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AMC paying $500k plus 11 weeks off and still making money off u

Discussion in 'Anesthesiology' started by aneftp, May 31, 2017.

  1. aneftp

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    Yes. I'm moonlighting back at my old hospital this weekend. Not "rural" but a little further (15-20 minutes) out from true suburban area.

    And payer mix is 13% commercial. Rest is Medicare and Medicaid

    My suburban area hospital payer mix is 60% commercial, 20% Medicare advantage and 15% Medicare and only 5% Medicaid.
     
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  3. acidbase1

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    Own billing. You definitely have to make more to compensate for the "hidden paychecks" groups have to offer. But the kicker is you work less for the same money
     
  4. Mman

    Mman Senior Member
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    am I correct when stating you are still a resident that has never had any job in anesthesia, let alone this particular one? Because I kinda find it hard to believe you found a rural gig that will get you $600-800K while working less than 40 hours a week. Will be interesting to see how what you think is going to happen actually pans out.
     
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  5. acidbase1

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    Well good thing I have a guarantee salary ;)
     
  6. chocomorsel

    chocomorsel Senior Member
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    Where is this magical country town? In what state? I personally prefer small towns.
     
  7. Mman

    Mman Senior Member
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    how does someone billing for themselves have a guaranteed salary? Who is guaranteeing it? And are they guaranteeing hours to go along with it? In general, if something sounds to good to be true it probably is and if the job is so good it wouldn't be empty waiting for you to take it nor would it be hiring a new grad.

    All I'm saying is beware.

    Lots of jobs make promises. Not all of them are kept.
     
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  8. ElmerFudd

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    60-65 hours a week?

    No thanks. Per hour, that pay qualifies as "decent". And when you factor in the fact that they're working your ass off, I'd say it sounds like a lousy job, ie where there are too many people in suits making a lot of money off of your blood, sweat, and personal risk.
     
  9. nimbus

    nimbus Member
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    Advice on taking over CRNA lead practice

    Could become a goldmine or it could be a disaster.
     
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  10. Mman

    Mman Senior Member
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    oh damn, didn't put the 2 threads together in my mind. Uhh. I can't believe they are taking a new grad into that sort of position. You need someone with 25+ years experience to be able to do it right. Somebody fresh out will just be taken advantage of from all sides. Doing your own cases while also supervising anesthetists in other rooms that the hospital will require you to bail out? Yikes. I mean I guess they can claim that won't ask you to bail them out, but things change. Also will be interesting to see how the case scheduling gets done. If you are the only doc around, you probably get all the unhealthy, uninsured or CMS patients sent your way. Hospital has a financial incentive to let the CRNAs do the healthy insured patients since they are collecting the anesthesia bill for those. Send the high risk, no pay patients to the doc who bills for himself.

    A situation like this is so bizarre I almost can't believe it is possible.
     
    #59 Mman, Jun 11, 2017
    Last edited: Jun 11, 2017
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  11. aneftp

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    So would u like to do u own billing and when times are tough and don't work as hard. But more time in between waiting for surgeons 1-2 hours at a time and make 400k no benefits. Pay for own health care and benefits. So that essentially takes that 400k down to around 370k.

    While u aren't "working" 60-65 hours a week. You are still physically at the hospital for 60-65 hours due to waiting for surgeons like my other friend in Maryland? Cause while u are waiting for surgeons at hospital. The AMC have more efficient billing at local surgical centers. And surgeons take their more lucrative cases there and leave u with junk patients plus waiting on surgeons to finish their cases at outpatient centers

    How does that sound?
     
  12. aneftp

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    I know. Until you actually go there. A guaranteed salary is one thing. Getting to keep billing on top of guarantee salary does happen. It's called a subsidy. Many rural places offer that.

    But buyer beware. Even AMC are encroaching on thos rural practices by taking less subsidy.

    My friend does mainly pain but he covers for doc who has direct anesthesia contract at a true rural hospital in North Carolina.

    Rural hospital gives doc $900k guarantee to provide coverage for hospital 24/7. So doc gives my friend roughly $200k to cover him 12 weeks out of the 52 weeks coverage. So main doc is getting $700k for 40 weeks of 24/7 coverage. And my friend gets $200k for 12 weeks of coverage. Not a bad arrangement.

    Hospital pays for Crna's.

    That arrangement has worked for anesthesia doc for past 12 years with direct contract. But hospital recently has approached by big AMC offering to save them $$$. So a 12 year "stable" contract isn't stable anymore.
     
  13. Mman

    Mman Senior Member
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    Depending on how late you work and how often there on nights and weekends, that's probably a pretty good deal (but 24/7 can sometimes mean you are there way too long to be worth it). But that's with hospital doing all the billing. Getting a guaranteed salary and then billing on top of that is kinda fishy if you ask me.
     
  14. aneftp

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    I know. My friend confirmed with me the hospital keeps the billing. They pay for the Crna's. The MD 24/7 52 week contract is $900k. Rural North Carolina (about 50 minutes from suburban area).

