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no i’m not saying that.
USAp Texas..how many more blows
Started by Howard888
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These days with the cost for healthcare on the exchanges for a family of 4 (medical malpractice policies have remained pretty stable as far as I know) I was paying around 25k a year for my own occurrence policy 8-9 years ago (don’t know what the current rate is) for a 1/3 million policy. But healthcare will cost you between 30-40k a year in true cost (premiums plus deductibles)
So making 550-600k as independent 1099 contractor working 40 hrs a week no calls no weekends and 10 weeks off at $350/hr 1099 means you are likely making less than an amc paying you 600k/10 weeks off plus some benefits.
Due to your healthcare and medical malpractice polices.
So between 500-600k is the grey zone whether to be independent or not.
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Your math is true, however my alternate take on this is what my spouse and I told each other before I went independent this time last year: it's not just about the numbers. We were OK with me making the same (or even slightly less factoring in taxes) because it completely eliminated the pager/in-house overnight/holiday/weekend work from our lives, as well as the dreaded "vacation lottery," around which you have to plan your life. I'll have to see what the taxes are like from this year, but it stands to be a bit more, since I didn't hit the road as much as some locums pros.
There is a benefit to this that goes beyond an absolute number in terms of overall fatigue, sustainability, etc. etc.
Correct. I got f’d this year with the vacation lottery. Worked thanksgiving day. Thanksgiving weekend
Worked all week except Christmas Day but worked late Christmas eve and got slammed Dec 26 Friday as well. So this week sucked. And doing the same next week.
The vacation lottery is a big deal to many people who choose to eventually go 1099. The ability to take time off anytime they want especially important holidays and summer breaks (especially if you have kids).
As for the calls. There are many jobs in Florida that pay 500k/4 days a week with no calls and 10 weeks off. Those jobs SUCK! Why? No one wants to work every week 7-5 (4 days) or 7-3 (5 days a week) with no early days. So you can make 500k w2 no calls. I WOULD NOT Advise anyone to do that. Unless it’s VA medical center job and u are age 57 and doing it with the intention to coast and retire at age 62. But VA jobs pay 320-350k and and not 500k.
when you work for yourself, you remove a salary cap.
that goes both ways. you can work less, or more - importantly when you want to work or do last minute shifts, you can rightfully demand a premium. because you’re taking a risk of non guaranteed work.
sometimes this means high hourly plus billing. that adds up. if you want guaranteed income, don’t do independent work.
unless you’re comfortable taking a risk on yourself and have the courage - don’t do it.
much easier to be employed. i was employed the first 10 years of my career and that’s where you hone your skills.
i never really cared fot crna supervision - doesn’t mean i can’t do it and i have done so - but i prefer md only models. i am of the belief that anesthesiologists should rightfully take this profession back and actually show up in the or and do as many cases in the or and be present. i know it’s not always feasible but we try.
i wouldn’t do it starting out, but i am 10 years into my practice plus i do pain clinic so it works for me. i have a 50/50 or 40/60 practice defending on the week. i can honestly retire if i want tomorrow but i’m busy with developing a brand and enterprise. it’s a lot of effort but that’s what i wanted to do. it’s my interest and passion.
sometimes i do cases before my clinic. sometimes after. in addition to my regular shifts. sometimes on weekends. when you work for yourself, it never really stops. you have commitments and working relationships with surgeons and facilities and other groups. you’re running a business - not merely showing up. lot of work behind the scenes is needed. i do have a very solid team of 3-4 docs that rotate work with me. they all work elsewhere and have their own gigs too. we make a shift schedule based on availability. we evaluate each type of work and come up with fmv and make sure it makes financial sense before we pursue it. the point is, we are negotiating directly with groups/ surgeons/facilities/other anesthesia groups.
i actually work more as an independent physician than when i used to for an amc that came with 10-12 weeks of vacation. but those vacations were rarely my choice and i did not want to give control of my schedule to others. however i take high quality time off when i want.
there’s no such thing as a free lunch in life. if someone’s promising you that - they’re not being honest or genuine.
you have to evaluate for yourself what works for me. i don’t want to relocate. i don’t want to be on fixed income either. and i wanted to invest in my brand and practice which i couldn’t do working for others. i don’t want to manage crnas either. so i crafted something that satisfies all of these and provides me income and reasonable schedule. is it right or wrong? i don’t know. it pays the bills and its honest man’s work, and there’s a lot of peace. i sleep well. and i am no longer irritated knowing that i’m making others rich and allowing management companies to skim a profit off of me.
