Are You Ready For Private Practice?

[GA8314]

"Bust your ass while you can and save for the inevitable demise of our specialty. Invest and live well below your means, and maybe one day open a day spa and do botox injections all day. "


Honestly exactly what I have been thinking. All MD practice now but I know it will not last. Huge market in this city, especially on my side, for Botox. I actually may attend one of those $$ one day courses. I know plastics looks down on other specialties doing it but f*ck it; it's my future and I have 3 little ones.

Maybe it will last. Who knows. Also, yes, f.ck them. You are a physician. You place lines and needles near large nerves including the spinal cord. You have the training to learn how to learn, know that you need to read about complications and risks/benefits, contraindications etc. Botox away. Who cares what the derm folks think.

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[k12balla]

There's nothing wrong with doing 40 hours a week, no call no weekends for 225-300k. In fact, most new grads are wising up to the current bs partnership tracks and going this route, while having other side ventures or pursuing fellowship.

However, there is a problem with doing 60-70 hours a week at 250k so you can " buy in " over two years and then work the same hours for a flat salary <400k with little to no profit sharing as the suits are now taking the cut. That's if they decide make you partner and aren't just stringing you along.

Greed and laziness plagues us all, but especially anesthesiology. Our predecessors made a killing, then when times got rough took the hush money and left us in this predicament. Although, before we go pointing fingers, I doubt anyone in their shoes would've acted any differently given the circumstances. In the end we're all selfish..

But yes, as the great jet said, be affable, available, fast, efficient, pleasant, etc etc. But before you completely pull your trousers down, hunched over the OR table, measuring precisely how much urine has been produced for a 30min chole, just remember the rules have changed and the end game is no longer the same. We were once highly sought after world class escorts, and we were compensated as such. Now when you're stroking that surgeon at 2 am, or offering to cover that holiday shift for your senor partner for peanuts, we're nothing more than cheap hookers trading our souls for kitchen tables on craigslist

 

[Planktonmd]

There's nothing wrong with doing 40 hours a week, no call no weekends for 225-300k. In fact, most new grads are wising up to the current bs partnership tracks and going this route, while having other side ventures or pursuing fellowship.

However, there is a problem with doing 60-70 hours a week at 250k so you can " buy in " over two years and then work the same hours for a flat salary <400k with little to no profit sharing as the suits are now taking the cut. That's if they decide make you partner and aren't just stringing you along.

Greed and laziness plagues us all, but especially anesthesiology. Our predecessors made a killing, then when times got rough took the hush money and left us in this predicament. Although, before we go pointing fingers, I doubt anyone in their shoes would've acted any differently given the circumstances. In the end we're all selfish..

But yes, as the great jet said, be affable, available, fast, efficient, pleasant, etc etc. But before you completely pull your trousers down, hunched over the OR table, measuring precisely how much urine has been produced for a 30min chole, just remember the rules have changed and the end game is no longer the same. We were once highly sought after world class escorts, and we were compensated as such. Now when you're stroking that surgeon at 2 am, or offering to cover that holiday shift for your senor partner for peanuts, we're nothing more than cheap hookers trading our souls for kitchen tables on craigslist

Very soon lubrication is going to be optional too

 

[BuzzPhreed]

Okay I've now read through this entire thread now and got up to speed.

I think there were some good points (minus the pissing contest) early on given both camps positions. However I also think that the VolatileAgent dude got a couple of things wrong.

First off, I worked in a practice where the CRNAs were employed by the practice. I did not make things better. It made them worse. All of the money flowed into the practice and went straight to the top. The result? I was put in compromising positions by the senior management without ever having the real promise of partnership. So I left. Rapidly. Once I figured out the real deal there.

This is essentially how AMC's are running nowadays. The truth is that, for the most part (and at least on the east coast), the true private practice model is dead... or dying quickly. And if you're a junior just getting out into the real world your hopes of becoming a partner are next to nil. And even if you do become a partner chances are you're not going to get a full stake because the guys who built the practice want to keep the majority of their stake for when they sell out.

So, what to do? If they treat you like an employee, act like an employee. Take your sick time. Demand that they indemnify you fully and don't force you to pay the tail if you leave. And don't sign-up for some ridiculous notice clause that makes you stay there for more than 90 days if you quit. Actually, we need to get completely away from this restrictive covenant horsesh*t and contracts altogether. These mother f*ckers are having their cake and eating it too. It stops when people refuse to take these kind of jobs and start treating you like the professional that you are, and not some red-headed stepchild that just deserves a beating.

 

[GA8314]

There's nothing wrong with doing 40 hours a week, no call no weekends for 225-300k. In fact, most new grads are wising up to the current bs partnership tracks and going this route, while having other side ventures or pursuing fellowship.

However, there is a problem with doing 60-70 hours a week at 250k so you can " buy in " over two years and then work the same hours for a flat salary <400k with little to no profit sharing as the suits are now taking the cut. That's if they decide make you partner and aren't just stringing you along.

