I can't get a definitive answer; will anesthesiologists have significant pay cut

Mar 28, 2010
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I am just looking for an honest simple definitive answer please?

I am a med student and considering gas and would like to know the facts, instead of the partisan biases, about the effects of healthcare reform.


For example, a position at 300K/year now. What should I expect in 5-10 years from now? 125K? 150K? 200K? 250K? 300K? Or nobody knows?


I am hearing 50% salary cuts to only 3.4% cuts, I don't know what is true.



And yes I know it is not about the money. Just curious what I am getting
myself into.


Thank you for those who are wiser and willing to share with me!
 
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GoodmanBrown

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No one knows. The healthcare bill doesn't have definite pay adjustments, it remains to be seen over the coming years. Many people expect specialists to lose out in the long-term, but anesthesiology is already very poorly reimbursed by Medicare.

This year, they got a slight raise, while many specialties got cuts. Only time will tell.
 

karizma098

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all specialties can probably expect a cut. it's probably not going to be a huge change though, not like the 30-40% cuts some are expecting. anesthesia's payouts from medicare ( and some insurance companies ) are already not that great...the bigger cuts are probably going to land on onc, interventional procedures, etc.
 

urge

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Get used to the idea there will be a 50% cut.

Prepare for the worst. Hope for the best. This way you will not regret your decision.
 

karizma098

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Get used to the idea there will be a 50% cut.

Prepare for the worst. Hope for the best. This way you will not regret your decision.
i understand the concept of bracing onesself for the worst....but isn't a 50% cut kind of extreme? in a field where the average salary is ~ 300k a year, do you honestly anticipate income to become 150k? many a nurse, pharmacist, high school administrator , store manager, etc etc make that income , if not more...
 

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i understand the concept of bracing onesself for the worst....but isn't a 50% cut kind of extreme? in a field where the average salary is ~ 300k a year, do you honestly anticipate income to become 150k? many a nurse, pharmacist, high school administrator , store manager, etc etc make that income , if not more...
very few people make 150K per year much less any of the ones u quoted....a few pharmacists and some crna s but thats about it. I would expect to make 190K in the future and anything more accept as a gift. Hopefully it wont be any worse than this
 

karizma098

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very few people make 150K per year much less any of the ones u quoted....a few pharmacists and some crna s but thats about it. I would expect to make 190K in the future and anything more accept as a gift. Hopefully it wont be any worse than this
i dont know any pharmacists making less than 130k a year, i should have clarified 'working anesthesiologist hours'. on a 50-55 hour work week many pharmacists and EVERY Crna would make 150k+. CRNA's at the hospitals i've been at routinely make 170k+ after a few years experience.

high school principals and administrators routinely make over 100-150k, many high school teachers that coach sports bring in over 100k as well. store managers for walgreens, CVS, etc all make more than 150k.

i think paying any physician less than 200k is an insult, FP or anesthesiologist. the money cuts aren't enough to push me out of the field, but definitely tick me off a bit. :mad:
 
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i dont know any pharmacists making less than 130k a year, i should have clarified 'working anesthesiologist hours'. on a 50-55 hour work week many pharmacists and EVERY Crna would make 150k+. CRNA's at the hospitals i've been at routinely make 170k+ after a few years experience.

high school principals and administrators routinely make over 100-150k, many high school teachers that coach sports bring in over 100k as well. store managers for walgreens, CVS, etc all make more than 150k.

i think paying any physician less than 200k is an insult, FP or anesthesiologist. the money cuts aren't enough to push me out of the field, but definitely tick me off a bit. :mad:

Thank you everyone for your responses!


I would guess that if anesthesiologists salaries were to decrease, so would CRNAs and AAs.
 

neutro

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Get used to the idea there will be a 50% cut.

Prepare for the worst. Hope for the best. This way you will not regret your decision.
no offense, but how can you pin a exact % like that?

50% is a HUGE cut.
 

RussianJoo

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no offense, but how can you pin a exact % like that?

50% is a HUGE cut.

dude he's just saying hypothetically.. the fact of the matter is that none of us know what's going to happen. we recently had a pay increase from medicare we might have more increases. or every ones salary might drop. what Urge was saying is that if there was a 50% cut would you still want to do this field? if the answer is yes then apply here and don't ask questions no one knows the answers to. if the answer is no i wouldn't do anesthesia for a 50% pay cut then apply to a field that where you would work for such a pay cut. but this is all hypothetical..
 

RabbMD

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Simple, Medicare pays around $22 a unit. Medicaid less in a lot of states. Anesthesiologist working average hours generate 10,000 units a year. If the blended unit decreases to Medicare rates of say $24/ unit then that means all the anesthesiologist brings in is $240,000 a year before expenses and benefits. Say $90,000 for that and you are left with $150,000. The belnded unit rate is the key.
 

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i dont know any pharmacists making less than 130k a year, i should have clarified 'working anesthesiologist hours'. on a 50-55 hour work week many pharmacists and EVERY Crna would make 150k+. CRNA's at the hospitals i've been at routinely make 170k+ after a few years experience.

high school principals and administrators routinely make over 100-150k, many high school teachers that coach sports bring in over 100k as well. store managers for walgreens, CVS, etc all make more than 150k.

i think paying any physician less than 200k is an insult, FP or anesthesiologist. the money cuts aren't enough to push me out of the field, but definitely tick me off a bit. :mad:

You do realize that pediatric specialist make 90k - 140k starting? They usually max out at about 170-200 ........

