Anesthesia Re-Entry Programs

[TeslaCoil]

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Anybody have any experience with these programs for re-entering anesthesia practice? I'm considering getting back into locums or maybe even a permanent return after 5 years of practicing pain mgmt. Any info would be much appreciated.

Anesthesiology Re-entry Program

www.asahq.org

 

[Timeoutofmind]

I came back after seven years or so of pain to do some part-time anesthesia, which I still do

My hospital made a big deal of credentialing me.

So
I just did some locums and brought the administration at my hospital case log… and then they were OK granting me privileges for Anesthesia.

People are pretty desperate for locums now so seems like a realistic path if you are comfortable with that…Always some nerves getting back into things but I found it pretty natural like riding a bike

 

[aneftp]

Try to get into some state facilities that are desperate. U can coast even at lower hourly rate. And than pick it up from there

Don’t be an idiot like this young pain doc who wanted to take call at a major level one center after being in pain only 2 years after fellowship. And he completely killed a patient even with residents. They fired him immediately. So don’t take call where u are the last resort.

 

[TeslaCoil]

Try to get into some state facilities that are desperate. U can coast even at lower hourly rate. And than pick it up from there

Don’t be an idiot like this young pain doc who wanted to take call at a major level one center after being in pain only 2 years after fellowship. And he completely killed a patient even with residents. They fired him immediately. So don’t take call where u are the last resort.

Yea def not. I would want to ease back into it.

 

[sloh]

Anybody have any experience with these programs for re-entering anesthesia practice? I'm considering getting back into locums or maybe even a permanent return after 5 years of practicing pain mgmt. Any info would be much appreciated.

Anesthesiology Re-entry Program

www.asahq.org

A little off topic but can you go into why you’re leaving pain?

 

[ERRES2288]

Try to get into some state facilities that are desperate. U can coast even at lower hourly rate. And than pick it up from there

Don’t be an idiot like this young pain doc who wanted to take call at a major level one center after being in pain only 2 years after fellowship. And he completely killed a patient even with residents. They fired him immediately. So don’t take call where u are the last resort.

Story?

 

[TeslaCoil]

A little off topic but can you go into why you’re leaving pain?

Sure. Year over year CMS cuts. Another -2.5% finalized for next year. Im in a private practice setting thats already strained, and every year they keep suffocating us. Its creating staffing problems at this point. We have cut every non-essential corner we can. Im chained to this place 47-48 weeks out of the year. 20-25 days of pto. Now that I have more young kids, I think Id rather go back to bread and butter anesthesia. Make the same if not more money, and take 13+ weeks of vacay per year. Not to mention pain mgmt patients are awful. The nature of the work is awful. Etc. its just heavily disincentivized at this point.

 

[Southpaw]

Sure. Year over year CMS cuts. Another -2.5% finalized for next year. Im in a private practice setting thats already strained, and every year they keep suffocating us. Its creating staffing problems at this point. We have cut every non-essential corner we can. Im chained to this place 47-48 weeks out of the year. 20-25 days of pto. Now that I have more young kids, I think Id rather go back to bread and butter anesthesia. Make the same if not more money, and take 13+ weeks of vacay per year. Not to mention pain mgmt patients are awful. The nature of the work is awful. Etc. its just heavily disincentivized at this point.

You either need to sell the practice to the hospital and work for them or get a stipend from the hospital. This is what all previously private anesthesia groups have done thanks to the ACA (Obama) and the NSA (Trump). We’ve become completely crippled financially and are wholly dependent on hospitals because our services are needed and the moneymaking ORs and procedure suites grind to a complete halt without us.

But yes, go do anesthesia. For now it’s good.

 

[aneftp]

Story?

Greed bruh. If u are rusty doing pain and accept major trauma one calls. U get exposed quickly. It’s not one incident. It’s multiple incidents in a short amount of time that exposes u. U can only hide so much on call when u are the last stop. Especially working with young residents.

Some people can fake it daytime hours doing GI preop all day win experienced crnas. Some people get exposed.

 

[GassYous]

Sure. Year over year CMS cuts. Another -2.5% finalized for next year. Im in a private practice setting thats already strained, and every year they keep suffocating us. Its creating staffing problems at this point. We have cut every non-essential corner we can. Im chained to this place 47-48 weeks out of the year. 20-25 days of pto. Now that I have more young kids, I think Id rather go back to bread and butter anesthesia. Make the same if not more money, and take 13+ weeks of vacay per year. Not to mention pain mgmt patients are awful. The nature of the work is awful. Etc. its just heavily disincentivized at this point.

