Are the incomes posted on gasworks exaggerations of reality?

[GravelRider]

Yeah but then the AMC just negotiates a stipend with the hospital so whats the difference? I dont see how this is a relevant. I think most hospitals lose money overall on anesthesia services whether by stipend or by costs> revenue. Working for an AMC in my opinion is very similar to working for a hospital directly. You've got a big corporate boss. Wouldnt you rather that boss be your partners? who are going to give you back as much as possible as they took from you... because they get the same cut...


Right. That is my point. There is a cost to the group of keeping the group running other than just "stealing professional fees" for the partners to add onto their house.

So the partners are taking none of that extra money and it’s all going back into building and maintaining the business, right?

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[OptionOffense]

I once interviewed at a partnership that the track was 8 years. At the end of the 8 years you were eligible for partnership when one of the current partners decided to retire…so the track was effectively a lot longer than 8 years. They were paying below market at the time for the track…maybe $300k. The partners were all making $1.5-2 million by my estimate…possibly more. There are way more examples of egregious partnership tracks like this than the 1 year tryout and nominal share buying that is fair.

I hear ya. That was par for the course 20-30 years ago. There were no AMCs but there sure were a lot of top-heavy group looking for the
"right" person.

 

[dabears505]

LOOOOL, 325k a year to do liver take backs and cardiac. Pretty sure every cardiac attending I know cannot block for jack and hasn't put in an epidural since residency.

Are you still in residency? You will find that in private practice most of the cardiac people can do all those other things. Maybe if the group is super big and you can avoid general call and only take cardiac call you might find people like that.

 

[pgg]

Man this place is just swarming with early trainees tellin' us how it is lately.

 

[nimbus]

LOOOOL, 325k a year to do liver take backs and cardiac. Pretty sure every cardiac attending I know cannot block for jack and hasn't put in an epidural since residency. So basically you want someone who is TEE proficient and maybe a tad quicker putting in an IJ. I'm not Cardiac trained so I guess I can't run a norepi, epi, or milrinone gtt if I needed to. Also don't know to place a radial a line on a patient with a 20% EF or severe LM disease. Can't read an ABG either or transfuse when needed.

Even at a Level 1 center you need a diverse set of anesthesiologists, INCLUDING general non cardiac ones man. What good is someone who can read a TEE but can't do an inter scalene or pop...or hasn't put in a spinal/epidural in years...esp when the VAST majority of your cases are ortho/ENT/plastics/gen surgery. You don't need trauma exposure to do a crani either....

What you see as a resident does not necessarily reflect the larger world. Most places are not as siloed as academics. Most people in a practice will do everything except for a smaller number doing hearts. But the heart folks will do everything+hearts. Cardiac anesthesiologists can be very good at blocks. Indeed, nowadays everybody is expected to be very good at blocks. Also, I see a lot of new hires coming through, and it helps to have trauma exposure and be comfortable with trauma to work at a trauma center. I do see a difference among people. Another area I see a difference among new hires is that some can reliably provide lung isolation with a DLT while others can’t. Everybody can do ISB/pop/spinal/epidural. Those are not advanced skills. If you think they can’t, you misjudge your peers.

 

[OptionOffense]

What you see as a resident does not necessarily reflect the larger world. Most places are not as siloed as academics. Most people in a practice will do everything except for a smaller number doing hearts. But the heart folks will do everything+hearts. Cardiac anesthesiologists can be very good at blocks. Indeed, nowadays everybody is expected to be very good at blocks. Also, I see a lot of new hires coming through, and it helps to have trauma exposure and be comfortable with trauma to work at a trauma center. I do see a difference among people. Another area I see a difference among new hires is that some can reliably provide lung isolation with a DLT while others can.

For a while, a lot of practices hired a regional team or guy who did the regional for every one on the schedule. That was his job. I always found that unfair cuz that is an easy job. So if youve been at that job you wont be good at regional. Usually it was these regional fellowship guys who really cannot do anything else but blocks. (can barely intubate-ive seen it).
But i agree, generally speaking cardiac folks are usually not the greatest regionalists or anything else. Cardiac is too easy. The plan and case is always the same.

 

[nimbus]

For a while, a lot of practices hired a regional team or guy who did the regional for every one on the schedule. That was his job. I always found that unfair cuz that is an easy job. So if youve been at that job you wont be good at regional. Usually it was these regional fellowship guys who really cannot do anything else but blocks. (can barely intubate-ive seen it).
But i agree, generally speaking cardiac folks are usually not the greatest regionalists or anything else. Cardiac is too easy. The plan and case is always the same.

