NAPA in trouble in NJ

[anbuitachi]

Closer to 400k per my source

yea closer to 400. mostly high 3s and low 4s

So if the consensus on here is that Napa sucks, why are people still working for them?

my understanding is they attract some younger attendings. but high turnover. younger attendings attracted to the 'large' salary, go there work hard, make good $ to them, and then realize they work too hard and they leave. napa offering signon bonus too. so new grads can make 550 to 600 which is a lot to new grads who are used to 10% of that while working hard

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[PainDrain]

this is close to happening at several other large NAPA locations. Hospitals hate them with a passion.

I can attest to them losing a contract in the northeast due to a huge liability issue. Long story short is they understaffed a location and an emergency went south. They had been struggling with staff since they got the contract the year before and the hospital system was fed up.

 

[IMGASMD]

I can attest to them losing a contract in the northeast due to a huge liability issue. Long story short is they understaffed a location and an emergency went south. They had been struggling with staff since they got the contract the year before and the hospital system was fed up.

It took me a month into my job to start taking calls…. Just to feel comfortable, to know all the players and equipments that we have. Even now after a year with my most recent job, since we cover multiple hospitals, I still don’t know a lot of pre/post op nurses.
A lot of these revolving doors, you really don’t know the person who’s coming to relieve you or decompress the schedule. I am actually more surprised some of these stories don’t happen more often or some of the tragedies just don’t get publicized.

 

[anbuitachi]

I can attest to them losing a contract in the northeast due to a huge liability issue. Long story short is they understaffed a location and an emergency went south. They had been struggling with staff since they got the contract the year before and the hospital system was fed up.

im surprised they didnt just blame the doctor.

 

[OptionOffense]

im surprised they didnt just blame the doctor.

Hard to be blamed when you are unaware of a case even going on.

 

[ToKingdomCome]

So if the consensus on here is that Napa sucks, why are people still working for them?

Do all NAPA sites suck though?

 

[IMGASMD]

I can attest to them losing a contract in the northeast due to a huge liability issue. Long story short is they understaffed a location and an emergency went south. They had been struggling with staff since they got the contract the year before and the hospital system was fed up.

We got time.

 

[anbuitachi]

Hard to be blamed when you are unaware of a case even going on.

blame the doctor for not being aware of a case going on

 

[OptionOffense]

blame the doctor for not being aware of a case going on

Good one! That is exactly how it is. Blame the doctor for not being told

 

[Twiggidy]

yea closer to 400. mostly high 3s and low 4s


my understanding is they attract some younger attendings. but high turnover. younger attendings attracted to the 'large' salary, go there work hard, make good $ to them, and then realize they work too hard and they leave. napa offering signon bonus too. so new grads can make 550 to 600 which is a lot to new grads who are used to 10% of that while working hard

That's true. It's just sad because it leads to high turnover and in my opinion it's why leads to a long of contention between surgeons (who tend to have less turnover) and a new attending anesthesiologist every year.

 

[hankbb02]

I’ll grant you that a good payor mix amc is superior to hospital employ, especially if one stays for long term. The advantage breaks down when you get to less good payor mix areas. I’ve just seen good private hospitals with good reputations lock up the insured patients while the amc or private practice is covering more sites to make ends meet.

Examples I’ve seen are private or privademic hospitals employing physicians for around 550-600 while the private or amc group in the same city has 3 year partner tracks starting at 350 and then partners top out at 525-550.

Benefits generally better when hospital employed too, particularly on the 401k front (less 3 year vesting periods).yY

You can't be a partner at an AMC.

 

[IMGASMD]

You can't be a partner at an AMC.

Not necessarily true. I was offered to “profit share” after x years.
Let’s say we suppose to make 1.5M for the mothership. If we make more than that, we get 60% and corporate gets the 40%. Or something like that…..

But is it “partnership”, probably not.

 

[Endee]

You can't be a partner at an AMC.

By my understanding, a lot of the AMC groups function like the PP groups they once were. There's revenue and expenses. The big difference is the AMC now takes a 30-40% chunk out of the revenue, so there's often a lot less profit afterwards for the "partners" to divide. Most of the people I know around Florida (very AMC heavy) work in this model. They get a base but still get profit sharing afterwards like @IMGASMD mentioned.

