Kaiser Permanente: Cushy or Cumbersome?

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By Anne Nonymous M.D.:

If Abraham Maslow was a soon-to-graduate anesthesiologist from Stanford, his occupational hierarchy of needs would likely contain elements we are all vying for: a juicy salary, excellent benefits, generous vacation time, a variety of interesting surgical cases, and well trained/supportive/minimal drama colleagues who are fun to be with. At the top of his eponymous pyramid of needs would probably be the pinnacle of anesthetic nirvana (achieved by relatively few luminaries such as Steve Shafer), whereas the foundation of basic physiological needs (such as food, clean water, granite countertops & stainless steel appliances in a cozy 3BR/2.5BA shelter with opportunities to redeem Groupons to the Slanted Door) would most certainly need to be addressed first.

Dr. Maslow would probably look within himself to see if his heart lies in academia, where the inquisitive mind is amply fulfilled but the pocketbook lamentably underfilled, or in private practice, where the inverse is somewhat true, or a hybrid program (eg. the VA, county hospital, or Kaiser Permanente) where valiant attempts are made to find the elusive balance between academics and finances.

If he was to research Kaiser Permanente, for example, he would read about their noble mission of delivering quality healthcare at affordable prices, educating himself about “vertical integration” and the three entities that compose the Kaiser corporation. After ensuring the company’s values are in line with his own, he would want to get to the nitty gritty. How much money would he get paid? How long would he need to work in order to receive that generous pension everybody keeps talking about?

It turns out that, despite being a generally well run juggernaut of a healthcare organization, each Kaiser region throughout the United States acts like a semi-autonomous fiefdom. In California, for example, the northern vs. southern regions function rather independently in many respects and, in terms of job offer packages, can be pretty distinct.

Compensation at Kaiser is standardized according to an established pay scale within each region, is pretty much non negotiable, but turns out to be remarkably fair. The paycheck overall is quite satisfactory, which probably amounts to more than academic salaries but less than private practice. Full time anesthesiologists (40+ hrs/week) in the northern California region can expect to earn low to mid $300Ks/yr, and a bit more if you have a subspecialty fellowship. Rare opportunities exist to work part time (ie. 32 hours/week) with roughly 80% of full time salary, as well as per diem (“pool physician”) docs who get paid an hourly rate (with no benefits). Opportunities abound to work extra hours, with choices to either bank the extra units as accrued time off or receive a cash payout.

How much money would he get paid? How long would he need to work in order to receive that generous pension everybody keeps talking about?

 The generous retirement plan is a strong selling point, but requires 20+years of service to KP (it’s been referred to as the “golden handcuffs” by some individuals). The retirement plan is actually composed of three parts (termed “plans” as well). The first component is the pension plan (“The Defined Benefit Plan”), based on the number of years of credited service and the average of the highest paid of three consecutive earning years. This is where the bulk of Dr. Maslow’s retirement money will come from, which probably amounts to about 60% or so of his full time work salary. The second component (“The Permanente Contribution Plan”) will, after becoming fully vested after five years, generate another $25-30K/yr. Lastly, the third component is a traditional 401K (“Salary Deferral Plan”) in which he’d make annual contributions (taken directly from his paycheck) and where that money would get invested (by Fidelity or a similar established investment company) on his behalf.

Put together, these 3 plans would help Dr. Maslow & Bertha live out the rest of their days at a not too shabby, nearly pre-retirement salary. With the retirement plan garnering so much attention, often overlooked are the other generous benefits. Covered benefits include life and long term disability insurance, as well as comprehensive health, dental, and vision insurances (of which there are no premiums). Professional liability (“malpractice “) insurance is covered as well (including a provision with all Kaiser patients requiring arbitration in lieu of filing lawsuits/court trials).

As Dr. Maslow realizes that an important facet of job satisfaction includes the workload as well as team dynamics, he queries both the quality of his potential teammates as well as the expected workload. It turns out that a full time anesthesiologist is expected to work a minimum of 40hrs/week, and that he would be paid by the time spent in the hospital, not by the number of cases that require CRNA supervision or individually performed. In summary, it is very doable.

In terms of employment in the Bay Area, the Kaiser system seems to be a very popular organization to join and thus the competition for spots are fierce. The quality of applicants for the limited number of positions is remarkable, frequently drawing candidates from the usual alphabet soup of top programs that compete with Stanford (eg. UCSF, MGH, BWH, JHU, etc). These days, Kaiser seems to be able to pick and choose their candidates.

In the end, after speaking with many authorities and doing copious research, Dr. Maslow submits to the fact that the perfect job out there for him is the one in which he’s hired. And given that Maslow’s ultimate aim involves fulfilling his true potential and being all he can be, one reckons he’ll do just fine.

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