CA3 here and interviewing for jobs. I've got a few offers so far, ranging from a 3 year partnership track, salaried employee with call (salary 75K more than annual salary during partnership track + full benefits), and a position working weekdays only 7-5 no call no weekends 250k + benefits. I've always valued hardwork and its merits, and 6 months ago I was set on pursuing a partnership track, suck it up for 2-3 years, and reap the benefits of being an owner. But now I'm weary that all that hardwork would end with nothing considering the current state of healthcare. Part of me wants to take the salaried with call or even the 7-5pm offer and say goodbye to potentially making more. I just can't stomach working my ass off, sacrificing time away from family, while the government takes almost half of it away to support the so-called "entitled". Its depressing that this is how I feel, as opposed to being excited about jumpstarting my career. Am I being overly negative? Is it really just doom and gloom now for us about to get started? Perhaps the seasoned attendings here can give me some insight? Thanks!
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Partnerships still worth it?
Started by buntatog
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Don't forget about the possibilities of the group not ever really making you partner, the group being sold to a national investment group, or the group becoming hospital employees.
The odds of one of those things happening over the next 5 years could be 50% or more.
So, after 6 years with this Group as a an empoylee only vs a 3 year track/partner which results in more cash in your pocket?
It's all 'bout the 3's.
Location, quality of life and hard income.
You are just getting out. Realize that whatever you do, it probably won't be your last gig.
Getting some experience in a salaried position with good income right off the bat isn't a bad thing.
If it's the "perfect group in the perfect location" it may be worth it to suck it up for a couple of years.
There are some really great groups out there that don't eat at your salary for the first 2 years.... equal financial partnership from day one but no voting rights until 2 years out. These groups are often gems as their is true equality.
Location, quality of life and hard income.
You are just getting out. Realize that whatever you do, it probably won't be your last gig.
Getting some experience in a salaried position with good income right off the bat isn't a bad thing.
If it's the "perfect group in the perfect location" it may be worth it to suck it up for a couple of years.
There are some really great groups out there that don't eat at your salary for the first 2 years.... equal financial partnership from day one but no voting rights until 2 years out. These groups are often gems as their is true equality.
I suspect that we will see many old timers retire or go half time next year as obamacare and higher taxes eat at our wages. This may be a good time to get in those good groups. Networking is worth it's weight in gold.
i'm still confused why this wont be offset by the projected huge shortage of anesthesiologists in the near future. i realize with government involvement we are not driven by usual market forces, but will not the law of supply/demand at least give us some leverage in preventing drastic cuts in wages? they cant plug all the leaks with mid-level care.
also, buntatog, youre lucky to find any kind of partnership track - assuming there is a future to it of course. where i am there haven't been partnership positions available within a 50-mile radius for several years.
2008-2009 hurt a lot of people. The market hasn't fully recovered since then, but we are pretty close to it. So those 55-60 y/o's that were getting ready to retire lost a lot in retirement funds. They now have gained much of their losses back + have worked an extra 5 years. Obamacare and higher taxes are a great incentive to retire if you are in that age bracket.
Furthermore, this market is nowhere even close to the early 2000's anesthesia market... where you could write where you wanted to go and reap a pretty nice income. The job market is no doubt tighter. Supply end of the equation is def. getting bigger an AMC's are converting all MD groups to ACT models whenever they can as their bottom end will get much fatter. Projections aren't always spot on... and reimbursement has already started to come down. It will go down further from here.
FWIW, there are tons of PP groups still in existence and doing very well. There are no AMC's in my area and most anesthesia groups are PP and not hospital employed positions (although that is changing).
I was suprised to see that MGMA averages had a 3-4% increase in anesthesia pay last year. Hardly enough to keep up with inflation, but @ least we held our ground and something to bring to the negotiation table if you are renewing your contract.
thanks for all the replies. I'm taking comfort in the fact that I actually have options at this point. I guess I just have to take a chance. And the worst that can happen is I switch jobs after the contractual time period. From how I see it, if it's an all MD partnership, given the decrease in reimbursement rates, the group would have to work harder to keep total revenue the same. But if it's a salaried position you're guaranteed your income regardless of how well or bad the group does (given you deliver to the expectations stated in your contract of course). I think I'm leaning towards salaried employee...