A big exception that I know of at least in this state is Envision in South Florida (specifically Broward/Ft. Lauderdale), where Sheridan originally started. There it's like a corporate owned practice, and every doc is employed/salary. So they never see productivity gains. But even other Envision practices around Florida do have profit sharing. I think it differs based on negotiations when the groups were getting acquired.

 

[sevo00]

Looks like they’re at $400 a hr now and time and a half if over 40 hrs

 

[IMGASMD]

Looks like they’re at $400 a hr now and time and a half if over 40 hrs

This sounds more permanent than I’d consider. Also sounds like they won’t pay travel, lodging…..
never cease to amuse me. Baggers CAN be choosers. That 1.5x can be huge tho.

 

[dannyboy1]

It’s very tricky. My old practice (private) went to an AMC who maintain same salary structure and paid vacation. Than hospital took over w2 (benefits better) salary slightly better. Looked better on paper. At least while they were fully staffed for a while.

Now 2 plus years later. They are short staff. This is where LARGE AMC do really do better. The large amc have a large pool of locums docs they can immediately plug in if short staff. While the previous amc managed the practice. Staffing was adequate and locums could be used to fill in the gap usually with less than 4 weeks notice for temp privileges.

Now the hospital based practice is very slow to respond to staffing shortages. They simply do not have that large of base of locums to pull from and they too cheap to pay the middle man recruiters 20-30% fees to get locums in quicker.

Define “short staff”. You see it as working harder (more calls, staying late). Hospital defines it as not being able to cover OR rooms. in the second case credentialing can take place in the blink of an eye ….

 

[sevoflurane]

This is where LARGE AMC do really do better. The large amc have a large pool of locums docs they can immediately plug in if short staff.

I wouldn’t be so sure of this statement, especially in this environment.

 

[amyl]

Which amc takes 30-40%? Geez that’s a ton.

Highest figure I know of in mine is 22% but most are below that- depends on how the initial buyout was structured

 

[Howard888]

I’ve been told USAP Houston takes 35%ish.

USAp central 25%ish

USAP Orlando 30% ish

Who knows though-this coming from people who I think in the know but these things aren’t published. Only those who originally know deal actually know.

That’s just Usap. You only being 22%-likely another reason Dallas does better

Napa-completely different story. There is no revenue sharing. How much they take-only they know-but it is widely believed that areas with good payer mixes and stronger rates-see Napa In North Carolina-they may be taking up to 50% based on what they pay MDs.

That is why AMCs are ruining healthcare. Increasing the cost of care with little to no benefit and MDs see little of it.

 

[maxxor]

I’ve been told USAP Houston takes 35%ish.

USAp central 25%ish

USAP Orlando 30% ish

Who knows though-this coming from people who I think in the know but these things aren’t published. Only those who originally know deal actually know.

That’s just Usap. You only being 22%-likely another reason Dallas does better

Napa-completely different story. There is no revenue sharing. How much they take-only they know-but it is widely believed that areas with good payer mixes and stronger rates-see Napa In North Carolina-they may be taking up to 50% based on what they pay MDs.

That is why AMCs are ruining healthcare. Increasing the cost of care with little to no benefit and MDs see little of it.

USRS (USAP sister portfolio company for radiology) maxes out at 40%, but will buy “less” if the practice has the foresight to accept less of a buyout.

 

[Howard888]

Yes that is the Welsh Carson model-Usap similar at 40%. I have heard multiple anesthesia groups did take 30% or more. Which was obviously to benefit those closer to retirement.

Again -that’s just Welsh Carson’s model.

The Napas of the world just pay salary. Sometimes they bonus and call it a “profit share” but they ultimately control where all the money goes. I do believe they take 50% in the markets that MDs accept terrible pay

 

[aneftp]

I’ve been told USAP Houston takes 35%ish.

USAp central 25%ish

USAP Orlando 30% ish

Who knows though-this coming from people who I think in the know but these things aren’t published. Only those who originally know deal actually know.

