Which job would you choose?

[Sliu238]

Option 1. 1099 (but covers malpractice), shift work. $180/hr for the day, $200/hr for call. In house call. Malpractice covered, nothing else (group offers discounted health insurance). Average for the group is $450k - to achieve that is about 2 weekday calls per mo, 1 weekend call per mo. All calls are in house. Pre and post call day off. Avg 6 to 8 wk vaca. Level 2 trauma with OB, and ASC. Can choose to work more, for more pay, or as little as you want. No partnership, everyone equal day 1.

Option 2. Corporate. W2 (all benefits covered including tail), partnership, 300k for 3 years with regular calls (roughly the same as Option 1) and 6-8 weeks vacation. Calls are mixture of in house call and back-up calls. Work pre and post call, but out early. Then $500k after partnership with 9-11 wk vaca. No guarantee in partnership but supposedly everyone makes it.

Option 3. W-2 (all benefits covered not including tail), no partnership. Everyone equal. $400k base + relocation bonus + $15k annual bonus. 24h in-house calls split evenly roughly 1:8. First to leave postcall day and usually can sleep some at night. 8 weeks PTO. Community hospital/bread butter, level 3 trauma.

Have offers from these jobs in the location I want to be at. Which would you choose and why?

(Some updates added)

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Members don't see this ad.

 

[shepardsun]

Option 1 for the flexibility. Option 2 sounds great but you have no guarantees you won't get hosed in the first three years.

 

[GassYous]

What does partnership mean with private equity? You don't have ownership. What is your 700+ buyin paying for exactly? No security.

Weird that job 3 can't tell you exactly what's up with the call schedule.

I think I'd pick 1

 

[DirtDocMD]

Option 1 allows you to work more, or less, your choice.

Option 2 is WAY too big of a $$$ hit ($300k) for “partnership” unless the partners REALLY make bank (and $500k is NOT “making bank”). If they already sold to private equity, you’re not gonna get any of that back in a “buyout”, either...

Option 3 is WAY too vague. It might be great, OR it might be your worst nightmare.

You’ll be 8 years into #2 before it pays off, financially (2 years to make partner, another SIX ((6 x $50k), to equal the $300 k you “lost”, buying in, making $500k vs. option #1 at $450k. You get more vacation, but with the flexibility of #1, that may even out. (And working pre AND post call for job #2 will eventually feel like an azz-kicking...).

Home call or in-house???

 

[Guillemot]

People are voting for option1, but no info was given on overhead for option 1. If you are paying for own benefits, lack of 401k match, payroll tax, accounting overhead, etc. You can probably chop at least ~10% off that 450k to find equivalent w2 income.

 

[Guillemot]

Ill vote for option 4: something else

 

[GravelRider]

They all sound cr@ppy

Option #1: Hourly pay rate is low. Nurses are making 200/hr. 450k is not great as 1099. Do you pay benefits, payroll taxes, etc..?

Option #2: What do you mean by private equity? That is a pricey buy-in. Any guarantees in case the partnership is not there in 3 years?

Option #3: Pay seems low, but need more info about call schedule, vacation, and workload.

I don’t like any of the options listed with the information provided.

 

[GassYous]

Eh my job is pretty similar to option 1 except no ob or trauma. I like it because of the flexibility. If I need to take some days or weeks off, it's available to me. The benefits are definitely expensive though.

 

[Sliu238]

What does partnership mean with private equity? You don't have ownership. What is your 700+ buyin paying for exactly? No security.

Weird that job 3 can't tell you exactly what's up with the call schedule.

I think I'd pick 1

Just clarified with the group. Call schedule is roughly 1:8 (in house call) but usually can sleep some at night and first to leave post-call day.

 

[Sliu238]

People are voting for option1, but no info was given on overhead for option 1. If you are paying for own benefits, lack of 401k match, payroll tax, accounting overhead, etc. You can probably chop at least ~10% off that 450k to find equivalent w2 income.

You are right. No benefits and no retirements. They do cover malpractice though.

 

[Sliu238]

Option 1 allows you to work more, or less, your choice.

Option 2 is WAY too big of a $$$ hit ($300k) for “partnership” unless the partners REALLY make bank (and $500k is NOT “making bank”). If they already sold to private equity, you’re not gonna get any of that back in a “buyout”, either...

