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Out of all the back and forth comments i've read in all the threads,this one has been the most straight forward,practical and encouraging.Thankyou,anesthesia is back on my menu.Let me answer the OP's question in a straightforward manner:
1. What other options do you have? Are your grades, scores and medical school good enough for Ortho for example?
2. Do you mind being an employee for your career; that is, no partnership or ownership in your practice?
3. Do you mind being told how to practice and in what manner?
4. Do you want to do your own cases or supervise 5 CRNAS whose union claims that you are an unnecessary expense?
5. Do you want the OPTION to earn more than an "average" wage in your specialty?
6. Do you want to set your own schedule in terms of lifestyle, vacation, hours worked, etc?
Anesthesia used to offer a lot more in terms of items 1-6 than it will in 2019. Unlike previous cycles there are many more medical school graduates DYING for any ACGME residency so the supply of available people won't be an issue for Residency programs. They will adapt to the new Paradigm of the specialty just like Pediatrics and Family Medicine have done the past 3 decades.
Anesthesia offers stable employment and job opportunities as an Employee of Mednax or Sheridan in 2019. This type of job is decent pay ( low compared to the better specialties) with a reasonable lifestyle (5 weeks vacation). However, retirement plans are poor and benefits are mediocre at best.
Anesthesiology is a reasonable choice for Med Students with limited options or a limited comprehension of the economic complexities of the specialty. That said, $350 is a decent wage but nowhere near the income other specialties offer for those willing to work hard.
I have no doubt that many will be satisfied with the new paradigm of the field. Best of Luck.
My observation has been that what opens the administrative doors for physicians is being a revenue generator for the hospital. The relationships are built when the hospital is working closely to keep you there and appease you. Then you slowly transition your role to more administrative duties and less clinical responsibility. This appears to be a pathway that is less available to an anesthesiologist (seen as a liability on a spreadsheet) as opposed to a surgeon or a cardiologist (who is seen as an asset). I am sure that exceptions exist, but it seems this is a more common route. It's not what you know but who you know.
Tell us what specialties are NOT losing autonomy/being bought out. This is the state of medicine in general.Here's your future:
http://www.businesswire.com/news/home/20151103005603/en/AmSurg’s-Physician-Services-Division-Sheridan-Acquires-Valley
Which may work for some; not I. If I didn't own my anesthesia group and have complete control over every aspect of it, I would quit medicine.
Which may work for some; not I. If I didn't own my anesthesia group and have complete control over every aspect of it, I would quit medicine.
Why? You dislike the day to day job of caring for patients in the OR? Don't get me wrong, I thoroughly enjoy the business aspects of being an owner of a group. But if I couldn't, I'd be perfectly content as an employee of an AMC provided the pay was appropriate for the level of work I was doing. Let's be honest, it's not like most of us can just drop out of medicine and go find a $300K per year job doing something else next month.
It's just a tough situation for most of us to wrap our heads around, especially most of the prior generation. I'm sure most of us didn't graduate medical school thinking, "Oh it's going to be so great working FOR someone." Don't get me wrong, our salaries are excellent and even the bottom portion of our salaries are better than 90% of working people in this country. The thing is, like most of our medical colleagues who have control over their practice/lifestyle/etc, anesthesiology is becoming a field where doctors are being told how to do things by some guy in a suit in an office building somewhere MAKING BANK. We're becoming a field where we'll always have to answer to someone. Unless you go into pain and open your own practice, get ready to be just another working stiff. Basically, we're renters.
Scratch that. The better comparison is sports. Anesthesiologist are the athletes. We get paid well, and a few of the superstars may get some perks, but we'll never own the team.
I'd really like to know the answer to this question. Are AMCs just out to make a quick buck with no long term strategic planning?What are AMCs going to do about bundled payments? Right now they can negotiate better reimbursement rates than small groups. Without that ability to get paid more for the same work, they have no competitive edge, and nothing of value to offer hospitals. Or if single payer comes about, same thing.
Anesthesia practices getting bought out and bid up like tulips ...
