USAP losing contracts

[Anesthesia19]

I am hearing that USAP in Texas is losing significant contracts. Specifically in Houston, Dallas and San Antonio. From some friends, they're stating it's simply due to them being understaffed and they elect not to renew contracts at certain sites to help consolidate.

Curious if this is due to partners having now fulfilled their post-buyout obligation and retiring (definitely happening in San Antonio), or if its due to difficult time recruiting, although it seems there's just a nationwide shortage of anesthesiologists as is.

Wondering if any other states are having similar scenarios with USAP?

---

Members don't see this ad.

 

[amyl]

I’m in dallas and we didn’t step away from any contracts with hospitals but we did triage some outside business. So far we have only given one surgeon away to another USAP group. We have actually had to pick up three surgeons from DAA as they are unable to fulfill their contract. So our commitments have actually expanded. We have lost a few docs but not for buyout reasons…. Their timing in dallas was awhile ago. A few retired - they were in their 70s. We lost one partner to a significant medical issue. Two just retired early - one due to burn out, the other as he had family Commitments he had to handle elsewhere than dallas.
Just wanted to set the record straight about USAP in dallas “loosing” contracts. It’s not true - we have increased our clinical footprint in dallas proper. In a rural area of Texas (almost 2 hours from dallas) USAP north Texas did walk away from a contact with a hospital as they could not come to a satisfactory agreement on trauma stipend for the work requested by the hospital. It was a straight up business decision that it wasn’t in the financial interest to continue that contract. There was plenty of more lucrative work elsewhere in the area for those partners.

 

[okayplayer]

.

 

[ethilo]

I'm kind of curious if USAP is having the same issues as the other large PE groups like TeamHealth / Envision regarding the No Surprises Act...

 

[anesussy]

I’m in dallas and we didn’t step away from any contracts with hospitals but we did triage some outside business. So far we have only given one surgeon away to another USAP group. We have actually had to pick up three surgeons from DAA as they are unable to fulfill their contract. So our commitments have actually expanded. We have lost a few docs but not for buyout reasons…. Their timing in dallas was awhile ago. A few retired - they were in their 70s. We lost one partner to a significant medical issue. Two just retired early - one due to burn out, the other as he had family Commitments he had to handle elsewhere than dallas.
Just wanted to set the record straight about USAP in dallas “loosing” contracts. It’s not true - we have increased our clinical footprint in dallas proper. In a rural area of Texas (almost 2 hours from dallas) USAP north Texas did walk away from a contact with a hospital as they could not come to a satisfactory agreement on trauma stipend for the work requested by the hospital. It was a straight up business decision that it wasn’t in the financial interest to continue that contract. There was plenty of more lucrative work elsewhere in the area for those partners.

"Yeah, our group is falling apart because our partners are finding more lucrative positions" is what I'm hearing

 

[nimbus]

"Yeah, our group is falling apart because our partners are finding more lucrative positions" is what I'm hearing

It reads like they stayed with USAP but left that particular hospital due to an inadequate trauma stipend.

 

[amyl]

It reads like they stayed with USAP but left that particular hospital due to an inadequate trauma stipend.

This. The division that fulfilled that contract was happy to let the trauma go. Many were older and ready to scale back. They are all just covering surgery centers now. The one that wanted more call etc elected to transfer to another division

 

[Howard888]

This. The division that fulfilled that contract was happy to let the trauma go. Many were older and ready to scale back. They are all just covering surgery centers now. The one that wanted more call etc elected to transfer to another division

As per the Austin thread-I’m hearing similar things.

Here’s the issue USAP now faces: with the NSA their contracts will not likely go up anymore than they have. Whatever they signed pre NSA is it. They’re the top of the market. If anything they’ll go down.

But while reimbursement won’t go up, costs of CRNAs, nurses, admin, cost of living are all skyrocketing.

USAp senior “partners” don’t want to pay CRNAs, junior partners, etc more so they are all working longer hours instead of pay staff more to maintain their income. They’re now facing burn out and people working more than pre Usap sale.

