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i deal with this on a daily basis. I turn the gas down to 0.5 mac on a guy who got 300 mcg of fentanyl and has 1 twitch. I leave the room they turn it up to 1.3 mac.... WTF
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A depressing job posting
Started by criticalelement
Sorry, you literally have no idea what you are talking about.
The reason rural hospitals are so big on hiring CRNAs is the rural pass through legislation that states they will be 100% reimbursed for CRNA services by the federal government, but it doesn't extend to anesthesiologists. CRNAs are essentially free to them to be hired. They don't cost anything because they can pass the cost on to the federal government regardless of how few cases they do. MDs do not get that same protections. We frequently have this battle come up to change the legislation and then the nursing lobbyists come out in full force.
It's complete BS and everybody knows it. We just can't grease the politicians wheels enough to undo it.
Good point!
But we like to think that we are the boss of ourselves although it might be an illusion... it's like being married, a wise wife will allow you to have the illusion that u have some control while in reality you just do what you are told 🙂
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By the way that thing about the CRNA being supervised by a "physician" not necessarily an anesthesiologist is another one of the ASA achievements. The ASA endorsed this stupid rule many years ago because they thought that was the best way to avoid conflict with the AANA... and we all know how successful that strategy was!
I'm not sure where that $1500 comes from. A while back when I was in the Navy, I asked the two cRNA's that I was working with who moonlighted how much they paid for malpractice insurance. They both told me ~$5000. And that was for part-time work.
My first year premium for part time claims made $1/3M was about $1700. Hooray for tort reform.
That is what we actually pay for their coverage (rounded off to nearest $100 of course).
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deleted50478
Sounds like a future ex-wife...
Haha when I was a fellow there was a doctor undergoing valve surgery who requested one of our cardiac anesthesiologist faculty to do their anesthetic with 'no resident'. She refused to do it saying she had to have a fellow 'helping' her. Essentially I ended up doing the case with the faculty doing a helicopter.
Is the future grimm? Probably depends on how you look at it. I think a previous poster was correct. In the future, everyone will either work for an academic institution or work for a corporation. Remember also, corporations are out to MAKE MONEY, not improve medicine. They'll take as few bodies as possible to generate the highest profit for the shareholders. So what I'm saying is, those private practice jobs will turn into workhorse jobs, especially if OB is involved.
Interesting enough, from personal experience, I find it interesting how difficult it is to get an academic job at this point. I think the chairmen are on to us PP folks who are trying to maybe work a little LESS hard than in PP and definitely take less call.
--what you say is true about corporations and even my non for profit hospital. They don't give a **** about patient care. Even here it's all about money. When I met with admin I said I wanted to leave bc patients were getting really ****ty care and we needed to fix that.... They just tried to negotiate what would get me to sign the contract. Don't care.
Idk about the academic thing tho I found it easy to get an academic job.... But I had connections. They seemed to want that I had pp experience
Interesting enough, from personal experience, I find it interesting how difficult it is to get an academic job at this point. I think the chairmen are on to us PP folks who are trying to maybe work a little LESS hard than in PP and definitely take less call.
--what you say is true about corporations and even my non for profit hospital. They don't give a **** about patient care. Even here it's all about money. When I met with admin I said I wanted to leave bc patients were getting really ****ty care and we needed to fix that.... They just tried to negotiate what would get me to sign the contract. Don't care.
Idk about the academic thing tho I found it easy to get an academic job.... But I had connections. They seemed to want that I had pp experience
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deleted171991
Now why do you think they appreciated your PP experience? Because all they are is another for-profit corporation in disguise, where the top "queens" get bonuses based on the same criteria as your community hospital CEO. And because academia is full of lazy arses in leadership positions, they need hard-working suckers as "worker bees". Somebody in the department actually has to work to make money, and it's gonna be you, not the (associate) "professors". 😛
Keeping my
for you.
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My own program wouldn't even interview me, and that was after being a resident AND a fellow. I must have been terrible, but I have other theories that I can't post here.
Probably for the best, no doubt.
