anes121508

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hoping to get some insight, opinions, and maybe even real experiences shared

Let's assume AMCs are the way of the future and pp doesn't exist.

If you have to work for an AMC, how do you go about looking for lesser of evils?

Usap, Sheridan, team health, North Star ect...how would you rank these if you had to? (Sad question I guess). If AMCs are going to be the way of the future, which AMC gig is the best situation? Basically, who would you work for and what do you look for in order to get screwed the least?
 
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Consigliere

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I would NEVER work for an AMC. Now I know the corn hole, folksy BS about "never say never" but I will reiterate - I WILL NEVER WORK FOR AN AMC. I will quit the practice of medicine before I ***** myself out in such a fashion. I just simply could NOT look myself in the mirror and see what I had become and continue living. I apologize to those unfortunate enough to be in such a situation; it's just who I am.
 

Ignatius J

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I don't get what the incentive is in working for an AMC. Why do you want to work your but off so faceless investors can profit? Would kill me. You put anyone on salary and they will do the bare minimum to get that check cashed.
 

Mman

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I don't get what the incentive is in working for an AMC. Why do you want to work your but off so faceless investors can profit? Would kill me. You put anyone on salary and they will do the bare minimum to get that check cashed.
the incentive is hundreds of thousands of dollars of cash in your pocket every year. Some people need to work and it's the best then can find for what they need.

I do agree that for a salary people in general will work just hard enough to not get fired. A smart AMC would/should have plenty of incentives in place to inspire a little better performance.
 

aneftp

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So what's worst?

Work like my sister worked 1998-2003 5 year partnership track making 120 , 140, 160 , 180, 200k. Than told she's not gonna to be a partner (along with 3 other MDs no partnership). While partners making 450-550k all the time?

Vs working for an AMC making 300-350k?

At least u know what u are getting yourself into with an AMC.

Don't think private practice groups weren't predatory with new grads in the past. They were. And those same predatory groups have sold out to AMCs in the past 3-5 years.
 

Mman

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Don't think private practice groups weren't predatory with new grads in the past. They were. And those same predatory groups have sold out to AMCs in the past 3-5 years.
I believe the majority of groups that sold to AMCs have been exactly those groups that essentially had pyramid structures with lots of MDs but few real partners. Some had excessively long partnership tracks (5-7 years). Others had various types of partner. The math for them selling to an AMC made the most sense since the payout went to a relatively small number of doctors.

For truly fair and equal groups, the AMC buyout math isn't quite as attractive.
 
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anes121508

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So what's worst?

Work like my sister worked 1998-2003 5 year partnership track making 120 , 140, 160 , 180, 200k. Than told she's not gonna to be a partner (along with 3 other MDs no partnership). While partners making 450-550k all the time?

Vs working for an AMC making 300-350k?

At least u know what u are getting yourself into with an AMC.

Don't think private practice groups weren't predatory with new grads in the past. They were. And those same predatory groups have sold out to AMCs in the past 3-5 years.
This precisely why I asked this question....

Most advice I get is "never work for them".

The second most common thing I hear is, "every private group is at risk of being bought out"

So that makes me think....you are gambling on a pp track.

I'm also guessing that by now, AMC's hire more docs than pp groups. So that means >50% of the jobs are AMC's. That means we should know the subtle differences in the way they are under run and how to avoid the worst ones. Know the enemy?
 
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anes121508

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I believe the majority of groups that sold to AMCs have been exactly those groups that essentially had pyramid structures with lots of MDs but few real partners. Some had excessively long partnership tracks (5-7 years). Others had various types of partner. The math for them selling to an AMC made the most sense since the payout went to a relatively small number of doctors.

For truly fair and equal groups, the AMC buyout math isn't quite as attractive.

However I've heard from people in fair and democratic groups that the hospital has demanded more out of them and they couldn't keep afloat without asking for a subsidy. In this circumstance they could either 1. play ball and shop around with the AMC's hoping to get some buyout. or 2. have some sort of hostile take over and be left with nothing.

My understanding is that A fair and democratic group without a subsidy can still be asked by the hospital to provide more and more services without getting any subsidy. If the AMC has deeper pockets, more resources, and can get more value/unit, they can afford to do this and the fair democratic group is out.

So is any group truly safe?

