Direction of Locums Rates

[lotsapain]

Touched a nerve or two there, didn’t I?
Everyone else picked up what I was trying to say….
1. MDA?! What the fu(k is a MDA? It’s redundant…. Anesthesiologists, like cardiologist, like gastroenterologist, like endocrinologist, is a physician only position. Do we call them MDC? MDG? MDE?!

2. I’d like to be a nurse in this set up. I punch in/out for 40 hrs, no call, no stress…. I will do you a solid, I can even sign my own chart and do my own pre-op. But I demand a morning break (at least 15 mins). Lunch break, and you better believe it, I will start asking when I can get out at 2pm.

I understand the call is part of the work, I will be glad to take calls, when it’s compensated like CRNAs, when I am not a partner (just an “employee”).

We are so reliant on CRNAs, we are already so fu(ked. At the same time we criticize each other, we are afraid to piss off crnas. WTFH!

All good points... its a closed loop as far as CRNAs go can't live with them can't live without them... they will gain independence soon enough some say let it be it will sort itself out once bodies start piling others say we have to fight it - frankly its a little too late for that. Surprisingly everyone should blame the old "partners" who stuffed their pockets while associates did all the work... if anyone offers you a 4 year partnership track RUN

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[anes12]

I’ve never seen an admin fired. Their numbers only grow with new bizarre roles created, and/or they get promoted.

Our old hospital CEO, for example, ran things into the ground financially and then got promoted to be CEO at a fancier hospital. Now the hospital keeps cutting our salaries while that guy undoubtedly got a golden handshake.

I get random emails or see internal webpages announcing Janet, MHA as the new “manager of XYZ” - as these new positions are endlessly created. I’ve also seen celebration and sadness emails thanking Janet when she moves to a new job.

But when a new doctor comes on board or leaves, nobody cares. I had several coworkers just disappear without any explanation or announcement.

This is modern healthcare.

If the top admins do get fired, they get the golden parachute along with it, and so it's a "win-win" for everybody. Middle management like roles with the titles of "regional director" or some "advisory" role may not be so lucky and they are the ones that usually throw staff under the bus.

 

[lotsapain]

What I don’t get are docs who never want to take call, never want to be in a room alone and don’t want anything to do with OB but still want to be paid yacht money. If I could find competent hardworking docs with a little flexibility I would gladly get rid of every crna tomorrow.

Just yesterday I had this conversation with someone who wanted guaranteed overnight hours AND a crna on call so he wouldn’t actually have to lift a finger. Please tell me on what fantasy planet you can be paid thousands to generate a few hundred in revenue at best. Non PE owned groups survive on razor thin margins.. not the fat cat billing that envision and team health generate. We actually have a business that has long term goals not “bleed practices dry and sell”.

Taking call is part of the job. Covering OB is part of the job. Providing actual patient care is part of the job. I’d say around 50% of my fellow MDAs don’t understand these 3 simple facts but are the first to cry when a crna steps up to the job they REFUSE for half the pay.

There are a lot of inconvenient truths in anesthesia.. crna encroachment is real and the shortage of MDAs will only make it worse. ASCs that would have never entertained the idea of solo crna are now writing new surgeon / gi / crna collaborative agreements to completely cut anesthesiologists out of the picture. Why? Because supervising a couple of endo rooms while the crna/aa do all of the cases is “slave labor” at $250/hr.

Sorry for the rant.. I spent most of the day yesterday with hospital admin writing new CRNA policy so we can permanently erase another MDA position. I fought tooth and nail to prevent this but the wonderful doc who “knew his worth” wanted the annualized equivalent of $2 million to generate and few thousand in revenue per day. He’s now earning $0 in his hotel room trying to find another gig.

Anyway I’m gonna go start a gallbladder.. on a Saturday.. by myself.. cheers.

I like it all great point of exactly what is happening... I have a few of these wonderful docs myself who want their malpractice paid, their ass wiped and rate increase as it gets later in the day. What do I know I want out of this profession.

 

[MirrorTodd]

All good points... its a closed loop as far as CRNAs go can't live with them can't live without them... they will gain independence soon enough some say let it be it will sort itself out once bodies start piling others say we have to fight it - frankly its a little too late for that. Surprisingly everyone should blame the old "partners" who stuffed their pockets while associates did all the work... if anyone offers you a 4 year partnership track RUN

In all honesty, the bodies won't start piling up though. Anesthesia is just pretty darn safe and it's really hard to actually someone. Pt's will certainly suffer but I don't believe that will be in any real measurable way.

 

[sevo00]

I work 45-50 hrs/week M-F. I don't "travel all over". I am married and my wife is supportive. I fly home every weekend and take off 12 weeks/year. We make it work. We are interested in financial independence. I plan on only working 26 weeks/year by the time I'm 50.

Obviously Great income for the hours worked and I’m jealous my pay will never be as close to yours. But you only see your wife on the weekends? Otherwise M-F your living alone in a hotel room? Sounds kind of depressing lol

 

[PainInTheAnes]

In order to do that two things have to happen:
1. Hospitals must negotiate with insurance companies to get decent per unit rates and that is tough because
2. Hospitals need people with experience in negotiating with insurance companies and they are very hard to find even for big institutions
3. Insurances do not negotiate with small entities, why should they as smaller entities cannot demand anything too few patients to gain
hence its a take it or leave it situation. Large entities that see tens to hundred thousand patients are worth negotiating with and even
then see point #2

Hospitals would love to hire people directly but that involves knowing how to do such a thing. I have seen it done by smaller
entities who then understood they cannot pay the salaries they offer - entire department jumps ship to the next big thing.....

