One more takeover.. future is bleak

[criticalelement]

http://www.businesswire.com/news/ho...s-Acquisition-Anesthesiology-Practice-Georgia

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[BLADEMDA]

Smart move to sell while the iron is hot.

 

[BLADEMDA]

AmSurg poised for 2016 growth — 8 things to know
Written by Laura Dyrda | January 25, 2016



AmSurg is in a position to monetize this year, as recent acquisitions are poised to show benefits, according to a Seeking Alpha report.

Here are eight key notes:

1. There are some concerns in the market, including AmSurg's unsuccessful attempts to purchase TeamHealth last year. The healthcare market is also expected to experience volatility throughout the election year.

2. Regulatory changes from the ACA — focusing on quality and cost-effectiveness — could be favorable for ASCs as the low-cost, high quality outpatient care setting. Data transparency trends could also boost ASC use.

3. AmSurg is a leading ASC company in consolidation as it works toward offering a full physician services platform and geographic expansion, according to the report. The company is looking to improve top line and cash flow growth rates.

4. The company can expect up to 2 percent growth in volume from uninsured patients who now are getting insurance, especially coupled with more services and geographic expansion from recent acquisitions.

5. Once a gastroenterology-heavy company, AmSurg has diversified to add anesthesiology and pain management services. The Sheridan Health acquisition at the end of 2014 provided scale and leadership in several services:

• Anesthesia
• Children's services
• Emergency medicine
• Radiology

6. The Sheridan acquisition is expected to continue high single-digit growth. The company acquired Valley Anesthesiology & Pain Consultants as well, with revenue per physician of around $650,000.

7. The company reported ASC segment growth over the past few years. AmSurg had a 9 percent procedure growth in 2013, 2 percent in 2014 and 6 percent in the first three quarters of 2015. The same center revenue increase was up 6 percent for the first three quarters of 2015. Additional, the unconsolidated centers in operation growth jumped 50 percent in 2013, 200 percent in 2014 and 44 percent in the first three quarters of 2015.

8. Sheridan has a major presence in Florida and with the state's acceptance of the ACA, the company reported ambulatory services operations growth of 31 percent in 2013, 29 percent in 2014 and 33 percent in 2015. Physician services was up 15 percent in 2014 and 13 percent for the first three quarters of 2015.

 

[BLADEMDA]

During 2015, Mednax acquired 10 physician group practices and two non-practice acquisitions for a total purchase price of $850 million.

 

[D P356]

...I went into anesthesia because i HAD to not because i wanted to.

dude, your posts make you look like a sourpuss. I hope you find something that makes you happy.

 

[criticalelement]

dude, your posts make you look like a sourpuss. I hope you find something that makes you happy.

Don't shoot the messenger.
If you choose anesthesia as a specialty, I don't want you complaining after you settle into a practice and find yourself packing yourself , your soon to be ex-wife and three small children in the car driving to your new job across the country because the practice you were in let you go. After you get into that new practice it will be the same old same old except you will be paying your ex wife alimony (because she divorced your sorry ass) and child support which takes away all of your income and you have very little money to save. You will work until your 73 because you wont have money saved. on your free time you will come on SDN, if itstill exists, and warn other folks not to go into anesthesia. Some medical student will call you a sourpuss because you will be just trying to help.

 

[Carbocation1]

Don't shoot the messenger.
If you choose anesthesia as a specialty, I don't want you complaining after you settle into a practice and find yourself packing yourself , your soon to be ex-wife and three small children in the car driving to your new job across the country because the practice you were in let you go. After you get into that new practice it will be the same old same old except you will be paying your ex wife alimony (because she divorced your sorry ass) and child support which takes away all of your income and you have very little money to save. You will work until your 73 because you wont have money saved. on your free time you will come on SDN, if itstill exists, and warn other folks not to go into anesthesia. Some medical student will call you a sourpuss because you will be just trying to help.

Just because you have a sh*tty life doesn't mean others will join in your misery. Hope you aren't this much of an Eeyore in real life.

