Las Vegas position

[UCB05]

---

Members do not see this ad.

Anesthesiologist position opening in Las Vegas in December 2025. 100% outpatient. 55% Opthy (cataract, oculoplastics, some peds), 35% Cosmetic Plastics, 10% ENT. No blocks. Usual day starts at 7, ends by 2-3. Pretty much a boutique, pre-retirement workload. Equal access to all lineups and equal division of call (rarely called in after hours, maybe once a year).Vacation varies depending on how much time you want to take off. Net,after billing and insurance, depending on how much vacation is taken, ranges from 450k (12 weeks off) to 600k (4 weeks vacation). 1099. Board certification required.

 

[cchoukal]

The difference in vacation of 8 weeks equates to 150K? So a week of work is worth $18.75K. Which means this is actually a $900K job. Where's the rest of the money going? Check my math.

 

[aneftp]

Im sure these are true numbers income wise with insurance and billing.

Good luck!

But I will pass. My crnas friends make 400-450k 1099 boutique. No calls no weekends 7-3p also with around 8 weeks off.

Just hire a crna and pay them those wages is my advice.

 

[caligas]

The difference in vacation of 8 weeks equates to 150K? So a week of work is worth $18.75K. Which means this is actually a $900K job. Where's the rest of the money going? Check my math.

I guess the thinking is that someone will take a lower hourly rate ($280 vs $312) to get 12 weeks off vs 4?

 

[amyl]

Call q? How many docs you sharing with? Weekend call?

 

[UCB05]

The difference in vacation of 8 weeks equates to 150K? So a week of work is worth $18.75K. Which means this is actually a $900K job. Where's the rest of the money going? Check my math.

Equal access doesn't imply all of us tend to pick the same lineups. The person that took more vacations, also tended to pick the shorter, less lucrative easier/lineups when working. We pick according to our call positions (first call picks first then second call picks, etc.), but we don't specifically dictate which lineups go to whichever call position.

 

[CopaceticOne]

Equal access doesn't imply all of us tend to pick the same lineups. The person that took more vacations, also tended to pick the shorter, less lucrative easier/lineups when working. We pick according to our call positions (first call picks first then second call picks, etc.), but we don't specifically dictate which lineups go to whichever call position.

Sounds pretty predatory to me. “Pick your own room” except for the surgeon has a preference for a particular few anesthesiologists. Or “what do you mean you didn’t know which days/locations various surgeons schedule their good insurance patients vs Medicare/Medicaid”.

 

[UCB05]

Call q? How many docs you sharing with? Weekend call?

Call q? How many docs you sharing with? Weekend call?

Every 5th basically and 1/5 weekends. Holidays (tracked and evenly divided). At one point a few years ago, a partner wanted to eliminate call. Although going in after hours to cover (ie. a hematoma) is extremely rare, I felt that would have been a bad decision.

 

[UCB05]

Sounds pretty predatory to me. “Pick your own room” except for the surgeon has a preference for a particular few anesthesiologists. Or “what do you mean you didn’t know which days/locations various surgeons schedule their good insurance patients vs Medicare/Medicaid”.

Just the exact opposite. Equal access means the newest and most senior member have equal access to the scheduled cases. First call picks his/her lineup from the avaiable scheduled cases, then second call picks, then third call picks and on down. We discourage surgeons creating disharmony. I fact, all of our surgeons are very personable and respect/appreciate the service we provide as a group.

 

[pgg]

To each their own.

I wouldn't work any place where the the daily lineup my "partners" and I were choosing paid dramatically different rates.

Also seems like a slow/inefficient way to make the day's schedule, unless there are only a handful of people working.

 

[aneftp]

To each their own.

I wouldn't work any place where the the daily lineup my "partners" and I were choosing paid dramatically different rates.

Also seems like a slow/inefficient way to make the day's schedule, unless there are only a handful of people working.

