NAPA Now in Trouble in Maryland

[Anestheski]

Apparently, NAPA has been fired from Greater Baltimore Medical Center. Since Spring ‘20, when NAPA bought the Greater Baltimore Medical Center contract from Mednax, there was a mass exodus of anesthesiologists and now they don’t have enough anesthesiologists to staff the ORs. Sounds like the same issue as in NJ and NV. Anyone else hear anything about this? What is happening with NAPA in Maryland or is this just more NAPA dominoes falling, like in other parts of the country?

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[GassYous]

Sounds familiar

 

[DrOwnage]

Can't wait to hear what the locum rates are going to be

 

[anbuitachi]

wait. anesthesiologists left because they went from mednax to napa? is napa that much worse than mednax? or non competes?

 

[amyl]

I thought mednax was dead

 

[NICMAN]

Well, If anybody exiting from that group is interested in coming to coastal Virginia (90 miles from the Outer Banks) to work in a nice private practice true partnership group then send me a private message. We could use one or two additional people starting January.

 

[jwk]

I thought mednax was dead

They are. NAPA bought American Anesthesiology (Mednax) for $50M for everything. Every group. My guess is that Mednax paid more than $50M for a single group in several cases back in their early days.

Two of the three NAPA groups in Atlanta are gone, both pretty unpleasant.

 

[Anestheski]

They are. NAPA bought American Anesthesiology (Mednax) for $50M for everything. Every group. My guess is that Mednax paid more than $50M for a single group in several cases back in their early days.

Two of the three NAPA groups in Atlanta are gone, both pretty unpleasant.

NAPA was fired from two places in Atlanta, in addition to being fired from Reno, Barnabas in NJ and now GBMC in Baltimore?

 

[Dr. Rude]

NAPA was fired from two places in Atlanta, in addition to being fired from Reno, Barnabas in NJ and now GBMC in Baltimore?

If your job sucks, and the job market suddenly turns good your two most logical options are:

1. Leave.

2. If unwilling to leave, do as little as possible to not get fired.

Makes perfect sense. It is why many AMCs (which are typically less desirable) are challenged. Same thing happened in the early-mid 2000s.

 

[Fpg1245]

They are. NAPA bought American Anesthesiology (Mednax) for $50M for everything. Every group. My guess is that Mednax paid more than $50M for a single group in several cases back in their early days.

Two of the three NAPA groups in Atlanta are gone, both pretty unpleasant.

Thats an insane discount. Considering how many practices they had.

 

[anbuitachi]

maybe napa will be sold soon

 

[Fpg1245]

maybe napa will be sold soon

Let the private equity daisy chain continue!
Maybe KKR can add this dumpster fire to their collection
Long live capitalism.

 

[GravelRider]

Let the private equity daisy chain continue!
Maybe KKR can add this dumpster fire to their collection
Long live capitalism.

Acquire, strip, and flip. The last one in the circle jerk gets to declare bankruptcy after every last cent in value has been squeezed out by the private equity jag offs. Ah, the wonders of American capitalism…

 

[anbuitachi]

Acquire, strip, and flip. The last one in the circle jerk gets to declare bankruptcy after every last cent in value has been squeezed out by the private equity jag offs. Ah, the wonders of American capitalism…

thats why our best and brightest go work on wall street. the cycle continues

 

[GassYous]

Thats an insane discount. Considering how many practices they had.

Not when you are losing all your contracts

 

[Fpg1245]

thats why our best and brightest go work on wall street. the cycle continues

The amount of intellectual capacity dedicated to these ventures is astounding. Thousands of college entrants with Ivy League aspirations whose sole goal is to work at big law or big finance firm focusing their efforts making life miserable for the rest of us. This is what passes for an upstanding American these days.

 

[Twiggidy]

thats why our best and brightest go work on wall street. the cycle continues

while it does involve a certain level of intellect, I'd say the majority is knowing the right people (aka going to the right school like an Ivy as said above) and being in the right place at the right time. We all had the intellectual capacity to graduate medical school and pass a multitude of exams and we could've chose business as our path. we just may have not gotten some of these venture jobs because we didn't have the correct school on our resume

 

[marr65]

The amount of intellectual capacity dedicated to these ventures is astounding. Thousands of college entrants with Ivy League aspirations whose sole goal is to work at big law or big finance firm focusing their efforts making life miserable for the rest of us. This is what passes for an upstanding American these days.

