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San Jose Anesthesiology Upheaval (CEP takeover). Who has the real scoop?

Discussion in 'Anesthesiology' started by Measured_in_KG, Feb 8, 2017.

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  1. Measured_in_KG

    Measured_in_KG Banned Banned Account on Hold

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    Gaswork presently has four separate ads for anesthesiologists in San Jose, all through CEP.

    I agreed to work some locum shifts for them. It has sucked so far, but maybe that's not all CEP's fault.

    Word is that CEP just won the bid for three hospitals in San Jose. Where I am (Regional), not a single doc from the old group joined on with CEP. The transition has been about as bad as you might fear.

    Anyone care to defend CEP? No way will they last if they are this incompetent everywhere.

    Thx.
     
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  3. noclaw

    noclaw

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    I think Ezekiel has been misinformed. CEP is not pulling up stakes.

    The group at Good Sam, who was one of the first anesthesia groups to join CEP, continues to support Regional and O'Connor until they recruit enough new docs. They'll probably need 2-3 years to get a stable group, maybe even longer.

    Only a fool would suppose that the best and brightest from Good Sam have agreed to leave Good Sam for either Regional or O'Connor. Your experience at Regional does not represent the best of CEP. Let's just say that the ones who are spending their time at O'Connor and Regional are not missed at Good Sam.

    Has CEP made Good Sam better or worse? That's the wrong question. Medicine is changing. The business of medicine is also changing, and not to make it better for the docs. It's not whether joining CEP was better than staying independent. It's whether joining CEP was better than being purchased by Sheridan. I might not be the right person to ask, but I think that my CEP contacts are on balance much happier than my Sheridan contacts, and that is even more true the younger they are.
     
    Last edited: Mar 10, 2017
  4. Measured_in_KG

    Measured_in_KG Banned Banned Account on Hold

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    Noclaw makes good points.

    Maybe CEP is no worse than other AMCs. Maybe they're even the best. The bottom line is that the future of anesthesiologists sucks.
     
  5. Measured_in_KG

    Measured_in_KG Banned Banned Account on Hold

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    I hear desperation is kicking in at Regional San Jose.

    My recruiter keeps begging me to return, saying that I can name my price and they are so desperate they will meet it. I emailed my favorite of the four administrators "managing" the cluster, only to hear she quit. Typical. She was the one who had a clue.

    The two docs I keep up with from there tell me they think CEP will be fired if they don't pre-emptively walk. I don't know what's the truth, besides the painfully obvious truth that the group who had been there for 20+ years knew what they were doing when they walked away.

    I don't know how they can possibly recruit into such a hot mess.








    keywords: CEP AMC Northern California AMC future anesthesia anesthesiology Lucas Sean Shawn
     
    Last edited: Mar 13, 2017
  6. Ezekiel2517

    Ezekiel2517 Anesthesiologist Physician 10+ Year Member

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    I deleted my old post on this but seems like I knew what I was talking bout
     
  7. caligas

    caligas ASA Member 5+ Year Member

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    You should name a price!
     
  8. Measured_in_KG

    Measured_in_KG Banned Banned Account on Hold

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    They apparently have a bet going who can be the first doc to see the Chief do something clinical: do a case, start an iv, do a pre-op, check on a patient in PACU. Anything clinical at all. Almost two weeks now and still nothing.

    Nope, I don't miss it there.

    Lucas Sean Shawn CEP job anesthesia AMC management incompetent recruit run future benefits contract gaswork sheridan emcare usap mednax crna
     
  9. gasspasser

    gasspasser ASA Member 7+ Year Member

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    So which groups are still independent in the area now? Did the GAS group split off and join CEP?
     
  10. noclaw

    noclaw

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    I don't want to engage in any speculation, but I can confirm that GAS (Group Anesthesia Services, of Los Gatos) has been a CEP partner since December of 2014.

    Most of the "independent" groups in the Bay Area aren't groups at all, but one (difficult) dude who has a patchwork of informal (and low-paying) arrangements throughout the Bay Area to cover cases here and there that aren't worth the real groups' time. One guy calls his group BAAMG. Another calls himself Pontine. Another guy hasn't even incorporated, but paws through table scraps at Canyon Pinole, Empire, and Precision surgical centers.

