CRNA: We are the Answer - WTF????

[Endee]

I've worked in some really strong, large ACT practices. I know jwk's group is similar.

There are lots of ACT practices where the physicians have ceded everything to the nurse anesthetists from preops to not coming for induction to letting them run L&D independently to billing QZ to preop and PACU orders, and on and on.

And there are plenty of strong ACT practices where the anesthesiologists assert their leadership, and create and maintain respect from both their team as well as the OR and surgeons. They evaluate every patient and make sure to introduce themselves as the physician who is in charge of their care, and that they will be supported by a team comprising nurse anesthetists or anesthesiologist assistants. They don't give up procedures like nerve blocks and in many cases central lines (although where I used to work, several of the AAs and CRNAs that were on the open heart team were permitted to do IJ central lines after demonstrating proficiency, but that was an attending-by-attending decision. Where I work now, only physicians do the central lines, and that's fine--their decision what to delegate). They are present for every single induction and regularly monitor the progress of every case they are supervising either in person or over the phone. They actively make intraop decisions through communication of status changes with the anesthetist in the room. They actively supervise L&D epidurals and C-section cases.

It's all what you make of it. In many, many parts of the country, ACT is the only viable practice model. I have no criticisms for groups who want to practice in the all-physician model. But the economics of that are becoming harder as time goes by. A lot of groups that have been all-physician have talked to me over the last few years about going to ACT with only AAs, if they're able to, because of the improved team cohesion and absence of political drama that it provides.

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[GravelRider]

One of the biggest challenges at maintaining MD only is the speed at which hospitals expand services and the pressure for groups to keep hospitals happy. The sleepy community hospital with 6 ORs can get absorbed into the big mega-system and have 2 EP labs, a new endo suite, and an attached surgicenter in a year or two...effectively doubling staffing needs. When you’re trying to keep hospital contracts and ward off AMCs, idealism about MD only care gets thrown out the window. You are merely recruiting whatever body can fill the chair. So while the cynic in me wants to believe that every ACT practice is in it for the cash, the realist in me knows the pressure of modern practice often necessitates compromising your ideals.

 

[PieOHmy]

It's all what you make of it. In many, many parts of the country, ACT is the only viable practice model.

And the AANA wants to dismantle the ACT practice model.
IF this is the future we need to partner with people who share this belief.
Thats not the AANA
so who?
AAs? PA?

 

[chocomorsel]

Don’t be silly. The solution is straight forward. Stop hiring new CRNAs and hire MDs instead. It’s a gradual wean, and it’d be very doable.

But that would mean less money for me

 

[chocomorsel]

I'm FP so my knowledge is very limited...

Are there enough anesthesiologists to cover all the ORs/endoscopy suites in the country?

I know in primary care there just aren't enough doctors to cover the need for primary care, not by a long shot. Is y'all's work force in better shape than ours?

There is not. However, we also provide anesthesia for procedures that could easily be done with some local, or little light sedation that doesn’t necessarily need full on GA or heavy sedation. All in the name of increasing productivity and lining someone’s pocketbook. That pocketbook could be our own.

Some of the stupid **** that comes to the OR and how the American culture is about “I don’t want to see, feel or hear anything” is also big part of the problem.

And recently, surgeons are not getting reimbursement for some in office procedures unless they bring them to the OR.

So... lots of unnecessary crap we do is about money. And no there ain’t enough of us around for that BS. Why leave money on the table?

 

[chocomorsel]

as long as your willing to double your overhead its no problem...

I would love to do this but my practice would collapse due to the economic forces in the area..

How does bringing in physicians instead of CRNAs double your overhead? Please explain.

 

[Hoya11]

How does bringing in physicians instead of CRNAs double your overhead? Please explain.

Lets take a look at the financial impact on a group like mine - 7 partners, 10 docs, 40 locations to cover.

For my practice at 40 rooms we have 10 docs and 40 CRNAs. 10 X 500k (total MD package) + 40 x 250k (total CRNA package) = 15 million

Vs. 40 docs at 500k = 20 million + hiring other staff for breaks/out of OR coverage ( because you have to have someone to respond to codes/breaks/blocks/help in difficult rooms if you have no one free roaming outside like in the ACT model) estimate that at 2 million for 4 more docs (one for every 10 rooms I think is a fair estimate).