Option 3 is WAY too vague. It might be great, OR it might be your worst nightmare.

You’ll be 8 years into #2 before it pays off, financially (2 years to make partner, another SIX ((6 x $50k), to equal the $300 k you “lost”, buying in, making $500k vs. option #1 at $450k. You get more vacation, but with the flexibility of #1, that may even out. (And working pre AND post call for job #2 will eventually feel like an azz-kicking...).

Home call or in-house???

Option 2 is mixture of home call and in-house call. Weekend calls are always in house, but week days calls can be either.

 

[Sliu238]

They all sound cr@ppy

Option #1: Hourly pay rate is low. Nurses are making 200/hr. 450k is not great as 1099. Do you pay benefits, payroll taxes, etc..?

Option #2: What do you mean by private equity? That is a pricey buy-in. Any guarantees in case the partnership is not there in 3 years?

Option #3: Pay seems low, but need more info about call schedule, vacation, and workload.

I don’t like any of the options listed with the information provided.

Just made some updates to make things more clear.
Option #1: only malpractice is covered, I pay for everything else.
Option #2: I meant corporate anesthesia group. No gaurantees in partnership (meaning won't be in contract) but was told everyone makes it.
Option #3: Roughly 1:8 call schedule (in-house but supposedly chill). 8 weeks PTO. Workload supposedly not heavy.

 

[ERRES2288]

Yikes working post call for #3? Even if first out this is not good for 400k. Buy in is huge for number 2

 

[IMGASMD]

Solo cases vs supervision? Who owns CRNAs?

Most jobs pay for malpractice. It is an “benefit” but sort of expected. Since it may be beneficial to the group that everyone carry the same policy. 15K-30K. Sounds like option 2 and 3 both have malpractice covered. So to me ain’t worthy to compare. (maybe the tail coverage is worth something…)

Option 2, sounds like one of those AMC deals, you will get this “partnership” if you stay for 3 years. Just means that if you meet your quota, you get some bonus. Sometimes there won’t be, if you don’t send enough back to the mothership. So even that ain’t guaranteed. More importantly, it’s a “partnership” in financial bonus only. You still don’t get much of a say if corporate don’t sign off on your decisions.

Seems like I came to the party a little late, you’ve already updated option 3. (Don’t know what you didn’t provide in the beginning). It doesn’t sound too bad to me. Other than you’re a W2…. Are you a hospital/group/amc employee? There’s some subtle differences, at least in my mind.

Sounds like you’re in some tough market if you’re expected to work post call. 2/3 jobs. And the one that you don’t, ain’t really paying you either.

My priority is different than some of other members
1. MD only. Vs % of supervision.
2. Private practice vs all other entities
3. Money (they’re all “similar” in the grand scheme of things…. I won’t starve to death, and I have enough to pay for my loans)
4. Vacation/free time. More the better, but does release to #3.

Good luck and congrats getting a new job where you wanted to be.

Edit: some wording

 

[narcotics999]

I am just interested in knowing where this shot hole is.

Option 1

 

[BLADEMDA]

All these offers are not good not even average. Clearly, this location must be PRIMO because I would pass on all 3 of those jobs. I initially thought someone had posted job offers from 2019 because that is what they are listing the pay at.

In 2022 CRNAs are getting around $160-$180 for 1099 work in most of my state. So, any 1099 job paying $180 isn't even valuing you at 25% greater than a CRNA. In 2019 the Physician rate was around $180-$200 for 1099. In 2022 the rate is $225-$250 per hour as a 1099 ( this is the discounted rate not the actual locums rate which is higher).

If you must live at that location then pick the easiest job and if you aren't sure which is easiest you didn't do your homework. Job #2 is the riskiest due to the 3 year track at low pay. The "partnership" pay can be obtained at many other locations as an employee by year 2.

 

[ERRES2288]

Agreed these are all below average

 

[GassYous]

Agreed these are all below average

Eh I like the flexibility of 1. I like being able to choose how much or little I want to work (day to day and vacation)

 

[kidthor]

Eh I like the flexibility of 1. I like being able to choose how much or little I want to work (day to day and vacation)

None sound overly amazing but I'd pick 1 for the same reason - plus at least people are roughly equal, as compared to 2. Vagueness inherent 3 makes it sounds suspicious, but could be ok.

