Thoughts on a job with low hourly pay, but very low intensity call

[Mehd School]

Greetings. I'm a new attending that joined a pseudo academic group on the east coast this past August as my first job. Things started off well but recently the floor has been pulled out from under us. A large hospital corporation has bought us out and we are expecting and being warned of sweeping changes in the coming months. Initially this job made a lot of sense to me because of the tremendous schedule flexibility and time off. It is not official yet, but that is likely going away. Because of this, the job I agreed to is effectively going to be a brand new job. New surgeons, new EMR, new support staff. And if I'm being honest, I am not incredibly passionate about training residents (many are great, we just have one particularly weak class that is not great to interact with).

Enter the new job offer. Private practice closer to home/family with atrociously low hourly pay. It is more of a "eat what you kill" practice, not so much in case type but more in you work more, you make more. You work less, you make less. Hourly pay is almost insulting, and is lower than almost any CRNA I know. So after hearing the lady out, who is the chief of this group, she told me this job makes sense because one can easily take a lot of call and not work much. Given the group dynamics you could be on call as much or as little as you want. It's home call, and in a week they average less than 2 cases between the hours of 8pm and 6am. There is OB, but they average 20 deliveries a month. You are effectively paid for your availability at home. They showed me their weekend case logs, and in the past 2 months (8 weekends) there have been 5 cases TOTAL. Now, they are busy during the day. They do cardiac, major vascular, thoracic nearly daily. I was expecting to see a lot of takebacks on the OR case logs and there is the occasional one but it is seemingly rare. It has been this way for years. This group hasn't hired an MD in about six years and recently just lost one to retirement.

So I am highly considering this job. The group, and especially the anesthesia chair has been incredibly transparent. She showed me three of her paystubs and is averaging between 50-60k per month pre tax and has three young children that she says she's able to see every night. My current job, which was previously a "lifestyle" job, is not that anymore. I am working more hours and taking more call than anyone in my group anticipated. I could potentially increase my salary by up to 50% at this other position.

Am I crazy for entertaining a job with such low hourly pay? Benefits are extremely average, but my current benefits are as well. I'm planning on flying to this place to spend a day or two with them and see the nuts and bolts.

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[POW16]

So you're home every night, minimal call back in and clear 50-60K/month. Call frequency, vacation, supervision ratios/own cases? Who gives a sh** what the hourly rate is ?

 

[Ronin786]

50-60k pre tax per month is a 600-720k job/year. Who cares what the hourly pay is if you're making that much at the end of the day and not working much at all. Only downside is being tied to the location when on call.

Questions you need answered is whether there is fair distribution of call, partner track logistics and the dangers of being bought out.

Let me know if you're not taking the job.

 

[NICMAN]

take the job

 

[IMGASMD]

50*12= 600K. That’s not a bad salary by any means.

On how many hours? Per week.
Separate out your time as “working” and “available”. If the result makes sense to you.

I don’t do well with home calls, because there is always a possibility of being called back. But if it’s really as chill as you make it sound, and closer to where you want to be. I think it certainly worth considering.

Good luck.

 

[Mehd School]

Thanks guys. Honestly when I heard the hourly number I internally shut off my brain because it's just a little over half of what I make at my locums gigs currently. But when it was put in context it seemed a lot more attractive. With my job now and a boat load of locums I'm going to make $500k this year. My napkin math says if I worked the same hours I am now I'd make a touch over $600k.

So what I would be giving up is schedule flexibility. But as I mentioned this may be going away anyway as we transition to the new private ownership of my current job. I thought that I wanted to kind of chill out and take as much time off as possible but what I've found out is that I'm young and hungry and want to work a ton to get ahead of my loans and get financially in good shape while I'm still young.

 

[Mehd School]

50*12= 600K. That’s not a bad salary by any means.

On how many hours? Per week.
Separate out your time as “working” and “available”. If the result makes sense to you.

I don’t do well with home calls, because there is always a possibility of being called back. But if it’s really as chill as you make it sound, and closer to where you want to be. I think it certainly worth considering.

Good luck.

