Have we reached peak AMC (Anesthesia Management Company)?

[anes121508]

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?

True statement. We are all part of the problem. The folks nearing retirement (I mean how can you blame them? Don't be a hater). The folks like me, that still sign up to work for them. And I'm not a desperate ***** that had no other options. Like others have said, it's more than money, it's location and family. Older guys and new grads have all played a role in fueling the AMC expansions. What's the solution? Maybe it's only the hospital CEOs (now wising up to the false promises of AMCs), that will curb the trend.

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[sevoflurane]

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"

If you let it get to that point then the group didn't see the train headlights and it's likely too late... unless you have barganing power.
If the OR's shut down, then the Hospital CEO has a lot of questions to answer. These things rarely happen from one day to the next, so you can plan for them. This isn't always the case. As the 'ol saying goes... "safety in numbers". Replacing 70-80 fte's is not an easy task for anyone.

 

[drdan4]

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.

So you became an AMC Employee instead of a Hospital Employee. And you think that justifies your seven figure buyout. Also, the rest of us PP groups clearly suck because we cannot garner the multiples you were able to command and hence we haven't sold out. Gotcha. Thanks.

Each PP I have moved to has been more successful in terms of income and location so I have no regrets about my decision.

Btw, you can stuff your 2.5 mil. I will more than double that in the coming years while you struggle in your AMC job (did you really think you were going to get a raise after your buyout term?).

 

[sevoflurane]

Sounds like you are taking it personally.
Take a breath and listen to what I am trying to tell you:
The point of my input on this thread is that you can't judge someone of being a "sellout" without knowing the circumstances of the sale itself.
Labeling somone a "sellout" sounds a bit harsh coming from someone who was in 2 groups who were exploring a sale themselves.
I don't find it wrong for pp groups to look into the safety of their shareholders.
And I never said I made 2.5 mil. That is all hypothetical talk... but I'm glad you're going to kill it in the future.
Good on you.

 

[C4C]

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

you called it.

I realize that I didn't "call it." Just because the market agrees with me today doesn't mean that the market won't disagree with me tomorrow.

I'm frankly surprised that the best minds of finance can't see that the incentives to work hard, pick up the extra case, stay late, and invest in the facility's long-term best interests all evaporate when the AMCs come barging in. I would have thought that Wall St. financial wizards would have understood incentives better. Oh, well.

 

[Ezekiel2517]

Nov 1, 2017:

I don't want to say I called it, but I see that ....

Nov 15, 2017:

I realize that I didn't "call it." Oh, well.

Life comes at you fast.

 

[Mman]

Without getting into specifics I am aware that American is doing poorly at several of their prime locations and at least a few are seriously considering kicking their ass to the curb. We've taken their business from some small locations, but I'm talking some of the big mega hospitals. Those hospitals are trying to figure out how to get around the noncompetes those docs are under. It's not easy to kick American out if you end up needing like 50 or 100 docs to start the next day. Unfortunately I think it will transition more to a hospital employee type gig than returning to private practice.

I also heard a random rumor that American was trying to sell off their anesthesia business as the growth in it was not what they hoped.

 

[Scotty_G]

American is part of Mednax I believe....They recently acquired some NJ hospital contracts but are having trouble filling some spots.

 

[Mman]

American is part of Mednax I believe....They recently acquired some NJ hospital contracts but are having trouble filling some spots.

Mednax is the mega corp, American is their anesthesia arm. They also do OB and NICU stuff.

 

[Hiram Coggin]

Without getting into specifics I am aware that American is doing poorly at several of their prime locations and at least a few are seriously considering kicking their ass to the curb. We've taken their business from some small locations, but I'm talking some of the big mega hospitals. Those hospitals are trying to figure out how to get around the noncompetes those docs are under. It's not easy to kick American out if you end up needing like 50 or 100 docs to start the next day. Unfortunately I think it will transition more to a hospital employee type gig than returning to private practice.

I also heard a random rumor that American was trying to sell off their anesthesia business as the growth in it was not what they hoped.

