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Author admits to staffing at 80% and then blames the anesthesia shortage on people cutting back. What a tool. Anesthesia's 'manufactured crisis' - Becker’s ASC
Anesthesia “manufactured crisis” 🙄
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Actually, this is exactly what I've seen in private practice. Game this out with me.
Say you are in a crowded marketplace with several bad actor anesthesia staffing agencies in town, probably paying out the a$$ for locums/ML rates/etc. To keep up with recruitment and retention you have to match rates if not exceed them for your busy hospital. Over 5 years, you incrementally have gone up 25% in salary overall for your employees.
Red Heels CRNA lives high on the hog, and realizes they can back down on their FTE status to 0.8 (32 hours per week) or less and get an extra day off a week at the same salary. Plus they can come back and ML at an OT rate on off days when they want (or not - hello 3/4 day weekends every week!). So what you've unwittingly done to yourself is increase your costs with a potential net decrease in coverage. The hospital that just increased your subsidy won't be pleased.
Let's say you try to get smart and say "Hey, to get that salary increase you need to stay 1.0 FTE" - Red Heels' response will be "OK, I'll just head to LoserVille ASC staffed by DeathStar and make more anyway". So you shake your head and throw your hands up. This is probably the most unsavory part of private practice employing care team model.
Say you are in a crowded marketplace with several bad actor anesthesia staffing agencies in town, probably paying out the a$$ for locums/ML rates/etc. To keep up with recruitment and retention you have to match rates if not exceed them for your busy hospital. Over 5 years, you incrementally have gone up 25% in salary overall for your employees.
Red Heels CRNA lives high on the hog, and realizes they can back down on their FTE status to 0.8 (32 hours per week) or less and get an extra day off a week at the same salary. Plus they can come back and ML at an OT rate on off days when they want (or not - hello 3/4 day weekends every week!). So what you've unwittingly done to yourself is increase your costs with a potential net decrease in coverage. The hospital that just increased your subsidy won't be pleased.
Let's say you try to get smart and say "Hey, to get that salary increase you need to stay 1.0 FTE" - Red Heels' response will be "OK, I'll just head to LoserVille ASC staffed by DeathStar and make more anyway". So you shake your head and throw your hands up. This is probably the most unsavory part of private practice employing care team model.
Looking from across the isle, these crna issues appear to be very common.
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A private practice employing CRNAs in this day and age makes absolutely zero business sense. I know some have tried. I understand the issues of history, culture, etc. but post-COVID the crna market has become unhinged.
Most CRNAs I know are 0.8 fte w2 somewhere for the salary (which has gone wild) and benefits. And then 1099 elsewhere on their off days for a very high $/hr rate.
This Dr Vijay Sudheebdra who is quoted in the article will soon suffer the same fate as Blockbuster video …he’s a goner for not changing with the times.
Read closely what he is quoted
“People only want to work 24/30/32 hrs a week” but get paid the same as 40 hrs”
Read what else he is quoted
“we never staff at 200%”. We are only staffed at 80/85%." Like dude, you want to overwork people by 20%. We get it. It's profit driven.
But the reason people cut back to 0.6 or 0.8 fte is to protect themselves if they get abused in terms of hours.
Read closely what he is quoted
“People only want to work 24/30/32 hrs a week” but get paid the same as 40 hrs”
Read what else he is quoted
“we never staff at 200%”. We are only staffed at 80/85%." Like dude, you want to overwork people by 20%. We get it. It's profit driven.
But the reason people cut back to 0.6 or 0.8 fte is to protect themselves if they get abused in terms of hours.
And that's why MD's need to ask for 20-30 weeks off at 1.0 FTE w2 pay without working 80 hrs a week. If you want to retain staff, that's what it will take. Don't work the regular traditional 44 weeks out of the year anymore even if it's 40 hours a week. That doesn't work anymore unless it's gonna to pay 700K plus 40 hours inclusive of call beeper hours and most hospitals and amc do not want to pay that.
Totally understand the plight of the private practice nowadays. Just don’t appreciate him referring to those trying to maximize their income per hour or cutting back for whatever reason as “taking advantage of the situation”. Also if you’re staffing your group at 80%, you’re overworking your staff and creating the burnout that leads to more part-timers.
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Those who have ownership want to maximize w2 staff workload. The harder the w2 staff work, the more profit back in the hands of the partners.
