Help me pick a job?

[booohooo]

Job 1:
MD only - Flagship hospital. Private group. Eat what you kill, blended unit. Average ~400K working ~45hrs/week. 6-8 week vacation. Blended unit value/average income has been steady in the group for years as far as I can tell. 18-20 weekday calls (home call, usually can sleep the night). 4 double weekend calls/year (Sat + Sun, 1st/2nd). Weekends are busy during the day, but seldom call back at night. No real benefits, everything comes out of pocket.

Job 2:
ACT model - Old hospital. Hospital employed. Covering 2-3 CRNAs 70% of the time (sometimes 4 crnas), doing own cases 30% of the time. $360k/yr for 40hr/wk, 4 weeks vacation + 7 paid holidays. "usually" 2-3% raise yearly. Hours worked above 40 are tracked and paid out at the same rate or can be taken as extra time off. Call burden is about the same from what I can tell except weekends are split (so working either sat, or sunday but same number of days overall. Amazing benefits, paid malpractice, health/dental, 401K matching, promise of a pension if you stay with them long enough (they claim they'll pay you up to 50% of your salary until you die if you retire with them on top of any money you set aside in your standard retirement accounts).

Which one should I take? They're both in the same town miles from each other.

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[osumd]

What are you looking for in a job? Is this your first job out of training? How does the case mix compare at these places? Are you tied to this town? These the only two options?

 

[booohooo]

Would be my second job. I've been with an all MD practice in another part of the country for 3 years now. Moving to be closer to family. These are my two best options in this city.

I do prefer to ride solo in the OR but having a hard time making a decision between these two jobs

 

[IMGASMD]

1. 8/10
2. 6.5/10

But I agree with above poster, if you can give a little more, would be helpful.

 

[Hoya11]

Job 1:
MD only - Flagship hospital. Private group. Eat what you kill, blended unit. Average ~400K working ~45hrs/week. 6-8 week vacation. Blended unit value/average income has been steady in the group for years as far as I can tell. 18-20 weekday calls (home call, usually can sleep the night). 4 double weekend calls/year (Sat + Sun, 1st/2nd). Weekends are busy during the day, but seldom call back at night. No real benefits, everything comes out of pocket.

Job 2:
ACT model - Old hospital. Hospital employed. Covering 2-3 CRNAs 70% of the time (sometimes 4 crnas), doing own cases 30% of the time. $360k/yr for 40hr/wk, 4 weeks vacation + 7 paid holidays. "usually" 2-3% raise yearly. Hours worked above 40 are tracked and paid out at the same rate or can be taken as extra time off. Call burden is about the same from what I can tell except weekends are split (so working either sat, or sunday but same number of days overall. Amazing benefits, paid malpractice, health/dental, 401K matching, promise of a pension if you stay with them long enough (they claim they'll pay you up to 50% of your salary until you die if you retire with them on top of any money you set aside in your standard retirement accounts).

Which one should I take? They're both in the same town miles from each other.

Job 1 sounds good until you got to the No benefits part.

That means you are making 400 ( which might even be lower it sounds like ) , after you factor in benefits, retirement, your down in the low 300s.
For a call taking job that is below market.

Job 2 sounds good but 4 weeks of vacation is low, usually at least 6.

Of those two options, I would choose Job 2. Decent Salary and Great benefits is peace of mind.

I would verify the salary of those in Job 1 because that sounds like a situation where you should be making 500k+ but paying your own benefits

 

[IMGASMD]

Job 1 sounds good until you got to the No benefits part.

That means you are making 400 ( which might even be lower it sounds like ) , after you factor in benefits, retirement, your down in the low 300s.
For a call taking job that is below market.

Job 2 sounds good but 4 weeks of vacation is low, usually at least 6.

Of those two options, I would choose Job 2. Decent Salary and Great benefits is peace of mind.

I would verify the salary of those in Job 1 because that sounds like a situation where you should be making 500k+ but paying your own benefits

350 even 325K vs 400K.

Consider
For job one, you maybe be able to write something off.
For job two, you’re a hospital employee just like your crnas. Just came out of a situation, the employer treat crnas better than the physicians..... think about that for a second. Crnas are cheaper than you to hire, easier to control than you. And at end of the day, probably bring same amount of money as you per case.....

I like to preserve my sanity as long as I can. Yes, some of them aren’t so bad. Yes some of them are actual people that I can go out and have a beer with. But, day to day grind with them, just aren’t worth it to me “right now.” I reserve my rights to change my mind later.

8/10 and 6.5/10
If they’re your only options.

 

[GassYous]

I agree with above. Job 1 pay is low but doesn't sound too horrible.

 

[sevo00]

both of these jobs are low. job 2 is worse, that little pay for managing sometimes 4 CRNAs... no thanks. Go with option 1

 

[sevoflurane]

keep looking

 

[AdmiralChz]

Both sort of suck, unless your income is depressed for a group buy in but it doesn’t seem to be the case. There are better jobs out there, especially after a year or two of buy in.

I give job 1 4/10 (no benefits will be a huge suck on income, and your time having to procure yourself) and job 2 5/10.

