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KetamineDreams

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Hello All,

I'm a CA3 who has started my job search and need some guidance regarding a few options. Unfortunately, I am geographically locked in due to my spouse's job so the options are limited. These 2 jobs seem to the best I can find currently.

Job 1: Private practice, 1099 approx. 550-600K a year for 50 hour work week (probably closer to 55-60 factoring in commute), on call 4 x a month, 1 weekend a month. Healthy OB, no trauma. In house call. Sit own cases. Commute 45 min to an hour in the evening. Work day 6am-5pm on average. 8 weeks vacation. Decent mix of case breadth and complexity. NO peds (not sure if good or bad). Production and performance pressure.

Job 2: Academic working primarily at non main campus site. W2 400K a year (ehh) for 40 hour work week. On call once a month. Can take an extra call or 2 to bring up FTEs and hit around 500K. Commute 30 minutes. Healthy OB as well. Yes trauma. In house call. Average work day 630-330pm. 50% sit own cases, 50% CRNA/resident. 4 weeks vacation (ehhh). Decent mix of case breadth and complexity. Some healthy peds (may become no peds as they expand their peds department). Less production and performance pressure.

Personally, I am a hard worker and love doing anesthesia so I find myself taking on a lot of late shifts and weekend coverage for extra money in residency. Knowing this about myself, I am tempted to pursue a job that does not incentivize working more (i.e. 40 hour a week academic). I've spent most of my 20's in medical school and residency and I want to prioritize personal and social development more once I am an attending.

However, I can't help but shake the feeling that I am getting completely fleeced by academic hospital for this salary. I know the work week is cush, but as I understand it 400K is well below market value for an anesthesiologist in 2024. And if I pick up a few more calls, it kind of defeats the purpose since now the job is no longer chill, and I am working close to the same I would have at private practice for less money.

On the other hand, private practice commute is not great, and I am not sure how happy I would be driving 45 minutes to an hour to get home everyday. I think the academic job has very good health insurance benefits, where you essentially do not pay for medical care as long as it is through their system. Unfortunately this benefit is currently worthless to me because I have no pre-existing conditions and am a healthy 29 year old. Then there is also the atrocious 4 weeks of academic vacation. Is being home by 330pm every day and taking minimal call worth 150-200K? I am really having trouble quantifying... which job would you take?

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Neither job is great.

If you can stomach 4 weeks off, job 2 is it. But that's below average even for academics. Does it ever go up?
 
Do you have student loans? If you're intending to stay in this location long term, would be worth confirming the academic job qualifies for PSLF. Depending on your loans situation, that could add up to a lot of money saved in the long run.
 
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Hour for hour, job 2 sounds equal or better than job 1. And while there is less vacation, the work-life balance is far superior, with opportunities to work more. Flexibility is a beautiful thing. Plus the academic job likely has far superior benefits...
 
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Neither job is great.

If you can stomach 4 weeks off, job 2 is it. But that's below average even for academics. Does it ever go up?

No, I don't think it does unless you obtain a management / leadership position. FWIW, my wife will only have 4 weeks of vacation for the foreseeable future, so while extra time off would be nice it's also not like i'd be doing that much with it.
 
Do you have student loans? If you're intending to stay in this location long term, would be worth confirming the academic job qualifies for PSLF. Depending on your loans situation, that could add up to a lot of money saved in the long run.

I do have about 300K in student loans. The job does qualify for PSLF.
 
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Hour for hour, job 2 sounds equal or better than job 1. And while there is less vacation, the work-life balance is far superior, with opportunities to work more. Flexibility is a beautiful thing. Plus the academic job likely has far superior benefits...

This is nice to hear. My wife will definitely be happier if I take job 2, and I think I probably would be too. Just having a hard time getting hung up on what I perceive to be a large compensation discrepancy. Job 2 does have better benefits, as I mentioned above regarding healthcare. I know they have a decent 401K match as well. As far as I can tell regarding Job 1 you have to figure out your own health insurance etc.
 
You have not commented on benefits or other ‘perks’, which can be substantial in academics jobs. My total compensation after incentives and benefits in academics was about 50% higher than my base.

That said, being a hard worker in academics can be very frustrating since there is a huge incentive to avoid work. And the vacation is a big gap, unless there’s like 2 weeks CME and admin days in academics.
 
