After watching Somnia screw up Long Beach, Bakersfield, and Fresno, Envision says, "Hold my beer."

[apoondoc]

So, it goes without saying that all the good anesthesia practices (and I mean ALL the good ones) were bought out 5+ years ago, or are simply not for sale.

But what to do if you are losing money with all your recent acquisitions, but your private equity backers want more growth at any cost? You overpay for even worse groups, just to show growth--that's what you do.

Envision, not content with merely running continual ads for their dismal sites in Lakewood, Van Nuys, and Torrance (and even their not-truly-terrible site in Marina Del Ray), now figures that they can staff two other money-losing Tenet facilities: Fountain Valley (85% Medicaid, 10% Medicare, 5% Workers' Comp) and Placentia Linda.

With recruiters paying $350/hour to work in Fresno and almost as much to work in Bakersfield, it seems there's never been a better time to be a terrible, terrible anesthesiologist with a not-quite-revoked medical license.

I pray for the poor patients. They didn't deserve this. (The Tenet administrators, however, will get EXACTLY what they deserve: more headaches, more empty promises, more bad outcomes, and more lawsuits.)

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[Hoya11]

So, it goes without saying that all the good anesthesia practices (and I mean ALL the good ones) were bought out 5+ years ago, or are simply not for sale.

But what to do if you are losing money with all your recent acquisitions, but your private equity backers want more growth at any cost? You overpay for even worse groups, just to show growth--that's what you do.

Envision, not content with merely running continual ads for their dismal sites in Lakewood, Van Nuys, and Torrance (and even their not-truly-terrible site in Marina Del Ray), now figures that they can staff two other money-losing Tenet facilities: Fountain Valley (85% Medicaid, 10% Medicare, 5% Workers' Comp) and Placentia Linda.

With recruiters paying $350/hour to work in Fresno and almost as much to work in Bakersfield, it seems there's never been a better time to be a terrible, terrible anesthesiologist with a not-quite-revoked medical license.

I pray for the poor patients. They didn't deserve this. (The Tenet administrators, however, will get EXACTLY what they deserve: more headaches, more empty promises, more bad outcomes, and more lawsuits.)

same is true near me..

5k for 24hr call, desperate pleas for coverage in random locations

Rural hospitals and big name AMCs teaming up. (probably a financial link between the hospital admins and the AMC admins)

I think the AMCs negotiate with these rural hospitals and get a huge stipend (probably partially funded by govt).

IMO just close these little rinky dink hospitals down, consolidate our medical care.

If you are going to live in podunk, get yourself a hotel when its time to deliver your babys and go to a real hospital...

 

[IMGASMD]

"There's an old saying in Tennessee — I know it's in Texas, probably in Tennessee — that says, fool me once, shame on — shame on you. Fool me — you can't get fooled again."

Apparently no one seen it coming.

 

[nimbus]

But what to do if you are losing money with all your recent acquisitions, but your private equity backers want more growth at any cost? You overpay for even worse groups, just to show growth--that's what you do.

AFAIK, Somnia didn’t pay anything for Long Beach, they were just awarded the contract in a RFP.

 

[GassYous]

So, it goes without saying that all the good anesthesia practices (and I mean ALL the good ones) were bought out 5+ years ago, or are simply not for sale.

But what to do if you are losing money with all your recent acquisitions, but your private equity backers want more growth at any cost? You overpay for even worse groups, just to show growth--that's what you do.

Envision, not content with merely running continual ads for their dismal sites in Lakewood, Van Nuys, and Torrance (and even their not-truly-terrible site in Marina Del Ray), now figures that they can staff two other money-losing Tenet facilities: Fountain Valley (85% Medicaid, 10% Medicare, 5% Workers' Comp) and Placentia Linda.

With recruiters paying $350/hour to work in Fresno and almost as much to work in Bakersfield, it seems there's never been a better time to be a terrible, terrible anesthesiologist with a not-quite-revoked medical license.

