"Job Market For Anesthesia Residents"

[Carbocation1]

Monday, April 24, 2017
Great Z's: Job Market For Anesthesia Residents

"At the time of the survey, 97% of the residents already had jobs lined up. Of those going into private practice, a majority of 55% were heading for jobs with partnership track. Only 13% took jobs in academic institutions. Most of the residents applied from 4-9 job positions and received offers from 1-3 locations. The mean starting salary was $299,605. This compares to $289,036 from the class of 2015."

"What kinds of private practice jobs were the residents starting? About 55% were going into a partnership track. Only 13% were going into jobs without partnership track. Another 20% were starting as hospital employees, like an HMO. Only 12% were going to work for an anesthesia staffing company."

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[repititionition]

check out the sample size. tiny.

 

[GravelRider]

"Of 1,585 residents with email addresses the ASA had on file, only 122 responded back."

 

[anbuitachi]

im guessing the rest were all busy looking for jobs

 

[AdmiralChz]

"Of 1,585 residents with email addresses the ASA had on file, only 122 responded back."

7.6% response rate? That's... pretty horrendous.

 

[Strider_91]

I wonder if people would criticize the sample size and study methods if it was a) a study showing how great CRNA job prospects were or b) how terrible anesthesia job prospects are for new residents

 

[GravelRider]

I wonder if people would criticize the sample size and study methods if it was a) a study showing how great CRNA job prospects were or b) how terrible anesthesia job prospects are for new residents

With a sample size that small you can make broad strokes conclusions. Yes, 97% of graduating anesthesia residents are getting jobs. However, the level of detail that is presented in the article is meaningless. If this were a research study then it would be too underpowered to make any conclusions about things like salary and private practice vs academics.

 

[BLADEMDA]

I wonder if people would criticize the sample size and study methods if it was a) a study showing how great CRNA job prospects were or b) how terrible anesthesia job prospects are for new residents

Those getting good gigs in private practice may have been more likely to respond to the survey thus skewing the data. The poor slobs stuck with an AMC may simply have decided to pass on the survey.

For example, please look at those getting true private practice gigs in the Northeast. The sample size is small but I seriously doubt the vast majority of residents are getting true partnership tracks in the Northeast.

 

[anbuitachi]

It may be similar to response rates to ITE scores on SDN. those who reveal their scores tend to have done well.

 

[Ezekiel2517]

Those getting good gigs in private practice may have been more likely to respond to the survey thus skewing the data. The poor slobs stuck with an AMC may simply have decided to pass on the survey.

For example, please look at those getting true private practice gigs in the Northeast. The sample size is small but I seriously doubt the vast majority of residents are getting true partnership tracks in the Northeast.

If these are "good gigs" in the survey and that's all they making, that's pretty sad. Not sure I'd even practice this specialty at those prices

 

[turnupthegas]

Random question: How much should one be making at an AMC working 50-60hrs a week with a better than normal payor mix?


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[hypnosMD]

Random question: How much should one be making at an AMC working 50-60hrs a week with a better than normal payor mix?


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Lots of moving parts there (negotiated rates with carriers, OR utilization/efficiency, supervision ratios just to name a few). If all are maximized, overhead is reasonable and you are capturing the revenue, I would guess 7-800k of 1099 or equivalent.
AMC's won't pay you any different based upon payor mix though. They arbitrarily decide a market rate, lump it into the W-2 number, skimp on benefits, and then find creative ways to extract more work per dollar from you (not filling vacancies, work post call, more call frequency, understaff).

