Pinnacle Anesthesia Consultants

[ecCA1]

Is this similar to NAPA?

How "Obamacare-proof" would something like this be?

The advertise partnership tracks...Is this a realistic expectation to have with such a group?

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[bala1]

Is this similar to NAPA?

How "Obamacare-proof" would something like this be?

The advertise partnership tracks...Is this a realistic expectation to have with such a group?

Pinnacle is like sheridan only worse.

they are based i believe in texas but made some strides into northeast when they bought out a big practice there.

 

[veetz]

You obviously don't know much about Pinnacle.

 

[IlDestriero]

You obviously don't know much about Pinnacle.

Thanks for clearing that up.

 

[bala1]

You obviously don't know much about Pinnacle.

Ok genius, tell me where i err!

 

[gaspassers]

Pinnacle is a large group owned by Emcare. Emcare also owns a few large to midsize groups around the country including North Pinellas Anesthesia in the Tampa area and Milford Anesthesia in the Connecticut/Mass area. They also staff anesthesia services in many smaller remote hospitals. I know working for them in the rural locations can be quite lucrative, but do not know how their larger groups are run.

There will never be true partnership at Emcare groups, it is owned by a private equity fund. There may be some form of profit sharing, but you will never have full financial partnership, and you will not have a significant voice in the operations of the practice for many years (basically until you are a clinical director).

Emcare is mainly involved in Emergency Medicine which is much further along with managament companies than Anesthesiology is. Emcare has a history of "managing" their practices very closely, in fact this past sunday there was a piece on 60 minutes about Emcare and HMA pushing EM physicians to admit a certain percentage of patients.

With all that being said, there are a subset of people who do not want to worry about the management of a group, who don't want to deal with hospital administration when problems arise, or work late/extra when there are staffing issues. For those people management companies are a decent gig

While I do not know which is a better financial deal, I would much rather work for NAPA than Emcare/Pinnacle. NAPA is a group owned by and controlled by anesthesiologists, while Emcare is owned by private equity funds.

 

[DocD5]

Obviously, none of you know anything about Pinnacle in Dallas. First off, they are not owned by Emcare. They only sold their corp. office to Emcare. They did not sell their practice. I recently accepted a position with them that is a partnership track position for PINNACLE, not Emcare, and I am very happy. To my knowledge, they no longer have sites in the northeast. They only hire to the DFW metroplex and they are the most reputable group in that area. Not to mention the fact, they pretty much saturate the entire region. They shoot you straight too, which is important to me in terms of my career.

 

[DocD5]

Explain how they are worse?

 

[bala1]

Obviously, none of you know anything about Pinnacle in Dallas. First off, they are not owned by Emcare. They only sold their corp. office to Emcare. They did not sell their practice. I recently accepted a position with them that is a partnership track position for PINNACLE, not Emcare, and I am very happy. To my knowledge, they no longer have sites in the northeast. They only hire to the DFW metroplex and they are the most reputable group in that area. Not to mention the fact, they pretty much saturate the entire region. They shoot you straight too, which is important to me in terms of my career.

DUDE they are giving it to you good and you are too naive to realize it. they are another AMC looking to make money off of you. there is no partnership, your j ob isnt stable.. I know these guys. I bet you somewhere in your contract it says they can terminate you without cause... That doesn't sound like a healthy relationhship!!!

 

[DocD5]

DUDE they are giving it to you good and you are too naive to realize it. they are another AMC looking to make money off of you. there is no partnership, your j ob isnt stable.. I know these guys. I bet you somewhere in your contract it says they can terminate you without cause... That doesn't sound like a healthy relationhship!!!

Sorry bud, but I'm not buying it. A lot of friends of mine from residency, and my own father are currently partners within the group. So if anyone has bad info, it's you my friend. As far as the contract, most private practice groups have a "term without cause' section. It's pretty standard language. I know this because Pinnacle was one of three contract offers I received from private practice and they ALL had the clause in there. They have to have it in order to protect the group in case things go south, not to screw you over. I would be real concerned about a group who wasn't smart enough to protect themselves like that. Talk to the recruiter there. She will explain it to you and shoot you straight.

