Who is approving these scams?

[Gator7]

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“Envision Physician Services is seeking an Anesthesiologist to start a new Anesthesia Residency Program at AdventHealth Tampa.”

Just saw this on gaswork. I know it’s not the first but it just makes my blood boil. Who at the ACGME is approving these labor scams?

It’s not good for the field, it’s not good for patients. I get why envision wants it. Can someone explain why the ACGME does?

 

[abolt18]

I don't think the acgme "wants" it, but they create a list of requirements and if a hospital can check all the boxes (or lie and Say they can check all the boxes), then I think the acgme more or less has to say yes. Same thing with the insane explosion of DO schools in the last 15 years. COCA has a list of requirements and if a place checks all the boxes, I don't believe COCA has the ability to say no based on their opinion.

 

[Iso4ane]

I would need $$$$ to live in Tampa. To run a new residency, I would need $$$$$$$$.

 

[Lab Lover]

Starting a residency run by an AMC:

 

[ak_ps]

residents will get absolutely hosed.

this is just another continued effort to staff ORs for envision in a highly devoid region of FL for W2 work ... where 1099 is king for apps ...

 

[TheLoneWolf]

residents will get absolutely hosed.

this is just another continued effort to staff ORs for envision in a highly devoid region of FL for W2 work ... where 1099 is king for apps ...

What's so wrong with Tampa? Genuine question as I am unaware of market forces there. Good weather, no state tax, tons of entertainment and a large international airport.

 

[aneftp]

What's so wrong with Tampa? Genuine question as I am unaware of market forces there. Good weather, no state tax, tons of entertainment and a large international airport.

AMC like team health (which purchased an de factor for profit mega Florida gulf to bay “private group” and Envison colluded to drive down anesthesia salaries for close to 15 years.

There is nothing wrong with Tampa area. Great weather. Warmer waters in the winter time. I cover that area some times. I got privileges at multiple places there (as 1099).

Hca has taken many of their contracts back from the AMCs as w2 in house Hca employees.

Advent health has also done the same taking anesthesia in house w2 on the west coast of Florida.

Even orlando health owned Bayfront in st Pete, Envison left in Feb 2025 this year and most of the docs stayed as w2 for orlando health w2 employees

That’s why I don’t understand why Orlando health and Advent health just take over all places w2 model all over central Florida including advent usap hospitals and envision run orlando health places.

There is no need for for these management companies anymore.

 

[Lab Lover]

There is no need for for these management companies anymore.

Nobody can exploit anesthesiologists and CRNAs better than anesthesiologists and CRNAs. Working for an AMC is almost everybody’s last choice Given the current shortage of personnel. People leave if they can. If the they choose to stay they do just enough to fly under the radar and stay out of the bottom decile.
The AMC vampire is crawling back in its coffin until there is parity or excess of anesthesiologists and CRNAs compared to needs. At the time it will emerge to suck out what blood it can.

 

[<(^_^)>]

I don't think the acgme "wants" it, but they create a list of requirements and if a hospital can check all the boxes (or lie and Say they can check all the boxes), then I think the acgme more or less has to say yes. Same thing with the insane explosion of DO schools in the last 15 years. COCA has a list of requirements and if a place checks all the boxes, I don't believe COCA has the ability to say no based on their opinion.

Requirements should then increase. From what I remember you barely had to do any neuro cases, low volume hearts. Absurdly low volume blocks/epidurals.

I say this not to cause a shortage, but to avoid lowering the quality of anesthesiologists.

At the end of the day the shortage will be met, whether it’s anesthesiologists or CRNAs/AAs. The important thing is maintaining a high standard. At the end of the day the public judges us by the actions of the bottom 1%.

 

[ak_ps]

What's so wrong with Tampa? Genuine question as I am unaware of market forces there. Good weather, no state tax, tons of entertainment and a large international airport.

it has nothing to do with tampa but rather the condition envision is in with regards to FL - and the current midlevel provider market (which for AMCs includes and is not limited to resident physicians) being heavily favorable towards 1099 work here

 

[aneftp]

it has nothing to do with tampa but rather the condition envision is in with regards to FL - and the current midlevel provider market (which for AMCs includes and is not limited to resident physicians) being heavily favorable towards 1099 work here

If u pay every mid level $200hr w2 in Tampa or even orlando or Jacksonville u will fill up the slots.

And that’s not even a high rate. Psychologically mid levels think they are getting paid market rate and 95% of them will take that rate over trying to travel to Ohio or Pa to try to make $240/hr 1099

But amc are still stuck like blockbuster video trying to pay prn w2 as low as $150-hr in many parts of Florida’s including orlando Tampa Miami. Maybe $175/hr

Just pay 1099 $200/hr. Pay prn w2 $200/hr w2.

This non sense the 1099 get paid more hurts the amc.

 

[circleK]

Why wouldn’t Advent Health start the residency program instead of Envision, the way HCA has started programs? I don’t know the Tampa (or FL for that matter) landscape but it seems weird that what is essentially a staffing company is put in charge of training physicians.

