Where would you go to earn the most?

[deleted162650]

Im pretty sure he meant south Dakota.. you can work every single day in San Diego and I bet you wouldnt be at 700

I meant San Diego.

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[dabears505]

Academics.

Is your base like 350 and you picked up work in 5 of your 6 weeks off?

 

[Mman]

I am sorry to correct you on this but you are simply wrong. The top 5% of private groups are earning $700k as partner probably even more. With a good payer mix and covering 4:1 that type of income is attainable. Yes, you do need to work hard (60 hours per week) and cover a lot of anesthetics but if money is your goal I can assure you it exists.

I even know partners in USAP who are still earning over $650k; again, they work very hard and a lot of hours but the money is there.

for the sake of discussion in an ACT model, pretend someone took 12 weeks vacation a year

40 weeks work
50 hours per week
median collections of $40 per unit

you would need to average 12.5 units per hour worked to come out to $1M (40*50*40*12.5) in revenue per year. Now sure there are going to be expenses in there (the AAs and CRNAs) but it is also possible to average way more than 12 units per hour if you are in an efficient work environment. I mean at 3:1 that is simply your time units and excludes base units. I have probably averaged about 15-20 units per hour worked over the years.

 

[dhb]

Maybe you can avoid some taxes but there's no way to avoid being the douche who sold his soul to work in UAE or Saudi Arabia.

Last i saw they pay around 300k... so not great if you have to US taxes because they don't have local taxes. And COL is high.

 

[ERRES2288]

Academics.

Wow

 

[deleted162650]

for the sake of discussion in an ACT model, pretend someone took 12 weeks vacation a year

40 weeks work
50 hours per week
median collections of $40 per unit

you would need to average 12.5 units per hour worked to come out to $1M (40*50*40*12.5) in revenue per year. Now sure there are going to be expenses in there (the AAs and CRNAs) but it is also possible to average way more than 12 units per hour if you are in an efficient work environment. I mean at 3:1 that is simply your time units and excludes base units. I have probably averaged about 15-20 units per hour worked over the years.

Aren’t you splitting that unit value with the CRNA? My understanding was that in the ACT model, the physician is billing 50% and the CRNA is billing 50%?

Hence why 2:1 doesn’t make financial sense.

 

[GassYous]

Aren’t you splitting that unit value with the CRNA? My understanding was that in the ACT model, the physician is billing 50% and the CRNA is billing 50%?

Hence why 2:1 doesn’t make financial sense.

Should be physician bills 100% and crna gets paid salary

 

[abolt18]

Aren’t you splitting that unit value with the CRNA? My understanding was that in the ACT model, the physician is billing 50% and the CRNA is billing 50%?

Hence why 2:1 doesn’t make financial sense.

But if you employ the crna, you as a group bill 100% and pay crna whatever salary you've agreed they deserve.

 

[BLADEMDA]

Aren’t you splitting that unit value with the CRNA? My understanding was that in the ACT model, the physician is billing 50% and the CRNA is billing 50%?

Hence why 2:1 doesn’t make financial sense.

2:1 is break even which is why most groups cover 3:1 or 4:1. If a group routinely covers 2:1 that group should hire more physicians and fewer nurses.
Profitability typically occurs at 3:1 or greater ratios.

 

[deleted162650]

Should be physician bills 100% and crna gets paid salary

That’s not how it works though

But if you employ the crna, you as a group bill 100% and pay crna whatever salary you've agreed they deserve.

Yes. That part is understood.

 

[Mman]

Aren’t you splitting that unit value with the CRNA? My understanding was that in the ACT model, the physician is billing 50% and the CRNA is billing 50%?

Hence why 2:1 doesn’t make financial sense.

no, we employ the CRNAs. We collect everything and the CRNA gets paid a salary. Everything beyond their salary is profit for me, whether that is 100K or 1M.

From a collections point of view, on CMS patients the billing is split between the physician and the CRNA (or AA). On commercially insured patients, that split can be whatever you negotiate (I know of one place that has a contract specifying 99/1 split). And almost all the money comes on the private side of things anyway.

 

[deleted162650]

no, we employ the CRNAs. We collect everything and the CRNA gets paid a salary. Everything beyond their salary is profit for me, whether that is 100K or 1M.

Yes, I understand. Those 3 CRNA salaries (and bennies) take a significant chunk of that 1 mil in collections.

