Fair pay?

[Timeoutofmind]

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I’m W2 pain

I have an opportunity to pick up OR Anesthesia shifts through my current pain employer…

7-1ish. Average shift of 6 hrs. (Which is actually what I want, just a chill, short day). Pays $1400 W2 (not 1099). So around $250 an hour…

Midwest – major metro area

50/50 supervision/Solo

(Supervision 1:2 with reasonable AAs)

Hospital and ASC work

Hospital has some sick patients and neurosurg/vascular etc, but it’s not the big house…

 

[aneftp]

I’m W2 pain

I have an opportunity to pick up OR Anesthesia shifts…

7-1ish. Average shift of 6 hrs. Pays $1400. So around $250 an hour…

Midwest – major metro area

50/50 supervision/Solo

(Supervision 1:2 with reasonable AAs)

Hospital and ASC work

Hospital has some sick patients and neurosurg/vascular etc, but it’s not the big house…

Are you out of your mind???$250/hr and only 6 hr guaranteed?

This is like my co worker in Florida who wants to visit his parents in Colorado and he’s trying to do some 1099 locums and they offered him $5000 flat 24 hrs for ob call (4000 deliveries a year) so it ain’t slow with only one crna

Thads horrific rate at barley $200/hr

 

[CopaceticOne]

For locums in today’s market you need better minimum $/day guarantee with clearly defined hours and a much better rate for each partial hour over the defined work time.

What they are offering right now is absolutely below market value for a major metro in the Midwest.

Edit: is this offer for ASC OR by your current W2 employer? If that is the case you’d need to look at time/stress of OR vs your pain practice.

 

[aneftp]

For locums in today’s market you need better minimum $/day guarantee with clearly defined hours and a much better rate for each partial hour over the defined work time.

What they are offering right now is absolutely below market value for a major metro in the Midwest.

Edit: is this offer for ASC OR by your current W2 employer? If that is the case you’d need to look at time/stress of OR vs your pain practice.

Add if it’s $250hr w2. Is atrocious taxed at 37%

OP said hospital and ASC work

 

[CopaceticOne]

I’m W2 pain

I have an opportunity to pick up OR Anesthesia shifts through my current pain employer…

7-1ish. Average shift of 6 hrs. (Which is actually what I want, just a chill, short day). Pays $1400 W2 (not 1099). So around $250 an hour…

Midwest – major metro area

50/50 supervision/Solo

(Supervision 1:2 with reasonable AAs)

Hospital and ASC work

Hospital has some sick patients and neurosurg/vascular etc, but it’s not the big house…

Also, I’m going to call you out for deleting the thread from last year which basically asked the same question.

 

[rick roller pump]

Extra shift through my W2 employer pays closer to $400/hr

 

[A Deep Breath]

As long as you keep the arrangement flexible and noncommittal, this has the potential to be a great opportunity.

Sure, the pay is approaching offensive, but you’re rekindling one of the most valuable skills a person can have in today’s world. They’re paying you to learn.

The world and your options may look different once anesthesiology is a viable way to earn money again.

 

[Timeoutofmind]

Extra shift through my W2 employer pays closer to $400/hr

Man
So you are saying if you worked an eight hour day there five days a week x 42 weeks you would make $670,000 as a day doc!???

 

[aneftp]

Man
So you are saying if you worked an eight hour day there five days a week x 42 weeks you would make $670,000 as a day doc!???

That’s average pay. I’ve been telling you guys on this message board.

That is the market rate for a 40 hr a week doc with 10 weeks off give or take

700k/10 weeks off /40 hrs a week

I take 500k/20 weeks off/40 hrs a week give or take
Nothing in house /plus crna with me all the time. No ob. Don’t ask me why they give me crna when I can do the case solo. But I ain’t complaining.

Work smarter guys. Don’t work hard.

I had a 30 week off job for almost 500k but ob call was annoying me. So I left that. lol. Again. I ain’t gonna to work hard for my money. You want easy work. Not hard work.

It’s not me being lazy. I do work and I do work hard at times. For you don’t want to go hard day in and day out. You will burn out quickly.

 

[rick roller pump]

Man
So you are saying if you worked an eight hour day there five days a week x 42 weeks you would make $670,000 as a day doc!???

Yes. When you factor in employer 401k contributions I made >760k and doubt I worked much more than 2000 hours.

This is high acuity 3:1-4:1 work so it demands a higher rate. I work hard when at work but find it tolerable due to high $/hour.

 

[aneftp]

Yes. When you factor in employer 401k contributions I made >760k and doubt I worked much more than 2000 hours.

This is high acuity 3:1-4:1 work so it demands a higher rate. I work hard when at work but find it tolerable due to high $/hour.

$400/hr w2 extra pay at 37% tax rate equals $252/hr

$350/hr 1099 at say 20% (some people are super aggressive and get taxed at 10%) =$270/hr at 20% 1099 tax rate after deductions

So imagine someone taking $250/hr w2 for extra pay. That’s $158/hr after taxes.

 

[UscGhost]

That’s average pay. I’ve been telling you guys on this message board.