Here's the downside of being a salaried employee: you can be fired if your salary is too expensive to support decreased revenue. I know it isn't breaking news, but if the bottom falls out the group is going to cut their employeed physicians before they back off on partner income.
The rules of being fired by a group differ by group (read the contract) and by state (different states offer different levels of protection to the employee).
But just like being on a "partnership track" might not guarantee becoming a partner (though for many groups it's a mere formality - ask about their track record), being a salaried employee doesn't guarantee you a salary for any period of time in the future. I'd argue a salaried employee is more likely to get fired than a partnership track physician.
See above.
Pursuing a partnership track is a fool's errand. You'll get punked out for years, the group will make money off your labor, then, come partnership time you'll be told "sorry, you're not a good fit."
So you're saying in no circumstances should anyone sign up for a partner track? We should all just become employees? The future of anesthesiology is no more partners?
How did I become a partner at my group?
Easy. Talked to their current partners. Asked detailed questions about how many people they had not offered partner to after the track time was over (answer: zero). Talked to the people currently on partnership track. Talked to the small handful of people that have left the group over the last 15 years and asked detailed questions.
Not every partnership is out to F&^% over the little guy. Some are open and honest and looking to hire people that can be partners for the long haul.
Warning, though, to be wary of pyramid style groups with a small handful of "super-partners" that have more money and more power than the rest. That's a big red flag IMHO.
Look for solid groups with equal footing and a long track record of making everyone on partnership track a partner.
There are excellent groups with excellent opportunities out there that are worth going after, just have to find them. Why not negotiate a deal in your contract to recoup your "buy-in" money if the group sells out during your partnership track?
Not necessarily. Just exercise EXTREME caution when dealing with groups offering partnership. Do your due diligence.
The future of anesthesiology will be that we are all either hospital employees or employees of an AMC. It is already happening at an alarming rate. I predict that by 2018, >75% of anesthesiologists will fall into 1 of the 2 categories above.
Lot's of BIG PP groups.
PP groups with 60-250+ members are HARD to get rid of, especially groups that have a good long and established relationships with hospitals administrators. Icing on the cake is when those groups are the ONLY group in town.
Somnia, TIVA, Sheridian can't touch those groups.
PP groups with 60-250+ members are HARD to get rid of, especially groups that have a good long and established relationships with hospitals administrators. Icing on the cake is when those groups are the ONLY group in town.
Somnia, TIVA, Sheridian can't touch those groups.
That's what I use to think, but it turns out it isn't true.
Take a partnership track job if you want, just take one where the early pay is worth the work and partnership is icing. I wouldn't take a large income hit today in the hopes that partner income will make up for it because the partnership may never come and the group may not survive. The more money they take from you early on, the more incentive they'll have to let you go and take the next sucker's money when you leave.
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Does anyone think that within 10 years all private groups will either get bought out or become hospital employees?
100% chance of this happening.
Want to bet?
I'd say it'll be between some and most. Definitely not a 100% chance. Too many groups with too much power and good will to be bought up by hospitals. It just doesn't make financial sense. Hospitals are big and inefficient. It's better for the hospital if the group remains separate so the physicians have an incentive to function more efficiently. Once the hospital makes them employees, they work just hard enough to not get fired and nothing gets done and money goes down the drain.
CA-3 with several different interview experiences in different groups. A couple of them have impressed me that the newbie gets pretty much the same pay as the partners. 1-2 year partnership imparts voting and ownership rights, but otherwise they are equal in work days, calls, cases, and most everything else right off the bat.
I also saw what some of you have described in that it is a longer 3 years partnership track, but full voting rights won't happen until after a total of 8 years. But that has to be weighed against the other perks of working for that group in a great location at a great hospital.
From my investigating so far there are many places that are pretty fair to new hires.
This is tough decision time.
I also saw what some of you have described in that it is a longer 3 years partnership track, but full voting rights won't happen until after a total of 8 years. But that has to be weighed against the other perks of working for that group in a great location at a great hospital.
From my investigating so far there are many places that are pretty fair to new hires.
This is tough decision time.
I agree with this post, but, the problems hospitals have with seperate private anesthesia groups is that it shifts some of the hospitals power over the group to the group. One thing hospitals and administrators hate more than losing money is anesthesiologist who have power. So I agree in the future there will be less and less private anesthesiologists and more and more employees. That is where it is going. Plain and simple. The money wont be there either and you will be working like a factory worker like a lot of us are doing now but it will get worse FOR SURE.