that goes both ways. you can work less, or more - importantly when you want to work or do last minute shifts, you can rightfully demand a premium. because you’re taking a risk of non guaranteed work.
sometimes this means high hourly plus billing. that adds up. if you want guaranteed income, don’t do independent work.
unless you’re comfortable taking a risk on yourself and have the courage - don’t do it.
much easier to be employed. i was employed the first 10 years of my career and that’s where you hone your skills.
i never really cared fot crna supervision - doesn’t mean i can’t do it and i have done so - but i prefer md only models. i am of the belief that anesthesiologists should rightfully take this profession back and actually show up in the or and do as many cases in the or and be present. i know it’s not always feasible but we try.
i wouldn’t do it starting out, but i am 10 years into my practice plus i do pain clinic so it works for me. i have a 50/50 or 40/60 practice defending on the week. i can honestly retire if i want tomorrow but i’m busy with developing a brand and enterprise. it’s a lot of effort but that’s what i wanted to do. it’s my interest and passion.
sometimes i do cases before my clinic. sometimes after. in addition to my regular shifts. sometimes on weekends. when you work for yourself, it never really stops. you have commitments and working relationships with surgeons and facilities and other groups. you’re running a business - not merely showing up. lot of work behind the scenes is needed. i do have a very solid team of 3-4 docs that rotate work with me. they all work elsewhere and have their own gigs too. we make a shift schedule based on availability. we evaluate each type of work and come up with fmv and make sure it makes financial sense before we pursue it. the point is, we are negotiating directly with groups/ surgeons/facilities/other anesthesia groups.
i actually work more as an independent physician than when i used to for an amc that came with 10-12 weeks of vacation. but those vacations were rarely my choice and i did not want to give control of my schedule to others. however i take high quality time off when i want.
there’s no such thing as a free lunch in life. if someone’s promising you that - they’re not being honest or genuine.
you have to evaluate for yourself what works for me. i don’t want to relocate. i don’t want to be on fixed income either. and i wanted to invest in my brand and practice which i couldn’t do working for others. i don’t want to manage crnas either. so i crafted something that satisfies all of these and provides me income and reasonable schedule. is it right or wrong? i don’t know. it pays the bills and its honest man’s work, and there’s a lot of peace. i sleep well. and i am no longer irritated knowing that i’m making others rich and allowing management companies to skim a profit off of me.
health insurance - the way it is currently administered, is a scam.
i personally don’t have classic health insurance. i use a health share plan with hsa for catastrophes. i pay $589/month for a family of 4. plan is called zion health share plan which has a 15k deductible. i’ve had it for 3 years.
rest i pay cash.
it scares many people including my parents and extended family and they find it odd that a physician like myself who studies insurance business and actuarial sciences for fun does not have insurance. it’s precisely because of that i opted for a health share plan. it satisfies the risk vs cost equation for me.
i am not going to drop over 30k on a product that’s not perfect.
secondly lets say if you get sick - there’s no guarantee that having insurance will cure you. there’s that risk too. but i’m ok with it. you can’t control every variable in life.
The health care plan works for you (and most of us) because we can withstand a catastrophic high hospital bill that involves a 30k deductible.
But it’s like the 3/5 year arms mortgages. The general public can’t handle increases in their bills and it will kill time. But 3-5 year arms are perfect for doctors who can make more to cover for any increase in interest rates
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I would avoid a health share like the plague.
What the most u can be hit with? 100k? Most of us can afford it.
I have seen articles on nbc about people owing 30k from pregnancy bills
“
Kaplan said she tried for months to get Sedera to reimburse her delivery costs, which the hospital discounted to around $7,000, without success.
“It was so stressful. I was crying my eyes out. I was bawling. I was pleading with Sedera. I was calling Sedera every day,” Kaplan said. “They had no mercy for us. No grace at all.”
