Marketing "101"

[urge]

Actually most groups have great patient satisfaction and outcomes. This country is full of excellent well trained anesthesiologists. We are a dime a dozen. If your group sucks and is dysfunctional, that will make you more vulnerable. But the expectation in most places is excellence.

I'm of the belief that our individual skills fit a bell shaped curve.

Parting from your belief that most of us are interchangeable in terms of skill, how would you market yourself over others?

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[deleted171991]

I'm of the belief that our individual skills fit a bell shaped curve.

Parting from your belief that most of us are interchangeable in terms of skill, how would you market yourself over others?

More affable, more available...

 

[bashwell]

Anesthesiology doesn't 'just' demand excellence, but perfection, and in this regard it is unique in comparison to all other specialties at least according to this post:

http://thegoatrodeoblog.com/2014/05/19/anesthesia-isnt-easy-1/

 

[urge]

More afable, more available...

No wonder crnas are practicing independently if according to you guys all that is needed to succeed is being nice and available.

 

[nimbus]

I'm of the belief that our individual skills fit a bell shaped curve.

Parting from your belief that most of us are interchangeable in terms of skill, how would you market yourself over others?

The best marketing we can do is to take ownership of our patients and our workplace. Keeping our skills up to date, taking initiative when new lines of service are introduced. For example, if your hospital wants to start a TAVR program or a robotic heart program, dive in and make yourself an expert. Don't be an obstructionist. Help the surgeons, nurses, and techs do their jobs when you can. Swing a mop if it helps. The stuff other people mentioned in this thread.

Still you can be replaced because there are others just as capable who are willing to do the same. There are some things out of our control.

 

[deleted171991]

No wonder crnas are practicing independently if according to you guys all that is needed to succeed is being nice and available.

Not all. You were asking how to market ourselves if we are seen as interchangeable in terms of skill. No offense, but for 80-90% of cases, the outcome won't be significantly different between anesthesiologists. That's why most surgeons don't care who's at the head, as long as it's not someone from their blacklist.

While many surgeons can figure out who's affable or available, they are pretty bad at recognizing good anesthesia, except when exceptionally good. All they can recognize are good or bad outcomes, which are not always related to our skills. Otherwise it's all artistic impression to them, smoke and mirrors; the world is a stage... That's why some of them are stupid enough to prefer CRNAs.

 

[Noyac]

Isn't the whole point of this thread about how to convince administration that you are great and hard to replace?

Tying the surgeon's gown and playing with the bovie doesn't cut it.

Great patient satisfaction and outcomes do.

Yes!
So being great or even just good enough at anesthesia means things like, no unexpected ICU admissions, no surgeon complaints about this anesthesiologists or that one, no complications, no cancellations possibly, and surgeons and staff that have no complaints about you or your partners. This is a group thing. If just one or two members are doing this then it ain't gonna help. The entire group must buy into the goal.

But the problem is that there are many many people out there that can do this. The AMC's will tell your administration that they can do all of this at a cheaper cost. We all know that the cheaper cost means that these issues above will arise and it won't matter because the previous group is already out of the picture and long forgotten.

So the goal is to avoid the AMC takeover. And the way to do this IMO is to be difficult to replace. In order to be difficult to replace you must express to your administrator exactly what your value is. Great outcomes won't do it because they are expected. You must eloquently sit down with the administrator and go through exactly what it is that your group does for them. And no, I would sit there and say, " hey come on I the the surgeons gown for them, who else is gonna do that?" That's not the point. The point is that you work as a team and everyone appreciates what it is that you bring to the game. You get people on your side if ever they are needed.

As anesthesiologist,we do so much day in and day out that is under the radar. The difficulty is explaining this to someone that make decisions on your future.

 

[Noyac]

And don't think I'm just taking about those stupid little things that make no difference in outcomes, like tying the surgeons gowns and ****. You need to take control of the daily OR schedule. Don't let the nurse do this. If there are issues with anything in the OR that you can control then do so.

Don't be a stool monkey.
And if your anesthesia director isn't doing this stuff then get them out of that position or you may be out of a job.

