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Discussion in 'Anesthesiology' started by bic_atlantis, Aug 27, 2017.
Fixed that for you.
From what you wrote, you may be a good fit for anesthesiology, especially if you have a bit of geographical flexibility. The lifestyle may not be what you are looking for, though, unless you go into pain or take a 7-3 position (which may involve cutting a lot of corners in a surgicenter or a community hospital).
I don't recall saying 300k for a 1:4 job is a good deal. In fact, I think it's a terrible deal. I'm merely stating objective data...no commentary behind it. When big business (or big government) is involved you are only worth what those controlling the money are willing to pay. It is beyond naive to not realize that the vast majority of anesthesiologists looking for jobs right now will be working for someone else. In fact, the vast majority of doctors will be working for someone else...surgeons included. That is the reality, like it or not.
I'll just add another data point to consider. The vascular surgeons at my institution were lamenting today how few private practice opportunities there are, and that most jobs are now hospital-employed.
I knew this was beginning to happen in other fields but didn't realize the extent of it. Even surgery is facing these problems.
You where justifying the 300k salary in your previous post. But sounds like we both agree it is a bad deal to work for anyone at 300k and if you do I would hope there would be some serious upside in a couple yrs. I am personally not against employment as long as the employer is treating you fairly. I know people employed that do just as well as the numbers I previously stated. Some of the physicians with the best packages in my area are employed surgeons. In my opinion, your best shot at getting treated fairly in anesthesia nationally is by joining a PP group.
I am just attempting to inform everyone of what they bring to the table on a monetary basis. By justifying a 300k salary to a 250k salary is missing the big picture. If I owned a management company or employed most of the providers in a group I would love to hear you on this forum justifying a 300k salary with minimal benifits bc that is an additional 700k in my pocket.
Thanks for your feedback. I'm actually not geographically flexible; I really want to return home to Southern California after school or residency.
Any idea if this is feasible with anesthesia/how much of a pay cut am I look at? Is 350k doable?
Quit stressing, you won't have a problem
For those fields where the patients are sick, mostly medicare and need a hospital vs an ASC then "employment" is the likely option. But, for those specialties where the ASC is the predominant player like ENT, Urology, Ortho, Optho, Podiatry, Hand, etc then private practice opportunities are still abundant.
This, at least, is entirely self-inflicted. And its actually something individual anesthesiologists can fix to some degree if that perception bothers them.
Most places I've been, a case ends, the surgeon exits, puts on a white coat, talks to family (if any), talks to the next patient, removes coat, goes to OR to do next case.
What do we do? Slum around in pajamas all day.
We gripe about how even RTs and ward nurses are wearing white coats these days, because patients mistake them for doctors. And then we don't wear them, and gripe that the patients mistake us for not-doctors. We're kind of stupid that way.
There's no reason why we can't put on a coat between patients and give the patients an obvious visual cue, followed by a "Hi I'm doctor ______" introduction. But we don't. Most of the time, I'm as guilty of it as other anesthesiologists are.
I am afraid you're wrong (about whose fault it is). It's mostly the hospitals. We don't have where to put our white coats, and it takes time to grab them and drop them off, like the surgeons. I have seen exactly one place where the hospital had put a huge white coat rack close to the OR entrance. (The same hospital had badges with huge MD letters under physician names.) Because we don't f***ing matter. When I was at an academic place, I couldn't get an official business card, even paid out of pocket. This while even the lowest intern had a ton, for free.
Btw, the white coat is one of my favorite things when in the ICU, and I 100% agree with you on how it affects our image.
But you are more ICU/medicine minded than most on this forum, which may be a little bit of bias towards a white coat. It makes sense, especially in the hierarchical world of the ICU. I love the image as well, but don't need to do my job in the OR and it's more about your attitude and your confidence when interacting with colleagues and staff.
Anecdotal, but every institution I've worked at (med school, residency, fellowship, and job next year which spans 3 hospitals) has long white coat racks that both anesthesiologists and surgeons use, so is it really all that uncommon? I barely noticed them, myself. The place I'm at now as a specific hanger for every attending, surgery and anesthesiology included.
The surgeons work in the same OR we do, see the same patients in preop as we do, and they can do it. Every OR I've worked in has had hooks or hangers for coats outside each OR or near the main OR entrance.
I agree it's usually not super convenient. And I don't do it as often as I should. But the surgeons, as a group, are a lot better at making the effort.
It's our fault. Wearing pajamas at work is one of the perks of being an anesthesiologist.
Have you noticed that 95% of the surgeons will never allow the patient/family to see them just in scrubs?
