5 Day Work Week?

[Dawkter]

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Curious… how many of you are working 5 days a week and taking call? I am noticing physically that by Thursday or Friday waking up early in the morning does get more challenging with the conventional M-F anesthesia work week. I would love to know more about different groups monthly schedules + vacation time pertaining to longevity in this career.

 

[rowsdower88]

7 years out of residency, I'm working full time which averages out to 4 days a week with one to two post-call days and one weekend a month. 8 weeks vacation. 3 guys in my group graduated residency after me and are already working 0.8 with one fewer workday, I'm envying these younger guys more as time goes on.

 

[aneftp]

7 years out of residency, I'm working full time which averages out to 4 days a week with one to two post-call days and one weekend a month. 8 weeks vacation. 3 guys in my group graduated residency after me and are already working 0.8 with one fewer workday, I'm envying these younger guys more as time goes on.

The times are changing. Unless you are making close to 7 figures with your work schedule on 44 weeks off.

We are literally moving towards an EM type of 10-14 days working “shifts” each month model.

I live in Florida. And almost every single job with reasonable alternative schedules gets filled rapidly.

As for me. I rotate between working 2 weeks days (40 hr each week). One week nights (starting at 5p) (not in house) (40 hr usually). 2 weeks off. My previous job was 2 weeks on including calls light beeper every other day and 3 weeks off.

I cannot imagine doing the q3-5 call schedule plus with pre and post call and 8 weeks off.

So unless you are a fully vested private practice partner with equity stake how profits can be siphon off junior partner track employees. Working your schedule will lead to burn out quickly.

 

[Mman]

Curious… how many of you are working 5 days a week and taking call? I am noticing physically that by Thursday or Friday waking up early in the morning does get more challenging with the conventional M-F anesthesia work week. I would love to know more about different groups monthly schedules + vacation time pertaining to longevity in this career.

Full time and going strong. I'm curious how waking up early gets tougher? After 20 years of waking up at the crack of dawn for work, I can't sleep past about 7 AM even on vacation.

 

[pmichaelmd]

Agreed, times are changing and rapidly. We work a 5 day week with 1:5 call more or less, post-call days off. As our practice has expanded its scope (CV, neurosurg, more out-of-OR locations) we are starting to feel the grind. 9 wks PTO. We are actively seeking ways to make our schedule more flexible but it has been challenging due to administrative desires to maintain the current structure. I am 19 years out of residency.

 

[agolden1]

Curious… how many of you are working 5 days a week and taking call? I am noticing physically that by Thursday or Friday waking up early in the morning does get more challenging with the conventional M-F anesthesia work week. I would love to know more about different groups monthly schedules + vacation time pertaining to longevity in this career.

I work in a group with cardiac, pedi, pain, and generalists. Five day work week for all, one weekend a month, one week day overnight a month and usually one-ish late call a week with somewhat early out before and after late call. 9 weeks vaca before 10 years with the group.

Most of the pedi and generalists are 0.9 FTE which equates to more weeks off, but not a four day work week. Most cardiac and pain have remained full time. I’m pain trained. I think the variance between anesthesia and pain clinic days as well as some admin work keeps me feeling balanced and not too burned out.

Admittedly if I have a week or two which is anesthesia heavy, particularly if sitting my own cases, I feel it.

 

[gasman11]

7 years out of training, I've been doing locums for 3 years now and I work 5 days a week Mon-Fri 55-60 hours a week, no call, no weekends, taking off about 6 weeks/year. The job is about 70% solo/30% supervision. The income is good but Its definitely a grind and I do feel it by day 5. I do take a 4 day week every now and then just for my own mental health and do not see this as a long term plan.

 

[aneftp]

7 years out of training, I've been doing locums for 3 years now and I work 5 days a week Mon-Fri 55-60 hours a week, no call, no weekends, taking off about 6 weeks/year. The job is about 70% solo/30% supervision. The income is good but Its definitely a grind and I do feel it by day 5. I do take a 4 day week every now and then just for my own mental health and do not see this as a long term plan.

The key is u are making around 7 figures. Without calls

The Op likely isn’t making anywhere near 7 figures plus doing calls.

It’s like this doc hates ob call 24 hrs. But he changed his mind when they were offering him $10800 on weekends continuously.

Money talks. And lessens the mental stress

 

[Dawkter]

The key is u are making around 7 figures. Without calls

The Op likely isn’t making anywhere near 7 figures plus doing calls.

It’s like this doc hates ob call 24 hrs. But he changed his mind when they were offering him $10800 on weekends continuously.

Money talks. And lessens the mental stress

Correct, nowhere close. It seems like most sustainable option across the board is to cut down to 0.8 FTE.

 

[aneftp]

Correct, nowhere close. It seems like most sustainable option across the board is to cut down to 0.8 FTE.

