Whose Who list of AMC (Anesthesia Management Companies).

[ketamine]

We need a Whose Who list of the AMC (Anesthesia Management Companies). Some thing like Scutworks for the AMC.

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[militarymd]

amsol

sheridan

parrish

 

[VolatileAgent]

this is the group you need to keep your eye on... this is the model of the future...

http://www.napaanesthesia.org/

 

[pmichaelmd]

I had extensive contact with NAPA and had a contract offer for a position with them. Even though I elected to take a different position, I have to say that NAPA seemed to have their act together and the offer seemed generous, especially to a newbie. Keep in mind, of course, that I'm using the word seemed as I don't have the extensive experience of others on this board. The only practice models I've known outside of anesthesia are those of the military and general practice.

I suppose taking a position with an AMC like NAPA would mean giving up some sort of control and ownership, but it seems to supply a steady, employed position. It would appear that a majority of the experienced people on this board feel that the only way to do it is to be self-employed and to thus retain control. It seems that AMCs are taking over somewhat and that that might be difficult in the years to come.

Interesting.

Regards,

PMMD

this is the group you need to keep your eye on... this is the model of the future...

http://www.napaanesthesia.org/

 

[VolatileAgent]

Interesting.

it is interesting.

counter to the op's post, i'm not ascribing any good/bad to this group. i'm merely pointing out that this type of practice will be the model of the future. they have a "collective bargaining" power that the vast majority of small, independent practices do not.

i am also personally familiar with their paradigm as, years ago (before even med school), i heard one of their senior managers (forget exactly who it was) speak at a conference. i, too, was impressed with their long vision and - most importantly - their adaptability.

i see this as the "wal-marting" of our business model, though. you can individually decide whether or not this is a good or bad thing. but, the fact is, we are for the most part a back-end service provider. (if you'd like me to explain what i mean by that, i will... and it doesn't have to do with proctology.) under that paradigm, napa is doing everything right... and they are growing.

anesthesia training programs are trying to address this "back-end" phenomenon, and all the challenges that go with that as they launch grads into practice, by renaming the specialty as "peri-operative medicine" and trying to foster the belief that we are "consultants". but, this to me is nothing more than cosmetic window-dressing and doesn't really change anything if grads enter the field under the "good ole boy" system.

i'll continue to argue that you're going to see an insurgence of these types of practice models, good or bad, and that the napa's of the world will gain dominance. they have a centralized management structure, they have capital, and their model is flexible and able to adapt.

my prediction (as i've stated before) is that by 2015 this type of practice model will likely have captured 20-25% of the anesthesia-provider market. effectively, you will not be able to work in a large "desirable" metropolitan-type practice without working for such a group.

again, this may not be a bad thing... provided they treat their employees equitably. they will have the power to collectively bargain with insurance companies, and will have the huge advantage of flexibility and manpower that, quite frankly, small groups will just not be able to compete with.

this type of practice is not a pure "practice management" company, in that they actually do have "partners" running the practice at the high end. what this model is akin to is a large law firm that has a few huge "partners" at the top who's job has become essentially to generate new business for the practice, and a boatload of "associates" who actually do the work.

again, there will always be room for the "small fry" practice in the rural area. and, there will always be room for the "hired gun" who wants to work independently. but, the small fry better watch out for the napas of the world who may be able to better negotiate services in your hospital. and, the hired gun will likely be working predominately for the napa-type group, even under locums.

this will happen. it has to. we lack a national cohesiveness in our practice management model(s) now. this leaves individual practices with the problem of trying to figure it out on their own. result? we are bossed around by policy wonks in washington. our pathetic involvement (most of us) in actually contributing to the ASAPAC and other more local action groups also hurts. but, the worst is the attitude that we can just "keeping doing what we always do" and succeed.

the face of healthcare is continually changing. he who does not have the power of collective bargaining is like a mom & pop hardware store trying to compete against home depot. sure, you may be able to stay in business, but you won't thrive.

napa has already figured this out... and they are WAY ahead of the curve.

