How many FTEs do I need?

[CaliCatheter]

How do groups measure the amount of FTEs required to cover a facility?

If facility gives you the amount of sites required along with times, how can you accurately measure the number of anesthesiologists you would need?

Thank you in advance...

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[Hoya11]

How do groups measure the amount of FTEs required to cover a facility?

If facility gives you the amount of sites required along with times, how can you accurately measure the number of anesthesiologists you would need?

Thank you in advance...

The bigger the facility the more complex it is.

It also depends on the model, eg MD only or 1:3-4 supervision of CRNAs.

You have to consider vacation. Sick call backup. Possibly evening relief if a hospital or late facility.

Here's an example of a BARE MINIMUM model:

Say I have 10 rooms to cover that all start at 730.

I need a CRNA in each room so thats 10 CRNAs DAILY.

I also need 3 MDs DAILY:

2 MDs supervise 3 CRNA rooms each = 6 rooms covered

1 MD supervises the other 4 CRNA rooms.

So every day I've got 3 MDs and 10 CRNAs working. Now we need vacation coverage.

3 MDs get 8 weeks each thats 24 weeks of vacation you need to provide. You need another MD to cover that, now your up to 4 FTE MDs. This MD can also provide some wiggle room for sick call/etc..

10 CRNAs get 6 weeks each thats 60 weeks of vacation you need to provide. So you need 2 more CRNAs to cover those 60 working weeks.

So now you've got 4 MDs and 12 CRNAs covering 10 rooms DAILY.

This is a NO CALL scenario (then you have to start talking about post call days off)

Hope that helps.

 

[Urzuz]

The bigger the facility the more complex it is.

It also depends on the model, eg MD only or 1:3-4 supervision of CRNAs.

You have to consider vacation. Sick call backup. Possibly evening relief if a hospital or late facility.

Here's an example of a BARE MINIMUM model:

Say I have 10 rooms to cover that all start at 730.

I need a CRNA in each room so thats 10 CRNAs DAILY.

I also need 3 MDs DAILY:

2 MDs supervise 3 CRNA rooms each = 6 rooms covered

1 MD supervises the other 4 CRNA rooms.

So every day I've got 3 MDs and 10 CRNAs working. Now we need vacation coverage.

3 MDs get 8 weeks each thats 24 weeks of vacation you need to provide. You need another MD to cover that, now your up to 4 FTE MDs. This MD can also provide some wiggle room for sick call/etc..

10 CRNAs get 6 weeks each thats 60 weeks of vacation you need to provide. So you need 2 more CRNAs to cover those 60 working weeks.

So now you've got 4 MDs and 12 CRNAs covering 10 rooms DAILY.

This is a NO CALL scenario (then you have to start talking about post call days off)

Hope that helps.

Or you could simplify your life (and get more professional satisfaction) by only hiring MDs

 

[BLADEMDA]

The bigger the facility the more complex it is.

It also depends on the model, eg MD only or 1:3-4 supervision of CRNAs.

You have to consider vacation. Sick call backup. Possibly evening relief if a hospital or late facility.

Here's an example of a BARE MINIMUM model:

Say I have 10 rooms to cover that all start at 730.

I need a CRNA in each room so thats 10 CRNAs DAILY.

I also need 3 MDs DAILY:

2 MDs supervise 3 CRNA rooms each = 6 rooms covered

1 MD supervises the other 4 CRNA rooms.

So every day I've got 3 MDs and 10 CRNAs working. Now we need vacation coverage.

3 MDs get 8 weeks each thats 24 weeks of vacation you need to provide. You need another MD to cover that, now your up to 4 FTE MDs. This MD can also provide some wiggle room for sick call/etc..

10 CRNAs get 6 weeks each thats 60 weeks of vacation you need to provide. So you need 2 more CRNAs to cover those 60 working weeks.

So now you've got 4 MDs and 12 CRNAs covering 10 rooms DAILY.

This is a NO CALL scenario (then you have to start talking about post call days off)

Hope that helps.

Now you need to factor in CRNAs/AAs for coverage after 300PM, 500PM, 700Pm, 900Pm, etc plus weekends. Typically you are looking at many more FTEs for after hours coverage besides the physician. Will you need more MD/DOs for on call/post call or weekends?

