Partnership versus non-Partnership tracts

[Ignatius J]

I am halfway through the CA-2 year and trying to get a feel for the positives and negatives of each.

In my state, it seems that parternship tracts are a rarer and rarer bird. If I wanted to do PP and wanted to be with a group long-term, what are the advantages and disadvantages of each?

Is it common for groups to grant partnerships even if you aren't on a "partnership tract"? Is it common for them not to ever look at you again? If you were a resident wanting to go into private practice (and you weren't picky about location), how would you go about it?

It's a loaded question, I know. But any advice/experience/wisdom is appreciated.

Thanks!

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[imfrankie]

a bird in the hand is worth...

 

[IlDestriero]

In the one PP group that I know a good deal about that offers both partner and non partner track positions, the partner track spots only open when they expand locations or someone leaves. There are about 2 partners for every non partner currently.
They pay the non partner guys pretty well. If you want to switch to the partner track you go down to the much lower partner track salary and the length of time is the same as everyone else. I would think that would be hard to swallow.

 

[bala1]

I am halfway through the CA-2 year and trying to get a feel for the positives and negatives of each.

In my state, it seems that parternship tracts are a rarer and rarer bird. If I wanted to do PP and wanted to be with a group long-term, what are the advantages and disadvantages of each?

Is it common for groups to grant partnerships even if you aren't on a "partnership tract"? Is it common for them not to ever look at you again? If you were a resident wanting to go into private practice (and you weren't picky about location), how would you go about it?

It's a loaded question, I know. But any advice/experience/wisdom is appreciated.

Thanks!

If they have you there already working like a dog for little pay, what incentive do they have to share any of their money with you at that point. There is NO incentive. If they make you a partner that means they make LESS MONEY!!

 

[deleted126335]

If they have you there already working like a dog for little pay, what incentive do they have to share any of their money with you at that point. There is NO incentive. If they make you a partner that means they make LESS MONEY!!

1. Word gets around. Doesn't look good to be painted as a liar and a crook. Some people don't care.
2. Some people are men of their word and keep their promises.
3. Always the concern that the guy who is working toward partnership might make things adversarial.

 

[urge]

Why would anyone want partnership in a declining business (anesthesia reimbursements)?

 

[bala1]

1. Word gets around. Doesn't look good to be painted as a liar and a crook. Some people don't care.
2. Some people are men of their word and keep their promises.
3. Always the concern that the guy who is working toward partnership might make things adversarial.

LOL. These guys are very short sighted, thats why management companies are taking over.They only know how to screw those who came after. No incentive to make anything fair. Yes eventually things will come crumbling down when enough people squawk but if you have a steady stream of new grads. Life is good.

 

[seinfeld]

Why would anyone want partnership in a declining business (anesthesia reimbursements)?

The million dollar question.

Probably because when your not partner you don't get to make decisions about distribution of funds. As amount of money difference between partner and non partner decline there is no advantage to having your salary more at risk then your contracted employees.Remember that when you own the business your the last one to get paid.

 

[deleted126335]

LOL. These guys are very short sighted, thats why management companies are taking over.They only know how to screw those who came after. No incentive to make anything fair. Yes eventually things will come crumbling down when enough people squawk but if you have a steady stream of new grads. Life is good.

Not everyone oprates that way.

 

[bala1]

Not everyone oprates that way.

Many many people do. Less than before because of the management companies taking over but if it wasnt for the management groups taking over it would be business as usual

 

[countingdays]

LOL. These guys are very short sighted, thats why management companies are taking over.They only know how to screw those who came after. No incentive to make anything fair. Yes eventually things will come crumbling down when enough people squawk but if you have a steady stream of new grads. Life is good.

Exactly. We hear a lot about evil management companies but the real enemy is the older generation of anesthesiologists.

 

[deleted126335]

Exactly. We hear a lot about evil management companies but the real enemy is the older generation of anesthesiologists.

