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After the divorce that only works out to 300k (not to mention the misery involved). Not worth it.
It's probably because of prior divorce(s) that they have to stay on the hamster wheel in the first place.

And airplanes need fuel, vacation homes need landscapers ... the classic story of their lifestyle expanding to consume the income they've got, plus 10%. It'd be funny if it wasn't so sad.
 

nimbus

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That is definitely the beauty of it.

Hey we got a noon toe amp addon. "No, I can't do it. I gotta make my yoga class." I'm sorry, but all the other rooms are going and you're next up. "Seriously? You're gonna make me miss my YOGA??"


I see. In this model, you need rules in place where that is not an option. In my group, we have a policy where if you are next up to do a case and you don’t respond or refuse or find your own replacement, you pay a hefty cash fine which goes directly to the person who does do the case.
 

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So if there was a differential hourly rate based on type of work (easy peasy surg center<peds cardiac stud) you’d be ok with that?

One issue I have with the “eat what you kill” model is that some people think it gives them the freedom to choose what and how much they kill.

I like to be paid for work that is actually being done vs magical hourly rate. The downside is that it’s more complicated. I’ve been through a lot of permutations and I like being paid by the actual work me or my partners do. One day you can do 14 blocks... the next two days maybe none at all, the day after doing hearts with CVL, a-lines, TEE with a report that is submitted after it’s been uploaded (takes time to do). The following week you are the intensivist in the ICU.

It’s complicated, but fair to those who do the extra work compared to the ASC mommy gig.
 
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I see. In this model, you need rules in place where that is not an option. In my group, we have a policy where if you are next up to do a case and you don’t respond or refuse or find your own replacement, you pay a hefty cash fine which goes directly to the person who does do the case.

That's certainly one approach.

Sadly, in corporate anesthesia practice this approach rather tough to implement. We have both models in our group each with its positives and negatives. But I do find it easier to tell someone... "You need to do X now and you will get paid for it" (hourly) vs "You need to do X now and I'm sorry you won't get much for it but if you don't do it we are going to have a problem."

Back to the USAP, I am wondering why they are going to the hourly model besides only to control costs.
 
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I like to be paid for work that is actually being done vs magical hourly rate. The downside is that it’s more complicated. I’ve been through a lot of permutations and I like being paid by the actual work me or my partners do. One day you can do 14 blocks... the next two days maybe none at all, the day after doing hearts with CVL, a-lines, TEE with a report that is submitted after it’s been uploaded (takes time to do). The following week you are the intensivist in the ICU.

It’s complicated, but fair to those who do the extra work compared to the ASC mommy gig.

In a pure, busy, private practice, I agree.

But does the ASC mommy gig have all the sweet payors moving up the value of your blended unit? ;)

In the end, we all want to work with others who are a part of the team and not out for themselves. I fear an hourly rate is just another way to mask the more than reasonable amount of arbitrage that seems to be occurring with USAP (I have yet to see evidence to the contrary).
 
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nimbus

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In a pure, busy, private practice, I agree.

But does the ASC mommy gig have all the sweet payors moving up the value of your blended unit? ;)

In the end, we all want to work with others who are a part of the team and not out for themselves. I fear an hourly rate is just another way to mask the more than reasonable amount of arbitrage that seems to be occurring with USAP (I have yet to see evidence to the contrary).

Yep. Hourly means less transparency. You’ll have no idea how much money is being collected under your name and how much money is going to people who never took care of the patient.
 

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In a pure, busy, private practice, I agree.

But does the ASC mommy gig have all the sweet payors moving up the value of your blended unit? ;)

Doesn’t matter. :)

Any fair group will have a blended unit.
Can’t send out the lazy guy to an ASC and expect him to take home the same pay as the guy who spent 9 hours in the OR taking care of the 8 year old who just got ran over by a tractor (real case a few months ago)- need to incentivize that work is all I am saying... even if it brings in less units than the 5 boob cases at the ASC.
 
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aneftp

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The hourly track is a bad thing if ur hours are not guaranteed. I know one usap place sends their hourly “full time” employees home early if schedule is tight.

