Have we reached peak AMC (Anesthesia Management Company)?

[norwood]

Plenty of my colleagues are in their late 50s and early 60s. Been doing anesthesia for 25+ years and still chasing after the almighty dollar. Some working like dogs!!!

Yep. If you can learn the following things:

- contentment with what you have
- not worrying about impressing the Joneses
- everything has a price, including money itself

... then you are ahead of the average doctor in understanding the financial world. People use derogatory terms like "mommy track" for jobs where people get to be at home with their families. But why? What's wrong with choosing time over superfluous amounts of money?

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[chocomorsel]

Yep. If you can learn the following things:

- contentment with what you have
- not worrying about impressing the Joneses
- everything has a price, including money itself

... then you are ahead of the average doctor in understanding the financial world. People use derogatory terms like "mommy track" for jobs where people get to be at home with their families. But why? What's wrong with choosing time over superfluous amounts of money?

Exactly. Agree wholeheartedly. I do mommy track pretty much because I make my own schedule and don't take call. Not interested in killing myself for money. If I can't make it on 250k, then I need better money management skills.

 

[deleted126335]

How do you not get rich making $650k in 1997 dollars?

I know, bad investments, Porsches, ex wives.....

Rockefeller was at one point the world's richest man and first ever American billionaire. Considering he was a billionaire in the early 1900's he is still considered as the richest person in modern history. When a reporter asked him, “How much money is enough?”
He responded, “Just a little bit more.”

 

[deleted162650]

Rockefeller was at one point the world's richest man and first ever American billionaire. Considering he was a billionaire in the early 1900's he is still considered as the richest person in modern history. When a reporter asked him, “How much money is enough?”
He responded, “Just a little bit more.”

 

[Engin]

CEP is definitely a cluster. They have Good Sam in San Jose where everyone wants to work at it has a great payer mix. As CEP doesn't share their units with their other (read poor payer mix San Jose hospitals), they have a hard time attracting candidates.

Envision (Sheridan wanted to buy team health, but for whatever reason bought Emcare as a consolidation prize). They claim to be moving into the cenral valley as they own so many contracts they can get higher reimbursement rates and make poor payer mix places break evens. Their Sheridan MAC practice subsidizes most of the poor payor mix as its payor mix is amazing.

They have a hard time keeping docs at envision mac. They basically tried to pay docs their nothing (initially made them pay their 7.5 % employment tax even though they were a w2, health insurance, malpractice, and had a near $3000 monthly administrative fee from all hirees). They've had to reverse their course on all those. They then hired a business firm to evaluate salaries in the area to see why they couldn't retain any of their new hires (many new grads or those that wanted to come back to the bay).

 

[Engin]

For newer grad this is how it works (how the sheridan mac deal worked)

Pay each partner about 1.5 mill (this is from rumor though) on dividends (so taxed at capital gains rate) , with partners needing to stay for 5 years. This sounds amazing but look at how it works.
-They then immediately cut 1/3 of your billing forever(!!!). Right there a 33% reduction in salary.
-As above, they initially paid the docs minimally (no malpractice, healthcare, added 3k/monthly administrative fee, minimal 401k). Slowly they've had to give some of these benefits back reluctantly. But every year they can stretch holding back these basic benefits they save alot of money.
-As they lost so many docs, the docs in many of those places are working 20% more, and this was a hard working group before. The old docs then screw the new hires (keep better paying cases, some refuse to do call, try to take all the blocks, etc) as they are so overworked creating a very malignant work environment.
- as its a w2 now, you get no benefits (they offer a token 401k match)

All in all you get about an extra year of pay after all its said and done with the buyout. Losing about 1/3 of billings is key for them make the buyout sexy, but really they claw almost all of that back.

Beware for any group selling out. Enjoy working you 80 plus hour work weeks in a malignant work environment post buyout for 5 years if you do.

As the final cherry on top, this story: There was a doc who met an Australian guy/girl, starting dating, got married, and then wanted to move permanently to Australia. This of course would have mean leaving the group before his/her 5 years contract was up. Instead of wokring something out with the doc, Sheridan threatened that person with a lawsuit if they left early.

