Anesthesiologist shortage

[lotsapain]

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I’ve run into plenty of boomers and senior partners who want the same thing. If anything, maybe more so than the younger folks.

Hey they created that bed of nails... let them sleep in it..... they collected 1.2 mil a year now they want a cushy job.... paleeesee ... what I am saying is folks on here keep asking for more money doing less work... there is a middle ground... I absolutely agree that anything more then 40-45 hours a week for a high stress high risk job is absurd.... for those who do choose to do more they can be compensated extra.... that being said asking absurd money (like locums do now) has it's limits. Now let me ask you this, what about guaranteed return on your money ? what about quality of delivered care?

 

[deleted641888]

Hey they created that bed of nails... let them sleep in it..... they collected 1.2 mil a year now they want a cushy job.... paleeesee ... what I am saying is folks on here keep asking for more money doing less work... there is a middle ground... I absolutely agree that anything more then 40-45 hours a week for a high stress high risk job is absurd.... for those who do choose to do more they can be compensated extra.... that being said asking absurd money (like locums do now) has it's limits. Now let me ask you this, what about guaranteed return on your money ? what about quality of delivered care?

I’m not sure what your question is. The market dictates what “absurd” is. The price is what the hospitals and groups are willing to pay. Quality of delivered care? I know absolute *****s delivering anesthetics and doing surgery every day. This is not exclusive to locums.

 

[sevo00]

You did know that this profession implies early morning starts right? Perhaps you are in the wrong field?! Pathology and ophthalmology are short too. Perhaps find a plastics surgery office twice a week if you can make it work ..... I understand your frustration but I am tired of hearing this consistent song of "I don't like this.... I don't like that" and pay me 600-700k to come in two days a week.... come on people I am very well aware of certain practices pushing crazy hours but you cannot expect to not work and get paid ...... this millenial approach to life will go so far.... I am all about safe workplace practices limiting call to 12-16 hours but rolling into a hospital when you feel like it.... then you are surprised why the profession is treated like it is.... bunch of snowflakes who want to get paid and do nothing... there is a middle ground..

Preach somewhere else boomer. Calling someone a snowflake because they want to be there for their child? Wow. Why don’t you pick up a book on parenting basics

 

[aneftp]

Hey they created that bed of nails... let them sleep in it..... they collected 1.2 mil a year now they want a cushy job.... paleeesee ... what I am saying is folks on here keep asking for more money doing less work... there is a middle ground... I absolutely agree that anything more then 40-45 hours a week for a high stress high risk job is absurd.... for those who do choose to do more they can be compensated extra.... that being said asking absurd money (like locums do now) has it's limits. Now let me ask you this, what about guaranteed return on your money ? what about quality of delivered care?

You should go on the crna locums forums. The professional 1099 crna travelers will not take anything less than $250-hr plus most want guarantee 40 hours and weekends is $300/hr and or overtime

Plus housing stipends

What many will do is get $4k a month tax free

Than rent a cheaper place (say 3k a month air b n b). So not only do they “profit 1k a month” tax free

They deduce the 3k a month air b n b long term rentals (that’s a 1k a month tax savings). So that’s another 24k real time savings a year to travel

 

[lotsapain]

Preach somewhere else boomer. Calling someone a snowflake because they want to be there for their child? Wow. Why don’t you pick up a book on parenting basics

This is why I don't waste my time here because of uneducated ****oles like yourself.... read a book go outside.... looser

 

[triggermaster]

You should go on the crna locums forums. The professional 1099 crna travelers will not take anything less than $250-hr plus most want guarantee 40 hours and weekends is $300/hr and or overtime

Plus housing stipends

What many will do is get $4k a month tax free

Than rent a cheaper place (say 3k a month air b n b). So not only do they “profit 1k a month” tax free

They deduce the 3k a month air b n b long term rentals (that’s a 1k a month tax savings). So that’s another 24k real time savings a year to travel

What do they do other ‘than rent a cheaper place’?

 

[deleted1183938]

I don’t know how long you have been out in practice. It’s the wild Wild West now.

I’ve been doing it over 2 decades plus.

We are in unchartered territory

You have random anesthesiologist (recycled) who cover places intermittent

Only the cushiest places (7-1/2pm) have full time docs with 1:2 or 1:3 coverage can retain anesthesia docs full time these days.

