How Important Is Partnership?

[chocomorsel]

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we have physicians in their 70s that take the same work load as physicians in their 30s

That sucks. Do they ever plan on retiring?

 

[chocomorsel]

Yep 95% of plastic surgeons in town do not take hospital ER call. Which leaves a lot of call for those who are willing. This is a guy who never spends more than $5k for a car (he has 2 1980’s Mercedes diesels and a 1988 bmw convertible), has 1 wife and no kids. Also hasn’t taken a vacation in over 20 years. Some people don’t have the same motives as others. I find them to be interesting characters. He is often found sleeping in a chair waiting to start a case. We take selfies with him while he’s asleep.

That just sounds sad. Hopefully his wife takes vacation without him.

 

[Mman]

That sucks. Do they ever plan on retiring?

I guess. In my experience they fall into one of 3 groups...

1) bad with money, spent too much, daytraded, etc, and need to work forever to make up for it
2) supporting large extended families whether that is supporting their kids into their 40s, paying for private school for grandchildren, etc.
3) no hobbies and just can't see themselves not working

 

[sevoflurane]

The mednax shop at my hospital apparently couldn’t get crnas to cover a bunch of shifts so they threw it up to the doctors. Guess who is getting screwed on an hourly rate? 150 for the docs but 200 when the crnas work it.

Mednax is not site dependent at all. They won’t budge of salary and when you break it down on an hourly basis your fighting for 10-15/hr extra.

Working for an AMC isn’t ideal-that is for certain....but what you say above is complete horsesh*t. It is very much site dependant. My guess is that practice sucked to begin with. At my site, our group received a pretty hefty base salary raise this year.

 

[Mman]

Working for an AMC isn’t ideal-that is for certain....but what you say above is complete horsesh*t. It is very much site dependant. My guess is that practice sucked to begin with. At my site, our group received a pretty hefty base salary raise this year.

Mednax lets physicians pick their own salary when they get bought out. Smaller salary = higher buyout. But then each site has to meet their profit quotas to get bonuses or have salary (or manpower) cut in the future if they don't.

 

[sevoflurane]

And we have way more applicants than available spots.

PP still >>>> AMC, but you have to be honest when you write blanket statements like the one above.

 

[sevoflurane]

Mednax lets physicians pick their own salary when they get bought out. Smaller salary = higher buyout. But then each site has to meet their profit quotas to get bonuses or have salary (or manpower) cut in the future if they don't.

Yeah that number, at least in my group, is super easy to meet.

 

[deleted941485]

They are taking the docs for *****s if they are paying crnas more for the shifts

Seem

Working for an AMC isn’t ideal-that is for certain....but what you say above is complete horsesh*t. It is very much site dependant. My guess is that practice sucked to begin with. At my site, our group received a pretty hefty base salary raise this year.

Wish it was horse**** buddy.

If you consider a hospital in one of the richest areas on the east coast and a good payer mix to boot a bad site

The fact of the matter is it’s controlled by corporate. They don’t budge. They do not care good shop or bad shop. This is what you get.

 

[sevoflurane]

Just business

Seem


Wish it was horse**** buddy.

If you consider a hospital in one of the richest areas on the east coast and a good payer mix to boot a bad site

The fact of the matter is it’s controlled by corporate. They don’t budge. They do not care good shop or bad shop. This is what you get.

Did you miss the line where we got a significant raise this year?

 

[PieOHmy]

Yep he also covers our local peds hospital. Lots of dog bites.

I would question the local dog pound

 

[sevoflurane]

Listen... I’ve been in PP for most of my career. When I hired on to this job wheels were already in motion to some degree for a sell (didn’t know that at the time). Having been on both sides of the equation I can say that it’s not “terrible” as you make it out to be. I’ve said this before, but what was there before makes a huge difference on what is there after the aquiaition.

Simply put, if your practice sucked and you sold down to a bad number then you have set in motion a bad group going forward. If your group was crushing it and sold down to a competitive salary and package that is on par with regional norms then your practice is still going to do fine.

 

[deleted941485]

Partnership is nice and has good perks. My first employer offered it to me afte 2 years but it felt ridiculous in this climate with buyouts and hospital takeovers. I walked after a year because the writing was on the wall.