 

[Guillemot]

1 sounds the best based on information provided. Working post call is miserable.

The hourly pay for a 1099 is below average though. If it were W2 with full benefits it would be decent though nothing amazing.

 

[DrZzZz]

- plus at least people are roughly equal

By people, do you mean anesthesiologists and anesthetists and other midlevels? That pay is horrendous, esp. being 1099.

 

[Volatile]

Agree with BLADEMDA, these all sound terrible. I hope/assume you are getting a great location for these, and I can’t say it seems worth it :/

 

[GassYous]

Now I feel sad about my job. Are you guys all making 1 mil+ no call nurses make you coffee

 

[Guillemot]

The salary is below average, but MGMA is 460k. Thats like $200*50hr*46weeks (my ballpark idea of an average job) probably W2 so 460k + benefits is not bad.

Its not amazing nor bad.

 

[ERRES2288]

Now I feel sad about my job. Are you guys all making 1 mil+ no call nurses make you coffee

Number 1 is probably the best when you take into account pre and post call day off. If call not busy and rest of days not too late then this job moves up to about average.

Number 2 is a huge buy in with slightly above average pay. Bad investment and doesn’t even sound like you get real ownership.

Number 3 is below average salary and working post in house call. Gross

 

[Volatile]

Now I feel sad about my job. Are you guys all making 1 mil+ no call nurses make you coffee

I think it’s the overall picture. I would never take a job that would require me to work pre/post call, if I did I would expect my salary to be $550k minimum and really should be $600k +. If it’s requiring me to take in house call, again $600k +. Also, things like malpractice/tail insurance are not “benefits,” these should be expected. I’ve provided locums work at absolute **** show hospitals and they have always provided tail coverage. Admittedly, I don’t work in big cities so my experiences are probably skewed. And I believe if you are happy with your compensation then who gives a **** what anyone thinks. My favorite place to moonlight is not the highest paying but I enjoy working there so I could care less.

 

[turnupthegas]

Option 1 allows you to work more, or less, your choice.

Option 2 is WAY too big of a $$$ hit ($300k) for “partnership” unless the partners REALLY make bank (and $500k is NOT “making bank”). If they already sold to private equity, you’re not gonna get any of that back in a “buyout”, either...

Option 3 is WAY too vague. It might be great, OR it might be your worst nightmare.

You’ll be 8 years into #2 before it pays off, financially (2 years to make partner, another SIX ((6 x $50k), to equal the $300 k you “lost”, buying in, making $500k vs. option #1 at $450k. You get more vacation, but with the flexibility of #1, that may even out. (And working pre AND post call for job #2 will eventually feel like an azz-kicking...).

Home call or in-house???

What’s bank these days for partners that aren’t killing themselves? High 6 figures are heard of but you are working for it

 

[narcotics999]

I think it’s the overall picture. I would never take a job that would require me to work pre/post call, if I did I would expect my salary to be $550k minimum and really should be $600k +. If it’s requiring me to take in house call, again $600k +. Also, things like malpractice/tail insurance are not “benefits,” these should be expected. I’ve provided locums work at absolute **** show hospitals and they have always provided tail coverage. Admittedly, I don’t work in big cities so my experiences are probably skewed. And I believe if you are happy with your compensation then who gives a **** what anyone thinks. My favorite place to moonlight is not the highest paying but I enjoy working there so I could care less.

Seriously, people are routinely getting W2 600K? The other post locum500/hr?

I got a quote of 475K in an academic place and I am considering it. Maybe I should ask more.

 

[kidthor]

Seriously, people are routinely getting W2 600K? The other post locum500/hr?

I got a quote of 475K in an academic place and I am considering it. Maybe I should ask more.

Academics at 475 sounds high, If it’s otherwise a good setup.

 

[BLADEMDA]

The salary is below average, but MGMA is 460k. Thats like $200*50hr*46weeks (my ballpark idea of an average job) probably W2 so 460k + benefits is not bad.

Its not amazing nor bad.

