Grass greener syndrome?

[Chloroform4Life]

Hey guys,

I'm trying to get some perspectives on my situation. I graduated in June '15 and have been working at my current PP gig since. All in all, I'm quite happy with how things are going. I get along well with the anesthesiologists, anesthetists, and even the surgeons at my hospital. Case load is not very stressful and I work on average probably 50 hours a week (call about 3-4 times per month and not too bad). 6 weeks paid vaca per year. The area is quite nice and I would consider it desirable.

Here's the kicker. I start at around 280k per year ramping up to 330k after 3 years. Not a partnership track. It is also a 1099 position so I have to cover all my FICA, retirement, and health insurance (probably 30-40k worth vs W2). So if my job was a W2, it'd probably be worth 250k up to 300k after 3 years and likely capped there.

I've been browsing this SDN forum and gasworks looking for comparable jobs but the problem is that comparing jobs is sorta like apples and oranges. There is just so many different factors to look at. Part of me feel like I'm being low-balled since I'm sure the partners are likely raking in 400-500k a year. Part of me feel like maybe this is just the going rate for new grads and I just need to suck it up.

I will take my oral board soon and hopefully be board certified, which should make it easier to search for jobs and explore new opportunities. It will be a little difficult to uproot family, move, sell house, ect. but it may be worth it for the right opportunity.

Any recent grad have the same dilemma? Any seasoned anesthesiologist have some advice?

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[Noyac]

Why is this not a partnership track position?

Did anyone notice the "turf builder" add attached to this post?

 

[Chloroform4Life]

Why is this not a partnership track position?

Did anyone notice the "turf builder" add attached to this post?

No. but I noticed a Sketcher Ad attached to your post.

Anyway. I'm guessing the partners don't want to share their pie. I was told that should a partner retire, then I can be considered for partnership, which in my mind is equivalent to not a partnership track. Coming out of residency, my option was to work for an AMC or for this private practice group as an employee. I probably could have done more searching for that perfect job but during residency, I didn't really have that much time for job interviews. I was made an offer and if I didn't take it, my future would have been uncertain and I didn't need uncertainty when +300k in debt.

 

[deleted162650]

I would not be happy with that job. No partnership ever in a PP group means your "colleagues" who are partners are only out to make money off your back and don't give 2 sheets about you. Time to find a practice where you're treated like a true colleague and have a very clearly delineated track to partnership. I would work in academics or Kaiser before I would ever consider your gig. At least since you're 1099 you can write off all that Surgilube you'll need everyday.

 

[deleted162650]

They are also really skirting the law by paying you 1099 when for all intents and purposes you are an employee of the group. Just another sign that these guys are only out use and use your use they are also really skirting the law by paying you 1099 when for all intents and purposes you are an employee of the group. Just another sign that these guys are only out use and abuse you.

 

[caligas]

Hey guys,

I'm trying to get some perspectives on my situation. I graduated in June '15 and have been working at my current PP gig since. All in all, I'm quite happy with how things are going. I get along well with the anesthesiologists, anesthetists, and even the surgeons at my hospital. Case load is not very stressful and I work on average probably 50 hours a week (call about 3-4 times per month and not too bad). 6 weeks paid vaca per year. The area is quite nice and I would consider it desirable.

Here's the kicker. I start at around 280k per year ramping up to 330k after 3 years. Not a partnership track. It is also a 1099 position so I have to cover all my FICA, retirement, and health insurance (probably 30-40k worth vs W2). So if my job was a W2, it'd probably be worth 250k up to 300k after 3 years and likely capped there.

I've been browsing this SDN forum and gasworks looking for comparable jobs but the problem is that comparing jobs is sorta like apples and oranges. There is just so many different factors to look at. Part of me feel like I'm being low-balled since I'm sure the partners are likely raking in 400-500k a year. Part of me feel like maybe this is just the going rate for new grads and I just need to suck it up.

I will take my oral board soon and hopefully be board certified, which should make it easier to search for jobs and explore new opportunities. It will be a little difficult to uproot family, move, sell house, ect. but it may be worth it for the right opportunity.

Any recent grad have the same dilemma? Any seasoned anesthesiologist have some advice?

They are essentially pocketing half the revenue you generate. You are making the same per hour as many crnas who work 36 to 40 hours for a total package worth well over $200k.

