castafari

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I am interested in doing a cardiac fellowship starting 2015. In the meantime I finish residency this summer and want to maximize income in one year. I am willing to move anywhere and do any cases. What is the best plan to maximize income? Locums? Rural location? I am single with no kids so I am willing to work unlimited hours.
 

Gaseous Clay

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Either do locums or see if your home program is willing to sign you on for one year. No private practice gig will hire you for one year.
 

imfrankie

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Either do locums or see if your home program is willing to sign you on for one year. No private practice gig will hire you for one year.
Doubt you will make big money at your home institution. Generally $/hr at academic programs isn't especially lucrative. We'll think on it. Don't work through an agency though. You want to find $200+/hr with malpractice, health insurance and unlimited hours opportunity. Where do you live?
 

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Focus on passing your boards and preparing for your fellowship. Usually, you are best off staying at your home program during a gap year.
 

imfrankie

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Focus on passing your boards and preparing for your fellowship. Usually, you are best off staying at your home program during a gap year.
I disagree. This guy wants to do cases 24/7, get paid, and I think it's great. You'll pay of your loans and get great experience. You can always read. Go to a busy, private practice place that does all kinds of cases big and small--all MD. You'll gain a ton of confidence through such a year. Tell them exactly what you want to accomplish. Do everything, offer to work for anyone, anytime--so long as you get paid. The group will be happy to have someone like you who might want to come back after a cardiac fellowship.
 

Mman

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I disagree. This guy wants to do cases 24/7, get paid, and I think it's great. You'll pay of your loans and get great experience. You can always read. Go to a busy, private practice place that does all kinds of cases big and small--all MD. You'll gain a ton of confidence through such a year. Tell them exactly what you want to accomplish. Do everything, offer to work for anyone, anytime--so long as you get paid. The group will be happy to have someone like you who might want to come back after a cardiac fellowship.
While that is solid advice, it certainly won't maximize his income. There is literally no way for an all MD group to have the same income as a group using an ACT model.
 

chmd

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Work for an AMC. They pay pretty well right off the bat. Plus they might be excited about getting a new cardiac attending. Check out buffalo ny
 
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castafari

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Sorry but what is an AMC? I'm currently a resident in NY state.
 

chmd

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Anesthesia management company - something like NAPA. Also I meant Erie, PA and not Buffalo, NY. I was in a similar situation last year and they had a pretty attractive job. You'll never make partner type money but it was 25% better than the jobs I checked out with private practice groups - in the years before partnership that is.
 

chmd

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Another idea would be interviewing with groups in the vicinity of your future fellowship. They may already know their future needs and potentially would count your interim year as a year towards partner if you returned after your fellowship.

I guess any group could do that, but it would seem more likely if you were in the neighborhood. Plus maybe you'd be able to work a little on the side (unwanted weekend calls, holidays, vacation, etc).
 

Gaseous Clay

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Doubt you will make big money at your home institution. Generally $/hr at academic programs isn't especially lucrative. We'll think on it. Don't work through an agency though. You want to find $200+/hr with malpractice, health insurance and unlimited hours opportunity. Where do you live?
I am being realistic. It's easy to say I'd work 24/7 and make "lots of money." Good luck finding a PP group who's going to take a one year player. If anything, they'd pay you crap and have you take tons of call. If my group was looking, we certainly would not consider a one year person. Sure, my group may not mean anything, but I cannot imagine a group recruiting someone knowing in one year, they'd need to replace you. Honestly, you're not going to make big bucks in one year right out of residency. Your best bet is trying to fill your 52 weeks with locums gigs but good luck with that.

The only chance you may have is if a place is desperate for a cardiac guy and is willing to have you for one year, let you do the fellowship, and let you come back after that. I could see that in a large group but those tend to be unfair with super partners. Make big bucks at an AMC? That's laughable.