 

[urge]

But the problem is that there are many many people out there that can do this. The AMC's will tell your administration that they can do all of this at a cheaper cost. We all know that the cheaper cost means that these issues above will arise and it won't matter because the previous group is already out of the picture and long forgotten.

So the goal is to avoid the AMC takeover. And the way to do this IMO is to be difficult to replace. In order to be difficult to replace you must express to your administrator exactly what your value is. Great outcomes won't do it because they are expected. You must eloquently sit down with the administrator and go through exactly what it is that your group does for them. And no, I would sit there and say, " hey come on I the the surgeons gown for them, who else is gonna do that?" That's not the point. The point is that you work as a team and everyone appreciates what it is that you bring to the game. You get people on your side if ever they are needed.

As anesthesiologist,we do so much day in and day out that is under the radar. The difficulty is explaining this to someone that make decisions on your future.

Your premise is that there are many people who can provide the same great service you do.

Thus, no matter what you say you do great, many others can do by the same logic. You are still not standing out.

In your scenario the only way to avoid being taken over by an AMC is to be the cheaper alternative. I just don't see any other alternative if you keep saying that anybody can do what you do just as well.

 

[Noyac]

Your premise is that there are many people who can provide the same great service you do.

Thus, no matter what you say you do great, many others can do by the same logic. You are still not standing out.

In your scenario the only way to avoid being taken over by an AMC is to be the cheaper alternative. I just don't see any other alternative if you keep saying that anybody can do what you do just as well.

I guess you haven't been there yet.

I have and I won. I'm just passing along the game plan.

Take it or leave it buddy.

It's your job, not mine.

 

[urge]

I guess you haven't been there yet.

I have and I won. I'm just passing along the game plan.

Take it or leave it buddy.

It's your job, not mine.

I'm in academia. To tell you the truth, even academic departments are absorbing groups. It's not just AMCs.

 

[dhb]

Do you change the ventilator circuit between each patient? we certainly don't.

 

[Arcan57]

Coming from the other major "contracted by the hospital as a group" field of medicine, CMGs (our AMCs) have a data driven approach to keeping contracts that involves identifying and hard-wiring behavior related to the 4 or 5 variables that influence contract turn-over. The major CMGs have their own names for these programs but they essentially revolve around having frequent contact with the admin team that's going to be determining who gets the contract and being actively viewed as an ally by these C-suite leaders. For a specialty that can be viewed as a commodity, anonymity is the first step to losing the contract.

 

[deleted171991]

Do you change the ventilator circuit between each patient? we certainly don't.

Are you in Europe or something?

 

[teeva]

LOL at tying surgical gowns and mopping the floors yourself if you think that'll save your job and garner respect. In time with experience, you can offer the hospital to take the tech and housekeeping crew salary at a 50% discount when you get desperate for income.

In residency, we did every ****ing piece of **** scut job like changing circuits/suction suction ourselves while the techs were no where to be found. So it's not like I don't know how to do that stuff or completely resistant to it.

In private practice, I have no idea where they keep circuits, suction canisters, suction tubing, Yankauer, Aline kits, central line kits, or hotline. They're set up for me between cases while I evaluate/consent the next patient so we as a team can keep cases rolling. In a well run place, there are two nurses to help start a case (one helps me with putting on monitors/induction/airway management as needed while another counts instruments with the tech and puts in Foley, and after the airway is secured they both prep), and the surgeon walks into OR only after patient is prepped, draped, and ready. Towards the end of the case, one of the nurses will go see the next patient and notify me if there are or aren't any issues

It's all about teamwork, efficiency, and no bad outcomes (perfection is the same as good enough, and neither can be measured, but a **** up is obvious). Admin doesn't hear about anything unless there's a **** up or surgeons complain. I walked into this job and it was already running well, so I don't now how to encourage or foster such an environment. Though I do suspect everyone's greatest motivator is going home early or on time.

 

[dhb]

Are you in Europe or something?

yes

 

[Noyac]

So I know we have been focused on the stupid things like tying the gowns, grabbing sutures, turning over you circuits but these are not what is gonna keep your job for you. These are not things that administration will say are necessary. They are just tasks that show everyone around you that you are a good team player. That's the goal, right? We aren't surgeons, so we don't need to act like them.

