here's the latest garbage i'm dealing with

[2Fast2Des]

I've peed once, into the plastic saline bottles that we use for emptying the patient's Foley.

12 hour case, middle of the night. I wear large legged scrubs for a reason.

12 hrs ... And no one to break you? I would have pushed some roc and snuck out the door to take a whiz if it came down to that.

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[emergentmd]

You guys are following the EM Track. You/EM do not own pts or bring any extra business in.

CMGs/Hospitals will take over with small pockets of SDG regardless of how well you are liked by specialist/give good care.
They will come in, screw everything up, cost hospital more money but its a small amount and they don' t care. They want control and will never admit it was a mistake.
Once they figure out the shortage of Anesthesiologist, CMG/HCA will open a buttload of residencies, flood the market, and drive down prices.

This is the time to make your money, pay off debt, invest in passive income streams so you can leave the Pits on your own terms.

EM still make 250/hr but it is a much harder job and not in the best places. This is what you guys will be left with in 5-10 yrs.

 

[periopdoc]

12 hrs ... And no one to break you? I would have pushed some roc and snuck out the door to take a whiz if it came down to that.

That was probably my first year of practice. At the time, we had 15 docs total. We've grown a lot since then. We are very good about checking on the guys that are still in the OR before we leave for the night, but once every one else has gone home, we are on our own. There is a backup call available, but I'm certainly not calling him in to give me a bathroom break.

Now, about the only long night cases are Cardiac, and we can just leave while on pump.

These days, I would probably just paralyze, and give the circulator a stick of phenylephrine, so I could step out.

 

[2Fast2Des]

That was probably my first year of practice. At the time, we had 15 docs total. We've grown a lot since then. We are very good about checking on the guys that are still in the OR before we leave for the night, but once every one else has gone home, we are on our own. There is a backup call available, but I'm certainly not calling him in to give me a bathroom break.

Now, about the only long night cases are Cardiac, and we can just leave while on pump.

These days, I would probably just paralyze, and give the circulator a stick of phenylephrine, so I could step out.

The problem with the OR nurses I've worked with is they have ZERO clinical skills. Asking them to assist in any drug administration or drawing up meds is tantamount to rocket science and easier to do things myself than watch them flounder. Would love to have OR nurses I can trust for at least a couple minutes if I needed to step out like that.

 

[MirrorTodd]

I feel like stepping out of the room during an active case is worse than just peeing into a bottle.

 

[Dr. Rude]

I feel like stepping out of the room during an active case is worse than just peeing into a bottle.

Compromise: You can pee in the sink just outside the OR. That way you are available in seconds.

 

[MirrorTodd]

Compromise: You can pee in the sink just outside the OR. That way you are available in seconds.

That way you can look in the window too, just like when they run the O-arm!

 

[IMGASMD]

Compromise: You can pee in the sink just outside the OR. That way you are available in seconds.

Must say. Definitely have considered this.

 

[gasdoc77]

I've peed once, into the plastic saline bottles that we use for emptying the patient's Foley.

12 hour case, middle of the night. I wear large legged scrubs for a reason.

I too have had a urine bottle at the end of a case where the patient had no foley🤔

 

[VolatileAgent]

i have 3 job offers elsewhere already. we are having a come-to-jesus meeting with administration next week. they play ball with us, or they are ****ed.

 

[chessknt]

i have 3 job offers elsewhere already. we are having a come-to-jesus meeting with administration next week. they play ball with us, or they are ****ed.

They aren't going to be ****ed as I mentioned above. Their way or the highway, these people will not ever cave but if they do please do share your delicious victory so we can vicariously savor it as well.

 

[ERRES2288]

They aren't going to be ****ed as I mentioned above. Their way or the highway, these people will not ever cave but if they do please do share your delicious victory so we can vicariously savor it as well.

They may cave by offering more money but yes the private practice gig is over

 

[secretasianman]

They will put “overhauled entire anesthesia service line to improve efficiency” onto their CV and get a raise in their next job.

 

[ambiturner]

i have 3 job offers elsewhere already. we are having a come-to-jesus meeting with administration next week. they play ball with us, or they are ****ed.

A quote I like from Simone’s maxims, granted about academics but true in this instance too:

“Whether to engage in battle depends on the stakes. It is best to enter a battle with overwhelming superiority in arms and ammunition, but for a uniquely important issue, one must be willing to put the job on the line, not as an idle threat or bluff, but in one’s heart. If you would never leave and they know it, they have you by the gonads. Employees, and faculty are employees, have only one trump card after all is said and done: resignation with dignity on one’s own terms.”

