Any private groups secure emergency stipend?

[caligas]

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Some at our hospital have talked about forming a Covid/suspected intubation team (anesthesia).

Has anyone approached hospital admin for a stipend for such a team?

 

[Peterluger]

Still a resident, obv in academics right now and soon there will be a dedicated intubation team, separate from the in-charge attending/resident. I’d imagine the same will occur in private practice in the near future, 100% out of necessity

 

[Ipassgas]

I'm a 1099 for a "group" with an exclusive contract at the hospital. As the future of elective surgery is murky, the group prez negotiated salary guarantees for everyone. In exchange for being part time critical care doctors (with the CRNAs being ICU nurses and makeshift RTs).
So yeah, I'm sure on my new ICU days, me and the CRNAs will be the intubation team. Since they're guaranteeing our salaries, it's kinda a stipend?

 

[Gas]

Has anyone had administration approach them about vent management? We are a private group, only do one small community hospital, and already get stipend.

None of us are ICU trained. Other hospital in town same setup as us and not planning on doing vent management.

 

[mmag]

At least one hospital is working on hiring my group for stipended 24/7 ICU procedures team to unload the intensivists.

 

[nimbus]

At least one hospital is working on hiring my group for stipended 24/7 ICU procedures team to unload the intensivists.

Region?

 

[mmag]

Region?

PNW

 

[Arch Guillotti]

Some at our hospital have talked about forming a Covid/suspected intubation team (anesthesia).

Has anyone approached hospital admin for a stipend for such a team?

Sounds a bit sketchy if you are already expected to do the intubations in the first place. Presumably hospitals will be cash strapped because of the loss of OR revenue. Who knows though, hospitals packed to the rafters generate some revenue also.

 

[ambiturner]

Sounds a bit sketchy if you are already expected to do the intubations in the first place. Presumably hospitals will be cash strapped because of the loss of OR revenue. Who knows though, hospitals packed to the rafters generate some revenue also.

A surgical intensivist once told me he generated more revenue rounding on our SICU than doing a busy day of general surgery cases. So if hospitals really do open extra ICUs they might do ok.

 

[caligas]

Sounds a bit sketchy if you are already expected to do the intubations in the first place. Presumably hospitals will be cash strapped because of the loss of OR revenue. Who knows though, hospitals packed to the rafters generate some revenue also.

we being asked to do a higher percentage of airways including the riskiest patients. The whole thing Including donning and doffing is tying people up for an hour per airway. We are needing to add a dedicated person just for Covid airways. We have employees and expenses and our revenue streams are drying up. We will be unable to pay our bills as a corporation and some of us as individuals. We are now going to be increasingly risking our own well being and that of our families. Our Private hospital is quite profitable.

still sketchy to ask for a little help?

 

[Arch Guillotti]

we being asked to do a higher percentage of airways including the riskiest patients. The whole thing Including donning and doffing is tying people up for an hour per airway. We are needing to add a dedicated person just for Covid airways. We have employees and expenses and our revenue streams are drying up. We will be unable to pay our bills as a corporation and some of us as individuals. We are now going to be increasingly risking our own well being and that of our families. Our Private hospital is quite profitable.

still sketchy to ask for a little help?

no I get it. I can just see some random admin saying why should we pay you guys for something you are doing already, that's all. Serious question - I have not put the gear on yet, why is it taking so long? Did you watch a video or something? Or some other resource instructing you how to do it? Our revenue stream is going to dry up also and some hard decisions are going to have to be made as well.

 

[coffeebythelake]

we being asked to do a higher percentage of airways including the riskiest patients. The whole thing Including donning and doffing is tying people up for an hour per airway. We are needing to add a dedicated person just for Covid airways. We have employees and expenses and our revenue streams are drying up. We will be unable to pay our bills as a corporation and some of us as individuals. We are now going to be increasingly risking our own well being and that of our families. Our Private hospital is quite profitable.

still sketchy to ask for a little help?

Our CEO took in close to $20 million in pay last year. We have nearly 10 administrators for each physician, right now probably sitting at home sipping their coffee while we deal with this crisis. Maybe they could trim the fat on their end.

 

[Arch Guillotti]

Our CEO took in close to $20 million in pay last year. We have nearly 10 administrators for each physician, right now probably sitting at home sipping their coffee while we deal with this crisis. Maybe they could trim the fat on their end.

