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aneftp said:
I’m very confused on rad onc. I think it’s a great career. One of the neighbors commands 900k a year working 3.5 days a week. I know her very well.

How many rad onc slots are there? The data is confusing. I think rad onc has even less then derm and it’s an even better lifestyle than derm.

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I think it’s much more difficult to set up shop or get a job where you want for rad onc because you need millions of dollars in equipment (linac, cyber knife) in order to practice so you’re beholden to a big hospital system or finance guys. Also it’s harder to be a tik tok radonc.
 
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aneftp said:
I’m very confused on rad onc. I think it’s a great career. One of the neighbors commands 900k a year working 3.5 days a week. I know her very well.

How many rad onc slots are there? The data is confusing. I think rad onc has even less then derm and it’s an even better lifestyle than derm.

Click to expand...
Rad onc job market has been a dumpster for nearly a decade now. Medical students fortunately aren’t oblivious enough to not look at their futures rationally when considering where they want to live and the life they want to have.
 
amyl said:
That’s true kidthor- the sky has been falling for years. Just like everyone told me not to do cv anes bc everything is going to be interventional cards and open cv surgery will be obsolete.
Fact is no one knows… no one could’ve predicted a global pandemic either.
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Just do a better echo than the cardiologist for the structural room. Boom, problem solved. Bonus is you tell admin they don’t have to stipend a cardiologist to cover that room anymore. They can ship that cardiologist back to the clinic or fire the “Advanced imaging” doctor they just hired. Save them big 💰💰💰
 
aneftp said:
I’m very confused on rad onc. I think it’s a great career. One of the neighbors commands 900k a year working 3.5 days a week. I know her very well.

How many rad onc slots are there? The data is confusing. I think rad onc has even less then derm and it’s an even better lifestyle than derm.

Click to expand...
If you have a rad onc job it's cush. So cush that people don't retire and open up jobs. There was a past projection for a big increase in radiation treatment that resulted in residency expansion. Treatments are shorter now and regulation wise there's no longer a need for a rad onc to be onsite at all times during treatment. The job market was awful for a good long time resulting in plummeting match rates that finally hit rock bottom ~2023. Now there's more concern due to low board pass rates of recent grads.
1742783288942.png
 
Radar26 said:
Just do a better echo than the cardiologist for the structural room. Boom, problem solved. Bonus is you tell admin they don’t have to stipend a cardiologist to cover that room anymore. They can ship that cardiologist back to the clinic or fire the “Advanced imaging” doctor they just hired. Save them big 💰💰💰
Click to expand...


Problem is that structural imaging requires a lot of attention/mental bandwidth and pays pennies. The hospital has to stipend the anesthesiologist if they are not stipending the cardiologist.
 
mmag said:
If you have a rad onc job it's cush. So cush that people don't retire and open up jobs. There was a past projection for a big increase in radiation treatment that resulted in residency expansion. Treatments are shorter now and regulation wise there's no longer a need for a rad onc to be onsite at all times during treatment. The job market was awful for a good long time resulting in plummeting match rates that finally hit rock bottom ~2023. Now there's more concern due to low board pass rates of recent grads.
View attachment 401017
Click to expand...

Yep. With hypofractionation, treatments that were 4-8weeks in the past can now be done in a week.
 
Structural, I’ve come to underStand, is actually not that lucrative for health systems.

TAVR generates way less money than SAVR all things equal, and the structural imaging reimbursement doesn’t pay enough to fully reimburse a typical cardiologist or anesthesiologist hourly wage.

It’s a service that large health systems want to offer but it is subsidized by everything else that makes much more money.
 
T-burglar said:
Structural, I’ve come to underStand, is actually not that lucrative for health systems.

TAVR generates way less money than SAVR all things equal, and the structural imaging reimbursement doesn’t pay enough to fully reimburse a typical cardiologist or anesthesiologist hourly wage.

It’s a service that large health systems want to offer but it is subsidized by everything else that makes much more money.
Click to expand...
Flip side: do 6-7 TAVRs per day and discharge in 1-2 days. Inpatient cost to the hospital is also much lower for most TAVRs.

It’s all about volume for some places. And, they keep the patients for all the pre/post imaging & labs which generate revenue.
 
No even with the shorter hospital stay SAVR is much better “all things equal”
 
CopaceticOne said:
Flip side: do 6-7 TAVRs per day and discharge in 1-2 days. Inpatient cost to the hospital is also much lower for most TAVRs.

It’s all about volume for some places. And, they keep the patients for all the pre/post imaging & labs which generate revenue.
Click to expand...
What is the facility fee reimbursement for the hospital tavr vs savr?

