"Demographics and Strategic Planning for Anesthesia: Tsunami Approaching"

[Carbocation1]

Planning on applying Gas this cycle but reading stuff like this makes me second guess. Would it be wise to bail into IM and go for an IM sub instead (cards)? In an era when everyone is fighting for a slice of a shrinking pie, won't other specialties who control patients get first dibs at the slice? My Attendings and CRNAs are all telling me to stay away from anesthesia.

http://www.anesthesiologynews.com/C...s-and-Strategic-Planning-for-Anesthesia/41486

JUNE 2, 2017

Ross Musumeci, MD, MBA

"Despite recent reports to the contrary, my personal experience suggests that the anesthesia labor market, and for anesthesiologists in particular, has deteriorated suddenly and rapidly within the last 12 months. This perception is supported by colleagues in the Anesthesia Business Group who run other large practices across the United States. The data presented above indicate that this change is driven by demographics, and it is likely to be exacerbated by compounding factors."

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[Brahnold Bloodaxe]

That article is ridiculously all over the place. On the one hand it spends hundreds of words painting a picture of the "world" demographic transformation and insisting this will result in a dramatic anesthesiologist shortage (as if that would be a bad thing for anesthesiologists lol) and then randomly interjects a paragraph describing how the job market has severely worsened over the last 12 months before diving right back into the completely contradictory demographic transformation/anesthesiologist shortage nonsense.

Then, just to be even more ludicrous, the author brings up Trump's travel ban and makes the claim our healthcare system will be shook to its foundations if we are denied the priceless and irreplaceable contributions of physicians from the medical hotbeds of Yemen, Sudan, Iran, Libya, Somalia and Syria!

So to summarize, the author believes anesthesiologists are fcked because there are simultaneously not enough jobs for anesthesiologists and an anesthesiologist shortage which will lead to anesthesiologists being overworked, while Somali doctors will soon be unable to continue propping up our healthcare system. Give that man a medal!

(Disclaimer: I believe the long term prospects of anesthesiology are somewhere between dismal and uncertain, but this article is the most ridiculous hodgepodge of non-arguments I've ever read on a serious website)

 

[urge]

Planning on applying Gas this cycle but reading stuff like this makes me second guess. Would it be wise to bail into IM and go for an IM sub instead (cards)? In an era when everyone is fighting for a slice of a shrinking pie, won't other specialties who control patients get first dibs at the slice? My Attendings and CRNAs are all telling me to stay away from anesthesia.

http://www.anesthesiologynews.com/C...s-and-Strategic-Planning-for-Anesthesia/41486

JUNE 2, 2017

Ross Musumeci, MD, MBA

"Despite recent reports to the contrary, my personal experience suggests that the anesthesia labor market, and for anesthesiologists in particular, has deteriorated suddenly and rapidly within the last 12 months. This perception is supported by colleagues in the Anesthesia Business Group who run other large practices across the United States. The data presented above indicate that this change is driven by demographics, and it is likely to be exacerbated by compounding factors."

Dr. Musumeci is President and CEO of Anaesthesia Associates of Massachusetts.

There is your answer. He is trying to set the tone saying the future is grim and thus you should take the lowball offer his group is offering. I would disregard his whole thesis.

People are aging but they want to live forever as long as they are not footing the bill. What will end up happening is either Medicare increases the pay rate for anesthesia or the hospitals will have to share a chunk of the facility fee with anesthesiologists. Nobody will work for peanuts when there is a shortage regardless of what he wants you to believe.

 

[GravelRider]

Planning on applying Gas this cycle but reading stuff like this makes me second guess. Would it be wise to bail into IM and go for an IM sub instead (cards)? In an era when everyone is fighting for a slice of a shrinking pie, won't other specialties who control patients get first dibs at the slice? My Attendings and CRNAs are all telling me to stay away from anesthesia.

http://www.anesthesiologynews.com/C...s-and-Strategic-Planning-for-Anesthesia/41486

JUNE 2, 2017

Ross Musumeci, MD, MBA

"Despite recent reports to the contrary, my personal experience suggests that the anesthesia labor market, and for anesthesiologists in particular, has deteriorated suddenly and rapidly within the last 12 months. This perception is supported by colleagues in the Anesthesia Business Group who run other large practices across the United States. The data presented above indicate that this change is driven by demographics, and it is likely to be exacerbated by compounding factors."

If you do have interest in IM+subspecialty then give it some serious consideration. Now with most people calling anesthesia fellowships mandatory, the time commitment is not much different. However, keep in mind that the high earning IM subspecialties are a lot more competitive than an anesthesia fellowship.

However, don't base your decision on this article. I would take what this guy says with a grain of salt. Anesthesia Associates of Massachusetts is essentially a regional AMC. This whole article reads like a propaganda piece.

