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deleted1183938
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Dallas is paying $300-325 last I heard.
Anesthesiologist shortage 12k by 2033
Started by amyl
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Correct. Not great
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deleted1183938
Almost Double that is $500+. So no.
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Outside NYC and 275 gets a lot of resumes
300-325 for locums in dallas? Is that what you meant?
Dallas proper has lots of good permanent jobs so it’s not a good locums market
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deleted1183938
Per hour
Yes dallas is not a good locums market… our permanent positions are good so less openings. Also lots of us locked into nice 3% mortgages on homes that have gone up in value- dallas is desirable location.
The most $ I’m hearing these days is Montana Portland and Memphis - all undesirable.
The most $ I’m hearing these days is Montana Portland and Memphis - all undesirable.
East access to skiing, mountain biking, Pacific Ocean, the best national parks, fly fishing, breweries, etc is soooo undesirable.
Didn’t they turn over the city to that BLM personal enrichment (but somehow Marxist 😂) group?
Probs, but it’s not always about politics. It’s sh**ty everywhere. But hey, we all have to make excuses for where we live…
Yeah seriously - one could do much worse than Portland. As a city it seems like it’d be a great locums spot.
Well if u have family and are established in the area with kids in school. It’s harder to move around.
Locums is the way to go if u are single or no kids and want to chase the $$$.
all correct information about Dallas.
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deleted1183938
So glad you are here to verify and confirm!! Put your stamp of approval on it why don’t ya?
No offense meant - Portland bad bc 13% income tax, expensive housing and clearly dip**** hospital admin. Montana is too cold for most and limited employment options for spouses if people care about that. Montana may be desirable for some - lucky them it’s probably a good gig for them - but not desirable for everyone.
Memphis seems great except for clearly stupid hospital admin and apparently it’s dangerous and full of criminals.
Dallas is a more mainstream desirable locale
Memphis seems great except for clearly stupid hospital admin and apparently it’s dangerous and full of criminals.
Dallas is a more mainstream desirable locale
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deleted87051
OAG is out of Providence but picked up more Legacy sites. Maybe Legacy isn’t run by dip****s.
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13% marginal (state + homeless + preschool) rate only applies in one of the three counties of the metro area. Homeless tax in the other two, but sunsets in 2030. No sales tax, FWIW.
Yes that’s what I meant - providence that didn’t pay oag when they asked are dip****s - the gossip I heard was that oags ask was very reasonable
Then live and work in Vancouver WA and do your shopping in Portland OR. !!!
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deleted1189238
Chicago is a **** market too except locums work, for now. These hospitals going to 1:4 supervision no doubt
Where do you get the 4x CRNA?
Most places don't plan 1:4 ratio unless u are dealing with Deathstar or other AMGs or Rush GI center
Most 1:4 are simple
Though doing 1:4 with a double lung/heart transplant plus Cabg in another room both rooms coming off pump simultaneously is stressful and less experienced crnas in those rooms. Have to delay coming off pump in one of those rooms and it’s 8pm and less staff available
That’s the type of 1:4 u don’t want.
There's really no 1:4 that I would want, I don't care how simple it is.
Likewise. I would never entertain a job prospect if it required 1:4. People here Can put it here however they want to help them sleep better at night but at that point you’re just a preop monkey and chart signer
Sort of… but you also do 4 times as many positive things- blocks, lines, difficult airways, etc.
And you get 4 times the liability. Kinda surprised the malpractice insurance companies don't demand higher rates for that.
Not when surgeons are breathing down your neck because you have 4x 730 starts with GAs or blocks
Yeah, you start early, get fast, probably have 2 blocks maybe 3 starting at 7:30. Luckily you get plenty of practice to be fast 😉.
So you just want to do solo?
There are many ways to skin a cat.
1:2
1:3
1:4
1:8 (crnas qz)
Solo.
The issue is we have a labor pool issue.
