Kaiser vs. USAP career advice?

[osoprop28]

I'm hoping to get some advice as I finish my residency and decide on a job. I'm deciding between Kaiser and USAP and little lost on how to make the decision.

USAP hospital is pure eat what you kill model with 2 year "partnership" track and the forced buy-in of their stocks.

Kaiser, as you guys probably know, is just salary (overtime paid after 40 hours), good benefits, but you're traveling to multiple hospitals and seems like just a cog in the wheel.

The pay is similar (obviously you can make more with USAP if I decide to work lot more), but it seems like USAP provides more flexibility in terms of creating your own vacation schedule and work hours. But I'm little weary of the forced stock purchase. Would you guys have any inputs on these practices??

Also, I read on other threads that you're giving up income in perpetuity from USAP? Can anyone explain this? Thank you so much!

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[dabears505]

What kind of salary does Kaiser give?

 

[osoprop28]

I believe Kaiser's starting salary is around $390?
And for USAP, it seems like if you take regular amount of calls with their usual work hours, you make around $400k

 

[pjl]

Just ignore that long term you are giving up %salary with USAP. That ship has sailed if you are looking at a USAP job. Kaiser you are giving up a % too, it just isn’t shown in the same way. Comparing what you earn to what you earn your employer will only make you unhappy, and really is not relevant when you are choosing between 2 jobs.

Evaluate both based on salary, hours, vacation, case load. In my calculations I would just straight subtract the stock purchase from the salary and treat it as a donation that ends up being worthless. Do the math for 1 year, 3 years, and 5 years. Choose the one with lifestyle/workload with the best ratio to pay, as long as neither is more work than you are willing to put in.

Otherwise, look around from a location standpoint if that is flexible, there are likely better options out there.

 

[AdmiralChz]

Also, I read on other threads that you're giving up income in perpetuity from USAP? Can anyone explain this? Thank you so much!

There’s over 500 posts on USAP here. Mostly Houston but this is required reading, and explains your question at least 4 or 5 times:

USAP - Partner track worth it?

I know how everyone feels about these huge AMCs, but unfortunately they seem to have control over certain locations/markets. I've heard a few people say USAP is one of the "less evil" AMCs. Just wondering, if you were forced to take a job with an AMC such as USAP, would you even roll the dice...

forums.studentdoctor.net

 

[Howard888]

Demand USAP match Kaisers salary for your “two years” of partnership track as you will have to buy stock.

If USAP will not do this and is paying you significantly less than Kaiser during those first two years...USAP is not worth it, go Kaiser

 

[GaseousClay]

I'm hoping to get some advice as I finish my residency and decide on a job. I'm deciding between Kaiser and USAP and little lost on how to make the decision.

USAP hospital is pure eat what you kill model with 2 year "partnership" track and the forced buy-in of their stocks.

Kaiser, as you guys probably know, is just salary (overtime paid after 40 hours), good benefits, but you're traveling to multiple hospitals and seems like just a cog in the wheel.

The pay is similar (obviously you can make more with USAP if I decide to work lot more), but it seems like USAP provides more flexibility in terms of creating your own vacation schedule and work hours. But I'm little weary of the forced stock purchase. Would you guys have any inputs on these practices??

Also, I read on other threads that you're giving up income in perpetuity from USAP? Can anyone explain this? Thank you so much!

Which kaiser are you referring to? In california, TPMG and SCPMG are very different in terms of pay and overtime.

 

[DirtDocMD]

“Basically” equal pay, but Kaiser will pay you extra for anything over 40 hours. How many hours a week at USAP?

You’re gonna be out $100-$200k on USAP stock. Maybe youymake money on that, maybe you’ll lose it all.

How much are you making those first two years with USAP?? It might be 6-8-10 years before you “break even” if the first two years are at a really low salary....

 

[Urzuz]

I know Kaiser is supervision for the most part. What is USAP?

If the jobs are pretty comparable for the most part, I would happily sacrifice a large chunk of money for not ever needing to interact with a CRNA.

