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Private practice anesthesia

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snowman8

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What are the most important aspects to inquire about when looking at private practice anesthesia groups?

What were your experiences on the interview trail?

After being in private practice for a year or two, what were some of the aspects of a private practice that you wish you would have inquired about during your interview?

What are the advatages of being a partner vs an associate in private practice?

Are there any resources on the web that discussed these issues?

What are the advantages and disadvatages of the different private practice models (fee-for-service, etc....)?

What is the best way to find out the financial stability of the group?
 

huron

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What are the advatages of being a partner vs an associate in private practice?

Are there any resources on the web that discussed these issues?

What are the advantages and disadvatages of the different private practice models (fee-for-service, etc....)?

What is the best way to find out the financial stability of the group?

There was a recent thread that covered many of these questions.

http://gasforums.studentdoctor.net/showthread.php?t=490306


There are good partnerships out there that will treat you honestly and pay you fairly where all the partners carry their fair share and you don't end up supporting some older partner who does very little work but gets the lion's share of the money.

The best situation is where you do your own cases and get to bill for them if you have to join a partnership you are very likely propping up someone else salary. You are getting paid less for doing more or the same amount of work as someone else for the empty promise of "making partner and finally getting paid "fairly and equally"

Unfortunately there are many bad partnerships out there. Places that will pay you little work you hard for three or more years without offering partnership then fire you and find a new graduate. Places where even when you make partner you find out there are two levels of partners and you are only eligible to do the crappy cases and get paid less.

You need to learn as much as you can about the group that you are joining, You need to go into that job knowing whether you will be offered partnership or be cast off like the last new grad they hired who worked for very little for three years and then got the boot.

AMC's are as bad or worse as the bad partnerships groups because if you choose to work for an AMC you will never get paid fairly. The AMC owner is going to take the lion's share of the money and feed you the table scraps. AMC owners are smooth talking lairs who job is to con you into working for far less than you could be paid anywhere else. They will pretend to be a partnership group, but you will always be a poorly paid employee of the AMC owner never an equal partner.

The other common AMC payment scam is the Bonus scam. AMC will promise that if you work hard, do more cases, take more call, your productivity will be rewarded with a big bonus that will offset the meager salary they pay. The AMC owner's have dreamed up hundreds of excuses for why they can't pay you the bonus this time but of course if you keep working hard next year you will get that big bonus. Just like a malignant group if you complain or confront the AMC owner about their lies you will get the boot and a bad recommendation to make finding a new job difficult.

So do your self and your career a favor don't work for crooks, whether they are AMC owners or malignant groups.
 

fastosprintini

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i agree with all what huron said, my personal crucial aspect of this conundrum is to insist to be able to speak to the person who left ! is that the person you are going to replace ? you really want to talk to him/her , if they won't let you it's a big red flag...
good luck, fasto
 

Lefty

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How can you find out how the practice is set up? If they pretend to be a fair partnership but really have 2 partner tracks--how do you find this out? Chances are the newer, younger guys who are there either don't know or don't want to tell for fear of losing their job and getting a bad letter of rec, etc.

Lefty
 

militarymd

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Not necessarily true....

The gal who is leaving our group thinks that we're screwing her....whereas we feel that he did not represent herself accurately to us from the beginning.

The guy who I've hired to replace her DID NOT get an opportunity to speak with the person leaving....

I told the new guy this is not necessary and that he should just trust me....The new guy signed on the dotted line without hesitation.









but then the new guy and I did our residencies together 10 years ago.


i agree with all what huron said, my personal crucial aspect of this conundrum is to insist to be able to speak to the person who left ! is that the person you are going to replace ? you really want to talk to him/her , if they won't let you it's a big red flag...
good luck, fasto
 

denied

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How can you find out how the practice is set up? If they pretend to be a fair partnership but really have 2 partner tracks--how do you find this out? Chances are the newer, younger guys who are there either don't know or don't want to tell for fear of losing their job and getting a bad letter of rec, etc.