 

[anbuitachi]

Ross wants to low ball anesthesiologists while encouraging more production of residents and cheap labor/future anesthesiologists so he can hire even more for cheaper. let's produce 5000 anesthesiologists a year so he can hire them for min wage

 

[anes121508]

That article is ridiculously all over the place. On the one hand it spends hundreds of words painting a picture of the "world" demographic transformation and insisting this will result in a dramatic anesthesiologist shortage (as if that would be a bad thing for anesthesiologists lol) and then randomly interjects a paragraph describing how the job market has severely worsened over the last 12 months before diving right back into the completely contradictory demographic transformation/anesthesiologist shortage nonsense.

Then, just to be even more ludicrous, the author brings up Trump's travel ban and makes the claim our healthcare system will be shook to its foundations if we are denied the priceless and irreplaceable contributions of physicians from the medical hotbeds of Yemen, Sudan, Iran, Libya, Somalia and Syria!

Agree

 

[anes121508]

Dr. Musumeci is President and CEO of Anaesthesia Associates of Massachusetts.

There is your answer. He is trying to set the tone saying the future is grim and thus you should take the lowball offer his group is offering. I would disregard his whole thesis.

People are aging but they want to live forever as long as they are not footing the bill. What will end up happening is either Medicare increases the pay rate for anesthesia or the hospitals will have to share a chunk of the facility fee with anesthesiologists. Nobody will work for peanuts when there is a shortage regardless of what he wants you to believe.

Interesting you say this...I know people who interviewed there and who also took jobs. From hearing their stories, it sounds like AAM is the shady pyramid type of practice you hear about on this forum all the time.

 

[anes121508]

Ross wants to low ball anesthesiologists while encouraging more production of residents and cheap labor/future anesthesiologists so he can hire even more for cheaper. let's produce 5000 anesthesiologists a year so he can hire them for min wage

In this article ....more demand and not enough supply, yet wages will go down? hmmm...

what's even more interesting is why this publication is publishing articles like this

 

[anbuitachi]

In this article ....more demand and not enough supply, yet wages will go down? hmmm...

what's even more interesting is why this publication is publishing articles like this

probably because people read it. their site doesn't need to have anesthesiologists best interest in mind. hey infact if you train 5000 anesthesiologists a year, they'll prob end up with more readers in the long run

 

[anesthesiadoc]

Interesting you say this...I know people who interviewed there and who also took jobs. From hearing their stories, it sounds like AAM is the shady pyramid type of practice you hear about on this forum all the time.

I'm all for critically viewing articles and having good discussions about them on SDN, but your inferences are incorrect about AAM. No shade, no pyramid here. Pretty transparent. Just a bunch of folks who work hard and play hard. Most equitable crew I've have the pleasure to work with. Feel free to PM me for details. Please leave the inferences and hearsay at the door.


Sent from my iPhone using SDN mobile

 

[Modanq]

Dr. Musumeci is President and CEO of Anaesthesia Associates of Massachusetts.

There is your answer. He is trying to set the tone saying the future is grim and thus you should take the lowball offer his group is offering. I would disregard his whole thesis.

People are aging but they want to live forever as long as they are not footing the bill. What will end up happening is either Medicare increases the pay rate for anesthesia or the hospitals will have to share a chunk of the facility fee with anesthesiologists. Nobody will work for peanuts when there is a shortage regardless of what he wants you to believe.

Maybe

 

[Scotty_G]

Please spill the beans anesthesiadoc... An old friend used to work there and left for greener pastures. Sounded like a bad job to me... Also you can't tell me a group of over 200 anesthesiologists is going to be equitable and fair. And last but not least! The group is in the works to sell to an AMC. Sounds great huh?

 

[deleted162650]

Also you can't tell me a group of over 200 anesthesiologists is going to be equitable and fair.

That's not true. ASMG in SD is that big and fair/equitable. Not to say they don't have their own set of issues, but they're fair.

OAG in Portland also comes to mind as a big fair group.

 

[Ezekiel2517]

That's not true. ASMG in SD is that big and fair/equitable. Not to say they don't have their own set of issues, but they're fair.

OAG in Portland also comes to mind as a big fair group.

I'd say a significant difference though is that asmg and oag are both all-MD groups where you do all your own cases. AAM employs a ton of crna's. Also, different compensation model than the typical pooled unit productivity based model prevalent on west coast.

 

[DrCommonSense]

Planning on applying Gas this cycle but reading stuff like this makes me second guess. Would it be wise to bail into IM and go for an IM sub instead (cards)? In an era when everyone is fighting for a slice of a shrinking pie, won't other specialties who control patients get first dibs at the slice? My Attendings and CRNAs are all telling me to stay away from anesthesia.

http://www.anesthesiologynews.com/C...s-and-Strategic-Planning-for-Anesthesia/41486

JUNE 2, 2017

Ross Musumeci, MD, MBA

"Despite recent reports to the contrary, my personal experience suggests that the anesthesia labor market, and for anesthesiologists in particular, has deteriorated suddenly and rapidly within the last 12 months. This perception is supported by colleagues in the Anesthesia Business Group who run other large practices across the United States. The data presented above indicate that this change is driven by demographics, and it is likely to be exacerbated by compounding factors."

I just checked out gasworks

Looks like salaries have gone up in the South and MidWest with some good jobs out there.