    My advice to any anesthesiologists looking at the smaller independent "groups" is to keep looking. Vi*le, Bl*ck, D*nn*ngs, K*rd*n...these are guys who are preying on your naivete and desperation. Don't bother with them.
     
    Last edited: Mar 10, 2017
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  11. Ezekiel2517

    Ezekiel2517 Anesthesiologist Physician 10+ Year Member

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    I would agree to be careful of the small independent groups you mention. not really sure it's wise to specifically name individuals on a public internet forum tho. Point is, as OP has now realized, is that it's not a wise move to join up with Regional, imo
     
  12. Measured_in_KG

    Measured_in_KG Banned Banned Account on Hold

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    Yes, the OP has realized Regional is a sh!tshow. It didnt take SDN to teach me that, but im obviously in the majority.

    My recruiter wants to send me to O'Connor and Washington Hospital in Fremont. I hear that CEPs even worse there, and that the locums docs get worked like slaves.

    I'm trying not to hold my experience as a locum gaspasser against CEP, but I cant find any anesthesiologists willing to say anything good about them. I hear ER docs like them, but they get scribes following them around writing their notes for them, so what's not to like.

    I started this thread trying to get somebody to defend CEP. Instead, we all kind of piled on Regional. Now that we've established Regional sucks, anybody want to defend CEP as anesthesia management??
     
  13. noclaw

    noclaw

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    CEP isn't really one entity. Not only is CEP Emergency different than CEP Anesthesia, each anesthesia subgroup is different. They do their best to respect the autonomy of the groups they phagocytose, so each group continues to have its own strengths, weaknesses, and idiosyncrasies.

    I hear from everyone, and agree, that CEP Regional sucks. I happen to know the guy who agreed to be president at regional was barely cutting it at Good Sam. And it's probably true that he's even a worse manager than he was a clinician. Any new recruit who signs on now is either hopelessly desperate, or hopelessly optimistic that HCA can turn Regional around. Since HCA has been at Regional for ~15 years now, I am not convinced, which is why I am not cashing in on Regional/CEP's desperation. YMMV. Maybe in a decade or two the surrounding demographics will have changed much like Los Gatos did in the last 20 years...

    It's not only the anesthesia department at Regional that is struggling. The hospital is in a crummy part of town, with a high percentage of Medi-Cal and uninsured patients. The hospitalists, surgeons, and nurses that staff the hospital are the kind you'd expect to find in a typical charity hospital--think Contra Costa Hospital in Martinez, for example. That should not be breaking news to anybody who knows the area or drops by for an interview.
     
  14. nimbus

    nimbus Member 10+ Year Member

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    What does this mean exactly?
     
  15. CYP450

    CYP450

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    A friend recently forwarded this discussion to me, and I’m happy to jump in.

    I’m a past president and one of the long-time managing partners for Group Anesthesia Services (GAS) in Los Gatos, CA. GAS formed the inaugural anesthesia practice when we joined CEP America in December 2014. Since then, I’ve served as the Director of Operations for CEP’s anesthesiology practice line.

    My former group recognized the expanding services expected from anesthesia groups and made the proactive decision to join CEP with 3 major goals in mind:
    • Acquire tools that will help us deliver more effective care
    • Develop programs that support and preserve our relationships with facilities
    • Preserve our roles as owners of our local practice
    These goals aligned with the core values of CEP’s democratic partnership, where success is driven as much by our commitment to our fellow physician partners as by our commitment to our patients. As one of the newer specialties in CEP, there’s no doubt we’ve experienced some growing pains as infrastructure has been adapted and built for anesthesiologists. Throughout this process, however, the CEP values of servant leadership, democracy, and transparency for our partners have affirmed our decision to join an organization that reflects the culture and values we previously embraced as a single specialty practice.

