Saturation of anesthesiologists?

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Mman said:
who doesn't have a connection to something? I assume everybody knows former residents and attendings from their program they trained at?
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Not everyone has relevant connections. A resident from San Francisco may not know anyone on the east coast that can help then land a job near DC.

I trained in the military. Most military physicians, when their commitment is up, return home or get a job at a civilian hospital near their last duty station. As a result, former residency classmates may be anywhere in the country, but we hardly keep in touch during the several years between residency and departing the military. The residency program itself has no connections outside of the military, as there is such a time delay between completing residency and being a free agent. So, those leaving the military have virtually no connections on which to draw, unless they are settling near a current or former duty station, or have a close friend that joined a practice where they, too, want to work and live. My former resident buddy that took a job in Wisconsin and my former assistant PD that returned home to Indiana couldn't help me find a job on the east coast (family-induced geographic limitation), though they both kept trying to recruit me to their practices. I had to rely on emails from practices, recruiters, Gaswork, etc to find my current position.

This is why I tell med students and residents to train where they want to eventually practice.

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FFP said:
There is no more lifestyle job, period. Try to ask for a part-time or mommy-track job instead of the full-time they are advertising, and see the reaction. It's such a great market, full of jobs... suuuure, if one counts the bad ones, too.

If the market were good, one could easily negotiate a better lifestyle for less money, or anything else. Good luck to the new grads with "negotiating".
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We have many people in no call regular hours positions but they all had to take call for 5 years or so when they first joined the group.
 
psychbender said:
Not everyone has relevant connections. A resident from San Francisco may not know anyone on the east coast that can help then land a job near DC.
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I never implied people had connections around the country/world. But they should have connections to some sort of nonacademic job somewhere. That's also why I suggest people do residency near where they want to live (if they are geographically limited).
 
I don’t know the nationwide market. Maybe other parts of the country are more saturated.

In my area we have a relative shortage. It’s a desirable area, the pay is as good as it’s ever been, and the people we make offers to seem to have a lot of options.
 
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psychbender said:
Not everyone has relevant connections. A resident from San Francisco may not know anyone on the east coast that can help then land a job near DC.

I trained in the military. Most military physicians, when their commitment is up, return home or get a job at a civilian hospital near their last duty station. As a result, former residency classmates may be anywhere in the country, but we hardly keep in touch during the several years between residency and departing the military. The residency program itself has no connections outside of the military, as there is such a time delay between completing residency and being a free agent. So, those leaving the military have virtually no connections on which to draw, unless they are settling near a current or former duty station, or have a close friend that joined a practice where they, too, want to work and live. My former resident buddy that took a job in Wisconsin and my former assistant PD that returned home to Indiana couldn't help me find a job on the east coast (family-induced geographic limitation), though they both kept trying to recruit me to their practices. I had to rely on emails from practices, recruiters, Gaswork, etc to find my current position.

This is why I tell med students and residents to train where they want to eventually practice.

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Of course a network of contacts won't develop itself for you. You have to take some agency and be proactive. Get to know your junior and senior residents as well as your own class. Overall, I trained with about 90 other residents (two classes above me, my class and two classes below) as well as a bunch of fellows and attendings. I have email addresses for every one of them that I got before they/I graduated. I'm not "friends" with most of them, but we definitely know each other. I have emailed quite a few over the years with questions about jobs, applicants to my current job, market issues, clinical concerns, etc. If I wanted to switch jobs today I wouldn't hesitate to reach out to any of them (I graduated 8 years ago). I did in fact get my current (and only, so far) job through residents from the years ahead of me.

Your residency program should also be helping you by keeping contact and location info for alumni to help out graduating residents. If you're a resident, talk to your PD. If they're not doing this, do your level best to get it started, if not for you then for future residents.
 
Mman said:
academic places justify their low salaries because of the prestige of working there (or so they claim).

The only people that take jobs in academics are people that have a dying need to teach, want to be a researcher, or can't hack it in the real world and none of those 3 groups of people are in position to demand/command a higher salary.
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Straw man
 
Twiggidy said:
Straw man
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huh?

Is there another group of people that seeks out lower paying jobs in academia? And I'm not talking down to those people that want to teach or do research. Those are good things.
 
Mman said:
huh?

Is there another group of people that seeks out lower paying jobs in academia? And I'm not talking down to those people that want to teach or do research. Those are good things.
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I think there are a fair amount of people who say to themselves, "Screw it. Give me 250k to cover a couple or residents. The 200k bump isn't worth me work 5x harder." Now I don't think that's necessarily them not being able to hack private practice. Some eventually bail on academics because they realize they need the money or just work more overtime in academics. My general theory on academics is that you can find your way to making 250-300 taking very little or next to no call because the departments are so big and there's always another hungry anesthesiologist lingering.