I still think your best chance is staying at your home program assuming you're good and wanted. Try to pick up extra shifts and call, sell your vacation, and focus on passing boards, that's my vote.
 

ssmallz

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What's big bucks to you guys? For a first year out, I would say anything above 350k should be considered pretty good and if someone's willing to work pretty hard, I don't see any reason why he can't do that. There's plenty of places out there where they are desperate for coverage and having a competent anesthesiologist willing to spend a full year would be pretty reasonable. If you're working in a reasonably busy OR in an eat what you kill model can clear 350k easy w/a decent payor mix.
 

imfrankie

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What's big bucks to you guys? For a first year out, I would say anything above 350k should be considered pretty good and if someone's willing to work pretty hard, I don't see any reason why he can't do that. There's plenty of places out there where they are desperate for coverage and having a competent anesthesiologist willing to spend a full year would be pretty reasonable. If you're working in a reasonably busy OR in an eat what you kill model can clear 350k easy w/a decent payor mix.
Yep. very easy for him. There are plenty of groups that would let him work as a temp guy for vacations, call, weekends, holidays, etc. You will have no trouble filling every moment of the year if you wish. Just don't let someone take a cut--you don't have to do it. The work is out there. Secondly, as far as supervising, I wouldn't do it. First year out working your own cases--that's how you get comfortable, get respect and will buff yourself best for your fellowship year and further career. Running around signing a bunch of charts--don't do it.
 

Mman

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Yep. very easy for him. There are plenty of groups that would let him work as a temp guy for vacations, call, weekends, holidays, etc. You will have no trouble filling every moment of the year if you wish. Just don't let someone take a cut--you don't have to do it. The work is out there. Secondly, as far as supervising, I wouldn't do it. First year out working your own cases--that's how you get comfortable, get respect and will buff yourself best for your fellowship year and further career. Running around signing a bunch of charts--don't do it.
That's fine to moralize it, but the OP wants to do anything and work anywhere and maximize $$$. Your idea doesn't maximize the $$$.
 

imfrankie

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That's fine to moralize it, but the OP wants to do anything and work anywhere and maximize $$$. Your idea doesn't maximize the $$$.
I'm not moralizing in this thread. The guy has never done a case by himself and I don't see that temporary supervisory work will pay more than primary provider. Incomes being equal for the temp worker, go with all-MD.
 

IlDestriero

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I did all my own cases for a few years after I got out of residency. There's nothing like that kind of experience. I recommend it for everyone.
Alone and unafraid is the way to go.
You get to hone your skills, develop good instincts, confidence, learn to trouble shoot on your own, the ability to manage an OR, to manage a surgeon, to deal with tricky patients and prickly administrators, etc.
That's what you want to do, money or not!
 
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Mman

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I'm not moralizing in this thread. The guy has never done a case by himself and I don't see that temporary supervisory work will pay more than primary provider. Incomes being equal for the temp worker, go with all-MD.
They won't be equal, or at least they shouldn't be. Jobs are out there that will pay him at least 50-100K more for a single year to work in an ACT model than to do his own cases.
 

sevoflurane

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While your income potential in general is increased by the ACT model, many all-MD groups exist out there which smoke 95% of ACT groups. Adding the fact that you don't have to supervise is just icing on the cake that makes your life that much better. This may not be the norm in the future.
For now, those lucrative MD only groups are def. out there. Just saying...
 
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Mman

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While your income potential in general is increased by the ACT model, many all-MD groups exist out there which smoke 95% of ACT groups. Adding the fact that you don't have to supervise is just icing on the cake that makes your life that much better. This may not be the norm in the future.
For now, those lucrative MD only groups are def. out there. Just saying...
95%? Really? In my limited experience, I've yet to see an MD model only come within 33% of the pay of ACT model jobs. I mean you can easily find locums-ish jobs covering small hospitals for essentially 10K per week starting salary. Do that for 48 weeks a year and you've got a nice salary for a year.
 

sleepallday

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95%? Really? In my limited experience, I've yet to see an MD model only come within 33% of the pay of ACT model jobs. I mean you can easily find locums-ish jobs covering small hospitals for essentially 10K per week starting salary. Do that for 48 weeks a year and you've got a nice salary for a year.