    Pretty light. Approx 50-60 OR cases a week. Cover 3-4 crna. Average 35 hours and usually done by 2-3pm each day than beeper. Very light Ob. But since small hospital. They had trouble getting blood for Ob patient bleeding last week on a Sunday.
     
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  15. nimbus

    nimbus Member
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    That sounds like easy $$ except the last part. That hospital must be BLEEDING money on anesthesia costs. 5 employees to cover 50-60 cases/week??
     
    #64 nimbus, Jun 11, 2017
    Last edited: Jun 11, 2017
  16. Arch Guillotti

    Arch Guillotti Senior Member
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    That is very light. Many busy smaller places do that many cases in a day.

    Resources are always a problem at small places. At the academic medical center or level one trauma center the blood bank is at your beck and call.

    Who covers OB?

    One ill-timed phone call can ruin your night. The schedule sounds sweet but the folks I know who cover 24/7 say that the sleep schedule wears them out over time.
     
  17. aneftp

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    Whoa. Just got off the phone with my buddy (we did residency together) just just told me. Tomorrow is his last day of call at the hospital and the hospital is taking the contract back from the MD in a month.

    He does pain primarily. So it's not a big a thing for him. But the other MD is gonna to have to take a little paycut.

    So they will be hospital employees. They will have 2 MDs. One week on. One week off. Pay is gonna to be around $380-400k Plus hospital benefits. So the hospital likely saves around $100k immediately. He says hospital is struggling and Medicaid expansion is still being talked about in the North Carolina house since the new govenor is democrat and obviously wants to expand it.

    So rural hospitals are being hurt since the Dems and the ACA put a poison pill by punishing rural hospitals that have many Indigent patient populations unless the states expand Medicaid.

    As for case load. They used to do just 4-6 real operating room cases a day when he started there in 2010 covering for the main MD. Plus 2-3 gi scopes.

    Now they do around 10 real operating room cases a day (gallbladder, cysto, hernias, knee replacement, shoulder scopes , basic rural hospital cases you expect). But GI they do 10-15 gi scopes now. So they are much busier. They have 3 Ors but want to expand to 4. The Crna's are kinda of pissed with increase case load so one of them left. So they need to recruit more Crna's to rural hospital.

    MD covers Ob. It's hit or miss as expected in rural hospital.

    So bottom line is lots of budget issues and rural hospital are trying to cut cost so even this direct Anesthesiologist contract is ending and hospital is taking back the contract and employing MDs.
     
  18. dr doze

    dr doze To be able to forget means to sanity
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    Not surprised. Everyone everywhere is under enormous pressure-including administrators. They are looking to cut wherever they can without causing too much damage, or more accurately without being forced to own it.

    They have their own invitation only listerv discussion groups where they talk about the stuff that we do. Don't doubt that some of those [email protected]%ers lurk here and cut and paste posts or at least get ideas.
     
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  19. Arch Guillotti

    Arch Guillotti Senior Member
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    How does he do pain if OR's are running?
     
  20. aneftp

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    He modifies his clinic (he's only works 3-4 days a week in pain.

    I will have to find out more info.

    He's employed for hospital for pain I know that. But the general anesthesia contract was independent of hospital. Now will be all under same hospital umbrella.
     
  21. aneftp

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    Yeah. He just told me the pain clinic is closed when he covers general anesthesia. But the office is still open to take phone calls.
     
  22. Stank811

    Stank811 Junior Member
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    It is all regional and circular over an extended period of time. In my area the exact opposite has been happening in the recent past. Not sure why hospital admins would want to take back the contract from MDs when medicaid expansion is potentially in the works seeing we do so well with medicaid.
     
  23. Mman

    Mman Senior Member
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    Did you just say many busy small hospitals do 50-60 cases a day? You and I have a different definition of small hospital. I've never seen what I consider a small hospital that does 15,000 surgeries a year. I mean you'd likely need 10-20 ORs to come close to handling that volume, certainly not the 3-5 ORs that small rural hospitals usually have.
     
  24. Arch Guillotti

    Arch Guillotti Senior Member
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    Agree. 10-12 OR's can pull it off though (this includes endoscopy).
     
  25. DrCommonSense

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    Thats it?

    On SDN most anesthesiology make about 1 million per year while working about 5 hours a week.

    Thats actually just an average deal at best considering he's in a rural area.
     
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  26. waterbottle10

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    Why don't they hire more AA instead of crna to save money
     
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  27. aneftp

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    Cause they got srna training program they can use as free labor.

    Heck. They don't even need an extra PAID CRNA overnight to run 2 rooms. Just Have one crna. One srna. MD is outside "medically directly one srna" while crna is non medically directly. There you go. 2 rooms of coverage and only one paid crna.

    Yet MD really is on the hook for both rooms with trauma cases in middle of the night.

    So they save on hiring another crna overnight.
     
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  28. nimbus

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    Any followup? Has the job met your expectations? 60k/month working 40hrs/week. How are the CRNAs?

    Sincerely curious.
     
