IntoTheWest

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Tejas is now part of Envision and STAR will be under USAP
 
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aneftp

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I still stand by my statement that USAP is the best of the AMCs. For those that can make $650 or more elsewhere as a full partner then by all means go do it. That type of job should be choice number 1. But, for many without connections or looking to live in a certain location USAP is a reasonable second choice.
What is the total cost of the buyin (including the force usap stock)

Say in the past group X
Year one 20% plus 6% billing
Year 2 15% plus 6% billing
Year 3 10% plus 6% billing

Partner. Just pay the 6% billing.


I know usap can claim more centralize billing (which essentially knocks down 6% billing to close to zero since they have one department working on all the billing) and can negotiate potentially 10-15% higher in network payments.

It’s really the usap internal stock force purchase that is the sticking point. I wouldn’t touch it.

Look at team health and united healthcare. Insurers can play hard ball and threaten to cancel even in network contracts.

August 12 2019 article

 

gasdoc77

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What is the total cost of the buyin (including the force usap stock)

Say in the past group X
Year one 20% plus 6% billing
Year 2 15% plus 6% billing
Year 3 10% plus 6% billing

Partner. Just pay the 6% billing.


I know usap can claim more centralize billing (which essentially knocks down 6% billing to close to zero since they have one department working on all the billing) and can negotiate potentially 10-15% higher in network payments.

It’s really the usap internal stock force purchase that is the sticking point. I wouldn’t touch it.

Look at team health and united healthcare. Insurers can play hard ball and threaten to cancel even in network contracts.

August 12 2019 article

:corny:
 
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BLADEMDA

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Again Blade don’t disagree but that 650 is maybe 20% tops of all USAP partners at various locations. Knowing many outside of Texas and even in Austin, the majority are 450-550 and working harder than ever before.

Not sure their buy in is worth 450-550 especially for the hours worked. Not sure if it’s worth it for 650.

But I do agree with you. If you have to live there and your other options are mednax or envision go USAP. However if it’s one of USAPs groups that makes 450-550, and there’s a decent academic job I’d highly highly consider it. Way less call and better life for blnot much less

Otherwise MOVE. Find the PP jobs. I can tell you on east coast mednax is crumbling quickly....lots of good PP jobs popping up. Same with Midwest

On this we agree, if you can find a real, good paying private practice job then take it. But, for many "real partnership" above $600K is an elusive dream. No matter how hard you work if your blended unit is 30 breaking $650 is next to impossible especially with rising CRNA salaries.

So, I think busting your arse for $650 is still worth it. I do agree that $450 makes the deal less attractive so look elsewhere.
Yes, some USAP groups do earn $450K these days so beware of signing up for a mediocre track just to earn less than median MGMA income.

I also agree "lifestyle" matters a lot so unless the $$$ are there just say "no" and move on. I would never sign on for a 2-3 year track earning crappy pay just to get to below MGMA median income. That's a bad deal and USAP needs to increase starting salaries to $300K+ for those groups where "partnership" status isn't above 75th percentile MGMA.

Now, Dallas and Houston have lucrative groups and good contracts with a nice payer mix. Please look there if you want USAP.
 
