Springfield, MA

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nimbus

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This is the future for all. Some will take 2 years few left standing 20. But no surprises act makes this inevitable. Whatever you do don’t do a partnership tract with employed positions paying 600k+.

Whether it’s a true partnership tract or an amc one…it’s not worth it as will either become employed or make way less than employed
 
This is the future for all. Some will take 2 years few left standing 20. But no surprises act makes this inevitable. Whatever you do don’t do a partnership tract with employed positions paying 600k+.

Whether it’s a true partnership tract or an amc one…it’s not worth it as will either become employed or make way less than employed
This is so true. Of the 5 true PP groups I interviewed for when I finished training, 4/5 are employed now. The last group was told in no uncertain terms at their most recent contract negotiation that this would be their last contract as a private group.

I remember getting told up and down by everyone I interviewed with that no one is getting employed and I’m gonna make so much money when I’m partner.

All 2 year tracts getting paid HALF of what I’m making currently.
 
This is the future for all. Some will take 2 years few left standing 20. But no surprises act makes this inevitable. Whatever you do don’t do a partnership tract with employed positions paying 600k+.

Whether it’s a true partnership tract or an amc one…it’s not worth it as will either become employed or make way less than employed
Hopefully the young guns will heed this excellent advice.
 
Existing private group is closing and becoming hospital employees. Trend continues.


If all anesthesia groups become hospital employed and disconnected from billing, what determines the market rate for our services?

For now hospitals are paying what we consider to be market rate. Maybe this is because there are PP alternatives that docs could go to instead of hospital employment and therefore the hospital has to compete ..

But if there is no PP group, everyone is hospital employed, what’s stopping the hospitals from paying us 250k annually? I mean that’s what you guys bill for so it seems fair right ? When you disconnect billing how do you assign value ?
 
If all anesthesia groups become hospital employed and disconnected from billing, what determines the market rate for our services?

For now hospitals are paying what we consider to be market rate. Maybe this is because there are PP alternatives that docs could go to instead of hospital employment and therefore the hospital has to compete ..

But if there is no PP group, everyone is hospital employed, what’s stopping the hospitals from paying us 250k annually? I mean that’s what you guys bill for so it seems fair right ? When you disconnect billing how do you assign value ?

Real value is derived from supply/demand. There just aren’t enough of us to cover all the surgery this country has an appetite for. Less surgery means less big juicy facilities fees. That’s why we command salaries that exceed what we can reasonably bill for and will continue to do so until that dynamic shifts.
 
Real value is derived from supply/demand. There just aren’t enough of us to cover all the surgery this country has an appetite for. Less surgery means less big juicy facilities fees. That’s why we command salaries that exceed what we can reasonably bill for and will continue to do so until that dynamic shifts.

Ok so what portion of the facility fee are we credited for ? 10 percent ? 50 percent?

I can get the same facility fee with a crna in every room

If the only offer in town is 300k do you move your family ?

Why don’t they pay us 800k since we generate so much facility fee?

Right now the market is set by alternatives to hospital employment for docs. Once PP goes away and there are no alternatives, we have no power to negotiate unless we are willing to walk away from low numbers.. and CRNAs will take those numbers
 
Ok so what portion of the facility fee are we credited for ? 10 percent ? 50 percent?

I can get the same facility fee with a crna in every room

If the only offer in town is 300k do you move your family ?

Why don’t they pay us 800k since we generate so much facility fee?

Right now the market is set by alternatives to hospital employment for docs. Once PP goes away and there are no alternatives, we have no power to negotiate unless we are willing to walk away from low numbers..


Nurses are hospital employed and they have power to negotiate.
 
If all anesthesia groups become hospital employed and disconnected from billing, what determines the market rate for our services?

For now hospitals are paying what we consider to be market rate. Maybe this is because there are PP alternatives that docs could go to instead of hospital employment and therefore the hospital has to compete ..

But if there is no PP group, everyone is hospital employed, what’s stopping the hospitals from paying us 250k annually? I mean that’s what you guys bill for so it seems fair right ? When you disconnect billing how do you assign value ?
It's called supply and demand.
 
It's called supply and demand.

Lol yes but there is an abundant supply of equivalent providers willing to work for less is my point , we’re going to be paid like ER / ICU docs soon
 
Nurses are hospital employed and they have power to negotiate.

Imo nurses are treated horrible by hospitals and this would argue against hospital employment being a good thing
 
Or until everyone is hospital employed and they collectively collude to drive down salaries.

