Does anyone know about the market in Jacksonville? Thinking about working there.
Jacksonville FL market for anesthesiologists and CRNAs
- Thread starter 7Poptart
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Hca
Usap
University of Florida
Mayo is pretty fully staff not any locums opportunities there
Some outpatient places
It was closed off for long time but starting to implode. Decent income for some locums opportunities. Not the best. But steady.
Depends what ur goals are. All the w2 full time pay in the 500s /mid 500s with calls.
Just like most non Miami areas in terms of compensation.
Stay away from Miami w2 or 1099. Supply and demand means lower pay. People have this ideological lifestyle that Miami brings so brings the income potential down there since more supply than demand
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I didn’t know USAP still had a foothold in Jacksonville
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The largest private/AMC group in Jacksonville- USAP.
This was near the end of usap buying up national practices in 2017. They entered the Jacksonville market back than.
Florida Anesthesia Associates and Jacksonville Anesthesia Become Part of U.S. Anesthesia Partners
U.S. Anesthesia Partners, Inc. (USAP), the nation’s leading Anesthesia-focused physician services organization, today announced that two leading pract
www.businesswire.com
Thus 2017 was the last true full end of buyout of mega practices by USAP. By the of 2017. The envision/KKR deal was announced. Usap was suppose to go ipo end of 2017….its like the AOL/time Warner mega merger announced beginning of 2000….the beginning of the end of the tech bubble boom. We all know the fiasco of that time warner buyout by AOL
I’m a history buff. Slow death by a thousands cuts till it was over 9 year later.
Same thing happened to American anesthesiology (mednax) in 2014. Slow death after 2014
How long will usap last ? I suspect they will be a much smaller entity in 2-3 years.
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What happened to mednax? A group I was involved with got a big buyout circa 2015…switched to another amc…now hospital employed fighting every year for call/budget/compensation. Most left after the buyin period ended. The people I know, mostly new, still there say it’s better, no PE BS that comes down from on high and says you’ve more call, no PP skimming off the top.This was near the end of usap buying up national practices in 2017. They entered the Jacksonville market back than.
Florida Anesthesia Associates and Jacksonville Anesthesia Become Part of U.S. Anesthesia Partners
U.S. Anesthesia Partners, Inc. (USAP), the nation’s leading Anesthesia-focused physician services organization, today announced that two leading practwww.businesswire.com
Thus 2017 was the last true full end of buyout of mega practices by USAP. By the of 2017. The envision/KKR deal was announced. Usap was suppose to go ipo end of 2017….its like the AOL/time Warner mega merger announced beginning of 2000….the beginning of the end of the tech bubble boom. We all know the fiasco of that time warner buyout by AOL
I’m a history buff. Slow death by a thousands cuts till it was over 9 year later.
Same thing happened to American anesthesiology (mednax) in 2014. Slow death after 2014
How long will usap last ? I suspect they will be a much smaller entity in 2-3 years.
Do you think hospital employment is the future, having been doing PP/locums for a bit it seems like it’s best option out there unless you’re a PP that keeps up with the times/isn’t a board of all people who’ve paid off mortgages
Hospital employment is the future but that’s only if hospital executives hire the right type of people to run it. That a big if. HCA is figuring it out. They are close. Not there yet figuring out market conditions with their health trust locums division and their w2 model. But hca can’t figure out the crna staffing at all in Jacksonvile. I’m laughing with my crna peeps about Jacksonville.
Hca Jax pissed of their crnas. So the crnas jump to UF health doing 1099. Gotta love them I’m sure crnas will bounce right back to hca jax once they raise their 1099 rates. It’s an absolute game now in Jacksonvile.
As for mednax. Mednax just dumped their American anesthesiology Division for Pennies on the dollar to napa around Covid time. Mednax recognized how much they were bleeding. This was before Covid as they were losing contracts
Because mednax stopped buying the lucrative practices circa 2014 as usap
Stepped in to buy up the lucrative practices. Usap offered groups potential stock incentives which make more sense to many potential sell out practices. Look at MD stock price (mednax American anesthesiology). It peaked in 2015 as USAP was just forming. Coincidence? Probably. Mednax has other divisions ob and peds as well.
Well the usap buying spree pretty much stopped after 2017. 2017 was when mednax started losing big contracts like the one in charlotte.
