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deleted87051
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Agree. You need stipends but I don’t know how you’d negotiate that if you’re not tied to an institution..
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Agree. You need stipends but I don’t know how you’d negotiate that if you’re not tied to an institution..
That’s why most of my private practice friends who didn’t sell out their private have abandoned their private groups and let the hospitals and surgery centers deal with anesthesia billing
Unless you are profiting off other junior partners backs paying them 60 cents on the dollar along plus paying crnas under market value. It’s is getting harder and harder to maintain private practice.
Can’t stay it’s impossible but it’s getting more difficult. You only positive being private is control over your practice model. But no control over income earnings.
Phoenix as well
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There are a few of us still fighting the fight.
Which is why so many private groups are far less appealing than the alternative these days. New grads buy the pitch that doc-owned and/or doc only is a superior model for quality, morals, or whatever makes you feel good.
You need ever larger stipends to make money in pp these days. To make market-competitive money, you need to cannibalize your lesser or non-shareholders / non-board members.
So what does a “healthy” stipend look like then? I would assume that it provides a set $ for each FTE that you would determine as a group and then still have productivity and call on top of it.
Sorry if this is a naive question, I’m a newish grad working at the same place I did residency so don’t have a lot of experience in this regard (yet).
Sorry if this is a naive question, I’m a newish grad working at the same place I did residency so don’t have a lot of experience in this regard (yet).
I think the PP guys in the 80s-90s-00s made 500k plus in that time. No stipend. All off of their own billing. Meanwhile I think AMC/hospital folks made 350k during that time.
So at that time, those PP groups could justifiably offer 2-4 yr partnership tracks for 300-350 and get new docs looking for that golden 500k plus partner salary and access to fully collecting your own insurance billings.
Nowadays, all that I think has happened is that that barrier to 500k plus salaries/your own billing collections has been removed. Now everyone gets them - even the AMC/hospital folks. And now PP groups, still billing the same, are NOT such an attractive option compared to the stability of the bigger group like a hospital/amc.
The hospitals/AMCs had no choice but to increase anesthesia salaries to meet the top-end of the market. The market that was previously dominated/determined by PP groups and their ~500k compensation that is determined by insurance companies. So in a way, while straight up increased demand has lead to the recent increase from 350-500, i do believe that PP insurance rates and having some PP groups out there helps give an important market-setting alternative for soulless AMC/hospitals that would otherwise drive you into the ground with CRNA compensation packages..
And further if insurance payment rates were equal for AMC/hospitals as they are for smaller PP groups, youd see a lot more smaller PP groups.
yes but if your earning less than market you just leave and get a job earning market.. its not like there is a huge risk..
so id argue that most of the remaining private group docs probably make more than market, or else they would leave
Some so earn more than market. But that number is shrinking day by day
Most stay due to family /kids/location and familiarity of the job.
I’m so flexible I can pop in almost anywhere and get used to a place in 2 days. Many docs are not able to do that. They like the routine
I can can tell you this. Most docs making even 700-800k in private are doing 900k-1 million of work and 8 weeks off . Now I have enough insight knowing there are regular people out there on 2 income working families making combined 70k trying to make ends meet with inflation.
I get that.
But the the health system is insane. We can’t be paying mid level nursing managers who contribute zero clinically 150k- that’s what they make. I could maybe justify 1-2 per hospital. But here are literally 6-7 nursing mid levels per small hospital. The duplication of managers is idiotic.
Crnas are gettin $250-hr plus travel and lodging at umpc Pittsburg proper. I’ve seen their contacts cause one of my crnas friends showed me it. 50 hr guaranteed for
Them.
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deleted87051
22yo new grad RN orientees in our health system make 120k per year. That’s the basement for an RN in our area.
That’s crazy good money. (For the education level 4 year college degree)
Wait til you find out about AAa. From what I hear, it’s 2 years to make a CRNA salary
That’s why the crnas are trying to thrash the AAs. They know the competition is there.
With the explosion of CRNA salary I don’t think this is true anymore. It’s closer to 60-70% of their pay nowadays. The AANA loves to portray them as earning equals with less training.
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But their training is basically the same. U think a DNAP adds anything? It's fluff and paperwork to justify a nursing "doctorate"
If my opinion. A brand new age 24/25 crna or AA are the same. Both jabs very little life experience and need seasoning.
Gone are the days where the average srna had 7 years nursing experience
Many have figured the game and are getting or trying to get into srna school as soon as possible.
I’m getting older. But couple of the srna I have worked with were born in 1999 and 2000! It’s like damn I’m old. They barely did did one year icu nursing and when you include vacation in that one year. They have likely 10/11 months experience.
AA are the same. So young. Many are 23/24 these days
Everyone has figured out where the money is.