 

[UscGhost]

No crnas is much better.
Assuming 10 ORs

MD
10 730 am starts
1 vacation
1 post call

12 FTEs...give or take depending on if postcall works or if postcall is always off or postcall is backup

All 10 rotate and take weekend calls..etc

 

[nimbus]

No crnas is much better.
Assuming 10 ORs

MD
10 730 am starts
1 vacation
1 post call

12 FTEs...give or take depending on if postcall works or if postcall is always off or postcall is backup

All 10 rotate and take weekend calls..etc

Also depends on how much vacation everybody wants. But I agree all MD is much simpler and you can staff with the fewest bodies/FTEs.

 

[aneftp]

All MD model is probably the easiest to figure out (but also least profitable). Same can be said for all crna method (to discount the aana propaganda machine). Depends who is actually collecting the billing.

 

[Justice4all]

How much profitable 4:1 to all MD? Just curious

 

[Drwine]

I share making the schedule for 3 sites our group covers so I have mastered the algebra for coverage. Feel free to post or PM me the number of rooms and after hours responsibilities and I will give you a number. Having some CRNAs and AAs allows you the flexibility to better deal with some wobble in staffing requirements. With all of the out of OR demands this has become more common than before. For example, we have GI, TEE/cardioversions, occasional MRI and a large number of structural heart cases that now are a regular responsibility.

 

[anesthesiadoc]

Drwine's point is an excellent one. The off site cases are the surprise attacks that will strain a staffing model. Two concepts that the C suite don't account for are the need for breaks (especially for CRNA's and residents), and the notion that there is no "bench" where extra anesthesiologists materialize out of the ether to run add on off site and OR cases (not to mention floor codes, anesthesia stats in the OR and PACU).

 

[Hoya11]

No crnas is much better.
Assuming 10 ORs

MD
10 730 am starts
1 vacation
1 post call

12 FTEs...give or take depending on if postcall works or if postcall is always off or postcall is backup

All 10 rotate and take weekend calls..etc

Well here you have 12 docs in total and 1 doc on vacation at a time.

That means each doc gets 4 weeks vacation.

In reality each doc gets 8 weeks vacation, times 10 docs per day, is 80 weeks you have to cover. You need 2 more Docs for that.

To simplify lets remove the post call guy and just assume its an ASC.

So you need 12 docs in total in a realistic MD only model of this theoretical 10 room ASC (again a no call scenario unlike above).

12 docs * 500 each is 6 Million in expenses.

4 docs (2 million) and 12 CRNAs (@250k each = 3 Million) = 5 Million in expenses

 

[ValentineD]

Drwine's point is an excellent one. The off site cases are the surprise attacks that will strain a staffing model. Two concepts that the C suite don't account for are the need for breaks (especially for CRNA's and residents), and the notion that there is no "bench" where extra anesthesiologists materialize out of the ether to run add on off site and OR cases (not to mention floor codes, anesthesia stats in the OR and PACU).

Can confirm, staffing model has imploded due to the proliferation of off sites. It evens out though because then you don't have to worry about breaks or lunches.

 

[CaliCatheter]

I share making the schedule for 3 sites our group covers so I have mastered the algebra for coverage. Feel free to post or PM me the number of rooms and after hours responsibilities and I will give you a number. Having some CRNAs and AAs allows you the flexibility to better deal with some wobble in staffing requirements. With all of the out of OR demands this has become more common than before. For example, we have GI, TEE/cardioversions, occasional MRI and a large number of structural heart cases that now are a regular responsibility.

Thank you all for the replies and great info.

Once you have calculated the cost of covering a facility and then calculate the projected collections, would you ask the facility for the difference as a subsidy?

I would assume with less desirable payor mix comes a heftier subsidy.

 

[nimbus]

Well here you have 12 docs in total and 1 doc on vacation at a time.

That means each doc gets 4 weeks vacation.

In reality each doc gets 8 weeks vacation, times 10 docs per day, is 80 weeks you have to cover. You need 2 more Docs for that.

To simplify lets remove the post call guy and just assume its an ASC.

So you need 12 docs in total in a realistic MD only model of this theoretical 10 room ASC (again a no call scenario unlike above).

12 docs * 500 each is 6 Million in expenses.

4 docs (2 million) and 12 CRNAs (@250k each = 3 Million) = 5 Million in expenses

12 docs @400 each is only 4.8mil. All MD saves money