That’s just Usap. You only being 22%-likely another reason Dallas does better

Napa-completely different story. There is no revenue sharing. How much they take-only they know-but it is widely believed that areas with good payer mixes and stronger rates-see Napa In North Carolina-they may be taking up to 50% based on what they pay MDs.

That is why AMCs are ruining healthcare. Increasing the cost of care with little to no benefit and MDs see little of it.

It’s essentially 40%
20% to the “partners “ pot to divide up
20% to usap privacy equity welsh Carson.

That’s why many of the original 2014 Orlando Houston partners have cut back significantly their hours.

Suppose you generate 1 million as a “partner” which some do. Their take home pay is $800k which is still darn good. But they are working 70 plus hours

So better to cut the hours down to 50-55 hours. Make 550k. Oh even better yet. Cut the hours down to 40 hours. Make 450k which less calls maybe one weekend every 6-7 weeks.

Work the new people hard. Try to makeup the 20% being given to privacy equity with working new people to death.

The real issue they face is crnas are leaving left and right. Screws up everything in the game plan. I know this for a fact. Crnas are leaving. As the back loaded incentive bonus is vested.

 

[Howard888]

Heard same thing on USAP all in Texas. Trying to pay CRNAs 25% rates in south. Jumping like flies.

As you said all this just makes MDs work harder so private equity and some senior partners still get paid.

Ships sinking though

 

[Status Sciaticus]

Not sure where these numbers are coming from but having interviewed at several USAPs, the numbers range between 17% - 25%. 40% would be insane.

 

[maxxor]

Not sure where these numbers are coming from but having interviewed at several USAPs, the numbers range between 17% - 25%. 40% would be insane.

USRS number comes directly from personal experience. I was told WCAS uses a similar model across their portfolio.

 

[Howard888]

You interview with GHA/Houston? I’ve been told by some folks pretty in the know it was >30%. Was told Orlando also around 30%. Austin/central 25%. Yes several at around only 20% but I’m pretty confident several at 30% or more.

Again only those in the group/part of sale know for sure but similar numbers been talked about for years.

Again though as bad as I think USAP is, Napa much worse as their is no split. Napa takes all and tries to get by paying as low as possible to take as much as possible.

It’s hard to say who is in a worse position-probably USAP. I say that as Napa has more room to increase salaries. CRNAs and new employees demanding more money. For USAP some of that money has to come out of existing partners pay as the revenues/expenses are split. At Napa, since they take more and no split they can raise without it coming out of existing employees pockets.

Neither in a great situation, but USAP in a cycle where senior MDs either have to work more or the money to increase pay comes out of their salaries-higher dissatisfaction

 

[Dr. Rude]

You interview with GHA/Houston? I’ve been told by some folks pretty in the know it was >30%. Was told Orlando also around 30%. Austin/central 25%. Yes several at around only 20% but I’m pretty confident several at 30% or more.

Again only those in the group/part of sale know for sure but similar numbers been talked about for years.

Again though as bad as I think USAP is, Napa much worse as their is no split. Napa takes all and tries to get by paying as low as possible to take as much as possible.

It’s hard to say who is in a worse position-probably USAP. I say that as Napa has more room to increase salaries. CRNAs and new employees demanding more money. For USAP some of that money has to come out of existing partners pay as the revenues/expenses are split. At Napa, since they take more and no split they can raise without it coming out of existing employees pockets.

Neither in a great situation, but USAP in a cycle where senior MDs either have to work more or the money to increase pay comes out of their salaries-higher dissatisfaction

But, don't you weep for the decreased amount of money that NAPAs owners will be taking home?

 

[pro-propofol]

The AMC increase the overhead with administrative layers decreasing profits and then take 20 %. So the overall reduction could be 40%.

That’s why “partners” are bailing. New hires take time to work this out for themselves.

 

[Mman]

The AMC increase the overhead with administrative layers decreasing profits and then take 20 %. So the overall reduction could be 40%.

by that math the AMC may have also increased collections by 30% via higher commercial rates than the group was previously (or otherwise would have been) collecting.

 

[Status Sciaticus]

USRS number comes directly from personal experience. I was told WCAS uses a similar model across their portfolio.

