Cedars Union Vote

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I told you non LA based peeps many years ago. Those ob anesthesiologists were raking in over 7 figures even during the leaner anesthesia years for most of anesthesia and it was a two tier system where someone like my friend got crappy payor mix and the old guard took lucrative insured mainly ob private patients.
 
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aneftp said:
I told you non LA based peeps many years ago. Those ob anesthesiologists were raking in over 7 figures even during the leaner anesthesia years for most of anesthesia and it was a two tier system where someone like my friend got crappy payor mix and the old guard took lucrative insured mainly ob private patients.
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Interesting about 10 years ago or so when Cedars was "private" they were offering a salary of around 350k where you only get paid for cases worked .... (the era of the two chairs if you know who I am talking about ) ie if you are on call you get paid ZERO unless you do a case and according to their "fair" distribution you are making around 350k on average..... I guess it was all a lie if you are saying their guys were making 7 figure salaries.... the current Cedars recruiter was posing himself as an arrogant dismissive ....pr*** at the last ASA....
 
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lotsapain said:
Interesting about 10 years ago or so when Cedars was "private" they were offering a salary of around 350k where you only get paid for cases worked .... (the era of the two chairs if you know who I am talking about ) ie if you are on call you get paid ZERO unless you do a case and according to their "fair" distribution you are making around 350k on average..... I guess it was all a lie if you are saying their guys were making 7 figure salaries.... the current Cedars recruiter was posing himself as an arrogant dismissive ....pr*** at the last ASA....
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Ob for private insurers is extremely profitable.

They keep that for themselves

The new kids get the crap Payor mix. I’m an old timer on these boards. I’m not that old but old timer sorta I’ve been around the block. I have friends all over the nation. My brother is out in Los Angeles also.

This gig has been going on in the private practice at cedars for over 3 decades.

I’m surprise cedars took them in as w2. Most places resist w2 in California. My brother practice the hospital tried to take them as w2 and they all formed a uniform stance giving the hospital a big F U a year ago. When you have a common stance with all members of the practice the hospital is F’d

But guess cedars had too much disagreements within the practice so easy for hospital to take over.
 
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It makes me absolutely sick to see this story play out over and over. And the story is older greedy ANESTHESIOLOGISTS screwing over their younger counterparts. When did we all become such shysters??
I’m in a group now that was advertised as democratic and equal but now that I’m here I realize that it is anything but. The ones at the top simply schedule themselves for the most favorable assignments; they generate enough RVUs during the week and by 3pm that they do better than the rest of us do. They do better financially taking little to no call than the rest of us do taking full call. All of us have recognized how the system seems to work, and the few at the top just look at us like “what are you going to do about it?”
The worst thing about the human race is HUMANS and their despicable behaviors.
 
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Blockit said:
It makes me absolutely sick to see this story play out over and over. And the story is older greedy ANESTHESIOLOGISTS screwing over their younger counterparts. When did we all become such shysters??
I’m in a group now that was advertised as democratic and equal but now that I’m here I realize that it is anything but. The ones at the top simply schedule themselves for the most favorable assignments; they generate enough RVUs during the week and by 3pm that they do better than the rest of us do. They do better financially taking little to no call than the rest of us do taking full call. All of us have recognized how the system seems to work, and the few at the top just look at us like “what are you going to do about it?”
The worst thing about the human race is HUMANS and their despicable behaviors.
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The market is in your favor.

Quit. Get your coworkers to quit. Either they will change, take call, or be in breach of contract.
 
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ucladoc2b said:
The market is in your favor.

Quit. Get your coworkers to quit. Either they will change, take call, or be in breach of contract.
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I definitely see that; there are plenty of locum opportunities in the greater metropolitan area that I am in, however many of these assignments are at a variety of hellscapes that most don’t want to work at. In addition, it is nice to see $350/hr for any locum opportunity, but once you factor in self-employment tax, fed/state/local tax it is the same earning potential if not a little bit better than where I am at now.
 
Blockit said:
I definitely see that; there are plenty of locum opportunities in the greater metropolitan area that I am in, however many of these assignments are at a variety of hellscapes that most don’t want to work at. In addition, it is nice to see $350/hr for any locum opportunity, but once you factor in self-employment tax, fed/state/local tax it is the same earning potential if not a little bit better than where I am at now.
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Cash defined benefits plan. Tax advantages

Though California s corp franchise fees suck.

If u make say 600k 1099. At most only 300k of that income is exposed to taxes.

So you will more than makeup ur 15.6% self employment taxes. Save on Medicare surtaxes as well. It all adds up.
 
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Well so this is the thing. If I assume 650k of 1099 income, that is about 250k of SEP/fed/state/local (depending on state of course).
So 400k income. Subtract from that expenses (malpractice, health, life, 401k) and maybe I’m left with 300k. So essentially my w2 income is 300k. How is that better? What am I missing?
 
