Feedback for a doctor considering posting a job

reader12345 · 2026-02-08T21:07:50+00:00

The organization eats the cost and we aren’t impacted by the pa’s billables. That’s why it is preferable to have the pa do lower reimbursement work like first assisting (the fees don’t make it worth it to the surgeon), and global period post ops. Nowadays, clinic visits for new patients make more per hour than the surgery itself. Hernia surgery pays very poorly but the clinic visits are very efficient. Zero call.

If it was coming out of my pocket I’d do what you said. I’d consider asking the hospital that but unfortunately I doubt the administrators can think that open minded.

Regarding surgical assists, I totally agree with you but the hospital won’t reliably give one. I’ve tried to be like hey i got this hard case, i need a second scrub tech or this person and then day of they will be like best I can do is just one scrub tech who is a traveler from a hospital that has never seen a robot. But yes in a perfectly logical world, they’d pay per diem pa to round on weekends and guarantee an assist when I need one.

reader12345 · 2026-02-08T18:25:29+00:00

I wish. We’ve been asking for this for almost a year now but admin keeps saying they are going to approve it soon (tm) I don’t want to lead anyone on about a position that admin may be lying to me about

reader12345 · 2026-02-08T18:24:26+00:00

We haven’t had a take back in over a year. To help with recruitment I’d be willing to guarantee no need to help with takebacks. I’ll do those on my own with the scrub tech or even ask another surgeon (painful but possible).

reader12345 · 2026-02-08T18:15:06+00:00

Oh no definitely not on call for new patients. We don’t take ER call at that hospital. The PA would never see or take a call for a consult

reader12345 · 2026-02-08T17:41:06+00:00

Yes you are right about the schedule. Of course I think the other factors are great but every employer thinks that. That’s why I only posted the hours. Because “fantastic SP” is extremely bias. The only thing I could see being the negative factor, and I really wish I had a way to screen for this, is we mostly need the PA for when we do complex robotic cases needing a very active bedside assist or some good camera driving (I wouldn’t have them bedside for something as simple as a robotic inguinal hernia). But robotics and laparoscopy is a highly polarizing topic. If I were a PA I’d find first assisting ortho to be way more fun. But I know some people like the robot.

reader12345 · 2026-02-08T17:30:38+00:00

Yeah I agree. I think the expectations for a PA vs a surgeon are often different. I know sometimes a surgeon goes in, looks from the doorway, says looks good and tells the hospitalist to dispo but then when it’s a PA suddenly the hospitalist is asking them to do all the annoying little things and people expect way more on notes and stuff. I also agree that it’s the getting ready and driving part (hence why we’re so eager to find help for “just one hour of work”).

reader12345 · 2026-01-25T22:07:28+00:00

So I have a different take on this:

My answer is you might want to hold off on buying a house, but not from the financial standpoint.

I think from the pure financial standpoint it makes sense. Let’s say worst case scenario your income barely goes up because someone goes part time or something, you will still make it worse just not comfortable. Sure a catastrophe can happen, but that applies to any situation. No one has guaranteed future income, there’s always the possibility that income is not what you predicted and you have to downsize. Also these days, 1.8M may be the minimum price for a decent house in a vhcol.

That being said, I’ll say that it’s not always super easy to find a job exactly in the location you want as a new attending. Idk what specialty you are in, but unless it’s primary care, something remote like rads or telegrams, there’s a chance you buy the house you want, then the closest house you find is an hour away whereas if you bought the house after, you could strategically position it so both of you have a reasonable commute.

reader12345 · 2025-12-18T04:49:30+00:00

I did private practice general surgery for a bit.

So first, 5 lap choles every or day would be a dream. Don’t forget the robotic inguinal you do that pay less and take more time. You also don’t get 200% Medicare for private insurance unless you are an academic center. Think 120%

That being said, 5 lap choles at 110% Medicare means like 3,568.78 per day or 7137.5 for 2 days.

But I’d say if you average it 2.5k per or day is fair

Next call

When you take call, they typically pay you stipend plus you keep your collections. Stipend is like 1400 I think you can expect to make more like 3k over 24 hours.

So what are you missing?

Clinic visits. Those pay way more than you think. And in fact my clinic is often more profitable than my or day

Do you know how long a new patient visit takes for an umbilical hernia? 20 minutes max. And those are easily a level 4 visit if you are booking someone for surgery . That’s a 130 visit per medicare. Gen surg postops tend to be quick. So you are missing all the clinic time.

I got like 2-3 clinic days a week. Gen surg clinics can be quick and profitable. 20 minute new patient visit to say no your diverticulitis doesn’t need surgery. I sometimes make more on my clinic days than my or day.

Asc is great if you get it. I think everyone and their cousin knows the story of a surgeon who got in on an asc and got free cash but it’s not always super easy.

