Anesthesiologist shortage 12k by 2033

[amyl]

Behind the anesthesia shortage plaguing ASCs

ASCs are facing anesthesia provider shortages and declining reimbursements, reducing their ability to provide care. ASCs may have an edge in recruiting anesthes

www.beckersasc.com

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[chessknt]

The pretense that the orthopod-owned asc is some kind of altruistic model to save medicare money is preposterous. Crying to CMS for more money so they don't have to cut in to their 7 figure salaries to pay for an anesthesiologist while most specialties are getting cut to the bone to earn 1/5th of what they do while working more is a bad look.

 

[JiPo]

“They were lucky to be invited to work at your surgery center.”

Goes to show you how little respect they had for anesthesiologists before the shortage. **** them

 

[nimbus]

I see the appeal of ASCs. No weekends, no call, sometimes a good payor mix.

But when people get in a car wreck, have an MI or an aortic dissection, have a stroke, or get cancer, they will need a hospital that is open 24/7/365 with in-house staff, imaging, lab, blood bank, ICU, Cath lab and everything else. That stuff is expensive so of course hospital facility fees are higher than ASC facility fees. ASCs just skim the most profitable part of the hospital’s business without contributing those other services to the community. They are the result of our perverted medical reimbursement system. The most essential and difficult work is not the best reimbursed. That’s why I philosophically oppose them and have turned down ASC work to the extent that I can.

 

[T-burglar]

I see the appeal of ASCs. No weekends, no call, sometimes a good payor mix.

But when people get in a car wreck, have an MI or an aortic dissection, have a stroke, or get cancer, they will need a hospital that is open 24/7/365 with in-house staff, imaging, lab, blood bank, ICU, and everything else. ASCs just skim the most profitable part of the hospital’s business without contributing those other services to the community. They are the result of our perverted medical reimbursement system. The most essential and difficult work is not the best reimbursed. That’s why I philosophically oppose them and have turned down ASC work to the extent that I can.

Completely agree. When my son seems disappointed that I have to work a given weekend (1-2x per quarter, I’m not a negligent father) I tell him buddy I’m sorry but if nobody felt compelled to work at night or on weekends then there would be nobody to care for you in an emergency.

I also have a decent amount of disdain for anesthesiologists that choose baby anesthesia over real doctor work. Sorry but it’s the truth.

 

[aneftp]

Let me ask a simple question.

The old days were crna were lucky to have 4-5 weeks paid time off and most worked 7-3 with docs taking over cases. Crnas worked 40 hours

Docs usually had 5-6 weeks off and worked on average 50-55 hours.

These days. Crnas have on average 8-10 weeks off. This doesn’t even include their “off days” many work 3-4 days a week now.

Docs have on average 10-12 weeks off paid.

Do we really have a “shortage?” When the number of weeks people take off “paid” has more than doubled in the last 10 years.

We are moving towards close to 15 weeks paid time off in many practices for docs that I know of.

I’m looking closely at a job that gives me 20 weeks paid time off that doesn’t require me to work more than 40 hours a week and it’s beeper call/night float beeper system that calls start 5pm and usually needs at 9/10pm and I go home. No ob. No trauma.

ASCs cannot compete with that arrangement requiring people to work there 7-4 daily.

 

[caligas]

Completely agree. When my son seems disappointed that I have to work a given weekend (1-2x per quarter, I’m not a negligent father) I tell him buddy I’m sorry but if nobody felt compelled to work at night or on weekends then there would be nobody to care for you in an emergency.

I also have a decent amount of disdain for anesthesiologists that choose baby anesthesia over real doctor work. Sorry but it’s the truth.

One weekend a quarter and you look down on docs that don’t do ANY weekends?

 

[T-burglar]

I’ll admit I’m part of the cohort that has chosen a smaller paycheck so that I can have more free time. This is way more common now than it was. It exacerbates the “shortage” which only leads to higher salaries to try to recruit which further allows CRNAs and Doctors to choose to work less because they’re making plenty with fewer hours.

I do not feel guilty at all. Working 50-60 hours is nonsense unless you hate your family and have no hobbies and don’t care about your fitness or health .

