here's the latest garbage i'm dealing with

[ERRES2288]

Hospital administrators know absolutely nothing about the business of anesthesia. Theyll pay heavily for this mistake. They'll have even worse staffing issues and pay more for less. The CEO might not get fired but someone will take the fall. Someone will get blamed for it.

Our group went from private practice to hospital employees in 2014. The salaries were similar to how much we were making and they offered better benefits (403b, 457, and traditional pension). At the time there wasn't any buyout. We were struggling to hire CRNAs and likely would have folded the group. we asked the hospital to take us as employees. we couldn't compete with the other anesthesia group who had a large stipend from their hospital and the group didn't pay crna salaries (the crnas were employed by the hospital).

As employees it was less stressful. we managed our own call schedules. We were always understaffed from 2014 to pandemic but we didn't stay any longer than 40 hours per week. we closed down sites as the day progressed so we can get staff home. Surgeons and Administrators werent happy and asked us to run more cases without adequate staff.

In 2022, hospital administration surprised us by transitioning all their anesthesia to NAPA. The reasoning was to streamline anesthesia and better recruiting. They wanted a single entity delivering anesthesia in all 17 hospital locations. No input from any of their anesthesia employees.

The transition was utter failure. Multiple C suite administrators resigned or forced to resign. Every anesthesia site had to decrease and only offered on certain days of the week. The hospital I was at lost 50% of their docs and >60% CRNA staff right away. Another satellite hospital lost all their staff. NAPA/hospital admin were so scared of losing everyone that the remaining anesthesia staff wrote their own contracts. negotiated 20% more salary (>600k/year), every single call is voluntary and pays >300/hr, post call day off, 6 figure sign on bonus.

Then a continuous trickle of people continued to leave once the stress and burn out began. The locums they brought in did only day shift work (we are a tertiary center and flag ship hospital. anyone taking call needs to comfortable doing hearts) and were paid even more than our current staff. The people we lost went to do locums work full time.

When this happened I went through all 5 stages of grief in early 2022. But it was such a blessing in disguise. Hospital administrators had no idea the current market and were under paying us. Every one of us are doing better financially whether they stayed on with NAPA or went elsewhere.

And yet administrators continue to force groups out and consolidate to these major AMCs

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[MirrorTodd]

In situations such as this, how much contact could one have with the REALLY higher up people to warn them of the fallout? Like "Hey C-suite, your admin person is really trying to **** over our anesthesia group. Here are all the reasons why that's a bad idea?" Would something like that even work?

 

[chessknt]

If a group is happy, leave them alone. Especially in this market. Anyone that threatens this balance will lose their shirt. I bet the CEO will get removed by the board of directors.

I'll bet he doesn't. It would be nice if we lived in a world where people actually took responsibility for their mistakes but instead we live in America.

 

[ambiturner]

In situations such as this, how much contact could one have with the REALLY higher up people to warn them of the fallout? Like "Hey C-suite, your admin person is really trying to **** over our anesthesia group. Here are all the reasons why that's a bad idea?" Would something like that even work?

It is a rare C-suite that values independent groups, no matter how efficient. From their perspective it’s easier to employ physicians and use them at a loss to support ‘key service lines’ that rip off Medicare for little actual QOL value and generate millions. Losing some money on anesthesia is small potatoes when you’re expanding a multimillion dollar heart center, starting an interventional pulm/GI/whatever program, etc. They’re not wrong that the total revenue of the hospital will grow by doing this, and size is the only thing that will let them survive - you’ll be doing anesthesia either way, but if the hospital get absorbed the whole c-suite gets wiped out and will lose their bloated salaries.

This guy’s resume will say something like ‘oversaw successful integration of anesthesia group with $25 million in revenue’. He will leave within 2 years before the $25 million in revenue is costing $35 million where it used to cost a $1-2 million subsidy to the private group.

 

[aneftp]

Hospital administrators know absolutely nothing about the business of anesthesia. Theyll pay heavily for this mistake. They'll have even worse staffing issues and pay more for less. The CEO might not get fired but someone will take the fall. Someone will get blamed for it.

