Would you rather...

[seinfeld]

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The conversation regarding Mednax brought up a few questions for me that i am curious to see how people of different levels (attending, residents, students) answer.

1. Would you rather be an owner or an employee. If so whats the drive, autonomy or more potential salary. Would you sacrifice lower income for autonomy?
2. Would you rather be employed by a hospital or an AMC?
3. What salary threshold of salary will people think the risk/stress or anesthesia is not worth the income?

 

[darby11]

great question

For me, I Think anything much lower than 300k is totally not worth it with the amount of low level daily chronic stress associated with this job. the kind of stress that shortens your life.

i would take a 50K pay cut for more autonomy.

i would prefer to be employed by the hospital if i am going to be employed. The AMCs goals inherently are different from yours. They are polar opposites.

 

[IlDestriero]

great question

For me, I Think anything much lower than 300k is totally not worth it with the amount of low level daily chronic stress associated with this job. the kind of stress that shortens your life.

i would take a 50K pay cut for more autonomy.

i would prefer to be employed by the hospital if i am going to be employed. The AMCs goals inherently are different from yours. They are polar opposites.

I think that's the future, employed by the hospital. My hospital wants to take over my academic group. Our Chairman is on the way out in the next few years and I fear that the new Chair will be hired based on their willingness to sell out the group's independence to the hospital. Maybe a parting gift from the current chair? If so, I won't make it to Professor Emeritus.

Cheers!

 

[jetproppilot]

The conversation regarding Mednax brought up a few questions for me that i am curious to see how people of different levels (attending, residents, students) answer.

1. Would you rather be an owner or an employee.

I've been in both worlds.
Chronologically:
1)Hired by group, made partner, #$%king awesome
2)Left secondary to family issues to an area dominated by AMC, became an employee, NO COMPARISON IN MONEY NOR GRATIFICATION compared to 1).
3)Privileged with opportunity to form my own group in AMC territory.... much to shock of AMC and Blue Bloods.
Happy, motivated, own boss, RECREATING 1)

CREATE YOUR OWN

"LUCK".

 

[chrisv]

What exactly is an AMC? And does it only affect ansthesia or is it affecting other fields of medicine also?

 

[courtnes]

What exactly is an AMC? And does it only affect ansthesia or is it affecting other fields of medicine also?

I think he means academic medical center, but not positive.

 

[pgg]

What exactly is an AMC? And does it only affect ansthesia or is it affecting other fields of medicine also?

Anesthesia management company.

Typically they promise savings to hospitals, win contracts with tales of unicorns and butterflies, add another layer of management and $ extraction, and it all ends in tears for hospitals, surgeons, and anesthesiologists alike.

 

[chrisv]

Pardon my naiveness 😕 again...
Is this type of encroachment going on in other fields of medicine also? If not, then what exactly is so special about anesthesia that allows them to do this?

Anesthesia management company.

Typically they promise savings to hospitals, win contracts with tales of unicorns and butterflies, add another layer of management and $ extraction, and it all ends in tears for hospitals, surgeons, and anesthesiologists alike.

 

[scudrunner]

The conversation regarding Mednax brought up a few questions for me that i am curious to see how people of different levels (attending, residents, students) answer.

1. Would you rather be an owner or an employee. If so whats the drive, autonomy or more potential salary. Would you sacrifice lower income for autonomy?
2. Would you rather be employed by a hospital or an AMC?
3. What salary threshold of salary will people think the risk/stress or anesthesia is not worth the income?

As a medical student:

1) Owner. Autonomy and job satisfaction is #1 priority because it equals happiness.

2) Hospital. Their motives are obvious and you can participate in decision making by becoming a board member or chief.

3) I wouldn't go into a specialty that paid less than 300K/yr since I'll be graduating with with >300K of school debt. Cardiology is my #2.

 

[sevoflurane]

I've been in both worlds.
Chronologically:
1)Hired by group, made partner, #$%king awesome
2)Left secondary to family issues to an area dominated by AMC, became an employee, NO COMPARISON IN MONEY NOR GRATIFICATION compared to 1).
3)Privileged with opportunity to form my own group in AMC territory.... much to shock of AMC and Blue Bloods.
Happy, motivated, own boss, RECREATING 1)

CREATE YOUR OWN

"LUCK".

