7-Figure Anesthesia Salaries?

[deleted171991]

New Bill: http://www.leginfo.ca.gov/pub/15-16/bill/sen/sb_0001-0050/scr_4_cfa_20150115_153946_sen_floor.html

DIGEST : This resolution designates the week of January 11 to January 17, 2015, as Physician Anesthesiologist Week.

Game changer.

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Members don't see this ad.

 

[Carbocation1]

Game changer.

Lol

You missed this part:

"The American Society of Anesthesiologists has identified the
perioperative surgical home as an innovative model in patient
care where the physician anesthesiologist directs the
anesthesia care team to provide support to the patient
throughout all aspects of surgical care and procedures; and
there is up to a 20 percent reduction in adverse events when
physician anesthesiologists lead the anesthesia care team."

 

[deleted171991]

Lol

You missed this part:

"The American Society of Anesthesiologists has identified the
perioperative surgical home as an innovative model in patient
care where the physician anesthesiologist directs the
anesthesia care team to provide support to the patient
throughout all aspects of surgical care and procedures; and
there is up to a 20 percent reduction in adverse events when
physician anesthesiologists lead the anesthesia care team."

That doesn't mean anything.

It's a preamble which might actually get nicely castrated. And even if it doesn't, it has zero value.

It's like the Senate proclaimed that the Earth revolves around the Sun. Or the opposite.

 

[Carbocation1]

Sort of off topic, but if the PSH model becomes the norm, will gas become a sub-specialty of IM? And how would that affect non-IM boarded anesthesiologists who are already in practice?

 

[deleted171991]

Sort of off topic, but if the PSH model becomes the norm, will gas become a sub-specialty of IM?

No. Even medical hospitalist fellowships have never taken off. And nobody considers hospital IM a true subspecialty.

For the type of money these jobs pay, people are less and less willing to sacrifice even more income (just to do some useless fellowship).

 

[Carbocation1]

No. Even medical hospitalist fellowships have never taken off. And nobody considers hospital IM a true subspecialty.

For the type of money these jobs pay, people are less and less willing to sacrifice even more income (just to do some useless fellowship).

Ah ok, I was worried about being forced to undergo extra training.

I sort of like the PSH model. Right now, surgeons are kings of the hospital because they bring in the $$$. But I believe we are seeing a paradigm shift take place where saving money/patient satisfaction will be of more value (shifting away from FFS to ACO). In this scenario, gatekeeper specialties will be the kings of the hospital. The entire hierarchy is being flipped upside down. And as a PSH gas doc, you are both a specialist making specialist pay, and a gatekeeper in reducing hospital costs, increasing patient satisfaction, and increasing OR efficiency. This sounds pretty valuable to me. Or am I way off?

 

[deleted171991]

Ah ok, I was worried about being forced to undergo extra training.

I sort of like the PSH model. Right now, surgeons are kings of the hospital because they bring in the $$$. But I believe we are seeing a paradigm shift take place where saving money/patient satisfaction will be of more value (shifting away from FFS to ACO). In this scenario, gatekeeper specialties will be the kings of the hospital. The entire hierarchy is being flipped upside down. And as a PSH gas doc, you are both a specialist making specialist pay, and a gatekeeper in reducing hospital costs, increasing patient satisfaction, and increasing OR efficiency. This sounds pretty valuable to me. Or am I way off?

Way off. As an employed gatekeeper, you will have all the stress and malpractice risks of the job, while not really seeing any of the money you save for your employer. So why bother? For every patient you discharge faster than you'd like, just to keep the overlords happy, you put yourself at risk.

What you are missing here is the way hospital administrators think. It's all about numbers, and improving those numbers. Almost at any price, even over your dead body (you don't have a union to protect you). More money saved = bigger pool for their year-end incentive pay.

Life is very much like medicine: you have to think in terms of benefits versus risks.

 

[IlDestriero]

Why do you think lack of a subsidy isn't compatible?

I agree. A group that is open to communication and easy to work with, providing all the services needed for little to no subsidy is at little risk of replacement by an AMC. The only risk might be to one offering to service multiple specialties, like Anesthesia, EM and radiology. Then your lean group is a casualty of cost cutting related to other departments.