Our group went from private practice to hospital employees in 2014. The salaries were similar to how much we were making and they offered better benefits (403b, 457, and traditional pension). At the time there wasn't any buyout. We were struggling to hire CRNAs and likely would have folded the group. we asked the hospital to take us as employees. we couldn't compete with the other anesthesia group who had a large stipend from their hospital and the group didn't pay crna salaries (the crnas were employed by the hospital).

As employees it was less stressful. we managed our own call schedules. We were always understaffed from 2014 to pandemic but we didn't stay any longer than 40 hours per week. we closed down sites as the day progressed so we can get staff home. Surgeons and Administrators werent happy and asked us to run more cases without adequate staff.

In 2022, hospital administration surprised us by transitioning all their anesthesia to NAPA. The reasoning was to streamline anesthesia and better recruiting. They wanted a single entity delivering anesthesia in all 17 hospital locations. No input from any of their anesthesia employees.

The transition was utter failure. Multiple C suite administrators resigned or forced to resign. Every anesthesia site had to decrease and only offered on certain days of the week. The hospital I was at lost 50% of their docs and >60% CRNA staff right away. Another satellite hospital lost all their staff. NAPA/hospital admin were so scared of losing everyone that the remaining anesthesia staff wrote their own contracts. negotiated 20% more salary (>600k/year), every single call is voluntary and pays >300/hr, post call day off, 6 figure sign on bonus.

Then a continuous trickle of people continued to leave once the stress and burn out began. The locums they brought in did only day shift work (we are a tertiary center and flag ship hospital. anyone taking call needs to comfortable doing hearts) and were paid even more than our current staff. The people we lost went to do locums work full time.

When this happened I went through all 5 stages of grief in early 2022. But it was such a blessing in disguise. Hospital administrators had no idea the current market and were under paying us. Every one of us are doing better financially whether they stayed on with NAPA or went elsewhere.

Seems like a northeast hospital my bff does locums.

It becomes a symbiotic relationship between full time Napa w2 docs and locums docs. They work with each other and both maximize their work hours/pay/overtime to the benefit of each other. While the hospital bleeds money.

Make no mistake. Napa is not footing the bill. Napa strong arms the hospital admin. The hospital is paying for the locums and even full time w2 Napa doc overtime.

Milk it while it’s good. Don’t feel bad. Hospitals are still making a ton of money.

 

[Dr. Rude]

Seems like a northeast hospital my bff does locums.

It becomes a symbiotic relationship between full time Napa w2 docs and locums docs. They work with each other and both maximize their work hours/pay/overtime to the benefit of each other. While the hospital bleeds money.

Make no mistake. Napa is not footing the bill. Napa strong arms the hospital admin. The hospital is paying for the locums and even full time w2 Napa doc overtime.

Milk it while it’s good. Don’t feel bad. Hospitals are still making a ton of money.

Agree with all except the part about hospitals making money. Many are bleeding. I don’t weep.
They put the screws to the docs and nurses whenever they could for years. They taught some of us well.

 

[chessknt]

Agree with all except the part about hospitals making money. Many are bleeding. I don’t weep.
They put the screws to the docs and nurses whenever they could for years. They taught some of us well.

The thing is they can afford to wait us out. There is a never ending line behind us laden with debt willing to work even at their rock bottom prices. They can just shuffle money around, post bonds, get a bailout or subsidy etc while they bleed on locums until they ultimately win. once they win enough they get the mgma data to drive salaries down then suddenly it is a stark violation to pay fair market value. The game is rigged, they have literally all the cards and can't lose.

 

[Dr. Anonymouss]

The thing is they can afford to wait us out. There is a never ending line behind us laden with debt willing to work even at their rock bottom prices. They can just shuffle money around, post bonds, get a bailout or subsidy etc while they bleed on locums until they ultimately win. once they win enough they get the mgma data to drive salaries down then suddenly it is a stark violation to pay fair market value. The game is rigged, they have literally all the cards and can't lose.

But this doesn't make sense with the way the market is right now. Why would any new residency grad settle for below market value compensation? There are plenty of jobs out there that are paying well above.

 

[abolt18]

But this doesn't make sense with the way the market is right now. Why would any new residency grad settle for below market value compensation? There are plenty of jobs out there that are paying well above.

Except that lots of new grads don't do a lot of shopping around, so they don't know their value.

