Match 2024

[coffeebythelake]

ER facilities fees do make tons of money. Have u seen the bills?

The actual payment (the super bill
Was even higher)

The hospital er got $1700 for my daughter abdominal pain facility fee

ER doc got $531

Labs and fees got paid $30

Those were the actual payments.

That’s simple visit the primary care referral to real ER. So we tried to save costs going to pcp first

Now my friend Emergency room urology stones visit was even more outrageous 21k for hospital facilities fees ER
$800 for ER doc.

Urology is huge money maker for hospitals anything urology related.

Thats why urologists try to keep all the outpatient urology stuff to their own clinics and outpatient centers to keep
The money themselves

Have u heard of EMTALA? I'm sure for every one of these mega bills from the ER they are also taking care of several uninsured patients that basically pay nothing. So you presented an anecdote. Not evidence.

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[WhatJobDoIPick]

ER referrals are just that. Referrals. Just like a referral from FM or IM or chiro or pain clinic. You want kickbacks?

My point is, you're not the money generator either. You're a facilitator, just like us. If they can use a robot (CRNA) to do your job, they will. Just like AI in radiology. The barrier is legal, not anything else.

We thought we were untouchable too, then "no surprises act" came. Then HCA pumped out residents. One the the supply curve works in your favor, then it doesn't.

 

[coffeebythelake]

My point is, you're not the money generator either. You're a facilitator, just like us. If they can use a robot (CRNA) to do your job, they will. The barrier is legal, not anything else.

And we are saying the robot (CRNA) is not that much cheaper than the actual anesthesiologist. I understand your point about supply and demand.

 

[aneftp]

Have u heard of EMTALA? I'm sure for every one of these mega bills from the ER they are also taking care of several uninsured patients that basically pay nothing. So you presented an anecdote. Not evidence.

That In network. I’m not even talking mega
Bills!

These are in network actual payments

Most patients have insurance. When ghetto hospitals the uninsured rates are only 10%.

I live in opt out state and that’s the percentage in ghetto hospitals

With obamacare and opt in states. The percentage of uninsured is very low

Even medical students in opt in states have figured how to get free healthcare and not pay any premiums as students. That’s the dirty little secret

 

[WhatJobDoIPick]

And we are saying the robot (CRNA) is not that much cheaper than the actual anesthesiologist

Everything is supply vs demand.

CRNAs are being pumped out.

The new grads will take lower wages when they are 100k in debt.

 

[Dr. Rude]

Everything is supply vs demand.

CRNAs are being pumped out.

The new grads will take lower wages when they are 100k in debt.

How many new grads are only 100K in Debt? Rich and Privileged mofos.

 

[NightyNight]

Supply versus demand will influence what CRNAs and docs make in 5 years. If CRNAs won’t take less than 200/hr W2 for example, then a call taking doc will want a differential or they will just do the CRNA hours.

Yes, everyone facilitates others to get a case done because the facility fee is where everyone is funded. Even surgeon pay can be funded by the hospital. Professional fees are decreasing so salaries are supported by other factors. One can only hope the younger grads demand good lifestyle despite debt.

 

[ambiturner]

My point is, you're not the money generator either. You're a facilitator, just like us. If they can use a robot (CRNA) to do your job, they will. The barrier is legal, not anything else.

And when they’ve employed all the surgeons they’ll be facilitators too. If a robot can do joint replacements then it will. Everyone is replaceable.

Corporate medicine aims to make the BRAND (Mayo, Penn, UCLA, whatever) the product that people want, not the individual doctors. In its final form we’ll all be salaried like engineers, project managers, whatever. Rate limiting step will be how easily you can train each field - CRNAs are not easy or cheap to train, nor are anesthesiologists. But still cheaper than surgeons.

For now enjoy that your reputation and skills can still get you a good job and in the right markets even some ownership or voting rights in a stable practice.

 

[aneftp]

How many new grads are only 100K in Debt? Rich and Privileged mofos.

200k ish seems to be the average debt for in state med school new grads.

400k for out of state/private school
New grads

Honestly new grads didn’t want roommates in med school. That could have easily save them 10k in rents each year rooming with someone.
A 2 bedroom apt in most cities or suburbs run less than $1700 vs one bedroom for $1400 (nothing fancy). And I say most. I didn’t say all cities

But by people not wanting roommates. They are wasting 40k easily over 40 years.

