if jobs like this are still out there....

[karizma098]

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okay.

so i've been hearing a growing trend of criticism from a lot of my attendings and other physicians about the fact that "it's impossible to make more than 250k in a area like cali, ny, or chicago without working your tail off in gas"

i know gaswork isn't the best place to look for a job - but that should help my point a bit more. if these types of jobs have just been listed in the past 2 weeks on gaswork, is the job situation/salary compensation really that bad?

http://gaswork.com/post/115165

http://gaswork.com/post/115128

http://gaswork.com/post/114490

im still far from seeing the light of such compensation, and i know a lot can change in the next 5 years, but for those residents and attendings out there who mention the job search, are these jobs not typical of the region? and if not, what's the catch?

just looking to educate myself. thanks!

 

[IN2B8R]

okay.

so i've been hearing a growing trend of criticism from a lot of my attendings and other physicians about the fact that "it's impossible to make more than 250k in a area like cali, ny, or chicago without working your tail off in gas"

i know gaswork isn't the best place to look for a job - but that should help my point a bit more. if these types of jobs have just been listed in the past 2 weeks on gaswork, is the job situation/salary compensation really that bad?

http://gaswork.com/post/115165

http://gaswork.com/post/115128

http://gaswork.com/post/114490

im still far from seeing the light of such compensation, and i know a lot can change in the next 5 years, but for those residents and attendings out there who mention the job search, are these jobs not typical of the region? and if not, what's the catch?

just looking to educate myself. thanks!

There's no point in making more than 250K. It's a wrigged system, uncle Sam gets everything you make over 250K back via the AMT (alternative minimum tax) system. Your attendings are smarter than you give them credit for, that's why they are happy at being at 250k and below....

 

[RussianJoo]

these jobs make you work your ass off like the attendings you spoke to have mentioned.

the cali job has frequent call and vacation time isn't given so that might mean something like 4 weeks or even less, most likely less. Flexible vacation really means you take the vacation when it's comfortable for the group not for you.

the Illinois job also a work horse probably, call frequency varies, what does that mean? 5 weeks vaca, that's pretty minimal too.

NY job: is listed by a recruitment agency a lot of times these people list jobs that seem good, to get you to call and then they'll say this one has been filled but we have a few others to offer you, so you can't really trust them, however the call schedule isn't listed, and it seems like they prefer a fellowship..

i too am only a medical student but that's my take on those jobs.. I am not saying they're terrible jobs, i'd love to have any of them but i think these are much harder working jobs than what people have seen in the past. I've heard of people having 8 weeks of vacation or more.

I am sure others will have different opinions.

 

[yasha83]

There's no point in making more than 250K. It's a wrigged system, uncle Sam gets everything you make over 250K back via the AMT (alternative minimum tax) system. Your attendings are smarter than you give them credit for, that's why they are happy at being at 250k and below....

I'm sure the bracket creep of the AMT is royally annoying anesthesiologists uniformly these days. Although I'm a bit confused, I thought the AMT essentially amounted to taxing those making above $175,000 or so?

 

[IN2B8R]

I'm sure the bracket creep of the AMT is royally annoying anesthesiologists uniformly these days. Although I'm a bit confused, I thought the AMT essentially amounted to taxing those making above $175,000 or so?

It's annoying everyone....The more you make, the worst the tax bracket, especially when it comes to the AMT (a fuggin shadow tax system that parallels the regular tax system that is meant to punish those who work hard and who try to move up the social ladder). Anesthesiologists and most subspecialists who earn 4-500K are not gonna reap much benefit for working hard--uncle Sam always has the KY-Jelly ready to go.... I get angry just typing these words and thinking about how much money I piss away each tax season.😡

 

[2ndyear]

First job, 2500-3000 deliveries means you're doing a lot of c-sections (30% section rate, over 800 sections per year maybe more, equals over 2/day on average). That means your q8 is now q4 'cuz if there's an appy/chole/bowel/whatever going on at night and you do that much OB, your second call is either in-house or on a very short leash. Pay is good though.