So I don't do well with home call either, currently. My hospital now is a busy trauma center and a very busy OB center. We are allowed "home call" if you're within 15 minutes of the hospital, which I currently live. But you get called in basically every single night so I just stay in house anyway. I guess I won't know until I get there but if there's such a low rate of call backs I think I'd be able to deal with it much better at home.

 

[Mehd School]

50-60k pre tax per month is a 600-720k job/year. Who cares what the hourly pay is if you're making that much at the end of the day and not working much at all. Only downside is being tied to the location when on call.

Questions you need answered is whether there is fair distribution of call, partner track logistics and the dangers of being bought out.

Let me know if you're not taking the job.

There are six MD's on staff right now (employed, not partners). I told the chair for me to consider this job I would need her to guarantee me at least 1 week day call each week and at least 1 weekend call each month. If I worked 1 call day per week and 1 weekend per month, and took 8 weeks of vacation per year I would still make >500k. I have been told that of the six MD's, 2 do not want to take any more call so the possibility of taking 2 week day calls is easy. And call is where you start to rake it in. You do get protected post call days but if you come in on your post call day you get minimum $1500 and are likely headed home by 10am or earlier.

 

[IMGASMD]

So I don't do well with home call either, currently. My hospital now is a busy trauma center and a very busy OB center. We are allowed "home call" if you're within 15 minutes of the hospital, which I currently live. But you get called in basically every single night so I just stay in house anyway. I guess I won't know until I get there but if there's such a low rate of call backs I think I'd be able to deal with it much better at home.

You will be making 600, at least right? If monthly is 50-60K. But obviously, if that’s no vacation time and you don’t get paid time off…. Then the months that you do, can be a little bumpy.

Our call back rate is about 10% weekday (after the last case js finished usually by 10pm). Weekend, always have a case or two. And still subject to be called back after those cases are done. Our response time is 30mins, however, our coverage area is pretty large, so it’s basically drop everything you’re doing, and go. But I’ve since found out, I am never the time limiting person in the whole scheme of things.

 

[Mehd School]

You will be making 600, at least right? If monthly is 50-60K. But obviously, if that’s no vacation time and you don’t get paid time off…. Then the months that you do, can be a little bumpy.

Our call back rate is about 10% weekday (after the last case js finished usually by 10pm). Weekend, always have a case or two. And still subject to be called back after those cases are done. Our response time is 30mins, however, our coverage area is pretty large, so it’s basically drop everything you’re doing, and go. But I’ve since found out, I am never the time limiting person in the whole scheme of things.

8 weeks of paid vacation. I could take more but it is not paid time off. I think that currently while I'm young and motivated I would aim to make $600k. One partner apparently took 2-3 week day calls and at least 1 weekend a month and made $800k a few years back. I don't think I'm interested in being on the hook quite that much but it is good to know if needed I could buckle down and make extra money. Most days the OR seems to wrap up around 6-7pm.

 

[BLADEMDA]

8 weeks of paid vacation. I could take more but it is not paid time off. I think that currently while I'm young and motivated I would aim to make $600k. One partner apparently took 2-3 week day calls and at least 1 weekend a month and made $800k a few years back. I don't think I'm interested in being on the hook quite that much but it is good to know if needed I could buckle down and make extra money. Most days the OR seems to wrap up around 6-7pm.

The job is fine but I’m wary with just the chair showing you her income. You should also verify the income with another anesthesiologist just to be certain. If the location works for you the extra call from home is fairly easy at this job

 

[nimbus]

When you say low hourly rate, do you include hours spent on home call in the denominator?

The burden of home call depends on your lifestyle. If you like to go for long hikes in the woods, long runs training for a marathon, spend time on a boat or surfing in the ocean, have a drink every night, etc, then home call can be a drag. If you have young kids and spend most of you time at home anyway, watch Netflix most nights, etc, and childcare is not an issue, home call with a low call in rate can be easily be incorporated into your life.

 

[coffeebythelake]

The chair of the anesthesia dept showing you her income doesn't mean you will make the same!

 

[DirtDocMD]

Is this an 8-3 job, an 8-5 job, or an 8am-8pm job??

