BLADEMDA

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Okay,

So which of the Anesthesia management companies offers the best retirement plan? Anyone know the numbers for the following:

1. Mednax/American Anesthesiology
2. Team Health
3. Northstar
4. Sheridan/Amsurg

I think Sheridan offers $5,000 per year to its Physician employees; the rest comes out of the salary.
The problem with these poor plans are they do not allow you to MAX out your yearly contributions because the company's contributions are so low.
 

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Okay,

I think Sheridan offers $5,000 per year to its Physician employees; the rest comes out of the salary.
Curious what you mean by 5k per year contribution to your reirement plan? You mean % match, flat 5k... I am assuming this is in addtition to pretax salary contributions distributed from earnings.

What is your maximal contribution in regards to your situation or any others you know of? Typically, with the amc's you can't max out your retirement accounts as easily.

This is a big reason AMC mergers drag on the group.
 
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Curious what you mean by 5k per year contribution to your reirement plan? You mean % match, flat 5k... I am assuming this is in addtition to pretax salary contributions distributed from earnings.

What is your maximal contribution in regards to your situation or any others you know of? Typically, with the amc's you can't max out your retirement accounts as easily.

This is a big reason AMC mergers drag on the group.
Flat $5K per year from Sheridan I believe provided you are full-time. I assume the other AMCs also have lousy retirement plans?
 

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Of all the big players, USAP comes out ahead in regards to retirement contribution and maintenance % of salary. The others usually bring you large buyouts with the least % forward salary and retirement contribution.

I think retirement is somewhat negotiable depending on the deal being made/ebitda and the merger entity.

I would bet that differences exists even within a particular AMCs- the better groups getting a better retirement deal. IDK.
 

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Of all the big players, USAP comes out ahead in regards to retirement contribution and maintenance % of salary. The others usually bring you large buyouts with the least % forward salary and retirement contribution.

I think retirement is somewhat negotiable depending on the deal being made/ebitda and the merger entity.

I would bet that differences exists even within a particular AMCs- the better groups getting a better retirement deal. IDK.
I think usap has a vesting period. I need to check my friends Dallas area contract. Maybe 5 years full vested? I know crnas have a vesting period.

Team health doesn't have a match. So it's strictly $18k if under age 50 pretax employee. They do have some executive pretax plan. But if team health goes under u may be F'd cause it's part of team health.

I will wait for for my friend Mednax retirement. I don't think it's that great either.

But I usually don't put a lot of weight into retirement plans per se. I look at total compensation. So we may save 35-39% "pretax". But eventually we gonna to be paying whatever the future rate is (let's assume 25% in retirement). So it's really only a 10% "tax savings". We can get tricky and say there are no taxes on dividends and distributions while in tax deferred accounts. Those calculations can get complicated
 
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I agree about "total compensation" package being the thing to look at. So, it also makes sense USAP would have the best retirement plan among the major players due to the fact it was founded by merging large private groups together.
 

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I agree about "total compensation" package being the thing to look at. So, it also makes sense USAP would have the best retirement plan among the major players due to the fact it was founded by merging large private groups together.
Just texted my good friend up north (original big group that sold out to medax long ago). It's 4% match (immediate vesting) as long as you are putting the same or more money away (up to 18K IRS limit for those under age 50 this year).

So if Mednax pays you say 350K. 4% of 350K is 14K mednax will give you. (assuming you contribute 14K or more).

"They match 4% every year. But they vote every year in January on that percentage"
 

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Just texted my good friend up north (original big group that sold out to medax long ago). It's 4% match (immediate vesting) as long as you are putting the same or more money away (up to 18K IRS limit for those under age 50 this year).

So if Mednax pays you say 350K. 4% of 350K is 14K mednax will give you. (assuming you contribute 14K or more).

"They match 4% every year. But they vote every year in January on that percentage"
Are you sure about that?
 

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Just texted my good friend up north (original big group that sold out to medax long ago). It's 4% match (immediate vesting) as long as you are putting the same or more money away (up to 18K IRS limit for those under age 50 this year).

So if Mednax pays you say 350K. 4% of 350K is 14K mednax will give you. (assuming you contribute 14K or more).