What are AMCs going to do about bundled payments? Right now they can negotiate better reimbursement rates than small groups. Without that ability to get paid more for the same work, they have no competitive edge, and nothing of value to offer hospitals. Or if single payer comes about, same thing.
Anesthesia practices getting bought out and bid up like tulips ...
What are AMCs going to do about bundled payments? Right now they can negotiate better reimbursement rates than small groups. Without that ability to get paid more for the same work, they have no competitive edge, and nothing of value to offer hospitals. Or if single payer comes about, same thing.
Anesthesia practices getting bought out and bid up like tulips ...
Noncompete enforceability varies a lot by locale, doesn't it?They will better at leveraging their noncompetes. Small groups that are owned by the docs will often acquiesce and consent to be employed by the hospital AMC and not enforce their noncompetes. A corporate owner that controls all the noncompetes is less likely to fold.
Is this practice buying frenzy just typical stock trader mindset, plow money into something in the hopes of a short term profit, before selling and leaving someone else with an asset with no intrinsic value? Can't get tulips out of my head.
Noncompete enforceability varies a lot by locale, doesn't it?
Seems like powerful motivation for hospitals to want nothing to do with AMCs.
I've read the argument here many times that an anesthesia group has exactly one asset of value - a contract with a hospital. And maybe a noncompete clause, IF enforceable.
I'm just wondering what's going to happen to all these private equity investors backing AMCs when the day comes that a hospital has no reason to keep the AMC around.
Is this practice buying frenzy just typical stock trader mindset, plow money into something in the hopes of a short term profit, before selling and leaving someone else with an asset with no intrinsic value? Can't get tulips out of my head.
The bottom end of our salaries is better than 99% of working people in the country (or at least 98%). And the rest of medicine is ending up in the same boat we are in. We don't see it because we aren't in their shoes, but it's gradually happening more and more. Anesthesiology isn't special in that regard.
It's modern medicine and it's unfortunate. I can't think of a specialty that is not increasingly shifting towards working as an employee of somebody else.
I agree with Mman. I will fight to maintain our salaries, but under a "worse case scenario", with no debt and a house paid (or nearly paid off), I would be happy in my role either Medically Directing (as now) or even better, sitting my own cases for 250-300K/year. I enjoy anesthesia quite a bit.
Now, of course, we are worth MORE than that, but some things are beyond our control. So, if it came to that, I'd be o.k. I think.
This is exactly why AMCs will eventually collapse. None of them have been designed to be sustainable from the beginning, and once bundled payments come, there's no reason to have them around.It isn't "stock market trader", it's hedge funds. That's what they do. The buy an asset that they can leverage the value of and resell for a profit. Their usual timeline isn't more than 3-5 years. They have no interest in long term riches.
This is exactly why AMCs will eventually collapse. None of them have been designed to be sustainable from the beginning, and once bundled payments come, there's no reason to have them around.
And that's exactly why they'll crumble. Hopsitals will go back to small groups with less bargaining power once bundled payments hit so that they have the upper hand in negotiations.But isn't part of their spiel, "We'll fight for you and protect you when bundled payments come."
This is exactly why AMCs will eventually collapse. None of them have been designed to be sustainable from the beginning, and once bundled payments come, there's no reason to have them around.
And that's exactly why they'll crumble. Hopsitals will go back to small groups with less bargaining power once bundled payments hit so that they have the upper hand in negotiations.
Also likely. I'm honestly surprised AMCs ever even became a thing, as hospitals could easily have done this already and cut out the middleman.Hospitals will not go back to small groups with less bargaining power. Hopsitals themselves are consolidating into behemoths. What is more likely is a hospital will employ their own anesthesiologists...much like they are employing all of the surgeons. Then they don't have to bother negotiating at all with physicians.
Also likely. I'm honestly surprised AMCs ever even became a thing, as hospitals could easily have done this already and cut out the middleman.
Around here they usually get around it by having a hospital group that they own in all but name, with which they have an exclusive contract that employs all physicians of all specialties within the hospital.In my state it is actually illegal for hospitals to directly employ physicians. Not sure if this is also the case elsewhere.
Around here they usually get around it by having a hospital group that they own in all but name, with which they have an exclusive contract that employs all physicians of all specialties within the hospital.