That is the market rate for a 40 hr a week doc with 10 weeks off give or take

700k/10 weeks off /40 hrs a week

I take 500k/20 weeks off/40 hrs a week give or take
Nothing in house /plus crna with me all the time. No ob. Don’t ask me why they give me crna when I can do the case solo. But I ain’t complaining.

Work smarter guys. Don’t work hard.

I had a 30 week off job for almost 500k but ob call was annoying me. So I left that. lol. Again. I ain’t gonna to work hard for my money. You want easy work. Not hard work.

It’s not me being lazy. I do work and I do work hard at times. For you don’t want to go hard day in and day out. You will burn out quickly.

Probably depends on your area. Certainly not MARKET rate. Market rate would be the average rate.

That would be almost $60 per unit. There are no places in so cal, for example, that pay $60 per unit.

Even Newport Beach only gets 50, and that's considered the top of the market...not market rate

Locums rates rely on hospitals that can't find staff because the pay is low or locati. If they paid all the docs like that, there wouldn't be a shortage at that site

 

[kidthor]

Probably depends on your area. Certainly not MARKET rate. Market rate would be the average rate.

That would be almost $60 per unit. There are no places in so cal, for example, that pay $60 per unit.

Even Newport Beach only gets 50, and that's considered the top of the market...not market rate

Locums rates rely on hospitals that can't find staff because the pay is low or locati. If they paid all the docs like that, there wouldn't be a shortage at that site

This is entirely on point - and even in Newport Beach the rates are going down and fully depend on hospital stipend to augment the paltry collections.

 

[nimbus]

$400/hr w2 extra pay at 37% tax rate equals $252/hr

$350/hr 1099 at say 20% (some people are super aggressive and get taxed at 10%) =$270/hr at 20% 1099 tax rate after deductions

So imagine someone taking $250/hr w2 for extra pay. That’s $158/hr after taxes.

We have progressive taxes. The entire amount is not taxed at 37%.

 

[gunnershow]

We have progressive taxes. The entire amount is not taxed at 37%.

With "extra pay", you are already at that marginal rate. So every extra hour you work will get taxed at that rate.

 

[narcotics999]

Probably depends on your area. Certainly not MARKET rate. Market rate would be the average rate.

That would be almost $60 per unit. There are no places in so cal, for example, that pay $60 per unit.

Even Newport Beach only gets 50, and that's considered the top of the market...not market rate

Locums rates rely on hospitals that can't find staff because the pay is low or locati. If they paid all the docs like that, there wouldn't be a shortage at that site

You are so behind. Anesthesia fee is nothing. Hospitals need us to grab the big fat facility fee. They are willing to pay to get ORs open.

 

[aneftp]

We have progressive taxes. The entire amount is not taxed at 37%.

It is taxed at least 35% for likely 90% of full time call taking married anesthesiologists and likely 100% of single anesthesiologists (since the single anesthesiologist starts getting nailed at 250k income)

So yes. The entire amount is taxed at least at the 35% tax bracket. Since one can assume you are likely making 250k/500k single/married as a full time w2 doc.

“

• Marginal rates.For tax year 2025, the top tax rate remains 37% for individual single taxpayers with incomes greater than $626,350 ($751,600 for married couples filing jointly). The other rates are:
  • 35% for incomes over $250,525 ($501,050 for married couples filing jointly).
  • 32% for incomes over $197,300 ($394,600 for married couples filing jointly).
  • 24% for incomes over $103,350 ($206,700 for married couples filing jointly).
  • 22% for incomes over $48,475 ($96,950 for married couples filing jointly).
  • 12% for incomes over $11,925 ($23,850 for married couples filing jointly).
  • 10% for incomes $11,925 or less ($23,850 or less for married couples filing jointly).
    

 

[nimbus]

It is taxed at least 35% for likely 90% of full time call taking married anesthesiologists and likely 100% of single anesthesiologists (since the single anesthesiologist starts getting nailed at 250k income)

So yes. The entire amount is taxed at least at the 35% tax bracket. Since one can assume you are likely making 250k/500k single/married as a full time w2 doc.

“

• Marginal rates.For tax year 2025, the top tax rate remains 37% for individual single taxpayers with incomes greater than $626,350 ($751,600 for married couples filing jointly). The other rates are:
  • 35% for incomes over $250,525 ($501,050 for married couples filing jointly).
  • 32% for incomes over $197,300 ($394,600 for married couples filing jointly).
  • 24% for incomes over $103,350 ($206,700 for married couples filing jointly).
  • 22% for incomes over $48,475 ($96,950 for married couples filing jointly).
  • 12% for incomes over $11,925 ($23,850 for married couples filing jointly).
  • 10% for incomes $11,925 or less ($23,850 or less for married couples filing jointly).

That’s not how marginal tax brackets work.

 

[aneftp]

That’s not how progressive tax brackets work.

You aren’t getting in it. The way the w2 taxes work for overtime

You are already full time. And already gonna to make 250/500k w2 guranteee paid. and being asked to work overtime at $250-400/hr w2 extra

Every dollar you work overtime as w2 above ur wages (500k as full time doc) will be taxed heavily at 35%

Ironically I’ve had arguments with Roth IRA and pretax 401k/403b and the argument people use is inversely your way of thinking. People say at our tax bracket to do pretax deductions first since it’s 35/37% tax savings! And not your progressive tax argument.