I think if you have an attractive practice, it’s not hard to recruit people that are good at everything. Maybe because we are eat what you kill PP, everyone is motivated to get good at regional and do their own. Never had a “block team” at any of our sites. We have hired graduates of the local regional fellowship but in practice they don’t do any exotic blocks that the rest of us don’t do.

 

[OptionOffense]

Maybe because we are eat what you kill PP,

This is key and should be the preferred mode of practice everywhere. So if you want to come to work and sit in the office or lounge all day, nobody is stoppin' you. Your paycheck will reflect this.

 

[nimbus]

Yeah but then the AMC just negotiates a stipend with the hospital so whats the difference? I dont see how this is a relevant. I think most hospitals lose money overall on anesthesia services whether by stipend or by costs> revenue. Working for an AMC in my opinion is very similar to working for a hospital directly. You've got a big corporate boss. Wouldnt you rather that boss be your partners? who are going to give you back as much as possible as they took from you... because they get the same cut...


Right. That is my point. There is a cost to the group of keeping the group running other than just "stealing professional fees" for the partners to add onto their house.

As we have witnessed, AMCs come and go. And they create a hot mess at each transition. They exist to extract as many health care dollars as possible while adding as little value as possible to the system. Hospitals have more incentive to keep the factory running and be around for the long haul. I think hospital interests align better with the average anesthesiologist. If I had to choose, I prefer to work for a hospital over an AMC.


The costs of running a practice can be shared by everyone, partners and non-partners alike. So can the profits. In our group, nothing changes from a financial perspective when you become a partner because you’ve shared equally in every expense and profit from the beginning.

 

[gasresident1]

What you see as a resident does not necessarily reflect the larger world. Most places are not as siloed as academics. Most people in a practice will do everything except for a smaller number doing hearts. But the heart folks will do everything+hearts. Cardiac anesthesiologists can be very good at blocks. Indeed, nowadays everybody is expected to be very good at blocks. Also, I see a lot of new hires coming through, and it helps to have trauma exposure and be comfortable with trauma to work at a trauma center. I do see a difference among people. Another area I see a difference among new hires is that some can reliably provide lung isolation with a DLT while others can’t. Everybody can do ISB/pop/spinal/epidural. Those are not advanced skills. If you think they can’t, you misjudge your peers.

I completely agree with you. It's tough when most residents place maybe 10-15 DLTs in residency, and most of the time the attending is heavily aiding in the guiding with FOB.

Weak areas I've strived to work on before residency finally ends:
-Thoracic epidurals
-DLTs
-Subclavian central lines
-High risk OB - stat c sections - eclampsia - get that Tuohy on a BMI 40+'er
-quick and efficient with US guided IVs
-awake FOB intubations
-perineural catheter placement - though most PP prob won't do this regardless
-nasotracheal intubation

Still, I won't feel comfortable out of residency with
-sick peds
-big cards cases - ie: dissections, arch cases, patients with LVADs getting transplants, etc.

With anything, I firmly believe you lose what you don't practice. It's hard to keep proficiency in everything especially if you are not using those skills often. It's not that I don't think they can't do it, it's just going to be exponentially more difficult for them, and they may not be able to do it on that difficult patient.

 

[Hork Bajir]

Cardiac is too easy. The plan and case is always the same.

Sorry dude, but I hear this all the time- from residents who don’t really understand half of what is actually going on in the heart room. It’s a CRNA mentality, thinking it’s all cookbook (trust me it’s not)

 

[thinkorswim]

But i agree, generally speaking cardiac folks are usually not the greatest regionalists or anything else. Cardiac is too easy. The plan and case is always the same.

It’s not hard to figure out where you fall on this curve.

 

[Hoya11]

So the partners are taking none of that extra money and it’s all going back into building and maintaining the business, right?

Of course partners take the money of the employees and partnership track docs. Just like the hospital and AMCs take from their employees.
The difference is in the partner model, you at least have a chance of becoming partner and being on the receiving end of that money you gave when you first joined. With the other employment options, you dont get ANY chance at that extra money, yet that is preferable to you ?

It just sounds like a lot of guys on here making 300-400 refusing to see how the guys making 600k+ got there. Must be by "scamming". No, we invested our sweat equity and time and took a risk.... so if you dont do that, and dont take on the costs and burdens of running a group i dont feel bad when I look at my w2...

