Another job thread

[Arch Guillotti]

From a forum member:

"Please help pick between these two jobs in highly competitive major US city:

Job 1: Private group, 2 year partner track, no buy-in, equal pay as partners but no voting rights or profit sharing. Everyone makes partner. Q10 home main OR call. Q10 OB call in house. They have been super busy and thus working some post call days, but that should stop hopefully with the new hires. Fair democratic group, equal access to cases and OB. MD only. Blended $34/unit, 1000-1200 units/month, stipends worth about $70k a year. 1099, no benefits. Can anyone enlighten me on how hard I would work at this job? I can't get a clear sense of how many hours a week this amounts to be.

Job 2: Multi-specialty group, also 2 year partner track, not everyone has made partner and its clear there is some internal political turmoil, not just in the anesthesia group but in the multi-specialty group as a whole. Corporate environment, bureaucracy, even partners don't have much say. Partners can not be fired though. For a 55 hour work week, year 1 is $365k, year 2 is $385 and then $400k as partner with a 1-2% increase yearly thereafter. 8 weeks paid vacation, 2 weeks sick leave. By year 10, its 10 weeks vacation and 2 weeks sick leave. Easy cases, bread and butter, half CRNA medical supervision, lots of time out of rooms, very "kushy", partners out of rooms hanging out a lot, nice surgeons and staff. 3-5 in house 12 hour calls a month. Benefits are health, dental, vision, disability, medical, crazy pension, no 401k match (18k as associate, 53k at partner). No major write offs as a W2 or K1. "

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[deleted162650]

34$ unit is dog poop.

 

[sevoflurane]

This is not a red or blue pill question.

 

[nimbus]

Pay is similar.

Do you want to do all your own cases? That would be the deciding factor for me.

1000-1200 units/month is an average workload. Probably no more than 45-50hrs/week and maybe 1 weekend/month.

 

[Twiggidy]

34$ unit is dog poop.

it's not even the dog poop's poop...

 

[eggscal99]

it's not even the dog poop's poop...

what exactly is a reasonable $ range? I get paid in the high $20's/unit (SoCal). I thought I was getting a great deal, until I heard the group couple blocks away is making almost 2x as much...
funny thing is, we were told that our group is barely breaking it even.

 

[nimbus]

what exactly is a reasonable $ range? I get paid in the high $20's/unit (SoCal). I thought I was getting a great deal, until I heard the group couple blocks away is making almost 2x as much...
funny thing is, we were told that our group is barely breaking it even.

That is the dog poop's poop's poop. The group couple blocks away is average. CSA bulletin publishes average unit values for various communities.

 

[GassmanMD]

That is the dog poop's poop's poop. The group couple blocks away is average.

Average for what region ? I am currently on the job search in SoCal and I've spoken to groups all over the state. Ive heard as low as $21 all the way up to $47. At least for my search, $34 seems average. California has MediCal patients and I think the unit value is $14 for those patients. Can anyone from the state confirm this?

 

[nimbus]

Average for what region ? I am currently on the job search in SoCal and I've spoken to groups all over the state. Ive heard as low as $21 all the way up to $47. At least for my search, $34 seems average. California has MediCal patients and I think the unit value is $14 for those patients. Can anyone from the state confirm this?

The range could be accurate. 34 is below average.

 

[BLADEMDA]

34$ unit is dog poop.

$34 per unit without the stipend? or, is the $34 number including the stipend? Big difference.

I like job "2" better because of the lifestyle; but $34 per unit PLUS the stipend for job 1 is a fair deal.


"stipends worth about $70k a year"

 

[eggscal99]

From a forum member:
Job 1: Private group, 2 year partner track, no buy-in, equal pay as partners but no voting rights or profit sharing. Everyone makes partner. Q10 home main OR call. Q10 OB call in house. They have been super busy and thus working some post call days, but that should stop hopefully with the new hires. Fair democratic group, equal access to cases and OB. MD only. Blended $34/unit, 1000-1200 units/month, stipends worth about $70k a year. 1099, no benefits. Can anyone enlighten me on how hard I would work at this job? I can't get a clear sense of how many hours a week this amounts to be.

