Some advice from the private practice gurus

[somedumbDO]

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So here's the deal I am in 1.5 yrs into a 3 yr partnership tract with a buy in. I am a double boarded peds/gen that occasionally do peds pain. I am worried w the cms pay cut phase in in the next 3 yrs. Also, the group recently took a 50k pay cut. Recently it has come to my attention that the board members 4 of em make all the business decisions without any feedback from the partners. I am from a business background and most of the decisions they make are not that smart. Combined with the fact that I routinely work 100 hr weeks and 2-3 weekends a month. I fear that I am assuming most of the risk w the Obama scare.

So I guess my questions are:

Is 3 yrs w buy in excessive w anesthesia?
How many hours a week do "jr partners" work?
Does your groups have total parity with respect to business decisions or do the board runs the group?
Also, do you let jr partners have some say into group decisions?
Are there any private practice peds groups still around?

Lastly, what is your gestalt feel for this situation? I have asked around and most of my buddies are non partner or accidemics and just wanted to get a feel from some of you veterans what is happening in the anesthesia world ?

 

[aneftp]

Think you have answered your own questions. But let's ask some more

1. How many hours a week do the senior partners work? How about weekends on call?

2. Do the 4 super partners make more? Since they make all the executive decisions?

3. What type of subsidy is the group getting? You mentioned $50k paycut per partner?

4. 3 years is a long time for partnership in this current environment. What is the spread between non partners and partners. That's your calculated buy in.

 

[deleted126335]

Are all partners equal? Are the 4 board members the only true partners? You mentioned that the decisions don't seem to be that smart, it is possible they are smart for those who have no long term vision for the group beyond what they can suck out for the next few years. WHAT ARE YOUR ALTERNATIVES to sucking it up for 18 more months and crossing your fingers?

It is not uncommon for the board to make the majority of the business decisions, but ideally all of the partners elect the board with that process being democratic.It is also common for the board to communicate verbally the rationale for what they are doing to the other partners, (if they do in fact answer to all the shareholders). If they don't answer to all the shareholders it is common to keep em in the dark and feed em ****.
Money is getting tighter. I have learned the hard way that even honorable people will do dishonorable things when face with a major hit to their income.

 

[imfrankie]

So here's the deal I am in 1.5 yrs into a 3 yr partnership tract with a buy in. I am a double boarded peds/gen that occasionally do peds pain. I am worried w the cms pay cut phase in in the next 3 yrs. Also, the group recently took a 50k pay cut. Recently it has come to my attention that the board members 4 of em make all the business decisions without any feedback from the partners. I am from a business background and most of the decisions they make are not that smart. Combined with the fact that I routinely work 100 hr weeks and 2-3 weekends a month. I fear that I am assuming most of the risk w the Obama scare.

So I guess my questions are:

Is 3 yrs w buy in excessive w anesthesia?
How many hours a week do "jr partners" work?
Does your groups have total parity with respect to business decisions or do the board runs the group?
Also, do you let jr partners have some say into group decisions?
Are there any private practice peds groups still around?

Lastly, what is your gestalt feel for this situation? I have asked around and most of my buddies are non partner or accidemics and just wanted to get a feel from some of you veterans what is happening in the anesthesia world ?

I am personally opposed to the buy-in concept in anesthesia. And no way would I ever consider it in a group which gets a stipend. I looked at some solid groups that had a nominal $50K "buy-in", one year until full voting partner, with equal blended units and scheduling from the get go. That's the only kind of group I'd ever buy a ring for with plans to marry. Hope you're getting better than $150/hr for those 100 a week. I feel for you. Yes, certainly there are private practice pediatric groups around. Look and you will find. Better luck to you in 2014.

 

[somedumbDO]

Think you have answered your own questions. But let's ask some more

1. How many hours a week do the senior partners work? How about weekends on call?

2. Do the 4 super partners make more? Since they make all the executive decisions?

3. What type of subsidy is the group getting? You mentioned $50k paycut per partner?

4. 3 years is a long time for partnership in this current environment. What is the spread between non partners and partners. That's your calculated buy in.

I was curious what other groups do that way I have an idea of what I should do. I was wondering if jr partners routinely get "hazed" aka extra call. I actually expect that but to what degree i take 10 more call 1,2,3,4 each per yr. Partners work one weekend a month at most 2. I don't know if super partners make more the financial aspects of the group are very hush hush. We have a peds subsidy that's it. Partners took a paycut due to anticipated decrease in reimbursement. 150k spread per partner and jr with an almost equivalent buy in.