Greed and laziness plagues us all, but especially anesthesiology. Our predecessors made a killing, then when times got rough took the hush money and left us in this predicament. Although, before we go pointing fingers, I doubt anyone in their shoes would've acted any differently given the circumstances. In the end we're all selfish..

But yes, as the great jet said, be affable, available, fast, efficient, pleasant, etc etc. But before you completely pull your trousers down, hunched over the OR table, measuring precisely how much urine has been produced for a 30min chole, just remember the rules have changed and the end game is no longer the same. We were once highly sought after world class escorts, and we were compensated as such. Now when you're stroking that surgeon at 2 am, or offering to cover that holiday shift for your senor partner for peanuts, we're nothing more than cheap hookers trading our souls for kitchen tables on craigslist

It's true that fair partnership track jobs are becoming fewer. Finding a fair deal with a fair group is definitely difficult. But, they do still exist.

Being limited geographically REALLY limits your job prospects, and I'd advocate for CA-3's and fellows to seriously consider broadening their horizons. Do you REALLY need to live in a certain area? Or us being up to 2 hours away (or more) for a smaller/mid-sized group with a good offer more in your cards?

If you want a "mommy track" job, there are plenty of AMC's which will pay you a decent amount of money as a daytime employee. But, if you want that PP/Partnership offer, then you may not find it in your back yard.

 

[criticalelement]

Actually, we need to get completely away from this restrictive covenant horsesh*t and contracts altogether. These mother f*ckers are having their cake and eating it too. It stops when people refuse to take these kind of jobs and start treating you like the professional that you are, and not some red-headed stepchild that just deserves a beating.

You are correct 100 percent but people need to work somewhere. It will get better when less anesthesiologists are produced or more retire from practice until then they will continue to Ass *** us.

 

[jetproppilot]

(ADDENDUM: I wrote this a cuppla years ago. Its got alotta useful information in it for you. I'm bumping it for the benefit of my CA-3 colleagues who may have missed it and are gonna be on their own in a few months.)


I'm starting a thread that I hope will be useful for the current and future CA-3s out there. At the end of this year, CA-3s, your life will take a dramatic change. You will have clinical responsibilities where your decision is the final decision. You will be faced with the new dillemas of becoming a team player in a group practice, where every decision/opinion/action you take will be scrutinized, with the end result being whether you become a partner or not. And you and I know your goal is to become a partner.......job security being the primary objective; major c-notes being the secondary objective.

Problem is, in academia where most of you currently reside, there is no guidance for emerging practitioners....academia will guide you up to and including your last case as a resident. Thats it. After that last anesthetizing case you perform, AMFYOYO. See ya. Youre on your own. Buh-bye.

My last case at Tulane (circa June 30th, 1996) was a 3 hour hysterectomy. After I was done, I went to my locker and cleaned out my stuff.. That was it. No........"So Bill, whats the practice that you're going to like? Group? Hmmmm....we've got a few former private practice dudes around here....why don't we have you talk with them to give you a little perspective of private practice life, OK?"......

.....nothing to that effect happened. And I venture to say most residencies out there are similar in that minimal advice is given to finishing-senior-residents.

This is a problem with academia, Dudes.

Things need to change in academia....most graduating residents matriculate into a private practice model and yet this IMPORTANT fact is ignored in your training. You are not prepared clinically, emotionally, and business-wise for such a career jump....a jump that we all make. Hopefully some academic-deities will read this and realize the existent black hole in their residency program.

My goal is to recruit my fellow private practice dudes (Mil, Noy, UT) to post here in an effort to guide you through the right way to matriculate into a private group from residency, with the ultimate goal being you hit partnership (read: 6th round NFL draft pick salary).

And here, I'll take a bit of a tangent for med students/interns.

This kinda info may not be for you.

Maybe you're an individualist destined to secure power in your practice of medicine.

I respect that.

I'll also tell you that if you've selected anesthesia as a specialty you're probably not destined for stardom. Yeah, if you really want it you can become a John Tinker/Alan Kaye/Michael Roizen. But most of us out here making our living at this profession are flying under the radar. By definition we are the offensive line of medicine. We are the players that nobody really cares about.

You're either comfortable with that or you're not.

And if you are not, you probably need to select another specialty. Deep-six your anesthesia selection and go for heart surgery. Transplant. Family Practice/Pediatrics/Internal Medicine in a rural area where youre da man. Something that you can potentially have your name in the paper for.

And because of the (egocentric) personalities I've seen here on SDN and because of my periodic exposures to unhappy anesthesiologists, I'm gonna string this out a bit..... and I want you to think about this long and hard.....if you select anesthesia to pay your bills you will never be more than a supporting actor. The Brad-Pitt-of-surgeons will always steal the thunder. They are the glory boys. You are the (metaphorically) short, bald dude on Seinfeld.

