Napa

[FelixWYW]

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Hi,

Does anyone have any knowledge or insight on NAPA (North American Partners in ANesthesia) AMC group in the NYC area. They provide anesthesia to the Northshore-LIJ hospitals? I've heard that they are shady. Can anyone comment on that?

thanks

 

[huron]

Hi,

Does anyone have any knowledge or insight on NAPA (North American Partners in ANesthesia) AMC group in the NYC area. They provide anesthesia to the Northshore-LIJ hospitals? I've heard that they are shady. Can anyone comment on that?

thanks

Working for an AMC, is a big mistake, if you care about getting treated fairly and honestly you would be wise to avoid working for an Anesthesia Management company whose only goal is to maximize profits at any cost. Please see post from pervious thread about NAPA showing they do not provide real malpractice insurance to their employees but instead provide worthless insurance via a Cayman Islands licensed segregated portfolio insurance company.



Quote:
Originally Posted by pmichaelmd
Anybody with more information on NAPA? I have a contract offer from them and it looks pretty straightforward and physician-friendly. I have passed it by some of my consultants and they agreed that it was physician friendly. The base salary is the base salary and the bonus structure seems fair, if somewhat nebulous. They pay tail, base salary is good, benefits are great, and they have expanded into one more state than listed by the poster above...seem to be a pretty stable group. I would love to hear about negative experiences with the large management organizations as I am 50:50 on signing with NAPA vs my other contract. BTW, I too have heard bad things about Sheridan, but who knows? Some people are simply greedy, some people are malcontents no matter the situation...

Cheers,
PMMD

Mil is right "nebulous bonus compensation" is a dead give away, if they intended to give you a bonus it would be clearly defined in the contract. However whenever money is offered as part of a bonus plan by an Anesthesia Management company that money is compensation that you are highly unlikely ever to receive. That nebulous language is there for one reason, to deny you of that bonus after you sign on and do the work.

"They pay tail" look at their web site and you will see they are self insured through an off shore insurance company.

"NAPA Partnership Physicians founded and capitalized Practice Security Insurance Company SPC, Ltd. (PRASEC), a Cayman Islands licensed segregated portfolio insurance company." From;

http://www.napaanesthesia.org/InsuranceServices/index.php

I have talked to a number of hospital administrators and most frown on off offshore Cayman Islands insurance products, so you are essentially practicing uninsured. The reason people use off shore locations like the Cayman Islands to hide their money is that it is next to impossible sue there and if you win it is next to impossible to collect. Those are qualities that you would not want in an insurance company. If you get sued they could decide not to cover you and you would be left with no legal recourse. When you quit NAPA your next employer is likely to require you to buy a tail since they will most likely interpret the this arrangement a tantamount to not being insured.

Heres how it could hurt you. You sign up for the Anesthesia Management company , then no thru no fault of your own you have a bad outcome. The Anesthesia Management Company fires you for cause citing "negligence". Therefore you are liable to pay for the tail, which the contract most likely obligates you to purchase. They apply your last month's salary any other money they owe you as a partial payment for the tail, and send you a bill for the rest of the cost of the tail.

The Anesthesia Management Company has the choice of the cost of the tail coverage it could be 40,000 or a year's salary. You dip into your saving to pay the balance on the AMC Tail, since now you probably can not get a tail from any other carrier due to your bad outcome.

You bite the bullet and get the tail, then get sued. The offshore insurance company doesn't respond they refuse to represent you. Now you have to pay for you own lawyer to defend yourself. You sue the Anesthesia Management company pay a fortune but when you win you get nothing since you were employed by the local, LLC which the Parent Anesthesia Management Company closed and declared bankrupt as soon as you filed your lawsuit They still operate at that hospital just with a different LLC.

You are unable to find a lawyer willing to sue the offshore insurance company since you have no chance of collecting. You loose the malpractice lawsuit but have no assets left since you have spent everything on lawyers. You can't declare bankruptcy, due to the new bankruptcy laws so you are required to pay 75% of your after tax salary for the next 5 to 7 years to the Plaintiff and their lawyers.

