Fair critical care salary

[jdh71]

Your argument makes sense. No one is going to feel bad for the poor doctor who charges medicare (taxpayers), makes 600k+, and then the federal government prosecutes this doctor.

But it is also true that NO ONE (except maybe other doctors) is going to feel bad for you. There is enough nuance here to drive a bus through that physicians will understand and supply and demand economics will understand but will be lost on the vast majority of people, and without some additional political will here that doctors need to be (significantly) paid more to work in locations where it is hard to get them, then the US attorney's will run with this ball all day long.

---

Members don't see this ad.

 

[martvubo]

Except that's not what anyone here is talking about. If you work hard enough and bill enough in professional services to earn 600k, the government is fine with that from a Stark prospective. I'm FM. Let's say I make $50 per patient I see. If I see 15,000 patients/year, that gets me to 750k. That's WAY above average for my specialty. But if I can prove that I'm just that busy and that's why the hospital paid me that much, the Feds would be OK with that.

What they are not OK with is the hospital paying you more because of anything else - performing surgery at the hospital, sending all of your labs/pathology to the hospital, referring your patients to hospital-employed doctors. Stuff like that.

If you are a not-terribly-busy CC doctor who is getting paid WAY more than the vast majority of CC doctors, the government is going to want to know why. If you and the hospital don't have a good answer, then you both get sued.

Right. I totally get that the intention of the Stark law is to prevent the kind of shady stuff you are describing in the second paragraph... my question was more to the bolded text "why is 'we have an ICU with critical patients and we haven't been able to get anyone to staff it for less money' not a 'good answer'?" If the government is forbidding that as a justification, then what happens to patients at this hospital that need ICU care?

 

[deleted171991]

Except that's not what anyone here is talking about. If you work hard enough and bill enough in professional services to earn 600k, the government is fine with that from a Stark prospective. I'm FM. Let's say I make $50 per patient I see. If I see 15,000 patients/year, that gets me to 750k. That's WAY above average for my specialty. But if I can prove that I'm just that busy and that's why the hospital paid me that much, the Feds would be OK with that.

What they are not OK with is the hospital paying you more because of anything else - performing surgery at the hospital, sending all of your labs/pathology to the hospital, referring your patients to hospital-employed doctors. Stuff like that.

If you are a not-terribly-busy CC doctor who is getting paid WAY more than the vast majority of CC doctors, the government is going to want to know why. If you and the hospital don't have a good answer, then you both get sued.

I'll tell you why: because nobody else would do the job for that money, and they needed somebody to cover critical care.

You don't have to prove billing or other BS. You need to prove that the market doesn't allow you to hire cheaper. The simple fact that the hospital has a functional ICU allows them to do a lot of things they couldn't otherwise. They win indirectly, but it's not kickback, hence no Stark. Otherwise no hospital would subsidize anesthesia groups.

 

[VA Hopeful Dr]

I'll tell you why: because nobody else would do the job for that money, and they needed somebody to cover critical care.

You don't have to prove billing or other BS. You need to prove that the market doesn't allow you to hire cheaper. The simple fact that the hospital has a functional ICU allows them to do a lot of things they couldn't otherwise. They win indirectly, but it's not kickback, hence no Stark. Otherwise no hospital would subsidize anesthesia groups.

Do hospitals subsidize anesthesiologists such that they make way more than other non-subsidized groups?

 

[deleted171991]

Do hospitals subsidize anesthesiologists such that they make way more than other non-subsidized groups?

Some hospitals subsidize groups with millions, just to cover areas which are not well-reimbursed for anesthesia, but bring them a lot of dough overall. E.g. open heart surgery (dear Medicare pays like 1200 for it).

 

[VA Hopeful Dr]

Right. I totally get that the intention of the Stark law is to prevent the kind of shady stuff you are describing in the second paragraph... my question was more to the bolded text "why is 'we have an ICU with critical patients and we haven't been able to get anyone to staff it for less money' not a 'good answer'?" If the government is forbidding that as a justification, then what happens to patients at this hospital that need ICU care?

The same thing that happens to patients at any hospital that doesn't have X service.

And I think your idea could be a fine answer, but getting the government to agree to it is the hard part.

 

[VA Hopeful Dr]

Some hospitals subsidize groups with millions, just to cover areas which are not well-reimbursed for anesthesia.

I didn't ask what the subsidies were, I asked if the subsidies result in significantly higher pay for the doctors in question.

 

[deleted171991]

I didn't ask what the subsidies were, I asked if the subsidies result in significantly higher pay for the doctors in question.

