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Northstar and NAPA in SE Michigan

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siednarb

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Today in the Metro Detroit area it was announced that Beaumont Health - one of the largest health care system in the Detroit area was turning toward Northstar for it's anesthesia services. Attached is the letter from Beaumont's CEO. NAPA recently acquired Mednax's American Anesthesia division which has the physician contract at Beaumont's other main hospitals in the area. I imagine that Beaumont will ask NAPA to take on the CRNAs or risk losing it all to NorthStar. I do not work for this health system but am in the area in one of the remaining private practice groups watching with concern the corporate take over of anesthesia the area.
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vector2

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"Top of their license" ✔

"Collaborative manner" ✔

"MDA" ✔


CEO sounds like a real gem.

And who exactly over the past 10-15 years has been moving to an outsourced model like he says? Mayo, Cleveland Clinic, Ochsner, Geisinger, and almost every other large, integrated health system similar to Beaumont (other than say Northwell) all have in-house anesthesia.

Also, what's going to happen to happen to the anesthesia residency there?
 
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ambiturner

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Beaumont was one of the most respected and desirable practices in the country just ten years ago. A joke at Michigan’s anesthesia department was ‘University of Michigan: we train Beaumont doctors’. One of the more recent ASA presidents works there.

Hard to believe this is going to be a desirable practice going forward...
 
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Pharmado

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I’ve never worked in a system where the hospital employs the CRNAS and the group is still independent. How does that work? Do the docs get all the anesthesia billing? Seems like a nightmare from a management perspective (Since you’ve got no control over hiring/firing CRNAs) but a $$$ from a financial perspective.
 
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Man o War

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Oh boy- CRNAs are going to hate that. My understanding of this situation is they’ve been trying to offload the nurses for longer than 2 years. They’ve been allowed quite a bit of latitude as far as scheduling, so you can imagine what the OT looks like.
 

cockblockandrun

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WTF is "MDA" (p.s. I know that it means but its infuriating to see the CEO write that).... I guess Deathstar is going to run Michigan to the ground. More locums work for me :)
 
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hypnosMD

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Notice the release never mentions positive feedback from “MDAs” regarding Deathstar. No surprises here. They better get ready for their call burden/hours to go up 50% (oh we are short staffed) and benefits to tank (all of which effectively equates to a massive decrease in hourly compensation).
 

DrZzZz

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I’ve never worked in a system where the hospital employs the CRNAS and the group is still independent. How does that work? Do the docs get all the anesthesia billing? Seems like a nightmare from a management perspective (Since you’ve got no control over hiring/firing CRNAs) but a $$$ from a financial perspective.

I'm sure one practice varies from the next. In my experience, the group and hospital split the anesthesia fees based on some agreement in the contract. Group doesn't have direct say in hiring and firing, of course, but certainly can influence the powers that be if anyone who has been hired is troublesome. Depends on the relationship as to how effective that conversation is. Financially, it's more lucrative than employing the CRNAs, but potentially can be more of a headache dealing with rogue CRNAs since it's harder to get them removed.
 

siednarb

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The original Beaumont (RO and Troy) anesthesia physician practices sold to Mednax ~ 7 years ago
Mednax sold off it's Anesthesia division to NAPA last month as I think most are aware
not sure what is going to happen to RO/Troy hospitals

Beaumont Dearborn and points south are all going to become NorthStar
Many of these hospitals had been with A4 (Ann Arbor group) which sold to a VC firm a year ago - SiroMed
Not sure if A4 is going to try to hold up noncompete against NorthStar

Also Beaumont CRNAs were starting to make overtures to forming a union from rumors I had been hearing

All of these factors I'm sure played a role in Beaumont making this move
The likely result will be decreased quality and devotion by these anesthesia departments to their institution over time

The ASA president who was once part of Beaumont's private practice (later Mednax) moved to Cedars Sinai in LA I think a year or two ago
 
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Southpaw

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I’ve never worked in a system where the hospital employs the CRNAS and the group is still independent. How does that work? Do the docs get all the anesthesia billing? Seems like a nightmare from a management perspective (Since you’ve got no control over hiring/firing CRNAs) but a $$$ from a financial perspective.

The billing is split 50:50 as the hospital will bill for CRNA professional services and the group will bill for physician medical direction (typically). From a money persective, it simply depends on the cost of the CRNAs. Your group income is professional billing fees. Your expenses are overhead (billing, CRNAs, etc.). It's simple math. From a management perspective, it depends on the relationship between the hospital and physician group. Obviously, one can imagine the hospital's incentive in the arrangement.

