Are the incomes posted on gasworks exaggerations of reality?

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turnupthegas said:
Again, I need to get out of SoCal. Locums here is around 200. Kaiser is 175/hr. Housing is also out control.
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I interviewed in NoCal a few years ago. Visited a few hospitals of the practice, one of the partner took me to his house. It was pretty nice, small (less than 2000), basically no yard. For a low low price of 1.2M, and he had a deal on it….. I am sure he can probably get more than 2M now.

traffic was horrendous starting from 3pm on. (5 lane highways, going less than 30mi/hr). Never understood the appeal of Cali.

If I want a small house and ****ty traffic, I’d just go practice in NYC. Where I don’t need a car and can live in a tiny apartment.

Sure SoCal, probably has weather going for you…. But 200/hr?! Even NJ/MA/CT are desperate, locum at 275 (within the last 6 months). These are not backwards, flyover country places, all within an hour or two of major cities.
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IMGASMD said:
I interviewed in NoCal a few years ago. Visited a few hospitals of the practice, one of the partner took me to his house. It was pretty nice, small (less than 2000), basically no yard. For a low low price of 1.2M, and he had a deal on it….. I am sure he can probably get more than 2M now.

traffic was horrendous starting from 3pm on. (5 lane highways, going less than 30mi/hr). Never understood the appeal of Cali.

If I want a small house and ****ty traffic, I’d just go practice in NYC. Where I don’t need a car and can live in a tiny apartment.

Sure SoCal, probably has weather going for you…. But 200/hr?! Even NJ/MA/CT are desperate, locum at 275 (within the last 6 months). These are not backwards, flyover country places, all within an hour or two of major cities.
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I think the appeal is for people who currently live in small houses with ****ty traffic. Some of these places also have high taxes, expensive gas, low MD salaries, and all the other problems California has. So you might as well get some nice weather.
 
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IMGASMD said:
The last time I looked, for all the name brand “academic” hospital, starts less than 300, right?
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Not anymore

ambiturner said:
I think the appeal is for people who currently live in small houses with ****ty traffic. Some of these places also have high taxes, expensive gas, low MD salaries, and all the other problems California has. So you might as well get some nice weather.
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It is nice to walk around outside in 60 degree weather when the rest of the country is having huge snow storms and no electricity
 
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anbuitachi said:
it has gotten significantly higher in t he past year or so
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Didn’t know. I suppose I should ask the endoscopy centers 7-3 no call, no weekends…. For a “competitive” salary then.

My friend who is GI used to work for one of the ivory tower was getting at least 40% less than PP. Not sure what a real PP in NYC for anesthesia would be….
 
IMGASMD said:
Didn’t know. I suppose I should ask the endoscopy centers 7-3 no call, no weekends…. For a “competitive” salary then.

My friend who is GI used to work for one of the ivory tower was getting at least 40% less than PP. Not sure what a real PP in NYC for anesthesia would be….
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I once googled a NYC PP that was mentioned on this board. Google returned a bunch of 1 star yelp reviews because patients were getting $1800-$2k anesthesia bills for 10-20min endoscopies.
 
It’s funny when people say $250-300. I just assume that’s per hour which is actually the going rate for a lot of locums MD per hour

Paying full time daytime no call no weekend doc 250k-275k is crazy low. Mommy track I guess

Again it depends on the location and I understand people need to live in certain area for various reasons.
 
kidthor said:
Kaiser SoCal's 175 requires you to agree to weekends, nights, and holidays at the same rate too.
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Is that the whole deal or are benefits on top of that? I would hope healthcare and the famous Kaiser retirement plan would be added, which is probably worth another 50-75/hr if realized.
 
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GassYous said:
Not anymore



It is nice to walk around outside in 60 degree weather when the rest of the country is having huge snow storms and no electricity
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175$/hr. You need to work 60+ hrs to buy that 2000sq house. Are you sure you have time to enjoy the sunshine?
 
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Kaiser is 220/hr now
 
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For those who think 250 is low for a day doc, our unit value is only about 30 per unit. On a good day that day doc will generate 40 units. 1200 a day, over a year with 6 weeks off the generate 275. Factoring in benefits, we are basically breaking even with that say doc. Not even abusing him or taking advantage of him. It must be nice to live in a place where a unit is worth more.
 
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dabears505 said:
For those who think 250 is low for a day doc, our unit value is only about 30 per unit. On a good day that day doc will generate 40 units. 1200 a day, over a year with 6 weeks off the generate 275. Factoring in benefits, we are basically breaking even with that say doc. Not even abusing him or taking advantage of him. It must be nice to live in a place where a unit is worth more.
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Wow dude. No stipend? Where the hell do you work?
 
