Want to work in Phoenix, AZ?

[Consigliere]

No problem. You'll be an AMC employee.

http://www.businesswire.com/news/ho...an-Services-Division-Sheridan-Acquires-Valley

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[urge]

Partnerships are dead.

 

[Twiggidy]

Partnerships are dead.

They really are. As I've posted somewhere else, if you're in medicine to "be your own boss" then anesthesiology had better be the LAST choice on your list (outside of pain...maybe)

 

[mostwanted]

I think as crazy as it maybe to work for an AMC, it is the older folks who have screwed the specialty the most. Even now 80-90% of desirable jobs, senior partners make every attempt to take advantage of the young folks. So stop all this whining, I would even say working for some of these AMCs is better than many of these "partnership" tracks, where you get raped for a few years and then tossed to the curve.

 

[Mad Jack]

I think as crazy as it maybe to work for an AMC, it is the older folks who have screwed the specialty the most. Even now 80-90% of desirable jobs, senior partners make every attempt to take advantage of the young folks. So stop all this whining, I would even say working for some of these AMCs is better than many of these "partnership" tracks, where you get raped for a few years and then tossed to the curve.

And that's in addition to the old guard selling out to AMCs in the first place. But hey, that's business.

 

[pgg]

I think as crazy as it maybe to work for an AMC, it is the older folks who have screwed the specialty the most. Even now 80-90% of desirable jobs, senior partners make every attempt to take advantage of the young folks. So stop all this whining, I would even say working for some of these AMCs is better than many of these "partnership" tracks, where you get raped for a few years and then tossed to the curve.

Sign a better contract. Be willing to walk (ie, relocate) if the "partnership" track looks like smoke and mirrors.

 

[ambiturner]

Did anyone else love that the president of the selling-out physician group's name was Robert coward? Because I thought that was delicious.

 

[Mman]

They really are. As I've posted somewhere else, if you're in medicine to "be your own boss" then anesthesiology had better be the LAST choice on your list (outside of pain...maybe)

Employed surgeons, IM docs, OBs, cardiologists, GI, etc all disagree.

 

[criticalelement]

I think as crazy as it mybe to work for an AMC, it is the older folks who have screwed the specialty the most. Even now 80-90% of desirable jobs, senior partners make every attempt to take advantage of the young folks. So stop all this whining, I would even say working for some of these AMCs is better than many of these "partnership" tracks, where you get raped for a few years and then tossed to the curve.

Agreed. The anesthesia business model of exploitation has been alive for a long long long time. Nothing new. Just new players in town.

 

[criticalelement]

Sign a better contract. Be willing to walk (ie, relocate) if the "partnership" track looks like smoke and mirrors.

Spot on.

Keep moving.

They turn the tables on you.. take a walk.

 

[Twiggidy]

Employed surgeons, IM docs, OBs, cardiologists, GI, etc all disagree.

The only slight difference is that in those specialties you have the ability to at least make an attempt to be independent, even if you're not making big money you can't still have your own practice. We can't say that in our field. We always work for someone else. We're splitting hairs but you really know what I mean.

 

[urge]

The only slight difference is that in those specialties you have the ability to at least make an attempt to be independent, even if you're not making big money you can't still have your own practice. We can't say that in our field. We always work for someone else. We're splitting hairs but you really know what I mean.

I don't think any independent physician can survive the next 5 years.

Actually, I correct myself, those who are highly regarded and take cash only will survive. I don't expect any anesthesiologist to fall in this category.

 

[GA8314]

I don't think any independent physician can survive the next 5 years.

Actually, I correct myself, those who are highly regarded and take cash only will survive. I don't expect any anesthesiologist to fall in this category.

You guys are looking through the prism of the larger urban centers or major suburban areas. There are plenty of smaller groups in the community whom aren't going to be impacted nearly as expediently as you suggest.

In fact, I really think that the FAD which we are seeing in the AMC's can be outlasted by these smaller groups which are often off the radar. We'll see. I hope so, since mine is such a group.

The AMC's have trended towards going after the larger, urban/suburban super profitable groups. Like the ones where the full partners were making 600+ with no stipends.... That's also not my group.....

 

[sevoflurane]

The sad thing about Valley is that they had a 5 year partnership track and it's my understanding that they left out those who did not make partner. 50+ employees at different stages of partnership (hearsay).

That's a huge punch in the gut. Terrible if you were months away from making partner.

 

[GaseousClay]

America's finest city is next up. SMH...

 

[BLADEMDA]

The sad thing about Valley is that they had a 5 year partnership track and it's my understanding that they left out those who did not make partner. 50+ employees at different stages of partnership (hearsay).

