Expected salary for 9 to 5 gig?

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maxim3L

maxim3L

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So today in my anesthesia elective I overheard some residents talking about "sweet ambulatory 9-5 gigs with no call" starting in the mid 300s for new grads..which promptly made my eyes pop out like a tex avery cartoon. 😱

Two questions:
1) is this a realistic expectation as a new grad in terms of salary, hours worked and no call? Or are jobs like these more like diamonds in the rough that you land by rubbing elbows with the chairman?

2) Why in the world would anyone do derm for the hours and take a lower salary (avg 290K in 2010) if this indeed was the case?

Pardon if these are noobile questions but I literally was taken back by the possibility of jobs like these existing. Anesthesia was pretty high on differential before hearing this, btw. Thanks for your answers in advance.
 
maxim3L said:
So today in my anesthesia elective I overheard some residents talking about "sweet ambulatory 9-5 gigs with no call" starting in the mid 300s for new grads..which promptly made my eyes pop out like a tex avery cartoon. 😱

Two questions:
1) is this a realistic expectation as a new grad in terms of salary, hours worked and no call? Or are jobs like these more like diamonds in the rough that you land by rubbing elbows with the chairman?

2) Why in the world would anyone do derm for the hours and take a lower salary (avg 290K in 2010) if this indeed was the case?

Pardon if these are noobile questions but I literally was taken back by the possibility of jobs like these existing. Anesthesia was pretty high on differential before hearing this, btw. Thanks for your answers in advance.
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Those ambulatory center gigs are not too hard to find from what I've seen looking at gaswork. As for the salary, I think that's gonna be hard to achieve as a new grad anywhere but the midwest.

As for why derm over a nice gig in gas, the stress is waaay lower in derm I'd imagine and , also, I am absolutely sure the average skin doc is making well over 290K even as a new grad. They could easily be doubling their salary in cash procedures which may not be factored in to that 290K figure.
 
No such thing as 9-5. It'd be more like 6:30 AM to 3:00 PM. Our days start early and that's universal.

While there are some jobs in ambulatory surgery centers, the vast majority are affiliated with a larger group covering a hospital so they aren't going to hire a new grad to do the easy outpatient stuff unless it's for cheap. In anesthesia, you get paid to work. As a rule of thumb, the more and harder you work, the more money you make.

Plus, as a new grad you wouldn't want to take a outpatient surgery center job. It's horrible. You'd lose all your skills quickly and then you'd be afraid to ever take another job taking care of actual sick patients in a hospital setting.
 
IlDestriero said:
7-3 Mommy track and ASC jobs can be found for ~300. I've seen many.
I doubt many derm folks are bringing in <300. Besides, the job is completely different. I wanted to love derm, but it was not for me. I'd rather pull teeth.
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I think a lot of people have a mistaken idea about derm honestly. The avg derm salary is about 350k. The avg derm does not make 500k or so. You also have to realize that there is a moderate amount of overhead in derm, and that the whole cash procedure market is one where the pie has gotten significantly smaller. IT's not just derms who do cosmetic stuff, it's a ton of other doctors and non doctors, including Fm/IM, dentists, chiropractors, estheticians, etc. So to think that the avg derm is making millions off of cash procedures is not accurate. Most derms have maybe 10-20% of their business that is cash based, cosmetic stuff. Avg starting salary for derms is in the 300-350k range. Of course the stress level is significantly lower than in anesthesia than other fields, that's why it's still a good deal even with comparable income.
 
Destriero, if you were an oral surgeon you would be able to pull teeth and provide anesthesia. :meanie:

IlDestriero said:
7-3 Mommy track and ASC jobs can be found for ~300. I've seen many.
I doubt many derm folks are bringing in <300. Besides, the job is completely different. I wanted to love derm, but it was not for me. I'd rather pull teeth.
Click to expand...
 
Alot of those 6:30 am - 3pm jobs wind up going to 6pm. In many cases the anesthesiologist can't leave the facility until the patient has been discharged home from recovery.
 
