How long to stay at first job

[makemoney2024]

Once upon a time I got recruited to do some locums cardiac anesthesia work at a hospital that was very, very short staffed.

I asked for what I thought was a ridiculous hourly rate ($270/hr + travel hotel & per diem for day work / no call back in 2018) and they immediately agreed. Should've asked for more.

I got credentialed, scheduled a few weeks of coverage over a few months, showed up, got oriented to the ORs doing general stuff for a couple days, and spent some time in a heart with one of the regulars. Surgeon was perplexed to see me there but said nothing.

There was a second locums cardiac anesthesiologist there for his first week also.

Then they tried to put us in hearts and the surgeons said NO we don't work with locums. I was annoyed because half the reason I was doing locums at all was for the cardiac case load, since the Navy had just closed our cardiac surgery program. It blew my mind that the hospital and group went to the trouble of bringing in multiple cardiac locums without even asking the surgeons if they'd work with locums.

The group was apologetic but didn't push the issue. I shrugged, and worked my scheduled weeks getting paid really well to sit healthy gen surg and urology cases. I think one of their partners canceled a vacation to do the cases I was going to do. I didn't go back.

So I totally understand the distrust surgeons can have for locums. Rational or irrational, it's a thing.

But as enormous a pile of bull**** that whole experience was, those surgeons didn't stoop to trying to pimping me.

It's weird that you think this is OK or normal.

We have normalized a lot of toxic bull in medicine. Hence why he thinks this is normal.

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[Ronin786]

Pimping by surgeon is asking what the plan is going to be. And how much you know about the patient. It’s not asking about anatomy or physiology. Basic history of the patient and your your plan for the patient. I don’t think it’s that far fetch to a conversation to have with any fellow surgeon

I think people are taking it as an exam pimping. It’s simply like an icu handoff report. The icu doc wants to know as much about the patient you are handing off. Or do you guys don’t even talk to the icu doc anymore when you transfer a patient over to their service?

Even then, why would a surgeon ask for "my plan" for a patient? That would still be very unusual.

 

[pgg]

Not backpedaling. Read my post. I said surgeons will grill new locums

You write a lot of really weird stuff.

There's a difference between collegially and professionally talking to another physician about a patient, and pimping, grilling, quizzing, interrogating, cross-examining, or whatever word you'll choose next, to describe the toxic bull**** that's actually happening in the scenario you describe.

You're not talking about an exchange of information relevant to the care of a patient. You're specifically describing an adversarial interview process to test another physician. And it's wildly bizarre that you think that's a tolerable state of affairs.

 

[neutro]

In my experience it’s overwhelmingly the other way around.
Like doing big open belly cases - no Hb done. Forget T/S etc

Patient shows up and now you deal with it.

Surgeon doesn’t even care or follow up with the patients and often would blame their “clinic”. They’re often clueless.

Not saying all are like that nor do I make a big deal about it or delay the care. Just let it go and deal with it. But I wouldn’t make a conclusion that “surgeons know their patients”.

The funniest are the ortho guys. Last year at an ASC, patient comes for total shoulder and was taking flecainide prn (as opposed to how it was prescribed by the cardiologist)

Preop HR 156…lol…of course defer the case

The ortho surgeon was so persistent that it HAD to be done, and “it’s just a cardiac med like aspirin”. I almost fell off my chair hearing that - I said let’s meet in 2 weeks. Sometimes you have to be gentle. No point in arguing with someone who is so far away from your mental wavelength.

 

[aneftp]

Even then, why would a surgeon ask for "my plan" for a patient? That would still be very unusual.

Say what? You have critically ill patients sometime and surgeons who don’t know you.

They have a right to ask you what your plan to do with the patient with their cases.

Is there something wrong with the surgeon asking you what the plan is?

this is where surgeons and other non anesthesia staff get pissed off at anesthesia with this attitude.

And I’ll tell you this for a fact. Even at my place when we had locums docs. The ones with this attitude were used last or not at all.

Trust me. Surgeons give feedback if there is other 1099 locums staff available to use.

