Making partner for new grads

[deleted171991]

Never

Agree. It may happen in patient-owning specialties, but definitely not in anesthesia. If one doesn't like the idea of being a blue-collar worker for life, one should stay away from hospital-based specialties.

How many family-owned stores have you seen pop up next to a big box store? Zero. There is no way back, except for playing the specialty-store or convenience store card, hence fellowships are important when they clearly differentiate the graduate from the non-, and not just by a piece of paper and board exam.

Once medicine becomes a protocolized service which everybody does the same way (what we call modern/evidence-based medicine), almost every trained monkey, including a silicone-based one, can do it. This is what the suits want and this is what the public wants: the walmartization of medicine. There are very few people ready to pay out of pocket for first class care, as long as the outcomes are the same.

The only specialties where this becomes tough to achieve are talent-based ones, such as surgical. Even there, they might break up the specialties in thinkers (as above) and doers (which might be just some trained talented tailors techs).

All of these may take a long time to happen, up to a century or so, but there is no doubt in my mind that it's where we are heading. Once artificial intelligence becomes even more intelligent, the whole point of knowledge-based jobs and specialties will become moot. That will threaten even the base fabric of capitalist societies, but that's a different story.

Young people should read a good amount of medical history, especially from the last 30-40 years. All this stuff that seems so improbable, so remote, is like current therapies that weren't possible decades ago. My own grandfather died from pulmonary edema secondary to MI and AKI 40 years ago, neither of which would kill him today. And the difference is not in doctors, it's in technology. The same technology that makes healthcare better also slowly phases out physicians in favor of cheaper people. Think about that. Good luck!

---

Members don't see this ad.

 

[Stank811]

The mega AMCs who are aggressively taking over practices nationwide are the future along with some percentage of hospital employment. The reason for their success is simple: It has become too expensive and too complicated to run an anesthesia group as a small business while keeping up with all the new quality reporting requirements and the increasingly complex and dwindling billing.
It's what happens in a free market when a big corporation opens a big store that sells the same goods for less money next to mom and pop's store!
So you can keep dreaming and convince yourself that the past will come back or decide to accept reality and adapt to this new situation.

So what AMC do you work for.
Not that complicated or expensive to keep up with the QCDR requirements. It cost us 8k per doc in our group to following quality metrics. Bundle payments and dwindling reimbursement are a separate issue but are issues seen by everyone...AMC, hospitals, PP.

 

[Planktonmd]

So what AMC do you work for.
Not that complicated or expensive to keep up with the QCDR requirements. It cost us 8k per doc in our group to following quality metrics. Bundle payments and dwindling reimbursement are a separate issue but are issues seen by everyone...AMC, hospitals, PP.

I am no longer in private practice and I don't work for an AMC.
Billing and collection is way more complicated than you are trying to portray, and even if you outsource your billing as many do, you can never achieve the collection ability of AMC's who have their dedicated highly aggressive collection and billing departments. Also your survivability depends entirely on your payer mix and unless you exist in an area where most of your patients are young, employed and have private insurance there is no way on earth you can survive without hospital subsidy.
And if that's the case and you are getting a stipend from the hospital, it is a matter of time before an AMC shows up and offer the CEO of the hospital to provide the same service with little or no stipend! Do you think the CEO loves you enough to refuse such a sweet deal???

 

[GA8314]

Agree. It may happen in patient-owning specialties, but definitely not in anesthesia. If one doesn't like the idea of being a blue-collar worker for life, one should stay away from hospital-based specialties.

How many family-owned stores have you seen pop up next to a big box store? Zero. There is no way back, except for playing the specialty-store or convenience store card, hence fellowships are important when they clearly differentiate the graduate from the non-, and not just by a piece of paper and board exam.

Once medicine becomes a protocolized service which everybody does the same way (what we call modern/evidence-based medicine), almost every trained monkey, including a silicone-based one, can do it. This is what the suits want and this is what the public wants: the walmartization of medicine. There are very few people ready to pay out of pocket for first class care, as long as the outcomes are the same.

The only specialties where this becomes tough to achieve are talent-based ones, such as surgical. Even there, they might break up the specialties in thinkers (as above) and doers (which might be just some trained talented tailors techs).