I can confirm this in general terms since I have heard much of the same stuff. American is a DUMPSTER FIRE. They were taken to litigation by one very large group of docs. Another large group threatened to strike. This doesn't begin to address the bad staffing problems they have all over the place. The docs who sold out 5-7 years ago are all realizing what a bad decision it was unless of course you are retiring.

 

[vegas0012]

Speaking of Mednax, in my email this morning :

Ok disregard. I can’t share a link here, but google Mednax and Seeking Alpha. This one analyst sees Mednax shares losing 20% in the near term.

 

[IMGASMD]

Graduating soon. Trying to revive this thread and see if anything has changed within the last 6 months to year.


Also what happens when these AMCs decides these places are no longer profitable enough for them. I’d imagining another AMC comes in? Or hospital starts their own? Has there been any precedents that either former partners or physicians buy the practice back? how would that work?

 

[Man o War]

Graduating soon. Trying to revive this thread and see if anything has changed within the last 6 months to year.


Also what happens when these AMCs decides these places are no longer profitable enough for them. I’d imagining another AMC comes in? Or hospital starts their own? Has there been any precedents that either former partners or physicians buy the practice back? how would that work?

Normally what I see is they then try and extract a bigger subsidy. They will use their size(if applicable) or non competes they made the physicians sign as leverage.

 

[San Marzano]

Normally what I see is they then try and extract a bigger subsidy. They will use their size(if applicable) or non competes they made the physicians sign as leverage.

And hospitals are really that stupid to fall for this textbook bait and switch routine? What a racket.

 

[callsux]

And hospitals are really that stupid to fall for this textbook bait and switch routine? What a racket.

never overestimate the intelligence of a hospital administrator

 

[Man o War]

And hospitals are really that stupid to fall for this textbook bait and switch routine? What a racket.

Yep.

 

[C4C]

Graduating soon. Trying to revive this thread and see if anything has changed within the last 6 months to year.

The big AMC news seems to be Mednax in North Carolina, but I don't know anything more that what I read on these boards.


In California, it does seem that Envision/Emcare has walked away from at least two hospitals in southern California. That would ordinarily be good news for private practice, except that I hear Somnia (with the care team model) picked up the vacated contracts. (Somnia is running ads on Gaswork for physicians and CRNAs to staff new contracts, so there seems to be some truth to the rumor.) Temecula has all but imploded and the MEC refused to give privileges to Envision's head honcho when his little affinity for fentanyl came to light.

CEP has been rebuffed in Santa Cruz, Redding, Los Banos, Elk Grove, French Camp, Stockton, Marin, Escondido, and Contra Costa. Taking a page from Envision/Sheridan/Emcare/Amsurg/Qualitas/AMR/Evolution playbook, CEP recently changed its name, very likely because their reputation was absolutely terrible. They are losing so much money in San Jose that they are putting their very best contract (Los Gatos) at risk. And nobody is more aware of this (and angry about it) than their ER physician founders, who are watching as their appetite for growth at all costs now threatens their entire enterprise.

IAMG, which isn't really an AMC as much as Prem Reddy's nepotistic scam, hardly warrants a mention because their reputation is so bad. The good news is that two hospital CEOs stood up to the Prem and his brother-in-law and booted IAMG out of their hospital: Alvarado in San Diego and Shasta Regional in Redding. I don't know enough to say which of those two is worse, though the fact that the Redding group is now offering a $50,000 signing bonus as they try to replace six anesthesiologists who left just this spring makes me think maybe Alvarado is somehow less bad. I wouldn't dare speculate about Riverside, Glendale, East LA, or any of the other IAMG/Prime Healthcare jobs that run in an endless loop on Gaswork, but in general--not just anesthesia, but the whole hospital--Prime Healthcare is the absolute bottom of the barrel.

The Permanente Group, which used to be exclusively for graduates who couldn't get a job elsewhere, then slowly evolved into a competitive job (thanks mainly to their pension, but also to their shift-work mentality), seems to be losing its luster. Whereas just a few years ago they required PRN positions for six months to a year even to be considered for full-time employment, they are now running ads for immediate full-time gigs in at least four of their southern California sites.



As always, I invite updates, additions, or corrections.