 

[somedumbDO]

Are all partners equal? Are the 4 board members the only true partners? You mentioned that the decisions don't seem to be that smart, it is possible they are smart for those who have no long term vision for the group beyond what they can suck out for the next few years. WHAT ARE YOUR ALTERNATIVES to sucking it up for 18 more months and crossing your fingers?

It is not uncommon for the board to make the majority of the business decisions, but ideally all of the partners elect the board with that process being democratic.It is also common for the board to communicate verbally the rationale for what they are doing to the other partners, (if they do in fact answer to all the shareholders). If they don't answer to all the shareholders it is common to keep em in the dark and feed em ****.
Money is getting tighter. I have learned the hard way that even honorable people will do dishonorable things when face with a major hit to their income.

All partners own equal portions of the corp. I have other job opportunities but want to do peds and wanted to know if private practice peds ie( neonates and sick kids) still exist? I guess my goal is to see what other people are doing since this is my first job see if this situation is common or an oddity. Board members haven't been elected since last 5 yrs even tho the articles of corp say they need a annual vote.

 

[urge]

100hrs/week seems excessive

 

[deleted126335]

It is possible that all partners own an equal amount of shares, but voting rights may not be equal. Have you seen the corporate bylaws and had them reviewed by an attorney who represents you? I cannot overemphasize the importance of this point. Private practice still does exist, but it is getting rarer.

 

[sevoflurane]

Yep. At 100hrs/wk with a peds fellowship, you better be bringing in @ least 550-600k with decent vacation. 100/wk is almost 2FTE's. Think 'bout that.

 

[nimbus]

Seriously, 100hr/wk is 7am-10pm 7 days/wk.....you should be getting at least 750k for that. Many people get 4-500k for 50 hrs/wk.

Everyone gets equal call/equal pay from day 1 in my group. Partner after 1 year.

 

[somedumbDO]

It is possible that all partners own an equal amount of shares, but voting rights may not be equal. Have you seen the corporate bylaws and had them reviewed by an attorney who represents you? I cannot overemphasize the importance of this point. Private practice still does exist, but it is getting rarer.

Haven't scene the corporate bylaws, just been told by talking with other partners. Is it common to have these public to jr partners?

 

[somedumbDO]

Yep. At 100hrs/wk with a peds fellowship, you better be bringing in @ least 550-600k with decent vacation. 100/wk is almost 2FTE's. Think 'bout that.

Good point, as jr partner now it's no where close as a partner it's pretty close

 

[somedumbDO]

Seriously, 100hr/wk is 7am-10pm 7 days/wk.....you should be getting at least 750k for that. Many people get 4-500k for 50 hrs/wk.

Average day is 630am-(7-8pm) with one 24hr call 1 shift usually on the weekend or Friday w backup call on he other weekend day, plus 24 hr peds call back q 3-4. Plus call 2 call back q week. I am including call back/pager call as part of work hrs. Being on pager call in my mind is still working? Unless I am misguided?

 

[aneftp]

Average day is 630am-(7-8pm) with one 24hr call 1 shift usually on the weekend or Friday w backup call on he other weekend day, plus 24 hr peds call back q 3-4. Plus call 2 call back q week. I am including call back/pager call as part of work hrs. Being on pager call in my mind is still working? Unless I am misguided?

You are working way too much. Backup call is still being "on". You can't leave area. You can't go out for drinks etc.

 

[deleted126335]

Haven't scene the corporate bylaws, just been told by talking with other partners. Is it common to have these public to jr partners?

Yes it is. You said junior partners. I guess not all partners are equal in terms of rights, even though they may be in terms of stock ownership. See if there is a "junior" partner you can talk to who will give you the scoop as to what type of partnership you are actually working towards.

 

[somedumbDO]

Yes it is. You said junior partners. I guess not all partners are equal in terms of rights, even though they may be in terms of stock ownership. See if there is a "junior" partner you can talk to who will give you the scoop as to what type of partnership you are actually working towards.

Jr partners r like me aka partnership tract

 

[deleted126335]

First it is partnership track. Not tract.

You are not a partner. You are working towards a partnership. The fundamental question is what type of partnership are you working towards? Is it a true equal partnership? Even though you may one day be a stock owner, that does not mean that compensation, work responsibilities, time commitment, and voting rights will be equal or even comparable. It is mandatory that people who are granted stock ownership at the time they sign on as "partners" have the opportunity to review the bylaws. At the point that you are in the process it is not mandatory. It might even be overstepping to ask for a hard copy since you have not yet been offered a partnership. It is not overstepping to specifically ask exactly what type of partnership is it that you have been working towards. If they make you feel that it is overstepping, or are evasive, you have your answer and a problem.

