USAP North and Central Locations

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Hi all,

I'm looking to apply to work at USAP in Texas but see there are different divisions in each region. Does anyone know which USAP divisions in North and Central Texas seem to be the better ones and which to avoid?

Thanks in advance.
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Pm me and I’ll give you my number or email. I’m in USAP north dallas -but also interviewed with metro, some little groups and several USAP divisions. Happy to explain why I picked what I did and help you find the best fit for you. Amy
 
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I’d stay very clear of central if I were you-unless you are already wealthy.

They pay you a crazy low salary, make you pay 100k+ for stock to be a “partner” which is nonsense. At the same time, Central Texas-San Antonio and Austin has perhaps the worst increase of cost of living in the country.

But if you already have a lot of money and want to live there-why not-but if you have the money, why work at all
 
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Howard888 said:
I’d stay very clear of central if I were you-unless you are already wealthy.

They pay you a crazy low salary, make you pay 100k+ for stock to be a “partner” which is nonsense. At the same time, Central Texas-San Antonio and Austin has perhaps the worst increase of cost of living in the country.

But if you already have a lot of money and want to live there-why not-but if you have the money, why work at all
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The starting salary for partnership track I was quoted for San Antonio was pretty decent I thought, and it only has a one year partnership track as opposed to three years in Dallas. Still a resident though so just what I’ve been told. But I think San Antonio is technically in the USAP South division.
 
You might be correct in San Antonio. Those horrible salary/partnership terms I’m referring to are Austin. I just mentioned San Antonio as Austin-San Antonio now being viewed as one big metroplex. Cost of living out of control throughout but definitely worst in Austin
 
Howard888 said:
I’d stay very clear of central if I were you-unless you are already wealthy.

They pay you a crazy low salary, make you pay 100k+ for stock to be a “partner” which is nonsense. At the same time, Central Texas-San Antonio and Austin has perhaps the worst increase of cost of living in the country.

But if you already have a lot of money and want to live there-why not-but if you have the money, why work at all
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San Antonio is probably the most affordable city out of the Big 4.

epcotdoc said:
The starting salary for partnership track I was quoted for San Antonio was pretty decent I thought, and it only has a one year partnership track as opposed to three years in Dallas. Still a resident though so just what I’ve been told. But I think San Antonio is technically in the USAP South division.
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Correct. Austin is USAP Central - offered "high 2s low 3s" - hahahah GTFO.
USAP SA has the best deal for a USAP group in Texas - 425k +50-100k sign-on for two years. Downside is that San Antonio is sleepy compared to Dallas/Houston/Austin, and they use paper charts/****ty EMRs. They also compensate pretty poorly for call.
 
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GandalfTheWhite said:
San Antonio is probably the most affordable city out of the Big 4.


Correct. Austin is USAP Central - offered "high 2s low 3s" - hahahah GTFO.
USAP SA has the best deal for a USAP group in Texas - 425k +50-100k sign-on for two years. Downside is that San Antonio is sleepy compared to Dallas/Houston/Austin, and they use paper charts/****ty EMRs. They also compensate pretty poorly for call.
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Yeah the more reasonable housing market is what made me look into it to begin with. And then one year track is a plus. Didn’t know about the paper charts though 👎🏻
 
Go interview at USAP San Antonio as the pay is good, sign on and short track. That more than compensates for the paper charting. That said, you can also interview in Dallas where partnership is worth $600k-$750K.
 
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Or more…. But we work for it. Trauma, big cases, Ortho blocks, etc. mine is a good gig for the right person. Very lucrative and dallas doesn’t suck
 
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amyl said:
Or more…. But we work for it. Trauma, big cases, Ortho blocks, etc. mine is a good gig for the right person. Very lucrative and dallas doesn’t suck
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who doesnt like doing a liver in between those boring lap choles lol
 
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So seems like thread after thread after thread-USAP central in Austin by far the worst USAP branch in Texas? Pays the least despite highest cost of living?

Sounds like USAP Dallas>USAP San Antonio>USAP Houston>>>>>>USAP Central

Personally I think they’re all a step below any private group but in Texas USAP almost only choice you have…but sounds like they are vastly different and stay clear of central????
 
Howard888 said:
So seems like thread after thread after thread-USAP central in Austin by far the worst USAP branch in Texas? Pays the least despite highest cost of living?

Sounds like USAP Dallas>USAP San Antonio>USAP Houston>>>>>>USAP Central

Personally I think they’re all a step below any private group but in Texas USAP almost only choice you have…but sounds like they are vastly different and stay clear of central????
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Yes
Yes
Metro is an all-private production based group. DAA is also a private group in Dallas. Lone star is a private ASC based group in SA.
@amyl and @sethco both are USAP partners here at different divisions that can answer your questions about USAP in Dallas. Seems like they are happy at their groups with their set-up.
 
