Private practice pay structure

[yungspleen]

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I am not a big fan of physician employment (it's more about cronyism than capitalism), but I don't see any major difference between this offer and any usual employee-type relationship. This is EXACTLY what I would expect. One gets a salary, some benefits, end of story. One is a (no)body, a cog in the machine.

This is the future of anesthesiology and a lot of medicine in general. This is why we always tell students to forget anesthesiology and go into a specialty where they could always start their own business. The kind of post that usually generates insults about doom and gloom etc.

Now the chickens have come home to roost.

I wonder how many prospective students you've turned off over the years. As a med student considering the field and reading SDN threads, your posts come in 1 of 2 flavors: Either about how the field of anesthesia is dying or about how much you hate your life and how much you love critical care medicine (not really sure why you harp on that subspecialty so much?). But regardless, those comments are in every thread dating back for years and yet residents I've talked to are still getting great job offers in the year 2020. I'm inclined to trust the job offers I hear about and assume you're just pessimistic and would be equally down on any specialty you had decided to do.

 

[deleted697127]

I wonder how many prospective students you've turned off over the years. As a med student considering the field and reading SDN threads, your posts come in 1 of 2 flavors: Either about how the field of anesthesia is dying or about how much you hate your life and how much you love critical care medicine (not really sure why you harp on that subspecialty so much?). But regardless, those comments are in every thread dating back for years and yet residents I've talked to are still getting great job offers in the year 2020. I'm inclined to trust the job offers I hear about and assume you're just pessimistic and would be equally down on any specialty you had decided to do.

Are you trying to tell me you don’t know anyone in real life that feels the same way he does. Why is it such a bad thing to hear different perspectives? Med students should be allowed to hear negativity.

 

[deleted1061998]

I wonder how many prospective students you've turned off over the years. As a med student considering the field and reading SDN threads, your posts come in 1 of 2 flavors: Either about how the field of anesthesia is dying or about how much you hate your life and how much you love critical care medicine (not really sure why you harp on that subspecialty so much?). But regardless, those comments are in every thread dating back for years and yet residents I've talked to are still getting great job offers in the year 2020. I'm inclined to trust the job offers I hear about and assume you're just pessimistic and would be equally down on any specialty you had decided to do.

100% agreed. every single anesthesiologist I did a rotation with was very happy with their lives and encouraged me to pursue the field. However, on sdn you have a very concentrated amount of pathologically delusional and cynical old docs who have nothing better to do then constantly complain. They will tell you to do ANYTHING but their specialty for every single specialty on here. "you could have made 10 times more if you went into business" 😆 . statements like these truly showcase how delusional they are and that they dont know $hit about any other career path.

 

[sethco]

100% agreed. every single anesthesiologist I did a rotation with was very happy with their lives and encouraged me to pursue the field. However, on sdn you have a very concentrated amount of pathologically delusional and cynical old docs who have nothing better to do then constantly complain. They will tell you to do ANYTHING but their specialty for every single specialty on here. "you could have made 10 times more if you went into business" 😆 . statements like these truly showcase how delusional they are and that they dont know $hit about any other career path.

Not saying I disagree with you, but where are you in the training process? Med stud, resident/fellow, recent BC/BE grad?

 

[IMGASMD]

Not saying I disagree with you, but where are you in the training process? Med stud, resident/fellow, recent BC/BE grad?

Looks like med student. M2/M3 is my best guess.

 

[deleted1061998]

Not saying I disagree with you, but where are you in the training process? Med stud, resident/fellow, recent BC/BE grad?

why does it matter where i am in the training process? I understand the field definitely has its problems but just encouraging others to not have such a myopic view thinking its sunshine and rainbows in other specialties as well as other careers. at the end of the day statistically speaking medicine has the highest pay ON AVERAGE of any other job and it offers the best job security.