No way I’m showing up for work to work 3-4 hours to get the cases started for the day and be sent home and lose income.

Getting up at 530am and being at work at 630am is 90% of the effort. Once you are at work. It doesn’t matter if you are working 2 hours or 10 hours. But being sent home early due to light schedule and not being paid is very very bad.

Believe me. They will try to structure pay for full time partnership employees if it ever gets that way. Right now. One group just does that for their employee track none partnership track peeps.
 
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Doesn’t matter. :)

Any fair group will have a blended unit.
Can’t send out the lazy guy to an ASC and expect him to take home the same pay as the guy who spent 9 hours in the OR taking care of the 8 year old who just got ran over by a tractor (real case a few months ago)- need to incentivize that work is all I am saying... even if it brings in less units than the 5 boob cases at the ASC.

Yes a blended unit is mostly accepted as a fair form of arbitrage. I do think the ASC guy should make less in that scenario. However, we must not forget his value to the practice in cranking out 12 carpal tunnels on primo private insurance patients (while taking heat for his three 10 minute turnovers).

I am very curious as to whether USAP would actually pay lazy ASC guy the same rate as peds trauma anesthesia stud.
 

aneftp

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Yes a blended unit is mostly accepted as a fair form of arbitrage. I do think the ASC guy should make less in that scenario. However, we must not forget his value to the practice in cranking out 12 carpal tunnels on primo private insurance patients (while taking heat for his three 10 minute turnovers).

I am very curious as to whether USAP would actually pay lazy ASC guy the same rate as peds trauma anesthesia stud.
Depends on the ASC cases.

Doing 15 endo solo cases is a lot harder work than 2 spine cases in the main hospital.

What would u rather do?

Some ASC work is no walk in the park.
 
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USAP is the big national company, but each state will have regions, and those regional units are the actual ones you are hired by and the ones that the non-compete is enforced against. So a Denver guy can work in Houston for a non-USAP place with no breaking of non-compete. Within each regional unit are the individual groups that sold something to USAP. USAP might buy their group and accounts receivable, or they might simply buy a percentage of their future collections. Those individual groups within the regional unit maintain a high level of autonomy. It is the individual group that structures the compensation packages, except that you have to use the USAP 401(k) program, which is a pretty good Vanguard program. Your group might choose eat what you kill, hourly, hours available, extra for weekends and call, extras for various things, etc. Unless it is obviously harmful to USAP, USAP will allow the individual group to create their own compensation arrangement.
 
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USAP is the big national company, but each state will have regions, and those regional units are the actual ones you are hired by and the ones that the non-compete is enforced against. So a Denver guy can work in Houston for a non-USAP place with no breaking of non-compete. Within each regional unit are the individual groups that sold something to USAP. USAP might buy their group and accounts receivable, or they might simply buy a percentage of their future collections. Those individual groups within the regional unit maintain a high level of autonomy. It is the individual group that structures the compensation packages, except that you have to use the USAP 401(k) program, which is a pretty good Vanguard program. Your group might choose eat what you kill, hourly, hours available, extra for weekends and call, extras for various things, etc. Unless it is obviously harmful to USAP, USAP will allow the individual group to create their own compensation arrangement.


Post buy-out is the $/RVU including benefits to the group higher or lower? This is the supposed benefit, right? Higher contracted rates? Sorry if this has been answered, but I couldn't find it.

Post buy-out if the local group feels they are getting hosed, can they simply sell their shares and become an independent group again, or are they now "owned?"
 
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Mikkel

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Post buy-out is the $/RVU including benefits to the group higher or lower? This is the supposed benefit, right? Higher contracted rates? Sorry if this has been answered, but I couldn't find it.

Post buy-out if the local group feels they are getting hosed, can they simply sell their shares and become an independent group again, or are they now "owned?"

Welcome to the Hotel California.
 
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sevoflurane

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Yes a blended unit is mostly accepted as a fair form of arbitrage. I do think the ASC guy should make less in that scenario. However, we must not forget his value to the practice in cranking out 12 carpal tunnels on primo private insurance patients (while taking heat for his three 10 minute turnovers).

