Northstar Anesthesia

[Psai]

AMCs can bill 30 percent more per unit for insurance cases vs the hospital. AMCs can fire at will and pay less than fair wage. Hospitals must pay fair wages and have HR departments. Hence, the vast majority of hospitals (over 80 percent) are better off with an AMC vs hiring their own providers.

Until we get a radical change in billing/reimbursement the AMC is here to stay.

Seems like changes in billing/reimbursement happen every year. Just in a generally unfavorable direction for physicians

---

Members don't see this ad.

 

[BuzzPhreed]

I agree with Doze. Hospitals do a poor job at anesthesia billing and reimbursement. In addition, hospitals overpay and get less work out of their employees.

This is not entirely true.

I work in a hospital-employed arrangement and I can tell you first hand that the people at the top end negotiate with payers for "packaged" care. That is, they work deals with groups similar to how the DRG works with CMS reimbursement. So when the patient within that PPO or EPO comes in as we have been negotiated into their network, their patients are steered to our facility because they get a better overall pre-negotiated deal, say, for a knee or hip or hernia. In effect our fee is rolled into the facility fee. And we are busy enough right now that there is no way that the hospital would "sell us out" to an AMC. Their fee more than covers my salary. And why would they want to turn over any control to an external vendor?

No, I don't necessarily think criticalelement is that far off.

 

[BLADEMDA]

This is not entirely true.

I work in a hospital-employed arrangement and I can tell you first hand that the people at the top end negotiate with payers for "packaged" care. That is, they work deals with groups similar to how the DRG works with CMS reimbursement. So when the patient within that PPO comes in as we have been negotiated into their network, their patients are steered to our facility because they get a better overall pre-negotiated deal, say, for a knee or hip or hernia. In effect our fee is rolled into the facility fee. And we are busy enough right now that there is no way that the hospital would "sell us out" to an AMC. Their fee more than covers my salary. And why would they want to turn over any control to an external vendor?

No, I don't necessarily think criticalelement is that far off.

Your hospital is accepting less to get the business. They are eating some of the anesthesia fee and other fees to land the cases. This certainly seems reasonable in today's economic climate and I commend your administration for looking at the big picture. Unfortunately, most CEOs don't understand the Global Fee concept very well and instead look at each department as a money maker or a money loser (anesthesia) which allows the AMC to steal the contract.

 

[anbuitachi]

AMCs can bill 30 percent more per unit for insurance cases vs the hospital. AMCs can fire at will and pay less than fair wage. Hospitals must pay fair wages and have HR departments. Hence, the vast majority of hospitals (over 80 percent) are better off with an AMC vs hiring their own providers.

Until we get a radical change in billing/reimbursement the AMC is here to stay.

I imagine things will be more different in future since hospitals are merging and expanding their network. They should be able to negotiate some good deals..

 

[pgg]

IMO, it would be much cheaper for a hospital to hire a competent well-paid chief of anesthesia, who can build a proper anesthesia department (including billing etc.), then to give these AMCs all that profit. I think the reason this is not happening is that the US has almost destroyed the private for-profit hospitals.

There are a lot more business-savvy MBA suits out there than business-savvy anesthesiologists. You've got to remember that the entire field of medicine selects strongly for people who didn't want to spend their lives in the business world. I can't claim a lot of experience in this area and I sure won't go so far as to claim that I could do it at this point ... but I'm positive that 90%+ of the anesthesiologists I know could barely keep a department of anesthesiologists running smoothly, much less do that AND maneuver through the hospital admin and insurance worlds.

Medicine selects for people not interested in business, and anesthesiology selects for people not interested in dealing with other people. Lots of us are in this field in part because we can end conversations with patients by shoving PVC between their vocal cords.

I totally understand the appeal AMCs have to hospital administrators.

 

[BuzzPhreed]

I totally understand the appeal AMCs have to hospital administrators.

... versus having to deal with a difficult group? I don't think this is limited to anesthesiologists. The bigger practice management companies are multipractice and usually pick-on the lucrative services that are more shift-like, don't demand an ongoing patient-physician relationship, and are consultant based without bringing new business into the hospital, like radiology, emergency medicine, and anesthesiology.