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For academics do they pay for malpractice , disability insurance , conferences , and cme. Even though you may have less vacation I would ask about personal days and conference. With conference and personal days my next job will be closer to 6 weeks than the advertised vacation of 4 weeks.

6-5 is brutal for job number 1 especially with the commute. When you’re sitting your own cases will you have time to eat ? My current job is like this and it sucked not having any time to eat lunch. I hate supervising tho so that’s also something else to consider. I would take a pay cut and Lower work life balance to do my own cases.
 
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Your spouse has to be making a **** ton of money to justify taking either of those jobs. They both suck.
 
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Job number 2 all day.

The academic job will have extra work available if you wanna hustle and make more money. And with the benefits, you may not make much use of health insurance now but when you have a kid with a lot of doctors visits or your wife gets breast cancer you will thank your lucky stars you have the job you have.
 
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Easily number 2
Waking up for a 6 am start? Working until 5 pm? F that!
Driving for an hour a day? That'll kill you even if you have a nice self driving ev car. There's nothing that can replace being at home with your family.

Job 1 would have to be 550-600 w2 for me to consider that

Why is the academic job starting at 630? You're getting up at 545 at least for that.

What is your spouse doing that locks you into this area? If you have multiple kids and family around willing to babysit and friends in the area I get it. Otherwise it's better if they get a new job unless they are making as much as you and cannot do so anywhere else (unlikely).
 
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Hello All,

I'm a CA3 who has started my job search and need some guidance regarding a few options. Unfortunately, I am geographically locked in due to my spouse's job so the options are limited. These 2 jobs seem to the best I can find currently.

Job 1: Private practice, 1099 approx. 550-600K a year for 50 hour work week (probably closer to 55-60 factoring in commute), on call 4 x a month, 1 weekend a month. Healthy OB, no trauma. In house call. Sit own cases. Commute 45 min to an hour in the evening. Work day 6am-5pm on average. 8 weeks vacation. Decent mix of case breadth and complexity. NO peds (not sure if good or bad). Production and performance pressure.

Job 2: Academic working primarily at non main campus site. W2 400K a year (ehh) for 40 hour work week. On call once a month. Can take an extra call or 2 to bring up FTEs and hit around 500K. Commute 30 minutes. Healthy OB as well. Yes trauma. In house call. Average work day 630-330pm. 50% sit own cases, 50% CRNA/resident. 4 weeks vacation (ehhh). Decent mix of case breadth and complexity. Some healthy peds (may become no peds as they expand their peds department). Less production and performance pressure.

Personally, I am a hard worker and love doing anesthesia so I find myself taking on a lot of late shifts and weekend coverage for extra money in residency. Knowing this about myself, I am tempted to pursue a job that does not incentivize working more (i.e. 40 hour a week academic). I've spent most of my 20's in medical school and residency and I want to prioritize personal and social development more once I am an attending.

However, I can't help but shake the feeling that I am getting completely fleeced by academic hospital for this salary. I know the work week is cush, but as I understand it 400K is well below market value for an anesthesiologist in 2024. And if I pick up a few more calls, it kind of defeats the purpose since now the job is no longer chill, and I am working close to the same I would have at private practice for less money.

On the other hand, private practice commute is not great, and I am not sure how happy I would be driving 45 minutes to an hour to get home everyday. I think the academic job has very good health insurance benefits, where you essentially do not pay for medical care as long as it is through their system. Unfortunately this benefit is currently worthless to me because I have no pre-existing conditions and am a healthy 29 year old. Then there is also the atrocious 4 weeks of academic vacation. Is being home by 330pm every day and taking minimal call worth 150-200K? I am really having trouble quantifying... which job would you take?
You can do better.

4 weeks vaca is a non-starter for me personally.
1.5-2 hrs per day commute is also a non-starter.

Staying in a particular location is a decision you have to live with.

Great market if you have a little flexibility.
 
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I do have about 300K in student loans. The job does qualify for PSLF.

Assuming you're on a standard repayment plan and PSLF still exists the same way 6-ish years from now (counting your residency for 4), that's saving you likely over 150k in the long run. Should be pretty easy math to get exact numbers. You could think of that as a "bonus" to the academic job. Even more if you factor in interest and the opportunity cost of having that money in the market.
 
