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Do GI docs follow anesthesiologists' orders?

SandP

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Mostly I have heard that anesthesiologists are under the direction of surgeons. Recently, however, I was on a rotation where it seemed the anesthesiologists controlled the GIs by demanding the GI finish cases by say 5pm or they were going to leave. Just wondering how common this is. I was previously under the impression that anesthesia is there when the operator/proceduralist is there.
 
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Nivens

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I rotated through a surgery-center type practices where the anesthesiologist (who was supervising multiple rooms) chewed out a particularly slow surgeon and told him he couldn’t let his resident operate until they were back on schedule. In a practice like that there is no relief- people go home when the work is done.

I think it should be said that the majority of my interactions with surgeons- even in a big ivory tower academic center- are extremely collaborative and collegial. Exceptions exist and stereotypes abound, but most of the time I feel like we’re working together to take care of the patient and get the work done.

Also, I see a ton of sketchy, time-wasting, feet-dragging behavior in my anesthesia colleagues that know they are getting relief at 4. You get bad apples in every bunch.
 
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cchoukal

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I work in a capitated system and we’re only staffed for so many locations at certain hours. If GI goes past 5, it creates a huge problem for the rest of the enterprise, and also forces physicians to stay later-than-planned and without compensation. We discuss, encourage, cajole, and remind GI of this as the days progress and usually find a happy meeting spot. Are they following my orders? Not exactly, but we all have to get along, get the work done, and meet the needs of the patients, which, in the long run means not going past 5.
 
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nimbus

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I rotated through a surgery-center type practices where the anesthesiologist (who was supervising multiple rooms) chewed out a particularly slow surgeon and told him he couldn’t let his resident operate until they were back on schedule. In a practice like that there is no relief- people go home when the work is done.

I think it should be said that the majority of my interactions with surgeons- even in a big ivory tower academic center- are extremely collaborative and collegial. Exceptions exist and stereotypes abound, but most of the time I feel like we’re working together to take care of the patient and get the work done.

Also, I see a ton of sketchy, time-wasting, feet-dragging behavior in my anesthesia colleagues that know they are getting relief at 4. You get bad apples in every bunch.




The incentives to finish on time are also better aligned when the surgicenter is physician owned and nobody wants to pay overtime for nurses and staff to stay late.
 
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jeesapeesa

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Mostly I have heard that anesthesiologists are under the direction of surgeons. Recently, however, I was on a rotation where it seemed the anesthesiologists controlled the GIs by demanding the GI finish cases by say 5pm or they were going to leave. Just wondering how common this is. I was previously under the impression that anesthesia is there when the operator/proceduralist is there.

depends on the facility and culture. in one facility we have a GI guy who is contracted to be able to do his cases until 9pm, preferably with anesthesia; he does around 3-5 cases per day during this time. personally i don't mind this because as someone said above, cases = compensation. as for add ons, in the other facilities GI would try to schedule it in the afternoon when rooms are finishing so anesthesia is mostly available, around 4-5 pm and would maybe have 3-5 cases. if it's a particularly busy day or if it's in the middle of the day, then they'll have no choice but to sedate them themselves with nurses.
 

SandP

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Time = money. My time past 5 PM is extremely valuable. I am not going to work 5-7 or 7-9 for the same billing as regular 40h/week work hours. Sorry, I have better things to do.
Fair enough but is this also something you would say to a surgeon? I just remember hearing somewhere else that the anesthesiologist follows the surgeon's schedule. Is it different for GI?
 

SnapperRocks

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Fair enough but is this also something you would say to a surgeon? I just remember hearing somewhere else that the anesthesiologist follows the surgeon's schedule. Is it different for GI?

I’m surprised people are even entertaining this discussion. Under the direction of surgeons? Operator? What are you exactly? You have a very strange way of asking questions. You use medical terms inappropriately. You seem to have no grasp on how doctors interact with each other.
 
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MirrorTodd

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I’m surprised people are even entertaining this discussion. Under the direction of surgeons? Operator? What are you exactly? You have a very strange way of asking questions. You use medical terms inappropriately. You seem to have no grasp on how doctors interact with each other.
Agreed.
 

Velefunt

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The incentives to finish on time are also better aligned when the surgicenter is physician owned and nobody wants to pay overtime for nurses and staff to stay late.

I wish this were universally true; Our larger surgeon owned surgery centers are poorly run and inefficient. They'd rather value flexibility in scheduling and ability to start/run late than efficiency and cost-effectiveness. It's aggravating.
 

chocomorsel

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I’m surprised people are even entertaining this discussion. Under the direction of surgeons? Operator? What are you exactly? You have a very strange way of asking questions. You use medical terms inappropriately. You seem to have no grasp on how doctors interact with each other.
Sounds like a naive student genuinely interested in how things work. Poorly worded, I agree.
 

aneftp

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I am in private practice. More cases = more money.
Depends. Waiting around for 2 hours for gi doc to show up for a 5 min egd at 5pm is not necessarily more money. Especially when you can go home at 230pm

the good comes with the bad In a private practice setting.

time is money. Waiting around costs you money.
 
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aneftp

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The real issue with any hospital based anesthesia private practice service is availability of staff after 3/5pm for elective gi procedures

it’s well known gi docs scope their more lucrative payor mixed at their outpatient surgery facilities. And even their Medicare healthier patients.

so what you are left at the hospital based gi anesthesia are your Sicker patients.

so gi doc does 10-12 scopes by 1130am. Makes $$. Goes to office 1230-430pm sees patients. Gets to hospital to do the one scope at 5pm. They aren’t wasting time

but as private anesthesia practice. You get paid $15-17? A unit For Medicare gi. 4-6 units? Max for a egd scope. So $60-90? And have to wait around for 2 hours just to make $60-90.