If not, then I find myself thinking ...."why take the gamble on a partnership track?".....it's alot easier to to eat sh** when you know what you know its coming.
 

Mman

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So is any group truly safe?

If not, then I find myself thinking ...."why take the gamble on a partnership track?".....it's alot easier to to eat sh** when you know what you know its coming.
Nothing is for sure, but sometimes the gamble on the unknown can pay off massively down the road. You just have to try to guesstimate the odds of given outcomes and the relative payoff/screw job for each of them. 7 years ago I was doing the same math.
 

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I truly think for the new generation of anesthesiologists it's not going to be that tough accepting an AMC job and being satisfied with it.
If you transition directly from being a resident to a job with an AMC because that's all you can find, you wouldn't have anything better to compare with and your expectations would be tailored to your new reality.
And if that's the case I would say it's better to go with with one of the big boys, because they are stable financially and they are less likely to lose their contracts.
 

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I believe the majority of groups that sold to AMCs have been exactly those groups that essentially had pyramid structures with lots of MDs but few real partners. Some had excessively long partnership tracks (5-7 years). Others had various types of partner. The math for them selling to an AMC made the most sense since the payout went to a relatively small number of doctors.

For truly fair and equal groups, the AMC buyout math isn't quite as attractive.

Agreed.
 

Stank811

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However I've heard from people in fair and democratic groups that the hospital has demanded more out of them and they couldn't keep afloat without asking for a subsidy. In this circumstance they could either 1. play ball and shop around with the AMC's hoping to get some buyout. or 2. have some sort of hostile take over and be left with nothing.

My understanding is that A fair and democratic group without a subsidy can still be asked by the hospital to provide more and more services without getting any subsidy. If the AMC has deeper pockets, more resources, and can get more value/unit, they can afford to do this and the fair democratic group is out.

So is any group truly safe?

If not, then I find myself thinking ...."why take the gamble on a partnership track?".....it's alot easier to to eat sh** when you know what you know its coming.

No group or AMC is ever safe. AMC lose contracts all the time. The most stable position is to be employed by the hospital.
 

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So what's worst?

Work like my sister worked 1998-2003 5 year partnership track making 120 , 140, 160 , 180, 200k. Than told she's not gonna to be a partner (along with 3 other MDs no partnership). While partners making 450-550k all the time?

Vs working for an AMC making 300-350k?

At least u know what u are getting yourself into with an AMC.

Don't think private practice groups weren't predatory with new grads in the past. They were. And those same predatory groups have sold out to AMCs in the past 3-5 years.
Damn, times were tough back then.
 

Noyac

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[QUOTE="Stank811, post: 17994162, member: 51364"The most stable position is to be employed by the hospital."[/QUOTE]
Why do you say this?
 

aneftp

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Personally I wouldn't recommend any new grad take any "partnership" track from any private group more than 1 year.

If they are 2-5 year tracks. Better have it in writing what type of compensation you may get in event of a sale.
 
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aneftp

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No group or AMC is ever safe. AMC lose contracts all the time. The most stable position is to be employed by the hospital.
Not necessarily any more.

Many hospitals/even academic centers are going with these "rolling one year contracts".

What does that mean? It means besides the typical 60-90 day notice period for termination without clause. Hospitals and academic centers can choose to "let your contract expire" after the year is up.

Which means they are firing you essentially by not renewing your contract.

The safest job these days is at the VA (after 2 years probationary period) cause you really can't be fired. They can demote u. They can do other stuff to u. Just can't fire u!
 

aneftp

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Damn, times were tough back then.
She did make "parity" non partner pay for 2003-2004. But she was a lame duck at that time cause she knew they were just waiting to hire someone else cheaper (new grad??!?) and than give her 90 days notice.

So she eventually left in March 2004 for another practice which she did make partner in 2 years. That group was much fairer. Cause they tell people after one year if they will become partner and will pay their malpractice tail if they aren't going to be partner.

So not all private groups are bad. Some are very fair.

Just do your research and ask around.
 
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Howard888

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The problem is AMCs are smart and are getting practices in high demand areas so new grads don't care and just take the jobs. If new grads turned down these jobs it would be a different story but most times they don't care and just want to live somewhere so they take them.

Look at a place like Austin. An AMC group and a large private group. From what I hear the private group job is light years better than the AMC job yet last I checked the AMC was having no problems recruiting people because they don't care they just want to live in Austin. And that's a city with a pretty high cost of living.

