Better Job or Higher Paying Job? An existential question....

[Twiggidy]

What are you guys' thoughts?

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[Stank811]

What are you guys' thoughts?

What makes it better and how much is the difference in total package, vacation, call frequency.

 

[Aether2000]

With regards to our careers, there are three things that are important: money, power, and time. You can have at most any two of the three.

 

[deleted162650]

I’ll go with the better higher paying job.

 

[Lecithin5]

I’ll tell you from personal experience-while money is important, I sacrificed a good chunk of change for a quality job with great people in a good location...and never looked back. It’s cliche, but happiness is priceless.

 

[chocomorsel]

They are not mutually exclusive. Why can’t you have both? I am with Salty on this one.

 

[Lecithin5]

They are not mutually exclusive. Why can’t you have both? I am with Salty on this one.

Agree, but I’m assuming the op was wondering if you could only have one...

 

[Twiggidy]

They are not mutually exclusive. Why can’t you have both? I am with Salty on this one.

I'm not sure it exists, outside of either being somewhere you don't want to be or doing some things you don't want to do.

 

[Twiggidy]

Maybe I should've worded the thread different....

Describe the perfect anesthesiology job/practice and be specific as possible? Maybe some of us will realize we have it better than we think

 

[Monty Python]

Use the "alarm clock" test. It's a workday, your alarm clock sounds, and your first thought upon reaching semi-consciousness is:

A). Oh f@*k, another day working at that hellhole.
B). La tee dah, whatever, ho hum.
C). Looking forward to work today, feeling useful and productive, surrounded by great people.

Answer choice C is priceless and independent of the size of your compensation. Answer choice A isn't worth the psychological price you pay to get your compensation, no matter how large.

Factors of job satisfaction, from a survey with N=200,000.

The top 10 factors are:

1. Appreciation for your work
2. Good relationships with colleagues
3. Good work-life balance
4. Good relationships with superiors
5. Company's financial stability
6. Learning and career development
7. Job security
8. Attractive fixed salary
9. Interesting job content
10. Company values

For your further consideration:
The Top 10 Factors For On-The-Job Employee Happiness

 

[pgg]

I voluntarily extended my time on Navy active duty despite the fact that it works out to something like $120/hour* and has occasional mandatory travel, and twice a year they make me get on a scale and do some push ups to prove I'm not a jelly-donut munching Private Pyle fatbody. But the department is full of good people, I do my own cases or work 1:1 with a resident, the hours aren't bad, and the call burden is exceptionally light.

I worked the same $170/hour moonlighting gig doing my own cases for several years, because the people were nice, the surgeons weren't cowboys, and it was 10 minutes from my house.

I quit a $200/hour moonlighting gig after just a few shifts because it was 3:1 or 4:1 supervision of militant cowboy CRNAs and greedy orthopods who'd book cardiac cripples to the surgicenter and an obnoxious ophthalmologist who'd bitch at me for refusing to do his retrobulbar blocks.

I just signed up for a $275/hour moonlighting gig, but I'm not that excited about it because it involves air travel and living in a hotel.

Pay and environment aren't binary yes/no things. It's a job and it's work. The answer is: enough money for an acceptable work environment.


* The promised pension does a good job of compensating for the low hourly rate.

 

[MoMoGesiologist]

The VA seems like an ideal job. Nice slow pace, good benefits.

 

[okayplayer]

Pgg correct, as usual.

 

[kidthor]

and an obnoxious ophthalmologist who'd bitch at me for refusing to do his retrobulbar blocks.

Ugh - I definitely never want to do one of those. Keep me away from the eye... Let the eye people poke the eye!

 

[narcusprince]

I would go for the job the has the best quality people around you. Their was a hospital in Florida where physicians were respected and the concepts of team were respected. Docs were not pitted against each other. Having worked in numerous locations inside and out of the military. I am looking for an environment of good people. I enjoy coming to work now for my last .mil gig with some pretty good people. The second thing is good systems where everyone is there to help you get the work done. Third would be money.

 

[GravelRider]

I think the answer is always “it depends.” What is the difference in pay? What is the difference in job quality? Where are you at in terms of FU money?

 

[sethco]

Maybe I should've worded the thread different....

