Complete and utter servitude

[gasdoc77]

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I write this not just as a sincere question to my experienced colleagues, but a glimpse into reality for trainees. In each of your respective practices, do you find that you are expected to make outlandish concessions as part of the status quo? I've been several places, each with its own injustices, but lately I've found practices (the current one in particular) that will do anything asked at any time. Want to run 10 cases into the night?-done. We will call people in from home who aren't on call. Not an exaggeration. Essentially, everyone is always on call. Never ever will a surgical case stack. We will call in people to avoid so much as a 10 minute overlap. Board a case at 6 pm after clinic? done. Show up at 7 an hour late? an anesthesiologist will have been waiting for an hour. It's truly become this gross characature of medicine. Pure unadulterated servitude. Is this what the "practice" of anesthesia has devolved to everywhere? Sound off.

 

[caligas]

Same for us.

 

[GasEmDee]

I am sorry to hear about your experience. At my institution, anesthesiologists have a fair say in our the schedule is organized and surgeons generally play nice with us. We have specific rules about how many rooms can be run at a particular time. We have a surgical operations committee that consists of surgeons, anesthesiologists and nurses. We make the rules together. There is a handful of child like surgeons who expect the OR to resolve around them, but they are the minority. When a surgeon tries to run roughshod over the rules, he usually gets a talking to. It's not to say that we don't bend over backwards from time to time, but I generally feel like a respected member of my medical staff.

 

[urge]

I write this not just as a sincere question to my experienced colleagues, but a glimpse into reality for trainees. In each of your respective practices, do you find that you are expected to make outlandish concessions as part of the status quo? I've been several places, each with its own injustices, but lately I've found practices (the current one in particular) that will do anything asked at any time. Want to run 10 cases into the night?-done. We will call people in from home who aren't on call. Not an exaggeration. Essentially, everyone is always on call. Never ever will a surgical case stack. We will call in people to avoid so much as a 10 minute overlap. Board a case at 6 pm after clinic? done. Show up at 7 an hour late? an anesthesiologist will have been waiting for an hour. It's truly become this gross characature of medicine. Pure unadulterated servitude. Is this what the "practice" of anesthesia has devolved to everywhere? Sound off.

Are you in a fee for service model? It would really suck if you are salaried.

 

[Consigliere]

Sounds about right gasdoc77.

 

[IlDestriero]

I would never take that job. Good luck. As mentioned above, I hope that it is eat what you kill.

 

[B-Bone]

It's called a contract, people. Gotta get a good one. Ours spells out very specifically how many rooms we are required to run at various times of the day and night. On very rare occasions, we'll exceed that number to help move the schedule along, and obviously for life/limb-threatening emergencies we are flexible, but we can always refuse. We can refuse to do elective cases in the middle of the night, though the hospital has a policy against this as well (they don't want to pay overtime/shift differentials for nurses/scrub techs/PACU/etc). If a surgeon says his lap chole or knee scope is an emergency, I will happily anesthetize that patient as long as they declare it a life/limb threatening emergency in the patient's chart. Then, the case is flagged and is reviewed by a panel of physicians which includes both surgeons and anesthesiologists on a monthly basis. Surgeons can lose their block time, first-starts, or even their operating privileges for abusing the scheduling rules. This practice environment didn't happen by accident. You have to get your group involved in the hospital politics, join committees and make yourselves indispensable. One of my partners is chief of staff of the hospital, and two of my other partners are past chiefs. We have people on every major hospital committee. If you have a seat at the table, you get to help create an environment that is reasonable. If you don't have a seat at the table, then you're probably on the menu.

 

[GasEmDee]

I'd ask you if you are one of my partners, but we are in different states. The current chief of staff is my partner. Another partner is past chief of staff. We have representatives on every relevant committee. It helps.

It's called a contract, people. Gotta get a good one. Ours spells out very specifically how many rooms we are required to run at various times of the day and night. On very rare occasions, we'll exceed that number to help move the schedule along, and obviously for life/limb-threatening emergencies we are flexible, but we can always refuse. We can refuse to do elective cases in the middle of the night, though the hospital has a policy against this as well (they don't want to pay overtime/shift differentials for nurses/scrub techs/PACU/etc). If a surgeon says his lap chole or knee scope is an emergency, I will happily anesthetize that patient as long as they declare it a life/limb threatening emergency in the patient's chart. Then, the case is flagged and is reviewed by a panel of physicians which includes both surgeons and anesthesiologists on a monthly basis. Surgeons can lose their block time, first-starts, or even their operating privileges for abusing the scheduling rules. This practice environment didn't happen by accident. You have to get your group involved in the hospital politics, join committees and make yourselves indispensable. One of my partners is chief of staff of the hospital, and two of my other partners are past chiefs. We have people on every major hospital committee. If you have a seat at the table, you get to help create an environment that is reasonable. If you don't have a seat at the table, then you're probably on the menu.

