CRNA vs. MD Anesthesiologist Income in 2015

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Psai said:
it's hard to donate to a group that doesn't stand up for you, trumpets horrible ideas and wastes money on a fancy, brand new headquarters
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Yeah, i get emails from the ama congratulating me on the aca....
 
Mad Jack said:
The government funding things is precisely why PCPs will always be paid less. There's simply more of them, and we can't afford to give them all neurosurgeon levels of pay.
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With the current climate the general movement is to bring the top down, not bring the bottom up.
 
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NOsaintsfan said:
With the current climate the general movement is to bring the top down, not bring the bottom up.
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More likely they'll bring everyone down, not just the top. The goal of turning physicians into employees is already in full swing in nearly every specialty. Once that's compete, they start tightening the screws. Right now that's politically untenable, because they'd be cutting doctor's pay directly. With bundled payments, however, they can claim they're cutting payments to the greedy hospitals, who will in turn cut the salaries of physicians. The politicians are absolving themselves of the political consequences by using bundled payments to obfuscate what's actually happening.

EMR wasn't about patient safety or cost savings. It was about increasing overhead enough to force physicians to become employees. Same goes for all the new regulations that came along with Obama's mess of a law. I guys what I'm saying is that the future isn't bright wherever you look. Anesthesia is certainly no exception. But with the glut of providers going into primary care and the majority of PCPs now in large groups or bring employees by hospitals, they'll probably see the bottom fall out before anesthesia, particularly with the necessity of anesthesia in cash cow surgery procedures versus the money drain that is primary care.
 
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BLADEMDA said:
In 5 years the median pay will be lower, much fewer true private practice jobs and more supervision of crnas (3-5 crnas per MD). AANA will use the ACA to keep chipping away at independent practice. A good analogy is a prisoner trying to dig his way out using a spoon. Progress is measured in decades not days.
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Can somebody explain why Anesthesiologists are making the choice to be employed rather than own their own practice? What economic pressure is driving all these docs to sell out? Are specialties that don't rely on the hospital, like FM, psych, ever going to face these pressures?
 
Mad Jack said:
More likely they'll bring everyone down, not just the top. The goal of turning physicians into employees is already in full swing in nearly every specialty. Once that's compete, they start tightening the screws. Right now that's politically untenable, because they'd be cutting doctor's pay directly. With bundled payments, however, they can claim they're cutting payments to the greedy hospitals, who will in turn cut the salaries of physicians. The politicians are absolving themselves of the political consequences by using bundled payments to obfuscate what's actually happening.

EMR wasn't about patient safety or cost savings. It was about increasing overhead enough to force physicians to become employees. Same goes for all the new regulations that came along with Obama's mess of a law. I guys what I'm saying is that the future isn't bright wherever you look. Anesthesia is certainly no exception. But with the glut of providers going into primary care and the majority of PCPs now in large groups or bring employees by hospitals, they'll probably see the bottom fall out before anesthesia, particularly with the necessity of anesthesia in cash cow surgery procedures versus the money drain that is primary care.
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Lol, you have no idea what you are talking about. Where is this "glut" of physicians going into primary care? Not sure where you are getting your information, but primary care, EM, and psych are easily the best job markets in all of medicine right now. I literally get inundated with PCP offers on a daily basis (have to start blocking recruiters), and offers are going up because health care organizations don't have ENOUGH primary care - not too much. Obviously, the market in large cities are a bit more saturated, but what field isn't? Everyone in IM is going into hospital medicine or sub-specialty. There were maybe 2 ppl in my class of 50 that went into outpatient general medicine. And FM itself isn't enough to fill up the PCP need in this country.
 
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olivarynucleus said:
Can somebody explain why Anesthesiologists are making the choice to be employed rather than own their own practice? What economic pressure is driving all these docs to sell out? Are specialties that don't rely on the hospital, like FM, psych, ever going to face these pressures?
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Its all about money plain and simple.

