Why do you think current M4s aren’t heeding the warnings of Anesthesia being “dead”?

[abolt18]

Yeah makes sense. I doubt I'd get a rate that's worthwhile. I just heard of people doing it right after med school and can't help wondering. That 0% interest for a year with REPAYE is hard to turn down, assuming I even get it with being married now and my wife working. Either way that's probably the best route.

It's not 0% interest. It's $0 payments with an interest subsidy of up to 1/2 of your accumulated interest. Meaning, my interest rate is 6%, government pays 3%, my EFFECTIVE interest rate is 3%.

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[AdmiralChz]

It's not 0% interest. It's $0 payments with an interest subsidy of up to 1/2 of your accumulated interest. Meaning, my interest rate is 6%, government pays 3%, my EFFECTIVE interest rate is 3%.

Still a good deal. But I highly doubt this program will be around in its current form for much longer (and let’s face it, it was meant for social workers, teachers, and others who are public servants requiring college/advanced degrees). Unless you work for an academic, public health system as staff you probably won’t qualify anyways.

 

[abolt18]

Still a good deal. But I highly doubt this program will be around in its current form for much longer (and let’s face it, it was meant for social workers, teachers, and others who are public servants requiring college/advanced degrees). Unless you work for an academic, public health system as staff you probably won’t qualify anyways.

For sure, but you may as well optimize your situation while you can in residency. I'll continue on RePAYE until I graduate, then I hope to refinance to a 5yr variable interest rate at the best rates I can find and ideal crush my loans in 2-3 years.

 

[zero0]

It's not 0% interest. It's $0 payments with an interest subsidy of up to 1/2 of your accumulated interest. Meaning, my interest rate is 6%, government pays 3%, my EFFECTIVE interest rate is 3%.

Sorry I meant $0 payments for 1st year, which again I doubt I'd even qualify for with a working spouse. Still the best deal on the table afaik.

 

[abolt18]

Sorry I meant $0 payments for 1st year, which again I doubt I'd even qualify for with a working spouse. Still the best deal on the table afaik.

You should definitely run the numbers. Payments are calculated based on "disposable income" which they define as your AGI minus 150% of poverty line for a family of your size (which is 2 it sounds like). Take 10% of that difference and divide by 12 and that's your monthly payments.

If your monthly payment is less than HALF of your monthly accumulated interest, then you will get some amount of subsidy.

If your loans accumulate $1000 of interest monthly and your calculated payment is $100 per month, your subsidy will be $400. Basically a 40% reduction in your interest rate.

Not to mention that if you set up for autopay from your bank account they drop your interest rate another 0.25%.

 

[R2R_MD]

students are applying to anesthesia than in previous years, and that they’re a lot more 250s/AOA caliber students applying as well. It seems like no matter how many rights midlevels get, or how many times people here try to warn students not to go into anesthesia, more and more people are gun

I’ve heard from the PD at my school that significantly more students are applying to anesthesia than in previous years, and that they’re a lot more 250s/AOA caliber students applying as well. It seems like no matter how many rights midlevels get, or how many times people here try to warn students not to go into anesthesia, more and more people are gunning for it.

Hey, anesthesia intern here.

Wanted to give you some insight into why I didn't heed those warnings and chose anesthesiology. It definitely had a lot to do with warning fatigue. It started with applying to medical school. I would comb the SDN forums looking on insights from my peers on a variety of issues: DO v IMG v USMD, because at that time I was waitlisted at an MD school, accepted to a DO school and still contemplating on going to medical school in a foreign country. There was a lot of consternation of the diminishing role IMGs would play in the upcoming match - the so-called IMG squeeze. So that didn't happen, and it continues to not happen - IMGs are still matching at the same rate.

There was also a lot of talk about increasing standards for medical school admissions. The school that waitlisted and subsequently rejected me effectively raised their admissions standards overnight, lauding their higher than average admission criteria for their incoming class of 2015 as if it were some sort of breakthrough. Four years later (when I was an MS3), their unmatched rate remained the same and a substantial chunk of their class matched at their home institution with minimal improvement in their match quality. Again, reality outweighed expectations.

