New HCA/NAPA Anesthesia Residency in Austin

[amyl]

Hca playing chess and everyone else playing checkers. They’re about to control the market while the ftc chases USAP. Not tomorrow no…. But setting themselves up to in the next few years. They don’t care if they turn out ****ty residents… ****ty residents can’t work elsewhere. In their minds, ****ty residents aren’t better than Crnas…. ****ty residents become ****ty staff. Hca can control them too

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[GravelRider]

I totally agree, but from the residents perspective what happens to them? Like clearly this program isn’t fit to be a program. On one side I get it, the education isn’t up to par with standards and this is no way to train competent anesthesiologists…. But at the same time, these individuals spent a lot of time and money to get to this point in their lives. This program was deemed acceptable according to the ABA even though it clearly isn’t. So what happens to the residents?

Maybe, but if this is a NAPA practice, I can guarantee you there are more than a couple disgruntled attendings willing to side with the residents and shake the tree a little bit. All of the NAPA true-believers out there made their millions with the private equity transactions and are not the rank and file at whatever little hospital this is. I guess I just don’t understand the story of a program being bad enough to prompt an ACGME site visit, but then pretending everything is fine when they actually do investigate.

Also, programs don’t go from being accredited to completely shutdown unless it’s truly something egregious. Usually there are warnings and probation periods before something drastic like a shut down happens.

 

[DolphinVA]

Hca playing chess and everyone else playing checkers. They’re about to control the market while the ftc chases USAP. Not tomorrow no…. But setting themselves up to in the next few years. They don’t care if they turn out ****ty residents… ****ty residents can’t work elsewhere. In their minds, ****ty residents aren’t better than Crnas…. ****ty residents become ****ty staff. Hca can control them too

Exactly this. From what I see across the drapes, HCA very happy selecting "untouchables" for their surgery and cardiology residents, bc they know their only option will be to stay within HCA after graduation. These are HCA apprenticeships, because even mediocre results are billable and add up to major profit if done in high volume.

 

[nimbus]

New CRNA program. Maybe it is just an innocent oversight but there is no mention of anesthesiologists in the description of their role.


“Certified Registered Nurse Anesthetists (CRNAs), registered nurses with specialized training in anesthesia, will be produced by the program. Upon completing the program and successfully passing the nurse anesthesia certification exam, these CRNAs will collaborate with various medical practitioners, including surgeons, dentists, and podiatrists, delivering a range of anesthesia services such as sedation, general and regional anesthesia, and pain management.“

UT Health San Antonio launches Texas' first nurse anesthesia program amid rising demand

SAN ANTONIO - In response to the increasing demand for anesthesia services, the UT Health San Antonio School of Nursing is introducing the region's first progra

news4sanantonio.com

 

[Shimmy8]

Local hospital (non-HCA) was PP but added a surgery residency. Killing productivity and slowing everything down. They’re losing surgeons now. OR productivity down. Larger stipend needed for anesthesia group. Can’t keep staff. Hiring their own ****ty grads now and doing 3-4 hour lap choles, etc.

These idiots can’t see the train wreck right in front of them. This all happened in a 5-6 year period too.

 

[amyl]

this generation of surgeons is lots more tolerant of crnas than the prior. They don’t care, they want their cases done. The liability issue is something nebulous off in the distance that may be an issue… most of them don’t think they are at all liable for crna only care…. All the GI drs we work with at the hospital have crna only care at the GI center… no interest in quality or even risk minimization…. Just get the cases done now and cheaper - it’s all about the money for them.

 

[Coffee PRN]

this generation of surgeons is lots more tolerant of crnas than the prior. They don’t care, they want their cases done. The liability issue is something nebulous off in the distance that may be an issue… most of them don’t think they are at all liable for crna only care…. All the GI drs we work with at the hospital have crna only care at the GI center… no interest in quality or even risk minimization…. Just get the cases done now and cheaper - it’s all about the money for them.

There is a Gi center near here that has RNs pushing propofol ….with the GI doc supervising.