 

[woopedazz]

Anesthesia residency is like 500 applicants for 5-10 spots

We only apply to 1-3 hospitals here in my state. So basically all those people applying don't get an Anaesthesia job

 

[Dr. Rude]

And when they’ve employed all the surgeons they’ll be facilitators too. If a robot can do joint replacements then it will. Everyone is replaceable.

Corporate medicine aims to make the BRAND (Mayo, Penn, UCLA, whatever) the product that people want, not the individual doctors. In its final form we’ll all be salaried like engineers, project managers, whatever. Rate limiting step will be how easily you can train each field - CRNAs are not easy or cheap to train, nor are anesthesiologists. But still cheaper than surgeons.

For now enjoy that your reputation and skills can still get you a good job and in the right markets even some ownership or voting rights in a stable practice.

Everybody has goals and ambitions. Man plans god laughs.

 

[Robotic Wis-Hipple]

Everything is supply vs demand.

CRNAs are being pumped out.

The new grads will take lower wages when they are 100k in debt.

This is mostly true. But the difference will always be shift work vs non-shift work and call. EM is clearly not an easy gig but it’s shift work, which is just easier to replace with whatever legal or acceptable cog a system wants.

Until CRNAs want to work >40yrs a week, go home when the work is done, skip q3 hr breaks, and take call for anything approaching my “hourly” rate then I’ll be worried.

The CRNA to anesthesiologist gap when compared at true hourly rates is already pretty damn close.

If we all end up hospital employed, which I suspect is the most likely future, then guess what? I’ll make $200/hr, work 36hrs/week with an OT, weekend, and holiday rate and it will be stipulated in my contract and don’t call me for 1 extra call or half day so you can open one more room to make the hospital more money.

 

[NightyNight]

This is mostly true. But the difference will always be shift work vs non-shift work and call. EM is clearly not an easy gig but it’s shift work, which is just easier to replace with whatever legal or acceptable cog a system wants.

Until CRNAs want to work >40yrs a week, go home when the work is done, skip q3 hr breaks, and take call for anything approaching my “hourly” rate then I’ll be worried.

The CRNA to anesthesiologist gap when compared at true hourly rates is already pretty damn close.

If we all end up hospital employed, which I suspect is the most likely future, then guess what? I’ll make $200/hr, work 36hrs/week with an OT, weekend, and holiday rate and it will be stipulated in my contract and don’t call me for 1 extra call or half day so you can open one more room to make the hospital more money.

We should have 8-10h shift based pay for transparency especially weeknights and weekends, if not hourly. I’m thinking it will likely end up around 180-200/hr W2 depending on what CRNA rates end up over time.

 

[nimbus]

200k ish seems to be the average debt for in state med school new grads.

400k for out of state/private school
New grads

Honestly new grads didn’t want roommates in med school. That could have easily save them 10k in rents each year rooming with someone.
A 2 bedroom apt in most cities or suburbs run less than $1700 vs one bedroom for $1400 (nothing fancy). And I say most. I didn’t say all cities

But by people not wanting roommates. They are wasting 40k easily over 40 years.

Seems worthwhile to skip a single $40k vacation as an attending in order to have your own place during med school and/or residency.

 

[aneftp]

Seems worthwhile to skip a single $40k vacation as an attending in order to have your own place during med school and/or residency.

Difference is 40k is paid for in cash as attending

Debt is accumulating with interest while in school.

 

[chessknt]

Supply versus demand will influence what CRNAs and docs make in 5 years. If CRNAs won’t take less than 200/hr W2 for example, then a call taking doc will want a differential or they will just do the CRNA hours.

Yes, everyone facilitates others to get a case done because the facility fee is where everyone is funded. Even surgeon pay can be funded by the hospital. Professional fees are decreasing so salaries are supported by other factors. One can only hope the younger grads demand good lifestyle despite debt.

Supply/demand actually doesn't apply to healthcare at all. There is huge demand and small supply of many medical subspecialties (pulm, rheum, Endo, every pediatric subspecialty) yet they aren't being offered more money, the need just goes unfulfilled and people have to wait months to over a year. Nobody wants to wait for surgeries because they generate incredible revenue and that drives your pay. As soon as that changes (and there is a reckoning coming, the system has to collapse in our lifetimes due to its completely unsustainable design) you will face the same economics every non surgical field has had to face for decades.

