Anesthesia Staffing Plan with Physicians Only

Discussion in 'Anesthesiology' started by militarymd, Dec 2, 2005.

  1. militarymd

    militarymd SDN Angel
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    Ok, so enough of the fighting on the internet. My wife told me that fighting on the internet is like the special olympics....it doesn't matter who wins or who gets the last word....you're all still ******ed.

    So clearly there is sentiment from the students/residents/more junior staff that:

    1) physician only anesthesia care is superior
    2) there is a "fight" for the profession underway where we need to get rid of the physician extenders.
    3) that this is so important that we should take less money to prevent the anesthesia team model.

    I will say that I disagree with all of the above. I have seen anesthesia practices across the country and in the military, and I just don't think any of the above is accurate.

    So, here is my question to all you folks who want to get rid of the anesthesia care team.

    How do you plan on staffing all the anesthetizing locations that exist and are going to increase over the next 10 years?????

    I would like to hear your plans beyond ....I'm going to a meeting to tell my story.

    I would like to hear concrete solution.

    Here is the solution to my practice, and if I and my partners wanted to, could be implemented with full support from the hospital administration and surgeons.

    1) fire all the CRNAs...they're hospital employees anyways, so it will be great for the hospital

    2) hire anesthesiologists to sit on all the stools

    3) Average income would be around 100,000 per year before taxes..this includes benefits (malpr, 401k, disabilit, etc.)....so gross would be around 170,000 per year.

    I've been in the military for the last 11 years, and I made more than that.

    Any of you residents who feel so strongly about MD only willing to take this deal???? Everyone gets paid the same, no partnership track....everyone partner from day one.
     
  2. jwk

    jwk CAA, ASA-PAC Contributor
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    Ahhhh, the voice of real-world experience and common sense... :thumbup:
     
  3. davvid2700

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    YOu live to torture me..


    I got to get out of here and hit the gym and some weights and get back to you when im fueled..

    I work for an all md practice. We have like 15 docs with 3 people off everyday. and i make mid- high 200's.. I dont know where you are getting your 100K figure.
     
  4. Noyac

    Noyac ASA Member
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    I have been a part of both models. I was in a large "Team" model b/4 joining my current group w/c is a 5 member MD only group. I see benefits to both. First of all, the team model makes more money, and can be more effeicient. You can have nurses and AA's do everything while you run around all day putting out fires, doing pre-ops, blocks, consults, etc. This model leads to a very busy day, as Mil has described before. It also allows for some people to hide and do nothing. The MD only model has less headache by far and is a much slower pace all while making less $$. I took a small pay cut to come to my current job (definitely not starving). I don't mind b/c I live exactly where I want to live. In order to make this MD only model attractive at all we need to be hosp. employees. Otherwise, we wouldn't make squat. The hosp. approached me and my partners about hiring nurses for our soon to open surgery center. We showed them that it would have been just as costly to hire 2-3 nurses as it would to hire 1 more MD and put an MD in every room. And nurses can't take call so more burden on the MD's. So in team models you tend to do more call cause there are less MD's to share it.

    I am in a semi rural area. Local trauma center and all services provided except heads. I think that there is the oportunity to get MD's to go to rural areas but it is only going to be as hosp. employees as far as I can tell. This is not a bad deal if you work it out right. I think as I have said b/4 that physician extenders are here to stay. However, their roles can be controlled somewhat if we are smart about it. I am not for indepence whatsoever. I gotta say the care in my current job is better than my previous job (don't mean to offend some of you). So IMHO, if you want to go to a MD only practice in a smaller town then youare goingto be a hosp. employee most likely. This is not a bad gig but your hosp. has to understand what services you are bringingto their facility and then they will pay accordingly.
    Gotta cut it short for now.
     
  5. militarymd

    militarymd SDN Angel
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    You torture me in return...so we're even.. :D


    Payer demographics, insurance reimburse, type of insurance, and OR efficiency all factor into the income.

    For my hospital, because of its inefficiency (surgeons with 2 rooms, etc.), the total revenue generated per anesthetizing location is very low despite high private insurance rates.

    Based on the revenue that we generate right now, and dividing it into the increased number of MDs that we would need yields the figure that I quoted.....a figure lower than what I made in the Navy, while working longer hours....not harder, because of the down time between cases.