 

[Ronin786]

Say what? You have critically ill patients sometime and surgeons who don’t know you.

They have a right to ask you what your plan to do with the patient with their cases.

Is there something wrong with the surgeon asking you what the plan is?

this is where surgeons and other non anesthesia staff get pissed off at anesthesia with this attitude.

And I’ll tell you this for a fact. Even at my place when we had locums docs. The ones with this attitude were used last or not at all.

Trust me. Surgeons give feedback if there is other 1099 locums staff available to use.

I don't know what surgeons you're working with. What kind of question is any surgeon going to ask me about my plan for a low EF patient or a COPD'er? That's like me having an opinion on their choice of mesh or anastomosis.

 

[aneftp]

You write a lot of really weird stuff.

There's a difference between collegially and profesisonally talking to another phyaician about a patient, and pimping, grilling, quizzing, interrogating, cross-examining, or whatever word you'll choose next, to describe the toxic bull**** that's actually happening in the scenario you describe.

You're not talking about an exchange of information relevant to the care of a patient. You're specifically describing an adversarial interview process to test another physician. And it's wildly bizarre that you think that's a tolerable state of affairs.

Clearly I hit a nerve with the word “pimp”

Means a lot to a lot of people especially with younger newer medical grads.

Again. It’s sounds intimidating. It’s no difference than signing out to icu attendings. Attending to attending

It’s not like the neuro surgeon is going right at you and saying, “come here boy, show me the circle of willis”.

But new locums grads if they aren’t savvy how to handle the game will get exposed pretty quickly.

Locums places get fed back who they want and who they don’t want back. Sure some places are desperate and will put up with someone as long as they don’t kill the patient. But when there is competition for lucrative locums slot’s especially weekends that pay upwards to 10k per 24 hours guarantee. These places will have their pick who they want to use.

 

[nimbus]

Clearly I hit a nerve with the word “pimp”

Means a lot to a lot of people especially with younger newer medical grads.

Again. It’s sounds intimidating. It’s no difference than signing out to icu attendings. Attending to attending

It’s not like the neuro surgeon is going right at you and saying, “come here boy, show me the circle of willis”.

But new locums grads if they aren’t savvy how to handle the game will get exposed pretty quickly.

Locums places get fed back who they want and who they don’t want back. Sure some places are desperate and will put up with someone as long as they don’t kill the patient. But when there is competition for lucrative locums slot’s especially weekends that pay upwards to 10k per 24 hours guarantee. These places will have their pick who they want to use.

Usually places that use locums are desperate.

Friend of mine just spent 3 days covering hearts for $400/hr. She hadn’t done any hearts in over 5 years and they still accepted her. It’s not like they can pick and choose.

 

[pgg]

Usually places that use locums are desperate.

Friend of mine just spent 3 days covering hearts for $400/hr. She hadn’t done any hearts in over 5 years and they still accepted her. It’s not like they can pick and choose.

The disconnect between paying massive sums for locums, even by today's standards, yet picking and choosing who's allowed to work based on surgeon whim, is interesting.

 

[kidthor]

Like doing big open belly cases - no Hb done. Forget T/S etc

Yes and then combine that with their aspirational suggestion that they won’t bleed at all and that labs will now delay the case and it’ll be your fault that they miss afternoon clinic. Maybe throw in some “why can’t you just draw the labs in the OR” or “we can just give O- blood” too.

 

[aneftp]

I don't know what surgeons you're working with. What kind of question is any surgeon going to ask me about my plan for a low EF patient or a COPD'er? That's like me having an opinion on their choice of mesh or anastomosis.

The surgeons want you to communicate what the plan is. Extubate or keep intubated. Icu or no icu in high risk cases. It’s basic 101 anesthesia

Usually places that use locums are desperate.

Friend of mine just spent 3 days covering hearts for $400/hr. She hadn’t done any hearts in over 5 years and they still accepted her. It’s not like they can pick and choose.

U can pick and choose locums when the place is 10 min from the beach and it’s almost 80 degrees in middle of winter.

 

[makemoney2024]

Usually places that use locums are desperate.

