Would you: Take a pay cut so you don’t work for AMC/pay cut to do your own cases solo?

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DrOwnage

DrOwnage

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Debating jobs at the moment. The area I’m moving to is heavy AMC. I’m almost decided that I would rather take a pay cut and do my own cases rather than supervising for an AMC. How does everyone feel about this? Talking about 10-15% salary difference. What’s everyone’s number?
 
DrOwnage said:
Debating jobs at the moment. The area I’m moving to is heavy AMC. I’m almost decided that I would rather take a pay cut and do my own cases rather than supervising for an AMC. How does everyone feel about this? Talking about 10-15% salary difference. What’s everyone’s number?
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Do own cases? Worth it

Working for AMC? Who cares as long as the paycheck clears.
 
It doesn’t matter these days where your paycheck comes from.

Some very large “private practice groups” function as AMCs as well

Like Florida Gulf to bay before they sold out twice (first to private equity) than to team health. Ingenious of the dude. They were like a De facto AMC. Same with the fair oaks (northern Virginia outside of dc). They had tons of practices before they sold out to Napa. They are just disguised as private when they really were AMC.

If the private place isn’t offering you true ownership. There is no difference between working for amc/hospital.
 
DrOwnage said:
Debating jobs at the moment. The area I’m moving to is heavy AMC. I’m almost decided that I would rather take a pay cut and do my own cases rather than supervising for an AMC. How does everyone feel about this? Talking about 10-15% salary difference. What’s everyone’s number?
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Need more details.

Short answer - probably yes. Especially if the supervisory work is higher risk.

When I took the job I have now for ~$450K (split of solo and reasonable ratio ACT), I declined a position with a ~$590K 40h/week group because they were 4:1 all the time. As a cardiac guy it would've been two hearts + two more rooms. I felt it was borderline unsafe and definitely not enjoyable. It was hard to walk away from that much money at the time, but it was the right call.

This was a few years ago, before salaries blew up. As fate would have it, the group I joined has seen its income grow substantially, to exceed the other group. Meanwhile that group, which was part of a multidisciplinary physician group, lacked the ability to keep up with the market, nothing changes, and it all but collapsed as people started leaving. I hear they've got a new deal now to stop the bleeding, but damage was done.

There's a thread titled "enough" in the private forum.
 
pgg said:
Need more details.

Short answer - probably yes. Especially if the supervisory work is higher risk.

When I took the job I have now for ~$450K (split of solo and reasonable ratio ACT), I declined a position with a ~$590K 40h/week group because they were 4:1 all the time. As a cardiac guy it would've been two hearts + two more rooms. I felt it was borderline unsafe and definitely not enjoyable. It was hard to walk away from that much money at the time, but it was the right call.

This was a few years ago, before salaries blew up. As fate would have it, the group I joined has seen its income grow substantially, to exceed the other group. Meanwhile that group, which was part of a multidisciplinary physician group, lacked the ability to keep up with the market, nothing changes, and it all but collapsed as people started leaving. I hear they've got a new deal now to stop the bleeding, but damage was done.

There's a thread titled "enough" in the private forum.
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Solo practice gig 450k base (only 4 weeks vacay) with good benefits, vs AMC 500k base (8 weeks vacay) 4:1, but sounds like 46 hour work week base?
 
DrOwnage said:
Solo practice gig 450k base (only 4 weeks vacay) with good benefits, vs AMC 500k base (8 weeks vacay) 4:1, but sounds like 46 hour work week base?
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Seriously? With only 4 weeks vacation, I will not look at the solo job unless > 600k.

W2 hourly rate minimum 300, 45 hours a week
4 weeks vacation + holidays+ sick leave+ cme: total 8 weeks

300*45*44=594,000 + call $ (MINIMUM!!!)
 
DrOwnage said:
Debating jobs at the moment. The area I’m moving to is heavy AMC. I’m almost decided that I would rather take a pay cut and do my own cases rather than supervising for an AMC. How does everyone feel about this? Talking about 10-15% salary difference. What’s everyone’s number?
Click to expand...
1:4 is absolutely hell and I wouldn’t even personally consider it. But 4 weeks of vacation for the solo job is ridiculous.

If those are the only two true options I’d easily pick the solo job. Whatever premium you’re paid to work 1:4 is just never worth it - the money difference is just irrelevant in my mind.