"They match 4% every year. But they vote every year in January on that percentage"
my buddy that works for them said they match, but only up to 10K per year. I have no way of independently verifying that.

I suspect with most (all?) AMCs you can find a job with a reasonable paycheck but the retirement benefits will be substandard overall. Total comp is obviously what counts, but for most job seekers they will prefer a higher paycheck number over a higher retirement number. I'm not saying that's right, but amongst the people looking for jobs the $$$ on the paycheck tend to be the primary concern.
 
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Just texted my good friend up north (original big group that sold out to medax long ago). It's 4% match (immediate vesting) as long as you are putting the same or more money away (up to 18K IRS limit for those under age 50 this year).

So if Mednax pays you say 350K. 4% of 350K is 14K mednax will give you. (assuming you contribute 14K or more).

"They match 4% every year. But they vote every year in January on that percentage"
The maximum allowed by law is limited to 265,000 of earned income. So, at 4% Mednax is MATCHING $10,600 per year.
 
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These retirement packages are pale shadows of what private groups could put away in self directed accounts as opposed to limited contributions in accounts with limited expensive choices


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I beg to differ. Can you cite a source for your assertion? I think it is determined by your plan, rather than the "law".
Sorry, you are correct. The % match is determined by the company's plan and not the IRS. But, I do believe the % match is limited to the $265,000 cap as set by the IRS.


Employer matching contributions
If your plan provides for matching contributions, you must follow the plan’s match formula.

Example: Your plan requires a match of 50% on salary deferrals that do not exceed 5% of compensation. Although Mary earned $360,000, your plan can only use up to $265,000 of her compensation when applying the matching formula for 2015. Mary’s matching contribution would be $6,625 (50% x (5% x $265,000)). Although Mary makes salary deferrals of $18,000, only $13,250 (5% of $265,000) will be matched. She must receive a matching contribution of $6,625 (50% x $13,250) under the terms of the plan.
 
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In many private practice groups the company "match" is 10-15% of the salary for the employee. This allows the partners to MAX out their retirement savings at the IRS limit for the year.

Let's take Alan (age 39) the Anesthesiologist as an example:

Alan earns a base salary of $300K. Alan's company, Private Gas Unlimited, has a 14% match based on his salary.

Per IRS rules Alan gets the following: .14 x 265,000= $37,100

Alan also contribute another $18,000 to his retirement each year from his own salary.

IRS limit for Alan is set at $53,000 total per year (both sources).

Alan's contribution: $18,000
Company's contribution (limited based on IRS law): $35,000

Total retirement for the year: $53,000
 
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These retirement packages are pale shadows of what private groups could put away in self directed accounts as opposed to limited contributions in accounts with limited expensive choices


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We agree here. I would argue that young attendings fail to grasp the importance of maximizing pre-tax retirement plans. An MD is better off with less compensation if that money could be put away in a deferred compensation plan. AMCs prey on this ignorance which is how they get away with a paltry 4% match rate.
 
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Anyone want to comment on USAP's salary match for retirement? Team Health? Northstar?
 

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I think usap has a vesting period. I need to check my friends Dallas area contract. Maybe 5 years full vested? I know crnas have a vesting period.

Team health doesn't have a match. So it's strictly $18k if under age 50 pretax employee. They do have some executive pretax plan. But if team health goes under u may be F'd cause it's part of team health.

I will wait for for my friend Mednax retirement. I don't think it's that great either.

But I usually don't put a lot of weight into retirement plans per se. I look at total compensation. So we may save 35-39% "pretax". But eventually we gonna to be paying whatever the future rate is (let's assume 25% in retirement). So it's really only a 10% "tax savings". We can get tricky and say there are no taxes on dividends and distributions while in tax deferred accounts. Those calculations can get complicated
Yes. This is why USAP has never really looked promising to me.
Part of their deal is that they offer stock (worth who knows how much) as part of the merger + a smallish buyout.
To me that compesnation model is not as attractive. That being said, I bet USAP goes to market in the next couple of years. They do release dividends which has made up some ground for the founding partnerships.
 