 

[anbuitachi]

For newer grad this is how it works (how the sheridan mac deal worked)

Pay each partner about 1.5 mill (this is from rumor though) on dividends (so taxed at capital gains rate) , with partners needing to stay for 5 years. This sounds amazing but look at how it works.
-They then immediately cut 1/3 of your billing forever(!!!). Right there a 33% reduction in salary.
-As above, they initially paid the docs minimally (no malpractice, healthcare, added 3k/monthly administrative fee, minimal 401k). Slowly they've had to give some of these benefits back reluctantly. But every year they can stretch holding back these basic benefits they save alot of money.
-As they lost so many docs, the docs in many of those places are working 20% more, and this was a hard working group before. The old docs then screw the new hires (keep better paying cases, some refuse to do call, try to take all the blocks, etc) as they are so overworked creating a very malignant work environment.
- as its a w2 now, you get no benefits (they offer a token 401k match)

All in all you get about an extra year of pay after all its said and done with the buyout. Losing about 1/3 of billings is key for them make the buyout sexy, but really they claw almost all of that back.

Beware for any group selling out. Enjoy working you 80 plus hour work weeks in a malignant work environment post buyout for 5 years if you do.

As the final cherry on top, this story: There was a doc who met an Australian guy/girl, starting dating, got married, and then wanted to move permanently to Australia. This of course would have mean leaving the group before his/her 5 years contract was up. Instead of wokring something out with the doc, Sheridan threatened that person with a lawsuit if they left early.

Suing a person in australia? i dont think sheridan will get much out of that.

 

[nycitygas]

For newer grad this is how it works (how the sheridan mac deal worked)

Pay each partner about 1.5 mill (this is from rumor though) on dividends (so taxed at capital gains rate) , with partners needing to stay for 5 years. This sounds amazing but look at how it works.
-They then immediately cut 1/3 of your billing forever(!!!). Right there a 33% reduction in salary.
-As above, they initially paid the docs minimally (no malpractice, healthcare, added 3k/monthly administrative fee, minimal 401k). Slowly they've had to give some of these benefits back reluctantly. But every year they can stretch holding back these basic benefits they save alot of money.
-As they lost so many docs, the docs in many of those places are working 20% more, and this was a hard working group before. The old docs then screw the new hires (keep better paying cases, some refuse to do call, try to take all the blocks, etc) as they are so overworked creating a very malignant work environment.
- as its a w2 now, you get no benefits (they offer a token 401k match)

All in all you get about an extra year of pay after all its said and done with the buyout. Losing about 1/3 of billings is key for them make the buyout sexy, but really they claw almost all of that back.

Beware for any group selling out. Enjoy working you 80 plus hour work weeks in a malignant work environment post buyout for 5 years if you do.

As the final cherry on top, this story: There was a doc who met an Australian guy/girl, starting dating, got married, and then wanted to move permanently to Australia. This of course would have mean leaving the group before his/her 5 years contract was up. Instead of wokring something out with the doc, Sheridan threatened that person with a lawsuit if they left early.

Sheridan should be billing at a much higher rate than MAC as an independent group. Were they not able to make up any lost ground/income repair? Did they think about bringing in CRNA/AAs and covering 1:4?

 

[pgg]

There is nobody waiting for them at home anymore.

I have a successful businessman in the family. He's been doing it for 30+ years, since his kids were in their early teens. They have been spoiled by all the opportunities his hard work and wealth brought them. Now he's old, and none of his kids gives a crap about him; both worship their stay-at-home mom. So the only thing he still has is his business.

When I was a med student in general surgery, some insane workaholic surgeon was explaining how to balance work and family. Dude was in the hospital from 6 AM to 7 or 8 PM every day. I don’t recall the details, but the gist of it was that he’d schedule one whole Saturday per month which each of his kids, 1 on 1 time. Real quality time. He said that was more time than most parents spent with their kids all month, so he was really knocking it out of the park in the dad department.

I’m looking around at the other student and the intern who’ve got incredulous looks on their faces, wondering if he’s screwing with us in a rare display of humble self awareness and regret for his life choices. The chief resident, who even now, still holds the honor of the biggest jerk and most malignant human being I’ve ever met in medicine (that mofo chewed us out one morning on the basis of the nutritional value of our post-round pre-OR breakfast choice) was just eating it up.