I've actually seen the complete opposite. I've not seen ACT model jobs come anywhere close to MD only groups in pay. The reason being is that most ACT model groups are within AMC's. In an AMC someone is always making money off of you. Those will never compare in pay to a pure ' eat what you kill' MD group.
 

pjl

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There are many groups out there who would like a 1 year guy, the trouble is finding them without an agency. Look very broadly. Ask on here and everywhere you can, someone somewhere will have a connection.
 

saratoga733

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md only groups that run lean in suburban hospitals with a nice payer mix with relatively light night and weekend caseloads can choose not to hire nurses and still do pretty well. nurses get paid even when there's nothing going on. do i swallow my lunch in between cases on some days? yes. but i rather do that than have a nurse screw around with my anesthetic. i imagine though most all md groups prefer board certified anesthesiologists with some experience?? at least that is the case where i work. when the **** ****s the fan in the middle of the night-- your it! no matter how good you think you are out of residency... you are a different doctor straight out of residency versus 1-2 years out. this is not anesthesia specific but true for all specialties... especially procedure heavy ones. i see it with my eyes everyday. you can't convince me to get my colonoscopy with the newbie on the block...
 

Lurch

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It seems as if many of you recommend "doing your own cases" straight out of residencies and fellowships but MD only practices are not only becoming fewer in number but do not generally hire fresh grads. Is there something I'm missing or is this becoming something of a pipe dream?
I did all my own cases for a few years after I got out of residency. There's nothing like that kind of experience. I recommend it for everyone.
Alone and unafraid is the way to go.
You get to hone your skills, develop good instincts, confidence, learn to trouble shoot on your own, the ability to manage an OR, to manage a surgeon, to deal with tricky patients and prickly administrators, etc.
That's what you want to do, money or not!
I
 

Mman

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I've actually seen the complete opposite. I've not seen ACT model jobs come anywhere close to MD only groups in pay. The reason being is that most ACT model groups are within AMC's. In an AMC someone is always making money off of you. Those will never compare in pay to a pure ' eat what you kill' MD group.
I'm referring to private groups, not AMCs. Pay is usually double in an ACT model compared to MD only, but at minimum 20-30% higher. It's just how billing works in our profession. I'd keel over and die if I found an MD only model offering 500K per year starting salary with minimal call back responsibilities, yet those are easy to find in rural America in ACT models.
 

sevoflurane

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95%? Really? In my limited experience, I've yet to see an MD model only come within 33% of the pay of ACT model jobs. I mean you can easily find locums-ish jobs covering small hospitals for essentially 10K per week starting salary. Do that for 48 weeks a year and you've got a nice salary for a year.
As a whole, you are right.

That's not to say that there are physician-only groups out there beating 95% of ACT groups.
 

Mman

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As a whole, you are right.

That's not to say that there are physician-only groups out there beating 95% of ACT groups.
There are exceptions to every rule and a great payer mix or favorable contract can make almost anything look good. But if you were to rank every group by reimbursement, 95% of the top 10-20% of groups would be ACT model.
 

Mman

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Not sure where you get your information M. I continue to disagree.
The job market.

A casual look and some phone calls to the MD only groups within 500 miles of me doesn't find one that fits your description. Meanwhile I can find dozens of people hired for north of $450K first year salary with less than 3 years experience at jobs with ACT model.
 
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sbmed100

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Mman,

I work in an all MD group. We work hard, but I guarantee you that we and five other all MD groups within fifteen miles are at or above the MGMA ninetieth (90) percentile for the Northeast. I don't want to know what a CRNA is, but I can tell you they have pretty much priced themselves out of the market here. $225,000/yr full package with benefits for a nurse that you have to supervise and give an hour of breaks to throughout the day? No thanks.

