Sound Physicians

[Maz777]

And while I have no particular knowledge about what Sound plans for these facilities, I personally worked at a Sound practice where I was routinely “medically supervising” 7-8 CRNAs.

The CMO of Sound Anesthesia is always touting on other sites about how amazing CRNAs are and how they provide equal care to physicians. She's an anesthesiologist.

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[Burned_Out]

They also say “collaborative care model” whatever that means. At one of their sites, the CRNAs practice independently. The CRNAs do OR cases and cover OB at night with no MD in house. It’s a 0:2 ratio at night. An MD can be called in but is usually not for routine cases. If they intend to use medical direction or medical supervision, why would they make up a “collaborative care model”?

That's what they tell you but let me set the record straight in terms of how the "care team model" plays out.

1. The CRNA will be the anesthetist in charge one day and they will do your preop. They will do a very cursory preop and put in some imaginary Mallampati class on the note. They will decide the anesthesia and tell you that regional is prescribed. You will find out that the patient is anti-coagulated but not mentioned in the note. You will figure something else is amiss when you go to anesthetize your patient. This is anesthesia through collaboration.

2. The CRNA will resent you being in anyway involved in their patients. They will do their independent practice until **** hits the fan. They will NEVER EVER bother to consult with another MD colleague because that would be an admission of weakness. Then the circulating nurse will note the patient in the room is in distress and call for help (because the CRNA is too proud to ask for assistance). Then you will find yourself in deep **** in that room and be asked to take over the CRNA.

3. The staff will blame you, Mr. MD, because they think you are supervising the CRNA. But this is independent practice you say? Well not according to the staff. The buck stops with you and you get all the blame.

4. Care team model means CRNA's are featured anesthesia care providers. They are unicorns. You're a 5th class nobody.

5. The CRNA's with the most experience are often times the worse to deal with. I've had 2 of them with over 28 years tell me they don't cancel cases. Their CRNA training says they defer to the surgeon always to determine if a case is appropriate. So we get back to #2 where things go awry in the OR.

 

[Burned_Out]

I find it strange, that on a forum where many say, “We gotta stick together against private equity!”, or “If only we could unionize!!”, there is so often a response to these situations of “I’ll locums/scab there for xxx $$$ an hour!”. I COULD see if these folks were looking for truly PUNITIVE money ($600-$800 an hour), but it’ll take a while to harm a hospital/AMC at $400/hour, when $325 plus is quickly becoming standard pay in some locations.

Ain’t sayin’, just sayin’……

$600-800/hour is coming. I laugh at $325/hr.

I was thinking to myself last week about how long this growth in locums pay is going to last. Those of us who are FT locums and getting high rates would not want to go back to $325/hr when things supposedly settle down. At that point, I'm either retiring or doing the bare minimum per diem to just keep my credentials going. But no way in hell am I going back to full-time practice at the pre-pandemic pay scale. I'm hearing other folks are stacking cash to get out of this field. So when they do try to lower the pay, there is going to be a large segment of workers who will disappear.

To answer your original question, we are sticking it to the man with our ability to withhold work. There are places that can't get help at any pay scale. You don't think that doesn't hurt them because they can't keep an OR open due to anesthesia shortage?

 

[nycitygas]

At the souks

Typical sound 1:8 ratio? Source? All the job listings posted above say "not to exceed 1:4 ratio".

Typical sound 1:8 ratio? Source? All the job listings posted above say "not to exceed 1:4 ratio".

The sound practice I’m familiar with recently had a job posting that said 1:4 supervision. My friend that worked there said it was routinely 1:8, CRNAs performed blocks, spinals, ect. I don’t think the MD even saw patients in pre op.

 

[nycitygas]

They probably meant it was a private practice group that staffed a VADs and heart transplant program. So yes, lots of call.

Lots of high acuity cases and a very busy OR schedule. And lots of call

 

[dchz]

At the souks


The sound practice I’m familiar with recently had a job posting that said 1:4 supervision. My friend that worked there said it was routinely 1:8, CRNAs performed blocks, spinals, ect. I don’t think the MD even saw patients in pre op.