 

[Dr. Rude]

Supply/demand actually doesn't apply to healthcare at all. There is huge demand and small supply of many medical subspecialties (pulm, rheum, Endo, every pediatric subspecialty) yet they aren't being offered more money, the need just goes unfulfilled and people have to wait months to over a year. Nobody wants to wait for surgeries because they generate incredible revenue and that drives your pay. As soon as that changes (and there is a reckoning coming, the system has to collapse in our lifetimes due to its completely unsustainable design) you will face the same economics every non surgical field has had to face for decades.

Interesting take. I never thought about it that way, but it makes sense.

 

[WhatJobDoIPick]

Supply/demand actually doesn't apply to healthcare at all. There is huge demand and small supply of many medical subspecialties (pulm, rheum, Endo, every pediatric subspecialty) yet they aren't being offered more money, the need just goes unfulfilled and people have to wait months to over a year. Nobody wants to wait for surgeries because they generate incredible revenue and that drives your pay. As soon as that changes (and there is a reckoning coming, the system has to collapse in our lifetimes due to its completely unsustainable design) you will face the same economics every non surgical field has had to face for decades.

I mean this depends.

Pedi subspecialties reimburse like crap from the insurers, so of course the big centers are going to pay employed subspecialits terribly.

If you have the business accumen to open a private pedi allergy or asthma practice I bet you can make a pretty penny charging cash.

The case study for this is Psych. COVID cranked up mental illness to warp factor 10 in America, and people with means got tired of waiting months to see an NP to mismanage their meds. So now my friends are billing $600 / hr in private practice.

 

[aneftp]

Supply/demand actually doesn't apply to healthcare at all. There is huge demand and small supply of many medical subspecialties (pulm, rheum, Endo, every pediatric subspecialty) yet they aren't being offered more money, the need just goes unfulfilled and people have to wait months to over a year. Nobody wants to wait for surgeries because they generate incredible revenue and that drives your pay. As soon as that changes (and there is a reckoning coming, the system has to collapse in our lifetimes due to its completely unsustainable design) you will face the same economics every non surgical field has had to face for decades.

My pulmonary friend who works for same massive entity as me does very well.

People focus purely on income. But forget the time off factor. Many specialities have tons of built in time off. So on paper they get cough cough 8-9 weeks. But days off in clinic. Even procedure days off. Post icu week off. I count it as 20 weeks off they get in a 52 week year. Tons of time off.

 

[dannyboy1]

I mean this depends.

Pedi subspecialties reimburse like crap from the insurers, so of course the big centers are going to pay employed subspecialits terribly.

If you have the business accumen to open a private pedi allergy or asthma practice I bet you can make a pretty penny charging cash.

The case study for this is Psych. COVID cranked up mental illness to warp factor 10 in America, and people with means got tired of waiting months to see an NP to mismanage their meds. So now my friends are billing $600 / hr in private practice.

Agreed. Demand is not gauged by those who want to see you. It’s by those who will pay to see you.

 

[chessknt]

Agreed. Demand is not gauged by those who want to see you. It’s by those who will pay to see you.

The problem is that you can't negotiate higher rates with insurance as a lone specialist because then you'll just be out of network and won't get any referrals and you can't negotiate with CMS at all. They pay exactly the same whether you are a 9+ year trained sub sub specialist or a 3 year FM grad. The outpatient office codes are specialty blind and those dictate everything.

 

[ToKingdomCome]

My pulmonary friend who works for same massive entity as me does very well.

People focus purely on income. But forget the time off factor. Many specialities have tons of built in time off. So on paper they get cough cough 8-9 weeks. But days off in clinic. Even procedure days off. Post icu week off. I count it as 20 weeks off they get in a 52 week year. Tons of time off.

My W2 pay is ok . But I get 19 weeks off (13 weeks post icu call) and I use it for 1099 to boost
My pay so I guess it’s solid time/money compensation

 

[Dr. Anonymouss]

I had a 260 step 2, 4 peer reviewed pubs, multiple honors, USMD, no red flags and I had 7 interviews out of 54 applied. It was definitely a rough cycle. I matched my #5 which surprised me honestly, but I’m going to be an anesthesiologist so I really have nothing to be upset about.

