Job Question

[Craysee]

Hello all,

I have a job question. I wanted to get an idea of what people would do in my position. I am 5 years out of residency but for the past 2 years I have worked in a GI center doing only GI cases. The offer at the time was 300k for M-F work. I figured I would do it for some time and then leave before my skills deteriorated to much. I stayed much longer than anticipated. I got fearful of losing my skills and what that would mean for my future career. So I wanted to get back into doing some regular OR case and started doing some locums on my vacation days while still at my current GI center till I found a new permanent position. Through a contact, I found and was offered an outpatient surgicenter position for 315K M-F schedule. Around the same time my locums position offered me a full time position that would pay 350k including call about 4-5x a month. Now the GI suite that I work for wants to keep me so bad that they offered to pay me 350k for only M-Th allowing me to still do locums on Fridays, weekends, and vacation days. So I have 3 job opportunities. I'm wondering which one I should take.

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[deleted171991]

Choose the one that will allow you to practice the widest range of cases, before you lose essential skills.

 

[ZzzPlz]

That seems like a great raise for the GI position, especially with reimbursement declining so much recently.

You can easily keep skills up by doing locums, especially with your ~50 extra days off per year and it sounds like you’ve got vacation time to locum on top of that

 

[nimbus]

That seems like a great raise for the GI position, especially with reimbursement declining so much recently.

You can easily keep skills up by doing locums, especially with your ~50 extra days off per year and it sounds like you’ve got vacation time to locum on top of that

Doing the math it’s almost a 50% raise. OP should try to find out how much they are collecting for his services.

 

[Wiscoblue]

At an average of $250 per scope, and doing 20 scopes every day at the ‘butt hut’ OP is probably bringing in close to $5000 per day and they are offering him $1682 of that. The GI docs are keeping 2/3rd of his earnings!

 

[Craysee]

At an average of $250 per scope, and doing 20 scopes every day at the ‘butt hut’ OP is probably bringing in close to $5000 per day and they are offering him $1682 of that. The GI docs are keeping 2/3rd of his earnings!

Its about 15-17 scopes per day and roughly 6-7hr days. But still you are correct.

 

[Craysee]

That seems like a great raise for the GI position, especially with reimbursement declining so much recently.

You can easily keep skills up by doing locums, especially with your ~50 extra days off per year and it sounds like you’ve got vacation time to locum on top of that

It's 6 weeks vacation on top of Friday-Sunday off and holidays off. I figure thats a lot of time to locums. I think financially I could do well; 350K for about an 25-30hr work week plus what I could bring in with locums. My concern is for 5+ years. Would I still be marketable in the job market? I'm still a young doc.

 

[dannyboy1]

At an average of $250 per scope, and doing 20 scopes every day at the ‘butt hut’ OP is probably bringing in close to $5000 per day and they are offering him $1682 of that. The GI docs are keeping 2/3rd of his earnings!

Umm, OP is bringing in nothing. The GI docs bring the patients. They just need to find the guy who will provide adequate anesthesia services for as cheap as they can find.

 

[dannyboy1]

It's 6 weeks vacation on top of Friday-Sunday off and holidays off. I figure thats a lot of time to locums. I think financially I could do well; 350K for about an 25-30hr work week plus what I could bring in with locums. My concern is for 5+ years. Would I still be marketable in the job market? I'm still a young doc.

If you don’t want this job I’ll take it. It sounds great

 

[cchoukal]

I can tell you we hired a CRNA who had been doing only GI for a few years. She had the right attitude and we felt like we could retrain her to be good. It’s been a long, hard road, for her and us. After a year, she’s finally adequate. Skill and knowledge atrophy is real.

 

[deleted162650]

Its about 15-17 scopes per day and roughly 6-7hr days. But still you are correct.

I hope they’re at least providing plenty of lube.

 

[anbuitachi]

Its about 15-17 scopes per day and roughly 6-7hr days. But still you are correct.

that's quick. im guessing they are healthy patients

 

[vector2]

Keep your current gig but make sure the locums you pick up has a good case mix (neuro, thoracic, regional, vascular etc). Make a case log so if you do leave you can show that you've also done 10 lobectomies, 100 blocks, a couple aortobifems over the past year and not just scopes.

