A depressing job posting

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FollowTheMoney said:
That's going to depend on location.
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i know, i'm just saying....on anesthesiology 300k salary what is consider massive house mortgage (forget aabout the size of the house for a second)? is buying a 500k house too much? how about 1 million?

assuming no student loans and you have 20% downpayment (100-200k)
 
I would feel comfortable buying a house that was less than a years gross salary. That would make you easily able to walk away, leave some extra for investing, and be enough below what you have the ability to afford that you could potentially move and do 2 mortgages of the same size if the job falls apart for some reason. Payments are like nothing then, even on a 15 year loan, so ~10% of your post tax. Many would say you can go to 3x your salary, but I feel like that will hold you to an area even if it isnt right.

There is no one "too big" number because some will make 200k some will make 1 mil.
Buying a 650k house in a market where that is mid range is a lot different than buying a house that is 650k in the county I grew up in where the most expensive house sold last year was 245k, so location plays a big role.

I would strongly urge renting for 1-2 years after residency to get to know the city, leave you more free to move on if it isn't the right fit, and likely build more of an emergency/downpayment/investing fund early on.
 
I cry at you people talking about spending just a year's income on a house. And more tears run when you talk about mid-range house costing $650k. That doesn't even buy a 1800 sqft townhouse around me.
 
teeva said:
I cry at you people talking about spending just a year's income on a house. And more tears run when you talk about mid-range house costing $650k. That doesn't even buy a 1800 sqft townhouse around me.
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Ouch. I just bought a home for less than 350k with 3000sq ft and 1400 sq ft in basement that is unfinished( which I will finish soon). I applaud people that are able to pay out the nose in real estate and cost of living.
Red
 
Just to highlight comment from my initial post that in the entire county where I grew up, the NICEST house sold last year was 245k.
There is a huge price that you guys pay to be city dwellers. Im sure it is worth it for you, whereas a guy like me would be extremely unhappy there.
 
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teeva said:
I cry at you people talking about spending just a year's income on a house. And more tears run when you talk about mid-range house costing $650k. That doesn't even buy a 1800 sqft townhouse around me.
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Cost of living. My 3200 square foot house was only 8 years old when I bought it in a nice neighborhood and it cost about 60% of my annual gross income. I could get a job in a really nice fun city, but I'd rather live where I do and retire 15 years earlier if I so desire. It's all about priorities.
 
Regardless of where you live or how much you spend on a house, it's a very good idea to rent for a year or more before you buy a place when taking a new job. For one thing, you probably really don't know the area, only what the realtors and Google tell you, and you may decide the job is not for you or, more likely, not as described.
I considered moving to a new city for an interesting lucrative PP opportunity. I would have bought a house and would have been moving about 2 years later, a year before making partner, when the group sold out to an AMC. So I would have left my good job, lost $ selling my house, lost at least 300k in income, and then took another hit selling the new house.
That would have been really really bad decision. And of note to the new guys, when recruiting me, it was all roses and dollar signs. Record profits and income, a new contract, a couple new partner track people >20 years on the old contracts, (smoke, mirrors, etc.)
Then when the AMC came calling it was again all about the value of the new contracts and the dollar signs, except this time for the partners.
 
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It all depends on the market regarding home purchases. In some markets, simply having the ability to buy a home is a winner for you as the housing will always increase (ie, NYC, SF, Boston). If you wait it out long enough in places like that you'll always get a return on your investment (provided 2008 doesn't happen again, which it probably will). It's also true that living in a small market and buying a 200k home will lead to a bright future as you won't have to work as long. Advantages/Disadvantages to both sides. Just depends on what you want.
 
IlDestriero said:
Regardless of where you live or how much you spend on a house, it's a very good idea to rent for a year or more before you buy a place when taking a new job. For one thing, you probably really don't know the area, only what the realtors and Google tell you, and you may decide the job is not for you or, more likely, not as described.
I considered moving to a new city for an interesting lucrative PP opportunity. I would have bought a house and would have been moving about 2 years later, a year before making partner, when the group sold out to an AMC. So I would have left my good job, lost $ selling my house, lost at least 300k in income, and then took another hit selling the new house.
That would have been really really bad decision. And of note to the new guys, when recruiting me, it was all roses and dollar signs. Record profits and income, a new contract, a couple new partner track people >20 years on the old contracts, (smoke, mirrors, etc.)
Then when the AMC came calling it was again all about the value of the new contracts and the dollar signs, except this time for the partners.
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Problem for us (guys) is many of us have irrational spouses (women) who don't want to rent especially with kids and pets. They want to decorate the house repaint it etc.

