How much do Cardiac Anesthesiologists make?

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Dr. Trafalgar Law

Dr. Trafalgar Law

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I’ve heard anecdotal numbers thrown around that 500,000$ is possible out of fellowship and can peak in high six figs in later attending years. Is this true? Furthermore, is it reasonable to think that doing this fellowship would insulate oneself against any potential CRNA encroachment?
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Definitely possible. Also possible for a generalist and in both cases you need to be very flexible geographically and be willing to work a lot. Not sure about “high six figures” - many jobs that start you pretty high keep you there unless, again, you work more.

The rest has been debated a lot including recently. Let’s see if I can find a thread to link to.

Biggest take home point - doing a CV fellowship (or ANY fellowship in anesthesiology) chasing large amounts of increased money will leave you disappointed.
 
Quick search revealed these threads. Check them out:

forums.studentdoctor.net

Fellowship Article by WCI

https://www.whitecoatinvestor.com/fellowship-rarely-makes-sense-financially/
forums.studentdoctor.net forums.studentdoctor.net

forums.studentdoctor.net

To those that did a fellowship, what were your reasons?

Well, like I said many times before. I probably made less than the median MGMA while I was out. Didn’t have the contacts to land the best paying PP gig; did not I want to supervise 3-4:1 all the time nor bust my ass at a 60+ hr a week job. I worked hard (50-60hrs) in Vegas for two years...
forums.studentdoctor.net forums.studentdoctor.net

forums.studentdoctor.net

Fellowship advice

CA-1 here. Obviously thinking about fellowships already as we have to apply so early. My question is essentially, would doing a cardiac fellowship make me a better all around anesthesiologist and better suited for handling everything? Or is cardiac so specialized? What fellowship would help? I...
forums.studentdoctor.net forums.studentdoctor.net
 
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Exactly.

Do a fellowship because you WANT to do it, not because you’re chasing dollar signs. As said, you can find yourself very disappointed. I’m cardiac trained and I absolutely know generalist who make more money than I do.

Think about it like this. Who probably had the better week financially, the guy who did a couple of open hearts and maybe a day or two in cath lab, or the guy who did 3 spines one day, a couple lap choles another day, and maybe a day at an ASC, and the another day of ortho.

As said above, you have to actually do the work to make the money, at least in most private practices. In academics, a fellowship may get you a 50k bump in salary, but academic CV only positions are becoming harder and harder to come by.
 
Twiggidy said:
Exactly.

Do a fellowship because you WANT to do it, not because you’re chasing dollar signs. As said, you can find yourself very disappointed. I’m cardiac trained and I absolutely know generalist who make more money than I do.

Think about it like this. Who probably had the better week financially, the guy who did a couple of open hearts and maybe a day or two in cath lab, or the guy who did 3 spines one day, a couple lap choles another day, and maybe a day at an ASC, and the another day of ortho.

As said above, you have to actually do the work to make the money, at least in most private practices. In academics, a fellowship may get you a 50k bump in salary, but academic CV only positions are becoming harder and harder to come by.
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I honestly didn't know CV-only academic positions even existed. Out of the few places I've seen, there's enough cardiac guys to make the cardiac call a bit less brutal which means it's impossible for everyone to be 100% cardiac on a day to day basis.
 
Dr. Trafalgar Law said:
I’ve heard anecdotal numbers thrown around that 500,000$ is possible out of fellowship and can peak in high six figs in later attending years. Is this true? Furthermore, is it reasonable to think that doing this fellowship would insulate oneself against any potential CRNA encroachment?
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It’s complicated. The demand for cardiac is high but that hasn’t translated into massive salaries. $500k is certainly obtainable. High six figures is going to be very rare.

Cardiac cases generate large units but the payer mix is bad as it’s an older pt population and mostly Medicare. Also most groups are run by generalists that aren’t going to value your contributions more than their own.

