"Doctors’ spat with Atrium Health spills into rare public view"

[BLADEMDA]

Frankly, I’m more in shock that the people on this board are in disbelief that this is happening. The writing has been on the wall for years that this was going to happen. Hospitals and AMCs will continue to exploit and maximize profits at the expense of YOUR license, but if you are willing to sign the contract then you have no one to blame but yourself. They will increase ratios until they have a serious lawsuit on their hands, so if that never happens then anesthesiologists will continue to be phased out. The job market will suffer and incomes will fall. Ultimately, the long term outlook for us is not good.

AMCs control large segments of the market. My advice is to avoid them if at all possible. But, for many of us (myself included) they may be the only game in town. I've begged my spouse to move West but she likes the Southeast. Happy wife means happy life.

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[Noyac]

The problem is when you are an unemployed doctor thinking about taking a job and being threatened with a multimillion dollar lawsuit that you will have to defend out of your own pocket.

Yes exactly, which is why one should never enter into an agreement with these ******.

 

[BLADEMDA]

Whenever you sign on with an AMC they will demand a non compete for at least that facility if not even a larger radius like 1-5 miles. It's how they squeeze the hospital administrators to play ball. The non compete makes it very difficult for the hospital to go in house.
Refusal to sign the non compete like in Charlotte results in no employment. Want to work for Mednax? Sign the non compete.

 

[FollowTheMoney]

I don't see how the field of anesthesiology is going to be compatible or viable with goals of CRNAs, AMCs, and hospitals. CRNAs want independence with increased pay and AMCs and hospitals want to reduce overhead and improve profits. Ratios will continue to increase and incomes will continue to decrease over time (currently stagnant due to increased work hours and supervision) as downward pressure from mid levels kills the job market/demand for anesthesiologists. The only way to preserve what is left of the specialty is for the ASA to start public service announcements on TV, take out ads in newspapers, contact local news agencies, etc. and explain the situation and inform the public about what is going on. There needs to be huge multi-centered studies comparing anesthesiologists and CRNAs with tangible evidence of increased morbidity and mortality with CRNAs in order to make a case for ourselves. Otherwise, they will continue to phase out anesthesiologists in the middle of the night. Either way, I don't see anesthesiologists winning this battle... they don't do their own billing anymore, there is no autonomy, no patient comes to see you or get care from you specifically, someone is willing to perform your job for half the price, and the people in charge of this whole situation are looking to cut costs and maximize profits.

 

[Psai]

I don't see how the field of anesthesiology is going to be compatible or viable with goals of CRNAs, AMCs, and hospitals. CRNAs want independence with increased pay and AMCs and hospitals want to reduce overhead and improve profits. Ratios will continue to increase and incomes will continue to decrease over time (currently stagnant due to increased work hours and supervision) as downward pressure from mid levels kills the job market/demand for anesthesiologists. The only way to preserve what is left of the specialty is for the ASA to start public service announcements on TV, take out ads in newspapers, contact local news agencies, etc. and explain the situation and inform the public about what is going on. There needs to be huge multi-centered studies comparing anesthesiologists and CRNAs with tangible evidence of increased morbidity and mortality with CRNAs in order to make a case for ourselves. Otherwise, they will continue to phase out anesthesiologists in the middle of the night. Either way, I don't see anesthesiologists winning this battle... they don't do their own billing anymore, there is no autonomy, no patient comes to see you or get care from you specifically, someone is willing to perform your job for half the price, and the people in charge of this whole situation are looking to cut costs and maximize profits.

Since when do they work for half the price? If they worked our hours, they would make comparable incomes. Many do work 2 jobs and come pretty darn close.

 

[deleted171991]

Frankly, I’m more in shock that the people on this board are in disbelief that this is happening. The writing has been on the wall for years that this was going to happen. Hospitals and AMCs will continue to exploit and maximize profits at the expense of YOUR license, but if you are willing to sign the contract then you have no one to blame but yourself. They will increase ratios until they have a serious lawsuit on their hands, so if that never happens then anesthesiologists will continue to be phased out. The job market will suffer and incomes will fall. Ultimately, the long term outlook for us is not good.

Can't like this enough. The first time I really saw this coming was when I found out, a few years ago, that a big hospital corporation was actually budgeting money for malpractice lawsuits (while increasing coverage ratios). As long as it's within the budget, they probably couldn't care less if an increase in profits results in a few more lawsuits and destroyed careers.