Some of those guys just live in a fantasy world.

 

[deleted126335]

When I was a med student in general surgery, some insane workaholic surgeon was explaining how to balance work and family. Dude was in the hospital from 6 AM to 7 or 8 PM every day. I don’t recall the details, but the gist of it was that he’d schedule one whole Saturday per month which each of his kids, 1 on 1 time. Real quality time. He said that was more time than most parents spent with their kids all month, so he was really knocking it out of the park in the dad department.

I’m looking around at the other student and the intern who’ve got incredulous looks on their faces, wondering if he’s screwing with us in a rare display of humble self awareness and regret for his life choices. The chief resident, who even now, still holds the honor of the biggest jerk and most malignant human being I’ve ever met in medicine (that mofo chewed us out one morning on the basis of the nutritional value of our post-round pre-OR breakfast choice) was just eating it up.

Some of those guys just live in a fantasy world.

I've run into a few of the over the top workaholics over the years. Everyone of them got a divorce at some point. They also have more than their share of seriously screwed up kids.

 

[Crabbygas]

The AMC's may be pissed at partners leaving before their 3-5 years is up but sooner or later somebody is going to clue the IRS in to the fact that these buyouts are not capital gains but salary and the whole buyout thing is fraud. Haha can't wait to see that case.

 

[deleted126335]

The AMC's may be pissed at partners leaving before their 3-5 years is up but sooner or later somebody is going to clue the IRS in to the fact that these buyouts are not capital gains but salary and the whole buyout thing is fraud. Haha can't wait to see that case.

Lots of accountants and lawyers might disagree.

 

[Notorious T.E.E.]

As the final cherry on top, this story: There was a doc who met an Australian guy/girl, starting dating, got married, and then wanted to move permanently to Australia. This of course would have mean leaving the group before his/her 5 years contract was up. Instead of wokring something out with the doc, Sheridan threatened that person with a lawsuit if they left early.

$1.5 million comes with a cost. I am routinely shocked at what people will agree to in contracts, only to be angry it's in the contract at a later point. If you are going to play cat and mouse with these AMCs, it is best to remember which of you is the mouse.

 

[Engin]

Sheridan should be billing at a much higher rate than MAC as an independent group. Were they not able to make up any lost ground/income repair? Did they think about bringing in CRNA/AAs and covering 1:4?

Not yet for the crnas. The bay area is mostly MD/DO. Sometimes OB you may get them, and of course kaiser you have them, but not really prevalent in private practice. As the bay area pays it's nurses really well (cali has a very strong nurse union) crnas make a lot and aren't really cost effective if you factor in they work 40 hours, and an MD/DO would have to work more in private practice. So from an hour pay basis it's not that much different, especially in a busy practice. Also, many surgeons won't work with a lot of Crnas, and the ucsf standford anesthesiologists here are fairly aggressive and workaholic types in the area.

The five years for the Mac group is up 11/2018. The partners will give a a few months notice if they are staying. This is going to get very interesting to see what happens.

 

[nycitygas]

Not yet for the crnas. The bay area is mostly MD/DO. Sometimes OB you may get them, and of course kaiser you have them, but not really prevalent in private practice. As the bay area pays it's nurses really well (cali has a very strong nurse union) crnas make a lot and aren't really cost effective if you factor in they work 40 hours, and an MD/DO would have to work more in private practice. So from an hour pay basis it's not that much different, especially in a busy practice. Also, many surgeons won't work with a lot of Crnas, and the ucsf standford anesthesiologists here are fairly aggressive and workaholic types in the area.

The five years for the Mac group is up 11/2018. The partners will give a a few months notice if they are staying. This is going to get very interesting to see what happens.

Okay, I get the CRNA part, but envisions billing rates can’t make up some of the shortfall?

The five years is up for a lot of groups in the next two years. I foresee a lot of AMC implosions coming soon.

 

[Engin]

Okay, I get the CRNA part, but envisions billing rates can’t make up some of the shortfall?

The five years is up for a lot of groups in the next two years. I foresee a lot of AMC implosions coming soon.

I don't know what they're billing rates are tbh. The business side is really left to corporate and one is fairly distanced from it.

 

[nycitygas]

I don't know what they're billing rates are tbh. The business side is really left to corporate and one is fairly distanced from it.