So this is BS unless its just Mass, NYC, Cali, etc.

 

[anes121508]

I'm all for critically viewing articles and having good discussions about them on SDN, but your inferences are incorrect about AAM. No shade, no pyramid here. Pretty transparent. Just a bunch of folks who work hard and play hard. Most equitable crew I've have the pleasure to work with. Feel free to PM me for details. Please leave the inferences and hearsay at the door.


Sent from my iPhone using SDN mobile

I would argue that hearsay is the majority of the discussion about practices on SDN. Hearsay, word of mouth, ect. Call it what you will. That being said, I see what you are saying and where you are coming from. I also commend you for offering for people to PM you. However, this is all I know (hearsay without a doubt as I am not the primary source): I know two people who interviewed there and didn't take the job offer. One went to a dinner. Neither knew the details of the the non-partnership track. Undefined length of track. No clear sense of how many people make partner and how many do not. No clear sense of what determines ability to make partner. No sense of the difference in pay, call amount, vacation between the partners and non-partners. Now, it is possible that these two people did not bother to ask the relevant questions.

I also spoke with other people who took jobs with AAM. They didn't know these details either. Once again, this may not be lack of transparency on the behalf of AAM. Could be that none of these people bothered to ask, and frankly didn't care.

I admit that I am completely speculating on the type of group AAM is, however these three things: 1. People who are taking jobs there and who interviewed there did not know the details of group. 2. The article published states that salaries are going down in the future despite lack of supply relative to demand (which is odd, and I think has to do with drinking the kool-aide from the AMC pitch people that want SR partners to sell their groups to them) 3. Somebody has previously mentioned that AAM is looking to sell to an AMC.

I could be 100% inaccurate, and I truly hope I am. However, it raises questions.

 

[Scotty_G]

They are looking to sell... just wait Blade will post the link when it becomes official :0

 

[2ndyear]

I just checked out gasworks

Looks like salaries have gone up in the South and MidWest with some good jobs out there.

So this is BS unless its just Mass, NYC, Cali, etc.

Salaries fairly flat in New England, cost of living is high compared to other places. Not an easy place to recruit to when other locales are dirt cheap and pay more. Especially for newly graduated residents with multiple hundreds of thousands of dollars in debt.

 

[DrCommonSense]

Salaries fairly flat in New England, cost of living is high compared to other places. Not an easy place to recruit to when other locales are dirt cheap and pay more. Especially for newly graduated residents with multiple hundreds of thousands of dollars in debt.

Thats true and untrue.

Many docs see themselves as "elite" and will refuse to live in the South/MidWest who are "backwoods" to "important" people.

Many are willing to take a big pay cut to remain in the "high culture" areas.

 

[skypilot]

Please spill the beans anesthesiadoc... An old friend used to work there and left for greener pastures. Sounded like a bad job to me... Also you can't tell me a group of over 200 anesthesiologists is going to be equitable and fair. And last but not least! The group is in the works to sell to an AMC. Sounds great huh?

Maybe they have changed but they used to be considered an undesirable company to work for that would exploit you and never make you a partner. Great for crnas though. No call. No weekend's. Good money.

 

[nimbus]

Thats true and untrue.

Many docs see themselves as "elite" and will refuse to live in the South/MidWest who are "backwoods" to "important" people.

Many are willing to take a big pay cut to remain in the "high culture" areas.

That's a paradox. Doctors are not elite in most large coastal metro areas. It's in the little podunk towns where they might be "elite" in terms of education, income, whatever. They may just want well educated neighbors and good ethnic food.

 

[DrCommonSense]

That's a paradox. Doctors are not elite in most large coastal metro areas. It's in the little podunk towns where they might be "elite" in terms of education, income, whatever. They may just want well educated neighbors and good ethnic food.

All I know in most of the big cities I've been in the docs stated that they "couldn't live elsewhere" because of the "culture" and so much to do.

Never understood it myself.

 

[nimbus]

All I know in most of the big cities I've been in the docs stated that they "couldn't live elsewhere" because of the "culture" and so much to do.

Never understood it myself.

Everybody is different. I don't need to understand or judge their decisions. I personally don't want to live anywhere else. Live where you want.

 

[practicemgr]

It is fascinating to read some of the interpretations of this article from people who imply that they know the intent of the author and the inner workings of the group. Here is my take on the matter...the author states the following facts:

1. There is a national shortage of anesthesia providers.
2. There are demographic reasons that the shortage will persist
3. Restricting immigration will worsen the shortage since the supply of anesthesiologists is supplemented by foreign physicians
4. The same demographic shift is causing people to move from private insurance to Medicare and will create financial stress for both the anesthesia group and the hospitals that pay it stipends.
5. Practices should be prepared to make a compelling case for increased stipends from hospitals so they can remain competitive

Far from implying that the future for individual anesthesiologists is dim, the article suggests the opposite. For individuals, this creates an employees market where groups will bid for personnel forcing salaries up, not down. Those who go into anesthesia will enjoy the benefit of being on the winning side of the supply/demand equation. Furthermore, the whole point of the article is that anesthesia groups that are proactive with aggressive recruiting, competitive salaries, and stipend requests to maintain their revenue will be successful. Those that do nothing are likely to fail. The author is encouraging anesthesia groups to treat their employees well, to focus on patient safety, and to keep their salaries competitive.
Nowhere in the article does it state that AAM expects employees to take below market salaries. In fact, salaries at AAM have gone up markedly in the past 12 months because the author took his own advice before writing the article.
It is clear that some authors in this thread did not get the point of the article, and it is also clear that they have absolutely no accurate information about AAM. I suggest that readers use their own judgement, gather their own information, and make their own interpretations.

