Cedars Sinai Anesthesiologist Spills the Beans

[sloh]

Link to full post here

This money hungry, VIP catering institution would run over any employee in the pursuit of a loose dollar on the floor while clapping for the “healthcare hero”. This became ever apparent in the management of the Anesthesiology department at Cedars Sinai when they decided to renegotiate the contract of their 100+ anesthesiologists much to chagrin of all employed. This supposed academic institution which prides itself on the label is anything but an academic institution, it depends heavily on residents and fellows to operate, but does little to support actual academic integration with its faculty. It makes it difficult for faculty to have dedicated time to lecture residents, it is not staffed well enough to provide relief for its residents or faculty, and it expects all to continue to work well past end of shift to finish the litany of cases it is too poorly staffed to cope with. Meanwhile Cedars decided to cut its nose off despite its face and pursue gouging its employees of their prior benefits including CME time (They offer but almost never approve), academic development, vacation, professorship opportunities, promised bonuses (rescinded) and a 401k that doesn't even match their employed admins. In gutting these benefits a reasonable employer would host a meeting to discuss the proposed changes then attempt to justify the means to the end. But when you work for a heavily fortified castle, with its army of lawyers standing at the ready atop its concrete walls, they feel untouchable and unaccountable to those who work with and for them and dictate the terms and the resolution far in advance of any discussion.

A quick bit of history is in order: the anesthesiology department requested a meeting with their leadership (ahead of proposed changes) which comprises the interim chair of anesthesiology (actually held by a surgeon which is very irregular), two vice chairs (non practicing and ill equipped anesthesiologists for leadership), an ever powerful head of HR (Making clinical power plays and decisions with no clinical/medical background) and a growing list of admins for the department.

Lawyers at the ready, cedars views any open discussion as collective bargaining. An institution that grips power like a dictatorship and refuses to listen to any demands of its nurses or physicians while expecting the employee to soldier on with a smile on their face. So why dont people ban together and take on this behemoth of a monster? Fear. Fear of reprisal, fear of judgement, fear of loss of reputation, loss of employment, cost of the fight, fear of retaliation with assignments or call. You may say "That sounds toxic just leave"... and many have or are in the process. This has only added to the shortfall of staffing. Meanwhile "leadership" forges ahead claiming they are heavily recruiting (not true) but it is at a rate dwarfed by its attrition. Simultaneously “leadership” laments over their difficulty recruiting because of the culture they themselves manifest and then project blame onto the very same department they engineered the culture for. A culture that becomes increasingly incentivized to be self serving despite being comprised of great people with amazing skills who work very well together. In time even the strongest camels cannot carry more straw. After all the warnings from their employees and begging for solutions Cedars leadership finally relented and decided to open discussion to the many line items. Alas, the joke remains on the employed because the dictatorship is steadfast in its deliberate neglect.

Leaderships last weapon of pleasure is the built in fear to solicit a dormant obedient employee, while pretending it is benevolent, supportive and patient centric. Thus the anesthesiologist shrinks quietly back behind the curtain, taking care of the safety and comfort of their patients as the pressure under the boot of their oppressor mounts. Meanwhile, their colleagues in arms stand idly by equally fearful, providing support just short of helpful action, and the system slowly spirals toward failure; another feat they undoubtedly will cast blame on the anesthesiologist who is too powerless or too fearful to effect change for themselves or patient care. The beast then forges ahead, scattering the remains of its employees so it can raise banners of success across the city, and the soldiers soldier on, hoping for a glimmer of hope and change or at least, a changing of the guard.

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[IMGASMD]

All too familiar of a story. Big hospital system crush any physician groups to exert dominance….

Loyalty has no meaning, nor does stability. Medicine in general has become a transactional field. Just look at all the nurses are doing. My service now will go to the highest bidder. I will choose my conditions and rules.

 

[gassyclimber]

From the surgeon interim dept chief all the way up to hospital leadership, that place 100% sounds like a toxic work environment. Probably why they’re afraid of unionization.

They can unfortunately bank on the churn of Anesthesiologists wanting to live in LA as well as the fear of lost income to those there currently. Student loan debt, mortgages, and families help give hospitals the upper hand. Hopefully word gets out to break that cycle.

