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general surgery job market

Discussion in 'Surgery and Surgical Subspecialties' started by salmonella, Nov 18, 2006.

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  1. salmonella

    salmonella Gram-Negative Rods

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    I recently heard stories about new general surgeons starting at $150,000 to $200,000 in reasonable size cities. I mean, some of the cushy and less prestigious medical subspecialties make at least that much. Why salary so low, considering the long grueling g surg training, bad lifestyle, shortage of surgeons, high prestige and increasing surgical safety? Is the job market going to get better at all?
  2. Pilot Doc

    Pilot Doc SDN Angel Moderator Emeritus

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    Most of the factors you cit "grueling training, high prestige" have no bearing on salaries. There are essentially two variables that determine starting salaries.
    1) income produced by the surgeon
    2) # of applicants for the job

    Lots of people want to live in reasonable size cities compared to small, rural communities. These cities have an ample supply of surgeons and high HMO penetration. So there aren't as many cases to go around, they reimburse less than average and lots of people want the jobs.

    Employers pay the least amount necessary to fill a job. If $150K will do it, why pay more?
  3. Enough

    Enough

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    The short answer is supply and demand. At this time there are more general surgeons than there are jobs. (Some areas may have a shortage – but not enough to make the difference).

    The second reason is that most general surgery residents graduating are in so much debt that they are willing to take any salary above a $100,000. (When in reality some PA (Physician Assistant) are making more money)



    "Is the job market going to get better at all?" answer is No! Not any time soon.
  4. Bovie9

    Bovie9 Member

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    I am still a resident, but I get a whole lot of those recruiting letters. I just got one yesterday- Colorado general surgery, excellent location, blah, blah, blah. It boasted a 300K guaranteed income.
  5. BaylorGuy

    BaylorGuy Enter witty comment here

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    Do it!
  6. Enough

    Enough

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    Watch-out for those “guaranteed income or income guarantees” ; In most case it means guaranteed income for $300 thousand for one or two years, but if you do not collect that amount plus your malpractice insurance and overhead cost, then you have to pay back the difference.

    It is away to lure you into the area.

    In most cases, you will not be able to collect $300 plus @60,000+ (malpractice) plus @ one third of you income goes to overhead $100,000+

    A total of $460,000.00

    Unless you are living in the hospital doing tons of cases your first two years, you will not be able to collect $460,000

    In realistic cases, private groups are hiring from $90,000 to $180,000. Hospitals can afford to pay more and offer from $125,000 to $220,000 but with strings attached.

    Remember nothing is for free.

    FYI – On average a general surgeon collects from insurance companies only a third of what is billed out. For example, if you bill out $100,000 you only get (collect) $30,000. The rest the insurance company’s CEO and investors eat it up.
  7. Faebinder

    Faebinder Slow Wave Smurf

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    The estimate is pretty straight forward I thought...

    $350 for a lap choly? Lets say you do 3 a day.

    That's $1050 a day.

    That's $4200 a week (4 days work + 1 day clinic (many are 3+2)).

    That's 48 weeks of work = $201,600 (raw, no taxes or insurance).

    What I am not including is how much you get paid for call, seeing people in followup and what you miss out on from accounts collectable and what the insurance (medicare/medicaid) refuses to pay.

    Someone with more experience can correct me of course but that's the rough estimate...
  8. Winged Scapula

    Winged Scapula Cougariffic! Administrator Lifetime Donor

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    Sorry, follow-up is included in the billing. You cannot bill extra for seeing a patient post-op within 30 days; its included in your $360 (or so) for doing the lap chole/whatever.
  9. Rook16

    Rook16 Neophyte

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    90k? what is this peds?
  10. Enough

    Enough

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    You are assuming that you are the only talent in town and will get most if not all of the gallbladder. Very few surgeons will do 3 gallbladders a day times 4 days a week.

    I have be out for 3 ½ years, and the group that hired me can not afford to continue to pay me $165,000. In reality, they are paying $165,000 plus $56,000 (malpractice) plus $60,000 overhead. A total of $281,000.


    It is quiet depressing sitting down every three months with our billing company, and see how much was billed out, how much is collected and how much is pending approval.


    The Insurance companies have the upper hand because the service has already been done. It’s not like you can put the colon back into the abdomen if they refuse to pay or pay you less. We are, after all these years of education and training, begging with our hands out from people who barely finish high school.
  11. Enough

    Enough

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    No general surgery.

