Job eval

[Pharmado]

Small-mid size Midwest city,
Hospital employed position, own cases/no supervision,
Eat-what-you-kill paying at a blended rate just under $30/unit 1st yr, just over $30 after
W-2 position, w/health/malpractice, tail coverage
Call 1:4 (about 50:50 home vs in-house), extra pay for in-house call amounting to ~25k/yr.
Av of 1200-1500 units/month per provider.
5% retirement (not sure if this is a 401k match or true retirement) with a 5 yr vesting.
Free to take vaca as you please, but it is unpaid.

A blended rate around $30 is not the greatest, but that is my take without anyone cutting into it. As a new grad, doing my own cases is appealing to give me real world experience. Any thoughts on this job?

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[deleted126335]

Big question. How are case/room assignments made?

 

[aneftp]

Small-mid size Midwest city,
Hospital employed position, own cases/no supervision,
Eat-what-you-kill paying at a blended rate just under $30/unit 1st yr, just over $30 after
W-2 position, w/health/malpractice, tail coverage
Call 1:4 (about 50:50 home vs in-house), extra pay for in-house call amounting to ~25k/yr.
Av of 1200-1500 units/month per provider.
5% retirement (not sure if this is a 401k match or true retirement) with a 5 yr vesting.
Free to take vaca as you please, but it is unpaid.

A blended rate around $30 is not the greatest, but that is my take without anyone cutting into it. As a new grad, doing my own cases is appealing to give me real world experience. Any thoughts on this job?

Sounds like an Apollo MD type of AMC job in Atlanta area a guy I knew worked at before he burned himself out. They are probably generating $50/unit even with accounting for Medicare and Medicaid patients. So they are easily shaving 40% off the top.

Expect to make $400-425k but work 60-65 hours a week.

1. Is it supervision or MD only?

2. What about holiday calls? Don't work for free. I wouldn't and expect a prelim to even be on call pre thanksgiving, thanksgiving or day after thanksgiving. Same with Xmas week.

These type of contracts are rigged to make it look like u are gonna to make money but the more u work the more the AMC makes. The less u work the more the AMC saves! They won both ways.

I find it hard to believe it's a true "hospital employed position". True Hospital employed position usually have guaranteed salary plus bonus/metrics. Because a true hospital would get blasted by shaving money off the top without a true guarantee income and get nailed with safe harbor violation with no pay vacation/eat what u kill structure.

 

[IlDestriero]

It sounds like a lot of work based on your average units in a direct provider practice and a crappy rate. Lose lose. The income will be fair, but you're doing $600k+ of work for ~$400k, so not so fair after all.
PS 1:4 sucks ass, especially when it's 1:3 when your "partners" are on vacation.

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Il Destriero

 

[urge]

1200 to 1500 u/month solo is a lot of work. That's easily over 70 hrs /week.

I used to supervise 2 to 4 rooms every day with late call once a week and was averaging around 2000/month.

I think you should keep looking.

 

[deleted162650]

You can easily do better than that in a desirable location. No way I'd take a job in a "small Midwest city" for that mediocre pay.

 

[Pharmado]

Thanks for the advice. I wondered when discussing the job on the phone if perhaps they were trying to sell me a job that wasn't quite as good as advertised. I also didn't understand why a hospital was offering eat-what-you-kill based earnings.

As for the scheduling, that was a big immediate concern for me. It is made by the person on in-house 24hr call. That would mean that I would get my turn making the schedule, but I wouldn't ever be able to give myself the best room (since I'm making the schedule for when I'm post call) and would always be at the whims of the partners that have been around for a long time and are presumably giving the best cases to each other and not the new guy.

One questions maybe someone can answer, about how many units/hr do people tend to earn? Saying 1200-1500 units/month doesn't mean anything to me because I have no good concept yet of how many units you tend to generate. Urge is telling me that's 70hrs/wk, and quite frankly I don't want to work that much, and certainly not for the money this job would end up paying me. I've very recently started keeping track of the units I think I'm generating, but with the ridiculously slow rate at which cases proceed when done by surgical residents (and sometimes med students) I'm not sure how well it translates. Again, I appreciate all of the advice.

