USAp Texas..how many more blows

[Howard888]

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Plaintiff's Counsel Reports Progress in Patient's Antitrust Suit Against U.S. Anesthesia Partners While FTC Restarts Related Case

/PRNewswire/ -- A federal judge in the United States District Court for the Southern District of Texas has issued a significant ruling in the antitrust class...

www.prnewswire.com

Everyone here knows they are guilty of this as are all amcs.. why would anyone work for usap right now let alone a “buy in”

 

[aneftp]

Plaintiff's Counsel Reports Progress in Patient's Antitrust Suit Against U.S. Anesthesia Partners While FTC Restarts Related Case

/PRNewswire/ -- A federal judge in the United States District Court for the Southern District of Texas has issued a significant ruling in the antitrust class...

www.prnewswire.com

Everyone here knows they are guilty of this as are all amcs.. why would anyone work for usap right now let alone a “buy in”

What about hospitals with their collusions?? 2-3 big hospital systems can game up on insurers which happens in many cities.

I support USAP. As crazy as it sounds.

 

[thinkorswim]

As much as I love your unwavering hatred toward USAP, I’m kind of rooting for them on this one.

Our profession needs to fight back somehow against profit-driven insurance companies and hospital systems.

 

[aneftp]

As much as I love your unwavering hatred toward USAP, I’m kind of rooting for them on this one.

Our profession needs to fight back somehow against profit-driven insurance companies and hospital systems.

We really need to redefine what a 501c executive pay should be.

Many 501c executive pay is in the 5-10 million range. It’s insane. And insurance companies won’t fight hospitals because they want to pick on the little guy (usap)

So if you support lawsuit vs usap. U are supporting the eventual hospitals take of anesthesia eventually. And than massive decreases in salaries as all hospitals in the region will collude to “keep costs” down by depressing physician salaries

We all know hospitals are fighting to keep the non competes in tact to limit completion.

That’s the irony of those clapping their hands of usap monopoly. What’s worst? Hospitals colluding together? I don’t know. Everything sounds bad

 

[Lab Lover]

We really need to redefine what a 501c executive pay should be.

Many 501c executive pay is in the 5-10 million range. It’s insane. And insurance companies won’t fight hospitals because they want to pick on the little guy (usap)

So if you support lawsuit vs usap. U are supporting the eventual hospitals take of anesthesia eventually. And than massive decreases in salaries as all hospitals in the region will collude to “keep costs” down by depressing physician salaries

We all know hospitals are fighting to keep the non competes in tact to limit completion.

That’s the irony of those clapping their hands of usap monopoly. What’s worst? Hospitals colluding together? I don’t know. Everything sounds bad

What you mean to say is, “Who would you rather be ****ed by”?

 

[aneftp]

What you mean to say is, “Who would you rather be ****ed by”?

Working for the hospital as w2 may be worst than working for usap. You got crazy ideas the hospitals executives draw up in the board room. Like the post a major nationwide w2 hospital system employing anesthesiologists clawing back extra shifts overtime pay on anesthesiologists who don’t average 42 hrs a week.

So if u average 38 hrs. And do an extra 8 hr post call shift. While you still get ur guaranteed pay. The 8 hrs post call u work. They will only pay u 4 of those 8 hrs becuase ur average is 4 hrs less. Talk about dumb stuff that hospital chain drew up. Who would want to work post call or sign up for extra shifts??

 

[amyl]

Being a hospital employee is better than USAP. there are some toxic admins for sure but in this market they’ll have to change (unless it’s a super desirable location).
With USAP (or other amc) there’s the private equity cut off the top… and it’s not small… up to 38% depending on location (I’ve heard Envision is often 40%)…. That means less pay and more work for the Dr.
hospitals at least don’t have to cover that large banker pay check…. It worked for awhile bc the market was different and the business guys could negotiate better rates - there was room for the banker cut… there just isn’t now.
You think hospital admin sucks? Lots of times I’ll agree with you…. But working your ass off to pay the bankers a huge chunk… that’s worse

 

[dannyboy1]

Only job to accept in this market is one where your hours and pay are clearly defined. Once that is the case it makes no difference who the employer is. I work for $$$. Not “unit based”, not “performance based” or any other bull$hit they try to pull on you.

 

[dannyboy1]

Being a hospital employee is better than USAP. there are some toxic admins for sure but in this market they’ll have to change (unless it’s a super desirable location).
With USAP (or other amc) there’s the private equity cut off the top… and it’s not small… up to 38% depending on location (I’ve heard Envision is often 40%)…. That means less pay and more work for the Dr.
hospitals at least don’t have to cover that large banker pay check…. It worked for awhile bc the market was different and the business guys could negotiate better rates - there was room for the banker cut… there just isn’t now.
You think hospital admin sucks? Lots of times I’ll agree with you…. But working your ass off to pay the bankers a huge chunk… that’s worse

Explain this percentage to the bankers to me? Does it come out of the docs salary?? Im assuming all are signing on as employees. If the salary is 30% less because they have to pay the owners, then they won’t be able to recruit.

 

[Howard888]

USAP was simple model. When they bought a group they negotiated what % of net income they would take and what would be left for the physicians. Numbers a little more complicated but that’s the jist.