 

[UscGhost]

It is taxed at least 35% for likely 90% of full time call taking married anesthesiologists and likely 100% of single anesthesiologists (since the single anesthesiologist starts getting nailed at 250k income)

So yes. The entire amount is taxed at least at the 35% tax bracket. Since one can assume you are likely making 250k/500k single/married as a full time w2 doc.

“

• Marginal rates.For tax year 2025, the top tax rate remains 37% for individual single taxpayers with incomes greater than $626,350 ($751,600 for married couples filing jointly). The other rates are:
  • 35% for incomes over $250,525 ($501,050 for married couples filing jointly).
  • 32% for incomes over $197,300 ($394,600 for married couples filing jointly).
  • 24% for incomes over $103,350 ($206,700 for married couples filing jointly).
  • 22% for incomes over $48,475 ($96,950 for married couples filing jointly).
  • 12% for incomes over $11,925 ($23,850 for married couples filing jointly).
  • 10% for incomes $11,925 or less ($23,850 or less for married couples filing jointly).

The entire amount is not taxed at that rate.

You literally explained in the bottom half of your post why you were wrong about that lol

 

[nimbus]

You aren’t getting in it. The way the w2 taxes work for overtime

You are already full time. And already gonna to make 250/500k w2 guranteee paid. and being asked to work overtime at $250-400/hr w2 extra

Every dollar you work overtime as w2 above ur wages (500k as full time doc) will be taxed heavily at 35%

Ironically I’ve had arguments with Roth IRA and pretax 401k/403b and the argument people use is inversely your way of thinking. People say at our tax bracket to do pretax deductions first since it’s 35/37% tax savings! And not your progressive tax argument.

Ahh my bad. You are talking about net from the overtime portion of the paycheck, not the entire paycheck. In that case, you are correct.

 

[aneftp]

The entire amount is not taxed at that rate.

You literally explained in the bottom half of your post why you were wrong about that lol

Overtime is taxed at the 35-37% tax bracket when you are full time w2 anesthesiologist.

Do you make more than 250k/500k as single/married anesthesiologist? As a w2?

Than anything extra on top of that w2 is taxed heavily.

I know the tax system (and I’m sure you know it well also)

That’s why I have zero interest in making 700k w2 with 10 weeks off. I’d rather make 500k with 20 weeks off. I know I can make the 200k 1099 pretty easily in 10 of those week or even more if I want to take calls. And that 1099 money is taxed much lower than the w2 extra money I can make.

 

[UscGhost]

Overtime is taxed at the 35-37% tax bracket when you are full time w2 anesthesiologist.

Do you make more than 250k/500k as single/married anesthesiologist? As a w2?

Than anything extra on top of that w2 is taxed heavily.

I know the tax system (and I’m sure you know it well also)

That’s why I have zero interest in making 700k w2 with 10 weeks off. I’d rather make 500k with 20 weeks off. I know I can make the 200k 1099 pretty easily in 10 of those week or even more if I want to take calls. And that 1099 money is taxed much lower than the w2 extra money I can make.

Yes that's correct. The extra amount you earn once you hit that threshold is taxed at that rate.

So yes, the take home portion goes down, so there is going to be a sweet spot.

1099, spouse in real estate, lots of tax advantaged ways to raise that threshold

 

[rick roller pump]

Lol I wish it was 37%. Im just shy of 50% marginal tax rate with state taxes. I do consider this when picking up extra W2 shifts. 200/hr post tax still worth it to me.

 

[Numbtastic]

Yes. When you factor in employer 401k contributions I made >760k and doubt I worked much more than 2000 hours.

This is high acuity 3:1-4:1 work so it demands a higher rate. I work hard when at work but find it tolerable due to high $/hour.

Wow, which state are you in?

 

[nimbus]

Lol I wish it was 37%. Im just shy of 50% marginal tax rate with state taxes. I do consider this when picking up extra W2 shifts. 200/hr post tax still worth it to me.

Wow. I’m in California and after 401k, catch up, and CBP deductions my effective tax rate is 21-22%. I could make it even lower by socking more away in the CBP but I have a life too.

 

[aneftp]

Wow. I’m in California and after 401k, catch up, and CBP deductions my effective tax rate is 21-22%. I could make it even lower by socking more away in the CBP but I have a life too.

The 21-22% effective tax rate is really just deferred money. Eventually you will have to pay money on that deferred money (at least some of it). So that true tax money when you finally start using it maybe much higher depending how much you want to withdraw. Or that effective tax rate could be that same number 21-22% if you die before you can spend it.

Effective tax rate doesn’t include Medicare or social security in the computer calculations as well

It’s just all a numbers game at the end of the day.

 

[NightyNight]

I’m W2 pain

I have an opportunity to pick up OR Anesthesia shifts through my current pain employer…

7-1ish. Average shift of 6 hrs. (Which is actually what I want, just a chill, short day). Pays $1400 W2 (not 1099). So around $250 an hour…

Midwest – major metro area

50/50 supervision/Solo

(Supervision 1:2 with reasonable AAs)

Hospital and ASC work

Hospital has some sick patients and neurosurg/vascular etc, but it’s not the big house…

Looks like equivalent of maybe $325/hr 1099. Others can correct me on the tax and take home equivalents.

