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The partnership system is outdated. I'm not surprised that the AMC model has been able to dethrone it. Models will keep changing during our careers.

Partnerships have been a puzzle to me since I started looking for jobs. It's the only business I know where you pay for something without intrinsic value, without knowing much details, which can be rescinded at any minute without your money back, and to top it off has an expiration date.
 
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If the partnership model is doomed, and the AMC model puts corporate profits above quality patient care, what other options are left to those of us about to start residency? Will the only job opportunities in 2018 be Sheridan vs. Somnia?
 
What about subspecialty groups, such as Peds Anesthesia practices? For example, if a group consists of highly qualified pediatric anesthesiologists covering the full spectrum of cases (hearts, transplants, pain, ICU, etc) how easy would it be for them to be replaced by an AMC?
 
Are there many pure subspecialty groups, except for pain and CCM? And how long will the former survive in academia, before being swallowed by the university?

Pain is tougher to replace (the patients might actually care about who's treating them), but CCM is "faceless", almost the same as anesthesia (or EM). Have you ever seen an ICU patient/family asking for a specific intensivist, as in they either get him/her or the patient is transferred to another hospital? The only protection for us is the surgeons' preference, but only if they are private.

Anything that's faceless service provider is prone to be overtaken by management companies promising more juice from squeezing the lemon, with bean counters and faceless numbered drones. If you are an anesthesiologist, get used to the idea that, to the bean counters, you are just a "body"- meaning a nobody.
 
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HalO'Thane said:
What about subspecialty groups, such as Peds Anesthesia practices? For example, if a group consists of highly qualified pediatric anesthesiologists covering the full spectrum of cases (hearts, transplants, pain, ICU, etc) how easy would it be for them to be replaced by an AMC?
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If you're covering those types of cases, you're probably at a solid academic center (or a high acuity, private practice hospital) and are reasonably protected from these concerns. This topic is more pertinent to those in private practice settings with high volume of bread and butter cases and only scattered sick cases. Think about it: is an AMC going to come in and supply qualified practitioners to take LVAD/Transplant/Pain/Pediatric call? AMC takeovers are a relatively new phenomenon such that until it becomes the norm across the board, they won't have subspecialist coverage for such cases. As such, subspecialization (and subsequent employment at a referral center) confers a measure of immunity from these concerns...for now.

I work in a large, private practice model probably not THAT unlike the group in Cali. that sold out to Sheridan. If an AMC did take over here, it would be because my group wanted it to. The AMC would need a vast majority of our shareholders (many subspecialists) to be on board and continue working...because the hospital expects pediatric anesthesiologists for kids and TEE certified anesthesiologists for cardiac and skilled regionalists for pain, etc.
 
Nobody is irreplaceable. As the number of subspecialty grads will increase (the same way anesthesia grad numbers have), AMCs will pick and choose the suckers they need. As long as we don't have a numerus clausus in place, it will only get better for them and worse for us. This is not doom and gloom, just simple market economy. See what happened to practicing law.

The only way to prevent this is to have very strong roots in the hospital/OR, so that the surgeons complain if they get a faceless drone instead of a specific anesthesiologist. I can see subspecialty-level relationships being a great advantage, especially in a private surgical setting. If the surgeons are employed they can complain all they want, if the hospital stands to gain money by changing the anesthesia group.
 
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FFP said:
Nobody is irreplaceable. As the number of subspecialty grads will increase (the same way anesthesia grad numbers have), AMCs will pick and choose the suckers they need. As long as we don't have a numerus clausus in place, it will only get better for them and worse for us. This is not doom and gloom, just simple market economy. See what happened to practicing law.

The only way to prevent this is to have very strong roots in the hospital/OR, so that the surgeons complain if they get a faceless drone instead of a specific anesthesiologist. I can see subspecialty-level relationships being a great advantage, especially in a private surgical setting. If the surgeons are employed they can complain all they want, if the hospital stands to gain money by changing the anesthesia group.
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True that the whole bent in healthcare is to replace the replaceable with cheaper alternatives. I am only re-sounding what has been said by Blade and others here before me. That is that specialization confers a measure of protection from the current state of affairs.

Practices can be trimmed and made more economically advantageous for most institutions but only in so far as expectations of these institutions are being met. I am not here saying that we needn't concern ourselves over our positions of employment...only that in being a sub-specialist, one is less likely to be in low demand. I hope that goes without saying.

Sure, in the future AMCs will acquire an increasing number of sub-specialists but in present day, the majority (anecdotally) are staying in academics. In the future, yeah, I could see many of the larger AMCs having the specialist capital to take over even established academic departments. Will it ever become commonplace? I don't know.
 
It seems that the Bay Area mac group sold out to Sheridan based on the decision of either a ultimate shareholder or a bunch of super shareholders. Everyone had to sign a contract for a little less money and commit for a few years.
 
hudsontc said:
That is that specialization confers a measure of protection from the current state of affairs.
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I agree, but only as long as one does not lose general anesthesiologist skills.
hudsontc said:
Sure, in the future AMCs will acquire an increasing number of sub-specialists but in present day, the majority (anecdotally) are staying in academics. In the future, yeah, I could see many of the larger AMCs having the specialist capital to take over even established academic departments. Will it ever become commonplace? I don't know.
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I think academics will be safe for a long time. The problem with academics is that they are becoming AMCs under disguise.
 
hudsontc said:
the hospital expects pediatric anesthesiologists for kids and TEE certified anesthesiologists for cardiac and skilled regionalists for pain, etc.
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I don't think any of those is particularly difficult to find.
 
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urge said:
I don't think any of those is particularly difficult to find.
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I have no doubt that an AMC can find them. The point is that they'll need to have A LOT of them for a specific location to take over any sizeable, skilled group. They'll also need to do so, presumably at a cost savings. My group has 8-10 cardiac folks who cover LVAD/Transplant/Cardiac call, 8-10 pediatric trained providers covering the pediatric hospital (as well as those doing peds cardiac/cath lab call), a similar number rotating through the perioperative pain service, and yet another group who are skilled at running the board (often with 20+ add-on cases in a day) and writing a good coverage schedule for the next day.

Yeah, AMC takeover could be forseeable when fellowship graduates' only two options are academics or AMC but that just isn't the case yet. They'll need to develop a fountainhead of talent before they're able to bowl over well-established, hospital-contracted groups--as opposed to having a mutual agreement for a buyout.
 
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