 

[fakin' the funk]

They are also really skirting the law by paying you 1099 when for all intents and purposes you are an employee of the group. Just another sign that these guys are only out use and use your use they are also really skirting the law by paying you 1099 when for all intents and purposes you are an employee of the group. Just another sign that these guys are only out use and abuse you.

Salty felt this was important enough to say twice.

But I'm curious how the 1099 vs W-2 thing works. Aren't there perks to being 1099 like deductible expenses?

 

[deleted171991]

Salty felt this was important enough to say twice.

But I'm curious how the 1099 vs W-2 thing works. Aren't there perks to being 1099 like deductible expenses?

It's still illegal.

 

[Chloroform4Life]

They are also really skirting the law by paying you 1099 when for all intents and purposes you are an employee of the group. Just another sign that these guys are only out use and use your use they are also really skirting the law by paying you 1099 when for all intents and purposes you are an employee of the group. Just another sign that these guys are only out use and abuse you.

Salty felt this was important enough to say twice.

But I'm curious how the 1099 vs W-2 thing works. Aren't there perks to being 1099 like deductible expenses?

Actually yes. I was able to deduct my health insurance premium and business related expenses such as ABA exam fee, medical license fee, ect. So it does help a little bit with taxes. You still pay more than if a W2 position covered those expenses for you though. Also, with 1099, you have to cover your entire FICA tax. in W2 you only have to cover half while employer covers half

 

[Taurus]

Run not walk away from this job!

 

[caligas]

http://www.gaswork.com/mobile/post/view/186492/

You're welcome.

 

[Chloroform4Life]

http://www.gaswork.com/mobile/post/view/186492/

You're welcome.

Haha, cant move to Hawaii. too far from family. and I'm not cardiac trained or TEE cert

 

[caligas]

Prefer the backcountry to the surf?

http://www.gaswork.com/mobile/post/view/175508/

You're welcome.

 

[caligas]

Prefer the backcountry to the surf?

http://www.gaswork.com/mobile/post/view/175508/

You're welcome.

Never mind, I want this one.

 

[Ezekiel2517]

Agree with other posts. If you arent on partner track, you really want to be making a lot more than that. They are making quite a bit of money off your back.
Regarding the 1099 v w2, I'm a W2 but I am still able to deduct a lot of expenses by being reimbursed by the group. The biggest benefit of 1099 is the ability to sock away 55K+ a year in a SEP or solo 401k or even defined benefit plan. Cons are that you pay the hefty self-employment tax and are responsible for all benefits, etc

 

[deleted162650]

Agree with other posts. If you arent on partner track, you really want to be making a lot more than that. They are making quite a bit of money off your back.
Regarding the 1099 v w2, I'm a W2 but I am still able to deduct a lot of expenses by being reimbursed by the group. The biggest benefit of 1099 is the ability to sock away 55K+ a year in a SEP or solo 401k or even defined benefit plan. Cons are that you pay the hefty self-employment tax and are responsible for all benefits, etc

Yes, if your group is set up correctly you can deduct virtually everything you would deduct as a 1099 through the group as a w-2 employee. This keeps your personal tax return very clean/simple which keeps the IRS off your back. If your group is set up correctly then you can also put upwards of 55K into a 401K each year and have a DBP option on top of that. At least that is how my group is set up, and I know our books our squeaky clean. If your group is not set up like this then it would behoove you to consult with a CPA or practice management firm.

Salty felt this was important enough to say twice.

Sorry, Ive got two 4 year olds at home so I guess I've finally reached the point where I just repeat myself without even realizing it. I'd like to think though that even my 4 year olds would realize the OP is getting screwed at his current job.

Also, with 1099, you have to cover your entire FICA tax. in W2 you only have to cover half while employer covers half

A little bit misinformed on that one. In an anesthesia practice essentially all revenue is generated from your clinical work. Whether the group pays 1/2 before calculating your salary, or you just pay it all, it's coming out of the same pot of money. You are essentially paying all of it either way, it just changes which line it goes in on the spreadsheet.

 

[ERRES2288]

How desirable is this area? Big coastal city?

 

[Consigliere]

Chloroform4Life - your job sucks. That salary with a lousy 6 weeks of vacation is just awful. Perhaps this is the new norm though. Anyone thinking about anesthesia - caveat emptor.