The couple has since paid the delivery bill, along with around $2,800 for Kaplan’s anesthesia, but still owe around $2,500 for a physician’s fee”
Health care cost sharing ministries left some members to pay high childbirth bills
Health care sharing ministries advertise reimbursements for members’ medical bills. But they are largely unregulated, and most have restrictions on maternity coverage.
well
the whole concept of “employer assisted health plan” is just another way for the employer to have leverage over you. then the issue becomes cost. the way bcbs and health insurances started and what it intended to accomplish is vastly different than what it has become today. it’s just a money grabbing business.
health shares do what they’re supposed to do if you understand them. i’m not here to advocate for one or the other, or commercial insurance vs health share - it’s a personal choice; but i prefer to pay cash for routine appts and if there’s a big bill, i have an account dedicated to that. at-least i have some control over that compared to relying over what the insurance company will pay or not pay.
it’s no different than car insurance…i keep my deductibles very high so i have a much lower out of pocket premium.
Correct. These health care plans are good for people who know what they are doing.
The article I linked where the plan didn’t pay was due to 1 year exclusion period for pregnancy. Duh. Those plans know exactly what people will do. Get pregnant
It’s like the old days when I was self employed. I paid an an extra $200 a month for a maternity rider plus $2500 extra maternity deductible for my wife (on top of the regular insurance premiums) with a one year maternity exclusion period.
So did the math. $2400 for the first year. Can’t get pregnant. And another $2400 for second year and get pregnant. That’s $4800 out of pocket plus rhe $2500 maternity deductible.
That’s $7300 out of pocket for me to get maternity coverager. I’m responsible and paid it in 2010.
Does it suck to be a woman to have to pay for maternity rider? Absolutely. But does it suck to be a young guy and pay for higher insurance for car insurance because you are a guy and at risk for getting into accidents? Absolutely. So why are guys not get equal rates as women drivers?? Even the most liberal left wingers can’t defend this sexiest attitude toward male drivers most of whom are targeted for higher insurance rate. Their excuse is “don’t drive”. It’s a right. Than the common excuse would be for women to don’t have sex.
72 nights in a hospital is F***in' harsh dude. Can you imagine the F***ery going on. I would need 7 figures. 550k Iwould Laugh at
Well. Imagine there are docs doing q4/5 calls routinely taking 60-70 calls at night as well PLUS working day time. And only 10 weeks off. For 550-600k. But instead of 24 hrs calls. They come in at 3/5pm and stay overnight.
That job is 36-38 weeks off for 550k. Depending how u want to approach it.
60-70 night calls 12-16 hr calls plus daytime hours for 600k and 8-10 week off.
Or 72 (24 hr calls). No other days.
What sounds better?
They both s**k. 500-550 is for full time minimal call burden. twice a month. anything more, start tacking on 5k for each call. and post call days.
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words to live by^^
I think you are so scarred from calls. Like ptsd. Lol
I get it. Calls suck. Especially solo busy calls w2 where you don’t feel “compensated”
I’m solo this upcoming weekend for Friday Sunday calls. But it’s my 1099 gig. So I don’t mind running up the bill like u said and it’s 4800 per 12 hrs for beeper me if I actually work or not. Or up to $5600 or $12000 if actually need to come to work the entire 24. If I were w2. I’d be pissed like you are cause it feels like you are working for me.
I don't want to be anywhere but my bed after hours. I actually don't care how much you pay me. I'm at that stage. and I'm not even that old. Half that **** is going to the government so they can waste and Im exposing myself to substantial liability.
He’s had for three years and has never had to use it. What could go wrong?
Have you gamed out a worst case scenario?
yes.
that’s an unintelligent comment.
a bomb can land on your head tomorrow. you should get insurance for that too?
your ppo is not going to cure glioblastoma either.
it’s about accepting risk and making a choice on risk vs cost. health insurance is not a perfect product. dental insurance is even a far worse product.
having so much confidence in insurance is silly to begin with. those are just the monetary costs. intangible costs are being stuck with an employer because they pay for your health insurance. A good majority of anesthesiologists with amcs are stuck and unhappy and getting exploited but choose to stay because of “benefits” they receive.
and fyi, i evaluated both commercial insurances low deductible/ hsa bronze plans and health share…and there was not much difference.
I am not advocating one or the other and you have to seriously lack wisdom to read this information on sdn from posters and apply it in your life without your own due diligence. Everyone should make a decision based on their own situation. You like your 35k/ year cost of insurance and having your employer chain you by the balls - perfect. Happy for you.
It always gets me when an employer will quote a "total comp" number when you ask for compensation numbers; benefits are always extremely overvalued.
good point.
and another thing…you know when you get those benefits package pdfs…let’s say it says employer will contribute $1000 and you contribute $800; for a total of $1800…at least that’s what it says on paper.
who knows, the cost of your health insurance is $1200 or $900 or $x amount
no one knows how much they’re actually contributing and what that contribution means.
