VA Ruling

[Arch Guillotti]

---

Members don't see this ad.

No... most private practices now are controlled by crooks and used car salesmen, and those shady characters are either selling out to AMCs or just waiting for a good offer to sell out.

Not everybody😎

 

[BLADEMDA]

We pay tail no matter when someone leaves. People usually don't leave. Every group and hospital has been approached by AMCs. AMCs are at risk from loosing their contracts to other AMCs. AMC are the used car sales men and women who are constantly knocking on administrations door looking to make a deal. They are present at every big healthcare convention meeting CEOs promising the world and delivery nothing special that the previous group couldn't have done on their own.

Clearly there are certain regions of this country where shady PP groups are prevalent and my guess these are the same areas in which AMCs have done well.

To be fair AMCs collect $130-$140 per unit these days. My former group was lucky to get half that rate. This means we couldn't compete against the AMC in terms of subsidy requirement from the hospital. That is how they really steal a lot of contracts. The system is rigged against the little guy.

USAP, for example, is not a shady AMC. They formed to assist with billing rates to compete against the bigger players in this field. This gives the groups which sold/formed USAP a lot of leverage in terms of negotiating with insurance companies. In addition, the founders all got stock in the new company plus a buyout.

 

[GravelRider]

We pay tail no matter when someone leaves. People usually don't leave. Every group and hospital has been approached by AMCs. AMCs are at risk from loosing their contracts to other AMCs. AMC are the used car sales men and women who are constantly knocking on administrations door looking to make a deal. They are present at every big healthcare convention meeting CEOs promising the world and delivery nothing special that the previous group couldn't have done on their own.

Clearly there are certain regions of this country where shady PP groups are prevalent and my guess these are the same areas in which AMCs have done well.

The question was why some private practices are having trouble attracting new grads. The prevailing notion is that we don't want to work hard and that we are seeking lifestyle over pay. My point is to tell you that is wrong. I work hard and I'm technically a millennial and most of my co-residents are/were the same way. No one is trying to get out of work and no one expects things handed to them (though some partners in these shady private practices expect things handed to them).

A lot of new grads have heard stories or have friends who were screwed over by a dishonest private practice. No one really wants to work for NAPA or Sheridan, but you at least sort of know what you are getting with them. Our generation grew up having easy access to information and its suspicious when these private practices are giving vague promises about the future, especially after hearing some bad experiences from other people.

 

[Consigliere]

Wow GravelRider....you are getting absolutely f_ucked in the a_ss sans lube. I'm sorry you and others like you are in the deplorable situation you are in. Hang tough and as soon as something better comes up, get the f_uck outta there.

 

[IlDestriero]

Wow GravelRider....you are getting absolutely f_ucked in the a_ss sans lube. I'm sorry you and others like you are in the deplorable situation you are in. Hang tough and as soon as something better comes up, get the f_uck outta there.

Yeah, that job sucks. A good academic job will pay better on day 1 with less call and more vacation. Come over to the dark side. Go home at 3. Go weeks without call. Lower ceiling for sure, but life's not all about the money. My late day this week was 5pm. A good academic job will be better than most (all?) AMC jobs. Good luck in the job search.


--
Il Destriero

 

[deleted162650]

FWIW, my group has seen the opposite phenomenon. We have interviewed a number of fresh grads for per diem contractor spots (7-3, no nights/call/weekends and whatever time off you want) and they have all begged us for a partner-track spot which unfortunately we don't have openings for right now. And we have a significant albeit very fair buy-in.

 

[doctalaughs]

I work for a private practice with a fake partnership track. I didn't even interview with AMCs when I was finishing residency out of principle. That was a mistake. I work about 60-65 hours a week and just had a "raise" in my second year to 300k. I do about 70% my own cases and take in-house call at a fairly busy trauma center with busy OB. I now get 5 weeks vacation. I was completely duped by this whole partnership track private practice thing. If I would have signed on with an AMC or academic place I would have been better off financially and with my lifestyle. We have one or two partners in the practice who go to meetings and handle administrative stuff. The rest of the partners work less than half the hours I work and when they do work, they dump the "hard" cases on the new guys. Shall I go on?