 

[AdmiralChz]

Also, don’t believe a “promise” of a pension. Very few jobs offer that anymore (as it’s exceptionally expensive for groups now that folks live far past retirement) - if it’s true, it needs to be explicitly spelled out in writing as part of a signed contract.

 

[booohooo]

So for Job 1, the benefits are paid for with pre-tax dollars but from your own billed income. So I guess there's some tax advantage there. Of course it doesn't beat having benefits paid for completely separately.

 

[AnesTDL]

This seems like it comes right down to what you want out of a job.

All the benefits and money won't matter if you hate going into work every day.

Will you be most professionally fulfilled by doing the cases yourself or not? That is what matters.

 

[Man o War]

Both sort of suck, unless your income is depressed for a group buy in but it doesn’t seem to be the case. There are better jobs out there, especially after a year or two of buy in.

I give job 1 4/10 (no benefits will be a huge suck on income, and your time having to procure yourself) and job 2 5/10.

I rate these the same. Keep looking

 

[Shimmy8]

I’d ask some of the tenured folks at Job 1 what they take home, how they structure it, etc.

I make around what these two jobs do, but I have more time off. But I also take a lot more call.

You should be getting more vacay in both, but the call burden isn’t badl.

 

[Velefunt]

Job 1

or

Keep looking.

or

Don't move closer to family.

 

[docforsure]

What do you guys define as benefits? For example, job 1 had pension plan, 401k, health plan, disability, malpractice all available at a "group" price but none of it is "free". If you want it, it comes out of your earned money albeit it's pre-tax money.


Job 2 has all those things but it's free, meaning it doesn't come out of your salary.

 

[GassYous]

What do you guys define as benefits? For example, job 1 had pension plan, 401k, health plan, disability, malpractice all available at a "group" price but none of it is "free". If you want it, it comes out of your earned money albeit it's pre-tax money.


Job 2 has all those things but it's free, meaning it doesn't come out of your salary.

It comes out of your billings either way. Nothing is free.

 

[Arch Guillotti]

It comes out of your billings either way. Nothing is free.

?

If you are an employee of the hospital it’s “free”. It’s part of your employment package.

 

[GassYous]

?

If you are an employee of the hospital it’s “free”. It’s part of your employment package.

?

Where do you think the hospital gets the money from? Fake covid diagnoses?

 

[Arch Guillotti]

?

Where do you think the hospital gets the money from? Fake covid diagnoses?

ok but if you are a hospital employee I would imagine it wouldn’t matter what your billing is. It’s the perpetual problem with just ”being an employee” - no incentive since your pay doesn’t change. As a hospital employee you have no right to the revenue you generate. You have a right for the hospital to honor their contract with you.

 

[osumd]

The pay for both sounds very low, but location matters & we don’t have that info.

More details about job 1 would be helpful. Is it a partnership track? If so, what are the partnership track details? When you say average is $400, is that what the partners are taking home on their W2 after expensing things like malpractice, health ins, etc? Or is that gross production prior to any expenses?

 

[docforsure]

The pay for both sounds very low, but location matters & we don’t have that info.

More details about job 1 would be helpful. Is it a partnership track? If so, what are the partnership track details? When you say average is $400, is that what the partners are taking home on their W2 after expensing things like malpractice, health ins, etc? Or is that gross production prior to any expense

The pay for both sounds very low, but location matters & we don’t have that info.

More details about job 1 would be helpful. Is it a partnership track? If so, what are the partnership track details? When you say average is $400, is that what the partners are taking home on their W2 after expensing things like malpractice, health ins, etc? Or is that gross production prior to any expenses?

It is partnership track. 2 years and you get voting rights and share owner in group. Once partner, you get ~$30K in bonus end of year.

45hr week, 8 weeks off would net me $400K in production in my pocket. This figure is after deduction of overhead costs of running the practice. From this I would pay for any benefits on a pre-tax basis. + the $30K in end year bonus once partner.


In job 2, while starting pay is $360k, it is strictly for 4 weeks vacation and 40hrs/week. It seems most people their end up doing 50hrs/week so they end up either taking those extra hours as vacation or as extra pay. If you took it all as extra pay, it would amount to $460k

 

[deleted162650]

45hr week, 8 weeks off would net me $400K in production in my pocket.

Who makes the daily schedule? Are you sure you’ll have access to the cases which will allow you to hit that income level, or do you have to “earn” that privilege?

 

[sevoflurane]

4 weeks is not sustainable in this profession. 1000% pass.

 

[docforsure]

Who makes the daily schedule? Are you sure you’ll have access to the cases which will allow you to hit that income level, or do you have to “earn” that privilege?

Yes schedule seems pretty democratic and is done on a rotating numbered system

 

[victor le cube]

Job one is better. But even that job needs more vacation. I would say a minimum of 8 weeks.

Also benefits in my opinion are overrated. I’m 1099 and run it through my s-Corp so I can write off a lot. Here’s sort of what operating costs are, which isn’t really that much IF you are getting a significantly higher salary. About $26.5k/year total:
$700/month malpractice
$800/month for high deductible PPO health insurance (myself and wife)
$220/month: accounting (includes payroll, state and federal taxes, tax returns etc)
-I do an HSA, solo 401k, and backdoor Roth. No match but I can put more in and choose where to put it. I also can have my wife on payroll in the s-Corp and her entire check goes to 401k.
-$500/month specialty own personal disability policy paid by me (my understanding is if you have your s-Corp pay the disability then the benifits, were it to pay out, would be taxed).