So what does matter? It's things like OR efficiency. When they administration wants to start a robot program you jump on board but in a way that makes it work and successful.

When a surgeon wants to try something new, you and your group do the research and come up with a workable plan. We developed a post-op pain management protocol for our total joint pts a few years back and cut the hospital days down about 33%. Currently, our total joint pts are ready to leave the hospital on POD#2. That was an improvement from day 3or 4.
When they wanted to start he robot program we didn't stomp our feet and complain. Instead we educated the staff on the cases. We did mock cases. And we "appeared" to devote great resources towards the program. None of us wanted it but that didn't matter.
Basically, your group needs to enable these things. Not be obstructionists.
We have a dozen anesthesiologist and ZERO crnas in a state that opted out over two years ago. I don't know everything but I do know that our relationship with our employer is one of trust. it isn't always a great relationship but it has survived some tough times.
Maybe I'm wrong or off base about this stuff but so far so good in my court.
I'm sure some day the situation will turn towards money and I will need to adapt but when it happens I will still be in the drivers seat somewhat.

When I posted this thread I was hoping for some others that might have been in my position would chime in with agreement or disagreement but so far just people making statements that they believe to be true but otherwise no real experience. That's fine, all comments are helpful.

 

[dhb]

What you say is great but we are not in the driver seat to implement these type of change: i wouldn't mind doing all that and more, but if the surgeons don't want it or see the need for it what can you do?

 

[pjl]

Things like pushing OR efficiency via changing the institutional culture and scheduling of cases will make an impact. Adding 15% more availability to schedule cases with no increase in anesthesia staffing by altering rules that were archaic was a recent move that gained us popularity.

Being proactive and mentioning to surgeons DURING THE CASES YOU ARE SITTING IN WITH THEM some of the options for analgesia which will reduce narcotic usage and/or facilitate earlier discharge is one of my favorites. There is a ton of new literature reinforcing various "fast track" protocols. They may not bite on the first time or second, but eventually, you will have their patients being happier and leaving the hospital 2 days earlier, like the above mentioned knees.

All of this and more can be considered "marketing" or just doing ones job, but when it comes down to it, you are helping patients, insurance companies, surgeons, and administration. That gets noticed.

Larger than any of these issues is that of attitude. All gains can be eroded if you get a stat C/S on your way out the door and throw your pager at a wall, challenge the validity of the OB opinion of urgency, and basically act like an ortho doc who is denied his god given right to a flip room. The correct answer is to bow your head, do the case, and if warranted discuss further in a more appropriate setting. Also, dont forget the nice little check you get from doing the case, it isnt like you are a volunteer here.
Tying a surgeons gown is equivalent to them handing you a tube or holding cricoid. It is a favor done by a coworker/friend, not something you need to pat yourself on the back over.

 

[urge]

....you will have their patients being happier and leaving the hospital 2 days earlier, like the above mentioned knees.

All of this and more can be considered "marketing" or just doing ones job, but when it comes down to it, you are helping patients, insurance companies, surgeons, and administration. That gets noticed.

I have never understood the long term economic benefit of sending a patient home a day or two earlier.

Sure you have some empty beds, which are only useful if the hospital is near 100% occupancy, but what eventually happens is the insurance carriers pay less since it doesn't need a prolonged hospitalization. It's like shooting yourself on the foot. From then on you are screwed, there is no turning back.

 

[pgg]

I have never understood the long term economic benefit of sending a patient home a day or two earlier.

Sure you have some empty beds, which are only useful if the hospital is near 100% occupancy, but what eventually happens is the insurance carriers pay less since it doesn't need a prolonged hospitalization. It's like shooting yourself on the foot. From then on you are screwed, there is no turning back.

In a world of bundled payments, shorter hospital stays would leave more profit. For the hospital, anyway.

 

[pjl]

Hospital operates at >90% capacity. More beds=more cases=more money.
Stinky Obama won't let us make any more beds, otherwise we would do that. All that provision in the Obamacare act has done is cause us to look for ways to decrease care of govt patients.

 

[urge]

Hospital operates at >90% capacity. More beds=more cases=more money.
Stinky Obama won't let us make any more beds, otherwise we would do that. All that provision in the Obamacare act has done is cause us to look for ways to decrease care of govt patients.