 

[GassYous]

There is a Gi center near here that has RNs pushing propofol ….with the GI doc supervising.

That is a disaster waiting to happen

 

[neutro]

There is a Gi center near here that has RNs pushing propofol ….with the GI doc supervising.

“Delegation”

 

[Test Boy]

There is a Gi center near here that has RNs pushing propofol ….with the GI doc supervising.

I wonder who intubates if something goes south? I’m guessing the RN will attempt it.

 

[GasPerspectives]

Over the past five years, the number of anesthesiology residents in training has increased 16%. The past two years there has been a 4% increase each year in the number of total PGY-1 and CA-1 positions offered. It seems like HCA and community hospitals have started opening new residencies wherever they can to save on staffing costs so I expect this number to only accelerate in the coming years.

15 new CRNA schools are planning on opening this year and at least 10 new schools are looking to gain accreditation for 2025.

Is anyone else concerned by this? Obviously there is a shortage now but the market is inelastic.

 

[Bertelman]

Is anyone else concerned by this? Obviously there is a shortage now but the market is inelastic.

This is the cycle of anesthesia. Report comes out that we have too many. Applicants plummet. Economy tanks, prolongs retirements, positions plummet. Covid happens, old people retire in droves, theres a shortage. Anesthetist traveling spurs locums spending spree. Salaries skyrocket. Interest increased, spots increase. 10 yrs from now, there will be too many.

Welcome to the show.

 

[nimbus]

This is the cycle of anesthesia. Report comes out that we have too many. Applicants plummet. Economy tanks, prolongs retirements, positions plummet. Covid happens, old people retire in droves, theres a shortage. Anesthetist traveling spurs locums spending spree. Salaries skyrocket. Interest increased, spots increase. 10 yrs from now, there will be too many.

Welcome to the show.

Anesthesia is not free of samsara.

 

[GasPerspectives]

This is the cycle of anesthesia. Report comes out that we have too many. Applicants plummet. Economy tanks, prolongs retirements, positions plummet. Covid happens, old people retire in droves, theres a shortage. Anesthetist traveling spurs locums spending spree. Salaries skyrocket. Interest increased, spots increase. 10 yrs from now, there will be too many.

Welcome to the show.

Well I agree with you, in previous cycles the number of spots didn't necessarily increase/decrease, they just went unfilled in down years. That won't happen in the future with the growth of DO graduates + IMGs willing to fill any and all residency positions left over in the SOAP. HCA and for-profit hospital residencies are willing to staff their residencies with bottom of the barrel applicants to save on costs.

Once we have a surplus of providers, hospitals will be able to bend anesthesiologists over like never before considering how much reimbursement is decreasing for services. Before, private practices were able to shield themselves from the surplus as they didn't rely on stipends, but this won't be the case in the future. I'm afraid this is the last peak of the cycle you described before a long and steady decline indefinitely.

 

[ambiturner]

Over the past five years, the number of anesthesiology residents in training has increased 16%. The past two years there has been a 4% increase each year in the number of total PGY-1 and CA-1 positions offered. It seems like HCA and community hospitals have started opening new residencies wherever they can to save on staffing costs so I expect this number to only accelerate in the coming years.

15 new CRNA schools are planning on opening this year and at least 10 new schools are looking to gain accreditation for 2025.

Is anyone else concerned by this? Obviously there is a shortage now but the market is inelastic.

Of course that’s concerning, but I and many others would have assumed this dystopian future would already be here and yet somehow it isn’t. Demand for anesthesia is likely up about 16% in that same timeframe. There’s never been more crnas than today and somehow demand is as high as ever to hire them. And who would want to work at HCA anyway? Good jobs will be available for good people, the money might not be as crazy but I don’t think anyone predicted it would get to where it is now either.