 

[C4C]

I thought this had been mentioned in this thread, but reviewing just now it appears I was mistaken:

UnitedHealthcare dumps Envision contract: 4 things to know

In case I lack sufficient privileges to post a link, Google "United Envision" to find that UnitedHealthcare is kicking Envision out of their entire network, effective no later than January, 2019. United specifically mentions Envision's out-of-network billing policies and Envision's inability to retain physicians as two reasons. Envision attempted to sue United, but a judge recently dismissed that suit (Judge tosses Envision lawsuit against UnitedHealth).

 

[pgg]

C4C, these stories warm my heart. May they all burn.

 

[midazzoler]

Speaking of AMCs:

Cranemere to Acquire NorthStar Anesthesia from TPG Growth

 

[nimbus]

Speaking of AMCs:

Cranemere to Acquire NorthStar Anesthesia from TPG Growth

Sad to see anesthesia get caught up in these acquisitions. These outfits could care less what the actual business is. It could be plastic molding, cement, anesthesia, doesn’t matter. They just want to buff the financials over 3-5 years, then flip for a profit. They usually have zero long term interest in the companies they acquire.

 

[deleted126335]

Sad to see anesthesia get caught up in these acquisitions. These outfits could care less what the actual business is. It could be plastic molding, cement, anesthesia, doesn’t matter. They just want to buff the financials over 3-5 years, then flip for a profit. They usually have zero long term interest in the companies they acquire.

Jesse Pinkman:
Are we in the meth business, or the money business?

 

[deleted171991]

Jesse Pinkman:
Are we in the meth business, or the money business?

And McDonald's is in the real estate business (the corporation owns the land, in prime locations, while the franchisees only own the buildings).

 

[deleted925573]

True statement. We are all part of the problem. The folks nearing retirement (I mean how can you blame them? Don't be a hater). The folks like me, that still sign up to work for them. And I'm not a desperate ***** that had no other options. Like others have said, it's more than money, it's location and family. Older guys and new grads have all played a role in fueling the AMC expansions. What's the solution? Maybe it's only the hospital CEOs (now wising up to the false promises of AMCs), that will curb the trend.

There are plenty of big groups that sell out when they had no risk of a takeover. How can you not blame them?

 

[aneftp]

There are a lot of dynamics to “selling out” particularly with anesthesia.

1. You get rich “selling” a business.

2. Anesthesia contracts have zero value once they are out bidded. Since we are all essentially consultants and do not bring in “revenue”

3. Groups are in constant pressure from hospital administration to provide more services.

So the question is when to sell out. If you wait too long. You will end up with zero PLUS looking for another job or working for new employer for less.

 

[Stank811]

There are a lot of dynamics to “selling out” particularly with anesthesia.

1. You get rich “selling” a business.

2. Anesthesia contracts have zero value once they are out bidded. Since we are all essentially consultants and do not bring in “revenue”

3. Groups are in constant pressure from hospital administration to provide more services.

So the question is when to sell out. If you wait too long. You will end up with zero PLUS looking for another job or working for new employer for less.

Or if you vote no you do better then you ever have before financially while still maintaining your independence as a business and make all your decisions as a group without having to listen to some corporate over lord who could care less about your group as long as they continue to funnel money away from you to them.

 

[BLADEMDA]

Or if you vote no you do better then you ever have before financially while still maintaining your independence as a business and make all your decisions as a group without having to listen to some corporate over lord who could care less about your group as long as they continue to funnel money away from you to them.

You can only vote "no" if your group is financially independent from the hospital (zero subsidy). Otherwise, the contract is at risk of being taken away by an AMC promising ZERO subsidy and more services.

 

[aneftp]

You can only vote "no" if your group is financially independent from the hospital (zero subsidy). Otherwise, the contract is at risk of being taken away by an AMC promising ZERO subsidy and more services.

Agreed.

Private practice groups are under constant attack. Even my sister group with zero subsidy

Not only OR coverage. But out of OR coverage.

GI wants X days. But want 10 hour availability EACH day a la carte where they want to pop in and out in between their more lucrative outpatient cases. So GI wants to book cases between 1130-1pm and after 3pm. U as a private practice can’t afford to tie up anesthesia person just to wait on hand and foot. But hospital wants those services.

Same with pulmonary/cardiology.

Want more rooms running after 3pm.