 

[T-burglar]

One weekend a quarter and you look down on docs that don’t do ANY weekends?

I should have added that I look down on docs that can’t read also

 

[caligas]

I should have added that I look down on docs that can’t read also

Sorry if I wasn’t clear on which docs you disdain for choosing a different work/life balance than you, was it that you take 1 or TWO weekends a quarter and not just one?

 

[Iso4ane]

I always feel like I’m in between two worlds. I didn’t graduate all too long ago, and felt that residency wasn’t too bad (I mean we could’ve done a surgical or IM residency), but there is a much larger focus on work-life balance. Now, I’m not opposed to having work-life balance, but anesthesia is one of those things where the more thoughtful seat time one has the better you’ll be. Sure a lot of it can be boring, but the less you sit the more opportunities you’ll miss.

 

[aneftp]

I always feel like I’m in between two worlds. I didn’t graduate all too long ago, and felt that residency wasn’t too bad (I mean we could’ve done a surgical or IM residency), but there is a much larger focus on work-life balance. Now, I’m not opposed to having work-life balance, but anesthesia is one of those things where the more thoughtful seat time one has the better you’ll be. Sure a lot of it can be boring, but the less you sit the more opportunities you’ll miss.

Anyone who’s finished after 2016 has had it pretty good in terms of housing market /stock market /economy/jobs

The low points of anesthesia market were 1995-2000. As well as 2011-2018 (with all the mega mergers/sell outs)

Low points of stock market during my time 2000-2002

2008/2009

Low points of housing market 1989-1992 (Cold War ending , housing prices in robust cities like San Diego and Washington DC went down and took almost one decade to return). As well as the housing crash of 2007-2010 (which also took well over one decade to return.

I don’t like to refer to young (younger grads) ages 30-38 as “young kids” but they haven’t seen the world like I have seen. I’ve seen it all in my lifetime.

I’ve had even older colleagues practice since the 1960/1970s/1980s to lean on their experience and guidance.

 

[abolt18]

I do not feel guilty at all. Working 50-60 hours is nonsense unless you hate your family and have no hobbies and don’t care about your fitness or health .

Hilarious. I'm working more than that, but it's not because of any of those things. I'd say I'm more intentional than ever about having quality time with my family, eating and sleeping well, exercising, and enjoying my free time (though my hobbies could use some more free time).

But the reality is I have some financial goals that I want to crush before I slow down, so that the rest of my life I can slow it down, work less, take more time off and less call.

"Live like no one else, so that later you can live and give like no one else." - Dave Ramsey

 

[narcusprince]

Ascs bend the rules. They allow non board certified docs to work in their practice and they pay them a lower salary. My first pp gig was in a surgery center like this. I had 6 weeks vacation. Now I have 14 weeks vacation much happier lifestyle working in the hospital.

 

[amyl]

10-12 weeks vacation is average?! I think there is a shortage that’s easier to quantify. Retirements outpace new grads by 1000/year. But I think the shortage is exacerbated by just about every fte wanting to work less.

 

[aneftp]

10-12 weeks vacation is average?! I think there is a shortage that’s easier to quantify. Retirements outpace new grads by 1000/year. But I think the shortage is exacerbated by just about every fte wanting to work less.

Yes! Min is 10 weeks off now. Excluding other off days like light work days off and holidays

Just remember data is easily manipulated. Trust me. I worked for govt entity briefly. I know how govt and other outside forces can manipulate data.

The number of new anesthesia grads has increased by over 90-% last 20 years (from 1000 to 1900)

The number of SRNA new grads has increased by more than 100% The last 20 years.

I know my stats.

 

[amyl]

so do you think the shortage stats are wrong?

 

[GravelRider]

Let me ask a simple question.

The old days were crna were lucky to have 4-5 weeks paid time off and most worked 7-3 with docs taking over cases. Crnas worked 40 hours

Docs usually had 5-6 weeks off and worked on average 50-55 hours.

These days. Crnas have on average 8-10 weeks off. This doesn’t even include their “off days” many work 3-4 days a week now.

