Anesthesia peak of competitiveness?

[Sriddymopboi]

Hospitals are in a free fall with anesthesia services costing millions over budget to staff. Either pay the amc, or private group. Or take it in house w2 model.

I saw a in house proposal w2 (well hospital created a shell w2 company solely own by the hospital) to staff anesthesiologists and CRNA ) Probably for legal protection. The numbers with guarantee annual bonus are getting higher and higher

With the sign on bonus it’s equivalent of 525k w2 and 9 weeks off. Based on 40 hour week plus plus weekend and weeknight night intensive.

So actual numbers likely 650k with standard 1 call every 8 days.

It’s getting close to what true market rate for full doc doc. 700-750k w2 with 9-10 weeks off with approx 50 hours work.

That’s the only way to get rid of locums docs who know they can make 800k 50 hours a week with 10 weeks off approximately

Where are you seeing these kind of salaries? California?

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[aneftp]

Where are you seeing these kind of salaries? California?

Hospitals that implode in the south Florida. And the south pays less than the northeast and Midwest

 

[anbuitachi]

Hospitals are in a free fall with anesthesia services costing millions over budget to staff. Either pay the amc, or private group. Or take it in house w2 model.

I saw a in house proposal w2 (well hospital created a shell w2 company solely own by the hospital) to staff anesthesiologists and CRNA ) Probably for legal protection. The numbers with guarantee annual bonus are getting higher and higher

With the sign on bonus it’s equivalent of 525k w2 and 9 weeks off. Based on 40 hour week plus plus weekend and weeknight night intensive.

So actual numbers likely 650k with standard 1 call every 8 days.

It’s getting close to what true market rate for full doc doc. 700-750k w2 with 9-10 weeks off with approx 50 hours work.

That’s the only way to get rid of locums docs who know they can make 800k 50 hours a week with 10 weeks off approximately

problem with locum is its not as stable. and so much traveling. here, they are renewed month to month i believe

 

[aneftp]

problem with locum is its not as stable. and so much traveling. here, they are renewed month to month i believe

The true professional locums (docs and crna’s) have 5 to even 10 current different contracts and privilege. They are ready to roll to any place on 30-60 days notice. It’s the novice locums who don’t know how to play the game.

Everyone understands it a business as locums. Both payor and payee. If you even hint their services aren’t needed x amount of days out. They will book their next assignment(s) and if you back track and tell them you still need them. It’s see ya. I already made plans to work elsewhere than you are screwed with staffing.

 

[anbuitachi]

The true professional locums (docs and crna’s) have 5 to even 10 current different contracts and privilege. They are ready to roll to any place on 30-60 days notice. It’s the novice locums who don’t know how to play the game.

Everyone understands it a business as locums. Both payor and payee. If you even hint their services aren’t needed x amount of days out. They will book their next assignment(s) and if you back track and tell them you still need them. It’s see ya. I already made plans to work elsewhere than you are screwed with staffing.

so when you have a contract, are you not working there? or are you saying you are working at 5-10 places at once

 

[aneftp]

so when you have a contract, are you not working there? or are you saying you are working at 5-10 places at once

These 1099 contracts are open ended. You get paid a certain rate when you work. You have privileges at multiple places. Like I have privileges at two other hospitals 1099 as needed. But I have w2 contract.

But they will call me if they need staffing help.

But the professional ones have long term contracts at one main place but keep the privileges at other places and offer once in a while.

 

[narcotics999]

Hospitals that implode in the south Florida. And the south pays less than the northeast and Midwest

any idea locum rate in Chicago? I got some offers but I feel they are on the lower side.

 

[CubsDynasty]

any idea locum rate in Chicago? I got some offers but I feel they are on the lower side.

Probably on the lower end. Chicago is reasonably desirable and has some ridiculous number of new grads every year that want to stay so the market supply is greater then most places.

 

[nimbus]

Definitely more popular but I remember when EM was growing in popularity.

https://sitemaster.pubs.asahq.org/DocumentLibrary/ASMOnlineFirst/2023/August%202023/ASAMON_08_2023_ONLINE%20FIRST_2023%20Residency%20Match_LR.pdf

 

[ProPropofol]

Love that nosedive that EM has lol

 

[pgg]

View attachment 374270
Love that nosedive that EM has lol

Cue the next cycle of skyrocketing salaries when they're short in 10 years.