I’m just not seeing the point of being paid less for 2-4 years so that you make partner when there isn’t a light at the end of the tunnel anyway.

I don’t like AMCs at all but at least they pay prevailing starting in a market and you don’t need to spend years chasing a prize that seems less likely than ever.

 

[Arch Guillotti]

If your group was crushing it and sold down to a competitive salary and package that is on par with regional norms then your practice is still going to do fine.

It's fine if you are OK with a corporation paying it's shareholders for work that you are doing.

 

[sevoflurane]

It is what it is. My say is pretty small with 70 shareholders. We lost a hospital system b4 merger. I get the upside of risk transference to an AMC.

 

[sevoflurane]

Good bet on their side as we recently acquired another hospital system.

 

[sevoflurane]

To answer the OP question. Ya I think partnership is important. So long as the group you join is legit. Plenty of pyramid schemes out there in the PP world where you end up being way worse off than any AMC.
Look for a great PP group with a long history of fairness that meets your economic/vaca/lifestyle needs.
Hard to get all 3, but they are out there. Good luck.

 

[sevoflurane]

Partnership is nice and has good perks. My first employer offered it to me afte 2 years but it felt ridiculous in this climate with buyouts and hospital takeovers. I walked after a year because the writing was on the wall.

I’m just not seeing the point of being paid less for 2-4 years so that you make partner when there isn’t a light at the end of the tunnel anyway.

I don’t like AMCs at all but at least they pay prevailing starting in a market and you don’t need to spend years chasing a prize that seems less likely than ever.

AMCs can start you at 400k.
I get your point.

On the other side, negotiate a % buyout for “time served” if you end up getting sold mid partnership. If they say no, then walk.

We had several like that when we merged. We gave them a very fat retention bonus.

We did not have to, but we did as it is fair and the least we could do. If the group is unwilling then, you should smell greed in the air and walk.

 

[Arch Guillotti]

We did not have to, but we did as it is fair and the least we could do. If the group is unwilling then, you should smell greed in the air and walk.

The greed is when the practice decides to sell out to the AMC in the first place.

 

[dannyboy1]

The greed is when the practice decides to sell out to the AMC in the first place.

Oh for gods sake. I am a recent grad and have been working for an AMC since graduation. Do I hate on the old partners for selling out? Nope. They were in the right place at the right time when the AMC came calling with lots of $$. I would have done the same. Last I checked none of us work for free and we all want the most money we can get for the work we are willing to put in. The old partners got lucky. Good for them.

 

[sevoflurane]

The greed is when the practice decides to sell out to the AMC in the first place.

I don’t think that statement is accurate. Forced hospital employment is a situation that happens to a lot of practices both in and out of anesthesia. If you end up down that road, you are not just working for someone else, but you are also missing out on a buy-out.

At least those Atrium Health docs got something before they were replaced.

 

[sevoflurane]

I would conceded that a ton of groups sell because of greed. But that is not always the driving force.

 

[Arch Guillotti]

I would conceded that a ton of groups sell because of greed. But that is not always the driving force.

I concede that also. Especially if the writing is on the wall a la Blade.

 

[Arch Guillotti]

Oh for gods sake. I am a recent grad and have been working for an AMC since graduation. Do I hate on the old partners for selling out? Nope. They were in the right place at the right time when the AMC came calling with lots of $$. I would have done the same. Last I checked none of us work for free and we all want the most money we can get for the work we are willing to put in. The old partners got lucky greedy. Good for them.

 

[ERRES2288]

But honestly what is so great about selling ? Lose all control in exchange for getting a salary advance for the next 5 years? Are the taxes saved by this really worth it?

 

[Arch Guillotti]

But honestly what is so great about selling ? Lose all control in exchange for getting a salary advance for the next 5 years? Are the taxes saved by this really worth it?

lump sum, especially if your hand is forced. favorable tax rate. golden parachute if you are set to retire soon.

 

[BLADEMDA]

But honestly what is so great about selling ? Lose all control in exchange for getting a salary advance for the next 5 years? Are the taxes saved by this really worth it?

