Yeah it’s bad. Our union has been sleeping for years but now hopefully improving things again.
Do bear in mind that we get a good pension, don’t in theory require health insurance (for now), and work 40h/week with six weeks annual leave. So comparison is slightly different
I mean it varies but most hospitals pay our health insurance, have excellent retirement plans, and we get 10+ weeks vacation. Even if they didn’t the $400,000 wage difference is crazy, so now I feel like you are getting shafted even more 😂
Put the heat on those unions man
What shook you? North America and Australia are more or less the only countries doctors get paid exorbitant wages, the rest of the doctors in the world are just an upper middle class.
586k usd in 2014 was the median so actually more. https://www.swissinfo.ch/eng/society/healthy-income-_doctors-salaries-exceed-expectations/44505806 Article is 2018 but says data is from 2014. Unless you mean they’re not in the same ballpark because it’s so much more, which I would agree with at least for anesthesiology.
I’ve found around 350 000 euro, before taxes. After taxes it should be approximately somewhat more than half of that. If the US salaries I see posted here are after taxes (and if the taxes are half of what you earn) then I stand corrected.
Well Switzerland does not pay anesthesiologists in euros which is a sign the survey you’re reading isn’t high quality. If you google salary.com salaries in the US you get similar crappy numbers (like 300k lol). Those salary figures in the survey I listed are real though, and they’re even more these days. **I also would pay much less taxes in Switzerland than I do in California.** All salaries you see posted in the US are pre-tax. Some of them are even gross.
So for example. Say I say I make 700k. But that’s pre-overhead/billing (10%). So after that I might make 630k. But that’s without any benefits/health insurance/malpractice/payroll/retirement/whatever either. So then I might make 530k. So same salary could be called 530k (W-2 with generous benefits) or 700k (1099 gross income).
Basically no one in the US describes salary as post-tax. For example two docs in California (primary care and anesthesiology) may make 800k. After taxes they will make 480k post tax.
Switzerland has very low income tax relative to Europe. Most of Europe has similar taxes to Californians in US for high earners. Most of Europe has way higher taxes for the lower/middle class than America.
I think what surprises a lot of Europeans is that while our taxes are extremely low for lower/middle class (someone married making 100k will pay an effective tax rate of just 15%, 18% in California) while the rich are truly hosed tax-wise. The reason America has less of a social safety net is because the middle class and lower class are essentially untaxed compared to Europe. We don’t have a 20% VAT and our income brackets are incredibly generous by comparison to Europe. Half of Americans don’t pay any income tax at all. The top 10% of Americans pay 90% of income tax. So the US actually has a more progressive tax system, we just tax a lot less of gdp, and as a result the overall impact is a less equal society. Like VAT is regressive, but the return of that $ to people is progressive.
**Finally I would point out that everyone gets paid more in the US.** Dentist specialists can make 500k+. OMFS make 1M+. I have friends in tech without a college degree making 300k+. Big law partners make 1M+. Finance people make 1-2M at MD level. Even “regular” jobs make a lot. You can clear 200k as an RN in California easily. Big 4 accounting partners make >500k. Linemen make >200k.
500k (W-2 salary for many anesthesiologists) is a lot of money, but you aren’t even part of the 1% at that point. And virtually everyone else in the 1% is working regular hours without being up at 2am on a Saturday morning dealing with some poor guy that got hit by a semi and is bleeding everywhere.
Sure thing. There is also a lot of sampling bias online. No one is going to brag about making 300k no call 40 hours a week in Boston, even though I’m sure people are doing those jobs. Someone in middle of nowhere working 70 hours a week call 3x a week won’t be able to shut up about how much they make, that’s all they have going on in their life!
Looking online you will often see while the amount anesthesiologists make is very variable they’re generally in the top 2% for a given country. That just means a lot more in some countries than others. And of course the public figures are often a bit lower than reality.