It makes it very hard to maintain services when hospital keeps saying yes to “revenue providers” at expense of private “non revenue generating” anesthesia.

 

[deleted126335]

You can only vote "no" if your group is financially independent from the hospital (zero subsidy). Otherwise, the contract is at risk of being taken away by an AMC promising ZERO subsidy and more services.

I think the whole "no subsidy you are less vulnerable" thing is overblown. It is all about the $$. Whether it is lowering a subsidy or squeezing an ubsubsidized anesthesia group to be more accommodating with the third party payers, or squeezing them to provide any case any time or more unproductive services. Money is fungible. Getting an anesthesia group to give up a seven figure subsidy is no different than getting them to cut a ****ty deal with the Anthems and Aetnas of the world which is no different than getting them to do very unproductive work because it is in the best interest of the institution.

 

[Stank811]

You can only vote "no" if your group is financially independent from the hospital (zero subsidy). Otherwise, the contract is at risk of being taken away by an AMC promising ZERO subsidy and more services.

False. Many AMC get subsidies from hospitals. It is a negotiation.

 

[Stank811]

Agreed.

Private practice groups are under constant attack. Even my sister group with zero subsidy

Not only OR coverage. But out of OR coverage.

GI wants X days. But want 10 hour availability EACH day a la carte where they want to pop in and out in between their more lucrative outpatient cases. So GI wants to book cases between 1130-1pm and after 3pm. U as a private practice can’t afford to tie up anesthesia person just to wait on hand and foot. But hospital wants those services.

Same with pulmonary/cardiology.

Want more rooms running after 3pm.

It makes it very hard to maintain services when hospital keeps saying yes to “revenue providers” at expense of private “non revenue generating” anesthesia.

Hmmm we don’t find it that hard. Again it is a negotiation be at the table and be willing to flex and you would be surprised how willing surgeons and hospital admin will flex to get on the same page.

 

[Stank811]

Hmmm we don’t find it that hard. Again it is a negotiation be at the table and be willing to flex and you would be surprised how willing surgeons and hospital admin will flex to get on the same page.

Hospital and surgeons do not want to work with AMCs. They would love to work with the local group to find a common ground but if you are to rigid they will look for someone who is willing to work with them

 

[Noyac]

I think the whole "no subsidy you are less vulnerable" thing is overblown. It is all about the $$. Whether it is lowering a subsidy or squeezing an ubsubsidized anesthesia group to be more accommodating with the third party payers, or squeezing them to provide any case any time or more unproductive services. Money is fungible. Getting an anesthesia group to give up a seven figure subsidy is no different than getting them to cut a ****ty deal with the Anthems and Aetnas of the world which is no different than getting them to do very unproductive work because it is in the best interest of the institution.

I hate term subsidy. It’s like calling a physician a provider.
Instead of subsidy, it is basically the cost of doing business. If these hospitals want to employ physicians or hire Amc’s It will cost them money. If we have private group then we need to hire office staff, we don’t call that a subsidy. And these hospitals need to understand and account for all the ancillary revenue physicians bring in to the system. Things like labs, imaging, etc. A well lead group will not allow a system to claim a loss on a practice without accounting for these outsid revenue sources generated. Don’t let some clueless CFO start talking about your EBITA without accounting for this revenue.
This is a good article from just last week describing a lot of this:
Do Most Hospitals Benefit from Directly Employing Physicians?

 

[Noyac]

Hospital and surgeons do not want to work with AMCs. They would love to work with the local group to find a common ground but if you are to rigid they will look for someone who is willing to work with them

I agree but I like to say, be reasonable.

 

[deleted126335]

Hospital and surgeons do not want to work with AMCs. They would love to work with the local group to find a common ground but if you are to rigid they will look for someone who is willing to work with them

Hospitals and surgeons want what they want when they want it for the lowest possible price. If they perceive that an AMC is more likely to bring them that they will choose it. If the perceive that direct employment is more likely, they will choose that. If they perceive that incentivizing anesthesiologists as a private practice will bring them that, they will choose that.

 

[Arch Guillotti]

Hospital and surgeons do not want to work with AMCs. They would love to work with the local group to find a common ground but if you are to rigid they will look for someone who is willing to work with them

Not around where I am. AMC'S are all over the place and have driven some decent groups out.