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The maximum allowed by law is limited to 265,000 of earned income. So, at 4% Mednax is MATCHING $10,600 per year.
My buddy is original buyout of Mednax circa 2007/2008. It's 4% of salary.
Anyone want to comment on USAP's salary match for retirement? Team Health? Northstar?
I have the team health benefits package I looked at a few months also. and there is no match. I'll pm u their package when I get home.
 
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Let's take a look at why you should MAX out your retirement plan at $53,000.

Alan starts work at an AMC at age 30. The AMC pays him a "1099" wage which allows him to max out his retirement plan. Alan has $10k saved up so far in his 401K. Alan plans on working until age 62. Assuming Alan earns a 4% rate of return on his investment he will have over $3.3 million in his 401K by age 62.

https://www.investor.gov/tools/calculators/compound-interest-calculator

Now, Bob the Anesthesiologist/Surfer/Skier likes to enjoy life and doesn't care as much about his 401K. He too wants to retire at age 62.

Bob works for an AMC which only contributes $10,600 per year. Bob also contributes monthly to his 401K for the maximum allowed by law. Assuming a 4% rate of return Bob will have $1.7 million in his 401K by age 62. (Bob had $1,000 to start with in his 401K/IRA from his residency days).

(NEW GRADUATES should factor 401K plans into any job decision)
 
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Private group I looked at was Automatic max contribution leaving you with 53k (assuming you out in the 18k). They also were offering additional pretax savings investments and giving automatic max to your HSA. Contributions started after year one.

One AMC I looked at gave a percent of your 18k up to max of 8k. They also offer a profit sharing plan which gets you to the 53k savings. 3 year vesting period.
 

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It's tough out there for new grads.

I've been fortunate to put 40-75k pretax almost yearly since I've been out in 2004 (2004 I only worked as attending for 6 months). But I was 1099 most of the time or had access to significant pretax saving back in academics with their 401a (that's 401a) plus 403b and 457b and their match. Even "w2" in private group past couple of years the retirement tax structure allow me to have them "contribute 33-34k and me put in another 17-18k pretax"

I did the weird safe harbor IRA self funded 401k for 5 years also along with a SEP account early on

I can probably cruise to retirement in 20 years (plan on retiring at age 62) by just putting 18k pretax (or equivalent IRS adjusted future amount) now. I front loaded a lot into my retirement.

Just being restricted to 18k pretax starring at age 30-32 for new grads puts them a significant disadvantage vs us older folks. I consider myself mid career at age 42 now.

A lot of money is exposed to taxes as W2 for AMC between 250-350k and up. Look at the marginal tax brackets. It's essentially 5% more marginal tax rate 28-33% jump). Plus don't forget the obamacare Medicare surtax 0.9% $200/250k and up plus the 3.8% surtax on investment. So even if u used the post tax money the AMC gave u to invest. Most of it would be subjected to the 3.8% surtax.

Essentially it's 5% extra income taxes u pay from w2 250-350k. PLUS the 3.8% investment surtax plus the 0.9% Medicare surtax should u try to invest it. In simple terms. That's 9.8% extra you are paying and u better hope that post tax investment is making u money.

As 1099 or even academic MD. I've generally kept my w2 adjust income below 250k after deductions. That's the key.

But it becomes super hard as AMC employee getting essentially 100k more in income exposed to the higher bracket.
 
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One more thing for new grads: Once you hit age 50 the IRS allows you to contribute another $6,000 in addition to the $18K towards your 401K. Thus, you are permitted to put up to $24K in a retirement plan but the maximum allowed after age 50 is $59K per year in total (employee plus employer). So, you go from age 30-49 at $53K per year then it jumps to $59K per year at age 50. If you MAX out the allowable 401K with a match to get to the IRS limit the odds favor you retiring at age 62 with well over $3.4 million just in your retirement plan alone.

Anyone who isn't looking into this savings vehicle is being foolish.
 
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I'm a w-2 academic physician. We have a 403b with $18k annual limit. The university doesn't match, but they flat out contribute 8% of salary (up to $22k) into the account after you complete one year of service. Vests after 3 years total employment.

