY DO NOT BUY YOU OUT. They simply take the contract. You get NOTHING.

It’s not “greed” or “selling out”, it is simply “cashing out”, while you still have the chance, before some CEO who is there on a 3 year stint to “slash costs”, renders what you have WORTHLESS, and hands the “exclusive anesthesia contract” over to a group that TAKES the contract (not BUY it).
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I think you have a reasonable point if a group has either a contentious relationship with the hospital or is heavily subsidy dependent. If your group has either of those, or both, and you're business savvy, sure take a buyout because your contract may not be renewed next cycle. However, if you have neither then what exactly can an AMC offer the hospital that you already aren't? If you have a good relationship with the hospital, you staff what they want, and you do it without asking for much, then you're solid and I don't think you have anything to worry about.

Anyone who's been here long enough and has paid attention has seen what goes on. AMC either buys a contract and runs the group into the ground (see this thread for an example), or they scoop the contract from an existing poorly run/heavily subsidized group under the guise of reducing or completely eliminating the contract. And they either do that and move on fine, or they run the group into the ground. I'll say this, USAP isn't perfect (they have ads for jobs all over gasworks) but they don't appear to be the dumpster fire that Mednax/NAPA is. Also, AMCs didn't offer buyouts to just any group. They did it most often to highly successful, well run groups and the AMCs knew they could make an easy profit.

If you are 'cashing out', and offering nothing to new grads but a now AMC job, don't be shocked when it all goes to hell. You should've known better. And in my opinion don't write about hospitals and patients suffering all due to your lack of foresight. No one forced you to 'cash out'. No one forced a noncompete on you. Yes, I feel bad because we share the same profession and I want physician only anesthesia to be an option. But geez, someone has to accept some responsibility here for everything that's happened.
 
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chocomorsel said:
If that is the case, hopefully he wasn’t part of the group that sold out to begin with.
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I'm almost sure he was. But, he was also 1 vote among many, so the fault doesn't lie with just him. In my opinion there should be some responsibility accepted by the majority who did vote to sell. You can't sell out and then cry about the hospital and patients suffering several years later, with no one accepting any responsibility for it. Still, I feel bad for everyone involved. It seems all around an awful situation and I'm sure blame could be passed around many ways here.
 
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Southpaw said:
I think you have a reasonable point if a group has either a contentious relationship with the hospital or is heavily subsidy dependent. If your group has either of those, or both, and you're business savvy, sure take a buyout because your contract may not be renewed next cycle. However, if you have neither then what exactly can an AMC offer the hospital that you already aren't? If you have a good relationship with the hospital, you staff what they want, and you do it without asking for much, then you're solid and I don't think you have anything to worry about.

Anyone who's been here long enough and has paid attention has seen what goes on. AMC either buys a contract and runs the group into the ground (see this thread for an example), or they scoop the contract from an existing poorly run/heavily subsidized group under the guise of reducing or completely eliminating the contract. And they either do that and move on fine, or they run the group into the ground. I'll say this, USAP isn't perfect (they have ads for jobs all over gasworks) but they don't appear to be the dumpster fire that Mednax/NAPA is. Also, AMCs didn't offer buyouts to just any group. They did it most often to highly successful, well run groups and the AMCs knew they could make an easy profit.

If you are 'cashing out', and offering nothing to new grads but a now AMC job, don't be shocked when it all goes to hell. You should've known better. And in my opinion don't write about hospitals and patients suffering all due to your lack of foresight. No one forced you to 'cash out'. No one forced a noncompete on you. Yes, I feel bad because we share the same profession and I want physician only anesthesia to be an option. But geez, someone has to accept some responsibility here for everything that's happened.
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When I was in Vegas there was very little subsidy given to anesthesiologists. Only the trauma people got a subsidy. It was all kill what you eat and most groups had no subsidy. Guess what? It is now USAP country.
There's greed everywhere. Not every group has to sell out to avoid being pushed out. I don't know about this group, but sometimes people just get old and lazy and want a quick payday.
 