It’s all about the money

 
CopaceticOne said:
Flip side: do 6-7 TAVRs per day and discharge in 1-2 days. Inpatient cost to the hospital is also much lower for most TAVRs.

It’s all about volume for some places. And, they keep the patients for all the pre/post imaging & labs which generate revenue.
Click to expand...
How often do they F up TAVRs these days and have to crash onto bypass?

I haven’t done a TAVR since I was a resident, but it was one of the most insufferable experiences ever. Spending a full day with a narcissist cardiac surgeon can only be made worse by adding in a narcissist interventional cardiologist to the party. Whenever they messed it up they both found new and creative ways to blame anesthesia.

Granted, I hope it’s much better in the real world.
 
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I guess my original point was to make the structural room part of your portfolio rather than letting it be the end of you. A fellowship trained anesthesiologist should do the echo since they are already billing for the anesthesia. But there will (most likely) be a constant need for surgical intervention which more often is a superior treatment IMO and the original reason why I did a CT fellowship in the first place. But these days it’s a mixed bag and the hospital wants to do a lot of both.

To the fellows reading this- learn echo for structural cases.
 
kidthor said:
How often do they F up TAVRs these days and have to crash onto bypass?

I haven’t done a TAVR since I was a resident, but it was one of the most insufferable experiences ever. Spending a full day with a narcissist cardiac surgeon can only be made worse by adding in a narcissist interventional cardiologist to the party. Whenever they messed it up they both found new and creative ways to blame anesthesia.

Granted, I hope it’s much better in the real world.
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Extremely infrequent. The case in good hands takes an hourish.
 
Radar26 said:
I guess my original point was to make the structural room part of your portfolio rather than letting it be the end of you. A fellowship trained anesthesiologist should do the echo since they are already billing for the anesthesia. But there will (most likely) be a constant need for surgical intervention which more often is a superior treatment IMO and the original reason why I did a CT fellowship in the first place. But these days it’s a mixed bag and the hospital wants to do a lot of both.

To the fellows reading this- learn echo for structural cases.
Click to expand...


Are you doing both the anesthetic and the imaging for mitraclips? Our hospital pays a stipend for the second anesthesiologist because the reimbursement for imaging still doesn’t cover the cost of taking them out of another room. It’s an unfunded mandate. Hospital picks up the tab because they want to have a program.


www.tctmd.com

CMS Extends MitraClip Coverage to Functional MR, Carves Out Imager Role

The NCD for transcatheter edge-to-edge repair specifies heart team makeup and volume requirements.
www.tctmd.com www.tctmd.com





“For the interventional echocardiographers, however, these may be either a cardiologist or an anesthesiologist, and these specialists need to have experience with at least 10 transseptal guidance procedures and 30 or more structural heart procedures. In addition, they must be board eligible or certified in transesophageal echocardiography, “with advanced training as required for privileging by the hospital where the TEER is performed.” Of note, if an anesthesiologist is doing the imaging guidance for the procedure, he or she “may not also furnish anesthesiology during the same procedure,” the NCD states.“
 
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Correct, all things considered, after the cost of the device and the poor Medicare reimbursement, and the loss of the facility fee , and the opportunity cost of putting either an anesthesiologist or cardiologist in the imaging position… structural is a luxury service offered by health systems with money that can squeeze it in.

The economic analyses I read on the subject determined that only transcatheter atrial septal interventions were the economically dominant procedure when comparing surgery and transcatheter interventions .
 
CopaceticOne said:
I wonder which donor kid didn’t get what they wanted. Also, interesting the are requesting info explicitly from Duke, Georgetown, and Stanford.
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Pretty much proves what we already know. Money can buy a lot of favors from politicians.

But it looks like Georgetown/medstar did increase its residency pay over the year.

Traditionally. Wash dc had been considered the “south “ and cheaper to live than the “north”. So Hopkins and Univeristy of Maryland residency used to always pay more than the two Washington DC programs in the “south” by around 10%.

At least govt fixed that stupidity.

Govt didnt fixed the mortgage lending non jumbo limits in that area. They considered West Virginia a high cost living area for mortgage so let West Virginia borrow more for non jumbo loans (729k) vs suburban Maryland 20 miles outside of dc (560k) which it considered Baltimore and thus cheap.

My point, govt makes no sense how much they set price limits for mortgages, residency training etc with regards to location
 
aneftp said:
Once general surgeons figure this out (the other specialist surgeons have figured out this year ago) by limiting their calls.