I totally agree with this, sadly. We will all have someone taking a cut of our work. There's a ton of large groups out there 20-30 years old with the owners close to retirement. AMC comes in and they can cash out for a nice retirement bundle of cash. What's the incentive for them to do otherwise? My buddy in Phoenix says one of the largest groups there is selling out to an amc.
On the other hand exactly zero of my buddies from residency have been burned by phony partnership tracks in the last 3 years. So are the oppotunities still out there? Yes, but for how long?
The groups that are ROCK STABLE (very few), (read:150 anesthesiologist) see the writing on the wall and sell to amcs. (sheridan, napa, anesthetix)m terrible terrible terrible. Oh, Mednax, American Anesthesiology is another one. DO you know how awful it is talking to an administrator and asking for a job. It sucks!!!
The sky is falling!!!!!
The sky is falling!!!!!
teach us oh wise med student
The sky is falling!!!!!
When you get some real world experience, then you can post cutesy cartoons. Until then - SIT DOWN, SON!
The sky isn't falling; but, it is changing from a beautiful sunny day to a partly cloudy one.
Anesthesiology is a hospital based specialty which is transitioning from a private practice model to an employee/AMC model. This is the way ER medicine is today (for the most part) and the way 75% of all Anesthesia practices will be by 2018.
The onslaught of govt. regulations, Medicare rules, ACOs, lower paid Medicaid patients and an abundant supply of cheaper mid level labor is forcing our older model of independent practice out and an employee one in.
There is still opportunity to land a nice gig earning $400K plus in any of these models. My concern is that once private practices dry up/sell out all that will be left are the lower paying AMC jobs or a few select, decent paying hospital based positions. The ASCs will likely hire their own providers and cap their salaries as well.
D
deleted126335
It depends on the demographics and voting rights of the group. In democratic groups there is an inclination to sell the company if a substantial number of docs have a short time horizon (less than 7 years or so) + enough fear and uncertainty of the younger docs who may be willing to setlle for a guarantee of five or so good years. If it is a young group with a long time horizon they are more likely to be resistant to sale/employment model.
gotta agree with blade on this one.
Lol, OK dude, I was just summarizing your entire post history.
So, you are assuming all medical students 25 years old with no life experience, that's cool.
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Alright, but you must listen closely, Grasshopper.
The problem is once you start making decent money, and your partners are as well, the hospital health system starts making noise about you making too much money and they start looking around for someone cheaper en masse.. And they usually find it. And your job is gone and you're out on the streets looking for another job. and the cycle goes on until everyone is making just above the bare minimum that is required to keep you from staying in bed and not working.
Valley.
NAPA
He says it's not a done deal, still in talks. But that's the word on the street.
There will still be decent jobs. But it sucks to have no other choice than to take a job that involves a third party taking a cut of your billing. But, that's the writing on the wall. It doesn't mean the sky is falling, but owning your own practice and owning 100% of your labor is going to be a thing of the past. We'll all be somebody's biatch.
And more and more, less people will go into medicine if this type of thing happens. I think there are still people going into medicine bc it's a decent gig for now, but given the escalating salaries in other professions with a much smaller and less stressful amount of work, few people will continue to go into medicine if it sucks.
Who will go into medicine and train for 12 plus years when you can get a BA, and make over 100k-150k by the time you are 30, have weekends off, and no one to sue you?
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deleted126335
Oversimplification.
Depends on a variety of factors in no particular order of importance:
-Size of your group
-Enforceability of non-competes
-How much your group is valued and respected by surgeons and administration.
-Desirability of the place you are located, how easy will it be to recruit replacements?
-Current supply/demand ratio for anesthesia personnel
-How unified your group is
-How smart is the guy (administrator) making the decisions? Plenty of huge mistakes (multi million $) have been made by CEOs
-What is your group's stomach for playing poker?
-How good is your legal and financial counsel and are you willing to listen to them?
With President ******* raising taxes AND decreasing our reimbursement, you're gonna get shafted from both ends, you rich greedy doctor. 😍
Get ready to WORK MORE for a LOT LESS... Somebody's gotta pay for obamacare right? Nobody gives a **** how many years you've sacrificed to get here or how much loans you have. You are FORBIDDEN from discussing money.