 

[Ezekiel2517]

Kaiser. It's not about salary, it's about total compensation. A pension for a physician is a rare thing. You can put away a lot annually on top of that. You can accrue vacation quickly and it's paid.

 

[BLADEMDA]

IMHO, the USAP stock should not be valued at zero. But, I would "mark it down" to 1/2 of what they make you purchase. So, for example, a $200,000 stock purchase is likely worth $100,000 by the time you get vested.

I prefer Kaiser over USAP for a number of reasons but ultimately location plays a huge role in your decision.

 

[deleted171991]

I didn't follow most of this discussion, because it smelled of Ponzi. But the real value of a stock like this should be either the amount one can get for selling it (market or liquidation value, both almost zero in this case) or the value of the dividends it throws at its owner in a safely foreseeable timeframe (2-3 years in this case). I would not trust the paper increases in owner equity, so I strongly doubt that USAP stock is a good investment based on EITHER calculation. Suckers, beware!

 

[osoprop28]

I think USAP is anywhere from 45-60 hours? But they said it depends on how much you want to work & earn so it varies.

My base salary is $350k for USAP but can make more with call. They quoted me that some docs make up to $750k since it's eat what you kill, but I'm not sure how much you have to work to make that amount..

And yes that $100k stock buy in is what's concerning me a little bit..

“Basically” equal pay, but Kaiser will pay you extra for anything over 40 hours. How many hours a week at USAP?

You’re gonna be out $100-$200k on USAP stock. Maybe youymake money on that, maybe you’ll lose it all.

How much are you making those first two years with USAP?? It might be 6-8-10 years before you “break even” if the first two years are at a really low salary....

 

[osoprop28]

So kaiser is actually solo in hospitals and CRNA in ASCs. So it seems like a split.

USAP is split as well, they have about 6-8 CRNA for about 15 ORs. So it seems like that's pretty similar.

I haven't interacted with CRNAs alot in residency, but what's your reasoning for avoiding CRNAs??

Some of my attendings talk about how tiring it is to be solo all the time and that CRNAs help you become a better supervisor? Not sure it's them being lazy or it's true..

I know Kaiser is supervision for the most part. What is USAP?

If the jobs are pretty comparable for the most part, I would happily sacrifice a large chunk of money for not ever needing to interact with a CRNA.

 

[osoprop28]

It's mid atlantic group in Virginia

Which kaiser are you referring to? In california, TPMG and SCPMG are very different in terms of pay and overtime.

 

[nimbus]

I think USAP is anywhere from 45-60 hours? But they said it depends on how much you want to work & earn so it varies.

My base salary is $350k for USAP but can make more with call. They quoted me that some docs make up to $750k since it's eat what you kill, but I'm not sure how much you have to work to make that amount..

It depends on the unit value net to you after USAP takes their cut and how much time you take off. If you’re getting $40/unit or less, you will work very very hard for 750k. If it’s over $50/unit it’s doable with a reasonable amount of work but still working hard.

 

[dchz]

Just ignore that long term you are giving up %salary with USAP. That ship has sailed if you are looking at a USAP job. Kaiser you are giving up a % too, it just isn’t shown in the same way. Comparing what you earn to what you earn your employer will only make you unhappy, and really is not relevant when you are choosing between 2 jobs.

Evaluate both based on salary, hours, vacation, case load. In my calculations I would just straight subtract the stock purchase from the salary and treat it as a donation that ends up being worthless. Do the math for 1 year, 3 years, and 5 years. Choose the one with lifestyle/workload with the best ratio to pay, as long as neither is more work than you are willing to put in.

Otherwise, look around from a location standpoint if that is flexible, there are likely better options out there.

This is solid advice.

OP, a lot of relevant info is missing:

1. Location location location, Kaiser job in LA or SD is way better than USAP job in Texas, Colorado, or Flordia (but the latter is taxed less so the numbers are very different after state income taxes).
2. You never said hours, 40 vs 60 (believe me when it will never be the low end of their estimate), so the 60 hour one should pay you at leat 1.5x more? no?

