Duplicate post. My mistake
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going back through the archives of anesthesiology news....
JANUARY 18, 2012
Selling Your Practice: Five Tips for When Suitors Come Calling
Ownership Structure
The makeup of an anesthesiology practice’s ownership is something that all potential acquirers consider. A practice owned by one or two partners employing, for example, between 50 and 75 clinicians usually will be seen by the buyer as an easier transaction than one that is owned by a large number of physician shareholders. The transaction itself is simpler because the buyer needs to negotiate with only a handful of decision makers. However, although negotiating with fewer shareholders may be simpler, a buyer may still have concerns over paying what could be a sizeable purchase price to a small number of doctors who still may be needed to run the business going forward. For anesthesiology groups with a large number of physician owners, potential acquirers will want to know that, although there is consensus among the shareholders, a few key leaders in the group have been empowered to communicate and negotiate on everyone’s behalf.
Physician groups choosing to sell their practices to a larger buyer often find the experience very rewarding, both financially and operationally. However, sellers do need to understand that although buyers typically strive to minimize change to the practice after closing, they will now be employees of what will likely be a more structured company. The new employer will almost certainly be more metrics driven and cost conscious. Staff layoffs are not a common occurrence in the transactions that we have seen, but buyers will undoubtedly have a focus on maximizing their return on investment. Overall, the feedback that we hear from physician groups that we have worked with is that the experience of selling their practice turned out to be very positive for all involved.
—Paul E. Kacik
......So even though the Suits focus is a return on their investment, the experience of the physicians is still overwhelmingly positive?
Depends on the Suitor? Goes back to my point....if pp groups are being forced to sell to AMC and AMC is a reality for employment in the future, why not pick the best ones that screw you over the least?
From what I've gathered so far, Sheridan and Northstar are quite different than USAP or TeamHealth. Obviously this is a small sample size of stories I've read and been told.
Maybe Anesthesiology News should do a followup piece which physician groups have had positive experiences transitioning to working for the AMC?
Has this already been done?
JANUARY 18, 2012
Selling Your Practice: Five Tips for When Suitors Come Calling
Ownership Structure
The makeup of an anesthesiology practice’s ownership is something that all potential acquirers consider. A practice owned by one or two partners employing, for example, between 50 and 75 clinicians usually will be seen by the buyer as an easier transaction than one that is owned by a large number of physician shareholders. The transaction itself is simpler because the buyer needs to negotiate with only a handful of decision makers. However, although negotiating with fewer shareholders may be simpler, a buyer may still have concerns over paying what could be a sizeable purchase price to a small number of doctors who still may be needed to run the business going forward. For anesthesiology groups with a large number of physician owners, potential acquirers will want to know that, although there is consensus among the shareholders, a few key leaders in the group have been empowered to communicate and negotiate on everyone’s behalf.
Physician groups choosing to sell their practices to a larger buyer often find the experience very rewarding, both financially and operationally. However, sellers do need to understand that although buyers typically strive to minimize change to the practice after closing, they will now be employees of what will likely be a more structured company. The new employer will almost certainly be more metrics driven and cost conscious. Staff layoffs are not a common occurrence in the transactions that we have seen, but buyers will undoubtedly have a focus on maximizing their return on investment. Overall, the feedback that we hear from physician groups that we have worked with is that the experience of selling their practice turned out to be very positive for all involved.
—Paul E. Kacik
......So even though the Suits focus is a return on their investment, the experience of the physicians is still overwhelmingly positive?
Depends on the Suitor? Goes back to my point....if pp groups are being forced to sell to AMC and AMC is a reality for employment in the future, why not pick the best ones that screw you over the least?
From what I've gathered so far, Sheridan and Northstar are quite different than USAP or TeamHealth. Obviously this is a small sample size of stories I've read and been told.
Maybe Anesthesiology News should do a followup piece which physician groups have had positive experiences transitioning to working for the AMC?
Has this already been done?
My best guess:
1. USAP
2. Team Health
3. American Anesthesiology (Mednax)
4. Northstar
5. Sheridan (Amsurg)
5. NAPA
Each group has local control so in certain areas the Mednax owned group may be superior to the Team Health one. It comes down to local control but some of the corporate overlords are indeed better than the others.
1. USAP
2. Team Health
3. American Anesthesiology (Mednax)
4. Northstar
5. Sheridan (Amsurg)
5. NAPA
Each group has local control so in certain areas the Mednax owned group may be superior to the Team Health one. It comes down to local control but some of the corporate overlords are indeed better than the others.
AMC are not the future. I would prefer an article on all the negative experiences so people can protect themselves from such an unnecessary middle man.
For what it's worth that's exactly what I wrote in to the editor yesterday. He makes a claim that most people are happy. I think he should follow up.
