clocking in?

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anes121508

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anyone ever ever work for an AMC where you clocked in and out?
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If we are on overtime (post call, staying after the end of a shift) then we attach a copy of the billing sheet to our overtime request. Don’t see the point of clocking in, if you are scheduled for a case it will be immediately apparent if you are not there...
 
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caligas said:
Wait, I’m confused now. Do they want me to think it’s the same or different? F-it, I’ll just keep my private practice job.
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The question was about clocking in for an AMC, right? If an AMC employee is not tracking hours, you can be darn sure the AMC owners are.
 
BLADEMDA said:
All "providers" may be told to "clock in and out" for each shift as well as "extra/after-hours" shifts. The AMC tracks those hours even if you are on salary. Your pay may or may not be affected.
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Our docs are required to clock in. Anesthetists clock in and out, since their OT is tied to those times.
 
BLADEMDA said:
All "providers" may be told to "clock in and out" for each shift as well as "extra/after-hours" shifts. The AMC tracks those hours even if you are on salary. Your pay may or may not be affected.
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So Blade, what's the motive for the AMC to make the docs clock in and out if you are salary and you don't get overtime?
 
GravelRider said:
So you don't record start time and end time on your anesthesia record? I guess only nurses do that?
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That’s for billing purposes.
I don’t get paid for overtime therefore I don’t clock in and out. Nurses do. I’m not a nurse.
And for the record I’m not a “provider” either.
 
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So my question stems from this:

PP recently sold to AMC by choice, historically profitable and good reputable group, hospital expansion/older docs/help with hiring caused group to sell/ect.

Salary job now, group still runs majority of day to day (creates call schedule, assigns rooms, vacation picks, ect), hours and schedule haven't really changed as compared to pre AMC, good work enironment

The OR's are much busier as predicted with the expansion of the hospital (running more rooms/day and more offsite locations). However, it still seems a variable and the volume fluctuates day to day.

The AMC hasn't been able to hire enough docs, several older docs retired. In order to staff all the locations they are paying locums for additional coverage. They also paying a decent hourly rate for the docs in the group to work during their vacation. I'm assuming they are losing money on days when they commit to paying locums/overtime help and the OR's aren't as busy as predicted.

Now the AMC wants to implement docs clocking in and out.

Have you guys seen a situation like this? What are your initial thoughts? Is there anyway that the AMC is just collecting data for the heck of it and not going to use it against the docs?
 
Noyac said:
That’s for billing purposes.
I don’t get paid for overtime therefore I don’t clock in and out. Nurses do. I’m not a nurse.
And for the record I’m not a “provider” either.
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Couldn't agree more. When I got the email, my initial reaction was feeling insulted. Out of curiosity I showed my wife (works in business for a large company) and asked her what she thought. Wife's response - "You kidding me? That's offensive!"

Can't imagine that any new grads will ever join unless they are desperate enough.

Am I nuts?
 
anes121508 said:
Couldn't agree more. When I got the email, my initial reaction was feeling insulted. Out of curiosity I showed my wife (works in business for a large company) and asked her what she thought. Wife's response - "You kidding me? That's offensive!"

Can't imagine that any new grads will ever join unless they are desperate enough.

Am I nuts?
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Start looking for a new job and jump off the sinking ship while you still have a chance and you still have your testicles.

They will 100% turn around and use the data against everyone - employed docs and locums alike.
 
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Noyac said:
That’s for billing purposes.
I don’t get paid for overtime therefore I don’t clock in and out. Nurses do. I’m not a nurse.
And for the record I’m not a “provider” either.
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Sounds like you are against the idea of overtime. Why is this? I work for an AMC and I am an employee. I have no share in any profits. My salary is set so why shouldn’t my hours be ? I understand that we are physicians and that things happen at all sorts of inconvenient hours. I have no problem staying late when needed, just want to be paid for it.
 
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dannyboy1 said:
Sounds like you are against the idea of overtime. Why is this? I work for an AMC and I am an employee. I have no share in any profits. My salary is set so why shouldn’t my hours be ? I understand that we are physicians and that things happen at all sorts of inconvenient hours. I have no problem staying late when needed, just want to be paid for it.
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IF however, you are an employee on salary without overtime compensations....clocking in can only serve the AMC purpose.
 
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anes121508 said:
Are you pp? the clock in is only because OT is given right?
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AMC practice. Docs clock in strictly as a verification of their presence. They do not clock out because they're not on any kind of OT arrangement.
 
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jwk said:
AMC practice. Docs clock in strictly as a verification of their presence. They do not clock out because they're not on any kind of OT arrangement.
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Verification of presence?? If you are not there the case will not go. Unless they think there are docs crazy enough to have a CRNA do a case under their liscence without even being in the building....
 