It's easy to envision a scenario where reimbursement stagnates (already has happened...) and yet CRNA demands (salary, benefits, overtime, etc.) increase leaving groups who employ CRNAs few options aside from 1) paying physicians less, 2) asking the hospital for a CRNA subsidy, or 3) asking the hospital to employ the CRNAs. One can also imagine how that scenario plays out and what position it puts the physician group in.

If a physician group is unwilling to do the cases themselves or if they are unable or unwilling to bring in AAs then they make the equation more difficult for themself.
 
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Southpaw

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The original Beaumont (RO and Troy) anesthesia physician practices sold to Mednax ~ 7 years ago
Mednax sold off it's Anesthesia division to NAPA last month as I think most are aware
not sure what is going to happen to RO/Troy hospitals

Beaumont Dearborn and points south are all going to become NorthStar
Many of these hospitals had been with A4 (Ann Arbor group) which sold to a VC firm a year ago - SiroMed
Not sure if A4 is going to try to hold up noncompete against NorthStar

Also Beaumont CRNAs were starting to make overtures to forming a union from rumors I had been hearing

All of these factors I'm sure played a role in Beaumont making this move
The likely result will be decreased quality and devotion by these anesthesia departments to their institution over time

The ASA president who was once part of Beaumont's private practice (later Mednax) moved to Cedars Sinai in LA I think a year or two ago

Your prediction of decreased quality and devotion is fact as it's been proven time and time again. Physicians will not perform well, long-term, in environments where corporate executives are constantly trying to find ways to profit off of them. They're smart people and they figure it out. Guess who REALLY suffers in the end? Communities and patients.

Corporate medicine is bad for everyone.
 
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Southpaw

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and that letter was signed by a physician, the CMO of the system. One MD calling another MDA, as if it means something less. If we don't stand up for ourselves no one will.
 
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chocomorsel

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and that letter was signed by a physician, the CMO of the system. One MD calling another MDA, as if it means something less. If we don't stand up for ourselves no one will.
I do locums in a place where all the OR staff including the anesthesiologists are all very familiar and comfortable with MDA. It’s also a place with rogue and rude CRNAs and wimpy docs. The doc who stood up to some of the surgeons got pushed out.
 
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dannyboy1

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I do locums in a place where all the OR staff including the anesthesiologists are all very familiar and comfortable with MDA. It’s also a place with rogue and rude CRNAs and wimpy docs. The doc who stood up to some of the surgeons got pushed out.
The surgeons will be respected and catered to because they bring in $$. We are an expense, a necessary evil. The CRNA can get away with rude and obnoxious behavior because they are paid less then us therefore are more valuable. These are the realities of life in anesthesia. We are not special. There are plenty of us who can do the job safely and effectively while also kissing @ss. The only thing that you should work for is a paycheck. If you expect anything else you will be disappointed.....
 
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chocomorsel

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The surgeons will be respected and catered to because they bring in $$. We are an expense, a necessary evil. The CRNA can get away with rude and obnoxious behavior because they are paid less then us therefore are more valuable. These are the realities of life in anesthesia. We are not special. There are plenty of us who can do the job safely and effectively while also kissing @ss. The only thing that you should work for is a paycheck. If you expect anything else you will be disappointed.....
Plenty of other places I have worked where this is not the norm. Where anesthesiologists are treated respectfully and called doctors not MDAs. I am at such a place now.

I don’t have to kiss ass, I don’t have to be rude. And I don’t take well to being treated like crap if I can help it.
 
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PainDrain

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Not sure what the deal is with NAPA in my area but I have been getting almost daily texts or calls from them. They must be desperate to fill some vacant spots because they definitely aren’t expanding in my region.
 

aneftp

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Sounds like the mednax scope anesthesia fiasco in North Carolina. Where hospital retain cRna billing rights. So had all the power to just give the contract to the scope anesthesia/fake 3rd party subsidy.
 

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I can’t stand the passive aggressive and derogatory use of ‘mda’
 

MoMoGesiologist

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Does anyone else not really care about the term MDA? so much easier than saying/typing “AnEsThesIOLoGist” (a whole 7 syllables!)
 
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deleted162650

Does anyone else not really care about the term MDA? so much easier than saying/typing “AnEsThesIOLoGist” (a whole 7 syllables!)

If that’s too big of a word for you, then how ‘bout you just say “Doctor”.
 