 

[sevoflurane]

For crying out loud... why would anybody work in that environment? Sounds like a lack of leadership.

Get outta there.

 

[BuzzPhreed]

I write this not just as a sincere question to my experienced colleagues, but a glimpse into reality for trainees. In each of your respective practices, do you find that you are expected to make outlandish concessions as part of the status quo? I've been several places, each with its own injustices, but lately I've found practices (the current one in particular) that will do anything asked at any time. Want to run 10 cases into the night?-done. We will call people in from home who aren't on call. Not an exaggeration. Essentially, everyone is always on call. Never ever will a surgical case stack. We will call in people to avoid so much as a 10 minute overlap. Board a case at 6 pm after clinic? done. Show up at 7 an hour late? an anesthesiologist will have been waiting for an hour. It's truly become this gross characature of medicine. Pure unadulterated servitude. Is this what the "practice" of anesthesia has devolved to everywhere? Sound off.

^^^^ This is where I was at... and what I left (as well as a few more than a handful of quality people over the past 3-4 years).

I am sorry to hear about your experience. At my institution, anesthesiologists have a fair say in our the schedule is organized and surgeons generally play nice with us. We have specific rules about how many rooms can be run at a particular time. We have a surgical operations committee that consists of surgeons, anesthesiologists and nurses. We make the rules together. There is a handful of child like surgeons who expect the OR to resolve around them, but they are the minority. When a surgeon tries to run roughshod over the rules, he usually gets a talking to. It's not to say that we don't bend over backwards from time to time, but I generally feel like a respected member of my medical staff.

^^^^ This is what I went back to. 👍

It's called a contract, people. Gotta get a good one. Ours spells out very specifically how many rooms we are required to run at various times of the day and night. On very rare occasions, we'll exceed that number to help move the schedule along, and obviously for life/limb-threatening emergencies we are flexible, but we can always refuse. We can refuse to do elective cases in the middle of the night, though the hospital has a policy against this as well (they don't want to pay overtime/shift differentials for nurses/scrub techs/PACU/etc). If a surgeon says his lap chole or knee scope is an emergency, I will happily anesthetize that patient as long as they declare it a life/limb threatening emergency in the patient's chart. Then, the case is flagged and is reviewed by a panel of physicians which includes both surgeons and anesthesiologists on a monthly basis. Surgeons can lose their block time, first-starts, or even their operating privileges for abusing the scheduling rules. This practice environment didn't happen by accident. You have to get your group involved in the hospital politics, join committees and make yourselves indispensable. One of my partners is chief of staff of the hospital, and two of my other partners are past chiefs. We have people on every major hospital committee. If you have a seat at the table, you get to help create an environment that is reasonable. If you don't have a seat at the table, then you're probably on the menu.

^^^^ This is 100% truth and the way it should be done.

For crying out loud... why would anybody work in that environment? Sounds like a lack of leadership.

Get outta there.

^^^^ This is a short and precise grip on the situation, along with unjustified fear of losing the contract. And it is also great advice. Get outta there.

 

[deleted126335]

For crying out loud... why would anybody work in that environment? Sounds like a lack of leadership.

Get outta there.

1. limited choices for those with troubled CVs, or other "issues"
2. Highly desirable area where someone is willing to eat **** to stay or family obligations where someone is willing to eat **** to stay.
3. Bad decision by job applicant who accepted the position and subsequently invested in the job and the community whose spouse established ties and is afraid to start over.
4. Financial hit that someone is willing to take by leaving.

Used to be at the described by the O.P.
Now at B-Bone type place. Although it is de-evolving. Really fast. Administration is under massive financial pressure and passing it down. We strategically retreat, fighting where we can.

 

[gasdoc77]

It's called a contract, people. Gotta get a good one. Ours spells out very specifically how many rooms we are required to run at various times of the day and night. On very rare occasions, we'll exceed that number to help move the schedule along, and obviously for life/limb-threatening emergencies we are flexible, but we can always refuse. We can refuse to do elective cases in the middle of the night, though the hospital has a policy against this as well (they don't want to pay overtime/shift differentials for nurses/scrub techs/PACU/etc). If a surgeon says his lap chole or knee scope is an emergency, I will happily anesthetize that patient as long as they declare it a life/limb threatening emergency in the patient's chart. Then, the case is flagged and is reviewed by a panel of physicians which includes both surgeons and anesthesiologists on a monthly basis. Surgeons can lose their block time, first-starts, or even their operating privileges for abusing the scheduling rules. This practice environment didn't happen by accident. You have to get your group involved in the hospital politics, join committees and make yourselves indispensable. One of my partners is chief of staff of the hospital, and two of my other partners are past chiefs. We have people on every major hospital committee. If you have a seat at the table, you get to help create an environment that is reasonable. If you don't have a seat at the table, then you're probably on the menu.

