Full time job w-2 $400k

[Oggg]

http://www.gaswork.com/post/164939

Does anyone who has a job like the one posted have any comments about how well the MD and CRNA setup works? Interesting, since it doesn't look like there is an anesthesia mgmt company pushing this.

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[k12balla]

Run away... Quickly

 

[Wiscoblue]

Hospital employee. $400 k for supervising nurses. Plus benefits. Call from home. Not a bad gig. I wouldn't take it. But it's not a bad job if you like the area and like to brew beer and wine and grow your own hops!

 

[deleted171991]

Not a bad gig? It's malpractice waiting to happen. Supervision is even worse than direction, because they will consult you mostly when they get in trouble, and you will have no idea of the patient since you didn't preop her (plus you don't get to decide the anesthesia plan, so they can f*ck it up in 10,000 ways and then call you in). Not worth the risks unless you own the practice and can hire your own good nurses.

 

[Wiscoblue]

Is Oregon an opt out state? Is the hospital billing QZ? The anesthesiologists liability might be limited, if so.

 

[deleted171991]

Is Oregon an opt out state? Is the hospital billing QZ? The anesthesiologists liability might be limited, if so.

Would you really risk it?

Any time your name gets on the chart, you can be held liable. Why? Because you have more money than the CRNA, hence you are the one sued. Doesn't matter who actually killed the patient in your absence.

 

[pgg]

Not a bad gig? It's malpractice waiting to happen. Supervision is even worse than direction, because they will consult you mostly when they get in trouble, and you will have no idea of the patient since you didn't preop her (plus you don't get to decide the anesthesia plan, so they can f*ck it up in 10,000 ways and then call you in). Not worth the risks unless you own the practice and can hire your own good nurses.

It depends. I used to moonlight at a place with a similar arrangement. The pseudo-independent CRNAs there did their own cases 90%+ of the time, and I did my own cases 90%+ of the time. Occasionally I'd be the day's medical director, or I'd be the #2 call person, and a CRNA would consult me for advice on something. In those cases I was no more liable for the anesthetic than the cardiologist who was consulted preop. If there was an emergency I would respond and help (aka fireman duty) but my name didn't go in the chart, and even if it did, as the helpful bystander responding to a crisis I don't think my liability was substantial.

I think it bears mentioning that although it may be the hospital's expectation that a CRNA in trouble would be helped by an available anesthesiologist, in the absence of any actual doctor-patient relationship existing before the SHTF there isn't any real liability to speak of.

The main thing I don't like about this particular job listing is that it says "The Anesthesiologist will sometimes run his or her own room/cases" which probably means it's relatively rare, which means you're just a preop clinic monkey, PACU monkey, block monkey, consult monkey. That kind of practice doesn't much appeal to me.

But $400K W2 + benefits with no weekends or call to speak of, if you wanted to live in that area ... one could sure do worse.

Of course the fact that they're advertising on Gasworks is a flag by itself.

 

[deleted171991]

I don't think there is enough legal precedent on this.

 

[urge]

I don't like the part that says: "CRNAs take first call and this position takes second call (every day?). Second call back is rare but required call back time is 30 minutes."

So, are you second call everyday? I'm assuming there is only one anesthesiologist, being that there are only 7 CRNAs. Are you at the mercy of the in-house CRNA to have to come in on a whim for a "supervision consultation" every single day?

Sounds like 365 days of home call to me. 400 is not going to cut it.

 

[pgg]

I don't think there is enough legal precedent on this.

I think there is.

If an internist commits malpractice and a code blue is called, and an EM physician responds because he's the hospital code blue fireman, is he liable for the internist's malpractice? Of course not; that's laughable.

If a CRNA commits malpractice and an overhead "stat-to-OR-five" is called, and an anesthesiologist responds because he's the OR fireman, is he liable for the CRNA's malpractice? Only if there's a pre-existing doctor-patient relationship, ie he's directing/supervising the CRNA. In those practices where the CRNAs do their thing and the anesthesiologists do theirs, we're no different than the EM doc responding to a code three floors away.

This is my opinion of course, but I don't think the notion of "some dude responding to emergencies" lacks precedent.

 

[deleted171991]

IMHO, both the CRNA and the supervising physician are liable, even if 100% of the mistake belongs to the CRNA. Why? Because the MD has a doctor-patient relationship just by supervising the CRNA. This is an opinion I won't change until I see multiple legal precedents established by superior courts.

Regarding emergencies, there is no good samaritan doctrine in medicine, especially in a hospital. Expect any first responder to be sued as part of the collective, especially if s/he makes even the smallest mistake.

Even if you stop and help voluntarily in a highway accident, you can be sued as if the victim were your patient. A layman cannot.

 

[pgg]

IMHO, both the CRNA and the supervising physician are liable, even if 100% of the mistake belongs to the CRNA. Why? Because the MD has a doctor-patient relationship just by supervising the CRNA.

That's my point though, in some of these anesthesiologist-fireman scenarios there is no supervision or direction. The CRNAs just do their thing by themselves in the general vicinity of anesthesiologists.

At that place I used to moonlight, the hospital also ran a freestanding ambulatory surgery center. Hospital admin didn't like the fact that there were just CRNAs there, so they paid for an anesthesiologist to literally SIT there and be available for emergencies. Weird but true. I'd hang out in the lounge and read a book for a few hours without ever seeing a patient or CRNA or speaking to anyone.

I know exactly what that Gasworks ad means by "supervision" and it ain't "supervision" at all. The giveaway is the #1 call CRNA with a #2 call physician who is at home. There isn't any "supervision" going on there. It's fireman duty with a 30 minute lag time..