Imagine you are a senior partner at a independent anesthesia group. You and your other senior partners have a few years left till retirement, say less than 5. All the sudden a big AMC approaches your group and says we will buy your group out of its current contract with the hospital for $2 million per partner. In addition you all can work as employees for us with full benefits for as long as you want until retirement. Sure you have partners in your group who are still young and not far out of residency with 30+ more years to practice but you and your senior partner buddies have controlling voting rights within the group.

What would you do?
 
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And if NPs can do everything a FM doc can, why is there such a need for FM docs? Seems society values the extended training and knowledge of physicians somewhat, OR they just need someone to "supervise" FM NPs in states where they can't practice independently.
 
NOsaintsfan said:
Its all about money plain and simple.

Imagine you are a senior partner at a independent anesthesia group. You and your other senior partners have a few years left till retirement, say less than 5. All the sudden a big AMC approaches your group and says we will buy your group out of its current contract with the hospital for $2 million per partner. In addition you all can work as employees for us with full benefits for as long as you want until retirement. Sure you have partners in your group who are still young and not far out of residency with 30+ more years to practice but you and your senior partner buddies have controlling voting rights within the group.

What would you do?
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But the younger docs could start their own practices if they wanted to.
 
olivarynucleus said:
But the younger docs could start their own practices if they wanted to.
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Very true, but hospitals often award non-compete contracts to groups to provide anesthesia services. Often times anesthesia services are seen as a commodity and hospitals award contracts to the cheapest bidder. Cheapest bidder usually = AMC
 
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BLADEMDA said:
This fact is best shown in the trending of academic salaries. If things are so rosy out there why does academic pay keep declining in your chart? Is it because there is a glut of labor for the Chairs to squeeze extra hard?
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1/4 of us are earning record profits as well.
It's not all doom and gloom out there.
 
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olivarynucleus said:
And if NPs can do everything a FM doc can, why is there such a need for FM docs? Seems society values the extended training and knowledge of physicians somewhat, OR they just need someone to "supervise" FM NPs in states where they can't practice independently.
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NPs can't do everything like a doctor, but they can lobby for permission to claim they are equal. You are welcome to claim your english bulldog can outrun a cheetah, doesn't make it true.
 
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sb247 said:
NPs can't do everything like a doctor, but they can lobby for permission to claim they are equal. You are welcome to claim your english bulldog can outrun a cheetah, doesn't make it true.
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If this is allowed to happen, from some idiotic political perspective, it may well be said that medicine didn't unite and take charge and care of its own or the general public for that matter. 8 years ago I wasn't quite so apt to see the threat as a totally genuine threat; but now, politics being what they are, it's strangely possible. I didn't say it was fair or right or sensible. I am just saying that it doesn't seem to be as unlikely as it seemed about 8 years ago.
 
sb247 said:
NPs can't do everything like a doctor, but they can lobby for permission to claim they are equal. You are welcome to claim your english bulldog can outrun a cheetah, doesn't make it true.
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All the fancy comparisons are cute and all, but what practical procedures or conditions can FM docs do/treat that FMNPs cant????
 
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Well, for starters, the docs can have a much better understanding of disease process, greater ability to conduct a physical examination, interpret labs and other tests, have a higher intelligence to put all the data together and come to a diagnosis.


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Wiscoblue said:
Well, for starters, the docs can have a much better understanding of disease process, greater ability to conduct a physical examination, interpret labs and other tests, have a higher intelligence to put all the data together and come to a diagnosis.


Sent from my iPad using Tapatalk
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So doctors are just overall smarter?
 
Hey,

So I started my primary care gig with kaiser after residency. About 7 years ago this kaiser region was seeing red and about to go under. They brought in consultants (ie Bain/McKinsey types) to see how they could save money, provide good care and stop hemorrhaging patients. One of the first things they did was take NPs out of primary care. They took away their panels and made it MD/DO only. They transferred them into specialties were they did well defined procedures and types of visits. Ie go to ortho and do joint injections

More knowledgeable, smarter, more cost effective, all of the above? idk what it was but they have not looked back. The physician only primary care model has worked. The change has worked. With the realms of data kaiser collects they probably have the data to prove it but can't publish it to be PC.

