Orange County Market

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gaslearnt

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Can anybody comment on the Orange County market? Do the jobs pay well relative to other parts of the county? Do you enjoy practicing there? Thanks!

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Can anybody comment on the Orange County market? Do the jobs pay well relative to other parts of the county? Do you enjoy practicing there? Thanks!
Well usap and Envison control all of Orange County (Florida). Pay is lower due to market control.
 
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Here's some reading material for you - if we're talking about OC in Southern California. Not too much has changed since these postings. Most PP groups in OC are still run by predatory boomers who think that 300-350K/year for a few years until you maybe get promoted in as a partner in a HCOL-VHCOL area is enough for you.



 
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Asking how much SoCal pays is basically asking someone how much they work. The unit value will vary from low 30s to about low 50 being the maximum. Every place will have a different reimbursement structure and unit breakdown. So a 45-60 hour work week in SoCal will be anywhere from 400k-600k. Anything higher is usually someone working more, or one of the best jobs that are few are far between.
 
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Unit value
Reimbursement for blocks
Call stipends

Those are the three primary revenue sources in a productivity model in OC. Some groups will increase base unit value by not paying for blocks or call stipends, so don't only look at base unit value. Whether insurance pays for blocks or not is irrelevant from the perspective of the worker
 
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Here's some reading material for you - if we're talking about OC in Southern California. Not too much has changed since these postings. Most PP groups in OC are still run by predatory boomers who think that 300-350K/year for a few years until you maybe get promoted in as a partner in a HCOL-VHCOL area is enough for you.




i think mission viejo still has a buy in? which seems crazy in this market but must be a lucrative gig
 
How many of these groups are hurting for staffing? How many are asking for more stipends? It would be a tough sell for a new graduate with medical school debt to move to some of these places if they planned on buying a home and starting a family unless it was two high income earners.
 
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How many of these groups are hurting for staffing? How many are asking for more stipends? It would be a tough sell for a new graduate with medical school debt to move to some of these places if they planned on buying a home and starting a family unless it was two high income earners.

yea san diego market is getting crushed. people leaving left and right. pay is way behind and cost of living is crazy
 
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Asking how much SoCal pays is basically asking someone how much they work. The unit value will vary from low 30s to about low 50 being the maximum. Every place will have a different reimbursement structure and unit breakdown. So a 45-60 hour work week in SoCal will be anywhere from 400k-600k. Anything higher is usually someone working more, or one of the best jobs that are few are far between.
Correct. That’s what my brother tells me. And he’s been there 20 years in private practice.

He said $60 a unit was a good rate

400-600k is also correct for Los Angeles proper.

Can make more moving further out. But everyone like la and Orange County proper.
 
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yea san diego market is getting crushed. people leaving left and right. pay is way behind and cost of living is crazy
It doesn't help that all the jobs in SD suck. Not a single good job in the area. COL has skyrocketed. Can't imagine a new grad thinking it's a good idea to stay or come to SD. Here, have a ****ty job and be unable to afford a home, sounds amazing.
 
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It doesn't help that all the jobs in SD suck. Not a single good job in the area. COL has skyrocketed. Can't imagine a new grad thinking it's a good idea to stay or come to SD. Here, have a ****ty job and be unable to afford a home, sounds amazing.
ASMG ****ty now too? I remember people jumping hurdles before and putting up with their rotation/audition system going to a different hospital every month just to be part of their group
 
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Wondering this too. One of my colleagues from residency recently joined.

ASMG ****ty now too? I remember people jumping hurdles before and putting up with their rotation/audition system going to a different hospital every month just to be part of their group
 
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Correct. That’s what my brother tells me. And he’s been there 20 years in private practice.

He said $60 a unit was a good rate

400-600k is also correct for Los Angeles proper.

Can make more moving further out. But everyone like la and Orange County proper.
60/unit for a blended unit seems absurdly high, esp in socal. Is that what top groups are getting or are they fudging their numbers to get that rate?
 
60/unit for a blended unit seems absurdly high, esp in socal. Is that what top groups are getting or are they fudging their numbers to get that rate?
No. 60 unit only for commercial.