 

[Chloroform4Life]

Perhaps y'all are right and my job does suck. Like I said, I will probably look for better opportunities once i am board certified. But for a new grad looking for a job, this was pretty comparable to what I got offered from an AMC. I guess it was just a matter of who you'd rather be screwed by: a big corporation or a small group of partners.

 

[deleted162650]

Perhaps y'all are right and my job does suck. Like I said, I will probably look for better opportunities once i am board certified. But for a new grad looking for a job, this was pretty comparable to what I got offered from an AMC. I guess it was just a matter of who you'd rather be screwed by: a big corporation or a small group of partners.

Good for you for waking up and deciding to look around. No one said your first job has to be your last job. Focus on your boards then polish up that CV and start making some calls. Chock this up to a learning experience and good luck finding a quality job.

 

[Man o War]

The grass IS greener. Get out of there ASAP.

 

[Chloroform4Life]

So, when I am planning my exit strategy, how do you guys recommend I do it? Should I let my group know I am looking for something else before I secure a new job? I know I have to give a 3 months notice per contract. Also, what if a potential employer want references from my current practice?

 

[criticalelement]

So, when I am planning my exit strategy, how do you guys recommend I do it? \

Call the senior partner into the room. Ask him if he could sit in the room while you go to lunch. Except after lunch, you aint coming back. Ever. Just dont come back. If he gives you a problem call the medical board on him and make up some bull sh t on him.

 

[Chloroform4Life]

Call the senior partner into the room. Ask him if he could sit in the room while you go to lunch. Except after lunch, you aint coming back. Ever. Just dont come back. If he gives you a problem call the medical board on him and make up some bull sh t on him.

Lol that won't work. We supervise crnas

 

[pjl]

You don't need to be board certified, just eligible, which you are.
You are not doing well at that job, unless you are not working for 25 of those 50 hours.
It takes 2-3 months to credential for a new job frequently, get the job, then put in notice.
Just for reference our total CRNA comp (including benefits and retirement and insurance, as well as 6 weeks off) for 40 hour weeks, no call is a total 245k .

Sent from my iPhone using SDN mobile app

 

[Chloroform4Life]

You don't need to be board certified, just eligible, which you are.
You are not doing well at that job, unless you are not working for 25 of those 50 hours.
It takes 2-3 months to credential for a new job frequently, get the job, then put in notice.
Just for reference our total CRNA comp (including benefits and retirement and insurance, as well as 6 weeks off) for 40 hour weeks, no call is a total 245k .

Sent from my iPhone using SDN mobile app

Can I join your practice as a CRNA?

 

[sethco]

So, just to play Devils advocate...

How many units are you generating per month ?
Are you doing your own cases or supervising?
What is your payor mix?
Are you able to move?
If not, how competitive is the local area? Have AMCs completely infiltrated the local area?
How many facilities are you covering?
How is the support staff?
Do you pay your own malpractice? Was a tail negotiated in the contract?

 

[IlDestriero]

As a data point, my friends group that had partners and non partner track people had partners making >6 while telling the non partner guys how fair and great it was to be making 375... You're getting bent over. And the 1099 makes it so much worse, though it can have some benefits. They're essentially using you like an AMC would. But instead of some venture capitalists or stock holders getting rich off your blood sweat and tears, it's your "friends".
You can likely work less and make more in academics, on top of good benefits, if you have any interest in teaching.



--
Il Destriero

 

[IlDestriero]

Prefer the backcountry to the surf?

http://www.gaswork.com/mobile/post/view/175508/

You're welcome.

I wonder if this is my friends group? (Not the guy above, lol)
They do well.


--
Il Destriero

 

[Chloroform4Life]

So, just to play Devils advocate...

How many units are you generating per month ?
Are you doing your own cases or supervising?
What is your payor mix?
Are you able to move?
If not, how competitive is the local area? Have AMCs completely infiltrated the local area?
How many facilities are you covering?
How is the support staff?
Do you pay your own malpractice? Was a tail negotiated in the contract?

I don't want to give away too much identifying information. But I mainly supervise 3-4 crnas. I don't know how many units I generate since I don't deal with billing but probably a buttload. I can move. I just don't want to deal with the hassles of job search and moving while studying for my oral boards. The group pays malpractice but I will likely have to cover tail unless my next employer does it. It shouldn't be too much after just 1 year of practice.