 

[karizma098]

thanks for the insight guys.

is it a hassle to do a fellowship? i've always been interested in peds anesthesia and pain. i know pain is an incredibly hard fellowship to obtain, but what about peds?

also, i don't think palm springs is bad, i've been there a few times, it gets awfully warm in the summer but its a really nice town - closeby to a few other cities, its a 'desert' of sorts but still a pretty place.

i'm still learning a lot more about call frequency.....4-5 weeks vacation does seem low as a lot of anesthesiologists i've spoken to routinely get 7-9 weeks of vacation, and often post call days off.

oh well, i guess if working my A** off is what it takes to pay off the loans and buy a house i guess that's what i'll have to do, been doing it for a few years now, guess it's a never ending cycle.
😀

 

[IlDestriero]

Money in anesthesia is not rocket science. The more you work the more you make, usually. If you work for a hospital on a salary, you will earn less than you bring in. If you work for a partnership as a non-partner, you will make less than you bring in. If you work at a place with lots of medicare/medicaid, you will make less than someone working at a place with more private insurance patients. If you're working at an undesirable location, and/or have special skills (fellowship, etc.) the hospital and/or group may pay you more to join and/or stay there.
The best place to make the biggest $$$$$ would be somewhere very busy, but efficient, in an "undesirable" area, where the majority of the patients have private insurance, as a partner in a group getting subsidies from the hospital. I don't know where this would be, but I would guess a small to midsized city, with limited hospital competition, in middle America.
Have fun, I won't see you there!

 

[sevoflurane]

Money in anesthesia is not rocket science. The more you work the more you make, usually. If you work for a hospital on a salary, you will earn less than you bring in. If you work for a partnership as a non-partner, you will make less than you bring in. If you work at a place with lots of medicare/medicaid, you will make less than someone working at a place with more private insurance patients. If you're working at an undesirable location, and/or have special skills (fellowship, etc.) the hospital and/or group may pay you more to join and/or stay there.
The best place to make the biggest $$$$$ would be somewhere very busy, but efficient, in an "undesirable" area, where the majority of the patients have private insurance, as a partner in a group getting subsidies from the hospital. I don't know where this would be, but I would guess a small to midsized city, with limited hospital competition, in middle America.
Have fun, I won't see you there!

Indiana. Rated top 3 best places to work as a physician time and time again. Tort reform. Extremely low litigation. Respect as an anesthesia provider. Cheap, Cheap, Cheap. 4000sqft home, new construction for $260K. Administration has agreed to pay 50$/unit regardless of medicaid, medicare, private practive or whatever.
I vacation in the mountains or on the west coast or the caribbean every vacation I have. I wish I lived in one of those places, but it doesn't make financial sense to me at this point in my life.

Once the dust settles with Obama, and I'm outta med school debt, and have a good chunck of change in the bank... well then, and only then, will I be heading out to find my retirement job = 1) location 2) Lifestyle 3) Good group with good guys that I call partners. This will hopefully happen by the age of 38.

 

[karizma098]

Indiana. Rated top 3 best places to work as a physician time and time again. Tort reform. Extremely low litigation. Respect as an anesthesia provider. Cheap, Cheap, Cheap. 4000sqft home, new construction for $260K. Administration has agreed to pay 50$/unit regardless of medicaid, medicare, private practive or whatever.
I vacation in the mountains or on the west coast or the caribbean every vacation I have. I wish I lived in one of those places, but it doesn't make financial sense to me at this point in my life.

Once the dust settles with Obama, and I'm outta med school debt, and have a good chunck of change in the bank... well then, and only then, will I be heading out to find my retirement job = 1) location 2) Lifestyle 3) Good group with good guys that I call partners. This will hopefully happen by the age of 38.

Indiana is great. My old man practices there, moved out as soon as he was done with residency. his group is in northwest indiana, just about 35-45 miles from downtown chicago - some of his partners even commute to chicago and just stay at the hospital for call ( which is just about 1:9 ). post call days are always off, and vacation is roughly 6 and a half weeks. the hospital subsidizes for the group at a rate of about 400k per anesthesiologist, this can go either straight into the doc's pocket, or they take the 'benefit plan' which includes all the malpractice, retirement, etc, and they take home about 330k. this is a starting salary....even then, he's having trouble finding an extra anesthesiologist to come in!

i grew up in indiana, so i just really do not want to live there, otherwise, post residency i'd just work for him, haha.

p.s. - 260k for a 4000 sq foot home, maybe in the boonies? in our neck of the woods that still runs 700k+ for a nice house, if you buy out in the farmland area maybe 350. if you buy out on the beach on lake michigan, its 1 mil+

 

[sevoflurane]

I live in a town of 50k. It has everything I need. My commute to the hospital is 8 minutes. Chi town is about 3.5 hours away. Indy and Cinnci are a little over 1 hour. Almost all my partners own 100+ acre Farms + high rise apartments in Chicago. Nice little compounds. Getting out of here is easy, especially if I'm going international. Just got back from Vail, CO. Total air commute time was 4 hours. Fronteir to Denver, Denver to Eagle/Vail. Was on the slopes by 12:00pm they day I left. Indiana is not a place to retire, but it's not as bad as people may think.