 

[aimedicine]

It depends on the net unit value after USAP takes their cut and how much time you take off. If you’re getting $40/unit or less, you will work very very hard for 750k. If it’s over $50/unit it’s doable with a reasonable amount of work but still working hard.

This is solid advice.

OP, a lot of relevant info is missing:

1. Location location location, Kaiser job in LA or SD is way better than USAP job in Texas, Colorado, or Flordia (but the latter is taxed less so the numbers are very different after state income taxes).
2. You never said hours, 40 vs 60 (believe me when it will never be the low end of their estimate), so the 60 hour one should pay you at leat 1.5x more? no?

I think USAP is anywhere from 45-60 hours? But they said it depends on how much you want to work & earn so it varies.

My base salary is $350k for USAP but can make more with call. They quoted me that some docs make up to $750k since it's eat what you kill, but I'm not sure how much you have to work to make that amount..

And yes that $100k stock buy in is what's concerning me a little bit..

So is the stock buy in taken from your salary?...so if your base is 350k doesn’t that mean your salary is really 250 after 100k buy in. Also I’ve heard other say things about USAP and how they take their own percentage of your salary so doesn’t that mean your salary is closer to 200k...i mean that’s a terrible job/salary...why are people still debating whether it’s a good job, your are potentially only making 200k in salary, that’s a terrible job!

 

[dchz]

So is the stock buy in taken from your salary?...so if your base is 350k doesn’t that mean your salary is really 250 after 100k buy in. Also I’ve heard other say things about USAP and how they take their own percentage of your salary so doesn’t that mean your salary is closer to 200k...i mean that’s a terrible job/salary...why are people still debating whether it’s a good job, your are potentially only making 200k in salary, that’s a terrible job!

My understanding:

The stock buy is with your income.

But the "cut" they take is before the income, as in the $350 they quote you is already after their cut is taken. But verify with your group.

 

[deleted50478]

This is solid advice.

OP, a lot of relevant info is missing:

1. Location location location, Kaiser job in LA or SD is way better than USAP job in Texas, Colorado, or Flordia (but the latter is taxed less so the numbers are very different after state income taxes).
2. You never said hours, 40 vs 60 (believe me when it will never be the low end of their estimate), so the 60 hour one should pay you at leat 1.5x more? no?

Agree to disagree

 

[osoprop28]

This is solid advice.

OP, a lot of relevant info is missing:

1. Location location location, Kaiser job in LA or SD is way better than USAP job in Texas, Colorado, or Flordia (but the latter is taxed less so the numbers are very different after state income taxes).
2. You never said hours, 40 vs 60 (believe me when it will never be the low end of their estimate), so the 60 hour one should pay you at leat 1.5x more? no?

So my location is in the DC/VA area, which is generally saturated and not lot of high paying PP gigs.

For the hours, kaiser quotes 40-45 (sometimes 50), but you get paid overtime after the 40 (although they do cap you after you earn certain amount). USAP varies I think and they quote anywhere up to 60 but you're getting paid for every case (so is kaiser but there is a ceiling since they cap - I'm not sure where this cap is)

 

[gasdoc77]

This is solid advice.

OP, a lot of relevant info is missing:

1. Location location location, Kaiser job in LA or SD is way better than USAP job in Texas, Colorado, or Flordia (but the latter is taxed less so the numbers are very different after state income taxes).
2. You never said hours, 40 vs 60 (believe me when it will never be the low end of their estimate), so the 60 hour one should pay you at leat 1.5x more? no?

Regarding hours, herein lies where physicians are lousy at time vs money. The percentage decrease in your awake free time comparing 40-60 hours is far greater than the percentage increase in your take home income. USAP vs Kaiser may be comparing a job to a career.

 

[osoprop28]

Regarding hours, herein lies where physicians are lousy at time vs money. The percentage decrease in your awake free time comparing 40-60 hours is far greater than the percentage increase in your take home income. USAP vs Kaiser may be comparing a job to a career.