 

[criticalelement]

Just because you have a sh*tty life doesn't mean others will join in your misery. Hope you aren't this much of an Eeyore in real life.

oh they will be just as miserable as i am.. FOR SURE

 

[D P356]

Don't shoot the messenger.
If you choose anesthesia as a specialty, I don't want you complaining after you settle into a practice and find yourself packing yourself , your soon to be ex-wife and three small children in the car driving to your new job across the country because the practice you were in let you go. After you get into that new practice it will be the same old same old except you will be paying your ex wife alimony (because she divorced your sorry ass) and child support which takes away all of your income and you have very little money to save. You will work until your 73 because you wont have money saved. on your free time you will come on SDN, if itstill exists, and warn other folks not to go into anesthesia. Some medical student will call you a sourpuss because you will be just trying to help.

In residency; changed it for you. I can't tell if you're projecting your experience on me or being hypothetical. If that happened in your life, I can empathize and now understand why you come across as negative. Either way, I hope you find satisfaction somewhere in your life. All the best to you, man.

 

[Consigliere]

In residency; changed it for you. I can't tell if you're projecting your experience on me or being hypothetical. If that happened in your life, I can empathize and now understand why you come across as negative. Either way, I hope you find satisfaction somewhere in your life. All the best to you, man.

Boy do I love the denial here....."Nope. No sir. Can't be that anesthesia really does suck, you must be a miserable person who is never happy." This is often followed up by some anemic offer for achieving happiness. Predictable.

 

[Consigliere]

What the foolish don't seem to realize is that prior to the AMC takeover, there were 28 anesthesiologists. Now there will be at least 6-8 less anesthesiologists as they up the number of CRNAs and increase the supervisory ratios. So that's 6-8 anesthesiologists who will lose their jobs and must now look for another lousy job in an increasingly competitive market. The future, as the original poster said, is indeed bleak.

 

[D P356]

Boy do I love the denial here....."Nope. No sir. Can't be that anesthesia really does suck, you must be a miserable person who is never happy." This is often followed up by some anemic offer for achieving happiness. Predictable.

That is the most positive post you've written in a while. Thank you, Eeyore.

 

[Planktonmd]

Don't shoot the messenger.
If you choose anesthesia as a specialty, I don't want you complaining after you settle into a practice and find yourself packing yourself , your soon to be ex-wife and three small children in the car driving to your new job across the country because the practice you were in let you go. After you get into that new practice it will be the same old same old except you will be paying your ex wife alimony (because she divorced your sorry ass) and child support which takes away all of your income and you have very little money to save. You will work until your 73 because you wont have money saved. on your free time you will come on SDN, if itstill exists, and warn other folks not to go into anesthesia. Some medical student will call you a sourpuss because you will be just trying to help.

That pretty much sums it!

 

[deleted171991]

In residency; changed it for you. I can't tell if you're projecting your experience on me or being hypothetical. If that happened in your life, I can empathize and now understand why you come across as negative. Either way, I hope you find satisfaction somewhere in your life. All the best to you, man.

A good residency can be a great experience. A nice fellowship (mine), awesome. Real life will mostly suck, because of lifestyle and atmosphere, unless you get lucky. There are fewer and fewer ways around it, as jobs become more corporate and anesthesiologists more insignificant.

I find that working hours per week and work intensity correlate pretty well with happiness, inversely. What we call mommy track should be a normal job, not the exception, by the way. Anything else and you live to work not work to live.

There goes my employability... I am strongly considering part-time/mommy-track at this point, unless it's a great job. Happy and frugal long life is way better than miserable hard work and heart attack in midlife.

 

[Notorious T.E.E.]

Don't shoot the messenger.
If you choose anesthesia as a specialty, I don't want you complaining after you settle into a practice and find yourself packing yourself , your soon to be ex-wife and three small children in the car driving to your new job across the country because the practice you were in let you go. After you get into that new practice it will be the same old same old except you will be paying your ex wife alimony (because she divorced your sorry ass) and child support which takes away all of your income and you have very little money to save. You will work until your 73 because you wont have money saved. on your free time you will come on SDN, if itstill exists, and warn other folks not to go into anesthesia. Some medical student will call you a sourpuss because you will be just trying to help.

This scenario isn't that uncommon (I can't speak about the ex wife portion). I can quickly think of 4 people that had this type of thing, or some variation, happen.

I can think of several more whose group got bought by an AMC or absorbed by a hospital long before they ever achieved partner and their big payday never came. The number of truly good jobs out there is rapidly shrinking.

When you are working a crappy job supervising 4 CRNAs and living 2-3 hours from your family or working as a career locum just so you won't have to pull your kids from their school life isn't quite so positive. It doesn't make you "Eeyore".

