Anesthesia in BFE

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Pharmado

PharmaDo
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Most of the best jobs, particularly in the "most desirable" areas are filled by word of mouth and knowing the right people tends to rule. That being said, how do jobs in BFE type areas get filled? I'm interested in moving to the country, somewhere in BFE (likely the Midwest or South-KY, TN, IN, MS, AL etc) and taking a job. I'm curious to know how these jobs get filled if they are in places that most people aren't keen on going and wouldn't naturally look. Do these rural type jobs get filled by placing an add on Gasworks, hiring recruiters or some other means? I've been really hesitant to deal with recruiters at all in any capacity, mostly because I feel like the jobs they advertise are likely to be the jobs that no one wants, and I've seen nothing to change my opinion on that. Does anyone have any input on this, or have experience working in rural areas (or even better, know of some good positions that are available)? I'd really like to hear from people in very small markets and get their feedback. Any help or advice would be appreciated.

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Same ways as all the other strong PP jobs are filled. Networking. We never advertise so when our group hires the new hires rarely leave. If we don't get a call showing interest and are looking we will email attending a at academics centers asking about potential interest in our area from strong candidates. Find an area you are interested in living in a call the hospital systems and get the anesthesia department contact information and send them an email introducing yourself and see if they are interested in hiring.
 
It always comes down to networking and cold-calling. It is unfortunate that I've decided to leave the area where I'm currently doing residency because it is significantly easier to network when you actually know people who work in the area.
 
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Depends what one's definition of "BFE"
Is.

One can work in "BFE" and split the difference in commute by living in the outer suburbs of a major metro area and drive 30-45 min to work.

For example. I can work in "BFE" Fredericksburg Virginia and live in outer DC suburbs (prince William or Loundon county)
 
Go to the ASA in October. Shake some hands and buy some drinks.
 
I'm not exactly sure what you're asking. Just by going to Gaswork and entering the 5 states you mentioned I came up with 54 jobs that aren't posted by recruiters. So, you could start there. Practice link will have some too. If you really want to live in a specific part of "BFE" you could Google the hospitals in that area and send a CV to the in house recruiter or CMO. There may be some practices in BFE that can get by on word of mouth, but generally speaking they have to advertise. A recruiter will charge $25k to $50k if they place you, so a lot of the smaller groups can't afford to utilizer recruiter candidates.
 
Look at a map, google hospitals in that area, cold turkey call them.
Utilize connections you have established in BFE.

I've did the BFE route for some time. Taxing to the mind but glorious to the wallet.
Make sure you get a good vacation package so you can get out of dodge- minimum 10 weeks.

Do that for 5-8 years, invest and get out of there before you get stuck. Try and do all aspects of anesthesia.

Then...move to a desireable area with a huge leg up on life.

This strategy has served me well, but the years in BFE were not all that exiting. One thing to keep in mind is that there are many PP groups in desireable areas that are above 85% MGMA average, so in the end it could be detrimental to move to BFE. Weigh your decisions accordingly. Patience and persistance in the job search is key.

All the best.
 
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Now I've heard of cold calling, and I've heard of quitting cold turkey, but cold turkey calling is a new one to me. :thinking:

I think I just coined it... Funny, that's what happens when you spend the first 13 years of your life in another country.

That's like the exact opposite of boat ownership.

Yeah... but boats are so nice when you have a large body of water in your back yard. :thumbup:

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Cold called the KY/TN/OH area just in this week and 3 interviews lined up.

Just like above, aggressive Google machining is your best friend.
 
Yup, I just need a couple more years until I join the club/mistake of owning a boat, but it will happen - it's the one thing that I've been unable to talk myself out of wanting. :D

Since your dog likes to boat, here's a cool story for you:

http://abcnews.go.com/US/navy-finds-missing-dog-fell-off-fishing-boat/story?id=37701943

Best story ever. Thanks for sharing Salty. I have a soft spot for GSDs.
Can't imagine the excitement of the owner when he received the call.
GSD are amazing canines.

