NAPA pulls out of WB and Scranton hospitals.

[Arch Guillotti]

Easy. One doc on vacation. One doc works post call (peels out early). Doc probably beeper call from home light call back. Two docs there all day.

17 Crnas usually means only 11-12 working daily. Post call OB crna. 3 crnas on vacation.
So 3 docs covering 10-12 locations routinely. OB crna essentially independent except c/s.

I am not sure how likely it is you are going to be peeling out early if you are running 10-12 locations. More like you will be working post call and probably miserable.

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[kidthor]

garbage

Garbage indeed.

 

[sevoflurane]

not in a million years.

 

[IlDestriero]

You can get $220 an hour to do vaca coverage at a sleeper group. This is a disaster in a crap location. Good luck.

 

[anbuitachi]

sounds like NAPA got the crap end of the deal?

 

[deleted126335]

sounds like NAPA got the crap end of the deal?

Maybe because the other party is allegedly reneging on the agreement.


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[kmurp]

I am not sure how likely it is you are going to be peeling out early if you are running 10-12 locations. More like you will be working post call and probably miserable.

Perhaps the post call doc leaves and NAPA just bills the entire amount under the CRNA?

 

[deleted126335]

Aug. 1 was supposed to be the drop dead date. Anybody know current status?

 

[IMGASMD]

they’re still hiring for locum and eventually perm.

 

[amyl]

[QUOTE="IMGASMD, post: 21957404, member: 826459"
It’s the same play book by NAPA/Mednax/Envision/Premier/USAP/AMC, don’t think they really have any other tricks, but why are they still expanding Sigh.
[/QUOTE]
Is it me or does this seem to be changing? Mednax is dwindling, envision on the verge of bankruptcy and just lost Phoenix, not familiar with AMC....
anyone think that this may be the end of the large anes management companies? What’s next- hospital employee? Different amcs? Kaiser model for insurance companies to take over? Thoughts.....?

 

[anbuitachi]

there was a post on FB, about how NAPA and Northwell health system now are having non competes on the institutional level. So even though the employee isnt shown a non compete necessarily on the contract, the institution will still be applying for it..

Unclear of the legitimacy of this claim. But i have a feeling its true

 

[IMGASMD]

[QUOTE="IMGASMD, post: 21957404, member: 826459"
It’s the same play book by NAPA/Mednax/Envision/Premier/USAP/AMC, don’t think they really have any other tricks, but why are they still expanding Sigh.

Is it me or does this seem to be changing? Mednax is dwindling, envision on the verge of bankruptcy and just lost Phoenix, not familiar with AMC....
anyone think that this may be the end of the large anes management companies? What’s next- hospital employee? Different amcs? Kaiser model for insurance companies to take over? Thoughts.....?[/QUOTE]

Mednax is not longer in play, right? So NAPA and all these smaller ones. Maybe they will all learn from Mednax, there is something wrong with the model.

Maybe it’s just a intrinsic flow to how anesthesia bills.

 

[deleted126335]

they’re still hiring for locum and eventually perm.

So I guess the docs that were working for NAPA in Northeast PA are SOL?

 

[amyl]

Mednax is not longer in play, right? So NAPA and all these smaller ones. Maybe they will all learn from Mednax, there is something wrong with the model.

Maybe it’s just a intrinsic flow to how anesthesia bills.
[/QUOTE]

Envision too, right? Mednax is done from what I’ve heard. Envision is likely next. Napa seems to be having trouble recruiting. Somnia still around? USAP expanding it seems. Anyone hear what’s becoming of all the envision contracts ?

 

[dannyboy1]

there was a post on FB, about how NAPA and Northwell health system now are having non competes on the institutional level. So even though the employee isnt shown a non compete necessarily on the contract, the institution will still be applying for it..

View attachment 314540

Unclear of the legitimacy of this claim. But i have a feeling its true

If this is true that is essentially the definition of collusion. Would love to see this go to court...

 

[IMGASMD]

So I guess the docs that were working for NAPA in Northeast PA are SOL?

Feels like NAPA will uphold their noncompete.

 

[deleted126335]

If this is true that is essentially the definition of collusion. Would love to see this go to court...

Not sure that is true. I was under three non competes (that I knew about) at a previous job with a private group.

1. I signed a non compete with my employer preventing me from working at the hospital My group provided service at or any hospital within a certain radius.

2. Our group signed a non compete with the hospital where we worked preventing the group from working within a certain geographic radius.

3. As a condition of employment with my group I was required to sign an individual non compete wit the hospital system we worked at preventing me from working within a certain geographic radius.

 

[cowbydoc]

Has anybody had experience changing jobs with a noncompete in a state that doesn’t allow them? I know Delaware, Colorado and Massachusetts do not enforce noncompetes against physicians.

 

[dannyboy1]

Not sure that is true. I was under three non competes (that I knew about) at a previous job with a private group.

