how much is this job worth?

[rick roller pump]

We are currently in the process of negotiating a salary increase with our hospital
Job:
hospital employed W2
semi-rural midwest
100% supervision 3:1/4:1
Wide case mix including peds, hearts (separate team), complex OB, many blocks
14-16 weeks vacation
18000 ASA units/year/FTE (we are very busy when we are at work)
Current salary in mid 500s, heart guys make about 100k more
Our argument is that although salary and vacation is good for a hospital employed position, we are highly busy/productive and thus deserve higher compensation. We have a projected shortage that we need to fill. Additionally nearby hospital where apparently they work less hard actually pays slightly more.

Any other thoughts on negotiation would be helpful. I enjoyed the comments on a recent similar MGMA thread.

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[GassYous]

"Look at the facility fees for one case and compare that to what we are asking for."

 

[Guillemot]

I love these threads that ask what a job is worth, but have huge omissions in the necessary information.

 

[rowsdower88]

Call schedule? 401k matching? Home call? Busy OB/nights/weekends? How much is it costing to fill the shortage with a locums or are you currently stepping up to staff it?

 

[Gaseous Clay]

How are you calculating your units produced/FTE? If you are supervising/medical directing, are you taking 100% of the units or 50%? 18k units for a medical direction practice is not abnormally high.

Basically there is a lot more information one needs. A practice could easily pay a consultant well over $10,000 to give them data analysis for a proper negotiation. Call requirements, payer mix, and total compensation would be helpful. Your group may want to pay for the MGMA and Sullivan Cotter data to help. But at the end of the day, you could spout off all kinds of data and support but if the hospital doesn't want to pay you any more, are you going to threaten to leave or just go home with your tail between your legs?

Based off the limited info you gave, I'd say the compensation is fair especially with that time off. You are well above the national average and I am surprised the hospital is cool with that unless you're working 1 week of call at a time and call back rates are high.

 

[rick roller pump]

Call roughly q14 in house (busy covering ORs and OB), pre and post day off. Rarely sleep much during call with ORs and OB. 24h in house weekend about 10 per year. About 20k 401k contribution from employer. Currently we are working more to fill in the gaps when short, tolerable now but could get worse.
Regarding the units, my understanding is that 18k is just our share, so does not count the CRNA time units. We do all the procedures.

 

[Howard888]

I wouldn’t pay the cardiac team any more. That’s unusual anywhere I’ve ever worked. As you said you hussle with OB and blocks. The only reason to pay cardiac more would be if they work more hours. Same hours same pay.

I would just ask to be paid same as hearts as that is what is industry standard

 

[buccsmf1]

Call roughly q14 in house (busy covering ORs and OB), pre and post day off. Rarely sleep much during call with ORs and OB. 24h in house weekend about 10 per year. About 20k 401k contribution from employer. Currently we are working more to fill in the gaps when short, tolerable now but could get worse.
Regarding the units, my understanding is that 18k is just our share, so does not count the CRNA time units. We do all the procedures.

dunno, sounds pretty decent. i think i'd trade the pre-call day off for the ability to come in at 3pm on your weekday call, eliminating the 24 hour call at least on the weekdays.

 

[BLADEMDA]

We are currently in the process of negotiating a salary increase with our hospital
Job:
hospital employed W2
semi-rural midwest
100% supervision 3:1/4:1
Wide case mix including peds, hearts (separate team), complex OB, many blocks
14-16 weeks vacation
18000 ASA units/year/FTE (we are very busy when we are at work)
Current salary in mid 500s, heart guys make about 100k more
Our argument is that although salary and vacation is good for a hospital employed position, we are highly busy/productive and thus deserve higher compensation. We have a projected shortage that we need to fill. Additionally nearby hospital where apparently they work less hard actually pays slightly more.

Any other thoughts on negotiation would be helpful. I enjoyed the comments on a recent similar MGMA thread.

Ask for $50K to narrow the pay with the Cardiac group. Your job is pretty good but if the Cards people get 14 weeks off they have it even better.

 

[rick roller pump]

I wouldn’t pay the cardiac team any more. That’s unusual anywhere I’ve ever worked. As you said you hussle with OB and blocks. The only reason to pay cardiac more would be if they work more hours. Same hours same pay.

