The death of PE in anesthesia.

[lotsapain]

Curve of aging population going up.

Curve of available anesthesiologists - going down.

I think the low of anesthesia residents was about 30 years ago - so we are seeing this low now.

I don’t think this trend will reverse any time soon. Economy and ASC money, and all that - likely will have a small roll. Lack of anesthesia bodies is the driving factor.

This is a complicated topic. NAPA and Envision loosing ground is old news.... larger private groups may re-emerge.... as far as the trend reversing, its also interesting as there are a lot of "sleepers" locums etc who are waiting for hospitals to self-employ. Northwell has not problems recruting neither does Barnabas, they initially set the salaries and sign-ons high and over recruit as a show of force and guarantees of "physician wellbeing" whatever that may mean... suddenly attendings and CRNA are coming out of the woodwork... as soon as the desirable positions will fill we will see a drop in salaries and market demand... eventually small community hospitals will die out, patients will go to ASCs and the rest to MEGA tertiary hospitals who will employ all the personnel.

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[Dr. Rude]

This is a complicated topic. NAPA and Envision loosing ground is old news.... larger private groups may re-emerge.... as far as the trend reversing, its also interesting as there are a lot of "sleepers" locums etc who are waiting for hospitals to self-employ. Northwell has not problems recruting neither does Barnabas, they initially set the salaries and sign-ons high and over recruit as a show of force and guarantees of "physician wellbeing" whatever that may mean... suddenly attendings and CRNA are coming out of the woodwork... as soon as the desirable positions will fill we will see a drop in salaries and market demand... eventually small community hospitals will die out, patients will go to ASCs and the rest to MEGA tertiary hospitals who will employ all the personnel.

Sounds more plausible than most predictions.

But, The sleeper locums aren't waiting for anything. They are just taking advantage of their flexibility and following the best cost/benefit situation. The Northwells and Barnabas's of the world are making a business decision-that their finance people agonize over and lie awake at night deciding when they can roll back. The MEGA tertiary hospitals will have a choice of investing massively in physical OR capacity or running a full second and maybe even a partial third shift to get the cases done. Likely, real money to be made for those clinicians willing to relocate or work second shift.

 

[lotsapain]

Sounds more plausible than most predictions.

But, The sleeper locums aren't waiting for anything. They are just taking advantage of their flexibility and following the best cost/benefit situation. The Northwells and Barnabas's of the world are making a business decision-that their finance people agonize over and lie awake at night deciding when they can roll back. The MEGA tertiary hospitals will have a choice of investing massively in physical OR capacity or running a full second and maybe even a partial third shift to get the cases done. Likely, real money to be made for those clinicians willing to relocate or work second shift.

They are and they aren't.... I speak from the "inside" having to recruit from the locums pool and at some point in time being a locums myself albeit the hourly rates what they are now where never even imaginable.... some locums go back and forth, when a truly lucrative and stable position emerges they flock to it. Covid was the ultimate equalizer and frankly I was under the impression that everyone will want to be employed at that point as many were fourloughed (ie USAP, Envision etc etc) and the fear of not having a job (so I thought) was going to force everyone's hand. The opposite has happened..... I hope when all the dust settles I will be either retired or doing something else (which is frankly possible as living with combination of depression/anxiety/PTSD is more common than anyone thinks). These are tumulous times, in NY/NJ private groups are re-emerging managing the multitude of ASCs while hospitals are gearing to self-employ.

I can assure you finance people are not laying awake at night at all. Why? (and I know this for a fact) because the Facility fees made by the surgeries afforded by the new inflow of personnel far outweighs the cost of anesthesia. As a matter of fact, they are loosing some money on employing physicians (ie anesthesia reimbursement is less then salaries) however that is irrelevant as the strong facility fees make up the rather small negative margin loss from anesthesia billing. Now, not everyone can take this type of hit, smaller health systems in rural areas may always be in the red or they may have to use state funds, or just not do high acuity or OB or run ORs at night so salaries can be commensurate to the work commitment.

Me personally, I would rather have a sane existence than sit in a large hospital at night doing a 5 hour revascularization on a 95 year old who does not really need the procedure because the risk outweighs the benefit. Frankly I deeply regret going into this profession or medicine in general as it became a sham, a scam, a prison of sorts..... true solution would be a doctor's union with strong protection both legally and ethically with sane work hours, staffing ratios and quality controls - ie AIRLINES should set the example. For that to happen more leadership should be physician based. Many of us have more business degrees, accumen and operational experience then most CEOs can dream of but they are bette sycophants and besides hiring an RN executive is so much cheaper and most importantly so easy to control....

Physicians did it to themselves by being greedy and disorganized now we reap the benefit....

 

[lotsapain]

What is the going rate for a non-compete buyout? Is it more than $100k per person?

Ha...... 1-2million per partner in a lucrative practice..

 

[lotsapain]

I haven't seen that. But it probably depends on what state you're in

Shhh.... I know people who walked away with their bonus when contractual terms were changed (ie sudden salary drop etc.)

 

[Dr. Rude]

Ha...... 1-2million per partner in a lucrative practice..