+1

Working for an AMC? C'mon now... That means you are putting your hard earned cash into somebodies pocket who isn't generating anything. They just hold the contract = everything. A well run group doesn't need to be "managed". That's just a big pile of BS. Wall of smoke with devious intentions. Someone eating off someone else's back. Pathetic. I'd rather be a hospital employee than to work for an AMC.

FWIW, i recently had a 6 hour conversation with a part owner of a management company (not looking for a job.... just vacationing at the same place).

Let me tell you.... It made me sick. It's the weak groups that will succumb to them.

 

[MDF1]

My group got acquired by an AMC not too long ago. When they told me it was coming obviously it was portrayed as "the best way forward for everyone...billing will be better blah blah" and while i didnt want to join an AMC, i figured id see how things played out. Since the acquisition ive felt like I want to vomit for working there now. The hospital, surgeons, and anesthesiologists are great and its a great place to work, but i just feel like a front door greeter at wall mart. Where I felt hard work, extra hours, taking extra call or going the extra mile was getting recognized and appreciated and perhaps rewarded in the future in some way, I now know that it will mean essentially nothing to anyone in the group or in the corporation and will get me nowhere except of course less free time.

They came to 'answer questions' the members of the group had and again felt like vomiting. No questions were answered in anything other than vague corporate language that resounded with the theme of "we could care less about any of your individual or collective concerns" Further meetings and listening to the 'business strategy' reveals that the goal of the company is to expand and acquire as many groups as possible, certainly nothing to do with us other than supplying a paycheck for labor. While there's less and less available partnership positions these days, i still think its worth waiting for and going after, even if it means sacrificing something else....like a cush schedule or your perfect location ect.

 

[Mman]

As a medical student:

1) Owner. Autonomy and job satisfaction is #1 priority because it equals happiness.

2) Hospital. Their motives are obvious and you can participate in decision making by becoming a board member or chief.

3) I wouldn't go into a specialty that paid less than 300K/yr since I'll be graduating with with >300K of school debt. Cardiology is my #2.

Your #2 choice of working for a hospital is fine, but your reason isn't. Whether you are employed by a hospital or an AMC, you are still part of the medical staff at the hospital you work at. Who signs the paycheck is irrelevant. But you won't me a board member as an active physician (or at least it will be very hard to get to that spot), but chief of staff is certainly possible if you work your way up from either background.

IMHO working for the hospital or AMC is basically the same thing.

 

[scudrunner]

Your #2 choice of working for a hospital is fine, but your reason isn't. Whether you are employed by a hospital or an AMC, you are still part of the medical staff at the hospital you work at. Who signs the paycheck is irrelevant. But you won't me a board member as an active physician (or at least it will be very hard to get to that spot), but chief of staff is certainly possible if you work your way up from either background.

IMHO working for the hospital or AMC is basically the same thing.

Well, neither choice is desirable to me but the hospital seems the lesser of two evils. My point was, involvement at an administrative level is possible in a hospital versus an AMC, and you can advocate for the specialty in order to create a better job for yourself and your colleagues. Yes, it may take time to get into that position, but at least the possibility exists.

 

[DrAwsome]

Pardon my naiveness 😕 again...
Is this type of encroachment going on in other fields of medicine also? If not, then what exactly is so special about anesthesia that allows them to do this?

I'm wondering where these corporations come from? Are they other medical groups or what? How can they buy out/replace groups? I'm so confused

 

[sevoflurane]

I'm wondering where these corporations come from? Are they other medical groups or what? How can they buy out/replace groups? I'm so confused

With promises of cheaper care. Its all about money.

They rely on physicians who are right out of residency vs. are not good vs. have a red flag in their background vs. legit MDs who have ties to the area.

"we can save you 2 million a year"

=

We will hire a new grad for 200k and max him out @ 300k with 4 weeks Vaca and 75 hrs. a week being on call q3-4 with 1-2 weekends a month, minimal 401k,little to no health insurance, malpractice help or disability (usually none).... It's robbery. CRNA's have it better than that.