I would just ask to be paid same as hearts as that is what is industry standard

They take more call, are busier when at work, and do have longer hours (often have to stay late to finish a heart or structural case when otherwise they would have gone home) hence the pay differential. I would take my job over theirs even with the pay difference.

 

[abolt18]

I wouldn’t pay the cardiac team any more. That’s unusual anywhere I’ve ever worked. As you said you hussle with OB and blocks. The only reason to pay cardiac more would be if they work more hours. Same hours same pay.

I would just ask to be paid same as hearts as that is what is industry standard

And everywhere I looked for jobs, cardiac made more (typically $30-100K).

 

[Volatile]

What time do you usually get off during the week? You’re ~3 calls/month so pretty light call but it sounds busy when you’re there. The 14-16wks of vacation is definitely high. All seems fairly reasonable. I guess if i was having to work until 5-6pm on my day shifts and I was busy the entire time that would get old. If I were getting off closer to 3pm then it’s not a bad gig, even if you’re busy. Also, what are the surgeons/CRNAs like? If your colleagues are mostly miserable to work with, no amount of money is going to make it better

 

[PainDrain]

Are you hiring????

 

[nimbus]

I wouldn’t pay the cardiac team any more. That’s unusual anywhere I’ve ever worked. As you said you hussle with OB and blocks. The only reason to pay cardiac more would be if they work more hours. Same hours same pay.

I would just ask to be paid same as hearts as that is what is industry standard

Probably a smaller pool of people taking more call than the rest of the group. Some cardiac anesthesiologists do 17-18k units/yr by themselves.

 

[DesiredMemberName?]

I wouldn’t pay the cardiac team any more. That’s unusual anywhere I’ve ever worked. As you said you hussle with OB and blocks. The only reason to pay cardiac more would be if they work more hours. Same hours same pay.

I would just ask to be paid same as hearts as that is what is industry standard

If the cardiac team takes more call, regularly stays later, and is billing more startup units, they should be paid more.

If the CV work is high complexity/acuity and fellowship training is required, they should be paid more for the ability to do cases that others can’t.

If the market is paying more for cardiac (and it generally is), they should be paid more to facilitate recruitment/retention.

 

[Gaseous Clay]

Pre and post call days off, 14-16 weeks off, and making mid 500s? Are you staying past 3-4 PM on normal days? Honestly, you are making out pretty well.

From my understanding, physician units when supervising are calculated by taking 50% (so if you are covering 3-4 rooms, you get 50% and the CRNA gets 50%). I have some data from probably about 7 years ago when I was in the southern region and the MGMA mean and median ASA units were 19,328 and 19,180 respectively (southern being key as this is heavily supervison/direction).

My opinion, keep admin happy and don't rock the boat. I understand this maybe a high stress job, especially being up most of the night. One thing is about OB. Do you cover all epidurals and the CRNA will do the C-section? Having CRNAs available in house along with you for OB could really help you out more than asking for $50k each.

 

[rick roller pump]

Average day ends around 3-4. Can be after 6 if you are in the late spot but not too often. Early out days where you are out before noon. We have CRNAs in house, but our volume at night necessitates this (otherwise we would need more than 1 MD). So we would do the epidural and manage, but they would sit the section.

Thanks everyone for the feedback. With the market being hot, I keep hearing about people clearing 600-700 so helpful to hear peoples thoughts.

 

[rick roller pump]

Are you hiring????

yes, you can message me if you would like. people are easy to get a long with. good relationship between docs and CRNAs

 

[BLADEMDA]

Average day ends around 3-4. Can be after 6 if you are in the late spot but not too often. Early out days where you are out before noon. We have CRNAs in house, but our volume at night necessitates this (otherwise we would need more than 1 MD). So we would do the epidural and manage, but they would sit the section.

Thanks everyone for the feedback. With the market being hot, I keep hearing about people clearing 600-700 so helpful to hear peoples thoughts.

Your job is solid. In this market you can ask for another $50K and likely get it. But, with 16 weeks off it's hard to demand $600K so a raise of $50K seems more realistic.

 

[JoelJoel84]

This is one of the easiest and cushiest jobs I’ve seen on this forum in a long time.

Don’t blow it.

 

[vector2]

This is one of the easiest and cushiest jobs I’ve seen on this forum in a long time.