AMCs will always win because they have big pockets, are in the best cities, and new grads won't say no
 

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In addressing the original question, my take on the AMC thing is that each AMC practice is different depending on the location. So within Sheridan, one place might be a better job than with a Sheridan group in another location. It's all individual. I know everyone here likes to talk a big game about how they will never work for anything but a great private practice. The reality is the vast majority of residents graduating will work for an AMC or big hospital system. There simply are not enough good private jobs out there anymore. Even the majority of all star residents with great connections and great letters will end up being employed.

Find the highest paying AMC job you can tolerate in a location you enjoy. Pay off your loans, start saving for retirement, and plan on going part time in 5-10 years. Develop other interests, open a small business, or supplement income with locums or per diem going forward. The future is working 65 hours per week for an AMC making 300k or less. Make sure you have an escape plan. There's a big time bubble forming within healthcare, and it will eventually burst. We are headed towards a European style single payer system or some bastardized version of it.
 

Mman

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AMCs will always win because they have big pockets, are in the best cities, and new grads won't say no
The way AMCs lose is by losing their hospital contracts. It's starting to happen. Hospitals were OK with the move towards AMCs because they felt it would give them more stability in their anesthesia department and occasionally lower cost. But over time some of them are finding it isn't all it was cracked up to be. A rotating cast of characters in the OR, nobody that can make a decision on site, etc. The grass isn't always greener and some of them are starting to turn away and want nothing to do with an AMC. You don't see the fancy press releases on Business Wire when those contracts are lost like you do when they get new ones, but I can assure you it is happening.

If enough of those hospitals that ditch AMCs and go back to private groups are happier, they will talk to their colleagues at other hospitals and the momentum might flip. And that would be so, so, so sweet for those of us that haven't sold out.
 
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anes121508

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In addressing the original question, my take on the AMC thing is that each AMC practice is different depending on the location. So within Sheridan, one place might be a better job than with a Sheridan group in another location. It's all individual. I know everyone here likes to talk a big game about how they will never work for anything but a great private practice. The reality is the vast majority of residents graduating will work for an AMC or big hospital system. There simply are not enough good private jobs out there anymore. Even the majority of all star residents with great connections and great letters will end up being employed.

Find the highest paying AMC job you can tolerate in a location you enjoy. Pay off your loans, start saving for retirement, and plan on going part time in 5-10 years. Develop other interests, open a small business, or supplement income with locums or per diem going forward. The future is working 65 hours per week for an AMC making 300k or less. Make sure you have an escape plan. There's a big time bubble forming within healthcare, and it will eventually burst. We are headed towards a European style single payer system or some bastardized version of it.

You make the point above that there simply aren't enough pp jobs that have minimal length partnership tracks for all the new grads so by default people will be looking at the amcs, which I completely agree with and is exactly why I proposed the question.

I like your advice that each site within the AMC may be different and to take the highest paying one ....THAT YOU CAN TOLERATE...

How do make sure you are able to tolerate the job? They may say work 50 hrs a week q6 call and 3:1 coverage....then before you know it they need to keep the admin at the hospital happy and cover three more ep rooms and create a full coverage cardiac group and oh by the way cover this new day surg spot.....so everything gets passed down to the guy lowest in the totem pole, because I'm assuming the AMC isn't going to do all that and make less proffit. I assume they just make me cover q2 home pager cardiac call in addition to the q6 in house call, work 60 hrs a week, cover 4-1 and quite often 6:1, and oh by the way there is no profit sharing this year.

Unless I say to the AMC, "hey I want to work 7-4, cover 3:1 , and I'm not takin any more than q6 call"...."put it in the contract please"

I mean is that even possible? (My feeling is that if this is a corporate route then it da** well should be...nobody joins Pepsi and is told, "hey by the way, the janitor quit and we need to keep our profit margins, so tonight after you are done with your new branding pitch, I need you to clean all the bathrooms on floors 10-30 which may or may not keep you up all night")

How do you negotiate with them?

what are the "I gotcha by the balls" clauses in the employment contract that have made for an intolerable workplace environment?
 