Blade, if you could do it again with your group , would you shop around to people other than Sheridan? Or go with becoming hospital employees? Or is this not even an option in some cases.
I know on prior threads you said your hand was forced and would do it again in a heart beat, but wondering if there were any other buyers?
I agree it comes down to local control (with big brother Mednax/team health/Sheridan) watching the pockets.
I think the "friendly buyouts" tend to have better structure simply because 90% forced retention rates (i.e. Selling partners must stay 3-5 years).
The hostile takeovers where 50% of the staff leave can be in flux for for years. It can become a revolving door
My buddy MD only group left in 2007 in California and the current hospital took millions of dollars in hit before it stabilized the anesthesia situation. They had gone with somnia. But it took 3 years. All the cost savings the hospital tried to do went out the door within 6 months with the anesthesia subsidy. They been through 3 hospital CEOs in 3 years in that time period.
Same stuff happening in Florida area where Sheridan took over a local hospital last year. Hostile takeover. All the Mds left. Most of crnas left as well. It's been 12-14 months and still not fully staffed. Sheridan got hospital by the balls cause they claimed they could do it with no subsidy. Now asking for 1 million.
Another great Sheridan story...sooner or later reputations will spread enough right?
Again it's local like blade mentioned . How do local people handle day to day operations.
My other friend (yes. I do know many in the business) told me it will continue being a revolving. He worked there for 10 months.
Apparently the current "chief" doesn't even live in Florida. He lives in New York and flies down on Monday afternoon and leaves on Thursday afternoon. Sheridan gives the chief a lot of leeway. He counts as (1 FTE) even though he doesn't do weekend calls or even Friday or Thursday calls!
So guy has been manipulating the system and Sheridan has gotten so big they really don't care and let the local chief handle things
I would go with USAP or Team Health over being a hospital employee because those AMCs would buy me out vs nothing from the hospital.
Yes, I know both of their Central Florida contracts forced out the existing groups. Now, both hospitals cover Trauma and they can't retain anesthesia staff. Nobody wants to work like a dog for an AMC so this requires a good staffing ratio and reasonable call.
I had a friend in one of those groups who lost his job due the hostile take-over.
ok definitely want to be clear here. USAP may be a better AMC because it allows the divisions to function mostly independently. it seems more like a coalition of a bunch of pp groups. maybe it seems to work more as theres strength in numbers negotiating, etc. and provides stability, etc. my group kinda does our own thing but we are "friends" with another group in the area and we cover and help for each other. That we are both part of the bigger group means we look out for each other while maintaining some independence. A few other usap groups are fair etc. but there is one division in USAP that has a bad reputation for badness. It seems much less like an AMC than some others.
to the other post -- `Im not married to dallas at all... I just wanted out of the frozen midwest.... this place seems as good as any... not sure the market is better anywhere else that is a decent sized city with good weather. Im settling in here and I like this job so....
to the other post -- `Im not married to dallas at all... I just wanted out of the frozen midwest.... this place seems as good as any... not sure the market is better anywhere else that is a decent sized city with good weather. Im settling in here and I like this job so....
Yup. Sheridan is in bed with most of the HCA hospitals. HCA basically abandoned their "w2 in house anesthesia model" 2-3 years ago. That's why you never see HCA ads anymore for anesthesia. Cause Sheridan has gobbled up most of them.
I try to tell some of my anesthesia friends at HCA hospitals with private contracts to "watch out" for Sheridan. some are clueless bragging how much "value" they bring to the hospital and Sheridan or any other AMC isn't gonna to take over. To them. They are in denial.
Anyways. The real reason for the Sheridan/HCA connection is
Look at the executive board. Remember the HCA inplosion in 1997/1998? Many of the former HCA members went to work at Amsurg
Guess who brought out Sheridan a couple of years ago....Amsurg! That's the HCA/Sheridan connection homies.
Of course Envison healthcare just purchased Amsurg.
Hey all,
A week or so ago I decided to write in to the editor of Anesthesiology News in response to an old article they published stating that the majority of experiences with AMCs have been positive.
I told him I've been job hunting and have heard many different stories that seem to contradict the the statement in the article. I told him that I've heard good and bad stories and that it seems that some AMCs are good and some are not so good.
I suggested a follow up story where he actually reaches out to people with experience with various AMCs and writes about the differences.
He is very interested in the story and asked if I could give him contacts of people who would be willing to be interviewed or write to him.
Feel free to PM me or email him: [email protected]
Who knows if it's worth it, but maybe if people speak out about their experiences, it will help us evaluate who to sell to or who to work for. Heck it might even start to hold the AMCs to a higher standard (doubt it, but why not try).
Thanks.
A week or so ago I decided to write in to the editor of Anesthesiology News in response to an old article they published stating that the majority of experiences with AMCs have been positive.