All of these may take a long time to happen, up to a century or so, but there is no doubt in my mind that it's where we are heading. Once artificial intelligence becomes even more intelligent, the whole point of knowledge-based jobs and specialties will become moot. That will threaten even the base fabric of capitalist societies, but that's a different story.

Young people should read a good amount of medical history, especially from the last 30-40 years. All this stuff that seems so improbable, so remote, are like current therapies which weren't possible decades ago. My own grandfather died from pulmonary edema secondary to MI and AKI 40 years ago, neither of which would kill him today. And the difference is not in doctors, it's in technology. The same technology that makes healthcare better also slowly phases out physicians in favor of cheaper people. Think about that. Good luck!

You act as if there's some grand conspiracy out there. I don't think it is common for hospital administrators (at least not ours in a 12 hospital system) to sit around thinking about how to commoditize a medical specialty. Seriously, and that's not being naive.

The same technology keeping people alive today are the same ASA 3/4 people that we see so frequently (because 1) they are alive and 2) they actually qualify for surgical interventions which may have nothing to do with their most serious comorbidities). These are the complicated patient whom are showing up more and more. Sure, anesthesia has become safer from a drug and equipment perspective, but our patients are a MESS.

This is why our specialty has a future. These patients require a significant amount of medical knowledge to take care of.

The sky is not falling.

 

[aneftp]

I am no longer in private practice and I don't work for an AMC.
Billing and collection is way more complicated than you are trying to portray, and even if you outsource your billing as many do, you can never achieve the collection ability of AMC's who have their dedicated highly aggressive collection and billing departments. Also your survivability depends entirely on your payer mix and unless you exist in an area where most of your patients are young, employed and have private insurance there is no way on earth you can survive without hospital subsidy.
And if that's the case and you are getting a stipend from the hospital, it is a matter of time before an AMC shows up and offer the CEO of the hospital to provide the same service with little or no stipend! Do you think the CEO loves you enough to refuse such a sweet deal???

Agreed.

The good payer mix groups have sold out (or in process of selling out).

Look at team health financials. (I look at that stock closely since amsurg is trying to pursue it)

They only spent around $150 million? on acquisitions back in 2013 and by 2014 that number went up to 500 million.

These AMCs are growing (mostly through borrowed money....funky financial voodoo crap Wall Street lets them do).

 

[Consigliere]

The sky is not falling.

You're right. It has already fell.

 

[GravelRider]

I don't necessarily buy that patients want the walmartization of medicine. I think the problem is patients are largely unaware of what is happening. The suits in medicine are pretty protected from public scrutiny because when you think about medicine, you think about doctors and nurses. That is why when rising healthcare costs are talked about, doctors tend to be vilified. Patients don't know that the consolidation of healthcare into corporations is what is driving the rising costs. Doctors recently went on strike in Great Britain and a vast majority of the population supported it. If we went on strike here, it would be a huge public relations problem because in their eyes we all drive Bentleys and have swimming pools filled with gold coins.

 

[criticalelement]

.

 

[criticalelement]

. Patients don't know that the consolidation of healthcare into corporations is what is driving the rising costs..

No truer words have been spoken.

 

[GA8314]

The sky is not falling. Change is inevitable. Your career will be what you decide to make of it. I acknowledge that there are forces which are negatively impacting ALL medical specialties, but it's still a good gig.

Live comfortably, not lavishly, pay off debts early, save aggressively, and enjoy your life. This doom and gloom mentality is truly self defeating.

 

[GravelRider]

The sky is not falling. Change is inevitable. Your career will be what you decide to make of it. I acknowledge that there are forces which are negatively impacting ALL medical specialties, but it's still a good gig.

Live comfortably, not lavishly, pay off debts early, save aggressively, and enjoy your life. This doom and gloom mentality is truly self defeating.

I think that attitude is self-defeating. Medicine is turning into Wall Street. The greed that is driving these changes is not only bad for us, but it is bad for patients. Decisions are being made based on what is best for some CEO, not for patients. If we just shrug and say it's a-ok then then all those negative predictions will come true.

