Jobs in extreme rural areas

[Pharmado]

Advertisement - Members don't see this ad

Some of our MSIV's that hit the interview trail recently came back describing jobs that programs were promoting that their residents have recently taken. Included in their report was a resident that took a 700k/yr job with 18 wks vacation in Alaska. I can imagine there are parts of Alaska so remote that it would take a serious recruitment effort to find the right candidate, but I'm still skeptical. I'm curious to know if such jobs actually exist or if this is just a pipe-dream that programs are putting in students heads. I consider it a red flag that programs are talking openly about jobs that fall beyond the realm of realistic expectation. Any thoughts or comments would be appreciated.

 

[jwk]

Supply and demand my friend - supply and demand. It might not be worth it to you to take that position. But they only need to find one.

 

[WholeLottaGame7]

Some of our MSIV's that hit the interview trail recently came back describing jobs that programs were promoting that their residents have recently taken. Included in their report was a resident that took a 700k/yr job with 18 wks vacation in Alaska. I can imagine there are parts of Alaska so remote that it would take a serious recruitment effort to find the right candidate, but I'm still skeptical. I'm curious to know if such jobs actually exist or if this is just a pipe-dream that programs are putting in students heads. I consider it a red flag that programs are talking openly about jobs that fall beyond the realm of realistic expectation. Any thoughts or comments would be appreciated.

A resident 2 years ahead of me took a job in Anchorage, Alaska, that paid ~600k/yr, 12 weeks vacay, 100K signing bonus split into 3 parts. So, they are out there.

 

[Carbocation1]

Anchorage (largest city in Alaska), 650K partner, 9 weeks vaca. http://gaswork.com/post/188415

 

[Doctor4Life1769]

Don't you lose a good chunk of that to taxes though?

 

[aneftp]

All supply/demand.

It doesn't even have to be super rural either to make good money.

My friend in the southeast (he does pain and anesthesia). He wants to give up anesthesia. But he's about 45-50 minutes drive from a city (1.5 million plus metro area) so u literally can be on outer suburbs. However the hospital requires 10 miles radius).

Anyways the real contract is worth $900k/52 weeks.

He splits the job. The guy who has the contract makes $450k. My friend takes in $400k (for the anesthesia portion). So the guy with the contract shaves 50k off the top! Just like how a management company works.

Now my friend will look for someone to work 26 weeks out the year and he said he will pay them $360k and pocket the $40k!!

Gotta love 'merica. Everyone shaving money off the top!!

And someone will take that $360k with 26 weeks off.

But my friend loves the rural area now. He's grown to love it. he's just tired of general anesthesia.

 

[aneftp]

Don't you lose a good chunk of that to taxes though?

Alaska no state income taxes.

U can defer a lot of pretax money in a defined benefits plan(aka 100k plus)

Pay urself "reasonable wages". Aka $130k w2. All the money after deduction flows back as passive income. Avoid paying Medicare surtax that way.

U would be surprised. Many people can get their effective tax rate to below 15% pretty easily

 

[Doctor4Life1769]

Alaska no state income taxes.

U can defer a lot of pretax money in a defined benefits plan(aka 100k plus)

Pay urself "reasonable wages". Aka $130k w2. All the money after deduction flows back as passive income. Avoid paying Medicare surtax that way.

U would be surprised. Many people can get their effective tax rate to below 15% pretty easily

This is something I'd like to learn more about.

 

[Pharmado]

I suppose that's something we should all learn.

 

[Pharmado]

All supply/demand.

It doesn't even have to be super rural either to make good money.

My friend in the southeast (he does pain and anesthesia). He wants to give up anesthesia. But he's about 45-50 minutes drive from a city (1.5 million plus metro area) so u literally can be on outer suburbs. However the hospital requires 10 miles radius).

Anyways the real contract is worth $900k/52 weeks.

He splits the job. The guy who has the contract makes $450k. My friend takes in $400k (for the anesthesia portion). So the guy with the contract shaves 50k off the top! Just like how a management company works.

Now my friend will look for someone to work 26 weeks out the year and he said he will pay them $360k and pocket the $40k!!

Gotta love 'merica. Everyone shaving money off the top!!

And someone will take that $360k with 26 weeks off.

But my friend loves the rural area now. He's grown to love it. he's just tired of general anesthesia.

Admittedly, I'd probably jump at 360k for 26 wks work.

 

[Apollyon]

I have a friend whose radiology group covers a few Alaska sites. Group partner buy in was just under $1million. One AK guy had it in a year. I'm EM - the $$ doesn't get that far.

 

[donkeykong1]

Alaska no state income taxes.

U can defer a lot of pretax money in a defined benefits plan(aka 100k plus)

Pay urself "reasonable wages". Aka $130k w2. All the money after deduction flows back as passive income. Avoid paying Medicare surtax that way.

U would be surprised. Many people can get their effective tax rate to below 15% pretty easily

How does one fudge their w2 like this? Aren't you under contract as an anesthesiologist for a set income each year

 

[aneftp]

This is something I'd like to learn more about.

Scwab offers defined benefits plan for small business owners. My brother in Los Angeles has been funding his plan for 10 plus years. There are fees involved. Just the cost of doing business.

My brother puts $125k pretax into the plan. Plus he puts $24k in his own 401k plan (he just turned 50 last year so it's $18k (adjusted for inflation, Check with IRS yearly) plus $6k more for age 50 or older.
And he's got some other weird pretax profit sharing thing (I will have to ask him) where he puts another 12.5 pretax.

So that's like $160k pretax savings.