GREED is the source of all evil on both sides its very simple. I humble suggest to people on this thread to come
down... don't demand rates you will just make it worse for yourself and the next guy.... solution is a modified
Doctors "union" ... organization if you will. ASA should just create a singular staffing company that any hospital in the country can
reach out to where all rates are the same and what you make is determined by:

1. Hours worked
2. Extra points accumulated for taking calls, doing many cases (ie fast paced endo) willing to do
high risk cases - peds, cardiac, cath lab.

This is rudimentary stuff and there are systems that have figured all this out.... happy staff = low turn over money is made FAIRLY.....

What do I know all millennials on here will cry they need to work 30 hours and make a million dollars just because they are entitled...

I’ll ask you what I ask other people who poor mouth people who do our Line of work.

What do you think is a fair hourly rate for the work we do? How about subspecialty work or overnight work?

Do you feel pay should be dictated by forces other than supply and demand, and if so, which forces?

I’m very surprised you could do admin and not have better perspective on the value of an hour of hospital time to any physician. You seem to lack an understanding of the vast sums of money thrown around in hospital coffers to consider anesthesiologists pay as so over the top compared to say…GI doctors or cardiologists.

My guess is you aren’t actually in “this profession,” since it appears you would work for literally less than a CRNA would make.

I wish we lived in your world where money didn’t matter and everyone had all they wanted and healthcare was infinite and free. Unfortunately, in the current world, nice and safe things cost money and neurosurgeons or other specialists don’t work out of the goodness of their hearts in most cases.

 

[PainInTheAnes]

Yes that is indeed the case and yes Locums Anesthesiologists are greedy... I am laughing at this conversation, only 3-4 years back $160 an hour was an amazing rate to have suddenly everyone knows what they "should be paid"... as far as 19k per OR per day that's highly overestimated only top tier facilities with 60/40 mix get that.....

3 or 4 years ago many CA1 residents moonlighted for 80-100 dollars an hour, definitely at my program this was the case. This statement you made is so inaccurate as to be laughable, and I imagine it makes people here immediately skeptical of your credentials.

 

[sevo00]

3 or 4 years ago many CA1 residents moonlighted for 80-100 dollars an hour, definitely at my program this was the case. This statement you made is so inaccurate as to be laughable, and I imagine it makes people here immediately skeptical of your credentials.

His username says it all. He’s a pain doc jealous of how much anesthesia making now. Prob has shares in a surgicenter so wants us to stop “being greedy” and work for less so he can continue to do his surgery center cases. Pay up homie

 

[GravelRider]

In order to do that two things have to happen:
1. Hospitals must negotiate with insurance companies to get decent per unit rates and that is tough because
2. Hospitals need people with experience in negotiating with insurance companies and they are very hard to find even for big institutions
3. Insurances do not negotiate with small entities, why should they as smaller entities cannot demand anything too few patients to gain
hence its a take it or leave it situation. Large entities that see tens to hundred thousand patients are worth negotiating with and even
then see point #2

Hospitals would love to hire people directly but that involves knowing how to do such a thing. I have seen it done by smaller
entities who then understood they cannot pay the salaries they offer - entire department jumps ship to the next big thing.....

GREED is the source of all evil on both sides its very simple. I humble suggest to people on this thread to come
down... don't demand rates you will just make it worse for yourself and the next guy.... solution is a modified
Doctors "union" ... organization if you will. ASA should just create a singular staffing company that any hospital in the country can
reach out to where all rates are the same and what you make is determined by:

1. Hours worked
2. Extra points accumulated for taking calls, doing many cases (ie fast paced endo) willing to do
high risk cases - peds, cardiac, cath lab.

This is rudimentary stuff and there are systems that have figured all this out.... happy staff = low turn over money is made FAIRLY.....

What do I know all millennials on here will cry they need to work 30 hours and make a million dollars just because they are entitled...

Huh? I lost you at “don’t demand the highest rate” and “millennials.”

 

[Anesthesia_Guy]

What do you think is a fair hourly rate for the work we do? How about subspecialty work or overnight work?

$300/hr. That's the rate I demand; I will not work for a penny less. My phone and email are blowing up with recruiters.

 

[lotsapain]

His username says it all. He’s a pain doc jealous of how much anesthesia making now. Prob has shares in a surgicenter so wants us to stop “being greedy” and work for less so he can continue to do his surgery center cases. Pay up homie

and you are a dumb ass. Not much else to say, never done pain. Lions don't care for the opinion of the sheep... keep walking .."homie"

 

[ambiturner]

and you are a dumb ass. Not much else to say, never done pain. Lions don't care for the opinion of the sheep... keep walking .."homie"

You still have not responded to my question: if hospitals don’t like dealing with locums, unreasonable private equity companies, or negotiating anesthesia insurance rates, why do they keep kicking out stable small private groups that have been doing all of that for them for decades in favor of big box AMCs? I am genuinely interested in your perspective on this.

 

[Arch Guillotti]

and you are a dumb ass. Not much else to say, never done pain. Lions don't care for the opinion of the sheep... keep walking .."homie"

cool it, “homie”. No need for this unless you want the thread locked.

 

[MirrorTodd]

and you are a dumb ass. Not much else to say, never done pain. Lions don't care for the opinion of the sheep... keep walking .."homie"

You sound like a regional guy I know.