So, should we really complain if anesthesiologist and other specialist make 150-180........

Time will tell. Pick a specialty for the love.....not the paycheck.
 

neutro

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dude he's just saying hypothetically.. the fact of the matter is that none of us know what's going to happen. we recently had a pay increase from medicare we might have more increases. or every ones salary might drop. what Urge was saying is that if there was a 50% cut would you still want to do this field? if the answer is yes then apply here and don't ask questions no one knows the answers to. if the answer is no i wouldn't do anesthesia for a 50% pay cut then apply to a field that where you would work for such a pay cut. but this is all hypothetical..
exactly, if this is all hypothetical then whats the point of throwing numbers around like that? its not my place to question the attending physician in any way, and they perhaps know a lot more about billing, etc since they are actually working and are more familiar with day to day transactions...

but...this is exactly how mis-information spreads, and some random lurker is going to read here 'oh, someone on SDN said that gas docs will get a 50% pay cut...so i wont even consider anesthesia, and also announce to everyone around me how bad anesthesia is!'

we saw the same thing happen with the CRNAs, but we made it through.

medicare is extended to 30 million more people (who had ZERO insurance). patients will still have private insurance [a great majority of them], i dont see a 50% net loss anywhere for us.

the closest example i can think of is what happened to oncologists in the early 2000s when the government put restrictions on making profit on chemo. sure oncologists suffered a loss, but it wasnt as drastic. they made the same yearly income pretty much, just that the yearly growth of their salary tapered off.

worst comes to worst, thats what will happen with anesthesia. no one really goes from 350k to 175k in a year. 175 K is what CRNAs make these days. Its hard for me to believe that a gas doc will compete with CRNA...i cant imagine that.
we will probably stay at 350k-400K while primary care gets a boost [and my heart goes out to Family docs who bust their balls, take care of patients that no one else would, and still make less than a CRNA - i think thats extremely unfair to them].

lets hope for the best.
 

karizma098

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You do realize that pediatric specialist make 90k - 140k starting? They usually max out at about 170-200 ........

So, should we really complain if anesthesiologist and other specialist make 150-180........

Time will tell. Pick a specialty for the love.....not the paycheck.
yes, we should complain. the responsibility an anesthesiologist holds on their shoulder's outshadows a pediatrician's, . no offense to them though. 90k is probably for academic jobs also. dont know about other places ,but in illinois if you're willing to do peds or family practice they will subsidize a large chunk of your tuition as well.

private practice peds is closer to the 150k-200k mark. same for FP, more for IM.

also, as a side note, by this same reasoning i admit that surgeons are often underpaid - it's not fair for a general or cardiothoracic surgeon to be compensated 250k / year while the anesthesiologist doing the case is making 30% more than that.

i simply stated paying doctors less than 200 is unfair, not that it doesnt happen. i wish peds and FP were compensated better, maybe in the future they will be.
 

karizma098

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worst comes to worst, thats what will happen with anesthesia. no one really goes from 350k to 175k in a year. 175 K is what CRNAs make these days. Its hard for me to believe that a gas doc will compete with CRNA...i cant imagine that.
we will probably stay at 350k-400K while primary care gets a boost [and my heart goes out to Family docs who bust their balls, take care of patients that no one else would, and still make less than a CRNA - i think thats extremely unfair to them].

lets hope for the best.
that's highly unlikely. i agree that we won't see a 50% cut , that's just not going to happen. but salaries staying at 350-400k is definitely not happening. we're not going to make the same as CRNA's, but both the CRNA's and MD's will see cuts, it's inevitable. they ARE going to reduce medicare reimbursements, and insurance companies ARE going to cut their reimbursements as well. crna's will probably fall back to the 120k mark and MD's will be in the high 200's. still not a bad living. in either case, we'll be fine.
 

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that's highly unlikely. i agree that we won't see a 50% cut , that's just not going to happen. but salaries staying at 350-400k is definitely not happening. we're not going to make the same as CRNA's, but both the CRNA's and MD's will see cuts, it's inevitable. they ARE going to reduce medicare reimbursements, and insurance companies ARE going to cut their reimbursements as well. crna's will probably fall back to the 120k mark and MD's will be in the high 200's. still not a bad living. in either case, we'll be fine.
In my city, that's currently the average starting salary (or so I've heard) for CRNA's and AA's. Do you think the starting salary will stay around that mark, or that the "after x number of years in the field" income will top out at that?
 

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Maybe a young buck like me does not know the value of money, but let's say a physician's salary is reduced to 150K. Isn't 150K a year still a ton of money?? My friends making 100K in other non-medical fields work really hard (~70 hours a week) but still live quite comfortably.

I know we have to pay loans etc etc. But 150K with excellent job security seems like a great gig to me.
 

Chloroform4Life

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Maybe a young buck like me does not know the value of money, but let's say a physician's salary is reduced to 150K. Isn't 150K a year still a ton of money?? My friends making 100K in other non-medical fields work really hard (~70 hours a week) but still live quite comfortably.

I know we have to pay loans etc etc. But 150K with excellent job security seems like a great gig to me.
Not if your student loans total up to 600k after interest.

150K minus tax is about 80k. if you spend half of that to pay your debt, giving you 40k a year to live on, you will pay off your debt in 15 years. 40k is not that bad, but it will be tough to budget kids, retirements, and a decent house in a nice neighborhood with that kind of money. I think doctors deserve to live better than a mediocre life given all they sacrifice throughout med school and residency.
 