Someone have mgma for 2022/2023?
I believe “average” is 530k w 8-9 weeks.
 
Job number 2 all day.

The academic job will have extra work available if you wanna hustle and make more money. And with the benefits, you may not make much use of health insurance now but when you have a kid with a lot of doctors visits or your wife gets breast cancer you will thank your lucky stars you have the job you have.
Fair points.
 
Easily number 2
Waking up for a 6 am start? Working until 5 pm? F that!
Driving for an hour a day? That'll kill you even if you have a nice self driving ev car. There's nothing that can replace being at home with your family.

Job 1 would have to be 550-600 w2 for me to consider that

Why is the academic job starting at 630? You're getting up at 545 at least for that.

What is your spouse doing that locks you into this area? If you have multiple kids and family around willing to babysit and friends in the area I get it. Otherwise it's better if they get a new job unless they are making as much as you and cannot do so anywhere else (unlikely).
I should clarify, the "start times" in the post refer to when I leave the house and when I walk back through the door (makes me the most sense to me in terms of quantifying time lost to work). So both jobs have 7am OR start times. Job 1 7am OR start they try to finish cases around 4 pm with some variability. With the anticipated commute I will be out the door at 6am and back through the door at 5 pm. For Job 2 7 am OR start time, and they try to finish cases around 3 pm, so with commute anticipate to be back home by 330 pm.

Both our families are in the area and she likes working for her current company. No kids yet. She makes around 350K working in tech. I think she is topped out in her current position, so 350K for the foreseeable future.
 
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Someone have mgma for 2022/2023?
I believe “average” is 530k w 8-9 weeks.

Oof, see if this is true, makes it much harder to stomach signing on to a job with 400k paycheck, although I assume MGMA is 530K for 50 hours a week? So 400K for 40 hours gets closer, but still below, and vacation far below average.
 
You can do better.

4 weeks vaca is a non-starter for me personally.
1.5-2 hrs per day commute is also a non-starter.

Staying in a particular location is a decision you have to live with.

Great market if you have a little flexibility.

So both jobs non starters for you lol. Yea, its tough being buoyed to a location. Maybe just need to keep looking... What's max commute you would tolerate? 1 hour?
 
So both jobs non starters for you lol. Yea, its tough being buoyed to a location. Maybe just need to keep looking... What's max commute you would tolerate? 1 hour?
Personally, 30 minutes in traffic, and that's pushing it.

Current commute is 11-12 minutes in the morning. 12-17 in the evening.
 
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I feel like an hour commute for anesthesia is much different than an hour commute for some other job. For me, I like having the wiggle room in case I have a sick patient, an epidural/block to do pre-op or a room to take over from the overnight person.

Much different compared to a surgeon showing up at 7:15 knowing everything about their patient or even when I'm in the ICU and I'm showing up for sign out.
 
Oof, see if this is true, makes it much harder to stomach signing on to a job with 400k paycheck, although I assume MGMA is 530K for 50 hours a week? So 400K for 40 hours gets closer, but still below, and vacation far below average.
The avg I have seen is about 100k for every 10hrs/week worked. My current job is like that.

How many weeks off a year does your wife have?
 
Neither job sounds amazing, but with your spouse already making 350K, 2 seems like the better option with benefits and qualifying for PSLF, and way better hours. While nice, the extra money above $731,201 will put you in the highest tax bracket federally, and who knows what from a state income tax standpoint. You will be doing exceptionally well, and be able to easily pay off a mortgage at the same time as investing heavily as long as you don't go crazy buying a home.

One thing I disagree with you on regarding vacation; just because your spouse only gets 4 weeks off, you will appreciate time off from a more stressful job the longer you are an attending.
 
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And if I pick up a few more calls, it kind of defeats the purpose since now the job is no longer chill, and I am working close to the same I would have at private practice for less money.
Seems like picking up extra work would make the pay difference minimal. There’s not enough information presented to understand total comp at job 2.

If you’re set on having some sort of job at one of these two places, another option to consider is to explore the option of a partial fte and add a locums component to your work to boost your income.

For what it’s worth, ignoring benefits of job 2, both jobs have hourly rates in the 200-250 range. A quick scan of gasworks locums postings in my state and I can see that it’s hard to find locum rates that low… for CRNAs.
 