    Modern healthcare’s mantra of “better patient care, broader delivery of care, more cost effective care” fails to acknowledge something just as important – providing a rewarding and satisfying environment for us, the clinicians providing care. We’re all living in a period where disruptive forces challenge us to improve healthcare with diminishing resources. Those challenges are amplified when high acuity hospitals offer little financial resources, but expect us to build a practice from the ground up. So, yes, there are challenges at some locations. However, as a physician partnership, we are committed to providing the financial resources, leadership, and education for anesthesiologists to thrive in a rapidly changing environment. As a democratic organization equally owned by over 2000 physicians, we empower every one of our partners and employees to create the vision of a better CEP and to contribute to achieving that vision.

    Continued success depends on our ability to recruit and support the next generation of clinicians and physician leaders. Direct and candid comments, like those shared on this blog, offer valuable insight on where perception may stray from reality. I welcome personal communication with anyone to help address these misperceptions. And, where we’ve failed to recognize weaknesses and opportunities for improvement, I appreciate the feedback and commit myself to fixing them.

    Peter Nosé, MD
    [email protected]
     
  16. dhb

    dhb Member Lifetime Donor Classifieds Approved 10+ Year Member

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    Nosé tampoco
     
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  17. apoondoc

    apoondoc

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    "proactive... acquire tools...aligned with the core values...servant leadership...culture and values...disruptive forces...empower...create the vision..."

    I have Bingo! In fact, I got horizontal, diagonal, and vertical Bingos. I was only one "synergy" and "move the needle" away from a meaningless business jargon total Blackout.

    My favorite term, though, was his use of "product line." Take note: you are not anesthesiologists. You are not physicians delivering anesthetics. You are now a product line offered by a bunch of eggheads who exchange memos full of business gobbledygook with other eggheads, while they buy and sell the work that you do. Embark on a career in anesthesiology at your peril. These will be your masters.

    I appreciate that Dr. Nose has joined the conversation. I would bet he is a very friendly and approachable. But he comes off as a perfect tool. Well, maybe not "perfect." If he were a perfect tool, I would expect him to offer at least some defense of the product line team leader he has propped up at Regional. By not defending that poor guy, Dr. Nose has, in so many words, confirmed that the chief is a total failure.

    The reality is that changing a stable group of anesthesiologists for a team of locum hacks has been a total disaster, and I receive phone calls or texts at least weekly from those remaining on the inside at Regional telling me the same thing. Where perception strays from that reality is the notion that CEP knows what the hell it is doing.
     
  18. aaabbbcccddd

    aaabbbcccddd

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    I was recently made aware of this forum and thread, and thought I'd add my experience. I don't have a specific dog in the hunt and will do my best to call it as I saw it. I worked a couple of weeks at Regional since I was thinking of relocating to San Jose. I decided against both Regional and CEP, but others might think I am being overly critical.

    First, the good:

    Doctors get good food at Regional.
    The hospital is convenient to 680 and 101, and has plenty of close parking.
    Even though the anesthesia group walked en masse, the rest of the surgical services (excepting at least OB) survived mostly intact, including surgeons, nurses, and techs.
    HCA seems committed to Regional.
    The locum rate was pretty good.
    The anesthesia techs are experienced and helpful.

    The Bad:

    90% of the surgical cases come from the ER. (The CEO touted this figure himself, and was proud of it.) What that means is that all the good surgical cases (elective, otherwise healthy, privately-insured) cases are going to other hospitals and surgeon-owned surgical centers, while Regional is left mopping up the uninsured, unhealthy, and traumatic.

    While the ortho trauma docs are above average, the other surgeons are significantly below average. The interventional radiologists are, while friendly, dangerous. The neurosurgeons are both slow (six hours to do a one-level microdiscectomy) and abusive. The obstetricians are mere contract workers, and are all brand new, to boot. I have never worked at a hospital where the DO surgeons are better than the MD surgeons. I think it is because the entire hospital finds it hard to recruit, so while the better DOs might accept the indignity of the assignment if they want to live in the Bay Area, only the very worst MDs will slum there. I didn't work with the cardiac surgeon, but I know he chased off a cardiac anesthesiologist who had promised to work for Regional through December, so that created a huge gap in their already tenuous schedule.

    The OR allows elective cases to be scheduled at absolutely any hour of the night or on weekends. The two weeks I was there I saw an 8-hour crani scheduled to start at 8 PM (It didn't go into the room until midnight.) as well as two other elective cases boarded for 11 PM.

