Negotiate your contract with AMCs

[TaoistDoc]

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For those of you who have been offered a job with AMCs before, can you negotiate the contract and what do you usually negotiate? I'm guessing AMCs pay all their employees pretty much the same so there's not much wiggle room for negotiation.

 

[deleted171991]

If the job market is so tight in your area that you are looking at an AMC, I expect you being able to "negotiate" exactly two things about your contract: you take it or you leave it.

 

[Planktonmd]

If the job market is so tight in your area that you are looking at an AMC, I expect you being able to "negotiate" exactly two things about your contract: you take it or you leave it.

Many new grads are taking jobs with AMCs for lack of alternatives and because private practice groups have either disappeared or they are offering ridiculous non partnership contracts worse than those offered by AMCs.

 

[Stank811]

I guess it all depends on your market….in my area graduating residents are avoiding AMC like the plague…and are will to travel a little further outside of their geographic region to find nice PP jobs or just stay in academics

 

[TaoistDoc]

I'm willing to travel. I'm looking at pretty much the whole southeast region. Jobs are pretty tight. Perhaps its because I'm looking for one a year in advance. My hope is that more will open up as I get closer to graduation.

 

[gasdoc77]

Having worked for an AMC VERY briefly, if I could emphasize one thing it would be to insist in them providing full tail coverage from day 1. Non-negotiable. This can change the dynamic and forces them to give some thought to how they treat you even after they have you. It forces them to have some skin in the game besides "get paid today for today's work" or whatever garbage they spew. O/w they could always be looking to replace you if the next guy will do it cheaper.

 

[aneftp]

Having worked for an AMC VERY briefly, if I could emphasize one thing it would be to insist in them providing full tail coverage from day 1. Non-negotiable. This can change the dynamic and forces them to give some thought to how they treat you even after they have you.

The big AMCs like Sheridan and mednax/American anesthesiology are self insured so they already cover your tail.

Another option is negogiating 1099 income. At least you can expense things

 

[aneftp]

Just talked to one of my friends. A private practice group just tried to offer him $230K (he's 10 years experience, board certified no lawsuit...clean) in suburban maryland. And that's taking call 4x a month. Just ridiculous. That's probably around 50 plus hours a week and one weekend a month also. With 6 weeks paid vacation and very little benefits.

Heck most CRNAs in suburban Maryland make 175K for 40 hours plus benefits (they usually work 3-4 days a week, no weekends and no call) a week with 6 weeks vacation.

At that pay, they will have a hard time getting someone to take the job. No wonder why they keep interviewing people. At $230K with overnight call and weekend responsible, they probably can't get a CRNA to work for $230K.

CRNAs aren't dumb. They calculate everything also.

I told my friend just to do locus and he can easily get more money since he's single and can move around.

So it's just not AMCs screwing MDs over. Private practice MDs screw people over just as well.

 

[IlDestriero]

You can try to negotiate anything. There is no way to know what they have flexibility on, though it may be nothing at an AMC. It depends on what they specify in the contract. Maybe a bigger signing bonus or just a signing bonus, relocation expenses, salary, vacation- especially if it changes over time, professional expense accounts, better parking, etc.
I was able to negotiate several things with the chairman that the division chief implied were not negotiable with my current job. It was not trivial, including base salary which continues to this day. When I was doing per diem work at another place, I asked for an extra $150/day. "OK, that's fine." was the response. 🙂
It is usually easier to get a one time thing, like a signing bonus or max vacation from day 1, than a recurring expense, like a base salary bump, etc.
If you have experience and take the same package as a new grad, you probably left something on the table, maybe quite a lot.

 

[BuzzPhreed]

Many new grads are taking jobs with AMCs for lack of alternatives and because private practice groups have either disappeared or they are offering ridiculous non partnership contracts worse than those offered by AMCs.