We interview all of our fellows that are interested as a courtesy. It's strange that they don't. I would think that's very detrimental to morale and potentially destructive to recruiting new fellows if you go on to bash the program at interview dinners, etc.
It's one thing to say you're only hiring one or two people and someone else beat you out for the job, quite another to say that you're not even worth consideration.
Probably they wanted a hollow scarecrow or a cowardly lion they can control and manipulate. That's the pattern I often see, they seek out those who will tow the party line and don't complain. Those residents who were actually skilled and had a brain to think with on their own weren't considered for hiring, but were smart enough to go elsewhere anyway.
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Yeah. It's was strange 4 years. My fellowship director gave me a chance by allowing me to be a fellow. When she accepted me midway through CA3 she kicked my a** every which way including sideways afterward. She knows I'm highly grateful for it. When I finished she knew I'd walk into fire for her (maybe she knew....yeah, she knew🙂). I think I literally owe her my career. The rest of the attendings......well.....
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Here's another scenario that's more likely:
They weren't considered for hiring because they couldn't play nice and get along with others, and they lacked the insight to see that the problem was them. They were probably technically competent, but so are most people.
I've seen this a couple times. People who are just unpleasant to work with or have significant, non-skill/knowledge related professionalism problems, don't get asked to come back, or don't get the departmental position they ask for, etc. Their response / defense mechanism is something like "yeah they couldn't handle the truth, I stood up to them, I don't take no crap, they wanted someone they could push around" ...
No, they just wanted someone competent who wasn't a pain in the ass to be around.
This notion that groups, programs, departments don't want people who are "skilled and have a brain" is absolute nonsense. Nobody wants incompetent and dangerous idiots.
The exception may be applying for a managerial type position where politics do come into play, and matter more than competence ... or professionalism for that matter.
But these people might be well served by looking in the mirror and considering the possibility that "hey, maybe the common thread in all my dysfunctional professional relationships is me".
"The 3 A's of Anesthesiology. Availability. Ability. Affability." A surgeon even said in our room that the last is more important then the first two. (Basically, don't argue with me and we can work together). Love anesthesia.
Very true.
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deleted171991
... because you are not a surgeon. 😛
If being affable is the most important, then we are slightly more than glorified sedation butlers. Bed up, bed down, cheer me up, jester!
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Yes, not all places are run like a regime. As a resident I worked at some great places where if you were decent and safe but always friendly and a team player, they'd extend you a job offer as you were finishing. I turned down some offers only because I needed to come back to CA.
I remember rotating at a private hospital, I'd come in in the morning, set up my room, and then go to the lounge to wait for the pt, and the techs would make me a breakfast sandwich. At my current place, the nurses/techs cook breakfast and lunch on an electric skillet or crock pot in the lounge all the time and we sit around the table like we're out at a bar; it avoids the monotony of cafeteria food. And all doctors/surgeons/anesthesiologists are treated equal by everyone. The admins check in every once in a while, but as long as no bad outcomes and no complaints from surgeons, everything is ok and we get left alone.
And then there were other places where you couldn't try anything different or practice new techniques. If you didn't prop/sux/tube everyone and/or didn't do whatever the surgeon said/wanted you were going to be a miserable resident or a short-lived attending. If you put in an art line and surgeon didn't want it, you got in trouble. If you delayed a case 10 mins to teach a resident to put in a central line, you got in trouble. If you didn't think a pt was optimized to go to the OR, your boss would get a phone call and someone would be sent in from another OR to replace you.
And yet they were able to continuously find new locums or full time hires month after month. Big city dreams and family obligations have a price.
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If anyone ever did a case that I (reasonably, and I'm very reasonable.) said wasn't optimized and couldn't go until later, tomorrow, etc. I would be the one waiting to talk to the boss not the surgeon. That can never fly and sets a precedent that cannot stand and is dangerous to the group and good patient care.
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deleted171991
They tend to care more about what's dangerous to the bottom line. 😉
Malpractice tends to be planned for in the budget.
Malpractice tends to be planned for in the budget.
Also, if the surgeon tried the run around play, we'd be having a chat as well.