I understand that there are fair and democratic private practices out there. Unfortunately, my story is not uncommon and new grads have heard too many of these stories. People kind of know what they are getting with an AMC. Are they being screwed by making 350k on 50-55 hours a week and 6 weeks vacation? Of course they are, but there is a level of transparency there that they don't get with a lot of private practices. All too often there is a sense of entitlement at these private practices where the guys who were there longer think they deserve something extra simply because they were there longer. When private practices say they can't hire new grads, it's not because of some whippersnapper millennial entitlement syndrome, it's because most private practices are viewed as being shady risks.

So are you actively looking for another job? Does anyone make partner and what makes the partnership tract "fake?"


Sent from my iPhone using SDN mobile

 

[deleted171991]

Yeah, that job sucks. A good academic job will pay better on day 1 with less call and more vacation. Come over to the dark side. Go home at 3. Go weeks without call. Lower ceiling for sure, but life's not all about the money. My late day this week was 5pm. A good academic job will be better than most (all?) AMC jobs. Good luck in the job search.


--
Il Destriero

Go home at 3? Not in my area (and probably Gravel's). It's more like go home at 5:30-6, even in academia.

 

[deleted171991]

So are you actively looking for another job? Does anyone make partner and what makes the partnership tract "fake?"


Sent from my iPhone using SDN mobile

The crappier a job is, the harder is to look for another. 😉

 

[Scotty_G]

I interviewed at Gravel's place back when I was a CA-3 and I'm happy I didn't take it 🙂 And those con-artists tried to get me to reconsider a year later lol.

 

[aneftp]

Yeah, that job sucks. A good academic job will pay better on day 1 with less call and more vacation. Come over to the dark side. Go home at 3. Go weeks without call. Lower ceiling for sure, but life's not all about the money. My late day this week was 5pm. A good academic job will be better than most (all?) AMC jobs. Good luck in the job search.


--
Il Destriero

Agree. Depends on the institution you are in. There are bad academic places and there are good academic places though. Like there are bad VA hospitals to work at and good VA hospitals. Bad Kaiser, good Kaisers.

 

[GravelRider]

Wow GravelRider....you are getting absolutely f_ucked in the a_ss sans lube. I'm sorry you and others like you are in the deplorable situation you are in. Hang tough and as soon as something better comes up, get the f_uck outta there.

No doubt it's terrible. My point is that there is this prevailing notion that young guys don't want to work and are only interested in lifestyle positions. I think that is false. If private practices are having a hard time recruiting new people it's because they are doing something shady or they have a reputation out there of being dishonest. Every single one of us knows someone who was screwed over by a bunch of con artists and that makes people a little trigger shy about taking a risk on a private practice these days.

 

[Arch Guillotti]

FWIW, my group has seen the opposite phenomenon. We have interviewed a number of fresh grads for per diem contractor spots (7-3, no nights/call/weekends and whatever time off you want) and they have all begged us for a partner-track spot which unfortunately we don't have openings for right now. And we have a significant albeit very fair buy-in.

Why isn't a partner track made available?

 

[GravelRider]

So are you actively looking for another job? Does anyone make partner and what makes the partnership tract "fake?"


Sent from my iPhone using SDN mobile

I won't go into specifics about the fake partnership. You can PM me if interested. I haven't jumped ship yet for a few reasons, but I do a lot of my own cases and often it's high acuity. I do everything except for hearts, so at the very least I'm gaining experience.

 

[deleted162650]

Why isn't a partner track made available?