Very true. Remember that you will essentially be paying someone else for your hard work. In the past this was considered "paying your dues" to the guys who went through all the hard work of starting and building the practice with the understanding that someday you'd share the pie. Now it's just a bunch of ****ing greedy dinguses trying to cash in on as much of your hard work as they can - for as long as they can - before they sell the practice out from under you and make even MORE money.

Having worked for an AMC VERY briefly, if I could emphasize one thing it would be to insist in them providing full tail coverage from day 1. Non-negotiable. This can change the dynamic and forces them to give some thought to how they treat you even after they have you. It forces them to have some skin in the game besides "get paid today for today's work" or whatever garbage they spew. O/w they could always be looking to replace you if the next guy will do it cheaper.

Do not sign unless you get this. This post is absolutely spot-on. Don't underestimate the dynamic of someone perceiving that they have you by the short hairs. If there's no gold in them, then they're just plain old handcuffs.

I'm willing to travel. I'm looking at pretty much the whole southeast region. Jobs are pretty tight. Perhaps its because I'm looking for one a year in advance. My hope is that more will open up as I get closer to graduation.

👍

 

[shaz8901]

http://www.kevinmd.com/blog/2013/12/anesthesia-practice-sold-warning-young-doctors.html

read this article, young physician anesthesiologists need to know to be weary of joining groups without partnership tracks.

 

[deleted171991]

In certain areas of the country, there are no more partnership tracks, except for attractive candidates.

I have been looking at gaswork in my Northeastern state, at there are only crappy jobs, unless you are cardiac- or pain-trained.

 

[Consigliere]

Just talked to one of my friends. A private practice group just tried to offer him $230K (he's 10 years experience, board certified no lawsuit...clean) in suburban maryland. And that's taking call 4x a month. Just ridiculous. That's probably around 50 plus hours a week and one weekend a month also. With 6 weeks paid vacation and very little benefits.

Heck most CRNAs in suburban Maryland make 175K for 40 hours plus benefits (they usually work 3-4 days a week, no weekends and no call) a week with 6 weeks vacation.

At that pay, they will have a hard time getting someone to take the job. No wonder why they keep interviewing people. At $230K with overnight call and weekend responsible, they probably can't get a CRNA to work for $230K.

CRNAs aren't dumb. They calculate everything also.

I told my friend just to do locus and he can easily get more money since he's single and can move around.

So it's just not AMCs screwing MDs over. Private practice MDs screw people over just as well.

Point 1 - that's becoming the norm
Point 2 - they will fill that job easily. They probably have 15 applicants applying which is why they keep interviewing people.

 

[BuzzPhreed]

Point 1 - that's becoming the norm

The next obvious question: why is that becoming the "norm"? I'll tell you why. Because people are willing to take these jobs! If everyone said "no" unless they were offered a partnership track it wouldn't happen. If a practice wants to fill itself with a bunch of spineless wimps who do nothing more than sign charts and let the CRNAs do all the clinical work (including blocks) then the surgeons and administrators shouldn't be surprised when the overall quality of care goes down. If you've got any kind of skills or ambition don't take this kind of job! You will be miserable.

Point 2 - they will fill that job easily. They probably have 15 applicants applying which is why they keep interviewing people.

Yeah, I know. And what you say is exactly what they told me when I quit where I was temporarily. No offense, but I saw the quality of some of those newer hires and there were more than a few that were foreign-trained, from crappy residency programs, and whose English was barely understandable. Again eventually the practice is only ****ing itself if they expect to stay in business for more than the next few years. Even some of the CRNAs were leaving because they couldn't stand it any longer. And the few quality people who were there were incredibly unhappy.

This is phenomenally shortsighted of practices if they expect to stay in business and keep the contracts. If you set your practice up to have high turnover and weak clinicians, you will get exactly what you bargained for in the end when everyone starts to complain, especially if surgeons have multiple choices about where to send their patients.

 

[deleted171991]

It's an employer's market. It's not like you can pick and choose, especially in desirable geographic areas. And it's only going to be worse.