It’s game over for hospitals. To this day. I ask each general surgeon why they don’t charge per hour they are required to take call even phone calls.

The mentality of being a doctor and hospitals taking advantage of free non billable phone calls is so old school. Hospitals already have such a hard time getting urologists to cover for calls and patients arrive septic with stones that need to be temp stented.
Click to expand...
Because hospitals own the majority of ascs, and to get priveldge and buy in they force you to have hospital priveldge, to get hospital priv you have to take call
 
hopefulraddaddypls said:
Because hospitals own the majority of ascs, and to get priveldge and buy in they force you to have hospital priveldge, to get hospital priv you have to take call
Click to expand...
Tell that to the urologist who don’t take calls anymore at most hospitals systems. Or ent docs

Some specialities can force their will on hospitals.
 
aneftp said:
Tell that to the urologist who don’t take calls anymore at most hospitals systems. Or ent docs

Some specialities can force their will on hospitals.
Click to expand...
Yup. All politics and power dynamics are local.
 
hopefulraddaddypls said:
Because hospitals own the majority of ascs, and to get priveldge and buy in they force you to have hospital priveldge, to get hospital priv you have to take call
Click to expand...


Depends on location. We have plenty of general surgeons who don’t take ER call. Our trauma/acute care surgeons do all the cases that come through the ER unless there is an insurance issue. But most of the surgeons want to use Davinci and none of the surgery centers around here have one so they come to the hospital.
 
nimbus said:
Depends on location. We have plenty of general surgeons who don’t take ER call. Our trauma/acute care surgeons do all the cases that come through the ER unless there is an insurance issue. But most of the surgeons want to use Davinci and none of the surgery centers around here have one so they come to the hospital.
Click to expand...
You probably need to rephrase it “our hospital employed” surgeon who is mandated calls

Eventually those will become slim pickings as the next gen of surgeons want lifestyle as well. Remember more women are going into surgeon. Many will just elect to do outpatient like cases hernia and breast surgery.

Once the general surgeons pool of call takers die down, hospitals have to rethink things again.
 
aneftp said:
You probably need to rephrase it “our hospital employed” surgeon who is mandated calls

Eventually those will become slim pickings as the next gen of surgeons want lifestyle as well. Remember more women are going into surgeon. Many will just elect to do outpatient like cases hernia and breast surgery.

Once the general surgeons pool of call takers die down, hospitals have to rethink things again.
Click to expand...
WTF. What’s up with the 1950s mentality?

Women make up about half the workforce where I work and they all take call - surgeons included.
 
kidthor said:
WTF. What’s up with the 1950s mentality?

Women make up about half the workforce where I work and they all take call - surgeons included.
Click to expand...
Good for you and them. The ones on the east coast in Florida are close to mommy track I deal with. Even the women surgeons. Maybe my sample pool of 12 hospitals I cover isn’t enough for your side of the world.

But my sister up in mid Atlantic says the same for her part of the world where the women general surgeons don’t do call

My brother in Los Angeles does have quite a few female general surgeons taking call. Even ones 8.5 months pregnant with a 1.5 year old toddler at home.
 
gunnershow said:
I've never met a female anesthesiologist who was hungry for call like the male docs who pull 120+ hours a week solo in-house.
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In general the people who are willing to work ridiculous hours are disproportionately male. That’s ok as long as everyone has the same opportunity and access.
 
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Dr. Rude said:
In general the people who are willing to work ridiculous hours are disproportionately male. That’s ok as long as everyone has the same opportunity and access.
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Yes and then people compare apples to oranges and use this example as a "gender pay gap", when one party works twice as much as another.
 
gunnershow said:
Yes and then people compare apples to oranges and use this example as a "gender pay gap", when one party works twice as much as another.
Click to expand...
Studies correct for hours worked -> still show a gap.


journals.lww.com

Gender Differences in Compensation in Anesthesiology in the ... : Anesthesia & Analgesia

er pay gap still existed for anesthesiologists in the United States. METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the...
journals.lww.com journals.lww.com
1743128113190.png
 
mmag said:
Studies correct for hours worked -> still show a gap.


journals.lww.com

Gender Differences in Compensation in Anesthesiology in the ... : Anesthesia & Analgesia

er pay gap still existed for anesthesiologists in the United States. METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the...
journals.lww.com journals.lww.com
View attachment 401258
Click to expand...
🤷‍♂️
 
aneftp said:
You probably need to rephrase it “our hospital employed” surgeon who is mandated calls

Eventually those will become slim pickings as the next gen of surgeons want lifestyle as well. Remember more women are going into surgeon. Many will just elect to do outpatient like cases hernia and breast surgery.