Obviously, since they are partners in those groups. And the Stark law does not make a difference between an employee and an owner.

 

[VA Hopeful Dr]

Obviously, since they are partners in those groups. And the Stark law does not make a difference between an employee and an owner.

So the partners in a subsidized group make significantly above what other partner anesthesiologists do even when accounting for volume?

 

[deleted171991]

Mea culpa. My memory was wrong. There is no mention of FMV for group practices.

Anyway, being in a specialty that can refuse to deal with governmental idiots: priceless.

 

[jdh71]

Mea culpa. My memory was wrong. There is no mention of FMV for group practices.

Anyway, being in a specialty that can refuse to deal with governmental idiots: priceless.

For now

 

[jdh71]

Do hospitals subsidize anesthesiologists such that they make way more than other non-subsidized groups?

You can pay the private practice GROUP whatever the two business entities agree on interestingly enough. This FMV pay stuff only applies to the individual physicians. This is one of the big reasons Hospitals are buying up practices and moving to employed physicians.

 

[lunaire]

Ok folks, update time.

Negotiated a decent deal (I think). $500k base with quality bonus of 50k per year. 7 days on/ off, 12H in house shift with the rest of the time at home call, but with an NP/PA in house to deal with BS pages. 2 weeks vacation time, and they'll get locums to cover. Considering that patient load is on the light side; seems to be a decent offer.

We'll be looking to hire a second intensivist to staff the model; if anybody is interested, give me a PM, and I'll give more details.

 

[jdh71]

Hmm. Looks like about 75%ile.

How about that . . .

 

[CCM-MD]

MGMA 2018 total comp, all practice types:
75th percentile $458,280
90th percentile $549,111

More like 90th i'd say.

 

[jdh71]

MGMA 2018 total comp, all practice types:
75th percentile $458,280
90th percentile $549,111

More like 90th i'd say.

90 is 90 and he’s not getting 90.

42k over 75th, 49k UNDER 90. I was closer. The tables are always a year behind and the salary creeping up. The table have been good for critical care for a number of years now. 500k is probably the tip top end of FMV for flyover country especially since they are paying for availability at night instead of each time called in. In 2014 I was offered 430k in fly over country to basically be available and cover an 8 bed icu that was most post op CV patients 14 days per month. Week on/week off or two on/two off.

 

[CCM-MD]

90 is 90 and he’s not getting 90.

42k over 75th, 49k UNDER 90. I was closer. The tables are always a year behind and the salary creeping up. The table have been good for critical care for a number of years now. 500k is probably the tip top end of FMV for flyover country especially since they are paying for availability at night instead of each time called in. In 2014 I was offered 430k in fly over country to basically be available and cover an 8 bed icu that was most post op CV patients 14 days per month. Week on/week off or two on/two off.

Its total comp. That includes bonuses. So he would get to 550k total comp with the quality bonus.

 

[jdh71]

Its total comp. That includes bonuses. So he would get to 550k total comp with the quality bonus.

When it comes to quality incentives don’t count those chickens before they come home to roost.

He MIGHT make 90. But like I said he will WORK for that. He’s not starting there.

 

[CCM-MD]

When it comes to quality incentives don’t count those chickens before they come home to roost.

He MIGHT make 90. But like I said he will WORK for that. He’s not starting there.

Agree. But if MGMA had a tab for base salaries, he might be at 90%ile base salary. Gotta compare apples to apples.

Regardless, congrats to OP. I wish I was making that much for that patient load. Though q1 call has the potential to become painful depending on the set up.

 

[icuanesthesiology]

There is money to be made in CCM, but like the others have said, you have to work for it. I am in a rural hospital in extreme flyover country. One of the more undesirable places in this country most would argue. I live in a different city about 3 hours away and stay in an apt for the time that I’m at work. I have a 7 on 7 off schedule per year contract with 2 weeks of vacation. We can work extra hours and get paid extra. I made about 675 last year which included about 50k toward student loans, (they are paying the balance off over 120 payments) but I average 18-20 shifts a month. And we see 12-20 patients a day. When on nights, I’ll often come in a few hours early to help the day guys since we are usually pretty busy and chronically short staffed. So some of my days are 18 straight hours in the ICU. It’s hard ass work and I’m getting pretty beat up...but I came out of training with 375k in student loans, my wife’s undergrad loans were about 35k, she stays at home with the kids, and I finished fellowship at age 37 with about 0 dollars saved for retirement and a negative 500k net worth. 4.5 years later our net worth is positive 100k. Yea!?
im always wondering...what would you all be making if you averaged 20 shifts per month? 18, 16? Do most people work more than their contract? Do other peopl have some kind of overtime rate which is more than their base rate? Do you all think it is fair compensation (too much? To little?) to make close to 700 while working 18-20 shifts, some days being 18 hours? Would other people work these kinds of hours seeing this many patients? The extra hours and shifts are mostly voluntary. I feel that the compensation is fair. It’s a s$#t place geographically, long hours, lots of patients, and lots of shifts. It’s also an extremely litigenous environment. The area is extremely poor so the attorneys circle the hospital looking for blood. I actually asked for a raise on our base. It’s around 450. I was declined because they felt we were all making a bunch from overtime. But I am almost working the job of 1.5-2 intensivists with the hours and the patient load. What do you all think?