 

[deleted1061998]

Looks like med student. M2/M3 is my best guess.

lmao look at you making assumptions. cant wait for the "im an attending so I know more than you" speech

 

[IMGASMD]

lmao look at you making assumptions. cant wait for the "im an attending so I know more than you" speech

You forgot to mention “while beating on my chest.....”

FTFY.

“im an attending so I know much more than you” while beating on my chest.

 

[deleted1061998]

You forgot to mention “while beating on my chest.....”

FTFY.

“im an attending so I know much more than you” while beating on my chest.

😆 that real cute my son. tell me how hard it is to be an anesthesiologist...as if i care about some random dude's advice on sdn

 

[aneftp]

True private practice is feast or famine. Administration tried to get more and more coverage. Sitting around in the hospital with no cases is time. Time is money.

payor mix is the key to private practice.

a fair practice means u give up 20% first year. 10% second year. Or something like that. Plus billing. That’s is your “buy in”. Some practices use to stretch it out to 5 year buy in. Aka 1-1.5 million buy in.

But most new grads looking for the quick pay day. 400-450k sounds good enough. With 8 weeks off.

true private practice used to pay as little as 180-280k 1st year. And up. New grads will balk at that. But there are very few true private practice places outside of MD only practice.s.

would u be willing to work 55 plus hours for 270k your first year? Than 330k 2nd year? Partners make production base. Meaning. The hardest guy working 70 hours a week plus 2 weekends a month pulls 700k plus the average. The average partner makes 500k. Assuming 7-8 weeks off. (Top 5 population area in north east)

So new grads see that pay structure. And see the amc 400-450k pay and take the amc rate. Cause they are giving up too much money the first two years.

 

[deleted1061998]

True private practice is feast or famine. Administration tried to get more and more coverage. Sitting around in the hospital with no cases is time. Time is money.

payor mix is the key to private practice.

a fair practice means u give up 20% first year. 10% second year. Or something like that. Plus billing. That’s is your “buy in”. Some practices use to stretch it out to 5 year buy in. Aka 1-1.5 million buy in.

But most new grads looking for the quick pay day. 400-450k sounds good enough. With 8 weeks off.

true private practice used to pay as little as 180-280k 1st year. And up. New grads will balk at that. But there are very few true private practice places outside of MD only practice.s.

would u be willing to work 55 plus hours for 270k your first year? Than 330k 2nd year? Partners make production base. Meaning. The hardest guy working 70 hours a week plus 2 weekends a month pulls 700k plus the average. The average partner makes 500k. Assuming 7-8 weeks off. (Top 5 population area in north east)

So new grads see that pay structure. And see the amc 400-450k pay and take the amc rate. Cause they are giving up too much money the first two years.

this is some really good insight. geniunely curious as to why and how anesthesiologists managed to let AMCs take over and this current situation came about. The argument I often hear is that AMCs can bargain better rates for insurance but its not like that is translating to more pay for the physician. What is hindering anesthesiologists from bypassing AMCs grouping together and not let anyone take advantage of them? Out of all the specialities you would think that this one has the lowest overhead.

 

[sevo00]

this is some really good insight. geniunely curious as to why and how anesthesiologists managed to let AMCs take over and this current situation came about. The argument I often hear is that AMCs can bargain better rates for insurance but its not like that is translating to more pay for the physician. What is hindering anesthesiologists from bypassing AMCs grouping together and not let anyone take advantage of them? Out of all the specialities you would think that this one has the lowest overhead.

the old partners nearing retirement wanted a big pay day. That's why so many groups sold to AMC. Younger guys like us left as being employees forever

 

[Splenda88]

Don't come back later and say we did not warn you...

 

[BLADEMDA]

this is some really good insight. geniunely curious as to why and how anesthesiologists managed to let AMCs take over and this current situation came about. The argument I often hear is that AMCs can bargain better rates for insurance but its not like that is translating to more pay for the physician. What is hindering anesthesiologists from bypassing AMCs grouping together and not let anyone take advantage of them? Out of all the specialities you would think that this one has the lowest overhead.

