Anesthesiologist position in Bismarck, ND

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zevilempire

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Our group is looking to hire a couple of Anesthesiologists (fellows and residents welcome) to replace a partner that is leaving to be closer to family and growth.

A little bit about the group, we do ACT model. Medical direction for all cases except CPB cases. Physicians do all epidurals.

Pay is $600k+ at 90th percentile.
9 weeks vacation. Post call day off and Weekend comp days.

Cases- broad variety from healthy kids to bread and butter hearts. No transplants.

Should he comfortable doing hearts and TEE. Fellowship not required.

Please feel to PM or email me at [email protected]
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zevilempire said:
Our group is looking to hire a couple of Anesthesiologists (fellows and residents welcome) to replace a partner that is leaving to be closer to family and growth.

A little bit about the group, we do ACT model. Medical direction for all cases except CPB cases. Physicians do all epidurals.

Pay is $600k+ at 90th percentile.
9 weeks vacation. Post call day off and Weekend comp days.

Cases- broad variety from healthy kids to bread and butter hearts. No transplants.

Should he comfortable doing hearts and TEE. Fellowship not required.

Please feel to PM or email me at [email protected]
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Why do physicians do all the epidurals? I am working in a place like this now and it blows.
My ideal job?? No damn OB doing my own cases. Second ideal job, the CRNAs handle all the epidurals.
 
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I just got called for a damn epidural. I hate this crap.
 
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makemoney2024 said:
Why do physicians do all the epidurals? I am working in a place like this now and it blows.
My ideal job?? No damn OB doing my own cases. Second ideal job, the CRNAs handle all the epidurals.
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It’s how the group was structured from inception. It’s a necessary evil. Can’t say it’s my favorite. But I knew what I was signing up for when I took the job. In this hot anesthesia market, you can find another job if you hate epidurals that much. Life is short. Don’t be miserable when you have choices
 
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Epidurals + Bismarck, ND = $1 million. Even at that compensation I would find it very, very hard to work there.
 
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zevilempire said:
It’s how the group was structured from inception. It’s a necessary evil. Can’t say it’s my favorite. But I knew what I was signing up for when I took the job. In this hot anesthesia market, you can find another job if you hate epidurals that much. Life is short. Don’t be miserable when you have choices
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It’s locums and I make good money and I like the CRNAs so I stay. Looking for something closer to home though
 
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zevilempire said:
Our group is looking to hire a couple of Anesthesiologists (fellows and residents welcome) to replace a partner that is leaving to be closer to family and growth.

A little bit about the group, we do ACT model. Medical direction for all cases except CPB cases. Physicians do all epidurals.

Pay is $600k+ at 90th percentile.
9 weeks vacation. Post call day off and Weekend comp days.

Cases- broad variety from healthy kids to bread and butter hearts. No transplants.

Should he comfortable doing hearts and TEE. Fellowship not required.

Please feel to PM or email me at [email protected]
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Pardon my ignorance but what exactly are weekend comp days?
 
Must be a Superman partner who requires several anesthesiologists to replace him.
 
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Another day of OB CSection and Epidural Hell. The icing on the cake being dingus husbands who need to learn to STFU instead of thinking they can just bully doctors like they do their wives. Because what happens then is I leave the room due to patient now playing into that damn negative energy and doing a shotty job of cooperating while feeding into that energy. Want another hospital? Please go ahead and go. An epidural is an elective procedure.

Too bad it’s the wife who suffers here and probably at home.

I need a new gig without OB.
 
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makemoney2024 said:
Another day of OB CSection and Epidural Hell. The icing on the cake being dingus husbands who need to learn to STFU instead of thinking they can just bully doctors like they do their wives. Because what happens then is I leave the room due to patient now playing into that damn negative energy and doing a shotty job of cooperating while feeding into that energy. Want another hospital? Please go ahead and go. An epidural is an elective procedure.

Too bad it’s the wife who suffers here and probably at home.

I need a new gig without OB.
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Interesting. We have all family leave the room for epidural placement. The excuse is that it is a sterile procedure.
 