That's a huge punch in the gut. Terrible if you were months away from making partner.

That's wrong. AMSurg/Sheridan must have paid out 400 million plus to buy them. I seriously doubt that Sheridan would have walked away from the deal if they demanded another 30 million more to pay those employees. Every single employee on a partner track should have gotten his/her cut. It's pure greed to exclude these physicians from the pot.

The way I see it every partnership track doctor deserved a fair cut from the deal. Even someone in year 2 should have received money. For example, 22/60 x 2 million (my bet is the number was closer to $3 million) means that doctor should have received $733,000.

Legally, the doctor in his/her final year of the track was owed nothing. Ethically and Morally the group should have paid her/him at least 4/5 buyout. Residents need to learn from this screw job to never sign on to a track without a clause specifying that you will be part of any buyout deal if one occurs during the track.

 

[GaseousClay]

That's wrong. AMSurg/Sheridan must have paid out 400 million plus to buy them. I seriously doubt that Sheridan would have walked away from the deal if they demanded another 30 million more to pay those employees. Every single employee on a partner track should have gotten his/her cut. It's pure greed to exclude these physicians from the pot.

The way I see it every partnership track doctor deserved a fair cut from the deal. Even someone in year 2 should have received money. For example, 22/60 x 2 million (my bet is the number was closer to $3 million) means that doctor should have received $733,000.

these *****s must be financially stupid for accepting a deal like that. from what I heard the MDs in phoenix were making well above 500k. why would they take $733k to take paycuts and lose the autonomy of owning their own group? and from what I hear from the potential SD buyout, the non partners are getting nothing or very little compared to the partners.

 

[BLADEMDA]

these *****s must be financially stupid for accepting a deal like that. from what I heard the MDs in phoenix were making well above 500k. why would they take $733k to take paycuts and lose the autonomy of owning their own group? and from what I hear from the potential SD buyout, the non partners are getting nothing or very little compared to the partners.

Please don't misunderstand my post. The partners received $2-$3 million each for the buyout plus salaries in the $400K range for 5-7 years and possibly AMSURG stock as well.

The employee received nothing but should have gotten 22 months on the track divided by the 60 month track times the total buyout per partner. That works out to $733,000 for the hypothetical doctor 22 months into his/her 60 month track.

 

[PainDrain]

Please don't misunderstand my post. The partners received $2-$3 million each for the buyout plus salaries in the $400K range for 5-7 years and possibly AMSURG stock as well.

The employee received nothing but should have gotten 22 months on the track divided by the 60 month track times the total buyout per partner. That works out to $733,000 for the hypothetical doctor 22 months into his/her 60 month track.

I have it on good authority that these numbers are way off. Much higher than reality.

 

[GaseousClay]

I have it on good authority that these numbers are way off. Much higher than reality.

if its anything less than $2million then those partners are suckers

 

[urge]

I have it on good authority that these numbers are way off. Much higher than reality.

Numbers seem awfully high. Why would anyone bid so much for a contract that expires in a few years?

 

[sevoflurane]

Those numbers seem high.

But to answer urges point...

How do you replace 260+ anesthesiologists that have deep ties to administration and the community all at once?

Answer:
Not very easily.

 

[ranvier]

PM me if interested in working in phoenix and performing your own cases.

 

[GaseousClay]

PM me if interested in working in phoenix and performing your own cases.

for Sheridan?

 

[ranvier]

There are small groups fighting the good fight.

 

[BLADEMDA]

if its anything less than $2million then those partners are suckers

I can guarantee you that at least a few super partners were Paid off quite well if the standard buyout wasn't at least $2 million each. It is common for the super partners to get $5-$7 million each while the regular partners get $1.5 or so. It Isn't fair but what do you expect from a group excluding someone 4 years into a 5 year track.

There simply isn't a reason to sell out unless the package is large or the super partners force the sale. No way I'd sell out in Phoenix for less than $2 million. Again, someone got paid quite well in terms of cash, stock, future management job, etc or all the above to make this deal happen.

Job security at a group of 260 plus is very good so why sell for pennies on the dollar? Sorry, but the math doesn't add up here as these lucrative groups command a premium in the market.

 

[pgg]

The sad thing about Valley is that they had a 5 year partnership track

Man, a person would have to be nuts to sign up for a partnership track that long.

 

[BLADEMDA]

Man, a person would have to be nuts to sign up for a partnership track that long.

and then get nothing after the super partners sell out to the AMC.