If you want to get the truth about NAPA you need to talk to former employees and look for lawsuits. If you find a lawsuit it will layout in black and white how the bonus system really operates and how NAPA treats their employees.

 

[Gas]

I would stay away from NAPA. A few people I know have worked for them and the consensus is they operate like a classic AMC. Abuse you and let you go right before you make partner. If you do make partner (someone has to), the structure is tiered such that you will never make as much as the top guys, who don't do as much as you. You are also always under the threat of being let go.

 

[dr2323]

I know this post is 2 yrs old, but I just came across it. I'd have to agree STRONGLY to be very cautious re NAPA. They recruited me to a practice, great-looking contract, I moved my family 500 miles and bought a house (of which they were very aware), and then 3 weeks before I was supposed to start they rescinded the contract for timing/staffing reasons (they cited delays in credentialing, but it took them over a month after they offered the position to get organized to send me a contract).
Now that sucked, losing the job, esp with a new mortgage and all. But what was shocking was that NO-ONE called me to let me know, not the NAPA recruiter or the hosp medical director with whom I had interviewed etc. I found out 2 weeks after the fact via a by-the-way email from the hospital saying "guess we aren't going ahead with your med staff application, right?". NAPA apparently "sent me a letter", which I never received. Incredibly unprofessional. It eased the blow of suddenly being unemployed, because I had a huge sense of relief that I wasn't going to be working for a company that could behave that way. I've worked for Sheridan, and yes they are "corporate" in their attitude and culture, but they always did what they said they were going to do. Not real flexible, but consistent and clear, in my experience - what you see is what you get.

 

[RecentGrad]

I have been offered a job at LIJ (New Hyde Park). This is part of NAPA. Wondering if anyone knows anything about this NAPA group in particular.

 

[Consigliere]

Take that job at your peril.

 

[Cornellian]

Hi,

Does anyone have any knowledge or insight on NAPA (North American Partners in ANesthesia) AMC group in the NYC area. They provide anesthesia to the Northshore-LIJ hospitals? I've heard that they are shady. Can anyone comment on that?

thanks

I have worked for NAPA for years. They are a great organization. They are quality driven and treat all staff fairly. I just read a quote about malpractice from somebody who does not know what they are reading. All NAPA Personnel are insured primarily by admitted carriers in the state in which they work giving all staff the full protection afforded by both the insurance company and the state's regulators including access in NY State to the free excess coverage. NAPA's quality processes are so good that they have elected to set up an offshore REINSURANCE company which has a relationship with the malpractice insurance company not the insureds. This was done because the NAPA experience is much better than average and the owner docs take advantage of this fact by making a profit, effectively the difference between normal experience (average performance) and the far better experience enjoyed by NAPA docs.

 

[Cornellian]

I know this post is 2 yrs old, but I just came across it. I'd have to agree STRONGLY to be very cautious re NAPA. They recruited me to a practice, great-looking contract, I moved my family 500 miles and bought a house (of which they were very aware), and then 3 weeks before I was supposed to start they rescinded the contract for timing/staffing reasons (they cited delays in credentialing, but it took them over a month after they offered the position to get organized to send me a contract).
Now that sucked, losing the job, esp with a new mortgage and all. But what was shocking was that NO-ONE called me to let me know, not the NAPA recruiter or the hosp medical director with whom I had interviewed etc. I found out 2 weeks after the fact via a by-the-way email from the hospital saying "guess we aren't going ahead with your med staff application, right?". NAPA apparently "sent me a letter", which I never received. Incredibly unprofessional. It eased the blow of suddenly being unemployed, because I had a huge sense of relief that I wasn't going to be working for a company that could behave that way. I've worked for Sheridan, and yes they are "corporate" in their attitude and culture, but they always did what they said they were going to do. Not real flexible, but consistent and clear, in my experience - what you see is what you get.