Once the old partners leave, envision will be forced to raise salaries to market rates.

 

[nycitygas]

Once the old partners leave, envision will have to raise salaries to market rates is my guess. They have probably already made their money back.

 

[mmag]

Sheridan should be billing at a much higher rate than MAC as an independent group. Were they not able to make up any lost ground/income repair? Did they think about bringing in CRNA/AAs and covering 1:4?

I was told that the contract was for a fixed unit value that was lower than the unit value at the time of the deal. If the actual collected unit value became lower, Sheridan still paid that out. Of course Sheridan bills at a much higher rate and made a great investment.

 

[nimbus]

I was told that the contract was for a fixed unit value that was lower than the unit value at the time of the deal. If the actual collected unit value became lower, Sheridan still paid that out. Of course Sheridan bills at a much higher rate and made a great investment.

Do they? Does anyone know the actual numbers or is it all hearsay? I’ve also heard from a couple of MAC refugees that they were heavily stipended by the facilities they worked in. Has that continued for Sheridan/Envision?

 

[deleted171991]

Once the old partners leave, envision will have to raise salaries to market rates is my guess. They have probably already made their money back.

I disagree. There is such an overproduction of suckers that they won't have a problem finding replacements. Especially since they tend to overwork their employees on purpose, anyway.

 

[B-Bone]

I disagree. There is such an overproduction of suckers that they won't have a problem finding replacements. Especially since they tend to overwork their employees on purpose, anyway.

This is likely to be market-dependent. We had an AMC come into town and take over a big contract about 2 years ago. They paid off the partners and slashed salaries (MD and CRNA). They have been struggling ever since. Losing staff, paying huge numbers to locums, etc. Nobody will take their full-time job at the offered salary. The AMC group represents about 10% of the anesthesiologists in the local metro market. The other 90% of places are paying 20-100% more for better work environments (even the VA and local University). The private groups (the majority of the jobs) are paying twice what the AMC is. Who's going to take that AMC job in this type of environment? And in 5 years (when the paid-off partners can leave), the house of cards comes tumbling down.

 

[mmag]

Do they? Does anyone know the actual numbers or is it all hearsay? I’ve also heard from a couple of MAC refugees that they were heavily stipended by the facilities they worked in. Has that continued for Sheridan/Envision?

Same source told me that that facility stipends remained the same as existing hospital contracts continued except Envision kept half and paid out half to the docs. Just ask those MAC-fugees if 35 50 rings a bell.

 

[drdan4]

Once the old partners leave, envision will have to raise salaries to market rates is my guess. They have probably already made their money back.

Sellouts suck. There is nowhere for them to go. I know our PP and many around will not touch a Sellout. They are pretty much relegated to work for ****ty pay at the AMC they sold their soul to. A fitting end for a greedy bastard.

And yes, we had a chance to sell out as Partners in my former group and chose not to. Never would have gotten this current great PP gig if I did....

 

[C4C]

I don't want to say I called it, but I see that Envision has lost 30% of its market cap today, and Business Insider is noting that the loss of "physician partners" is playing a role.

I also see that Somnia is recruiting for directors at two of their sites. One might be a new contract for them (which goes against my thesis that Somnia is in Retreat Mode), but the other one (Kern) was the site of their first foray into California, and if their Chief walked, it must be even worse than I imagined. As DrDan4 points out above, it must be very, very hard to get a job after having slept with the enemy.

 

[BLADEMDA]

Nashville-based Envision Healthcare shares plummeted by more than a third on Wednesday after the company posted lower-than-expected earnings and offered a weaker-than-expected fourth-quarter forecast.

Envision (NYSE: EVHC), which owns and operates hundreds of surgery centers, reported earnings of $40.7 million, or 73 cents per diluted share. While that's up compared to the $37.7 million of third-quarter earnings a year ago, it was below the 88 cents per share that analysts had expected. The company reported third-quarter revenue of $3.07 billion, which nearly tripled its year-ago figure.

As of 2:53 p.m. Wednesday, shares were trading at $28.25, down more than 33 percent for the day. The stock's 52-week range is $26.56 to $74.75.