I realize I could be making your argument at this point and it doesn't bother me because it's just the internet. I will stand by the fact that in private practice I think we work much harder and therefore deserve the "higher" pay. There are many days I would trade half of my salary to dump a resident in my room or on OB so I only had to be bothered for "real" problems.
 
Twiggidy said:
I will stand by the fact that in private practice I think we work much harder and therefore deserve the "higher" pay.
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That's basically what I'm saying.
 
Some also gravitate towards academics, based on subspecialty. The majority of anesthesia-critical care trained physicians are in academia, because few private groups are willing or able to entertain the dual position. I imagine those wanting a pure Peds practice will also more heavily lean towards academics, along with those that only want to do transplants, VADS, and complex redo hearts. While all of those things are done in private practice, someone who wants to ONLY do those things would be more likely to find a home at an academic quaternary referral center.

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Twiggidy said:
I think there are a fair amount of people who say to themselves, "Screw it. Give me 250k to cover a couple or residents. The 200k bump isn't worth me work 5x harder." Now I don't think that's necessarily them not being able to hack private practice. Some eventually bail on academics because they realize they need the money or just work more overtime in academics. My general theory on academics is that you can find your way to making 250-300 taking very little or next to no call because the departments are so big and there's always another hungry anesthesiologist lingering.

I realize I could be making your argument at this point and it doesn't bother me because it's just the internet. I will stand by the fact that in private practice I think we work much harder and therefore deserve the "higher" pay. There are many days I would trade half of my salary to dump a resident in my room or on OB so I only had to be bothered for "real" problems.
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Is private practice really five times the work of academics? Just how much busier are you in PP?
 
Mman said:
A lot busier. Faster cases, faster turnovers, more rooms, no residents doing all the procedures for you.
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I think that sounds ideal at the tail end of a career. Starting off after residency, I think private practice would make you more competent and confident and expand your skill set. But who wants to work that hard...
 
MoMoGesiologist said:
Is private practice really five times the work of academics? Just how much busier are you in PP?
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Again, it's based on where I trained versus what I do now. I know academic anesthesiologists have the headache of supervising new residents but once they hit about midway through CA1 year they should have somewhat an idea of what they're doing. At that point it's chart signing and putting out fires with a little bit of teaching. Sitting the stool or covering 2-4 rooms and doing it all as efficient (aka fast) as possible and personally fielding every call when on call overnight is A LOT harder.
 
MoMoGesiologist said:
I think that sounds ideal at the tail end of a career. Starting off after residency, I think private practice would make you more competent and confident and expand your skill set. But who wants to work that hard...
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At the tail end of your career you want to work with competent surgeons and take no in-house overnight call. Hell, I want that now but that gets labelled as "mommy track" and those gigs are disappearing.
 
narcusprince said:
Whats the work/lifestyle/pay balance working for the VA?
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Based on eye test, your lifestyle will be pretty darn good given they don't have labor and delivery. L&D I'd argue is the only thing that kills the lifestyle of this field no matter where you practice.

Pay is probably similar to most academic practices since most are affiliated in some way with academic centers, but based on work: pay ratio you probably come out on top at a VA since they tend to not be as nearly as busy as the average practice. This is based on my experience with VAs. Everywhere I've been they were known as the "cush" rotation.
 
Not all private practice jobs are created equal. I am paid very well, and do relatively little work (in my opinion). If I went to either of the academic programs back home, I'd work a lot harder, but make >$150k less than I do now.

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psychbender said:
Not all private practice jobs are created equal. I am paid very well, and do relatively little work (in my opinion). If I went to either of the academic programs back home, I'd work a lot harder, but make >$150k less than I do now.

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Psych How does it compare with the military practice? I know military academic practice is not bad at all.
 
narcusprince said:
Psych How does it compare with the military practice? I know military academic practice is not bad at all.
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When I'm in the OR, I do 80-90% my own cases, as opposed to once or twice a week in the Army. We have shorter turnovers here than we did back in the Army, but we consistently ran more rooms later while I was active duty, compared to now. Here, rooms start coming down by noon, down to just a couple of locations by 1500, often call team only by 1600 or 1700. Contrast that with all rooms running at 1500, down to three or four at 1700, then just one by 1900 in the .mil. Some days, we're a little tight, and rooms stay open well into the afternoon, but that's rarer, and balanced out by days where the OR's a ghost town by 1500. We're salaried hospital employees, so get paid the same, regardless.

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Mman said:
A lot busier. Faster cases, faster turnovers, more rooms, no residents doing all the procedures for you.
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The only thing I'll dispute there is the notion that residents are some kind of procedure efficiency easy button. 🙂

 
Consigliere said:
As someone who has been in practice over 10 years, I'll tell you that the market is saturated RIGHT NOW. In 5-10 years we'll be lucky to get $200k per annum. Trust me.
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you were saying? You posted this in 2012...Our nurses make more than that.

