Why are MD salaries going down and CRNA salaries going up

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kidthor said:
This of course assumes your academic job gives all that. Having had two now. none checked off all those boxes.

I must say I'd LOVE to be able to put away the employer side 401k 55K. My academic job has a match that caps at 28K with a 5 year vesting period. F that.
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Lol my academic match is like 8k
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kidthor said:
This of course assumes your academic job gives all that. Having had two now. none checked off all those boxes.

I must say I'd LOVE to be able to put away the employer side 401k 55K. My academic job has a match that caps at 28K with a 5 year vesting period. F that.
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i don't get it, i thought the 55k per year for all contributions? 401k, 403b, etc...
 
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narcotics999 said:
In spite of these tricks, I think it is no better than a 400K academic W2 job with stellar healthcare, 403b with 36K retirement match, 457b, vacation, sick leave, and some CME $.
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Agree. Depends on the academic job and benefits. Again many academic jobs are essentially 95% clinical these days

If u can get an academic job paying 400k w2 with generous benefits and reasonable work hours

Q10-12 calls (12 hour shifts on call). Than go for it.

Let me know which ones exist. Not many.

I had a state w2 benefits job similar 401a/403b/457b with free health insurance. It pays in the mid 350s these days and people still quit that state academic job to take the 500k-550k private job with 8-10 weeks off.

So there are a lot of calculations to be had when comparing
 
I’ve never heard of a job outside academics with only 4 weeks vacation.
 
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kidthor said:
For comparative info my academic setup in a very HCOL area is:

3-4 calls a month
400k or so W2 after overtime
about 50-60 hours a week of work, too often high turnover 3:1 supervision
reasonable healthcare and disability benefits
4wks vacation
28k 401k match (except this year "due to covid" it's 14k with next year also in limbo)
no CME fund, no licensing compensation and such
no sick days (you can call out sick if you're sick but you'll have to make it up somewhere because you'll be "short")
no meeting days (same - you can go to a meeting, but you'll pay for it and make up the days off and with no CME fund it's out of pocket)
no academic productivity rewards and no benefits

IMO academics is going downhill these days due to decreasing benefits with stagnant pay with more work. They've always asked for a lot for free in academics, but now you get no reward for it.

Lots of my colleagues with very impressive CVs are jumping ship and doing locums or PP. I'm considering it myself.

I'm sure there are good academic jobs out there but they're dwindling and/or are somewhere undesirable.
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The private section has a thread listing numbers and hours. Probably better over there
 
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Judging by this thread, things are a lot better than 5 yrs ago.


forums.studentdoctor.net

What Job offers are current residents getting?

I'm about to start PGY1 and hopefully will be in the job market in 4-5 years...and i'm hearing some "horror stories" about current job offers for anesthesiology....is 250k really the current norm???
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nimbus said:
Judging by this thread, things are a lot better than 5 yrs ago.


forums.studentdoctor.net

What Job offers are current residents getting?

I'm about to start PGY1 and hopefully will be in the job market in 4-5 years...and i'm hearing some "horror stories" about current job offers for anesthesiology....is 250k really the current norm???
forums.studentdoctor.net forums.studentdoctor.net
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Yes it just shows everyone’s crystal ball is cloudy. Job market is great. New grads, don’t settle
 
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nimbus said:
Judging by this thread, things are a lot better than 5 yrs ago.


forums.studentdoctor.net

What Job offers are current residents getting?

I'm about to start PGY1 and hopefully will be in the job market in 4-5 years...and i'm hearing some "horror stories" about current job offers for anesthesiology....is 250k really the current norm???
forums.studentdoctor.net forums.studentdoctor.net
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Ha that's so interesting that you were looking at that too. I was just looking at that thread last night. Did the site recommend it to you?
 
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I did a quick inflation adjustment of 3% per year.

If you believe the number that was kicking around of 350. It should be 400 after 5 years. Just putting it out there.

I miss some of those people who were participating in the discussions five years ago, and happy to see some senior members who are still helping out the new generation of anesthesiologists.
 
narcotics999 said:
In spite of these tricks, I think it is no better than a 400K academic W2 job with stellar healthcare, 403b with 36K retirement match, 457b, vacation, sick leave, and some CME $.
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LOL no academic job is letting you write off your range rover and pay all your business expense bills.
 
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How does one write off a Range Rover going to and from the hospital? I must have a terrible accountant.
 