That worked well for blockbuster for a while with their late fees model. However with mail in dvds/blu ray's netflix didn't charge late fees. Killed their late fees model
"Transactional mercenaries" is what admin called us during the last round of contract negotiations
Intended as an insult, taken as a compliment.
im in one and doing well - yes its a very rare thing
but all i can say is if you have rates that are competitive, and contracts that are good payer mix and busy, it washes everything else over
thats how it always was made to work in the past wtih pp groups
part of the squeeze is CRNAs, but part of the squeeze is insurance reimbursements have gone up 2% while provider salaries are up 25%
and if we addressed bad actor insurance companies we could have more practices like mine
how long will it last i dont know
This is a good straightforward explanation of the market pressures…. The numbers don’t work for many practices….even without amc overhead- Hence the reason many amc practices have gone to extended care team models. Unfortunately there are way too many anesthesiologists who are willing to be sell outs.
Only 3 partners and zero associates walked from my old practice- the rest stuck their head in the sand. They didn’t even need to speak up - I did…. They just needed to agree that patients come before profits…. They didn’t.
There is no loyalty anymore. I think too many people wear their emotions on their sleeves.
My colleague left his partnership in Connecticut 18 months ago to move to Florida.
Making 750-800k working 60/65 hrs a week with 7-8 weeks off usually but the stress of managing the practice and the locums pay and begging the hospital for every single penny.
He’s so much happier now working for an amc 500k/30 weeks off. He made 250k 1099 on his spare weeks off plus still kept around 15 weeks off working basically 40 hrs a week
So makes the same but doubles his vacation and works less. That’s what I call a win.
Don’t get your head stuck in the sand, leave your job if things don’t change.
We are at a cross roads in staffing model. Envision is leaving most of central Florida with hospital taking over w2 in house. As far as I know the vast if jobs available are only at the places that offer 9-10 weeks off. It’s even posted on gas work which hospitals do not have vacancies. Surprise surprise. Almost all the places listed without vacancies have at least 20 weeks off. The only places with openings are more traditional models.
I keep telling people this. This is the only way to recruit w2 docs these days.
Crnas recruitment is a mess still.
I keep telling people this. This is the only way to recruit w2 docs these days.
Crnas recruitment is a mess still.
We’ve actually slowly transitioned to a more physician/less CRNA model over the past few years (employed position).They’ve priced themselves out and don’t want to work the hours we need coverage (they have never taken call).
Here, we were recently flabbergasted by the fascinating claim that it'd be easier to recruit CRNAs if we let them take call.
Granted, this was in the context of some fingerpointing at us, trying to blame our (physician) group for their CRNA recruiting troubles. But they seriously made the assertion that IF ONLY we let the CRNAs take 24h calls they'd line up around the corner for the job.
It's absolute nonsense, of course. CRNAs don't sign up for 24h call unless it's actually just easy daylight work, followed by dinner in the cafeteria and then chilling in the lounge or call room and then sleeping overnight to "cover" emergencies that rarely come in to those hospitals. They want to get a FTE and full time pay for one easy 24h shift and two 8s, or better yet, a 24 and a 12 that the hospital agrees is "full time". A 24h shift here would be brutal.
Its like admin is living in some kind of bizarro opposite world. But we said OK and now there's a plan to put them on the night schedule. I'll keep checking the sidewalk to see if that line forms.
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Yeah. By us they can do a 24 and a 16. Of course the 16 isn’t really necessary, really all we need is a 12 but they need to reach 40 hours so the 16 hour shift was invented.
Docs can have that model also
Work 16 hr Friday. And 24 hr Sunday.
It’s far cheaper than bringing in a locums docs.
It actually works best as a 0.5 fte
Staffing models gotta evolve. Because no one wants to work 42 weekends like that. 21 weekends is perfect for 275k ish. So 550k for 42 weekends.
This solves a long staffing and weekend issues. Works out to $327:hr.
Yeah that might soften the blow, and actually even be safer than working a full 24, but when the nights always include at least one SBO / butt pus / appy / cold leg, plus assorted OB demands... nights here are just not desirable times to be working UNLESS they're accompanied by a substantial pay premium. No sane CRNA is going to sign up for that for regular hour pay to hit their FTE.
Our group pays the overnight 12h physician shift at a rate 2.5x the rate for the same number of daylight hours.
It'd be a totally different story if night call was home pager or even in-house but high probability of sleeping uninterrupted.
They also think CRNA recruiting would be easier if we let them do blocks (i.e. if we "let them" show up 30+ minutes earlier to block their first starts). Maybe your CRNAs are different but I'm wondering what fantasy world they inhabit where CRNAs are looking to move up their arrival time from 0700 to 0630 so they can do some extra work.