Every group they bought decided on a different number. The bigger the % the group decided to give up to USAP FOREVER the more upfront money the original partners who were selling to usap got.

This number was 20-40%z. But As Amyl said many groups were in mid to high 30%s.

Again this is the % of net income that PE gets to keep in perpetuity….without doing the clinical work.

Many groups got an initial lift with usap rates and usap then used its size to negotiate higher rates with commercial payers…it was actually not a terrible model compared to most amcs.

Again This model worked well at first and many MDs incomes got close or above to what they were presale but then no surprises act happened and covid exacerbated the crna shortage and crna costs skyrocketed. Not to mention the salaries of non clinical employees,

So now usap can no longer get increased payer rates. Hospitals and patient advocate groups are aware of how high their rates are and how much goes to PE. Some desperate ones will still give usap a stipend but many decided to save the 35% going to PE and do it themselves.

Clinically MDs are having to work longer or go to high supervision ratios just to make the same they were 3 years ago. PE still getting 35% though with no increased hours or supervision. Yet some usap groups are still asking “junior partners” to do a buy in. It’s crazy. Stay clear. Hospitals budgets are getting tighter and they’ll stop paying for a PE profit.

I’m not in favor of insurance companies but I’m also not in favor of PE. If private owned Md groups banned together to get higher rates and no money went to PE I’d support that.

 

[dannyboy1]

USAP was simple model. When they bought a group they negotiated what % of net income they would take and what would be left for the physicians. Numbers a little more complicated but that’s the jist.

Every group they bought decided on a different number. The bigger the % the group decided to give up to USAP FOREVER the more upfront money the original partners who were selling to usap got.

This number was 20-40%z. But As Amyl said many groups were in mid to high 30%s.

Again this is the % of net income that PE gets to keep in perpetuity….without doing the clinical work.

Many groups got an initial lift with usap rates and usap then used its size to negotiate higher rates with commercial payers…it was actually not a terrible model compared to most amcs.

Again This model worked well at first and many MDs incomes got close or above to what they were presale but then no surprises act happened and covid exacerbated the crna shortage and crna costs skyrocketed. Not to mention the salaries of non clinical employees,

So now usap can no longer get increased payer rates. Hospitals and patient advocate groups are aware of how high their rates are and how much goes to PE. Some desperate ones will still give usap a stipend but many decided to save the 35% going to PE and do it themselves.

Clinically MDs are having to work longer or go to high supervision ratios just to make the same they were 3 years ago. PE still getting 35% though with no increased hours or supervision. Yet some usap groups are still asking “junior partners” to do a buy in. It’s crazy. Stay clear. Hospitals budgets are getting tighter and they’ll stop paying for a PE profit.

I’m not in favor of insurance companies but I’m also not in favor of PE. If private owned Md groups banned together to get higher rates and no money went to PE I’d support that.

Which begs the question, who is taking a job there if that’s the situation? If it’s people who simply won’t move let’s change the thread title to “I live in a $hitty market and refuse to relocate and am willing to be abused”. Also. How are salaries promised if 30% of net needs to go to PE. How can you give someone a number. ??

 

[Southpaw]

USAP was simple model. When they bought a group they negotiated what % of net income they would take and what would be left for the physicians. Numbers a little more complicated but that’s the jist.

Every group they bought decided on a different number. The bigger the % the group decided to give up to USAP FOREVER the more upfront money the original partners who were selling to usap got.

This number was 20-40%z. But As Amyl said many groups were in mid to high 30%s.

Again this is the % of net income that PE gets to keep in perpetuity….without doing the clinical work.

Many groups got an initial lift with usap rates and usap then used its size to negotiate higher rates with commercial payers…it was actually not a terrible model compared to most amcs.

Again This model worked well at first and many MDs incomes got close or above to what they were presale but then no surprises act happened and covid exacerbated the crna shortage and crna costs skyrocketed. Not to mention the salaries of non clinical employees,

So now usap can no longer get increased payer rates. Hospitals and patient advocate groups are aware of how high their rates are and how much goes to PE. Some desperate ones will still give usap a stipend but many decided to save the 35% going to PE and do it themselves.

Clinically MDs are having to work longer or go to high supervision ratios just to make the same they were 3 years ago. PE still getting 35% though with no increased hours or supervision. Yet some usap groups are still asking “junior partners” to do a buy in. It’s crazy. Stay clear. Hospitals budgets are getting tighter and they’ll stop paying for a PE profit.

I’m not in favor of insurance companies but I’m also not in favor of PE. If private owned Md groups banned together to get higher rates and no money went to PE I’d support that.

Correct. The signing of the NSA by Donald Trump was the death knell for many private practice anesthesiologists and many AMCs. Especially in a post-COVID world where inflation went wild and CRNA salaries skyrocketed.

Insurance companies hold all of the power. The NSA gave it to them. The power of negotiation that AMCs held relative to smaller private practices suddenly vanished. Hospitals had to decide either to support the anesthesia group with a subsidy or call their bluff and watch them leave. AMCs continued to overpromise and underdeliver and stretched anesthesiologists to work harder while at work and work longer hours to justify the same salary. The math doesn’t add up.

The NSA exacerbated an already bad problem of insurance companies holding power over physicians. Still, I maintain of the AMCs USAP was the best with how they treated anesthesiologists. The NSA ruined them though.