Than it gets blended with the lower unit like medi-cal

Unlike usap charging $130-140/unit in many places for commercial and blending it with Medicare rates
 
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ASMG ****ty now too? I remember people jumping hurdles before and putting up with their rotation/audition system going to a different hospital every month just to be part of their group



Not to get too specific in a public forum.

1. Compensation has not kept up with the post-pandemic market. That has led to retention issues with historically high turnover the past 2 years. It is being addressed.

2. Recruiting is still robust. Despite the crazy housing costs, people still want to move here or stay if they’re already in the area. This is true for surgeons and proceduralists too. People don’t move here to FIRE. Attributes of the group are location, fairness (scheduling, case picking, vacation, etc), autonomy, and doing our own cases.


3. New hires still rotate but it is common now to do it only 3-4 months because all the sites need people. If you find your people and your home, you can match there. I think it is beneficial for the new hires to “live” the different sites. They have very different cultures.

The group was formed in the 1950s. It’s been through good times and bad. The last 2 years have been challenging. I still really love my job. The group, my partners, our surgeons, OR staff and the hospital have been extremely supportive when I had my own personal challenges. I’m surrounded by good people.
 
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ASMG ****ty now too? I remember people jumping hurdles before and putting up with their rotation/audition system going to a different hospital every month just to be part of their group

theyve had a huge cohort of people leave the group due to lack of adequate stipends. this resulted in some of the hospitals giving a lot more in stipends so i hear its much better (at some locations). believe it or not UCSD has had a substantial pay raise as has UC irvine for that matter so lot of people leaving private practice (kaiser, asmg, etc) for academics. You can basically work as a private practice doc at the UC without having to publish or teach residents
 
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theyve had a huge cohort of people leave the group due to lack of adequate stipends. this resulted in some of the hospitals giving a lot more in stipends so i hear its much better (at some locations). believe it or not UCSD has had a substantial pay raise as has UC irvine for that matter so lot of people leaving private practice (kaiser, asmg, etc) for academics. You can basically work as a private practice doc at the UC without having to publish or teach residents
Talk with your feet. That’s the only way when words fail. I don’t know why people, especially educated people fail to see this.
Gosh it’s good to be locums. Pay me my money or I walk.
 
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theyve had a huge cohort of people leave the group due to lack of adequate stipends. this resulted in some of the hospitals giving a lot more in stipends so i hear its much better (at some locations). believe it or not UCSD has had a substantial pay raise as has UC irvine for that matter so lot of people leaving private practice (kaiser, asmg, etc) for academics. You can basically work as a private practice doc at the UC without having to publish or teach residents
UCSD anesthesiologists have to take one call per week and have to hustle to break 450k. Most are making around 400k.

UC compensation is public knowledge. Take a gander at what the average cardiac anesthesiologist makes at UCSD. It ain't good.
 
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Talk with your feet. That’s the only way when words fail. I don’t know why people, especially educated people fail to see this.
Gosh it’s good to be locums. Pay me my money or I walk.
On the flip side. U didn’t practice in 1995-1998 or 2012-2018? when the job market was extremely tight in many parts of the country.

It’s good to be a locums (for now). Maybe the next couple of years in many parts of the country.

The question is whether many urban places start to go to a supervision 1:8 model to save on cost. That would quickly contract the anesthesiologist job market.

It’s like EM job market. Many ER docs wouldn’t work for less than $300/hr from 2015-2019. Not worth their time. Now they will take much less.
 
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The question is whether many urban places start to go to a supervision 1:8 model to save on cost. That would quickly contract the anesthesiologist job market.


Where to find all those CRNAs?
 
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I agree with Aneftp- I think the extended care team will be the model… just turn the anesthesiologist into the liability sponge
 
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Where to find all those CRNAs?
Dime a dozen. Still cheaper to pay crnas $200-250-h -1099. Than have docs do the calls.

That’s the market right now. Cut out the middle guys.

I really do not know why local hospitals don’t know how to form their own internal agency and avoid agency fees especially urban hospitals.
 
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UCSD anesthesiologists have to take one call per week and have to hustle to break 450k. Most are making around 400k.

UC compensation is public knowledge. Take a gander at what the average cardiac anesthesiologist makes at UCSD. It ain't good.

Whoah that’s really bad. How do you afford a house in SD on that income?
 