I started reading a lot about anesthesiology and the mid-level provider squeeze early in med school. I have anesthesiologists in my family and I became familiarized with the CRNA-anesthesiologist dynamic in undergrad. The time I spent in the OR during those days, I saw the CRNAs as providers that can expand the scope and reach of any given physician - instead of covering 1 room, the anesthesiologist was covering 3-4 ORs at one time. I never saw CRNA's as particularly motivated to do nerve blocks, put in lines or round in the ICU as attendings - mainly because most of them, if not all of them, were not qualified to do so. Basically, the extent of their practice was very limited.

When I started residency, my first week in the anesthesiology pre-operative clinic (where we optimize high risk patients for TAVRs/CABGs, etc.) my attending spent most of his time fending off calls from concerned patients that didn't want a "nurse" providing anesthesia. People are VERY concerned about going under and when they find out CRNAs will be managing their care, many of them are quite resistant to the idea. That kind of lends credence to the idea that there is a lack of appeal over a nurse providing perioperative management among the general populace. Moreover, I'm fortunate to be in an academic hospital where the cardiothoracic and the vast majority of surgical ICU attendings are anesthesiologists. Again, what I'm trying to get at is that the scope of an anesthesiologist's practice is wide.

We go back to warning fatigue. I got a lot of flack in medical school for choosing anesthesia as a speciality, one guy going as far as telling me it was the equivalent of a nurse. When I started residency, I was perplexed (!!!) by the amount of ARNPs, NPs, PAs, etc that covered the emergency, transplant, oncology, etc services. It's almost as if I have to go through their mid-level provider, to even get on their list. Again, reality was very different from what I was told.

What I'm trying to say is if someone says bullsh*t long and loud enough, it becomes a mantra. This is an unfortunate habit in medicine nowadays and I've just become skeptical of all "warnings" I've received over the last 4 years, each one more wrong than the last. It doesn't help that anesthesiology salaries have not decreased and the prospective job growth in the field is increasing.

 

[PieOHmy]

Hey, anesthesia intern here.

Wanted to give you some insight into why I didn't heed those warnings and chose anesthesiology. It definitely had a lot to do with warning fatigue. It started with applying to medical school. I would comb the SDN forums looking on insights from my peers on a variety of issues: DO v IMG v USMD, because at that time I was waitlisted at an MD school, accepted to a DO school and still contemplating on going to medical school in a foreign country. There was a lot of consternation of the diminishing role IMGs would play in the upcoming match - the so-called IMG squeeze. So that didn't happen, and it continues to not happen - IMGs are still matching at the same rate.

There was also a lot of talk about increasing standards for medical school admissions. The school that waitlisted and subsequently rejected me effectively raised their admissions standards overnight, lauding their higher than average admission criteria for their incoming class of 2015 as if it were some sort of breakthrough. Four years later (when I was an MS3), their unmatched rate remained the same and a substantial chunk of their class matched at their home institution with minimal improvement in their match quality. Again, reality outweighed expectations.

I started reading a lot about anesthesiology and the mid-level provider squeeze early in med school. I have anesthesiologists in my family and I became familiarized with the CRNA-anesthesiologist dynamic in undergrad. The time I spent in the OR during those days, I saw the CRNAs as providers that can expand the scope and reach of any given physician - instead of covering 1 room, the anesthesiologist was covering 3-4 ORs at one time. I never saw CRNA's as particularly motivated to do nerve blocks, put in lines or round in the ICU as attendings - mainly because most of them, if not all of them, were not qualified to do so. Basically, the extent of their practice was very limited.

When I started residency, my first week in the anesthesiology pre-operative clinic (where we optimize high risk patients for TAVRs/CABGs, etc.) my attending spent most of his time fending off calls from concerned patients that didn't want a "nurse" providing anesthesia. People are VERY concerned about going under and when they find out CRNAs will be managing their care, many of them are quite resistant to the idea. That kind of lends credence to the idea that there is a lack of appeal over a nurse providing perioperative management among the general populace. Moreover, I'm fortunate to be in an academic hospital where the cardiothoracic and the vast majority of surgical ICU attendings are anesthesiologists. Again, what I'm trying to get at is that the scope of an anesthesiologist's practice is wide.