 

[usnavdoc]

“Delegation”

You can only delegate what you are credentialed to personally do when it comes to a regular rn. So in the bylaws someone gave credentials to gi guys to do mod/deep sedation apparently

 

[neutro]

You can only delegate what you are credentialed to personally do when it comes to a regular rn. So in the bylaws someone gave credentials to gi guys to do mod/deep sedation apparently

Yeah
They can do that as per texas law

The issue is that they need to state that clearly on consent
Also they retain full responsibility of actions of person they’re delegating to

 

[drapesdowntubeout]

Just got a private message from a NAPA anesthesia residnet who wishes to remain anonymous. Their residency primary consists of doing cataracts and preoping for CRNAs. The SRNAs are primarily given all the learning cases. This is absolutely ridiculous and needs to be brought up to the ASA and ACGME. This is piss poor training just for the PE firm to get cheap labor to staff rooms. Anyone have contact for the ACGME? I will email and call them personally. Also would like to complain to NAPA

nuvance staffs a few small hospitals in my area, its a little guy in between multiple bigger entities

they have their own anesthesia group for most of their locations but for some of the more rural locations they inherited napa

they are not a malignant entity but a desperate one'

im confused as to how they are tied to austin tx residency program

Apparently they had contacted the acgme and when the acgme came for a site visit everyone was basically forced to lie out of fear of retaliation

Come on. It’s 2024. Whistleblowing or whatever you want to call it is the easiest thing in the world now. Everyone carries a recorder in their pocket. How would they force people to lie? Who is going to retaliate?

This program is in the most populated area of the country. If it got shut down, the ACGME could grant area programs a few more spots to absorb the residents. They would not be left stranded and the other programs would probably be happy to have the labor.

In the age of social media and ubiquitous recording devices, you would have to be either really insane or really dumb to threaten retaliation and “force” residents to lie (commit fraud if the program is not meeting certain educational requirements). I truly do not understand people who put up with situations like this when there are multiple ways out…whether it’s a job or something like this.

Hoya11 is the closest. GravelRider's first paragraph is sort of the point.... they didn't force anybody. Nuvance Health is a regional health system that was created when Western Connecticut Health Network and Health-Quest combined several years ago. Their goal seems to be focused on becoming a regional academic system. This anesthesia residency is associated with, contracted with, and serve as employees of Nuvance Health -- an important distinction. NAPA isn't hiring residents. Yes, NAPA staffs the attendings in the ORs, but whether it's them or a different group in the future, supporting the Nuvance residency is part of their contract with the hospital. Is it going to be someone's top rank or competing with Mayo Clinic? Likely not... but this is utter nonsense about only cataracts, SRNAs (there's only 1), and preoping for CRNAs. The training is solid.

This one disgruntled resident, who is probably less anonymous than they think, seems to be spreading false information across every interface they can. (SDN, discord, med student spreadsheet, ACGME). The site visit? Yeah... it's a little more involved than putting all the residents in the room and asking for a thumbs up or down. They dig through case logs, didactic calendars, etc. There was no coup.

Now whether HCA would hold NAPA to the same standard that Nuvance has, who knows....

 

[nycitygas]

In Houston, there is a GI center where the unsupervised CRNA also doubles as the circulator RN. I am not kidding. Similar situation in a pain center with an AA with previous RN training.

The job market is already turning. I give it 2-3 years and we will be flush with AA/CRNAs. 4 new CRNA programs and 2 AA schools in the works.

I find the younger employed proceduralists want nothing to do with unsupervised crna care. Why take the extra risk while not receiving any financial benefit? Anesthesiologists will enjoy a strong market for years especially since the new grads have no desire to work more than 40 hours a week. MD only practices will become a thing of the past here though.

 

[Howard888]

Your last sentence/paragraph is exactly why the market won’t be flush with AAs/CRNAs-I think we have 10 years at least with demand>>>supply.

MD only practices, of which there are still many, will be replaced by direction or supervision. Per ASA statistics, 85%+ of these practices rely on stipends. Hospital margins still at all time lows. Hospital administrators don’t get the math correct, but they’ll still view direction and supervision as cheaper and to be fair large systems can save a few million switching although it’s usually not half of what they think they’ll save. It’s already happened in several big areas recently.

