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Discussion in 'Anesthesiology' started by godfather, Jun 20, 2011.
beware of this organization, very predatory. for specifics email me and i will give you the lowdown.
Why are you ending up in these bad situations? Blemished CV? Visa issues?
Somnia took over my friends contract in Bakersfield 4 years ago and it's been a complete mess at Kern ever since.
My friend was pulling close to mid $500s with 10 weeks vacation. U work like a dog but u are getting paid fairly.
Now they offer like $350k and give u like 6 weeks...at same time working like a dog.
Think the administrator who made the initial ontract with Somnia got fired long ago from that medical center.
Sad thing is my brother and sister know those Somnia guys way back in the days from Yale when they were residents. They said those guys were always scheming and weren't very good residents back then. Trying to do the least amount of work as possible.
Now they try to pay the least amount. Ummm
You gotta becareful with these management companies. Some of them are okay. I think Sheridan has gotten "fairer" the past couple of year.
"Rookies" or just misinform MDs need to be better educated when negotiations contracts and it's just not the "bottom line money".
You got to see if malpractice tail is cover. Always ask for occurrence malpractice if you are going to be on a W2. Start there and then work down from there.
You gotta see the language in the "no compete" radius. Does that include other facilities' radius that they do business with.
Gotta look at "expected numbers of hours" you would be required to work. One thing to work around 50-60 hours. But if you are working close to 70 hours, your contract needs to be amended.
These are some of the things you need to go over either with a contract attorney or some savvy friends who can help you.
Sorry my friend but my situation with Somnia was quite different. My group was being subsidized by the hospital to get more docs and CRNA. Instead of hiring, they hoarded the money and had me everyone else work more hours. Naturally, us new birds had to fly longer and harder than the old ones and I was getting my butt whooped. Yeah, they paid me some more money but who wants to work 80 hours a week, week after week, and listen to the surgeons complain. Despite being up for partnership, and being offered it, I couldn't take it any more....the senior guys would have some lame excuse dejoure when I told them the hours were nuts....always followed by the words "but your making more money Lamont."
So the hospital got wise and interviewed a bunch of these national groups. I spoke to most of them too! Somnia had a ton of great questions, came with a team of people and tried to get their arm around our issues before suggesting a plan. Somnia's plan, which I did not look at until after the fact, seeing that I was on vacation, was really great. Somnia had this massive report which paired up pay with hours of work so I finally felt like I was getting paid a fair day's wage for a fair day's work or, in my case, had the chance to finally work a fair day's work and got paid very fairly for it.
Although Somnia is really large company of like 500 people, Dr. Goldstein, the Chief Medical Officer and their Chief Executive Officer, Dr. T. Howell (??), were on the site for nearly two months with this woman who coordinated the transition, I think her name was Nicholetta or something like that, was here almost 24 hours a day even though she just had a baby and was far from home.
Listen, I was just one of the minions and don't know much about business stuff, but the Somnia folks got a great Peroperative clinic going, an acute and chronic pain service started, and implemented this awesome quality assurance program. Also, things just got real organized and structured like a military unit or something (I'm guessing because I never served) but I heard that dr. Howell used to work for FEMA and maybe that's why.
I have to tell you that Dr. Goldstein tried to retain everyone but let's face it, some of the fat cats living high off the hog and not working that much; the fact that they had been able to get a way with making 3 or 4 times what would be considered fair made it hard for Dr. Goldstein and Nicholetta to keep them as part of team. Somnia and their suits are smart folks but they aren't magicians.
Anyways, everyone feels their a cool cat by talking trash about Somnia but listen here, I just don't see it, I don't hear it, and i don't live it. I'm one happy guy and, in fact, when my misses Tanisha finishes her fellowship in cardiac i asked Dr. Goldstein and Nicholetta if they could find a place for her and I she is looking forward to becoming part of the Somnia family.
Anyone wants to call me to hear more, just send me your email and I will exchange telephone numbers.
Check out my rap:
I got myself a task...
That sitting behind my mask
And pushing some milky prop
I ain't no dope.
Somnia are some cool cats,
Not focused on getting those pats
Making the team all happy
Son, so quick it be real snappy.
You also know Bush 43's head of FEMA "Brownie" was great, don't you? You remember Bush 43 saying what a great job Michael Brown was doing at FEMA during hurricane Katrina.
Don't look too much into all the hoopla all these guys/gals over state their "experiences"
I am not saying Somnia or Sheridan is all evil. They are a management company and their job to try to present things in their best interest. It's just business. Like you said, you don't know much about the business of medicine. Well, medicine is a multi trillion dollar a year business. Everyone wants a cut. And most want to take a cut off your hard earned work.
