What’s the perfect job?

[T-burglar]

lol your ideal job is no black or poor people

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Members don't see this ad.

 

[GassYous]

550 plus benefits opportunity for extra work if wanted - 12 weeks vacation. Desirable location. Medical direction of AAs n crnas… never go over bc AAs. Opportunity to teach residents and AA students if wanted. Community suburban hospital but call in house bc of OB. No big cases or high acuity- nice suburban pt population

Sign me up

 

[amyl]

I’m tempted…. But I think they need 2-3 anyways . Pm me if interested- you are USAP ?

 

[amyl]

Sign me up

I should have clarified - this was an offer for discussion not my ideal job. Didn’t mean to be confusing or offensive

 

[Ventil8]

I think I'm in my "perfect" job. Its a work hard play hard model. 55h per week with call. Great coworkers who are nearly all equal caliber. Mix of high acuity and easy stuff. Make a lot of money with 12w off. Produce in 95th%ile but paid there too. Oh, and in a fun smaller city with tons to do.

 

[SRYSPAC]

Sign me up

Sounds great except the in-house and OB part

 

[abolt18]

We are all searching for the perfect job.

For me. It’s the 0.8 fte job. I prefer (2) 16 hr plus benefits plus pro rated vacation.

7p-11p Tuesday and Wednesday

350k (based on 450k ish fte) with 10 weeks off.

Or a 24/16 job. (I was offered a 500k/10 weeks job but that required Friday/sunday ) full time 16/24 1.0. Meaning 42 weekends. Way too much weekends for me.

I’d like to compress my work schedule as much as I can these days.

Opens up a world of opportunities (on my own time) to choose to work extra somewhere else. Or take time off for myself.

I think the days of working 60 plus hours plus 6 calls a month for 700-750k are over for most of us. Assuming 10 weeks off

That’s why people are choosing to to do locums more like me. To control our own schedules

So what’s your perfect job/pay/time off

I'd say my current job is about as close to perfect as it can get for me and my preferences. Only thing for me that would make it better: Mountains nearby and better matching for retirement (or even the option to do mega backdoor Roth contributions to my 403b would be great).

Working in Indiana. W2 employee of non-profit hospital (PSLF qualifying). Earning >90%ile MGMA. Mostly sitting my own cases with AA direction 1-2 days per month. NO crnas. Average 52 hours/week because I take extra call. Only took 6 weeks vacation this year but will take our standard 8 weeks going forward (likely more after I save up a little more money). Doing a bit of everything case-wise but easy to give away call, especially OB, if you don't want it.

Extremely collegial group and surgeons. Very few people I dislike working/interacting with. Great schools. Affordable COL. Good people. Really can't complain, other than that there are no mountains. Much too flat here.

 

[pmichaelmd]

Ideal job for me: W2 employee (assuming no need for 1099 write-offs), home call with rare call-back and early out pre-call day, post-call day off 4-6 times/month, limited nighttime OB with primary coverage by an OB team at night, $650k base with overtime at $350/hr after 5pm or for work on post-call days, 12-14 weeks vacation with the opportunity for more vacation with 0.9 down to 0.75 FTE work status. Medical direction of no greater than 3:1 and never more, with the ability to do solo cases 10-25% of the time. Admin time once a month plus a director's stipend of $30k/year if performing in a leadership role.

 

[finalpsychyear]

The perfect job usually changes as you get into your 40s imo. If you have saved and worked hard and are 10+ years of attending hood by then your investment returns for example VOO has been in the 10-13% range since 2010. Friends of mine have been saving 250-300 range if you count all retirement/investment/employer match and some even in the 4-5m liquid range by early 40s thanks to the bull run of the decade.

Getting 8-10% at that point forward is going to be already adding 80%+ of your W2 income.

It should all be lifestyle work from that point on working enough to support your yearly expenses while on average your NW increases 400-500k indef.

This is my advice to my newly minted gas sibling 28 yo who is aiming going PT by 40yo at the latest.

 

[gasmd98]

I prefer to interact with people who are asleep.