If x hospital wants to start 20 rooms by 7/730am
Plus add on flex to 22 room by 9-10am
Still wants to run 12 rooms by 3p
8 rooms by 5p
Where do u find the bodies ?
No need to have MDs sitting ASA 1-3 ASC type cases. Also prefer ACT model for bigger cases as 4 hands.
MD only isn’t justified. Cost prohibitive and less hands on deck. Debates over supervision ratios can be had all day but it’s not a one hat fits all: higher the acuity, lower the supervision ratio and vice versa. MD only would die out sooner but CRNAs have been smarter than MDs in negotiating and setting terms so the cost savings isn’t what it used to be and there aren’t enough CRNAs or AAs. MD only will still eventually go away but what was a 5-10 year window is probably now 10-15
MD only isn’t justified. Cost prohibitive and less hands on deck. Debates over supervision ratios can be had all day but it’s not a one hat fits all: higher the acuity, lower the supervision ratio and vice versa. MD only would die out sooner but CRNAs have been smarter than MDs in negotiating and setting terms so the cost savings isn’t what it used to be and there aren’t enough CRNAs or AAs. MD only will still eventually go away but what was a 5-10 year window is probably now 10-15
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deleted641888
Been there, done that, got good. You also have 4 times as many morning breaks, lunch breaks, and afternoon breaks, as well as 4 times as many arguments with surgeons scheduling suboptimal patients for their purely elective surgeries. That's if your ratios don't exceed 1:4 (ours did frequently when severely understaffed). Don't get me started on the liability aspect.
Also solo'd hearts/transplants/dissections. Still prefer solo 100% of the time regardless of the case.
I’ll GLADLY take the 20-30 percent pay cut to continue to sit my own cases if that ever happens.
But I don’t think it will. Wage gap will continue to narrow as the clamor for independence continues across specialties. The only incentivized pay will be call and weekends, which physicians will still bear the brunt of.
It’s strange to argue cost effective and point out CRNAs are beating the brakes off of us negotiating contracts in the same paragraph. They are modestly cost effective… for now.
Trying to rein in midlevel care is a lost cause at this point. No amount of supervision ratios or billing identifiers are going to change that.
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So let the seniors docs take the easy 1:4 asc type of Asa 1-3 patients
The junior docs do solo Asa 4.5
All docs get paid the same?
Good luck with that explaining to the millennial generation they take the harder cases solo. Rot away in high risk 6-8 hour peds scoliosis case. While the senior guys chill outside.
Most crnas are not available 7-3 (5) days a week these days (at least in the south)
Once docs figure it out not wanting to be available daily. It’s game over for hospitals
When I'm solo, the day is stress free and I never seem to have complications. When I'm supervising, I respond to anesthesia stats all the time, have to deal with preventable PACU issues, and have to manage egos instead of managing my patients. So MD only isn't justified according to whom?
The problem is that the bar for entry to become an anesthesiologist is also low. So many anesthesiologists actually suck, including many faculty that are ironically charged with teaching residents. So if that’s the case, there often wont be a distinction between CRNA and MD.
I predict more solo work in the future. In the past, care team made financial sense. The math is changing now. Sure, MD salaries are going up. But CRNA salaries (on a relative scale) have increased more. If you have a MD in the room, you just pay the MD. With care team model, you must pay 1 CNRA per room + 1/2 vs 1/3 vs 1/4 MD (depending on concurrency ratio). When MD salaries were > 2x/hr CRNA salary, this made sense financially. Now with CRNA and MD salary becoming closer on a per hour basis, care team does not make financial sense unless ratio is high (3:1 minimum, likely 4:1). I think this will lead to more docs in rooms. The lazy MDs who can't sit a case themselves or those who simply don't give a **** will accept a position in a firefighter role (>4:1 QZ).
< 1:4 is not cost effective at all.
It is not the bar that is low. It is because these anesthesiologists have significant skill atrophy.
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deleted643396
This is actually a big problem. There are a lot of anesthesiologists who could not functionally make it through a case on their own. Supervising is a self-fulfilling prophesy where the more you supervise, the more you need to supervise.