 

[deleted162650]

You're right. It has already fell.

Well I honestly hope you're right cuz if this is what Anesthesia is gonna be like in a post sky-fall word I'm in good shape

 

[deleted171991]

You act as if there's some grand conspiracy out there. I don't think it is common for hospital administrators (at least not ours in a 12 hospital system) to sit around thinking about how to commoditize a medical specialty. Seriously, and that's not being naive.

The same technology keeping people alive today are the same ASA 3/4 people that we see so frequently (because 1) they are alive and 2) they actually qualify for surgical interventions which may have nothing to do with their most serious comorbidities). These are the complicated patient whom are showing up more and more. Sure, anesthesia has become safer from a drug and equipment perspective, but our patients are a MESS.

This is why our specialty has a future. These patients require a significant amount of medical knowledge to take care of.

The sky is not falling.

There is no conspiracy, but there is a plan. Good governments make long-term plans, occasionally spanning decades. They are not supposed to think short-term, like individual citizens do. Same applies to well-managed large corporations. These people plan for the long-term, and have the sources and the patience to follow those plans for many years. The walmartization of medicine started decades ago (just remember the HMOs). It just proceeds with slow enough steps that those involved don't really feel it. It's like the rotation of Earth. But the changes are happening and, for the external unbiased long-term observer, they are significant over time.

One simple proof is how the inflation-adjusted incomes in medicine have changed. That's the best indicator for a bad job (market) in a capitalist society. We see them as stagnant, like Earth. The truth is that they drop, in real terms, by the inflation rate every year. But since it's only 4% or so, nobody notices, except for people who look back 10 years or so, and see the 40% drop in purchasing power (which is what really matters).

The sky is not falling yet, but keeping one's head in the sand is a virtual guarantee for not noticing when it will. At this point, I would not plan my life around the hope that it will not fall. The question is only when, and whether we'll be able to predict it before it happens (like with CRNAs), or it will happen almost overnight (like Obamacare).

If I am sure of something is that night comes after day, and that there is a dawn ever after the darkest night. While I can't predict when either of those happen, I can at least plan for them. The way I tend to see things, I will only have pleasant surprises in the future.

 

[GA8314]

I think that attitude is self-defeating. Medicine is turning into Wall Street. The greed that is driving these changes is not only bad for us, but it is bad for patients. Decisions are being made based on what is best for some CEO, not for patients. If we just shrug and say it's a-ok then then all those negative predictions will come true.

I never said you should accept whatever comes your way. I'm an organized medicine and PAC advocate. Just realize that the sky is NOT falling.

 

[deleted171991]

You're right. It has already fell.

If we go back 50 years, yes. We are about 80% worse than those physicians, and I am not speaking only about incomes.

If you go back only 10-20 years, the worst for the under 50 generations is yet to come.

 

[Mman]

One simple proof is how the inflation-adjusted incomes in medicine have changed. That's the best indicator for a bad job (market) in a capitalist society. We see them as stagnant, like Earth. The truth is that they drop, in real terms, by the inflation rate every year. But since it's only 4% or so, nobody notices, except for people who look back 10 years or so, and see the 40% drop in purchasing power (which is what really matters).

My partners earned about $550K per year in 1990. If you adjusted for 3% inflation it'd be nearly $1.2M per year right now. Inflation slowly eats away at income even if your income rises (under inflation). That's why you need your investments to earn greater than inflation over time.

 

[deleted171991]

My partners earned about $550K per year in 1990. If you adjusted for 3% inflation it'd be nearly $1.2M per year right now. Inflation slowly eats away at income even if your income rises (under inflation). That's why you need your investments to earn greater than inflation over time.

In a good job market, salaries rise with inflation (so that their purchasing power stays the same), or even faster. So your partners earning in 2015 probably less than half what they earned in 1990 is called technological progress by some, slow and steady (but guaranteed) obsoletion by others.

Extrapolating what has happened in the last 25 years, we can virtually guarantee that we will make much less than half of what we make today by the time we retire. Actually, if history repeats itself, things will tend to speed up as time passes, so that the next "salary half-life" will be much shorter than 25 years. Or, to use medical terms, we are following zero-order kinetics.