I can imagine few fates worse than getting on an outpatient clinic treadmill seeing a dozen chronically noncompliant and unhelpable patients every day. The occasional patient you can help wouldn't be enough to offset the rest of it.

Isn’t that why we all chose anesthesia over family practice back in med school? Intern year clinic almost killed me and it was only 4 hours once a week.

 

[Ravenclaw90]

I'd say my current job is about as close to perfect as it can get for me and my preferences. Only thing for me that would make it better: Mountains nearby and better matching for retirement (or even the option to do mega backdoor Roth contributions to my 403b would be great).

Working in Indiana. W2 employee of non-profit hospital (PSLF qualifying). Earning >90%ile MGMA. Mostly sitting my own cases with AA direction 1-2 days per month. NO crnas. Average 52 hours/week because I take extra call. Only took 6 weeks vacation this year but will take our standard 8 weeks going forward (likely more after I save up a little more money). Doing a bit of everything case-wise but easy to give away call, especially OB, if you don't want it.

Extremely collegial group and surgeons. Very few people I dislike working/interacting with. Great schools. Affordable COL. Good people. Really can't complain, other than that there are no mountains. Much too flat here.

Is your job hiring? Would love to chat with you about options in Indiana. Can I send you a PM?

 

[GravelRider]

The perfect job usually changes as you get into your 40s imo. If you have saved and worked hard and are 10+ years of attending hood by then your investment returns for example VOO has been in the 10-13% range since 2010. Friends of mine have been saving 250-300 range if you count all retirement/investment/employer match and some even in the 4-5m liquid range by early 40s thanks to the bull run of the decade.

Getting 8-10% at that point forward is going to be already adding 80%+ of your W2 income.

It should all be lifestyle work from that point on working enough to support your yearly expenses while on average your NW increases 400-500k indef.

This is my advice to my newly minted gas sibling 28 yo who is aiming going PT by 40yo at the latest.

Correct. Although, saving $300k per year for the past 10 years as a new grad might not have been very doable. It was not long ago where $350k was considered very good for a full time, call taking anesthesiologist. Put student loan debt on top of that and probably only a handful of 10 year attendings were able to have $4-5 million saved by age 40 (dual physician income couples don’t count). The gist of what you are saying is really great advice, though. Heavy savings upfront allows you a lot of flexibility in your 40s and beyond as you coast towards true retirement. This is probably a better plan than the aggressive “FIRE” crowd because retaining the ability to work gives you insurance against economic fluctuations and any curveballs life may throw at you.

I think $2 million by age 40 is a much more achievable goal for most people. Using some of your numbers here, if you have $2 million by age 40 and never invest another dollar, but don’t touch it, you will have over $9 million by age 60 and over $13 million by age 65…assuming 8% compounding returns. Theres obviously a lot of assumptions built in there, but the theme of aggressively saving early on allows you to find the perfect job when you are in your 40s.

 

[finalpsychyear]

Correct. Although, saving $300k per year for the past 10 years as a new grad might not have been very doable. It was not long ago where $350k was considered very good for a full time, call taking anesthesiologist. Put student loan debt on top of that and probably only a handful of 10 year attendings were able to have $4-5 million saved by age 40 (dual physician income couples don’t count). The gist of what you are saying is really great advice, though. Heavy savings upfront allows you a lot of flexibility in your 40s and beyond as you coast towards true retirement. This is probably a better plan than the aggressive “FIRE” crowd because retaining the ability to work gives you insurance against economic fluctuations and any curveballs life may throw at you.

I think $2 million by age 40 is a much more achievable goal for most people. Using some of your numbers here, if you have $2 million by age 40 and never invest another dollar, but don’t touch it, you will have over $9 million by age 60 and over $13 million by age 65…assuming 8% compounding returns. Theres obviously a lot of assumptions built in there, but the theme of aggressively saving early on allows you to find the perfect job when you are in your 40s.