2 of my same year co-residents are working with sound in fort worth. it's basically signing charts.

Wonder what they think of their job security.

 

[IMGASMD]

2 of my same year co-residents are working with sound in fort worth. it's basically signing charts.

Wonder what they think of their job security.

Or liability…..

 

[Dr. Rude]

The CMO of Sound Anesthesia is always touting on other sites about how amazing CRNAs are and how they provide equal care to physicians. She's an anesthesiologist.

From my previous post: "We have established what you are. We are just negotiating the price."

 

[aneftp]

All the CRNAs are “independent”. No medical direction there. MDs do their own cases in other rooms and give breaks. Hearts (10/month) are MD only. L&D was CRNA only although that unit will be closing soon due to low volume (30/month).

Basically Sound is the Trojan horse that brings CRNAs to predominantly MD only communities. If it’s an opt out state, they will opt out.

Crna’s are not cheap. Even full time ones.

Many places are letting crna’s work 7-8 (24 hour shifts) for base pay 220k plus 9 weeks off paid.

Guess what? They got a ton of open dates to pickup locums$200/hr or even in house overtime at $220/hr w2

So it’s easy math. They can choose when they want to work extra or take time ofd

It’s an easy 100k extra for them doing just an extra shift a week but more importantly. They can choose when they want to do that extra shift. They can say no. Full time Docs can’t and don’t have that flexibility

 

[IMGASMD]

Crna’s are not cheap. Even full time ones.

Many places are letting crna’s work 7-8 (24 hour shifts) for base pay 220k plus 9 weeks off paid.

Guess what? They got a ton of open dates to pickup locums$200/hr or even in house overtime at $220/hr w2

So it’s easy math. They can choose when they want to work extra or take time ofd

It’s an easy 100k extra for them doing just an extra shift a week but more importantly. They can choose when they want to do that extra shift. They can say no. Full time Docs can’t and don’t have that flexibility

I’ve long been telling people that all these AMCs treat crnas as prized possession, and treat docs as necessary expenses.

There’s a deal right now for crnas, 6 x 24hour call/month, getting paid as a full time CRNA. They get to do whatever they want for the other 24 days a month.

Welcome to corporate medicine y’all, where you’re just a body, no more no less.

 

[Anesthesia_Guy]

The CMO of Sound Anesthesia is always touting on other sites about how amazing CRNAs are and how they provide equal care to physicians. She's an anesthesiologist.

What a disgusting, sell out pig she is.

 

[Arantius]

The CMO of Sound Anesthesia is always touting on other sites about how amazing CRNAs are and how they provide equal care to physicians. She's an anesthesiologist.

I actually know her and she doesnt say care is equal. Where are you seeing this? For the record, she was in the trenches with us at a rough startup taking call etc. Unless its changed now (that was more than a year ago)...What other CMO is doing that? Serious question. Most I have come across are in a plush corner office and havent been in an OR in a decade

 

[Arantius]

$600-800/hour is coming. I laugh at $325/hr.

I was thinking to myself last week about how long this growth in locums pay is going to last. Those of us who are FT locums and getting high rates would not want to go back to $325/hr when things supposedly settle down. At that point, I'm either retiring or doing the bare minimum per diem to just keep my credentials going. But no way in hell am I going back to full-time practice at the pre-pandemic pay scale. I'm hearing other folks are stacking cash to get out of this field. So when they do try to lower the pay, there is going to be a large segment of workers who will disappear.

To answer your original question, we are sticking it to the man with our ability to withhold work. There are places that can't get help at any pay scale. You don't think that doesn't hurt them because they can't keep an OR open due to anesthesia shortage?

You think? I'm still seeing rates 400 ish, full time locums too... BUT I can hear the desperation building...

 

[IMGASMD]

I actually know her and she doesnt say care is equal. Where are you seeing this? For the record, she was in the trenches with us at a rough startup taking call etc. Unless its changed now (that was more than a year ago)...What other CMO is doing that? Serious question. Most I have come across are in a plush corner office and havent been in an OR in a decade

I don’t know her, nor Sound anesthesia.