A crucial aspect of the perioperative environment?

Absolutely.

The lead role?

Absolutely not. You are the offensive lineman. The punter that comes on in a crutch and kicks a fifty-six-yard punt. Or a field-goal kicker. You are Morten Anderson. Mr. Carney of the New Orleans Saints. Grammatica.

Again, get comfortable with this. And if this makes you uncomfortable take another route that'll satisfy your needs.

Are you comfortable being a sixth-round offensive lineman for the Tampa Bay Buccaneers?

Yes?

Great.

Then hear me out cuz you can personally benefit greatly. You can be in the top tier of reimbursement in the physician milleau.

TOTALLY different ballgame out here compared to the academic environment you are used to, folks.

Out here its about accomodating surgeons (without giving a "kiss-ass" impression), providing superior patient care, and getting the cases done as fast and efficient as possible.

Thats it.

Pretty simple s h it, huh?

Kinda like poker in that it takes a few minutes to learn but a lifetime to master.

So I'll start with a few suggestions and I'm sure my colleagues will chime in with ARE YOU READY FOR PRIVATE PRACTICE suggestions.

1) Now that you're employed by C-NOTE ANESTHESIA, LLC, its important, at least initiallly, to lose your individuality. Don't take that the wrong way. No, the group doesnt want a robot. They picked you, so thats a good thing. What a group doesnt want out of a new-hire is a dude/dudette who is inflexible, who insists on doing a certain situation a certain way..

...but heres a very important kicker....they arent gonna point this out to you. You either figure this out on your own and get accepted, or....uhhhhhh....you fall into the unliked, inflexible category.

Clandestine profiling going on???....Absolutely.

You may never hear a negative comment until your pink slip is presented. You either make the grade or you don't. On your own.

Most successful private groups are successful for a cuppla reasons: they are deft at anesthesia, and they know how to keep people happy. Successful anesthesia groups are able, amicable, and available.

You're used to putting the IJ in a CABG before induction but your new group typically does it after? Time for you to adapt to the group way.....you like a tube for knee scopes but the group exclusively uses LMAs? Youre used to regional for fem-pops but your new group does all GA??....same message....unless patient outcome is affected, fall into line....


Your new group will expect you to fall into line, not make waves, all the while with a smile on your face. Make conversation with the ortho dude during the 11pm hip ORIF. Make the impression that no matter what the request, you're happy to do it. Being a new-hire is not the time to take a stand about an issue. If presented with something weird, like a 2am BTL, do it. Then the next morning, call one of the senior partners and ask them if what occurred is normal. If it is not, the senior partner will address it. Not your turf right now. Later when you are a partner, yes. Now, no.

2)Make yourself irreplaceable. Private practice is all about speed, efficiency, and proficiency. Don't waste time. Don't do twenty minute pre-ops. Don't take twenty minutes to do anything. If you are taking twenty minutes right now to do an A-line/central line/epidural/etc, work on it NOW. Make yourself da masta. Problems? Seek out a deft attending and watch how he does it. Emulate him.

You are a CA-3 now. You need to concentrate on making yourself better, right now. Pick up the pace on your labor epidurals. Yeah, nobody gives a s h it how long you take right now....but come July on your first month with C-Note Anesthesia LLC, if you leave the main OR to go put in an eoidural and you return 45 minutes later, thats a problem.
More optimistically, if you leave the main OR for a labor epidural and you are back on the floor 15 minutes later, the senior partners will notice that.

3) There are a handful of procedures that we private practice dudes do every day. And the more deft you are at those procedures as a new hire, the better you're gonna look. Central lines, A lines, epidurals, spinals, interscalene blocs, axillary blocks, and of course intubations, are the crux of our procedural world. The better you are at those procedures, the better you're gonna look. Make an effort right now, as a resident, to optimize your skills. Think about speed, something your academic-attendings won't emphasize........believe me, they should be emphasizing speed...but thats another thread altogether.......

....are you at a residency where thats impossible? Where you do three interscalenes annually and yet the group you joined does three interscalenes daily?....its all good.......just be prepared to humbly learn from your senior partners. Watch them. Learn from them. Emulate them. All the while thinking about the Holy Grail....

4) Accept the fact that for at least the first year of private practice, you need to just go-with-the-flow. Don't make waves. Don't cancel cases unless you are absolutely sure its gonna affect patient outcome. Don't complain about your schedule. Don't make enemies with surgeons/CRNAs/circulators/administrators.

Gotta orthopedist wanting to do a hip ORIF on an ICU patient in florid pulmonary edema (yep, a situation I remember)? Well you gotta step up to the plate and say absolutely not.

Conversely, gotta true urgent-yet-not-emergent case being postponed 2 more hours because of NPO issues, with the surgeon sitting in the doctors lounge? Step up to the mike. Call for the patient.