Not that I disagree with you, but maybe you and bala 1 would be doing the same if you were 20 years older and in a position to do so?

 

[countingdays]

Not that I disagree with you, but maybe you and bala 1 would be doing the same if you were 20 years older and in a position to do so?

No. I value ethical behavior highly.

There needs to be a lot more anti-trust activity in medicine/healthcare.

 

[deleted126335]

No. I value ethical behavior highly.

There needs to be a lot more anti-trust activity in medicine/healthcare.

You are not the only one.

 

[countingdays]

You are not the only one.

Good!

 

[Ignatius J]

No. I value ethical behavior highly.

There needs to be a lot more anti-trust activity in medicine/healthcare.

I think you hit the nail on the head, and a lot of what I was interested in hearing about in asking the question.

Private practice anesthesiology seems dominated by group contracts. If you want to move to a particular city, you better hope one of the couple groups that have contracts is hiring and you better take whatever the heck compensation and hours they want to give you or you are looking elsewhere. There definitely isn't fair play going on there. It seems to be almost a monopoly in most big cities.

As a resident, that's the picture that has been painted in my mind by recent graduates, faculty, and upper level job seekers.

Thank you all for the responses. I'd be interesting in hearing from a "veteran" about their perspective on things. For all of the flack that younger generations get, it really seems as if the older generation of anesthesiologists has made it very difficult on the new generations of grads with monopolies, CRNA models, etc. Not trying to bait or flame, just my opinion that could very well be wrong.

 

[bala1]

Not that I disagree with you, but maybe you and bala 1 would be doing the same if you were 20 years older and in a position to do so?

The ideal model in my opinion is. If you work you get paid, if you dont, you dont get paid. Period. I dont care if you are 50 or 30. I dont care how long youve been around. If you cant take call anymore on weekends because you are too ****ing old, thats fine. You wont be making money.

Anesthesia is probably one of the most corrupt fields of medicine. Everyone is in on it. Certainly the older partners were the most blatant and dirty about it.I am actually happy that it is being broke up. The exclusive contract arrangements are the worst in terms of fairness. This should certainly be brought up over and over. You can be the greatest doctor but unless you work for this certain group you cannot work. Seems kind of ridiculous.

 

[bala1]

I think you hit the nail on the head, and a lot of what I was interested in hearing about in asking the question.

Private practice anesthesiology seems dominated by group contracts. If you want to move to a particular city, you better hope one of the couple groups that have contracts is hiring and you better take whatever the heck compensation and hours they want to give you or you are looking elsewhere. There definitely isn't fair play going on there. It seems to be almost a monopoly in most big cities.

As a resident, that's the picture that has been painted in my mind by recent graduates, faculty, and upper level job seekers.

Thank you all for the responses. I'd be interesting in hearing from a "veteran" about their perspective on things. For all of the flack that younger generations get, it really seems as if the older generation of anesthesiologists has made it very difficult on the new generations of grads with monopolies, CRNA models, etc. Not trying to bait or flame, just my opinion that could very well be wrong.

Exclusive contracts are what is killing us as individual doctors, you are very insightful for your level of training. For example, if you are interested in working one of long island NY's 20 hospitals. You have one choice. One mega group. If they are not hiring, or hiring someone else or if they dont "LIKE" you for some reason. No long island for you. You have to move to New Jersey. Seems ridiculous to me. Its good for the mega group but horrible for the individual anesthesiologist. It is a way for the groups and hospitals to have POWER over you. Im not even getting into the financials of the whole thing.

 

[urge]

Exclusive contracts are what is killing us as individual doctors, you are very insightful for your level of training. For example, if you are interested in working one of long island NY's 20 hospitals. You have one choice. One mega group. If they are not hiring, or hiring someone else or if they dont "LIKE" you for some reason. No long island for you. You have to move to New Jersey. Seems ridiculous to me. Its good for the mega group but horrible for the individual anesthesiologist. It is a way for the groups and hospitals to have POWER over you. Im not even getting into the financials of the whole thing.