 

[Carbocation1]

I understand that AMCs are a big force right now. But what's the general consensus on the status of AMCs/employment opportunities for new grads circa 2018-20 when bundled payments/single payer happen? Will gas still be one of the better paid specialists in medicine? Or will the low valuation of anesthesia services by Medicrap/CMS degrade gas salaries towards the Primary Care range? Thanks.

 

[BLADEMDA]

I understand that AMCs are a big force right now. But what's the general consensus on the status of AMCs/employment opportunities for new grads circa 2018-20 when bundled payments/single payer happen? Will gas still be one of the better paid specialists in medicine? Or will the low valuation of anesthesia services by Medicrap/CMS degrade gas salaries towards the Primary Care range? Thanks.

Circa 2016 Anesthesia is an "above average" reimbursement specialty compared to the others. That's my view of the salary ranges circa 2016. So, what about 2020? I suspect "average" will be the norm which is still higher than primary care.

 

[Mman]

Circa 2016 Anesthesia is an "above average" reimbursement specialty compared to the others. That's my view of the salary ranges circa 2016. So, what about 2020? I suspect "average" will be the norm which is still higher than primary care.

I view forecasts of future income in our specialty the same way I do forecasts of corporate earnings or stock performance. The immediate forecasts are pretty damn good. Companies know how much money they will likely earn next quarter. But when you start looking out years in advance, the guesses get a lot less accurate.

I'm pretty confident nothing will drastically change for anesthesia in 2016. I'm slightly less confident in 2017. Beyond that I'm not sure and your guess mostly depends if you are an optimist or a pessimist. Personally I feel we will continue to experience slightly decreasing revenues per patient over the next 5-10 years but no draconian cuts. Those at the top of the food chain (AMCs, hospitals, university departments, super partners in pyramid schemes/groups) will continue to maintain their revenue while squeezing more from the bottom of the food chain (new grads).

 

[deleted162650]

Man, a person would have to be nuts to sign up for a partnership track that long.

Ya I think Valley was a bad deal. 5 years is beyond excessive and they were also known to let people go at the 4.5 year mark. I think if you signed on for that kind of abuse you shouldn't even be upset/surprised when you get screwed out of a big buy-out deal (fool me once . . .). There are other fair and equally if not more lucrative options in the Phoenix metro area.

 

[aneftp]

That's wrong. AMSurg/Sheridan must have paid out 400 million plus to buy them. I seriously doubt that Sheridan would have walked away from the deal if they demanded another 30 million more to pay those employees. Every single employee on a partner track should have gotten his/her cut. It's pure greed to exclude these physicians from the pot.

The way I see it every partnership track doctor deserved a fair cut from the deal. Even someone in year 2 should have received money. For example, 22/60 x 2 million (my bet is the number was closer to $3 million) means that doctor should have received $733,000.

Legally, the doctor in his/her final year of the track was owed nothing. Ethically and Morally the group should have paid her/him at least 4/5 buyout. Residents need to learn from this screw job to never sign on to a track without a clause specifying that you will be part of any buyout deal if one occurs during the track.

My friend was on year 4 of a 5 year partnership before mednax purchased the group.

He did get 750k payment.

So blade u are spot on. If group is fair they will give those in partnership track partial payment.

 

[aneftp]

One of biggest disadvantages of working for AMC (assume W2) is the tax disadvantage.

Most have zero 401k (or equivalent matching)

This mean the most you could sock away us $18-23k a year pretax ($5000 is age 50 or older catch up).

I don't want to make $330-350k W2 and be exposed to that much tax liability with AMC.

Better to get paid 350k 1099 with no benefits. Sock away 50k plus away and pay less in taxes. Since most AMC benefits suck anyways.

 

[jimbomd]

Heard partners walked away w $1.9m each. Friend of a friend who is a partner there.

 

[caligas]

Heard partners walked away w $1.9m each. Friend of a friend who is a partner there.

Is that taxed as capital gains?

 

[jimbomd]

yes

 

[kaioukenx]

Speaking as a recent grad, private practice jobs hardly seem worth it to try to navigate nowadays. The subset of groups that have fair pay, a reasonable partnership track, current partners that won't screw you over, AND have security from AMC takeovers - well, it seems to be growing smaller by the week. It just isn't the percentage play.

That's not to say that the non-PP jobs are necessarily good, but there is something to be said for stability and peace of mind. Not to mention, financial planning for the future becomes easier when you don't have to consider the presence/absence of an incoming pot of gold. Maybe there will be rock stars that can circumvent the current environment, but for an anesthesiologist with average (or even above average) business acumen and negotiating savvy, it just seems like a leap of faith to wander into murky waters.