We probably need a union. Hate even saying that out loud.

Make the money while you can.
This will be the only way if you're hospital employed, you would need at least half the people willing to walk, and some would accept lower salaries rather disrupt work/life/family. The thing that anesthesia has is that it's the bottleneck for the money making parts (surgeries) for the hospital, the group has to be tightly knit with people willing to negotiate hard with the hospital.
One very large and aggressive community hospital I worked (in a not extremely desirable area) was known for trying to own every specialty over the years. Eventually they self-employed when they wouldn't renegotiate with the PP anesthesia group. It was great for a few years for the employed docs, the locums all did the nights and weekends, big sign on and salary. The hospital had to shift money from radiology and surgery which pissed them off. Over the long term though I would bet that money is getting shifted back, that group now has to keep their eye on the ball and try to predict where it's heading; the person looking has to look at timing and decide when to take a job and when to walk, not feasible for all.
 
Lol yes but there is an abundant supply of equivalent providers willing to work for less is my point , we’re going to be paid like ER / ICU docs soon


It depends on the region. In the neighborhood surrounding our hospital, a 700SF 1BR apartment rents for $3000-4500/mo. Once they start having kids and want to buy a house, it’ll likely cost at least $10-15K/month for housing. There is an income floor that even young new grad CRNAs would accept to live and work around here. COL is a barrier to a flood of low cost workers.
 
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Or until everyone is hospital employed and they collectively collude to drive down salaries.

We probably need a union. Hate even saying that out loud.

Make the money while you can.
That’s highly illegal, doesn’t happen in fields with the numbers we push
 
Lol yes but there is an abundant supply of equivalent providers willing to work for less is my point , we’re going to be paid like ER / ICU docs soon
Abundant and willing providers? Someone should send them our way. Can’t get crnas here for less than 250k no call
 
How is it illegal?
Collective collusion to drive down salaries is illegal. It’s in the Sherman anti trust act and there’s tons of precedent about it. If the hospitals negotiate as a group then they must negotiate against another entity like a union as far as I know. Otherwise free market competition
 
Lol yes but there is an abundant supply of equivalent providers willing to work for less is my point , we’re going to be paid like ER / ICU docs soon

I’m still trying to figure out where this abundant supply of workers is coming from that’s going to drive down wages. We’re estimated to be about 6000 anesthesiologists AND 12000 CRNAs short of anticipated needs over the next 10 years.
 
I’m still trying to figure out where this abundant supply of workers is coming from that’s going to drive down wages. We’re estimated to be about 6000 anesthesiologists AND 12000 CRNAs short of anticipated needs over the next 10 years.

Agree there is a shortage. But that doesn’t necessarily translate to higher wages in healthcare.

Once you lose all PPs, hospitals have complete control and can turn the screws. Let’s not hire more docs, let’s make the ratios 1:8 and put the other docs in a room by themselves. Genius!

Your controlling entity is now not a physician but an admin with little respect for our autonomy and importance. And although hospital employment makes a lot of sense right now, I do question if it’s the right move long term to just throw up our hands and say, forget billing for our services! We just can’t make it work! Why don’t we just try to make it work and regulate insurance companies in order to maintain our autonomy and not pass the bill on to the (untrustworthy) hospital..

Seems like the easy move but not necessarily the right move.

I’ve been through a hospital take over and I’m sure while some are fine some are not.

If you told this Springfield group they could remain private with a 15% increase from insurance payers vs be taken over by the hospital via asking for subsidy , I’m sure they would choose to remain independent. And who suffers ? United healthcare? Sorry not sorry . Pay us fairly and let us remain independent
 
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but the options for employment these days are AMC, hospital employed, or pp. true pp groups are rare and stuck in the past with 2-3 year partnership tracks at reduced salaries.

AMC is the worst as their profit cuts run from 18% (lowest I’ve heard) to 40% (highest I’ve heard). That’s lots of $ for a middle man who can no longer negotiate better rates and have allegedly been collectively colluding to keep rates high (and salaries low) with local monopolies.
True pp is the best deal IF everyone is paid the same - financial partner from day one or on board certification - I did not find any of these groups in my job search - sevos group is the only one I know. Most pp jobs want a 2 to even 3 year buy in - that’s ridiculous - the only way you can get away with that these days is by maintaining a local monopoly in a desirable area.
That leaves hospital employed. Hospital admin often suck - but the contracts are often more black and white with number of hours and call spelled out with extra $ for extra work. No middle men mean the hospital can pass the $ along in salary and benefits to the people doing the work. It can also be more efficient as staffing for ORs and anesthesia can be better matched.
 