I told him I've been job hunting and have heard many different stories that seem to contradict the the statement in the article. I told him that I've heard good and bad stories and that it seems that some AMCs are good and some are not so good.
I suggested a follow up story where he actually reaches out to people with experience with various AMCs and writes about the differences.
He is very interested in the story and asked if I could give him contacts of people who would be willing to be interviewed or write to him.
Feel free to PM me or email him: [email protected]
Who knows if it's worth it, but maybe if people speak out about their experiences, it will help us evaluate who to sell to or who to work for. Heck it might even start to hold the AMCs to a higher standard (doubt it, but why not try).
Thanks.
D
deleted643396
The problem is that such an article will undoubtedly have bias. The AMCs often advertise in publications like Anesthesiology News. If there is bad press regarding an AMC in the particular publication, that AMC may threaten to remove advertisements and thus decrease revenue for the publication. I also think you will get a lot of "interviews" from people at the top of these companies basically submitting "quotes" that might as well be an advertisement for the company. I could easily see an article with the following quotes:
"Sheridan taking over the business management was the best thing we ever did. Now we can focus on what we care about the most...our patients."
"NAPA has been a great working environment. I have grown in my career and am offered all kinds of leadership opportunities."
Unfortunately, word of mouth and anecdotal stories are still the best way to spread the word about bad jobs. I have perused websites like Glassdoor, and while I think the idea is good, there is not enough data on the site to be of any real use. An anonymous website that does not rely on funding from outside companies would be the best way to spread the word.
"Sheridan taking over the business management was the best thing we ever did. Now we can focus on what we care about the most...our patients."
"NAPA has been a great working environment. I have grown in my career and am offered all kinds of leadership opportunities."
Unfortunately, word of mouth and anecdotal stories are still the best way to spread the word about bad jobs. I have perused websites like Glassdoor, and while I think the idea is good, there is not enough data on the site to be of any real use. An anonymous website that does not rely on funding from outside companies would be the best way to spread the word.
I realize this and figured they get funding from the major companies. If you click on the corporate profiles part it has an automatic section for Team Health. I'm sure you are right, but don't journalists have strong morals and ethical beliefs to report the truth? What's the downside of anonymously writing in to him? Might as well try. Plus, if he does actually publish something with real experiences, it will turn more heads than a thread on SDN.
I'll post his reply email....
"Dr XXX
Sorry for the delay in reply but it took me awhile to wrap my brain around this. It is certainly an important issue and one which is increasingly vital to a high percentage of anesthesiologists.
We will work on this. It may take awhile to get something coherent together, but the idea is a very good one. I appreciate your suggesting it.
If you know of anyone who has had experiences (good or bad; I don’t want to pre-judge) with AMCs, who might like to be interviewed on the topic, please tell them they are free to contact me, or alternatively give me their name and contact info.
Best regards,
James Prudden"
Sorry for the delay in reply but it took me awhile to wrap my brain around this. It is certainly an important issue and one which is increasingly vital to a high percentage of anesthesiologists.
We will work on this. It may take awhile to get something coherent together, but the idea is a very good one. I appreciate your suggesting it.
If you know of anyone who has had experiences (good or bad; I don’t want to pre-judge) with AMCs, who might like to be interviewed on the topic, please tell them they are free to contact me, or alternatively give me their name and contact info.
Best regards,
James Prudden"
D
deleted50478
Better make it anonymous if he wants the truth, and disregard the statements of anyone who sold out to an AMC.
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D
deleted643396
I think the idea is a decent one, but I just think it's too easily exploited by the AMCs. I'm not sure Anesthesiology News is used to doing in depth investigative reporting like the New York Times. People who want to speak out will want to maintain anonymity.
I would instead maybe suggest presenting the idea to a prolific and well-read blogger who is not sympathetic to the AMC growth seen around the country. Offer to help write the article as a guest post or do some of the leg work to collect information. If the article is good enough then it is possible that a condensed version gets written for Anesthesiology News or something like KevinMD.
Why is that correct? In the private forum I've told it like it exists For an AMC which bought my practice. So, the only statements which are acceptable to you are the negative ones? Each local group may run the place differently from the other groups. There is no one AMC practice out there but there are common themes to them.
Now THAT'S funny!
D
deleted50478
Ha ha. You are the one assuming there will only be negative opinions if people who have been paid off are excluded.
I think you might just be right though
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Agree. My former practice which I may consider returning to was taken over by a AMC recently. Weird takeover where the principal 3 owners got a little cash for their cooperation (less than 1 million but cash is cash and they are older anyways never divorce)
They were 4 MDs ( I left, one moved away, one retired, and two of the MDs are older so they are splitting a job) short but hired 3 very quickly within 2 months. Everyone seems pretty happy. The AMC threw a bone for being short staff in July for Mds taking extra calls. So the MDs remaining made pretty good money (42k plus) and July was super light at the hospital.