 

[IlDestriero]

Well if you terminate me without cause you are obligated to give me 6 months notice or 6 months pay. So, not all contracts are the same. That protects the group and me both. If it was a true partnership, you'd also have to buy me out of my share of the practice. What's your buy out if you're terminated?
The problem with some of these partnerships is they have no value beyond one contract. I'm guessing "partnership" is really just some incentive compensation. Or am I wrong and you are actually a partner (owner) of the whole amc?

 

[sevoflurane]

Sorry bud, but I'm not buying it. A lot of friends of mine from residency, and my own father are currently partners within the group. So if anyone has bad info, it's you my friend. As far as the contract, most private practice groups have a "term without cause' section. It's pretty standard language. I know this because Pinnacle was one of three contract offers I received from private practice and they ALL had the clause in there. They have to have it in order to protect the group in case things go south, not to screw you over. I would be real concerned about a group who wasn't smart enough to protect themselves like that. Talk to the recruiter there. She will explain it to you and shoot you straight.

Bridget?

Yeah, she's nice. I interviewed with the Pinnacle group in San Antonio while looking 5 or so years ago. Didn't get very far with her as she was pretty much left out of the loop. The group in San Antonio was nice and there wasn't much talk about Pinnacle as it was a recent acquisition. I decided to pass. Later I found out that some of those docs left and formed their own group. It may be different now though. I don't know.
Just sharing my experience.

 

[sevoflurane]

Explain how they are worse?

Do you currently work for pinnacle?

 

[DocD5]

Well if you terminate me without cause you are obligated to give me 6 months notice or 6 months pay. So, not all contracts are the same. That protects the group and me both. If it was a true partnership, you'd also have to buy me out of my share of the practice. What's your buy out if you're terminated?
The problem with some of these partnerships is they have no value beyond one contract. I'm guessing "partnership" is really just some incentive compensation. Or am I wrong and you are actually a partner (owner) of the whole amc?

The contracts that I have seen have a '90 day out' clause. That applies to me and the group. I have never heard of your 6 month reference. My understanding, is that if you are terminated without cause, they would have to pay you for the 90 days, whether they have you work or not. The group would not have to buy me out of my share of the practice until I was a full partner, which will not happen until the 4th year. Once you are full partner, you are paid like the other partners within that division, and you have voting rights that affect the entire group. Unless they just hire you in as a financial partner, without the guarantee of voting rights.

 

[DocD5]

Do you currently work for pinnacle?

I was recently hired, but will not start until I have privs. I have another 3-4 months to go.

 

[DocD5]

Bridget?

Yeah, she's nice. I interviewed with the Pinnacle group in San Antonio while looking 5 or so years ago. Didn't get very far with her as she was pretty much left out of the loop. The group in San Antonio was nice and there wasn't much talk about Pinnacle as it was a recent acquisition. I decided to pass. Later I found out that some of those docs left and formed their own group. It may be different now though. I don't know.
Just sharing my experience.

Yeah, Bridget is the only one I have spoken with. She is the one that will shoot you straight, even if the docs don't. Some recruiters will try to BS you to take the job, but she pretty much keeps it real. As far as San Antonio, I heard the same thing. They also had some others in Corsicana and Nacogdoches I believe, but I guess it didn't work out. To my knowledge it's just Dallas and Fort Worth for Pinnacle.

 

[Consigliere]

The contracts that I have seen have a '90 day out' clause. That applies to me and the group. I have never heard of your 6 month reference. My understanding, is that if you are terminated without cause, they would have to pay you for the 90 days, whether they have you work or not. The group would not have to buy me out of my share of the practice until I was a full partner, which will not happen until the 4th year. Once you are full partner, you are paid like the other partners within that division, and you have voting rights that affect the entire group. Unless they just hire you in as a financial partner, without the guarantee of voting rights.