 

[abolt18]

Yes that is indeed the case and yes Locums Anesthesiologists are greedy... I am laughing at this conversation, only 3-4 years back $160 an hour was an amazing rate to have suddenly everyone knows what they "should be paid"... as far as 19k per OR per day that's highly overestimated only top tier facilities with 60/40 mix get that.....

Supply and demand. You don't pay enough, you won't fill the spots. I don't think it's greedy to actually ask for, or even demand more. No one is forcing you to meet their demands. Tell them no and deal with the consequences, good or bad. Just as they will have to deal with the consequences if they ask for too much. But if they know they can get more $$$ across town with more perks (like reimbursed expenses), why in the world would they work with you?

Would you tell your child to just take what's offered to them? Or tell them to ask for more if you know the market allows it? In any field outside of medicine you would not call it greedy if someone asked for a raise, or sought a higher paying job.

On a second thought, what was the normal hourly rate for anesthesiologists 10, 20, or 30 years ago? Has that even come close to keeping up with inflation? The corporate world gives inflation adjusted raises every year, while physicians experience reimbursement cuts every year, demanding more work for less money.

I say good for these docs who are able to demand more. I hope it serves them, and our whole specialty well!

 

[BLADEMDA]

"GREED is the source of all evil on both sides its very simple. "

For years hospital administrators have underfunded their anesthesia groups leading many of them to sell out to AMCs or fold and become employees. The AMCs played the game by overcharging Insurance companies massive rates for anesthesia and they capitulated. These days the lack of providers has led to the shift from employer to employee or from owner to worker. In this system, it is simply FOOLISH not to demand a fair wage for your work. What is a fair wage? Well based on what I was earning in 1999 I would say $800K-$950K working about 45 hours per week. That's the true private practice adjusted rate based on inflation. How about the real AMC wage? If the AMC didn't exist and all the money you earned either through cases or hospital stipend went directly to the employee what would the pay be? My guess is at least $100-$150K higher than your W-2 pay. For other hospital employed anesthesiologists they are are taking advantage of you by keeping your pay low while paying exorbitant locums rates.

For 2023 all of you really need to evaluate your situation. If the majority of anesthesiologists demanded a fair wage by 2023 standards the hospitals and AMCs would have no choice but to pay it. But, by staying in that low paying job you are enabling the current disparity in pay between the real wage of an an anesthesiologist and the discounted wage of those mired in their situations. Either demand a fantastic quality of life at $400-$450K (think 40 hours per week or less with no overnight call) or demand $600K for the typical W-2 job out there. This is the same type of job a locums would get over $750K for in 2023.

 

[lotsapain]

You still have not responded to my question: if hospitals don’t like dealing with locums, unreasonable private equity companies, or negotiating anesthesia insurance rates, why do they keep kicking out stable small private groups that have been doing all of that for them for decades in favor of big box AMCs? I am genuinely interested in your perspective on this.

A valid question. I have not seen too many "stable" private groups, most of them are unable to get reimbursed fairly for their efforts and indeed doing it for "decades" resulted in decade old salaries, as the older partners retire new guys won't work for the same money sweat equity or not.
The other reason for small private groups to be kicked out as you have aptly put it is due to move to Value Based Care. This required having to collect MIPS data, align with the OPPE standards of the hospital, do quality reporting and data analytics. Certainly some entrepreneurial groups may have the bandwidth to do that, most do do not. Quality reporting is a requirement now even for private payers. Hospitals are also under pressure together with HICAP scores etc etc. With competition being high, larger hospital systems may getaway by using internal Quality and Analytics to take care of this, smaller cannot.
Most importantly from what I have seen most private groups are now asking for a Stipend which no hospital wants to pay only to find out later that the larger players will also ask for a stipend if your payor mix is garbage (which is 80% of the time).
Again as you have mentioned if the group is indeed stable and not asking for money they should not be touched if they are able to keep up with the times. Going back to my greed point, I guess AMC offers a lower stipend and reliable data reporting..... Honestly most hospitals just want to own the anesthesia piece to collect the units and if they are smart they can afford to pay anesthesiologists more and just come out even from the collection without making anything as the facility fee is what makes the money not the anesthesia reimbursement.... but everyone wants to have it all, make money on anesthesia and facility fee....

 

[lotsapain]

cool it, “homie”. No need for this unless you want the thread locked.

I absolutely agree there was no need for the OP to trigger anyone...

 

[lotsapain]

"GREED is the source of all evil on both sides its very simple. "

For years hospital administrators have underfunded their anesthesia groups leading many of them to sell out to AMCs or fold and become employees. The AMCs played the game by overcharging Insurance companies massive rates for anesthesia and they capitulated. These days the lack of providers has led to the shift from employer to employee or from owner to worker. In this system, it is simply FOOLISH not to demand a fair wage for your work. What is a fair wage? Well based on what I was earning in 1999 I would say $800K-$950K working about 45 hours per week. That's the true private practice adjusted rate based on inflation. How about the real AMC wage? If the AMC didn't exist and all the money you earned either through cases or hospital stipend went directly to the employee what would the pay be? My guess is at least $100-$150K higher than your W-2 pay. For other hospital employed anesthesiologists they are are taking advantage of you by keeping your pay low while paying exorbitant locums rates.

For 2023 all of you really need to evaluate your situation. If the majority of anesthesiologists demanded a fair wage by 2023 standards the hospitals and AMCs would have no choice but to pay it. But, by staying in that low paying job you are enabling the current disparity in pay between the real wage of an an anesthesiologist and the discounted wage of those mired in their situations. Either demand a fantastic quality of life at $400-$450K (think 40 hours per week or less with no overnight call) or demand $600K for the typical W-2 job out there. This is the same type of job a locums would get over $750K for in 2023.

