Are your arguments going to revolve around a misguided idea of there existing an era in anesthesiology where there was no competition against starting a group or a financial risk inherent in doing so?
Huh? No one is doubting that there has always been competition to get contracts at hospitals. What has changed in the past 30 years is the fact that business
now is mostly done by (1) lawyering and (2) conglomeration/vertical integration of services, for better or for worse. It is the, as it was put, "Wal-marting" of our profession. Gone are the days when a handshake and a gentleman's agreement meant something.
To the point, the big change in that timeframe, which you either don't understand or ignore, is that
other entities are using your medical license to bill for services
you provide. This was never the case thirty years ago. You worked for a practice (that you either
owned or were in the process of becoming an owner) that submitted a bill directly for services, and the arrangement was in essences that once you proved yourself worthy you would be included in an equal sharing for the work you did.
What we have now with AMCs can hardly be called a "practice" because, as an
employee of that practice, you are subject (and that's the key word here) to the working arrangements
they provide and contract you for. Furthermore, they often require you to sign all manner of restrictive covenants that state you can't work in the places that
they provided work for you regardless as to whether or not you felt that arrangement was fair, safe, not what was promised, etc. You are usually collecting a flat salary, with no real promise of profit sharing or future ability to become a shareholder, where they can often
dictate the manner in which you are going to practice. And, if you leave because you don't like it, guess what? That
restrictive covenant is still in effect.
To claim that the practice environment hasn't changed is either naive or ignorant. We're not talking a town with several groups of anesthesiologists and an unlimited supply of potential future partners like in the Jefferson Parish vs. Hyde supreme court case in 1984. We're talking about massive regional groups, sometimes employing hundreds (and even over a thousand now) anesthesiologists, who are not going to let you compete against them if you don't like their deal. We're
letting them use
our medical licenses to make money with no real promise of future profit sharing or ability to walk away and stay in the same area with meaningful employment.
My solution? If you want to work in such an arrangement and screw yourself, don't sign a contract. Just have them hire you as an at-will employee. Sure, you can follow their employee handbook and whatnot. But, if you don't like the deal, you are free to walk away.
If everyone did this, they'd be forced to change their current bullshit employment tactics.
(Apparently you wanted the long answer.)
