Cases in the Middle of the Night

This situation that you described is characteristic of groups that hire new guys as cheap labor which is obviously your case.
Working all night and then having to work next day hoping that someone will relieve you by noon is definitely not the norm in private practice.
But on the other hand, in life you get what you deserve, so hang in there buddy.

Planktonmd said:

This situation that you described is characteristic of groups that hire new guys as cheap labor which is obviously your case.
Working all night and then having to work next day hoping that someone will relieve you by noon is definitely not the norm in private practice.
But on the other hand, in life you get what you deserve, so hang in there buddy.

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Every group is different and not all groups suck. The docs in my group get to exempt night call when they're 55. All are free to swap their night shifts to someone else, which they frequently do, because the night shifts are compensated better.

coprolalia said:

I don't know what's worse: being on-call in house, or from home. I just finished three back-to-back cases, which is unusual for our practice.

For all intents and purposes, they were "routine". But, driving in from home to cover... Our overnight census is pretty low normally. This was an unusual night. Felt like I was back in residency.

Even better... get to go back in a couple of hours for more. No point in going to bed now, but I'm sure I'll get relieved by mid-morning.

It doesn't necessarily end when residency ends, dudes/dudettes.

-copro

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If you have access to a legitimate private call room, why not just sleep there and save the time spent on driving. Might add up to several hours of sleep. Or at least a cat-nap.

trinityalumnus said:

If you have access to a legitimate private call room, why not just sleep there and save the time spent on driving. Might add up to several hours of sleep. Or at least a cat-nap.

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Nothing I hate worse than driving to and from the hospital in the middle of the night.

I just stay there...even if all I'm doing is surfing the internet....wondering why plank came back after saying he wasn't.

Planktonmd said:

This situation that you described is characteristic of groups that hire new guys as cheap labor which is obviously your case.
Working all night and then having to work next day hoping that someone will relieve you by noon is definitely not the norm in private practice.
But on the other hand, in life you get what you deserve, so hang in there buddy.

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Gosh that's a bit rash... You have no knowledge of what schedule the others in his group have. Perhaps they are all in the same boat. Indeed, he mentioned that they rarely work late at night. In that situation, perhaps the group has chosen not to hire enough personnel to allow for a routine day off after call. Occasionally, one would get burned. If they are a small group, that extra body that they rarely really need is much more expensive on a per physician basis than in a larger group.

jwk said:

Every group is different and not all groups suck. The docs in my group get to exempt night call when they're 55. All are free to swap their night shifts to someone else, which they frequently do, because the night shifts are compensated better.

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Just curious. What percent of your docs are 55 or over? Something like that could potentially get out of hand. Also, if it's not too presumptuous of me, do the 55 year olds off the call schedule take a pay cut for that privilege. Just wondering how others handle this issue. Call is certainly a bigger burden as you age.....

militarymd said:

....wondering why plank came back after saying he wasn't.

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I came back because I realised that I miss having fun on this forum despite the presence of some very annoying little whiny guys.
I also saw that you were back so I said, what the heck, lets give it a shot!

kmurp said:

Just curious. What percent of your docs are 55 or over? Something like that could potentially get out of hand. Also, if it's not too presumptuous of me, do the 55 year olds off the call schedule take a pay cut for that privilege. Just wondering how others handle this issue. Call is certainly a bigger burden as you age.....

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I love my system. Essentially we have a formula and what it means is that the more you work the better you get paid. We are a polar group. Older partners already have money in the bank... they take less call. Us younglings take a lot more... but we make a lot more too. It is fair and everyone is happy.

Arch Guillotti said:

lol

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typical aa, urm, liberal, left winged approach.....

quoting out of context....addressing the wrong group of people.

kmurp said:

Just curious. What percent of your docs are 55 or over? Something like that could potentially get out of hand. Also, if it's not too presumptuous of me, do the 55 year olds off the call schedule take a pay cut for that privilege. Just wondering how others handle this issue. Call is certainly a bigger burden as you age.....

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Everyone takes equal call in my group, from the new guy (me), to the people that have been partners for 25 years. You don't want to take call??? Thats fine, it just means you can't work there anymore.

I also refuse to go home and drive back for stuff. I stay there when I'm on.

we do call in house.