No. The new model is to retain some ownership and control after the sale. It is a partial sale/collaboration these days which is driving the acquisitions. Groups can retain management which will boost insurance contracts by 30% while receiving stake in the new company. The salaries are still very good along with dividends and stock in the new company.

That is the model most groups will likely go with from now on. The easy targets have already sold out and the weak groups aren't worth anything as the AMCs can simply undercut their subsidies driving them out of business. That said, small groups which are lean and receiving a small subsidy can hold their own against large AMCs depending on the payer mix. If the payer mix isn't very good the AMC doesn't have the bargaining power to steal the contract. AMCs have overhead and lots of dead weight that small groups wouldn't tolerate.

 

[Arch Guillotti]

That is the model most groups will likely go with from now on. The easy targets have already sold out and the weak groups aren't worth anything as the AMCs can simply undercut their subsidies driving them out of business. That said, small groups which are lean and receiving a small subsidy can hold their own against large AMCs depending on the payer mix. If the payer mix isn't very good the AMC doesn't have the bargaining power to steal the contract. AMCs have overhead and lots of dead weight that small groups wouldn't tolerate.

aka "the sweet spot".

 

[chocomorsel]

Oh for gods sake. I am a recent grad and have been working for an AMC since graduation. Do I hate on the old partners for selling out? Nope. They were in the right place at the right time when the AMC came calling with lots of $$. I would have done the same. Last I checked none of us work for free and we all want the most money we can get for the work we are willing to put in. The old partners got lucky. Good for them.

You really enjoy drinking Kool Aid. What's your favorite flavor?

 

[sevoflurane]

The absolute worst thing of a merger is lost opportunity for those that come later- that sucks. It just drives the market rate for good anesthesiologists down. I honestly feel guilty from that point of view, but it wasn’t my decision in the end. Shifting market share from PP to AMC was never in my plans. But hey, here I am. I am not hating life and am very happy with my AMC. They have been good to all of us (both shareholders and new recruits). I thought it was going to be a **** show. It definitely is not that. Our management are the same partners pre and post merger. That in and of itself has been a great face to deal with on an administrative level. They still run the group, negotiate contracts and look out for our partners as a whole. We still have a “partner” board and we discuss issues/fairness regularly.

 

[deleted87051]

The absolute worst thing of a merger is lost opportunity for those that come later- that sucks. It just drives the market rate for good anesthesiologists down. I honestly feel guilty from that point of view, but it wasn’t my decision in the end. Shifting market share from PP to AMC was never in my plans. But hey, here I am. I am not hating life and am very happy with my AMC. They have been good to all of us (both shareholders and new recruits). I thought it was going to be a **** show. It definitely is not that. Our management are the same partners pre and post merger. That in and of itself has been a great face to deal with on an administrative level. They still run the group, negotiate contracts and look out for our partners as a whole. We still have a “partner” board and we discuss issues/fairness regularly.

Do any of the pre-sale partners regret the decision now? Volumes and unit values have just kept rising in the last few years. The sky didn’t fall.

 

[Maverikk]

To the OP: you've gotten a lot of informed responses here, what I would say as someone who not long ago was in your situation: there's more factors than just having a partnership track. Ask about RVUs, vacation, daily census and turnover times. Forget about trying to see if they're about to sell, no real definitive way to tell and it would be a bad luck situation but one you'd be easy to leave. Look for the locations you want to live in and look hard around there, it is true good groups in desirable locations are hard to come by. If you're more flexible (ie you don't want to live in a metro area) then investigate more thoroughly, there are still a lot of good PP groups that you can reach out to that do less advertising that you'd have to sweet talk more; the way to do this is look at the hospitals in a certain area and cold call, sounds intimidating but just do it, nothing to lose. If you find a good AMC position it wouldn't be bad but I would suggest one where you're doing your own cases. AMCs are good where you're getting paid by the hour, in PP you're concerned about turnover time, surgeon readiness etc which you don't have to worry about at all in a pay-per-hour AMC, but those are the good sites where those administrative things (WHICH ARE HUGE, they take a ton of time to change) are taken care of. For example: My friend works for an AMC for 160/hr, that's less than 40/Unit but no turnover time accounted for, if your turnovers are 25min it doesn't make sense but if they're 45min it makes sense even with base units due to stress of pushing to get things done/on call.