It will without a doubt insulate you from crna encroachment.
 
vector2 said:
I honestly didn't know CV-only academic positions even existed. Out of the few places I've seen, there's enough cardiac guys to make the cardiac call a bit less brutal which means it's impossible for everyone to be 100% cardiac on a day to day basis.
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They’re few and far between. Probably depends on the cardiac volume of the institution but I definitely know of at least one or two. Not a terrible career if you love hearts and have decent surgeons.

I was eyeing one place that would've taken a bit of convincing for the Mrs to live there because it was in a University town with awful weather but it would've been a career move. In the end a bunch of things didn't align but it was academic, pure hearts, at a place with "University" in it's name. I feel if those opportunities come for a CV fellowed anesthesiologist you give them a serious look IF you did the fellowship because you like hearts. If you're after money just find a practice that does a bunch of volume and has a lot of opportunity for call stipends.
 
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Twiggidy said:
They’re few and far between. Probably depends on the cardiac volume of the institution but I definitely know of at least one or two. Not a terrible career if you love hearts and have decent surgeons.

I was eyeing one place that would've taken a bit of convincing for the Mrs to live there because it was in a University town with awful weather but it would've been a career move. In the end a bunch of things didn't align but it was academic, pure hearts, at a place with "University" in it's name. I feel if those opportunities come for a CV fellowed anesthesiologist you give them a serious look IF you did the fellowship because you like hearts. If you're after money just find a practice that does a bunch of volume and has a lot of opportunity for call stipends.
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See, I'm doing the fellowship because I love doing hearts and all associated with it, but I'd never take that job because I also love doing everything else. A job where I get to do everything, including hearts, is my ideal situation.
 
nimbus said:
You even love OB?
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For now, yes.

Though this may be because my favorite OB anesthesia attending is a MAJOR proponent of moms getting a little anxiolysis/sedation after baby's out during c-sections so I find myself not having to talk to them. I can only imagine it'll be better in PP where surgeons take 1/4-1/2 the time.

I love anything but sick or nicu peds.
 
abolt18 said:
See, I'm doing the fellowship because I love doing hearts and all associated with it, but I'd never take that job because I also love doing everything else. A job where I get to do everything, including hearts, is my ideal situation.
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This was true for me. I was burnt the heck out after fellowship doing high intensity hearts for a year. Or maybe it was having our first kid in fellowship (with a Type I dissection in the early AM prior to delivery!). I actually do more general than cardiac now, which from a lifestyle perspective is much more reasonable. Basically I work smarter, not harder.

nimbus said:
You even love OB?
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It's not all bad. There are parts that absolutely suck (mostly the heinously terrible communication with OB/GYN that seems to exist at every institution), but I really enjoy the patient population. We don't have a lot of granola "here's my 20 page birth plan" moms and we have enough cred at our shops to tell them to shove it. For the most part, it's a very appreciative patient population and you can make a big, lasting impact. It also pays very well (at least, private insurance does).

I do most of our high risk cardiac OB work in my group. It pays terribly but is professionally rewarding.

But a few bad shifts up there I am grateful for a break.
 
Dr. Trafalgar Law said:
I’ve heard anecdotal numbers thrown around that 500,000$ is possible out of fellowship and can peak in high six figs in later attending years. Is this true? Furthermore, is it reasonable to think that doing this fellowship would insulate oneself against any potential CRNA encroachment?
Click to expand...

No specialty is insulated from the mid-level creep, even cardiac. Nurses do all the lines, TEE placement, some even play with the probe and make "diagnosis." Don't do the year if you think you're going to make yourself immune to that. Do CRNAs do a cardiac fellowship to do these cases? Nope...
 
This is totally region dependent. You should have no issue finding 500k if you’re even somewhat geographically flexible, and that’s for a reasonable schedule. If you really want to grind you can definitely make more than that. High 6 figures would not be typical unless you own part of a surgery center or one of those sketchy ketamine clinics the nurses seem to be flocking to.
Most places I’ve worked or done locums at have docs sitting the stool for cardiac cases. Definitely depends though.
 