Agree there is a shortage. But that doesn’t necessarily translate to higher wages in healthcare.

Once you lose all PPs, hospitals have complete control and can turn the screws. Let’s not hire more docs, let’s make the ratios 1:8 and put the other docs in a room by themselves. Genius!

Your controlling entity is now not a physician but an admin with little respect for our autonomy and importance. And although hospital employment makes a lot of sense right now, I do question if it’s the right move long term to just throw up our hands and say, forget billing for our services! We just can’t make it work! Why don’t we just try to make it work and regulate insurance companies in order to maintain our autonomy and not pass the bill on to the (untrustworthy) hospital..

Seems like the easy move but not necessarily the right move.

I’ve been through a hospital take over and I’m sure while some are fine some are not.

If you told this Springfield group they could remain private with a 15% increase from insurance payers vs be taken over by the hospital via asking for subsidy , I’m sure they would choose to remain independent. And who suffers ? United healthcare? Sorry not sorry . Pay us fairly and let us remain independent
While the bold is true- Think child psych, rheumatology, etc., etc.,
As long as the ORs are the cash cow of the hospital, They will pay up to keep them open. Should that change we will have a problem. Also relaxing screening and training rules for importing large numbers of international anesthesiologists would be a problem. Maybe brutal and sweeping national legislation on tort reform. But absent something like the above...Things look pretty good for at least a few years on a national basis. Lots of local variation.
 
Collective collusion to drive down salaries is illegal. It’s in the Sherman anti trust act and there’s tons of precedent about it. If the hospitals negotiate as a group then they must negotiate against another entity like a union as far as I know. Otherwise free market competition
The collusion doesn't need to be explicit though. It can be tacit collusion. Traditional antitrust laws are ill-equipped to deal with implicit collusion because there is no explicit agreement or direct communication.

Similar to what is happening in the poultry market, companies use algorithms/data/AI to monitor competitors' prices in real time and automatically adjust their own prices to match or slightly undercut them. This can result in a form of "shadow collusion," where competitors avoid price wars, sustaining artificially high prices (or lower salaries) without direct communication.
 
Or until everyone is hospital employed and they collectively collude to drive down salaries.

Illegal, but people and corporations do illegal things. 🙁

We probably need a union. Hate even saying that out loud.

Isn't that what a private anesthesia group is when it negotiates for a stipend from a hospital?
 
The collusion doesn't need to be explicit though. It can be tacit collusion. Traditional antitrust laws are ill-equipped to deal with implicit collusion because there is no explicit agreement or direct communication.

Similar to what is happening in the poultry market, companies use algorithms/data/AI to monitor competitors' prices in real time and automatically adjust their own prices to match or slightly undercut them. This can result in a form of "shadow collusion," where competitors avoid price wars, sustaining artificially high prices (or lower salaries) without direct communication.
Seems like your example is a benefit to the consumer, am I missing something there?

And tacit collusion on wage fixing would be a pretty high risk conspiracy for a group of hospital admins made of dozens of individuals to engage in. That sort of thing will land you in prison and stripped from ever working in an industry again.

I doubt it happens or would happen the way you presume it would. Too high risk for the involved parties that are already killing it financially. All it takes is a single allegation to bring all of the paper trail to light, and it would be very obvious, but also very dumb, because hospital systems don’t exactly want to work with each other.

Any hospital that sees other hospitals underpaying critical staff for profitable business would immediately pay just a little more to bring people in. They’ll pay as little as possible, but definitely will compete within reason to get profitable staff in.
 
Also relaxing screening and training rules for importing large numbers of international anesthesiologists would be a problem.
It is already happening I my state (Midwest).

The collusion doesn't need to be explicit though. It can be tacit collusion.
Paying at MGMA percentage anyone?

Any hospital that sees other hospitals underpaying critical staff for profitable business would immediately pay just a little more to bring people in. They’ll pay as little as possible, but definitely will compete within reason to get profitable staff in.
And this is where our power still can be. Say f-u to extended medical supervision. Say no to running additional non-emergent rooms. Basically we need to collectively grow spines and stand up for ourselves.
 