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makemoney2024 said:
Another day of OB CSection and Epidural Hell. The icing on the cake being dingus husbands who need to learn to STFU instead of thinking they can just bully doctors like they do their wives. Because what happens then is I leave the room due to patient now playing into that damn negative energy and doing a shotty job of cooperating while feeding into that energy. Want another hospital? Please go ahead and go. An epidural is an elective procedure.

Too bad it’s the wife who suffers here and probably at home.

I need a new gig without OB.
Click to expand...

What was the husband saying?
 
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sevo00 said:
What was the husband saying?
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Dumb ****. Should have gone to the other hospital. Heck I didn't even know the other hospital is an actual hospital because it looks like a clinic unless they mean the one that is 80 miles away. And "Can you get someone else to do it?" After I had been trying for all of 3-4 minutes. MotherF.... NO!! We are all tied up and your woman is a G2 who walked in at 8 CM and she's writhing in bed and can't stay still or position.
Anyway the woman (child all of 18 BTW) kept apologizing the kind of apology like "I am sorry about my man being an ass", and "I am sorry I couldn't cooperate". My colleague came up within 10 minutes but it was too late. Would have gotten it if dingus hadn't been there as I would have stuck another level. But the seed was planted in her head and she was too damn tense.

The other one wanted special permission from the OB to be in the OBSuite before the pinch test because he didn't like how the last stat C Section went that required GA. Like he was gonna get preferential treatment. dingus looked at me literally saying "are you sure?? Are you sure??" And I said, these are the rules and protocols for a reason and I don't need you in there freaking out if everything does't go perfectly and then making your wife panic. These are the ****ing rules. Ain't no way he would have talked to a man like that. As I was walking away he says "Well I can start yelling at everyone like I did last time". I promptly told the OB to go tell him to calm the **** down.

American patients and family members are so ****ing entitled and rude as hell.

I have seen social media of people who've moved to work overseas and they say it's ****ing heaven compared to this cluster full of too many jerks who don't appreciate jack.
 
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makemoney2024 said:
Dumb ****. Should have gone to the other hospital. Heck I didn't even know the other hospital is an actual hospital because it looks like a clinic unless they mean the one that is 80 miles away. And "Can you get someone else to do it?" After I had been trying for all of 3-4 minutes. MotherF.... NO!! We are all tied up and your woman is a G2 who walked in at 8 CM and she's writhing in bed and can't stay still or position.
Anyway the woman (child all of 18 BTW) kept apologizing the kind of apology like "I am sorry about my man being an ass", and "I am sorry I couldn't cooperate". My colleague came up within 10 minutes but it was too late. Would have gotten it if dingus hadn't been there as I would have stuck another level. But the seed was planted in her head and she was too damn tense.

The other one wanted special permission from the OB to be in the OBSuite before the pinch test because he didn't like how the last stat C Section went that required GA. Like he was gonna get preferential treatment. dingus looked at me literally saying "are you sure?? Are you sure??" And I said, these are the rules and protocols for a reason and I don't need you in there freaking out if everything does't go perfectly and then making your wife panic. These are the ****ing rules. Ain't no way he would have talked to a man like that. As I was walking away he says "Well I can start yelling at everyone like I did last time". I promptly told the OB to go tell him to calm the **** down.

American patients and family members are so ****ing entitled and rude as hell.

I have seen social media of people who've moved to work overseas and they say it's ****ing heaven compared to this cluster full of too many jerks who don't appreciate jack.
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lol chocomorsel
 
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makemoney2024 said:
Dumb ****. Should have gone to the other hospital. Heck I didn't even know the other hospital is an actual hospital because it looks like a clinic unless they mean the one that is 80 miles away. And "Can you get someone else to do it?" After I had been trying for all of 3-4 minutes. MotherF.... NO!! We are all tied up and your woman is a G2 who walked in at 8 CM and she's writhing in bed and can't stay still or position.
Anyway the woman (child all of 18 BTW) kept apologizing the kind of apology like "I am sorry about my man being an ass", and "I am sorry I couldn't cooperate". My colleague came up within 10 minutes but it was too late. Would have gotten it if dingus hadn't been there as I would have stuck another level. But the seed was planted in her head and she was too damn tense.