 

[deleted126335]

Heck most CRNAs in suburban Maryland make 175K for 40 hours plus benefits (they usually work 3-4 days a week, no weekends and no call) a week with 6 weeks vacation.

At that pay, they will have a hard time getting someone to take the job. No wonder why they keep interviewing people. At $230K with overnight call and weekend responsible, they probably can't get a CRNA to work for $230K.

CRNAs aren't dumb. They calculate everything also.

So it's just not AMCs screwing MDs over. Private practice MDs screw people over just as well.

Regrettably, I suspect that there will be people who will take that job.
For those who think that the floor for doc salaries are CRNA salaries, I would beg to differ. Some exploitive, abusive practices might prefer CRNAs for the same money. Would you want a group of young hungry docs running around your practice hating your guts for exploiting them?

 

[deleted171991]

Most practices prefer CRNAs, and those who prefer docs tend to not offer a partnership track (and skim 30-40% of the profits).

It's sad and disgusting that we as professionals take all the malpractice risk, while the groups reap most of the benefits. I am beginning to believe that, except for a partnership track, the best jobs are locums or prn jobs (without an intermediary). You might make less money, but you will work much less and they'll actually treat you like you matter.

 

[aneftp]

Regrettably, I suspect that there will be people who will take that job.
For those who think that the floor for doc salaries are CRNA salaries, I would beg to differ. Some exploitive, abusive practices might prefer CRNAs for the same money. Would you want a group of young hungry docs running around your practice hating your guts for exploiting them?

I suspect that the market will bear what it will bear.

The CRNAs don't want to take weekends or nights. The senior partners want to do as little week nights as possible and avoid weekends all together.

If they can't find anyone, they will just start advertising (like some places) for weekend only shifts (5pm-7am Friday night, 6pm-7am Saturday nights, and 6pm-7PM sunday night). We've all seen some sort of package between 220-300K for the weekend shift MD advertised from time to time.

Some new grad or newer grad (or someone who needs the income) will take those jobs as well.

 

[Mman]

The next obvious question: why is that becoming the "norm"? I'll tell you why. Because people are willing to take these jobs! If everyone said "no" unless they were offered a partnership track it wouldn't happen.

How exactly will you organize "everyone" to do that? Because there are lots of people that happily take those jobs. So if one person has a moral high ground and turns it down, there are a bunch of others just waiting for the chance.

With the huge proliferation of AMCs, it's a sellers market (in terms of jobs in PP). Within 10-20 years, the job choices will be either AMC or academic or a long partnership track at one of the few private gigs remaining.

 

[pgg]

The next obvious question: why is that becoming the "norm"? I'll tell you why. Because people are willing to take these jobs! If everyone said "no" unless they were offered a partnership track it wouldn't happen.

You'd have better luck manipulating the price of soybeans by telling the guys on somefarmerforum.net that the market price is unfair and that they shouldn't sell at $X, but rather sit on their decomposing beans until $(X+1) is offered. Which is to say, no luck at all.

The balance between supply and demand can't be fundamentally altered by indignation over the market price. Maybe anesthesiologist demand could be increased by fighting CRNA independent practice in the legislature; maybe anesthesiologist supply could be decreased by reducing residency slots. Anything else is just complaining about the weather.

 

[IlDestriero]

Because there are lots of people that happily take those jobs. So if one person has a moral high ground and turns it down, there are a bunch of others just waiting for the chance.

Within 10-20 years, the job choices will be either AMC or academic or a long partnership track at one of the few private gigs remaining.

I'm not sure there are going to be people lining up sign up for that job in MD above. It is the worst offer I have heard outside of academics at a few notoriously low paying places (where full time is 3 days a week). At least academics offers less than half 1/2 the call and some other perks. It's lower than bad partnership tracks that I was offered. One can make that in the .mil supervising residents 1:1, getting out by 3, and waiting to hit 20 years for your pension to start paying out.

