MEDNAX buy out--stay or go

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Should I stay


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Mountainman12

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My group is being bought out by an AMC. They offered me about 1/3 the buy out the partners get (more like 1/4th after taxes) if I sign a five year contract. I've worked with the group for almost a year. Do I stay or run like hell? I have no strong ties to the geographic location.

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Like anything else, it depends on your alternatives.
 
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My group is being bought out by MEDNAX. They offered me about 1/3 the buy out the partners get (more like 1/4th after taxes) if I sign a five year contract. I've worked with the group for almost a year. Do I stay or run like hell? I have no strong ties to the geographic location.
Feel like I'm answering my own question but thought I would put it out there.
 
Basically they want you to give a big portion of your future income to pay off the people who sold you out. Now you have the privilege of becoming an employee with less autonomy and less pay. Thanks but no thanks
 
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Unless you have strong ties to the area, it sounds like an easy decision. If I had to guess, I'd bet they're giving you in the neighborhood of $500k to stay. So that works out to about 100k a year for your commitment. In 5 years, you'll have developed roots in the area and won't want to move.
I'm betting they're not offering you a great rate or benefits either.


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Il Destriero
 
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Feel like I'm answering my own question but thought I would put it out there.

Why not ask for a good salary like $400K plus the buyout for the 5 years? If they say no you leave the practice. A total package of $500k per year for 5 years really isn't bad these days and if you like job/area then why not consider it?
 
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What is their offer besides the buyout?
 
I kind of agree with blade. Also If there are more non-partners you may have more leverage than you think because they need the workforce for the sale to go through. I would certainly negotiate higher.
 
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Why not ask for a good salary like $400K plus the buyout for the 5 years? If they say no you leave the practice. A total package of $500k per year for 5 years really isn't bad these days and if you like job/area then why not consider it?

Yeah, I could try that. Just concerned about making roots somewhere when I will likely want to leave in 5 years.
 
What is their offer besides the buyout?

They say most will average 350K post buy out. Salary would be very low like 160K but you make the difference by working the premium hours outside of 7-3 M-F.
 
Why not ask for a good salary like $400K plus the buyout for the 5 years? If they say no you leave the practice. A total package of $500k per year for 5 years really isn't bad these days and if you like job/area then why not consider it?

Blade, my partners are in the process to sell out as well. And I am pretty new to the group. One of the big AMCs is trying to offer us $425k plus "metric bonus" plus generous health benefits/occurrence malpractice and way more than average vacation time (it's a lot more than standard industry 6-7 weeks) and to stay on. I am currently taking q6 beeper and it may be q3 call with new scheduled.

No cash to stay on. f that

But it's like shifting numbers. Q3 call is a lot different than q6 call.

I'll let my soon to be "former partners" suffer with more calls since they are taking the cash.
 
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Jesus man. I make more than that in academia in a desirable city working 7-3ish most days and only 200 clinical days a year with about a call a month. With a real benefit package as well.
And I never cover more than 2:1.
Run.


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Il Destriero
 
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Further confirmation of the AMC takeover.
 
They say most will average 350K post buy out. Salary would be very low like 160K but you make the difference by working the premium hours outside of 7-3 M-F.

This is literally my worst nightmare, joining a PP group that sells out in the first 1-2yrs after I join. Now this is me as a pre-fellow speaking, but I'm actually offended by that offer, I'd tell them to kick rocks. 160k guaranteed is a joke, you'll have no recourse or leverage if you sign and after a year see that you only made 230k from working the after hours. I don't sign 5 years for a "you should potentially, maybe, if the stars align make 350".
 
This is literally my worst nightmare, joining a PP group that sells out in the first 1-2yrs after I join. Now this is me as a pre-fellow speaking, but I'm actually offended by that offer, I'd tell them to kick rocks. 160k guaranteed is a joke, you'll have no recourse or leverage if you sign and after a year see that you only made 230k from working the after hours. I don't sign 5 years for a "you should potentially, maybe, if the stars align make 350".