I would place that type of job at the 30th percentile in the real world. If the benefits are solid like a $40K+ retirement package, deluxe healthcare plan at $0 per month with company contribution for the HSA at $5K+, 8-10 weeks vacation and of course malpractice that would bring it up to the 40th percentile.

Total Package should exceed $515K if you include the healthcare plan at the employee's expense. I do not add the malpractice cost to the package because that is part of any W-2 job.

 

[Volatile]

Seriously, people are routinely getting W2 600K? The other post locum500/hr?

I got a quote of 475K in an academic place and I am considering it. Maybe I should ask more.

Not routine, I am extrapolating if I were asked to work pre/post call or take in house calls, which would not be worth it to me. And again, these offers were not in big cities. 475k is high for academics. I was offered low $300s for an academic job and I felt like it was a good job when you considered hours/call burden. Salaries are all over the place and difficult to compare, if you’re happy with the job and compensation then go for it.

 

[BLADEMDA]

I think it’s the overall picture. I would never take a job that would require me to work pre/post call, if I did I would expect my salary to be $550k minimum and really should be $600k +. If it’s requiring me to take in house call, again $600k +. Also, things like malpractice/tail insurance are not “benefits,” these should be expected. I’ve provided locums work at absolute **** show hospitals and they have always provided tail coverage. Admittedly, I don’t work in big cities so my experiences are probably skewed. And I believe if you are happy with your compensation then who gives a **** what anyone thinks. My favorite place to moonlight is not the highest paying but I enjoy working there so I could care less.

You are correct but I would just counter with in-house call at non trauma facility 1:8 or 1:10 wouldn't be so bad if you got pre and post call off at $550K.

I stand by my post that a decent private practice gig (average work week of 45-49 hours) should pay $515K-$575K if you include the benefits (malpractice not included in that figure as it should be part of the job).

This isn't 2019 any longer and inflation is here but fortunately salaries have moved higher since 2019.

 

[kidthor]

You are correct but I would just counter with in-house call at non trauma facility 1:8 or 1:10 wouldn't be so bad if you got pre and post call off at $550K.

I stand by my post that a decent private practice gig (average work week of 45-49 hours) should pay $515K-$575K if you include the benefits (malpractice not included in that figure as it should be part of the job).

This isn't 2019 any longer and inflation is here but fortunately salaries have moved higher since 2019.

I’m honestly not seeing many jobs with that total comp with those hours…. I’m seeing W2 400ish with terrible benefits or 350 with ok benefits. Almost nowhere with great benefits.

I keep hearing it’s a hot market and I do see lots of places hiring but nothing amazing out there?

I’d like to be proven wrong though!

 

[gcc322]

I will abstain from voting because all these jobs suck…but driving on the highway today I saw a semi truck with the advertisement on the rear end that read “$175-200k as an owner-operator, home on weekends..” No offense to truck drivers on this forum and I understand the investment for a truck and trailer, but inflation is real. Get all your worth. Individuals without a degree and bachelors are encroaching…

 

[rowsdower88]

My Job.

I work in a large midwest city. I'm less than 5yrs out of residency. No fellowship.

Hospital employed W-2, ~640k pre-tax + 401k/457b + benefits. No buy-in.

No OB, No Trauma, No Peds, No Hearts. I take a bit more call than others, but everyone is pretty hungry within the group. Post-call days off, occasional pre-call days off if schedule is light. Call from home. 8 weeks vacation. Probably spend 40-50hrs a week in the hospital.

I do all my own cases. I found the job off gasworks. I was pretty flexible location-wise coming out of residency.

If you don't mind living in the midwest (LCOL) you can find jobs like this pretty quick. Looking at this guy's options makes me depressed. But if you have to live there, I get it.

Edit - The only reason I'm sharing this: worker solidarity brother, know your worth.

 

[Hoya11]

Option 1. 1099 (but covers malpractice), shift work. $180/hr for the day, $200/hr for call. In house call. Malpractice covered, nothing else (group offers discounted health insurance). Average for the group is $450k - to achieve that is about 2 weekday calls per mo, 1 weekend call per mo. All calls are in house. Pre and post call day off. Avg 6 to 8 wk vaca. Level 2 trauma with OB, and ASC. Can choose to work more, for more pay, or as little as you want. No partnership, everyone equal day 1.