My friend has surgery center contract in prime downtown location in a bit top 15 metro area The long time doc he was paying 420k /8 weeks for th last 15 years is retiring. Doc is old school willing to work to 6pm some days there. He just works. He’s ok

But the new people want more. And balk when it’s 6pm (2 days a week) so he can’t get anyone for 450k/9 weeks now. It’s been 4 months. So his private group has been cross covering the surgery center and it’s annoying them also!

I see it!! I get it.

 

[aneftp]

What do they do other ‘than rent a cheaper place’?

Pocketing the difference if they rent cheaper place. And they deduct the cheaper place for more tax savings. That’s why they prefer 1099. They won’t work w2 anymore.

Remember the housing stipend is literally tax free they they are getting

So 48k tax free is equivalent to another 75k in “income” not taxed. It’s even better if they have a semi fake address to be “more than 50 miles from home” so they just pocket the entire 48k tax free

 

[Coffee PRN]

You should go on the crna locums forums. The professional 1099 crna travelers will not take anything less than $250-hr plus most want guarantee 40 hours and weekends is $300/hr and or overtime

Plus housing stipends

What many will do is get $4k a month tax free

Than rent a cheaper place (say 3k a month air b n b). So not only do they “profit 1k a month” tax free

They deduce the 3k a month air b n b long term rentals (that’s a 1k a month tax savings). So that’s another 24k real time savings a year to travel

You can’t take tax free reimbursements/stipends and then also deduct business expenses for those reimbursements.

 

[aneftp]

You can’t take tax free reimbursements/stipends and then also deduct business expenses for those reimbursements.

And hospitals can’t claim “free care” and go after patients while deducting those as expenses per accounting books. It’s a grey area

How do you want to play the game?

It’s common knowledge in the 1099 crna locums world this dedution on travel expenses and people think I deduct a lot.

This crna I know deducts airplane and boat gasoline money. Close to 100k a year in fuel. It’s insane. And they ain’t using their own fuel to actually go to work assignments. Locums places pay for their assignments for travel the majority of the time. They will log a few flights for true business expenses to locations they like. Just in case of adults. Same with the boat which is usually used for personal deep sea fishing. It ain’t a cheap boat either.

 

[Coffee PRN]

That question in particular is not a grey area. I’ve researched it at depth and also asked my CPA. I wish I could have my cake and eat it by deducting expenses while also getting them fully reimbursed, but it doesn’t fly by the IRS.

Travel nurses, who are much more numerous and have been doing this much longer, also have the same situation with their stipends and they must duplicate expenses to qualify for their stipends being tax free. You must be traveling from your tax home.

 

[sevo00]

This is why I don't waste my time here because of uneducated ****oles like yourself.... read a book go outside.... looser

learn to spell. what the hell is looser

 

[narcotics999]

You can’t take tax free reimbursements/stipends and then also deduct business expenses for those reimbursements.

If only IRS finds it, lol

 

[pgg]

You can’t take tax free reimbursements/stipends and then also deduct business expenses for those reimbursements.

Wait for it ...

It’s a grey area

LOL

 

[AKMD_1984]

You can’t take tax free reimbursements/stipends and then also deduct business expenses for those reimbursements.

From my understanding it depends how it’s invoiced.

If you spend it for legitimate business needs, you deduct it.

You can ask the locums company to take that credit and instead of categorizing it, just increase the income for you so it’s not entered as an expense item on your behalf rather increased income. There’s no double dipping this way.

All this can be negotiated. It’s minor stuff.

It’s the same math but treated differently.

 

[Coffee PRN]

From my understanding it depends how it’s invoiced.

If you spend it for legitimate business needs, you deduct it.

You can ask the locums company to take that credit and instead of categorizing it, just increase the income for you so it’s not entered as an expense item on your behalf rather increased income. There’s no double dipping this way.

All this can be negotiated. It’s minor stuff.

It’s the same math but treated differently.

I believe we are saying the same thing?

If the locums agency is already giving it to you as a reimbursement (e.g. does not include it as income on your 1099), then you cannot then go and deduct that expense you were already reimbursed for on your tax return.

How much the IRS can actually catch this if it's not on your 1099 is another question.

 

[AKMD_1984]

I believe we are saying the same thing?

If the locums agency is already giving it to you as a reimbursement (e.g. does not include it as income on your 1099), then you cannot then go and deduct that expense you were already reimbursed for on your tax return.