Urzuz said:
Start looking for a new job and jump off the sinking ship while you still have a chance and you still have your testicles.

They will 100% turn around and use the data against everyone - employed docs and locums alike.
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Agree. This is my gut feeling. However, anyone with personal experience of this exact situation? Pp sells to amc, amc requires clocking in and out for salary non overtime employees, then turn around and use the data to justify lower comp/less docs/more weekends/ect?
 
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dannyboy1 said:
Verification of presence?? If you are not there the case will not go. Unless they think there are docs crazy enough to have a CRNA do a case under their liscence without even being in the building....
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If you are supervising residents or CRNAs, a different colleague (or several) could cover your rooms for you even if you weren't there.
 
anes121508 said:
Have you guys seen a situation like this? What are your initial thoughts? Is there anyway that the AMC is just collecting data for the heck of it and not going to use it against the docs?
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My initial suspicion is not that they want to use it against the individuals, but want to collect the data to find opportunities to streamline operations in the future (get by with fewer docs). So not use it against you in the short term, but long term use the data to get by providing the same care with less people needed.
 
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anes121508 said:
Agree. This is my gut feeling. However, anyone with personal experience of this exact situation? Pp sells to amc, amc requires clocking in and out for salary non overtime employees, then turn around and use the data to justify lower comp/less docs/more weekends/ect?
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No because it's a ridiculous situation. Why would you be okay with someone following your hours that closely? They're out to get you for sure; there is nothing good that will come of this whatsoever.
 
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It would be helpful if we knew your current workload. Is your call schedule light? Do you have a lot of early days? What are your average hours per week? How many rooms do you supervise?

It sounds like from your first post that workload is pretty reasonable for your current pay (i.e. you are happy). That is likely going to change and once they have you up to a certain average quarterly hours worked that they deem to be efficient/profitable, they will stop making you punch in. They may also be trying to determine if they can hire CRNAs instead of docs because, as mentioned, CRNAs like set hours (and we pretend we don't).
 
Mman said:
My initial suspicion is not that they want to use it against the individuals, but want to collect the data to find opportunities to streamline operations in the future (get by with fewer docs). So not use it against you in the short term, but long term use the data to get by providing the same care with less people needed.
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You may be correct. The amc is currently using locums due to expansion of the sites. I’d imagine they would rather make their case that we don’t need those extra docs.
 
Psai said:
No because it's a ridiculous situation. Why would you be okay with someone following your hours that closely? They're out to get you for sure; there is nothing good that will come of this whatsoever.
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Can’t say i disagree. And as you point out, I only think of one conclusion: nothing good can possibly come of it (for me at least).
 
GravelRider said:
It would be helpful if we knew your current workload. Is your call schedule light? Do you have a lot of early days? What are your average hours per week? How many rooms do you supervise?

It sounds like from your first post that workload is pretty reasonable for your current pay (i.e. you are happy). That is likely going to change and once they have you up to a certain average quarterly hours worked that they deem to be efficient/profitable, they will stop making you punch in. They may also be trying to determine if they can hire CRNAs instead of docs because, as mentioned, CRNAs like set hours (and we pretend we don't).
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Pay is decent give my the fact that cost of living is cheap. Other groups in town are private. We are very similar to one of the private groups and way less than the other pp group. Benefits are awful. Regardless, the compensation is plenty given my light workload...

1st Call is 1:18 (12p-7am). We have a back up home call cardiac team (q8, leave by 7p, pager at home over night, next day is off). Typical day is 6:45-3:30. We have a late shift till 4:30 q18. We have an early day out by 1pm q10ish. We cover some outpatient centers and days are wildly variable ranging from 12pm-5pm about once a week. So all in all I don’t work much and my quality of life being home and Around with my family is great.

Cover 3:1. When doing cardiac we do 2:1.

It’s not like the amc doesn’t already know that I don’t work much though.
 
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anes121508 said:
Couldn't agree more. When I got the email, my initial reaction was feeling insulted. Out of curiosity I showed my wife (works in business for a large company) and asked her what she thought. Wife's response - "You kidding me? That's offensive!"

Can't imagine that any new grads will ever join unless they are desperate enough.

Am I nuts?
Click to expand...
The new grads WILL be desperate, especially in certain geographic areas. Actually, any idiot who goes into anesthesia after the residency spots increased by 40% in the last ~5 years (not to mention the TONS of new CRNAs), deserves this kind of job.
 