It is a very difficult balancing act. I faced this recently at my old house I only stayed about one year. We rented and it was like fighting tooth and nails with my wife just to rent. Than she wanted to start shopping for homes after 6 months and I told her to hold off cause I still wasn't sure about staying.

So there is theory (don't buy but rent for 1-2 years) and there is the spouse and kids to account for.
 
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aneftp said:
Problem for us (guys) is many of us have irrational spouses (women) who don't want to rent especially with kids and pets. They want to decorate the house repaint it etc.

It is a very difficult balancing act. I faced this recently at my old house I only stayed about one year. We rented and it was like fighting tooth and nails with my wife just to rent. Than she wanted to start shopping for homes after 6 months and I told her to hold off cause I still wasn't sure about staying.

So there is theory (don't buy but rent for 1-2 years) and there is the spouse and kids to account for.
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tell your wife that you are the one making the decisions and she can chill and accept that or point at the door..
 
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criticalelement said:
tell your wife that you are the one making the decisions and she can chill and accept that or point at the door..
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With kids, and even without in some states, that's not such a great idea. A housewife can become a very expensive future alimony or property division, one that will cost way more than what she wastes today. Your spouse is your business partner, and she can sink you. Plus hell hath no fury...

People should consider this before marrying. That's the parents' job. Ideally, one should always aim to marry a higher earner, so these issues become (almost) moot. (And no, @urge, this is NOT how I chose my wife. :p)
 
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criticalelement said:
tell your wife that you are the one making the decisions and she can chill and accept that or point at the door..
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LOL.

There should be some bargaining always, but I wouldn't recommend giving the wife an ultimatum especially one that includes the door. Either way, it will not end pretty and you will lose in both instances.
 
criticalelement said:
can you expound on this?
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There is always a financial side to a marriage. Actually, most fights in a marriage are somehow related to money. And when 40+% of marriages end in divorce, marriage is suddenly not such a great personal financial plan, especially for a (future) high earner. Divorce law is still anchored in the last century or -ies, in many states. (Young) people tend to forget about this during romance.

True love can conquer (almost) any problem, but 1. true lifelong love and fidelity are rare (since people don't believe anymore that they are damned if they divorce) and 2. money can't buy happiness, but it sure doesn't hurt.

I have an extraordinary wife, one in a million, but I am not as optimistic about the other 999,999 spouses.
 
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41f9d9d9f27c1d7278228b676ea56b0c84425f27d0e069eb287001da24397b6d.jpg

(i might get banned for that one. but i still think it's funny. sorry moderators:))
 
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Mman said:
I know CRNAs making $120K a year driving brand new Mercedes SUVs. It's not because they should, it's because they don't manage money well and they can afford the car payment in their monthly budget. It's like racking up credit card debt because they monthly payment hasn't gotten out of hand yet.
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You could replace CRNA with virtually any profession in this statement. Most people are terrible with money, physicians/non-physicians, you name it.
 
FFP said:
With kids, and even without in some states, that's not such a great idea. A housewife can become a very expensive future alimony or property division, one that will cost way more than what she wastes today. Your spouse is your business partner, and she can sink you. Plus hell hath no fury...

People should consider this before marrying. That's the parents' job. Ideally, one should always aim to marry a higher earner, so these issues become (almost) moot. (And no, @urge, this is NOT how I chose my wife. :p)
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Issues don't become moot when kids are involved.

Even if wife is higher earner. Kids complicate things. I posted before how my best bud (anesthesiologist) got divorced late last year from orthopedic wife.

Orthopedic wife makes a lot more than he does. Yet she's gets custody of the kids and he's the one paying like $4000/month for child support.

Divorce laws and family law are all quirky in how they seperate man from woman and parents from children. Two completely different sets of laws.
 