I happen to know this doctor. She left out that she had a terrible malpractice history and legendarily bad references. She refused to cooperate with the Hospital's Credentialing Committee and the hospital refused her privileges. She was fully informed the whole time. Wow, information on the web can be very deceiving.

 

[Cornellian]

I would stay away from NAPA. A few people I know have worked for them and the consensus is they operate like a classic AMC. Abuse you and let you go right before you make partner. If you do make partner (someone has to), the structure is tiered such that you will never make as much as the top guys, who don't do as much as you. You are also always under the threat of being let go.

I have worked for NAPA for years. They are great. No one has ever been let go before making partner. NAPA has almost no turnover and provides an evergreen contract after a trial period whereby termination is for serious cause only, and with nearly 800 staff there have been fewer terminations than 1 per year. In fact the inside NAPA joke is be careful about joining. It tends to be a life sentence.

 

[drccw]

I have worked for NAPA for years. They are great. No one has ever been let go before making partner. NAPA has almost no turnover and provides an evergreen contract after a trial period whereby termination is for serious cause only, and with nearly 800 staff there have been fewer terminations than 1 per year. In fact the inside NAPA joke is be careful about joining. It tends to be a life sentence.

I got a contract from NAPA.. it's really honking long....

They make it hard to leave.... the weird malpractice setup (spin it like you want, but it's definitely not standard) and there was a non-compete clause of 7 miles.. I drew a 7 mile circle and that ended up being about 15 hospitals... no thanks

drccw

 

[cchoukal]

I have worked for NAPA for years. They are great. No one has ever been let go before making partner. NAPA has almost no turnover and provides an evergreen contract after a trial period whereby termination is for serious cause only, and with nearly 800 staff there have been fewer terminations than 1 per year. In fact the inside NAPA joke is be careful about joining. It tends to be a life sentence.

No one? Not ever? Come on. Sounds fishy.

 

[deleted126335]

No one? Not ever? Come on. Sounds fishy.

Especially for a new poster who has only 3 posts all singing NAPA's praises.

Maybe he is one of NAPAs owners.

 

[foxtrot]

I have worked for NAPA for years. They are great. No one has ever been let go before making partner. NAPA has almost no turnover and provides an evergreen contract after a trial period whereby termination is for serious cause only, and with nearly 800 staff there have been fewer terminations than 1 per year. In fact the inside NAPA joke is be careful about joining. It tends to be a life sentence.

Why do you only have three posts? My bet is that you work for NAPA and know you have a disgruntled employee. I also have my doubts about "no one has ever been let go before making partner." Sounds like a bunch of BS to me.

 

[Trisomy13]

I don't know Cornellian but I can vouch for NAPA being fair in at least my situation, which is admittedly not one of their NYC locations. I've been with them for 1.5 years and have never had a problem other than those inherent to a large company, e.g. paperwork, paperwork... From talking to a couple of my colleagues, I'm in a better spot than some of them that took small PP jobs. I can't speak to others experiences.

 

[nycdoctor123]

i know a few attendings who got burned by napa

 

[Girevik]

I know several people who work for NAPA. They are chronically understaffed and they when they take a place over those that can leave do so. This then leads to pulling folks from one place to work at the next. Also whoever said that everyone has made partner is in a way not being clear. Typically there isn't a partnership option. You work for them period. Bottom line: If you want any say so regarding how you practice or the hours you work look elsewhere. If you don't mind doing exactly what you are told with little or no control over your lifestyle and pay then NAPA may be for you.

 

[jwk]

I have worked for NAPA for years. They are a great organization. They are quality driven and treat all staff fairly. I just read a quote about malpractice from somebody who does not know what they are reading. All NAPA Personnel are insured primarily by admitted carriers in the state in which they work giving all staff the full protection afforded by both the insurance company and the state's regulators including access in NY State to the free excess coverage. NAPA's quality processes are so good that they have elected to set up an offshore REINSURANCE company which has a relationship with the malpractice insurance company not the insureds. This was done because the NAPA experience is much better than average and the owner docs take advantage of this fact by making a profit, effectively the difference between normal experience (average performance) and the far better experience enjoyed by NAPA docs.