How much the IRS can actually catch this if it's not on your 1099 is another question.

So the locums company cannot qualify that as a separate reimbursement. They just increase your rate to reflect what you would have been given for travel/ meals/ etc. make the overall income more without including the reimbursement component.

Then you can deduct it after spending money on those things yourself

When you classify on invoice these items then it’s double dipping

 

[Coffee PRN]

So the locums company cannot qualify that as a separate reimbursement. They just increase your rate to reflect what you would have been given for travel/ meals/ etc. make the overall income more without including the reimbursement component.

Then you can deduct it after spending money on those things yourself

When you classify on invoice these items then it’s double dipping

Exactly. It's one or the other, you can't take the tax free stipend and then deduct as well.

 

[aneftp]

Exactly. It's one or the other, you can't take the tax free stipend and then deduct as well.

Correct.

I’m not saying it’s legal.

It’s like 1099 paid crna couples (or MD couples) or whatever. If they both go on vacation/cme/travel assignments together. That’s double the fun literally for tax purposes even if they are using one car for travel.

 

[agammaglobulin]

You did know that this profession implies early morning starts right? Perhaps you are in the wrong field?! Pathology and ophthalmology are short too. Perhaps find a plastics surgery office twice a week if you can make it work ..... I understand your frustration but I am tired of hearing this consistent song of "I don't like this.... I don't like that" and pay me 600-700k to come in two days a week.... come on people I am very well aware of certain practices pushing crazy hours but you cannot expect to not work and get paid ...... this millenial approach to life will go so far.... I am all about safe workplace practices limiting call to 12-16 hours but rolling into a hospital when you feel like it.... then you are surprised why the profession is treated like it is.... bunch of snowflakes who want to get paid and do nothing... there is a middle ground..

Come on. No one is asking for 600k to work 2 days a week. There is nothing wrong with wanting to work less and make less. People who want their weekends off and mommy track/surgicenter positions are happy to take 350-400k in this market.

Like most things, the truth is in the middle. Most PP groups use to have much earlier exit times each day and, inflation adjusted, equal or better pay. So although the younger "millennials" want more time off, it's probably actually more total hours worked for less pay. For example, 10-12 weeks off while working 7a-5p making $500K in 2024 is more work AND less pay than 6 weeks off working 7a-3p making $350K in 2000.

 

[deleted1183938]

Like most things, the truth is in the middle. Most PP groups use to have much earlier exit times each day and, inflation adjusted, equal or better pay. So although the younger "millennials" want more time off, it's probably actually more total hours worked for less pay. For example, 10-12 weeks off while working 7a-5p making $500K is more work AND less pay than 6 weeks off working 7a-3p making $350K in 2000.

What happened to earlier release times? I still see it in some practices.

 

[aneftp]

What happened to earlier release times? I still see it in some practices.

The real issue was salaries were really depressed in many markets from 2011-2018. With AMCs buying practices left and right.

350k average 50 hours a week a 5-6 calls a month with hardly any overtime potential (meaning if y were short staff suck it up) and 6 weeks vacation was pretty much standard in Florida for 6-7 years in the mid 2010s.

Now the standard is 450k/8-10 weeks average 42 hours a week in Florida with overtime/weekend potential to push it to 550-600k w2 with amc

 

[medicine2wallstreet]

You did know that this profession implies early morning starts right? Perhaps you are in the wrong field?! Pathology and ophthalmology are short too. Perhaps find a plastics surgery office twice a week if you can make it work ..... I understand your frustration but I am tired of hearing this consistent song of "I don't like this.... I don't like that" and pay me 600-700k to come in two days a week.... come on people I am very well aware of certain practices pushing crazy hours but you cannot expect to not work and get paid ...... this millenial approach to life will go so far.... I am all about safe workplace practices limiting call to 12-16 hours but rolling into a hospital when you feel like it.... then you are surprised why the profession is treated like it is.... bunch of snowflakes who want to get paid and do nothing... there is a middle ground..

Completely agree with you here. Getting to the hospital at or before 630 is the definition of an anesthesiologist job. ORs have early first starts. Go be a family doc or pain doc if you want to get to work at 830. I don't wanna hear the bitching.

I'm 33 and sick of the bitching and moaning from my age group about what they signed up for.

This is America.

YOU HAVE TO WORK FOR A LIVING.