Lefty

There are only a few sure ways to get the full story. Talk to someone who left the group and get the full story. Fund a lawsuit by someone who left the group and was so mad about having their money stolen they sued. I have gotten some very good information by talking to the groups current or past locum's anesthesiologist, they will feel free to talk an most likely know what is wrong with a group where thay worked.


Alternatively you might be able to find the guy you are going to replace and get the full story from them;


I am currently working at a surgery center, owned by the surgeons they have decided that the only way to get quick turnover is to flip flop anesthesiologists, we bill for our own cases so the cost of sitting around doing nothing between ever other case is born exclusively by anesthesia. When I interviewed I was told this practice was rare and was soon to be entirely eliminated. It is clear the surgeon owners are intent on overstaffing the anesthesia department at the surgery center. I have threatened to quit if anyone else is hired, as I am the newest person in the department and thus get the worst schedules, i.e. the most of the highly undesirable flip flop rooms or the obscene waste of time the triple flip days, where three anesthesiologists are assigned to one surgeon. Recently they have started to interview for another unneeded anesthesiologist, they have tried to hide interviewee's visit nor was I introduced except by pure accident since it is obvious that they are hiding the truth about the undesirable elements of the practice.

I would be glad to tell the interviewee about the problems at our surgery center, but the owners are intent on not allowing the interviewee to learn the truth about their plan to over staff the surgery center.

Chesterfield lists some ways to look into groups to see how they plan to treat you.

You also need to look at the new section of gaswork.con. The "request for proposals" then "Search - Anesthesia Groups" which will show a list of most of the AMC you want to avoid. A number of the worst AMC's are playing games with their names and trying to pretend to be a partnership group and to trying to hide their past from their new employees. So you need to figure out if you are about to join a real partnership group or an AMC posing as one.

The UPIN number info is getting old soon there should be a NPI look up site that hopefully will show some good information. This site gives some NPI info and other good directory info.

http://www.hmedata.com/npi.asp

If anyone know of other good physician directory information web sites please post them to help the rest of us.



Quote:
Originally Posted by chesterfield
Keep a copy of every communication you have with the group. Record or immediately write a summary of all oral conversation with any group members.

Use this opportunity to investigate the practice. Before you go check out the hospital web site for the names of the Anesthesia doctor who work there. Your goal is to find the names of all the doctors who have left the practice in the last few years. Google all of those names along with the names of the corporation. Asking for this information from the group will get you labeled as a malcontent but to take a job with out an investigation the backgrounds of your employers is a recipe for disaster.

When you get there try to get as many months of the call schedule as possible. Old call schedules often have phone number of recently departed members of the group, plus they tell you how fair the call schedule is.

While you are in town go to the county court house and look up the names of all of the members of the group looking for lawsuits.

If your interview goes well and you are seriously considering the group you need to contact the people who have left to get the real information about how he group treats its employees.

How to find old employees of a group;

Look up all the anesthesiologist in that town with the state licence database,
http://www.docboard.org/docfinder.html

Look up all the anesthesiologist in that town with the AMA directory, ASA Directories for the last three or four years.

Look up all the anesthesiologist in that town with UPIN number search, great for towns with more than one hospital since it lists the billing address with the name separating out different practice locations.
http://upin.ecare.com/
or
http://www.upinregistry.com/provider_form.asp

Another good database dr-411 since it gives some info not seen elsewhere,
http://www.dr-411.com/default.asp


With all the names you have found you should be able to find a few former employees to contact about the group since this is your best source of unbiased information.

These databases will help you get current names and addresses of former employees.

Google is often helpful.

Searching for current phone number and addresses
http://www.zabasearch.com/

or your favorite directory search database.

Doc board is good for finding some one who has moved;
http://www.docboard.org/docfinder.html
which may give a current address.

If you have no luck you might want to invest a few buck and ask your local detective to search for people you can't locate. They also can search for lawsuits more broadly than the court house.

Now call your names and politely ask them to tell you about there experience at your potential employer.

While this is just the basics, your hospital credential application probably will be ten to twenty pages of invasive questions, many of which will be verified. Why shouldn't you know as much about your potential employer?