 

[aneftp]

You guys are following the EM Track. You/EM do not own pts or bring any extra business in.

CMGs/Hospitals will take over with small pockets of SDG regardless of how well you are liked by specialist/give good care.
They will come in, screw everything up, cost hospital more money but its a small amount and they don' t care. They want control and will never admit it was a mistake.
Once they figure out the shortage of Anesthesiologist, CMG/HCA will open a buttload of residencies, flood the market, and drive down prices.

This is the time to make your money, pay off debt, invest in passive income streams so you can leave the Pits on your own terms.

EM still make 250/hr but it is a much harder job and not in the best places. This is what you guys will be left with in 5-10 yrs.

The shortage of “anesthesia” is due to crnas driving up prices.

I have said all along when the “average CRNA salary was 160k-170k W2 and the average MD salary was 370k”. The AANA claimed docs made twice as much.

But when you add back after hours working and overnights and weekends. All that all back to the crna’s differential pay they normally would get. The CRNA salary for similar doc hours would be close to 300k.

And that’s what locums crna’s are pulling east. Many doing 400k. So locums MDs are pulling 600k easy without nights and weekends. 800k-1 million for those who hustle.

Do you really think the crna’s will take a pay cut? We got crna’s getting paid just about $200/hr to cover weekends. And we can barely get CRNA coverage on the weekends at that rate.

The locums docs make $300/hr. But they do it cause it’s 24 hours continuous pay.

 

[Status Sciaticus]

Is this from experience? Has anyone actually ever relieved themselves in the OR?

heard of a resident in a midwest residency program who peed into a sharps container and got fired. May be urban legend but I thought I saw a thread about it here

 

[Gern Blansten]

heard of a resident in a midwest residency program who peed into a sharps container and got fired. May be urban legend but I thought I saw a thread about it here

 

[nimbus]

Yup, I know a few practices which would normally be considered desirable who have docs picking up the empty weekend and late crna shifts that once had a crna in them. With a market where an entire segment refuses to work any off hours it just creates huge vacuums to drive up locums rates.

CRNAs doing late shifts and weekend shifts contributed to our current CRNA mess. It’s about time doctors filled those shifts

 

[nimbus]

The only issue is that this puts an undue burden on physicians to do elective stuff on the weekends. Should anesthesiologists groups be expected to have several people on call every weekend so they can do the work for every surgical service? There’s neuro surgeons, orthos, general, ENT, OBGYN all wanting to do semi elective or non urgent stuff over the weekend.

Is it really a tenable situation to expect 4 MDs to take anesthesia call for Saturday cases vs 3 CRNAs (who didn’t work 5 days that week like the MD) and 1 MD?

Anything is possible if the price is right, but you’re really stretching groups thin by doing that sort of thing.

Yeah we have 4+heart call every Saturday and 3+ heart call every Sunday. MD only. But we’re a pretty big group so it adds up to 1 weekend per month for noncardiac people. For cardiac people it’s 2weekends per month. But one of the weekends is heart call where you’re rarely called in.

 

[Status Sciaticus]

CRNAs doing late shifts and weekend shifts contributed to our current CRNA mess. It’s about time doctors filled those shifts

Doesnt this lead to docs filling weekend and late shifts which are undersirable, and thus driving further dissatisfaction and burnout? Why would docs want to largely do the crap shifts and get paid the same they would if they worked the day shift?

 

[nimbus]

Doesnt this lead to docs filling weekend and late shifts which are undersirable, and thus driving further dissatisfaction and burnout? Why would docs want to largely do the crap shifts and get paid the same they would if they worked the day shift?

Because if you don’t need a doctor for cases done during crap shifts, you don’t ever need a doctor, day or night. Doctors can’t just skim the daytime cream, be nowhere to be seen during nights and weekends, and scream “we are essential to safe anesthesia care!”

 

[Status Sciaticus]

Because if you don’t need a doctor for cases done during crap shifts, you don’t ever need a doctor, day or night. Doctors can’t just skim the daytime cream, be nowhere to be seen during nights and weekends, and scream “we are essential to safe anesthesia care!”

No one is saying that. I specifically said if you disproportionately stack docs towards the crap shifts and thin them out during the normal daytime or weekday shifts. You need them 24/7, not just when CRNAs dictate the shifts they dont want to do. thats a pushover-mentality.