Option 2. Corporate. W2 (all benefits covered including tail), partnership, 300k for 3 years with regular calls (roughly the same as Option 1) and 6-8 weeks vacation. Calls are mixture of in house call and back-up calls. Work pre and post call, but out early. Then $500k after partnership with 9-11 wk vaca. No guarantee in partnership but supposedly everyone makes it.

Option 3. W-2 (all benefits covered not including tail), no partnership. Everyone equal. $400k base + relocation bonus + $15k annual bonus. 24h in-house calls split evenly roughly 1:8. First to leave postcall day and usually can sleep some at night. 8 weeks PTO. Community hospital/bread butter, level 3 trauma.

Have offers from these jobs in the location I want to be at. Which would you choose and why?

(Some updates added)

Job 2. Ask for 2 years instead of 3. After those years you really have what you want. If its a good stable group dont be afraid to invest those first years.

 

[shepardsun]

My Job.

I work in a large midwest city. I'm less than 5yrs out of residency. No fellowship.

Hospital employed W-2, ~640k pre-tax + 401k/457b + benefits. No buy-in.

No OB, No Trauma, No Peds, No Hearts. I take a bit more call than others, but everyone is pretty hungry within the group. Post-call days off, occasional pre-call days off if schedule is light. Call from home. 8 weeks vacation. Probably spend 40-50hrs a week in the hospital.

I do all my own cases. I found the job off gasworks. I was pretty flexible location-wise coming out of residency.

If you don't mind living in the midwest (LCOL) you can find jobs like this pretty quick. Looking at this guy's options makes me depressed. But if you have to live there, I get it.

Edit - The only reason I'm sharing this: worker solidarity brother, know your worth.

I make half this working twice as much living in a HCOL location doing academics...maybe I should reconsider my life choices

 

[turnupthegas]

My Job.

I work in a large midwest city. I'm less than 5yrs out of residency. No fellowship.

Hospital employed W-2, ~640k pre-tax + 401k/457b + benefits. No buy-in.

No OB, No Trauma, No Peds, No Hearts. I take a bit more call than others, but everyone is pretty hungry within the group. Post-call days off, occasional pre-call days off if schedule is light. Call from home. 8 weeks vacation. Probably spend 40-50hrs a week in the hospital.

I do all my own cases. I found the job off gasworks. I was pretty flexible location-wise coming out of residency.

If you don't mind living in the midwest (LCOL) you can find jobs like this pretty quick. Looking at this guy's options makes me depressed. But if you have to live there, I get it.

Edit - The only reason I'm sharing this: worker solidarity brother, know your worth.

I gotta get the flip out of California

 

[rowsdower88]

I gotta get the flip out of California

We're hiring. PM me if you're interested, I get a finders fee if admin signs you. Gotta buy a winter coat though.

 

[ans2021]

So continuing with this conversation as often those good high paying jobs don't get posted on gaswork and are often word of mouth, how would this job match up with "good jobs"? 150k buy in over 2 years. Once partner W2 around 475k after maxing out 401k and benefits? High deductible plan no HSA. A little above average cost of living.

 

[Velefunt]

Now I feel sad about my job. Are you guys all making 1 mil+ no call nurses make you coffee

Comparison is the thief of joy.

 

[Velefunt]

My Job.

I work in a large midwest city. I'm less than 5yrs out of residency. No fellowship.

Hospital employed W-2, ~640k pre-tax + 401k/457b + benefits. No buy-in.

No OB, No Trauma, No Peds, No Hearts. I take a bit more call than others, but everyone is pretty hungry within the group. Post-call days off, occasional pre-call days off if schedule is light. Call from home. 8 weeks vacation. Probably spend 40-50hrs a week in the hospital.

I do all my own cases. I found the job off gasworks. I was pretty flexible location-wise coming out of residency.

If you don't mind living in the midwest (LCOL) you can find jobs like this pretty quick. Looking at this guy's options makes me depressed. But if you have to live there, I get it.

Edit - The only reason I'm sharing this: worker solidarity brother, know your worth.

I'm glad somebody out there is winning. Kudos, my man!