    While convenient, the surrounding area is rough. My two weeks there I was aware of two physicians' cars that got broken into, and security merely shrugged their shoulders.

    Worst of all, CEP is running the staff so inefficiently there is no way anybody can be making any money. It was routine while I was there to have three or four rooms scheduled, and to have an additional three, four, or five anesthesiologists sitting around getting paid for doing nothing. Not only the OB guy (dedicated 24 hours a day for the ~30 deliveries they do a month) and the trauma guy (in house 24 hours a day, whose primarily responsibility was to be a pre-op scut monkey) and the "Chief" (whose only responsibility, as far as I could discern in two weeks there, was to sit in his little closet with his earbuds in watching Youtube. I am not exaggerating.), but also one or two other guys scheduled until 3:00 pm for cases that never come. In addition to all that waste, they also have three (or is it four?) dedicated "administrators" who run the board (No, somehow that is not the Chief's job, even when he is on the schedule as the AIC) and make the next day's assignments from somewhere off campus. Word is that CEP took the contract without a stipend. If that is true, they are losing millions of dollars a year. I don't know where that money is coming from, but there's no way the three guys doing cases can generate enough money to pay four administrators, four break docs, plus leave any cream for CEPs top dogs.




    So, if I were a new graduate, I would look elsewhere. If I absolutely had to live in San Jose and couldn't get a job at Washington Hospital in Fremont, I might "get my foot in the door" at Regional, and hope to move up and out as quickly as possible. I didn't like what I saw from CEP's management, but it is possible that the mess they inherited at Regional (and the poor, overwhelmed shmuck they placed in charge there) is the rare outlier, and that they are on top of their game at their other hospitals.
     
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  19. dhb

    dhb Member Lifetime Donor Classifieds Approved 10+ Year Member

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    Correct me if i'm wrong but it's my impression that the good was much shorter that the bad.
     
  20. aneftp

    aneftp 7+ Year Member

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    Usually when a company takes a contract "without subsidy"

    It's very misleading. I know quite a few hospitals that provide "bridge income" to the new AMC for 1-2 years until staff stabilizes.

    XXXX AMC is notorious for convincing hospital management especially in the north east. But it happens on the west coast also.

    It just happened at my old hospital were the AMC is getting half the locums payment from the hospital even though they aren't taking a "subsidy"

    Gotta love how MBAs talk among themselves. And shift money around to make it look like they aren't losing money (hospital side or AMC side)
     
  21. epidural man

    epidural man ASA Member 10+ Year Member

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    Peter,

    You are in the right job. You should consider working for a publically traded company where you have to answer to stock holders.

    In the same spirit of apoondoc, I think you could sound even better and please those that listen to crap like this if you talk a little about six sigma, add a line about team stepps (barriers, tools and strategies, outcomes, etc). Dazzle a little with a line or two about how National Patient Safety Goals are being met, etc.
     
  22. IMGASMD

    IMGASMD ASA Member

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    Patient satisfaction, PDSA cycle, forward thinking, added value if he didn't mention them already.

    I have to be honest, TL;DR the dissertation.
     
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  23. aneftp

    aneftp 7+ Year Member

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    The talking points all these management companies love to put on their websites and brochures are all the same.

    We all know the truth. It has ZERO TO DO WITH PATIENT CARE.

    I've seen it so many times.

    It has everything to do with fake agendas these MBA devise in the board room and EVERY MANAGEMENT COMPANY copy cats.

    Just remember "metrics" companies make up can be easily manipulated. Like this big AMC said they had a 90% MD retention rate after 1 year and 80% retention rate after 2 years. I asked them point blank how many MDs were retained voluntarily. Meaning the vast majority of those MDs retained were due to buyout stipulations to stay for 2-3 years!! That's what I mean by metrics are all made up. Take away the MDs who got a cash payout and the mandatory 2-5 year stay period. Their retention rate likely drops to 60%. A huge difference between 90% and 60%.

    Sad but true.
     
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  24. Measured_in_KG

    Measured_in_KG Banned Banned Account on Hold

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    I just saw that a fifth (or is it sixth) company is now scrambling to find warm bodies for Regional. They've had to increase the daily rate, as well.