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I sometimes regret buying a house and wonder if I made a mistake. Been at my gig a few years and it's stable but I worry about the long term prospects. The house is an anchor but realistically there isn't much around here for 200K; atleast not something you really would want to live in. That buys an 1200 sq ft dump where I am at. I didn't go crazy on my house, it's definitely in a reasonable area. Good re sale potential. I am surrounded by middle class people and we have great schools. On the other hand if I rented for five years I could pay off my debt but have no equity and be making someone else money renting their house. My mortgage payment is only 500 more a month then my previous rent.
 
All these medical students who come here wondering if anesthesia is right for them.. please read this thread very carefully. Most of us are W2 employees and have about as much say in our practices as the janitor does in the hospital's administration. All of the benefits that come with anesthesia such as not having to run an office or build a practice means that you have virtually no roots where you live and you can be easily swept out of a job with next to no notice. When my group lost one of our contracts they cut loose 9 docs, many of whom had just made partner and quite a few had just bought expensive homes in the area. I knew them all very well and not a single one of them landed on their feet. That was a couple of years ago I haven't had a peaceful night of sleep since.

Yeah I know it looks cool when you walk into an OR and see me chilling in my comfy chair, playing grabazz with the nurses and clocking most days by 1:00 but there's a lot of soul selling that goes along with the job which many people just aren't mentally prepared for.
 
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Gasworks said:
All these medical students who come here wondering if anesthesia is right for them.. please read this thread very carefully. Most of us are W2 employees and have about as much say in our practices as the janitor does in the hospital's administration. All of the benefits that come with anesthesia such as not having to run an office or build a practice means that you have virtually no roots where you live and you can be easily swept out of a job with next to no notice. When my group lost one of our contracts they cut loose 9 docs, many of whom had just made partner and quite a few had just bought expensive homes in the area. I knew them all very well and not a single one of them landed on their feet. That was a couple of years ago I haven't had a peaceful night of sleep since.

Yeah I know it looks cool when you walk into an OR and see me chilling in my comfy chair, playing grabazz with the nurses and clocking most days by 1:00 but there's a lot of soul selling that goes along with the job which many people just aren't mentally prepared for.
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He just kept it real folks.
 
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Gasworks said:
All these medical students who come here wondering if anesthesia is right for them.. please read this thread very carefully. Most of us are W2 employees and have about as much say in our practices as the janitor does in the hospital's administration. All of the benefits that come with anesthesia such as not having to run an office or build a practice means that you have virtually no roots where you live and you can be easily swept out of a job with next to no notice. When my group lost one of our contracts they cut loose 9 docs, many of whom had just made partner and quite a few had just bought expensive homes in the area. I knew them all very well and not a single one of them landed on their feet. That was a couple of years ago I haven't had a peaceful night of sleep since.

Yeah I know it looks cool when you walk into an OR and see me chilling in my comfy chair, playing grabazz with the nurses and clocking most days by 1:00 but there's a lot of soul selling that goes along with the job which many people just aren't mentally prepared for.
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Here's a cat with experience! Listen to him newbies.
 
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Gasworks said:
I knew them all very well and not a single one of them landed on their feet.
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What does that even mean? Pretty sure they aren't on the corner panhandling.
 
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IlDestriero said:
Yeah, I'm sure every one landed on their feet.
In a different place, after selling their homes, etc. But certainly on their feet.
Change happens. You can bend like the reed in the storm or break like an oak.
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It is a very small percentage of people on this planet that even in the worst case imaginable for their profession/job are still nearly 100% guaranteed to have a 6 figure income (US$ inflation adjusted going forward) for however long they choose to work.

It's OK to be pessimistic about the future of medicine, anesthesiology, whatever. But let's be realistic. In the grand scheme of things, we are arguing about "first world problems". All of us will have a roof over our heads. If things don't go well we'll be drinking tap water instead of something fancier.
 
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Mman said:
It is a very small percentage of people on this planet that even in the worst case imaginable for their profession/job are still nearly 100% guaranteed to have a 6 figure income (US$ inflation adjusted going forward) for however long they choose to work.

