Southern California Anesthesiology: Private Practice model vs W2 model. How to compare?

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LifeofGas

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I am feeling burned out, I need some perspective.

1) For the private practices people. Is being 1st call once a week, and 2 weekend call a month normal? (Post call day still work at least a half day, or sometimes hooked till 12pm)
2) How do you compare a private practice gig (1099) to a hospital gig (w2) that offers benefits?

Backstory:

I've been doing private practice for few years now in Southern California. I live in a high cost of living area and my current group services a few small hospitals in the area including few small surgery centers. My timing for joining the group is not ideal as they were acquired by a national company soon after. The upside of the merger is that the newbies were offered retention bonuses that is distributed for couple of years. The downside of the merger is that the AMC takes a significant % cut of our take home. Anyway, I stayed because I figured that the retention bonus is good enough to offset the % pay-cut I got.

Anyway, I decided to work my ass off after the merger, thinking that I will get a big payouts and stuff. After adding up my total earnings for the year, I found out that I made roughly about the same as pre-merger. Lets just say ~$400-450k. (The retention bonus is added in). I thought the number look decent (or not decent...please let me know...because this is my first job). I have a good amount of pre-tax money deposit into my account (40% of which is saved up for taxes). Things starting to feel a little less peachy when I looked at the time I spent working. I think I took 10 days off for vacation during pandemic and maybe a little bit more the prior year. I looked at my call schedule, I basically took 2 weekends (sat and Sunday) calls every month in addition to 1 call per week. On top of that, I probably work Saturday on one of the other free weekends at a surgery center. My gf is complaining that I am always working. With my feeling the burnout...I am beginning to agree with her.

So here is the thing, I love what I do. I like that my job offer a variety of cases from OB, vascular, urology, neuro, spine, thoracic, ortho, and plastics. I enjoy that I get to keep up my skills. However, I was chatting with my friend from residency the other day and he was saying that at his job, (at a hospital system close by) he was getting ~300k of salaried job, working about 40-50 hrs week and takes calls every 15 days, and work on a weekend every few month. He gets post call day off, paid vacations, CME stipend, sick days, and also benefits (401k, health insurance, malpractice). downside is they don't do so much regional blocks, and they don't have OB's.

I know that if I had worked the same crazy hours during pre-pandemic time, my pay would be much higher. Regardless, I was surprised at how many weekends my friend gets to enjoy being off pager at his W2 gig. I am jealous that he get post Call day off, paid vacations, and expenses paid to CME (+ paid days off for CME events!?!) Am I missing something thinking that his gig is better than mine?

Anyway...please comment...any advice/observation is appreciated.
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Sounds horrible. That I guess is the price you pay for living in Southern California.
What’s the point if you don’t even have time to enjoy that great weather?
 
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If you are doing "OB, vascular, urology, neuro, spine, thoracic, ortho, and plastics" at multiple hospitals with a broad payor mix, you take 1 call a week and 2 weekends a month, only took 10 days off last year, and only pulled in 400-450, then someone else is taking home 35-50% of your collections.
 
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Lemme guess, west side of la pp bought up by napa? You are getting bent over. That call burden alone should net an extra 200k or so and the lack of vacation another 50+ imo. One of the worst jobs I have ever heard of.
 
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OP, I have worked similar hours to what you describe in the "open market" (non partner) and pulled in $550-$575K. This is just working for hourly pay and not doing my own billing. You really should be earning in excess of $600K in your market for the job you have described. In fact, $650K would be my estimate for your type of job.
 
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Op, you make my job sound like a dream. Sat AND Sunday? Two weekends a month? I hope at least it’s home call. Post call day working?

You ARE working too much. If I did my math right. On average you “work” 168 hr/2 week period.

You know there are only 168 hr/week right?!

You NEED a new job.
 
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Not much to add to the folks above, but what is the call burden like? In house? Home call? Doing a lot of cases on weekends?

You’re getting screwed, but answers to above could shed more light on just how bad you’re getting it.
 
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Shimmy8 said:
Not much to add to the folks above, but what is the call burden like? In house? Home call? Doing a lot of cases on weekends?