In all fairness the few peeps hitting 4-5m were 42-43 and were doing side work to be closer to 500k. They all still spent well but got married and had kids late 30s which probably helped. Now they r working half the amount and making same or more doing locums. One literally works seven 16 hr shifts
In a row a month and is gone for 2 week international vaca most months as his nest egg is completed and he just makes and spends as his nw grows.

 

[aneftp]

2010-2020 pretty much considered the lost decade for many non partner anesthesia docs who didn’t get a buyout. Factor in the housing crash in 2008 (for those who purchased homes 2005/6 as their first homes).

It’s all about timing in life.

Now if you got out say 2017. Got ur first home by 2018/2020

You are sitting pretty by age 37-39. Because of the boom in the stock market since 2017 plus the housing increase plus the incredible anesthesia job market since 2021.

 

[sloh]

In all fairness the few peeps hitting 4-5m were 42-43 and were doing side work to be closer to 500k. They all still spent well but got married and had kids late 30s which probably helped. Now they r working half the amount and making same or more doing locums. One literally works seven 16 hr shifts
In a row a month and is gone for 2 week international vaca most months as his nest egg is completed and he just makes and spends as his nw grows.

Not having kids until 35+ def helps. It also allows a physician to not take some mediocre w2 job for the benefits and job security bc they have dependents.

 

[Status Sciaticus]

Ideal job:
40 hours/week, 4 day work week.
6 weeks - 8 weeks off.
$1M/year
No kids

 

[aneftp]

I just got my ideal job. 7 (24 hr beeper) calls in a 2 week period. Usually done 7-8pm OR (with crna). Close to half a million.

Basically 2 weeks on. 3 weeks off. Beeper. Very light ob and call backs. 300-400 deliveries a year.
1:3 crna coverage
Crna for the OR on call 24/7.
30 weeks off

Ob will be the X factor. It’s light. MD covers OB

But we all know ob census can change with new ob being hired. But traditionally they have never had more than 1000 deliveries in their 70 year history.

This frees me up for 20 weeks of locums to inflict more damage. And still gives me 10 weeks free for vacation.

 

[Maverikk]

I just got my ideal job. 7 (24 hr beeper) calls in a 2 week period. Usually done 7-8pm OR (with crna). Close to half a million.

Basically 2 weeks on. 3 weeks off. Beeper. Very light ob and call backs. 300-400 deliveries a year.
1:3 crna coverage
Crna for the OR on call 24/7.
30 weeks off

Ob will be the X factor. It’s light. MD covers OB

But we all know ob census can change with new ob being hired. But traditionally they have never had more than 1000 deliveries in their 70 year history.

This frees me up for 20 weeks of locums to inflict more damage. And still gives me 10 weeks free for vacation.

So about 250/hr? Just compressed, although if it's not busy how many actual hours worked may be different. If it's just one crna or do you do it?

 

[aneftp]

So about 250/hr? Just compressed, although if it's not busy how many actual hours worked may be different. If it's just one crna or do you do it?

Correct. I’m guaranteeing my w2 pay. Than freeing up my time off

I will probably work around 100-120 hrs those two weeks. It’s not bad.

Crna does or cases. Cause doc has to cover OB. Unless it’s a really short cysto or gi case and no patients on ob. Than doc does Gi/cysto case solo.

 

[finalpsychyear]

I just got my ideal job. 7 (24 hr beeper) calls in a 2 week period. Usually done 7-8pm OR (with crna). Close to half a million.

Basically 2 weeks on. 3 weeks off. Beeper. Very light ob and call backs. 300-400 deliveries a year.
1:3 crna coverage
Crna for the OR on call 24/7.
30 weeks off

Ob will be the X factor. It’s light. MD covers OB

But we all know ob census can change with new ob being hired. But traditionally they have never had more than 1000 deliveries in their 70 year history.

This frees me up for 20 weeks of locums to inflict more damage. And still gives me 10 weeks free for vacation.

Sounds like you will be working those 20 wks doing locums. Will you come close to your w2 pay without killing yourself or are you keeping it lifestyle friendly gigs only.