 

[deleted171991]

There are a lot more business-savvy MBA suits out there than business-savvy anesthesiologists. You've got to remember that the entire field of medicine selects strongly for people who didn't want to spend their lives in the business world. I can't claim a lot of experience in this area and I sure won't go so far as to claim that I could do it at this point ... but I'm positive that 90%+ of the anesthesiologists I know could barely keep a department of anesthesiologists running smoothly, much less do that AND maneuver through the hospital admin and insurance worlds.

Medicine selects for people not interested in business, and anesthesiology selects for people not interested in dealing with other people. Lots of us are in this field in part because we can end conversations with patients by shoving PVC between their vocal cords.

I totally understand the appeal AMCs have to hospital administrators.

Then, once we are fed up with anesthesia companies, we should all go and get business degrees, like Buzz.

 

[BuzzPhreed]

Just finished my first semester!

 

[anbuitachi]

Just finished my first semester!

is a cheap mba even worth it..?

 

[BuzzPhreed]

This isn't some online MBA, son.

I'll give you one hint: the program I'm in is a top 25 MBA program -- not executive -- who also happens to have a college b-ball team ranked in the top 25.

So I guess you're going to have to better define "cheap"? As far as cost, I can tell you that I'm getting tuition assistance from my employer. Not paying for the whole thing but makes it a relative no-brainer.

Furthermore, you wouldn't believe the connections I've already made. Diversify or die. If you can't beat 'em, join 'em.

 

[Mman]

Wow, I understood that they could negotiate a better per unit rate but I had no idea it was 30% more.

I suspect it's even more than that for most of them.

 

[combatwombat]

I am an intern now, going to start CA-1 year in July. I just found out Northstar is bidding to take over the anesthesia practice at the academic medical center where I will do my training. Is there anything I can do to stop this?

I did two anesthesia rotations at hospitals that were taken over by Northstar, and in both cases academics crumped.

 

[deleted171991]

I am an intern now, going to start CA-1 year in July. I just found out Northstar is bidding to take over the anesthesia practice at the academic medical center where I will do my training. Is there anything I can do to stop this?

I did two anesthesia rotations at hospitals that were taken over by Northstar, and in both cases academics crumped.

You can pray they won't get the contract. There have been cases of residency programs shattered after an AMC takeover.

 

[Planktonmd]

You can pray they won't get the contract. There have been cases of residency programs shattered after an AMC takeover.

AMCs exist for one and only one reason: putting money in the pockets of share holders.
They achieve that by maximum utilization of assets (Employees, Facilities, Overhead...)
This maximum utilization of assets is not compatible with the nature of residency programs where trainees are supposed to be given time and opportunity to learn and develop skills.
You can't train soldiers by throwing them in full battle on the first day.

 

[norwood]

What do you suggest? Go on strike? Form a union? Good luck with that. We don't get to ask for rights, like nurses.

If you're an employed doc, like the poor guys stuck at Northstar, I thought it was actually legal to form a union - no?

 

[deleted171991]

If you're an employed doc, like the poor guys stuck at Northstar, I thought it was actually legal to form a union - no?

That is correct.

 

[norwood]

That is correct.

Do you think they'll manage to push their docs far enough that it happens? They have enough trouble finding help as it is (as evidenced by their eternal Gaswork posts) that I don't see them being able to just hire people to break a strike.

 

[deleted171991]

They have trouble finding people, for now. As more and more anesthesiologists are replaced by CRNAs, it will get easier.

 

[norwood]

They have trouble finding people, for now. As more and more anesthesiologists are replaced by CRNAs, it will get easier.

Which is why, if their anesthesiologists are smart...

 

[combatwombat]

[QUOTE="FFP, post: 16033921, member: 171991" You can pray they won't get the contract. There have been cases of residency programs shattered after an AMC takeover.[/QUOTE]

Do you know of any examples? The move evidence I can site the more likely the decision makers at my hopsital are to listen to me.