 

[nycitygas]

230K is low but they'll find somebody. Do you know what Kaiser offers there?

The job market is so bad...I hope things gets better but I am not optimistic.

 

[BuzzPhreed]

How exactly will you organize "everyone" to do that?

You start by not intimating on this very forum that job candidate should endorse this "take it or leave it" mentality; that if you don't take the job there is someone else willing to fill your shoes. I've seen some of those "someone elses" and they are invariably 1) lazy 2) clinically weak or 3) can't speak English. If that's what private practices are attracting by lowballing and not offering a partnership track, then it'll sort itself out in a few years when Mednax or NAPA or Sheridan comes in and underbids and/or offers a more quality product.

You start by telling residents - while they are in residency - to avoid such jobs. Residency programs are woefully inept at preparing future consultants for the real world in that regard, mostly because they have no clue what it's like in the real world. They're stuck in the ivory tower. You invite people in to teach them if you have to. You tell them what they should and should not tolerate and how to walk away if they find they're in a b.s. job.

You start by making sure graduating residents know that they should be geographically flexible or risk getting stuck in a miserable situation. Some jobs will be a complete waste of the last four years of their training. You tell them that working for an AMC or directly for a hospital owned practice is far better than working in a private practice group that's going to pay you a ****ty salary indefinitely with no promise or partnership. That it's better working for a better wage and where everyone is in the same boat, not in some massive power differential with a bunch of dinguses dangling some carrot in front of you and whipping you from behind with some nebulous promise of partnership somewhere in the undefined future if you don't rock the boat. You tell them that no one owns you.

Look, these fatcat grayhair greedy dinguses need to decide if they're either going to reverse this trend and/or actually pay better. I went back to my old job where we're all in the same boat. I work for a hospital-owned practice. I got a 30% pay increase at the same time compared to the bulls*** false private practice I thought I was joining. I make $4000 more/month in take home pay (after taxes) than I did in the short time I was in that other lousy arrangement. And I actually get to be an anesthesiologist and not just some paper pusher. That job was a screw-job all the way around for multiple reasons elucidated on other threads. And I truly feel bad for those people who are miserable and stuck in that situation, many of whom told me on my departure how much they hated it.

If that's becoming the "norm", then I'll go back to residency and do something else. I'm already enrolled into an MBA program that starts this fall. Diversify or die. Each person - and each person alone - is responsible for the employment choices they make. If more would just say "no" to these idiots who are exploiting them, it would stop.

 

[BuzzPhreed]

230K is low but they'll find somebody. Do you know what Kaiser offers there?

The job market is so bad...I hope things gets better but I am not optimistic.

The job market is NOT bad. You just want to live in NYC. It's always been bad in NYC.

 

[Mman]

seems like somebody in this thread is a bit unrealistic. Please tell me how people several hundred thousands dollars in debt should turn down the only job offers they can find because they aren't good enough.

I have a great job. I work for a private job and we haven't sold out to the man. It's your platonic ideal. But I'm not going to look down on somebody that needs to feed their family. It's easy for you to talk tough on an anonymous internet forum when you aren't a new grad sitting on house and car and loan payments. I'm a realist and a capitalist. It's up to employers to offer the lowest paycheck they can to fill the position adequately. It's up to employees to take the best deal they can get. In an employer's market, the employees will necessarily be forced to take jobs that don't pay as much. Economics 101. We aren't allowed to form unions.


Nobody should take or leave anything. But only 1 poster here seems to take personal offense to people's geographic restrictions on a job hunt. Not every person in the country can pick up and move anywhere.

 

[BuzzPhreed]

Please tell me how people several hundred thousands dollars in debt should turn down the only job offers they can find because they aren't good enough.

Easy. It's called locums.

Not every person in the country can pick up and move anywhere.