We are in a position right now where our daytime workload increased substantially while our call burden has remained pretty much unchanged. We need daytime help but not more partners in the call pool. We felt this was a way to meet the need and not get into a position where we hire a partner track guy and end up not having enough work to go around if our volume trickles back down. We have a few peri-retirement guys. Once they call it quits they will replaced with more partner track dudes.

 

[deleted171991]

Why isn't a partner track made available?

 

[deleted162650]

Haha. Yes we run in the black on our contractors, but in return they get a pretty sweet lifestyle gig. They dictate their availability to us, they are always off at 3, they don't work weekends or nights - ever. It's a mommy track type thing. We have 2 contractors and close to 30 partners so it's not like we're running some pyramid scheme over here.

 

[ProRealDoc]

I hear your beef here but please tell me what you think all the hours I have spent in administrator after administrators office for the past 12 yrs convincing them that this practice is better as all MD? Yeah this practice that some new grad wants to waltz into and reap all the benefits that I have worked my arse off for. I have hired new grads many times and they frequently come in with absolutely zero concept of what the members of the group they feel "equal" to have done for them even before they entered residency or medical school in some cases.

To say that there is "absolutely nothing your racket does that the employee couldn't," is utterly and completely short sighted. The practice of anesthesia aside, it takes years for a new grad to contribute beyond doing cases. If you think this demands equal pay then we will have to completely disagree. And FFP, I know you and I don't often disagree.

So I say,Don't walk into my group and claim to be equal because you know how to do a safe anesthetic. Ever single new grad has a **** ton to learn. And anesthesia is also one of those things they still need to learn. No "you" are not equal. But we think you have what it takes and we are pleased to have you join our practice to continue to hone your skills. Sit back, pay attention, and don't complain. If thats too hard to do then JOIN an AMC and punch a clock like a nurse. But if you want to be a doctor then stick around.

Harsh words, I know. But reality is real. And I'm sure many will think a lot less of me for this post but I only speak what I know.

 

[deleted171991]

Haha. Yes we run in the black on our contractors, but in return they get a pretty sweet lifestyle gig. They dictate their availability to us, they are always off at 3, they don't work weekends or nights - ever. It's a mommy track type thing. We have 2 contractors and close to 30 partners so it's not like we're running some pyramid scheme over here.

I wasn't suggesting otherwise. The fact that you have 30 partners says everything.

 

[skypilot]

MD only doesn't necessarily mean an absolute pay cut. My MD only practice makes about the same $/doc as many ACT practices. MD only does require more docs staying late and less vacation time however. I would argue that it's a helluva lot less stressful and more enjoyable than puttin on your roller skates and "covering" 4 rooms though.

Yes, when you are doing your own cases you end up with a much less predictable schedule. You might have no idea if you will be done by 4 pm or by 7 pm. There may even be more call and very slightly less money. But there is a lot of satisfaction that comes with being able to control every single one of your outcomes to the best of your ability.

 

[Arch Guillotti]

We are in a position right now where our daytime workload increased substantially while our call burden has remained pretty much unchanged. We need daytime help but not more partners in the call pool. We felt this was a way to meet the need and not get into a position where we hire a partner track guy and end up not having enough work to go around if our volume trickles back down. We have a few peri-retirement guys. Once they call it quits they will replaced with more partner track dudes.

Why don't you stretch out the call some and put some of the call pool people on during the day?

If the volume trickles down there should be someone on the cusp of retirement.

I can understand your justification for taking the approach that you are, but I think there are other ways to go about it.

 

[deleted162650]

Why don't you stretch out the call some and put some of the call pool people on during the day?

If the volume trickles down there should be someone on the cusp of retirement.

I can understand your justification for taking the approach that you are, but I think there are other ways to go about it.

Everyone is scheduled essentially equal amounts of call. Traditionally the call people get to come in late and be off post-call but lately we have been working "pre" and post-call due to additional site acquisitions (outpatient and GI stuff). If the trend continues towards increased volume then we will certainly hire more partner track people, but we are kinda on the cusp right now. We never want to "over-promise and under-deliver" with new hires so this is where we're at now. So far it's been working out for us and the contractors we have are happy with their situation as there's really no other jobs in the area that offer anything similar.