These are very interesting findings though likely not based on any real facts AT THIS POINT in time (this may have been true about 3-4 years back. In certain instances if the so called AMC did not exist then you would be payed less.... I am referring to small community hospitals that cannot stay above water where once the tide of insurance reimbursements turned (it keeps trending down if you read what is happening with Medicare cutting rates yet again etc...... odd isn't it inflation goes up... rates goes down makes no sense) downwards they could not clear $350-400k in account receivables per partner. I mean yes if you work for Hospital for Joint Diseases, Mayo Clinic, big HCA for profit hospital in a decent area then yes you are likely underpaid. I agree that for $450 you SHOULD have quality of life and $600-650 should be the standard for a busy practice...... I wish we COULD DEMAND something, someone here said they DEMAND $300 /h won't work for a penny less.... well that sounds wonderful but the Locums market is not as simple as it looks the high paying jobs have a Caveat - you will be doing cases no one WANTS TO DO (ie dangerous uncouth stuff that will make your hair turn gray) or you will be doing many cases quickly or will have to go into some dangerous areas if you are in the city. Granted perhaps in some suburban places where you have to work one week on one week off to be away from your family it fair to ask for whatever you want.

As was mentioned earlier you want to be in NYC, Miami, etc ie highly desirable areas you better be ready to swallow some s**t... and/or be paid less than what you think you demand.

All of the above is made much more complex if you ever worked for one of those AMCs in the past and not enough years have passed (or one of the wonderful locum agencies "accidentally" presented you) and they OWN your name for years and won't clear you or tell you go directly through them at a lower rate (this is especially true in Florida and NYC/NJ as its densely owned by large corps).

Bottom line I wish we as doctors organized then we can demand fair rates, humane treatment, safe surgical practices (ie do not operate on the dead in the middle of the night... or day for that matter). I would love to make a 1 mil + a year (and some locums do) but what happens when we bleed the system dry (nurses are demanding increases too etc etc) and no one can pay us because they are broke (yes hospitals are going broke read Becker's Hospital report) ..... I can already hear the answers - by that time we can go into real estate etc.... what about the younger generation and the patients etc..... ? Granted we have been all screwed for many years by everyone ... I don't have the answer I hope someone else finds it... and I hope I can retire by then (and not die from undue stress).

 

[bobg504]

Obviously Great income for the hours worked and I’m jealous my pay will never be as close to yours. But you only see your wife on the weekends? Otherwise M-F your living alone in a hotel room? Sounds kind of depressing lol

My wife works from home so she's with me a lot. Either way, this is a strategic short term sacrifice. I do not believe rates will remain this high forever, so this will set us up.

 

[sirspamalot]

My wife works from home so she's with me a lot. Either way, this is a strategic short term sacrifice. I do not believe rates will remain this high forever, so this will set us up.

I got 99 problems but charging 350/hr ain't one. There is no "do it for the greater good" get that nonsense outta here.

Kudos to you and know that you are spot on doing it right financially and living the life you and your wife are happy with.

Haters : Hate the game not the playa

1099 for lyfe. #750orGTFO..

 

[PainInTheAnes]

These are very interesting findings though likely not based on any real facts AT THIS POINT in time (this may have been true about 3-4 years back. In certain instances if the so called AMC did not exist then you would be payed less.... I am referring to small community hospitals that cannot stay above water where once the tide of insurance reimbursements turned (it keeps trending down if you read what is happening with Medicare cutting rates yet again etc...... odd isn't it inflation goes up... rates goes down makes no sense) downwards they could not clear $350-400k in account receivables per partner. I mean yes if you work for Hospital for Joint Diseases, Mayo Clinic, big HCA for profit hospital in a decent area then yes you are likely underpaid. I agree that for $450 you SHOULD have quality of life and $600-650 should be the standard for a busy practice...... I wish we COULD DEMAND something, someone here said they DEMAND $300 /h won't work for a penny less.... well that sounds wonderful but the Locums market is not as simple as it looks the high paying jobs have a Caveat - you will be doing cases no one WANTS TO DO (ie dangerous uncouth stuff that will make your hair turn gray) or you will be doing many cases quickly or will have to go into some dangerous areas if you are in the city. Granted perhaps in some suburban places where you have to work one week on one week off to be away from your family it fair to ask for whatever you want.

As was mentioned earlier you want to be in NYC, Miami, etc ie highly desirable areas you better be ready to swallow some s**t... and/or be paid less than what you think you demand.

All of the above is made much more complex if you ever worked for one of those AMCs in the past and not enough years have passed (or one of the wonderful locum agencies "accidentally" presented you) and they OWN your name for years and won't clear you or tell you go directly through them at a lower rate (this is especially true in Florida and NYC/NJ as its densely owned by large corps).

Bottom line I wish we as doctors organized then we can demand fair rates, humane treatment, safe surgical practices (ie do not operate on the dead in the middle of the night... or day for that matter). I would love to make a 1 mil + a year (and some locums do) but what happens when we bleed the system dry (nurses are demanding increases too etc etc) and no one can pay us because they are broke (yes hospitals are going broke read Becker's Hospital report) ..... I can already hear the answers - by that time we can go into real estate etc.... what about the younger generation and the patients etc..... ? Granted we have been all screwed for many years by everyone ... I don't have the answer I hope someone else finds it... and I hope I can retire by then (and not die from undue stress).