One of biggest disadvantages of working for AMC (assume W2) is the tax disadvantage.

Most have zero 401k (or equivalent matching)

This mean the most you could sock away us $18-23k a year pretax ($5000 is age 50 or older catch up).

I don't want to make $330-350k W2 and be exposed to that much tax liability with AMC.

Better to get paid 350k 1099 with no benefits. Sock away 50k plus away and pay less in taxes. Since most AMC benefits suck anyways.

That tax benefit is worth probably $12k-15k in a high income tax state. But it's also somewhat canceled out by the employer half of SS tax.

 

[BLADEMDA]

Heard partners walked away w $1.9m each. Friend of a friend who is a partner there.

My estimate was $2 million which is typical buyout money for solid groups. Those guys sold too cheaply as I wouldn't have agreed to less than $2.5 million and demanded they include every doctor on a partnership track for a slice of the pie.

That Group in Arizona was a premier group (much better than mine) and the AMC will make a killing once they introduce lots more of the "ACT model" into the mix.

 

[aneftp]

My estimate was $2 million which is typical buyout money for solid groups. Those guys sold too cheaply as I wouldn't have agreed to less than $2.5 million and demanded they include every doctor on a partnership track for a slice of the pie.

That Group in Arizona was a premier group (much better than mine) and the AMC will make a killing once they introduce lots more of the "ACT model" into the mix.

It depends how many partners.

My sister group up north has 32 equal partners along with around 20 employed MD. All MD group as well.

It's hard to spread the wealth with all MD group. They are looking at around 1-1.5 mil at this point and not worth it for them to sell out. Their group has no subsidy.

All MD groups will net less since more money to share. The big group in orlando got in the mid 2 mil range but they were more of an ACT model with MDs doing their own cases 30% of the time.

 

[okayplayer]

Heard partners walked away w $1.9m each. Friend of a friend who is a partner there.

Are all partners treated equally? I.e. The guy who has been there 20 years and the guy who made partner 6 months ago?

 

[nimbus]

Are all partners treated equally? I.e. The guy who has been there 20 years and the guy who made partner 6 months ago?

One difference will be tax treatment. The guy who bought his share 6mos ago will likely owe short term capital gains instead of long term. Huge difference.

 

[Mman]

One difference will be tax treatment. The guy who bought his share 6mos ago will likely owe short term capital gains instead of long term. Huge difference.

Not true. The entire payout is taxed at capital gains regardless of how long somebody has been there.

The major differentiator in terms of how big the payout is is how many docs are partners and how many aren't. Pyramid groups with a large number of docs and small number of partners get huge buyouts if they screw the nonpartners.

 

[nimbus]

Not true. The entire payout is taxed at capital gains regardless of how long somebody has been there.

The major differentiator in terms of how big the payout is is how many docs are partners and how many aren't. Pyramid groups with a large number of docs and small number of partners get huge buyouts if they screw the nonpartners.

My point is that there is a difference between long term and short term capital gains. Short term capital gains is taxed as regular income. Those who became partner and held their corporate share for less than a year will have to pay a lot more tax.

I agree with the rest of your statement.

 

[IlDestriero]

I have it on good authority that these numbers are way off. Much higher than reality.

Than they are fools, because they were doing well.

 

[Mman]

My point is that there is a difference between long term and short term capital gains. Short term capital gains is taxed as regular income. Those who became partner and held their corporate share for less than a year will have to pay a lot more tax.

I agree with the rest of your statement.

Not my understanding at all. It's all long term capital gains for anybody per my discussion with lawyers and accountants on both ends (with American and our own). It has nothing to do with how long you have held "corporate share".

 

[nycitygas]

Do you think the super partners forced the sale?

 

[BLADEMDA]

One difference will be tax treatment. The guy who bought his share 6mos ago will likely owe short term capital gains instead of long term. Huge difference.

No. That's not true. Every partner worked as an employee for 5 years before partner. Second, the sale may be structured as an "asset sale" which results in long term capital gains rate.

 

[urge]

Heard partners walked away w $1.9m each. Friend of a friend who is a partner there.

Blade was right.

What was the buy in? Was it a good investment in the long run?

 

[nimbus]

No. That's not true. Every partner worked as an employee for 5 years before partner. Second, the sale may be structured as an "asset sale" which results in long term capital gains rate.

In some groups, people pay a nominal $xxxxx when they become partner to purchase one share of the corporation. That is the cost basis from which the capital gains are calculated. If it's held for less than a year, I guessed it would be considered short term. But maybe there is a work around.