A depressing job posting

[criticalelement]

Here is an actual Job posting. I deleted location info but its not too fa r away from a major metropolis over 600k people

-Need 1 MD and 4 CRNAs for ongoing coverage starting July 1st (arrival on June 30th for onboarding)

- The Group covers 3 ORs + OB

-The CRNAs will be on 1st call under supervision of the surgeons and must be comfortable with working independently and doing their own spinals, epidurals, etc.

- Call rotation is 1:4 to 1:5 depending on the staffing each day

-The practice does roughly 500 OB cases per year.

-Cases include General Surgery, Ortho. Surgery, Urology

-EMR is Meditech

-OT is available!

This is how much our expertise is valued. Have someone who has ZERO training in your specialty signing off on it. I opened this right after opening the uplifting thread but it didnt fit in that thread so i put it in this one. THis is also a NON OPT OUT STATE.

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Members don't see this ad.

 

[chocomorsel]

Screw it. The surgeons think we aren't important and interchangeable, let them take the fall when **** goes south!!!! I just left a supervision job and couldn't be happier. Let them all be independent!!

 

[nimbus]

Here's another one. You can work for CRNAs

http://www.gaswork.com/post/176668

 

[Carbocation1]

This is messed up. I sincerely hope these are rare exceptions and not the norm.

 

[imfrankie]

This is messed up. I sincerely hope these are rare exceptions and not the norm.

I regret to say it is becoming very common. If you love the idea of doing anesthesia, I would highly recommend considering pedi-hearts. Ain't no one taking your place and the surgeons will respect you.

 

[criticalelement]

I regret to say it is becoming very common. If you love the idea of doing anesthesia, I would highly recommend considering pedi-hearts. Ain't no one taking your place and the surgeons will respect you.

Not only is this a lie. Its a damn lie. And you will be in training for 6 years for this And there will be only a selct few places where you can do peds hearts. And the kinda places where you do peds hearts are the kinda places where they pay you 185k 4 weeks off one week cme and they have a ss hole face boss.

 

[turtledog]

I just left a supervision job and couldn't be happier. Let them all be independent!!

Doesn't that just make the job search even harder if CRNAs are competing directly?

 

[amyl]

My job is considering replacing me with a crna. Some surgeons were against it because they don't want to "supervise" them. However, legal came in and said they are not liable u less they specifically direct the anesthesia plan... And not vague like spinal vs geta, directing like give 100mcg of fentanyl.... Then the surgeons were like ok whatever - those cases decided a little while ago that surgeons weren't "liable" for their "supervision" was the nail in the coffin. Idk do a fellowship in ccm -- bc this horse has left the barn.

 

[Planktonmd]

My job is considering replacing me with a crna. Some surgeons were against it because they don't want to "supervise" them. However, legal came in and said they are not liable u less they specifically direct the anesthesia plan... And not vague like spinal vs geta, directing like give 100mcg of fentanyl.... Then the surgeons were like ok whatever - those cases decided a little while ago that surgeons weren't "liable" for their "supervision" was the nail in the coffin. Idk do a fellowship in ccm -- bc this horse has left the barn.

Very sad...

 

[Psai]

My job is considering replacing me with a crna. Some surgeons were against it because they don't want to "supervise" them. However, legal came in and said they are not liable u less they specifically direct the anesthesia plan... And not vague like spinal vs geta, directing like give 100mcg of fentanyl.... Then the surgeons were like ok whatever - those cases decided a little while ago that surgeons weren't "liable" for their "supervision" was the nail in the coffin. Idk do a fellowship in ccm -- bc this horse has left the barn.

then when the patient's lawyer comes at them with the captain of the ship argument, what's going to happen to the surgeon

 

[gasdoc77]

then when the patient's lawyer comes at them with the captain of the ship argument, what's going to happen to the surgeon

Lawyers (and patients ) take note of this opportunity. Furthermore, you will likely find anesthesiologist expert witnesses lining up for free. Now is your chance to pay off those student loans!