Why don’t they want to pay CRNAs, junior partners more -because 25-35% depending on the group, if their revenue goes to private equity

So yes unless inflation and cost of living changes, which is unlikely, USAP groups likely to burn out.

You can’t recruit anyone of quality who will accept 250-300 salary to be a “junior partner” who will then have to pay 100k to be a senior partner.

CRNAs make that salary right now. You can easily get jobs 400k plus straight out right now.

Austin really feeling this because cost of living outpacing rest of Texas.

 

[epidural man]

CRNA's getting 400K?

When their salaries get a little higher, do you guys think I could get a CRNA job? I wouldn't mind one of you supervising me.

I'd even put up with your dogma $hit, like opioids cause chest wall rigitidy bla bla bla.

As long as you let me mix the alfentanil and propofol in the same bottle.

 

[Status Sciaticus]

CRNA's getting 400K?

When their salaries get a little higher, do you guys think I could get a CRNA job? I wouldn't mind one of you supervising me.

I'd even put up with your dogma $hit, like opioids cause chest wall rigitidy bla bla bla.

As long as you let me mix the alfentanil and propofol in the same bottle.

I read it as 250-300 being what CRNAs are making, and 400k for new grad jobs is what he/she is saying, not CRNAs making 400k.
But yes, in SA specifically, there are 2-3 new small groups that are slowly picking off the USAP non-renewals. Mostly ASC for now. Lone Star is one of them and ad is listed on gaswork.

I dont see USAP losing any foothold in Dallas and Houston. Both are markets with very good payor mixes (Dallas more so).

 

[nimbus]

CRNA's getting 400K?

When their salaries get a little higher, do you guys think I could get a CRNA job? I wouldn't mind one of you supervising me.

I'd even put up with your dogma $hit, like opioids cause chest wall rigitidy bla bla bla.

As long as you let me mix the alfentanil and propofol in the same bottle.

In residency it was the pet project of a couple of our attendings to do alfenta/propofol induction and intubation with no paralysis. It kinda sorta worked. And it was better than mivacurium.

 

[GassYous]

In residency it was the pet project of a couple of our attendings to do alfenta/propofol induction and intubation with no paralysis. It kinda sorta worked. And it was better than mivacurium.

Yeah but back then people checked oxygenation by looking at lips and digits as they held the ether on the patients face so...

 

[IMGASMD]

Yeah but back then people checked oxygenation by looking at lips and digits as they held the ether on the patients face so...

One of my attending did a remi bolus with me once, without any other agents.

I didn’t like it.

 

[Anesthesia19]

I read it as 250-300 being what CRNAs are making, and 400k for new grad jobs is what he/she is saying, not CRNAs making 400k.
But yes, in SA specifically, there are 2-3 new small groups that are slowly picking off the USAP non-renewals. Mostly ASC for now. Lone Star is one of them and ad is listed on gaswork.

I dont see USAP losing any foothold in Dallas and Houston. Both are markets with very good payor mixes (Dallas more so).

I have heard from reliable sources that in Houston they are pulling out of a major hospital system. Sounds like it's voluntarily (although they're leaving that system without sufficient coverage) but seems like it's due to a combination of understaffing and possibly not being the most lucrative hospital system.

I'm assuming those partners/non partners are being shifted to another hospital system

 

[Howard888]

I read it as 250-300 being what CRNAs are making, and 400k for new grad jobs is what he/she is saying, not CRNAs making 400k.
But yes, in SA specifically, there are 2-3 new small groups that are slowly picking off the USAP non-renewals. Mostly ASC for now. Lone Star is one of them and ad is listed on gaswork.

I dont see USAP losing any foothold in Dallas and Houston. Both are markets with very good payor mixes (Dallas more so).

Yes-, particularly if you include benefits, many CRNAs getting 250- and a decent proportion getting close to 300

Easy to find a job straight out of residency for 400 right now.