Seems like your example is a benefit to the consumer, am I missing something there?
It depends what context you're talking about but the dynamics work similarly. For the consumer, the few incumbent companies (this sort of tacit collusion generally happens in oligopolies) would ratchet prices upwards. See below:

"Antitrust has a long history with agriculture and the poultry industry, although the way it's being viewed and enforced has been changing recently. But that's only one side of the story, because even as antitrust evolves, the way companies run their businesses has evolved too. A lot.

When the Sherman Act and the Clayton Act and the Packers and Stockyards Act were all created, the middlemen of America were smaller and not as technically sophisticated, obviously. If you're going to influence prices, you're probably doing it in a back room somewhere, smoking a cigar, probably playing poker.

But today, companies have a host of new data sources and tech-powered tools to run their businesses. And when it comes to chicken and souped up data sources, we have to talk about agrostats.

And this company collects real-time proprietary data from all of the meatpacking producers in a given market, whether it's pork or poultry or chicken or turkey. And they put all this data in these giant books, and they give them out to these various competitors, which now have basically a setup of everything that their competitors are doing, including their price, including their supply, including every single thing part of their market. And now they can know that, oh, I can probably raise my price because I'm under price relative to my competitor, but I won't lose market share because my competitor is charging more for this product.

The idea, and this is something that we're seeing in many aspects of our economy, is that when large companies share competitively sensitive information, using often faceless intermediaries, that sharing of information can result in higher prices to consumers, but it could also result in depriving, in this instance, family farmers and others of a fair return on investment.

But what we are encountering now is almost a supercharging of data sharing and coordination. And so the use of technology and intermediaries has created the opportunity for companies to contribute information, for example, to a central database or service, and have that service essentially perform the function of coordinating and using that data to help those companies extract higher prices or offer lower returns to people who are selling their goods and services.”

In the case of physician wages being suppressed by tacit collusion among the incumbent employers, employers in the healthcare industry often rely on shared compensation benchmarking tools and reports, which aggregate salary data across institutions. These tools provide visibility into "market rates," which can create a focal point for salaries that all companies use to set their pay structures. If all incumbents adhere closely to the same benchmarks, it can suppress upward pressure on wages or just gradually lower them over time.

Large incumbents often use their market power and data to influence policy or lobby for regulations that disadvantage smaller competitors or independent practitioners. This reduces external competitive pressure to raise salaries.

And tacit collusion on wage fixing would be a pretty high risk conspiracy for a group of hospital admins made of dozens of individuals to engage in. That sort of thing will land you in prison and stripped from ever working in an industry again.
That's if they are found guilty which seems difficult. Tacit collusion does not involve explicit agreements, written contracts, or direct communication between companies. Instead, it occurs when companies independently adopt strategies that result in similar outcomes (e.g., suppressing wages) by observing each other's behavior or using shared market data. Without clear evidence of intentional coordination, proving collusion becomes almost impossible. Similar business practices driven by market forces, benchmarking, or AI systems are not illegal unless there’s evidence of intentional coordination. Courts typically require proof of an agreement or concerted action, which is absent in tacit collusion.

Many companies use the same third-party vendors for salary benchmarking, market analytics, or workforce planning. This creates shared knowledge of "market norms," which can align behaviors without any explicit interaction.

Industry-standard compensation surveys or data platforms (e.g., MGMA reports in healthcare) create natural focal points for salaries. Companies setting their wages around these benchmarks are not inherently acting illegally, even if the result suppresses salaries.

Current antitrust laws are designed to address explicit collusion (e.g., price-fixing agreements) and are less effective at regulating tacit behaviors. Regulators often lack the tools, resources, or expertise to detect and prove subtle forms of tacit collusion. Companies may argue that their practices are legitimate responses to market conditions, such as physician oversupply or reimbursement constraints, rather than intentional wage suppression.
 
Any hospital that sees other hospitals underpaying critical staff for profitable business would immediately pay just a little more to bring people in. They’ll pay as little as possible, but definitely will compete within reason to get profitable staff in.
I think you observe this happening in regions where there are a larger number of smaller competitors. If we look at specialties like hospitalists or family medicine in desirable locations such as Southern or Northern California where Sutter Health and Kaiser have achieved market dominance, the W2 offers are all pretty similar and don't really keep up with inflation
 
It depends what context you're talking about but the dynamics work similarly. For the consumer, the few incumbent companies (this sort of tacit collusion generally happens in oligopolies) would ratchet prices upwards. See below:

"Antitrust has a long history with agriculture and the poultry industry, although the way it's being viewed and enforced has been changing recently. But that's only one side of the story, because even as antitrust evolves, the way companies run their businesses has evolved too. A lot.