If that's the attitude then people sharing it deserve exactly what they get. If someone wants to work in a PP that doesn't offer you a partnership track, be prepared to suffer the power differential and bring a lot of KY with you to work each day.

What should really happen is that all of the non-partners who've been there for a while should get together and start looking elsewhere. Then they should go to the partners and say "make us a partner or we're leaving". Even if only 4-5 people did this it would totally rock a practice. Trust me. I was one of three who left that horrible situation in the past year and the doo-doo hit the fan as it was.

 

[BuzzPhreed]

It's up to employers to offer the lowest paycheck they can to fill the position adequately. It's up to employees to take the best deal they can get. In an employer's market, the employees will necessarily be forced to take jobs that don't pay as much. Economics 101. We aren't allowed to form unions.

I have a problem with calling and treating someone as an "employee" that has a medical license and is being forced into a situation where he/she is allowing someone else to bill and collect an income without a care of the actual risks to that individual that are involved. The system is stacked against the professional that has earned that degree and certification. And until someone or some group challenges it, it's going to continue. Or get worse.

You can't invoke pure "capitalism" here. There's too many regulations in place stacked against the individual.

 

[nycitygas]

I actually live in a completely different part of the country and the market here is pretty similar.

I agree with you that the market is better in many other places but I cannot live anywhere else due to family considerations. My parents are getting older and I need to be close by to help take care of them. Not everybody can just pick up and move.

 

[BuzzPhreed]

I actually live in a completely different part of the country and the market here is pretty similar.

I agree with you that the market is better in many other places but I cannot live anywhere else due to family considerations. My parents are getting older and I need to be close by to help take care of them. Not everybody can just pick up and move.

Then you are f*cked. What else do you want me to say? If you won't move, then you'll have to take whatever you can get (until the FTC or the courts have the balls to put an end to this specific kind of monopoly). So, lube up. Take what you can get. Even if that means you gotta give the senior partners a handjob every morning. Don't forget to smile.

 

[Arch Guillotti]

I have been looking at gaswork in my Northeastern state, at there are only crappy jobs, unless you are cardiac- or pain-trained.

Gaswork is not really known for being a source for many "good" jobs although there are some decent ones on there at times.

 

[Arch Guillotti]

The next obvious question: why is that becoming the "norm"? I'll tell you why. Because people are willing to take these jobs! If everyone said "no" unless they were offered a partnership track it wouldn't happen.

Good luck with that.

 

[Arch Guillotti]

Easy. It's called locums.

Locusm isn't necessarilyeasy if you have wife and/or kids.

 

[Arch Guillotti]

What should really happen is that all of the non-partners who've been there for a while should get together and start looking elsewhere. Then they should go to the partners and say "make us a partner or we're leaving".

That seems like a terrible strategy.

 

[Arch Guillotti]

You start by making sure graduating residents know that they should be geographically flexible or risk getting stuck in a miserable situation. Some jobs will be a complete waste of the last four years of their training. You tell them that working for an AMC or directly for a hospital owned practice is far better than working in a private practice group that's going to pay you a ****ty salary indefinitely with no promise or partnership.

Sorry you had such a crummy job.

The job market doesn't seem to be great these days but there are still practices out there that out aren't to get you.

 

[ether123]

It is very hard to find any true partnership jobs. The sad thing is that this is a relatively new phenomeonon. Even 5 years ago there were jobs in rural areas that were offering partnerhsip track. All of that has tried up as everyone is trying to follow the AMC model. I think right now academia is the way to go. The difference in pay wont be that significant, but the benefits in academia will be better. This, in addition to a real career ladder where u will be respected based on your tenure and given leadership opportunities.

 

[Mman]

Then you are f*cked. What else do you want me to say? If you won't move, then you'll have to take whatever you can get (until the FTC or the courts have the balls to put an end to this specific kind of monopoly). So, lube up. Take what you can get. Even if that means you gotta give the senior partners a handjob every morning. Don't forget to smile.