Docs have on average 10-12 weeks off paid.

Do we really have a “shortage?” When the number of weeks people take off “paid” has more than doubled in the last 10 years.

We are moving towards close to 15 weeks paid time off in many practices for docs that I know of.

I’m looking closely at a job that gives me 20 weeks paid time off that doesn’t require me to work more than 40 hours a week and it’s beeper call/night float beeper system that calls start 5pm and usually needs at 9/10pm and I go home. No ob. No trauma.

ASCs cannot compete with that arrangement requiring people to work there 7-4 daily.

Where are these 15 week PTO jobs where you work 40 hours per week? I’m seeing compensation increases and maybe a few places that were previously 4 weeks off move to 6-7 weeks off, but I am not seeing 15 weeks off as per routine. I would say 6-8 is becoming more standard.

 

[GravelRider]

Completely agree. When my son seems disappointed that I have to work a given weekend (1-2x per quarter, I’m not a negligent father) I tell him buddy I’m sorry but if nobody felt compelled to work at night or on weekends then there would be nobody to care for you in an emergency.

I also have a decent amount of disdain for anesthesiologists that choose baby anesthesia over real doctor work. Sorry but it’s the truth.

Why don’t people understand that it’s a simple economic question? If people are moving to daytime and weekday only work, it’s because those off hours are not being compensated appropriately. Why should you expect someone who is working nights and weekends make only marginally more than someone working banker’s hours? If people are choosing not to do a certain type of work then it’s not being compensated appropriately. Appealing to people’s sense of public duty or pride will only get you so far.

 

[Howard888]

Anesthesia is a necessary cost. What it’s paid used to be largely based on your contracts, payer mix, or utilization, and staffing model.

With no surprises act, it’s now more about hospital employment or subsidies…so now it really is more about supply demand.

The more attractive the area or lower the acuity the job, the easier it will be to get staff and the less salary/weeks vacation required to recruit. Less desirable the opposite.

The shortage is 100% real and applies to CRNAs too. The issue is increasing/aging population but more than that it’s the number of anesthetizing sites. Out of OR sites, ASCs, community hospitals, even office based anesthesia.

Add in more dual income households and you have less requirement to work to support your household.

ASCs are only going to increase and commercial payers will drive cases there. Total joints and spinal fusions soaring in ASCs. There are now cardiac ASCs where stents are placed. ASCs are about efficiency. May not be cardiac or peds but there is skill in managing a busy ASC. Similar to a busy ob unit.

Requiring 10 weeks of vacation is nuts unless all of your call is level 1 trauma or something. Most call shifts have decent chance of few hours sleep and I know many anesthesiologists in country who take call at smaller community hospitals and love call/would never give it up as they often get sleep and get post call off.

Trust me other specialties hear about all this vacation and judge accordingly as most take much less (ED and IR only two who take as much). But like I said it’s all supply demand. If the demand is there you can ask for 10 weeks vacation and tell these other specialties who cares. Hospitals have to have us to get surgeries done.

That demand isn’t going anywhere….so enjoy your 10+ weeks off or use it to make more money working more

 

[JiPo]

Why don’t people understand that it’s a simple economic question? If people are moving to daytime and weekday only work, it’s because those off hours are not being compensated appropriately. Why should you expect someone who is working nights and weekends make only marginally more than someone working banker’s hours? If people are choosing not to do a certain type of work then it’s not being compensated appropriately. Appealing to people’s sense of public duty or pride will only get you so far.

My shop underpays significantly for Fri, Sat, Sun calls, and the response I got was "it all evens out at the end." rather than increasing the pay to make it market rate. And they wonder why no one likes taking weekend calls.

 

[Agast]

You guys should get together and start a training camp for pain docs thinking of getting back into the OR. $8,000 for 3-days with a skills lab and anesthesia machine refresher. There are probably enough unhappy people 5 years out who would sign up for this while anesthesia’s hot.

 

[aneftp]

Where are these 15 week PTO jobs where you work 40 hours per week? I’m seeing compensation increases and maybe a few places that were previously 4 weeks off move to 6-7 weeks off, but I am not seeing 15 weeks off as per routine. I would say 6-8 is becoming more standard.