Once the general surgeons pool of call takers die down, hospitals have to rethink things again.
Click to expand...

Our trauma surgeons have a very good lifestyle. Full time is 6x24hr in-house shifts/month followed by 24hrs backup from home. One guy practices vascular surgery on the side. 2 are moms with young kids, one is married to an anesthesiologist. They also have a chief resident from the local navy GS residency and additional GS and EM residents every month and they have a deep pool of very experienced nurse practitioners. It’s a good gig with lots of time off.
 
I
mmag said:
Studies correct for hours worked -> still show a gap.


journals.lww.com

Gender Differences in Compensation in Anesthesiology in the ... : Anesthesia & Analgesia

er pay gap still existed for anesthesiologists in the United States. METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the...
journals.lww.com journals.lww.com
View attachment 401258
Click to expand...
I’d to know what adjustments they make for certain jobs and cases. This is why I don’t believe many of the studies.

Like in a blended unit system. As the call doc. You want to choose the highest grossing units. I see zero mention of that type of adjustment in that article because some docs may decide to just take it easier and pace themselves for the call than try to kill themselves. Do the authors think we are stupid or the public’s buys their bs article? Because hours work has zero impact on pay if one doc is gonna to choose the less grossing units case on call. Taking call me nothing. It doesn’t now the call is structure. These are just surveys of 2000-3000 respondents and the authors tried to Chinese ccp propaganda the public again.

This is not me being sexist. It’s the authors selectively choosing what variables to select.

If you are a shark female or male anesthesiologist in modern times. U are gonna to be making a lot of dough.
 
nimbus said:
Our trauma surgeons have a very good lifestyle. Full time is 6x24hr in-house shifts/month followed by 24hrs backup from home. One guy practices vascular surgery on the side. 2 are moms with young kids.
Click to expand...
Good for the surgeons. I’m happy for them. That’s the why hospitals need to compensate general surgeons accordingly.

Just like I’ve been telling everyone the anesthesia full time w2 jobs that get taken up have tons of time off as well.

No one wants to daily grind it out daily.
 
aneftp said:
I

I’d to know what adjustments they make for certain jobs and cases. This is why I don’t believe many of the studies.

Like in a blended unit system. As the call doc. You want to choose the highest grossing units. I see zero mention of that type of adjustment in that article because some docs may decide to just take it easier and pace themselves for the call than try to kill themselves. Do the authors think we are stupid or the public’s buys their bs article? Because hours work has zero impact on pay if one doc is gonna to choose the less grossing units case on call. Taking call me nothing. It doesn’t now the call is structure. These are just surveys of 2000-3000 respondents and the authors tried to Chinese ccp propaganda the public again.

This is not me being sexist. It’s the authors selectively choosing what variables to select.

If you are a shark female or male anesthesiologist in modern times. U are gonna to be making a lot of dough.
Click to expand...


Agree with this. It’s not as if male anesthesiologists get $1.3x/unit while female anesthesiologists only $1x/unit. And call stipends are the same for everybody. We have our share of workaholic female anesthesiologists and they make the same as the workaholic boys. But it is hard to be a workaholic mom with primary childcare duties. That’s where the difference lies.

At our local academic program, the 2 highest paid anesthesiologists are women. The chair and the chief of peds who grinds out a ton of peds call.
 
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mmag said:
Studies correct for hours worked -> still show a gap.


journals.lww.com

Gender Differences in Compensation in Anesthesiology in the ... : Anesthesia & Analgesia

er pay gap still existed for anesthesiologists in the United States. METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the...
journals.lww.com journals.lww.com
View attachment 401258
Click to expand...
There is no way you can adjust for hours worked. Hours 50-60 are worth far more money than hours 30-40.

There is no difference but what you’re willing to negotiate. CMS and other insurance does not ask for physician sex when billing
 
aneftp said:
I

I’d to know what adjustments they make for certain jobs and cases. This is why I don’t believe many of the studies.

Like in a blended unit system. As the call doc. You want to choose the highest grossing units. I see zero mention of that type of adjustment in that article because some docs may decide to just take it easier and pace themselves for the call than try to kill themselves. Do the authors think we are stupid or the public’s buys their bs article? Because hours work has zero impact on pay if one doc is gonna to choose the less grossing units case on call. Taking call me nothing. It doesn’t now the call is structure. These are just surveys of 2000-3000 respondents and the authors tried to Chinese ccp propaganda the public again.