I do not believe a new grad is going to land a $350k ASC job without running around hard and driving 4 CRNAs. ...And, I don't think it will be easy for a new grad to get that. You will be lucky to make mid-3 sucking up plenty of call and taking care of sick people. I just don't buy it. Too much kick-back going on in our field for a new grad to land that kind of SECURE opportunity. All IM(experienced)HO.
 
imfrankie said:
I do not believe a new grad is going to land a $350k ASC job without running around hard and driving 4 CRNAs. ...And, I don't think it will be easy for a new grad to get that. You will be lucky to make mid-3 sucking up plenty of call and taking care of sick people. I just don't buy it. Too much kick-back going on in our field for a new grad to land that kind of SECURE opportunity. All IM(experienced)HO.
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So what is anesthesia paying these days? And isn't mid 3 350k? How do you predict the CRNA influx affecting future salaries?

Also looking at salary data, are the salaries posted not real then? I see a number of posts for 300-400k.
 
imfrankie said:
I do not believe a new grad is going to land a $350k ASC job without running around hard and driving 4 CRNAs. ...And, I don't think it will be easy for a new grad to get that. You will be lucky to make mid-3 sucking up plenty of call and taking care of sick people. I just don't buy it. Too much kick-back going on in our field for a new grad to land that kind of SECURE opportunity. All IM(experienced)HO.
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Why "secure" in all caps? There are many entry level insecure jobs?
 
DrAwsome said:
I think a lot of people have a mistaken idea about derm honestly. The avg derm salary is about 350k. The avg derm does not make 500k or so. You also have to realize that there is a moderate amount of overhead in derm, and that the whole cash procedure market is one where the pie has gotten significantly smaller. IT's not just derms who do cosmetic stuff, it's a ton of other doctors and non doctors, including Fm/IM, dentists, chiropractors, estheticians, etc. So to think that the avg derm is making millions off of cash procedures is not accurate. Most derms have maybe 10-20% of their business that is cash based, cosmetic stuff. Avg starting salary for derms is in the 300-350k range. Of course the stress level is significantly lower than in anesthesia than other fields, that's why it's still a good deal even with comparable income.
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This. Attending on my derm elective during med school explained this to me. What makes derm so lucrative is not a ridiculous pay but how well they are payed for the hours that they work and the minimal stress that they encounter (rarely, if ever, does derm have emergencies in the outpt setting). Of course, they can increase their net, but that's going to add to the stress level of cramming more patients into their schedule. The derms at the high end of the spectrum are likely performing Mohs.
 
gasblaster said:
This. Attending on my derm elective during med school explained this to me. What makes derm so lucrative is not a ridiculous pay but how well they are payed for the hours that they work and the minimal stress that they encounter (rarely, if ever, does derm have emergencies in the outpt setting). Of course, they can increase their net, but that's going to add to the stress level of cramming more patients into their schedule. The derms at the high end of the spectrum are likely performing Mohs.
Click to expand...


MOHs took a huge hit lately, and MOHs are making in the 400k range not the 800k plus range as before. So while it's certainly not. Bad it's comparable to other specialties. Also what makes derm lucrative is that they can see many pts a day given many low complexity issues. I had an attending that would see 60 pts a day. So do the math. Again the cosmetic dealio is not necessarily what makes derm that lucrative given that there is limited number of ppl willing and able to pay for cosmetic services and a brutal amt of competition for these clients, not to mention that this brings extra overhead and headache. But overall making 350k for banker hours overall and little liability is not bad. That's why derm is so competitive.
 
DrAwsome said:
MOHs took a huge hit lately, and MOHs are making in the 400k range not the 800k plus range as before. So while it's certainly not. Bad it's comparable to other specialties. Also what makes derm lucrative is that they can see many pts a day given many low complexity issues. I had an attending that would see 60 pts a day. So do the math. Again the cosmetic dealio is not necessarily what makes derm that lucrative given that there is limited number of ppl willing and able to pay for cosmetic services and a brutal amt of competition for these clients, not to mention that this brings extra overhead and headache. But overall making 350k for banker hours overall and little liability is not bad. That's why derm is so competitive.
Click to expand...

