burnttoast101
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I created this account just to comment about CAA.
I joined them briefly in the mid-2010s. Everything said here about them is true.
Their biggest problem is that they were a small fish trying to act like they were already swimming in the big NAPA or Mednax or Sheridan/Envision ocean. They were a private practice group trying to be an AMC with the power-structure so lopsidedly in favor of the super partners that it was completely out of balance. The pay was low and the risk was high. They were too big for their britches. While I was there, they lost their Virginia Eye Institute contract. The writing was on the walls even back then.
"Why would anyone join them in the first place?" Simple. Geography. I wanted to be closer to friends and family. It was early in my career and, while I wasn’t unhappy at the practice I was leaving, the geography and location of being in the up-and-coming renaissance of the Richmond area was appealing. It was less about the actual job, which I knew I could do, and more about the outside-of-work lifestyle that had been missing in the practice I was leaving.
That said, I did not stay employed with CAA for very long. I currently work full-time in private practice. This is my fourth job and it took me a while to find the place that checks all the boxes. I can honestly say the CAA job was the worst one I've had since finishing residency, though.
When I agreed to work for them, I was given a nebulous promise about how I could become a partner someday. There was no formal partnership track. I admit they were honest about that part up front. The lie, if you will, that they allow to fester is was that one could someday eventually become partner. With no firm commitment, this creates an incredible power imbalance between the partners (haves) and the associates (have-nots). You quickly become a hamster on their wheel. With no exact date when that would happen was given either verbally or in writing, I took the job anyway. Huge mistake.
Shortly after I joined, one of the other anesthesiologists (with whom I became good friends and still am to this day, who also left shortly after I did) told me that he tried to pull me aside when I was interviewing to tell me not to come there. I wish he had.
I worked and had privileges at three of their facilities with 95% medical direction model. Rarely did my own cases here and there. My life as an anesthesiologist with them was basically as a paper-chaser. It was exhausting. Anyone who as ever worked with HCA's legacy EMR system will agree that it is terrible. I had very little actual patient contact outside of trying to quickly assess them preoperatively, get the consent, and keep the OR going. The CRNAs did all the clinical work and did not want or expect any actual input from the anesthesiologists. If you offered it, they complained about you to CAA's offsite management.
Some clinical situations that I recall: Every patient - even for an elective case that was appropriately NPO - was intubated with succinylcholine. In one case, a freshly minted CRNA was readying to give a dose of ondsansetron at the beginning of a long case when I politely suggested she wait until closer to the end of the case while trying to explain the pharmacokinetics. She responded, "Well, I'm going to give it now anyway." And she did. I later found out that she complained to one of the senior anesthesiologists that I was micromanaging her.
One very busy morning, I witnessed as the chief CRNA (who was about 29) was pushing one of the patients I'd pre-op'ed what I thought was the wrong way down the OR hallway to the PACU. I asked where she was going and she responded that the case was quick and she'd already finished it. This was a general anesthesia case. She'd never even called me to let me know let alone to help start it. She just pushed the patient into the OR and did the case completely by herself. On her way to the PACU, she casually tells me she knew I was busy and didn't want to bother me. And that I now need to come to the PACU and sign the chart. I was furious.
That is the attitude of the CRNAs who work there. I have never before or since worked with such malignantly indepedent CRNAs who had such little regard for involving the Anesthesiologists. Your plan? Pfft. Just a suggestion. They were going to do the case they wanted to either way. On one occasion, I walked into the pre-op area where a 90-year-old demented patient with a fractured hip had been incrementally given 80 mg of ketamine so the spinal could be placed. The patient was leaned over frog-legged and moaning in pain with the CRNA struggling for no idea how long. No discussion in advance. Just did it. On another occasion, I went into a room I was directing and a CRNA who wasn't involved in the case was placing an a-line in the middle of the case for some reason I could not ascertain. No discussion. Just did it.
The group of CAA anesthesiologists was responsible for allowing and fostering this clinical practice environment. Period.
The practice had also allowed the hospital to post metrics and publicly shame the Anesthesiologists for case delays. In one instance, a surgeon who was notoriously late (and who would threaten to take his cases elsewhere when pointed out to him) would always shift whatever blame back to the anesthesia team unfortunate enough to be assigned to his room. The solution to placate this guy was to look at the Anesthesia service as the root cause of his delays. For whatever reason (surgeons late, patient's late, etc), it was Anesthesia's fault. Fine. If that's the way they wanted to play it, okay. But then too publicly post the Anesthesiologists names on the lists case delays. Why? What motivational purpose did that serve other than to public shame them for factors beyond their control? That's but one example how toxic that place was.
They also covered procedurally the ICU with the doc on call. If OB was busy, you would have to try to attend to that while the offsite Intensivist may call you to place a central line or intubate a patient. Call was frequent and brutal, especially in Johnston-Willis which is a very horizontally spread hospital. And a disproportionate amount of call fell on the non-partners.
I could go on and on. I was never privy to the inner workings of that place. I did hear a lot of water cooler talk about how unhappy but trapped a lot of the doctors were. That place had a lot of turnover for a lot of reasons. That should tell you everything you need to know. The Richmond scene may be very tough to make it work, but I think a lot of the problem with CAA was a bunch of top-heavy fat cats who thought they knew more about the Anesthesia business than they did/do. They were trying to be something they were not instead of being fair and equitable. They treated their doctors like employees and not partners - and that was obvious.
You just cannot sustain a practice model where the doctors feel taken advantage of and disenfranchised with what's going on. I got out quickly because I could. I feel sorry for those who were trapped. And now it sounds like they're going to be scrambling. Sad.