It's OK to be pessimistic about the future of medicine, anesthesiology, whatever. But let's be realistic. In the grand scheme of things, we are arguing about "first world problems". All of us will have a roof over our heads. If things don't go well we'll be drinking tap water instead of something fancier.
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the old standby there is always someone's situation that is worse. Whatever gets you by man.
 
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Mman said:
It is a very small percentage of people on this planet that even in the worst case imaginable for their profession/job are still nearly 100% guaranteed to have a 6 figure income (US$ inflation adjusted going forward) for however long they choose to work.

It's OK to be pessimistic about the future of medicine, anesthesiology, whatever. But let's be realistic. In the grand scheme of things, we are arguing about "first world problems". All of us will have a roof over our heads. If things don't go well we'll be drinking tap water instead of something fancier.
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Hard to look at it that way when you read articles like this. I always compare myself to the top, not the bottom. I worked extremely hard to get to this point, made sacrifices along the way, and have more education than any of these CEOs making 50-150 million dollars a year. My first thought is always why isn't that me? How can that be me? I never compare myself to the bottom of society where the majority of people have no education, skills, work ethic, etc.

http://www.publicintegrity.org/2014/06/09/14912/skyrocketing-salaries-health-insurance-ceos
 
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FollowTheMoney said:
Hard to look at it that way when you read articles like this. I always compare myself to the top, not the bottom. I worked extremely hard to get to this point, made sacrifices along the way, and have more education than any of these CEOs making 50-150 million dollars a year. My first thought is always why isn't that me? How can that be me? I never compare myself to the bottom of society where the majority of people have no education, skills, work ethic, etc.

http://www.publicintegrity.org/2014/06/09/14912/skyrocketing-salaries-health-insurance-ceos
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We are in medicine, not business. In medicine, the lowest and median salary are far higher than people in business, but business is a pyramid with a few people getting mega rich at the top. Surely you didn't go into medicine because you thought you might earn $50M a year. People do go into business because of that possibility.

And please note I'm not arguing in favor of CEO salaries, but pointing out it's hard for us to complain about our own in relation to theirs.
 
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criticalelement said:
the old standby there is always someone's situation that is worse. Whatever gets you by man.
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WTF? Gets me by? Being guaranteed a great income for life gets me by. That doesn't do anything for you?

If you are worried that somebody makes more money than you, you will literally never be happy financially because somebody will always make more. If you make $1M a year, you notice that surgeon next door making $1.2M a year. If you make $10M a year, you notice that lazy CEO making $20M a year.

Somebody will ALWAYS make more. The point is, we make enough to lead comfortable lives. As JPP once said on this very forum, you will never worry how much it costs to put gas in your tank which puts you better off than the vast majority of Americans.
 
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Mman said:
It is a very small percentage of people on this planet that even in the worst case imaginable for their profession/job are still nearly 100% guaranteed to have a 6 figure income (US$ inflation adjusted going forward) for however long they choose to work.

It's OK to be pessimistic about the future of medicine, anesthesiology, whatever. But let's be realistic. In the grand scheme of things, we are arguing about "first world problems". All of us will have a roof over our heads. If things don't go well we'll be drinking tap water instead of something fancier.
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Sorry, but setting myself back 8 years and going a quarter of a million in debt to come out and have some nurse threaten my livelihood and drive my salary down while some scumbag CEO is making money off of me by taking advantage of the situation doesn't sit well with me. If you maintain this pie in the sky attitude that everything is great you are putting yourself in a precarious situation and leaving yourself vulnerable. There is no job security anymore and salaries are on the way down so I don't know why you are so optimistic. With inflation, taxes, high cost of living, etc. just making 6 figures doesn't allow you to be truly comfortable anymore. The nurses and AMCs see a red target on our back and I'm supposed think everything it's not that bad. We are heading down a slippery slope here.
 
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It's not about somebody making more but they are making that off my back by giving me less with nothing in return
 
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Mman said:
WTF? Gets me by? Being guaranteed a great income for life gets me by. That doesn't do anything for you?

If you are worried that somebody makes more money than you, you will literally never be happy financially because somebody will always make more. If you make $1M a year, you notice that surgeon next door making $1.2M a year. If you make $10M a year, you notice that lazy CEO making $20M a year.