If you’re doing sick cases, at least $400/hr 1099 so that’s somewhere around 275-300 on the W2 side. I know of one place that has started to offer W2 employees 325/hr W2 to work extra day shifts for guaranteed 8 hours.

If you were just sitting around doing preops and didn’t carry a phone at some easy place, then okay to take a lower rate IMO cuz you don’t need to go get credentialed elsewhere.

 

[Status Sciaticus]

$400/hr w2 extra pay at 37% tax rate equals $252/hr

$350/hr 1099 at say 20% (some people are super aggressive and get taxed at 10%) =$270/hr at 20% 1099 tax rate after deductions

So imagine someone taking $250/hr w2 for extra pay. That’s $158/hr after taxes.

Could you outline how you are getting your 1099 effective tax rate down that low?

 

[aneftp]

Could you outline how you are getting your 1099 effective tax rate down that low?

Please read basis 101 small business deductions. Lots of people think I’m crazy with my deductions. My effective tax rate some years are around 15-18% if I’m pure 1099. (No w2 income).

My effective tax rate was a lot higher last year at around 27% since I made too much plus I had a ton of w2 income as well.

there are docs and crna pure 1099 effective tax rates as low as 10%. Many do not even pay themselves a salary or a very low salary (which I know is legal)

They put their college kids on the payroll to lower their taxes as well. There are so many ways to play the tax system. Google is your friend. And if you are asking these questions. You may need to consult a tax professional to guide you. You are way behind the 8 ball if you need to ask this.

 

[Aether2000]

US Anesthesiologists make a median of $472k, placing us in the top 1 percentile of US income. As a profession, we are fortunate to be the wealthy in society based on income standards, although the wealthy usually only perceive those making far more than themselves as wealthy. According to the Medscape compensation report, anesthesiologists rank 8th in compensation among all physician specialties yet 46% believe they are not being paid fairly. Perhaps this is due to work hour demands or a large standard deviation in anesthesiologist pay, but it is curious nearly half of anesthesiologists, among the highest income earners in America, believe themselves to be unfairly paid.

 

[AKMD_1984]

US Anesthesiologists make a median of $472k, placing us in the top 1 percentile of US income. As a profession, we are fortunate to be the wealthy in society based on income standards, although the wealthy usually only perceive those making far more than themselves as wealthy. According to the Medscape compensation report, anesthesiologists rank 8th in compensation among all physician specialties yet 46% believe they are not being paid fairly. Perhaps this is due to work hour demands or a large standard deviation in anesthesiologist pay, but it is curious nearly half of anesthesiologists, among the highest income earners in America, believe themselves to be unfairly paid.

that’s a relative comparison.

i do not think attorneys should be paid $1000/hr and $150 to writing yes and no on email.

i do not think ceos of major corporations should be paid 30-40M

i do not think athletes should be paid 30m to throw a ball.

at the same time i do not think that pediatricians should be paid 250k or whatever they’re making this year median income.

i do not think that there is method or pattern to this.

 

[aneftp]

US Anesthesiologists make a median of $472k, placing us in the top 1 percentile of US income. As a profession, we are fortunate to be the wealthy in society based on income standards, although the wealthy usually only perceive those making far more than themselves as wealthy. According to the Medscape compensation report, anesthesiologists rank 8th in compensation among all physician specialties yet 46% believe they are not being paid fairly. Perhaps this is due to work hour demands or a large standard deviation in anesthesiologist pay, but it is curious nearly half of anesthesiologists, among the highest income earners in America, believe themselves to be unfairly paid.

Wealth is different than income.

Remember that. If you are getting out of bed more than 1 time a month to have to work. You are not wealthy.

Most docs won’t make real money till age 30-33 these days. Add student debt. Likely around age 40 before they get out of debt. That’s assuming they don’t have a family to raise.

Yes. It’s sounds like we are spoiled. You are wasting (consuming) 8 plus years of your life to pursue
medicine.

At least be thankful the residency years are easier on those who finished in the last 18 years since the 80 hr work week rules took place in 2004. I can’t imagine the kids these days surviving on an average 110-120 hr work week like us old timers. And I’m not old old.

 

[Aether2000]

Wealth is different than income.

Remember that. If you are getting out of bed more than 1 time a month to have to work. You are not wealthy.

Most docs won’t make real money till age 30-33 these days. Add student debt. Likely around age 40 before they get out of debt. That’s assuming they don’t have a family to raise.

Yes. It’s sounds like we are spoiled. You are wasting (consuming) 8 plus years of your life to pursue
medicine.

At least be thankful the residency years are easier on those who finished in the last 18 years since the 80 hr work week rules took place in 2004. I can’t imagine the kids these days surviving on an average 110-120 hr work week like us old timers. And I’m not old old.