It’s the old way the blended units system worked.
The early doc out usually picked the shortest least lucrative room. The call doc/longest would take the highest unit rooms (sometimes GI, sometimes vascular )

Times change. Some places still hang on to the old way of doing things.

I don’t think it’s unfair the way they do it. It’s completely transparent. Just old ways.

If they able to recruit. Than it works. If they are not able to recruit. Than they gotta change.

The free market will dictate the practice.

 

[UCB05]

To each their own.

I wouldn't work any place where the the daily lineup my "partners" and I were choosing paid dramatically different rates.

Also seems like a slow/inefficient way to make the day's schedule, unless there are only a handful of people working.

It has worked for over 35 years. Tomorrow's schedule is usually ready by noon.

 

[aneftp]

It has worked for over 35 years. Tomorrow's schedule is usually ready by noon.

Great. Getting done by 2-3pm is key these days.

Work gets old real fast when 5 pm is considered good time to leave.

Psychologically those 2 extra hours are painful.

That’s why the doc who posted about a 7-5pm job in north Dallas suburbs for the same pay 5 days a weeks doesn’t understand the psychology behind being done by 2/3pm. Especially 5 days a week.

 

[UCB05]

It’s the old way the blended units system worked.
The early doc out usually picked the shortest least lucrative room. The call doc/longest would take the highest unit rooms (sometimes GI, sometimes vascular )

Times change. Some places still hang on to the old way of doing things.

I don’t think it’s unfair the way they do it. It’s completely transparent. Just old ways.

If they able to recruit. Than it works. If they are not able to recruit. Than they gotta change.

The free market will dictate the practice.

We don't blend units. 100% transparent.

 

[UCB05]

Great. Getting done by 2-3pm is key these days.

Work gets old real fast when 5 pm is considered good time to leave.

Psychologically those 2 extra hours are painful.

That’s why the doc who posted about a 7-5pm job in north Dallas suburbs for the same pay 5 days a weeks doesn’t understand the psychology behind being done by 2/3pm. Especially 5 days a week.

Lower call lineups end earlier, sometimes by 11 and sometimes the day off.

 

[aneftp]

We don't blend units. 100% transparent.

That’s fine. As long as the rules are in place and everyone knows those rules.

I’m just surprise you guys are able to keep it going.

It’s a little less money for the market but just the capital markets working. If people are happy with the arrangement. That’s free will

 

[pgg]

As I said, to each their own. Transparency is key. Glad it works for you.

I'm in a group where everybody does everything, except cardiac. Some people like certain types of cases, and dislike others. Some of us enjoy doing blocks more than others (I don't), some of us enjoy OB more than others (I do), some of us do hearts (I do) ... there's room for all of us to be somewhat tilted toward the stuff we like and away from the stuff we don't. We all get paid the same, with small stipends for various administrative jobs. Days are compensated equally, with a premium for call and weekends. I've never had to care what insurance any patient had, or didn't have. I"ve never had to care if a surgeon was efficient or slow. I've never had to care if canceling a case for medical reasons would impact my income for the day.

Your setup sounds exhausting to me, but obviously it's working for you. 🙂

 

[UCB05]

Our practice was predicated on lifestyle (OP/ASC) when I joined (33 years ago) and has now morphed into a near perfect pre-retirement/retirement practice. A good income with all the intangibles (easy, low stress/risk cases with highly successful, competent and likeable surgeons who own their ASCs). Could we make more? Easily, a lot more, but we would be giving up the intangibles. Something a person under 50 probably wouldn't appreciate.

 

[CopaceticOne]

Our practice was predicated on lifestyle (OP/ASC) when I joined (33 years ago) and has now morphed into a near perfect pre-retirement/retirement practice. A good income with all the intangibles (easy, low stress/risk cases with highly successful, competent and likeable surgeons who own their ASCs). Could we make more? Easily, a lot more, but we would be giving up the intangibles. Something a person under 50 probably wouldn't appreciate.

I can respect that.

