24 hour “shifts” crna vs MD

[aneftp]

Seems the trend for anesthesia is 24 hours shifts especially crnas

This is a problem. A big problem These crnas literally work 7 “shifts” on average a month

The math is simple 7x24 equals 168 hours

160 hours divided by 4 weeks equals 40 hours a week.

Now some docs i know are getting into the train gravy train. Working 2 days a week for 450k.

This frees up a world of opportunities to either travel or make even more money on side gigs.

The 24 hours crnas are artificially creating a daytime 7-3 shortage since they are working less days and not available. And mind u. The weekday Monday-Thursday work isn’t bad at most places. So it counter balances weekend garage cases.

I think docs need to think the same way to convert to this model as well. It will further collapse an already short staffing situation. I did some locums work recently. And I’m presenting that idea to the hospital. 7 docs. 24/7 coverage. Super light call backs for 450k. Averages out to 45 hours a week I believe

It’s gonna to cost the hospital a lot. But at a cost of 1 million a year per locums docs Paying docs $450k is a lot cheaper even bringing in more docs to cover 24/7. The key is consistent coverage and not scrambling for locums coverage.

---

Members don't see this ad.

 

[Shimmy8]

The real question in a care team model is small hospitals that have OB and want a free CRNA for OB and the OR with physician as well. Expensive as hell.

 

[Dr. Rude]

The real question in a care team model is small hospitals that have OB and want a free CRNA for OB and the OR with physician as well. Expensive as hell.

Do you want to gamble in the devil's lottery? E.g., smaller hospital that does some OB. Doing an after hours main OR case with solo doc. Do you have another doc or CRNA to be available for call or leave uncovered? A very expensive insurance policy. But less expensive than unavailable anesthesia for an OMG obstetric emergency.

 

[triggermaster]

The real question in a care team model is small hospitals that have OB and want a free CRNA for OB and the OR with physician as well. Expensive as hell.

Where I used to work we had physicians doing solo coverage for the cases and OB during nights and weekends. There was crna backup to get you out of the OR to do OB if necessary. Paying a crna for backup coverage with very rare call in wasn’t all that expensive.

 

[aneftp]

Where I used to work we had physicians doing solo coverage for the cases and OB during nights and weekends. There was crna backup to get you out of the OR to do OB if necessary. Paying a crna for backup coverage with very rare call in wasn’t all that expensive.

I have seen it both ways.

Crna in house. Doc called in for c/s or cases at night

And doc in house. Crna on beeper for OR

The issue now is crnas don’t want to be beeper

Docs don’t want to be beeper.

Thus we have problems.

That’s why I advocate going towards a hourly model Mindset. (2) 24 hrs if lighter case load hospital. 1 (24) and 1 (16) at busier trauma hoops for docs. There are job opportunities that are becoming more open to this type of MD staffing model.

We have become a pay me a lot of money mentality if I’m gonna to be available/working

Or give me a lot of time off mentality.

 

[Anesthesia_Guy]

Make hay while the sun shines heads because it won't always be this good.

 

[IMGASMD]

Do you want to gamble in the devil's lottery? E.g., smaller hospital that does some OB. Doing an after hours main OR case with solo doc. Do you have another doc or CRNA to be available for call or leave uncovered? A very expensive insurance policy. But less expensive than unavailable anesthesia for an OMG obstetric emergency.

Make a backup call system? And no OR cases unless true emergency? The least desirable, would be 2nd call comes in when there’s an OR case.

I know a few practices that would work CRNAs during the day, only docs take calls. If the price is reasonable, I don’t see why that’s a problem.

 

[Coffee PRN]

Did 24 hour call in residency, never going back. Hours 20-24 in the OR were some of my lowest moments.

 

[ucladoc2b]

We still have 24s. 50-70% case between 2300-0700. The worst is the waiting around at the ungodly hours.

 

[Bertelman]

Did 24 hour call in residency, never going back. Hours 20-24 in the OR were some of my lowest moments.

