San Antonio groups

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ProwlerturnGas

ProwlerturnGas

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My wife wants to move back to Texas. Ideally SA or Dallas area. Gaswork jobs are all PE groups? Anything else? Are the bigger groups decent?
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It's mostly PE groups (or academics) at this point in all the metropolitan areas in TX, although some of the PE jobs around seem pretty decent (and some are not). I think Dallas is dominated by Metro and USAP. San Antonio used to be a last bastion of PP until 2017-2019 when both the long-standing groups sold. Star to USAP, Tejas to Envision. Houston is pretty much all USAP or academics. Austin is USAP and NAPA (?) I believe.

Some of the USAP groups are doing well and people are generally happy; some are struggling to retain talent - lots of issues but bottom line is they're squeezing out more work for less money. I heared from second-hand sources that USAP San Antonio, in particular, has turned sour and lots of people are leaving at the end of this year.

Lots of medical schools in Texas, too, which tend of offer decent lifestyle and average salary + great benefits. Not sure who is hiring right now though, many institutions had temporary COVID-related hiring freezes but I think that's mostly over now.

If you are willing to live 1-2 hours outside the big cities (still in the suburbs though) there are more options including some more traditional PP groups.
 
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Morzh said:
It's mostly PE groups (or academics) at this point in all the metropolitan areas in TX, although some of the PE jobs around seem pretty decent (and some are not). I think Dallas is dominated by Metro and USAP. San Antonio used to be a last bastion of PP until 2017-2019 when both the long-standing groups sold. Star to USAP, Tejas to Envision. Houston is pretty much all USAP or academics. Austin is USAP and NAPA (?) I believe.

Some of the USAP groups are doing well and people are generally happy; some are struggling to retain talent - lots of issues but bottom line is they're squeezing out more work for less money. I heared from second-hand sources that USAP San Antonio, in particular, has turned sour and lots of people are leaving at the end of this year.

Lots of medical schools in Texas, too, which tend of offer decent lifestyle and average salary + great benefits. Not sure who is hiring right now though, many institutions had temporary COVID-related hiring freezes but I think that's mostly over now.

If you are willing to live 1-2 hours outside the big cities (still in the suburbs though) there are more options including some more traditional PP groups.
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Can you elaborate on this? I'm looking at that SA group and dont want to walk in on a powder keg if I can help it.
 
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There is a small group of guys trying to get something going in SA right now. Physician only. They have ads on gaswork I’ve talked to them. They say they have a whole lot of surgeons that aren’t happy with the way the big groups have been run since the buyouts and plenty of work. They are trying to close on some contracts and need people. Seriously considered jumping ship. Seems like a high risk high reward deal for someone young and eager.
 
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DocMcCoy said:
There is a small group of guys trying to get something going in SA right now. Physician only. They have ads on gaswork I’ve talked to them. They say they have a whole lot of surgeons that aren’t happy with the way the big groups have been run since the buyouts and plenty of work. They are trying to close on some contracts and need people. Seriously considered jumping ship. Seems like a high risk high reward deal for someone young and eager.
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Which group is this? Might be interested. Thx
 
GandalfTheWhite said:
Can you elaborate on this? I'm looking at that SA group and dont want to walk in on a powder keg if I can help it.
Click to expand...

I'm not in the group so most of my knowledge is second-hand, but I do have a lot of contacts in both groups in the city.

My understanding is that Star and Tejas were very stable pp groups for quite a long time, and then for various reasons Star sold to USAP in 2017 or 2018. Then in 2019 Tejas sold to Envision, possibly for fear of being unable to compete against USAP. Things were mostly OK in these groups post-buyout for the first few years, but for multiple reasons the workload has just gotten really out of control, primarily at USAP. I know 2 people in the 2-year partnership track period who are easily working 65 hr weeks, often stuck working late into the evening (8-9pm) even when not on call, with no extra compensation for those late hours. They're also taking 8+ calls/month without post-call days off. The "partners" are still making really good money but they're working harder than ever as well.