 

[aka_tigerj]

My job is considering replacing me with a crna. Some surgeons were against it because they don't want to "supervise" them. However, legal came in and said they are not liable u less they specifically direct the anesthesia plan... And not vague like spinal vs geta, directing like give 100mcg of fentanyl.... Then the surgeons were like ok whatever - those cases decided a little while ago that surgeons weren't "liable" for their "supervision" was the nail in the coffin. Idk do a fellowship in ccm -- bc this horse has left the barn.

holy f*ck...i can only imagine that this will spread like wildfire...

 

[amyl]

Captain of the ship is dead in medical law. If you want the specific cases that went to decide these things - no more captain of the ship and that surgeons are off the hook - they are on the aana website along with a long article about this topic. Google surgeon crna liability and it will come up. The wording of the laws equate crnas and anesthesiologists. Here's a med law blog that sums it up more concise than the aana website.
http://lawmedconsultant.com/3226/supervision-of-crnas-does-not-create-liability-for-surgeons/

 

[amyl]

Also btw - all this is happening in my hospital in a non opt out state -- Indiana -- supposedly one of the least crna friendly states. Essentially all the states are, in practice, opt out.

 

[Consigliere]

Doesn't that just make the job search even harder if CRNAs are competing directly?

Of course. Here you have a job that COULD have employed 5 MDs but instead will employ 1 and 4 CRNAs. This is how CRNAs will be employable and anesthesiologists will be UNEMPLOYED. Welcome to your future, current residents. I feel sincere pity for you.

 

[unnumzaan]

Here's another one. You can work for CRNAs

http://www.gaswork.com/post/176668

Can someone enlighten this MS-0 on this job listing? It's my first time actually seeing one.

525k base 1099 with no weekends, no holidays, no call, doing 50/50 anesthesia own cases and pain clinic with eventual transition into most outpatient pain and never having to manage CRNAs/AAs sounds pretty sweet to me...

Or is this an example of one of the few good gigs out there?

 

[nimbus]

Can someone enlighten this MS-0 on this job listing? It's my first time actually seeing one.

525k base 1099 with no weekends, no holidays, no call, doing 50/50 anesthesia own cases and pain clinic with eventual transition into most outpatient pain and never having to manage CRNAs/AAs sounds pretty sweet to me...

Or is this an example of one of the few good gigs out there?

It's pain in the middle of nowhere. Many people with urban or suburban backgrounds would go insane living there.

 

[Ronin786]

It's pain in the middle of nowhere. Many people with urban or suburban backgrounds would go insane living there.

That's not the worst of it, 1 anesthesiologist on staff, 15+ CRNAs. The group is filled with and run by CRNAs, look at who the owner is.

 

[unnumzaan]

I'm starting to understand. They're a nearly-all CRNA practice that needs a MD/DO for a liability sponge, to take the tough cases, and now to keep pain referrals in-house.

Edit: Des Moines is actually pretty nice, if this is anywhere close to there.

 

[cognitus]

Here is an actual Job posting. I deleted location info but its not too fa r away from a major metropolis over 600k people

-Need 1 MD and 4 CRNAs for ongoing coverage starting July 1st (arrival on June 30th for onboarding)

- The Group covers 3 ORs + OB

-The CRNAs will be on 1st call under supervision of the surgeons and must be comfortable with working independently and doing their own spinals, epidurals, etc.

- Call rotation is 1:4 to 1:5 depending on the staffing each day

-The practice does roughly 500 OB cases per year.

-Cases include General Surgery, Ortho. Surgery, Urology

-EMR is Meditech

-OT is available!

This is how much our expertise is valued. Have someone who has ZERO training in your specialty signing off on it. I opened this right after opening the uplifting thread but it didnt fit in that thread so i put it in this one. THis is also a NON OPT OUT STATE.

I guess this is depressing. Every industry always has crappy jobs. Question is that are you the anesthesiologist at the low end of the pole that would have to consider this gig? Are you competitive enough that there are plenty of other, better jobs out there? Or will this be the norm and will even the most competitive anesthesiologist have to consider this opening?

 

[Winged Scapula]

Screw it. The surgeons think we aren't important and interchangeable, let them take the fall when **** goes south!!!! I just left a supervision job and couldn't be happier. Let them all be independent!!

#notallsurgeons

Many of us value your expertise and have left hospitals and groups staffed by cRNA's. Fortunately I work in a large market where I have the option to go elsewhere.