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dchz

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Fair enough... wasn't trying to be cute..but i dont want to be bogged down in #s on a public forum.. I am most interested in broad concepts and educating people.
As far as 3 years,... its really a 2 year partner track... you have to work 1 year with us on a call package before we vote you in on a partner track..
Reason: Sometime someone you hire ends up not working out for clinical skills, behavior issues.. any reason, but if they are hired onto the partner track immediately, then we have to pull you off partner track and then we get this reputation of not allowing partner track people to become partners... when in actuality, your employment did not work out.
so we hire everyone onto a call taking track and if you want to be considered for partnership, you just let your site leadership know and you perform well. After 1 year with us in a call taking slot, we have already watched you and we believe you at least have the clinical skills.
We need partners.... it does us no good to trick people and screw them last minute. Look at this forum... how quickly someone tricked or screwed by us would make it known.
Once you go on partner track, there are evaluations done by the local HR leadership and you are given feedback. We have you attend physician executive courses, leadership courses..stuff I have mentioned on other posts.
We are very very sensitive to bringing someone on partner track and not making them partner... It happens but its rare.... We still hear about a few incidents that occurred years ago PRE USAP and its talked about like it happened last year. If someone is struggling, having behavior issues, clinical issue, we work with them and the professional HR team that we have.. .USAP has Local Houston and national HR team as well as inhouse counsel to guide the physicians on the proper and ethical treatment of people.
I would give you a number but more importantly... if we put you on the track, your gonna make it unless issue arise that our Local HR and National HR people along with Houston physician leadership think its not in the best interest of the company... and THAT would be a big deal to us... a really big deal..

Wow... you get it. I have reached the 1 person. I am celebrating in my mind. we are nothing nothing nothing like the strategic companies Mednax etc... WE are owners of the company. Very different than having a few shares bought on the stock exchange like with Mednax. We are physician led, mostly physician owned and wall street managed company.... in simplistic terms... Our clinical governance is a group of docs elected by the partership.

For every person that replies, you've reached at least 5 others that don't reply. So you're actually doing better than it looks. I am also someone that you've reached. Furthermore, I've got interviews upcoming in many divisions in Texas and would love to find a good fit to be a future partner. Let me express my gratitude for you time.

For the clarity of content, what you refer to as a "2 year partnership track" is really 3 years, because the associate is going 3 years without partner pay. It really makes it look shady when you try to explain it's a 2 year partnership track that takes 3 years to occur. Many divisions advertise this as 3 years to partner. It is my opinion that this is the best way to phrase it.

I would like your confirmation on the following:

If the associate does not meet what you consider to be clinically strong or USAP partnership material. They are still bound by USAP non-compete and will be unable to find work in within 5 miles of any USAP facility for the 2 years after they've concluded their association with USAP.

Example, a new graduate signs on at the Vegas location in July 2018. The associate is not put on the partnership track at the end of their year in July 2019. By the terms of the non-compete, that associate cannot go to UT Houston Memorial Hermann to work in their anesthesiology department as an academic attending until July 2021 (or any location within 5 miles of any USAP location, including future locations that might result from future buyout)

Is the above example accurate? if inaccurate, please explain how so.
 
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dchz

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I’ve said it before, but if you are a quality applicant, you don’t have to pick between the different AMCs, all of which are bad options. Great private practice groups with real partnerships and autonomy are hiring. Don’t settle for these terrible predatory AMC jobs! Listen to this convoluted tale this guy is trying to tell here and ask yourself why he is having to come on SDN to recruit. Good jobs don’t require lengthy nonsensical explanations for why they are structured the way they are.

Use your alumni networks and find the quality private groups. This is absolutely worth the effort guys!


Please PM me.
 

dchz

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My college/med school buddy makes 1 mil the past 3 years working 35 hours a week in Dallas area. General anesthesia doing his own billing. Just to put things into perspective how much money there is still in Texas.

No middle man to take profit.

Please PM me.
 

dchz

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If San Antonio is acquired it really will be a monopoly.

Half of San Antonio got acquired by Envision. Turning what used to be MD only to ACT model.

STAR and TEJAS are good groups in San Antonio. Interviewed with both and liked them. Have friends there and are happy.

Neither will exist in 1 month.
 
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linkin06

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I have been told, though of course from their own HR, that the noncompete has never been enforced. Certainly a CYA measure, but I would gather if you left on good terms it would be a bitch move and certainly spread by word of mouth if they tried to keep you from legitimately working.
 

chocomorsel

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My college/med school buddy makes 1 mil the past 3 years working 35 hours a week in Dallas area. General anesthesia doing his own billing. Just to put things into perspective how much money there is still in Texas.