I am just saying look into every contract in details, especially the malpractice tail, the no compete and also the "out clause" that they may have for "no cause".
Once young doctors get educated on these matters, it levels the playing field. These management companies and also private practice groups are hoping they get uninformed new grads to do some work until they find other people.
Just look at the openings they have had ongoing in places unfilled for years. The current hospital my spouse works for they have failed to maintain adequate or contractually binding staffing. Anesthesiologists currently staffed have been asked(forced to work back to back 24 hour call days for weeks unending). This has been going on for over three months. They have been either unwilling or unable to staff other hospitals in the state and neighboring states that they are under contract to manage. They even had the balls to ask my spouse to work at other Somnia Hospitals that they don't have adequate staffing for during upcoming vacation time(this while just completing three weeks of every other day 24 hour call-yes that is over 21 days of 24hour call then post call then 24 hour call. IF YOU ARE A HOSPITAL ADMINISTRATOR DONT WORK WITH THIS COMPANY UNLESS YOU JUST HAVE NO INTENTION OF BEING A QUALITY HEALTH CARE FACILITY AND WANT CHAOS. This would be fine if they intended to support their employees with plans to fully staff in the future - just check out Palm Springs, El Paso, Las Cruces, Farmington and other locations - ongoing failure to staff adequately - listings continuously on gaswork etc., This isn't the only problem...they also want anesthesiologist to do cases that certain facilities don't have adequate facilities or staffing for such as Cardiac or Pediatric cases that should be done elsewhere for patient safety( I read somewhere that a certain Somnia Exec was sanctioned in the past for such dangers to patient safety, apparently hasn't learned lesson now pushes others to do dirty work). You might say, "wow the overtime would be financially a gain......Somnia is now complaining and lobbying for less pay during these overtime situations- they want it both ways understaff for less money out of their pocket and don't want to pay existing staff for working to cover their incompetence or unwillingness to live up to contractual obligations . Just Tell Somnia NO, run away....or better yet have a contract that has a financial penalty for each day they don't have adequate staffing or record every conversation and keep every communication where your asked to lessen your values and commitment to patient safety.
What you do as an anesthesiologist if you are considering working for them:
1) Ask for $500k and 8 weeks.
2) Do not sign a contract with any type of restrictive covenant.
3) They pay the tail if you leave -- no matter what.
4) Notification clause = 30 days. Tops.
If they balk, tell them you'll still be willing to work for them... as locums for $3k/day.
I have no doubt that there are AMCs that are better than some abusive practices. An AMC would have been a step up from my first job.
Palm Springs (DR) used to be a decent gig. It's too bad to hear it has gone under. I wonder how things are over at Eisenhower. I bet they wouldn't put up with that BS.
My experience with Somnia mirror's this predatory practice. Somnia, Inc. has several PC's nationwide operating under different entities. Never consider signing a contract with these dishonest sharks. They breach every contract they sign. They continue to lose contracts at a rapid pace. Three contracts in the state of CA have been or will be terminated over the upcoming months. They have over a dozen ads on gas work for a reason, their reputation is horrific. Reach out to me for specifics.
Just reviving an old thread to agree what a predatory practice Somnia is.
They offered me a daily rate of 1400 and my malpractice is deducted from my daily rate. Can you guys believe that? I mean it should be at least 1600 a day with malpractice coverage on top of that. I didn't even ask about car or hotel because I am sure they would deduct that too.
Apparently they have some per diems who maybe have been lucky enough to negotiate above this BS. At least I hope so because really, are people OK with these?
AMCs are for docs who are unpopular with the Old Boys' Club. Whatever people say here, the most important skills an anesthesiologist needs are people skills (including networking). One is supposed to be a good obeying puppy, lick the employer/boss's hand, wag one's tail, play with the other stupid puppies and bark happily. If one bites, one can be blacklisted pretty fast. This is the problem with not owning patients, and being judged mostly on artistic impression. If one is a barker, one should never ever consider anesthesia.
Calling doctors healthcare "workers" is not a mistake. Employed anesthesiologists are nothing more than blue collar workers. A dime a dozen. Why pay them anything more than the minimum needed to hire one? There are enough desperate people out there, and there will be many more, with all the suckers becoming anesthesia "providers".
Of course there are also some truly incompetent docs out there, but many of those who work at AMCs are not. It's all a matter of supply vs demand.
