Best fellowship in terms of future salary?

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nimbus said:
I agree the greatest need is for generalists. If you have peds and cardiac folks who don’t mind giving up their subspecialty, then it’s not a problem.
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Right now there is a huge demand for generalists. Locums are making money hand over fist. But, once the demand abates in 5 years the better job and the better long term career is Cardiac/Pain. But, you want a flexible person who can fill in as a generalist while also being Boarded in their subspecialty. Those without fellowships are much easier to hire and typically get paid a lower salary by AMCs/ hospitals/academic centers. Yes, you must do one extra year but that isn’t much over a 30 year career.
 
Aheadbyacentury said:
Not really! I engage all the recruiters when they call and inquire about how much they are paying. Its not that much more than CRNAs to be honest. Im shocked.. They say "URGENT NEED" then I ask how urgent$$? and I am very underwhelmed.
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CRNAs are earning $145-$175 per hours plus the food, auto. housing etc. Physicians are $225-$325 per hour with Cardiac Locums in the higher end of the range ($275-$325 per hour). Non cardiac generalists are in the $215 (AMC rate) -$250 per hour rate in my neck of the woods. Some trauma centers pay $300 or more per hour for weekend coverage in house.

But, there are many hours available so you can rack up 50-55 hours per week as a physician or CRNA.
 
BLADEMDA said:
CRNAs are earning $145-$175 per hours plus the food, auto. housing etc. Physicians are $225-$325 per hour with Cardiac Locums in the higher end of the range ($275-$325 per hour). Non cardiac generalists are in the $215 (AMC rate) -$250 per hour rate in my neck of the woods. Some trauma centers pay $300 or more per hour for weekend coverage in house.

But, there are many hours available so you can rack up 50-55 hours per week as a physician or CRNA.
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i havent seen rates that high by the agencies that call me for MDs.. but i know CRNA locums make 160/hr
 
Sounds
BLADEMDA said:
CRNAs are earning $145-$175 per hours plus the food, auto. housing etc. Physicians are $225-$325 per hour with Cardiac Locums in the higher end of the range ($275-$325 per hour). Non cardiac generalists are in the $215 (AMC rate) -$250 per hour rate in my neck of the woods. Some trauma centers pay $300 or more per hour for weekend coverage in house.

But, there are many hours available so you can rack up 50-55 hours per week as a physician or CRNA.
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Numbers seem correct for the Northeast.
 
BLADEMDA said:
CRNAs are earning $145-$175 per hours plus the food, auto. housing etc. Physicians are $225-$325 per hour with Cardiac Locums in the higher end of the range ($275-$325 per hour). Non cardiac generalists are in the $215 (AMC rate) -$250 per hour rate in my neck of the woods. Some trauma centers pay $300 or more per hour for weekend coverage in house.

But, there are many hours available so you can rack up 50-55 hours per week as a physician or CRNA.
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Are they doing rush credentialing at these hospitals? Or is the usual BS 90 days.
 
I am still getting BS offers like $180 an hour and saying no to the local groups as that is the "going" rate. I have a full time job and and am just needing a little prn work on the side to keep my business and payroll open on the 1099 side.
 
chocomorsel said:
I am still getting BS offers like $180 an hour and saying no to the local groups as that is the "going" rate. I have a full time job and and am just needing a little prn work on the side to keep my business and payroll open on the 1099 side.
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2 years ago it was $180. These days it is a MINIMUM of $200 for side gig through an AMC. The "going rate" is $225-$250 per hour for non cardiac coverage. Cardiac coverage is higher. I recommend you say "no" and counter with $225 per hour. Then, you can settle in the middle at $215 if you want the gig.
 