Describe the perfect anesthesiology job/practice and be specific as possible? Maybe some of us will realize we have it better than we think

Everybody is going to be different, but here is mine, in no particular order

-MD/DO practice only
-No OB, transplants or Trauma. Some might include Cardiac patients but this is my bread and butter and the reason I did fellowship in the first place. 90%+ of my cases are Cardiac/EP/Thoracic and that is my ideal
-Patient population with minimal self pay patients. Bonus points for lower percentage of CMS patients
-Compensation based on how much you work. Not necessarily eat what you kill as that may build contention with some people more likely to be put in easier or higher generating rooms. More of a pooled unit system, where compensation is divided based on days worked with greater compensation for later hours worked on those days
-Reasonably flexible PTO time. If you want to take 3 weeks PTO and make more money, that's fine. If you want to take 10 weeks and make less, that's also fine
-Fair benefit system. Let's face it, we are probably in the highest tax bracket we will ever be in. A good 401k system or equivalent plus an HSA are very valuable
-Good work environment with good relationships with ancillary staff and surgeons
-Hospital system(s) and administrators that care about patient care
-If home call practice, have surgeons that only post true emergencies after hours, instead of convenience emergencies
-Good work/life balance
-Good physician lounge with lunch/snacks provided. This is very underrated as it is extremely helpful knowing there is always something available for those >12 hour days
-Frequent CME offerings that don't interfere with daily work schedule
-Practice in a low tax, cost of living, and malpractice environment

I'm sure everybody has their own lists and priorities. I'm happy in my current job and feel it checks the vast majority of boxes for me

 

[Twiggidy]

Everybody is going to be different, but here is mine, in no particular order

-MD/DO practice only
-No OB, transplants or Trauma. Some might include Cardiac patients but this is my bread and butter and the reason I did fellowship in the first place. 90%+ of my cases are Cardiac/EP/Thoracic and that is my ideal
-Patient population with minimal self pay patients. Bonus points for lower percentage of CMS patients
-Compensation based on how much you work. Not necessarily eat what you kill as that may build contention with some people more likely to be put in easier or higher generating rooms. More of a pooled unit system, where compensation is divided based on days worked with greater compensation for later hours worked on those days
-Reasonably flexible PTO time. If you want to take 3 weeks PTO and make more money, that's fine. If you want to take 10 weeks and make less, that's also fine
-Fair benefit system. Let's face it, we are probably in the highest tax bracket we will ever be in. A good 401k system or equivalent plus an HSA are very valuable
-Good work environment with good relationships with ancillary staff and surgeons
-Hospital system(s) and administrators that care about patient care
-If home call practice, have surgeons that only post true emergencies after hours, instead of convenience emergencies
-Good work/life balance
-Good physician lounge with lunch/snacks provided. This is very underrated as it is extremely helpful knowing there is always something available for those >12 hour days
-Frequent CME offerings that don't interfere with daily work schedule
-Practice in a low tax, cost of living, and malpractice environment

I'm sure everybody has their own lists and priorities. I'm happy in my current job and feel it checks the vast majority of boxes for me

That actually sounds like a damn good practice

 

[Twiggidy]

I think the answer is always “it depends.” What is the difference in pay? What is the difference in job quality? Where are you at in terms of FU money?

I question whether “FU” money needs to be a concern if you love the job/love the practice

 

[Twiggidy]

The VA seems like an ideal job. Nice slow pace, good benefits.

Also no OB. Most anesthesiologists I know who work at the VA, love it.

 

[narcotics999]

A high paying job may not be a good job, a low paying job surely is a bad one.

 

[nimbus]

High pay can make a crappy job feel “better” too.

 

[GravelRider]

I question whether “FU” money needs to be a concern if you love the job/love the practice

FU money is always a concern. Nothing lasts forever.

 

[pgg]

-Good physician lounge with lunch/snacks provided. This is very underrated as it is extremely helpful knowing there is always something available for those >12 hour days

One of the locums jobs I used to work had wonderful physician lounges, and anything from the hospital cafeteria was free to physicians, any time.

Such a small thing. I couldn't have consumed more than $10 or so per day I worked there. But I really do miss it, out of proportion to the negligible financial benefit.

 

[gasdoc77]

Also no OB. Most anesthesiologists I know who work at the VA, love it.

I know a guy who works at the VA. Was BSing one day with him about winning the powerball and he said he would keep working there. Looked him in the eye and he was dead serious. Said that particularly with his liability at that point it would only make sense. I think he needs to check his vaporizer for a leak (but seriously, it must be pretty good).

 

[DirtDocMD]

There is a point of diminishing returns. At a certain point, that extra 10-20% income is not going to make that big of a difference in your quality of life, but an extra 10-20% of your TIME, will.