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I think it's a must to have a watercraft in your part of the word Salty. Good for easy cheese memory making. Def. a hole in your pocket tho.
 
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Yup, I just need a couple more years until I join the club/mistake of owning a boat, but it will happen - it's the one thing that I've been unable to talk myself out of wanting. :D

the best boat is somebody else's boat
 
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double post, oops
 
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I've did the BFE route for some time. Taxing to the mind but glorious to the wallet.
Make sure you get a good vacation package so you can get out of dodge- minimum 10 weeks.

Do that for 5-8 years, invest and get out of there before you get stuck. Try and do all aspects of anesthesia.

Then...move to a desireable area with a huge leg up on life.

This strategy has served me well, but the years in BFE were not all that exiting. One thing to keep in mind is that there are many PP groups in desireable areas that are above 85% MGMA average, so in the end it could be detrimental to move to BFE. Weigh your decisions accordingly. Patience and persistance in the job search is key.

All the best.

Sevo, what areas of the country did you work in when out in BFE? I have an interview lined up in the midwest, town of <20k. Own cases, total comp ~420k + health, malpractice with tail and 6wks vaca. It seems like a great job so far as I can tell. Is that under typical market value for BFE type jobs? It doesn't seem like overwhelming reimbursement for so small a place, but my family would probably be very happy there.
 
Sevo, what areas of the country did you work in when out in BFE? I have an interview lined up in the midwest, town of <20k. Own cases, total comp ~420k + health, malpractice with tail and 6wks vaca. It seems like a great job so far as I can tell. Is that under typical market value for BFE type jobs? It doesn't seem like overwhelming reimbursement for so small a place, but my family would probably be very happy there.

Well vacation seems low to me. How busy would your weeks be? If your doing 30-40 hr weeks with light call burden that's not bad but if it's a 60h/wk gig then I would keep looking for better.
 
Sevo, what areas of the country did you work in when out in BFE? I have an interview lined up in the midwest, town of <20k. Own cases, total comp ~420k + health, malpractice with tail and 6wks vaca. It seems like a great job so far as I can tell. Is that under typical market value for BFE type jobs? It doesn't seem like overwhelming reimbursement for so small a place, but my family would probably be very happy there.


You dont have to go to BFE for that. Unless you like BFE.
 
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Sevo, what areas of the country did you work in when out in BFE? I have an interview lined up in the midwest, town of <20k. Own cases, total comp ~420k + health, malpractice with tail and 6wks vaca. It seems like a great job so far as I can tell. Is that under typical market value for BFE type jobs? It doesn't seem like overwhelming reimbursement for so small a place, but my family would probably be very happy there.

Look at Indiana. Consistently rated one of the best physician friendly states in the nation.

You need to add at least a couple hundred to that 420k and add 4-6 weeks vaca (you pay for it... trust me)

420k and 6 weeks isn't really that hot.

My best year was well into the 700k range in an all MD practice.
 
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I just helped place a friend in a west coast pp group with 10-12 weeks vaca and 400k.

You really need to look at all possibilities and not be committed to the Midwest only.
 
Look at Indiana. Consistently rated one of the best physician friendly states in the nation.

You need to add at least a couple hundred to that 420k and add 4-6 weeks vaca (you pay for it... trust me)

420k and 6 weeks isn't really that hot.

My best year was well into the 700k range in an all MD practice.

Yup. My buddy asked me to take over his 24/7 (super light calls obviously) 26 week a year job in rural area (60 miles from surburia). He makes around 400k. You must be 10 min call back from hospital. He tried commuting thing and leaving his family in surburia for a year but then moved his family rural and he loves it there. But he has his own pain business so done well on the pain side to give up the anesthesia side. There was post about pain doc tired and wanting to move back to anesthesia side. He's opposite. But it's taken him 10 plus years to build his own pain business where he controls his own hours and patient selection. So when you control your own business. Much more satisfaction with pain.


Th "total" deal is really worth $900k to be on call and work 24 hours a day/7 days a week. But it's rural. Usually done by 2-3pm. Not many cases. Hospital pays crnas seperately you supervise. Calls are very very light. You will sleep all night 90-95% of the time.