 

[sethco]

Kidding aside, from what you describe, I would not wait for boards to start you job search

 

[Arch Guillotti]

So, when I am planning my exit strategy, how do you guys recommend I do it? Should I let my group know I am looking for something else before I secure a new job? I know I have to give a 3 months notice per contract. Also, what if a potential employer want references from my current practice?

No way I would tell them.

 

[kilvinsky]

You don't know anything about anesthesia revenue generation or billing, you couldn't be bothered to look for a good job, you cannot move due to family reasons, you are making 50 cents for every dollar you generate, you didn't negotiate tail coverage when you joined, you are more worried about boards than how to finding another job. You want to tell your employers you are looking for another job. I call BS. No one is this dumb. You are a troll, but a good one, I'll give you 4/5 stars for portraying the naive young doctor getting screwed by his partners to the hilt.

 

[IlDestriero]

No way I would tell them.

Yes! Tell them after the ink is dry on the new contract.
They're treating you badly now, just wait until they know you're leaving.

 

[Chloroform4Life]

You don't know anything about anesthesia revenue generation or billing, you couldn't be bothered to look for a good job, you cannot move due to family reasons, you are making 50 cents for every dollar you generate, you didn't negotiate tail coverage when you joined, you are more worried about boards than how to finding another job. You want to tell your employers you are looking for another job. I call BS. No one is this dumb. You are a troll, but a good one, I'll give you 4/5 stars for portraying the naive young doctor getting screwed by his partners to the hilt.

I don't know who you are, but based on your post history, you seem to have a very malignant personality, so I could care less about what you say. But just to set the record straight for everyone else, no I am not trolling. They don't teach us about RVUs in residency and as an employee, I don't have access to the books. I never said I couldn't move due to family reason. I never said I couldn't be bothered to look for a good job. I am definitely going to be looking for a good job. Its why I am trying to get opinions on this subject. Negotiating the contract for my first job was difficult. I got some things I want changed but couldn't get tail coverage. I am focused on my board be cause a lot of the good jobs I see posted on gaswork says they want board certified.

So before you go running you mouth assuming bullsheet, get your facts straight.

 

[ERRES2288]

You don't know anything about anesthesia revenue generation or billing, you couldn't be bothered to look for a good job, you cannot move due to family reasons, you are making 50 cents for every dollar you generate, you didn't negotiate tail coverage when you joined, you are more worried about boards than how to finding another job. You want to tell your employers you are looking for another job. I call BS. No one is this dumb. You are a troll, but a good one, I'll give you 4/5 stars for portraying the naive young doctor getting screwed by his partners to the hilt.

This is very harsh for no reason. You've never made a mistake before? The guy or girl is a brand new attending who is less than one year out and realizing they ended up at a crappy job (and yes it is very crappy from a $$ standpoint). At least they are recognizing it now with essentially nothing lost. It's a great learning experience in the importance of becoming savy and knowing your worth.

 

[kazuma]

I graduated the same time as you and I'd agree, your job sounds terrible. There are decent jobs out there so keep looking. Definitely sign with the new group before putting in your notice.

FWIW, they didn't teach billing at my program either. A lot of my attendings didn't know about billing either. But there was a billing question on our 2014 ITE and I the only reason I got it right was due to my PP rotations in med school.

Best of luck with boards and new job hunt.

 

[Ezekiel2517]

I agree that you shouldn't give your notice until you have secured a job. At the same time, don't burn any bridges with your current group. Working those last few months will be tough but you want to leave on good terms. You never know who those partners know and they may be able to help you in the future. Think about purchasing the ASA relative value guide to learn more about how anesthesia is billed for in PP

 

[pjl]

I recall a practice management booklet as part of your ASA membership, read that at some point when you are bored of studying.

And no, you cant join us as a CRNA, we would not treat you that way, unless you actually wanted to work exactly like they do. If you did, then yes, you could get in on that deal.

Sent from my iPad using SDN mobile app

 

[Scotty_G]

Crappy job man!!! I agree with everyone. You need to look for a new job

 

[urge]

I would start looking right away. Best place to go is where your friends have gone. Worst case scenario go to an AMC. Once you have tested the market I would give my notice.