BLADEMDA said:
2 years ago it was $180. These days it is a MINIMUM of $200 for side gig through an AMC. The "going rate" is $225-$250 per hour for non cardiac coverage. Cardiac coverage is higher. I recommend you say "no" and counter with $225 per hour. Then, you can settle in the middle at $215 if you want the gig.
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CRNAS make 160/hr
 
BLADEMDA said:
CRNAs are earning $145-$175 per hours plus the food, auto. housing etc. Physicians are $225-$325 per hour with Cardiac Locums in the higher end of the range ($275-$325 per hour). Non cardiac generalists are in the $215 (AMC rate) -$250 per hour rate in my neck of the woods. Some trauma centers pay $300 or more per hour for weekend coverage in house.

But, there are many hours available so you can rack up 50-55 hours per week as a physician or CRNA.
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I've cast a net far and wide the last year looking for cardiac locums work, and the two places (both in the Midwest) that I've ended up are paying ~ $270/hr.

For night/weekend/holiday work the rate's a touch higher. Actually, a weekend trauma/general call at one of them reaches about $312/hr but it's non-****ing-stop for 24h and that money is earned.

If you know someone paying $325/hr for cardiac locums send me a PM and I'll drop what I'm doing and go there. 🙂 I'm looking to burn all of my accrued vacation time and do about a week of locums per month for the 334 days I have left in the Navy.
 
pgg said:
I've cast a net far and wide the last year looking for cardiac locums work, and the two places (both in the Midwest) that I've ended up are paying ~ $270/hr.

For night/weekend/holiday work the rate's a touch higher. Actually, a weekend trauma/general call at one of them reaches about $312/hr but it's non-****ing-stop for 24h and that money is earned.

If you know someone paying $325/hr for cardiac locums send me a PM and I'll drop what I'm doing and go there. 🙂 I'm looking to burn all of my accrued vacation time and do about a week of locums per month for the 334 days I have left in the Navy.
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That's good money but I'd rather be asleep in my bed at night
 
Paincrusher said:
Lol, you clearly are not in the field of pain management. I beg you to tell me a field expanding as quickly as pain medicine. Within the last five years the scope of practice has expanded significantly to include Vertiflex, Intracept, New RF and SCS technologies, Peripheral Nerve Stim…the list goes on. You clearly are clueless, ignorant or just plain stupid.
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I’m likely stupid.
 
Pain is the obvious answer, but it seems like salaries in general for all anesthesiologists have been going up recently (maybe inflation is part of it).

Peds seemed to always be a low-lier in terms of salary but even that’s changing.

In peds cardiac I have seen many offers that are 500k+. One that I feel comfortable mentioning is anesthesia associates of New Mexico, as it’s posted on gaswork.com
700k starting is not too shabby!

However pain+owning your own center/clinic (still possible in smaller cities in the Midwest/south) crushes all. 700k is nothing…1.5-2million/year is attainable.
 
invitro said:
Peds seemed to always be a low-lier in terms of salary but even that’s changing.
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Posting so residents aren't dissuaded away from peds fellowship by reading stuff like this. Not going to go into specifics since this not in the private forum, but residents & fellows can PM me for details. (tl;dr: We are well above 50%ile MGMA for pain doing 100% peds anesthesia.)

I'm several years out doing 100% peds, and I've been out-earning all of my co-residents who went into pain this entire time. They don't have in house call, but the hustling never ends if you want the 80+ percentile pain salaries. And my true "buy-in" was hundreds of thousands less than the pain guys.

Most my pain co-residents switched from one exploitative position to a new one, and had to start over at a new position or build their own practice from scratch. Several of them had to move their family to get outside of the non-compete. (Got that exploitative job to be close to family? Not any more...) They aren't even at their full earning potential yet, while I'm ready to scale down to 1-2 weeks a month. (I have to admit though that "dumb luck" investments helped, but it would have occurred within 3-4 years regardless.)

Just because a significant portion of the patients are medicaid doesn't mean that your compensation must reflect this. Push back against people who are trying to take advantage of you, and save your niceness for your patients. Pick a group and institution that values what you bring to the OR.
 