That's how people lower their tax load especially in high state income tax rates like California.

http://www.schwab.com/public/schwab...ness_retirement/personal_defined_benefit_plan

 

[aneftp]

How does one fudge their w2 like this? Aren't you under contract as an anesthesiologist for a set income each year

Reasonable wages. MD. So I am An MD so expects to make reasonably $130k.

My CRNA self employed friends pay themsleves $50k reasonable wages.

 

[Doctor4Life1769]

Scwab offers defined benefits plan for small business owners. My brother in Los Angeles has been funding his plan for 10 plus years. There are fees involved. Just the cost of doing business.

My brother puts $125k pretax into the plan. Plus he puts $24k in his own 401k plan (he just turned 50 last year so it's $18k (adjusted for inflation, Check with IRS yearly) plus $6k more for age 50 or older.
And he's got some other weird pretax profit sharing thing (I will have to ask him) where he puts another 12.5 pretax.

So that's like $160k pretax savings.

That's how people lower their tax load especially in high state income tax rates like California.

http://www.schwab.com/public/schwab...ness_retirement/personal_defined_benefit_plan

Thanks so much for the information - I'll look into the link. My future job also has some profit sharing involved so that would be good for me to know.

 

[Mman]

Pay urself "reasonable wages". Aka $130k w2. All the money after deduction flows back as passive income. Avoid paying Medicare surtax that way.

As an anesthesiologist, a wage that low is sure to draw attention to your tax return that you'd probably not rather have. If you want to be safer, just pay yourself 50th percentile MGMA. That's what we do. It's a lot harder to argue that 50th percentile isn't a reasonable wage.

 

[Random Anesthesiologist]

Any other areas besides Alaska with rural Anesthesiologists? Also, how about Ccm anesthesiology in rural areas?

 

[pgg]

Scwab offers defined benefits plan for small business owners.

Interesting, I always figured fees would be much higher.

$1200 setup and $1200/year isn't bad at all if it lets you put away six figures pre-tax every year.

 

[deleted162650]

The amount you can put into a DBP typically scales with age. May only be 40-50k when you first start out but can be in excess of 200k + as you near retirement age.

 

[pgg]

What's the rule? I thought you have to put away equal amounts every year for a fixed # of years to fund the plan (i.e. you can't contribute less in year N because it was a bad year or your boat needed a new engine). I didn't know there was an age component in the math.

 

[deleted162650]

What's the rule? I thought you have to put away equal amounts every year for a fixed # of years to fund the plan (i.e. you can't contribute less in year N because it was a bad year or your boat needed a new engine). I didn't know there was an age component in the math.

Well I don't know the formula, but I know that's how ours works. I'm not at the point in my career where I can take advantage of it yet, but I'll ask. What you're saying is also correct though. I know in ours you are only allowed to adjust the amount you're putting in every few years (3-5 I think). Again I'll look into the details and let you know. In the mean time maybe doze or blade will chime in.

 

[Arch Guillotti]

Reasonable wages. MD. So I am An MD so expects to make reasonably $130k.

Too low. Don't recommend this approach.

 

[Arch Guillotti]

What's the rule? I thought you have to put away equal amounts every year for a fixed # of years to fund the plan (i.e. you can't contribute less in year N because it was a bad year or your boat needed a new engine). I didn't know there was an age component in the math.

It depends on the plan. Numbers are crunched by a TPA/actuary typically.

 

[Doctor4Life1769]

Out of curiosity, what do y'all use for your business checking/savings account? I have looked at no fee ones, seems Capital One is the best option, currently also offering 1.0% interest.

 

[Ezekiel2517]

I know people who pay themselves <100K with that approach and never get in trouble. It's a common misconception that setting yourself up as a corp saves you money. I know from talking to accountants that it does not, it actually costs you some money compared to simply being 1099. Also, I understand people socking away those kind of sums into a DBP if they are behind in their retirement savings or are looking to retire in a few years but to put away 6 figures annually just to lower their taxes is kinda stupid IMO. You should not have anywhere close to the expenses you have now when you retire since the house is paid for, kids are out of college, etc. Obviously save for the future with a SEP or solo 401k, but also enjoy the fruits of your labor now while you still can, tomorrow is not guaranteed.

 

[Mman]

What's the rule? I thought you have to put away equal amounts every year for a fixed # of years to fund the plan (i.e. you can't contribute less in year N because it was a bad year or your boat needed a new engine). I didn't know there was an age component in the math.

The "defined benefit" part means the account has to target an annual benefit to you of a certain amount when you retire. Currently that is no more than $210,000 per year or your average wage for your 3 highest years (whichever is lowest, so $210K).

So when you contribute to it, you have to contribute on a schedule that targets it providing you $210K per year at a given retirement age. I believe they generally limit contributions to about 50K per year under age 50 and then after that it scales up depending on how long you have been contributing. If you didn't start contributing until age 58, you can put away more per year. If you started at age 40, you will be able to put away less per year. You can always contribute less than the maximum for that target benefit, but then you might not get the full benefit in the end, but you can never contribute more than the calculated max.

Once the account (or plan) reaches a balance that will provide you with that $210K benefit per year, you can no longer contribute to it. You do, I believe, have the option of opening another plan at that point. Then when you retire the question is what happens to the money. You can either get an annuity that will pay you a monthly sum of money until you die, or you can just take the lump sum cash and do as you wish.

 

[Arch Guillotti]

Then when you retire the question is what happens to the money. You can either get an annuity that will pay you a monthly sum of money until you die, or you can just take the lump sum cash and do as you wish.

Roll it over to a 401K.

 

[pgg]

Thanks. A defined benefit plan is something I'll have to look at more closely when my Navy days are over.