I know the chances of them taking advice from a PGY-1 are near zero but I'd like to do more than pray.

 

[k12balla]

Look up the ut elpaso program that got taken over by somnia. The entire residency shut down, staff fired, residents months away from graduating left to fend for themselves.

 

[Ronin2258]

Med Students should examine Northstar and AMCs as proof that the field is in big trouble.
...
3. AMCs are taking market share every day and cutting salaries. You will likely be employed by these guys at $250-$275K.
...
7. Anesthesia will end up with Family practice type income with three times the stress, 30% more work hours and lots of night time/weekend call.

Heck, I get a better starting salary being hired by the VA/Academic program. Just the paperwork taking forever.

 

[deleted171991]

Heck, I get a better starting salary being hired by the VA/Academic program.

For now. Those guys aren't idiots.

 

[Planktonmd]

That is correct.

Unfortunately most of us anesthesiologists are puss**s in reality and that's why a union is probably never going to happen!

 

[BuzzPhreed]

Unfortunately most of us anesthesiologists are puss**s in reality and that's why a union is probably never going to happen!

You forgot to add "spineless" in there.

 

[anbuitachi]

Heck, I get a better starting salary being hired by the VA/Academic program. Just the paperwork taking forever.

Most med students don't know how much anesthesiologists make. Even those going into it. They might see it in medscape surveys but that's not far off from 250-275. So I think if you tell med student they'll be making that starting... They'd be pretty happy

 

[emergentmd]

This is why doctors across the board will make less. The newer generation have no clue how much their previous generations made. So making 200K sounds GREAT.

When I started as an attending (EM) 15 yrs ago, we were paid twice a month. The first check my gross was 8K. I thought that it seemed alittle light esp for what I was quoted. But 8k x 24 checks = 192K + benefits worth about 70K.

I thought ok, i can live with that. The 2nd check actually was the rest of what you billed in the previous month. Needless to say, the 2nd check was 18-22K. So I ended up making 325K+ benefits the first year. This was before becoming partners which jacked it up past 400K.

But looking back, if they paid me 192K plus benefits, I would have been just as content. I would think most new EM grads would take a 250K+ package. I would jump ship in a heartbeat if they lowered my pay to that level.

This is one reason why AMC/Emcare type companies will eventually take over. They know the new grads will take a lower pay b/c their expectations are just not as high.

 

[IkeBoy18]

Thank you for this information. I think most attendings arent as forthcoming with this information which makes it hard for us to know. All we see online are pretty low salaries except MGMA but everyone says MGMA listed salaries are too high. Of course we can look up salaries at public academic institutions but these are typically very low and usually dont include the entire package, also the n = low, as AAMC says 85% of anesthesiologists work in PP. At least that was the stat I read a while back.

This is why doctors across the board will make less. The newer generation have no clue how much their previous generations made. So making 200K sounds GREAT.

When I started as an attending (EM) 15 yrs ago, we were paid twice a month. The first check my gross was 8K. I thought that it seemed alittle light esp for what I was quoted. But 8k x 24 checks = 192K + benefits worth about 70K.

I thought ok, i can live with that. The 2nd check actually was the rest of what you billed in the previous month. Needless to say, the 2nd check was 18-22K. So I ended up making 325K+ benefits the first year. This was before becoming partners which jacked it up past 400K.

But looking back, if they paid me 192K plus benefits, I would have been just as content. I would think most new EM grads would take a 250K+ package. I would jump ship in a heartbeat if they lowered my pay to that level.

This is one reason why AMC/Emcare type companies will eventually take over. They know the new grads will take a lower pay b/c their expectations are just not as high.

 

[Sirach38]

Exactly. I think most of us who decided on gas, did so with the idea that we would be making 200k-250k after residency because this is what the surveys say and because this is what our mentors make in academics and they seem to be living a very happy and comfortable life. When I chose gas this is what I knew. That is why when people talk about me making 200k as a worst case scenario, it doesn't really scare me. I am sure things would be a lot different if I had been used to a 400-500k salary for years and all of a sudden they decided to cut my salary in half.