I joined them briefly in the mid-2010s. Everything said here about them is true.
Their biggest problem is that they were a small fish trying to act like they were already swimming in the big NAPA or Mednax or Sheridan/Envision ocean. They were a private practice group trying to be an AMC with the power-structure so lopsidedly in favor of the super partners that it was completely out of balance. The pay was low and the risk was high. They were too big for their britches. While I was there, they lost their Virginia Eye Institute contract. The writing was on the walls even back then.
"Why would anyone join them in the first place?" Simple. Geography. I wanted to be closer to friends and family. It was early in my career and, while I wasn’t unhappy at the practice I was leaving, the geography and location of being in the up-and-coming renaissance of the Richmond area was appealing. It was less about the actual job, which I knew I could do, and more about the outside-of-work lifestyle that had been missing in the practice I was leaving.
That said, I did not stay employed with CAA for very long. I currently work full-time in private practice. This is my fourth job and it took me a while to find the place that checks all the boxes. I can honestly say the CAA job was the worst one I've had since finishing residency, though.
When I agreed to work for them, I was given a nebulous promise about how I could become a partner someday. There was no formal partnership track. I admit they were honest about that part up front. The lie, if you will, that they allow to fester is was that one could someday eventually become partner. With no firm commitment, this creates an incredible power imbalance between the partners (haves) and the associates (have-nots). You quickly become a hamster on their wheel. With no exact date when that would happen was given either verbally or in writing, I took the job anyway. Huge mistake.
Shortly after I joined, one of the other anesthesiologists (with whom I became good friends and still am to this day, who also left shortly after I did) told me that he tried to pull me aside when I was interviewing to tell me not to come there. I wish he had.
I worked and had privileges at three of their facilities with 95% medical direction model. Rarely did my own cases here and there. My life as an anesthesiologist with them was basically as a paper-chaser. It was exhausting. Anyone who as ever worked with HCA's legacy EMR system will agree that it is terrible. I had very little actual patient contact outside of trying to quickly assess them preoperatively, get the consent, and keep the OR going. The CRNAs did all the clinical work and did not want or expect any actual input from the anesthesiologists. If you offered it, they complained about you to CAA's offsite management.
Some clinical situations that I recall: Every patient - even for an elective case that was appropriately NPO - was intubated with succinylcholine. In one case, a freshly minted CRNA was readying to give a dose of ondsansetron at the beginning of a long case when I politely suggested she wait until closer to the end of the case while trying to explain the pharmacokinetics. She responded, "Well, I'm going to give it now anyway." And she did. I later found out that she complained to one of the senior anesthesiologists that I was micromanaging her.
One very busy morning, I witnessed as the chief CRNA (who was about 29) was pushing one of the patients I'd pre-op'ed what I thought was the wrong way down the OR hallway to the PACU. I asked where she was going and she responded that the case was quick and she'd already finished it. This was a general anesthesia case. She'd never even called me to let me know let alone to help start it. She just pushed the patient into the OR and did the case completely by herself. On her way to the PACU, she casually tells me she knew I was busy and didn't want to bother me. And that I now need to come to the PACU and sign the chart. I was furious.
That is the attitude of the CRNAs who work there. I have never before or since worked with such malignantly indepedent CRNAs who had such little regard for involving the Anesthesiologists. Your plan? Pfft. Just a suggestion. They were going to do the case they wanted to either way. On one occasion, I walked into the pre-op area where a 90-year-old demented patient with a fractured hip had been incrementally given 80 mg of ketamine so the spinal could be placed. The patient was leaned over frog-legged and moaning in pain with the CRNA struggling for no idea how long. No discussion in advance. Just did it. On another occasion, I went into a room I was directing and a CRNA who wasn't involved in the case was placing an a-line in the middle of the case for some reason I could not ascertain. No discussion. Just did it.
The group of CAA anesthesiologists was responsible for allowing and fostering this clinical practice environment. Period.
The practice had also allowed the hospital to post metrics and publicly shame the Anesthesiologists for case delays. In one instance, a surgeon who was notoriously late (and who would threaten to take his cases elsewhere when pointed out to him) would always shift whatever blame back to the anesthesia team unfortunate enough to be assigned to his room. The solution to placate this guy was to look at the Anesthesia service as the root cause of his delays. For whatever reason (surgeons late, patient's late, etc), it was Anesthesia's fault. Fine. If that's the way they wanted to play it, okay. But then too publicly post the Anesthesiologists names on the lists case delays. Why? What motivational purpose did that serve other than to public shame them for factors beyond their control? That's but one example how toxic that place was.
They also covered procedurally the ICU with the doc on call. If OB was busy, you would have to try to attend to that while the offsite Intensivist may call you to place a central line or intubate a patient. Call was frequent and brutal, especially in Johnston-Willis which is a very horizontally spread hospital. And a disproportionate amount of call fell on the non-partners.
I could go on and on. I was never privy to the inner workings of that place. I did hear a lot of water cooler talk about how unhappy but trapped a lot of the doctors were. That place had a lot of turnover for a lot of reasons. That should tell you everything you need to know. The Richmond scene may be very tough to make it work, but I think a lot of the problem with CAA was a bunch of top-heavy fat cats who thought they knew more about the Anesthesia business than they did/do. They were trying to be something they were not instead of being fair and equitable. They treated their doctors like employees and not partners - and that was obvious.
You just cannot sustain a practice model where the doctors feel taken advantage of and disenfranchised with what's going on. I got out quickly because I could. I feel sorry for those who were trapped. And now it sounds like they're going to be scrambling. Sad.
.