 

[Scotty_G]

Turnupthegas it doesn't matter. You are not going to be paid what you actually bill. The AMC is taking all of the extra money. Basically if you have an idea how many units you are billing you can multiply that by the "avg"/blended unit value of the group to get a rough estimate. So let's make things easy. Let's say you did 10,000 units in a year. (If you are working 50-60 hrs you would probably do more) Anyway you need to know the blended unit value. This is dependent on your region of the US + what you negotiate with the carriers. The AMC gets a higher unit value vs virtually all groups (even really good payor ones) So let's again make math easy. Say the blended unit value is 60 (Many AMC contracts at groups have a higher unit value than that) multiply that by 10,000 and what do you get? $600,000. Now like hypnosis said it's not that simple when you factor in other things. (Overhead, physician only vs supervision/ types of cases etc) But that should give you rough idea. You want to get an idea of the payor mix/unit value when you are looking at groups. Aka how much medicare/medicaid vs comm insurance. That can help you decide if partnership track/job is worth it and acceptable.

 

[BLADEMDA]

Random question: How much should one be making at an AMC working 50-60hrs a week with a better than normal payor mix?


Sent from my iPhone using SDN mobile

$400-$425K W-2 on the low end vs $500-$525K on the higher end.

 

[turnupthegas]

Thanks for the replies guys.

Looks like they are collecting a pretty steep paycheck on our physician fees. SUCKS. I haven't heard of anyone making in the 500K range at these AMCs most are in the high 300's and low to mid 400's. Maybe senior partners whom have sold?

 

[Carbocation1]

Would physician's employed by an AMC receive the 15% corporate tax rate under Trump's plan?

"The biggest impact might be if you receive a 1099 and operate under a corporation (LLC, S-corp, C-corp). Your corporate tax rate may be lowered from 35% to 15%. All business profit, even income earned by a physician from an S corporation, will be subject to the 15% rate."
3 Ways a Trump Presidency Could Affect Doctors Financially

 

[DrCommonSense]

Those getting good gigs in private practice may have been more likely to respond to the survey thus skewing the data. The poor slobs stuck with an AMC may simply have decided to pass on the survey.

For example, please look at those getting true private practice gigs in the Northeast. The sample size is small but I seriously doubt the vast majority of residents are getting true partnership tracks in the Northeast.

I have a feeling most of these surveys are skewed UP by the people who are doing well.

People with higher incomes or networths are going to respond to the Medscape surveys QUICKER/HIGHER frequency than others with lower numbers.

 

[Pharmado]

I'm a graduating senior and I've never had this study sent to me. I would have gladly filled it out. I didn't even talk to groups more than once if there salary offers started as low as these quoted numbers. I feel like the job I agreed to is pretty standard and it is >400k as a hospital employee. I don't think the people filling out these surveys are the ones with the best jobs.

 

[GA8314]

It's been said ad nauseam but if you can maintain some level of geographic flexibility, that will really help you. I've always thought that career facilitates family, but I admit it's not that simple if you live over a few hours away from family you want to be "close" to. But, if you are somewhat flexible, that seems to really help.

That partnership may not be in your home town, or the best city. But, what if it's close, as in within a couple hours? Lots of people will not choose to live that far away, but it can make all the difference. And, it doesn't mean you need to be in BFE either.

 

[Stank811]

I agree with Pharmdo. The individuals that snagged the good jobs don't reply to these surveys just like the people who make 7 figures usually don't report to mgma. People feel by not replying it provides them some protection but any entity with money can obtain payor mixes in any geographical region they are interested in...not a coincidence that AMC come knocking on the door of the most successful groups when they want to enter a new region...they know who to attempt to pay off when they enter a region to hopefully get control and spread. AMC on average will take about 35-50 percent of profit off the top of what you collect in billing and even more if you supervise.

 

[turnupthegas]

I'm a graduating senior and I've never had this study sent to me. I would have gladly filled it out. I didn't even talk to groups more than once if there salary offers started as low as these quoted numbers. I feel like the job I agreed to is pretty standard and it is >400k as a hospital employee. I don't think the people filling out these surveys are the ones with the best jobs.

What part of the country are you in?