I'll tell you another thing. They are desperate for primary care doctors and they are willing to pay for them. They will not go back to the old model . I know you guys may smirk at these figures. But if you told me 5 years ago that 240k base plus bonus/pension/5% match with no call and no weekends 800-500pm was possible in FM I would have laughed. That's the reality and they still can't get adequate staffing. When direct primary care takes off it will only get worse. Well I guess better
 
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Ronin786 said:
Yes.

I can play football, doesn't mean I come close to Tom Brady. Not sure why that's a difficult concept.
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no you do the same work by throwing a football so you should get the same pay
 
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Welcome to the jungle, baby.

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headline.png
 
anthroguy said:
Hey,

So I started my primary care gig with kaiser after residency. About 7 years ago this kaiser region was seeing red and about to go under. They brought in consultants (ie Bain/McKinsey types) to see how they could save money, provide good care and stop hemorrhaging patients. One of the first things they did was take NPs out of primary care. They took away their panels and made it MD/DO only. They transferred them into specialties were they did well defined procedures and types of visits. Ie go to ortho and do joint injections

More knowledgeable, smarter, more cost effective, all of the above? idk what it was but they have not looked back. The physician only primary care model has worked. The change has worked. With the realms of data kaiser collects they probably have the data to prove it but can't publish it to be PC.

I'll tell you another thing. They are desperate for primary care doctors and they are willing to pay for them. They will not go back to the old model . I know you guys may smirk at these figures. But if you told me 5 years ago that 240k base plus bonus/pension/5% match with no call and no weekends 800-500pm was possible in FM I would have laughed. That's the reality and they still can't get adequate staffing. When direct primary care takes off it will only get worse. Well I guess better
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Anthro,

Would you mind telling us in what city you work? I read on here that an FM doc in Modesto started at about 200K, or that they he was paid about the same as pharmacists. For living in California with near 50% taxes and 500K debt, that sounds....not worth it. With some retirement savings, then taxes, then 50-60K loan payments for almost 20 years to be living in Modesto with about 40k left over sounds........well you get the idea.
 
I looked through the jobs posted on Gaswork the other day and I came to this conclusion:

The jobs are MUCH worse on average in 2015 than they were in 2009. If this trend continues the new graduate in 2019 is looking at even fewer partnership tracks, lower starting pay ($250K?) and more employee positions with AMCs.
 
Blade, why is it that so many qualified US MD grads, who score >240s of the USMLEs still go into a dying specialty like anesthesia?

also, how easy would it be to switch to primary care ie FM, IM from anesthesia? Does it even occur that often?
 
Is it normal that cRNAs have access to the doctor's lounge? Just wondering, because at my hospital they do.
 
NOsaintsfan said:
Its all about money plain and simple.

Imagine you are a senior partner at a independent anesthesia group. You and your other senior partners have a few years left till retirement, say less than 5. All the sudden a big AMC approaches your group and says we will buy your group out of its current contract with the hospital for $2 million per partner. In addition you all can work as employees for us with full benefits for as long as you want until retirement. Sure you have partners in your group who are still young and not far out of residency with 30+ more years to practice but you and your senior partner buddies have controlling voting rights within the group.

What would you do?
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Just wanted to add. If buyout for younger docs is high enough (2 plus million per partner) taxed at 15-20% rate.

You could bet set for life even with a 2 million buyout at age 40.

Unless you are simply careless with your money. Most of us (my cohort) in late 30s/early 40s should have net worth between 750k-1.5 million (that's just average) from working the past 10 year. That's already accounting for housing losses (for those of us who brought at peak and took losses) and stock market crash and recovery.

Money generates quickly once u get over 1 million. And that's with even conservative investing.

So add another 1-1.4 million post tax buyout money to your already net worth even at age 40. You are talking now having 2-2.5 million.

Sure you will be working simply cause you are able body and the money is still there even as employee. But once you reach a certain mark. You are pretty much set for life even investing conservatively.

So it's not only the old guys selling but younger guys can get a jump start on inching closer to retirement.
 
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aneftp said:
Just wanted to add. If buyout for younger docs is high enough (2 plus million per partner) taxed at 15-20% rate.