High income quickly becomes wealth. The average 34 year old American has retirement savings of $49k and a bank account of $5,400. A physician with a 1099 income can sock away 70k in a SEP IRA year one and thereafter, and if they split a 1099 and W2 job, the contributions can be over 100k per year. The average anesthesiologist has over 100k in a bank account and many have far more. Debt from undergrad and medical school are largely based on school choices. The average public university medical school tuition is 41k per year while private medical schools are far more expensive. Same for undergrad, so the overall indebtedness can be paid off in 3 years for public school education but may be longer for private, yet with an income average of $472k, it is difficult to imagine it would take more than a few years to pay off all college debt. But there again are choices. Some elect to not pay off their debt for 20 years while others want no debt at all, and will do it in 2.

Of course residency itself is not lucrative, but is higher paying than the median income of all workers in the US. The average resident salary is $73k while the median income of individuals in the US is $42k.

 

[aneftp]

High income quickly becomes wealth. The average 34 year old American has retirement savings of $49k and a bank account of $5,400. A physician with a 1099 income can sock away 70k in a SEP IRA year one and thereafter, and if they split a 1099 and W2 job, the contributions can be over 100k per year. The average anesthesiologist has over 100k in a bank account and many have far more.

U would be surprise how little many anesthesiologists have in their bank accounts.

There are quite a few living paycheck to paycheck even at 500k or more.

They carry credit card debt etc. and these are the non divorce ones!

The divorce ones are in worst shape. It takes them another 5 years to recover.

We live in a consumption society. Spend spend spend.

 

[PainInTheAnes]

Wealth is different than income.

Remember that. If you are getting out of bed more than 1 time a month to have to work. You are not wealthy.

Most docs won’t make real money till age 30-33 these days. Add student debt. Likely around age 40 before they get out of debt. That’s assuming they don’t have a family to raise.

Yes. It’s sounds like we are spoiled. You are wasting (consuming) 8 plus years of your life to pursue
medicine.

At least be thankful the residency years are easier on those who finished in the last 18 years since the 80 hr work week rules took place in 2004. I can’t imagine the kids these days surviving on an average 110-120 hr work week like us old timers. And I’m not old old.

I’m suspicious on how many hours old timers were truly working.

Like what, were you just doing elective stuff all night every night? I went to a heavy program and there simply wasn’t that much work to do.

Not every surgeon would sandbag their block time until 9pm and without CRNA coverage there is no way in hell they’d have been able to do things during the day.

You’re either stealing hours from crnas by relieving them with residents (not possible) or just paying crnas for more hours than they work (also an impossibility in any department).

So where is the delta of 120 coming from? Did you run the entire residency on Saturday with 20 rooms of elective cases?

There’s more cases than ever now. Do you expect anyone to believe that there’s 120 hours of OR work PER RESIDENT in a time where demand wasn’t even close to as high?

Old timers always lie. They lie to new grads, they lie to hospital admins, they lie to each other, they lie to the media. Thats the lesson.

A sample schedule:

630am to 630pm Monday to Friday baseline. 60 hours.

Change to q3 call with post call work until noon each day.

28 + 28 + 12 = 68

Add in a 24 hour weekend call EVERY WEEKEND = 68 + 24 = 92

This is preposterous. There’s no way every single resident in most programs was working a 24 hour call consistently each weekend. What, are they running 8 rooms on Saturday and Sunday around the clock? I call BS as there’s no way in this universe enough nursing teams would tolerate that weekend in weekend out.

Not to mention there aren’t even surgeons who want to do all that. They aren’t all pathological weirdos who are looking to have heart attacks even in academics.

 

[aneftp]

I’m suspicious on how many hours old timers were truly working.

Like what, were you just doing elective stuff all night every night? I went to a heavy program and there simply wasn’t that much work to do.

Not every surgeon would sandbag their block time until 9pm and without CRNA coverage there is no way in hell they’d have been able to do things during the day.

You’re either stealing hours from crnas by relieving them with residents (not possible) or just paying crnas for more hours than they work (also an impossibility in any department).

So where is the delta of 120 coming from? Did you run the entire residency on Saturday with 20 rooms of elective cases?

There’s more cases than ever now. Do you expect anyone to believe that there’s 120 hours of OR work PER RESIDENT in a time where demand wasn’t even close to as high?

Old timers always lie. They lie to new grads, they lie to hospital admins, they lie to each other, they lie to the media. Thats the lesson.

A sample schedule:

630am to 630pm Monday to Friday baseline. 60 hours.

Change to q3 call with post call work until noon each day.

28 + 28 + 12 = 68

Add in a 24 hour weekend call EVERY WEEKEND = 68 + 24 = 92

This is preposterous. There’s no way every single resident in most programs was working a 24 hour call consistently each weekend. What, are they running 8 rooms on Saturday and Sunday around the clock? I call BS as there’s no way in this universe enough nursing teams would tolerate that weekend in weekend out.

Not to mention there aren’t even surgeons who want to do all that. They aren’t all pathological weirdos who are looking to have heart attacks even in academics.

I think people have this generation gap in what it takes to work.

Icu was brutal q2 plus post call to 1pm than on call the next day.

There are less 24 hr calls in residency. It’s more shift work these days.

You do 2 weekends a month in residency years Friday /Sunday 24 hours. That’s 48 hrs. Sometimes 3 weekends a month. The New York programs were notorious.