Go public!

 

[caligas]

no I get it. I can just see some random admin saying why should we pay you guys for something you are doing already, that's all. Serious question - I have not put the gear on yet, why is it taking so long? Did you watch a video or something? Or some other resource instructing you how to do it? Our revenue stream is going to dry up also and some hard decisions are going to have to be made as well.

Excellent resource

Guidance for Donning and Doffing Personal Protective Equipment (PPE) During Management of Patients with Selected Viral Hemorrhagic Fevers in U.S. Hospitals Personal Protective Equipment (PPE) | Ebola (Ebola Virus Disease) | CDC

The following informational materials demonstrate the procedures described in CDC guidance for donning and doffing (i.e., putting on and removing) personal protective equipment for all healthcare providers entering the room of a patient hospitalized with known or suspected Ebola virus disease or...

www.cdc.gov

 

[DocVapor]

no I get it. I can just see some random admin saying why should we pay you guys for something you are doing already, that's all. Serious question - I have not put the gear on yet, why is it taking so long? Did you watch a video or something? Or some other resource instructing you how to do it? Our revenue stream is going to dry up also and some hard decisions are going to have to be made as well.

I can't speak for anywhere else but we're being told to head straight to the shower after each COVID-19 intubation because it's so awkward and high risk for contamination doffing the gear we have. That could certainly be part of it.

 

[Robotic Wis-Hipple]

I can't speak for anywhere else but we're being told to head straight to the shower after each COVID-19 intubation because it's so awkward and high risk for contamination doffing the gear we have. That could certainly be part of it.

Honest question; if doffing is such high risk for contamination (and I believe it is, especially if rushed), and you then go shower. Isn’t blasting your skin with hot water very likely to aerosolize therefore just putting you in a hot virus vapor box?

 

[Robotic Wis-Hipple]

Our CEO took in close to $20 million in pay last year. We have nearly 10 administrators for each physician, right now probably sitting at home sipping their coffee while we deal with this crisis. Maybe they could trim the fat on their end.

I feel like there’s a “wish in one hand...” saying for this.

 

[caligas]

Honest question; if doffing is such high risk for contamination (and I believe it is, especially if rushed), and you then go shower. Isn’t blasting your skin with hot water very likely to aerosolize therefore just putting you in a hot virus vapor box?

correct. Our shower protocol has been to bring a nurse (of your choosing) with you to provide assistance.

 

[dhb]

All evidence points to extremely low chance of infection if proper barrier (i think eye protection and facemask) are used and proper hand hygiene applied. I personnally don't think the gowns shoe covers etc etc are of any use

 

[UscGhost]

I agree.

I dont think my feet are a vector for infection

 

[psychbender]

Has anyone had administration approach them about vent management? We are a private group, only do one small community hospital, and already get stipend.

None of us are ICU trained. Other hospital in town same setup as us and not planning on doing vent management.

I'm Anes/CCM in a private group. We created a special agreement to loan my services to the hospital at a fixed rate when I joined. Facing this crisis, the hospital emergently credentialed many of my partners for critical care, and our agreement is being expanded to the rest of my group, so we'll get reimbursed for any of us working in the units.

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[chocomorsel]

I'm Anes/CCM in a private group. We created a special agreement to loan my services to the hospital at a fixed rate when I joined. Facing this crisis, the hospital emergently credentialed many of my partners for critical care, and our agreement is being expanded to the rest of my group, so we'll get reimbursed for any of us working in the units.

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Well, well. Congrats? Or you created a slippery slope?
The question is, do your partners want to be in the unit? Most of our colleagues hate the unit.
I know you gotta do what you gotta do though.

 

[Ronin786]

I'm Anes/CCM in a private group. We created a special agreement to loan my services to the hospital at a fixed rate when I joined. Facing this crisis, the hospital emergently credentialed many of my partners for critical care, and our agreement is being expanded to the rest of my group, so we'll get reimbursed for any of us working in the units.

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How would you guys handle dividing shifts? I assume most are already accounted on. Or are you staffing extra for airways/acuity?

 

[psychbender]

Well, well. Congrats? Or you created a slippery slope?
The question is, do your partners want to be in the unit? Most of our colleagues hate the unit.
I know you gotta do what you gotta do though.