When the Sherman Act and the Clayton Act and the Packers and Stockyards Act were all created, the middlemen of America were smaller and not as technically sophisticated, obviously. If you're going to influence prices, you're probably doing it in a back room somewhere, smoking a cigar, probably playing poker.

But today, companies have a host of new data sources and tech-powered tools to run their businesses. And when it comes to chicken and souped up data sources, we have to talk about agrostats.

And this company collects real-time proprietary data from all of the meatpacking producers in a given market, whether it's pork or poultry or chicken or turkey. And they put all this data in these giant books, and they give them out to these various competitors, which now have basically a setup of everything that their competitors are doing, including their price, including their supply, including every single thing part of their market. And now they can know that, oh, I can probably raise my price because I'm under price relative to my competitor, but I won't lose market share because my competitor is charging more for this product.

The idea, and this is something that we're seeing in many aspects of our economy, is that when large companies share competitively sensitive information, using often faceless intermediaries, that sharing of information can result in higher prices to consumers, but it could also result in depriving, in this instance, family farmers and others of a fair return on investment.

But what we are encountering now is almost a supercharging of data sharing and coordination. And so the use of technology and intermediaries has created the opportunity for companies to contribute information, for example, to a central database or service, and have that service essentially perform the function of coordinating and using that data to help those companies extract higher prices or offer lower returns to people who are selling their goods and services.”

In the case of physician wages being suppressed by tacit collusion among the incumbent employers, employers in the healthcare industry often rely on shared compensation benchmarking tools and reports, which aggregate salary data across institutions. These tools provide visibility into "market rates," which can create a focal point for salaries that all companies use to set their pay structures. If all incumbents adhere closely to the same benchmarks, it can suppress upward pressure on wages or just gradually lower them over time.

Large incumbents often use their market power and data to influence policy or lobby for regulations that disadvantage smaller competitors or independent practitioners. This reduces external competitive pressure to raise salaries.


That's if they are found guilty which seems difficult. Tacit collusion does not involve explicit agreements, written contracts, or direct communication between companies. Instead, it occurs when companies independently adopt strategies that result in similar outcomes (e.g., suppressing wages) by observing each other's behavior or using shared market data. Without clear evidence of intentional coordination, proving collusion becomes almost impossible. Similar business practices driven by market forces, benchmarking, or AI systems are not illegal unless there’s evidence of intentional coordination. Courts typically require proof of an agreement or concerted action, which is absent in tacit collusion.

Many companies use the same third-party vendors for salary benchmarking, market analytics, or workforce planning. This creates shared knowledge of "market norms," which can align behaviors without any explicit interaction.

Industry-standard compensation surveys or data platforms (e.g., MGMA reports in healthcare) create natural focal points for salaries. Companies setting their wages around these benchmarks are not inherently acting illegally, even if the result suppresses salaries.

Current antitrust laws are designed to address explicit collusion (e.g., price-fixing agreements) and are less effective at regulating tacit behaviors. Regulators often lack the tools, resources, or expertise to detect and prove subtle forms of tacit collusion. Companies may argue that their practices are legitimate responses to market conditions, such as physician oversupply or reimbursement constraints, rather than intentional wage suppression.
I suppose you could argue that anesthesia wages are being suppressed but to me it doesn’t seem to be the case. Most of the wage suppression I see comes from places with partnership tracks that people know full well underpay them for a long period.

Academics is hard to argue due to the lower workload that is generally seen there and the benefits packages almost getting up to reasonable compensation for each area.

I don’t think that this sort of wage suppression is occurring how you think it is. If hospital administrators are what we talk about on this forum, I find it doubtful they’d be able to use some sort of complex analysis of market compensation data to keep wages down across systems for an entire city or region. There’s also the issue that we are free to do locum tenens and there isn’t any wage suppression going on there except what we tolerate.

If this is common practice I’d be interested to know how you know about it and any examples you’ve got that are widely reported. If it’s out there then I’m surprised that it isn’t investigated, unless the tacit collusion isn’t substantially lowering wages for a region. Most places wages are going up and up in anesthesia. No room to collude when you’re trying to compete
 
I suppose you could argue that anesthesia wages are being suppressed but to me it doesn’t seem to be the case. Most of the wage suppression I see comes from places with partnership tracks that people know full well underpay them for a long period.