Friend of mine just spent 3 days covering hearts for $400/hr. She hadn’t done any hearts in over 5 years and they still accepted her. It’s not like they can pick and choose.

Wow!

 

[aneftp]

Wow!

Yup. My buddy just nailed it for 62k the other week covering hearts all guaranteed rate even on beeper in upper Midwest. (On his week post beeper call).

That’s what I’m trying yo tell u guys. Keep the full time job for 450-500k. Get the post beeper call week off. So double ur Vacation from 8 to 16 or 10 to 20 weeks off

Do locums on ur post beeper call weeks (the places that offer beeper calls).

Best of both worlds. Stability of full time gig. Plus plenty of time to make another 200-400k extra on the side plus still keep ur 8-10 weeks vacation to take real vacation

 

[Ronin786]

The surgeons want you to communicate what the plan is. Extubate or keep intubated. Icu or no icu in high risk cases. It’s basic 101 anesthesia

U can pick and choose locums when the place is 10 min from the beach and it’s almost 80 degrees in middle of winter.

I'm going to drop it since you're clearly backtracking from what you said earlier. But if your surgeon friend's criteria of whether a grad is good or bad is based off of those questions, he needs to work a little harder.

 

[GravelRider]

The surgeons want you to communicate what the plan is. Extubate or keep intubated. Icu or no icu in high risk cases. It’s basic 101 anesthesia

U can pick and choose locums when the place is 10 min from the beach and it’s almost 80 degrees in middle of winter.

That’s fine. I also “pimp” my surgeons daily about things like expected duration of procedure, expected blood loss, potential complications, need for regional adjuncts for pain control, etc..

Discussing broad strokes of my anesthetic plan like plan for access, a-lines, and need for post-op ventilation is not pimping. It’s professionalism. In a straightforward case this discussion could be as simple as “you ok with an LMA?” These are basic things that I thought even CA1s did? Your original post made it seem like people on the locums trail should be prepared for a sequel to the oral boards.

 

[makemoney2024]

Yup. My buddy just nailed it for 62k the other week covering hearts all guaranteed rate even on beeper in upper Midwest. (On his week post beeper call).

That’s what I’m trying yo tell u guys. Keep the full time job for 450-500k. Get the post beeper call week off. So double ur Vacation from 8 to 16 or 10 to 20 weeks off

Do locums on ur post beeper call weeks (the places that offer beeper calls).

Best of both worlds. Stability of full time gig. Plus plenty of time to make another 200-400k extra on the side plus still keep ur 8-10 weeks vacation to take real vacation

Wait. She is doing hearts the entire time? For the entire weekend? It’s in house or something? Or they pay a flat rate regardless. Trying to figure the 62k number.
Never mind. I see it now. How does this guy or gal negotiate this? Directly or through a Locums company?

 

[aneftp]

Wait. She is doing hearts the entire time? For the entire weekend? It’s in house or something? Or they pay a flat rate regardless. Trying to figure the 62k number.
Never mind. I see it now. How does this guy or gal negotiate this? Directly or through a Locums company?

That’s why u gotta be veteran savvy. Locums is a learning experience. I’m trying to teach new grads or newer grads how to handle themselves. Keep the peace. First impressions matter.

This is from two plus decades of experience.

People may think I say weird things but there is a lot of truth to what I say.

Everything is negotiable. Flat rate PLUS CALL STIPEND.

He negotiated through locums company. And he doesn’t even do hearts at his main place.

I dabble myself. I have another 52-55k week coming up myself. The money is in the call coverage. I really don’t care for weekdays to be honest. 80-90% of the work is done 7-5p most places.

 

[nimbus]

U can pick and choose locums when the place is 10 min from the beach and it’s almost 80 degrees in middle of winter.

This place is 10min from the beach, temp in the 60s but it has been rainy recently.

 

[makemoney2024]

That’s why u gotta be veteran savvy. Locums is a learning experience. I’m trying to teach new grads or newer grads how to handle themselves. Keep the peace. First impressions matter.

This is from two plus decades of experience.

People may think I say weird things but there is a lot of truth to what I say.