Money talks...bull**** walks. Americans nowadays don’t give two cents about morals/ethics, it’s all about getting as much money as they can.

 

[Dr. Rude]

The amount of intellectual capacity dedicated to these ventures is astounding. Thousands of college entrants with Ivy League aspirations whose sole goal is to work at big law or big finance firm focusing their efforts making life miserable for the rest of us. This is what passes for an upstanding American these days.

“They don't mean to do harm; but the harm does not interest them. Or they do not see it, or they justify it because they are absorbed in the endless struggle to think well of themselves”

-T.S. Eliot

 

[aneftp]

Thats an insane discount. Considering how many practices they had.

Mednax made a lot of money. It’s the stockholders who took the real hit who purchase stock at the height.

Every ate the table in the game for 5 plus years Mednax executives who did stock options. Even the original sellers got mednax stocks which almost quadrupled in addition to their 1-2 million dollar per partner buyout.

Mednax was what usap is. And that’s the danger of usap. Only so many top of the cream practices left. Only usap couldn’t find an ipo price end of 2017. Usap will longer on for a couple more years. The shell “partner” game will be sold to junior people. But at the end of the day. Someone is taking a bite of the profits at usap. And we all know there is only so much profit that can me
made as labor costs go up and up.

 

[Anestheski]

Mednax made a lot of money. It’s the stockholders who took the real hit who purchase stock at the height.

Every ate the table in the game for 5 plus years Mednax executives who did stock options. Even the original sellers got mednax stocks which almost quadrupled in addition to their 1-2 million dollar per partner buyout.

Mednax was what usap is. And that’s the danger of usap. Only so many top of the cream practices left. Only usap couldn’t find an ipo price end of 2017. Usap will longer on for a couple more years. The shell “partner” game will be sold to junior people. But at the end of the day. Someone is taking a bite of the profits at usap. And we all know there is only so much profit that can me
made as labor costs go up and up.

What’s the deal with Napa then??

 

[GassYous]

Mednax made a lot of money. It’s the stockholders who took the real hit who purchase stock at the height.

Every ate the table in the game for 5 plus years Mednax executives who did stock options. Even the original sellers got mednax stocks which almost quadrupled in addition to their 1-2 million dollar per partner buyout.

Mednax was what usap is. And that’s the danger of usap. Only so many top of the cream practices left. Only usap couldn’t find an ipo price end of 2017. Usap will longer on for a couple more years. The shell “partner” game will be sold to junior people. But at the end of the day. Someone is taking a bite of the profits at usap. And we all know there is only so much profit that can me
made as labor costs go up and up.

The game is up. One of the original practices has a waiting list to leave.

 

[DesiredMemberName?]

Any word on what’s going on with NAPA at Inova Fairfax?

 

[amyl]

Mednax made a lot of money. It’s the stockholders who took the real hit who purchase stock at the height.

Every ate the table in the game for 5 plus years Mednax executives who did stock options. Even the original sellers got mednax stocks which almost quadrupled in addition to their 1-2 million dollar per partner buyout.

Mednax was what usap is. And that’s the danger of usap. Only so many top of the cream practices left. Only usap couldn’t find an ipo price end of 2017. Usap will longer on for a couple more years. The shell “partner” game will be sold to junior people. But at the end of the day. Someone is taking a bite of the profits at usap. And we all know there is only so much profit that can me
made as labor costs go up and up.

Just curious how you know so much about USAP and what market of USAP you are referring to? Do you work for USAP or a competitor? In what market? Private message me if you prefer -
USAP has no interest in going public -
I’m not sure where you get your information but it is contrary to what I know.

 

[amyl]

Let the private equity daisy chain continue!
Maybe KKR can add this dumpster fire to their collection
Long live capitalism.

What’s kkr?

 

[sevo00]

What’s kkr?

The PE firm that owns envision

 

[aneftp]

Just curious how you know so much about USAP and what market of USAP you are referring to? Do you work for USAP or a competitor? In what market? Private message me if you prefer -
USAP has no interest in going public -
I’m not sure where you get your information but it is contrary to what I know.