5) So You're on call today. You are running the board.

Anticipate. Think ahead. Dr Smith the orthopedist just started a knee scope. How long does he take? 30 minutes? If he's got a case to follow, have you sent for the next patient? If the next case requires intervention by you (i.e. epidural for TKA), make sure everything is finished before Dr. Smith is done with his knee scope. Have the to-follow knee replacement in the holding area, epidural in and dosed before he is finished.

Go to the front desk frequently. Ask "has anybody pre-opped?" That one question will keep you informed if you've been busy doing something else......HAS ANYBODY PREOPPED???....if the answer is yes then you may be behind the eight-ball already. It is difficult, but doable, to stay ahead of an OR schedule. But thats your job. Thats how you can make yourself invaluable. Staying ahead of the OR schedule.

6) Be flexible. Hmmmmm....senior partner going to Las Vegas in November and needs you to switch a cuppla calls? "No problem, dude" is the right answer. I'm not implying that you incur abusive behavior, but hey, this is real life....and people periodically need to switch schedules. Make it a point during your partnership-trek to be flexible. Cuz this is the kinda s h it thats remembered come your partner-anniversary day

So thats a good start, albeit introductory. Theres a million things we need to cover on this subject, and I want my resident colleagues out there to hear the salient ones concerning successful private practice matriculation.

REAL WORLD info. Period. No holds barred. Love it or leave it. Thats how it goes down out here.



MIL, NOY, UT et al,

chime in with your wisdom.

A 2006 Post that's Still Being Circulated.
UHHHHHH....it's 2015 LOL......guess this info was RELEVANT....

 

[aka_tigerj]

A 2006 Post that's Still Being Circulated.
UHHHHHH....it's 2015 LOL......guess this info was RELEVANT....

Very, very relevant. Thanks JPP

 

[ccarm6]

JetPropPilot and other voices of wisdom in the field of Anesthesia,
I know I am far below and years away as an M3 who has been interested in the field of Anesthesia since prior to entering med school, but I am curious if you would still pick Anesthesia as a career if you could do it all again? Are the conditions in the real world (read: other side of residency) as bleak as this forum's depression ridden comments are making them out to be? Is there any indication as to what the future of the field of Anesthesia is going to look like as someone who will be class of 2021-22 from residency/fellowship?

 

[Chloroform4Life]

JetPropPilot and other voices of wisdom in the field of Anesthesia,
I know I am far below and years away as an M3 who has been interested in the field of Anesthesia since prior to entering med school, but I am curious if you would still pick Anesthesia as a career if you could do it all again? Are the conditions in the real world (read: other side of residency) as bleak as this forum's depression ridden comments are making them out to be? Is there any indication as to what the future of the field of Anesthesia is going to look like as someone who will be class of 2021-22 from residency/fellowship?

Let me look into my crystal ball....

Ahhhhhh, yessss, I see now.... 2022.

The president of the U.S. is Paul Ryan after Hillary Clinton crashed the U.S economy. National debt is now 30 trillions and is 200% our GDP.

CRNA groups own contracts with hospitals and hire anesthesiologists to do their preops and sign their charts so they can pass on their liability in case they kill someone.

Seriously though...things will likely get worse in the future before it gets better. A lot can change in a 30-years career. No one can see what will happen 1 year in the future, let a lone 5 or 6. Maybe AMCs will crash and burn with the changes in healthcare, maybe they won't. Maybe data will come out to show that CRNA practices lead to worse outcome (now that we're starting to collect more outcome data for the ACA), maybe they won't.....A lot can change.

If I had to pick my specialty again, I'll still probably do anesthesia but might consider interventional radiology. Everything is trending toward intravascular and more minimally invasive procedures, leading to more demands. Don't have to worry about mid-levels or dealing with surgeons/administrators as much.....

 

[deleted162650]

JetPropPilot and other voices of wisdom in the field of Anesthesia,
I know I am far below and years away as an M3 who has been interested in the field of Anesthesia since prior to entering med school, but I am curious if you would still pick Anesthesia as a career if you could do it all again? Are the conditions in the real world (read: other side of residency) as bleak as this forum's depression ridden comments are making them out to be? Is there any indication as to what the future of the field of Anesthesia is going to look like as someone who will be class of 2021-22 from residency/fellowship?

I don't know, it's gonna be hard to be a blind anesthesiologist. I assume you're blind of course because you apparently didn't see the 38 other threads addressing this exact topic, some at great length.

 

[ERRES2288]

I'm also a M3 planning on anesthesia however EM is gaining ground quick as I think EM's future is more stable with a very high $$$/time ratio.

 

[amLOLdipine]

I'm also a M3 planning on anesthesia however EM is gaining ground quick as I think EM's future is more stable with a very high $$$/time ratio.

And a extremely high burnout rate.

Plus, EM is just as vulnerable in terms of mid-levels.

 

[ERRES2288]

And a extremely high burnout rate.