 

[Shimmy8]

I interviewed for a pp position with a 2 year associate track to partner and then a graduated buy in over the next 2 years as a partner (only receive partial partner share). Set up was a bit weird, but understandable. However, I ended up not taking the job partially because it was like pulling teeth trying to get the $$$ info about how much more partners made on average. Completely dumbfounding that they were being shady about this information and not offer it without me asking even on the interview. Didn't trust them.

Anyway, I took a job with what I guess could be described as a regional AMC in the South and am very happy. Like GravelRider said, I know my financial ceiling is capped but it's completely transparent, I have friends in the group that are very happy and not being screwed, and I'll have a life. I may end up going academic later in life but right now I'm happy with how things worked out.

 

[zero0]

I noticed you guys are pretty stoked on this ASA Member meme lately. Does this have anything to do with it?

 

[floridaboy18]

I hate to be the party pooper but the fight isn't exactly over. There is a 30 day comment period still to go. This is a comment from the VA:

The VA gave some background on its decision to leave the nurse anesthetists out of getting full practice authority. "We received 104,256 comments against granting full practice authority to VA CRNAs," the authors noted. "The American Society of Anesthesiologists lobbied heavily against VA CRNAs having full practice authority. They established a website that would facilitate comments against the CRNAs, which went as far as providing the language for the comment. These comments were not substantive in nature and were akin to votes in a ballot box."

So as we are now in a strong position, but we are still in need of support. Make comments but make them personal.

Where can the comments be made this time?

Sent from my SM-N910V using Tapatalk

 

[DrCommonSense]

That's what the management fee is for. Don't tell me that all partners have similar contributions. 😉

I will happily pay the person who works his butt off to keep the group running. I won't work my butt off for the wiseguy whose only merit is that he was there earlier, and who works less than I do. I don't believe in "seniority".

So yeah, you will see people like me trying to get an acceptable salary for a decent amount of work, and have a life, not work their butts off for some extra crumbs from the lords' table, just because we are not part of the local old boys' club. I don't have a problem with working a lot, just with being taken advantage of.

Wow so damn true.

Usually its only one person that did all the "work" to keep a contract for a partnership. That person should be paid a management fee for all that effort.

Outside of him/her, everyone should be paid the same for equal work.

 

[aneftp]

Wow so damn true.

Usually its only one person that did all the "work" to keep a contract for a partnership. That person should be paid a management fee for all that effort.

Outside of him/her, everyone should be paid the same for equal work.

My previous group the two main guys paid themselves at $70K extra "management fee". But other than that, it was equal money for everyone. The founded the group 17 years ago and had to borrow roughly 300K money to start up the practice. So they took risks to start the practice. And have to attend most of the hospital meetings with administration and surgeons.

 

[DrCommonSense]

My previous group the two main guys paid themselves at $70K extra "management fee". But other than that, it was equal money for everyone. The founded the group 17 years ago and had to borrow roughly 300K money to start up the practice. So they took risks to start the practice. And have to attend most of the hospital meetings with administration and surgeons.

Yeah that sounds fair.

However, the vast majority of partnerships aren't "fair" like that these days.

Also, with the CRNA pressures coupled with the AMC pressures, many of these groups will sell out over the next few years before new grads obtain a "partnership".

 

[DrCommonSense]

Victory is sweet indeed.

How permanent is this ruling? When can they revisit the decision again?

Just read the comments from the militant CRNAs when that chief of anesthesia in Michigan wrote an OpEd article about needing anesthesiologists. The CRNAs were literally saying things such as "no need for docs who are overpaid and twice as expensive".

The head of the CRNAs organization also chimed in that docs are overpaid and should only work in "collaboration" models.