We go back to warning fatigue. I got a lot of flack in medical school for choosing anesthesia as a speciality, one guy going as far as telling me it was the equivalent of a nurse. When I started residency, I was perplexed (!!!) by the amount of ARNPs, NPs, PAs, etc that covered the emergency, transplant, oncology, etc services. It's almost as if I have to go through their mid-level provider, to even get on their list. Again, reality was very different from what I was told.

What I'm trying to say is if someone says bullsh*t long and loud enough, it becomes a mantra. This is an unfortunate habit in medicine nowadays and I've just become skeptical of all "warnings" I've received over the last 4 years, each one more wrong than the last. It doesn't help that anesthesiology salaries have not decreased and the prospective job growth in the field is increasing.

i can promise you mon ami this is a warning you wish you wouldve heeded. youll be working your little wee wee off.

 

[deleted941485]

i can promise you mon ami this is a warning you wish you wouldve heeded. youll be working your little wee wee off.

Seriously you think their scope of practice is a problem now wait another 10 years.

 

[Mman]

Seriously you think their scope of practice is a problem now wait another 10 years.

we have identical quotes here in this forum 10 years ago and yet my group is paying new physician hires more than 50% more than we did 7-10 years ago.

This is like the stock market endless permabear talk that is always warning of the impending crash.

 

[tennessee2244]

we have identical quotes here in this forum 10 years ago and yet my group is paying new physician hires more than 50% more than we did 7-10 years ago.

This is like the stock market endless permabear talk that is always warning of the impending crash.

The goddamn permabears man. I couldn't agree more. Those people suck. Stocks only go up and anesthesiology only gets better and better as a specialty!

 

[dabears505]

Hey, anesthesia intern here.

Wanted to give you some insight into why I didn't heed those warnings and chose anesthesiology. It definitely had a lot to do with warning fatigue. It started with applying to medical school. I would comb the SDN forums looking on insights from my peers on a variety of issues: DO v IMG v USMD, because at that time I was waitlisted at an MD school, accepted to a DO school and still contemplating on going to medical school in a foreign country. There was a lot of consternation of the diminishing role IMGs would play in the upcoming match - the so-called IMG squeeze. So that didn't happen, and it continues to not happen - IMGs are still matching at the same rate.

There was also a lot of talk about increasing standards for medical school admissions. The school that waitlisted and subsequently rejected me effectively raised their admissions standards overnight, lauding their higher than average admission criteria for their incoming class of 2015 as if it were some sort of breakthrough. Four years later (when I was an MS3), their unmatched rate remained the same and a substantial chunk of their class matched at their home institution with minimal improvement in their match quality. Again, reality outweighed expectations.

I started reading a lot about anesthesiology and the mid-level provider squeeze early in med school. I have anesthesiologists in my family and I became familiarized with the CRNA-anesthesiologist dynamic in undergrad. The time I spent in the OR during those days, I saw the CRNAs as providers that can expand the scope and reach of any given physician - instead of covering 1 room, the anesthesiologist was covering 3-4 ORs at one time. I never saw CRNA's as particularly motivated to do nerve blocks, put in lines or round in the ICU as attendings - mainly because most of them, if not all of them, were not qualified to do so. Basically, the extent of their practice was very limited.

When I started residency, my first week in the anesthesiology pre-operative clinic (where we optimize high risk patients for TAVRs/CABGs, etc.) my attending spent most of his time fending off calls from concerned patients that didn't want a "nurse" providing anesthesia. People are VERY concerned about going under and when they find out CRNAs will be managing their care, many of them are quite resistant to the idea. That kind of lends credence to the idea that there is a lack of appeal over a nurse providing perioperative management among the general populace. Moreover, I'm fortunate to be in an academic hospital where the cardiothoracic and the vast majority of surgical ICU attendings are anesthesiologists. Again, what I'm trying to get at is that the scope of an anesthesiologist's practice is wide.

We go back to warning fatigue. I got a lot of flack in medical school for choosing anesthesia as a speciality, one guy going as far as telling me it was the equivalent of a nurse. When I started residency, I was perplexed (!!!) by the amount of ARNPs, NPs, PAs, etc that covered the emergency, transplant, oncology, etc services. It's almost as if I have to go through their mid-level provider, to even get on their list. Again, reality was very different from what I was told.