USAP has to realize with inflation and cost of living, they aren’t going to get many people to work for a crna salary for 2-3 years and then spend 100k for stock in an uncertain future with the NSA.

So they will have to decide: pay junior partners and CRNAs more, walk away from a poor paying facility, or have your current partners work more hours to make the same amount of money with increasing staffing costs.

Something has to give and we’re starting to see the give.

 

[Dr. Rude]

….


Something has to give and we’re starting to see the give.

Has anybody actually seen improvement in OR efficiency, I.e. being less accommodative of surgeons? Including the prominent high volume ones? Something that everyone talks about but almost never happens.

 

[mtbtx]

San Antonio - Austin is just a mess rn... you hate to see it

 

[DirtDocMD]

Has anybody actually seen improvement in OR efficiency, I.e. being less accommodative of surgeons? Including the prominent high volume ones? Something that everyone talks about but almost never happens.

USAP facility down the road from me started a “1 room after 7 pm” rule a while back. Surgeons didn’t like it (and it kinda hammered the on-call anesthesiologist, though the other anesthesiologists/CRNA’s were able to get home earlier), but it eventually became “the way things are”, and the surgeons learned to live with it, after they realized their b****ing wasn’t getting them anywhere...

 

[amyl]

I will only speak about USAP dallas… PE doesn’t take 25-35% from any group…. The highest is 22%, most below that, and is related to the cash each group took to join. Partnership track drs make lots more than our crnas. While you are required to buy 100k of stock over 5 years you are also given 100k. My dividend from my free stock was my stock purchase $ this year so the “buyin” is a wash. Just makes you an owner and share holder.

 

[Arantius]

Interesting. I’m in San Antonio and I also heard of USAP giving up contract in Houston. Have a friend who is a doc there. I want to eventually get back to DFW but I’m thinking I’ll let the dust settle on USAP and Envision before I make another move. Envision also losing contracts all over (biggest one I heard is Banner in AZ). Wonder what the end landscape will look like for anesthesia

 

[Anesthesia19]

I will only speak about USAP dallas… PE doesn’t take 25-35% from any group…. The highest is 22%, most below that, and is related to the cash each group took to join. Partnership track drs make lots more than our crnas. While you are required to buy 100k of stock over 5 years you are also given 100k. My dividend from my free stock was my stock purchase $ this year so the “buyin” is a wash. Just makes you an owner and share holder.

Safe to say you don't get a large dividend every year though correct? And definitely not at the tune of 20k yearly guaranteed (to make it a "wash" of 1/5th of 100k buyin).

Also, I assumed the peanuts you get paid for the 2-3 year partner track was the actual buyin 🤷‍♂️

 

[vm26]

Safe to say you don't get a large dividend every year though correct? And definitely not at the tune of 20k yearly guaranteed (to make it a "wash" of 1/5th of 100k buyin).

Also, I assumed the peanuts you get paid for the 2-3 year partner track was the actual buyin 🤷‍♂️

Seems like I'm missing something here. In my field (rad), PE purchases a PP by paying partners something like 8-10x/annual income in the form of cash and stocks. Partners are then required to hang around for a few years before they take off. New radiologists are paid about 40-45%/RVU less than a traditional PP (eg. I would have to read about twice the amount I do now in a PE group in order to make the same working as a partner in traditional PP group). Despite what is advertised, the new rads never become real partners/owners of the practice. Is there a different set-up in anesthesia?

 

[thinkorswim]

Seems like I'm missing something here. In my field (rad), PE purchases a PP by paying partners something like 8-10x/annual income in the form of cash and stocks. Partners are then required to hang around for a few years before they take off. New radiologists are paid about 40-45%/RVU less than a traditional PP (eg. I would have to read about twice the amount I do now in a PE group in order to make the same working as a partner in traditional PP group). Despite what is advertised, the new rads never become real partners/owners of the practice. Is there a different set-up in anesthesia?