Go to 0.8fte. Start filling up some prn 1099 gigs. Sniff around till you feel comfortable. Doesn’t mean you will be working on your off days. But it’s plan B at this stage. If you can’t get Fridays off. Go for Tuesdays. I know that sounds weird. But that allows you to piggy back Mondays pto off for long weekend.

 

[IVdoc]

I've seen jobs advertise for $500K for 26 weeks work. They sound attractive. When I inquired via email about these jobs, they tell me it's 90-100hrs/week, 7 days per week with no post-call days off. Plus they have a busy OB, all physician group, working all day OR, on-call at night from home for OR and OB is in hospital. That works out to be $192/hr 1099. For those who just see the $500K and 26 weeks, it sounds like a dream job. But the devil is in the details. Pass

 

[rowsdower88]

The times are changing. Unless you are making close to 7 figures with your work schedule on 44 weeks off.

We are literally moving towards an EM type of 10-14 days working “shifts” each month model.

I live in Florida. And almost every single job with reasonable alternative schedules gets filled rapidly.

As for me. I rotate between working 2 weeks days (40 hr each week). One week nights (starting at 5p) (not in house) (40 hr usually). 2 weeks off. My previous job was 2 weeks on including calls light beeper every other day and 3 weeks off.

I cannot imagine doing the q3-5 call schedule plus with pre and post call and 8 weeks off.

So unless you are a fully vested private practice partner with equity stake how profits can be siphon off junior partner track employees. Working your schedule will lead to burn out quickly.

Made close to seven figures two years ago with some extra call. Not taking the extra call more recently has hurt the bottom line, but likely will still be around 700-800. No hearts, no ob, no peds, no trauma, home call, good colleagues and surgeons, LCOL. Lots of trade-offs that can make a job you find unappealing worth sticking around for for others. Even my 1st calls usually aren't that bad and those are once or twice a month. Plus (big one) my wife likes her job here.

We're close to our FIRE number. So downshifting to 0.8 or lower and doing more international work is something I'll be doing soon.

 

[jon stewart]

What do you think is appropriate weekend compensation for call that involves being back call Friday (home call), 24 hr on Saturday that ends 7am Sunday then being backup into Monday morning 7am, no post call day off Monday but on the list to go home on the earlier side?

There is a Crna for your back up Friday night and then another attending if needed. The Saturday call backup would be another attending at night with a CRNA during the day 7a-7p


When you folks are saying post call days off you mean after being in house overnight right?

 

[aneftp]

What do you think is appropriate weekend compensation for call that involves being back call Friday (home call), 24 hr on Saturday that ends 7am Sunday then being backup into Monday morning 7am, no post call day off Monday but on the list to go home on the earlier side?

There is a Crna for your back up Friday night and then another attending if needed. The Saturday call backup would be another attending at night with a CRNA during the day 7a-7p


When you folks are saying post call days off you mean after being in house overnight right?

60 hrs beeper call coverage on the low end is 18k guaranteed (min) up to 25k regardless if it’s beeper or not.

The way I see is is
$3500 at min to be on beeper 7p-7a Friday night that’s at min plus whatever hours you work

24 hrs beeper on Saturday is at min $8000 regards if u do one case or not. Up to 12k.

Same for Sunday. $8000 on the low end beeper ip to 12k if u work say at least 20 of those hours.

I’ve seen crnas get $2800 just for 12 hr beeper coverage plus 4 hr call back guarantee. On weekends.

I keep reiterating our time is valuable on beeper. Our weekends at valuable.

Anesthesia Docs need to learn from locums crnas. They don’t leave a dime on the table.

 

[jon stewart]

60 hrs beeper call coverage on the low end is 18k guaranteed (min) up to 25k regardless if it’s beeper or not.

The way I see is is
$3500 at min to be on beeper 7p-7a Friday night that’s at min plus whatever hours you work

24 hrs beeper on Saturday is at min $8000 regards if u do one case or not. Up to 12k.

Same for Sunday. $8000 on the low end beeper ip to 12k if u work say at least 20 of those hours.

I’ve seen crnas get $2800 just for 12 hr beeper coverage plus 4 hr call back guarantee. On weekends.

I keep reiterating our time is valuable on beeper. Our weekends at valuable.

Anesthesia Docs need to learn from locums crnas. They don’t leave a dime on the table.

Makes sense why the senior partners don’t do many if any of these calls. The rate of reimbursement of these shifts is abysmal compared to what you just mentioned!

 

[dabears505]

What do you think is appropriate weekend compensation for call that involves being back call Friday (home call), 24 hr on Saturday that ends 7am Sunday then being backup into Monday morning 7am, no post call day off Monday but on the list to go home on the earlier side?