Some are better than others (Sheridan, somnia, EM care)... but they all want the same thing. To rob u of your hard earned efforts in college and your medical education and your efforts in the hospital.

If I was a new grad, I'd go for a LARGE PP group. 30-50+ MDs sounds about right. Safety in numbers.

BTW... For the most part, there is a big diff. btw AMC and a Hospital employee.

 

[DrAwsome]

With promises of cheaper care. Its all about money.

They rely on physicians who are right out of residency vs. are not good vs. have a red flag in their background vs. legit MDs who have ties to the area.

"we can save you 2 million a year"

=

We will hire a new grad for 200k and max him out @ 300k with 4 weeks Vaca and 75 hrs. a week being on call q3-4 with 1-2 weekends a month, minimal 401k,little to no health insurance, malpractice help or disability (usually none).... It's robbery. CRNA's have it better than that.

Some are better than others (Sheridan, somnia, EM care)... but they all want the same thing. To rob u of your hard earned efforts in college and your medical education and your efforts in the hospital.

If I was a new grad, I'd go for a LARGE PP group. 30-50+ MDs sounds about right. Safety in numbers.

BTW... For the most part, there is a big diff. btw AMC and a Hospital employee.

That's not what I'm asking. I'm asking where are these groups coming from? Are they conglomerates of other physicians that recruit other physicians or what? And when did they show up? And as I've said before, it's time to start standing up and striking when necessary, as well as unionizing. We are always screwed and we take it. Look at what happened with PA firefighters-governor took their $$ and made them minimum wage, and they sued. Why don't we sue, demand what we need, etc?

 

[sevoflurane]

That's not what I'm asking. I'm asking where are these groups coming from? Are they conglomerates of other physicians that recruit other physicians or what? And when did they show up? And as I've said before, it's time to start standing up and striking when necessary, as well as unionizing. We are always screwed and we take it. Look at what happened with PA firefighters-governor took their $$ and made them minimum wage, and they sued. Why don't we sue, demand what we need, etc?

I would say there are a lot of different varieties to your question.

Some practitioners do sue... but most of the time it's easier and cheaper to move on.

 

[jwk]

With promises of cheaper care. Its all about money.

They rely on physicians who are right out of residency vs. are not good vs. have a red flag in their background vs. legit MDs who have ties to the area.

"we can save you 2 million a year"

=

We will hire a new grad for 200k and max him out @ 300k with 4 weeks Vaca and 75 hrs. a week being on call q3-4 with 1-2 weekends a month, minimal 401k,little to no health insurance, malpractice help or disability (usually none).... It's robbery. CRNA's have it better than that.

Some are better than others (Sheridan, somnia, EM care)... but they all want the same thing. To rob u of your hard earned efforts in college and your medical education and your efforts in the hospital.

If I was a new grad, I'd go for a LARGE PP group. 30-50+ MDs sounds about right. Safety in numbers.

BTW... For the most part, there is a big diff. btw AMC and a Hospital employee.

Giant groups (100 or more MD/CRNA/AA) are pretty hard to swallow up, but it's been done. A group with just 30 MD's or so could be ripe for the picking.

 

[D P356]

.

 

[sevoflurane]

Giant groups (100 or more MD/CRNA/AA) are pretty hard to swallow up, but it's been done. A group with just 30 MD's or so could be ripe for the picking.

Perhaps. Nobody is immune jwk. The problem with huge groups is that they sometimes function as an AMC (not all of course). Pyramid structure with super partners and little chance getting to the top.... or huge partnership tracks.
A big group in phoenix comes to mind. Currently a 4 year partnership track....😱
They are pretty immune to a hostile takeover however.

 

[Arcan57]

That's not what I'm asking. I'm asking where are these groups coming from? Are they conglomerates of other physicians that recruit other physicians or what? And when did they show up? And as I've said before, it's time to start standing up and striking when necessary, as well as unionizing. We are always screwed and we take it. Look at what happened with PA firefighters-governor took their $$ and made them minimum wage, and they sued. Why don't we sue, demand what we need, etc?

