A poll and question for everyone - the price of supervision

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Please read the post below for context and pick your answer.

  • I work in an ACT model, and I would want to continue business as usual

    Votes: 15 35.7%

  • I work in an ACT model, and I would take 20% less pay to do all my own cases as the solo provider

    Votes: 10 23.8%

  • I work in a physician-only group, and I would want to continue business as usual

    Votes: 17 40.5%

  • I work in a physician-only group, and I would take 20% more pay and supervise in an ACT model

    Votes: 0 0.0%
  • Total voters
    42
U

Urzuz

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I thought of this question while driving today, and thought it would be interesting and generate some discussion. A lot of this boils down to individual preference and what you find most important.

For those in an ACT model where you supervise most/all cases, would you take a 20% pay cut to do all of your own cases? Why or why not?

For those in a physician-only group or a group where you do mostly your own cases, would you move to a practice where you supervise 100% of the time but you make 20% more? Why or why not?
 
Not sure if you intentionally meant to restrict your poll to these practice options alone, or if you would also consider other practice options (e.g. academic anethesiology, hospital-employed)? Although I suppose academic anesthesiology could oversee residents and/or SRNAs, or hospital-employed could be ACT or physician-only, etc.
 
bashwell said:
Not sure if you intentionally meant to restrict your poll to these practice options alone, or if you would also consider other practice options (e.g. academic anethesiology, hospital-employed)? Although I suppose academic anesthesiology could oversee residents and/or SRNAs, or hospital-employed could be ACT or physician-only, etc.
Click to expand...

I purposefully restricted the options to these four for the sake of simplicity. I didn't want to focus necessarily on academics vs. private, nor supervision of residents/SRNAs. I suppose what I wanted to get a sense of is how much people value autonomy and the ability to do your own cases, versus the earning potential of hiring CRNAs, running multiple rooms, and collecting a heftier paycheck. Is managing CRNAs (both from a medical and personality standpoint) worth a larger paycheck? How do people in ACT practices feel about this? And would anesthesiologists in physician-only practices feel that doing their own cases isn't THAT important, and the bottom line is all that really matters?

I am also wondering if this will produce a "grass is always greener" phenomenon, where people are always feeling like someone else has got it better.
 
I have done both, but prefer doing my own cases. In some instances, doing your own cases does not necessarily mean a pay cut, although I suspect in most cases it does.
 
I do a mix of supervision and my own cases, and much prefer the days where I get to be in my own room. If physician-only anesthesia is dead, then I will leave the specialty for good, as I have no debt, and really liked the ICU. I work with what are supposed to be some of the best CRNAs in the country, with loads of experience, and yet they still keep making rookie mistakes, or getting into major trouble and refusing to ask for help. In my civilian gigs, they will at least ask for help at some point, but still constantly do the same stupid things day after day (like lying to me about reversing, then giving flumazenil, rather than neostigmine, to the morbidly obese, mod-severe COPDer that just had a 45 minute lap-chole, and received 50mg roc at the start of the case, who is awake, weak, and desatting in the PACU).
 
chocomorsel said:
I have done both, but prefer doing my own cases. In some instances, doing your own cases does not necessarily mean a pay cut, although I suspect in most cases it does.
Click to expand...

True, though it doesn't necessarily mean a pay cut, I wanted to figure out some way to "value" doing your own cases. Clearly making MORE money doing your own cases would be everyone's dream (I assume?), but I suppose I'm trying to find the "value" people place on independently doing your own cases. For instance, if I told someone that they were make double or triple the amount they make solo if they move to a supervision role, I'm sure some people would snatch that up in a heartbeat. Financially it may make sense to sacrifice one's autonomy. But what is everyone's number? What is the price of autonomy? 20% more? 50% more? 100% more?
 
Urzuz said:
True, though it doesn't necessarily mean a pay cut, I wanted to figure out some way to "value" doing your own cases. Clearly making MORE money doing your own cases would be everyone's dream (I assume?), but I suppose I'm trying to find the "value" people place on independently doing your own cases. For instance, if I told someone that they were make double or triple the amount they make solo if they move to a supervision role, I'm sure some people would snatch that up in a heartbeat. Financially it may make sense to sacrifice one's autonomy. But what is everyone's number? What is the price of autonomy? 20% more? 50% more? 100% more?
Click to expand...


That's a personal decision for you to make. Supervising 4 CRNAs (or more) should be worth a minimum of 50% boost in income than doing your own cases. However, in this job market there are many desperate CA-3s willing to sign on the bottom line for ANY job which pays over $300K. These naive new graduates will be worked to death covering 4 rooms so the senior partners/AMC executives can buy 3rd homes, yachts, etc.