A 457 is offered, too, but only to those making >$360k in an academic spot. I'm sadly not quite that high and so don't qualify. So to help continue saving, I do a backdoor Roth, max an HSA, and contribute to a regular brokerage account in a tax-efficient manner.

Having access to the 457 would be nice, but sadly it is out of reach.
 
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If the 457 plan is the only one your employer offers, the limits are the same as with a 401(k) - a maximum of $18,000 in 2016 for those under 50 years old, and up to $24,000 for those 50 and over.

But here's the difference: If your employer also offers a 401(k) or 403(b) plan, you can contribute to both the 457 and the other plan. Moreover, you can invest up to the maximum in each account. In 2016, the limits are $18,000 in each type of account, plus catch-up contributions - so you could make a total retirement contribution of as much as $36,000 (or $48,000 if you are 50 or older). Investing the max in both is a terrific option if you're getting started saving a little late, or you just want to maximize the advantages of these plans (tax breaks and matching, if any).

http://money.cnn.com/retirement/guide/401k_457plans.moneymag/index2.htm?iid=EL
 

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If the 457 plan is the only one your employer offers, the limits are the same as with a 401(k) - a maximum of $18,000 in 2016 for those under 50 years old, and up to $24,000 for those 50 and over.

But here's the difference: If your employer also offers a 401(k) or 403(b) plan, you can contribute to both the 457 and the other plan. Moreover, you can invest up to the maximum in each account. In 2016, the limits are $18,000 in each type of account, plus catch-up contributions - so you could make a total retirement contribution of as much as $36,000 (or $48,000 if you are 50 or older). Investing the max in both is a terrific option if you're getting started saving a little late, or you just want to maximize the advantages of these plans (tax breaks and matching, if any).

http://money.cnn.com/retirement/guide/401k_457plans.moneymag/index2.htm?iid=EL
Yup. My state employee w2 academic job one hoped that because a 401a (plus their match) essentially allowed me to get 15k pretax plus their 24k match into the 401a

Than 17-18k pretax 403b plus another 17-18k into the 457b. That's basically 74-75k pretax money.

Of note. Be EXTREMELY CAREFUL of 457b. Look at irs rules. Not all 457b plans are treated the same.

Essentially only state govt and federal govt 457b plans safe for rollover.

If you are offered a 457b at non state or federal government plan. (Certain tax exempt organizations may offer 457b) Watch out. You will have a hard time rolling it over and will be subject to taxes (if under age 59).

https://www.irs.gov/retirement-plans/non-governmental-457b-deferred-compensation-plans
 
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If you are covered by a nongovernmental 457b, you might be able to roll the monies to another 457b if you leave your job for another company that offers a 457b. One other downside of nongovernmental 457bs:


Plan must remain unfunded

Non-governmental 457 plans must remain unfunded. Plan assets are not held in trust for employees, but remain the property of the employer (available to its general creditors in the event of litigation or bankruptcy). Non-governmental 457(b) plans commonly use “rabbi trusts” to hold employee deferrals. The rabbi trust is funded, but the trust assets remain available to creditors. Employees are lower in priority than general creditors in the event of legal claims against the employer."

That means if your employer goes bankrupt the monies put away for you are accessible to your employer's creditors.
 

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If you are covered by a nongovernmental 457b, you might be able to roll the monies to another 457b if you leave your job for another company that offers a 457b. One other downside of nongovernmental 457bs:


Plan must remain unfunded

Non-governmental 457 plans must remain unfunded. Plan assets are not held in trust for employees, but remain the property of the employer (available to its general creditors in the event of litigation or bankruptcy). Non-governmental 457(b) plans commonly use “rabbi trusts” to hold employee deferrals. The rabbi trust is funded, but the trust assets remain available to creditors. Employees are lower in priority than general creditors in the event of legal claims against the employer."

That means if your employer goes bankrupt the monies put away for you are accessible to your employer's creditors.
I believe a lot of university 457s are non-governmental. However, how much of a risk is it that a major private university goes bankrupt, thereby placing your 457 assets at risk? Think major players like Columbia, Emory, USC, etc.