 

[Carbocation1]

Way off. As an employed gatekeeper, you will have all the stress and malpractice risks of the job, while not really seeing any of the money you save for your employer. So why bother? For every patient you discharge faster than you'd like, just to keep the overlords happy, you put yourself at risk.

What you are missing here is the way hospital administrators think. It's all about numbers, and improving those numbers. Almost at any price, even over your dead body (you don't have a union to protect you). More money saved = bigger pool for their year-end incentive pay.

I see, thanks. If I pick this specialty, I would much rather become a classical anesthesiologist rather than some mutant, bureaucratic form of an anesthesiologist. I will admit it is tough to focus on school with all this BS looming in the future of us medical students.

 

[IlDestriero]

I'm actually concerned that my hospitals not so long term goal is to employ many of its physicians. When that happens, I'll lose my Cadillac benefits plan and I will probably leave. After any sweetheart reach around salary guarantee, etc.

 

[BLADEMDA]

I'm actually concerned that my hospitals not so long term goal is to employ many of its physicians. When that happens, I'll lose my Cadillac benefits plan and I will probably leave. After any sweetheart reach around salary guarantee, etc.

Where will you go? Maybe, one of the remaining private groups? That % keeps getting smaller and smaller each year but I readily admit there will likely be a core bunch of groups which NEVER sell out. This 20-25% of hard core private groups don't get a subsidy, are located in small towns, rural or Midwest Amercia. They have the best shot of surviving the AMC hoard; they can hold out as long as the ACA isn't altered to include the Medicare Option.

New graduates should search out these groups even if it means moving to a subpar location (in that person's mind).

 

[Planktonmd]

Why do you think lack of a subsidy isn't compatible?

The groups who are not getting subsidy money from the hospital will have increasingly hard time covering their overhead and paying their providers with the declining reimbursement and the added cost of quality and patient satisfaction reporting metrics.

 

[yappy]

A super Senior partner in a large group may take home $1.3 million per year. That super senior partner has 4 junior track employees working for him. Still, he is doing cases, taking call and dealing with the business.

The CEO or CFO of a large AMC Is making mega millions (net worth well over $50 million), doesn't do cases, no call and has dozens of employees to deal with the business.

The day of the super senior partner is coming to a close while the CEO/CFO or founding CRNA owner continues to rake in millions each year while he stays home watching the price is right.

So my friends, which of these two models is the real monopoly of this field.

Over the years I've begun to view the insertion of executive staff into every area of commerce as a ridiculous overhead or cost (depending on if you're a producer or consumer). Indeed, theirs is a subsidized position made possible by those who actually produce value. Imagine the wealth available once this structure is automated, or executive duties are at the very least outsourced, to everyone involved in commerce or investing.

 

[criticalelement]

No. That's just market economy. One can choose the cheapest supplier of goods or provider of services.

.

If the hospital are benefitting from it financially, it's a kickback and ti doesnt benefit patients . That is why I am against the exclusive contract. There should be multiple groups operating in a hosptal which are totally not an entity of the hospital. Period. Then you will begin to see meritocracy. Exclusive contracts have proliferated because the hospitals want control of the anesthesia groups and they want to control price. Both of these are bad in my opinion. We should have rejected this initially when that trend started. Look at it now. These exclusive contract groups just got bigger and consolidated more to the point where some states your only option is to work for one big management group.

 

[Carbocation1]

 

[criticalelement]

garbage. this guy is a business man. Hell say anything you want him to say in the name of the almighty dollar. You work for him he will be happy to take 50 percent of your salary to enrich himself all while smiling at you an teliing you he is doing you a favor

 

[Psai]

A super Senior partner in a large group may take home $1.3 million per year. That super senior partner has 4 junior track employees working for him. Still, he is doing cases, taking call and dealing with the business.

The CEO or CFO of a large AMC Is making mega millions (net worth well over $50 million), doesn't do cases, no call and has dozens of employees to deal with the business.

The day of the super senior partner is coming to a close while the CEO/CFO or founding CRNA owner continues to rake in millions each year while he stays home watching the price is right.