What I'm trying to say is if someone says bullsh*t long and loud enough, it becomes a mantra. This is an unfortunate habit in medicine nowadays and I've just become skeptical of all "warnings" I've received over the last 4 years, each one more wrong than the last. It doesn't help that anesthesiology salaries have not decreased and the prospective job growth in the field is increasing.

Bro, I'm sorry. Give it a few years.

Hey, anesthesia intern here.

Wanted to give you some insight into why I didn't heed those warnings and chose anesthesiology. It definitely had a lot to do with warning fatigue. It started with applying to medical school. I would comb the SDN forums looking on insights from my peers on a variety of issues: DO v IMG v USMD, because at that time I was waitlisted at an MD school, accepted to a DO school and still contemplating on going to medical school in a foreign country. There was a lot of consternation of the diminishing role IMGs would play in the upcoming match - the so-called IMG squeeze. So that didn't happen, and it continues to not happen - IMGs are still matching at the same rate.

There was also a lot of talk about increasing standards for medical school admissions. The school that waitlisted and subsequently rejected me effectively raised their admissions standards overnight, lauding their higher than average admission criteria for their incoming class of 2015 as if it were some sort of breakthrough. Four years later (when I was an MS3), their unmatched rate remained the same and a substantial chunk of their class matched at their home institution with minimal improvement in their match quality. Again, reality outweighed expectations.

I started reading a lot about anesthesiology and the mid-level provider squeeze early in med school. I have anesthesiologists in my family and I became familiarized with the CRNA-anesthesiologist dynamic in undergrad. The time I spent in the OR during those days, I saw the CRNAs as providers that can expand the scope and reach of any given physician - instead of covering 1 room, the anesthesiologist was covering 3-4 ORs at one time. I never saw CRNA's as particularly motivated to do nerve blocks, put in lines or round in the ICU as attendings - mainly because most of them, if not all of them, were not qualified to do so. Basically, the extent of their practice was very limited.

When I started residency, my first week in the anesthesiology pre-operative clinic (where we optimize high risk patients for TAVRs/CABGs, etc.) my attending spent most of his time fending off calls from concerned patients that didn't want a "nurse" providing anesthesia. People are VERY concerned about going under and when they find out CRNAs will be managing their care, many of them are quite resistant to the idea. That kind of lends credence to the idea that there is a lack of appeal over a nurse providing perioperative management among the general populace. Moreover, I'm fortunate to be in an academic hospital where the cardiothoracic and the vast majority of surgical ICU attendings are anesthesiologists. Again, what I'm trying to get at is that the scope of an anesthesiologist's practice is wide.

We go back to warning fatigue. I got a lot of flack in medical school for choosing anesthesia as a speciality, one guy going as far as telling me it was the equivalent of a nurse. When I started residency, I was perplexed (!!!) by the amount of ARNPs, NPs, PAs, etc that covered the emergency, transplant, oncology, etc services. It's almost as if I have to go through their mid-level provider, to even get on their list. Again, reality was very different from what I was told.

What I'm trying to say is if someone says bullsh*t long and loud enough, it becomes a mantra. This is an unfortunate habit in medicine nowadays and I've just become skeptical of all "warnings" I've received over the last 4 years, each one more wrong than the last. It doesn't help that anesthesiology salaries have not decreased and the prospective job growth in the field is increasing.

Man o man, give it a few years. You will wish so bad that you had listened.

 

[Mman]

The goddamn permabears man. I couldn't agree more. Those people suck. Stocks only go up and anesthesiology only gets better and better as a specialty!

stocks go up and down over the short term, and up over the long term. Anesthesia as a specialty has been dead and dying since the 1970s. There is not a single practicing anesthesiologist in the country that entered the specialty during a time that it was a hot field with a bright future and yet most people doing the job have done fairly well for themselves and are not imminently going to be unemployed. Personally I lucked into the best job I could have probably had in any specialty.

 

[Status Sciaticus]

we have identical quotes here in this forum 10 years ago and yet my group is paying new physician hires more than 50% more than we did 7-10 years ago.

This is like the stock market endless permabear talk that is always warning of the impending crash.

+2. And if youre on this forum long enough, you discover that its the same 5-10 people regurgitating these predictions and that the sky is falling down.