I’ve started letting my partners have my weekend call. Yes, it costs me $50-$60k a year, but it is easily HALF of my headaches, and the Govt would have taken 1/3rd of it, anyway.

Weekends—No support staff at the hospital to help expedite cases. A hospital who thinks I ought to provide a $200k a year CRNA to help expedite case load, but refuses to spend a couple hundred $$ to get a cleaning lady and a transporter to help cut turnover times in half.

Surgeons who think the weekend is for the case they have been sitting on for 3-4 days, while they did their good paying cases at ASC’s during the week. Cases that could wait but have to be done NOW because they have social plans or “a full day on Monday”.

I’ll do real emergencies all day long, but I get sick of the surgeon drama from folks who cannot or will not manage their time. Guys who act like 10 year olds when I tell them there are cases in front of them, and want to argue that they should get to go first, but refuse to follow policy and discuss it with their surgical colleagues.

In my career, it has not been the patients that have been the challenge. It has been a-hole surgeons, slow or incompetent surgeons, administrators looking to save a dime or polish up their resume for a better job, or the AMC’s /groups that think you ought to work 70 hours a week so they can make a profit or so the other workaholic partners can afford their 2nd/3rd wife....

 

[Twiggidy]

A high paying job may not be a good job, a low paying job surely is a bad one.

I’m not sure that’s 100% true.

250 no nights no weekends isn’t 7-5 is more than what 90% of people in the US make but most of us will probably look harder at the 350-450 job with 4-8 calls per month because the pay is higher

 

[Twiggidy]

High pay can make a crappy job feel “better” too.

There’s validity to that but that’s basically “working until payday”

 

[Twiggidy]

I know a guy who works at the VA. Was BSing one day with him about winning the powerball and he said he would keep working there. Looked him in the eye and he was dead serious. Said that particularly with his liability at that point it would only make sense. I think he needs to check his vaporizer for a leak (but seriously, it must be pretty good).

Speaking of the lotto, I feel bad for any state that doesn’t let you claim your winnings anonymously. Rest In Peace to the people who win this week

 

[pgg]

Speaking of the lotto, I feel bad for any state that doesn’t let you claim your winnings anonymously. Rest In Peace to the people who win this week

This is an interesting read:

Winning the Lottery is Very Dangerous (A Practitioner's Guide) - LONG - Page 1 - AR15.COM

 

[Twiggidy]

This is an interesting read:

Winning the Lottery is Very Dangerous (A Practitioner's Guide) - LONG - Page 1 - AR15.COM

Yeah man. I’ve read all of those stories. You can make a valid argument that they shouldn’t let the jackpot get large (just keep it at a set number) or do away with the lottery completely. If you win and don’t move to a foreign country where no one knows you, you’re stupid.

Then in my Sex and the City voice, “it made me wonder...” what do all the billionaire tech people that live in our state do? There was the one Google guy that OD’d with the prostitute
https://nypost.com/2018/06/27/prostitute-convicted-in-google-execs-overdose-death-charged/

 

[Ronin786]

The VA seems like an ideal job. Nice slow pace, good benefits.

I know not all VAs are the same, but the ones I've worked at suck. The CRNAs are as militant as they come (related to the fact that they're not employed by the anesthesiologists), the CRNAs are usually old/suck and many of the anesthesiologists fall into the same boat. Too many people go to the VA for the slow pace and the pension and it's a ****ty place to be if you have any motivation or drive.

 

[Twiggidy]

This is an interesting read:

Winning the Lottery is Very Dangerous (A Practitioner's Guide) - LONG - Page 1 - AR15.COM

The funny thing is, I feel like if I won 5 million dollars I should folllow those same instructions and disappear like Keyser Soze.

edit: btw spoiler alert

 

[pgg]

The funny thing is, I feel like if I won 5 million dollars I should folllow those same instructions and disappear like Keyser Soze.

Clearly the answer is to not have any friends in the first place. One cannot be betrayed if one has no people.