I pray for the poor patients. They didn't deserve this. (The Tenet administrators, however, will get EXACTLY what they deserve: more headaches, more empty promises, more bad outcomes, and more lawsuits.)

I heard about those rates and seriously considered it but I'd rather not work in a ****ty system that lacks staff

 

[apoondoc]

AFAIK, Somnia didn’t pay anything for Long Beach, they were just awarded the contract in a RFP.

I am sure that, strictly speaking, you are correct.

But just like the dude who walks onto a car lot and drives away with a "No Money Down" car, it's not really fair to say nobody overpaid. Committing to staff operating rooms and the labor/delivery unit and take cover every call assignment when you know physicians demand $40/unit and your blended unit is below $30 unit is a money-losing proposition.

Now, it is possible that Envision negotiated some fat stipend. But since smaller, leaner, more efficient, local groups with demonstrated allegiance to the hospital and community wouldn't do the job "for less," then it is logically sound to say that, yes, Envision overpaid. Even if they paid zero dollars.

 

[aneftp]

Most hospitals systmems with subsidized locums cost with new anesthesia management companies. This is how business people work with business people. My buddy group lost their Bakersfield contract in 2007 and explained it all to me. It still happens in 2021 when amc and hospitals admin. That’s why they can continue to operate.
Consider one Or down each day costs the hospitals upwards to 20-50k per Or. paying to subsidize anesthesia a couple of thousand is chump change to keep the facility payments rolling.

 

[Shimmy8]

Once PE has locked in to a losing facility or at least maxed out profits and is looking for the next sucker…what’s the end game?? 8:1? 12:1? I feel like I’m in one of these situations…

 

[C4C]

I'm betting it's even worse than it appears.

These hospitals tend to find themselves in a negative feedback loop. Once the surgical volume falls below a critical level, it is impossible to keep decent anesthesiologists on staff. In short order, all the anesthesiologists who are the least bit employable leave the sinking ship. Meanwhile, the thoughtful surgeons take note of the anesthetic care their patients are being offered, and start booking their cases elsewhere, which only compounds the problem.

Some hospitals will try to stay afloat on whatever cases come through the ER; others recruit young or desperate surgeons with promises of unlimited block time. New anesthesia recruits quickly figure out that the hospitals that aren't busy are not busy for a reason: inexperienced surgical techs, below average nurses, poor support. Sure, the "new surgeons" are excited about all the block time, but it turns out those cases just never materialize.

Huge gaps in the schedule become the norm. Administration keeps preaching that huge surgical volumes await, if only we can seduce the right surgeon to book the right case, and then to fall in love with the ragtag team of left behinders.

You expect a lot of one-off 7:30 cases for trigger finger releases, exams under anesthesia, or knee manipulations. Sometimes, those cases are even scheduled at 0600 so that the wily surgeon doesn't disrupt his full schedule elsewhere.

Surgeons are no dummies, of course. They realize that they sit in the drivers' seat, and they make increasingly absurd (and dangerous) requests, dangling the promise of additional cases in front of management.

Meanwhile, the financial support the anesthesiologists require grows ever more burdensome to the hospital, and with each additional defection, the call burden grows worse for the remaining anesthesiologists. At this point, you can almost forgive administration for falling for the glossy presentation from the AMCs.

 

[caveat87]

I know several hospital systems that are absolutely kicking themselves for going the route of the amc (I work on the east coast). I firmly believe the best model nowadays for hospitals with mediocre payer mix is to utilize a private group with a strong allegiance and most likely stipend from the hospital. In this model, the physicians have autonomy and will work harder to maintain their decision making ability compared to hospital or amc employed docs. The hospital saves money compared to direct employment of anesthesia providers and the headaches associated with filling staffing gaps.