 

[9blade]

Videos like this are why people think anesthesiologists are filthy rich. Just look at the comments. Lots of people saying they want to be anesthesiologists.

 

[PieOHmy]

Videos like this are why people think anesthesiologists are filthy rich. Just look at the comments. Lots of people saying they want to be anesthesiologists.

I wonder what practice she is at.
SHe also says that she has her own business.. So maybe a lions share of her money is from her business

 

[9blade]

I wonder what practice she is at.
SHe also says that she has her own business.. So maybe a lions share of her money is from her business

yea, I want to guess that the biggest part of her anesthesiology salary comes from that.

 

[IMGASMD]

Is she doing pain? And that’s her business? There’s a pain doctor who hires Anesthesiologists to staff her three or four pain offices. I wouldn’t be surprised that she can make a mil +.

 

[nimbus]

Divorced anesthesiologist, theater buff, New Jersey, with an 8 year old. Not that hard to find. She’s all over TV and the internet. It’s likely a lot of her income comes from media activities.

 

[PieOHmy]

Divorced anesthesiologist, theater buff, New Jersey, with an 8 year old. Not that hard to find. She’s all over TV and the internet. It’s likely a lot of her income comes from media activities.

find her for me so i can call her and give her a piece of my mind. And.... there is no way that chick does meatball anesthesia with her temperment.

 

[zero0]

Videos like this are why people think anesthesiologists are filthy rich. Just look at the comments. Lots of people saying they want to be anesthesiologists.

Cringe

 

[anbuitachi]

we have identical quotes here in this forum 10 years ago and yet my group is paying new physician hires more than 50% more than we did 7-10 years ago.

This is like the stock market endless permabear talk that is always warning of the impending crash.

unfortunately n=1 doesnt mean much. you could be in the best group in the country with the best payor mix with the fastest and nicest surgeons. or your group couldve been underpaying in the last 10 years..

However, anesthesiology salaries have gone up and down like a rollercoaster in the past few decades. We are still making far less than in the 1980s adjusting for inflation, but making more than 1990s

Anyway, i found aneftp's post in 2010!!!

He was posting salaries of ~mid 400 TEN years ago. Inflation in the past decade 2010-2019 was 20.3% total. So hopefully those salaries went up 80k or so

My first post on this forum!

Anyways, I've been out in practice almost 6 years now. Can't believe it's been that long.

To answer the OP's concerns about salaries for anesthesiologists.

As other posters have stated, we really don't know what the future holds. I come from a family of anesthesiologist siblings/brother's in law. I'm the youngest of the bunch so I have a little more perspective.

Anesthesia has always been a weird field in terms of salaries.

In the 1980's (the golden age of anesthesia reimbursements), MD's were routinely making over $500-600K. Keep this in mind. That's 1980's money. Adjusted for inflation that's probably close to over 1 million in 2010 dollars, all working less than 50 hours a week.

Fast forward to the mid 1990s when there were no jobs for anesthesiologists. My brother who completed his cardiac fellowship in 1996 took a job on the East Coast for $110K. That's right $110K! My brother in law came out in 1997 and he got $120K, my sister started at $120K in 1998. Than my other brother in law came out in 2001 and started at $180K.

When I came out in 2004, I started at $220K. Anesthesia salaries really started making a comeback in the early 2000s, so I have been lucky. Currently I make in the mid $400k range doing strictly outpatient anesthesia 530am-3PM down in the South. No weekends, no calls.

My brother (who's the oldest and has been out since 1996) is currently working in downtown Los Angeles proper and makes almost $600K a year. But he works 60 plus hours a week and also does cardiac.

My brother in law currently makes in the low 400Ks in the east coast. But he works about 50 hours a week. His other partners work like crazy 60/70 hours and pull over $700K a year. My best friend from med school works in the "holy grail" of Anesthesia reimbursements...aka Texas. He was making close to 1 million as of 2008 (prior to lehman brother's financial crash). Last year he took a hit and his salary went down to $600K (he had to give up his yellow Lamborghini).

I'm not stupid. Anesthesia salaries (along with other specialities) will go down again. Using the Canadian model since I know some Canadian anesthesiologists. Most of them up there still make in the $300-400K range but they all work close to 60 hours a week.