1. I signed a non compete with my employer preventing me from working at the hospital My group provided service at or any hospital within a certain radius.

2. Our group signed a non compete with the hospital where we worked preventing the group from working within a certain geographic radius.

3. As a condition of employment with my group I was required to sign an individual non compete wit the hospital system we worked at preventing me from working within a certain geographic radius.

The difference is that YOU signed the non compete and it is considered part of what you are giving to the employer in exchange for a benefit (usually the signing bonus ). It’s another thing entirely when your current employer ( in this case northwell) colludes with another entity to exclude you from the market if you would leave...

 

[Zekchar]

The difference is that YOU signed the non compete and it is considered part of what you are giving to the employer in exchange for a benefit (usually the signing bonus ). It’s another thing entirely when your current employer ( in this case northwell) colludes with another entity to exclude you from the market if you would leave...

Agreed. It sounds very shady and unethical. More importantly (as a non-lawyer) it sounds illegal. It's akin to blacklisting, which if proven is a major penalty and has severe consequences.

As for the greater Envision, Mednax, NAPA, Somnia, USAP picture, I think it comes down to the numbers. Market returns are ~10% with 8% real after inflation. Private equity, which is backing all these entities demands a premium for the lack of liquidity. If you are to give up capital for 5-10 years, you are expecting %12-15 and up returns. As stretched as medicine is and with so many hands in the pot, it is likely that those margins to appease investors simply isn't there. These entities continue to squeeze as much as they can, but the juice has run out. A reckoning is hopefully coming and private equity will be chased out of the picture. At that point my hope is that it goes back to small groups, W2 employment, or hospital system employment.

 

[amyl]

perhaps whats next to follow AMCs will be the kaiser model. I've heard gossip about united health care making a play for envision... but its just gossip. I have a friend who works for kaiser - i think shes underpaid but she seems to be happy. Wouldnt be dumb for united to undercut its rates, renege on its deals, to put itself in a better position to buy up. any thoughts?

 

[GassYous]

People seem to like kaiser because the pay is reasonable and the hours are predictable.

 

[skypilot]

Has anybody had experience changing jobs with a noncompete in a state that doesn’t allow them? I know Delaware, Colorado and Massachusetts do not enforce noncompetes against physicians.

Non compete agreements are specifically prohibited for physicians in many northeastern states except if the practice is sold. Should be the law everywhere.

 

[deleted126335]

Non compete agreements are specifically prohibited for physicians in many northeastern states except if the practice is sold. Should be the law everywhere.

Varies hugely by state. Even within states.

 

[skypilot]

Varies hugely by state. Even within states.

Yes it does. Every state should copy Massachusetts and render void any non-compete for Physicians.

Massachusetts was an early adopter, in 1977, of a statutory prohibition on physician non-competes. Mass. Gen. Law Ch. 112 § 12X renders void any non-compete provision restricting “the right of a physician to practice medicine in a particular locale and/or for a defined period of time.”

In the early 1980s, Delaware and Colorado enacted similar laws. 6 Del. Code Ann. § 2707; Colo. Rev. Stat. § 8-2-113.[1] In 2016, Rhode Island followed suit and enacted a law just like Massachusetts’ statute. R.I. Gen. Laws §5-37-33.

 

[Zekchar]

People seem to like kaiser because the pay is reasonable and the hours are predictable.

I interviewed at several California Kaiser spots before accepting my current position. The Walnut Creek Kaiser was offering ~300k for ~45-50hrs/week of work and some call coverage. The real benefit was the pension plan. I remember that it was something along the lines of 2% increase per year up to 50% of final 3 years pay or so. In other words, if you stayed at Kaiser for 25 years and retired at age 55 (30 yr at start + 25 years at Kaiser) you would have a pension of ~150k in perpetuity. I remember thinking that it was a good gig but that the salary was fairly low considering the very high cost of living and high tax burden in California. I can see both the pros and cons of such a contract, but it wasn't the right situation for me.

 

[deleted126335]

I interviewed at several California Kaiser spots before accepting my current position. The Walnut Creek Kaiser was offering ~300k for ~45-50hrs/week of work and some call coverage. The real benefit was the pension plan. I remember that it was something along the lines of 2% increase per year up to 50% of final 3 years pay or so. In other words, if you stayed at Kaiser for 25 years and retired at age 55 (30 yr at start + 25 years at Kaiser) you would have a pension of ~150k in perpetuity. I remember thinking that it was a good gig but that the salary was fairly low considering the very high cost of living and high tax burden in California. I can see both the pros and cons of such a contract, but it wasn't the right situation for me.

Lots of pension plans look like empty promises currently.

 

[kidthor]

Lots of pension plans look like empty promises currently.

Yeah I'd be wary of any non-government issued pension - it might not really come to fruition. But of all places Kaiser is most likely to be around when folks retire.