 

[BLADEMDA]

I had a 260 step 2, 4 peer reviewed pubs, multiple honors, USMD, no red flags and I had 7 interviews out of 54 applied. It was definitely a rough cycle. I matched my #5 which surprised me honestly, but I’m going to be an anesthesiologist so I really have nothing to be upset about.

Were all 7 interviews at top 20 programs? Did any of your classmates not Match?

 

[aneftp]

I had a 260 step 2, 4 peer reviewed pubs, multiple honors, USMD, no red flags and I had 7 interviews out of 54 applied. It was definitely a rough cycle. I matched my #5 which surprised me honestly, but I’m going to be an anesthesiologist so I am happy,

Yeah. It’s crazy match. A 290s score matched a a lower tier program. Community program didn’t even go past 17 in their rank list (lowest score was 250).

I’m just hoping this won’t be 1994-1995 again for (those starting residency 1990/1991) who finished 4 years later. 1990/91probably the toughest matches up until this year (2024). Where there may not be demand in 2028 and salaries can tank

I don’t have a crystal ball but crnas won’t work for less than 200k with no calls or weekends 4 days a week. So crnas set the bar for what the low end do the market will take.

 

[NightyNight]

Yeah. It’s crazy match. A 290s score matched a a lower tier program. Community program didn’t even go past 17 in their rank list (lowest score was 250).

I’m just hoping this won’t be 1994-1995 again for (those starting residency 1990/1991) who finished 4 years later. 1990/91probably the toughest matches up until this year (2024). Where there may not be demand in 2028 and salaries can tank

I don’t have a crystal ball but crnas won’t work for less than 200k with no calls or weekends 4 days a week. So crnas set the bar for what the low end do the market will take.

Yeah. I see salaries going down. But will be the delta for docs taking all the call? Only a 100k more?

 

[Agast]

I visited my residency program’s page. It’s a top 10 program and they posted their matched medical students list - Several DOs and students from schools that would be considered mid to low tier. It actually made me feel really proud that they could have filled their roster with big names in the current environment and didn’t. I think years of selecting for temperament when anesthesiology was unpopular carried over and the stats don’t carry as much weight as they would for specialities that are more egoistic.

 

[aneftp]

Yeah. I see salaries going down. But will be the delta for docs taking all the call? Only a 100k more?

That’s why docs need to go to the purely hourly model with uber style 10-20% premium pricing after off peak hours.

Work. Get paid. Want to leave early. Don’t get paid. Get x guarantee hours to show up. No one will show up for only 4 hours and be sent home.

Almost every hospital will be in trouble with this model of paying anesthesia.

Surgery centers work because it’s set hours or close to set hours.

Hospitals we got eye surgeons booking elective (they call it urgent virtrectomy) at 5pm but they won’t show up to 7p. Finish office. Go see their kids/dinner with spouse than roll back to the hospital to do a 90-120 min virtrectomy. Hospitals would love for anesthesia to be paid the same rate 7-3p as the guy who wants to come in 3-11p shift That ain’t happening with this culture.

That anesthesia person will just want to work 7am-11p and take 2 days off.

 

[NightyNight]

That’s why docs need to go to the purely hourly model with uber style 10-20% premium pricing after off peak hours.

Work. Get paid. Want to leave early. Don’t get paid. Get x guarantee hours to show up. No one will show up for only 4 hours and be sent home.

Almost every hospital will be in trouble with this model of paying anesthesia.

Surgery centers work because it’s set hours or close to set hours.

Hospitals we got eye surgeons booking elective (they call it urgent virtrectomy) at 5pm but they won’t show up to 7p. Finish office. Go see their kids/dinner with spouse than roll back to the hospital to do a 90-120 min virtrectomy. Hospitals would love for anesthesia to be paid the same rate 7-3p as the guy who wants to come in 3-11p shift That ain’t happening with this culture.

That anesthesia person will just want to work 7am-11p and take 2 days off.