    The surgeons WOULD NOT support the all MD model if it met they lost their second room, so if we go all MD, we wind up making the quoted figure.

    The surgeons feel that CRNAs sitting in the room is fine.....outcome here in the last 10 years....nothing bad...everyone goes home fine...so that's what I have.

    100,000 does not include benefits....gross IS 170,000 and change..if your figure includes benefits then it would be similar to pay here, but I suspect your gross is 300,000+.....right? mid 200's plus benefits.
     
  6. militarymd

    militarymd SDN Angel
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    Noyac,

    I'm not sure why, but some hospitals are not willing to have physicians for employees....Some will, but ours definitely will do anything to not have employee physicians.

    A number of hospitals are currently changing their employees to independent contractor status...meaning they have to bill for their own services...meaning...significant decrease in $$$

    Loveless (sp?) in Alburqurque , NM is doing that....I've run across at least one other hospital in the last year that did that....leaving all MD groups making my quoted figures.
     
  7. Noyac

    Noyac ASA Member
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    Yeah, my hosp. did not want to employ Physicains either. Then they figured it out. They can either hire the MD's or pay them a stipend to make up the difference. Otherwise, no anesthesia. They could theoretically go with an all nurse staff for anesthesia services but as you know they will not have many services provided if there are not any MD's and the others (hospitalists, surgeons, etc.) would have to take on the burdens of not having anesthesiologists. The other physicians wanted MD anesthesia and the hosp. had to oblige(?). recently, it was reported that hospals are paying stipends to a larger portion of anesthesia groups around the country. I think it was more than 70% (but don't quote me) of the groups were receiving a stipend from their hosp. Some of these stipends were, as you hosp. does, hiring crna's for your group to supervise and bill for (not sure if you bill for them). To comment on your last line "leaving all MD's making my quoted figures." The hosp's will only get the lesser skilled MD for that salary and the occassional person that really wants to live there. My hosp. had to up the ante to get the group we have now. Interesting times in anesthesia for sure.
     
  8. toughlife

    toughlife Resident
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    I'd take 170K a year.
     
  9. thegasman

    thegasman ASA Member
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    I personally think that anesthesia care team in its ideal form as we anesthesiologists see it is a great way to practice. But if you are supervising a CRNA, you are ultimately responsible for the outcome. And how many hotshot CRNA/SRNA have we seen on here who think they are better/know better than we are. Can we trust them to do the right thing? I've seen and heard of CRNAs doing whatever they want when the attending is not around in contradiction to instructions. I've also seen a lot of CRNAs who are slack and give substandard care (CRNA says "oh we don't need to have LMAs on hand for backup, I know I can intubate this kid")---some residents and other MDs are this way too - but to me the most concerning thing is having responsibility for direction of a case where someone else is providing the anesthetic---how do I know they are doing a good job and not in there just f***ing things up. The CRNAs often resent the attendings too, they say hey we are doing all the work, they are getting the respect and the money, what do we need them for we could do this by ourselves. Anesthesia care team? It only works in my mind if everyone is on board. Don't get me wrong -- I have seen some great CRNAs who work well with MDs, (and some crappy MDs too), but the idea is only good if both parties do what they should and have their minds right.
     
  10. nitecap

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    According to both Medical and Nurse Practice acts, If you are a MD and Supervising a CRNA. And that CRNA is belived to be competent in both your eyes, eyes of your associates, of expert witnesses. And that CRNA makes a call when you are out of the room, without consulting anyone and it is within their scope of practice stated in the Nursing practice act as well as AANA standards of care, and that judgement call harms the patient then that MD is not liable for an independent judgement made by the presumed to be competent CRNA.

    Now if a great personally injury lawyer spins the law ans facts then I suppose anything is possible, Im just saying legally thats what both practice acts state. Thats what they teach me in school (crna). Thats what I read in the Texas occupations code and texas administration code.
     
  11. jetproppilot

    jetproppilot Turboprop Driver
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    THEGASMAN,

    welcome to SDN anesthesia.

    We are looking forward to more of your intuitive posts.
     
  12. jetproppilot

    jetproppilot Turboprop Driver
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    Nitecap,

    If you project your obviously (sometimes) knowledgable mindset in the right fashion, you will make a great contribution to the anesthesia realm.