She can be a great person and physician. However, if she condone what others have been saying, 1:8 or the collaboration care model, for the corporation she’s working for, to maximize profit. She isn’t a good role model by any stretch of imagination.

 

[nimbus]

I’ve long been telling people that all these AMCs treat crnas as prized possession, and treat docs as necessary expenses.

There’s a deal right now for crnas, 6 x 24hour call/month, getting paid as a full time CRNA. They get to do whatever they want for the other 24 days a month.

Welcome to corporate medicine y’all, where you’re just a body, no more no less.

Yes. That was one of the CRNA positions offered at our local Sound hospital, 6x24 hr OB shifts/month for a full time salary. It was a good deal because they had very few deliveries. I imagine those positions are being eliminated now because that unit is closing in 2 months.

 

[nimbus]

Well, I found the CMO to be extremely competent and she had a military career before anesthesia as I recall- she showed up when I helped in Phoenix and took call, not many in leadership will do that. She was good- and knew wtf was happening at the site. I don’t think she’s the one to blame for their corporate BS. Don’t know the CMO before her you are talking about. I mean does anyone think the corporate models are going to survive at all? I think it’s the governments way to get us to single payer (take everything in house).

Fwiw this CMO is now with HCA. So no longer relevant to this thread but it would be interesting to know why she jumped ship.

 

[Blockit]

Fwiw this CMO is now with HCA. So no longer relevant to this thread but it would be interesting to know why she jumped ship.

Because that’s where the bigger money is.

 

[nycitygas]

I heard though the sound group in my area that runs 1:8 is hemorrhaging money. Guess CRNAs that do blocks, epidurals, ect aren’t cheap.

Payor mix at the hospital is terrible.

 

[IMGASMD]

I heard though the sound group in my area that runs 1:8 is hemorrhaging money. Guess CRNAs that do blocks, epidurals, ect aren’t cheap.

Payor mix at the hospital is terrible.

Administrators all know something that defy logic.
Whatever they’re losing, they will get back 10 folds in no time.

 

[Blockit]

I heard though the sound group in my area that runs 1:8 is hemorrhaging money. Guess CRNAs that do blocks, epidurals, ect aren’t cheap.

Payor mix at the hospital is terrible.

Oh, I have no doubt that they are. My comment was intended to refer to this CMO. Working at sound was probably just a steppingstone for her to make bigger money somewhere else. Because that’s what these “administrative physicians” are really concerned about.

 

[NeedleJockey]

I thought it was more due to them being unable to staff up the ORs to their contractual obligations, despite using locums.

OAG was meeting contractual obligations.

 

[MirrorTodd]

Oh, I have no doubt that they are. My comment was intended to refer to this CMO. Working at sound was probably just a steppingstone for her to make bigger money somewhere else. Because that’s what these “administrative physicians” are really concerned about.

Kinda like those peeps that work at the SEC and then magically gets solid jobs in hedge funds etc.

 

[Howard888]

OAG was meeting contractual obligations.

I have no knowledge of the situation..but my guess is they had a stipend though.

Again, MD only anesthesia will not survive unless you are fortunate enough to have a great payer mix/concentration of cases and do not require a stipend.

Economics don’t work and too many places are showing it can be done with CRNAs.

Yes, there are lots of stories from rough transitions to direction or supervision or crna only but truth is there are many facilities that after the transition have done well with minimal complications.

This is all money. Im not saying that direction is superior to md only or anything like that-but surgeries have gotten safer, anesthesia has gotten safer. If you are MD only and require a stipend…I suggest you see if you could do direction and not have a stipend….because if not you will get replaced. Might take 1year, might take 5. Only thing slowing it down slightly is there is a big shortage of CRNAs

 

[Arantius]

I have no knowledge of the situation..but my guess is they had a stipend though.

Again, MD only anesthesia will not survive unless you are fortunate enough to have a great payer mix/concentration of cases and do not require a stipend.