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chocomorsel said:
When I was in Vegas there was very little subsidy given to anesthesiologists. Only the trauma people got a subsidy. It was all kill what you eat and most groups had no subsidy. Guess what? It is now USAP country.
There's greed everywhere. Not every group has to sell out to avoid being pushed out. I don't about this group, but sometimes people just get old and lazy and want a quick payday.
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That’s interesting. From your Vegas-era posts I gathered it was just a ton of independent contractors running around chasing surgeons, and not really organized formal groups. Is that wrong?

But, you’re right. Greed is everywhere, especially here in America.
 
Southpaw said:
I'm almost sure he was. But, he was also 1 vote among money, so the fault doesn't lie with just him. In my opinion there should be some responsibility accepted by the majority who did vote to sell. You can't sell out and then cry about the hospital and patients suffering several years later, with no one accepting any responsibility for it. Still, I feel bad for everyone involved. It seems all around an awful situation and I'm sure blame could be passed around many ways here.
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Especially if the old guards are all gone, or about to be gone. Some of the “buyouts” are basically future incomes in a better packaged money. So rather than income tax, you’d be paying a capital gain tax. Which still is 15-20% difference on that same money.

It’s the future anesthesiologists who will pay ultimately. It’s the same formula, I am just surprised that people haven’t learned. Or just like everyone says, all these CEOs just going through rotations, as long as the balance sheets look good, they couldn’t give a damn.
 
Southpaw said:
That’s interesting. From your Vegas-era posts I gathered it was just a ton of independent contractors running around chasing surgeons, and not really organized formal groups. Is that wrong?

But, you’re right. Greed is everywhere, especially here in America.
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There was that but most people belonged to some kind of group. The largest group in town had at least 70 docs or so.
They are the ones who started the sell out process. My friend's wife is part of that group and people are unhappy and he says the reason they sold was because of the old farts who wanted a payday and the younger people wanted no part of it. But they were outnumbered.
 
Southpaw said:
I'm almost sure he was. But, he was also 1 vote among money, so the fault doesn't lie with just him. In my opinion there should be some responsibility accepted by the majority who did vote to sell. You can't sell out and then cry about the hospital and patients suffering several years later, with no one accepting any responsibility for it. Still, I feel bad for everyone involved. It seems all around an awful situation and I'm sure blame could be passed around many ways here.
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I can't remember if he'd moved there, before or during the sale. Anyway, yeah, when you sell out, bad things can happen.

"One vote among Money" huh? Freudian slip there?
 
Anyway, I am interested in a takeover of a likely lucrative contract. I may have an in. It's a small booming town. I need a few docs (five) interested in a small/medium town but with access to an airport.
Anyone interested?
 
Southpaw said:
I'm almost sure he was. But, he was also 1 vote among many, so the fault doesn't lie with just him. In my opinion there should be some responsibility accepted by the majority who did vote to sell. You can't sell out and then cry about the hospital and patients suffering several years later, with no one accepting any responsibility for it. Still, I feel bad for everyone involved. It seems all around an awful situation and I'm sure blame could be passed around many ways here.
Click to expand...
You all can believe what you want. In an 8 year period, at my hospital, we went through THREE different CEO’s. None of the COO’s, CFO’s, etc, remained, either.

Those “good relationships” with the hospital are all a “mirage”. There is no institutional memory. A new guy shows up every 3-ish years, and they all have the same directive—cut costs.

My hospital is also on it’s THIRD radiology group, 3rd-4th hospitalist group, and they’ve changed the contractors that run the cafeteria and janitorial services, as well.

Again, administration doesn’t care about “relationships”, or even “quality of care”. They are buffing up their resume (by cost-cutting), and won’t be around long enough to deal with lingering drama.