In a nutshell anesthesia is not lucrative to make money unless the subsidies are factored in. If one of Orlando Houston or Dallas. If anyone of of the big 3 starts losing their big contracts. That’s the beginning of the end by usap. It is. I know the guys in Houston are pretty miserable. But they have martial problems which make make it even worst for them. Lol. The Orlando docs are pretty miserable and partners leaving as well. Dallas I’m hearing not great things. My college med school roommate feeds me most I know about Dallas area since he’s been down there almost 25 years. He’s even abandon his once lucrative fee for service anesthesia gig due to out of network billing 2 years ago so does straight locums.
Before mednax and even usap did not even need subsidies to make money. They also kept salaries artificially low with market share. But they have zero control how to handle the current job market situation.
The crnas are out of control with their demands. That adds stress to the bottom line for these AMC
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Well apparently HCA just got rid of all the anesthesiologists in national leadership so I have heard. I do locums at one of their sites in FL and it’s all they are talking about right now. I’m not sure how you run an employment model for anesthesia under internal medicine or whatever they are trying to do but they are going to try. Probably because it’s cheaper.
They would be better off just going with a national group if they don’t have anesthesia running anesthesia. I’ve seen it before and it’s a disaster. So, I’d stay on the prn side/ locums side at HCA.
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As one locums doc who’s pulling in 2 million a year always tells me “I’m here to make hospitals executives pay for their poor decisions “. And he does it with his flashy white teeth smile.
Just offer docs all hourly contracts. It’s the best motivation. Get rid of the middle men. The locums company. Lock in schedules 60 days in advance.
No one wants to be controlled but 60 days is fair enough for both employees and employer these days in the anesthesia world.
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Where do you do locums?
Anywhere I can get a good deal.
I talk to people from PA, California, Virginia , Tennessee and even Texas and Georgia.
I’ve done locums in California Tennessee Georgia and Florida but state licenses are getting expensive to maintain.
PA and California gotta be super careful reporting 1099 taxes. They are after a lot of people for state income taxes.
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This was near the end of usap buying up national practices in 2017. They entered the Jacksonville market back than.
Florida Anesthesia Associates and Jacksonville Anesthesia Become Part of U.S. Anesthesia Partners
U.S. Anesthesia Partners, Inc. (USAP), the nation’s leading Anesthesia-focused physician services organization, today announced that two leading practwww.businesswire.com
Thus 2017 was the last true full end of buyout of mega practices by USAP. By the of 2017. The envision/KLD deal was announced. Usap was suppose to go ipo end of 2017….its like the AOL/time Warner mega merger announced beginning of 2000….the beginning of the end of the tech bubble boom. We all know the fiasco of that time warner buyout by AOL
I’m a history buff. Slow death by a thousands cuts till it was over 9 year later.
Same thing happened to American anesthesiology (mednax) in 2014. Slow death after 2014
How long will usap last ? I suspect they will be a much smaller entity in 2-3
And hca just threw big support behind the aana…. As far as I’m concerned hca is the devil.
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What do you mean they are after people?
Reporting 1099 income from those states with state income taxes.
States want /need tax revenue.
If u live in California and always pay 9-11.25% state income taxes. And doing locums in Maryland. Do u really want to pay another 9% in county and state income taxes?
You won’t get back a 1:1 credit. U end up paying like 14% income taxes (state) when it’s all said and done.
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I thought you paid state taxes in the state where you made the $… not both
Too many questions. A job is a job.
Work load and compensation is all that matters.
Find something that fits your needs.
Only you can answer that.
Benefits can be inflated. I had search and a job spreadsheet mid 400s claiming it’s really a 700k a year job working 40 hrs. I’m like “Whatcha talkin bout Willis"
Like bro. You can’t be serious with ur inflated “benefits”
Tax laws vary from state to state. Since you live in Texas and I live in Florida. We pay zero state income taxes. But if we worked in say Georgia or California as 1099. We would pay non resident state income taxes on 1099 income earned.
But it gets super complicated if you lived in Georgia. And than did 1099 work in California. Georgia will give you a partial credit. I forgot how much for state income taxed paid to California.
But there is a reason why super rich or celebrities people live in no income tax states. Many “forget” to file non resident state income earned and just file in Texas Florida Nevada Tennessee etc.