 

[skypilot]

It is fascinating to read some of the interpretations of this article from people who imply that they know the intent of the author and the inner workings of the group. Here is my take on the matter...the author states the following facts:

Nowhere in the article does it state that AAM expects employees to take below market salaries. In fact, salaries at AAM have gone up markedly in the past 12 months because the author took his own advice before writing the article.

It is good that they are finally raising salaries because they were finding it impossible to recruit physicians. Maybe they ARE turning a new leaf. I just wonder where the money came from to raise the salaries.

 

[aneftp]

It is good that they are finally raising salaries because they were finding it impossible to recruit physicians. Maybe they ARE turning a new leaf. I just wonder where the money came from to raise the salaries.

Crna's are demanding more money as well. The $100/hr crna 1099 is quickly becoming $140-150 in many places that have turned to crna only model (like gi centers).

 

[GravelRider]

It is fascinating to read some of the interpretations of this article from people who imply that they know the intent of the author and the inner workings of the group. Here is my take on the matter...the author states the following facts:

1. There is a national shortage of anesthesia providers.
2. There are demographic reasons that the shortage will persist
3. Restricting immigration will worsen the shortage since the supply of anesthesiologists is supplemented by foreign physicians
4. The same demographic shift is causing people to move from private insurance to Medicare and will create financial stress for both the anesthesia group and the hospitals that pay it stipends.
5. Practices should be prepared to make a compelling case for increased stipends from hospitals so they can remain competitive

Far from implying that the future for individual anesthesiologists is dim, the article suggests the opposite. For individuals, this creates an employees market where groups will bid for personnel forcing salaries up, not down. Those who go into anesthesia will enjoy the benefit of being on the winning side of the supply/demand equation. Furthermore, the whole point of the article is that anesthesia groups that are proactive with aggressive recruiting, competitive salaries, and stipend requests to maintain their revenue will be successful. Those that do nothing are likely to fail. The author is encouraging anesthesia groups to treat their employees well, to focus on patient safety, and to keep their salaries competitive.
Nowhere in the article does it state that AAM expects employees to take below market salaries. In fact, salaries at AAM have gone up markedly in the past 12 months because the author took his own advice before writing the article.
It is clear that some authors in this thread did not get the point of the article, and it is also clear that they have absolutely no accurate information about AAM. I suggest that readers use their own judgement, gather their own information, and make their own interpretations.

Treat your employees well, pay them fairly, and practice good medicine. That's the take home point? Should we commend the author for figuring that out? Is he only suggesting this out of desperation for staffing needs? If there was a steady supply of new grads filling staffing needs, would he be suggesting a different working environment?

Maybe AAM has changed their ways. However it will take a little time for them to change their poor reputation. Reputations are usually earned. Having an appropriate amount of cynicism is a perfectly reasonable defense mechanism for job seekers in this market.

 

[acidbase1]

I'm graduating in a few weeks and the job market is ridiculously good right now. Not sure what these ppl are looking at

 

[nimbus]

I'm graduating in a few weeks and the job market is ridiculously good right now. Not sure what these ppl are looking at

Agree. Almost every group in my area is hiring. Incidentally we even had recent hires from AAM.

 

[deleted171991]

I'm graduating in a few weeks and the job market is ridiculously good right now. Not sure what these ppl are looking at

Where?

Don't let yourself be fooled. Many jobs don't equate many good jobs. In my market, there are always a good number of announcements on gaswork, some of them for years. ("Almost every group is hiring." Yeah, sure.) What the groups do is fish. They just throw in the bait, wait till a sucker bites, then, if the fish is not fat enough, they throw it back and catch another. The bigger a group is, the less they depend on the extra 1-2 bodies they want to hire, so they just sit and wait.

A truly good job is so good you can't imagine yourself leaving it. There aren't that many nowadays. In a truly good market, you can dictate your terms, at least as work hours go: no call, part time etc. When you see minimal inclination for contract negotiation, you know it's not a good market.

 

[IMGASMD]

Agree. Almost every group in my area is hiring. Incidentally we even had recent hires from AAM.

I would like to know too!

 

[nimbus]

Where?

Don't let yourself be fooled. Many jobs don't equate many good jobs. In my market, there are always a good number of announcements on gaswork, some of them for years. ("Almost every group is hiring." Yeah, sure.) What the groups do is fish. They just throw in the bait, wait till a sucker bites, then, if the fish is not fat enough, they throw it back and catch another. The bigger a group is, the less they depend on the extra 1-2 bodies they want to hire, so they just sit and wait.