 

[GA8314]

I can think of few if any professions (or jobs, whatever) where, adjusted for inflation, people are doing substantially better than they were 25-40 years ago.

So, it's NOT only medicine (or anesthesia), it's a problem we have in our entire economy. Now, instead of 350-450k that many of us make, imagine the degreed supervisor on the factory floor making $75-125k (for an auto company)? Imagine the squeeze THAT guy is feeling.

What do both Bernie Sanders AND Donald Trump supporters have in common?? They are MILLIONS of people GETTING THE SQUEEZE. And they are fed up. This is a problem much much bigger than our subspecialty of medicine.

 

[Mman]

In a good job market, salaries rise with inflation (so that their purchasing power stays the same), or even faster. So your partners earning in 2015 probably less than half what they earned in 1990 is called technological progress by some, slow and steady (but guaranteed) obsoletion by others.

Most of what our group lost to inflation was 10-20 years ago. Last 5 years we have actually grown income by 5-10% per year and are now approaching 15% per year through growth. Not sure how long it can last but 2016 off to a good start and 2017 looks great at this point.

 

[BLADEMDA]

CEOs/CFOs keep cutting the subsidy and expect Groups to take it or leave it. The options are to fold the group and become hospital employees or join an AMC where the MBAS do the negotiating with the hospital. The Group gets a buyout and the hospital gets a subsidy reduction.

Hence, any group receiving a subsidy must be willing to cut that subsidy or possibly, do without it entirely in order to keep their contract. In addition, if the CEO demands more services that same group must bit the bullet once again and provide those additional services at no cost to the hospital. Hence, in many hospitals (not all) the payer mix just isn't good enough to support the demand for services, keep up with all the govt. metrics and regulations while receiving squat from the hospital administration.

Some groups sell out because they want to while others sell out because they have no other viable business alternative.

 

[deleted171991]

Did you have employees 20 years ago, @Mman? Do you have employees now? Because that can explain the growth.

Regardless, I will say it again: partners are far from being representative for the average or median American anesthesiologist in 2016. The latter is an employee, working for a group like yours, or an AMC. That is the guy recent grads will mostly become, not you, no offense. And that's the guy who's not far from being paid like a CRNA on an hourly basis, 5 years from now, unless he takes on a lot of liability and/or works much harder than he ever had to before.

 

[aneftp]

I am too young for the heydays of anesthesia (circa early to mid 80s). I have 3 collegues in their mid 60s and early 70s still working. The 73 year is in better shape than some of the 50 year old but he's semi retired now. I think the other guys in their 60s are just bored as well. Never divorced. Kids grown. Making money on their own. That's the only reason I see them still working.

Anyways they tell me of the days of billing units PER 6 Minutes. That's how people were making $400-500k in the 1980s working 40 hours a week. That's why many switched from internal medicine/peds to anesthesia circa 1982-1984. Many got in the old 2 year residency track (since they were already credited with one year internal medicine/peds).

So they were young attendings who switched to lucrative anesthesia.

 

[GravelRider]

The fact of the matter is that private anesthesia groups are now competing with Wall Street. Many of these AMCs are owned by Wall Street. Private practice medicine in any field is dead. Anesthesia is just ahead of the curve.

The fact that any entity providing healthcare services can be owned by investors on Wall Street is an ENORMOUS conflict of interest that the public really is completely blind to. This, in my opinion, is the number 1 problem afflicting our healthcare system.

 

[dannyboy1]

I am too young for the heydays of anesthesia (circa early to mid 80s). I have 3 collegues in their mid 60s and early 70s still working. The 73 year is in better shape than some of the 50 year old but he's semi retired now. I think the other guys in their 60s are just bored as well. Never divorced. Kids grown. Making money on their own. That's the only reason I see them still working.

Anyways they tell me of the days of billing units PER 6 Minutes. That's how people were making $400-500k in the 1980s working 40 hours a week. That's why many switched from internal medicine/peds to anesthesia circa 1982-1984. Many got in the old 2 year residency track (since they were already credited with one year internal medicine/peds).