My advice: Work as much as you reasonably can, live like a resident for now, and save up.
Get ready to WORK MORE for a LOT LESS... Somebody's gotta pay for obamacare right? Nobody gives a **** how many years you've sacrificed to get here or how much loans you have. You are FORBIDDEN from discussing money.
My advice: Work as much as you reasonably can, live like a resident for now, and save up.
Not many hospitals want constant turnover of anesthesia personnel. On the contrary, the hospital, surgeons and staff want reliable, consistent, quality anesthesia from people they know. Now, this doesn't mean you get to demand salaries above the national or regional average (for an average job) but if you are willing to negotiate wisely most administrators would prefer to keep you on.
I'm not sure what this other awesome profession is that you speak of. It's not law. Can't get a job there. And I don't think a BA gets you squat theses days, certainly not 6 figures in 10 years. Your local Starbucks is full of BAs pulling $10/hr.
I can't think of many professions that give you the job stability and relatively guaranteed income >$150k and portability of skill set and earning potential. Obviously there are downsides, but I'm pretty sure I am making more than my current neighbors, and working fewer hours. My high school friend has had a stable job for the last decade, but his company has downsized/outsourced from a team of 30 to 5. He's working on his résumé, of course. Whatever turnover and instability we are expecting for anesthesiology has been happening to every other industry for the last couple decades.
Nope, just in medicine. You have no experience and a narrow perspective. Just wait and you'll see how right I was/am.
My advice: live like a resident for now, and save up.
🙁
Resident lifestyle 4 LiFe. 🙁
So say that a small group (4-5 MDs) really wants you for their partnership track and is pressing you to make a decision in 2 weeks (now reasons that they are seemingly desperate are: theyve been having a hard time gettinh anyone on board due to location in the middle of BFE; a-hole senior partner is known to be a prick that drives track individuals away, but is now retiring and needs a replacement) simple b&b cases, 1:4 1st and 2nd call from home, 3 year to partner). start 270k,280,290 then partner pay (500k). the frequent light call is a bummer. is it unreasonable to ask for 300k for each year until partnership to make it a little more desireable, considering that there are no-call positions to be had for 250-300k? i dnt consider myself a superstar by any means but I am a workhorse...but there is no guarantee of the group not selling out in the next 3 years so I just want to secure my earnings if it goes either way. Am i being greedy here? appreciate all your input.
3 years to partnership for a "desperate" group in the middle of BFE is a long time. That should be a 12-18 months partnership, certainly 2 years tops. That is one thing I would try to negotiate on more than starting salary. Also, I'd be surprised if they are making 500k this year, let alone 3 years from now. Does this group receive a sizable stipend? If so, I bet it's going down, way down unless somehow all your patients have private insurance and the ORs busy and efficient (don't see that happening in BFE).
If you want to work there, I'd do no less than 2 years partner making 300k/315k. Your initial counter could be 18 months partner making 290k/310k or even 1 year partner at 275k.
As a side note, do you really want to do simple b&b your 1st year out?
If you want to work there, I'd do no less than 2 years partner making 300k/315k. Your initial counter could be 18 months partner making 290k/310k or even 1 year partner at 275k.
As a side note, do you really want to do simple b&b your 1st year out?
I wouldn't prioritize making an extra 30k pre-tax first year out if you can get a shorter partnership track.
My priorities would be:
1) shorter partnership track
2) if you can't get that and you think they're likely to sell the group then go for a cut of the money if they sell the group, maybe 33% from day one, 66% year 2, then 100% as a partner (of course)
3) sign on bonus
4) more money during partnership track
You can make 300 or more in a major city. You have to decide how likely it is that the 500k will really be there 3 years from now. It might. It might not. If you actually prefer a smaller town, then your decision is easier.
My priorities would be:
1) shorter partnership track
2) if you can't get that and you think they're likely to sell the group then go for a cut of the money if they sell the group, maybe 33% from day one, 66% year 2, then 100% as a partner (of course)
3) sign on bonus
4) more money during partnership track
You can make 300 or more in a major city. You have to decide how likely it is that the 500k will really be there 3 years from now. It might. It might not. If you actually prefer a smaller town, then your decision is easier.
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