Right, I was referring to USAP since we are on an anesthesia forum and discussing anesthesia AMCs. Its wild that radiologists are getting screwed that badly.

You interview with GHA/Houston? I’ve been told by some folks pretty in the know it was >30%. Was told Orlando also around 30%. Austin/central 25%. Yes several at around only 20% but I’m pretty confident several at 30% or more.

Again only those in the group/part of sale know for sure but similar numbers been talked about for years.

Again though as bad as I think USAP is, Napa much worse as their is no split. Napa takes all and tries to get by paying as low as possible to take as much as possible.

It’s hard to say who is in a worse position-probably USAP. I say that as Napa has more room to increase salaries. CRNAs and new employees demanding more money. For USAP some of that money has to come out of existing partners pay as the revenues/expenses are split. At Napa, since they take more and no split they can raise without it coming out of existing employees pockets.

Neither in a great situation, but USAP in a cycle where senior MDs either have to work more or the money to increase pay comes out of their salaries-higher dissatisfaction

Only SA and 1 Dallas group where I saw the numbers.
Initial interview with Austin which I shut down after they said salaries are "high 2s, low 3s". I'm not here to work for CRNA pay while supervising CRNAs.
Interviewed with GHA which was offering the highest pay (still is) at a little over 400k on their track, but didnt see their percentage either.

I think for this to be a credible discussion, we should actually see the numbers instead of relying on hearsay. You'd be surprised at some of the interviews I've been on at private places where you only get 70-80% of your collections until youre a partner. Thats 20-30% right there being taken off the top. Gotta look at the whole picture, not just AMC bad, PP good. I would definitely work at a few USAPs over PP, and definitely USAP over Envision/Deathstar/NAPA.

I would say NAPA is definitely in the worse position. They've lost several northwell contracts, and likely will be out of LI in the next decade. The fact that NAPA has room to increase salaries tells you how much they were underpaying their docs. For USAP, atleast the ones I interviewed at, you're making production minus your tribute to private equity which includes your billing.

I havent drank the KoolAid and will be working at a PP gig, so I dont have an incentive to lie to you, but my information is n=1.

 

[Status Sciaticus]

The AMC increase the overhead with administrative layers decreasing profits and then take 20 %. So the overall reduction could be 40%.

That’s why “partners” are bailing. New hires take time to work this out for themselves.

When I interviewed, the overhead was included in the line-item with the PP tribute, not in addition to it.

by that math the AMC may have also increased collections by 30% via higher commercial rates than the group was previously (or otherwise would have been) collecting.

which ideally should cover their 20% tribute, but this varies from group to group.

 

[Mman]

which ideally should cover their 20% tribute, but this varies from group to group.

oh I know, it's just if you want to get technical about the math on it gotta at least include everything. I have seen groups see their collections nearly double when they joined an AMC because they had crappy rates with no way to improve and AMC had jaw dropping rates.

 

[Howard888]

All fair and true..but with PP at least once you are partner you get full pay vs any money going. to private equity

Whereas USAP makes you take less than full “partners” for 2-4 years, pay six figures for a stock that is basically cryptocurrency and you always give up that percentage to private equity forever. Only PP I would turn down for USAP would be one of the old school pyramid PPs-but they don’t exist as they all sold to amcs (southeast in Charlotte the prime example).

When I say USAP has it worse I just mean for the MDs not the organization. USAP crumbling in some areas because their rates aren’t going up but they have to pay nurses and new MDs more. Because of the split, some of that money must come out of the “partners” salaries. Hence why they either have to work more, not hire partners, or decrease their salaries. Right now they are all just working more and burning out. As a typical split is 75/25-the MDs suffer much more than private equity-both from a finacial standpoint and work/life standpoint.

Napa as organization I agree in worse shape. At least there the MDs can demand no change in work/life etc and Napa had fund to raise salaries.