A truly good job is so good you can't imagine yourself leaving it. There aren't that many nowadays. In a truly good market, you can dictate your terms, at least as work hours go: no call, part time etc. When you see minimal inclination for contract negotiation, you know it's a bad market.

Where I am you can get all of that......but not right off the bat. You can't be an inexperienced fresh grad bringing not much to the table and demand no call parttime. You will be SOL.

When I finished residency my current group hired 1 fulltime person in a year. Now we are hiring at least 1-2/month. I'd say the job market is pretty good.

 

[deleted126335]

People have realized that security is a no longer an attainable goal. Historically people would take less and work harder in the belief that they were buying stability and security. Word is out that it is an illusion. The only thing left is your hourly rate and working conditions. They go to south...bye


Sent from my iPhone using SDN mobile app

 

[deleted162650]

Agree. Almost every group in my area is hiring. Incidentally we even had recent hires from AAM.

You are the only group in your area.

 

[nimbus]

You are the only group in your area.

You know very well we are not the only group! Basically every other group and Kaiser is also hiring right now. Like I said it's a good time to be looking for work.

 

[GravelRider]

People have realized that security is a no longer an attainable goal. Historically people would take less and work harder in the belief that they were buying stability and security. Word is out that it is an illusion. The only thing left is your hourly rate and working conditions. They go to south...bye


Sent from my iPhone using SDN mobile app

This is the key. Your ability and willingness to leave a bad job is the only leverage that you really have.

Word of advice: Signing bonuses can act as bait to hook you into a bad job. With a sudden influx of a seemingly large sum of money after residency there is a temptation to put it towards a house you can't afford. Now you are truly stuck in a bad job.

I will admit that the job market does seem to be opening up a bit...even in the much loathed east. A decent indicator is locums rates. I've seen a few emails for $200+/hr locums rates with differentials for call and overtime in some major east coast cities. This doesn't mean it's an anesthesia utopia, but it may mean the revolving door at many of these practices is seeing more people leave rather than enter.

 

[IMGASMD]

Is 200 actually a good rate? I know people who are pulling 180 as hospitalist?
But if you cannot have security, what else is there?

 

[GravelRider]

Is 200 actually a good rate? I know people who are pulling 180 as hospitalist?
But if you cannot have security, what else is there?

Not really...but better than what it has been. Previously I had seen rates in the 150-175 range in those places. It's my hopeful sign that the market is slowly improving...even in areas with a traditionally bad market. I'm trying to have a positive outlook.

It also depends on what you are doing for those rates. A hospitalist shift can be a real grind in a busy place with a lot of admissions/cross coverage. I had a moonlighting gig as a hospitalist where I made $2k for a 10 hour shift. It was a busy and exhausting 10 hours, though.

 

[urge]

It is fascinating to read some of the interpretations of this article from people who imply that they know the intent of the author and the inner workings of the group. Here is my take on the matter...the author states the following facts:

1. There is a national shortage of anesthesia providers.
2. There are demographic reasons that the shortage will persist
3. Restricting immigration will worsen the shortage since the supply of anesthesiologists is supplemented by foreign physicians
4. The same demographic shift is causing people to move from private insurance to Medicare and will create financial stress for both the anesthesia group and the hospitals that pay it stipends.
5. Practices should be prepared to make a compelling case for increased stipends from hospitals so they can remain competitive

Far from implying that the future for individual anesthesiologists is dim, the article suggests the opposite. For individuals, this creates an employees market where groups will bid for personnel forcing salaries up, not down. Those who go into anesthesia will enjoy the benefit of being on the winning side of the supply/demand equation. Furthermore, the whole point of the article is that anesthesia groups that are proactive with aggressive recruiting, competitive salaries, and stipend requests to maintain their revenue will be successful. Those that do nothing are likely to fail. The author is encouraging anesthesia groups to treat their employees well, to focus on patient safety, and to keep their salaries competitive.
Nowhere in the article does it state that AAM expects employees to take below market salaries. In fact, salaries at AAM have gone up markedly in the past 12 months because the author took his own advice before writing the article.
It is clear that some authors in this thread did not get the point of the article, and it is also clear that they have absolutely no accurate information about AAM. I suggest that readers use their own judgement, gather their own information, and make their own interpretations.

What you say seems accurate. However, it is not what the article says. Did you create an account just to twist the article into reality? Are you the author?

Despite recent reports to the contrary, my personal experience suggests that the anesthesia labor market, and for anesthesiologists in particular, has deteriorated suddenly and rapidly within the last 12 months.

See how it says anesthesiologists, not groups or AMCs? The med student who started this thread is thinking about not doing anesthesia because the article keeps saying the market for (individual) anesthesiologists is in shambles.

How can he say "labor market" is bad when I get about 20 emails a week offering jobs with all sorts of perks, and the new grads are getting very generous offers?