There are about 4-5 people on this forum that have a REALLY good handle on what the current and near term future state of the anesthesiology job market look like. I hope the silent majority that read rather than post are paying close attention while they are making the decisions that will affect the rest of their lives.

 

[aneftp]

What the foolish don't seem to realize is that prior to the AMC takeover, there were 28 anesthesiologists. Now there will be at least 6-8 less anesthesiologists as they up the number of CRNAs and increase the supervisory ratios. So that's 6-8 anesthesiologists who will lose their jobs and must now look for another lousy job in an increasingly competitive market. The future, as the original poster said, is indeed bleak.

I betcha the 6-8 MDs who won't lose jobs are the ones u took a 3-4 million dollar buyout cause they gotta remain there for the next 3-5 years!

Usually when a buyout happens. Nothing happens within the first 6 months. But by slow attrition. They don't replace the people who left.

 

[Mman]

Boy do I love the denial here....."Nope. No sir. Can't be that anesthesia really does suck, you must be a miserable person who is never happy." This is often followed up by some anemic offer for achieving happiness. Predictable.

Nah, it's don't go into medicine (not just anesthesia). Then again people have been handing out that advice for 20+ years. I, for one, love my job. I loved my residency. I love anesthesia. I get up excited to go to work every day. Is there some BS like excessive paperwork and regulations and clipboard holders? Sure. But the actual taking care of patients part is exceedingly fun to me and I could not imagine doing anything else even if my pay got slashed.

Some people are never happy. They probably blame their circumstances around them (job, boss, etc), but truth is they'd be miserable with whatever lot in life they chose.

 

[shishka32]

If I can ask as a med student, what is the holy grail specialty that would make you all content and happy? What would you apply into now if you had the same grades, step 1 score, and research experience that you did as a student? I am honestly asking because there are some of us students that can't just match into our number 1 derm program due to average step 1's/grades/research. Many specialties such aren't looking all that great right now but I want to go into a field with my eyes open to all of the pros/cons of said specialty. I don't have a true passion to pick a specific field so I'm just looking for a job I enjoy plus a decent salary and working environment.

Derm/ENT/Uro/Ortho/Neuro/Ophtho - great if you can get into them but step 1 scores average >245, usually need all honors or close to it + multiple pubs to match, some work insanely hard for life (neurosurg), horrible residency
General surgery - work a million hours a week for less money than anesthesia, almost have to do a fellowship (7-10 years of training after med school), easier to match into, horrible residency
Rads - cool but not a great job market, bleak future with too many residents in training, doesn't involve patients which is bad for some people, diagnosing all day but not many treatment options to offer
Path - boring plus horrible job market
EM - good for now, some downsides such as nights/weekends/drug seekers, corporate groups buying out EM groups too
Neuro/Psych - low salary, takes a special person to do it (definitely not me)
Peds - low salary, longer hours, lots of BS and parents
IM - it's IM, rounding sucks, low pay unless you get into a good subspecialty, have to deal with non-compliant fat smokers in clinic and rounds for life
IM subspecialty - depends, GI is great, cards job market is ok from what I hear, groups being bought out left and right, have to deal with non-compliant fat smokers in clinic and rounds for life
Anesthesia - nothing needs to be said that you don't already know

Am I missing any specialties? The sentiment I get from this forum is all med students ever need to go into a surgical subspecialty or derm otherwise you are relegated to an inferior specialty owned by corporate interests with no autonomy or job satisfaction forever. But without that 250 step score, I guess it brings me down to rads, EM, or IM subspecialty as options.

 

[caligas]

To above:

PM&R?

Rad-onc?

Marry Rich?

Or "the Graduate" theory: "one word; plastics"

 

[deleted162650]

I would still do Anes and I had the grades/scores to do a surgical sub specialty if I wanted. There are still great jobs around if you are flexible geographically. Who know what things will be like in 20 years. Pick a field where you don't mind going to work every day.

But marry rich --> be a full time housewife/husband does seem like a nice gig (although my stay-at-home-mom wife definitely works harder than me)

 

[Notorious T.E.E.]