 

[aneftp]

Exactly, chessknt is mistaken about the desperation of new graduates. They only take jobs where they think they’re getting a great deal, only to find out 4 months later that if they’d looked a bit harder they’d make 50% more with better QOL.

It’s just big groups or academics preying on the rookies. If the word gets out though (imagine if private docs did lectures at their old residency on what’s true market value for anesthesiologists lolll) that model will crumble

I’m not sure about that. New grads want lifestyle at 40 hours a week no calls or weekends and willing to take a pay hit. or want to make 700k and up and working 65-70 hours a week.

That 500-600k range for salary at 55/60 hours q 4/5 call isn’t gonna to attract most new grads in my opinion.

They want to be beeper call with rare call back for that money. Not in house. And no post call beeper work.

Or they want to work 40-45 hours and very little calls or weekend commitment if they dont owe a lot

That in between job is the hardest to fill.

 

[Status Sciaticus]

I’m not sure about that. New grads want lifestyle at 40 hours a week no calls or weekends and willing to take a pay hit. or want to make 700k and up and working 65-70 hours a week.

That 500-600k range for salary at 55/60 hours q 4/5 call isn’t gonna to attract most new grads in my opinion.

They want to be beeper call with rare call back for that money. Not in house. And no post call beeper work.

Or they want to work 40-45 hours and very little calls or weekend commitment if they dont owe a lot

That in between job is the hardest to fill.

If that in-between job is hard to fill, then either the job requirements are too high or the pay is too low.
The 500k-600k job you're mentioning is really 400k if you don't account for the inflation thats occurred over the last 1.5 years.

 

[dabears505]

Man where are these jobs 650 - 700 for 60 hrs?

 

[Dr. Rude]

Man where are these jobs 650 - 700 for 60 hrs?

Places most new grads don't want to live.

 

[cchoukal]

What do you think a fair hourly rate is for an anesthesiologist who inevitably works some at night is?

650000/46 weeks/60 hours is 235$/hour. I think most people would consider that fair compensation, not super high, not super low. If you’re not getting that you’re getting hosed imo

That all sounds fine, but where will this money come from? Assuming the typical 1000 units/month of the typical solo MD practice, you'd have to have a blended unit of $55 before overhead and benefits. Or does the hospital have to backstop this with subsidies?

 

[Dr. Anonymouss]

Except that lots of new grads don't do a lot of shopping around, so they don't know their value.

That’s sad

 

[Dr. Anonymouss]

Exactly, chessknt is mistaken about the desperation of new graduates. They only take jobs where they think they’re getting a great deal, only to find out 4 months later that if they’d looked a bit harder they’d make 50% more with better QOL.

It’s just big groups or academics preying on the rookies. If the word gets out though (imagine if private docs did lectures at their old residency on what’s true market value for anesthesiologists lolll) that model will crumble

This is the education I need and quite frankly wish was available to us who go through the process. I don’t know my worth and what is truly out there, but based on MGMA data if I was lookin for jobs right now I’d be using 469k as a baseline reference and hoping to be above that number when the negotiating is all said and done.

Reference - Offerdx – Physician Salaries (MGMA, AMGA, and more)

 

[pocafx]

Man where are these jobs 650 - 700 for 60 hrs?

Indiana

 

[aneftp]

I’ve made this point ad nauseum that we as a profession need to stop thinking in terms of billing and units and start holding hospitals feet to the fire to “subsidize” (pay what we’re worth) anesthesia services.

The global billing fees and facility fees scale with inflation. Physician fee schedules don’t. This is by design with the ACA, it is meant to simplify insurance and reimbursement by giving a hospital a big sum to divvy up between the physicians and overhead and keep some profit for themselves, and force private groups to integrate into the health systems.

Big referral centers are massively profitable. Stories you hear of hospitals closing are empty hospitals that aren’t doing enough procedures or taking care of enough people. It’s sad for rural areas but it’s by design in the ACA, otherwise the government would be trying to save these places.

So yes, the hospital will “subsidize” our pay by paying us our fair share of the massive facility fees they collect for their surgeries.