A few things:

1. Demand for service is not going down any time soon. Recent COVID Medicaid expansion being codified in several laws has assured this and entitlements never get cut.

2. The supply shortage of anesthesia is not getting better any time soon, and will in fact get worse with retirements of older practitioners, as will happen to every field. More people who want day doc type jobs enter this field every year. God help us when a doctor forgoes having children because then they have almost zero reason to work full time.

3. Facility fees are very high right now. Hospitals compete for those fees as the government dictates. To compete for those fees you need a few things, surgeons and anesthesiologists being a couple of those things.

4. Private practice surgeons will remain in ownership because it’s financially viable. They’re fine with their situations for the most part. Anesthesiologists cannot have viable practices with our ability to bill. This means to get anesthesiologists to get the fees, hospitals have to pay us with other means (stipends or locums).

5. If hospital A and B are in the same city, they want to do surgeries to get the fees. If they are fighting over one anesthesiologist, then that doctor will go to the hospital that pays the most generally or has other things that doctor wants. There is no moral or ethical question to be answered here. It’s supply and demand, that’s it. Accounts receiveable in anesthesia is a relic that is quickly fading as the ACA covers more and more people with terrible reimbursement for our services. This is by design to centralize healthcare and eliminate most private groups.

 

[dannyboy1]

A few things:

1. Demand for service is not going down any time soon. Recent COVID Medicaid expansion being codified in several laws has assured this and entitlements never get cut.

2. The supply shortage of anesthesia is not getting better any time soon, and will in fact get worse with retirements of older practitioners, as will happen to every field. More people who want day doc type jobs enter this field every year. God help us when a doctor forgoes having children because then they have almost zero reason to work full time.

3. Facility fees are very high right now. Hospitals compete for those fees as the government dictates. To compete for those fees you need a few things, surgeons and anesthesiologists being a couple of those things.

4. Private practice surgeons will remain in ownership because it’s financially viable. They’re fine with their situations for the most part. Anesthesiologists cannot have viable practices with our ability to bill. This means to get anesthesiologists to get the fees, hospitals have to pay us with other means (stipends or locums).

5. If hospital A and B are in the same city, they want to do surgeries to get the fees. If they are fighting over one anesthesiologist, then that doctor will go to the hospital that pays the most generally or has other things that doctor wants. There is no moral or ethical question to be answered here. It’s supply and demand, that’s it. Accounts receiveable in anesthesia is a relic that is quickly fading as the ACA covers more and more people with terrible reimbursement for our services. This is by design to centralize healthcare and eliminate most private groups.

All good. Problem is this will inevitably lead to CRNA independence. As the facilities really don’t collect that much when we are medically direction vs medical supervision the hospital will inevitably want to fill as many rooms as possible for as cheap as possible. Guess what happens then….

 

[PainInTheAnes]

All good. Problem is this will inevitably lead to CRNA independence. As the facilities really don’t collect that much when we are medically direction vs medical supervision the hospital will inevitably want to fill as many rooms as possible for as cheap as possible. Guess what happens then….

I think supervision model stays intact, probably gonna pay more than it does especially in areas where it's harder to get enough MDs like the southeast. The fact is that the average CRNA coming out of school neither has the skill nor the desire to be independently practicing, and even more skilled ones cannot feasibly handle an entire OR worth of services (I literally know zero CRNAs who are facile in all of regional, OB, basic peds, and cardiac. Maybe some have 2 of those skills but rarely more than that.)

Hiring only CRNAs will severely limit what a hospital can do and who they can keep safe. It's obvious in most hospitals, as the independence movement has very little traction outside very rural areas and the VA, both of which aren't going to run the gamut of all the large hospital services.

 

[GravelRider]

All good. Problem is this will inevitably lead to CRNA independence. As the facilities really don’t collect that much when we are medically direction vs medical supervision the hospital will inevitably want to fill as many rooms as possible for as cheap as possible. Guess what happens then….

That was always the end game and thinking otherwise is engaging in denial. Might as well milk it in the meantime.

 

[Anesthesia_Guy]

...someone here said they DEMAND $300 /h won't work for a penny less.... well that sounds wonderful but the Locums market is not as simple as it looks the high paying jobs have a Caveat - you will be doing cases no one WANTS TO DO (ie dangerous uncouth stuff that will make your hair turn gray) or you will be doing many cases quickly or will have to go into some dangerous areas if you are in the city.

I did and my experiences have been nothing like what you wrote. They certainly do exist as described, and may be the norm, but I have been fortunate enough to land good gigs.

 

[GravelRider]

I think supervision model stays intact, probably gonna pay more than it does especially in areas where it's harder to get enough MDs like the southeast. The fact is that the average CRNA coming out of school neither has the skill nor the desire to be independently practicing, and even more skilled ones cannot feasibly handle an entire OR worth of services (I literally know zero CRNAs who are facile in all of regional, OB, basic peds, and cardiac. Maybe some have 2 of those skills but rarely more than that.)

Hiring only CRNAs will severely limit what a hospital can do and who they can keep safe. It's obvious in most hospitals, as the independence movement has very little traction outside very rural areas and the VA, both of which aren't going to run the gamut of all the large hospital services.

I think what would happen is they will give certain cases a sort of “level” score based on complexity, skills required, and comorbidities. The higher level cases will get assigned an anesthesiologist or care team. I don’t think we are there yet, but in another decade we may be.