So I doubt the CRNAs aren't going to attempt to keep fighting this forever.

 

[aneftp]

How permanent is this ruling? When can they revisit the decision again?

Just read the comments from the militant CRNAs when that chief of anesthesia in Michigan wrote an OpEd article about needing anesthesiologists. The CRNAs were literally saying things such as "no need for docs who are overpaid and twice as expensive".

The head of the CRNAs organization also chimed in that docs are overpaid and should only work in "collaboration" models.

So I doubt the CRNAs aren't going to attempt to keep fighting this forever.

What the public doesn't realize is Crna's aren't cheaper.

Unless they are employed by hospital or management company.

But the ASA needs to inform the public (and just focus on Medicare cause the public doesn't understand the complex private insurance billing). But ASA needs to keep it simple by telling the public anesthesia billing is the same with Md or crna. So the Medicare system isn't saving a single cent.

 

[aneftp]

If crnas want independence. Let Sheridan employ them as solo crnas. Let's see how much "cheaper" they are when they are making 180-200K solo cases and working 55-60 hours a week for Sheridan full time with calls 1:4/5 and lates. Plus weekend calls.

 

[Noyac]

Where can the comments be made this time?

Sent from my SM-N910V using Tapatalk

http://www.safevacare.org/

 

[aneftp]

http://www.safevacare.org/

https://www.regulations.gov/comment?D=VA-2016-VHA-0011-178740

 

[DrCommonSense]

What the public doesn't realize is Crna's aren't cheaper.

Unless they are employed by hospital or management company.

But the ASA needs to inform the public (and just focus on Medicare cause the public doesn't understand the complex private insurance billing). But ASA needs to keep it simple by telling the public anesthesia billing is the same with Md or crna. So the Medicare system isn't saving a single cent.

You're 100% correct. There will be ZERO cost savings for the patients or insurers, so from a cost/benefit savings for the general society, its a wash with less trained providers with no supervision to boot.

However, there are very powerful interests backing the CRNAs including:

1) Democratic party who most support strong nursing lobbies.
2) Hospital Administration/CEOs so that they can just end subsidies and pocket the difference for their own bonuses
3) CRNA lobbies and major nursing organizations
4) Political "think thanks"
5) Liberal Media such as the NYTimes, Washington Post, etc.
6) Some Republican members of Congress who look at this as a "free market issue"
7) VA leadership

Possible people on the side of Anesthesiologists:

1) ASA and possibly AMA
2) Lukewarm support from Surgeons (probably most from cardiac guys due to TEE needs, others not so sure) due to liability issues due to "needing to supervise" CRNAs. That is why CRNAs are trying to get that rule removed so that surgeons won't be concerned about liability issues.
3) Some pro physician Republicans


The most critical support would come from patients when they are TOLD that the costs of removing physician supervision will give them ZERO financial benefit/insurance cost benefit but will decrease their safety due to less oversight of CRNAs.

That is the best method I think as a PR campaign. That is why the CRNAs are strongly trying to show there is no safety difference.


I truly think the CRNA militant behavior is due to jealousy of Anesthesiologists salaries.

Why would they want independence? They will just have more liability, no back up and no increase in salaries due to oversupply of providers.

The only benefit will be the hospital administrators that can pocket the difference.

 

[Mman]

No... most private practices now are controlled by crooks and used car salesmen, and those shady characters are either selling out to AMCs or just waiting for a good offer to sell out.

Well I'm sure you have personally verified the reputability of every private group in the country so you can comment on what percentage are controlled by crooks or shady characters. The vast majority of private groups I am aware of personally are on the up and up. I do know several, though, that sold out to AMCs. I didn't think highly of them before they sold out, though, so it wasn't a surprise. I do not personally know enough, however, to comment on the majority nationally.

I do find the viewpoint by some, however, that all private groups are evil and trying to screw over new grads to be somewhat of an urban legend that is grounded more in hearsay than in fact. I mean if you read it online somewhere it must be true, right?

