Inland Empire (Southern California) Status: 2019

Discussion in 'Anesthesiology' started by true_dat, Jan 10, 2019.

  1. true_dat

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    I've been a contributor over at Sermo.com for a number of years. After my recent phone upgrade, I can no longer log into Sermo via the app. While complaining about that fact with some colleagues, they suggested that I check out StudentDoctor.net. They point out that there are many more sub-forums, more lively debates, and more granular discussions.

    To that end, I thought I'd share some of my experiences with some of the anesthesia groups in Southern California, particularly the Inland Empire.

    I am going to aim for at least plausible deniability of what I write here, just so that I can be as candid as possible. If you meet me in real life, I will deny that I am the author of this thread. Anybody who claims to be the author can, therefore, be assumed to be lying.

    San Diego/ASMG/Escondido

    First, a statement of the obvious: I'd prefer to live and work in San Diego (who wouldn't??), but ASMG has a simply awful recruiting system. Perhaps if I were straight out of residency with my entire career yet ahead of me, I would agree to play their little game. But now that I'm seasoned and have a proven track record, I don't feel like subjecting myself to their tedious "match" system.

    Since they have a hammer lock on all of San Diego (outside of government jobs, which don't appeal to me), and a very, very sh*++y Prime Healthcare gig (and exactly half of the coverage at Grossmont, where they and the not-quite-a-group that takes the worst half of cases got sued for price fixing and collusion), I had to look north. I interviewed at Escondido, but was advised by more than one young hire that the the ossified Chair very much wants newbies whom he can mold, manipulate, and manage without question or blowback. That, and the group has a very tenuous relationship with some Kaiser surgeons who are only biding their time until Kaiser builds its own hospital in Escondido, whereupon ~half of Palomar's volume (and even a higher percentage of their good-paying cases) go bye-bye.

    Temecula/Murrieta/Rancho Springs/Menifee

    I didn't consider it very seriously, but I did engage with a couple of recruiters who had tipped their hand that Envision was D-E-S-P-E-R-A-T-E desperate for warm bodies after they took over three struggling hospitals in Temecula. I have since learned that the situation in Temecula/Murrieta/Rancho Springs is even worse than I feared (and I have quite a capacity to fear what I thought pessimistically could be the worst). A friend of a friend who had been there 20+ years with his wife, house, family, and kids recently had enough of the turmoil and agreed to commute 3+ hours to a 20-hour/week in Santa Barbara that offers zero future possibility of turning into a full-time gig. While I grant that I only have a single data point to go by, that is a pretty damning single point.

    Pomona


    I interviewed with the group at Pomona, but absolutely nothing of what they told me made sense--and many of the "facts" they stated in the interview were verifiably false by the simplest of Googling. I decided against the job, but I later learned that the job offer itself must be further evidence of their desperation, since I am not Asian. Take that for what you will.

    ...More to come.

    TL/DR: Anesthesia private practices are a mess, and getting worse each day. While some of our enemies are AMCs and CRNAs, real life practicing anesthesiologists are more than happy to screw each other over, as well.
     
    #1 true_dat, Jan 10, 2019
    Last edited: Jan 11, 2019
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  2. SaltyDog

    SaltyDog Homey O'Stasis
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    A good chunk of the above regarding SD is false (not all, but a decent chunk).
     
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  3. Man o War

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    Have you noticed the influx of new posters and the type of stuff they’re posting?
    I’m skeptical.
     
  4. Psai

    Psai This space for lease
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    I don't know who to believe, the guy with zero posts and no credibility or the guy that's been here for ten years. I guess I'll just have to get hired in SD and find out for myself.
     
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  5. dchz

    dchz Avoiding the Dunning-Kruger
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    Which part of it is true?

    which part false?
     
  6. dchz

    dchz Avoiding the Dunning-Kruger
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    How Asian do you have to be? :ninja:


     
  7. SaltyDog

    SaltyDog Homey O'Stasis
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    I’ll answer those questions by PM if you’re really interested in an effort to preserve anonymity.

    I’m no longer in SD so I have no dog in this fight, but I am quite familiar with the market there and I don’t like to see misinformation spread about.
     
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  8. nycitygas

    nycitygas ASA Member
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    Are you talking about the Pomona group in LA? I have a friend there, he seems to love it. Hard work but good pay.

    He is Asian though haha
     
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  9. Mman

    Mman Senior Member
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    sounds like Southern California is a mess. Not so bad elsewhere.
     
  10. nimbus

    nimbus Member
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    It’s not hard to reset sermo password.
     