 

[kidthor]

"GREED is the source of all evil on both sides its very simple. "

For years hospital administrators have underfunded their anesthesia groups leading many of them to sell out to AMCs or fold and become employees. The AMCs played the game by overcharging Insurance companies massive rates for anesthesia and they capitulated. These days the lack of providers has led to the shift from employer to employee or from owner to worker. In this system, it is simply FOOLISH not to demand a fair wage for your work. What is a fair wage? Well based on what I was earning in 1999 I would say $800K-$950K working about 45 hours per week. That's the true private practice adjusted rate based on inflation. How about the real AMC wage? If the AMC didn't exist and all the money you earned either through cases or hospital stipend went directly to the employee what would the pay be? My guess is at least $100-$150K higher than your W-2 pay. For other hospital employed anesthesiologists they are are taking advantage of you by keeping your pay low while paying exorbitant locums rates.

For 2023 all of you really need to evaluate your situation. If the majority of anesthesiologists demanded a fair wage by 2023 standards the hospitals and AMCs would have no choice but to pay it. But, by staying in that low paying job you are enabling the current disparity in pay between the real wage of an an anesthesiologist and the discounted wage of those mired in their situations. Either demand a fantastic quality of life at $400-$450K (think 40 hours per week or less with no overnight call) or demand $600K for the typical W-2 job out there. This is the same type of job a locums would get over $750K for in 2023.

I nominate this for post of the year. Spot on.

 

[lotsapain]

I did and my experiences have been nothing like what you wrote. They certainly do exist as described, and may be the norm, but I have been fortunate enough to land good gigs.

I am glad that was your experience. In the tristate are that IS the experience I assume you are not in NY/NJ/ etc. even in Florida there are many places that do structural heart disease treatment etc that are very high risk

 

[lotsapain]

All good. Problem is this will inevitably lead to CRNA independence. As the facilities really don’t collect that much when we are medically direction vs medical supervision the hospital will inevitably want to fill as many rooms as possible for as cheap as possible. Guess what happens then….

That indeed will happen... this is becoming a useless thread most people are expressing opinions based on lack of facts or financial understanding of reimbursements / Value Based Care or CMS rules... the money WILL run out and sooner then everyone thinks

 

[lotsapain]

A few things:

1. Demand for service is not going down any time soon. Recent COVID Medicaid expansion being codified in several laws has assured this and entitlements never get cut.

2. The supply shortage of anesthesia is not getting better any time soon, and will in fact get worse with retirements of older practitioners, as will happen to every field. More people who want day doc type jobs enter this field every year. God help us when a doctor forgoes having children because then they have almost zero reason to work full time.

3. Facility fees are very high right now. Hospitals compete for those fees as the government dictates. To compete for those fees you need a few things, surgeons and anesthesiologists being a couple of those things.

4. Private practice surgeons will remain in ownership because it’s financially viable. They’re fine with their situations for the most part. Anesthesiologists cannot have viable practices with our ability to bill. This means to get anesthesiologists to get the fees, hospitals have to pay us with other means (stipends or locums).

5. If hospital A and B are in the same city, they want to do surgeries to get the fees. If they are fighting over one anesthesiologist, then that doctor will go to the hospital that pays the most generally or has other things that doctor wants. There is no moral or ethical question to be answered here. It’s supply and demand, that’s it. Accounts receiveable in anesthesia is a relic that is quickly fading as the ACA covers more and more people with terrible reimbursement for our services. This is by design to centralize healthcare and eliminate most private groups.

Again this is very short sighted without having understanding of how healthcare actually works. 3- Facility fees are NOT going up I am not sure where you are getting that. It depends highly on negotiated rates also. 4 - that is also not entirely true there are indeed viable practices in good payer mix areas and in hospitals that understand that all service lines cannot be preserves equally to make financial sense 5. Hospitals go out of business all the time read Becker's review.... anyway this is becoming a useless thread, opinions are just that. Without understanding how healthcare works this is a mute point discussing. The rates will go down one way or the other so enjoy the ride!

 

[Anesthesia_Guy]

I am glad that was your experience. In the tristate are that IS the experience I assume you are not in NY/NJ/ etc. even in Florida there are many places that do structural heart disease treatment etc that are very high risk

Assumption correct.

 

[lotsapain]

Assumption correct.

That's great let me know where this is I will go next month. Seriously as tristate area blows.

 

[PainInTheAnes]

That indeed will happen... this is becoming a useless thread most people are expressing opinions based on lack of facts or financial understanding of reimbursements / Value Based Care or CMS rules... the money WILL run out and sooner then everyone thinks

I’d like to hear where you’re getting your facts and what your intricate understanding of hospital reimbursement is. Here’s what I know: the government will not allow large hospital centers to close, as they are vital to the cities they serve. They are too big to fail, and will be financially incentivized to do a lot of surgery on the population.

Lots of surgery means lots of competition for our services, regardless of what billing we do, and this will drive our pay up over time as it has the last couple of years.

I’d be happy to listen to an actual rebuttal other than “the money will run out just you wait”. Do you work in CMS in some capacity to have something to base that claim on? From what I see, more and more money gets shoveled into CMS each year as we use public health insurance for more people.

It’s enough money to do things like this:

Massachusetts General Hospital Breaks Ground on State-of-the-Art Clinical Care Building

Facility along Cambridge Street will provide exceptional care, increased capacity and strengthen ties to West End and Beacon Hill neighborhoods

www.massgeneral.org

So it seems like there’s 2 billion extra dollars floating around just a single hospital system. How can you explain a project like this if the money is running out?