So main guy takes $500k for 26 weeks. (So he's taking money off the top himself)

That's how much these true rural deals are supposed to be worth.

Than I see NAPA come into another rural area and try to offer a low ball hanging fruit 380k with 16 weeks off to do the same 24/7 call for 36weeks. So Napa is shaving a lot more off the top.
 
Yup. My buddy asked me to take over his 24/7 (super light calls obviously) 26 week a year job in rural area (60 miles from surburia). He makes around 400k. You must be 10 min call back from hospital. He tried commuting thing and leaving his family in surburia for a year but then moved his family rural and he loves it there. But he has his own pain business so done well on the pain side to give up the anesthesia side. There was post about pain doc tired and wanting to move back to anesthesia side. He's opposite. But it's taken him 10 plus years to build his own pain business where he controls his own hours and patient selection. So when you control your own business. Much more satisfaction with pain.


Th "total" deal is really worth $900k to be on call and work 24 hours a day/7 days a week. But it's rural. Usually done by 2-3pm. Not many cases. Hospital pays crnas seperately you supervise. Calls are very very light. You will sleep all night 90-95% of the time.

So main guy takes $500k for 26 weeks. (So he's taking money off the top himself)

That's how much these true rural deals are supposed to be worth.

Than I see NAPA come into another rural area and try to offer a low ball hanging fruit 380k with 16 weeks off to do the same 24/7 call for 36weeks. So Napa is shaving a lot more off the top.

Wow NAPA steals more from you than the federal government
 
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Wow NAPA steals more from you than the federal government

I don't know, that NAPA deal sounds more like what most hospitals in middle of nowhere pay for an anesthesiologist to be on call 24/7. Many hospitals I know of that use job sharing where 2 docs split the 52 weeks (some do 1 week on/off, others do 2 at a time, etc) tend to be in the range of $300-$350K for each of the 2, or $600-$700K total.
 
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The total 700-900k+ for rural jobs was what I had assumed was common for true BFE jobs. I appreciate all the comments, this is genuinely helpful. Now I just need to find one of these jobs since I actually want to live in BFE (ok, my wife really wants to live in BFE and I'm happy when my wife is happy), and I have the benefit of not caring a great deal which part of the country I work in.
 
I don't know, that NAPA deal sounds more like what most hospitals in middle of nowhere pay for an anesthesiologist to be on call 24/7. Many hospitals I know of that use job sharing where 2 docs split the 52 weeks (some do 1 week on/off, others do 2 at a time, etc) tend to be in the range of $300-$350K for each of the 2, or $600-$700K total.

But Napa is only giving 16 weeks vacation in the above post...not 26 in a 2 doc split...so you get to work 10 more weeks for the same pay....doesn't sound awesome but impossible to say without more details. In one scenario a week of call is worth around 13,461 (1,923 per day) and in the other a week of call is worth around 9,700 (1,385 per day), so Napa is skimming another 200K + per year off the top on an already bad deal...just classic AMC shenanigans in my opinion.
 
But Napa is only giving 16 weeks vacation in the above post...not 26 in a 2 doc split...so you get to work 10 more weeks for the same pay....doesn't sound awesome but impossible to say without more details. In one scenario a week of call is worth around 13,461 (1,923 per day) and in the other a week of call is worth around 9,700 (1,385 per day), so Napa is skimming another 200K + per year off the top on an already bad deal...just classic AMC shenanigans in my opinion.

You also have to figure that NAPA is generating more for the billing than the private group. So they screw the doctors and they screw the insurance companies, who in turn screw the patients. Everybody wins with NAPA!
 
I don't know, that NAPA deal sounds more like what most hospitals in middle of nowhere pay for an anesthesiologist to be on call 24/7. Many hospitals I know of that use job sharing where 2 docs split the 52 weeks (some do 1 week on/off, others do 2 at a time, etc) tend to be in the range of $300-$350K for each of the 2, or $600-$700K total.
Napa was offering 16 weeks. When a real job sharing is 26 weeks.