Economics don’t work and too many places are showing it can be done with CRNAs.

Yes, there are lots of stories from rough transitions to direction or supervision or crna only but truth is there are many facilities that after the transition have done well with minimal complications.

This is all money. Im not saying that direction is superior to md only or anything like that-but surgeries have gotten safer, anesthesia has gotten safer. If you are MD only and require a stipend…I suggest you see if you could do direction and not have a stipend….because if not you will get replaced. Might take 1year, might take 5. Only thing slowing it down slightly is there is a big shortage of CRNAs

Exactly- my locums recruiter lives up there and said that OAG asked for a way bigger stipend and had multiple rooms shut down because they couldn’t staff that’s why the change and now “emergency” locums rates. I would love to go there but OR license is a pain and not in the compact so I doubt I’ll get it in time.

 

[chessknt]

I feel like after the current crunch 5-10 years down the road MD anesthesia is going to be toast because the rates being demanded were so high literally the only way to be economically viable is high ratio crnas and the aftermath is going to be a field dominated by crnas since there will be no reason to go back. The hospital I am at now brought crnas in for the first time to fill MD holes and this is a hospital that is very anti midlevel. We lost 10% of our ICU rns to Crna school last year, a new record.

Feel sorry for people just starting their training, we are watching the nurses take over the field in real time here...

 

[Howard888]

I feel like after the current crunch 5-10 years down the road MD anesthesia is going to be toast because the rates being demanded were so high literally the only way to be economically viable is high ratio crnas and the aftermath is going to be a field dominated by crnas since there will be no reason to go back. The hospital I am at now brought crnas in for the first time to fill MD holes and this is a hospital that is very anti midlevel. We lost 10% of our ICU rns to Crna school last year, a new record.

Feel sorry for people just starting their training, we are watching the nurses take over the field in real time here...

Correct. But you can at least maintain some control or at least keep your job a bit longer if you embrace direction and even control the asset (employ the CRNAs). Even with CRNAs pricey right now you should be able to staff cheaper than MD only unless your contracts are terrible. Reduce stipend demands through direction. Otherwise hospital will do it for you.

Too many MD only groups are putting their Flag in the sand and drawing the line. Refusing to do direction. It’s a fight you can’t win. As long as you’re willing to lose your contract/job over it, that’s fine, but don’t go into that fight expecting to come out on top.

It’s game over for MD only

 

[nimbus]

Correct. But you can at least maintain some control or at least keep your job a bit longer if you embrace direction and even control the asset (employ the CRNAs). Even with CRNAs pricey right now you should be able to staff cheaper than MD only unless your contracts are terrible. Reduce stipend demands through direction. Otherwise hospital will do it for you.

Too many MD only groups are putting their Flag in the sand and drawing the line. Refusing to do direction. It’s a fight you can’t win. As long as you’re willing to lose your contract/job over it, that’s fine, but don’t go into that fight expecting to come out on top.

It’s game over for MD only

If only a line could be drawn at medical direction. Could be game over for medical direction too.

 

[GravelRider]

I find it strange, that on a forum where many say, “We gotta stick together against private equity!”, or “If only we could unionize!!”, there is so often a response to these situations of “I’ll locums/scab there for xxx $$$ an hour!”. I COULD see if these folks were looking for truly PUNITIVE money ($600-$800 an hour), but it’ll take a while to harm a hospital/AMC at $400/hour, when $325 plus is quickly becoming standard pay in some locations.

Ain’t sayin’, just sayin’……

Technically a “scab” is someone crossing a picket line. It doesn’t sound like there is a strike, but I could be wrong.

 

[ambiturner]

Correct. But you can at least maintain some control or at least keep your job a bit longer if you embrace direction and even control the asset (employ the CRNAs). Even with CRNAs pricey right now you should be able to staff cheaper than MD only unless your contracts are terrible. Reduce stipend demands through direction. Otherwise hospital will do it for you.