It’s pretty much the same thing in anesthesia, just lower the percentages and maybe add in some CRNAs to the mix. I suppose it’s all a matter of perspective though, since I’m not sure how one can be an owner of something that is financially controlled by another corporate entity. But what do I know.

 

[amyl]

Safe to say you don't get a large dividend every year though correct? And definitely not at the tune of 20k yearly guaranteed (to make it a "wash" of 1/5th of 100k buyin).

Also, I assumed the peanuts you get paid for the 2-3 year partner track was the actual buyin 🤷‍♂️

We have every year I’ve been partner. Yes it has been a wash. I wasn’t paid peanuts…. Will discuss numbers if we can move to the private forum?

 

[IMGASMD]

Seems like I'm missing something here. In my field (rad), PE purchases a PP by paying partners something like 8-10x/annual income in the form of cash and stocks. Partners are then required to hang around for a few years before they take off. New radiologists are paid about 40-45%/RVU less than a traditional PP (eg. I would have to read about twice the amount I do now in a PE group in order to make the same working as a partner in traditional PP group). Despite what is advertised, the new rads never become real partners/owners of the practice. Is there a different set-up in anesthesia?

It’s mostly like that…..
the ones that I’ve seen, they come in, “buy out” is something like 5x-7x the annual revenue. Then subtract out your salary for the next 5-7 yrs. Whatever is left is your capital gain.
Per partner
700K * 7 = cool 5M
You’re bound to AMC for
7 yrs @ 500K = 3.5M

5-3.5=1.5
1.5M * 0.8 (capital gain tax rate@20%) = 1.2M
Congratulations, you just sold your soul and all your future earning for a cool 1.2M….

PS.
If you be really technical, probably not even. Since that 1.5M supposedly be taxed as income. So it would be have been
1.5M* 0.6 (40% income tax rate) = 900K

So you really “gained” 300K. But have 1.2M now certainly doesn’t hurt.

 

[DrZzZz]

I’m not sure how one can be an owner of something that is financially controlled by another corporate entity.

Same way I consider myself Jeff Bezos' partner as an owner of Amazon. 😉

 

[Howard888]

We have every year I’ve been partner. Yes it has been a wash. I wasn’t paid peanuts…. Will discuss numbers if we can move to the private forum?

As you said-can only speak for your group. USAP can be extremely different group to group.

While Dallas was only 22% max I bet the minimum is 15% because I believe that is USAPs minimum to buy a group-probably most are 20%

But guess what -Houston was 35% or close to it. Austin I heard in 20s.

Also to be fair, I hear the Texas USAP groups doing much better than Colorado or Nevada-both of which I hear are struggling.

And yes-the dividends to meet stock purchase is great-but you obviously paid several hundred more thousand of a lesser salary as a second buy in-so Dividends haven’t covered all of that.

The problem with USAP is now inflation and cost of living combined with the no surprises act.

The success of USAP was always dependent on them continuing to have the highest contracts around to afford the 15-35% of revenue to PE.

The no surprises act just capped USAP. No insurance company is going to raise USAP rates anymore because they’d rather go OON and go to arbitration where they can show the arbiter that USAP is way above the median rate or qpa.

While there was a favorable ruling for providers in that arbitration must consider more than the qpa, USAP will not be able to continue and justify rates that are twice the qpa. The arbitration will either keep the same rates or reduce the rates.

With inflation, crna costs and cost of living sky rocketing-there will be a tipping point in that MD salaries will have to go down….or they work longer hours for the same pay. Why-because no matter what, 15-35% of revenue goes towards Private Equity. Alternatively they can cut poor paying contracts to increase your commercial mix and revenue per case (as well as reduce staffing needs)..which sounds like what is happening in Houston.