Academics is hard to argue due to the lower workload that is generally seen there and the benefits packages almost getting up to reasonable compensation for each area.

I don’t think that this sort of wage suppression is occurring how you think it is. If hospital administrators are what we talk about on this forum, I find it doubtful they’d be able to use some sort of complex analysis of market compensation data to keep wages down across systems for an entire city or region. There’s also the issue that we are free to do locum tenens and there isn’t any wage suppression going on there except what we tolerate.

If this is common practice I’d be interested to know how you know about it and any examples you’ve got that are widely reported. If it’s out there then I’m surprised that it isn’t investigated, unless the tacit collusion isn’t substantially lowering wages for a region. Most places wages are going up and up in anesthesia. No room to collude when you’re trying to compete
This has literally happened in Academic Radiology.

Step 1. The academic places come up with a “new” pay and productivity survey. Let’s call it AAARAD.

Step 2. The colluders only survey themselves and other allies to provide “selected” data. This data on compensation and expected productivity is locked behind not only a paywall but also behind required membership in a nebulous administrators professional society.

Step 3. Once enough manufactured data has been compiled, everyone benchmarks radiology to those numbers

Step 4. Done. Implicit collusion via wage suppression. “We target 75th of AAARAD” sounds good but AAARAD has been artificially constructed to be super low.

PostScript. Someone accidentally sent me a copy of AAARAD for 2023. Hilariously their 50th percentile productivity for academic rads is the same as median private practice rad MGMA wRVU. Yet the pay is much less.
 
This has literally happened in Academic Radiology.

Step 1. The academic places come up with a “new” pay and productivity survey. Let’s call it AAARAD.

Step 2. The colluders only survey themselves and other allies to provide “selected” data. This data on compensation and expected productivity is locked behind not only a paywall but also behind required membership in a nebulous administrators professional society.

Step 3. Once enough manufactured data has been compiled, everyone benchmarks radiology to those numbers

Step 4. Done. Implicit collusion via wage suppression. “We target 75th of AAARAD” sounds good but AAARAD has been artificially constructed to be super low.

PostScript. Someone accidentally sent me a copy of AAARAD for 2023. Hilariously their 50th percentile productivity for academic rads is the same as median private practice rad MGMA wRVU. Yet the pay is much less.
Academic radiology is not the same work as private practice radiology. Overreading is substantially less onerous.
 
Academic radiology is not the same work as private practice radiology. Overreading is substantially less onerous.
No. I have to differ there.

It’s much like you guys “sitting your own cases”
Vs working 4:1 coverage or whatever.

If you give a damn about quality, over reading is harder because you have to double check everything the resident or fellow did.

And when I’m covering residents it’s often 3 or 4:1.
 
No. I have to differ there.

It’s much like you guys “sitting your own cases”
Vs working 4:1 coverage or whatever.

If you give a damn about quality, over reading is harder because you have to double check everything the resident or fellow did.

And when I’m covering residents it’s often 3 or 4:1.
Yes, and I’m sure you’re overreading the real time trauma scans overnight, just like academic anesthesia attendingd are always present and involved in overnight appendectomy inductions and epidurals.

There’s a reason that less productive people tend towards academics in nearly every specialty
 
Yes, and I’m sure you’re overreading the real time trauma scans overnight, just like academic anesthesia attendingd are always present and involved in overnight appendectomy inductions and epidurals.
At my shop they absolutely are, too many errors without the final read.

And absolutely yes, we are there for every case.
 
Yes, and I’m sure you’re overreading the real time trauma scans overnight, just like academic anesthesia attendingd are always present and involved in overnight appendectomy inductions and epidurals.

There’s a reason that less productive people tend towards academics in nearly every specialty

Uh yes. Have you not seen the lawsuits over independent resident call? Medicine has changed. Independent overnight resident call is vanishingly rare.
 
I suppose you could argue that anesthesia wages are being suppressed but to me it doesn’t seem to be the case. Most of the wage suppression I see comes from places with partnership tracks that people know full well underpay them for a long period.

Academics is hard to argue due to the lower workload that is generally seen there and the benefits packages almost getting up to reasonable compensation for each area.

I don’t think that this sort of wage suppression is occurring how you think it is. If hospital administrators are what we talk about on this forum, I find it doubtful they’d be able to use some sort of complex analysis of market compensation data to keep wages down across systems for an entire city or region. There’s also the issue that we are free to do locum tenens and there isn’t any wage suppression going on there except what we tolerate.