That's the best case scenario sort term. Think about the consequences a few years later.

Profits last a few yrs until they revise payment and say: well, if a knee is in-house 2 days instead of 3, then we will pay you less. It's a race to the bottom. You cannot win.

Just remember what happened to the cataracts.

What does Obama have to do with number of beds?

 

[pjl]

For profit physician owned hospitals are not able to add beds.

 

[pd4emergence]

The fact is most of us are terrible at marketing ourselves and our group to both the hospital and surgeons. Hospital admins see us as a very expensive but necessary commodity or resource. They know nothing about our specialty, they don't know about the things a group does to make efficiency better or their or's safer. They do know how often a surgeon comes to them and complains about availability, or a inappropriate case cancellation, or the multitude of other thing that surgeons sometimes complain about that ultimately ends up being blamed on "anesthesia". The suits also know exactly how much money they are spending on anesthesia services. Any group or person is replaceable. To me, some of the things that groups do to make themselves standout to the suits and the surgeons at a facility:

1. Be present, I have lived in a medical direction world for much longer than I'd like, if you are not involved with your cases and never show up, if you let the OR languish and you are sitting in the lounge drinking coffee, or you let mid levels do things that you should be doing, you will get replaced

2. Have a rock solid, airtight reason for canceling a case. Also great communication with the surgeon is a must. There's an art to canceling cases. If you can get the surgeon to halfway believe that it was his/her idea to cancel a case, or at least convince them that they really don't want any part of it, everybody will come away from the experience much happier.

3. Outside of the or cases are becoming more and more of what we do, embrace them, work with the admin to figure out a way to efficiently us your resources so that they are done safely and with a reasonable amount of resource investment

4. Be a part of the fabric of the or and hospital. Committee involvement is a must. Schedule involvement is also a must. Preop holding and pacu involvement is a must. The more you are involved with these thing the harder it will be for admin to replace you.

5. As much as possible work with the surgeons. A consistently confrontational relationship is a problem.

6. Consistency within a group is important. If everybody does thing differently, then surgeons don't know where they stand.

Remember the saying if you are not at the table, then you are on the menu

 

[Mman]

I have never understood the long term economic benefit of sending a patient home a day or two earlier.

Because staying in the hospital costs a lot of money. Between the physical space, the staffing (RNs, NAs, janitors, etc), the food, the pharmacy, the whole thing. It adds up to gobs of money being spent. There is also a strong correlation (I know, cause or effect) between length of stay and complications. But in general, the longer you are in a hospital the more likely you develop a complication.

As a patient if you don't have to be in a hospital, you are far better off not being in a hospital.

So getting patients out faster is better for patients, better for cost, and better for overall satisfaction of everybody.

 

[urge]

Because staying in the hospital costs a lot of money. Between the physical space, the staffing (RNs, NAs, janitors, etc), the food, the pharmacy, the whole thing. It adds up to gobs of money being spent. There is also a strong correlation (I know, cause or effect) between length of stay and complications. But in general, the longer you are in a hospital the more likely you develop a complication.

As a patient if you don't have to be in a hospital, you are far better off not being in a hospital.

So getting patients out faster is better for patients, better for cost, and better for overall satisfaction of everybody.

I think you guys are seeing the trees, but not the forest.

The physical space is a fixed cost, whether there is a pt or not.

The hospital food is basically pennies for a business the size of the hospital.

The nurses and janitors are salaried, another fixed cost.

The drugs are actually a cost, but by the time they are getting ready for discharge most of them are PO which are pretty cheap.

I still don't see the long term benefit of struggling to send a pt home a day or two early, knowing that your reimbursement will drop because of your efforts.

 

[Mman]

I think you guys are seeing the trees, but not the forest.

The physical space is a fixed cost, whether there is a pt or not.

The hospital food is basically pennies for a business the size of the hospital.

The nurses and janitors are salaried, another fixed cost.

The drugs are actually a cost, but by the time they are getting ready for discharge most of them are PO which are pretty cheap.