 

[Aheadbyacentury]

Should be physician bills 100% and crna gets paid salary

Lots of "shoulds" in this world.

 

[Mman]

Yes, I understand. Those 3 CRNA salaries (and bennies) take a significant chunk of that 1 mil in collections.

sure, but I posted insanely lowball numbers for collections. Their salaries are essentially fixed while as your productivity rises, it is all profit.

 

[turnupthegas]

I’m know three practices in CA where some cracked a million. Yes they are working a lot. Q3 call. It’s terrible, but it can be done. First year out may be tough. I had a friend who was on partnership track but worked so much they just made partner. 1.5 years out and made 750k

 

[raztes]

It’s definitely possible to earn 700k on the west coast even just a couple years out. Private practice. 7-9 weeks vacay a year. With all the tax savings PP affords you get a decent sized tax advantage, thus making both the greater pay (post tax is same as the w2 most post on here as average income) and saving more into retirement.

 

[amyl]

West coast? Meaning California included? I can’t imagine paying that kind of state income tax?

 

[pmichaelmd]

If I recall, stay away from the Northeast. They seem to be the lowest on the salary scale. We in the South used to be at the top, but that may no longer be the case. The new MGMA just came out and 2020 was such an interesting year. I would look to the rural South and Midwest as a way to make $$, but agree with all of the above. You will never make I banker money in medicine, but you should be more than comfortable. Find a place that makes you happy and in which you can find a life OUTSIDE of work, that will be more important to your mental health than you can even imagine right now.

PMMD

 

[sevoflurane]

If I recall, stay away from the Northeast. They seem to be the lowest on the salary scale. We in the South used to be at the top, but that may no longer be the case. The new MGMA just came out and 2020 was such an interesting year. I would look to the rural South and Midwest as a way to make $$, but agree with all of the above. You will never make I banker money in medicine, but you should be more than comfortable. Find a place that makes you happy and in which you can find a life OUTSIDE of work, that will be more important to your mental health than you can even imagine right now.

PMMD

Very true. Spent 6 -7 years in BFE. About one week off a month. Even then, probably a wise decision but man… those years were rough compared to where I live now. Lifestyle, location, income… in that order.

 

[GassYous]

Being on call sucks and I'm not even that old yet. I'll take lower pay for that hit.

 

[chocomorsel]

I have been out for almost ten years now and finally making a nice income. As in >$550.
However it's not even in Anesthesia. Never was lucky on the anesthesia side but obviously was far from having difficulty paying bills. Most I ever made in Anesthesia was $450. But never had an in, that's for sure. Got an "in" in CCM. It is truly about who you know. And this is in the Lone Star State.

 

[raztes]

It is all about who you know, the homework you do, how the potential practice is set up and many factors including limiting tax liability. Don’t settle for big city AMC low balling. I, for one, could not stand an AMC taking a big cut from my work, or not getting paid for every bit of work I do. Decent partnerships are out there and relatively easy to find if you are willing to find them and go anywhere.

 

[PainDrain]

I have been out for almost ten years now and finally making a nice income. As in >$550.
However it's not even in Anesthesia. Never was lucky on the anesthesia side but obviously was far from having difficulty paying bills. Most I ever made in Anesthesia was $450. But never had an in, that's for sure. Got an "in" in CCM. It is truly about who you know. And this is in the Lone Star State.

You’re making that kind of money in CCM?

 

[chocomorsel]

You’re making that kind of money in CCM?

Apparently I now “know” the right people.
Thank you Covid. Ended up giving me a pretty decent reputation.

 

[PainDrain]

Apparently I now “know” the right people.
Thank you Covid. Ended up giving me a pretty decent reputation.

Good for you. It’s great to hear it can be done in CCM.

 

[Airway]

Apparently I now “know” the right people.
Thank you Covid. Ended up giving me a pretty decent reputation.

Congrats! Can I ask - I assume that you are doing full time critical care with a fairly hard job? (I believe full time CCM to be 26weeks*7days*12 hrs) and a hard job is 12-16 sick people (ecmo, devices, undifferentiated shock, transplant with high morbidity) +- house staff or mid levels which could change census.