So my friends, which of these two models is the real monopoly of this field.

I don't understand how an AMC with all this extra weight on it at the top can outcompete a group of physicians/crnas who only have to worry about their own pay.

 

[BLADEMDA]

An exclusive contract at a hospital that prevents you from just applying for privileges is not an antitrust violation according to the court.

Exclusive contracts at the majority of hospitals in a city or region that allows the group to receive higher billing from insurers/patients and which prevents competition from less expensive groups IS an antitrust violation. Jefferson Parish has nothing in common with today's megagroups.

You don't understand the situation. The Insurance companies have agreed to pay the AMC higher reimbursements than the local groups. The hospitals can take advantage of this higher reimbursement by utilizing the AMC which eliminates any required subsidy to provide the service. The AMC then screws over the Physician employee by slashing his pay. The AMC gets the contract by working with the Insurance company to get higher reimbursement rates and reducing overhead costs like billing, management and of course, the providers' salaries.

Without the tacit agreement of the insurance companies the AMCs wouldn't be able to steal as many contracts or force groups out of business. The playing field isn't level but the HOSPITAL isn't the only reason why you will end up as an employee of an AMC.

Even if the Group works harder than the AMC and cuts staffing levels to the bone it will NOT be able to compete with the AMC's better revenue generation due to superior contractual rates for services with insurance companies.

 

[Carbocation1]

Is the IM-->subspecialty route really that bad? Do you get to make cool diagnoses are is most of it just management of chronic diseases?

I enjoy taking care of patients but being around too many people for an excessive period of time is annoying to me and I have a low tolerance for BS. Hence the appeal of gas.

 

[kazuma]

I wish I had! and I would discourage anyone else from boarding this sinking ship.

There's a lot of doom and gloom on this board and our specialty does have some significant challenges in the future. However, my friends in PP paint a different picture. The golden days are gone, but they're all making a comfortable living as partners in great groups and they live modest lifestyles while making max contributions to retirement funds etc. Personally, I'm looking forward to it. FWIW, I know a couple guys in AMC jobs and while it's not as great as being a partner in a private group, they seem to be reasonably happy... for now. Fortunately, all the grads from my program have ended up in great groups but based on what I have read here, apparently that's not the case at other programs across the country. I love anesthesia, it's been a long road and I can't wait to get to work in a busy PP group.

 

[BLADEMDA]

Let me show you an example:

Group X collects $5 million from Insurance companies. Another $8 million from CMS. In order to provide all the necessary services to the hospital like 24/7 coverage, OB MD (A) In house, extra CRNA in house, 2 additional rooms at all times, etc the hospitals pays the group X a $2 million subsidy.

The new CEO decides to fire Group X and hire the AMC. The AMC collects $8 million from the insurance companies, $8 million from CMS, ZERO hospital subsidy but the CEO agrees to delete the 2 additional rooms, eliminate 4 full time MD (A) positions by transitioning to 4:1 ratio. The AMC nets a profit of $3 million per year while the hospital CEO pays NO SUBSIDY.

 

[BLADEMDA]

There's a lot of doom and gloom on this board and our specialty does have some significant challenges in the future. However, my friends in PP paint a different picture. The golden days are gone, but they're all making a comfortable living as partners in great groups and they live modest lifestyles while making max contributions to retirement funds etc. Personally, I'm looking forward to it. FWIW, I know a couple guys in AMC jobs and while it's not as great as being a partner in a private group, they seem to be reasonably happy... for now. Fortunately, all the grads from my program have ended up in great groups but based on what I have read here, apparently that's not the case at other programs across the country. I love anesthesia, it's been a long road and I can't wait to get to work in a busy PP group.

In 5 years that busy PP group may not exist at all. The vast majority of new job openings are employee based positions with no partnership. I advise caution in your optimism and planning for the future where the AMC is the largest employer of Anesthesiologists.

Any group getting a subsidy from the hospital is at risk of being eliminated by an AMC.