Could you explain this little further??

 

[dchz]

Could you explain this little further??

You're awake 112 hours per week. (7x24-7x8).

Going from 40 hours to 60 hours = going from 60% to 46% awake free time is a 23% decrease in free time. But you won't get 23% increase pay.

I don't like that type of accounting, because you should be asking for a 50% increase in pay because of your productivity not a 23% increase in pay. not to mention that you will be working less desirable hours that should be inherently compensated more.

 

[BW15]

This is solid advice.

OP, a lot of relevant info is missing:

1. Location location location, Kaiser job in LA or SD is way better than USAP job in Texas, Colorado, or Flordia (but the latter is taxed less so the numbers are very different after state income taxes).
2. You never said hours, 40 vs 60 (believe me when it will never be the low end of their estimate), so the 60 hour one should pay you at leat 1.5x more? no?

Anyone know how much Kaiser Socal pays anesthesiologists full time and part time? Everything I've read says that the pay is very low and given how strong the anesthesia market is right now it doesn't seem worth it to go with Kaiser.

 

[aneftp]

Kaiser used to have good pension. Many docs “retired at age 50” and worked elsewhere. The pension plan changed sometime in the last 10 years and it’s not as good for newer hires.

 

[deleted162650]

Anyone know how much Kaiser Socal pays anesthesiologists full time and part time? Everything I've read says that the pay is very low and given how strong the anesthesia market is right now it doesn't seem worth it to go with Kaiser.

Kaiser SoCal pays horribly. Kaiser in other locations pays SIGNIFICANTLY better for the same hours. I wouldn’t ever consider Kaiser SoCal, but I would entertain Kaiser Denver for example.

Your days will likely be more chill at Kaiser as well. Everyone is an employee, so you don’t have surgeons breathing down your neck like you would in PP.

 

[dantt]

Let's make sure we present all the facts here. You also have to buy shares in Kaiser (at least northern California).

 

[GaseousClay]

Kaiser SoCal pays horribly. Kaiser in other locations pays SIGNIFICANTLY better for the same hours. I wouldn’t ever consider Kaiser SoCal, but I would entertain Kaiser Denver for example.

Your days will likely be more chill at Kaiser as well. Everyone is an employee, so you don’t have surgeons breathing down your neck like you would in PP.

I bet you kaiser pays a lot more than you think in so cal. My buddy hits $400k working 45-50 hours a week. With benefits and no overhead that’s likely comparable to a lot of pp gigs in so cal. Guys who work a lot there and are more senior can go up into 550-600 range, plus a lot more if you have a fellowship and earn a stipend. Also factor in knowing when you go home everyday, not worrying about billing, paid vacations/education time, and never having to carry a pager it’s a pretty sweet gig. I don’t know many better in so cal including my own. (Anyone hiring at so cal kaiser? Haha )

 

[deleted162650]

I bet you kaiser pays a lot more than you think in so cal. My buddy hits $400k working 45-50 hours a week. With benefits and no overhead that’s likely comparable to a lot of pp gigs in so cal. Guys who work a lot there and are more senior can go up into 550-600 range, plus a lot more if you have a fellowship and earn a stipend. Also factor in knowing when you go home everyday, not worrying about billing, paid vacations/education time, and never having to carry a pager it’s a pretty sweet gig. I don’t know many better in so cal including my own. (Anyone hiring at so cal kaiser? Haha )

Is he fellowshipped and gets a stipend? The base pay is under 300, so it takes a lot of extra work to make up that additional 120K + he's getting. Also factor in that at many locations, they will string you along for years as per diem before offering a full employee position.

Where did you end up? Shoot me a PM.

I know a few people at Kaiser SoCal, and all seem to be happy there. It's just not my cup of tea. The package was significantly better for the older guys than the new hires as well.

 

[Ezekiel2517]

Total compensation at TPMG is as good or better than any PP group or AMC in the state of CA. Easily. I know the numbers. Kaiser does their due diligence. They use mgma and other regional data to guide their compensation. They know what they're doing.