 

[IlDestriero]

I live in a town of 50k. It has everything I need. My commute to the hospital is 8 minutes. Chi town is about 3.5 hours away. Indy and Cinnci are a little over 1 hour. Almost all my partners own 100+ acre Farms + high rise apartments in Chicago. Nice little compounds. Getting out of here is easy, especially if I'm going international. Just got back from Vail, CO. Total air commute time was 4 hours. Fronteir to Denver, Denver to Eagle/Vail. Was on the slopes by 12:00pm they day I left. Indiana is not a place to retire, but it's not as bad as people may think.

Sounds like my kind of place, respect, coin, easy lifestyle, lots of time off. I could get a penthouse apt in Chicago for holidays and long weekends. The problem though, is that my wife would be living on the beach in San Diego with the kids.🙁

 

[badasshairday]

The problem though, is that my wife would be living on the beach in San Diego with the kids.🙁

arrgh...

Yeah, the midwest in general is very good for physicians. My fiancee (future Physician Assistant) wants to be in CA too. We are both originally from CA.

I've been looking up those salary/cost of living converters, basically a 300K income in Milwaukee is equivalent to a ~600K Bay Area/LA/SD. Milwaukee is a fine town, has the lake front, nice downtown, traffic is non-existant compared to the hair graying rush of CA traffic. Nice homes in great neighborhoods around 250K, versus 750K+ for similar great neighborhoods in CA. Monetarily it makes so much more sense to stay somewhere where the cost of living is cheap to pay off our loans make $. I don't know though, I go back in forth every day about where I want to settle down.

 

[IlDestriero]

arrgh...

Yeah, the midwest in general is very good for physicians. My fiancee (future Physician Assistant) wants to be in CA too. We are both originally from CA.

I've been looking up those salary/cost of living converters, basically a 300K income in Milwaukee is equivalent to a ~600K Bay Area/LA/SD. Milwaukee is a fine town, has the lake front, nice downtown, traffic is non-existant compared to the hair graying rush of CA traffic. Nice homes in great neighborhoods around 250K, versus 750K+ for similar great neighborhoods in CA. Monetarily it makes so much more sense to stay somewhere where the cost of living is cheap to pay off our loans make $. I don't know though, I go back in forth every day about where I want to settle down.

My honest advice to you would be to take one of those midwest jobs in a nonpartner track to cut your teeth and move on. When you have paid off ALL your debt, have $1-200k in your retirement accts, $150-200K for a downpayment and closing costs, and another $50k or so in an emergency fund, you can move to your dream job in CA. That sounds like a lot of money and a long time, but if you are making $400k and skip the new Supercharged Range Rover or BMW M5, you can get there faster than you think. Rent a nice place, get a kick ass home theater system, a 3 series Beemer, take some sweet vacations, and bank the rest. You will be that much more marketable with several years of experience, and you can be comfortable taking a (relative or actual) lower paying job, because you're already on really solid financial ground. Many people follow this path with great success. I used to work in a place where houses were $750-1000 per sq ft. You needed ~$1.5M to get anything remotely reasonable. You could get in the door for about 1.25, but the houses needed everything. The happiest staff there were the ones that had worked elsewhere for 5-10 years and came with a load of money already. They didn't have to worry about how to pay the bills or afford a house, etc.
That's CA.

 

[sevoflurane]

This is great advice and it's essentially my plan. I just brought in a new anesthesiologist to our group (good friend from medical school). He was born and raised in Los Angeles/Pasedena. He is finishing his residency at USC. The whole time I've known him he has stated that he will NEVER leave California. Apparently the chief resident from his program is doing the same thing. Moving out to Indiana. My buddy came here, took a look around and had his contract signed within 1 week. My entire family lives in San Fran/San Jose...