 

[Aheadbyacentury]

"Everything Woke turns to ****" Healthcare is a perfect example..
These woke politicians*Obama (woke officer in chief) greenlit(they succumbed to the nursing mob) NP legislation. All the bedside nurses, and Icu nurses that provide a valuable service to patients and the country decided "im gonna become an NP" and left bedside nursing to become NPs. Now there is a even bigger nursing shortage. And the nurses y ou have now are younger and more inexperienced. Because of this shortage and the exodus to NP school, and administrative roles the demand for RNs is even bigger. Hence they are making more and more and more money.. So now the hospitals have to give in to the mob even more and cough up more money.. Hence it is squeezing the system's budget. They cant train nurses fast enough.. Now there are ads saying "1 year to you BSN degree" on instagram, twitter, tiktok... If i had to blame anyone for this disaster it would fall clearly on the shoulders of Obama and the Affordable Woke Act.

 

[Aheadbyacentury]

I firmly believe the best model nowadays for hospitals with mediocre payer mix is to utilize a private group with a strong allegiance and most likely stipend from the hospital.

They tried this. It didnt work. The group will ask for more and more subsidy to maintain MGMA salary. The hospital will put more and more demands on the group until it goes bust and everyone leaves or they sell to an AMC. That is the natural evolution of these things.

Personalities play a role too. Only the most "yella" and malleable anesthesiologist can be compliant and go along with administrators. I certainly cannot. Eventually you find yourself at 11 pm doing something very very high risk for pittance reward and you make your displeasure known vociferously at the next board meeting.. And you have just sealed your fate.. YOU are OUT... Now the hospital cannot get another pvt small group.. They dont exist anymore.. SO they have to sell their soul to Envision, Napa etc etc...

Its a disaster.

 

[Aheadbyacentury]

I'm betting it's even worse than it appears.

These hospitals tend to find themselves in a negative feedback loop. Once the surgical volume falls below a critical level, it is impossible to keep decent anesthesiologists on staff. In short order, all the anesthesiologists who are the least bit employable leave the sinking ship. Meanwhile, the thoughtful surgeons take note of the anesthetic care their patients are being offered, and start booking their cases elsewhere, which only compounds the problem.

Some hospitals will try to stay afloat on whatever cases come through the ER; others recruit young or desperate surgeons with promises of unlimited block time. New anesthesia recruits quickly figure out that the hospitals that aren't busy are not busy for a reason: inexperienced surgical techs, below average nurses, poor support. Sure, the "new surgeons" are excited about all the block time, but it turns out those cases just never materialize.

Huge gaps in the schedule become the norm. Administration keeps preaching that huge surgical volumes await, if only we can seduce the right surgeon to book the right case, and then to fall in love with the ragtag team of left behinders.

You expect a lot of one-off 7:30 cases for trigger finger releases, exams under anesthesia, or knee manipulations. Sometimes, those cases are even scheduled at 0600 so that the wily surgeon doesn't disrupt his full schedule elsewhere.

Surgeons are no dummies, of course. They realize that they sit in the drivers' seat, and they make increasingly absurd (and dangerous) requests, dangling the promise of additional cases in front of management.

Meanwhile, the financial support the anesthesiologists require grows ever more burdensome to the hospital, and with each additional defection, the call burden grows worse for the remaining anesthesiologists. At this point, you can almost forgive administration for falling for the glossy presentation from the AMCs.

Your post is accurate, but not accurate for large health systems who hire the surgeons... They just tell them you MUST operate for your entire block time of youre out.......... With your model, the surgeons had too much financial control over the hospital and they lobbied the woke officer in chief (Obama) to put an end to this.

 

[Mman]

They tried this. It didnt work. The group will ask for more and more subsidy to maintain MGMA salary. The hospital will put more and more demands on the group until it goes bust and everyone leaves or they sell to an AMC. That is the natural evolution of these things.

Personalities play a role too. Only the most "yella" and malleable anesthesiologist can be compliant and go along with administrators. I certainly cannot. Eventually you find yourself at 11 pm doing something very very high risk for pittance reward and you make your displeasure known vociferously at the next board meeting.. And you have just sealed your fate.. YOU are OUT... Now the hospital cannot get another pvt small group.. They dont exist anymore.. SO they have to sell their soul to Envision, Napa etc etc...