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I read SDN nearly everyday and have been for about the past year. Nearly every week a different person asks about what the future compensation will be.

If I could see into the future I would win the lotto every week. The truth is, NO ONE knows what will happen! Opinions are like a%%holes, everyone has one.

Doctors have faced compensation cuts for the past 20 years and they have always been creative about making sure there pay does not decrease. Will we work more? most likely, will you do a few procedures that werent really needed for some extra billing? yes.

The only thing that I can tell you for sure is that taxes will definately be going up in the future. Look at Greece!

So even if anesthesiologists still make 400K, they are going to pay a lot more in taxes.
 

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i understand the concept of bracing onesself for the worst....but isn't a 50% cut kind of extreme? in a field where the average salary is ~ 300k a year, do you honestly anticipate income to become 150k? many a nurse, pharmacist, high school administrator , store manager, etc etc make that income , if not more...
Store Manager? I worked at a department store as an assistant manager at night to pay for college and I made $12 an hour, the manager couldn't have been making much more

Why is everyone so upset about $300K turning into $200K?

I have a friend who just started as a Pediatrician first year out of residency. She works M-F in the practice from 8a-6p, before that she has to see the inpatients and the covers the NICU, yes the NICU one day a week. It is only a 7 bed unit, but she still does vent management, intubations, etc...She makes 90K a year

I have another friend who just finished a PICU fellowship. He is doing alot of the same things you are, vent management, central lines, LPs, extremely sick and complex children who often die in from of him. Heme Onc kids, organ transplants, congenital hearts, trauma, etc....He works 7 days on (24-7 for seven days, he is in house during they day, on call at night) and then has 7 days off. He makes $145K a year.
 

karizma098

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Store Manager? I worked at a department store as an assistant manager at night to pay for college and I made $12 an hour, the manager couldn't have been making much more

Why is everyone so upset about $300K turning into $200K?

I have a friend who just started as a Pediatrician first year out of residency. She works M-F in the practice from 8a-6p, before that she has to see the inpatients and the covers the NICU, yes the NICU one day a week. It is only a 7 bed unit, but she still does vent management, intubations, etc...She makes 90K a year

I have another friend who just finished a PICU fellowship. He is doing alot of the same things you are, vent management, central lines, LPs, extremely sick and complex children who often die in from of him. Heme Onc kids, organ transplants, congenital hearts, trauma, etc....He works 7 days on (24-7 for seven days, he is in house during they day, on call at night) and then has 7 days off. He makes $145K a year.
i was referring to healthcare related store managers, Walgreens, CVS, as i mentioned in my previous post.

yes, there are peds making 90k. i'm sorry for your friend, but i'm sick of hearing about peds making 90. the only place i see that is at big university centers for cushy jobs. most peds docs in chicago easily break 150k their first year out. glance over at the peds forums if you don't believe me.

7 days on and 7 days off tend to pay less. IM docs in that field also start out at around 150k.

people are upset about 300k becoming 200k because 100grand is 33 percent of your income. that is a big change in lifestyle, retirement funding, time taken to pay off loans, kids college money, vacations, everything.

and please everyone, no more anecdotal ' i have a friend who makes 8 dollars an hour working trauma surgery in peds in new york city' bs.

the 'average' starting salary is 130-150k, as listed on numerous online sources.

once again, i feel terrible for the peds and FP guys. if i had it my way, id pay them double, but i'm not the president, so in the meantime, i'd just like to protect my own interests, if that's okay.

and to above poster, no, 150k is not a ton of money when u start earning @ age 30 or older.
 
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IlDestriero

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yes, we should complain. the responsibility an anesthesiologist holds on their shoulder's outshadows a pediatrician's, . no offense to them though. 90k is probably for academic jobs also. dont know about other places ,but in illinois if you're willing to do peds or family practice they will subsidize a large chunk of your tuition as well.

private practice peds is closer to the 150k-200k mark. same for FP, more for IM.

also, as a side note, by this same reasoning i admit that surgeons are often underpaid - it's not fair for a general or cardiothoracic surgeon to be compensated 250k / year while the anesthesiologist doing the case is making 30% more than that.

i simply stated paying doctors less than 200 is unfair, not that it doesnt happen. i wish peds and FP were compensated better, maybe in the future they will be.
The CT surgeons that I work with, and worked with at my last job, all make close to 7 figures and the head of CT at both places made WELL over $1M. The only CT surgeon making 200k is in the active duty military. Gen surg is another story. That's their problem. Clinic pays poorly, the OR pays well. It's not surprising that we can make more working in the OR every day. Our salaries may fall, as will all specialists, but we're not going to be hurting, and it's easy to downsize your lifestyle a bit as needed. You know, like a 34 foot sailboat instead of the 42 footer.;) or maybe an M3 instead of an M5 with a garmin GPS instead of the $3500 factory Navi.:eek:
 

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My first post on this forum!

Anyways, I've been out in practice almost 6 years now. Can't believe it's been that long.

To answer the OP's concerns about salaries for anesthesiologists.

As other posters have stated, we really don't know what the future holds. I come from a family of anesthesiologist siblings/brother's in law. I'm the youngest of the bunch so I have a little more perspective.

Anesthesia has always been a weird field in terms of salaries.

In the 1980's (the golden age of anesthesia reimbursements), MD's were routinely making over $500-600K. Keep this in mind. That's 1980's money. Adjusted for inflation that's probably close to over 1 million in 2010 dollars, all working less than 50 hours a week.