Sent from my iPhone using SDN mobile

 

[aneftp]

I agree with Pharmdo. The individuals that snagged the good jobs don't reply to these surveys just like the people who make 7 figures usually don't report to mgma. People feel by not replying it provides them some protection but any entity with money can obtain payor mixes in any geographical region they are interested in...not a coincidence that AMC come knocking on the door of the most successful groups when they want to enter a new region...they know who to attempt to pay off when they enter a region to hopefully get control and spread. AMC on average will take about 35-50 percent of profit off the top of what you collect in billing and even more if you supervise.

Agree. In my area not one single AMC. Than in late 2012. The first practice "sold out" to one of the big 3 AMCs. This set off a domino effect and now in 2017. With exception of 2 very minor hospitals (less than 100 beds) within a 45 mile radius. It's all AMC.

Even the surgery centers are run by AMCs. Very few independent anesthesia practices.

 

[Shimmy8]

I took a job where I'll work up to $330k and 8 weeks vacation in a desirable city in the South. Great benefits with profit sharing 30k into 401k. 40-50 hours a week. Plenty of opportunity to pick up shifts and bring that to 375k if you're really motivated. Not a true AMC but sort of a regional one. Non-partner.

Pay is overall lower than others but I'm taking a cut to live in this city.

 

[DrCommonSense]

I took a job where I'll work up to $330k and 8 weeks vacation in a desirable city in the South. Great benefits with profit sharing 30k into 401k. 40-50 hours a week. Plenty of opportunity to pick up shifts and bring that to 375k if you're really motivated. Not a true AMC but sort of a regional one. Non-partner.

Pay is overall lower than others but I'm taking a cut to live in this city.

Your salary actually sounds about right these days.

Everyone on SDN has 99 percent board scores and make 900k, so mere mortals need to understand that salary is respectable.

 

[BLADEMDA]

Your salary actually sounds about right these days.

Everyone on SDN has 99 percent board scores and make 900k, so mere mortals need to understand that salary is respectable.

The "salary" vs "total compensation" depends on the work-load and call combined with the intensity plus supervisory ratios.

This "formula" allows one top come up with fair compensation. A typical AMC expects 4:1 coverage of crnas, 50 hours per week of work and 4-5 calls per month for about $380K total compensation.

If you are working 60 hours per work covering 4:1 then that same $380K is too low. Also, if all your patients are ASA3 and 4 plus you are covering 4:1 your stress level is much higher than simply 2:1 or doing your own cases. I place a value on these factors so money/compensation is simply a metric along with the other metrics to decide on whether the AMC is playing fairly with you. My hunch is the AMC expects to make at least 50-100% off your back after paying you that compensation.

A Hospital employed position is typically better than an AMC job but YMMV.

 

[BLADEMDA]

Here is a good idea of real compensation as an employee:

"To be blunt, my impression is that the future marketplace is unlikely to pay for a physician anesthesiologist to do solo anesthesia care for each and every surgical patient."
Richard Novak, MD

AN ANESTHESIOLOGIST’S SALARY

 

[nimbus]

If you are working 60 hours per work covering 4:1 then that same $380K is too low. Also, if all your patients are ASA3 and 4 plus you are covering 4:1 your stress level is much higher than simply 2:1 or doing your own cases. I place a value on these factors so money/compensation is simply a metric along with the other metrics to decide on whether the AMC is playing fairly with you. My hunch is the AMC expects to make at least 50-100% off your back after paying you that compensation.

A Hospital employed position is typically better than an AMC job but YMMV.

60hrs a week covering 4 rooms should be a million dollar job. You can do much better than 380k doing your own cases working 60hrs/week, even in areas considered low pay. That is 90th percentile hours and you should be getting 90th percentile pay.

 

[BLADEMDA]

60hrs a week covering 4 rooms should be a million dollar job. You can do much better than 380k doing your own cases working 60hrs/week, even in areas considered low pay. That is 90th percentile hours and you should be getting 90th percentile pay.

I totally agree with you. That's why "compensation" shouldn't be the only metric involved in this discussion. In fact, it's just one metric about a potential position but an important one nonetheless.