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abolt18 said:
Though this may be because my favorite OB anesthesia attending is a MAJOR proponent of moms getting a little anxiolysis/sedation after baby's out during c-sections so I find myself not having to talk to them.
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I can see giving some Propofol to shut them up.....I did it routinely. Giving a benzo is a bad idea though. All you need is some antegrade amnesia and a new mom bitching that she didn't remember her delivery because you "drugged her up."
 
Twiggidy said:
They’re few and far between. Probably depends on the cardiac volume of the institution but I definitely know of at least one or two. Not a terrible career if you love hearts and have decent surgeons.

I was eyeing one place that would've taken a bit of convincing for the Mrs to live there because it was in a University town with awful weather but it would've been a career move. In the end a bunch of things didn't align but it was academic, pure hearts, at a place with "University" in it's name. I feel if those opportunities come for a CV fellowed anesthesiologist you give them a serious look IF you did the fellowship because you like hearts. If you're after money just find a practice that does a bunch of volume and has a lot of opportunity for call stipends.
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Yup. Some of the CV only gigs are really nice schedule wise. Pay isn't as great since you spread the RVUs around to make the schedule work, but if you love hearts and don't want to do EGDs/mastectomies/whatever then it's not a bad gig.
 
Consigliere said:
I can see giving some Propofol to shut them up.....I did it routinely. Giving a benzo is a bad idea though. All you need is some antegrade amnesia and a new mom bitching that she didn't remember her delivery because you "drugged her up."
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And this....

This is like performing a triple double and they complain about that one turnover
 
I think I mostly enjoy it because it’s one place in the OR where you truly are a team and we all know each other’s roles. It just makes sense to me as a former team athlete. I know what they’re supposed to do and they know what I’m supposed to do. It’s the rooms where no one is on the same page that drive me crazy, ie most OB floors.
 
Twiggidy said:
I think I mostly enjoy it because it’s one place in the OR where you truly are a team and we all know each other’s roles. It just makes sense to me as a former team athlete. I know what they’re supposed to do and they know what I’m supposed to do. It’s the rooms where no one is on the same page that drive me crazy, ie most OB floors.
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Team athlete? Orange theory/CrossFit team or a legit sport?
What sport and position? Athleticism is subjective...

I do like the team mentality of cardiac. It can be surgeon dependent as well.
 
Dr. Trafalgar Law said:
I’ve heard anecdotal numbers thrown around that 500,000$ is possible out of fellowship and can peak in high six figs in later attending years. Is this true? Furthermore, is it reasonable to think that doing this fellowship would insulate oneself against any potential CRNA encroachment?
Click to expand...

It may be very difficult to find the same position that can pay around 500 starting out of fellowship that will eventually pay in 700-800K range couple years later. More likely if you want the higher eventual salary, you will probably need to be willing to take less starting out (sort of like a buy-in). Think 300-400k starting for the first 1-3 years.
On the other hand, if you are willing to switch jobs, 500k starting out at one job and then high six figures at another job (Once again, after a certain time period of lower salary) is definitely doable, but I don't think that is what you meant
 
D P356 said:
Team athlete? Orange theory/CrossFit team or a legit sport?
What sport and position? Athleticism is subjective...

I do like the team mentality of cardiac. It can be surgeon dependent as well.
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D1 college football. They guys who's locker was next to me was a Pro Bowler and has 2 Super Bowl rings. If only talent spread like COVID-19.

Honestly, if I could choose any sport to be good or even average at I'd choose professional golf. An average to above averge PGA tour player who never wins a major still does pretty good financially, i.e., Ricky Barnes. Well, maybe average NBA player is better choice but I'm not nearly tall enough.
 
It’s more about the job though. Cardiac cases are a ton of fun and mentally challenging.
 
FWIW, Currently my group pays extra to cover cardiac call and also cardiac folks get a bump in salary.
 
San jose, Regional medical center was offering, Experienced cardiac anesthesiologist 900k. And a leadership position to boot. But he did not take that offer for personal reasons. He is been in practice for 15 years and excellent.
 