 

[Southpaw]

Which begs the question, who is taking a job there if that’s the situation? If it’s people who simply won’t move let’s change the thread title to “I live in a $hitty market and refuse to relocate and am willing to be abused”. Also. How are salaries promised if 30% of net needs to go to PE. How can you give someone a number. ??

That’s true for a lot of anesthesiologists. We’re all just people. We get married and we have kids. Our spouses develop social networks. Our kids go to school and get friends. While it’s tolerable to reestablish all of that in a new location it’s never ideal. No one feels like they went through the arduous tasks of medical school and residency just to be manipulated and abused by business types. And yet that’s exactly what occurs.

 

[ScarfTheVerb]

Did USAP wrong you somehow? You posted the exact same thing on Reddit. Have an axe to grind?

 

[Account1]

We really need to redefine what a 501c executive pay should be.

Many 501c executive pay is in the 5-10 million range. It’s insane. And insurance companies won’t fight hospitals because they want to pick on the little guy (usap)

So if you support lawsuit vs usap. U are supporting the eventual hospitals take of anesthesia eventually. And than massive decreases in salaries as all hospitals in the region will collude to “keep costs” down by depressing physician salaries

We all know hospitals are fighting to keep the non competes in tact to limit completion.

That’s the irony of those clapping their hands of usap monopoly. What’s worst? Hospitals colluding together? I don’t know. Everything sounds bad

There’s no evidence of hospitals keeping pay down in this fashion. Most of them pay much higher than USAP or other AMCs now. Hospitals aren’t interested in anti trust lawsuits any more than USAP is

 

[aneftp]

There’s no evidence of hospitals keeping pay down in this fashion. Most of them pay much higher than USAP or other AMCs now. Hospitals aren’t interested in anti trust lawsuits any more than USAP is

bruh. If hospitals weren’t interested in keeping pay low. Why are they against eliminating anti competes?? Think. Think very slowly about that.

All the hca hospitals in Floria pretty much pay anesthesia the same even after taking over from Sheridan Envison.

We can extrapolate to other specialities as well. Like the 3 big hospital systems where I live in Florida all pay employee general surgeons roughly the same. It’s all colluding today. If they were interested in paying more. They would lift the non competes.

 

[Account1]

bruh. If hospitals weren’t interested in keeping pay low. Why are they against eliminating anti competes?? Think. Think very slowly about that.

All the hca hospitals in Floria pretty much pay anesthesia the same even after taking over from Sheridan Envison.

We can extrapolate to other specialities as well. Like the 3 big hospital systems where I live in Florida all pay employee general surgeons roughly the same. It’s all colluding today. If they were interested in paying more. They would lift the non competes.

Can’t speak for HCA facilities. I’ve yet to see one that pays particularly well regardless of who staffs them. I submit that the constant vacancies they have means they’re attempting to pay below market rate and not succeeding at hiring because of it. HCA is perfectly within rights to do that in their system, but they cannot collude with say University of Miami and agree on wage depression. Thats highly illegal and checked for often.

But to accuse hospital systems of colluding with one another is pretty baseless, and also doesn’t benefit each colluding system because they all lose by not being able to keep their staffs full, as anesthesia staff have many options. Non competes are in place to screw with clinicians because it’s still legal to have them, and most often they’re not enforced on challenge. But that’s not collusion like you’re saying.

 

[aneftp]

Can’t speak for HCA facilities. I’ve yet to see one that pays particularly well regardless of who staffs them. I submit that the constant vacancies they have means they’re attempting to pay below market rate and not succeeding at hiring because of it. HCA is perfectly within rights to do that in their system, but they cannot collude with say University of Miami and agree on wage depression. Thats highly illegal and checked for often.

But to accuse hospital systems of colluding with one another is pretty baseless, and also doesn’t benefit each colluding system because they all lose by not being able to keep their staffs full, as anesthesia staff have many options. Non competes are in place to screw with clinicians because it’s still legal to have them, and most often they’re not enforced on challenge. But that’s not collusion like you’re saying.

It’s not baseless claims

I see how they run the numbers.

They say the “comp” at competitor hospital w2 employee is 500k. They just want to match.

No one wants to “overpay” even though both hospitals are short on crna and docs and use 1099 locums.

That’s collusion.

Now third hospital in the area. Hca kicks out Envison and pretty much tries to pay the same!

That’s 3 different hospitals trying to low ball. And usap is the one actually paying higher than the w2 hospitals!! I’m not kidding

 

[Account1]

It’s not baseless claims

I see how they run the numbers.

They say the “comp” at competitor hospital w2 employee is 500k. They just want to match.

No one wants to “overpay” even though both hospitals are short on crna and docs and use 1099 locums.

That’s collusion.

Now third hospital in the area. Hca kicks out Envison and pretty much tries to pay the same!

That’s 3 different hospitals trying to low ball. And usap is the one actually paying higher than the w2 hospitals!! I’m not kidding

Except they aren’t colluding. They’re hiring locums with competitive rates, many of which you and I are personally benefitting from. Just because the W2 rates stink doesn’t mean someone isn’t getting fair pay or better in the system. They’re just willing to sacrifice staff stability instead of paying more for full time people

Now if they communicated to make all locums AND w2 offers lowball and all decided they’d eat the cost of shutting down ORs to in effect break the “striking” (not working for certain pay) doctors by starving them out of the area, THAT would be collusion.