We just had a meeting to renegotiate with our AMC. We collectively asked for a 100K raise EACH on top of a 95th percentile salary on MGMA.

We will get it. Because a competing hospital 5 miles down the road is already offering what we asked for.

If they dont give it, we walk away and form our own corporation.
 
anbuitachi said:
from that VA that i've been too, lifestyle work balance is strong, which is one of its most attractive points. comes out to be 150 a hr.
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It varies a lot among VAs. Some bigger hospitals are run like private hospitals, with focus on turnover, 3 rooms per anesthesiologist, long days, a lot of off-floor crap, in-house calls etc.
 
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neutro said:
you were saying? You posted this in 2012...Our nurses make more than that.

We just had a meeting to renegotiate with our AMC. We collectively asked for a 100K raise EACH on top of a 95th percentile salary on MGMA.

We will get it. Because a competing hospital 5 miles down the road is already offering what we asked for.

If they dont give it, we walk away and form our own corporation.
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The plural of anecdote is NOT evidence. Glad I was slightly wrong though. As some other astute citizen on SDN pointed out, it's not all about salary, but rather how much and under what conditions you earn that salary.
 
neutro said:
you were saying? You posted this in 2012...Our nurses make more than that.

We just had a meeting to renegotiate with our AMC. We collectively asked for a 100K raise EACH on top of a 95th percentile salary on MGMA.

We will get it. Because a competing hospital 5 miles down the road is already offering what we asked for.

If they dont give it, we walk away and form our own corporation.
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Same. We just finished and got raises on top of already high MGMA(non AMC- so bigger subsidy)
 
neutro said:
We will get it. Because a competing hospital 5 miles down the road is already offering what we asked for.
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And this other hospital could suddenly absorb your whole department if you guys decide to walk? (not trying to be contrarian, just honestly curious how you see this playing out)

neutro said:
If they dont give it, we walk away and form our own corporation.
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No non-compete??
 
Consigliere said:
The plural of anecdote is NOT evidence. Glad I was slightly wrong though. As some other astute citizen on SDN pointed out, it's not all about salary, but rather how much and under what conditions you earn that salary.
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wrong again.
environment and conditions are good as well as living area.
 
SaltyDog said:
And this other hospital could suddenly absorb your whole department if you guys decide to walk? (not trying to be contrarian, just honestly curious how you see this playing out)



No non-compete??
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no non compete.

there is nothing to play out - the anesthesiologists that are here, have been for 30 years, had their own group and are well liked by surgeons who are also a private entity. this was way before the AMC take over which took over only because it was getting impossible to manage CRNA schedules. it was not about quality of work or service.
it is difficult to hire anesthesiologists to this area, mostly location reasons - but i love it here and am familiar with it because i did my residency here and relocated back.
we have a very diverse group of doctors, and everyone gets the same contract/call/pay and PTO of 10 weeks. its a fair place. you get extra for fellowship and chair position.
 
neutro said:
no non compete.

there is nothing to play out - the anesthesiologists that are here, have been for 30 years, had their own group and are well liked by surgeons who are also a private entity. this was way before the AMC take over which took over only because it was getting impossible to manage CRNA schedules. it was not about quality of work or service.
it is difficult to hire anesthesiologists to this area, mostly location reasons - but i love it here and am familiar with it because i did my residency here and relocated back.
we have a very diverse group of doctors, and everyone gets the same contract/call/pay and PTO of 10 weeks. its a fair place. you get extra for fellowship and chair position.
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Ok that’s all very nice. How ‘bout my first question? Was the group bought out by the AMC initially? Impressive that you guys could avoid a non-compete.
 
SaltyDog said:
Ok that’s all very nice. How ‘bout my first question? Was the group bought out by the AMC initially? Impressive that you guys could avoid a non-compete.
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no, the hospital gave the contract TO the AMC and the original group was given choice to be employees or relocate. the original group did not have the means to hire, fire, deal with CRNAs and it was getting hard to manage and deal with their headache.

there was no non compete and the anesthesiologists were given a choice to be employed or remain as independent contractors. the employed physicians, for benefits reasons, chose employment but negotiated no non compete. the pay was market rate as well as last three years of compensation that was matched.

all but one stayed back - the one that left found a top notch position in a state across the country. he wanted to move anyway out of his own will - was not pushed out.
 
I'm glad they were able to negotiate favorable terms in what could been an ugly situation. I guess I'll just give up on ever getting an answer to my initial question.
 
It’s interesting to see something favorable like this which contrasts so much from what happened in North Carolina. Is your pay the same now as before you became an employee?

