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Thx. In medical center? How much call are you taking and how busy? I've heard UT has really stretched its folks thin and is not paying well. Not sure about others.
Houston job market??
Started by Ravenclaw90
Not asking you to give away “site-specific” details, but what finally pushed you to leave your current job, and what do you find more “appealing” about the new place to which you’re headed??
I’ve left a few jobs in my time (happy to share my experiences), just interested in others’ stories. Always find them educational….
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Won’t answer for her. But for me it’s always about
1. Workload vs pay vs equality
I can almost guarantee you 80% of primary wage earners leave jobs for those reasons
The other 20% has to do with family, spouses jobs
What aneftp said- lack of work life balance is a factor for sure.
For me patients come first and my license second. I think this market is a stress test for practices… and mine has been found lacking. They don’t have the same commitment to quality patient care that I do… I think extended care team is damgerous and end of our specialty and I won't participate…. I lost a lot of respect for my colleagues who not only didn’t speak up… they didn’t back me up - they were quiet and went along with it. I’ve also found out that a few in our leadership have undermined the partnership for their own benefit and always choose the hospital over partners (likely aligning themselves for the post amc employment model), I hope my new partners are more team players as I am.
Luke Howard, I don’t see the amc model working anymore…. Previously the middle men could pay for themselves by negotiating better rates with insurance and holding a local monopoly… (envision, Napa, USAP, etc.) enforced by ridiculous non competes leading to relatively low salaries. Hospitals would pay stipends for stable work force and the headache of managing anesthesia. That model is falling apart. So the result is AMCs will ask for more and more money… eventually hospitals will get sick of paying PE and will just take anesthesia in house.
Partners in other USAP markets have told me they have gotten a pay cut or anticipate one soon- I wasn’t about to do extended care team period much less for a pay cut or be partners will people who didn’t look after their other partners.
I'm proud of you for sticking to your morals unlike all the other vaginal sell outs! That takes courage, a quality lacking in most of the invertebrate anesthesiologists I have had the misfortune of associating with.
Sorry to hear that things have gotten so bad over there. I enjoyed my couple months over there during fellowship with the Cardiac team. Especially disheartening that those same people didn't speak up about extended care team. I can't even imagine. As you know, I used to recommend your group, especially for Cardiac in the DFW area if they didn't want to go to multiple hospitals.
The South Carolina job sounds great and I think you'll like the area. Good for you on pulling the cord. I'm not quite at the point, as I still like my day to day work. Care team (let alone extended care team) Would be the final straw for me. Thankfully, I don't see that happening any time soon and there's too many people opposed to CRNAs in my group
Thanks sethco… i really appreciate your support - as you all know I used to too… but it’s changed.
Thanks - ironically the only people who have spoken out about the issues have vaginas…. Just the two of us lol - I think she’s working on an exit plan too but she has more moving parts than I do
It’s true. We are stretched thin but not because of lack of trying. hiring is really tough . We can’t provide PP money or that time off they do , so in turn we’re being stretched thin. I found a niche here where I hold a “leadership” position, feel valued and can handle day to day management by myself . Money could be better but with benefits and match it’s not terrible. PTO is not good but you get sick days and can accrue vacation and holiday worked , including the last 2 weeks of December. Overall happy with what i do… but not for everyone. cases at hospitals are high acuity as well as patients. There is plenty of support though as never feel you’re alone.
Not gonna to answer for amyl
But in my experience extended care model with unknown mid level providers are asking for trouble as your familiarity of these crnas and aa are lacking.
The skill set of these mid levels varies so much these days. You got the young brash crnas who really have no clue what they are doing. Those are the more dangerous ones. The ones who won’t call u till it’s late.
Everyone sees the locums money so want to make as much as possible but they lack the experience
That wasn't my question though. What is the structure/make-up of the *extended* care team versus the ACT model? Just want to understand exactly what everyone is talking about (iow, have I just become accustomed to this situation, or is extended some new iteration I should watch out for?).
Extended care team means running more rooms than 4:1 supervision ratios.