Of course it all depends on the numbers and the partnership. But you should be able to vet those things before you commit.

 

[Hoya11]

As we have witnessed, AMCs come and go. And they create a hot mess at each transition. They exist to extract as many health care dollars as possible while adding as little value as possible to the system. Hospitals have more incentive to keep the factory running and be around for the long haul. I think hospital interests align better with the average anesthesiologist. If I had to choose, I prefer to work for a hospital over an AMC.


The costs of running a practice can be shared by everyone, partners and non-partners alike. So can the profits. In our group, nothing changes from a financial perspective when you become a partner because you’ve shared equally in every expense and profit from the beginning.

i agree with you there. hospital preferable to AMC. but partnership in a busy and fair group better than both.

 

[Katheudontas parateroumen]

I got a job offer recently.
AMC at a large medical center that does everything in desirable metro area.

Majority mid level supervision never more than 1:4.
425k base
100k rotating call compensation
25k end year bonus
$225/hr extra shifts as wanted
8 weeks PTO

that’s the initial offer after they advertised 550k+ compensation. What should I be looking out for in terms of a fair rotating call for this kind of job? Any other things you’d be having your eyes on?

 

[Drwine]

I plan to retire in June and just do a little per diem initially. I have practiced cardiac anesthesia in a private practice for my entire career but I have been actively engaged at doing everything except major pediatric cases, chronic pain and critical care. When I am working like I don't need the money I will prove that Optionffense and gasresident1 are wrong because I will do any case as long as I am not late for dinner.

 

[OptionOffense]

It’s not hard to figure out where you fall on this curve.

View attachment 350878

Dude I did cardiac anesthesia in my former life. I know. Stop with this. I find General stuff harder. you have to be on your toes more. A potpourri of regional, chidlren, trauma cases, OB, difficult MACS, full stomachs Spinals for Orthopedics recovery room issues.

 

[GravelRider]

Of course partners take the money of the employees and partnership track docs. Just like the hospital and AMCs take from their employees.
The difference is in the partner model, you at least have a chance of becoming partner and being on the receiving end of that money you gave when you first joined. With the other employment options, you dont get ANY chance at that extra money, yet that is preferable to you ?

It just sounds like a lot of guys on here making 300-400 refusing to see how the guys making 600k+ got there. Must be by "scamming". No, we invested our sweat equity and time and took a risk.... so if you dont do that, and dont take on the costs and burdens of running a group i dont feel bad when I look at my w2...

Of course it all depends on the numbers and the partnership. But you should be able to vet those things before you commit.

So because hospitals and AMCs skim money, you should too? When the practice was being formed at the beginning, were the original partners giving part of their professional fees to someone wanting to buy a new boat? That is essentially what you are asking someone on a partnership track to do. What percentage of the excess professional fees of partnership track folks would you estimate are used to build and maintain the business?

Then when someone suggests that when evaluating a potential partnership opportunity, you should sit down and review the books and finances of that partnership with a lawyer or accountant, the partners on here come out with pitchforks screaming GTFO! Tell me, do you think in the business world when someone is considering investing and becoming a partner of a business that they don’t sit down with lawyers and accountants before making a decision? It seems to me that many of these anesthesia businesses are a little too insulated from free market economics…with the whole exclusive contract stuff. It seems to me that many partnership tracks exist to inflate the salaries of existing partners and not to build and grow a business.

The only time I ever made <$500k salary is when I was lied to on a fake partnership track. I learned a lot of lessons then and one of those lessons is to be wary of Ponzi scheme partnership tracks. Anything less than absolute clarity on where your money is going and what you are buying into is a huge red flag.

To be clear, I am not opposed to some sort of nominal “buy-in” or risk-taking on the part of a potential partner, but it’s kind of like porn where you know the **** opportunities when you see them…and the vast majority are ****. Most people are much better off taking a well-paying employed position than taking a huge risk with your time and optimism on what is more likely than not to be a scam. I wish it weren’t that way, but it is.

 

[Southpaw]

Dude I did cardiac anesthesia in my former life. I know. Stop with this. I find General stuff harder. you have to be on your toes more. A potpourri of regional, chidlren, trauma cases, OB, difficult MACS, full stomachs Spinals for Orthopedics recovery room issues.