But both jobs seem to be below market for the workload. Is there any way to negotiate more vacation at the solo job? Or can you come up with a third option!? DC metro is rough but I think the academic jobs there offer an overall better package than the two options you listed.
 
DrOwnage said:
Solo practice gig 450k base (only 4 weeks vacay) with good benefits, vs AMC 500k base (8 weeks vacay) 4:1, but sounds like 46 hour work week base?
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If those are your choices and you must accept one because you're geographically limited, I'd go with the solo group. 4 weeks $450K is well below market outside the big "desirable" cities though.

DrOwnage said:
This area is busy metropolitan (D.C) and no one offers close to that compensation.
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Not far from there in the much nicer Shenandoah Valley 🙂 there's a private group that's roughly $600s with 12 weeks, mix of solo and not-outrageous ACT. Take less vacation, earn more. PM me if you can move an hour west of DC for a much better job.
 
Alternatively, if your situation allows you to do locums...alll you would have to do would be 24 weeks of 4 12s @ 400/hr to replace that 450k. Then you have the freedom to choose whatever else you want to do with the other 28 weeks a year.
 
l
DrOwnage said:
This area is busy metropolitan (D.C) and no one offers close to that compensation.
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its not good. And I know the dc area well.

My good crna friend makes in the low 400s no nights and weekend inside the city and very close surroundings.

Don’t fall for it. I’d take it if it were one week on. 5 days than 2 weeks off. So I’d take it with 35 weeks off.
 
Another good semi-near DC is University of Virginia. All the people I know there love it and they’re definitely hiring.
 
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Why not just move to DMV and do locums at one or more of the numerous hospitals? No need to be employed when you can pick and choose hospitals/shifts you want and create your own schedule
 
This may not be the thread to ask this but those who encourage the “do full time locums” and make more, when you do these locums gigs do you feel like you get fair cases or is whatever group/hospital you do locums for just giving you the crap cases/surgeons they’d rather not work with. Just genuinely curious. I always side eye these “cardiac locums” listing because I feel like they’re not just letting “unknown guy”’strut in off the street and do hearts but maybe I’m wrong
 
M
Twiggidy said:
This may not be the thread to ask this but those who encourage the “do full time locums” and make more, when you do these locums gigs do you feel like you get fair cases or is whatever group/hospital you do locums for just giving you the crap cases/surgeons they’d rather not work with. Just genuinely curious. I always side eye these “cardiac locums” listing because I feel like they’re not just letting “unknown guy”’strut in off the street and do hearts but maybe I’m wrong
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Most Fair places will break you in easy. They won’t put you in uncomfortable positions.

I do have a semi full time gig. And if we have a 1099 docs. Im not gonna to put him or her in uncomfortable position. Till the surgeons get to know you a little better.

So you usually won’t be doing hearts your first few days new to a place.
 
DrOwnage said:
Debating jobs at the moment. The area I’m moving to is heavy AMC. I’m almost decided that I would rather take a pay cut and do my own cases rather than supervising for an AMC. How does everyone feel about this? Talking about 10-15% salary difference. What’s everyone’s number?
Click to expand...
Hell yes take a pay cut to do your own cases. I’ve always predominantly done my own cases (10 percent of the time i medically direct), and wouldn’t have any other way, even though I know that I make less than my counterparts who predominantly direct/supervise. Peace of mind is worth a good chunk of change.
 
nimbus said:
Consider Kaiser?
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I was being kind of vague on purpose haha. But yes the gig I’m considering is Kaiser there, which makes the 450 look better because of the benefits and potential pension in the later years. I’ve kind of grinded for 5 years straight at 3 different jobs (wife is military) so I’m ready to settle down for a long term job.

The only other downside is with these jobs there is 1:7 at weekday call and 1 weekend a month built into the base salary. Same with AMC jobs. Despite what some people are saying I’ve struggled to find high paying jobs in the area or high paying locums that are close. I’m confined to the area around Walter Reed medical center. Even 15-20 miles in that area is not a completely doable due to traffic and commute, I also have kids to pick up.

The Kaiser job sounds like bread and butter, way less stress. No trauma, some OB. The locations are within 10-15 minutes of a potential houses we’re looking at buying. Also real estate is expensive af there ughhh.
 