Somebody will ALWAYS make more. The point is, we make enough to lead comfortable lives. As JPP once said on this very forum, you will never worry how much it costs to put gas in your tank which puts you better off than the vast majority of Americans.
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You have a small mentality.

I know what my value is. i know what OUR value is. And our value is not having some middleman in our pockets, some nurse executive and sell out anesthesiologist making policies on how we practice by trying to make every shoe fit every situation and some CEO who grants exclusive contracts to anesthesia management companies w ho think they can marginalize our existence. No, that does not sit well with me. Sure I make a decent living. But without these BOZOS i can be making three times what im making and provide better care. And for your info i watch gas prices all of the time and i am acutely aware of the price of a tank of gas. I dont mind people who make more than me if they got it in a fair and honest way. being president of a group that leverages relationships with politicians to screw professional physicians to make a living is not fair and honest. these folks are making money because people like "YOU" are saying we make enough. Why create noise//
 
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This is why AMCs and insurance companies smell blood in the water.
 
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FollowTheMoney said:
This is why AMCs and insurance companies smell blood in the water.
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Insures wants to cut reimbursements. Amcs wants to make profit.

They are at conflicts.

If insurers cut reimbursements. Amcs can only cut salaries only so much.

Crnas won't work for 100k a year. Amcs can't pay crnas $100k a year. You get to a breaking point.
 
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So my admin is deciding whether to replace me w an MD/DO or add a couple crnas and make them take back up call. My hospital, not in an opt out state, allows crnas to do their cases wo anesthesiologists supervision. it was brought up that we should go to the team care model.... Admin is vehemently opposed. It's not even open for discussion.... They said there is no way they are going to pay anesthesiologists salaries to "sit around and do nothing all day."

We are the nerdy smart kids on the playground getting our asses kicked by the big dumb bullies.
 
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aneftp said:
Insures wants to cut reimbursements. Amcs wants to make profit.

They are at conflicts.

If insurers cut reimbursements. Amcs can only cut salaries only so much.

Crnas won't work for 100k a year. Amcs can't pay crnas $100k a year. You get to a breaking point.
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I understand they each have a different agenda. However, the commonality here is that they both are able and willing to screw you over in the process of achieving their political agenda. Never underestimate how low the bar can go. I'm sure there are anesthesiologists who would never have believed 10 years ago that there are serious job offers in PP right now for 220k. AMCs can cut as much as they want because there will always be a sucker ready to take the bait. CRNAs are going to get cut over time too. These CRNA mills aren't being mass produced for fun. The party is coming to an end soon.
 
amyl said:
So my admin is deciding whether to replace me w an MD/DO or add a couple crnas and make them take back up call. My hospital, not in an opt out state, allows crnas to do their cases wo anesthesiologists supervision. it was brought up that we should go to the team care model.... Admin is vehemently opposed. It's not even open for discussion.... They said there is no way they are going to pay anesthesiologists salaries to "sit around and do nothing all day."

We are the nerdy smart kids on the playground getting our asses kicked by the big dumb bullies.
Click to expand...
Wow. Why are you leaving this job btw? And would you do gas again if you went back?
 
criticalelement said:
You have a small mentality.

I know what my value is. i know what OUR value is. And our value is not having some middleman in our pockets, some nurse executive and sell out anesthesiologist making policies on how we practice by trying to make every shoe fit every situation and some CEO who grants exclusive contracts to anesthesia management companies w ho think they can marginalize our existence. No, that does not sit well with me. Sure I make a decent living. But without these BOZOS i can be making three times what im making and provide better care. And for your info i watch gas prices all of the time and i am acutely aware of the price of a tank of gas. I dont mind people who make more than me if they got it in a fair and honest way. being president of a group that leverages relationships with politicians to screw professional physicians to make a living is not fair and honest. these folks are making money because people like "YOU" are saying we make enough. Why create noise//
Click to expand...


No. You just don't get it. I know what our value is. My group kills it, in the 99th percentile of income for our specialty. But if the day comes and medicine implodes and I'm sitting on a stool getting $125K a year, my life won't be that bad. I won't be on the street. I could still afford to send my kids to college. I'd still have a roof over my head. I'd still be able to retire at age 65.