If you have to keep a crnas/md around for 2 extra hours. It will cost the practice $200-400 just to make $60. The math makes no sense.

Thus you can’t sit around doing nothing yourself

my hospitals I have worked at (community) have cut off elective gi procedures at 3pm. Of course the Gi docs complain to admin. We tell them anesthesia available 7-3pm. He’s welcome to scope at 7am. Even at 645am if he wants too. ....ooops. He can’t. He’s scoping at 630am at his more profitable GI center. Violating oig opinion 12-06 and taking money from anesthesia at his surgery center paying his own cRnas $125/hr for 6 hours.
 
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NICMAN

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The real issue with any hospital based anesthesia private practice service is availability of staff after 3/5pm for elective gi procedures

it’s well known gi docs scope their more lucrative payor mixed at their outpatient surgery facilities. And even their Medicare healthier patients.

so what you are left at the hospital based gi anesthesia are your Sicker patients.

so gi doc does 10-12 scopes by 1130am. Makes $$. Goes to office 1230-430pm sees patients. Gets to hospital to do the one scope at 5pm. They aren’t wasting time

but as private anesthesia practice. You get paid $15-17? A unit For Medicare gi. 4-6 units? Max for a egd scope. So $60-90? And have to wait around for 2 hours just to make $60-90.

If you have to keep a crnas/md around for 2 extra hours. It will cost the practice $200-400 just to make $60. The math makes no sense.

Thus you can’t sit around doing nothing yourself

my hospitals I have worked at (community) have cut off elective gi procedures at 3pm. Of course the Gi docs complain to admin. We tell them anesthesia available 7-3pm. He’s welcome to scope at 7am. Even at 645am if he wants too. ....ooops. He can’t. He’s scoping at 630am at his more profitable GI center. Violating oig opinion 12-06 and taking money from anesthesia at his surgery center paying his own cRnas $125/hr for 6 hours.
Which is exactly why our GI docs know to schedule urgent scopes first. If they want to “add on” urgent cases at the end of the day then they are going to have to wait behind all the urgent and emergent Lao Appys and choles.
 

jwk

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Private practice here. We agree to staff GI until 5pm. Cases pre-scheduled the day before are not supposed to run past 5, but if they're posted, we do them.

Anything else is an add-on. If we can do them before 5pm, we're happy to do that. If it's after 5pm, they may have to wait and share us with the surgeons that are still operating as well.
 

hypnosMD

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If you work for an AMC you will be called in from home to do that add on scope at 5 even though you left post call at 3 pm and thought you were done (happened to a friend with Deathstar). You might can stand your ground, but the more you fight that battle the more you are seen as not a “team player”. That isn’t a dynamic that makes for a long and illustrious career (not to mention morale!) Glad retirement is around the corner for this gal.
 

aneftp

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If you work for an AMC you will be called in from home to do that add on scope at 5 even though you left post call at 3 pm and thought you were done (happened to a friend with Deathstar). You might can stand your ground, but the more you fight that battle the more you are seen as not a “team player”. That isn’t a dynamic that makes for a long and illustrious career (not to mention morale!) Glad retirement is around the corner for this gal.
This is where you have to negotiate overtime pay with amc. I know a guy who milked an amc for over 700k (base was 375k plus metrics whatever where most were earning 450k).

it’s hurts the amc once they are forced to pay ot money. Sure. Come back in. It’s gonna to cost the amc min $400 for that Gi scope that the amc will end up collecting less than $100 after 5pm.
 
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marr65

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This is where you have to negotiate overtime pay with amc. I know a guy who milked an amc for over 700k (base was 375k plus metrics whatever where most were earning 450k).

it’s hurts the amc once they are forced to pay ot money. Sure. Come back in. It’s gonna to cost the amc min $400 for that Gi scope that the amc will end up collecting less than $100 after 5pm.

Yep! If you are an employee definitely negotiate OT pay after 3pm or if you are working post call. $250/hr sounds about right.
 

kidthor

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This is where you have to negotiate overtime pay with amc. I know a guy who milked an amc for over 700k (base was 375k plus metrics whatever where most were earning 450k).

it’s hurts the amc once they are forced to pay ot money. Sure. Come back in. It’s gonna to cost the amc min $400 for that Gi scope that the amc will end up collecting less than $100 after 5pm.

This AMC can hire another schmuck for much less than that per hour. They'll force you to do it for <200/hr or you'll be unloaded, I suspect. There's a sucker born every minute.

Plus why aren't you doing that late night ERCP under "MAC"? They don't need to be intubated. Why're you slowing GI down with GETA on a nearly dead ESLD patient about to go into prone-apneic-vomit-aspiration-mode? Be a team player, broheim. Don't you know your AMC 401K has a 20 year vesting period?

But God bless if your friend really made 700K total with OT. I doubt it's real but respect it if true.
 
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chocomorsel

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This is where you have to negotiate overtime pay with amc. I know a guy who milked an amc for over 700k (base was 375k plus metrics whatever where most were earning 450k).

it’s hurts the amc once they are forced to pay ot money. Sure. Come back in. It’s gonna to cost the amc min $400 for that Gi scope that the amc will end up collecting less than $100 after 5pm.
It's promising that a guy working for an AMC could actually negotiate that. Take it or leave it was my understanding of the contracts from what I have read of people on here who work for these companies.
 
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