I guess the only benefit that is really a big deal would be 401k match but even there you need to consider the overall pay package and quality of the day to day job. And I also wouldn't trust the pension either.

 

[Sriddymopboi]

Job one is better. But even that job needs more vacation. I would say a minimum of 8 weeks.

Also benefits in my opinion are overrated. I’m 1099 and run it through my s-Corp so I can write off a lot. Here’s sort of what operating costs are, which isn’t really that much IF you are getting a significantly higher salary. About $26.5k/year total:
$700/month malpractice
$800/month for high deductible PPO health insurance (myself and wife)
$220/month: accounting (includes payroll, state and federal taxes, tax returns etc)
-I do an HSA, solo 401k, and backdoor Roth. No match but I can put more in and choose where to put it. I also can have my wife on payroll in the s-Corp and her entire check goes to 401k.
-$500/month specialty own personal disability policy paid by me (my understanding is if you have your s-Corp pay the disability then the benifits, were it to pay out, would be taxed).

I guess the only benefit that is really a big deal would be 401k match but even there you need to consider the overall pay package and quality of the day to day job. And I also wouldn't trust the pension either.

Question, as a 4th year going into anesthesiology, when should I learn how to do this stuff? How did you learn this stuff?

 

[GassYous]

Question, as a 4th year going into anesthesiology, when should I learn how to do this stuff? How did you learn this stuff?

Learn it now. Read some books, listen to podcasts, you have the world at your fingertips and it isn't just for scrolling on instagram models.

 

[IMGASMD]

Question, as a 4th year going into anesthesiology, when should I learn how to do this stuff? How did you learn this stuff?

If you’re going to some ivory tower, you probably won’t really learn it. If you’re going to a private practice residency, maybe you’ll get some sense. If you’re going to a AMC residency, good luck my friend. They’ll just feed you lies from the beginning.

It may take up to a few years after residency to really understand what’s going on. In the mean time, white coat investor, here, understand your retirement, understand your debt management are all important for your financial literacy.

 

[Sriddymopboi]

If you’re going to some ivory tower, you probably won’t really learn it. If you’re going to a private practice residency, maybe you’ll get some sense. If you’re going to a AMC residency, good luck my friend. They’ll just feed you lies from the beginning.

It may take up to a few years after residency to really understand what’s going on. In the mean time, white coat investor, here, understand your retirement, understand your debt management are all important for your financial literacy.

Thank you. I'm probably going to the ivory tower so will try my best to seek out some opportunities to learn financial literacy. I've heard good things about the WCI. Think getting the book is helpful?

 

[chudat]

Job one is better. But even that job needs more vacation. I would say a minimum of 8 weeks.

Also benefits in my opinion are overrated. I’m 1099 and run it through my s-Corp so I can write off a lot. Here’s sort of what operating costs are, which isn’t really that much IF you are getting a significantly higher salary. About $26.5k/year total:
$700/month malpractice
$800/month for high deductible PPO health insurance (myself and wife)
$220/month: accounting (includes payroll, state and federal taxes, tax returns etc)
-I do an HSA, solo 401k, and backdoor Roth. No match but I can put more in and choose where to put it. I also can have my wife on payroll in the s-Corp and her entire check goes to 401k.
-$500/month specialty own personal disability policy paid by me (my understanding is if you have your s-Corp pay the disability then the benifits, were it to pay out, would be taxed).

I guess the only benefit that is really a big deal would be 401k match but even there you need to consider the overall pay package and quality of the day to day job. And I also wouldn't trust the pension either.

How much do you pay your accountant?

 

[sloh]

If you’re going to some ivory tower, you probably won’t really learn it. If you’re going to a private practice residency, maybe you’ll get some sense. If you’re going to a AMC residency, good luck my friend. They’ll just feed you lies from the beginning.

It may take up to a few years after residency to really understand what’s going on. In the mean time, white coat investor, here, understand your retirement, understand your debt management are all important for your financial literacy.

Yeah, keep reading and learning after residency. Take it from someone who switched from a W2 to 1099. As a 1099, I’m now making 2-3x my W2. Know your worth.

 

[abolt18]

Thank you. I'm probably going to the ivory tower so will try my best to seek out some opportunities to learn financial literacy. I've heard good things about the WCI. Think getting the book is helpful?

Google and download the 16 page pdf called "if you can" by bill bernstein. Read it, then re-read it while following his recommendations through the book. This pdf is free to all, that was Bernstein's intent when he wrote it.

I'd then get the WCI's 2nd book, the whitecoat investor's financial boot camp. Actually get that today because it'll only take you a short time to read Bernstein's pdf. It's worth every penny and gives you a VERY simple to follow set of directions in a 12 step fashion.

Then WCI's first book and blog, forum, and podcast at your leisure. Even in academics you'll be very well off learning this.