If you do not find any skeletons in the closet or areas of concern you need to find a competent lawyer and some trusted friends to look at your contract. Finding a lawyer who knows anything about anesthesia contacts is very difficult many attorneys will claim to be able to review a contact. So just because your buddy and fellow resident used that attorney does not say much about his competence in reviewing anesthesia contacts and providing relevant feedback.

Lastly don't ever buy a house until you have been there at least a year or made partner.
But don't say that to the realtor they force you to take a "tour of the town" with, you can be sure that everything you say to her will funnel back the anesthesia group.
 

militarymd

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I can't believe that you are staying on.....YOU are bearing the COST of the OR's inefficiency so that the surgeon can make MORE bucks on YOUR back.

I would quit...PERIOD.
 

militarymd

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Would your group allow a new hiree to review your Operating Agreement??

In addition the the employment agreement ask to see the corporate bylaws (these are as important as your employment contract) and have them reviewed by an attorney that specializes in medical contracting.
 

militarymd

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We have never had an applicant ask. Personally I WOULD be willing to have a new hiree review our operating agreement as long as all financial info was redacted and he was willing to sign a confidentiality agreement. I suspect that not everyone in our group would agree on this point. Remember the corporate bylaws are not the same as your professional services agreement with the hospital which I would NOT let a potential applicant review.


I guess I'm confused.

I equate "Operating Agreement" (of our LLC) as what you're calling "corporate bylaws"....which should not have any financial info...at least hard numbers.....are we on the same page?

What you call "professional servcies agreement" is what I call "contract" with the hospital.....why would you not let a new hiree see that if you're willing to let them see the OA?



For me....it depends on the new hiree....I would let some see the papers, but not others.
 

jetproppilot

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AMC's are as bad or worse as the bad partnerships groups because if you choose to work for an AMC you will never get paid fairly. The AMC owner is going to take the lion's share of the money and feed you the table scraps. AMC owners are smooth talking lairs who job is to con you into working for far less than you could be paid anywhere else. They will pretend to be a partnership group, but you will always be a poorly paid employee of the AMC owner never an equal partner.
.

I'd say this is generally an accurate statement.

With exceptions, as I serendipitously found out.

Those of you who follow my posts will recall I geographically limited myself because of family reasons. If you are looking to maximize your earning potential this isnt a wise thing to do.

My geographic decision, however, came after eight years in a lucrative practice in bum$%ck egypt. The egypt job allowed me to pay off my student loans (200K), my personal debts, and put a sizeable amount of money away.

I currently work for an AMC and have been pleasantly surprised. I was very skeptical since I grew up in a "real" private practice where I was a "real" partner.

Salary is good. Working conditions are good. Nine weeks vacation. Plenty of early days. No empty promises as of yet. Competent colleagues/CRNAs. Very nice hospital. Good surgeons. Collegial environment.

I'm happy at work.

I still make a great living, and am here with them.

Thats priceless.
 

zippy2u

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Denied, you just ain't gettin' paid right. When ya walk in the front door, the clock starts. When ya walk out the back door the clock stops. Who cares how much flip floppin' they do, you still gettin' paid because you ain't walked out the back door when you're between cases. Now multiply $180-200/hr by the # of hrs ya worked that week and that's your weekly paycheck. It ain't rocket science Daddy-O. Regards. ----Zippy
 

militarymd

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bump for dr doze....did I get your answer correct?

I guess I'm confused.

I equate "Operating Agreement" (of our LLC) as what you're calling "corporate bylaws"....which should not have any financial info...at least hard numbers.....are we on the same page?

What you call "professional servcies agreement" is what I call "contract" with the hospital.....why would you not let a new hiree see that if you're willing to let them see the OA?



For me....it depends on the new hiree....I would let some see the papers, but not others.
 

snowman8

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Bump

Can anyone provide more detailed answers to my questions?
 

Planktonmd

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This thread was started in 2008 and since then things have changed dramatically
The most important question to ask now is: Is the group stable? and does the group have a realistic chance to survive Obama care and value based purchase?
Many small and midsize groups are doomed and will soon be taken over by AMCS.
 