I had no idea about buy outs when I took the job (straight out of residency). Wasn't even on the radar. I got the job early and it seemed good so I took it. But now I'm board certified, have good clinical experience behind me so hopefully won't be hard to GTFO.
 
My group is being bought out by MEDNAX. They offered me about 1/3 the buy out the partners get (more like 1/4th after taxes) if I sign a five year contract. I've worked with the group for almost a year. Do I stay or run like hell? I have no strong ties to the geographic location.
Look at the total package, buyout plus salary plus benefits for five years, and compare with the alternatives you have. Don't forget to compare working hours, calls and vacation.
 
They say most will average 350K post buy out. Salary would be very low like 160K but you make the difference by working the premium hours outside of 7-3 M-F.
Don't let the door hit you...
 
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They say most will average 350K post buy out. Salary would be very low like 160K but you make the difference by working the premium hours outside of 7-3 M-F.

Wow. They are paying you CRNA money and then saying you can work overtime to make more.
 
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5 year commitment is way too long for 1/3 the buyout. I assume your partners are getting 3/3 of the buyout with a 15 year commitment??? Not!

1/3 buy out really should me around a 24-30 month commitment.
 
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The ratio of people to cake is too big.

You could set the building on fire. Put strychnine in the guacamole. Or take your travelers checks to a competing resort.
 
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My group is being bought out by MEDNAX. They offered me about 1/3 the buy out the partners get (more like 1/4th after taxes) if I sign a five year contract. I've worked with the group for almost a year. Do I stay or run like hell? I have no strong ties to the geographic location.

Why do AMCs keep buying groups out? With their running the business side of things and letting you focus on medicine combined with their revenue coming from better negotiated rates with insurers, not by taking your income, you'd think PP groups would be begging AMCs, if not paying THEM, to help you out. They bring so much good to the table so why would anyone need to get paid to nestle into the AMC bosom?
 
They say most will average 350K post buy out. Salary would be very low like 160K but you make the difference by working the premium hours outside of 7-3 M-F.

Hahahaha, a CRNA makes double that working those hours with more vacation time. That offer is a complete insult, tell them to f themselves
 
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Hahahaha, a CRNA makes double that working those hours with more vacation time. That offer is a complete insult, tell them to f themselves

Between pre-call days and post call days, we get a good chunk of the 7-3 M-F off as a trade of for the after hours time. End up actually working around 44 hrs/wk. Not quite as bad as it seems but still, I'll be looking for the door.
 
Between pre-call days and post call days, we get a good chunk of the 7-3 M-F off as a trade of for the after hours time. End up actually working around 44 hrs/wk. Not quite as bad as it seems but still, I'll be looking for the door.

That actually sounds worse. When are you gonna spend time with your kids?
 
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Insane....I would be laughing my way out the door. 160k? I would counter with for 160k and benefits, I will work Tues,Wed, Thurs from 900-1200 with no call or holidays and 8 weeks vacation.
 
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Did I mention I would get a free iphone?
 
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Walk away. Join a group that values you. Screw AMCs.


Sent from my iPad using Tapatalk
 
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Just make sure wherever you go is better than what you have now AND if you leave have a clause stating that if the group sells you get in on the buyout.

Sorry you are going through all this.
 
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We pay our CRNAs $160 k for M-F 45 hrs / week no call. That's truly insulting.


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They say most will average 350K post buy out. Salary would be very low like 160K but you make the difference by working the premium hours outside of 7-3 M-F.
That is really bad. Tell them to look for another fool.
 
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Jesus man. I make more than that in academia in a desirable city working 7-3ish most days and only 200 clinical days a year with about a call a month. With a real benefit package as well.
And I never cover more than 2:1.
Run.


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Il Destriero
Makes you wonder when will academic department try to take groups controlled by AMCs.
 