So MDs-I think Napa in better shape than USAP-but like all USAP depends on the group

For the organization-agree USAP in better shape than Napa

 

[Howard888]

Honestly at this point I would say an academic job with low research requirements is probably better than most USAP or Napa jobs

 

[GravelRider]

Are we sure that NAPA is in trouble as a whole? They will likely lose a bunch of contracts in NY because Northwell has been very aggressive at bringing every single specialty “in-house.” Anesthesia was frankly one of the last holdouts to not become employees of Northwell. Aside from a few noisy loss of contracts, they seem to continue to expand. Everywhere you look seems to have a NAPA practice. I’m just not convinced that NAPA is in as much trouble as we suspect (hope). Are we even sure that the Northwells and RWJs that are looking to rid themselves of NAPA are going to be successful in court?

Who is paying the $400 rates in NJ? Is that NAPA trying to cling to the contract or the hospital trying to recruit people to boot NAPA out?

 

[Mman]

Are we sure that NAPA is in trouble as a whole? They will likely lose a bunch of contracts in NY because Northwell has been very aggressive at bringing every single specialty “in-house.” Anesthesia was frankly one of the last holdouts to not become employees of Northwell. Aside from a few noisy loss of contracts, they seem to continue to expand. Everywhere you look seems to have a NAPA practice. I’m just not convinced that NAPA is in as much trouble as we suspect (hope). Are we even sure that the Northwells and RWJs that are looking to rid themselves of NAPA are going to be successful in court?

Who is paying the $400 rates in NJ? Is that NAPA trying to cling to the contract or the hospital trying to recruit people to boot NAPA out?

I just know large hospitals in multiple states that are trying to rid themselves of NAPA. They were quite happy with Mednax overall. NAPA screwing the pooch in terms of hospital relationships.

Now if or when those hospitals can cut bait and fight noncompetes is another story, but they are trying.

 

[Status Sciaticus]

All fair and true..but with PP at least once you are partner you get full pay vs any money going. to private equity

Whereas USAP makes you take less than full “partners” for 2-4 years, pay six figures for a stock that is basically cryptocurrency and you always give up that percentage to private equity forever. Only PP I would turn down for USAP would be one of the old school pyramid PPs-but they don’t exist as they all sold to amcs (southeast in Charlotte the prime example).

When I say USAP has it worse I just mean for the MDs not the organization. USAP crumbling in some areas because their rates aren’t going up but they have to pay nurses and new MDs more. Because of the split, some of that money must come out of the “partners” salaries. Hence why they either have to work more, not hire partners, or decrease their salaries. Right now they are all just working more and burning out. As a typical split is 75/25-the MDs suffer much more than private equity-both from a finacial standpoint and work/life standpoint.

Napa as organization I agree in worse shape. At least there the MDs can demand no change in work/life etc and Napa had fund to raise salaries.

So MDs-I think Napa in better shape than USAP-but like all USAP depends on the group

For the organization-agree USAP in better shape than Napa

To your first sentence, it doesnt matter if you get 100% of your pay or pay with a percentage going to private equity. Only the dollar amount matters. 100% of 350K is still less than 80% of 500k.
You are right that the stock buy in is onerous, but I imagine you can sell it outright after you buy it and arent required to hold it.

You are also mixing up a few things.
Most if not all of the USAPs pay you a salary during your 2-3 year track, not a percentage of your production. This is different than being in a production based model.
The whole "money coming out of partner pay" sounds like pure conjecture. You are omitting the fact that new hires are occurring due to expansion, new contracts, or renegotiation.

Unfortunately, true PP equitable groups are far and few nowadays.

Honestly at this point I would say an academic job with low research requirements is probably better than most USAP or Napa jobs

I thought this way as well, but if you find me a gig that pays 500k, with 8-10 weeks off in a non-HCOL place, I would sign up for that academia job. But the academic programs in texas are total crap. Houston is 315k with 4 weeks off, UTSW I heard is 350k with 2 weeks off (F that), SA is 300 with 4 weeks off. TTUL is 425-450 with 6 weeks but its in BFE.

Are we sure that NAPA is in trouble as a whole? They will likely lose a bunch of contracts in NY because Northwell has been very aggressive at bringing every single specialty “in-house.” Anesthesia was frankly one of the last holdouts to not become employees of Northwell. Aside from a few noisy loss of contracts, they seem to continue to expand. Everywhere you look seems to have a NAPA practice. I’m just not convinced that NAPA is in as much trouble as we suspect (hope). Are we even sure that the Northwells and RWJs that are looking to rid themselves of NAPA are going to be successful in court?