So an outpatient M-F job I have now will go way down to the mid 200s. Hospital Based anesthesiologist will still command in the $300-400K range. We just won't see many anesthesiologists like my friend in Texas making close to one million anymore.

The lesson here is not to live a lavish lifestyle (the Italian Sports Car, the two homes and the boat etc). I know salaries will take a hit (my radiology friends are going through it right now).

FYI: My other non-MD other brother is a pharmacist at Walgreens. He's been out since 1997. He pulls in over $150K a year on the east coast. Pharmacist get paid very well.

The salaries that are really out of order are the CRNAs. I'm down in Florida and most CRNA "command" at least $150K (w2) or $200K (1099). AA's even get $120K and up.

If we are taking a hit, the CRNAs and AAs are in for a rude awakening. Most of the inflated CRNA salaries are out in rural areas.

 

[Mman]

Anyway, i found aneftp's post in 2010!!!

He was posting salaries of ~mid 400 TEN years ago. Inflation in the past decade 2010-2019 was 20.3% total. So hopefully those salaries went up 80k or so

He posted his starting salary was $220K in 2004 which sounds about right. Nowadays people don't have much trouble finding starting salaries around $400K.

 

[CidHighwind]

He posted his starting salary was $220K in 2004 which sounds about right. Nowadays people don't have much trouble finding starting salaries around $400K.

Weird, many here would have you believing that docs had it so much easier 15 years ago

 

[anbuitachi]

He posted his starting salary was $220K in 2004 which sounds about right. Nowadays people don't have much trouble finding starting salaries around $400K.

yes 220k in 2004 , 450 in 2010! (doubled in 6 years!!) i wonder what he makes now in 2020. if all it did was keep up with inflation, should be ~530s


Note 220k in 2004, adjusted for inflation in 2019 is 300k, which is what a lot of jobs around me are paying, myself included. so its not that outrageous at least in my area

 

[PieOHmy]

He posted his starting salary was $220K in 2004 which sounds about right. Nowadays people don't have much trouble finding starting salaries around $400K.

but youre doing 10x more work

 

[PieOHmy]

yes 220k in 2004 , 450 in 2010! (doubled in 6 years!!) i wonder what he makes now in 2020. if all it did was keep up with inflation, should be ~530s


Note 220k in 2004, adjusted for inflation in 2019 is 300k, which is what a lot of jobs around me are paying, myself included. so its not that outrageous at least in my area

You have to stop thinking about what the absolute value of what youre making and start thinking relative value.
Sure 400k is a good salary. BUt would you do it for covering 4 rooms every single day 10 hours/d in addition to taking in house call once a week?

 

[anbuitachi]

You have to stop thinking about what the absolute value of what youre making and start thinking relative value.
Sure 400k is a good salary. BUt would you do it for covering 4 rooms every single day 10 hours/d in addition to taking in house call once a week?

for sure that as well. the field is hurting in multiple ways
i personally never cover 4 crnas cause i refused to apply to any jobs that cover 4 crnas

 

[Mman]

but youre doing 10x more work

I do literally the exact same work I did 10 years ago when I was making $225K a year.

 

[PieOHmy]

I do literally the exact same work I did 10 years ago when I was making $225K a year.

What is your point?
Exactly the same work with same pay, less pay, or more pay?

 

[Mman]

What is your point?
Exactly the same work with same pay, less pay, or more pay?

exactly the same work for way, way, way more pay

 

[deleted162650]

exactly the same work for way, way, way more pay

Was that 225k because you were still on the track? If so, how does partner pay compare today v 10 years ago?

 

[Mman]

Was that 225k because you were still on the track? If so, how does partner pay compare today v 10 years ago?

our partner pay is significantly higher than 10 years ago

 

[BLADEMDA]

There is a HUGE dichotomy in anesthesia. Successful private groups have continued to increase revenue above inflation. As long as their payer mix has remained stable the overall revenue has increased faster than inflation due to collections. They are the "haves" of anesthesia.

