Truly great and truly private practice groups….

[Blockit]

Hello friends,
Experienced generalist here, at the midpoint of my career. I have been following posts in this forum for quite a while now, and I have been impressed with how many seasoned anesthesiologists post here. Being that “Word of mouth“ is one of the best ways to learn about jobs in our specialty, I would love to hear from all of you about any experiences you may have with truly great private practice groups that have managed to remain independent.

I’m looking to find one of those groups. I’m looking to find a group that is fair and equitable, one that is specifically structured to meet the needs of ALL of its practitioners, rather than a few superpartners. One with a friendly, stable relationship with its clients that is not struggling to survive.

I am happy to do my own cases, I actually prefer it, but I’ve done a fair bit of medical direction/supervision through my career. I could go either way. It also doesn’t matter exactly where this group is. I am free to roam. Prefer a place where the cost-of-living isn’t ridiculous, where one can live a peaceful life without having to murder yourself to make it to 50th percentile MGMA. A place where partners generally like each other and support each other.

In this world of anesthesia that exists today, where all sorts of entities skim off of your hard work to profit for themselves, does my desired unicorn still exist?

Thanks for any and all information/suggestions

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[IMGASMD]

Depends where you want to end up, right? Also the timing of the groups’ need. What kind of money you’re expecting to make. So many factors, and no prefect answers. You have kids?

There’s a Virginia group that everyone talks about, that might worth exploring.

NJ/NY/CT areas may have some diamonds in the rough, but some of those just aren’t stable enough. Or as you eluded to, a lot of partner, super partner structures. The most ridiculous one was 5 years to partner, but didn’t have one open when I looked. They told me, it maybe another 2 years before partner spot opens up. But it was advertised as one of the highest paying one in the state…

People’s priority change with time. My needs as a semi-newly grad is different than mid-career attendings and certainly is very different than people who are in the twilight of their career.

Isn’t it always boils down to location, money and lifestyle…. Pick two and be happy? No prefect job, unfortunately.

 

[abolt18]

A handful that I'm aware of by word of mouth/talking directly to them. These are all physician-only groups.

Roanoke, VA
ACI in Indianapolis.
Billings, MT
Missoula, MT
Grand Junction, CO
Mountain West Anesthesia (all over Utah) (though they just started supervising a little bit)
More Utah groups.
Medford, OR
Eugene, OR
I know there's some megagroup in Oregon that i believe it's physician only and is purported to be all those things you described.

Maybe check out Idaho as well. I don't know anything about those groups other than that it's mostly ACT model in Boise... I think.

 

[Blockit]

Thank you both. Bolt, I have heard of that group in Virginia but I’m not much for that state. All of the other groups you list you’ve heard positive things about them all?

 

[nimbus]

I know there's some megagroup in Oregon that i believe it's physician only and is purported to be all those things you described.

That’s OAG and they’ve started to use CRNAs.

 

[abolt18]

Thank you both. Bolt, I have heard of that group in Virginia but I’m not much for that state. All of the other groups you list you’ve heard positive things about them all?

My experience with these groups varies anywhere from friends and acquaintances in the groups with whom I've spoken in great detail, to groups I've heard about 3rd or 4th hand. I do believe they are all partnership track jobs where all partners are equal.

 

[Arch Guillotti]

Thank you both. Bolt, I have heard of that group in Virginia but I’m not much for that state. All of the other groups you list you’ve heard positive things about them all?

So what part of the country do you want to go to?

 

[Blockit]

I keep thinking Midwest. Colorado, Indiana, Iowa, Idaho, etc. Someplace where the money is good enough to where it makes tolerating some of the other junk we deal with a bit easier 😊

 

[Beach bum]

I keep thinking Midwest. Colorado, Indiana, Iowa, Idaho, etc. Someplace where the money is good enough to where it makes tolerating some of the other junk we deal with a bit easier 😊

It does seem that there are a fair amount of opportunities in Indiana that are egalitarian.

 

[Beach bum]

Thank you both. Bolt, I have heard of that group in Virginia but I’m not much for that state. All of the other groups you list you’ve heard positive things about them all?

Why do you not care for Virginia? Seems like the main drawback is the very low reimbursement?

 

[deleted697127]

It does seem that there are a fair amount of opportunities in Indiana that are egalitarian.

I couldn’t even find Indiana on a map, let alone one of their beaches.

 

[Beach bum]

I couldn’t even find Indiana on a map, let alone one of their beaches.

It’s in the “fly over zone”!!! No idea if they have beaches!!