 

[BLADEMDA]

Data from the graduating class of 2013 (I expect things are worse now);

At the time of the study, almost all the respondents had received job offers, with 97 percent having confirmed jobs. All residents in all regions reported having >85 percent confirmed jobs; however, those responding from the Midwest region only had 87 percent confirmed jobs. Less than half (38 percent) of residents were joining anesthesiology groups with plans to become a partner, while a majority (62 percent) has accepted group employee positions. The starting salary showed a mean of $252,986 with some regional differences. Residents were also asked to rank factors most important in choosing a job. These factors were call requirements, stability of the hospital system, stability of the group, schedule flexibility, vacation/ability to take time off, monetary compensation, job description and geography.



Regarding fellowships, 34 percent of responders reported they would be entering a fellowship after graduating from residency. Responders were asked to cite reasons for choosing a fellowship, and 53 percent of responders stated they were “Interested in that subject and wanted to learn more/develop skills”; however, 45 percent cited they “Thought it [fellowship] would make you a more competitive/desirable candidate when looking for a job” as a reason for choosing a fellowship (Figure 3).

 

[kazuma]

Where will you go? Maybe, one of the remaining private groups? That % keeps getting smaller and smaller each year but I readily admit there will likely be a core bunch of groups which NEVER sell out. This 20-25% of hard core private groups don't get a subsidy, are located in small towns, rural or Midwest Amercia. They have the best shot of surviving the AMC hoard; they can hold out as long as the ACA isn't altered to include the Medicare Option.

New graduates should search out these groups even if it means moving to a subpar location (in that person's mind).

In your opionion what would you consider a small town? Population <750K? <500K, <250K? Relatively isolated in that the nearest comparable city is 3-6 hours away?

The groups who are not getting subsidy money from the hospital will have increasingly hard time covering their overhead and paying their providers with the declining reimbursement and the added cost of quality and patient satisfaction reporting metrics.

I'm curious what would be considered low overhead for an anesthesia group, I've heard numbers ranging from 3-15%.

In 5 years that busy PP group may not exist at all. The vast majority of new job openings are employee based positions with no partnership. I advise caution in your optimism and planning for the future where the AMC is the largest employer of Anesthesiologists.

Any group getting a subsidy from the hospital is at risk of being eliminated by an AMC.

Possibly true, but I think it has all of the criteria that would make it be potentially one of the hard core independent groups of the future you describe. AMC's have tried to compete for business but haven't been successful thus far. I'm also going to plan for the worst by living a relatively modest lifestyle. Planning on spending less than 500K on a house, max retirement contributions, FU account, no luxury cars <$25K- paid w/ cash, keeping vacations and toys modest (no boats, time shares, or vacation homes), and sending the kids to good public schools. I plan on working hard, taking extra calls with the goal to have my student loans paid off in 7-10 years.

 

[BLADEMDA]

Kazuma,

If your group has the following characteristics then I see good reason for optimism:

1. No group Subsidy ( a token subsidy less than $250K is probably fine)
2. Well established relationship with surgeons and staff (group is well-liked)
3. A long history at the hospital
4. Active with Boring Committees, medical staff
5. Provide excellent on-demand service to Surgeons, Gi, Cards, etc.
6. Medium to small sized city (less than 500,000 population is ideal)

If your group has all six of these items then Congrads on a winner.

 

[okayplayer]

Kazuma,

If your group has the following characteristics then I see good reason for optimism:

1. No group Subsidy ( a token subsidy less than $250K is probably fine)
2. Well established relationship with surgeons and staff (group is well-liked)
3. A long history at the hospital
4. Active with Boring Committees, medical staff
5. Provide excellent on-demand service to Surgeons, Gi, Cards, etc.
6. Medium to small sized city (less than 500,000 population is ideal)

If your group has all six of these items then Congrads on a winner.

Kazuma is going to come work for my group and he will be all set.

 

[kazuma]

Kazuma,

If your group has the following characteristics then I see good reason for optimism:

1. No group Subsidy ( a token subsidy less than $250K is probably fine)
2. Well established relationship with surgeons and staff (group is well-liked)
3. A long history at the hospital
4. Active with Boring Committees, medical staff
5. Provide excellent on-demand service to Surgeons, Gi, Cards, etc.
6. Medium to small sized city (less than 500,000 population is ideal)

If your group has all six of these items then Congrads on a winner.