 

[chesterfield]

i am also personally familiar with their paradigm as, years ago (before even med school), i heard one of their senior managers (forget exactly who it was) speak at a conference. i, too, was impressed with their long vision and - most importantly - their adaptability.

i see this as the "wal-marting" of our business model, though. you can individually decide whether or not this is a good or bad thing. but, the fact is, we are for the most part a back-end service provider. (if you'd like me to explain what i mean by that, i will... and it doesn't have to do with proctology.) under that paradigm, napa is doing everything right... and they are growing.

i'll continue to argue that you're going to see an insurgence of these types of practice models, good or bad, and that the napa's of the world will gain dominance. they have a centralized management structure, they have capital, and their model is flexible and able to adapt.

again, this may not be a bad thing... provided they treat their employees equitably. they will have the power to collectively bargain with insurance companies, and will have the huge advantage of flexibility and manpower that, quite frankly, small groups will just not be able to compete with.

this type of practice is not a pure "practice management" company, in that they actually do have "partners" running the practice at the high end. what this model is akin to is a large law firm that has a few huge "partners" at the top who's job has become essentially to generate new business for the practice, and a boatload of "associates" who actually do the work.

again, there will always be room for the "small fry" practice in the rural area. and, there will always be room for the "hired gun" who wants to work independently. but, the small fry better watch out for the napas of the world who may be able to better negotiate services in your hospital. and, the hired gun will likely be working predominately for the napa-type group, even under locums.

napa has already figured this out... and they are WAY ahead of the curve.

I do not doubt that the head bean counter at an AMC can give a great speech using all of the hot management words of the month. This is how they are so successful they don't practice medicine but work 24/7 trying to find ways to fool you into working harder, more hours for less money. They also need to give a good presentation to fool the hospital administration into picking them over the anesthesiologists who are currently providing services, they promises better services and most importantly regular payments to the key hospital administrators.

What is so dangerous with the AMC is that they redefine most of the things you have been told to look for and expect in an employment situation. We all want to be partner, but the model of the AMC is we are always only the employees of the owners, and a non owner has no right to expect any participation in the profits of the AMC and no expectation to be rewarded for increased productivity. The AMC owners deliberately con you with lies like with the "partnership from day one" and claim they make you a "partner" immediately. New graduates don't know any better and fall for this lie. Consequently, they make a bad choice by thinking they will work for the AMC instead of a real group that plays the partnership game, but don't give real ownership partnership until after one to three years. This title inflation cost the AMC nothing since partnership at a AMC means nothing.

I have seen a week of vacation redefined in a similar manner, to you, me and just about every other anesthesiologist vacation starts at 3pm on Friday and extends to 7am Monday ten days after that Friday. The AMC redefine it to mean mid morning on Monday till noon on the Friday 4 days latter.

Paying for malpractice insurance and tail coverage the AMC claim that they pay for malpractice insurance including the tail but this is redefined by AMC by forming off shore insurance companies.

I have talked to a number of hospital administrators and most frown on off offshore Cayman Islands insurance products, so you are essentially practicing uninsured. The reason people use off shore locations like the Cayman Islands to hide their money is that it is next to impossible sue there and if you win it is next to impossible to collect. Those are qualities that you would not want in an insurance company. If you get sued they could decide not to cover you and you would be left with no legal recourse. When you quit the AMC your next employer is likely to require you to buy a tail since they will most likely interpret this arrangement a tantamount to not being insured.

You many get a promise of a bonus for the AMC after working a set periods of time but the idea of a guaranteed bonus is redefined to an outright lie of working for something you never will get. Any promises of future compensation such at the "nebulous bonus compensation" that "pmichaelmd" mentioned in his AMC contract is a dead give away, if they intended to give you a bonus it would be clearly defined in the contract. However whenever money is offered as part of a bonus plan by an Anesthesia Management company that money is compensation that you are highly unlikely ever to receive. That nebulous language is there for one reason, to deny you of that bonus after you sign on and do the work.

I could go on with other games the AMC play. Redefining call, Redefining 401k plans, Redefining acces to the key financial records, Redefining the right to patient records, Redefining giving notice, and Redefining non compete clauses to name a few.

 

[VolatileAgent]

I could go on with other games the AMC play. Redefining call, Redefining 401k plans, Redefining acces to the key financial records, Redefining the right to patient records, Redefining giving notice, and Redefining non compete clauses to name a few.

but, by your post are you suggesting that every PM company and none of the private practices do these things? come on, dude.

there's one simple answer to your quandry: whatever you negotiate, get it in writing. then, they break the contract, just don't show up to work... and you be sure to let the hospital administrator know what they did to you. that goes for whomever your employer is.