4 years to partnership!?! Yikes. Don't be surprised if you get the ole "well, you really aren't partner material. We've received a lot of complaints about you" speech. That is, of course, after having been worked like a dog with a reduced salary for 4 years.

 

[DocD5]

4 years to partnership!?! Yikes. Don't be surprised if you get the ole "well, you really aren't partner material. We've received a lot of complaints about you" speech. That is, of course, after having been worked like a dog with a reduced salary for 4 years.

Well, you are a partner going into your 4th year. So it's actually 3 years to partner. That could happen, but then again, any other group can do the same thing. Do you know of any stable, reputable, solid groups in Dallas where you start as a partner on day 1? I sure don't.

 

[bala1]

Do you know of any stable, reputable, solid groups in Dallas where you start as a partner on day 1? I sure don't.

Touche.

 

[jwk]

Yeah, Bridget is the only one I have spoken with. She is the one that will shoot you straight, even if the docs don't. Some recruiters will try to BS you to take the job, but she pretty much keeps it real. As far as San Antonio, I heard the same thing. They also had some others in Corsicana and Nacogdoches I believe, but I guess it didn't work out. To my knowledge it's just Dallas and Fort Worth for Pinnacle.

A recruiter that "shoots straight"? HAHAHAHA - that's funny right there - I don't care who y'are, that's funny! HAHAHAHA

 

[DocD5]

A recruiter that "shoots straight"? HAHAHAHA - that's funny right there - I don't care who y'are, that's funny! HAHAHAHA

Most of them are full of crap, but she has been pretty solid. She hired some of the partners from 5 years ago that i know. Now i have had some sketchy offers from recruiters promising me the moon sun and stars. But that was mainly from agencies and a small practice out in Oklahoma.

 

[Consigliere]

Touche.

That's not a touche, douche. If the poster MUST work in Dallas, then so be it.

 

[bala1]

That's not a touche, douche. If the poster MUST work in Dallas, then so be it.

It is touche because he is conceding to the fact there are no reputable groups in dallas, including pinnacle/emcare/anesthesicare.

 

[Subaru]

Having known multiple Anesthesiologist partners that work for Pinnacle in the DFW area I can say that what DocD5 says pretty much is the nail on the head. Each of the groups under Pinnacle seem to have their own way of setting up their partner tracks, compensation model, etc....so some groups could be shady, but far from most. Basically set up like a loose federation with a majority of the decisions being made by the individual groups under the Pinnacle umbrella, which like DocD5 said essentially sold their billing rights to EMCARE for a couple hundred K per partner, so basically each year you lose 1 or 2% of revenue for that lump sum up front.

This means your groups area payor mix will decide your income, with some partners raking in mid to high 400 and other groups on the high side of 700k currently. All of this is just what I have from close buddies as I don't work for them...but would entertain a spot as a future Anesthesiologist

 

[Consigliere]

It is touche because he is conceding to the fact there are no reputable groups in dallas, including pinnacle/emcare/anesthesicare.

It's all good, kid.

 

[Mman]

all I know is that if you work for a company, you can't be a partner. No such thing when working for the man. They can call it a "partnership" but isn't the same. It's like comparing a guy who runs a mom and pop burger joint to a guy that manages a McDonalds. Not the same thing when you have a corporate overlord.

If you haven't been a true partner in an independent practice, you might not even know the difference.

 

[deleted126335]

all I know is that if you work for a company, you can't be a partner. No such thing when working for the man. They can call it a "partnership" but isn't the same. It's like comparing a guy who runs a mom and pop burger joint to a guy that manages a McDonalds. Not the same thing when you have a corporate overlord.

If you haven't been a true partner in an independent practice, you might not even know the difference.

 

[bala1]

It's all good, kid.

Hey consigliere? How do you think the market is? Would you recommend Anesthesiology for future medical students?

 

[Consigliere]

Hey consigliere? How do you think the market is? Would you recommend Anesthesiology for future medical students?

