Anesthesiologist shortage 12k by 2033

[anbuitachi]

It's not necessarily "slowly getting leverage" but can result in a much more instantaneous response of hospital kicking out the group the moment they ask for a stipend. I know because it happened in another hospital across town. Group asked for a stipend last year to stay competitive with surging market pay rates that were resulting in them not being able to recruit as their billing collections were not enough to offer competitive salaries vs the market. Hospital laughed and said "if we are going to pay you we might as well employ you". They then refused contract renewal with the group and sought to employ their own anesthesiologists. Their jaws about hit the floor when they couldn't recruit a single person either and they scrambled to bring in locums staffing for $400/hr. They ended up bleeding themselves dry paying locums to try and keep the ORs running and to this day are staffing with locums and cannot hire an anesthesiologist to save their life. If they had not been so arrogant and out of touch with the market they could have kept the private group offering superior coverage for far less money.

its disappointing this hospital is still in business. they should go bankrupt and close

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[anbuitachi]

All of the private practice or former private practice guys I know who worked 50+ hours a week were making $1.2 million or more 10-15 years ago. You can justify those hours when it pays for your Ferrari collection, McMansion, and ski house while still being able to save for retirement. Nowadays the difference in lifestyle between 400k and 500k does not justify killing yourself with nights, weekends, and 50+ hour workweeks.

Despite all the talk about how much locums are getting paid now, it is still a lot less than those private practice guys 10-15 years ago when accounting for inflation and approximate hourly pay of those private practice guys at the peak.

It was not that good. Maybe I didn't get out enough, but, The only people I know who made that type of money were lucky enough to be in an area with an excellent payor mix or were exploiting senior partners or supervised more than four rooms or did pain in their own facility.

I tend to agree although 1.2m seems a stretch in a group where everyone was equal. I knew of some groups 2005-2015 making 650ish (not inflation adjusted) working 55ish. Good hospital stipend. Fair groups. Sold out.

That’s 850k or so in today’s dollars. Makes me realize how little I make comparatively.

my 70 year old colleague says this. he used to make 1.2m in PP decades ago. had a yacht. he had to sell that off. makes a fraction of that now and works more

 

[pgg]

my 70 year old colleague says this. he used to make 1.2m in PP decades ago. had a yacht. he had to sell that off. makes a fraction of that now and works more

The fact that he's 70 and still working, despite making $millions decades ago, and bought a yacht he couldn't afford (had to sell off because his income changed), suggests that the larger problem is that he's an idiot.

 

[anbuitachi]

The fact that he's 70 and still working, despite making $millions decades ago, and bought a yacht he couldn't afford (had to sell off because his income changed), suggests that the larger problem is that he's an idiot.

sure but at least he had a yacht. which i wont ever have

 

[amyl]

its disappointing this hospital is still in business. they should go bankrupt and close

Curious where this hospital is? Also if ******* admins paid the price….
Memphis, Portland, etc. all these admins f’ing around and finding out… yet things really don’t change.

 

[Caninehalitosis]

The beckersasc article references Providence in Portland and the Billings clinic in Montana. Neither case has anything to do with a shortage of anesthesiologists. If you dig through these forums you will find that in both cases the administrations of the hospitals elected to replace long serving Anesthesia groups with AMC groups: Sound at Providence and USAP in Montana. Their particular shortage was self inflicted.

 

[pgg]

sure but at least he had a yacht. which i wont ever have

That's one way to look at it.

Another way to look at it is to be glad you won't be working when you're 70.

Unless you're an idiot like him.

 

[kidthor]

sure but at least he had a yacht. which i wont ever have

To be fair the yachting world is more of a headache than it’s worth. Even just getting out of most marinas is a production.

But I sort of want one…

 

[nimbus]

The beckersasc article references Providence in Portland and the Billings clinic in Montana. Neither case has anything to do with a shortage of anesthesiologists. If you dig through these forums you will find that in both cases the administrations of the hospitals elected to replace long serving Anesthesia groups with AMC groups: Sound at Providence and USAP in Montana. Their particular shortage was self inflicted.

