Napa

[TheLoneWolf]

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Anyone recently worked or currently working for Napa and care to share their experiences?

PP>AMC for sure but an interesting opportunity came up.

Routinely 1:4 supervision or QZ 1:6ish?

 

[IMGASMD]

Anyone recently worked or currently working for Napa and care to share their experiences?

PP>AMC for sure but an interesting opportunity came up.

Routinely 1:4 supervision or QZ 1:6ish?

If they can(can’t staff 1:4) they will do QZ.
You’ll feel less valuable, because they actually will treat their cRNas better than you.
At the same time, if they’re the only game in town, or has big presence, you’re stuck.

Their contract is vague, especially if there is something that they need.

But everyone will say, every market is different.

Good luck.

 

[kidthor]

That all sounds absolutely awful.

 

[aneftp]

Napa paying w2 650k-700k in New York. But the peeps they’re working hard. 60-65 hours a week for it.

Lots of overtime.

My buddy does locums up there and thats what the w2 guys are making.

It’s a lot of work 65 hours so not a Cush job.

 

[IMGASMD]

Napa paying w2 650k-700k in New York. But the peeps they’re working hard. 60-65 hours a week for it.

Lots of overtime.

My buddy does locums up there and thats what the w2 guys are making.

It’s a lot of work 65 hours so not a Cush job.

Some of those maybe volunteered time to a certain degree. But at some point you’re so short and tired you just can’t.
You have some obligations to the hospital, you have to cover what Napa and the hospital agree upon. You’ll feel pressure from both napa (regional head honcho) and the hospital. They will try to staff as much as they can with locums, but you just won’t have any stability…..

To op: there are many discussions about AMCs. In general they are all the same. Their goal, just like any other corporation, is to make money.


There are some discussion on AMCs and Hospital employment positions. At the end of the day, you’d have to do what’s best for you and your family.

 

[jwk]

Only one left out of the original three here in Atlanta.

 

[Howard888]

Whatever you do don’t sign a non compete. Seems like they are losing a system every quarter. Inova Fairfax last quarter, Raleigh this quarter. Reno, NJ before that…pattern continues

 

[Southpaw]

Whatever you do don’t sign a non compete. Seems like they are losing a system every quarter. Inova Fairfax last quarter, Raleigh this quarter. Reno, NJ before that…pattern continues

Need more details please. Are Inova Fairfax and Raleigh going private or hospital employed?

 

[narcusprince]

Napa paying w2 650k-700k in New York. But the peeps they’re working hard. 60-65 hours a week for it.

Lots of overtime.

My buddy does locums up there and thats what the w2 guys are making.

It’s a lot of work 65 hours so not a Cush job.

I work for NAPA now. Im happy with my pay/contract. Always time to make more money. If you want a cushy job their are some locations that are more cushy. Im in a selfish get it before its gone phase.

 

[anbuitachi]

I work for NAPA now. Im happy with my pay/contract. Always time to make more money. If you want a cushy job their are some locations that are more cushy. Im in a selfish get it before its gone phase.

What do people make there? 700k+. is it 10% salary for retirement?

 

[IMGASMD]

What do people make there? 700k+. is it 10% salary for retirement?

One offer that I know of, they didn’t offer more than 5% of the base. Also there’s a vesting period.

 

[sbmed100]

Lots of variability. I'm at a primarily MD only place. Hours are dependent on the OR volume. Anywhere from 35 hours a week to 55 hours a week over the last year. Find a practice with strong local leadership, that's what matters really - whether AMC employed, hospital employed or (yikes) an academic practice. My buddies in private practice are really struggling now cause labor costs have gone up while revenue has decreased from the no surprises act.

 

[dabears505]

I do prn work with NAPA and have been extremely happy with them. Pay a very fair wage. Excellent benefits compared to a lot of private groups. Hours are reasonable, and if they are not you are usually compensated for extra hours.

Obviously some downsides like being understaffed, but these days it's unstable at most practices.