I know the original usap guys. U know as well as I know the original plan was for an end of 2017 ipo. You can spin it every way you want. Of course every usap structure is different these days as they morph into different local entities. But the mother ship plan was ipo and no market

It still the “best” deal in town for many usap practices but many of the guys have cut back significantly their hours.

 

[Howard888]

Absolutely agree on USAP. I also know some of the original guys and plan in 2017 was 100% ipo but price wasn’t there so they sold to other institutional investors.

Now with NSA, increasing labor costs, collapse of Mednax, now Napa -there is likely never to be an ipo as they will get less than what they value their stock internally -which is why the stock is a pyramid scheme. So amyl is not incorrect-no plans now because it can’t be done.

USAP done. Original owners of first 3-4 groups killed it, terrible deal for any new grads unless they give you the stock which only a couple USAP sites do.

For those late to the bandwagon-Colorado, Vegas, Austin, it’s a sinking ship with people leaving and new grads working so much harder than original partners did to pay off private equity

 

[amyl]

Not trying to spin it but most of those guys have gone. It’s not the same company. I wasn’t a partner in 2017 so I can’t speak to what their plans were. Lots of those same old guys thought they would hire people for 350….
They were wrong. They’re retired or retiring or at least listening to us younger people.
Because I’ve been put in charge of recruiting for my group we’ve completely revised our hiring practices, changed our compensation model and are doing things differently.
Maybe the rest of USAP hasn’t gotten the message but it has to start somewhere - here is not the USAP you speak of. They’re changing just not as quickly as I’d like… but I only have some control of my little piece of the action.

 

[amyl]

unless they give you the stock which only a couple USAP sites do

That’s not true - everyone who makes partner gets stock they don’t have to pay for.

Things have changed - Some of the information y’all have is dated

 

[dannyboy1]

Absolutely agree on USAP. I also know some of the original guys and plan in 2017 was 100% ipo but price wasn’t there so they sold to other institutional investors.

Now with NSA, increasing labor costs, collapse of Mednax, now Napa -there is likely never to be an ipo as they will get less than what they value their stock internally -which is why the stock is a pyramid scheme. So amyl is not incorrect-no plans now because it can’t be done.

USAP done. Original owners of first 3-4 groups killed it, terrible deal for any new grads unless they give you the stock which only a couple USAP sites do.

For those late to the bandwagon-Colorado, Vegas, Austin, it’s a sinking ship with people leaving and new grads working so much harder than original partners did to pay off private equity

These days it’s best to work for a salary. Simple, easy. How many hours for how much$

 

[aneftp]

That’s not true - everyone who makes partner gets stock they don’t have to pay for.

Things have changed - Some of the information y’all have is dated

The problem (and it’s not just usap). It’s the Ponzi scheme in general. The new people work x amount and give up 40%

The new people aren’t interested in working 60-65 plus hours. They want to work closer to 45-50 hours a week. But the “partners” want the new people to work more. Because the more they work. The more profit rolls into the partners who are just chilling and doing less work.

So ask yourself? Is the extra work hours/calls mandatory for new people? Yes or no? Because you aren’t a “team player” doing extra calls/working post call? Again. This isn’t just a usap thing.

Frankly. That’s why people would rather just take a standard w2 job with pretty set hours or whatever. Or just do 1099 work.

 

[amyl]

Agree. Which is why it’s in our contract (just to be clear I am speaking of my division of USAP - I’m not privy to others contracts) that call is shared equally and that partner track people are paid on production. Vacation lottery also equal.
There is no dumping on juniors or associates. Only differential in my group based on seniority is that you don’t have to take call anymore after 60 if you don’t want to.
Frankly I hope we are successful as other divisions are taking note and will hopefully follow suit.

 

[Howard888]

Fully agree and my information is not out to date. There are definitely USAP sites still requiring some form of stock purchase and paying even lower than 350 to start.