And FYI, the group I’m in has NOT sold out, but we have certainly talked about it. The hospital has tried to snake our contract at least 3 times, since I have been here. Twice to give it to out-of-state AMC’s (no buyout offer, just take the contract), and once to their own “physician management group”. This group has been here 27+ years....
 
chocomorsel said:
There was that but most people belonged to some kind of group. The largest group in town had at least 70 docs or so.
They are the ones who started the sell out process. My friend's wife is part of that group and people are unhappy and he says the reason they sold was because of the old farts who wanted a payday and the younger people wanted no part of it. But they were outnumbered.
Click to expand...
Sounds familiar
 
DirtDocMD said:
You all can believe what you want. In an 8 year period, at my hospital, we went through THREE different CEO’s. None of the COO’s, CFO’s, etc, remained, either.

Those “good relationships” with the hospital are all a “mirage”. There is no institutional memory. A new guy shows up every 3-ish years, and they all have the same directive—cut costs.

My hospital is also on it’s THIRD radiology group, 3rd-4th hospitalist group, and they’ve changed the contractors that run the cafeteria and janitorial services, as well.

Again, administration doesn’t care about “relationships”, or even “quality of care”. They are buffing up their resume (by cost-cutting), and won’t be around long enough to deal with lingering drama.

And FYI, the group I’m in has NOT sold out, but we have certainly talked about it. The hospital has tried to snake our contract at least 3 times, since I have been here. Twice to give it to out-of-state AMC’s (no buyout offer, just take the contract), and once to their own “physician management group”. This group has been here 27+ years....
Click to expand...
Welcome to modern medicine. Don’t bother doing more than the bare minimum. Let em get what they pay for…..
 
Southpaw said:
If you are 'cashing out', and offering nothing to new grads but a now AMC job, don't be shocked when it all goes to hell. You should've known better. And in my opinion don't write about hospitals and patients suffering all due to your lack of foresight. No one forced you to 'cash out'. No one forced a noncompete on you. Yes, I feel bad because we share the same profession and I want physician only anesthesia to be an option. But geez, someone has to accept some responsibility here for everything that's happened.
Click to expand...

I agree with much of what is being said in this thread. If offered a million-dollar buyout, don't hesitate and take it. If someone else takes the million-dollar buyout, don't begrudge them. You are just jealous, envious, and wish one were being offered to you.

Overall, do the bare contractually obligated minimum but not the slightest bit more. Make hay while the sun is shining. Stop acting like an owner if you are an employee. You do not get the upside and shouldn't therefore don't suffer through the downside. There is no loyalty. Get yours and get out.

Can we also please stop talking about the hospitals and patients suffering when talking about these things. It's disingenuous. The vast majority of us do not (should not) care about the hospital nor patients as a whole. You are an employee whose job it is to take care of patients scheduled in your room or in the rooms you're supervising. Nothing more, nothing less. If they fire you today, you take a locum gig the following week and relocate elsewhere for a perm position. The end. It's not personal, it's business.

You have no say in the relationship between the hospital, AMCs, and the community. You're there to do a job under the most lucrative of circumstances to yourself and then go home. Stop pretending otherwise. Everything else is just marketing and social media posturing.
 
Here comes the locums on gaswork:

GasWork.com - Reference #354682

Reference #354682
www.gaswork.com www.gaswork.com

Funny recruiter is a CRNA. Maybe I should be a recruiter too.

The other post by staff care provides 20$ completion bonus for 13 weeks.
 
Zekchar said:
I agree with much of what is being said in this thread. If offered a million-dollar buyout, don't hesitate and take it. If someone else takes the million-dollar buyout, don't begrudge them. You are just jealous, envious, and wish one were being offered to you.

Overall, do the bare contractually obligated minimum but not the slightest bit more. Make hay while the sun is shining. Stop acting like an owner if you are an employee. You do not get the upside and shouldn't therefore don't suffer through the downside. There is no loyalty. Get yours and get out.

