AMC paying $500k plus 11 weeks off and still making money off u

[aneftp]

For a new grad AMC in Florida paying $500k with 10/11 weeks of vacation is a lot of money in this tight job environment.

It's pretty hard work. Like 60-65 hours a week. Doing lines to prep the cardiac patients after a busy night of call. So u working all the time. They likely still making 250k off ur hard labor. Plus they use free labor with srna program.

The key to this Florida market (central Florida) is team health/Sheridan/usap all have to compete with each other

Vs south Florida (palm beach to Miami) where Sheridan has a monopoly

And the west side of Florida where team health (purchased Florida gulf to bay entities) control the Tampa market so drive down salaries. Sheridan has pockets of places further south on the west coast.

So competition can be good.

Sheridan/amsurg/envision health seems the most oblivious to market forces. Thus losing people left and right.

Usap trying to flip the company public so offering some shares in stock (whatever it's worth but the original partners who sold out getting a bigger value of the stock)

Team health seems pretty aggressive even with the black stone taking it private. They were paying in the mid 400s with 8-9 weeks up in Maryland awhile ago as well

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[GravelRider]

Be careful with non-competes. I've seen non-competes that say something to the effect of "you cannot work for any of our competitors for 2 years."

With that said, a job like this may be a better option than a long partnership track. You take a job like this out of residency knowing that it's a short term thing. You work for a few years, save a bunch of money, and then look for greener pastures. Again, be careful with non-competes and don't live like you are making $500k.

 

[sevoflurane]

Why the heck would any new grad look for greener pastures with 500k and 11 weeks and no buy in?. 60 hours a week is not THAT hard.
It's better than residency with 3X vacation and a decent compensation package to pay down debt.
Sounds like the perfect work hard play hard gig- my favorite type of setup.
Not for the millennial that wants the 7-3pm gig. That's for sure.
Glad there is some competition.
About time.

 

[nimbus]

It's $200/hr....which is fair, at least in my region.

 

[GravelRider]

Why the heck would any new grad look for greener pastures with 500k and 11 weeks and no buy in?. 60 hours a week is not THAT hard.
It's better than residency with 3X vacation and a decent compensation package to pay down debt.
Sounds like the perfect work hard play hard gig- my favorite type of setup.
Not for the millennial that wants the 7-3pm gig. That's for sure.
Glad there is some competition.
About time.

I said it was a good option...but don't expect it to be long term. I don't know the area, so maybe it's undesirable...but, if an AMC is offering that kind of money/vacation in a desirable area then the work environment probably stinks. They can't recruit and retain. Once the lousy work environment with old dudes that can't/won't work and militant CRNAs gets old, it's time to look for greener pastures. I don't care how much money you are making, if the work environment s*cks then the job won't be sustainable...but maybe I'm just an idealistic millennial .

 

[BLADEMDA]

I said it was a good option...but don't expect it to be long term. I don't know the area, so maybe it's undesirable...but, if an AMC is offering that kind of money/vacation in a desirable area then the work environment probably stinks. They can't recruit and retain. Once the lousy work environment with old dudes that can't/won't work and militant CRNAs gets old, it's time to look for greener pastures. I don't care how much money you are making, if the work environment s*cks then the job won't be sustainable...but maybe I'm just an idealistic millennial .

The area is very desirable and is a top destination in Florida with one of the largest airports in the State.

Most of the "old dudes" have retired; they sold the group to an AMC years ago.

The job itself is very hard with a considerable number of hours per week but the pay is fair. As far as being "sustainable" I think one could do 5-10 years at such a job without much difficulty assuming a starting age under 40.

 

[AdmiralChz]

That's a solid job, particularly if someone has a lot of debt to pay off.

Someone is going to be making $$ of our work, that's how jobs work. I don't have a problem with it, just want fair compensation. Working the same hours as residency would be tough but having 3-4x the vacation and making 10x in salary would make it very bearable.

Like Blade said, great first job for 5-10 years eliminate debt build a financial foundation/start a family and move on. Florida is a solid state to practice in as well - no state income tax!

 

[Notorious T.E.E.]

For a new grad AMC in Florida paying $500k with 10/11 weeks of vacation is a lot of money in this tight job environment.

It's pretty hard work. Like 60-65 hours a week. Doing lines to prep the cardiac patients after a busy night of call. So u working all the time. They likely still making 250k off ur hard labor. Plus they use free labor with srna program.