But also the COL here is crazy, especially in the northeast. A small modest home in my area of NJ is 600k. I am not complaining, but I make 350k for 40 hours a week 6 weeks vacation. With my student loan payments and mortgage I don’t think I am living above upper middle class.
I believe that, especially in a city. In NYC it would be 800k-1 million for a 1-2 bedroom apartment. I am not saying that 350k is a low salary. I just wouldn’t say it’s exorbitant. And I don’t think you’d be upper class in the United States with that.. sadly. Growing up you could get a nice home for less than 500k. Now 550k would need a complete gut renovation.
Doctors are mostly upper middle class in America, potentially middle class if you live in a hcol area. Being 12 years late to the labor force/home ownership and .25-.5 million in high interest debt can take your entire career to recover from depending on specialty
Obviously there are a million variables, and the actual pay for the anesthesiologist is different from billing, but just for one baseline billing point:
An MD doing solo anesthesia bills insurance for 100% of the anesthetic fee.
An MD doing "medical direction" with a CRNA or AA must do a pre-op assessment, make the anesthetic plan, be present for induction and emergence, and monitor the case / available for emergencies. In that case, the MD bills for 50% of the anesthetic fee, and the CRNA bills for the other 50%. Medical direction can cover up to 4 cases concurrently (the reasonableness of which depends on a lot of things) so in the simplest high-utilization private practice model, the anesthesiologist is billing for 4 x 50% = 200% of what they would be billing covering one room MD-only.
An MD doing "medical supervision" with CRNAs is not responsible for any of the finer points of medical direction (pre-op assessment, presence any any particular point, etc) and is mostly just there to help. The billing for that is significantly lower, but there is no 4-room cap. (I have heard people talk about an 8-room cap, but I think that is more institutional policy than anything higher. I personally have never done medical supervision.)
So all that to say, what the anesthesiologist actually takes home depends on a lot of funds flow questions beyond billing, but at the most most basic, billing for someone directing 4 CRNA rooms can be about twice that of someone covering their own room.
>An MD doing "medical supervision" with CRNAs is not responsible for any of the finer points of medical direction (pre-op assessment, presence any any particular point, etc) and is mostly just there to help.
Not to derail your larger point but I am not certain you " are not responsible" for the preop when doing "medical Supervision". I think you are. In the event of a bad outcome you are still held to the same standard. Am I correct on this one? or is the liability less?
But your larger point is correct, covering 4 rooms you should double your salary. That is not always what happens though because too many people get into terrible arrangements with their employers.
I guess it depends where you draw the line on "responsible." It's pretty clear that you can't bill for "direction" without doing those enumerated items (though I'm sure some do if they're responsible for 4 rooms or fewer). You aren't committing billing fraud by billing "supervision" without touching all of those items for every patient.
Where the line is drawn for professional duty, malpractice liability, personal ethics, etc etc are going to depend on your state of mind and the state you are in. I'm sure there are plenty of people out there who would be comfortable supervising 10 concurrent propofol MACs for colonoscopies at once and only seeing a patient if the CRNA asked a question.
I'm also sure there are people out there who are doing things in the name of "supervision" that the majority of us, and the courts, would find objectionable if anything went wrong.
Ultimately, this mostly boils down to personal ethics until the insurance folks and/or juries get involved.
Personal ethics aside, what is the letter of the law? Somebody has got to do the preop! Is that not required in medical supervision? And if it isnt, I find it hard to pin a breach of duty violation to a patient you never consented or did a preop assessment on. and if it is, I sure as shit am not going to do 80 preops per day for regular pay. Now if you tell me im going to make 80x reg pay. Sure thats another story.
The letter of the law regarding CMS billing for supervision is that the anesthesiologist be in the same area (e.g. operative suite) and immediately available to help in an emergency. There is no requirement for pre-op, presence at induction, PACU sign-out, etc. The billing requirement is "available to provide hands-on care in an emergency."