    Private groups and even hospitals in the east coast can not afford to pay a lot of money. YOU as the well educated and well trained specialist have to generate income. With the dropping insurance reimbursement for your hard work and the liability as a surgeon, you are needed by the community but you do not generate enough income. The insurance companies are holding on to your money and laughing all the way to the bank.
  12. The_Sensei

    The_Sensei Removed

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    That's all?!?! Glad I went into anesthesia....:)
  13. salmonella

    salmonella Gram-Negative Rods

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    But anesthesia could potentially be replaced by CRNAs, whereas no mid level professionals could ever replace general surgeons. Don't you think in long term gen surg offers more job security?
  14. Enough

    Enough

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    Very strong point! That is the best advantage surgeons have, it take at a minimum 9 years after college to make a surgeon and no one can do our job. But the low reimbursement and high malpractice is killing our profession.
  15. Bovie9

    Bovie9 Member

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    This would be a VERY stupid thing to do!! Why the hell would somebody that wants to be a surgeon go into anesthesia??
  16. salmonella

    salmonella Gram-Negative Rods

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    I guess it's pretty cool that as an anesthesiologist, you will have the ability/talents to help the surgeon out without actually "getting your hands dirty." Sitting on a comfy chair to watch operation could be more fun than actually doing it. Unfortunately I've heard too many horror stories about how surgeons mistreat their anes colleagues. Have you guys seen that actually happen?
  17. Leukocyte

    Leukocyte Senior Member

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    ..Only BEHIND their backs. Honestly dude, how would you imagine a situation will end if a 5'7 dude surgeon "mistreats" a 5'9 dude anesthesiologist? I think we dudes learnt that in high school!:cool:

    Yes, one time during my MS3 year, a surgeon did raise his voice on an attending anesthesiologist...they both got suspended via orders from their department's chair person.
  18. FliteSurgn

    FliteSurgn This space for rent.

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    Bigger cities will have lower salaries overall compared to smaller cities. Once again, supply and demand is what controls how much someone is willing to pay a new doc to come there.

    Since I just went through a job search after leaving the military, I can give some insight to the job market. There are plenty of jobs available, but you may have to be flexible about where you go. My wife and I had a fairly good idea where we wanted to end up so we concentrated on a few decent-sized Midwestern cities, but also entertained offers from a few "headhunters". Almost every offer was for at least $200k with a one-year guarantee. This is in addition to your overhead (rent, malpractice, etc). Some guarantees were all the way up to $400k. Most also offered a production bonus and you would convert to production-based pay if you overcame your guarantee during the guarantee period. Otherwise, you would switch to production-based pay at the end of your guarantee period.

    In the end, I took an offer that I found on my own by writing a letter to the practices in an area that I wanted to live. Since the area was more desireable, the guarantee wasn't quite as high as some of the other offers I had, but the potential was phenomenol. Our overhead is less than 20% and the other partners bring home $400-$800k per year. I billed $120k my first month and our collection rate is about 40-50%. If I continue at that rate, I'd overcome my guarantee amount in less than 6 months. I work about 40 hours per week and take one weeknight of call during the week plus every fifth weekend.
  19. salmonella

    salmonella Gram-Negative Rods

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    [QUOTE=Leukocyte;4420692]..Only BEHIND their backs. Honestly dude, how would you imagine a situation will end if a 5'7 dude surgeon "mistreats" a 5'9 dude anesthesiologist? I think we dudes learnt that in high school!:cool:

    Yes, one time during my MS3 year, a surgeon did raise his voice on an attending anesthesiologist...they both got suspended via orders from their department's chair person.[/QUOTE]


    How often does "mistreatment" happen in private practice world?
  20. The_Sensei

    The_Sensei Removed

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    No. Anesthesiologists will always be in demand and will NEVER be replaced by nurses.
  21. The_Sensei

    The_Sensei Removed

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    They wouldn't....:confused:
  22. The_Sensei

    The_Sensei Removed

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    Those who are mistreated allow themselves to be mistreated. Please do not mistake silence on the part of an anesthesiologist while a surgeon is having a tirade as being abusive. Often times the anesthesiologist is taking the moral high ground allowing the immature surgeon to vent and therefore continue with the operation thus optimizing patient care. The mistreatment of anesthesiologists by surgeons is more urban legend than anything else. In my 4 years of private practice, I have had nothing but collegial relationships with EVERY surgeon with whom I work. Several are very good friends of mine who often hang out with me.
  23. The_Sensei

    The_Sensei Removed

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    Almost never.
  24. dynx

    dynx Yankee Imperialist

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    I spent some time in a private CT surg practice. The difference there is that everyone knows eachother very well. Its great. They all work with each other very often since there isnt 20 residents in for 5 attendings rotating through different areas every day. The dynamic is much different because they both voice complaints without getting butt-sore since they know each others personality.

    Greatest exchange ever:
    anesthesia:how's your daughter application doing for residency?
    Surgeon: She was going to apply to anesthesia so I pulled her out of medical school and made her a hooker so she could earn a respectable living.