You’re getting screwed, but answers to above could shed more light on just how bad you’re getting it.
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First call is in house depends on which hospital I cover. In house because of OB coverage. Second call is there in case first call is doing a case and OB needs assistance. (Typical weekend is both first and second call, on sat/sun). I happened to live next to the hospital, so I go home, but I still count as in house. We don’t have a separate person covering OB due to volume. Case volumes during the weekend is hit or miss, can be busy, but mostly sporadic cases here and there. I guess if calls were more busy and productive, it maybe worth being on call on the weekend. I don’t know, It’s draining just being on hook.
 
IMGASMD said:
Op, you make my job sound like a dream. Sat AND Sunday? Two weekends a month? I hope at least it’s home call. Post call day working?

You ARE working too much. If I did my math right. On average you “work” 168 hr/2 week period.

You know there are only 168 hr/week right?!

You NEED a new job.
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Its both Sat and Sunday, First and second call. Postcall day usually work, unless OR is extremely light. The arguement is that since private practice are production based structure, I don’t make any money if I don’t work post call day. So yeah...I’m plus and minus about the post call day work. Worse is when they need a “hook” in case some surgeon add on a case? The group run a tight ship...so not a lot of wiggle room.
 
Just to get as much info as possible before passing judgement...

How many Units on average do you bill per year? What is the average unit value? Is it a blended rate or eat what you kill? When you're not on call, what is your average day? How busy are the calls (I.e. Do you frequently sleep while in house overnight)? You said the company takes 10%. Do you still pay for billing management and office staff?
 
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kire1820 said:
Its both Sat and Sunday, First and second call. Postcall day usually work, unless OR is extremely light. The arguement is that since private practice are production based structure, I don’t make any money if I don’t work post call day. So yeah...I’m plus and minus about the post call day work. Worse is when they need a “hook” in case some surgeon add on a case? The group run a tight ship...so not a lot of wiggle room.
Click to expand...

Did you make partner? Are you being paid in units? Just like @sethco is wondering.

If you’re not making units, like your senior partners, you’re being boned. Hard.

It’s not a tight ship. It’s a ship you should get off.
 
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@sethco @IMGASMD I am not a partner. To be honest, I don't actually know what being a partner means. Stock options? Frankly in my current situation, once the retention bonus completes, there appears to be no upside...except that I have a great working relationship with all OR staff and colleagues, and the sense of familiarity.
 
kire1820 said:
@sethco @IMGASMD I am not a partner. To be honest, I don't actually know what being a partner means. Stock options? Frankly in my current situation, once the retention bonus completes, there appears to be no upside...except that I have a great working relationship with all OR staff and colleagues, and the sense of familiarity.
Click to expand...

Even if you're not a partner and don't know what that means, you still need to know how much Revenue you are generating. Otherwise, you don't truly know your worth to the practice
 
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Partnership means profit sharing and voting rights. You have a say in how the business is run. Ownership matters.
 
sethco said:
Even if you're not a partner and don't know what that means, you still need to know how much Revenue you are generating. Otherwise, you don't truly know your worth to the practice
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On paper, its about 1000 unit, but this doesn't include payments from other sites that I go to.
 
kire1820 said:
On paper, its about 1000 unit, but this doesn't include payments from other sites that I go to.
Click to expand...

1000 units per month? That’d be within the range of an average workload. And then how much do you estimate from the other sites? If you’re spending more than 20% of your time at those then I would think you are well into the 90th %ile of units.
 
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ambiturner said:
1000 units per month? That’d be within the range of an average workload. And then how much do you estimate from the other sites? If you’re spending more than 20% of your time at those then I would think you are well into the 90th %ile of units.
Click to expand...

Depends on how they count time too.
 
Am I the only one to presume that we are talking about Orange Coast Anesthesia, who became NAPA recently?

I don't know if mentioning that is somehow verboten, but it is certainly the group that immediately came to mind. I further assume that your friend from residency is with Allied. If they are only paying $300k, they are even worse than I thought. (It might not be Allied, of course. If I'm corrected, I'll try to come back here and clean this up. I hear they don't do a lot of regional, but I was unaware that they didn't do OB.)
 