Still, a hospital employed position is more likely to be reasonable about staffing and supervisory ratios than an AMC while paying a total compensation package in excess of $400K.

Overall, I'd avoid AMCs if at all possible even ones which are "regional."

 

[BLADEMDA]

For those that believe my posts discourage Med Student from matching into Anesthesiology, my answer to them is that all residencies will fill in 2018. Every spot, even FP, is now a coveted position by someone desperate to actually practice medicine in the USA:

 

[BLADEMDA]

 

[BLADEMDA]

Competitive specialties have match rates less than 80% for U.S. seniors. These competitive specialties are very careful to limit the number of residency positions so that the graduates have a relatively easy time in the job market. The leaders of these "competitive specialties" understand the "law of supply vs demand." This directly translates into higher starting salaries or very easy jobs (sometimes both).

But, when the leadership chooses to ignore the law of supply vs demand combined with the changing marketplace to SUPERVISION vs direct care the result is lower salaries and predatory hiring practices. In addition, the corporate "take-over" of Anesthesiology has accelerated these changes to the specialty leaving the new graduate in a tough job environment.

The chickens have come home to roost.

 

[BLADEMDA]

More highlights from the report:

• Overall, the number of residency positions offered hit a record high of 31,757, up more than a thousand from 2016. Almost 36,000 people submitted applications.
• The number of first-year residency positions — 28,849 — was also a new record. Of those, 27,688 were filled.
• Almost 80 percent of matched residents landed a spot in one of their top three ranked choices.
• From 2013 to 2017, the number of first-year residency spots in a handful of fields grew by more than 10 percent, including anesthesiology, emergency medicine, family medicine, internal medicine, neurology, and plastic surgery. Only diagnostic radiology saw the number of spots offered drop by more than 10 percent over that time.

 

[aneftp]

More highlights from the report:

• Overall, the number of residency positions offered hit a record high of 31,757, up more than a thousand from 2016. Almost 36,000 people submitted applications.
• The number of first-year residency positions — 28,849 — was also a new record. Of those, 27,688 were filled.
• Almost 80 percent of matched residents landed a spot in one of their top three ranked choices.
• From 2013 to 2017, the number of first-year residency spots in a handful of fields grew by more than 10 percent, including anesthesiology, emergency medicine, family medicine, internal medicine, neurology, and plastic surgery. Only diagnostic radiology saw the number of spots offered drop by more than 10 percent over that time.

Numbers are misleading unless taking into historical context.

1. Number of lcme medical schools remained steady for a very long time till early 2000. Usf (university of south Florida) was the last lcme med school for almost 30 years (it opened in 1970s). So no new med schools opened till the early 2000s. So it was always 128 lcme med schools for the longest time.

Now there are 16 brand new med schools with more new med school grads competing for those residency slot.

2. In my opinion (adjusted for lcme med school total class size which remain consistent at around 15k total med school slots vs total number of anesthesiology slots available (1000 slots). The most competitive anesthesiology residency applicants were with the med school classes of 1990 and 1991. It's also no coincidence that same class entering the the work force in 1994/1995 faced the worst job outlook in the past 40 years for anesthesiology.

Also I'm a little bias. But I get a chuckle when the AAMC releases this "record" number of med school applications reaches 50k like they did in 2015

Medical School Applicants, Enrollees Reach New Highs - News Releases - Newsroom - AAMC

Well it doesn't account for the increase in med school slots from 2000 to 2015.

Cause my matriculation year and application (1995/1996) there was a "record 46k applicantions for 15k slots". So adjusted for number of slots. It's technically still easier to get into med school these days than it was "back in my days". Of course something called the internet boom started happening in the mid 1990s and the number of med school applications tanked to 35k. So 1999-2000 entering classes was much easier to to get into med school. I have a super memory of stats. I just wish the aamc would keep these stats posted on line. Cause I would always read the stats and data the aamc would public.