So yes I've just grown accustomed 😢
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I have covered 1:6. It’s dangerous when the crnas are bad and the higher level of care in bigger cases.
We aren’t talking taking over case at 12-1pm when the day has gone by.
We are taking starting the day 1:6 and than going up to 1:10.
How do you even see 8 people for first case starts? If there’s a block thrown in? These jobs are liability sponge jobs. They would have to pay north of 800 for anyone reasonable to take it
Many will pay 800. It’s cheaper than 1200…but the issue even these PE places can’t get around with that is call burden. That’s the real issue. Too many hospitals..too many call sites…call doesn’t generate enough revenue…nor do people want to take call after Covid and I don’t blame them. What’s the answer…pay for call. Hospitals can decide to have OB or not. Post an appy at 2am or 10 next day. Time is money. Anesthesia as a specialty needs to demand in house rates for taking call regardless of home call, low volume, etc. it’s a cost. Don’t bend
Depends on the setup. If it’s basic interscalene, pop, adductor canal. I can do 4 of them in 15 min because the lpn/anesthesia tech has drawn up the meds for me already. I can see the other 4 patients in 15 minutes so I would need to show up at 630am to see all 8 patients and block them all and ready to go by 715am
Some people just take too long to preop.
But a lot depends on the complexity of the case as well.
You must have one heck of a pre-admission testing clinic if all the ducks are lined up so you can see this number of patients in such a short time period. This sounds like hell to me both from a limited time perspective and liability standpoint…
What the flying F***??
I understand how some people can"t stand academics and some of its drawbacks but personally I would just jump ship to an academic position instead of this nightmare 1:6 + situation. I don't even feel like 1:4 ACT is practicing anesthesia.
Some true state academic places are hitting the mid 550s, even low 600 plus added perks as some posters have stated in these posts with not a lot of overkilling urself crazy 65-70 average either.
Their paid time off is still much less than private practice people but the overall package for hours worked plus benefits/retirement package is likely within 10%-15% of what usap partners is making.
But academics has tons of politics and uneven workload within the own department faculty. Which is often times far worst than just putting your head down and working like a dog in private practice. So there are positives and negatives with academics
That’s what makes you wonder why kill urself for 750k supervising 1:6-1:10
I think if they were making. 1-1.2 million (which is what they should be getting paid). It’s a more reasonable salary.
Politics I get it, but at the end of the day you don't have to get involved. You can just show up, take great care or your patients and do some teaching. Uneven workload is a fact for sure. I guess that can be hard to swallow for some people. It's all about perspective. 40-50 hours/week in academics is a breeze compared to 1:6-1:10. But if you're constantly worried about what the chair or division chiefs are doing then yea maybe it's not right for some.
I don’t plan to take any call now that isn’t exceptionally compensated. It simply isn’t worth the nagging thought of not silencing my phone or the pager digging into my leg.
How much is that feeling worth? To many people no dollar amount is high enough, and that’s great for people who want to take call. I’m almost to the point where I refuse to take it or agree to it because practices demand so much.
If you’re at a small practice often they ask for 90-180 nights of call if you factor in both primary, backup/specialty/OB.
It’s simply too much because hospitals don’t want to turn away any patients whatsoever for publicity and reputation reasons. Then you end up with patients waaaay out of the hospitals capability either intraoperative or postoperatively.
Bad situations happen from improper capabilities in my experience
Would u do 72-90 total (24) hr calls (no trauma) plus 2 crnas doing ob and or at night for 500k
Not super busy ob. Around 4500 a delivery. And not be woken up at night 90% of the time cause crnas cover ob.
That’s ur entire schedule. The rest of the days is off. So 26 plus weeks off. Work 2 calls a week. Or sometimes just 2 calls in 3 days and the next 11 days off.
The jobs I’m referring to are 5 days a week plus the mentioned 90-180 days of call with rarer post call days. That’s common call burden in bad rural jobs I see
I’m talking total days of work. 72-90 total days.