 

[Dr. Rude]

The job is fine but I’m wary with just the chair showing you her income. You should also verify the income with another anesthesiologist just to be certain. If the location works for you the extra call from home is fairly easy at this job

Questions:

How many hours per week are you available to be called in?

How many hours per week are you actually in the hospital?

How likely are these numbers to change?

Are your personality/life style/family obligations stressed by having lots of potential need for you to go to work on short notice?

 

[Volatile]

If the call is so “light,” why are there multiple partners not wanting to take call? I agree with speaking to partners other than the chief.

 

[gcc322]

So if one doc is post call and given 8 weeks vacation/year most weeks another will be gone - How does a group of 4 cover a hospital that does major surgical cases, especially cardiac? And no cases on the weekends? That sounds very unusual to me.

So you would be an employee of the group that is owned by the chief, who is going to pay you hourly? I’m guessing she is making significantly more than she told you..and she is making money off you. That’s not a bad thing by any means..just not everyone can accept that fact.

Home call in the right setting is awesome. I take home call and 60% of the time it is great. Spending time with your family, playing golf, mowing your yard….you get paid while doing it! Driving back and forth to the hospital 2-3 times per night on a bad OB call sucks and wears on both you and your family.

It’s definitely worth checking out though.

 

[Mehd School]

If the call is so “light,” why are there multiple partners not wanting to take call? I agree with speaking to partners other than the chief.

Because they have made their money and are in their early 70's. They're entering into retirement slowly and cutting back at their own pace.

 

[Mehd School]

So you would be an employee of the group that is owned by the chief, who is going to pay you hourly? I’m guessing she is making significantly more than she told you..and she is making money off you. That’s not a bad thing by any means..just not everyone can accept that fact.

Home call in the right setting is awesome. I take home call and 60% of the time it is great. Spending time with your family, playing golf, mowing your yard….you get paid while doing it! Driving back and forth to the hospital 2-3 times per night on a bad OB call sucks and wears on both you and your family.

It’s definitely worth checking out though.

Hospital employees. Everyone makes the same hourly. Chief gets two stipends: one for leading the department and the other for making the schedule. She is wanting to pass off the schedule making and stipend to me possibly.

Thank you all for your help and insight. To answer the question regarding one person on vacation at a time and how do they make coverage - lots of PRN call from MD's at outside groups. Call is such low intensity that they have a significant pool of MD's to pull from to cover call when needed. I am going to try to get it put in my contract that I have dibs on call selection over these people. I have already been verbally promised this.

 

[GravelRider]

8 weeks of paid vacation. I could take more but it is not paid time off. I think that currently while I'm young and motivated I would aim to make $600k. One partner apparently took 2-3 week day calls and at least 1 weekend a month and made $800k a few years back. I don't think I'm interested in being on the hook quite that much but it is good to know if needed I could buckle down and make extra money. Most days the OR seems to wrap up around 6-7pm.

Hold on. Something doesn’t make sense here. How are you paid hourly, but also have 8 weeks paid vacation? Do you get a salary and then compensated for call? What about benefits? The job sounds worth looking into, but I’m always wary of jobs where there is a lot of time tied to a “phone/pager.”

 

[Greenbayslacker]

$60k/month and 40 hrs/week = $375/hour

 

[bigdan]

I’m with GravelRider. Something’s up.

You’ve either hit the Lotto with an easy job paying you $720,000/yr, or you’re not going to get paid that much, or it’s not that easy.

Moreover, if they’re not aggressively hiring, will you be working more once those 70 year old non-call taking partners of yours move on to greener (or heavenly) pastures?

I hope you get that bag, brah, but would urge continued due diligence.

 

[Southpaw]

I'm not understanding this job posting - at all. What is your hourly rate, and why are you even being paid hourly? You said 'eat what you kill' and 'paid by the hour' and 'hospital employee'. Hospital employee jobs that I know of give a W2 salary, benefits, and if you work beyond what's in your contract (or pick up call from others) then you make more. You haven't explicitly said what the hourly rate was but were I you I'd wonder why you're being paid by the hour to begin with. I just find it an odd setup, unless you're a locums 1099 worker.