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GandalfTheWhite said:
San Antonio is probably the most affordable city out of the Big 4.


Correct. Austin is USAP Central - offered "high 2s low 3s" - hahahah GTFO.
USAP SA has the best deal for a USAP group in Texas - 425k +50-100k sign-on for two years. Downside is that San Antonio is sleepy compared to Dallas/Houston/Austin, and they use paper charts/****ty EMRs. They also compensate pretty poorly for call.
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Out of curiosity, is the position in San Antonio care team or physician only? How much are they working for this with call and how much PTO?

Of the three big hospital systems in the DFW area, two have fully converted to EMR (including Intraop), but HCA still likes to use Meditech 👎
 
sethco said:
Out of curiosity, is the position in San Antonio care team or physician only? How much are they working for this with call and how much PTO?

Of the three big hospital systems in the DFW area, two have fully converted to EMR (including Intraop), but HCA still likes to use Meditech 👎
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I was told 10-15% supervision once partner. None during first year. I think 5 calls a month and I think 7 weeks PTO to start. But I’ve also heard they are short staffed and partners are having to work a lot more, so I’m not sure.
 
sethco said:
Out of curiosity, is the position in San Antonio care team or physician only? How much are they working for this with call and how much PTO?

Of the three big hospital systems in the DFW area, two have fully converted to EMR (including Intraop), but HCA still likes to use Meditech 👎
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It’s MD only as of now. A few AAs/CRNAs. But it’s still not significant. I think they said 10% of the time. Ideally in OB or easy cases.

4-5 calls per month. I think post call is off unlike a couple of the Dallas locations. Their call burden includes late call and only OB is overnight in house. 7-8 weeks off.
I suspect they will hit 500k/8 weeks before they get any serious talent/hard workers. They’re already paying locums companies 400/hr to recruit bodies.

This market will definitely stay like this for the next few years. Maybe even get more short staffed. And thus more are going the way of locums to leverage themselves similar to the nurses during the pandemic.
 
GandalfTheWhite said:
It’s MD only as of now. A few AAs/CRNAs. But it’s still not significant. I think they said 10% of the time. Ideally in OB or easy cases.

4-5 calls per month. I think post call is off unlike a couple of the Dallas locations. Their call burden includes late call and only OB is overnight in house. 7-8 weeks off.
I suspect they will hit 500k/8 weeks before they get any serious talent/hard workers. They’re already paying locums companies 400/hr to recruit bodies.

This market will definitely stay like this for the next few years. Maybe even get more short staffed. And thus more are going the way of locums to leverage themselves similar to the nurses during the pandemic.
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The market is insane right now. Can you PM me the link for the locums position? 400/hr x 50 hours x 44 weeks is 880k. I don't see how that is sustainable. Almost certainly, they are taking a loss on this unless they are getting a nice stipend from the hospital(s)
 
sethco said:
The market is insane right now. Can you PM me the link for the locums position? 400/hr x 50 hours x 44 weeks is 880k. I don't see how that is sustainable. Almost certainly, they are taking a loss on this unless they are getting a nice stipend from the hospital(s)
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Gasworks has several listed at 300-325/hr if you search by city. That is what is paid out to the anesthesiologist. I extrapolated the extra 75/hr that the locums company is taking for themselves.

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6 different locums companies trying to hire for the same location. I imagine the partners there should be making 650-700k, similar to Dallas partner pay.
 
GandalfTheWhite said:
Gasworks has several listed at 300-325/hr if you search by city. That is what is paid out to the anesthesiologist. I extrapolated the extra 75/hr that the locums company is taking for themselves.

GasWork.com - Reference #344863

Reference #344863
www.gaswork.com www.gaswork.com

GasWork.com - Reference #366520

Reference #366520
www.gaswork.com www.gaswork.com

GasWork.com - Reference #364421

Reference #364421
www.gaswork.com www.gaswork.com

GasWork.com - Reference #346809

Reference #346809
www.gaswork.com www.gaswork.com

GasWork.com - Reference #346974

Reference #346974
www.gaswork.com www.gaswork.com

GasWork.com - Reference #355025

Reference #355025
www.gaswork.com www.gaswork.com

GasWork.com - Reference #366523

Reference #366523
www.gaswork.com www.gaswork.com


6 different locums companies trying to hire for the same location. I imagine the partners there should be making 650-700k, similar to Dallas partner pay.
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With that much competition from locums companies, do you think the rate actually paid out to the anesthesiologist will differ? Could I make them bid against each other?
 
mmag said:
With that much competition from locums companies, do you think the rate actually paid out to the anesthesiologist will differ? Could I make them bid against each other?
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Yes. Keeping in mind that there will be a ceiling since they have to pay your malpractice and living expenses and also turn a profit. I think you could squeeze another 50/hr if they’re desperate. Sometimes they will go back to USAP and ask for a higher hourly to compensate.
 
