This Practice Urgently Needs Your Help To Win Their Salary Negotiation

Note: An anesthesia group reached out to Offcall for help with their salary negotiation, and to protect them, we're keeping their identity anonymous. Read more details below. If you or your group is also going through a negotiation and need data or help, please reach out: contact@offcall.com

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"We’ve stayed independent, covered everything, and kept the hospital running 24/7. But the numbers no longer add up — and now we need data to prove it."

In a rural part of the South, a physician-only anesthesia group covers a busy 12-OR referral hospital that serves as the anchor for a sprawling, underserved area. With services ranging from general surgery to OB, ortho, ENT, and urology, the hospital relies on the group for full-spectrum anesthesia coverage — day and night, weekday and weekend.

The 18-physician group (16 FTEs) includes a mix of full- and part-time partners. They’ve operated independently for years, without hospital employment or national contracts. CRNAs aren't employed by the group, but they are allowed to practice independently in this area.

Coverage Model: Always On Call

Weekdays are staffed with 12 anesthesiologists onsite, plus flex shifts depending on volume. Night call is taken from home on a rotating basis and includes OB and trauma. Weekend call spans Friday night to Monday morning, with primary and backup coverage split across the group.

The work is unpredictable — some nights are quiet, others stretch into 24-hour marathons — but the group shows up, every time.

Compensation Model: Volume-Driven, Call-Intensive

The group’s income comes from a blended model:

• RVU-based pay for clinical shifts
• Call stipends of $1,600/weeknight and $2,500/weekend day, plus RVUs
• Annual group bonus tied to net revenue

A $765/day hospital call stipend offsets some of the burden, but the group otherwise carries its own financial risk. Billing is managed internally, with support from an outside revenue cycle management (RCM) partner. All partners share overhead and participate in regular financial reviews.

The Financial Squeeze

Over the past two years, net revenue has dropped 22%, driven by unpredictable case volumes — especially in surgical subspecialties, plus decreased reimbursement and changing payor mix. Meanwhile, costs are rising due to locums coverage and inflation.

To make matters worse, two nearby hospitals have moved to CRNA-only staffing, creating pressure to reduce physician-based models — even as the work remains constant.

As a result, the group is facing a major employment negotiation with hospital leadership that threatens to take away their independence and hinder patient care.

“We really value the ability to make our own decisions about how to distribute call, how often we can take vacation days and how those can be structured, and how much we pay within our group for things like taking weekend vs. weekday call — basically being able to make decisions about our lifestyle and tailor the money and time to the values and priorities of the group instead of a corporate structure."

The Group’s Dilemma: Independence vs. Stability

The group has opened formal discussions with hospital leadership. Options on the table include:

• Increasing the existing call stipend
• Moving to a set-payment model, with the hospital handling billing
• Exploring a hybrid employment model for long-term stability

But there’s a catch: Every proposal must pass through a third-party fair market valuation (FMV) firm. And the group fully expects the FMV report to undervalue their call burden and availability, especially in a rural, high-acuity setting.

What They Need Now

The group isn’t looking for a buyout. They want:

• Compensation that reflects reality — and supports recruitment.
• Preserved independence, but with sustainable income.
• A coverage model that accounts for call intensity.
• Data to counter FMV assumptions and make their case to hospital leadership.

“We take pride in caring for our rural community, which often involves caring for our friends and acquaintances," the group said. "We actively develop and maintain great relationships with our nursing and surgical colleagues. We take our patient feedback surveys seriously and try to improve based on comments, and quickly incorporate the latest medical advances and guidelines despite being rural.”

They added: “We’re doing everything right — efficient coverage, minimal subsidies, excellent care — and somehow we’re still slipping backward. We need real data to back us up when the FMV firm says we’re worth less than we know we are.”

Why This Matters

This story isn’t unique. Across the country, independent physician groups — especially in rural areas — are carrying the weight of 24/7 coverage without adequate compensation, facing FMV walls that don’t reflect real-world complexity.

It’s a tough time for anesthesiologists, who are in short supply across the country. Even though overall demand for surgical services is growing, and anesthesia is important to hospitals’ bottom lines, anesthesia reimbursement payments are declining.

Staying independent, the group says, is the best way to ensure they continue to practice medicine and feel passionate about their work, as opposed to burning out or quitting: “We take pride in ownership of our group and feel a commitment to each other as business partners that goes beyond that of clinical colleagues. We think about how our actions will affect not just ourselves but our group. Like many small business owners, we are proud of the many challenges we’ve overcome as a group and want to be able to continue to have control over our destiny.”

How You Can Help

The group told Offcall that they need accurate, high-confidence benchmarking data to be able to win their negotiation: “Understanding how your pay compares — by shift type, call burden, geography, and practice model — is no longer optional. It’s survival.”

They are calling on anesthesiologists across the country to enter their compensation data using Offcall’s anonymous tool.

“We know many of you have been in our shoes," the group said. "Help us get the right information and data that will help us keep the practice that we love.”

The Ask

Submit your compensation data by this coming Sunday, April 20, at 5pm ET. Our goal is to collect data points from 100 anesthesiologists.

Also, we'll be sharing the compiled data from this project with everyone who submits their salaries by the deadline.

Let's do this!

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Looking to benchmark your own compensation or preparing for a hospital negotiation of your own? Sign up for Offcall to access real-world, physician-reported data on our platform to see what others are earning — and where the gaps are. Also reach out to contact@offcall.com so we can help.