 

[aneftp]

The old original cedar Sinai’s practice the true partner private guys who covered ob made 7 figures easy not working hard

Gave all the ghetto (medi-cal) teaching patients to the new grads in partnership track.

 

[anonperson]

Job market is booming for most specialties across the country.

Your main leverage in these situations is to leave. No point in eating $hit for no reason. The organization will either negotiate in good faith or not. You can tell quickly which camp they are in.

The anesthesia groups at two of the community hospitals I operate out of in Los Angeles county are actively hiring but having trouble due to a variety of factors. I'm hearing the same thing from other colleagues in various places in Los Angeles county and Orange County.

I'm not anesthesia, but had a similar situation with garbage leadership and a bad work environment. Several colleagues left for different places literally 5 miles away and everyone who left is happier and better payed. Meanwhile, colleagues who stuck around are still dealing with the same issues.

 

[bronx43]

Sounds like every other academic (“fakedemic”) institution (“corporation”) in the country. If you replaced Cedars Sinai with my previous ivory tower shop, it would be entirely believable.

 

[datruth585]

All too familiar of a story. Big hospital system crush any physician groups to exert dominance….

Loyalty has no meaning, nor does stability. Medicine in general has become a transactional field. Just look at all the nurses are doing. My service now will go to the highest bidder. I will choose my conditions and rules.

This is why more anesthesiologists need to consider contracting, locum tenens, 1099 work.

There is no loyalty.

They make you take all the risk and all the stress, allowing them to take the rest.

 

[Dr. Rude]

Love to hear on this subject from that sanctimonious recently retired, female, well published anesthesiologist.

 

[Anesthesia_Guy]

Love to hear on this subject from that sanctimonious recently retired, female, well published anesthesiologist.

A true "Karen."

 

[IMGASMD]

This is why more anesthesiologists need to consider contracting, locum tenens, 1099 work.

There is no loyalty.

They make you take all the risk and all the stress, allowing them to take the rest.

I’ve always like the idea of brotherhood/sisterhood; that we are in this together. The current environment really makes this impossible.

Sure the money is good, but without that “stability,” there just isn’t much higher order business that can be done. Fighting CRNA encroachment, AMCs cutting costs tactics or the latest hospitals takeover of private practices.

We are all small potatoes compared to all these other entities, even smaller when we are going it at alone (Locum) vs group (private practices.)

 

[IlDestriero]

The answer is easy, change jobs. All the handcuffs are self imposed. The environment won’t change much if it’s that toxic. There’s 50 hospitals in the LA area. Sell the house that doubled or more in the last 10 years and cry in your new S class as you drive to your better job every morning.

 

[sloh]

The answer is easy, change jobs. All the handcuffs are self imposed. The environment won’t change much if it’s that toxic. There’s 50 hospitals in the LA area. Sell the house that doubled or more in the last 10 years and cry in your new S class as you drive to your better job every morning.

Even with the cedars comp, these docs be driving S classes anyways

Unless they are just really financially irresponsible

 

[SRYSPAC]

All this tracks; I had a residency classmate go there for their OB and THEN a Regional fellowship , and what he described his attending days as sounds very consistent with the overall vibe of the original post.

 

[sevo00]

All this tracks; I had a residency classmate go there for their OB and THEN a Regional fellowship , and what he described his attending days as sounds very consistent with the overall vibe of the original post.

Damn talk about a waste of two years

 

[kidthor]

All the handcuffs are self imposed.

This is what I learned after several years of therapy.

Also, that’s what she said.

 

[anbuitachi]

Damn talk about a waste of two years

gunning for academia job i guess. its crazy how much they care about fellowship for ob, and more for regiona l as well

 

[IlDestriero]

gunning for academia job i guess. its crazy how much they care about fellowship for ob, and more for regiona l as well

Seriously, what are they doing in these OB fellowships that I can’t do? I’d argue that I do more as I do fetal surgery, which they almost certainly don’t.