 

[BLADEMDA]

For those entering this field as residents, the job market is wide open. IF you do a Cardiac Fellowship, your career is enhanced with fewer cases to supervise vs a general person and higher pay as a locums. Unlike many on this board, I believe 1/2 those doing a cardiac fellowship, or more, will earn more money and have a better career than someone without a fellowship but this "payback" period is at least 20 years, if not 25.

Regardless of whether you choose to do a fellowship, the job market is wide open right now and demand is high. I've never seen demand this high in 30+ year career. The reason this field is competitive once again is because $500K is the norm and $800K+ is available to those willing to bust their arse. CRNAs are routinely earning $300K+ these days, some $400K or more.

So yes, this field is one in which a mediocre Med Student can finish residency in 4 years then make a boat load of money.

 

[aneftp]

View attachment 374270
Love that nosedive that EM has lol

The number of new Lcme med schools have exploded since 2000. I can’t keep up anymore with the new med schools. I’m sure the number of residency class numbers haven’t kept up either. Especially if you want to add new do schools in addition to foreign med schools.

 

[BLADEMDA]

204 Medical Schools

 

[BLADEMDA]

• Some 40,375 residents matched into programs, an increase of 1,170 over last year, according to the release. Over the past five years, residency matches have risen almost 15%.

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

2022 Median Step 2 Scores- 2023 likely a few points higher

 

[sevo00]

For those entering this field as residents, the job market is wide open. IF you do a Cardiac Fellowship, your career is enhanced with fewer cases to supervise vs a general person and higher pay as a locums. Unlike many on this board, I believe 1/2 those doing a cardiac fellowship, or more, will earn more money and have a better career than someone without a fellowship but this "payback" period is at least 20 years, if not 25.

Regardless of whether you choose to do a fellowship, the job market is wide open right now and demand is high. I've never seen demand this high in 30+ year career. The reason this field is competitive once again is because $500K is the norm and $800K+ is available to those willing to bust their arse. CRNAs are routinely earning $300K+ these days, some $400K or more.

So yes, this field is one in which a mediocre Med Student can finish residency in 4 years then make a boat load of money.

Agree with everything except last part. No longer a easy match for mediocre med students as it was a few years ago. Anesthesia is now a competitive match

 

[nimbus]

2022 Median Step 2 Scores- 2023 likely a few points higher

View attachment 374319

This chart is interesting to me.

The story is that IMGs have to be the best of the best in order to match. I would have expected their scores to be higher than US seniors matching the same specialty. But their step 2 scores are almost universally lower than US seniors matching into the same specialty.

Could be a few explanations.

1. Non US IMGs may have less English proficiency affecting their test scores.

2. IMGs may be matching into more obscure, less competitive programs within the same specialty.

3. US seniors, as a group, are probably better at standardized tests than US IMGs.

 

[NightyNight]

Anesthesia market seems great for now. But does anyone think that locums or 1099 will dry up soon in 2025?

I wouldn’t go into anesthesia because of the pay right now. You have to imagine it will be a lot different in 4 years. It might be bad in terms of a variety of factors like number of calls or unsafe supervision.

I wouldn’t go back into medicine if I knew how crazy the corporate world is getting for docs

 

[ambiturner]

Anesthesia market seems great for now. But does anyone think that locums or 1099 will dry up soon in 2025?

I wouldn’t go into anesthesia because of the pay right now. You have to imagine it will be a lot different in 4 years. It might be bad in terms of a variety of factors like number of calls or unsafe supervision.

I wouldn’t go back into medicine if I knew how crazy the corporate world is getting for docs

I wouldn’t bet on making insane locums money in 2026, no. But I never in a million years saw this coming either - right before the pandemic, the salary surveys my hospital uses to set pay actually showed a decrease in hourly rate (only year that’s happened in like 15-20) so the fact that it’s shot up so much has been a huge unexpected win.

Best case scenario for this field, and what I think will happen in the end, is locums will cool off when hospital employed groups finally pony up big and raise the median salary. I don’t think there’ll be a huge decrease in overall salary but they’ll find other ways to make you miserable later down the line: higher supervision ratios, chipping away benefits, more call slots, etc. If this doesn’t happen I’m worried it’ll speed calls for CRNA independence or lower skill sedation services since the hospitals/surgeons/govt won’t put up with this forever.