 

[BLADEMDA]

Exactly. I think most of us who decided on gas, did so with the idea that we would be making 200k-250k after residency because this is what the surveys say and because this is what our mentors make in academics and they seem to be living a very happy and comfortable life. When I chose gas this is what I knew. That is why when people talk about me making 200k as a worst case scenario, it doesn't really scare me. I am sure things would be a lot different if I had been used to a 400-500k salary for years and all of a sudden they decided to cut my salary in half.

Academic Anesthesiologists work a lot less than PP ones. So, let's hope your AMC job reflects that nice academic lifestyle. It isn't just what you earn but what you have to do to get that salary that matters to a lot of people.

 

[deleted171991]

Academic Anesthesiologists work a lot less than PP ones.

Wrong. They used to. Nowadays many academic centers are squeezing their employees, especially the junior attendings who are also the worst-paid (on top of everything, for the reasons mentioned above). Speaking of AMCs...

If one does not work with residents, one can eat the same crap as in PP but for an academic salary. More and more young grads fall into this trap, as they have trouble finding good PP jobs.

 

[emergentmd]

Their expectations are not as high not out of ignorance. Their expectations are not as high because they realize that the profession of medicine is in the process of being broken across most specialties.

I am sure it is multifactorial and everyone has a different reason for why 270K (without benefits) a year is great. But I can tell you that all of these averages for EM (I am sure for all specialties) that I see can published could not be true for full time docs. I am sure it is a combo of full time, part time, EMs who work in urgent care, etc. I do not know of any full time EM doc who makes anywhere close to that low. At 270k working 140hrs a month would come to $160/hr. You could not find a boarded EM doc to work for that wage unless under rare circumstances (ie hawaii).

But if I was an EM med student/resident and the published avg was 270K, I would be excited at 160/hr,

 

[emergentmd]

Exactly. I think most of us who decided on gas, did so with the idea that we would be making 200k-250k after residency because this is what the surveys say and because this is what our mentors make in academics and they seem to be living a very happy and comfortable life. When I chose gas this is what I knew. That is why when people talk about me making 200k as a worst case scenario, it doesn't really scare me. I am sure things would be a lot different if I had been used to a 400-500k salary for years and all of a sudden they decided to cut my salary in half.

I guess ignorance is bliss and there is nothing wrong with setting a low expectation then to realize that you make so much more. This is where the CMGs lay the groundwork to lower wage and keep more $$$. All they need to do is fine a bunch of newly minted docs and give them the published rate and all would be happy.

I know better and actually do some moonlighting with a CMG but the rate I get is atleast 2X what they are offering new grads. I do feel sorry for some of the full timers where I moonlight b/c they got a crappy contract b/c they did not know what they could have negotiated for.

 

[Sirach38]

I guess ignorance is bliss and there is nothing wrong with setting a low expectation then to realize that you make so much more. This is where the CMGs lay the groundwork to lower wage and keep more $$$. All they need to do is fine a bunch of newly minted docs and give them the published rate and all would be happy.

I know better and actually do some moonlighting with a CMG but the rate I get is atleast 2X what they are offering new grads. I do feel sorry for some of the full timers where I moonlight b/c they got a crappy contract b/c they did not know what they could have negotiated for.

Thank God for SDN (especially this forum).

 

[IkeBoy18]

FYI, as a boarded junior academic anesthesiologist I am paid less than that.

yikes

 

[kazuma]

FYI, as a boarded junior academic anesthesiologist I am paid less than that.

Based on the rough numbers I calculated, new, non-boarded, non-fellowship trained attendings at my place make around 160/hr. Not bad pay to sit around and surf ebay/craigslist/triathlon sites all day while the residents do your work. They aren't required to do their own cases, there is exactly one day per year (16 hours actually) where 3 (un)lucky attendings staff the OR's while the residents rest/take the ITE. Rarely a younger attending will do a few of their own cases in July when staffing is lean. Pretty boring though, perhaps that's why some of them seem miserable and have have low career satisfaction compared to the PP folks I rotated with as a med student. This is one of the top reasons I am not choosing a career in academics despite the fact that I like teaching and working with residents.