I'm not a cardiac anesthesiologist. A cardiac anesthesiologist has the potential to be a complete anesthesiologist the way no other can, sick peds being the one exception. They get board certified in TEE and are very comfortable doing the sickest of patients. They can do general and they can easily get very proficient at blocks. Wanna talk about a waste of a fellowship year? Everything regional related is found on youtube. Even a year spent doing OB (which IMO is another waste of a year) has more value as not everyone (not even some cardiac folks) is comfortable caring for the sickest OB patients found in academic centers.

I can't take the rest of your post seriously - difficult MACS? full stomach spinals? WTF is that anyway. regardless if you come out of residency not being proficient at MACs or spinals then your residency program didn't hold up its end of the bargain.

in my hospital, no one touches a TEE probe unless they are board certified in it. That's the cardiac people. And it's like that in a lot of major places doing high level cardiac. Cardiac has immense value, proven by the current market where places are absolutely paying more for cardiac training but rarely for any other fellowship.

Peds got flooded several years back - now no one wants to do the fellowship. Expect it to make a comeback soon enough.

 

[Mman]

Even a year spent doing OB (which IMO is another waste of a year) has more value as not everyone (not even some cardiac folks) are comfortable caring for the sickest OB patients found in academic centers.

which OB patients would a cardiac fellowship trained person not be comfortable caring for? OB fellowship complete useless IMHO for clinical care. Only helps as an academic credential for an academic job that requires it.

 

[Southpaw]

which OB patients would a cardiac fellowship trained person not be comfortable caring for? OB fellowship complete useless IMHO for clinical care. Only helps as an academic credential for an academic job that requires it.

A cardiac attending MAY be comfortable caring a BMI 70 eclamptic patient with known placenta percreta (with imaging showing invasion into the bladder) but the OB attending is more in tune with the requirements of the case. Also, having worked with both cardiac attendings and OB fellowship trained attendings, if I were to ask the actual OB/GYNs who they prefer working with, they choose the OB fellowship trained anesthesiologist. That has to count for something.

I generally agree with you that an OB year is a waste of a year, but I know for a fact that when hospital administration asks the OB/GYNs who they want to staff their OB floor they'll ask for OB fellowship trained anesthesiologists.

 

[OptionOffense]

I'm not a cardiac anesthesiologist. A cardiac anesthesiologist has the potential to be a complete the anesthesiologist the way no other can, sick peds being the one exception. They get board certified in TEE and are very comfortable doing the sickest of patients. They can do general and they can easily get very proficient at blocks. Wanna talk about a waste of a fellowship year? Everything regional related is found on youtube. Even a year spent doing OB (which IMO is another waste of a year) has more value as not everyone (not even some cardiac folks) are comfortable caring for the sickest OB patients found in academic centers.

I can't take the rest of your post seriously - difficult MACS? full stomach spinals? WTF is that anyway. regardless if you come out of residency not being proficient at MACs or spinals then your residency program didn't hold up its end of the bargain.

in my hospital, no one touches a TEE probe unless they are board certified in it. That's the cardiac people. And it's like that in a lot of major places doing high level cardiac. Cardiac has immense value, proven by the current market where places are absolutely paying more for cardiac training but rarely for any other fellowship.

Peds got flooded several years back - now no one wants to do the fellowship. Expect it to make a comeback soon enough.

There should have been a comma between full stomach and spinals. (Patients with full stomachs, spinals etc.) 2 seperate entities. My point is, I think being a general anesthesiologist, taking all comers, is a more challenging job than doing the same case over and over where the plan is the exact same. Most of the cases you do not extubate in cardiac.

With regards to Mac cases. My point was, some Mac cases are not as easy as you think and requires judgement and understanding to navigate them. If you don't understand that, I dont think you have done enough cases.

 

[Southpaw]

There should have been a comma between full stomach and spinals. (Patients with full stomachs, spinals etc.) 2 seperate entities. My point is, I think being a general anesthesiologist, taking all comers, is a more challenging job than doing the same case over and over where the plan is the exact same. Most of the cases you do not extubate in cardiac.

I’ve never worked in a place where cardiac people are not taking care of full stomachs or doing spinals. I’d describe that as very routine and easily within their wheelhouse.

 

[OptionOffense]

I’ve never worked in a place where cardiac people are not taking care of full stomachs or doing spinals. I’d describe that as very routine and easily within their wheelhouse.

It is within their wheelhouse. Definitely. But many places the cardiac folks dont do as much of that stuff.
For example, when I was a resident, my attending had never placed an LMA. Seriously. This was 15 years after the lma came out.