Yes, I believe it does. In addition the starting salary and partner salary (after 1-2 yrs) is well above the numbers you posted above. AMC's have tried to compete but have been unsuccessful. Sometimes you get lucky, I'm surely counting my blessings.

 

[dhb]

You don't understand the situation. The Insurance companies have agreed to pay the AMC higher reimbursements than the local groups.

Why would insurance companies accept this? do they have stakes in AMCs? do they get a kickback from the AMC ? Doesn't sound reasonable from a business perspective for insurance companies.

 

[criticalelement]

Let me show you an example:

Group X collects $5 million from Insurance companies. Another $8 million from CMS. In order to provide all the necessary services to the hospital like 24/7 coverage, OB MD (A) In house, extra CRNA in house, 2 additional rooms at all times, etc the hospitals pays the group X a $2 million subsidy.

The new CEO decides to fire Group X and hire the AMC. The AMC collects $8 million from the insurance companies, $8 million from CMS, ZERO hospital subsidy but the CEO agrees to delete the 2 additional rooms, eliminate 4 full time MD (A) positions by transitioning to 4:1 ratio. The AMC nets a profit of $3 million per year while the hospital CEO pays NO SUBSIDY.

THAT IS A KICKBACK and should be illegal all day long

 

[Arch Guillotti]

The groups who are not getting subsidy money from the hospital will have increasingly hard time covering their overhead and paying their providers with the declining reimbursement and the added cost of quality and patient satisfaction reporting metrics.

Nobody knows what will happen with reimbursement although it will probably decline for a lot of us in the future. My group has not seen a decline recently. Our overhead is very little.

Meaningless metrics bring up a good point since some AMC's claim that have the tools or whatever to track and meet some arbitrary stupid metrics. However, it is possible to write metrics into a contract.

 

[Arch Guillotti]

It's also a convenient view if you aren't a communist.

I don't believe anybody is entitled to anything when it comes to a job. If you go looking for a job, you go looking. You will hopefully get some interviews and some job offers and then decide which is best for you. Bitching about what you get offered is just stupid IMHO. A job offer is a take it or leave it proposition. If you choose to accept the offer, don't go whining that the employer is stealing from you.


And keep in mind, I'm in a group where everybody is a partner. We don't even have anybody on a partnership track since we haven't hired anybody in years. I'm more likely to be looking for a job in the future than I am to be hiring a non partner. But if I took a job somewhere else as an employee or on a prolonged partnership track, I sure wouldn't have animosity towards my bosses so long as they treated me fairly according to my contract.

I also agree that what you get offered depends on the job market. That's the whole point. As a physician, you are essentially a commodity. Your value may go up or down over time. If you need a job when your value is at a low point, don't complain about what the going rate is.

I agree with the general sentiment of Mman on this thread. It stinks that AMC's have infiltrated our profession like they have. It stinks that groups have sold out to them. It stinks that folks are led on by unscrupulous groups. It stinks when all three happen at the same time. I am in an area with a high AMC penetration rate but there are still a number of practices in my state that I am personally familiar with that are fair equitable groups.

 

[bronx43]

Is the IM-->subspecialty route really that bad? Do you get to make cool diagnoses are is most of it just management of chronic diseases?

I enjoy taking care of patients but being around too many people for an excessive period of time is annoying to me and I have a low tolerance for BS. Hence the appeal of gas.

There can be a lot of BS in IM and IM subspecialties, but you're not going to escape BS unless you go live in the mountains as a hermit. Gas BS from what I can tell is dealing with administration and CRNAs. IM BS is less so administrators but moreso the patients. Some have more BS than others, and critical care probably has the least amount of BS.

The best thing about IM is the versatility. Inpatient, outpatient, mix of both. Hardcore, chill, in between. Procedures, no procedures, mix of both. Start your own practice? Sure. Employment? Sure. Industry? Sure (mostly as heme/onc or rheumatology)

 

[Baller MD]

There can be a lot of BS in IM and IM subspecialties, but you're not going to escape BS unless you go live in the mountains as a hermit. Gas BS from what I can tell is dealing with administration and CRNAs. IM BS is less so administrators but moreso the patients. Some have more BS than others, and critical care probably has the least amount of BS.