 

[cchoukal]

We do the same thing where the higher up call people pick their cases, and they usually select based on anticipated number of units, but we do blend, so the units are worth the same, but obviously the number of units varies widely by case type. I like it better than being paid strictly for time. There’s kind of a gamify-ing aspect that is sometimes fun to think about.

 

[UCB05]

We do the same thing where the higher up call people pick their cases, and they usually select based on anticipated number of units, but we do blend, so the units are worth the same, but obviously the number of units varies widely by case type. I like it better than being paid strictly for time. There’s kind of a gamify-ing aspect that is sometimes fun to think about.

Agreed. Our group did away with blended units because not minding doing Medicare/Medicaid as an individual eventual reduced the disincentive of covering Medicare/Medicaid as a group. We still have a fair amount of Medicare (but very little Medicaid) from our Opthy practices, but they average 4 cataracts/hr.

 

[Dantrolene FC]

Agreed. Our group did away with blended units because not minding doing Medicare/Medicaid as an individual eventual reduced the disincentive of covering Medicare/Medicaid as a group. We still have a fair amount of Medicare (but very little Medicaid) from our Opthy practices, but they average 4 cataracts/hr.

4 cataracts/hr? They’re scheduled for 50 minutes at my place. 30 minutes for the case and 20 minutes for turnover.

 

[amyl]

Is this red rock?

 

[UCB05]

4 cataracts/hr? They’re scheduled for 50 minutes at my place. 30 minutes for the case and 20 minutes for turnover.

Goodness gracious. Sounds like a hospital case. The only way 50 minute cataract cases would be covered in our community is if the facility pays a stipend in one form or another.

 

[UCB05]

Is this red rock?

Red Rock Anesthesia (Hasan' s group) or Red Rock SC (on Sahara)? We're Desert Anesthesia.

 

[CopaceticOne]

4 cataracts/hr? They’re scheduled for 50 minutes at my place. 30 minutes for the case and 20 minutes for turnover.

Yikes! My friend’s local group schedules 4/hr but they average 4.5 in terms of throughput. See 5-6 preops in batches and then bounce between 2 rooms.

 

[NPJR]

As I said, to each their own. Transparency is key. Glad it works for you.

I'm in a group where everybody does everything, except cardiac. Some people like certain types of cases, and dislike others. Some of us enjoy doing blocks more than others (I don't), some of us enjoy OB more than others (I do), some of us do hearts (I do) ... there's room for all of us to be somewhat tilted toward the stuff we like and away from the stuff we don't. We all get paid the same, with small stipends for various administrative jobs. Days are compensated equally, with a premium for call and weekends. I've never had to care what insurance any patient had, or didn't have. I"ve never had to care if a surgeon was efficient or slow. I've never had to care if canceling a case for medical reasons would impact my income for the day.

Your setup sounds exhausting to me, but obviously it's working for you. 🙂

The problem is that some of the stuff I like to do is the "easiest" and the stuff I do not like to do is the riskiest "hardest". That's how anesthesiologists think. Everyone has to rotate everywhere equally save cardiac and peds to maintain a cohesive group

 

[Dantrolene FC]

Goodness gracious. Sounds like a hospital case. The only way 50 minute cataract cases would be covered in our community is if the facility pays a stipend in one form or another.

It’s at the surgery center. That’s how long every cataract is scheduled for. Some surgeons are faster, some are slower. But that’s the average time. 30 minutes for the case and 20 minutes for turnover. But like I said, some are slower…

I’m paid on salary. They don’t keep track of my billable units, but I have to be in the bottom 5th percentile nationwide but I’m going to make $700k this year.

 

[aneftp]

It’s at the surgery center. That’s how long every cataract is scheduled for. Some surgeons are faster, some are slower. But that’s the average time. 30 minutes for the case and 20 minutes for turnover. But like I said, some are slower…

I’m paid on salary. They don’t keep track of my billable units, but I have to be in the bottom 5th percentile nationwide but I’m going to make $700k this year.

700k means nothing without context
1. Workload
2. Hours worked
3. Time off.