 

[Guillemot]

There are all sorts of ways to try to game people in regard to hours. Bottom line though, if someone is on call, they're working. If they are on pager call, with a reasonable chance to be called in they're still working. They aren't working as hard as when they're in the OR, but their time is not their own. I would count 1st call pager call into the 50 hours, especially if OB involved. Eg:

Eg #1:
Mon: 8
Tues: 8
Wed: 24 1st pager
Th: 0
Fri: 10

= 50 hrs

Eg #2:
Mon: 9
Tues: 9
Wed: 15 1st pager
Th: 8
Fri: 9

= 50 hrs

Both will claim 50 hours/week, but one of these jobs is much worse as Eg #2 is actually 59 hours.



Eg. If you are counting the first pager call as 15hrs because they were "only" in the hospital from 0700-2100, 0200-0300, that's at best disingenuous.


If you're on some time of pager call where you are unlikely to be called in, then sure dont count it as the full 24h.

 

[IMGASMD]

There are all sorts of ways to try to game people in regard to hours. Bottom line though, if someone is on call, they're working. If they are on pager call, with a reasonable chance to be called in they're still working. They aren't working as hard as when they're in the OR, but their time is not their own. I would count 1st call pager call into the 50 hours, especially if OB involved. Eg:

Eg #1:
Mon: 8
Tues: 8
Wed: 24 1st pager
Th: 0
Fri: 10

= 50 hrs

Eg #2:
Mon: 9
Tues: 9
Wed: 15 1st pager
Th: 8
Fri: 9

= 50 hrs

Both will claim 50 hours/week, but one of these jobs is much worse as Eg #2 is actually 59 hours.



Eg. If you are counting the first pager call as 15hrs because they were "only" in the hospital from 0700-2100, 0200-0300, that's at best disingenuous.


If you're on some time of pager call where you are unlikely to be called in, then sure dont count it as the full 24h.

That’s why I don’t understand locum job, that covers beeper calls. Do you want it to be busy or not?

I suppose you can have a base rate of $1800 for 24 hours. And get a rate of x with 2-4 hour guarantee?

Even when I’m not “working” it’s the fact they’re paying for my “time”. If I actually work, then I should get more.

 

[Gaseous Clay]

Which city/location is the best? I have a feeling option 3 will provide a better quality of life and if you had to pick one, I’d go with 3. I’d maybe consider 2 if they dropped partnership to 18-24 months and raised the starting salary to 350k. Good luck.

 

[kidthor]

That’s why I don’t understand locum job, that covers beeper calls. Do you want it to be busy or not?

I suppose you can have a base rate of $1800 for 24 hours. And get a rate of x with 2-4 hour guarantee?

Even when I’m not “working” it’s the fact they’re paying for my “time”. If I actually work, then I should get more.

A ton of jobs I’ve encountered recently (mine included) expect people to do be various forms of backup call for free. You bill when you do cases, but the backup call status is not reimbursed. Is that common in other people’s shops?

 

[coffeebythelake]

A ton of jobs I’ve encountered recently (mine included) expect people to do be various forms of backup call for free. You bill when you do cases, but the backup call status is not reimbursed. Is that common in other people’s shops?

no that is absolutely ridiculous

 

[narcotics999]

A ton of jobs I’ve encountered recently (mine included) expect people to do be various forms of backup call for free. You bill when you do cases, but the backup call status is not reimbursed. Is that common in other people’s shops?

My first crappy academic job 2nd call (backup call) was paid 800$ on weekday. I was only called in twice in a year.

 

[IMGASMD]

My first crappy academic job 2nd call (backup call) was paid 800$ on weekday. I was only called in twice in a year.

Out of how many?

One of my job, we didn’t get any compensation for taking backup call.

Current job, if you get called back as backup, you get minimum of 2 hours @ 250 by the hospital. Which is something.

Weekend backup call, pays a base rate of 750, and 4 hours minimum pay if called in. haven’t been called in yet.

 

[CHARLESTONMMM]

We are a very small group that covers Q4 home call and every 4th weekend. Community Hospital refuses to pay a subsidy other than a couple of hundred a day for call. Pay is continuously going down thanks to a poorly reimbursement area and high Medicare population. Vacation time off is what you can get a locums to cover you. So basically I’m working 1.3 FTE to maintain above average pay but I’m sacrificing a substantial amount of lifestyle for it. Being part of a small group has its issues.