 

[AdmiralChz]

Not around where I am. AMC'S are all over the place and have driven some decent groups out.

My fellowship hospital is the home base of a major “good” AMC - the care provided in the main OR is so bad the surgeons trip over each other to find any excuse to have CV anesthesiology do the case. They have to be told no multiple times a day, usually the answer is “don’t you know how bad it is over here?”

This definitely isn’t the case everywhere, but you don’t want to be seen as such a liability. Be an asset and a positive influence, not a total liability. As soon as the contract is up, expect this major home base to look elsewhere for a contract.

 

[Man o War]

Agreed.

Private practice groups are under constant attack. Even my sister group with zero subsidy

Not only OR coverage. But out of OR coverage.

GI wants X days. But want 10 hour availability EACH day a la carte where they want to pop in and out in between their more lucrative outpatient cases. So GI wants to book cases between 1130-1pm and after 3pm. U as a private practice can’t afford to tie up anesthesia person just to wait on hand and foot. But hospital wants those services.

Same with pulmonary/cardiology.

Want more rooms running after 3pm.

It makes it very hard to maintain services when hospital keeps saying yes to “revenue providers” at expense of private “non revenue generating” anesthesia.

Yes but the problem is, whether it’s a private group, AMC, or the hospital employs the anesthesia group, these same challenges exist. So if someone else is saying they can do it and your group is saying you can’t, they wonder why.
We find that the hospital staffing rooms/suites is more the limiting factor than us. They only want to pay a certain amount of staff, especially after 5:00 pm or so, so there’s only a limited number of sites that need coverage.

 

[Stank811]

My fellowship hospital is the home base of a major “good” AMC - the care provided in the main OR is so bad the surgeons trip over each other to find any excuse to have CV anesthesiology do the case. They have to be told no multiple times a day, usually the answer is “don’t you know how bad it is over here?”

This definitely isn’t the case everywhere, but you don’t want to be seen as such a liability. Be an asset and a positive influence, not a total liability. As soon as the contract is up, expect this major home base to look elsewhere for a contract.

We are not commodities and we should never let anyone ever convince us of such.

 

[mmag]

HCA, KKR team up for Envision bid
For profit hospital and private equity together...
Exclusive: HCA, KKR team up for Envision bid - sources

 

[prinzmetal7]

Reading threads like this can be disheartening as a medical student. The corporatization of medicine is affecting all specialties, not just anesthesiology. My goal is to focus on patient care, not on the politics of corporate medicine. Still, I'm glad this forum is so active with a diversity of opinions because it allows me to better understand, navigate, and plan for my future career. I wish I could say the same for my classmates, but I'll be honest most of them have no idea what's waiting for them.

It's far past time that the AMA, ASA, and all the other specialty societies heavily lobby the government to ban non-physician ownership of a medical corporation such as they have done in countries like Canada.

 

[mmag]

Focusing on patient care is one of many things you should be doing. I might be decades from my own med school application but even then students needed to show leadership in some fashion or at least involvement in extra curricular activities. Heck even college applicants need to show those things. If anyone has done alumni interviews for college, don't you see that every other kid is the president and founder of some company, non-for profit, club, or app? Good test scores and grades don't get you far these days

There must be someone wrong with med school takes in all these high achieving students wanting to make a difference and in the end churns out corporate drones.

Reading threads like this can be disheartening as a medical student. The corporatization of medicine is affecting all specialties, not just anesthesiology. My goal is to focus on patient care, not on the politics of corporate medicine. Still, I'm glad this forum is so active with a diversity of opinions because it allows me to better understand, navigate, and plan for my future career. I wish I could say the same for my classmates, but I'll be honest most of them have no idea what's waiting for them.

It's far past time that the AMA, ASA, and all the other specialty societies heavily lobby the government to ban non-physician ownership of a medical corporation such as they have done in countries like Canada.