If I can ask as a med student, what is the holy grail specialty that would make you all content and happy? What would you apply into now if you had the same grades, step 1 score, and research experience that you did as a student? I am honestly asking because there are some of us students that can't just match into our number 1 derm program due to average step 1's/grades/research. Many specialties such aren't looking all that great right now but I want to go into a field with my eyes open to all of the pros/cons of said specialty. I don't have a true passion to pick a specific field so I'm just looking for a job I enjoy plus a decent salary and working environment.

Derm/ENT/Uro/Ortho/Neuro/Ophtho - great if you can get into them but step 1 scores average >245, usually need all honors or close to it + multiple pubs to match, some work insanely hard for life (neurosurg), horrible residency
General surgery - work a million hours a week for less money than anesthesia, almost have to do a fellowship (7-10 years of training after med school), easier to match into, horrible residency
Rads - cool but not a great job market, bleak future with too many residents in training, doesn't involve patients which is bad for some people, diagnosing all day but not many treatment options to offer
Path - boring plus horrible job market
EM - good for now, some downsides such as nights/weekends/drug seekers, corporate groups buying out EM groups too
Neuro/Psych - low salary, takes a special person to do it (definitely not me)
Peds - low salary, longer hours, lots of BS and parents
IM - it's IM, rounding sucks, low pay unless you get into a good subspecialty, have to deal with non-compliant fat smokers in clinic and rounds for life
IM subspecialty - depends, GI is great, cards job market is ok from what I hear, groups being bought out left and right, have to deal with non-compliant fat smokers in clinic and rounds for life
Anesthesia - nothing needs to be said that you don't already know

Am I missing any specialties? The sentiment I get from this forum is all med students ever need to go into a surgical subspecialty or derm otherwise you are relegated to an inferior specialty owned by corporate interests with no autonomy or job satisfaction forever. But without that 250 step score, I guess it brings me down to rads, EM, or IM subspecialty as options.

I think the hours for general surgery in private practice are not much different than anesthesiology, and the pay isn't that much different either. You also have ownership options in surgery centers, although that is starting to disappear. If I were coming out or med school now I would give surgery a serious look.

 

[deleted162650]

No reason you can't have an ownership stake in an ASC as an anesthesiologist.

 

[Notorious T.E.E.]

No reason you can't have an ownership stake in an ASC as an anesthesiologist.

I'm aware of far more surgical jobs with surgery center ownership opportunities, but maybe it's regional.

 

[BLADEMDA]

10 fastest-growing jobs for college grads

http://www.cnbc.com/2016/03/16/10-fastest-growing-jobs-for-college-grads.html?slide=11

 

[deleted162650]

It's a little more risky when your not the surgeon since you can't control the pt flow. If all of a sudden the high volume surgeons decide to go elsewhere your SOL

 

[patriot6]

10 fastest-growing jobs for college grads

http://www.cnbc.com/2016/03/16/10-fastest-growing-jobs-for-college-grads.html?slide=11

Sorry Blade, but I think this list is a decade late for most here.

 

[deleted171991]

No reason you can't have an ownership stake in an ASC as an anesthesiologist.

Fat chance unless you bring pain patients.

 

[deleted171991]

I, for one, love my job. I loved my residency. I love anesthesia. I get up excited to go to work every day. Is there some BS like excessive paperwork and regulations and clipboard holders? Sure. But the actual taking care of patients part is exceedingly fun to me and I could not imagine doing anything else even if my pay got slashed.

 

[Mman]

Fat chance unless you bring pain patients.

many surgeons appreciate having anesthesiologists with a personal vested interest in the financial efficiency of a surgery center.

 

[deleted171991]

many surgeons appreciate having anesthesiologists with a personal vested interest in the financial efficiency of a surgery center.

Not in my experience.

Even when they partner with anesthesiologists, those are mostly wiseguys who hire a few monkeys to work for them. So yeah, the 1-2 partners in the group have a huge vested interest, and the 4-5 employees have a salary. This is not 10-15 years ago. There is a sucker born every minute going into anesthesia.

Next thing I am gonna hear is how good it is to partner with a plastics surgeon and how much they appreciate us.

 

[Mman]

Not in my experience.

Even when they partner with anesthesiologists, those are mostly wiseguys who hire a few monkeys to work for them. So yeah, the 1-2 partners in the group have a huge vested interest, and the 4-5 employees have a salary. This is not 10-15 years ago. There is a sucker born every minute going into anesthesia.