And one last thing. 1989-1990 was the "easiest time" to get into med school. 29k applications for those 15k slots.

Just a little lesson for those folks. Since residency slots are limited especially since mid 1990s due to William Jefferson Clinton and Newt Gingrich legislation.

 

[d9sccr]

Competitive specialties have match rates less than 80% for U.S. seniors. These competitive specialties are very careful to limit the number of residency positions so that the graduates have a relatively easy time in the job market. The leaders of these "competitive specialties" understand the "law of supply vs demand." This directly translates into higher starting salaries or very easy jobs (sometimes both).

But, when the leadership chooses to ignore the law of supply vs demand combined with the changing marketplace to SUPERVISION vs direct care the result is lower salaries and predatory hiring practices. In addition, the corporate "take-over" of Anesthesiology has accelerated these changes to the specialty leaving the new graduate in a tough job environment.

The chickens have come home to roost.

At a time when medical school tuition continues to shoot up

 

[DrCommonSense]

The "salary" vs "total compensation" depends on the work-load and call combined with the intensity plus supervisory ratios.

This "formula" allows one top come up with fair compensation. A typical AMC expects 4:1 coverage of crnas, 50 hours per week of work and 4-5 calls per month for about $380K total compensation.

If you are working 60 hours per work covering 4:1 then that same $380K is too low. Also, if all your patients are ASA3 and 4 plus you are covering 4:1 your stress level is much higher than simply 2:1 or doing your own cases. I place a value on these factors so money/compensation is simply a metric along with the other metrics to decide on whether the AMC is playing fairly with you. My hunch is the AMC expects to make at least 50-100% off your back after paying you that compensation.

A Hospital employed position is typically better than an AMC job but YMMV.

Salary is dependent on whether they can get someone to fill the position at that salary. Supply/Demand trumps all of this stuff.

 

[aneftp]

Salary is dependent on whether they can get someone to fill the position at that salary. Supply/Demand trumps all of this stuff.

Not any more these days. These AMCs have morphed into super companies literally full service to with stand even money losers (supply/demand)

Sheridan team health mednax (American anesthesiology) even napa all have rapid deployment teams (special ops teams). Many code names of employed w2 anesthesiologists ready to come in for deteriorating situations

They also own and run their own staffing locums companies (D and y with Team Health) tiva with Sheridan.

Sheridan is absolutely the hardest to bargain for a new comer to go in and say "I want This much". U can bargain with them as locums cause they know that comes out of a different pot of money in their corporate structure. But for W2 negotiations. As a new comer it's very hard to bargain with Sheridan. Now the old guys (the grandfathered docs who remain after a takeover may get a different deal to stay). But a new comer will have a hard time negotiating with Sheridan

 

[BLADEMDA]

Salary is dependent on whether they can get someone to fill the position at that salary. Supply/Demand trumps all of this stuff.

I'm simply reporting the current job market. AMCs tend to pay around $380K total compensation for a Board Certified Anesthesiologist with approximately 2 years of experience. Of course, local markets dictate whether the AMC can offer a new grad $300-$325K and he/she accepts that offer. In "hot markets" AMCs may offer sub $300K vs less desirable markets where the offer can be over $400K.

Current over-supply limits salaries because locums pay at the $200-$225 per hour seems to be the going rate and the AMCs can get locums at that pay. Hence, they will rarely exceed $400K because the overall job market has an excess supply in it and that means locums availability. So, if you are holding out for that big W-2 wage from an AMC I wish you the best of luck.

The AMCs which do pay more like Northstar typically run a "collaborative model" or they demand you take a lot of call. The wages for W-2 Anesthesiologists are pretty bad IMHO based on the fact that the actual collections from said jobs are at least 50-100% higher than the AMC is offering the employee.

 

[DrCommonSense]

I'm simply reporting the current job market. AMCs tend to pay around $380K total compensation for a Board Certified Anesthesiologist with approximately 2 years of experience. Of course, local markets dictate whether the AMC can offer a new grad $300-$325K and he/she accepts that offer. In "hot markets" AMCs may offer sub $300K vs less desirable markets where the offer can be over $400K.