 

[chesterfield]

but, by your post are you suggesting that every PM company and none of the private practices do these things? come on, dude.

I never mentioned the private practices places and the wording of the post makes it clear than not every AMC uses all of these practices.

However it is clear that NxPx from your post and the previous discussion of “pmichaelmd’s” contract engages in at least three of the practices mentioned above. The redefinition of the word partner, the redefinition of malpractice insurance and the redefinition of the bonus plan.

You posted their web site but did you take the time to look at the web site and read about their offshore self insurance plan;

“NxPx Partnership Physicians founded and capitalized Practice Security Insurance Company SPC, Ltd. (PRASEC), a Cayman Islands licensed segregated portfolio insurance company.”

Practicing bare realy worries me with the new bankruptcy laws


PA is experiencing an insurance crisis. This is part of the reason why PA has so many anesthesia positions on gaswork. Many physicians are electing to leave the state to find a better Medical Malpractice environment.

The Medical Malpractice ‘Crisis’:
Recent Trends And The Impact
Of State Tort Reforms

“Rate increases in other states, such as Pennsylvania, ranged from 26 to 73 percent in 2003”
“Reduced capacity. The structure of the insurance market has changed dramatically in some of the states facing the sharpest rise in premiums (such as Nevada, West Virginia, Pennsylvania, and Ohio).”

AMA Declares War on Malpractice Crisis

Corlin says the situation is so bad that it has reached the critical stage in a dozen states -- Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington, and West Virginia -- and 30 other states are reaching the breaking point.

The only reason one would use an offshore insurance company is so that they can claim to have the required capitalization but keep there money where they have total control over the money with little chance of it being taken away. You the physician being sued and the plaintiff have no guarantee of any coverage since you will have little or no legal recourse.

Heres how it could hurt you. You sign up for the Anesthesia Management company , then no thru no fault of your own you have a bad outcome. The Anesthesia Management Company fires you for cause citing “negligence”. Therefore you are liable to pay for the tail, which the contract most likely obligates you to purchase. They apply your last month’s salary any other money they owe you as a partial payment for the tail, and send you a bill for the rest of the cost of the tail.

The Anesthesia Management Company has the choice of the cost of the tail coverage it could be 40,000 or a year’s salary. You dip into your saving to pay the balance on the AMC Tail, since now you probably can not get a tail from any other carrier due to your bad outcome.

You bite the bullet and get the tail, then get sued. The offshore insurance company doesn’t respond they refuse to represent you. Now you have to pay for you own lawyer to defend yourself. You sue the Anesthesia Management company pay a fortune but when you win you get nothing since you were employed by the local, LLC which the Parent Anesthesia Management Company closed and declared bankrupt as soon as you filed your lawsuit They still operate at that hospital just with a different LLC.

You are unable to find a lawyer willing to sue the offshore insurance company since you have no chance of collecting. You loose the malpractice lawsuit but have no assets left since you have spent everything on lawyers. You can’t declare bankruptcy, due to the new bankruptcy laws so you are required to pay 75% of your after tax salary for the next 5 to 7 years to the Plaintiff and their lawyers.

there's one simple answer to your quandry: whatever you negotiate, get it in writing. then, they break the contract, just don't show up to work... and you be sure to let the hospital administrator know what they did to you. that goes for whomever your employer is.

I wish things were that simple. As most AMC own the administration talking to the administration is like talking to a wall. If you “just don't show up to work” you will be “abandoning” the call schedule which is an offence that is reportable to the National physician database along with the fact that administration will suck up the AMC and let them get even with you by reporting that you abandoned the call schedule ever time you have to verify you privileges when you apply for hospital credentials elsewhere.


With an entry in the physician database and the hospital giving you bad references you may have a tough time getting a good job elsewhere.

 

[VolatileAgent]

With an entry in the physician database and the hospital giving you bad references you may have a tough time getting a good job elsewhere.

good points indeed. but, the fact is that they have to work to the letter of the contract, if you are smart enough to get a contract. sure, they can say "just this one time" time and time again. but, i'd argue that you're more likely to get screwed by a private practice group that has no intention of offering you a spot when your two-year contract is up. the difference is, they bait you with the "you'll be a partner if you hang in there" attitude that makes you take it. whereas, there are no such false pretenses in a PM group.

or, you can just call in sick. again and again and again. what are they going to do? nothing. and, during those "sick" days look for another job.

i'm not necessarily saying one is better or worse than the other. different jobs offer different tracks, and different compensation packages to reflect that. some people just want to work their hours for a salary. you can get such a job in a PM group. much harder in a private practice where you are a "partner" (or on that track). PM groups also have a larger pool to cover you if/when you don't show up.

bottom line: get it in writing... and have a good lawyer (which every physician should). likewise, have a good accountant too.