 

[lotsapain]

I’d like to hear where you’re getting your facts and what your intricate understanding of hospital reimbursement is. Here’s what I know: the government will not allow large hospital centers to close, as they are vital to the cities they serve. They are too big to fail, and will be financially incentivized to do a lot of surgery on the population.

Lots of surgery means lots of competition for our services, regardless of what billing we do, and this will drive our pay up over time as it has the last couple of years.

I’d be happy to listen to an actual rebuttal other than “the money will run out just you wait”. Do you work in CMS in some capacity to have something to base that claim on? From what I see, more and more money gets shoveled into CMS each year as we use public health insurance for more people.

It’s enough money to do things like this:

Massachusetts General Hospital Breaks Ground on State-of-the-Art Clinical Care Building

Facility along Cambridge Street will provide exceptional care, increased capacity and strengthen ties to West End and Beacon Hill neighborhoods

www.massgeneral.org

So it seems like there’s 2 billion extra dollars floating around just a single hospital system. How can you explain a project like this if the money is running out?

I am no longer interested in this useless conversation as you presenting what MGH does, a hospital which is NIH funded and granted, is not indicative as to what the rest of the country does. Too big to fail applies to select few institutions..... truly I do not want to waste my breath not because I cannot support my arguments I just no longer have the time to partake in this polemic.

 

[sevo00]

I am no longer interested in this useless conversation as you presenting what MGH does, a hospital which is NIH funded and granted, is not indicative as to what the rest of the country does. Too big to fail applies to select few institutions..... truly I do not want to waste my breath not because I cannot support my arguments I just no longer have the time to partake in this polemic.

As soon as someone asks you for any sort of evidence to back your claims...you get irritated and call this a pointless conversation. I still standby what I said to you earlier . Pay up "homie". Go ahead and leave the thread no one is going to miss you. Bye Felicia

 

[sirspamalot]

As soon as someone asks you for any sort of evidence to back your claims...you get irritated and call this a pointless conversation. I still standby what I said to you earlier . Pay up "homie". Go ahead and leave the thread no one is going to miss you. Bye Felicia

Dayum son yaint gotta do him like that bro. Lol.

 

[nimbus]

I am no longer interested in this useless conversation as you presenting what MGH does, a hospital which is NIH funded and granted, is not indicative as to what the rest of the country does. Too big to fail applies to select few institutions..... truly I do not want to waste my breath not because I cannot support my arguments I just no longer have the time to partake in this polemic.

It’s not just top-10 NIH funded institutions.


We have 6 local hospital systems including Kaiser and academics. 5 of them have recently built new $1bil towers or are soon breaking ground on new $1bil towers. It’s an arms race. Most of them look like a Ritz Carlton inside. There’s tons of money sloshing around.

 

[dannyboy1]

That indeed will happen... this is becoming a useless thread most people are expressing opinions based on lack of facts or financial understanding of reimbursements / Value Based Care or CMS rules... the money WILL run out and sooner then everyone thinks

I’m not sure what you are suggesting. Should we cap what we earn/ask for in the name of saving the hospital money?? You think they will remember our altruism and sacrifice. Absolutely not. This is a business. For some reason there is a shortage of anesthesia providers these days and hospitals are willing to pay up to keep the OR open. Make hay while the sun shines. I promise you, when the market turns, the hospital will be just as ruthless at negotiating rates down.

 

[GassYous]

When insurance company ceos are banking multiple millions there's no shortage of money. Do you think that the elderly and poor will give up their Medicare and Medicaid?

 

[MirrorTodd]

I’m not sure what you are suggesting. Should we cap what we earn/ask for in the name of saving the hospital money?? You think they will remember our altruism and sacrifice. Absolutely not. This is a business. For some reason there is a shortage of anesthesia providers these days and hospitals are willing to pay up to keep the OR open. Make hay while the sun shines. I promise you, when the market turns, the hospital will be just as ruthless at negotiating rates down.

Stop being greedy physicians and ask for LESS pay. Don't you get it! The money will RUN OUT sooner rather than later! THEN, where will you be when the number of people needing surgery is still rising, but there is ZERO dollars to actually pay any anesthesia people to do it!?
Brotha sounds like Chicken Little.

 

[ambiturner]

I’m not sure what you are suggesting. Should we cap what we earn/ask for in the name of saving the hospital money?? You think they will remember our altruism and sacrifice. Absolutely not. This is a business. For some reason there is a shortage of anesthesia providers these days and hospitals are willing to pay up to keep the OR open. Make hay while the sun shines. I promise you, when the market turns, the hospital will be just as ruthless at negotiating rates down.

I mean, they don’t even remember our ‘altruism and sacrifice’ from a once in a century pandemic 18 months ago so it’s a safe bet they won’t remember shaving a few bucks off a locums rate!

 

[doctalaughs]

Stop being greedy physicians and ask for LESS pay. Don't you get it! The money will RUN OUT sooner rather than later! THEN, where will you be when the number of people needing surgery is still rising, but there is ZERO dollars to actually pay any anesthesia people to do it!?
Brotha sounds like Chicken Little.

You guys are absolutely right - make as much money as your services demand while you can. If that’s 500 dollars an hour- great. Plenty of lawyers charge that for less valuable services.

Hospitals will either find a way to pay what the market demands or fail to the competition. If that means firing useless administrators (of which there are a TON) then GREAT.

You should demand less when the drug companies, the device manufacturers, the insurance company execs and the pharmacy benefit managers voluntarily decide to make less.