 

[aneftp]

Completely agree with you here. Getting to the hospital at or before 630 is the definition of an anesthesiologist job. ORs have early first starts. Go be a family doc or pain doc if you want to get to work at 830. I don't wanna hear the bitching.

I'm 33 and sick of the bitching and moaning from my age group about what they signed up for.

This is America.

YOU HAVE TO WORK FOR A LIVING.

I try not to show up till 650am at my job

Cases start at 730am. I can see all my patients in 20 min or less and block them.

If I have 7am start. I will show up 640am

If I do my own cases. I will show up at 7am

This 630am show up is way too early for me. Not that I can’t show up that early. I can get all the patients ready quickly.

At surgery center. I show up 7am.

Even doing locums. I don’t show up to 7am (for 730 starts)

 

[anbuitachi]

so what do you do with CME reimbursements at a w2 job. report that as income.. ? you buy a laptop for 2k, get 2k in reimbursement. what is that 2k on your taxes?

 

[aneftp]

so what do you do with CME reimbursements at a w2 job. report that as income.. ? you buy a laptop for 2k, get 2k in reimbursement. what is that 2k on your taxes?

Cme reimbursement are tax free as w2 for employee . Employer deducts

As 1099 self employed u are employer and employee. Remember you have to pay self employment taxes as well so that’s a hit

 

[dabears505]

I think the shortage will continue because nobody wants to do overnight in house call anymore. It's just gotten to a point where there's enough money to be made on the day time that the marginal utility of that night shift money is just not worth it anymore. Either day salaries have to go down, or consolidation requiring in house anesthesia will have to take place. I'm not sure some people will do overnight at any rate so just increasing the rate might not solve the problem. Already seeing a steady amount OB departments shut down.

 

[aneftp]

I think the shortage will continue because nobody wants to do overnight in house call anymore. It's just gotten to a point where there's enough money to be made on the day time that the marginal utility of that night shift money is just not worth it anymore. Either day salaries have to go down, or consolidation requiring in house anesthesia will have to take place. I'm not sure some people will do overnight at any rate so just increasing the rate might not solve the problem. Already seeing a steady amount OB departments shut down.

Night float slot is preferred slot at my work place.
Trauma 2 place. Better deal 4 docs

Trauma 1 place 20 miles away also preferred slot also. 4 docs. Easy.

It’s the day docs they can’t find! Ain’t no one want to work 5 days a week daytime. Unless they can get out before 2pm routinely.

Switch to night float. Have docs who want to do it. The docs who don’t want to do nights can do days.

 

[deleted1130227]

Night float slot is preferred slot at my work place.
Trauma 2 place. Better deal 4 docs

Trauma 1 place 20 miles away also preferred slot also. 4 docs. Easy.

It’s the day docs they can’t find! Ain’t no one want to work 5 days a week daytime. Unless they can get out before 2pm routinely.

Switch to night float. Have docs who want to do it. The docs who don’t want to do nights can do days.

yup. Currently, the night pay differential is amazing. My younger self would have been all over it. My current old self just can't do the nights any more.

 

[NightyNight]

Once everyone is “employed”, I wonder what control people will have with their schedule. When that critical mass is reached, I think people will be forced to work for less. Despite shortages, I have a feeling salaries will drop like they did for primary docs. Some are making close to 200k. Wonder if anesthesia goes down to 400-450 for 50-60h per week.

 

[aneftp]

Once everyone is “employed”, I wonder what control people will have with their schedule. When that critical mass is reached, I think people will be forced to work for less. Despite shortages, I have a feeling salaries will drop like they did for primary docs. Some are making close to 200k. Wonder if anesthesia goes down to 400-450 for 50-60h per week.

It will cost Hospital a lot. Can it happen? Definitely

But with crnas demanding more 2-3 days a week as W2 or going 1099 full Time. They aren’t exactly gonna to save the hospital any money.

A 2-3 day a week crna working 16/24 equivalent of to really losing an extra crna for the other 3 days. You aren’t saving money with crnas anymore

The all MD module supposedly according to the Aana is the least efficient model

So we got the collaboration model. Thads the model we are trending towards.

10% savings using crna. That’s about it.

Those who want to work more and off peak hours nights and weekends will likely get more

Depends if doc go the crna way of hourly. It will be great for those who want to work. Those
Who want to sign charts will not be so good.