Like anything in life, if you’re happy/content with what you are doing and feel you are adequately compensated that’s all that matters. Since you are asking strangers if your job blows, you probably already know the answer. Of course you must consider location, family, etc. sometimes you can give a little for location. It seems you are giving hours, $$, quality of life, and family time (gf doesn’t seem happy). Not worth it. For perspective, have a full time gig and locums on the side. I know my locums company scrapes off the top but I am 100% ok with it because it pays well and I don’t work hard. Your company is taking a cut and you are not/ should not be ok with it and you are working hard.
 
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Volatile said:
Like anything in life, if you’re happy/content with what you are doing and feel you are adequately compensated that’s all that matters. Since you are asking strangers if your job blows, you probably already know the answer. Of course you must consider location, family, etc. sometimes you can give a little for location. It seems you are giving hours, $$, quality of life, and family time (gf doesn’t seem happy). Not worth it. For perspective, have a full time gig and locums on the side. I know my locums company scrapes off the top but I am 100% ok with it because it pays well and I don’t work hard. Your company is taking a cut and you are not/ should not be ok with it and you are working hard.
Click to expand...

Thanks Volatile as well as everyone above who have commented.

I think in many ways, it is a price to pay for the location I choose to be in. Thanks @sethco for your analysis and thanks to all those who have PM me. I think I got the perspective I needed. Southern California is just a ****ty place for anesthesiologist (of course exceptions do exist). Anyhow, I got a free day to really decompress, and I am feeling better. I do have a lot to think about, but as of now, I am going to continue to work hard and keep positive. The world is busy battling the pandemic. What I'm complaining of is first world problem. Back to work!
 
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Was gf with you in residency? Is she reaping a benefit from your hard work?

Mark Cuban once told a story about how a girlfriend told him to choose between his business or her...

His response: “what’s your name again?”

Though her observation may be correct, you’re still single and have to make decisions about your well being.
 
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I know how you feel. I work in So Cal, hitting 1000 units a month usually means on the order of 30k a month + stipends. During vacation you don't paid. So basically to make in the 400s you gotta bust your ass and take minimal vacation.
 
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LifeofGas said:
...downside is they don't do so much regional blocks, and they don't have OB's.
Click to expand...
This statement explains perfectly why you are getting taken advantage of the way you are. No OB and minimal regional blocks are HUGE plusses. The fact that you see them as "downsides" speaks volumes about your inexperience and naivety. OB sucks and doing blocks is just more work, especially if you are an employee. You are getting bent over and taking it in through the out door HARD. Wise up or keep getting punked out like a little b_itch. Your choice.
 
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Consigliere said:
This statement explains perfectly why you are getting taken advantage of the way you are. No OB and minimal regional blocks are HUGE plusses. The fact that you see them as "downsides" speaks volumes about your inexperience and naivety. OB sucks and doing blocks is just more work, especially if you are an employee. You are getting bent over and taking it in through the out door HARD. Wise up or keep getting punked out like a little b_itch. Your choice.
Click to expand...

This is the truth. Can't stand ob. I like regional cause I get paid and patients do better but as an employee **** it.
 
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Consigliere said:
This statement explains perfectly why you are getting taken advantage of the way you are. No OB and minimal regional blocks are HUGE plusses. The fact that you see them as "downsides" speaks volumes about your inexperience and naivety. OB sucks and doing blocks is just more work, especially if you are an employee. You are getting bent over and taking it in through the out door HARD. Wise up or keep getting punked out like a little b_itch. Your choice.
Click to expand...

Don’t sugar coat it. Tell it like it is.
 