It sacrifices a groups “independence”, but how independent can you really be if every time Medicaid or Medicare announces a cut, there’s mass panic about declining reimbursement? Independent? I’d say these groups are wholly dependent on the good will of CMS and insurance companies.

Agree. At trauma centers. A level 2 trauma nets a hospital $10-20k per trauma subsidy “activation”
Most general public do not know this. I know this for a fact.

Assuming most have insurance these days. Hospitals get insurance money plus the trauma subsidy.


“The bill was extraordinary. Sutter Health Memorial Medical Center charged $44,914 including an $8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists and usually associated with the most severely injured patients.” And that was a minor trauma alert for Sutter

This is California where the trauma alert is lower. But in my part of the south. Trauma alert starts at 10k.

Trauma one can activate a 30k or even a 40k fee.

And you as anesthesia feel sorry for the hospital? Hospitals are getting those trauma alert fees. And you feel sorry you are ripping them off at $250/hr for night trauma calls?

 

[nimbus]

Agree. At trauma centers. A level 2 trauma nets a hospital $10-20k per trauma subsidy “activation”
Most general public do not know this. I know this for a fact.

Assuming most have insurance these days. Hospitals get insurance money plus the trauma subsidy.


“The bill was extraordinary. Sutter Health Memorial Medical Center charged $44,914 including an $8,928 “trauma alert” fee, billed for summoning the hospital’s top surgical specialists and usually associated with the most severely injured patients.” And that was a minor trauma alert for Sutter

This is California where the trauma alert is lower. But in my part of the south. Trauma alert starts at 10k.

Trauma one can activate a 30k or even a 40k fee.

And you as anesthesia feel sorry for the hospital? Hospitals are getting those trauma alert fees. And you feel sorry you are ripping them off at $250/hr for night trauma calls?

The other part of this is that the vast majority of trauma activations are minor, eg old person on blood thinners falls and bumps their head. They all get pan scanned when they arrive. We used to number ours and would consider it a good year if we get over 3500.

 

[chessknt]

Except that lots of new grads don't do a lot of shopping around, so they don't know their value.

And they are being mass produced a-la HCA style residencies. You might not take less than 400/hr and just not work for a while until you can get that rate but the new grad will take that 200/hr job no problem and be happy about it especially if they dont have to move.

 

[sbmed100]

New grads I know mostly bounce around in academics for a year or two where they’re obviously getting fleeced. Others land at AMCs where they are waiting 3+ years for partner. They make 550-600 in the AMC jobs but they work 55+ hours for it with a lot of call most of the time.

These days if you’re working calls where you’re regularly up at night and normal days are past 5pm, you should be making at least 650 imo. More like 700-750 if subspecialist peds or cardiac.

Instead they take salaries on partner tracks that crush their souls. It’s kinda sad to see the disillusionment

Wow...55 hours...while working a week! The humanity. Really, really can't wait for this recession and mindset reset. Backup plan is to nominate Elon to the ASA.

 

[Coffee PRN]

And they are being mass produced a-la HCA style residencies. You might not take less than 400/hr and just not work for a while until you can get that rate but the new grad will take that 200/hr job no problem and be happy about it especially if they dont have to move.

I disagree. Residency spots are increasing but not at a fast enough rate to cover retirements+increased procedural volume from the largest segment of the population aging. The number of anesthesia residency spots is public knowledge. This isn't EM.

I think residents these days also tend to be more financially savvy with WSI being a resource and concepts like FIRE being widespread in the media. Most of my colleagues are very thorough comparing multiple jobs and choosing the best one.

 

[chessknt]

I disagree. Residency spots are increasing but not at a fast enough rate to cover retirements+increased procedural volume from the largest segment of the population aging. The number of anesthesia residency spots is public knowledge. This isn't EM.

I think residents these days also tend to be more financially savvy with WSI being a resource and concepts like FIRE being widespread in the media. Most of my colleagues are very thorough comparing multiple jobs and choosing the best one.

You're on sdn, I'm betting your colleagues aren't bottom barrel HCA churn and burn trainees.

 

[sbmed100]

What do you feel is a fair hourly rate for in house work as an anesthesiologist? What’s your time worth to you?