Same problem in anesthesia. Insurance companies refuse to play ball because they have all the power due to the no surprises act while medicare keeps cutting. The good thing for now is that there aren't enough people to do the cases so it's easy to ask for stipends from the hospitals but who knows how long that will last.

 

[TeslaCoil]

Same problem in anesthesia. Insurance companies refuse to play ball because they have all the power due to the no surprises act while medicare keeps cutting. The good thing for now is that there aren't enough people to do the cases so it's easy to ask for stipends from the hospitals but who knows how long that will last.

Yea I get that. But Id rather supervise 3-4 crnas doing routine anesthesia cases all day and take 13 weeks of vacay than supervise 3-4 pain midlevels seeing 8-10 new patients and 70-80 med refills, 70-90 procedures per week with 4-5 weeks vacation and same pay.

 

[Ronin1]

Yea I get that. But Id rather supervise 3-4 crnas doing routine anesthesia cases all day and take 13 weeks of vacay than supervise 3-4 pain midlevels seeing 8-10 new patients and 70-80 med refills, 70-90 procedures per week with 4-5 weeks vacation and same pay.

You would be better off getting a good hood pain job. Easy money. If you can repeat those numbers in HOPD you are a baller plus some

 

[NPJR]

Sure. Year over year CMS cuts. Another -2.5% finalized for next year. Im in a private practice setting thats already strained, and every year they keep suffocating us. Its creating staffing problems at this point. We have cut every non-essential corner we can. Im chained to this place 47-48 weeks out of the year. 20-25 days of pto. Now that I have more young kids, I think Id rather go back to bread and butter anesthesia. Make the same if not more money, and take 13+ weeks of vacay per year. Not to mention pain mgmt patients are awful. The nature of the work is awful. Etc. its just heavily disincentivized at this point.

It must be real bad if you are considering going back into anesthesia after doing pain managment hours. And there is no such thing as bread and butter anesthesia. Things can go south immeditately on any patient and even in when labeled bread and butter anesthesia the patients arent bread and butter

 

[asdfjklmed]

It must be real bad if you are considering going back into anesthesia after doing pain managment hours. And there is no such thing as bread and butter anesthesia. Things can go south immeditately on any patient and even in when labeled bread and butter anesthesia the patients arent bread and butter

Few things here

1. Not sure if you worked in pain management, but "pain management hours" are not as cushy as they sound. Most jobs average 4 weeks vacation. If you are a private practice owner, I imagine it would be tough to allow yourself to take more than 4-6 weeks vacation due to lost income and patients being upset. On any given day when you leave work, you will be hunted down if you forget to refill meds, call back a patient, or some other task. Not even including finishing notes here or other administrative tasks which is another layer of taking work home. Seeing an obscene amount of pain patients 4-5 days a week even if its just for 8 hours in a day will burn you out real quick unless the big $$$ are rolling in.

2. Regarding "things can go south immediately" in bread and butter anesthesia, presumably this is why you did a residency. You are trained well to prevent such scenarios and hence why most day to day anesthesia you dont have patients dying in every case even if they are ASA 3 and 4. I would guess majority of patients in a hospital anesthesia setting average ASA 2-3 so this shouldn't be something "scary" to the average anesthesiologist. Anesthesia for sure has its downsides, but bread and butter cases routinely going south is not realistic for most providers (MD and CRNA).

Not sure why you are trying to scare OP from going back to anesthesia. Do you feel super stressed in every single case you do?
For context: Pain trained, practiced few years and left to do locum anesthesia for all the reasons OP mentioned.

 

[Timeoutofmind]

I do pain
Hospital employed
I only work about 1000 hours a year
Make around $400 an hour
So 400,000
See 23 or so patients a day… whether procedures, or office visits
No mid level supervision
Mostly just bread and butter procedures
Very minimal narcs… only when I feel truly indicated
Never chart outside of work or stay after to chart

It’s pretty golden

My job is good for a hospital employee position but not a unicorn ($69/rvu)

A lot of people get taken advantage of in private practice pain…

 

[NPJR]

Few things here

1. Not sure if you worked in pain management, but "pain management hours" are not as cushy as they sound. Most jobs average 4 weeks vacation. If you are a private practice owner, I imagine it would be tough to allow yourself to take more than 4-6 weeks vacation due to lost income and patients being upset. On any given day when you leave work, you will be hunted down if you forget to refill meds, call back a patient, or some other task. Not even including finishing notes here or other administrative tasks which is another layer of taking work home. Seeing an obscene amount of pain patients 4-5 days a week even if its just for 8 hours in a day will burn you out real quick unless the big $$$ are rolling in.