The other one wanted special permission from the OB to be in the OBSuite before the pinch test because he didn't like how the last stat C Section went that required GA. Like he was gonna get preferential treatment. dingus looked at me literally saying "are you sure?? Are you sure??" And I said, these are the rules and protocols for a reason and I don't need you in there freaking out if everything does't go perfectly and then making your wife panic. These are the ****ing rules. Ain't no way he would have talked to a man like that. As I was walking away he says "Well I can start yelling at everyone like I did last time". I promptly told the OB to go tell him to calm the **** down.

American patients and family members are so ****ing entitled and rude as hell.

I have seen social media of people who've moved to work overseas and they say it's ****ing heaven compared to this cluster full of too many jerks who don't appreciate jack.
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Yeah I think the only way to win on the LD floor is to calmly stand your ground. It’s an exhausting place…I had a RN try to dissuade a pdph patient who absolutely didn’t want a patch from getting a sphenopalatine ganglion block because “those never work”. Took a lot for me to not lose it on her for undermining a very reasonable therapeutic strategy all because she knew better.

Ive had some FOBs become angry toward me if the epidural doesn’t go in instantly and that’s always pleasant. Only needed to call security once…

Unfortunately Americans want to have it their way, whether that be in the OB suite or Burger King drive through. But fortunately where I practice most patients are appreciative of what I offer them.
 
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makemoney2024 said:
I like it!! Every hospital is different and I have been at some like these.
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At my old gig we said one support person for epidural placement. Usually spouse or patient’s mother. Sometimes the private doula. We had a small group of hospital employed doulas, they didn’t count against the cap. They played ball well if we got involved.
 
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CopaceticOne said:
Interesting. We have all family leave the room for epidural placement. The excuse is that it is a sterile procedure.
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I've heard too many stories of husbands fainting and hitting their head when they see the needle that I wouldn't allow them in the room.
 
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GassYous said:
I've heard too many stories of husbands fainting and hitting their head when they see the needle that I wouldn't allow them in the room.
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Same. If the husband balks I say "fine...no epidural" and start walking out. Nearly 100% of the time they comply.
 
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GassYous said:
I've heard too many stories of husbands fainting and hitting their head when they see the needle that I wouldn't allow them in the room.
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NicholasPavona said:
Same. If the husband balks I say "fine...no epidural" and start walking out. Nearly 100% of the time they comply.
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I simply stopped doing them with family members in the room.
Too many times, I catch them trying to take photos or film me performing the epidural, no doubt to use later for whatever reason.
Now I simply say its too much of an infection risk. Either they wait outside or it doesn't get done. You'd be surprised how quickly the patient gets on your side when they hear 'no epidural in a crowded room'
 
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I let one person stay but they sit the f down. I also sedate the mommie if I need too- thankfully the culture on the l and d floor where I am now is reasonable. 50-100 of fentanyl really helps to calm down and hold still. If she’s really freaking out - versed. Makes for such a better experience for us all.
 
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amyl said:
I let one person stay but they sit the f down. I also sedate the mommie if I need too- thankfully the culture on the l and d floor where I am now is reasonable. 50-100 of fentanyl really helps to calm down and hold still. If she’s really freaking out - versed. Makes for such a better experience for us all.
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Interesting, we NEVER give versed to pregnant patients here.
 
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amyl said:
I let one person stay but they sit the f down. I also sedate the mommie if I need too- thankfully the culture on the l and d floor where I am now is reasonable. 50-100 of fentanyl really helps to calm down and hold still. If she’s really freaking out - versed. Makes for such a better experience for us all.
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This sounds ridiculous.
 