I'd want to jump off a bridge having to hear 60 or even 20 pts a day. I'll take the liability 😀 Massive respect for the dermatologists, IM, peds and everyone who interfaces extensively with patients, though.
 
I notice a lot of people don't like "clinic". Even House hated it in a fiction TV show. Is it a preference thing or is it universally disliked because of something basic to working clinic? I guess what I'm asking is there anyone that enjoys doing clinic time?


pgg said:
I'd rather pull my own teeth than see clinic (of any kind).
Click to expand...
 
AngryBird69 said:
I'd want to jump off a bridge having to hear 60 or even 20 pts a day. I'll take the liability 😀 Massive respect for the dermatologists, IM, peds and everyone who interfaces extensively with patients, though.
Click to expand...


Well it's certainly not for everybody, but simply an explanation of how derm works. The more patients you see, with low complexity issues, and the lower the liability with good hours, is sort of what makes this such a competitive specialty, not a necessarily massive amount of $$. There are many other specialties with much higher income overall that are ultimately less competitive.
 
AngryBird69 said:
Why "secure" in all caps? There are many entry level insecure jobs?
Click to expand...

ALL anesthesia jobs are fundamentally insecure unless you work for the government at 1/2 market wages.

Every group is one AMC bid and a gaggle of stupid administrators away from being unemployed. Some groups are certainly safer than others and may be lower risk, but ALL contracts are up for renegotiation at some point.

I think new grads are well advised to view every job as insecure at first. Certainly until they've proved themselves over time and have some claws or roots into the group, and even then, see above AMC / gaggle caveat. We provide a service that is viewed by many as a commodity and therefore natural rightsizing targets.
 
yappy said:
I notice a lot of people don't like "clinic". Even House hated it in a fiction TV show. Is it a preference thing or is it universally disliked because of something basic to working clinic? I guess what I'm asking is there anyone that enjoys doing clinic time?
Click to expand...

I could write volumes on why I loathe clinic work. The highlights, off the top of my head:

- I basically dislike talking to people about their self-inflicted problems, which is about 97% of non-pediatric medicine.

- Pediatric patients typically have parents with them.

- The time-constrained assembly line nature of clinic work is unappealing to me. Especially since one oh-by-the-way patient who goes past 15 minutes will bone up the rest of the day's schedule and then you're stuck working through lunch, or doing assembly-line work on pissed off people with self-inflicted disease, or both.

- Making incremental changes to someone's hypertension or diabetes medication, and then checking back in 3 months, at which time you discover they were noncompliant and gained 15 more pounds. I'd rather roll a boulder up a hill repeatedly.

- All those notes to write.


I enjoy the short, meaningful, brief, substantive, not protracted, to-the-point patient contact in anesthesia. The ideal anesthesia encounter is in OB:

Patient in pain, not in the mood to talk.
Quick options/consent discussion while setting up for the epidural.
Epidural in, pain relieved.
2 minutes of idle talk with profoundly grateful patient while programming her pump.
Even dad is grateful that someone was able to chill out his cranky wife.
Out of the room, off someplace to chart in peace.

10 minutes of work, and in that moment I get more credit and gratitude than the OB who put up with her for the last 7+ months and has to put his CLINIC behind to rush over to deliver her baby. 🙂



Some people enjoy clinic and choose specialties where they get to do a lot of it. They might like the human contact, or the long term relationships with patients, or maybe they just don't like the smell of butt pus at 9 PM when Monday Night Football is on. Whatever, I'm glad somebody does it. Respect and gratitude to them.
 
imfrankie said:
I do not believe a new grad is going to land a $350k ASC job without running around hard and driving 4 CRNAs. ...And, I don't think it will be easy for a new grad to get that. You will be lucky to make mid-3 sucking up plenty of call and taking care of sick people. I just don't buy it. Too much kick-back going on in our field for a new grad to land that kind of SECURE opportunity. All IM(experienced)HO.
Click to expand...