There's something to be said about a stable income with good lifestyle. With 1099 some days you get upset if you're in a crappy room, if the surgical volume goes down with holidays, or if the case distribution isn't completely fair. Sometimes I see people fight for cases & procedures all because they need the units. But for job #2: need to clarify why some people didn't make partnership?

 

[Ezekiel2517]

Average for what region ? I am currently on the job search in SoCal and I've spoken to groups all over the state. Ive heard as low as $21 all the way up to $47. At least for my search, $34 seems average. California has MediCal patients and I think the unit value is $14 for those patients. Can anyone from the state confirm this?

I once worked in L.A. For the L.A region, 34 is actually above the average, from my experience. I actually am not even aware of any group in LA that is >40. Unit values are better in orange county.

 

[GassmanMD]

I once worked in L.A. For the L.A region, 34 is actually above the average, from my experience. I actually am not even aware of any group in LA that is >40. Unit values are better in orange county.

Thanks, this was very helpful. The $47 unit value I heard about is indeed Orange County.

 

[aneftp]

Thanks, this was very helpful. The $47 unit value I heard about is indeed Orange County.

My brother has worked in LA proper for past 12 years. He's unit blended system. Yes, billing units sucks. I've seen his insurance payments. Better off doing locums for $1200/8 hours than doing 20 cataracts for anesthesia that barely pay like $75/case!

Commerical/private insurance if you are lucky can get $70/unit at most, mainly in the $60s....medical is super low like $15/unit (it was $17 I guess last time i was out there).

Just sucks California billing for anesthesia.

Saying that, if you happen to find a place with great payer mix, I've still see people still making very good money out in Los Angeles but you gonna to be working for it (q5 calls, work post call occasionally...all MD) Expect to work 60 hours a week if you want to pull in real money.

 

[deleted171991]

That's single payer for you folks who tout the value of socialized medicine.

 

[deleted162650]

Average for what region ? I am currently on the job search in SoCal and I've spoken to groups all over the state. Ive heard as low as $21 all the way up to $47. At least for my search, $34 seems average. California has MediCal patients and I think the unit value is $14 for those patients. Can anyone from the state confirm this?

Medi-Cal is 12-14$/unit (can't remember which exactly). They pay a little better - like 16$/unit for OB. It is possible to negotiate better rates with some of the Medi-Cal HMO carriers like Molina, etc. MediCare is like 20-22$/unit. Most private insurance contract rates pay in the 60-something$/unit range. My previous gig would bill at 75$/unit for out-of network cases. *These values are general SoCal figures. This is why payer mix is so crucial for us. I would expect average to be in the mid to upper 30's.

I get paid in the high $20's/unit (SoCal)

That is soul crushing - find a new job.

I actually am not even aware of any group in LA that is >40.

That may be true within LA proper, but there are some groups in the 'burbs/valley/etc. that have a strong payer mix and do quite well.

Unit values are better in orange county.

Yes and no - again, depends on the hospital and local payer mix. Some places are almost all government pay, other places - well - not so much.

 

[Ezekiel2517]

That may be true within LA proper, but there are some groups in the 'burbs/valley/etc. that have a strong payer mix and do quite well.

Yes and no - again, depends on the hospital and local payer mix. Some places are almost all government pay, other places - well - not so much.

Obviously I am making generalizations. Generally speaking overall oc has a better payer mix than LA. But LA is huge fukn place. Tons of different groups. I'm mainly referring to groups of decent size, like more than 20 docs. Not surprisingly, those specific groups in the wealthier areas will have a good payer mix as well. But even nearly all of these groups do not have unit values that match the better groups in OC.

 

[caligas]

Interesting discussion.

Would be good to know about vacation for these jobs.

 

[GassmanMD]

$34 per unit without the stipend? or, is the $34 number including the stipend? Big difference.

I like job "2" better because of the lifestyle; but $34 per unit PLUS the stipend for job 1 is a fair deal.


"stipends worth about $70k a year"

Is there much variability amongst groups in terms of stipends? Do groups in better payer markets function without any stipends? Don't these stipends kind of even things out between the low and high RVU groups?

 

[abolt18]

A doc I worked with in med school said their blended unit was high 40s to mid 50s usually. The month I was with him, he said it was $51 that month. This was in Utah. Pretty high amount of private insurance I believe.