Can we also please stop talking about the hospitals and patients suffering when talking about these things. It's disingenuous. The vast majority of us do not (should not) care about the hospital nor patients as a whole. You are an employee whose job it is to take care of patients scheduled in your room or in the rooms you're supervising. Nothing more, nothing less. If they fire you today, you take a locum gig the following week and relocate elsewhere for a perm position. The end. It's not personal, it's business.

You have no say in the relationship between the hospital, AMCs, and the community. You're there to do a job under the most lucrative of circumstances to yourself and then go home. Stop pretending otherwise. Everything else is just marketing and social media posturing.
Click to expand...

I’m in private practice. I’ve seen AMCs crumble all around me. No I don’t want my practice to sell. No I don’t want the million dollar buyout (which is really just a cash advance over 4-5 years after they cut my current PP salary).

I mentioned the ‘cry me a river’ letter about patients because that’s what the Reno guys are doing, several years after taking the buyout. But I don’t blame them - what else can they do? Uproot and move the family who’s settled? Seems less ideal in almost all circumstances. But again, I’m here saying if you’re in a stable situation there’s most often not a reason to sell.
 
Southpaw said:
I’m in private practice. I’ve seen AMCs crumble all around me. No I don’t want my practice to sell. No I don’t want the million dollar buyout (which is really just a cash advance over 4-5 years after they cut my current PP salary).

I mentioned the ‘cry me a river’ letter about patients because that’s what the Reno guys are doing, several years after taking the buyout. But I don’t blame them - what else can they do? Uproot and move the family who’s settled? Seems less ideal in almost all circumstances. But again, I’m here saying if you’re in a stable situation there’s most often not a reason to sell.
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No Subsidy- No sale
Small Subsidy- No sale
Medium Subsidy- Think about selling
Large Subsidy- They are coming for you unless you are a mega group
 
narcotics999 said:
OK, today is 1/29. The deadline was 1/27. What happened on Friday? OR closed? Everyone skiing in Tahoe?
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1643636764047.gif
 
Found this

“Renown has provided an extension while the parties work to resolve the matter. Local physicians continue to provide anesthesia care to patients. There have been no interruptions in service, nor do we anticipate any, due to this issue. We continue to negotiate in good faith with NAPA and will provide an update once this issue is resolved.” -Renown Spokesperson”
 
I hope the anesthesiologists prevail here because despite the fact that they sold to private equity and it’s ridiculous for them to be surprised when private equity investors want to squeeze them for profits, a win for the anesthesiologists here would make these sales a lot more risky for PE in the future. It would also make them more willing to listen to local leadership on how the people actually working want to run the practice at a local level.

My guess, is NAPA wins this battle. The hospital needs NAPA more than NAPA needs the hospital. The anesthesiologists will also compromise about how they want to staff the hospital. Let the CRNA hiring spree commence.
 
GravelRider said:
I hope the anesthesiologists prevail here because despite the fact that they sold to private equity and it’s ridiculous for them to be surprised when private equity investors want to squeeze them for profits, a win for the anesthesiologists here would make these sales a lot more risky for PE in the future. It would also make them more willing to listen to local leadership on how the people actually working want to run the practice at a local level.

My guess, is NAPA wins this battle. The hospital needs NAPA more than NAPA needs the hospital. The anesthesiologists will also compromise about how they want to staff the hospital. Let the CRNA hiring spree commence.
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The whole thing is kind of strange. NAPA was supposed to be kicked out on 1/27, but what was the hospitals plan? Was a different management company given the contract with the hope to sign the current docs? (Assuming the judge voided the non compete). Hospital employed? Hope that the original docs resurrected the old group on the fly? There seems to have been no planning for the morning after.
 
dannyboy1 said:
The whole thing is kind of strange. NAPA was supposed to be kicked out on 1/27, but what was the hospitals plan? Was a different management company given the contract with the hope to sign the current docs? (Assuming the judge voided the non compete). Hospital employed? Hope that the original docs resurrected the old group on the fly? There seems to have been no planning for the morning after.
Click to expand...