Let me repeat again and again: you are a nobody in medicine if you don't have your own patients, your own respected brand. Nobody goes to a different facility because of their favorite anesthesiologist.

 

[DeadSpace]

Let me repeat again and again: you are a nobody in medicine if you don't have your own patients, your own respected brand. Nobody goes to a different facility because of their favorite anesthesiologist.

Had a patient in preop a couple weeks ago tell me last year they had a great anesthesiologist at our facility do her anesthesia and was hoping to request him again. I got excited since as you elude to people never seem to remember our faces or names and don't specifically request us. She describes him and I actually go through some effort to find out who it was and if they were there today so I could connect them.

Turns out it was a damn CRNA she was talking about.

Does family practice have patients confuse their nurse practitioners for them?

If the patients aren't loyal to us we've already lost. The business/admin of the industry are interested in saving money, they definitely aren't loyal to us.

 

[GravelRider]

I don't see how the field of anesthesiology is going to be compatible or viable with goals of CRNAs, AMCs, and hospitals. CRNAs want independence with increased pay and AMCs and hospitals want to reduce overhead and improve profits. Ratios will continue to increase and incomes will continue to decrease over time (currently stagnant due to increased work hours and supervision) as downward pressure from mid levels kills the job market/demand for anesthesiologists. The only way to preserve what is left of the specialty is for the ASA to start public service announcements on TV, take out ads in newspapers, contact local news agencies, etc. and explain the situation and inform the public about what is going on. There needs to be huge multi-centered studies comparing anesthesiologists and CRNAs with tangible evidence of increased morbidity and mortality with CRNAs in order to make a case for ourselves. Otherwise, they will continue to phase out anesthesiologists in the middle of the night. Either way, I don't see anesthesiologists winning this battle... they don't do their own billing anymore, there is no autonomy, no patient comes to see you or get care from you specifically, someone is willing to perform your job for half the price, and the people in charge of this whole situation are looking to cut costs and maximize profits.

Multi-centered studies comparing anesthesiologists and CRNAs would be the death of the profession.

 

[skypilot]

I don't see how the field of anesthesiology is going to be compatible or viable with goals of CRNAs, AMCs, and hospitals. CRNAs want independence with increased pay and AMCs and hospitals want to reduce overhead and improve profits. Ratios will continue to increase and incomes will continue to decrease over time (currently stagnant due to increased work hours and supervision) as downward pressure from mid levels kills the job market/demand for anesthesiologists. The only way to preserve what is left of the specialty is for the ASA to start public service announcements on TV, take out ads in newspapers, contact local news agencies, etc. and explain the situation and inform the public about what is going on. There needs to be huge multi-centered studies comparing anesthesiologists and CRNAs with tangible evidence of increased morbidity and mortality with CRNAs in order to make a case for ourselves. Otherwise, they will continue to phase out anesthesiologists in the middle of the night. Either way, I don't see anesthesiologists winning this battle... they don't do their own billing anymore, there is no autonomy, no patient comes to see you or get care from you specifically, someone is willing to perform your job for half the price, and the people in charge of this whole situation are looking to cut costs and maximize profits.

Exactly. The only way you can make your own little protest statement against this evolving system is refusing to work as a supervisor. Either work for an all MD group, a group with many docs and a few CRNAS, or just say at the outset that you are happy to provide service doing your own cases but you won't supervise and you will accept the decreased pay that results. (and the vast decrease in liability and chance of getting sued) You should still be able to garner an income that would make most people envious. As has been said before, a supervised room costs the CRNA's salary plus a fraction of the Anesthesiologist's salary, plus breaks and lunches . And its not free when the shift ends at 3:30 and the case goes to 6:00 pm!

 

[Man o War]

Multi-centered studies comparing anesthesiologists and CRNAs would be the death of the profession.

Which profession?
I can’t believe some of the crap care I saw over the years with CRNAs. I know for sure there would’ve been countless adverse events and deaths if a doc hadn’t been around to fix what was going on.
There are CRNAs graduating and starting practice with only observed cardiac cases and procedures according to my cohorts who work with them.

 

[ProRealDoc]

You all are focusing on the first half of the problem for these docs.

For arguments sake let’s say a judge rules their non competes unenforceable, do they even want to work for Atrium/Scope?

Will they be forced to do supervision? What are the pay/hours/benefits like?