Too many MD only groups are putting their Flag in the sand and drawing the line. Refusing to do direction. It’s a fight you can’t win. As long as you’re willing to lose your contract/job over it, that’s fine, but don’t go into that fight expecting to come out on top.

It’s game over for MD only

If a group of MDs was willing to work for lower wages and was able to recruit effectively there is no reason they couldn’t remain MD only. You are correct that it would require accepting lower rates than most are touting on here.

 

[abolt18]

Correct. But you can at least maintain some control or at least keep your job a bit longer if you embrace direction and even control the asset (employ the CRNAs). Even with CRNAs pricey right now you should be able to staff cheaper than MD only unless your contracts are terrible. Reduce stipend demands through direction. Otherwise hospital will do it for you.

Too many MD only groups are putting their Flag in the sand and drawing the line. Refusing to do direction. It’s a fight you can’t win. As long as you’re willing to lose your contract/job over it, that’s fine, but don’t go into that fight expecting to come out on top.

It’s game over for MD only

Or you can do like my group did and when the hospital required them to bring in midlevels, they refused to do crnas, and instead brought in AAs for Endo and low acuity cases. We are #nevercrna here.

 

[Maverikk]

The landscape is definitely changing, it's tough to do MD only without a big stipend or a great payor mix as noted above.
Controlling the situation is the most important part, if your chair and the hospital CMO are never going out for beers together or your leadership isn't always looking for improvement and balancing hospital demands with what's best for the group you'll be finished when times get tough, and they're tough.
If you're shutting down rooms all the admin behind a desk sees is lost money and when some AMC pitches they can provide bodies at a cheaper cost who wouldn't say no. They only say no when things start to go clinically south. Yes anesthesia is very safe; but it's a numbers game, you do enough and you'll eventually run into trouble. I've seen one OB center and one GI place who gave pushback to the hospital because it was all CRNA staffed and they had just one poor outcome in each case and the OBs and GI docs pushed back, granted for liability I'm sure.

The hard part is what to do next. Anesthesia will always be seen as an expense to a hospital. Private groups should be asking what the best balance to keep everyone paid, work-life balanced and fill the hospital needs. I think more medical direction will come to the west coast.

 

[IMGASMD]

I for one can accept lower pay. If someone wants to pay me for 40 hours/week, 1.5X after 40 to work alone, and never have to deal with bull****; have permission to demand for morning break, lunch break AND start moaning at 230 for a 3 o’clock out.

Ain’t a bad deal.

It’s all relative. I’ve heard of CRNA getting 300/hr, maybe only for a few months. However, I am perfectly fine at 250/hr to do above mentioned work.

Just here to say, they ain’t “cheaper” nor will they stay “cheap” for long.

 

[Howard888]

$300/hr some crazy locum rate. I can tell you going prn rate average in southeast around $175/hr. Some areas northeast average hits $200 or slightly higher. Average crna take home yearly still only about half an MD (outside of academic MDs)

Locums in desperate area different and yes mid 200s or more possible but that is not the norm.

AAs get paid almost same as CRNAs.

It’s cheaper than MDs. It’s also not about what you get paid, it’s about what your contracts are. Majority of MD only groups don’t have contracts or a payer mix good enough to not get a stipend from the hospital.

Hospitals budgets are tighter than ever. They will choose the group who will use crnas or aas any day if they promise a lower stipend.

It’s the arrogance of some of these MD only groups not recognizing this that is causing them to lose contracts, embrace direction-can be CRNAs or aas. Or you better have phenomenal contracts or payer mix….

 

[abolt18]

$300/hr some crazy locum rate. I can tell you going prn rate average in southeast around $175/hr. Some areas northeast average hits $200 or slightly higher. Average crna take home yearly still only about half an MD (outside of academic MDs)

Locums in desperate area different and yes mid 200s or more possible but that is not the norm.

AAs get paid almost same as CRNAs.

It’s cheaper than MDs. It’s also not about what you get paid, it’s about what your contracts are. Majority of MD only groups don’t have contracts or a payer mix good enough to not get a stipend from the hospital.