So there is a huge difference in life experience with new grads.
if admin balks at a stipend negotiate a revenue guarantee- harder for them to argue with…. Add up the mgma +/- crna salaries in the area if care team. Looks like you are offering a fair market deal and stability.
This is especially beneficial if a practice has been billing QZ for high ratio care team and is now getting hit w AD modifier instead.
Can also cut billing staff to bare bones - bad collections is now the hospitals problem.
I want no part of these things but I do understand the playbook. The difference in mindset between a doctor and a business person.
This is especially beneficial if a practice has been billing QZ for high ratio care team and is now getting hit w AD modifier instead.
Can also cut billing staff to bare bones - bad collections is now the hospitals problem.
I want no part of these things but I do understand the playbook. The difference in mindset between a doctor and a business person.
That’s why the compress schedule makes more sense for docs and crnas. No staff means no cases.
Out of sight. Out of mind.
If I’m not there. I’m not there.
Unfortunately 1:1 match with a perm job would be closer to 800k-1.2mil if you do apples to apples of Locum rates... facilities would never go for that as there is no going back regardless of how short sighted that maybe Besides if you are leveraged with locums above certain percentage the state comes and gives you money so.... figure that..
FL market is and will continue to be a roller coaster... Today Palatak tomorrow Tampa... Today HCA tomorrow something else... if you worked for any of them you are screwed. Contracts get cancelled last minute when a cheaper option arises... so be careful. Also you will get to WORK for your money .... just understand that....
I agree.
Everyone is playing everyone in terms of locums jobs in Florida (and I assume elsewhere in the USA )
It’s a circus.
The w2 docs down here will game the system using locums to their advantages
1. To either make more money for themselves with extra calls/extra shifts.
2. To work less and have locums docs get hammered during the days.
The Jobs tend to be seasonal as more snowbirds flock down for winter months. So less locums opportunities sept -November (high demand for thanksgiving and Xmas week for locums) but most locums don’t want to work holidays. I declined 12k for holidays 24 hr ob call. For Xmas and new years already. Now if they can get the rate up to $800/hr like last year. I’d consider a 24 hr call.
12k for 24-hour call is only 500/hr. Hardly anything noteworthy for holiday call. I would easily expect 600/hr, and would shoot for 800/hr
It’s supply and demand. They are counting on someone to take the money. Selling the call as light and hardly any cases.
Someone who doesn’t celebrate it or single or no family may take it
Depends on the holiday for me, I value some more than others
Those aren't "regular" physicians.
Not just supply and demand. Market is distorted. Couple of examples. Place where I am w2 at needed holiday coverage. Not enough docs to take the call. They try to get some of us to take it at the usual W2 overtime rate. Unsurprisingly, no takers. They end up paying the locums more than 500/hr to take the call. Had they offered 350 to the w2 guys it would have been easily covered. But they don’t negotiate. The rate in the contract is what they will pay. Some locums places will not accept you if you live too close to the site (don’t want to bring up the local market is the reason given). Makes you think that there are indeed enough anesthesia providers to go around, but in the effort to keep local salaries low, hospitals are restricting supply and it backfires on them…
sounds like a kaiser. I am hearing kaiser is going to pay the locums company $515/hr and $690/hr (ot) while associate physicians making less than $200/hr. the locums will probably be at $400/hr after what the locums company poaches. why would anyone join as associate/partner there now, plus most are so short staffed that the whole "lifestyle" gig is out the window because everyone is working like dogs. so they work their full time employees to the bone with low pay and thus cant hire anyone, and instead going to locums and spending an ungodly amt of money to keep ORs open. make it make sense.
Except at my place the amount of required calls is written into the contract so the option of working the employed docs to the bone dosent exist. Plenty of interest in taking extra if the price was right but they would rather pay the locums more. 🤷.
its more that they are trying to do the same or more work with far less, aka supervising more rooms, squeezing in more cases into one room, less fluff than what was the draw of a KP gig
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That’s why you gotta negotiate massive vacation time off and not restrict yourself to the standard 8-10 weeks off.
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deleted643396
So what is a week of vacation worth as W2? IF (and that’s a big if) a place is willing to negotiate more than the 6-8 weeks vacation (that’s more in line with average), what is a reasonable decrease in salary per extra week vacation.
Most places are not willing to negotiate vacation because the new guy coming in getting 12-18 weeks off and then going out making $400/hr locums is not going to sit well with current employees. Employers are very uneasy about attracting new employees with sweetheart deals because it can make the locals unhappy. They would much rather push through paying high locums rates hoping that the influx of CRNAs coming in the next few years will solve their staffing issues.