I'm also not sure why the chief would show you her paystubs. I mean, I think the transparency is great, but she gets two stipends, neither of which you should expect for a while after taking this job. You're also already vying to pick up all this extra call (from partners who don't want it, and from others who help this group out) without fully understanding the job.

Is the rate for call different than your in-house rate?

I would look at it this way. Day docs these days (7-3 M-F, no call no weekends no nights) are making 350ish, maybe more for less desired areas. Depending on the setup (hospital employed, AMC, PP, etc.) a call taking doc should expect to make 25-30% more. It sounds to me like the bulk of your salary, if I'm reading the posts correctly, is going to come from call. Now it may be fine and it'll all work out, but if all your money is coming from low volume call I just find it an odd setup and I'd be wondering why the value of daytime work is so low?

I'd just hate for you to sign yourself up for all of this call because you're expecting to make what the chief does and you end up working a ton or getting called in a lot for silly stuff to support the salary.

 

[aneftp]

There is a big difference between 2 cases between 8pm-7am in the morning average. That makes zero sense.

What matters is how many are actually being done after 11pm. If u are being called back for an epidural (some places don’t require in house ob coverage if u are less than 15 min door to door away even with running epidural)

 

[teacher2md]

I agree with others here— if call is so easy, why is it so heavily incentivized?

Hupothetically speaking, what would be your salary if you took a normal amount of call (2 calls/month)?

 

[IlDestriero]

The chair of the anesthesia dept showing you her income doesn't mean you will make the same!

Exactly. My chair makes >x2, though that includes some enterprise level work as well.
The details matter here. Is the hourly rate low and the call compensation very very high? Are you counting hours sitting at home on the weekend on home call in there? Are you working 12+ hour days every day when you’re in the OR?
You’re looking at making over 600k and claim lower than CRNA hourly pay, so something isn’t really adding up for me.
Also, if the call is ridiculously over compensated your partners may decide to vote and change the compensation model to be more fair. You don’t need to offer a huge call stipend to sleep in your bed 90% of the time while others slog it out 7-7 for CRNA rates. The model doesn’t make much sense to me as written here.

 

[Maz777]

Just focus on total expected yearly compensation.

That being said, this compensation model doesn't seem sustainable in the long run. Someone in administration will likely look to cut costs and decrease the call stipend or force you to be in house. Then you are screwed and will be looking for a new job. You aren't going to be making what the Chair makes.

 

[secretasianman]

Just ask to see everyone’s’ w2/1099. If it checks out then go for it? If these guys pushing past 70 are still doing it, then it may be because the money is so worth it.

 

[PpfSuxTube]

Sorry but this doesn't add up to me.
What place has busy major vascular thoracic and cardiac without a lot of takebacks?
Sorry but it doesnt exist...

So it's either not busy, not major or has takebacks...

Hourly rate is isnt the most relevant number. 600 per yr with 8 weeks vacation and not much night work is far more relevant

 

[GassYous]

Just ask to see everyone’s’ w2/1099. If it checks out then go for it? If these guys pushing past 70 are still doing it, then it may be because the money is so worth it.

or they didn't make enough

 

[pgg]

Sorry but this doesn't add up to me.
What place has busy major vascular thoracic and cardiac without a lot of takebacks?

Um

Every hospital that doesn't have fellows and residents operating?

 

[Mehd School]

Thank you to everyone that took the time to reply. It is a strange job in the pay structure. It is a W2 position where you are promised a salary ($425k) but that is essentially a placeholder. Those that work exactly 1 FTE will make that. Those who work more will make more and those who work less will make less because at its core it is an hourly pay structure. Being that this hospital is close to where I grew up, I know a few people that work there and went to high school with one of the general surgeons that operates there. There is typically 1-2 hearts each day, and 1-2 major vascular (aortobifem, fem pop, sometimes open AAA) 4 days per week. The youngest cardiac/vascular surgeon there has been operating for 15 years. They are an experienced group and it is rare for a takeback. With that said I was told there was one on Monday this week so it definitely happens.

You are allotted 8 weeks of paid vacation within your contract that states $425k. With that said, the people making north of $650k I was told take closer to 4 weeks of vacation. And in terms of people saying it would be $325+/hour if you worked 40 hours a week, well that's the issue with this job. You're going to be on the hook for probably 70-100 hours per week to be a high earner but over half of that will be at home on call.