 

[GravelRider]

So, when I am planning my exit strategy, how do you guys recommend I do it? Should I let my group know I am looking for something else before I secure a new job? I know I have to give a 3 months notice per contract. Also, what if a potential employer want references from my current practice?

I am also a new grad in a crappy job with partners making money off my back (and not working themselves on top of it). The thing that aggravates me the most about it is that these old crusty partners are "has-been" anesthesiologists who I wouldn't even consider letting them give anesthesia to a loved one. They are propped up by the crnas. Frankly, it's quite embarrassing when a crna has to explain things to these washed up hacks.

There seems like there are other jobs out there, but you have to be willing to relocate (wife needs to be on board). However, those decent jobs are buried among piles and piles of lousy jobs, so you have to be patient. I've had 3 other job offers since I started looking, but this time I've learned my lesson from this mistake. I think that is the biggest takeaway...learn from this and be a lot more critical of other offers you may get. The hardest thing I have found about looking for a job is going on interviews. It takes using post-call days and strategic use of your limited vacation time. Most other practices realize the nature of the market, so they are willing to remain confidential.

If your owners are as childish and vindictive as mine then I would certainly wait until the absolute last minute to tell them (i.e. after you've signed the new contract and have started the credentialing process). They will no doubt make your last few weeks miserable in terms of call schedule and case load.

 

[Chloroform4Life]

Thanks everyone for the advices. It sounds like we're in the same boat, GravelRider. I thought I did enough research during residency before taking this first job, but you really don't know what it's like in the real world until you get out into the real world. I will definitely be more patient this time around. They say most anesthesiologists go through 3-5 jobs before finding the right one. I'm hoping to go just through 2. So I'm not going to rush into anything.

 

[2ndyear]

I don't want to give away too much identifying information. But I mainly supervise 3-4 crnas. I don't know how many units I generate since I don't deal with billing but probably a buttload. I can move. I just don't want to deal with the hassles of job search and moving while studying for my oral boards. The group pays malpractice but I will likely have to cover tail unless my next employer does it. It shouldn't be too much after just 1 year of practice.

I would call your malpractice carrier immediately and clear things up about what type of insurance you have. If you have to pay tail coverage go back and look at your contract to make sure that is true. Your insurer will then be able to tell you how much it will go up as long as you are employed in your current practice. You're right, it shouldn't be too much, but as someone who as written a check for tail coverage, it still sucks. I looked around and nobody would offer 'nose' coverage across state lines. You might have luck if you stay with the same insurer in the same state for nose, or so I'm told. Also with the job market the way it is now I wouldn't expect too many offers to just pick up 10 grand of tail coverage unless you were going to an area of exceptional need with a special skill set that is hard to find.

 

[kilvinsky]

I don't know who you are, but based on your post history, you seem to have a very malignant personality, so I could care less about what you say. But just to set the record straight for everyone else, no I am not trolling. They don't teach us about RVUs in residency and as an employee, I don't have access to the books. I never said I couldn't move due to family reason. I never said I couldn't be bothered to look for a good job. I am definitely going to be looking for a good job. Its why I am trying to get opinions on this subject. Negotiating the contract for my first job was difficult. I got some things I want changed but couldn't get tail coverage. I am focused on my board be cause a lot of the good jobs I see posted on gaswork says they want board certified.

So before you go running you mouth assuming bullsheet, get your facts straight.

So maybe you are for real. So you need to figure out how the business (not the practice) of medicine works real fast. So here are a few lessons:

Other anesthesiologists are not your friends. Rather they are the people with whom you share a workload. They will dump the worst reimbursing, most difficult cases on you and try to take as much of the money you generate as possible, either in the form of a buy in, expenses, or both.

Surgeons are not your friends. The thing they want most from you is for your not to cancel the case and they will do/say anything to make that happen. They also want to cut at their convenience, and really don't care about your schedule, whether the patient is optimized, or post op pain management.

Nurses are not your friends: they will dump whatever menial tasks on you that they can, and don't care about your supplies, your machine, your lines, or if you need assistance with a procedure. They just want to go home at the end of their shift having done as little work as possible. They especially love it when you transport the patient to the OR.

