Typical

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Good for groups to be in multiple hospital systems so they are not entirely reliant on one hospital contract.

We practice at 4 hospitals (soon to be 5) and 7ish surgery centers. We lost a hospital contract 4 years ago... we weathered that storm without much of a hiccup.
 
certainly a loss for that community. one would hope that the hospital admin did everything they could to make it work with the existing group (multiple negotiations for stipend reduction), but likely they didn't give AF and just went with the lowest bidder. also hard to know if that area is has a poor payor mix and thus any group will be dependent on a stipend to maintain a market salary and attract good talent.

the sad fact is that the new group will come in and not long after they won't be a cent cheaper. at that point either hospital admin will accept life for what it is, or it'll be a revolving door of anesthesia. but without a doubt, right as rain, what that hospital will NOT have very soon is a group of physicians who live and work in the community and want to see it thrive.
 
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sevoflurane said:
Good for groups to be in multiple hospital systems so they are not entirely reliant on one hospital contract.

We practice at 4 hospitals (soon to be 5) and 7ish surgery centers. We lost a hospital contract 4 years ago... we weathered that storm without much of a hiccup.
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Agree but it’s hard if you’re in a small town with one hospital.
 
sevoflurane said:
Since we lost that contract we’ve grown 30-40%.
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I believe you're Mednax (AA)? At least on the east coast they're losing more contracts than they are gaining. That's certainly been the case in my area. Also, historically speaking most anesthesiology groups have been beholden to one hospital/one system. Not that it provides any semblance of job security, but that's also typically REQUIRED in a contract which normally has non-compete language. Now if your group is working without a contract, you can do whatever you want. But most anesthesiology groups only GROW so far as the hospital system that they contract with grows. I'm not saying this is a good thing, but no one here should pretend that of all physician groups, or within a hospital or health system, that the anesthesiology group holds real power.
 
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nimbus said:
They even sponsored a squirrel statue. So much for being a fabric of the community.

Sleep E. Squirrel, MD
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I was reading about this group, they have given hundreds of thousands to various hospital related donations, and sponsor many community activities. And apparently built a squirrel statue.
Save your cash folks and put it toward subsidy reduction. They don’t care how much you’ve done for them, they will push you out without thinking twice.
 
Lol. My group recently gave the hospital a “donation”. Felt more like a kickback...
 
Man o War said:
I was reading about this group, they have given hundreds of thousands to various hospital related donations, and sponsor many community activities. And apparently built a squirrel statue.
Save your cash folks and put it toward subsidy reduction. They don’t care how much you’ve done for them, they will push you out without thinking twice.
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They should've gone with a squirrel statue that more closely resembles the Fark mascot.
 
We are providers, don't ever forget that! Sad to say that but it's the reality of today. Spend less than you make so that if a day like this come, put two middle fingers in the air at the admin as you walk out.
 
Man o War said:
I was reading about this group, they have given hundreds of thousands to various hospital related donations, and sponsor many community activities. And apparently built a squirrel statue.
Save your cash folks and put it toward subsidy reduction. They don’t care how much you’ve done for them, they will push you out without thinking twice.
Click to expand...
Very true. Remember that hospital administrators change out every few years. No matter how generous and community oriented your group has been in the past, those administrators will be gone either climbing the ladder or moving on to other locations and the new ones will have no source of reference with the group. Money will mean everything. Groups need to be smart and fiscally conservative these days. There is nothing wrong with making charitable donations to hospitals and being community present but don’t expect it to pay off in job security.
 
Noyac said:
Very true. Remember that hospital administrators change out every few years. No matter how generous and community oriented your group has been in the past, those administrators will be gone either climbing the ladder or moving on to other locations and the new ones will have no source of reference with the group. Money will mean everything. Groups need to be smart and fiscally conservative these days. There is nothing wrong with making charitable donations to hospitals and being community present but don’t expect it to pay off in job security.
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Yep. Bottom line is they have to keep the hospital (or move it words) the black. Stipends are the easiest way to cut a budget and if there is push back then they'll find an anesthesia company who doesn't care about stipends (or nurses who are cheap) fast.
 
Some people say that the best job security is to get directly involved with hospital leadership/administration. Always helps to have a spy inside the boardroom.

But going back to the overall theme here, the future is always uncertain and life has few guarantees other than it begins and ends at some point. Appropriately assessing risk and planning for it is easier said than done, but something we should all be working on. For some people (like me), that means I am very far away from being emotionally/intellectually ready to buy a house. Personally, I am trying to prevent lifestyle creep and chip away at my mountain of med school student loan debt.
 