Adductor canal said:
San jose, Regional medical center was offering, Experienced cardiac anesthesiologist 900k. And a leadership position to boot. But he did not take that offer for personal reasons. He is been in practice for 15 years and excellent.
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Is it related to the cep/vituity related meltdown of the anesthesiology departments in san jose?
 
Adductor canal said:
San jose, Regional medical center was offering, Experienced cardiac anesthesiologist 900k. And a leadership position to boot. But he did not take that offer for personal reasons. He is been in practice for 15 years and excellent.
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I’m wondering if that 900k was legit. That’s getting into CV surgeon money.
 
I’m wondering if that 900k was legit. That’s getting into CV surgeon money.
Experienced Ortho PA who take night calls are paid. 250-300k in Central Valley ca. So why is it surprising that cardiac anesthesiologist with experience is making good income. The down side is that, on call everyday.
some of the hospital don’t have high cardiac volume and in order to attract patients get affiliated as a Stanford program and some surgeons come from there On specific days.

it related to the cep/vituity related meltdown of the anesthesiology departments in san jose?
dont know a lot of details, but you are correct. Years ago they had a stable group. Negotiations with hospital for subsidy to cover night calls lead to the break up. BTW, Regional and O’Connor are notorious for bad surgeons worse outcomes, and an anesthesiologist colleague of mine who has worked there Told me to stay away from that mess.
Now San Jose is a expensive dump. Uninsured patients and gangs in the bad parts of town.
 
Adductor canal said:
I’m wondering if that 900k was legit. That’s getting into CV surgeon money.
Experienced Ortho PA who take night calls are paid. 250-300k in Central Valley ca. So why is it surprising that cardiac anesthesiologist with experience is making good income. The down side is that, on call everyday.
some of the hospital don’t have high cardiac volume and in order to attract patients get affiliated as a Stanford program and some surgeons come from there On specific days.

it related to the cep/vituity related meltdown of the anesthesiology departments in san jose?
dont know a lot of details, but you are correct. Years ago they had a stable group. Negotiations with hospital for subsidy to cover night calls lead to the break up. BTW, Regional and O’Connor are notorious for bad surgeons worse outcomes, and an anesthesiologist colleague of mine who has worked there Told me to stay away from that mess.
Now San Jose is a expensive dump. Uninsured patients and gangs in the bad parts of town.
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Dude, please learn how to quote posts correctly.
 
I’m making about $330k doing 1/3 cardiac/general BUT I’m now taking every 4th week off and giving away almost all my call.

So my point is there are so many variables, it’s hard to compare. I could make 50% more if I wanted/needed.
 
On this topic, does anyone know (roughly) how much an intra-op TEE reimburses for? I’m seeing on quick google search that cpt code 93312-93318 would end up around 300$. Does that sound accurate?
 
Radar26 said:
On this topic, does anyone know (roughly) how much an intra-op TEE reimburses for? I’m seeing on quick google search that cpt code 93312-93318 would end up around 300$. Does that sound accurate?
Click to expand...

That’s about right. You can get more for tissue Doppler and 3D (some payers, although now they have been asking proof of why you are doing it). I don’t do my own billing but TEE sadly woefully underpays.

I think there are new codes planned or maybe already approved... anyone using them?
 
AdmiralChz said:
That’s about right. You can get more for tissue Doppler and 3D (some payers, although now they have been asking proof of why you are doing it). I don’t do my own billing but TEE sadly woefully underpays.

I think there are new codes planned or maybe already approved... anyone using them?
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you get paid more for TDI???!?

Isn't the TDI a part of a complete exam that everyone skips? (Diastology)
 
dchz said:
you get paid more for TDI???!?

Isn't the TDI a part of a complete exam that everyone skips? (Diastology)
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I don’t think so.
Please share if this is the case.
There is no specific billing codes for tdi or 3d as far as i know.
 
