Private Practice Groups

[DrRobert]

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Do all anesthesiologists within a private practice group have the same financial package?

In other words:

1. Are all new hires offered the same salary/benefits? Or will the group offer one candidate a better package than another candidate? If so, what determines which package is offered to which candidate?

2. Do all the partners in the group receive the same salary/benefits?

 

[militarymd]

That's what we do right now....everyone is paid the same...has the same benefits.


I'm working on changing that....there needs to be pay for performance incentive.


Everyone getting paid the same is great...as long as everyone is "equal", but that frequently is not the case.

 

[aredoubleyou]

I would expect that if one is truley a partner that they have access to the books and see where the money is coming in and where it is going out.

MilMD- when you say performance, do you mean to say something relative to how much an individual billed, or something similar, - or do you mean to say that someone will be subjectively judging the partners, as a boss judges employees?

 

[stephend7799]

Do all anesthesiologists within a private practice group have the same financial package?

In other words:

1. Are all new hires offered the same salary/benefits? Or will the group offer one candidate a better package than another candidate? If so, what determines which package is offered to which candidate?

2. Do all the partners in the group receive the same salary/benefits?

umm certainly depends on where you are:

If it is a desirable area.. no way.. usually the new guys are giving a significantly lower salary and heavier workload for a period of 3-5 years in which they prove themselves and then they are maybe offered partnership.. Total b u ll s h i t. never accept anything less then what you are worth. (the going average rate for an anesthesiologist in your area) for promise of partnership in the future.. Thats a setup to be used and abused.

2. depends on the partnership.. some partners split everything down the middle.. some partners have a pay per performance

 

[jetproppilot]

Do all anesthesiologists within a private practice group have the same financial package?

In other words:

1. Are all new hires offered the same salary/benefits? Or will the group offer one candidate a better package than another candidate? If so, what determines which package is offered to which candidate?

2. Do all the partners in the group receive the same salary/benefits?

Depends on what youre referring to, Robert.

If Group A is hiring 3 anesthesiologists, it will nearly always offer the same package...i.e. X dollars for the first 1-2 years, then 1-2 years to partner.

But starting salary/benefits for you will depend on where you want to live. There may be a 100-200K difference based on location.

If you'd like you can search my posts with key word partnerships or group practice or something like that. I've posted lengthy posts on group practice, compensation, etc. Very important stuff that noone will tell you about that used to be (before this forum) learned by individual trial and error.

I humbly disagree with Mil...I believe in the equal compensation among partners philosophy. But like he said, everyone needs to be doing equal work.

Instead of altering your practice setup, Mil, I'd get rid of the slackers and bring in some UT/Noyac prototypes.

In my previous (fee for service) gig we all got the same $, vacation, etc except for the "senior of equals" dude who started the group..he handled 90% of the administrative stuff (billing issues, hiring, firing, meetings, etc) so he got an extra cuppla K a month and 2 extra weeks of vacation...we were all cool with that since he put up with extra headaches we didnt have to.

There are still groups out there that are unfair...i.e. long partnership track, may or may not make you partner/senior guys who will always make more than you etc so it still pays to do research on the groups history, or better yet, join a group where you have a "mole" who can give you the real scoop. And thats another point..."The Real Scoop" is very important when youre joining a group. They wont tell you any negatives about their group when they take you out to dinner...but its good for you to find out whatever you can. Are they a respected group? Good relationship with the surgeons? How long have they been at Hobokoe Memorial? Have any anesthesiologists left? Why did they leave?

Call the hospital CEO. Ask Mr Suit about the anesthesia group. Hows their relationship with hospital administration? Rocky? Smooth?

Find out 2 or 3 surgeons in the community. Call them. Ask them how they like the anesthesia group.

Call a cuppla CRNAs (if applicable). Ask them stuff to.

Point being, go into a group with your eyes as wide open as possible. It may prevent future disappointment.

 

[cdql]

I'm a bit curious about anesthesia private practice. Do they send you out to hospitals/clinics to perform procedures? Or do you work in your own ambulatory unit?

 

[jetproppilot]

I'm a bit curious about anesthesia private practice. Do they send you out to hospitals/clinics to perform procedures? Or do you work in your own ambulatory unit?

Wherever your group has a contract, you'll go. You may be at only one hospital. Maybe your group covers a hospital and a surgery center.
Just depends.