You're right that a new grad would probably have trouble getting a good ASC job. Not because they're something spectacular, but because a decent group is going to be reluctant to give a new grad a chance without a few years of experience proving their ability to work alone and with very limited back up. You don't want to be working the kinks out, figuring out who is ASC material, etc on the fly, and with no safety net.
The no late/call/weekend track jobs are out there for the new guys, but you have to be ok with the other folks making much more, for not all that much more work.
 
pgg said:
ALL anesthesia jobs are fundamentally insecure unless you work for the government at 1/2 market wages.

Every group is one AMC bid and a gaggle of stupid administrators away from being unemployed. Some groups are certainly safer than others and may be lower risk, but ALL contracts are up for renegotiation at some point.

I think new grads are well advised to view every job as insecure at first. Certainly until they've proved themselves over time and have some claws or roots into the group, and even then, see above AMC / gaggle caveat. We provide a service that is viewed by many as a commodity and therefore natural rightsizing targets.
Click to expand...

What is the hourly market rate for a government job out of my curiousity. Locums is now about $175/hour in my area.
 
To the OP. Finish med school, finish PGY -1 ,then decide whether you'd like to try anesthesiology, make it through CA-1, and then during the end of CA-2 start to look for a job. By then we may be treating the aftermath of radiation poisoning at many surgery centers, secondary to a lunatic dictators missile launch. Can you tell me what the price of gasoline will be in 5 years? How much GE will be trading for ?
How about asking a physiology question , If I told you the story of a surgicenter case I did several weeks ago, you'd probably decide to squeeze pimples - inducing at 4-5pm , in an office building center, no backup, skeleton crew ,airway hell, almost crashed the plane > landed the plane, probably would have crashed if I was newguy. My hand and back hurt for a week. Decide what specialty you like and what may keep you from burning out- I am burnt regardless, my wife is toast. The salary questions here are comical unless you are currently - TODAY- looking for a job. How much will gasoline cost in 2 months ???
 
cincincyreds said:
What is the hourly market rate for a government job out of my curiousity. Locums is now about $175/hour in my area.
Click to expand...

I don't know what the VA pays, I was just joking about the military and job security. 🙂


But to answer your question re: the military ... it's hard to give an apples-to-apples comparison of .mil to private practice pay, but for anesthesia it's about 1/2 market rates. The military offers some good benefits, and of course there's some unpleasant baggage too.

A new grad out of residency coming onto active duty for a few years to pay back 'scholarship' time will make somewhere around $150K/yr during their payback period (about $60/hr for a 50 hour work week, given 30 days of paid vacation/year). Of course,
- they have no student loan debt
- they lived pretty well as medical students (full ride + stipend)
- if they did residency at a .mil hospital, they got paid $60-90K/year during residency
They may or may not come out ahead, depending on many factors.

Once the 'scholarship' time is paid back, those who choose to stay in the military are eligible for retention bonuses that (currently) raise that figure to around $250K/yr (very roughly about $100/hr). This is about what someone would get if they woke up one day and decided to join. This is a very rough estimate since there are different paths in, with different obligations, different pay schedules. Some paths aren't always open, depending on what specialists the military needs at any given time.

Most of us moonlight too. Depending on where you are, how much you want to work, and other factors, that might be anywhere from another $0 - $150K+. It's not unheard of for people to double their .mil pay with outside work ... but they work for it.

If you can put up with the 1/2 pay and military-isms for 20 years, you can retire and start collecting retirement pay immediately. Military retirement pay for senior officers is a lot of money, indexed to inflation, starting in your mid-40s, for the rest of your life. Even so, financially it doesn't make any sense to accept 1/2 market wages for that long. If you came in with time credit, or had extra time owed from undergraduate ROTC, a service academy, or something else ... that calculus changes.

There are other ways to squeeze $ out of the military if you plan ahead. After some hoop jumping, the military will pay you your usual salary to go do a fellowship at any institution you choose. I know someone (not in anesthesia) who just started a 3-year fellowship, and the Navy's paying him ~$250K/year to be there. I'll get the same for my fellowship in a couple years. There are some other financial benefits too (some tax-free pay, ability to transfer $100-150K worth of GI Bill benefits to your kids, etc) but the bottom line is you're looking at getting 1/2 of your fair market value in order to enjoy and tolerate the good and bad of being in the military.