The going rate is 650-700k/9-10 weeks off based on 40/45 hours of work inclusive of calls
Overtime built in at $300/hr w2.
That’s what many smarter hospitals employed models are going to or somewhere near that.
Each week of vacation (in my opinion) is worth at least 15k a week.
Which makes sense cause a locums doc working 40 hours at $350-400 a hour makes …15k a week!
It’s magic.
15k x 42 weeks work is $630k w2 roughly plus “benefits”
It’s simple math
Me personally. I’d take 450-500k and take 20-26 weeks off. Gives me more flexibility in terms of vacation planning or locums work.
This is exactly what’s happening at a Kaiser near me. Their management kept thinking they were hot stuff based on historical trends and then were baffled when people started leaving when they refused to increase pay. They are now reportedly paying the locums companies 600+ an hour to find anyone.
Wow is Kaiser that bad? In SoCal it seems like a lot of anesthesiologists who have kids gravitate towards Kaiser for more work-life balance
They used to be good for balance but they’re not anymore. Now the associates and partners are being worked hard since people are leaving so they’re the last lackeys standing. People won’t sign up for per diems either because the rates are so poor compared to locums (including locums at those same Kaisers!!!).
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deleted643396
I don’t think that’s the going rate. That would be a 99th percentile type of job. The going rate is more like $475-650k for 6-8 weeks vacation and a 50 hour work week inclusive of calls. I would say that is the average job out there right now. $500k with 26 weeks off is a real unicorn job. As indicated by multiple posters in this thread, employers are not really willing to negotiate with full time employees or potential employees. The full time jobs out there are mediocre, at best, because you almost invariably know you are stepping into a short-staffed situation where they’ll pay you “extra” for “voluntary” OT at a suboptimal rate ($250/hr). That’s the reality for the vast majority of full time, permanent jobs out there. The market is heavily favoring locums at the moment and it seems most hospitals are counting on the huge increase in CRNA school spots to start cooling down the anesthesia market in the next couple of years.
Still seems strange. But for whatever reason they would rather pay locums. I’m getting sick of seeing locums at my place make twice what I am making, so I’m looking into locums currently. If you can’t beat em…..
Anyone have a source or data on the number of new Crna positions over time? The Crna shortage seems more acute than the physician shortage. Most CRNAs I meet are per diem or locum as well, even the young ones.
I know they’re opening programs but you’re right, in my market the CRNAs will not be locked down for a job and stick to their 1099 per diem guns. A few newly hospital employed departments around here filled all their MD spots and couldn’t get more than a few crnas to interview, let alone sign on.
Which SoCal Kaiser is this?
Crnas locums cost the equivalent of a full time MD. And probably cost more than a full time Md when you factor in hardly any of them want 5 (8) these days. They all want (4) 10s or (3) 12s as 1099.
As for “unicorn” jobs. I’m staring at the barrel of 26 week off job (all beeper when on) for 500k 10 miles from my house. Solo on call. No ob
A 475k job (with crna on ob and or) md on beeper 17 miles away with 20 weeks off
Another 500k job with 26 weeks off beeper 30 miles away. MD on beeper win crna for the OR on beeper as well (that job asked me if I wanted 650k/13 weeks off)
I have 3 options
Not exactly unicorn when I have options.
The only hold up is how much sign on bonus I can extract out of them. And they want 2-3 years commitment where I want a lebron James 1 plus 1 deal to bail in a year if I want. That’s how the king negotiates most of his previous contracts. 1 plus 1 And threaten to bail as free agent in one year.
Crnas have figured it out. Especially since they are paid hourly to began with
They want to dictate their schedule as 1099. This leaves huge gaps in scheduling. Like Fridays are short staff at most places.
I’ve been telling places to bring out 100k sign on bonus over 2 years (not 4!) to recruit w2 crna. It’s far cheaper than locums crnas. 230k plus 100k sign on plus 9 weeks Basically 280k average /9’weeks off.
No one listens to me. So they rather bleed 500k for crna locums per year. 350-400k 1099 for crna plus agency fees.
It’s just dumb math hospitals are playing
Why does Kaiser bother to keep the ORs open? It makes more $$$ by doing nothing. Make the patients wait, lol
The 60, 75 miles minimal distance I heard from NAPA. Fxck it!
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Savvy locums guy I know has multiple addresses he can use for this reason.
Is it really 26 weeks off if you're working 80+ hours in a week? Or is this a 40 hours per week for 26 weeks, which seems unlikely even in BFE.
80 hours a week gets you 34 weeks off
26 weeks off is around 48 hours worked.
Yes. I guess it’s bfe if there are two international airports with non stop flights to Europe 20-25 minutes away.
Of the weeks you work, how many weekends are you covering ? Both days ?
