1099 Chicago Suburbs vs W2 for New Grads

[NightyNight]

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Just an update for those looking around out there. Word on the street from a locum friend is that Alexian, which is run by Northstar, is looking to extend their CRNA coverage model to over 1:6

And they will do the same at Rush in the suburbs. He was just surprised that some Loyola? people doing locums were interested in a W2 job with PE. He took a first call and cross covering OB was insane when also covering a GI and OR CRNA. He won’t be doing any more of those obviously. There are 70 something calls a year. And schedule is made around CRNA preference. That would kill my life expectancy.

Anybody else hear the same thing?

 

[2buckchuck]

Just an update for those looking around out there. Word on the street from a locum friend is that Alexian, which is run by Northstar, is looking to extend their CRNA coverage model to over 1:6

And they will do the same at Rush in the suburbs. He was just surprised that some Loyola? people doing locums were interested in a W2 job with PE. He took a first call and cross covering OB was insane when also covering a GI and OR CRNA. He won’t be doing any more of those obviously. There are 70 something calls a year. And schedule is made around CRNA preference. That would kill my life expectancy.

Anybody else hear the same thing?

This is the Napa playbook too. Stretch the docs to 1:6 or 1:8 (or more), save money by having less doctors. Gotta have the cheapest butt in the seat and the cheapest “supervision” possible.

 

[2buckchuck]

This is the Napa playbook too. Stretch the docs to 1:6 or 1:8 (or more), save money by having less doctors. Gotta have the cheapest butt in the seat and the cheapest “supervision” possible.

To piggyback on this, I did locums at a facility that Napa staffed. Their goal was to have one (maybe two) doc(s) pre-op all the patients and sign them out of PACU. The CRNAs would do all the blocks, lines etc (including central lines and swans for open hearts) and would do the entire case themselves. The one doc I saw practicing like this never stepped foot in the OR. I entertained the idea of joining that hospital (bc I liked the people a lot), and was in some meetings with regional VP types. This is how they save money, and this is how PE profits.

Also, the CRNAs didn’t like it either. A lot of them were locums and in their locums contracts they had “doctor present at induction” as part of it. I also would tell the CRNAs that their liability would be increasing as they had more responsibility and if they didn’t call us timely if something bad was happening, we were going to end up under the bus.

 

[2buckchuck]

To piggyback on this, I did locums at a facility that Napa staffed. Their goal was to have one (maybe two) doc(s) pre-op all the patients and sign them out of PACU. The CRNAs would do all the blocks, lines etc (including central lines and swans for open hearts) and would do the entire case themselves. The one doc I saw practicing like this never stepped foot in the OR. I entertained the idea of joining that hospital (bc I liked the people a lot), and was in some meetings with regional VP types. This is how they save money, and this is how PE profits.

Also, the CRNAs didn’t like it either. A lot of them were locums and in their locums contracts they had “doctor present at induction” as part of it. I also would tell the CRNAs that their liability would be increasing as they had more responsibility and if they didn’t call us timely if something bad was happening, we were going to end up under the bus.

The CRNAs with good insight were afraid of doing blocks and lines (even with us showing them how) because they were afraid they were gonna hurt somebody.

The ones with poor insight would show up in pre-op and say “so and so told me to come do this block.” Have you ever done this block? Have you watched any YouTube videos about this block? Do you know anything about any of this equipment? Universally the answer was no.

 

[NightyNight]

The CRNAs with good insight were afraid of doing blocks and lines (even with us showing them how) because they were afraid they were gonna hurt somebody.

The ones with poor insight would show up in pre-op and say “so and so told me to come do this block.” Have you ever done this block? Have you watched any YouTube videos about this block? Do you know anything about any of this equipment? Universally the answer was no.

Ughhh! Outside of the heart room stuff, this appears to be the plan at suburb Rush per him. He had to “proctor” a CRNA for a block who just took a course.

Who in their right mind would pick up a job promoting their own atrophy and liability?

 

[2buckchuck]

Ughhh! Outside of the heart room stuff, this appears to be the plan at suburb Rush per him. He had to “proctor” a CRNA for a block who just took a course.

Who in their right mind would pick up a job promoting their own atrophy and liability?

I can kind of maybe slightly possibly understand if it’s a state that’s very doctor-friendly malpractice wise (damage caps, tort reform etc). But in a state where economic, noneconomic and/or punitive damages aren’t capped the sky is the limit for malpractice verdicts.

As an aside, a former medical malpractice attorney told me it was cheaper to kill someone than to maim them. If they die, they don’t have years of future medical bills. Obviously no one goes out and tries to hurt people, but it’s how the lawyers look at it.