Don’t blow it.

I mean, I don't know if I'd go that far. The job sounds solid but I think average anesthesiologist is probably doing 10,000 to 15,000 units per year. If they're doing 18,000 with supervision and with that much time off then they're probably busting ass when they are there. Either through long hours or being a 4:1 pre-op monkey who spends all their time in holding and fudges all the TEFRA direction steps.

 

[rick roller pump]

As vector pointed out, hours are quite reasonable, however we are working very hard when there so would not call it cush. We are there for induction and critical portions and do all the procedures, but operate very lean

 

[IlDestriero]

You need to recognize that the extra 8 weeks of vacation alone is worth close to 100k. Don’t get too greedy.
Sounds pretty solid, but I’d retire before I covered 1:4, or even 1:3 honestly. YMMV.

 

[JoelJoel84]

I’m not trying to be too critical or a pain in the a, but with pre and post call day off , this job is essentially:

Working 3 days a week, with 16 weeks vacation , and getting a CRNA to sit the stool all night when you are call, for 550k.

Plus covering 1:3 during the day is really not that bad, especially if you have other CRNAs handling the breaks. It’s the 4th room that somehow always pushes the day into a bad place.

We cover 1:4 (when covering), and are on call overnight solo , doing both the ORs and busy OB in between. For the same money and half the vacation, with no pre call day off.

Not the best situation right now for us, but just a comparison for how your situation isn’t too bad.

 

[rick roller pump]

I’m not trying to be too critical or a pain in the a, but with pre and post call day off , this job is essentially:

Working 3 days a week, with 16 weeks vacation , and getting a CRNA to sit the stool all night when you are call, for 550k.

Plus covering 1:3 during the day is really not that bad, especially if you have other CRNAs handling the breaks. It’s the 4th room that somehow always pushes the day into a bad place.

We cover 1:4 (when covering), and are on call overnight solo , doing both the ORs and busy OB in between. For the same money and half the vacation, with no pre call day off.

Not the best situation right now for us, but just a comparison for how your situation isn’t too bad.

By pre-call off, I mean that you don't come in until late afternoon on call day. Perhaps I am using that term wrong. So on a call week I would work 4 shifts total but the call shift is 14-15 hours.

Overall agree though that we do have it good. I was just trying to see what members on this board thought, since lately with the hot market many groups have been asking for more salary/stipend. Even when things are good, they can always be better.

Appreciate those that took the time to respond. It is helpful to compare hours/salary as the market seems to be rapidly changing.

 

[PpfSuxTube]

I would just ask to be paid same as hearts as that is what is industry standard

What industry do you work in?

 

[narcotics999]

Get the local market rate. If the hospital down the street pays more with better life style, your hospital should match.

 

[medicine2wallstreet]

Alright disclaimer I'm just a resident but this job sounds un friggin believable. Can't imagine a better job honestly. This is well past any of the groups I'm currently interviewing with. Almost a damn joke it's so good. 14-16 weeks vacation? Come on man. I don't care how bad ob is at night. Ob is easy as hell. The only thing that would make this a moderately difficult job on night call is if you're getting blasted by peri arrest traumas.

Is this a troll post by OP?

There is no such thing as complex ob no matter what high risk labels OB says. Drive the needle push the drug. Get the video scope for hostile airway. If things get bad cause of bad tone bomb the patient with volume. Ob patients can tolerate so much anyways. Again, ob is easy.

14 weeks vacation and 550k salary. Out by 3 or 4 most days. I mean let's be real here.

If you aren't a level I trauma center, which I surmise you aren't because no mention of trauma, this is a cush job.

 

[ucladoc2b]

Ob is easy as hell.

You lost me at this.

 

[livefree1212]

Alright disclaimer I'm just a resident but this job sounds un friggin believable. Can't imagine a better job honestly. This is well past any of the groups I'm currently interviewing with. Almost a damn joke it's so good. 14-16 weeks vacation? Come on man. I don't care how bad ob is at night. Ob is easy as hell. The only thing that would make this a moderately difficult job on night call is if you're getting blasted by peri arrest traumas.

Is this a troll post by OP?

There is no such thing as complex ob no matter what high risk labels OB says. Drive the needle push the drug. Get the video scope for hostile airway. If things get bad cause of bad tone bomb the patient with volume. Ob patients can tolerate so much anyways. Again, ob is easy.