 

[ZzzPlz]

It's 6 weeks vacation on top of Friday-Sunday off and holidays off. I figure thats a lot of time to locums. I think financially I could do well; 350K for about an 25-30hr work week plus what I could bring in with locums. My concern is for 5+ years. Would I still be marketable in the job market? I'm still a young doc.

If I’m looking to hire and you tell me you’ve been actively trying to keep yourself well rounded by doing locums, I can tell you are responsible and have good work ethic. I also suspect getting yourself in a gig like what you have going does not come by being a d bag or dangerous.
I don’t think this hurts your marketability for a job in the future at all

 

[nimbus]

I hope they’re at least providing plenty of lube.

And lunch.

 

[Robotic Wis-Hipple]

If you move to M-Th, who takes your Friday? A CRNA perhaps? How long do you think it takes the GI guys to realize they can pay them 1/2 your rate?

Otherwise, if you can deal with the butthut 4 days a week, make 350k, and you’re driven enough to keep your skills up doing legit locums I think that sounds pretty good.

 

[deleted171991]

If you move to M-Th, who takes your Friday? A CRNA perhaps? How long do you think it takes the GI guys to realize they can pay them 1/2 your rate?

Otherwise, if you can deal with the butthut 4 days a week, make 350k, and you’re driven enough to keep your skills up doing legit locums I think that sounds pretty good.

Bingo!

This is basically an offer from them to cover their butts while they are searching for a Mo-Fr cheap replacement. The moment they find one, the OP is bye-bye.

I would not waste any more time in the GI job, except to find a better job elsewhere (real job, not ASC/GI joke). Although, to me, the OP is seriously handicapped. A few locum days won't change that.

 

[chocomorsel]

If you move to M-Th, who takes your Friday? A CRNA perhaps? How long do you think it takes the GI guys to realize they can pay them 1/2 your rate?

Otherwise, if you can deal with the butthut 4 days a week, make 350k, and you’re driven enough to keep your skills up doing legit locums I think that sounds pretty good.

Maybe the GIs take off Fridays too. Ever think of that?

 

[Robotic Wis-Hipple]

Maybe the GIs take off Fridays too. Ever think of that?

Well, OP is currently working at the lab M-F now....

 

[chocomorsel]

Well, OP is currently working at the lab M-F now....

My bad. Didn’t pay enough attention to detail.
Yes, I wonder what that’s about. I was gonna say that not all GI docs are that greedy, but I would lose that argument.

 

[Foodie]

Let's do the math:
$250 per scope * 15 scopes/day = $3750/day
With your previous offer of $315K, the GI guys were likely making $3750/day * 5 days/week * 50 weeks = $937.5K/year (!!!!). They were taking most of your reimbursement.
When they are offering you $350K, they will be making $3750/day * 4 days/week * 46 weeks = $690K/year. They are still skimming about half of your reimbursement.

I would leave that GI gig or ask the GI guys to pay you per case when you are there M-Th, while doing your locums on your non-GI days. Or find an anesthesia group who will take you on board part-time for those free days (difficult, I know). I agree with the above that the GI guys may not ask you to come back once they find a cheaper replacement. That's the downside of working at one place only and the skills required are not specialized. You have no leverage.

What kind of cases are done at the outpatient surgery center? What are the hours? 315K stinks if 1) it doesn't provide opportunities to gain skills or 2) you work 40 hrs/wk with premium insurance carriers.

Like OP I am also 5 years out of residency. I left a full-time salaried hospital work a while ago for fee-for-service surgery center work on weekdays. I still take hospital calls on weekends. I feel that my skillset has improved since making the move, as the variety of cases has dramatically increased (I go to about nine different sites now). I definitely don't take things for granted. Even the gig that looks good now can always change, which is why I feel the need to keep up my skills to stay competitive. I know several colleagues in their early 40's who still don't know how to perform ultrasound-guided blocks and refuse to do any kind of challenging cases (i.e. neurospine, thoracic, ENT challenging airways) and would beg everyone else to switch cases. This is baffling to me.