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I was thinking of smaller non profit healthcare systems (not major universities). Think rural hospitals. Or failing poorly insured inner city hospitals l.


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For the other PP who are maxing out out at 53k, are you putting some of this into a Roth account?

(I'm not talking about doing a back door Roth outside of the groups retirement, I'm taking about putting a portion of 401k profit sharing plan into a Roth account, I think the max is about $17k of the $53k total).
 
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I know the topic of the thread had to do with AMCs, though could anyone comment on what they've seen from academics?


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I know the topic of the thread had to do with AMCs, though could anyone comment on what they've seen from academics?


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Now you have your thinking cap on. If you do a fellowship then get a job in academics the total compensation package will likely exceed any AMC after just 5 years. After 10 years it won't even be close and you likely will have moved up the ladder.

These days a good academic job is far better than an AMC IMHO.
 
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Now you have your thinking cap on. If you do a fellowship then get a job in academics the total compensation package will likely exceed any AMC after just 5 years. After 10 years it won't even be close and you likely will have moved up the ladder.

These days a good academic job is far better than an AMC IMHO.
I respectfully disagree. From experience (esp for new grads), usually private practice or even AMC jobs offer considerable more money than academics. At my home institution, academic folks who did really well were there for almost two decades and savvy with politics.
 
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I respectfully disagree. From experience (esp for new grads), usually private practice or even AMC jobs offer considerable more money than academics. At my home institution, academic folks who did really well were there for almost two decades and savvy with politics.
Have you seen a chart with median academic salaries? Do you know what median is for a TEE Certified CT Anesthesiologist? You may be shocked to learn that some academic institutions are paying 10th percentile while others are 75th percentile.

https://www.glassdoor.com/Salary/Cleveland-Clinic-Cardiothoracic-Anesthesiologist-Salaries-E17787_D_KO17,48.htm
 

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For the other PP who are maxing out out at 53k, are you putting some of this into a Roth account.
You're talking about "Roth 401k," as opposed to the "Mega Backdoor Roth IRA" that White Coat Investor describes.

My answer is no. I do all the $$$ as traditional 401k, bc even though my marginal tax bracket will likely be high in retirement, I anticipate that it will be lower than it currently is.
 
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I found this online so you can see that some departments use 25th percentile for base salary:

The academic base (minimum) salary level will be set uniformly by academic rank throughout the clinical Department faculty, and will be adjusted at least every three years based in part on the 3-year average of the 25th Percentile AAMC Faculty Salary Statistics on Medical School Faculty Compensation.
 
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This is 4 years old and the numbers are higher in 2016:

 
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Median Academic Compensation for a fellowship trained Anesthesiologist is likely higher than an AMC when the benefits are included in the total package. This level of median compensation does not occur until 5-7 years post fellowship for the majority of Anesthesiologists. But, Academic salaries have been rising the past few years while the private sector has been falling (AMC or employed positions).

Another reason to do a fellowship is to leave the door open for academics. You may decide that working as the Bi$% for an AMC isn't what you have in mind as a career.
 
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aneftp

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Median Academic Compensation for a fellowship trained Anesthesiologist is likely higher than an AMC when the benefits are included in the total package. This level of median compensation does not occur until 5-7 years post fellowship for the majority of Anesthesiologists. But, Academic salaries have been rising the past few years while the private sector has been falling (AMC or employed positions).

Another reason to do a fellowship is to leave the door open for academics. You may decide that working as the Bi$% for an AMC isn't what you have in mind as a career.
I have many friends in mainly state academic centers. They have fantastic benefits package. Heck I was back in academics for a bit and that state institution had an awesome benefits package (easily worth $60-70k and upwards to $100k cause they paid for faculty kids college education (and it wasn't even limited to state schools). They would just pro rate whatever the going state tuition rate was give you credit. And it was tax free benefit. And they even paid for faculty medical school or law school or whatever professional school education (that was taxable benefit but still awesome benefits)

My CT collegues were paid $325k. I got $300k as generalist assistant professor. I could have work some extra and made up more money but didn't feel like it. I didn't do a fellowship but it was worth $10k extra had I done one in the compensation.