These new schools won’t be nearly enough to replace current retirees, switch over md only practices, and cover the increasing population with ever increasing anesthetizing sites. Crna school applications actually have gone down at many places as traveling nurses can make so much and crna schools come with a ton of debt too.

New crna/as grads are no different than new MDs. 40 hour weeks tops, often less, as they try and get 3 12s. Many have part time aesthetic clinics and other side hustles. They work when they want.

The shortage has at least 10 years..maybe much longer than that.

 

[<(^_^)>]

I expect a lot of people currently medically directing are going to be surprised when the market shifts not toward directing or supervising, but to MD only (for sicker patients) and CRNA only (for less sick patients). In the current market medical direction doesn’t save much if anything over MD only anyway. With the no surprises act every anesthesiology group will need a subsidy (even crna only) in the next 10 years I expect.

 

[pgg]

I expect a lot of people currently medically directing are going to be surprised when the market shifts not toward directing or supervising, but to MD only (for sicker patients) and CRNA only (for less sick patients). In the current market medical direction doesn’t save much if anything over MD only anyway. With the no surprises act every anesthesiology group will need a subsidy (even crna only) in the next 10 years I expect.

This was exactly the arrangement at a group I did some moonlighting with in California 10-15 years ago. I was in the Navy and looking for extra cash and cases to do because the Navy hospital was an extra-slow glorified surgicenter.

Independent-ish CRNAs did their cases, we did ours. The scheduler put the easy stuff with them and the harder stuff with us. It was a community hospital so "hard" meant the patient were wrecks, but the surgeries were rarely complex. Occasionally we'd get a surgeon who said some particular patient or another was sick and needed "MD anesthesia" and the people running the practice would accommodate it.

On the plus side physicians were always doing their own cases and never responsible for CRNAs. The down side is that every sick or troublesome patient went to the physicians and the nurses were just skipping along, fat dumb and happy, talking themselves up as our equal, but never doing anything difficult.

I don't know if you're right and this is the future, or how far out that future is. But it seems plausible to me.

 

[Howard888]

Other than neonatal peds you’re kidding yourselves. Already hospitals running 1:4 or higher for all levels of acuity cases -thoracic, neuro, trauma etc. even places foing 1:3/1:4 hearts.

There won’t be a place for MD only.

 

[Dr. Rude]

Other than neonatal peds you’re kidding yourselves. Already hospitals running 1:4 or higher for all levels of acuity cases -thoracic, neuro, trauma etc. even places foing 1:3/1:4 hearts.

There won’t be a place for MD only.

I worry about exceeding 1:4 becoming the norm.

 

[<(^_^)>]

Other than neonatal peds you’re kidding yourselves. Already hospitals running 1:4 or higher for all levels of acuity cases -thoracic, neuro, trauma etc. even places foing 1:3/1:4 hearts.

There won’t be a place for MD only.

You think MD only is some incredible expense, but these days it is not. Increased CRNA wages have made the savings of the medical direction model evaporate. There are about 50:50 ratios of CRNAs and MDs in the US today. If all the MDs are 1:4 or 1:8 and there is no MD only anesthesia, what do all the other MDs do? Just become unemployed? Clearly not. Mathematically it makes 0 sense that all the MDs would become liability sponges with very high ratios, and then 80% of the rest would just quit medicine.

My point is that in this dystopian cost-cutting future there won't be a place for medical direction, which is more expensive than MD and CRNA only. There may not even be a place for supervision, which is also more expensive than MD and CRNA only. The cheapest model is 100% CRNA coverage. The next cheapest is MD and CRNA 100% independent. Supervision and medical direction are more expensive models, and if a hospital is focused on controlling costs at the expense of patient care, they'll move toward MD and CRNA independently providing care, or if they're truly desperate (and we have seen some backwater places do this) 100% CRNA.

 

[kidthor]

I worry about exceeding 1:4 becoming the norm.