Again, its VERY variable.

I've got buddies in Las Vegas...kinda weird out there in that anesthesiologists from different groups go to all the hospitals out there...followed a buddy of mine around a few years ago and we went to 3 different hospitals for 3 cases....inefficient IMHO but thats how it is. Reimbursement out there is really good. Alotta private insurance cases.

 

[DrRobert]

Depends on what youre referring to, Robert.

If Group A is hiring 3 anesthesiologists, it will nearly always offer the same package...i.e. X dollars for the first 1-2 years, then 1-2 years to partner.

Thanks. 👍

Say you wanted to hire 2 new anesthesiologists. I was thinking of a scenario where one of the candidates may be highly sought after (trained at MGH, etc) while the other candidate may be less sought after (trained at a DO program, etc). Would you offer them both the same package? Or would the MGH doc get offered a better starting salary?

 

[jetproppilot]

Thanks. 👍

Say you wanted to hire 2 new anesthesiologists. I was thinking of a scenario where one of the candidates may be highly sought after (trained at MGH, etc) while the other candidate may be less sought after (trained at a DO program, etc). Would you offer them both the same package? Or would the MGH doc get offered a better starting salary?

Another good question that I've posted to at-length.

In the private world, with very few exceptions, nobody really cares where you trained...what they care more about is 1)can you do your job with no complaining 2)can you get along with their clients (surgeons) 3)will you be a good fit in the group

So the answer is no...MGH dude wont get a better package.

 

[Zoom-Zoom]

Another good question that I've posted to at-length.

In the private world, with very few exceptions, nobody really cares where you trained...what they care more about is 1)can you do your job with no complaining 2)can you get along with their clients (surgeons) 3)will you be a good fit in the group

So the answer is no...MGH dude wont get a better package.

jetpro, would you say this is true for most specialties, or is it particularly so in gas?

 

[jetproppilot]

jetpro, would you say this is true for most specialties, or is it particularly so in gas?

True for ALL specialties.

 

[jetproppilot]

Thanks. 👍

Say you wanted to hire 2 new anesthesiologists. I was thinking of a scenario where one of the candidates may be highly sought after (trained at MGH, etc) while the other candidate may be less sought after (trained at a DO program, etc). Would you offer them both the same package? Or would the MGH doc get offered a better starting salary?

And further, Dude,

MGH grads are not "highly sought after". Thats a myth propegated in the academia milleau.

All we care about is that you finished an allopathic residency in good standing and that you can get along with peers/clients/OR personel.

 

[militarymd]

I would expect that if one is truley a partner that they have access to the books and see where the money is coming in and where it is going out.

MilMD- when you say performance, do you mean to say something relative to how much an individual billed, or something similar, - or do you mean to say that someone will be subjectively judging the partners, as a boss judges employees?

Everyone gets to look in my group...partner or not.

When I say "performance", I'm talking about things like ....ability to turn a room in a timely manner, time from in the room to patient comfort on L&D, ability to do awake intubations, ability to communicate with patients, etc.

Some subjective...others not. Believe it or not, there are a lot of smucks in priviate practice right now....left over from the 1990's when all you need is a pulse to get into residency.

 

[militarymd]

Depends on what youre referring to, Robert.

If Group A is hiring 3 anesthesiologists, it will nearly always offer the same package...i.e. X dollars for the first 1-2 years, then 1-2 years to partner.

But starting salary/benefits for you will depend on where you want to live. There may be a 100-200K difference based on location.

If you'd like you can search my posts with key word partnerships or group practice or something like that. I've posted lengthy posts on group practice, compensation, etc. Very important stuff that noone will tell you about that used to be (before this forum) learned by individual trial and error.

I humbly disagree with Mil...I believe in the equal compensation among partners philosophy. But like he said, everyone needs to be doing equal work.

Instead of altering your practice setup, Mil, I'd get rid of the slackers and bring in some UT/Noyac prototypes.

In my previous (fee for service) gig we all got the same $, vacation, etc except for the "senior of equals" dude who started the group..he handled 90% of the .................

I''m working on it.....good people are hard to find.

 

[cfdavid]

I''m working on it.....good people are hard to find.

Looks like medicine is truly no different from the business world. I hear that complaint from just about every business owner or hiring manager I've ever spoken to. lol

In a way, that's good. Because it allows those with talent and work ethic to be noticed and well compensated. (albeit frusterating for employers)

 

[DrRobert]

That's what we do right now....everyone is paid the same...has the same benefits.