Funny thing is people will buy in with over 1 million dollars and by the time you get there that contract might evaporate. Partnership tracks are the biggest scam ever.

 

[deleted126335]

I think you hit the nail on the head, and a lot of what I was interested in hearing about in asking the question.

Private practice anesthesiology seems dominated by group contracts. If you want to move to a particular city, you better hope one of the couple groups that have contracts is hiring and you better take whatever the heck compensation and hours they want to give you or you are looking elsewhere. There definitely isn't fair play going on there. It seems to be almost a monopoly in most big cities.

As a resident, that's the picture that has been painted in my mind by recent graduates, faculty, and upper level job seekers.

Thank you all for the responses. I'd be interesting in hearing from a "veteran" about their perspective on things. For all of the flack that younger generations get, it really seems as if the older generation of anesthesiologists has made it very difficult on the new generations of grads with monopolies, CRNA models, etc. Not trying to bait or flame, just my opinion that could very well be wrong.

You are not wrong. 50 something y.o. anesthesiologists have caused lots of harm to 30 something y.o. anesthesiologists. I don't blame the younger generation one bit. They are just responding to a different set of incentives than the generation that came before.

What I do blame the younger generation for is thinking that they are any different or as a group would behave any differently given the same incentives. Today's gung ho, idealistic, cutting edge fresh grads are tomorrow's lazy, exploiting, selfish, behind the times attendings.

Not all, but enough. Just like not all but enough of my generation and the generation that came before had no vision for anything beyond their own retirement or next paycheck.

 

[Ignatius J]

You are not wrong. 50 something y.o. anesthesiologists have caused lots of harm to 30 something y.o. anesthesiologists. I don't blame the younger generation one bit. They are just responding to a different set of incentives than the generation that came before.

What I do blame the younger generation for is thinking that they are any different or as a group would behave any differently given the same incentives. Today's gung ho, idealistic, cutting edge fresh grads are tomorrow's lazy, exploiting, selfish, behind the times attendings.

Not all, but enough. Just like not all but enough of my generation and the generation that came before had no vision for anything beyond their own retirement or next paycheck.

Great point.

Unfortunately, from what I surmise, figuring out the angle for professional success in Anesthesiology is perhaps the most difficult task.

It's definitely a war out there.

 

[countingdays]

You are not wrong. 50 something y.o. anesthesiologists have caused lots of harm to 30 something y.o. anesthesiologists. I don't blame the younger generation one bit. They are just responding to a different set of incentives than the generation that came before.

What I do blame the younger generation for is thinking that they are any different or as a group would behave any differently given the same incentives. Today's gung ho, idealistic, cutting edge fresh grads are tomorrow's lazy, exploiting, selfish, behind the times attendings.

Not all, but enough. Just like not all but enough of my generation and the generation that came before had no vision for anything beyond their own retirement or next paycheck.

It's not that they set out to steal and exploit, just given the chance, they will steal and exploit.
If you drop your wallet in front of a 50yo anesthesiologist he'll probably pick it up and put it in his pocket. Opportunistic thieves.
In his mind he'll justify it saying he was on that sidewalk first, he earned that sidewalk, and you should be glad to get to use the sidewalk at all. Never mind that he doesn't actually own anything but the ability to steal/exclusive contract.

 

[IlDestriero]

It's not that they set out to steal and exploit, just given the chance, they will steal and exploit.
If you drop your wallet in front of a 50yo anesthesiologist he'll probably pick it up and put it in his pocket. Opportunistic thieves.
In his mind he'll justify it saying he was on that sidewalk first, he earned that sidewalk, and you should be glad to get to use the sidewalk at all. Never mind that he doesn't actually own anything but the ability to steal/exclusive contract.

Part of the problem is that's what happened to them 10 or more years ago. Fair and reasonable groups were probably founded that way. The partner that paid his dues over 4 or 5 years and lost $1M+ isn't going to vote to cut the partner track in half and pay them fairly.