That is an interesting statement! as a little while ago I was exposed to their "top anesthesia dog" and he had no prior high level leadership experience came from academics...... left me with a very unpleasant aftertaste. Most of HCA guys came directly from Envision and were playing same envision song and dance and using same aloof practices of not giving a s**t..... I am curious how this will play out as HCA CMO of anesthesia was 2 years out of residency and succeeded an Envision CMO after which she successfully jumped to sound (or was it the other way around)
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Well I don’t know the specific people but I do know that HCA consolidated and all the anesthesiologists are gone that were in leadership. Maybe they are giving up on employment? Maybe they are pulling an optum and buying an already existing mega group?
Well the VP position is available :
so ....... I guess so lol
You maybe right a certain HCA CMO who came from Sound magically disappeared from Linkedin and every other page.... I won't even ask how you know this.
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I work at one of the employed places as a locums and it’s all they talked about last week
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Looks like they'll even take a CRNA for the position...
That's what the CRNAs are saying, so they removed everyone? what was the reasoning?
Well that is the new rage, its already starting in NJ one of the large system's VP of anesthesia is a CRNA...... since physicians don't have a spine anymore and only look out for their individual self this is the result it will only get worse.... I mean CRNAs are always relieved on the dot, not so much with physicians you do the math... until we band together this is what it will be
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I assume this is public......can you name the system?
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They don’t know but the rumor is that they are running it with non anesthesia people because it’s cheaper. There’s an internal med clincial officer in charge now
That is like running an airplane factory by a guy who built buses before... it is sorta the same but not really..... we don't have to go far look at Boeing. What's the world coming to.
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We had a damn pharmacist in charge of surgical services in a hospital I worked at back in the 80's. It was every bit the ****-show you would imagine - literally. Among other things he canceled a surgeon's order for a bowel prep - didn't want the schedule delayed - and patient had major complications related to that.
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Very astute.
I hear gossip about Houston losing contracts but no one has details - just hopeful gossiping I think.
I don’t know anything about the Houston usap market. The one doc who I have intelligence on. He’s just miserable. (Original pre-2014 usap partner) but sticking around due to family. Bad jobs are almost like bad marriages. Or both. People stick around for various reasons. Kids in school. Marriages, divorce , elderly parents.
But anyone not married/no kids or empty nester who is miserable at any job in any city. I would advise you to explore locums.
Locums is NOT the ultimate answer... Have YOU done locums yourself ? from what I read prior you dont like traveling.... locums providers in many facilities are still treated like crap.... people in general fail to learn lessons... in academics the think "oh locums... they make more then us an are probably dumb shi** who can't get a regular job like me.. let me put em in the worst rooms"..... in private practice same though process the reasoning is " I want to work less let me hand off the bulk of work to locums" little do they know many of the locums were chairs, directors ex partners well trained etc etc... then word gets around and the facilities loose all locums. rates increase the cycle repeats.... and then there are just bad locums jobs in level 1 trauma / burn that isn't worth the money nor the mental pain ...... the answer is a fair collegial well compensated w2 or 1099 full time job where everyone including the admin of the hospital want the same thing - good outcomes in an efficient environment fueled by well ran pre-op clininc and inpatient services its a simple freaking formula....
Locums is the answer and has been the answer since 2020. It’s like the collapse of the Soviet Union in 1989 for the anesthesia market.
The rise of the AMC from 2007-2017 did a lot of damage to the anesthesia market with consolidation.
I agree on a fair w2 model. That model is best being paid hourly with Uber surged pricing.
The older/lazier/not motivated docs get paid base hourly paid working 7-1 or 7-3 whatever they want to work
Pricing goes up with less desirable hours and weekends.
But to fix the system requires you to blow it up first.
As I have said you have not done locums enough clearly to understand the workings of it... I both worked locums and employed locums
and negotiated their contracts.... it goes bad both ways..... some locums hold the facility in real dire need by the balls manipulating hours, per hour rates, refusing to work unless they do 5 calls a week (which offends other locums etc etc) alternatively refusing to work unless they go to specific loations only.... on the other hand facilities who are not too strapped but do have locums send them to the worst locations just because they can treat them with disrespect etc... this model does not work either way neither w2 nor locums its all f*** up ...
the locums market is being driven down by rising salaries especially in NY tristate area....at any rate this is a useless discussion as clearly everyone has an opinion unsupported by facts as is the case with the country in general......