But there are some faculty that gamed the system as they moved higher in the food chain...we all know the politics of the academic world.

And we all have to consider the physical work involved academic operation room vs private practice AMC operating room.
 

G-Man82

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Some places also peg their salary to the 50th percentile of the AAMC for Anesthesiologists.

But back on topic, all the academic places that I had applied to had excellent benefits packages and generous contributions to retirement plans. Once you factor in all those contributions, bonuses within the subspecialty, bonuses for academic work and education of residents and fellows, profit-sharing, etc, the academic places seem like pretty good places to work.

The couple PP places that I had applied to, which were all AMCs (TeamHealth, American Anesthesiology, and USAP) that had CCM practices, never really gave me the details of their retirement plans. That was a red flag.


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pjl

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For the other PP who are maxing out out at 53k, are you putting some of this into a Roth account?

(I'm not talking about doing a back door Roth outside of the groups retirement, I'm taking about putting a portion of the defined benefit plan into a Roth account, I think the max is about $17k of the $53k total).
I do my 17k as Roth.


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Notorious T.E.E.

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I have many friends in mainly state academic centers. They have fantastic benefits package. Heck I was back in academics for a bit and that state institution had an awesome benefits package (easily worth $60-70k and upwards to $100k cause they paid for faculty kids college education (and it wasn't even limited to state schools). They would just pro rate whatever the going state tuition rate was give you credit. And it was tax free benefit. And they even paid for faculty medical school or law school or whatever professional school education (that was taxable benefit but still awesome benefits)

My CT collegues were paid $325k. I got $300k as generalist assistant professor. I could have work some extra and made up more money but didn't feel like it. I didn't do a fellowship but it was worth $10k extra had I done one in the compensation.

But there are some faculty that gamed the system as they moved higher in the food chain...we all know the politics of the academic world.

And we all have to consider the physical work involved academic operation room vs private practice AMC operating room.

My issue with academics is the paltry vacation time. I've not seen any places with more than 4 weeks off (and 2 for CME). I don't feel like I take a lot of vacation, but I would need more than 4 weeks.

I can verify the $5k flat for Sheridan. I talked with them for awhile about a few positions. There were several deal breakers, but that was one.

The USAP site I spoke with didn't offer anything toward retirement year one (and the employee couldn't contribute either....never heard of that before so I thought there may be some confusion) but year 2 was allegedly $30k+ on the employer side if the employee maxed their contribution. Again, there were deal breakers so I didn't pursue things further. It has been awhile since I talked with both groups, so things may have changed.

I think the bottom line with AMCs is the retirement isn't great, the daily schedule isn't great, the autonomy of the group isn't great, the salary may not be great, the vacation isn't great, they are crawling with CRNAs, and they really should be considered last resort or a "patch" between one job and another for most people.
 

caligas

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I do my 17k as Roth.


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Me too, my understanding is that there is no clear consensus on whether or not to do this at our income level.

The real disaster would be if income tax went away right as you retire with a big Roth account. But this ain't super likely.
 
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Me too, my understanding is that there is no clear consensus on whether or not to do this at our income level.

The real disaster would be if income tax went away right as you retire with a big Roth account. But this ain't super likely.
If you think that your tax bracket in retirement will be higher than it is now then the ROTH is a great deal. But, if you are in the highest tax bracket now then I doubt the ROTH is the better option vs 40% deferred tax savings. Since I plan on being in the $250K and below income bracket when I retire (the level which the Democrats consider rich) I figure that the liberals will leave that bracket below 35%. The liberal mentality that those who work hard should pay for all those who choose NOT to work really does astonish me.

I also fully believe the Liberals will be in charge far more often going forward in this country. The demographics favor the entitlement state attitude and big government. This means tax increases across the board and slower growth like France.
 
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dr doze

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Roth's are great if you are a resident and have extra cash to pay taxes or a fresh attending who only has an attending salary for part of a year. Or called up to the military to fulfill an obligation and take the associated income hit and have the cash in savings. or take a leave of absence for any reason fellowship, whatever.

tiphatsmiley.gif to pgg and et al.

If you are a top bracket investor today, they are probably not the best choice.