Envision blamed some of the results on hurricanes Harvey and Irma, estimating a negative impact of $22 million on the quarter’s revenue. It also cited a decline in revenue that can be attributed to the Affordable Care Act amid continued uncertainty about the law.

“During the third quarter of 2017, our organization responded to a number of challenges, ranging from hurricanes that impacted two of our key markets to continued deceleration of health sector utilization following two years of heightened demand driven by coverage expansion,” Christopher Holden, Envision's president and CEO, said in a news release.

Envision’s fourth-quarter revenue forecast is 34 percent lower than analysts' expectations, at $1.88 billion to $2.02 billion, with an adjusted profit of between 44 cents and 54 cents per share.

In response, the company announced that its board of directors unanimously decided to initiate a “full review of a broad range of alternatives to enhance shareholder value.” The company said there is no timetable for completion of the strategic review and that it will not give updates on the review unless appropriate or required.

“While we have made considerable progress in building the new Envision around a set of highly-differentiated physician-centric clinical solutions, the board believes that a review at this time — with all options on the table, including continuing to execute on our strategic plan — is in the best interests of Envision shareholders,” William Sanger, chairman of the board of directors, said in the release.

The move comes less than a year after Envision merged with AmSurg to create one of the largest health care providers in the country. The company has also made several acquisitions this year. Prior to Tuesday’s report, the company had been meeting its earnings targets.


Richard Close, a health care analyst with Canaccord Genuity, called the earnings report “very disappointing” and said the fourth-quarter projections were alarming. However, Close said he expects Envision — which he called "the market leader" — to bounce back. Close added that he is "encouraged that the company understands that the need to address the poor operational results and evaluate strategies to deliver shareholder returns.”

 

[dchz]

I don't want to say I called it, but I see that Envision has lost 30% of its market cap today, and Business Insider is noting that the loss of "physician partners" is playing a role.

I also see that Somnia is recruiting for directors at two of their sites. One might be a new contract for them (which goes against my thesis that Somnia is in Retreat Mode), but the other one (Kern) was the site of their first foray into California, and if their Chief walked, it must be even worse than I imagined. As DrDan4 points out above, it must be very, very hard to get a job after having slept with the enemy.

Yeah subtlebrag... but credit where credit is due...

you called it.

 

[sevoflurane]

Sellouts suck. There is nowhere for them to go. I know our PP and many around will not touch a Sellout. They are pretty much relegated to work for ****ty pay at the AMC they sold their soul to. A fitting end for a greedy bastard.

And yes, we had a chance to sell out as Partners in my former group and chose not to. Never would have gotten this current great PP gig if I did....

Don't be so naive in your views.
Understand that groups VOTE to sell out or not. In some groups you need a super majority and in others a simple majority.
Big difference.
You may sell even if you didn't want to.

 

[AdmiralChz]

Don't be so naive in your views.
Understand that groups VOTE to sell out or not. In some groups you need a super majority and in others a simple majority.
Big difference.
You may sell even if you didn't want to.

Not just that, I know of some groups where select “super partners” had double (or more!) voting rights and took the rug out of the younger partners as the old guard neared retirement. Sickening.

Lesson - be wary of groups with multiple layers of partners like this.

 

[sleepallday]

Don't be so naive in your views.
Understand that groups VOTE to sell out or not. In some groups you need a super majority and in others a simple majority.
Big difference.
You may sell even if you didn't want to.

Yup, and some PP groups vote to sell but are forced to reverse their decision to keep their contract with the hospital.

 

[sevoflurane]

Yup, and some PP groups vote to sell but are forced to reverse their decision to keep their contract with the hospital.

In that case, your ledership isn't very good or the time isn't right.

 

[drdan4]

Don't be so naive in your views.
Understand that groups VOTE to sell out or not. In some groups you need a super majority and in others a simple majority.
Big difference.
You may sell even if you didn't want to.

You won't get much sympathy coming off a seven figure buyout regardless of the circumstance. Truth is there is always an excuse...unreasonable administration, poor payor mix, dwindling (or no) stipend blah blah blah. Most people leave a bad situation..not grab as much as they can while simultaneously screwing an entire generation of Anesthesiologists and compromising patient care.

There is too much young talent out there..none of which has baggage or lack of integrity/scruples that a Sellout will carry for the rest of his/her career.