 

[cchoukal]

Every time someone posts about how great it must be to work for the VA, I feel the need to post. I work for a large academic, university affiliated VA in a large urban area, and it is definitely not all peaches and cream. My department colleagues who work directly at the University make quite a bit more money than we do, for one. Sure, they might work harder, but I’m not sure that it evens out. I work a lot of hours (its Saturday night at 8 PM and I’m in the OR doing an ex lap). It’s probably true that, compared to some jobs, the hours that I spend might be less intense, but a lot of hours in the hospital is a lot of hours in the hospital. The pay is totally inflexible, so when we lose people and the work continues, we all have to pitch in and do more for free. Administratively, this place is a nightmare. It takes months to hire anybody, and every administrative task is an exercise in futility. Yes, the benefits are good, the pension is nice, and I personally really like most of the people I work with. It’s a friendly, collegial environment, people are reasonable. I happen to have research and teaching responsibilities that I also enjoy, so there is plenty to keep me here.

But it ain’t no picnic.

 

[GA8314]

Even 2 years ago I would have prioritized money over just about everything. I think it depends on your stage in life, goals, savings rate, and how you choose to live your life.

More recently I've come to value a good balance of lifestyle, work environment (ancillary staff and surgeons as well as colleagues), and pay/benefits. I'm not sure I'd be too interested in going to a pressure cooker unless for a large premium in pay at this point. I could still do it, but it would need to be strongly incentivized.

I've trained in environments where people in general were less friendly, more abrasive, and rigid. Surgeons gave new meaning to the definition of privilege. My current gig is so much better and that's worth a lot to me now.

 

[psychbender]

Ideal job:
- Solo physician care in the OR, with a wide range of cases from Ortho, to healthy Peds, Vascular, some Cardiac, and Thoracic, etc. Minimal OB.
- Part-time coverage of a closed ICU
- Production-based compensation with a blended unit, scheduler blind to patient insurance, fair with case assignments
- A system that does not penalize efficiency
- Flexible vacation/time off. Those that want to work more can sell their vacation time to colleagues. Those that want to do less call and generally work less are able to, but make less as a result
- Good benefits and the ability to deduct most expenses through the group
- Location close enough to meet family obligations
- Throw in some unicorns, dragons, and other nonexistent things, while I'm at it.

Thanks to the military, I have no debt, and have some savings, so making fat stacks of cash is less of a priority to me than getting to do what I want to do at work, and having some time off to spend with the family.

 

[deleted162650]

Ideal job:
- Solo physician care in the OR, with a wide range of cases from Ortho, to healthy Peds, Vascular, some Cardiac, and Thoracic, etc. Minimal OB.
- Part-time coverage of a closed ICU
- Production-based compensation with a blended unit, scheduler blind to patient insurance, fair with case assignments
- A system that does not penalize efficiency
- Flexible vacation/time off. Those that want to work more can sell their vacation time to colleagues. Those that want to do less call and generally work less are able to, but make less as a result
- Good benefits and the ability to deduct most expenses through the group
- Location close enough to meet family obligations
- Throw in some unicorns, dragons, and other nonexistent things, while I'm at it.

Thanks to the military, I have no debt, and have some savings, so making fat stacks of cash is less of a priority to me than getting to do what I want to do at work, and having some time off to spend with the family.

Just clarify a couple points on a blended unit system for you:

The scheduler doesn’t need to be blinded to insurance because the blended unit takes that out of the equation. You do need a system to equitably divvy up high v low unit value cases though.

There is no need to sell vacation either. Work more = more units billed = more money. Work less = less units billed = less money. Take as much or little time off as you want. As much or as little call as you want.

 

[psychbender]

Just clarify a couple points on a blended unit system for you:

The scheduler doesn’t need to be blinded to insurance because the blended unit takes that out of the equation. You do need a system to equitably divvy up high v low unit value cases though.

There is no need to sell vacation either. Work more = more units billed = more money. Work less = less units billed = less money. Take as much or little time off as you want. As much or as little call as you want.

Points taken. I have never existed in such a system (always been salary or hourly locums), so I have very little knowledge on how they function at that level. I'd just like a fair system that rewards productivity, while allowing equal access to cases, and flexibility to make more or less, based on individual desires regarding money vs time.

 

[deleted171991]

The people who think they value money over job quality are currently working in a good place, and have not worked in a really bad one before. The difference (in stress and satisfaction) is unbelievable.

Back when I was a CCM fellow, I remember waking up with a smile on my face, every single day. I don't feel like that even when I'm in the SICU in my current job.

 

[deleted171991]

I would go for the job the has the best quality people around you. Their was a hospital in Florida where physicians were respected and the concepts of team were respected. Docs were not pitted against each other. Having worked in numerous locations inside and out of the military. I am looking for an environment of good people. I enjoy coming to work now for my last .mil gig with some pretty good people. The second thing is good systems where everyone is there to help you get the work done. Third would be money.