 

[GaseousClay]

They also train SRNAs at least at so. cal kaiser. Big negative for me.

 

[narcotics999]

They also train SRNAs at least at so. cal kaiser. Big negative for me.

I heard one of the sites 1:2 at the hospital and 1:3 at ASC.

Why bother? Based on SDN calculation, these types of ratio are not financially more efficient than MD solo.

 

[aimedicine]

Why do jobs in Florida suck?? Can anyone comment on the south job market....most gigs I’ve seen so far is abysmal.

 

[deleted171991]

I heard one of the sites 1:2 at the hospital and 1:3 at ASC.

Why bother? Based on SDN calculation, these types of ratio are not financially more efficient than MD solo.

Because, that way, you only need to find half/one-third the competent people you'd need otherwise.

 

[Urzuz]

So kaiser is actually solo in hospitals and CRNA in ASCs. So it seems like a split.

USAP is split as well, they have about 6-8 CRNA for about 15 ORs. So it seems like that's pretty similar.

I haven't interacted with CRNAs alot in residency, but what's your reasoning for avoiding CRNAs??

Some of my attendings talk about how tiring it is to be solo all the time and that CRNAs help you become a better supervisor? Not sure it's them being lazy or it's true..

I have never worked with CRNAs as an attending, but from having witnessed firsthand interactions during training, and reading about others' supervision practices on this board, it is clear that working with a CRNA is less anesthesiology and more psychiatry. "How can I keep her happy? Better not be late to break her out for her lunch. Will she get mad at me if I want to induce the patient differently? I don't want to be pedantic and sour our relationship even though I like things done differently. Maybe I'll just let her practice bad medicine because it probably won't lead to any morbidity." Look no further than this board as to how spineless anesthesiologists can be when dealing with their CRNAs, especially if they aren't directly hiring and firing them.

The only way I can see supervising CRNAs leading one becoming a better physician is that you probably get more real life training in crisis management. Apart from that, solo MD is the way to go if you place value on things such as job satisfaction and the actual care you will be providing.

 

[drdan4]

I have only done Solo. When you do a 8hr Complicated Medicaid Vascular case and walk out with $400 for the entire day, you tend to soften your stance on Supervision. Blame the ASA and their incompetence in negotiating Medicaid and in particular competitive Medicare rates (2nd lowest for Anesthesia?). They are fully culpable for the current Supervison model.

If I had my way, Medicaid = Solo CRNA, Medicare = 1:3 Supervison and Insured = Solo MD. You get what you pay for...

 

[dannyboy1]

I have only done Solo. When you do a 8hr Complicated Medicaid Vascular case and walk out with $400 for the entire day, you tend to soften your stance on Supervision. Blame the ASA and their incompetence in negotiating Medicaid and in particular competitive Medicare rates (2nd lowest for Anesthesia?). They are fully culpable for the current Supervison model.

If I had my way, Medicaid = Solo CRNA, Medicare = 1:3 Supervison and Insured = Solo MD. You get what you pay for...

If the CRNA is competent enough for the Medicaid vascular case then she is also competent enough for the well insured ASA 2 lap chole....

 

[drdan4]

They are incompetent to do ANY Anesthesia. Supervison or not. Not the point of the post. The reimbursement has to improve to justify Solo MD for Medicare/Medicaid. But hey, if you want to rot in a room all day for the $30-40/hr that Medicaid pays be my guest...

 

[dannyboy1]

They are incompetent to do ANY Anesthesia. Supervison or not. Not the point of the post. The reimbursement has to improve to justify Solo MD for Medicare/Medicaid. But hey, if you want to rot in a room all day for the $30-40/hr that Medicaid pays be my guest...

Are there still so many eat what you kill models. I’m an employee so knowing or caring about insurance/units is a foreign concept to me, but I thought that most PP places were at least blended units?