 

[Dantrolene FC]

700k means nothing without context
1. Workload
2. Hours worked
3. Time off.

1. Sitting my own cases. It’s a good variety of cases but not a lot of complex cases. I’m basically rarely stressed. On average, it’s 3-5 cases per day. Endo is about 8-12. Bread and butter ENT is about 5 cases. Ortho is 3 joints. Peds dental is 3-4 cases.

That should you an idea of the workload.

2. 40 hours per week (officially it’s 80 per pay period). In house call counts towards hours worked. So when you do the weekend, you get the next week off. So basically you do four 10s and 12s on Fri-Sun, then you get the next week off.

Mon-Thursday is home call with a post call day off. You usually go home around 5-7 pm and get called in about 10% of the time. I’ve been called in 3 times this year.

Call is flexible. Some take extra call (for the post call days). So take less call. Some take more weekends and less weekdays. Some take more weekdays and no weekends. Some do no call unless absolutely required. We can allow this because call is compensated in a way where people volunteer to do it.

3. 8.5 weeks, plus post call weeks, plus holidays.

Base pay is $575k. We get paid $400/hr if we go above our regularly scheduled shifts (which is always voluntary and never mandated unless your patient is dying which is rare).

Between now and May, I have 15 weeks off if you count post call weeks an PTO.

 

[aneftp]

1. Sitting my own cases. It’s a good variety of cases but not a lot of complex cases. I’m basically rarely stressed. On average, it’s 3-5 cases per day. Endo is about 8-12. Bread and butter ENT is about 5 cases. Ortho is 3 joints. Peds dental is 3-4 cases.

That should you an idea of the workload.

2. 40 hours per week (officially it’s 80 per pay period). In house call counts towards hours worked. So when you do the weekend, you get the next week off. So basically you do four 10s and 12s on Fri-Sun, then you get the next week off.

Mon-Thursday is home call with a post call day off. You usually go home around 5-7 pm and get called in about 10% of the time. I’ve been called in 3 times this year.

Call is flexible. Some take extra call (for the post call days). So take less call. Some take more weekends and less weekdays. Some take more weekdays and no weekends. Some do no call unless absolutely required. We can allow this because call is compensated in a way where people volunteer to do it.

3. 8.5 weeks, plus post call weeks, plus holidays.

Base pay is $575k. We get paid $400/hr if we go above our regularly scheduled shifts (which is always voluntary and never mandated unless your patient is dying which is rare).

Between now and May, I have 15 weeks off if you count post call weeks an PTO.

So around 16 weeks off. Not bad.

That wouldn’t put u at bottom 5%

 

[Dantrolene FC]

So around 16 weeks off. Not bad.

That wouldn’t put u at bottom 5%

I mean bottom 5% in units billed, not hours worked. I basically sit around half the day doing nothing. I had a 2 hour turnover the other day.

 

[aneftp]

I mean bottom 5% in units billed, not hours worked. I basically sit around half the day doing nothing. I had a 2 hour turnover the other day.

I’m probably 1% lowest billable units paid by work per work load

Good for u since u have stable income

Though my 2 million dollar boys at likely 0.1% lower billable units paid per hour worked. They just made 33k doing 3 cases all weekend. With a crna

 

[Dantrolene FC]

I’m probably 1% lowest billable units paid by work per work load

Good for u since u have stable income

Though my 2 million dollar boys at likely 0.1% lower billable units paid per hour worked. They just made 33k doing 3 cases all weekend. With a crna

How do I get that gig? Are you and them locums?

 

[aneftp]

How do I get that gig? Are you and them locums?

There are so many locums scams going on these days. They last 1 year than u gotta go find the next place to scam after.

It’s like being a fired hospital executive. They keep finding new jobs.