I’ve read a lot of your posts, and really appreciate your candor. I’m a medical student and will be picking my specialty soon. I’m very interested in the subject matter/skill set of anesthesiology and the ability to make good money while not working like a surgeon. I know, however, that the field is incredibly vulnerable at the moment and surgery is the safest from mid levels and hospital admin oppression. The problem is, I have zero interest in becoming a surgeon. Would you recommend suffering through a surgery residency to someone like me?
@FFP, your cynicism always makes me laugh. Maybe because it almost mirrors mine. I mostly wag my tail, bark happily, but sometimes I bite. I have never worked for an AMC nor do I plan on it. I was just wondering if their per diem rates were any better and I am looking for something before July since my other assignment ended early.
Funny thing is the recruiter sounded exasperated when I told her the rates sucked especially when you added in the deductions on malpractice. She says, "you aren't the first one to say this, I have heard it plenty of times before" like her hands were tied and there was nothing she could do. She's just an underling.
What besides surgery interests you? Do you like blood and guts? Do you like talking to people and thinking more instead of doing more?
What year are you in?
I’ve said it a million times before. DO NOT pick a specialty you don’t like because you think it’s “safe” from whatever the perceived threat is. Surgery can change quickly if we get single payer. Or insurance companies ration surgeries themselves to cut costs by imposing BMI limits, lifestyle disqualifications, etc. And then you’re going to be stuck in a specialty you don’t like and you still will make what is considered “average money” now.
I'm interested in the acute changes/manipulation of cardio/pulm physiology, giving a patient a drug and seeing an immediate effect, resuscitation, and crisis situations. So naturally I'm drawn to gas and EM, but I fully realize how precarious of a position both of these fields are in. I am simply not interested in completing the brutal training required to become a surgeon and living in the hospital. Cutting people open and standing in one spot for hours on end, no matter the body part, has no appeal to me. I've thought about ophtho and IM subspecialties. Ophtho is facing real encroachment from optometrists, however, and IM subspecialties require suffering through an IM residency and 6+ years of post grad training.
Ya 1000% do not do surgery if that is how you feel. The happy surgeons (that's the goal right?) are the ones who as residents will gladly volunteer to scrub into and assist in that 4 hr add on case that came in at 4pm after being in the hospital since 5am.
My 1 optho friend has echoed what you have said about the optometrist thing, but I don't know how much of an actual threat it is vs an annoyance.
If you don't like IM, it will crush your soul in a different way than surgery. It's become somewhat of a dumping ground. But the subspecialties seem pretty good. Competitive though.
Anesthesia has tons of pros, but you don't own the patients unless you do pain or maybe ICU depending on unit. Some people love that about the field, but you really gotta think why did you go into medicine, and do you want ownership of patients and dictate their long term treatment course.
Unfortunately for most of us there is no perfect field.
If you like Critical care, Do IM and CCM or ER and CCM or even Anes and CCM. They are all all five years. I don’t know how competitive CCM from IM is.
If they paid people fairly they wouldn’t exist.
They make a living off of paying people less than they earn and give nothing in return.
That's an easy NO. Let me tell you one thing though: if you don't like surgeons (not just surgery), you probably shouldn't be in anesthesiology either.
Also, as an employee, you barely make more money in anesthesia than in IM, for example. And the lifestyle is much better in IM subspecialties.
I once made the mistake of talking to an AMC recruiter (for geographical reasons). Never again. Underling is an understatement.
That's what I figured. This is just depressing because I am actually competitive for ortho, ENT, etc. but have no interest in them whatsoever. It makes me mad that greed, laziness, and shortcuts have just about killed the field of anesthesiology.
It seems as though medical school is a waste of time for those not interested in surgery these days.
It's a beautiful field (applied physiology and pharmacology), but most bean counters have no idea about what we do and the breadth of our knowledge. Hence one may end up like one of those (many) great artists whose works were not valued by their contemporaries.
If you’re geographically flexible, anesthesiology is far from dead. Plenty of great gigs left.
Agree. But that applies to many specialties, not just us. Except that few other specialties are more at risk from midlevels than anesthesiology.
At risk in what way? Midlevels have been around in our specialty forever, and there’s still a healthy job market so long as one doesn’t insist on staying in certain areas of the country.
I would argue that every non surgical specialty is just as “at risk” as anesthesia. Midlevels are a some a dozen these days and multiplying rapidly.
When I started residency, there was a healthy job market right where there isn't one anymore 10-12 years later. Many of my seniors didn't even bother with a fellowship.
The avalanche is growing bigger and faster. Just you wait...
Do you think I'd likely struggle to get a good job as a new grad in Houston, Dallas, or Austin in 6 years?