It’s related to the shortage because the longstanding groups needed and asked for stipend support to continue recruiting and staff the hospitals. Instead the hospitals mistakenly bought an unrealistic sales pitch from the AMCs. Why do YOU think the existing groups were replaced?

 

[nimbus]

To be fair the yachting world is more of a headache than it’s worth. Even just getting out of most marinas is a production.

But I sort of want one…

Better to make friends with a rich surgeon and bring him a nice cheese plate when you’re invited to his yacht. It’s $50.

 

[makemoney2024]

Well yeah they can't retire because they're not getting paid enough

This is a spending problem. When teachers making less than 100k are retiring comfortable we seriously cannot say people making triple that cannot retire. Overconsumption problem.

 

[rowsdower88]

To be fair the yachting world is more of a headache than it’s worth. Even just getting out of most marinas is a production.

But I sort of want one…

Two happiest days in a boat owners life...

 

[T-burglar]

Lmao at doctors wanting to own yachts

 

[periopdoc]

Why do YOU think the existing groups were replaced?

Control

 

[sbmed100]

my 70 year old colleague says this. he used to make 1.2m in PP decades ago. had a yacht. he had to sell that off. makes a fraction of that now and works more

Those numbers were limited to senior partners in PP and it's not the whole story. They got a K-1 distribution, and then expenses were taken out: office and billing, med mal, family medical, etc. so not quite thaaat high...

 

[Coffee PRN]

Those numbers were limited to senior partners in PP and it's not the whole story. They got a K-1 distribution, and then expenses were taken out: office and billing, med mal, family medical, etc. so not quite thaaat high...

Adjust for inflation, and it’s even higher. Imagine the equivalent of 3 million dollars salary today…**** I’d be looking into yachts and side pieces too lol

 

[Caninehalitosis]

It’s related to the shortage because the longstanding groups needed and asked for stipend support to continue recruiting and staff the hospitals. Instead the hospitals mistakenly bought an unrealistic sales pitch from the AMCs. Why do YOU think the existing groups were replaced?

I think it was a failure of administration to understand the anesthesia market. It was a failure of Administration to appreciate and work with established groups within their institution. Private equity backed Anesthesia management companies sole interest is rent seeking. They want to skim money from docs and hospitals. I agree that administrators are susceptable to unrealistic sales pitches.

 

[IIMC]

Lmao at doctors wanting to own yachts

Husband and I just bought a yacht last week. Or rather a bluewater sailboat. It will take about 5-6 years to learn the systems and get it ready for ocean crossings. First stop: North Pacific. We’ve owned two other smaller boats in the past. They are a lot of work and expense but if you actually take them out on the water (many boat owners almost never do), they can be a source of true joy. Looking forward to sailing away and not looking back.

 

[dozitgetchahi]

I see the appeal of ASCs. No weekends, no call, sometimes a good payor mix.

But when people get in a car wreck, have an MI or an aortic dissection, have a stroke, or get cancer, they will need a hospital that is open 24/7/365 with in-house staff, imaging, lab, blood bank, ICU, Cath lab and everything else. That stuff is expensive so of course hospital facility fees are higher than ASC facility fees. ASCs just skim the most profitable part of the hospital’s business without contributing those other services to the community. They are the result of our perverted medical reimbursement system. The most essential and difficult work is not the best reimbursed. That’s why I philosophically oppose them and have turned down ASC work to the extent that I can.

Don’t cry for the hospitals, dude. Most hospitals in any locale where I have lived or worked engage in the sort of ultra greedy behavior that would make John D Rockefeller or Jeff Bezos blush.

I have no sympathy for them whatsoever.

 

[rowsdower88]

Don’t cry for the hospitals, dude. Most hospitals in any locale where I have lived or worked engage in the sort of ultra greedy behavior that would make John D Rockefeller or Jeff Bezos blush.

I have no sympathy for them whatsoever.

Probably true statements for most hospitals, but I felt sorry for the AMC closure in Atlanta. It definitely served a poorer population and it's an open question if it could have survived if Georgia had accepted the Medicaid expansion (or maybe Wellstar just ran them into the ground).