That's an East Coast thing. Plenty of surgeons in scrubs 24/7 around here.
You can come work as a 1099 contractor for my group in coastal SoCal M-F, 7-3, no call (no nights, no weekends - unless you ask for weekends) for 300K. Of course we may make fun of you for being a "mommy" tracker, but if you can't take a joke and dish it right back you probably aren't a good fit anyways.
Clearly your hospitals haven't been visited by overbearing departments of health or other clipboard wielding organizations with their absurd requirements for various layers of paper gowns, facial covers, and spacesuits if you come within a mile of the OR. No surgeon is donning a white coat in between cases in my region because it would break about 57 dress code commandments. In fact, a white coat is often the best way to identify a clipboard soldier from afar.
Now you just hold that job for me for another 5 years and i'll even wear an apron and bake everyone cookies every other friday.
Out of curiosity, how much extra would a weekend pay? Seems like a decent deal, although no bennies/vacation is kind of rough.
How much are the non-mommies in your group making/what are their hours and call like?
That's a great deal in my part of the world (assuming 5-6 weeks of vacation), and you guys also have lower malpractice premiums.
A 1099 contractor usually funds their own retirement, health insurance, malpractice, and employer payroll taxes. The group doesn't pay for anything. It ends up being the equivalent of a 220-230k W2 job. I don't think it's a good deal.
That's exactly how much a W-2 job pays here for the same job, except that one's benefits suck, and one doesn't get tax deductions, or the opportunity to contribute 53K to one's own retirement funds. I would take the 1099 job in a heartbeat.
Let's not mention that some of the arseholes use the W-2 just to be able to block the employee from working for anybody else in their spare time. Plus let's not forget that one may have a problem enforcing a non-compete with a 1099. Plus it's much easier to explain quitting a bad 1099 job vs a bad W-2 one. There is a reason why most AMCs want W-2 employees.
Someone needs to introduce you to better pharmaceutical reps.
40 hr week anesthesia jobs are 220 w weak benefits where you are? And this is common? There are fm jobs out there that pay more for those hours.
Im not disagreeing as i have no idea, im just shocked.
Next time somebody asks about the future of anesthesiology, I should quote you on that.
1099 vs $230k w2 really depends on the w2 benefits.
If w2 benefits suck. No or little retirement matching. Poor health benefits. (Remember most small private gorup that employ will make u pay ur malpractice retail) and their Health insurance isn't much better cause it's barely subsidized especially since they aren't required to subsidized non working spouses or kids)
I'd take a 300k 1099 slot over a 300k w2 position if the w2 benefits suck. Cause ur only "real" savings would be the employer portion of payroll taxes (roughly $8-9k) as a w2. U can make up that employer portion of the payroll taxes up easily with 1099 deductions (travel, car, business "expenses" like computers, cell phones) plus u can put away 54k of ur own money into retirement (w2 is only 18k pretax).
Barring any dramatic/unforeseen changes, the job will still exist 5 years from now. We're gonna expect you to hit the ground running with a strong cookie game on day 1 though. How are your peanut butter skills??
It's just an hourly pay gig. Weekends don't pay any different. And what do you mean no vacation?? It's a contractor gig - as much or as little vacation as you want. You give us your availability. "Paid" vacation is a sign of a bad gig. @nimbus had a good post about that not too long ago.
I can PM you some other details. Are you an MS or an intern?
So, for the OP the answer to the question about Anesthesiology being a "good career" is a mixed bag:
1. 1/4 of the graduates will get "sweet" private practice gigs making really good money. These people will do very well financially in the specialty making it a good choice despite the politics of the filed.
2. 1/4 will end up in academics of some sort or a low paying govt. job (military/VA). They will be "okay" with the situation because they chose that route. Those who move up the chain in academia will end up doing quite well IMHO.
3. 1/2 will end up in as "employees" of a company (AMC) or hospital or even a private group (no partnership). These people are the ones my posts are most relevant for because they represent the new majority going forward.
If you can live with numbers 2 or 3 then by all means choose Anesthesiology. But, if you are only picking the filed because of number 1 then that is a big risk to take these days. However, others on SDN have gotten these "sweet" jobs which makes it all worthwhile in my opinion.
Finally, the job itself is really not bad most days and if the AANA issue along with the AMCs were to disappear I would opine that this field may indeed be the best one in the house of medicine.
Interesting data from ASA Monitor showing what the job market holds for FRESH grads, though a very small N.