DrOwnage said:
I was being kind of vague on purpose haha. But yes the gig I’m considering is Kaiser there, which makes the 450 look better because of the benefits and potential pension in the later years. I’ve kind of grinded for 5 years straight at 3 different jobs (wife is military) so I’m ready to settle down for a long term job.

The only other downside is with these jobs there is 1:7 at weekday call and 1 weekend a month built into the base salary. Same with AMC jobs. Despite what some people are saying I’ve struggled to find high paying jobs in the area or high paying locums that are close. I’m confined to the area around Walter Reed medical center. Even 15-20 miles in that area is not a completely doable due to traffic and commute, I also have kids to pick up.

The Kaiser job sounds like bread and butter, way less stress. No trauma, some OB. The locations are within 10-15 minutes of a potential houses we’re looking at buying. Also real estate is expensive af there ughhh.
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Kaiser sucks. I’m telling you. But to each their own

If you are looking to do no work. Better off at the Washington DC VA (veterans admin)

For years way less openings at the DC VA (compared to Baltimore VA which has more openings). It’s like mafia trying to get into the dc va place. Even crnas have a hard time getting a job there cause it’s much easier work pace. Workload…think about why dc is more in demand than Baltimore va.

Kaiser dc has already had to farm out 1099 work to other docs as well.

But it’s ur life. If you need to pickup kids. It’s the sacrifice many of us would need to consider as well.
 
Twiggidy said:
This may not be the thread to ask this but those who encourage the “do full time locums” and make more, when you do these locums gigs do you feel like you get fair cases or is whatever group/hospital you do locums for just giving you the crap cases/surgeons they’d rather not work with. Just genuinely curious. I always side eye these “cardiac locums” listing because I feel like they’re not just letting “unknown guy”’strut in off the street and do hearts but maybe I’m wrong
Click to expand...

I haven't done locums in a few years, but I was mostly treated OK.

Bottom line, the places that need locums help want above all for their rooms to be staffed and for things to go smoothly. Throwing an unknown locums who's unfamiliar with the place into the difficult rooms with picky surgeons creates problems. It makes the board runner's day not go smooth. When I was moonlighting as a generalist they gave me simple stuff, at least at first.

We didn't have locums at the Navy hospitals, but when I ran the board I'd put the reservists (aka ".mil locums") doing their annual two weeks in the simplest rooms with the least dramatic surgeons. I was looking to fill a hole in the schedule, not have to put out fires myself.


As for cardiac "unknown guy" drama - I had one outlier experience. A place advertised a need for cardiac anesthesia. I talked to the dept and they had a flexible and ongoing need that fit my off-duty Navy schedule, a couple hours from my house. They offered a great rate for the time (almost $300/hr - think this was early 2019?) Spent a couple months getting credentialed. Scheduled 3 or 4 weeks of work over a few months. Showed up, got a day of orientation, and the cardiac surgeons both said "what the hell, we're not working with locums" ... absolutely bizarre. The cardiac guys in the group there had been getting crushed with cases and call and they were pissed. But apparently nobody ever talked to the surgeons ahead of time.

I was there at the same time as another cardiac anesthesia locums, who was told the same thing, who was a little less annoyed than me. In the end they paid us a premium rate to solo sit gall bladders and outpatient ortho. I was a little bent about it because half the reason I was moonlighting away from the Navy in the first place was to keep doing hearts after the Navy closed its cardiac surgery program. The other guy couldn't stop laughing at getting paid that much to do ASA 1s and 2s. I made the best of it, did my contracted weeks, and didn't go back.

These days with widespread desperation for staffing, I suspect cardiac surgeons are indulged less often, and things are tilted more toward "either do your case with the unknown guy I put in the room or don't do your case" ...
 
Twiggidy said:
This may not be the thread to ask this but those who encourage the “do full time locums” and make more, when you do these locums gigs do you feel like you get fair cases or is whatever group/hospital you do locums for just giving you the crap cases/surgeons they’d rather not work with. Just genuinely curious. I always side eye these “cardiac locums” listing because I feel like they’re not just letting “unknown guy”’strut in off the street and do hearts but maybe I’m wrong
Click to expand...
Rarely am I given the runt assignments. The full timers are Generally very fair to locums in places I’ve been.