Who is paying the $400 rates in NJ? Is that NAPA trying to cling to the contract or the hospital trying to recruit people to boot NAPA out?

NAPA in NY/NJ probably is.
Theyre probably trying to either staff or contract in freestanding docs that they can bring under their noncompete so RWJ cant bid for them/contract them directly.

 

[GravelRider]

To your first sentence, it doesnt matter if you get 100% of your pay or pay with a percentage going to private equity. Only the dollar amount matters. 100% of 350K is still less than 80% of 500k.
You are right that the stock buy in is onerous, but I imagine you can sell it outright after you buy it and arent required to hold it.

You are also mixing up a few things.
Most if not all of the USAPs pay you a salary during your 2-3 year track, not a percentage of your production. This is different than being in a production based model.
The whole "money coming out of partner pay" sounds like pure conjecture. You are omitting the fact that new hires are occurring due to expansion, new contracts, or renegotiation.

Unfortunately, true PP equitable groups are far and few nowadays.

I thought this way as well, but if you find me a gig that pays 500k, with 8-10 weeks off in a non-HCOL place, I would sign up for that academia job. But the academic programs in texas are total crap. Houston is 315k with 4 weeks off, UTSW I heard is 350k with 2 weeks off (F that), SA is 300 with 4 weeks off. TTUL is 425-450 with 6 weeks but its in BFE.


NAPA in NY/NJ probably is.
Theyre probably trying to either staff or contract in freestanding docs that they can bring under their noncompete so RWJ cant bid for them/contract them directly.

NAPA used to have their “SWAT” program where you got a salary that was maybe $50k higher than a permanent spot and you took assignments to fill in at random hospitals that needed staffing. I guess they didn’t have enough “SWAT” team employees?

 

[Mman]

To your first sentence, it doesnt matter if you get 100% of your pay or pay with a percentage going to private equity. Only the dollar amount matters. 100% of 350K is still less than 80% of 500k.

I greatly agree with this

 

[Howard888]

I greatly agree with this

I agree with this as well-but here’s the problem-you have to look at hourly rate and not salary. That is where USAP is failing big time -because of the no surprises act.

The USAP model is buy the group in the state with the highest contract rates. Then buy up other groups in the state using those rates as a “lift”. Then once you have a large market share-negotiate higher rates.

This was all fine and good until no surprises act. Now USAP has the top rates in a state. With the no surprises act, insurance companies would rather go to arbitration than increase rates because it’s easy for them to show how much higher USAP is than average. If anything they will likely win arbitration at a lower rate than they previously contracted with USAP, but definitely not higher.

So, unless they pick up new business with a higher commercial mix than existing business or new business they can staff more efficient, USAP groups revenue is not going up.

But what is going up is USAP expenses-CRNAs, admin, RNs, MD employee tract salaries. As the deal with the revenue split is that expenses are split too…the MDs feel this increase in expenses much more than private equity.

You are faced with working more because you don’t want to pay CRNAs, employees, or new “partnership track” MDs more.

So while yearly salary may stay same or not dip much, hourly rate goes down a lot and so does satisfaction. Partners leave or retire, culture goes to crap.

That’s horrible in academic Texas. Many academic jobs in southeast or Midwest pay 400/450k with 6/8 weeks vacation and good sign on bonuses.

This is why USAP is letting go of some facilities with bad payer mixes or inefficient staffing. It’s another way to both need less employees and increase their commercial mix…but it’s just a bandaid. Inflation, crna salaries, md employee salaries aren’t going to go back down. USAP rates also aren’t going to go up and the % of money going to private equity will stay the same.

It will implode. Some USAP groups 3-5 years (Colorado groups ugly-my fist bet), Dallas groups 10-15 years.

No surprises act changed the game

 

[Mman]

I agree with this as well-but here’s the problem-you have to look at hourly rate and not salary.

while I agree, that is sort of tangential to my point. There is a not insignificant amount of push on this forum implying it would be better to be your own boss making $400K (total package) than to earn $500K total package working for the man because someone is "stealing" you money.