As a new grad in this day and age, would def join napa instead of a private group on a partnership .

 

[narcotics999]

I do prn work with NAPA and have been extremely happy with them. Pay a very fair wage. Excellent benefits compared to a lot of private groups. Hours are reasonable, and if they are not you are usually compensated for extra hours.

Obviously some downsides like being understaffed, but these days it's unstable at most practices.

As a new grad in this day and age, would def join napa instead of a private group on a partnership .

You get benefits for prn work?

 

[aneftp]

Lots of variability. I'm at a primarily MD only place. Hours are dependent on the OR volume. Anywhere from 35 hours a week to 55 hours a week over the last year. Find a practice with strong local leadership, that's what matters really - whether AMC employed, hospital employed or (yikes) an academic practice. My buddies in private practice are really struggling now cause labor costs have gone up while revenue has decreased from the no surprises act.

Agreed. People think true private practices places are the gold standard. They are not at many facilities these days.

It’s a pain with insurance reimbursement. The smaller practice have less negotiating leeway.

My sister is at true private and they may abandon their practice and just keep their surgery center which is more lucrative. And they are around 45% commercial combined (65% at one hospital and 35% at the bigger hospital) (both hospitals owned by same system) plus surgery centers

They say their employees MDs cost them more and more with labor cost. Primarily 90% MD only practice unless at surgery center. The top guys makes 1-1.2 million but work 70 plus hours a week. Doing 2 weekends a momthb

Most of the partners make 700k-750k but it’s 60 plus hours a week also. No easy money even in private world.

So you can make decent money with Napa at a more guaranteed rate with overtime

The only way Napa can pay this is because someone else is forking over the money. They aren’t generous. The way it works is Napa strong arms hospital’s administration to fork over
The extra overtime/duties to w2 and locums docs.

Napa isn’t losing a dime on paying you extra. That’s how they work.

It’s a huge problem at many hospitals. Hospitals administrators are saying wtf but sometimes they don’t have a choice if they want to keep the OR running. So hospital administrators fork over the money Donald trumps/stormy Daniel’s stripper style in hush money and it’s perfectly legal. What hospital admin pays Napa for extra pay is the same as trump paying strippers. And some of these hospitals are partially taxpayer funded via taxing revenue generated by local and county taxes.

Lol. I love to throw shade comparing what’s being done to trump is the same thing that happens in real world hospitals payments to these AMCs

 

[IMGASMD]

Agreed. People think true private practices places are the gold standard. They are not at many facilities these days.

It’s a pain with insurance reimbursement. The smaller practice have less negotiating leeway.

My sister is at true private and they may abandon their practice and just keep their surgery center which is more lucrative. And they are around 45% commercial combined (65% at one hospital and 35% at the bigger hospital) (both hospitals owned by same system) plus surgery centers

They say their employees MDs cost them more and more with labor cost. Primarily 90% MD only practice unless at surgery center. The top guys makes 1-1.2 million but work 70 plus hours a week. Doing 2 weekends a momthb

Most of the partners make 700k-750k but it’s 60 plus hours a week also. No easy money even in private world.

So you can make decent money with Napa at a more guaranteed rate with overtime

The only way Napa can pay this is because someone else is forking over the money. They aren’t generous. The way it works is Napa strong arms hospital’s administration to fork over
The extra overtime/duties to w2 and locums docs.

Napa isn’t losing a dime on paying you extra. That’s how they work.

It’s a huge problem at many hospitals. Hospitals administrators are saying wtf but sometimes they don’t have a choice if they want to keep the OR running. So hospital administrators fork over the money Donald trumps/stormy Daniel’s stripper style in hush money and it’s perfectly legal. What hospital admin pays Napa for extra pay is the same as trump paying strippers. And some of these hospitals are partially taxpayer funded via taxing revenue generated by local and county taxes.

Lol. I love to throw shade comparing what’s being done to trump is the same thing that happens in real world hospitals payments to these AMCs

I was thinking, everything is well said…. Until WTF, how did Trump enter the conversation?! [emoji1787]

 

[jwk]

Hospitals administrators are saying wtf but sometimes they don’t have a choice if they want to keep the OR running.