You are fortunate in Dallas-best payer mix in Texas so it should hit you last -will hit but not nearly as soon as Austin (cost of living by far increasing the most) or Houston/San Antonio (payer mix worse)

I’m guessing private equity cashes out one more time now before the effects of all these economic pressures kick in-which means some of partners who sold cash out, then all the young people who weren’t part of sale get frustrated and eventually USAP crumbles like Other AMCs are-I’m talking over 10-15 years of course

 

[GassYous]

It’s mostly like that…..
the ones that I’ve seen, they come in, “buy out” is something like 5x-7x the annual revenue. Then subtract out your salary for the next 5-7 yrs. Whatever is left is your capital gain.
Per partner
700K * 7 = cool 5M
You’re bound to AMC for
7 yrs @ 500K = 3.5M

5-3.5=1.5
1.5M * 0.8 (capital gain tax rate@20%) = 1.2M
Congratulations, you just sold your soul and all your future earning for a cool 1.2M….

PS.
If you be really technical, probably not even. Since that 1.5M supposedly be taxed as income. So it would be have been
1.5M* 0.6 (40% income tax rate) = 900K

So you really “gained” 300K. But have 1.2M now certainly doesn’t hurt.

Buyout is taxed as capital gains

 

[dannyboy1]

As you said-can only speak for your group. USAP can be extremely different group to group.

While Dallas was only 22% max I bet the minimum is 15% because I believe that is USAPs minimum to buy a group-probably most are 20%

But guess what -Houston was 35% or close to it. Austin I heard in 20s.

Also to be fair, I hear the Texas USAP groups doing much better than Colorado or Nevada-both of which I hear are struggling.

And yes-the dividends to meet stock purchase is great-but you obviously paid several hundred more thousand of a lesser salary as a second buy in-so Dividends haven’t covered all of that.

The problem with USAP is now inflation and cost of living combined with the no surprises act.

The success of USAP was always dependent on them continuing to have the highest contracts around to afford the 15-35% of revenue to PE.

The no surprises act just capped USAP. No insurance company is going to raise USAP rates anymore because they’d rather go OON and go to arbitration where they can show the arbiter that USAP is way above the median rate or qpa.

While there was a favorable ruling for providers in that arbitration must consider more than the qpa, USAP will not be able to continue and justify rates that are twice the qpa. The arbitration will either keep the same rates or reduce the rates.

With inflation, crna costs and cost of living sky rocketing-there will be a tipping point in that MD salaries will have to go down….or they work longer hours for the same pay. Why-because no matter what, 15-35% of revenue goes towards Private Equity. Alternatively they can cut poor paying contracts to increase your commercial mix and revenue per case (as well as reduce staffing needs)..which sounds like what is happening in Houston.

You are fortunate in Dallas-best payer mix in Texas so it should hit you last -will hit but not nearly as soon as Austin (cost of living by far increasing the most) or Houston/San Antonio (payer mix worse)

I’m guessing private equity cashes out one more time now before the effects of all these economic pressures kick in-which means some of partners who sold cash out, then all the young people who weren’t part of sale get frustrated and eventually USAP crumbles like Other AMCs are-I’m talking over 10-15 years of course

Yup. The only way for the AMC to make $$ in this environment is to get a large subsidy. New grads have no interest in working hard and taking lots of call to line some PE pocket.
In my shop we have a ton of locums patching the holes at 300$/hr. They can’t hire full time. Everybody wants set hours and a set amount of call. Don’t know how much longer the AMC’s last until they just cease to exist. Rising costs of borrowing will only speed up the collapse…..

 

[kidthor]

New grads have no interest in working hard and taking lots of call to line some PE pocket.
In my shop we have a ton of locums patching the holes at 300$/hr. They can’t hire full time. Everybody wants set hours and a set amount of call. Don’t know how much longer the AMC’s last until they just cease to exist. Rising costs of borrowing will only speed up the collapse…..

I'd only work hard and take a bunch of call to line my own pocket. Indeed it's the better move to make a controlled daytime $300/hr than to take a bunch of Saturday overnight call for $150/hr (or for free) with no viable upside. I think this movement will speed the rate of hospital employed setups.

 

[IMGASMD]

Buyout is taxed as capital gains

It is, hence net gain of 1.2M not 1.5M.