Places like Endeavor sites in IL consider a full time at 60h weekly. I don’t know how you can hire people with that model. That’s a lot of primary and backup call. Get worked to the bone. Easier when I was 29. Not even 40 and feel worn out

 

[pgg]

if you don't think PE and hospitals are working on correcting the anesthesiology shortage then I dunno what to say.

I'm not sure I've seen much evidence that they're smart enough to do that.

We've seen a decade+ of one bad decision after another from those guys and here we are.

 

[BLADEMDA]

I visited my residency program’s page. It’s a top 10 program and they posted their matched medical students list - Several DOs and students from schools that would be considered mid to low tier. It actually made me feel really proud that they could have filled their roster with big names in the current environment and didn’t. I think years of selecting for temperament when anesthesiology was unpopular carried over and the stats don’t carry as much weight as they would for specialities that are more egoistic.

I think the programs are definitely NOT using just stats to select their classes. All you have to do is look over their MATCH for this year and last year to see that DEI matters a great deal to program directors along with the interview combined with the how each applicant would fit in with the program. My hunch is that stats no longer matter like they once did in my day and even just 10 years ago. This comment was not meant to stir up any political discussion or your view of right/wrong or fair/unfair as to the Match process but rather my viewpoint on what the program directors are looking for in their classes. Ironically, the community programs are likely to use "stats" more than top 20 programs where the program directors may rank 260 Step 2 applicants much lower than certain applicants which fit their narrative/goals. This means that the game has changed for applicants so they better adjust to the new rules if they want to Match in 2025.

 

[ToKingdomCome]

I think the programs are definitely NOT using just stats to select their classes. All you have to do is look over their MATCH for this year and last year to see that DEI matters a great deal to program directors along with the interview combined with the how each applicant would fit in with the program. My hunch is that stats no longer matter like they once did in my day and even just 10 years ago. This comment was not meant to stir up any political discussion or your view of right/wrong or fair/unfair as to the Match process but rather my viewpoint on what the program directors are looking for in their classes. Ironically, the community programs are likely to use "stats" more than top 20 programs where the program directors may rank 260 Step 2 applicants much lower than certain applicants which fit their narrative/goals. This means that the game has changed for applicants so they better adjust to the new rules if they want to Match in 2025.

So per you, match process is for snowflakes now? On brand comment by blade!

 

[gunnershow]

So per you, match process is for snowflakes now? On brand comment by blade!

I picked a residency at random and looked at their last few match classes. What blade is saying totally checks out.





Notice anything?

 

[nimbus]

I was browsing a USMLE tutoring site and saw a significant number of anesthesia resident/tutors with 260-270+ USMLEs. They’re probably not the only ones at their programs. Anybody with 240+ USMLEs will have no problem passing their anesthesia boards so beyond that it becomes a non-factor.

 

[nimbus]

I picked a residency at random and looked at their last few match classes. What blade is saying totally checks out.





Notice anything?

I don’t think your choice of Yale is random but we can play anecdotes.

Notice anything? I do think there is a lot of self selection when students are ranking residency programs.

 

[sevo00]

Okay let’s play anecdotes.

Notice anything?

What would you say is the primary demographic that lives in Nebraska?

 

[BLADEMDA]

I was browsing a USMLE tutoring site and saw a significant number of anesthesia resident/tutors with 260-270+ USMLEs. They’re probably not the only ones at their programs. Anybody with 240+ USMLEs will have no problem passing their anesthesia boards so beyond that it becomes a non-factor.

I didn't say that the class was unqualified; what I said was that pure stats no longer matter like they did 10 years ago. That's factually correct and aligns with your statement above. I doubt AOA matters either because class diversity takes precedent at many programs particularly those in the top 10-15. Contrary to what the hard core Bernie Sanders' fans on this board think about me I have accepted (grudgingly) the new reality of this country across every field from airline pilots to supreme court justices to anesthesiologists. But, I doubt the Chinese or Japanese or Koreans care one iota about diversity for entrance into their programs/schools.

If in the near future we start to fall way behind those other countries it will be because we moved away from a pure merit based system which strives to be color blind. I truly hope that doesn't happen but I have already accepted the fact it will. I can't help but post how I feel about this subject even if it is politically incorrect.

 

[nimbus]

What would you say is the primary demographic that lives in Nebraska?

Same for New Haven.