You could bet set for life even with a 2 million buyout at age 40.

Unless you are simply careless with your money. Most of us (my cohort) in late 30s/early 40s should have net worth between 750k-1.5 million (that's just average) from working the past 10 year. That's already accounting for housing losses (for those of us who brought at peak and took losses) and stock market crash and recovery.

Money generates quickly once u get over 1 million. And that's with even conservative investing.

So add another 1-1.4 million post tax buyout money to your already net worth even at age 40. You are talking now having 2-2.5 million.

Sure you will be working simply cause you are able body and the money is still there even as employee. But once you reach a certain mark. You are pretty much set for life even investing conservatively.

So it's not only the old guys selling but younger guys can get a jump start on inching closer to retirement.
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Good points. I can't disagree with anything you wrote.

The concern is for the future. I hope partnerships exist in 5 years when I get done with training. Of course I am planning on being employed but it would be nice to not be.
 
chudat said:
Blade, why is it that so many qualified US MD grads, who score >240s of the USMLEs still go into a dying specialty like anesthesia?

also, how easy would it be to switch to primary care ie FM, IM from anesthesia? Does it even occur that often?
Click to expand...

cause not everyone choose career based on money? i chose anesthesia b/c i couldn't see myself doing social work all day on medicine, or round 5 hours. I didn't wan to stand in one spot for a big part of my day in surgery. It was either radiology or anesthesiology, and neither are doing well
 
Ditto..

Currently on peds. Spend a large part of my day scheduling follow up appointments after patients are discharged

OTE="anbuitachi, post: 16681714, member: 229930"]cause not everyone choose career based on money? i chose anesthesia b/c i couldn't see myself doing social work all day on medicine, or round 5 hours. I didn't wan to stand in one spot for a big part of my day in surgery. It was either radiology or anesthesiology, and neither are doing well[/QUOTE]
 
anbuitachi said:
cause not everyone choose career based on money? i chose anesthesia b/c i couldn't see myself doing social work all day on medicine, or round 5 hours. I didn't wan to stand in one spot for a big part of my day in surgery. It was either radiology or anesthesiology, and neither are doing well
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Rads= Interventional
Anesthesiology= Peds, Cardiac, Critical Care or Pain

That's how I see it going forward.
 
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A wise person recently told me that we might very soon end up like in the 90's when, after a wave when many had been going into an anesthesia fellowship, nobody went into one, because the job market was bad even with fellowship.

I still believe that the main reasons to do a fellowship are to become excellent at the favorite subspecialty (the one you would practice if you were paid FP salary), and/or as a backup plan (as a second specialty, such as Pain or CCM). Don't do a residency/fellowship just because the job market rewards it, but definitely stay away from those the market couldn't care less about for the foreseeable future. (E.g. in a society that doesn't reward well most artists, smart people won't plan to become one.) Try to do something you can do well, possibly stand out at.
 
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People need to not grossly look at "salaries per se".

amsurg (Sheridan)/ health/Mednax (American anesthesiology) etc are all paying around $350-400k at most places (plus are self insured with malpractice so essentially has its own malpractice tail coverage (likely a 20-30k value). Plus offering between 6-8 weeks paid vacation.

That all sounds good on paper. But the issue is which of the locations are working 60 hours-65 hours and which of their locations are working 50 hours? It's a big difference in hours.

Even all Kaiser's are not the same. But the pay is similar. Why kill yourself at a busier Kaiser than a chiller Kaiser (similar to VA practices as well)

That's why "salary" has no meaning to me unless hours worked/calls/acuity of calls (beeper or in house) are taken into context for the whole equation.

I can tell u this. A CRNA making 180k 4 days a week 7-5 no calls no weekend 6 weeks plus benefits is getting a much better deal than a MD slaving away call q4 2 weekends a month call who's making 350k and 6 weeks vacation working an average of 65 hours.
 
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BLADEMDA said:
By 2015 the DNAP CRNA should be in place for some schools. I suspect the Obama Health Care plan will be in full swing as well.