There’s been a lot of wildly inaccurate info about the Texas USAP groups lately. I’m a longtime SDN member and partner in one of these groups and thought I’d try to clear the air with a throwaway account for some attempt at anonymity.

USAP Dallas
Lots of small to medium groups that are still mostly independently functioning so there’s a lot of variability in workload, casetype, starting and partner pay, etc. Still a fair amount of MD only/doing a a good percentage of your own cases. In general, Dallas has the best payor mix so a lot of these groups are very very lucrative.

USAP Houston
More of a uniform group—3 large groups that are becoming more and more aligned. Some big shake ups lately but still a big strong group. Hard working but partners are making 95th+ percentile pay. Higher partner track pay but longest track to partner and they have lots of employed docs helping boost partner pay. Mostly supervision.

USAP Austin
One unified group. Mostly supervision. Very low partner track pay but partners do very well with probably the best lifestyle in TX. They seem very happy. COL has gotten crazy in Austin the last few years.

USAP San Antonio
Kind of like Dallas, but with a bad payor mix. Lots of small groups that are becoming more unified but jobs can be very variable. Small but growing contingent of CRNAs. They may be offering some nice starting salaries but partners probably making the least on average—though COL is the lowest.

—

In general TX is a great place to practice anesthesia and you could do much worse than any of these jobs. Most of the partners in these groups are making similar or better money than pre-USAP thanks to better $/unit and maybe some improved efficiency. They maintain pretty much complete local control over practice decisions. Everyone complains about the stock purchase, but there is usually a stock gift to go along with it and it has historically thrown a good dividend. Even if you just subtract the money spent on stock out of your salary your first five years as partner you are probably better off than most other places in the country.

I have good friends in all of these divisions, so I feel like this is hopefully a fair generalization, but please clarify if you feel like I’ve misrepresented something.
 
Aren't these W2s?? I'd much rather be a partner and not throw way half my salary in taxes...
 
I think this assessment was accurate until recently.

Last I talked to folks..Austin is no longer the lifestyle job it was…they are really struggling to hire CRNAs and MDs..and working much longer hours and much more in the room. But…guess what they still pay crap to everyone…you think they might learn. I see this group failing first of all USAP groups.

San Antonio-as others stated, also can’t get staff
 
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Howard888 said:
I think this assessment was accurate until recently.

Last I talked to folks..Austin is no longer the lifestyle job it was…they are really struggling to hire CRNAs and MDs..and working much longer hours and much more in the room. But…guess what they still pay crap to everyone…you think they might learn. I see this group failing first of all USAP groups.

San Antonio-as others stated, also can’t get staff
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Yea, recruiting seems to be a problem everywhere. Lots of CRNAs chasing high pay. I’d advise people to focus more on partner life than partner track. You’re in the track for 2-3 years and a partner for 20-30.
 
But that’s the problem..partner life is looking bleak for most USAP groups.

With no surprises act, USAp will not be able to negotiate any higher rates. They are highest in the state. Any insurance company will readily just point that out in arbitration.

CRNA salaries will not go down and only continue to go up.

Supply/demand not changing soon.

Govt not going to increase payment anything soon.

The 20-35% revenue to private equity never going away.

So I disagree fully-focus on the most you can make in partnership track now, because odds are partner life will only get worse and worse at USAP groups for all of those reasons.

What I see: Dallas survives the longest because of payer mix

Houston the next longest for similar reasons and size

San Antonio ultimately fails-hospitals employ the MDs and go to supervision or a new private group emerges

Austin-fails first. Med School employs everyone, Baylor Scott and White gains market share and they already employ anesthesia.
 
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Haha, you really have a hard on for trashing the austin group.

What you’re saying applies to any group in the country. The good thing about being a partner in a private practice group is that when you work more you make more—that’s what’s happening in my division right now.
 
Yeah I’m not the only one trashing Austin group on here-see above. The salary they are trying to offer new partners is a crime and makes the anesthesia profession look bad. They used to have a good lifestyle because they used to get CRNAs and new partners for cheaper than anywhere because they wanted to live in Austin….so they got to work less at expense of new hires.

Now that Austin has become so expensive and they are asking people to take crap salaries and buy stock-word spreads quickly and so does reputation.

100% agree private group only way to go for the future. The no surprises act was the death blow to the AMC model. You can’t get significant returns to private equity when you’re not going to be able to get rate increases as salaries for nurses and employees go up.
 
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TXAG99 said:
The good thing about being a partner in a private practice group is that when you work more you make more—that’s what’s happening in my division right now.
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Those of us humping it already don’t really want to work more.
 