The key to this Florida market (central Florida) is team health/Sheridan/usap all have to compete with each other

Vs south Florida (palm beach to Miami) where Sheridan has a monopoly

And the west side of Florida where team health (purchased Florida gulf to bay entities) control the Tampa market so drive down salaries. Sheridan has pockets of places further south on the west coast.

So competition can be good

So what's your take on the job? A good option? I don't know how much the AMC is making off the anesthesiologist, but the salary/vacation is more than the few remaining private groups in the Florida area I've seen.

I would be worried about sustainability. If you are from the area/at UF and you land there a few years out of residency there's probably not much to loose. As soon as the market turns a little bit that $500k turns to $400k or less pretty quick. Not that a similar scenario isn't a risk everywhere, but Blackstone will probably lead the pack in ratcheting down salaries to increase profits.

 

[Stank811]

Why the heck would any new grad look for greener pastures with 500k and 11 weeks and no buy in?. 60 hours a week is not THAT hard.
It's better than residency with 3X vacation and a decent compensation package to pay down debt.
Sounds like the perfect work hard play hard gig- my favorite type of setup.
Not for the millennial that wants the 7-3pm gig. That's for sure.
Glad there is some competition.
About time.

Because there are greener pastures. I do like to see an AMC offer some reasonable vacation but they are still likely making 400-500 off the person who takes the position and over a career that is a hell of a bug in with no ownership at the end.

 

[aneftp]

So what's your take on the job? A good option? I don't know how much the AMC is making off the anesthesiologist, but the salary/vacation is more than the few remaining private groups in the Florida area I've seen.

I would be worried about sustainability. If you are from the area/at UF and you land there a few years out of residency there's probably not much to loose. As soon as the market turns a little bit that $500k turns to $400k or less pretty quick. Not that a similar scenario isn't a risk everywhere, but Blackstone will probably lead the pack in ratcheting down salaries to increase profits.

It's right in heart of downtown orlando Florida. So location is pretty good. I know the two managing partners just retired (likely did their required 3 years after selling out) so that's why they are being more aggressive.

It's not easy work. But for a new grad who has 200k plus student loans to pay back and used to residency type hours. It may be a good short term 2-3 years job. Figure housing cost cheaper than other parts of the country. No state income taxes.

Let's assume $330-350k take home after w2 taxes. Housing $2-3k a month. And that would be living large. Even if u spend like crazy. Say 12-13k a month. Say with housing plus living the life. 15k a month. U would still have 150k leftover AFTER taxes each year.

U can still blow more money and still pay able to pay off 200k student loans in 2 years pretty easily.

There is no non compete clause (unlike usap). The only "non compete" is working at same facility u signed agreement to work at. And malpractice tail is paid for.

For us "older folks". Trauma 1 gets old. I'm through with that stage in my life. But for newer grads. It's not bad pay. Especially new grad who's on the go go and used to working a lot of hours

No retirement match would be the big downside. So that's why I said 330-350k after tax income. Stil a lot of money with time off. Team health health benefits are better than Sheridan and USAP. USAP probably the worst health benefits and Sheridan isn't much better.

 

[Planktonmd]

It's right in heart of downtown orlando Florida. So location is pretty good.

I wouldn't call that a pretty good location!

 

[aneftp]

I wouldn't call that a pretty good location!

Downtown LA, downtown D.C., downtown SF. Downtown Miami, downtown tampa, downtown Houston, New Orleans, Charlotte, Atlanta, Dallas, Baltimore etc

Take ur pick. It's not in the boonies. I guess if u don't like golfing and tennis year and boating year round than Florida isn't ur cup of tea.

 

[AdmiralChz]

Downtown Orlando is great, and I'm fair from a city guy. The traffic is pretty horrendous but what central metro area isn't? It's cheap living (order of magnitude less than LA, NYC) and the area is nice with a newly renovated bar/restaurant scene and nearby Amway center for athletic/major events within walking distance. Lake Eola downtown is a great hike and has great vistas/farmers market.

Downtown is far enough away from Universal/Disney that you aren't overrun with tourists, which is a main concern with living in the area. About an hour to Cocoa Beach/Cape Canaveral which is a plus.

 

[pgg]

60 hours a week is not THAT hard.