I am very curious as to whether USAP would actually pay lazy ASC guy the same rate as peds trauma anesthesia stud.

We incentivize this work as well. You do x amount of cases btw 7-3 and you get extra $. As I said, the more fair you try to get, the more complicated the system becomes. In our group, 12 carpal tunnels would generate an extra $450 take home on top of daily rate and overtime units after 3pm.
 
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dchz

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USAP is the big national company, but each state will have regions, and those regional units are the actual ones you are hired by and the ones that the non-compete is enforced against. So a Denver guy can work in Houston for a non-USAP place with no breaking of non-compete.

I do not believe this is true. In fact, the labor lawyer that reviewed a previous offer told me it is not.

The non-compete is pretty iron-clad. I think a lot of people are underestimating it. Sure it can be mediated out of court or negotiated, but i would value the non-compete at about $60k to the anesthesiologist.
 
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We incentivize this work as well. You do x amount of cases btw 7-3 and you get extra $. As I said, the more fair you try to get, the more complicated the system becomes. In our group, 12 carpal tunnels would generate an extra $450 take home on top of daily rate and overtime units after 3pm.

This is cool. I love the idea of complicated systems of fairness that have a lot of careful thought behind them. More than just a blended unit.

I haven't found them to solve the problem of motivation, but maybe ours is not complicated enough yet. ;)
 

nimbus

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Depends on the ASC cases.

Doing 15 endo solo cases is a lot harder work than 2 spine cases in the main hospital.

What would u rather do?

Some ASC work is no walk in the park.


In that example the endo lineup is 75 base units vs 26-30 for the spines (assuming there is hardware). The endo lineup is more work, more units, and would be compensated accordingly.
 
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thinkorswim

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That is definitely the beauty of it.

Hey we got a noon toe amp addon. "No, I can't do it. I gotta make my yoga class." I'm sorry, but all the other rooms are going and you're next up. "Seriously? You're gonna make me miss my YOGA??"

Yoga class at noon? Are you sure you’re on the right forum?

Either you don’t work in an “eat what you kill” environment or your partners just suck.
 

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Post buy-out is the $/RVU including benefits to the group higher or lower? This is the supposed benefit, right? Higher contracted rates? Sorry if this has been answered, but I couldn't find it.

Post buy-out if the local group feels they are getting hosed, can they simply sell their shares and become an independent group again, or are they now "owned?"
The $/RVU are supposed to be higher. The thing is that USAP cannot reveal its actual contracted rates to the interested group until after they have signed up with USAP. To do otherwise somehow runs afoul of anticompetition laws. So the new group has to trust that the new $/RVU will be higher. If it is not high enough to make up for the money that now has to flow to USAP, then word would get out pretty fast and USAP would not be able to make any new acquisitions, which would spoil much of their business model. If insurance companies had to pay every group the same rate, there would be little incentive to go with USAP.

This gets into the problem with contracted rates with insurance companies that permeates all of healthcare. Are the discounted rates from insurance companies worth being 'in network' when there are so many different discounted rates with only the biggest companies receiving the highest payments? This has led to some groups dropping an insurance company, which leads patients to receive the surprise out of network bill from anesthesia or ER or radiology or some independent group. While it is frustrating for the patient, should a professional medical group be forced to take a lousy rate from an insurance company? There is some legislation pending that is going to require all medical groups to take all insurance payments (with different twists on how to determine how much). This is going to have many unintended consequences that will take away much of the independent group's power and autonomy.
 
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Arch Guillotti

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This has led to some groups dropping an insurance company, which leads patients to receive the surprise out of network bill from anesthesia or ER or radiology or some independent group. While it is frustrating for the patient, should a professional medical group be forced to take a lousy rate from an insurance company?

No they shouldn't but there is a potential big problem if patients start complaining to the hospital.
 
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The $/RVU are supposed to be higher. The thing is that USAP cannot reveal its actual contracted rates to the interested group until after they have signed up with USAP. To do otherwise somehow runs afoul of anticompetition laws. So the new group has to trust that the new $/RVU will be higher. If it is not high enough to make up for the money that now has to flow to USAP, then word would get out pretty fast and USAP would not be able to make any new acquisitions, which would spoil much of their business model. If insurance companies had to pay every group the same rate, there would be little incentive to go with USAP.