 

[bigdan]

I think you’re getting fu€ked, brah.

That may be okay to you, if you determine that money is your #1 need right now, but you need to understand the manner in which you’re getting screwed.

If you’re looking for work/life compensation balance, you need to leave. Many of the Anes/CCM folks I know (presuming from your handle that that’s your training) are in the orbit of $500,000 with at least 12 weeks off (1 week ICU, 1 week off post-ICU, then 2 weeks OR anesthesia). If you’re out of the debt hole, you’ll still be able to keep roof over head with “only” $500,000, even though it represents a 25% pay cut.

Last, don’t forget you can vote with your feet. You asked for more money, and they told you to pound sand. You sorta affirm/confirm their decision to pay you less then you want (and deserve) by simply going back to work. If you and your group are chronically understaffed but still “make it work”, you’re probably helping save them money (cost of recruitment of new docs, orientation, salary and benefits, vacation, CME, etc). Everyone has a price. Your employer is happy having you guys work for whatever that amount is, and you’re apparently happy with $675,000 for 1 billion hours per week. Until those economics don’t work for one of you, things will continue as is.

Look around. There are lots of better options, at least from my viewpoint

 

[icuanesthesiology]

All great points and all correct, but money is certainly my big issue right now. Trying to get out of over 400k in student loan debt, save a bunch for retirement, emergency fund, college fund, and send two kids to private schools...my hope is about 5.5 more years of this (total 10 years) the student loans will be gone, we will have enough saved for college, and the retirement nest egg will be well on its way to success.
To compare to the traditional 1 week icu, 1 week off, and two weeks anesthesia...that is about 12 weeks off for 500 or so. I get about 20-22 weeks off per year and make almost 700. 200k more. And that goes a long way toward our savings goals. My weeks on can be tough, but when I’m off. I’m off. We also have a good amount of flexibility in how we do the schedule. For example, I worked a lot in the beginning of December and took about 12 days off for the holidays. I always have 2 weekends off a month. And I usually take 5-6 weeks off in a row in the summer. Also If my kids have some kind of school event in the AM, I can put myself on nights, and leave a little early and be home in time to see the show, event, etc and be back to work that night. Also, I am somewhat geographically limited. We love our town and school. Everytime I look at other jobs and really delve into the details, I realize what I have is pretty decent for my particular situation...at least for a few more years.
But I wasn’t happy when they denied the base pay raise. We had just had a few people leave the group and it seemed obvious it was time to pony up some more, even a trifle as a small token of thanks for the hard work we put in, but they said no, nothing.
More than anything else, it was insulting. It did prompt me to look though. There are a few prospects. I have an interview coming up in a couple of weeks. Just curious what others are doing out there.
Thanks for the thoughts though. It’s helpful.

 

[bigdan]

Sounds like you have an idea of where you’re at, and where you need to be. I was just rendering a random internet opinion. I’m not being judgemental, or calling you out. We’re all getting screwed, it just helps the situation if we understand exactly how it is that we’re getting screwed. You’re baking a lot of bread, that’s for sure: $700,000 is good coin, and debt is debt.

What did you refinance those loans down to, by the way?