 

[Justice4all]

Don’t forget the dunes!!!

 

[Silo004]

A handful that I'm aware of by word of mouth/talking directly to them. These are all physician-only groups.

Roanoke, VA
ACI in Indianapolis.
Billings, MT
Missoula, MT
Grand Junction, CO
Mountain West Anesthesia (all over Utah) (though they just started supervising a little bit)
More Utah groups.
Medford, OR
Eugene, OR
I know there's some megagroup in Oregon that i believe it's physician only and is purported to be all those things you described.

Maybe check out Idaho as well. I don't know anything about those groups other than that it's mostly ACT model in Boise... I think.

OAG is that group and they are hiring a lot right now. CAG is a pretty solid group as well. Have some friends that work there. More supervision at CAG.

 

[IntoTheWest]

ACI in Indianapolis has now become IU Health employees and no longer physician only, they will be utilizing AAs. Methodist Hospital the main hospital ACI staffed is the main training site for AA program.

 

[abolt18]

ACI in Indianapolis has now become IU Health employees and no longer physician only, they will be utilizing AAs. Methodist Hospital the main hospital ACI staffed is the main training site for AA program.

Fo reals? When did that happen? I had heard IU was always trying to do that, but the group seemed pretty committed to fighting that off.

Edit: confirmed with a friend in the group. That comes as a big surprise to me.

 

[linkin06]

Another one bites the dust....another one bites the dust.

seems like I went into medicine a decade too late.

 

[Status Sciaticus]

better AAs than CRNAs

 

[Gaseous Clay]

I interviewed with IU last year right before COVID started and that was part of their pitch was the take over. All my contacts who worked elsewhere around Indy said that had been rumored for years and never believed it would happen. Does anyone know if many of the ACI employees stayed?

 

[Blockit]

I interviewed with IU last year right before COVID started and that was part of their pitch was the take over. All my contacts who worked elsewhere around Indy said that had been rumored for years and never believed it would happen. Does anyone know if many of the ACI employees stayed?

What did you think of them at that time?

 

[abolt18]

I interviewed with IU last year right before COVID started and that was part of their pitch was the take over. All my contacts who worked elsewhere around Indy said that had been rumored for years and never believed it would happen. Does anyone know if many of the ACI employees stayed?

Sounds like most of the docs stayed on. It was 100+ docs. No midlevels. Everyone a partner or on partner track. I'm curious what IUs package is like and how it compares to the original ACI job.

 

[GassYous]

I interviewed with IU last year right before COVID started and that was part of their pitch was the take over. All my contacts who worked elsewhere around Indy said that had been rumored for years and never believed it would happen. Does anyone know if many of the ACI employees stayed?

How is a takeover part of the pitch...

Most savvy groups would lie to your face to get you in before they stab you in the back

 

[Gaseous Clay]

What did you think of them at that time?

Job at University hospital. I lived in Indy for 5 years so certainly no expert but for a family, we would’ve only considered the suburbs like Carmel or Westfield and those are already getting overcrowded with awful traffic. At the end of the day did not want a 45+ minute commute.

I had rotated at Methodist as a med student and wasn’t too interested in working there. I prefer smaller places and I eventually found that in Ohio.

 

[Gaseous Clay]

Sounds like most of the docs stayed on. It was 100+ docs. No midlevels. Everyone a partner or on partner track. I'm curious what IUs package is like and how it compares to the original ACI job.

I’m not an expert on academic packages but IU seemed to have a good overall package but can’t compete with PP. My guess is they needed to take a pay cut but probably improved on their lifestyle. Pure speculation on my part.

 

[Velefunt]

OAG is that group and they are hiring a lot right now. CAG is a pretty solid group as well. Have some friends that work there. More supervision at CAG.

I was told CAG also has a 4-tier partnership level (ie: Super Partners with something akin to dividends?). I've also got a few colleagues in CAG, but we don't talk money. I'd clarify if interviewing.

 

[ambiturner]

For those of you in truly great and truly private practice groups, do you think the model can survive? How many years before every group is employed by a big health system or AMC?

 

[sevoflurane]

For those of you in truly great and truly private practice groups, do you think the model can survive? How many years before every group is employed by a big health system or AMC?

They can survive… and flourish. Have a good business model, be good at what you do and don’t be a predatory group.

 

[Shimmy8]

For those of you in truly great and truly private practice groups, do you think the model can survive? How many years before every group is employed by a big health system or AMC?

It will survive as long as that particular group wants it to.