You leave at 5-6pm most days when not on call. The hours add up. If you are late. You can be there to 8-9pm 2-3x a week. Plus work the next day to 3pm. That’s early day out.

Monday 12 hr
Tuesday 24
Thursday 11 hr
Friday 24 hr
Sunday 24 hr

Those are typical hours.

Anesthesia is as more shielded than surgery in terms of hours. More like 90-hrs when doing anesthesia easy each week. 120 hr easily in icu.
Icu
24 hr Monday
6 hrs Tuesday
24 Wednesday
6 hr Thursday
24 Friday
6 hr Saturday
24 Sunday

That’s your 120 hrs

Don’t call it bs if you haven’t experienced it.

That’s why the younger generation has a different mindset in terms of hours they want to work. The participation trophy award. It works to my advantage because folks aren’t willing to work more when they become attendiings.

You really think a resident who’s use to being cuddled during residency will turn it up a notch when they become attendings and want to work rigorous hours? Maybe if the compensation is enough. But most won’t turn it up a notch.

Surgeons these days are hit or miss how much they want to work. Remember more dei and more women are in the surgery fields. More surgeons will not want to work a full
Load.

 

[PainInTheAnes]

I think people have this generation gap in what it takes to work.

Icu was brutal q2 plus post call to 1pm than on call the next day.

There are less 24 hr calls in residency. It’s more shift work these days.

You do 2 weekends a month in residency years Friday /Sunday 24 hours. That’s 48 hrs. Sometimes 3 weekends a month. The New York programs were notorious.

You leave at 5-6pm most days when not on call. The hours add up. If you are late. You can be there to 8-9pm 2-3x a week. Plus work the next day to 3pm. That’s early day out.

Monday 12 hr
Tuesday 24
Thursday 11 hr
Friday 24 hr
Sunday 24 hr

Those are typical hours.

Anesthesia is as more shielded than surgery in terms of hours. More like 90-hrs when doing anesthesia easy each week. 120 hr easily in icu.
Icu
24 hr Monday
6 hrs Tuesday
24 Wednesday
6 hr Thursday
24 Friday
6 hr Saturday
24 Sunday

That’s your 120 hrs

Don’t call it bs if you haven’t experienced it.

That’s why the younger generation has a different mindset in terms of hours they want to work. The participation trophy award. It works to my advantage because folks aren’t willing to work more when they become attendiings.

You really think a resident who’s use to being cuddled during residency will turn it up a notch when they become attendings and want to work rigorous hours? Maybe if the compensation is enough. But most won’t turn it up a notch.

Surgeons these days are hit or miss how much they want to work. Remember more dei and more women are in the surgery fields. More surgeons will not want to work a full
Load.

How many residents per year did you have in your program? 3-5? That’s the only possible way I could see this being necessary, and programs that small are certainly not the norm. Most large university programs have 10-15 per year at least.

What are you even DOING working post call in the ICU? Are your handoffs taking 5 hours? Why couldn’t your next day residents handle the work like a normal doctor?

Again I worked in incredibly busy ICU and could admit someone in like 20 minutes. Admits 20 years ago weren’t even complicated. Are these sadsaps taking 2 hours to put in a CVL? I could line an entire 20 bed ICU in residency in 4 hours, were you doing that every single day? Writing a novel note every day on every patient? What gives?

I admitted 20 patients in a 24 hour period once and still handed off just fine. Because I knew how to do my job and so did my relief.

The idea of working post call until noon in the ICU can only be explained by every single anesthesia resident being the worst resident in history.

Now the NY programs are notorious for coddling! How could their tune have changed that much? Seems like BS to me

 

[gunnershow]

How many residents per year did you have in your program? 3-5? That’s the only possible way I could see this being necessary, and programs that small are certainly not the norm. Most large university programs have 10-15 per year at least.

What are you even DOING working post call in the ICU? Are your handoffs taking 5 hours? Why couldn’t your next day residents handle the work like a normal doctor?

Again I worked in incredibly busy ICU and could admit someone in like 20 minutes. Admits 20 years ago weren’t even complicated. Are these sadsaps taking 2 hours to put in a CVL? I could line an entire 20 bed ICU in residency in 4 hours, were you doing that every single day? Writing a novel note every day on every patient? What gives?

I admitted 20 patients in a 24 hour period once and still handed off just fine. Because I knew how to do my job and so did my relief.

The idea of working post call until noon in the ICU can only be explained by every single anesthesia resident being the worst resident in history.

Now the NY programs are notorious for coddling! How could their tune have changed that much? Seems like BS to me

Sometimes there's a culture whereby the overnight resident has to round and present on their admits, which leads to a lot of overlap between call resident and day resident.

 

[PainInTheAnes]

Sometimes there's a culture whereby the overnight resident has to round and present on their admits, which leads to a lot of overlap between call resident and day resident.

Sounds dumb, our residency wasn’t dumb

 

[Status Sciaticus]

Please read basis 101 small business deductions. Lots of people think I’m crazy with my deductions. My effective tax rate some years are around 15-18% if I’m pure 1099. (No w2 income).