 

[deleted126335]

Indiana is also a very strong anti medical tort state. Ironic, the ambulance chaser may become our ally.

 

[Vaporized]

So what is the best future bet? Go somewhere where it is all MD right now and work until they go AMC or forced supervision and stash away as much as possible. OR start somewhere academic/employee get foot in the door for when they bundle payments with the assumption they will still (hopefully) have training programs for 25 + years and get pension. The latter no OB much better calls.

 

[Planktonmd]

#notallsurgeons

Many of us value your expertise and have left hospitals and groups staffed by cRNA's. Fortunately I work in a large market where I have the option to go elsewhere.

Unfortunately you are the exception... not the rule

 

[Planktonmd]

So what is the best future bet? Go somewhere where it is all MD right now and work until they go AMC or forced supervision and stash away as much as possible. OR start somewhere academic/employee get foot in the door for when they bundle payments with the assumption they will still (hopefully) have training programs for 25 + years and get pension. The latter no OB much better calls.

Is switching specialties still an option for you?

 

[Carbocation1]

Is switching specialties still an option for you?

Come on now...

 

[IlDestriero]

Here's another one. You can work for CRNAs

http://www.gaswork.com/post/176668

If you're a partner doing your own cases and getting your fair share of the income, does it matter if the boss is a CRNA?
I suppose you'd have to look at what personal risk you and your income have as a partner due to increased liability potential of independent crnas, if any. I don't know anything about that.

 

[deleted162650]

So what is the best future bet? Go somewhere where it is all MD right now and work until they go AMC or forced supervision and stash away as much as possible. OR start somewhere academic/employee get foot in the door for when they bundle payments with the assumption they will still (hopefully) have training programs for 25 + years and get pension. The latter no OB much better calls.

If you want to stash away as much as possible, then you should find private group that currently supervises 4:1. This is most lucrative model when run right. At least then you'll also already be used to supervising when it's forced on the rest of us.

Starting out as an employee/academic is honestly not a bad option. Just keep in mind that you will be at the mercy of your employer's whims from day 1. There's nothing to say that those nice benefits or that pension will continue to be there throughout your career. Academic institutions are subject to market forces just like PP groups, plus they have to work with the budget the state/feds give them and we have seen many instances of government bankruptcies forcing budget cuts.

If you're thinking academics make sure you're OK supervising trainees and teaching the same things over and over to brand new pants-on-head ******ed CA1's who can't even flush an IV yet . Residents deserve quality staff who like to teach and not someone who's in academics just because that's the best job offer they could find.

I've come to the realization that MD only anesthesia and PP in general may not be around for my entire career, so I'd like to get a piece of it while I still can. I like sitting my own cases, and I like being a partner in a practice with some say as to how we do things both medically and as a business entity. And at least this way when I'm 75 (and still working because I live in CA), I'll be able to sit down with our young whippersnapper new hires and tell them about how we used to actually do our own cases (barefoot, up hill both ways in the snow)

 

[deleted126335]

If you're a partner doing your own cases and getting your fair share of the income, does it matter if the boss is a CRNA?
I suppose you'd have to look at what personal risk you and your income have as a partner due to increased liability potential of independent crnas, if any. I don't know anything about that.

That is like asking, while eating and enjoying a delicious chocolate dessert that tastes better than most desserts at the table that yours has a big scoop of dogsh1t in it. Do you mind?

 

[IlDestriero]

But that job doesn't have a pile of dog **** in the bowl, it's a fat stack of Benjamins. Who is eating **** in this scenario?

 

[Carbocation1]

I would rather work for hard-working CRNAs for big money than for the lazy, fat cat grey-hairs who sold out this profession to begin with.

 

[IlDestriero]

I would rather work for hard-working CRNAs for big money than for the lazy, fat cat grey-hairs who sold out this profession to begin with.

I think that all the guys working for AMCs and freely handing over a percentage of their billing are eating a much bigger bowl of stool.

 

[gasdoc77]

I think that all the guys working for AMCs and freely handing over a percentage of their billing are eating a much bigger bowl of stool.

Work for Northstar and you can do both. Work for an AMC and a CRNA. How you like them desserts!

 

[deleted50478]

Work for Northstar and you can do both. Work for an AMC and a CRNA. How you like them desserts!