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FFP said:
The new grads WILL be desperate, especially in certain geographic areas. Actually, any idiot who goes into anesthesia after the residency spots increased by 40% in the last ~5 years (not to mention the TONS of new CRNAs), deserves this kind of job.
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Welcome back! I see you’re as cheery as ever!
 
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FFP said:
The new grads WILL be desperate, especially in certain geographic areas. Actually, any idiot who goes into anesthesia after the residency spots increased by 40% in the last ~5 years (not to mention the TONS of new CRNAs), deserves this kind of job.
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Is there a link discussing the number of graduates per year showing a big change? I don't recall seeing it.
 
Mman said:
Is there a link discussing the number of graduates per year showing a big change? I don't recall seeing it.
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I was pretty surprised when I went digging for NRMP data.

Perusing here, Table 3 on page 12:
http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf

Anesthesiology PGY-1 spots increased from 1,000 to 1,202 from 2013 to 2017. An increase of 20%, which is in line with just about every other mainstream specialty.

Interestingly, Advanced positions declined from 580 to 441 (next page) and R (Physicians) spots increased 73 to 100 over the same time span (some of these are reserved research positions that often may not fill as at my residency, but lets assume they are all standard spots). So in total: 1,653 Anesthesiology spots in 2013 to 1,743 in 2017 or about a 5% increase overall. That's less of an increase that is seen in EM, IM, FM or Surgery over the same amount of time.

I expect the number to take a small bump this year as it seems like there are a lot of new programs opening all of the sudden this year (ex: Brown, several community programs in Florida), but I would be surprised if it is more than 20 or 30 additional positions.
 
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Why are these places allowed to open up new programs when it seems like the current ones often don't completely fill? Further, per the match data from 2016, while our field seems to have mean step scores on par with internal medicine/gen surg, our bottom quartile is much lower. This seems to suggest that we have an relative excess of spots vs demand.

How are these decisions made about which programs are allowed to open up residencies? Do they take into account future job market, current match stats, etc. Or is it just if you meet the minimum criteria you can open up shop?
 
Pseudo AMC employee.

We staff an entire city and constantly shuffle people around daily to make things even across different sites.

Each hospital has its own “call pool” with obviously different types of cases, responsibilities, staffing styles, etc.

We clock in/out daily to make sure big picture hours are close to even across sites, to track how often folks are getting brought back in for call cases, post call work, etc.

I’m not working for a national company though, so I know the data isn’t being “used” by anyone to change anything. Just trying to keep it all fair.
 
Mman said:
Is there a link discussing the number of graduates per year showing a big change? I don't recall seeing it.
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There was a discussion about this in the last year or so.

I distinctly remember a huge increase, definitely more than 20%. But even if my memory is wrong, it doesn't matter. The number of CRNAs has increased TREMENDOUSLY in the last 10 years, and they are taking a large percentage of the (good) jobs that were going to the docs before. In 10 years, we went from a lot of solo docs to a lot of 1:3 coverage. (My own residency program went from less than 5 CRNAs to about 100.)

When salaries are stagnant or going down (in many geographical areas), in the middle of an economic boom, one knows that the market is fscked.
 
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AdmiralChz said:
I was pretty surprised when I went digging for NRMP data.

Perusing here, Table 3 on page 12:
http://www.nrmp.org/wp-content/uploads/2017/06/Main-Match-Results-and-Data-2017.pdf

Anesthesiology PGY-1 spots increased from 1,000 to 1,202 from 2013 to 2017. An increase of 20%, which is in line with just about every other mainstream specialty.

Interestingly, Advanced positions declined from 580 to 441 (next page) and R (Physicians) spots increased 73 to 100 over the same time span (some of these are reserved research positions that often may not fill as at my residency, but lets assume they are all standard spots). So in total: 1,653 Anesthesiology spots in 2013 to 1,743 in 2017 or about a 5% increase overall. That's less of an increase that is seen in EM, IM, FM or Surgery over the same amount of time.

I expect the number to take a small bump this year as it seems like there are a lot of new programs opening all of the sudden this year (ex: Brown, several community programs in Florida), but I would be surprised if it is more than 20 or 30 additional positions.
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I remember doing the math, dont remmeber what year, but in a couple of years anesthesia spots had a huge spo t increase and then the increase slowed down afterwards... id have to check what year that was in
 
jwk said:
Our docs are required to clock in. Anesthetists clock in and out, since their OT is tied to those times.
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Wow, who in their right mind would work for one of these companies
 
acidbase1 said:
Wow, who in their right mind would work for one of these companies
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Jwk's group is massive. Probably the biggest in our (big) city. Not saying it's right, but I guess some people out there are ok with it.
 