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AnesProfesso said:
How does one write off a Range Rover going to and from the hospital? I must have a terrible accountant.
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Not my group but another group does this. In their contract, they require that you to maintain a home office. Then they commute from the home office to the hospital. My group doesn’t allow auto deductions, only mileage when traveling between sites on the same day which is very rare.
 
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Why doesn't it surprise me that it was a pain guy giving himself a 30k salary...always schemin'. I wonder how that even happened, since thats a lower salary than a resident!

IRS compares trends of two to three years salary, and I believe any consecutive years if there is a more than 10% change, there is a flag and POSSIBLE audit. For instance, you cannot go from a 400k salary to 250K salary without raising a flag.

Any accountant worth his weight will hammer in the fact in you to learn the difference between tax avoidance and tax evasion. So, I am not sure how your 'buddy' has managed to escape this all this time. 30K salary on 1.3 mil is asking for an investigation - and like any governmental agency, they typically do not care until you're caught - but when you're caught and dig deeper, you're done.

Maybe he means 30k per month which seems more reasonable?

In all honesty, I dont really find it all that weird from typical private practice pain doc. This is one thing I find very off putting about my colleagues. They leave anesthesia to make 'more money' and 'be independent' and 'avoid call', but then they end up with these schemes, evasions, and questionable things. Just the overall way of how they do things is never straight in my experience.
 
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ERRES2288 said:
I’ve never heard of a job outside academics with only 4 weeks vacation.
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Usap has 2 weeks PAID vacation

So they claim you can make 450k (60-70 hours a week with very poor healthcare insurance and 2 weeks paid vacation)
 
nimbus said:
Not my group but another group does this. In their contract, they require that you to maintain a home office. Then they commute from the home office to the hospital. My group doesn’t allow auto deductions, only mileage when traveling between sites on the same day which is very rare.
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I assume that would get hammered in an audit. I mean you can do whatever you want until the IRS actually stops and looks.

edit: IIRC the standard the IRS uses is your normal place of work and you can't deduct travel from home to that location. For anesthesia, can't really argue most of your clinical work is at home.
 
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neutro said:
Why doesn't it surprise me that it was a pain guy giving himself a 30k salary...always schemin'. I wonder how that even happened, since thats a lower salary than a resident!

IRS compares trends of two to three years salary, and I believe any consecutive years if there is a more than 10% change, there is a flag and POSSIBLE audit. For instance, you cannot go from a 400k salary to 250K salary without raising a flag.

Any accountant worth his weight will hammer in the fact in you to learn the difference between tax avoidance and tax evasion. So, I am not sure how your 'buddy' has managed to escape this all this time. 30K salary on 1.3 mil is asking for an investigation - and like any governmental agency, they typically do not care until you're caught - but when you're caught and dig deeper, you're done.

Maybe he means 30k per month which seems more reasonable?

In all honesty, I dont really find it all that weird from typical private practice pain doc. This is one thing I find very off putting about my colleagues. They leave anesthesia to make 'more money' and 'be independent' and 'avoid call', but then they end up with these schemes, evasions, and questionable things. Just the overall way of how they do things is never straight in my experience.
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It’s 30k a year. We got back 20 plus years.

Everything is run through the books. Office/staff

Dentist do this all the time with paying themselves a very low salary deducting office expenses.

Remember pain is running expenses through a real office. Not like hospital based anesthesia or er docs.
 
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aneftp said:
Usap has 2 weeks PAID vacation

So they claim you can make 450k (60-70 hours a week with very poor healthcare insurance and 2 weeks paid vacation)
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We are 100% eat what you kill productivity based. What’s paid vacation? Paid vacation would just mean another doctor is working to pay you to take time off. We don’t do that.
 
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nimbus said:
We are 100% eat what you kill productivity based. What’s paid vacation? Paid vacation would just mean another doctor is paying you to take time off. We don’t do that.
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Ultimately thr question is how much money you are making (for your group, for your hospital, for VC) vs. How much money you are bringing home.
 
aneftp said:
It’s 30k a year. We got back 20 plus years.

Everything is run through the books. Office/staff

Dentist do this all the time with paying themselves a very low salary deducting office expenses.

Remember pain is running expenses through a real office. Not like hospital based anesthesia or er docs.
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My folks had a dry cleaners when I was growing up. Every car we ever had was owned by the business. All the gas, groceries and meals out were purchased with a business card too. I wouldn’t dream of doing that as a W2 anesthesiologist but I can see how a dentist with their own office might do that.
 