Everything is negotiable. Flat rate PLUS CALL STIPEND.

He negotiated through locums company. And he doesn’t even do hearts at his main place.

I dabble myself. I have another 52-55k week coming up myself. The money is in the call coverage. I really don’t care for weekdays to be honest. 80-90% of the work is done 7-5p most places.

Well some of us aren’t that lucky. Not from lack of trying. I have not been able to negotiate a continuous rate for sitting at home but am overall happy w my hourly rate.

 

[aneftp]

Well some of us aren’t that lucky. Not from lack of trying. I have not been able to negotiate a continuous rate for sitting at home but am overall happy w my hourly rate.

It all comes and goes.

I keep a backup locums place I may cover once every 2 months. It doesn’t pay a continuous rate but its fairly consistent work whenever I want it.

Just have 3-4 places credential simultaneously to juggle them. I don’t rely on one place. As one door closed. The other opens up. Even this one place. I hadn’t worked for almost 18 months but they needed help again. Best of all I can roll from my regular w2 job and go take a 1099 friday night call there without any gaps on work time. Literally finish up at 2-230pm and drive 20 min and take call for extra cash. Finish up around 9pm. Drive home. If they call me back that’s fine. If not I’m sleeping in my own bed.

 

[makemoney2024]

It all comes and goes.

I keep a backup locums place I may cover once every 2 months. It doesn’t pay a continuous rate but its fairly consistent work whenever I want it.

Just have 3-4 places credential simultaneously to juggle them. I don’t rely on one place. As one door closed. The other opens up. Even this one place. I hadn’t worked for almost 18 months but they needed help again. Best of all I can roll from my regular w2 job and go take a 1099 friday night call there without any gaps on work time. Literally finish up at 2-230pm and drive 20 min and take call for extra cash. Finish up around 9pm. Drive home. If they call me back that’s fine. If not I’m sleeping in my own bed.

That’s great. I don’t want to be doing this 20 plus years out post residency.

 

[aneftp]

That’s great. I don’t want to be doing this 20 plus years out post residency.

If u have a wife and kids. And gone through 2 stock market crashes one of which took 7 years to recover and a housing crash which took 15 years to recover.

U will be working in 20 years

I only plan on working “full time” till my kids finish college. But that will be another 8-9 years.

 

[neutro]

Yes and then combine that with their aspirational suggestion that they won’t bleed at all and that labs will now delay the case and it’ll be your fault that they miss afternoon clinic. Maybe throw in some “why can’t you just draw the labs in the OR” or “we can just give O- blood” too.

Yeah….👍

 

[makemoney2024]

If u have a wife and kids. And gone through 2 stock market crashes one of which took 7 years to recover and a housing crash which took 15 years to recover.

U will be working in 20 years

I only plan on working “full time” till my kids finish college. But that will be another 8-9 years.

Note to self. No wife or kids. lol.

 

[DesiredMemberName?]

The surgeons want you to communicate what the plan is. Extubate or keep intubated. Icu or no icu in high risk cases. It’s basic 101 anesthesia

U can pick and choose locums when the place is 10 min from the beach and it’s almost 80 degrees in middle of winter.

But if they can pick and choose, why are they paying above market rates?

 

[aneftp]

But if they can pick and choose, why are they paying above market rates?

Follow the money trail.

It’s like government contracting where they charge $10 for a pencil.

And private corporation if it’s sub contracting out a project will only pay a contractor $1 a pencil. Because that money is coming out of the private corporation pocket book and not the govt pocket book.

Same with the Willis//wade Atlanta prosecutor trump fiasco where Willis paid wade 700k private contractor money to prosecutor trump and paid two other lawyers 70k

Get it? Because when SOMEONE ELSE is paying the locums money it’s easy to over pay LEGALLY for the same services they can get someone else to do cheaper.

That’s the way it works in the locums market.

Say I have contract directly with usap/anesthesia on call/envison/envoy/team health/dystsffing on call/napa/bridgecare. Follow who is actually paying the locums money. If the hospital entity is paying it. It’s open pocket book. The actual entities above named. They will want to hold on to their pocket book and be much frugal in paying u the rates or hours you want.