Good luck to OP, hope you find your happy medium.

 

[dchz]

I can tell you we hired a CRNA who had been doing only GI for a few years. She had the right attitude and we felt like we could retrain her to be good. It’s been a long, hard road, for her and us. After a year, she’s finally adequate. Skill and knowledge atrophy is real.

Is it atrophy if you never had it in the first place?

 

[dchz]

or ask the GI guys to pay you per case when you are there M-Th

This is def a good strategy, but I do not think OP has enough leverage.

 

[chocomorsel]

Let's do the math:
$250 per scope * 15 scopes/day = $3750/day
With your previous offer of $315K, the GI guys were likely making $3750/day * 5 days/week * 50 weeks = $937.5K/year (!!!!). They were taking most of your reimbursement.
When they are offering you $350K, they will be making $3750/day * 4 days/week * 46 weeks = $690K/year. They are still skimming about half of your reimbursement.

I would leave that GI gig or ask the GI guys to pay you per case when you are there M-Th, while doing your locums on your non-GI days. Or find an anesthesia group who will take you on board part-time for those free days (difficult, I know). I agree with the above that the GI guys may not ask you to come back once they find a cheaper replacement. That's the downside of working at one place only and the skills required are not specialized. You have no leverage.

What kind of cases are done at the outpatient surgery center? What are the hours? 315K stinks if 1) it doesn't provide opportunities to gain skills or 2) you work 40 hrs/wk with premium insurance carriers.

Like OP I am also 5 years out of residency. I left a full-time salaried hospital work a while ago for fee-for-service surgery center work on weekdays. I still take hospital calls on weekends. I feel that my skillset has improved since making the move, as the variety of cases has dramatically increased (I go to about nine different sites now). I definitely don't take things for granted. Even the gig that looks good now can always change, which is why I feel the need to keep up my skills to stay competitive. I know several colleagues in their early 40's who still don't know how to perform ultrasound-guided blocks and refuse to do any kind of challenging cases (i.e. neurospine, thoracic, ENT challenging airways) and would beg everyone else to switch cases. This is baffling to me.

Good luck to OP, hope you find your happy medium.

Come on guys, are these numbers even close to accurate?
Where are you getting $250 per case from? What if the practice is mostly Medicare? $3750 per day?
I really find in hard to believe that the average reimbursement is that high. It can be so relative depending on the patient population.
Does anyone on here who has done solely GI vouch for these numbers?
They sound crazy high to me. But maybe I am used to being lowballed. LOL

 

[ZzzPlz]

Come on guys, are these numbers even close to accurate?
Where are you getting $250 per case from? What if the practice is mostly Medicare? $3750 per day?
I really find in hard to believe that the average reimbursement is that high? It can be so relative depending on the patient population.
Does anyone on here who has done solely GI vouch for these numbers?
They sound crazy high to me. But maybe I am used to being lowballed. LOL

I think you’re right. Screening colon units were just cut in half if I’m not mistaken. If the payer mix isn’t good you could be looking at more like 85-125 per scope

 

[deleted162650]

Come on guys, are these numbers even close to accurate?
Where are you getting $250 per case from? What if the practice is mostly Medicare? $3750 per day?
I really find in hard to believe that the average reimbursement is that high. It can be so relative depending on the patient population.
Does anyone on here who has done solely GI vouch for these numbers?
They sound crazy high to me. But maybe I am used to being lowballed. LOL

Ok, let’s go worst case scenario: all Medicare.

16 scopes per day x 7 units per scope average x 21$/unit = $2352/day = $11,760/wk x 46wks = $540,960/yr.

OP be gettin’ raped.

 

[anbuitachi]

I wonder how much insurance pays the GI doc for a scope

 

[narcotics999]

Ok, let’s go worst case scenario: all Medicare.