The best thing about IM is the versatility. Inpatient, outpatient, mix of both. Hardcore, chill, in between. Procedures, no procedures, mix of both. Start your own practice? Sure. Employment? Sure. Industry? Sure (mostly as heme/onc or rheumatology)

Isn't that much harder nowadays with decreasing reimbursements and high overhead? Certain fields will prosper more than IM when starting your own business like derm and psych for obvious reasons.

 

[Planktonmd]

Nobody knows what will happen with reimbursement although it will probably decline for a lot of us in the future. My group has not seen a decline recently. Our overhead is very little.

Meaningless metrics bring up a good point since some AMC's claim that have the tools or whatever to track and meet some arbitrary stupid metrics. However, it is possible to write metrics into a contract.

Metrics are everything for hospitals and CEOs today, they desperately need that extra money that comes with meeting those stupid performance measures.
If you don't speak the metrics language it's a matter of time before an AMC convinces your CEO that they understand it better than you and can help him make money.

 

[Planktonmd]

I agree with the general sentiment of Mman on this thread. It stinks that AMC's have infiltrated our profession like they have. It stinks that groups have sold out to them. It stinks that folks are led on by unscrupulous groups. It stinks when all three happen at the same time. I am in an area with a high AMC penetration rate but there are still a number of practices in my state that I am personally familiar with that are fair equitable groups.

Unfortunately those "fair equitable groups" will not survive too long

 

[BLADEMDA]

I agree with the general sentiment of Mman on this thread. It stinks that AMC's have infiltrated our profession like they have. It stinks that groups have sold out to them. It stinks that folks are led on by unscrupulous groups. It stinks when all three happen at the same time. I am in an area with a high AMC penetration rate but there are still a number of practices in my state that I am personally familiar with that are fair equitable groups.

Hang in there Arch. As long as you can show value to the CEO/CFO they will keep your group on contract. If AMCs can't convince the CEO to hire them over you based on finances (AMC will eliminate or reduce the subsidy) then the next tactic is to use the metric data for tracking "quality" by CMS.

 

[BLADEMDA]

Kazuma is going to come work for my group and he will be all set.

Fine. But, the fact remains that in 2015 approximately 70% of all newly minted Anesthesiologists will NOT be offered partnership track positions.
These new Anesthesiologists will be employees with most of them remaining in that type of position for the rest of their working lives.

The hospital or AMC will exploit their labor to maximize profit. This is the new Anesthesiology Career which awaits future residents.

 

[Planktonmd]

Hang in there Arch. As long as you can show value to the CEO/CFO they will keep your group on contract. If AMCs can't convince the CEO to hire them over you based on finances (AMC will eliminate or reduce the subsidy) then the next tactic is to use the metric data for tracking "quality" by CMS.

Sometimes I have to agree with you!

 

[bronx43]

Isn't that much harder nowadays with decreasing reimbursements and high overhead? Certain fields will prosper more than IM when starting your own business like derm and psych for obvious reasons.

Oh yeah, definitely. I mean, it may still be feasible depending on the local market, but it isn't like what it was 20 years ago. My point was more that you can still aim to do it in fields like rheumatology, concierge primary care, or allergy/immunology. It will be difficult, but I personally know people that have done this and are doing very well.

 

[Arch Guillotti]

Hang in there Arch. As long as you can show value to the CEO/CFO they will keep your group on contract. If AMCs can't convince the CEO to hire them over you based on finances (AMC will eliminate or reduce the subsidy) then the next tactic is to use the metric data for tracking "quality" by CMS.

I hope so. Just like Mman, we renew our contract every 2 years. Nobody in my practice is looking to sell out and as far as I know everything is on the up and up with administration. We receive no subsidy and have an "emergency"plan in case the hospital asks for concessions with a future contract.

