SDN members see fewer ads and full resolution images. Join our non-profit community!

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

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

  1. SDN is made possible through member donations, sponsorships, and our volunteers. Learn about SDN's nonprofit mission.
  1. aneftp

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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.
     
  2. SDN Members don't see this ad. About the ads.
  3. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    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 10+ Year Member

    3,725
    1,282
    Mar 22, 2005
    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.
     
    QueenJames, dmk5n and nimbus like this.
  5. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    Well good thing I have a guarantee salary ;)
     
  6. chocomorsel

    chocomorsel Senior Member Physician 10+ Year Member

    1,371
    498
    May 24, 2006
    somewhere always warm
    Where is this magical country town? In what state? I personally prefer small towns.
     
  7. Mman

    Mman Senior Member 10+ Year Member

    3,725
    1,282
    Mar 22, 2005
    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.
     
    aneftp and nimbus like this.
  8. ElmerFudd

    ElmerFudd

    36
    29
    Jun 11, 2017
    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 10+ Year Member

    2,125
    1,291
    Jan 13, 2006
    Advice on taking over CRNA lead practice

    Could become a goldmine or it could be a disaster.
     
    acidbase1 likes this.
  10. Mman

    Mman Senior Member 10+ Year Member

    3,725
    1,282
    Mar 22, 2005
    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.
     
    Last edited: Jun 11, 2017
    mostwanted, pgg and FFP like this.
  11. aneftp

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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 10+ Year Member

    3,725
    1,282
    Mar 22, 2005

    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

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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.
     
    nimbus likes this.
  15. nimbus

    nimbus Member 10+ Year Member

    2,125
    1,291
    Jan 13, 2006

    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??
     
    Last edited: Jun 11, 2017
  16. Arch Guillotti

    Arch Guillotti Senior Member Administrator Physician Lifetime Donor Classifieds Approved 10+ Year Member

    7,174
    787
    Aug 8, 2001
    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

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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 Lifetime Donor Classifieds Approved 10+ Year Member

    3,341
    1,093
    Dec 6, 2006
    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.
     
    dmk5n, aneftp and Arch Guillotti like this.
  19. Arch Guillotti

    Arch Guillotti Senior Member Administrator Physician Lifetime Donor Classifieds Approved 10+ Year Member

    7,174
    787
    Aug 8, 2001
    How does he do pain if OR's are running?
     
  20. aneftp

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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 10+ Year Member

    466
    158
    Aug 26, 2004

    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 10+ Year Member

    3,725
    1,282
    Mar 22, 2005
    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 Administrator Physician Lifetime Donor Classifieds Approved 10+ Year Member

    7,174
    787
    Aug 8, 2001
    Agree. 10-12 OR's can pull it off though (this includes endoscopy).
     
  25. DrCommonSense

    DrCommonSense

    1,671
    425
    Sep 20, 2016
    Texas
    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.
     
    QueenJames and waterbottle10 like this.
  26. waterbottle10

    waterbottle10 5+ Year Member

    222
    29
    Jan 27, 2011
    Why don't they hire more AA instead of crna to save money
     
    acidbase1 likes this.
  27. aneftp

    aneftp 7+ Year Member

    1,667
    544
    Mar 23, 2010
    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.
     
    dr doze likes this.
  28. nimbus

    nimbus Member 10+ Year Member

    2,125
    1,291
    Jan 13, 2006

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

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

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    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
     
    QueenJames and nimbus like this.
  30. nimbus

    nimbus Member 10+ Year Member

    2,125
    1,291
    Jan 13, 2006

    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

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    No BS nimbus, the CRNAs are horrible. Just goes to show how hard it is to kill someone
     
    QueenJames likes this.
  32. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    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

    nimbus Member 10+ Year Member

    2,125
    1,291
    Jan 13, 2006

    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?
     
    Last edited: Oct 5, 2017
  34. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    They're making about 450-475k. Yes presently I have a guarantee
     
    QueenJames likes this.
  35. dhb

    dhb Member Lifetime Donor Classifieds Approved 10+ Year Member

    3,292
    502
    Jul 12, 2006
    :wow:
     
    okayplayer likes this.
  36. Scotty_G

    Scotty_G Junior Member 10+ Year Member

    360
    42
    Jun 21, 2004
    Northeast
    What area of the country is this acidbase?
     
  37. Neurodelic

    Neurodelic ASA Member 2+ Year Member

    50
    8
    Jun 2, 2013
    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 10+ Year Member

    466
    158
    Aug 26, 2004
    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.
     
    acidbase1 and nimbus like this.
  39. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    nm
     
    Last edited: Oct 14, 2017
  40. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    Nm
     
    Last edited: Oct 14, 2017
    dhb and QueenJames like this.
  41. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    Northwest
     
  42. nimbus

    nimbus Member 10+ Year Member

    2,125
    1,291
    Jan 13, 2006

    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.
     
    Last edited: Oct 13, 2017
    FFP and dhb like this.
  43. Scotty_G

    Scotty_G Junior Member 10+ Year Member

    360
    42
    Jun 21, 2004
    Northeast
    Northwest eh so then you are probably in rural WA state. (or Oregon/Montana) I put my money on WA.
     
    acidbase1 likes this.
  44. Man o War

    Man o War 2+ Year Member

    731
    656
    Apr 13, 2015
    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

    AdmiralChz ASA Member 7+ Year Member

    1,961
    1,050
    Sep 8, 2008
    South
    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.
     
    Last edited: Oct 14, 2017
  46. chocomorsel

    chocomorsel Senior Member Physician 10+ Year Member

    1,371
    498
    May 24, 2006
    somewhere always warm
    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.
     
    acidbase1, dchz, sheeed and 1 other person like this.
  47. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
  48. acidbase1

    acidbase1 5+ Year Member

    306
    109
    Jul 28, 2011
    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
     
    nimbus likes this.
  49. chocomorsel

    chocomorsel Senior Member Physician 10+ Year Member

    1,371
    498
    May 24, 2006
    somewhere always warm
    I hope you fix the place and improve care.
     
    acidbase1 likes this.
  50. nimbus

    nimbus Member 10+ Year Member

    2,125
    1,291
    Jan 13, 2006

    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 Gold Donor Classifieds Approved 10+ Year Member

    5,341
    4,294
    Oct 17, 2007
    the opposite pole
    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.
     
    Last edited: Oct 14, 2017

Share This Page