 

[Blockit]

It will survive as long as that particular group wants it to.

I'm not sure about that. I have been familiar with situations where a new CEO comes in and makes it their personal mission to rid their facility of *something* troublesome to them, an anesthesia group being one of those things sometimes. Especially if CEO bonus is tied to cost-cutting. It is very easy for a CEO or board to make an offer to an anesthesia group that the group has no choice but to refuse because it is far too low or far too unreasonable.

 

[nimbus]

I'm not sure about that. I have been familiar with situations where a new CEO comes in and makes it their personal mission to rid their facility of *something* troublesome to them, an anesthesia group being one of those things sometimes. Especially if CEO bonus is tied to cost-cutting. It is very easy for a CEO or board to make an offer to an anesthesia group that the group has no choice but to refuse because it is far too low or far too unreasonable.

Reading stuff like this makes me feel pretty fortunate to work in a place with long term administrators. Our hospital CEO has been at our hospital since 1987 and CEO since 2004. Our systemwide CEO has been at the helm since 2000. Both are reasonable and widely respected. So no merry go round and no attendant drama. At least for now.

 

[<(^_^)>]

I'm not sure about that. I have been familiar with situations where a new CEO comes in and makes it their personal mission to rid their facility of *something* troublesome to them, an anesthesia group being one of those things sometimes. Especially if CEO bonus is tied to cost-cutting. It is very easy for a CEO or board to make an offer to an anesthesia group that the group has no choice but to refuse because it is far too low or far too unreasonable.

'The hospital is broken': Sherman surgery vice chair calls anesthesia shortage a crisis and if what the group is asking for isn’t unreasonable this is often the result. What a disaster. 90% reduction in surgical volume.

 

[Status Sciaticus]

any of these truly equitable groups in Seattle or Texas? Or in a major metro?

 

[amyl]

Metro in dallas is about as close as you will come in Texas metro…. Maybe in a small town somewhere.

 

[Velefunt]

any of these truly equitable groups in Seattle or Texas? Or in a major metro?

Bellingham - between Seattle and Vancouver. All MD. Not USAP. Hiring.

 

[Status Sciaticus]

Bellingham - between Seattle and Vancouver. All MD. Not USAP. Hiring.

wasnt there a bunch of drama about them legally about onerous non-competes and long parternship tracks?

 

[Blockit]

wasnt there a bunch of drama about them legally about onerous non-competes and long parternship tracks?

Yes. And on top of that PeaceHealth is where the ER doctor was removed for speaking out in the early days of the pandemic. Doesn’t sound like a great place to be as far as work culture.

 

[kidthor]

wasnt there a bunch of drama about them legally about onerous non-competes and long parternship tracks?

Yep!:


Bellingham medical providers must end illegal non-compete contracts, pay $110K as a result of AG Ferguson consent decree

Bellingham medical group agrees to end decades-long monopoly in Whatcom, Skagit counties

All healthcare noncompete agreements seem unnecessary in my opinion... but this one was particularly bad at 3 years!

 

[narcotics999]

All healthcare noncompete agreements seem unnecessary in my opinion

I wish. Then a lot of AMC would lose providers.

 

[Beach bum]

Looked at a contract years ago with an amc. Absolutely the most onerous one sided creation I have ever seen. Can’t imagine why anyone would come close to entering into anything close to that deal!!

 

[IMGASMD]

Looked at a contract years ago with an amc. Absolutely the most onerous one sided creation I have ever seen. Can’t imagine why anyone would come close to entering into anything close to that deal!!

The only thing in town.
Everything else is garbage.
Perhaps better pay than some others.
False sense that there’s a HR department, they will “protect” you.
Promise it’ll get soooo much better when they’re fully staffed.



Just to hijack your comment a little bit. AMCs (PP too) will come back to you with the “standard” answer of, everyone in the practice has to have the same contract. It may be true, probably more so with “partnership” agreements since everyone is “equal” partner. However, I will forever and always encourage people to spend that $1000 (less than your one day pay….) to have someone look over the contract. At the end of the day, you know you tried and won’t be wondering if you did everything to make it a better contract. Also your lawyer may know something that your colleagues/co-residents don’t know. Also when they’re desperately bleeding money, maybe they’d try something different to stop the bleeding.

 

[DartmouthMS1]

Throwing in for my group in Sacramento. All MD practice about 100 or so docs strong. We cover two major hospitals in the area and associated surgery centers. 2 year partnership track which gives you equity and voting. There's dedicated cardiac, peds and OB subgroups. I've been here for 3+ years out of training doing non-cardiac adults and am pretty happy here. We have good surgeons and collegial environment, lots of great nursing and tech support, excellent facilities and equipment.

