The Hammer of Doom and Gloom

[FulfilledDeer]

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So I certainly understand that times they are a-changin', but I curious when people think the hammer will fall? I'm an MS-2 and I feel so bad for the MS-4's because it seems like they're necessarily going in blind to a lot of things. But will it be any different for me? What is the first class that will graduate with a somewhat clearer picture of the immediate future of the specialty?

Also, tangentially, how's the outlook for academic anesthesia? I don't seem to read a lot about that on these boards.

 

[shopsteward]

So I certainly understand that times they are a-changin', but I curious when people think the hammer will fall? I'm an MS-2 and I feel so bad for the MS-4's because it seems like they're necessarily going in blind to a lot of things. But will it be any different for me? What is the first class that will graduate with a somewhat clearer picture of the immediate future of the specialty?

It's the future. We're all blind to it all the time, and it was ever thus.

 

[BLADEMDA]

So I certainly understand that times they are a-changin', but I curious when people think the hammer will fall? I'm an MS-2 and I feel so bad for the MS-4's because it seems like they're necessarily going in blind to a lot of things. But will it be any different for me? What is the first class that will graduate with a somewhat clearer picture of the immediate future of the specialty?

Also, tangentially, how's the outlook for academic anesthesia? I don't seem to read a lot about that on these boards.

There is no "hammer" per se but rather a slow, continual progression towards an employment model. This means that over the next 10 years the majority of Anesthesiologists will be working for a Management Company or a Hospital organization.
The result of this "employment" model is a decrease in mean income to a level just above academic pay.

The way to view the situation is a continuous drip from a faucet rather than turning the water on full force. How can you stop the leak? You can't stop it but you can look for the few remaining independent practices and hope they offer you a FAIR partnership track with inclusion for a payout if a buyout occurs.

Academic anesthesia looks strong going forward with only a leveling off of pay increases; a fellowship is usually required to advance in academia.

 

[aneftp]

So I certainly understand that times they are a-changin', but I curious when people think the hammer will fall? I'm an MS-2 and I feel so bad for the MS-4's because it seems like they're necessarily going in blind to a lot of things. But will it be any different for me? What is the first class that will graduate with a somewhat clearer picture of the immediate future of the specialty?

Also, tangentially, how's the outlook for academic anesthesia? I don't seem to read a lot about that on these boards.

The real question you need to ask yourself as a med student is is the future of USA medicine in trouble.

As a med student you guys may be in the biggest trouble of them all.

Think about that.

There will be cuts for almost everyone. Would people go into ortho if they were going to make 250-300k max? Everything is relative.

Everything is cyclical. GI and cards docs were going back into internal medicine in the mid 90s. Why? Their incomes took a noise dive.

As an MS-2 you applied for med school after the ACA was passed. You are the first class to graduate with a clear picture of medicine in general.

 

[BLADEMDA]

 

[FulfilledDeer]

There is no "hammer" per se but rather a slow, continual progression towards an employment model. This means that over the next 10 years the majority of Anesthesiologists will be working for a Management Company or a Hospital organization.
The result of this "employment" model is a decrease in mean income to a level just above academic pay.

The way to view the situation is a continuous drip from a faucet rather than turning the water on full force. How can you stop the leak? You can't stop it but you can look for the few remaining independent practices and hope they offer you a FAIR partnership track with inclusion for a payout if a buyout occurs.

Academic anesthesia looks strong going forward with only a leveling off of pay increases; a fellowship is usually required to advance in academia.

Oh, I was mistaken then. For some reason I thought there was going to be something...acute. That's depressing. It's like I'm tasked with holding grains of sand to determine my salary. The more in my hands, the bigger my salary. But I have to hold them for 7 more years.

I actually have a question about academics: I can look up salaries of state school doctors (for example, California) online. Their base pay is dismal. But they get an extra bump which puts most of them into decent pay ($300-ish, with the chair at like $600ish). I'm led to believe that is grants for research. Is that accurate?

The real question you need to ask yourself as a med student is is the future of USA medicine in trouble.

As a med student you guys may be in the biggest trouble of them all.

Think about that.

That's a tiny bit nebulous, can you be a bit more specific? I mean, yeah, the future of medicine is in trouble. I certainly went in knowing that. It's a question of degree, but I'm confortable with most of the projections I hear. But I wasn't really aware going in that anesthesiology was going to be hit the hardest. It's definitely one of my top choices right now, but the disproportionate pay decreases (not to mention encroachment) make me think maybe I should look elsewhere.

 

[IlDestriero]

I actually have a question about academics: I can look up salaries of state school doctors (for example, California) online. Their base pay is dismal. But they get an extra bump which puts most of them into decent pay ($300-ish, with the chair at like $600ish). I'm led to believe that is grants for research. Is that accurate?

Academic salary is very variable from center to center.
Chairs of big centers can certainly make around $1m, but don't expect to rise to that level.
Posted salaries may not include incentive compensation for call, production bonuses, etc. They can offer generous benefits, retirement, malpractice, tail coverage, tuition plans, other perks, etc. Those jobs also tend to be very stable and secure as well. Academic/admin time off, limited call, etc. That all has value.
You need to research each job you might be interested in and determine the total value of the package. You might be surprised, though probably not in CA.
Someone ecstatic about their 400k 1099 offer might be significantly better off with their other only $300k academic offer in the long run.
And not all academic jobs pay poorly either. Especially in comparison to non partner track or employed positions.
YMMV.