Man o War

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The way AMCs lose is by losing their hospital contracts. It's starting to happen. Hospitals were OK with the move towards AMCs because they felt it would give them more stability in their anesthesia department and occasionally lower cost. But over time some of them are finding it isn't all it was cracked up to be. A rotating cast of characters in the OR, nobody that can make a decision on site, etc. The grass isn't always greener and some of them are starting to turn away and want nothing to do with an AMC. You don't see the fancy press releases on Business Wire when those contracts are lost like you do when they get new ones, but I can assure you it is happening.

If enough of those hospitals that ditch AMCs and go back to private groups are happier, they will talk to their colleagues at other hospitals and the momentum might flip. And that would be so, so, so sweet for those of us that haven't sold out.
This is true, I know of one who is about to lose their contract in my old home town. Hospital is going with one of the 2 private groups that are already established.
 
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anes121508

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Makes sense...guys part of a group = vested interest/harder working / willing to go the extra mile...satisfaction is higher and people stay

Crappy job satisfaction and no vested interest = revolving door of people performing below their capabilities

Isn't that why Google and these places are striving to improve workplace satisfaction and morale?...aren't there studies that actually price this?

Hospital CEOs are that blind? Unable to see the bigger picture? ....most attractive job would probably be with a group at a hospital where the CEO fired the AMC and has seen the light. If you know of a place, sign me up.
 
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Mad Jack

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I don't get what the incentive is in working for an AMC. Why do you want to work your but off so faceless investors can profit? Would kill me. You put anyone on salary and they will do the bare minimum to get that check cashed.
There will likely be a time in the future in which entire geographic regions are completely AMC controlled, or the only careers available are those with AMCs because the PPs simply aren't hiring. When the choice is between abandoning your family, not having a job, or an AMC- well, things get tough.
 

Scotty_G

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Ha I know of one guy who got fired at a VA job and he wasn't even there a year! (He did some bad stuff though) In the northeast there are huge areas of AMCs. Just look at the NY/NJ tristate area. If you are going to be employed I would rather be employed by the hospital vs an AMC. At least you can talk to the big-wigs and perhaps even know them on a personal level if it is a smaller/comm hospital.
 

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There are no small community hospitals in the northeast any longer. The few that still do exist are in the crosshairs of the big corporate hospitals and the corporate hospitals that masquerade as academic medical center networks.
 

aneftp

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The problem is AMCs are smart and are getting practices in high demand areas so new grads don't care and just take the jobs. If new grads turned down these jobs it would be a different story but most times they don't care and just want to live somewhere so they take them.

Look at a place like Austin. An AMC group and a large private group. From what I hear the private group job is light years better than the AMC job yet last I checked the AMC was having no problems recruiting people because they don't care they just want to live in Austin. And that's a city with a pretty high cost of living.

AMCs will always win because they have big pockets, are in the best cities, and new grads won't say no
Huh?

Are u saying one job is AMC in Austin? And another job with large private group in Austin?

So both jobs in Austin?

And new grads choosing AMC?

It's means one thing: large private group has pyramid partnership scheme and paying new grads much lower.
 

aneftp

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Ha I know of one guy who got fired at a VA job and he wasn't even there a year! (He did some bad stuff though) In the northeast there are huge areas of AMCs. Just look at the NY/NJ tristate area. If you are going to be employed I would rather be employed by the hospital vs an AMC. At least you can talk to the big-wigs and perhaps even know them on a personal level if it is a smaller/comm hospital.
U can't get fired after 2 years from VA for unless u are totally inept/racists/criminal.

The key is 2 years.
 

Howard888

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No....I thought I was clear.

From what I hear the private job is way better than the AMC job -no pyramid scheme.

My logic is this: the AMC is able to hire new grads. If new grads will accept a far inferior job in the same city with a decent cost of living then the AMCs will continue to thrive.

Let alone in areas where the AMC has a monopoly as someone pointed out.

No one is choosing the AMC over the private group, in fact the opposite. But the private group can only hire so many. Those that aren't hired still choose the AMC instead of moving because of the popularity of the city



Huh?

Are u saying one job is AMC in Austin? And another job with large private group in Austin?

So both jobs in Austin?

And new grads choosing AMC?

It's means one thing: large private group has pyramid partnership scheme and paying new grads much lower.
 

nolagas

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Huh?

Are u saying one job is AMC in Austin? And another job with large private group in Austin?

So both jobs in Austin?

And new grads choosing AMC?