 

[deleted697535]

26 wks icu per yr? no effing way

 

[chocomorsel]

Congrats! Can I ask - I assume that you are doing full time critical care with a fairly hard job? (I believe full time CCM to be 26weeks*7days*12 hrs) and a hard job is 12-16 sick people (ecmo, devices, undifferentiated shock, transplant with high morbidity) +- house staff or mid levels which could change census.

No ECMO no transplant as of now. That may change. Lots of support.

 

[Airway]

26 wks icu per yr? no effing way

Agree, not for me. But it gives a good reference point for fte

 

[chocomorsel]

26 wks icu per yr? no effing way

And not 26 weeks. To each their own.
Being at the beck and call of a surgeon? Treated crappily by some? Dealing with egotistical CRNAs?
Being on call each week or and sometimes being awake and getting killed for 24 hours? Not my thing.

 

[deleted697535]

Yes you guys do have it hard it sounds like... Dont anyone come up north anyways, you would all hate it. Its terrible

 

[LifeisaBeach]

Good luck with 700k first year these days. Even hitting the locum jackpot is hard to do 700k with no experience. You can get lucky and find locum gigs that pay close to that, but they are disappearing fast

I talked to a recruiter at LocumTenens.com last week who said they are lush with Anesthesia gigs right now and their rates are going up. I think now is the best time to get back into locum work for high return on my time and I'm making the shift.

 

[sevoflurane]

I talked to a recruiter at LocumTenens.com last week who said they are lush with Anesthesia gigs right now and their rates are going up. I think now is the best time to get back into locum work for high return on my time and I'm making the shift.

What are rates quoted? 250-350?

 

[sevoflurane]

Locums only makes sense if your earning potential is higher than at your local shop. Once you count to/from travel time, it is likely a wash. Only upside is 1099/ability to dictate your life.
I would bet mist practices pay out 2k+ for a 12 hour shift once you take benefits into account. Some much higher than that.

My last cardiac gig was 1000/day plus 1500/heart. So could walk out of hospital @3pm with 4k in your pocket.

 

[aneftp]

My buddy made 820k his last full year in Los Angeles county in 2018. Worked like a dog. 70 hours a week. Took around 7 weeks off. Q 3/4 calls.
There is money to be made. But it’s hard work.

LA county is a very large county. So don’t be jumping for joy think it’s on rodeo drive. It’s ain’t in Beverly Hills

 

[GassYous]

My buddy made 820k his last full year in Los Angeles county in 2018. Worked like a dog. 70 hours a week. Took around 7 weeks off. Q 3/4 calls.
There is money to be made. But it’s hard work.

LA county is a very large county. So don’t be jumping for joy think it’s on rodeo drive. It’s ain’t in Beverly Hills

I'd rather work 45 h/week q15 call for half that

 

[aneftp]

What are rates quoted? 250-350?

I’m seeing $300/hr guarantee 8 hours at many surgery centers looking for last min help (2 weeks notice)

they know they will lose money if they can’t find anyone to staff

Crnas are getting $160/hr now. This is the south. Atlanta Georgia and most florida areas.
Depends how desperate employers get.

 

[chocomorsel]

I talked to a recruiter at LocumTenens.com last week who said they are lush with Anesthesia gigs right now and their rates are going up. I think now is the best time to get back into locum work for high return on my time and I'm making the shift.

Did you get specifics on how “high up?”

 

[chocomorsel]

I’m seeing $300/hr guarantee 8 hours at many surgery centers looking for last min help (2 weeks notice)

they know they will lose money if they can’t find anyone to staff

Crnas are getting $160/hr now. This is the south. Atlanta Georgia and most florida areas.
Depends how desperate employers get.

Wow. FL the crap hole of anesthesia with those rates? Sign me up. Send a link.

 

[chocomorsel]

I’m seeing $300/hr guarantee 8 hours at many surgery centers looking for last min help (2 weeks notice)

they know they will lose money if they can’t find anyone to staff

Crnas are getting $160/hr now. This is the south. Atlanta Georgia and most florida areas.
Depends how desperate employers get.

Wow. FL the crap hole of anesthesia with those rates? Sign me up. Send a link.

 

[jthedestroyr]

I have been out for almost ten years now and finally making a nice income. As in >$550.
However it's not even in Anesthesia. Never was lucky on the anesthesia side but obviously was far from having difficulty paying bills. Most I ever made in Anesthesia was $450. But never had an in, that's for sure. Got an "in" in CCM. It is truly about who you know. And this is in the Lone Star State.