IMHO there are good groups and bad groups. Same as always. The only way you will know for sure ahead of time is to have a personal connection from within that can give you the honest answer.

 

[deleted126335]

Well I'm sure you have personally verified the reputability of every private group in the country so you can comment on what percentage are controlled by crooks or shady characters. The vast majority of private groups I am aware of personally are on the up and up. I do know several, though, that sold out to AMCs. I didn't think highly of them before they sold out, though, so it wasn't a surprise. I do not personally know enough, however, to comment on the majority nationally.

I do find the viewpoint by some, however, that all private groups are evil and trying to screw over new grads to be somewhat of an urban legend that is grounded more in hearsay than in fact. I mean if you read it online somewhere it must be true, right?

IMHO there are good groups and bad groups. Same as always. The only way you will know for sure ahead of time is to have a personal connection from within that can give you the honest answer.

Yes that is true. But some things are different now. The risk/reward ratio of a partnership buy in has never been higher. What is also true is that there are plenty of dishonorable people out there. What is also true is that otherwise honorable people will do dishonorable things when faced with a hit to their income. An honorable person I know who is president of a good group recently increased their partnership track time from two years to four years. His position is the market has changed and why should we pay more than market price for a solid doc? Hard to argue. But the risk of a long buy in has never been higher. I don't envy new grads. I think that you are extrapolating your obviously good local situation and market to the whole country. It is a lot harder for lots of people looking for jobs now.

 

[Mman]

I think that you are extrapolating your obviously good local situation and market to the whole country. It is a lot harder for lots of people looking for jobs now.

No, I'm merely commenting on the jobs of friends from residency that are scattered about the country. I mean maybe they lie to me about how good they have it, but none of them took me up on a job offer when we needed to hire somebody so they can't have it too rough. I also still talk to attendings at my former residency and ask about what kinds of jobs grads are heading to. We keep a pretty tight network so it's not hard to see what the current market is.

 

[GravelRider]

Well I'm sure you have personally verified the reputability of every private group in the country so you can comment on what percentage are controlled by crooks or shady characters. The vast majority of private groups I am aware of personally are on the up and up. I do know several, though, that sold out to AMCs. I didn't think highly of them before they sold out, though, so it wasn't a surprise. I do not personally know enough, however, to comment on the majority nationally.

I do find the viewpoint by some, however, that all private groups are evil and trying to screw over new grads to be somewhat of an urban legend that is grounded more in hearsay than in fact. I mean if you read it online somewhere it must be true, right?

IMHO there are good groups and bad groups. Same as always. The only way you will know for sure ahead of time is to have a personal connection from within that can give you the honest answer.

And this is unacceptable: "The only way you will know for sure ahead of time is to have a personal connection from within that can give you the honest answer." Therein lies the problem. When you can't trust the used car salesman selling you the jalopy, it's just safer to assume that they all are crooks. When I have close to $300k in loan debt, I'll take my business to the big auto-mart down the road where I will at least get some kind of warranty. The dishonesty of the private practice jokers has contributed to the spread of AMCs.

 

[sevoflurane]

And this is unacceptable: "The only way you will know for sure ahead of time is to have a personal connection from within that can give you the honest answer." Therein lies the problem. When you can't trust the used car salesman selling you the jalopy, it's just safer to assume that they all are crooks. When I have close to $300k in loan debt, I'll take my business to the big auto-mart down the road where I will at least get some kind of warranty. The dishonesty of the private practice jokers has contributed to the spread of AMCs.

I agree with Mman here. You seem like someone who is just out of residency and landed a bad job and are projecting your experience.
Just on this board alone we have many anesthesiologists in some really solid groups- and I'm counting the people I actually know.
Yeah... we are not killing it like it was 2005 anymore. It's also not the mid 90's where you are making 90k and picking up extra shifts in the ED.
Things could be much worse.