 

[pgg]

Seriously, what are they doing in these OB fellowships that I can’t do? I’d argue that I do more as I do fetal surgery, which they almost certainly don’t.

When I was a resident I did a complicated OB rotation at Brigham, where they had OB fellows (twoor three? it's been a while). Two of them had trained at reputable places in Europe, and had moved to the USA. Somehow in order to be eligible for US licensure and board certification they had to do more years as resident-equivalents. So instead of redoing a residency, they had worked a deal in which they could meet the requirement by being "fellows" in non-ACGME programs. This was more humane than being residents again and they got the opportunity to study something more complex or in depth. So one of them did a neuroanesthesia fellow and then an OB anesthesia fellowship. Not sure if he had to do a third one also or if those two years met the requirement.

I knew someone in the Navy who did a split regional/OB fellowship. As you know the rules and opportunity costs for fellowships in the military are different, and sometimes the fellowship year can work out to be a parole year to the civilian world without impacting obligated service, so it's free. Makes sense to do any fellowship you're interested in if that's the case.

And I guess OB fellowships might open the door to some specific jobs but yeah it seems like the year could be better spent for 99% of people.

 

[anbuitachi]

Seriously, what are they doing in these OB fellowships that I can’t do? I’d argue that I do more as I do fetal surgery, which they almost certainly don’t.

so the department can they say all their ob anes are fellowship trained and patients automatically equate that as better

 

[triggermaster]

so the department can they say all their ob anes are fellowship trained and patients automatically equate that as better

Yeah, except no one asks and even fewer chose their hospital based on OB fellowship-trained anesthesiologists. They’re advertising to a captive customer base.

 

[SRYSPAC]

My residency classmate had his training sponsored by the same folks that brought us LIV golf, he is definitely NOT an academic

 

[pgg]

Yeah, except no one asks and even fewer chose their hospital based on OB fellowship-trained anesthesiologists. They’re advertising to a captive customer base.

There are markets where well-insured patients have a choice about where to go, and the facilities advertise luxury birthing rooms and all kinds of other crap. I can see the fellowship trained anesthesia being an advertising point.

These practices can be freakishly lucrative and less painful to work in, because that demographic by definition isn't full of drug users and morbidly obese hillbillies and teenage mothers-to-be. I suppose there are worse things in life than being pigeonholed into a 100% OB practice and earning a fortune doing it.

 

[Dr. Rude]

There are markets where well-insured patients have a choice about where to go, and the facilities advertise luxury birthing rooms and all kinds of other crap. I can see the fellowship trained anesthesia being an advertising point.

These practices can be freakishly lucrative and less painful to work in, because that demographic by definition isn't full of drug users and morbidly obese hillbillies and teenage mothers-to-be. I suppose there are worse things in life than being pigeonholed into a 100% OB practice and earning a fortune doing it.

All true, but you will have to tolerate patients like this:

 

[IMGASMD]

All true, but you will have to tolerate patients like this:

I didn’t watch it. But if I can get 10 of generally healthy, with insurance that pay for epidural full as billed. Hey…. I would probably still bitch and moan, about all that money that I have to count.

I said this before, 5 years ago, our billing company told us that we should negotiate much more than what we were billing for epidurals. We reluctantly threw out the number $1800 per. They laughed at us.

We were in some ****ty neighborhood, with another hospital right across the highway from us.

Can’t imagine what they can bill with premium insurance.

 

[nimbus]

There are markets where well-insured patients have a choice about where to go, and the facilities advertise luxury birthing rooms and all kinds of other crap. I can see the fellowship trained anesthesia being an advertising point.

These practices can be freakishly lucrative and less painful to work in, because that demographic by definition isn't full of drug users and morbidly obese hillbillies and teenage mothers-to-be. I suppose there are worse things in life than being pigeonholed into a 100% OB practice and earning a fortune doing it.

I can think of 3-4 hospitals in Southern California that fit this profile, Cedars being one of them. All with very busy L+D and good payor mix. I don’t think any of them require an OB fellowship to do epidurals and the vast majority of people who work there have not done OB anesthesia fellowships. None of them advertise “OB fellowship trained” anesthesiologists. Interestingly several of the OB anesthesia faculty at Cedars have actually done an ACTA fellowship.