 

[gunnershow]

I can kind of maybe slightly possibly understand if it’s a state that’s very doctor-friendly malpractice wise (damage caps, tort reform etc). But in a state where economic, noneconomic and/or punitive damages aren’t capped the sky is the limit for malpractice verdicts.

As an aside, a former medical malpractice attorney told me it was cheaper to kill someone than to maim them. If they die, they don’t have years of future medical bills. Obviously no one goes out and tries to hurt people, but it’s how the lawyers look at it.

Malpractice is secondary. I try to practice anesthesia the same way I would want someone to do for my family. It upsets me to no end that there are so many people in our profession who agree to work unsafe ratios. Doubly so for cardiac anesthesiologists because they really should know better and they also have a lot of leverage. If people don't agree to do this, it doesn't happen.

 

[NightyNight]

I can kind of maybe slightly possibly understand if it’s a state that’s very doctor-friendly malpractice wise (damage caps, tort reform etc). But in a state where economic, noneconomic and/or punitive damages aren’t capped the sky is the limit for malpractice verdicts.

As an aside, a former medical malpractice attorney told me it was cheaper to kill someone than to maim them. If they die, they don’t have years of future medical bills. Obviously no one goes out and tries to hurt people, but it’s how the lawyers look at it.

Yeah. Lifetime medical care is more expensive than just sending to the grave. Brain injury from hypoxia is the biggest cost. Plus the plaintiff lawyer can showcase the patient in front of a jury for extra $$$

 

[deleted1183938]

To piggyback on this, I did locums at a facility that Napa staffed. Their goal was to have one (maybe two) doc(s) pre-op all the patients and sign them out of PACU. The CRNAs would do all the blocks, lines etc (including central lines and swans for open hearts) and would do the entire case themselves. The one doc I saw practicing like this never stepped foot in the OR. I entertained the idea of joining that hospital (bc I liked the people a lot), and was in some meetings with regional VP types. This is how they save money, and this is how PE profits.

Also, the CRNAs didn’t like it either. A lot of them were locums and in their locums contracts they had “doctor present at induction” as part of it. I also would tell the CRNAs that their liability would be increasing as they had more responsibility and if they didn’t call us timely if something bad was happening, we were going to end up under the bus.

Are smoking crack? You WILLINGLY, with a CLEAR mind wanted to work at a zoo like this???
Maybe you need some crack. I know I would to want to work in a crazy house like this.

 

[2buckchuck]

Are smoking crack? You WILLINGLY, with a CLEAR mind wanted to work at a zoo like this???
Maybe you need some crack. I know I would to want to work in a crazy house like this.

I didn’t know any better. It took me time to learn the Private Equity playbook for anesthesia. As I learned more about the anesthesia job landscape I kept a safe distance.

 

[NightyNight]

I didn’t know any better. It took me time to learn the Private Equity playbook for anesthesia. As I learned more about the anesthesia job landscape I kept a safe distance.

It’s good that you gained wisdom versus just looking at the money. That’s why I’m surprised somebody would leave a situation with residents in a teaching institution for preop-ing and lunching for 6 CRNAs. The locums people don’t consistently get a break for lunch even if the agency said so. Spread thin as possible. Wonder if academics is that bad to consider going to PE. Never thought that was possible.

 

[2buckchuck]

It’s good that you gained wisdom versus just looking at the money. That’s why I’m surprised somebody would leave a situation with residents in a teaching institution for preop-ing and lunching for 6 CRNAs. The locums people don’t consistently get a break for lunch even if the agency said so. Spread thin as possible. Wonder if academics is that bad to consider going to PE. Never thought that was possible.

Where I was the “department” was 95% locums. There were 7-8 semi-regular locums docs with no actual Napa employees. There were 20-25 locums/PRN CRNAs and 4 Napa-employed CRNAs. Every day we got to work the docs would just divide up the cases (one person to GI with max 4 rooms, three people upstairs covering 3-4 rooms). Napa brought in a hatchet man to try to roll out a program that was essentially independent CRNA practice, but he couldn’t physically make us take on 8-10 rooms. Nothing changed about the way the locums docs practiced bc none of us were comfortable in that model.

It was a weird model. The Napa guy would literally see everyone’s patients in pre-op (for “efficiency”). We would then come behind and actually talk to the patients we were gonna take care of. He wouldn’t go into the OR (even during a CPB case when they were coming off bypass and the CRNA and surgeon were both asking for him to come in). He never did, so the surgeon just grabbed the TEE probe through the drape to try to get a rough idea of LV function.