You see. We all value our time
If you want to work 200 daytime hours more power to u with no calls. (52 weekends x 2 days) equals 104 days (all weekends off). Plus (10 weeks of vacation). (50 day time)
So you work 200 total daytime hours out of a year
I’d rather have an addition 120 days off
We all value our time differently (as our sleep)
As I said before. The q4/5 calls plus working 5 days a week for 500-550k with 8-10 weeks off are not being filled. People don’t want to take all those calls in addition to working days.
The rural area call burden is low. But ain’t no one taking those 500k/1099 gigs with 26 weeks off. Cause of the call burden no matter how light.
Those gigs are at min 2 million a year for 365/7 days a week coverage (24 hrs a days). They would have to pay a doc 1 million. For 26 weeks off cover usage and that still works out to less than $238/hr coverage. Even at 1 million a year for 26 weeks. So them offering 500k for 26 weeks is an insult these days. That’s $119/hr to be available for 168 hrs a week.
I’d take my 70k for
The week as locums and run with that.
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Envision and NAPA love to offer these jobs. A full time (500k) salary for only 26 weeks of work! But those weeks you’re covering days or nights for 84 hours a week. That comes out to an average of 42 hours a week with no PTO. Plus having to take call and some of these places are not easy to work at. I don’t understand how people gleefully take these jobs
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Gotta have 2 crna with u so they don’t wake u up it’s more than 15 deliveries a day.
I like to sleep on call.
People gotta make the system work for them.
Even non busy places the crna should cross cover ob and or and if or is going on. The crna does or case and doc covers the ob.
D
deleted87051
How many deliveries/year? If it’s busy OB it should be 2x that. A 24hr shift on a busy L&D should generate $10k.
Yeah at least 800k for that. No way
This sounds awful. Basically q4. If no vacation weeks then this is over 2000hrs a year.
Those nocturnist jobs are everywhere - NAPA and Envision.
It’s great if it works for your lifestyle or you are in accumulation phase and need to work that hard.
8x24 watch out often they want that in a 4 week cycle. So there’s actually 13 of those. 2496 hours.
That’s terrible pay. No way.
It’s great if it works for your lifestyle or you are in accumulation phase and need to work that hard.
8x24 watch out often they want that in a 4 week cycle. So there’s actually 13 of those. 2496 hours.
That’s terrible pay. No way.
Peeps aren't working hard (at least the jobs I know that are night float). The woman doc does night float. Sleeps all the night and flies out to take vacation everywhere around the world. She has 2 crnas on with her at night. They do the epidurals and the OR cases.
Had a 2 week trip to Italy just now. Went Kayaking in August in Alaska. Flew to Chicago for a concert. Went to Australia in March.
The key is to be selective which job you are taking. My motto is to work smart, not hard.
So she's working less than the day docs. The day docs are the ones running around and the case load dies down around 6pm. She has the better gig. So the day docs are leaving the practice now cause they are working too hard.
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So she doesn’t go to any OR cases or c-sections?
Not for the c/s which already has epidurals running 90% of the time. crnas pretty independent downstairs.
Operating room, she will go start it with crna.
She said it's much easier than her old job where she was a partner making 750-800/8 weeks off. She did her own cases, cardiac etc. for years. But she's seen the light. Some people just don't know any better till they find something better. But if your only job you ever had for 12 years, you don't know.
Why kill yourself?
Junk ad that just arrived in my email
So they are slowly responding to market conditions with no weekends. It’s still a $800k gig I told them without weekends to be stuck in middle Georgia. The lake is nice though. The ritz i think hotel is on the lake. Not worth it for 500k even with no weekends.
“
Cross Country is seeking an Anesthesiologist for assistance in Central Georgia. Please see some details below.
So they are slowly responding to market conditions with no weekends. It’s still a $800k gig I told them without weekends to be stuck in middle Georgia. The lake is nice though. The ritz i think hotel is on the lake. Not worth it for 500k even with no weekends.
“
Cross Country is seeking an Anesthesiologist for assistance in Central Georgia. Please see some details below.