Furthermore, when USAP took over they really started to interfere with the "way things were" in San Antonio. For better or worse it was a bit of an old-fashioned model where many of the long-timers had "hold" surgeons that they routinely worked with and literally followed from hospital to hospital. Not the most efficient model, for sure, but there were a lot of very stable surgeon-anesthesiologist relationships that often went back decades. USAP kind of broke a lot of that up.

Bottom line is all of the above events transpiring in a few short years have rapidly led to a profoundly different mood in this once quiet and stable market.

Apparently there is a massive exodus (dozens of anesthesiologists) presently happening at USAP, with an especially big chunk of people scheduled to leave/retire by the end of the year. This makes the overwork situation even worse for those left behind. USAP recently announced they are pulling out of many surgery centers they previously serviced, presumably so they can circle the wagons around their primary hospital system (Baptist) who pays them a healthy stipend to have an exclusive contract.

Tejas/Envision is also short-staffed (although morale and working conditions there don't sound quite as bad... yet), and do not currently have the manpower to pick up the cases left behind by USAP. So the timing is ripe for some start-up groups (as well as other out-of-town AMCs, like EmerenceHealth) to form / move in to try and get some contracts with those centers - another poster mentioned this recently. Any new group would be picking up cases primarily in these outpatient surgery centers. All the major hospitals are still pretty tightly covered by either USAP or Envision, for now.
 
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DocMcCoy said:
There is a small group of guys trying to get something going in SA right now. Physician only. They have ads on gaswork I’ve talked to them. They say they have a whole lot of surgeons that aren’t happy with the way the big groups have been run since the buyouts and plenty of work. They are trying to close on some contracts and need people. Seriously considered jumping ship. Seems like a high risk high reward deal for someone young and eager.
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Will this be vegas style with multiple groups at each hospital and surgeon request? Has San Antonio always been that way?
 
Morzh said:
I'm not in the group so most of my knowledge is second-hand, but I do have a lot of contacts in both groups in the city.

My understanding is that Star and Tejas were very stable pp groups for quite a long time, and then for various reasons Star sold to USAP in 2017 or 2018. Then in 2019 Tejas sold to Envision, possibly for fear of being unable to compete against USAP. Things were mostly OK in these groups post-buyout for the first few years, but for multiple reasons the workload has just gotten really out of control, primarily at USAP. I know 2 people in the 2-year partnership track period who are easily working 65 hr weeks, often stuck working late into the evening (8-9pm) even when not on call, with no extra compensation for those late hours. They're also taking 8+ calls/month without post-call days off. The "partners" are still making really good money but they're working harder than ever as well.

Furthermore, when USAP took over they really started to interfere with the "way things were" in San Antonio. For better or worse it was a bit of an old-fashioned model where many of the long-timers had "hold" surgeons that they routinely worked with and literally followed from hospital to hospital. Not the most efficient model, for sure, but there were a lot of very stable surgeon-anesthesiologist relationships that often went back decades. USAP kind of broke a lot of that up.

Bottom line is all of the above events transpiring in a few short years have rapidly led to a profoundly different mood in this once quiet and stable market.

Apparently there is a massive exodus (dozens of anesthesiologists) presently happening at USAP, with an especially big chunk of people scheduled to leave/retire by the end of the year. This makes the overwork situation even worse for those left behind. USAP recently announced they are pulling out of many surgery centers they previously serviced, presumably so they can circle the wagons around their primary hospital system (Baptist) who pays them a healthy stipend to have an exclusive contract.