    If you ever made this joke in academic medicine **** would fly. Everyone is so damn uptight.
  25. Enough

    Enough

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    I do not know where you are practicing, but if you would tell us I would love to move there and make $800,000.

    It sounds like a fantasy.

    Unless you are one of three surgeons in the state.
  26. FliteSurgn

    FliteSurgn This space for rent.

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    The average reimbursement for a lap chole is actually closer to $1000.
  27. FliteSurgn

    FliteSurgn This space for rent.

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    Wow, come right out and call me a liar. Whatever. Our practice is busy and we're all quick. We do a ton of cases. For example, today was my half-day, I did a lap inguinal hernia and a trach/PEG then 2 hours in the office. We're off for the Holiday and I'm back on Monday with a lap inguinal hernia, 2 lap ventral hernias, an umbilical hernia, a lap chole, a venous access port, and a colon resection. I'll be done by 3pm. Our overhead is very low. That all adds up to lucrative income potential. I've billed over $250k since starting in September...and I'm complaining that I'm not busy enough. I could add quite a bit of surgical volume without sacrificing my time at home with the wife and kids.

    I just saw new survey numbers yesterday...the median income for a general surgeon in practice at least 3 years is over $300k. The average starting salary right out of residency is $200k. And the average starting salary for an experienced surgeon seeking a new place is $250k.

    I guess we both know which side of those averages we each fall on.
  28. supercut

    supercut Senior Member

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    Salaries aren't dictated by how much time you spent in training. They are dictated only by how much revenue you can generate. Which is dependent on 2 things:
    How much payors are willing to pay (decreasing rapidly and annually)
    How many cases you do.

    Translation: To maintain the same revenue, because you are getting paid less per procedure, you have to do more cases each year.

    Ultimately the money in the surgeon's pocket is revenue-expenses. Since revenue decreases and expenses increase regularly, you can predict the outcome.

    You better be in this for the fun rather than the money.
  29. Surgeon24

    Surgeon24 Member

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    FliteSurgn,

    Two questions:

    1-) How many days a week do you operate? What is your typical week routine? (clinic time, office, etc..)

    2-) Are you working in a private clinic?
  30. Leukocyte

    Leukocyte Senior Member

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    I do not think she is calling you a liar. She is just surprized/curious (as I am). $800,000/year is above the MAXIMUM avarage that is compliled by legitamate physician survey companies like AMGA and Allied-Physicians.

    You are not a liar, you are just an exception to the rule. Maybe it is because you are a smart businessman, or maybe because you are practicing in a "physician shortage area", or...

    The thing is the OP was asking for AVERAGE compensation, and youR income does not reflect that. It is good to see that there are surgeons who are making this much especially now with the DECLINING compensations.

    Good Luck.
  31. Leukocyte

    Leukocyte Senior Member

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    AMGA and Allied-Physicians have been in the business of physician surveyS for a very long time now to earn trust and legitimacy.

    Please refer to these links to get the most "accurate", "un-biased" physician compensations that you can possibly have:

    http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

    http://www.allied-physicians.com/salary_surveys/physician-salaries.htm

    Good Luck.
  32. Leukocyte

    Leukocyte Senior Member

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    As always Supercut, you are very right.:thumbup:

    Honest posts like yours always glow with truth and gives people like me confidence.

    Again, I appreciate your honesty VERY much!

    Good Luck!
  33. Pilot Doc

    Pilot Doc SDN Angel Moderator Emeritus

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    That is a completely true statement. The issue is the degree to which the best available data describes reality. There is good reason to think the correlation is poor.

    If your question is whether Specialty X makes more than Y, it's a decent tool. Regional variations in payment are of some utility as well. But if your question is how much a single surgeon will make in a given job, it's useless. Not to knock you or anybody else, but the data just doesn't exist.
  34. Leukocyte

    Leukocyte Senior Member

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    True. The data we have are just AVERAGES. Average starting, Average in 3 years, and Average maximum.

    So the "maximum" in the Allied-Physicians' survey is just an average of the maximum. It does not mean that a specific surgeon can only get paid so much. The maximum reported is $520,000...this means there are surgeons who are getting paid a maximum salary of less than $520,000, and there are surgeons who are getting paid a maximum salary of more than $520,000 (How much more than $520,000? We do not know. We do not have the "un-biased" data.)

    So basically, the "Maximum" that is reported on the Allied-Physicians' survey says, "it is possible to acheive a salary of $520,000". It does NOT say, "$520,000 is all you can possibly make".

    Thank you for clarifying my point.:)

    Good Luck.
  35. Smoke This

    Smoke This Sweet cuppin' cakes!