- Small Hospital
- 2 MD's & 4 CRNA's working independently and doing just under 4000 cases annually (200 births)
- Working 2 weeks on/2 weeks off, Mon-Fri & on call full time for OR cases only (CRNA's handle OB)
- Mainly Bread & Butter & OB - Some healthy peds, rare thoracic, ortho, outpatient.
- $500k w/ 26 weeks PTO
- 1099 position
- Located less than 45 minutes from Macon, GA and bordering the Oconee River, this quaint town has much to offer including restaurants, bakeries, breweries, lake life, and the plethora of year-round events celebrating this historic Peach State town!
So sleeping through epidurals and c-sections = good, being awake at 1:6 = bad? Is the former really a desirable practice?
Yeah different strokes.
Can’t pay me enough to take call or weekends anymore. Got enough vac that I can do all those trips, but I’m good hanging at home with the kids.
Once you have a normal life, ain’t no going back. Night shift is a cardiac risk factor?
But hey, increases call pay for those who want/need it, so win-win!
Can’t pay me enough to take call or weekends anymore. Got enough vac that I can do all those trips, but I’m good hanging at home with the kids.
Once you have a normal life, ain’t no going back. Night shift is a cardiac risk factor?
But hey, increases call pay for those who want/need it, so win-win!
l
will u do it for 1.5-2 million? Plus with a crna.
Nope - not in accumulation phase anymore.
But it’s a great time to be an anesthesiologist in accumulation phase!
But it’s a great time to be an anesthesiologist in accumulation phase!
I use to think 5-7 Million was a lot. Excluding the house. But the field goal post keeps moving. I think 12-15 mil should be most people goal by age 55.
So if u already have 5 million by age 40-45. U should be able to cruise with little effort.
The kids just get more expensive either college cars etc.
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That’s insane to me— by the 4% rule that’s $480k spending per year in retirement. That’s 2.5-3x what I spend now with a young family…
Do you count that in today's dollars or in dollars 20 years in the future?
Anyone who is calculating retirements should be accounting for inflation of 2.5-3%. The typical expected real return from the broad stock market is 7-8%
Assuming the stock market accounts for this inflation with augmented returns (it usually does), then using a real rate of return means your calculation of how many of todays dollars you need to retire is a proper calculation.
There's very few things a retiring person will need in the future that aren't going to generally be covered by a smart planner. Healthcare and long term care are the big ones, but anyone who looks into it minimally or has a spouse with a decent job will be covered. Medicare advantage also isn't that much to just buy.
Vacations and luxury items of course could jump in price, but if they do that substantially it just means you need to work a week a month past 60, which isn't a terrible fate either because it gives you something to do a week a month. Vacations and living abroad gets old for people raised in the US.
Beyond healthcare, vacations/luxuries, and I suppose grandchildren I can't see why a normal goal of 5-10 million isn't totally appropriate.
Could you elaborate why you think people will need to potentially double that goal? At a 4.5% withdrawal rate on 5 million you're looking at 225k per year likely in perpetuity. Basic expenses including meals out should only run about 5-10k per month. How much are you planning on spending once your mortgage and kids are not on the ledger?
In today’s dollars. Most docs are targeting 300k to live off per year (post tax)
$225k (pretax) isn’t gonna to cut it for todays living standard. Assume you live for 30 years in retirement to age 85 (retire age 55) You will likely need closer to 8-9 million most of it pretax. If you live off 300k post tax. Property taxes in some of my semi retired doc friends homes are 35-40k a year alone. They aren’t giving up those properties till they can’t handle it anymore.
Ok ok. 🧌and/or disconnected from reality. Entertaining, I'll give it that.
40k for gasoline last year for the boat. Sure. Some of us always chip in for gasoline when we are out with them. Still costs them likely 25k even with friends contributions. They sometimes sell back the fish (they particularly love swordfish). Those fish are aggressive.
People don’t stop living when they retire. They stay active. Vacation. If all cost money. Maintaining second homes (or renting them out partial year)