It's not the hours on the clock but how each of the minutes go ...

60 hours on your feet with 3 or 4 CRNAs risking your license is worlds different than 60 hours of sitting your own cases.

I'm betting that an AMC paying $500K with 11wks off is going to have you extended, stretched, in constant motion, and at risk.

 

[Magnus67]

It's not the hours on the clock but how each of the minutes go ...

60 hours on your feet with 3 or 4 CRNAs risking your license is worlds different than 60 hours of sitting your own cases.

I'm betting that an AMC paying $500K with 11wks off is going to have you extended, stretched, in constant motion, and at risk.

Amen to that.


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[Mman]

Florida is a solid state to practice in as well - no state income tax!

I was under the impression Florida was a difficult state from a medical licensing and malpractice point of view. I've never heard anybody say anything good about working there other than no state income tax.

 

[aneftp]

It's not the hours on the clock but how each of the minutes go ...

60 hours on your feet with 3 or 4 CRNAs risking your license is worlds different than 60 hours of sitting your own cases.

I'm betting that an AMC paying $500K with 11wks off is going to have you extended, stretched, in constant motion, and at risk.

The practice has functioned the same before and after the AMC buyout.

So they were running all around 1:4 pre team health buy Out.

The AMC was paying much less though (380k plus $25k metric bonus) and just recently increased the pay.

I'm sure the 3-4 super partners were making $700-800k easily pre buy out as well.

So $500k salary still means the AMC pocketing 200-250k profit per MD provider in 2017.

 

[sevoflurane]

It's not the hours on the clock but how each of the minutes go ...

60 hours on your feet with 3 or 4 CRNAs risking your license is worlds different than 60 hours of sitting your own cases.

I'm betting that an AMC paying $500K with 11wks off is going to have you extended, stretched, in constant motion, and at risk.

ACT? I don't speak that language.
Point taken though.

 

[drdan4]

ACT = Pre-op Monkey, Break B!tch and Fireman.

Nobody does a 4 year Residency to learn how to supervise CRNAs forever.

I am convinced CRNA loving AMCs are secretly funding AANA and paying the ASA to look the other way. They will not relent till all Anesthesiologists are slaves!

 

[Arch Guillotti]

Someone is going to be making $$ of our work, that's how jobs work.

Not all of them.

Business owners keep the profits after all the expenses are paid.

That's how jobs work when you are an employee, not an owner.

 

[deleted162650]

ACT? I don't speak that language.
Point taken though.

ACT?? I think that's a brand of mouthwash right?

 

[sevoflurane]

ACT?? I think that's a brand of mouthwash right?

While yes Salty...
I believe you are correct.

 

[BLADEMDA]

ACT = Pre-op Monkey, Break B!tch and Fireman.

Nobody does a 4 year Residency to learn how to supervise CRNAs forever.

I am convinced CRNA loving AMCs are secretly funding AANA and paying the ASA to look the other way. They will not relent till all Anesthesiologists are slaves!

AMCs want to make money. lots of money. In order to do that they allow 4:1 supervision or even 5:1 coverage if they can get away with it. Once you are employed by an AMC they own you. But, how you handle your cases and do the anesthetic is pretty much your decision.

Orlando is a low cost part of Florida and you can live 15 min from the hospital pretty cheaply or pay more and live 5 minutes away. For a new grad or someone under the age of 40 who doesn't mind covering 4 rooms and working 60 hours per week for $500K with 10 weeks of vacation then I advise you to at least go interview. The vast majority of people who move to the Central Florida area like it a lot and typically stick around for a long time.

It's not an easy job at a Level 1 Trauma center covering over 1 million residents. There is no OB but plenty of Trauma, hearts, lungs, vascular, gun shot wounds, MVAs, Ortho, etc.

 

[BLADEMDA]

ACT = Pre-op Monkey, Break B!tch and Fireman.

Nobody does a 4 year Residency to learn how to supervise CRNAs forever.

I am convinced CRNA loving AMCs are secretly funding AANA and paying the ASA to look the other way. They will not relent till all Anesthesiologists are slaves!

Let me tell you something slim: If you pay people enough money they will do anything and I mean anything to keep that money flowing.

That's why academics trains so many Residents and SRNAS: $$$

 

[Stank811]

Let me tell you something slim: If you pay people enough money they will do anything and I mean anything to keep that money flowing.