But these are unlikely conversations as I'm more than reasonable and there is only one surgeon at my shop that would even consider doing something like that and I already successfully avoid working with him.
But these are unlikely conversations as I'm more than reasonable and there is only one surgeon at my shop that would even consider doing something like that and I already successfully avoid working with him.
Would you post them in the private forum?
I happen to be very good friends with a CRNA who works at my program, located in a large urban city in the North East, not NYC, SF or Boston. This person who happens to be ~ 5 years out of training shared that they take home $90/hr. Said person also works 16 hours overtime per week. Do the math! 90 x (40+16) x 26 (paychecks per year) = $262,000!!
There you have it! I know recent grads making $220 k per year. How is this even fair?
There you have it! I know recent grads making $220 k per year. How is this even fair?
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If by "taking home" you mean after taxes that is pretty good. If it is gross, that is very poor. 262 for 16 hours ot is terrible.
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deleted171991
It's not. Where I work, most anesthesiologists make ~$120/hour (plus benefits) during the day, and that's with supervision. I would take $96 plus benefits for easy stool sitting, somebody else doing the preop and PACU work, 2-3 breaks per day, minimal malpractice worries, treated by the hospital as almost equal to the docs, and much less stress overall. It's a no-brainer. That's why I always advise people to go the CRNA route, not the MD route.
One of the seasoned traveler CRNAs that works at my hospital (and has an attitude that wouldn't get her hired in many places) drives a brand new Mercedes SUV. Capisci?
More than likely their OT rate is 1.5 base pay...
Your math is confusing.
56x90x52=262.
Hourly employees don't usually get paid vacation, so assuming full time is 40 hours (ours is 36) and if they take 6 weeks, that's 231.
16 hours of OT is 40-50% of another job.
231 for 1.5x the work isn't so hot.
Though 90x40x46= 165, which is about the CRNA average. So $90 an hour seems reasonable for a CRNA. Crunching the numbers, I make more than twice that.
As noted above, they may get time and a half for OT? So maybe even more?
PS if anyone is taking 220 starting and you're not in a partner track where partners are making 4-500+, you're a sucker. I know mommy track anesthesiologists making 300 + benefits.
If that were the hourly rate at our shop for anesthetists (it is close), they would make 90*40*52 (6 weeks paid vacation), and 135*16*46. PLUS 3500 CME, 10k or so health benefits, ~20k retirement, and some other small benefits like a tiny amount of disability/life/dental.
281 plus benefits for total cost to group of ~315.
There is no freaking way we would allow that much overtime (100k), that is 1/2 another anesthetist, and there is a lot more flexibility having a 2nd human around.
By the way, FFP if you promise to not complain about anesthesia being in the toilet we could probably give you what you just asked for pretty easily.
281 plus benefits for total cost to group of ~315.
There is no freaking way we would allow that much overtime (100k), that is 1/2 another anesthetist, and there is a lot more flexibility having a 2nd human around.
By the way, FFP if you promise to not complain about anesthesia being in the toilet we could probably give you what you just asked for pretty easily.
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@repititionition I'm gonna hold my tongue on some of my theories. The are some discussions that are handled well on SDN. I don't think this one would be.
We almost never pay overtime either, the late call team would stay and direct provide before we approved overtime. The only time it usually happens would be a rare real emergency right after we sent everyone home and are still maxed out or when the residents or fellows are all off taking the board exam, etc.
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deleted171991
You know what I meant. Wiseguy. 😛
I know CRNAs making $120K a year driving brand new Mercedes SUVs. It's not because they should, it's because they don't manage money well and they can afford the car payment in their monthly budget. It's like racking up credit card debt because they monthly payment hasn't gotten out of hand yet.
I think a lot of people feel entitled here.
It all comes down to payer mix. If you are at indigent (poor) area with 70-80% Medicare/Medicaid mix. I can almost guarantee you to generate 15k units (remembers Medicare pays around $20/unit). So that's like working 55-60 hours a week roughly depending how fast surgeons area and down time And Medicaid is even worse.