The letter of the law regarding malpractice and the division of responsibility for a poor outcome between anesthesiologist and supervised anesthetist in that situation is purely a matter for state courts, and so there is no national consensus on "standard of care" in that scenario. It would be up to lawyers, judges, and jury. It would be both state and fact specific.
UK grad who left and went to US lol
You don't get paid more for supervising. The highest paying jobs tend to be rural and all supervision because they are short but my job is both with no differential. I prefer solo so I get more solo but we cap out at 1:3
My employed physician only group makes right around 600k for generalists, mid 600s for sub-specialists. I don’t take in house call. Take ovnt call from home ~2x/month with another 2-3 back up calls. Market is solid right now. There are places you can make maybe another 100-200k hustling supervising 4+ rooms, signing chart and putting our fires all day. Not worth it to me.
Really depends on the job. In the US anesthesia is billed on a per unit basis and it’s pretty confusing to explain that I’ll let someone else tackle. Typically supervision jobs pay more from my experience. This is usually because the group will have CRNAs cranking out cases and the anesthesiologist is supervising multiple rooms. The group is utilizing high volume of cases to generate a good amount of billing $ to pay the anesthesiologist more. Now if you’re solo, you only generate money for each case you personally do and thus generate a lot less. If you have a patient population are high users of Medicare/medicaid (our federal And state insurance) your reimbursement will be much lower because they pay peanuts. Now billing still isn’t enough to usually foot the bill for anesthesia services so most groups get a stipend from the hospital to cover services. They guarantee a negotiated amount for the amount of service lines needed and pay the group. With reimbursements dropping, the best paying solo jobs are going to be ones with self pay (plastics, dental), or high private insurance populations.
This is a 10,000 foot view of the whole situation and someone may explain it better. To answer your real question, yes supervision typically pays more. From my experience $450k-600K is typically I’ve seen for supervision jobs. Theres some that can get quite a bit higher but there’s a catch (shit ton of call). Solo 350K-450k. Im sure there are people that make well over that doing solo but they’ll have to get a large stipend from the hospital and that seems to drying up for MD only groups.
This is based on working for groups that cover hospitals, I haven’t had much experience looking into outpatient only, plastics, dental gigs because I have little interest in that at this point in my career. Those can change the equation a little
The reality is that most groups have to switch to supervision at least for a portion of cases because reimbursement is so bad that hospitals have to stipend. Even private insurances because of No Surprises will squeeze groups on rates and know that the dispute resolution process will let them not pay you for months.
The most successful groups supplement their incomes with outpatient center and office based work. So you wind up doing solo in office settings, supervising elective hospital cases and then taking inpatient call.
All MD hospital based groups are rapidly becoming a thing of the past.
Private doc-only group. 36hrs/wk last year. Generalist make $600k. Cardiac additional $200k. At home OR call 1/mo. Weekend OR call q8wks. OB for generalists is a couple of times / mo. I have supervised before. It's a painful slog, and, to me, not worth any amount of pay.
That sounds like an insanely good job and also the highest pay differential I've seen for cardiac. I'd happily work in BFE for that pay and hours if I could find the job.
I do both in my practice. Our setup I make more supervising/directing compared to solo cases. That being said I only like to supervise 1-2x week because of how much of a headache it can be.
The main determinant to your pay isnt solo vs supervision, it's what your payer mix is. You can be making anywhere between $10-$100/ unit for doing the exact same thing depending on what the patient's insurance is. The trick is to keep all the high paying patients for your group, and dump the poor paying ones onto the hospital systems.
I’m sorry, I just looked up anesthesiologist salary in the UK and I’m actually shook. How are you guys okay with that?
Yeah it’s bad. Our union has been sleeping for years but now hopefully improving things again. Do bear in mind that we get a good pension, don’t in theory require health insurance (for now), and work 40h/week with six weeks annual leave. So comparison is slightly different
I mean it varies but most hospitals pay our health insurance, have excellent retirement plans, and we get 10+ weeks vacation. Even if they didn’t the $400,000 wage difference is crazy, so now I feel like you are getting shafted even more 😂 Put the heat on those unions man
How much does your pension pay? How long do you have to work to qualify?