My effective tax rate was a lot higher last year at around 27% since I made too much plus I had a ton of w2 income as well.

there are docs and crna pure 1099 effective tax rates as low as 10%. Many do not even pay themselves a salary or a very low salary (which I know is legal)

They put their college kids on the payroll to lower their taxes as well. There are so many ways to play the tax system. Google is your friend. And if you are asking these questions. You may need to consult a tax professional to guide you. You are way behind the 8 ball if you need to ask this.

I’m 1099
I max out my solo 401k, deduct my home office, deduct about 10-12k mileage, Augusta rule my house, deduct all my travel for Locums.
I have no kids.
What other deductions there that I’m not using?

 

[PainInTheAnes]

I’m 1099
I max out my solo 401k, deduct my home office, deduct about 10-12k mileage, Augusta rule my house, deduct all my travel for Locums.
I have no kids.
What other deductions there that I’m not using?

PMed

 

[kidthor]

I was capped at 80 hrs a week (it had just been instated around when I started) and I think it was too much. It's not safe for patients or healthcare workers to be worked that much. There's also just no point - a good proportion of those hours was engaged in nonsense tasks (e.g. spending hours on end "consenting" patients in the middle of the night, copying paper notes, finding paper vitals sheets, restocking anesthesia carts, sitting with patients on ICU-hold, and so forth). Probably capping trainees around 60 hours a week is reasonable IMO - and we should limit the nonsense work tasks.

 

[aneftp]

How many residents per year did you have in your program? 3-5? That’s the only possible way I could see this being necessary, and programs that small are certainly not the norm. Most large university programs have 10-15 per year at least.

What are you even DOING working post call in the ICU? Are your handoffs taking 5 hours? Why couldn’t your next day residents handle the work like a normal doctor?

Again I worked in incredibly busy ICU and could admit someone in like 20 minutes. Admits 20 years ago weren’t even complicated. Are these sadsaps taking 2 hours to put in a CVL? I could line an entire 20 bed ICU in residency in 4 hours, were you doing that every single day? Writing a novel note every day on every patient? What gives?

I admitted 20 patients in a 24 hour period once and still handed off just fine. Because I knew how to do my job and so did my relief.

The idea of working post call until noon in the ICU can only be explained by every single anesthesia resident being the worst resident in history.

Now the NY programs are notorious for coddling! How could their tune have changed that much? Seems like BS to me

Routine to round to 12/1pm. You are stuck there

There is no night floats.

We cover 1 trauma one. And one separate children only hospital. Same program. Other residents went to thr children hospital but it’s under the main umbrella hospital.

So you are saying the icu overnight person just leaves at 7am? And the night float icu resident doesn’t do 24 hr? I dunno. It’s been so long.

It’s been shown handoff mistakes have increased dramatically with the institution of the 80 hr work weeks. Too many problems with handoffs.

 

[PainInTheAnes]

Routine to round to 12/1pm. You are stuck there

There is no night floats.

We cover 1 trauma one. And one separate children only hospital. Same program. Other residents went to thr children hospital but it’s under the main umbrella hospital.

So you are saying the icu overnight person just leaves at 7am? And the night float icu resident doesn’t do 24 hr? I dunno. It’s been so long.

It’s been shown handoff mistakes have increased dramatically with the institution of the 80 hr work weeks. Too many problems with handoffs.

I think handoff risk is way overblown. There’s lots of redundant systems in icus now that handoffs shouldn’t affect anything. Plenty of paper trails, and rounding should eliminate mistakes if attendings or fellows are actually doing their jobs. Those studies were also done at the emergence of EMRs, which facilitate error reduction in myriad ways.

I’d rather have a handoff than a drunk person managing things which is what a resident is at the tail end of a 24 hour call. Handoff errors are due to poor communication, and that’s just incompetence rather than process related imo

Most icu are night float now. Good enough for the best hospitals in the world, good enough for me. If outcomes differed then institutions would use the better system, but they don’t differ.

Regardless of mistakes on handoffs, those errors are the responsibilities of the attending and fellows in charge, full stop. If you want to sleep and let others manage your patients then it falls on you when bad things happen and you’re not looking.

What I can’t fathom is how residents were getting stuck in ORs for 90 hours a week routinely. It’s really really hard to achieve that and surgical volumes have only increased across the board. So how is it that programs were so short staffed before? Makes no sense.

There’s posts on sdn from 20 years ago quoting hours like 60-65 on main OR. Can’t imagine it was 50% higher 3 years prior to that.

 

[Dr. Anonymouss]

Please read basis 101 small business deductions. Lots of people think I’m crazy with my deductions. My effective tax rate some years are around 15-18% if I’m pure 1099. (No w2 income).

My effective tax rate was a lot higher last year at around 27% since I made too much plus I had a ton of w2 income as well.

there are docs and crna pure 1099 effective tax rates as low as 10%. Many do not even pay themselves a salary or a very low salary (which I know is legal)

They put their college kids on the payroll to lower their taxes as well. There are so many ways to play the tax system. Google is your friend. And if you are asking these questions. You may need to consult a tax professional to guide you. You are way behind the 8 ball if you need to ask this.

author or link to book? Unable to find. Any other books you recommend for jumping into the 1099 anesthesia world.