You have a weird definition of "f*cked". I don't consider somebody that gets 1-2 months vacation a year and makes well into the 200s or 300s of salary a year as being in such a terrible situation. That's better than 98% of the US population can ever hope to do. Hell, the majority of physicians in the country would kill for that job. Pediatricians are doctors. You think they get that kinda money?

 

[Mman]

You can't invoke pure "capitalism" here. There's too many regulations in place stacked against the individual.

I'm not "invoking" capitalism. It is capitalism. It's an employer offering a job. It's an employee deciding whether to take it.

I get that you wish it was 1960 and every MD had their own sign hanging in their own window and did whatever they want, but that's just not how things work any longer.

 

[Planktonmd]

With the increased percentage of employed anesthesiologists, the rapid decline of true private practice and the progress towards single payer system it's becoming more conceivable to form anesthesiologists union like they do in Europe.
The reason why physicians can not unionize right now is because many of them are independent vendors or businesses which makes a union look like price fixing to the government, this problem does not exist if all the union members are salaried employees.
This solution although not very "capitalistic" as some might say, could offer some protection and empower the employed anesthesiologist.

 

[IlDestriero]

I've already trademarked The United Anesthesia Workers Union.

 

[aneftp]

Then you are f*cked. What else do you want me to say? If you won't move, then you'll have to take whatever you can get (until the FTC or the courts have the balls to put an end to this specific kind of monopoly). So, lube up. Take what you can get. Even if that means you gotta give the senior partners a handjob every morning. Don't forget to smile.

Why is it illegal for anesthesia groups to control market share...aka the anti trust laws

"in 1996, the FTC issued a BusinessReviewLetterdescribingwhyit would likely challenge the joint venture combination of five Orange County, California anesthesia practices under the antitrust laws. See, FTC Business Review Letter, Orange Los Angeles Medical Group, Inc. (“ORLA”) (March 8, 1996.)."

http://www.anesthesiallc.com/component/content/article/335

But it's ok for big business like Mednax to control market share and extract higher payments from insurers.

Surprise the FTC hasn't looked into this. It may (and probably too late) by the time the FTC looks into this.

 

[nimbus]

Why is it illegal for anesthesia groups to control market share...aka the anti trust laws

"in 1996, the FTC issued a BusinessReviewLetterdescribingwhyit would likely challenge the joint venture combination of five Orange County, California anesthesia practices under the antitrust laws. See, FTC Business Review Letter, Orange Los Angeles Medical Group, Inc. (“ORLA”) (March 8, 1996.)."

http://www.anesthesiallc.com/component/content/article/335

But it's ok for big business like Mednax to control market share and extract higher payments from insurers.

Surprise the FTC hasn't looked into this. It may (and probably too late) by the time the FTC looks into this.

The antitrust environment is significantly different now with the consolidation of both medical groups and hospital systems. There have been several similar mergers in the area without FTC challenge since the case described. The difference between "competitive" and "non-competitive" has become a matter of semantics. Hospital medical staffs that are nominally open are de facto closed for anesthesia.

 

[BuzzPhreed]

I'm not "invoking" capitalism. It is capitalism. It's an employer offering a job. It's an employee deciding whether to take it.

It's not a fair market. And, that is what capitalism is based on. This is not capitalism.

Practices have figured out that when they hold the cards they can do whatever they want. The result is that the little guy (in this case the single anesthesiologist trying to negotiate on his/her own in a captive market) gets screwed.

 

[BuzzPhreed]

The antitrust environment is significantly different now with the consolidation of both medical groups and hospital systems. There have been several similar mergers in the area without FTC challenge since the case described. The difference between "competitive" and "non-competitive" has become a matter of semantics. Hospital medical staffs that are nominally open are de facto closed for anesthesia.

The FTC is also "interested" in the recent formation of ACOs and the potential for market domination by certain mega-practices. There will be lawsuits. Or direct action by the FTC to block mergers.