In these "everyone is equal" groups, how are the big decisions regarding the everyday operations of the group made? For example, if one of the partners is not pulling his/her weight, who makes the decision to fire that person - does everyone in the group get a vote?

 

[jetproppilot]

In these "everyone is equal" groups, how are the big decisions regarding the everyday operations of the group made? For example, if one of the partners is not pulling his/her weight, who makes the decision to fire that person - does everyone in the group get a vote?

Usually every partner has a vote.

 

[stephend7799]

When I say "performance", I'm talking about things like ....ability to turn a room in a timely manner, time from in the room to patient comfort on L&D, ability to do awake intubations, ability to communicate with patients, etc.

.

who looks at those things.. you dont get paid more for getting the patient comfortable 3 minutes before the other guy.. Im not saying its not important because those are fine details that i pride myself on.. but its not reimbursable.....

neither is bedside manner.. (im not saying its not important) but you cant teach someone manners.. thats something that should have been taught in grade school

 

[stephend7799]

I''m working on it.....good people are hard to find.

especially if you are recruiting in alabama..


you do have non boarded people doing crazy stuff.. that does not make sense.. but they get away with it.. because humans tolerate a lot of bad practice.. anesthesia tolerates mediocrity moreso then say surgery or orthopedics... (i know i will be flamed for that one) but its true

 

[militarymd]

In these "everyone is equal" groups, how are the big decisions regarding the everyday operations of the group made? For example, if one of the partners is not pulling his/her weight, who makes the decision to fire that person - does everyone in the group get a vote?

When I say everyone is equal...I'm only referring to compensation. I only have 2 people who are partners.

Only the partners can make big decisions....hiring...firing....OR scheduling ....meeting with hospital administration....hospital committeess...etc.

We have decided from the beginning that we need to make things fair....(compensation wise) ...period....for everyone.....However, only a few people have the right to Hire and fire...so non-partners can be let go very easily.

 

[militarymd]

who looks at those things.. you dont get paid more for getting the patient comfortable 3 minutes before the other guy.. Im not saying its not important because those are fine details that i pride myself on.. but its not reimbursable.....

neither is bedside manner.. (im not saying its not important) but you cant teach someone manners.. thats something that should have been taught in grade school

We are private practice...with a small census for deliveries...so we cannot staff L&D with a full time person....sooooo...the person doing epidurals have other duties in the OR.....SOOO ....if you take a long time doing an epidural....it means that duties in the OR are uncovered.....pre-ops,inductions, nerve blocks, etc.

In a competitive environment...and I'm in a competitive environment....everything counts.

 

[Noyac]

especially if you are recruiting in alabama..


you do have non boarded people doing crazy stuff.. that does not make sense.. but they get away with it.. because humans tolerate a lot of bad practice.. anesthesia tolerates mediocrity moreso then say surgery or orthopedics... (i know i will be flamed for that one) but its true

I really gotta disagree with you on that one. I have seen more mediocrity in surgery of all types in the past few years than I care to remember. I would say mediocrity is in every field. No specialty is immune.
Would you call an orthopod that does a TKA in 5 hours mediocre? I would. I'm also sure that in residency many of you guys deal with mediocrity in the OR everyday. You just may not be aware of it yet. Thats why many of them are in academics.

What do you think JET?

 

[jetproppilot]

I really gotta disagree with you on that one. I have seen more mediocrity in surgery of all types in the past few years than I care to remember. I would say mediocrity is in every field. No specialty is immune.
Would you call an orthopod that does a TKA in 5 hours mediocre? I would. I'm also sure that in residency many of you guys deal with mediocrity in the OR everyday. You just may not be aware of it yet. Thats why many of them are in academics.

What do you think JET?

TOTALLY concur, Noy.

My previous gig was blessed with mostly good surgeons. Good results, and fast to boot.

Unfortunately my current gig has alotta mediocre surgeons. Ninety minute c-sections from a cuppla the OB, some dude that takes 4-5 hours for a basilic vein transfer ( 😱 ), an ortho dude who HAS to have "Gwen" the CST with him on his cases, and if she isnt he takes forever and is indecisive,

etc etc.

We do have our share of quick people too though. Just not as many as at my previous home.