Its a disaster.

I feel like the number of private groups in my neck of the woods has not changed at all in the last 5 years. The selling out was nearly all prior to that. There has been some consolidation of private groups joining forces, but that's about it.

 

[nimbus]

"Everything Woke turns to ****" Healthcare is a perfect example..
These woke politicians*Obama (woke officer in chief) greenlit(they succumbed to the nursing mob) NP legislation. All the bedside nurses, and Icu nurses that provide a valuable service to patients and the country decided "im gonna become an NP" and left bedside nursing to become NPs. Now there is a even bigger nursing shortage. And the nurses y ou have now are younger and more inexperienced. Because of this shortage and the exodus to NP school, and administrative roles the demand for RNs is even bigger. Hence they are making more and more and more money.. So now the hospitals have to give in to the mob even more and cough up more money.. Hence it is squeezing the system's budget. They cant train nurses fast enough.. Now there are ads saying "1 year to you BSN degree" on instagram, twitter, tiktok... If i had to blame anyone for this disaster it would fall clearly on the shoulders of Obama and the Affordable Woke Act.

Investment bankers and private equity partners never struck me as a particularly “woke” crowd. They are apex capitalists and are the ones who are screwing the average anesthesiologist and our patients. Hospital CEO’s also don’t strike me as particularly woke.

 

[deleted126335]

Investment bankers and private equity partners never struck me as a particularly “woke” crowd. They are apex capitalists and are the ones who are screwing the average anesthesiologist and our patients. Hospital CEO’s also don’t strike me as particularly woke.

They are not. They are the ones exploiting the “best intentions” of the woke elected officials.

 

[caligas]

So, it goes without saying that all the good anesthesia practices (and I mean ALL the good ones) were bought out 5+ years ago, or are simply not for sale.

But what to do if you are losing money with all your recent acquisitions, but your private equity backers want more growth at any cost? You overpay for even worse groups, just to show growth--that's what you do.

Envision, not content with merely running continual ads for their dismal sites in Lakewood, Van Nuys, and Torrance (and even their not-truly-terrible site in Marina Del Ray), now figures that they can staff two other money-losing Tenet facilities: Fountain Valley (85% Medicaid, 10% Medicare, 5% Workers' Comp) and Placentia Linda.

With recruiters paying $350/hour to work in Fresno and almost as much to work in Bakersfield, it seems there's never been a better time to be a terrible, terrible anesthesiologist with a not-quite-revoked medical license.

I pray for the poor patients. They didn't deserve this. (The Tenet administrators, however, will get EXACTLY what they deserve: more headaches, more empty promises, more bad outcomes, and more lawsuits.)

Is that $350/hr doing your own cases?

 

[O2sats]

So, it goes without saying that all the good anesthesia practices (and I mean ALL the good ones) were bought out 5+ years ago, or are simply not for sale.

But what to do if you are losing money with all your recent acquisitions, but your private equity backers want more growth at any cost? You overpay for even worse groups, just to show growth--that's what you do.

Envision, not content with merely running continual ads for their dismal sites in Lakewood, Van Nuys, and Torrance (and even their not-truly-terrible site in Marina Del Ray), now figures that they can staff two other money-losing Tenet facilities: Fountain Valley (85% Medicaid, 10% Medicare, 5% Workers' Comp) and Placentia Linda.

With recruiters paying $350/hour to work in Fresno and almost as much to work in Bakersfield, it seems there's never been a better time to be a terrible, terrible anesthesiologist with a not-quite-revoked medical license.

I pray for the poor patients. They didn't deserve this. (The Tenet administrators, however, will get EXACTLY what they deserve: more headaches, more empty promises, more bad outcomes, and more lawsuits.)

What makes lakewood so bad? I don't work there (or anywhere in california), but I would like to live in that area if I were to move.