 

[Mman]

Quick thoughts: 100 hrs/week is excessive, although counting being on call from home as work isn't quite right. How painful call is depends on likelihood of being called in. With peds call, is it less than 25% chance of coming in at any point? If so, I wouldn't really count that as work hours.

3 year partnership track isn't excessive, but the partnership itself may or may not be worth it. True private practice gigs are getting rarer by the year and as they do, partnership tracks will get longer because the alternative will just be working as an employee of a corporation for 1/2 the salary.

Also a little weird that only 4 partners make all the decisions unless they are "super partners" in some fashion and everybody else is frozen out from them in which case nobody else is truly a partner.

 

[somedumbDO]

I appreciate the input. My goal is to see what is "standard" or a resemblance of standard before I invest another 2.5 yrs plus 150k into being "partner". For peds right now the market is very open. Unfortunately these are the things you realize after being in the "gig". I don't mind hard work just as long as there is parity at the end! My biggest question is how do you treat your partnership track employees?

 

[deleted126335]

I appreciate the input. My goal is to see what is "standard" or a resemblance of standard before I invest another 2.5 yrs plus 150k into being "partner". For peds right now the market is very open. Unfortunately these are the things you realize after being in the "gig". I don't mind hard work just as long as there is parity at the end! My biggest question is how do you treat your partnership track employees?

Unfortunately what is "standard" varies greatly. "Standards" are dropping as far as integrity goes. You have invested 18 months of very hard work. I hope that it was not in vain. Not to mention what has gone before. You need to acquire more information about your present gig before you can make an informed decision. Good Luck.

 

[urge]

Your hours are long without taking into account backup call or peds call. anything higher than 60 is unsustainable to me.

3 year partnership seems reasonable if you live in a competitive market.

Sounds like the rewards of partnership are dwindling. My question is: should the buy in, or track years, be reduced accordingly?

How long is the group"s contract with the hospital?

 

[somedumbDO]

Your hours are long without taking into account backup call or peds call. anything higher than 60 is unsustainable to me.

3 year partnership seems reasonable if you live in a competitive market.

Sounds like the rewards of partnership are dwindling. My question is: should the buy in, or track years, be reduced accordingly?

How long is the group"s contract with the hospital?

They have two yrs then reevaluate, market is moderate.

 

[sleepallday]

Partners took a paycut due to anticipated decrease in reimbursement. 150k spread per partner and jr with an almost equivalent buy in.

This sounds a little suspect. The partners ALREADY took a paycut without there actually being a decrease in reimbursement yet. So where is all the extra money going right now.

I would be a little concerned if there were only 4 partners making all the decisions for the group. Those four would obviously be making decisions that benefit them. In my group all the partners vote on just about every decision. This can sometimes be a pain since we have about 30 partners.

 

[Mcwane]

Unless you have some crazy strikes against your record or your wife has to live there, you are getting screwed.

3 years is fine for a great job. Great jobs are transparent and full of people that like their jobs despite the stresses of anesthesia (doom and gloom). Superpartners are a huge warning sign IMO.

Feel free the PM me, but there are a lot of red flags in the original post.

Based on your post, I think there's more info about your specific group that's needed. Until you know how much you, your partners, and your superpartners make.....it makes it difficult to give you an answer.

But it sounds like you already know the answer. No fellowship trained pp attending works 100 hours a week and makes what you mentioned. You are worth more for sure.

 

[Mac4]

You work way too much hours, not good for you, your wife/SO, kids or your patients. Partnership or not, is there any way you can reduce some calls?

 

[BLADEMDA]

HOURS WORKED IN THE HOSPITAL per week and A FUDGE FACTOR for weekends/nights (post 800 pm). You aren't working anywhere near 100 hours and my bet the real number is 65 hrs per week.

Hence, the pay for the work at your current gig is solid. Keep doing a good job and finish out the track.

 

[BLADEMDA]

Are all partners equal? Are the 4 board members the only true partners? You mentioned that the decisions don't seem to be that smart, it is possible they are smart for those who have no long term vision for the group beyond what they can suck out for the next few years. WHAT ARE YOUR ALTERNATIVES to sucking it up for 18 more months and crossing your fingers?