BioChemDork said:
Posting so residents aren't dissuaded away from peds fellowship by reading stuff like this. Not going to go into specifics since this not in the private forum, but residents & fellows can PM me for details. (tl;dr: We are well above 50%ile MGMA for pain doing 100% peds anesthesia.)

I'm several years out doing 100% peds, and I've been out-earning all of my co-residents who went into pain this entire time. They don't have in house call, but the hustling never ends if you want the 80+ percentile pain salaries. And my true "buy-in" was hundreds of thousands less than the pain guys.

Most my pain co-residents switched from one exploitative position to a new one, and had to start over at a new position or build their own practice from scratch. Several of them had to move their family to get outside of the non-compete. (Got that exploitative job to be close to family? Not any more...) They aren't even at their full earning potential yet, while I'm ready to scale down to 1-2 weeks a month. (I have to admit though that "dumb luck" investments helped, but it would have occurred within 3-4 years regardless.)

Just because a significant portion of the patients are medicaid doesn't mean that your compensation must reflect this. Push back against people who are trying to take advantage of you, and save your niceness for your patients. Pick a group and institution that values what you bring to the OR.
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the reimbursement for peds anesthesia is solely dependent on the profitability of the group you are working for since it generates little revenue in and of itself. Obvious, I know, but still worth pointing out. It is a service that needs to be provided in many places, just make sure that you are joining a practice that is bringing in plenty of money elsewhere.
 
Justice4all said:
All my co-residents with a pain fellowship have returned to the OR within 3-5 years.
Yes, there is potential for making $1million plus but it’s not just plug and play. An entrepreneurial spirit is needed and only a few got it.
Peds here. Academic . Not low tier and I like the variety
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I recommend a newly minted PAIN fellow join an existing group of Orthopedists or Neurosurgeons for a patient base. I also recommend he/she make sure that any deal includes an ownership stake in an ASC. Now, if you combine the 2 together (partnership and ownership in an ASC) the overall compensation package should be quite good. Will it be over 50th % MGMA for Pain? It should be and If it isn't there is something wrong going on.

Now, for those that prefer Peds over Pain that is fine also. You have a valuable skill set and should be compensated for it. There is a need for BOTH in our country and both can do well. I think one should pursue the area of most interest and do a fellowship.
 
BLADEMDA said:
I recommend a newly minted PAIN fellow join an existing group of Orthopedists or Neurosurgeons for a patient base. I also recommend he/she make sure that any deal includes an ownership stake in an ASC. Now, if you combine the 2 together (partnership and ownership in an ASC) the overall compensation package should be quite good. Will it be over 50th % MGMA for Pain? It should be and If it isn't there is something wrong going on.

Now, for those that prefer Peds over Pain that is fine also. You have a valuable skill set and should be compensated for it. There is a need for BOTH in our country and both can do well. I think one should pursue the area of most interest and do a fellowship.
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Yes this is it!

I don't understand why so many people do pain fellowships and go back into the or even it's just part time. Just grab that ownership, do your procedures and count the benjamins.
 
GassYous said:
Yes this is it!

I don't understand why so many people do pain fellowships and go back into the or even it's just part time. Just grab that ownership, do your procedures and count the benjamins.
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Is this as easy as it sounds? I can’t imagine there’s a ton of orthopedists who are enthusiastic about giving away ownership in their practices, particularly because they’d likely be billing more than you and would control a lot of your referrals. I’ve heard of this setup in a large multispecialty spine group with excellent salaries but have never met a pain fellow who found a job like this. Much more commonly they joined a pain practice partnership or an academic group.