Nah, not taking the bait. You want hourly? Become a CRNA. The shift/hourly mentality is degrading us...take it from the front, literally the front of the front lines. Daily battle. Your predecessors worked their asses off to establish a rep and maybe they made bank but they were working 70 hours a week and answered calls/emails/came in off call at all hours. You're working far less and demonstrating how replaceable you are by leaving with 20 minutes to go to the case and then making a stink when the CRNAs say they provide equivalent care.

 

[vector2]

Wow...55 hours...while working a week! The humanity. Really, really can't wait for this recession and mindset reset. Backup plan is to nominate Elon to the ASA.

What makes you think a mindset reset is coming? My bet is it doesn't disappear even after inflation/a recession are done.


Also, 55 hrs a week, week after week, sucks big time. 7a - 6p in the OR five days a week (+call) is a recipe for burnout.

 

[chessknt]

Nah, not taking the bait. You want hourly? Become a CRNA. The shift/hourly mentality is degrading us...take it from the front, literally the front of the front lines. Daily battle. Your predecessors worked their asses off to establish a rep and maybe they made bank but they were working 70 hours a week and answered calls/emails/came in off call at all hours. You're working far less and demonstrating how replaceable you are by leaving with 20 minutes to go to the case and then making a stink when the CRNAs say they provide equivalent care.

Ah but then they sold it at enormous profit and now that incentive is gone because now all that hard work pads someone else's pocket

 

[sbmed100]

Ah but then they sold it at enormous profit and now that incentive is gone because now all that hard work pads someone else's pocket

Many shops around me still have a profit sharing component. Don't neglect the fact that new grads make a full 300% more than their predecessors just 12 years ago. Oh...did you not know that?

 

[sbmed100]

What makes you think a mindset reset is coming? My bet is it doesn't disappear even after inflation/a recession are done.


Also, 55 hrs a week, week after week, sucks big time. 7a - 6p in the OR five days a week (+call) is a recipe for burnout.

This is for a call gig. You're not prime time for 55 hours a week.

 

[sbmed100]

Ok, then what’s a fair blended unit value to you? You do believe that we should be paid for the work we do, right?

If you do, then the question is how much? You are welcome to live in the past of squeezing every last unit out on a GI day and sending your defenseless, lawyerless patients to collections to ruin their credit, but I don’t see things that way personally. Let the hospital do the dirty work I say.

My predecessors also sold out our entire field to AMCs, showing them to be the most short sighted, greediest doctors of any specialty, so spare me the “respect for elders” and “back in my day” Schlick.

The hospital wants to start a new cardiac surgery program. You and your peers have to figure it out, go to a bunch of meetings/hospital promotional events/come up with new protocols/recruit, credential, onboard and vet cardiac anesthesiologists AND make sure they get along with who the hospital has hired as their cardiac surgeons. What is the fair blended unit value for all this the time and effort? Who takes the fall if it fails?

 

[chessknt]

Many shops around me still have a profit sharing component. Don't neglect the fact that new grads make a full 300% more than their predecessors just 12 years ago. Oh...did you not know that?

Because they will never get the 7+ figure payouts you got. I'm sure you wouldn't trade places to be in their shoes either.

 

[nimbus]

The hospital wants to start a new cardiac surgery program. You and your peers have to figure it out, go to a bunch of meetings/hospital promotional events/come up with new protocols/recruit, credential, onboard and vet cardiac anesthesiologists AND make sure they get along with who the hospital has hired as their cardiac surgeons. What is the fair blended unit value for all this the time and effort? Who takes the fall if it fails?

I don’t understand the point of this post. Every generation of anesthesiologists has always done this and every generation going forward will continue to do this. It’s been going on for 100yrs and will continue for the next hundred years. The newest anesthesiologists should take the best deal they can get. They don’t owe the older generation anything.

Speaking as a member of the older generation, I agree many of my peers were sellouts and created a mess of the specialty.

 

[kidthor]

Personally I think our value is similar that to of a big law firm partner. That’s essentially the level of service and expertise the hospitals are getting from us. The national average partner billing rate is $728/hr and for an associate it’s $535/hr. Also I guarantee you we are worth far more than a law firm associate.

Plus if you want your lawyer to dance at a moment’s notice at midnight on Saturday, that’ll be extra.