Fast forward to the mid 1990s when there were no jobs for anesthesiologists. My brother who completed his cardiac fellowship in 1996 took a job on the East Coast for $110K. That's right $110K! My brother in law came out in 1997 and he got $120K, my sister started at $120K in 1998. Than my other brother in law came out in 2001 and started at $180K.

When I came out in 2004, I started at $220K. Anesthesia salaries really started making a comeback in the early 2000s, so I have been lucky. Currently I make in the mid $400k range doing strictly outpatient anesthesia 530am-3PM down in the South. No weekends, no calls.

My brother (who's the oldest and has been out since 1996) is currently working in downtown Los Angeles proper and makes almost $600K a year. But he works 60 plus hours a week and also does cardiac.

My brother in law currently makes in the low 400Ks in the east coast. But he works about 50 hours a week. His other partners work like crazy 60/70 hours and pull over $700K a year. My best friend from med school works in the "holy grail" of Anesthesia reimbursements...aka Texas. He was making close to 1 million as of 2008 (prior to lehman brother's financial crash). Last year he took a hit and his salary went down to $600K (he had to give up his yellow Lamborghini).

I'm not stupid. Anesthesia salaries (along with other specialities) will go down again. Using the Canadian model since I know some Canadian anesthesiologists. Most of them up there still make in the $300-400K range but they all work close to 60 hours a week.

So an outpatient M-F job I have now will go way down to the mid 200s. Hospital Based anesthesiologist will still command in the $300-400K range. We just won't see many anesthesiologists like my friend in Texas making close to one million anymore.

The lesson here is not to live a lavish lifestyle (the Italian Sports Car, the two homes and the boat etc). I know salaries will take a hit (my radiology friends are going through it right now).

FYI: My other non-MD other brother is a pharmacist at Walgreens. He's been out since 1997. He pulls in over $150K a year on the east coast. Pharmacist get paid very well.

The salaries that are really out of order are the CRNAs. I'm down in Florida and most CRNA "command" at least $150K (w2) or $200K (1099). AA's even get $120K and up.

If we are taking a hit, the CRNAs and AAs are in for a rude awakening. Most of the inflated CRNA salaries are out in rural areas.
 

karizma098

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My first post on this forum!

Anyways, I've been out in practice almost 6 years now. Can't believe it's been that long.

To answer the OP's concerns about salaries for anesthesiologists.

As other posters have stated, we really don't know what the future holds. I come from a family of anesthesiologist siblings/brother's in law. I'm the youngest of the bunch so I have a little more perspective.

Anesthesia has always been a weird field in terms of salaries.

In the 1980's (the golden age of anesthesia reimbursements), MD's were routinely making over $500-600K. Keep this in mind. That's 1980's money. Adjusted for inflation that's probably close to over 1 million in 2010 dollars, all working less than 50 hours a week.

Fast forward to the mid 1990s when there were no jobs for anesthesiologists. My brother who completed his cardiac fellowship in 1996 took a job on the East Coast for $110K. That's right $110K! My brother in law came out in 1997 and he got $120K, my sister started at $120K in 1998. Than my other brother in law came out in 2001 and started at $180K.

When I came out in 2004, I started at $220K. Anesthesia salaries really started making a comeback in the early 2000s, so I have been lucky. Currently I make in the mid $400k range doing strictly outpatient anesthesia 530am-3PM down in the South. No weekends, no calls.

My brother (who's the oldest and has been out since 1996) is currently working in downtown Los Angeles proper and makes almost $600K a year. But he works 60 plus hours a week and also does cardiac.

My brother in law currently makes in the low 400Ks in the east coast. But he works about 50 hours a week. His other partners work like crazy 60/70 hours and pull over $700K a year. My best friend from med school works in the "holy grail" of Anesthesia reimbursements...aka Texas. He was making close to 1 million as of 2008 (prior to lehman brother's financial crash). Last year he took a hit and his salary went down to $600K (he had to give up his yellow Lamborghini).

I'm not stupid. Anesthesia salaries (along with other specialities) will go down again. Using the Canadian model since I know some Canadian anesthesiologists. Most of them up there still make in the $300-400K range but they all work close to 60 hours a week.

So an outpatient M-F job I have now will go way down to the mid 200s. Hospital Based anesthesiologist will still command in the $300-400K range. We just won't see many anesthesiologists like my friend in Texas making close to one million anymore.

The lesson here is not to live a lavish lifestyle (the Italian Sports Car, the two homes and the boat etc). I know salaries will take a hit (my radiology friends are going through it right now).

FYI: My other non-MD other brother is a pharmacist at Walgreens. He's been out since 1997. He pulls in over $150K a year on the east coast. Pharmacist get paid very well.

The salaries that are really out of order are the CRNAs. I'm down in Florida and most CRNA "command" at least $150K (w2) or $200K (1099). AA's even get $120K and up.