Don't know how long it will last but they are basically offering package close to the low 400s plus benefits (paid occurrence malpractice and health worth at least $10k). They been working roughly 40-45 hours plus beeper calls from home as usual pre AMC take over. So the hours have been same even short staff.
Maybe they are trying to get off to a good start to make the hospital happy. Who knows. But guys there are pretty happy.
I've kinda of take half the summer with my kids being off from school and traveling but i may return in the fall.
Like blade said. It matters how the new practice is run locally. My old practice is basically being run the same with locums coverage filling in the open call slots with short staff and the new MDs are coming on board by Sept/October since full credendialing can take 2-3 months And other MDs have a 90 day out clause. One has a 120 day out clause from Pennslyvania. Weird. I'd never sign a 120 day out clause. I like 60 day out clauses my self.
Anyone seriously interested in writing this, please PM me. I can facilitate its placement in a major online outlet with a readership very receptive to this type of piece.
Excuse the stupid question... but I am very very veryyyy curious.
Future residents should probably understand that they will be working for an AMC, juggling multiple rooms overseeing CRNAs, working MORE hours, getting paid less to do it, with less vacation, and the possibility they will have to be fired/lose contracts and move to different hospitals if the BOSSES don't get hospital contracts?
Future residents should probably understand that they will be working for an AMC, juggling multiple rooms overseeing CRNAs, working MORE hours, getting paid less to do it, with less vacation, and the possibility they will have to be fired/lose contracts and move to different hospitals if the BOSSES don't get hospital contracts?
D
deleted171991
Yep!
In the future, anesthesiologists will be assembly lane workers. Yes, other specialties will suck, too, but not as much by far. If you think you hate clinic and supervising NPs, wait till you have to supervise 4-6 ORs where CRNAs can actually hurt people in your absence, on your license and malpractice.
D
deleted171991
Just a year or two longer. Anesthesia is becoming worthless without a good fellowship.
As long as you don't become a hospitalist, or some other type of cog. Do something where you build your own brand with the patients, not your employer's.
You might be interested to hear what Richard Novak at Stanford says:
https://theanesthesiaconsultant.com/2016/01/02/10-trends-for-the-future-of-anesthesiology/
D
deleted682700
Dont you love the older anesthesiologists who are getting a lot of money selling to AMC and making sure the younger middle aged ones to suffer pay cuts in perpetuity. The older incompetent ones are up in the as- of the administration too.
And many of them do not know how to improve efficiency or quality. Many of the CEOs on wall street are 40 year old energetic people. In medicine, the 40 year olds are shoved in Ors while the AARP members serve the role of visionaries. sad...
D
deleted643396
Yes, and to a degree patients will be "stuck" within a system...especially as these large hospital systems start putting out their own insurance products. However, people still inherently want to see their doctor, so you have more clout with a system when you are the doctor the patient wants to see.
The healthcare system is actually becoming very similar to consumer electronic products where you buy into an "ecosystem." Once you start owning Apple products, it tends to be in your best interest to continue to own apple products in the name of interoperability. The same thing with healthcare. Once your primary care doctor is part of one of these large consolidated "ecosystems," it is in your best interest to stay within that system.
D
deleted682700
The corporates are working to make sure that all the education, experience mean nothing. There is no added value per TPTB. The race is to get mid level providers masquerading as doctors with white coats on. Just get a chuckle at it. Read stanford prison experiment
Just adding my 2 cents.. Our small MD only group sold to a national AMC (hint starts with an S) and our situation checks most of the boxes previously posted.. superpartners getting rich, paycuts in perpetuity, etc.. luckily we have a low stress gig and so far haven't lost a single doc since the transition. In addition, our new benefits package is top notch as we never had 401k matching, hsa, fsa and our health insurance is way cheaper than what a small local group could provide for us. Also being part of a huge publicly traded company with growing presence across the country give at least some very slight feeling of stability since there is always a chance of lateral transfer to another practice or state if things go south here.
Down side? Publicly traded companies only care about one thing, their stock price. Your "valued service" that you think you provide is no more valued than the guy who empties the garbage cans at their corporate headquarters. These guys have squeezed the job market so tight that there are 3 people waiting to jump into your spot if you have a problem doing your job and keeping your mouth shut.
Down side? Publicly traded companies only care about one thing, their stock price. Your "valued service" that you think you provide is no more valued than the guy who empties the garbage cans at their corporate headquarters. These guys have squeezed the job market so tight that there are 3 people waiting to jump into your spot if you have a problem doing your job and keeping your mouth shut.