My only advice is stay away from some of the worse HCA facilities right now, UF Jax, and Baptist downtown.
I’ve in the business for 20 plus years lol
I know the locums game. Some locums won’t sit their own cases. Some demand stuff like you say. You get rid of them when you have the chance. The more higher price locums get let go first usually as well. I’m not picky. I’ve had places canceled on me last minute. I got be a d to them. But I’m not.
My buddy is the regional director for one of the big amc. He let go of two locums in the past 2 weeks. Because he had enough of them. One of the locums was former president of the practice who sold out to the amc. But enough is enough. He let him go of the 1099’locums he was doing at his own place he’s been there 25 plus years. Some people are very demanding.
Hca is hit or miss. But I’m perfectly happy taking 12k a call from hca. 36k for the weekend.
I have the negotiated hca contract in my hand right now. I’m not lying about this.
I call that money ball.
You are in a heavily dense metro area. Supply drives down demand.
Go to upstate New York and crnas are making almost $300/hr.
Remember. Every market is different. And that’s why I encourage everyone doing locums to not get comfortable and have 4-5 sites going at the same time.
The crna locums forums are even worse than the MDs by the way. With their demands.
You make 12k a call? and 36 a wekeend... you are making $700 an hour hard to believe... at any rate this is not about letting go of locums its about facilites treating people like shi*.... you are saying regular academic attendings are no worse... its all garbage
It’s all a game at this point. Supply and demand. I routinely do 40-50k a week locums. The money is in the calls. The continuously billing.
$410/hr x 24 hr plus $2400 call stipend. It’s simple math. 12k. Per 24 hr. I did 112 hr last week.
And this isn’t even the highest rate.
The problem with academics is u have two groups
1. The group that does academics
2. The group that does clinical
And they both get paid the same. That creates a big divide in the “workload”. My 112 hr “workload” last week is equivalent to many Napa places 50 hr “workload” in the north east. No way I can do 112 hrs the way some north east places work.
I’m extremely leery of doing locums 7-3 (5 days a week). Basically practices will treat u like crap and the Napa full time w2 boys/girls will game the w2 extra pay system and take “extra” call after the locums docs do the dirty work 7-3. The napa
Boys are making close to 700k w2 up north at some places working probably around 50 hours with the way they game using locums docs.
The market pay for w2 docs if they want to treat them fairly is 650-700k w2 45 hrs a week (call inclusive) 10 weeks off.
Its saves you long run over the cost of locums.
Or have a night float system. Pay everyone around 500k and give them 20 weeks off. Rotate the night float docs into the system. It all comes out the same hours and pay equivalents and. Adjusting for weeks paid off.
What area/states and what hospitals are locums people making $12K/call and $36K for a weekend? That sound amazingly high. I've only been doing locums this year and these are not the rates that the locums agencies are offering me or what locums agencies who openly advertise are the going rates for call and weekend call. What I have been offered and seen offered are weekday $800-$1000 to hold the pager on-call at night then $400-$450/hr called back this is home call. Weekend offers from different agencies have been $1600 to $3000 for 24hr pager call from home and if called in $400-$450/hr of time worked with guaranteed 1-2hrs of $400-450/hr if called in even if doing 30mins of OR work. Unless someone is working 24hr straight in the ORs, there is no way that I would be making $12K/call night. I have never been offered or seen advertisement that the call is paid hourly for 24hrs. What have other locums been offered for taking call as locums? Is the paid hourly for locums on-call 24hr the norm or is the X dollars for holding the pager and then X dollars/hr if called in the norm? I want to know so that I can gage if I am being swindled
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Hes not lying. I worked for Napa this compensation is true. I miss the good old Napa days. We were understaffed but their was always plenty of extra call and weekends to work.
These places are becoming a dime a dozen
As one shop closes up shop. The next one opens up.
The people with the best deals come in as a team. Offer these places continuous coverage. The coordinated attacks at these locums places gets you essentially unlimited access to revenue streams.
Hospitals change the deal. Everyone pulls out and these hospitals are stressed out with coverage immediately. It’s cycles. These hospital needs.
These guys left the one place that paid well for 2020-2022. . Hit another place for 20 months. That gig dried up
They came back to the place that didn’t need them and charging them even more in 2024. It’s becoming hilarious at this point. I mean it’s serious business and lots of money involved.