If I’m ever required or expected to do 1:4 I’d quit anesthesiology or half retire and do locums (MD only). More than 1:4 is an absolutely nonstarter because 1:4 is absolute hell to begin with.

 

[aneftp]

Residents save anesthesia cost after hours since most facilities down to 1:2 staffing after 7pm. Even the busier ones. So once crna and one resident overnight.

 

[Dr. Rude]

You think MD only is some incredible expense, but these days it is not. Increased CRNA wages have made the savings of the medical direction model evaporate. There are about 50:50 ratios of CRNAs and MDs in the US today. If all the MDs are 1:4 or 1:8 and there is no MD only anesthesia, what do all the other MDs do? Just become unemployed? Clearly not. Mathematically it makes 0 sense that all the MDs would become liability sponges with very high ratios, and then 80% of the rest would just quit medicine.

My point is that in this dystopian cost-cutting future there won't be a place for medical direction, which is more expensive than MD and CRNA only. There may not even be a place for supervision, which is also more expensive than MD and CRNA only. The cheapest model is 100% CRNA coverage. The next cheapest is MD and CRNA 100% independent. Supervision and medical direction are more expensive models, and if a hospital is focused on controlling costs at the expense of patient care, they'll move toward MD and CRNA independently providing care, or if they're truly desperate (and we have seen some backwater places do this) 100% CRNA.

Maybe from an anesthesia payroll standpoint only. Your analysis fails to take in things like productivity, efficiency, utilization, cost of complications, malpractice, intangibles, etc. that come from being better educated and trained and if you will forgive me brighter on average.

 

[sbmed100]

Your last sentence/paragraph is exactly why the market won’t be flush with AAs/CRNAs-I think we have 10 years at least with demand>>>supply.

MD only practices, of which there are still many, will be replaced by direction or supervision. Per ASA statistics, 85%+ of these practices rely on stipends. Hospital margins still at all time lows. Hospital administrators don’t get the math correct, but they’ll still view direction and supervision as cheaper and to be fair large systems can save a few million switching although it’s usually not half of what they think they’ll save. It’s already happened in several big areas recently.

These new schools won’t be nearly enough to replace current retirees, switch over md only practices, and cover the increasing population with ever increasing anesthetizing sites. Crna school applications actually have gone down at many places as traveling nurses can make so much and crna schools come with a ton of debt too.

New crna/as grads are no different than new MDs. 40 hour weeks tops, often less, as they try and get 3 12s. Many have part time aesthetic clinics and other side hustles. They work when they want.

The shortage has at least 10 years..maybe much longer than that.

No way 10 years..probably less than two in desirable areas IMO. Two confounding factors would be complete CRNA independence (would solve the shortage TODAY) and if stock market returns are historically low int he next few years (anesthesiologists tend not to retire.)

 

[BLADEMDA]

In Houston, there is a GI center where the unsupervised CRNA also doubles as the circulator RN. I am not kidding. Similar situation in a pain center with an AA with previous RN training.

The job market is already turning. I give it 2-3 years and we will be flush with AA/CRNAs. 4 new CRNA programs and 2 AA schools in the works.

I find the younger employed proceduralists want nothing to do with unsupervised crna care. Why take the extra risk while not receiving any financial benefit? Anesthesiologists will enjoy a strong market for years especially since the new grads have no desire to work more than 40 hours a week. MD only practices will become a thing of the past here though.

In 3-5 years the market will turn so those doing locums will have a harder time finding work and the pay will level off. This includes anesthesiologists and CRNAs because they are truly making a killing right now doing locums. So, the next 3 years is the time to make lots of hay. Of course, eventually the tide turns and the market tightens up.

 

[Howard888]

Fully disagree with this. Economic returns since 2009 are unprecedented. Covid made many re-evaluate bring in medicine at all. This is Continuing to lead to retirements and/or job reduction from full to part time. Duel income households have increased leading to less desire for full time work.