It sounds as though his call shifts are not equivalent to what we all experienced in residency. Doesn't sound like an academic center.

 

[IlDestriero]

There’s one hospital in my region that will give CRNAs 1/2 pay and benefits for 1 24/wk.
I would do that in a heartbeat. You could swap days around and work a couple days one week, take 2 weeks off, rinse, repeat. It could add many years to my career. It’s not the lowest acuity place, but it’s not a trauma center either. I joke about the acuity in my shop, and how the worst train wreck days in my residency, at a reasonably big referral center without trauma, wouldn’t even register on the Richter scale where I am now. When things get crazy, it’s impressive.

 

[DocMcCoy]

There’s one hospital in my region that will give CRNAs 1/2 pay and benefits for 1 24/wk.
I would do that in a heartbeat. You could swap days around and work a couple days one week, take 2 weeks off, rinse, repeat. It could add many years to my career. It’s not the lowest acuity place, but it’s not a trauma center either. I joke about the acuity in my shop, and how the worst train wreck days in my residency, at a reasonably big referral center without trauma, wouldn’t even register on the Richter scale where I am now. When things get crazy, it’s impressive.

1 24/week at 0.5FTE…. This might be my new dream job. I would do that in a heart beat.

 

[Shimmy8]

24s are awesome…when they’re awesome 😂.

They can add years to career or take years off your life.

I’m in a 50-60% overnight Level 1/stroke kinda place.

 

[Dr. Rude]

24s are awesome…when they’re awesome 😂.

They can add years to career or take years off your life.

I’m in a 50-60% overnight Level 1/stroke kinda place.

not so bad in your 30s and 40s. Suck your soul in 50s and 60s. Not for everyone, but for most.

 

[aneftp]

not so bad in your 30s and 40s. Suck your soul in 50s and 60s. Not for everyone, but for most.

It’s not for everyone. I’m in my late 40s. I can handle 24 even in busy trauma 2 (closer to trauma 1 on weekends with gun shots , big auto wrecks etc) hospital. In fact i did like 12 weekends (for extra pay) (24) over a 4.5 month period. This past summer.

So I can handle it.

I’m more thinking. Like right now. I got pretty cush Daytime job but I’m working 18-20 days out of a 20/21 weekday month. I don’t work more than 35/36 hours I estimate. It’s pretty easy

But it would be even more chill working 7.6 days out of a month. That’s what one doc is doing. Working 92 days out of a year for 450k plus benefits. Not a bad deal. He’s in late 59-62 range. But very fit guy. He said he will do it for 2-3 years max and retire. But time off is what he’s after.

He was used to having 20 weeks off at previous job. AMC came in and cut it down to 12 weeks. Still not bad. They up their salary by 60k but cut an MD slot. His work week hours were the same 38 hrs a week. But 8 less weeks of vacation from 20 to 12. In exchange for 60k more. It’s funky math
You figure each week of vacation is worth 10k a week. AMC counts it ws $8500 a week.

Either way at more time off is key as you get older.

I really get around 11 weeks off and it rolls over. But I’d like 15/16 weeks off these days. 26 weeks is a ton based on these 2 day work week equivalent (figure it takes one day just to recover from 24 hr busy calls)

 

[GravelRider]

I know of a place that has CRNAs do 1 24hr and 1 12hr shift per week as full time. Pay there is very competitive and the CRNAs are free to fill in their off days with very lucrative per diem opportunities in the area.

I have yet to see a physician job offer something similar.

 

[aneftp]

I know of a place that has CRNAs do 1 24hr and 1 12hr shift per week as full time. Pay there is very competitive and the CRNAs are free to fill in their off days with very lucrative per diem opportunities in the area.

I have yet to see a physician job offer something similar.

There are more places offering it. Works out to 90 workdays a year. Obviously places with 24/7 needs in house. Like busy ob or trauma places.

This is the next step.

Crnas have been far ahead of the game with this.

Notice back years ago. Many years would be coming in odd 11-7
Or 1-9 shifts

Now most only want to come in at 7/8am and get most off days with longer shifts