 

[BLADEMDA]

Based on the rough numbers I calculated, new, non-boarded, non-fellowship trained attendings at my place make around 160/hr. Not bad pay to sit around and surf ebay/craigslist/triathlon sites all day while the residents do your work. They aren't required to do their own cases, there is exactly one day per year (16 hours actually) where 3 (un)lucky attendings staff the OR's while the residents rest/take the ITE. Rarely a younger attending will do a few of their own cases in July when staffing is lean. Pretty boring though, perhaps that's why some of them seem miserable and have have low career satisfaction compared to the PP folks I rotated with as a med student. This is one of the top reasons I am not choosing a career in academics despite the fact that I like teaching and working with residents.

In 3-5 years I'd love to get that $160 per hour job teaching residents. As long as the weather is warm I'm interested in spending my last 8-10 years in practice as a "junior" attending. While PP has its advantages including income and less B.S. academia makes for a more interesting career; of course, I'm not that excited about the notion of working with certain types of CA-1s

 

[k12balla]

Exactly. I think most of us who decided on gas, did so with the idea that we would be making 200k-250k after residency because this is what the surveys say and because this is what our mentors make in academics and they seem to be living a very happy and comfortable life. When I chose gas this is what I knew. That is why when people talk about me making 200k as a worst case scenario, it doesn't really scare me. I am sure things would be a lot different if I had been used to a 400-500k salary for years and all of a sudden they decided to cut my salary in half.

You can't compare making 250 k now vs 500 k in the past in PP, its apples and oranges. You're working more hours, supervising more, taking on more liability and responsibility, all with less job security. Its one thing to be humble and live modestly, its another to be downright foolish and not perform your due diligence on your worth in the market. Ignorance of what could've been is not an excuse, as the pacificity of your mindset and similar new grads with low expectations will only lead to a continued downward trajectory of reimbursement.

This is why physicians continue to get screwed when it comes to all matters financial. You are taught to be altruistic, trust your consultants, and do it for the good of humanity. Meanwhile, everyone has their hand in your pockets, looking for any angle with which to exploit you, and preying on your ignorance.

I recommend you read "The Successful Physician Negotiator"
Amazon product


Reading SDN, WCI, bogleheads, etc are great resources for helping to manage your finances and plan for retirement, but the most important thing you can ever do in your career, which will cost you hundreds of thousands if not millions over the long haul, is negotiating your initial contract. And you can't do that successfully if you don't appreciate what your assets are worth.

Also read "The Rape of Emergency Medicine" for a brief history on ER being overrun by suits and taking a giant cut of your paycheck, and the foreshadowing of things to come in Anesthesiology.
http://www.aaemrsa.org/resources/rape-of-em

 

[Baller MD]

You can't compare making 250 k now vs 500 k in the past in PP, its apples and oranges. You're working more hours, supervising more, taking on more liability and responsibility, all with less job security. Its one thing to be humble and live modestly, its another to be downright foolish and not perform your due diligence on your worth in the market. Ignorance of what could've been is not an excuse, as the pacificity of your mindset and similar new grads with low expectations will only lead to a continued downward trajectory of reimbursement.

This is why physicians continue to get screwed when it comes to all matters financial. You are taught to be altruistic, trust your consultants, and do it for the good of humanity. Meanwhile, everyone has their hand in your pockets, looking for any angle with which to exploit you, and preying on your ignorance.

I recommend you read "The Successful Physician Negotiator"
Amazon product


Reading SDN, WCI, bogleheads, etc are great resources for helping to manage your finances and plan for retirement, but the most important thing you can ever do in your career, which will cost you hundreds of thousands if not millions over the long haul, is negotiating your initial contract. And you can't do that successfully if you don't appreciate what your assets are worth.