I agree with Aneftp- I think the extended care team will be the model… just turn the anesthesiologist into the liability sponge
Not for me. I would 100% leave the practice of medicine before that ever happened.
 
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UCSD anesthesiologists have to take one call per week and have to hustle to break 450k. Most are making around 400k.

UC compensation is public knowledge. Take a gander at what the average cardiac anesthesiologist makes at UCSD. It ain't good.
Someone I know doesn’t work crazy hours. Cardiac doc. Not bad I say. Also this is 2022 they’ve gotten more money since.
 

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Someone I know doesn’t work crazy hours. Cardiac doc. Not bad I say. Also this is 2022 they’ve gotten more money since.
Does he work a 2nd job to make adequate money?

No need to answer. It's a rhetorical question.
 
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Someone I know doesn’t work crazy hours. Cardiac doc. Not bad I say. Also this is 2022 they’ve gotten more money since.
What does “other pay” entail if it’s not OT pay? What’s he or she doing for this $287K?
 
What does “other pay” entail if it’s not OT pay? What’s he or she doing for this $287K?

I know university jobs often have a modest base pay from the university which is what the pension is based off of and then a separate compensation from the medical group.

Just a guess though.
 
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Whoah that’s really bad. How do you afford a house in SD on that income?
Condo probably. If they've been working there for a while housing was pretty reasonable (1/3 to 1/2 the mortgage of what it would be now) 5-6 years ago. These days single family housing probably off the table anywhere near UCSD.
 
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When I was in academics at another state institution with public database for employees. Salaries were split one for the academic portion and one for the clinical portion. So many senior faculty members made a lot more than what was published. The worker bees like me worked.

I’m sure same thing in California.

And those senior faculty hide well from clinical duties. 2 non clinical days a week off. There was also almost unlimited “cme” type of days off. So the worker bees got 2 weeks cme. Senior facility took as much as 5 extra weeks of cme in addition to the lowly 25/26 regular annual paid time off available (that rolls over) plus 13 sick days.
 
UCSD anesthesiologists have to take one call per week and have to hustle to break 450k. Most are making around 400k.

UC compensation is public knowledge. Take a gander at what the average cardiac anesthesiologist makes at UCSD. It ain't good.
Wow. Thanks for the info.
 
yea san diego market is getting crushed. people leaving left and right. pay is way behind and cost of living is crazy


Odd thing is that while a few people actually moved to other VHCOL areas for better pay (Bay area, Seattle, OC), most are switching between similar jobs back and forth and sometimes back again within town. They’re mostly changing jobs without moving. Don’t actually know anyone who has left the West Coast.
 
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When I was in academics at another state institution with public database for employees. Salaries were split one for the academic portion and one for the clinical portion. So many senior faculty members made a lot more than what was published. The worker bees like me worked.

I’m sure same thing in California.

And those senior faculty hide well from clinical duties. 2 non clinical days a week off. There was also almost unlimited “cme” type of days off. So the worker bees got 2 weeks cme. Senior facility took as much as 5 extra weeks of cme in addition to the lowly 25/26 regular annual paid time off available (that rolls over) plus 13 sick days.

From my understanding, the numbers on that website are basically the W2 income. It doesn’t reflect any benefits (pension, healthcare, etc) or compensation from non-UC facilities such as the VA.

And you are definitely correct that a $450k income could mean long hours with multiple calls for one person and maybe only a handful of clinical days with no call for another. There is no escaping the academic ladder.
 
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From my understanding, the numbers on that website are basically the W2 income. It doesn’t reflect any benefits (pension, healthcare, etc) or compensation from non-UC facilities such as the VA.

And you are definitely correct that a $450k income could mean long hours with multiple calls for one person and maybe only a handful of clinical days with no call for another. There is no escaping the academic ladder.
Yes all true

But what I meant was my salary was 300k back in academics 11-12 years ago

But that state website reported my public salary as 285k officially. The other 15k had to be sniffed through the college of medicine profile because 5% of my salary was based on academic teaching and the other 95% clinical

So people looking on the public system didn’t get the entire picture if they went looking for one location

Same thing with federal salary searches. Especially federal officially in administration positions. Public salary searches don’t reveal the entire salary. It’s 90% true in most cases. But not all the salary is listed in public data searches unless u really search for different localities.
 