As it stands now though, systems are incentivized to do cases and compete to get staff to do them. CMOs and CEOs get fired if they can’t staff anesthesia, and they pay what the market requires every time, and have compete with each other to get staff since it’s zero sum.

USAP never pays higher than employed on an hourly or call adjusted basis. I’ve seen a dozen of their markets’ numbers, it’s always horrendous rate with forced overtime everywhere.

 

[aneftp]

Except they aren’t colluding. They’re hiring locums with competitive rates, many of which you and I are personally benefitting from. Just because the W2 rates stink doesn’t mean someone isn’t getting fair pay or better in the system

Now if they communicated to make all locums AND w2 offers lowball and all decided they’d eat the cost of shutting down ORs to in effect break the “striking” (not working for certain pay) doctors by starving them out of the area, THAT would be collusion.

As it stands now though, systems are incentivized to do cases and compete to get staff to do them. CMOs and CEOs get fired if they can’t staff anesthesia, and they pay what the market requires every time, and have compete with each other to get staff since it’s zero sum.

USAP never pays higher than employed on an hourly or call adjusted basis. I’ve seen a dozen of their markets’ numbers, it’s always horrendous rate with forced overtime everywhere.

No. You are missing the point. No hospital wants to “overpay “ for w2 docs or crna.

Yet they finally raised the w2 rates 3 years after I said those were not market rates in 2023. It took them 2 years of locums and millions wasted on locums. Admin at both hospitals go to dinner together. It’s the biggest scam collusion I’ve seen.

I am by no means supporting amc. They are all run differently. I’m saying w2 hospitals employees aren’t exactly the answer either.

 

[Account1]

No. You are missing the point. No hospital wants to “overpay “ for w2 docs or crna.

Yet they finally raised the w2 rates 3 years after I said those were not market rates in 2023. It took them 2 years of locums and millions wasted on locums. Admin at both hospitals go to dinner together. It’s the biggest scam collusion I’ve seen.

I am by no means supporting amc. They are all run differently. I’m saying w2 hospitals employees aren’t exactly the answer either.

I think we’ve got different definitions of collusion then. What I’m describing are activities that violate anti trust laws. What you’re describing seems to be typical supply and demand in areas where people have viable alternatives to W2 work in the form of locums work.

You’ve said it yourself that you get some outstanding rates in those areas that are always short. That pretty much rules out true wage fixing collusion. Just because they’re short on full time with low offers doesn’t mean they’re colluding to do so, they’re just cheap and betting on locums being too unstable for workers to volunteer to do. Most cases they’re correct, and W2 docs give up pay for stability, which is a fair trade.

From markets I’ve seen, USAP colludes far worse than hospital systems, which again pay higher baseline per hour than USAP in every market with no partnership servitude. And USAP weaponize their monopoly against the worker AND the consumer. That’ll get you tagged for anti trust in a big hurry.

 

[aneftp]

I think we’ve got different definitions of collusion then. What I’m describing are activities that violate anti trust laws. What you’re describing seems to be typical supply and demand in areas where people have viable alternatives to W2 work in the form of locums work.

You’ve said it yourself that you get some outstanding rates in those areas that are always short. That pretty much rules out true wage fixing collusion. Just because they’re short on full time with low offers doesn’t mean they’re colluding to do so, they’re just cheap and betting on locums being too unstable for workers to volunteer to do. Most cases they’re correct, and W2 docs give up pay for stability, which is a fair trade.

From markets I’ve seen, USAP colludes far worse than hospital systems, which again pay higher baseline per hour than USAP in every market with no partnership servitude. And USAP weaponize their monopoly against the worker AND the consumer. That’ll get you tagged for anti trust in a big hurry.

Has rates/pay gone up in Colorado? Since USAP left from hospitals? Nope.

Hospitals don’t want to pay for anesthesia. They will pay as low as possible.

I do agree from 2016-2022 USAP in most areas low balled their new employees. But hospitals taking over from places USAp left or kicked out hasn’t exactly raised the pay.

I’m pretty neutral with hospital employee vs amc

Now if u are a true state employee with soviegn immunity getting similar to what an amc is offering. Than that’s way better.

I’ve never been a non govt hospitals employee though.

 

[amyl]

If I had a dime for every time I heard “we don’t want to set the market” in regard to salaries in my old job I could’ve retired. They said these things to keep crna and employee salaries low. They said if we raised them then utsw would just go higher and higher…

hospitals and AMCs only pay what they HAVE to to keep the money rolling in for ORs and facilities fees.
Again the fault lies with us… settling for less. Willing to accept a bad deal because we want to stay in a given location. It’s fine I’m not judging… we all have choices. I loved my old job for a long time until things changed with the market and group leadership… then it was a bad job. I love my current job but if it changes I’m out…

 

[Lab Lover]

I’m pretty neutral with hospital employee vs amc

Agree, with one caveat. They are both predators that look at us as prey to feed on. All politics are local, but In general hospitals are less effective predators that look upon us as prey. In general the AMCs are more effective predators because their leadership used to be us.