Coming from another specialty where CMGs (contract management groups) are prevalent, they've been around a fairly long time (EmCare was founded in '72). Since they are large groups that are constantly looking to expand, their market penetration has been increasing over time to the point where in some markets they may be the only choice. The emergency medicine version is more benign than what is being described on this thread, but I don't know if they actually are better or just that good PP EM jobs are comparatively rarer than in anesthesia. Striking or unionizing isn't really applicable, most CMG groups would like to keep some percentage of the current groups but they are staffed such that they can pull in locums to cover until they can recruit locally.

Starting a PP group is expensive even without office overhead (you have to have the cash reserves to weather ~6mo before you start collecting on your insurance billing), and just because you have a group doesn't mean you'll get a contract. CMGs can play the field and fail at 80% of their bids because they don't have to care about geography as much. A doc with local ties starting a PP group that can't get a contract is going to have to move.

Increasing regulatory burdens (especially CMS core measure documentation) regarding EM likely will spell the end of small democratic groups for us. Given the level of documentation already mandated for the OR I don't know how much of a factor this will be for anesthesia.

 

[Dermpath]

Coming from another specialty where CMGs (contract management groups) are prevalent, they've been around a fairly long time (EmCare was founded in '72). Since they are large groups that are constantly looking to expand, their market penetration has been increasing over time to the point where in some markets they may be the only choice. The emergency medicine version is more benign than what is being described on this thread, but I don't know if they actually are better or just that good PP EM jobs are comparatively rarer than in anesthesia. Striking or unionizing isn't really applicable, most CMG groups would like to keep some percentage of the current groups but they are staffed such that they can pull in locums to cover until they can recruit locally.

Starting a PP group is expensive even without office overhead (you have to have the cash reserves to weather ~6mo before you start collecting on your insurance billing), and just because you have a group doesn't mean you'll get a contract. CMGs can play the field and fail at 80% of their bids because they don't have to care about geography as much. A doc with local ties starting a PP group that can't get a contract is going to have to move.

Increasing regulatory burdens (especially CMS core measure documentation) regarding EM likely will spell the end of small democratic groups for us. Given the level of documentation already mandated for the OR I don't know how much of a factor this will be for anesthesia.

I'm also interested in this issue. I guess what I am confused about is, why does any specialty need to be managed? Wouldn't there just be an opening and a candidate is interviewed for a position? I also have the same question as poster above too. Are these MD/DO type groups that are recruiting others? Or are these non MD groups? Also how can they save money-by not paying docs much or what? And if we all become hospital employees in the future, are we then allowed to unionize and can we expect 40 or less hours a week with no productivity bonus and stuff?

 

[IlDestriero]

I'm also interested in this issue. I guess what I am confused about is, why does any specialty need to be managed? Wouldn't there just be an opening and a candidate is interviewed for a position? I also have the same question as poster above too. Are these MD/DO type groups that are recruiting others? Or are these non MD groups? Also how can they save money-by not paying docs much or what? And if we all become hospital employees in the future, are we then allowed to unionize and can we expect 40 or less hours a week with no productivity bonus and stuff?

They provide the service cheaper and promise better service, etc.
For example a group of 20 MDs have a no CRNA, solo MD care practice earning them all 450k including a $1m subsidy from the hospital to cover low volume OB call and infrequent 24 hour trauma service.
(Note I'm intentionally keeping the details very simple for illustration.)
The group takes in $8m from patient care and $1m from the hospital.
The management company comes in and says they can do it with no subsidy at all, and provide the same level of service, or better, and safer, with a care team approach. Saving the hospital $1m/yr as well. Their bid for the contact $0, the old group wants $1m/yr and a guaranteed 5% raise over 3 yrs.
They hire 30 CRNAs at $150k, 5 mds at 300k and one manager at 400k. Total cost $6.4m. That gives the management company a profit of $1.6m/yr.
They can also decrease costs and overhead because they have hundreds of employees, not just 20 and can provide affordable "Honda accord" benefits vs the "Rolls Royce" plans the physician group had. All profit got the AMC.
Overly simplified, but you get the idea.