 

[deleted126335]

Great point.

Unfortunately, from what I surmise, figuring out the angle for professional success in Anesthesiology is perhaps the most difficult task.

It's definitely a war out there.

Because there is no magic formula. Luck is a huge factor.

clinical skills, credentials, work ethic, communication skills, timing, business savy, willingness to relocate to where the best opportunities are, personal connections all play a role.

Very unsettling when you think about it.

 

[seinfeld]

What's the deal with that. Partnership track positions are scams. AMCs are all crooks. Hospitals will screw you out of income. The government doesn't want free market in medicine.

News flash. Life is not fair , the only person looking out for you and your family during a crisis is you. Someday you may be presented with a decision which is not the best for the profession, but is the best decision for your family. You are naive to think that most would put their family or personal interests behind some global good. If that we're the case we would all be car pooling, Prius owning, solar panel using people.

Happy New Year!

 

[seinfeld]

I hear your point. Some of the old guys in my group are still bitter about how they were treated becoming partners in the 90s. They did make changes to the partner structure to make it more fair as a result. I realize not every group does so. But lets be careful not to invite so much regulation that being an owner of business no longer has the reward of extracting income from the labors of its employees because at the end of the day is that not what every business in america does? Too much regulation and we would all essentially be working for government.

 

[bala1]

I. But lets be careful not to invite so much regulation that being an owner of business no longer has the reward of extracting income from the labors of its employees because at the end of the day is that not what every business in america does? Too much regulation and we would all essentially be working for government.

That is laughable.
What business? The only thing the top heavy partenership groups have on anybody is that 'THEY WERE THERE FIRST" Thats it.There is no business. The business is already there. You dont have to generate income, and of course an exclusive contract with the hospital certainly doesnt hurt "business".

A real business would be multiple anesthesia groups in hospitals covering and earning the referrals from the surgeons based on meritocracy. There is no meritocracy in the system now.

 

[IlDestriero]

That is laughable.
What business? The only thing the top heavy partenership groups have on anybody is that 'THEY WERE THERE FIRST" Thats it.There is no business. The business is already there. You dont have to generate income, and of course an exclusive contract with the hospital certainly doesnt hurt "business".

A real business would be multiple anesthesia groups in hospitals covering and earning the referrals from the surgeons based on meritocracy. There is no meritocracy in the system now.

Have you worked in one of those practices? Following a surgeon around sucks, but those jobs are there if you want them. One case at the big house and three more at the ASC later after lunch. It's that what you want? Real efficient. Eat what you kill at 15 different locations in the city with 100 different surgeons/proceduralists. Sign me up. At least you'll have a lot of down time.
I didn't even want to do job where we had to go to two sites on the same day. Who's watching your patient in the PACU when you have to leave to go across town? Your only partner there is already done. Better get her up and out because you're going to be late. Think the other group in town will hook you up? Sure, why not?
The biggest whiner on this board does this. He's really happy with that set up. Pays really well too.
The contract is the business. If you can do it better, start your own group. Take over one location and go from there.

 

[deleted126335]

That is laughable.
What business? The only thing the top heavy partenership groups have on anybody is that 'THEY WERE THERE FIRST" Thats it.There is no business. The business is already there. You dont have to generate income, and of course an exclusive contract with the hospital certainly doesnt hurt "business".

A real business would be multiple anesthesia groups in hospitals covering and earning the referrals from the surgeons based on meritocracy. There is no meritocracy in the system now.

Sometimes that (plus enforceable non-competes) is enough to make all the difference in the world- Solid secure ownership good pay position with authority vs. Employee, low pay, low security position.