Practices can't form large coalitions that prevent fair trade practices. This is tantamount to what's happening now (unintended consequence of the ACA) which creates captive markets, reduces competition, and actually increases healthcare costs as these mega-practices have significant leverage to negotiate higher fees. The potential for a group of disgruntled anesthesiologists to successfully revisit a legal challenge of the 1984 landmark Hyde case where the Supreme Court did not at the core of the decision feel that this represented an unfair competitive advantage to this small practice in an area with multiple alternate choices where patients could seek care or where anesthesiologists could be employed. This is rapidly becoming defunct as the "WalMarting" of medicine continues, including what these huge AMCs have been doing over the past few years.

 

[deleted126335]

It's not a fair market. And, that is what capitalism is based on. This is not capitalism.

Practices have figured out that when they hold the cards they can do whatever they want. The result is that the little guy (in this case the single anesthesiologist trying to negotiate on his/her own in a captive market) gets screwed.

"Fair" is a four letter word. Depends on where you sit. A few years ago, surgeons and administrators were having apoplectic fits over anesthesiologists increasing income demands coupled with refusal to provide increased services. In their minds this has been a long time coming.

 

[BuzzPhreed]

"Fair" is a four letter word. Depends on where you sit. A few years ago, surgeons and administrators were having apoplectic fits over anesthesiologists increasing income demands coupled with refusal to provide increased services. In their minds this has been a long time coming.

We're talking about two different things.

You're talking about subsidies and stipends demanded by groups for covering services. Large groups (like Mednax) come to administrators and say, "give us your ER and radiology, and we'll provide anesthesia without a subsidy" to cover, for example, OB 24/7/365 with its hit-or-miss censuses. Private groups who only provide anesthesia-only services can't reasonably cover this without a stipend and without taking a hit. And the administrators end up giving the contract to the multi-specialty group. This in and of itself is fraught with all kinds of potential anti-trust issues, especially since these large multi-specialty groups negotiate higher fees from payers when they are saturated in an area..

What I'm talking about is a PP group who has the sole contract at (several) hospital(s) in an area and can drive down salary and "force" you to work with them if you want to live in that region. They "employ" you without ever making the promise to make you a profit-sharing partner. This creates a huge power imbalance in stake and equity. They make you sign a restrictive covenant. They put all manner of handcuffs in the contract. And it gets very hard to get out of that situation, stay local, and find meaningful employment. They pay new grads $230k-250/yr while they themselves are making $500-600k/yr (or more) by collecting on the non-partner's work. Likewise the non-partner doesn't have a say in the day-to-day management of operations and is in essence dictated to about how they should practice "if you ever want a chance at partnership" at some nebulous and ill-defined time in the future. These guys don't truly care about finding and developing talent. They just care about having someone to sign the consent forms and other paperwork while the CRNAs do all the clinical care (including blocks and lines) while they position themselves to sell the practice to the AMC when they're ready to retire, which is soon for a lot of them.

There's no point in working in that arrangement. The pay is worse than an AMC or hospital-owned group. There is a palatable power differential on a day-to-day basis, often with the non-partner taking more call or getting more challenging cases or greater assignment load. And the contract weighs heavily in the practice's favor often with a lot of restrictive language that takes more than it gives. Like it or lump it. "If you don't want to work for us, you won't be able to work in this region." That's inherently not what the Hyde case was about.

 

[Mman]

It's not a fair market. And, that is what capitalism is based on. This is not capitalism.

Practices have figured out that when they hold the cards they can do whatever they want. The result is that the little guy (in this case the single anesthesiologist trying to negotiate on his/her own in a captive market) gets screwed.

We do not work in a specialty where it is even possible to exist as an independent contractor in a large hospital system. Just can't work. The staffing demands of an anesthesia department, the call responsibilities, and the negotiations of contracts with all sorts of payers effectively prohibit it from happening.