No middle man to take profit.
Well, don’t let the world know about this. That’s insane. I knew Dallas had money. Glad to be moving back home but not looking forward to all the traffic.

But can you let a sista have a connect for a part time gig? Lol.
 

chocomorsel

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It’s also a matter of perspective. I wasn’t a partner in 2013. I was fresh out of residency, and anyone expecting to make partner or transaction money immediately has rather unrealistic expectations.

You can call the stock whatever you like, but the dollars hitting my account are similar to those the partners made prior to the transaction. Also keep in mind there has been significant growth in the past 6 years with existing hospitals expanding, opening new facilities, and accepting other groups/facilities. As the group grows the groups benefits. And yes, USAP profits as well.

I’m not high enough in the chain to know anything definitive about an IPO, but let me know how Mednax’s stock has performed since 2017.
Supervising or doing own cases?
 
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chocomorsel

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I still stand by my statement that USAP is the best of the AMCs. For those that can make $650 or more elsewhere as a full partner then by all means go do it. That type of job should be choice number 1. But, for many without connections or looking to live in a certain location USAP is a reasonable second choice.
Are you a USAP sales person? How much you making for each USAP post? Haha.
 
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aneftp

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Lots of driving around?
U run around town with your own surgeon doing cases with them. Just the way things work in Dallas and some parts of Vegas as well.

Can be lucrative with good payor mix and high unit billing cases (aka spine cases).
 

chocomorsel

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U run around town with your own surgeon doing cases with them. Just the way things work in Dallas and some parts of Vegas as well.

Can be lucrative with good payor mix and high unit billing cases (aka spine cases).
Drove around in Vegas. Kept thinking one day I would get into an unnecessary wreck. Vegas is much smaller than Dallas.
But I would do it part time. You got a hookup?
 

Howard888

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Selling to AMCs and then converting to ACT. I’m actually in huge favor of ACT, but that’s a double transition.

I’d stay clear of San Antonio for a few years until things work themselves out
 

Neopolymath

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Selling to AMCs and then converting to ACT. I’m actually in huge favor of ACT, but that’s a double transition.

I’d stay clear of San Antonio for a few years until things work themselves out
Why is that?
 
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bobg504

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Don't do it. Run for the hills. I am speaking from personal experience. Stay away.
 
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There's another thread in the forum regarding what's going to happen if/when Medicare For All passes. Though there is no agreement that it will pass nor when, everybody seems to agree that USAP partnership (tied to stock) won't be worth anything once we are all paid governmental rates. Sure, USAP will claim to have a hammer lock on the good practices with large percentage of payers with "supplemental" insurance or even the boutique hospitals that only do plastics/cash cases...but I'll believe that only when I see it.

In other words, I read the tea leaves (not even two years since Hillary said "single payer will never, ever happen" and already a majority of democratic presidential candidates are running on a M4A platform) to say USAP's days are numbered.

If you accept a job with USAP and think that the partnership is likely to be worth anything in 5+ years, you are betting the opposite. (And you'll have lots of pundits and armchair experts willing to agree with you. Ordinarily, I would not vote against the monied interests of the AHA, big Pharma, lobbyists, and the insurance companies, either. But I happen to think that we are in the midst of a revolution (see: marijuana legalization, gay marriage), and the changes have only begun.
 
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aneftp

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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.
 
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Impromptu

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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.

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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aneftp

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Act models generate much more per buyout simply cause they are ripping off crnas in lower pay. We all know. But i digress This Colorado (I think it’s all Md practice so involves less money)

Read it at length how some of the usap agreements works.

“Shareholders approved the merger on January 30, 2015. The merger took place eleven days later. Each shareholder who had voted for the merger and had executed the related agreements would receive (1) $626,000 in cash; (2) $224,000 in USAP common stock, to fully vest in five years; and (3) a signing/retention bonus reflective of his or her prior income. Old GCA sent Crocker $100 for his share, an amount that he refused. He later demanded payment in the amount of $1,030,996.”