If we are taking a hit, the CRNAs and AAs are in for a rude awakening. Most of the inflated CRNA salaries are out in rural areas.
thank you so much for the post.

it's nice to hear from someone who's not all doom and gloom. i agree, there are random anesthesiologists bring in 600-700k+ even here in chicago, but they work their A** off and are few and far between. the sky might fall a little, but i don't think making 300k/year is going to be impossible.
 

karizma098

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The CT surgeons that I work with, and worked with at my last job, all make close to 7 figures and the head of CT at both places made WELL over $1M. The only CT surgeon making 200k is in the active duty military. Gen surg is another story. That's their problem. Clinic pays poorly, the OR pays well. It's not surprising that we can make more working in the OR every day. Our salaries may fall, as will all specialists, but we're not going to be hurting, and it's easy to downsize your lifestyle a bit as needed. You know, like a 34 foot sailboat instead of the 42 footer.;) or maybe an M3 instead of an M5 with a garmin GPS instead of the $3500 factory Navi.:eek:
wow, thats good to hear. for some reason i thought the Card. surgeons were really hurting, similar to the general surgeons. im' happy for them, it's a rough job!
 

badasshairday

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The lesson here is not to live a lavish lifestyle (the Italian Sports Car, the two homes and the boat etc). I know salaries will take a hit (my radiology friends are going through it right now).
Rads and Cards were put on the chopping block this time, ie. medicare cuts (which private insurers follow suit). The unique thing about Anesthesiology is that it regulates it's own reimbursements through supply/demand. I mean medicare already pays crap for anesthesiology services, but private insurers pay way more, so a cut/bump in medicare reimbursement doens't really mean much. Over supply will do Anesthesiology in. But we all know that eventually corrects itself.
 

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This thread makes me nauseous.
 

LIDO

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i was referring to healthcare related store managers, Walgreens, CVS, as i mentioned in my previous post.

yes, there are peds making 90k. i'm sorry for your friend, but i'm sick of hearing about peds making 90. the only place i see that is at big university centers for cushy jobs. most peds docs in chicago easily break 150k their first year out. glance over at the peds forums if you don't believe me.

7 days on and 7 days off tend to pay less. IM docs in that field also start out at around 150k.

people are upset about 300k becoming 200k because 100grand is 33 percent of your income. that is a big change in lifestyle, retirement funding, time taken to pay off loans, kids college money, vacations, everything.

and please everyone, no more anecdotal ' i have a friend who makes 8 dollars an hour working trauma surgery in peds in new york city' bs.

the 'average' starting salary is 130-150k, as listed on numerous online sources.

once again, i feel terrible for the peds and FP guys. if i had it my way, id pay them double, but i'm not the president, so in the meantime, i'd just like to protect my own interests, if that's okay.

and to above poster, no, 150k is not a ton of money when u start earning @ age 30 or older.
Many pediatric specialist work in academic centers, not for "cushy jobs", but because of the patient volume. Also, these jobs are not that "cushy". Have you worked with a pediatric oncologist or cardiologist at one of these "cushy" academic jobs? Many of them bust hump.

Honestly, if I decide to go the anesthesiologist route it will be for the love of physio, pharmacology, and alleviating pain/fear. I will most likely end up working at an academic center and never expect to see the 250-350 salaries.

Do the job for the love and interest. A decrease in salary is devastating only if that is the most important aspect.

Nobody knows the outcome. Nobody can predict the market and politics. But you CAN learn to predict and understand your passion.
 

Taurus

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This was helpful.

What Does the Health Care Reform Legislation Mean for Anesthesia Practices?

March 29, 2010

The 21.2% SGR Medicare Payment Cut -- Back on the Table, For Now

On Friday afternoon, March 26th, the Senate adjourned for the “Spring District Work Recess” without adopting House-passed legislation that would have extended current Medicare physician payment rates through April 30, 2009. A vote on extending those rates is scheduled for the afternoon of April 12th, the day that the Senate returns. Readers should make sure to contact their Senators once again to communicate the urgency of repealing the sustainable growth rate (SGR) formula – not just for deferring the SGR-driven decrease.

CMS will once again instruct the Part B contactors to hold claims for the first two weeks of the month so that no retroactive adjustments will be necessary. Late last week, CMS issued the following notice:

CMS believes Congress is working to avert the negative update that will take effect April 1. Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS (including anesthesia services) for the first 10 business days of April. This hold will only affect claims with dates of service April 1, 2010, and forward. In addition, the hold should have minimum impact on provider cash flow because, under the current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.

What does the health care reform package, which passed the House of Representatives on Sunday, March 21st by a vote of 219-212, change for practicing anesthesiologists & Nurse Anesthetists?

1. Expand coverage: With 32 million uninsured Americans to be covered by 2019, there will be more elective surgeries and fewer charges to be written off. -Once the legislation – the Patient Protection and Affordable Care Act of 2009 (PPACA, H.R. 3590) -- is fully implemented, 95 percent of the population will have health insurance.

1. Young adults are more likely to have coverage, since their insured parents can now keep them on the policy until age 26. Anesthesiologists who are themselves parents of young adults will have better options for helping to insure them. This provision of the legislation takes effect immediately.

2. Health insurance will be more affordable for families and small businesses because of tax credits and subsidies.

1. Insurance market reforms : Within six months, health plans will be no longer be able to set lifetime or unreasonable limits on the dollar value of benefits. Beginning in 2014, health plans will be prohibited from (a) imposing any pre-existing condition exclusions or engaging in medical underwriting and (b) charging higher premiums or denying coverage based on health status. This too should theoretically reduce some of the collection difficulties experienced by health care providers. Anesthesiologists are not typically the doctors with whom patients have their strongest or most enduring relationships and thus balance billing can be problematic. Fairer, continuing, no-surprises coverage for patients should benefit anesthesia groups that might not have been paid when the health plan denied or canceled coverage in the past.