If this is common practice I’d be interested to know how you know about it and any examples you’ve got that are widely reported. If it’s out there then I’m surprised that it isn’t investigated, unless the tacit collusion isn’t substantially lowering wages for a region. Most places wages are going up and up in anesthesia. No room to collude when you’re trying to compete

I don’t think it’s happening to anesthesia nearly as much as other specialties like EM, hospitalists, and FM but if this thread on Springfield serves as a canary, it could be coming for anesthesia, albeit gradually over the next couple of years.

And I don’t think the analysis needs to be all that complex, at least not to the extent that it requires the incumbent employers to spend an enormous amount of time or resources to rig the game in their favor.

Wrt widespread reporting, this is already happening in medicine. It’s just hard to point at the colluders holding a smoking gun bc it’s tacit and not explicit. Heck, the larger employers can even be at each others’ throats wrt acquiring market share and STILL lower physician salaries in lockstep. Many physicians will just accept the offers as “the way things are.”
 
The majority of Anesthesiologists I know making $1 million or more are doing locums or 1099 work. Salaried jobs are typically just 1/2 the year at most for these doctors. The shortage has created a fantastic opportunity for those willing to hustle and travel for work. 2024 and 2025 are truly the golden years for those willing to exploit the staffing shortages nationwide. The tables have turned in terms of negotiating power; eventually they will turn again in favor of the hospitals. When will that happen? I don't know but predicting the timing is very difficult.

Anyone working more than 50 hours per week for "median wage" is being foolish in my opinion or locked into their job for personal/geographic reasons.
Median pay is now another name for a 40 hour per week job with minimal or no call. That's the reality of this job market. Like many of you I get 3-4 texts per day for locums opportunities nationwide. That shows there is a huge demand for our services, demands that aren't being met. Hence, anyone can set a high hourly wage and likely one of the facilities will agree to it.

All it takes to succeed in this market are the following: Board Certification, 1 malpractice case or less, 1/2 a brain, minimal skill set and a willingness to travel to various locations.
 
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All it takes to succeed in this market are the following: Board Certification, 1 malpractice case or less, 1/2 a brain, minimal skill set and a willingness to travel to various lolocations.
AND no history of addiction.
 
Yep. That is the is the explicit rule of our institution. Likewise, no induction without an attending.
Regardless, not having to do anything and having competent help means the job is substantially easier.

Same goes for most radiology programs too. The idea that attending are overreading in real time overnight is laughable at higher level institutions. It’s a retirement job for most people or a job for incompetents where the residents are better than the attendingd on average.
 
Regardless, not having to do anything and having competent help means the job is substantially easier.

Same goes for most radiology programs too. The idea that attending are overreading in real time overnight is laughable at higher level institutions. It’s a retirement job for most people or a job for incompetents where the residents are better than the attendingd on average.
I advise you talk to people who actually work in these places now not those who trained 10+ years ago.

There has been a sea change in resident oversight expectations, mainly due to nuclear malpractice lawsuits.

But also, residents have filed qui tam lawsuits over insufficient supervision. I am personally familiar with this case which had details changed for publication.

 
I advise you talk to people who actually work in these places now not those who trained 10+ years ago.

There has been a sea change in resident oversight expectations, mainly due to nuclear malpractice lawsuits.

But also, residents have filed qui tam lawsuits over insufficient supervision. I am personally familiar with this case which had details changed for publication.

I advise you talk to people who actually work in these places now not those who trained 10+ years ago.

There has been a sea change in resident oversight expectations, mainly due to nuclear malpractice lawsuits.

But also, residents have filed qui tam lawsuits over insufficient supervision. I am personally familiar with this case which had details changed for publication.

If what you say is true, then you’re absolutely underpaid for what you’re doing in academics. I’d advise looking for a new job where you’ll be fairly compensated for your work. There are ample opportunities available to do so if you feel the compensation is unfair.

However, there are other benefits to academic practice to consider as an intangible benefit that’s worth some amount of money. Things , like educational fulfillment, scheduling flexibility, and general collegiality and work environment. Many of those things are lacking in non academic practices, which increases the need for financial compensation in them.
 
yep. I’m looking right now. Academics as a business model is in serious trouble.

Unfortunately, when they collapse, they will be the ones to bring midlevels into radiology.
 
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