“USAP would buy out all existing GCA shares for a substantial lump sum of cash plus USAP common stock. To receive that payment, shareholders of old GCA would be required to execute various agreements, including a new employment agreement reflecting a 21.3% reduction in pay and a five-year employment commitment”


Obviously the Houston Dallas and Orlando mergers got better sweetheart deals.

But this legal case is just an example how usap buyouts work.

Anyone saying “new partners” are making the same 2019 income as pre merger 2013 partners is lying up their you know what. Unless they are once again playing magic tricks what the usap stock is worth.
 
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Mikkel

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Act models generate much more per buyout simply cause they are ripping off crnas in lower pay. We all know. But i digress This Colorado (I think it’s all Md practice so involves less money)

Read it at length how some of the usap agreements works.

“Shareholders approved the merger on January 30, 2015. The merger took place eleven days later. Each shareholder who had voted for the merger and had executed the related agreements would receive (1) $626,000 in cash; (2) $224,000 in USAP common stock, to fully vest in five years; and (3) a signing/retention bonus reflective of his or her prior income. Old GCA sent Crocker $100 for his share, an amount that he refused. He later demanded payment in the amount of $1,030,996.”

“USAP would buy out all existing GCA shares for a substantial lump sum of cash plus USAP common stock. To receive that payment, shareholders of old GCA would be required to execute various agreements, including a new employment agreement reflecting a 21.3% reduction in pay and a five-year employment commitment”


Obviously the Houston Dallas and Orlando mergers got better sweetheart deals.

But this legal case is just an example how usap buyouts work.

Anyone saying “new partners” are making the same 2019 income as pre merger 2013 partners is lying up their you know what. Unless they are once again playing magic tricks what the usap stock is worth.

If you made $800k prebuy, you make $630k annual postbuy. Over 5 years, you lost $850k in income, net negative $224k.

$224k in stock offsets this at 5 years, but you lose money every year because of USAP's 21.3% cut. You LOSE $170k every year with this deal.


So, you give away 21.3% of your income in perpetuity, in exchange for stock in a Ponzi company.

How stupid do you have to be to fall for this?
 
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deleted50478

If you made $800k prebuy, you make $630k annual postbuy. Over 5 years, you lost $850k in income, net negative $224k.

$224k in stock offsets this at 5 years, but you lose money every year because of USAP's 21.3% cut. You LOSE $170k every year with this deal.


So, you give away 21.3% of your income in perpetuity, in exchange for stock in a Ponzi company.

How stupid do you have to be to fall for this?

They don’t give away any of their own money. The money they lose in future income was pre-paid in the sell out and with lower taxes. What they give away is the income of every person who works in those hospitals who was not part of selling out for as long as USAP exists.

It isn’t stupid, immoral, but not stupid.
 
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Mikkel

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They don’t give away any of their own money. The money they lose in future income was pre-paid in the sell out and with lower taxes. What they give away is the income of every person who works in those hospitals who was not part of selling out for as long as USAP exists.

It isn’t stupid, immoral, but not stupid.

They committed to work 5 years for 21.3% less income. They lose that income they would have had otherwise. It's not like they got a check and then retired immediately.

Yes, their decision also forfeited money that future employees will never get. Definitely immoral, I agree.

When the end result is perpetually losing 21.3% of your income in exchange for Ponzi shares, it really is stupidity.
 

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It is not about stupidity. It is about weighing the alternatives currently available and one’s priorities.

What priorities are those? Losing money long term, giving up your practice to be an employee, and getting shares in a Ponzi scheme?

The alternative was continuing to make 100% of their income.
 

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What priorities are those? Losing money long term, giving up your practice to be an employee, and getting shares in a Ponzi scheme?

The alternative was continuing to make 100% of their income.

just to be clear, as a partner in a private practice your "income" is never guaranteed and can vary considerably year to year and there is no promise it will continue to be whatever it is now 5 years into the future.
 