 

[aneftp]

Sounds like you will be working those 20 wks doing locums. Will you come close to your w2 pay without killing yourself or are you keeping it lifestyle friendly gigs only.

The goal is for me to decide what I want to do with my free time off. Even if I make zero on the side. I’m fine with the w2 salary. I get 30 weeks off.

I like the stability of w2 with full health benefits.

We can make it a super lifestyle job with 20 weeks off instead of 30 weeks off. It’s our choice how we want to run it.

I don’t like the w2 tax exposure if I’m making 700k w2. I can generate 1099 income 20k no calls no weekends 1099 each week I’m off. That amount can more than double if I add calls. But those jobs are always morphing and changing

Most of the 1099 docs I meet with kids have same or similar deal as me. 20-26 weeks off plus doing 1099 locums on the side

The ones who are empty nesters or no kids tend to be your “full time “ locums

 

[PainInTheAnes]

The goal is for me to decide what I want to do with my free time off. Even if I make zero on the side. I’m fine with the w2 salary. I get 30 weeks off.

I like the stability of w2 with full health benefits.

We can make it a super lifestyle job with 20 weeks off instead of 30 weeks off. It’s our choice how we want to run it.

I don’t like the w2 tax exposure if I’m making 700k w2. I can generate 1099 income 20k no calls no weekends 1099 each week I’m off. That amount can more than double if I add calls. But those jobs are always morphing and changing

Most of the 1099 docs I meet with kids have same or similar deal as me. 20-26 weeks off plus doing 1099 locums on the side

The ones who are empty nesters or no kids tend to be your “full time “ locums

Are you a single earner? That’s the way I could see this setup. Seems like a lot of work to just get benefits. Are you getting full retirement matching from w2 as well? Then it would be worth the cal burden to me.

7 calls per 2 weeks x 11 is 77 full overnight calls with decent premium hour work per year. That’s q5 call for the year. Seems like a decent clip.

I wouldn’t work 20 of those 30 weeks off personally. Maybe 15 and then you’re really not working much but still at highest tax bracket on single income.

 

[aneftp]

Are you a single earner? That’s the way I could see this setup. Seems like a lot of work to just get benefits. Are you getting full retirement matching from w2 as well? Then it would be worth the cal burden to me.

7 calls per 2 weeks x 11 is 77 full overnight calls with decent premium hour work per year. That’s q5 call for the year. Seems like a decent clip.

I wouldn’t work 20 of those 30 weeks off personally. Maybe 15 and then you’re really not working much but still at highest tax bracket on single income.

I’m not really concern about health benefits. I have two other means of subsidized health benefits.

Calls aren't bad. Ob is super light. It's not in house, can have running epidural from home. For those who have covered light OB, by light I mean 1 epidural a weekend. That's how light it is. Of course things can change. I've looking at this as one year at a time. Maybe 60 days at a time.

Just after time off and not juggling 5 locums jobs at the same time.

Other job I have on tap is 92 total calls all 24hr in house, That's all the work I do for the entire year as well. So around 7-8 calls a month. Rest of the month off. Also 500K. No other shifts.

Just looking to compress everything and roll with it.

 

[PainInTheAnes]

I’m not really concern about health benefits. I have two other means of subsidized health benefits.

Calls aren't bad. Ob is super light. It's not in house, can have running epidural from home. For those who have covered light OB, by light I mean 1 epidural a weekend. That's how light it is. Of course things can change. I've looking at this as one year at a time. Maybe 60 days at a time.

Just after time off and not juggling 5 locums jobs at the same time.

Other job I have on tap is 92 total calls all 24hr in house, That's all the work I do for the entire year as well. So around 7-8 calls a month. Rest of the month off. Also 500K. No other shifts.

Just looking to compress everything and roll with it.