Obviously within any given job how much you work matters. Although if you ask me, the $/hr isn't the most important number. It's the frequency and intensity of call that matters. Working from 7A to noon is no big deal. Working Midnight to 7 AM on Saturday night is infinitely more painful. There are jobs out there where the 45 hours of work is way more inconvenient/painful than the 50-55 hours of work elsewhere.

 

[pro-propofol]

by that math the AMC may have also increased collections by 30% via higher commercial rates than the group was previously (or otherwise would have been) collecting.

The insurance companies know the playbook and collections are going down.
Hospital subsidies are not rising because they know about the buyout and are reluctant to pay private equity.
New hires now get the stock for free because it has no market value.
Partners are angling for administrative duties and jump ship and join hospital administration for the big bucks.
What’s the best deal?
It’s all a gamble.

 

[aneftp]

The insurance companies know the playbook and collections are going down.
Hospital subsidies are not rising because they know about the buyout and are reluctant to pay private equity.
New hires now get the stock for free because it has no market value.
Partners are angling for administrative duties and jump ship and join hospital administration for the big bucks.
What’s the best deal?
It’s all a gamble.

One of the major original partners in a southern facility who sold out circa 2012-2015 with huge payout and the original partners still maintain total control of the practice despite large AMC being the parent company. The original partners of the 8-15 are now down to just 4. Let’s just say the AMC has 100% turnover after 4-5 years cause the original partners have their own schedule and the newer hires

Well one of them is jumping ship to be w2 at large area new hospital opening up to head up that anesthesia dept as director. They likely had a guarantee 7-10 total control deal.

Even my buddy up north who group had a guarantee 10 year total control deal. That gig is up. And he’s jumping ship to be director for a large amc

 

[Dr. Rude]

while I agree, that is sort of tangential to my point. There is a not insignificant amount of push on this forum implying it would be better to be your own boss making $400K (total package) than to earn $500K total package working for the man because someone is "stealing" you money.

True, but it is more complicated than that. Not having to answer to someone else, the perceived security of ownership is as important as not having to send taxes to Rome. For many of us, It is better to Rule in Hell than to serve in Heaven.

 

[aneftp]

To your first sentence, it doesnt matter if you get 100% of your pay or pay with a percentage going to private equity. Only the dollar amount matters. 100% of 350K is still less than 80% of 500k.
You are right that the stock buy in is onerous, but I imagine you can sell it outright after you buy it and arent required to hold it.

You are also mixing up a few things.
Most if not all of the USAPs pay you a salary during your 2-3 year track, not a percentage of your production. This is different than being in a production based model.
The whole "money coming out of partner pay" sounds like pure conjecture. You are omitting the fact that new hires are occurring due to expansion, new contracts, or renegotiation.

Unfortunately, true PP equitable groups are far and few nowadays.

I thought this way as well, but if you find me a gig that pays 500k, with 8-10 weeks off in a non-HCOL place, I would sign up for that academia job. But the academic programs in texas are total crap. Houston is 315k with 4 weeks off, UTSW I heard is 350k with 2 weeks off (F that), SA is 300 with 4 weeks off. TTUL is 425-450 with 6 weeks but its in BFE.


NAPA in NY/NJ probably is.
Theyre probably trying to either staff or contract in freestanding docs that they can bring under their noncompete so RWJ cant bid for them/contract them directly.

True academic places have min 25 annual leave days off. That’s 5 weeks. 1-2 weeks of cme. Add another 10-13 days paid sick leave. Plus holiday pay (if state). That’s 8-9 weeks off.

 

[agammaglobulin]

The chances of an AMC paying an MD more, for the same work, than a PP is nearly zero. Maybe if you change states, supervision ratios, vacation time, etc it’s possible but, by definition, AMCs are taking money from the business that would otherwise be split amongst the MDs.

 

[sbmed100]

The chances of an AMC paying an MD more, for the same work, than a PP is nearly zero. Maybe if you change states, supervision ratios, vacation time, etc it’s possible but, by definition, AMCs are taking money from the business that would otherwise be split amongst the MDs.