Plus, EM is just as vulnerable in terms of mid-levels.

Not true. In the new medscape survey, EM was 55% burnout and anesth was 50%. Most specialties averaged right around 50.

While EM is subject to mid-levels it is not nearly as bad. There is a much greater shortage of EM docs currently. Now 20 years from now, who knows.

 

[Ronin786]

Well now you can do both EM and Anesthesia, takes the guessing out of it.


http://forums.studentdoctor.net/threads/combined-anesthesia-em-residency.1193584/

 

[bashwell]

EM vs anesthesia burnout is probably more dependent on personality than the fields themselves. Just a few examples:

-Some dislike waking up early in the morning, others dislike night shifts or rotating shifts.

-Some dislike having to monitor for hours, others dislike being interrupted every few minutes.

-Some dislike working with surgeons or being second fiddle to the surgeon, others dislike that specialists often second guess you.

-Some dislike that they only have maybe 10-15 minutes of interaction with patients, others dislike all the annoying ED patients (e.g., drug seekers, alcoholics, GOMERs, psych issues).

-Some dislike that their work is essentially critical care in the OR, others dislike that they don't get enough emergent cases and too much social bs.

-Some get stressed out by having to be "the guy" or "the girl" who has to secure the airway when surgeons and everyone else are watching and waiting on them, others get stressed out by having to multitask and handle multiple patients at the same time while in "the fish bowl".

-Some get nervous when they have to take over the breathing for patients who are then possibly minutes or seconds away from death if anything should go wrong, others get nervous when patients and consultants are yelling at them and the hospital is pushing them to move the meat along.

Etc

 

[ccarm6]

I don't know, it's gonna be hard to be a blind anesthesiologist. I assume you're blind of course because you apparently didn't see the 38 other threads addressing this exact topic, some at great length.

Well I guess you're living up to your name, SaltyDog. Sorry to annoy you, new to the whole SDN thing and just trying to justify that my choice in Anesthesia is the right one and that the future of the field looks promising.

 

[amLOLdipine]

Well I guess you're living up to your name, SaltyDog. Sorry to annoy you, new to the whole SDN thing and just trying to justify that my choice in Anesthesia is the right one and that the future of the field looks promising.

If it's any consolation (and you probably know this if you've done an anesthesiology rotation), most anesthesiologists I've met in real life are really laid-back. Probably some of the most approachable physicians you will find in any specialty.

 

[Man o War]

I'm also a M3 planning on anesthesia however EM is gaining ground quick as I think EM's future is more stable with a very high $$$/time ratio.

Your risk of being replaced by a midlevel as an EM doc is going to be much greater in my opinion.

 

[Consigliere]

Well I guess you're living up to your name, SaltyDog. Sorry to annoy you, new to the whole SDN thing and just trying to justify that my choice in Anesthesia is the right one and that the future of the field looks promising.

It doesn't - it's dismal. Caveat emptor.

 

[criticalelement]

burnout rate.

Plus, EM is just as vulnerable in terms of mid-levels.

Anesthesia is much much much more vulnerable. We have been widgetized completely except for the ICU and pain. Other than those two subspecialties it doesnt matter who puts the tube in.. As i said before Curious George can be doing the anesthesia as long as patient is breathing at the end of the case.

Meet the Anesthesiologist of the future....

http://data:image/jpeg;base64,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

 

[projectpat]

Let's not degrade this great JPP thread into the same convo that's constantly repeated on this forum..

Go shadow an anesthesiologist or two


Sent from my iPhone using SDN mobile

 

[CabriniGreen]

Yeah, I might have more fun fishing than being a doctor, but 300k+ and job security and health care is worth something.
Oh, now I have to supervise some cute 20-something-year-old nurses? Ok!
At least I don't have to smell **** all day and can play golf more than your average 50 year-old retiree...ok!

 

[Chloroform4Life]

Yeah, I might have more fun fishing than being a doctor, but 300k+ and job security and health care is worth something.
Oh, now I have to supervise some cute 20-something-year-old nurses? Ok!
At least I don't have to smell **** all day and can play golf more than your average 50 year-old retiree...ok!

Only if they were all cute 20 something. Those generally have the best attitudes too.

 

[Consigliere]

Yeah, I might have more fun fishing than being a doctor, but 300k+ and job security and health care is worth something.
Oh, now I have to supervise some cute 20-something-year-old nurses? Ok!
At least I don't have to smell **** all day and can play golf more than your average 50 year-old retiree...ok!

If you think you'll have any job security as an anesthesiologist, then you've got a lot to learn.

 

[Psai]

Yeah, I might have more fun fishing than being a doctor, but 300k+ and job security and health care is worth something.
Oh, now I have to supervise some cute 20-something-year-old nurses? Ok!
At least I don't have to smell **** all day and can play golf more than your average 50 year-old retiree...ok!