That’s really good. I hope compressed jobs become more common everywhere. Not enough people willing to grind it out 5 days a week including myself unless it’s locums

 

[aneftp]

That’s really good. I hope compressed jobs become more common everywhere. Not enough people willing to grind it out 5 days a week including myself unless it’s locums

There really why I left my last job even though it was easy. I can’t stand 5 days a week. Like u said unless it’s locums 1099 5 days a week. And even than. I wouldn’t do 5 (10s) 1099. I’d do 4 (10s). Take Friday or Monday off

 

[cchoukal]

That’s really good. I hope compressed jobs become more common everywhere. Not enough people willing to grind it out 5 days a week including myself unless it’s locums

I do 80% at my main practice, and that feels about right. I do a couple days a month at my old VA job to stay in the mix (and keep really good health insurance). I think a few of our new hires have opted for 0.8, as well. I think 0.8 plus full call is a real job and should be supported by groups (it is by our's). Now that we're fully staffed and post-call work should be very rare, maybe I'd feel differently, but having one real, known day off each week is a really terrific lifestyle benefit.

 

[kidthor]

I do 80% at my main practice, and that feels about right. I do a couple days a month at my old VA job to stay in the mix (and keep really good health insurance). I think a few of our new hires have opted for 0.8, as well. I think 0.8 plus full call is a real job and should be supported by groups (it is by our's). Now that we're fully staffed and post-call work should be very rare, maybe I'd feel differently, but having one real, known day off each week is a really terrific lifestyle benefit.

I suppose it depends too on how many hours 80% FTE amounts to. I remember at a previous job they considered 40hrs a week to be "part time", and 50 hrs a week was the minimum to be considered full time (and they really expected you to work more than that)!!! If you worked a mere 40 hours a week they'd reduce your vacation time and benefits too.

 

[aneftp]

I suppose it depends too on how many hours 80% FTE amounts to. I remember at a previous job they considered 40hrs a week to be "part time", and 50 hrs a week was the minimum to be considered full time (and they really expected you to work more than that)!!! If you worked a mere 40 hours a week they'd reduce your vacation time and benefits too.

2010-2020 48-52hrs was considered full time
2010-2010 52-55 was considered full time

These days 40 hrs is considered full time.

Beeper is so hard to quantify as a full time 1.0 fte

I value it higher than others. Many private places value it as 0.1 to 0.2 hrs of “work” being on beeper

For me. It’s closer to 0.5 hrs of real work.

12 hrs of beeper is worth 6 hours of work

That’s just may take

I don’t sleep that well on beeper to be honest. Just a different type of sleep

 

[cchoukal]

I suppose it depends too on how many hours 80% FTE amounts to. I remember at a previous job they considered 40hrs a week to be "part time", and 50 hrs a week was the minimum to be considered full time (and they really expected you to work more than that)!!! If you worked a mere 40 hours a week they'd reduce your vacation time and benefits too.

That's exactly right. We're EWYK, so if people want to work less they can. Calls are freely traded and almost always taken by hungrier members, and vacation is theoretically unlimited (based on your desired earnings). I took 10 weeks my first year, 8 in my second. I casually track my hours, mostly to prove to my spouse I'm not working as much as she thinks, and it does average around 40-45. This week, I had a busier-than-normal call, I do one OB overnight, and a saturday OB day, so the total is 42 hours, but I'm off today (post), tomorrow, pre-night-OB on Thursday, and post-OB friday, so it overall feels really good most of the time.

 

[Twiggidy]

Sliding into this thread late but my answer is simple.

Doing what I enjoy doing while working with people I enjoy working with, both surgeons and nurses, and being at home most nights (I’m ok with home call).

I’m alluding at little bit to what PGG posted but money doesn’t mean a thing to me if the surgeons I work with make me miserable, I hate the cases, and can’t stand the nurses and there’s too much in house call. I don’t mind coming to work if I like what I’m doing, who im working with, and what we’re trying to accomplish. The money will work itself out.

 

[GravelRider]

Sliding into this thread late but my answer is simple.

Doing what I enjoy doing while working with people I enjoy working with, both surgeons and nurses, and being at home most nights (I’m ok with home call).

I’m alluding at little bit to what PGG posted but money doesn’t mean a thing to me if the surgeons I work with make me miserable, I hate the cases, and can’t stand the nurses and there’s too much in house call. I don’t mind coming to work if I like what I’m doing, who im working with, and what we’re trying to accomplish. The money will work itself out.