This is it in a nutshell.

 

[anbuitachi]

my area has a lot of napa. one thing i do appreciate is they indirectly cause anesthesiologist to be paid a slightly fairer wage . they are big employers here and they drive market up. house admin not happy because they want minimum wage for 24/7 work and NAPA is coming in here demanding stipends. there is benefit to having a collecting negotiating unit.

but napa is getting kicked out in many areas here. unclear how market will behave in the future

 

[sbmed100]

This is it in a nutshell.

Exactly. The anesthesia piece is such a small piece of the pie in the context of overall surgical services revenue.

 

[IMGASMD]

Exactly. The anesthesia piece is such a small piece of the pie in the context of overall surgical services revenue.

They have to “show” they did something to justify their existence.

 

[deleted643396]

Agreed. People think true private practices places are the gold standard. They are not at many facilities these days.

It’s a pain with insurance reimbursement. The smaller practice have less negotiating leeway.

My sister is at true private and they may abandon their practice and just keep their surgery center which is more lucrative. And they are around 45% commercial combined (65% at one hospital and 35% at the bigger hospital) (both hospitals owned by same system) plus surgery centers

They say their employees MDs cost them more and more with labor cost. Primarily 90% MD only practice unless at surgery center. The top guys makes 1-1.2 million but work 70 plus hours a week. Doing 2 weekends a momthb

Most of the partners make 700k-750k but it’s 60 plus hours a week also. No easy money even in private world.

So you can make decent money with Napa at a more guaranteed rate with overtime

The only way Napa can pay this is because someone else is forking over the money. They aren’t generous. The way it works is Napa strong arms hospital’s administration to fork over
The extra overtime/duties to w2 and locums docs.

Napa isn’t losing a dime on paying you extra. That’s how they work.

It’s a huge problem at many hospitals. Hospitals administrators are saying wtf but sometimes they don’t have a choice if they want to keep the OR running. So hospital administrators fork over the money Donald trumps/stormy Daniel’s stripper style in hush money and it’s perfectly legal. What hospital admin pays Napa for extra pay is the same as trump paying strippers. And some of these hospitals are partially taxpayer funded via taxing revenue generated by local and county taxes.

Lol. I love to throw shade comparing what’s being done to trump is the same thing that happens in real world hospitals payments to these AMCs

At least Trump probably got some kinky sex action out of the deal.

 

[DesiredMemberName?]

They say their employees MDs cost them more and more with labor cost. Primarily 90% MD only practice unless at surgery center.

Is this one of those practices that “doesn’t offer partner track positions?”

It’s one thing to pay someone less because they want part-time work or aren’t interested in partnership, but there are plenty of practices where partner track is not even an option. The partners at these practices have been leeching/profiting off other physicians’ work for years. Does anyone have any sympathy for them?

 

[DesiredMemberName?]

I will also add that the same market forces that are allowing NAPA and other AMCs to command increased stipends from the hospital allow private groups to do the same.

If anything, the private group can make a better argument that the money is going to recruit and retain talent that benefits the hospital because there are no outside investors with their hands in the pie.

 

[aneftp]

Is this one of those practices that “doesn’t offer partner track positions?”

It’s one thing to pay someone less because they want part-time work or aren’t interested in partnership, but there are plenty of practices where partner track is not even an option. The partners at these practices have been leeching/profiting off other physicians’ work for years. Does anyone have any sympathy for them?

No, it's the most fair group. 35 true equal partners. They bill per minute on the seat. The most equal way in terms of hours worked. OB is different beast but it's also MD only 2 year partnership track. Everyone works hard. None of this 1:3/4 ACT models where seniors partners make 1 million working 40 hours a week and take monday-thursday calls . While the junior partenrs and employees work weekend calls and make half as much.

You will be working hard at my sister practice. Employees do not take calls.