 

[Maz777]

Are u locums? At the trauma 1? That’s the real question. So you are new grad locums at trauma one facility? The trauma one facility in my area won’t even take locums docs not board certified. That means no new grads. They desperate. But not that desperate.

There is one thing being new grad and full
Time or semi 0.6 or whatever. And another thing being new grad locums at trauma one.

Look at my current hospital. Even when we had locums. None of them new grads locums. For locums, we need someone with experience. It can be a difficult place to work with high risk ob and gun shots etc. typical bs stuff.

I’m not trying to be bias anti new grad. We break our full time new grads in. No calls for few first weeks (when we regularly did take calls). Don’t throw full time new grads to the wolves. Introduce them to surgeons.

With locums. You don’t get that type of introduction.

You think much too highly of your gig. I have a news flash: you guys aren't special.

And you need new friends.

 

[aneftp]

You think much too highly of your gig. I have a news flash: you guys aren't special.

And you need new friends.

I have plenty of friends. Thank u very much.

No. There are better gigs. Always strive for better. Be a step ahead.

 

[NightyNight]

Yup. My buddy just nailed it for 62k the other week covering hearts all guaranteed rate even on beeper in upper Midwest. (On his week post beeper call).

That’s what I’m trying yo tell u guys. Keep the full time job for 450-500k. Get the post beeper call week off. So double ur Vacation from 8 to 16 or 10 to 20 weeks off

Do locums on ur post beeper call weeks (the places that offer beeper calls).

Best of both worlds. Stability of full time gig. Plus plenty of time to make another 200-400k extra on the side plus still keep ur 8-10 weeks vacation to take real vacation

Is your job beeper call all week? You coming in often in the evening or night and then working the next day? That can easily get tiring despite the ample time off.

 

[mysideofthedrape]

Yup. My buddy just nailed it for 62k the other week covering hearts all guaranteed rate even on beeper in upper Midwest. (On his week post beeper call).

Where are you guys finding these jobs? I’ve been in practice almost 8 years now and picking up some cardiac locums here and there with my vacation but never for that kind of money.

 

[aneftp]

Where are you guys finding these jobs? I’ve been in practice almost 8 years now and picking up some cardiac locums here and there with my vacation but never for that kind of money.

I just finished up a massive week. 50k plus again

U just have to shoot ur shot and ask. The worse they can say is no. I’ve had plenty of jobs say no to me. U move on. One of the beauties of having a full time job. I got the security of a full time job plus opportunity to do a week every 2 months or so.

Although im seriously thinking dropping down to 0.5 keep half the benefits.

It’s not forever. This current gig ends soon. Two locums docs are converting to full time. What’s funny is they took a much lower guarantee than me and only found out about it last 2 months It’s pretty chill job. Just not for me full time. So they been trying to Tanya Harding hit me at the knee caps Nancy Kerrigan style for the locums hours.

I already lined up something for the summer up north Guarantee 4 (24 hr) calls in a 7 day period. That’s a min of 96 hours I can bill. Got 2 crnas with me for the night. They said I can work post call as well. It’s easy math folks. That’s 40k just for the 4 calls. And anything else I want to make post call.

 

[makemoney2024]

I just finished up a massive week. 50k plus again

U just have to shoot ur shot and ask. The worse they can say is no. I’ve had plenty of jobs say no to me. U move on. One of the beauties of having a full time job. I got the security of a full time job plus opportunity to do a week every 2 months or so.

Although im seriously thinking dropping down to 0.5 keep half the benefits.

It’s not forever. This current gig ends soon. Two locums docs are converting to full time. What’s funny is they took a much lower guarantee than me and only found out about it last 2 months It’s pretty chill job. Just not for me full time. So they been trying to Tanya Harding hit me at the knee caps Nancy Kerrigan style for the locums hours.

I already lined up something for the summer up north Guarantee 4 (24 hr) calls in a 7 day period. That’s a min of 96 hours I can bill. Got 2 crnas with me for the night. They said I can work post call as well. It’s easy math folks. That’s 40k just for the 4 calls. And anything else I want to make post call.