 

[Noyac]

TOTALLY concur, Noy.
We do have our share of quick people too though. Just not as many as at my previous home.

Ditto. BR had some good surgeons as well as anesthesiologists and crna's.

 

[DrRobert]

especially if you are recruiting in alabama.

I wouldn't think this would be the case with UAB being a powerhouse.

 

[jetproppilot]

I wouldn't think this would be the case with UAB being a powerhouse.

sorry, I dont see "recruiting in alabama" as some stumbling block.

Funny how "society" people deem certain geographical locations below them.

Man, how they have missed the boat.

 

[militarymd]

There is a lot of preconception about where new grads want to "live"...especially younger new grads.....Usually the deep south and relatively small towns are out of the question.


Having said that...everyone who are raising small families love the south....at least where I am...

 

[cfdavid]

sorry, I dont see "recruiting in alabama" as some stumbling block.

Funny how "society" people deem certain geographical locations below them.

Man, how they have missed the boat.

Yeah, it seems like it could be self-limiting. Hell, I'd be happy to practice in upper Michigan (note: I didn't say the upper penninsula..lol).

Regardless of where you practice medicine, your colleagues, though perhaps from very different backgrounds, will all be educated people. Usually, that's a good enough common denominator(similar experiences/education) to begin developing a nice personal life etc.

 

[Noyac]

Just as a side note. I have worked with people from all over the country with training from Stanford to Dartmouth back to Seattle. I practiced in the south for 3 yrs and across the board (surgery, cards, ICU, and anesthesia) these were the friendliest and most skilled professionals I have worked with by far. I miss the south for that reason mostly. My lifestyle just mandates me living where I do for now.

 

[militarymd]

Yeah, it seems like it could be self-limiting. Hell, I'd be happy to practice in upper Michigan (note: I didn't say the upper penninsula..lol).

Regardless of where you practice medicine, your colleagues, though perhaps from very different backgrounds, will all be educated people. Usually, that's a good enough common denominator(similar experiences/education) to begin developing a nice personal life etc.

Don't count on that....especially in anesthesia....remember the 90's and what it produced.

 

[bubalus]

There have been a couple things said about pay. It seems like there are several ways pay can be structured:

1. You eat what you kill. You get the startups and time minus the overhead. Can be good or bad depending on what cases you end up with--15 tonsils and tubes, 2 hearts, or the 2 5-hour TKAs.

2. Pure time. You work more, you get paid more. Doesn't matter whether you do hearts, heads, ortho, or whatever.

3. Some sort of mixture--a fraction of pooled startups plus time.

What do you guys think is the best option for new people joining a group?

Thanks.

 

[militarymd]

There have been a couple things said about pay. It seems like there are several ways pay can be structured:

1. You eat what you kill. You get the startups and time minus the overhead. Can be good or bad depending on what cases you end up with--15 tonsils and tubes, 2 hearts, or the 2 5-hour TKAs.

2. Pure time. You work more, you get paid more. Doesn't matter whether you do hearts, heads, ortho, or whatever.

3. Some sort of mixture--a fraction of pooled startups plus time.

What do you guys think is the best option for new people joining a group?

Thanks.

option 2

 

[Disciple]

And further, Dude,

MGH grads are not "highly sought after". Thats a myth propegated in the academia milleau.

All we care about is that you finished an allopathic residency in good standing and that you can get along with peers/clients/OR personel.

When we go through the candidate pool but still need to find more candidates, we start to use our connections with strong programs like Mass General, UCSF, etc. to find people who may be strong candidates but may not have heard of us or our job openings.

That doesn't mean we are only considering people from those programs. It just means we may look there first for candidates because we know it's a lot harder to make it through those programs poorly trained. We aren't going to be dialing up Texas El Paso to see if they have an available graduating resident, fellow, or faculty member.

OK, so who is right?

 

[Ruban]

This has probably been asked before, but I couldn't find it using the search function, so: are MOST anesthesiologists paid by OR time, or by number/type of cases.

For example, let's say its a simple lap chole that should take 1 hr, but then the pt develops massive complications intraoperatively and the case takes 5 hours. Does the anesthesiologist still make the same money as if the case took 1 hour?

I'm confused becaue anesthesiologists complain about surgeons being slow. If the pay is based on time, then does it really matter how slow the surgeon is, since the compensation would be the same...