There's an entire forum worth of other .mil pros and cons (with the cons generally getting more attention), but the above mostly sums up the financial side of it, at least for anesthesia.
 
cincincyreds said:
What is the hourly market rate for a government job out of my curiousity. Locums is now about $175/hour in my area.
Click to expand...

VA pays on salary and their rates are publicly available. The USAJobs site lists salary in their ads. Be warned, however, that they list only base pay, and market, locality, and retention components can more than double the base. In SF, at least, it is well above 1/2 market rate and closer to what someone at Kaiser or an academic institution makes.
 
The VA is a pretty good gig. I think they are getting around 275k, great benefits, lots of vacation, and mostly supervise nurses/residents 1:1 here where 275k goes a long ways.
 
Maybe it's me, but I never see the surgeon's PA or NP arguing about what they should or should not be doing.
 
imfrankie said:
Maybe it's me, but I never see the surgeon's PA or NP arguing about what they should or should not be doing.
Click to expand...

On a different note, can someone tell me why CRNAs are paid so much? Who determines their salary, and why are nurses being paid what a lot of physicians are making? It's not cost effective at all to make 150k+ for nurse. Can someone please elaborate on this issue?
 
Zumba said:
On a different note, can someone tell me why CRNAs are paid so much? Who determines their salary, and why are nurses being paid what a lot of physicians are making? It's not cost effective at all to make 150k+ for nurse. Can someone please elaborate on this issue?
Click to expand...

Supply, Demand, and Anesthesiologist-based billing
 
GypsySongman said:
Supply, Demand, and Anesthesiologist-based billing
Click to expand...

Supply/demand? there are a ton of CRNAs and a ton of anesthesiologists. You really think that nurses wouldn't work for much less? What is anesthesiologist based billing? They could pay nurses less and pay the MDs more couldn't they?
 
Zumba said:
Supply/demand? there are a ton of CRNAs and a ton of anesthesiologists. You really think that nurses wouldn't work for much less? What is anesthesiologist based billing? They could pay nurses less and pay the MDs more couldn't they?
Click to expand...

we don't get paid a salary, we bill for our services. 'they' don't pay the crna's, we do. we pay what it takes to keep them based on supply demand. lowering salaries short-term would lead to increased turnover and decreased quality. you can't just tell them that they're getting 15% pay cuts without expecting them all to quit, and they would quit as long as they can go work at the hospital up the road making more.
 
pgg said:
Yes, supply and demand.


On another note, be careful about begrudging ANY professional his paycheck because you think it's too much. All of the same (poor) arguments can be made against us.
Click to expand...


If we are worth the same as nurses, i think there already is a problem. CRNAs are making what many many MD's are already. And the salary expectation for CRNAs is there because it was initially so high. They are basically making doctor salary with nurse training. Pretty sweet deal no? None of the liability or the work but all the reward. And given the thousands of CRNAs that are pumped out of the system every year, I don't see how there isn't enough supply. I find that hard to believe.
 
Don't forget that anesthesiologists are above averagely compensated among physicians.

There has been a national shortage of anesthesia personnel, both docs and CRNAs for about 12 years. Supply is in the process of meeting demand. These trends take a while to correct. The ability to choose your metro area is going away. The amount of locum tenens work available for CRNAs is drying up. Things like signing bonuses, overtime, relo packages, choice of shifts are going away. Things like shaving benefits package are better tolerated than cutting wages. These things are all happening for the first time in years.

Anesthesiologists do make more on average than CRNAs. Both absolutely and per hour. The ratio of anesthesiologist hourly rate to CRNA hourly rate has been going down. How close that it gets to unity on a national average basis is not knowable. Throw in changing staffing models, changes in scope of practice laws and reimbursement rules into the mix and it is anyone's guess.
 