Exactly like that.Ok so essentially like the Kaiser/Permanente Medical Group arrangement.
Hospitals will not go back to small groups with less bargaining power. Hopsitals themselves are consolidating into behemoths. What is more likely is a hospital will employ their own anesthesiologists...much like they are employing all of the surgeons. Then they don't have to bother negotiating at all with physicians.
Aren't most of those jobs amc jobs?All you have to do is go to gaswork.com and it will almost immediately become clear to you that anesthesia is alive and well and most likely will be for quite some time. Will there be pay cuts? Maybe, but not anytime in the immediate future. IF it happens it will be insidious. This further highlights the need for future and current anesthesiologists who are active in the political community. We should all work together to ENSURE the future of the specialty, rather than sit back and speculate as to what may or may not happen to us.
All you have to do is go to gaswork.com and it will almost immediately become clear to you that anesthesia is alive and well and most likely will be for quite some time. Will there be pay cuts? Maybe, but not anytime in the immediate future. IF it happens it will be insidious. This further highlights the need for future and current anesthesiologists who are active in the political community. We should all work together to ENSURE the future of the specialty, rather than sit back and speculate as to what may or may not happen to us.
No idea what you're on about... It looks pretty good from where I'm standing. People have been dooming and glooming over this subject for decades.
Where do you expect salaries to level out at? I think the disconnect may be coming from the fact that current med students like myself expect these lower salaries in anesthesia (for all specialties for that matter). We've gone into medicine with a knowledge that we won't get rich. I just went on GassWork and see salaries in the upper 200s and mid 300s and I think that sounds great. Even if the starting salary bottomed out in the low 200s I'd still consider it. What am I missing? Is it just that current attendings feel this salary does not justify the training and lifestyle/stress/liability?
Where do you expect salaries to level out at? I think the disconnect may be coming from the fact that current med students like myself expect these lower salaries in anesthesia (for all specialties for that matter). We've gone into medicine with a knowledge that we won't get rich. I just went on GassWork and see salaries in the upper 200s and mid 300s and I think that sounds great. Even if the starting salary bottomed out in the low 200s I'd still consider it. What am I missing? Is it just that current attendings feel this salary does not justify the training and lifestyle/stress/liability?
Salaries in the 200-300s is great if you are not just starting to save for retirement in your 30s, have been able to put equity into a home, and do not have over 300K in student debt. You're better off getting a middle management job somewhere for salary around 120k while working a lot less hours with a lot less stress. The real problem is that in medicine you now have a system where a few at the top are making a lot of money off the backs of a lot of hardworking doctors at the bottom while seeing none of the liability.
The loss of salary is a symptom of a much larger problem in medicine, which is the loss of autonomy. Doctors used to make a lot more because they had control. Medicine has become corporatized and so heavily government regulated that doctors have been reduced to relatively interchangeable cogs in a broken system. The loss of salary is just the most objective symptom of that change.
Salaries in the 200-300s is great if you are not just starting to save for retirement in your 30s, have been able to put equity into a home, and do not have over 300K in student debt. You're better off getting a middle management job somewhere for salary around 120k while working a lot less hours with a lot less stress.
Where do you expect salaries to level out at? I think the disconnect may be coming from the fact that current med students like myself expect these lower salaries in anesthesia (for all specialties for that matter). We've gone into medicine with a knowledge that we won't get rich. I just went on GassWork and see salaries in the upper 200s and mid 300s and I think that sounds great. Even if the starting salary bottomed out in the low 200s I'd still consider it. What am I missing? Is it just that current attendings feel this salary does not justify the training and lifestyle/stress/liability?
Ok, so far I've seen a lot of talking and circular reasoning, but not one iota of actual hard proof for all the doom and gloom. And thats all I'm gonna say for now.
LOL! You must be joking? This sounds like something someone would say whose been making >500k their entire career and completely out of touch with reality. I'd rather be a physician at 31 making 300k and owing 300k any day over some middle management guy who likely won't even get to 120k until mid to late 30s. Add in the job security of a physican and it's not even close.