2. Regarding "things can go south immediately" in bread and butter anesthesia, presumably this is why you did a residency. You are trained well to prevent such scenarios and hence why most day to day anesthesia you dont have patients dying in every case even if they are ASA 3 and 4. I would guess majority of patients in a hospital anesthesia setting average ASA 2-3 so this shouldn't be something "scary" to the average anesthesiologist. Anesthesia for sure has its downsides, but bread and butter cases routinely going south is not realistic for most providers (MD and CRNA).

Not sure why you are trying to scare OP from going back to anesthesia. Do you feel super stressed in every single case you do?
For context: Pain trained, practiced few years and left to do locum anesthesia for all the reasons OP mentioned.

Not tryna scare anyone, Just sayin pain gotta be pretty bad if you are considering coming back to anesthesia and start waking up at the ass cracka dawn to deal with this F***ery.

 

[TeslaCoil]

It must be real bad if you are considering going back into anesthesia after doing pain managment hours. And there is no such thing as bread and butter anesthesia. Things can go south immeditately on any patient and even in when labeled bread and butter anesthesia the patients arent bread and butter

Yaaa. Wasnt born yesterday buddy. Im still a boarded anesthesiologist. I know how fast things can go south. I think most people understand what I mean when I say bread and butter. (regional, ortho, gen surg, healthy peds, OB). As in NOT transplants, hearts, half dead vascular patients.

I wouldn't mind taking call one day a week for the added benefit of additional paid time off.

 

[TeslaCoil]

I do pain
Hospital employed
I only work about 1000 hours a year
Make around $400 an hour
So 400,000
See 23 or so patients a day… whether procedures, or office visits
No mid level supervision
Mostly just bread and butter procedures
Very minimal narcs… only when I feel truly indicated
Never chart outside of work or stay after to chart

It’s pretty golden

My job is good for a hospital employee position but not a unicorn ($69/rvu)

A lot of people get taken advantage of in private practice pain…

yea, this would be my alternative. A hospital job.

Few things here

1. Not sure if you worked in pain management, but "pain management hours" are not as cushy as they sound. Most jobs average 4 weeks vacation. If you are a private practice owner, I imagine it would be tough to allow yourself to take more than 4-6 weeks vacation due to lost income and patients being upset. On any given day when you leave work, you will be hunted down if you forget to refill meds, call back a patient, or some other task. Not even including finishing notes here or other administrative tasks which is another layer of taking work home. Seeing an obscene amount of pain patients 4-5 days a week even if its just for 8 hours in a day will burn you out real quick unless the big $$$ are rolling in.

2. Regarding "things can go south immediately" in bread and butter anesthesia, presumably this is why you did a residency. You are trained well to prevent such scenarios and hence why most day to day anesthesia you dont have patients dying in every case even if they are ASA 3 and 4. I would guess majority of patients in a hospital anesthesia setting average ASA 2-3 so this shouldn't be something "scary" to the average anesthesiologist. Anesthesia for sure has its downsides, but bread and butter cases routinely going south is not realistic for most providers (MD and CRNA).

Not sure why you are trying to scare OP from going back to anesthesia. Do you feel super stressed in every single case you do?
For context: Pain trained, practiced few years and left to do locum anesthesia for all the reasons OP mentioned.

exactly. And thank you!

 

[TeslaCoil]

I do pain
Hospital employed
I only work about 1000 hours a year
Make around $400 an hour
So 400,000
See 23 or so patients a day… whether procedures, or office visits
No mid level supervision
Mostly just bread and butter procedures
Very minimal narcs… only when I feel truly indicated
Never chart outside of work or stay after to chart

It’s pretty golden

My job is good for a hospital employee position but not a unicorn ($69/rvu)

A lot of people get taken advantage of in private practice pain…

btw, what part of the country is this in? and how many days per week are you working vs vacation time? Yea 69/rvu is solid. You can only get that in a hospital. Which is whats sickening. The cards have been stacked so hard against private practice, its sad.