I think you hit the nail on the head. A paucity of leadership is to blame. For all job applicants I implore you to ask individuals in a group (subtly and in a "curbside" manner) one on one about morale. Ask if there are any groups within the group ie divisions (and not in a good sense). Possibly even ask what their policy is for bringing down rooms in the afternoon/evening. All this will elucidate a practice environment and what kind of relationship a practice has with the hospital

 

[BuzzPhreed]

1. limited choices for those with troubled CVs, or other "issues"
2. Highly desirable area where someone is willing to eat **** to stay or family obligations where someone is willing to eat **** to stay.
3. Bad decision by job applicant who accepted the position and subsequently invested in the job and the community whose spouse established ties and is afraid to start over.
4. Financial hit that someone is willing to take by leaving.

Used to be at the described by the O.P.
Now at B-Bone type place. Although it is de-evolving. Really fast. Administration is under massive financial pressure and passing it down. We strategically retreat, fighting where we can.

In my case it was 2 and 3. But it was worth it to walk away. And I think you meant to say "financial hit that someone is unwilling to take by leaving" for #4. In my case it was so bad that I was willing to take the financial hit. And it was decently brutal but not a total butt-rape.

On that note, if you are looking for a job and their terms are unreasonable, my advice? Don't take it. Those terms are they don't pay for the tail, they make you pay back any "bonus" money (relocation, sign-on, etc.), or they have greater than a 90-day adios-muchachos clause. That goes for any job not just PP jobs. If the handcuffs are not truly golden, walk away. Otherwise you're going to be paying someone a lot of money (in my case, those "someones" would be attorneys).

 

[deleted126335]

1. limited choices for those with troubled CVs, or other "issues"
2. Highly desirable area where someone is willing to eat **** to stay or family obligations where someone is willing to eat **** to stay.
3. Bad decision by job applicant who accepted the position and subsequently invested in the job and the community whose spouse established ties and is afraid to start over.
4. Financial hit that someone is willing to take by leaving.

Used to be at the described by the O.P.
Now at B-Bone type place. Although it is de-evolving. Really fast. Administration is under massive financial pressure and passing it down. We strategically retreat, fighting where we can.

Forgot one:

Solid applicant and absolutely sh1tty market. It's coming.

 

[Consigliere]

Forgot one:

Solid applicant and absolutely sh1tty market. It's coming.

It's already here.

 

[IlDestriero]

Disagree.

 

[missiongirl]

On that note, if you are looking for a job and their terms are unreasonable, my advice? Don't take it. Those terms are they don't pay for the tail, they make you pay back any "bonus" money (relocation, sign-on, etc.), or they have greater than a 90-day adios-muchachos clause. That goes for any job not just PP jobs. If the handcuffs are not truly golden, walk away. Otherwise you're going to be paying someone a lot of money (in my case, those "someones" would be attorneys).[/QUOTE]



Very true, watch out for the above, and take it as a red flag. Also BEWARE that if it is presented by the recruiter or in a job ad, or even verbally in any way that the post call day is "usually" off, that means you should assume that it is NEVER OFF and you will be working a ridiculous amount of hours (including call) in an undermanned sweatshop and trapped by the above terms in your contract. And make sure that if your call is "home call" you understand what exactly you are responsible for, including whether or not your ER/ICU people can handle an airway (are they internal medicine, ER residency trained or FPs with no airway training) or not because if you are responsible for all intubations do you really want to live the allowed 20-30 mins away on "home call" with no one in house at the hospital who knows how to intubate? are you responsible for Neonatal Resuscitation? OB emergencies? Just a few things to think about and get clarified in writing if you can.

 

[gasdoc1]

I'm just wondering how they have the nursing staff to do all this? Your hospital must be paying a fortune in overtime. In my hospital, the surgeons are always limited by the nursing staff, not anesthesia. Maybe it's because we are a "for profit", medium sized hospital, but we only have one nursing team for elective cases after 7:00 pm, plus one call team. The hospital would never pay another nursing team unless there were 2 REAL emergencies, so the most ORs we would have running is 2, plus OB, and an occasional emergency cardiac cath. Maybe 1 or 2 days a week the 3rd call has to come back in, and on a very rare occasion, the 4th. We have other BS to deal with though, there is no such thing as the "perfect job".