Not as familiar with other parts of the country but here’s a brochure from Inova Fairfax, no mention of anesthesia.

https://www.inova.org/sites/default/files/ifhwc-brochure.pdf

 

[kidthor]

There are markets where well-insured patients have a choice about where to go, and the facilities advertise luxury birthing rooms and all kinds of other crap. I can see the fellowship trained anesthesia being an advertising point.

These practices can be freakishly lucrative and less painful to work in, because that demographic by definition isn't full of drug users and morbidly obese hillbillies and teenage mothers-to-be. I suppose there are worse things in life than being pigeonholed into a 100% OB practice and earning a fortune doing it.

A friend of mine joined a private practice with a very fancy hospital and very highfalutin OB population (with a fantastic payor mix). My friend is OB fellowship trained with an impeccable CV… and a very smart, skilled anesthesiologist.

But when it came down to it the group wouldn’t let them do OB anesthesia at all because it reimbursed so well and all of the non fellowship trained partners wanted the money while giving the new non-partner underlings garbage cases.

So sure the OB fellowship trained anesthesiologist could be a selling point, but in a high $$$ practice I bet you the partners are going to siphon off all the money.

 

[nimbus]

A friend of mine joined a private practice with a very fancy hospital and very highfalutin OB population (with a fantastic payor mix). My friend is OB fellowship trained with an impeccable CV… and a very smart, skilled anesthesiologist.

But when it came down to it the group wouldn’t let them do OB anesthesia at all because it reimbursed so well and all of the non fellowship trained partners wanted the money while giving the new non-partner underlings garbage cases.

So sure the OB fellowship trained anesthesiologist could be a selling point, but in a high $$$ practice I bet you the partners are going to siphon off all the money.

Is this the same place where GI endoscopy is also reserved for the chosen?

 

[GassYous]

A friend of mine joined a private practice with a very fancy hospital and very highfalutin OB population (with a fantastic payor mix). My friend is OB fellowship trained with an impeccable CV… and a very smart, skilled anesthesiologist.

But when it came down to it the group wouldn’t let them do OB anesthesia at all because it reimbursed so well and all of the non fellowship trained partners wanted the money while giving the new non-partner underlings garbage cases.

So sure the OB fellowship trained anesthesiologist could be a selling point, but in a high $$$ practice I bet you the partners are going to siphon off all the money.

Buntington Heach?

 

[Fpg1245]

A friend of mine joined a private practice with a very fancy hospital and very highfalutin OB population (with a fantastic payor mix). My friend is OB fellowship trained with an impeccable CV… and a very smart, skilled anesthesiologist.

But when it came down to it the group wouldn’t let them do OB anesthesia at all because it reimbursed so well and all of the non fellowship trained partners wanted the money while giving the new non-partner underlings garbage cases.

So sure the OB fellowship trained anesthesiologist could be a selling point, but in a high $$$ practice I bet you the partners are going to siphon off all the money.

This type of behavior is rampant in other fields too. I can’t tell you the number of people who have done fellowship for stuff only to sit on their hands doing general cases all day and getting no where near them. It’s a waste of talent perhaps or perhaps it’s not difficult to master.

 

[Dr. Rude]

This type of behavior is rampant in other fields too. I can’t tell you the number of people who have done fellowship for stuff only to sit on their hands doing general cases all day and getting no where near them. It’s a waste of talent perhaps or perhaps it’s not difficult to master.

It is difficult to master. Unfortunately mastering one’s craft is not always valued in the marketplace. The best does not always win.

 

[CubsDynasty]

It's also a different market nowadays. 5-10 years ago some of the best jobs were only available to those with fellowships so there was the push to do fellowship. Today the best paying jobs out there are generalist jobs so we dissuade residents from doing most fellowships now.

 

[lotsapain]

The answer is easy, change jobs. All the handcuffs are self imposed. The environment won’t change much if it’s that toxic. There’s 50 hospitals in the LA area. Sell the house that doubled or more in the last 10 years and cry in your new S class as you drive to your better job every morning.