 

[Southpaw]

The cards have been stacked so hard against private practice, its sad.

Indeed. All but the largest private anesthesia practices have lost greatly with IDR and tried desperately to avoid. But insurers have all the power and control since the signing of the NSA as insurers could just cancel contracts if anesthesia groups didn't accept their low ball contract offers. This left anesthesia groups to bill out of network which none wanted to do with IDR/arbitration rules in place. Of course prior to the NSA anesthesia groups LOVED billing out of network because they charged whatever they wanted and insurers generally accepted on behalf of the patient. The NSA hosed private anesthesia groups (who at times were in the wrong pre-NSA).

I can't imagine any smaller private physician practice being able to survive in this environment. All of the power lies with insurance companies and hospitals, thanks both to the ACA and the NSA.

 

[ScarfTheVerb]

I do pain
Hospital employed
I only work about 1000 hours a year
Make around $400 an hour
So 400,000
See 23 or so patients a day… whether procedures, or office visits
No mid level supervision
Mostly just bread and butter procedures
Very minimal narcs… only when I feel truly indicated
Never chart outside of work or stay after to chart

It’s pretty golden

My job is good for a hospital employee position but not a unicorn ($69/rvu)

A lot of people get taken advantage of in private practice pain…

Nice

 

[AKMD_1984]

what about half and half? or 60/40?
solo md anesthesia cases and pain clinic 2 days a week…

 

[Burned_Out]

I would advise the original poster to not give up on pain completely. There has been talk of the locums job market tightening up recently. I am 100% locums and see this with some of my locums colleagues having trouble latching onto new jobs.

When a hospital starts subtracting locums help, they start with the 8 hour people. Then they get rid of the bread & butter anesthesiologists before they move on with the rest. The more skilled you are, the more they want you. This is not to say you aren't an excellent anesthesiologist. But you'll need to relearn how to do peds, ob, vascular and thoracic at some point as the market tightens. Your regional skills must be excellent doing pain, so that's a plus.

 

[Timeoutofmind]

btw, what part of the country is this in? and how many days per week are you working vs vacation time? Yea 69/rvu is solid. You can only get that in a hospital. Which is whats sickening. The cards have been stacked so hard against private practice, its sad.

Midwest

I work 37 weeks a year
Four days a week

 

[AKMD_1984]

i’m curious - teslacoil

just two months ago you were aggressively defending implanting stims and a lot of pain therapies

what changed your mind about going back into anesthesia?

seems more like burnout from speciality than money id say…is it lack of meaningful work?

 

[Hoya11]

i’m curious - teslacoil

just two months ago you were aggressively defending implanting stims and a lot of pain therapies

what changed your mind about going back into anesthesia?

seems more like burnout from speciality than money id say…is it lack of meaningful work?

Maybe tired of the responsibilities of being a surgeon

 

[TeslaCoil]

i’m curious - teslacoil

just two months ago you were aggressively defending implanting stims and a lot of pain therapies

what changed your mind about going back into anesthesia?

seems more like burnout from speciality than money id say…is it lack of meaningful work?

That was a lot longer ago than that. I dont hate pain. But Im kind of starting to see the writing on the wall. And again, Im trying to find ways to stay home with the kids more. Tired of the 5 day work week 47-48 weeks per year.

 

[sloh]

That was a lot longer ago than that. I dont hate pain. But Im kind of starting to see the writing on the wall. And again, Im trying to find ways to stay home with the kids more. Tired of the 5 day work week 47-48 weeks per year.

Really respect you for being truthful about pain considering your past posts. Thanks

 

[Maz777]

I would not recommend taking a supervision locums gig. You'll need to do your own cases to actually feel competent again. When a CRNA you don't know inevitably gets into trouble, your movements need to be reflexive. That is not the time to be worrying about the basics.

 

[Alpamayo]

Anybody have any experience with these programs for re-entering anesthesia practice? I'm considering getting back into locums or maybe even a permanent return after 5 years of practicing pain mgmt. Any info would be much appreciated.

Anesthesiology Re-entry Program

www.asahq.org

TeslaCoil -

You do NOT need to go through a re-entry program. You DO need a bit of luck, be flexible, build relationships, and move slowly to get your skills back and not put patients at risk, in addition to be willing to take a financial hit (initially) to build your future.