Yea, I don’t want to kill myself though. Good for you I guess. Four 24 hour calls in a week sounds like a nightmare unless you are guaranteed sleeping that’s not all broken up.
I also belong to a FB group that helps each other out there on what’s out there. Unlike all this boasting here but no one is interested in dropping any hints of where these mythical jobs are for the ones who are interested in killing themselves.
I really don’t believe any of your stories.

 

[aneftp]

Yea, I don’t want to kill myself though. Good for you I guess. Four 24 hour calls in a week sounds like a nightmare unless you are guaranteed sleeping that’s not all broken up.
I also belong to a FB group that helps each other out there on what’s out there. Unlike all this boasting here but no one is interested in dropping any hints of where these mythical jobs are for the ones who are interested in killing themselves.
I really don’t believe any of your stories.

I’ve been around the block a long time. I don’t need to make any of this stuff. Couple of people do know me personally. They have seen my actual paystubs from locums gigs. Just like people don’t believe my 21% effective tax rates.

Go on the crna locums boards. They are also bank.

It’s not about boasting. It’s about educating those out there what income potential is out there.

Don’t sell yourself short. These jobs are all over the country. I just found my good friend a gig in the mid south 30 min from their home town to supplement. 40k for the vacay week. They got twin starting college in the fall so they got bills to pay.

U play with these recruiting agencies. Some will bite. Of course there are ones where u will kill urself. I just to stay clear of them. But for one week it may be worth it.

I belong to private fb groups also.

 

[NightyNight]

I’ve been around the block a long time. I don’t need to make any of this stuff. Couple of people do know me personally. They have seen my actual paystubs from locums gigs. Just like people don’t believe my 21% effective tax rates.

Go on the crna locums boards. They are also bank.

It’s not about boasting. It’s about educating those out there what income potential is out there.

Don’t sell yourself short. These jobs are all over the country. I just found my good friend a gig in the mid south 30 min from their home town to supplement. 40k for the vacay week. They got twin starting college in the fall so they got bills to pay.

U play with these recruiting agencies. Some will bite. Of course there are ones where u will kill urself. I just to stay clear of them. But for one week it may be worth it.

I belong to private fb groups also.

Interested to know your wisdom about IL and Indiana. I think I will have to 1099 for 2024 since the W2 jobs with benefits have too many demons that were not disclosed. Shady contract language.

Meanwhile, I’m watching the Wisconsin-Illini game with a US Bank guy. Has his own ski lift and not just some talk. He doesn’t work 50h. Even the underlings make 200-250k without sleeping in a crap bed once a week. Objectively medicine is a poor investment for all the increasing risks.

 

[gunnershow]

Yea, I don’t want to kill myself though. Good for you I guess. Four 24 hour calls in a week sounds like a nightmare unless you are guaranteed sleeping that’s not all broken up.
I also belong to a FB group that helps each other out there on what’s out there. Unlike all this boasting here but no one is interested in dropping any hints of where these mythical jobs are for the ones who are interested in killing themselves.
I really don’t believe any of your stories.

He does this by letting CRNAs run wild overnight and do whatever they want in order to get his 8 hours of sleep. He has admitted as much. There's no way a boomer anesthesiologist is doing 100h weeks of real work. If there are 2 CRNAs on overnight, it's a busy enough place that you shouldn't be sleeping much. But he has no loyalty to the practice or to their divisions of labor. Nor does he have any compunction over abandoning his patients and letting nurses play doctor.

In my experience with supervision, all it takes is for one lazy POS anesthesiologist to let CRNAs induce ASA 4s and do blocks, and now you've established an expectation that's impossible to ethically meet.

 

[aneftp]

Interested to know your wisdom about IL and Indiana. I think I will have to 1099 for 2024 since the W2 jobs with benefits have too many demons that were not disclosed. Shady contract language.

Meanwhile, I’m watching the Wisconsin-Illini game with a US Bank guy. Has his own ski lift and not just some talk. He doesn’t work 50h. Even the underlings make 200-250k without sleeping in a crap bed once a week. Objectively medicine is a poor investment for all the increasing risks.

