Bayside Anesthesia Medical Group

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Anyone want to weigh in on this offer from Bayside Anesthesia at Providence Saint John's Health Center in Santa Monica?

Start at $300/hour OR time
Raise every six months
Partners at $400/hour OR time
Three years to partnership
$71K buy in
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What percent of the time are you in the OR vs being "available" compared to partners. I'd guess a lot more. Therefore the 71k buy in is probably bull**** and actually much higher. Don't know anything about the group, but that is the obvious way to **** over new people.
 
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gunnershow said:
How do you get anyone to take call with this sort of model
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The senior partners probably take all the easy home call with a nice fat stipend for little to no time in the hospital. When not on call, they’ve got the quickest and most efficient rooms every day. They’ll just chalk it up to surgeon preference.

The junior partners probably work the late calls. They’ll badger the nurses to get that add on buttock I&D in the OR right away so they can start collecting their $400/hr for OR time.

The “partnership-track” plebeians probably sit around in the lounge waiting to see when they’ll be called for that random emergency in the middle of the day so they can start collecting their $300/hr. You see, this is how the group shows the hospital that they are always available.
 
I can’t speak for the market in the area, but in general this sounds like a terrible job. OR utilization in most hospitals is pretty lousy. If they run at 75% efficiency (very best you can likely hope for) then you are getting $225/hr now and $300/hr as a partner. I would expect around 65-70% efficiency on a standard full day schedule and 60% for late shifts, call etc. That puts you at 3 years of $180-210/hr. Then after 3 years you are getting $240-270/hr.

The buy in is 71k plus lost wages. If you work 45 hrs/wk, 44 wks/yr for 3 years and you are getting $60/hr less, you’ve given up another $356,400. Overall you are looking at about the equivalent of 500k in wages. That’s your true buy in. That’s a lot for a job that doesn’t seem amazing.
 
Its a drama filled place with a lot of characters. The director or principal is a goofball. They have some nerdy docs and some athlete docs that somehow all seem to get along. Whenever I locum there I always get some horrible add on at like 245 but I'm saved because I leave at 3.
 
Their previous partnership track timeline was three years to Junior Partner, followed by two years to Full Partner, followed by three year buy-in (15%, 10%, 5%), followed by one to two years to receive voting rights. Almost a decade before becoming a vested partner!

Does “three years to partnership” mean Junior Partner? Or Full Partner with voting rights?
 
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pulseoximetry said:
Their previous partnership track timeline was three years to Junior Partner, followed by two years to Full Partner, followed by three year buy-in (15%, 10%, 5%), followed by one to two years to receive voting rights. Almost a decade before becoming a vested partner!

Does “three years to partnership” mean Junior Partner? Or Full Partner with voting rights?
Click to expand...
This is about as manipulative as you can get. 9-10 years before becoming a full partner? There is a nationwide shortage of anesthesiologists. No one should put up with this.
 
Man. This is so bad on so many levels even on the low end the practice still will make $50/unit (and I’m factoring in hospital subsidies) and medi cal and Medicare

You are just getting paid for OR time which is even worst than getting paid per unit

60 min Or time $300
60 min knee scope (let’s say that’s a min 9 units) ($450) ($50/unit)

Why would anyone agree to this type of pay model.

The partners aren’t making $400/hr OR time. Usually in these practices they add 7-10% admin fees and pad their income.

I’ve see this playbook in the San Francisco area. My groomsmen got burned bad. Really bad. Money isn’t a big deal to him. He doesn’t have any kids and likes to travel and ride his motorcycle. So he’s a perfect fit for a practice like this this. But even he didn’t he felt ripped off. And he was fine making 250k a year.
 
pulseoximetry said:
Bayside is offering the following:

“$300 an hour if you take call
$275 an hour if just outpatient
Cardiac is 1hr stipend per day
3 years to partnership”

Pay is for OR time, not a guaranteed 8 or 10 or 12 hour shift like Cedars or Kaiser
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Neither of these entities guarantees shifts
 
aneftp said:
Man. This is so bad on so many levels even on the low end the practice still will make $50/unit (and I’m factoring in hospital subsidies) and medi cal and Medicare

You are just getting paid for OR time which is even worst than getting paid per unit

60 min Or time $300
60 min knee scope (let’s say that’s a min 9 units) ($450) ($50/unit)
Click to expand...

A knee scope is 4 base units. Standard time units are 15min. A 60 min knee scope would be 8 units. @$50/unit it’s $400.
 
nimbus said:
A knee scope is 3 base units. Standard time units are 15min. A 60 min knee scope would be 7 units. @$50/unit it’s $350.
Click to expand...
Private insurers will give u another unit for Asa class (I don’t think Medicare gives u extra unit). U can classify 50% of the USA population as Asa class 3 easily obesity, sleep apnea, etc.
 
aneftp said:
Private insurers will give u another unit for Asa class (I don’t think Medicare gives u extra unit). U can classify 50% of the USA population as Asa class 3 easily obesity, sleep apnea, etc.
Click to expand...