Bro, what kind of lala land are you from

 

[deleted171991]

Bro, what kind of lala land are you from

Norway... the land of trolls.

 

[MirrorTodd]

Considering the doom that the profession has certainly undergone, I should just stay in military medicine then right? Since, it's gonna be impossible to make any real money and new grads are essentially screwed, why should anyone go into private practice at this point? Sorry to hijack Jet, your OP was fantastic and I'm willing to bet still applies today, but the defeatist mindset of so many posts just irks me. It's like the upper level equivalent of this:

 

[psychbender]

Considering the doom that the profession has certainly undergone, I should just stay in military medicine then right? Since, it's gonna be impossible to make any real money and new grads are essentially screwed, why should anyone go into private practice at this point? Sorry to hijack Jet, your OP was fantastic and I'm willing to bet still applies today, but the defeatist mindset of so many posts just irks me. It's like the upper level equivalent of this:

No, do not stay in milmed, unless your ADSO is already going to put you past the halfway mark to retirement. You get paid less than a civilian CRNA during your payback period, and only hit low to mid 200s if you take an added multi-year contract after that initial payback. You can do far better on the outside, even in today's market. It'll take a massive downturn in the civilian market for the military to look like a good long-term career choice for most physicians.

 

[sevoflurane]

Having never been in the military, I agree with PB.
I have been in PP for less than 10 years. Could honestly retire completely in a nother 5-7 years, but won't. Things are different but not THAT different.
I can tell you that I 100% would do it all over again in PP. The job is fun and private practice offers a lot of flexibility depending on your skillset and group/AMC (not all AMCs are built the same way-- Somnia is NOT Mednax or USAP)

Now as for opportunities... there still are plenty.

Join, make partner.
Join make partner and sell.
Join an AMC with no buy in.
Work at an ASC.
Go to BFE and cash in.
Start a ketamine infusion clinic.
If you are really lucky... you work in the mountains with @Noyac
It ain't over folks...

Just last week I was given the opportunity to become a shareholder in an ASC.

In the end there is nothing like a well run PP ship, yet there are still opportunities out there.

You want security? Go into surgery and deal with clinic.

They will still need an anesthesiologist in the OR to do the cases they went to clinic for.

 

[VolatileAgent]

i am 54 yrs old. been doing this now for over a decade. i gotta get at least ten more years out of this career.

the situation is worse than i tried to forewarn you about back then. go back and read this thing from the beginning. crnas are still employees for the most part. it doesn't matter where. being the mostly lazy and greedy bastards that we are, we still haven't effectively figured out how to include them and hence control them.

now they are demanding to do regional anesthesia and put in central lines at my current hospital. and the hospital is ****ing freaking out. why? because the hospital currently pays them **** and so they are leaving left and right. what is administrations solution? to increase the locum rate... which has only pissed off the full fte staff crnas even more. next step? they are pressuring our group to change the staff bylaws to allow them to do invasive procedures.

do the surgeons want this? hell no! but guess what? many of the surgical groups are employed by the hospital so administration has them by the short hairs.

dudes, the situation is getting worse. when you get slowly ****ed in the *** over a decade or longer, you learn to deal with the pain incrementally. go back and read this thread from the start. know what you're getting into.

get your chapstick out and pucker up. thats your future.

 

[Psai]

i am 54 yrs old. been doing this now for over a decade. i gotta get at least ten more years out of this career.

the situation is worse than i tried to forewarn you about back then. go back and read this thing from the beginning. crnas are still employees for the most part. it doesn't matter where. being the mostly lazy and greedy bastards that we are, we still haven't effectively figured out how to include them and hence control them.

now they are demanding to do regional anesthesia and put in central lines at my current hospital. and the hospital is ****ing freaking out. why? because the hospital currently pays them **** and so they are leaving left and right. what is administrations solution? to increase the locum rate... which has only pissed off the full fte staff crnas even more. next step? they are pressuring our group to change the staff bylaws to allow them to do invasive procedures.

do the surgeons want this? hell no! but guess what? many of the surgical groups are employed by the hospital so administration has them by the short hairs.

dudes, the situation is getting worse. when you get slowly ****ed in the *** over a decade or longer, you learn to deal with the pain incrementally. go back and read this thread from the start. know what you're getting into.

get your chapstick out and pucker up. thats your future.