16 scopes per day x 7 units per scope average x 21$/unit = $2352/day = $11,760/wk x 46wks = $540,960/yr.

OP be gettin’ raped.

medicare only pays 80%. the other 20% is no guarantee.

I work fee for service for a while. My coworker told me to send out ppo billing a month later. Hopefully the hospital and the surgeons will swallow the possible unpaid deductible first.

In NYC, I knew a GI guy only use crna. pays 75$/hr.

No way OP will get the full fee.

 

[deleted162650]

medicare only pays 80%. the other 20% is no guarantee.

I work fee for service for a while. My coworker told me to send out ppo billing a month later. Hopefully the hospital and the surgeons will swallow the possible unpaid deductible first.

In NYC, I knew a GI guy only use crna. pays 75$/hr.

No way OP will get the full fee.

Well, if you’re smart, you collect the 20% copay at the time of service. But still, absolute worst case scenario of doing only Medicare and collecting only the 80% would still put you at $432,768. Keep in mind that no stand alone GI center is doing just Medicare. I bet the payer mix is pretty good.

And ya, everyone sends out their billing after a delay in hopes of avoiding being caught with the deductible. Problem is everyone has caught onto that strategy. Now it’s s race to see who can submit their bill the latest.

 

[sleepallday]

Hello all,

I have a job question. I wanted to get an idea of what people would do in my position. I am 5 years out of residency but for the past 2 years I have worked in a GI center doing only GI cases. The offer at the time was 300k for M-F work. I figured I would do it for some time and then leave before my skills deteriorated to much. I stayed much longer than anticipated. I got fearful of losing my skills and what that would mean for my future career. So I wanted to get back into doing some regular OR case and started doing some locums on my vacation days while still at my current GI center till I found a new permanent position. Through a contact, I found and was offered an outpatient surgicenter position for 315K M-F schedule. Around the same time my locums position offered me a full time position that would pay 350k including call about 4-5x a month. Now the GI suite that I work for wants to keep me so bad that they offered to pay me 350k for only M-Th allowing me to still do locums on Fridays, weekends, and vacation days. So I have 3 job opportunities. I'm wondering which one I should take.

OP- You have a lot more leverage then your giving yourself credit for. They obviously love you or else they wouldn't give you the offer they did. Correct me if I'm wrong but it sounds like you'll be getting $350k for 28 hours/week (plus any possible benefits?). Thats pretty sweet. Also, I'm sure these GI docs are not dumb. If they wanted to save some money and go the CRNA route, that would have happened a long time ago. Sounds like they would feel a lot more comfortable with a doc there.

I would take this deal in a heartbeat and do some locums on the side to keep your skills up. But since it sounds like they really want you, I would play my luck and ask for a little more. Maybe ask to be given the chance to buy some shares in the GI center (if they own it) or the practice. Whats the worst that can happen? You still have two back-up options.

 

[anbuitachi]

Agreed. With those rates 350k for 30 hr, you are getting paid like a EM doc.. can't beat that!

 

[Mman]

random thoughts on the topic...

--7 units per scope seems ambitious since screening colonoscopies only get 3 base units these days instead of 5 previously
--some/?many GI docs that employ anesthesia staff do not have some awesome deal with insurance companies per unit. I know quite a few that have the patients pay cash for the anesthesia services and it's way less than you'd get as an anesthesia group billing out for it. So don't quite assume some massive profit margin by the GI docs on the anesthetic. They also have to foot the bill for the supplies for the anesthetic. I mean they make a little, but it's not the killing you'd think.

 

[Wiscoblue]

They usually ‘find’ something to biopsy. Does that change the code from a screening scope to something else?

I had a screening colonoscopy a couple years ago at our hospital. The total charge was just over 15,000 and my insurance paid over $10,000.

 

[AdmiralChz]

Agreed. With those rates 350k for 30 hr, you are getting paid like a EM doc.. can't beat that!

Only working normal daytime hours and not predominantly nights/weekends! Family friendly schedule for sure.

 

[anbuitachi]

They usually ‘find’ something to biopsy. Does that change the code from a screening scope to something else?