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dabears505 said:
For those who think 250 is low for a day doc, our unit value is only about 30 per unit. On a good day that day doc will generate 40 units. 1200 a day, over a year with 6 weeks off the generate 275. Factoring in benefits, we are basically breaking even with that say doc. Not even abusing him or taking advantage of him. It must be nice to live in a place where a unit is worth more.
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Sounds like you need a stipend.
 
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dabears505 said:
For those who think 250 is low for a day doc, our unit value is only about 30 per unit. On a good day that day doc will generate 40 units. 1200 a day, over a year with 6 weeks off the generate 275. Factoring in benefits, we are basically breaking even with that say doc. Not even abusing him or taking advantage of him. It must be nice to live in a place where a unit is worth more.
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How much stipend do partners get for taking call? I.e. what is difference in pay to full call taking position.
 
dabears505 said:
For those who think 250 is low for a day doc, our unit value is only about 30 per unit. On a good day that day doc will generate 40 units. 1200 a day, over a year with 6 weeks off the generate 275. Factoring in benefits, we are basically breaking even with that say doc. Not even abusing him or taking advantage of him. It must be nice to live in a place where a unit is worth more.
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40 units is a ****ty day though? Even with an unproductive lineup of two low value cases just the time value from 7-3 in one room is 30 units. Are you doing one case a day or something

I have a relatively unproductive day today but still generating about 50 units 7-3
 
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So (as a med student) had not heard of this stipend before. I was looking into it, it's paid to anesthesia groups by the hospital because their billing does not cover their costs of anesthesia and staffing? Assuming this is the fault of insurance not paying enough to anesthesia providers? Is this how it has always been?

Seems like it could be an area for concern (as in the above example) if you aren't receiving one or if multiple large organizations collectively decided they will no longer provide them. Is this model a concern for anyone interested in anesthesia?
 
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Gilakend said:
So (as a med student) had not heard of this stipend before. I was looking into it, it's paid to anesthesia groups by the hospital because their billing does not cover their costs of anesthesia and staffing? Assuming this is the fault of insurance not paying enough to anesthesia providers? Is this how it has always been?

Seems like it could be an area for concern (as in the above example) if you aren't receiving one or if multiple large organizations collectively decided they will no longer provide them. Is this model a concern for anyone interested in anesthesia?
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Depends on payor mix. Lot of government payor = low pay and you can't hire anyone. If you want to hire people, you need to offer more money and you get that from stipends. Hospitals will make much more from the facility fee from one case than they spend on any stipend. But if you take too much in stipends you open yourself up to someone else coming in with lies about being able to eliminate the stipend and getting the admin salivating over less expenditures.
 
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Gilakend said:
Assuming this is the fault of insurance not paying enough to anesthesia providers? Is this how it has always been?
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insurance always pays enough. The problem is Medicare/caid don't pay squat and don't cover the bills. If you have a high enough percentage of government patients, you can't keep up no matter how good your commercial insurance rates are.

So when you start hearing talk about "medicare for all", that is a death blow for anesthesia and every single location in the country is going to need assistance from the hospital to pay the bills because the professional fees won't cover anything close to it.
 
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Mman said:
insurance always pays enough. The problem is Medicare/caid don't pay squat and don't cover the bills. If you have a high enough percentage of government patients, you can't keep up no matter how good your commercial insurance rates are.

So when you start hearing talk about "medicare for all", that is a death blow for anesthesia and every single location in the country is going to need assistance from the hospital to pay the bills because the professional fees won't cover anything close to it.
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That's pretty eye-opening. Obviously in a M4A situation hopefully more places would just offer a stipend. But what's the worst-case scenario in something like this? MDs start to make CRNA wages?

Given that in my lifetime M4A seems very possible (if not likely) do you personally think that is a reason to avoid anesthesia? I'm assuming cuts like this would happen across all specialties, but after learning things here seems it would disproportionately affect anesthesia more than I realized.
 
Gilakend said:
That's pretty eye-opening. Obviously in a M4A situation hopefully more places would just offer a stipend. But what's the worst-case scenario in something like this? MDs start to make CRNA wages?

Given that in my lifetime M4A seems very possible (if not likely) do you personally think that is a reason to avoid anesthesia? I'm assuming cuts like this would happen across all specialties, but after learning things here seems it would disproportionately affect anesthesia more than I realized.
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You should just pick whatever specialty makes you happy. EM was on fire now it’s in the dumps. Radiology is all over the place. Supposedly also the rad onc market is weird now too. The anesthesia market right now is hot despite all these concerns of poor payor mix (which are real concerns).