 

[Wiscoblue]

This sounds very much like Rockford, IL. Lousy place to live. Lousy patients and poor insurance mix. That is the reason the anesthesia group is employed and subsidized by the hospital. I bet the real blended unit is not a whole lot more than 35.


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[aneftp]

This sounds very much like Rockford, IL. Lousy place to live. Lousy patients and poor insurance mix. That is the reason the anesthesia group is employed and subsidized by the hospital. I bet the real blended unit is not a whole lot more than 35.


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Many underserved (doesn't even have to be rural) hospitals get millions federal funding. Especially blue states that opted in with obamacare. (Won't get too much into the politics of the ACA and coercion into opting in with federal funding of poorer hospitals)

Don't think a "poor hospital" is poor per se once the federal funding is added back.

Sure anesthesia may be a "losing dept/operating in the red" but those hospitals generally get millions to cover the losing departments.

It's how much the hospital admin values certain services is how much they decided to divide up the money.

 

[Notorious T.E.E.]

Small-mid size Midwest city,
Hospital employed position, own cases/no supervision,
Eat-what-you-kill paying at a blended rate just under $30/unit 1st yr, just over $30 after
W-2 position, w/health/malpractice, tail coverage
Call 1:4 (about 50:50 home vs in-house), extra pay for in-house call amounting to ~25k/yr.
Av of 1200-1500 units/month per provider.
5% retirement (not sure if this is a 401k match or true retirement) with a 5 yr vesting.
Free to take vaca as you please, but it is unpaid.

A blended rate around $30 is not the greatest, but that is my take without anyone cutting into it. As a new grad, doing my own cases is appealing to give me real world experience. Any thoughts on this job?

$30 per unit is not good. The value of the malpractice, retirement, health, and taxes is probably around $50k. If you add that and the $25k call pay to what you are likely to generate (14,500 units) you come out to total package over $500k. So, that isn't unreasonable, but Q4 call with some in house and working the post call day is a pretty bad lifestyle job. I'd keep looking.

 

[deleted162650]

I've very recently started keeping track of the units I think I'm generating, but with the ridiculously slow rate at which cases proceed when done by surgical residents (and sometimes med students) I'm not sure how well it translates.

Good on ya for doing that. Unless the PP job would have you doing big line-ups of super short cases very regularly, the difference between now and then won't be drastic when you're counting your units. Now you're just generating more time and less start-up units as compared to PP. You should still have a solid idea of how many hours it takes to bring in >12K units/mo which is substantial.

If you're open to/prefer practicing in small Midwest towns, then why are you even looking at these crap-ass AMC jobs. This is the last real gold mine in Anesthesia. Just ask some of the people on this board. Take advantage of your willingness to live in BFE.

 

[Pharmado]

Unfortunately, I haven't found the goldmine BFE job yet. I prefer rural areas because that's what makes my wife happy, and we have no real geographic restrictions (I've even contacted places in Alaska), but I don't have any connections. None of the few contacts that my program has provided have panned out yet. Hopefully that changes, but it hasn't so far. The job I mentioned above presented itself as a hospital employed position, but it does have similarities to AMC jobs. They talked big, but I always felt something wasn't exactly right. I appreciate everyone's comments and assistance.

 

[Notorious T.E.E.]

Unfortunately, I haven't found the goldmine BFE job yet. I prefer rural areas because that's what makes my wife happy, and we have no real geographic restrictions (I've even contacted places in Alaska), but I don't have any connections. None of the few contacts that my program has provided have panned out yet. Hopefully that changes, but it hasn't so far. The job I mentioned above presented itself as a hospital employed position, but it does have similarities to AMC jobs. They talked big, but I always felt something wasn't exactly right. I appreciate everyone's comments and assistance.

It's still pretty early assuming you are a 2017 graduate. You have plenty of time to search.