 

[deleted171991]

Focusing on patient care is one of many things you should be doing. I might be decades from my own med school application but even then students needed to show leadership in some fashion or at least involvement in extra curricular activities. Heck even college applicants need to show those things. If anyone has done alumni interviews for college, don't you see that every other kid is the president and founder of some company, non-for profit, club, or app? Good test scores and grades don't get you far these days

There must be someone wrong with med school takes in all these high achieving students wanting to make a difference and in the end churns out corporate drones.

What's wrong is judging one's qualifications for medical school or college based on subjective crap, such as "extracurricular activities", recommendation letters etc. If it can't be measured precisely, it shouldn't be a criterion for admission.

People don't become corporate drones in medical school or residency, but when they start a family and their risk-tolerance decreases by orders of magnitude.

 

[mmag]

What's wrong with trying to get the whole package? Leadership ability and clinical acumen? Much easier to listen to someone if I know they are smart with good judgement .. plenty of talking heads in administrative medicine.

What's wrong is judging one's qualifications for medical school or college based on subjective crap, such as "extracurricular activities", recommendation letters etc. If it can't be measured precisely, it shouldn't be a criterion for admission.

 

[deleted171991]

What's wrong with trying to get the whole package? Leadership ability and clinical acumen? Much easier to listen to someone if I know they are smart with good judgement .. plenty of talking heads in administrative medicine.

Because it's worthless and mostly irrelevant. Whatever cannot be measured is just smoke and mirrors. Leadership for what? To become a good doctor? It's irrelevant for many specialties. And how do you measure "clinical acumen" objectively in a pre-medical person?

Plus all recommendation letters show is good family connections, not merit. Same goes for "volunteering", charitable activities, blah blah blah. Nobody who does them for unselfish reasons advertises them.

Meaning that I personally wouldn't believe 90% of all the unmeasurable hype about a person.

 

[mmag]

I agree with you that there's a lot of crap in the application process and I personally hated it. However the challenges of practicing medicine and anesthesia in particular now is not lack of medical knowledge.

In a pre-med, good science grades and high mcat means you have the ability to learn the material regardless of your major. There are more applicants than spots for those who have the ability to pass all the steps. So then what? You would try to avoid the gunner jerks and especially folks with sociopathic tendencies that would sell you out and put you down. It's all about surrogate measures. Premed -> med school : practice

Grades, MCAT -> passing Steps -> passing specialty boards : Gotta have a license and initial board certification to have a job.
Extracurriculars -> giving a care about what happens beyond you : maybe that person will do some M&M's or educational talks. Joining the hospital committees, ASA and state society and actually doing something about the challenges physician faces.
Rec letters -> Getting other people to believe in them and beyond that express it by writing letters which are a chore. : Convincing the old dude to stop letting cRNas do what ever they want and perpetuating the idea that we don't do any patient care.
Interview -> are you going to be that jerk gunner? : Are you going to be that jerk who complains and/or pisses everyone off?

If all one care about is the measurable, I'd suggest becoming a cRNa. You'll be smarter than everyone in nursing school, at work, and in nurse anesthesia school. Shorter education and less debt. You get paid by the hour, paid breaks, and overtime with great worker protections. You have an excellent professional organization that advocates for your job security. Over the course of a career, you are likely to make more money than an anesthesiologist considering the opportunity cost and hours worked difference.

Because it's worthless and mostly irrelevant. Whatever cannot be measured is just smoke and mirrors. Leadership for what? To become a good doctor? It's irrelevant for many specialties. And how do you measure "clinical acumen" objectively in a pre-medical person?

Plus all recommendation letters show is good family connections.

 

[deleted171991]

I agree with you that there's a lot of crap in the application process and I personally hated it. However the challenges of practicing medicine and anesthesia in particular now is not lack of medical knowledge.

In a pre-med, good science grades and high mcat means you have the ability to learn the material regardless of your major. There are more applicants than spots for those who have the ability to pass all the steps. So then what? You would try to avoid the gunner jerks and especially folks with sociopathic tendencies that would sell you out and put you down. It's all about surrogate measures. Premed -> med school : practice

Grades, MCAT -> passing Steps -> passing specialty boards : Gotta have a license and initial board certification to have a job.
Extracurriculars -> giving a care about what happens beyond you : maybe that person will do some M&M's or educational talks. Joining the hospital committees, ASA and state society and actually doing something about the challenges physician faces.
Rec letters -> Getting other people to believe in them and beyond that express it by writing letters which are a chore. : Convincing the old dude to stop letting a cRNas do what ever they want and perpetuating the idea that we don't do any patient care.
Interview -> are you going to be that jerk gunner? : Are you going to be that jerk who complains and/or pisses everyone off?