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Blockit said:
Well so this is the thing. If I assume 650k of 1099 income, that is about 250k of SEP/fed/state/local (depending on state of course).
So 400k income. Subtract from that expenses (malpractice, health, life, 401k) and maybe I’m left with 300k. So essentially my w2 income is 300k. How is that better? What am I missing?
Click to expand...
You can put away 150-200k pretax into defined benefits plan pretax. Depending on your age.

Another 40k pretax section 179
Another 70-80k pretax business expenses
Healthcare 20k
Pay ur spouse (are they working? ) if not they can be your officer manager pay them 25k. Put another 23k pretax into retirement

Than what is left is what you really pay state and federal taxes on

Vs getting taxed on almost the entire 650k income (minus ur 401k pretax)

So 200k plus more income is exposed to taxes 35% plus 9-10% California state income taxes)

You would save at least 50k in taxes even accounting for self employment taxes. Save probably another 2-3k in Medicare taxes as well
 
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Blockit said:
Well so this is the thing. If I assume 650k of 1099 income, that is about 250k of SEP/fed/state/local (depending on state of course).
So 400k income. Subtract from that expenses (malpractice, health, life, 401k) and maybe I’m left with 300k. So essentially my w2 income is 300k. How is that better? What am I missing?
Click to expand...


You may be confusing W2 with after-tax “take home” income. If your W2 says 300, you still need to pay taxes on that amount.
 
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Ahhh…that is why I love coming here. You all educate me!
So that 250k figure I quoted was on 650k of income, but it sounds like I could deduct all of those items that you mentioned before everything gets taxed? So pay self employment tax/fed/state only on the income left AFTER all of those things are deducted?
I’m not sure why I thought that you had to pay all that tax on your gross income.
 
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aneftp said:
You can put away 150-200k pretax into defined benefits plan pretax. Depending on your age.

Another 40k pretax section 179
Another 70-80k pretax business expenses
Healthcare 20k
Pay ur spouse (are they working? ) if not they can be your officer manager pay them 25k. Put another 23k pretax into retirement

Than what is left is what you really pay state and federal taxes on

Vs getting taxed on almost the entire 650k income (minus ur 401k pretax)

So 200k plus more income is exposed to taxes 35% plus 9-10% California state income taxes)

You would save at least 50k in taxes even accounting for self employment taxes. Save probably another 2-3k in Medicare taxes as well
Click to expand...
How do defined benefit plans work if you are self-employed? Do you have to have an accountant set it up? Are there group plans to join? Also, Does anyone do these plans for just the side business locums work if they have a steady W-2 gig?
 
Pharmado said:
How do defined benefit plans work if you are self-employed? Do you have to have an accountant set it up? Are there group plans to join? Also, Does anyone do these plans for just the side business locums work if they have a steady W-2 gig?
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If you generate or expect to generate more than 400-500k of 1099 income and expect to have at least 100k plus disposable income you don’t need

If you are asking these questions. You really need some help that is beyond many people on these boards are willing to walk you through

Just google cash plan vs defined benefits. Charles Schwab and others have those options.

If you expect just to make 30-100k side 1099 income. Solo 401k or sep ira is better option.

Just be careful with sep ira which is super easy to setup and fund and the pro rata rules for backdoor Roth conversion or else you may be heading towards double taxation with the pro rata rules
 
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aneftp said:
You can put away 150-200k pretax into defined benefits plan pretax. Depending on your age.

Another 40k pretax section 179
Another 70-80k pretax business expenses
Healthcare 20k
Pay ur spouse (are they working? ) if not they can be your officer manager pay them 25k. Put another 23k pretax into retirement

Than what is left is what you really pay state and federal taxes on

Vs getting taxed on almost the entire 650k income (minus ur 401k pretax)

So 200k plus more income is exposed to taxes 35% plus 9-10% California state income taxes)

You would save at least 50k in taxes even accounting for self employment taxes. Save probably another 2-3k in Medicare taxes as well
Click to expand...
Defined benefit plan varies HEAVILY based on age and has a certain number of years you need to keep 1099 income. Worth it to some, but probably not the younger anesthesiologists.

I am very curious what business expenses you are writing off to get to 70-80k. Not doubting you, but would love to learn more.
 
aneftp said:
I’m surprise cedars took them in as w2. Most places resist w2 in California. My brother practice the hospital tried to take them as w2 and they all formed a uniform stance giving the hospital a big F U a year ago. When you have a common stance with all members of the practice the hospital is F’d
Click to expand...

Is this PIH? I heard something similar happened there.