 

[GassYous]

It is, hence net gain of 1.2M not 1.5M.

By your numbers it would be 4-2.1 = 1.9 mil and it comes early so you make money with compounding in the market or with real estate or whatnot for a few extra years

 

[Mman]

It is, hence net gain of 1.2M not 1.5M.

also part of the benefit is guaranteeing that salary for 5 or 7 years or whatever. In a true private group, there is no promise of tomorrow. Some groups have sold out in the past partially because of fears their income was about to crater.

 

[IMGASMD]

also part of the benefit is guaranteeing that salary for 5 or 7 years or whatever. In a true private group, there is no promise of tomorrow. Some groups have sold out in the past partially because of fears their income was about to crater.

True.
Then I would say that’s a good sell and/or the AMC didn’t do their job vetting the practice. (Maybe they don’t care for the name of market share….)

 

[Status Sciaticus]

Safe to say you don't get a large dividend every year though correct? And definitely not at the tune of 20k yearly guaranteed (to make it a "wash" of 1/5th of 100k buyin).

Also, I assumed the peanuts you get paid for the 2-3 year partner track was the actual buyin 🤷‍♂️

Average offer for dallas was 325-375k/year with extra cash for extra call. 6 weeks off seems to be uniform.

We have every year I’ve been partner. Yes it has been a wash. I wasn’t paid peanuts…. Will discuss numbers if we can move to the private forum?

yes please, mods please move?

 

[Mman]

True.
Then I would say that’s a good sell and/or the AMC didn’t do their job vetting the practice. (Maybe they don’t care for the name of market share….)

I'm not saying those practices became less profitable, but there has been plenty of fear mongering on this board and in this profession for decades about how the sky is always falling. Once you get within 10 or 15 years of retirement, if somebody guarantees your pay for a long period of time and you are scared it can be an attractive proposition.

 

[IMGASMD]

I'm not saying those practices became less profitable, but there has been plenty of fear mongering on this board and in this profession for decades about how the sky is always falling. Once you get within 10 or 15 years of retirement, if somebody guarantees your pay for a long period of time and you are scared it can be an attractive proposition.

I hold no ill well toward older partners. Everyone is at different parts of their lives. Different market, different times. At the end of the day, still Everyman for himself.

 

[aneftp]

It’s purely a payor mix game folks. Usap etc cannot maximize their billing practices if payor mix is 70-80% Medicare. Only so many places you can cherry pick off the top. See mednax/American anesthesiology circa 2007-2013. Than usap started the next lucrative buyout with Houston Dallas and Orlando groups. These groups weren’t special or anything. They just happen to have good payor mix. Payor mix is all that matters in anesthesia world. Not efficiency with turnover. Not quality metrics in anesthesia.

Let’s get real here. The only metric in anesthesia is. “Did the patient live?” That’s it. All the rest is marketing BS these companies send proposal to hospital’s management.

So the only places USAP will pull out of are non money making places (aka places that require subsidies from hospital usually) or too many manpower demands. Like usap quickly pulled out of surgery center they stole from my buddy. They promised them 3 crnas and 1 doc daily. Problem was place was 70% Medicare and only 2 or running most of the time and rarely 3. But usap just couldn’t waste money having crna sitting around.

My buddy made it work cause he used the dreaded collaborative model. Meaning he would run the 3rd room himself when needed. But he also did pain management himself there. So it was no biggie.

 

[Prometheus2772]

I work for Usap in Las Vegas and it is generally a well run group. The problem that I see for AMC based anesthesia groups in this country is inflation. Nurses are now making $55 an hour here in Las Vegas and scrub techs are making $43 an hour. Most anesthesiologists in this country averaged about $180 an hour doing general OR cases before COVID. That has been the historic norm for the last 20 years.