 

[FulfilledDeer]

Academic salary is very variable from center to center.
Chairs of big centers can certainly make around $1m, but don't expect to rise to that level.
Posted salaries may not include incentive compensation for call, production bonuses, etc. They can offer generous benefits, retirement, malpractice, tail coverage, tuition plans, other perks, etc. Those jobs also tend to be very stable and secure as well. Academic/admin time off, limited call, etc. That all has value.
You need to research each job you might be interested in and determine the total value of the package. You might be surprised, though probably not in CA.
Someone ecstatic about their 400k 1099 offer might be significantly better off with their other only $300k academic offer in the long run.
And not all academic jobs pay poorly either. Especially in comparison to non partner track or employed positions.
YMMV.

Ah, thanks! It's a bit far off for me, but it's good to hear some of this stuff now. If this is the case, I guess I should be expecting academics to get much more competitive in 7-ish years.

 

[IlDestriero]

Good jobs are competitive now.
We have many qualified applicants for each available position, and that's just the ones we interview.

 

[aneftp]

Academic salary is very variable from center to center.
Chairs of big centers can certainly make around $1m, but don't expect to rise to that level.
Posted salaries may not include incentive compensation for call, production bonuses, etc. They can offer generous benefits, retirement, malpractice, tail coverage, tuition plans, other perks, etc. Those jobs also tend to be very stable and secure as well. Academic/admin time off, limited call, etc. That all has value.
You need to research each job you might be interested in and determine the total value of the package. You might be surprised, though probably not in CA.
Someone ecstatic about their 400k 1099 offer might be significantly better off with their other only $300k academic offer in the long run.
And not all academic jobs pay poorly either. Especially in comparison to non partner track or employed positions.
YMMV.

Oh yeah. I am seriously thinking about getting back into academics after being 1099 for the past 7 years.

Some state schools benefits are trendmendous. Healthcare is essentially free if you use their health system. By free. I mean zero deductible and zero premiums for the family. Even if go outside the system my deducuble for family is only $3000. They pay my auto insurance. My homeowners insurance. I get a total of 46 paid days off including paid liberal scheduled sick leave and cme. Call is once every 14-15 days. One weekend call every 6 weeks.

Complete immunity from lawsuit. They have to drop me from lawsuit in order for case to proceed. Malpractice obviously is included.

We are talking easily $80-100k worth of benefits here. (For example my occurrence malpractice premiums alone for same policy would be at least 25k a year and my own family Heath insurance premiums are already 10k a year soon to be $14k thanks to obamacare with a $7000 deductible for 2014.

Plus work hours in academics are around 50 hours a week but its pretty easy work. A lot of ineffiencies in state hospitals.

An academic job paying 260k-300k is similar to a 350-400k 1099 job with much more stability.

 

[aneftp]

Oh, I was mistaken then. For some reason I thought there was going to be something...acute. That's depressing. It's like I'm tasked with holding grains of sand to determine my salary. The more in my hands, the bigger my salary. But I have to hold them for 7 more years.

I actually have a question about academics: I can look up salaries of state school doctors (for example, California) online. Their base pay is dismal. But they get an extra bump which puts most of them into decent pay ($300-ish, with the chair at like $600ish). I'm led to believe that is grants for research. Is that accurate?






That's a tiny bit nebulous, can you be a bit more specific? I mean, yeah, the future of medicine is in trouble. I certainly went in knowing that. It's a question of degree, but I'm confortable with most of the projections I hear. But I wasn't really aware going in that anesthesiology was going to be hit the hardest. It's definitely one of my top choices right now, but the disproportionate pay decreases (not to mention encroachment) make me think maybe I should look elsewhere.

Oregon just passed law requiring private insurance to pay NPs and PAs in independent practice the same as FPs and Internal med/Peds in July 2013.

How do you think those fields will do?

What's to think NPs and PAs will start invading Emegency medicine. Many EM depts are starting to be run by management companies themselves further cutting salaries.

NPs are starting to do GI procedures and getting formally trained.

 

[FulfilledDeer]

Oregon just passed law requiring private insurance to pay NPs and PAs in independent practice the same as FPs and Internal med/Peds in July 2013.

How do you think those fields will do?

What's to think NPs and PAs will start invading Emegency medicine. Many EM depts are starting to be run by management companies themselves further cutting salaries.

NPs are starting to do GI procedures and getting formally trained.

I see where you're going. I'm not actually sure where those fields are headed. There's the worst case scenario, and a pretty rosy picture, and also somewhere in between. But I strongly, strongly feel there needs to be good research showing nurse =/= doctor. For those fields and others.

I've offered this in another forum once, with no takers, but if anyone has any specific ideas on how to go about this I've got nothing but time on my hands. Okay, that's not entirely accurate, but I'm motivated and have time. It's tough with no specialty knowledge to know where to even begin.