Group asked for more money, hospital tried to bring them in house, group said “thanks, but no thanks.” Once the hospital realized they wouldn’t be able to keep the ORs running and lights on, they paid up.
 
Blockit said:
It makes me absolutely sick to see this story play out over and over. And the story is older greedy ANESTHESIOLOGISTS screwing over their younger counterparts. When did we all become such shysters??
I’m in a group now that was advertised as democratic and equal but now that I’m here I realize that it is anything but. The ones at the top simply schedule themselves for the most favorable assignments; they generate enough RVUs during the week and by 3pm that they do better than the rest of us do. They do better financially taking little to no call than the rest of us do taking full call. All of us have recognized how the system seems to work, and the few at the top just look at us like “what are you going to do about it?”
The worst thing about the human race is HUMANS and their despicable behaviors.
Click to expand...
Yeah and that’s why hospitals are bringing in anesthesia in house everywhere.

When you can’t keep your own house in order, you invite external forces

Surgeons, nursing staff and junior docs complain about these issues is a big factor here
 
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Blockit said:
It makes me absolutely sick to see this story play out over and over. And the story is older greedy ANESTHESIOLOGISTS screwing over their younger counterparts. When did we all become such shysters??
I’m in a group now that was advertised as democratic and equal but now that I’m here I realize that it is anything but. The ones at the top simply schedule themselves for the most favorable assignments; they generate enough RVUs during the week and by 3pm that they do better than the rest of us do. They do better financially taking little to no call than the rest of us do taking full call. All of us have recognized how the system seems to work, and the few at the top just look at us like “what are you going to do about it?”
The worst thing about the human race is HUMANS and their despicable behaviors.
Click to expand...


You really need a system where everybody can pick their own daily schedule. Otherwise the designated “schedulemaker” is much too powerful.
 
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Agreed. Or at least have firm rules about how the schedule is assigned. It isn’t clear to me exactly how the administrative leaders of the group actually got those positions, but it appears that they are not democratically elected by the rest of the members.
 
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nimbus said:
You really need a system where everybody can pick their own daily schedule. Otherwise the designated “schedulemaker” is much too powerful.
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Picking own rooms can be problematic as well. I have seen systems where the senior guys pick certain days to be high priority because they know the good lineups are on those days.

You just need a neutral intermediary (either a person or system design) so that the schedule maker can't directly influence which person gets which cases.
 
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UscGhost said:
Picking own rooms can be problematic as well. I have seen systems where the senior guys pick certain days to be high priority because they know the good lineups are on those days.

You just need a neutral intermediary (either a person or system design) so that the schedule maker can't directly influence which person gets which cases.
Click to expand...


That is a valid point.

Just have Qgenda assign the numbers. Distribution of days of the week are easily trackable. If the best lineups are usually on Monday and Tuesday, you don’t want all your #1 days to be on Friday. Qgenda can generate a report of how many Mondays or Fridays each person gets over a quarter or over a year.
 
Blockit said:
Agreed. Or at least have firm rules about how the schedule is assigned. It isn’t clear to me exactly how the administrative leaders of the group actually got those positions, but it appears that they are not democratically elected by the rest of the members.
Click to expand...


I’ve seen 3 different types.

1. Very fair minded people who do it out of a sense of duty. These people often sacrifice their own needs to meet the requests of the rest of the department.

2. People who want to manipulate the schedule to their own advantage.

3. People who are voluntold because nobody else wants to do it. It’s a difficult job.
 
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aneftp said:
Ob for private insurers is extremely profitable.

They keep that for themselves

The new kids get the crap Payor mix. I’m an old timer on these boards. I’m not that old but old timer sorta I’ve been around the block. I have friends all over the nation. My brother is out in Los Angeles also.

This gig has been going on in the private practice at cedars for over 3 decades.

I’m surprise cedars took them in as w2. Most places resist w2 in California. My brother practice the hospital tried to take them as w2 and they all formed a uniform stance giving the hospital a big F U a year ago. When you have a common stance with all members of the practice the hospital is F’d

But guess cedars had too much disagreements within the practice so easy for hospital to take over.
Click to expand...
Met a guy in one of my locums journeys who's group started infighting because the OB guys worked like dogs and complained all the time. However they didn't want to give up their OB shifts to the rest of the group who wanted to help them out and ease their loads. Yup. The greed is real in medicine.
Also just met another guy who was a founding member of a group out West who also didn't want to give the new guys access to OB because "the OBs didn't want an ever ending pool of different people". Yeah dude sounds like greed to me. Was also raking in 7 figures before expenses. He left because his group was becoming too socialist. haha
 
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aneftp said:
Ob for private insurers is extremely profitable.

They keep that for themselves

The new kids get the crap Payor mix. I’m an old timer on these boards. I’m not that old but old timer sorta I’ve been around the block. I have friends all over the nation. My brother is out in Los Angeles also.