 

[deleted1183938]

Where I was the “department” was 95% locums. There were 7-8 semi-regular locums docs with no actual Napa employees. There were 20-25 locums/PRN CRNAs and 4 Napa-employed CRNAs. Every day we got to work the docs would just divide up the cases (one person to GI with max 4 rooms, three people upstairs covering 3-4 rooms). Napa brought in a hatchet man to try to roll out a program that was essentially independent CRNA practice, but he couldn’t physically make us take on 8-10 rooms. Nothing changed about the way the locums docs practiced bc none of us were comfortable in that model.

It was a weird model. The Napa guy would literally see everyone’s patients in pre-op (for “efficiency”). We would then come behind and actually talk to the patients we were gonna take care of. He wouldn’t go into the OR (even during a CPB case when they were coming off bypass and the CRNA and surgeon were both asking for him to come in). He never did, so the surgeon just grabbed the TEE probe through the drape to try to get a rough idea of LV function.

Jesus Christ!! Even when called for help by the CRNAs he wouldn’t? Coming off bypass? And the surgeons were ok with this why?
And why was he seeing all the patients if you guys had your own rooms? This is the absolute opposite of inefficient if you guys are gonna follow up with seeing the patients yourselves.
Sounds like an absolute **** show and badness Waiting to happen to a poor patient.

 

[2buckchuck]

Jesus Christ!! Even when called for help by the CRNAs he wouldn’t? Coming off bypass? And the surgeons were ok with this why?
And why was he seeing all the patients if you guys had your own rooms? This is the absolute opposite of inefficient if you guys are gonna follow up with seeing the patients yourselves.
Sounds like an absolute **** show and badness Waiting to happen to a poor patient.

I think after that the two surgeons came to an agreement between themselves that if he wasn’t going to show up like that they just weren’t going to do any cardiac cases - there were a few other hospitals close by so it wouldn’t have been a huge issue for the patients to transfer.

This was after I had left - when I was there I did most of the cardiac cases bc I had done a cardiac fellowship and am echo certified (and competent).

Everyone had to learn how to work around this guy. He would pre-op my patients and tell the pre-op RN to not do a 2nd PIV or that the patient didn’t need an art line or block. This wasn’t a big facility - a lot of the same surgeons doing the same kinds of cases (spine, vascular, general, ortho etc). There was an established way to do things (this surgeon likes art lines and does neuromonitoring for every spine case, this surgeon likes spinals for knees and hips, this surgeon wants TAP blocks etc) - every surgeon ask was usually reasonable so there was no reason to re-invent the wheel. So when this guy would see everyone and would say “1 PIV and no art line for this C3-T2 posterior fusion with neuromonitoring”, the pre-op nurses would go check our assignments. If it was that one guy they were SoL. If it was anybody else, they would just set up everything like normal.

 

[deleted1183938]

I think after that the two surgeons came to an agreement between themselves that if he wasn’t going to show up like that they just weren’t going to do any cardiac cases - there were a few other hospitals close by so it wouldn’t have been a huge issue for the patients to transfer.

This was after I had left - when I was there I did most of the cardiac cases bc I had done a cardiac fellowship and am echo certified (and competent).

Everyone had to learn how to work around this guy. He would pre-op my patients and tell the pre-op RN to not do a 2nd PIV or that the patient didn’t need an art line or block. This wasn’t a big facility - a lot of the same surgeons doing the same kinds of cases (spine, vascular, general, ortho etc). There was an established way to do things (this surgeon likes art lines and does neuromonitoring for every spine case, this surgeon likes spinals for knees and hips, this surgeon wants TAP blocks etc) - every surgeon ask was usually reasonable so there was no reason to re-invent the wheel. So when this guy would see everyone and would say “1 PIV and no art line for this C3-T2 posterior fusion with neuromonitoring”, the pre-op nurses would go check our assignments. If it was that one guy they were SoL. If it was anybody else, they would just set up everything like normal.

Jesus Christ. Where is this **** show and is it still up and functional under NAPA?? With this goober still in charge?

 

[NightyNight]

For those looking, suburb Rush is no longer looking for docs to do locums. They don’t want to credential anyone else. Just CRNAs. Probably better off with Endeavor or another system.

And apparently it may get bad for existing locums since 4 new people signed up as a click. They trying to create a boys club and boys can only be from a “certain” background. So weird.

 

[Coffee PRN]

For those looking, suburb Rush is no longer looking for docs to do locums. They don’t want to credential anyone else. Just CRNAs. Probably better off with Endeavor or another system.