-
"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."

 

[Mman]

I'm also interested in this issue. I guess what I am confused about is, why does any specialty need to be managed? Wouldn't there just be an opening and a candidate is interviewed for a position? I also have the same question as poster above too. Are these MD/DO type groups that are recruiting others? Or are these non MD groups? Also how can they save money-by not paying docs much or what? And if we all become hospital employees in the future, are we then allowed to unionize and can we expect 40 or less hours a week with no productivity bonus and stuff?

Expanding upon the previous answer to these questions. The specialty doesn't need to be managed, but considering we are essentially all hospital (or surgery center) based, most of us tend to work in a large group of some sort.

1) You work for the hospital and/or academic department of a medical school. They sign you to a contract to work so many days or hours and so many nights and weekends for a fixed rate. They bill for your services and you collect a paycheck.

2) You work for an AMC. It's a large corporation that is contracted by the hospital to cover all their anesthesia needs. You don't worry about billing and collect a paycheck. If you are a squeaky wheel, they can replace you with somebody else who will do it for cheaper.

3) You work for a private group that has an exclusive contract with the hospital to provide anesthesia coverage to that hospital. Within the group you all decide how you will provide that coverage and how many docs (and possibly CRNAs) you need to do it. Your group handles all the billing. Your salary depends on how well the group is doing. But if things are managed well, you make far more money than option #1 or option #2 and you have the satisfaction of managing the business and not working for the man. More work, more incentive, more reward.



The purpose of the AMCs is to underbid private groups for hospital contracts and hire cheap, crappy labor to do the job instead of you. Barely speaking English foreign medical grads, etc.

 

[Substance]

When you own your own group, you work for the patient.

When you are an employee, you work for the admin. This runs counter to the Oath. I cannot believe we tolerate it.

The purpose of the AMCs is to underbid private groups for hospital contracts and hire cheap, crappy labor to do the job instead of you. Barely speaking English foreign medical grads, etc.

You just described Pathology.

 

[Dermpath]

When you own your own group, you work for the patient.

When you are an employee, you work for the admin. This runs counter to the Oath. I cannot believe we tolerate it.



You just described Pathology.

so what do we do about this?

 

[Dermpath]

They provide the service cheaper and promise better service, etc.
For example a group of 20 MDs have a no CRNA, solo MD care practice earning them all 450k including a $1m subsidy from the hospital to cover low volume OB call and infrequent 24 hour trauma service.
(Note I'm intentionally keeping the details very simple for illustration.)
The group takes in $8m from patient care and $1m from the hospital.
The management company comes in and says they can do it with no subsidy at all, and provide the same level of service, or better, and safer, with a care team approach. Saving the hospital $1m/yr as well. Their bid for the contact $0, the old group wants $1m/yr and a guaranteed 5% raise over 3 yrs.
They hire 30 CRNAs at $150k, 5 mds at 300k and one manager at 400k. Total cost $6.4m. That gives the management company a profit of $1.6m/yr.
They can also decrease costs and overhead because they have hundreds of employees, not just 20 and can provide affordable "Honda accord" benefits vs the "Rolls Royce" plans the physician group had. All profit got the AMC.
Overly simplified, but you get the idea.

-
"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."

Ok thanks that helps my understanding a little. But what I still do not grasp is "who" are these management companies? Are they a bunch of older attendings who form them? Are they non docs? Like can me and you form one of these groups and start hiring other docs? That's what I'm trying to figure out. And who is this "manager" person-an MD or what?

Also why have these models become more frequent lately and is there a way to stop this and go back to other ways of practicing?

Lastly, most people in medicine are the best and brightest, yet our compensation is declining. In most industries,salaries for high in demand people are increased not decreased. Even nurses demand and pretty much get what they want. Why dont we?

 

[IlDestriero]

Ok thanks that helps my understanding a little. But what I still do not grasp is "who" are these management companies? Are they a bunch of older attendings who form them? Are they non docs? Like can me and you form one of these groups and start hiring other docs? That's what I'm trying to figure out. And who is this "manager" person-an MD or what?

Also why have these models become more frequent lately and is there a way to stop this and go back to other ways of practicing?