This gets into the problem with contracted rates with insurance companies that permeates all of healthcare. Are the discounted rates from insurance companies worth being 'in network' when there are so many different discounted rates with only the biggest companies receiving the highest payments? This has led to some groups dropping an insurance company, which leads patients to receive the surprise out of network bill from anesthesia or ER or radiology or some independent group. While it is frustrating for the patient, should a professional medical group be forced to take a lousy rate from an insurance company? There is some legislation pending that is going to require all medical groups to take all insurance payments (with different twists on how to determine how much). This is going to have many unintended consequences that will take away much of the independent group's power and autonomy.

This makes sense. However, I've noticed when some management companies take over a contract, $$ seem to go down for those that did not get to partake in the benefit of the buyout. People leave. And then you're always seeing openings on gaswork for what was once a tough job to get in a desirable area. All those better rates... and salaries go down? Seems fishy.
 

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This makes sense. However, I've noticed when some management companies take over a contract, $$ seem to go down for those that did not get to partake in the benefit of the buyout. People leave. And then you're always seeing openings on gaswork for what was once a tough job to get in a desirable area. All those better rates... and salaries go down? Seems fishy.

Salaries do go down. For some groups it is 10% but for others they hold the line by working harder. People leave because one can only work so many years like a hamster on a wheel before tiring out even if the money is still good. Sevoflurane knows this is true. For some of us, the ability to slow down or even get off the wheel entirely is a lifelong goal. This creates openings in even the most desirable areas.
 
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This is the typical job some of you expect 90th percentile MGMA income for:
1566781994034.png
 
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nimbus

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It is best when compensation matches productivity. One shouldn’t get 75th percentile compensation for 90th percentile productivity. But I’m afraid that’s what many get when they sign on to an AMC.
 
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Salaries do go down. For some groups it is 10% but for others they hold the line by working harder. People leave because one can only work so many years like a hamster on a wheel before tiring out even if the money is still good. Sevoflurane knows this is true. For some of us, the ability to slow down or even get off the wheel entirely is a lifelong goal. This creates openings in even the most desirable areas.

I just read the Denver lawsuit that involved USAP merger. 21.3% reduction in salary! This is where I do not understand the assertion that $/RVU to the local group goes up post-merger.
 

aneftp

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I just read the Denver lawsuit that involved USAP merger. 21.3% reduction in salary! This is where I do not understand the assertion that $/RVU to the local group goes up post-merger.
Efficiency in terms of
1. Billing (a small group pays 6% in billing). Large groups have centralized billing so one mega wholly owned billing office can bill for all of usap/mednax/Sheridan etc charges. So adding one more usap group doesn’t really cost usap any billing cost since they can use the same office people.

2. Larger groups can negotiate higher unit rates.
 

aneftp

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Who pays the malpractice tail if u leave usap?

At least with team health Sheridan. They may be evil but they require no tail to be purchase.

That’s another 10-30k to think about if things don’t work out if u are considering usap.
 
D

deleted50478

Who pays the malpractice tail if u leave usap?

At least with team health Sheridan. They may be evil but they require no tail to be purchase.

That’s another 10-30k to think about if things don’t work out if u are considering usap.
It’s occurrence so no tail
 
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deleted50478

Guess that has changed over
The years. Once u become big enough. U can essentially become self
Insured.
They were self insured at GHA and switched to outside occurrence policy with USAP. If they’re back to being self-insured I think it would function like an occurrence policy and not require tail. If not, so much the worse.
 
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aneftp

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If usap partnership model is viable for the next 7-10 years. It is a reasonable job to take on.

Cause it’s literally gonna to take u at least 6 years to break even on the lost income u gave up the first 3 years working form them.