The above story is the rule not the exception as far the self imposed handcuffs, sometimes it is easier said than done, I have changed several states in the past year alone which has significant effect on family life, mental and physical health etc. Yes indeed you can change jobs relatively easily though in areas like NJ/NY for example locums jobs assumes going from bad to worse in terms of cases you will get and how you will be treated.

Across the country really far out rural hospitals are bleeding anesthesiologists and some are ALL locums staffed, yet they don't think they have a problem as they look to find a "guy" who will run their department lean (by either self-sacrificing or banking in by gouging all calls and then leaving within a year after making bank) for some odd reason which I fail to understand it seems paying for a locum provider 1.2mil + is ok but increasing a full timers salary by 100k is not ..... I am guessing that when locums are used extensively hospitals (especially the majority - non for profit ) are getting a government subsidy so why hire full timers when they can work the 3 locums guys to death if they are willing to make the $$$$$$...... unfortunately you can't explain neither the medicine nor the long term finance piece to either A. non medical administration or B. to CMOs who have forgotten they are physicians long ago and their main goal is to preserve the job they stole, clawed and killed to get ....

You will see more and more of all of this happening until all of this will collapse - I do not see any other way of this ending as there is a limit how much money you can bleed paying agencies $500+ an hour...... I am guessing this will all reset itself and everyone will go back to making 300k (i hope that is not the case).

Going back to your comment there seems to be an abundance of locum jobs that pay well but you will have to go to bumble**** nowhere
to make that cash, I guess if there is an airport close and you can go home every weekend it is doable......

As far as Cedars I have met their recruiter he seems to be full of himself and dismissive - there in lies the problem RECRUITERS SUCK..... often physicians don't even get to step 2 because recruiters (Who are NOT incentivised as opposed to LOCUM firms) NEVER follow up......

GO figure.... medicine is in the sad state of things as was pointed above TRANSACTIONAL patient is the least important person on the totem pole..... I hope there are some good institutions out there but then again those NEVER have a problem hiring.

 

[kidthor]

As far as Cedars I have met their recruiter he seems to be full of himself and dismissive - there in lies the problem RECRUITERS SUCK..... often physicians don't even get to step 2 because recruiters (Who are NOT incentivised as opposed to LOCUM firms) NEVER follow up......

Agreed. I dealt with their recruiter in the past and it’s one of the flakiest enterprises I’ve experienced. Cedars is apparently desperate to hire anyone, yet back when I contacted them multiple times they were always impossibly too busy to get back to me. Their loss…

Recruiters do indeed suck. It’s a marvel that they’re employed at most places - they tend to be a net drain on the system.

 

[lotsapain]

Agreed. I dealt with their recruiter in the past and it’s one of the flakiest enterprises I’ve experienced. Recruiters do indeed suck. It’s a marvel that they’re employed at most places.

They are employed because no one wants that job.... the juice is not worth the squeeze.... good recruiters have to fly threw hoops to get a candidate to continue the conversation let alone sign up. If you indeed pay them well and incentives they will get you people...... most places have no choice they need a warm body to make some phone calls, only recently have I seen a recruiter replaced and it was for something egregious otherwise its all the same..... that is the biggest failure of most large anesthesia staffing companies (esp Envis) and similar but perhaps slightly lesser of others...... god forbid a recruiter in a decent place gets offended by you .... they can and do blacklist you in their files you will never get through the door again. As a matter of fact I think that most people should go directly to the source.... ie write an email to the CEO.

 

[Burned_Out]

A friend of mine joined a private practice with a very fancy hospital and very highfalutin OB population (with a fantastic payor mix). My friend is OB fellowship trained with an impeccable CV… and a very smart, skilled anesthesiologist.

But when it came down to it the group wouldn’t let them do OB anesthesia at all because it reimbursed so well and all of the non fellowship trained partners wanted the money while giving the new non-partner underlings garbage cases.

So sure the OB fellowship trained anesthesiologist could be a selling point, but in a high $$$ practice I bet you the partners are going to siphon off all the money.

Was this Old Pueblo Anesthesia out of Tucson, AZ? lol...