In most cases we make their lives easier when we show up. 1000 bonus points if you’re actually helpful and try to make their day to day smoother by doing add ons or mixing into the schedule nicely and willingly
 
DrOwnage said:
I was being kind of vague on purpose haha. But yes the gig I’m considering is Kaiser there, which makes the 450 look better because of the benefits and potential pension in the later years. I’ve kind of grinded for 5 years straight at 3 different jobs (wife is military) so I’m ready to settle down for a long term job.

The only other downside is with these jobs there is 1:7 at weekday call and 1 weekend a month built into the base salary. Same with AMC jobs. Despite what some people are saying I’ve struggled to find high paying jobs in the area or high paying locums that are close. I’m confined to the area around Walter Reed medical center. Even 15-20 miles in that area is not a completely doable due to traffic and commute, I also have kids to pick up.

The Kaiser job sounds like bread and butter, way less stress. No trauma, some OB. The locations are within 10-15 minutes of a potential houses we’re looking at buying. Also real estate is expensive af there ughhh.
Click to expand...
Is Kaiser there like Kaiser here (nor-cal)? The jobs can actually be quite good, and the numbers for pay and vacation don't take into account a number of factors like benefits and overtime. Here, at least, if you work more, you bank it as vacation or pay, and you get checks for what would be retirement contributions over the federal limits. So, in the end, again, at least the Kaiser job I had considered, there was probably another 50K a year that just kind of materialized, and people ended up taking way more than 4 weeks of vacation (like, WAY more). And then there's the more obvious benefits of the pension, 401K, and healthcare. Given all that, the 450K job could actually be quite good. I didn't end up taking the Kaiser job because of location and the sense that I'd be leaving one "company" job (VA) for another (Kaiser), but it was a very appealing package overall.

As for treatment of locums, I will echo what others have said. When we used locums, we gave them assignments that wouldn't create issues. I would hope this would be universal because, A) we don't need problems, and B) recruitment and onboarding new locums is a hassle, so we want them to succeed with us.
 
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Yeah. I've certainly heard some locums gigs in the central part of the state that are notoriously bad. We had one guy who quit our group for various reason go do locums and he said people we're walking out after one week. The surgeon (CV) there was a PITA and was literally running people off to the point that no amount of money was worth it. If i were single with no kids i feel like the best move in our field is to be mercenary locums until you're ready to settle have an family. Plenty of opportunity to make that money and see the world in the best years of you life. Honestly when I was finishing training the locums market just wasn't as good as it is now.
 
Twiggidy said:
Honestly when I was finishing training the locums market just wasn't as good as it is now.
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Moreover, the locums market had a stink to it, to the point that we had a lot of threads advising new grads not to sabotage their careers by being locums right out of residency.

It used to be that a large fraction of locums were clowns who couldn't hold a steady job or dinosaur part-timers. This thing where top talent choose to be locums to maximize income and travel is a new phenomenon.
 
pgg said:
Moreover, the locums market had a stink to it, to the point that we had a lot of threads advising new grads not to sabotage their careers by being locums right out of residency.

It used to be that a large fraction of locums were clowns who couldn't hold a steady job or dinosaur part-timers. This thing where top talent choose to be locums to maximize income and travel is a new phenomenon.
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That part. I think I’m still jaded to this day from the way we, certainly myself included, viewed locums.

And I hate to add this aspect but myself, who already gets a different view when he walks into the OR, didn’t want to add fuel to that fire.
 
Twiggidy said:
Yeah. I've certainly heard some locums gigs in the central part of the state that are notoriously bad. We had one guy who quit our group for various reason go do locums and he said people we're walking out after one week. The surgeon (CV) there was a PITA and was literally running people off to the point that no amount of money was worth it. If i were single with no kids i feel like the best move in our field is to be mercenary locums until you're ready to settle have a family. Plenty of opportunity to make that money and see the world in the best years of you life. Honestly when I was finishing training the locums market just wasn't as good as it is now.
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Anyone without kids or empty nesters should be doing full time locums unless they have stake in the practice already and dont
Want to travel
 
DrOwnage said:
I was being kind of vague on purpose haha. But yes the gig I’m considering is Kaiser there, which makes the 450 look better because of the benefits and potential pension in the later years. I’ve kind of grinded for 5 years straight at 3 different jobs (wife is military) so I’m ready to settle down for a long term job.