Ok so the MD only group costs 22 million. The ACT group costs 15 million. 7 million dollar difference, not quite double but financially crippling for any private, unsubsidized group to take on an unneeded 7 million dollar expense.

Like I said, 7 partners, 7 million dollars in additional cost, how do you think December is going to look for you that year? The practice would fold.

Its easy to say MD only when you have a model that that is possible to accomplish. Its tough out there and very often its simply not possible to do MD only.

As another example, one year our group took on an additional 1.5 million in CRNA expenses due to raises and misutilization by the hospital at some of the off-sites. Well we are a >20 million dollar company so no big deal right?

As I said 7 partners, so that is a 200k hit to each partner, and your salary is now in the 200s for the year. Thats for a pretty heavy call taking position in a busy inner city hospital. Not sustainable

Its a very tight margin for many practices, those without access to the books or in different situations may find it hard to understand.

 

[IMGASMD]

Lets take a look at the financial impact on a group like mine - 7 partners, 10 docs, 40 locations to cover.

For my practice at 40 rooms we have 10 docs and 40 CRNAs. 10 X 500k (total MD package) + 40 x 250k (total CRNA package) = 15 million

Vs. 40 docs at 500k = 20 million + hiring other staff for breaks/out of OR coverage ( because you have to have someone to respond to codes/breaks/blocks/help in difficult rooms if you have no one free roaming outside like in the ACT model) estimate that at 2 million for 4 more docs (one for every 10 rooms I think is a fair estimate).

Ok so the MD only group costs 22 million. The ACT group costs 15 million. 7 million dollar difference, not quite double but financially crippling for any private, unsubsidized group to take on an unneeded 7 million dollar expense.

Like I said, 7 partners, 7 million dollars in additional cost, how do you think December is going to look for you that year? The practice would fold.

Its easy to say MD only when you have a model that that is possible to accomplish. Its tough out there and very often its simply not possible to do MD only.

As another example, one year our group took on an additional 1.5 million in CRNA expenses due to raises and misutilization by the hospital at some of the off-sites. Well we are a >20 million dollar company so no big deal right?

As I said 7 partners, so that is a 200k hit to each partner, and your salary is now in the 200s for the year.

Its a very tight margin for many practices, those without access to the books or in different situations may find it hard to understand.

After 200+ post. We are finally here. When it’s all said and done, it’s all about the Benjamins.
This is where the AANA sells themselves.... it’s not about patient safety nor satisfaction. But we don’t like to talk about it, we hide behind all these “healthcare providers” talk. The other point that we don’t discuss enough is also @chocomorsel said, why do every single procedure “need” anesthesia? And why would anyone leave any money on the table.... lastly, we’re all waiting for crna independent practice to f up. Either it hasn’t happened (doubtful) or it got shove under the bed or whichever hospital hires them have done their own calculation, by save enough money and buy very good malpractice with that money.

I think we need to talk about all these issues honestly to arrive at a better resolution. I, personally, would take a pay cut to be in a MD only practice. @Hoya11, I am even willing to take your crna pay with opportunity to take calls or make 1.5 overtime that you pay your CRNAs to do my own cases.....

Edit: while we are here. We can also discuss different payment schedule. If you get a platinum insurance, you get MD in the room. Gold plan, ACT with MD supervising. Silver, independent CRNAs. We also don’t like this idea.... second tier insurance, second tier reimbursement. That would also solve some problems, if CRNAs cases don’t get reimbursed the same way MD only cases..... since I am putting everything on the table.

 

[PieOHmy]

After 200+ post. We are finally here. When it’s all said and done, it’s all about the Benjamins.
This is where the AANA sells themselves.... it’s not about patient safety nor satisfaction. But we don’t like to talk about it, we hide behind all these “healthcare providers” talk. The other point that we don’t discuss enough is also @chocomorsel said, why do every single procedure “need” anesthesia? And why would anyone leave any money on the table.... lastly, we’re all waiting for crna independent practice to f up. Either it hasn’t happened (doubtful) or it got shove under the bed or whichever hospital hires them have done their own calculation, by save enough money and buy very good malpractice with that money.

I think we need to talk about all these issues honestly to arrive at a better resolution. I, personally, would take a pay cut to be in a MD only practice. @Hoya11, I am even willing to take your crna pay with opportunity to take calls or make 1.5 overtime that you pay your CRNAs to do my own cases.....