About half my group volunteered. No one is forced, and we're still maintaining a pool to continue to staff the OR and L&D. With OR volume down, it'll be a nice revenue stream to help keep the lights on.

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[psychbender]

How would you guys handle dividing shifts? I assume most are already accounted on. Or are you staffing extra for airways/acuity?

A lot of the details remain to be ironed out. As of now, aside from myself, none of my group is needed in the units. As we admit more positive cases and rule-outs, however, we'll start pulling from my colleagues that have volunteered, to decompress the intensivists. At the moment, one ICU team is managing all of our higher acuity (most of whom are still arguably floor patients) CoVids or rule-outs, while the other teams manage the regular unit patients. What I've proposed to the group is to staff in week-long blocks, and adjust our OR call schedule as people are pulled to the unit. I'm also advocating for mandatory down time before rotating back into the OR, as risk of exposure is higher with repeated contact and direct management of these patients. Since OR volume is so low, we should be able to manage our OR and call commitments with a reduced staffing pool. By the time the hospital starts allowing elective cases to return, our presence in the unit should not be needed, and we should ideally be back to near normal staffing.

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[chocomorsel]

A lot of the details remain to be ironed out. As of now, aside from myself, none of my group is needed in the units. As we admit more positive cases and rule-outs, however, we'll start pulling from my colleagues that have volunteered, to decompress the intensivists. At the moment, one ICU team is managing all of our higher acuity (most of whom are still arguably floor patients) CoVids or rule-outs, while the other teams manage the regular unit patients. What I've proposed to the group is to staff in week-long blocks, and adjust our OR call schedule as people are pulled to the unit. I'm also advocating for mandatory down time before rotating back into the OR, as risk of exposure is higher with repeated contact and direct management of these patients. Since OR volume is so low, we should be able to manage our OR and call commitments with a reduced staffing pool. By the time the hospital starts allowing elective cases to return, our presence in the unit should not be needed, and we should ideally be back to near normal staffing.

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Weeklong blocks, in a crisis, may be too much.
Good luck. How big is your ICU?

 

[psychbender]

During normal times, we have about 42 ICU beds between four docs. If we take over the ASC and convert it to an ICU with two or three patients per OR, that adds 12-18. We have other expansion options that can give us more vented beds, as well. Right now, our rate limiting issue would be intensivists and critical care nurses, not the vents themselves.

As for the shift duration. A week of 12 hour shifts is what all of us ICU docs here already do, and where I pulled my number. We could also try splitting a week into a three and four day shifts, and we have precedent for that, as well with done of the intensivists. Bottom line, we're not sure yet, but we have the volunteers and the agreement with the hospital ironed out to get paid for the work.

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[AdmiralChz]

@psychbender :

Are y’all going to pay people the same (assuming W2 salaried) depending on whether they cover the unit vs OR? Hourly rate? Who is paying - billing the patient? Hospital? Who covers at night?

 

[chocomorsel]

During normal times, we have about 42 ICU beds between four docs. If we take over the ASC and convert it to an ICU with two or three patients per OR, that adds 12-18. We have other expansion options that can give us more vented beds, as well. Right now, our rate limiting issue would be intensivists and critical care nurses, not the vents themselves.

As for the shift duration. A week of 12 hour shifts is what all of us ICU docs here already do, and where I pulled my number. We could also try splitting a week into a three and four day shifts, and we have precedent for that, as well with done of the intensivists. Bottom line, we're not sure yet, but we have the volunteers and the agreement with the hospital ironed out to get paid for the work.

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Strong work buddy. Good luck. Keep us posted.

 

[psychbender]

@psychbender :

Are y’all going to pay people the same (assuming W2 salaried) depending on whether they cover the unit vs OR? Hourly rate? Who is paying - billing the patient? Hospital? Who covers at night?

The hospital will bill CC time and procedures, my group will collect a flat rate per doctor, per shift worked. We are not salaried, but paid based on how much we work and how much call we take (and in my case, how much ICU time I take). When I joined, I negotiated that an ICU day pays more than regular OR days or even most call days. Right now, nights are still covered by the hospital-employed intensivists. If we start picking up night shifts, the same rate applies.

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