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Southpaw

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Does anyone else not really care about the term MDA? so much easier than saying/typing “AnEsThesIOLoGist” (a whole 7 syllables!)

the funny thing about the term MDA is that I've only seen it used in places with CRNAs, which leads me to believe that they start it for nefarious reasons. I'd love to be proven wrong. So if any of you MD only peeps out there get called MDA at your place, then let us hear it.
 
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chocomorsel

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the funny thing about the term MDA is that I've only seen it used in places with CRNAs, which leads me to believe that they start it for nefarious reasons. I'd love to be proven wrong. So if any of you MD only peeps out there get called MDA at your place, then let us hear it.
Absolutely true.
 

amyl

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I do locums in a place where all the OR staff including the anesthesiologists are all very familiar and comfortable with MDA. It’s also a place with rogue and rude CRNAs and wimpy docs. The doc who stood up to some of the surgeons got pushed out.
which state is this?
 

sevoflurane

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I’ve never been called an MD(A).
I’ve never supervised in the 10+ years i’ve been out of residency.
 
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chocomorsel

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I’ve never been called an MD(A).
I’ve never supervised in the 10+ years i’ve been out of residency.
You are a lucky, lucky man. My friends who used to not supervise are now supervising. I avoid it in practice as much as I can. Rather work collaboratively with nurses than supervise them.
 

narcotics999

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You are a lucky, lucky man. My friends who used to not supervise are now supervising. I avoid it in practice as much as I can. Rather work collaboratively with nurses than supervise them.

What is the meaning of "collaboratively"? You still cover their axx when $hit hits the fan? Are you liable for their mistakes if they ask your help?
 

chocomorsel

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What is the meaning of "collaboratively"? You still cover their axx when $hit hits the fan? Are you liable for their mistakes if they ask your help?
As in they do their cases completely on their own and I do my own cases completely on their own. That is my definition of it. Instead of running around like a chicken with my head cut off putting out fires and dealing with bad attitudes. And I would not be liable for any of their problems. Just my own.
Of course, in the real world, when a room is in crisis and calls for help, then everyone usually goes running to assist. This happened to me recently in a case with an emergency. I do think that this could create a problem for a physician though who goes to help a room staffed by a CRNA simply because we are seen as having deeper pockets. Of course you would hope that as someone running to assist, you aren't named in a lawsuit. I don't put people's names down on paper when they come to help me. I just write "called for help and assistance arrived."
A nurse though is taught differently and I wouldn't put it past them to try and throw someone else, a helping doc under the bus.
 
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MoMoGesiologist

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As in they do their cases completely on their own and I do my own cases completely on their own. That is my definition of it. Instead of running around like a chicken with my head cut off putting out fires and dealing with bad attitudes. And I would not be liable for any of their problems. Just my own.
Of course, in the real world, when a room is in crisis and calls for help, then everyone usually goes running to assist. This happened to me recently in a case with an emergency. I do think that this could create a problem for a physician though who goes to help a room staffed by a CRNA simply because we are seen as having deeper pockets. Of course you would hope that as someone running to assist, you aren't named in a lawsuit. I don't put people's names down on paper when they come to help me. I just write "called for help and assistance arrived."
A nurse though is taught different and I wouldn't put it past them to try and throw someone else, a helping doc under the bus.
Is that why the circulator always asks for my name anytime I go into a room? Nurses are always writing down names, writing up people. Is there a course in nursing school on how to eff other people over? Maybe it’s called “Not on my license 101l
 
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chocomorsel

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Is that why the circulator always asks for my name anytime I go into a room? Nurses are always writing down names, writing up people. Is there a course in nursing school on how to eff other people over? Maybe it’s called “Not on my license 101l
Probably. They document it. Pay attention next time.
We were always taught, document document document to CYA. Anytime you call a or communicate w doctors about something, document.
 

IMGASMD

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Probably. They document it. Pay attention next time.
We were always taught, document document document to CYA. Anytime you call a or communicate w doctors about something, document.

They don’t ever want to be caught “practicing medicine” without a license. I document what’s “necessary” to get paid, unless it’s a very bad case....

If that’s too big of a word for you, then how ‘bout you just say “Doctor”.

What about doctor of nursing practice?!
 