Hospital administrators are not your friends: they just want you to be available to the surgeons at all times, without compensation. Like RN's, also love it when you transport the patient to the OR. That way you get blamed for all the delays.

Regarding anesthesia billing and management, residency programs don't teach this because most professors don't know anything about it. Like most important things in life, it is self taught. I would google some keywords and spend a few hours every day figuring it out. Once you figure out which way the money is flowing, it becomes a lot easier to figure out the practice. Good luck.

 

[criticalelement]

So maybe you are for real. So you need to figure out how the business (not the practice) of medicine works real fast. So here are a few lessons:

Other anesthesiologists are not your friends. Rather they are the people with whom you share a workload. They will dump the worst reimbursing, most difficult cases on you and try to take as much of the money you generate as possible, either in the form of a buy in, expenses, or both.

Surgeons are not your friends. The thing they want most from you is for your not to cancel the case and they will do/say anything to make that happen. They also want to cut at their convenience, and really don't care about your schedule, whether the patient is optimized, or post op pain management.

Nurses are not your friends: they will dump whatever menial tasks on you that they can, and don't care about your supplies, your machine, your lines, or if you need assistance with a procedure. They just want to go home at the end of their shift having done as little work as possible. They especially love it when you transport the patient to the OR.

Hospital administrators are not your friends: they just want you to be available to the surgeons at all times, without compensation. Like RN's, also love it when you transport the patient to the OR. That way you get blamed for all the delays.

Regarding anesthesia billing and management, residency programs don't teach this because most professors don't know anything about it. Like most important things in life, it is self taught. I would google some keywords and spend a few hours every day figuring it out. Once you figure out which way the money is flowing, it becomes a lot easier to figure out the practice. Good luck.

This is a gem of a post and sums up the dynamics in anesthesia. Especially the part about OTHER ANESTHESIOLOGISTS not being your friends. Sure they will help you at times but their goal(s) are to make themselves look good or to have easier cases (more money) than you. Thank you for this post and this thread is a fantastic.

Anesthesia is a decent science and can be a good practice but has been corrupted and bastardized to the point of un bearability everywhere. Your happiness as a practicioner is dependent on too many people, scenarios or things to happen so much that there are almost no good jobs out there.

 

[caligas]

So maybe you are for real. So you need to figure out how the business (not the practice) of medicine works real fast. So here are a few lessons:

Other anesthesiologists are not your friends. Rather they are the people with whom you share a workload. They will dump the worst reimbursing, most difficult cases on you and try to take as much of the money you generate as possible, either in the form of a buy in, expenses, or both.

Surgeons are not your friends. The thing they want most from you is for your not to cancel the case and they will do/say anything to make that happen. They also want to cut at their convenience, and really don't care about your schedule, whether the patient is optimized, or post op pain management.

Nurses are not your friends: they will dump whatever menial tasks on you that they can, and don't care about your supplies, your machine, your lines, or if you need assistance with a procedure. They just want to go home at the end of their shift having done as little work as possible. They especially love it when you transport the patient to the OR.

Hospital administrators are not your friends: they just want you to be available to the surgeons at all times, without compensation. Like RN's, also love it when you transport the patient to the OR. That way you get blamed for all the delays.

Regarding anesthesia billing and management, residency programs don't teach this because most professors don't know anything about it. Like most important things in life, it is self taught. I would google some keywords and spend a few hours every day figuring it out. Once you figure out which way the money is flowing, it becomes a lot easier to figure out the practice. Good luck.

Your only friends are us, the posters of SDN.

 

[Arch Guillotti]

Other anesthesiologists are not your friends. Rather they are the people with whom you share a workload. They will dump the worst reimbursing, most difficult cases on you and try to take as much of the money you generate as possible, either in the form of a buy in, expenses, or both.

That's a pretty broad generalization. Not true for everyone.

 

[sethco]

I would start looking right away. Best place to go is where your friends have gone. Worst case scenario go to an AMC. Once you have tested the market I would give my notice.

I'm willing to bet that the worst case scenario of the AMC, is significantly better than this current job

 

[deleted162650]

Anesthesia is a decent science and can be a good practice but has been corrupted and bastardized to the point of un bearability everywhere.

Not everywhere. There are many, many quality jobs still out there. The number of good, fair, quality jobs seems to vary dramatically depending on which region we're talking about.