We know it is all about the money... Who said it wasnt?
And you wouldnt take a pay cut to go in all MD. I already know you wouldnt.

 

[IMGASMD]

We know it is all about the money... Who said it wasnt?
And you wouldnt take a pay cut to go in all MD. I already know you wouldnt.

Then come out and say it out loud and proud. Why do these discussions all start with patient safety?

Actually if it’s in the right place. You bet I would. I don’t make “partner” money to begin with. Not all about Benjamin right now. Maybe in another 10 years when I am getting tired of fighting.....

 

[psychbender]

If we had enough anesthesiologists, another option would be to hire non-partner, day only docs. If you're spending $250k per CRNA and $500k per partner, then you can let those four CRNAs go, have the partner cover a single room, and hire three day docs for ((250 x 4)/3) = $333k. You wouldn't be able to hire enough to replace them all, as we've already established that there just aren't enough of us, but it's a start for heavy ACT groups to move a little more toward offering physicians in the room for the entire case.

Also, many on here have previously said that they would be fine with M-F, 7-3, no holidays, weekends, nights, for $300k. In my very limited experience, I think it would be a good idea for groups to offer some of these employed positions to decrease their reliance on midlevels.

 

[chocomorsel]

We know it is all about the money... Who said it wasnt?
And you wouldnt take a pay cut to go in all MD. I already know you wouldnt.

Do you two know each other?

 

[MoMoGesiologist]

Lets take a look at the financial impact on a group like mine - 7 partners, 10 docs, 40 locations to cover.

For my practice at 40 rooms we have 10 docs and 40 CRNAs. 10 X 500k (total MD package) + 40 x 250k (total CRNA package) = 15 million

Vs. 40 docs at 500k = 20 million + hiring other staff for breaks/out of OR coverage ( because you have to have someone to respond to codes/breaks/blocks/help in difficult rooms if you have no one free roaming outside like in the ACT model) estimate that at 2 million for 4 more docs (one for every 10 rooms I think is a fair estimate).

Ok so the MD only group costs 22 million. The ACT group costs 15 million. 7 million dollar difference, not quite double but financially crippling for any private, unsubsidized group to take on an unneeded 7 million dollar expense.

Like I said, 7 partners, 7 million dollars in additional cost, how do you think December is going to look for you that year? The practice would fold.

Its easy to say MD only when you have a model that that is possible to accomplish. Its tough out there and very often its simply not possible to do MD only.

As another example, one year our group took on an additional 1.5 million in CRNA expenses due to raises and misutilization by the hospital at some of the off-sites. Well we are a >20 million dollar company so no big deal right?

As I said 7 partners, so that is a 200k hit to each partner, and your salary is now in the 200s for the year. Thats for a pretty heavy call taking position in a busy inner city hospital. Not sustainable

Its a very tight margin for many practices, those without access to the books or in different situations may find it hard to understand.

Maybe your attendings are overpaid. If we were all willing to accept a 100k salary, then we could really show those CRNAs who’s boss!

 

[Southpaw]

We know it is all about the money... Who said it wasnt?
And you wouldnt take a pay cut to go in all MD. I already know you wouldnt.

Actually I think a lot of people would. Like everything I think change is difficult. People in MD-only can’t see it any other way even if it’d benefit everyone to move to a hybrid model. And people in strictly ACT can’t see life any other way. It’s what they’ve always done. And day to day MD-CRNA relationships are generally fine. Honestly if it weren’t for the AANA everyone would be fine.

I assure you, when 4 hands rather than 2 are needed to help the patient everyone in the room is glad for them all. Except the AANA.

 

[IMGASMD]

Do you two know each other?

Jon Snow, is that you?

 

[Urzuz]

40 docs at 500k = 20 million + hiring other staff for breaks/out of OR coverage ( because you have to have someone to respond to codes/breaks/blocks/help

Hire extra staff for breaks? Lol. We live very different lives...

 

[PieOHmy]

Then come out and say it out loud and proud. Why do these discussions all start with patient safety?

Actually if it’s in the right place. You bet I would. I don’t make “partner” money to begin with. Not all about Benjamin right now. Maybe in another 10 years when I am getting tired of fighting.....

not politically correct to say that.
we all know it is.