I recommend Medicine (M.D.) as a career. I still think it is a great job and worth the effort for most people. But, the negatives do need to be discussed. Realistic understanding of the field and the expected reimbursement are vital to anyone choosing a specialty.

Life is more than just earning a paycheck. But, a career as a physician in any specialty will consume most of your time.

Anesthesiology does have issues. I think some of them are big ones and a student needs to see all the issues prior to entering the field. For every FFP on SDN there is a Salty or Mman who are doing fantastic. That said, I’d say Southpaw and Dannyboy May reflect the norm better.

 

[deleted1061998]

I recommend Medicine (M.D.) as a career. I still think it is a great job and worth the effort for most people. But, the negatives do need to be discussed. Realistic understanding of the field and the expected reimbursement are vital to anyone choosing a specialty.

Life is more than just earning a paycheck. But, a career as a physician in any specialty will consume most of your time.

Anesthesiology does have issues. I think some of them are big ones and a student needs to see all the issues prior to entering the field. For every FFP on SDN there is a Salty or Mman who are doing fantastic. That said, I’d say Southpaw and Dannyboy May reflect the norm better.

I understand it does have issues but for the student with average board scores that doesnt like clinic it seems like a good option. Last time I checked the 2019 mgma, anesthesia still among the highest paying of anyfield. People always love to criticize without providing alternatives and it is hard to deny a concentrated amount of cynicism on sdn in general. For all those criticizing i would respect them much more if they provide alternatives and even if the alternative is more enticing (eg - psychiatry) you actually have to like the WORK involved with it no matter how good it looks on paper. Lastly, if one is to complain about the buisness aspects which are very real in anesthesia, they can choose to do a pain fellowship.

 

[BLADEMDA]

I understand it does have issues but for the student with average board scores that doesnt like clinic it seems like a good option. Last time I checked the 2019 mgma, anesthesia still among the highest paying of anyfield. People always love to criticize without providing alternatives and it is hard to deny a concentrated amount of cynicism on sdn in general. For all those criticizing i would respect them much more if they provide alternatives and even if the alternative is more enticing (eg - psychiatry) you actually have to like the WORK involved with it no matter how good it looks on paper. Lastly, if one is to complain about the buisness aspects which are very real in anesthesia, they can choose to do a pain fellowship.

Feel free to ask Southpaw or Dannyboy. I wouldn’t pick Anesthesiology just for the pay. I think per hour of work there are many specialties which pay as well. Anesthesiology involves a lot of weekends and nights most of the time. When you take that into account it really adds perspective to the field/specialty.

Rather than having tunnel vision try to get a view of the whole situation. That means seeing the bad as well as the good because once you are matched it can be very difficult to change specialties.

 

[circleK]

I love being an anesthesiologist and always encourage others to enter the field when asked. The colleagues who are the happiest seem to be the ones who truly enjoy the actual day to day work of anesthesia. And there is still a lot of variation out there as far as type of job and compensation structure unless you are locked into one region that is completely dominated by a particular AMC. As an example our PP group uses a completely even pay structure across the board. Eliminates any backstabbing/fighting for cases. Works cause we’re a tight knit group. The key is to do your research thoroughly before signing that contract. And keep reading this board, the employment discussions especially are one of the few great resources for keeping up with the different anesthesia landscapes across the country from people who are actually working in the field.

 

[deleted1061998]

Feel free to ask Southpaw or Dannyboy. I wouldn’t pick Anesthesiology just for the pay. I think per hour of work there are many specialties which pay as well. Anesthesiology involves a lot of weekends and nights most of the time. When you take that into account it really adds perspective to the field/specialty.

Rather than having tunnel vision try to get a view of the whole situation. That means seeing the bad as well as the good because once you are matched it can be very difficult to change specialties.