 

[Planktonmd]

Well I'm sure you have personally verified the reputability of every private group in the country so you can comment on what percentage are controlled by crooks or shady characters. The vast majority of private groups I am aware of personally are on the up and up. I do know several, though, that sold out to AMCs. I didn't think highly of them before they sold out, though, so it wasn't a surprise. I do not personally know enough, however, to comment on the majority nationally.

I do find the viewpoint by some, however, that all private groups are evil and trying to screw over new grads to be somewhat of an urban legend that is grounded more in hearsay than in fact. I mean if you read it online somewhere it must be true, right?

IMHO there are good groups and bad groups. Same as always. The only way you will know for sure ahead of time is to have a personal connection from within that can give you the honest answer.

The ones who are on "the up and up" are the ones who got together with other groups and became mega groups, thes are basically AMCs under a different name, the rest are crooks and used car salesmen trying to make a buck by scamming the young gullible guys.

 

[Mman]

And this is unacceptable: "The only way you will know for sure ahead of time is to have a personal connection from within that can give you the honest answer." Therein lies the problem. When you can't trust the used car salesman selling you the jalopy, it's just safer to assume that they all are crooks. When I have close to $300k in loan debt, I'll take my business to the big auto-mart down the road where I will at least get some kind of warranty. The dishonesty of the private practice jokers has contributed to the spread of AMCs.

That's fine, you can assume everyone is a crook, but that's the equivalent of someone arguing that bonds are a safer investment than stocks because they don't have the risk of dropping as much. Parking your money in bonds for 40 years instead of stocks ensures you will have a lower return, but if that is "safer" to you than the risk of making more money, go be safe.

And I'm not telling you what to do, I'm just saying that I wouldn't throw the baby out with the bathwater. There are some legitimately good and great groups still out there and they still hire people and they still make them partner. If my group imploded tomorrow, I wouldn't go work for an AMC. I'd go take a partnership track job with a private group that I knew people at. I'd pay my dues again and a few years down the road enjoy the benefits of becoming an owner rather than an employee.

 

[Mman]

The ones who are on "the up and up" are the ones who got together with other groups and became mega groups, thes are basically AMCs under a different name, the rest are crooks and used car salesmen trying to make a buck by scamming the young gullible guys.

So basically you have no idea what you are talking about but like to rant and rave against perceived injustice? Thanks.

 

[Planktonmd]

So basically you have no idea what you are talking about but like to rant and rave against perceived injustice? Thanks.

No I think you are the one who is constantly trying to advertise for your group on this forum. It is very obvious that you are in one of those mega groups that is basically an AMC pretending to be a private group to get more victims.
I also think you are one of those new guys who finally made it to the high ranks of the crooks in your group (used car dealership), and now since they gave you a seat at the table you feel entitled to screw the new guys. I bet you your senior "partners" laugh at you when they see how greedy you have suddenly become after they let you think you are a boss!

 

[Planktonmd]

Not everybody😎

True... not everybody... but most.

 

[GravelRider]

That's fine, you can assume everyone is a crook, but that's the equivalent of someone arguing that bonds are a safer investment than stocks because they don't have the risk of dropping as much. Parking your money in bonds for 40 years instead of stocks ensures you will have a lower return, but if that is "safer" to you than the risk of making more money, go be safe.

And I'm not telling you what to do, I'm just saying that I wouldn't throw the baby out with the bathwater. There are some legitimately good and great groups still out there and they still hire people and they still make them partner. If my group imploded tomorrow, I wouldn't go work for an AMC. I'd go take a partnership track job with a private group that I knew people at. I'd pay my dues again and a few years down the road enjoy the benefits of becoming an owner rather than an employee.

It's actually not like stocks and bonds at all. You said the only way to know if a group is being honest is to know someone on the inside. That is a problem because it implies there are a lot of groups who are being dishonest and it's just the applicant's problem for not having the inside info.