    You will contribute to our profession, and you will make a great living for yourself, commensurate to your personal sacrifice.

    Heres my advice. And I know you will resent it, but I'm gonna give it to you anyway.

    Anesthesiologists are the czars of anesthesia. We struggled, stressed, lost relationships, put everything on hold...

    in order to get accepted to medical school. We survived the acceptance onslaught.

    And finished medical school, four years of our lives sacrificed to learn physiology and pathophysiolgy.

    Then we went to residency.

    We were slaves for four years.

    All along, though, we learned our craft.

    Not in a protocol-based-reaction-realm, but in a I'm-doing-this-because-of-that realm.

    Our knowledge base is on a different level than yours.

    We emerged from residency ready to practice medicine .....which is different than putting the tube in, turning the sevo dial counterclockwise to the desired level, and sitting down to start your chart.

    We start cases, and cancel cases. We initiate regional anesthesia, and refuse regional anesthesia.

    We look at an INR different than you. An INR of 1.3 may be OK for regional, if we say so.

    Accept this, do your part, and you will succeed.

    You are not trained to practice medicine.

    We are.
     
  13. nitecap

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    Not taking anything the wrong way. I respect your training as well and knowledge and any sacrafices you have made along the way.

    I understand, accept, and respect that your scope of practice will always be greater than mine and that is not at all a botherson to me. I do believe how ever that I am intellegent and can learn what you do.

    For instance lets say this super smart guy gets into medschool thinking orthopedic surgery all the way because his uncle does that. And maybe he had a lot of crap, personal issues to deal with and screwed up a few blocks and bombed a few tests. Not because he couldnt, just because he didnt make the grade. So he only matches with IM and is totally displeased, because he knows he is as intelligent as the guy who got the ortho match. So what, could this guy not be a great surgeon after that intense training that surgeons get. After ten years of training could this guys not be bright surgeon.

    Like I said man I respect your knowledge, experience ect, and not shiznit talking at all believe me. I just believe that sometimes you guys try to rank and assess intellegence and brilliance on test scores and torture/painful ordeals that you were subjected to in residency. Just because you took a certain test and did better on it than the guy next to you doesnt mean that that guy isnt as bright, doesnt mean he has a lesser IQ, doesnt mean he cant be just as successful as you, and doesnt mean he cant do something and get the same good outcome.

    CRNA's in the rural arena make non protocol descisions based on great experience everyday JPP. It seems as though you work with more of the complainsent not to say lazy, but I guess just not that motivated CRNA's. maybe older ones, not sure.

    If the Czar status/title is what you desire than you can rightfully have it, I will just be that soldier in the field leading my team, family, community, coworkers to brighter outcomes and hopefully futures.
     
  14. jetproppilot

    jetproppilot Turboprop Driver
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    First of all, Mil, I commend you.

    Posting "My wife told me..." shows that you are a dedicated husband and father. Congrats on being able to see through this era's temporary-family view. Sounds like you wont be a victim of the greater-than-50% divorce rate in the US, which leaves helpless kids hopelessly stranded.

    Secondly, I cant come to your group for 100K.

    Or 200k.

    Or 300K.

    Sorry.
     
  15. jetproppilot

    jetproppilot Turboprop Driver
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    OH NO, bro.

    CZAR status is beyond unimportant to me. My 2 year old's peace/security/happiness means more to me than any stupidass job.

    But reality is reality. I am a doctor, and you are a nurse.

    When I was 24 years old, I picked my profession.

    When you were X years old, you picked yours.

    Lets not gray the lines here.
     
  16. nitecap

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    hello, why are you looking at my posts.
     
  17. davvid2700

    davvid2700 Membership Revoked
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    what do YOU think the outcome of the research would be?
     
  18. nitecap

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    you guys are weak, I would crush you head to head no digity no doubt
     
  19. davvid2700

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    Dude you talk way too much "s h i t" for someone who hasnt even finished one year in crna.. They must be teaching you some serious stuff at "Baylor".
    Maybe I should call over there and talk to the chairwoman Lydia something or another is it conlay and ask her how crnas in her department can be disrespecting the knowledge of physicians. Its funny I have a friend over there and one at ben taub, IS today friday, well maybe i will wait til monday to call my friend to find out who you are. and if you are as awesome as you think you are.
     