Lastly, most people in medicine are the best and brightest, yet our compensation is declining. In most industries,salaries for high in demand people are increased not decreased. Even nurses demand and pretty much get what they want. Why dont we?

Yes. We can start one tomorrow. I'm 1/2 serious. They are owned by physicians, CRNAs😱, MBAs, whoever has some money, understands anesthesia and anesthesia delivery, and a business plan. I would start one with a couple people I work with now, experienced guys with business and management backgrounds. It could work.
The manager is just a managing "partner" anesthesiologist hired to be the department head. He gets more because he's the mouthpiece for the AMC and keeps the "workers" in line.


-
"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."

 

[pgg]

The purpose of the AMCs is to underbid private groups for hospital contracts and hire cheap, crappy labor to do the job instead of you. Barely speaking English foreign medical grads, etc.

I wonder if we'll see hospitals start to wise up to the AMC tactics. For a while, hospitals could say they didn't know any better, because the concept was new. Now that we've seen so many places just go straight to hell when the AMC comes in with their bottom rung strip-mall-CRNA-mill labor and anesthesiologists who've fled or been kicked out of good jobs, I wonder if hospitals will be less eager to swallow the AMC bait.

 

[Mman]

I wonder if we'll see hospitals start to wise up to the AMC tactics. For a while, hospitals could say they didn't know any better, because the concept was new. Now that we've seen so many places just go straight to hell when the AMC comes in with their bottom rung strip-mall-CRNA-mill labor and anesthesiologists who've fled or been kicked out of good jobs, I wonder if hospitals will be less eager to swallow the AMC bait.

I think the answer is that it depends on the hospital and the administrators. Some are probably wise to it. Others probably care more about balancing their budget in which case an AMC's calling might sound a lot better.

 

[sevoflurane]

I wonder if we'll see hospitals start to wise up to the AMC tactics. For a while, hospitals could say they didn't know any better, because the concept was new. Now that we've seen so many places just go straight to hell when the AMC comes in with their bottom rung strip-mall-CRNA-mill labor and anesthesiologists who've fled or been kicked out of good jobs, I wonder if hospitals will be less eager to swallow the AMC bait.

You betcha Pgg... but not before the AMC gets their piece of the pie.

A group I know very well has come full circle with a hospital system.

Lost the contract to an AMC who brought in poor providers.
Bad outcomes followed, including an 17 y/o kid who died from hypokalemic arrest 2/2 to sux administration after induction with a "full stomach". Unfortunately for the patient, the provider didn't check labs after a crush injury. Pre-op K+ was 8.0 in change.
Once the hospital started to loose it's reputation in the community due to this and other bad outcomes the hospital tried to get out of the contract with the AMC.

Ohhh... but wait, it gets better.

In order to get out of the contract with the AMC, the hospital had float a 1 million dollar check to the AMC.

That is how large subsidies are sometimes made. Hospital administration licking their wounds and realizing the importance of quality care.

Unfortunate, but true story coming from a buddy who currently works in that group.

 

[Dermpath]

You betcha Pgg... but not before the AMC gets their piece of the pie.

A group I know very well has come full circle with a hospital system.

Lost the contract to an AMC who brought in poor providers.
Bad outcomes followed, including an 17 y/o kid who died from hypokalemic arrest 2/2 to sux administration after induction with a "full stomach". Unfortunately for the patient, the provider didn't check labs after a crush injury. Pre-op K+ was 8.0 in change.
Once the hospital started to loose it's reputation in the community due to this and other bad outcomes the hospital tried to get out of the contract with the AMC.

Ohhh... but wait, it gets better.

In order to get out of the contract with the AMC, the hospital had float a 1 million dollar check to the AMC.

That is how large subsidies are sometimes made. Hospital administration licking their wounds and realizing the importance of quality care.

Unfortunate, but true story coming from a buddy who currently works in that group.

As I've predicted before, I think this is exactly what will happen. I will thre will be a # of years where this will continue to happen-"cost savings" aka greed will lead to cheaper, crappier providers being brought into the system, with poor outcomes aka lawsuits and lots of lost $$$, which will eventually lead to a full circle of a desperate need for quality MDs, and the realization that there is a reason why MDs are not nurses and vice versa. But it may take some time for this to come full circle.