There is a Crna for your back up Friday night and then another attending if needed. The Saturday call backup would be another attending at night with a CRNA during the day 7a-7p


When you folks are saying post call days off you mean after being in house overnight right?

A lot of places give 1500 for friday night plus an hourly rate for hours worked. About 2500 for being on call over weekend plus hourly. Not common in desirable areas to get 18k. People in my area fight over who gets these calls for the rate I listed.

 

[jon stewart]

A lot of places give 1500 for friday night plus an hourly rate for hours worked. About 2500 for being on call over weekend plus hourly. Not common in desirable areas to get 18k. People in my area fight over who gets these calls for the rate I listed.

I guess the location is a big factor aswell.
No doubt for 18k it would be desirable !

 

[aneftp]

A lot of places give 1500 for friday night plus an hourly rate for hours worked. About 2500 for being on call over weekend plus hourly. Not common in desirable areas to get 18k. People in my area fight over who gets these calls for the rate I listed.

It’s it’s w2 extra pay for weekend that’s close to pure stupidity to be taking even those rates.

Friday night maybe since u are working Friday days already but that’s about it.

 

[spike7585]

6 x 24 hour in house shifts spread out throughout the month - small community hospital, no trauma

Comes out to 1700ish hours a year

Effectively comes out to low 30 hours a week on a 52 week average. Or right at 40 hours a week on a 44 week a year system (8 weeks off)

 

[aneftp]

6 x 24 hour in house shifts spread out throughout the month - small community hospital, no trauma

Comes out to 1700ish hours a year

Effectively comes out to low 30 hours a week on a 52 week average. Or right at 40 hours a week on a 44 week a year system (8 weeks off)

So u have 293 days off a year give or take as well. Right?

 

[spike7585]

So u have 293 days off a year give or take as well. Right?

Correct

 

[cittykat]

I work 0.8 FTE and take proportional call. Epic says I worked 56hrs the over the past 2 weeks based on first case start to last case end times. That is an underestimate because I usually show up to work about 30min before my first case starts. Also took a 14hr in-house overnight shift (5pm-7am) on June 1. So my actual time at work was 64hrs over 2weeks. At least at our hospital Epic showed us we don’t work as much as we thought we do.

 

[dannyboy1]

I work 0.8 FTE and take proportional call. Epic says I worked 56hrs the over the past 2 weeks based on first case start to last case end times. That is an underestimate because I usually show up to work about 30min before my first case starts. Also took an 14hr in-house overnight shift (5pm-7am) on June 1. So my actual time at work was 64hrs over 2weeks. At least at our hospital Epic showed us we don’t work as much as we thought we do.

View attachment 420631

Would hate to have EPIC decide how much I worked. I work a shift. Weather on not cases fill that shift is beyond my control….

 

[cittykat]

Would hate to have EPIC decide how much I worked. I work a shift. Weather on not cases fill that shift is beyond my control….

Epic doesn’t make any decisions, it just tracks our historical hours. Before we started tracking our hours on Epic, we thought 1.0 FTE would be around 50hrs/week but it turns out a full FTE is actually closer to 40hrs/week. We have peel off system so I go home when it’s my turn.

One of the hospitals in our system just went hospital employed (foundation model). They have a shift system and I think they actually have a better deal. I think it’s a test for the hospital system to see which way is cheaper. If they decide to expand the foundation model, it’ll be the end of our group but we may be working less for more money albeit with possibly less control.

 

[aneftp]

Epic doesn’t make any decisions, it just tracks our historical hours. Before we started tracking our hours on Epic, we thought 1.0 FTE would be around 50hrs/week but it turns out a full FTE is actually closer to 40hrs/week. We have peel off system so I go home when it’s my turn.

One of the hospitals in our system just went hospital employed (foundation model). They have a shift system and I think they actually have a better deal. I think it’s a test for the hospital system to see which way is cheaper. If they decide to expand the foundation model, it’ll be the end of our group but we may be working less for more money albeit with possibly less control.

Epic is sorta of ok. Depends if it’s act model or md only model.

The “highest” time epic doc by data is chief doc who pay themselves 400k more than their regular staff because they manipulate the system. They purposely put themselves in the longest rooms like neuro and sit in office. Supervise 1:1 90% of the time.

So to a lazy admin auditing productivity. The chief appears to be “working “.

 

[cittykat]

Epic is sorta of ok. Depends if it’s act model or md only model.

The “highest” time epic doc by data is chief doc who pay themselves 400k more than their regular staff because they manipulate the system. They purposely put themselves in the longest rooms like neuro and sit in office. Supervise 1:1 90% of the time.

So to a lazy admin auditing productivity. The chief appears to be “working “.

We’re MD only, 100% doing our own cases. If we’re not sitting on a stool in the OR, we’re not working.