Thanks!

 

[jetproppilot]

OK, so who is right?

My post came out looking offensive...unintentional...not meant to dis MGH grads (or whatever ivy league school), because I know they turn out alotta good residents. But so do other places.

It is my opinion that everyone in training thinks the ivy leaguers have a distinct advantage when searching for a private practice job.

I believe most groups have "where you did your residency" way down on the priority list.

 

[DrRobert]

This has probably been asked before, but I couldn't find it using the search function, so: are MOST anesthesiologists paid by OR time, or by number/type of cases.

For example, let's say its a simple lap chole that should take 1 hr, but then the pt develops massive complications intraoperatively and the case takes 5 hours. Does the anesthesiologist still make the same money as if the case took 1 hour?

I'm confused becaue anesthesiologists complain about surgeons being slow. If the pay is based on time, then does it really matter how slow the surgeon is, since the compensation would be the same...

Thanks!

I believe most regions of the country still bill by units. An anesthesia unit is determined by a formula that includes OR time, health of the patient, and the type of surgery.

Maybe some private practice docs could comment more on the anesthesia unit and how it might vary from region to region, case to case.

 

[CanGas]

Where I work a procedure has a certain number of units up front then so many units per 15 min. Those units per 15 min generally increase after certain time periods, say 2hr, 6hr, ect.

So if you do 6 lap chole's in 4hrs or you do 2 lap chole's in 4hrs you would make the same number of "time units" for the 4 hrs of work but would make more with the "startup units" if you did 6 cases vs 2 cases.

Besides, who wants to sit around on a 3hr appy?

 

[GasEmDee]

I don't think the two perspectives conflict with one another at all.

In some ways, this issue is a lot like name-brand clothing, in that there is a selection and cultural bias invovled: People who feel that brand name is important are more likely to go to brand-name places. The importance of brand name is reinforced while they are there, and then after graduation they are more likely to prefer colleagues from brand-name places. People who did not go to brand-name institutions are (overall) less likely to care about it, because of the same self-selection bias.

That being said, training at a rigorous, top-tier instituation says a lot. Like UT said, its a lot harder to get through these places with poor skills. People who go to places like that tend to be quite motivated, and are likelier to have had a track record of excellence throughout their lives.

All things being equal, I think that the brand-name trained person has a perceivable edge. However, things are rarely equal; technical and people skills easily trump brand-name credentials. So the applicant from the 3rd-tier institution who has reputation for good people and technical skills would more likely be selected than the person from the 1st-tier institution who has a reptuation for ruffling feathers at work. This is how I would reconcile Jet and UT's posts.

My post came out looking offensive...unintentional...not meant to dis MGH grads (or whatever ivy league school), because I know they turn out alotta good residents. But so do other places.

It is my opinion that everyone in training thinks the ivy leaguers have a distinct advantage when searching for a private practice job.

I believe most groups have "where you did your residency" way down on the priority list.

 

[bubalus]

Anesthesia bills like taxi drivers--you pay a bigger chunk for the flag drop and a per mile charge. With anesthesia you get startup points and time. In general, the more complex, difficult cases get more points. You get 30 for a liver transplant, 5 for a lap chole, 5 for labor epidural. There are also additional things that increase the amount startup points: A-line, CVP, Swan, ASA physical status, emergency case, placing TEE probe(this is just placing the probe, not doing the exam).

For example, the 2 hour academic lap chole: 5 startup units plus 2 hours time. Now 2 one hour lap choles (which would be long in private practice if you've got a decent surgeon): 10 startup units plus 2 hours.

So the money seems to be either doing a bunch of quick cases (T&A, ear tubes) or big cases with lots of additional things (the emergent CABG in a sick person that gets an A-line and Swan). The most I've done is 14 ENT cases (T&A, tubes, etc) in a day. If I remember correctly, they're 4 or 5 startup points plus time. That's somewhere between 56 - 70 startup points plus time. 2 CABGs with A-lines, Swans, and TEE puts you in the same general area. Beats the hell out of doing 3 TKAs in a day.

As I was getting at with my earlier post, this is how we bill, but not necessarily how a group pays its members. You may get what you bill minus overhead, an hourly wage (better for the poor guy stuck in the slow ortho room), or some magic formula.

If you're really interested in this, find a copy of the ASA relative value guide and you can see what procedures are worth.