It's hard to have conversations with these people when they're so utterly detached from reality.
We've got a few that like the 1100 - 2300 time slot. It's a useful shift for us, because they help us clean up the day's overflow. And the evenings tend to slow down a little, so occasionally they get to relax and do nothing for a couple hours.
It's the overnights that nobody really wants.
We have CRNAs signing up to be on the overnight call team (24h shifts). They are protected mornings and afternoons. And often even evenings. They’re on the hook from 11p-7a. If needed they help w breaks/lunches/dinners but as I said they’re generally not doing cases until 11p. They do have to be in the hospital for 24 hours though. I do not know if they make a premium as they’re employed by the hospital, but I suspect they do.
They work the bare minimum number of hours to attain full time employed status so they can have benefits (insurance and matching retirement) which is generally 0.8 fte. So they work a 24hr and a 8hr shift. And that’s it.
The other 5 days of the week they work 1099 elsewhere for big money rate or they stay home w kids.
If your hospital wants to find 24h tell them they can easily find them if they want to pay them for 24hr but generally only really need them to work 8 of those 24 hours. They’ll easily find CRNAs. If however they actually want them to work 24 hours I wish your hospital the best. They’ll find no one. Ever. Anywhere. Unless they want a physician. We tend to be fooled into doing crap like that.
Times have change. People want it all. Time off. Compressed schedules.
Very few crnas work 5 days a week excluding 1099 locums. (And they generally are older 1099 crna locums who don’t want the grind of the 10-14 hr days)
This one inexperienced doc taking over a hospital contract got laughed out the door by the crnas when he proposed they work 5 days a week 7-3 as w2. He was paying them well 250k but they ain’t gonna to be available 5 days a week.
Jealous of y’all who have extra CRNAs to help with lunches and breaks.
Admin floated having a CRNA on Saturdays to help with our ridiculous weekends. Shockingly no takers for the terrible rates they were offering.
Admin floated having a CRNA on Saturdays to help with our ridiculous weekends. Shockingly no takers for the terrible rates they were offering.
I help w breaks if I’m able. I’m unable to do lunches as I’m responsible for other rooms and not tying myself up for 30 min. Most of our anesthesiologists do not help w breaks. I certainly don’t blame them. The CRNAs are employees of the hospital. It is the hospitals responsibility to ensure breaks and lunches are accomplished.
if you are medically directing and drop in for a break or a lunch, you may not be compliant. Don't think that the CRNAs who are the beneficiaries of you dropping in are not aware of that and capable of using it against your group and/or the hospital should things become adversarial.
If it’s $190-200/hr crna rate on weekdays (in Florida) and market rate like in Florida
Than $210/hr will get the crnas on weekend
What is the going market rate for crnas on weekdays vs weekends
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Not necessary true. You can delegate another anesthesiologist to cover for you and they are immediately available
I’ve seen this excuse time and time again from docs who don’t want to give breaks.
Or the doc who won’t relieve the crna from the last case at an ASC. Because the ASC pacu can’t be “unmanned”. Give me a break.
You are right... except that most of us are running 1:4 most of the time. Granted there is usually someone who is not, but with 3-4 rooms texting/calling multiple docs “I would like to drop in for a break for awhile can you and docs x and y sign in to rooms A,B, and C? Is just too much of an administrative burden give all the other **** that we have to deal with running 3-4 rooms.
Correct.
Ideally at a busy place (say 20 ORs) u need 2 extra free crnas.
But some docs also do such piss poor job timing breaks
I don’t know. Maybe just do cowboy style run it 20% less staffing on purpose and hope for case cancellation or surgeons coming late.
Yeah.. one of many reasons I'll never work at 4:1. At my place (~10 locations), it's 50% solo, 50% start the day at 2:1. CRNAs get breaked out by docs easily with this model. As shorter add-on cases come up in the day (sections, TEEs, EGDs), one of the supervising docs will go solo temporarily and sign out their rooms to others. Proceduralists are happy about immediate availability of anesthesia, docs are happy at ratios and involvement in patient care, and CRNAs are happy to get breaked out and relieved on time.
It's cheaper to run solo than 1:2. Why bother?