 

[jdh71]

There is money to be made in CCM, but like the others have said, you have to work for it. I am in a rural hospital in extreme flyover country. One of the more undesirable places in this country most would argue. I live in a different city about 3 hours away and stay in an apt for the time that I’m at work. I have a 7 on 7 off schedule per year contract with 2 weeks of vacation. We can work extra hours and get paid extra. I made about 675 last year which included about 50k toward student loans, (they are paying the balance off over 120 payments) but I average 18-20 shifts a month. And we see 12-20 patients a day. When on nights, I’ll often come in a few hours early to help the day guys since we are usually pretty busy and chronically short staffed. So some of my days are 18 straight hours in the ICU. It’s hard ass work and I’m getting pretty beat up...but I came out of training with 375k in student loans, my wife’s undergrad loans were about 35k, she stays at home with the kids, and I finished fellowship at age 37 with about 0 dollars saved for retirement and a negative 500k net worth. 4.5 years later our net worth is positive 100k. Yea!?
im always wondering...what would you all be making if you averaged 20 shifts per month? 18, 16? Do most people work more than their contract? Do other peopl have some kind of overtime rate which is more than their base rate? Do you all think it is fair compensation (too much? To little?) to make close to 700 while working 18-20 shifts, some days being 18 hours? Would other people work these kinds of hours seeing this many patients? The extra hours and shifts are mostly voluntary. I feel that the compensation is fair. It’s a s$#t place geographically, long hours, lots of patients, and lots of shifts. It’s also an extremely litigenous environment. The area is extremely poor so the attorneys circle the hospital looking for blood. I actually asked for a raise on our base. It’s around 450. I was declined because they felt we were all making a bunch from overtime. But I am almost working the job of 1.5-2 intensivists with the hours and the patient load. What do you all think?

I don’t think you are getting “screwed”. You are being currently compensated for the work you are doing and well. I’d estimate if I worked an extra three critical care shifts per month I’d be tacking on an additional 150k with the differential and RVU bonus. Which would put me still less than your gross earnings there. It sounds like they have already factored in a ****ty place to live differential.

The one thing you could do to bring home your point might be to back off work to your current contracted minimum. And see if there is any squawking. If there is you need to ask for a reconsideration of the base to work the kind of hours you were. 450k base is not arguably an unreasonable ask based on location but probably tops out on the border of the fair market end of things. The only way to prove your point is to prove it. But I do get that it’s kind of a tough spot given what you’re trying to do with your personal financial situation. Tiger by the ears there.

Also, am I understanding correctly THEY are paying off your loans over the next ten years?

 

[chocomorsel]

I think you’re getting fu€ked, brah.

That may be okay to you, if you determine that money is your #1 need right now, but you need to understand the manner in which you’re getting screwed.

If you’re looking for work/life compensation balance, you need to leave. Many of the Anes/CCM folks I know (presuming from your handle that that’s your training) are in the orbit of $500,000 with at least 12 weeks off (1 week ICU, 1 week off post-ICU, then 2 weeks OR anesthesia). If you’re out of the debt hole, you’ll still be able to keep roof over head with “only” $500,000, even though it represents a 25% pay cut.

Last, don’t forget you can vote with your feet. You asked for more money, and they told you to pound sand. You sorta affirm/confirm their decision to pay you less then you want (and deserve) by simply going back to work. If you and your group are chronically understaffed but still “make it work”, you’re probably helping save them money (cost of recruitment of new docs, orientation, salary and benefits, vacation, CME, etc). Everyone has a price. Your employer is happy having you guys work for whatever that amount is, and you’re apparently happy with $675,000 for 1 billion hours per week. Until those economics don’t work for one of you, things will continue as is.

Look around. There are lots of better options, at least from my viewpoint

Where are these jobs of which you speak? Hard for me to find a combo job honestly and the ICU gigs are close to the $500k +/- 25K.

 

[psychbender]

Yeah, I'm also nowhere near bigdan's figure of 12 weeks ICU, 12 off, 28 anesthesia, $500+k.

Then again, I'm solo more often than not in the OR, and my ICU weeks are just twelve hour days with 8-12 patients per day.

Sent from my SM-G930V using SDN mobile

 

[bigdan]

Mayo
Eastern and Western PA
Wisc
Michigan
California (not the fancy parts)

 

[lunaire]

As the OP in this thread, since it got resurrected-- A few job market insight from someone that just got done with interviews:

For pure ICU work; with the average schedule of working 7 days on/off, 2 week vacation - expect base 350-370k, with various bonus. Usually end up with $400-425k after various bonus.

There are good jobs offers popping up here and there. The one I took is approximately 475k with 4 weeks vacation. Night shift, but in a good geographic location. There were a a couple jobs offering 500k per annum nearby as well (not sure what the details were). One thing to note with these good jobs is that they go quickly. My current job was on the market for less than a month before they recruited me. They also pull off the job posting once they have 1 or 2 qualified candidates. If you are looking for a good job, you gotta actively search for them.