That's why academics trains so many Residents and SRNAS: $$$

Agreed but 500k for a 1 mil job isn't enough. Like you said AMC are out to make a lot of money. Unfortunately the way they make a ton of money is by paying off groups for their future earnings...the part that burns is when you realize they plan to make all that money off the backs of the individuals providing the care and earning the money.

 

[aneftp]

Agreed but 500k for a 1 mil job isn't enough. Like you said AMC are out to make a lot of money. Unfortunately the way they make a ton of money is by paying off groups for their future earnings...the part that burns is when you realize they plan to make all that money off the backs of the individuals providing the care and earning the money.

Yes. That's what the employee vs employer model is.

But let me tell u something. Doing ur own billing is risks vs reward.

Do you take the guarantee 500k with 10/11 weeks off with paid malpractice and tail and decent health benefits (another 30k value)

Or do u do ur own billing. No middle man. My brother does own cases and pays billing company 6%. He makes 550-600k out west coast and takes around 7-8 weeks off. And he's in good part of Los Angeles. But still works 55-60 hours a week with calls 1:5 including cardiac and ob.

Or do u take an AMC job for 500k with 10-11 weeks vacation?

My sister friend in Maryland also does fee for service. Doing peak times he was making 500k plus and 9-10'weeks off. During recession his income tanked to mid 300s and still working 60 plus hour (waiting around more in between cases for surgeons)

People think 1 million dollar a year jobs are a dime a dozen. They aren't. Even for those doing fee for service. And even those making 1 million. It's not consistent income either. My buddy in Texas income dropped from 800k to 400k during recession working the same 60 hours a week.

Again. I think more of these jobs will open up depending on level of competition. It's a hard job. But pay/vacation is reasonable with very little tie in. U can leave if you want. Good job for new grad or newer grad who wants to make some money and or pay off debt quickly.

 

[sleepallday]

Agreed but 500k for a 1 mil job isn't enough. Like you said AMC are out to make a lot of money. Unfortunately the way they make a ton of money is by paying off groups for their future earnings...the part that burns is when you realize they plan to make all that money off the backs of the individuals providing the care and earning the money.

Your assumption that the AMC will make 500K off you is likely overestimated unless the AMC is getting a monster stipend. Level 1 trauma with a high medicare/medicaid population is not getting you 1mil. The AMC is making closer 150k-200k off you after all the expenses are paid. I didn't see anyone mention the call frequency but this sounds like a job worth looking into.

 

[nimbus]

Your assumption that the AMC will make 500K off you is likely overestimated unless the AMC is getting a monster stipend. Level 1 trauma with a high medicare/medicaid population is not getting you 1mil. The AMC is making closer 150k-200k off you after all the expenses are paid. I didn't see anyone mention the call frequency but this sounds like a job worth looking into.

As someone who does my own cases, I can't see how you're not making $1mil working hard and supervising 4 rooms at a time. For example if the blended unit is $40 and an average room generates 50units/day you'd get 4x50x40=$8000/day revenue. Subtract $4000 for CRNA compensation and that still leaves $4000/doctor/day which is $20k per week not counting call and weekends. What am I missing?

 

[BLADEMDA]

As someone who does my own cases, I can't see how you're not making $1mil working hard and supervising 4 rooms at a time. For example if the blended unit is $40 and an average room generates 50units/day you'd get 4x50x40=$8000/day revenue. Subtract $4000 for CRNA compensation and that still leaves $4000/doctor/day which is $20k per week not counting call and weekends. What am I missing?

Nothing. The "super-partners" at that facility were earning in excess of 7 figures each and every year with some years exceeding $1.5 million each.

 

[Notorious T.E.E.]

The practice has functioned the same before and after the AMC buyout.

So they were running all around 1:4 pre team health buy Out.

The AMC was paying much less though (380k plus $25k metric bonus) and just recently increased the pay.

I'm sure the 3-4 super partners were making $700-800k easily pre buy out as well.

So $500k salary still means the AMC pocketing 200-250k profit per MD provider in 2017.

Presumably if a super partner was making $700k they were making a chunk of it off the work of the 16 junior partners. What were they making? $400k? If that's the case that $500k is looking more like break even relative to what was available before. The profits for TeamHealth are likely coming from increase payment per RVU from insurance contracts. They are making money on your work, but is it money that was attainable before the buyout?