The market is terrible. Difficult to find a decent job. Very difficult. I would definitely NOT recommend anesthesiology to future medical students THAT I LIKED. Med students that I dislike immensely? I strongly recommend anesthesiology as a career - and I paint an even rosier picture of the future of anesthesiology than SDN if you can believe that.

 

[DocD5]

all I know is that if you work for a company, you can't be a partner. No such thing when working for the man. They can call it a "partnership" but isn't the same. It's like comparing a guy who runs a mom and pop burger joint to a guy that manages a McDonalds. Not the same thing when you have a corporate overlord.

If you haven't been a true partner in an independent practice, you might not even know the difference.

I would agree with you, if Pinnacle was part of a company that had a corporate overlord. What you are not understanding, is the same thing that I initially didn't understand either. Bottom line, Pinnacle did NOT sell their practice to Emcare. Pinnacle only sold off their practice management services. Pinnacle is still physician owned, and they only sold the corporate office in which they previously owned to Emcare. Therefore, the partnerships are TRUE PARTNERSHIPS. It is hard for docs to understand this if you don't have the facts. Believe me, I would never join a practice that is ran by a company such as Emcare. That is one reason why I joined Pinnacle, in addition to the partners being family and friends.

 

[DocD5]

Having known multiple Anesthesiologist partners that work for Pinnacle in the DFW area I can say that what DocD5 says pretty much is the nail on the head. Each of the groups under Pinnacle seem to have their own way of setting up their partner tracks, compensation model, etc....so some groups could be shady, but far from most. Basically set up like a loose federation with a majority of the decisions being made by the individual groups under the Pinnacle umbrella, which like DocD5 said essentially sold their billing rights to EMCARE for a couple hundred K per partner so basically each year you lose 1 or 2% of revenue for that lump sum up front.

This means your groups area payor mix will depend on your income with some partners raking in mid to high 400 and other groups on the high side of 700k currently. All of this is just what I have overheard from buddies as I don't work for them...but would entertain a spot as a future Anesthesiologist

Thank you! FINALLY someone who actually knows what they are talking about!

 

[bkell101]

Wanted to bump this thread....anybody have any recent experience with this group? Specifically in Fort Wort? (Pinnacle USAP)

 

[mostwanted]

Pinnacle got bought out by USAP. I think if they are offering partnership tracks now, they are different from a couple of years ago.


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[sevoflurane]

Pinnacle got bought out by USAP. I think if they are offering partnership tracks now, they are different from a couple of years ago.


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Very limited partnerships if even attainable. Not a true partner.
The Pinnacle/USAP deal is one of those partnerships that are actually doing quite well. They are a founding partner with USAP and as such have received a lot of dividends with considerable income restoration.
If and when USAP sells (which they will due to part of it being owned by a private equity firm), the founding partners should do quite well with their stock options.
If you get acquired by USAP now, you will most certainly not get the same deal as some of the founding partnerships.

 

[Ignatius J]

Obviously, none of you know anything about Pinnacle in Dallas. First off, they are not owned by Emcare. They only sold their corp. office to Emcare. They did not sell their practice. I recently accepted a position with them that is a partnership track position for PINNACLE, not Emcare, and I am very happy. To my knowledge, they no longer have sites in the northeast. They only hire to the DFW metroplex and they are the most reputable group in that area. Not to mention the fact, they pretty much saturate the entire region. They shoot you straight too, which is important to me in terms of my career.

They are in "partnership" with USAP, no?

 

[sevoflurane]

They are in "partnership" with USAP, no?

Yes they have since been acquired by USAP.

 

[amyl]

the market in dallas is different to say the least. I have four offers right now - fee for service (aka eat what you kill) for an upstart, one shady af pp gig, one pp gig that I thought was awesome but my lawyer freaked at the contract and then an offer from pinnacle usap. the non compete and 90 termination notice is the same for pp as it is for pinnacle - they get a bad rap for this I guess but the less shady pp gig has the same clauses. I think partnership tracks have gone the way of the dodo bird... we missed that boat my friends.... its the old guys who defaulted into anes when it wasn't competitive that cashed in on that one (yea maybe a little bitter ;-). pinnacle is what it is. I too have heard the rumors that they will be bought.... although by who I cant imagine. I am very blessed to have multiple offers because I do think the market is sh-- I just have no idea which one to take....

