Anesthesiology back on Merritt Hawkins' top 20 recruited specialties

[Carbocation1]

https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/2017_Physican_Incentives_Review.pdf

ANESTHESIOLOGY BACK IN THE TOP 20
"Similarly, anesthesiology was absent from Merritt Hawkins’ top 20 recruiting assignments since 2010, but returned to the list in the 2017 Review. Demand for anesthesiology was suppressed in part by the recession, which had a particularly inhibiting effect on elective procedures.

Demand also may have been limited by the ongoing effort to redirect healthcare away from a volume-based model toward a value-based model in which prevention and resource utilization are emphasized and the number of procedures requiring anesthesia is thereby reduced. Nevertheless, demand for procedures (elective and non-elective) driven by an improving economy and patient aging continues to be strong, creating more openings for anesthesiologists, particularly with large single specialty groups and academic medical centers."

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[Carbocation1]

Why Compensation for Some Medical Specialties is in Decline
John Commins, June 7, 2017


HealthLeaders: Are CRNAs playing a role in the compensation decline for anesthesiologists?

Singleton: Yup. A lot of the recruiting work we are doing are with mega-groups. We saw this in the hospital-based specialties where you have these huge single-specialty groups. Most of them have moved to a more aggressive form of MD oversight, depending upon state regulations.

Where maybe it was 40% or 50% that were staffed by CRNAs, now it's 70% to 80%, and you don't need the MDs.

Why Compensation for Some Medical Specialties is in Decline

 

[Carbocation1]

 

[Strider_91]

Interesting that the high compensation continues to get higher and higher and the low gets drastically lower and lower. In my mind this trend could be due to older group owners making more off of CRNA and letting their younger brethren suffer.


Same things happen in law where the older partners just abuse their younger colleauges. There is no honor when money is involved.

 

[Consigliere]

No surprise here. I don't believe that anesthesiology recruitment is on the rise though.

 

[deleted126335]

No surprise here. I don't believe that anesthesiology recruitment is on the rise though.

Agreed. Recent volatility has been due to groups losing contracts, running lean, and five year buyouts being renegotiated as the initial term is up.

 

[Strider_91]

Interesting that the high compensation continues to get higher and higher and the low gets drastically lower and lower. In my mind this trend could be due to older group owners making more off of CRNA and letting their younger brethren suffer.


Same things happen in law where the older partners just abuse their younger colleauges. There is no honor when money is involved.

Also interesting how the average hasn't changed but it is becoming more bimodal, thus lowering starting salaries but keeping the average falsely high.

 

[anbuitachi]

nurse practitioner is the 4th most recruited medical specialty. popular as ever i see. and it looks like radiology is skyrocketing, so is derm. why is urgent care a specialty..
but it looks like anesthesiology is one of the lowest paid specialties on that list! Only NP, PA, and a few IM, stuff are lower

And i think its messed up they are not having more derm programs. i been trying to schedule an appt with my derm for ages and it hasnt been going well. they are so backed up!!. And with so many patients it should be easy to support more residents/programs.. sounds like a financial reason for not opening more

 

[KeyzerSoze]

View attachment 220046

So we're all mathematically literate enough to understand that the wild year to year swings in that chart are almost certainly some kind of artifact, right?

Sent from my XT1585 using Tapatalk

 

[Temeraire]

When I was on my cardiology rotation this year as an intern, my cardiology attending complained about how her anesthesiology buddies at the same institution were being paid more than her. It was surreal. I guess the grass the always greener. To be fair, she wasn't an interventionalist, but we're also in the Bay Area with the MD-only model everywhere (two factors I thought depressed salaries).

 

[BLADEMDA]

When I was on my cardiology rotation this year as an intern, my cardiology attending complained about how her anesthesiology buddies at the same institution were being paid more than her. It was surreal. I guess the grass the always greener. To be fair, she wasn't an interventionalist, but we're also in the Bay Area with the MD-only model everywhere (two factors I thought depressed salaries).

Unless she does "Interventional" her job is more comparable to I.M. than Anesthesiology. That's her "salary comparison." Interventional Cards makes substantially more money than Anesthesiology in most parts of the country. But, they work hard for the money like I did for many, many years.