 

[VolatileAgent]

here's more info on the model of the future... (aka., a business alliance called "anesthesia business group")

http://www.biospace.com/news_story.aspx?StoryID=21049920&full=1

remember what i said about collective bargaining...

 

[VolatileAgent]

an interesting read from the asa on the subject:

http://www.asahq.org/Newsletters/2006/02-06/pracMgmt02_06.html

 

[VolatileAgent]

Practicing bare realy worries me with the new bankruptcy laws


PA is experiencing an insurance crisis. This is part of the reason why PA has so many anesthesia positions on gaswork. Many physicians are electing to leave the state to find a better Medical Malpractice environment.

The Medical Malpractice ‘Crisis':
Recent Trends And The Impact
Of State Tort Reforms

"Rate increases in other states, such as Pennsylvania, ranged from 26 to 73 percent in 2003"
"Reduced capacity. The structure of the insurance market has changed dramatically in some of the states facing the sharpest rise in premiums (such as Nevada, West Virginia, Pennsylvania, and Ohio)."

AMA Declares War on Malpractice Crisis

Corlin says the situation is so bad that it has reached the critical stage in a dozen states -- Florida, Georgia, Mississippi, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas, Washington, and West Virginia -- and 30 other states are reaching the breaking point.

The only reason one would use an offshore insurance company is so that they can claim to have the required capitalization but keep there money where they have total control over the money with little chance of it being taken away. You the physician being sued and the plaintiff have no guarantee of any coverage since you will have little or no legal recourse.

Heres how it could hurt you. You sign up for the Anesthesia Management company , then no thru no fault of your own you have a bad outcome. The Anesthesia Management Company fires you for cause citing "negligence". Therefore you are liable to pay for the tail, which the contract most likely obligates you to purchase. They apply your last month's salary any other money they owe you as a partial payment for the tail, and send you a bill for the rest of the cost of the tail.

The Anesthesia Management Company has the choice of the cost of the tail coverage it could be 40,000 or a year's salary. You dip into your saving to pay the balance on the AMC Tail, since now you probably can not get a tail from any other carrier due to your bad outcome.

You bite the bullet and get the tail, then get sued. The offshore insurance company doesn't respond they refuse to represent you. Now you have to pay for you own lawyer to defend yourself. You sue the Anesthesia Management company pay a fortune but when you win you get nothing since you were employed by the local, LLC which the Parent Anesthesia Management Company closed and declared bankrupt as soon as you filed your lawsuit They still operate at that hospital just with a different LLC.

You are unable to find a lawyer willing to sue the offshore insurance company since you have no chance of collecting. You loose the malpractice lawsuit but have no assets left since you have spent everything on lawyers. You can't declare bankruptcy, due to the new bankruptcy laws so you are required to pay 75% of your after tax salary for the next 5 to 7 years to the Plaintiff and their lawyers.

i don't think you answered pmichael's question on the other thread, so i'll pose it again.

do you know of anyone that this has happened to? or, are we still talking theory here?

 

[chesterfield]

good points indeed. but, the fact is that they have to work to the letter of the contract, if you are smart enough to get a contract. sure, they can say "just this one time" time and time again. but, i'd argue that you're more likely to get screwed by a private practice group that has no intention of offering you a spot when your two-year contract is up. the difference is, they bait you with the "you'll be a partner if you hang in there" attitude that makes you take it. whereas, there are no such false pretenses in a PM group.

or, you can just call in sick. again and again and again. what are they going to do? nothing. and, during those "sick" days look for another job.

i'm not necessarily saying one is better or worse than the other. different jobs offer different tracks, and different compensation packages to reflect that. some people just want to work their hours for a salary. you can get such a job in a PM group. much harder in a private practice where you are a "partner" (or on that track). PM groups also have a larger pool to cover you if/when you don't show up.

bottom line: get it in writing... and have a good lawyer (which every physician should). likewise, have a good accountant too.