There is money to be made in CCM, but like the others have said, you have to work for it. I am in a rural hospital in extreme flyover country. One of the more undesirable places in this country most would argue. I live in a different city about 3 hours away and stay in an apt for the time that I’m at work. I have a 7 on 7 off schedule per year contract with 2 weeks of vacation. We can work extra hours and get paid extra. I made about 675 last year which included about 50k toward student loans, (they are paying the balance off over 120 payments) but I average 18-20 shifts a month. And we see 12-20 patients a day. When on nights, I’ll often come in a few hours early to help the day guys since we are usually pretty busy and chronically short staffed. So some of my days are 18 straight hours in the ICU. It’s hard ass work and I’m getting pretty beat up...but I came out of training with 375k in student loans, my wife’s undergrad loans were about 35k, she stays at home with the kids, and I finished fellowship at age 37 with about 0 dollars saved for retirement and a negative 500k net worth. 4.5 years later our net worth is positive 100k. Yea!?
im always wondering...what would you all be making if you averaged 20 shifts per month? 18, 16? Do most people work more than their contract? Do other peopl have some kind of overtime rate which is more than their base rate? Do you all think it is fair compensation (too much? To little?) to make close to 700 while working 18-20 shifts, some days being 18 hours? Would other people work these kinds of hours seeing this many patients? The extra hours and shifts are mostly voluntary. I feel that the compensation is fair. It’s a s$#t place geographically, long hours, lots of patients, and lots of shifts. It’s also an extremely litigenous environment. The area is extremely poor so the attorneys circle the hospital looking for blood. I actually asked for a raise on our base. It’s around 450. I was declined because they felt we were all making a bunch from overtime. But I am almost working the job of 1.5-2 intensivists with the hours and the patient load. What do you all think?

I think you need to approach this differently. Calculate your compensation per hour. It should be $150-200/h, more if your RVU is high, or if your geographical location sucks. Working 18H per day sucks, but admin may not put a premium on the overtime. I also think that if you are not getting paid for overtime, you should not stay beyond your shift. Know your worth and value. 6H extra work is worth at least $900. Your employer is probably billing for it, why should you work this if you don't get paid for it?

To answer your question: if I worked 16/18/20 shifts per month, I would be making 523k/585k/639k per year. As mentioned earlier in this thread, at this level of compensation, Stark law start to become a concern. I would not expect you (or me) to make significantly more than this without some kind of legal maneuvering. In your situation, I would work whatever hours you are compensated for, and not more. Not a great idea to aggressively negotiate higher pay. Also consider optimizing your tax burden/budget, you should be saving up a lot more than that over 4.5 years.

 

[cali_doc_7531]

All great points and all correct, but money is certainly my big issue right now. Trying to get out of over 400k in student loan debt, save a bunch for retirement, emergency fund, college fund, and send two kids to private schools...my hope is about 5.5 more years of this (total 10 years) the student loans will be gone, we will have enough saved for college, and the retirement nest egg will be well on its way to success.
To compare to the traditional 1 week icu, 1 week off, and two weeks anesthesia...that is about 12 weeks off for 500 or so. I get about 20-22 weeks off per year and make almost 700. 200k more. And that goes a long way toward our savings goals. My weeks on can be tough, but when I’m off. I’m off. We also have a good amount of flexibility in how we do the schedule. For example, I worked a lot in the beginning of December and took about 12 days off for the holidays. I always have 2 weekends off a month. And I usually take 5-6 weeks off in a row in the summer. Also If my kids have some kind of school event in the AM, I can put myself on nights, and leave a little early and be home in time to see the show, event, etc and be back to work that night. Also, I am somewhat geographically limited. We love our town and school. Everytime I look at other jobs and really delve into the details, I realize what I have is pretty decent for my particular situation...at least for a few more years.
But I wasn’t happy when they denied the base pay raise. We had just had a few people leave the group and it seemed obvious it was time to pony up some more, even a trifle as a small token of thanks for the hard work we put in, but they said no, nothing.
More than anything else, it was insulting. It did prompt me to look though. There are a few prospects. I have an interview coming up in a couple of weeks. Just curious what others are doing out there.
Thanks for the thoughts though. It’s helpful.