 

[sanityonleave]

At least Trump probably got some kinky sex action out of the deal.

I bet NAPA would be quite happy to f*** you if they got an extra buck for it.

 

[Southpaw]

I will also add that the same market forces that are allowing NAPA and other AMCs to command increased stipends from the hospital allow private groups to do the same.

If anything, the private group can make a better argument that the money is going to recruit and retain talent that benefits the hospital because there are no outside investors with their hands in the pie.

Were I the hospital I’d demand to see an increased recruitment package for new hires as opposed to just splitting the money among the partners, which is what plenty of private groups would do.

 

[Hoya11]

Were I the hospital I’d demand to see an increased recruitment package for new hires as opposed to just splitting the money among the partners, which is what plenty of private groups would do.

IME hospitals don’t like to give out big bucks to small private groups. They prefer big corporations that their system is in cahoots with , like NAPA.

Most of the time the private group is understaffed overworked and underpaid from the hospital mismanaging the surgical services. And then when money is given now they are going to harass the private group to “make sure it’s going to good use” - god forbid the current doctors get a pay raise and more time off ..

 

[IMGASMD]

IME hospitals don’t like to give out big bucks to small private groups. They prefer big corporations that their system is in cahoots with , like NAPA.

That’s what I’ve seen too. They think they get a great deal from napa, until nothing gets covered or all covered by locums. [emoji3526]

 

[Hoya11]

That’s what I’ve seen too. They think they get a great deal from napa, until nothing gets covered or all covered by locums. [emoji3526]

I think it will lead to a trend of more directly hospital employed jobs once they kick NAPA out and have destroyed the private group .

 

[PeterGriffin]

I think it will lead to a trend of more directly hospital employed jobs once they kick NAPA out and have destroyed the private group .

I feel like that is definitely the end game.

 

[IMGASMD]

I feel like that is definitely the end game.

I sure hope the hospitals at some point will just accept paying for anesthesia is part of doing business…. Leave the anesthesia department alone. Give the damn stipend and move on. Why be in the business of managing doctors??

I would love to know if anyone knows any hospital gave the anesthesia contract back to a private group. [emoji1744]

 

[Southpaw]

I would love to know if anyone knows any hospital gave the anesthesia contract back to a private group. [emoji1744]

I’ve seen this happen.

 

[Southpaw]

Whatever you do don’t sign a non compete. Seems like they are losing a system every quarter. Inova Fairfax last quarter, Raleigh this quarter. Reno, NJ before that…pattern continues

So I can’t speak to Inova Fairfax (though I am curious how things panned out) but I am hearing ECAA (a private group) is taking over for NAPA in Raleigh.

 

[IMGASMD]

I’ve seen this happen.

Wow. That would be some story to tell…. It was probably like any other day at the hospital. (I am romanticizing it)

Wonder how many of the original partners were still around…. And how do they fare now?

 

[Southpaw]

Wow. That would be some story to tell…. It was probably like any other day at the hospital. (I am romanticizing it)

Wonder how many of the original partners were still around…. And how do they fare now?

Well Reno sold to American Anesthesia I believe. NAPA took over. NAPA couldn’t deliver, hospital wanted them out, and hospital supported the guys to go private again. I don’t know how many originals were still there but I imagine plenty.

I don’t know what Raleigh was before American Anesthesia, but now that NAPA is out, ECAA is taking them private again.

I’m curious about Inova Fairfax. They were a private group (and a great one at that) before they sold to American.

 

[IMGASMD]

Well Reno sold to American Anesthesia I believe. NAPA took over. NAPA couldn’t deliver, hospital wanted them out, and hospital supported the guys to go private again. I don’t know how many originals were still there but I imagine plenty.

I don’t know what Raleigh was before American Anesthesia, but now that NAPA is out, ECAA is taking them private again.

I’m curious about Inova Fairfax. They were a private group (and a great one at that) before they sold to American.

Hahaha. I want more details!

But I just googled Reno and Napa. The last news they publicized was Renown hired them? (As hospital employees?) that was April 2022.