Inflation is blowing that out of the water. All of these other medical personnel have seen at least a 30 to 50% pay increase. The problem is that people in this country have a problem with absolute numbers. They’re OK with an RN getting a pay increase of 30 or 40% because the absolute number isn’t that high. But for an anesthesiologist to get a 50% pay increase, that takes the absolute number from 450,000 to 675,000 a year. But that’s what the number should be now. When I look at locums rates, they are accomplishing this goal, but anesthesia groups, due to Medicare, Medicaid, insurers, and the new surprise act, are not able to keep up with this.

The average Anesthesiologist in this country works at least 2500 hours a year. At $300 an hour, that is $750,000 a year. $300/hr should be the new floor for Anesthesiologist pay.

I am not in the management of the group here at all, but I know that a few people have left and I can’t imagine that others in Texas are not leaving as well. Plastic surgeons are paying people $400 an hour to do anesthesia for easy cases with no call. Locum tenens is paying $300-$400 an hour. The insurance based anesthesia system is going to break Unless hospitals drastically change stipends, or Medicare increases reimbursement.

Washington DC hit the money printer button to give $7 trillion to lazy people so they could sit at home. It’s time for them to hit the money printer button again.

I am getting on a soapbox a little bit, but if I were looking for a job right now, I don’t think I’d sign anything with a noncompete and I would probably form an LLC, or PC and do 1099 work as this all settles out.

 

[Mman]

The average Anesthesiologist in this country works at least 2500 hours a year.

that cannot be true

 

[deleted875186]

that cannot be true

Seems true to me. 56 hours a week with 7 weeks vacation.

 

[BLADEMDA]

It’s mostly like that…..
the ones that I’ve seen, they come in, “buy out” is something like 5x-7x the annual revenue. Then subtract out your salary for the next 5-7 yrs. Whatever is left is your capital gain.
Per partner
700K * 7 = cool 5M
You’re bound to AMC for
7 yrs @ 500K = 3.5M

5-3.5=1.5
1.5M * 0.8 (capital gain tax rate@20%) = 1.2M
Congratulations, you just sold your soul and all your future earning for a cool 1.2M….

PS.
If you be really technical, probably not even. Since that 1.5M supposedly be taxed as income. So it would be have been
1.5M* 0.6 (40% income tax rate) = 900K

So you really “gained” 300K. But have 1.2M now certainly doesn’t hurt.

Typically, it is a 5 year deal. The tax rate is CAPITAL GAINS at 20% and salary is around $450k but that is negotiable.

 

[Prometheus2772]

57 hours a week is probably average. I probably work 65. Most AMC buyout are definitely less than $1 million. And that is only if your practice is profitable. I know some practices that have been bought out by AMCs where the partners got zero because their business was poorly run and they had a bad payer mix. And most of the AMC buyouts, like the one in Reno end up getting paid back. Buyout in Reno was about $700,000, partners had a five year commitment at a solid 150 thousand or 200,000 less than they were making. The only upside is if the value of the company goes up when it is sold. With inflation and the no surprises act, I don’t know that these AMC‘s are going to be worth more. I wish I had invested in Comphealth and Staffcare.

Typical fee for service medicine is having serious problems right now. Not just for anesthesia but also other lower reimbursing specialties like gynecology and General Surgery. Their reimbursement is the same, but all of their office staff, rent, and supplies have gone up a solid 50%, yet their reimbursement has not changed. I heard from one cardiothoracic surgeon that quite a few cardiac and vascular surgeons are going to do locums. One hospital here in Las Vegas hired six locums cardiac surgeons to cover their service. Each of them works a week at a time.

 

[kidthor]

that cannot be true

I’m at about 2500 hrs a year in academics.

 

[Arch Guillotti]

I know some practices that have been bought out by AMCs where the partners got zero because their business was poorly run and they had a bad payer mix.

This is called losing a contract.

 

[Mman]

Seems true to me. 56 hours a week with 7 weeks vacation.

that is brutal, I don't know of a single practice near me that gets near that much work except for academics. My average year is around 1800 hours inhouse with some call from home not counted in that.

