Waiting list to leave is funny. Here’s your 90 day notice. Accept it or fire me today.
Nope- We pool our units and pay 100% on time - I didn’t mean production as in units generated - I meant production as in you work more you make more… rather than be the salaried and stuck in the OR for nothing about extra.
Well……sort of. Even time based systems aren’t completely fair, but edge toward equal somewhat. One person’s 5 hr AAA isn’t equal to the person’s 3 appys that total 5 hrs, as far as intensity of cases done for the same money
Usually when the original partners sell out. They gotta stay x amount of years. Plus the non compete radius
At some point, the circle does come to an end. Just like crypto had its run and has come to a grinding halt, so will private equity in anesthesia practices. There simply isn't enough value left to be stripped and costs to be cut, while providing 15% annual returns to investors. Eventually the returns simply are not there and private equity will exit this market. Hopefully we are getting to that point here shortly with USAP and NAPA having their troubles.
Interesting. So what’s the future for NAPA given that they’ve been fired recently from a number of hospitals? And what’s going to replace it-direct hospital employment?
Napa is basically a glorified staffing company with no physical assets. They won’t own physical buildings that operate asc or hospitals. Maybe they do own or lease a corporate building. But that’s about it in terms of assets.
Do you see W2 hospital employment better than an AMC? Also, If an AMC like NAPA cares about its investors I wouldn’t think they’d want to be fired from a bunch of hospitals even though they have no overhead.
Remember being employed by a hospital means just that. You do they case they want you to do. You cover the supervision ratio they want you to cover. They hire, they fire, and they pay you what the CFO says is ok to keep the books balanced. Not sure I can argue whether it's better or not.
Nothing is perfect.
This is just one of the many examples of how American capitalism is failing. It has become a corrupt farce that rewards inefficiency and failure while not actually contributing to any improvement in the system. I hope they all crash and burn but I know it will never happen.
How much lower is your income ceiling than it was before? In my neck of the woods that mid 300s partnership track salary only ended up in the mid 400s you’re starting at, maybe low 500s, so the break even point versus a salaried job was 5-10 years from the start date. In an environment where groups fold every few months that’s a risky bet with a limited payoff and a tough sell to people with loans to pay.
It's sad that a societally admirable path is one into finance, banking, consulting, and PE. I remember all too many of my high school and college classmates wanting to go into finance and the like... all the fancy recruiting presentations, spiffy websites, and the lure of money with an important job seem to be a big draw. Who wouldn't want a glamorous lifestyle with a nebulous yet important-seeming job?
My personal anecdote was at a wedding between two finance people, one of whom was a hedge fund manager. I sat at the “poor table” that had 8 people at it, 5 of whom were MDs. I listened to the small talk between all the hedge fund, PE and finance guys and I could believe how they openly discussed things that likely qualified as fraud. One was talking about how his fund unloaded a huge financial loss by moving it to a different division. Another was talking about how his series A funding was closed and how he basically took a huge cut and he didn’t care what happened after that. It was really eye opening; so much money and people flaunting their wealth but not really doing anything to benefit society.
Yes - certainly.
Some practices will reimburse for these types of things. You may can't fly first class and stay at the Four Season or if you don't you may only get like 1/4 of it reimbursed. Better than nothing, but yes, nothing compared to the all expense paid trips business folks get.
When you say hospital W2 is $500k, how many hours a week are you talking? These AMCs sound like they typically require 65 hours a week which is insane.
So what do you do if there is a shortfall or a windfall?
This was the best part of our group switching to salaried. I don't have to worry about busting to get my numbers. I get paid what I get paid. From my experience there are many more shortfalls that the hospital eats than windfalls I would be losing out on.
Bingo. That’s why hospitals loath to employ anesthesia as w2 employees. When you think about it. Weekend and after 5pm cases are highly inefficient. But surgeons and gi doctors want to do it around their office hours.
I get it, the way it was phrased didn’t seem to make that point clearly.
It is partly the older guys but mostly the organizations like the AMA who havent been fighting for the profession. They allowed medicare and government to get a hold of medicine and now they are burying us with yearly reimbursement cuts significantly, more regulations, steeper hoops to jump through, mandates, EMR requirements where it just simply isn't feasible to be a small independent shop doing good by every patient you meet without drowning in these regulations. This is why every group sold out if they could.
So far in my short attending career, I've worked in academics. So, I've been wondering how people learn how many units each case is worth. Is there a table you have easy access too, or do you just a feel for it over time?
Where is this?
To each their own, I guess. Sounds more like a group of individuals who happen to work in the same building than a group of partners, but ... to each their own.
To each their own, I guess. Sounds more like a group of individuals who happen to work in the same building than a group of partners, but ... to each their own.
i mean, i think a lot of places sell the "partnership" thing but reality they are a bunch of individuals who work in the same building. I'm sure some people will reply how at their gig they have weekly poker nights and go on ski trips together, but i honestly feel like those are outliersTo each their own, I guess. Sounds more like a group of individuals who happen to work in the same building than a group of partners, but ... to each their own.
To each their own, I guess. Sounds more like a group of individuals who happen to work in the same building than a group of partners, but ... to each their own.
Pooled units with time-based compensation (work more, get more; work less, get less) is the most fair system imho even knowing it is also not perfect. as i said elsewhere, six hours of a AAA doesn't equal six hours of ureteroscopies, or six hours of OB, but it's probably as close to get as fair if everyone is doing all the same cases distributed is some almost random fashion. Any introduction of a human decision is when things skew to the unfair
the increased costs of healthcare typically comes from the large $ value due to the interplay between commercial insurance and hospital billing.