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amyl said:
I let one person stay but they sit the f down. I also sedate the mommie if I need too- thankfully the culture on the l and d floor where I am now is reasonable. 50-100 of fentanyl really helps to calm down and hold still. If she’s really freaking out - versed. Makes for such a better experience for us all.
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I’m sorry but this is crazy. You’re giving verses to patients on L&D. Idk maybe times have changed but I always learned that versed was contraindicated in pregnant patients. Also now they will totally forget the whole birthing process. This is like a a law suit waiting to happe. If I was a expert witness I def would tell the prosecuting attorney that this is not standard of care
 
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I didn’t mean to imply versed regularly…They don’t forget - because I only give versed if they’re screaming- it’s very rare but I have done it. I’ve had to put epidurals in tweaking meth patients writhing around… sorry not sorry but she got versed… why is it contraindicated? In every case? I like to think things through and take patients on a case by case basis…. Lots of medicine is a risk benefit analysis. Most get nothing, a little crazy ones get fentanyl 50 in the iv, 50 in the epidural, the screaming drug addicts may get more. I think I’ve used versed once this year… she was on drugs - like tox screen positive in labor. Incidentally I am actually lighter handed than one or two of our docs… he often gives precedex fentanyl or versed.
 
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amyl said:
I let one person stay but they sit the f down. I also sedate the mommie if I need too- thankfully the culture on the l and d floor where I am now is reasonable. 50-100 of fentanyl really helps to calm down and hold still. If she’s really freaking out - versed. Makes for such a better experience for us all.
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If they are this bad just do a mini spinal then an epidural. Your OB nurses sound terrible.
 
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Yes the OB nurses are generally terrible but improving rapidly. I’m sure they think I’m a b— but idc…. I’m a patient advocate not a lazy nurse enabler. We have recently taken over half that contract from another group that couldn’t hire. The nurses had been used to the old group and their way of doing things. When I first joined the service I had to insist on a pulse ox for HR for test dose. The nurse said - in front of the patient - the other guys don’t do that. Culture change has actually happened rapidly there considering how ingrained cultures usually are.
 
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sevo00 said:
I’m sorry but this is crazy. You’re giving verses to patients on L&D. Idk maybe times have changed but I always learned that versed was contraindicated in pregnant patients. Also now they will totally forget the whole birthing process. This is like a a law suit waiting to happe. If I was a expert witness I def would tell the prosecuting attorney that this is not standard of care
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Are you kidding me? So because of a little memory issue some entitled mom is gonna sue? And you are gonna throw an coleague under the bus over some Versed if there was no outright harm? I mean plenty of moms have given birth and never remembered it in the past. Remembering a birth is not a guarantee.
 
makemoney2024 said:
Mini apinal? What’s that?? lol
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A CSE dose such as 1 ml .25% marcaine. Works right away and lets them sit still for the epidural. Only done this a handful of times for special circumstances or complete squirrels but it works fine. Giving versed and fentanyl is ridiculous and I am surprised the L&D nurses do it to begin with.
 
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I’m not sure what they would sue me for? Not remembering labor? They’re drug addicts - they probably also don’t remember getting pregnant. This small patient population I’m talking about hasn’t had prenatal care, are drug addicts and likely have undiagnosed psychiatric issues - I can’t imagine anyone would fault me for benzo with documented pcp or meth or cocaine on a tox screen in a laboring patient. some patients who are in distress are sometimes offered a small dose of fentanyl - it’s always very early on in the labor process - not later- and only for patients pretty hyped up who WANT it. It’s offered for some distressed patients - her choice.
What say you all on precedex for epidural placement - this is something I haven’t done but one of the ob drs does
 
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I def will give versed in a epidural to C-section scenario where the patient is freaking out in an attempt to try and avoid converting to general.

Our ob nurses routinely give fentanyl while in labor before the patients even ask for an epidural. Really not that uncommon.
 
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crash2500 said:
I def will give versed in a epidural to C-section scenario where the patient is freaking out in an attempt to try and avoid converting to general.