East coast
West coast
Mid west
South

It’s every where

6 weeks is circa 2006/2010

8 weeks is circa 2016

10 weeks Is circa 2022

 

[triggermaster]

East coast
West coast
Mid west
South

It’s every where

6 weeks is circa 2006/2010

8 weeks is circa 2016

10 weeks Is circa 2022

I just get 8 weeks off like a sucker!

 

[aneftp]

Anesthesia is a necessary cost. What it’s paid used to be largely based on your contracts, payer mix, or utilization, and staffing model.

With no surprises act, it’s now more about hospital employment or subsidies…so now it really is more about supply demand.

The more attractive the area or lower the acuity the job, the easier it will be to get staff and the less salary/weeks vacation required to recruit. Less desirable the opposite.

The shortage is 100% real and applies to CRNAs too. The issue is increasing/aging population but more than that it’s the number of anesthetizing sites. Out of OR sites, ASCs, community hospitals, even office based anesthesia.

Add in more dual income households and you have less requirement to work to support your household.

ASCs are only going to increase and commercial payers will drive cases there. Total joints and spinal fusions soaring in ASCs. There are now cardiac ASCs where stents are placed. ASCs are about efficiency. May not be cardiac or peds but there is skill in managing a busy ASC. Similar to a busy ob unit.

Requiring 10 weeks of vacation is nuts unless all of your call is level 1 trauma or something. Most call shifts have decent chance of few hours sleep and I know many anesthesiologists in country who take call at smaller community hospitals and love call/would never give it up as they often get sleep and get post call off.

Trust me other specialties hear about all this vacation and judge accordingly as most take much less (ED and IR only two who take as much). But like I said it’s all supply demand. If the demand is there you can ask for 10 weeks vacation and tell these other specialties who cares. Hospitals have to have us to get surgeries done.

That demand isn’t going anywhere….so enjoy your 10+ weeks off or use it to make more money working more

It comes down to everything. Workload

An asc next door to me can’t get anyone to work for 500k. No calls no weekends 50 hours a week. With 8 weeks off.

Sounds good on paper. Right?

Nope. I ain’t taking that job.

50 hours a week with no early days and 5 days a week is brutal.

The pace is crazy. 10-12 blocks a day for one anesthesia doc as well.

Surgeons have a ton of down time. Anesthesia doesn’t have much down time. My general surgeon friends have lots of down time. They can run and have lunch with their spouse outside the hospital. They aren’t restricted like anesthesia.

Surgeons have a lot of off days as well half clinic days. So anesthesia is like airline pilots. When u are on the clock. It can be stressful.

 

[Status Sciaticus]

Isnt the shortage a good thing? Drive the demand even higher and with it, the locums rate and the compensation.
Instead of just punching in and out, it may be the first time an anesthesiology group can demand ownership into a surgery center.

 

[Agast]

Isnt the shortage a good thing? Drive the demand even higher and with it, the locums rate and the compensation.
Instead of just punching in and out, it may be the first time an anesthesiology group can demand ownership into a surgery center.

I believe it’s not done due to safe harbor/Stark Law regulations. An out of network surgery center that doesn’t bill Medicare could probably offer shares to anesthesiology.

 

[aneftp]

Listen folks. There is no real shortage.

The asc “shortage “ is self created by what I term the 5 day work week. Ain’t no one want to work 5 days a week. I keep stressing this point.

People don’t get it.

We got crnas (and docs) keep covering (from my hospital) Per diem 1099 1-2 days local ASC.

Why? Because the regular MD and regular crnas don’t want to work 5 days a week.

Who wants to work 5 days a week?

We have office workers who don’t want to not only work 5 days a week. They don’t even want to physically show up to work but rather work remotely.

The work culture has changed. Since anesthesia is near impossible to work remotely outside of admin or pat clinic work. People will work longer hours with more off days

This creates this artificial shortage.

The issue is the true ASC used to run 7-2pm/3pm max. I talked to long time surgeon. Now you have ASC run to 5/6pm consistently. Who is working to 5pm 5 days a week?