How about a private practice group that does not receive any subsidy from the hospitals that they serve? Even if it is a physician-only practice- how safe are they? I understand that nobody is safe these days, but I imagine that this aforementioned group received some sort of subsidy
 
Lecithin5 said:
How about a private practice group that does not receive any subsidy from the hospitals that they serve? Even if it is a physician-only practice- how safe are they? I understand that nobody is safe these days, but I imagine that this aforementioned group received some sort of subsidy
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A private MD-only group, with no subsidy, good standing in the hospital (respected, serves on committees, etc), and good relationships with surgeons (the group is perceived as hard-working and efficient), is a GOOD AS IT GETS. But achieving all of those things is rare in my opinion. Several on this board brag about it often. HOWEVER, even if that group has all of that, they still require two things for success. Surgical volume and a good payor mix. In fact, multiply the RVU equivalent of their volume by their average payor rate and you have their salary. If they have neither volume nor good payor mix, they're reliant on a subsidy. If they have one without the other, they're either subsidy dependent or working for below market wages very likely. Now take all of that, and imagine what is happening in rural and rural-ish areas where volume is lost and at the same time patients become dependent on the government (jobs lost, factories leaving town for Mexico, etc). Those groups STRUGGLE. Admin gets restless and itchy, and sooner rather than later pulls the trigger for change. And in comes the AMC promising golden eggs but a couple of years later delivering a rotten egg.
 
Word on the street is that multiple private groups in SW Virginia have lost contracts with their primary hospitals.
 
I am from Virginia and every time I look at jobs there I just can't justify the pay cut. Obviously there are enough out there willing to take low pay?
 
I just heard from a colleague in the know that this group’s subsidy was in the neighborhood of $900,000 per year. I don’t personally know any of them.
So, take that or leave it but might be a good ballpark figure.
 
dr doze said:
So is everyone.

The cemeteries are filled with indespensible men.

- Charles DeGaulle
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To an extent. A hospital will hold on to a garbage surgeon bringing in volume versus a garbage anesthesiologist. But that's really just stating the obvious.

Consigliere said:
The geography is irrelevant, hard on. The point is we are very dispensable.
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He's correct. I think many times on here we talk up rural anesthesia being this place where you can "thump your chest" so to speak because "where the hell else are you going to find an anesthesiologist?" Well, as is being show, like Ian Malcolm said, "Life finds a way."
 
Man o War said:
I just heard from a colleague in the know that this group’s subsidy was approximately $900,000 per year.
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Yep. Sounds like a good per day call rate. You guys can do the math
(Do we want to move this conversation to private as dollar rates are starting to show up?)
 
Twiggidy said:
Yep. Sounds like a good per day call rate. You guys can do the math
(Do we want to move this conversation to private as dollar rates are starting to show up?)
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I can delete if not.
I don’t see that as an absurd number on first glance, surely in this location there’s going to have to be a subsidy. I also heard the group was willing to decrease it. How much are they really going to save when that CRNA overtime starts rolling in?
 
Just as an aside - about 7 years ago, I met the guy who is the CEO of the hospital "system" (2 hospitals - one small, and the other rinky-dink much smaller) in the OPs article at a recruiting event. He was SO drunk, he spilled a glass of wine. Not impressive.

Worst move of my life, that job (and I have ****ed up every which way to Monday).
 
rakotomazoto said:
Some people say that the best job security is to get directly involved with hospital leadership/administration. Always helps to have a spy inside the boardroom.

But going back to the overall theme here, the future is always uncertain and life has few guarantees other than it begins and ends at some point. Appropriately assessing risk and planning for it is easier said than done, but something we should all be working on. For some people (like me), that means I am very far away from being emotionally/intellectually ready to buy a house. Personally, I am trying to prevent lifestyle creep and chip away at my mountain of med school student loan debt.
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I have always made good money when I sold my house. In the range of the average stock market return or slightly better. But my wife is pretty damn good at house selection and maintenance/upgrades. If I so,d. Y current house right now, I would list it for 60% more than I paid for it 6 yrs ago.
 
Man o War said:
I can delete if not.
I don’t see that as an absurd number on first glance, surely in this location there’s going to have to be a subsidy. I also heard the group was willing to decrease it. How much are they really going to save when that CRNA overtime starts rolling in?
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Maybe somebody in here has the math worked out, but I just don't get how crnas are cost efficient. When you factor in a 35 hour work week plus benefits, it doesn't take long to see those numbers start to shoot up. Add in the anesthesiologist's salary on top of that and I personally just don't get how it's "cost-effective" to turn to the care team model.
 
rakotomazoto said:
Some people say that the best job security is to get directly involved with hospital leadership/administration. Always helps to have a spy inside the boardroom.
Click to expand...