 

[nimbus]

That’s a lot of call to take imo for a big group. From what I can remember from previous convos I feel you aren’t paid enough for it. That’s my personal opinion on it of course, but I’m impressed you can recruit well with that kind of call burden every weekend.

The counter to this is that a subspecialist in a large single specialty practice would probably pull in at least a million dollars taking that much call that required them in the hospital potentially for 24 hours. If you’re pulling that much weight for a hospital with 5 people in the pool every Saturday then they really ought to give you a big stipend for that non emergent work. All just my opinion of course, and you are in a fairly desirable metro if I remember right

No one is in house for 24hrs. Our toughest call is actually 2nd call who can be working 17hrs (7a-midnight) on a very busy day…but that is rare. 1st call is split. 7a-5p and 5p-7a. Most nights even 1st night call sleeps midnight-7a.

 

[deleted875186]

That’s a lot of call to take imo for a big group. From what I can remember from previous convos I feel you aren’t paid enough for it. That’s my personal opinion on it of course, but I’m impressed you can recruit well with that kind of call burden every weekend.

The counter to this is that a subspecialist in a large single specialty practice would probably pull in at least a million dollars taking that much call that required them in the hospital potentially for 24 hours. If you’re pulling that much weight for a hospital with 5 people in the pool every Saturday then they really ought to give you a big stipend for that non emergent work. All just my opinion of course, and you are in a fairly desirable metro if I remember right

If the call was terrible then they would be understaffed …. Must be manageable.

 

[nimbus]

That seems pretty fair, but it's still a lot to have 4 people on the hook for a 24 hour period every Saturday. If you don't mind me asking, how big is your group? I know I hate being glued to the pager but I typically work at a stroke rescue center, which means that your odds of getting called are ~50% from what I've seen. That's not even considering OB, which I'm guessing you have a separate call pool for assuming your group does that.

Group is about 300. 22 at our site. We are a stroke center too, but there are a lot of stroke centers in town so ours is not that busy. OB is optional/voluntary, only 6-7 of the 22 cover it. We have 3-4 people from the larger group who voluntarily pick up the bulk of OB days/nights/weekends. After 20+ years of being “hooked”, I guess I’m just used to it.

How frequent is your weekend call?

 

[nimbus]

If the call was terrible then they would be understaffed …. Must be manageable.

Very manageable. Very easy to give away calls if you don’t want them.

 

[Dr. Rude]

Mine in my workplace is pretty much all voluntary. Well compensated so easy to give away. Probably I average 0.75 Friday/Saturday overnights per month so not bad at all for me. If I wanted to crush it money wise I could probably get 2-3 per month

Voluntary mechanisms by which those who want to make more and work more and those who want to work less and make less are critical for group well being.

 

[Dr. Rude]

i have 3 job offers elsewhere already. we are having a come-to-jesus meeting with administration next week. they play ball with us, or they are ****ed.

So, did you come to an agreement? If not, What happens January 1?

 

[Twiggidy]

Voluntary mechanisms by which those who want to make more and work more and those who want to work less and make less are critical for group well being.

Exactly this

 

[med2010]

What ended up happening @VolatileAgent

 

[DirtDocMD]

What ended up happening @VolatileAgent

After turning over 1/2 his 401K to his first wife, and the house, at the age of 45, and then purchasing a $2 million home that his 2nd wife “Just loved!”, purchasing four brand new cars for the kids/new wife/AND himself, sending his 2 children with his first wife to private universities in the Northeast, and agreeing to his younger 2nd wife’s request to send his 2 kids he had with her, to “The best private school in town!”, oh, and buying a really nice boat—- he has decided, after much deliberation, to eat whatever schidt sandwich they offer...

Just kidding (I hope), but who hasn’t seen this scenario over and over....?

 

[sevoflurane]

After turning over 1/2 his 401K to his first wife, and the house, at the age of 45, and then purchasing a $2 million home that his 2nd wife “Just loved!”, purchasing four brand new cars for the kids/new wife/AND himself, sending his 2 children with his first wife to private universities in the Northeast, and agreeing to his younger 2nd wife’s request to send his 2 kids with her to “The best private school in town!”, oh, and buying a really nice boat—- he has decided, after much deliberation, to eat whatever schidt sandwich they offer...

Just kidding (I hope), but who hasn’t seen this scenario over and over....?

I had a partner exactly like this minus the divorce/wife issues. He was pretty funny.
Also had a Tahoe seabreacher submarine.

 

[HemeOncHopeful19]

I had a partner exactly like this minus the divorce/wife issues. He was pretty funny.
Also had a Tahoe seabreacher submarine.