If all one care about is the measurable, I'd suggest becoming a cRNa. You'll be smarter than everyone in nursing school, at work, and in nurse anesthesia school. Shorter education and less debt. You get paid by the hour, paid breaks, and overtime with great worker protections. You have an excellent professional organization that advocates for your job security. Over the course of a career, you are likely to make more money than an anesthesiologist considering the opportunity cost and hours worked difference.

When deciding life-changing things, such as who gets admitted to medical school etc., I find it highly irresponsible to base one's decisions on subjective (and very probably inflated) information, especially in the country of "fake it till you make it". That's my view as an outsider, coming from a system (one of many-many) where subjective smoke does not matter (much) for admissions.

The best doctors I know are modest people. They don't join hospital committees and other BS. Generally, they tend to excel at their jobs and not care about much else (except maybe true research). They are not "leaders", because usually "leaders" are takers. And the truly best docs tend to be givers, at least the ones I would want for my family.

I also doubt that if we only cared about the measurable, we would get CRNA-level people. If anything, we would weed out the actors who get accepted into various programs (e.g. residency) for non-objective reasons, while actually being professionally "mid-level". The conscience-lacking sociopaths who then become "leaders" and managers, and develop/run exactly those medical corporations you so much dislike.

 

[pgg]

What's wrong is judging one's qualifications for medical school or college based on subjective crap, such as "extracurricular activities", recommendation letters etc. If it can't be measured precisely, it shouldn't be a criterion for admission.

I don't fully agree ... the problem with ECs isn't the fact that they're ECs, it's verifying them and sifting through the exaggeration and outright lies.

Every high school kid who blew on a clarinet a couple times is a "musician"
Every kid who Napoleon Dynamite'd his way through a karate class is a "martial artist"
Etc

But there's real work and talent out there too. My high school age daughter is a level 9 gymnast and spends about 4 hours/day in the gym, 6 days/week. I think she ought to get the nod over some other kid with identical grades and test scores, who does nothing but hang out under the "no loitering" sign in the 7/11 parking lot.

Anything that demonstrates an ability to do something difficult, and excel at it, ought to be given weight in admissions. Depending on what that thing is, it might be evidence the prospective student is driven, can perform under pressure, can function with other people.

There are countries where admissions is entirely or mostly dependent upon a single nationally administered exam. That might be fair (or maybe not, cf the other thread about affirmative action and kids' opportunities) but an ability to cram for an exam, and having the resources/wealth to do so in the first place, might not be the best marker for who'll make good doctors.

I did a minor in comp sci as an undergrad, and those classes were full of the stereotype - male nerds good at math. Some of the upper division courses required group work (this is the way software is built in the real world ... in teams) and some of those guys simply. Could. Not. Function. Maybe the university's admission committee would've been better off discounting SAT math scores in favor of kids who did some ECs involving other people.

 

[deleted171991]

I don't fully agree ... the problem with ECs isn't the fact that they're ECs, it's verifying them and sifting through the exaggeration and outright lies.

Every high school kid who blew on a clarinet a couple times is a "musician"
Every kid who Napoleon Dynamite'd his way through a karate class is a "martial artist"
Etc

But there's real work and talent out there too. My high school age daughter is a level 9 gymnast and spends about 4 hours/day in the gym, 6 days/week. I think she ought to get the nod over some other kid with identical grades and test scores, who does nothing but hang out under the "no loitering" sign in the 7/11 parking lot.

Except that we shouldn't care about her gymnastics, unless we are admitting people to major in Phys Ed or similar.

Anything that demonstrates an ability to do something difficult, and excel at it, ought to be given weight in admissions. Depending on what that thing is, it might be evidence the prospective student is driven, can perform under pressure, can function with other people.

EVERYTHING MEASURABLE BEING EQUAL. Which is not the case in the US. Also, AP courses in relevant fields are one thing; volunteering so that it looks good on CV (driven, blah-blah) shouldn't.