By the way, this is how much the hospitals pay the lawyers per hour when they hire outside counsel. Probably similar for when they hire consultants to make graphs and PowerPoints.

So that’s the answer - we are worth in the ballpark of $728/hr plus extra for off hours work.

 

[sbmed100]

I don’t understand the point of this post. Every generation of anesthesiologists has always done this and every generation going forward will continue to do this. It’s been going on for 100yrs and will continue for the next hundred years. The newest anesthesiologists should take the best deal they can get. They don’t owe the older generation anything.

Speaking as a member of the older generation, I agree many of my peers were sellouts and created a mess of the specialty.

The point of this post is that it’s not just showing up to work and clocking in and out. Sitting in an OR is not seen as providing value from a hospital’s perspective. You ARE replaceable. Maybe not so much in the next two years, but trust one thing, the market doesn’t always go up. Also, there is always competition from lower cost “providers.”

 

[nimbus]

Personally I think our value is similar that to of a big law firm partner. That’s essentially the level of service and expertise the hospitals are getting from us. The national average partner billing rate is $728/hr and for an associate it’s $535/hr. Also I guarantee you we are worth far more than a law firm associate.

Plus if you want your lawyer to dance at a moment’s notice at midnight on Saturday, that’ll be extra.

By the way, this is how much the hospitals pay the lawyers per hour when they hire outside counsel. Probably similar for when they hire consultants to make graphs and PowerPoints.

So that’s the answer - we are worth in the ballpark of $728/hr plus extra for off hours work.

Big law partners become partners by drawing clients/business. They’re more like cardiologists and spine surgeons.

 

[nimbus]

The point of this post is that it’s not just showing up to work and clocking in and out. Sitting in an OR is not seen as providing value from a hospital’s perspective. You ARE replaceable. Maybe not so much in the next two years, but trust one thing, the market doesn’t always go up. Also, there is always competition from lower cost “providers.”

Agree 100%. We are all replaceable and sitting on committees and supporting new service lines does not make us any less replaceable. I’ve seen many “irreplaceable” surgeons, anesthesiologists, oncologists, cardiologists, etc, etc get replaced and essentially forgotten in a matter of months. It just depends on luck and current labor supply/demand balance. If you enjoy meetings, go for it. But it won’t prevent you from being replaced when market conditions change. If you want to clock in, clock out, and sit on a stool all day, that’s fine too. You have as much job security as everybody else.

 

[anaesthetic]

The point of this post is that it’s not just showing up to work and clocking in and out. Sitting in an OR is not seen as providing value from a hospital’s perspective. You ARE replaceable. Maybe not so much in the next two years, but trust one thing, the market doesn’t always go up. Also, there is always competition from lower cost “providers.”

Everything comes at a cost. I’ve known partners who went to the meetings and built up their cardiac surgery programs or transplant programs “from the ground up” and entrenched themselves in the hospital systems… only to realize they don’t know who their kids are and vice versa.

You’re asking the newer generation of anesthesiologists to make the same sacrifices “for the sake of the practice” or for the sake of the specialty, and most of us will say “no thanks.”

I didn’t sell out this specialty. You did.

 

[kidthor]

Everything comes at a cost. I’ve known partners who went to the meetings and built up their cardiac surgery programs or transplant programs “from the ground up” and entrenched themselves in the hospital systems… only to realize they don’t know who their kids are and vice versa.

You’re asking the newer generation of anesthesiologists to make the same sacrifices “for the sake of the practice” or for the sake of the specialty, and most of us will say “no thanks.”

I didn’t sell out this specialty. You did.

Yeah - I spent a good five years hustling and going to hospital committee meetings for free because I thought it would be good for the department and good for my career. But ultimately it gave me nothing and gave the hospital free work which they’ve now completely forgotten. Unfortunately and sadly nobody really cares. If they cared then you’d get paid did it. All the administrators get paid to go to meetings by the way.

 

[Hoya11]

Everything comes at a cost. I’ve known partners who went to the meetings and built up their cardiac surgery programs or transplant programs “from the ground up” and entrenched themselves in the hospital systems… only to realize they don’t know who their kids are and vice versa.

You’re asking the newer generation of anesthesiologists to make the same sacrifices “for the sake of the practice” or for the sake of the specialty, and most of us will say “no thanks.”