It's means one thing: large private group has pyramid partnership scheme and paying new grads much lower.
It means one of two things (or both): 1) people who can't get jobs at Capitol will take AAG/Mednax jobs because they would rather live in Austin and work at Mednax than work in a 'less desirable' location where they could make partner, or 2) they avoid Capitol because of it's reputation (deserved or not) for underpaying partnership track people only to fire them after 2 years.
 

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Its about the JOB not who signs the paycheck. Job means all the factors not just the amount on the check. The area, the types of cases, the people you will call a colleague. I listen to partnership track people in renal, pulmonary, Gi and hear their stories about what it takes to be partner and wonder why anyone would, after being a resident, indenture themselves to low wages, long hours with the POTENTIAL to become partner. My group did that to people in the late 90's and those current partner are still bitter. Luckily for me instead of reacting by screwing future partners they changed the process to be more fair, but the partners still made money off me until I was voted in.

At my gig, now run by an AMC, a new grad gets a fair wage right from the start. No loss for a "buy in". No worry about whether this months revenue cover expenses and all the back office stuff is non-exisitant, including those ridiculous partner meetings that turned into complaining sessions.
 

Mad Jack

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There are no small community hospitals in the northeast any longer. The few that still do exist are in the crosshairs of the big corporate hospitals and the corporate hospitals that masquerade as academic medical center networks.
Or they are being bought up by venture capital firms and for-profit corporations looking to turn a profit- essentially the AMCs of the hospital side of things. The last are falling in my home state, and it is quite sad to watch.
 

deepstate2016

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eh, you get paid and work for the man. Is it nicer not working for the man? Bet your ass. But at least as wage slaves we can pick the best plantation.
 

amyl

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I thought I would never work for an amc. never. Id never sell out. Id never get screwed over. are you kidding me? USAP is a cake walk compared to the bs predatory pp groups here. I don't want to post names publicly but I talked to almost everyone in dallas and the stories would floor you. everything from contracts two lawyers laughed at, literally, to the partner continually asking me out during contract negotiations... which I always said no to and thus no contract materialized. my town is full of thieves, criminals, under handed behavior and pigs.... usap has literally been a dream in comparison. sorry. i hate to admit it. there are worse things than an amc and not all are the same.
 

Scotty_G

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Asking you out? Dam you woulda had the accelerated path to partner! Amyl weren't you in Indiana or somewhere up there? What made you choose Dallas? Surely other areas don't have as much AMC's.
 

aneftp

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I thought I would never work for an amc. never. Id never sell out. Id never get screwed over. are you kidding me? USAP is a cake walk compared to the bs predatory pp groups here. I don't want to post names publicly but I talked to almost everyone in dallas and the stories would floor you. everything from contracts two lawyers laughed at, literally, to the partner continually asking me out during contract negotiations... which I always said no to and thus no contract materialized. my town is full of thieves, criminals, under handed behavior and pigs.... usap has literally been a dream in comparison. sorry. i hate to admit it. there are worse things than an amc and not all are the same.
That's the reason the pyramid scheme 3-5 year partnership tracks have sold out. They know their time is up. Cash out at or near the peak and sell out to AMC.

Remember anesthesia itself is a service. A valuable service. But at the end of the day. An anesthesia contract has no inherent physical value. A pyramid scheme group who loses their anesthesia contract ends up with nothing. Zero. Nada.

Cause we don't bring patients in.

It's not like a surgeon bringing income and revenue into a hospital.
 

sleepallday

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The way AMCs lose is by losing their hospital contracts. It's starting to happen. Hospitals were OK with the move towards AMCs because they felt it would give them more stability in their anesthesia department and occasionally lower cost. But over time some of them are finding it isn't all it was cracked up to be. A rotating cast of characters in the OR, nobody that can make a decision on site, etc. The grass isn't always greener and some of them are starting to turn away and want nothing to do with an AMC. You don't see the fancy press releases on Business Wire when those contracts are lost like you do when they get new ones, but I can assure you it is happening.

If enough of those hospitals that ditch AMCs and go back to private groups are happier, they will talk to their colleagues at other hospitals and the momentum might flip. And that would be so, so, so sweet for those of us that haven't sold out.
I have already seen this in my area. Some of the bigger, more financially stable hospitals have already let it be known that they are not interested in having corporations of any medical specialties in their system. The only two options are PP or hospital employed.
 