I still don't see the long term benefit of struggling to send a pt home a day or two early, knowing that your reimbursement will drop because of your efforts.

I think you have no idea how a hospital runs. Nurses are not "fixed costs", nor are janitors. At our hospital when a unit is light on patients, they send nurses home and it comes out of their PTO time. Or they float them to another unit that is shortstaffed.

Having a patient in a hospital generates both a bill to whoever is paying it (insurance, CMS, etc) and expenses for the hospital. In the new land of bundled payments and getting denied any reimbursement if there is a complication (even a simple UTI), there is very strong incentive on all sides to get patients out the door as fast as you safely can.

Their will be constant push to get better and at some point a limit will be reached because you will then start getting readmissions, but until then they want to keep getting better.

 

[urge]

1 Nurses are not "fixed costs", nor are janitors. At our hospital when a unit is light on patients, they send nurses home and it comes out of their PTO time.

2 Having a patient in a hospital generates both a bill to whoever is paying it (insurance, CMS, etc) and expenses for the hospital. In the new land of bundled payments and getting denied any reimbursement if there is a complication (even a simple UTI), there is very strong incentive on all sides to get patients out the door as fast as you safely can.

1 You cannot force PTO day to day at your convenience if your unit is empty. They go to other units where they are not really needed to "help". Or they sit in the pantry all day. Even worse if they are union.

2 I can see you have no clue of what you are talking about. The hospital bill is per cpt code, not for individual days. You are not charging more or less by discharging them earlier. That's where the imaginary profit comes in.

I'm not opposed to sending people home when they are ready. I'm opposed to the idea that cutting a day here and there is profitable, when in reality the profits don't materialize, and insurance will pay less every time since its a shorter hospitalization.

The only way you profit (sort term) from sending someone home early is if put a new patient in that bed.

 

[pgg]

1 You cannot force PTO day to day at your convenience if your unit is empty.

Hospital where I moonlight will tell RNs (with less than 24h notice!) "we don't need you, don't come in" ...

The hospital is very, very nimble and aggressive when it comes to matching patient load with staff in the hospital. They will move patients around to consolidate and empty entire wards when they can, to the point of turning the lights out (and for all I know the HVAC too).

When the OR schedule isn't full, they tell the periop RNs and scrubs the same thing.

They all hate it, but it seems the best concession they could wring out of the hospital was to rotate the unpaid days off as evenly as possible. I don't know if they're unionized. They seem to have some angst about the job market. Maybe they're just happy to have a job.

 

[urge]

Hospital where I moonlight will tell RNs (with less than 24h notice!) "we don't need you, don't come in" ...

The hospital is very, very nimble and aggressive when it comes to matching patient load with staff in the hospital. They will move patients around to consolidate and empty entire wards when they can, to the point of turning the lights out (and for all I know the HVAC too).

When the OR schedule isn't full, they tell the periop RNs and scrubs the same thing.

They all hate it, but it seems the best concession they could wring out of the hospital was to rotate the unpaid days off as evenly as possible. I don't know if they're unionized. They seem to have some angst about the job market. Maybe they're just happy to have a job.

There would be riots at my hospital if that were the case.

 

[pjl]

The market is much more complex than a lot of you guys realize. I dont pretend to know all the angles, however there is a definite benefit to shaving days. Long term declines in reimbursement due to more efficient patient processing are not going to come about that much later because we unnecessarily keep patients in house longer, all that does is put you on the back end of the market. Meanwhile being near the front of the market can earn you a tidy sum.

Our hospital is in a competitive market. We have gained insurance company market share by providing care for a certain diagnosis at a lower price, which is done by lowering days admitted and a lot of other steps. Despite that, our quality metrics are better than the competition, with lower complication and readmission rates. You more than make up for the slightly decreased reimbursement by cutting a day or two off the hospitalization. For us, where we hit within 5 beds of max capacity ~90 days a year getting a knee out in half the time means we can do 2x the number of knees. Obviously we arent 100% efficient in this way, but that is the basic point. Made up numbers, but 35k+35K>>45k.
We are nearing a point (3-5 years) where we will be needing to open a second shift for elective cases during the week.