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Consigliere said:
This statement explains perfectly why you are getting taken advantage of the way you are. No OB and minimal regional blocks are HUGE plusses. The fact that you see them as "downsides" speaks volumes about your inexperience and naivety. OB sucks and doing blocks is just more work, especially if you are an employee. You are getting bent over and taking it in through the out door HARD. Wise up or keep getting punked out like a little b_itch. Your choice.
Click to expand...
Now now.... I'm sure somewhere there is an AMC that will let him/her do ALL the blocks, but only if they agree to take some extra call. 😜
 
Consigliere said:
In most groups, OB can be extremely painful.
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Most people don't like OB. Not surprising. I don't love OB and I can choose not to do it if I want but I continue to bc I like to keep my skills sharp, I like the procedures and I also like the challenge of it. OB can be challenging bc of the expectations. Everyone expects perfection from you, despite this being a very imperfect patient population. The fact that I typically make at least twice as much covering L+D from 7-5pm as I would have made in the OR that day is also an incentive.
 
OB is painful because most L and D nurses consider you like EVS and basically call you for an epidural like they call EVS to mop something. Id be fine never doing OB for the rest of my career.
 
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OB is a PITA at most places, but I continue to do it only to keep that skill set. I also have a nice side gig in BFE, the hospital pays me a nice hourly rate as long as an epidural is going, which is almost always my entire 48hr shift on the weekend, usually only 1-3 ladies admitted at a time. It’s a nice paycheck, my wife calls it our honey hole :)
 
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Volatile said:
OB is a PITA at most places, but I continue to do it only to keep that skill set. I also have a nice side gig in BFE, the hospital pays me a nice hourly rate as long as an epidural is going, which is almost always my entire 48hr shift on the weekend, usually only 1-3 ladies admitted at a time. It’s a nice paycheck, my wife calls it our honey hole :)
Click to expand...
Hate it, but would do a side gig like that.
 
Consigliere said:
This statement explains perfectly why you are getting taken advantage of the way you are. No OB and minimal regional blocks are HUGE plusses. The fact that you see them as "downsides" speaks volumes about your inexperience and naivety. OB sucks and doing blocks is just more work, especially if you are an employee. You are getting bent over and taking it in through the out door HARD. Wise up or keep getting punked out like a little b_itch. Your choice.
Click to expand...
Haha, lots of comments since I last checked. I hear you, it is a HUGE bonus to not do OB and blocks. I think at this stage of my career, I'd like to be more versatile in case I ended up having to relocate for any reason, I'd be a more attractive candidate. Therefore, having a job that would expose me to a OB and regional block is a plus in my eye. Honestly I don't mind it, but yes, I think in my later years...I would ideally want something less envolved.

@Volatile I figured out what PITA means...but what is BFE?
 
LifeofGas said:
Haha, lots of comments since I last checked. I hear you, it is a HUGE bonus to not do OB and blocks. I think at this stage of my career, I'd like to be more versatile in case I ended up having to relocate for any reason, I'd be a more attractive candidate. Therefore, having a job that would expose me to a OB and regional block is a plus in my eye. Honestly I don't mind it, but yes, I think in my later years...I would ideally want something less envolved.

@Volatile I figured out what PITA means...but what is BFE?
Click to expand...
How did you figure out what PITA means? Use that technique to figure out the BFE. I am too close to banning to spell it out for you. HAHA
 
LifeofGas said:
Haha, lots of comments since I last checked. I hear you, it is a HUGE bonus to not do OB and blocks. I think at this stage of my career, I'd like to be more versatile in case I ended up having to relocate for any reason, I'd be a more attractive candidate. Therefore, having a job that would expose me to a OB and regional block is a plus in my eye. Honestly I don't mind it, but yes, I think in my later years...I would ideally want something less envolved.

@Volatile I figured out what PITA means...but what is BFE?
Click to expand...

Dr Google knows it all!

the version I am more used to is, BumbleFck America. But it is aka bum f Egypt. I guess there are places worse than America....
 
LifeofGas said:
Haha, lots of comments since I last checked. I hear you, it is a HUGE bonus to not do OB and blocks. I think at this stage of my career, I'd like to be more versatile in case I ended up having to relocate for any reason, I'd be a more attractive candidate. Therefore, having a job that would expose me to a OB and regional block is a plus in my eye. Honestly I don't mind it, but yes, I think in my later years...I would ideally want something less envolved.

@Volatile I figured out what PITA means...but what is BFE?
Click to expand...