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When I was in academics at another state institution with public database for employees. Salaries were split one for the academic portion and one for the clinical portion. So many senior faculty members made a lot more than what was published. The worker bees like me worked.

I’m sure same thing in California.

And those senior faculty hide well from clinical duties. 2 non clinical days a week off. There was also almost unlimited “cme” type of days off. So the worker bees got 2 weeks cme. Senior facility took as much as 5 extra weeks of cme in addition to the lowly 25/26 regular annual paid time off available (that rolls over) plus 13 sick days.


I wouldn’t consider giving talks and sitting on panels at out of town ASRA and SPA meetings to be “time off”. Even the evening “networking” dinners sound exhausting. Some people probably enjoy that but for me it is not “down time”, it would be “work”. I don’t enjoy that kind of activity and prefer to do cases at the hospital, have my off hours to myself, and sleep at home.
 
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From my understanding, the numbers on that website are basically the W2 income. It doesn’t reflect any benefits (pension, healthcare, etc) or compensation from non-UC facilities such as the VA.

And you are definitely correct that a $450k income could mean long hours with multiple calls for one person and maybe only a handful of clinical days with no call for another. There is no escaping the academic ladder.


The flip side is that if you enjoy academic or administrative activities, it is highly rewarded in that system. Some of the highest paid anesthesiologists in the area work in academics.
 
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UCSD pays RVUs too now btw


The RVUs make up a very small part of the compensation and $/unit is almost unimaginably low. Most of the compensation comes from the shift. If you end up with a quiet shift and do no work, you get paid almost the same as if you’ve been up all night.
 
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That’s pretty bad for cardiac even in the area.

depends on hours worked. the chair person makes $1.2M but she works like crazy. This person works 40 hours a week most of the year if that. lot of non clinical days.
 
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Condo probably. If they've been working there for a while housing was pretty reasonable (1/3 to 1/2 the mortgage of what it would be now) 5-6 years ago. These days single family housing probably off the table anywhere near UCSD.

yea you basically have to move far east which defeats the purpose of living in san diego
 
yea you basically have to move far east which defeats the purpose of living in san diego

The California trap:
1. Visit prime California and think “it’s so perfect, we’re moving here!”
2. Start looking at houses and realize you can’t afford the house/lifestyle you want in the prime area.
3. Convince yourself you’ll just move a “bit” further out and it’ll still be great.
4. Congrats, you now live in the literal desert, your commute is 1.5 hours, and somehow your house and bills are STILL 2-3x more than anywhere else in the country.
5. Tell everyone how great it is to live here while wiping the sweat off your forehead from another 105 degree day.
 
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The California trap:
1. Visit prime California and think “it’s so perfect, we’re moving here!”
2. Start looking at houses and realize you can’t afford the house/lifestyle you want in the prime area.
3. Convince yourself you’ll just move a “bit” further out and it’ll still be great.
4. Congrats, you now live in the literal desert, your commute is 1.5 hours, and somehow your house and bills are STILL 2-3x more than anywhere else in the country.
5. Tell everyone how great it is to live here while wiping the sweat off your forehead from another 105 degree day.

facts
 
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The California trap:
1. Visit prime California and think “it’s so perfect, we’re moving here!”
2. Start looking at houses and realize you can’t afford the house/lifestyle you want in the prime area.
3. Convince yourself you’ll just move a “bit” further out and it’ll still be great.
4. Congrats, you now live in the literal desert, your commute is 1.5 hours, and somehow your house and bills are STILL 2-3x more than anywhere else in the country.
5. Tell everyone how great it is to live here while wiping the sweat off your forehead from another 105 degree day.


Most of the hospitals have a 30min response time. We’re contractually required to live near the hospitals which are coastal with one exception. Nobody lives in the desert.

There are some doctors who live in San Diego and commute to rural desert hospitals in Brawley, El Centro, and even Yuma.
 
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Odd thing is that while a few people actually moved to other VHCOL areas for better pay (Bay area, Seattle, OC), most are switching between similar jobs back and forth and sometimes back again within town. They’re mostly changing jobs without moving. Don’t actually know anyone who has left the West Coast.
Seattle is better pay? I thought that was USAP-run and generally not great.
 
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