The topic came up because someone asked why a new grad would take an AMC job over a private practice job. I'm just telling you that in most regions of the country (maybe not yours), the private practices are viewed as being dishonest crooks who have screwed people over. That's all. I'm not here to debate the merits of private practice vs. AMC. We would all prefer to work in a private practice, but most have become pyramid schemes where the new guys will never have the perks of the guys who were simply there longer.

 

[GravelRider]

I agree with Mman here. You seem like someone who is just out of residency and landed a bad job and are projecting your experience.
Just on this board alone we have many anesthesiologists in some really solid groups- and I'm counting the people I actually know.
Yeah... we are not killing it like it was 2005 anymore. It's also not the mid 90's where you are making 90k and picking up extra shifts in the ED.
Things could be much worse.

Again, I was just responding to the question of why a new grad would take an AMC job over a private practice job.

 

[Mman]

It's actually not like stocks and bonds at all. You said the only way to know if a group is being honest is to know someone on the inside. That is a problem because it implies there are a lot of groups who are being dishonest and it's just the applicant's problem for not having the inside info.

The topic came up because someone asked why a new grad would take an AMC job over a private practice job. I'm just telling you that in most regions of the country (maybe not yours), the private practices are viewed as being dishonest crooks who have screwed people over. That's all. I'm not here to debate the merits of private practice vs. AMC. We would all prefer to work in a private practice, but most have become pyramid schemes where the new guys will never have the perks of the guys who were simply there longer.

I hear everything you are saying, but when you say "most have become pyramid schemes" I fundamentally disagree. You don't have the knowledge of that many groups to say that. I don't have the knowledge. Nobody does. I'm just telling you there are still lots of good groups out there. You can say there are bad groups out there. There are. I agree. But there are also good groups out there.

And it is like stocks and bonds in that working for an AMC might have less potential downside than joining a private group (like a bond), but it also has substantially less potential upside (like a stock).

I'm not here to tell people what to do with their lives. It's a personal decision. I'm just saying based on my experience and my knowledge that if I lost my job tomorrow, I would go join another private group on a parter track. That's what I would do, no questions asked.

 

[deleted171991]

The ones who are on "the up and up" are the ones who got together with other groups and became mega groups, thes are basically AMCs under a different name, the rest are crooks and used car salesmen trying to make a buck by scamming the young gullible guys.

I had at least one interview where I was told that "we are looking for fresh grads, because they accept lower salaries". I hadn't even asked about compensation yet. I appreciated the honesty. Others just stopped talking to me once they saw I was not wide-eyed and gullible. They were not looking for competent anesthesiologists, they were looking to make money on their employees' backs.

Gaswork is choke-full of bad jobs. For the uninitiated, the way to recognize those is that the announcement is up for many-many months, if not years. They are fishing for suckers. It doesn't cost them much, especially if they use a recruiter. They just lie in waiting, like the predators they are. They are smart, so they tend to delete and repost the job announcements, to seem fresh for the untrained eye. Just by watching one's state for years, one can learn a lot about the crap out there. One can even see when they found a sucker, the job goes away for a year or two, then it always comes back (and that's how one knows it's a bad one).

I never really knew what the rat race was, as a doctor, until I moved to the US. It's sad. By the time young grads realize what they signed up for by choosing this specialty, there is no turning back.

 

[Mman]

Gaswork is choke-full of bad jobs.

I agree that gaswork is a relatively terrible way to look for a job. It's basically fishing for suckers.

 

[deleted171991]

I agree that gaswork is a relatively terrible way to look for a job. It's basically fishing for suckers.

For people who are not "in-network", meaning most recent grads, that's the only way. And don't think the leads we got from residency or fellowship were much better (except if academic). There are so few good jobs and so many docs... One can choose between a predatory PP or a predatory AMC, except that the AMC is more transparent.