Also was not aware that knee scopes (29881) are 4 base units now. I edited my post to reflect that. But yes hourly vs unit pay really depends on many factors (payer mix, case mix, turnover). If you’re doing mitraclips all day, units win. OTOH, unit pay only pays for OR time+transport to PACU or ICU time. It never pays for break/turnover time between cases.
 
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aneftp said:
Private insurers will give u another unit for Asa class (I don’t think Medicare gives u extra unit). U can classify [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]]][emoji[emoji[emoji6]][emoji[emoji6]]]% of the USA population as Asa class [emoji[emoji[emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6]]]][emoji[emoji6][emoji6]][emoji[emoji[emoji6]][emoji[emoji6][emoji6]]]] easily obesity, sleep apnea, etc.
Click to expand...

Some private insurers have dropped ASA classification for extra units. Another spear into our reimbursement.
 
nimbus said:
Also was not aware that knee scopes (29881) are 4 base units now. I edited my post to reflect that. But yes hourly vs unit pay really depends on many factors (payer mix, case mix, turnover). If you’re doing mitraclips all day, units win. OTOH, unit pay only pays for OR time+transport to PACU or ICU time. It never pays for break/turnover time between cases.
Click to expand...

I thought it was 3 for diagnostic, 4 if they do anything
 
Nunchuk said:
Anyone have any details on the other private groups in the LA area like Pasadena or Torrance? Are their starting packages any better or are all LA area jobs similar to this?
Click to expand...


I may be out of date but I think most LA jobs still pay by unit production+stipends. Not hourly.

Kaiser does offer a good signon bonus. One of our new gyn’s is married to an anesthesiologist and he took a job with Kaiser because they could use the signon bonus at this stage in their career. I don’t think many private practices could match it.
 
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centdoc said:
Some private insurers have dropped ASA classification for extra units. Another spear into our reimbursement.
Click to expand...
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Pharmado said:
I can’t speak for the market in the area, but in general this sounds like a terrible job. OR utilization in most hospitals is pretty lousy. If they run at 75% efficiency (very best you can likely hope for) then you are getting $225/hr now and $300/hr as a partner. I would expect around 65-70% efficiency on a standard full day schedule and 60% for late shifts, call etc. That puts you at 3 years of $180-210/hr. Then after 3 years you are getting $240-270/hr.

The buy in is 71k plus lost wages. If you work 45 hrs/wk, 44 wks/yr for 3 years and you are getting $60/hr less, you’ve given up another $356,400. Overall you are looking at about the equivalent of 500k in wages. That’s your true buy in. That’s a lot for a job that doesn’t seem amazing.
Click to expand...
Can you help me understand how this would be different than being paid by base units? For my lizard brain, I assume you are at the whim of OR inefficiencies regardless of pay structure.
 
greenrustVT said:
Can you help me understand how this would be different than being paid by base units? For my lizard brain, I assume you are at the whim of OR inefficiencies regardless of pay structure.
Click to expand...

If you have a lot of shorter cases, you’d get hosed with the hourly system based on OR time due to long turnovers/waiting around for surgeons/different surgeons in same OR with different start times/nursing delays etc. Also If you are unit based, you’d be naturally incentivized to be more efficient and churn out more cases. With the strictly OR time model, you get punished for being efficient.

Even with similar OR utilization rates, having a decent blended unit value and being paid time units AND startup units will let you come out way ahead most days except for maybe the rare two 6 hr crani days where it could be more equal.

Kaiser SoCal is offering $250/hr for the entire shift and not just OR time and some local groups are doing near $300-325/hr for per diem for the whole shift as well. IMHO these are better options than this setup.
 
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Nunchuk said:
If you have a lot of shorter cases, you’d get hosed with the hourly system based on OR time due to long turnovers/waiting around for surgeons/different surgeons in same OR with different start times/nursing delays etc. Also If you are unit based, you’d be naturally incentivized to be more efficient and churn out more cases. With the strictly OR time model, you get punished for being efficient.

Even with similar OR utilization rates, having a decent blended unit value and being paid time units AND startup units will let you come out way ahead most days except for maybe the rare two 6 hr crani days where it could be more equal.

Kaiser SoCal is offering $250/hr for the entire shift and not just OR time and some local groups are doing near $300-325/hr for per diem for the whole shift as well. IMHO these are better options than this setup.
Click to expand...
250/hr for crna or MD? For later, Fxxk it.
 
aneftp said:
Kaiser proper LA. ? Like within 30 min downtown. Or way off Fontana
Click to expand...
LA proper, SCPMG is having a real crisis in hiring is what I've heard, the ever increasing rates of PP/locums hasn't kept up with the Kaiser model and they can't increase the salary because of the downstream effect it has on their pension. Hence their large sign on bonus, people who can do the math though realize it's not competitive, even taking into account the pension and especially in the high cost of living there
 
Maverikk said:
LA proper, SCPMG is having a real crisis in hiring is what I've heard, the ever increasing rates of PP/locums hasn't kept up with the Kaiser model and they can't increase the salary because of the downstream effect it has on their pension. Hence their large sign on bonus, people who can do the math though realize it's not competitive, even taking into account the pension and especially in the high cost of living there
Click to expand...
My Florida former colleague is back in LA now says Kaiser north county is paying $390/hr now as well

Glad the rates are up.
 