 

[FrankWhite]

How difficult is it for a new grad to break into a PP gig with a partnership track? Are the AMCs mostly in highly desirable living areas?

 

[MDF1]

When you own your own group, you work for the patient.

When you are an employee, you work for the admin. This runs counter to the Oath. I cannot believe we tolerate it.

Thats exactly the way I feel after the takeover.

 

[IlDestriero]

As I've predicted before, I think this is exactly what will happen. I will thre will be a # of years where this will continue to happen-"cost savings" aka greed will lead to cheaper, crappier providers being brought into the system, with poor outcomes aka lawsuits and lots of lost $$$, which will eventually lead to a full circle of a desperate need for quality MDs, and the realization that there is a reason why MDs are not nurses and vice versa. But it may take some time for this to come full circle.

Hospitals are very risk averse, the safety gurus meet and bat around ideas, hospital administrators as well. As these disasters, lost $$, settlements, broken promises, etc. increase, word will spread like wildfire and JPP won't be the only one in the 1% club.

-
"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."

 

[Substance]

so what do we do about this?

The only way that anything could be done about this is if the major physician organization steadfastly opposed the employing of physicians. Hospitals would have to negotiate with physicians on an independent, mercenary-like, contract basis, so that the physician, who has the complete trust of the public, can practice medicine in a safe, effective, timely fashion. Independent medical companies run by MBAs would be SOL.

Of course, this requires a united front from all physicians in every specialty, and we're just not gonna see that.

The collective failure of physicians to realize that they are ultimately working for the patients and that their high incomes are directly the result of the public's trust in them is the cause for our current woes. Once we chase greed and bend to uncouth pressures, the patients will take their business to someone they do trust.

 

[Mman]

The only way that anything could be done about this is if the major physician organization steadfastly opposed the employing of physicians. Hospitals would have to negotiate with physicians on an independent, mercenary-like, contract basis, so that the physician, who has the complete trust of the public, can practice medicine in a safe, effective, timely fashion. Independent medical companies run by MBAs would be SOL.

Of course, this requires a united front from all physicians in every specialty, and we're just not gonna see that.

The collective failure of physicians to realize that they are ultimately working for the patients and that their high incomes are directly the result of the public's trust in them is the cause for our current woes. Once we chase greed and bend to uncouth pressures, the patients will take their business to someone they do trust.

Signing a contract with a hospital on an independent basis is essentially the same as working for the AMC. Very little difference. Who your boss is financially changes, but your clinical work day and prospects for career advancement are the same.

 

[Substance]

Signing a contract with a hospital on an independent basis is essentially the same as working for the AMC. Very little difference. Who your boss is financially changes, but your clinical work day and prospects for career advancement are the same.

There is one big difference. When an employee, the employer pays you for your time and time only. They also have the ability to unilaterally change the conditions of your employment at any notice. As a contracted professional, the terms of the arrangement are set out from the beginning, and any change from those terms must be re-negotiated by each side before being implemented. Furthermore, you are paid for your expertise, not just your time. It's more of an equal relationship than a master/slave relationship.

True independent practice is the real way to go. It takes a lot of effort but its well worth it.

 

[Mman]

There is one big difference. When an employee, the employer pays you for your time and time only. They also have the ability to unilaterally change the conditions of your employment at any notice. As a contracted professional, the terms of the arrangement are set out from the beginning, and any change from those terms must be re-negotiated by each side before being implemented. Furthermore, you are paid for your expertise, not just your time. It's more of an equal relationship than a master/slave relationship.

True independent practice is the real way to go. It takes a lot of effort but its well worth it.

Perhaps you could explain to me the difference between being an employee of the hospital or an employee of the AMC. The contract is the same. The only difference is the entity signing the paycheck.

AMC employees are "contracted professionals". Their work terms are set out from the beginning and must be renegotiated to change. But when you sign the contract, it'll have plenty of vague language in it. Same thing with a hospital contract.