Lecithin5

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As in they do their cases completely on their own and I do my own cases completely on their own. That is my definition of it. Instead of running around like a chicken with my head cut off putting out fires and dealing with bad attitudes. And I would not be liable for any of their problems. Just my own.
Of course, in the real world, when a room is in crisis and calls for help, then everyone usually goes running to assist. This happened to me recently in a case with an emergency. I do think that this could create a problem for a physician though who goes to help a room staffed by a CRNA simply because we are seen as having deeper pockets. Of course you would hope that as someone running to assist, you aren't named in a lawsuit. I don't put people's names down on paper when they come to help me. I just write "called for help and assistance arrived."
A nurse though is taught differently and I wouldn't put it past them to try and throw someone else, a helping doc under the bus.
That’s kind of the annoying thing about helping someone who documents names- for example, if I am asked to help place a difficult epidural after a colleague attempted God knows how many times, only for them to document “Dr Lecithin5 came to help place epidural...”. Great, thanks a lot
 

meschler

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Your prediction of decreased quality and devotion is fact as it's been proven time and time again. Physicians will not perform well, long-term, in environments where corporate executives are constantly trying to find ways to profit off of them. They're smart people and they figure it out. Guess who REALLY suffers in the end? Communities and patients.

Corporate medicine is bad for everyone.
Except for the shareholders
 
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siednarb

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sent to me by some Beaumont docs

Dear Physician Colleagues,

As you saw in a note from Adam and the press release this morning, Randy Moore, the current CEO of the AANA, will join NorthStar as our new Chief Anesthetist Officer. Randy will not officially start with NorthStar until early September, and at that time many of you will have the opportunity to meet and work with Randy.

As physician leaders at NorthStar, we felt it was important to acknowledge the trepidation you might be feeling regarding a CEO of the AANA taking on such a critical leadership position at NorthStar. We know that sometimes the AANA and ASA can be at odds with each other and with NorthStar’s vision of delivering team-based anesthesia care.

With this context, we want to assure you that Randy joins NorthStar with the clear understanding and expectation that he is partnering with our physician leadership to further NorthStar’s team-based approach. At the core of everything we do is a belief that physician anesthesiologists and CRNAs must work closely together as #OneTeam to create trust, unity, and partnership in how we care for our patients. Randy is fully supportive of this approach and excited to join our team under this banner. And in turn, we are excited to have a strong CRNA partner in Randy.

We are confident that when Randy officially joins the team, your interactions with him will confirm what we have shared here. Given that is a few months away, we wanted to ensure you had this note of confidence from us to assuage any potential concerns.

Please don’t hesitate to reach out to us if you’d like to discuss further.

All the best,

Josh Lumbley, MD MBOE FASA
Chief Quality Officer


(picture screen grab off video of the new Northstar "Chief Anesthesia Officer" aka former AANA CEO - zoom in on the name plate in the background on his desk)
 

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IMGASMD

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sent to me by some Beaumont docs

Dear Physician Colleagues,

As you saw in a note from Adam and the press release this morning, Randy Moore, the current CEO of the AANA, will join NorthStar as our new Chief Anesthetist Officer. Randy will not officially start with NorthStar until early September, and at that time many of you will have the opportunity to meet and work with Randy.

As physician leaders at NorthStar, we felt it was important to acknowledge the trepidation you might be feeling regarding a CEO of the AANA taking on such a critical leadership position at NorthStar. We know that sometimes the AANA and ASA can be at odds with each other and with NorthStar’s vision of delivering team-based anesthesia care.

With this context, we want to assure you that Randy joins NorthStar with the clear understanding and expectation that he is partnering with our physician leadership to further NorthStar’s team-based approach. At the core of everything we do is a belief that physician anesthesiologists and CRNAs must work closely together as #OneTeam to create trust, unity, and partnership in how we care for our patients. Randy is fully supportive of this approach and excited to join our team under this banner. And in turn, we are excited to have a strong CRNA partner in Randy.

We are confident that when Randy officially joins the team, your interactions with him will confirm what we have shared here. Given that is a few months away, we wanted to ensure you had this note of confidence from us to assuage any potential concerns.

Please don’t hesitate to reach out to us if you’d like to discuss further.

All the best,

Josh Lumbley, MD MBOE FASA
Chief Quality Officer


(picture screen grab off video of the new Northstar "Chief Anesthesia Officer" aka former AANA CEO - zoom in on the name plate in the background on his desk)

I was thinking what’s the big deal, they hired someone..... after reading this, finally daunt on me.....
what the actual F U K?!
 
D

deleted126335

At best it shows an utter disregard for the emotions of the Northstar physicians. At worst it send a deliberate message that this is our culture, these are our values.
 
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pgg

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Lololol

A few days working in a Northstar surgicenter a few years back was enough for me to just quit and walk out. What an absolute ****show.