Wellstar faces federal complaints after Atlanta Medical Center closure

A group of elected officials are asking for a federal investigation following the closing of two hospitals in metro Atlanta.

www.fox5atlanta.com

Georgia House leaders signal Medicaid expansion is off the table in 2024

Georgia House leaders are signaling Medicaid health coverage won't be expanded in 2024. A bill introduced Tuesday by a top lieutenant to Republican House Speaker Jon Burns proposes to create a Comprehensive Health Care Commission.

apnews.com

 

[nimbus]

Probably true statements for most hospitals, but I felt sorry for the AMC closure in Atlanta. It definitely served a poorer population and it's an open question if it could have survived if Georgia had accepted the Medicaid expansion.

Wellstar faces federal complaints after Atlanta Medical Center closure

A group of elected officials are asking for a federal investigation following the closing of two hospitals in metro Atlanta.

www.fox5atlanta.com

Georgia House leaders signal Medicaid expansion is off the table in 2024

Georgia House leaders are signaling Medicaid health coverage won't be expanded in 2024. A bill introduced Tuesday by a top lieutenant to Republican House Speaker Jon Burns proposes to create a Comprehensive Health Care Commission.

apnews.com

Hahnemann closed too but they were the victim of bad actors who promised to rescue them.

The Death of Hahnemann Hospital

When a private-equity firm bought a Philadelphia institution, the most vulnerable patients bore the cost.

www.newyorker.com

 

[nimbus]

Don’t cry for the hospitals, dude. Most hospitals in any locale where I have lived or worked engage in the sort of ultra greedy behavior that would make John D Rockefeller or Jeff Bezos blush.

I have no sympathy for them whatsoever.

Yes, it’s a ruthless predatory business.

 

[Guillemot]

Probably true statements for most hospitals, but I felt sorry for the AMC closure in Atlanta. It definitely served a poorer population and it's an open question if it could have survived if Georgia had accepted the Medicaid expansion (or maybe Wellstar just ran them into the ground).

Wellstar faces federal complaints after Atlanta Medical Center closure

A group of elected officials are asking for a federal investigation following the closing of two hospitals in metro Atlanta.

www.fox5atlanta.com

Georgia House leaders signal Medicaid expansion is off the table in 2024

Georgia House leaders are signaling Medicaid health coverage won't be expanded in 2024. A bill introduced Tuesday by a top lieutenant to Republican House Speaker Jon Burns proposes to create a Comprehensive Health Care Commission.

apnews.com

Medicaid doesn't pay. So the answer is no.

 

[rowsdower88]

Medicaid doesn't pay. So the answer is no.

Your skepticism is warranted, but medicaid expansion has helped hospitals.

This report claims expansion resulted in a ~2% reduction in uncompensated care burden for the hospitals it studied. Optimistically, it may have helped a hospital with an especially large indigent population that was on the margin of closing. There's a million factors to consider, so I won't make the strong claim that it would have saved the hospital on it's own (especially if Wellstar was likely mismanaging).

https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2017_may_dranove_aca_medicaid_expansion_hospital_uncomp_care_ib.pdf

 

[amyl]

Agree…. It’s a failure of admin to understand the anesthesia market…. Resulting in a shortage of anesthesiologists and crnas. My point was the stories are accumulating and it doesn’t seem like admin is catching on.
It seems like the feeling is the problem is temporary- not permanent

 

[triggermaster]

I think it was a failure of administration to understand the anesthesia market. It was a failure of Administration to appreciate and work with established groups withing their institution. Private equity backed Anesthesia management companies sole interest is rent seeking. They want to skim money from docs and hospitals. I agree that administrators are susceptable to unrealistic sales pitches.

i don’t think administrators were involved at all a lot of the time. Substitute administrators with partners in anesthesia groups. They chose to sell the group to private equity because they were rent seeking trying to skim money off all the non-partners that would want to work at that hospital. Maybe administrators could have pulled the exclusive contracts that allowed the partners to exploit their fellow doctors, but they had ORs to staff. Anesthesiologists who were partners in private practices that are now AMCs are even worse than short-sighted administrators because they screwed their own.

 

[aneftp]

What do you guys think about places keeping the 40 hour work week (includes call hours) plus giving 18-22 weeks PAID OFF for 500k w2?