I've read postings where locums CRNAs saying how the "ologists" can say the CRNAs are pricing themselves out when the anesthesiologists are making some ridiculous rates (which they state as $600/hr, which is a rate I have never seen offered for a general anesthesiologist). Locums CRNAs also making comments like the anesthesiologists are the ones overpaid for doing "paperwork". I personally would prefer to do my own cases but most of the locums jobs and permanent jobs in the US have anesthesiologist supervising or collaborative or whatever BS the admin want to call it. Unfortunately it is rare to have a locums assignment doing own cases or less than 1:4 staffing. It keeps getting worse as the CRNAs in those "collaborative" model don't want anesthesiologists inputs and don't want to be supervised but if lawsuits happen, I would not be surprised when they would claim that you were "supervising" them. I have worked with some excellent CRNAs and I have also worked with militant CRNAs
I always find out the staffing model of a locums gig before committing.. ask to speak with the site director if needed.. just refuse to do 4:1. Many places are desperate enough to accept solo (except on call). You may have to settle for 350-400 but your day is much easier than trying to run around 4 rooms and time breaks around blocks, inductions, and preops.
Well you only start 2:1. With this, no break staff needed, no extra staff needed for sections etc, all add-ons done before 5. And usually the 2 rooms are the busiest (think 8 blocks or 15 cystos/endos a room). I'm not sure how tenable it is for PP but it's the best for OR flow and patient care.
Yeah, 1:2 is a money loser for PP. Is this hospital employed or AMC?
Solo 1099 can suck at some locums places if u are the lone doc solo in a busy act model. You can get abused. Nursing staff has patient by the Or door rushing you. Getting bounced from room to room. Like you are your own flip room.
I’m on my 7th urology case by 230p with no morning break or lunch and the other docs who have been supervising are chilling watching Fox News in the break room finally asking if I need a lunch break. Which I declined. But I don’t really need more than 5 min to eat which I can do in between cases.
The regular w2 docs take the slower ortho or neuro rooms with 1:4 and just relax most of the day. So not all 4 rooms are busy.
So it varies how you can be treated as solo doc.
Speaking of crisis markets- what’s going on at the Minneapolis VA? Had several recruiters promise me base 700k with over a million with call. I assume there’s some catch
Minneapolis VA Updates its Bylaws
The Minneapolis Veteran Affairs Medical Center (VAMC) recently updated its bylaws, allowing CRNAs to practice independently.
Concerning CRNA breaks - somehow we've blown past acknowledging the real problem, and spend all our time dwelling on the manufactured problem of how to get CRNAs their breaks.
The real problem is nurses who somehow can't manage their nutrition and bodily functions to the degree that someone needs to assist them 3-5 times per day. There is no sane earthly reason why a healthy adult can't work two or three whole hours, from 7 until 9 or 10, without needing a pee break or a snack.
It's one thing if someone is stuck in a 6 or 8 hour case. This is not the norm, however.
I put up with giving them breaks now, because it's politically advisable for me and my group to play that game. That doesn't make it any less ridiculous. I feel like I'm one step away from bringing these helpless people some graham crackers and a juice box.
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Oh, agreed. It's about choosing battles.
It's just one of a thousand cuts, but I'm not dead yet.
So why are they recruiting doctorsMinneapolis VA Updates its Bylaws
The Minneapolis Veteran Affairs Medical Center (VAMC) recently updated its bylaws, allowing CRNAs to practice independently.www.mnmed.org
Good question. I assume they need at least some doctors, and couldn't retain the ones they had. Low pay or intolerable practice environment.
Like any sane anesthesiologist, I oppose independent CRNA practice.
But having worked in places where that was the state of affairs ... for purely selfish reasons, it was nice. I did my own cases, and I wasn't involved with or responsible for any of the things the independent CRNAs did.
The only down side is the schedule triage results in the sicker people and bigger cases always going to the doctor while the "equally capable" CRNAs always did the healthy and easy work. And the instant they get something complex, they're suddenly interested in your opinion. It's hard to tell them to **** off, but at least your name's not on the chart.
A CRNA I work with just shared with me that he took a 1099 position at an ortho ASC. 375/h. 10 weeks vacation.
That's an excellent rate for CRNAs and pretty good for an anesthesiologist at $375/hr. My city and surrounding area, a large metro area, they are offering anesthesiologist $214-240/hr W2 and $200-250/hr prn W2 I have even heard of offers in the city of $200-$211 1099 for anesthesiologists who have to get their own malpractice. CRNAs are probably feeling even more inflated since they are getting such high hourly rates while some anesthesiologists are taking crappy W2 jobs run by private equity