The 2016 Job Market for Graduating Anesthesiology Residents | ASA Monitor | ASA Publications
I still believe my post is more accurate than the small sample you posted above. Even with that small sample 1/2 the new grads weren't going to join a partnership track.
The sample size is simply too small to make any meaningful comparisons. Also, how many "tracks" won't actually work out? I've seen that happen to several people on SDN.
So, you post a graph of first year salaries? How about salaries from years 5-10? The above graph is worthless.
Strictly speaking, 1/2 of the new grads weren't joining a partnership.
1/4 were not
And 1/2 were going to fellowship. I would imagine a larger % of fellowship grads will find the partner tracks. But that data isn't there.
The problem with the white coats is they have lost much of their meaning. Most of the time at the places I have rotated, the person not wearing the white coat is the doctor. Damn near everyone else has a white coat on. I'm not sure why the radiology tech at my last rotation wears one or many of these other sub-mid-level healthcare employees wear one. Its stupid and shouldn't be allowed.
My thoughts about the name badges are as follows. Why do nurses RN or RN/BSN or dietitians or rad tech (as examples) get these big bold letters below their name badge? Clearly the intent is to make it clear they are the nurse. At my rotation site, physicians just have a boring white badge and small letters under their name that state "physician." Why don't physicians deserve some type of a distinctive name badge so that one can easily identify them as a physician without reading the words on their badge? I wouldn't want something under my badge like the RNs have, but a unique color or something to set us apart.
Interesting. I always thought a 1099 wasn't as advantageous as a W2, but I'm starting to think if you can utilize it to your benefit it may not be so bad. The only downside for me is if my spouse doesn't have health insurance through an employer, I have to pay for private health insurance and that could cost $18000-24000.
Does compensation mean salary or all benefits?
If you are in PP, you can do a 55K cash balance (defined benefits, like a pension) which you can roll over every 5 years into your 401k. You can't really lose money in these plans (IRS qualification is rigid for these), so you basically put it into CD's until rollover.
You put 18k into 401k, and company puts in 36k as profit sharing contribution (totaling 54k).
Together, that's 109k tax advantaged, with 91K coming from your company (18k from you). PRETAX.
This is what Blade is referring to and is huge in the long run. Even if W2 is the same, the advantage assuming AMC matches 50% (so 9k to your 18k), is $81k/year PRETAX difference between AMC and your PP group if you are full partner. Considering the AMC is also going to skim off your salary/income, and the PP to AMC difference is as large as Blade suggests. To some extent life changing in terms of gaining financial independence...
In PP you can also set up a Defined Benefit Plan that allows you to contribute incredible amounts into a pre-tax account. It scales with age, but for ours it maxes out north of 200K for guys in their late 50's on up. This is in addition to your 401K.
Wow. I thought we were maxing it out at 55k Defined Benefits......
Jesu Cristo, where did you all learn this information?
SDN Anesthesia forum.
Age dependent. The key to getting "rich" is tax deferred savings!
Study finds many doctors don't save enough for retirement
AMCs are the worst for contributing towards your 401K plan. That salary may sound good but leaving out that $36K employer contribution can be a major problem for a new graduate.
Why Aren’t Doctors Rich?
Defined Benefit Plans Physicians, Dentists, Small Medical Practices
Look over the web site and read the client examples on the site.
Defined benefit cash balance plans are great, but also complicated and require an actuary in addition to a fiduciary investment manager, so they are generally more expensive than 401ks and fees can rack up quickly. Given the generally overall lower return (it's a pension type retirement plan, so the corporation takes on the risk, not the employees, if you're partner though it's one in the same) the fees can quickly overcome the tax benefit one sees so you really need to do your homework on them. If you have a lot of employees, this can also make them challenging to run.
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Yes, these types of plans are not for everyone. They are best suited for an ALL MD group or a 1099 job. That said, there are big institutional players in this business these days so the costs for a Defined benefit plan can be quite reasonable.
Now, everyone can MAX out the 401K side at $54,000 per year ($60K for those over 50) with very low fees. If the AMCs would pay their low salaries and include a contribution of $36,000 per year they would not necessarily all be bad jobs. But, as it stands today the big players SQUEEZES the little guy and denies him/her a full retirement contribution as allowed by law.
Unfortunately, the AMC approach is rational. Most employees would rather have the $$ as salary as opposed to a 401k contribution. Even though the 401k is in most cases in their long term best interest. Saw this time and again when we were recruiting CRNAs. All they cared about was the base salary/ hourly take home pay. We didn't get the bang for the bucks for the top shelf retirement plan or top shelf health insurance when recruiting.
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