 

[anbuitachi]

When I was on my cardiology rotation this year as an intern, my cardiology attending complained about how her anesthesiology buddies at the same institution were being paid more than her. It was surreal. I guess the grass the always greener. To be fair, she wasn't an interventionalist, but we're also in the Bay Area with the MD-only model everywhere (two factors I thought depressed salaries).

Did you tell her whats wrong with that?

 

[nimbus]

When I was on my cardiology rotation this year as an intern, my cardiology attending complained about how her anesthesiology buddies at the same institution were being paid more than her. It was surreal. I guess the grass the always greener. To be fair, she wasn't an interventionalist, but we're also in the Bay Area with the MD-only model everywhere (two factors I thought depressed salaries).

She may not be that busy. She may not be generating the clinical revenues that those anesthesiologists are.

 

[Temeraire]

She alternates between managing the inpatient service, covering the CCU on weekends, and seeing outpatients in clinic. Overall, I do believe she logs fewer hours at work than most full-time anesthesiologists her age, but that doesn't stop her from complaining.

She may not be that busy. She may not be generating the clinical revenues that those anesthesiologists are.

 

[Carbocation1]

Medscape Young Physician Compensation Report 2017
Carol Peckham | June 14, 2017

Anesthesia needs to get higher up on this food chain.

Medscape: Medscape Access

 

[Carbocation1]

Is this a realistic depiction of what new grads are getting? Still breaking 300K on average to start?

 

[AdmiralChz]

Is this a realistic depiction of what new grads are getting? Still breaking 300K on average to start?

I'm just about done with residency, and almost all (haven't specifically discussed this with everyone) of my co-residents going straight into practice will start above 300. So yes, but expect to work for that money. Interestingly my friends in EM (definitely limited sample size) make quite a bit less than this graph.

 

[Carbocation1]

I'm just about done with residency, and almost all (haven't specifically discussed this with everyone) of my co-residents going straight into practice will start above 300. So yes, but expect to work for that money. Interestingly my friends in EM (definitely limited sample size) make quite a bit less than this graph.

Thanks. I was also surprised to see EM this high.

 

[anbuitachi]

I'm just about done with residency, and almost all (haven't specifically discussed this with everyone) of my co-residents going straight into practice will start above 300. So yes, but expect to work for that money. Interestingly my friends in EM (definitely limited sample size) make quite a bit less than this graph.

This really depends on where you are. It's pretty common to get jobs below 300 esp in academics and partner tracks in PP.
EM job market is still pretty good i hear and i'm not surprised at the 300+ for under 40. They have a lot more room than we do to pick up extra shifts/moonlight since they work fewer hours at base line

 

[anbuitachi]

Is this a realistic depiction of what new grads are getting? Still breaking 300K on average to start?

I dont know abou tmany other places but here, younger attendings make more than older ones since its eat what you kill. The younger ones end up working longer hours, thus making more money. Things slow down after 40, can't do those 80 hr weeks anymore. I imagine unless you are in a partnership employment model, it will apply to you too

 

[Postictal Raiden]

Is this a realistic depiction of what new grads are getting? Still breaking 300K on average to start?

I find it interesting that EM pays better than Rads according to this graph

 

[anbuitachi]

I find it interesting that EM pays better than Rads according to this graph

EM is a very high paying specialty. Not surprising at all

 

[bronx43]

EM is highly paid because of two things.
1. They are often subsidized by the hospital due to the fact that EM keeps their beds filled which generates profit
2. They overbill to a criminal level. (is chronic knee pain really critical care time???)
3. There is a relative shortage

#2 is starting to change now as insurance companies are reviewing more and more EM billing to make sure they are actually legit. A good chunk of their billing is straight up wrong, and/or their documentation doesn't support it.

#1 will likely persist until the whole system comes crashing down

 

[d9sccr]

I'm just about done with residency, and almost all (haven't specifically discussed this with everyone) of my co-residents going straight into practice will start above 300. So yes, but expect to work for that money. Interestingly my friends in EM (definitely limited sample size) make quite a bit less than this graph.

I don't know anyone making less than $300k out of residency. Even our academics with obligated call makes more. NE (i.e. NYC) I know make less, at least at one prominent institution.

 

[waterbottle10]

I don't know anyone making less than $300k out of residency. Even our academics with obligated call makes more. NE (i.e. NYC) I know make less, at least at one prominent institution.

Many prominent institutions in NYC make less

 

[nimbus]

Many prominent institutions in NYC make less

So where does all that money go?