 

[chocomorsel]

Actually I think a lot of people would. Like everything I think change is difficult. People in MD-only can’t see it any other way even if it’d benefit everyone to move to a hybrid model. And people in strictly ACT can’t see life any other way. It’s what they’ve always done. And day to day MD-CRNA relationships are generally fine. Honestly if it weren’t for the AANA everyone would be fine.

I assure you, when 4 hands rather than 2 are needed to help the patient everyone in the room is glad for them all. Except the AANA.

I have been in both. Prefer MD only. Even though sometimes I starve.

 

[Urzuz]

Lets take a look at the financial impact on a group like mine - 7 partners, 10 docs, 40 locations to cover.

For my practice at 40 rooms we have 10 docs and 40 CRNAs. 10 X 500k (total MD package) + 40 x 250k (total CRNA package) = 15 million

Vs. 40 docs at 500k = 20 million + hiring other staff for breaks/out of OR coverage ( because you have to have someone to respond to codes/breaks/blocks/help in difficult rooms if you have no one free roaming outside like in the ACT model) estimate that at 2 million for 4 more docs (one for every 10 rooms I think is a fair estimate).

Ok so the MD only group costs 22 million. The ACT group costs 15 million. 7 million dollar difference, not quite double but financially crippling for any private, unsubsidized group to take on an unneeded 7 million dollar expense.

Like I said, 7 partners, 7 million dollars in additional cost, how do you think December is going to look for you that year? The practice would fold.

Its easy to say MD only when you have a model that that is possible to accomplish. Its tough out there and very often its simply not possible to do MD only.

As another example, one year our group took on an additional 1.5 million in CRNA expenses due to raises and misutilization by the hospital at some of the off-sites. Well we are a >20 million dollar company so no big deal right?

As I said 7 partners, so that is a 200k hit to each partner, and your salary is now in the 200s for the year. Thats for a pretty heavy call taking position in a busy inner city hospital. Not sustainable

Its a very tight margin for many practices, those without access to the books or in different situations may find it hard to understand.

You are making this too complicated by applying these hypothetical numbers. Keep it simple - you join the group, you eat what you kill. How can you not make that work? If you can't, you guys either have a bad payor mix, terrible contracts, or you guys aren't busy. Oh, or the partners are abusing their slaves, I mean anesthesiologists.

Don't go through mental gymnastics to try to justify why having an MD-only practice won't work. As the other poster said, just admit that whoever set up your group that way wanted to make more at the expense of the integrity of the specialty.

 

[chocomorsel]

Lets take a look at the financial impact on a group like mine - 7 partners, 10 docs, 40 locations to cover.

For my practice at 40 rooms we have 10 docs and 40 CRNAs. 10 X 500k (total MD package) + 40 x 250k (total CRNA package) = 15 million

Vs. 40 docs at 500k = 20 million + hiring other staff for breaks/out of OR coverage ( because you have to have someone to respond to codes/breaks/blocks/help in difficult rooms if you have no one free roaming outside like in the ACT model) estimate that at 2 million for 4 more docs (one for every 10 rooms I think is a fair estimate).

Ok so the MD only group costs 22 million. The ACT group costs 15 million. 7 million dollar difference, not quite double but financially crippling for any private, unsubsidized group to take on an unneeded 7 million dollar expense.

Like I said, 7 partners, 7 million dollars in additional cost, how do you think December is going to look for you that year? The practice would fold.

Its easy to say MD only when you have a model that that is possible to accomplish. Its tough out there and very often its simply not possible to do MD only.

As another example, one year our group took on an additional 1.5 million in CRNA expenses due to raises and misutilization by the hospital at some of the off-sites. Well we are a >20 million dollar company so no big deal right?

As I said 7 partners, so that is a 200k hit to each partner, and your salary is now in the 200s for the year. Thats for a pretty heavy call taking position in a busy inner city hospital. Not sustainable

Its a very tight margin for many practices, those without access to the books or in different situations may find it hard to understand.

Must you make 500K? Would you be OK with making a little less?
And you don't need four extra docs. You can have one to lend a hand.
The people in the rooms can do their own blocks and take lunches in between cases.
Are you guys responsible for codes outside of the OR? If not, how many codes are you guys having in a given week? Shouldn't be many.
In between cases, there are docs available if there are emergencies.

But you point out the most important part. The money.

 

[PieOHmy]

Hire extra staff for breaks? Lol. We live very different lives...