Chief is rotated q2 years. Comes with $2500 monthly stipend. It’s usually a hot potato and people get voluntold/peer pressured to do it.

Our schedule maker gets a bigger stipend ($3k/mo) because that job is a PITA.

 

[Simba1711]

I changed to shift work this year. It’s been so much better for my stress and work life balance. I work 4-5 days a week and no nights or weekends. I get paid guaranteed for 8 hours 7-3. Also recently diagnosed with chronic health conditions that make taking call more and more difficult.

The vacation is abut the same as my academic job and the salary is slightly higher albeit 1099. The benefits were better in academics but my retirement plan is way better at my current job.

 

[aneftp]

I changed to shift work this year. It’s been so much better for my stress and work life balance. I work 4-5 days a week and no nights or weekends. I get paid guaranteed for 8 hours 7-3. Also recently diagnosed with chronic health conditions that make taking call more and more difficult.

The vacation is abut the same as my academic job and the salary is slightly higher albeit 1099. The benefits were better in academics but my retirement plan is way better at my current job.

If u have a spouse with access to healthcare. Being paid 1099 especially at our income level is way better

But if u are 1099 and no other acces to healthcare and family of 4-5 working 7-3 no call no weekss for 500k and no healthcare access besides ACa exchanges. Academic jobs beats 500k 1099.

 

[sanityonleave]

Academics, VHCOL.

4 days a week is full time for us with 8 weeks of vacation (up to 9 after 10 years). Call is 2x/mo, 1 in-house overnight (5p-7a), 1 backup (12p until sent home - average 11pish - callback rate is <5%). Couple of evening swings (3-10) per month. OB is covered separately.

I actually scaled back to .75FTE (3 days/week) because I take extra call for transplants and cardiac and didn't want to work all the time. I certainly make less than most of the folks posting but it's not terrible, and the work isn't a grind. I do cases I enjoy, teach, and only rarely (1x/mo) have a day where I am just pushing the meat all day (e.g., endo or EP). I do live a very different lifestyle (read: cheaper) than most, but I could easily see myself working my job into my 60s/70s - and I have plenty of time, money and energy to do things now.

YMMV, but I'd say to folks reading this: grinding it for $$ til you can FIRE at 55 is the path to happiness for some, but there are others. I'd much rather do a job I enjoy with more control and more flexibility / less $$ than work 14 hour days covering 4:1 making lots of dough.

Strong caveat: no kids and none happening. I think that changes the financial calculus a lot.

 

[aneftp]

Very few people work 5 days a week. Even city Kat epic time say Thursday May 28 long weekend
Tuesday June 1
June 2 call
June 4 off
June 5

City kat says they are 0.8 fte

The days of 1.0 fte 5 days a weeks/42/44 weeks a year are becoming uncommon unless it pays 700k and up.

 

[NPJR]

I work 0.8 FTE and take proportional call. Epic says I worked 56hrs the over the past 2 weeks based on first case start to last case end times. That is an underestimate because I usually show up to work about 30min before my first case starts. Also took a 14hr in-house overnight shift (5pm-7am) on June 1. So my actual time at work was 64hrs over 2weeks. At least at our hospital Epic showed us we don’t work as much as we thought we do.

View attachment 420631

How do you activate this feature on EPIC? would love to know my start and stop times

 

[cittykat]

How do you activate this feature on EPIC? would love to know my start and stop times

We have a tab called “anesthesia analytics”. Likely depends on your build.

 

[aneftp]

Went to Fourth of July party yesterday . Met up with a few old colleagues. Not a single one works 5 days a week 40-44 weeks year. Not a single one works a traditional schedule either (q3-7 calls).

Well one does the traditional schedule sorta.

But he’s chief and demands 2 non clinical days a week (literally written in his contract) and pays himself a 200k chief salary/medical director/czar and barely works and makes 2x as much as his workers bees.

Times change. And we are all evolving in our work careers.

There is so much work out there. These alt schedules are simply creating a huge vacuum of extra open holes in the schedule. And it’s open to admin to figure it out. The chief I was talking about finally had their Netflix (as opposed to old blockbuster video ideology) and let their daytime docs do compressed schedules for 26 weeks off no calls no nights and magically got 2 docs to hire within 1 month of making it available. It’s not a bad schedule id even consider taking it but it’s 30 min from my house but my current gig is 15 min from my house

Now two more docs want the similar deal. But they both want to split it meaning working 1 week a month 13 weeks on/39 weeks off for 250k plus benefits. 0.5 fte plus benefits pretax 457/403/401a. A significant tax savings. Averages out to around $325/hr for the hours worked. It’s a decent job for someone in their late 50s/early 60s winding down their careers to do one week a month. No stress. 100% supervision or solo anytime if u are just bored out of your mind.