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I would be wary of this 330pm relief "promise." Most academic place are attempting to run as crappy private practice gigs and will start to squeeze you and keep you late. What might be 330pm relief now will prolly change to 5pm in the not too distant future. I couldn't imagine only having 4 weeks of vacay and making 400k. That is depressing.
 
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Nationally neither job is great but anesthesia pay is very location dependent. I personally would take number 2 especially with a spouse making 350k.
 
Most state hospitals allow
403b
457b
401a (or similar)
Plus 25-30k retirement match

Tax benefits

Ur 550-600k 1099 job I assume comes with no benefits /8 weeks off 55 hr work week

I estimate ur “hourly 1099 compensation “ is between. $265-275/hr but u are gurantee those hours. U have more tax write off as 1099

But find out if malpractice (6-25k) and billing fees (5-6%) if EXCLUDED from the overall compensation Because if they subtract that against ur compensation. You can be looking at 50k less.

50 hours worked seems fair but if y are working (5) 10 hour weeks. It’s painful. U need post call days off.

Overall without knowing the location. It’s hard to compare apples to apples.

Like I would take $300/hr for a Hospital 12 min from my house and work just 8 hr. But I would drive 45 min to another hospital for $375/hr and work 72 hours straight.

So you are right about commute times. It does factor into the compensation
 
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If you're geographically constrained then I would pick job 2 no question - it's not unlike the job I have now. I work about 40ish hrs/wk and take call 1-2 times a month with a salary a bit north of 400K. You may be underestimating the value of some of the W2/academic benefits. It does depend on the particular environment, but there's something to be said for a cush job and lifestyle. All that said yes it's a bit underpaid, but it's not that bad. The vacation time is a bit weak though... is there any academic or meeting time?

Personally I wouldn't even consider job #1 because I wouldn't want to take 4x/month call and work 50 hrs plus commute that long every day. It would crush my soul.

If you're not geographically constrained then of course you can do a lot better than either job.
 
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If you're geographically constrained then I would pick job 2 no question - it's not unlike the job I have now. I work about 40ish hrs/wk and take call 1-2 times a month with a salary a bit north of 400K. You may be underestimating the value of some of the W2/academic benefits. It does depend on the particular environment, but there's something to be said for a cush job and lifestyle. All that said yes it's a bit underpaid, but it's not that bad. The vacation time is a bit weak though... is there any academic or meeting time?

Personally I wouldn't even consider job #1 because I wouldn't want to take 4x/month call and work 50 hrs plus commute that long every day. It would crush my soul.

If you're not geographically constrained then of course you can do a lot better than either job.
If it’s a true state academic job

It’s usually 21-25 days equivalent pto. Plus they throw in some “bonus” days whatever they want to call it officially (2-5 extra days). It’s in the state contracts usually.

So works out to 25-26 real days off. Add in 5 cme days. (Some senior academic attendings have unlimited admin/cme days). That’s how people game the system.

Add in 13 paid sick days.

You really get close to 9 weeks off plus it rolls over.

So yes. The academic job does have some perks.

Now many are adding paid paternal/maternity leave. That’s a 2-3 month paid benefit. That’s 80-90k value paid time off (outside of accrued leave)
 
If it’s a true state academic job

It’s usually 21-25 days equivalent pto. Plus they throw in some “bonus” days whatever they want to call it officially (2-5 extra days). It’s in the state contracts usually.

So works out to 25-26 real days off. Add in 5 cme days. (Some senior academic attendings have unlimited admin/cme days). That’s how people game the system.

Add in 13 paid sick days.

You really get close to 9 weeks off plus it rolls over.

So yes. The academic job does have some perks.

Now many are adding paid paternal/maternity leave. That’s a 2-3 month paid benefit. That’s 80-90k value paid time off (outside of accrued leave)
what does “true state” mean.
 
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So both jobs non starters for you lol. Yea, its tough being buoyed to a location. Maybe just need to keep looking... What's max commute you would tolerate? 1 hour?

I’ve always been 10-15 min from the hospital.
Never had to spend the night at the hospital on 1st call.
In the rare occasion I have some inefficiencies in my scheduling I can go home, chill, eat good healthy food/work out.
 