That's exactly my way of thinking, too. Unfortunately, it's very hard to predict which job will satisfy the first two requirements. I have had even insider friends "lie" to me about the quality of a job, simply because they were in denial.

In my limited experience, the more difficult you are to replace, the higher your job satisfaction will probably be. Even in a bad system, management tends to kiss up to those they depend on.

 

[CubsDynasty]

I see a few people mentioning "minimal/NO OB" in their ideal practice. Is this a reflection of just not enjoying doing OB, decreased pay/RVUs compared to general OR cases or other reasons?

 

[deleted162650]

I have had even insider friends "lie" to me about the quality of a job, simply because they were in denial.

Are you sure that’s what it is, or is it just that you can find a way to be miserable anywhere?

 

[Twiggidy]

I see a few people mentioning "minimal/NO OB" in their ideal practice. Is this a reflection of just not enjoying doing OB, decreased pay/RVUs compared to general OR cases or other reasons?

Depending on the payor mix, OB can be very lucrative, so I think you can figure it out from there.

 

[Twiggidy]

What about career opportunites/career growth? I haven't seen much about that. Is this something that is limited to academics?. Does anyone feel like they're at a dead end because you basically go to work to make money and then go home?

For instance, FFP you seem to like critical care because you said you were happier in fellowship but you're not "as' happy now, so why stay where you are?

 

[deleted171991]

Are you sure that’s what it is, or is it just that you can find a way to be miserable anywhere?

You are so right. All of us (I am not the only one here) who haven't found a job we can look forward to, in the last 5 years or so, are just miserable human beings. There is nothing wrong with the jobs/market, and "slavery was a choice".

Or, maybe, you should go and thank your gods every day for your LUCK. I used up all of mine when I got married to the best wife.

 

[Twiggidy]

I see a few people mentioning "minimal/NO OB" in their ideal practice. Is this a reflection of just not enjoying doing OB, decreased pay/RVUs compared to general OR cases or other reasons?

I'll expand a bit more.

I tend to crap on OB coverage but the reality is OB anesthesia is probably the one branch of medicine where you get immediate results for a patient and they're usually the most thankful.

"Doctor I'm in in pain. Can you help?"
"Yes ma'am" *8-15 min later after epidural is in
"Thank you Doctor. The pain is no significantly better and/or gone"

There are few branches of medicine where you can catch a win like that.

Now everything else that surrounds that situation. The nurses, the OBs, the faulty equipment, sometimes the husbands, the doulas, the midwives and most importantly THE TIME. 12-24 hours of your life stuck in the hospital. It's that last part where you tend to lose a good majority of anesthesiologist, more so in private practice because you tend to be personally responsible for everything.

Most of us, dare I say just about all of us, favor OR work because we did anesthesia to have sleeping patients and more importantly to have control over out situations. On OB, you tend to lose some of that control and all the patients are awake. That's annoying.

 

[Twiggidy]

I have had even insider friends "lie" to me about the quality of a job, simply because they were in denial.

Are you sure that’s what it is, or is it just that you can find a way to be miserable anywhere?

I don't think FFP is 100% wrong here. I think it relates to a previous post where someone said "the money is so good you convince yourself it's a good job" (not exact quote) I really think money is the important factor for a good amount of people in our field

 

[sethco]

I see a few people mentioning "minimal/NO OB" in their ideal practice. Is this a reflection of just not enjoying doing OB, decreased pay/RVUs compared to general OR cases or other reasons?

Combination of

-Difficult, sometimes entitled, patients with "birth plans"
-Dealing with Midwives and Doulas
-High liability with sometimes uncompensated risk
- +/- poor payor mix
-Significant after hours involvement with frequent emergencies
-Dealing with OBs as "Surgeons" that don't generally work well in a team setting
-Difficult nursing staff that feel they know more than you

I liked doing OB in residency much more than doing it in private practice

 

[narcusprince]

Depending on the payor mix, OB can be very lucrative, so I think you can figure it out from there.

OB in my opinion feels better in well supported practices. 1st does the hospital have a NICU and neonatologist available for the c sections. If a nurse practitioner is doing the NRP that brings my stress level up. Also who is doing the NRP if its me my stress level goes up. 2nd who is doing the epidurals in the middle of the night? CRNAs? Senior residents? If its me that increases my level of stress. I actually like OB and ob nurses the things that make it very stressful can easily be mitigated by a good system.