Hospitals budgets are tighter than ever. They will choose the group who will use crnas or aas any day if they promise a lower stipend.

It’s the arrogance of some of these MD only groups not recognizing this that is causing them to lose contracts, embrace direction-can be CRNAs or aas. Or you better have phenomenal contracts or payer mix….

crnas at my training hospital were making $280K for their 40hrs/week. Phenomenal benefits too (2:1 match on retirement, employer does 10% while employee does 5%). More if they worked the occasional weekend because they got time and a half.

Attendings were making $350K for what amounted to 50hrs/week and next to no call. Work weekends and late shifts to make more.

Source: I was an attending there for a year.

 

[<(^_^)>]

$300/hr some crazy locum rate. I can tell you going prn rate average in southeast around $175/hr. Some areas northeast average hits $200 or slightly higher. Average crna take home yearly still only about half an MD (outside of academic MDs)

Locums in desperate area different and yes mid 200s or more possible but that is not the norm.

AAs get paid almost same as CRNAs.

It’s cheaper than MDs. It’s also not about what you get paid, it’s about what your contracts are. Majority of MD only groups don’t have contracts or a payer mix good enough to not get a stipend from the hospital.

Hospitals budgets are tighter than ever. They will choose the group who will use crnas or aas any day if they promise a lower stipend.

It’s the arrogance of some of these MD only groups not recognizing this that is causing them to lose contracts, embrace direction-can be CRNAs or aas. Or you better have phenomenal contracts or payer mix….

I don’t really get the logic here. Embrace medical direction or what, the hospital does something disastrous like go with medical direction model?

If you say “ah but you’ll control the transition to medical direction” not really, because guess what? Sound will always say they’re cheaper. Oh you’re 1:3? Well sound says they’re safe doing 1:4. Oh you’re 1:4? Well sound says they’re safe doing 1:8.

Fundamentally some MDs want to do their own cases, even if they make less. Even if they lose the contract. There’s nothing wrong, or arrogant, with wanting to do your own cases.

 

[nimbus]

I don’t really get the logic here. Embrace medical direction or what, the hospital does something disastrous like go with medical direction model?

If you say “ah but you’ll control the transition to medical direction” not really, because guess what? Sound will always say they’re cheaper. Oh you’re 1:3? Well sound says they’re safe doing 1:4. Oh you’re 1:4? Well sound says they’re safe doing 1:8.

Fundamentally some MDs want to do their own cases, even if they make less. Even if they lose the contract. There’s nothing wrong, or arrogant, with wanting to do your own cases.

As I’ve mentioned before, Sound does not do medical direction in our area. Their CRNAs are independent and do their own cases while anesthesiologists are doing their own case in their own rooms.

 

[nimbus]

Given current CRNA salaries, won’t medical direction also need stipends? Medical direction also leads to higher call burden for the remaining MDs and that is not free. At least with MD only models, the calls are spread out. In terms of bodies per anesthetizing location, MD only, independent CRNA only, or a combination of the two are the most efficient. Medical direction and medical supervision models add extra bodies of unknown value.

 

[Coffee PRN]

As I’ve mentioned before, Sound does not do medical direction in our area. Their CRNAs are independent and do their own cases while anesthesiologists are doing their own case in their own rooms.

Is there a difference in pay? (adjusting for hours worked for a fair comparison)

 

[nimbus]

Is there a difference in pay? (adjusting for hours worked for a fair comparison)

The Sound physicians there get paid very well for a low work burden, partly because the OR volume declined a lot. (They have an 2 year fixed contract and are being paid their contracted rate even though there is very little work. Sound is keeping their word.) The CRNA only OB unit will be closing soon so I don’t know what will happen to them.

 

[Blockit]

As I’ve mentioned before, Sound does not do medical direction in our area. Their CRNAs are independent and do their own cases while anesthesiologists are doing their own case in their own rooms.