It is not uncommon for the board to make the majority of the business decisions, but ideally all of the partners elect the board with that process being democratic.It is also common for the board to communicate verbally the rationale for what they are doing to the other partners, (if they do in fact answer to all the shareholders). If they don't answer to all the shareholders it is common to keep em in the dark and feed em ****.
Money is getting tighter. I have learned the hard way that even honorable people will do dishonorable things when face with a major hit to their income.

The Gospel truth here by Doze.

 

[somedumbDO]

HOURS WORKED IN THE HOSPITAL per week and A FUDGE FACTOR for weekends/nights (post 800 pm). You aren't working anywhere near 100 hours and my bet the real number is 65 hrs per week.

Hence, the pay for the work at your current gig is solid. Keep doing a good job and finish out the track.

Well not to argue but if you count on call hrs from peds call, weekends( we take call 1then backup call the other weekend day) and call 2 back up its 100 hrs granted one can argue home call hrs are not real work " production " hours but these are hours I can't watch a movie or see a concert. I guess my other question is all this pager/home call also normal?

 

[deleted126335]

Well not to argue but if you count on call hrs from peds call, weekends( we take call 1then backup call the other weekend day) and call 2 back up its 100 hrs granted one can argue home call hrs are not real work " production " hours but these are hours I can't watch a movie or see a concert. I guess my other question is all this pager/home call also normal?

Like everything else, it depends. I would say that for a high income job (90+ percentile mgma) it might be expected. For an average salary job-it suc ks.

 

[Multifidus]

Well not to argue but if you count on call hrs from peds call, weekends( we take call 1then backup call the other weekend day) and call 2 back up its 100 hrs granted one can argue home call hrs are not real work " production " hours but these are hours I can't watch a movie or see a concert. I guess my other question is all this pager/home call also normal?

I've got to agree that you really shouldn't be counting home call as hours worked. It certainly can impact your quality of life and your satisfaction with your job, but I would never consider sitting at home on-call as work hours. Now, if you are in house for OB-call or something like that, sure, count it.

I work a 40-50 hour per week gig with about 2 home calls per week and 1.5 weekends per month. If I counted home call in my hours, I would be in the 75-100/hr/wk range. We have a primary call person and a backup call. Call is fair for our group from day one, until you hit age 65, then you go down to just backup call and holiday call.

Honestly, your buy-in sounds pretty fair for the current market. Maybe at the top of the fair range.

Try to enjoy your home-calls a little more. While I probably wouldn't go to a concert or movie either, that's about all I wouldn't go to (well maybe a sporting event or any type of show). Otherwise I am going out with my family and enjoying my time at home. Just take 2 cars everywhere to ward off evil call spirits. If I am within 30-45 mins of the hospital, all is good.

 

[pgg]

I think home/pager call really depends on how often you get called in. Past the 50/50 point or thereabouts, I call it work.

 

[BLADEMDA]

Here is the bottom line:

If you are earning MGMA 75th percentile or more and average less than 2800 hours or so per year at work (home call doesn't count) then consider yourself lucky.
MGMA 75th percentile is posted in the private forum.

A current PGY-1 may NEVER see that level of income as a partner regardless of how many hours he/she works.

Again, look at how many hours PER YEAR you work at your job then look at the income. I agree that nighttime work is particularly painful so account for that as well.

 

[Yo GabbaPentin]

I posted similar questions regarding my first job about 6 months ago. There were some red flags and a similar "hush hush" type of atmosphere. Thankfully, I started a NEW job about a month ago. It is not uncommon for new grads to get screwed despite our best efforts to avoid doing so. We don't know all of the specifics to your situation, but the fact that you are posting concerns here should tell you something. With CMS/Obama/insurance companies tightening the screws, be prepared to have to fight for every dollar you are paid over the next several years. Everyone is panicking and the non partners/new grads will suffer MUCH more than the established partners. Unfortunately just the way it is.

 

[somedumbDO]

I appreciate all the advice from the ol gurus out there

 

[imfrankie]

I appreciate all the advice from the ol gurus out there

I'd get out of it. You're a fellowship-trained guy that can find a much happier arrangement. Three years is hogwash in this age of uncertainty. Your "buddies" are going to get paid then be gone.

 

[nimbus]

My actual work hours are about 60hrs/week. Not counting "on call" time. I used to take 10 days / month of heart call....now dropped down to 7 days/month. When I take a weekend of heart call and don't get called in, I don't add 48hrs to my work hrs for the week. If I did, I would be well over 100hrs on certain weeks although I didn't actually work that much. Then again I don't drink and I live in a great area where I don't have the urge to leave town on weekends, so I don't personally consider call to be much of a burden. I do go to the gym, go for a run, eat out, catch movies and concerts, all while I am taking call. Our compensation is based purely on unit production so I feel I am fairly reimbursed for the time I do put in.