14 weeks vacation and 550k salary. Out by 3 or 4 most days. I mean let's be real here.

If you aren't a level I trauma center, which I surmise you aren't because no mention of trauma, this is a cush job.

High risk OB without an extra set of hands can be terrible and exhausting. If this job is 4:1 at all times and high acuity it wouldn’t exactly be a cakewalk. The unique aspect of this job seems to be a much higher level of PTO in lieu of salary. Otherwise it doesn’t seem like a dream job by any measure

 

[crash2500]

Alright disclaimer I'm just a resident but this job sounds un friggin believable. Can't imagine a better job honestly. This is well past any of the groups I'm currently interviewing with. Almost a damn joke it's so good. 14-16 weeks vacation? Come on man. I don't care how bad ob is at night. Ob is easy as hell. The only thing that would make this a moderately difficult job on night call is if you're getting blasted by peri arrest traumas.

Is this a troll post by OP?

There is no such thing as complex ob no matter what high risk labels OB says. Drive the needle push the drug. Get the video scope for hostile airway. If things get bad cause of bad tone bomb the patient with volume. Ob patients can tolerate so much anyways. Again, ob is easy.

14 weeks vacation and 550k salary. Out by 3 or 4 most days. I mean let's be real here.

If you aren't a level I trauma center, which I surmise you aren't because no mention of trauma, this is a cush job.

 

[medicine2wallstreet]

I'm no expert by any means in anesthesia but I assuredly have spent enough time on OB to decide that I think it is easy in comparison to other things in anesthesia. The reason most anesthesiologists don't like it is because of awake and screaming patients.

 

[ucladoc2b]

I'm no expert by any means in anesthesia but I assuredly have spent enough time on OB to decide that I think it is easy in comparison to other things in anesthesia. The reason most anesthesiologists don't like it is because of awake and screaming patients.

And the obesity, unrealistic expectations, undiagnosed scoliosis, questionable c/s calls at 0300, undiagnosed placental attachment issues and the resulting MTP, aspiration risk, pre eclampsia/eclampsia instability , difficult airways…

 

[medicine2wallstreet]

I'm not trying to start an argument. It's just my opinion.

 

[pgg]

I actually like (or don't mind) OB for the most part, but the baby and family bring a dimension of risk and stress that other cases just don't have. It's not generally the technical ease or difficulty that makes it unpleasant.

Residents are well shielded from the worst things in anesthesia - it's not your credit card yet.

Also be wary of thinking you've got enough time anywhere in any subspecialty to make generalizations like that. The learning curve is still pretty steep when you finish residency. New graduates are safe, but it takes time to get good.

 

[rick roller pump]

Alright disclaimer I'm just a resident but this job sounds un friggin believable. Can't imagine a better job honestly. This is well past any of the groups I'm currently interviewing with. Almost a damn joke it's so good. 14-16 weeks vacation? Come on man. I don't care how bad ob is at night. Ob is easy as hell. The only thing that would make this a moderately difficult job on night call is if you're getting blasted by peri arrest traumas.

Is this a troll post by OP?

There is no such thing as complex ob no matter what high risk labels OB says. Drive the needle push the drug. Get the video scope for hostile airway. If things get bad cause of bad tone bomb the patient with volume. Ob patients can tolerate so much anyways. Again, ob is easy.

14 weeks vacation and 550k salary. Out by 3 or 4 most days. I mean let's be real here.

If you aren't a level I trauma center, which I surmise you aren't because no mention of trauma, this is a cush job.

Not a troll post and I can assure there are much easier jobs out there. Perhaps I misrepresented our acuity. We are level 1 trauma, cover young peds as a generalist, have a generally sick pt population, and complex ob (see ucladoc's post). Add the high supervision ratio on top of that. Not saying our schedule isn't great, but we work very hard when we are at work.

 

[medicine2wallstreet]

Not a troll post and I can assure there are much easier jobs out there. Perhaps I misrepresented our acuity. We are level 1 trauma, cover young peds as a generalist, have a generally sick pt population, and complex ob (see ucladoc's post). Add the high supervision ratio on top of that. Not saying our schedule isn't great, but we work very hard when we are at work.