 

[caligas]

I’ve done one cataract and one toe amp so far this year. Should make around $950k. (The toe amp guy was pretty sick, I wake up in one of my lake houses thinking about how he’s doing sometimes)

 

[Dantrolene FC]

I’ve done one cataract and one toe amp so far this year. Should make around $950k. (The toe amp guy was pretty sick, I wake up in one of my lake houses thinking about how he’s doing sometimes)

Yeah, put you probably had to medically direct to get that kind of wages with those cases.

 

[secretasianman]

I’ve done one cataract and one toe amp so far this year. Should make around $950k. (The toe amp guy was pretty sick, I wake up in one of my lake houses thinking about how he’s doing sometimes)

hey i did a toe amp the other day. did he have diabetes too? maybe its the same guy!

 

[Burned_Out]

We had a system similar to this one in Vegas. The guy with the most power is the guy who makes the call schedule. If Surgeon Smith operates all his total joints on Tuesday and Thursday, that anesthesiologist making the call schedule made sure he was assigned 1st call only on those dates. The rest of us got the other call dates that were less lucrative when for example general surgery operated.

Eventually it got so out of hand with people gaming the system that the hospital pulled my little group's contract. For instance on one of the less lucrative days, the 5th call anesthesiologist would decide to pick 1 case in this room and another case in another room according to the unit values. He would leave other cases uncovered in his original room & lineup. It got to the point that enough people did this and refused to cover a whole surgeon's lineup. Needless to say, a few people ruined it for everyone else.

 

[Burned_Out]

Agreed. Our group did away with blended units because not minding doing Medicare/Medicaid as an individual eventual reduced the disincentive of covering Medicare/Medicaid as a group. We still have a fair amount of Medicare (but very little Medicaid) from our Opthy practices, but they average 4 cataracts/hr.

I'm not understanding how doing away with blended units led to people not minding taking care of the Medicare/Medicaid patients? If you get paid less for Medicaid cases, are you making it up in volume like with the cataracts.

In my above post, we got people to somewhat stop gaming the system by instituting blended units. You get paid by same unit value whether private or govt. insurance covered the patient.

 

[2019medstudent]

Any place without blended units has got to be near 100% where there are docs being taken advantage of

 

[Burned_Out]

In my first job a couple decades ago, it was an eat what you kill system. No blended units. Well I was the new guy getting vascular, hearts and trauma that paid medicare/medicaid/nothing because of uninsures patients. My senior partners took home the bigger paycheck all the while finishing by 1 pm doing plastics. They didn't bother to take call because the folks coming thru the ER don't have insurance. Naively, I was forced to take call as new guy.

No blended units encourages gaming the system.

 

[aneftp]

In my first job a couple decades ago, it was an eat what you kill system. No blended units. Well I was the new guy getting vascular, hearts and trauma that paid medicare/medicaid/nothing because of uninsures patients. My senior partners took home the bigger paycheck all the while finishing by 1 pm doing plastics. They didn't bother to take call because the folks coming thru the ER don't have insurance. Naively, I was forced to take call as new guy.

No blended units encourages gaming the system.

so many young docs taken advantage of over the year with the old system.

The old docs are long gone by now or part time.

And you know what. Most of them don’t feel an ounce of remorse what they did.

 

[Burned_Out]

so many young docs taken advantage of over the year with the old system.

The old docs are long gone by now or part time.

And you know what. Most of them don’t feel an ounce of remorse what they did.

Some of them still linger around in senior positions (i.e., super partners who's vote counts more than jr. partners) steering their groups to decisions that benefit themselves only. Some pocket the hospital stipends for themselves and go begging the hospital for more because they can't hire or keep anyone. Another way they still take advantage of others is basing production not on units generated, but days worked. They show up for 1 or 2 easy cases in the morning for a few hours and claim the same productivity as the guy doing 12 hours of non-stop, high acuity cases. There are several variants of this productivity scheme. But you're right. Aneftp, they are part-time. But they still make the same as the full-timers.

The old adage when I left residency was be careful of the PP groups composed of only a bunch of old guys and a crop of new people. I never found that advice to be untrue.