If it’s truly a supervision model which is not routinely practiced in NC or in hospitals with the type acuity Atrium has, I encourage these physicians to not sign with Atrium/Scope and reform their own private group.

No possible way Scope could get 50, let alone 100 locums to staff the hospitals. Atrium has competitors in town and surgeons operate at multiple facilities. 50 new faces would not encourage them to pick Atrium.

Let a judge rule the non compete unenforceable. Do not sign with Scope. Reform a group and negotiate hard. Do not do supervision if you do not want to.

Easy for me to say, problem is you know there will be a few who will be too scared to jeapordize their life in CLT to negotiate.

Unfortunate as this stand off could have ramifications for Anesthesia regionally and nationally.

I think this is the sticky point that forces most docs to give in. They are unwilling to relocate/do locums so they take the path of least resistance.

 

[ProRealDoc]

AMCs control large segments of the market. My advice is to avoid them if at all possible. But, for many of us (myself included) they may be the only game in town. I've begged my spouse to move West but she likes the Southeast. Happy wife means happy life.

How can it be a happy life if you ain't happy? She may be happy but you won't.

 

[deleted162650]

How can it be a happy life if you ain't happy? She may be happy but you won't.

Clearly you’re not married.

 

[gasdoc77]

Can't like this enough. The first time I really saw this coming was when I found out, a few years ago, that my big hospital corporation was actually budgeting money for malpractice lawsuits (while increasing coverage ratios). As long as it's within the budget, they probably couldn't care less if an increase in profits results in a few more lawsuits and destroyed careers.

Let me repeat again and again: you are a nobody in medicine if you don't have your own patients, your own respected brand. Nobody goes to a different facility because of their favorite anesthesiologist.

You are leaving out the most important point. They aren’t just budgeting for lawsuits, they are budgeting for patient injuries/deaths. This illustrates the seedy underbelly that is our current healthcare system. Unnecessary and avoidable deaths are okay with these administrators as long as they have budgeted for it!!!!!

 

[ProRealDoc]

I don't see how the field of anesthesiology is going to be compatible or viable with goals of CRNAs, AMCs, and hospitals. CRNAs want independence with increased pay and AMCs and hospitals want to reduce overhead and improve profits. Ratios will continue to increase and incomes will continue to decrease over time (currently stagnant due to increased work hours and supervision) as downward pressure from mid levels kills the job market/demand for anesthesiologists. The only way to preserve what is left of the specialty is for the ASA to start public service announcements on TV, take out ads in newspapers, contact local news agencies, etc. and explain the situation and inform the public about what is going on. There needs to be huge multi-centered studies comparing anesthesiologists and CRNAs with tangible evidence of increased morbidity and mortality with CRNAs in order to make a case for ourselves. Otherwise, they will continue to phase out anesthesiologists in the middle of the night. Either way, I don't see anesthesiologists winning this battle... they don't do their own billing anymore, there is no autonomy, no patient comes to see you or get care from you specifically, someone is willing to perform your job for half the price, and the people in charge of this whole situation are looking to cut costs and maximize profits.

Most specialties seem to be utilizing this model more and more. I've seen PA/NPs doing initial consults, writing H&Ps and rounding on patients with the docs just co-signing their notes. Many rural hospitals even advertise NPs as they would physicians lending credibility to the notion of equivalency between the two. Medicine lost the game the moment they allowed the suits to run the show.

Make hay while the sun shines, live below your means and save/invest like your life depends on it.

 

[ProRealDoc]

Clearly you’re not married.

I am! It's a two way street, if they want a nice lifestyle, they also have to make sacrifices is all I'm saying.

 

[GravelRider]

Which profession?
I can’t believe some of the crap care I saw over the years with CRNAs. I know for sure there would’ve been countless adverse events and deaths if a doc hadn’t been around to fix what was going on.
There are CRNAs graduating and starting practice with only observed cardiac cases and procedures according to my cohorts who work with them.

The study will never be done for a multitude of reasons, but I’m sure there would be no measurable difference in outcomes. I’ve seen plenty of near misses and adverse outcomes with anesthesiologist only care.

 

[deleted171991]

The study will never be done for a multitude of reasons, but I’m sure there would be no measurable difference in outcomes. I’ve seen plenty of near misses and adverse outcomes with anesthesiologist only care.

+1. There is less and less critical care or difficult airway management etc. in anesthesia. We are not doing the big open cases of the past anymore and technology has made the job easier.