I think that’s the money ball these days. I’m not interested in making more money exposed to w2 taxes. Meaning it stupid to work and make 700k w2 with 9 weeks off.

I’d rather take time off or do 1099 gigs with those extra weeks off. I see more and more places offer these schedules now to entice docs to sign on

I have no desire to go for 100k sign on bonus/2 year commitment that gets exposed to taxes. I’d rather get more time off.

More time off means less docs available to work. Means more anesthesia shortages.

 

[GravelRider]

What do you guys think about places keeping the 40 hour work week (includes call hours) plus giving 18-22 weeks PAID OFF for 500k w2?

I think that’s the money ball these days. I’m not interested in making more money exposed to w2 taxes. Meaning it stupid to work and make 700k w2 with 9 weeks off.

I’d rather take time off or do 1099 gigs with those extra weeks off. I see more and more places offer these schedules now to entice docs to sign on

I have no desire to go for 100k sign on bonus/2 year commitment that gets exposed to taxes. I’d rather get more time off.

More time off means less docs available to work. Means more anesthesia shortages.

I don’t think it’s common for $500k jobs to be 40 hour work weeks with 22 weeks PTO. That’s $400+/hr W2 plus benefits. I just don’t think stable employed jobs like that are common enough to have any impact on an anesthesia shortage. The money right now is in locums. The stable employment market for anesthesia is otherwise pretty mediocre. $500k for call taking 50 hour work weeks with 8 weeks vacation is probably more typical.

 

[GassYous]

What do you guys think about places keeping the 40 hour work week (includes call hours) plus giving 18-22 weeks PAID OFF for 500k w2?

I think that’s the money ball these days. I’m not interested in making more money exposed to w2 taxes. Meaning it stupid to work and make 700k w2 with 9 weeks off.

I’d rather take time off or do 1099 gigs with those extra weeks off. I see more and more places offer these schedules now to entice docs to sign on

I have no desire to go for 100k sign on bonus/2 year commitment that gets exposed to taxes. I’d rather get more time off.

More time off means less docs available to work. Means more anesthesia shortages.

That is amazing pay

 

[aneftp]

I don’t think it’s common for $500k jobs to be 40 hour work weeks with 22 weeks PTO. That’s $400+/hr W2 plus benefits. I just don’t think stable employed jobs like that are common enough to have any impact on an anesthesia shortage. The money right now is in locums. The stable employment market for anesthesia is otherwise pretty mediocre. $500k for call taking 50 hour work weeks with 8 weeks vacation is probably more typical.

Well 3 jobs like that have recently pop up within 45 min of the area I’m targeting. It’s true 40 hours work week. It’s not bad

2 filled super quickly. The other the paperwork is being negotiated.

U get the best of both worlds. Stability of w2 job plus tons of time off. Like I said. I have zero interest working for 700k w2 due to the taxation of the upper end range (it’s even worst if u are single since u start paying 35% taxes around 225k (500k as married). So all single people should focus on limiting their w2 income unless they have access to 403!457b/401a accounts to limit their taxes

 

[Coffee PRN]

Well 3 jobs like that have recently pop up within 45 min of the area I’m targeting. It’s true 40 hours work week. It’s not bad

2 filled super quickly. The other the paperwork is being negotiated.

U get the best of both worlds. Stability of w2 job plus tons of time off. Like I said. I have zero interest working for 700k w2 due to the taxation of the upper end range (it’s even worst if u are single since u start paying 35% taxes around 225k (500k as married). So all single people should focus on limiting their w2 income unless they have access to 403!457b/401a accounts to limit their taxes

That 1099 income is going to be subject to the same 35/37% income tax though. Not many significant deductions besides solo k unless you can stash a lot away in CBP

 

[amyl]

Yea - what location is 40h work week w 18-22wks pto for 500?!?!
I haven’t heard of permanent gigs like this

 

[aneftp]

Yea - what location is 40h work week w 18-22wks pto for 500?!?!
I haven’t heard of permanent gigs like this

They are popping up north and south. My friend is one of the corp regional medical directors

U gotta do what u gotta do to stabilize staffing.

It’s called loss mitigation at this point.