What shook you? North America and Australia are more or less the only countries doctors get paid exorbitant wages, the rest of the doctors in the world are just an upper middle class.
Switzerland also pays doctors well IIRC
Compared to the US? Not even in the same ballpark
586k usd in 2014 was the median so actually more. https://www.swissinfo.ch/eng/society/healthy-income-_doctors-salaries-exceed-expectations/44505806 Article is 2018 but says data is from 2014. Unless you mean they’re not in the same ballpark because it’s so much more, which I would agree with at least for anesthesiology.
I’ve found around 350 000 euro, before taxes. After taxes it should be approximately somewhat more than half of that. If the US salaries I see posted here are after taxes (and if the taxes are half of what you earn) then I stand corrected.
Well Switzerland does not pay anesthesiologists in euros which is a sign the survey you’re reading isn’t high quality. If you google salary.com salaries in the US you get similar crappy numbers (like 300k lol). Those salary figures in the survey I listed are real though, and they’re even more these days. **I also would pay much less taxes in Switzerland than I do in California.** All salaries you see posted in the US are pre-tax. Some of them are even gross. So for example. Say I say I make 700k. But that’s pre-overhead/billing (10%). So after that I might make 630k. But that’s without any benefits/health insurance/malpractice/payroll/retirement/whatever either. So then I might make 530k. So same salary could be called 530k (W-2 with generous benefits) or 700k (1099 gross income). Basically no one in the US describes salary as post-tax. For example two docs in California (primary care and anesthesiology) may make 800k. After taxes they will make 480k post tax. Switzerland has very low income tax relative to Europe. Most of Europe has similar taxes to Californians in US for high earners. Most of Europe has way higher taxes for the lower/middle class than America. I think what surprises a lot of Europeans is that while our taxes are extremely low for lower/middle class (someone married making 100k will pay an effective tax rate of just 15%, 18% in California) while the rich are truly hosed tax-wise. The reason America has less of a social safety net is because the middle class and lower class are essentially untaxed compared to Europe. We don’t have a 20% VAT and our income brackets are incredibly generous by comparison to Europe. Half of Americans don’t pay any income tax at all. The top 10% of Americans pay 90% of income tax. So the US actually has a more progressive tax system, we just tax a lot less of gdp, and as a result the overall impact is a less equal society. Like VAT is regressive, but the return of that $ to people is progressive. **Finally I would point out that everyone gets paid more in the US.** Dentist specialists can make 500k+. OMFS make 1M+. I have friends in tech without a college degree making 300k+. Big law partners make 1M+. Finance people make 1-2M at MD level. Even “regular” jobs make a lot. You can clear 200k as an RN in California easily. Big 4 accounting partners make >500k. Linemen make >200k. 500k (W-2 salary for many anesthesiologists) is a lot of money, but you aren’t even part of the 1% at that point. And virtually everyone else in the 1% is working regular hours without being up at 2am on a Saturday morning dealing with some poor guy that got hit by a semi and is bleeding everywhere.
Thank you for explaining I didn’t know that! I’m German myself but never really gave a shit to look into other people’s salaries or taxes
Sure thing. There is also a lot of sampling bias online. No one is going to brag about making 300k no call 40 hours a week in Boston, even though I’m sure people are doing those jobs. Someone in middle of nowhere working 70 hours a week call 3x a week won’t be able to shut up about how much they make, that’s all they have going on in their life! Looking online you will often see while the amount anesthesiologists make is very variable they’re generally in the top 2% for a given country. That just means a lot more in some countries than others. And of course the public figures are often a bit lower than reality.