 

[Mman]

A cardiac attending MAY be comfortable caring a BMI 70 eclamptic patient with known placenta percreta (with imaging showing invasion into the bladder) but the OB attending is more in tune with the requirements of the case. Also, having worked with both cardiac attendings and OB fellowship trained attendings, if I were to ask the actual OB/GYNs who they prefer working with, they choose the OB fellowship trained anesthesiologist. That has to count for something.

I generally agree with you that an OB year is a waste of a year, but I know for a fact that when hospital administration asks the OB/GYNs who they want to staff their OB floor they'll ask for OB fellowship trained anesthesiologists.

the most difficult OB patients are the cardiac ones. The rest is easy. Honestly the ability to do TEE is probably more life saving on OB than anything you learn in an OB fellowship.

 

[OTCAwesome]

It is within their wheelhouse. Definitely. But many places the cardiac folks dont do as much of that stuff.
For example, when I was a resident, my attending had never placed an LMA. Seriously. This was 15 years after the lma came out

Academics are completely different than the "real world" most of us practice in. Personally I'm critical care trained, do probably 50% CV then the rest is everything else under the sun including lots of sick OB and regional. I do not do sick peds because the volume is not high enough for me to maintain my comfort level and we have several peds trained partners.

To the poster that said no-one at their shop touches the TEE probe unless they are boarded in CV and echo, I think that's overkill, sounds more like people protecting their turf. I have my basic and passed the advanced, are we not allowed to learn anything new unless we go back to fellowship slave labor to do it? Just a thought.

 

[Southpaw]

the most difficult OB patients are the cardiac ones. The rest is easy. Honestly the ability to do TEE is probably more life saving on OB than anything you learn in an OB fellowship.

I don’t disagree with a thing you said. I still believe an OB fellowship has value in certain practices.

 

[Southpaw]

To the poster that said no-one at their shop touches the TEE probe unless they are boarded in CV and echo, I think that's overkill, sounds more like people protecting their turf. I have my basic and passed the advanced, are we not allowed to learn anything new unless we go back to fellowship slave labor to do it? Just a thought.

I agree, it is overkill. Doesn’t matter what I think though as that’s what the credentials committee of the hospital decided.

 

[amyl]

LOOOOL, 325k a year to do liver take backs and cardiac. Pretty sure every cardiac attending I know cannot block for jack and hasn't put in an epidural since residency. So basically you want someone who is TEE proficient and maybe a tad quicker putting in an IJ. I'm not Cardiac trained so I guess I can't run a norepi, epi, or milrinone gtt if I needed to. Also don't know to place a radial a line on a patient with a 20% EF or severe LM disease. Can't read an ABG either or transfuse when needed.

Even at a Level 1 center you need a diverse set of anesthesiologists, INCLUDING general non cardiac ones man. What good is someone who can read a TEE but can't do an inter scalene or pop...or hasn't put in a spinal/epidural in years...esp when the VAST majority of your cases are ortho/ENT/plastics/gen surgery. You don't need trauma exposure to do a crani either....

No. You misunderstand me. Partners do the big cases… our day docs (325k) do not take trauma, liver or cardiac call or do any of those cases. They don’t take call at all which makes them day docs 7-3 m-f 6 weeks vacation, full benefits. We have two days docs now and they go to surgery centers half the time and cover care team with General cases the other half. We don’t make them do Neuro or any of the other bad 💩 we do. Ability to do the big cases is only for the partners… we do have other kind of cases, hence the desire for day docs.
We have recently been a little frustrated with the crnas and thus all the partners agreed it’s worth a pay cut to hire more docs. Day docs and partner track people. The two jobs are very different.

 

[UscGhost]

Of course partners take the money of the employees and partnership track docs. Just like the hospital and AMCs take from their employees.
The difference is in the partner model, you at least have a chance of becoming partner and being on the receiving end of that money you gave when you first joined. With the other employment options, you dont get ANY chance at that extra money, yet that is preferable to you ?

It just sounds like a lot of guys on here making 300-400 refusing to see how the guys making 600k+ got there. Must be by "scamming". No, we invested our sweat equity and time and took a risk.... so if you dont do that, and dont take on the costs and burdens of running a group i dont feel bad when I look at my w2...

Of course it all depends on the numbers and the partnership. But you should be able to vet those things before you commit.

That's the usual mentality of the senior guys. They make that much because they game the schedule..pick rooms or lucrative lineups or have a pyramid shaped compensation scheme.