I love blocks and do a bunch. Dislike OB and don’t do any.
 
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LifeofGas said:
Haha, lots of comments since I last checked. I hear you, it is a HUGE bonus to not do OB and blocks. I think at this stage of my career, I'd like to be more versatile in case I ended up having to relocate for any reason, I'd be a more attractive candidate. Therefore, having a job that would expose me to a OB and regional block is a plus in my eye. Honestly I don't mind it, but yes, I think in my later years...I would ideally want something less envolved.

@Volatile I figured out what PITA means...but what is BFE?
Click to expand...
I’m military so acronyms are my life!
For years I said “bum **** nowhere” ..... then I was corrected that Egypt is apparently worse than nowhere lol.
And I encourage you to maintain as many skill sets as you can early in your career, it will only keep doors open. The sweet spot for OB is finding a community hospital that does ~500 deliveries/yr. it’s just enough to do a few epidurals and c/s’s each week, maintain your comfort but not hate it. And those small community hospitals generally pay well and have the best doc lounges stocked with all you can eat!
 
Volatile said:
I’m military so acronyms are my life!
For years I said “bum **** nowhere” ..... then I was corrected that Egypt is apparently worse than nowhere lol.
And I encourage you to maintain as many skill sets as you can early in your career, it will only keep doors open. The sweet spot for OB is finding a community hospital that does ~500 deliveries/yr. it’s just enough to do a few epidurals and c/s’s each week, maintain your comfort but not hate it. And those small community hospitals generally pay well and have the best doc lounges stocked with all you can eat!
Click to expand...
I need to find this mythical hospital. Would love a doctors lounge that is filled like this
 
Where I trained there was obviously no doctors lounge. But we had a small fridge that would be stocked with sandwiches for call people. There used to be this fat ass cardiac surgeon who used to sit down after cases and raid that fridge, basically double fisting sandwiches. One day one of the anesthesiologists walked by and goes "Dr. X, why are you eating all the call sandwiches, you make 1.5 mil a year." I almost died.
 
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DrOwnage said:
Where I trained there was obviously no doctors lounge. But we had a small fridge that would be stocked with sandwiches for call people. There used to be this fat ass cardiac surgeon who used to sit down after cases and raid that fridge, basically double fisting sandwiches. One day one of the anesthesiologists walked by and goes "Dr. X, why are you eating all the call sandwiches, you make 1.5 mil a year." I almost died.
Click to expand...

Old habits die hard.
Eat when you can sleep when you can.
New is better than old. Free is always better.

After becoming an attending I also know why my attendings never bother to go to ASA, PGA free dinners. You make enough to do whatever you want with your time. Don’t need to spent 3 hours for a $50 meal.

Volatile said:
I’m military so acronyms are my life!
For years I said “bum **** nowhere” ..... then I was corrected that Egypt is apparently worse than nowhere lol.
And I encourage you to maintain as many skill sets as you can early in your career, it will only keep doors open. The sweet spot for OB is finding a community hospital that does ~500 deliveries/yr. it’s just enough to do a few epidurals and c/s’s each week, maintain your comfort but not hate it. And those small community hospitals generally pay well and have the best doc lounges stocked with all you can eat!
Click to expand...

You had me at all you can eat!
 
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DrOwnage said:
Where I trained there was obviously no doctors lounge. But we had a small fridge that would be stocked with sandwiches for call people. There used to be this fat ass cardiac surgeon who used to sit down after cases and raid that fridge, basically double fisting sandwiches. One day one of the anesthesiologists walked by and goes "Dr. X, why are you eating all the call sandwiches, you make 1.5 mil a year." I almost died.
Click to expand...
One of the most memorable things in residency was me being on call and walking past the Subway seeing a 50 something year old cardiac surgeon eating a footlong at 9PM waiting for the Type A to roll through the door.
 
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IMGASMD said:
Just out of curiosity, anyone know of anywhere else in the world that has AYCE for less than $15? Such a foreign concept for rest of the world.
Click to expand...

They have (or had) nice freestanding buffets and hotel buffets in Korea but the concept was imported from the US.
 
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