Introduction

[JSBMD]

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Hello everyone, I would like to introduce myself. I have been perusing this fine forum somewhat regularly after happening on to it a couple months back. I find the discussions interesting, and at times illuminating.

As to my background, I finished anesthesiology residency WAY back in 1997, and have been in various PP settings since then. I worked in hospital-based medium sized groups at four different locations (various reasons, some good, some bad for the change of employment, but the last group I was with 9 years) before moving on to strictly outpatient stuff. For the past few years, I have been running two surgery centers and feel that I have found my ideal job. Yes, there is a life for anesthesiologists without call.

Anyhow, what drew me to this site was the discussion of cases, techniques, etc. Any of the PP guys out there will know what I mean when I say that the one thing you residents will miss is the discussion time with your colleagues. I spend many days chatting with my surgical colleagues, but much, much less time with my anesthesia colleagues. Just a reality of private practice I think, as no one seems to want to stick around much after the pay stops (meaning the cases end).

So here I am. I hope I can offer some insight to the discussions here, both as they pertain to anesthesia itself, and to life in private practice.

 

[RussianJoo]

cool, welcome.

 

[Direct Laryngoscopy]

Welcome to the site!

A few questions to start off? What part of the country do you practice and have practiced? What were some of the qualities of the 'bad' practices models you experienced? And how can we avoid them as we transition into post residency practice?

You should join the anesthesia club if you don't want to speak about some issues publicly. Only ASA members can post there. Welcome and look forward to your posts.

 

[epidural man]

Welcome

 

[JSBMD]

Thank you guys/girls for the welcome...

As to the questions asked, here is more background info. I finished residency back in a time when the job market was coming off a very difficult time. Jobs were scarce, applicants were somewhat desperate. My residency, and my preferred location for post-residency work, was in Southern California. The market here was as bad (or worse) than it was anywhere else in the country at that time. So, I took a job in Phoenix. Good group, fair, no buy-in to partnership(!). Problem was my wife and I just never felt at home there in Phoenix. Long story short, we cut our losses and came back to Cali.

First job in Cali was in an OK hospital, with an OK group. However, there really was never any partnership "track", and after a year or so, it was fairly obvious that there never would be a partnership there, just a "contractor" status. I stayed on there almost another year despite that fact, but ultimately left as I couldn't picture doing that another 25 years.

Next job was an absolute disaster! Was with a group of crooks who promised partnership track, buy-in that looked sort of reasonable, 6 page contract, whole thing. Their story even as to why they needed more providers was perfectly reasonable and even appealing. They had hired a business consultant who took their desires (more money, less call) and come up with a newfangled plan to increase the group size in order to expand coverage to newly cropping up outpatient surgery centers (1999 remember), while still only having the home hospital as the call obligation. We (yes, there were 8 others hired along with me) were sold on the idea of covering both a hospital and many outpatient centers, while only having the one source of call diluted among a greater number of providers.

Great in theory, but the problem was that the group was run by a couple of crooks, as I said earlier. They worked all of the young guys like dogs, paid us only 10-20% of what was owed us, with story after story as to why the billing lag was holding our money up. Always we were told next month would be better. (Note for you residents: this may sound insane, but it actually isn't that difficult to do to someone, because we typically get paid for cases 30-90 days AFTER submitting a bill for services rendered. So, you see, no one of us expected to see any money for 2-3 months. After that it was just a game of them taking advantage of our patience. Groups usually pay monthly, so you can see how they got away with this in the short term.) Ultimately, we banded together and threatened to quit, expecting the crooks to fold their hand, but they never did, so I quit that group. I figure they stole $100K from me, more from others. Believe it or not, a good friend who joined there when I did stayed on another year, thinking that the crooks would straighten up once associates started leaving. They didn't, and he probably lost over $300 to those crooks.

After that I found a very nice, honest group at a small/medium sized suburban hospital. I joined, gun-shy at first, but came to realize that these were honest, honorable folks. Ultimately made partner, came to be Vice-Chair of the department, and was very happy with that group for nine years. Until the hospital closed! Yes, that does in fact happen folks.

After that I took over as anesthesia director at a 4 OR surgery center nearby, and have been at this position for the past several years. What I do now is not only work in cases myself, but coordinate anesthesia coverage for the other rooms. Sounds easy, but the problem is not all 4 rooms are running every day. So it's a bit of having a steady crew, with more folks to call on when need increases. A year and a half ago, I was approached to provide similar coverage for a second surgery center nearby, as that center's administrator had heard of my success providing anesthesiologists for my first center. I love what I do, and the practice style I now have. No more nights, weekends, or holidays spent in the hospital.

So, that's the details of my work history. As to advice on how to avoid getting into a bad group environment, I would say to look carefully at the entire group, not just the "salesman" of the group. Talk to as many members of a group you may be looking at as possible. Ask questions such as how long that person has been there, any friction in the group, pay differences and why, "open books" or closed (RUN if they are closed, even to non-partners....that's the setting with the crooks I worked with), etc. Ultimately, I learned that it wasn't the end of the world to have to start over, just inconvenient. Also, I would figure out what location I could live with versus not live with. For instance, I have friends in Las Vegas who continually try to lure me out there, with the promise of more money. Problem is, I don't want to live in Las Vegas, so it wouldn't work for me.

 

[eosinophilic]

wow...great post and great info even though I wont be looking for a job for at least four years.

so definitely NO to groups with closed books...

 

[JSBMD]

The whole "closed books" thing was subtle. This was how the crooks fooled a whole group of us associates. The 6 page contract went into great details about how one becomes a partner, including buy-in, year by year status, voting rights, etc. The pay was defined as a percent of whole group productivity, minus the buy-in percent, year by year. Very reasonable sounding. Read the contract over many, many times before signing. Problem was, one of the small details was that only partners can see the books. They didn't want hospital staff or admin or other groups knowing their financials. Seemed reasonable.

Problem was, when we all knew we weren't being paid a reasonable amount, we couldn't demand a look at the books. After quitting, we even considered suing for stolen monies. Lawyers wouldn't touch it. Without having seen an authentic set of books, we were told, we wouldn't be able to refute a fake set of books.

I realized that this just had to be a "lesson learned" kind of situation, so I moved on. Still hoping to see my former "senior partners" in a gurney in pre-op one day...

 

[Foodie]

Thank you very much for sharing your experience. What useful information for us residents!