The problem with having md only group (and I work in one ) is if someone calls out, the post call person has to pick up the slack and stay. Not much wiggle room..

 

[chocomorsel]

not politically correct to say that.
we all know it is.

Cue @Consigliere. He's up front. He don't beat around the bush.

 

[sevoflurane]

Lets take a look at the financial impact on a group like mine - 7 partners, 10 docs, 40 locations to cover.

For my practice at 40 rooms we have 10 docs and 40 CRNAs. 10 X 500k (total MD package) + 40 x 250k (total CRNA package) = 15 million

Vs. 40 docs at 500k = 20 million + hiring other staff for breaks/out of OR coverage ( because you have to have someone to respond to codes/breaks/blocks/help in difficult rooms if you have no one free roaming outside like in the ACT model) estimate that at 2 million for 4 more docs (one for every 10 rooms I think is a fair estimate).

Ok so the MD only group costs 22 million. The ACT group costs 15 million. 7 million dollar difference, not quite double but financially crippling for any private, unsubsidized group to take on an unneeded 7 million dollar expense.

Like I said, 7 partners, 7 million dollars in additional cost, how do you think December is going to look for you that year? The practice would fold.

Its easy to say MD only when you have a model that that is possible to accomplish. Its tough out there and very often its simply not possible to do MD only.

As another example, one year our group took on an additional 1.5 million in CRNA expenses due to raises and misutilization by the hospital at some of the off-sites. Well we are a >20 million dollar company so no big deal right?

As I said 7 partners, so that is a 200k hit to each partner, and your salary is now in the 200s for the year. Thats for a pretty heavy call taking position in a busy inner city hospital. Not sustainable

Its a very tight margin for many practices, those without access to the books or in different situations may find it hard to understand.

I will need my mandatory 30 minute breaks throughout the day and I better not work one minute over 3pm... and benefits.... benefits... $$$

It’s a wash IMO.... make a little less and do your own cases one patient at a time or constantly deal with a big PITA for “maybe” more $$$.

My average career income over 10+ years sits around 575k in MD only + 9-12 weeks per year.

(Working above average likely).

 

[IMGASMD]

The problem with having md only group (and I work in one ) is if someone calls out, the post call person has to pick up the slack and stay. Not much wiggle room..

No. But as long as it’s up front, and everyone understands/agrees. We’ve all had emergencies. I can work for my boss/partner if it’s dealt equally for all members.

 

[IMGASMD]

I will need my mandatory 30 minute breaks throughout the day and I better not work one minute over 3pm... and benefits.... benefits... $$$

It’s a wash IMO.... make a little less and do your own cases one patient at a time or constantly deal with a big PITA for “maybe” more $$$.

My average career income over 10+ years sits around 575k in MD only + 9-12 weeks per year.

(Working above average likely).

Please don’t forget my breakfast before 9am preferred. If you have someone free after lunch, I also need my afternoon tea.

 

[sevoflurane]

The problem with having md only group (and I work in one ) is if someone calls out, the post call person has to pick up the slack and stay. Not much wiggle room..

I have a scrip for that:

500mg of Sukitup.

Broke my hand a few weeks ago mountain biking. First time I’ve called off EVER. We just make it work.

Doesn’t happen often even with 70+ MDs.

I hear your point though.

 

[Southpaw]

you guys are amazing. so honest. so altruistic. I bet none of you have even sold your practice to big national management companies!

 

[sevoflurane]

you guys are amazing. so honest. so altruistic. I bet none of you have even sold your practice to big national management companies!

If you think all groups merge with AMCs just for the $$$, think again.

Better yet, ask groups what they received and what their current compensation is relative
to years past after an AMC or hospital system ate them up without a buyout.

 

[Southpaw]

If you think all groups merge with AMCs just for the $$$, think again.

Better yet, ask groups what they received and what their current compensation is relative
to years past after an AMC or hospital system ate them up without a buyout.

I’m real curious as to why a MD only group out west would sell if it isn’t for the money? Unless it isn’t as rosy a picture as you paint and the hospital is forcing a move one way or the other.

 

[sevoflurane]

I’m real curious as to why a MD only group out west would sell if it isn’t for the money? Unless it isn’t as rosy a picture as you paint and the hospital is forcing a move one way or the other.

Unless you understand this market I wouldn’t bother speculating.

 

[Southpaw]

Unless you understand this market I wouldn’t bother speculating.