    Two of the three young graduates who had signed to start in July have backed out. Uh oh.

    I also hear that the docs at Good Sam are pissed at how much money they are having to kick in to keep CEP Regional afloat. Funny how easy it was to predict.
     
  25. booohooo

    booohooo 2+ Year Member

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    The group at Mercy General in Sac is CEP now too. Anyone got good information on what it's like over there?
     
  26. JusticeisBlindnotDumb

    JusticeisBlindnotDumb Banned Banned Account on Hold

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    I don't know anything about CEP Sacramento, but I'm hearing terrible things about CEP's anesthesia department in general. I figure the second client who came to me was merely a coincidence, but having just picked up my third, I can clearly see a pattern.

    If you were not treated fairly at CEP, send me a direct message and let's start a dialog about legal redress. I won't charge you anything until after we win.

    You will be surprised to find how the law is generally in your favor in labor disputes. You can also rest assured--even though CEP is deservedly known as being vindictive--I will shield your identification from them as long as possible. Believe me, they have so many former employees angry at them that they will not be able to trace the complaint back to you. Furthermore, if your attempts to gain employment apart from CEP are *in any way* subject to tortious interference, you may be awarded significant punitive damages.

    Some things you may have tolerated, but are explicitly illegal include the following:

    Contracting with you as a 1099, but demanding your uncompensated presence at meetings.
    Contracting with you as a 1099, but mandating a prescribed number of shifts you must cover.
    Contracting with you as a 1099, but demanding you provide breaks to others.
    Contracting with you as a 1099, but demanding your physical presence in the hospital in the absence of any need for your expertise (exclusive of call obligations).
    Contracting with you as a 1099, but demanding 30 days' notice to terminate contract.
    Requiring you to perform non-emergent cases without full ancillary backup, including the on-site presence backup anesthesiologists.

    I am also interested in hearing when any non-clinical administrative assistants insisted, suggested, cajoled, encouraged, or even hinted that you were to manage a case or cases in a particular fashion. California law specifically limits the practice of medicine to medical doctors, and management companies are commonly known to ignore such prohibitions.
     
  27. caligas

    caligas ASA Member 5+ Year Member

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    Buy out or hostile takeover?
     
  28. ranvier

    ranvier I can't anesthetize a rumor. 10+ Year Member

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    Wow this is a good read...
     
  29. Engin

    Engin Senior Member Bronze Donor Classifieds Approved 10+ Year Member

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    I used to work with a nearby group ..

    The problem CEP is having is that they don't share the pooled unit value with other hospitals (not saying they should). So working at Good Sam makes a lot of money and is a desireable job, but Regional, O'Conner, etc don't and hence there is a problem getting docs here. In fairness, prior to CEP the hospital was a terrible payer mix before, and are a terrible payer mix now. I don't know who will figure a profitable model for these poor payer mix hospitals.

    I have heard some people take advantage of this as locums naming a reasonable rate (2xx/hr for 8 to 12 hours, and then a ridiculous rate after that set shift so they actively try t\o get one off) . It can be worthwhile for people that need to be in the area to do a mix of locums with them and others and can work 4-5 shifts a week making ok money and no calls in the bay area. IMO corporate groups are terrible full time jobs, but as part time jobs can be stomachable for people that are location dependent.

    As Sheridan has moved to St. Rose in Hayward (the old regional group has signed on here. As Sheridan/MAC pays the same pooled rate across its norcal hospitals it has worked to keep the docs there. Sheridan is getting medicare rates for medicaid patients and hence can take over hospitals like these so far...
     
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  30. booohooo

    booohooo 2+ Year Member

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    apparently, neither. They "joined" CEP to achieve *insert buzz words here*
     
  31. booohooo

    booohooo 2+ Year Member

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    Is Sheridan the better deal here? I'm a recent graduate in the Bay area and my options seem to be Sheridan OR one of the CEP sites. I can't tell which one will screw me less.
     