No matter how involved you are, it seems unlikely to get you in the “boardroom”.
 
d9sccr said:
Maybe somebody in here has the math worked out, but I just don't get how crnas are cost efficient. When you factor in a 35 hour work week plus benefits, it doesn't take long to see those numbers start to shoot up. Add in the anesthesiologist's salary on top of that and I personally just don't get how it's "cost-effective" to turn to the care team model.
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One of the articles stated the group was 6 docs and 2 CRNAs. So yeah they were likely very inefficient. Maybe the CRNAs were there for breaks and an available body? Perhaps the call doc supervised the 2 CRNAs so that he could be available for PACU and a very slow OB service? Hard to say. But a subsidy of 900k seems steep for such a small setup, and no doubt admin will just go w the lowest bidder.

If the hospital was willing to buyout the group that would’ve been the only real way to keep the group intact. I imagine that hospital is just a sleep little place, likely to be bought out in the near future, with no real way to sustain a solid private practice Anesthesia group outside of a massive subsidy or 4:1 supervision with a revolving door of CRNAs and anesthesiologists.
 
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Arch Guillotti said:
No matter how involved you are, it seems unlikely to get you in the “boardroom”.
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Well I’m not on the board of my hospital but I could be. The medical Staff President has a spot. Instead I’m on a Physician Leadership Council which I see as a more effective spot at this time. So it is very possible to sit on the board.
 
d9sccr said:
Maybe somebody in here has the math worked out, but I just don't get how crnas are cost efficient. When you factor in a 35 hour work week plus benefits, it doesn't take long to see those numbers start to shoot up. Add in the anesthesiologist's salary on top of that and I personally just don't get how it's "cost-effective" to turn to the care team model.
Click to expand...

If the AMC pays the physicians/CRNAs vs the hospital
 
Noyac said:
Well I’m not on the board of my hospital but I could be. The medical Staff President has a spot. Instead I’m on a Physician Leadership Council which I see as a more effective spot at this time. So it is very possible to sit on the board.
Click to expand...

I was President of the Medical Staff (and therefore was a non-voting member of the Board) during the "merger" of our community hospital and the large healthcare system nearby.
We served on committees, went to meetings, helped with recruitment.
Our group donated regularly to community charities.
My wife was on the hospital foundation board and two other local boards.
My partner's wife is an active hospital volunteer.
Etc, etc...

We seriously thought such work would get us some goodwill. Not the reason for doing those things, of course, but it couldn't hurt, right? Except that nobody local calls the shots anymore.

In a few months we will all be gone, replaced by somebody from the group that has the larger system contract. "A more efficient model".

Keep your options open (mine is retirement...).
 
There is no honor amongst thieves, particularly those that go into hospital administration. Most of them have contempt towards physicians, perhaps from their own failed attempts to get into medical school.
 
gasdoc77 said:
There is no honor amongst thieves, particularly those that go into hospital administration. Most of them have contempt towards physicians, perhaps from their own failed attempts to get into medical school.
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they don't see patients and they don't see healthcare
for them it is about money and bonuses.
 
oldguy55 said:
I was President of the Medical Staff (and therefore was a non-voting member of the Board) during the "merger" of our community hospital and the large healthcare system nearby.
We served on committees, went to meetings, helped with recruitment.
Our group donated regularly to community charities.
My wife was on the hospital foundation board and two other local boards.
My partner's wife is an active hospital volunteer.
Etc, etc...

We seriously thought such work would get us some goodwill
Click to expand...

It did. Just not enough to counter the massive economic pressures that exist. Doing all of the above used to matter-somewhat. It still matters now-just very little. The above strategies are the equivalent of fighting the last war.
 
oldguy55 said:
I was President of the Medical Staff (and therefore was a non-voting member of the Board) during the "merger" of our community hospital and the large healthcare system nearby.
We served on committees, went to meetings, helped with recruitment.
Our group donated regularly to community charities.
My wife was on the hospital foundation board and two other local boards.
My partner's wife is an active hospital volunteer.
Etc, etc...

We seriously thought such work would get us some goodwill. Not the reason for doing those things, of course, but it couldn't hurt, right? Except that nobody local calls the shots anymore.

In a few months we will all be gone, replaced by somebody from the group that has the larger system contract. "A more efficient model".

Keep your options open (mine is retirement...).
Click to expand...
I hear you, Oldguy.
I have no illusions that my participation will derail any administrative decisions made at the mega million dollar office building a mere 600 miles away. But what it will do is keep my finger on the pulse of the system in order to be able to inform my group appropriately. And in the event of a move to a cheaper version of my group, we will be able to prepare sooner. That’s the best we can do in reality.
 
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