Than what to make of the usap stock in case u need to sell it done the road. What is the vesting period? 3 years? What is the value of the usap if it never goes public and u need to sell it. If u forced to buy it say at 2.5 and they tell u it’s worth $2. U are F’d if u need to get out after 5 years. U Would have given up income for 3 years. Plus losing stock value for fully purchased stock.
 

linkin06

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If usap partnership model is viable for the next 7-10 years. It is a reasonable job to take on.

Cause it’s literally gonna to take u at least 6 years to break even on the lost income u gave up the first 3 years working form them.

Than what to make of the usap stock in case u need to sell it done the road. What is the vesting period? 3 years? What is the value of the usap if it never goes public and u need to sell it. If u forced to buy it say at 2.5 and they tell u it’s worth $2. U are F’d if u need to get out after 5 years. U Would have given up income for 3 years. Plus losing stock value for fully purchased stock.
I think vesting May be four years? At least I know the people who sell to USAP partners required to stay on for that length

Also, I think I read here once how partner was trying to say the USAP stock was better than AAPL
 
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One positive thing about usap (I can be fair and balanced like Fox News!) is usap is a well oil machine in terms of contracts, HR etc.

That part I do give them props.

But the business structure itself relies on a quasi Ponzi scheme with forced stock purchased from partnership track. All the new partners drink the magic portion saying how wonderful this usap stock and it’s their golden ticket.

If it were truly not a scheme. Than they would require the existing original partners to keep buying the internal stock and none of them are stupid enough to buy more at artificially inflated internal prices. That tells you something.
A couple comments and questions came to me but I didn’t read further so forgive me if it is redundant.
USAP stock continues to be gobbled up by partners and there is a limit to what they can purchase as I know it. There are far more buyers than sellers “currently”.
The forced stock purchase is an odd comment to me since I also understand that the funds to purchase the stocks are provided to the partner by USAP about a month after signing on. Can anyone confirm this one?
 

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My concerns about USAP, as well as a few imperfect solutions:

1. Buying company stock. Even if it is a good stock, the general idea is to diversify your investments and risks. Having a large investment in your own corporation concentrates your risks, because if your company does poorly you may lose your job as well as losing significant value in your investment portfolio. In the Enron collapse, many of the workers had company stock, so once Enron collapsed they had no value in their investments.

Solution, the $50,000 forced investment (or whatever amount it is) should just be a small portion of your investments.

A word about the stock buy-in. I do not think it is a ponzi scheme, as I do not think that the continued growth in prices is reliant on new partner buy-ins. Instead, the growth in share prices and dividends is based on on all of the groups' continued payment of their 10% or 20% of collections to USAP. That is not a ponzi scheme, but rather based on business income.

2. Most/many hospital contracts will require the anesthesia group to accept all insurance policies that the hospital accepts, so that their patients never find a surprise out of network bill. From what I have read and infer on this thread, USAP requires the flexibility to be able to drop an insurance company because they do not offer competitive compensation. That can cause contention with the hospital. I can see why USAP would want this ability, because insurance companies could very well abuse that power and pay a pittance to the anesthesia groups. USAP is big enough that they have some heft with the insurance companies, and would not typically be out of network. I can see why hospitals do not want the bad publicity from out of network billing.

Solution: I do not have a good solution.

3. Similar to #2, if the national legislation passes that forbids groups from not accepting any insurance, then there will be a major reworking of compensation formulas.

Solution: USAP must use their professed wall street and business muscle to get the legislation passed in a manner favorable to them. Caution, they may not have as much muscle as they believe they do.

I am sure that their investment backers and their own PAC have enough clout and finances to either defeat of delay with legal processes that in our current Supeme Court environment will squash any negative legislation for years. That may be one strength or reason to sign up.

4. If single payer health care passes, then USAP's current model will cause most or many of its groups to go out of business.

Solution: USAP will need to be flexible if this happens. They also need to be big enough to demand that legislation occurs in a way that allows them to continue. If this happens, most of medicine will have a major upheaval. It will then have lawsuits and take many years to implement, so there will be a grace period. Caution is the same, that they may not have as much muscle as they think they do.

There are a few other concerns, but this post is long enough as it is.
 