So I am going to continue to pursue this job further and see where it ends up. It makes a lot of sense for where I'm at in my career and my current priorities, and the location change would be great.

Thanks again

 

[psychbender]

Are you calculating the effective hourly rate that you describe as insulting based on in-house AND pager hours? If so, that's where we're getting all confused. The two should not be paid out at the same rate. If I'm an employer, there is no way I'm paying you the same rate to sit at home watching TV and sleeping as I would pay you to generate billable work.

In my old, hospital- employed position, I was paid salary, which they calculated based on 8 hours a day, M-F, 52 weeks a year (vacation was paid). My actual hours worked were not taken into consideration. Sent home at 10am? Paid for an 8-hour day. Worked all day and into the night? Same 8-hour day. Unless I worked over the weekend, my in-house hours, including call, were usually fewer than 40. This system is ok when staffing is sufficient and stable, and work really does average out to close to 40hr/wk. However, lose several colleagues, volume picks up, and that salaried position starts to suck, as the actual hours worked climb above 40, plus additional uncompensated time on pager.

 

[DirtDocMD]

Before you sign anything, I want you to:

1) Look at their daily OR schedules, and see how many rooms are running past 5pm, each day.

2) See if there is some sort of GUARANTEE that you have equal access to these “ EZ home calls”, that insures that it’s not just 2-3 of the senior guys who are getting most of them (not OLD guys, but more seniority than YOU). ALSO, that you are not getting all the WEEKENDS (when you’d like to leave town), while they get all WEEKDAYS (since they’re stuck in town, anyway).

This might be a job that allows lots of flexibility, to make money when you want, or take it easy when you want. Then again, it may be one where they’re trying to stick the “new guy” there til 7pm (which doesn’t get you extra or call pay), everyday, and dump all the weekends and holidays in your lap (which, despite the call pay, gets old FAST).

 

[Mehd School]

Are you calculating the effective hourly rate that you describe as insulting based on in-house AND pager hours? If so, that's where we're getting all confused. The two should not be paid out at the same rate. If I'm an employer, there is no way I'm paying you the same rate to sit at home watching TV and sleeping as I would pay you to generate billable work.

In my old, hospital- employed position, I was paid salary, which they calculated based on 8 hours a day, M-F, 52 weeks a year (vacation was paid). My actual hours worked were not taken into consideration. Sent home at 10am? Paid for an 8-hour day. Worked all day and into the night? Same 8-hour day. Unless I worked over the weekend, my in-house hours, including call, were usually fewer than 40. This system is ok when staffing is sufficient and stable, and work really does average out to close to 40hr/wk. However, lose several colleagues, volume picks up, and that salaried position starts to suck, as the actual hours worked climb above 40, plus additional uncompensated time on pager.

It is paid the same hourly regardless of circumstance. In house, home call, holiday call, etc. Always same rate.

 

[Mehd School]

Before you sign anything, I want you to:

1) Look at their daily OR schedules, and see how many rooms are running past 5pm, each day.

2) See if there is some sort of GUARANTEE that you have equal access to these “ EZ home calls”, that insures that it’s not just 2-3 of the senior guys who are getting most of them (not OLD guys, but more seniority than YOU). ALSO, that you are not getting all the WEEKENDS (when you’d like to leave town), while they get all WEEKDAYS (since they’re stuck in town, anyway).

This might be a job that allows lots of flexibility, to make money when you want, or take it easy when you want. Then again, it may be one where they’re trying to stick the “new guy” there til 7pm (which doesn’t get you extra or call pay), everyday, and dump all the weekends and holidays in your lap (which, despite the call pay, gets old FAST).

Thanks for your input. I have seen their daily OR schedule for the past 2 months (they use epic). They're pretty much done on 90% of the days by 5-6pm. If there are things still running it is almost always one room.