  32. caligas

    caligas ASA Member 5+ Year Member

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    *Spiritual awareness?*

    *racial equality?*

    *Simultaneous orgasm?*
     
  33. Engin

    Engin Senior Member Bronze Donor Classifieds Approved 10+ Year Member

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    I was at the former (sher...) and they are worse than what everyone says. I had family reasons for staying and left soon after I joined as the hours worked did not justify my salary. A lot of ob in house 24 hour call doing only a few procedures for the day and minimal stipend. The older guys who got the pay out also take advantage of the system and are very unhappy so there's a lot of backstabbing and stealing cases. From the mac days, the corporate overlords collect 33% of what used to be paid with more hours as there is a big retention issue and the hours stated are true only if they're fully staffed.

    My advice, i would ask for no call if you go work a corporate group. Persobally, I would never work full time for one. But part time at two or so places (and thus you end up working 4-5/ days a week with no call and make 75% of the pay of your 70 hour/week corporate bay area colleges.

    And read the above post by noclaw. He/she nails it. Watch out for those names listed. The * stand for vowels...
     
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  34. gaswerx

    gaswerx

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    I was a member of the group that left RMC. I now work for Sheridan. CEP has a tiered system. There is no shared income across the organization. If you work at GSH you will have a decent income and call schedule. If you work at RMC, the call is heavy, the income is significantly less because demographics are poor and CEP gave up more than $1.5 million in anesthesia stipends to snake that contract away. Now consider the $250,000, 5 year buy in to become a partner, the 30% withhold (of which you may or may not get 20% back) and it's not hard to figure out why they are running continuous ads to fill the place. Ask why the current CEP director of anesthesia left at the end of September to return to GSH. Ask why there are so many locums. Ask why there is so much chaos after the previous group was able to run the place and recruit for 25 years.
    CEP has no idea how to run an uninsured trauma service coupled with a low volume OB service and declining elective schedule in the main OR.
    They gave up more than $2,000,000 in stipends to retain the GSH contract and acquire the RMC contract. They do not pool revenue between facilities as other groups do. Is it any wonder they can't make it work? Their silo model does not work. I bet those contracts go back out for RFP before too long.
     
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  35. Measured_in_KG

    Measured_in_KG Banned Banned Account on Hold

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    I'm interested to read that the CEP director is leaving after not even a year.

    God help the field of anesthesiology.
     
  36. gaswerx

    gaswerx

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    Icing on the cake. Rumor mill says the FBI is investigating the RMC trauma program for fraudulent billing. True? Who knows? I am waiting for the perp walk photos.
     
  37. apoondoc

    apoondoc

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    SJRMC CEO just got fired.

    CEP also got rebuffed at Contra Costa (denied RFP) and Marin County (buyout offer refused).
     
  38. hypnosMD

    hypnosMD

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    I wish I could take this and copy/paste it to many threads. These AMC's prey on your sense of being a "team player" despite viewing you as an hourly grunt on their staffing grid. If you are part of a group/partnership, then by all means you should be honored to pull your weight. If you are gonna work for the corporate anesthesia overlords, then be the hourly grunt that they view you as. Outline exactly what your hourly rate/overtime are going to be (example 200-250/hr for 8 hours/day then time and a half after that) and work as a 1099. Don't let them blur the amount you are making per hour by chronically understaffing, working you post call, cutting benefits, etc. Falling for that is a rookie move. It is naive to think that your W-2 status offers you ANY additional security with these guys!!!!
     
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  39. nimbus

    nimbus Member 10+ Year Member

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    What was his severance? That's one of the best things that can happen to a hospital CEO. It's always win or win for them. They usually take a little time off and then land a nice job elsewhere.
     
  40. Twiggidy

    Twiggidy ASA Member 2+ Year Member

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    It really seems like these AMCs get super shady when it involves places that are highly desired to live
     
  41. User21218

    User21218 2+ Year Member

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    Is there anybody that has experience with O'Connor that can speak on the experience? I see most of the posts in this thread focus on regional and lump O'Connor in. I am considering moving to Bay Area and am also considering envision in Walnut Creek.

    I am only looking for those people that have had experience at O'Connor and am not looking for second hand info. There is a lot of negativity surrounding my residency program on here and I know a lot of that is misinformed. You can also PM me if you want.
     

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