People just value time off.

Sure, does locums still pay more? Yes, but you get guaranteed w2 pay. And the hourly average is within 10% of market locums per hour pay in the area.
And you avoid having to hustle as figure out your locums schedule every 30-60 days

 

[eyeeye_captain]

There is so much work out there. These alt schedules are simply creating a huge vacuum of extra open holes in the schedule. And it’s open to admin to figure it out.

I’ll highlight this as someone on the other side of the drape who is seeing this adversely affect patient care.

I’m pretty laid back, but when you potentially hurt my patients, I go through the roof. I keep privileges at a hospital for my extra sick or certain insurances patients. A few weeks ago I had 3 retinal detachments come in, so urgent surgeries to be done. I was told I could do 1 if I did a 7:00 start, and no, they couldn’t fully open the room or do after hours. Nobody could cover.

I’ve known the anesthesia group for years. We’re friendly and collegial. Our kids are in the same classes.

I was very fortunate to be able shoehorn the other 2 on my partner with lucky circumstances. This kind of attitude, while I don’t begrudge you getting yours, does in reality lead to potential harm to patients.

 

[aneftp]

I’ll highlight this as someone on the other side of the drape who is seeing this adversely affect patient care.

I’m pretty laid back, but when you potentially hurt my patients, I go through the roof. I keep privileges at a hospital for my extra sick or certain insurances patients. A few weeks ago I had 3 retinal detachments come in, so urgent surgeries to be done. I was told I could do 1 if I did a 7:00 start, and no, they couldn’t fully open the room or do after hours. Nobody could cover.

I’ve known the anesthesia group for years. We’re friendly and collegial. Our kids are in the same classes.

I was very fortunate to be able shoehorn the other 2 on my partner with lucky circumstances. This kind of attitude, while I don’t begrudge you getting yours, does in reality lead to potential harm to patients.

Correct. U don’t know who the providers are these days. It can be pretty scary if u are the surgeon.

But on the other hand. You and other surgeons cherry pick your cases. Do the more profitable and healthier patients at the ASC during standard hours.

But what I have also found is these “urgent” retina detachments come in at 12pm-2pm. You can literally shut down ur profitable ASC and tell ur patients to wait 2-3 extra hours and go to the hospital and anesthesia will accommodate you quickly with true emergency

But surgeons want to finish their cases outpatient first than go to the hospital. Or whatever fits their schedule best.

We all do what’s best for US. Let’s not try to sugar coat it that it’s harmful to the patient. If the surgery were urgent. Drop everything you are doing and run to the hospital and do it. Delay all the elective stuff

I promise you. We will do everything possible to accommodate you since our manpower dies down around 4-5pm.

Healthcare unfortunately expensive (and inefficient). It’s labor intensive. Anesthesia (physicians wise) definitely is moving towards this “shift “ mentality just like the crna have done for ages.

I’ve offer to come in at 4pm-11pm and be the closer at $420/hr for a hospital. Do all my cases. Their crnas leave around 9pm except one crnas. So I’ve given them the opportunity to run an extra room after 9pm. . But they want me to come in at 11am to help with lunch breaks etc. That MESSES up MY SCHEDULE. Cause I’m working 7-3 elsewhere lol. Takes me 30-40 min to run back to cover.

You see. I work on MY OWN TIME.

You operate on YOUR OWN TIME

Time is very precious and I have figured out as we all age. I value time. I’m sure you value your time. So it’s not about the patient. It’s about YOU and YOUR TIME. When you want to do the retina detachment.

 

[circleK]

Our schedule maker gets a bigger stipend ($3k/mo) because that job is a PITA.

I’ll agree with this. Been doing the schedule for a decade. Looks like I should be asking for more compensation for this thankless job.

 

[eyeeye_captain]

Correct. U don’t know who the providers are these days. It can be pretty scary if u are the surgeon.

But on the other hand. You and other surgeons cherry pick your cases. Do the more profitable and healthier patients at the ASC during standard hours.

But what I have also found is these “urgent” retina detachments come in at 12pm-2pm. You can literally shut down ur profitable ASC and tell ur patients to wait 2-3 extra hours and go to the hospital and anesthesia will accommodate you quickly with true emergency

But surgeons want to finish their cases outpatient first than go to the hospital. Or whatever fits their schedule best.

We all do what’s best for US. Let’s not try to sugar coat it that it’s harmful to the patient. If the surgery were urgent. Drop everything you are doing and run to the hospital and do it. Delay all the elective stuff

I promise you. We will do everything possible to accommodate you since our manpower dies down around 4-5pm.

Healthcare unfortunately expensive (and inefficient). It’s labor intensive. Anesthesia (physicians wise) definitely is moving towards this “shift “ mentality just like the crna have done for ages.