 

[waterbottle10]

What money lol. The pay mix sucks for those hospitals. They are also inefficient. Turnover takes forever. Surgery takes much longer than PP as well. Money goes to salary, drugs, equipment. Many ppl also have research and administrative days

 

[GravelRider]

So where does all that money go?

My guess is real estate. It's not easy to grow and expand when a parking spot costs a million bucks.

 

[deleted171991]

So where does all that money go?

In the employers' pocketses. Big fat pocketses, thieves, thieves, stealing from poor Gollum!

 

[deleted126335]

In the employers' pocketses. Big fat pocketses, thieves, thieves, stealing from poor Gollum!

the hospitals are all pleading poverty. People can't pay their copays and deductibles, fewer people have commercial insurance, Drug and device costs going up, etc.

 

[deleted171991]

the hospitals are all pleading poverty. People can't pay their copays and deductibles, fewer people have commercial insurance, Drug and device costs going up, etc.

And that's why they hire more administrators and clipboard nurses, to save money.

 

[ambiturner]

Assuming that you take call, don't have a bunch of academic/admin days, and are not in a partnership track, that should be the minimum you consider. Note that you might be quoted a lower base but have bonuses, incentives etc.

 

[Brahnold Bloodaxe]

Is this a realistic depiction of what new grads are getting? Still breaking 300K on average to start?

General surgery only 270k? That can't be right. Also, ortho at $350k is almost a full $200k less than the 2015 MGMA median quoted for those with 3-4 years in practice. I could go on with most of these specialties. Either this source is dramatically over-representing academics or several fields took huge pay cuts since 2015.

EM is highly paid because of two things.
1. They are often subsidized by the hospital due to the fact that EM keeps their beds filled which generates profit
2. They overbill to a criminal level. (is chronic knee pain really critical care time???)
3. There is a relative shortage

#2 is starting to change now as insurance companies are reviewing more and more EM billing to make sure they are actually legit. A good chunk of their billing is straight up wrong, and/or their documentation doesn't support it.

#1 will likely persist until the whole system comes crashing down

I don't consider that overbilling. Is chronic knee pain a critical issue? No, which is why you should arrange an appointment for it with your family doc or ortho like a civilized person. Showing up in an ED is tantamount to saying "fck waiting, I'm kind of a big deal so see me NAUUU!!" Why should the ED physicians not charge you more for the privilege of showing up at any and all times of day, unscheduled? Availability has a price, if you don't want to pay critical care prices for non critical care issues don't show up to the ED with those issues, very simple, but the docs will rightly charge you high prices if you do.

 

[bronx43]

I don't consider that overbilling. Is chronic knee pain a critical issue? No, which is why you should arrange an appointment for it with your family doc or ortho like a civilized person. Showing up in an ED is tantamount to saying "fck waiting, I'm kind of a big deal so see me NAUUU!!" Why should the ED physicians not charge you more for the privilege of showing up at any and all times of day, unscheduled? Availability has a price, if you don't want to pay critical care prices for non critical care issues don't show up to the ED with those issues, very simple, but the docs will rightly charge you high prices if you do.

??? It's overbilling because that's what overbilling is... whether or not you think it is. You can argue all you want about what you think is fair, but no one gives a s***. Each code has a very stringent criteria and definition, and if the clinical scenario or service provided does not fit it, then it's technically fraud. I would love to see an ED doc (or anyone) show up in court with the argument "well, they showed up at 2am, so I charged them more than what is legally allowed by Medicare, because, you know... availability and stuff"

 

[Brahnold Bloodaxe]

??? It's overbilling because that's what overbilling is... whether or not you think it is. You can argue all you want about what you think is fair, but no one gives a s***. Each code has a very stringent criteria and definition, and if the clinical scenario or service provided does not fit it, then it's technically fraud. I would love to see an ED doc (or anyone) show up in court with the argument "well, they showed up at 2am, so I charged them more than what is legally allowed by Medicare, because, you know... availability and stuff"

Maybe I'm misunderstanding what it was you meant by "critical care time" being billed for chronic knee pain in the ED. I am no expert on billing, but in my opinion chronic knee pain should definitely bill differently depending on whether it is treated in the ED or in the clinic. I don't know whether this higher rate is called "critical care time" but the exact name of the code is not the point, the general concept of a higher billing rate is. Not only is this "fair," but in addition to being "fair" it is also legal, seeing as it is common practice to bill much higher for the very same things in the ED than in the clinic and last time I looked the entire profession of EM isn't behind bars for medicare fraud despite doing just that. If you want to argue that a Z-pack prescription from an ED at 2AM should bill the same exact thing as a Z-Pack prescription from a PCP at 2PM scheduled days in advance that is your prerogative, but that's not how it works in the real world and there is nothing "illegal" about it.