The risk you took was buying in and hoping the pyramid didn't collapse before you got to the top. And now you sell the new guys on that same plan. Eventually someone gets screwed in this game of hot potato...you just hope it's not you.

I don't necessarily have a problem with the idea that you got there first and decided to take that risk. But I do dislike the idea that these systems rely on new grads coming out who don't have enough experience to know better

 

[amyl]

Also we don’t haze the partner track people… they take exactly the same amount of call as partners do. We see them as junior colleagues just doing the time we did…. They would probably like to do away with the track altogether but those of us that just made partner and had to do our time wouldn’t vote for it.
They don’t get stuck in the OR any later than partners - they often go home earlier because there’s someone else that wants the $. They are only salaried for the first year so the second year they are compensated for time worked. While they do take a small percent age off the top - 10 then 5% when you make partner you are given 100,000$ worth of stock.
We are a very fair group - maybe not every USAP division is like us… I don’t know.

 

[OptionOffense]

We have recently been a little frustrated with the crnas

Whats going on with the CRNAs? They are undermining the super-partners?

AAs dude.
www.anesthetist.org

 

[nimbus]

It is within their wheelhouse. Definitely. But many places the cardiac folks dont do as much of that stuff.
For example, when I was a resident, my attending had never placed an LMA. Seriously. This was 15 years after the lma came out.

Academics doesn’t reflect the larger world.


At most of our sites, cardiac folks typically spend 20% of their time doing hearts. The rest of their time is spent doing everything else. When they’re doing the other stuff, they’re more likely to be doing aortic cases, livers, chest cases. Typically higher end cases.


Also our younger cardiac folks do plane blocks and extubate stable uncomplicated hearts in the room.

 

[D P356]

For a while, a lot of practices hired a regional team or guy who did the regional for every one on the schedule. That was his job. I always found that unfair cuz that is an easy job. So if youve been at that job you wont be good at regional. Usually it was these regional fellowship guys who really cannot do anything else but blocks. (can barely intubate-ive seen it).
But i agree, generally speaking cardiac folks are usually not the greatest regionalists or anything else. Cardiac is too easy. The plan and case is always the same.

Non-physician syntax appreciated; Ban hammer is now on standby

 

[dabears505]

The big company will pay you 4-450 forever. If you do partner track, you will get 2 years of 300 and 550-600 where I live. As a new grad, I think it's foolish and shortsighted to go to the AMC. So what if you somehow don't become partner. You get experience and you can always find the AMC job. If it works out, you stand to make a ton more.

 

[Twiggidy]

Cardiac is too easy. The plan and case is always the same.

Hilarious

 

[chocomorsel]

Where is this?!?!

A place where you run around like a chicken with your head cut off putting out CRNA fires in a 1:4 scenario every damn day.
I bet it’s also really cold and grey.

 

[USCTrojan11]

Imagine growing your business to a point where you need a business partner for whatever reason…need more capital, need expertise, need someone to share the work, etc. Now imagine telling that potential business partner you are going to haze him for 3+ years, give him the worst schedule, and his compensation will be proportionally less. At the end of those 3+ years….maybe, just maybe, you’ll actually be a partner in the business. Yeah, good luck with that in the real business world.

I once interviewed at a partnership that the track was 8 years. At the end of the 8 years you were eligible for partnership when one of the current partners decided to retire…so the track was effectively a lot longer than 8 years. They were paying below market at the time for the track…maybe $300k. The partners were all making $1.5-2 million by my estimate…possibly more. There are way more examples of egregious partnership tracks like this than the 1 year tryout and nominal share buying that is fair.

Agree to disagree.

Here's the actual real life scenario of a group. YOU, as the OG partner bring in $800 +/- $100 depending on the year. You've built this single employee LLC for the past 6 years and things are picking so you need a new partner. Now you project expand revenue (NOT PROFITS) by 50% when new guy starts (surgeons asking for more cases). Over the next 3 years, you ramp up to a 100% aka double the revenue (because it takes time to get that new person up to speed, credential at all sites, learning call responsibilities, for you to recruit more surgeons, surgeons recruit more patients by expanding their referral base or recruit more surgeons to their group, etc - doesn't happen with a flip of a switch). Over the first 3 years, your "new guy" is guaranteed $400 each plus a signing bonus to afford moving costs. Also he splits the schedule evenly and doesn't have to worry about collections, contracts, billing. At the end of year 3, he makes partner. Year 4 he makes $800 +/- $100. He also didn't have to take out the loan 6 years ago to afford the startup costs, didn't have to advertise or endear himself to get contracts. Finally, you made good on your contract and paid him $400 in a covid year when ASCs were closed while you took a giant hit and only paid yourself $350 in 2020.