 

[psychbender]

The all MD module supposedly according to the Aana is the least efficient model

So we got the collaboration model. Thads the model we are trending towards.

10% savings using crna. That’s about it.

Ok, but the collaborative model, with docs and CRNAs each doing their own cases, is not any more efficient than physician-only, as everyone is still just doing their own cases. At least with medical direction or supervision models, there can be a physician free to see the next case, do the block, see a patient in PACU, etc.

 

[aneftp]

Ok, but the collaborative model, with docs and CRNAs each doing their own cases, is not any more efficient than physician-only, as everyone is still just doing their own cases. At least with medical direction or supervision models, there can be a physician free to see the next case, do the block, see a patient in PACU, etc.

Usually only need one md available like any md only model works.

I’ve been in md only practice. That’s just the way things work.

 

[psychbender]

Usually only need one md available like any md only model works.

I’ve been in md only practice. That’s just the way things work.

I know that. I'm commenting on the idea that collaborative is efficient, but physician- only is not. If CRNAs are doing their cases independently, and physicians are doing their cases independently, then it is not any more efficient than of they were all physicians doing their own cases. I would actually argue that it is less efficient, given CRNAs have substantially less experience with blocks, lines, prepping sick patients solo than physicians do. I saw this in the Army all the time. I could block my own patients between cases, but if a CRNA wanted to do their own block, they'd need to have someone get them out from the room (who then finished the case for them) while they struggled with the block, and still sometimes delayed the start of the next case.

 

[aneftp]

I know that. I'm commenting on the idea that collaborative is efficient, but physician- only is not. If CRNAs are doing their cases independently, and physicians are doing their cases independently, then it is not any more efficient than of they were all physicians doing their own cases. I would actually argue that it is less efficient, given CRNAs have substantially less experience with blocks, lines, prepping sick patients solo than physicians do. I saw this in the Army all the time. I could block my own patients between cases, but if a CRNA wanted to do their own block, they'd need to have someone get them out from the room (who then finished the case for them) while they struggled with the block, and still sometimes delayed the start of the next case.

So that doc does the harder cases. Crnas can be shifted towards more appropriate cases.

Hospitals will pay docs say 10-15% extra in collaborative model.

Docs 450k/45 hours a week including calls/weekends some pre call early ours, post call off.

Crnas 380k/40 hours a week 4 days a week 7-5pm. M-Thursday or Tuesday-Friday

Sounds like a win win for the hospital

 

[crash2500]

So that doc does the harder cases. Crnas can be shifted towards more appropriate cases.

Hospitals will pay docs say 10-15% extra in collaborative model.

Docs 450k/45 hours a week including calls/weekends some pre call early ours, post call off.

Crnas 380k/40 hours a week 4 days a week 7-5pm. M-Thursday or Tuesday-Friday

Sounds like a win win for the hospital

Lol no doc gonna take a job where you work all nights and weekends AND more hours for 70 k more than a nurse.

You have to be the most outrageous poster on here.

 

[dabears505]

Lol no doc gonna take a job where you work all nights and weekends AND more hours for 70 k more than a nurse.

You have to be the most outrageous poster on here.

You may think he's outrageous but it's coming. This shortage is going to accelerate the demise of physician anesthesiologist

 

[NightyNight]

You may think he's outrageous but it's coming. This shortage is going to accelerate the demise of physician anesthesiologist

Thus save and downsize wherever you can. The faster out of the rat race, the better. I wish I was 59 and could just leave.

 

[crash2500]

You may think he's outrageous but it's coming. This shortage is going to accelerate the demise of physician anesthesiologist

Lol ok. No one is arguing a change in practice model but those hours and numbers are chicken little numbers.

 

[Status Sciaticus]

You may think he's outrageous but it's coming. This shortage is going to accelerate the demise of physician anesthesiologist

Nah. Just offer to work for the same hours as the anesthesia nurse. No brainer option would be to pick you. Do a side business/enjoy your life with all that free time off.

 

[aneftp]

Lol no doc gonna take a job where you work all nights all weekends AND more hours for 70 k more than a nurse.

You have to be the most outrageous poster on here.

You are laughing but those jobs already exist and it’s in plain site with crna locums making 380k 1099 working 4 days a week 10 hours a day. These are essentially full time crnas who have worked at the same facility for years. Like
Napa facilities up north and envision/envoy facilities down south.