Regarding peds reimbursement a few posts up, for most mixed groups peds will be a money loser. However big children’s hospitals are able to use their name recognition to negotiate big rates from insurers (parents with sick kids who are told by their insurance companies that they can’t go to the top children’s hospital in town make a lot of ruckus and bad press). This combined with big philanthropic endowments and subsidies results in a handful of very profitable peds groups across the country - this combined with most of them being academic pyramids and the salaries for senior docs at some big children’s hospitals are quite high.
 
ambiturner said:
Is this as easy as it sounds? I can’t imagine there’s a ton of orthopedists who are enthusiastic about giving away ownership in their practices, particularly because they’d likely be billing more than you and would control a lot of your referrals. I’ve heard of this setup in a large multispecialty spine group with excellent salaries but have never met a pain fellow who found a job like this. Much more commonly they joined a pain practice partnership or an academic group.

Regarding peds reimbursement a few posts up, for most mixed groups peds will be a money loser. However big children’s hospitals are able to use their name recognition to negotiate big rates from insurers (parents with sick kids who are told by their insurance companies that they can’t go to the top children’s hospital in town make a lot of ruckus and bad press). This combined with big philanthropic endowments and subsidies results in a handful of very profitable peds groups across the country - this combined with most of them being academic pyramids and the salaries for senior docs at some big children’s hospitals are quite high.
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No personal experience but I don't think it is easy. The practice I know of is a spine group. You need to be in the right place at the right time.
 
ambiturner said:
Is this as easy as it sounds? I can’t imagine there’s a ton of orthopedists who are enthusiastic about giving away ownership in their practices, particularly because they’d likely be billing more than you and would control a lot of your referrals. I’ve heard of this setup in a large multispecialty spine group with excellent salaries but have never met a pain fellow who found a job like this. Much more commonly they joined a pain practice partnership or an academic group.

Regarding peds reimbursement a few posts up, for most mixed groups peds will be a money loser. However big children’s hospitals are able to use their name recognition to negotiate big rates from insurers (parents with sick kids who are told by their insurance companies that they can’t go to the top children’s hospital in town make a lot of ruckus and bad press). This combined with big philanthropic endowments and subsidies results in a handful of very profitable peds groups across the country - this combined with most of them being academic pyramids and the salaries for senior docs at some big children’s hospitals are quite high.
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yes its as easy as it sounds..

they "give up ownership" to someone who is billing for millions of dollars in pain procedures..

they dont make you partner to be nice, busy pain docs who keep the procedures (and surgery referals) in house are worth millions - for better or for worse that is the reality.

so when they make you partner, they are making partner someone who brings in probably as much as they do or more, and refers back to the spine guys in the group

its very prevalent in PP world to have an ortho group with at least one dedicated pain guy
 
Do you know what "partnership" means in an Orthopedic group? It means you share in the overhead and pay your costs. They refer you patients and assist with billing. You don't collect money off the ACL or Laminectomy. What you do get is a referral base, office space, staff, etc and the chance to see a lot of patients who need procedures. You do the procedures in the office and/or ASC. You get a cut of the profits from the ASC as an owner because you bring in a lot of revenue. You also receive your "collections" on the office side minus expenses. That is what partnership means most of the time.
 
BLADEMDA said:
Do you know what "partnership" means in an Orthopedic group? It means you share in the overhead and pay your costs. They refer you patients and assist with billing. You don't collect money off the ACL or Laminectomy. What you do get is a referral base, office space, staff, etc and the chance to see a lot of patients who need procedures. You do the procedures in the office and/or ASC. You get a cut of the profits from the ASC as an owner because you bring in a lot of revenue. You also receive your "collections" on the office side minus expenses. That is what partnership means most of the time.
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I’d hope that would be the case, I just don’t believe it’s that prevalent because 1) the practices like this I’m familiar with pay far above the pain averages to the point where they are outliers and 2) you could potentially be in a position where you were dependent on the surgeons/sports docs/etc for referrals and they would justify not offering full partnership or taking a bigger cut, kind of like a lot of rad oncs that work for urologists.