The only way we can show a difference is if we stop bailing them out. And the only way it will happen will be if they are allowed to practice solo, in independent groups, with no anesthesiologist firefighter in sight. Even then, the bean counters may just live with it, if the "budget" allows. How many bad surgeons have you seen that are not kicked out by the hospital, despite obvious bad outcomes, because they are bringing in money and profits? Why would it be different with a cheap CRNA, who decreases costs?

The only way this will end will be if a hospital gets hit with tens of millions in punitive damages for cutting corners, as an example to everybody else. Don't hold your breaths.

 

[Man o War]

+1. We are mostly not doing the big open cases of the past anymore.

The only way we will show a difference is if we stop bailing them out. And the only way it will happen will be if they are allowed to practice solo, in independent groups, with no anesthesiologist firefighter in sight. Even then, the bean counters may just live with it, if the "budget" allows. How many bad surgeons have you seen that are not kicked out by the hospital, despite obvious bad outcomes, because they are bringing in money and profits? Why would it be different with a cheap CRNA, who saves money?

The only way this will end will be if a hospital gets hit with tens of millions in punitive damages for cutting corners

+1. There is less and less critical care or difficult airway management etc. in anesthesia. We are not doing the big open cases of the past anymore and technology has made the job easier.

The only way we can show a difference is if we stop bailing them out. And the only way it will happen will be if they are allowed to practice solo, in independent groups, with no anesthesiologist firefighter in sight. Even then, the bean counters may just live with it, if the "budget" allows. How many bad surgeons have you seen that are not kicked out by the hospital, despite obvious bad outcomes, because they are bringing in money and profits? Why would it be different with a cheap CRNA, who decreases costs?

The only way this will end will be if a hospital gets hit with tens of millions in punitive damages for cutting corners, as an example to everybody else. Don't hold your breaths.[/QUOTE

Exactly. Don’t disagree with any of this.
I disagree with the notion that a properly designed study would show no difference. I’m 100% positive it would.
A properly designed study doesn’t allow supervision/bailouts.

 

[deleted171991]

Exactly. Don’t disagree with any of this.
I disagree with the notion that a properly designed study would show no difference. I’m 100% positive it would.
A properly designed study doesn’t allow supervision/bailouts.

Nope, that's not a properly designed one. That's an unethical one, which will never happen. The same reason most hospitals tend to keep at least one anesthesiologist firefighter around.

 

[ERRES2288]

actually Scope's business model is to bill QZ and have 6:1 and 8:1 ratios. Mednax was already a normal ACT practice. Scope wants to take it further and cut the number of doctors in half.

I hope they crash and burn. Unfortunately patients will get hurt in the process. ACT is a safe and effective model. Going to near total autonomy for CRNAs with a doc around to just put a name on a chart and never be in the room is just stupid.

I have also heard through the grapevine that the plan is to go up to 8:1 and thus decrease the need for physicians from 100 down to around 30. This is at a level 1 trauma center mind you. Not safe in my opinion but the bean counters don’t care. This could just be the beginning if this “model” takes off.

 

[BLADEMDA]

FT OB and General anesthesiologists needed to partner in an all physician, local group in Charlotte. Work with CRNAs not to exceed 1:4.
Full Description
BC/BE Obstetric and General Anesthesiologists. Local based physician group in the Charlotte area recruiting fellowship-trained OB and general anesthesiologists to participate in a redesigned anesthesia department based on the Perioperative Surgical Home concept. Call and schedule allows for an excellent work-life balance. Leadership opportunities available.

 

[pgg]

You are leaving out the most important point. They aren’t just budgeting for lawsuits, they are budgeting for patient injuries/deaths. This illustrates the seedy underbelly that is our current healthcare system. Unnecessary and avoidable deaths are okay with these administrators as long as they have budgeted for it!!!!!

 

[Mman]

FT OB and General anesthesiologists needed to partner in an all physician, local group in Charlotte. Work with CRNAs not to exceed 1:4.

You can read the job description, I'm just telling you what Scope told the hospital. And this is the guy behind Scope IIRC...

 

[BLADEMDA]

You can read the job description, I'm just telling you what Scope told the hospital. And this is the guy behind Scope IIRC...

The guy behind scope believes in the AANA Collaborative model. If this is the model I'd avoid the job like the plague.

MDs, CRNAs and Care Teams: The Ins and Outs of 4 Anesthesia Care Models

 

[BLADEMDA]

I have also heard through the grapevine that the plan is to go up to 8:1 and thus decrease the need for physicians from 100 down to around 30. This is at a level 1 trauma center mind you. Not safe in my opinion but the bean counters don’t care. This could just be the beginning if this “model” takes off.