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Howard888

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The problem with the stock is two fold:

The price at which you purchase it and the ability to sell it.

It is a pyramid scheme in the sense that every new group acquired adds EBITA and hence increases the value of the stock immediately.

This is why I say USAP May be the best AMC or least evil overal for existing partners who partake in the sale,, but in my opinion it is the worst for new grads or new hires.

New grads or new hires are coming in with little income and lots of debt. Many of these USAP jobs come with little signing bonus. They then require you to wait 2-3 years, make less money, then purchase stock.

Compare this to partners who were part of the sale. They got cash up front from selling future hires revenue and got it at a capital gains rate. They got the stock given to them as part of the sale-and more shares as it was valued less.

Here’s a good example for a new hire:

For three years you make 150-200K less than partners. At year 3 you are required to buy $125000 in shares. The share price I’d say $5 a share. That buys 25000 shares. But wait....three years ago when you were hired the share price was $2.50. When the group sold to USAP they received $250,000 in stock at that $2.50 a share. That’s 100,000 shares!!!!!

This is where the GREED of these local groups comes in. Not USAP. All USAP asks for a local group to become a partner is to buy the minimum amount of stock. It’s the local groups who require new hires to get paid less with little sign on bonus and then purchase stock at a much higher price. That is GREED and a recipe for eventual disaster.

To summarize. What these local groups get from you a new hire, and remember they just got a huge cash payment and you likely have debt:

$400-$700,000 in salary over 3 years
Eventual ownership of 3-4x the amount of stock than you when they had to purchase none ($25000 vs $100,000)
And some % of revenue of yours to USAP forever. NO partner control of majority voting rights at the corporate level.

GREED.


Unless these new USAP groups start offering much higher salaries and shorter partnership tracts, stay clear.

1. Take private group job
2. Academics or other AMC job of good sign on bonus, lifestyle, salary
3. My last option would be USAP
 
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nimbus

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Proceed with caution. Like USAP, USACS is part of the Welsh Carson portfolio.

 
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RadsWFA1900

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Proceed with caution. Like USAP, USACS is part of the Welsh Carson portfolio.


This is an scheme of epic size and scale. If a group is owned by a VC firm or part of an investment portfolio means if you ain’t in the board room you’re gonna get screwed.
 
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Great info in this thread.

Just curious if anyone knows about the Florida USAP groups, specifically the Jacksonville group? I know they are new to USAP but wondering if anyone has any true info regarding the practice and how they are doing?

Thanks!
 

RadsWFA1900

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This is an scheme of epic size and scale. If a group is owned by a VC firm or part of an investment portfolio means if you ain’t in the board room you’re gonna get screwed.

The MD cog gotta resist getting sucked into the whole shareholder thing. It’s just a game and the only way to win is to find someone more gullible to buy in.

This is likely fraud. Also, how are they gonna make any money when the balance billing legislation gets passed?
 

BLADEMDA

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Great info in this thread.

Just curious if anyone knows about the Florida USAP groups, specifically the Jacksonville group? I know they are new to USAP but wondering if anyone has any true info regarding the practice and how they are doing?

Thanks!

I know firsthand they are doing quite well. They work hard but as long as things remain as they are in terms of billing USAP Jax and USAP Orlando are doing quite well.

USAP is the best of the AMCs and despite all the negatives you read on this thread if you want to live in Florida there are maybe 3-4 jobs/groups better than USAP in the entire state.

If I was coming out of fellowship today (and couldn't land a sweet academic job) combined with a desire to live in Florida then I would likely sign up with USAP.
 
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deleted50478

I know firsthand they are doing quite well. They work hard but as long as things remain as they are in terms of billing USAP Jax and USAP Orlando are doing quite well.

USAP is the best of the AMCs and despite all the negatives you read on this thread if you want to live in Florida there are maybe 3-4 jobs/groups better than USAP in the entire state.

If I was coming out of fellowship today (and couldn't land a sweet academic job) combined with a desire to live in Florida then I would likely sign up with USAP.
You wouldn’t just start a private practice group and take a contract from an AMC? ;)

(I’ve been ranting against AMCs for years and ‘you don’t have to choose to work for them’ is the usual response.:smack:
 

Noyac

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The MD cog gotta resist getting sucked into the whole shareholder thing. It’s just a game and the only way to win is to find someone more gullible to buy in.