Also read "The Rape of Emergency Medicine" for a brief history on ER being overrun by suits and taking a giant cut of your paycheck, and the foreshadowing of things to come in Anesthesiology.
http://www.aaemrsa.org/resources/rape-of-em

Do you know how bad it currently is in EM and if it got any better since?

 

[Mman]

Reading SDN, WCI, bogleheads, etc are great resources for helping to manage your finances and plan for retirement, but the most important thing you can ever do in your career, which will cost you hundreds of thousands if not millions over the long haul, is negotiating your initial contract. And you can't do that successfully if you don't appreciate what your assets are worth.

While I agree in theory, not sure I've ever seen a job that had much (if any) wiggle room to negotiate. Anesthesiologist jobs are essentially take it or leave it when it comes to the money. The supply of physicians outweighs the demand of jobs, at least for any good job. You can always try to negotiate around the edges, but you certainly won't make a life or career altering change in your finances from negotiations.

 

[anbuitachi]

This is why doctors across the board will make less. The newer generation have no clue how much their previous generations made. So making 200K sounds GREAT.

When I started as an attending (EM) 15 yrs ago, we were paid twice a month. The first check my gross was 8K. I thought that it seemed alittle light esp for what I was quoted. But 8k x 24 checks = 192K + benefits worth about 70K.

I thought ok, i can live with that. The 2nd check actually was the rest of what you billed in the previous month. Needless to say, the 2nd check was 18-22K. So I ended up making 325K+ benefits the first year. This was before becoming partners which jacked it up past 400K.

But looking back, if they paid me 192K plus benefits, I would have been just as content. I would think most new EM grads would take a 250K+ package. I would jump ship in a heartbeat if they lowered my pay to that level.

This is one reason why AMC/Emcare type companies will eventually take over. They know the new grads will take a lower pay b/c their expectations are just not as high.

Wow that is a Lott of money for 15 years ago... Did not realize em gets paid so well.. And w a lifestyle too

 

[k12balla]

It's more than just the contract. Everyday we are faced with multiple opportunities to negotiate that we don't. More so than just getting good deals on loans, your house, your car, etc. Every time someone asks you to do something, we respond before carefully weighing our options. Table down, sure no problem. Can you stay late, sure no problem. Run the PSH? You got it. Want to take a buy out in return for selling your soul? Boy would I!

 

[k12balla]

I know plenty of people making a killing in EM signing up for shifts to fill a calander to keep the suits happy. Again, the are happy getting paid 250/hr, not realizing that the company bills $350/hr and is taking a huge cut. It's all in your perspective. I think as physicians, we should work to eradicate the middle man unless absolutely necessary, which is very rare. Eventually, insurance companies will wise up to the fact that they're paying extra just for overhead, and their reimbursements will fall.

 

[emergentmd]

Wow that is a Lott of money for 15 years ago... Did not realize em gets paid so well.. And w a lifestyle too

If I was not a partner at my gig, I would be out the door at the rate we are paying nonpartners. But if I have no clue what pay is like as I am an "insider", I would take my $200/hr with benefits and smile. THAT is ALOT of money working 15 dys a month.

But I know better and I get job offers way higher than that all of the time that I reject weekly. I would not step foot in a CMG for $200 an hr unless they include a room at the RITZ.

EM pay has not gone down from what I can see. It is either stable or up in the past 15 yrs. Its all supply and demand. Every hospital want EM boarded docs. There are just not enough coming out. So when CMGs call, I throw out outrageous requests. Sometimes I get it, sometimes I dont. Big deal, I am busy enough. I reject shifts for $400/hr all the time.

As a little funny tidbit, I had a CMG call me up to cover a shift during Christmas. I have a family and Christmas is protected. So I told them I need 20K for a shift to work. They came back and offered 12k. Never heard from them after I rejected it. I guess some other guy sucked it up for about that much.

 

[Baller MD]

If I was not a partner at my gig, I would be out the door at the rate we are paying nonpartners. But if I have no clue what pay is like as I am an "insider", I would take my $200/hr with benefits and smile. THAT is ALOT of money working 15 dys a month.

But I know better and I get job offers way higher than that all of the time that I reject weekly. I would not step foot in a CMG for $200 an hr unless they include a room at the RITZ.