Add this to aging population and certificate of needs going away and ever increasing anesthetizing sites:a few new schools will barely put a dent in the shortage.

Now popular areas will not have shortages but there will be tons of shortages for at least next decade overall

 

[ambiturner]

Fully disagree with this. Economic returns since 2009 are unprecedented. Covid made many re-evaluate bring in medicine at all. This is Continuing to lead to retirements and/or job reduction from full to part time. Duel income households have increased leading to less desire for full time work.

Add this to aging population and certificate of needs going away and ever increasing anesthetizing sites:a few new schools will barely put a dent in the shortage.

Now popular areas will not have shortages but there will be tons of shortages for at least next decade overall

So your assessment is that there’ll be shortages and decent pay/hours for both CRNAs and MDs, but we’ll either be doing high ratio supervision or working in a collaborative model?

I think that’s very plausible, but personally I think the shortage will be over in 3-5 years except in subspecialties since so many people are foregoing fellowship. But I could be wrong about the last part if CRNAs continue making inroads in peds/cardiac/etc.

 

[BLADEMDA]

Fully disagree with this. Economic returns since 2009 are unprecedented. Covid made many re-evaluate bring in medicine at all. This is Continuing to lead to retirements and/or job reduction from full to part time. Duel income households have increased leading to less desire for full time work.

Add this to aging population and certificate of needs going away and ever increasing anesthetizing sites:a few new schools will barely put a dent in the shortage.

Now popular areas will not have shortages but there will be tons of shortages for at least next decade overall

I didn’t say shortage. Rather, the exorbitant locums gigs in popular spots will dry up to some extent. The remote locations will still need help. There won’t be a surplus supply in 5 years but rather a return to a more normal employment situation in terms of jobs. This is a good thing as the shortages today are on the extreme side in many locations. As for Anesthesiology becoming EM that may still occur at some point but it’s at least 10+ years away.

 

[<(^_^)>]

I didn’t say shortage. Rather, the exorbitant locums gigs in popular spots will dry up to some extent. The remote locations will still need help. There won’t be a surplus supply in 5 years but rather a return to a more normal employment situation in terms of jobs. This is a good thing as the shortages today are on the extreme side in many locations. As for Anesthesiology becoming EM that may still occur at some point but it’s at least 10+ years away.

I just wanted to say I have been reading your posts for probably 10 years now (before I signed up) and this is probably the most optimistic I’ve seen you haha.

 

[ToKingdomCome]

How dope is Austin though ? Jobs are bad there ?

 

[Howard888]

Terrible jobs in Austin -choices are Napa and USAP. USAP still calls it a partnership and pays very little for 2-3 years as a “buy in”. Napa at least just pays you a crappy salary to start. Drive all over town and cost of living and buying homes anywhere near downtown Austin is at California levels. Traffic at California levels too.

Cool city but Visit don’t live.

 

[kidthor]

Terrible jobs in Austin -choices are Napa and USAP. USAP still calls it a partnership and pays very little for 2-3 years as a “buy in”. Napa at least just pays you a crappy salary to start. Drive all over town and cost of living and buying homes anywhere near downtown Austin is at California levels. Traffic at California levels too.

Cool city but Visit don’t live.

For peds people there’s a new Texas Children’s hospital opening up which sounds like a nice academic option in Austin actually - they’re actively recruiting with an expected open date within the year. It still has some of the Austin downsides mentioned, but also people do seem to love the place too.

 

[PeterGriffin]

Terrible jobs in Austin -choices are Napa and USAP. USAP still calls it a partnership and pays very little for 2-3 years as a “buy in”. Napa at least just pays you a crappy salary to start. Drive all over town and cost of living and buying homes anywhere near downtown Austin is at California levels. Traffic at California levels too.

Cool city but Visit don’t live.

Cost of living does suck here.
I'm with AAG (NAPA), we don't pay a crappy salary. When I joined, it was the old school "partnership" track. That's long gone.