Be honest. I told the guy who covers that surgeon center across the street. It’s a 700k a year job that can be split with 2 docs (350k each ) each working 25 hours a week. He about threw up at my suggestion. But I’m correct. They will continue to bleed locums money at $350/hr trying to get locums coverage for the ASC.

Rather than pay 700k for 2 docs to split the job.

 

[JiPo]

Listen folks. There is no real shortage.

The asc “shortage “ is self created by what I term the 5 day work week. Ain’t no one want to work 5 days a week. I keep stressing this point.

People don’t get it.

We got crnas (and docs) keep covering (from my hospital) Per diem 1099 1-2 days local ASC.

Why? Because the regular MD and regular crnas don’t want to work 5 days a week.

Who wants to work 5 days a week?

We have office workers who don’t want to not only work 5 days a week. They don’t even want to physically show up to work but rather work remotely.

The work culture has changed. Since anesthesia is near impossible to work remotely outside of admin or pat clinic work. People will work longer hours with more off days

This creates this artificial shortage.

The issue is the true ASC used to run 7-2pm/3pm max. I talked to long time surgeon. Now you have ASC run to 5/6pm consistently. Who is working to 5pm 5 days a week?

Be honest. I told the guy who covers that surgeon center across the street. It’s a 700k a year job that can be split with 2 docs (350k each ) each working 25 hours a week. He about threw up at my suggestion. But I’m correct. They will continue to bleed locums money at $350/hr trying to get locums coverage for the ASC.

Rather than pay 700k for 2 docs to split the job.

But if the artificial shortage is here to stay, isn’t that shortage? It doesn’t matter whether it is artificial or not.

 

[finalpsychyear]

Hilarious. I'm working more than that, but it's not because of any of those things. I'd say I'm more intentional than ever about having quality time with my family, eating and sleeping well, exercising, and enjoying my free time (though my hobbies could use some more free time).

But the reality is I have some financial goals that I want to crush before I slow down, so that the rest of my life I can slow it down, work less, take more time off and less call.

"Live like no one else, so that later you can live and give like no one else." - Dave Ramsey

I feel like the millenials in medicine are in a unique position where they still have most of the work ethic like the baby boomers but have hobbies and a semblance for work life balance. Gen Z is further tilted towards lifestyle and ready to blow the whistle at the slightest injustice.

Kudos to you for recognizing not to take the $$ that's available for granted as things can change 3-5 years from now in any field. Milk it while you can, invest heavily and be in a position where you are working for pleasure in the next 5-10 years and are FAT FIRE eligible at any point.

 

[Coffee PRN]

I feel like the millenials in medicine are in a unique position where they still have most of the work ethic like the baby boomers but have hobbies and a semblance for work life balance. Gen Z is further tilted towards lifestyle and ready to blow the whistle at the slightest injustice.

Kudos to you for recognizing not to take the $$ that's available for granted as things can change 3-5 years from now in any field. Milk it while you can, invest heavily and be in a position where you are working for pleasure in the next 5-10 years and are FAT FIRE eligible at any point.

I’m a millennial that likes their time off, and I’ve been trying to balance that with making hay while the sun still shines.

I’m working about 54 hours a week making around 700-800k. Ideally I would like to work a little less, but it’s uncertain how long this market will last.

 

[finalpsychyear]

I’m a millennial that likes their time off, and I’ve been trying to balance that with making hay while the sun still shines.

I’m working about 54 hours a week making around 700-800k. Ideally I would like to work a little less, but it’s uncertain how long this market will last.

Fantastic. I hope my younger female sibling who signed for 400k (plus sign on and some possible bonuses) at an academic center is about to graduate this year from gas can strive for that. For her right now it's all about support and comfort and getting confidence before testing higher waters in 1-2 years. She is a gen z and at least acknowledges that she is taking a pay cut but 400k is lot of money for a single person with no debt.