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    :laugh:
    Haha, I got that bull**** too. I'm only an intern! Reminds me of the job flyers all the Okies had in their pockets in The Grapes of Wrath when they showed up in CA.
  36. supercut

    supercut Senior Member

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    Wow...you've given me new hope. I've been teetering on the verege of quitting, but if there are truly jobs like this out there, I might hang on. I'd be very happy to be working only 40 hrs per week and making the money that you report. I've been hearing that you have to work your a$$ off in order to have any hope of barely covering your salary guarantee. Would your partners be OK with you if you decided that your current work load is enough for you?

    How far out of residency are you and how do you get to be so quick? At my current program, if I looked at the scheudule and saw the day you will have on Monday I would utter some explititvies because I would be in the OR til 6pm at least. THen I'd have to round again and wouldn't leave til 7 at least.
  37. FliteSurgn

    FliteSurgn This space for rent.

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    My partners and I all operate Monday through Friday. We each work 4 1/2 days per week. Currently, I have clinic one afternoon per week plus 2 hours in the morning of my 1/2 day. My partners do a little more clinic than I do since they have larger practices than I do.

    I am three years out of residency, but just entered private practice after having my services underutilized by the US Air Force for the last few years.
  38. FliteSurgn

    FliteSurgn This space for rent.

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    As long as I kept taking my fair portion of call, they wouldn't care. Our practice is an "eat what you kill" arrangement. We share overhead expenses (office rent, support staff, infrastructure, etc). So, you make what you bring in minus your share of the overhead.

    My residency training imparted a lot of confidence, independence, and speed. Being underutilized after residency significantly slowed down my usual operative pace, but I am starting to get it back now that I've started getting a caseload that challenges me...instead of 80% endoscopy like I had in the military.
  39. do2b4sure

    do2b4sure Removed

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    NO way, this is totally wrong for surgenry salary. I promise guys. My friend is also a surgeon and he ahs a huge huge house. It costs more than 90,000$ for sure.
  40. Taus

    Taus . Moderator

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    brilliant
  41. driedcaribou

    driedcaribou Senior Member Moderator Emeritus

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    Wow, that's great FliteSurgn - I'm glad you are able to find so much time for your family and make an impressive income.

    Is there any area of gen surg that you focus more on?
  42. merlin

    merlin Senior Member

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    In what way does where you trained, university vs. community, influence your chances in the job market, given that you want to be a general surgeon but that you want to practice in a place such as the Bay Area in N. Cali? If you train at a community program is that going to knock you out of the competitive job markets, saying you don't want to become an academic physician?
  43. MacGyver

    MacGyver Removed

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    Thats true in the short term, CRNAs are definitely more of a threat to MDAs than PAs/NPs are to surgeons. HOWEVER, not even surgery is immune from the long term threat. The UK just authorized NPs to do surgery.
  44. driedcaribou

    driedcaribou Senior Member Moderator Emeritus

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    It seems to me that the College of Surgeons in the UK should open up more training positions for doctors instead of monopolizing the market.
  45. Enough

    Enough

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    Where are the “Powerful Chairmans/Chairwomans” who flexed their muscle in M&M. They should be flexing their muscle to fight to protect this field from all of this assault.
  46. MacGyver

    MacGyver Removed

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    The bottom line is that the so-called "leaders" of most medical fields are too busy whoring out their professions to midlevels so they can bill for their procedures and make more money. They are close to retirement, so they view it as "cashing out" before the **** hits the fan.

    Same trend for radiology and outsourcing.

    Same trend for MDAs and CRNAs.

    Same trend for primary care and PAs/NPs

    350k isnt enough for these people, so they decide to sell out their field to midlevels so they could pull in 450k instead. The biggest problem in american medicine is greed at the top levels.
  47. MacGyver

    MacGyver Removed

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    Do you have evidence that there is a severe shortage of surgeons in the UK?

    BTW, the UK underwent this shift in policy not because people couldnt get their surgeries, but because its a cost cutting move.
  48. neolith77

    neolith77

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    My dad has been saying this for the last 7 years, and he's been practicing for 35 years. He's trying to get me not to go, saying it is a mistake due to this very thing.
  49. joejabjab

    joejabjab

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    what does your dad want you to do instead?
  50. Enough

    Enough

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    The field of surgery has changed so much in the past ten to twenty years. Forget the money, problems with reimbursement, malpractice, doing more work for less pay. What frustrates me the most is the lack of respect for the surgeon or at the least for the job of the surgeon.

    I was doing a difficult case last week and I needed help from the scrub nurse, circulating nurse and anesthesiologist; ……and they simply did not care. They were there for their shift work and I was demanding too much of them to do their job. What's even worse is if I yelled or complained, they would write me up and I would have to get sensitivity classes and my privilege maybe suspended.

    They’re stacking everything against us.

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