 

[MCAJrob]

Yea - what location is 40h work week w 18-22wks pto for 500?!?!
I haven’t heard of permanent gigs like this

We have a couple openings for cardiac jobs that are 35-40 hours of in hospital work per week, 10 weeks off, and there are post call days. Will pull in 675-700 this year myself with signing bonus and extra calls, which are included in that 35-40 hours.

This means the average W2 hourly, not including benefits, is around 375-425/hr at our place for cardiac.

General jobs at our group are about the same, but less call so less money earned, but hours are also better. Probably 350-375/hr for general on W2, not including benefits either.

Located 20 minutes from Cincinnati.

 

[ambiturner]

They are popping up north and south. My friend is one of the corp regional medical directors

U gotta do what u gotta do to stabilize staffing.

It’s called loss mitigation at this point.

So how do you roll that back? Once the market turns do they just start decreasing pay/increasing hours?

 

[anbuitachi]

We have a couple openings for cardiac jobs that are 35-40 hours of in hospital work per week, 10 weeks off, and there are post call days. Will pull in 675-700 this year myself with signing bonus and extra calls, which are included in that 35-40 hours.

This means the average W2 hourly, not including benefits, is around 375-425/hr at our place for cardiac.

General jobs at our group are about the same, but less call so less money earned, but hours are also better. Probably 350-375/hr for general on W2, not including benefits either.

Located 20 minutes from Cincinnati.

how are your calls paid? or what is the hourly pay of your calls?

 

[aneftp]

So how do you roll that back? Once the market turns do they just start decreasing pay/increasing hours?

We have crna to thank.

like there was this meeting and Hospital
admin said to have crna cover ob weekends.

Fair enough but when they ran the numbers. Crnas would cost them double than an extra doc.

U see. Crnas are based on hourly models. That’s the money ball to use against them and bring in more docs but more time off.

 

[aneftp]

We have a couple openings for cardiac jobs that are 35-40 hours of in hospital work per week, 10 weeks off, and there are post call days. Will pull in 675-700 this year myself with signing bonus and extra calls, which are included in that 35-40 hours.

This means the average W2 hourly, not including benefits, is around 375-425/hr at our place for cardiac.

General jobs at our group are about the same, but less call so less money earned, but hours are also better. Probably 350-375/hr for general on W2, not including benefits either.

Located 20 minutes from Cincinnati.

Congrats. U guys probably know how to use the locums to ur advantage?

Have locums docs do the brunt of the daytime work. Make extra money doing extra calls but within the frames work of the 40 hours.

 

[MCAJrob]

how are your calls paid? or what is the hourly pay of your calls?

There’s a fair amount of home call, q4 overall for cardiac at present. Once the opening comes available it will be q3 cardiac call. Even with that we’ll probably still only put in 35-40 hours per week.

Generalists take around 4 first calls and 4 second calls per month. Extra calls paid at a flat rate. Still get post call if you take extra 1st call. Some hourly incentives exist but they aren’t used a ton due to few late days.

Cardiac call is combined with general call. So many times on cardiac call you’re gonna get a post call day. Otherwise you finish the cardiac case and only come back for heart cases.

Overall hours work out to 35-40 even with the nominal call burden being relatively high. The hospital only runs 1 room at a time overnight unless there’s also a heart so that limits what surgeons can do overnight and prevents non emergencies from being done past 7pm. Very light OB (soon no OB) also keeps the night case numbers down.

 

[MCAJrob]

Congrats. U guys probably know how to use the locums to ur advantage?

Have locums docs do the brunt of the daytime work. Make extra money doing extra calls but within the frames work of the 40 hours.

We use some PRN people for general locums. No cardiac locums as of yet. It’s a good setup and they’re consistent and like the place.

As mentioned above even with the cardiac openings the entire practice is probably averaging 35-40 hours a week. Our cardiac volume is consistent and can be busy but when you’re not on the hook for transplants or covering multiple hospitals then cardiac call becomes very reasonable. Only takebacks and dissections for the most part

 

[Hoya11]

We use some PRN people for general locums. No cardiac locums as of yet. It’s a good setup and they’re consistent and like the place.