 

[Coffee PRN]

Fantastic. I hope my younger female sibling who signed for 400k (plus sign on and some possible bonuses) at an academic center is about to graduate this year from gas can strive for that. For her right now it's all about support and comfort and getting confidence before testing higher waters in 1-2 years. She is a gen z and at least acknowledges that she is taking a pay cut but 400k is lot of money for a single person with no debt.

With how young she is coming out of residency she should be set with some wise investing.

 

[abolt18]

I’m a millennial that likes their time off, and I’ve been trying to balance that with making hay while the sun still shines.

I’m working about 54 hours a week making around 700-800k. Ideally I would like to work a little less, but it’s uncertain how long this market will last.

I should make that this year as a W2, but I'm going to estimate my weekly hours as averaging more in the 60s. Doing my own cases 99% with rare direction of AAs.

You do a lot of supervision? Taking only 6 weeks off this year, but most in my group take 8-11.

 

[nimbus]

A few years ago I remember reading median work hours for anesthesiologists were about 58-59 hours. Nowadays similar surveys report 50-51 hours. That definitely contributes to the shortage.

 

[aneftp]

I’m a millennial that likes their time off, and I’ve been trying to balance that with making hay while the sun still shines.

I’m working about 54 hours a week making around 700-800k. Ideally I would like to work a little less, but it’s uncertain how long this market will last.

Hopefully you are getting 9-10 weeks off with that income. Plus standard pre call and post call days off.

It’s not the total hours per week that matter in as much as what type of hours it entail

Meanings 50 hour surgery center a week job 5 day a week job is much stressful than a hospital based 54 hour week job with pre call and post call off.

As long as some weeknight calls you get plenty of sleep. U should be fine long term

But if continuously working plus taking less time off. You will burn urself out.

 

[aneftp]

A few years ago I remember reading median work hours for anesthesiologists were about 58-59 hours. Nowadays similar surveys report 50-51 hours. That definitely contributes to the shortage.

They were never 58-59. They were based on 44-46 hour weeks.

I’m looking right at the the last mgma data I purchased in 2015 (for 2014 survey year)

Median hours worked 44 hours
Median pay 443k
Median retirement benefits 37k
Median weeks worked 44

 

[nimbus]

They were never 58-59. They were based on 44-46 hour weeks.

I’m looking right at the the last mgma data I purchased in 2015 (for 2014 survey year)

Median hours worked 44 hours
Median pay 443k
Median retirement benefits 37k
Median weeks worked 44

I agree 58-59 hours/week sounds high but that’s what I read. I think the only specialty that had higher median hours was vascular surgery. I wish I could find the survey but I can’t.


This is the current survey showing 52 hours on page 18. Anesthesiology is now on the lower end of the list.

Medscape: Medscape Access

 

[Coffee PRN]

I should make that this year as a W2, but I'm going to estimate my weekly hours as averaging more in the 60s. Doing my own cases 99% with rare direction of AAs.

You do a lot of supervision? Taking only 6 weeks off this year, but most in my group take 8-11.

Locums, I specify no supervision in my contracts, and take about 8 weeks off a year.

 

[aneftp]

Locums, I specify no supervision in my contracts, and take about 8 weeks off a year.

The real money is in the 24 hour continuously billing for calls especially on weekends for locums.
But 700-800k for 50 plus hours locums sounds right.

If you can find spots for 65 hours weekends calls to integrate at least 2x a month. You can almost double your current money plus maintain your weeks off at 8. But it’s always a fight for those weekend calls slots with locums.

I’ve notice in this market. The full time w2 staff like to ride the 1099 locums hard during daytime. And full time w2 staff like to take incentivized extra calls usually weeknights. (avoiding the busier daytime work) plus get paid extra. So full time w2 docs amc salary around 500k really hit close to 700k working only 45 hours. While maintaining their 10 weeks paid time off

Many ways to game the system. W2 or 1099

So it’s a symbiotic relationship between full time w2 doc in short staffing situations and 1099 docs.

 

[Hoya11]

Behind the anesthesia shortage plaguing ASCs

ASCs are facing anesthesia provider shortages and declining reimbursements, reducing their ability to provide care. ASCs may have an edge in recruiting anesthes

www.beckersasc.com

I would not turn down a job paying significantly higher than any hospital call doc and with 12 weeks off and no call or weekends.