As you said you just control your pond. Glad you are..wish you could get the rest

 

[Twiggidy]

The problem (and it’s not just usap). It’s the Ponzi scheme in general. The new people work x amount and give up 40%

The new people aren’t interested in working 60-65 plus hours. They want to work closer to 45-50 hours a week. But the “partners” want the new people to work more. Because the more they work. The more profit rolls into the partners who are just chilling and doing less work.

So ask yourself? Is the extra work hours/calls mandatory for new people? Yes or no? Because you aren’t a “team player” doing extra calls/working post call? Again. This isn’t just a usap thing.

Frankly. That’s why people would rather just take a standard w2 job with pretty set hours or whatever. Or just do 1099 work.

Exactly.... all of this is just a version of the mafia. The people at the top want their "taste". We're just a bunch of Jackie Apriles ....not even Furios.

 

[amyl]

Idk where you get the 40% from?

 

[aneftp]

Idk where you get the 40% from?

Partners who work same hours as worker bees. So apple to apple comparison.

The worker bees generates 800k in revenue working an average of 65 hours a week. What do they actually take home? 450k-460k. And that’s with maybe 4 weeks of vacation

The partners who generates 800k in revenue will take home 640k but relies on the worker bee(s) to siphon and claw back the 20% private equity has taken.

So when Envison is offering 500k working 50-55 hours a week with 10 weeks of Vacation. That’s envision job is sounding a lot better.

I still think in areas where usap still offers profit sharing it’s still the best gig in town. But new grads don’t see it that way. What they see if “if I’m working 50 hours a week on new hire status”. And I’m only seeing 400k with 4 weeks. That 500k job with 10 weeks sounds much better. That new grad says. I gonna take an extra call each week and still give back so much to the partners and privacy equity. I’m only getting 60’cents on the dollar back.

 

[Twiggidy]

Partners who work same hours as worker bees. So apple to apple comparison.

The worker bees generates 800k in revenue working an average of 65 hours a week. What do they actually take home? 450k-460k. And that’s with maybe 4 weeks of vacation

The partners who generates 800k in revenue will take home 640k but relies on the worker bee(s) to siphon and claw back the 20% private equity has taken.

So when Envison is offering 500k working 50-55 hours a week with 10 weeks of Vacation. That’s envision job is sounding a lot better.

I still think in areas where usap still offers profit sharing it’s still the best gig in town. But new grads don’t see it that way. What they see if “if I’m working 50 hours a week on new hire status”. And I’m only seeing 400k with 4 weeks. That 500k job with 10 weeks sounds much better. That new grad says. I gonna take an extra call each week and still give back so much to the partners and privacy equity. I’m only getting 60’cents on the dollar back.

The difference is at some point the in the former example, the employee becomes a partner and reaps the benefit of being a partner, in the later, you're losing the 40% in perpetuity. Also, you better make sure that 50-55 hrs is in writing because you better believe that someone isn't going to be clocking you out if there are cases to be done and calls to be covered.

 

[marr65]

These days it’s best to work for a salary. Simple, easy. How many hours for how much$

Yep, if you aren’t a true partner then you are just an employee. You just got to be sure to get overtime pay over certain hours and make sure to define those hours in your contract.

 

[GravelRider]

The difference is at some point the in the former example, the employee becomes a partner and reaps the benefit of being a partner, in the later, you're losing the 40% in perpetuity. Also, you better make sure that 50-55 hrs is in writing because you better believe that someone isn't going to be clocking you out if there are cases to be done and calls to be covered.

Well in talking to some new grads they are thinking “is that piece of pie even going to be there when it’s my turn at the table?” With the way the dominoes have been falling lately, can you blame them? Why not take the sure thing now and just live in 2-5 year increments?

 

[aneftp]

The difference is at some point the in the former example, the employee becomes a partner and reaps the benefit of being a partner, in the later, you're losing the 40% in perpetuity. Also, you better make sure that 50-55 hrs is in writing because you better believe that someone isn't going to be clocking you out if there are cases to be done and calls to be covered.

That’s why I mention if usap partnership is still offered is still the best gig in town. But only up to a certain point.

If the calls are fair. Meaning equal

But often times. The new hires get stuck working a lot more. I know a couple Of new grads who left. They just said F this. Again. These are locally managed practices. There is no one glove fits all approach for these parent companies.