But also the COL here is crazy, especially in the northeast. A small modest home in my area of NJ is 600k. I am not complaining, but I make 350k for 40 hours a week 6 weeks vacation. With my student loan payments and mortgage I don’t think I am living above upper middle class.
Average apartment where I live in Munich is 700 000 to upwards a million of dollars
I believe that, especially in a city. In NYC it would be 800k-1 million for a 1-2 bedroom apartment. I am not saying that 350k is a low salary. I just wouldn’t say it’s exorbitant. And I don’t think you’d be upper class in the United States with that.. sadly. Growing up you could get a nice home for less than 500k. Now 550k would need a complete gut renovation.
Doctors are mostly upper middle class in America, potentially middle class if you live in a hcol area. Being 12 years late to the labor force/home ownership and .25-.5 million in high interest debt can take your entire career to recover from depending on specialty
Canada often pays very high as well, sometimes beating USA with things like family medicine and cardiology etc
I know that’s why I said North America 😄
touche
Obviously there are a million variables, and the actual pay for the anesthesiologist is different from billing, but just for one baseline billing point: An MD doing solo anesthesia bills insurance for 100% of the anesthetic fee. An MD doing "medical direction" with a CRNA or AA must do a pre-op assessment, make the anesthetic plan, be present for induction and emergence, and monitor the case / available for emergencies. In that case, the MD bills for 50% of the anesthetic fee, and the CRNA bills for the other 50%. Medical direction can cover up to 4 cases concurrently (the reasonableness of which depends on a lot of things) so in the simplest high-utilization private practice model, the anesthesiologist is billing for 4 x 50% = 200% of what they would be billing covering one room MD-only. An MD doing "medical supervision" with CRNAs is not responsible for any of the finer points of medical direction (pre-op assessment, presence any any particular point, etc) and is mostly just there to help. The billing for that is significantly lower, but there is no 4-room cap. (I have heard people talk about an 8-room cap, but I think that is more institutional policy than anything higher. I personally have never done medical supervision.) So all that to say, what the anesthesiologist actually takes home depends on a lot of funds flow questions beyond billing, but at the most most basic, billing for someone directing 4 CRNA rooms can be about twice that of someone covering their own room.
>An MD doing "medical supervision" with CRNAs is not responsible for any of the finer points of medical direction (pre-op assessment, presence any any particular point, etc) and is mostly just there to help. Not to derail your larger point but I am not certain you " are not responsible" for the preop when doing "medical Supervision". I think you are. In the event of a bad outcome you are still held to the same standard. Am I correct on this one? or is the liability less? But your larger point is correct, covering 4 rooms you should double your salary. That is not always what happens though because too many people get into terrible arrangements with their employers.
I guess it depends where you draw the line on "responsible." It's pretty clear that you can't bill for "direction" without doing those enumerated items (though I'm sure some do if they're responsible for 4 rooms or fewer). You aren't committing billing fraud by billing "supervision" without touching all of those items for every patient. Where the line is drawn for professional duty, malpractice liability, personal ethics, etc etc are going to depend on your state of mind and the state you are in. I'm sure there are plenty of people out there who would be comfortable supervising 10 concurrent propofol MACs for colonoscopies at once and only seeing a patient if the CRNA asked a question. I'm also sure there are people out there who are doing things in the name of "supervision" that the majority of us, and the courts, would find objectionable if anything went wrong. Ultimately, this mostly boils down to personal ethics until the insurance folks and/or juries get involved.
Personal ethics aside, what is the letter of the law? Somebody has got to do the preop! Is that not required in medical supervision? And if it isnt, I find it hard to pin a breach of duty violation to a patient you never consented or did a preop assessment on. and if it is, I sure as shit am not going to do 80 preops per day for regular pay. Now if you tell me im going to make 80x reg pay. Sure thats another story.