 

[Ignatius J]

Have you worked in one of those practices? Following a surgeon around sucks, but those jobs are there if you want them. One case at the big house and three more at the ASC later after lunch. It's that what you want? Real efficient. Eat what you kill at 15 different locations in the city with 100 different surgeons/proceduralists. Sign me up. At least you'll have a lot of down time.
I didn't even want to do job where we had to go to two sites on the same day. Who's watching your patient in the PACU when you have to leave to go across town? Your only partner there is already done. Better get get up and out because you're going to be late. Think the other group in town will hook you up? Sure, why not.
The biggest whiner on this board does this. He's really happy with that set up. Pays really well too.
The contract is the business. If you can do it better, start your own group. Take over one location and go from there.

Can you really take over a contract when the partners in the group are probably on a first name basis with the hospital administrators? To me, that's the Catch-22. Does it matter how well you do it when the hospital people know the current group like the back of their hand and have worked with them for years, even decades?

 

[IlDestriero]

If a group is providing high quality service at a fair price they would never change. There is no reason to bring in a new team. I know that there are plenty of shady groups providing marginal or overpriced service, or AMC groups with their broken promises to choose from. My friend's group had been slowly expanding for years by displacing small AMC groups that didn't provide what they initially offered. I think jets new group did the same thing.
The COO isn't going to be posting these jobs on Gaswork. You're going to have to look for them yourself.

 

[Ignatius J]

If a group is providing high quality service at a fair price they would never change. There is no reason to bring in a new team. I'm know that there are plenty of shady groups providing marginal or overpriced service, or AMC groups with their broken promises to choose from. My friend's group had been slowly expanding for years by displacing small AMC groups that didn't provide what they initially offered. I think jets new group did the same thing.
The COO isn't going to be posting these jobs on Gaswork. You're going to have to look for them yourself.

How do you find out which groups are providing services they initially offered? Do to non-compete clauses, you don't have the ability to have experienced it.

I guess that is the luck part. If answers were easy, I'm sure we wouldn't be discussing this.

 

[bala1]

I didn't even want to do job where we had to go to two sites on the same day. Who's watching your patient in the PACU when you have to leave to go across town? Your only partner there is already done. Better get get up and out because you're going to be late. Think the other group in town will hook you up? Sure, why not.
The biggest whiner on this board does this. He's really happy with that set up. Pays really well too.
The contract is the business. If you can do it better, start your own group. Take over one location and go from there.

It does not have to be the way you mention.

I wont start my own group because i practice medicine I don't practice, lets give a kick back to the hospital and low ball our new employees on a partnership promise. Why do I have to start my own group and take over an exclusive contract to be able to practice the way i want to practice anyway?

 

[IlDestriero]

I can't even understand how you want to practice.
You can go it alone, have gas will travel style or you can be part of a group of some kind.
A lose affiliation of physicians +/- CRNAs that work when they want and if the surgeons want them to do their cases won't work. The hospital/asc/surgeons need to get the cases done, cover call and late work, etc. they aren't going to start calling around to see who's available. They want to know they're covered. Period. That's the expectation.
There are fair groups out there, go find one.
There is at least one major hospital that works that way, our used to. One group was contracted to the hospital, and others could practice there as well. I'm sure it was a scheduling nightmare.

 

[bala1]

I can't even understand how you want to practice.
You can go it alone, have gas will travel style or you can be part of a group of some kind.
A lose affiliation of physicians +/- CRNAs that work when they want and if the surgeons want them to do their cases won't work. The hospital/asc/surgeons need to get the cases done, cover call and late work, etc. they aren't going to start calling around to see who's available. They want to know they're covered. Period. That's the expectation.
There are fair groups out there, go find one.
There is at least one major hospital that works that way, our used to. One group was contracted to the hospital, and others could practice there as well. I'm sure it was a scheduling nightmare.

If there is an exclusive contract by definition it is not fair.

I am not looking for a group.

You have been brainwashed!! I bet you are an ASA member.
It is no surprise that you have faculty listed as your credentials because you think like a typical faculty member.