 

[NPJR]

Another way they still take advantage of others is basing production not on units generated, but days worked. They show up for 1 or 2 easy cases in the morning for a few hours and claim the same productivity as the guy doing 12 hours of non-stop, high acuity cases. There are several variants of this productivity scheme. But you're right. Aneftp, they are part-time. But they still make the same as the full-timers.

The old adage when I left residency was be careful of the PP groups composed of only a bunch of old guys and a crop of new people. I never found that advice to be untrue.

How do you guys feel about a system where rvus are not tracked and the way you are paid is an hourly model. Everybody gets the same irregardless of the # of cases, the way to make more is work more hours. How is that system gamed? What are the pitfalls or a system that is an hourly model without regard to amount of complexity of cases?

 

[aneftp]

How do you guys feel about a system where rvus are not tracked and the way you are paid is an hourly model. Everybody gets the same irregardless of the # of cases, the way to make more is work more hours. How is that system gamed? What are the pitfalls or a system that is an hourly model without regard to amount of complexity of cases?

That’s what my 2 million dollar a year boys say. They were screwed early on their careers with production than salary model. Both are not great and subject to tons of abuse.

Pay people hourly. Partners can leave at 12pm if they want. They just get less. The beauty of hourly.

Plus rate adjust for weekends and nights.

Partners stick u with more nights and weekends. You get paid more.

Sure you can stil manipulate the schedule by giving yourself easy cases but time and money always matter.

These days. It’s always about time and money.

I always joke about my guaranteed beeper calls as locums. But it’s still me being tied to the hospital at 30-45 min response time. I’m never truly free when I’m on the clock.

 

[Lab Lover]

How do you guys feel about a system where rvus are not tracked and the way you are paid is an hourly model. Everybody gets the same irregardless of the # of cases, the way to make more is work more hours. How is that system gamed? What are the pitfalls or a system that is an hourly model without regard to amount of complexity of cases?

Case assignments: I’ll take the healthy hysterectomy, knee scope etc., with the solid CRNAs You can have the train wrecks with the marginal CRNAs

 

[IVdoc]

What do people think about an independent contractor job where you are only paid for the OR time, not paid for time spent preparing for the case (preop, checking machine, etc) and not paid for PACU. Doing own cases but no anesthesiologist outside OR to "staff" any issues in PACU? If you hang out to watch your patients in PACU at the end of the day or come in an hour early for preop/block patients then that cuts into your hourly rate. I've seen jobs like this where the hourly rate seems good but if you stay extra pre or post then that time is not paid for so this dilutes your hourly rate and then the offered hourly rate doesn't sound appealing. Plus you have to get your own malpractice insurance

 

[cchoukal]

What do people think about an independent contractor job where you are only paid for the OR time, not paid for time spent preparing for the case (preop, checking machine, etc) and not paid for PACU. Doing own cases but no anesthesiologist outside OR to "staff" any issues in PACU? If you hang out to watch your patients in PACU at the end of the day or come in an hour early for preop/block patients then that cuts into your hourly rate. I've seen jobs like this where the hourly rate seems good but if you stay extra pre or post then that time is not paid for so this dilutes your hourly rate and then the offered hourly rate doesn't sound appealing. Plus you have to get your own malpractice insurance

I wouldn't take an hourly job like this. Long delays and not getting paid? No way.

 

[icecoldstar]

That’s what my 2 million dollar a year boys say. They were screwed early on their careers with production than salary model. Both are not great and subject to tons of abuse.

Pay people hourly. Partners can leave at 12pm if they want. They just get less. The beauty of hourly.

Plus rate adjust for weekends and nights.

Partners stick u with more nights and weekends. You get paid more.

Sure you can stil manipulate the schedule by giving yourself easy cases but time and money always matter.

These days. It’s always about time and money.

I always joke about my guaranteed beeper calls as locums. But it’s still me being tied to the hospital at 30-45 min response time. I’m never truly free when I’m on the clock.

What's your beeper call rate? Or rather what should rest of us be asking for?