I know! They advertise it like it's something great not something terrible. Wtf?

 

[postbacpremed87]

The anesthesiologist who answers to a CRNA.

This cannot be serious....

 

[IlDestriero]

I know! They advertise it like it's something great not something terrible. Wtf?

It may be much better than working for a non medical MBA.
I don't know anyone that worked for them.

 

[gasdoc77]

It may be much better than working for a non medical MBA.
I don't know anyone that worked for them.

I do. They are predatory. They take over an existing practice that might be a little overstaffed and create attrition by SLASHING salaries. They pretty much offer no benefits either so consider that when you see their ads.

 

[Mman]

Here is an actual Job posting. I deleted location info but its not too fa r away from a major metropolis over 600k people

-Need 1 MD and 4 CRNAs for ongoing coverage starting July 1st (arrival on June 30th for onboarding)

- The Group covers 3 ORs + OB

-The CRNAs will be on 1st call under supervision of the surgeons and must be comfortable with working independently and doing their own spinals, epidurals, etc.

- Call rotation is 1:4 to 1:5 depending on the staffing each day

-The practice does roughly 500 OB cases per year.

-Cases include General Surgery, Ortho. Surgery, Urology

-EMR is Meditech

-OT is available!

This is how much our expertise is valued. Have someone who has ZERO training in your specialty signing off on it. I opened this right after opening the uplifting thread but it didnt fit in that thread so i put it in this one. THis is also a NON OPT OUT STATE.

Lots of small hospitals in non opt out states staff like that. They essentially function like a normal ACT model M-F during the day (and periodically nights and weekends), but they can't afford to pay enough MDs to cover 24/7 so they have CRNAs on call being "supervised" by the surgeon at night or occasionally on weekends. CMS rules state CRNA must be supervised by a physician, not anesthesiologist.


As to those citing lawyers or law decisions talking about how it doesn't impact a surgeon's malpractice: HA HA HA HA HA. Go ask their malpractice insurer. Their rates will go way up. I know surgeons that stopped going to those places because once their malpractice carrier found out the arrangement they were going to jack their rates way up.

We all know when the stuff hits the fan the lawyers go searching for the deepest pockets. They will bypass the CRNA and coming hunting surgeon even if it's an anesthesia complication.

 

[turtledog]

We all know when the stuff hits the fan the lawyers go searching for the deepest pockets. They will bypass the CRNA and coming hunting surgeon even if it's an anesthesia complication.

Why do you think the surgeon has deeper pockets than the CRNA/anesthesia group?

 

[Mman]

Why do you think the surgeon has deeper pockets than the CRNA/anesthesia group?

because surgeon malpractice coverage is probably 10-20x or more greater than CRNA. Our CRNAs cost about $1500 a year to insure. And remember, we aren't talking about an "anesthesia group", we are talking about a small hospital that employs a handful of CRNAs.

 

[Winged Scapula]

Unfortunately you are the exception... not the rule

I'm truly sorry to hear that. I know I have other colleagues here in town that feel the same way that I do.

In fact several of the plastic surgeons I work with demand that the large anesthesia group here do not provide cRNA's for their cases either.

 

[Winged Scapula]

because surgeon malpractice coverage is probably 10-20x or more greater than CRNA. Our CRNAs cost about $1500 a year to insure. And remember, we aren't talking about an "anesthesia group", we are talking about a small hospital that employs a handful of CRNAs.

How much malpractice are they required to carry? 1mil/3mil?

Obviously the rates are different by geographic location but I'd love to have a rate only 10 to 20 times $1500 LOL.

 

[bashwell]

Is what anesthesiologists face with CRNAs as bad or worse than what psychiatrists face with clinical psychologists where I've heard some can even prescribe certain medications in a few states?

 

[PainDrain]

Lots of small hospitals in non opt out states staff like that. They essentially function like a normal ACT model M-F during the day (and periodically nights and weekends), but they can't afford to pay enough MDs to cover 24/7 so they have CRNAs on call being "supervised" by the surgeon at night or occasionally on weekends. CMS rules state CRNA must be supervised by a physician, not anesthesiologist.


As to those citing lawyers or law decisions talking about how it doesn't impact a surgeon's malpractice: HA HA HA HA HA. Go ask their malpractice insurer. Their rates will go way up. I know surgeons that stopped going to those places because once their malpractice carrier found out the arrangement they were going to jack their rates way up.