Physicians at the LEAST greedy of all the players and the most essential component of the system. Seriously - like 8-9% of the total healthcare dollars.

That guy must be an administrator or trying to hire and skim off the top or something.

 

[lotsapain]

You guys are absolutely right - make as much money as your services demand while you can. If that’s 500 dollars an hour- great. Plenty of lawyers charge that for less valuable services.

Hospitals will either find a way to pay what the market demands or fail to the competition. If that means firing useless administrators (of which there are a TON) then GREAT.

You should demand less when the drug companies, the device manufacturers, the insurance company execs and the pharmacy benefit managers voluntarily decide to make less.

Physicians at the LEAST greedy of all the players and the most essential component of the system. Seriously - like 8-9% of the total healthcare dollars.

That guy must be an administrator or trying to hire and skim off the top or something.

and you are shortsighted. Next you will tell me an airplane is a car with wings... you cannot possibly involve drug companies or device manufacturers in this discussion they do not share in the overall hospital reimbursement pattern.

If you would like to contribute as everyone should why not join a political action committee with AMA and indeed lobby for higher reimbursement rates for physicians. Asking hospitals for money is like going to the bank asking to increase your account by transferring money from your neighbors account.

 

[lotsapain]

Stop being greedy physicians and ask for LESS pay. Don't you get it! The money will RUN OUT sooner rather than later! THEN, where will you be when the number of people needing surgery is still rising, but there is ZERO dollars to actually pay any anesthesia people to do it!?
Brotha sounds like Chicken Little.

Amen someone got brains.

 

[lotsapain]

It’s not just top-10 NIH funded institutions.


We have 6 local hospital systems including Kaiser and academics. 5 of them have recently built new $1bil towers or are soon breaking ground on new $1bil towers. It’s an arms race. Most of them look like a Ritz Carlton inside. There’s tons of money sloshing around.

Remember a building does not fall apart in 50 years its a long-term investment meant to provide patient care and better overall working conditions. You cannot compare apple to oranges. A better comparison would be if say a system.. Kaiser etc. had 5 hospitals, one being a posh palace where a private group gets paid 1mil a pop and another hospital in an underserved area where a group works just as hard or harder and gets paid half... you cannot use capital budgeting / investments the same way it also has to do with taxation, non-for profit re-investment etc. Remember non-for-profit facilities HAVE to reinvest back into community one of the way to do it is to build facilities. That is by law, reinvesting into physicians does not quite work the same. I am not saying they cannot pay you more but its a complex mechanism by which this is not a fair comparison. Granted after the facilities are build and business is attracted what should be encouraged by a sound system is profit sharing for physicians... this is done for primary care providers now should be done for all professions.

 

[Anesthesia_Guy]

That's great let me know where this is I will go next month. Seriously as tristate area blows.

Midwest

 

[sirspamalot]

Remember a building does not fall apart in 50 years its a long-term investment meant to provide patient care and better overall working conditions. You cannot compare apple to oranges. A better comparison would be if say a system.. Kaiser etc. had 5 hospitals, one being a posh palace where a private group gets paid 1mil a pop and another hospital in an underserved area where a group works just as hard or harder and gets paid half... you cannot use capital budgeting / investments the same way it also has to do with taxation, non-for profit re-investment etc. Remember non-for-profit facilities HAVE to reinvest back into community one of the way to do it is to build facilities. That is by law, reinvesting into physicians does not quite work the same. I am not saying they cannot pay you more but its a complex mechanism by which this is not a fair comparison. Granted after the facilities are build and business is attracted what should be encouraged by a sound system is profit sharing for physicians... this is done for primary care providers now should be done for all professions.

tl;dr

Money. I like money. They like money more. They have to convert their thing of money into another thing thats worth money. Just like I do at home.

 

[dannyboy1]

and you are shortsighted. Next you will tell me an airplane is a car with wings... you cannot possibly involve drug companies or device manufacturers in this discussion they do not share in the overall hospital reimbursement pattern.

If you would like to contribute as everyone should why not join a political action committee with AMA and indeed lobby for higher reimbursement rates for physicians. Asking hospitals for money is like going to the bank asking to increase your account by transferring money from your neighbors account.

Quite frankly, the best way to negotiate higher reimbursement is to be employed by large hospital systems. They are the only ones with negotiating power.

 

[sirspamalot]

Quite frankly, the best way to negotiate higher reimbursement is to be employed by large hospital systems. They are the only ones with negotiating power.

Have you tried doing this? Because that is a silly statement. The only negotiation you'll have is when you arrive and the job prospect appears tangible. When they're you're best-est new friend. And that's when you'll get a flag planted at a number well behind the line if you're not careful. Then a year later when you ask for what, another 10k 20k they'll grimace and give it to you (while still skimming your pro fees and netting 3M).

That laughter in the boardroom? They aren't laughing with you bro.

You'll need to aggressively negotiate up front and if they need you, they'll do it grudgingly.. but it might take MONTHS.. particularly if they have to send it up to the mothership. Strongly consider working locums first.. once you're there, and if you're good, they'll be incentivized to retain you, obviously.

Thats how it works with big bad corporate. Smaller corporate? They'll decide fairly quickly if they can meet your requirement - or not. They love the "A" candidate but aren't willing to compromise on pay (#youknow) or 1099 status? Bye bye and good luck. While "radoncs" are soon to be a dime a dozen.. quality still matters in smaller locations where referral patterns survive because of interpersonal skillz. Eventually, even corporate understands..