 

[mwa]

Not to derail the thread, but I do not believe the $51/unit value for Utah. I've been here since 2008, working for the group that controls 90% of the state's market, and we aren't coming close to $51. Iasis and HCA--the other hospital owners who split up the other 10% of the market--do worse than we do, not better.

So, nobody in Utah is averaging $51/unit, not even for a very good month.

 

[GassmanMD]

Not to derail the thread, but I do not believe the $51/unit value for Utah. I've been here since 2008, working for the group that controls 90% of the state's market, and we aren't coming close to $51. Iasis and HCA--the other hospital owners who split up the other 10% of the market--do worse than we do, not better.

So, nobody in Utah is averaging $51/unit, not even for a very good month.

Guess everything we see on sdn must be read with a huge grain of salt.

 

[deleted162650]

Is there much variability amongst groups in terms of stipends? Do groups in better payer markets function without any stipends? Don't these stipends kind of even things out between the low and high RVU groups?

Yes, huge variability. Some groups receive none, or almost none while other groups may be getting in excess of 7 figures per year from the hospital. It very well can be a function of the payer mix at a given hospital where they need to supplement the docs' billing in order to attract docs in the first place, but not always. Stipends also pay for things like call coverage or other administrative type duties the hospital asks the physicians to handle despite a good payer mix. Stipends can even things out, but it's nice to not have to rely on the generosity of the administration to make a decent living. Keep in mind that admin is always gonna try to protect their bottom line, so relying on a big stipend also puts a big crosshair on your back as there's always someone out there who just might be willing to do it cheaper than you.

You want to look for a job at a hospital that serves a predominantly upper middle class population. You want to be taking care of people that have jobs - scratch that - careers, and therefore private insurance.

 

[caligas]

Yes, huge variability. Some groups receive none, or almost none while other groups may be getting in excess of 7 figures per year from the hospital. It very well can be a function of the payer mix at a given hospital where they need to supplement the docs' billing in order to attract docs in the first place, but not always. Stipends also pay for things like call coverage or other administrative type duties the hospital asks the physicians to handle despite a good payer mix. Stipends can even things out, but it's nice to not have to rely on the generosity of the administration to make a decent living. Keep in mind that admin is always gonna try to protect their bottom line, so relying on a big stipend also puts a big crosshair on your back as there's always someone out there who just might be willing to do it cheaper than you.

You want to look for a job at a hospital that serves a predominantly upper middle class population. You want to be taking care of people that have jobs - scratch that - careers, and therefore private insurance.

Well said. I think a big stipend is ok and fairly safe IF you are in a location that is not top tier desirability and you have a group with the mindset to "earn your keep," so to speak, rather than one dominated by entitled douchebags.

 

[deleted126335]

Yes, huge variability. Some groups receive none, or almost none while other groups may be getting in excess of 7 figures per year from the hospital. It very well can be a function of the payer mix at a given hospital where they need to supplement the docs' billing in order to attract docs in the first place, but not always. Stipends also pay for things like call coverage or other administrative type duties the hospital asks the physicians to handle despite a good payer mix. Stipends can even things out, but it's nice to not have to rely on the generosity of the administration to make a decent living. Keep in mind that admin is always gonna try to protect their bottom line, so relying on a big stipend also puts a big crosshair on your back as there's always someone out there who just might be willing to do it cheaper than you.

You want to look for a job at a hospital that serves a predominantly upper middle class population. You want to be taking care of people that have jobs - scratch that - careers, and therefore private insurance.

As Tom Lehrer said, "specialize in diseases of the rich."
Of course, hospitals that serves upper middle class population often equals desirable location...often equals lots of interest of docs living there...often equals low salaries for said docs.

 

[Arch Guillotti]

Well said. I think a big stipend is ok and fairly safe IF you are in a location that is not top tier desirability and you have a group with the mindset to "earn your keep," so to speak, rather than one dominated by entitled douchebags.

Maybe if your hospital administration is reasonable and stable. If not I think a stipend might not be so safe.

 

[deleted162650]

As Tom Lehrer said, "specialize in diseases of the rich."
Of course, hospitals that serves upper middle class population often equals desirable location...often equals lots of interest of docs living there...often equals low salaries for said docs.

Please elaborate. For us, payer mix is king. A blended unit in the high 40's = 450k without a dollar from the hospital. We're not like surgeons where the pt population gets diluted and volume drops.