I'm a big donor to the ASA PAC and my state society and I fight tooth and nail for every ounce of respect we get. I'm on the chief of staff path in our 1000 bed hospital (still a few years out fortunately). I regularly work to ensure my state doesn't opt out of CMS guidelines for supervision.

But when people take their concern for our specialty (and medicine in general) and start extrapolating it to the extreme that they are worried about their personal ability to live...that's when I call B.S. I took out loans for my med school and am still paying them off. I know the value of a dollar. And in a worst case scenario, I'm still better off than 90% of Americans who are better off than 99% of the rest of the planet.


The problem is that some people aren't happy unless they get what they feel they deserve. But those people will literally never be happy. They need to learn to adjust their attitude and be happy regardless of what happens in life. That doesn't mean you accept it or don't fight for what is right, but you can't let yourself my depressed by factors external to your control.
 
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Knowing that attitude, all the anesthesiologists should be planning their exit Amyl. The writing is on the wall.
Though admin will change their tune at the first bad outcome. As will the surgeon or GI guy that gets named as the supervisor of the "just a nurse" CRNA.
They also obviously don't understand the care team.
 
FollowTheMoney said:
I understand they each have a different agenda. However, the commonality here is that they both are able and willing to screw you over in the process of achieving their political agenda. Never underestimate how low the bar can go. I'm sure there are anesthesiologists who would never have believed 10 years ago that there are serious job offers in PP right now for 220k. AMCs can cut as much as they want because there will always be a sucker ready to take the bait. CRNAs are going to get cut over time too. These CRNA mills aren't being mass produced for fun. The party is coming to an end soon.
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There were lots of private jobs paying $200-220k 10 years ago especially in the northeast.

My first job was $185k full time in 2004 in mid Atlantic. (Govt job) max income capped at I think 220k at that time.

My buddy first job was $195k 2004 north east. (PP 5 year partnership) partners made 450-500k

My other buddy first job in southeast was $220k in 2004. (PP 3 year partnership) partners made 500-550k

Another one took PP Southern California 2005 started at 220k 2 year partnership. Partners made 400-450k

Granted these were highly desirable locations.

That's 10 years ago.

So I don't know why people magically think they should make 300k to start.
 
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aneftp said:
There were lots of private jobs paying $200-220k 10 years ago especially in the northeast.

My first job was $185k full time in 2004 in mid Atlantic. (Govt job) max income capped at I think 220k at that time.

My buddy first job was $195k 2004 north east. (PP 5 year partnership) partners made 450-500k

My other buddy first job in southeast was $220k in 2004. (PP 3 year partnership) partners made 500-550k

Another one took PP Southern California 2005 started at 220k 2 year partnership. Partners made 400-450k

Granted these were highly desirable locations.

That's 10 years ago.

So I don't know why people magically think they should make 300k to start.
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Because 220k in 2005 was the same as 268k in 2015?
 
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This job sucks. Want it? They are looking.... Why am I leaving? 1. Bfe flyover state 2. Admin 3. A couple dingus surgeons 4. One dingus anesthesiologist who is always the fly in the ointment 5. A partner who isn't be/bc n is shady as hell 6. Another partner who is be but not bc n is really scary plus partner who is whack job pain guy w no fellowship who is crazy shady 7. Have to work post call 8. Take call from 7am fri to 7am Monday.... Then off call but still work.... First out 9. Zero back up.... It's just you 10. You cover OB, trauma, or, endo call and airway back up call - one person to do all that 11. You do elective cases on the weekend 12. Patients are so mismanaged pre and post op 13. Icu is a joke - run by hospitalists that don't do lines, etc. run epi and ppn in bad peripheral ivs for a week so if I often manage my own Icu patients 14. Crnas do their own cases but surgeons expect us to back them up even if that means leaving our patient on the table unsupervised 15. no lunch or other breaks ever... Stuck in a 8 hour case? oh well there likely no one to give you a pee break 16. Half the nurses are brand new grads - OR staff is good but floor, step down, icu and OB nurses are horrible. 17. Admission histories and h and ps are worthless - you always have to start w square one with the patients 18. Patient population is awful - 90% Asa 3-4, average bmi 40 with plenty in the 50s n 60s, majority smoke. 19. Limited equipment and pharmacology.... Want me to keep going?
 
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