My group is being bought out by MEDNAX. They offered me about 1/3 the buy out the partners get (more like 1/4th after taxes) if I sign a five year contract. I've worked with the group for almost a year. Do I stay or run like hell? I have no strong ties to the geographic location.

Of course it depends on the details of the deal and your original situation. For the figures that you quoted, 160k plus work for more than that, that is one of the worst offers ive ever heard. So definitely leave and good luck to you.
 
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Jesus man. I make more than that in academia in a desirable city working 7-3ish most days and only 200 clinical days a year with about a call a month. With a real benefit package as well.
And I never cover more than 2:1.
Run.


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Il Destriero

This is not the first time I've heard of this kind of job, which I think is one of the best. But I really never thought you could earn >350k in academics unless you have been there for 10-15yrs and climbed some ranks. I guess every set up is different or the university is in a strange place? High income in an academic environment sounds like a win win but I have to say this was NOT the case at my training university where new attgs (even peds trained) started around 290k and advanced ~7-8k per year with the place.
 
My group is being bought out by MEDNAX. They offered me about 1/3 the buy out the partners get (more like 1/4th after taxes) if I sign a five year contract. I've worked with the group for almost a year. Do I stay or run like hell? I have no strong ties to the geographic location.

Mountain man....as someone who worked a few shifts for an AMC moonlighting, the more important question is what is your coverage ratio? I only worked a few shifts because I was genuinely scared for my clean malpractice record. These guys will hire the greenest, most incompetent CRNAs they can find, and set up the model such that you can wind up supervising a dangerous number of cases. My last shift i was supervising 8 CRNAs at one point...I had no idea what was happening on endo (or my other rooms for that matter). I had a couple near misses because of CRNA stupidity. I will never work in that environment again. Nothing like hearing a code called overhead in one of YOUR rooms and not even so much as a phone call from the CRNA. And guess what your recourse is against the dangerous CRNA that doesn't give a crap what happens to your license? I would VERY leery of signing a contract locking you in and committing to that hell.
 
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Makes you wonder when will academic department try to take groups controlled by AMCs.

NYMC was run by NAPA until NAPA got kicked out recently. They seemed really happy about it
 
Who is running NYMC now?

I'm not an insider but I believe it's the academic faculty headed by Dr. McGoldrick and they're hiring. I hear that Northwell is not happy about NAPA either but I don't think that's going to go anywhere considering the fact that John Di Capua is the chair for Hofstra.
 
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Makes you wonder when will academic department try to take groups controlled by AMCs.

I think it's more likely that lousy pseudo academic centers will be taken over by AMCs. It's already happened in some places. Administration views anesthesia as an expense, they have limited commitment to academia, the department is a second rate "academic" program that is little more than a resident training shop, the AMC comes in and offers to take over, cut the oversized subsidy, etc., then they fire 1/2 the bloated workforce, lean it up and make a fat profit. Win:win.
The profit generators can keep the "academic practice" going.


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Il Destriero
 
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My group is being bought out by MEDNAX. They offered me about 1/3 the buy out the partners get (more like 1/4th after taxes) if I sign a five year contract. I've worked with the group for almost a year. Do I stay or run like hell? I have no strong ties to the geographic location.

I am surprised that they are offering you anything at all.
 
I'd add that I bet the group that was happy to hire you was in negotiations with AMCs before you were hired. Did they disclose that to you? That alone would drive me away, I wouldn't want to keep working with them. The whole $160 thing doesn't help much either.
You can get a mommy track job with benefits for ~300. They're smoking crack.
BTW, a very common complaint seen with the AMCs after take over is promising bonuses, etc based on metrics that change or are actually unattainable. Some PP groups do that as well. Promise bonuses based on profits, don't share the books showing that a disproportionate amount of the overhead/expenses are coming out of your income stream and then you don't make the metrics for profit sharing. Be very careful with a low base and promises of >100% more in bonuses. Unless you have no non compete, that gives you an easy out.


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Il Destriero
 
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I am surprised that they are offering you anything at all.