 

[amyl]

These hospitals are stupid… there’s just not room to pay an amc 20-40% off the top. hire a consultant, make a good package and hire your own damn anesthesiologist and crna/aas. If you pay people enough and hire enough people to give them vacation time you will get people. Foster a decent culture.
It’s really pretty easy

 

[aneftp]

These hospitals are stupid… there’s just not room to pay an amc 20-40% off the top. hire a consultant, make a good package and hire your own damn anesthesiologist and crna/aas. If you pay people enough and hire enough people to give them vacation time you will get people. Foster a decent culture.
It’s really pretty easy

U mean similar to how atrium healthcare hired a consultant who “started his own anesthesia shell company” obviously backed by atrium (in charlotte North Carolina) trying to escape under the mednax/american anesthesiology/southeast anesthesia umbrella

That seemed to work fairly well. Couple of docs from Florida I know moved up to North Carolina and are fairly happy with atrium shell company

 

[amyl]

I’m not familiar with that story- do tell?
I actually meant hire a consultant to take anesthesia in house - be employed by the hospital not a shell company.

 

[deleted87051]

I’m not familiar with that story- do tell?
I actually meant hire a consultant to take anesthesia in house - be employed by the hospital not a shell company.

C

Thread '"Doctors’ spat with Atrium Health spills into rare public view"'

Mar 13, 2018

Doctors’ spat with Atrium Health spills into rare public view

Doctors’ spat with Atrium Health spills into rare public view

BY DEON ROBERTS

[email protected]
March 13, 2018 04:40 PM

Updated 1 hour 22 minutes ago

Atrium Health and a group of about 100 anesthesiologists who work at its Charlotte-area hospitals are preparing to part ways, in a contract spat that’s spilling into public view.

Atrium plans to replace Southeast Anesthesiology Consultants with a new provider, a move that ends a roughly 40-year relationship between the two Charlotte-based...

• Carbocation1
• Replies: 355
• Forum: Anesthesiology

 

[deleted87051]

These hospitals are stupid… there’s just not room to pay an amc 20-40% off the top. hire a consultant, make a good package and hire your own damn anesthesiologist and crna/aas. If you pay people enough and hire enough people to give them vacation time you will get people. Foster a decent culture.
It’s really pretty easy

Pretty funny how staffing problems magically disappear when hospitals pay competitive compensation and provide good working conditions.

We are still an independent PP but when we hired a consultant for our latest contract negotiations, the hospital hired their own consultant. Turns out our consultant and the hospital’s consultant agreed on what the FMV for our services (nature of cases, hours of coverage, efficiency or lack thereof, etc) was.

 

[amyl]

C

Thread '"Doctors’ spat with Atrium Health spills into rare public view"'

Mar 13, 2018

Doctors’ spat with Atrium Health spills into rare public view

Doctors’ spat with Atrium Health spills into rare public view

BY DEON ROBERTS

[email protected]
March 13, 2018 04:40 PM

Updated 1 hour 22 minutes ago

Atrium Health and a group of about 100 anesthesiologists who work at its Charlotte-area hospitals are preparing to part ways, in a contract spat that’s spilling into public view.

Atrium plans to replace Southeast Anesthesiology Consultants with a new provider, a move that ends a roughly 40-year relationship between the two Charlotte-based...

• Carbocation1
• Replies: 355
• Forum: Anesthesiology

So atrium brought in a consultant that ended up starting Scope instead of bringing it in house for atrium?

Charlotte is an interesting example as it was one of the first amc takedown cities. It seems as though the AMC bad behavior didn’t leave with Mednax. The current groups in Charlotte are Providence, scope and ? I don’t know that much about the market - everything I’ve heard is second hand - but I hear low pay and long hours - so is that an improvement over Mednax? Doesn’t sound like it? Maybe someone else knows better details?
Howard? Aneftp?

I hate to say it but it’s similar in DFW. USAP has lost some contracts and symmetry has picked them up. The Baylor system owns 20% of symmetry. Symmetry seems worse than USAP - except in that symmetry doesn’t have non competes. Markets don’t necessarily recover after AMCs…. Or at least takes longer than 7 years

 

[abolt18]

Pretty funny how staffing problems magically disappear when hospitals pay competitive compensation and provide good working conditions.

We are still an independent PP but when we hired a consultant for our latest contract negotiations, the hospital hired their own consultant. Turns out our consultant and the hospital’s consultant agreed on what the FMV for our services (nature of cases, hours of coverage, efficiency or lack thereof, etc) was.

Hopefully their agreement was to your benefit!

 

[aneftp]

I’m not familiar with that story- do tell?
I actually meant hire a consultant to take anesthesia in house - be employed by the hospital not a shell company.

Scope anesthesia was formed out of the mednax atrium 2017 North Carolina break up.