I saw the position before you posted. It looked like decent compensation, but the hours, CRNAs, in house call, and lack of a retirement plan would keep me from giving them a call. Not to mention working for a private equity group. If you're a resident at UF with the desire to stay in Florida though this may be one of the best options. Unfortunately.

 

[deleted162650]

Nothing. The "super-partners" at that facility were earning in excess of 7 figures each and every year with some years exceeding $1.5 million each.

Were you one of them?

 

[nimbus]

Nothing. The "super-partners" at that facility were earning in excess of 7 figures each and every year with some years exceeding $1.5 million each.

Does that mean the AMC is now making $500-$1mil off the slave they hire for $500k?

 

[aneftp]

Were you one of them?

Only 3 super partners.

 

[acidbase1]

Does that mean the AMC is now making $500-$1mil off the slave they hire for $500k?

Sure does. That's why I'm going rural to work for myself. I don't feel like killing myself to make some older anesthesiologist rich

 

[Mman]

Sure does. That's why I'm going rural to work for myself. I don't feel like killing myself to make some older anesthesiologist rich

Out of curiousity, all things being equal between 2 jobs would you rather take the higher paying job working for somebody else or the lower paying job where you are your own boss?

 

[deleted126335]

Out of curiousity, all things being equal between 2 jobs would you rather take the higher paying job working for somebody else or the lower paying job where you are your own boss?

It is better to reign in Hell than to serve in Heaven.

-John Milton


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[Arch Guillotti]

Sure does. That's why I'm going rural to work for myself. I don't feel like killing myself to make some older anesthesiologist rich

I am not sure that "going rural" provides the payer mix nor the volume to be all that you want it to be cracked up to be. Are you going to be a solo anesthesiologist that contracts directly with hospitals or anesthesia groups, are you going to do locums, or are you going to try and find a small group?

 

[Mman]

It is better to reign in Hell than to serve in Heaven.

-John Milton


Sent from my iPhone using SDN mobile app

that's fine. I just see lots of talk on this forum about how people hate it when others make money off them. My question is what if you made more money personally but had to know somebody else was getting some additional. Is that worse than making less and having nobody making something?

This is a separate question from whether you'd like to be a boss or an employee. Would the idea of somebody billing you out for $120 a unit and paying you $100 a unit be worse than you billing yourself for $75 a unit? There are some here that would seem to want to earn their own 75 cents instead of having someone give them $1 for the same thing. Financially I find that to be kinda strange.

 

[GravelRider]

Out of curiousity, all things being equal between 2 jobs would you rather take the higher paying job working for somebody else or the lower paying job where you are your own boss?

But I think the "all things being equal" part of that equation is a stretch...or at least it is unlikely to remain that way. At a finite point in time it is better to take the higher paying job. However, our careers are not finite points in time. When changes occur in the healthcare market it is better to be responsible for your own fate rather than be subject to someone's decision whose interest does not match your own...or even those of your patients.

It's not uncommon to hear stories of people in high paying jobs who were extremely dissatisfied and left to go start some cafe or coffee shop in their neighborhood. They are working harder, making less, but more satisfied because now they are their own boss.

 

[Mman]

But I think the "all things being equal" part of that equation is a stretch...or at least it is unlikely to remain that way. At a finite point in time it is better to take the higher paying job. However, our careers are not finite points in time. When changes occur in the healthcare market it is better to be responsible for your own fate rather than be subject to someone's decision whose interest does not match your own...or even those of your patients.

It's not uncommon to hear stories of people in high paying jobs who were extremely dissatisfied and left to go start some cafe or coffee shop in their neighborhood. They are working harder, making less, but more satisfied because now they are their own boss.

I don't disagree with any of that and I was specifically trying to avoid bringing that into it. Just talking money. There are some here that some to be morally opposed to having someone else collect 1 cent from their effort even if it personally brought them more money in return.

 

[GravelRider]

I don't disagree with any of that and I was specifically trying to avoid bringing that into it. Just talking money. There are some here that some to be morally opposed to having someone else collect 1 cent from their effort even if it personally brought them more money in return.

I see what you are saying, but I think it is difficult to think about it that way without looking at the bigger picture. Maybe it's psychological too. You are the one up all night in the trauma or putting epidurals in on L&D...not the person snuggled up in bed at home generating passive income off your work.