The second cohort is where most residents can expect to find jobs. This is hospital employment, management companies, academia or being an employee of a group. This cohort has done quite poorly over the past 10 years with their income not keeping up with inflation. I would estimate those salaries are $50,000-$80,000 below the expected wage vs 2010. This is due to a variety of reasons but mostly middle men taking a cut of the proceeds. CRNAs play a role as well because there are more midlevels available in the market place. In order to maximize profits the AMCs, hospitals etc have chosen the supervisory model for anesthesia. This means one needs fewer supervisors and more stool sitters driving down wages for anesthesiologists.
These are the "have-nots" of anesthesia.

The "have-nots" outnumber the "haves" by 3:1. Mman is is the "have" cohort while Aneft is in the "have not"majority. This huge dichotomy is only growing larger as the wage gap between these cohorts will double again over the next 10 years if nothing else changes. That translates into over a $200K difference in salary at a minimum by 2030.

 

[PieOHmy]

exactly the same work for way, way, way more pay

That is very interesting! Everyone in the industry is making less money or making the same and working a ton more except you.
How does that work?
Either you have stable of "dopes" that you are skimming off of or it's not true.

 

[nimbus]

There is a HUGE dichotomy in anesthesia. Successful private groups have continued to increase revenue above inflation. As long as their payer mix has remained stable the overall revenue has increased faster than inflation due to collections. They are the "haves" of anesthesia.

The second cohort is where most residents can expect to find jobs. This is hospital employment, management companies, academia or being an employee of a group. This cohort has done quite poorly over the past 10 years with their income not keeping up with inflation. I would estimate those salaries are $50,000-$80,000 below the expected wage vs 2010. This is due to a variety of reasons but mostly middle men taking a cut of the proceeds. CRNAs play a role as well because there are more midlevels available in the market place. In order to maximize profits the AMCs, hospitals etc have chosen the supervisory model for anesthesia. This means one needs fewer supervisors and more stool sitters driving down wages for anesthesiologists.
These are the "have-nots" of anesthesia.

The "have-nots" outnumber the "haves" by 3:1. Mman is is the "have" cohort while Aneft is in the "have not"majority. This huge dichotomy is only growing larger as the wage gap between these cohorts will double again over the next 10 years if nothing else changes. That translates into over a $200K difference in salary at a minimum by 2030.

The dichotomy stems from AMC buyouts. Too many groups saw dollar signs and proceeded with a sale despite evidence that the sky is not falling. The demographics of the US population alone signals that our services will remain in high demand. Rather than preserve a good practice for the long haul, they decided to go for the quick buck. Practices that never sold out are sitting pretty. I started practice in 1996. Both unit values and volume have never been higher.

 

[BLADEMDA]

The dichotomy stems from AMC buyouts. Too many groups saw dollar signs and proceeded with a sale despite evidence that the sky is not falling. The demographics of the US population alone signals that our services will remain in high demand. Rather than preserve a good practice for the long haul, they decided to go for the quick buck. Practices that never sold out are sitting pretty. I started practice in 1996. Both unit values and volume have never been higher.

Your post does not alter the facts of the "haves" vs the "have-nots" in anesthesia. I congratulate you on being in the "have" cohort which is no longer the majority.

The average resident will likely be forced into the "have-not" cohort and will not be "sitting pretty" circa 2030.

 

[BLADEMDA]

That is very interesting! Everyone in the industry is making less money or making the same and working a ton more except you.
How does that work?
Either you have stable of "dopes" that you are skimming off of or it's not true.

Your statement is incorrect. There is a successful cohort making more money than ever in anesthesia. The "haves" are a minority but doing very well.

 

[BLADEMDA]

I know some of you are angry at reading the truth. But, the FACT is the private payers are now at 4-5 X Medicare where as 10 years ago they were 3 X Medicare. This means if your payer mix is less than 50% CMS/Self pay/Tricare etc you are doing very well with reimbursements 4-5 X Medicare rates.

I have seen groups getting 6 X Medicare rates from some insurance companies. This means that 1 private insurance case pays the same amount as 5-6 CMS cases. The gap only grows larger with each passing year. The "wage gap" between cohorts also grows larger.

AMCs rarely ever give a pay raise. Successful private groups are seeing a 5% raise per year. Over time this is a lot of money when you compound it.

 

[anbuitachi]

Agree with Blade.