If you lose your key and need a locksmith at 2AM you better believe it's gonna cost you more than the very same service would if you had made an appointment for Thursday and waited. This logic is so obvious that even the bloodsucking insurance companies and government understand it, which is why EM docs bill much higher rates than clinic docs and aren't locked up for it. Not sure why it's such a problem for you, however.

 

[nycitygas]

This really depends on where you are. It's pretty common to get jobs below 300 esp in academics and partner tracks in PP.
EM job market is still pretty good i hear and i'm not surprised at the 300+ for under 40. They have a lot more room than we do to pick up extra shifts/moonlight since they work fewer hours at base line

The EM docs in my Hospital make $300/hr and they have trouble recruiting. Starting salaries of 400k+ are common.

 

[anbuitachi]

The EM docs in my Hospital make $300/hr and they have trouble recruiting. Starting salaries of 400k+ are common.

sounds exactly like what people say in the EM forums. Some new grads think 200$/hr jobs are not good enough. Some ppl make 300 +, locums can get significantly higher. The demand for EM docs is just so high right now and for the foreseeable future. Best specialty for MDs. People are starting to realize that. 12x 8 hr shifts / month is 350k / yr job, that's 24 hr/s of work per week. You can see the trends in competitiveness in getting into EM residency. More people in EM are satisfied w their salary than derm

 

[turnupthegas]

These gnarly EM jobs must be out major cities and making more based on RVUs.

My EM buddies are making 285-295k. That's NYC, LA, and Miami.


Sent from my iPhone using SDN mobile

 

[anbuitachi]

These gnarly EM jobs must be out major cities and making more based on RVUs.

My EM buddies are making 285-295k. That's NYC, LA, and Miami.


Sent from my iPhone using SDN mobile

Thats higher than anesthesiology in those cities. Way higher per hour

 

[nimbus]

Thats higher than anesthesiology in those cities. Way higher per hour

I don't know anybody working full time who makes that little in LA.

 

[nycitygas]

These gnarly EM jobs must be out major cities and making more based on RVUs.

My EM buddies are making 285-295k. That's NYC, LA, and Miami.


Sent from my iPhone using SDN mobile

I consider Houston and Dallas major cities. I confirmed it with my friend (partner in private group). Salary is roughly 475-500k for typically schedule.

I think TX is different bc the preponderance of free standing EDs and the resulting EM provider shortage. Once these close down, the shorthand will end and salaries will come down

 

[epidural man]

https://www.merritthawkins.com/uploadedFiles/MerrittHawkins/Pdf/2017_Physican_Incentives_Review.pdf

ANESTHESIOLOGY BACK IN THE TOP 20
"Similarly, anesthesiology was absent from Merritt Hawkins’ top 20 recruiting assignments since 2010, but returned to the list in the 2017 Review. Demand for anesthesiology was suppressed in part by the recession, which had a particularly inhibiting effect on elective procedures.

Demand also may have been limited by the ongoing effort to redirect healthcare away from a volume-based model toward a value-based model in which prevention and resource utilization are emphasized and the number of procedures requiring anesthesia is thereby reduced. Nevertheless, demand for procedures (elective and non-elective) driven by an improving economy and patient aging continues to be strong, creating more openings for anesthesiologists, particularly with large single specialty groups and academic medical centers."

This is an awesome document - thanks for sharing.

Some interesting data it points out:

Us population will grow 12% in the next 15 years.
The population of 65+ will grow by 55% in the same time frame.
1/3 of doctors in the next 10 years will be 65+.
Medical school graduates have increased the last 15 years by 27.5% - but available residency spots have only grown by 8% ( I assume there was a huge surplus of spots, but also the article points out that the increase won't happen because of the cap on Medicare spending which funds residencies.)
Birth rate has steadily decreased from 123 to 1000 women in 1957, to 62 to 1000 women in 2016.
Half the counties in the US don't have an OB/Gyn doc, and the number of OB/GYN grads hasn't increased since 1980
The psychiatry shortage in this country is absolutely nuts - and the largest share of health care spending in US is on Mental Health disorders!
More cases of skin cancer are detected every year than the combined cases of breast, prostate, lung, and colon (wow!)
TKA demand will increase 673% by 2030

 

[anbuitachi]

This is an awesome document - thanks for sharing.