 

[sevoflurane]

Do any of the pre-sale partners regret the decision now? Volumes and unit values have just kept rising in the last few years. The sky didn’t fall.

Yeah Nimbus... in a group this size someone is always looking at greener pastures, but we are the best game in town currently and the shareholders have done well with the multiple. No regrets there.

I think we’ve lost 2 in 3 years and hired about 15ish including cardiac, peds and CC. We have had some leave and join some other west coast PP groups that are hard to crack into in super nice towns... and one has realized that even though we are AMC owned, we still have a great gig. She might be coming back. Grass is always greener.

I think the biggest thing is accelerated retirements. We have had a bunch of those.

What we do offer that is somewhat unique is flexibility/part time positions. I love where I live and really like the people I work with so I don’t see myself moving ever. Hopefully 50-60% FTE soon and enjoy this outdoor paradise a bit more as location is paramount at this point in my career. For me, I can’t think of a better location, but it’s not for everybody.

 

[sevoflurane]

 

[sevoflurane]

@nimbus ....We were pretty sure that one of our hospital systems next move was to try and employ us.
That did not happen and we are glad it didn’t.

 

[deleted162650]

For example: My friend works for an AMC for 160/hr, that's less than 40/Unit but no turnover time accounted for, if your turnovers are 25min it doesn't make sense but if they're 45min it makes sense even with base units due to stress of pushing to get things done/on call.

LOL. That is some AMC sales pitch snake oil bull***t right there. $160/hr sucks. I don’t care how long turnover times are. It doesn’t matter to me if I’m sitting in the lounge or in the OR - I’m in the hospital and not at home. My time is worth more than that.

 

[dannyboy1]

LOL. That is some AMC sales pitch snake oil bull***t right there. $160/hr sucks. I don’t care how long turnover times are. It doesn’t matter to me if I’m sitting in the lounge or in the OR - I’m in the hospital and not at home. My time is worth more than that.

?
160 x 40 x 52 = 330k
Not bad at all if it’s a 40/hr week job.
Would need more information.
is it W2 or 1099?
How many weeks vacation?

 

[Mman]

?
160 x 40 x 52 = 330k
Not bad at all if it’s a 40/hr week job.
Would need more information.
is it W2 or 1099?
How many weeks vacation?

when it comes to compensation, calculating the value of benefits is also very important as they can be a significant portion of the total package. Unfortunately most AMCs skimp on benefits because the average worker would prefer $1 of salary compared to the same $1 value of a benefit.

 

[kidthor]

when it comes to compensation, calculating the value of benefits is also very important as they can be a significant portion of the total package. Unfortunately most AMCs skimp on benefits because the average worker would prefer $1 of salary compared to the same $1 value of a benefit.

At least then you actually get the cash up front, rather than being trapped in a sketchy 5 year retirement vesting scheme.

 

[NICMAN]

how lucrative are we talking? Can you provide range?

trade secret 🙂.

 

[psychapp121]

trade secret 🙂.

give a range

 

[Maverikk]

LOL. That is some AMC sales pitch snake oil bull***t right there. $160/hr sucks. I don’t care how long turnover times are. It doesn’t matter to me if I’m sitting in the lounge or in the OR - I’m in the hospital and not at home. My time is worth more than that.

Yes I agree it is not a great rate, I was addressing the OP's original question about partnership track and what other things to think about. If you're doing three lap choles in a day and getting out by 1 your time is worth more than that, if you're getting out at 6 your time is not worth more than that. And being a partner wouldn't matter.

 

[Mman]

At least then you actually get the cash up front, rather than being trapped in a sketchy 5 year retirement vesting scheme.

I'm not even talking about that, I'm just saying that even vested 1:1 dollars people would prefer taxable salary over a benefit that might even have tax advantages. Total package of $500K that is $50K benefits and $450K salary is less attractive than a total package of $500K that is $15K benefits and $485K salary. So most AMCs run skimpy on their benefits to make the salary number as high as possible.