 

[nimbus]

There is too much young talent out there.

That is the crux of the problem. When there is a dearth of talent the problem will solve itself. Unfortunately anesthesia talent is literally a dime a dozen.

Tech Giants Are Paying Huge Salaries for Scarce A.I. Talent

 

[caligas]

You won't get much sympathy coming off a seven figure buyout regardless of the circumstance. Truth is there is always an excuse...unreasonable administration, poor payor mix, dwindling (or no) stipend blah blah blah. Most people leave a bad situation..not grab as much as they can while simultaneously screwing an entire generation of Anesthesiologists and compromising patient care.

There is too much young talent out there..none of which has baggage or lack of integrity/scruples that a Sellout will carry for the rest of his/her career.

Meh, I’m not buying the scarlet letter theory that people that were involved in a buyout are somehow branded. Any concrete examples?

 

[sevoflurane]

You won't get much sympathy coming off a seven figure buyout regardless of the circumstance. Truth is there is always an excuse...unreasonable administration, poor payor mix, dwindling (or no) stipend blah blah blah. Most people leave a bad situation..not grab as much as they can while simultaneously screwing an entire generation of Anesthesiologists and compromising patient care.

There is too much young talent out there..none of which has baggage or lack of integrity/scruples that a Sellout will carry for the rest of his/her career.

So when the Hospital gives you an ultimatum to join them then your golden parachute is gone and you are left holding nothing.... in some instances working the same hours with the same pay as an AMC.

 

[sevoflurane]

Meh, I’m not buying the scarlet letter theory that people that were involved in a buyout are somehow branded. Any concrete examples?

Never heard of this either.

 

[nimbus]

Most people leave a bad situation..not grab as much as they can while simultaneously screwing an entire generation of Anesthesiologists and compromising patient care.

There is too much young talent out there..none of which has baggage or lack of integrity/scruples that a Sellout will carry for the rest of his/her career.

This is completely the opposite of truth. Basically everybody would grab the $$$ if the deal was good enough.

Everybody has a number. If it’s big enough and the math works out, 99.99999% of people will accept a buyout. Even you and all the other self-righteous people on this board. However, even within the same practice, the number varies depending on what stage of career you are in. If you are about to sign a partnership track contract, look at the demographics of the group. If it’s full of 50-60yo partners, a buyout is much more attractive to the group than a group full of 30 somethings.

 

[drdan4]

So when the Hospital gives you an ultimatum to join them then your golden parachute is gone and you are left holding nothing.... in some instances working the same hours with the same pay as an AMC.

I am on my third consecutive partnership track having made partner twice before. Both groups chose to part ways rather than sell out. Mostly because Administration were douches and AMC are scum. Wasn't really a choice. So my view is a little different but to each their own I guess.

Our group and the two local ones I keep in touch with don't hire Sellouts...we have hired a few disgruntled Non-Sellout AMC employees. I don't know (or care) what other PP groups do. Given the adversarial relationship between AMCs and what's left of Private Practice I don't understand why this stance surprises anyone here.

Last I checked in late 2016 (someone can correct me if I am wrong), there are about 46,000 anesthesiologists in the U.S. Half of those are employed by medical centers and university hospitals, 42 percent are local private groups and 8% AMCs. To the young guys, don't settle for the bottom of the barrel.

 

[caligas]

I am on my third consecutive partnership track having made partner twice before. Both groups chose to part ways rather than sell out. Mostly because Administration were douches and AMC are scum. Wasn't really a choice. So my view is a little different but to each their own I guess.

Our group and the two local ones I keep in touch with don't hire Sellouts...we have hired a few disgruntled Non-Sellout AMC employees. I don't know (or care) what other PP groups do. Given the adversarial relationship between AMCs and what's left of Private Practice I don't understand why this stance surprises anyone here.

Last I checked in late 2016 (someone can correct me if I am wrong), there are about 46,000 anesthesiologists in the U.S. Half of those are employed by medical centers and university hospitals, 42 percent are local private groups and 8% AMCs. To the young guys, don't settle for the bottom of the barrel.

How do you guarantee that new associates have never received compensation as part of a buyout package? What if they voted against and spoke vehemently against the buyout but were out-voted by partners, maybe had no real vote due to super partners?