 

[Ignatius J]

I do not know much about Pinnacle. I do know and have worked with as a resident a certain other partner group of USAP and I was not impressed, nor have I heard good stories from former, younger employees.

I still do not know how private equity groups can make money off of physician practices. That is officially against the law in my state's jurisprudence. But they do it. Weird.

 

[Chloroform4Life]

the market in dallas is different to say the least. I have four offers right now - fee for service (aka eat what you kill) for an upstart, one shady af pp gig, one pp gig that I thought was awesome but my lawyer freaked at the contract and then an offer from pinnacle usap. the non compete and 90 termination notice is the same for pp as it is for pinnacle - they get a bad rap for this I guess but the less shady pp gig has the same clauses. I think partnership tracks have gone the way of the dodo bird... we missed that boat my friends.... its the old guys who defaulted into anes when it wasn't competitive that cashed in on that one (yea maybe a little bitter ;-). pinnacle is what it is. I too have heard the rumors that they will be bought.... although by who I cant imagine. I am very blessed to have multiple offers because I do think the market is sh-- I just have no idea which one to take....

Why did your Lawyer freaked?

 

[IlDestriero]

the market in dallas is different to say the least. I have four offers right now - fee for service (aka eat what you kill) for an upstart, one shady af pp gig, one pp gig that I thought was awesome but my lawyer freaked at the contract and then an offer from pinnacle usap. the non compete and 90 termination notice is the same for pp as it is for pinnacle - they get a bad rap for this I guess but the less shady pp gig has the same clauses. I think partnership tracks have gone the way of the dodo bird... we missed that boat my friends.... its the old guys who defaulted into anes when it wasn't competitive that cashed in on that one (yea maybe a little bitter ;-). pinnacle is what it is. I too have heard the rumors that they will be bought.... although by who I cant imagine. I am very blessed to have multiple offers because I do think the market is sh-- I just have no idea which one to take....

I thought you switched to an academic job? Are you moving again? If so, some may benefit learning what made you decide to jump ship again from the recent academic position.
Good luck with the decision.


--
Il Destriero

 

[amyl]

My lawyer freaked bc the contract seems to treat me as an employee when it suits their purposes and an independent contractor when that suits their purposes.... There was some clause that said if the irs audits the group and I'm found to be an employee I'm liable for the penalties interest etc not the group. I haven't decided what I'm doing....
When I decide I'll definitely share my thoughts if there's interest....

 

[bkell101]

the more I read this board the more I realize it's amazing how much I don't know....it's scary thinking about taking a job and not knowing what you are truly getting yourself into.....I'm not sure any residency/fellowship can prepare new grads for the harsh reality today's job market.....for example, this has been alluded to several times, but what differentiates a "true" partnership position from a bogus one?....or liability when the IRS comes looking (contractor vs employee)?

if somebody with years of experience in the real world is trying to figure out the best move to make, I guess that makes me chop liver? the fish in the barrel to shoot?

 

[GravelRider]

the more I read this board the more I realize it's amazing how much I don't know....it's scary thinking about taking a job and not knowing what you are truly getting yourself into.....I'm not sure any residency/fellowship can prepare new grads for the harsh reality today's job market.....for example, this has been alluded to several times, but what differentiates a "true" partnership position from a bogus one?....or liability when the IRS comes looking (contractor vs employee)?

if somebody with years of experience in the real world is trying to figure out the best move to make, I guess that makes me chop liver? the fish in the barrel to shoot?