 

[drccw]

So my location is in the DC/VA area, which is generally saturated and not lot of high paying PP gigs.

For the hours, kaiser quotes 40-45 (sometimes 50), but you get paid overtime after the 40 (although they do cap you after you earn certain amount). USAP varies I think and they quote anywhere up to 60 but you're getting paid for every case (so is kaiser but there is a ceiling since they cap - I'm not sure where this cap is)

FYI check out USAPs non compete; I talked to them a bit ago and they require it (they said it was non negoatiable), which ended the interview rather awkwardly.... I was only interviewing to cover one site, but the non compete was from all of their sites (and as former First Colonies they cover a lot)

drccw

 

[epidural man]

Why are we even talking about this?

Kaiser...no brainer.

 

[Noyac]

OP, one thing to consider is benefits. With USAP you will pay about $25,000/yr (everyone is different and this is an estimate) out of your salary. With Kaiser, they may pay them. That’s a huge swing towards Kaiser.

 

[deleted941485]

Not a huge fan of the Kaiser way but USAP has all the worst qualities of PP. Kaiser > USAP

 

[Noyac]

This just in:

'We have not lost our way': Kaiser CEO's memo to staff after Labor Day protests

Bernard J. Tyson, chairman and CEO of Oakland, Calif.-based Kaiser Permanente, sent a memo to his staff Sept. 3 to address Labor Day protests employees held in five cities amid threats of a potential nationwide strike.

www.beckershospitalreview.com

 

[osoprop28]

Why are we even talking about this?

Kaiser...no brainer.

Could you explain why??

 

[epidural man]

Could you explain why??

Kaiser: 8 hour work day every day. Call gets extra. People are around to help if you need help. Some one breaks you if you need to pee. No ridiculous and horrible buy-in system that totally usurps and rapes the new guy. A great pension. Most systems I am aware of are very fair and good people that work with each other. Usually talented surgeons. Good and relatively cheap health care.

These are some I can think of.

I know a lot of people that have worked at kaiser. The only one unhappy physician I have heard of was pain. The pain guys get screwed. I wouldn’t do pain for kaiser.

 

[lakersbaby]

Kaiser: 8 hour work day every day. Call gets extra. People are around to help if you need help. Some one breaks you if you need to pee. No ridiculous and horrible buy-in system that totally usurps and rapes the new guy. A great pension. Most systems I am aware of are very fair and good people that work with each other. Usually talented surgeons. Good and relatively cheap health care.

These are some I can think of.

I know a lot of people that have worked at kaiser. The only one unhappy physician I have heard of was pain. The pain guys get screwed. I wouldn’t do pain for kaiser.

your info may be outdated those pain guys are killing it. not only are they making a significant and i mean signifcantly higher base salary than the generalists they can make a ton more money working in the OR along with doing pain. In addition, they only do procedures while the PM&R docs are doing the clinic with the difficult narcotic patients. They have been getting raises almost every year. They do like 8 procedures a day while my buddies in PP are cranking out 15-20.

 

[Twiggidy]

Kaiser: 8 hour work day every day. Call gets extra. People are around to help if you need help. Some one breaks you if you need to pee. No ridiculous and horrible buy-in system that totally usurps and rapes the new guy. A great pension. Most systems I am aware of are very fair and good people that work with each other. Usually talented surgeons. Good and relatively cheap health care.

These are some I can think of.

I know a lot of people that have worked at kaiser. The only one unhappy physician I have heard of was pain. The pain guys get screwed. I wouldn’t do pain for kaiser.

I'm not sure about the Pain portion, but the rest of the post, from what I hear, is pretty correct. Most people who work for Kaiser are pretty satisfied.

 

[bobg504]

FYI check out USAPs non compete; I talked to them a bit ago and they require it (they said it was non negoatiable), which ended the interview rather awkwardly.... I was only interviewing to cover one site, but the non compete was from all of their sites (and as former First Colonies they cover a lot)

drccw

Stay FAR away from this place. The USAP take over of the group has been disastrous with MANY physicians leaving