The question i have is how many of you out there also have a CRNA in house with you? Most of the time seems like a waste of money, except when OB labor Epi's get busy and the Cardiac ORs are running.

kmurp said:

Just curious. What percent of your docs are 55 or over? Something like that could potentially get out of hand. Also, if it's not too presumptuous of me, do the 55 year olds off the call schedule take a pay cut for that privilege. Just wondering how others handle this issue. Call is certainly a bigger burden as you age.....

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Actually, only a couple are older than 55. That means almost 40 are still on the hook.

Ours is large and very busy practice, with 24/7 in-house coverage, and as an outsider looking in (I'm one of the anesthetists) their system seems very fair and equitable. We have MD shifts set up to provide overlapping coverage for all our operating areas, with the longest shift being 12 hours. Each shift has a value, with a 7-3 day shift rated as 1 all the way up to a night weekend or holiday shift rated at 4. Through a commercially available scheduling program, the shift distribution is kept pretty even, so each person gets about the same number of days, evenings, nights, long shifts, short shifts, weekends, etc. They then take the receipts for each month, take out for overhead and reserves, and divide it by the total number of points accumulated by all the docs for the month. That gives a value per point. Multiply the number of points each doc has by the value per point, and that's their pay for the month.

coprolalia said:

Yeah, this is the second time this has happened in the past 5 months and I just got back from a two-week vacation. They're really putting me through the ringer.



If you're referring to me (although, personally, I think that was an attempted shot at militarymd), rest assured that nothing about me is "little". And, the only whining I've seen lately is coming from you...





-copro

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What's the point of all of this? Its really distracting and non-productive. I clink on the thread seeing a new post has been added and all it ends up being is garbage.

jwk said:

Actually, only a couple are older than 55. That means almost 40 are still on the hook.

Ours is large and very busy practice, with 24/7 in-house coverage, and as an outsider looking in (I'm one of the anesthetists) their system seems very fair and equitable. We have MD shifts set up to provide overlapping coverage for all our operating areas, with the longest shift being 12 hours. Each shift has a value, with a 7-3 day shift rated as 1 all the way up to a night weekend or holiday shift rated at 4. Through a commercially available scheduling program, the shift distribution is kept pretty even, so each person gets about the same number of days, evenings, nights, long shifts, short shifts, weekends, etc. They then take the receipts for each month, take out for overhead and reserves, and divide it by the total number of points accumulated by all the docs for the month. That gives a value per point. Multiply the number of points each doc has by the value per point, and that's their pay for the month.

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It's interesting that working a weekend night pays 4x what a normal day shift does. I'm guessing there's not a problem finding people interested in those shifts...

I actually was referring to you when I mentioned annoying little whiny people, and although you are claiming to have certain physical attributes you certainly act and whine like a little person.
And if you are so happy in your job and think it's OK to work all night and then come next day to work hoping they might let you go home by noon then I rest my case, you got what you deserve.
Why are you whining about it though? Doesn't that prove my assumption that you are a whiny little thing?

coprolalia said:

Yeah, this is the second time this has happened in the past 5 months and I just got back from a two-week vacation. They're really putting me through the ringer.



If you're referring to me (although, personally, I think that was an attempted shot at militarymd), rest assured that nothing about me is "little". And, the only whining I've seen lately is coming from you...





-copro

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coprolalia said:

rest assured that nothing about me is "little".

-copro

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So, you are a fatty?

Arch Guillotti said:

Out of context enough that you feel the need to attempt to insult me

And for the record I am a white guy.

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but you're a still just a D.O.

militarymd said:

but you're a still just a D.O.

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And you're still just an M.D.......practicing in Huntsville, AL.....get the f#ck over yourself.

I've heard the group in Huntsville does very well...assume nasa and the defense industry have good insurance.

Consigliere said:

And you're still just an M.D.......practicing in Huntsville, AL.....get the f#ck over yourself.

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archie needs big brother to help him?

militarymd said:

but you're a still just a D.O.

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Consigliere said:

And you're still just an M.D.......practicing in Huntsville, AL.....get the f#ck over yourself.

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no offense meant against other D.O.'s......just archie's

GoodmanBrown said:

It's interesting that working a weekend night pays 4x what a normal day shift does. I'm guessing there's not a problem finding people interested in those shifts...

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No problem at all. Swaps happen all the time, and everything is done on the computer to keep everything straight. We track the original shifts separately from the end result in case there are any questions about everything being equitable. The group decides each year how much to value each shift compared to the others. As workloads change or shifts change or get added or deleted, it's easy to change the value of a shift.

seinfeld said:

What's the point of all of this? Its really distracting and non-productive. I clink on the thread seeing a new post has been added and all it ends up being is garbage.