With all that being said, transparency and fairness are the keys to long term job satisfaction. You have to get the sense that you have a shared fate. You could be making $1mil/year but if your "partner" is getting $2m for half the work.... It will not be tolerable in the long run. Just human nature.

 

[StayOnTop]

Sorry for bursting into the discussion, but is reimbursement for Anesthesia really going down? I thought CMS was raising Anesthesia this year by 1%.

 

[Consigliere]

somedumbdo is an appropriate moniker for you. You are getting hosed. Big time. Just wait until this group has used you for 2.9 years and then says "sorry, no partnership for you."

 

[cognitus]

somedumbdo is an appropriate moniker for you. You are getting hosed. Big time. Just wait until this group has used you for 2.9 years and then says "sorry, no partnership for you."

Isn't this a risk in any partnership track job? How do you reduce it?

 

[ProRealDoc]

Isn't this a risk in any partnership track job? How do you reduce it?

You avoid the jobs with long partnership tracks and go for the most money you can make upfront. I respect those who can stomach the risk of a 3-yr partnership track nowadays. Personally, I prefer all the money to end up in my pocket from the get-go, rather than paying a buy-in to a group in exchange for a promise.

Promises won't pay your debts; cold, hard cash will.

 

[Mman]

I'd get out of it. You're a fellowship-trained guy that can find a much happier arrangement. Three years is hogwash in this age of uncertainty. Your "buddies" are going to get paid then be gone.

Is 3 years really hogwash? Every year that goes by there are fewer and fewer truly private groups out there. So the supply of groups to join is decreasing. Seems to me that buy ins should be going up in duration since there is more demand for fewer spots. Though I agree in principle that this is the wrong time to be starting out a buy in time period with future uncertainties.

To me the degree to which a buy in is fair or not has almost nothing to do with the length or amount. It has more to do with the group you are joining. If it's a fair group and income and call and decision making is spread out equally, it's hard to complain about any buy in (so long as there is an equal buy out on the other end). But a really short and sweet buy in doesn't make a crappy group any more tolerable.

 

[countingdays]

A buy-in shouldn't have anything to do with supply and demand. It should equal the value of the share of the business you get at the end. Anything more isn't buying-in, it's getting screwed. The value of anesthesia groups is going down, so buy-ins shouldn't be increasing.

 

[Mman]

A buy-in shouldn't have anything to do with supply and demand. It should equal the value of the share of the business you get at the end. Anything more isn't buying-in, it's getting screwed. The value of anesthesia groups is going down, so buy-ins shouldn't be increasing.

Buy in is time and money, not just money.

And I agree in theory the overall value of a group is going down, but the groups are becoming more scarce so the relative value is increasing. The alternative is to work for an academic department or be an employee of an AMC.

 

[imfrankie]

Buy in is time and money, not just money.

And I agree in theory the overall value of a group is going down, but the groups are becoming more scarce so the relative value is increasing. The alternative is to work for an academic department or be an employee of an AMC.

The increasing scarcity of private groups doesn't increase their value it decreases it through uncertainty.

 

[Mman]

The increasing scarcity of private groups doesn't increase their value it decreases it through uncertainty.

When jobs that pay more are more scarce, they become more valuable.

 

[imfrankie]

The increasing scarcity of private groups doesn't increase their value it decreases it through uncertainty.

Don't let someone sell you a future about which they have little certainty. Mr, excuse me doctor, partner (better, hospital executive) would you please show me the ten year exclusive with income contract? "Uh, err, uh…well historically the hospital has been very happy with the anesthesia group because we(they) bring so much value blah blah blah." No, the relative value over a buy-in time frame is not increasing.

There is, however, one thing about which you do have some confidence: you are now a fellowship-trained pediatric anesthesiologist. Since this field is now a recognized board specialty, when you pass the test your relative value increases.

I have seen so much greed in this profession over the years--excuse me while I vomit--people want to grab as many chairs as they can before the music stops. Anesthesia groups have no power over the turntable--the thing is way over in the next city where the hospital and insurance executives are working to get themselves paid.

Find yourself a group of honest, hard-working, well-intentioned folks that live within their means, get yourself out of debt and go home at the end of each day with a fair paycheck and a feeling you've done some fulfilling work.