As for the clocking out approach. It depends. It’s fraud if someone clocks you out. It actually happen to a crna I knew. It did not end well for the parent company. They ended up losing a lot more money. 30 days of pay to make the problem go away. All over trying to save one hour of pay.

 

[Twiggidy]

That’s why I mention if usap partnership is still offered is still the best gig in town. But only up to a certain point.

If the calls are fair. Meaning equal

But often times. The new hires get stuck working a lot more. I know a couple Of new grads who left. They just said F this. Again. These are locally managed practices. There is no one glove fits all approach for these parent companies.

As for the clocking out approach. It depends. It’s fraud if someone clocks you out. It actually happen to a crna I knew. It did not end well for the parent company. They ended up losing a lot more money. 30 days of pay to make the problem go away. All over trying to save one hour of pay.

I agree with a lot of this. People are realizing it’s a service industry and just a job. We should all be inching towards mercenary mentality

 

[amyl]

Partners who work same hours as worker bees. So apple to apple comparison.

The worker bees generates 800k in revenue working an average of 65 hours a week. What do they actually take home? 450k-460k. And that’s with maybe 4 weeks of vacation

The partners who generates 800k in revenue will take home 640k but relies on the worker bee(s) to siphon and claw back the 20% private equity has taken.

So when Envison is offering 500k working 50-55 hours a week with 10 weeks of Vacation. That’s envision job is sounding a lot better.

I still think in areas where usap still offers profit sharing it’s still the best gig in town. But new grads don’t see it that way. What they see if “if I’m working 50 hours a week on new hire status”. And I’m only seeing 400k with 4 weeks. That 500k job with 10 weeks sounds much better. That new grad says. I gonna take an extra call each week and still give back so much to the partners and privacy equity. I’m only getting 60’cents on the dollar back.

Come interview with us. These are not our numbers at all. Our package is much much better than 400 and 4 weeks vacation.

 

[amyl]

Fully agree and my information is not out to date. There are definitely USAP sites still requiring some form of stock purchase and paying even lower than 350 to start.

As you said you just control your pond. Glad you are..wish you could get the rest

Well my pond listened to me, I wouldn’t go so far as to say I control it ;-) the men are still in charge - I don’t really have any ambition to control anything but when it looks broke to me I’m going to try to fix it. The docs I work with are the best
I hear colorado is all hired up. Well at least The Denver area - they pay a high percentage of production (last I checked) for the two year track. I am told that worked and they’ve hired a ton of physicians. Denver is doing well from what I hear.
Idk what’s going on in Florida or Seattle
Or the mid Atlantic - Despite us being a “national” company lots of USAP is run very locally. We are a bunch of groups. If anyone has Information or constructive criticism of USAP in other markets DM me. Im all ears- would like to change it for the better in any way I can

 

[Howard888]

We just hired a person from Colorado. Still short and apparently some USAP docs broke off, took some ASCs, and are now getting legal at them by USAP. It’s not what you are making it out to be. And everyone on here knows USAP Austin/Central pays less than 300 to start, 3 years, and s stick purchase. That’s your neighbor

Also I really hope you aren’t talking about paying people by “production” meaning based on units produced then some percentage of that.

That’s the oldest, biggest scam unless you can equally distribute commercial orthopedic cases amongst everyone in the group-which is almost impossible.

This was a scam because older partners cherry picked the highest unit producing cases and/or commercial cases from new grads.

Anesthesia billing dictates you can not have an equal group paying people on production if that means units or revenue.

The truly fair/equal anesthesia groups pay based on time. Put all the revenue/units in a pot and distribute based on hours worked.

I really really hope you aren’t talking a revenue/unit production based system.

 

[aneftp]

We just hired a person from Colorado. Still short and apparently some USAP docs broke off, took some ASCs, and are now getting legal at them by USAP. It’s not what you are making it out to be. And everyone on here knows USAP Austin/Central pays less than 300 to start, 3 years, and s stick purchase. That’s your neighbor

Also I really hope you aren’t talking about paying people by “production” meaning based on units produced then some percentage of that.

That’s the oldest, biggest scam unless you can equally distribute commercial orthopedic cases amongst everyone in the group-which is almost impossible.