 

[amyl]

And the hospitals don’t take 18-40% off the top off the top to pay useless bankers who add zero value. Hospital admin may suck but they’re not leeches…. You are more likely to get paid the $ you bring in with hospital employment than an AMC. The less useless middlemen the better for us….

 

[CopaceticOne]

And the hospitals don’t take 18-40% off the top off the top to pay useless bankers who add zero value. Hospital admin may suck but they’re not leeches…. You are more likely to get paid the $ you bring in with hospital employment than an AMC. The less useless middlemen the better for us….

No, but in academics they take a giant cut but then tell the dept that there are budget issues and it is because of anesthesia services being a “cost”.

Gaslighting everywhere.

 

[ambiturner]

No, but in academics they take a giant cut but then tell the dept that there are budget issues and it is because of anesthesia services being a “cost”.

Gaslighting everywhere.

Forget who said it here but they said it best: academics is the original AMC

 

[Account1]

Has rates/pay gone up in Colorado? Since USAP left from hospitals? Nope.

Hospitals don’t want to pay for anesthesia. They will pay as low as possible.

I do agree from 2016-2022 USAP in most areas low balled their new employees. But hospitals taking over from places USAp left or kicked out hasn’t exactly raised the pay.

I’m pretty neutral with hospital employee vs amc

Now if u are a true state employee with soviegn immunity getting similar to what an amc is offering. Than that’s way better.

I’ve never been a non govt hospitals employee though.

It looks to me like the pay has gone up actually. USAP Colorado on a per hour basis was one of the worst I'd ever seen. They were hustling to make 550k as partners. Before that capping at 450k. Now starting at some non USAP hospitals is 500+ on gaswork. No chance that Sound and other groups are working people like USAP was hours wise.

They want to pay as low as possible. That doesn't mean they can just shut down the ORs though if they aren't willing to pay the money. Hospital CEO get fired over that. So they have to raise pay eventually to match the market. Denver is just one of the worst markets in the country second only to NYC pretty much.

 

[Account1]

And the hospitals don’t take 18-40% off the top off the top to pay useless bankers who add zero value. Hospital admin may suck but they’re not leeches…. You are more likely to get paid the $ you bring in with hospital employment than an AMC. The less useless middlemen the better for us….

The real benefit to employment is you can't be strongarmed into extra coverage by your "partners" when they offer to expand coverage without having staff in place. That's why USAP and other AMCs suck. You have no protection from new sites popping up if your "clinical governance board" (your bosses who don't do clinical work) say so. Associate and don't like it? Oops you lost your partnership track. Partner and don't like it? Oops, we gave you bad assignments from now on, hoping you quit.

If your boss is the hospital CEO, they can't tell you to cover more sites without changing the contract that they originally put together and agreed to. Such a different situation also when your group leader is actually involved with the site administration, unlike fake USAP or Envision admins who are "site chief"

 

[amyl]

The real benefit to employment is you can't be strongarmed into extra coverage by your "partners" when they offer to expand coverage without having staff in place. That's why USAP and other AMCs suck. You have no protection from new sites popping up if your "clinical governance board" (your bosses who don't do clinical work) say so. Associate and don't like it? Oops you lost your partnership track. Partner and don't like it? Oops, we gave you bad assignments from now on, hoping you quit.

If your boss is the hospital CEO, they can't tell you to cover more sites without changing the contract that they originally put together and agreed to. Such a different situation also when your group leader is actually involved with the site administration, unlike fake USAP or Envision admins who are "site chief"

lol. Account1… we must know each other…. I could have written this post…. Are you also disavowed ? ;-)

 

[AKMD_1984]

The real benefit to employment is you can't be strongarmed into extra coverage by your "partners" when they offer to expand coverage without having staff in place. That's why USAP and other AMCs suck. You have no protection from new sites popping up if your "clinical governance board" (your bosses who don't do clinical work) say so. Associate and don't like it? Oops you lost your partnership track. Partner and don't like it? Oops, we gave you bad assignments from now on, hoping you quit.

If your boss is the hospital CEO, they can't tell you to cover more sites without changing the contract that they originally put together and agreed to. Such a different situation also when your group leader is actually involved with the site administration, unlike fake USAP or Envision admins who are "site chief"

100%

once you have tasted independent work (locums or super prn), it’s really hard to go back to full time w2 jobs.

i refuse to be an instrument to someone else’s wealth
i refuse to be an instrument to someone else’s wealth
i refuse to be an instrument to someone else’s wealth

repeat it 10 more times…repeat it every day for a month and see how your life changes…

academics or hospital employment is at least a little bit more tolerable - your partners and you are treated the same (generally).

however, i look at amc leadership (clinical or admin) as just refined pimps. that’s what they are…often taking a commission over someone else’s labor without any real risk, skill or clinical contribution. they’re paper pushers exploiting your talent and labor.

i’d rather work for 1/2 price at a VA or an academic place than an amc with a known history to treat docs poorly or promote crnas.

honestly, i’d rather do charity cases where surgeons and patients are appreciative and i actually get reminded why i became a dr than play games with anesthesia groups. at least that work is fulfilling.

in my experience most clinical chiefs are sellouts. they’ve all cut deals for themselves. they’re nothing special nor do they care about you. thinking otherwise is foolishness and stupidity.

every anesthesiologist should keep this in mind and look closely at the following before signing any long term contracts

- distribution of labor
- control of scheduling and who has it

These things are learned over time, often after a lot of grief and loss. I suppose that’s what experience is.