Many insurance carriers don't allow you to cover four rooms which is the only way you are going to make money on Crnas. You can't put them in with some surgeons, you don't want to put them in difficult or complicated cases (which is pretty much all that is left at hospitals these days), I don't want to teach them complicated regional, etc. Why bother?
 

IlDestriero

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That's a lot for a CRNA. We don't pay anywhere near that and still get a constant flow of applications, even when we're not hiring.
Though our CRNAs only work 40 hours and have no call or weekend work.
 

sbmed100

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IlDestriero,

Crna base salary $169,000 + 28k family medical + 12k malpractice + fees/licenses+ nominal bonus + disability = it's just not worth it to employ people who one day want to replace you
 
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IlDestriero

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Not in my hood. Plenty of CRNAs and a desirable city means lower pay and benefits.
 

Stank811

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MMan I was able to find a primarily all MD group with a more than reasonable salary first year out. Groups similar to what Imfrankie is referring to still exist and are not all that uncommon in my region for new graduates to find positions in their first year out. As with any job the more geographically limited you are the more difficult it will be.
 

saratoga733

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IlDestriero,

Crna base salary $169,000 + 28k family medical + 12k malpractice + fees/licenses+ nominal bonus + disability = it's just not worth it to employ people who one day want to replace you

Amen brother!

Glad to hear there are groups out there like ours...
 

Impromptu

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If you can get a job with the big group in Utah you can make a ton of money. It is MD only eat what you kill for cases and hours, though units were blended. They typically hire "part time", but don't let that throw you. You can take call for many of the older guys who don't want to take call. When I interviewed there they told me that one of their "part-time" guys was one of the highest earners that year, because he worked more hours by taking lots of call.

The difficult part was that there were 50 MDs applying for 2 part time jobs. Good luck.
 

Mman

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Mman,

I work in an all MD group. We work hard, but I guarantee you that we and five other all MD groups within fifteen miles are at or above the MGMA ninetieth (90) percentile for the Northeast. I don't want to know what a CRNA is, but I can tell you they have pretty much priced themselves out of the market here. $225,000/yr full package with benefits for a nurse that you have to supervise and give an hour of breaks to throughout the day? No thanks.

Many insurance carriers don't allow you to cover four rooms which is the only way you are going to make money on Crnas. You can't put them in with some surgeons, you don't want to put them in difficult or complicated cases (which is pretty much all that is left at hospitals these days), I don't want to teach them complicated regional, etc. Why bother?
I've never suggested that such groups don't exist. But they are an extreme minority. And those groups aren't hiring new grads with starting salaries at the 90th percentile for a 1 year job.

Also, your CRNA salaries seem so out of whack with the rest of the country I'm not sure where to start. We are definitely on the low end with new grads salary only slightly above 100K + benefits. Also not sure why you have insurance carriers that won't let you cover 4 rooms, that's just odd.
 

Gaseous Clay

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I am surprised at the optimism in this thread. Good luck to the OP but he/she will need a lot of luck or connections to land a high paying job for just one year and being a fresh grad. Now if the OP is at a top program with excellent recommendations and interviews well, yes, maybe, but I still can't imagine too many groups wanting to take on someone in this situation. But who knows, maybe the OP is the Lebron James of anesthesia who can push an anesthesia dept into the top 100 in the USA so they can put that on the local town's billboard.
 

countingdays

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I am surprised at the optimism in this thread. Good luck to the OP but he/she will need a lot of luck or connections to land a high paying job for just one year and being a fresh grad. Now if the OP is at a top program with excellent recommendations and interviews well, yes, maybe, but I still can't imagine too many groups wanting to take on someone in this situation. But who knows, maybe the OP is the Lebron James of anesthesia who can push an anesthesia dept into the top 100 in the USA so they can put that on the local town's billboard.
Yeah, he needs to A) pretend he plans to stay there indefinitely, B) go somewhere where they'll want him to return after fellowship and are ok with him coming and going, or c) do locums.
 