All those things add up then yeah I get it now. Young peds and level I trauma with all that is the real deal.

 

[PpfSuxTube]

Alright disclaimer I'm just a resident but...

you were doing great until here...

Ob is easy as hell

Interesting

There is no such thing as complex ob

That's cool too.

Cool down lad, you will get your pants pulled down soon enough....

Overall the job is pretty chill I do agree but I'm a cardiac guy and intensivist so I've been lucky enough to have seen a lot and can do a lot. Quick. A bad bleed on OB or afe is the worst. Perimortem section or hysterectomy stay with you for weeks

 

[sevo00]

I'm not trying to start an argument. It's just my opinion.

Your opinion is wrong

 

[aneftp]

Get the local market rate. If the hospital down the street pays more with better life style, your hospital should match.

It doesn’t matter what the market rate is. I tell a lot of folks. As long as someone is willing to stay and work under certain conditions and pay scale. Employers have no incentive to increase pay. You can bitch all you want. You can tell employees x competitors is paying this much for less work load.

Employers won’t care. Only things employers care about is staffing. If mass exodus threaten to leave. Say 15 docs. If more than 30% threaten to leave at one time. It a ball game over for the employer. They cannot recruit 3-4 new docs in 3 months.

 

[aneftp]

Get the local market rate. If the hospital down the street pays more with better life style, your hospital should match.

It doesn’t matter what the market rate is. I tell a lot of folks. As long as someone is willing to stay and work under certain conditions and pay scale. Employers have no incentive to increase pay. You can bitch all you want. You can tell employees x competitors is paying this much for less work load.

Employers won’t care. Only things employers care about is staffing. If mass exodus threaten to leave. Say 15 docs. If more than 30% threaten to leaveIt a ball game over for the employer. They cannot recruit 3-4 new docs in 3 months.

 

[<(^_^)>]

Average day ends around 3-4. Can be after 6 if you are in the late spot but not too often. Early out days where you are out before noon. We have CRNAs in house, but our volume at night necessitates this (otherwise we would need more than 1 MD). So we would do the epidural and manage, but they would sit the section.

Thanks everyone for the feedback. With the market being hot, I keep hearing about people clearing 600-700 so helpful to hear peoples thoughts.

The people clearing 700 generally don’t have 16 weeks of vacation though. You currently make 15,277 per work week. If you take 10 weeks that’s 641k. Or if you work 50 hours a week that’s 305 dollars an hour. 340 an hour at 45 hours a week. Even if the hours are high intensity that’s pretty good pay.

 

[Modoc]

sounds like a great gig tbh

 

[anbuitachi]

There are ways to negotiate. Can trade vacation for higher pay. But I agree with above, will be difficult to increase much with that much time off.

 

[IlDestriero]

I'm not trying to start an argument. It's just my opinion.

Our OB coverage includes fetal surgery, and that’s not just a walk in the park.

 

[medicine2wallstreet]

I've done intrauterine fetal transfusions. Anything more complex than that is only done at extremely high levels of hospital care at a few select centers in the nation and is very clearly not a part of normal obstetric anesthesia services. But feel free to tell me how it's difficult.

 

[Dr. Rude]

I've done intrauterine fetal transfusions. Anything more complex than that is only done at extremely high levels of hospital care at a few select centers in the nation and is very clearly not a part of normal obstetric anesthesia services. But feel free to tell me how it's difficult.

Epidural or Prop sux tube. Agonizing decision.

 

[Status Sciaticus]

 

[NICMAN]

I'm no expert by any means in anesthesia but I assuredly have spent enough time on OB to decide that I think it is easy in comparison to other things in anesthesia. The reason most anesthesiologists don't like it is because of awake and screaming patients.

You've never crashed on ECMO due to AFE with complete thrombo-embolization of the pulmonary arteries/RV or had to do a crash section/hysterectomy with MTP on a morbidly obese patient with no pre-natal care who was bleeding out who you find out later had multiple elective abortions and C/S.s with placenta percreta.

Experience is a sometimes harsh instructor.

 

[nimbus]

I'm no expert by any means in anesthesia but I assuredly have spent enough time on OB to decide that I think it is easy in comparison to other things in anesthesia. The reason most anesthesiologists don't like it is because of awake and screaming patients.

So what are the hard things you do in anesthesia?