I agree that anesthesia is very time intensive hour wise (avg 60hrs a week) and you are correct that many specialities pay as much if not more per hour but i honestly just enjoyed it more than anything else I rotated in...I dont see myself rotting away in clinic for the rest of my life.

 

[deleted162650]

i honestly just enjoyed it more than anything else I rotated in...I dont see myself rotting away in clinic for the rest of my life.

Then this is a good fit for you. The negative Nancy’s are talking more to those that just think we’re a lifestyle specialty.

Just be aware that the number of really good jobs out there are shrinking. To land one you are gonna need to go to a reputable well-networked residency program, bust your butt to be a rockstar, and be geographically flexible.

 

[deleted1061998]

Then this is a good fit for you. The negative Nancy’s are talking more to those that just think we’re a lifestyle specialty.

Just be aware that the number of really good jobs out there are shrinking. To land one you are gonna need to go to a reputable well-networked residency program, bust your butt to be a rockstar, and be geographically flexible.

appreciate the honest perspective. My attendings always had me come in for call to get the full picture and I was easily there 60-65 hours a week. I think by lifestyle some mean that once you're off you are really off. Other specialities may be deceptive in this aspect in that they still have 2-3 hours of charting to deal with that you are not compensated for. not to mention dealing with people constantly complaining wore me down more than the intense atmosphere of anesthesia.

 

[Southpaw]

appreciate the honest perspective. My attendings always had me come in for call to get the full picture and I was easily there 60-65 hours a week. I think by lifestyle some mean that once you're off you are really off. Other specialities may be deceptive in this aspect in that they still have 2-3 hours of charting to deal with that you are not compensated for. not to mention dealing with people constantly complaining wore me down more than the intense atmosphere of anesthesia.

there is no perfect specialty. But some are certainly better than others. You mentioned Psych. Outpatient hours. No nights. No weekends. Cash paying patients. One slight problem - you have to sit in a chair, all day every day, and listen to people talk about their issues.

Derm. Outpatient hours. No nights. No weekends. One slight problem - you spend all day every day dealing with skin.

I need to work with my hands, think on my feet, and deal with sick people and/or practice acute medicine. I think I’d be a solid surgeon. But I chose anesthesia. I honestly don’t regret it most days - this is a great job with great pay and allows me what I need for fulfillment out of medicine.

But there are issues with anesthesia. Real ones that don’t seem to be going anywhere. Great jobs aren’t multiplying. Management companies aren’t going anywhere. Wall Street wants a piece of us. Hospital administrators increasingly want a stake in how we do our work day in/day out. We will always have to deal with hospitals and the suits. CRNAs but in my opinion management companies and hospital administrators more negatively affect our jobs than CRNAs.

Anesthesia may always be a great job. Maybe. It’s a good job for now. If you know and understand what anesthesia is and what it isn’t before committing, then go for it. But what isn’t fair is 3rd years deciding on anesthesia because they had a fun rotation, people were nice, and they’ve looked at income data.

 

[Status Sciaticus]

there is no perfect specialty. But some are certainly better than others. You mentioned Psych. Outpatient hours. No nights. No weekends. Cash paying patients. One slight problem - you have to sit in a chair, all day every day, and listen to people talk about their issues.

Derm. Outpatient hours. No nights. No weekends. One slight problem - you spend all day every day dealing with skin.

I need to work with my hands, think on my feet, and deal with sick people and/or practice acute medicine. I think I’d be a solid surgeon. But I chose anesthesia. I honestly don’t regret it most days - this is a great job with great pay and allows me what I need for fulfillment out of medicine.

But there are issues with anesthesia. Real ones that don’t seem to be going anywhere. Great jobs aren’t multiplying. Management companies aren’t going anywhere. Wall Street wants a piece of us. Hospital administrators increasingly want a stake in how we do our work day in/day out. We will always have to deal with hospitals and the suits. CRNAs but in my opinion management companies and hospital administrators more negatively affect our jobs than CRNAs.