Tejas/Envision is also short-staffed (although morale and working conditions there don't sound quite as bad... yet), and do not currently have the manpower to pick up the cases left behind by USAP. So the timing is ripe for some start-up groups (as well as other out-of-town AMCs, like EmerenceHealth) to form / move in to try and get some contracts with those centers - another poster mentioned this recently. Any new group would be picking up cases primarily in these outpatient surgery centers. All the major hospitals are still pretty tightly covered by either USAP or Envision, for now.
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Yikes.
I was told that they get OT (150-175/hr after 5PM) but if that seems to be untrue, and no post call day after call days, that sounds ridiculous. Probably better to let this situation implode/work itself out rather than shoot myself in the foot by signing and getting screwed by their noncompete.

Any idea where these dozens of anesthesiologists are going? What an unfortunate outcome for the two once-private groups.
 
GandalfTheWhite said:
Yikes.
I was told that they get OT (150-175/hr after 5PM) but if that seems to be untrue, and no post call day after call days, that sounds ridiculous. Probably better to let this situation implode/work itself out rather than shoot myself in the foot by signing and getting screwed by their noncompete.

Any idea where these dozens of anesthesiologists are going? What an unfortunate outcome for the two once-private groups.
Click to expand...

Again, I may be mistaken on some of the details. Maybe there is some premium pay for after-hours work... but from the couple of disgruntled people I've spoken with it clearly isn't (A) enough to make it worth it or (B) optional extra work. Also, take my heresay with a grain a salt because maybe there are others in the group who are indeed happy but I'm not connected with them. It is possible that if you are willing to put up with the miserable hours there may be some very nice money after the 2-year partnership track. All I know for sure is that not a single graduating resident from the University program is joining USAP (usually at least 2-4 join them each year), and I know of at least one recent grad who did join but is looking to leave ASAP. Everyone who wants to stay in San Antonio is either joining Tejas or staying at the university.

As to where people are going... I don't know. I think many are older and ready to retire. Others are leaving the city. Unfortunately I think they all have non-competes that preclude them from joining Tejas or signing on with any new start-ups in the city.

It is sad to witness, although thankfully for me I'm doing so as a nearby interested observer and not a direct player. I think it's a similar story to one that's played out many times before across the country with these private equity backed management companies. Unfortunately the payor mix in San Antonio is worse than Houston or Dallas, and so I suspect the business model USAP/Envision uses elsewhere will net them much thinner margins in San Antonio... which means the "lean squeeze" they eventually put on the groups to turn their profit may be more painful than usual.

Who knows what will happen. Maybe USAP will weather the storm and wind up dominating the city after all. Maybe Envision can capitalize on the situation and successfully expand their footprint if they can keep their doctors happy. Maybe everything will just implode and the big AMC's will leave town, leaving the door wide open for someone new. Throw in the unpredictability of United Healthcare contracts, surprise billing legislation and its impacts, and other general economic factors... the ground feels very shaky there right now.
 
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Morzh said:
Again, I may be mistaken on some of the details. Maybe there is some premium pay for after-hours work... but from the couple of disgruntled people I've spoken with it clearly isn't (A) enough to make it worth it or (B) optional extra work. Also, take my heresay with a grain a salt because maybe there are others in the group who are indeed happy but I'm not connected with them. It is possible that if you are willing to put up with the miserable hours there may be some very nice money after the 2-year partnership track. All I know for sure is that not a single graduating resident from the University program is joining USAP (usually at least 2-4 join them each year), and I know of at least one recent grad who did join but is looking to leave ASAP. Everyone who wants to stay in San Antonio is either joining Tejas or staying at the university.

As to where people are going... I don't know. I think many are older and ready to retire. Others are leaving the city. Unfortunately I think they all have non-competes that preclude them from joining Tejas or signing on with any new start-ups in the city.

It is sad to witness, although thankfully for me I'm doing so as a nearby interested observer and not a direct player. I think it's a similar story to one that's played out many times before across the country with these private equity backed management companies. Unfortunately the payor mix in San Antonio is worse than Houston or Dallas, and so I suspect the business model USAP/Envision uses elsewhere will net them much thinner margins in San Antonio... which means the "lean squeeze" they eventually put on the groups to turn their profit may be more painful than usual.