I am truly baffled that you still have student debt after making at least 450k/year for 4.5 years (most recently 675k per year!) in an admittedly extremely low cost of living area. Do you realize you could have been out of student debt in 2 years if you didn't let your lifestyle get so out of control? 675k/yr in a prototypical flyover state (Oklahoma) leaves you with 440k/yr post-tax if you file with your wife. You can live like you make 100k per year (80k post tax), which easily puts you in the top 25% of household income in your state and affords a very comfortable lifestyle, and have a whopping 360k/yr left over to pay off debt. If you "only" made 450k for the past few years, you would have had 242k/yr extra while living off a net salary of 80k/yr...that is almost 1.1 MILLION dollars you could have put towards paying off student debt, building a retirement fund, saving for college, etc, etc.

In other words, I don't understand why you are subjecting yourself to ten years of objectively horrible working conditions and time away from family, when you could be out of debt in a year or two and move on to a location where you make 400-500k, work way less, and actually get to come home to your wife and kids (almost) every night. I will never understand how some physicians can complain about being in student debt for over a decade post-residency while making more than half a million dollars a year.

 

[jdh71]

student loan shaming

nice

 

[cali_doc_7531]

student loan shaming

nice

A lot of people don't discuss salary in person and/or might be too polite to call someone out on poor financial decisions. I thought it was worth making an account (normally a lurker) to remind the poster and others how student loans don't have to be this decades long burden. I didn't call him an idiot for taking out student loans or going to medical school. In fact, he is clearly hard-working and will make quite a bit in lifetime earnings due the combination of his chosen specialty and work ethic.

 

[jdh71]

A lot of people don't discuss salary in person and/or might be too polite to call someone out on poor financial decisions. I thought it was worth making an account (normally a lurker) to remind the poster and others how student loans don't have to be this decades long burden. I didn't call him an idiot for taking out student loans or going to medical school. In fact, he is clearly hard-working and will make quite a bit in lifetime earnings due the combination of his chosen specialty and work ethic.

how is any of it *your* business in person or online

go be a classless ass somewhere else

 

[cali_doc_7531]

how is any of it *your* business in person or online

go be a classless ass somewhere else

I mean, "it "being none of my business" could be said of anything anyone posts online. Kinda a silly argument. In short though, I am frustrated seeing physician after physician be in hundreds of thousands of dollars in debt for 10-20 years after residency and working themselves into the ground to make a higher salary when they could much more easily cut expenses for a few years and never have to worry about debt again.

 

[jdh71]

I mean, "it "being none of my business" could be said of anything anyone posts online. Kinda a silly argument. In short though, I am frustrated seeing physician after physician be in hundreds of thousands of dollars in debt for 10-20 years after residency and working themselves into the ground to make a higher salary when they could much more easily cut expenses for a few years and never have to worry about debt again.

thats really neat but this person wasn’t asking for your advice on their student loans

thanks for weighing in it was really helpful

 

[bigdan]

The guy did offer up the student loans as reasons for working that hard in two separate posts. It's relevant to his posts and relevant to his rationale for working so hard, and he asked for the Forum's opinions. Seems like fair game to me.

 

[jdh71]

It’s free country and a free forum you all can do what you want.

I for one am glad there are so many smart and classy people willing to student loan shame a guy without knowing any of the more specifics

 

[bigdan]

C'mon.

There are money discussions all over this forum. Why attack someone for being "so smart and classy" for commenting/rendering an opinion on student loans?

 

[cali_doc_7531]

C'mon.

There are money discussions all over this forum. Why attack someone for being "so smart and classy" for commenting/rendering an opinion on student loans?

Exactly. Also, it is not like he was vague about salary and loan numbers. He mentioned both in two posts and lamented about having to work incredibly hard for 10 years to get out of debt. His situation is so striking that if calling it such is "student loan shaming", then I guess we can never discuss debt and student loans around @jdh71 again.

 

[jdh71]

Exactly. Also, it is not like he was vague about salary and loan numbers. He mentioned both in two posts and lamented about having to work incredibly hard for 10 years to get out of debt. His situation is so striking that if calling it such is "student loan shaming", then I guess we can never discuss debt and student loans around @jdh71 again.

the guy wasn’t asking for your loan advice and your post to him was shaming

you can discuss loans as much as you like

again it’s a free forum so if you feel like you need to apologize and rationalize your boorish behavior that’s on you

 

[psychapp121]

thats really neat but this person wasn’t asking for your advice on their student loans

thanks for weighing in it was really helpful

dude stop crying aboutit. That guys post was spot on..the guy grossed 2 million dollars..how the hell did he not pay of all the loans and have a ton left over living in Oklahoma? Lol

 

[jdh71]

dude stop crying aboutit. That guys post was spot on..the guy grossed 2 million dollars..how the hell did he not pay of all the loans and have a ton left over living in Oklahoma? Lol

he didn’t ask for loan advice and I’m not “crying” about anything

if we want to have constructive conversations about contracts and compensation then it really helps to stay in lane or we won’t have much conversation

I’m sure there is more going on that you don’t know about and is none of your business. It’s about having class. Maybe you lack it too. Sorry I guess.