I hope everyone there gets a really bad sunburn and then falls into a field of cacti. I'd like to give them all paper cuts and then pour lemon juice in them. May the fleas of a thousand camels ...
 

MirrorTodd

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sent to me by some Beaumont docs

Dear Physician Colleagues,

As you saw in a note from Adam and the press release this morning, Randy Moore, the current CEO of the AANA, will join NorthStar as our new Chief Anesthetist Officer. Randy will not officially start with NorthStar until early September, and at that time many of you will have the opportunity to meet and work with Randy.

As physician leaders at NorthStar, we felt it was important to acknowledge the trepidation you might be feeling regarding a CEO of the AANA taking on such a critical leadership position at NorthStar. We know that sometimes the AANA and ASA can be at odds with each other and with NorthStar’s vision of delivering team-based anesthesia care.

With this context, we want to assure you that Randy joins NorthStar with the clear understanding and expectation that he is partnering with our physician leadership to further NorthStar’s team-based approach. At the core of everything we do is a belief that physician anesthesiologists and CRNAs must work closely together as #OneTeam to create trust, unity, and partnership in how we care for our patients. Randy is fully supportive of this approach and excited to join our team under this banner. And in turn, we are excited to have a strong CRNA partner in Randy.

We are confident that when Randy officially joins the team, your interactions with him will confirm what we have shared here. Given that is a few months away, we wanted to ensure you had this note of confidence from us to assuage any potential concerns.

Please don’t hesitate to reach out to us if you’d like to discuss further.

All the best,

Josh Lumbley, MD MBOE FASA
Chief Quality Officer


(picture screen grab off video of the new Northstar "Chief Anesthesia Officer" aka former AANA CEO - zoom in on the name plate in the background on his desk)
Have we really fallen so far that we are now including hashtags in our professionally written letters/memos?
 
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D P356

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I’d think the politics are all local, but that’s a bad look.
“Hey guys, we brought in the mouthpiece/leader of the organization that’s against you; but it’s okay.
#synergy #team
 
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hankbb02

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Today in the Metro Detroit area it was announced that Beaumont Health - one of the largest health care system in the Detroit area was turning toward Northstar for it's anesthesia services. Attached is the letter from Beaumont's CEO. NAPA recently acquired Mednax's American Anesthesia division which has the physician contract at Beaumont's other main hospitals in the area. I imagine that Beaumont will ask NAPA to take on the CRNAs or risk losing it all to NorthStar. I do not work for this health system but am in the area in one of the remaining private practice groups watching with concern the corporate take over of anesthesia the area.
View attachment 308744 View attachment 308745
First thing I noticed was the acronym MDA. It makes my blood boil that the nurse lobby has been so successful in obscuring our credentials. I got a cover letter the other day from an idiot calling herself a MDA.
 
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hankbb02

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Does anyone else not really care about the term MDA? so much easier than saying/typing “AnEsThesIOLoGist” (a whole 7 syllables!)
Hey why don't you call yourself a MD? Novel idea isn't it. I sometimes wonder how some people got through medical school.
 
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ambiturner

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My first instinct if I was working at this place would be to run and run fast. But let’s say you find a more physician friendly practice, who’s to say the place doesn’t look like this in 5 years? I don’t think anyone saw Beaumont turning into this, maybe until they sold out.

For an early career anesthesiologist I think this is the tough question: do you accept this crappy model as the inevitable future and go with the flow, or do you keep trying to find the shrinking number of well-run physician led practices?
 
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osumd

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My first instinct if I was working at this place would be to run and run fast. But let’s say you find a more physician friendly practice, who’s to say the place doesn’t look like this in 5 years? I don’t think anyone saw Beaumont turning into this, maybe until they sold out.

For an early career anesthesiologist I think this is the tough question: do you accept this crappy model as the inevitable future and go with the flow, or do you keep trying to find the shrinking number of well-run physician led practices?
How is this a tough question?
 

Twiggidy

Manny Rivers Cuomo
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My first instinct if I was working at this place would be to run and run fast. But let’s say you find a more physician friendly practice, who’s to say the place doesn’t look like this in 5 years? I don’t think anyone saw Beaumont turning into this, maybe until they sold out.

For an early career anesthesiologist I think this is the tough question: do you accept this crappy model as the inevitable future and go with the flow, or do you keep trying to find the shrinking number of well-run physician led practices?
If you accept things then you'll never have change. I know that's tough when you either currently don't have a job or have a job you don't want but most of these places feed off desperation.
 
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