But plenty of others got ZERO. You will be assimilated resistance is futile.


"I can assure you finance people are not laying awake at night at all. Why? (and I know this for a fact) because the Facility fees made by the surgeries afforded by the new inflow of personnel far outweighs the cost of anesthesia."

Agree. I was referring to global hospital financials. Not the OR/Anesthesia piece. Hospitals are struggling Their surgery volume is one bright spot. Along with some cardiac and a few other areas.


"Me personally, I would rather have a sane existence than sit in a large hospital at night doing a 5 hour revascularization on a 95 year old..."

Agree. But your 35 year old self might have felt differently...if the price was right.

 

[GassYous]

But plenty of others got ZERO. You will be assimilated resistance is futile.


"I can assure you finance people are not laying awake at night at all. Why? (and I know this for a fact) because the Facility fees made by the surgeries afforded by the new inflow of personnel far outweighs the cost of anesthesia."

Agree. I was referring to global hospital financials. Not the OR/Anesthesia piece. Hospitals are struggling Their surgery volume is one bright spot. Along with some cardiac and a few other areas.


"Me personally, I would rather have a sane existence than sit in a large hospital at night doing a 5 hour revascularization on a 95 year old..."

Agree. But your 35 year old self might have felt differently...if the price was right.

Nah he doesn't.

 

[IMGASMD]

Nah he doesn't.

He didn’t know better.

 

[amyl]

USAP didn’t lay anyone off for covid. What?!

 

[Airway]

true solution would be a doctor's union with strong protection both legally and ethically with sane work hours, staffing ratios and quality controls - ie AIRLINES should set the example

Wouldn't look closely at the airline industry. Big business and our political system is trying to decrease training for pilots.

1 airline made a bid to reduce flight hours required for new pilots. FAA rejects it

Regulations require 1,500 hours of flight time for pilot certification. Regional airline Republic Airways wanted graduates of its flight school to be eligible in half that time. The FAA said no.

www.npr.org

And for years they have been trying to remove the copilot position

Why airplanes might soon have just one pilot | CNN

Two-pilot planes have been the norm in commercial aviation for more than 30 years. As technology advances, airlines are looking at single-pilot operations as a way of saving money and addressing the pilot shortage -- but is it both feasible and safe?

www.cnn.com

 

[nimbus]

USAP didn’t lay anyone off for covid. What?!

Does anybody know the outcome of the Boise group that laid off a bunch of CRNAs at the beginning of COVID? Were they all hired back?

 

[amyl]

That isn’t a USAP group

 

[nimbus]

That isn’t a USAP group

I know. I was wondering if anybody knows what happened with the Boise group, if they hired back most/all of their CRNAs.

 

[lotsapain]

He didn’t know better.

My 35 year old would of done another residency so my 10 years later year old wouldn't have to be disgusted as much as he is..... yes after residency if the price was right maybe I would of spent more time in rooms to spend less time in them later... but at that time salaries were much less Sheridan/Envision started emerging as big buyout player and partnerships have died essentially erasing those opportunities.... fast forward 11-12 years later locums are making a killing if you have the steam..... I see 1990 medical practice rules by surgeons still being practices in 2022 who needs that? Same rot ...... different stench.... wrapped in the descriptions "I am doing this asymptomatic choly at 1 am tonight for patient satisfaction and safety...." sure not because you are out of network and if the patient leaves you cannot charge x10 for the same surgery......

 

[ProEra]

Anyone have any recent info re anesthesia staffing at North Shore and LIJ in Long Island. NAPA is kicked out, are all the physicians now hospital employed?

Was there any “buy out” by the hospital of the restrictive covenants that NAPA had in place?

How is the compensation now compared to compensation with NAPA?

 

[GravelRider]

Anyone have any recent info re anesthesia staffing at North Shore and LIJ in Long Island. NAPA is kicked out, are all the physicians now hospital employed?

Was there any “buy out” by the hospital of the restrictive covenants that NAPA had in place?

How is the compensation now compared to compensation with NAPA?

GasWork.com - Reference #362542

Reference #362542

www.gaswork.com

Northwell is recruiting for all former NAPA hospitals in their network including NS and LIJ. The word is that Northwell “bought out” the NAPA restrictive covenants. I don’t know much about compensation difference between the two.

 

[anbuitachi]

GasWork.com - Reference #362542

Reference #362542

www.gaswork.com

Northwell is recruiting for all former NAPA hospitals in their network including NS and LIJ. The word is that Northwell “bought out” the NAPA restrictive covenants. I don’t know much about compensation difference between the two.

i dont see salary in there. new york pay transparency law requires salary!

 

[NovAsthesia]

Does anyone have any insights as to how those doctors are doing now (the ones that the hospital system hired directly after the AMCs left)? Are they happier? Are they still sticking around or thinking about leaving? I wonder if they’re getting along okay with the hospital or if it was just a short “honeymoon” period before the hospital management took control of every aspect of their day to day practice?

 

[IlDestriero]

There's no money to be made in Anesthesia, hence the death of PE

8:1. Let’s do this!

 

[Dr. Rude]

8:1. Let’s do this!