 

[deleted162650]

if you're getting out at 6 your time is not worth more than that. And being a partner wouldn't matter.

Wrong. My time is always worth more than that. If you’re at the hospital from 7a-6p and all you’ve done is 3 choles, then your group sucks at scheduling and you have yourselves to blame (but at least it’s still not because the C-suite needs to extract its pound of flesh).

 

[gasdoc77]

Wrong. My time is always worth more than that. If you’re at the hospital from 7a-6p and all you’ve done is 3 choles, then your group sucks at scheduling and you have yourselves to blame (but at least it’s still not because the C-suite needs to extract its pound of flesh).

I agree 100%. When Mav says "your time" he means in the eyes of corporate. F that. I decide the value of my time based upon the market and we agree upon it before we agree to work together. It is then the group's job to most efficiently use that time. They bear the risk to eek out a profit or a loss, all while fulfilling THEIR agreement to the hospital. ONLY way to work with an AMC is straight hourly with up-front defined rates for daytime/overtime/nights/weekends, etc. Our job's are 24/7 365 and the AMC will gladly pay you "500k!!!"to work as many of those hours as they physically can. Time vs money people!!! Maybe the suits are right and doctors really are terrible at business.

ps and yes, 160/hr is a CRNA rate. Groups readily pay locums 250+ an hour so THAT is fair market rate for the daytime hours

 

[deleted697127]

I agree 100%. When Mav says "your time" he means in the eyes of corporate. F that. I decide the value of my time based upon the market and we agree upon it before we agree to work together. It is then the group's job to most efficiently use that time. They bear the risk to eek out a profit or a loss, all while fulfilling THEIR agreement to the hospital. ONLY way to work with an AMC is straight hourly with up-front defined rates for daytime/overtime/nights/weekends, etc. Our job's are 24/7 365 and the AMC will gladly pay you "500k!!!"to work as many of those hours as they physically can. Time vs money people!!! Maybe the suits are right and doctors really are terrible at business.

ps and yes, 160/hr is a CRNA rate. Groups readily pay locums 250+ an hour so THAT is fair market rate for the daytime hours

Locums are to fill staffing holes. For instance, someone is out for surgery and they need someone for 4 weeks to fill the groups scheduled obligations beyond what members of the group are willing to staff so they don’t breach their contract or lose proceduralists to competing groups willing to cover. I don’t think you can assume locums rates are equivalent to your market value for non locums work. Sure, you can go do locums for your negotiated rate as you please, but this also comes with risk.

 

[Mman]

ps and yes, 160/hr is a CRNA rate. Groups readily pay locums 250+ an hour so THAT is fair market rate for the daytime hours

we get locums for $200/hr or less. I mean you think $2500 for a 10 hour shift? That's $12,500 a week for no nights or weekends which is definitely not the going rate we have paid or that I have colleagues work for elsewhere.

 

[gasdoc77]

2k for 7-3 is very common. I know of countless prior contracts at that rate amongst many of my colleagues. That said, the voices on this board who have to PAY for locums (either directly or through an AMC) will exaggerate rates downward for obvious reasons.

 

[Mman]

2k for 7-3 is very common. I know of countless prior contracts at that rate amongst many of my colleagues. That said, the voices on this board who have to PAY for locums (either directly or through an AMC) will exaggerate rates downward for obvious reasons.

2K for 7-5 is extremely common from what I've seen on the working and buying end of it. I view it as a standard rate. I've never been offered 2K for 7-3 during a weekday.

 

[Arch Guillotti]

2K for 7-5 is extremely common from what I've seen on the working and buying end of it. I view it as a standard rate. I've never been offered 2K for 7-3 during a weekday.

I have. Only one place though.

 

[Status Sciaticus]

Just business


Did you miss the line where we got a significant raise this year?

I thought you were in PP?? Why the move to an AMC?

?
160 x 40 x 52 = 330k
Not bad at all if it’s a 40/hr week job.
Would need more information.
is it W2 or 1099?
How many weeks vacation?

330k is kinda low, especially when youre assuming the person is working 40 hours per week for FIFTY TWO WEEKS per year.. AKA year round...