1. Health insurance exchanges: Effective January 1, 2014, the states must establish “American Health Benefit Exchanges,” in which health plans wishing to tap into the increased pool of potential customers will offer qualified health benefit plans. The “public option” that was part of the legislation adopted by the House in 2009 is gone. It will be very important for our specialty to keep an eye on provisions regarding access to and payment for anesthesia services as the federal criteria for qualified plans develop.

1. Medicaid will add 16 million low-income enrollees who will presumably seek more non-emergency services. Providing care for a large number of patients whose health plan pays for anesthesia services using a $9.30 (NJ) or $14.50 (FL) conversion factor could wreak havoc on practice finances.

1. PQRI: In 5 years physicians will be required to report quality measures under Medicare’s Physician Quality Reporting Initiative, or see a reduction in their payments. Like ASA and others, we have long expected that the carrot of the annual PQRI bonus would at some time turn into the stick of lowered payments for noncompliance, and now we know when that will happen.

1. PQRI bonuses will decrease from current incentives of 2% of overall Medicare charges today and in 2011 to 0.5% of charges in 2012, 2013 and 2014. Providers who don’t participate in PQRI will see payments drop by 1.5% in 2015 and 2% in 2016.

1. Increase payroll taxes on unearned income: “High-income earners,” i.e., single taxpayers with salaries of $200,000 or more and couples with combined salaries of at least $250,000, will pay a Medicare surtax of 0.9% beginning in 2013. The “fixes” bill, the “Health Care and Education Reconciliation Act of 2010.” (H.R. 4872), which both the Senate and the House passed on Thursday March 25th will apply the an additional 3.8 percent tax on investment income that exceeds the threshold.

1. The PPACA also limits contributions to Flexible Spending Accounts and increases the threshold for deducting medical expenses from 7.5 percent to 10 percent of adjusted gross income.

1. Tax high-cost (“Cadillac”) health insurance benefits: The fixes bill also lessened the impact of the 40% excise tax on Cadillac health insurance benefits by delaying implementation until 2018.

1. Fraud and abuse enforcement: The PPACA contains a package of changes intended to reduce waste, fraud and abuse. Of particular interest to anesthesiologists are the following:

1. Fines for fraudulent activity will increase to as much as $50,000 for each violation. All payments to the practice may be suspended pending a fraud investigation.

1. The Department of Health and Human Services will establish a new national fraud and abuse data collection program, which will submit information to the National Practitioner Data Bank.

1. The PPACA also requires HHS to establish a self-disclosure protocol for Stark violations.

1. Physician-owned hospitals that do not have provider agreements in place before December, 2010 will be ineligible to participate in Medicare.

1. Manufacturers of drugs, biologics, equipment and supplies will be required to disclose gifts to physicians.

What does the legislation not do?

1. Fix the SGR problem: The PPACA does not address the untenable formula driving bigger and bigger Medicare physician payment cuts. An amendment introduced by Senator Judd Gregg (R-NH) but that was not adopted would have frozen payment rates at current levels under 2013. It would not have done away with the Sustainable Growth Rate formula, however, and the annual cycle of threatened reductions and last-minute temporary rescues by Congress will continue.

1. Cut Medicare rates: Contrary to the belief of many who oppose health care reform, payment levels and coverage under traditional Medicare fee-for-service, the form of coverage enjoyed by 80% of Medicare beneficiaries, is unchanged by the passage of the legislation. Benefits stay the same, except for tsome of the drug, vision etc. benefits offered by the Medicare Advantage plans to which 24% of eligible patients belong. When the Medicare Advantage program was set up in 2003 budget legislation, Congress gave private health insurers a 15-percent incentive to launch plans. That bonus will be eliminated. This means that some beneficiaries who like their Medicare Advantage plans will not be able to keep them. It also means that the 76 percent with traditional Medicare will no longer be subsidizing the Medicare Advantage costs of the 24 percent.

Why do ASA and other medical specialty societies oppose the legislation?

ASA and other specialties sent a joint letter to Speaker of the House Nancy Pelosi on March 19 stating their disappointment and opposition to the Senate bill. This was based on two factors:

(1) the bill’s failure to correct the malignant SGR formula and

(2) the creation of “the unelected, unaccountable Independent Payment Advisory Board (IPAB). The IPAB must make recommendations every January 15th to the President and Congress for ways to reduce Medicare costs when spending exceeds the Consumer Price Index (through 2017) or the Gross Domestic Product (after 2017). There will be restrictions on Congress’ ability to change the recommendations, and if Congress fails to act, CMS will implement the IPAB’s recommendations.

ASA also rejects the bill’s “anti-discrimination” provisions that would require health plans to credential and pay providers based on state scope of practice laws, not on health plans’ own quality standards.

The AMA announced its qualified support for S.3590 on March 19, saying:

By extending coverage to the vast majority of the uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens, and promoting clinical comparative effectiveness research, the AMA believes that H.R. 3590 does, in fact, improve the ability of patients and their physicians to achieve better health outcomes.

Supporters of the PPACA cite Congressional Budget Office estimates that the legislation will cut the federal budget deficit by $138 billion over the next ten years and by a further $1.2 trillion in the following ten years. Spending is expected to increase by $938 billion over the next 10 years – less than if the health care reform package had not become law.

Where do things stand procedurally?

In the end, the Reconciliation bill passed the Senate 56 to 43, and the House approved it again, this time on a 220 to 207 vote. It now awaits President Obama’s signature.