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The solution is easy. Just put him on your ignore list. THe only time I have to read his posts is when people quote him.

dr doze said:

Whether it's a "waste" depends on how busy you are and your agreement with the hospital for service. I have worked at a level one trauma center with open hearts, 4000 deliveries. 1 doc 2 CRNAs in house @ night. We were not overstaffed.

The more interesting question is the small-midsized hospital that does some OB and what staffing model you use for call.

-Do you have a crna only in house for epidurals and intubations and call in a doc only for a c-section or OR case?
-Do you do in house call with a doc and call a crna or back up doc in whenever you have a case going so there is someone immediately available to respond to a second emergency?
-Do you do in house call with a doc and only call the back up in if there is an emergent need while doing a case in the OR, albeit with a delay?
-Do you have both a doc and a crna in house?
-Do you do no in house call? If so is there a second call person?

All of the above are reasonable staffing models. Which is used is based on local customs and desired coverage level.

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This is our system at small mid-sized hospital. Call from home with a 2nd call backup that we essentially never use and no crna's. We won't call backup for anything except life or limb emergencies which usually only means the true emergent c/s. Even the c/s's seem to be able to wait the majority of the time. Epidurals while the 1st call person is busy just have to wait. Right now we are understaffed which will remain until July (thanks to Dre') and we built into our contract a very profitable means of compensation if we have to work postcall which I did this past week for the first time in years. I got crushed the night b/4 and never left the hospital. My partners got me out the next day by noon and I banked some heli-ski funds. Should cover one full day in the heli.

militarymd said:

no offense meant against other D.O.'s......just archie's

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Okay, then none taken.

dr doze said:

Sounds like a nice deal. How many deliveries per year?

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About 1000 del/yr. But the nice thing is only a 30% epidural rate.

dr doze said:

Whether it's a "waste" depends on how busy you are and your agreement with the hospital for service. I have worked at a level one trauma center with open hearts, 4000 deliveries. 1 doc 2 CRNAs in house @ night. We were not overstaffed.

The more interesting question is the small-midsized hospital that does some OB and what staffing model you use for call.

-Do you have a crna only in house for epidurals and intubations and call in a doc only for a c-section or OR case?
-Do you do in house call with a doc and call a crna or back up doc in whenever you have a case going so there is someone immediately available to respond to a second emergency?
-Do you do in house call with a doc and only call the back up in if there is an emergent need while doing a case in the OR, albeit with a delay?
-Do you have both a doc and a crna in house?
-Do you do no in house call? If so is there a second call person?

All of the above are reasonable staffing models. Which is used is based on local customs and desired coverage level.

Click to expand...

I work in a medium sized hospital. We have one in house CRNA after about 11, we also have a second and third call crna that stay until the work is done and can be called back (by the way the hospital employs the CRNA's). We also have a back up call M.D. to call in if there is a bus wreck or some other unexpected disaster (back up is called in maybe once or twice a year). We are usually fairly busy in the OR with addons and elective cases until 9 or ten at night. Because of a fairly busy OB service we stay in house. We do our own epidurals and the only time the CRNA's go up to OB is to do a c section or fill out a preop. It is not in our contract to stay in house but we all do because there is rarely a time when an epidural is not running and it just isn't worth going anywhere. We are usually out by early morning (6 or 7). Sometimes stay till 8 or 9 if things are really busy.

Our guys that are older than 55 don't take call either. But we are paid well for call and don't take more than one call per week or so. People in our call pool make a good bit more than the non call takers. It seems to work out well and this is not a source of contention in our group.

As for our call nights, some are really busy and I don't even see the call room. Just as many are really good and I sleep from about 10 till the morning. Some are medium, some sleep here and there but usually interupted by an epidural or c section. Most of our surgeons don't like to work at night and will try to do what they can to put it off till the a.m. There are a few who don't seem to have a clock at home and will do anything at any time.

pd4

pd4emergence said:

I work in a medium sized hospital. We have one in house CRNA after about 11, we also have a second and third call crna that stay until the work is done and can be called back (by the way the hospital employs the CRNA's). We also have a back up call M.D. to call in if there is a bus wreck or some other unexpected disaster (back up is called in maybe once or twice a year). We are usually fairly busy in the OR with addons and elective cases until 9 or ten at night. Because of a fairly busy OB service we stay in house. We do our own epidurals and the only time the CRNA's go up to OB is to do a c section or fill out a preop. It is not in our contract to stay in house but we all do because there is rarely a time when an epidural is not running and it just isn't worth going anywhere. We are usually out by early morning (6 or 7). Sometimes stay till 8 or 9 if things are really busy.