Im in the have nots. 99.9% of my patients are either medicaid, medicare, or uninsured. Explains my low salary. I'm salaried and work has definitely been increasing. The hospital is trying to get out of the red

 

[MoMoGesiologist]

All this time I thought I was a “have”... and realizing I’m a ”have not”... hurts, man...

 

[nimbus]

Your post does not alter the facts of the "haves" vs the "have-nots" in anesthesia. I congratulate you on being in the "have" cohort which is no longer the majority.

The average resident will likely be forced into the "have-not" cohort and will not be "sitting pretty" circa 2030.

Our current new hires make 3-4x what I did as a new grad, some hardworking ones 5x.

 

[deleted162650]

Your statement is incorrect. There is a successful cohort making more money than ever in anesthesia. The "haves" are a minority but doing very well.

I mentioned in another thread awhile back that the senior partners in my group noted that this past year is the best year financially in my group’s history. The workload has been stable, and the structure of our partner track has not changed since the group’s inception.

We are blessed with a stable, strong payer mix, and increasing volume.

 

[deleted126335]

Your statement is incorrect. There is a successful cohort making more money than ever in anesthesia. The "haves" are a minority but doing very well.

All true. But breaking into the successful cohort gets harder and harder. That successful cohort is also a perpetual target for AMCs and hospital administrators. Also some of that successful cohort is successful because they prey upon other anesthesiologists.


Sent from my iPhone using SDN mobile

 

[Mman]

Agree with Blade.

Im in the have nots. 99.9% of my patients are either medicaid, medicare, or uninsured. Explains my low salary. I'm salaried and work has definitely been increasing. The hospital is trying to get out of the red

you are telling me that 1/1000 patients you see has insurance? I find that impossible to believe in any setting except a VA.

 

[BLADEMDA]

Most of you are posting the "truth" as you see it in your world. But, Doze has it right when he states the "haves" are smaller in number than 10 years ago and harder than ever to break into as a new grad. Anesthesia is NOT about working hard alone. You can work until you drop (80+ hours per week) in a CMS practice (90% CMS) or 40 hours in a private payer practice with 60% private insurance. Which Anesthesiologist will make more money and have a much better life?

This is the reason USAP can attract new talent. At least they offer decent income and benefits with increasing income over time. Most other AMCs don't even offer the Faux partnerships. It is straight salary without any guaranteed raises.

I think SDN attracts more than its share of "haves" who are likely giving a false impression to the majority of new grads.
The reason to do a fellowship is to get a coveted, rare "have" position. If you can get one of those spots, which are very hard to obtain, without a fellowship then by all means take it.

My hunch is that if Mman or Salty had an open position there would be 20, 30 or even 40 qualified applicants vying for that position. In my neck of the woods, even average MGMA income jobs attract 20-30 applicants per position.

When USAP posts available positions in good locations they fill the positions. The job market for the new grad is anything but rosy.

 

[CidHighwind]

Are you insinuating that Anesthesiology is the new path/Radonc?

 

[PieOHmy]

My hunch is that if Mman or Salty had an open position there would be 20, 30 or even 40 qualified applicants vying for that position. In my neck of the woods, even average MGMA income jobs attract 20-30 applicants per position.

No Anesthesia job gets 20 applicants.. Not in 2020..

 

[anbuitachi]

you are telling me that 1/1000 patients you see has insurance? I find that impossible to believe in any setting except a VA.

? you mean private insurance? i said 99.9% have medicaid/medicare or uninsured. i look at the insurance for all my patients, because its right up there in epic next to patients weight. and i dont remember seeing any private insurance in the past 6 months

 

[Mman]

? you mean private insurance? i said 99.9% have medicaid/medicare or uninsured. i look at the insurance for all my patients, because its right up there in epic next to patients weight. and i dont remember seeing any private insurance in the past 6 months

yes, that is what I find impossible to believe.

 

[Mman]

My hunch is that if Mman or Salty had an open position there would be 20, 30 or even 40 qualified applicants vying for that position. In my neck of the woods, even average MGMA income jobs attract 20-30 applicants per position.

We have hired a doc almost every single year for probably 15+ years, sometimes 2 in a year. The funny thing is, we have had multiple people turn down our offers in the last 5 years.