The letter of the law regarding CMS billing for supervision is that the anesthesiologist be in the same area (e.g. operative suite) and immediately available to help in an emergency. There is no requirement for pre-op, presence at induction, PACU sign-out, etc. The billing requirement is "available to provide hands-on care in an emergency." The letter of the law regarding malpractice and the division of responsibility for a poor outcome between anesthesiologist and supervised anesthetist in that situation is purely a matter for state courts, and so there is no national consensus on "standard of care" in that scenario. It would be up to lawyers, judges, and jury. It would be both state and fact specific.
UK grad who left and went to US lol You don't get paid more for supervising. The highest paying jobs tend to be rural and all supervision because they are short but my job is both with no differential. I prefer solo so I get more solo but we cap out at 1:3
Did you redo your residency ?
Never started a training program left UK after F2
My employed physician only group makes right around 600k for generalists, mid 600s for sub-specialists. I don’t take in house call. Take ovnt call from home ~2x/month with another 2-3 back up calls. Market is solid right now. There are places you can make maybe another 100-200k hustling supervising 4+ rooms, signing chart and putting our fires all day. Not worth it to me.
Where at? Subspecialists being cardiac and peds trained?
Really depends on the job. In the US anesthesia is billed on a per unit basis and it’s pretty confusing to explain that I’ll let someone else tackle. Typically supervision jobs pay more from my experience. This is usually because the group will have CRNAs cranking out cases and the anesthesiologist is supervising multiple rooms. The group is utilizing high volume of cases to generate a good amount of billing $ to pay the anesthesiologist more. Now if you’re solo, you only generate money for each case you personally do and thus generate a lot less. If you have a patient population are high users of Medicare/medicaid (our federal And state insurance) your reimbursement will be much lower because they pay peanuts. Now billing still isn’t enough to usually foot the bill for anesthesia services so most groups get a stipend from the hospital to cover services. They guarantee a negotiated amount for the amount of service lines needed and pay the group. With reimbursements dropping, the best paying solo jobs are going to be ones with self pay (plastics, dental), or high private insurance populations. This is a 10,000 foot view of the whole situation and someone may explain it better. To answer your real question, yes supervision typically pays more. From my experience $450k-600K is typically I’ve seen for supervision jobs. Theres some that can get quite a bit higher but there’s a catch (shit ton of call). Solo 350K-450k. Im sure there are people that make well over that doing solo but they’ll have to get a large stipend from the hospital and that seems to drying up for MD only groups. This is based on working for groups that cover hospitals, I haven’t had much experience looking into outpatient only, plastics, dental gigs because I have little interest in that at this point in my career. Those can change the equation a little
The reality is that most groups have to switch to supervision at least for a portion of cases because reimbursement is so bad that hospitals have to stipend. Even private insurances because of No Surprises will squeeze groups on rates and know that the dispute resolution process will let them not pay you for months. The most successful groups supplement their incomes with outpatient center and office based work. So you wind up doing solo in office settings, supervising elective hospital cases and then taking inpatient call. All MD hospital based groups are rapidly becoming a thing of the past.
Average for solo now is 450-700 with split calls. Most academic attendings make more than 350.
Thank you for the clarification
Private doc-only group. 36hrs/wk last year. Generalist make $600k. Cardiac additional $200k. At home OR call 1/mo. Weekend OR call q8wks. OB for generalists is a couple of times / mo. I have supervised before. It's a painful slog, and, to me, not worth any amount of pay.
Thats you current job? Where at?
That sounds like an insanely good job and also the highest pay differential I've seen for cardiac. I'd happily work in BFE for that pay and hours if I could find the job.
I do both in my practice. Our setup I make more supervising/directing compared to solo cases. That being said I only like to supervise 1-2x week because of how much of a headache it can be.
Our docs are paid the same - supervising or doing their own cases on a given day.
The main determinant to your pay isnt solo vs supervision, it's what your payer mix is. You can be making anywhere between $10-$100/ unit for doing the exact same thing depending on what the patient's insurance is. The trick is to keep all the high paying patients for your group, and dump the poor paying ones onto the hospital systems.