So they were young attendings who switched to lucrative anesthesia.

Well, they had to sit through long a$$ cases without smartphones or the internet so at least our generation has something better than them

 

[bpm1]

Well, they had to sit through long a$$ cases without smartphones or the internet so at least our generation has something better than them

they brought novels, magazines, popular mechanics, playboy etc etc... Reading was pleasurable back then.

 

[amyl]

Partnership. New grads. Lol.

Jon snow is alive so anything can happen I guess....

 

[Arch Guillotti]

Partnership. New grads. Lol.

They aren't common that's for sure. But the myth that they don't exist is perpetuated by SDN.

 

[Mman]

Did you have employees 20 years ago, @Mman? Do you have employees now? Because that can explain the growth.

Regardless, I will say it again: partners are far from being representative for the average or median American anesthesiologist in 2016. The latter is an employee, working for a group like yours, or an AMC. That is the guy recent grads will mostly become, not you, no offense. And that's the guy who's not far from being paid like a CRNA on an hourly basis, 5 years from now, unless he takes on a lot of liability and/or works much harder than he ever had to before.

no employees then, small handful of part time employees now (<10% of total docs). Revenue increases are due to contracted rates rising around 5% per year, surgical volume rising around 5% per year, expanding pain services, and % insured patients rising about 1-2% per year.

 

[GA8314]

Not many people are willing to do what some of us did do. Which is move to a lesser desirable area (or simply new area further from family for example) in order to attain ownership status. I'm full partner in August, and while nothing is a certainty, I'll be shocked if this doesn't move forward as planned. I have reasons for thinking this.

Point being, if you want ownership, it may not be in your back yard or favorite neighborhood. But, if you can be flexible geographically, and let the group know that you are willing to relocate for a partnership opportunity and then work like you want to be an owner for 1-3 years, then there ARE opportunities out there.

Further rewarding those who can be flexible is the fact that partnership openings don't happen every day (or every year even). Groups get, for example, a 2 year notice from an older partner, and they get the feelers out. Once they fill that spot, there may not be another opportunity at that group for 5 years. I've seen this multiple times in my own job hunt.

Flexibility, while not possible for everyone for lots of reasons, is your friend if ownership is your goal.

But, you either value ownership or not. If you do then it would seem many would be willing to move for it. If not willing to do much (not that moving isn't "much") then that suggests that perhaps you don't value ownership like you say you do.

You'd be surprised how some smaller communities (even 400k towns) have a difficult time recruiting. You show up ready to be an asset to those groups and then work like it, and you have a great shot at being an owner. Just my opinion.

 

[skypilot]

I am no longer in private practice and I don't work for an AMC.
Billing and collection is way more complicated than you are trying to portray, and even if you outsource your billing as many do, you can never achieve the collection ability of AMC's who have their dedicated highly aggressive collection and billing departments. Also your survivability depends entirely on your payer mix and unless you exist in an area where most of your patients are young, employed and have private insurance there is no way on earth you can survive without hospital subsidy.
And if that's the case and you are getting a stipend from the hospital, it is a matter of time before an AMC shows up and offer the CEO of the hospital to provide the same service with little or no stipend! Do you think the CEO loves you enough to refuse such a sweet deal???

Doesn't this spell trouble for the hospital employed model? The hospital hires a bunch of high priced physicians. They do not have the dedicated expertise in billing and collection that the AMCs do. Soon the hospital realizes it is headed toward bankruptcy and they try to cut physician salaries. This leads to a mass exodus of talented physicians. The remaining physicians are less motivated to produce because they have no chance of ever making partner.

 

[deleted126335]

Doesn't this spell trouble for the hospital employed model? The hospital hires a bunch of high priced physicians. They do not have the dedicated expertise in billing and collection that the AMCs do. Soon the hospital realizes it is headed toward bankruptcy and they try to cut physician salaries. This leads to a mass exodus of talented physicians. The remaining physicians are less motivated to produce because they have no chance of ever making partner.

"This leads to a mass exodus of talented physicians"

Depends on one's alternatives.

"The remaining physicians are less motivated to produce because they have no chance of ever making partner."