So they are shaving 10 weeks off the top.

10 weeks is worth $80k easily.
 
Napa was offering 16 weeks. When a real job sharing is 26 weeks.

So they are shaving 10 weeks off the top.

10 weeks is worth $80k easily.

Well if you're doing 26 for 300 then it's more like 100k and even more if you consider it overtime.
 
Most of the best jobs, particularly in the "most desirable" areas are filled by word of mouth and knowing the right people tends to rule. That being said, how do jobs in BFE type areas get filled? I'm interested in moving to the country, somewhere in BFE (likely the Midwest or South-KY, TN, IN, MS, AL etc) and taking a job. I'm curious to know how these jobs get filled if they are in places that most people aren't keen on going and wouldn't naturally look. Do these rural type jobs get filled by placing an add on Gasworks, hiring recruiters or some other means? I've been really hesitant to deal with recruiters at all in any capacity, mostly because I feel like the jobs they advertise are likely to be the jobs that no one wants, and I've seen nothing to change my opinion on that. Does anyone have any input on this, or have experience working in rural areas (or even better, know of some good positions that are available)? I'd really like to hear from people in very small markets and get their feedback. Any help or advice would be appreciated.

Take the time to talk with your family and really thoroughly consider each option and location. There is value in working with nice people and doing decent cases. You dont hear "I dont care about location at all" very much. There is certainly risk of genuine unhappiness in certain extreme places. How do they hire? They are desperately awaiting the phone to ring from you or a recruiter or anyone with a pulse.. You enable them to do safe surgery and make OR/inpatient monies. You are gold to them, be happy where you go trust me, good luck
 
Most of the best jobs, particularly in the "most desirable" areas are filled by word of mouth and knowing the right people tends to rule. That being said, how do jobs in BFE type areas get filled? I'm interested in moving to the country, somewhere in BFE (likely the Midwest or South-KY, TN, IN, MS, AL etc) and taking a job. I'm curious to know how these jobs get filled if they are in places that most people aren't keen on going and wouldn't naturally look. Do these rural type jobs get filled by placing an add on Gasworks, hiring recruiters or some other means? I've been really hesitant to deal with recruiters at all in any capacity, mostly because I feel like the jobs they advertise are likely to be the jobs that no one wants, and I've seen nothing to change my opinion on that. Does anyone have any input on this, or have experience working in rural areas (or even better, know of some good positions that are available)? I'd really like to hear from people in very small markets and get their feedback. Any help or advice would be appreciated.

There is SO much more you need to take into account than just location, money, and time off. You need to ask questions about the CRNAs who are going to be working under your license. There is nothing worse than running 4 rooms with average or poorly skilled CRNAs, or CRNAs who don't call you when they should because they think they know more than you. In fact I'd take a pay cut to avoid that if I had to choose. I would also suggest taking a job only in a hospital where you either employ the CRNAs yourself as a group or you have say in who gets fired if they suck or are militant.
 
Napa was offering 16 weeks. When a real job sharing is 26 weeks.

So they are shaving 10 weeks off the top.

10 weeks is worth $80k easily.


I've seen perfectly reasonable 26 week jobs that pay $300K. NAPA paying $380K for 36 weeks is well within the realm of reasonable depending on the job. I think it's closer to reality than $450K for 26 weeks.
 
I've seen perfectly reasonable 26 week jobs that pay $300K. NAPA paying $380K for 36 weeks is well within the realm of reasonable depending on the job. I think it's closer to reality than $450K for 26 weeks.
Maybe.

But my friend who does pain also isn't making 450k. He's making $400k for the 26 weeks in the OR. The main guy is taking in $500k for 26 weeks.

The guy who has the contract is shaving money off the top.

The real contract is worth $900k.

That's my point. His "partner" is only shaving "$50k" of the top.

Napa is shaving much much more. That's the real point.

The other issue is how much hospital admin is getting from the Federal govt.