Zumba said:
On a different note, can someone tell me why CRNAs are paid so much? Who determines their salary, and why are nurses being paid what a lot of physicians are making? It's not cost effective at all to make 150k+ for nurse. Can someone please elaborate on this issue?
Click to expand...

Meh. The CRNAs where I work are hospital employees and they make $185k to START. Not a bad deal at all. Makes you feel like an idiot for becoming a physician.
 
Consigliere said:
Meh. The CRNAs where I work are hospital employees and they make $185k to START. Not a bad deal at all. Makes you feel like an idiot for becoming a physician.
Click to expand...


Why would they make that much? That's not very cost effective. They are more $ than anesthesiologists. I don't get it. Doesn't it make sense to pump out more anesthesiologists?
Who came up with taht salary? It sort of makes me want to get a little CRNA degree.
 
Zumba said:
Why would they make that much? That's not very cost effective. They are more $ than anesthesiologists. I don't get it. Doesn't it make sense to pump out more anesthesiologists?
Who came up with taht salary? It sort of makes me want to get a little CRNA degree.
Click to expand...

-This is probably not a highly desirable area. It costs money to recruit and retain good quality people in smaller cities, rural areas, etc.
-Anesthesiologists average well more than twice that salary. Though we usually work longer hours than the CRNAs..
-Resident training is limited, you can't just increase training numbers by 10 or 20%.
 
Zumba said:
Why would they make that much? That's not very cost effective. They are more $ than anesthesiologists. I don't get it. Doesn't it make sense to pump out more anesthesiologists?
Who came up with taht salary? It sort of makes me want to get a little CRNA degree.
Click to expand...

You haven't been listening. It is about supply and demand. You need to educate yourself about the economics of an anesthesia practice. You need to educate yourself in the way that anesthesi is conducted:

MD only
ACT
CRNA only

You need to educate yourself on other business aspects of an anesthesia practice:

Staffing models, reimbursement rules, scope of practice laws, ability to flex to meet demand, back up call issues, etc.

You are embarassing yourself with your statements.
 
dr doze said:
You haven't been listening. It is about supply and demand. You need to educate yourself about the economics of an anesthesia practice. You need to educate yourself in the way that anesthesi is conducted:

MD only
ACT
CRNA only

You need to educate yourself on other business aspects of an anesthesia practice:

Staffing models, reimbursement rules, scope of practice laws, ability to flex to meet demand, back up call issues, etc.

You are embarassing yourself with your statements.
Click to expand...

No need to be so harsh. I do understand the different models btw.
 
While you're on the topic of 9 to 5 gigs in a no stress setting, I'm going into Psychiatry where I can work 9 to 3 on a consult service, and then 2 hours of cash only private patients and have very low stress for $250K to $300K range. My attending is doing this. One of the sweetest deals in all of medicine.
 
Zumba said:
No need to be so harsh. I do understand the different models btw.
Click to expand...

Your earlier posts made it seem like you have no idea how reimbursement works in the anesthesia world. Increduluous that a CRNA might make 185K? Really? I bet that if you added up every podunk little community hospital in America, that might be the median total package for CRNAs working at them.
 
Leo Aquarius said:
While you're on the topic of 9 to 5 gigs in a no stress setting, I'm going into Psychiatry where I can work 9 to 3 on a consult service, and then 2 hours of cash only private patients and have very low stress for $250K to $300K range. My attending is doing this. One of the sweetest deals in all of medicine.
Click to expand...

Except you spend your day talking to mental patients...
 
IlDestriero said:
And you get to spend your day talking to mental patients...
Click to expand...

fixed

Bipolar and schizophrenia patients are much more interesting than chronic pain pts. I don't know how anesthesiologists end up going in to pain - these patients suck the life out of you.
 
Mman said:
Your earlier posts made it seem like you have no idea how reimbursement works in the anesthesia world. Increduluous that a CRNA might make 185K? Really? I bet that if you added up every podunk little community hospital in America, that might be the median total package for CRNAs working at them.
Click to expand...

It's not really a surprise, it's SAD that they would make that much. If you don't see that, that's problematic. Them making doctor salaries when they are nurses is pretty sad for the medical profession.
 
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