Even if one works for a GREAT company (in any profession or field), NOBODY gives this kind of glowing recommendation unless they're getting paid to say it.

 

[sandrak]

Ive have worked as an anesthesiologist for years in the chicago area. Thank god I'm close to retiring because the type of promises these groups are offering to take over contracts of hospitals in not realistic. As employee you have no say in your lifestyle or the amount you work. You will be burnt out going form hospital to hospital on a whim, they will work you like a dog for very little compensation. They dont' care about employees, they only want to make money. You will be in employee forever with no say, very basic, if any benefits. This is dog eat dog america coming to medicine. Watch out and be very aware of what you are getting into here -- all the promises are nebulous for a reason. BE CAUTIOUS!!

 

[sandrak]

I would stay away from NAPA. A few people I know have worked for them and the consensus is they operate like a classic AMC. Abuse you and let you go right before you make partner. If you do make partner (someone has to), the structure is tiered such that you will never make as much as the top guys, who don't do as much as you. You are also always under the threat of being let go.

This is pretty obvious when you talk to them. They never give you any specifics. You they are basically using and abusing you as a resource. They benefits are poorly defined because they are terrible. Be very careful here. This business is going to die soon and the greedy people at the top will get rich in the meantime.

 

[Trisomy13]

Ive have worked as an anesthesiologist for years in the chicago area. Thank god I'm close to retiring because the type of promises these groups are offering to take over contracts of hospitals in not realistic. As employee you have no say in your lifestyle or the amount you work. You will be burnt out going form hospital to hospital on a whim, they will work you like a dog for very little compensation. They dont' care about employees, they only want to make money. You will be in employee forever with no say, very basic, if any benefits. This is dog eat dog america coming to medicine. Watch out and be very aware of what you are getting into here -- all the promises are nebulous for a reason. BE CAUTIOUS!!

It sounds like you don't work for NAPA but are making judgement about what it is like to work for them. I am at a hospital that was "taken over" by NAPA and disagree with your generalizations. It is true that you are an employee and have little control over your hours. But I never feel like I'm worked like a dog. Hardly. It is not true that they don't care about the employees. After we got up to staff here we have been able to influence many of the details of our day-to-day schedule. I am compensated quite fairly (far beyond several other offers at the time) and have a competitive benefits package. And from my discussions with the administrators and surgeons here, we are held in much higher regard than the previous group. Patient safety and quality control is a huge part of the company model, as mentioned in an earlier post (that did quite frankly sound like a paid advertisement). We have a strong group at our hospital and are by and large happy to be here.

Point being, take all the negatives with a grain of salt, because they aren't the only side to the story here.

 

[Trisomy13]

This is pretty obvious when you talk to them. They never give you any specifics. You they are basically using and abusing you as a resource. They benefits are poorly defined because they are terrible. Be very careful here. This business is going to die soon and the greedy people at the top will get rich in the meantime.

Doubtful 🙂

 

[sandrak]

Doubtful 🙂

It might be better than the old group, but I think there is a lot of cream that is skimmed off the top here to make the bottom line fatter for the people at the top, and the profit is not shared with the people that are actually doing the work and making the efficiency goals and safety improvements happen everyday.

 

[saratoga733]

had a convo with a new hire at work the other day (ex-napa employee) who joined napa straight out of residency. left as soon as he was able to find greener pastures. said 300/yr looks good until you realize you were doing 600/yr worth of work... while the people delegating the work sit on their butts all day, go to meetings, and gets paid >>> you. unfortunately, the reality is many non-napa PP gigs out there operate in the same fashion. napa just happens to be front and center because of their size.