 

[aneftp]

author or link to book? Unable to find. Any other books you recommend for jumping into the 1099 anesthesia world.

Forget books. Just use Google. Tons of articles

 

[gunnershow]

I think handoff risk is way overblown. There’s lots of redundant systems in icus now that handoffs shouldn’t affect anything. Plenty of paper trails, and rounding should eliminate mistakes if attendings or fellows are actually doing their jobs. Those studies were also done at the emergence of EMRs, which facilitate error reduction in myriad ways.

I’d rather have a handoff than a drunk person managing things which is what a resident is at the tail end of a 24 hour call. Handoff errors are due to poor communication, and that’s just incompetence rather than process related imo

Most icu are night float now. Good enough for the best hospitals in the world, good enough for me. If outcomes differed and institutions would use the better system, but they don’t differ.

Regardless of mistakes on handoffs, those errors are the responsibilities of the attending and fellows in charge, full stop. If you want to sleep and let others manage your patients then it falls on you when bad things happen and you’re not looking.

What I can’t fathom is how residents were getting stuck in ORs for 90 hours a week routinely. It’s really really hard to achieve that and surgical volumes have only increased across the board. So how is it that programs were so short staffed before? Makes no sense.

There’s posts on sdn from 20 years ago quoting hours like 60-65 on main OR. Can’t imagine it was 50% higher 3 years prior to that.

It's usually not the main OR where you rack up the high hours. Maybe if you had a bad week on a cardiac rotation where you stayed til 7 every day and also had a weekend 24, you'd hit 90 hours.

For me (and I graduated relatively recently), it was q2-3 24s on ICU and OB where you would clock the most hours.

People (new and old) have a tendency to extrapolate their worst weeks or months to all of their residency. Anesthesia residency is not that bad. It astounded me to hear my coresidents complain when you could look across the drapes and see the kind of hours the surgical residents were putting in. And unlike us, many of them don't get much opportunity for sleep on their 24s -- I know this from intern year.

 

[aneftp]

I think handoff risk is way overblown. There’s lots of redundant systems in icus now that handoffs shouldn’t affect anything. Plenty of paper trails, and rounding should eliminate mistakes if attendings or fellows are actually doing their jobs. Those studies were also done at the emergence of EMRs, which facilitate error reduction in myriad ways.

I’d rather have a handoff than a drunk person managing things which is what a resident is at the tail end of a 24 hour call. Handoff errors are due to poor communication, and that’s just incompetence rather than process related imo

Most icu are night float now. Good enough for the best hospitals in the world, good enough for me. If outcomes differed and institutions would use the better system, but they don’t differ.

Regardless of mistakes on handoffs, those errors are the responsibilities of the attending and fellows in charge, full stop. If you want to sleep and let others manage your patients then it falls on you when bad things happen and you’re not looking.

What I can’t fathom is how residents were getting stuck in ORs for 90 hours a week routinely. It’s really really hard to achieve that and surgical volumes have only increased across the board. So how is it that programs were so short staffed before? Makes no sense.

There’s posts on sdn from 20 years ago quoting hours like 60-65 on main OR. Can’t imagine it was 50% higher 3 years prior to that.

The purpose of decreasing resident hours was to get them more rest and reduce medical errors

So far the data is very mixed with medical errors and reduced resident errors. It’s a complex forumula

Medicine is safe before and after the 80 hr work week? Right? With handoffs etc

But the crnas can apply the same logic saying we are over trained? I’m just playing devils advocate.

I think anesthesia passing rates for first time test takers have gone from 78-80%? To close to 90%? So you guys are getting smart with less training.

We are advancing as a profession. Pretty soon AAs will not need us with their 24 month masters program.

 

[PainInTheAnes]

The purpose of decreasing resident hours was to get them more rest and reduce medical errors

So far the data is very mixed with medical errors and reduced resident errors. It’s a complex forumula

Medicine is safe before and after the 80 hr work week? Right? With handoffs etc

But the crnas can apply the same logic saying we are over trained? I’m just playing devils advocate.

I think anesthesia passing rates for first time test takers have gone from 78-80%? To close to 90%? So you guys are getting smart with less training.

We are advancing as a profession. Pretty soon AAs will not need us with their 24 month masters program.

Of course that was the purpose back in 2003, supposedly. The hidden purpose of that is that this was going to break into the public eye soon and no one would ever want to be treated by people working 120 hour weeks routinely.

I think the restrictions were far more about PR for hospitals than anything else. With the internet the winds of change were blowing and the system wanted to get ahead of that.

If you think resident unions now are doing some good things imagine them still working 100 hour weeks in 2008 or 2014, while trying to get women into medicine more often.

The first time a resident who was a mother of 2 flew through a windshield after a 30 hour shift doing scut work at northwestern medical center the entire system would come crashing down with a 100 million dollar lawsuit. Or imagine the rash of self harm that would’ve come when social media entered the mix. PR apocalypse for every academic center in the country.

This was driven by PR, money, and liability, not any concern for patients. It’s a complex formula indeed but the rulers of medicine at that time knew the writing was on the wall.