 

[Arch Guillotti]

Never heard of this either.

I have.

 

[GA8314]

I am on my third consecutive partnership track having made partner twice before. Both groups chose to part ways rather than sell out. Mostly because Administration were douches and AMC are scum. Wasn't really a choice. So my view is a little different but to each their own I guess.

Our group and the two local ones I keep in touch with don't hire Sellouts...we have hired a few disgruntled Non-Sellout AMC employees. I don't know (or care) what other PP groups do. Given the adversarial relationship between AMCs and what's left of Private Practice I don't understand why this stance surprises anyone here.

Last I checked in late 2016 (someone can correct me if I am wrong), there are about 46,000 anesthesiologists in the U.S. Half of those are employed by medical centers and university hospitals, 42 percent are local private groups and 8% AMCs. To the young guys, don't settle for the bottom of the barrel.

You get a chance to become a full partner in a successful PP group, you take it. And, you recognize you are in a privileged position and never take it for granted.

 

[nimbus]

I am on my third consecutive partnership track having made partner twice before. Both groups chose to part ways rather than sell out.

What does this mean? They disbanded??

 

[Noyac]

Some here have found it easy to criticize members for selling out. Every situation is different. Nobody can put an absolute on a situation without being in the other persons shoes. I hope I never have to make this decision. It won’t be an easy one since I am completely committed to my location. I do not want to live anywhere other than my current location. We don’t have options here. If an AMC comes to my location and we don’t want to work in that environment then we must move. This is huge, especially for people with families. So don’t pretend to be better than those that had to make what must be very difficult decisions. And don’t get me wrong, some just plain “sold out” for the cash and that I can’t support in good faith. That is a different situation.

But I also think that there are some here and all over the country that bare (or is it bear) some responsibility for even working for these AMC’s. Anyone that willing signs up to work for one of these companies is just as culpable. Why are we not berating these individuals?

 

[GravelRider]

Some here have found it easy to criticize members for selling out. Every situation is different. Nobody can put an absolute on a situation without being in the other persons shoes. I hope I never have to make this decision. It won’t be an easy one since I am completely committed to my location. I do not want to live anywhere other than my current location. We don’t have options here. If an AMC comes to my location and we don’t want to work in that environment then we must move. This is huge, especially for people with families. So don’t pretend to be better than those that had to make what must be very difficult decisions. And don’t get me wrong, some just plain “sold out” for the cash and that I can’t support in good faith. That is a different situation.

But I also think that there are some here and all over the country that bare (or is it bear) some responsibility for even working for these AMC’s. Anyone that willing signs up to work for one of these companies is just as culpable. Why are we not berating these individuals?

It's "bear"...unless you think people who work for AMCs should have to show up to work naked or something.

You mention how you are tied to your location. Well the same can be said for many people who "willingly" sign up to work for an AMC. In many locations, the AMC (or mega-hospital system employment...which is often worse than an AMC) is the only game in town. Do you live somewhere you don't want to live just to stick to some principle about not working for these corporations? It's not an easy answer.

 

[Noyac]

It's "bear"...unless you think people who work for AMCs should have to show up to work naked or something.

You mention how you are tied to your location. Well the same can be said for many people who "willingly" sign up to work for an AMC. In many locations, the AMC (or mega-hospital system employment...which is often worse than an AMC) is the only game in town. Do you live somewhere you don't want to live just to stick to some principle about not working for these corporations? It's not an easy answer.

Well of course. It goes both ways. I didn’t think I was saying it wasn’t.

 

[GA8314]

Bottom line is to work your butt off, respond to the needs of the hospital, provide excellent service to your surgeons, and hope administration doesn't buy the AMC sales pitch. Even the subsidy reduction game seems to catch up with the AMC's when their promises and recruitment challenges come to roost. I am really hoping that word gets around amongst hospital execs on these issues. My hunch is that they are.

 

[sevoflurane]

I am on my third consecutive partnership track having made partner twice before. Both groups chose to part ways rather than sell out. Mostly because Administration were douches and AMC are scum. Wasn't really a choice. So my view is a little different but to each their own I guess.

Our group and the two local ones I keep in touch with don't hire Sellouts...we have hired a few disgruntled Non-Sellout AMC employees. I don't know (or care) what other PP groups do. Given the adversarial relationship between AMCs and what's left of Private Practice I don't understand why this stance surprises anyone here.