Oh and believe me, the predators are out there. As someone who has been prey for the past year, I can tell you that they are licking their chops for every new grad that comes skipping out of the gate. I had a lawyer look at my contract and there were no major red flags...except for the lies. You also don't know the group dynamics like whether the "super partners" are taking 18 weeks of vacation compared to the 4 that were offered to you or if they work 2 or 3 days a week on the weeks that they actually work. Those things don't come across in the contract.

 

[deleted171991]

the more I read this board the more I realize it's amazing how much I don't know....it's scary thinking about taking a job and not knowing what you are truly getting yourself into.....I'm not sure any residency/fellowship can prepare new grads for the harsh reality today's job market.....for example, this has been alluded to several times, but what differentiates a "true" partnership position from a bogus one?....or liability when the IRS comes looking (contractor vs employee)?

if somebody with years of experience in the real world is trying to figure out the best move to make, I guess that makes me chop liver? the fish in the barrel to shoot?

The main thing that differentiates a contractor from an employee is that you work regularly for more than one group (and I am not talking about moonlighting). Basically, you are a business owner by behavior, not just by contract provisions. No real business has just one long-term client.

The typical example is a self-employed locum guy. The closer one is to that, the less likely the IRS will have anything to comment. These things are explained by IRS publications.

https://www.irs.gov/Businesses/Smal...ependent-Contractor-Self-Employed-or-Employee

See form SS-8 for more fun.

True partnership vs bogus one? That's easy. In a true partnership, the organizational structure is flat and everybody is equal; there are no senior or super partners, no special rights or benefits, and no way to get a bigger slice of the pie except by working proportionally more.

 

[Mman]

There was some clause that said if the irs audits the group and I'm found to be an employee I'm liable for the penalties interest etc not the group.

Penalties and interest on what? As an employee you can't be liable for anything except your own personal tax return.

 

[Notorious T.E.E.]

Penalties and interest on what? As an employee you can't be liable for anything except your own personal tax return.

I think he is saying the contract was an independent contractor position, but if the IRS determined he was actually an employee of the company then he would be liable for penalties and interest assessed to the company. Although you are right, you are only responsible for your own return, if you sign a contract saying you are responsible for someone else's return then by law you are. Hence his attorney's hesitation with the contract.

 

[Arch Guillotti]

the market in dallas is different to say the least. I have four offers right now - fee for service (aka eat what you kill) for an upstart, one shady af pp gig, one pp gig that I thought was awesome but my lawyer freaked at the contract and then an offer from pinnacle usap. the non compete and 90 termination notice is the same for pp as it is for pinnacle - they get a bad rap for this I guess but the less shady pp gig has the same clauses. I think partnership tracks have gone the way of the dodo bird... we missed that boat my friends.... its the old guys who defaulted into anes when it wasn't competitive that cashed in on that one (yea maybe a little bitter ;-). pinnacle is what it is. I too have heard the rumors that they will be bought.... although by who I cant imagine. I am very blessed to have multiple offers because I do think the market is sh-- I just have no idea which one to take....

Why are you leaving academics? I thought you just changed jobs?

 

[Arch Guillotti]

what differentiates a "true" partnership position from a bogus one?

You are an owner with equivalent interest right as everyone else.

 

[Mman]

I think he is saying the contract was an independent contractor position, but if the IRS determined he was actually an employee of the company then he would be liable for penalties and interest assessed to the company. Although you are right, you are only responsible for your own return, if you sign a contract saying you are responsible for someone else's return then by law you are. Hence his attorney's hesitation with the contract.

I can't think of a liability an employee could have to a company that an independent contractor couldn't. The difference would be if the IRS determined you were a partner, not an employee, to hold you responsible for some of the company's penalties. I mean your personal taxes are different a bit between W2 and 1099, but neither places you at risk of penalties assessed against the company as far as I can tell.

 

[amyl]

I think he is saying the contract was an independent contractor position, but if the IRS determined he was actually an employee of the company then he would be liable for penalties and interest assessed to the company. Although you are right, you are only responsible for your own return, if you sign a contract saying you are responsible for someone else's return then by law you are. Hence his attorney's hesitation with the contract.

yes this is exactly it.