As the rewards for hard work and sacrifice - Money, Security, Autonomy, Respect diminish...
So too will the willingness to work hard and sacrifice. It will translate to the bottom line in terms of productivity.

 

[deleted171991]

Doesn't this spell trouble for the hospital employed model? The hospital hires a bunch of high priced physicians. They do not have the dedicated expertise in billing and collection that the AMCs do. Soon the hospital realizes it is headed toward bankruptcy and they try to cut physician salaries. This leads to a mass exodus of talented physicians. The remaining physicians are less motivated to produce because they have no chance of ever making partner.

Big hospital systems are getting as good at billing as AMCs, and they have even more negotiating power.

 

[Mman]

Big hospital systems are getting as good at billing as AMCs, and they have even more negotiating power.

huh? big hospitals are terrible at billing, almost as a rule, they are very inefficient on the whole at collections.

 

[deleted171991]

I honestly don't see where a management company can beat Epic (or a similarly powerful EMR) at coding and billing. It just needs to be templated and scripted properly, to capture as much as possible.

One doesn't need an AMC to become good at collections. One needs a good collections agency. Same goes for billing and coding; if one has a good EMR and IT support already, one needs just a handful of in-house true billing experts to implement the same kind of system an AMC would use.

There is nothing an AMC does that a handful of carefully hired in-house experts could not approximately reproduce, over time, or that could not be done by good billing and collections or consulting agencies. The main force of an AMC is negotiating power, something a big hospital system should be able to do better (absent political influence).

 

[Consigliere]

FFP is right.

 

[Mman]

Various private groups at our mega sized level 1 trauma center that have been gobbled up by the hospital have seen the collections by their department decrease 30-50% compared to when they were private (for same case mix/volume). Surgeons, IM specialty groups, etc. I've heard plenty of similar stories from other large hospitals.

While you'd think they "should" be good at it, they just aren't. It isn't as simple as collecting the data. That's why hospitals don't really want to run their own anesthesia department. It's financially better to have someone else do it. Part of the reason for this is that the actual boots on the ground are probably more meticulous in their documentation when they reap the benefits of the billing. When the doc doesn't care what gets billed, they tend not to sweat the details as much.

 

[Planktonmd]

Various private groups at our mega sized level 1 trauma center that have been gobbled up by the hospital have seen the collections by their department decrease 30-50% compared to when they were private (for same case mix/volume). Surgeons, IM specialty groups, etc. I've heard plenty of similar stories from other large hospitals.

While you'd think they "should" be good at it, they just aren't. It isn't as simple as collecting the data. That's why hospitals don't really want to run their own anesthesia department. It's financially better to have someone else do it. Part of the reason for this is that the actual boots on the ground are probably more meticulous in their documentation when they reap the benefits of the billing. When the doc doesn't care what gets billed, they tend not to sweat the details as much.

I am sorry to hear that your "mega sized trauma center" is terrible at billing and collection, I just can't help it to wonder how can these previously private groups tell that their billing is not as good after the hospital took them over??? Once the hospital is doing the billing the "providers" become employees, and employees don't usually have access to the books of the hospital to my best knowledge!
On the other hand, I agree with you that hospitals are not great at anesthesia billing but AMCs are, and that's why they are going to take over your practice sooner or later!
Once again you tell us how wonderful your world is, and how exceptional your group is, and how rosy the future is going to be for you and your buddies.
But unfortunately your vision does not jive with reality, and most of us don't have those exceptional skills and qualifications you and your buddies seem to have, hence we have to live in our own miserable world and deal with issues that seem to be so irrelevant to you.

 

[Mman]

I am sorry to hear that your "mega sized trauma center" is terrible at billing and collection, I just can't help it to wonder how can these previously private groups tell that their billing is not as good after the hospital took them over???

Because the physicians have bonuses based on collections from their work so they see the data and laugh at it.

Also, sorry your world is ending. Not everybody's is. And no, the AMCs aren't coming. We are coming for them. Already took 1 contract from them. Hoping to take more. The view of the majority of posters here is far more skeptical than the reality I encounter on a daily basis or the reality the dozens of friends and former colleagues I have in private practice around the country tell me about.