 

[aneftp]

Anesthesia market seems great for now. But does anyone think that locums or 1099 will dry up soon in 2025?

I wouldn’t go into anesthesia because of the pay right now. You have to imagine it will be a lot different in 4 years. It might be bad in terms of a variety of factors like number of calls or unsafe supervision.

I wouldn’t go back into medicine if I knew how crazy the corporate world is getting for docs

I agree. Anything can change.

But crnas aren’t taking less. Remember that.

Hospitals due to their ineptitude with scheduling cases and their inefficiencies.

Crnas are on hourly model

Docs aren’t.

When docs go on hourly models. Which in theory is the most equitable way of payment.

Certain hours worked become more costly for employers.

Do we pay the Tuesday-Thursdays 7-3 hours say $200/hr for docs? $150/hr for crnas?

The Mondays get paid maybe $220/hr? For docs ? $170/hr for crnas?

Night time hours Monday-Thursdays paid day $275/hr? Docs. And $200/hr crnas?

Weekends days $350/hr? Docs? $225/hr for crnas? Weekend nights 5pm-7am $400/hr? $250/hr for crnas?

I think Uber surge pricing/compensation is the way to go. You make incentives for less popular hours worked.

Now the backup positions will have to be paid also. That will cost the hospital

Don’t laugh at those w2 hourly models. A 450k/salary is based on 2087 hours meaning your “hourly” pay is $215/hr

$215/hr x 2087 hours equals 449k based on full time work load

 

[NightyNight]

I wouldn’t bet on making insane locums money in 2026, no. But I never in a million years saw this coming either - right before the pandemic, the salary surveys my hospital uses to set pay actually showed a decrease in hourly rate (only year that’s happened in like 15-20) so the fact that it’s shot up so much has been a huge unexpected win.

Best case scenario for this field, and what I think will happen in the end, is locums will cool off when hospital employed groups finally pony up big and raise the median salary. I don’t think there’ll be a huge decrease in overall salary but they’ll find other ways to make you miserable later down the line: higher supervision ratios, chipping away benefits, more call slots, etc. If this doesn’t happen I’m worried it’ll speed calls for CRNA independence or lower skill sedation services since the hospitals/surgeons/govt won’t put up with this forever.

Yes. CRNA independence will likely happen everywhere since cost is more important than any perioperative input. And more call slots. That’s the problem. This independence doesn’t mean that they will work nights. The physician takes on the worst stuff without a transparent hourly model.

 

[NightyNight]

I agree. Anything can change.

But crnas aren’t taking less. Remember that.

Hospitals due to their ineptitude with scheduling cases and their inefficiencies.

Crnas are on hourly model

Docs aren’t.

When docs go on hourly models. Which in theory is the most equitable way of payment.

Certain hours worked become more costly for employers.

Do we pay the Tuesday-Thursdays 7-3 hours say $200/hr for docs? $150/hr for crnas?

The Mondays get paid maybe $220/hr? For docs ? $170/hr for crnas?

Night time hours Monday-Thursdays paid day $275/hr? Docs. And $200/hr crnas?

Weekends days $350/hr? Docs? $225/hr for crnas? Weekend nights 5pm-7am $400/hr? $250/hr for crnas?

I think Uber surge pricing/compensation is the way to go. You make incentives for less popular hours worked.

Now the backup positions will have to be paid also. That will cost the hospital

Don’t laugh at those w2 hourly models. A 450k/salary is based on 2087 hours meaning your “hourly” pay is $215/hr

$215/hr x 2087 hours equals 449k based on full time work load

I think 215/hr W2 is acceptable for now depending on the benefits for your family. But after 2000 hours, there needs to be a premium if CRDAs getting OT after 40.

 

[GassYous]

Anesthesia market seems great for now. But does anyone think that locums or 1099 will dry up soon in 2025?

I wouldn’t go into anesthesia because of the pay right now. You have to imagine it will be a lot different in 4 years. It might be bad in terms of a variety of factors like number of calls or unsafe supervision.