The work load from this model can be intense in a high acuity center. It works in a low acuity setting. Having covered more than 4 rooms (whatever model or BS you want to call it) the work load is much higher as you run from room to room bailing out mostly mediocre crnas. I'd never recommend it in a level 1 trauma center because the type of CRNA you need to run this model costs 20-30% more than your typical crna. If you don't hire these types of crnas the burnout and malpractice risk will eat you alive.

 

[ERRES2288]

When you supervise more than 4:1 do you still preop/see each patient? Or are you there to literally just put out the fire?

 

[BigRedBeta]

It's interesting that Mednax, in a way, is kind of on the right side of things. Emphasis on "kind of". As an PICU attending, I always find myself thinking about the what if, and I think it was the right thing for Southeast Anesthesia to raise questions about patient safety.

I wonder though, given that Mednax started out in neonatology and other more specialized pediatric fields, if there was some hubris about the sense of security the size of the Southeast Anesthesia group provided. It's challenging to replace 15 neonatologists or even 5 high risk OB's or pediatric cardiologists on a quick timeline, but given the setup in modern anesthesiology with CRNA's and their growing independence, supervision models that stretch the border of patient safety and all the like, it seems that there's no size of anesthesia practice that is likely safe from such poaching. If you really can get buy in by hospital systems for a 3:1 conversion factor, this certainly won't be the last group under attack.

 

[dannyboy1]

Let me repeat again and again: you are a nobody in medicine if you don't have your own patients, your own respected brand. Nobody goes to a different facility because of their favorite anesthesiologist.

Positives and negatives in every field. Yes, we get treated as subhuman by hospital administrators and surgeons. Most surgeons work a lot harder than us building and maintaining their “brand”. Late night office hours, long difficult conversations with family. Ect. I work around 45 hrs/week. Get paid well and don’t give a second thought to my job when I’m not working. Different strokes for different folks...

 

[BLADEMDA]

When you supervise more than 4:1 do you still preop/see each patient? Or are you there to literally just put out the fire?

Typically, the Anesthesiologist must do the preop or co-sign the preop note; he/she is fully responsible if anything goes wrong even in this 8:1 model.

 

[Southpaw]

Typically, the Anesthesiologist must do the preop or co-sign the preop note; he/she is fully responsible if anything goes wrong even in this 8:1 model.

In such a high supervision ratio one has to imagine the anesthesiologist does fewer and fewer - intubations, lines, creative inductions, smooth wakeups, and they’re involved in almost no intra-op decision making. I can’t imagine them being respected by nurses or surgeons either as they’re both everywhere and nowhere at the same time.

Anesthesiologists should absolutely refuse to work in this model. I would MUCH rather work in a collab model where a CRNA does their own cases and I do mine. Also - this field is what we make it. Don’t let admins or surgeons dictate your practice. Have a spine, be a real f’ing doctor. And advocate, advocate, advocate both locally and nationally.

And if you’re a Debbie downer (not you Blade....) and wanna litter the forum with ‘whoa is me, the specialty is doomed...’ then leave, and go be an internist.

 

[deleted171991]

And if you’re a Debbie downer (not you Blade....) and wanna litter the forum with ‘whoa is me, the specialty is doomed...’ then leave, and go be an internist.

I assume you were talking about me. I could ignore it, or I could just tell you that wishful thinking doesn't fix much. I too am tired of the elephant in the room, but young kids should know what they are getting into. Yes, this used to be an awesome specialty (for those who can put their egos aside), and still is in patches, but let's stop lying to ourselves about where it's headed. It's headed exactly towards arrangements like Blade's. If you don't see it coming yet, that means only that you have a touch more time until the hurricane reaches you too.

Now we as a specialty can all play Neville Chamberlain, as until now, or finally stand up and play Churchill. My guess is that it's too late anyway.

 

[deleted126335]

In such a high supervision ratio one has to imagine the anesthesiologist does fewer and fewer - intubations, lines, creative inductions, smooth wakeups, and they’re involved in almost no intra-op decision making. I can’t imagine them being respected by nurses or surgeons either as they’re both everywhere and nowhere at the same time.