I’ve offer to come in at 4pm-11pm and be the closer at $420/hr for a hospital. Do all my cases. Their crnas leave around 9pm except one crnas. So I’ve given them the opportunity to run an extra room after 9pm. . But they want me to come in at 11am to help with lunch breaks etc. That MESSES up MY SCHEDULE. Cause I’m working 7-3 elsewhere lol. Takes me 30-40 min to run back to cover.

You see. I work on MY OWN TIME.

You operate on YOUR OWN TIME

Time is very precious and I have figured out as we all age. I value time. I’m sure you value your time. So it’s not about the patient. It’s about YOU and YOUR TIME. When you want to do the retina detachment.

Tell me you don’t know anything about being in clinic without needing to tell me. Much less what scheduling cases is like. Maybe you just have crappy or demanding retina docs in Florida. I can’t remember the last patient I did overnight when I couldn’t limp them along to normal hours

I was asking for, in theory, a 7:30 to 10:30, in my normally scheduled block, for urgent cases, with lead time to find even the laziest CRNA you’ve got. I don’t think that’s unreasonable. Like I said, I get that you want to work as little as possible for as much as possible - who doesn’t. But when you can’t be bothered to staff easy cases that need to go during normal hours that then potentially hurts patients, that’s irresponsible.

 

[aneftp]

Tell me you don’t know anything about being in clinic without needing to tell me. Much less what scheduling cases is like. Maybe you just have crappy or demanding retina docs in Florida. I can’t remember the last patient I did overnight when I couldn’t limp them along to normal hours

I was asking for, in theory, a 7:30 to 10:30, in my normally scheduled block, for urgent cases, with lead time to find even the laziest CRNA you’ve got. I don’t think that’s unreasonable. Like I said, I get that you want to work as little as possible for as much as possible - who doesn’t. But when you can’t be bothered to staff easy cases that need to go during normal hours that then potentially hurts patients, that’s irresponsible.

Tell me how much it cost to run an OR every minute.

It is much costlier to run the OR even paying crnas to do solo.

Clinics patients don’t generate much money at all. But you obviously need clinic patients. So you are in a catch-22.

If you have a 730-1030 am hospital block time. Why didn’t they let you use your own block time?

unless you are confusing your ASC block time 730-1030am with hospitals block time and just want to switch on the fly.

I always ask surgeons if they want to bump surgeons. Declare it an emergency. Come on in within 2 hours. It’s a very reasonable request.

The Or is not Burger King. Have ur your own ways. An emergency is an emergency.

 

[eyeeye_captain]

Tell me how much it cost to run an OR every minute.

It is much costlier to run the OR even paying crnas to do solo.

Clinics patients don’t generate much money at all. But you obviously need clinic patients. So you are in a catch-22.

If you have a 730-1030 am hospital block time. Why didn’t they let you use your own block time?

unless you are confusing your ASC block time 730-1030am with hospitals block time and just want to switch on the fly.

I always ask surgeons if they want to bump surgeons. Declare it an emergency. Come on in within 2 hours. It’s a very reasonable request.

The Or is not Burger King. Have ur your own ways. An emergency is an emergency.

Very much dependent on the site, come on. I do know that eyes make next to nothing or net negative in a bunch of situations. Heck, the University of Michigan published how they lose money on any RD (granted, it’s a tertiary hospital with trainees, and their OR times are 3x mine). Link

Nope, same 7:30-noon block for almost a decade. Can’t try to accuse me of cherry picking since I take any insurance anywhere it’s taken, especially with urgent cases.

Clinic patients don’t make money?!?! If I stopped operating I’d make at least 2-3x replacing that time even it if it were a full OR schedule and I was hanging out in clinic instead.

Bump the total joints with the higher facility fee? You think that flies with the hospital even if they’re wrong? Said anesthesiology staff has told me previously they can make it work, but I know I’m bottom rung.

You’re being facetious again. An emergency and and urgency aren’t the same. I’m not crying wolf and slotting in cases that don’t need to go. Please tell me what my above situation was inappropriate to request. It’s fine that you’re a “hey, I’m here but not a second more” kinda person.

 

[amyl]

What do you think is appropriate weekend compensation for call that involves being back call Friday (home call), 24 hr on Saturday that ends 7am Sunday then being backup into Monday morning 7am, no post call day off Monday but on the list to go home on the earlier side?

There is a Crna for your back up Friday night and then another attending if needed. The Saturday call backup would be another attending at night with a CRNA during the day 7a-7p


When you folks are saying post call days off you mean after being in house overnight right?

No. We get the post call day off even when it’s home call. About half the time we get the day off after second call.