Does anybody actually stop and wonder why AMCs are so gung ho about trying to acquire practices? We are talking about companies with valuations in the billions of dollars. They have a lot of smart people working for them. They are not nearly as pessimistic about the future of the "industry" and they are putting their money where their mouth is. Don't get me wrong, I'm personally better off if everybody thinks anesthesia is terrible and doesn't want to do it. I'll be richer in the end. But I'm trying to spread the honest truth, not some woe is me the world is ending BS.


Just watch. In the end, the groups that didn't sell out will be the ones smiling.

 

[Planktonmd]

Because the physicians have bonuses based on collections from their work so they see the data and laugh at it.

Also, sorry your world is ending. Not everybody's is. And no, the AMCs aren't coming. We are coming for them. Already took 1 contract from them. Hoping to take more. The view of the majority of posters here is far more skeptical than the reality I encounter on a daily basis or the reality the dozens of friends and former colleagues I have in private practice around the country tell me about.


Does anybody actually stop and wonder why AMCs are so gung ho about trying to acquire practices? We are talking about companies with valuations in the billions of dollars. They have a lot of smart people working for them. They are not nearly as pessimistic about the future of the "industry" and they are putting their money where their mouth is. Don't get me wrong, I'm personally better off if everybody thinks anesthesia is terrible and doesn't want to do it. I'll be richer in the end. But I'm trying to spread the honest truth, not some woe is me the world is ending BS.


Just watch. In the end, the groups that didn't sell out will be the ones smiling.

Blah Blah Blah... I give your wonderful group a maximum of 5 years survival... actually I bet that while you are spilling all that crap here your "senior" partners are already negotiating with AMCs and you might not even be aware of it.

 

[Mman]

Blah Blah Blah... I give your wonderful group a maximum of 5 years survival... actually I bet that while you are spilling all that crap here your "senior" partners are already negotiating with AMCs and you might not even be aware of it.

I am a senior partner. Everybody is 100% equal. And yes, we've already met with the AMCs and turned down their lowball offers. I've seen the numbers. I've been wined and dined. I've said no thanks.

I actually like the AMCs being around. Nothing makes negotiating with an insurance company easier than the idea you could sell out to an AMC that will charge them 30% more per case tomorrow.

 

[deleted126335]

Mman,

I am willing to bet that you have an above average size group of docs, well credentialed and deep in sub specialists who are fellowship trained and work at a tertiary care facility that is located in a place that is not on many docs radars as desirable.

If the most important thing to me was to delay employment by a hospital or AMC, that is the type of practice that IMO has the best chance of long term survival as independent.

 

[Stank811]

I am a senior partner. Everybody is 100% equal. And yes, we've already met with the AMCs and turned down their lowball offers. I've seen the numbers. I've been wined and dined. I've said no thanks.

I actually like the AMCs being around. Nothing makes negotiating with an insurance company easier than the idea you could sell out to an AMC that will charge them 30% more per case tomorrow.

I know of several groups similar to Mman. Dr Doze is probably correct, all the groups I am familiar with are MD heavy (not always subspecialty heavy) and there are no senior partners. So when an AMC offers you X amount that is split 30-40 different ways vs split between 5-10 senior partners the deal is not nearly as tempting. I am also confident that hospital administrators at several facilities are turning sour on the AMC smoke and mirrors game.

I also agree 100% with FFPs post above regarding the business side of anesthesia and collections. Doesn't take an AMC to do it and it doesn't take 7% or more to have a company do it for you either.

 

[bkell101]

I would say that of those 10% of jobs that are for partnership, only 10% of that 10% are for real partnerships. The rest are fake or just a way to get you to sign a contract at a lower salary. There are a lot of predators out there.

In this day and age of employment, I think it will be imperative for docs to get their hours spelled out EXACTLY in the contract and what the compensation will be if you work over those hours. If you don't have very specific workload language written in your contract then these employers will have no problem increasing your workload without increasing compensation. In that sense, we will almost have to take a page out of the nursing book and possibly demand hourly compensation with premiums on overtime, nights, holidays, and weekends. I also think a real physician union will become necessary.