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They don’t give away any of their own money. The money they lose in future income was pre-paid in the sell out and with lower taxes. What they give away is the income of every person who works in those hospitals who was not part of selling out for as long as USAP exists.

It isn’t stupid, immoral, but not stupid.
I’m sorry, but is there someone holding a gun to people’s heads forcing them to work for USAP? Everyone who works for USAP ( or any other employer in this country) makes a choice to work there. If you don’t like your job, leave. If you can’t find anything better, then that is just the market at work....
 
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BLADEMDA

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What priorities are those? Losing money long term, giving up your practice to be an employee, and getting shares in a Ponzi scheme?

The alternative was continuing to make 100% of their income.
The owners of GHA, JLR, Pinnacle, Tejas, Star, etc decided to sell out. The majority voted on the sale of their group. How was that decision immoral? Why do owners of any company owe a future employee they have never met a darn thing?

If new Employees don’t like the new owners or group structure then go elsewhere for employment. That is how the free market works. The fact we see so many AMCs is because our field has an uncertain future and large AMCs collect 20-30 percent more from private insurance companies vs the previous groups.
 
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sevoflurane

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The owners of GHA, JLR, Pinnacle, Tejas, Star, etc decided to sell out. The majority voted on the sale of their group. How was that decision immoral? Why do owners of any company owe a future employee they have never met a darn thing?

If new Employees don’t like the new owners or group structure then go elsewhere for employment. That is how the free market works. The fact we see so many AMCs is because our field has an uncertain future and large AMCs collect 20-30 percent more from private insurance companies vs the previous groups.

That is not always true.
 

sevoflurane

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The owners of GHA, JLR, Pinnacle, Tejas, Star, etc decided to sell out. The majority voted on the sale of their group. How was that decision immoral? Why do owners of any company owe a future employee they have never met a darn thing?

If new Employees don’t like the new owners or group structure then go elsewhere for employment. That is how the free market works. The fact we see so many AMCs is because our field has an uncertain future and large AMCs collect 20-30 percent more from private insurance companies vs the previous groups.

This is a reason to sell. Risk of loosing contracts, AMC take overs (not mergers), Hospital demanding to be employed, looming unfavorable legeslation, overhead, complience, etc.

I have always favored PP over anything else.... you are right though. If the group votes to go one way, well that is just how it works.
 

gasdoc77

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just to be clear, as a partner in a private practice your "income" is never guaranteed and can vary considerably year to year and there is no promise it will continue to be whatever it is now 5 years into the future.
Correct. In all transactions someone takes the “long” position and someone takes the “short” position. In this case the docs shorted their own specialty and the future docs’ incomes and Walstreet is laughing all the way to the bank. Stupid? You decide.
 

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I’m sorry, but is there someone holding a gun to people’s heads forcing them to work for USAP? Everyone who works for USAP ( or any other employer in this country) makes a choice to work there. If you don’t like your job, leave. If you can’t find anything better, then that is just the market at work....
Except it's not a free market, it's a racket, so stop faulting employees. There isn't much difference between employers simply because there are enough suckers plus they can replace us with CRNAs.
 
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aneftp

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If you made $800k prebuy, you make $630k annual postbuy. Over 5 years, you lost $850k in income, net negative $224k.

$224k in stock offsets this at 5 years, but you lose money every year because of USAP's 21.3% cut. You LOSE $170k every year with this deal.


So, you give away 21.3% of your income in perpetuity, in exchange for stock in a Ponzi company.

How stupid do you have to be to fall for this?
Incorrect. They got 2-3 million up front straight cash plus the stock options

They aren’t stupid. And that 2-3 million is taxed at 15%. Long term capital gains.

It’s a great deal for those in their 50s.
 

FFP

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Incorrect. They got 2-3 million up front straight cash plus the stock options

They aren’t stupid. And that 2-3 million is taxed at 15%. Long term capital gains.