I had a screening colonoscopy a couple years ago at our hospital. The total charge was just over 15,000 and my insurance paid over $10,000.

I'm guessing most of it is facility fees?? Otherwise that'd be some insane payment for a scope

 

[Foodie]

Well, if you’re smart, you collect the 20% copay at the time of service. But still, absolute worst case scenario of doing only Medicare and collecting only the 80% would still put you at $432,768. Keep in mind that no stand alone GI center is doing just Medicare. I bet the payer mix is pretty good.

This. Btw, now Medicare pays 5 units for EGD, 4 units for colon, and 5 units for a double.

 

[anbuitachi]

This. Btw, now Medicare pays 5 units for EGD, 4 units for colon, and 5 units for a double.

Man those are cuts across the board for anesthesiology. When will we ever see increases. sigh.

 

[deleted171991]

Man those are cuts across the board for anesthesiology. When will we ever see increases. sigh.

When we are the ones paying.

 

[caligas]

If you move to M-Th, who takes your Friday? A CRNA perhaps? How long do you think it takes the GI guys to realize they can pay them 1/2 your rate?.

But I thought everyone here says CRNAS make almost what MDs make per hour.

 

[deleted697127]

If you move to M-Th, who takes your Friday? A CRNA perhaps? How long do you think it takes the GI guys to realize they can pay them 1/2 your rate?

Otherwise, if you can deal with the butthut 4 days a week, make 350k, and you’re driven enough to keep your skills up doing legit locums I think that sounds pretty good.

Anesthesia cases M-Th, nursing sedation Friday.

 

[Craysee]

Thanks for all the replies. I doubt the GI group will move to CRNAs. They had some bad experiences in the past and refuses to use them. Also some bad experiences with MDs hence I think the offer for pay increase. Friday would be covered by locums Anesthesiologist or the MD that covers vacations. Where do people live who are making 400k + on strictly GI? I never anticipated they would give me full fee per scope but 350k for even M-F is on the high side where I am. Literally the only reason this is even a consideration is the pay per hours worked.

 

[Hoya11]

Thanks for all the replies. I doubt the GI group will move to CRNAs. They had some bad experiences in the past and refuses to use them. Also some bad experiences with MDs hence I think the offer for pay increase. Friday would be covered by locums Anesthesiologist or the MD that covers vacations. Where do people live who are making 400k + on strictly GI? I never anticipated they would give me full fee per scope but 350k for even M-F is on the high side where I am. Literally the only reason this is even a consideration is the pay per hours worked.

Personally, I could not do GI all day every day.. just couldnt do it man..

I would go with the surgicenter job for 315k if it allows you to do a variety of things (kids/blocks) and maybe negotiate to 325k

or if I could get the call job from 350k up to 375 or 400k that would be my #1 option..

Sure its only a little bit more money and you have the call responsibilities, but could not go Gi all day for me not an option, maybe that is what you are feeling in your soul

 

[anbuitachi]

Personally, I could not do GI all day every day.. just couldnt do it man..

I would go with the surgicenter job for 315k if it allows you to do a variety of things (kids/blocks) and maybe negotiate to 325k

or if I could get the call job from 350k up to 375 or 400k that would be my #1 option..

Sure its only a little bit more money and you have the call responsibilities, but could not go Gi all day for me not an option, maybe that is what you are feeling in your soul

but OP only there for 6-7 hrs a day. And being how busy GI centers are, i imagine it will go by quick. you have the rest of the day to yourself to do whatever!

 

[GravelRider]

Life is WAY too short to spend it sitting in an OR or giving whiney CRNAs breaks. Keep the low stress GI gig and do some locums on the side. Enjoy life. Keep the flexibility. That kind of flexibility is worth whatever money the GIs are siphoning off your billing. Develop some hobbies, spend time with family/friends, and just be grateful that you only have to spend 28 hours a week dealing with needy patients/proceduralists and still make a good living. There will always be some kind of anesthesia job out there no matter how rusty you are.