Don’t let anyone get slick with you. If it smells funny, it probably is rotten.

Always have a one month “i hate this job clause” so you can exit without any issues.

Pay for your own malpractice, benefits, health insurance when you can - yes i know it sucks and it’s expensive…but don’t create handcuffs for yourself.

The minute these three things are not part of any contract or negotiations, your confidence and ability to earn income on your terms increases tremendously because walking away is much easier. That’s the most powerful move we have available.

 

[jsammi245]

100%

once you have tasted independent work (locums or super prn), it’s really hard to go back to full time w2 jobs.

i refuse to be an instrument to someone else’s wealth
i refuse to be an instrument to someone else’s wealth
i refuse to be an instrument to someone else’s wealth

repeat it 10 more times…repeat it every day for a month and see how your life changes…

academics or hospital employment is at least a little bit more tolerable - your partners and you are treated the same (generally).

however, i look at amc leadership (clinical or admin) as just refined pimps. that’s what they are…often taking a commission over someone else’s labor without any real risk, skill or clinical contribution. they’re paper pushers exploiting your talent and labor.

i’d rather work for 1/2 price at a VA or an academic place than an amc with a known history to treat docs poorly or promote crnas.

honestly, i’d rather do charity cases where surgeons and patients are appreciative and i actually get reminded why i became a dr than play games with anesthesia groups. at least that work is fulfilling.

in my experience most clinical chiefs are sellouts. they’ve all cut deals for themselves. they’re nothing special nor do they care about you. thinking otherwise is foolishness and stupidity.

every anesthesiologist should keep this in mind and look closely at the following before signing any long term contracts

- distribution of labor
- control of scheduling and who has it

These things are learned over time, often after a lot of grief and loss. I suppose that’s what experience is.

Don’t let anyone get slick with you. If it smells funny, it probably is rotten.

Always have a one month “i hate this job clause” so you can exit without any issues.

Pay for your own malpractice, benefits, health insurance when you can - yes i know it sucks and it’s expensive…but don’t create handcuffs for yourself.

The minute these three things are not part of any contract or negotiations, your confidence and ability to earn income on your terms increases tremendously because walking away is much easier. That’s the most powerful move we have available.

Honestly, I wish I could go full PRN / 1099 but it's the job instability that scares me. I have been a W2 employee since I came out of training but have been thinking more and more of just switching to 1099.

 

[aneftp]

Honestly, I wish I could go full PRN / 1099 but it's the job instability that scares me. I have been a W2 employee since I came out of training but have been thinking more and more of just switching to 1099.

If u don’t have kids in school or family ties, there is close to zero reason to be w2 these days. Unless u got a kick ass w2 schedule. (Good hours/close to half the year off)

 

[CopaceticOne]

every anesthesiologist should keep this in mind and look closely at the following before signing any long term contracts

- distribution of labor
- control of scheduling and who has it

1,000% true

 

[aneftp]

I believe usap in Maryland has gone straight hourly for their full time (not just per diem) w2 employees at a few hospital.

I think that’s the future as well

Work more hours even if that means waiting for cases get paid more. Work more nights get paid more than daytime weekdays. Same with working more weekends. Get paid more.

Sure there are a few weakness that can be exposed with this hourly model by workers who will game it. But it solves 90% of the compensation problem.

As for non clinical or less than 20% clinical chiefs. We need to stop this charade. A chief who works less than 20 hours clinically in the OR shouldn’t be paid for full clinical work. If chief is 20% clinical and geting paid 700k w2 while regular staff get paid 450k. That’s a problem. I’d rather that chief be 100% non clinical and paid $450k. And divide that 250k leftover to the remaining staff

This basically handicaps the chief. Limits their power. But they are focus 100% on non clinical aspects a clinical staff won’t really get jealous because non clinical chief isn’t making 70% more than they are.

Because we know in these situations the chief who is 20% clinical tries to make up all these bs excuses they gotta be in meetings, schedule themselves post call Fridays etc. this eliminates the fake clinical chief.

 

[AKMD_1984]

Honestly, I wish I could go full PRN / 1099 but it's the job instability that scares me. I have been a W2 employee since I came out of training but have been thinking more and more of just switching to 1099.

2-3 part time 1099 gigs without a non compete
that’s the way to do it
even 2 would be fine

 

[AKMD_1984]

I believe usap in Maryland has gone straight hourly for their full time (not just per diem) w2 employees at a few hospital.

I think that’s the future as well

Work more hours even if that means waiting for cases get paid more. Work more nights get paid more than daytime weekdays. Same with working more weekends. Get paid more.

Sure there are a few weakness that can be exposed with this hourly model by workers who will game it. But it solves 90% of the compensation problem.

