Night Float for Small Private Practice

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Impromptu

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We have 5 MDs in our midwest mid-sized town practice at a single hospital. 10 CRNAs. Every day one of us is doing a 24 hours shift. Nights are relatively calm, except for OB and the occasional gall bladder or appendectomy. 2 call CRNAs who come in to do cases if there is an epidural running or multiple OR cases. One MD is usually on vacation each week.

Is there a way for 5 MDs to stop doing so many 24 hour calls and switch to a night float system, at least during the week days? I am trying to do it by hand, but I think 5 MDs might be too tight to do this effectively.

Has anyone had any success converting to such a call system?

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What is your regular post call system?

That would be the dividing line for me, if post call off it is easy, just rotate. My friends 5 guy group did straight rotation:
Week 1: vacation
Week 2 night call starting Monday
Week 3: 2nd busiest
Week 4: 3rd busiest
Week 5: busiest/2nd call
Week 6: vacation

If you are working post call that week can be brutal if you do 7 nights plus some daytime.

Other thing to consider would be the weekend 5-6 days before vacation to be call so the night float is only 5 days.
 
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Fire the CRNAs and switch to all MD and you'll be on call once in 10 days and still get your post call day off.
 
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Is there a way for 5 MDs to stop doing so many 24 hour calls and switch to a night float system, at least during the week days?

Can you run the OR with 3 physicians only?
 
Not clear about whether your call is in house or not. 24 hr in house call q5 post residency really suucks. Even if you sleep at night. We tried a night float system about 15 years ago. It was universally hated.
Not saying you should do the following, but the options are:

have CRNAs to stay in house for epidurals and you guys take home call and come in for a case. Obviously you will have to pay them more/hire more.
hire more docs and cut the pie smaller.
get more money out of administration to pay for the above (chortle)
pjl's system
Keep on truckin
 
It is a "supervision" system, so not medical direction. The charge doctor sees the pre-ops, places epidurals, does blocks, helps when the CRNAs need help, and does charge things. Post call MD is almost always off, especially with 10 CRNAs. 1 charge MD, 2 other MDs, 9 CRNAs (one is usually on vacation, too) to run 8 OR rooms, Ancillary (Endo/MRI), cath lab, and C-sections. Possibility of 11 lines are required in our contract. September-December we usually have those 11 lines. Other times of the year are often a bit less.

We are in-house only if there is a case or epidural running, which is most of the time.

We had a subsidy the first couple of years to help with start up, but that is now gone, and there is no chance of it coming back. Big hospital system and can be penny pinching. We are more secure without a subsidy, and pay and benefits remain excellent.

I can sort of make a night float system work, but if someone is sick or wants to change days it easily become pretty complicated.

Perhaps we can make it a pseudo-night float system where the 24 hour call person takes a normal OR room most of the day and someone else is charge until in the afternoon. We've done that on occasion when the call person was requested by a friend to provide their anesthesia. It seemed less stressful to me.
 
Why so? I like the concept of a night float but never actually worked one.

The week that you were on the night float was completely and thoroughly despised by a super majority of the group. Myself included.
 
The system I mentioned is pretty easy to swap out a guy if there is sickness or whatever, just have the night float guy cover a day in addition. Assuming this is rare and nights arent all that busy that should be safe. There should be a hefty premium if there is abuse of that.

You basically have 2 weeks out of 5 where you are off during days for appointments using that other groups schedule, you could split them up, but that friend would take vacation and come home at 3 pm on Monday to start work, so it was like an extra vacation day to have night float follow vacation.

I personally like night float, but it seemed like older guys didnt like it as much as they didnt flop schedules as easily. I kind of think it was more because they didnt try and just tried to treat it as a home vacation week and come in every night. They were constantly complaining about being tired, yet were going out golfing every morning/afternoon.

Switching our call person from the busiest assignment during the day to the easiest was the best decision we ever made regarding schedules. 100% liked the change, and morale on and post call was vastly improved.

Your MD:CRNA ratio does seem a bit low though, which probably makes your life more stressful at work than it would be if you traded one CRNA for an MD daily, but only you know your practice. More it is that there doesnt seem to be much of a "bench" in case something unexpected or tragic happened. I would consider my next hire to be an MD, but you will take a financial hit... I guess it may be different if your CRNAs are working independent with you as firefighter, but I like the opportunity to be in a room sometimes.
 
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I haven't read all the responses but I may have some points to consider.
First, how many sites does your group cover mon-fri?
 
You need one more doc. Three docs for the daytime hours, one at night that doesn't come in until late, one off post-call, one on vacation. Screw the 24hr shift. That's unreasonable in a busy practice.
 
I haven't read all the responses but I may have some points to consider.
First, how many sites does your group cover mon-fri?
We cover up to 11 sites or lines (8 ORs, OB, Cath lab, and other (Endo/MRI)). This is not medical direction. Only 1/2 the time do we need all 11 lines.
 
I don't envy the job of the fireman. I don't think I'd take that job.
One big peds hospital I know of has a night float. It is very popular. Night float for a week and get the following week off. That's in addition to their usual vacation. I don't think you can do that with only 5 guys. You'd need 6.
 
Don't know why you think you cannot do night float.

Right now you have 3 physicians working and two home (post call and vacation). Have the current post call person cover Monday to Friday evenings plus Saturday and Sunday. If he/she gets sick then revert to 24hr calls with no post call day off until that person gets back.

I would fire 3 anesthesiologist and have 1 cover all 11 ORs while the other is on vacation.
 
So one would be on 24 hours a day for 7 days? Followed by a week off? Pass.
You'd bank crazy loot for 26 weeks of work though.
One day guy one night float and one on vaca might work. 17 weeks off and almost twice the loot...
You hiring?
 
We cover up to 11 sites or lines (8 ORs, OB, Cath lab, and other (Endo/MRI)). This is not medical direction. Only 1/2 the time do we need all 11 lines.
My recommendation is to get rid of all the crnas and hire MD's to replace them.
I assume on median MGMA that you are spending about $ 3,550,000 on your current practice structure (5x$350,000+10x$180,000).
I would think you could cover your needs with 11MD's( 9 working and 2on vacation at all times). At a cost of $3,850,000. You will save that extra $300,00o on benefits not needed for the extra crnas.
Then you will have the calls less often and have the flexibility to arrange a schedule you like.
This is a very generalized approach but it gets the conversation started.
 
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So one would be on 24 hours a day for 7 days? Followed by a week off? Pass.
You'd bank crazy loot for 26 weeks of work though.
One day guy one night float and one on vaca might work. 17 weeks off and almost twice the loot...
You hiring?
My interpretation of night float is something like 5p-7a for a week and then off the next week, but please correct me if I'm wrong.
 
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