I wouldn’t go back into medicine if I knew how crazy the corporate world is getting for docs

That's what happened to EM. Awesome job market, no open spots in scramble, people getting paid a ton for locums and then it went to crap 5 years later.

 

[NightyNight]

That's what happened to EM. Awesome job market, no open spots in scramble, people getting paid a ton for locums and then it went to crap 5 years later.

Yeah. So for all the med students, getting in now is not the best time. Choose something else that interests you rather than coming out to a likely bad job market whether it’s pay or call burdens.

 

[voxveritatisetlucis]

HCA is probably also going to keep opening more residencies like they did with EM

 

[NightyNight]

I just see most things getting bad in next 5 years for anesthesia. Guess people can enjoy the 1099 stuff for now. Hopefully the coming anesthesia grads demand good compensation and more importantly sane working conditions. ASA hasn’t done anything to stop the care team model from getting unsafe. Hope I can preserve my sanity over next 2 decades or win the lotto.

 

[narcotics999]

That's what happened to EM. Awesome job market, no open spots in scramble, people getting paid a ton for locums and then it went to crap 5 years later.

Why it went to crap? More graduates? PE? Er middle levels?

 

[Dr. Rude]

I agree. Anything can change.

Why it went to crap? More graduates? PE? Er middle levels?

all of the above.

 

[pgg]

That's what happened to EM. Awesome job market, no open spots in scramble, nmpeople getting paid a ton for locums and then it went to crap 5 years later.

EM is different. The barrier to entry for someone to work in an ER is lower, and there are more paths to get there. Apart from EM trained physicians, there are places where FM and IM cover ERs. PAs and NPs can see patients. Urgent care centers with staff tilted toward the nonphysician side are a thing for EM.

It's just us and CRNAs (and some places AAs) and CRNAs don't cost less than physicians. Other physicians aren't going to fill in for us and do what we do if there are staffing gaps. PAs and NPs aren't going to start doing anesthesia. Demand for our services are spiraling upward, procedures drive hospital system revenue, and the market is and will force them to pay us.

I'm not saying the anesthesia market can't crash or decline, but if it does, it'll be for different reasons than the EM correction.

My bet is that pay for employed anesthesia positions will gradually rise until the differential for locums and employed decreases to the point that the hassle of doing locums isn't worth the smaller financial premium for doing it. We're already seeing it happen, in broad terms.

 

[psychbender]

The point that CRNAs are not cheaper is the one that hospital administrators need to note most. On a per hour worked basis, there is little difference in the cost, particularly with travelers. I swear at least half the CRNAs at my current place are travelers, and they all make more per hour than I do. Even the ones actually employed here fulltime don't make that much less than I do. If CRNA wages keep rising, ours will always rise with them, as we can always directly compete with them. As a patient, if you knew the cost was the same, would you rather be taken care is by a solo nurse or a solo physician?

 

[aneftp]

The point that CRNAs are not cheaper is the one that hospital administrators need to note most. On a per hour worked basis, there is little difference in the cost, particularly with travelers. I swear at least half the CRNAs at my current place are travelers, and they all make more per hour than I do. Even the ones actually employed here fulltime don't make that much less than I do. If CRNA wages keep rising, ours will always rise with them, as we can always directly compete with them. As a patient, if you knew the cost was the same, would you rather be taken care is by a solo nurse or a solo physician?

The daily availability of w2 docs far surprises the daily availability of w2 crnas.

Look at ur daily schedule. How many full time w2 crnas actually work 7-3 daily these days? Not many especially at trauma centers or even busy community non trauma places. Why? Because they prefer days ago

Hospital admin solution to crna shortage at 3pm time is to have the w2 full time docs slide in and cover for the crna who wants to leave for the day or the missing crna who only works 2-3 days a week. They work some hybrid 24/8/24/24 hour shift in a 2 week pay period. And very likely to call out sick during their 8 hour shift. It’s all a game of availability. For me. Showing up to work is 90% of the game.

Crnas will complain that docs leave early say 12/1pm. Yes it’s a perk. But some days. I’d rather just do 24 hours and get credit for 3 days of work

 

[ToKingdomCome]

The point that CRNAs are not cheaper is the one that hospital administrators need to note most. On a per hour worked basis, there is little difference in the cost, particularly with travelers. I swear at least half the CRNAs at my current place are travelers, and they all make more per hour than I do. Even the ones actually employed here fulltime don't make that much less than I do. If CRNA wages keep rising, ours will always rise with them, as we can always directly compete with them. As a patient, if you knew the cost was the same, would you rather be taken care is by a solo nurse or a solo physician?