My conjecture is that MD Anesthesiology income is reduced 25-30% from today's levels. CRNA income should hold at today's levels but I am not sure if cost of living is keeping up with the dollar now known as hard toilet paper.

Anyone else care to speculate?
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Swing and a miss.

Been 7 years and anesthesia is still a great gig.
 
nolagas said:
7 years ago there were thousands more partnership jobs than there are today.
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Plus the average salary on Gaswork is 30% lower than in 2009. The job market is worse today than in 2009 and that is a fact. The decline has been slow over the past 7 years but make no mistake there has been a decline.

The glass is "half-full" so depending on your perspective the specialty is still "a great gig" for a med student. From my point of view I see a glass "half empty" and would definitely not use the words "great gig" to describe the vast majority of jobs on Gaswork.
 
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With 35 completed anesthesiology practice acquisitions reported (see list below), the year 2015 easily broke the previous record of 29 completed anesthesia practice transactions set in 2014. In the face of this heightened state of acquisition activity, Haverford has also observed a significant increase in the relative valuations being paid for anesthesiology practices. What is driving this increase in valuations? Enhanced competition among prospective buyers is likely a big contributing factor to the higher valuations being paid for anesthesia practices. Our listing of transactions below shows that 15 different buyers completed transactions in 2015 versus 12 buyers in 2014. When Haverford is advising an anesthesiology practice client in connection with the sale of their practice, we carefully orchestrate the sale process to fuel competition among multiple prospective buyers, ensuring the highest possible valuation for our client’s anesthesia practice. As more transactions are completed by the anesthesiology consolidators, these companies become larger and gain leverage in their rate negotiations with commercial payors. This leverage translates into higher reimbursement rates for these larger companies. In today’s competitive acquisition market, Haverford is finding that acquirers are increasingly willing to incorporate a portion of this prospective reimbursement enhancement into their projections and valuation models when making purchase offers for our clients’ practices. Haverford Healthcare Advisors’ team is comprised of leading national experts in anesthesia practice valuation. We are also among the most active firms providing transaction advisory services to anesthesiology practices. If you wish to have a better understanding of the value of your practice, please contact us to learn how we can be of assistance. Haverford can also help to determine if your practice is a candidate for acquisition by a national consolidator and how best to position your practice for sale. W
 
BLADEMDA said:
Take a look at this graph since 2009 and tell me things haven't changed significantly:

AN0715_020a_1935_425.jpg
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The chart shows 115 practices have been acquired through 2015 and they suggest maybe another 40 will be acquired in 2016. That's only 2-3 practices per state. Although the trend isn't good, the vast majority of practices have not sold out. The n is still exceedingly small.
 
anthroguy said:
Hey,

So I started my primary care gig with kaiser after residency. About 7 years ago this kaiser region was seeing red and about to go under. They brought in consultants (ie Bain/McKinsey types) to see how they could save money, provide good care and stop hemorrhaging patients. One of the first things they did was take NPs out of primary care. They took away their panels and made it MD/DO only. They transferred them into specialties were they did well defined procedures and types of visits. Ie go to ortho and do joint injections

More knowledgeable, smarter, more cost effective, all of the above? idk what it was but they have not looked back. The physician only primary care model has worked. The change has worked. With the realms of data kaiser collects they probably have the data to prove it but can't publish it to be PC.

I'll tell you another thing. They are desperate for primary care doctors and they are willing to pay for them. They will not go back to the old model . I know you guys may smirk at these figures. But if you told me 5 years ago that 240k base plus bonus/pension/5% match with no call and no weekends 800-500pm was possible in FM I would have laughed. That's the reality and they still can't get adequate staffing. When direct primary care takes off it will only get worse. Well I guess better
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You think if fam med truly paid 240k with no calls or wknd and 45hr work week that the job market wouldnt be flooded in another 5 or 10yrs, med studemt will be all over that opportunity like white on rice...if there is any field in medicine that is primed for complete annihilation by midlevel and over supply of providers its family med and psych. And those figures you quote is very regional, most fam med are not msking 240k base with no calls wknds...
 
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