Locums is a business. You provide a service. They provide the compensation.
Either one can break a contract within 30-60 days. Whatever the negotiations entails.
The crnas are way ahead of the hourly rate game than the docs. It’s the best way to compensate people.
I won’t or am very hesitant to take any beeper call rate than isn’t less than my standard overtime or in house rate. Not worth my time to be sitting around even at home and not getting paid at least $300/hr beeper and playing in my own pool. Because I can get called in anytime. My current weekday beeper rate after 7pm I have is $333/hr which isn’t bad. All inclusive. I’m getting paid regardless. No work. I’m paid $333/hr. Work I’m paid $333/hr weekdays.
Weekends is a completely different beast. That’s the money ball. It’s gonna to cost the hospital a lot of money.
Remember to always look who exactly is paying the locums bill. Follow the deepest pocket book. The hospital.
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Appreciate your insight. Would love to pick your brain via PM about viable locums options in the area. Thanks.
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I’ll add to this:
Deals dry up in bigger and more attractive markets. The facts of the work these days is there physically aren’t enough docs to staff cases throughout the country.
The smaller markets now are unable to get full time fellowship trained docs. They will be locums forever if the few full timers want any vacation or if they ever want any expertise working in their facilities.
Find a deal with one of those facilities and just ride it forever. No one will ever come. This includes some markets like Phoenix that don’t have any big residencies feeding them new grads.
There’s no one to hire unless you live in a top 20 metro now.
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Houston USAP isn't losing any contracts they aren't walking away from. If anything, the hospitals systems want them to take over more.
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Thank you for first hand information- I suspected rumor and conjecture and wishful thinking
Yeah it’s all supply demand out there. While the amcs are horrible, they did squash much of the competition. So there aren’t a lot of options left for hospitals other than employ vs an amc like USAP. Some would rather just pay a stipend. So it’s a stipend supply/demand game.
Problem is staffing shortages are so high, and pay rising so fast, particularly for CRNAs…even the amcs can’t get high enough stipends. Also the MDs who work W2s are starting to figure out CRNAs or locum MDs are making way more than them and starting to demand more or leave.
It’s an ugly game…but one you can make money in if you know how
Problem is staffing shortages are so high, and pay rising so fast, particularly for CRNAs…even the amcs can’t get high enough stipends. Also the MDs who work W2s are starting to figure out CRNAs or locum MDs are making way more than them and starting to demand more or leave.
It’s an ugly game…but one you can make money in if you know how
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However- lots of these rural places do some shady stuff - like extended supervision ratios. One place had one dr for all the rooms… let crnas do hearts with extended care team, do the echo (couldn’t bill but they did them), had a crna training program. Gave all the drs 20 weeks vacation and only one lived in town. Most were pain management guys who probably wouldn’t be of much help to the crnas running amok anyway. Premier anesthesia site. I heard they do the same thing in Jackson? TN…. 6:1 etc.
if they want decent drs in rural america they need to offer acceptable jobs…
Maybe the Houston hospitals administrators are smarter than other hospitals. It’s cheaper to keep her mentality and give usap what they are demanded. Than switch to different providers and companies.
Hospitals for some reason loathe to pay for ancillary services like EM/Radiology/Anesthesia. But are raking in so much in facilities fees. It makes more sense to kickback usap extra.
Which begs the question. If hospitals are kicking back anesthesia money. Isn’t this a stark violation?? It’s to the hospital’s advantage to keep surgery going so they can make money. Why hasn’t anyone ever addressed the legality of subsidies?
Most of the surgery they do after 4pm are bs elective surgery anyways. Only true emergency cases should be done after hours.
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Gi physicians bring patients to their center.
Hospital employed surgeons bring patients back to the hospital.
We get into semantics yeah. But a kickback is a kickback.
The hospital kicking back money to anesthesia to provide searches so hospitals can make money.
I really don’t know how you can explain to a Medicare audit board an elective hysterectomy at 8pm while kicking back anesthesia money to sustain this non essential (for 8pm) service.
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Stark law just says we can’t be paid to refer Medicare and Medicaid patients to a certain facility or be paid to refer those patients to a certain vendor. Since we don’t control or direct where patients go (except maybe friends and family), we are not in danger of violating Stark law.
Because we don’t refer, we’re no different than an X-ray tech or a nurse who keeps the hospital running.
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