Sign me up for that deal anyday. Hell, I'd do it for a lot less to get access and equity in that group.

Your alternative is just make $425k a year in a "fair" AMC or hospital employed group with no growth, no ability to expand and 20-30 year olds with MBAs but no healthcare or real world experience questioning why Dr. Ortho is telling him you won't do a case and reminding you that Dr. Ortho makes a lot of money for the hospital.

It'd be hard for me to feel motivated when I know I could mail it in and make the same pay. Waking up for a 4am crani hits different when the collections go to your pocket rather than knowing if you slept through the call and delayed it til 7am, you'd get the same paycheck.

 

[nimbus]

The big company will pay you 4-450 forever. If you do partner track, you will get 2 years of 300 and 550-600 where I live. As a new grad, I think it's foolish and shortsighted to go to the AMC. So what if you somehow don't become partner. You get experience and you can always find the AMC job. If it works out, you stand to make a ton more.

But it’s only 550-600 if they can attract more suckers to work for 300. If not, partner income will decline. What if the anesthesia shortage continues and the group needs to offer 450 to the new hires when you become partner? One needs to find out what proportion of the partner income is subsidized by the new hires and what the income would be if everyone got paid the same. Is it a big ponzi or just a small one?


PS- my personal opinion but I think it’s just disrespectful to pay any new grad anesthesiologist $300k unless they are working very low hours.

 

[OptionOffense]

Agree to disagree.

Here's the actual real life scenario of a group. YOU, as the OG partner bring in $800 +/- $100 depending on the year. You've built this single employee LLC for the past 6 years and things are picking so you need a new partner. Now you project expand revenue (NOT PROFITS) by 50% when new guy starts (surgeons asking for more cases). Over the next 3 years, you ramp up to a 100% aka double the revenue (because it takes time to get that new person up to speed, credential at all sites, learning call responsibilities, for you to recruit more surgeons, surgeons recruit more patients by expanding their referral base or recruit more surgeons to their group, etc - doesn't happen with a flip of a switch). Over the first 3 years, your "new guy" is guaranteed $400 each plus a signing bonus to afford moving costs. Also he splits the schedule evenly and doesn't have to worry about collections, contracts, billing. At the end of year 3, he makes partner. Year 4 he makes $800 +/- $100. He also didn't have to take out the loan 6 years ago to afford the startup costs, didn't have to advertise or endear himself to get contracts. Finally, you made good on your contract and paid him $400 in a covid year when ASCs were closed while you took a giant hit and only paid yourself $350 in 2020.

Sign me up for that deal anyday. Hell, I'd do it for a lot less to get access and equity in that group.

Your alternative is just make $425k a year in a "fair" AMC or hospital employed group with no growth, no ability to expand and 20-30 year olds with MBAs but no healthcare or real world experience questioning why Dr. Ortho is telling him you won't do a case and reminding you that Dr. Ortho makes a lot of money for the hospital.

It'd be hard for me to feel motivated when I know I could mail it in and make the same pay. Waking up for a 4am crani hits different when the collections go to your pocket rather than knowing if you slept through the call and delayed it til 7am, you'd get the same paycheck.

I dont care about your problems. Market rate plus 20percent just for having to read that.

 

[Mman]

I dont care about your problems. Market rate plus 20percent just for having to read that.

market rate is about $350-$400K per year

 

[GravelRider]

Agree to disagree.

Here's the actual real life scenario of a group. YOU, as the OG partner bring in $800 +/- $100 depending on the year. You've built this single employee LLC for the past 6 years and things are picking so you need a new partner. Now you project expand revenue (NOT PROFITS) by 50% when new guy starts (surgeons asking for more cases). Over the next 3 years, you ramp up to a 100% aka double the revenue (because it takes time to get that new person up to speed, credential at all sites, learning call responsibilities, for you to recruit more surgeons, surgeons recruit more patients by expanding their referral base or recruit more surgeons to their group, etc - doesn't happen with a flip of a switch). Over the first 3 years, your "new guy" is guaranteed $400 each plus a signing bonus to afford moving costs. Also he splits the schedule evenly and doesn't have to worry about collections, contracts, billing. At the end of year 3, he makes partner. Year 4 he makes $800 +/- $100. He also didn't have to take out the loan 6 years ago to afford the startup costs, didn't have to advertise or endear himself to get contracts. Finally, you made good on your contract and paid him $400 in a covid year when ASCs were closed while you took a giant hit and only paid yourself $350 in 2020.