Except for me

 

[md2010sgu]

My honest advice to you would be to take one of those midwest jobs in a nonpartner track to cut your teeth and move on. When you have paid off ALL your debt, have $1-200k in your retirement accts, $150-200K for a downpayment and closing costs, and another $50k or so in an emergency fund, you can move to your dream job in CA. That sounds like a lot of money and a long time, but if you are making $400k and skip the new Supercharged Range Rover or BMW M5, you can get there faster than you think. Rent a nice place, get a kick ass home theater system, a 3 series Beemer, take some sweet vacations, and bank the rest. You will be that much more marketable with several years of experience, and you can be comfortable taking a (relative or actual) lower paying job, because you're already on really solid financial ground. Many people follow this path with great success. I used to work in a place where houses were $750-1000 per sq ft. You needed ~$1.5M to get anything remotely reasonable. You could get in the door for about 1.25, but the houses needed everything. The happiest staff there were the ones that had worked elsewhere for 5-10 years and came with a load of money already. They didn't have to worry about how to pay the bills or afford a house, etc.
That's CA.

Whoa...teach me the ways Yoda 👍

 

[DScully]

My honest advice to you would be to take one of those midwest jobs in a nonpartner track to cut your teeth and move on. When you have paid off ALL your debt, have $1-200k in your retirement accts, $150-200K for a downpayment and closing costs, and another $50k or so in an emergency fund, you can move to your dream job in CA. That sounds like a lot of money and a long time, but if you are making $400k and skip the new Supercharged Range Rover or BMW M5, you can get there faster than you think. Rent a nice place, get a kick ass home theater system, a 3 series Beemer, take some sweet vacations, and bank the rest.

👍

Very smart. Thanks for the advice!!

 

[Pilot Doc]

Whoa...teach me the ways Yoda 👍

Run the numbers, it's not too hard.

The post says you need to
- pay off debts (assume 100K)
- $200K in retirement
- $200K for down payment
- $50K in emergency fund

$550K total

So you get a $400K/yr job with a $40K/yr pre-tax retirement contribution, so you've got retirement part set in 5 years. Call taxes 40% of income leaving you with $260 ($400-$160) to spend/save. You need to save $70K/yr to make the non-retirment $350K in savings/debt paydown over 5 years. That leaves you $190K/yr to retire on. Figure $30K/yr for rent, $10K/yr for cars, $20K/yr for a couple swanky vacations - that still gives you $130K to spend on food, clothing, etc.

The numbers are rough, but there's enough margin there that it'll work.

 

[SleepIsGood]

I know a few people that landed jobs in Chicago this year getting 300 K...no fellowship

 

[pillowhead]

Run the numbers, it's not too hard.

The post says you need to
- pay off debts (assume 100K)
- $200K in retirement
- $200K for down payment
- $50K in emergency fund

$550K total

So you get a $400K/yr job with a $40K/yr pre-tax retirement contribution, so you've got retirement part set in 5 years. Call taxes 40% of income leaving you with $260 ($400-$160) to spend/save. You need to save $70K/yr to make the non-retirment $350K in savings/debt paydown over 5 years. That leaves you $190K/yr to retire on. Figure $30K/yr for rent, $10K/yr for cars, $20K/yr for a couple swanky vacations - that still gives you $130K to spend on food, clothing, etc.

The numbers are rough, but there's enough margin there that it'll work.

200k for retirement seems really really low.

 

[IlDestriero]

200k for retirement seems really really low.

Why? You're not retiring on it. The 200k in your retirement acct recommendation is the front load before you move to your dream job in CA, HI, or wherever. You're still going to max it out, and than some, for another 20-30 years. That initial $200k should be worth $1.5-2M when you finally retire. If you're really paranoid you could stay in middle America for another couple years and save even more or buy a retirement annuity or something.
You could also save for a much larger down payment on your house, or larger emergency fund, but that means more time in Iowa or Indiana instead of where you and your wife want to live and raise your kids. If you don't want to live in a location that is really expensive, you can just move there right away. But, it's hard to save for a house, quickly pay down your loans, and max out your retirement plans when you're making 300k, or less, starting out in CA and want a $1M house.