 

[YCAGA]

he didn’t ask for loan advice and I’m not “crying” about anything

if we want to have constructive conversations about contracts and compensation then it really helps to stay in lane or we won’t have much conversation

I’m sure there is more going on that you don’t know about and is none of your business. It’s about having class. Maybe you lack it too. Sorry I guess.

What is more likely...a doctor suddenly making 500k/year after living off 20-50k/year for over a decade and then dramatically and unnecessarily increasing their lifestyle...or some secretive expense that is costing 200-300k/year post tax in a flyover state that is “very cheap”?

Your defensiveness and name calling honestly says more about you and your likely financial choices than anyone else’s comments in this thread says about them.


Sent from my iPhone using SDN

 

[jdh71]

What is more likely...a doctor suddenly making 500k/year after living off 20-50k/year for over a decade and then dramatically and unnecessarily increasing their lifestyle...or some secretive expense that is costing 200-300k/year post tax in a flyover state that is “very cheap”?

Your defensiveness and name calling honestly says more about you and your likely financial choices than anyone else’s comments in this thread says about them.


Sent from my iPhone using SDN

Now we are going to make assumptions about me? Now the foul is mine? It must be because I’m so bad at money right?! You guys are too much.

we are attracting a classy group in here

 

[bigdan]

I don’t get it.

A person voluntarily posts his work hours and salary, and includes specifics on his (and his wife’s) student loan debt, and ends the post - presumably soliciting opinions - with “what do you think?” In response to an opinion, the poster reconfirmed not only that the debt is considerable, but also offers a specific amount, and that the debt is of particular importance in his decision to continue his work as is. This seemingly makes the loan debt an important point in this discussion. Without ad hominem attack or insult, an opinion is then offered expressing bewilderment at the inability to pay off the debt more quickly given the salaryebt ratio.

You then insult those that posted an opinion over a lack of class for responding to the gentleman’s request for opinion? It’s a free forum indeed, but your replies seem a bit out of proportion to the seemingly benign (and salient) opinions offered. I can’t tell if you’re implying that “there’s more to the story”, or if you know something we don’t about the situation, or if you’re trolling. But the thread is arguably more derailed and less beneficial when people are attacked for sharing their opinions, as opposed to using the space for offering varied and alternative viewpoints in a constructive manner.

 

[jdh71]

Called it like I saw it. Others have agreed. It was a shaming post. It wasn’t just like some friendly sounding advice EVEN IF there is some truth that the person probably could have paid off their loans sooner. There are ways to say and do things and then there are ways to say and do things. Too often medicine attracts the socially awkward or inept. But yes. Let’s make the problem *me*.

 

[cali_doc_7531]

Too often medicine attracts the socially awkward or inept.

Haha ok.

In all seriousness, sorry to derail this thread so much. Hopefully we can get it back on topic and stop with the personal attacks. I hope that guy sees my post as a wake-up call and not me being a jerk just for fun. Anyways...

 

[ShockIndex]

This thread reads like a transcript from the Dave Ramsey Show...or maybe Jerry Springer.

 

[spacegun]

I dont think there’s any problem with offering OP student loan advice, but what I think @jdh71 had a problem with was how it said and done. The student loan advice is helpful and informative with good content, but it could’ve been said and done in a more constructive way rather than coming across like a harangue.

 

[icuanesthesiology]

I am truly baffled that you still have student debt after making at least 450k/year for 4.5 years (most recently 675k per year!) in an admittedly extremely low cost of living area. Do you realize you could have been out of student debt in 2 years if you didn't let your lifestyle get so out of control? 675k/yr in a prototypical flyover state (Oklahoma) leaves you with 440k/yr post-tax if you file with your wife. You can live like you make 100k per year (80k post tax), which easily puts you in the top 25% of household income in your state and affords a very comfortable lifestyle, and have a whopping 360k/yr left over to pay off debt. If you "only" made 450k for the past few years, you would have had 242k/yr extra while living off a net salary of 80k/yr...that is almost 1.1 MILLION dollars you could have put towards paying off student debt, building a retirement fund, saving for college, etc, etc.