Theatrics to get everyone to the table for a compromise?
 
GravelRider said:
I hope the anesthesiologists prevail here because despite the fact that they sold to private equity and it’s ridiculous for them to be surprised when private equity investors want to squeeze them for profits, a win for the anesthesiologists here would make these sales a lot more risky for PE in the future. It would also make them more willing to listen to local leadership on how the people actually working want to run the practice at a local level.

My guess, is NAPA wins this battle. The hospital needs NAPA more than NAPA needs the hospital. The anesthesiologists will also compromise about how they want to staff the hospital. Let the CRNA hiring spree commence.
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IMO non-competes get especially questionable when they can basically be sold to another company, and still apply after the company loses the contract.

Honestly I think our only hope is for tech workers to push for legislation and hope there isn’t a lobbied carve out for healthcare workers.
 
HemeOncHopeful19 said:
IMO non-competes get especially questionable when they can basically be sold to another company, and still apply after the company loses the contract.

Honestly I think our only hope is for tech workers to push for legislation and hope there isn’t a lobbied carve out for healthcare workers.
Click to expand...

They (AMCs) will then say, I’m the bigger person here….. why don’t you go to work for our other practice that’s 100 miles away and leave your family for a year…. Because we are the hero in this story.
 
HemeOncHopeful19 said:
IMO non-competes get especially questionable when they can basically be sold to another company, and still apply after the company loses the contract.

Honestly I think our only hope is for tech workers to push for legislation and hope there isn’t a lobbied carve out for healthcare workers.
Click to expand...

Same thing can be said of exclusive contracts to provide anesthesia services.
 
caligas said:
I’ve always said Reno is a hidden gem; no state income tax, fun downtown, great whitewater/fishing in the summer and minutes to Mt Rose in the winter.

Wonder if my wife is ready to leave the east coast 🤔

Update: she is NOT.
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I don’t think it’s well hidden these days based on the real estate prices there compared to other places I’ve looked at
 
I think Reno’s best asset is the opportunity to do cases solo while earning a great living. Cost of living is still decent vs most of California and Seattle. This is an opportunity in the making for any young person starting out on his/her career.
 
BLADEMDA said:
I think Reno’s best asset is the opportunity to do cases solo while earning a great living. Cost of living is still decent vs most of California and Seattle. This is an opportunity in the making for any young person starting out on his/her career.
Click to expand...

Or a disaster
 
An entity I haven’t seen anyone on this thread blame is the insurance companies. If they treated “the little guy” the same or even remotely close to the big AMC machines the good groups with good hospital relationships wouldn’t need to ask for subsidies.
 
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Twiggidy said:
An entity I haven’t seen anyone on this thread blame is the insurance companies. If they treated “the little guy” the same or even remotely close to the big AMC machines the good groups with good hospital relationships wouldn’t need to ask for subsidies.
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At first I was thinking that they are not that smart for letting these huge conglomerates get together and use their market power to push for higher unit values. Then I realized that they side stepped the whole issue with the balance billing legislation and that they're pretty smart after all.
 
GassYous said:
Or a disaster
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How is it a disaster? They need staff and there is no track. Worst case scenario is you make some money and get experience for a year or two at a very fair wage. The most likely outcome is much more favorable as one of three scenarios unfolds:

1. New Group forms- you are in at the ground level. No non-compete with NAPA
2. Hospital employee- Again, no non-compete and you can really demand a high wage
3. NAPA retains the contract and you join with them.

Win-win scenario.
 
They need staff and they are short. Long hours, more call. What if it's a disaster and they can't hire anyone else? They already have a problem with getting people there. Hospital employee or napa retains contract = you are screwed.
 
GassYous said:
They need staff and they are short. Long hours, more call. What if it's a disaster and they can't hire anyone else? They already have a problem with getting people there. Hospital employee or napa retains contract = you are screwed.
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We know they have a problem getting people. The market is the best it’s ever been. Demand an hourly wage. You might work hard but at least you will get paid.
 