 

[deleted171991]

There will always be some kind of anesthesia job out there no matter how rusty you are.

I doubt that. S/he needs to practice diverse general anesthesiology (hospital-level, not ASC) at least like 50 days/year to be taken seriously when applying for the next job. S/He's becoming a glorified CRNA, and s/he probably has 20-30 more years to go.

If I were in this situation, I would be very afraid of a Joan Rivers-type moment of truth.

If a young attending wants a 40 hour-workweek, s/he should get a VA or mommy track job, not GI or ASC. Don't chase the money: Privilege and Perspective

 

[GravelRider]

I doubt that. S/he needs to practice diverse general anesthesiology (hospital-level, not ASC) at least like 50 days/year to be taken seriously when applying for the next job. S/He's becoming a glorified CRNA, and s/he probably has 20-30 more years to go.

If I were in this situation, I would be very afraid of a Joan Rivers-type moment of truth.

If a young attending wants a 40 hour-workweek, s/he should get a VA or mommy track job, not GI or ASC. Don't chase the money: Privilege and Perspective

Nope. I’ve seen some real losers get jobs easily. If you are halfway motivated you can find a job. Is it a dream job as a partner in good private practice? Absolutely not. We talk all the time about how AMCs are revolving doors looking for warm bodies.

If he is bored doing what he’s doing or is unhappy and unfulfilled then he should move on, but not out of fear that he’ll lose skills. What skills is he losing anyway? How to intubate? Grab a glidescope and move on. Epidurals? Just don’t do OB (or it takes a few to get the feel back). Blocks? Come on...watch a YouTube video. Knowledge? He’s working 28 hours a week. I bet he is way more willing to read and stay up to date than the AMC scut monkey working 60 hours a week supervising crnas. At least he’s hands-on with patients, which is a lot more than some supervisors can say.

In the end this is a job, not a calling. It’s a means to pay the bills, support a family, and maybe save for retirement so you never have to step foot in a healthcare facility as a worker ever again. If working the “butt hut” allows him to attain those goals faster then he should.

My vote remains to keep the butt hut (I like that term) job unless he is miserable doing GI (I would be miserable doing only GI).

 

[anbuitachi]

Nope. I’ve seen some real losers get jobs easily. If you are halfway motivated you can find a job. Is it a dream job as a partner in good private practice? Absolutely not. We talk all the time about how AMCs are revolving doors looking for warm bodies.

If he is bored doing what he’s doing or is unhappy and unfulfilled then he should move on, but not out of fear that he’ll lose skills. What skills is he losing anyway? How to intubate? Grab a glidescope and move on. Epidurals? Just don’t do OB (or it takes a few to get the feel back). Blocks? Come on...watch a YouTube video. Knowledge? He’s working 28 hours a week. I bet he is way more willing to read and stay up to date than the AMC scut monkey working 60 hours a week supervising crnas. At least he’s hands-on with patients, which is a lot more than some supervisors can say.

In the end this is a job, not a calling. It’s a means to pay the bills, support a family, and maybe save for retirement so you never have to step foot in a healthcare facility as a worker ever again. If working the “butt hut” allows him to attain those goals faster then he should.

My vote remains to keep the butt hut (I like that term) job unless he is miserable doing GI (I would be miserable doing only GI).

Funny, we had a new attending recently who worked in an easy place for years and we found out he had forgotten how to intubate. he got fired for that.

 

[GravelRider]

Funny, we had a new attending recently who worked in an easy place for years and we found out he had forgotten how to intubate. he got fired for that.

That’s at an academic place teaching residents. I bet that same guy found another job pretty easily. Worse comes to worse he finds a job supervising CRNAs where they do the intubating for him.

 

[dannyboy1]

Nope. I’ve seen some real losers get jobs easily. If you are halfway motivated you can find a job. Is it a dream job as a partner in good private practice? Absolutely not. We talk all the time about how AMCs are revolving doors looking for warm bodies.

This. I live and work in the northeast so have interviewed with quite a few AMC’s. The first question was usually “when can you start”?