It’s a great deal for those in their 50s.
Just for the sake of precision, it's taxed at 23.8% + state tax. Still a great deal.
 

Mman

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Correct. In all transactions someone takes the “long” position and someone takes the “short” position. In this case the docs shorted their own specialty and the future docs’ incomes and Walstreet is laughing all the way to the bank. Stupid? You decide.

the ultimate who laughs last depends on the state of anesthesia reimbursement 10 years down the road
 
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the ultimate who laughs last depends on the state of anesthesia reimbursement 10 years down the road


To some extent. However, the money guys will move on to other investments in other industries. We are one trick ponies.
 

nimbus

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Incorrect. They got 2-3 million up front straight cash plus the stock options

They aren’t stupid. And that 2-3 million is taxed at 15%. Long term capital gains.

It’s a great deal for those in their 50s.


If they were giving up $200k/yr going forward, 2mil is a 10x multiple which may have occurred in a few cases. 3mil is 15x which is highly unlikely. We know Denver USAP was a 1mil/partner deal which included the stock valued around $200k.
 
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aneftp

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Just for the sake of precision, it's taxed at 23.8% + state tax. Still a great deal.
Just for the sake of precision, it's taxed at 23.8% + state tax. Still a great deal.
Not necessarily 23.8 (3.8% surtax Obamacare on investment). Depends what their w2 wages were that were being paid out in 2013. Plus zero state income taxes in Florida and Texas.
 

aneftp

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If they were giving up $200k/yr going forward, 2mil is a 10x multiple which may have occurred in a few cases. 3mil is 15x which is highly unlikely. We know Denver USAP was a 1mil/partner deal which included the stock valued around $200k.
It was 2 million at one of the 3 original usap places . Plus approx 600k usap stock
 
D

deleted50478

I’m sorry, but is there someone holding a gun to people’s heads forcing them to work for USAP? Everyone who works for USAP ( or any other employer in this country) makes a choice to work there. If you don’t like your job, leave. If you can’t find anything better, then that is just the market at work....

Ridiculous. You don’t have to hold guns to people’s heads to coerce them. There are only so many anesthesiology jobs out there. Not everyone has to work for an AMC, but a large percentage of people do. Not working isn’t a viable option. If there were enough real private practice jobs to go around, no one would work for an AMC.

Monopolies and exclusive contracts prevent the market from working.
 
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Shimmy8

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My company is a regional AMC. Really only game in town besides academics, so it is what it is.

We have a similar structure to USAP, just on a smaller scale. Have option (NOT a requirement) to buy stock in company. But many of us young guys have had the same discussion about pricing, stock value, etc. that’s been had above. I don’t want to call it a Ponzi scheme, but...
 

PieOHmy

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Ridiculous. You don’t have to hold guns to people’s heads to coerce them. There are only so many anesthesiology jobs out there. Not everyone has to work for an AMC, but a large percentage of people do. Not working isn’t a viable option. If there were enough real private practice jobs to go around, no one would work for an AMC.

Monopolies and exclusive contracts prevent the market from working.
When I posted these sentiments 14 years ago in other forums I was told start your anesthesaia group and compete for these exclusive contracts. I am vehemntly opposed to exclusive contracts and it WOULD open the market up for use..

Healthcare is a contrived marketplace and OBAMA care has made it alot worse
 
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dannyboy1

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Ridiculous. You don’t have to hold guns to people’s heads to coerce them. There are only so many anesthesiology jobs out there. Not everyone has to work for an AMC, but a large percentage of people do. Not working isn’t a viable option. If there were enough real private practice jobs to go around, no one would work for an AMC.
Soo... market forces.
To me the only thing to look for in a job are the hours/vacation/salary ratio. Private practice...AMC....hospital employed.... makes no difference.
Back in the day there were plenty of PP out there that would treat new associates far worse than any AMC.....
 
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