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  11. GravelRider

    GravelRider SDN Lifetime Donor
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    I can tell he’s not from Sermo because he didn’t use the word “noctor” (which is unfortunate because it’s a great word).
     
  12. SaltyDog

    SaltyDog Homey O'Stasis
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    There are still lots of excellent groups.

    I would even recommend a couple mentioned by the OP.
     
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    #12 SaltyDog, Jan 11, 2019
    Last edited: Jan 11, 2019
  13. DM27

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    I think the OP may have sold me a timeshare once...
     
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  14. Mr.S

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    I have an aquaintance who worked at ASMG in san diego.
    He left after 18 months sold his house never to return.
    He basically told me what the OP suggest. They tried to control him like a chess piece. And he wasnt havin it.
    He said the "Sun Tax" was too much.
     
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  15. GaseousClay

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    Have a couple buddies down in SD. UCSD has a big department now and you can even work there without being on an academic track. They have had a significant raise as well as RVU based payments. Not sure how happy the people there are now though. ASMG match system can suck my friend was there for a year then left right before the match but a lot of people love it there depending on which place you match to. It does sound terrible for someone who has already been out in practice for a while to basically 'audition' again. Haven't heard anything good about ACCMG or the other grossmont group. I think Permanente is probably the best bet down there.
     
  16. OP
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    true_dat

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    I'm happy to be corrected. Really, I am. I invite corrections and will go back and edit my original post so that future readers are not misinformed.



    After receiving a private message, I understand that issue has been taken with my characterization of Grossmont Anesthesia Services (GAS). (Left unsaid, therefore, is the fact that most people generally agree with my characterization of ASMG.)

    I interviewed with Dr. K and his colleague Dr. Y at GAS in 2014 or 2015. They could have undergone significant improvements since then, of course. (Or, it could be that the accuser's experiences are so much older than mine that the difference was that they went downhill only after the accuser ceased keeping tabs on GAS.) I know that they had disappointed at least three "full-time hires" in the recent past: one who moved to California from the midwest somewhere and turned back around within 30 days, one who was moving south from the Bay Area (but also didn't last the month), and another who drove in daily from South Orange County.

    Dr. K* seemed a nice enough guy, but he was very cagey about the breakdown of assignments between Grossmont and Alvarado. He was also very cagey about how cases at Grossmont were assigned to GAS or to ASMG (should a new hire ever make it from Alvarado to "the big leagues" of Grossmont). Dr. Y was much less evasive, but told impossibly optimistic stories that simply could not have been true, or else they would not have been advertising for years and years on Gaswork. For the record, it was much easier to trust Dr. K than Dr. Y.

    From my days working a lucrative gig "in the desert" I had a contact who was working PRN for GAS at Alvarado. He showed me the paperwork from their biller (whose name was either Dwayne or Duane, should the accuser want to fact check me), which showed 10.5% was taken off the top of what was a ~$28 unit.

    Sure, some of you are saying, $25.20 net per unit isn't great, but if you make it up billing huge numbers, who cares? Well, the PRN guy put me in contact with a very kind, upfront, and forthright female DO who told me that I can hope to generate between 750 and 800 units a month...from a job that puts you on call every 5th night and every 5th weekend. The DO naively believed that they were "only weeks" away from securing a stipend from Prem Reddy for anesthesia coverage. What I learned later was that the Alvarado CEO fired IAMG (a subdivision of Pacific Medical Management that "manages" the bulk of anesthesia groups at Prime Healthcare California hospitals) because of IAMG's dishonesty, and that Prem himself was butthurt about the CEO's actions. (IAMG's President is somehow related to Prem.) So there was very, very little hope that Alvarado would be the first-ever of Prem's hospitals to stipend anesthesia coverage. Sorry.

    Oh, and as for the lawsuit: here's summary from the FTC:

    Two San Diego County Anesthesiology Groups Agree to Settle FTC Charges of Fixing Prices

    Anyway, I invite corrections. I was hoping to get back "on topic" (the Inland Empire) today, but I thought it better to let people know that I am doing my very best to tell the truth about my experiences.

    TL/DR: Grossmont Anesthesia Services (GAS) has a terrible contract at Prime Healthcare's Alvarado Hospital, and a slightly-less terrible contract sopping up the cases at Grossmont that ASMG doesn't want.
     