Ok because I can’t be the only one wondering, I looked up the submarine and google says they run around $40k.

I don’t know what I expected but it was more than that tbh. Also, now I kinda want one so I can pretend I’m flying a jet.

 

[Ashers]

Ok because I can’t be the only one wondering, I looked up the submarine and google says they run around $40k.

I don’t know what I expected but it was more than that tbh. Also, now I kinda want one so I can pretend I’m flying a jet.

I need to stop flying first/business class so I can learn how to navigate a boat and get one of these or maybe two. I can't decide between the shark and orca.

Who am I kidding, the closest I get to captaining a boat is stand up paddling.

 

[Dr. Rude]

I need to stop flying first/business class so I can learn how to navigate a boat and get one of these or maybe two. I can't decide between the shark and orca.

Who am I kidding, the closest I get to captaining a boat is stand up paddling.

That’s better than me. The closest I get is deciding how many antiemetics to bring on the cruise.

 

[doctalaughs]

Ok because I can’t be the only one wondering, I looked up the submarine and google says they run around $40k.

I don’t know what I expected but it was more than that tbh. Also, now I kinda want one so I can pretend I’m flying a jet.

They start at 85k. Not that I own one (I don’t even buy cars more than 25k new).

Still less than I would have thought.

 

[dabears505]

They start at 85k. Not that I own one (I don’t even buy cars more than 25k new).

Still less than I would have thought.

You've never gotten a car above 25k?

 

[pgg]

I watched a couple videos of those fish submarine jet things and all I could think was how it was a setup for torpedoing a real boat and decapitating yourself. The cockpit views showed that visibility is complete **** with the water constantly splashing over the canopy.

 

[doctalaughs]

You've never gotten a car above 25k?

Nope, I just don’t value cars or most other shiny toys. I’ll drop that on a single vacation but have no interest in cars.

 

[drmwvr]

heard of a resident in a midwest residency program who peed into a sharps container and got fired. May be urban legend but I thought I saw a thread about it here

Learned this wasn't a head the hard way......

 

[GassYous]

Nope, I just don’t value cars or most other shiny toys. I’ll drop that on a single vacation but have no interest in cars.

Nowadays it's hard to find a car below 25k. I heard average car is pushing 50k

 

[MirrorTodd]

View attachment 364779 Learned this wasn't a head the hard way......

hahaha the grog!

 

[Gasworks]

I watched a couple videos of those fish submarine jet things and all I could think was how it was a setup for torpedoing a real boat and decapitating yourself. The cockpit views showed that visibility is complete **** with the water constantly splashing over the canopy.

Yeah you’d have to take it offshore away from any other type of craft to really enjoy it.. probably fun to rent for an hour at most. I’d rather put the cash into a couple of high end seadoos.. way more fun and at least 1% less deadly.

 

[HemeOncHopeful19]

Yeah you’d have to take it offshore away from any other type of craft to really enjoy it.. probably fun to rent for an hour at most. I’d rather put the cash into a couple of high end seadoos.. way more fun and at least 1% less deadly.

But what I need to know is can you pilot a seadoo from an enclosed cockpit while blasting Kenny Loggins?

 

[Twiggidy]

Nowadays it's hard to find a car below 25k. I heard average car is pushing 50k

This person either lives somewhere with good public transportation, is bike friendly, or I’m skeptical

 

[pgg]

This person either lives somewhere with good public transportation, is bike friendly, or I’m skeptical

I love people who buy or lease new cars.

If they didn't exist I wouldn't be able to buy perfectly good slightly used cars at a discount.

 

[nimbus]

A new Nissan Sentra which can be had for about $25k is a lot better than a Nissan Sentra of 10-15 yrs ago.

 

[Twiggidy]

I love people who buy or lease new cars.

If they didn't exist I wouldn't be able to buy perfectly good slightly used cars at a discount.

I’ve just been seduced by German reliability, even if it means expensive servicing. When my socialist state (if I’m still here) requires everyone to be electric I’ll still probably go with the guy’s saying gluten tag versus the guy who too busy playing with his Twitter toy

 

[Justice4all]

Toyota sedans can be purchased under 25k and slight used hybrid version is possible under that price.

 

[Iso4ane]

I’ve just been seduced by German reliability, even if it means expensive servicing. When my socialist state (if I’m still here) requires everyone to be electric I’ll still probably go with the guy’s saying gluten tag versus the guy who too busy playing with his Twitter toy

Question: Is the new Supra German or Japanese?