Man **** that

 

[d9sccr]

I wasn't present, but heard that it was proposed to teach midlevels (NPs, not just crnas) regional and pain blocks at ASRA...and widely supported

 

[ZzzPlz]

i am 54 yrs old. been doing this now for over a decade. i gotta get at least ten more years out of this career.

the situation is worse than i tried to forewarn you about back then. go back and read this thing from the beginning. crnas are still employees for the most part. it doesn't matter where. being the mostly lazy and greedy bastards that we are, we still haven't effectively figured out how to include them and hence control them.

now they are demanding to do regional anesthesia and put in central lines at my current hospital. and the hospital is ****ing freaking out. why? because the hospital currently pays them **** and so they are leaving left and right. what is administrations solution? to increase the locum rate... which has only pissed off the full fte staff crnas even more. next step? they are pressuring our group to change the staff bylaws to allow them to do invasive procedures.

do the surgeons want this? hell no! but guess what? many of the surgical groups are employed by the hospital so administration has them by the short hairs.

dudes, the situation is getting worse. when you get slowly ****ed in the *** over a decade or longer, you learn to deal with the pain incrementally. go back and read this thread from the start. know what you're getting into.

get your chapstick out and pucker up. thats your future.

Wow two necro bumps to bitch. Rough call night?
Been there. Keep grinding brother. Save up so you don’t have to work another 10 years where you’re not happy

 

[Mman]

Wow two necro bumps to bitch. Rough call night?
Been there. Keep grinding brother. Save up so you don’t have to work another 10 years where you’re not happy

after a 9 year and 9 month posting hiatus (Feb 2009 was their last post).

 

[VolatileAgent]

Wow two necro bumps to bitch.

go back and read the entire thread. i warned you guys about this **** ten years ago. militarymd? HA! his compnay employs CRNAs now! if he dare show his face here again, he won't deny it. he can't. he works as an employee now through a subsidiary of a AMC called Epix out of atlanta. (that's as far as i will out him so no ToS violation) i love looking back at his attempt at schooling me about how things really work. what a joke.

i got stories. trust me. it's been a while since i posted, yes. but change is subtle and takes years. it's the slow chipping away. slow grinding down. it has been going on relentlessly in the background. everyone is getting ***ed. not just anesthesiologists. the corporate boobs are taking over.

i'm just trying to survive it, squirrel away enough money, and then go retire somewhere like belize or costa rica. that's my escape plan. i told you guys this **** was gonna happened. people wanted to make it personal instead.

go back. read the thread.

 

[VolatileAgent]

so the question is when any of you guys are going to say enough is enough and fight to take back our profession? or are we as doctors going to continue to let "them" dictate what we do?

 

[Mr.S]

go back and read the entire thread. i warned you guys about this **** ten years ago. militarymd? HA! his compnay employs CRNAs now! if he dare show his face here again, he won't deny it. he can't. he works as an employee now through a subsidiary of a AMC called Epix out of atlanta. (that's as far as i will out him so no ToS violation) i love looking back at his attempt at schooling me about how things really work. what a joke.

i got stories. trust me. it's been a while since i posted, yes. but change is subtle and takes years. it's the slow chipping away. slow grinding down. it has been going on relentlessly in the background. everyone is getting ***ed. not just anesthesiologists. the corporate boobs are taking over.

i'm just trying to survive it, squirrel away enough money, and then go retire somewhere like belize or costa rica. that's my escape plan. i told you guys this **** was gonna happened. people wanted to make it personal instead.

go back. read the thread.

You are spot on my friend. Spot on. I wish I had gone into ER medicine. I know thats not roses either , but at least I am the patients primary doctor which gives me some leverage with the corporate heads. In Anesthesia I dont even have control of the patient.

 

[Mr.S]

so the question is when any of you guys are going to say enough is enough and fight to take back our profession? or are we as doctors going to continue to let "them" dictate what we do?

There are people at the ASA, AMA and in academic medicine who are undermining your argument daily.. How are you going to win against these folks?
You can go on a crusade to not give money to ASA and have ASA membership drop off by 50 percent. And write articles and call residency programs etc etc etc about not joining the ASA
That wont go un noticed believe me.

 

[Noyac]

Wow. That’s one hell of a grudge to hold, 9+ yrs.
don’t get me wrong, I’m not disagreeing with your statements.

But on the surface it seems like your group does not have any clout. It seems as your group may have been living high on the hog.

 

[VolatileAgent]

REAL WORLD info. Period. No holds barred. Love it or leave it. Thats how it goes down out here.

where are you jetprop? i miss your self-congratulatory and bombastic style. you are old skool.

things aren't anymore like what you described back then. i think we're about the same age, you're probably still in NoLa area, and you've seen it change. your old skool PP recs are 12 years too late now.

most new grads will have to suck-up the deal that Envision, Mednax, Amsurg, etc. healthcare offers them. you go to some sweatshop job and you'll get some 23 yr old circulating nurse (who just learned what a Allis clamp is last week) who is fully capable on commenting and criticizing your care in the OR. and you'd better listen to her because if you piss her off she's going to complain to management and you'll get that pink slip you warn about, jet.

it's different now. everything is done by committee. you sit in ****ing meetings and there's no discussion, just people who've never even taken a college biology course telling you what they expect from you.

good luck.

me? i'm saving up. i'm checking out. just can't do it now. your rules, jetprop? nice ideals that no longer apply. relics of a bygone era. the jobs you're talking about don't exist anymore. even when you're a full partner in a private practice group (which i am and is rare these days) slowly, the encroachment starts to bury you. our service agreement makes me a de facto employee and i'm completely beholden to the hospital.

chapstick. pucker. and kiss the ass. or do something else with your life.