It's possible in an ASC setting with good insurance rates.

But when you negotiate insurance rates by todays rules (small groups have no leverage), and you are a little anesthesia group covering this surgery center with 5 rooms, your going to get reimbursement rates in the lower 10-25% of payers. And your not going to be able to make that work.

So, do I feel bad for the orthopods who may have to foot that bill? No - I agree.

But, I feel the true justice would be having the insurance companies pay anesthesia a fair rate, the same rate regardless of size of the group.

 

[Howard888]

Large groups can no longer negotiate rates either. Payers will just go to arbitration . With CRNA salaries approaching an average of 250k nationwide (already above that in some areas)for a 4 day work week, ASCs aren’t the home runs they used to be when CRNAs salaries were 150k.

Just like hospitals, many need stipends now too, even if staffed with large amc groups-remember amcs target 25% profit margins.

 

[aneftp]

Large groups can no longer negotiate rates either. Payers will just go to arbitration . With CRNA salaries approaching an average of 250k nationwide (already above that in some areas)for a 4 day work week, ASCs aren’t the home runs they used to be when CRNAs salaries were 150k.

Just like hospitals, many need stipends now too, even if staffed with large amc groups-remember amcs target 25% profit margins.

Crnas are clearly picking and choosing WHEN they want to work in this job market.

I suggested we move towards an Uber type of surge pricing /compensation model.

Those who want to work 7-3 house Tuesday-Thursday get x base pay

Those who want to work 7am Monday or Friday get 5% model base

Those who want to work past 5pm-Friday get 5% extra.

Those who want to work weekends days get 20% Those who work weekend nights gets 30% more.

I think it will be a game changer with staffing needs. It will be on a first come first serve need to sign up.

You incentivize pay for more critical times

This folks is the new model of compensation

 

[anbuitachi]

Let me ask a simple question.

The old days were crna were lucky to have 4-5 weeks paid time off and most worked 7-3 with docs taking over cases. Crnas worked 40 hours

Docs usually had 5-6 weeks off and worked on average 50-55 hours.

These days. Crnas have on average 8-10 weeks off. This doesn’t even include their “off days” many work 3-4 days a week now.

Docs have on average 10-12 weeks off paid.

Do we really have a “shortage?” When the number of weeks people take off “paid” has more than doubled in the last 10 years.

We are moving towards close to 15 weeks paid time off in many practices for docs that I know of.

I’m looking closely at a job that gives me 20 weeks paid time off that doesn’t require me to work more than 40 hours a week and it’s beeper call/night float beeper system that calls start 5pm and usually needs at 9/10pm and I go home. No ob. No trauma.

ASCs cannot compete with that arrangement requiring people to work there 7-4 daily.

Do we have a shortage? Yes we do. FT work is 40 hours. If you are working more than 40, there's probably some type of shortage. Or you can simply define shortage by market supply vs demand, in which case we also have a shortage. Neither of these are 'artificial' though. Im not really sure what artificial means. I guess if government creates a regulation that suddenly changes what is allowed, then it could be 'artificial'

 

[anbuitachi]

ASA should get surgeons on board to fight for more medicaid medicare reimbursements. fight this "33% rule"

 

[TexasMed22]

They were never 58-59. They were based on 44-46 hour weeks.

I’m looking right at the the last mgma data I purchased in 2015 (for 2014 survey year)

Median hours worked 44 hours
Median pay 443k
Median retirement benefits 37k
Median weeks worked 44

Since when does MGMA include median hours worked? Out of curiosity, what does it look like for other specialties (heme onc, ortho, rads)?
(I know medscape includes this in their yearly salary report, but their salaries are so depressed that I'm skeptical of the data entirely)

 

[anbuitachi]

Since when does MGMA include median hours worked? Out of curiosity, what does it look like for other specialties (heme onc, ortho, rads)?

I think you need the full report.

 

[Dr. Rude]

Since when does MGMA include median hours worked? Out of curiosity, what does it look like for other specialties (heme onc, ortho, rads)?