We all know when the stuff hits the fan the lawyers go searching for the deepest pockets. They will bypass the CRNA and coming hunting surgeon even if it's an anesthesia complication.

To say that a surgeon is off the hook while supervising a CRNA isn't likely to stand. Remember that most unexpected deaths/disasters in the closed claims are airway related resulting in permanent disability or death; a CRNA who loses an airway won't be looking to perform a surgical airway and that will fall on the surgeon for failing to perform a crico.

 

[PainDrain]

I realized today just how poor the basic understanding of physiology and anesthetic methods are of most Crnas. Long story short I get called for hypotension in a simple case. I find the gas was at 1.5 MAC and patient got narcotics a few minutes before; meanwhile the pressors are getting pushed like crazy and fluid is getting slammed into a patient with poor reserve. WTF? Maybe start by turning the gas down and letting some of that dilaudid wear off, let the surgical stimulus bring the pressure up instead of sending the patient into CHF?

 

[deleted480308]

Ws....I've been thinking about surgery. How hard is it in most places to demand a physician for my cases instead of crna?

 

[IlDestriero]

Ws....I've been thinking about surgery. How hard is it in most places to demand a physician for my cases instead of crna?

There's a difference between a CRNA working solo and a CRNA being supervised by an anesthesiologist. What arrangements are available will vary by facility. If a group always supervises CRNAs, the likelihood of being able to request a solo anesthesiologist instead may be zero. They would have to bring in an additional person just to cover your room. That's a money loser for the group. That person should be covering 3-4 rooms, not just one.
At our place if a patient requested no CRNA, which has happened, they would get a resident/fellow/or solo attending assuming they requested in advance. If they said attending only, the party line is that it is a training hospital, and that is not possible. Though we will accommodate that if they insist, when appropriate, but not day of surgery requests.

 

[Twiggidy]

The moral of the story is that we, as anesthesiologists, have created many of our own problems. Why are CRNAs getting more independent opportunity? Well, because they're going to practice in places that many of us MDs refuse to go. We'd rather be in hip urban/suburban areas instead of the boonies. (Hey, I'm one of them. I'd probably work at The Gap before heading to the sticks). Like a few other fields that are service fields (pathology, radiology, etc), graduate a bunch of residents who all want jobs in a handful of areas. Of course the nurses are going to read between lines and say, "Hey, the language says THIS, and we can do that."

Is the future grimm? Probably depends on how you look at it. I think a previous poster was correct. In the future, everyone will either work for an academic institution or work for a corporation. Remember also, corporations are out to MAKE MONEY, not improve medicine. They'll take as few bodies as possible to generate the highest profit for the shareholders. So what I'm saying is, those private practice jobs will turn into workhorse jobs, especially if OB is involved.

Interesting enough, from personal experience, I find it interesting how difficult it is to get an academic job at this point. I think the chairmen are on to us PP folks who are trying to maybe work a little LESS hard than in PP and definitely take less call.

In summary, get a job where you won't lose your mind. Save your money. Don't go MC Hammer with those paychecks. Then if anesthesia does go to crap, we can all trade shifts at The Gap and use the 40% employee discount.

 

[Winged Scapula]

In general small rural communities have a culture of self reliance. In a small county lots of people know and work with each other. A jury in a small town is unlikely to find against someone who might take care of them or their family and find against what might ver well be the towns largest employer, (the hospital). How much independent CRNA practice goes on in the ugly medmal regions like Miami, Philadelphia, Cleveland, et al.?

Yes I understand that and why the deeper pockets are always picked.

The figure of $1500 a year for CRNA malpractice insurance was mentioned above and I was curious what's a typical rate and what amount of med mal insurance they're required to have. Is it as much as we (physicians) have to have?

 

[Winged Scapula]

Ws....I've been thinking about surgery. How hard is it in most places to demand a physician for my cases instead of crna?

As @IlDestriero notes, it will vary.

The factors are going to be availability, the type of case you're doing and to some extent, your reputation and the willingness of the group to please you. To date, I've been accommodated but I can't guarantee that will always be the case (as they hire more and more CRNAs locally).