I agree with this. There is way more solo work now, which I enjoy. Despite the thinking that MDs are going to be doing the ASA 4s and 5s, I see the opposite happening. Most of the ASCs around me are staffed by solo MD coverage where the trauma centers are increasing the CRNA presence. CRNAs are just not cost effective, especially for independent surgery centers.
Believe me, I am plenty fast... Open AAA (on my own) gets thoracic epidural, induced, and lined up in 20-25min (without anesthesia tech support). But I can't be in multiple places at once. You've never had 2 or 3 ASA 4 730 starts? It's maddening trying to navigate this. The 1:4 doc just has the CRNA induce on their own and never shows their face in the room. I'm not interested in that kind of practice.
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whoever you are supervising is terrible then
Yeah, almost like they're not doctors and have never been held to the standard of doctors. Usually with high acuity cases I'm able to solo them, but sometimes you don't have a choice and who you get is who you get. I try to anticipate and steer clear of problems but there's only so much you can do with arrogant egos that refuse to notify or call for help. I often have to tell the circulator or surgeon to call for me if they sense trouble brewing.
Yes. There's a lot of terrible out there.
The problem is there are a lot of locums CRNAs out there that are either terrible or "uncomfortable" for extended periods of "orientation" which means they're just terrible.
My ability to control which CRNAs are hired, retained, and scheduled with me is approximately nil.
It’s moving the goalposts to go from 1:4 is terrible to 1:4 with 3 ASA 4s at 7:30 is terrible. I agree with the second set of goalposts 😂.
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U sound like this colleague of mine who is truly a superstar. The issue is he’s not making 800k plus any more after selling out the practice for a couple of million each and making 60% of what he made before. No benefits to pushing the limit doing high risk cases when I can cover 1:2 or even 1:1 like I did yesterday.
Bingo. There are 3 types of w2 crnas out there these days
The part timer prn crna who has other things in their life
The full time crna (rare) who works 5 days a week. In our practice only 4 of the 32 crna slots are filled by 7-3 crnas
The compressed schedule crnas who work 1-3 crnas a week. 0.75-1.0. Those crnas push 350k with overtime currently in my practice with overtime. Plus another 100k in 1099 income. And frankly work the same amount of days as the day doc who’s available 5 days a week.
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deleted643396
There are also a lot more CRNAs being pumped out these days. The quality of their training is worse because they themselves are being trained by relatively inexperienced CRNAs. A lot of bad (weird) habits are being perpetuated. I’ve worked with some really great experienced CRNAs who can make my supervision days a pleasure, but some of these new grad CRNAs are barely functioning at a CA1 level. Those days can be quite stressful. The difference is a CA1 is usually pretty timid, but these new CRNAs are having it ingrained that they are our equal, so they are cocky and make bad decisions. I would much much much rather do my own cases than deal with a 1:4 day supervising a bunch of fresh grad CRNAs.
The delta is closing between care team and md only…. For lots of places it’s not a $ issue it’s a number of bodies issue.
I do worry that more places faced with the shortage will just end up convincing their surgeons to delegate for the crnas… it’s happening on the outskirts of dallas already. Admin won’t pay us if they can find another way…. And don’t for one sec think that any admin ever cared a rats ass about safety, liability or patient outcome.
I do worry that more places faced with the shortage will just end up convincing their surgeons to delegate for the crnas… it’s happening on the outskirts of dallas already. Admin won’t pay us if they can find another way…. And don’t for one sec think that any admin ever cared a rats ass about safety, liability or patient outcome.
Exactly what’s happening at my shop. Fortunately, CRNAs don’t want to cover weekends or calls. The minute they negotiate this, no reason to keep us around.
I agree with your last statement. I work outside of the ER and have encountered physicians who are poor clinically but admin keep them around to maintain certifications and keep revenue coming in. As most things in life, it is all about the Benjamins.