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I suppose my experience with USAP was not all that positive. They bid on a contract for anesthesia coverage for multiple hospitals and surgery center and once the contract was awarded to USAP, immediately began widely advertising for both physician and CRNA positions at these same hospitals. It became apparent that everyone with a non-compete with the former AMC would be replaced (most of the physicians and CRNAs). Recruiters from multiple agencies began contacting physicians and CRNAs from other local hospitals, across the country, and even called the current physicians and CRNAs that had the non-competes with the former AMC, asking if they would be interested in the multiple positions that would be opening. Ultimately the hospital system opted out of the contract with USAP because of impending mass exodus of over 100 CRNAs and physicians, and reverted to the original AMC.
 
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we have an interviewee from texas who seems like a pretty hard worker but says USAP tries to squeeze as much work out of you as possible. 4:1 staffing with complex cases he/she could not handle it after 2 years. Lifestyle not sustainable long term. I forget where in texas.
 
GaseousClay said:
we have an interviewee from texas who seems like a pretty hard worker but says USAP tries to squeeze as much work out of you as possible. 4:1 staffing with complex cases he/she could not handle it after 2 years. Lifestyle not sustainable long term. I forget where in texas.
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Once again, that is practice/location specific. My USAP group is MD/DO only. Has always been this way. I know of other USAP groups that are either also no CRNAs or mixed model. Also know other USAP groups that like to maximize supervisory ratios. Whatever works for them, but no thanks.
 
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So whats better solo or supervison? kinda nice not to worry about room turn over.
 
Sounds like USAP Austin/Central. Last report I got from a friend is things are no better, likely worse. The group used to have late days, early days, always be off pre call and post call.

Now they never have late days or early days, work pre call, post call “mercenary”. They refuse to pay CRNAs and new MDs market salaries particularly for the cost of living there. You are either supervising 1-4 with complex cases or half of them are just sitting in the room because they don’t have enough CRNAs.

They are doing all this to try and keep their income in the same as it was pre USAP deal.

USAP Austin a perfect example of why never to sell. They are working so much more and enjoying it so much less to make the same or less amount of money (particularly when you factor in inflation and cost of living).

Avoid that group at all costs.
 
Howard888 said:
Sounds like USAP Austin/Central. Last report I got from a friend is things are no better, likely worse. The group used to have late days, early days, always be off pre call and post call.

Now they never have late days or early days, work pre call, post call “mercenary”. They refuse to pay CRNAs and new MDs market salaries particularly for the cost of living there. You are either supervising 1-4 with complex cases or half of them are just sitting in the room because they don’t have enough CRNAs.

They are doing all this to try and keep their income in the same as it was pre USAP deal.

USAP Austin a perfect example of why never to sell. They are working so much more and enjoying it so much less to make the same or less amount of money (particularly when you factor in inflation and cost of living).

Avoid that group at all costs.
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How about Dallas divisions?
 
Heard way better than Austin…Dallas>Houston>San Antonio>Austin

Will be interesting to see how things survive
 
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Austin has the best payor mix and is the most desired city to live in Texas. Why are they struggling the most? AAG/NAPA used to hire day docs (7-5 x 5 - 50 hours a week) for like 250k a few years ago and they had no shortage of applicants.
 
Dallas is much more heterogenous compared Houston, Austin, or remnants of star anesthesia (USAP South Texas, San Antonio).

The groups in Dallas pretty much function independently under the USAP corporate umbrella.
 
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nycitygas said:
Austin has the best payor mix and is the most desired city to live in Texas. Why are they struggling the most? AAG/NAPA used to hire day docs (7-5 x 5 - 50 hours a week) for like 250k a few years ago and they had no shortage of applicants.
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Austin demographics are not very high percentage of private payors. What makes you think it has the best payor mix?

A few years ago the houses in Austin didn't cost $500/sqft and it didn't have LA traffic. It also nearly doubled in size in the last 10 years without road expansions or housing increase.

I can also tell you Austin is probably the least desirable city to live in Texas....
 
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nycitygas said:
Austin has the best payor mix and is the most desired city to live in Texas. Why are they struggling the most? AAG/NAPA used to hire day docs (7-5 x 5 - 50 hours a week) for like 250k a few years ago and they had no shortage of applicants.
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I wonder how much that $100/hr job pays these days.
 
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Is USAP the only big group in Austin? There used to be another one a few years ago that would start super low don’t remember name
 
Yes…I would steer clear of both though. Both pay much lower to start than what the national average of what you can get right now for an area that has a very extreme/high cost of living (I agree with original poster-Austin becoming one of least desirable places to live in Texas-still great place to visit for a weekend or week, but daily would be painful and expensive).

If you had to pick one? Man-probably AAG/NAPA-from what I hear less driving, less hours, less unpredictability…but USAP might have higher salary eventually (apparently at USAP though they milk the junior partners for 3-4 years first-pay very low for work they do).

Tough call., unless you have a huge desire to live in Austin stay clear
 
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