This is likely fraud. Also, how are they gonna make any money when the balance billing legislation gets passed?
Some groups are given the money to buy the shares. So that’s fine, just don’t count on the money being there. That way if it is then it’s bonus.

I’m skeptical of the balance billing legislation. Even if it passes I think it will get held up in the courts for a long time.
 

AdmiralChz

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You wouldn’t just start a private practice group and take a contract from an AMC? ;)

I love the enthusiasm, but this is pretty much impossible to come in and just “take” a contract from any practice much less an AMC. Maybe you’re being sarcastic, though?

It’s a good thought exercise though. To do so you’d need to be able to do this: 1) Convince a hospital/system to break a multi-year agreement or happen to come in at the end of one
2) Negotiate better commercial payer rates to require the same stipend (or no stipend), or be OK with making much less.
3) Find an entire practice of new docs +/- anesthetists as they all will be under a non-compete which will be rigorously enforced.

Trying to undercut 1 or 3 will land you in an expensive legal battle against a private equity firm with deeper pockets than you. If you can succeed at 2 then you are a true master and please come work for us!

Does it happen? Absolutely, see Minnesota and Charlotte but those are the exceptions as the hospitals were furious with those Mednax (and in the case of Charlotte there were other sort of weird factors) and even then they fought tooth-and-nail in the public and legal spheres. I haven’t heard anything out of a Charlotte in a while, I have no clue how that ended up but the new group sounded sketchy at best and given the magnitude of the changeover they had to hire some questionable docs. Despite what you hear on here about Minnesota the jury is 100% still out whether or not it will be a success - I will cheer for them to be sure, but maintain cautious optimism.
 
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amyl

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Im in USAP in Texas and yes was vested after a year. Depending on circumstances the non competes are not enforced. As far as the partnership being worth it - I am half way through my track and it better be. USAP dominates my town. It seems like most desirable cities have been taken over by AMCs of one kind or another... i have heard the same vague reports of things not going well in vegas for usap but havent heard any specifics.
 

RadsWFA1900

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I love the enthusiasm, but this is pretty much impossible to come in and just “take” a contract from any practice much less an AMC. Maybe you’re being sarcastic, though?

It’s a good thought exercise though. To do so you’d need to be able to do this: 1) Convince a hospital/system to break a multi-year agreement or happen to come in at the end of one
2) Negotiate better commercial payer rates to require the same stipend (or no stipend), or be OK with making much less.
3) Find an entire practice of new docs +/- anesthetists as they all will be under a non-compete which will be rigorously enforced.

Trying to undercut 1 or 3 will land you in an expensive legal battle against a private equity firm with deeper pockets than you. If you can succeed at 2 then you are a true master and please come work for us!

Does it happen? Absolutely, see Minnesota and Charlotte but those are the exceptions as the hospitals were furious with those Mednax (and in the case of Charlotte there were other sort of weird factors) and even then they fought tooth-and-nail in the public and legal spheres. I haven’t heard anything out of a Charlotte in a while, I have no clue how that ended up but the new group sounded sketchy at best and given the magnitude of the changeover they had to hire some questionable docs. Despite what you hear on here about Minnesota the jury is 100% still out whether or not it will be a success - I will cheer for them to be sure, but maintain cautious optimism.

1. Hospitals probably won’t break a contract prematurely but then you basically strike as contract renewal comes up which is what every 5-10yrs

2. I’m sure they probably get slightly better rates but probably not as great. Some base their bussiness model on OON billing too so there’s that. Also, a lot of them push the 3:1 or 4:1 supervising or collaborative practice to make ends meet to.

3. Non competes are a sticking point but honestly if you shut down a hospital system while they look for new practitioners in pretty sure a judge could see the issues with that and not enforce the non compete.

AMCs are tough to crack. The ones that do well probably would have done just a small well as a PP. it’s state dependent and payor dependent.
 

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