Medicare rates are approximately 30% of private insurance rates for anesthesia services, whereas they average approximately 80% of private insurance rates for other specialties, so this represents a tremendous problem for anesthesia providers.8-11

See where it says providers instead of the groups or AMCs, which would be correct?

The bottom line is that the changes we are likely to see will have a disproportionately negative effect on anesthesia providers relative to other specialties, and we are likely to see a significant decrease in our reimbursement over the coming years.

Providers again!

The administrators will have pay true market value (not mentioned anywhere in the article) and try to push Medicare to do the same. It's been long overdue, but since they were skimming off the top they didn't care. Now they do.

 

[nimbus]

It is good that they are finally raising salaries because they were finding it impossible to recruit physicians. Maybe they ARE turning a new leaf. I just wonder where the money came from to raise the salaries.

Right. And who was pocketing that money before the raises?

 

[deleted126335]

This is the key. Your ability and willingness to leave a bad job is the only leverage that you really have.

Word of advice: Signing bonuses can act as bait to hook you into a bad job. With a sudden influx of a seemingly large sum of money after residency there is a temptation to put it towards a house you can't afford. Now you are truly stuck in a bad job.

I will admit that the job market does seem to be opening up a bit...even in the much loathed east. A decent indicator is locums rates. I've seen a few emails for $200+/hr locums rates with differentials for call and overtime in some major east coast cities. This doesn't mean it's an anesthesia utopia, but it may mean the revolving door at many of these practices is seeing more people leave rather than enter.

Another reason for this is because groups have been running as lean as possible. Everybody working with little to no excess capacity. Excess capacity costs money. People get burned out or somebody leaves unexpectedly or gets sick...They need to get somebody on the playing field yesterday.

 

[anbuitachi]

My guess is jobs are opening up cause older physicians are retiring since stocks have done really well over the past 8 years. All it takes is another depression/recession and the market will go to crap. even without it, the # of anesthesiology grads will quickly take up all the jobs . The job market here also seem to have improved over the last year. I highly doubt it will last long especially given the residency slots will be filled. It's scary how bad some of the anesthesiologists are out there especially in the municipal public hospitals..

 

[MedAnes2017]

This is the key. Your ability and willingness to leave a bad job is the only leverage that you really have.

Word of advice: Signing bonuses can act as bait to hook you into a bad job. With a sudden influx of a seemingly large sum of money after residency there is a temptation to put it towards a house you can't afford. Now you are truly stuck in a bad job.

I will admit that the job market does seem to be opening up a bit...even in the much loathed east. A decent indicator is locums rates. I've seen a few emails for $200+/hr locums rates with differentials for call and overtime in some major east coast cities. This doesn't mean it's an anesthesia utopia, but it may mean the revolving door at many of these practices is seeing more people leave rather than enter.

So would you recommend that new graduates not buy a house until they find a stable job? Rent in my mind is throwing money down the drain whereas paying for mortgage is putting down money that you can get back when you sell the house again...

 

[pgg]

So would you recommend that new graduates not buy a house until they find a stable job? Rent in my mind is throwing money down the drain whereas paying for mortgage is putting down money that you can get back when you sell the house again...

During the first couple years of a 30-year mortgage, interest is typically more than 2/3 of the monthly payment. Even for a 15-year mortgage, interest is still 1/3 to 1/2 the first year of payments.

Whether you throw $1 down the drain in rent or $.70 down the drain in mortgage interest for the first year or two you have a new job hardly matters in the long run. Also consider the money you'll throw down the drain paying real estate agent commissions and other closing costs when you buy/sell, and the money you'll throw down the drain for property taxes and maintenance.

And there's something to be said for the "pick up and get the hell out of town in a hurry" advantage to renting when you're a couple weeks out of residency ...

So yeah, I'd give serious thought to renting at first. If you love the job, what have you really lost? 6 months or a year of home ownership joy?

 

[GravelRider]

So would you recommend that new graduates not buy a house until they find a stable job? Rent in my mind is throwing money down the drain whereas paying for mortgage is putting down money that you can get back when you sell the house again...

My advice...rent until you know the job (or area) you are in is one you can be in for at least 5 years.

Don't forget the other costs to homeownership that is throwing money down the drain...insurance, taxes (very significant in my neck of the wood, maybe not in yours), maintenance/repairs, etc... Put all of that money into an index fund while you are renting and you have a pretty nice investment there.

Buying a home is a very individualized decision with too many variables to comment on here (the NY Times has a pretty thorough calculation tool to tell you if buying is better than renting). The home you live in should be thought of as a luxury that you can afford and not an investment. I have known more than a couple of physicians who got stuck in a bad job because they bought that expensive home and were underwater on a mortgage.

 

[nimbus]

On average, a homeowner who pays $2000/month on a mortgage spends much more on housing than a renter who pays $2000/month on rent. Homeowners spend BIG bucks on remodeling projects, landscaping, furniture, interior design, etc. Renters rarely consider those things and simply live there. Homeowners justify it by telling themselves it is an investment but it's really just lifestyle creep. If it brings you joy that is fabulous. But early in your career it is costly, it can shackle you to a bad situation, and it can be a distraction. Wait til you know you love the job and the job loves you back.