Anesthesiologists should absolutely refuse to work in this model. I would MUCH rather work in a collab model where a CRNA does their own cases and I do mine. Also - this field is what we make it. Don’t let admins or surgeons dictate your practice. Have a spine, be a real f’ing doctor. And advocate, advocate, advocate both locally and nationally.

And if you’re a Debbie downer (not you Blade....) and wanna litter the forum with ‘whoa is me, the specialty is doomed...’ then leave, and go be an internist.

People are going to do what they have to do to support their families. Not all, but enough. Few of Those who have invested years in residency and selected this field are going to retrain. Many will try to find a bolt hole in a sub specialty, but most of us will just make the best of our choices. If that means being the fire department to 6 rooms. So be it. I am at the FU stage of my career and am less than full time and wouldn’t do so at this point. Early in my career, I would have done the math about what was best for my family and made my choice.

 

[Southpaw]

I assume you were talking about me. I could ignore it, or I could just tell you that wishful thinking doesn't fix much. I too am tired of the elephant in the room, but young kids should know what they are getting into. Yes, this used to be an awesome specialty (for those who can put their egos aside), and still is in patches, but let's stop lying to ourselves about where it's headed. It's headed exactly towards arrangements like Blade's. If you don't see it coming yet, that means only that you have a touch more time until the hurricane reaches you too.

Now we as a specialty can all play Neville Chamberlain, as until now, or finally stand up and play Churchill. My guess is that it's too late anyway.

I had you in mind when I posted, but the post wasn’t directed at anyone in particular. You’re a smart guy, one of the most intelligent posters on this forum, and for reasons that aren’t worth going into you appear to have restricted yourself geographically. That’s fine, most of us deal with families and the restrictions that families typically place on us, by choice. Still, for the geographically limited, I feel there are leadership opportunities both within a group, or even hospital administration, that can effect change for the positive.

Now, is that easy to accomplish? Absolutely not, but it’s sometimes shocking to me that people who are intelligent enough to get to where we are, allow themselves to be cast into undesirable locales or practices, and once they decide their situation can’t be improved, they still stay!!

 

[deleted126335]

It is far easier to achieve a leadership role by being a CRNA advocate and pushing for higher supervisory ratios.

 

[Southpaw]

People are going to do what they have to do to support their families. Not all, but enough. Few of Those who have invested years in residency and selected this field are going to retrain. Many will try to find a bolt hole in a sub specialty, but most of us will just make the best of our choices. If that means being the fire department to 6 rooms. So be it. I am at the FU stage of my career and am less than full time and wouldn’t do so at this point. Early in my career, I would have done the math about what was best for my family and made my choice.

I just want to point out that the 6:1 fireman situation is one practice, that’s unlikely to find staffing for such a model UNLESS the current folks get out of their non compete. And if those folks get out, and decide to stay in such an undesireable model, it’s VERY likely bc they literally can’t afford to move (no savings, too big/expensive/unsellable house, kids in private school, spouse spends wayyy too much money, etc) and go to a more desirable practice. Do I feel bad for those particular people? Not really.

Charlotte is a desirable market. A fireman setup will likely fail for many reasons. And it’s a perfect opportunity for a well run private practice, who can operate with no stipend, to step in and bid the contract.

There are some practices, and situations, where the current setup is so rotten for so many reasons that it’s better to let it burn and be the Phoenix to rise from the ashes. Or, just go find something better. There’s tons of good opportunities out there. I’ve personally seen quite a few posted on this forum.

 

[Southpaw]

It is far easier to achieve a leadership role by being a CRNA advocate and pushing for higher supervisory ratios.

I think this is only the case if -

- crna is significantly cheaper than MD
- crna provides a service of equivalent quality, or close enough, to the MD
- MD can’t prove their worth in supervision/direction/value to group, etc

I don’t believe the above are true. I haven’t seen that to be case in the environments I’ve been exposed to. However, if the MDs are so expensive (stipend...) or provide such poor quality service, or can’t recruit good young people, then change will be inevitable.

 

[AdmiralChz]

I just want to point out that the 6:1 fireman situation is one practice, that’s unlikely to find staffing for such a model UNLESS the current folks get out of their non compete. And if those folks get out, and decide to stay in such an undesireable model, it’s VERY likely bc they literally can’t afford to move (no savings, too big/expensive/unsellable house, kids in private school, spouse spends wayyy too much money, etc) and go to a more desirable practice. Do I feel bad for those particular people? Not really.