If you mean the market as a whole I’ve been around long enough to understand it more than most. If you mean the particular market you work in then no, certainly not.

 

[sevoflurane]

To put it simply, buyouts are actually going down and some AMCs have stopped buying anesthesia practices all together.

A common scenario that still exists is group takeover or being forced out and replaced (amc/hospital).

Atrium is a classic example, except it happened in reverse. AMC out, new AMC in.

Collateral damage?

Those doing the work.

Awful for those guys.

But they DID get a buyout. So it’s not all negative when they left the hospital system for the last time.

 

[sevoflurane]

IMO, that group was one step ahead of the administrators at Atrium heath.

Good for them. They managed to walk away with something.

 

[Southpaw]

To put it simply, buyouts are actually going down and some AMCs have stopped buying anesthesia practices all together.

A common scenario that still exists is group takeover or being forced out and replaced (amc/hospital).

Atrium is a classic example, except it happened in reverse. AMC out, new AMC in.

Collateral damage?

Those doing the work.

Awful for those guys.

But they DID get a buyout. So it’s not all negative when they left the hospital system for the last time.

The old Southeast guys who got a buyout from Mednax were long gone when Atrium brought ScopeNC in. And Mednax’s inability/refusal to work with the hospital on issues important to the hospital led to their ousting. Recent articles point to the hospital being pleased with the end result. The anesthesiologists who lost their jobs were innocent pawns. Almost all of them received nothing when Southeast sold.

 

[sevoflurane]

Of course they are happy. A new AMC is “delivering better care at reduced $$$”

Blah...!

You sure all those Docs are gone?

 

[sevoflurane]

Anyways... this is about CRNAs.
Not AMCs.

Cheers

 

[Southpaw]

Anyways... this is about CRNAs.
Not AMCs.

Cheers

I’m glad your group is able to make it work MD only. I’m absolutely 100% positive that your day to day is nicer. I wish everyone had such options. If your group perceived the buyout to be in everyone’s best interest then so be it.

 

[Dejavu]

Nope. You can say all you want “just go all MD” but that’s a total fantasy for mid-to-large groups. There simply aren’t the bodies out there.

We would need to hire 300+ more MDs if we went MD only. We have to provide a body at ~280 locations every morning at 0730. Never mind call, weekend schedules, OB, etc.

No one can say, with a straight face, that that is financially a good idea.

 

[GravelRider]

Isn’t it funny how we can be so idealistic about MD only care, but when it comes to accepting money from corporations that bring absolutely nothing to the table but more expense to our patients, those ideals get thrown out? Just a thought. Everyone is idealistic until they are shown a fat check.

 

[Mman]

I’m glad your group is able to make it work MD only. I’m absolutely 100% positive that your day to day is nicer.

We are too far down the efficiency pathways to even contemplate it. I mean we could maybe go physician only (don't forget the DOs) but would probably need about an extra 150 docs or so and would then have to add on top of that to have multiple docs free putting in blocks and things pre and postoperatively so the doc in the room can just turn the room over in 10 minutes and not waste time between cases doing anything but dropping one patient off and rolling the next back.

 

[AdmiralChz]

We would need to hire 300+ more MDs if we went MD only. We have to provide a body at ~280 locations every morning at 0730. Never mind call, weekend schedules, OB, etc.

No one can say, with a straight face, that that is financially a good idea.

Never mind financially, it’s just not possible period. Even if you hire “mommy trackers” or whatever still there’s not enough fish in the sea, especially if the other groups are trying to do the same.

 

[Southpaw]

We are too far down the efficiency pathways to even contemplate it. I mean we could maybe go physician only (don't forget the DOs) but would probably need about an extra 150 docs or so and would then have to add on top of that to have multiple docs free putting in blocks and things pre and postoperatively so the doc in the room can just turn the room over in 10 minutes and not waste time between cases doing anything but dropping one patient off and rolling the next back.

My group would need 50-60 more docs. I don’t know how MD only places keep up the efficiency when pre/post issues arise or when they’re in places w 10 min turnovers and heavy block rooms.

Anyway, yes my group is too far down the supervision path. The hospital and surgeons would not accept any decreases in efficiency. My group is still private with no interest in selling. At best I could see somewhat of a hybrid model because it would be nice to do some cases solo, but it simply isn’t doable at current growth/recruiting rates.