And apparently it may get bad for existing locums since 4 new people signed up as a click. They trying to create a boys club and boys can only be from a “certain” background. So weird.

4 locums docs signed together as a clique? Trying to see if I’m understanding you right

 

[NightyNight]

4 locums docs signed together as a clique? Trying to see if I’m understanding you right

Yup. I was going to signup and see how locums would be to keep options open. But it’s closed for now.

So asked someone who is there and was told that a group of locums signed on as W2. I was surprised but then heard they got plans to mold things their way. Don’t know if PE allows that but seen some people post they leave sites alone sometimes.

 

[dabears505]

Is this in aurora or the gi center in the city?

 

[NightyNight]

Is this in aurora or the gi center in the city?

Aurora Naperville area

 

[dabears505]

What were they paying?

 

[NightyNight]

What were they paying?

550 last time I heard. But that’s with like 75 calls over 42 weeks. And pretty much all supervision

 

[Ronin786]

Yup. I was going to signup and see how locums would be to keep options open. But it’s closed for now.

So asked someone who is there and was told that a group of locums signed on as W2. I was surprised but then heard they got plans to mold things their way. Don’t know if PE allows that but seen some people post they leave sites alone sometimes.

Was this group of Locums out of Loyola by chance?

 

[NightyNight]

Was this group of Locums out of Loyola by chance?

Yes per the locum contact I know going there. Really surprised after I heard how call can end up with a busy OB. They got a CRNA covering OB so it’s cross coverage with OR. Lookin at it as just could end up in a bad situation. Apparently there were a couple incidents. Not sure exactly but seems like how PE would distribute coverage.

 

[dabears505]

It's honestly not seeming like a bad job if a crna is on house for ob. Especially for someone 50 plus where doing own cases is probably not a priority anymore.

 

[NightyNight]

It's honestly not seeming like a bad job if a crna is on house for ob. Especially for someone 50 plus where doing own cases is probably not a priority anymore.

Definitely do your own cases. Just after 5pm or weekends

 

[deleted1183938]

For those looking, suburb Rush is no longer looking for docs to do locums. They don’t want to credential anyone else. Just CRNAs. Probably better off with Endeavor or another system.

And apparently it may get bad for existing locums since 4 new people signed up as a click. They trying to create a boys club and boys can only be from a “certain” background. So weird.

What kind of background? Good ol’ boys club of America or another background??

 

[nimbus]

What kind of background? Good ol’ boys club of America or another background??

I was curious too. There are sooo many possibilities in anesthesia.

 

[ambiturner]

Knowing a little about the area and the institution this may be an insinuation that they were south Asian, but could easily be a rush grad or boys club too.

 

[NightyNight]

Knowing a little about the area and the institution this may be an insinuation that they were south Asian, but could easily be a rush grad or boys club too.

It’s a boy’s club that certainly doesn’t include melanin. Funny how the rumor that the old group didn’t have enough women but they go ahead with the opposite after the change.

I haven’t heard of a South Asian club anywhere in anesthesia. They are second tier at best. There is always someone from the old guard at top.

 

[NightyNight]

What kind of background? Good ol’ boys club of America or another background??

Good ol types. Here’s one sports convo (which is second hand). Started with college basketball and ended with LeBron shouldn’t talk and just play basketball. 🤔. That’s code for blacks shouldn’t inject themselves into any political discourse. Wasn’t even a criticism of his game on the court.

 

[deleted1183938]

Good ol types. Here’s one sports convo (which is second hand). Started with college basketball and ended with LeBron shouldn’t talk and just play basketball. 🤔. That’s code for blacks shouldn’t inject themselves into any political discourse. Wasn’t even a criticism of his game on the court.

Well damn!! And these are younger dudes???

 

[NightyNight]

Well damn!! And these are younger dudes???

I’m guessing probably 40s-50s. Don’t think it really matters if they might have views which are not egalitarian in the workplace. Not saying everything is always going to be even but assume a lot of folks have seen a clique skew case and call assignments in their own groups based on X factors. Nobody needs to have friends outside of the workplace but going there shouldn’t feel guarded.

 

[deleted1183938]

I’m guessing probably 40s-50s. Don’t think it really matters if they might have views which are not egalitarian in the workplace. Not saying everything is always going to be even but assume a lot of folks have seen a clique skew case and call assignments in their own groups based on X factors. Nobody needs to have friends outside of the workplace but going there shouldn’t feel guarded.

I see what you mean. And you make total sense.