The combined PPACA, Reconciliation bill and Manager’s Amendment run several thousand pages in length. We have tried to summarize the most significant provisions that will affect anesthesia practice above; undoubtedly there will be questions from you, our readers, and we will probably uncover issues that are just as important for us all to understand. Please check next Monday’s Alert (April 5) for any updates.

With best wishes

Tony Mira
President and CEO
Anesthesia Business Consultants, LLC​
 
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Pardon my ignorance here, but I don't know a lot about how Medicare/Medicaid works. If these reimbursements are decreased, would doctors have the ability to not see Medicare/Medicaid patients, or at least put a cap on the number of these patients they treat, and fill the bulk of their patient load with insured or the occasional private pay?
 

HenryH

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The salaries that are really out of order are the CRNAs. I'm down in Florida and most CRNA "command" at least $150K (w2) or $200K (1099). AA's even get $120K and up.

If we are taking a hit, the CRNAs and AAs are in for a rude awakening. Most of the inflated CRNA salaries are out in rural areas.
I thought that CRNA's and AA's were both paid the same salaries when employed in the same practice... ? Are the CRNA's you referenced who command $150k working in rural/"solo" practices?
 

hoyden

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You do realize that pediatric specialist make 90k - 140k starting? They usually max out at about 170-200 ........

So, should we really complain if anesthesiologist and other specialist make 150-180........

Time will tell. Pick a specialty for the love.....not the paycheck.
Compare the work hours and the job intensity and then compare salaries.
 

LIDO

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Compare the work hours and the job intensity and then compare salaries.
Never said the level of intensity was identical. Anesthesiologist (from what attending docs have told me) are chilled out 95% of the time and have 5% of anal clenching fear.

Pediatric oncologist work with the constant stress of having the lives of children rest in their hands. Plus, you will NOT cure each child....and the ones that don't make it must be devastating for the treating physician over the years.

I am not trying to compare money to job / intensity. You missed the message in my post. I am saying do what you love, and no matter how much (or "little) you make, you will be happy.

Oh....and pediatric specialist do have long hours, on call, nights in the hospital.
 

tncekm

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very few people make 150K per year much less any of the ones u quoted....a few pharmacists and some crna s but thats about it. I would expect to make 190K in the future and anything more accept as a gift. Hopefully it wont be any worse than this
If MD's qualified for overtime, really $150,000 is probably similar to what some nurses are making (read: RN/BSN). If you're working a 55hr/wk workweek (pretty average for physicians), that's just over $40/hr assuming overtime pays time and a half. If you don't figure for overtime style compensation, that's still $52/hr. That's what dental hygienists make in high paying cities like San Francisco on a 2yr prereq + 2yr certificate program. The average public employee, with crap for education, is making about $38/hr with ridiculous retirement benefits (up to 90% retirement salary in CA). If you calculate benefits into the average public employee workers income, they make $57/hr, more than many family practitioners--again, these people have CRAP for an education, made little to no sacrifice, and all they have to do is provide unions (and therefore politicians) with money and votes for stealing other peoples money.
 
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aneftp

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I thought that CRNA's and AA's were both paid the same salaries when employed in the same practice... ? Are the CRNA's you referenced who command $150k working in rural/"solo" practices?
No we are talking about a major US city on the East Coast that pays this salary to AA's (around 120K with benefits) and $150K for CRNAs. I'm sorry I can't specifically name the city or the hospital because AA's are only licensed in only a few jurisdictions. But let's just say this city has well over 5-6 million people within it's surrounding metropolitan area.

Those CRNAs out in solo practice or doing locums in rural area make routinely $250K plus. A few of them I know out in Texas make over $300K. I've work with plenty of CRNAs and they can easily make over $200K with 10 weeks of vacation doing locums if they wanted. But the rural area CRNAs out by themselves really do pull $250K and up easy.
 

Matty44

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Im sorry, but I have to say that I believe you're wrong. Unless the one hospital you refer to is just some weird aberration. When working in the ACT model, AAs and CRNAs at the same hospital will get the same salary and benefits according to their level of experience. Hence, AA with 3 years experience will make the same as a CRNA with 3 years experience. Only difference in pay comes when the CRNA is working independently.
 

aneftp

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Im sorry, but I have to say that I believe you're wrong. Unless the one hospital you refer to is just some weird aberration. When working in the ACT model, AAs and CRNAs at the same hospital will get the same salary and benefits according to their level of experience. Hence, AA with 3 years experience will make the same as a CRNA with 3 years experience. Only difference in pay comes when the CRNA is working independently.
Experience does matter in pay scales.

However, the one particular location pays the AA's $120K (it was as low as $90K four years ago). and the CRNAs around $150K.

Perhaps the primary difference in salaries at the hospital is the AA's generally work 7AM-3PM M-F while the CRNA's work 7AM-7PM and pull a few 7PM-7AM shifts and work at least one weekend a month. For some reason the anesthesia dept. does not want the AA's working overnight or weekends. Maybe it's just perference of the group or the hospital wanting it that way. Who knows. But those are the salaries. My brother in law is one of the senior anesthesiologist of the group so I know those are the salaries.
 

Matty44

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Wait, are you saying that CRNAs make $150k on average cause they work more total hours than the AAs, or are you saying that a new grad CRNA starts at $150k for a 40hr/wk and a new grad AA starts at $120K for the same hours?
 