 

[VolatileAgent]

But on the surface it seems like your group does not have any clout.

haha. clout. that's rich. they will shut any practice down who doesn't pucker and suck. clout? i don't even know what that means. the system hired an AMC at one of their affiliates. they are woefully unhappy with them. do you think that stops them from threatening us with dropping our services agreement every time we renegotiate? clout. that's rich.

It seems as your group may have been living high on the hog.

i have no idea what you mean by that. our subsidy, by industry standards, is a joke. it's martyrdom. it barely covers our costs and doesn't even remotely approach an FTE. jesus christ himself wouldn't have agreed to it. and we cover some next-level ****, especially when it comes to OB.

 

[VolatileAgent]

you know why the negotiate with us at all Noyac? because they have to.

as soon as that changes? they'll stop. it's business. not personal. and, even at a non-profit, it's never about the patient. only efficiency and cost-containment. that's how administrator jerks careers are built and not by taking care of people.

 

[sevoflurane]

I wasn't present, but heard that it was proposed to teach midlevels (NPs, not just crnas) regional and pain blocks at ASRA...and widely supported

Ugh... leadership in their own bubble at it's best.

 

[sevoflurane]

Ohhh VA... good to see you back on this board bro. Long time since residency.
Hope you are navigating these waters to your advantage.
You are right on so many levels. I feel you, and we all should.
Come out west... it's still pretty descent over here, for now...

 

[dannyboy1]

most new grads will have to suck-up the deal that Envision, Mednax, Amsurg, etc. healthcare offers them. you go to some sweatshop job and you'll get some 23 yr old circulating nurse (who just learned what a Allis clamp is last week) who is fully capable on commenting and criticizing your care in the OR. and you'd better listen to her because if you piss her off she's going to complain to management and you'll get that pink slip you warn about, jet.

Speaking as one of the new grads. I work for an AMC in the northeast. Typically I work around 45 hours/week and take one weekend call/month. Mix of supervision and doing my own cases. For this fairly easy work I make close to 400,000 per year. You guys who experienced the heyday of PP may think this sucks but my only point of reference is residency and this sure beats that. BTW you always need to smile and make nice to nurses, you should have figured that out in internship....

 

[VolatileAgent]

Speaking as one of the new grads. I work for an AMC in the northeast.

you are an employee. good for you. millenials don't seem to have a problem with this concept. wait a few years until that pay is cut in half and see how you feel. (p.s. i'm currently outpacing your salary by about 25-30% and i don't answer, directly at least, to anyone else but my partners)

BTW you always need to smile and make nice to nurses, you should have figured that out in internship....

this has nothing to do with what i was talking about, jr.

 

[VolatileAgent]

Ohhh VA... good to see you back on this board bro. Long time since residency.
Hope you are navigating these waters to your advantage.
You are right on so many levels. I feel you, and we all should.
Come out west... it's still pretty descent over here, for now...

good to hear from you too, [mod edit]. and nice to see you still around here. yeah, west of mississippi is still relatively untouched, but it's coming. i'm doing okay in PP but just getting sick of the encroachment and the concessions. it's only a matter of time before we kowtow completely to the nurses. we missed the boat not bringing them in and making them part of the team. and the AAs just haven't taken off like i'd hoped by this point.

[mod edit] rules, dude. love that side of [mod edit].

 

[Psai]

I wasn't present, but heard that it was proposed to teach midlevels (NPs, not just crnas) regional and pain blocks at ASRA...and widely supported

What's the point of that? They don't like having jobs?

 

[VolatileAgent]

First off, I worked in a practice where the CRNAs were employed by the practice. I did not make things better. It made them worse.

okay, so that's one example. so what? doesn't tell us much. your practice probably didn't make them shareholders or otherwise have a stake so they were just employees like they would have been working for the hospital.

the point is the paradigm needs to shift. i've been doing this long enough that i know what gets int their heads: they believe they do the exact same job as us. many of them. not all of them. and, until we acknowledge and try to reward those who are good and loyal and reign in the others, we're going to keep having meetings with administration like the one i had today.

my proposal is that you tier it - separately - just like you do with associates joining your practice. i'm not talking about working it like your some mini AMC. i'm saying you bring in and control all the talent. this way, you dictate who does what and not through administration. **** gets handled internally before it even gets to administration.

people like to be owners. i'm an owner. i get it. when you work with nurses who are hospital employees - some of them even unionized - "grievance" takes on a whole new meaning. you are forced to deal with people. you are forced to sit in meetings and listen to all manner of ridiculous bull****. why? because you have abrogated control

this is what has to stop.