You'd be lucky to generate 350k with 6-7 weeks off with no one shaving anything off the top. Remember you get zero benefits and pay the billing company 6-7% of collections as well. That's 350k 1099 working ur butt off.
You could very well be on call 24 hours and do 1-2 Medicaid epidurals. That's like $75-100 a epidural and tying up 24 hours of ur time.
So if management company is paying new grads guaranteed 275-300k. And it's reasonable work hours. (50 hours or so) It's guaranteed money. You won't be starving I can tell you that. You will have a steady paycheck. The fee for service world can be scary once payer mix changes.
It all comes down to payer mix. If you are at indigent (poor) area with 70-80% Medicare/Medicaid mix. I can almost guarantee you to generate 15k units (remembers Medicare pays around $20/unit). So that's like working 55-60 hours a week roughly depending how fast surgeons area and down time And Medicaid is even worse.
You'd be lucky to generate 350k with 6-7 weeks off with no one shaving anything off the top. Remember you get zero benefits and pay the billing company 6-7% of collections as well. That's 350k 1099 working ur butt off.
You could very well be on call 24 hours and do 1-2 Medicaid epidurals. That's like $75-100 a epidural and tying up 24 hours of ur time.
So if management company is paying new grads guaranteed 275-300k. And it's reasonable work hours. (50 hours or so) It's guaranteed money. You won't be starving I can tell you that. You will have a steady paycheck. The fee for service world can be scary once payer mix changes.
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deleted50478
It's not as if the salaried person will be better off with a worsening payor mix. The middlemen are still going to charge a toll on all the money that unnecessarily passes through their fingers.
I think most people have failed to realize the big picture here... you are either a hamster on a wheel or you're the one laughing from a far enjoying the energy that's being generated for you. This thread is acknowledging the menial offers that are being given to run on the wheel. The reality is any type of hamster can run on the wheel because at the end of the day it doesn't matter as long as that wheel is moving. Instead of trying to figure out how to run on the wheel the best, figure out how to be the one laughing from a far.
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Day 1 at my shiny new super promising booming partnership track private practice job: "listen kid, save your money.. don't buy a massive house or a porsche.. you never know whats waiting around the corner".
5 years later at the same job.. group sold to AMC. No more profit sharing, increased calls, busier days, W2 salary and we pay for our own health insurance. Promising contracts not producing volume, lost a couple of surgery centers when they decided to just employ their own salaried docs. Guy who told me to save my money.. still living in the same house he bought when he was a resident and driving an 8 year old car. Thinking about retiring if things stay the same. The rest of us feeling duped with jumbo mortgages and leased german cars we can barely afford.
Moral of the story.. why did I let that woman sucker me into marrying her.. should've stayed single.. this house would be an awesome place for a bachelor.
5 years later at the same job.. group sold to AMC. No more profit sharing, increased calls, busier days, W2 salary and we pay for our own health insurance. Promising contracts not producing volume, lost a couple of surgery centers when they decided to just employ their own salaried docs. Guy who told me to save my money.. still living in the same house he bought when he was a resident and driving an 8 year old car. Thinking about retiring if things stay the same. The rest of us feeling duped with jumbo mortgages and leased german cars we can barely afford.
Moral of the story.. why did I let that woman sucker me into marrying her.. should've stayed single.. this house would be an awesome place for a bachelor.
Middlemen won't enter places they will lose money.
Believe it or not. There are places where anesthesia services are money losers. A lot of hospital employed positions involving trauma in red states.
Some of my friends true fee for service have seen their incomes takes huge hits with no middlemen in past 5-6 years.
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We see it a lot in the military. Every crowd of 19- and 20-year-old E3s has a few shiny new Mustangs or Ricemobiles. They get duped into an "affordable" monthly payment but the fine print of the loan says something like 19% interest and a 7 year payment plan. I guess if you're a single teenager there are worse ways to learn how interest works.
I don't know how many times I've been asked, "doc when are you gonna get a new car?"
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deleted126335
What's consider a massive house? Is 500k too much? How bout 850k? 950k?