You would need to be an idiot to belayed scope anesthesia and the consultant hired by atrium weren’t in it together. And u betcha atrium help fund the operations of anesthesia

No one can take over that large of a practice without help from the hospital system. Especially a “consultant”. This wasn’t a mega corp like Envison or team health taking over a 9 plus hospital system to provide anesthesia. This was “scope” anesthesia with nothing.

 

[GassYous]

So atrium brought in a consultant that ended up starting Scope instead of bringing it in house for atrium?

Charlotte is an interesting example as it was one of the first amc takedown cities. It seems as though the AMC bad behavior didn’t leave with Mednax. The current groups in Charlotte are Providence, scope and ? I don’t know that much about the market - everything I’ve heard is second hand - but I hear low pay and long hours - so is that an improvement over Mednax? Doesn’t sound like it? Maybe someone else knows better details?
Howard? Aneftp?

I hate to say it but it’s similar in DFW. USAP has lost some contracts and symmetry has picked them up. The Baylor system owns 20% of symmetry. Symmetry seems worse than USAP - except in that symmetry doesn’t have non competes. Markets don’t necessarily recover after AMCs…. Or at least takes longer than 7 years

As far as I know usap took out non competes from contracts and stopped enforcing them even prior to the rule change.

 

[amyl]

As far as I know usap took out non competes from contracts and stopped enforcing them even prior to the rule change.

Not true. My non compete is up in January… the non solicitation clause is longer. Usap’s history in Vegas at least is to tie things up in courts for years.
The DFW market is still locked up… some market share going to symmetry - which is offering more $ n vacation than USAP but still do extended care team and also have possibly questionable culture?

 

[GassYous]

Not true. My non compete is up in January… the non solicitation clause is longer. Usap’s history in Vegas at least is to tie things up in courts for years.
The DFW market is still locked up… some market share going to symmetry - which is offering more $ n vacation than USAP but still do extended care team and also have possibly questionable culture?

From new contracts not from preexisting ones. I know someone who moved from a usap group to a local private group nearby with no problems despite the non compete.

 

[amyl]

Ah when I was still there our new contracts still had a year non compete and more stringent non solicitation but it’s probably changed 🤷‍♀️

 

[DirtDocMD]

So atrium brought in a consultant that ended up starting Scope instead of bringing it in house for atrium?

Charlotte is an interesting example as it was one of the first amc takedown cities. It seems as though the AMC bad behavior didn’t leave with Mednax. The current groups in Charlotte are Providence, scope and ? I don’t know that much about the market - everything I’ve heard is second hand - but I hear low pay and long hours - so is that an improvement over Mednax? Doesn’t sound like it? Maybe someone else knows better details?
Howard? Aneftp?

I hate to say it but it’s similar in DFW. USAP has lost some contracts and symmetry has picked them up. The Baylor system owns 20% of symmetry. Symmetry seems worse than USAP - except in that symmetry doesn’t have non competes. Markets don’t necessarily recover after AMCs…. Or at least takes longer than 7 years

Symmetry=Phil Eichenholz (founder of Northstar, and also formerly of Sound)

Notice below, he doesn’t mention “Anesthesiologists”. Also note that this is a guy who started an “AMC”, AND sold the thing to “private equity”.

“Hey everybody!! I helped create this problem, and now I’m here to profit from it, er, fix it!!”

 

[amyl]

Two of the four sites that symmetry has taken over in DFW are running extended care team. They hired two horrid anesthesiologists - both are infamous in DFW - I guess that’s all they can get 🤷‍♀️ The one guy couldn’t do blocks so they had to hire a crna that knew how to do them *sigh* how are these residency programs turning out such terrible docs with personality disorders and horrid clinical skills.
I feel sorry for the patients -

 

[jjak34]

Two of the four sites that symmetry has taken over in DFW are running extended care team. They hired two horrid anesthesiologists - both are infamous in DFW - I guess that’s all they can get 🤷‍♀️ The one guy couldn’t do blocks so they had to hire a crna that knew how to do them *sigh* how are these residency programs turning out such terrible docs with personality disorders and horrid clinical skills.
I feel sorry for the patients -

Crazy world out there. Thankful to be MD only with healthy enough staffing where we would get rid of someone who couldn't do the basics. Long may it last...

 

[deleted87051]

Two of the four sites that symmetry has taken over in DFW are running extended care team. They hired two horrid anesthesiologists - both are infamous in DFW - I guess that’s all they can get 🤷‍♀️ The one guy couldn’t do blocks so they had to hire a crna that knew how to do them *sigh* how are these residency programs turning out such terrible docs with personality disorders and horrid clinical skills.
I feel sorry for the patients -

Is this an older anesthesiologist? I have yet to meet a recent grad (<5-10yrs out) who can’t do blocks.

 

[gunnershow]

Is this an older anesthesiologist? I have yet to meet a recent grad (<5-10yrs out) who can’t do blocks.

Older anesthesiologists are the ones keeping this "extended care team" model afloat. They have no compunction selling out the profession to sit in the lounge all day.