Having stuff in a contract is great, but AMC knows it cost 50K to 100K to sue them so they see complying with the letter of the contract as optional. I had a contract with an AMC which I had the right to see all financial records as we were paid on the imaginary bonus system. Despite repeated requests when I was an employee and after I left the group through my attorney they have refused to released the records which I have the contractual right to see. I did receive a few pages of heavily edited worthless garbage to pretend that the AMC sent me something but it was nowhere near what I was legally entitled to see.

This is the difference between an AMC and a private group. Most private groups would quickly see the costs and the benefits and show you the records or comply with the letter of the contract because 100k is something to them. The AMC that runs a continuous scam ripping off dozens to hundreds of doctors has the resources to fight longer than you can afford to fight any contract issues. Plus they have the motivation since if you prevail they will have to pay the rest of the dozens of people they have screwed.

The AMC contract you get will be so one sided that your great attorney will only be able to do so much before they see you as a problem and refuse to hire you. Now when I see 20+ page contacts of crap I don't even bother wasting money on an attorney to try to fix the problems. I toss the contract in the trash where they belong and look for another position, but unfortnatly most new graduates and many attorney do not know the difference between a good contract and a piece of garbage.

 

[Pilot Doc]

Re Chesterfield's comments:

Sounds like a situation ripe for unionization.

 

[militarymd]

This is the difference between an AMC and a private group. Most private groups would quickly see the costs and the benefits and show you the records or comply with the letter of the contract because 100k is something to them. The AMC that runs a continuous scam ripping off dozens to hundreds of doctors has the resources to fight longer than you can afford to fight any contract issues. Plus they have the motivation since if you prevail they will have to pay the rest of the dozens of people they have screwed.

.

private groups can and will do the same thing.

 

[amyl]

can you explain why anes. are "back door providers?" i confess i don't understand exactly what you mean by that.

 

[Pilot Doc]

can you explain why anes. are "back door providers?" i confess i don't understand exactly what you mean by that.

Anesthesia is a commodity. A hospital can replace every MD/CRNA it has and patients won't know or care. Much like the physical therapists ... or the brand of beds the hospital uses. Most other docs, in contrast, have their own practice and bring revenue (i.e. patients) to the hospital. A hospital would not want to replace all their OB's, for instance, because a large portion of the OB business would follow the expelled physicians.

 

[VolatileAgent]

Anesthesia is a commodity. A hospital can replace every MD/CRNA it has and patients won't know or care. Much like the physical therapists ... or the brand of beds the hospital uses. Most other docs, in contrast, have their own practice and bring revenue (i.e. patients) to the hospital. A hospital would not want to replace all their OB's, for instance, because a large portion of the OB business would follow the expelled physicians.

yes, exactly. as back-end providers, we simply provide a service to a customer that's been brought to us. we do not generate new customers. (interesting when you use the word "customer" instead of "patient", isn't it?)

chesterfield:

i think you are a bit alarmist. the fact is, the management company has a fiduciary responsibility to the hospital. as such, it behooves them to provide the best service in order that their contracts are renewed. word of mouth is probably more potent in our business than anywhere else, and trust that these administrators do their homework. likewise, in order to provide that service, they need to have happy employees. do they have not-so-happy ones? sure. but, the fact that they can stay in business (at least with napa since 1986) tells me that they aren't exactly doing what you purport they are doing, which would represent a "worst case" scenario.

now, do a few junior associate-level attendings buy the pig in the poke and expect that they are going to have a cush job if they go there? maybe. but, they are also gaining valuable experience. many of them may work their asses off for two years and feel that they've accomplished little and gotten screwed. but, the reality is that they've gotten two years of solid practice experience that makes them more marketable to a future employer. this phenomenon happens so much in the "regular" day-to-day business world that companies have a hard time figuring out how to keep and retain quality employees - and i imagine napa is no different. if one is among the complainers that offers no value to the organization, i'm sure that will be the same employee looking for a job when the contract is up.

point is, we provide a service. the concept of a "practice" in anesthesia seems a little archaic and silly to me, because we don't actively go out and generate a patient population to bring in business. the business is handed to us.

this is why i believe that the predominate model of the future will be the napa-type practice, especially with the lack of effecient, collective, and cohesive practice models that are able to effectively lobby washington and, perhaps more importantly, managed healtcare systems to maximize their profits. right now, we are essentially taking what we're given. these large management-type practices are going to be what small practices are competing against in the future. again, it's the home depot vs. the mom&pop hardware store.

so, while i think you raise some interesting discussion points, that's all i think they are. the reality is not how you describe it. sure, people will occassionally feel they got screwed. but, the point is that if you are a valuable, hard-working employee (a concept that is hard for most doctors to accept, i'll admit) you will be rewarded accordingly.

it doesn't matter whether you like this or not. this is the direction in which we are moving.