I didn’t sell out this specialty. You did.

This discussion sounds like a rent vs buy argument.

With all the changes in healthcare right now in most markets across the country , I think the current generation of new grads are in the renting mentality. They don’t want to own any of this mess until it settles down.

I chose a “buy” job . Meetings , group politics , undefined hours and long calls, initially partner track compensation. And though it worked out for me by sheer luck, there is a lot of risk to your hours and income and significant downside to “buying” if your place leaks.

On the other hand , I have seen new docs compare job offers in vastly different parts of the country with completely different cultures and schools and weather, and make a decision based on 20k to move their family to a culture-less tundra . Some people just make very poor life decisions being smart folks

 

[gasdoc77]

Nah, not taking the bait. You want hourly? Become a CRNA. The shift/hourly mentality is degrading us...take it from the front, literally the front of the front lines. Daily battle. Your predecessors worked their asses off to establish a rep and maybe they made bank but they were working 70 hours a week and answered calls/emails/came in off call at all hours. You're working far less and demonstrating how replaceable you are by leaving with 20 minutes to go to the case and then making a stink when the CRNAs say they provide equivalent care.

....the culture that hospital administrators and AMC admin will push at every turn in an effort to capitalize on the sense of duty of physicians, meanwhile they "network" on golf courses. "Physicians are bad with money" LOL

 

[MirrorTodd]

I have not met a single physician who will leave a case with 20 minutes to go. I'm sure they are out there, but I have most definitely not met them.

 

[Southpaw]

I have not met a single physician who will leave a case with 20 minutes to go. I'm sure they are out there, but I have most definitely not met them.

You’re right. They’re out there. I’ve had physicians want to sign cases out to me knowing the patient is emerging from anesthesia.

 

[dabears505]

I have not met a single physician who will leave a case with 20 minutes to go. I'm sure they are out there, but I have most definitely not met them.

20 minutes? Come on man. That's a bit excessive. Like coughing on the tube is one thing, but 20 minutes is excessive for a straight forward case.

 

[LaryngoSpazz]

I have not met a single physician who will leave a case with 20 minutes to go. I'm sure they are out there, but I have most definitely not met them.

You must not give lunch breaks to fellow physicians then. Almost impossible to do it efficiently if you don’t start or finish cases for people.

 

[ERRES2288]

If I’ve been there 12 hours on a weekend and night person shows up with a healthy gallbladder going with 20 min left you better believe I’m outta there

 

[Gern Blansten]

If I’ve been there 12 hours on a weekend and night person shows up with a healthy gallbladder going with 20 min left you better believe I’m outta there

Yeah. A bit of context counts.

 

[MirrorTodd]

You must not give lunch breaks to fellow physicians then. Almost impossible to do it efficiently if you don’t start or finish cases for people.

That's a little different than peacing out at the end of the day when your case is basically finished...especially if said physicians are being paid hourly.

 

[Coffee PRN]

Yeah I've got no problem taking over to get a colleague home. 20 minutes turns into counts not matching up, waiting for x ray, PACU hold, ICU transfer, etc. I'm going to be there anyways, why not make someone happy and get them home early?

 

[nimbus]

If I’ve been there 12 hours on a weekend and night person shows up with a healthy gallbladder going with 20 min left you better believe I’m outta there

I’ve been in this situation many times and finish my cases. To me it is a matter of both patient safety (fewer handoffs) and professionalism. I’m the one who told my patient that I’d take care of them.

 

[vector2]

I’ve been in this situation many times and finish my cases. To me it is a matter of both patient safety (fewer handoffs) and professionalism

I might stay a little bit later as well if I was picking up an extra blended unit or two. Different story when salaried.

 

[nimbus]

I might stay a little bit later as well if I was picking up an extra blended unit or two. Different story when salaried.

As a rule, I don’t hand off cases even though I do offer relief. It’s just the way I practice. I’ve stayed 5-6 hours after my “relief” comes on duty to finish a case. I also stay late when I’m not on call if my case goes long.

I think this “handoff” culture in anesthesia is one of the reasons why people think we are replaceable space holders. Because we do it all the time and have no personal investment in our patients. Surgeons and nurses certainly notice.