499D9832-BD57-4D75-A53E-FBA3B79CF486.jpeg

AAC02984-E437-4131-853B-4481FE9F142D.jpeg


93355 includes 3D for mitral clips, tavr, etc. Can’t bill separately.
 
dchz said:
you get paid more for TDI???!?

Isn't the TDI a part of a complete exam that everyone skips? (Diastology)
Click to expand...

I have no clue, the billing office sometimes asks me questions that makes me think I did. I’m not breaking the bank with TEE at all, and another reason the field isn’t quite as lucrative as folks think.

chocomorsel said:
How are you privy to this info?
Click to expand...

Welcome back.
 
AdmiralChz said:
I have no clue, the billing office sometimes asks me questions that makes me think I did. I’m not breaking the bank with TEE at all, and another reason the field isn’t quite as lucrative as folks think.



Welcome back.
Click to expand...
Thanks. I better learn how to behave! They trying to get rid of a girl.
 
Radar26 said:
On this topic, does anyone know (roughly) how much an intra-op TEE reimburses for? I’m seeing on quick google search that cpt code 93312-93318 would end up around 300$. Does that sound accurate?
Click to expand...

So from above, 5-6 units. So $100-$120 for your Medicare pts. In a busy practice you might generate an extra $40k in billing a year by having tee expertise. Just further proves the point that form a billing standpoint cv anesthesiologists can’t justify large salaries.

However, we are an essential part of the heart team that supports the cath lab. The cath lab is a cash cow for the hospital. That is where our value is from an administration standpoint. Administration wants happy successful heart surgeons. For the most part the surgeons see what we bring to the table and have our backs.
 
For those unaware nonprofit hospitals have to file a 990 tax form which is a public form and searchable online. Required listings on that form are the compensation of officers, directors, and highest compensated employees. CV surgeon representation is always on there for the handful of places I've been curious enough to check.
 
sevoflurane said:
My salary range over 10 years has been from 450k (worst year but 15 weeks off) to 750k (best year working hard and 8 weeks off)
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What do you consider to be "'working hard?" I currently do 70-80 hrs/wk with 6wks vacation 10 years into my career and don't make that kind of money. I'd love to go to a state where I can make 750K+ and I'm willing to put in the hours (I know this thread is about cardiac guys and I'm not cardiac trained)
 
leaverus said:
What do you consider to be "'working hard?" I currently do 70-80 hrs/wk with 6wks vacation 10 years into my career and don't make that kind of money. I'd love to go to a state where I can make 750K+ and I'm willing to put in the hours (I know this thread is about cardiac guys and I'm not cardiac trained)
Click to expand...
It's not so much "that state" as it is finding the right practice. You need a busy practice with a good payor mix (ie mostly commercial insurance) and probably a busy OB service. The unit value also needs to be above average. You can take a bunch of call, probably like 2x a week overnight and a couple of weekends and you can certainly get to that number.

Let's do rough math
$750000/$50 per unit = 15000 units

so you need to be busy enough to pull 15000 units per year. That's 1250 units per month. Roughly 315 units per week. Roughly 40ish units per day. And that's not counting the 6-8 weeks of vacation so it's definitely more per month/per week/per day
(This all assumes a RVU based practice)

We a busy OR and a busy OB service and not giving any calls away and taking some other folks calls it can be done provided all those stars align.

Edit: Keep in mind, there isn't a practice anywhere that's going to offer you a W2 750k salary. Just wont happen. So given that you do 80hrs/week you currently either have a unit value that is too low, getting salary and not productivity based pay, or do mostly low unit cases
 
leaverus said:
What do you consider to be "'working hard?" I currently do 70-80 hrs/wk with 6wks vacation 10 years into my career and don't make that kind of money. I'd love to go to a state where I can make 750K+ and I'm willing to put in the hours (I know this thread is about cardiac guys and I'm not cardiac trained)
Click to expand...

70-80 hours a week you should be pulling at least 700 mang
 
It’s not just payor mix. BFE practices need to have a fat subsidy in order to capture and keep talented cardiac guys.
 
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