 

[Lab Lover]

Very much dependent on the site, come on. I do know that eyes make next to nothing or net negative in a bunch of situations. Heck, the University of Michigan published how they lose money on any RD (granted, it’s a tertiary hospital with trainees, and their OR times are 3x mine). Link

Nope, same 7:30-noon block for almost a decade. Can’t try to accuse me of cherry picking since I take any insurance anywhere it’s taken, especially with urgent cases.

Clinic patients don’t make money?!?! If I stopped operating I’d make at least 2-3x replacing that time even it if it were a full OR schedule and I was hanging out in clinic instead.

Bump the total joints with the higher facility fee? You think that flies with the hospital even if they’re wrong? Said anesthesiology staff has told me previously they can make it work, but I know I’m bottom rung.

You’re being facetious again. An emergency and and urgency aren’t the same. I’m not crying wolf and slotting in cases that don’t need to go. Please tell me what my above situation was inappropriate to request. It’s fine that you’re a “hey, I’m here but not a second more” kinda person.

OR availability is a finite resource. Personnel and physical space. Excess capacity is financial drag to an organization. We require surgeons to grade the urgency of nonscheduled cases. Emergent-right now, urgent-2-4 hours, and add on. We bump another surgeon if necessary which is common for emergencies, rare for urgencies. Add on-we will let you know. You call at 5pm and want time 7:30-10:30 next am for an unscheduled case? Unlikely that you will be able to be accommodated. Just the way that it is. We will let you know as the day progresses.

 

[Twiggidy]

I need to have a good sit down with @aneftp with resume in hand and find out how to hustle. I love the numbers I just don't know where to find them. Either that or I'm a terrible negotiator

 

[aneftp]

I need to have a good sit down with @aneftp with resume in hand and find out how to hustle. I love the numbers I just don't know where to find them. Either that or I'm a terrible negotiator

I’m like the aana. I throw out random crap. Some of it sticks. Some of it doesn’t stic

Very much dependent on the site, come on. I do know that eyes make next to nothing or net negative in a bunch of situations. Heck, the University of Michigan published how they lose money on any RD (granted, it’s a tertiary hospital with trainees, and their OR times are 3x mine). Link

Nope, same 7:30-noon block for almost a decade. Can’t try to accuse me of cherry picking since I take any insurance anywhere it’s taken, especially with urgent cases.

Clinic patients don’t make money?!?! If I stopped operating I’d make at least 2-3x replacing that time even it if it were a full OR schedule and I was hanging out in clinic instead.

Bump the total joints with the higher facility fee? You think that flies with the hospital even if they’re wrong? Said anesthesiology staff has told me previously they can make it work, but I know I’m bottom rung.

You’re being facetious again. An emergency and and urgency aren’t the same. I’m not crying wolf and slotting in cases that don’t need to go. Please tell me what my above situation was inappropriate to request. It’s fine that you’re a “hey, I’m here but not a second more” kinda person

Very much dependent on the site, come on. I do know that eyes make next to nothing or net negative in a bunch of situations. Heck, the University of Michigan published how they lose money on any RD (granted, it’s a tertiary hospital with trainees, and their OR times are 3x mine). Link

Nope, same 7:30-noon block for almost a decade. Can’t try to accuse me of cherry picking since I take any insurance anywhere it’s taken, especially with urgent cases.

Clinic patients don’t make money?!?! If I stopped operating I’d make at least 2-3x replacing that time even it if it were a full OR schedule and I was hanging out in clinic instead.

Bump the total joints with the higher facility fee? You think that flies with the hospital even if they’re wrong? Said anesthesiology staff has told me previously they can make it work, but I know I’m bottom rung.

You’re being facetious again. An emergency and and urgency aren’t the same. I’m not crying wolf and slotting in cases that don’t need to go. Please tell me what my above situation was inappropriate to request. It’s fine that you’re a “hey, I’m here but not a second more” kinda person.

You just said the or time was yours 7-1030am. So am I missing something

Unless you gave up your OR time already for that day. Than you go to the add on list. Or bump another surgeon if it’s emergency.

So if it’s truly patient care. You cancel your elective clinics that makes you money. And take care of the add on retina. Right?

So is this about patient care? Or about losing money in the clinic?

I am trying to find an angle to support your “patient care” to do the retinal detachment

 

[aneftp]

Just to add. There is old school solo ob gyn i worked with. He would stop his clinic run over to the hospital 15 min away and deliver a baby. Sure his clinic patients get annoyed and sometimes he’s 2-3 hr late for clinics.

But he is DOING WHAT’s best for HIS PATIENT. And not worrying about his clinic patients

 

[aneftp]

The real question is why can’t anesthesia do the retina after 6-7p? Can the hospital not accommodate a semi urgent case after 6-7pm? I’ve done retinas at 8-9pm before mutiple times.

And this was community hospital no ob. They try not to do elective after 7pm. But certainly retinal we do after hours.