There are many different Sound “practice models” depending on what the situation was at whatever practice they sucked up. In my case, I was at a practice where CRNA’s took no call. Only we physicians did. So you would supervise six-eight rooms during the day, and then come 5 PM it will be expected that you would take over for the CRNA and continue doing the cases that were left one after the next sometimes until two or 3 AM. And you did this every third night. For a flat salary.

 

[pgg]

There are many different Sound “practice models” depending on what the situation was at whatever practice they sucked up. In my case, I was at a practice where CRNA’s took no call. Only we physicians did. So you would supervise six-eight rooms during the day, and then come 5 PM it will be expected that you would take over for the CRNA and continue doing the cases that were left one after the next sometimes until two or 3 AM. And you did this every third night. For a flat salary.

I hope that flat salary was around $1.2M.

 

[JoelJoel84]

There are many different Sound “practice models” depending on what the situation was at whatever practice they sucked up. In my case, I was at a practice where CRNA’s took no call. Only we physicians did. So you would supervise six-eight rooms during the day, and then come 5 PM it will be expected that you would take over for the CRNA and continue doing the cases that were left one after the next sometimes until two or 3 AM. And you did this every third night. For a flat salary.

I wish there was a ‘Dislike’ button.

 

[dizzy21]

There are many different Sound “practice models” depending on what the situation was at whatever practice they sucked up. In my case, I was at a practice where CRNA’s took no call. Only we physicians did. So you would supervise six-eight rooms during the day, and then come 5 PM it will be expected that you would take over for the CRNA and continue doing the cases that were left one after the next sometimes until two or 3 AM. And you did this every third night. For a flat salary.

Given the market I’m surprised people sign up for this. I always emphasize to residents or new attending that you have way more leverage than you think you do. AMCs and private equity would like to keep you oblivious to this fact.

 

[pgg]

Given the market I’m surprised people sign up for this. I always emphasize to residents or new attending that you have way more leverage than you think you do. AMCs and private equity would like to keep you oblivious to this fact.

People who "must" live in a certain location. Family, spouse's job, or maybe they just like the weather and never learned how to shop for warmer/cooler clothes. Only way I can explain it.

 

[Blockit]

Given the market I’m surprised people sign up for this. I always emphasize to residents or new attending that you have way more leverage than you think you do. AMCs and private equity would like to keep you oblivious to this fact.

Well, I didn’t sign up for that; sound came in and bought the AMC that was already there. I unsigned as fast as I could 🤣

 

[ERRES2288]

There are many different Sound “practice models” depending on what the situation was at whatever practice they sucked up. In my case, I was at a practice where CRNA’s took no call. Only we physicians did. So you would supervise six-eight rooms during the day, and then come 5 PM it will be expected that you would take over for the CRNA and continue doing the cases that were left one after the next sometimes until two or 3 AM. And you did this every third night. For a flat salary.

Serious question. Why did you and the others take this job or stay around. You’re describing a very challenging job. I hope you were making at least 650k

 

[Blockit]

Serious question. Why did you and the others take this job or stay around. You’re describing a very challenging job. I hope you were making at least 650k

I did not stay around. There were a few that didn’t stay around. The ones that did stay around stayed for all of the usual reasons. Two of them had been veterans of several buyouts and had purchased large homes with those buyouts. That combined with the shackles they wore around their ankles (children in private school) seemingly made them willing to do anything. A few others were misfits from other places. It certainly was considered a “desirable“ area, but in my opinion, nothing is that desirable.

 

[Arch Guillotti]

Serious question. Why did you and the others take this job or stay around. You’re describing a very challenging job. I hope you were making at least 650k

Not even worth it for that.

 

[pgg]

I did not stay around. There were a few that didn’t stay around. The ones that did stay around stayed for all of the usual reasons. Two of them had been veterans of several buyouts and had purchased large homes with those buyouts. That combined with the shackles they wore around their ankles (children in private school) seemingly made them willing to do anything. A few others were misfits from other places. It certainly was considered a “desirable“ area, but in my opinion, nothing is that desirable.

:s/heat/AMC/g

 

[MirrorTodd]

:s/heat/AMC/g

Great movie.