Are they paying themselves to administer the health plan and what you’re contributing through them isn’t really that good of a deal?
unless you get the actual cost of health insurance from the insurance company you won’t ever know how much is being contributed. That information will never be made available to you…because that’s “negotiated cost”….
Well if you work for the state or the Feds it’s public knowledge. So a cobra plan is around $2000 for a a family for me. Or $900 for individuals.
If I work for the state is $180 a month no deductible with Aetna with is a pretty good deal. $20/40 co pay primary and specialist. $100 er visits $25 urgent care
So the true cost of the plan for the state is $2000. So your “subsidy” is $1800 a month
But the state is far better than an AMC plan which is around $900 a month with a $4000 deductible and 12k in network max and $30k max out of network. That’s amc cobra is around $2200 a month. It’s listed when u leave a place and they send you cobra letters.
So the information is available.
The call pay/lifestyle paradox ends with this. Once people are happy with their income, the demand curve becomes pretty stiff to get them in the hospital past 5pm.
how do you explain discrimination in premiums between admin, non physician employees and physician employees?
corporations purchase a plan for set cost - each type of employee pays different price for their healthcare
a biller for an amc is not paying the same as the anesthesiologist for same benefits. it’s paid proportionally
is that right or wrong? i don’t know. but why should i subsidize it for others?
Yeah. I never been a hospital or amc employee till this year so never paid attention. Usually private or independent or state or fed.
But looking at the new w2 hospital owned healthcare you are correct. It’s weird. Charging higher income earners more. It’s wrong. And I agree.
It might be, but I suspect you are just a making a political point and not really doing risk mitigation. It wouldn’t surprise me when a real health crisis hits, you might have a pretty skinny network, and end up compromising your financial health, for what tax savings exactly? Point taken, just find folks like you on this board have the luxury of being the Ayn Rand’s of the world until reality strikes.
I wish you the best of success.
Pre ACA. Most real insurance covered up to millions in lifetime limits.
The ACA (which I have argued so times) over emphasized fear into the public about pre existing conditions which disallowed them to qualify for insurance like maternity coverage and “lifetime” limits.
Like wtf. My lifetime limit was 5 million on my blue cross indemnity plan. I’d be dead or close to dead if I reached the 5 million limit.
That’s what akmd is trying to say. Insurance is a scam to many of us. We just really need the basic plan.
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There isn’t all that much that one would need that’s legit standard of care in a crisis that isn’t covered.
Maybe if you’re talking 4th line chemos you’d be out of luck, but anything normal is covered by catastrophic plans
if i need 4th line of chemo; id probably hang it up and do DNR.
on a philosophical and spiritual note…
a lot of this is how you view life, death, what exactly is quality of life and what’s the best way to actually live and what should be your priorities.
what is a purposeful and a “good life” vs trying to live to 105 years old and try to live scared and insure against each catastrophe - because you can’t.
I have already survived two near death experiences - once as a 10 year old child (we were vacationing - i was supposed to jump onto a cable car from the pad at a cliff but slipped and the next incoming cable would have taken me off the cliff - but i ducked at the right moment and came out. my dad was watching from the side and he thought i was gone); and once in medical school where i crashed my car because i fell asleep behind the wheel from fatigue. Car hit a snow bank flipped twice and ended up on the other side of the road. Came out scratch-less both times and didn’t harm anyone except the first floor of the office building was gone.
So I am thankful, blessed and grateful everyday. But I don’t sit in the corner worry about whether or not my insurance will cover certain ailment.
To me, a good life is about being healthy, making decent money (which is automatic for most anesthesiologists), making my wife and kids independent as soon as possible. Yes it’s nice to have material desires, but that doesn’t really bring contentment.
I’m not saying you shouldn’t insure against catastrophes - i have business insurance, disability insurance, of course car, home insurance. Health insurance as a product is a scam. And I often see too many groups and drs themselves pride themselves on “my employer provides this” without actually looking at material and tangible cost.
I keep my health insurance, malpractice insurance, taxes and retirement items seperate from the places I work. All of these are strings holding you back. The benefit is that it allows for great mobility and quick work and staffing.
Once you get comfortable with these expenses; it’s really not that bad especially the benefits of being independent. All of them are write offs or deductions anyway.