This is not me being sexist. It’s the authors selectively choosing what variables to select.

If you are a shark female or male anesthesiologist in modern times. U are gonna to be making a lot of dough.
Click to expand...
60% of the female anesthesiologists at my place are past time. 0% of the men are part time. We all get paid the exact same salary, with the exception of the part-timers.

Edit: as a matter of fact. One person is paid more than the rest. It’s one of the women.
 
The funny thing about the gender pay disparity is that, if anything, I suspect it exists at academic elite institutions (who publish this data).

Most private practice or hospital employed jobs there is simply no way to pay someone more. I'm hospital employed. Our new hires make just as much (per shift) as the person who has been there 30 years. They actually make more per year as the young guys like me tend to work more. There is no way to be unfair even if we wanted to.

Private practice may have a short buy in period where you make less but the length of this is not dependent on gender. Most private practice near me all profit is divided so no one can be screwed by unprofitable assignments. I will say that in a true eat what you kill, it could be theoretically possible for there to be a gender pay gap if assignments are consistently unfair. This seems to be less and less common and most places are at least using blended units.

Academic pay structure is weird and I don't really understand it but it seems as though there are various levels of pay based on criteria which to me seem a little bit subjective. This is where I would expect the pay gap to be the most prevalent.
 
rick roller pump said:
The funny thing about the gender pay disparity is that, if anything, I suspect it exists at academic elite institutions (who publish this data).

Most private practice or hospital employed jobs there is simply no way to pay someone more. I'm hospital employed. Our new hires make just as much (per shift) as the person who has been there 30 years. They actually make more per year as the young guys like me tend to work more. There is no way to be unfair even if we wanted to.

Private practice may have a short buy in period where you make less but the length of this is not dependent on gender. Most private practice near me all profit is divided so no one can be screwed by unprofitable assignments. I will say that in a true eat what you kill, it could be theoretically possible for there to be a gender pay gap if assignments are consistently unfair. This seems to be less and less common and most places are at least using blended units.

Academic pay structure is weird and I don't really understand it but it seems as though there are various levels of pay based on criteria which to me seem a little bit subjective. This is where I would expect the pay gap to be the most prevalent.
Click to expand...
in todays world. Yes. Very hard to get true pay difference between men and women for structured w2 contracts.

The legal profession published a similar pay inequality article also a few years ago. Especially more female lawyer grads now. And pointed to federal legal hiring was all about equality and that no female lawyers on private practice side could bill $1000/hr as some of their male counterparts.
 
rick roller pump said:
The funny thing about the gender pay disparity is that, if anything, I suspect it exists at academic elite institutions (who publish this data).

Most private practice or hospital employed jobs there is simply no way to pay someone more. I'm hospital employed. Our new hires make just as much (per shift) as the person who has been there 30 years. They actually make more per year as the young guys like me tend to work more. There is no way to be unfair even if we wanted to.

Private practice may have a short buy in period where you make less but the length of this is not dependent on gender. Most private practice near me all profit is divided so no one can be screwed by unprofitable assignments. I will say that in a true eat what you kill, it could be theoretically possible for there to be a gender pay gap if assignments are consistently unfair. This seems to be less and less common and most places are at least using blended units.

Academic pay structure is weird and I don't really understand it but it seems as though there are various levels of pay based on criteria which to me seem a little bit subjective. This is where I would expect the pay gap to be the most prevalent.
Click to expand...
Academics often have a component of pay based on academic rank. You can play games with promotion as P&T committees are capricious and arbitrary, often denying tenure or promotion for stupid things like “slow down in paper trajectory” even if the person has more papers and citations than others.

Arbitrary approval = secret discrepancies.
 
mmag said:
Studies correct for hours worked -> still show a gap.


journals.lww.com

Gender Differences in Compensation in Anesthesiology in the ... : Anesthesia & Analgesia

er pay gap still existed for anesthesiologists in the United States. METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the...
journals.lww.com journals.lww.com
View attachment 401258
Click to expand...
A survey

7.2% response rate

Absolute worthless garbage
 
mmag said:
Studies correct for hours worked -> still show a gap.


journals.lww.com

Gender Differences in Compensation in Anesthesiology in the ... : Anesthesia & Analgesia

er pay gap still existed for anesthesiologists in the United States. METHODS: In 2018, we surveyed 28,812 physician members of the American Society of Anesthesiologists to assess the association of compensation with gender and to identify possible causes of wage disparities. Gender was the...
journals.lww.com journals.lww.com
View attachment 401258
Click to expand...


Lol studies? Bro this is a survey
 
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