A small rural hospital in the South was getting a whooping 18 million from Uncle Sam. Hospital admin was generous enough to give than "anesthesix, which sold out to team health" 5 million in anesthesia subsidy. And they were doing between 20-40 OR cases a WEEK! Anesthesix shaved 1 million off the top and than paid the 4 MDs and 7 crnas "generous salaries". To the tune of $500k with 10-12 weeks off and crnas close to 200k.

So they were still clearing easily 1-1.5 million with the 5 million dollar contract.

Payer mix was horrendous. So no matter how good an AMC is in rural hospitals. They don't have much they can wiggle with 80-90% Medicare/Medicaid. 95% of Ob patients were Medicaid.
 
Maybe.

But my friend who does pain also isn't making 450k. He's making $400k for the 26 weeks in the OR. The main guy is taking in $500k for 26 weeks.

The guy who has the contract is shaving money off the top.

The real contract is worth $900k.

That's my point. His "partner" is only shaving "$50k" of the top.

Napa is shaving much much more. That's the real point.

My point is they are different hospitals. I've never seen a small not busy hospital that required 24/7 call that could generate $900K of anesthesiologist revenue a year. To me that is amazing. The "real contract" isn't worth $900K, it's likely worth far less but they can't hire somebody for less. You seem to imply that different small hospitals in BFE are all bringing in the case volume/mix to support the same $900K per year. They aren't and many aren't even close.

My real point is that the NAPA job isn't necessarily shaving even more off the top, it's possibly less. Terrible payer mix and low case volume means there will be very little revenue. Some of these hospitals do something like 6-10 cases per day, or maybe 40 per week (say 2000 per year). If many are no pay or CMS, that's not much to go around.

The only question is how much money the hospital is willing to lose paying for an anesthesiologist.
 
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Doximity has a new feature that lets you see median estimated compensation by county. The surprising part is that average compensation doesn't vary by much. The lowest counties are around 360k and the highest are around 410k. The numbers seem low, they are in my area. But it's useful for comparison purposes.
 
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Look at Indiana. Consistently rated one of the best physician friendly states in the nation.

You need to add at least a couple hundred to that 420k and add 4-6 weeks vaca (you pay for it... trust me)

420k and 6 weeks isn't really that hot.

My best year was well into the 700k range in an all MD practice.
This.

The nice thing about Indiana, in addition to its high pay and physician friendly laws is that you can work in "BFE" easily while living in Indianapolis. Sure Indianapolis isn't LA or NYC, but with about 2 million metro population it has all the basic large city amenities. Just a 30 minute drive in the right direction can get you to some small towns with small hospitals. If being somewhat close to a very large city is important then you could also look at the Chicagoland area. Valparaiso, Hammond, etc.

If you are ok with a city in the range of 250-500k population then check out Fort Wayne. South Bend, a bit smaller but has Notre Dame in it, would also be a sweet deal financially.
 
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This.

The nice thing about Indiana, in addition to its high pay and physician friendly laws is that you can work in "BFE" easily while living in Indianapolis. Sure Indianapolis isn't LA or NYC, but with about 2 million metro population it has all the basic large city amenities. Just a 30 minute drive in the right direction can get you to some small towns with small hospitals. If being somewhat close to a very large city is important then you could also look at the Chicagoland area. Valparaiso, Hammond, etc.

If you are ok with a city in the range of 250-500k population then check out Fort Wayne. South Bend, a bit smaller but has Notre Dame in it, would also be a sweet deal financially.
I wish I could deal with that cold. Otherwise I would consider Indiana. But I am now happy in the desert with my new group.
 
There is a lot of give and take.

People live in big cities LA/SF, NYC, DC, Philly, Miami, Chicago (all those cities traditionally have paid lower even in boom years). Dallas and Houston used to be big cities that paid very well but not anymore.

As salaries get artificially (350-400k AMC pay), I reckon more people will choose the more desirable city over the small town.

Make the money now because the AMCs are gonna into the mid size towns (Knoxville TN used to make a killing for example) and driving down those salaries
 
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