The only other downside is with these jobs there is 1:7 at weekday call and 1 weekend a month built into the base salary. Same with AMC jobs. Despite what some people are saying I’ve struggled to find high paying jobs in the area or high paying locums that are close. I’m confined to the area around Walter Reed medical center. Even 15-20 miles in that area is not a completely doable due to traffic and commute, I also have kids to pick up.

The Kaiser job sounds like bread and butter, way less stress. No trauma, some OB. The locations are within 10-15 minutes of a potential houses we’re looking at buying. Also real estate is expensive af there ughhh.
Click to expand...
U want to know how to get the most bang for the buck. Go part time either at Kaiser 0.6 FTE which allows you to be a partner. Or 0.5 FTE at the VA. @kaiser u get full time benefits at the 0.6 FTE and if u pay out any time worked extra it counts towards the pension calculation. Kaiser has a lot of fat compared to true private practice so you don't run lean like most private practices. Very generous paternity and maternity leave policy. U supervise CRNA's part of the time but it's not a big deal in a vertically integrated system like Kaiser which is incentivized for good outcomes. When lawsuits happen they occur under arbitration and the system doesn't hang you out to dry like non kaiser systems.

VA: benefits are prorated so if you go to 0.5 fte you get 0.5 benefits. The advantage is that you can side gig at other places. kaiser doesn't allow you to. Don't know if that VA is academic affiliated but if it is, you get residents. So your job is even more chill. It's actually refreshing to go into academia and teach residents from the perspective of someone that actually has to make the sausage unlike most of their academic attendings.

The VA is a weird world since the workload is literally laughable. That is a challenge in itself. Also going back to academics is challenging when you have to work with academic surgeons who think they are good but couldn't hack it in the private world. Like seriously, it's the blind leading the blind. Then again I don't spare this criticism for the anesthesia side either. I do think that CA-3 should be required to shadow a private practice anesthesiologist to truly understand what the standard is in the "real" world when they graduate. Happy to chat since I am very experienced in both. (in the west coast side though)
 
ucsfgaspain said:
U want to know how to get the most bang for the buck. Go part time either at Kaiser 0.6 FTE which allows you to be a partner. Or 0.5 FTE at the VA. @kaiser u get full time benefits at the 0.6 FTE and if u pay out any time worked extra it counts towards the pension calculation. Kaiser has a lot of fat compared to true private practice so you don't run lean like most private practices. Very generous paternity and maternity leave policy. U supervise CRNA's part of the time but it's not a big deal in a vertically integrated system like Kaiser which is incentivized for good outcomes. When lawsuits happen they occur under arbitration and the system doesn't hang you out to dry like non kaiser systems.

VA: benefits are prorated so if you go to 0.5 fte you get 0.5 benefits. The advantage is that you can side gig at other places. kaiser doesn't allow you to. Don't know if that VA is academic affiliated but if it is, you get residents. So your job is even more chill. It's actually refreshing to go into academia and teach residents from the perspective of someone that actually has to make the sausage unlike most of their academic attendings.

The VA is a weird world since the workload is literally laughable. That is a challenge in itself. Also going back to academics is challenging when you have to work with academic surgeons who think they are good but couldn't hack it in the private world. Like seriously, it's the blind leading the blind. Then again I don't spare this criticism for the anesthesia side either. I do think that CA-3 should be required to shadow a private practice anesthesiologist to truly understand what the standard is in the "real" world when they graduate. Happy to chat since I am very experienced in both. (in the west coast side though)
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Not all VA jobs are the same. Washington DC VA has traditionally been way better job than Baltimore VA thus harder to get into. Even in this hot anesthesia market. It’s pretty walled in and depends on who u know to get in

But OP just wants 7-3 job and pick up their kids. And doesn’t want to drive more than 20 min tops. So that’s where they have to compromise with what’s out there
 
DrOwnage said:
Debating jobs at the moment. The area I’m moving to is heavy AMC. I’m almost decided that I would rather take a pay cut and do my own cases rather than supervising for an AMC. How does everyone feel about this? Talking about 10-15% salary difference. What’s everyone’s number?
Click to expand...
How are the academic gigs in DC ?
 