I am doubled boarded in both pain and anesthesia. I did pain exclusively for ~15 years before transitioning back into anesthesia ~ 4 years ago. I had done ok in pain and have no particular ax to grind. But for the usual reasons cited in other threads, it was time to get out. I spoke with several anesthesia re-entry programs. They were either too far from home or charged thousands of $ (with no guarantee of employment) that it made no sense.

At the time, I was new to the area and did not have many professional contacts. I cold-called anesthesia practices, walked up to the surgical desk at some hospitals to meet with the anesthesia board runner. Eventually one group agreed to have lunch, and we hit it off. They let me do proctored cases (not paid) to establish a critical mass of general OR cases to apply for privileges. I was credentialed in around 3 months (and practiced pain part-time to keep some $ coming in). From there I worked PRN for the group anywhere from 8 - 24 hrs per week, and still did the part-time pain gig as the clinic volume dictated. I made it a point to introduce myself to the anesthesiologists, AAs, CRNAs .... all of them were incredibly professional and generous in helping me get up to speed. I was initially assigned bread and butter cases, and if I ran into trouble, there was always a partner to help out. My full capacity / reaction time of general OR skills returned over a couple of months, I took a NYSORA course to update my regional U-S skills, and I began doing L&D epidurals and C-sections. After a year I left pain altogether and hired on as an associate with the anesthesia group full-time. While there are the usual headaches as with ANY pain or anesthesia job, I am the happier now than I ever have been in my entire career.

I have had conversations with several former pain colleagues who want to go back into anesthesia - some part-time, some full. They too have been discouraged by the lack of great options afforded by re-entry programs. Others have gone back into anesthesia via the locums route or working part-time in an ASC (having not done a general anesthesia case in years). They have had a difficult time as their skills and speed have atrophied. If you can find an anesthesia group that can provide proctoring / mentoring for the first couple of months, and from there you can figure out if you want a split pain vs anesthesia schedule (or go full-anesthesia) that would be the ideal scenario. Given the shortage of anesthesiologists in the US, you'd be surprised at what opportunities exist if you put yourself out there.

 

[TeslaCoil]

TeslaCoil -

You do NOT need to go through a re-entry program. You DO need a bit of luck, be flexible, build relationships, and move slowly to get your skills back and not put patients at risk, in addition to be willing to take a financial hit (initially) to build your future.

I am doubled boarded in both pain and anesthesia. I did pain exclusively for ~15 years before transitioning back into anesthesia ~ 4 years ago. I had done ok in pain and have no particular ax to grind. But for the usual reasons cited in other threads, it was time to get out. I spoke with several anesthesia re-entry programs. They were either too far from home or charged thousands of $ (with no guarantee of employment) that it made no sense.

At the time, I was new to the area and did not have many professional contacts. I cold-called anesthesia practices, walked up to the surgical desk at some hospitals to meet with the anesthesia board runner. Eventually one group agreed to have lunch, and we hit it off. They let me do proctored cases (not paid) to establish a critical mass of general OR cases to apply for privileges. I was credentialed in around 3 months (and practiced pain part-time to keep some $ coming in). From there I worked PRN for the group anywhere from 8 - 24 hrs per week, and still did the part-time pain gig as the clinic volume dictated. I made it a point to introduce myself to the anesthesiologists, AAs, CRNAs .... all of them were incredibly professional and generous in helping me get up to speed. I was initially assigned bread and butter cases, and if I ran into trouble, there was always a partner to help out. My full capacity / reaction time of general OR skills returned over a couple of months, I took a NYSORA course to update my regional U-S skills, and I began doing L&D epidurals and C-sections. After a year I left pain altogether and hired on as an associate with the anesthesia group full-time. While there are the usual headaches as with ANY pain or anesthesia job, I am the happier now than I ever have been in my entire career.

I have had conversations with several former pain colleagues who want to go back into anesthesia - some part-time, some full. They too have been discouraged by the lack of great options afforded by re-entry programs. Others have gone back into anesthesia via the locums route or working part-time in an ASC (having not done a general anesthesia case in years). They have had a difficult time as their skills and speed have atrophied. If you can find an anesthesia group that can provide proctoring / mentoring for the first couple of months, and from there you can figure out if you want a split pain vs anesthesia schedule (or go full-anesthesia) that would be the ideal scenario. Given the shortage of anesthesiologists in the US, you'd be surprised at what opportunities exist if you put yourself out there.

Thank you for your thoughtful and encouraging advice. I will keep all of that in mind.