If I go through with this I am going to demand that I have a guaranteed number of call days each week and month. This job only makes sense if you can rack up hours on home call. If I join and those calls are withheld then I just screwed myself. Ideally I'd want a guarantee of at least 1 weekday call per week and 1 weekend call per month. I'll definitely keep an eye out for what you're stating. If things smell too good to be true then they probably are. One significant factor here is that it is not necessarily in a location many people would die to live at. To me it's a very nice area, 45 minutes outside of a major city and where I grew up. But no one is flocking there.

 

[nimbus]

Thank you to everyone that took the time to reply. It is a strange job in the pay structure. It is a W2 position where you are promised a salary ($425k) but that is essentially a placeholder. Those that work exactly 1 FTE will make that. Those who work more will make more and those who work less will make less because at its core it is an hourly pay structure. Being that this hospital is close to where I grew up, I know a few people that work there and went to high school with one of the general surgeons that operates there. There is typically 1-2 hearts each day, and 1-2 major vascular (aortobifem, fem pop, sometimes open AAA) 4 days per week. The youngest cardiac/vascular surgeon there has been operating for 15 years. They are an experienced group and it is rare for a takeback. With that said I was told there was one on Monday this week so it definitely happens.

You are allotted 8 weeks of paid vacation within your contract that states $425k. With that said, the people making north of $650k I was told take closer to 4 weeks of vacation. And in terms of people saying it would be $325+/hour if you worked 40 hours a week, well that's the issue with this job. You're going to be on the hook for probably 70-100 hours per week to be a high earner but over half of that will be at home on call.

So I am going to continue to pursue this job further and see where it ends up. It makes a lot of sense for where I'm at in my career and my current priorities, and the location change would be great.

Thanks again

Sounds like the base pay is slightly under $10k/ week ($425K/44weeks). But the low volume/low callback home calls come with heavy stipends which is where you make your money and you can take a lot of call because call is not busy. How much is the nightly home call stipend? If the call stipend is $2500/night (and maybe more for each weekend day) and you do it twice a week, then I see how you can get to $15k+ for every week worked.

I’d also want to know how the weekday cases are assigned/distributed. Who makes the case assignments or do you pick your own cases based on call position?

If it’s an “hourly pay structure”, is there a clear hourly rate for doing cases in the hospital and another hourly rate for being on call at home? Our anesthesia techs are paid by the hospital on this system and they significantly increase their income by being on call a lot, even though they aren’t actually in the hospital. Same for our specialty call (cardiac and ophtho) nurses and surgical techs. They’re a small pool who take a lot of call. Even though they aren’t in the hospital much more than the general pool, they take much more call and are paid accordingly.

 

[chocomorsel]

It is paid the same hourly regardless of circumstance. In house, home call, holiday call, etc. Always same rate.

Well that’s why it’s so low and you are looking at it all wrong. You need to look at the actual hours your are spending at the hospital versus what you are gonna be making at the end of the year once all the calls are added in. Home call needs to be looked at as their stipend not the hours spent at home holding the pager, just the hours at the hospital. When you calculate it that way your hourly rate is going to be much higher.
As a locums do you get paid to be at home holding the pager the same exact hourly rate?

 

[PpfSuxTube]

Um

Every hospital that doesn't have fellows and residents operating?

Very true! Our outcomes have tanked since a new final year resident started a 6 month placement with us... gone soon but they might hire the resident 🤔

 

[vector2]

Thanks for your input. I have seen their daily OR schedule for the past 2 months (they use epic). They're pretty much done on 90% of the days by 5-6pm. If there are things still running it is almost always one room.

If I go through with this I am going to demand that I have a guaranteed number of call days each week and month. This job only makes sense if you can rack up hours on home call. If I join and those calls are withheld then I just screwed myself. Ideally I'd want a guarantee of at least 1 weekday call per week and 1 weekend call per month. I'll definitely keep an eye out for what you're stating. If things smell too good to be true then they probably are. One significant factor here is that it is not necessarily in a location many people would die to live at. To me it's a very nice area, 45 minutes outside of a major city and where I grew up. But no one is flocking there.

In any case, it seems like the structure is a bit different than most positions given the way the "hourly" rate works and how dependent your income is on call/stipend.

Make sure you explain exactly what you need to your attorney before they look over the preliminary contract. There is conceivably a lot of weasel language which could make the contract superficially appear fair when in fact it's not.