But whatever… things go in cycles and it’s hard to predict the future. So I’d just pick a speciality based on what you like doing.
 
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kidthor said:
You should just pick whatever specialty makes you happy. EM was on fire now it’s in the dumps. Radiology is all over the place. Supposedly also the rad onc market is weird now too. The anesthesia market right now is hot despite all these concerns of poor payor mix (which are real concerns).

But whatever… things go in cycles and it’s hard to predict the future. So I’d just pick a speciality based on what you like doing.
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Em went from fire, great job market, no open spots in soap to everyone trying to FIRE in less than five years. Rad onc is good but only if you can get a job (not many jobs out there). Radiology was horrible for years and people were doing multiple fellowship years and then the applicants who wouldn't have been able to get in a few years earlier are graduating into a great market.
 
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Gilakend said:
That's pretty eye-opening. Obviously in a M4A situation hopefully more places would just offer a stipend. But what's the worst-case scenario in something like this? MDs start to make CRNA wages?

Given that in my lifetime M4A seems very possible (if not likely) do you personally think that is a reason to avoid anesthesia? I'm assuming cuts like this would happen across all specialties, but after learning things here seems it would disproportionately affect anesthesia more than I realized.
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in M4A situation, severe downward pressure on salaries of anesthesiologists and CRNAs. There will have to be some support from hospitals to offset it because hospitals cannot function without the revenue from ORs.

Here's a dirty secret about medicare... it cannot even pay for the services it delivers. Medicare is offset by revenue from private insurance everywhere to keep the hospitals and physicians afloat. If you only collected Medicare, the services could not be provided (some could, but in a global sense).
 
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kidthor said:
You should just pick whatever specialty makes you happy. EM was on fire now it’s in the dumps. Radiology is all over the place. Supposedly also the rad onc market is weird now too. The anesthesia market right now is hot despite all these concerns of poor payor mix (which are real concerns).

But whatever… things go in cycles and it’s hard to predict the future. So I’d just pick a speciality based on what you like doing.
Click to expand...

I feel like given the unpredictability this is probably the best advice. It's just a challenge for me, because if I were to rank "things that are most important in my future career" job security is far and away number 1. But seems impossible to predict per the examples above.
 
Gilakend said:
So (as a med student) had not heard of this stipend before. I was looking into it, it's paid to anesthesia groups by the hospital because their billing does not cover their costs of anesthesia and staffing? Assuming this is the fault of insurance not paying enough to anesthesia providers? Is this how it has always been?

Seems like it could be an area for concern (as in the above example) if you aren't receiving one or if multiple large organizations collectively decided they will no longer provide them. Is this model a concern for anyone interested in anesthesia?
Click to expand...

interesting because i had a similar discussion with a "billing" person in my hospital.
here medicaid pays about 10$ a unit, compared to private of about 70$/unit. managed care plans pays about 6$/unit. medicare about 25$/unit
a huge chunk of patients are also on a special program for the poor, where they pay a bundle to the hospital out of pocket (some very low #), none of it goes to anesthesia

however government insurance has a maximum payout. so for example one of my cases generated 40 units. patient has medicaid, and that may be over the limit, so medicaid will REFUSE to pay any of the bill.

so i would say i generate about 50k of collection a year. so hospital will have to supplement the rest of my salary
 
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Gilakend said:
That's pretty eye-opening. Obviously in a M4A situation hopefully more places would just offer a stipend. But what's the worst-case scenario in something like this? MDs start to make CRNA wages?

Given that in my lifetime M4A seems very possible (if not likely) do you personally think that is a reason to avoid anesthesia? I'm assuming cuts like this would happen across all specialties, but after learning things here seems it would disproportionately affect anesthesia more than I realized.
Click to expand...

put it on the cons list when you choose. if you want less affect, go into surgical field
 
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anbuitachi said:
interesting because i had a similar discussion with a "billing" person in my hospital.
here medicaid pays about 10$ a unit, compared to private of about 70$/unit. managed care plans pays about 6$/unit. medicare about 25$/unit
a huge chunk of patients are also on a special program for the poor, where they pay a bundle to the hospital out of pocket (some very low #), none of it goes to anesthesia

however government insurance has a maximum payout. so for example one of my cases generated 40 units. patient has medicaid, and that may be over the limit, so medicaid will REFUSE to pay any of the bill.

so i would say i generate about 50k of collection a year. so hospital will have to supplement the rest of my salary
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I find that very hard to believe. Medi-cal is something like 14 per unit. 6 per unit? Doesn't even make sense, no one would work at that level. Managed care in the northeast ranges from 30s-140s with a median and mean of about 90. Medicare at 25 I can believe.
 