Yeah I agree. Without the current docs to sign on (some of whom have a vested interest in staying in the area beyond a job), it'll be an uphill battle to recruit for such a model at an almost academic center (Level 1 Trauma at least) - my suspicion is they'll have to somehow scrape by with locums, and even then the people willing to take the job will probably be the lowest common denominator who would do anything for a reasonable job in a reasonable location. Likely docs who have run into significant issues in the past with lawsuits, interpersonal/professional problems or even substance abuse. Only other way to get people is to do a "bait and switch" type of thing where you say 1:3-1:4 and then spring on them 1:6-1:8 when it's too late I suppose.

 

[Man o War]

In such a high supervision ratio one has to imagine the anesthesiologist does fewer and fewer - intubations, lines, creative inductions, smooth wakeups, and they’re involved in almost no intra-op decision making. I can’t imagine them being respected by nurses or surgeons either as they’re both everywhere and nowhere at the same time.

Anesthesiologists should absolutely refuse to work in this model. I would MUCH rather work in a collab model where a CRNA does their own cases and I do mine.

In such a high supervision ratio one has to imagine the anesthesiologist does fewer and fewer - intubations, lines, creative inductions, smooth wakeups, and they’re involved in almost no intra-op decision making. I can’t imagine them being respected by nurses or surgeons either as they’re both everywhere and nowhere at the same time.

Anesthesiologists should absolutely refuse to work in this model. I would MUCH rather work in a collab model where a CRNA does their own cases and I do mine. Also - this field is what we make it. Don’t let admins or surgeons dictate your practice. Have a spine, be a real f’ing doctor. And advocate, advocate, advocate both locally and nationally.

And if you’re a Debbie downer (not you Blade....) and wanna litter the forum with ‘whoa is me, the specialty is doomed...’ then leave, and go be an internist.

The type of hand wringing I see on here only exists on SDN. None of the residents or fellows I’ve written letters for have a) had any trouble finding good jobs or b) had to accept jobs they don’t want or are forced into 6:1 supervision.
Look, if an anesthesiologist has backed him/herself into a corner and stay at a job they hate, that’s their choice. You don’t have to accept it, you choose to.
And according to the stuff I heard decades ago when I chose anesthesia, I should’ve been replaced by nurses about 20 years ago. And making about 50% less than I am now.
If you think this doesn’t exist in other specialties, yes it does. Every specialty has to balance desireable location, salary, and work conditions.
Good post Southpaw.

 

[dannyboy1]

How do you know the Anesthesiologists don't actually prefer Scope over Mednax? I know I'd prefer to be a hospital employee over an AMC employee. Also, Southeast Anesthesiology is a shell company for Mednax. I'd either start my own group if released from the non compete or work for the hospital. Mednax and Sheridan would be dead last on my list.

Why does it make a difference to you hospital employee vs AMC? As an employee the only things I care about are hours, compensation, and role (supervision vs own cases ect). Dosent matter who signes th check as long as it dosent bounce.

 

[Dr.whom]

Why does it make a difference to you hospital employee vs AMC? As an employee the only things I care about are hours, compensation, and role (supervision vs own cases ect). Dosent matter who signes th check as long as it dosent bounce.

I agree. Hospital administrators are no more your friends than AMC administrators are. I think AMCs just left more of a bad taste in our mouth due to how they were formed....... from older docs selling out their professions for a quick profit leaving us younger docs with the concequences.

 

[BLADEMDA]

Why does it make a difference to you hospital employee vs AMC? As an employee the only things I care about are hours, compensation, and role (supervision vs own cases ect). Dosent matter who signes th check as long as it dosent bounce.

I disagree because the AMC isn't local and doesn't really care about the patients or the staffing model/quality. The hospital has a direct vested interest in maintaining quality and for the bad practice if a suit happens. It is the hospital which must answer for the 6:1 or lack of staff/equipment to the medical staff and community. The AMC could not care less about anything except keeping the contract. You don't matter to them at all except as a provider with a number. Ever try to actually visit HR as an AMC employee? What about complaints about the dirty, decadent, lazy chief the AMC has assigned to be your boss? Do you think they care what you think or how you are treated? Great Doctor vs crappy Doctor really has little meaning to the AMC.