What questions do you ask to tell if a "partnership tack" is not a true partnership track? What do you look for? How do know before signing with the group?

 

[GravelRider]

What questions do you ask to tell if a "partnership tack" is not a true partnership track? What do you look for? How do know before signing with the group?

I've learned a lot in my 1 year out since residency, and I have made mistakes. You will too. This is my first job (in anesthesia), but certainly not my last. In retrospect, my gut told me something was fishy.

I would say talk to recent hires (if they let you), and find out about turnover. If people are leaving, they are leaving for a reason. That would be the biggest indication to me. I would ask about any hierarchy and call structure. Does everyone take equal call or are the fat cat partners on the golf course by 2 while you finish all the OR cases everyday? How long to partnership? Anything over 2 years needs a really good explanation (i.e. there is no good explanation). I real partnership should be very transparent.

When I interviewed for this current job (fake partnership) and asked questions, many of the answers I was given were vague. I would say you should ask direct questions and if you suspect they are being shady, they probably are. It's difficult to have these direct conversations when you are interviewing as a resident. You feel just grateful that you are even getting an interview. You are worried you might offend someone by asking about the financials of the group. You don't want to seem like you are trying to avoid work by asking about the call structure. These practices know that, which is why they are able to feast on new grads.

 

[Notorious T.E.E.]

I am a senior partner. Everybody is 100% equal. And yes, we've already met with the AMCs and turned down their lowball offers. I've seen the numbers. I've been wined and dined. I've said no thanks.

I actually like the AMCs being around. Nothing makes negotiating with an insurance company easier than the idea you could sell out to an AMC that will charge them 30% more per case tomorrow.

I don't know if you will be successful in fending off AMCs but I do admire your spirit. This specialty needs more physicians interested in competing with AMCs rather than selling for the promise of five more good years.

 

[GravelRider]

I know there is a lot of stigma with being seen as clock-punchers, but my biggest piece of advice for every resident becoming an employee is to get your contract to CLEARLY state what your workload will be and how you are compensated for going beyond that workload. I can't state that strongly enough. There is nothing that creates more resentment toward your job if you feel like you are working for nothing. There is nothing wrong with being employed. It doesn't mean you are a bad anesthesiologist because you can't get a rare private practice partnership. Your employer just needs to respect you for skills and your time.

I also want to see these fake partnerships out there fail. You are often better off working for an AMC than getting duped by these rats. They are lying to people and doing something that is arguably considered fraud and probably illegal.

 

[deleted50478]

What questions do you ask to tell if a "partnership tack" is not a true partnership track? What do you look for? How do know before signing with the group?

How many docs have been on a partnership track in the last 5 years and how many are now partners. What was the deal with the others?

If they answer honestly it'll tell you everything. Hard to tell if they are honest about it though.

 

[caligas]

How many docs have been on a partnership track in the last 5 years and how many are now partners. What was the deal with the others?

If they answer honestly it'll tell you everything. Hard to tell if they are honest about it though.

Anybody have a link to a "fake partnership" job ad? How do they operate? This is the first I've heard of them.

 

[GravelRider]

There are many reasons for fake partnerships...planning to sell out to an AMC soon, impending hospital takeover, just overall uncertainty. It's basically dangled as bait to get you to sign a contract that has lower than market wages and to make you psychologically feel like you have to prove something when you start working. They'll tell you that the local AMC may pay more, but you won't have the big upside of being a partner. It's pure dishonesty. It's hard to tell from an ad. You have to talk to these people in person. Remember, you are a well-educated professional. If it sounds like they are trying to haze you for a couple years for some ambiguous goal then call them out on it and walk away.

 

[deleted171991]

Or one can just avoid these jokers by not signing for any partnership track that's longer than two years. Then, even if one doesn't become partner, the damage is limited.

Let's be serious. No partnership track contract will have provisions for the case the person does not make it to partner, or the group is sold etc. It's more like take it or leave it.

The whole idea of long partnership tracks is dangling the bait in front of suckers. One doesn't need more than a few months to figure out whether an employee is partner material. One year is more than enough.