There are countries where admissions is entirely or mostly dependent upon a single nationally administered exam. That might be fair (or maybe not, cf the other thread about affirmative action and kids' opportunities) but an ability to cram for an exam, and having the resources/wealth to do so in the first place, might not be the best marker for who'll make good doctors.

Those countries tend to outperform us in many indicators, including population health.

I did a minor in comp sci as an undergrad, and those classes were full of the stereotype - male nerds good at math. Some of the upper division courses required group work (this is the way software is built in the real world ... in teams) and some of those guys simply. Could. Not. Function. Maybe the university's admission committee would've been better off discounting SAT math scores in favor of kids who did some ECs involving other people.

Interestingly, I have a similar degree. Maybe that's why both of us excel at medical thinking (a logical and probabilistic scientific process), and most likely have a higher IQ (mine lower than yours). And guess what? The top 1% of programmers can produce more and better code by degrees of magnitude than the "team players", which are really the CS "midlevels". (That's why the best companies recruit from TopCoder and similar sites.)

Yes, the "nerds" can be difficult to work with, but almost all great software products have a few measurable geniuses behind. When one reads their code, one understands the concept of "beautiful mind". The same way a highly intelligent and knowledgeable physician will have an impressive thinking process - just read their notes. (I have met more truly smart people in computer science than in medicine, which kind of proves my point. Medicine is full of actors.)

We should have more of them in medicine, too, and maybe our "research" would become meaningful (among others); right now, it's about as valuable as our admission process. Or we would have Amazons and Googles and Teslas and true innovation in healthcare, too, not just crappy management companies and hospital systems (that's our version of "innovating").

Let me put it this way: medicine is science, and the admission process should be scientific (not political). You can teach a smart person how to behave, but you can't make a genius out of an average mind. And while I understand that a lot of medicine is average and monkey see monkey do, do we want "doctors", in the original sense of the word (a person whose life is dedicated to learning and spreading of knowledge)? Or MiDlevels?

 

[GravelRider]

Except that we shouldn't care about her gymnastics, unless we are admitting people to major in Phys Ed or similar. ;


EVERYTHING MEASURABLE BEING EQUAL. Which is not the case in the US. Also, AP courses in relevant fields are one thing; volunteering so that it looks good on CV (driven, blah-blah) shouldn't.


Those countries tend to outperform us in many indicators, including population health.


Interestingly, I have a similar degree. Maybe that's why both of us excel at medical thinking (a logical and probabilistic scientific process), and most likely have a higher IQ (mine lower than yours). And guess what? The top 1% of programmers can produce more and better code by degrees of magnitude than the "team players", which are really the CS "midlevels". (That's why the best companies recruit from TopCoder and similar sites.)

Yes, the "nerds" can be difficult to work with, but almost all great software products have a few measurable geniuses behind. When one reads their code, one understands the concept of "beautiful mind". The same way a highly intelligent and knowledgeable physician will have an impressive thinking process - just read their notes. (I have met more truly smart people in computer science than in medicine, which kind of proves my point. Medicine is full of actors.)

We should have more of them in medicine, too, and maybe our "research" would become meaningful (among others); right now, it's about as valuable as our admission process. Or we would have Amazons and Googles and Teslas and true innovation in healthcare, too, not just crappy management companies and hospital systems (that's our version of "innovating").

Let me put it this way: medicine is science, and the admission process should be scientific (not political). You can teach a smart person how to behave, but you can't make a genius out of an average mind. And while I understand that a lot of medicine is average and monkey see monkey do, do we want "doctors", in the original sense of the word (a person whose life is dedicated to learning and spreading of knowledge)? Or MiDlevels?

Count me in the camp who is unimpressed by these “TopCoders.” All these nerds do is figure out ways to quantify data so that they can find better ways to advertise to us to get us to buy cr@p we don’t need. Amazon, Facebook, and Google are nothing but advertising firms. The other savants find ways to game the financial system. Maybe that’s where the money is right now, but these so-called “beautiful minds” are not really contributing to the advancement of the species at the moment. I’ll take the social community organizer or the guy still making chairs by hand any day over these nerds.