I couldn’t find anything on Raleigh yet.
Will keep on looking.

 

[jwk]

I would love to know if anyone knows any hospital gave the anesthesia contract back to a private group. [emoji1744]

More likely (and happening) is the hospital simply absorbing the anesthesia group when they leave the AMC - assuming no non-competes are in the way. I think the economics of re-establishing a private practice would be pretty daunting.

 

[Southpaw]

Hahaha. I want more details!

But I just googled Reno and Napa. The last news they publicized was Renown hired them? (As hospital employees?) that was April 2022.

I couldn’t find anything on Raleigh yet.
Will keep on looking.

Raleigh is recent. The group there is going to be staffed/managed by another private group in the state. I don’t have details.

I believe the Reno group is private but I could be wrong, they may be hospital employed. There’s a long time poster here that works there.

I tend to agree with @jwk in that it’s more likely a group will become hospital employed if the hospital kicks out the AMC.

 

[GassYous]

Raleigh is recent. The group there is going to be staffed/managed by another private group in the state. I don’t have details.

I believe the Reno group is private but I could be wrong, they may be hospital employed. There’s a long time poster here that works there.

I tend to agree with @jwk in that it’s more likely a group will become hospital employed if the hospital kicks out the AMC.

Reno became a private group again after selling out to mednax which sold to napa who was having problems

 

[Howard888]

Raleigh recent also heard ECAA….but from what I’ve heard so far this wasn’t like renown where the hospital employed the MDs or NJ where they bought the non competes of MDs.

As of now no one knows how ECAA (they’re based out of Greenville, NC-not close enough to Raleigh to staff) is going to staff the system but as this was recent that may just not be public knowledge yet. Can’t imagine they would have taken over without some plan to keep most the current staff

 

[aneftp]

I don’t know what Raleigh was before American Anesthesia, but now that NAPA is out, ECAA is taking them private again.

I’m curious about Inova Fairfax. They were a private group (and a great one at that) before they sold to American.

Fairfax Virginia is way too complex of an anesthesia practice for any private group to takeover. The number and sheer volume of everything done there (peds complex cases, extremely busy women’s OB, major hearts/lungs including transplants). Fairfax is not your run of the mill suburban trauma one center. You simply cannot plug and play locums docs and expect it to run smoothly. Add that they are extremely short staff crna’s as well. The peel off order is horrible.

I leave at 10-11am as early out Fairfax you are lucky to leave by 3-4pm early out.

 

[deleted87051]

Well Reno sold to American Anesthesia I believe. NAPA took over. NAPA couldn’t deliver, hospital wanted them out, and hospital supported the guys to go private again. I don’t know how many originals were still there but I imagine plenty.

I don’t know what Raleigh was before American Anesthesia, but now that NAPA is out, ECAA is taking them private again.

I’m curious about Inova Fairfax. They were a private group (and a great one at that) before they sold to American.

Fairfax Virginia is way too complex of an anesthesia practice for any private group to takeover. The number and sheer volume of everything done there (peds complex cases, extremely busy women’s OB, major hearts/lungs including transplants). Fairfax is not your run of the mill suburban trauma one center. You simply cannot plug and play locums docs and expect it to run smoothly. Add that they are extremely short staff crna’s as well. The peel off order is horrible.

I leave at 10-11am as early out Fairfax you are lucky to leave by 3-4pm early out.

Here’s a recent ad. I know it’s said everywhere but the schools in the area are actually some of the best in the country.

Directory of In-House Physician Recruiters - PracticeMatch

A List of In-House Hospitals and Physician Groups that are posting their opportunities on the PracticeMatch.com website

www.practicematch.com

 

[aneftp]

Here’s a recent ad. I know it’s said everywhere but the schools in the area are actually some of the best in the country.