Call burden is low (1st call about once a month most months, few months of the year might have 2), 4-5 weekends a year. At my hospital, it's home call with seldom callback at night. Our surgeons don't want to do bull**** cases in the middle of the night any more than we do. You can take more call if you want to work harder. There's a stipend associated with call positions. Eat what you kill model with a blended average unit. We use a numbered scheduling system and the doc doing the monthly schedule goes through great lengths to make sure schedule assignments are as fair and balanced as he can make it. Daily schedule assignments are made by 1st call for the next day (including new hires). Most people take about 6-8 weeks vacation and get the weeks they want off. Most people work one major holiday a year, sometimes 2. Income wise, we're around the median mark for a "full time" doc but you can request less or more work as you'd like. Very flexible in that regard. We have retirement vehicles available to put away 56K+ annually which can be self directed or invested in a managed pooled fund. You're paid as a W2 but can deduct personal practice related expenses through the practice which is reimbursed to you on a tax-free basis. medical, disability, malpractice are available through the group.

We have office staff that take care of all the billing, credentialing, scheduling and the business side of things. Many of our docs are on different committees that oversee and direct different aspects of the practice. Docs are free to be as involved (or not) with the business aspects of the practice as they please. Overall it's a solid and equitable group, one of the last few remaining private anesthesia groups in the state and i think deserves a mention in this thread

 

[IMGASMD]

Throwing in for my group in Sacramento. All MD practice about 100 or so docs strong. We cover two major hospitals in the area and associated surgery centers. 2 year partnership track which gives you equity and voting. There's dedicated cardiac, peds and OB subgroups. I've been here for 3+ years out of training doing non-cardiac adults and am pretty happy here. We have good surgeons and collegial environment, lots of great nursing and tech support, excellent facilities and equipment.

Call burden is low (1st call about once a month most months, few months of the year might have 2), 4-5 weekends a year. At my hospital, it's home call with seldom callback at night. Our surgeons don't want to do bull**** cases in the middle of the night any more than we do. You can take more call if you want to work harder. There's a stipend associated with call positions. Eat what you kill model with a blended average unit. We use a numbered scheduling system and the doc doing the monthly schedule goes through great lengths to make sure schedule assignments are as fair and balanced as he can make it. Daily schedule assignments are made by 1st call for the next day (including new hires). Most people take about 6-8 weeks vacation and get the weeks they want off. Most people work one major holiday a year, sometimes 2. Income wise, we're around the median mark for a "full time" doc but you can request less or more work as you'd like. Very flexible in that regard. We have retirement vehicles available to put away 56K+ annually which can be self directed or invested in a managed pooled fund. You're paid as a W2 but can deduct personal practice related expenses through the practice which is reimbursed to you on a tax-free basis. medical, disability, malpractice are available through the group.

We have office staff that take care of all the billing, credentialing, scheduling and the business side of things. Many of our docs are on different committees that oversee and direct different aspects of the practice. Docs are free to be as involved (or not) with the business aspects of the practice as they please. Overall it's a solid and equitable group, one of the last few remaining private anesthesia groups in the state and i think deserves a mention in this thread

Sounds like a good group. I will be the asshat. How does someone get into the ob group? And what is the differential for doing ob and general? Thanks.

 

[DartmouthMS1]

Sounds like a good group. I will be the asshat. How does someone get into the ob group? And what is the differential for doing ob and general? Thanks.

I do believe there is a differential, the OB subgroup probably makes more on average. I couldn't tell you how much though because I don't know. What I do know is that the OB subgroup is a pretty mixed bag of people, comprised of younger and older partners. They also take a lot more night call, which is in house call and do a lot of high risk OB here.

When I joined the group, I kind of wanted to do OB but then I lost interest quickly seeing how nice it was not to be up all night running around. I think that's what happens with most people here. There's been at at least one recent hire that had continued interest in the OB group and was added to the pool after 4 to 6 months in. So if you're really really interested, it's not completely off the table.

 

[pauly21]

I was told CAG also has a 4-tier partnership level (ie: Super Partners with something akin to dividends?). I've also got a few colleagues in CAG, but we don't talk money. I'd clarify if interviewing.

Hopefully posting on an older thread like this doesn’t cause issues, browsing this thread to see what’s out there.

I also know some CAG colleagues. Their tier structure is related to FTE status and not a “super partner” type thing.