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They’re going to have to rearrange, Ive heard some are getting rid of the pension for a 401k as the increasing salaries won’t make it soluble. I don’t know all the technical details of the PMGs or how they interact with Kaiser itself…I always thought of them as a large multi speciality PP group with benefits and retirement tied to the hospital plan. Do the nurses and Kaiser employees have the same pension? If their playbook is to offer bigger sign on bonuses to get people in the golden handcuffs I think they’re underestimating the shortage and how long it will last. I’ve talked to two people who I trust, one stayed on at my training program I was in and one moved into admin at a large hospital chain I worked at. The two points I learned: almost half the class in my training program went into locums, when I finished none did. For a moderately desirable metro area the going price for an anesthesiologist working full time is 700k w2. My friend who told me this said this isn’t what they’ll offer but is their ceiling for people smart enough to negotiate.

If you’re single/spouse can travel you’re in the best position possible right now, can work 6 months a year and make anywhere from 400-600k depending on how much you want to work. I worked with a good crna who sold his house and bought an RV with his wife who did tech work from home. Nice dude, knew what he was doing, getting anywhere from 200-350/hr, no mortgage, school loans paid. Eventually we started talking which is why I know his rates, he was attempting to buy beachfront property in the Cayman Islands as an investment, told me frankly most anesthesiologists don’t bargain and don’t know how much they’re worth.
 
Maverikk said:
They’re going to have to rearrange, Ive heard some are getting rid of the pension for a 401k as the increasing salaries won’t make it soluble. I don’t know all the technical details of the PMGs or how they interact with Kaiser itself…I always thought of them as a large multi speciality PP group with benefits and retirement tied to the hospital plan. Do the nurses and Kaiser employees have the same pension? If their playbook is to offer bigger sign on bonuses to get people in the golden handcuffs I think they’re underestimating the shortage and how long it will last. I’ve talked to two people who I trust, one stayed on at my training program I was in and one moved into admin at a large hospital chain I worked at. The two points I learned: almost half the class in my training program went into locums, when I finished none did. For a moderately desirable metro area the going price for an anesthesiologist working full time is 700k w2. My friend who told me this said this isn’t what they’ll offer but is their ceiling for people smart enough to negotiate.

If you’re single/spouse can travel you’re in the best position possible right now, can work 6 months a year and make anywhere from 400-600k depending on how much you want to work. I worked with a good crna who sold his house and bought an RV with his wife who did tech work from home. Nice dude, knew what he was doing, getting anywhere from 200-350/hr, no mortgage, school loans paid. Eventually we started talking which is why I know his rates, he was attempting to buy beachfront property in the Cayman Islands as an investment, told me frankly most anesthesiologists don’t bargain and don’t know how much they’re worth.
Click to expand...
If places can’t fill spots. They must change.

If docs keep complaining and don’t leave. Than the employer has no incentive to increase w2 page.

And I’m glad someone understands the market rate for a w2 anesthesiologist full call taking should be making 700k assuming 40-45 hrs of work call hours inclusive with 10 weeks off

And people keep saying it’s not possible for their market area. It’s because the docs are themselves to blame if they keep taking lower offers.
 
Maverikk said:
For a moderately desirable metro area the going price for an anesthesiologist working full time is 700k w2.
Click to expand...


As much as I want to believe this idk I just don’t see it out. I’m in dc area (so maybe because it’s a more desirable area?) the average pay for full call taking is still 450k. Does that sound about right?
 
sevo00 said:
As much as I want to believe this idk I just don’t see it out. I’m in dc area (so maybe because it’s a more desirable area?) the average pay for full call taking is still 450k. Does that sound about right?
Click to expand...
If it’s private practice that’s low
 
sevo00 said:
Wow that’s awesome. Yeah we still not there in the dc area wtf
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What's the market like there? Are multiple hospitals in need of anesthesiologists? Most markets are regional and depends on how much/little supervision they do...Even so 450 is low unless your're working 3-4 days a week and little call
 
aneftp said:
If places can’t fill spots. They must change.

If docs keep complaining and don’t leave. Than the employer has no incentive to increase w2 page.

And I’m glad someone understands the market rate for a w2 anesthesiologist full call taking should be making 700k assuming 40-45 hrs of work call hours inclusive with 10 weeks off

And people keep saying it’s not possible for their market area. It’s because the docs are themselves to blame if they keep taking lower offers.
Click to expand...
I’m not saying it doesn’t exist as I’m sure it does, but 700k at 45 hrs a week including call hours is a little optimistic. You can certainly make the 700k but the hours will be a bit higher. If I’m wrong DM me so I can send you a cv
 
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