Next thing I am gonna hear is how good it is to partner with a plastics surgeon and how much they appreciate us.

In my experience it is true. We have ownership interest in several surgery centers and it is a lucrative business. Everybody working there is an equal partner (no "monkeys to work for them").

Just because your experience is terrible doesn't mean it is that way everywhere.

 

[deleted171991]

In my experience it is true. We have ownership interest in several surgery centers and it is a lucrative business. Everybody working there is an equal partner (no "monkeys to work for them").

Just because your experience is terrible doesn't mean it is that way everywhere.

It seems that your group is fair, and you are all partners. How many such groups still exist in 2016? Usually, even if there is a "partnership track", it's 3-4 years long, and hugely underpaid.

Obviously, it's all in our own experience.

 

[Mman]

It seems that your group is fair, and you are all partners. How many such groups still exist in 2016? Usually, even if there is a "partnership track", it's 3-4 years long, and hugely underpaid.

Obviously, it's all in our own experience.

Because it is all in our own experience, it's important for both sides to be presented. Not everybody's experience is miserable.

How many such groups exist in 2016? I know of more than a few. Nearly every person I was a resident with that isn't in academics is in a fair group.

 

[deleted171991]

Because it is all in our own experience, it's important for both sides to be presented. Not everybody's experience is miserable.

How many such groups exist in 2016? I know of more than a few. Nearly every person I was a resident with that isn't in academics is in a fair group.

Did you graduate in the last 5 years? Does your rule apply to current graduates, in 2016?

I am sure that every rule has exceptions. In my non-BFE area, the rule tends to be what I said, especially for fresh grads.

 

[ZzzPlz]

Graduated in July and even before I'm an anesthesia partner (2-year) I can start buying surgery center shares (1-year). BF to the E

 

[shishka32]

Alright. So general surgery, rad onc, and PM&R. Rad onc is pretty tough to match into but I'll take a look. Hopefully I like one of these three specialties.

 

[D P356]

Alright. So general surgery, rad onc, and PM&R. Rad onc is pretty tough to match into but I'll take a look. Hopefully I like one of these three specialties.

As a student you should get as much exposure to all the fields, and find what fits you (satisfaction, career goals, work life balance, income goals). In the selection process as a student, it's much like dating a chick; just because she looks pretty doesn't mean she'll be a good fit for you in the long run. Find some different attendings you trust and get their opinions of their fields while you rotate through their service. If you don't rotate through a specialty you want to explore, go schedule it. It is your career.

There is a lot of negativity on the board from a select few. They complain. Don't trust people on the Internet....even Blade, who knows everything.

Find the specialty that fits you, make a plan for matching in that specialty and "grab it by the haunches and hump it into submission."

Good luck.

 

[pjl]

Because it is all in our own experience, it's important for both sides to be presented. Not everybody's experience is miserable.

How many such groups exist in 2016? I know of more than a few. Nearly every person I was a resident with that isn't in academics is in a fair group.

Mman sounds like he is in a similar job to me in all ways except location. So there are at least 2 groups like that.
*edit: except for 30% own cases.
And yes...graduated within past 5 years, and double yes, have hired another new grad this year. Probably made it too easy on the new grad. Cold called him up and invited him to an interview. Offered job.

 

[Mman]

Did you graduate in the last 5 years? Does your rule apply to current graduates, in 2016?

I am sure that every rule has exceptions. In my non-BFE area, the rule tends to be what I said, especially for fresh grads.

No I did not graduate in the last 5 years, but my rule does apply today. We continue to hire as partners retire and will continue to do so. Is there an endless supply of great jobs out there? Of course not. And of course there aren't quite as many as before. But they are out there. Just because you don't see them on gasworks doesn't mean they don't exist.

 

[Stank811]

Similar boat as mman and Pjl and I graduated within the last 5yrs

 

[deleted162650]

Mman sounds like he is in a similar job to me in all ways except location. So there are at least 2 groups like that.
*edit: except for 30% own cases.
And yes...graduated within past 5 years, and double yes, have hired another new grad this year. Probably made it too easy on the new grad. Cold called him up and invited him to an interview. Offered job.

Similar boat as mman and Pjl and I graduated within the last 5yrs

Care to share what general region you guys are in? No need to be overly specific, I'm really just curious.

 

[pjl]

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[deleted171991]

5


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Aka Midwest.