Sign me up for that deal anyday. Hell, I'd do it for a lot less to get access and equity in that group.

Your alternative is just make $425k a year in a "fair" AMC or hospital employed group with no growth, no ability to expand and 20-30 year olds with MBAs but no healthcare or real world experience questioning why Dr. Ortho is telling him you won't do a case and reminding you that Dr. Ortho makes a lot of money for the hospital.

It'd be hard for me to feel motivated when I know I could mail it in and make the same pay. Waking up for a 4am crani hits different when the collections go to your pocket rather than knowing if you slept through the call and delayed it til 7am, you'd get the same paycheck.

3 years to get someone up to speed? You need to recruit better.

But yeah, agree to disagree. Nominal buy-ins and some risk-taking on potential partners is fine. 3+ year partner tracks that inflate the pay of partners are Ponzi schemes. You also forget to mention that your potential partner CAN’T take out loans to start a practice or take on the risks of building a new practice because we live in a world of exclusive contracts.

 

[Mman]

But yeah, agree to disagree. Nominal buy-ins and some risk-taking on potential partners is fine. 3+ year partner tracks that inflate the pay of partners are Ponzi schemes.

definitely not a ponzi scheme. The worst you could say is that it is like a pyramid scheme, except that once you make partner you are on the top of the pyramid too so not the same as MLM companies. Then again, if you are already making as much or more money on a partnership track as you would get paid to be an employee elsewhere, what's the difference? I took less money to work on a partnership track because I knew long term I would make way more money and that turned out correct.

The problem comes when people expect to be made partner and are not. That's a problem.

 

[OptionOffense]

definitely not a ponzi scheme. The worst you could say is that it is like a pyramid scheme, except that once you make partner you are on the top of the pyramid too so not the same as MLM companies. Then again, if you are already making as much or more money on a partnership track as you would get paid to be an employee elsewhere, what's the difference? I took less money to work on a partnership track because I knew long term I would make way more money and that turned out correct.

The problem comes when people expect to be made partner and are not. That's a problem.

Whatever nomenclature you want to use to make you feel better. Its a house of cards. I dont wanna be your partner. Pay me market rate plus 20% just to have to endure the complaining of your flimsy exclusive contract where you have to endear yourself.

 

[vector2]

Another area I see a difference among new hires is that some can reliably provide lung isolation with a DLT while others can’t.

We had a mixture of a too big residency expansion + declining thoracotomy/VATS/esophagectomy cases over the last couple years.....and the struggle here is real. Indeed, 10-20 lung isolation cases, especially if a lot of them are "easy" trauma VATS on a skinny 20 yr old with an old retained hemopneumo s/p GSW, are not sufficient to to be comfortable with the full spectrum of difficult pts with difficult DLT placement getting difficult thoracic surgeries.

 

[ERRES2288]

market rate is about $350-$400K per year

For a non track reasonable call taking position, market rate is 400-450k

 

[GravelRider]

definitely not a ponzi scheme. The worst you could say is that it is like a pyramid scheme, except that once you make partner you are on the top of the pyramid too so not the same as MLM companies. Then again, if you are already making as much or more money on a partnership track as you would get paid to be an employee elsewhere, what's the difference? I took less money to work on a partnership track because I knew long term I would make way more money and that turned out correct.

The problem comes when people expect to be made partner and are not. That's a problem.

The overwhelming majority of partnership tracks I have seen pay below market rate. You also get laughed at when asking to review the finances before making a commitment. Can you imagine trying to recruit a business partner in the real world and then laughing at him when he wants to review the finances before committing? Anesthesia groups are insulated by exclusive contracts from market forces that would require them to play fairly. AMCs wouldn’t exist if not for exclusive contracts.

 

[amyl]

Whats going on with the CRNAs? They are undermining the super-partners?

AAs dude.
www.anesthetist.org

have a plan in place to start making that happen once they can get licensed in Texas. Crna lobby has prevented thus far.

 

[OptionOffense]

have a plan in place to start making that happen once they can get licensed in Texas. Crna lobby has prevented thus far.

Are your CRNAs acting up?

I thought they had it in Texas?

 

[xClashx]

Anyone know how the chronic pain job market is in GA, NC, CO, Texas?