Again, the question is what are you willing to accept as salary to work at a job in an acceptable location? The market has determined that rate to be in the $275-$300K range for a new Anesthesiologist to supervise/direct 3-4 CRNAs plus take frequent Call.
 
BLADEMDA said:
That's a personal decision for you to make. Supervising 4 CRNAs (or more) should be worth a minimum of 50% boost in income than doing your own cases. However, in this job market there are many desperate CA-3s willing to sign on the bottom line for ANY job which pays over $300K. These naive new graduates will be worked to death covering 4 rooms so the senior partners/AMC executives can buy 3rd homes, yachts, etc.

Again, the question is what are you willing to accept as salary to work at a job in an acceptable location? The market has determined that rate to be in the $275-$300K range for a new Anesthesiologist to supervise/direct 3-4 CRNAs plus take frequent Call.
Click to expand...

Mostly agree with the above numbers. But I would change the supervision ratio to 1:2-3. 1:4 is rare and only when that 4th room is a sleeper, like a long stable case, or the eyeball room. And my call is 2-4 times per month for frequency. Salary is right on but partner track for those numbers. No partner track and I would think its a little low.

So I actually prefer supervising multiple rooms. Im sure every CRNA situation is different, but ours work for the group. So I do the pre-ops, communicate the plan, I am paged for induction, I stay and do the beginning of the case until it is stable and underway, then leave. Repeat and do the same in other rooms. Give breaks and lunches. Do blocks and lines myself. I honestly look at people doing their own cases and think, god how inefficient. Why should an MD be setting up suction and getting meds out of the pixis and watching stable vitals. I am called with problems and for extubations after I get the case rolling. I am happy with this arrangement and feel like I get all the action without the monotony because I can come and go in the case as I please. So i dont really see it as a a nuisance that would require more salary. Sure there are days when I am assigned to go solo, or cover the ICU and intubate solo, so there is always autonomy. I guess it depends on the gig, I wouldnt want to be supervising in a surgicenter all day just doing MAC cases, but in the right setting I dont feel Im missing out on what I consider to be the important parts of the case.
 
Hoya11 said:
Mostly agree with the above numbers. But I would change the supervision ratio to 1:2-3. 1:4 is rare and only when that 4th room is a sleeper, like a long stable case, or the eyeball room. And my call is 2-4 times per month for frequency. Salary is right on but partner track for those numbers. No partner track and I would think its a little low.

So I actually prefer supervising multiple rooms. Im sure every CRNA situation is different, but ours work for the group. So I do the pre-ops, communicate the plan, I am paged for induction, I stay and do the beginning of the case until it is stable and underway, then leave. Repeat and do the same in other rooms. Give breaks and lunches. Do blocks and lines myself. I honestly look at people doing their own cases and think, god how inefficient. Why should an MD be setting up suction and getting meds out of the pixis and watching stable vitals. I am called with problems and for extubations after I get the case rolling. I am happy with this arrangement and feel like I get all the action without the monotony because I can come and go in the case as I please. So i dont really see it as a a nuisance that would require more salary. Sure there are days when I am assigned to go solo, or cover the ICU and intubate solo, so there is always autonomy. I guess it depends on the gig, I wouldnt want to be supervising in a surgicenter all day just doing MAC cases, but in the right setting I dont feel Im missing out on what I consider to be the important parts of the case.
Click to expand...

Sounds like you employ the nurses which I'd imagine is a night a day difference from someone working as an employee of an AMC. A friend of mine left an AMC hell job where he was supervising a minimum of 4rooms and due to production pressures sometimes 5rooms. The nurses felt abandoned because he was frequently unavailable when they needed him. Sounded like he was always running around trying to put out fires pre/intra/postop where he could while the rest of the nurses worked essentially independent. He's a great anesthesiologist and I'm glad he got out of there.
 
kazuma said:
Sounds like you employ the nurses which I'd imagine is a night a day difference from someone working as an employee of an AMC. A friend of mine left an AMC hell job where he was supervising a minimum of 4rooms and due to production pressures sometimes 5rooms. The nurses felt abandoned because he was frequently unavailable when they needed him. Sounded like he was always running around trying to put out fires pre/intra/postop where he could while the rest of the nurses worked essentially independent. He's a great anesthesiologist and I'm glad he got out of there.
Click to expand...

The difference in dynamic when you employ the CRNAs directly as opposed to another arrangement cannot be overstated.
 
Once you get a taste of the scam of supervision, there's no turning back.
 
Hoya11 said:
Mostly agree with the above numbers. But I would change the supervision ratio to 1:2-3. 1:4 is rare and only when that 4th room is a sleeper, like a long stable case, or the eyeball room. And my call is 2-4 times per month for frequency. Salary is right on but partner track for those numbers. No partner track and I would think its a little low.