    #16 true_dat, Jan 11, 2019
    Last edited: Jan 14, 2019
  17. Mr.S

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    I find it interesting that when anesthesia groups come up with a reasonable price for coverage that is anti-ccomptetive but insurance companies are allowed to price fix essentially by eliminating all competition legally
     
  18. OP
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    true_dat

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    I'm sorry if I come across as a bit of a whiner. That was not my goal. Instead, I was trying only to give a sober view of a slice of the groups in Southern California to help round out the picture future applicants might have. (I certainly could have predicted that current employees of some of the less desirable practices would have objected to being called out, but I am surprised to receive such blowback from former employees. Not only might the former employee's experience be so out-of-date as not to be valid anymore, but if a former employee elected to leave the program, how can a criticism of the program reflect poorly on the guy who left? Anyway, if any former employees would like to refute my version of the facts, feel free.)

    Before I waste any column inches talking about Riverside and San Bernadino Counties, I thought I'd prove that I'm not all negative.

    Mission Viejo

    I cold-contacted Mission Viejo Anesthesia Consultants and they extended an interview. That interview was everything an interview should have been. I met with a bunch of the partners, we spoke in an informal manner about the practice of anesthesia, their habits and customs, my habits and customs, and how they are keeping CRNA encroachment at bay. It was exactly the kind of meeting that you would expect from a stable physician-only group in a nice hospital. In the end, the timing didn't work out, but I would wholeheartedly recommend anybody try to get on with Mission Viejo Anesthesia Consultants.
     
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  19. nimbus

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    +1 for MAC. Super solid peeps.
     
  20. SaltyDog

    SaltyDog Homey O'Stasis
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    @true_dat : May I ask over what time frame you conducted this grand tour of SoCal Anesthesia practices? Also, why would you leave a
    I am also very curious where, after all this, you ended up (no need to be super specific).
     
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  21. OP
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    true_dat

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    I don't want this thread to be about me, but suffice it to say that after slumming for a while as a PRN anesthesiologist for one of the big players, I'm now settled. The time spent hustling gave me an appreciation for how many awful programs exist, and also opened my eyes to how inadequately residents are prepared for evaluating private practice.

    This is very likely to be my last post in this thread. I wanted to touch on the trouble in Riverside, but I'm beginning to think that nobody wants to hear details on the open secret that all jobs advertised on Gaswork are terrible. (Given a moment's reflection, that makes sense: good jobs are filled by word-of-mouth. Terrible jobs need Gaswork postings...and, even worse, recruiters.)

    Parkview and Riverside Community Hospital

    Parkview, which was recently sold to AHMC, and Riverside Community Hospital, are now both staffed by Emcare/Envision. Envision has now employed three (or is it four??) different recruiters to try to scare up warm bodies, because administrators at both hospitals are threatening to sue Envision for breech of contract, because fentanyl-addicted T. Crapenter made all sorts of promises that his few remaining anesthesiologists can't possibly fulfill, since his brush demeanor caused over half the staff to leave immediately, and more are fleeing the sinking ship each month.

    Riverside Medical Clinic

    As evidence of just how bad it is at RCH, two anesthesiologists just jumped ship to work for Riverside Medical Clinic for $24/unit. (That is not a typo: twentyfour dollars per unit. Yes, Medicare rates for everything.) Full disclosure, I worked at RMC for a single week, and for five straight days they managed to cause my jaw to drop at how poorly run an outpatient facility can be in the richest country on earth. From flying gnats in the sterile core and operating room to the lack of critical medicines available, to the fact that they recycle "Single Use Only" equipment, to the anesthesiologists' stubborn insistence on 8-hours NPO even for clears, to their absolute ignorance of the even existence of ERAS, to the rusty carts and iv poles and outdated equipment, to the anesthesiologist who had four helpers (one on each extremity) holding down a screaming child while she--the anesthesiologist--assaulted the child with a nerve stimulator, as though the fact that the child had so much strength as to require four adults to hold him down left his neuromuscular function somehow in question, to the fact that they do rotator cuff repairs three days a week and yet not a single anesthesiologist does nerve blocks (they don't even have blunt needles, an ultrasound machine, or a proper nerve stimulator in the facility) to...I lose track of all the ways that place sucked. It was kind of too bad, because the surgeons were nice.

    Anyway, the truth is that RCH, Parkview, and RMC have all gone from bad to worse since Kaiser has come to town and vacuumed up all the good insured lives. (RMC is going on a hiring tear, claiming that they are growing. Their growth is into the medicaid community. They recently joined with IEHP (Inland Empire's version of Cal-Optima (Medicaid)). So, yeah, legally it's "growth," but it's not the kind of growth anybody would like.
     
  22. narcotics999

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    Thanks for the info. Did you interview with Kaiser and know the current rates/salary in SoCal?
     

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