 

[RabbMD]

Currently the most anyone can elect to defer in a 401k or a 403b under age 50 is $16500. If your practice offers a match or profit sharing, or you work as a 1099 somewhere with say a solo 401k you cap total is $49000. If you are fortunate to also have a 457 then you can defer another 49k, but that is fairly rare. Say you have a HD healthplan and a wife, add anoth $6150 for a hsa, you make too much for either a Roth Ira or a more deductible Ira, but if you have no other iras aside from a Roth, you can contribute $5000'each for your wife and yourself to a nondeductible IRa and immediately convert it to a Roth for both 2009 and 2010 until April 15th. So adding all that up, unless you have a job that contributes a lot to your 401k for you, or access to a 457, the most anyone could contribute is $16500 + $6150+ $10000 for this tax year or $32750. Add another $10k for last years Ira contribution if you have not done it, and another $16500 if your wife works too, but yearly that is still not a lot above $40,000.

 

[Doctor4Life1769]

Run the numbers, it's not too hard.

The post says you need to
- pay off debts (assume 100K)
- $200K in retirement
- $200K for down payment
- $50K in emergency fund

$550K total

So you get a $400K/yr job with a $40K/yr pre-tax retirement contribution, so you've got retirement part set in 5 years. Call taxes 40% of income leaving you with $260 ($400-$160) to spend/save. You need to save $70K/yr to make the non-retirment $350K in savings/debt paydown over 5 years. That leaves you $190K/yr to retire on. Figure $30K/yr for rent, $10K/yr for cars, $20K/yr for a couple swanky vacations - that still gives you $130K to spend on food, clothing, etc.

The numbers are rough, but there's enough margin there that it'll work.

I'm assuming those figures above are purposely high? 30K/year for rent sounds high (but I'm from the South, rent here's relatively cheaper) ... and I'd love to hit up those swanky vacation hot spots 😎

Overall, great posts on money management. There needs to be more of this and I'm glad that it's been posted. Thanks!

 

[Masseter Spasm]

Peds Fellowship + "call frequency varies" (as Dream Machine pointed out) is suspicious. I would be wary of joining a group seeking a fellowship-trained individual that does not already have similar individuals in place. If you join a group as a cardiac or pediatric fellowship-trained anesthesiologist, you may find that you are perpetually on call for these cases in addition to taking regular call.

 

[Pilot Doc]

Currently the most anyone can elect to defer in a 401k or a 403b under age 50 is $16500.

I'm not as familiar with the 401/457/etc IRS nomenclature as I should be. You are correct that 401k contribution limits are low -basically trivial for a physician retirement plan. However, there are easy ways for private practices to set up non-401K retirement plans that allow $40K/yr contributions. If your goal is to find a wealth building job somewhere in middle america, those practices are not hard to find.

The reason these retirement plans are rarely seen is that the IRS generally requires all employees to be treated equally. So a hospital employed doc will never see a $50K contribution plan b/c every hospital employee would have it too. But for a private practice that has only physcian employees, it's not a problem. (And if you do have admin staff or CRNA's you want on a different plan, you employ them under a different corporation.)

 

[Pilot Doc]

I'm assuming those figures above are purposely high? 30K/year for rent sounds high (but I'm from the South, rent here's relatively cheaper) ... and I'd love to hit up those swanky vacation hot spots 😎

Yes - my numbers were chosen so that no one could say "There's no way you can afford X for $YK/year" You can likely do substantially better than my example, esp if you're willing to live a typical middle class lifestyle for 5 years.

Take the lifestyle of a family that nets $100K/yr, grosses $60K. In the my example, you net $260 k/yr. You could pretty easily save a million bucks in 5 years.

 

[md2010sgu]

Currently the most anyone can elect to defer in a 401k or a 403b under age 50 is $16500. If your practice offers a match or profit sharing, or you work as a 1099 somewhere with say a solo 401k you cap total is $49000. If you are fortunate to also have a 457 then you can defer another 49k, but that is fairly rare. Say you have a HD healthplan and a wife, add anoth $6150 for a hsa, you make too much for either a Roth Ira or a more deductible Ira, but if you have no other iras aside from a Roth, you can contribute $5000'each for your wife and yourself to a nondeductible IRa and immediately convert it to a Roth for both 2009 and 2010 until April 15th. So adding all that up, unless you have a job that contributes a lot to your 401k for you, or access to a 457, the most anyone could contribute is $16500 + $6150+ $10000 for this tax year or $32750. Add another $10k for last years Ira contribution if you have not done it, and another $16500 if your wife works too, but yearly that is still not a lot above $40,000.

Keep the nuggets of retirement knowledge coming 👍👍👍 I wish there was a current thread in the forums about this. It's such an important aspect of life that many young peeps ignore until it's too late. I'm going to start reading up heavily about this stuff now.