So I actually prefer supervising multiple rooms. Im sure every CRNA situation is different, but ours work for the group. So I do the pre-ops, communicate the plan, I am paged for induction, I stay and do the beginning of the case until it is stable and underway, then leave. Repeat and do the same in other rooms. Give breaks and lunches. Do blocks and lines myself. I honestly look at people doing their own cases and think, god how inefficient. Why should an MD be setting up suction and getting meds out of the pixis and watching stable vitals. I am called with problems and for extubations after I get the case rolling. I am happy with this arrangement and feel like I get all the action without the monotony because I can come and go in the case as I please. So i dont really see it as a a nuisance that would require more salary. Sure there are days when I am assigned to go solo, or cover the ICU and intubate solo, so there is always autonomy. I guess it depends on the gig, I wouldnt want to be supervising in a surgicenter all day just doing MAC cases, but in the right setting I dont feel Im missing out on what I consider to be the important parts of the case.
Click to expand...
This is exactly the set up we have and your feelings are the same as mine.
 
Consigliere said:
Once you get a taste of the scam of supervision, there's no turning back.
Click to expand...
I am in a medical direction private practice and I have to disagree with this. I get tired of settling for "good enough" anesthesia that I observe daily, knowing that I personally could deliver much smoother anesthetics with all the window dressings. Alas, I have to choose my battles and thus keep my mouth shut so long as nothing I observe will cause direct harm/injury. In those instances I make gentle suggestions and/or ask questions that put myself and my team on the same page. This is what the residents have to look forward to.
 
As usually, this kind of thread is about greed. If one is a partner and, thus, the extra money made in an ACT model is not pocket change, one will be ready to swear that the CRNA is the best invention since sliced bread.
 
Last edited by a moderator:
Urzuz said:
True, though it doesn't necessarily mean a pay cut, I wanted to figure out some way to "value" doing your own cases. Clearly making MORE money doing your own cases would be everyone's dream (I assume?), but I suppose I'm trying to find the "value" people place on independently doing your own cases. For instance, if I told someone that they were make double or triple the amount they make solo if they move to a supervision role, I'm sure some people would snatch that up in a heartbeat. Financially it may make sense to sacrifice one's autonomy. But what is everyone's number? What is the price of autonomy? 20% more? 50% more? 100% more?
Click to expand...

I turned down an offer making ~100k more because it was constant supervision, never in room solo. Better location too. I am very glad to be in a practice where I supervise ~70%.
 
chocomorsel said:
Not always true. Some people like me hate supervising.
And remember how you said you would kill for my setup? I knew you were full of ****.
Click to expand...
Whatevs dawg...I got mine.
 
Nah, just a greedy anesthesthesiologist.
Don't hate the playa, hate the game, blah blah, blah as his response shows. He already is acknowledging that he likes the CRNA supervision scam.
He or she would make a great administrator.
 
chocomorsel said:
Nah, just a greedy anesthesthesiologist.
Don't hate the playa, hate the game, blah blah, blah as his response shows. He already is acknowledging that he likes the CRNA supervision scam.
He or she would make a great administrator.
Click to expand...

I already AM a great administrator f_uck you very much.
 
Consigliere said:
And I have my suspicions that you take it in the bum but I haven't said anything about it.
Click to expand...

Looks like Consigliere is going to have to resign from his administrative duties and sell his share of the practice for his anti-gay remarks. 😉
SDN may have to cut all ties too... :laugh:
 
I prefer to do my own cases and do not want to supervise. Unfortunately, I probably will eventually. I think there is a level of respect we get being in there throughout the case and not breezing in and out that supervising anesthesiologists don't get. Just based on my experiences.

There are also particular things I like to be able to do that I wouldn't do if I wasn't going to be there throughout the whole process. I am pretty much a Cowboy, but I'm only a Cowboy because I trust myself to be able to look for and deal with ramifications of my judgment. I wouldn't trust another cRNA consistently enough to do what I like to do. Anyone else have problems with this?
 
FollowTheMoney said:
Looks like Consigliere is going to have to resign from his administrative duties and sell his share of the practice for his anti-gay remarks. 😉
SDN may have to cut all ties too... :laugh:
Click to expand...
What's anti-gay about them? They are a statement of fact: gay men take it in the pooper...nothing anti-gay about that.
 
Consigliere why do you come on here? Enjoy all that money you are making supervising your BFFs and just move along. Mods isn't he basically a troll with his telling us to give up and spreading his crna love?
 
Hoya11 said:
Mostly agree with the above numbers. But I would change the supervision ratio to 1:2-3. 1:4 is rare and only when that 4th room is a sleeper, like a long stable case, or the eyeball room. And my call is 2-4 times per month for frequency. Salary is right on but partner track for those numbers. No partner track and I would think its a little low.