In other words, I don't understand why you are subjecting yourself to ten years of objectively horrible working conditions and time away from family, when you could be out of debt in a year or two and move on to a location where you make 400-500k, work way less, and actually get to come home to your wife and kids (almost) every night. I will never understand how some physicians can complain about being in student debt for over a decade post-residency while making more than half a million dollars a year.

I guess since this debate about student loans all started with my post, I should weigh in...um no thanks to the student loan advice. It’s like you read a book called Financial Planning for Dummies and then decided to give some ridiculous kindergarten level advice about my financial situation without asking a damn question. Do you know about the health of my children and wife?!!! Do you know my extended family dynamic? Do you know anything about my personal life? No. If I needed over simplified financial advice with an extra helping of self righteousness and preaching, I would have asked for it.
And if people would read the details, I haven’t saved 100k in these few years, my NET WORTH has increased by almost 650k in the past 4 years or so. Our net worth has increased by an average of 13k/month for about 48 months. Is that enough? Not really interested in opinions on that. My wife and I have decided it’s enough.
As for the student loans, if I don’t have them, they won’t pay them. I won’t make that money. It will be gone. I have made a decision that I am willing to deal with this situation for 120 months so that this job will pay my loans. Every dollar I put toward my student loans myself would be a dollar lost in compensation. Would it be worth paying off earlier to buy my freedom? Maybe, but that is less money for my wife and kids. Again, this is a personal choice my wife and I have made, and I’m not really looking for opinions on that matter.
And as a final note on my personal finances. I NEVER complained about my student loans. It’s a free country and I made a decision as a free thinking adult to take on that debt. That debt is no ones burden but my own. I see it as the greatest investment I have ever and will ever make. If anything, I am thankful that I had the opportunity to take out those loans and pay for med school 100% based on my future earnings. Without those loans, I wouldn’t be a physician. Alas, though, I also fall into the tangential trap...
To get back to my true question...
I asked a fairly specific question, and unfortunately I have gotten very few responses because everyone has been talking about how I spend and save my money. I have access to average salary data, but I don’t always believe it. It’s helpful to hear real life stories.
What do people think is fair compensation for 14, 16, 18, and 20 twelve hour ICU shifts per month. (Or some other combo of ICU, anesthesia, etc.) Do people get an overtime premium? What is people’s average hourly rate?
I was a little vague in my OP. I make between 200 and 250 an hour, but get an overtime bonus which takes it to about 300/hr for every hour worked above 14 twelve hour shifts per month. My loans are paid on top of this. They pay around 50k/yr for this.
I am starting to a suspect not only is this fair, but it is pretty good and I should be satisfied with my compensation.
As someone stated before, I am “pounding sand” and it’s hard, but I don’t mind pounding sand if I believe it’s fair, and that pounding of sand leads to a better and more secure life for my wife and children.
And thanks to those who have weighed in on the salary job data!

 

[chocomorsel]

As the OP in this thread, since it got resurrected-- A few job market insight from someone that just got done with interviews:

For pure ICU work; with the average schedule of working 7 days on/off, 2 week vacation - expect base 350-370k, with various bonus. Usually end up with $400-425k after various bonus.

There are good jobs offers popping up here and there. The one I took is approximately 475k with 4 weeks vacation. Night shift, but in a good geographic location. There were a a couple jobs offering 500k per annum nearby as well (not sure what the details were). One thing to note with these good jobs is that they go quickly. My current job was on the market for less than a month before they recruited me. They also pull off the job posting once they have 1 or 2 qualified candidates. If you are looking for a good job, you gotta actively search for them.



I think you need to approach this differently. Calculate your compensation per hour. It should be $150-200/h, more if your RVU is high, or if your geographical location sucks. Working 18H per day sucks, but admin may not put a premium on the overtime. I also think that if you are not getting paid for overtime, you should not stay beyond your shift. Know your worth and value. 6H extra work is worth at least $900. Your employer is probably billing for it, why should you work this if you don't get paid for it?

To answer your question: if I worked 16/18/20 shifts per month, I would be making 523k/585k/639k per year. As mentioned earlier in this thread, at this level of compensation, Stark law start to become a concern. I would not expect you (or me) to make significantly more than this without some kind of legal maneuvering. In your situation, I would work whatever hours you are compensated for, and not more. Not a great idea to aggressively negotiate higher pay. Also consider optimizing your tax burden/budget, you should be saving up a lot more than that over 4.5 years.

And where do you find these jobs? I have one like this that pays about $ 470 the benefits suck. And the overtime rate is the same as regular rate. Thinking of sticking to 1099 for now for this reason.