 

[BLADEMDA]

The type of hand wringing I see on here only exists on SDN. None of the residents or fellows I’ve written letters for have a) had any trouble finding good jobs or b) had to accept jobs they don’t want or are forced into 6:1 supervision.
Look, if an anesthesiologist has backed him/herself into a corner and stay at a job they hate, that’s their choice. You don’t have to accept it, you choose to.
And according to the stuff I heard decades ago when I chose anesthesia, I should’ve been replaced by nurses about 20 years ago. And making about 50% less than I am now.
If you think this doesn’t exist in other specialties, yes it does. Every specialty has to balance desireable location, salary, and work conditions.
Good post Southpaw.

Plenty of bad Jobs on Gaswork. In fact, over 3/4 of the posted jobs are mediocre to bad jobs. This wasn't the case 10 years ago. Also, very few major medical centers would ever go 5-6:1 supervision back then vs today where if they can find suckers to agree to the model they would implement it.

I'm glad there are good, even great, jobs out there. I encourage those starting out in their career to look hard for one. But, the majority of jobs posted are anything but good jobs and if you lack connections it can be very difficult to secure a good job. I believe a fellowship helps open doors to those fewer and fewer good jobs so that's why I encourage residents to do the extra year.

 

[aneftp]

Crna working similar hours as MD with similar nights and weekends make in the high 200s low 300s.

The thinking that Crna are cheaper is misguided. And some Crna cannot function independently. It’s just the simple truth.

 

[gaspasser2004]

I interviewed at SEA in 2009 and all they were offering at the time was non-partnership tracks. I have no problem being an employed doc (in fact I am now) but I'll be damned if I am going to be employed by other anesthesiologist-owners. I walked away before going through a second round of interviews. To their credit, they were very transparent that they already had their group of physician owners and that I would not be one.

Like it or not, but the anesthesia care team model is here to stay. There will be some botique groups and some situations that will support an all MD group, but those opportunities will be the exception and not the rule. Our time is just too valuable to sit on a stool, chart vitals, and watch the day go by. We bring value in our preop assessment, intraoperative trouble shooting, and postoperative management. I don't think that we can do more than 4:1 any more than I think a primary care physician can see 100 patients in a day with NP's/CRNA's. There is some point where we optimize our cost/benefit and this ratio will be different for each institution.

 

[Psai]

I interviewed at SEA in 2009 and all they were offering at the time was non-partnership tracks. I have no problem being an employed doc (in fact I am now) but I'll be damned if I am going to be employed by other anesthesiologist-owners. I walked away before going through a second round of interviews. To their credit, they were very transparent that they already had their group of physician owners and that I would not be one.

Like it or not, but the anesthesia care team model is here to stay. There will be some botique groups and some situations that will support an all MD group, but those opportunities will be the exception and not the rule. Our time is just too valuable to sit on a stool, chart vitals, and watch the day go by. We bring value in our preop assessment, intraoperative trouble shooting, and postoperative management. I don't think that we can do more than 4:1 any more than I think a primary care physician can see 100 patients in a day with NP's/CRNA's. There is some point where we optimize our cost/benefit and this ratio will be different for each institution.

Yeah but why should I be responsible for 4 patients when someone is taking the billing for 3.5 of those people?

 

[dmk5n]

Here is an article bu Dr Wherry (SCOPE principal) spelling out what his anesthesia model preferences are....
MDs, CRNAs and Care Teams: The Ins and Outs of 4 Anesthesia Care Models

 

[Noyac]

Here is an article bu Dr Wherry (SCOPE principal) spelling out what his anesthesia model preferences are....
MDs, CRNAs and Care Teams: The Ins and Outs of 4 Anesthesia Care Models

This is the most biased article I have read in quite some time. Is this guy really a physician? If so, he has so,d out his fellow physicians. He states that certain MD’s are trouble in the supervision model, that crna’s can be supervised by “other” physicians with little to no liability, and the rhetoric just continues. What a flippin TOOL.

 

[mmag]

Like it or not, but the anesthesia care team model is here to stay. There will be some botique groups and some situations that will support an all MD group, but those opportunities will be the exception and not the rule. Our time is just too valuable to sit on a stool, chart vitals, and watch the day go by. We bring value in our preop assessment, intraoperative trouble shooting, and postoperative management.

As long as I pay the same for physician only care as I would for a CRNA, I will seek out sole physician care. I don't think a surgeon's time is too valuable to do "boring" cases like lap appy. I'm willing to take a pay cut to not supervise/direct and bring value as a full spectrum preoperative physician practicing at the top of my training.

 

[ERRES2288]

So the question remains, how is Scope going to be able to replace 100 anesthesiologists by July?