Maybe you need to look for a new job

 

[makemoney2024]

The point that CRNAs are not cheaper is the one that hospital administrators need to note most. On a per hour worked basis, there is little difference in the cost, particularly with travelers. I swear at least half the CRNAs at my current place are travelers, and they all make more per hour than I do. Even the ones actually employed here fulltime don't make that much less than I do. If CRNA wages keep rising, ours will always rise with them, as we can always directly compete with them. As a patient, if you knew the cost was the same, would you rather be taken care is by a solo nurse or a solo physician?

Hate to burst your bubble but there are plenty of patients out there who love midlevels over physicians and pick them over us. We obviously are a different bunch, but laypeople are easy to influence.
But I think majority of people still prefer physicians. Or at least I hope. 😂

 

[Dr. Anonymouss]

Hate to burst your bubble but there are plenty of patients out there who love midlevels over physicians and pick them over us. We obviously are a different bunch, but laypeople are easy to influence.
But I think majority of people still prefer physicians. Or at least I hope. 😂

The ones who prefer mid levels over physicians utilize them as their PCP. It’s likely because they get more face to face time and don’t feel so rushed, so they it makes them feel better. But when it comes to something as serious as surgery, especially when it’s life or death, they will pick the most knowledgeable and skilled person for the job. It will always be the doctors.

 

[makemoney2024]

The ones who prefer mid levels over physicians utilize them as their PCP. It’s likely because they get more face to face time and don’t feel so rushed, so they it makes them feel better. But when it comes to something as serious as surgery, especially when it’s life or death, they will pick the most knowledgeable and skilled person for the job. It will always be the doctors.

Always? Yeah. It’s never a good idea to be so sure and use words like always and never. Plenty of people grow up in small towns and all they know are CRNAs. Many others work in the OR and unfortunately have seen their fare share of lazy anesthesia docs and for this reason prefer CRNAs. See them online pointing this out. And the public trust nurses more than doctors in general.

 

[Coffee PRN]

Always? Yeah. It’s never a good idea to be so sure and use words like always and never. Plenty of people grow up in small towns and all they know are CRNAs. Many others work in the OR and unfortunately have seen their fare share of lazy anesthesia docs and for this reason prefer CRNAs. See them online pointing this out. And the public trust nurses more than doctors in general.

“Never a good idea to use the word never” 🤔

 

[psychbender]

Only the Sith deal in absolutes.

 

[mmag]

That's what happened to EM. Awesome job market, no open spots in scramble, people getting paid a ton for locums and then it went to crap 5 years later.

There's an ASA monitor article predicting an EM like future for Anesthesiology.

A Self-Defeating Prophecy: Workforce Projections in Emergency Medicine and Anesthesiology | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

.

 

[aneftp]

There's an ASA monitor article predicting an EM like future for Anesthesiology.

A Self-Defeating Prophecy: Workforce Projections in Emergency Medicine and Anesthesiology | ASA Monitor | American Society of Anesthesiologists

The official news publication of the American Society of Anesthesiologists, the ASA Monitor delivers the latest specialty and industry news, and

pubs.asahq.org

View attachment 383158.

It could happen.

But I think the ideology of newer grads is to give a big F U to their employers whether it’s private or hospital or amc employer. There is no loyalty with newer grads. Maybe some have family commitments and are afraid to jump ship. But most will not blink about taking another job within months of starting a w2 job if it’s not working out.

This creates instability.

Crnas are even worst.

So what you have is no control of employees unless there is something in it for them. 12 weeks paid paternity leave. Loan forgiveness etc. if they don’t fall into their category. They will bail when the going gets tough.

What the authors fail to mention is the mid levels and this includes AA. A place where crna went crazy and even threaten to all resign if they bring in AA. Well AA where brought into large practice I know of. Guess what? Crnas worked along side.

And guess what happened next? AA came and went. They left for more money elsewhere. And crnas really had nothing else to say.

So whether it’s md, crna, or aa. People will bail.