BLADEMDA said:
How is it a disaster? They need staff and there is no track. Worst case scenario is you make some money and get experience for a year or two at a very fair wage. The most likely outcome is much more favorable as one of three scenarios unfolds:

1. New Group forms- you are in at the ground level. No non-compete with NAPA
2. Hospital employee- Again, no non-compete and you can really demand a high wage
3. NAPA retains the contract and you join with them.

Win-win scenario.
Click to expand...

Who is the new staff working for? I assume NAPA still has the contract, so you would be employed by them. On what planet is there no non-compete with NAPA? Unless I missed something, I would wait for the implosion to happen, not jump in while it’s happening.
 
GravelRider said:
Who is the new staff working for? I assume NAPA still has the contract, so you would be employed by them. On what planet is there no non-compete with NAPA? Unless I missed something, I would wait for the implosion to happen, not jump in while it’s happening.
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It's a sad state of affairs when a non-compete prevents someone from working at a hospital that desperately needs help. But that's the world that corporatized medicine created. It's turned the simplest of economic paradigms (straight up supply and demand) into something oppressive and byzantine. The sadder thing is that they'll label us as the bad guys and cite a shortage with need for a price cap, like they've done to the nurses.
 
kidthor said:
It's a sad state of affairs when a non-compete prevents someone from working at a hospital that desperately needs help. But that's the world that corporatized medicine created. It's turned the simplest of economic paradigms (straight up supply and demand) into something oppressive and byzantine. The sadder thing is that they'll label us as the bad guys and cite a shortage with need for a price cap, like they've done to the nurses.
Click to expand...

Individual rights and free markets are often constrained by commerce and capitalism.
 
GassYous said:
They need staff and they are short. Long hours, more call. What if it's a disaster and they can't hire anyone else? They already have a problem with getting people there. Hospital employee or napa retains contract = you are screwed.
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What about locums?

I just read about the non-compete clauses in Nevada. It seems quite restrictive, especially after the new amendments passed last year. It does not apply to hourly wage employees.

Are locum providers hourly wage workers?
 
Just remember mednax was high flying from 2007-2014 buying up the most lucrative groups. Only so many lucrative groups to buy out. Than usap starting merging and buying spree in 2014. They have slowed significantly the last 2 years as well. So USAP is a ticking time bomb in the last couple of years.
 
aneftp said:
Just remember mednax was high flying from 2007-2014 buying up the most lucrative groups. Only so many lucrative groups to buy out. Than usap starting merging and buying spree in 2014. They have slowed significantly the last 2 years as well. So USAP is a ticking time bomb in the last couple of years.
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Whatever happened to the Mednax group in fairfax va. That huge group. I never see ads for that place.. must be a lucrative place to work
 
DirtDocMD said:
You all can believe what you want. In an 8 year period, at my hospital, we went through THREE different CEO’s. None of the COO’s, CFO’s, etc, remained, either.

Those “good relationships” with the hospital are all a “mirage”. There is no institutional memory. A new guy shows up every 3-ish years, and they all have the same directive—cut costs.

My hospital is also on it’s THIRD radiology group, 3rd-4th hospitalist group, and they’ve changed the contractors that run the cafeteria and janitorial services, as well.

Again, administration doesn’t care about “relationships”, or even “quality of care”. They are buffing up their resume (by cost-cutting), and won’t be around long enough to deal with lingering drama.

And FYI, the group I’m in has NOT sold out, but we have certainly talked about it. The hospital has tried to snake our contract at least 3 times, since I have been here. Twice to give it to out-of-state AMC’s (no buyout offer, just take the contract), and once to their own “physician management group”. This group has been here 27+ years....
Click to expand...

With all that said, does your group have a buyin or immediate partnership?

I hope that if your group's opinion is that the hospital admin is unstable and cash out is always on the table.....then you are transparent with new hires and aren't working them for a discount with the hopes they make partner in 5 years.
 
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