GravelRider

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Honestly, young ones...plan for part time. It's the only way you can maintain any control. Get a part time gig and do per diem or locums to supplement. Otherwise you will be looking at 65 hour weeks and 4-6 weeks vacation. The AMCs have wisened up to this and are offering less part time opportunities.
 

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There will likely be a time in the future in which entire geographic regions are completely AMC controlled, or the only careers available are those with AMCs because the PPs simply aren't hiring. When the choice is between abandoning your family, not having a job, or an AMC- well, things get tough.
The future is now my man.
 
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Psai

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I thought I would never work for an amc. never. Id never sell out. Id never get screwed over. are you kidding me? USAP is a cake walk compared to the bs predatory pp groups here. I don't want to post names publicly but I talked to almost everyone in dallas and the stories would floor you. everything from contracts two lawyers laughed at, literally, to the partner continually asking me out during contract negotiations... which I always said no to and thus no contract materialized. my town is full of thieves, criminals, under handed behavior and pigs.... usap has literally been a dream in comparison. sorry. i hate to admit it. there are worse things than an amc and not all are the same.
:eek:
 

Planktonmd

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I thought I would never work for an amc. never. Id never sell out. Id never get screwed over. are you kidding me? USAP is a cake walk compared to the bs predatory pp groups here. I don't want to post names publicly but I talked to almost everyone in dallas and the stories would floor you. everything from contracts two lawyers laughed at, literally, to the partner continually asking me out during contract negotiations... which I always said no to and thus no contract materialized. my town is full of thieves, criminals, under handed behavior and pigs.... usap has literally been a dream in comparison. sorry. i hate to admit it. there are worse things than an amc and not all are the same.
You just described the reality of private practice groups in most "desirable areas": pimps, used car salesmen and "senior partners" in private groups are pretty much the same kind of scum!
 
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anes121508

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I thought I would never work for an amc. never. Id never sell out. Id never get screwed over. are you kidding me? USAP is a cake walk compared to the bs predatory pp groups here. I don't want to post names publicly but I talked to almost everyone in dallas and the stories would floor you. everything from contracts two lawyers laughed at, literally, to the partner continually asking me out during contract negotiations... which I always said no to and thus no contract materialized. my town is full of thieves, criminals, under handed behavior and pigs.... usap has literally been a dream in comparison. sorry. i hate to admit it. there are worse things than an amc and not all are the same.
Sad that you had to deal with that. The highlighted part of your post above is part of the reason I posted the original thread. As I talk to people, I'm getting the sense that not all AMC's are created equally and some are much better than others. In fact, some are far less evil than predatory PP groups.

So we can put USAP on the list of AMC's that you shouldn't run the opposite way from? Any others?
 
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anes121508

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Its about the JOB not who signs the paycheck. Job means all the factors not just the amount on the check. The area, the types of cases, the people you will call a colleague. I listen to partnership track people in renal, pulmonary, Gi and hear their stories about what it takes to be partner and wonder why anyone would, after being a resident, indenture themselves to low wages, long hours with the POTENTIAL to become partner. My group did that to people in the late 90's and those current partner are still bitter. Luckily for me instead of reacting by screwing future partners they changed the process to be more fair, but the partners still made money off me until I was voted in.

At my gig, now run by an AMC, a new grad gets a fair wage right from the start. No loss for a "buy in". No worry about whether this months revenue cover expenses and all the back office stuff is non-exisitant, including those ridiculous partner meetings that turned into complaining sessions.
100% agree. The details of the job itself and the work environment are hard to even put a price on. Makes all the difference in the world when you go to work happy.

Your AMC seems to have kept an enjoyable work environment But there are people out their who were told that the details of the job itself and the work environment would be one thing....and the AMC doesn't keep their word and makes life miserable. Are you able to share which AMC you are happy with?
 
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anes121508

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There will likely be a time in the future in which entire geographic regions are completely AMC controlled, or the only careers available are those with AMCs because the PPs simply aren't hiring. When the choice is between abandoning your family, not having a job, or an AMC- well, things get tough.
Absolutely agree, which is why I think it's worth going beyond "run far far away from ALLLLLL AMC's." Ethically, I wish I could. You are spot on....Because of family, location, and a dwindling amount of PP groups out there, it's just not that simple.