AegriSomnia

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It's probably because of the hours worked past 5PM. Many places pay a shift differential for weekend, evening, or overnight hours worked. Where I am, nurses, medics, and RTs can earn up to $8 extra per hour if working overnight or weekends and that adds up over the year. I'm guessing that the CRNAs would have a higher shift differential and that would account for the difference in pay over the year.
 

Matty44

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AAs and CRNAs are typically hired at a starting salary which encompasses the first 40 hrs worked. Any time over that is usually time and a half, and if they are on call, its usually time and a half too, but may vary if its in house or beeper call. But EVERYONE I have ever talked to about AA vs CRNA salary has said that if they are working the same hours, in the same facility, the pay is equal, that's why I have a hard time believing that an AA would make $30k less than an equally experienced CRNA - if in fact that's what is being implied.
 

aneftp

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Wait, are you saying that CRNAs make $150k on average cause they work more total hours than the AAs, or are you saying that a new grad CRNA starts at $150k for a 40hr/wk and a new grad AA starts at $120K for the same hours?
The AA's are lucky they have gotten a big boost in income recently. Can't remember when the legislation took place but it used to be only 2 to 1 supervision. Now it's up to 4 to one supervision. AA legislation is constantly changing from state to state. Frankly I can't even keep up with it.

Anyways, the difference in income is a combination of experience, hours worked, weekends worked etc. It's all a matter of negotiations and supply and demand. But the going wages are what the market currently dictates.
 

Matty44

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I guess I'm having a hard time making myself clear...OBVIOUSLY if a CRNA has more experience, works more hours, AND works weekends, then YES, they would make more than an AA with less experience who is working less hours. Can you just give a simple yes or no to my following statement please? Are you saying that an AA with EQUAL experience and EQUAL hours worked will make less than a CRNA at this hospital you are talking about?
 

HenryH

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I'd also like to know the answer to Matty44's question as I am considering AA school. So the AA's working for the group aren't allowed to work any overtime hours? Do the CRNA's get paid time and a half to work for every hour worked over 40 in a week?
 

urge

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AAs and CRNAs are identical in terms of everything when they work in the same group.
 

Matty44

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I know that, but it sounds like aneftp is claiming there is a hospital that has a $30k discrepancy. Unless he's just having trouble being clear about what's really occurring there...which I think is the case.
 

aneftp

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I know that, but it sounds like aneftp is claiming there is a hospital that has a $30k discrepancy. Unless he's just having trouble being clear about what's really occurring there...which I think is the case.
You guys/gals appear pretty young or not too knowledgeable how private practice works or just business works. This isn't meant to be insulting but there are variables in any and most contract negotiations.

Not everyone makes the same money regardless of work experience/training level. In a perfect world, they would happen but it's not a perfect world.

My brother in law's group is private. They have contracts with 2 hospital and 2 surgery centers. Thus the AA/CRNAs are not employees of the hospital but of the anesthesia practice.

1. AA's (primarily women with kids in this practice) are ok with working 7AM-3PM for $120K.
2. CRNAs (primarily men and probably the main bread winner) are ok with working "shifts" since they are nurses by training. They don't mind working 7am-7pm or 7pm-7am shifts. Because the CRNAs work more nighttime shifts and overnight and do weekends, they get paid more. None of the AAs work on weekends.

They also employ a few part time CRNAs who only work days and they have one CRNA full time day only W2 who does get paid around $130k but she's much older in her late 50s with 20 plus years experience.

Think about it. If you are a woman with 2 young kids and you are offered a 7AM-3PM job, no calls, no weekends and a chance to be with your kids when they get home from school. There are a lot of professional women who make that decision to take less pay.

Once you get out in the "real world" you'll find out how to or how not to negotiate contracts. Let's swing over to the MD side. When I came down to Florida I was offered a job at an outpatient facility for $375K. I turned them down. Some negotiations later, I got them up to $420K, but I still turned them down. I didn't have a good feeling about how the surgeons wanted things to be done. A colleague of mine ended up taking the same job for $380K. They had offered him $360k and he thought he was making out like a bandit at $380K. So he ended up taking a job for $40K less than what I was offered. This is obviously after the fact since I didn't know him until after he signed on for the contract. He's still kicking himself for signing the contract.

But you also need to know when to stop haggling. One locums CRNA with my current practice was offered $190K as a 1099 (this is down in Florida). We usually pay CRNAs $180-190K 1099, $140-150K W2. We finally offered her $200K which was more than other CRNAs who had been there more than 3 years. She wanted another $10K. Finally we just decided to go in another direction with another CRNA for $190K. So you have to know how to play the cards in the negotiations game.
 

Matty44

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Okay, so apparently you STILL can't answer my simple question. If an AA and CRNA at this hospital work the same amount of hours and have equal experience, will they get paid equally? Very simple question. Yes or no please.

We all understand the concept of making different amounts of money for working different amounts of hours/different times (nights, weekends, call, etc). The only reason we're interested in what you are saying is because you initially made a statement that implied that AAs were getting paid less than CRNAs at this hospital as a matter of title, not because they worked less hours or had less experience.

And yes, despite how 'young' you may think I am, I do understand that different people can negotiate different contracts, but we're talking on average here.
 

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What he said is that for the hours that most of the AAs wanted to work the salary was 120K and a CRNA that worked similar hours got paid similarly. The reason the other CRNAs are getting paid more is because of working longer shifts along with nights and weekends. That is why they are getting paid more. The question is not are they getting paid the same, because when working the same hours/days they are, but are the AAs able to work shifts similar to the CRNAs in that practice or is it open to the CRNAs only.
 
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