Sdn is strange. On these forums supervising is seen as the seventh level of hell and everyone pines for the “good old days” of doing your own room. However wherever I worked the solo rooms would go to the locums/per diem and if you tried to place the senior guys in a room alone there would be a lot of pushback …..
 
dannyboy1 said:
Sdn is strange. On these forums supervising is seen as the seventh level of hell and everyone pines for the “good old days” of doing your own room. However wherever I worked the solo rooms would go to the locums/per diem and if you tried to place the senior guys in a room alone there would be a lot of pushback …..
Click to expand...
The majority of people over age 50 in this profession hate being in the operating room but can’t control their spending enough to quit. It’s got to be a sad existence.
 
PainInTheAnes said:
The majority of people over age 50 in this profession hate being in the operating room but can’t control their spending enough to quit. It’s got to be a sad existence.
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Seems to be universal regardless of age. Everyone seems to quickly learn to love “supervising”
 
dannyboy1 said:
Seems to be universal regardless of age. Everyone seems to quickly learn to love “supervising”
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To each their own. I've known people that started off from training primarily wanting to be solo, then discover that they preferred to not be in a room all day. I've also seen plenty of the opposite; people that didn't think directing was so bad come to dread it, and pine for the days they get to be in a room alone. The market should be able to accommodate both kinds of people, but it seems that in areas where direction or supervision dominate, groups/AMCs/hospitals are unwilling to even entertain the idea of a physician working solo (even at a reduced rate).
 
PainInTheAnes said:
The majority of people over age 50 in this profession hate being in the operating room but can’t control their spending enough to quit. It’s got to be a sad existence.
Click to expand...
Absolutely true. I Wil admit my spending habits can range anywhere between 20-30k each month these days. This is with no student loan, no car payment no credit card debt, public schools for the kids and a $4500 a month mortgage

Just stupid crap I spend on. Though vacation spending skews a lot of my spending.

I used to spend $7k a month. Than it became 10k. Than kids made it 15k etc a month.

Just my fault at times.
 
aneftp said:
Absolutely true. I Wil admit my spending habits can range anywhere between 20-30k each month these days. This is with no student loan, no car payment no credit card debt, public schools for the kids and a $4500 a month mortgage

Just stupid crap I spend on. Though vacation spending skews a lot of my spending.

I used to spend $7k a month. Than it became 10k. Than kids made it 15k etc a month.

Just my fault at times.
Click to expand...
what are you spending 10k a month on?
 
Twiggidy said:
This may not be the thread to ask this but those who encourage the “do full time locums” and make more, when you do these locums gigs do you feel like you get fair cases or is whatever group/hospital you do locums for just giving you the crap cases/surgeons they’d rather not work with. Just genuinely curious. I always side eye these “cardiac locums” listing because I feel like they’re not just letting “unknown guy”’strut in off the street and do hearts but maybe I’m wrong
Click to expand...
Depends on the location but I’m full time locums and no place has “thrown” me into some dangerous situation. Having a bad outcome because the place is making an effort to abuse their locums is not a good look for the group/hospital/amc either. They also know it’s a two way street. They can get rid of you within 30 days and you can leave within 30. Generally they want you to come back because it is also not super simple to find capable and safe locums as well.

I’ve been treated with respect all places I go. I may not be trusted with all cases/locations/surgeons initially but over time as they get to know you take good care of patients places pretty much integrate you. The more capable and professional care you give the greater your leverage later on with contracts.
 
secretasianman said:
what are you spending 10k a month on?
Click to expand...
I try to take a side trip once a month. That’s 2-3k usually. 5k if I take the kids.

Sometimes unexpected household expenses like I had a pool leak. That’s $1500. Kids braces x 1 and soon to be 2. Tennis lessons, cheer etc. just normal stuff. If all adds up. Got another 20k I gotta spend on new hvac units soon. So I budget that.

I put 2k each month into kids 529

Basically the kids cost me 5k a month with food/clothing alone.

Gonna to wrap the cybertruck. That’s $5500 for PPF black wrap. That’s a personal preference expense. But I just did the lease hack to buyout cybertruck. Basically saved me $6k more since u can lease and buyout and bypass the income limits for EV tax credits with leases (assuming the lease holder lets you buyout the lease immediately to avoid rent charges (interest) from accumulating. Massive tax write off on the cybertruck since I put it in service by Dec 31 2024. 60k tax write off plus the lease hack. Basically I turned a 80k truck into a 52k net purchase.
 
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