 

[dmk5n]

Why your house is a terrible investment, per JL Collins
Why your house is a terrible investment


Well, let’s see now (pulling out our lined yellow pad), let’s make a list. To be really terrible:

• It should be not just an initial, but if we do it right, a relentlessly ongoing drain on the cash reserves of the owner.
• It should be illiquid. We’ll make it something that takes weeks, no – wait – even better, months of time and effort to buy or sell.
• It should be expensive to buy and sell. We’ll add very high transaction costs. Let’s say 5% commissions on the deal, coming and going.
• It should be complex to buy or sell. That way we can ladle on lots of extra fees and reports and documents we can charge for.
• It should generate low returns. Certainly no more than the inflation rate. Maybe a bit less.
• It should be leveraged! Oh, oh this one is great! This is how we’ll get people to swallow those low returns! If the price goes up a little bit, leverage will magnify this and people will convince themselves it’s actually a good investment! Nah, don’t worry about it. Most will never even consider that leverage is also very high risk and could just as easily wipe them out.
• It should be mortgaged! Another beauty of leverage. We can charge interest on the loans. Yep, and with just a little more effort we should easily be able to persuade people who buy this thing to borrow money against it more than once.
• It should be unproductive. While we’re talking about interest, let’s be sure this investment we are creating never pays any. No dividends either, of course.
• It should be immobile. If we can fix it to one geographical spot we can be sure at any given time only a tiny group of potential buyers for it will exist. Sometimes and in some places, none at all!
• It should be subject to the fortunes of one country, one state, one city, one town…No! One neighborhood! Imagine if our investment could somehow tie its owner to the fate of one narrow location. The risk could be enormous! A plant closes. A street gang moves in. A government goes crazy with taxes. An environmental disaster happens nearby. We could have an investment that not only crushes it’s owner’s net worth, but does so even as they are losing their job and income!
• It should be something that locks its owner in one geographical area. That’ll limit their options and keep ’em docile for their employers!
• It should be expensive. Ideally we’ll make it so expensive that it will represent a disproportionate percentage of a person’s net worth. Nothing like squeezing out diversification to increase risk!
• It should be expensive to own, too! Let’s make sure this investment requires an endless parade of repairs and maintenance without which it will crumble into dust.
• It should be fragile and easily damaged by weather, fire, vandalism and the like! Now we can add-on expensive insurance to cover these risks. Making sure, of course, that the bad things that are most likely to happen aren’t actually covered. Don’t worry, we’ll bury that in the fine print or maybe just charge extra for it.
• It should be heavily taxed, too! Let’s get the Feds in on this. If it should go up in value, we’ll go ahead and tax that gain. If it goes down in value should we offer a balancing tax deduction on the loss like with other investments? Nah.
• It should be taxed even more! Let’s not forget our state and local governments. Why wait till this investment is sold? Unlike other investments, let’s tax it each and every year. Oh, and let’s raise those taxes anytime it goes up in value. Lower them when it goes down? Don’t be silly.
• It should be something you can never really own. Since we are going to give the government the power to tax this investment every year, “owning” it will be just like sharecropping. We’ll let them work it, maintain it, pay all the cost associated with it and, as long as they pay their annual rent (oops, I mean taxes) we’ll let ’em stay in it. Unless we decide we want it.
• For that, we’ll make it subject to eminent domain. You know, in case we decide that instead of getting our rent (damn! I mean taxes) we’d rather just take it away from them.
• Mr. Risky Start-up: It should increase stress, lead to more divorces, but then be impossible to divide.
• DMDave: You only need one motivated (read: desperate) seller to set the price for the whole neighborhood. Imagine your so-called “investment” suddenly get scuttled when your neighbor decided to sell his particle-board mansion at 20% below assessment.

 

[mostwanted]

I would recommend renting for at least one year as an attending.

One of the best financial decisions I made, paid off all student loans, cash closing on a house tomorrow.


Sent from my iPhone using SDN mobile

 

[urge]

Why your house is a terrible investment, per JL Collins
Why your house is a terrible investment


Well, let’s see now (pulling out our lined yellow pad), let’s make a list. To be really terrible:

• It should be not just an initial, but if we do it right, a relentlessly ongoing drain on the cash reserves of the owner.
• It should be illiquid. We’ll make it something that takes weeks, no – wait – even better, months of time and effort to buy or sell.
• It should be expensive to buy and sell. We’ll add very high transaction costs. Let’s say 5% commissions on the deal, coming and going.
• It should be complex to buy or sell. That way we can ladle on lots of extra fees and reports and documents we can charge for.
• It should generate low returns. Certainly no more than the inflation rate. Maybe a bit less.
• It should be leveraged! Oh, oh this one is great! This is how we’ll get people to swallow those low returns! If the price goes up a little bit, leverage will magnify this and people will convince themselves it’s actually a good investment! Nah, don’t worry about it. Most will never even consider that leverage is also very high risk and could just as easily wipe them out.
• It should be mortgaged! Another beauty of leverage. We can charge interest on the loans. Yep, and with just a little more effort we should easily be able to persuade people who buy this thing to borrow money against it more than once.
• It should be unproductive. While we’re talking about interest, let’s be sure this investment we are creating never pays any. No dividends either, of course.
• It should be immobile. If we can fix it to one geographical spot we can be sure at any given time only a tiny group of potential buyers for it will exist. Sometimes and in some places, none at all!
• It should be subject to the fortunes of one country, one state, one city, one town…No! One neighborhood! Imagine if our investment could somehow tie its owner to the fate of one narrow location. The risk could be enormous! A plant closes. A street gang moves in. A government goes crazy with taxes. An environmental disaster happens nearby. We could have an investment that not only crushes it’s owner’s net worth, but does so even as they are losing their job and income!
• It should be something that locks its owner in one geographical area. That’ll limit their options and keep ’em docile for their employers!
• It should be expensive. Ideally we’ll make it so expensive that it will represent a disproportionate percentage of a person’s net worth. Nothing like squeezing out diversification to increase risk!
• It should be expensive to own, too! Let’s make sure this investment requires an endless parade of repairs and maintenance without which it will crumble into dust.
• It should be fragile and easily damaged by weather, fire, vandalism and the like! Now we can add-on expensive insurance to cover these risks. Making sure, of course, that the bad things that are most likely to happen aren’t actually covered. Don’t worry, we’ll bury that in the fine print or maybe just charge extra for it.
• It should be heavily taxed, too! Let’s get the Feds in on this. If it should go up in value, we’ll go ahead and tax that gain. If it goes down in value should we offer a balancing tax deduction on the loss like with other investments? Nah.
• It should be taxed even more! Let’s not forget our state and local governments. Why wait till this investment is sold? Unlike other investments, let’s tax it each and every year. Oh, and let’s raise those taxes anytime it goes up in value. Lower them when it goes down? Don’t be silly.
• It should be something you can never really own. Since we are going to give the government the power to tax this investment every year, “owning” it will be just like sharecropping. We’ll let them work it, maintain it, pay all the cost associated with it and, as long as they pay their annual rent (oops, I mean taxes) we’ll let ’em stay in it. Unless we decide we want it.
• For that, we’ll make it subject to eminent domain. You know, in case we decide that instead of getting our rent (damn! I mean taxes) we’d rather just take it away from them.
• Mr. Risky Start-up: It should increase stress, lead to more divorces, but then be impossible to divide.
• DMDave: You only need one motivated (read: desperate) seller to set the price for the whole neighborhood. Imagine your so-called “investment” suddenly get scuttled when your neighbor decided to sell his particle-board mansion at 20% below assessment.

I agree with most but not the part where is says it doesn't pay a dividend. It does. The dividend is a place to live which no other investment does. If you were to look for an equivalent house for rent it would be like 3 to 6 % of the total price of the house, after tax money, so it is really closer to 5 to 9 % pre tax. How many stocks pay 5 to 9% dividend?

5 to 9% pre tax minus 1% for repairs minus 1% for property taxes minus 0.5% for insurance= it really pays 2.5 to 6.5 % pre tax which is ok.

I would advise new grads to stay away from homes at the moment. Interest rates have been the lowest in history and prices the highest. We currently have the biggest housing bubble in history. Bigger than 2006. Mortgage rates should be around 6% for about 4 years before the bubble comes down to reality. Remember people used to fully pay houses in cash only 80 years ago. Unless you think rates will go lower I wouldn't buy a house. Most likely rates will go up.

I think rates will go up because of pensions. They were calculated based on an 8% interest rate, thus at the moment they are massively underfunded. When the baby boomers retire in droves and there is no money to pay them the Fed will have no choice but to increase rates to try to keep the pensions afloat. How many people will be able to bid up houses at 6% mortgage rate?

Once rates are higher, cities and states will have a harder time paying their loans (bonds) and will increase taxes (including property taxes) even further, which will put even more downward pressure on houses.

Let's say mortgage rates are 6% and property taxes 2%. Do you think houses will go up in value?

 

[aneftp]

I just laugh at all those who use the "home as a bad investment"

It's ur primary home. Enjoy it. A landlord can kick you out or raise ur rents.

We can say a lot of things are bad investments. Everyone should shop at thrift stores for their clothing. Cause ur appearance don't matter as anesthesiologist since u switch to scrubs every day.

So I tend to buy $5-8 Walmart t shirts and cheap shoes from Payless. My t shirts are raggy and average 6 years with faded colors.

It drives my wife crazy I don't spend money on clothing. My yearly clothing costs are less than $150 a year.

So don't waste money on clothing

Also I keep the house at 82 degrees in the Florida heat so cooling ur house is a bad investment. U are just wasting electricity. You will never get back ur investment on electricity.

I also bike to work cause I get a rebate to bike 5 miles to work and buying gasoline is a bad investment.