As for non clinical or less than 20% clinical chiefs. We need to stop this charade. A chief who works less than 20 hours clinically in the OR shouldn’t be paid for full clinical work. If chief is 20% clinical and geting paid 700k w2 while regular staff get paid 450k. That’s a problem. I’d rather that chief be 100% non clinical and paid $450k. And divide that 250k leftover to the remaining staff

This basically handicaps the chief. Limits their power. But they are focus 100% on non clinical aspects a clinical staff won’t really get jealous because non clinical chief isn’t making 70% more than they are.

Because we know in these situations the chief who is 20% clinical tries to make up all these bs excuses they gotta be in meetings, schedule themselves post call Fridays etc. this eliminates the fake clinical chief.

yes this fake non-clinical chief can be replaced by AI.

i have often been burnt by “oh the chief is on call and has a meeting and will be there shortly to take over the case”.

shortly turns into 3 hours.

and there was never a meeting.

imagine you’re stuck as an employee at these groups…no thanks.

 

[triggermaster]

We really need to redefine what a 501c executive pay should be.

Many 501c executive pay is in the 5-10 million range. It’s insane. And insurance companies won’t fight hospitals because they want to pick on the little guy (usap)

So if you support lawsuit vs usap. U are supporting the eventual hospitals take of anesthesia eventually. And than massive decreases in salaries as all hospitals in the region will collude to “keep costs” down by depressing physician salaries

We all know hospitals are fighting to keep the non competes in tact to limit completion.

That’s the irony of those clapping their hands of usap monopoly. What’s worst? Hospitals colluding together? I don’t know. Everything sounds bad

Then

 

[AKMD_1984]

the market overall has gotten smarter in terms of labor value and they won’t stand for mgt company antics. just look at the conversations on sdn.

5 years ago hardly anyone was doing locums. before covid, people were joining groups and hospitals are were either content with their jobs or didn’t really care to make noise. now the same groups are falling apart. some of it is their own doing.

now it’s a challenge to schedule someone to just interview. then if they agree, contract negotiations. then cost of labor/work and schedule the group desires which is often not clear on day 1. then benefits. i guess even if the rest of those things were tolerable, the lack of control is still a big one - when it comes to time off, case load sharing. many candidates find all this very risky to hand over control to someone - esp. experienced docs that know their value and worth.

i mean you can’t buy a clean profile, good skills, experience, adaptability and customer skill services at walmart. those aren’t taught in residency or tested on multiple choice exams. those take time to develop.

character of chairman and leadership matters as well. it matters when people get slick with you.

so many of us decided to take a chance on ourselves. form our own llcs and just do contract work. am i saying it’s easy? not easy - but it has different challenges but those are 100% under our control. if you don’t like the responsibility, don’t be independent. but if you like being compensated for your time and labor without cap on income, nothing else is better than to work for yourself.

 

[aneftp]

the market overall has gotten smarter in terms of labor value and they won’t stand for mgt company antics. just look at the conversations on sdn.

5 years ago hardly anyone was doing locums. before covid, people were joining groups and hospitals are were either content with their jobs or didn’t really care to make noise. now the same groups are falling apart. some of it is their own doing.

now it’s a challenge to schedule someone to just interview. then if they agree, contract negotiations. then cost of labor/work and schedule the group desires which is often not clear on day 1. then benefits. i guess even if the rest of those things were tolerable, the lack of control is still a big one - when it comes to time off, case load sharing. many candidates find all this very risky to hand over control to someone - esp. experienced docs that know their value and worth.

i mean you can’t buy a clean profile, good skills, experience, adaptability and customer skill services at walmart. those aren’t taught in residency or tested on multiple choice exams. those take time to develop.

character of chairman and leadership matters as well. it matters when people get slick with you.

so many of us decided to take a chance on ourselves. form our own llcs and just do contract work. am i saying it’s easy? not easy - but it has different challenges but those are 100% under our control. if you don’t like the responsibility, don’t be independent. but if you like being compensated for your time and labor without cap on income, nothing else is better than to work for yourself.

Big questions for you

1. Are you married?
2: do you have kids in school?

Very few true locums I know generally are empty nesters or close to empty nesters (kids in 11/12th grade) or single

 

[AKMD_1984]

Big question/ for you

1. Are you married?
2: do you have kids in school?

True locums I know generally are empty nesters or close to empty nesters (kids in 11/12th grade) or single

1. yes.
2. yes.

Well I don’t know what true locums means to you. However, plenty of people in my area do independent work or take locums gigs. They aren’t employed. For them, little bit of travel as needed is better than being stuck in a job with no control.

 

[aneftp]

1. yes.
2. yes.

Well I don’t know what true locums means to you. However, plenty of people in my area do independent work or take locums gigs. They aren’t employed. For them, little bit of travel as needed is better than being stuck in a job with no control.

good for u

Most of the guys I know in Florida have hybrid w2 20-30 weeks off jobs and supplement locums on top of that.

 

[AKMD_1984]

good for u

Most of the guys I know in Florida have hybrid w2 20-30 weeks off jobs and supplement locums on top of that.

there are plenty of groups that will offer 3-4 days a week gig but they’d expect 40-46 weeks of commitment.

i do not think it’s common to have a 20-30 week contract. i would love a 26 week week contract. that works too.

i suppose anything can be negotiated.