    #77 nimbus, Oct 4, 2017
    Last edited: Oct 4, 2017
  29. acidbase1

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    Job is awesome, working harder bc I'm doing pain on the side. CRNAs are a nightmare but I'm close to an exclusive contract so that'll take care of itself
     
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  30. nimbus

    nimbus Member
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    Good to hear. How does scheduling/case selection work? Do you have any supervision or direction role for the CRNAs? I've always wondered how those situations work in reality.
     
  31. acidbase1

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    No BS nimbus, the CRNAs are horrible. Just goes to show how hard it is to kill someone
     
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  32. acidbase1

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    Presently one of the older CRNAs makes the schedule and he's been pretty fair with case selection. Right now everyone is independent. But with my proposal it will be supervision and clearly I'd make the daily assignments
     
  33. nimbus

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    So do the CRNAs make what you make? Are you all making well over $500k for less than 40hrs/week? Do you get a medical director stipend or does the hospital guarantee your unit value?
     
    #82 nimbus, Oct 5, 2017
    Last edited: Oct 5, 2017
  34. acidbase1

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    They're making about 450-475k. Yes presently I have a guarantee
     
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  35. dhb

    dhb Member
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    :wow:
     
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  36. Scotty_G

    Scotty_G Junior Member
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    What area of the country is this acidbase?
     
  37. Neurodelic

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    That's seems unrealistic. Just to be clear, you're saying that each CRNA is making 450-475k while working 40 hr/wk? Did i get any of that wrong?
     
  38. Stank811

    Stank811 Junior Member
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    If they practice in an opt out state and are not employed they will make as much as a physician. Most of the time the ORs are not busy enough to produce that much income in the rural settings in which these scenarios occur. But if a hospital does become busy enough they will often recruit anesthesiologist which seems to be the case with acidbase.

    A more common scenario is a group of CRNAs will cover several hospitals all 45 min apart that each have 1-2 ORs which are not filled on a daily basis and all do OB. So they scramble around doing bread and butter cases and taking q2 on call for 200 a yr which still is probably better then most of the AMC jobs I see people post on this forum bc no one is taking 500k off the top of the work you do.
     
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  39. acidbase1

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    nm
     
    #88 acidbase1, Oct 13, 2017
    Last edited: Oct 14, 2017
  40. acidbase1

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    Nm
     
    #89 acidbase1, Oct 13, 2017
    Last edited: Oct 14, 2017
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  41. acidbase1

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    Northwest
     
  42. nimbus

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    Wow. So who's pocketing the rest now? You or the hospital? Or are you splitting it? Maybe it's just me but I always think the people actually doing the work should get the $$$, whether they are a doctor or a nurse. I wonder how long the CRNAs will stay. If it was me I'd leave just to make a point, even if my new job paid 200k.
     
    #91 nimbus, Oct 13, 2017
    Last edited: Oct 13, 2017
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  43. Scotty_G

    Scotty_G Junior Member
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    Northwest eh so then you are probably in rural WA state. (or Oregon/Montana) I put my money on WA.
     
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  44. Man o War

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    Bet you are a popular guy/gal at the moment.
    I remember clearly the temper tantrums the nurses had when my old group brought in the first AA. I can't imagine the meltdowns you will witness at your place of employment here in the next several months.
     
  45. AdmiralChz

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    Exactly my thought, I’m really surprised at these salaries - you could pay two mid levels for $450K or just pay one half and pocket the rest as an owner. Weird.

    Also I can’t see many employees staying at a job willingly when your pay is slashed by half acutely like that.
     
    #94 AdmiralChz, Oct 14, 2017
    Last edited: Oct 14, 2017
  46. chocomorsel

    chocomorsel Senior Member
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    Acid base, I wouldn't be on a public forum bragging about this. Do you know how many nurses come on here? And with the details you have given, someone may be able to ID you and make your life difficult.

    Good luck though. Maybe keep us posted on the private forum.
     
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  47. acidbase1

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  48. acidbase1

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    I disagree with you. They now will be part of an ACT not working independently, therefore, they shouldn't make the same money. Furthermore, they aren't qualified to be practicing independently. (Nor are any CRNAs imo) Quality has severely been lacking. You sound very pro independent CRNA

    I don't think anyone should be magooing their way through our specialty. I was brought in due to poor care
     
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  49. chocomorsel

    chocomorsel Senior Member
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    I hope you fix the place and improve care.
     
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  50. nimbus

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    I understand you are adding value. However I doubt the existing CRNAs will stay. They will probably leave and end up being replaced.
     
  51. FFP

    FFP Grunt, cog, body, pompous ass
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    It sounds like you're a greenhorn fresh grad, hence you probably don't deserve much more money than they do. I sincerely hope they will all just leave and find themselves another gig.

    I tend to agree with @nimbus, that anesthesia providers should not be employees, preyed upon by some monopoly that holds the keys to anesthesia services in a medical facility. Anesthesiologists (and CRNAs, where legal) should be free to practice as independent providers, like surgeons do.
     
    #100 FFP, Oct 14, 2017
    Last edited: Oct 14, 2017

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