Anesthesia may always be a great job. Maybe. It’s a good job for now. If you know and understand what anesthesia is and what it isn’t before committing, then go for it. But what isn’t fair is 3rd years deciding on anesthesia because they had a fun rotation, people were nice, and they’ve looked at income data.

to be fair, and maybe the devil's advocate, isnt this how most people end up deciding their career choice - 3rd and 4th year rotations?

 

[Southpaw]

to be fair, and maybe the devil's advocate, isnt this how most people end up deciding their career choice - 3rd and 4th year rotations?

students approach those rotations with varying ability to judge the field for what it is. I tried to convey that message. In my opinion its tough to really see anesthesia for what it is as a medical student. But perhaps that was just me. Examples - do medical students understand CRNAs? Supervision vs MD only? Call on nights and weekends for anesthesia? AMGs? Do they interact with administrators or even understand we do and what that entails? And on and on about the intricacies of our field....

 

[deleted1061998]

students approach those rotations with varying ability to judge the field for what it is. I tried to convey that message. In my opinion its tough to really see anesthesia for what it is as a medical student. But perhaps that was just me. Examples - do medical students understand CRNAs? Supervision vs MD only? Call on nights and weekends for anesthesia? AMGs? Do they interact with administrators or even understand we do and what that entails? And on and on about the intricacies of our field....

No but there really isnt a way to understand that as a med student. the vast majority of students are obligated to do decide the rest of their careers based on one month worth of experience. Also since you were arguing that we pick a speciality based on income... I mean this is nothing new. I am willing to bet that was part of your decision too. All it takes is one glance at the average salaries and the average mean step scores to tell that both are directly correlated with actual "interest" meaning nothing. Nothing is amazingly interesting about skin and bones but they offer the lifestlyle/salary/prestige which give med students a hard on. Laslty at the end of the day every single job becomes repetitive.

 

[IMGASMD]

to be fair, and maybe the devil's advocate, isnt this how most people end up deciding their career choice - 3rd and 4th year rotations?

Yes. Then doesn’t that mean we need some people to point out the negative aspects of the speciality? Because it was so “fun” while we were students. So the starry-eyed medical students (m2/m3/m4) come along, at least they have “some” ideas what challenges our speciality is facing?

We are, whether we like it or not, treated as service industry. We serve the patient, surgeon and hospital. We are easier to replace than most other specialities.

It is fun, until it is not. When I am 60, I may not want to take calls q5. What I want now is different 20 years from now. I may no longer want to do my own cases.

These things should be thought about but often not. How many of your attendings had time to go in depths with you? How many of us really understood any of challenges when we were m2/m3/m4, other than it’s a fun rotation and all my attendings have great lives.......

 

[Southpaw]

No but there really isnt a way to understand that as a med student. the vast majority of students are obligated to do decide the rest of their careers based on one month worth of experience. Also since you were arguing that we pick a speciality based on income... I mean this is nothing new. I am willing to bet that was part of your decision too. All it takes is one glance at the average salaries and the average mean step scores to tell that both are directly correlated with actual "interest" meaning nothing. Nothing is amazingly interesting about skin and bones but they offer the lifestlyle/salary/prestige which give med students a hard on. Laslty at the end of the day every single job becomes repetitive.

I am encouraging students to find their passion and follow it. It's much easier to spend a 30 year career in medicine, and be pleased with the income that comes with it, if you actually find the work pleasing. There's a massive salary difference between family medicine and spine surgery. Does that mean medical students shouldn't be family doctors? Of course not. Simply because one has the scores for a field doesn't mean they should do that field. That's all I'm saying.

Anesthesia is a unique field. And most 3rd year rotations through it are so barely scratching the surface of what we do it's almost laughable. And yet you're forced to consider entering it based on that. I'm only encouraging students who entertain the idea of anesthesia to ask the tough questions and be honest with themselves.