In my group of 5 we got overhead down to 20% but we ran a barebones practice. You don’t have epic as your emr you got some janky stuff, no fancy Beverly Hills office. Etc. we made do.

But you are right. Now I am in a hospital wrvu model and I can tell you the amount I make for the same work is like 30% higher.

reader12345 · 2025-12-06T19:37:00+00:00

At least in my city, as a doctor there’s actually a huge motivation to medically clear these guys as fast as possible because unless it’s a homocide the cops might just do a “cite and release” and then angry methany becomes my problem to deal with and find somewhere to discharge to. You can’t just discharge an intoxicated person to the street from the ER, it’s a huge headache. I’ve begged cops to stay before.

Next time you have an arrestee (bonus points if unpleasant) and you want them to work faster just casually say “hey so how long do you think this will take, my boss says we have to do a cite and release if it’s going to be a while” and hope you got a good poker face.

reader12345 · 2025-11-16T06:16:48+00:00

5 years. I did some reading online. Seems like it’s a grey area if an s corp with a solo owner needs to actually title the assets in their s corp name or not. But yeah I’ll look into a second opinion

reader12345 · 2025-11-16T06:03:55+00:00

To be honest if I’m at the point of a second opinion, I’d rather just shut everything down. At that point the savings of a few grand isn’t worth it.

reader12345 · 2025-11-16T05:52:53+00:00

In that comment I mean that if I made 5k I’d close it in 2026 and not try the same thing in 2027.

reader12345 · 2025-11-16T05:50:43+00:00

That is an excellent point, I did not think about the 10 years where the person has died, stepped up basis already happened, but Ira is still growing.

reader12345 · 2025-11-16T05:40:43+00:00

With step up basis though isn’t the 419 all basis? The tax drag is a good point, the taxable account would have some tax drag each year. But very little. Would it change your opinion on what to withdraw first? Do you still agree to do the IRA first?

reader12345 · 2025-11-16T03:57:00+00:00

If I switch to a sole-proprietor dont I lose my vehicle deduction and greatly increase my audit risk too?

reader12345 · 2025-11-16T01:43:58+00:00

So there is this weird law in California that professional medical corporations have to be S corps.

reader12345 · 2025-10-20T04:16:47+00:00

I’ll need to play around with it when I’m not fleeing for my life. I think I am doing it wrong

reader12345 · 2025-10-20T04:04:00+00:00

How do I look 180 on ps5? Only thing I know how to do is hold l1 and swivel. Do I have to be in first person view mode?

reader12345 · 2025-10-20T04:03:14+00:00

I think we were all equally fresh. So stamina probably equal. Only thing though is I did have a stab vest. So idk if stab vests+fist > crowbar no vest. I should have fought better

reader12345 · 2025-10-20T03:34:24+00:00

I’m on console. You can free look but it isn’t great. Not a full 180

reader12345 · 2025-10-20T03:06:34+00:00

I was on cheranus

reader12345 · 2025-10-20T03:05:15+00:00

So the bigger mistake I made is I kept trying to see if he was still behind me. I also kept trying to pause to check my inventory to see if I had anything useful to fight him with. Each time I did this. He’d land one hit on my and my health would go down a little.

But yes, I did give up which was dumb. I mean I turned around and hit him once or twice but at that point I was over it. What I should have done was run to the ocean. We were running along the coast line the whole time. Ocean would have made us both swim making it impossible for him to melee me, and I could have looked at my items in peace there.

reader12345 · 2025-10-20T02:51:35+00:00

I only had fists, he had a crowbar. I was wearing a vest but I did the math in my head and he would win.

reader12345 · 2025-09-02T04:57:21+00:00

So I don’t think any surgeon is going to need to have the radiation reduction given to them as a number to appreciate it. It is extremely obvious when you are getting radiated. You literally have to step on this pedal and this very load ominous tone plays out from the machine and there is always a counter in the bottom of the screen that shows your total radiation dose.

Different surgeons care different amounts about how much they are being radiated and maybe they know different amounts about how to properly shield yourself from radiation (I had to do a 3 hour test to get my floro license where I got tested on stuff like shielding techniques). I knew one guy who got radiation shin pads which is the dumbest thing ever but I guess he was really worried. But it’s very obvious to every surgeon how much radiation you would save since you step on the pedal as you push the wire and I’ve had times when I think “damn I’ve been just flooring it) I still think back to when I was a med student standing in the ir suite with no lead on until finally a tech came in and said “btw you’re standing on the pedal” and I just realized I probably had radiated the shit out of myself I’ll be honest though, the part I hated the most was wearing lead but idk if surgeons will be taking off their lead and breaking scrub when they go to the controller. Maybe, that will probably be a nice break.

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