I know we work for it in CCM, but you and I have talked a lot about job satisfaction. I get a ton of satisfaction in CCM as we aren't seen as "expendable," as we are in the OR.

 

[jthedestroyr]

Crnas are getting $160/hr now. This is the south. Atlanta Georgia and most florida areas.
Depends how desperate employers get.

Can confirm -> 160-180/H I've heard for CRNA.

 

[Osteoth]

Can confirm -> 160-180/H I've heard for CRNA.

Lmao that’s more than the hospitalists are making

 

[jthedestroyr]

Lmao that’s more than the hospitalists are making

And they’re working 3d max, no call.

 

[Splenda88]

26 wks icu per yr? no effing way

What's wrong with 26 wks? I think the 7 on/off is a good schedule.

 

[DazedWanderer]

Last i saw they pay around 300k... so not great if you have to US taxes because they don't have local taxes. And COL is high.

Yeah this would be high enough salary to attract a lot of European locum docs, as this is already around double the salary an anesthesiologist could expect to earn in Europe. They don't need to pay high enough to attract American physicians, just high enough to attract the well trained physicians from other developed countries with high quality healthcare training.

 

[<(^_^)>]

Yeah this would be high enough salary to attract a lot of European locum docs, as this is already around double the salary an anesthesiologist could expect to earn in Europe. They don't need to pay high enough to attract American physicians, just high enough to attract the well trained physicians from other developed countries with high quality healthcare training.

The salaries of European doctors on the whole are WIDELY understated and people are easily misled trying to look up averages. If you were in Switzerland trying to look up anesthesiologist pay in the US you might think the BLS figure of 270k is accurate for example: Anesthesiologists

If you google anesthesiology salary Switzerland you’ll see things like ~357k CHF (1 CHF = 1.08 USD). In reality the median in 2014 was 518k CHF, or 560k USD. Doctors’ salaries exceed expectations and that was 7 years ago.

In general these figures are kept hush hush where possible. If you thought earning a lot of money put a target on your back it’s way worse in Europe so take any “googled” figures with a massive grain of salt.

The one exception is NHS docs in UK truly are paid crap by most 1st world country standards. Private is much better, but not everyone can be private and even private pay isn’t comparable to US/Canada/AUS/many other countries in Western Europe.

 

[DazedWanderer]

The salaries of European doctors on the whole are WIDELY understated and people are easily misled trying to look up averages. If you were in Switzerland trying to look up anesthesiologist pay in the US you might think the BLS figure of 270k is accurate for example: Anesthesiologists

If you google anesthesiology salary Switzerland you’ll see things like ~357k CHF (1 CHF = 1.08 USD). In reality the median in 2014 was 518k CHF, or 560k USD. Doctors’ salaries exceed expectations and that was 7 years ago.

In general these figures are kept hush hush where possible. If you thought earning a lot of money put a target on your back it’s way worse in Europe so take any “googled” figures with a massive grain of salt.

The one exception is NHS docs in UK truly are paid crap by most 1st world country standards. Private is much better, but not everyone can be private and even private pay isn’t comparable to US/Canada/AUS/many other countries in Western Europe.

Switzerland is certainly an exception rather than the norm. Switzerland is not part of the EU and its salaries are not in line with other major European countries. Not hard to find job advertisements from the NHS online offering a very generous 90,000 pounds (125,000 USD) annual salary for a fellowship-trained cardiac anesthesiologist. EU countries like Germany/France tend to pay notably less than Switzerland but more than the UK.

NHSJobs.com: Medical: Anaesthesia vacancies | trac.jobs

 

[<(^_^)>]

Switzerland is certainly an exception rather than the norm. Switzerland is not part of the EU and its salaries are not in line with other major European countries. Not hard to find job advertisements from the NHS online offering a very generous 90,000 pounds (125,000 USD) annual salary for a fellowship-trained cardiac anesthesiologist. EU countries like Germany/France tend to pay notably less than Switzerland but more than the UK.

NHSJobs.com: Medical: Anaesthesia vacancies | trac.jobs

Yes as I mentioned the NHS pays garbage. Germany and France are about 300k USD for by American standards cush jobs with strong job security. None would be tempted by 300k USD in America, let alone 150k.

 

[coffeebythelake]

Are these numbers based on the "whole package" (e.g., including medical, dental, retirement matching, other benefits)?