EM pay has not gone down from what I can see. It is either stable or up in the past 15 yrs. Its all supply and demand. Every hospital want EM boarded docs. There are just not enough coming out. So when CMGs call, I throw out outrageous requests. Sometimes I get it, sometimes I dont. Big deal, I am busy enough. I reject shifts for $400/hr all the time.

As a little funny tidbit, I had a CMG call me up to cover a shift during Christmas. I have a family and Christmas is protected. So I told them I need 20K for a shift to work. They came back and offered 12k. Never heard from them after I rejected it. I guess some other guy sucked it up for about that much.

So is 'the rape of emergency medicine' still a big deal or no? It seems that good offers are still out there if you are willing to look. Was this the case when the book was written? Has things gotten worse or better since the book was released?

 

[emergentmd]

So is 'the rape of emergency medicine' still a big deal or no? It seems that good offers are still out there if you are willing to look. Was this the case when the book was written? Has things gotten worse or better since the book was released?

Never read that book but I am sure I know what the book is all about.

Sure, EM docs will always be beholden to admin. There are alot of political CRAP. Independent groups will continue to dwindle. I have accepted that EM Docs will eventually be hospital/CMG employees. I am lucky that I am still a partner but this will not last very long.

It sucks, but b/c all of these hospital ADMINS want Boarded EM docs. And if the CMGs want to play ball, they got to find the boarded docs that do not exist. All of the FSEDs are sucking up these docs at 180+/hr sitting surfing the internet like what I am doing now. I am in the last hr of my FSED shift and i have seen a total of 4 pts today and all were cough/colds. Not too bad $/pt pay.

Its great for EM docs now b/c demand far outstrip supply.

 

[BuzzPhreed]

AMCs can bill 30 percent more per unit for insurance cases vs the hospital. AMCs can fire at will and pay less than fair wage. Hospitals must pay fair wages and have HR departments. Hence, the vast majority of hospitals (over 80 percent) are better off with an AMC vs hiring their own providers.

Until we get a radical change in billing/reimbursement the AMC is here to stay.

1) I just looked at our billing for 2014 and we are far and away the most lucrative practice the hospital owns. By a long shot.
2) Hospitals can "fire at will" too.
3) Hospitals have to have HR departments no matter what. Unless they farm EVERYTHING out from the nurses to the techs to even the people who clean the floors.

The vast majority of hospitals just do not, at the current time, have a lot of experience managing anesthesia practices. I can assure you that ours didn't until they dropped the PP group who was here before, hired us, and started managing our group about 6.5 years ago. And now that they've learned how to do it and see how much money we are bringing in, they would be crazy to let us go.

 

[Baller MD]

1) I just looked at our billing for 2014 and we are far and away the most lucrative practice the hospital owns. By a long shot.
2) Hospitals can "fire at will" too.
3) Hospitals have to have HR departments no matter what. Unless they farm EVERYTHING out from the nurses to the techs to even the people who clean the floors.

The vast majority of hospitals just do not, at the current time, have a lot of experience managing anesthesia practices. I can assure you that ours didn't until they dropped the PP group who was here before, hired us, and started managing our group about 6.5 years ago. And now that they've learned how to do it and see how much money we are bringing in, they would be crazy to let us go.

What kind of anesthesia model does your hospital run?

 

[kazuma]

Forgot to say that I work solo 99%. "Academic" is a modifier that applies only to my salary, not my duties... or privileges.

Nice, I'd like to see more of my attendings do their own cases. With AMC takeovers being a real threat even in academics, it makes me wonder if some of the older folks could survive on their own. Maybe its like riding a bike? Perhaps a very rusty bike in need of a major tune up before it can be safely ridden?

 

[Apollyon]

Just an aside, but @emergentmd is in Texas, and what he is quoting doesn't extrapolate to all other places (like South Carolina, Pennsylvania, New York, and, as he mentions, Hawai'i). To flatly refuse, as he states, means that he wouldn't be finding that for which he searches.