You can't go up to big medical center X and tell them you'd like to staff an OR from 7-5 5 days a week and be on some sort of call once a week and will stay late to finish whatever runs in that room. An anesthesia department must function as a group and it must negotiate as a group. Therefore, if you'd like to work there you need to be part of that group or be part of another group taking that contract over.

The little guy doesn't get "screwed". The little guy weighs various job offers from different AMCs, private groups, and academic departments and selects the offer that they find most attractive. That is capitalism.

 

[BuzzPhreed]

We do not work in a specialty where it is even possible to exist as an independent contractor in a large hospital system.

Who said that? In systems where there are competing groups (non-exclusive contract for services) I imagine that there is a lot more equity. Competition is healthy. That's really what capitalism is. The cream rises.

 

[Consigliere]

The next obvious question: why is that becoming the "norm"? I'll tell you why. Because people are willing to take these jobs! If everyone said "no" unless they were offered a partnership track it wouldn't happen. If a practice wants to fill itself with a bunch of spineless wimps who do nothing more than sign charts and let the CRNAs do all the clinical work (including blocks) then the surgeons and administrators shouldn't be surprised when the overall quality of care goes down. If you've got any kind of skills or ambition don't take this kind of job! You will be miserable.

Of course they are. It's hard to get on your moral high horse when you're $300k in debt with a wife and kids to provide for.

 

[Triple AAA]

Then you are f*cked. What else do you want me to say? If you won't move, then you'll have to take whatever you can get (until the FTC or the courts have the balls to put an end to this specific kind of monopoly). So, lube up. Take what you can get. Even if that means you gotta give the senior partners a handjob every morning. Don't forget to smile.

In an ideal world, I would agree with much of what you are saying. I haven't been around long enough to see how things 'used to be', and/or to really know if the current situation is really as bad as you say it is.

With that said, times are considerably different then they were when we were growing up. People just don't have 'stable' jobs that they stay at for 20+ years or so. Everyone is constantly moving around the country, and it is not uncommon to switch jobs several times in one's career anymore. Furthermore, with more double income families each year (considerably more than when we were kids, anyway), it is nearly impossible to find a location that works equally well for both earners. Some compromise has to be reached, and sometimes we have to settle here and there.

Bottom line: there are many jobs that offer decent packages up front, but do not guarantee fair compensation years down the line (lack of partnership track, tail coverage, etc). Tail coverage is unfortunately becoming less and less common, especially in private practice. I don't think taking these jobs is necessarily a bad thing if you aren't planning on staying for more than a few years. But I agree, it's not an ideal place to settle down for the long haul.

 

[anbuitachi]

The next obvious question: why is that becoming the "norm"? I'll tell you why. Because people are willing to take these jobs! If everyone said "no" unless they were offered a partnership track it wouldn't happen. If a practice wants to fill itself with a bunch of spineless wimps who do nothing more than sign charts and let the CRNAs do all the clinical work (including blocks) then the surgeons and administrators shouldn't be surprised when the overall quality of care goes down. If you've got any kind of skills or ambition don't take this kind of job! You will be miserable.



Yeah, I know. And what you say is exactly what they told me when I quit where I was temporarily. No offense, but I saw the quality of some of those newer hires and there were more than a few that were foreign-trained, from crappy residency programs, and whose English was barely understandable. Again eventually the practice is only ****ing itself if they expect to stay in business for more than the next few years. Even some of the CRNAs were leaving because they couldn't stand it any longer. And the few quality people who were there were incredibly unhappy.

This is phenomenally shortsighted of practices if they expect to stay in business and keep the contracts. If you set your practice up to have high turnover and weak clinicians, you will get exactly what you bargained for in the end when everyone starts to complain, especially if surgeons have multiple choices about where to send their patients.

This will soon change since more and more medical schools are opening up in the US. Soon even the awful anesthesiologists will be mostly US trained.