It does generally mean higher COL though.

 

[deleted126335]

Please elaborate. For us, payer mix is king. A blended unit in the high 40's = 450k without a dollar from the hospital. We're not like surgeons where the pt population gets diluted and volume drops.

It does generally mean higher COL though.

IN GENERAL Higher payor rates go along with with desirable areas to live. Desirable areas to live lead to an surfeit of practitioners. Think NYC, San Fransisco, Boston, Wash, D.C., Austin, Ann Arbor, Charleston, S.C., Madison, WI, Florida Coast.

For the above, What does the market unit rate, salary/benefits, lifestyle, COL, security look like compared to Oklahoma, West Virginia, Northern LA, Central PA look like? for the average job seeker?

 

[abolt18]

Not to derail the thread, but I do not believe the $51/unit value for Utah. I've been here since 2008, working for the group that controls 90% of the state's market, and we aren't coming close to $51. Iasis and HCA--the other hospital owners who split up the other 10% of the market--do worse than we do, not better.

So, nobody in Utah is averaging $51/unit, not even for a very good month.

I am obviously not privy to the actual books there at MWA, but I am only sharing what I was told, which may have been inaccurate or simply misunderstood by myself. He explained that the RVUs were converted to a point system for payment, and he may have said that was the price per point. I also don't know if this was before overhead costs came out. I'm not totally sure. In any case, you would certainly know better than I do.

 

[GaseousClay]

From a forum member:

"Please help pick between these two jobs in highly competitive major US city:

Job 1: Private group, 2 year partner track, no buy-in, equal pay as partners but no voting rights or profit sharing. Everyone makes partner. Q10 home main OR call. Q10 OB call in house. They have been super busy and thus working some post call days, but that should stop hopefully with the new hires. Fair democratic group, equal access to cases and OB. MD only. Blended $34/unit, 1000-1200 units/month, stipends worth about $70k a year. 1099, no benefits. Can anyone enlighten me on how hard I would work at this job? I can't get a clear sense of how many hours a week this amounts to be.

Job 2: Multi-specialty group, also 2 year partner track, not everyone has made partner and its clear there is some internal political turmoil, not just in the anesthesia group but in the multi-specialty group as a whole. Corporate environment, bureaucracy, even partners don't have much say. Partners can not be fired though. For a 55 hour work week, year 1 is $365k, year 2 is $385 and then $400k as partner with a 1-2% increase yearly thereafter. 8 weeks paid vacation, 2 weeks sick leave. By year 10, its 10 weeks vacation and 2 weeks sick leave. Easy cases, bread and butter, half CRNA medical supervision, lots of time out of rooms, very "kushy", partners out of rooms hanging out a lot, nice surgeons and staff. 3-5 in house 12 hour calls a month. Benefits are health, dental, vision, disability, medical, crazy pension, no 401k match (18k as associate, 53k at partner). No major write offs as a W2 or K1. "

#2 sounds like permanente

 

[deleted162650]

IN GENERAL Higher payor rates go along with with desirable areas to live. Desirable areas to live lead to an surfeit of practitioners. Think NYC, San Fransisco, Boston, Wash, D.C., Austin, Ann Arbor, Charleston, S.C., Madison, WI, Florida Coast.

For the above, What does the market unit rate, salary/benefits, lifestyle, COL, security look like compared to Oklahoma, West Virginia, Northern LA, Central PA look like? for the average job seeker?

I think we're sorta talking about 2 sides of the same coin here. I'm talking more on the micro level looking at specific markets as opposed to the macro region v. region level. Let's say you have your heart set San Fran. You are better off taking that gig at Sausalito Regional than you would be working at Our Lady of the Tenderloin.

I don't disagree that financially at least, you come out way ahead working in BFE.

 

[Ezekiel2517]

Let's say you have your heart set San Fran. You are better off taking that gig at Sausalito Regional than you would be working at Our Lady of the Tenderloin.

it's funny bc there are actual hospitals that somewhat closely correlate with the hypothetical scenario you describe and your statement would not hold true.

 

[nimbus]

it's funny bc there are actual hospitals that somewhat closely correlate with the hypothetical scenario you describe and your statement would not hold true.

I work in a large pooled multi site practice and we all have access to unit value data from each of our sites. At least in our practice, what saltydog says is very much true. Average unit value at our poshest hospitals are 60% higher than our more ghetto hospitals.