This gig has been going on in the private practice at cedars for over 3 decades.

I’m surprise cedars took them in as w2. Most places resist w2 in California. My brother practice the hospital tried to take them as w2 and they all formed a uniform stance giving the hospital a big F U a year ago. When you have a common stance with all members of the practice the hospital is F’d

But guess cedars had too much disagreements within the practice so easy for hospital to take over.
Click to expand...

I have been around as long or longer and yes LA gigs are mostly 1099 Cedars broke that mold sometime ago when the Old guard departed.
 
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Blockit said:
It makes me absolutely sick to see this story play out over and over. And the story is older greedy ANESTHESIOLOGISTS screwing over their younger counterparts. When did we all become such shysters??
I’m in a group now that was advertised as democratic and equal but now that I’m here I realize that it is anything but. The ones at the top simply schedule themselves for the most favorable assignments; they generate enough RVUs during the week and by 3pm that they do better than the rest of us do. They do better financially taking little to no call than the rest of us do taking full call. All of us have recognized how the system seems to work, and the few at the top just look at us like “what are you going to do about it?”
The worst thing about the human race is HUMANS and their despicable behaviors.
Click to expand...

Its a simple pattern, the have-nots get angry then at some point become the HAVEs and the pattern repeats itself ... people are greedy by default so is everyone on this forum (but to a different extent). Show me a doctor who now does medicine for medicine? Anesthesia is not even a real profession in the eyes of the surgeons, GIs etc.... as we do not bring cases in.... (in Germany its in reverse for example)...... the administrators are NOT physicians (or even health professionals) who never understand the underlying issues by not ever living them..... yes humans are a virus one that destroys everything in its path.... you can also thank social media though the "old guard" were what they were way before.....

get rich quick schemes - its the same story over and over with Mednax, USAP, Napa, Envision buying practices only to find out later "oh why did we sell we are now screwed" ......... GREED....

Hospitals buying out practices may not be a solution either now you are really their bitch with no buffer zone.... the few solid private practices with good unit value are still going strong, have the best negotiating power (how do you kick out 60 people?!?!) and longevity. Everyone was short sighted who's fault is that .....
 
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nimbus said:
I’ve seen 3 different types.

1. Very fair minded people who do it out of a sense of duty. These people often sacrifice their own needs to meet the requests of the rest of the department.

2. People who want to manipulate the schedule to their own advantage.

3. People who are voluntold because nobody else wants to do it. It’s a difficult job.
Click to expand...

Definitely between 3 and 1 for me. Definitely among my less enjoyable days in the hospital.
 
GassYous said:
Heard that one before
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I asked him how were new associates and partners who were hungry supposed to make a more fair income and he said "Well they can take call other places, like doing Livers". I kid you not. So.... You mean to tell me the transplat surgeons on one of the most compliated transplants around want an ever ending pool of new faces, but, but, the super highly skilled, dealing with death daily (cough cough) OBs do NOT? SMH. Greed is a powerful rationalizer.

Same dude showed me the numbers he was making out with USAP out west direct contracting as a locums, but when I asked him who his contacts were, he kept pushing it off and saying "well, they only bought out my contract from the agency because they want me to lead the team, you won't get the same rate" etc. Dude why are you gatekeeping a practice where you are a locums and not even an owner? People are so damn weird. Many really think THEY are special and deserve good things while others deserve scraps. Selfish.
 
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Doesn't California have a corporate practice of medicine law that would prevent the hiring of W2's? Sounds like its toothless lol
 
makemoney2024 said:
I asked him how were new associates and partners who were hungry supposed to make a more fair income and he said "Well they can take call other places, like doing Livers". I kid you not. So.... You mean to tell me the transplat surgeons on one of the most compliated transplants around want an ever ending pool of new faces, but, but, the super highly skilled, dealing with death daily (cough cough) OBs do NOT? SMH. Greed is a powerful rationalizer.

Same dude showed me the numbers he was making out with USAP out west direct contracting as a locums, but when I asked him who his contacts were, he kept pushing it off and saying "well, they only bought out my contract from the agency because they want me to lead the team, you won't get the same rate" etc. Dude why are you gatekeeping a practice where you are a locums and not even an owner? People are so damn weird. Many really think THEY are special and deserve good things while others deserve scraps. Selfish.
Click to expand...

You don’t get it. We/they/I deserve it. You don’t.
 
makemoney2024 said:
So how have they done it for Cedars Sinai all these years? As 1099s?
Click to expand...
They create a separate medical group (in this case Beverly Anesthesiology) that employs the docs and is technically owned/run by physicians. Same as Kaiser with its Permanente Medical Group model.
 
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