This was a scam because older partners cherry picked the highest unit producing cases and/or commercial cases from new grads.

Anesthesia billing dictates you can not have an equal group paying people on production if that means units or revenue.

The truly fair/equal anesthesia groups pay based on time. Put all the revenue/units in a pot and distribute based on hours worked.

I really really hope you aren’t talking a revenue/unit production based system.

No easy solution. While paying based on time in theory is the more equitable. Not all time is equals.

Depending on acuity of the cases. Plus the dreaded ob beeper calls. If not in house but not getting credit for time since no epidural running.

 

[GassYous]

We just hired a person from Colorado. Still short and apparently some USAP docs broke off, took some ASCs, and are now getting legal at them by USAP. It’s not what you are making it out to be. And everyone on here knows USAP Austin/Central pays less than 300 to start, 3 years, and s stick purchase. That’s your neighbor

Also I really hope you aren’t talking about paying people by “production” meaning based on units produced then some percentage of that.

That’s the oldest, biggest scam unless you can equally distribute commercial orthopedic cases amongst everyone in the group-which is almost impossible.

This was a scam because older partners cherry picked the highest unit producing cases and/or commercial cases from new grads.

Anesthesia billing dictates you can not have an equal group paying people on production if that means units or revenue.

The truly fair/equal anesthesia groups pay based on time. Put all the revenue/units in a pot and distribute based on hours worked.

I really really hope you aren’t talking a revenue/unit production based system.

Not just that but there's a waiting list to leave. Stuck for one year rather than 90 day notice or whatever. And still have to cover the cases.

 

[Mman]

My take home on what has happened with Napa compared to Mednax. I gathered all this from friends that have worked for both as well as talking with hospital administrators that have dealt with both.

Mednax main idea was to buy out super profitable practices and let them just keep running themselves however they wanted as long as it remained profitable. Everybody wins. Hospitals are happy because they are interacting with the same people they always have and docs are happy because nobody telling them how to run their practice.

NAPA takes over. NAPA wants to wring out as much profit as they can. They handicap docs ability to make decisions on the ground. Hospital administrators don't even know who to talk to when problems arise and have literally never met anyone from NAPA even months after the switch. Docs not happy because they are getting screwed more and more, hospitals not happy because the model is falling apart and nobody at NAPA is even available to try to fix it.

Literally the only thing keeping any of the NAPA places afloat is the noncompetes. That's basically it.

 

[Dr. Rude]

My take home on what has happened with Napa compared to Mednax. I gathered all this from friends that have worked for both as well as talking with hospital administrators that have dealt with both.

Mednax main idea was to buy out super profitable practices and let them just keep running themselves however they wanted as long as it remained profitable. Everybody wins. Hospitals are happy because they are interacting with the same people they always have and docs are happy because nobody telling them how to run their practice.

NAPA takes over. NAPA wants to wring out as much profit as they can. They handicap docs ability to make decisions on the ground. Hospital administrators don't even know who to talk to when problems arise and have literally never met anyone from NAPA even months after the switch. Docs not happy because they are getting screwed more and more, hospitals not happy because the model is falling apart and nobody at NAPA is even available to try to fix it.

Literally the only thing keeping any of the NAPA places afloat is the noncompetes. That's basically it.

Agree. But the reason this is happening is that in general NAPA jobs are below average. So those who have the ability to leave do so. Those who choose not to leave lower their effort down to the bare minimum of their contractual requirements and lose the hustle and race each other to the door. Had the shortage of anesthesia personnel not occurred or if there was a glut, the NAPAs of the world would be doing fine.

 

[thinkorswim]

Well in talking to some new grads they are thinking “is that piece of pie even going to be there when it’s my turn at the table?” With the way the dominoes have been falling lately, can you blame them? Why not take the sure thing now and just live in 2-5 year increments?

This sentiment cannot be overstated. The younger generation is coming out onto a landscape where they feel sold out by the older guys, coupled with a very uncertain future for reimbursement and employment model. Although they are just starting to earn a decent income, they find themselves farther behind the curve than those before them, with buying a house being more difficult than ever. You can’t fault them for valuing a higher income earlier in their career. This is one of the reasons the traditional partnership buy in is dying a slow death in my opinion.