I would also add that all of the above for only 32-36 hours per week. Even my most beloved hobbies get tiresome if I was doing them for 50 hours a week. I like variety and shifting gears day to day. Doing anesthesia week in and week out for long hours will feel like a grind no matter how friendly you are with surgeons and staff.

 

[castafari]

That’s 80-% of most VA hospitals ! Many are working just 7-430p (like show up actually at 7am and not 630am ). And the work 4 days a week. The pay is still low. Around 330-350k in most regions.

But the workload is super easy at 80% of VA. I say 80% of VA. Cause the other 20% you actually have to work. Those are the VA that consistently have job openings.

Plus outside of being an idiot. They can’t fire you after 2 years unless u make a lot of enemies. You can claim you aren’t comfortable doing lungs or hearts and they will reasonably accommodate you.

A lot of time to moonlight on that schedule. Plus, VA can pay more now under the PACT act

 

[AKMD_1984]

No “job” can ever be perfect.

 

[aneftp]

No “job” can ever be perfect.

Correction

No job can be perfect forever. That’s retirement

I have had percent jobs for periods of time 6-18 months.

Market changes quickly.

 

[nimbus]

No “job” can ever be perfect.

My job is not perfect (pay could be better) but I like it very much and enjoy my days at work.

 

[AKMD_1984]

My job is not perfect (pay could be better) but I like it very much and enjoy my days at work.

Job is good for a little while but you’re still on other people’s time.
Once you’ve tasted working for yourself and can do it successfully, you can never look back.

 

[nimbus]

Job is good for a little while but you’re still on other people’s time.
Once you’ve tasted working for yourself and can do it successfully, you can never look back.

What exactly do you mean by “working for yourself”? Locums or solo independent practice? Or something outside medicine? My parents were small business people, they worked for themselves. My job is better.

 

[AKMD_1984]

What exactly do you mean by “working for yourself”? Locums or solo independent practice? Or something outside medicine? My parents were small business people, they worked for themselves. My job is better.

Good, a job is better to you.

Like working for myself is better for me. What’s better in comparison between me and you cannot be answered, nor that is relevant or useful to me.m

I value my time, independence and lack of authority over my schedule. I value the ability to say no unequivocally.

It depends on the individual. Overwhelming majority of physicians lack business acumen. They land a job out of residency and expect a graduation with a 6-7x paycheck but never learn how their employer is generating income to pay their salary. They never “follow the money”. They never learn the pressure points.

It’s ok. I didn’t either.,

So to say that a “job is better” because my parents were in business doesn’t make sense to me. What does that even mean? That certainly cannot be extrapolated to everyone in the market. It doesn’t apply to me at least.

Job with one employer means you’ve lost your ability to negotiate.

I can’t comment on your parents and their perception of their business vs your lovely job.

But those who own their practices, groups, and maintain independence and do it successfully never look back. Certainly don’t look at full time employment where they hand over their time easily.

And the answer is yes to your above queries minus the locums bit. I don’t do locums. Last time I did two weeks of locums was in March of this year.

 

[nimbus]

Good, a job is better to you.

Like working for myself is better for me. What’s better in comparison between me and you cannot be answered, nor that is relevant or useful to me.m

I value my time, independence and lack of authority over my schedule. I value the ability to say no unequivocally.

It depends on the individual. Overwhelming majority of physicians lack business acumen. They land a job out of residency and expect a graduation with a 6-7x paycheck but never learn how their employer is generating income to pay their salary. They never “follow the money”. They never learn the pressure points.

It’s ok. I didn’t either.,

So to say that a “job is better” because my parents were in business doesn’t make sense to me. What does that even mean? That certainly cannot be extrapolated to everyone in the market. It doesn’t apply to me at least.

Job with one employer means you’ve lost your ability to negotiate.

I can’t comment on your parents and their perception of their business vs your lovely job.