 

[Arch Guillotti]

Unfortunately those "fair equitable groups" will not survive too long

My group is hoping to buck the trend

 

[BLADEMDA]

Even in Anesthesiology the upper 10% of Anesthesiologists will do quite well unless the ACA is altered to include the Medicare Option. When and If the Medicare Option is included on the exchanges the game is over even for the last, elite 10% which includes MMan. Unfortunately, the budget busting ACA leads to a single payer system or more likely, the Medicare Option. I hope the remaining elite few recognize just how fragile their current business model is to devastation by the Federal government.

 

[BLADEMDA]

Even in Anesthesiology the upper 10% of Anesthesiologists will do quite well unless the ACA is altered to include the Medicare Option. When and If the Medicare Option is included on the exchanges the game is over even for the last, elite 10% which includes MMan. Unfortunately, the budget busting ACA leads to a single payer system or more likely, the Medicare Option. I hope the remaining elite few recognize just how fragile their current business model is to devastation by the Federal government.

I feel that my post above needs clarification:

1. I have no idea when the Medicare Option will be added to the exchanges. It could be 5,10 or even 20 years until Congress and the President agree to this major alteration. In the meantime 20-25% of Anesthesiologists will keep doing quite well and the top 10% will bank serious money.

2. There will be a solid, hard core % of groups which remain successful and profitable for the next 10 years; I think these private practice groups can make a lot of money doing this gig. As long as they have a good payer mix this a very lucrative specialty.

3. Networking and fellowships can help secure a spot in one of these solid, private practice groups. While partnership tracks are rarer these days they are still out there. It's worth the effort to land one of those spots.

4. Avoid long partnership tracks and groups with subsidies if possible. Both are red flags in this environment. Perhaps, you may need to work at academia or an AMC until the right offer comes along.

 

[Arch Guillotti]

2. There will be a solid, hard core % of groups which remain successful and profitable for the next 10 years; I think these private practice groups can make a lot of money doing this gig. As long as they have a good payer mix this a very lucrative specialty.

What do you consider a good payer mix?

 

[kazuma]

What do you consider a good payer mix?

More specifically what's a decent blended unit?

 

[Arch Guillotti]

More specifically what's a decent blended unit?

I don't know. Our payer mix is maybe 40% commercial.

 

[SoulinNeed]

It's obviously too early for me to be thinking about salary, I am curious as to what constitutes a good Anesthesia market? I was thinking about ultimately practicing in Wisconsin for my career? Is that a good market?

 

[BLADEMDA]

I don't know. Our payer mix is maybe 40% commercial.

Commercial/HMO at around 40% is a good benchmark. Once you start falling below 30% most groups end up needing a subsidy. I recommend you run lean even if your commercial/hmo payer mix is only 30% (the bottom number for survival in this market as a small Group) and avoid a hospital subsidy.

If you are 4:1 ratio then a good payer mix is lower than if you are MD only. MMan is likely over 45% HMO/Commercial payer in his group.

Blended units above 40 usually means a profitable, successful group.

Perhaps, Groups will have to suck it up these days and accept even lower blended units like the low 30's in order to avoid takeover by AMCs.

For some hospitals with 70% CMS, 10% no pay and 20% commercial/HMO the numbers are too low for a modern group these days. Hospital employment or the AMC are the only options.

 

[BLADEMDA]

If the blended unit is in the low 30s then certain AMCs will push the collaborative model of care to eliminate the subsidy. Essentially, the AMC knows CMS dosen't pay enough to support the ACT so the AMC utilizes the much cheaper collaborative model.

If the hospital is rural they may be CRNA only but then these CRNAs typically demand compensation in the $225-250K range due to the call burden.

 

[Apollyon]

If the blended unit is in the low 30s then certain AMCs will push the collaborative model of care to eliminate the subsidy. Essentially, the AMC knows CMS dosen't pay enough to support the ACT so the AMC utilizes the much cheaper collaborative model.

If the hospital is rural they may be CRNA only but then these CRNAs typically demand compensation in the $225-250K range due to the call burden.

In my rural hospital, we have 2 CRNAs (both experienced, both really good, and know their limits). We are not critical access, but I don't know why (as we qualify, both for volume, and for location/distance). Neither one of these guys is anywhere near $225K.