 

[Mman]

I see what you are saying, but I think it is difficult to think about it that way without looking at the bigger picture. Maybe it's psychological too. You are the one up all night in the trauma or putting epidurals in on L&D...not the person snuggled up in bed at home generating passive income off your work.

For me the bigger picture is I work so that I can invest ever larger sums of money into stocks that represent ownership of companies that make money. So every second of every day my companies are out there earning money, of which a share of the profit belongs to me. The more I physically work and save, the more passive income I can generate every day in the future, no matter how I earned that money. When my passive income exceeds my expenditures, well then no more work is necessary and I can be my ultimate own boss. The boss with no need to ever work again.

 

[acidbase1]

I am not sure that "going rural" provides the payer mix nor the volume to be all that you want it to be cracked up to be. Are you going to be a solo anesthesiologist that contracts directly with hospitals or anesthesia groups, are you going to do locums, or are you going to try and find a small group?

Payer mix is awesome, volume is good enough to make well over 500k, straight contract 1099 employee and hope to start own group

 

[GravelRider]

For me the bigger picture is I work so that I can invest ever larger sums of money into stocks that represent ownership of companies that make money. So every second of every day my companies are out there earning money, of which a share of the profit belongs to me. The more I physically work and save, the more passive income I can generate every day in the future, no matter how I earned that money. When my passive income exceeds my expenditures, well then no more work is necessary and I can be my ultimate own boss. The boss with no need to ever work again.

I get that. However, you are assuming that the "all things being equal" will last over the entirety of your 20-30 year career. You can't make a decision about a job based on a single moment in time. When things change, which scenario is more likely to maintain your best interests over the course of that career? A career is an investment just like the ones you mention. You don't base your investment decisions based on one piece of information, do you?

 

[nimbus]

Payer mix is awesome, volume is good enough to make well over 500k, straight contract 1099 employee and hope to start own group

500K+ 1099 is available in most big cities if it's not AMC territory, and apparently also in many AMC cities. Go rural if you like rural living but don't do it for the money. I always found the differential to be unimpressive.

 

[Mman]

I get that. However, you are assuming that the "all things being equal" will last over the entirety of your 20-30 year career. You can't make a decision about a job based on a single moment in time. When things change, which scenario is more likely to maintain your best interests over the course of that career? A career is an investment just like the ones you mention. You don't base your investment decisions based on one piece of information, do you?

I'm specifically trying to avoid bringing those other issues into my question which is why I'm solely asking about the money issue of it. I've never suggested somebody should take a job simply because it pays more. If you want to have some broader overarching discussion about jobs, please feel free I just don't have the energy to rehash that topic again here at this point. I had a far more narrow focus to my question specifically relating to things I've seen posted here.

 

[acidbase1]

500K+ 1099 is available in most big cities if it's not AMC territory, and apparently also in many AMC cities. Go rural if you like rural living but don't do it for the money. I always found the differential to be unimpressive.

I'll make quite a bit more than that actually, however, the big difference is I won't get whored out for it. Will probably work 30-40% less

 

[GravelRider]

I'm specifically trying to avoid bringing those other issues into my question which is why I'm solely asking about the money issue of it. I've never suggested somebody should take a job simply because it pays more. If you want to have some broader overarching discussion about jobs, please feel free I just don't have the energy to rehash that topic again here at this point. I had a far more narrow focus to my question specifically relating to things I've seen posted here.

I think I tried to answer your narrow question. There is a psychological aspect of being the source of passive income for someone while you are taking on the stress and liability. There may be an ethical/moral component as well given that you are contributing to the increase in healthcare costs by paying for a middleman without adding any extra value to the system. Those costs are eventually passed down to the patients who we should be advocating for as physicians.

With that said, all things being equal, you should take the highest paying job in the location you want to live in...even if it is working for an AMC.

 

[aneftp]

Payer mix is awesome, volume is good enough to make well over 500k, straight contract 1099 employee and hope to start own group

Wait a second. Are u an employee? Or doing ur own billing?

The 1099 "employee" regally does not meet the criteria for independent contractor status. Just look up the IRS independent contractor guidelines and what criteria you have to meet.

Regardless are you giving up ur billing rights in exchange for guaranteed income?

 

[nimbus]

My understanding is that most rural areas have terrible payor mix. Your patients aren't going to be Google, Facebook, and Apple employees.