But those who own their practices, groups, and maintain independence and do it successfully never look back. Certainly don’t look at full time employment where they hand over their time easily.

And the answer is yes to your above queries minus the locums bit. I don’t do locums. Last time I did two weeks of locums was in March of this year.

Do you have employees? Provide benefits? Hire and fire? Do they ever get injured on the job?

My parents had a dry cleaners that at one time employed 30 people. I worked for them. It enabled them to put 3 kids through private universities and grad schools. But it consumed them too. They sometimes took 1 week of vacation/year, some years none. Maybe they weren’t doing it right. I knew it wasn’t for me. I didn’t want to run a business which is one of the reasons I went into anesthesia. I didn’t inherit their capitalist entrepreneurial gene. I’m happy to schlep in the factory. Different strokes. I’m glad you like it. It’s important to know yourself.

 

[finalpsychyear]

Correction

No job can be perfect forever. That’s retirement

I have had percent jobs for periods of time 6-18 months.

Market changes quickly.

Yes. My sibling working in academic center found out not allowed to do locums period even if your part time. Is this normal for academic centers? No wonder they had several openings on top of the shortage. At least they have a 4 month notice without penalty if they ever walk.

Bottom line they want to do more procedures and while its great supervising residents/crnas isn't it good for your first job to be in the "doing" vs just stepping in role which is why 1 day a month they were hoping to do some locums nearby purely to keep there own skills sharp and the money was just a bonus.

 

[pgg]

Overwhelming majority of physicians lack business acumen. They land a job out of residency and expect a graduation with a 6-7x paycheck but never learn how their employer is generating income to pay their salary. They never “follow the money”. They never learn the pressure points.

For all this talk about following the money and pressure points, in the end all work is compared based on two things: effective hourly rate, and painfulness of the work.

Granted, there are some people who add their egos as a third factor, who perseverate on the heinous notion that someone, somewhere, somehow, might be making a buck off their back. God forbid. And they'll tolerate all manner of ****ty work in ****ty dysfunctional hospitals in ****ty cities with ****ty people, living in hotels and rental cars and airports, as a fair (to them) tradeoff for being their own boss. Of course, they're still dependent upon different masters under different terms. But it's an OK deal for them, and that's fine.

It's been interesting to observe over the last few years, as locums rates skyrocketed and W2 wages lagged (for a while), all these closet MBAs crawl out of the woodwork touting their business acumen, and low key looking down on the employed schleps who just live normal working lives making mid-upper 6 figure salaries working for the same master under a different name.

 

[pgg]

Yes. My sibling working in academic center found out not allowed to do locums period even if your part time. Is this normal for academic centers? No wonder they had several openings on top of the shortage. At least they have a 4 month notice without penalty if they ever walk.

Bottom line they want to do more procedures and while its great supervising residents/crnas isn't it good for your first job to be in the "doing" vs just stepping in role which is why 1 day a month they were hoping to do some locums nearby.

I'd say yes and no to this.

The hard part of anesthesia is the thinking part, and a new attending at an academic hospital can certainly do all of that, with or without residents doing most of the monkey skills. There's benefit to sitting your own cases and just being present in the OR for many hours, because problems are rare events and you need to be present to see them unfold and get reps dealing with them.

I think a lot of people overemphasize the importance of tube and block and line skills. A new grad is good enough (ie safe and able) at that stuff, and will gradually get more efficient over time. True rot and incompetence comes to lazy attendings in high ratio ACT practices where they let the CRNAs run amok and are minimally involved beyond signing charts. Young academic attendings doing 2:1 work with residents who need close supervision are not at similar risk of becoming helpless.

Anesthetics go wrong because of bad decision making and missing early signs of impending badness, much more often than they go bad because a central line took 20 minutes instead of 7.

 

[AKMD_1984]

For all this talk about following the money and pressure points, in the end all work is compared based on two things: effective hourly rate, and painfulness of the work.