Obviously my situation must be different because when the hospital makes more money, I get more money, so I am motivated to safely provide care that optimizes profit. That is not to say that we are cavalier about it, there are many times where we voice caution in the push for efficiency. That voice of caution has actually gained us respect in the eyes of the administration on many occasions, or at least that is the lip service we get...There is a certain respect given when you are sharing the profits and you put the brakes on moves that are guaranteed to net you more money.

 

[pjl]

Also, that is a very common model for nursing staff to "force" PTO if a nurse is not needed. They can also take it unpaid if they dont want to use PTO.

There is a group in the city next to mine that does the same thing with CRNAs. The CRNAs I work with hate that model and talk about how "nobody would want to work there," but that group has all their positions staffed. The market cant be as strong as some think if people are able to get away with that stuff.

 

[urge]

The market is much more complex than a lot of you guys realize. I dont pretend to know all the angles, however there is a definite benefit to shaving days. Long term declines in reimbursement due to more efficient patient processing are not going to come about that much later because we unnecessarily keep patients in house longer, all that does is put you on the back end of the market. Meanwhile being near the front of the market can earn you a tidy sum.

Our hospital is in a competitive market. We have gained insurance company market share by providing care for a certain diagnosis at a lower price, which is done by lowering days admitted and a lot of other steps. Despite that, our quality metrics are better than the competition, with lower complication and readmission rates. You more than make up for the slightly decreased reimbursement by cutting a day or two off the hospitalization. For us, where we hit within 5 beds of max capacity ~90 days a year getting a knee out in half the time means we can do 2x the number of knees. Obviously we arent 100% efficient in this way, but that is the basic point. Made up numbers, but 35k+35K>>45k.
We are nearing a point (3-5 years) where we will be needing to open a second shift for elective cases during the week.

Obviously my situation must be different because when the hospital makes more money, I get more money, so I am motivated to safely provide care that optimizes profit. That is not to say that we are cavalier about it, there are many times where we voice caution in the push for efficiency. That voice of caution has actually gained us respect in the eyes of the administration on many occasions, or at least that is the lip service we get...There is a certain respect given when you are sharing the profits and you put the brakes on moves that are guaranteed to net you more money.

If you are cancelling elective cases because you have no beds, then fast track away. Otherwise, the inefficiencies in the system will consume your "on paper" profits.

Regardless, congratulations for being at the forefront of driving reimbursement to the ground. Countless generations to follow will think fondly of you.

 

[pjl]

You act as if it would be a good thing for a cataract patient to still be admitted for a week.

 

[pgg]

If you are cancelling elective cases because you have no beds, then fast track away. Otherwise, the inefficiencies in the system will consume your "on paper" profits.

Regardless, congratulations for being at the forefront of driving reimbursement to the ground. Countless generations to follow will think fondly of you.

Sure, no raindrop thinks it's responsible for the flood, but I'm not sure that's really a fair criticism.

Reimbursement cuts and bundled payments ARE coming. No one doubts this. If you can cut costs NOW then there is at least a period of time when you're ahead of the curve and profit is higher. (Though perhaps for the hospital, not us.)

At best you're confusing cause and effect here. The CAUSE is reduced payments and the EFFECT is an effort to reduce costs. Not the other way around.

Your initial criticism was along the lines of "well hospitals can't really cut costs with early discharges because their costs are fixed" ... and when presented evidence that those costs really aren't as fixed as you think, your response changed to the assertion that reducing costs amounts to immoral future-generation-screwing? It seems you just don't like the idea and are reaching for reasons to not like it.

 

[urge]

Reimbursement cuts and bundled payments ARE coming. No one doubts this. If you can cut costs NOW then there is at least a period of time when you're ahead of the curve and profit is higher. (Though perhaps for the hospital, not us.)

Your initial criticism was along the lines of "well hospitals can't really cut costs with early discharges because their costs are fixed" ... and when presented evidence that those costs really aren't as fixed as you think, your response changed to the assertion that reducing costs amounts to immoral future-generation-screwing? It seems you just don't like the idea and are reaching for reasons to not like it.

I understand reimbursement cuts are coming, but you guys are working on fast tracking those too.

Same criticism stands. I added the last bit for shock value.