A lot of small business that become much bigger does involve a lot of hook ups/connections.

Like this one guy in my neighborhood no college education. Couple of years community college. His uncle got him in the business of selling coffee cups to franchises like Dunkin’ Donuts Starbucks bmw etc. just a middle guy. Without connections no way he makes it.

As far as banking. There is a lot of hookups and connections. A certain religion likes to help each other in the banking industry. Some are legit. Some are outright criminals like sac and plokin who just happen to get away with technical aspects how they haven’t been brought down.

I’m sure that us banker with the ski business has been helped along the way. It rarely happens magically through hard work alone.

As for medicine. It doesn’t make u filthy rich. It’s also upper middle class career. If I had to do it over. I likely won’t. My kids won’t go into medicine. I’ll likely be in the tech business because that was happening as I started med school.

He does this by letting CRNAs run wild overnight and do whatever they want in order to get his 8 hours of sleep. He has admitted as much. There's no way a boomer anesthesiologist is doing 100h weeks of real work. If there are 2 CRNAs on overnight, it's a busy enough place that you shouldn't be sleeping much. But he has no loyalty to the practice or to their divisions of labor. Nor does he have any compunction over abandoning his patients and letting nurses play doctor.

In my experience with supervision, all it takes is for one lazy POS anesthesiologist to let CRNAs induce ASA 4s and do blocks, and now you've established an expectation that's impossible to ethically meet.

dude. Some places I do my own cases all weekend. 100-% solo. I do my own ob coverage.

I don’t need crnas.

There are some places with 2 MD attendings in house with 6 crnas. Now that’s crazier than than 1 MD and 2 Crna.

 

[gunnershow]

A lot of small business that become much bigger does involve a lot of hook ups/connections.

Like this one guy in my neighborhood no college education. Couple of years community college. His uncle got him in the business of selling coffee cups to franchises like Dunkin’ Donuts Starbucks bmw etc. just a middle guy. Without connections no way he makes it.

As far as banking. There is a lot of hookups and connections. A certain religion likes to help each other in the banking industry. Some are legit. Some are outright criminals like sac and plokin who just happen to get away with technical aspects how they haven’t been brought down.

I’m sure that us banker with the ski business has been helped along the way. It rarely happens magically through hard work alone.

As for medicine. It doesn’t make u filthy rich. It’s also upper middle class career. If I had to do it over. I likely won’t. My kids won’t go into medicine. I’ll likely be in the tech business because that was happening as I started med school.

dude. Some places I do my own cases all weekend. 100-% solo. I do my own ob coverage.

I don’t need crnas.

There are some places with 2 MD attendings in house with 6 crnas. Now that’s crazier than than 1 MD and 2 Crna.

I'm not saying you can't do anesthesia. I'm saying you can't pull 100h weeks at your stage in life without sacrificing something. And from what you've said about insisting that CRNAs be on with you overnight... my wager is that the sacrifice is patient care.

 

[makemoney2024]

He does this by letting CRNAs run wild overnight and do whatever they want in order to get his 8 hours of sleep. He has admitted as much. There's no way a boomer anesthesiologist is doing 100h weeks of real work. If there are 2 CRNAs on overnight, it's a busy enough place that you shouldn't be sleeping much. But he has no loyalty to the practice or to their divisions of labor. Nor does he have any compunction over abandoning his patients and letting nurses play doctor.

In my experience with supervision, all it takes is for one lazy POS anesthesiologist to let CRNAs induce ASA 4s and do blocks, and now you've established an expectation that's impossible to ethically meet.

I knew there had to be a catch. Thank you for breaking it down. Yeah have worked w some Cocky CRNAs and have seen the harm they cause by having boomer bosses let them run amok.

 

[Drangue]

Nowadays we don’t care why they’re leaving their old job. We only care that they’re qualified and they want to work with us. We’ve had plenty of people leave after 1-3 years too. But at least they worked with us for that time.

This is comforting actually. Good to know