Granted, there are some people who add their egos as a third factor, who perseverate on the heinous notion that someone, somewhere, somehow, might be making a buck off their back. God forbid. And they'll tolerate all manner of ****ty work in ****ty dysfunctional hospitals in ****ty cities with ****ty people, living in hotels and rental cars and airports, as a fair (to them) tradeoff for being their own boss. Of course, they're still dependent upon different masters under different terms. But it's an OK deal for them, and that's fine.

It's been interesting to observe over the last few years, as locums rates skyrocketed and W2 wages lagged (for a while), all these closet MBAs crawl out of the woodwork touting their business acumen, and low key looking down on the employed schleps who just live normal working lives making mid-upper 6 figure salaries working for the same master under a different name.

You’re missing the following factors from your analysis:


Equity in practice
Control of surgeons and patients
Payor mix
Ability to grow the business and brand

That has significant impact on current and future income.

 

[pgg]

You’re missing the following factors from your analysis:


Equity in practice

Ego, irrelevant to dollars per hour worked. But whatever helps you prertrend you're on equal footing with the administrators and private equity and insurance companies (and even patients) who control you.

Control of surgeons and patients

Locums have less control over that than permanent staff, which is to say neither have any real control, beyond the ability to go get a different job with different surgeons and different patients.

Payor mix

LOL

Ability to grow the business and brand

It's a fantasy to think any anesthesiologist who does anesthesia for a living has a brand. If you're the owner of a management company and selling your employees' labor, paying them less than they generate, and skimming off the top, sure there's a brand there - but you're not an anesthesiologist any more.

That has significant impact on current and future income.

As a locums you're trading one set of problems for a different set of problems. Generally more money for generally poorer working conditions, with the perk of easier quitting. Let's not pretend there's more to it than that.

Most of the things you cite above are an illusion.

I get it - I did locums on top of my W2 job for 13 years. There are positive aspects to it. The freedom to walk on a moment's notice is a perk and I have done that. But this ego-stroking "businesss acumen" swagger is misplaced and kind of annoying.

 

[AKMD_1984]

I don’t use this language very often - but your responses above are quite stupid, and reflective of poor/absent knowledge on quite a few important factors.

I sincerely do not have time to go back and forth with you on a Monday morning.

But no - I’m a working anesthesiologist. No one is sitting around and “managing” or ripping anyone off.

Thanks.

 

[pgg]

I don’t use this language very often - but your responses above are quite stupid, and reflective of poor/absent knowledge on quite a few important factors.

I sincerely do not have time to go back and forth with you on a Monday morning.

But no - I’m a working anesthesiologist. No one is sitting around and “managing” or ripping anyone off.

Thanks.

At your convenience, go ahead and regale us with your business acumen.

 

[Twiggidy]

You’re missing the following factors from your analysis:


Equity in practice
Control of surgeons and patients
Payor mix
Ability to grow the business and brand

That has significant impact on current and future income.

I’d make an argument that 2 out of 4 of these we as anesthesiologists have little to no control over.

I’ll give you a little benefit of the doubt on branding. There are certainly groups in the anesthesia world we know to run from and those that are know good groups and that is based on branding but that for the most part benefits anesthesiologists in the job search. It’s a rare thing that a hospital is seeking out an anesthesia because they heard they’re good. Let’s face it “good” comes with a cost and most place just send out an RFP and take the lowest bidder

 

[nimbus]

Yep, I'm going pain right now. Almost 2 years in practice, and considering going back to the OR. I just don't know about taking call, working nights, weekends, etc. Being in the OR can be so much more stressful...

After a while the OR becomes your safe space

 

[kidthor]

My sibling working in academic center found out not allowed to do locums period even if your part time. Is this normal for academic centers?

In my experience it’s more common than not that academic employers prohibit you from doing any outside work. My current academic employer actually allows us to do outside work but very few people do it because they have adequate internal venues to make extra, if wanted.

 

[Bryan O’Blivion]

0.65 FTE, enough to qualify for benefits like health/dental/disability and tax advantaged savings/retirement with matching. A structure that allows this requirement to be distributed so that one can take 3 week plus vacation or locums for variety and extra money. A working environment with people you respect and enjoy.