So I actually prefer supervising multiple rooms. Im sure every CRNA situation is different, but ours work for the group. So I do the pre-ops, communicate the plan, I am paged for induction, I stay and do the beginning of the case until it is stable and underway, then leave. Repeat and do the same in other rooms. Give breaks and lunches. Do blocks and lines myself. I honestly look at people doing their own cases and think, god how inefficient. Why should an MD be setting up suction and getting meds out of the pixis and watching stable vitals. I am called with problems and for extubations after I get the case rolling. I am happy with this arrangement and feel like I get all the action without the monotony because I can come and go in the case as I please. So i dont really see it as a a nuisance that would require more salary. Sure there are days when I am assigned to go solo, or cover the ICU and intubate solo, so there is always autonomy. I guess it depends on the gig, I wouldnt want to be supervising in a surgicenter all day just doing MAC cases, but in the right setting I dont feel Im missing out on what I consider to be the important parts of the case.
Click to expand...

I disagree. I think you learn to be incredibly efficient by yourself.

I remember in residency sometimes it took an act of God to get the attending anesthesiologist and the surgeon in the same room for time out. Lots of inefficiencies.

I'll flip a room as fast as any ACT model easy cheesy.
 
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I work in a blended practice in which we employ the CRNAs and, in general, I'm happy to come to work. Some of our CRNAs are engaged in pushing the envelope of quality care, and others wanna sit on the stool and get paid. Some days I enjoy pushing my employees to do better work; other days, I wanna sit in a room and do what I do best. Like the OP said, grass is greener...
 
I work in ACT model and would take a pay cut to work in ACT model compared to MD only. I think it's just better. I realize not all agree, but I have no desire to sit on the stool in the room for the duration of the case. I'd rather spend all my time coming up with plans and actually doing things rather than just sitting around. Some days I'll do 15 or 20 peripheral nerve blocks. Other days I'll put in 4 or 5 central lines. Other days I'll get to do several difficult intubations. I like doing procedures and I do a TON more supervising multiple rooms compared to if I was just stuck in a single room all day.

We employ our own CRNAs/AAs and I think that makes all the difference.
 
At my last job the boss was good friends with one of the CRNAs who could do no wrong. The CRNA could be disrespectful and totally ignore my instructions. But nothing happened to him. The boss was a lazy middle aged sexist though. Treated women like we didn't belong there.
So hiring your own CRNAs doesn't solve all problems of the head doc plays favorites. No thank you. Half were cool and the other half would have attitude problems, be argumentative etc. too much of a head ache for a female anesthesiologist.
 
chocomorsel said:
At my last job the boss was good friends with one of the CRNAs who could do no wrong. The CRNA could be disrespectful and totally ignore my instructions. But nothing happened to him. The boss was a lazy middle aged sexist though. Treated women like we didn't belong there.
So hiring your own CRNAs doesn't solve all problems of the head doc plays favorites. No thank you. Half were cool and the other half would have attitude problems, be argumentative etc. too much of a head ache for a female anesthesiologist.
Click to expand...

Sounds like you had a fundamental problem with the way the group functioned. Obviously employing the CRNAs and AAs doesn't fix every potential problem that can pop up. Just like being an MD only group doesn't fix all the problems. Plenty of those groups are terrible as well.
 
GaseousClay said:
Consigliere why do you come on here? Enjoy all that money you are making supervising your BFFs and just move along. Mods isn't he basically a troll with his telling us to give up and spreading his crna love?
Click to expand...
Not spreading CRNA love douche.......spreading reality.
 
Mman said:
I work in ACT model and would take a pay cut to work in ACT model compared to MD only. I think it's just better. I realize not all agree, but I have no desire to sit on the stool in the room for the duration of the case. I'd rather spend all my time coming up with plans and actually doing things rather than just sitting around. Some days I'll do 15 or 20 peripheral nerve blocks. Other days I'll put in 4 or 5 central lines. Other days I'll get to do several difficult intubations. I like doing procedures and I do a TON more supervising multiple rooms compared to if I was just stuck in a single room all day.

We employ our own CRNAs/AAs and I think that makes all the difference.
Click to expand...

Eh, you can teach a monkey to intubate and put in lines, etc. I just came from an ACT model and there was a lot more sitting by attendings when supervising there than doing their own cases. Some were really good at acting busy though.
 
Ignatius J said:
Eh, you can teach a monkey to intubate and put in lines, etc. I just came from an ACT model and there was a lot more sitting by attendings when supervising there than doing their own cases. Some were really good at acting busy though.
Click to expand...

There are dysfunctional MD only groups just like there are dysfunctional ACT groups. I love my group. I almost never get to sit down during the day because I'm constantly busy doing things. It's physically very tiring, but it makes the time fly and that's what vacation is for to recharge from.
 
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