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Lurch

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This thread was started in 2008 and since then things have changed dramatically
The most important question to ask now is: Is the group stable? and does the group have a realistic chance to survive Obama care and value based purchase?
Many small and midsize groups are doomed and will soon be taken over by AMCS.
What do you consider a mid-sized group numbers-wise?
 

Planktonmd

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What do you consider a mid-sized group numbers-wise?
Well any group that is affiliated with an independent hospital (not part of a mega corporation) is vulnerable because sooner or later independent hospitals will have to join big corporations and at that point the anesthesia group will be screwed.
The big corporations that run hospitals have already formed alliances with large anesthesia groups and these groups will be the ones inheriting all the new contracts as the corporation swallows new hospitals.
This is happening all over the country and it's a matter of time before the concept of independent hospital or independent anesthesia group will disappear.
This is why joining a private practice group now with a promise of partnership is absolutely stupid.
 

Lurch

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Well any group that is affiliated with an independent hospital (not part of a mega corporation) is vulnerable because sooner or later independent hospitals will have to join big corporations and at that point the anesthesia group will be screwed.
The big corporations that run hospitals have already formed alliances with large anesthesia groups and these groups will be the ones inheriting all the new contracts as the corporation swallows new hospitals.
This is happening all over the country and it's a matter of time before the concept of independent hospital or independent anesthesia group will disappear.
This is why joining a private practice group now with a promise of partnership is absolutely stupid.

So you would take a W2 job with a larger PP group maximizing profit with the hopes that the group will weather obamacare and AMC takeover for the time being? Or would you recommend caving and going straight to AMC? I feel the answer may be dependent on geography as some areas are more buffered from AMCs at this point while for others the writing is on the wall in the nearer future.

As always, your opinion and that of others is much appreciated.
 

amyl

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I agree plank. I'm a hospital employee. I wouldn't ever take a partnership track job unless I was ok with not getting to make partner, because it think that's a thing of the past. There's always a chance my hospital gets bought out, I guess I have to hope we are small enough not to be noticed by the big corps but large enough not to be strangled by obamacare
 

Planktonmd

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So you would take a W2 job with a larger PP group maximizing profit with the hopes that the group will weather obamacare and AMC takeover for the time being? Or would you recommend caving and going straight to AMC? I feel the answer may be dependent on geography as some areas are more buffered from AMCs at this point while for others the writing is on the wall in the nearer future.

As always, your opinion and that of others is much appreciated.
The large anesthesia groups and AMCs are not that different anymore. They are both large corporations with profit as the only goal.
The problem with large corporations is that when reimbursement falls they will have to cut expenses and usually the first expense they cut is the number and compensation of employees.
The people at the top of the pyramid and the share holders must make money, that's the bottom line.
But you will have no choice since there are no other options.
 

dr doze

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The large anesthesia groups and AMCs are not that different anymore. They are both large corporations with profit as the only goal.
The problem with large corporations is that when reimbursement falls they will have to cut expenses and usually the first expense they cut is the number and compensation of employees.
The people at the top of the pyramid and the share holders must make money, that's the bottom line.
But you will have no choice since there are no other options.


Mostly agree. Almost Everyone does what they can to serve their values. Most people's top value is maximizing their income. Long term security, Pride in what you do are other values. Some people have more of a long term perspective than others. Through the 2000s when there was a shortage of anesthesia personnel we shortened the time of partnership to docs and raised CRNA salaries. Some partners bitterly opposed this- IMO they were very simply thinking from a short term perspective. The market is what the market is. When there was a shortage of personnel in the early mid 2000s a lot of the people who took AMC jobs were either geographically limited, had problems with their CVs, had quality issues or had zero business savvy. AMCs had a really bad reputation for providing sh1tty service and actually lost contracts for providing that type of service. Now that there is no shortage of quality anesthesia personnel their ability to provide decent to good service at a low price is greater. I have no doubt that there are plenty of recent grads who are allstars, the type of doc that any private practice group would have loved to hire a decade ago on a shortened partnership track who because of market conditions have to choose an employed type job. Timing is everything. We are/were a high quality private practice group that has been broken due to market conditions.
 
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