  20. davvid2700

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    hey is the search button working? Ill get ahold of your posts.. print those bad boys up and send it in to lydia et al....
     
  21. davvid2700

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    maybe i should just get ask my friends to forward the posts to james "jimmy" walker.. he is the director isnt he?
     
  22. nitecap

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    the glock is hot
     
  23. nitecap

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    A great director at that, best in the country Id atest.
     
  24. nitecap

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  25. davvid2700

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    Dude say i wont do it.. say it.. cmon.. call me a p u s sy once more.. I will call you out!.. I dont need to know who you are! Ill just print out all of your b u l l s h i t and send it to them.. Maybe ill make several copies..
     
  26. davvid2700

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    they will figure out who you are ... maybe you WILL be working in podunk oklahoma after they find out how you really feel.. Houston is a small anesthesia community as you well know
     
  27. nitecap

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    gas gas gas
     
  28. jetproppilot

    jetproppilot Turboprop Driver
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    Anyone adversely affecting someone elses career based on an internet forum exchange needs to find a hobby.
     
  29. jetproppilot

    jetproppilot Turboprop Driver
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    David,

    I dont know you, and you dont know me.

    But your threats of adversely affecting someone else's career is over the edge.

    Pissed off?

    Great. I respect that. Tell the dude to go f uck himself, or whatever you feel necessary for catharsis.

    But threatening with letters, email, etc is pansy ass b ull****.

    Step down on that s hit.
     
  30. davvid2700

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    Listen, im not gonna do it..

    one more of your b u l l s h i t comments Im gonna do it. I think the program directors over at Baylor COLLEGE OF MEDICINE anesthesia department and over at ben taub general should know that they are training a crna who has absolutely no respect for the mds.That is not a safe thing. IF you wanna play that s h i t go into practice in montana. DOnt play that when you are training at a world class institution learning from world class physicians.. I think an apology is in order not for me but for everyone who worked as hard as they did on this board to have somone like you belittle their accomplishments and achievements with your rhetoric.

    Be careful with your response
     
  31. jetproppilot

    jetproppilot Turboprop Driver
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    Again, bro, you are crossing the line with your tantalizing rhetoric.

    You're using below-the-belt tactics.
     
  32. davvid2700

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    dude he was asking for it. You think I enjoy doing that kind of s h i t. I still got your number nitecap.. Have a good night
     
  33. davvid2700

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    and we're waiting for some kind words from you.. That is if you decide to come back and play with us. since we dont have social skills
     
  34. jetproppilot

    jetproppilot Turboprop Driver
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    I've been where you are when it comes to your emotional/anger levels with a poster you adamantly disagree with.

    Just keep your opinions on the forum.
     
  35. nitecap

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    yeap yeap
     
  36. militarymd

    militarymd SDN Angel
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    I believe that 's my point of this thread.
     
  37. Noyac

    Noyac ASA Member
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    I think Mil's wife is the smartest person in the WORLD!!!!!
     
  38. davvid2700

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    Your propaganda is all bull****. go look back at your posts about "telling residents how to study" and "be a man" b u l l s h i t". all of a sudden when i call you out on it you cower down "as you should" and say " well i never said I was better than an MD". Yes you did . Not only that you were putting down my education and training and sacrifice along with those of the other people on this board who are attendings or working very hard towards that end. I want every trainee on this board to have the right information and you are spouting b u l l s h i t. giving out false information. "talking out of your a s s h o le" Listen I do know where you are training. I dont have any personal information on you. So it cannot be slander or liable. plus im not gonna say anything bad about you. "The thing speaks for itself" All i have to do is forward all the posts to teh appropriate people at baylor and they will find out who you are. I have freinds there. I know 2 people on this board that are interviewing there in the near future. Probably not that hard. SO i ask you the same question that you ask me ? do you want things to get ugly? Put all this stuff on a scale and figure out what weighs more. Whats important to you? What you want in the future? You dont need to be explaining yourself to anybody. And although this board is anonymous you should not be going out of your way to piss people off. only a kid does this.. so be careful, get your scale out put all the stuff i have told you on the scale and figure out what is important!!!
     