Last I checked in late 2016 (someone can correct me if I am wrong), there are about 46,000 anesthesiologists in the U.S. Half of those are employed by medical centers and university hospitals, 42 percent are local private groups and 8% AMCs. To the young guys, don't settle for the bottom of the barrel.

So what you are saying is that 2 groups you were in looked at selling out but didn't because administration put the Heisman on your group and therefore you really didn't have a "choice" to sell out?... but you DID looked into "selling out". If the AMC gave you a crappy multiple then that's their choice.

But you won't hire those that did sell...

The above sounds like a double standard don't you think?

I have a sneaking suspicion that if a contract worth 2.5 mil hit either of your groups square in the face and administration wasn't a barrier you would take it.

Again, look at the big picture. YOU don't know if the hospital wanted to swallow your group as a whole and MAKE you sign a hospital employed position.

That very well could have been my fate, but we had a strategic plan to counter that future.

Labeling someone a "sellout" isn't exactly the term I would call it- that's a bit harsh.

It's "risk transference" and in my opinion a smart way to do business if there is serious risk of becoming a hospital employee.

Avoiding becoming a hospital employee means that said group won that chess game. As mentioned before, many people in many groups did not vote for a partnership with an AMC- labeling them "sellouts" is extremely short sided without knowing the circumstances of the sale.

 

[deleted171991]

But I also think that there are some here and all over the country that bare (or is it bear) some responsibility for even working for these AMC’s. Anyone that willing signs up to work for one of these companies is just as culpable. Why are we not berating these individuals?

Because it's like saying that the peasants, who bow to the new king just to survive, are the same as the aristocracy whom he has made rich.

 

[Stank811]

So what you are saying is that 2 groups you were in looked at selling out but didn't because administration put the Heisman on your group and therefore you really didn't have a "choice" to sell out?... but you DID looked into "selling out". If the AMC gave you a crappy multiple then that's their choice.

But you won't hire those that did sell...

The above sounds like a double standard don't you think?

I have a sneaking suspicion that if a contract worth 2.5 mil hit either of your groups square in the face and administration wasn't a barrier you would take it"

I am aware of a group that was hit with 3mil in their face...of course a lot of details involved in when and how the 3mil would be payed...admin was in board...and the group voted no.

As I have been saying for the past 5 yrs the AMC model is a joke and will have to evolve. Physicians in any specialty are not a commodity which includes anesthesia. AMC business model views all of us as commodities and replaceable with CRNAs in 95percent of cases and is more than comfortable moving towards a collaborative model. Many of the groups hit with 2 plus mil in the face are groups witg primarily MDs. AMC love groups like this bc it has dollar signs written all over it if the can convince the suckers to sell. If the group does sell there is no question in my mind over the next decade they become an ACT model that is collaborative (that is if they can keep the contract that long), that is why many feel some of us are sellouts

 

[anes121508]

So what you are saying is that 2 groups you were in looked at selling out but didn't because administration put the Heisman on your group and therefore you really didn't have a "choice" to sell out?... but you DID looked into "selling out". If the AMC gave you a crappy multiple then that's their choice.

But you won't hire those that did sell...

The above sounds like a double standard don't you think?

I have a sneaking suspicion that if a contract worth 2.5 mil hit either of your groups square in the face and administration wasn't a barrier you would take it.

Again, look at the big picture. YOU don't know if the hospital wanted to swallow your group as a whole and MAKE you sign a hospital employed position.

That very well could have been my fate, but we had a strategic plan to counter that future.

Labeling someone a "sellout" isn't exactly the term I would call it- that's a bit harsh.

It's "risk transference" and in my opinion a smart way to do business if there is serious risk of becoming a hospital employee.

Avoiding becoming a hospital employee means that said group won that chess game. As mentioned before, many people in many groups did not vote for a partnership with an AMC- labeling them "sellouts" is extremely short sided without knowing the circumstances of the sale.

Sevo, what was the "strategic plan"


Many buyouts I hear about in real life and on sdn are becexause it
Was take the $$ from amc vs get swallowed by hospital. What is the strategy when hospital says "hey we now own you"