 

[BIS40]

Ok
I joined Private practice community hospital that was taken over by Napa two years ago, last summer,close to my home town. basically to work on long island, Napa is dominant and talking to people they are trying to take over everyone here big and small, even spreading to other states. I was in Florida for awile, and when you compare to Sheridan there, definitely better benefits/retirement and advancement. Sheridan, starts decent salary, but everyone equal everywhere and no where to go, no retirement, and I hear cutting contribution to healthcare coverage significantly/like half.
Original group members/partners I can't say we're happy about takeover, and some retired or left, but still good group of people and still doing ok.
The trick with Napa is being careful which place you get into, different deals and the financials different when you reach profit sharing. with Sheridan, doesnt seem to matter- all the same, might just be easier places to work than others( trauma, etc)
Unfortunately with state of healthcare, private anesthesia groups and if they can exist- if it's worth the gamble of partner track, can't say- seeing lots changes. Example, other than sheridan, looking at private groups in Florida, many have closed partner track or have record of screwing people- that's among those where partners didn't cash in and sell contract to Sheridan. ( Sheridan seems to pay out partners and take over, Napa doesnt-- through whatever means, gets their way in and just takes over adding to massive holdings,)
Just my insight, so far has been fair to me, but I certainly have friends in pp other parts of country with currently sweet gigs, geography plays big part.
Closing example, I did a brief 6 months in LA-Cali few years ago- was amazing how everyone in community was stealing each others contracts and people will take any job to be there, also they say over ten years ago it was embarrassment if you went to Kaiser ( probably original corporate job in anesthesia), now it is very competitive and they don't even take people on full time, make you work part time as working interview. But probably most stable in that area. Times are changing, this is a reflection. Unfortunately, mega groups are becoming structure of survival in medicine due to bargaining power with size and overhead.
My two sense, feel free to respond.

 

[extubatedeep]

Hi all, anyone with reliable info regarding NAPA and it's contract with NS-LIJ? Word has it the health system is NOT renewing their contract. Is there any validity to this. Don't want to start a rumor here. Just want the facts. I am looking to head back to Long Island after residency. How will this effect the job market there? Thanks in advance for any insights.

 

[CrazyJake]

Looking at NAPA jobs in Northeast. Any updates?

Maybe Cornelian can offer 1 more glowing review!!!

 

[risnwb]

From what I understand every location is different. I looked at some that were basically **** jobs, flat salary (low) with lots of call and no incentives, others I was in residency with have signed with Napa groups that offer some form of partnership. Buy in tends to be pretty hefty and usually years to partner is something like 4-5 in the New York/New Jersey area. That being said, the money in the end from those groups is pretty good compared to anything else out there in the tristate area.

 

[turnupthegas]

Can anyone comment on NAPA in the NYC/LI area? Any positive experiences at the North Shore/LIJ or Brooklyn locations? NYC seems to be a tough market, with not many options outside of AMC and low-paying academic jobs.

 

[easternether]

Can anyone comment on NAPA in the NYC/LI area? Any positive experiences at the North Shore/LIJ or Brooklyn locations? NYC seems to be a tough market, with not many options outside of AMC and low-paying academic jobs.

i've only heard bad things. the reality is that most hospitals these days will just employ their own anesthesiologists so the future of these kinds of groups seems grim.

 

[Trisomy13]

FWIW, I'm still at the NAPA job I started over six years ago, and I'm still content and stand by my previous posts in this thread and others. Again with the caveat that experiences may differ by site/location.

 

[facted]

First off, each NAPA site operated relatively independently of the others so it's hard to classify it all in one big group. With that being said, they are actually very fair from my experience. Pay is medicore in the pre-partner years, but the NYC area market is a tough one. Some of the sites are increasing this pay in order to attract more people. Call structure is relatively fair. I have never heard of anyone getting kicked out prior to making partner outside of the first few months / first year. They don't abuse you and kick you to the curb the month before partnership. Each site is different with partnership structure, so you'll have to pry around. North Shore is more tiered than LIJ from what I hear. Not sure about the other sites.

Overall, it's a pretty well structured group with plenty of HR support. Benefits are relatively good and they're upfront about them. I have never felt lied to about any part of my job from day 1 onwards. Overall, for the NY area, I would recommend them, with the caveat that each site is different and you really have to dig around.