This type of job sounds awesome and I hope every pain fellow can get something like this, but seeing what jobs our pain trainees take and what they are doing after a few years it just doesn’t seem like the norm.
 
ambiturner said:
I’d hope that would be the case, I just don’t believe it’s that prevalent because 1) the practices like this I’m familiar with pay far above the pain averages to the point where they are outliers and 2) you could potentially be in a position where you were dependent on the surgeons/sports docs/etc for referrals and they would justify not offering full partnership or taking a bigger cut, kind of like a lot of rad oncs that work for urologists.

This type of job sounds awesome and I hope every pain fellow can get something like this, but seeing what jobs our pain trainees take and what they are doing after a few years it just doesn’t seem like the norm.
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when you are in training its hard to know what the real world is like and what options are really out there..

you have only seen academia, you have only read about salaries online, etc.. this leads to a lot of bad first jobs IMO

who is going to give you the real world advice? the academic pain guys training you? these guys are the example of what NOT to be IMO
 
I will be finishing my pain fellowship soon and was interviewing for jobs all last year. There were so many jobs that never even offered me partnership or said I had the “potential” to be partner after they assess how well I did. There were tons of shady jobs out there for pain. My friends doing general anesthesia are definitely making more than me and had the extra year to work. I am still happy I did a fellowship but will I make more in the future that I am not sure ? Doing this fellowship wasn’t really about making more money I just enjoy practicing pain management more than anesthesia. I think the best thing is to make sure you really enjoy the fellowship first before thinking about salary or job security.
 
pain 1 year out.
community practice
autonomy is everything. i definitely dont make as much as anesthesia but I have no weekends, nights, holiday work.
i completely control my schedule and see as many patients as i want, do as many procedures as i want.
90% of my patients are reasonable. the other 10% can be a "battle" but at the end of the day I quickly put my foot down and welcome them to get second opinions.
it's the perfect lifestyle job that I've envisioned and I do feel like I make a difference in the community. I can't help everyone but I do my best and things have worked out fairly well.
 
sloh said:
How do these conversations usually go? Like is it explicit?
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I assume you just tell the patient that they have to try other things than narcotics and you'd like to try some injections. If they don't agree with your plan you can't treat them.
 
GassYous said:
Yes this is it!

I don't understand why so many people do pain fellowships and go back into the or even it's just part time. Just grab that ownership, do your procedures and count the benjamins.
Click to expand...
Probably to maintain their skills and have a bit of variety in their lives. Sometime surgeons get too draining, sometimes its the pain patients.

JelloIsJigglin said:
pain 1 year out.
community practice
autonomy is everything. i definitely dont make as much as anesthesia but I have no weekends, nights, holiday work.
i completely control my schedule and see as many patients as i want, do as many procedures as i want.
90% of my patients are reasonable. the other 10% can be a "battle" but at the end of the day I quickly put my foot down and welcome them to get second opinions.
it's the perfect lifestyle job that I've envisioned and I do feel like I make a difference in the community. I can't help everyone but I do my best and things have worked out fairly well.
Click to expand...
How much less would you say?
Are you making 400 when theyre making 500? or is it something more significant. Feel free to PM if you dont want to post it.
 
I don't understand this whole I'm forced to give narcs to patients business. Narcs cause harm if used for chronic pain, plain and simple. I'm sure snorting cocaine will make ppls chronic back pain go away but noone prescribes that and noone asks for it. Just say no. Do part time anesthesia to fill the income gap until you build a patient base. Or take a salaried position where the norm is no opioids. (I know I'm oversimplifying things but I get frustrated)
 
JelloIsJigglin said:
the other 10% can be a "battle"...
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One time, I had a patient at the end of the day...I had no where to go or anything to do that particular day. This patient was a talker and I always had to cut our time "short" so I thought to myself - on this particular day, just let her talk her self out....see what she does. It was a self-inflicted pain, I know...but I was super curious to know how long she would go.

Two hours later...I couldn't take it anymore. I had to shut her off and go home. I kinda wish I didn't do that. I really would have liked to see if she would have talked until midnight.
 
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