 

[countingdays]

Exclusive contracts are a necessary evil. They should be used to ensure call coverage and to increase O R efficiency. They should not be used by the contract holders to steal from those who don't control the contract with the hospital.

You can't just show up and offer your services at a hospital. That can't and probably shouldn't be changed. If the group is fully staffed, you're s o l, sucks but there's nothing to do about it. The problem comes when the group Does need help but uses the exclusive contract to exploit the new docs.

 

[seinfeld]

Bala1 you have a very naive viewpoint and what you are calling for is not a plausible business model. Although i am sure you could find some groups willing to give up all their medicaid/medicare cases for you to do and to bill for.

As many have said the contract is what makes the business. Exclusive contracts are great for me and my family as they offer stability. Groups offer easier call coverage, redistribution of income ( as someone who does cardiac and critical care i would be the least paid in my group but dealing with the sickest people and most stressful cases). The partners that have come before me established a reputation for providing great anesthesia care and meeting the need of the hospital and its surgeons. That my friend is an asset and is worth money (remember when people speak ill without fact you can file suit for libel, so its well established that ones reputation is an asset)

As others have said good luck creating your own group, i wish you luck.

 

[bala1]

Bala1 you have a very naive viewpoint and what you are calling for is not a plausible business model. Although i am sure you could find some groups willing to give up all their medicaid/medicare cases for you to do and to bill for.

As many have said the contract is what makes the business. Exclusive contracts are great for me and my family as they offer stability. Groups offer easier call coverage, redistribution of income ( as someone who does cardiac and critical care i would be the least paid in my group but dealing with the sickest people and most stressful cases). The partners that have come before me established a reputation for providing great anesthesia care and meeting the need of the hospital and its surgeons. That my friend is an asset and is worth money (remember when people speak ill without fact you can file suit for libel, so its well established that ones reputation is an asset)

As others have said good luck creating your own group, i wish you luck.

Forget it!! I wish you and your family luck. And you do understand that I can have your job if i decide to work for less. I hope you understand that. There is my business model. Your family will have stability until you no longer have the exclusive contract, somebody else does

 

[IlDestriero]

Forget it!! I wish you and your family luck. And you do understand that I can have your job if i decide to work for less. I hope you understand that. There is my business model. Your family will have stability until you no longer have the exclusive contract, somebody else does

Good luck. Hahaha.

 

[bala1]

I have no doubt that you will attain your goal of working for less.

Thats ok with me; at least I have my dignity unlike you who probably is in the 4th year of a six year partnership track eating crow. You are probably a card carrying ASA member.

 

[deleted126335]

Thats ok with me; at least I have my dignity unlike you who probably is in the 4th year of a six year partnership track eating crow. You are probably a card carrying ASA member.

You are a fool.

 

[bala1]

You are a fool.

So are you!!

 

[MiracleforMD]

This thread went from interesting discourse to pure **** quickly. Thanks bala

 

[scudrunner]

It does not have to be the way you mention.

I wont start my own group because i practice medicine I don't practice, lets give a kick back to the hospital and low ball our new employees on a partnership promise. Why do I have to start my own group and take over an exclusive contract to be able to practice the way i want to practice anyway?

Kickbacks are illegal.

I am really having a hard time following your whole argument.

I see nothing unfair about a $150k buy-in over a two year partnership track for a great group.

Also, wtf is wrong with the ASA? They are anesthesiologists looking out for anesthesiologists.

 

[bala1]

This thread went from interesting discourse to pure **** quickly. Thanks bala

Oh yeah, blame me!! I'm not the one who started the name calling. Scroll up!

 

[IlDestriero]

You have been brainwashed!! I bet you are an ASA member.
It is no surprise that you have faculty listed as your credentials because you think like a typical faculty member.

I believe this is where you started to post like a jackhole, in case there was any confusion.

 

[bala1]

Kickbacks are illegal.

I am really having a hard time following your whole argument.

I see nothing unfair about a $150k buy-in over a two year partnership track for a great group.