Earlier in my career I did work in a posh hospital in a resort area that did have a terrible unit value because most of the patients were well to do retirees on medicare. They'd roll up in Bentleys and we'd still get $18.65/unit which is what medicare was at the time. So yes there can be exceptions.

 

[deleted162650]

it's funny bc there are actual hospitals that somewhat closely correlate with the hypothetical scenario you describe and your statement would not hold true.

So then that begs the question: how heavily is the group at Our Lady of the Tenderloin subsidized? I bet it's substantial (and if you are referring to St Mary's) I know it's substantial. They maybe just 1 admin change away from a significant income hit. Also, what's the volume comparison? How hard are those guys working v the guys at Sausalito General?

 

[Ezekiel2517]

So then that begs the question: how heavily is the group at Our Lady of the Tenderloin subsidized? I bet it's substantial (and if you are referring to St Mary's) I know it's substantial. They maybe just 1 admin change away from a significant income hit. Also, what's the volume comparison? How hard are those guys working v the guys at Sausalito General?

lol, i get the point you're making and I agree with it. I'm just saying the specific example you used isn't the best to illustrate your point. No part of SF is ghetto lol. It's the most expensive real estate in the country and arguably the world. I know people who work at both locales you used in your hypothetical. Not gonna go into details like unit values, income, or subsidies here. And there's other hospitals and facilities closer to the "Tenderloin" than st mary's, and groups in the area that do very well without relying on heavy subsidies.

 

[D P356]

So then that begs the question: how heavily is the group at Our Lady of the Tenderloin subsidized? I bet it's substantial (and if you are referring to St Mary's) I know it's substantial. They maybe just 1 admin change away from a significant income hit. Also, what's the volume comparison? How hard are those guys working v the guys at Sausalito General?

Don't forget about another option at the Greasy Spoon Sugery Center.

 

[Twiggidy]

Sorry, I just regained consciousness after reading someone getting $21/unit in SoCal

 

[Twiggidy]

lol, i get the point you're making and I agree with it. I'm just saying the specific example you used isn't the best to illustrate your point. No part of SF is ghetto lol. It's the most expensive real estate in the country and arguably the world. I know people who work at both locales you used in your hypothetical. Not gonna go into details like unit values, income, or subsidies here. And there's other hospitals and facilities closer to the "Tenderloin" than st mary's, and groups in the area that do very well without relying on heavy subsidies.

Say what?

 

[nimbus]

Say what?

Yeah I'm pretty sure I walked through the ghetto when I was there earlier this year.

 

[Ezekiel2517]

Yeah I'm pretty sure I walked through the ghetto when I was there earlier this year.

lmao why don't you look up some of the rents in the parts you think are "ghetto". Even the most "ghetto" parts of sf are more expensive than anywhere else in the state.

 

[Ezekiel2517]

Say what?

please share with all of us evidence of how "ghetto" SF is. I could use a good laugh.

 

[nimbus]

lmao why don't you look up some of the rents in the parts you think are "ghetto". Even the most "ghetto" parts of sf are more expensive than anywhere else in the state.

No I definitely walked through some ghetto public housing project walking from Nob Hill to Golden Gate Park. Several blocks of dilapidated 2 story townhomes n weeds.

 

[teeva]

Just cuz you pay $3000/mo for rent or mortgage for a studio doesn’t mean it’s not ghetto when homeless bums sleep right outside your window or on your doorstep and keep you up at night.

Just cuz you make $200k and can barely afford a car, parking, or own any kind of real estate doesn’t mean your rich.

 

[Twiggidy]

please share with all of us evidence of how "ghetto" SF is. I could use a good laugh.

Well where do I begin.....

Western Addtion
Potrero Hill Projects
The Tenderloin
Bayview
Visitation Valley
Ingleside
The Mission at Cesar Chaves and Treat St.


To name a few......how's that for a good chuckle?

 

[IlDestriero]

The only reason our unit rate is high is because we have historically been able to negotiate very favorable rates from the insurance companies which successfully dilutes the government cheese rate. Some of your rates are horrendous.
I'd consider looking for a better job.
There's no reason to take on all that work, stress and risk for 1/2 the reward.


--
Il Destriero