Directory of In-House Physician Recruiters - PracticeMatch

A List of In-House Hospitals and Physician Groups that are posting their opportunities on the PracticeMatch.com website

www.practicematch.com

I grew up in the area. I know it like the back of my head. My friends have worked at Fairfax over 20-30 years. Couple of them retired. So I know the practice past and present inside/out as well.

The original buyout was mainly due to inova admin in bed with the guy from inova fair oaks practice who just got lucky with even better payor mix than Fairfax. So inova admin kept pressuring Fairfax practice for more and more coverage. In the end like all practices. Only so much a group can take from admin demands and sold out. They actually got a very good deal with stock that quadrupled (for those that sold out). Unlike the Usap fake stock option that never materialized.

But is just a very complex practice to run these days like I said. You need major resources to staff the practice. It’s more complex practice than 95% of major tertiary care university owned academic places that are staffed even better. I’m not sure inova can even run the practice in house w2 themselves. They have no clue how to.

 

[jwk]

But is just a very complex practice to run these days like I said. You need major resources to staff the practice. It’s more complex practice than 95% of major tertiary care university owned academic places that are staffed even better. I’m not sure inova can even run the practice in house w2 themselves. They have no clue how to.

And this will be the problem with hospitals trying to run anesthesia departments when their primary concern for decades has been keeping the surgeons happy. They suddenly realize there is not an endless supply of anesthesiologists and anesthetists to just keep opening more operating rooms and running later and later in the day.

 

[Iso4ane]

And this will be the problem with hospitals trying to run anesthesia departments when their primary concern for decades has been keeping the surgeons happy. They suddenly realize there is not an endless supply of anesthesiologists and anesthetists to just keep opening more operating rooms and running later and later in the day.

You’re right there is not an endless supply, but money talks.

 

[Hoya11]

And this will be the problem with hospitals trying to run anesthesia departments when their primary concern for decades has been keeping the surgeons happy. They suddenly realize there is not an endless supply of anesthesiologists and anesthetists to just keep opening more operating rooms and running later and later in the day.

They only realize this when they take control of the department. Until that point its viewed as someone elses fault and they can fix it.

 

[DesiredMemberName?]

On the one hand, it seems like hospital employment might actually make hospital admin care about efficient utilization of anesthesia resources. On the other, once you’re employed, you’re probably not so worried about efficiency any more.

 

[ambiturner]

On the one hand, it seems like hospital employment might actually make hospital admin care about efficient utilization of anesthesia resources. On the other, once you’re employed, you’re probably not so worried about efficiency any more.

If you’re an hourly employee they’ll treat you like an hourly employee. Think of how they treat their OR nursing teams, how many times have you seen a call team circulator and scrub brought in to do a short case or start another room because a surgeon didn’t want to wait? Same thing with us once we’re on the same incentive structure.

 

[deleted87051]

If you’re an hourly employee they’ll treat you like an hourly employee. Think of how they treat their OR nursing teams, how many times have you seen a call team circulator and scrub brought in to do a short case or start another room because a surgeon didn’t want to wait? Same thing with us once we’re on the same incentive structure.

But I’ve also seen the slow walk at 2:30pm because the shift ends at 3. Goes both ways.

 

[aneftp]

If you’re an hourly employee they’ll treat you like an hourly employee. Think of how they treat their OR nursing teams, how many times have you seen a call team circulator and scrub brought in to do a short case or start another room because a surgeon didn’t want to wait? Same thing with us once we’re on the same incentive structure.

Hourly w2 is the worst to be unless it comes with gold plated healthcare university and retirement benefits.

Only reason I’m a w2 (was 1099 for long time as well) I’d because of state university benefits. No one believes me but I’m at 21% for effective tax rate making 450k w2 which isn’t bad for 40 hour week. Plus the generous benefits.

When I was 1099 my effective tax rate was 12-15% for 500k 1099 working 40-45 hours a week no benefits.

But 1099 hourly is by far the fairest way to compensate anesthesia “providers”. Locums crna’s making 400-450k at my place easy. Plus those housing $4000/month stipend. (50k housing they just pocket since most live within 45 min-1 hour driving distance