Mman said:
I assume that would get hammered in an audit. I mean you can do whatever you want until the IRS actually stops and looks.

edit: IIRC the standard the IRS uses is your normal place of work and you can't deduct travel from home to that location. For anesthesia, can't really argue most of your clinical work is at home.
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IRS can't even return phone calls these days never mind run an audit

Took them 8 months to fix my amended return and I had to call multiple times
 
GassYous said:
IRS can't even return phone calls these days never mind run an audit

Took them 8 months to fix my amended return and I had to call multiple times
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Who knows? IRS has been traditionally massively understaffed, but I imagine they would prioritize activities that generate extra $ for them. Audits of rich people seem like a good bang for buck
 
nimbus said:
We are 100% eat what you kill productivity based. What’s paid vacation? Paid vacation would just mean another doctor is working to pay you to take time off. We don’t do that.
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Which is fine. Except usap “partnership” track means someone is taking 20% off the top and the private equity is taking another 20% off that. So u get to keep 60% on the dollar u make. So they want to abuse their new grads as much as possible. The more they work. The more the “partners” get back their 20%
 
aneftp said:
Which is fine. Except usap “partnership” track means someone is taking 20% off the top and the private equity is taking another 20% off that. So u get to keep 60% on the dollar u make. So they want to abuse their new grads as much as possible. The more they work. The more the “partners” get back their 20%
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To me “paid vacation” is yet another way to obfuscate how much revenue you generate every day you work. If a job offers “paid vacation”, the first question I’d ask is where does that money come from? The answer is most likely to be from the remaining 50 weeks of the year they underpaid you. I prefer transparency and zero paid vacation.
 
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O
aneftp said:
It’s 30k a year. We got back 20 plus years.

Everything is run through the books. Office/staff

Dentist do this all the time with paying themselves a very low salary deducting office expenses.

Remember pain is running expenses through a real office. Not like hospital based anesthesia or er docs.
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Pray do tell me how mortgage is paid from a 30k salary, or the house is owned through LLC also
 
aneftp said:
No mortgage. House is paid off
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Ok, so taxes, home insurance, maintenance costs, groceries, costs of daily living, car, travel…? Clothes, incidentals…

I’m having a hard time buying this. Seems fishy
 
nimbus said:
To me “paid vacation” is yet another way to obfuscate how much revenue you generate every day you work. If a job offers “paid vacation”, the first question I’d ask is where does that money come from? The answer is most likely to be from the remaining 50 weeks of the year they underpaid you. I prefer transparency and zero paid vacation.
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Makes sense either way. How do you guys schedule vacation? I was in practice in Vegas where I had to switch days with partners in order to get vacation. Terrible.
 
chocomorsel said:
Makes sense either way. How do you guys schedule vacation? I was in practice in Vegas where I had to switch days with partners in order to get vacation. Terrible.
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As a group, we decide how many weeks vacation we would like and staff accordingly. Currently everyone is guaranteed 8 weeks off, unpaid of course. But people take anywhere from 2-12 weeks according to their preference. Obviously people who take only 2 weeks have a higher income than people who take 12. We can have up to 4 people off on any given week. Vacation book opens up in October for the following year and we rotate picks, picking 2 weeks at a time.
 
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nimbus said:
As a group, we decide how many weeks vacation we would like and staff accordingly. Currently everyone is guaranteed 8 weeks off, unpaid of course. But people take anywhere from 2-12 weeks according to their preference. Obviously people who take only 2 weeks have a higher income than people who take 12. We can have up to 4 people off on any given week. Vacation book opens up in October for the following year and we rotate picks, picking 2 weeks at a time.
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Sounds much better. Kinda like the group I dreamed of being in before I went to the ICU.
 
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nimbus said:
As a group, we decide how many weeks vacation we would like and staff accordingly. Currently everyone is guaranteed 8 weeks off, unpaid of course. But people take anywhere from 2-12 weeks according to their preference. Obviously people who take only 2 weeks have a higher income than people who take 12. We can have up to 4 people off on any given week. Vacation book opens up in October for the following year and we rotate picks, picking 2 weeks at a time.
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we decide each year how many weeks vacation we can take (based on staffing). It's all paid in the sense that your paycheck is constant. You can buy and sell vacation to someone else if you want to take more or less, the price being whatever you and the other doc can agree on.
 
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