 

[Broken Ankles]

yes, exactly. as back-end providers, we simply provide a service to a customer that's been brought to us. we do not generate new customers. (interesting when you use the word "customer" instead of "patient", isn't it?)

...
this is why i believe that the predominate model of the future will be the napa-type practice, especially with the lack of effecient, collective, and cohesive practice models that are able to effectively lobby washington and, perhaps more importantly, managed healtcare systems to maximize their profits. right now, we are essentially taking what we're given. these large management-type practices are going to be what small practices are competing against in the future. again, it's the home depot vs. the mom&pop hardware store.
...
it doesn't matter whether you like this or not. this is the direction in which we are moving.

is this the direction that other "back-end providers," (radiologists, pathologists, hospitalists, em) are taking as well, or is it mainly anesthesiology?

 

[dhb]

is this the direction that other "back-end providers," (radiologists, pathologists, hospitalists, em) are taking as well, or is it mainly anesthesiology?

imaging can be sent over the net and read in India the next minute for far less $ (will the patient know who red his rx, ct?
same goes for path... at least in gas you need some kind of physical presence

 

[amyl]

Anesthesia is a commodity. A hospital can replace every MD/CRNA it has and patients won't know or care. Much like the physical therapists ... or the brand of beds the hospital uses. Most other docs, in contrast, have their own practice and bring revenue (i.e. patients) to the hospital. A hospital would not want to replace all their OB's, for instance, because a large portion of the OB business would follow the expelled physicians.

is this the way it has to be? maybe we should be in partnership with the surgeons? has anyone ever tried that and had it work? rather than work for the hospital, the surgeon and anes bring the patient to the hospital. probably would work if there weren't crna's as many surgeons would just hire them instead...you think?

 

[militarymd]

is this the way it has to be? maybe we should be in partnership with the surgeons? has anyone ever tried that and had it work? rather than work for the hospital, the surgeon and anes bring the patient to the hospital. probably would work if there weren't crna's as many surgeons would just hire them instead...you think?

The model you are describing exists in many parts of the country. The doom and gloom which you see here (and which I partially subscribe to) exists also in certain parts of the country.

What you describe is exactly how it works in Dallas where UT is...in Las Vegas where I have former partners working....in AZ where there is a group that I considered working....and in various other parts of the US.

There are multiple models of delivering anesthesia care.

The AMC model is only one of them....whether the AMC will become dominant or not is dependent ONLY on economics....

As I have said before it is just about the money....with quality a distant second.

 

[amyl]

do you think there might be an upside to AMC's... I mean what if they get enough power to fight for better compensation... If it is all about the bottom line wouldn't that be in the AMC's best interest to band together to fight for the way it used to be and get better compensation for doc's...which they would then get a bigger part of.... just trying to figure out if there could be an upside to walmarting. after all isn't that how unions started?

 

[militarymd]

do you think there might be an upside to AMC's... I mean what if they get enough power to fight for better compensation... If it is all about the bottom line wouldn't that be in the AMC's best interest to band together to fight for the way it used to be and get better compensation for doc's...which they would then get a bigger part of.... just trying to figure out if there could be an upside to walmarting. after all isn't that how unions started?

Sure there is, but the advantages/disadvantages will vary based on the type of OR/anesthesia model that exists in the different markets that are out there.

AMC's won't work very well in places like UT's practice where the surgeons contract with the anesthesia group or anesthesiologist....and the surgeons are not willing to change that.

However, in environments where anesthesia groups have exclusives (ie providing 24/7 service coverage for all anesthesia services in the hospital)....AMC's MAY be able to compete...but usually by paying its MD's less or charging the hospital more by charging a managing fee.

It's case by case....model dependent....There is no single answer that is the best.