  39. jetproppilot

    jetproppilot Turboprop Driver
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    And I know that you knew that I knew.... :laugh:
     
  40. jwk

    jwk CAA, ASA-PAC Contributor
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    David and nitecap - y'all need to GET A FRIGGIN' GRIP!!!
     
  41. nitecap

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    yeah well
     
  42. threepeas

    threepeas Senior Member
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    i was an ER PA before going to medschool and am very interested in anesthesiology. I was one of the more accomplished PAs in my field. I worked in trauma surgery/ critical care before going to ER. I did at least 1500 invasive procedures in the ICU before going to the ER. I had alot of frustration in the ER because although not nearly as well trained I had better common sense and judgement than 1/3 of the docs, i was exceptional with my hands and doing what was best for the patient. Even though I had alot of confidence and picked up the basics very well, I felt I "created" good luck more than "practiced" good medicine. When I made a mistake the doc is the one who took the heat too. I felt guilty about this. I wanted to take full responsibility for my actions so I made the committment to go to medschool and drag my wife and 3 kids with me. The ER is a similar environment as anesthesia because of the inherent badness that can occur at any moment and this is a volatile environment for physician extenders to work in. An ER doc once told me two things that I believe ring true. physician extenders are by definition lazy compared to docs because they took the easiest road. they trained for two years instead of 8. i didnt want to admit it at the time but i believe it is true except that it is not true laziness but a difference in level of committment. it is the difference between a true professional who is dedicated to the field, research and society at large and takes personal responsibility when the **** hits the fan versus being a worker bee (although potentially a good one that is needed). second, physician extenders are excellent when the scope of practice is narrow such as occurs in walkin clinic medicine or doing a procedure that anyone with skill can be trained to do. what makes MDs special is their ability to deal with situations that have a wide variety of possibilities. the moral of my story is this. our health care system needs physician extenders, but their limits must be known. as a PA it is pounded into us that we are "dependent" practicioners. i dont think CRNAs and NPs have this humble attitude. they entered the frey through political measures but their role really makes no logical sense medically(take a nurse, give them minimal [2years] training, and say they can practice medicine). and worse they are constently trying to push the envelope to full independence. this is what annoys me and probally others. A PA knows his place and therefore is not a threat. CRNAs/NPs create an adversive atmosphere b/c they are politically/medically trying to manipulate things to gain more power and independence. i believe they are trying to cheat the system. so MDs job should not be to get rid of physician extenders, but to keep them in their place based on their training and experience. promote anesthesiology assistants, and redefine the role of NP/CRNAs to be clear they are "dependent" practicioners. if the physician extender wants more independence go to medschool and make the sacrifice.
     
  43. toughlife

    toughlife Resident
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    Amen brother!
     
  44. davvid2700

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    amen again. I applaud you for making the committment and dedication to your field. thank you for your insight and i look forward to hearing other insightful posts..
     
  45. davvid2700

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    Why are you still spouting? Monday is 2 days away. I have a fax machine and address. and motivation and a printer Do you want the program director at baylor wondering who this is a Srna talking "smack" You do not want that reputation at your level.(thats a statement) Trust me you dont. Just eat your "humble ass pie" and I will drop the issue. Thank you very much. And if you wanna be able to talk "s H i t" like the captain go to captain school and you can talk as much s h i t as you want and I will pat you on the back and say GO MAN>
     
  46. jwk

    jwk CAA, ASA-PAC Contributor
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    just like two little kids.......
     
  47. apma77

    apma77 Senior Member
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    another great MD vs CRNA debate............guys spare me the BS and talk about something that hasnt been grinded over n over

    yes..all you CRNAs out there you have more knowledge than MDs ..now go away and leave us alone :eek:
     
  48. militarymd

    militarymd SDN Angel
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    Actually, I started to ask those who would have no CRNAs around about how they would staff all the anesthetizing locations that are out there...and will increase over the next 10 years.
     
  49. militarymd

    militarymd SDN Angel
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    Yeah, she looked over my shoulder, and then called us all ******s as she walked out of my office.
     
  50. nitecap

    nitecap Membership Revoked
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    dvid2007 has been a ghost since I punked him out
     

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