 

[DirtDocMD]

I work for Usap in Las Vegas and it is generally a well run group. The problem that I see for AMC based anesthesia groups in this country is inflation. Nurses are now making $55 an hour here in Las Vegas and scrub techs are making $43 an hour. Most anesthesiologists in this country averaged about $180 an hour doing general OR cases before COVID. That has been the historic norm for the last 20 years.

Inflation is blowing that out of the water. All of these other medical personnel have seen at least a 30 to 50% pay increase. The problem is that people in this country have a problem with absolute numbers. They’re OK with an RN getting a pay increase of 30 or 40% because the absolute number isn’t that high. But for an anesthesiologist to get a 50% pay increase, that takes the absolute number from 450,000 to 675,000 a year. But that’s what the number should be now. When I look at locums rates, they are accomplishing this goal, but anesthesia groups, due to Medicare, Medicaid, insurers, and the new surprise act, are not able to keep up with this.

The average Anesthesiologist in this country works at least 2500 hours a year. At $300 an hour, that is $750,000 a year. $300/hr should be the new floor for Anesthesiologist pay.

I am not in the management of the group here at all, but I know that a few people have left and I can’t imagine that others in Texas are not leaving as well. Plastic surgeons are paying people $400 an hour to do anesthesia for easy cases with no call. Locum tenens is paying $300-$400 an hour. The insurance based anesthesia system is going to break Unless hospitals drastically change stipends, or Medicare increases reimbursement.

Washington DC hit the money printer button to give $7 trillion to lazy people so they could sit at home. It’s time for them to hit the money printer button again.

I am getting on a soapbox a little bit, but if I were looking for a job right now, I don’t think I’d sign anything with a noncompete and I would probably form an LLC, or PC and do 1099 work as this all settles out.

Yep.

Cops, Nurses, Firemen all making $100k plus these days (and some at $150k-$200k). Meanwhile, no significant increases in Medicare/Medicaid in 20 years.

CRNA’s are in the $250k-$300k range. AMC’s can’t think Docs are going to continue working themselves to the bone, for $400k-$450k. Even at 2-3% inflation, most anesthesiologists should be at mid-$500’s, by now.

USAP talked with us 3-4 years ago. If we had taken their offer, we’d have been “locked in” at $400-$425k, right now, in order for them to be showing any “profit”. We’re currently having trouble finding folks at over $600k. At $400k, we’d have all quit by now and moved on.

If the AMC’s can’t get major increases in private pay insurance rates, or some major stipends (or the Govt doesn’t start throwing worthless paper dollars at Medicare, like they have everything else), then there’s gonna be some serious issues, soon.

 

[GassYous]

Yep.

Cops, Nurses, Firemen all making $100k plus these days (and some at $150k-$200k). Meanwhile, no significant increases in Medicare/Medicaid in 20 years.

CRNA’s are in the $250k-$300k range. AMC’s can’t think Docs are going to continue working themselves to the bone, for $400k-$450k. Even at 2-3% inflation, most anesthesiologists should be at mid-$500’s, by now.

USAP talked with us 3-4 years ago. If we had taken their offer, we’d have been “locked in” at $400-$425k, right now, in order for them to be showing any “profit”. We’re currently having trouble finding folks at over $600k. At $400k, we’d have all quit by now and moved on.

If the AMC’s can’t get major increases in private pay insurance rates, or some major stipends (or the Govt doesn’t start throwing worthless paper dollars at Medicare, like they have everything else), then there’s gonna be some serious issues, soon.

Why? Location? I would move for 600

 

[Dr. Rude]

Why? Location? I would move for 600

You would. Buts lots of people won’t.

Do a search in recent threads on job markets in and immediately around big metro areas. That’s where most people actually live.

If you polled young docs and gave them a choice:

1. 450-500 package in big metro area that they are somewhat familiar with, including suburbs reasonably close to some family.

2. 600+ package and much lower cost of living in small town USA that they have never set foot in far from family.

Most would choose 1.

 

[DirtDocMD]

Why? Location? I would move for 600

PM sent