Collaborative Anesthesia practices

[IVdoc]

Have attending anesthesiologists or anesthesia residents had experiences with this "collaborative" anesthesia practice? I saw on Reddit a few months ago someone posted that Sound Anesthesia took over a facility in Columbus, GA and was promoting "CRNA residents" practice at the "full scope" of their nursing licenses, that AAs need not apply per the post. The Reddit post stated that GA is not an "Opt-Out" state. So I guess the anesthesiologists who take these jobs in non-Opt-Out states must be the liability sponges with no real input into the anesthetic care. I have been offered jobs where CRNAs do all the blocks, CRNAs that proceed with full anesthesia care without the anesthesiologists present for anything. I have always declined these jobs because they sound horrible even if the pay is decent or the location is OK. I would not be able to stomach these types of "collaborative" practices on a permanent basis, seems like a waste of our medical education and training.

If it's a collaborative environment where it's an opt-out state, that's fine, the CRNAs take full liability but if it's a state with no opt-out and the CRNAs are independent (CRNAs doing blocks, CRNAs not notifying you at any point in the anesthetic care or with any intraoperative issues) that is of concern for me. Not my cup of tea

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[circleK]

I would be leery even in an opt out state.

 

[psychbender]

Regardless of opt-out or non opt-out nature of the state, in such a practice an anesthesiologist is being recruited solely to meet some requirement (state law, hospital bylaw) and soak up liability. They have made it plain that they only need your license, not your expertise. Why anyone would take one of these jobs (aside from the utterly desperate or ridiculously lazy) is beyond me, but there's always a sucker somewhere willing to ***** themselves out.

 

[nimbus]

My friend does this for Sound in an opt out state. Was hired primarily to cover a low volume cardiac program (140 pump cases/yr). He gives them 32 weeks per year for a very good fixed weekly rate (by any standard except perhaps @aneftp ’s 😉). There are also 2 other part-time cardiac anesthesiologists there.

There’s a CRNA there who is full time and basically runs the department. My friend just covers pump cases/structural/and EP lab and collects a nice check for very little work. He has nothing to do with any of the cases that he is not personally performing.

 

[psychbender]

@nimbus' friend's thing seems to be different than a "collaborative" practice. In that situation, it is actual independent practice for the CRNAs and anesthesiologists. He does his cases, they do theirs, and narry the two shall meet.

My old Army job functioned like a collaborative practice. CRNAs did what they wanted, but there was an anesthesiologist around, who could try to rescue the situation or be blamed for the outcome, however things played out. Having come up through that kind of environment immediately after training (and walking into so many easily avoidable emergencies), I will never do so again, and would prefer even complete independence over this kind of "collaboration."

 

[circleK]

Even in a “completely independent” practice I would look closely at the exact wording of any contracts and bylaws and specifically ask questions about what happens in case of a critical situation in an independent CRNA’s room. Never want your liability increased without your knowledge.

 

[NicholasPavona]

...and narry[sic] the two shall meet."

The same cannot be said about my fist and the side of a smarmy CRNA's head.

 

[IlDestriero]

Sound tried to take over a group where my friend works. Rich suburban hospital, part of a bigger healthcare system. They wanted to switch from 3-4:1 to 8:1. They do it all, neuro, cardiac, vascular, etc. Imagine 8:1 with a cardiac and vascular and neuro room with a couple ortho, a gyn onc and 2 more for good measure. What’s your involvement in any of those cases as the anesthesiologist? None. Liability sponge.
It was an essentially a done deal, they told the group they were out, they were all scrambling for jobs with like 60 days notice, etc. Then the surgeons all went ballistic. They weren’t part of the secret negotiations with Sound and when the word got out many threatened to take their practices elsewhere and wouldn’t work at 8:1. The hospital then went back and offered the anesthesia group a contract. Though having said that the guy told me that he thought his group was getting greedy in what they wanted in the new contract and might have started all the problems themselves. That was a few years back. Imagine the disaster it would be now with all the hiring problems. It would be 8:1 full of Locums MDs and CRNAs. Locums supervising Locums. Thats a set up for success. The surgeons were smart to revolt and they all dodged a bullet. Including the CEO who would probably have been fired for letting his fancy suburban hospital go off the rails and burn down trying to save a couple million dollars on a service that literally facilitates keeping the lights on and the bills paid.

 

[dmk5n]

I locumed there a Loooong time ago. It was still Amsol back then. I wanted to see how they ran things. A lot of Docs there were asking me what i used to prepare for Boards. Big Blue, Dr Ho, etc.... But Columbus always been a crap-show. A lotta military there=poor payors...Big ortho group there preferred the CRNA's to Docs at their ASC, hopsital. This is how they got traction before selling out to PE. Not much has changed. Docs take the calls. These groups are now going to all the rural hospitals in Georgia getting contracts but they have no bodies. No docs or CRNA's.

 

[aneftp]

I locumed there a Loooong time ago. It was still Amsol back then. I wanted to see how they ran things. A lot of Docs there were asking me what i used to prepare for Boards. Big Blue, Dr Ho, etc.... But Columbus always been a crap-show. A lotta military there=poor payors...Big ortho group there preferred the CRNA's to Docs at their ASC, hopsital. This is how they got traction before selling out to PE. Not much has changed. Docs take the calls. These groups are now going to all the rural hospitals in Georgia getting contracts but they have no bodies. No docs or CRNA's.

The smart locums docs take the 1099 calls and bill continuously especially on weekends. The smart w2 docs let the 1099 locums docs bill 72 hrs on weekends and w2 docs chill and relax on weekends.

Never be a call taking w2 doc without being rewarded with something. Never let employers tell u w2 call is included in their contracts. As long as the w2 hours on call count against the 40 hrs.

 

[A Deep Breath]

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Even in a “completely independent” practice I would look closely at the exact wording of any contracts and bylaws and specifically ask questions about what happens in case of a critical situation in an independent CRNA’s room. Never want your liability increased without your knowledge.

Is it common for our CRNA liability to be written down anywhere?