Taking a closer look at what makes the AMCs differ from one another and maybe figuring out which ones are tolerable could help sort things out for people.
 
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Stank811

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Absolutely agree, which is why I think it's worth going beyond "run far far away from ALLLLLL AMC's." Ethically, I wish I could. You are spot on....Because of family, location, and a dwindling amount of PP groups out there, it's just not that simple.

Taking a closer look at what makes the AMCs differ from one another and maybe figuring out which ones are tolerable could help sort things out for people.

Wouldn't it be easier to tell us which AMCs you are stuck working for based on your situation? People on her then can give you more specific feedback on your options. Sounds like you already know what groups currently hold the contracts in your area.
 
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anes121508

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That's the reason the pyramid scheme 3-5 year partnership tracks have sold out. They know their time is up. Cash out at or near the peak and sell out to AMC.

Remember anesthesia itself is a service. A valuable service. But at the end of the day. An anesthesia contract has no inherent physical value. A pyramid scheme group who loses their anesthesia contract ends up with nothing. Zero. Nada.

Cause we don't bring patients in.

It's not like a surgeon bringing income and revenue into a hospital.

So in this environment where PP groups are falling left and right, why should a new grad agree to any PP group with a track longer than the contract they have with the hospital? Unless the group puts in a structured clause in the contract that you get 1/3 of the buyout after 1 year, 2/3 of the buyout after 2 years, ect., it's a risk. As you have pointed out above, the pp group doesn't bring patients into the hospital. They only rely on their relationship with the hospital and the surgeons. Unfortunately, when the hospital wants more off-site coverage, wants to cut the stipend, the CT surgeons want cardiac anes coverage at all times, a slow ambulatory center is opening up, you have to buy into quality metric reporting systems, ect.....relationship and history can only go so far. So what are you "buying" into, other than risk and uncertainty?

In today's environment, I think it's hard to sell a pp track of 3 years without a contract with the hospital >3 years or some sort of clause in the event of a buyout. I'm new with this and that's just my initial gut feeling. I'm open to hearing the argument from you guys that are in PP, have been around for a while, and are on the other side of things.
 
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anes121508

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Wouldn't it be easier to tell us which AMCs you are stuck working for based on your situation? People on her then can give you more specific feedback on your options. Sounds like you already know what groups currently hold the contracts in your area.
My original intent was to create the thread for all new grads that may be considering or looking at AMCs. Kinda like the threads out there that discuss what residencies/fellowships are worth applying to.

But here is my personal example:

1. Home town there is: North Star, Team Health, and 3 year pp track.

2.Big city with wife willing to stay because has current job: Academics

3. City wife would love to live and has great connections for jobs: USAP
 

Mman

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So in this environment where PP groups are falling left and right, why should a new grad agree to any PP group with a track longer than the contract they have with the hospital?
1) the length of the hospital contract is nearly irrelevant as all contracts have out clauses
2) you should only join a PP group in the scenario if you believe they will act in good nature towards you. I joined a group where I had personal connections to partners. You should ask to speak with former partners or people that left before becoming partner (if there are any). In the end, it's all about the people and whether or not you can establish a level of trust.
 
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anes121508

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1) the length of the hospital contract is nearly irrelevant as all contracts have out clauses
2) you should only join a PP group in the scenario if you believe they will act in good nature towards you. I joined a group where I had personal connections to partners. You should ask to speak with former partners or people that left before becoming partner (if there are any). In the end, it's all about the people and whether or not you can establish a level of trust.
Even if they are good people and I believe all of their intentions, their hand can still be forced by the hospital admin though correct? I have a friend who was 28 months into a 36 month track, making significantly less, taking slightly more call, and a week less of vacation than the partners, but he loved the group and the people he worked with. 1 person in 15 years or something like that didn't make partner, 2 people left in last 10 years (retirement and personal issues). He said the groups intention was to stay independent, but hospital admin forced their hand. They sold, he got nothing. Has two kids in the school system, a wife with a job, and now working for an AMC that he hates.

I guess if it was as peachy and trustworthy of a group as he made it out to be they could have included him in the buyout? But then again, they weren't obligated to. I guess my point is that in this climate, is trust enough?
 

Shimmy8

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Anyone work one of the AMC affiliated groups that is MD only? Curious how those are run.