Current over-supply limits salaries because locums pay at the $200-$225 per hour seems to be the going rate and the AMCs can get locums at that pay. Hence, they will rarely exceed $400K because the overall job market has an excess supply in it and that means locums availability. So, if you are holding out for that big W-2 wage from an AMC I wish you the best of luck.

The AMCs which do pay more like Northstar typically run a "collaborative model" or they demand you take a lot of call. The wages for W-2 Anesthesiologists are pretty bad IMHO based on the fact that the actual collections from said jobs are at least 50-100% higher than the AMC is offering the employee.

Yup.

So the guy who mentioned a 330K W2 salary is making 380K in total compensation for a 50 hour work week with call.

So that sounds about average if not above average in this market. Its definitely ABOVE average for "desirable" bigger cities and possible average to slight below for BFE/rural areas.

Also survey numbers such as MGMA are probably skewed far upwards due to the older "partners" that don't offer such deals to younger anesthesiologists anymore since the changes in the job market.

 

[nimbus]

Doximity has a feature that shows compensation data in specific counties. The striking thing to me is that there isn't much difference between the lowest and highest paid counties. Averages range from $360 on the coastal population centers to $420 in BFE counties in North Dakota. I can't vouch for the accuracy of their data though.

 

[aneftp]

There are a couple of ways to think about income

Straight fee for service is the best way to maximize income/earning potential.

But there are pitfalls. A bad payer mix or changing payer mix for the worse. Or Lack of surgeons can drive down income very quickly. So income may not be stable.

My very good friend in Texas was making 800k at peak in the mid 2000s. Than economy tanked and his income tanked as well. Dropping almost 50% while working the same 60-65 plus hours a week (more waiting around for case and of course if u fee for service waiting around is no good since no income ) it was some lean times for years for him.

But he's branched out. Does 80% anesthesia for more lucrative spine cases now along with adding pain injections. So he's rolling in $90-100k a month these days. He knows the money isn't gonna to last forever but he's gonna to ride tide out on his current gravy train. Pinnacle/usap Is massive in Dallas but he's carved out his own niche. Key is to get ur own contracts and do good work with surgeons and they will bring u more business.

My sister friend in Maryland was making in the high 500s fee for service. Economy tank. Even as it's rebounded. Much more Medicaid especially with the expansion of Medicaid in opt in states. So income now in the high 300s low 400s. No benefits. Pays malpractice and health. So that $400k AMC starts to sound better for him.

Two situations. In two different parts of the country.

 

[sevoflurane]

As you get older, time off in a beautiful location in your backyard becomes #1.
My 2 cents on this.

 

[Pharmado]

What part of the country are you in?


Sent from my iPhone using SDN mobile

Indiana.

Salary alone was >400k, total compensation pretty close to 500k. It is worth noting that I am not supervising, this is all doing my own cases. I did have geographic flexibility and picked a situation that I felt was best for my family. It is out in BFE, but that's where my wife wanted to go. I think I'm on the higher end of compensation for my graduating class, but I'm definitely not the highest. Only 2 of my other classmates decided to leave town and both are likely to make more than me, although they are both going to "less desirable" places in Texas.

 

[d9sccr]

Indiana.

Salary alone was >400k, total compensation pretty close to 500k. It is worth noting that I am not supervising, this is all doing my own cases. I did have geographic flexibility and picked a situation that I felt was best for my family. It is out in BFE, but that's where my wife wanted to go. I think I'm on the higher end of compensation for my graduating class, but I'm definitely not the highest. Only 2 of my other classmates decided to leave town and both are likely to make more than me, although they are both going to "less desirable" places in Texas.

If you're graduating from IU, most of those jobs pay close to that $500k mark in the area I thought? Even the ones in Indy are pretty close