 

[Howard888]

For Austin…that salary should be 600k minimum. Cost of living is California. If it’s that…then sure. Knowing Napa, my guess is it’s under 500k which won’t get you anything meaningful in Austin

 

[PeterGriffin]

For Austin…that salary should be 600k minimum. Cost of living is California. If it’s that…then sure. Knowing Napa, my guess is it’s under 500k which won’t get you anything meaningful in Austin

Average doc in our group makes more than than

 

[MirrorTodd]

Average doc in our group makes more than than

Y'all ever need any prn docs? I may or not be moving to Ft Hood (this is all hypothetical to any Russians reading this) and will have ample time to play substitute doc. Feel free to pm me.

 

[Howard888]

Ahhh average doc….what about new docs? Feel like there is more going on here. How many years to make that much? If it’s more than 2 years or starting is less than 450 for those two years…not worth it. 2 years at 450 then 600+ after-ok not bad for Austin. I will say that is one of the higher Napa salaries I have heard and not the number that is usually told in Austin but if you say so

 

[anbuitachi]

ACGME need to go thru the case logs. residents need to be educated that you cant graduate as a competent anesthesiologist that way. and once the word spreads, no one will hire graduates from that program other than maybe NAPA, and they'll be high risk for lawsuits and poor care. do they really want that? curious what their basic pass rate is or ITE (even though kind of unrelated to quality of care). its insane that attendings there are letting this slide. its pathetic

 

[IlDestriero]

Sounds like a recipe for success!

 

[Status Sciaticus]

Cost of living does suck here.
I'm with AAG (NAPA), we don't pay a crappy salary. When I joined, it was the old school "partnership" track. That's long gone.

So what is the starting salary?
How about hours per week and call for that salary?
And what is your supervision ratio?

 

[medicine2wallstreet]

Terrible jobs in Austin -choices are Napa and USAP. USAP still calls it a partnership and pays very little for 2-3 years as a “buy in”. Napa at least just pays you a crappy salary to start. Drive all over town and cost of living and buying homes anywhere near downtown Austin is at California levels. Traffic at California levels too.

Cool city but Visit don’t live.

People like this on here drive me nuts. Either you let private equity pimp you or you let old boomers in a private practice pimp you on a partnership track. Make your decision.

You were clearly shocked that ol buddy is doing over 600k in Austin for NAPA. Private equity jobs make a handsome sum from the start now although your top end salary will never be as high. Still plenty of private practice boomer jobs that pimp you for 400k or less for 4 years around here.

PE jobs aren't what they used to be. 540k start 12 weeks vacation where I'm at isn't that bad. Versus taking a private practice job for 350k start on a 4 year track.

 

[Howard888]

starting salaries of over 500k is new for private equity groups if it’s happening. At least in the south. Perhaps they are finally dealing with supply/demand issues.

Other than northeast I’ve never seen Napa pay over 500 without substantial overtime and I know in Austin that was not the case pre Covid. USAP in Austin I know pays substantially under 500 for first 3 years.

But again as you mention if they do pay that much then yes it is better than some private practices…although I still have my doubts about Napa in Austin unless folks are now working 60 hour weeks.

 

[ToKingdomCome]

People like this on here drive me nuts. Either you let private equity pimp you or you let old boomers in a private practice pimp you on a partnership track. Make your decision.

You were clearly shocked that ol buddy is doing over 600k in Austin for NAPA. Private equity jobs make a handsome sum from the start now although your top end salary will never be as high. Still plenty of private practice boomer jobs that pimp you for 400k or less for 4 years around here.

PE jobs aren't what they used to be. 540k start 12 weeks vacation where I'm at isn't that bad. Versus taking a private practice job for 350k start on a 4 year track.

540k for 12 months off seems amazing. Where is this ?

 

[sevo00]

540k for 12 months off seems amazing. Where is this ?

I love 12 months off the year! Even better would be 13 months

 

[medicine2wallstreet]

540k for 12 months off seems amazing. Where is this ?

It's 12 weeks man haha. It's in the southeast. Don't wanna give my location away.