GassYous said:
I find that very hard to believe. Medi-cal is something like 14 per unit. 6 per unit? Doesn't even make sense, no one would work at that level. Managed care in the northeast ranges from 30s-140s with a median and mean of about 90. Medicare at 25 I can believe.
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Managed care Medicaid, about 6 a unit. Clearly we get subsidized by hospital from their facility billing I guess
 
Gilakend said:
I feel like given the unpredictability this is probably the best advice. It's just a challenge for me, because if I were to rank "things that are most important in my future career" job security is far and away number 1. But seems impossible to predict per the examples above.
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It's impossible to predict. All jobs in medicine have some flux to them but compared to most other professions you have reasonable job stability. And even if your job implodes you can get another one and/or do locums.
 
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aneftp said:
It’s funny when people say $250-300. I just assume that’s per hour which is actually the going rate for a lot of locums MD per hour

Paying full time daytime no call no weekend doc 250k-275k is crazy low. Mommy track I guess

Again it depends on the location and I understand people need to live in certain area for various reasons.
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For those making 350 or less for full time, call taking positions, what’s the appeal? Why not work 6 months elsewhere for the same money, then vacation all you want? I’m not even talking BFE- there are a handful of medium to large cities around the country where you’ll still get paid somewhere between 1.5 and 2x.
 
osumd said:
For those making 350 or less for full time, call taking positions, what’s the appeal? Why not work 6 months elsewhere for the same money, then vacation all you want? I’m not even talking BFE- there are a handful of medium to large cities around the country where you’ll still get paid somewhere between 1.5 and 2x.
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Location, location, location.

Do you want to be away from your family and/or kids and/or boyfriends for half a year?

And that’s how AMCs tie you down too right? Buy a local shop, and tell you that you have a “secure” job, and you don’t have to deal with any administrative stuff. (All lies, but at least that’s what they will sell you….)

Certainly if you’re single and young, you will be more mobile….. make the money while you can, until you have to settle down.
 
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anbuitachi said:
Managed care Medicaid, about 6 a unit. Clearly we get subsidized by hospital from their facility billing I guess
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In CA, straight MediCal (Medicaid equivalent in CA) pays $12-13/unit but some MediCal managed care plans pay over $30/unit for anesthesia. $6/unit is $30-35/hr if you count base units. They pay $17-18/hr at In n out burger and Panda Express. I find that hard to fathom.


This document dated 2021 says “no more than $10/unit” so maybe $6/unit exists.


 
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Gilakend said:
That's pretty eye-opening. Obviously in a M4A situation hopefully more places would just offer a stipend. But what's the worst-case scenario in something like this? MDs start to make CRNA wages?

Given that in my lifetime M4A seems very possible (if not likely) do you personally think that is a reason to avoid anesthesia? I'm assuming cuts like this would happen across all specialties, but after learning things here seems it would disproportionately affect anesthesia more than I realized.
Click to expand...


It really depends how they carved up the pie, and how manpower is when they do it. We may make as much as travel nurses if there’s an anesthesia shortage when the decisions are made.
 
nimbus said:
In CA, straight MediCal (Medicaid equivalent in CA) pays $12-13/unit but some MediCal managed care plans pay over $30/unit for anesthesia. $6/unit is $30-35/hr if you count base units. They pay $17-18/hr at In n out burger and Panda Express. I find that hard to fathom.


This document dated 2021 says “no more than $10/unit” so maybe $6/unit exists.


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That's why medicaid is a disaster. The government thinks we should be making minimum wage. They are heavily a part of the problem with health care
 
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GassYous said:
Depends on payor mix. Lot of government payor = low pay and you can't hire anyone. If you want to hire people, you need to offer more money and you get that from stipends. Hospitals will make much more from the facility fee from one case than they spend on any stipend. But if you take too much in stipends you open yourself up to someone else coming in with lies about being able to eliminate the stipend and getting the admin salivating over less expenditures.
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In this case, takeover is not bad. AMC takes the contract and forces Hospital to pay. AMC usually does not have enough staff. They look for locums; you get paid 300-350 per hour, 10 hours a day.
 
Silo004 said:
Very much way. I am in a fairly desirable city on the West Coast and can tell you anyone taking overnight call, breaking 60 hrs a week should be making no less than 450k, bare minimum. And 550 to 600 is not unreasonable.
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That 55 hours of week of straight forward presentations. If you throw in Morbid obesity, patients with bad airways, ng tubes, surly staff and surgeons, crnas that dont listen 450 is just simply not enough. I dont know what is.. but thats not enough
 
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