Some interesting data it points out:

Us population will grow 12% in the next 15 years.
The population of 65+ will grow by 55% in the same time frame.
1/3 of doctors in the next 10 years will be 65+.
Medical school graduates have increased the last 15 years by 27.5% - but available residency spots have only grown by 8% ( I assume there was a huge surplus of spots, but also the article points out that the increase won't happen because of the cap on Medicare spending which funds residencies.)
Birth rate has steadily decreased from 123 to 1000 women in 1957, to 62 to 1000 women in 2016.
Half the counties in the US don't have an OB/Gyn doc, and the number of OB/GYN grads hasn't increased since 1980
The psychiatry shortage in this country is absolutely nuts - and the largest share of health care spending in US is on Mental Health disorders!
More cases of skin cancer are detected every year than the combined cases of breast, prostate, lung, and colon (wow!)
TKA demand will increase 673% by 2030

What happens when this group dies off? Huge doctor surplus?

 

[Brahnold Bloodaxe]

What happens when this group dies off? Huge doctor surplus?

Not really, as you can see by this population pyramid, the baby boomer generation that is getting old isn't larger than the subsequent generation that will get old after them. There isn't going to be a geezer shortage anytime soon.

 

[deleted126335]

Lots of People will just get motrin instead of TKA.

 

[BLADEMDA]

This is an awesome document - thanks for sharing.

Some interesting data it points out:

Us population will grow 12% in the next 15 years.
The population of 65+ will grow by 55% in the same time frame.
1/3 of doctors in the next 10 years will be 65+.
Medical school graduates have increased the last 15 years by 27.5% - but available residency spots have only grown by 8% ( I assume there was a huge surplus of spots, but also the article points out that the increase won't happen because of the cap on Medicare spending which funds residencies.)
Birth rate has steadily decreased from 123 to 1000 women in 1957, to 62 to 1000 women in 2016.
Half the counties in the US don't have an OB/Gyn doc, and the number of OB/GYN grads hasn't increased since 1980
The psychiatry shortage in this country is absolutely nuts - and the largest share of health care spending in US is on Mental Health disorders!
More cases of skin cancer are detected every year than the combined cases of breast, prostate, lung, and colon (wow!)
TKA demand will increase 673% by 2030

The psychiatry shortage in this country is absolutely nuts

 

[Laryngophed]

The psychiatry shortage in this country is absolutely nuts

I'm glad someone else caught that.

 

[waterbottle10]

Not really, as you can see by this population pyramid, the baby boomer generation that is getting old isn't larger than the subsequent generation that will get old after them. There isn't going to be a geezer shortage anytime soon.

How does that work. Birth rate according to posts above is now half of what it used to be in 1950s.

And yes the psych issue is ridiculous.

 

[Brahnold Bloodaxe]

How does that work. Birth rate according to posts above is now half of what it used to be in 1950s.

Because a high birth rate is only needed to increase the population. The parents of the baby boomer generation had to have high birth rates to create the huge baby boomer population, but the boomers themselves only needed 2 children per woman to ensure that successive generations would not be smaller. Then on top of all that you have immigration which increased dramatically after passage of the Hart-Celler act of 1965 (what an effing debacle that has been).

 

[nimbus]

Because a high birth rate is only needed to increase the population. The parents of the baby boomer generation had to have high birth rates to create the huge baby boomer population, but the boomers themselves only needed 2 children per woman to ensure that successive generations would not be smaller. Then on top of all that you have immigration which increased dramatically after passage of the Hart-Celler act of 1965 (what an effing debacle that has been).

"The Hart–Celler Act of 1965 marked a radical break from the immigration policies of the past. Previous laws restricted immigration from Asia and Africa, and gave preference to northern and western Europeans over southern and eastern Europeans.[2] In the 1960s, the United States faced both foreign and domestic pressures to change its nation-based formula, which was regarded as a system that discriminated based on an individual's place of birth."

Yep that debacle allowed me to immigrate to this country.