Do you realize the vast majority of private practices no longer have partnership track? (almost none in the northeast that I know of) Thus there is no EQUAL split amongst the MDs...as an employed anesthesiologist of a PP group you are almost certainly making less than those who have been there since the 'old days.' So indeed, there are AMC jobs where you can make more, for the same work, than a pure PP job especially for the first 3, 5 or 7 years and because corporate rules actually exist, you are treated better.

 

[agammaglobulin]

In that scenario, you aren’t a partner in a private practice. You are an employee. I didn’t explicit say it, but my comment was directed at partners in an equitable group. I didn’t realize that was rare…

 

[Status Sciaticus]

NAPA used to have their “SWAT” program where you got a salary that was maybe $50k higher than a permanent spot and you took assignments to fill in at random hospitals that needed staffing. I guess they didn’t have enough “SWAT” team employees?

Its such a D0uchy name. SWAT... lol like chill out Rambo....

I agree with this as well-but here’s the problem-you have to look at hourly rate and not salary. That is where USAP is failing big time -because of the no surprises act.

The USAP model is buy the group in the state with the highest contract rates. Then buy up other groups in the state using those rates as a “lift”. Then once you have a large market share-negotiate higher rates.

This was all fine and good until no surprises act. Now USAP has the top rates in a state. With the no surprises act, insurance companies would rather go to arbitration than increase rates because it’s easy for them to show how much higher USAP is than average. If anything they will likely win arbitration at a lower rate than they previously contracted with USAP, but definitely not higher.

So, unless they pick up new business with a higher commercial mix than existing business or new business they can staff more efficient, USAP groups revenue is not going up.

But what is going up is USAP expenses-CRNAs, admin, RNs, MD employee tract salaries. As the deal with the revenue split is that expenses are split too…the MDs feel this increase in expenses much more than private equity.

You are faced with working more because you don’t want to pay CRNAs, employees, or new “partnership track” MDs more.

So while yearly salary may stay same or not dip much, hourly rate goes down a lot and so does satisfaction. Partners leave or retire, culture goes to crap.

That’s horrible in academic Texas. Many academic jobs in southeast or Midwest pay 400/450k with 6/8 weeks vacation and good sign on bonuses.

This is why USAP is letting go of some facilities with bad payer mixes or inefficient staffing. It’s another way to both need less employees and increase their commercial mix…but it’s just a bandaid. Inflation, crna salaries, md employee salaries aren’t going to go back down. USAP rates also aren’t going to go up and the % of money going to private equity will stay the same.

It will implode. Some USAP groups 3-5 years (Colorado groups ugly-my fist bet), Dallas groups 10-15 years.

No surprises act changed the game

So USAP is the only group that will be affected by the No Surprises Act? Other PP, AMCs, and academic programs wont be affected? The way you describe USAP is also how envision, napa, and sheridan acquire practices. I'm not saying its all sunshine and roses with USAP, but understand that this situation is not unique to one entity. Its going to affect smaller PP more because they wont be able to shoulder the burden of lawyer fees for arbitration as easily.

True academic places have min 25 annual leave days off. That’s 5 weeks. 1-2 weeks of cme. Add another 10-13 days paid sick leave. Plus holiday pay (if state). That’s 8-9 weeks off.

my program has 4+1 for CME. 5 days sick leave. Most places (academia or PP or AMC) have holidays off. So 6 weeks off.

The chances of an AMC paying an MD more, for the same work, than a PP is nearly zero. Maybe if you change states, supervision ratios, vacation time, etc it’s possible but, by definition, AMCs are taking money from the business that would otherwise be split amongst the MDs.

You assume that a local private practice as the same bargaining power as a large AMC with rate negotiation.... which is blatantly not true.

 

[nimbus]

this is close to happening at several other large NAPA locations. Hospitals hate them with a passion.

I can attest to them losing a contract in the northeast due to a huge liability issue. Long story short is they understaffed a location and an emergency went south. They had been struggling with staff since they got the contract the year before and the hospital system was fed up.

Reno

Renown provides update on moving away from North American Partners in Anesthesia

On April 1, the contract between dozens of northern Nevada anesthesiologists and NAPA expired.

www.kolotv.com