And to be quite honest, I really do hope there is something amazingly interesting about skin and bones for the people who are in those fields.

 

[deleted1061998]

Yes. Then doesn’t that mean we need some people to point out the negative aspects of the speciality? Because it was so “fun” while we were students. So the starry-eyed medical students (m2/m3/m4) come along, at least they have “some” ideas what challenges our speciality is facing?

We are, whether we like it or not, treated as service industry. We serve the patient, surgeon and hospital. We are easier to replace than most other specialities.

It is fun, until it is not. When I am 60, I may not want to take calls q5. What I want now is different 20 years from now. I may no longer want to do my own cases.

These things should be thought about but often not. How many of your attendings had time to go in depths with you? How many of us really understood any of challenges when we were m2/m3/m4, other than it’s a fun rotation and all my attendings have great lives.......

this entire sub revolves around the negatives of the speciality....we get it. that $hit has become a broken record. there are threads on here from 06-07 saying in 10 years time anesthesia will only be run by CRNAs and anesthesiologists will be making minimum wage and I am yet to see either happen. Good to hear the positives every once in a while.

 

[dannyboy1]

It is fun, until it is not. When I am 60, I may not want to take calls q5. What I want now is different 20 years from now. I may no longer want to do my own cases.

So don’t take q5 call. It’s not as if that is the definition of anesthesia. Plenty of positions that offer work/life balance, of course the trade off is that you make less $$, but you have to decide what you value more. Cash or free time. It’s not the specialty’s fault if you want to have your cake and eat it too....

 

[dannyboy1]

I am encouraging students to find their passion and follow it. It's much easier to spend a 30 year career in medicine, and be pleased with the income that comes with it, if you actually find the work pleasing.

Is anyone really passionate about their work after a few years in? For me anesthesia is a relatively easy job with a steady paycheck. So long as you maintain a work/life balance you should be able to do this job for a long time...

 

[IMGASMD]

So don’t take q5 call. It’s not as if that is the definition of anesthesia. Plenty of positions that offer work/life balance, of course the trade off is that you make less $$, but you have to decide what you value more. Cash or free time. It’s not the specialty’s fault if you want to have your cake and eat it too....

priorities change. People change. And all of that should be a conversation and consideration. There are senior partners, not only have the cake, ate it and still try to get a refund on it.

isn’t it location, money lifestyle pick two?

 

[deleted1061998]

Is anyone really passionate about their work after a few years in? For me anesthesia is a relatively easy job with a steady paycheck. So long as you maintain a work/life balance you should be able to do this job for a long time...

agreed. passion is cute when youre still in elementary school, but at this point in life its more like doing what you least hate.

 

[UnoMas]

Is anyone really passionate about their work after a few years in? For me anesthesia is a relatively easy job with a steady paycheck. So long as you maintain a work/life balance you should be able to do this job for a long time...

I don't have anything to add to the conversation but I am glad it will eventually become 'relatively easy' as I am in the 3rd week of CA1 and it's hard as ****, possibly the hardest thing I have ever done in my life. I don't think any other specialty has this steep of a learning curve. Even the surgical residents are always babysat by their attending

 

[dannyboy1]

I don't have anything to add to the conversation but I am glad it will eventually become 'relatively easy' as I am in the 3rd week of CA1 and it's hard as ****, possibly the hardest thing I have ever done in my life. I don't think any other specialty has this steep of a learning curve. Even the surgical residents are always babysat by their attending

Yeah, it’s got a steep learning curve. But once you get the the plateau it’s fairly simple.

 

[Status Sciaticus]

So don’t take q5 call. It’s not as if that is the definition of anesthesia. Plenty of positions that offer work/life balance, of course the trade off is that you make less $$, but you have to decide what you value more. Cash or free time. It’s not the specialty’s fault if you want to have your cake and eat it too....

why not both? Pain?