Mman

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Yeah, he needs to A) pretend he plans to stay there indefinitely, B) go somewhere where they'll want him to return after fellowship and are ok with him coming and going, or c) do locums.
agreed. A 1 year hired gun position isn't terribly likely for a new grad. But if you sign up at a gig under the pretense of staying indefinitely, you gotta know what kind of notice you need to provide to terminate the position. Some places might take away signing bonuses and similar things if you leave within a certain time or don't provide adequate notice.
 

IlDestriero

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But who knows, maybe the OP is the Lebron James of anesthesia who can push an anesthesia dept into the top 100 in the USA so they can put that on the local town's billboard.
One of the area hospitals apparently does some light peds stuff, they used to have a big billboard patting themselves on the back for being named a "top hospital" for pediatric care by some organization I've never heard of. Every time I saw it all I could think was "Bïtch, please!" Everyone and their mother knows where to go for the best pediatric care in the region, the giant Children's Hospital a few miles down the road...
I didn't even know they did peds stuff, their ED sends us emergency cases all the time. Including healthy 17yo kids for an appy and simple ORIFs and CRPPs.:rolleyes:
 

sevoflurane

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One of the area hospitals apparently does some light peds stuff, they used to have a big billboard patting themselves on the back for being named a "top hospital" for pediatric care by some organization I've never heard of. Every time I saw it all I could think was "Bïtch, please!" Everyone and their mother knows where to go for the best pediatric care in the region, the giant Children's Hospital a few miles down the road...
I didn't even know they did peds stuff, their ED sends us emergency cases all the time. Including healthy 17yo kids for an appy and simple ORIFs and CRPPs.:rolleyes:

The funny thing is that this type of propaganda actually works. Perception is important in this industry.

But yeah... puhlease.
 

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I am interested in doing a cardiac fellowship starting 2015. In the meantime I finish residency this summer and want to maximize income in one year. I am willing to move anywhere and do any cases. What is the best plan to maximize income? Locums? Rural location? I am single with no kids so I am willing to work unlimited hours.
My vote is to stay on for a year. Do whatever extra work you can - nights, weekends, etc. Try and pick up some locums in the area. Contracting directly is obviously better than dealing with a locums company. Work your vacation, post-call etc.
 
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castafari

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I am surprised at the optimism in this thread. Good luck to the OP but he/she will need a lot of luck or connections to land a high paying job for just one year and being a fresh grad. Now if the OP is at a top program with excellent recommendations and interviews well, yes, maybe, but I still can't imagine too many groups wanting to take on someone in this situation. But who knows, maybe the OP is the Lebron James of anesthesia who can push an anesthesia dept into the top 100 in the USA so they can put that on the local town's billboard.
I never claimed to be the LebronJames or any **** like that but thought maybe there were good opportunities out there for the supremely hungry applicant with unlimited work potential.
 

Gaseous Clay

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Wow you took that "joke" the wrong way. With that attitude, I take that part back about hopefully you'll interview well. Holy cow!
 

risnwb

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The most money I've found available year 1 when looking for a job this year is from private groups offering "full time with call" positions but no partnership... So basically crap jobs that they can't get people to take because they are probably gonna sell, so they offer higher salary...
 

countingdays

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The most money I've found available year 1 when looking for a job this year is from private groups offering "full time with call" positions but no partnership... So basically crap jobs that they can't get people to take because they are probably gonna sell, so they offer higher salary...
Doesn't that describe ALL jobs these days? No wait, some are already AMC jobs.
 

risnwb

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Doesn't that describe ALL jobs these days? No wait, some are already AMC jobs.
Basically true, but the private groups have offered to pay a little more than the AMCs... maybe because you are working face to face with the people f***ing you and the $$ is supposed to make up for it.