Our guys that are older than 55 don't take call either. But we are paid well for call and don't take more than one call per week or so. People in our call pool make a good bit more than the non call takers. It seems to work out well and this is not a source of contention in our group.

As for our call nights, some are really busy and I don't even see the call room. Just as many are really good and I sleep from about 10 till the morning. Some are medium, some sleep here and there but usually interupted by an epidural or c section. Most of our surgeons don't like to work at night and will try to do what they can to put it off till the a.m. There are a few who don't seem to have a clock at home and will do anything at any time.

pd4

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That seems like a really nice set up.

Sorry you guys are working so hard! 30% ED rate seems low but great. Remi PCA and take that down to zero!

WOrking on my Colorado license now.

Noyac said:

This is our system at small mid-sized hospital. Call from home with a 2nd call backup that we essentially never use and no crna's. We won't call backup for anything except life or limb emergencies which usually only means the true emergent c/s. Even the c/s's seem to be able to wait the majority of the time. Epidurals while the 1st call person is busy just have to wait. Right now we are understaffed which will remain until July (thanks to Dre') and we built into our contract a very profitable means of compensation if we have to work postcall which I did this past week for the first time in years. I got crushed the night b/4 and never left the hospital. My partners got me out the next day by noon and I banked some heli-ski funds. Should cover one full day in the heli.

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dr doze said:

Our guys that are older than 55 don't take call either. But we are paid well for call and don't take more than one call per week or so. People in our call pool make a good bit more than the non call takers. It seems to work out well and this is not a source of contention in our group.



pd4

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Can I ask what the ratio of call time pay to "regular" time is? Do docs that are younger than 55 for whom the time off is more important have the option to opt out of call? The reason I ask is that these issues are a source of contention within our group.[/QUOTE]

A call night is paid about 3 times what a regular day is paid. We are on the hook for a full 24 hrs but dont usually come in till around 2 or 3 on weekdays. Sometimes have to come in earlier and sometimes have to stay later but not often. We have about 15% (2 soon to be 3) of the group that do not take call. If some one younger than 55 wanted to stop we would talk about it but I imagine that he would be allowed to not take call. This would be true up to the point that the number of call days per month got to be more than what people were willing to take. I think the reason that this is not too much of a problem for us is that most of us want to take call because our call if well paid. It is not a discussion for the 55 and over guys, if they want to stop they can. Luckily we are pretty evenly spread in ages and don't have alot of guys that will be turning 55 at the same time.

DrDre' said:

Sorry you guys are working so hard! 30% ED rate seems low but great. Remi PCA and take that down to zero!

WOrking on my Colorado license now.

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Our epidural rate is probably 90% and at least 35% get sections ...

Seems many of you are against doing many epidurals. We have roughly 7,000 dels/yr with >90% epidural rate. We have one md and one midlevel on OB 24/7. With a good payer mix, we make good money on it. The ob shift is 24 hours, roughly once per month per md. Some trade those shifts away, and others collect. Obviously the shift can range from mild to severe depending on whether there are 5 or 40 deliveries and 1 or >10 c/s in your 24 hours.
The ob team also helps out in the main or during the evening and weekends if needed acutely and for giving breaks to the guy(s) down there.
Hope obamacare doesn't kill our $ for epidurals.
T

Just out of curiosity: what, specifically, do you have your midlevels do up on OB? Do they run around and place epidurals, or do you just have them do the bolusing? Do you place all spinals for sections, or are you just supervising?

tucker27705 said:

Seems many of you are against doing many epidurals. We have roughly 7,000 dels/yr with >90% epidural rate. We have one md and one midlevel on OB 24/7. With a good payer mix, we make good money on it. The ob shift is 24 hours, roughly once per month per md. Some trade those shifts away, and others collect. Obviously the shift can range from mild to severe depending on whether there are 5 or 40 deliveries and 1 or >10 c/s in your 24 hours.
The ob team also helps out in the main or during the evening and weekends if needed acutely and for giving breaks to the guy(s) down there.
Hope obamacare doesn't kill our $ for epidurals.
T

