While this is true, having worked in academics in a system without after hours compensation, I can see the appeal. In academics there are multiple forces that can keep you late on any given day. Surgeon lets the med student close for 30 mins, nurses take 45 mins to turn over a room, surgeon shows up an hour late because they had a meeting and didn’t tell anyone, room sits empty in the morning and starts at 2 pm because surgeon had clinic, all of this occurs on the regular and is tolerated by the administration. There is nothing more infuriating than sitting around waiting to do a non-urgent add on at 430 pm knowing that everyone there will get something out of it (nurse overtime, CRNA hourly rate, surgeons on RVU model, hospital facility fee, not to mention they keep the anesthesia billing) except you, the employed, salaried anesthesiologist. It makes the hospital view your time as inherently less valuable. At least when there’s an after hours rate it forces the hospital to think twice about their inefficiencies and indeed as the COVID crunch has dragged on we have seen the administration start to reevaluate how much inefficiency they are willing to tolerate precisely because of personnel costs. Whether this continues when the pandemic is over remains to be seen.