 

[cittykat]

The real question is why can’t anesthesia do the retina after 6-7p? Can the hospital not accommodate a semi urgent case after 6-7pm? I’ve done retinas at 8-9pm before mutiple times.

And this was community hospital no ob. They try not to do elective after 7pm. But certainly retinal we do after hours.

Since most eye surgery is done at OPSCs, many hospitals have a very shallow pool of surgical techs who have recent experience with eye surgery. Often their availability determines when the surgery can happen.

 

[aneftp]

Since most eye surgery is done at OPSCs, many hospitals have a very shallow pool of surgical techs who have recent experience with eye surgery. Often their availability determines when the surgery can happen.

That’s fair enough. And yes I know it’s a pain to schedule retina in hospitals. But just like I tell my kids. If it’s urgent enough I will drop everything to make it work.

That’s my real point to the eye doc. At the end of the day. It comes down to cash flow. Not truly “patient care”. Never use patient care when you have your own self best interests at stake. We all don’t want to say it. We pick and choose our battles.

It’s like rad onc ordering us to do a total body mri at 2am on Monday morning so they can have their scans by 8am. They do what’s best for them. I forced them in at 3am to sit there which they refused to do. No idiot rad onc doc is coming in at 3am Monday morning. So in the end they gave up on the mri. Not about patient care. It’s about self interest.

 

[gunnershow]

I’ll highlight this as someone on the other side of the drape who is seeing this adversely affect patient care.

I’m pretty laid back, but when you potentially hurt my patients, I go through the roof. I keep privileges at a hospital for my extra sick or certain insurances patients. A few weeks ago I had 3 retinal detachments come in, so urgent surgeries to be done. I was told I could do 1 if I did a 7:00 start, and no, they couldn’t fully open the room or do after hours. Nobody could cover.

I’ve known the anesthesia group for years. We’re friendly and collegial. Our kids are in the same classes.

I was very fortunate to be able shoehorn the other 2 on my partner with lucky circumstances. This kind of attitude, while I don’t begrudge you getting yours, does in reality lead to potential harm to patients.

You should have just threatened to do them in the middle of the night. Clearly you knew about them the day before. The OR will magically find daytime availability when faced with that option. But I don't really get how they refused to do the cases after hours. Is this a hospital or a glorified surgery center?

Also I don't understand how you have a 3 hour block that is not staffed? Did you release it? Do you basically never fill that block so they got rid of it? A 3 hour block is the biggest pain in the ass to staff because it makes for an unproductive day for everyone but you.. wouldn't be surprised if it got axed.

 

[eyeeye_captain]

You should have just threatened to do them in the middle of the night. Clearly you knew about them the day before. The OR will magically find daytime availability when faced with that option. But I don't really get how they refused to do the cases after hours. Is this a hospital or a glorified surgery center?

Also I don't understand how you have a 3 hour block that is not staffed? Did you release it? Do you basically never fill that block so they got rid of it? A 3 hour block is the biggest pain in the ass to staff because it makes for an unproductive day for everyone but you.. wouldn't be surprised if it got axed.

Busy hospital system with multiple branches. Consistently poor staffing for eyes but boy howdy they know how to do ortho.

5 hour block for years, consistently need 3+. Not a black hole, show up on time, get cases done efficiently. Funnily they asked if I could bring more volume, but they won’t let me.

They turned “elective” block into 2 weeks prior notice to keep it. Clearly that doesn’t work with services that have urgent/emergent cases. And they won’t staff after hours. I’m not doing my case and being the scrub and circulator as well, if they’ll even open a room.

 

[gunnershow]

Busy hospital system with multiple branches. Consistently poor staffing for eyes but boy howdy they know how to do ortho.

5 hour block for years, consistently need 3+. Not a black hole, show up on time, get cases done efficiently. Funnily they asked if I could bring more volume, but they won’t let me.

They turned “elective” block into 2 weeks prior notice to keep it. Clearly that doesn’t work with services that have urgent/emergent cases. And they won’t staff after hours. I’m not doing my case and being the scrub and circulator as well, if they’ll even open a room.

Urgent cases go on the addon list and get done whenever there is availability. Emergent cases bump all others, but ideally go in a dedicated addon room. Keeping blocks open for surgeons who might have something urgent, but who are usually otherwise operating at their ASC down the street makes no sense. You can try filling some of the block with electives so you can follow with urgent cases, but no ambulatory surgeon wants to do that unless they absolutely must send the elective cases to the hospital. So if you keep your block empty, why should people bother staffing it?

The one part of this that still doesn't make sense is that they refused retinal detachments after hours. It's a surgical emergency that needs to be done on an urgent basis. What kind of dump of a hospital is this? I would be bringing that to the CMO, but I suspect there's more to the story here.