 

[Substance]

Perhaps you could explain to me the difference between being an employee of the hospital or an employee of the AMC. The contract is the same. The only difference is the entity signing the paycheck.

AMC employees are "contracted professionals". Their work terms are set out from the beginning and must be renegotiated to change. But when you sign the contract, it'll have plenty of vague language in it. Same thing with a hospital contract.

Being and employee is just that, no matter whom its with. As an employee you have no power over your employer.

When acting as a contracted professional, you have power during contract negotiations, and power to renegotiate as per the terms in the contract. This is different than employment. Furthermore, as a contracted incorporated professional the tax code (domestically at least) encourages the payments to be taxed at the corporate rate, and allows dividends to be distributed among first-degree relatives. Being paid as an employee by a corporation prohibits one from enjoying a lower tax rate. Otherwise, every Walmart worker would be incorporating.


I suppose the real way to go about the negotiations is to get a lawyer go over the contract with a fine-toothed comb to spot the vagaries and have those changed into something more specific. Of course, the other party, whether hospital or AMC, may opt to sign a contract with someone nowhere near as contract savvy, but that's more the fault of our profession and not of the hospitals.

As far as I have understood, being a rank-and-file employee makes it nearly impossible to have any contract renegotiations, hence the existence of unions for those individuals. Independent contractors have more leeway in renegotiations. Furthermore they have more say as to what stipulations are in the contract from the beginning.

 

[Mman]

Being and employee is just that, no matter whom its with. As an employee you have no power over your employer.

When acting as a contracted professional, you have power during contract negotiations, and power to renegotiate as per the terms in the contract. This is different than employment. Furthermore, as a contracted incorporated professional the tax code (domestically at least) encourages the payments to be taxed at the corporate rate, and allows dividends to be distributed among first-degree relatives. Being paid as an employee by a corporation prohibits one from enjoying a lower tax rate. Otherwise, every Walmart worker would be incorporating.


I suppose the real way to go about the negotiations is to get a lawyer go over the contract with a fine-toothed comb to spot the vagaries and have those changed into something more specific. Of course, the other party, whether hospital or AMC, may opt to sign a contract with someone nowhere near as contract savvy, but that's more the fault of our profession and not of the hospitals.

As far as I have understood, being a rank-and-file employee makes it nearly impossible to have any contract renegotiations, hence the existence of unions for those individuals. Independent contractors have more leeway in renegotiations. Furthermore they have more say as to what stipulations are in the contract from the beginning.

My point is that you have little to no power to negotiate a contract that is different than anybody else working in that location whether you are signing with a hospital or an AMC. It's all the same. They likely have dozens of other MDs with identical contracts and they aren't going to do a special one with you. It tends to be take it or leave it offer to some extent with little negotiation of anything major in the contract. If you don't want it, they'll find someone else or use a locum's until they can.

For example, Kaiser is a large health system in California and their MDs are employees of the health system and have essentially identical contracts. Works the same way for AMCs.

Now if you are talking about a small hospital with only 1-2 docs you may have some more leeway to negotiate.

 

[Substance]

My point is that you have little to no power to negotiate a contract that is different than anybody else working in that location whether you are signing with a hospital or an AMC. It's all the same. They likely have dozens of other MDs with identical contracts and they aren't going to do a special one with you. It tends to be take it or leave it offer to some extent with little negotiation of anything major in the contract. If you don't want it, they'll find someone else or use a locum's until they can.

For example, Kaiser is a large health system in California and their MDs are employees of the health system and have essentially identical contracts. Works the same way for AMCs.

Now if you are talking about a small hospital with only 1-2 docs you may have some more leeway to negotiate.

Yeah, I see what you are saying. That's an important part of capitalism and I cannot see fault for the AMC/Hospitals for strongarming if there is a big pool of people willing to be strongarmed. It's more of a fault with our own profession.

Small hospitals are where its at, that's true.

The only way around this would be for the governing body of medicine, the AMA, and the anesthesia society to denounce the physician-as-employee model and place it in the realm of unethical behavior inasmuch as the physician's primary loyalty rests with their employer and not with the patient in those arrangements.