Anesthesia/CCM work models

[GravelRider]

What are some work models that you folks who do both anesthesia and ccm work in?

I've been thinking a bit about this because I was a hospitalist before and a lot of full time intensivists jobs take a similar model as hospitalists...7 on/7 off. So, let's assume a 1.0 FTE intensivist works about 24 weeks a year with 24 weeks off. I was a hospitalist, so I know this is hard work. However, it gets me thinking about a combo job in anesthesia/ccm. In my imaginary world where you did 50% anesthesia and 50% CCM you would work about 12 weeks in the ICU with then 12 weeks off (these are your "post-call" days). The rest of your time would be spent doing OR anesthesia, but you would have no OR call obligation because of your 7 days "on" in the ICU each month. Sprinkle in another 6 weeks of actual vacation, I think this would make for a pretty sweet gig. You are still working hard, but you get to vary your practice, increase your visibility within the hospital, not burn out from full-time ICU, and have a decent amount of time away from clinical duty to maintain good work life balance. Now a lot of this assumes you have "physician extenders" or residents in the ICU to handle the scut work and be a presence during the night.

Is this at all in line with reality that people who do both are seeing? What are some other models? I think my description of the above would get a lot more residents interested in pursuing critical care...so long as hospitals were on board with this.

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[partydoc]

This is how its set up for the faculty at my program.

 

[seinfeld]

In my place we treat the ICU as a room assignment. Generally I work it so you have at least 3 days straight in the ICU for continuity, honestly 4 is about the right number of consecutive days. You get to still go home based on your call rotation, if you can't leave for some pressing ICU issue , we will allow OT to be placed. Weekends are more complicated but in general if your working a weekend you'll cover the unit, and another general guy will get OT for OR, and if no ICU person is scheduled then the shift goes up for OT. Night calls are covered but all anesthesiologists, including the non fellowship trained guys when they do in house night call (the units have 2 NP/PAs in house to cover the unit so its basic resuscitation and triage medicine) . Hopefully soon we can transition to a model where the ICU guys are the ones taking all the night call but the generalists have not been convinced that taking more night anesthesia call is in their best interest.

 

[Wiscoblue]

How do you bill for ICU services? What's the reimbursement compared to a day in the OR?

 

[Ezekiel2517]

How do you bill for ICU services? What's the reimbursement compared to a day in the OR?

It's based on time and bundled under "critical care management". First 35 minutes is a set number of units. Then goes up incrementally if more time is spent on a patient. There are certain things included in the bundle and you can additionally bill for procedures and such performed on the patient, such as lines. How it compares to the OR depends on how many patients you are covering. Could be much more or much less than average OR day depending on your number of pts and what your avg OR day is.

 

[G-Man82]

For me, in an academic center, 1 FTE is currently 32 weeks. That's dropping to 26 weeks soon. So 50-50 Anesthesia and CCM for me is handled separately. I do 7 days straight in CCM, or 4 consecutive shifts in the teleICU. Each of those is considered 1 week. After my ICU time, I always get a few days off, before returning to OR time. 5 days in the OR is a week for me, but that doesn't have to be consecutive. When wearing my anesthesia cap, I don't do nights or weekends in the OR. That obligation is covered by the ICU. No OT for me in ICU, but in general because of our teleICU, I get to sleep through the nights when on duty, rather than get called for whatever at 3 am unless my presence is required in the unit, which is rare.


Edited to remove those ridiculous smiles that show up whenever you put 2 O's together: No OR

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[seinfeld]

In my model our group contracts with the hospital for an hourly rate. The hospital then captures all the billings. If we tried to bill on our own we would not make enough revenue to cover our expenses, and that would require a stipend. So this a way to get around the stipend issues. Everyone in our group gets equal pay, regardless of where they work or their individuals billings. If we did have an RVU model no one would do cardiac or critical care without some fudge factor for providing those services. So we keep it simple and uncomplicated.

 

[deleted126335]

Our group has several docs who are half ccm half OR. Separate corporations. They have half an FTE requirements for call and salary and benefits and vacations on the anesthesia side. They work a lot harder during their crit care weeks, but they also earn more per hour those weeks as well.

 

[Wiscoblue]

My question is, do the ccm guys bring in what they take home? Or are they being subsidized by the guys in the OR?

We used to have a very Medicaid heavy pain component to our group. The pain guys took home over a mill. We analyzed the numbers and found that the rest of us were helping them to the tune of 400k. Needless to say, the pain practice had to be split off into a separate blended unit which was much lower than the OR unit.

 

[hookgrip]

Our group has several docs who are half ccm half OR. Separate corporations. They have half an FTE requirements for call and salary and benefits and vacations on the anesthesia side. They work a lot harder during their crit care weeks, but they also earn more per hour those weeks as well.

How does this setup usually work? 2 weeks OR + 7 on/7 off ICU per month?

I have also heard that the demand for anesthesia-trained CCM docs is much lower than CCM docs trained in IM or surgery. Is there any merit to that statement?

 

[deleted126335]

Don't know about demand issues for CCM. Anesthesiologists have always had a strong presence in our ICUs.
The docs who split are assigned a month at a time of OR or the units. However, they do lots of trading for their own personal reasons including some who like to work ALOT and some who are more lifestyle oriented. Haven't paid close attention to how they schedule themselves, but generally they are assigned a week on and a week off. What they actually do varies quite a bit different.

The CCM guys have their own deal. They take home quite a bit more per hour of work on the CCM side as compared to the anesthesia side. Don't know what they generate for the hospital vs. subsidy issues, etc. Separate corporations. They earn it though. They work like dogs, routinely up all night. They are the dumping ground of the hospital.