Our ob nurses routinely give fentanyl while in labor before the patients even ask for an epidural. Really not that uncommon.
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I'll use Ketamine for the epidural to C-section freakout
 
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amyl said:
I didn’t mean to imply versed regularly…They don’t forget - because I only give versed if they’re screaming- it’s very rare but I have done it. I’ve had to put epidurals in tweaking meth patients writhing around… sorry not sorry but she got versed… why is it contraindicated? In every case? I like to think things through and take patients on a case by case basis…. Lots of medicine is a risk benefit analysis. Most get nothing, a little crazy ones get fentanyl 50 in the iv, 50 in the epidural, the screaming drug addicts may get more. I think I’ve used versed once this year… she was on drugs - like tox screen positive in labor. Incidentally I am actually lighter handed than one or two of our docs… he often gives precedex fentanyl or versed.
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Tweaking meth patient writhing around unable to sit still? No epidural from me
 
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Arch Guillotti said:
A CSE dose such as 1 ml .25% marcaine. Works right away and lets them sit still for the epidural. Only done this a handful of times for special circumstances or complete squirrels but it works fine. Giving versed and fentanyl is ridiculous and I am surprised the L&D nurses do it to begin with.
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I know I know. As soon as I started typing auto correct kicked in but I had started asking anyway and decided to follow thru. lol. Was just being silly.
I do them pretty frequently as of late. Just do 25mcg of Fent and works immediately.
 
I had learned that benzo exposure during labor -> floppy baby syndrome. So I did some digging.

ACOG still recommends against benzodiazepine use during the 3rd trimester.

"ACOG recommends that benzodiazepines be avoided or prescribed sparingly as a treatment for perinatal anxiety. (STRONG RECOMMENDATION,MODERATE-QUALITY EVIDENCE)"

"Benzodiazepine exposure during pregnancy has been associated with an increased risk of neonatal sedation, decreased muscle tone, respiratory compromise, and NICU admission. For this reason, tapering off of or avoiding use in the third trimester is often recommended, although the absolute risk for NICU admission is low (133/1,000, 95% CI 17–274)"

From: ACOG 2023 Guidelines Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum
I'd probably skip the epidural instead of giving some midaz and exposing myself to trouble personally.
 
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lolnotacop said:
I had learned that benzo exposure during labor -> floppy baby syndrome. So I did some digging.

ACOG still recommends against benzodiazepine use during the 3rd trimester.

"ACOG recommends that benzodiazepines be avoided or prescribed sparingly as a treatment for perinatal anxiety. (STRONG RECOMMENDATION,MODERATE-QUALITY EVIDENCE)"

"Benzodiazepine exposure during pregnancy has been associated with an increased risk of neonatal sedation, decreased muscle tone, respiratory compromise, and NICU admission. For this reason, tapering off of or avoiding use in the third trimester is often recommended, although the absolute risk for NICU admission is low (133/1,000, 95% CI 17–274)"

From: ACOG 2023 Guidelines Treatment and Management of Mental Health Conditions During Pregnancy and Postpartum
I'd probably skip the epidural instead of giving some midaz and exposing myself to trouble personally.
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That sounds more like they are addressing chronic po benzo use rather than a one time dose for a mommy losing her sh— I agree it’s not ideal but on occasion I’ve found it helpful- I’ve never had a mommy get too sleepy or be forgetful 🤷‍♀️ I think we don’t all have the same patient populations
 
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Arch Guillotti said:
choco. Lighten up.
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Interesting that YOU actually responded tactfully to me and now want to somehow jump on me for some reason.
When the other guy called me a jerk for making a very obvious joke.
And so glad choco keeps living in your mind rent free. So many of you stay bothered by her? Why?
Nah, I will respond how I consider to be appropriate whether you agree with it or not.
 
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makemoney2024 said:
Interesting that YOU actually responded tactfully to me and now want to somehow jump on me for some reason.
When the other guy called me a jerk for making a very obvious joke.
And so glad choco keeps living in your mind rent free. So many of you stay bothered by her? Why?
Nah, I will respond how I consider to be appropriate whether you agree with it or not.
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Please explain how I “jumped” on you. It was an offhand comment. You seem very defensive with a chip on your shoulder.
 
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