Agree. If it's a non-shareholder we are talking about here with less than a year with the group, then there really isn't any obligation.
The way I understand it, non-shareholders that were with the group less than a year didn't get anything when MAC and Valley merged with Sheridan.
Sounds like total package will be around 500K+ for 5 years. That isn't a bad deal IMO, but if you don't have ties and have similar opportunities elsewhere, then jump ship. In the end you have to be happy wherever you go. This is of paramount importance.
 
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Mountain man....as someone who worked a few shifts for an AMC moonlighting, the more important question is what is your coverage ratio? I only worked a few shifts because I was genuinely scared for my clean malpractice record. These guys will hire the greenest, most incompetent CRNAs they can find, and set up the model such that you can wind up supervising a dangerous number of cases. My last shift i was supervising 8 CRNAs at one point...I had no idea what was happening on endo (or my other rooms for that matter). I had a couple near misses because of CRNA stupidity. I will never work in that environment again. Nothing like hearing a code called overhead in one of YOUR rooms and not even so much as a phone call from the CRNA. And guess what your recourse is against the dangerous CRNA that doesn't give a crap what happens to your license? I would VERY leery of signing a contract locking you in and committing to that hell.


They say they will bring on the CRNA's slowly over time with and cap the number. Supervising 8 CRNA's sounds like a nightmare.
 
BS garbage as others have said. I dodged 2 bullets in my young career where both practices I almost joined are in the process of AMC/employee position takeover. Mountain I assume you were making >300k before current Mednax transaction? BTW Hoya there are academic practices where you can earn >350k. Let's just say I trained at one of them :) And it is not in the boonies. Destriero I assume you are in the midwest?
 
I'd add that I bet the group that was happy to hire you was in negotiations with AMCs before you were hired. Did they disclose that to you? That alone would drive me away, I wouldn't want to keep working with them. The whole $160 thing doesn't help much either.
You can get a mommy track job with benefits for ~300. They're smoking crack.
BTW, a very common complaint seen with the AMCs after take over is promising bonuses, etc based on metrics that change or are actually unattainable. Some PP groups do that as well. Promise bonuses based on profits, don't share the books showing that a disproportionate amount of the overhead/expenses are coming out of your income stream and then you don't make the metrics for profit sharing. Be very careful with a low base and promises of >100% more in bonuses. Unless you have no non compete, that gives you an easy out.


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Il Destriero

Nope, they didn't disclose it. I had no idea. I thought I was on a one year partnership track otherwise I almost certainly wouldn't have taken the job. Old bait and switch.
 
BS garbage as others have said. I dodged 2 bullets in my young career where both practices I almost joined are in the process of AMC/employee position takeover. Mountain I assume you were making >300k before current Mednax transaction? BTW Hoya there are academic practices where you can earn >350k. Let's just say I trained at one of them :) And it is not in the boonies. Destriero I assume you are in the midwest?

I wish I would have been as wise. Won't happen again. Pay structure is similar to pre-transaction. Low salary and real money is working outside 7-3 M-F. Yes, made >300 under this structure working around 45 hrs/wk.
 
I wish I would have been as wise. Won't happen again. Pay structure is similar to pre-transaction. Low salary and real money is working outside 7-3 M-F. Yes, made >300 under this structure working around 45 hrs/wk.

I am currently in similar shoes as you. I am 1 year out from residency, although I make less and work more than you. I was given the ol' bait & switch, much like you. Do you have a fellowship? I didn't want to do a fellowship, but I am now thinking of using this as an opportunity to do a fellowship.
 
I am currently in similar shoes as you. I am 1 year out from residency, although I make less and work more than you. I was given the ol' bait & switch, much like you. Do you have a fellowship? I didn't want to do a fellowship, but I am now thinking of using this as an opportunity to do a fellowship.
The problem is that, except for CCM, it's pretty tough to land a post-match fellowship. And even post-match is a year ahead or more. So, realistically, if you want a fellowship, you have to apply about 15-18 months before.
 
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