Also, how is the CCM market compared to anesthesia?
I realize these are extremely broad and speculative questions, but I know almost nothing about these things as a med student.
I don't know that market, but any big city market has a huge chance of being overtaken by the ACT model and AMCs. The farther away from an attractive place, the higher the chances of a truly good job.
CCM for anesthesiologists is a much worse market than CCM for internists (especially if the person did a pulm-CCM fellowship).
If one is "flexible", I am sure one will find a good job even 10-20 years from now. It may be in BFE's BFE, your spouse may leave you (or live separately), but that's what flexible means.
The market in those areas is quite strong for both new grads and subspecialists. Had several great offers coming out of cardiac, but I didn’t really want to stay in Texas for family reasons.
I don’t regret my decision in the field at all. Have a great job lined up, plenty of time off to spend with my growing family. I work so I can spend time with them and be involved in my community, this isn’t true for everyone but it keeps me quite content. Can’t say that at all about many of my med school classmates in IM subs - the market is TIGHT for almost all of them except CCM.
Also, our specialty is out in the open and aware about the mid level situation which hasn’t substantively changed in many years. EM is the next frontier for mid levels and plus they’ll have NPs joined with PAs chomping at the bit.
I agree medicine as a whole is going to undergo change, but there will be nowhere to hide in any specialty when that comes around.
It depends on what you consider a good job. Academics? Houston and Dallas should be good options if you set yourself up as a good candidate for academics. Private practice? No. They already aren’t good markets for private practice and will most likely be worse in 6 years. VA? Sure. Houston and Dallas should be good if they keep hiring docs at VAs. Austin doesn’t have a VA with ORs.
Yes, but there is a huge difference between having one's own patients and not. The former will always have jobs, if patients feel the added value. The latter will always have to beg from and depend on the former (and there is nothing safe or sure about that).
If Trump has his way, the VA will be contracted out to management companies, so I wouldn't bet on that horse.
Not if there’s a gaggle of midlevels who have good bedside manner, the heart of a nurse, but are crappy clinicians(insert frustrated face emoji since I’m old and don’t know how). You know how important “bedside manner” is to most people.
I have witnessed at least two cases of egregious and clear malpractice (with injury to patients), where the patients did not even consider reporting the surgeons, because they were "so nice" (to quote the patients).
Many patients would rather deal with smiling underqualified healthcare "providers" than grumpy competent doctors.
Yeah it's pretty easy to imagine, especially in a place like the ER, how patients might prefer midlevels.
"That PA listened to me when no one else would. All the doctors told me my baby didn't need a head CT but she ordered one right away."
If you are competitive for ortho and ent then you are likely competitive for derm. That would be my choice. Good money, low stress, 36 hour work weeks, you’re not missing Thanksgiving dinner with your family to take care of some drug addict.
If you are competitive for ent and ortho then you are competitive for top tier IM program, which opens up a ton of options. Stop worrying about rounds because they get better (less stressful) when you are no longer a clueless medical student and actually know how to take care of patients.
I hear you man. It’s frustrating. Even my own wife, who knows better started to fall victim to this. I sent her to the best doc in town for what she had going on, and she didn’t like him. He’s pretty dry, I’ll admit. But who gives a crap. Do you want a friend or the most competent person to treat you? She eventually realized that thankfully.
There is no way one can be a popular doc if one is under production pressure. Hence the key to survival, in a midlevel world, is independent practice.
For example, in anesthesia I just don't have time to chit-chat (and we meet only briefly), and I come across as grumpy. Be my patient or a family member during a SICU week, and you'll love me. And I take the same thorough care of ALL my patients.
Yeah if I bail on anesthesia I'll probably run to IM or derm. I just worry because there is a lot of midlevel encroachment in derm now. And even IM subspecialties have encroachment (e.g. NPs thinking they can run the ICU).
+1. I used to hate the ICU (including rounds). I now know that I should have hated the quality of the teaching. Except that how can one do individualized teaching when one has 3 residents and also has to think and write notes about 15 patients?
Medical education used to be personal mentoring and apprenticeship, not this assembly-lane mass-production thing.
And hazing, don't forget the hazing.
It always seemed to me that there was plenty of time for individualized teaching during the many hours that rounds took.
That endless neverending rounding was a big piece of what drove me away from internal medicine. It's possible I just didn't grasp how important the process was at the time. Sort of the way med students who hang out with us in the OR don't always grasp the things we're doing internally when we sit there quietly looking at stuff.
Maybe you should start thinking out loud
Yes vitally important stuff like where will I go for dinner tonight