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tucker27705 said:

Seems many of you are against doing many epidurals. We have roughly 7,000 dels/yr with >90% epidural rate. We have one md and one midlevel on OB 24/7. With a good payer mix, we make good money on it. The ob shift is 24 hours, roughly once per month per md. Some trade those shifts away, and others collect. Obviously the shift can range from mild to severe depending on whether there are 5 or 40 deliveries and 1 or >10 c/s in your 24 hours.
The ob team also helps out in the main or during the evening and weekends if needed acutely and for giving breaks to the guy(s) down there.
Hope obamacare doesn't kill our $ for epidurals.
T

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There's the key right there......good payer mix....and you only do one shift a month so your group is huge.

Obama WILL kill you reimbursement across the board.

tucker27705 said:

Seems many of you are against doing many epidurals. We have roughly 7,000 dels/yr with >90% epidural rate. We have one md and one midlevel on OB 24/7. With a good payer mix, we make good money on it. The ob shift is 24 hours, roughly once per month per md. Some trade those shifts away, and others collect. Obviously the shift can range from mild to severe depending on whether there are 5 or 40 deliveries and 1 or >10 c/s in your 24 hours.
The ob team also helps out in the main or during the evening and weekends if needed acutely and for giving breaks to the guy(s) down there.
Hope obamacare doesn't kill our $ for epidurals.
T

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Do you guys charge a flat rate for epidurals or do you bill separately by carrier?

Noyac said:

Do you guys charge a flat rate for epidurals or do you bill separately by carrier?

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In my place we charge a flat rate for epidurals - x$....The hospital is reimbursing and they deal with the insurance later.
So Dre is joining your group? Cool!

Noyac said:

Do you guys charge a flat rate for epidurals or do you bill separately by carrier?

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We make about 150-250 per epidural just billing insurance (depending on medicaid vs. private ins.). We probably have about an 80-90% epidural rate. We make about one FTE (even with the sh**ty reimbursement) off our ob service. If one good thing can be said about covering ob, we make this FTE without having to have a true extra person on the schedule to cover ob.

Hey guys...posting monetary info may not be ideal...lot of 'public lurkers' on here...may give off the wrong impression....just a thought. Perhaps better suited for private forum

SleepIsGood said:

Hey guys...posting monetary info may not be ideal...lot of 'public lurkers' on here...may give off the wrong impression....just a thought. Perhaps better suited for private forum

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You may be right but I'll bet if you asked a laboring mom if she thought an epidural was worth $150-250 I'd be willing to bet she would say yes, every time. Actually, this is a fairly low cost. What does the kit alone cost? $80?

2win said:

So Dre is joining your group? Cool!

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Yeah, somehow we fooled him into thinking this was a "dream" job. Just wait till he gets here, he'll wish he was back in residency.

kmurp said:

Gosh that's a bit rash... You have no knowledge of what schedule the others in his group have. Perhaps they are all in the same boat. Indeed, he mentioned that they rarely work late at night. In that situation, perhaps the group has chosen not to hire enough personnel to allow for a routine day off after call. Occasionally, one would get burned. If they are a small group, that extra body that they rarely really need is much more expensive on a per physician basis than in a larger group.

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You haven't been here long enough, it's obvious

Even if it is as hard as working in residency- at least I will be in a great location with fun partners!

Plus, I hear my boss will lend me his souped up jeeps once in a while!

Remind "Train tracks" that he is welcome to visit in spring for some peak-baggin!

Noyac said:

Yeah, somehow we fooled him into thinking this was a "dream" job. Just wait till he gets here, he'll wish he was back in residency.

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Noyac said:

You may be right but I'll bet if you asked a laboring mom if she thought an epidural was worth $150-250 I'd be willing to bet she would say yes, every time. Actually, this is a fairly low cost. What does the kit alone cost? $80?

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The intelligent half would think it a bargain at 3x that, and the other half think epidural analgesia is a God-given inalienable right that the government should pay for ... either way I don't think that particular cost is on any patient's radar.

We ought to collude to triple it on principle.

I really like doing OB anesthesia, but easily 90% of my annoying prima donna entitled patients hail from that demographic.

Noyac said:

Yeah, somehow we fooled him into thinking this was a "dream" job. Just wait till he gets here, he'll wish he was back in residency.

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Hey Noy,
If i get tired of the warm weather in Florida would you hire me?