 

[aneftp]

there are plenty of groups that will offer 3-4 days a week gig but they’d expect 40-46 weeks of commitment.

i do not think it’s common to have a 20-30 week contract. i would love a 26 week week contract. that works too.

i suppose anything can be negotiated.

yeah. I calculated my w2 real hourly pay
500k/32 weeks of work divided by 40 hrs (I really work between 28-42 hrs ) that comes out to a true $390/hr as a w2. It’s not a bad deal as a w2.

That others at the sister trauma hospital who do a night float are 530k/26 weeks divided by 49 hrs (5p-7a) x 7 calls equals $416/hr for their actual hours worked as w2

Plus benefits.

It’s not a bad deal. These hybrid models. Plus do locums on top of it.

I don’t know why anyone would commit to a 44-46 week schedule these days as w2.

 

[AKMD_1984]

yeah. I calculated my w2 real hourly pay
500k/32 weeks of work divided by 40 hrs (I really work between 28-42 hrs ) that comes out to a true $390/hr as a w2. It’s not a bad deal as a w2.

That others at the sister trauma hospital who do a night float are 530k/26 weeks divided by 49 hrs (5p-7a) x 7 calls equals $416/hr for their actual hours worked as w2

Plus benefits.

It’s not a bad deal. These hybrid models. Plus do locums on top of it.

I don’t know why anyone would commit to a 44-46 week schedule these days as w2.

the 26 week jobs dont pay in 500k range in my area...they more like 300k range.

 

[amyl]

and that’s why all markets are local. Akmd is in the dreaded DFW area… sucks for amc dominance, sucks for attorney general endorsement of extended care team models. Texas sucks. And it’s full of idiots that think the sun rises and sets in dallas… or Plano/frisco… or southlake. It never felt like home to me I just stayed as long as I did for my husband.

San Antonio and bfe may be exceptions - idk

 

[aneftp]

and that’s why all markets are local. Akmd is in the dreaded DFW area… sucks for amc dominance, sucks for attorney general endorsement of extended care team models. Texas sucks. And it’s full of idiots that think the sun rises and sets in dallas… or Plano/frisco… or southlake. It never felt like home to me I just stayed as long as I did for my husband.

San Antonio and bfe may be exceptions - idk

My buddy in that same Frisco area clearing 1.5 million 1099 this year. Just brought himself another Ferrari. Depends how much u wanna hustle. He’s been in that area for 25 years.

But my 15 year old son just wants to drive his Porsche 911 c4s with apr tune.

 

[aneftp]

the 26 week jobs dont pay in 500k range in my area...they more like 300k range.

That sucks. In Florida they are popping up like hot cakes. 72 calls a year gig didn’t even hit the open market when the one doc announced he was leaving for family reasons (he has special needs child at home). So 72 calls out of 365 days a week. (293 days off). I don’t think the hourly pay is great (550k/72 calls/24 hr calls equals $318/hr) but u get massive days off.

They had docs still lining up and interviewing for the job when I told the young doc to take the job immediately because there is no negotiations. Someone would want it. Hospital employed w2. 550k. U can run it anyway u want it. 40 weeks off or 30 weeks off. Worst case is 26 weeks off if you want to pace yourself.

 

[zaitoun]

100%

once you have tasted independent work (locums or super prn), it’s really hard to go back to full time w2 jobs.

i refuse to be an instrument to someone else’s wealth
i refuse to be an instrument to someone else’s wealth
i refuse to be an instrument to someone else’s wealth

repeat it 10 more times…repeat it every day for a month and see how your life changes…

academics or hospital employment is at least a little bit more tolerable - your partners and you are treated the same (generally).

however, i look at amc leadership (clinical or admin) as just refined pimps. that’s what they are…often taking a commission over someone else’s labor without any real risk, skill or clinical contribution. they’re paper pushers exploiting your talent and labor.

i’d rather work for 1/2 price at a VA or an academic place than an amc with a known history to treat docs poorly or promote crnas.

honestly, i’d rather do charity cases where surgeons and patients are appreciative and i actually get reminded why i became a dr than play games with anesthesia groups. at least that work is fulfilling.

in my experience most clinical chiefs are sellouts. they’ve all cut deals for themselves. they’re nothing special nor do they care about you. thinking otherwise is foolishness and stupidity.

every anesthesiologist should keep this in mind and look closely at the following before signing any long term contracts

- distribution of labor
- control of scheduling and who has it

These things are learned over time, often after a lot of grief and loss. I suppose that’s what experience is.

Don’t let anyone get slick with you. If it smells funny, it probably is rotten.

Always have a one month “i hate this job clause” so you can exit without any issues.

Pay for your own malpractice, benefits, health insurance when you can - yes i know it sucks and it’s expensive…but don’t create handcuffs for yourself.

The minute these three things are not part of any contract or negotiations, your confidence and ability to earn income on your terms increases tremendously because walking away is much easier. That’s the most powerful move we have available.

are you saying to pay for own benefits, health insurance, malpractice even as a W2 employee? Why would anyone do that when it's offered in the employment contract?

 

[zaitoun]

My buddy in that same Frisco area clearing 1.5 million 1099 this year. Just brought himself another Ferrari. Depends how much u wanna hustle. He’s been in that area for 25 years.

But my 15 year old son just wants to drive his Porsche 911 c4s with apr tune.

Does he do locums at USAP sites?