 

[Mman]

My group would need 50-60 more docs. I don’t know how MD only places keep up the efficiency when pre/post issues arise or when they’re in places w 10 min turnovers and heavy block rooms.

Anyway, yes my group is too far down the supervision path. The hospital and surgeons would not accept any decreases in efficiency. My group is still private with no interest in selling. At best I could see somewhat of a hybrid model because it would be nice to do some cases solo, but it simply isn’t doable at current growth/recruiting rates.

we occasionally have a doc do their own room when we are either fat with docs or tight on AAs/CRNAs

 

[Mman]

Never mind financially, it’s just not possible period. Even if you hire “mommy trackers” or whatever still there’s not enough fish in the sea, especially if the other groups are trying to do the same.

I'd ballpark you'd need an extra 20000 anesthesiologists in the country (if not more) if you transitioned to all physician care across the country.

 

[Urzuz]

I don’t know how MD only places keep up the efficiency when pre/post issues arise or when they’re in places w 10 min turnovers and heavy block rooms.

I know after working with CRNAs for so long it may be tough to understand, but issues that require your presence don’t arise frequently enough to make a difference in efficiency.

If issues are that common then you’re doing it wrong.

 

[Hoya11]

Must you make 500K? Would you be OK with making a little less?
And you don't need four extra docs. You can have one to lend a hand.
The people in the rooms can do their own blocks and take lunches in between cases.
Are you guys responsible for codes outside of the OR? If not, how many codes are you guys having in a given week? Shouldn't be many.
In between cases, there are docs available if there are emergencies.

But you point out the most important part. The money.

We dont make 500k. Its the total package including benefits, malpractice, retirement, license costs, etc.. I think that number is on par with a salary of 425 which I think is average.

You need one extra doc for float coverage for 40 rooms?!

Yes of course we are resonsible for code coverage outside the OR... isnt that usually how it is?

Code blue, hmm just let me wait until they finish closing and ill run up there between cases..

The numbers I used in my example were reasonable and round..

 

[Hoya11]

I will need my mandatory 30 minute breaks throughout the day and I better not work one minute over 3pm... and benefits.... benefits... $$$

It’s a wash IMO.... make a little less and do your own cases one patient at a time or constantly deal with a big PITA for “maybe” more $$$.

My average career income over 10+ years sits around 575k in MD only + 9-12 weeks per year.

(Working above average likely).

Right but you probably work in what many would consider an undesirable area, and therefore cant compare apples to apples of those living in the big cities.

Its not a wash, and its not "maybe" a little more money. Its ACT or collapse, did you see the math? We dont get a stipend, as many dont around here.

 

[Hoya11]

You are making this too complicated by applying these hypothetical numbers. Keep it simple - you join the group, you eat what you kill. How can you not make that work? If you can't, you guys either have a bad payor mix, terrible contracts, or you guys aren't busy. Oh, or the partners are abusing their slaves, I mean anesthesiologists.

Don't go through mental gymnastics to try to justify why having an MD-only practice won't work. As the other poster said, just admit that whoever set up your group that way wanted to make more at the expense of the integrity of the specialty.

That was a simple and accurate example. We do indeed have a bad payor mix, as Im sure many practices in urban areas do.

If MD only worked people everywhere, people would do it everywhere.

Its not that there are evil ACT groups out there where people are raking in millions at the expense of safety.

Its not that we just stink at math and cant figure out that its essentially the same.

Its not the same.

There are financial situations where it doesn't work and people need to accept that.

I can tell you for certain, my group would not be able to afford MD only per my example.

 

[Southpaw]

I know after working with CRNAs for so long it may be tough to understand, but issues that require your presence don’t arise frequently enough to make a difference in efficiency.

If issues are that common then you’re doing it wrong.

You won’t believe me, and I’m not completely spilling the beans as I appreciate my anonymity here, but I have enough information personally to know that you’re wrong. This isn’t to say that I don’t believe in the MD only model but there’s no question it’s less efficient than ACT. No question.

 

[deleted162650]

Yes of course we are resonsible for code coverage outside the OR... isnt that usually how it is?

No, not outside of academics. It's typically CCM, or ER, or hospitalists that respond to codes where I've worked. If the hospital wants your department to be responsible for that, and they expect you guys to provide a free body at all times to do that, then you should absolutely be getting paid for that.