Who knows what will happen. Maybe USAP will weather the storm and wind up dominating the city after all. Maybe Envision can capitalize on the situation and successfully expand their footprint if they can keep their doctors happy. Maybe everything will just implode and the big AMC's will leave town, leaving the door wide open for someone new. Throw in the unpredictability of United Healthcare contracts, surprise billing legislation and its impacts, and other general economic factors... the ground feels very shaky there right now.
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Thanks again for your insight. It definitely has ruled out the city for the time being. I much preferred Dallas anyways.
 
What’s going on I’m San Antonio now? How’s USAP doing? Is envision/tejas hanging on? Anyone know what the SA market is doing? What’s going on w USAP there?
 
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amyl said:
What’s going on I’m San Antonio now? How’s USAP doing? Is envision/tejas hanging on? Anyone know what the SA market is doing? What’s going on w USAP there?
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I was supposed to do locums with a company contracted with USAP, but I canceled the contract a couple months in advance. A day or 2 after I canceled my contract, I heard from another company that USAP pulled out of at least 1 hospital in San Antonio, and Emergenc (I don't think there's an "e" on the end) took over the contract where USAP was. There are now a ton more locums jobs posted in San Antonio than there were earlier this year.
 
Ashers said:
I was supposed to do locums with a company contracted with USAP, but I canceled the contract a couple months in advance. A day or 2 after I canceled my contract, I heard from another company that USAP pulled out of at least 1 hospital in San Antonio, and Emergenc (I don't think there's an "e" on the end) took over the contract where USAP was. There are now a ton more locums jobs posted in San Antonio than there were earlier this year.
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I believe Envision is its subsidiary.
Some trauma 1s are going on divert because they cant get trauma coverage in house due to anesthesia shortages, which seems insane.
I offered to do locums through an agency, but the offers havent really hit levels that would be worth my while.... yet
 
A pedi friend of mine allegedly just got an awesome offer to do a week there. Crazy #s but probably lots of call and pedi specific
 
GandalfTheWhite said:
I believe Envision is its subsidiary.
Some trauma 1s are going on divert because they cant get trauma coverage in house due to anesthesia shortages, which seems insane.
I offered to do locums through an agency, but the offers havent really hit levels that would be worth my while.... yet
Click to expand...
Are you saying that envision owns emergenc health?
 
I am in San Antonio and am trying to set up some off duty employment locally. Feel free to pm me and I will let you know how things go.
 
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amyl said:
Are you saying that envision owns emergenc health?
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Im not 100% sure but I think theyre both owned by the same PE group.
MirrorTodd said:
I am in San Antonio and am trying to set up some off duty employment locally. Feel free to pm me and I will let you know how things go.
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Yeah LMK. I like San Antonio so I wouldnt mind vacationing there and doing some locums in the meantime. Major downside is all the papercharting.
 
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GandalfTheWhite said:
I believe Envision is its subsidiary.
Some trauma 1s are going on divert because they cant get trauma coverage in house due to anesthesia shortages, which seems insane.
I offered to do locums through an agency, but the offers havent really hit levels that would be worth my while.... yet
Click to expand...
This is completely incorrect, Envision and USAP are two separate companies.
 
Morzh said:
Again, I may be mistaken on some of the details. Maybe there is some premium pay for after-hours work... but from the couple of disgruntled people I've spoken with it clearly isn't (A) enough to make it worth it or (B) optional extra work. Also, take my heresay with a grain a salt because maybe there are others in the group who are indeed happy but I'm not connected with them. It is possible that if you are willing to put up with the miserable hours there may be some very nice money after the 2-year partnership track. All I know for sure is that not a single graduating resident from the University program is joining USAP (usually at least 2-4 join them each year), and I know of at least one recent grad who did join but is looking to leave ASAP. Everyone who wants to stay in San Antonio is either joining Tejas or staying at the university.