 

[BLADEMDA]

I don’t think your choice of Yale is random but we can play anecdotes.

Notice anything? I do think there is a lot of self selection when students are ranking residency programs.

My Med School has a lot of trouble attracting qualified black applicants. The person who accepts med students is a black, male American. He told me that qualified applicants simply have better options than my old med school and they get scholarship money. He is left with fewer qualified applicants and the school rarely offers full scholarships. This same reasoning holds true for Residency applicants. The qualified pool is much smaller so they can choose top 10 programs meaning Nebraska doesn't get a single one. Hence, Yale, MGH, Stanford, etc gets the best applicants of all races and this matters when the pool of a certain ethnic group is small.

 

[gunnershow]

I don’t think your choice of Yale is random but we can play anecdotes.

Notice anything? I do think there is a lot of self selection when students are ranking residency programs.

Oh really? You think the local demographics of CT is 50% Nigerian Female? They don't even bother to recruit descendants of American slaves, it's straight up just checking color boxes.

 

[BLADEMDA]

Oh really? You think the local demographics of CT is 50% Nigerian Female? They don't even bother to recruit descendants of American slaves, it's straight up just checking color boxes.

Tone it down or the liberals will ban you. It isn't worth it.

 

[secretasianman]

I think the programs are definitely NOT using just stats to select their classes. All you have to do is look over their MATCH for this year and last year to see that DEI matters a great deal to program directors along with the interview combined with the how each applicant would fit in with the program. My hunch is that stats no longer matter like they once did in my day and even just 10 years ago. This comment was not meant to stir up any political discussion or your view of right/wrong or fair/unfair as to the Match process but rather my viewpoint on what the program directors are looking for in their classes. Ironically, the community programs are likely to use "stats" more than top 20 programs where the program directors may rank 260 Step 2 applicants much lower than certain applicants which fit their narrative/goals. This means that the game has changed for applicants so they better adjust to the new rules if they want to Match in 2025.

I think they matter more and the bar for just the entry point has become completely unreasonable. For others, they hardly matter when they are already labeled a star applicant.

 

[abolt18]

I picked a residency at random and looked at their last few match classes. What blade is saying totally checks out.





Notice anything?

I noticed Bob Gaiser, their PD and he is literally one of the most kind, genuine, and education-focused people I've ever worked with. He is the man! I also can't imagine him playing that hard into the whole DEI for the sake of DEI.

 

[GassYous]

I noticed Bob Gaiser, their PD and he is literally one of the most kind, genuine, and education-focused people I've ever worked with. He is the man! I also can't imagine him playing that hard into the whole DEI for the sake of DEI.

Was he at a different program? I interviewed with him and thought he was great

 

[Dr. Anonymouss]

Were all 7 interviews at top 20 programs? Did any of your classmates not Match?

2/9 did not match. None were top 20. UAB, MUSC, Wake, Cleveland Clinic Florida, Cincinnati, Case western metro health, Kentucky.

 

[abolt18]

Was he at a different program? I interviewed with him and thought he was great

Previous chair at UK. And PD at Penn before that.

 

[gunnershow]

Previous chair at UK. And PD at Penn before that.

I'm sure he's incredible but he was president of the ABA and they went all in on DEI during his time. Maybe he doesn't even believe in it, but for the past 3-4 years, he's selected West Africans as half his class. This is wildly disproportionate to any demographic spread. This isn't a coincidence.

 

[rowsdower88]

I picked a residency at random and looked at their last few match classes. What blade is saying totally checks out.





Notice anything?

Bro looks at some photos with happy black people in them and immediately thinks something must be wrong here.

 

[triggermaster]

I visited my residency program’s page. It’s a top 10 program and they posted their matched medical students list - Several DOs and students from schools that would be considered mid to low tier. It actually made me feel really proud that they could have filled their roster with big names in the current environment and didn’t. I think years of selecting for temperament when anesthesiology was unpopular carried over and the stats don’t carry as much weight as they would for specialities that are more egoistic.

I could list about 40 top 10 programs, but anyway…

 

[mmag]

Oh really? You think the local demographics of CT is 50% Nigerian Female? They don't even bother to recruit descendants of American slaves, it's straight up just checking color boxes.

You are not suppose to talk about West African and Caribbean over representation in medicine.