Also, wtf is wrong with the ASA? They are anesthesiologists looking out for anesthesiologists.

Anesthesiologist own little, we don't bring patients to the hospital,we are viewed as widgets by surgeons and administrators, we have little political clout in the hospital and the patients don't choose us. What am i buying into? The privelege to be called your partner? i can generate my own accounts receivables. I just DONT GET IT! and never have.

Kick backs are illegal? really? So is prostitution!!

Nothing is wrong with the ASA, they are great. Just keep on paying dues buddy.

 

[sevoflurane]

Anesthesiologist own little, we don't bring patients to the hospital,we are viewed as widgets by surgeons and administrators, we have little political clout in the hospital and the patients don't choose us. What am i buying into? The privelege to be called your partner? i can generate my own accounts receivables. I just DONT GET IT! and never have.

Kick backs are illegal? really? So is prostitution!!

Nothing is wrong with the ASA, they are great. Just keep on paying dues buddy.

I will agree with the part highlighted.

Friend, it seems that you have been burned in the past.

There are plenty of groups that are fair and plenty of groups that are highly respected by surgeons, administration and the rest of the hospital staff. Experience with negotiating contracts, managing OR flow and efficiency as well as setting up hospital wide policies are highly valued. Also, not all anesthesiologist are created equally. Just last night I was speaking to a friend that heads a group about this. New grads get better over time.... but many take some years to polish out their skills.

 

[bala1]

I will agree with the part highlighted.

Friend, it seems that you have been burned in the past.

There are plenty of groups that are fair and plenty of groups that are highly respected by surgeons, administration and the rest of the hospital staff. Experience with negotiating contracts, managing OR flow and efficiency as well as setting up hospital wide policies are highly valued. Also, not all anesthesiologist are created equally. Just last night I was speaking to a friend that heads a group about this. New grads get better over time.... but many take some years to polish out their skills.

i have not been burned. Wont let myself be burned. Of course new grads get better over time.. duh!!! They are fully qualified. There is No reason to steal money from them. It is a form of hazing and needs to stop. There is No reason for it other than to line your pocket. Highly respected or NOT they will revoke your contract at a moments notice (90 days) if need be. Ive personally have seen it happen maybe 20 times in the past 10 years. Imagine having four children like someone I know, and being part of a group that was revoked by no fault of your own and having to work two states away and having your family far away. And having to only see them on weekends? That is what is happening. Ive heard that story multiple, multiple, mutiple times. And if you haven't than you have your head in the sand. Keep paying those ASA dues my friend. And of course state dues on top of that. The president of the ASA was a CRNA now. Good times ahead

 

[desflurane]

Interesting discussion. In order to get something of use out of this: what is a job-seeker to do?

The trend towards mergers and consolidation will continue. If the practice is lucrative it will be purchased. Period. Hospitals want it, senior partners want it, Obama wants it.

The question becomes what is the long term outcome of this consolidation?. Supposing that the majority of new graduates can only find salaried jobs or "B" partnerships (B=bull****), fast forward ten years when all the original "A" partners are retired and all that is left are salaried folks (MDs and CRNAs) then what? My guess is that they'll be a lot of turnover. Not sure if that will really matter to anyone.

Lots of residents want to know what the future will be and there are a lot of folks on these boards who claim to know the answer. I don't think anyone really does. There are a lot of people claiming this is exactly what happened with the HMO revolution and eventually that faded away back to fee-for-service. I don't think Obamacare is going anywhere and perhaps a salaried position isn't such an awful thing.

My advice is do a fellowship in what you like, try positioning yourself as a consultant. If you can go somewhere less populated, you will get a better job. If you can't or don't want to then a salaried gig might be the next best thing. If it has to be a salaried gig then, make it at the best practice you can find. Sometimes the AMCs get kicked out and the hospital retains docs they like. If you are offered a partnership, vet the practice thoroughly. Oh, and keep your expenses low until you have no debt.