As mentioned above even with the cardiac openings the entire practice is probably averaging 35-40 hours a week. Our cardiac volume is consistent and can be busy but when you’re not on the hook for transplants or covering multiple hospitals then cardiac call becomes very reasonable. Only takebacks and dissections for the most part

So this seems like sub 700k with cardiac work , inflated by temporary sign on bonus, heavy cardiac home call even if your not called in your still on the beeper, and it’s in what many would consider an undesirable area .. personally I would rather take the 500k job without the heavy beeper call in the more desirable area like east/west coast

 

[triggermaster]

So this seems like sub 700k with cardiac work , inflated by temporary sign on bonus, heavy cardiac home call even if your not called in your still on the beeper, and it’s in what many would consider an undesirable area .. personally I would rather take the 500k job without the heavy beeper call in the more desirable area like east/west coast

Most of the ‘East/west coast’ is undesirable.

 

[MCAJrob]

So this seems like sub 700k with cardiac work , inflated by temporary sign on bonus, heavy cardiac home call even if your not called in your still on the beeper, and it’s in what many would consider an undesirable area .. personally I would rather take the 500k job without the heavy beeper call in the more desirable area like east/west coast

Sign on bonus is 25k per year for 3 years.

Cardiac beeper call hits different when you take it and you’re out at noon the next day too, or post call entirely if you’re called in. Our hourly rate of actual hours worked is unmatched in any w2 job I’ve seen, but I’m happy to be shown otherwise.

Many smaller practices like ours take their cardiac call a week at a time, it’s not as bad as it sounds. If you get to larger places to spread it out then you’re inevitably looking at taking trauma, OB, and transplant call in most cases for way less money.

To each their own with desirability. Cincinnati has pretty much everything a young family minded or mid career anesthesiologist could want.

 

[Hoya11]

Sign on bonus is 25k per year for 3 years.

Cardiac beeper call hits different when you take it and you’re out at noon the next day too, or post call entirely if you’re called in. Our hourly rate of actual hours worked is unmatched in any w2 job I’ve seen, but I’m happy to be shown otherwise.

Many smaller practices like ours take their cardiac call a week at a time, it’s not as bad as it sounds. If you get to larger places to spread it out then you’re inevitably looking at taking trauma, OB, and transplant call in most cases for way less money.

To each their own with desirability. Cincinnati has pretty much everything a young family minded or mid career anesthesiologist could want.

I’m happy you enjoy Cincinnati. Your right about the compensation it is high. My point is that it’s high because your in Cincinnati. Supply and demand issues, maybe a better term than desirability, make those type of less populated locations pay higher in order to attract people out there.

Our practice lost a couple of people to upstate NY because we couldn’t match their package. It always blew my mind .. you would really choose there over here for 100k more? But your right to each their own

 

[GassYous]

I’m happy you enjoy Cincinnati. Your right about the compensation it is high. My point is that it’s high because your in Cincinnati. Supply and demand issues, maybe a better term than desirability, make those type of less populated locations pay higher in order to attract people out there.

Our practice lost a couple of people to upstate NY because we couldn’t match their package. It always blew my mind .. you would really choose there over here for 100k more? But your right to each their own

What's wrong with upstate? letchworth, finger lakes, saratoga springs, poconos

 

[aneftp]

What's wrong with upstate? letchworth, finger lakes, saratoga springs, poconos

Update New York paying locums crnas close to $300/hr. It’s insane.

It’s not for everyone.

 

[GravelRider]

What's wrong with upstate? letchworth, finger lakes, saratoga springs, poconos

Poconos are Pennsylvania

 

[GassYous]

Poconos are Pennsylvania

Oh sorry, didn't realize that once you pick a state you become unable to travel to nearby areas

 

[makemoney2024]

I’m happy you enjoy Cincinnati. Your right about the compensation it is high. My point is that it’s high because your in Cincinnati. Supply and demand issues, maybe a better term than desirability, make those type of less populated locations pay higher in order to attract people out there.

Our practice lost a couple of people to upstate NY because we couldn’t match their package. It always blew my mind .. you would really choose there over here for 100k more? But your right to each their own

Yes. Some people choose to go to cold places for money.

 

[makemoney2024]

Update New York paying locums crnas close to $300/hr. It’s insane.

It’s not for everyone.

What’s it paying MDs? $500?