Where I'm at people show up to work even without patients. Some of these guys have the best job on earth. They will even get a pension for years of doing nothing. The concept of forced PTO is foreign to me. I wouldn't work under such conditions. Would you?

 

[urge]

You act as if it would be a good thing for a cataract patient to still be admitted for a week.

It sounds like it, but no.

Some things are a no brainer. A case that used to be done under GA with a bunch of complications and required hospitalization vs. An ambulatory MAC with few complications. Who would choose the former?

A knee is a little different. You basically do the same anesthetic but you force feed the guy with all sorts of analgesics like celebrex, gabapentin, tylenol, ketamine, etc., like you were making foie gras out of the guy.

Then you force him to exercise the next day telling them is good for him even though his level of pain it's telling him otherwise. Then you send him home for his wife to have to deal with him and his rehab. Sounds fantastic.

 

[Spinach Dip]

I thought the drive to get patients out of the hospital ASAP was due (at least in part) to to reduce the hospital's liability if/when post-operative complications occur.

ie. "You were not in the hospital when you started showing signs of infection, so there's no way you got it from us. Don't even think about suing." .... "But after reviewing your insurance policy, we've decided we will re-admit you to treat it."

 

[pgg]

Where I'm at people show up to work even without patients. Some of these guys have the best job on earth. They will even get a pension for years of doing nothing.

Sounds like my life, some days.

Lately, we have idle ORs, idle anesthesiologists, idle CRNAs, and surgeons with a case backlog because we're short periop nurses and scrub techs. It's hard to comprehend sometimes.

The concept of forced PTO is foreign to me. I wouldn't work under such conditions. Would you?

Forced paid time off sounds great, as long as it's not a symptom of the employer's dysfunction that puts the job itself at risk of being cut/lost completely due to mismanagement.

Forced unpaid time off? That would suck. I wouldn't want to work someplace where I was non-salaried and where my hours (and pay) were semi-arbitrarily cut on short notice. For a while they were missing around one day a week, or a 20% cut in take-home income. But I get the impression that those nurses had no better options in the region. People will put up with a lot if the alternative is unemployment.

 

[deleted162650]

Where I'm at nurses are forced take non-PTO on slow days (if they either don't have or choose not to use their PTO). This is especially true at the hospitals surgery center. As a result we keep loosing all our best and most competent nurses and techs only to be stuck with travelers who often times don't know their ass from their elbow.

 

[nimbus]

Forced unpaid time off? That would suck. I wouldn't want to work someplace where I was non-salaried and where my hours (and pay) were semi-arbitrarily cut on short notice. For a while they were missing around one day a week, or a 20% cut in take-home income. But I get the impression that those nurses had no better options in the region. People will put up with a lot if the alternative is unemployment.

We have this from time to time in my practice. When there aren't any cases there aren't any cases. Couple summers ago it was getting worrisome but things turned around as they usually do.

 

[Mman]

Where I'm at people show up to work even without patients. Some of these guys have the best job on earth. They will even get a pension for years of doing nothing. The concept of forced PTO is foreign to me. I wouldn't work under such conditions. Would you?

The nurses here have no other option. There isn't a hospital within 500 miles that doesn't do the exact same thing. In fact I was unaware that any major hospitals still existed in this country that wouldn't give people forced PTO when they weren't needed.

 

[Mman]

Also, that is a very common model for nursing staff to "force" PTO if a nurse is not needed. They can also take it unpaid if they dont want to use PTO.

There is a group in the city next to mine that does the same thing with CRNAs. The CRNAs I work with hate that model and talk about how "nobody would want to work there," but that group has all their positions staffed. The market cant be as strong as some think if people are able to get away with that stuff.

That's kinda what American Anesthesia does with CRNAs. They force them to stay late (beyond their scheduled shift) on days when they are full and then force them home early the next day so as to not exceed 40 hours in a week and get OT.

 

[deleted50478]

That's kinda what American Anesthesia does with CRNAs. They force them to stay late (beyond their scheduled shift) on days when they are full and then force them home early the next day so as to not exceed 40 hours in a week and get OT.

Or they get OT after 3:00 even if they went home at 10:00 the day before...

Which is fair enough in my opinion.