In making demands on salary are you concerned they will tell you to take a hike and find new anesthesiologists like in NC? They were apparently able to find 90 some pretty quickly.

If I may ask are you in the Midwest?

neutro said:
no, the hospital gave the contract TO the AMC and the original group was given choice to be employees or relocate. the original group did not have the means to hire, fire, deal with CRNAs and it was getting hard to manage and deal with their headache.

there was no non compete and the anesthesiologists were given a choice to be employed or remain as independent contractors. the employed physicians, for benefits reasons, chose employment but negotiated no non compete. the pay was market rate as well as last three years of compensation that was matched.

all but one stayed back - the one that left found a top notch position in a state across the country. he wanted to move anyway out of his own will - was not pushed out.
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I
 
SaltyDog said:
I'm glad they were able to negotiate favorable terms in what could been an ugly situation. I guess I'll just give up on ever getting an answer to my initial question.
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I don’t know what answer you’re looking for.
 
No the other hospital is not going to absorb our dept since:
1. Our hospital, the amc and anesthesiologists have a long standing history of good faith negotiations resulting in a favorable outcome.
2. The competing hospital imposes a non compete which we will not tolerate.
 
ERRES2288 said:
It’s interesting to see something favorable like this which contrasts so much from what happened in North Carolina. Is your pay the same now as before you became an employee?

In making demands on salary are you concerned they will tell you to take a hike and find new anesthesiologists like in NC? They were apparently able to find 90 some pretty quickly.

If I may ask are you in the Midwest?


I
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I can’t tell you what will happen in the future but we will come to some sort of a fair agreement which we can all work with. That has been the pattern thus far.
Our case volumes are going up and we opened two new facilities so there’s plenty of work for us.
 
So I'm just curious how the other hospital offering 100K more than your AMC affects you. You guys asked for a 100K raise. If your AMC says no, then what?
 
ERRES2288 said:
It’s interesting to see something favorable like this which contrasts so much from what happened in North Carolina. Is your pay the same now as before you became an employee?

In making demands on salary are you concerned they will tell you to take a hike and find new anesthesiologists like in NC? They were apparently able to find 90 some pretty quickly.

If I may ask are you in the Midwest?


I
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Yeah don’t believe the doom and gloom on Sdn that is so prevalent. I suggest instead talking to real attendings in real groups and cross checking and referencing what they say to get a fair idea on the market and compensation.

Anesthesia is a great profession even if the money wasn’t there.
 
SaltyDog said:
So I'm just curious how the other hospital offering 100K more than your AMC affects you. You guys asked for a 100K raise. If your AMC says no, then what?
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We will cross that bridge once we hear back. We have only sent a proposal thus far. And again the chairs of all these hospitals know each other well. Most of them were colleagues in residency. There is significant solidarity among anesthesiologists in this town either academic, non profit or for profit. That was the whole reason behind our group fighting hard for non compete because they wanted the flexibility in case it comes down to that.
 
neutro said:
Yeah don’t believe the doom and gloom on Sdn that is so prevalent. I suggest instead talking to real attendings in real groups and cross checking and referencing what they say to get a fair idea on the market and compensation.

Anesthesia is a great profession even if the money wasn’t there.
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Because everybody on the Internet is an attending. 😀
 
neutro said:
We will cross that bridge once we hear back. We have only sent a proposal thus far. And again the chairs of all these hospitals know each other well. Most of them were colleagues in residency. There is significant solidarity among anesthesiologists in this town either academic, non profit or for profit. That was the whole reason behind our group fighting hard for non compete because they wanted the flexibility in case it comes down to that.
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You clearly are in a different environment than I am in because where I’m at the old “handshake, smile, and gentlemanly agreement” you are describing means absolutely nothing. There is no solidarity and there is no friendship in this game. That is also potentially bad advice to be giving residents. If it is not spelled out word for word in a contract then it didn’t happen. Trust no one but yourself. You may also be in a state where there is either law or precedent of non-compete clauses be unenforceable. What you perceive as good will might just be the law.
 
neutro said:
wrong again.
environment and conditions are good as well as living area.
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Not wrong. You give a SINGLE example....I, and others, can give you 50 scenarios that are the exact opposite of what you describe.

Try again
 
neutro said:
We will cross that bridge once we hear back. We have only sent a proposal thus far. And again the chairs of all these hospitals know each other well. Most of them were colleagues in residency. There is significant solidarity among anesthesiologists in this town either academic, non profit or for profit. That was the whole reason behind our group fighting hard for non compete because they wanted the flexibility in case it comes down to that.
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And....and....there is ample unicorn parking right next to the pots of gold at the ends of the rainbows we follow each day to our job.
 
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