Hours worked is also an imperfect metric. Home call as opposed to in house call? Call intensity whether home or in house? No way to quantify that globally. In our local market mix of medium metro suburban and semi rural hospitals. Call intensity has gone down for the semi rural, up mildly for the suburban, up hugely for what passes for inner city in our area.

As @aneftp stated, the ASCs are all working harder and longer, atleast in our area.

Reason: the semi rural hospitals don’t pay for weekend call for gensurg and sub specialties on weekends and ship everything after hours to the big hospital.

 

[DirtDocMD]

ASA should get surgeons on board to fight for more medicaid medicare reimbursements. fight this "33% rule"

Prepare for rant…

You would THINK the AHA (American Hospital Association), would have already tried to help. The reason so many groups need subsidies these days (paid by the hospital), is because Medicare/Medicaid reimbursement rates are still stuck in the 1990’s ($18-$24 a point).

I dunno, “maybe” the money they’re (hospitals) paying out is worth it to them for the “control” they get over Anesthesia groups??

Hospitals are still making plenty of money after 3/5 pm. Surgeons are still making plenty after 3/5pm. (Medicare PAYS them well). However, ANESTHESIA groups have little/no control over what gets done at later hours, and are getting forced into doing these cases (Medicare/Medicaid/Self (no) pay), that can’t even cover the cost of a daytime CRNA, much less a nighttime one or a Doc.

I’m not complaining about the real emergencies. I’m talking about the after hours “I was busy at my surgery center!” cases the surgeons do, or the “after clinic” cases that the hospital allows to get scheduled because it’s more money for THEM.

Anesthesiologists didn’t complain as much when these cases actually PAID (mixed pay per point/private insurance/eat what you kill), in the old days. At least you were getting PAID handsomely for the “lack of control” over your schedule (which is the real “con”/negative of anesthesia, compared to many other specialties).

NOW, there’s simply some AMC or hospital employer taking that time from you, because you’re a “salaried” Doc, in many cases. In many facilities extra hours does NOT mean extra pay. THIS is why so many Doc’s are wanting/demanding consideration for anything over 40 hours or non 7-3/5 or weekend work. You’re not doing it for yourself or the group YOU own, anymore, it’s now being demanded by an AMC or hospital that pockets that money.

I’ve been fortunate to be a part of a private group for many years, but a poorly-run hospital with inefficient OR’s, that continues to accomodate jerk surgeons on evenings/weekends/whenever, finally led me to go part-time, a few years back. I was simply TIRED of having so much of MY life revolve around poorly-run OR’s, and surgeons’ “social schedules” or their “profitable” work at THEIR surgery center.

If I was formulating the “perfect” compensation model, these days, I would be paid BY THE MINUTE that I was required to be at the hospital (AND “on call”). Don’t care if I’m doing a case, waiting for your azz-dragging staff to turn over a room/get a patient ready, or waiting on the a-hole surgeon who decides to show up at 4:30pm after making bank at his ASC (and taking a one hour detour to go to Starbucks and round on a couple of patients before showing up). Why should I sit around for FREE because of YOUR inefficient practices??

The hospital isn’t a non-profit county/church-owned center to “help the community”, anymore. It’s a “for-profit” corporate-owned enterprise, so we can forego the “You’re a greedy doctor!” accusations, while everyone in the c-suite is making “doctor money” (or more) shuffling papers from 8-5 M-F, with nothing but a Master’s degree…

Weekends/nights?? Hey, YOU (the hospital), gets a boatload of money for being a “trauma center”, from the state, and if you’re gonna get that, AND let surgeons post non-urgent/non-emergent CRAP all day long, well, you can pay me “time-and-a-half”, like everyone else.

Again, that may sound “petty”, but if a hospital isn’t going to listen to Anesthesia input about how to make things efficient, make “emergency call” simply extra time to generate revenue doing elective cases, or give the contract to some AMC that values Docs as nothing more than hamsters to spin their money-making wheel, then they can PAY for it.

 

[anbuitachi]

our overnight calls have definitely been getting tougher. more cases. hospital busier overall. and currently we get no extra pay for call except for weekend call