Don’t care how massive... punching a clock? Absolutely not. I went to fing med school. Name one other specialty who punches a clock
 
acidbase1 said:
Don’t care how massive... punching a clock? Absolutely not. I went to fing med school. Name one other specialty who punches a clock
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If I had to guess, this is probably more common than you think, especially for the AMC-type arrangements. The docs aren't the owners anymore. They're employees.

And a number of these AMCs are more than anesthesia. They frequently include all the in-house specialties.
 
jwk said:
If I had to guess, this is probably more common than you think, especially for the AMC-type arrangements. The docs aren't the owners anymore. They're employees.

And a number of these AMCs are more than anesthesia. They frequently include all the in-house specialties.
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That’s why I asked. Our Amc says this is standard for all their sites
 
Shimmy8 said:
Pseudo AMC employee.

We staff an entire city and constantly shuffle people around daily to make things even across different sites.

Each hospital has its own “call pool” with obviously different types of cases, responsibilities, staffing styles, etc.

We clock in/out daily to make sure big picture hours are close to even across sites, to track how often folks are getting brought back in for call cases, post call work, etc.

I’m not working for a national company though, so I know the data isn’t being “used” by anyone to change anything. Just trying to keep it all fair.
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What do you mean by pseudo?

I have a feeling they Want to shuffle us around too
 
I work for an AMC and No I don’t clock in.... that’s about as insulting (and stupid) as it gets.

We are a large group of physicians.
 
Shimmy8 said:
We clock in/out daily to make sure big picture hours are close to even across sites, to track how often folks are getting brought back in for call cases, post call work, etc.
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This is something that should be taken care of by accurate effective scheduling. You don’t need a punch clock to make it fair. Unless you have a bunch of whinny docs who personally keep track of their hours compared to others and feel like they are getting shafted. Or you have some docs that manipulate the daily schedule in order to work less or more depending. Either way it sounds like your schedule was manipulated and many felt it was unfair so your group had to resort to a punch clock. That’s not a good situation. If your master schedule were fair it would all even out in time. There are not many things that drive me crazy in a group practice more than bickering amongst partners about time at work and case load. It can be toxic.
 
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Noyac said:
This is something that should be taken care of by accurate effective scheduling. You don’t need a punch clock to make it fair. Unless you have a bunch of whinny docs who personally keep track of their hours compared to others and feel like they are getting shafted. Or you have some docs that manipulate the daily schedule in order to work less or more depending. Either way it sounds like your schedule was manipulated and many felt it was unfair so your group had to resort to a punch clock. That’s not a good situation. If your master schedule were fair it would all even out in time. There are not many things that drive me crazy in a group practice more than bickering amongst partners about time at work and case load. It can be toxic.
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I’m new. I have no idea what was done before. I just know that I clock in and I truly don’t give a s***. It’s not beneath me, I’m an employee and I was told to clock in so I do. Maybe there were guys before manipulating things? Over/understaffing certain sites? No idea.

We have many, many different clinical sites across an entire city. Schedule is as fair as can be.

Hours are analyzed to make sure post call folks at one site aren’t working til 3p every day while another site has guys leaving at 9am. I dunno, makes sense to me. No matter how well our master schedule is done it can’t account for changing volume across 10+ clinical sites daily, trauma, emergency cases, etc.
 
Shimmy8 said:
I’m new. I have no idea what was done before. I just know that I clock in and I truly don’t give a s***. It’s not beneath me, I’m an employee and I was told to clock in so I do. Maybe there were guys before manipulating things? Over/understaffing certain sites? No idea.
No matter how well our master schedule is done it can’t account for changing volume across 10+ clinical sites daily, trauma, emergency cases, etc.
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Don’t fret it. I was just trying to speculate on what would have made your group go to a “clock”.
And don’t think for a second that there are not people trying manipulate the schedule, your schedule. I was in a large group that covered many sites across a large metropolitan city. We thought we had a very fair and well planned schedule. Then some of us started to put our heads together and it dawned on us. We were being manipulated, even some of the long time partners. A group of females with children had taken over the scheduling and slowly managed to make it so that they could pick up their kids at school most days. We caught on when we noticed that we rarely saw females working past certain hours. They had a good thing going and since the group was so large it was easy to disguise. But they got greedy and it became obvious. I left shortly after that but I doubt they went to a “clock” system. Just because the group is massive doesn’t mean it can’t be fairly scheduled.
 
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I sincerely appreciate your honesty. This is the type of stuff I love about this forum.

I am an absolute cynic and skepticist by nature so I’m trying my best not to be naive, but I think I get a fair shake. But always good to be reminded that someone, somewhere is looking to take advantage.
 
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