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what does “true state” mean.
Sovereign immunity
401, 403b, real 457b that’s asset protected
Pension eligibility
State employee health benefits or similar
Comp for state holidays worked
 
I’ve always been 10-15 min from the hospital.
Never had to spend the night at the hospital on 1st call.
In the rare occasion I have some inefficiencies in my scheduling I can go home, chill, eat good healthy food/work out.
Those are harder to find in a true bigger city. The 10-15 min commute. That does factor into “compensation “ time for me. The commute time.

I had that for half my working career and loved it. Put less than 10k miles on my cars for the year

Now I easily put 20k. I think I put 25k the past year cause I was driving to many places in my own car

The work around longer commutes is to take tons of time off.
 
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Commute time=work time. Time spent commuting should be counted as work hours. It really eats into your quality of life.
 
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Be wary of PSLF. With how much your wife makes. 5 years at 700k between the two of you. You will pay off the loan making the minimum payment before they are even forgiven.

Regardless of that, I’d take the academic job.
 
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Be wary of PSLF. With how much your wife makes. 5 years at 700k between the two of you. You will pay off the loan making the minimum payment before they are even forgiven.

Regardless of that, I’d take the academic job.
yeah, need to fully investigate if married filing separate makes sense here. Some of the payment plans (SAVE, in particular) allow that status.
 
yeah, need to fully investigate if married filing separate makes sense here. Some of the payment plans (SAVE, in particular) allow that status.

Be wary of PSLF. With how much your wife makes. 5 years at 700k between the two of you. You will pay off the loan making the minimum payment before they are even forgiven.

It depends on if he's on an income driven repayment schedule as well. Even then, I thought the max was 10% of discretionary income (correct me if I'm wrong). So even if he's filing jointly with those caveats I still think he would come out ahead with PSLF. If he's graduating this year he also benefited from the covid "forbearance" and those years count towards the 10 total.
 
So both jobs non starters for you lol. Yea, its tough being buoyed to a location. Maybe just need to keep looking... What's max commute you would tolerate? 1 hour?
ill tell you something right now. commuting will eventually wear you out, even something as low as 30 min. i think there are studies that show that it quite literally takes years off your life. i've personally investigated places that would have been marginally better jobs but significantly extended my commute and I just knew i couldn't stomach it. all it takes is one bad day stuck in traffic or even your own personal car problems and you'll certainly wish you lived within biking distance of work.

another factor is benefits. since #2 is academic affiliated can I assume it has benefits attached? Health insurance probably isnt a big deal because of you wife's job, but a lower base salary should be supplemented with a good benefits package.

given your total picture including your wife's position, my personal preference is job one but you may have to move closer to the job.

out of curiosity, how long is your wife's commute? find a way to split the difference
 
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Location? 1) Cost of living. It would be very different making 400K in a VHCOL area than middle of nowhere.
2) Commute. 1 hour in a SoCal parking lot is very different than 1 hour on a rural interstate. You can get one of those fancy cars with auto-pilot. After living 10 minutes from work for 10 years, I would never want to live anywhere farther than that. I suspect we are talking about Bay Area/San Jose. But with $750-1M combined you can buy/rent somewhere closer to your work.

1099 vs. W2. I think the rule of thumb is the former needs an extra 100-120K to match the perks of an academic job. But if this is where I think it is, the money won't go as far. I would take job #1, work like hell while you can, and pay off those loans. Someone wise once told me "your first job won't be your last" (nevermind that I'm trying to prove them wrong.)

Finally, it sounds like the decision is already made for you. Spouse prefers #2. Everything was contingent on their needs. You have already made the most important life/financial/career decision. Just listen to them, and wait for the RSU.

I look forward to the return of "which 3M house I should buy" thread from OP in the future.
 
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No, I don't think it does unless you obtain a management / leadership position. FWIW, my wife will only have 4 weeks of vacation for the foreseeable future, so while extra time off would be nice it's also not like i'd be doing that much with it.
Sounds like you don't NEED more time off, but assuming you are happy with your income already, could also ask to work less than 1.0 FTE since the salary is relatively lower anyways. Or even make a big jump where you're working 3 of 4 weeks per month. 1 week to flex for house chores, stocks, or working PRN/locums somewhere that pays more, esp. while you don't have kids.
 
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