As to where people are going... I don't know. I think many are older and ready to retire. Others are leaving the city. Unfortunately I think they all have non-competes that preclude them from joining Tejas or signing on with any new start-ups in the city.

It is sad to witness, although thankfully for me I'm doing so as a nearby interested observer and not a direct player. I think it's a similar story to one that's played out many times before across the country with these private equity backed management companies. Unfortunately the payor mix in San Antonio is worse than Houston or Dallas, and so I suspect the business model USAP/Envision uses elsewhere will net them much thinner margins in San Antonio... which means the "lean squeeze" they eventually put on the groups to turn their profit may be more painful than usual.

Who knows what will happen. Maybe USAP will weather the storm and wind up dominating the city after all. Maybe Envision can capitalize on the situation and successfully expand their footprint if they can keep their doctors happy. Maybe everything will just implode and the big AMC's will leave town, leaving the door wide open for someone new. Throw in the unpredictability of United Healthcare contracts, surprise billing legislation and its impacts, and other general economic factors... the ground feels very shaky there right now.
Click to expand...
So much speculation in this thread but the models actually take payor mix into consideration. Stipends can vary vastly depending on whether you have a good payor mix or not. Most companies, PE or not are currently having enormous trouble with staffing and the no surprises act is causing severe problems with reimbursements. Add this to reimbursements generall going down, medicaid and medicare not paying enough , and increase demand for anesthesia outside the OR and lack of supply and you get a recipe for many undermanned groups.
 
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Looks like sound is advertising jobs in San Antonio now too, at Texas Vista Medical center (formerly southwest general)….looks like it used to be staffed by tejas/envision but not sure how long ago.
 
Doing locums in SA currently with aforementioned new group, everyone is locums. They have one permanent hire that I’ve seen at this hospital. I was told they plan to have all permanent positions filled by Jan but I dont see that happening….It’s pretty crazy.

Everyone who was USAP here quit at once I was told, and because of non competes im guessing they’re just doing locums in other cities.
 
Oh and the paper charting blows. It’s like back to dark ages.
 
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Ezrunner said:
Doing locums in SA currently with aforementioned new group, everyone is locums. They have one permanent hire that I’ve seen at this hospital. I was told they plan to have all permanent positions filled by Jan but I dont see that happening….It’s pretty crazy.

Everyone who was USAP here quit at once I was told, and because of non competes im guessing they’re just doing locums in other cities.
Click to expand...
How is it working there? What were you able to negotiate the rate to?
 
The position at Texas Vista advertises 17 weeks off... at an insane pay 500k plus. I may consider it. Looking around San Antonio. Also, WHAT IS WITH UH? Why is pay so low 300k?!? Is there some magical bonus that makes University Hospital worth it!?
 
Arantius said:
The position at Texas Vista advertises 17 weeks off... at an insane pay 500k plus. I may consider it. Looking around San Antonio. Also, WHAT IS WITH UH? Why is pay so low 300k?!? Is there some magical bonus that makes University Hospital worth it!?
Click to expand...
no. most academic places are behind the ball on salaries.
 
Arantius said:
The position at Texas Vista advertises 17 weeks off... at an insane pay 500k plus. I may consider it. Looking around San Antonio. Also, WHAT IS WITH UH? Why is pay so low 300k?!? Is there some magical bonus that makes University Hospital worth it!?
Click to expand...
UH spent all their money giving CRNA raises. So the physicians get nothing.

Chair recently resigned so may be things might change.
 
GandalfTheWhite said:
Im not 100% sure but I think theyre both owned by the same PE group.

Yeah LMK. I like San Antonio so I wouldnt mind vacationing there and doing some locums in the meantime. Major downside is all the papercharting.
Click to expand...
Think I forgot to reply to this thread. Been working with emergenc for about 4 months now. They just upgraded the Christus hospitals to Medaxion. Paper post op orders remain. PM me if you have any questions.
 
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