Same place as full time docs 450k doing calls who work on average 45 hours a week.

Sure the docs can probably make 550k w2 doing extra calls. But what I’m saying really exists up and down the east coast already for the hours I quoted with long time crna locums. One crna locums been at same place for 9
Years. It’s pretty funny. That’s in Florida. Another in New York I know. Been there 5 years.

 

[deleted1183938]

I try not to show up till 650am at my job

Cases start at 730am. I can see all my patients in 20 min or less and block them.

If I have 7am start. I will show up 640am

If I do my own cases. I will show up at 7am

This 630am show up is way too early for me. Not that I can’t show up that early. I can get all the patients ready quickly.

At surgery center. I show up 7am.

Even doing locums. I don’t show up to 7am (for 730 starts)

I am at a practice where they want cut times at 0700. And wheels in somewhere between. 0630-0645. And let me tell you, I struggle to get there by 6. I think it’s atrocious. I run late a lot. Don’t know how long I am gonna last. Lol

 

[T-burglar]

I would never join a practice that wanted incision at 7 , and I would leave if a shift to that were proposed. Lol **** that **** you’re risking early onset dementia depriving yourself of sleep for years

 

[sevo00]

I would never join a practice that wanted incision at 7 , and I would leave if a shift to that were proposed. Lol **** that **** you’re risking early onset dementia depriving yourself of sleep for years

Agree. ******ios

 

[Howard888]

Agree. ******ios

Is all this for real? I’ve worked in 3-4 major metropolitan areas (each with 6/8 hospitals). At 80% of these facilities we’d had 2-4 rooms every morning that were 6:30 in room. Then a good few rooms 6:45 in room and rest 7. Maybe only 1-2 rooms later than 7am. I’ve worked at surgery centers that were 6am in room with blocks in preop.

6:30 in room pretty standard. At least in southeast.

Guess other areas in country different? Good luck finding a job with 7:30 starts in southeast

 

[sevo00]

Is all this for real? I’ve worked in 3-4 major metropolitan areas (each with 6/8 hospitals). At 80% of these facilities we’d had 2-4 rooms every morning that were 6:30 in room. Then a good few rooms 6:45 in room and rest 7. Maybe only 1-2 rooms later than 7am. I’ve worked at surgery centers that were 6am in room with blocks in preop.

6:30 in room pretty standard. At least in southeast.

Guess other areas in country different? Good luck finding a job with 7:30 starts in southeast

Never been at a hospital with start times before 7:30

 

[psychbender]

Is all this for real? I’ve worked in 3-4 major metropolitan areas (each with 6/8 hospitals). At 80% of these facilities we’d had 2-4 rooms every morning that were 6:30 in room. Then a good few rooms 6:45 in room and rest 7. Maybe only 1-2 rooms later than 7am. I’ve worked at surgery centers that were 6am in room with blocks in preop.

6:30 in room pretty standard. At least in southeast.

Guess other areas in country different? Good luck finding a job with 7:30 starts in southeast

Which states? I've worked in 3 Georgia hospitals, and none started before 0730, except for cardiac at one (0700).

 

[pgg]

My fellowship institution did in-OR start times of 0630 for hearts and for each of the 365 days I was there I fully understood how weird and ridiculous and unnecessary that was. The lifers at that institution didn't see anything amiss.

0730 is early enough. I get annoyed when I see the odd 0715 on the board where I work now.

 

[aneftp]

My fellowship institution did in-OR start times of 0630 for hearts and for each of the 365 days I was there I fully understood how weird and ridiculous and unnecessary that was. The lifers at that institution didn't see anything amiss.

0730 is early enough. I get annoyed when I see the odd 0715 on the board where I work now.

My first institution trauma one center

The night team coming off duty started the 630am heart cases. Lines in by 650-7am

Cardiac wanted 7am cut time.

These days the night float team leaves at 630am to go to their second job across town to make more money.

 

[Howard888]

OK, Texas, NC, and TN-big cities, Nashville, Charlotte, Dallas

Literally every hospital. 6:30 was more common than 7:30. Most were 6:45-7 in room but usually 2-4 6:30 in room every day. Orthopedic ASCs in room 6-6:15 for one or two rooms. Usually Neuro or ortho was 6:30 but would even be gyn or something sometimes. Nursing staff actually preferred these starts as their shift finished at 2:30.

7:30 as the norm was unheard of.