Regarding emergencies, there is no good samaritan doctrine in medicine. Expect any first responder to be sued if s/he makes even the smallest mistake.

Bringing good samaritan law into the thread is a red herring. Of course if the responder commits malpractice he's liable. But the responder isn't liable for the malpractice committed prior to his arrival.

 

[Mman]

IMHO, both the CRNA and the supervising physician are liable, even if 100% of the mistake belongs to the CRNA. Why? Because the MD has a doctor-patient relationship just by supervising the CRNA. This is an opinion I won't change until I see multiple legal precedents established by superior courts.

Where are you looking to find this legal precedent that you seek? Because it's probably already there.

 

[Mman]

I know exactly what that Gasworks ad means by "supervision" and it ain't "supervision" at all. The giveaway is the #1 call CRNA with a #2 call physician who is at home. There isn't any "supervision" going on there. It's fireman duty with a 30 minute lag time..

Not necessarily. I've seen small hospitals where anesthesiologists actually follow medical direction all day long, but at night the CRNA is on call and "supervised" by the surgeon. Anesthesiologist not on call at all. So it's possible it's a medical supervision model during the day but a separate model at night.


strange but true

 

[deleted171991]

Where are you looking to find this legal precedent that you seek? Because it's probably already there.

If it's there, I did not bump into it while reading various blogs or googling it. But I have bumped into cases where the anesthesiologist who was directing (not supervising) a CRNA was more liable for all the stupid things she's done than the CRNA herself.

Don't you wonder why the CRNA malpractice premiums are usually 1o times smaller than anesthesiologist ones?

 

[GassmanMD]

Hospital employee. $400 k for supervising nurses. Plus benefits. Call from home. Not a bad gig. I wouldn't take it. But it's not a bad job if you like the area and like to brew beer and wine and grow your own hops!

No paragraph has ever described my goals more concisely. Brew your own!

 

[urge]

That's my point though, in some of these anesthesiologist-fireman scenarios there is no supervision or direction.

I know exactly what that Gasworks ad means by "supervision" and it ain't "supervision" at all. The giveaway is the #1 call CRNA with a #2 call physician who is at home. There isn't any "supervision" going on there. It's fireman duty with a 30 minute lag time..

Supervision in these terms means that you are available for consultation or help. Does not mean that you are actually supervising the anesthetic.

Supervision is a euphemism for fireman duty.

 

[pgg]

Not necessarily. I've seen small hospitals where anesthesiologists actually follow medical direction all day long, but at night the CRNA is on call and "supervised" by the surgeon. Anesthesiologist not on call at all. So it's possible it's a medical supervision model during the day but a separate model at night.


strange but true

I stand corrected. Odd that the hospital and surgeon would put up with that.

 

[deleted171991]

Bringing good samaritan law into the thread is a red herring. Of course if the responder commits malpractice he's liable. But the responder isn't liable for the malpractice committed prior to his arrival.

Don't red herring me, please. I am not trolling, just chatting.

In an emergency, it can be pretty difficult to establish who did what and when and whose mistake caused the bad outcome. Plus people are getting sued just because they were present.

 

[urge]

Don't you wonder why the CRNA malpractice premiums are usually 1o times smaller than anesthesiologist ones?

Because they are 10 times safer than we are?

Just kidding.

 

[deleted171991]

Not necessarily. I've seen small hospitals where anesthesiologists actually follow medical direction all day long, but at night the CRNA is on call and "supervised" by the surgeon.

And in situations like that, there are various precedents. Traditionally, the surgeon is the captain of the ship (since s/he is the MD in the room), though occasionally s/he is not found liable for pure anesthesia mistakes. I wonder how that would change if there was a physician anesthesiologist "supervising".

Even if state law does not require supervision, but hospital bylaws and contracts do, I would err on the side of being found liable for every supervised CRNA mistake.

 

[pgg]

Don't red herring me, please. I am not trolling, just chatting.

I didn't think you were trolling; I just thought good samaritan bit wasn't relevant.

In an emergency, it can be pretty difficult to establish who did what and when and whose mistake caused the bad outcome. Plus people are getting sued just because they were present.

That's a fair point. I don't think it's reasonable to be especially worried about the everpresent "anyone can sue anyone for anything" risk though, if you have zero involvement in a case prior to the emergency call. EM docs don't live in fear of getting sued for what a paramedic does prehospital.

 

[Hockeyguy]

This sounds like the job where they only want a doc in place as a formality for by-laws or something like that. Especially if CRNAs take all call and weekends. I've seen some arrangements like that in Illinois. Usually not a practice you want to be involved in.

 

[Oggg]

Clearly it's a fireman-duty situation. MDs and CRNAs would be independent, but expected to help one another out in an emergency. MD probably would get the tougher cases.

Even if you aren't liable for malpractice that happened prior to your arrival, you are then thrust into an emergency where time is of the essence but you have no clue what is going on? What if you arrive 1min after the CRNA finally puts the ETT in and they tell you they're ok? You leave and then get called back 5minutes later cuz the O2Sat = EtCo2 = 0. The lawyers will count you responsible for not checking ETT placement for the CRNA that you were not supervising. Or what if it takes the CRNA 30 minutes to figure out/ admit to you that they were giving neo not epi while you were doing chest compressions on the patient. You'd be on the hook.

I wonder what my malpractice company would say.

 

[Mman]

I stand corrected. Odd that the hospital and surgeon would put up with that.

It's what small hospitals do when they want an anesthesiologist but can't have somebody on call all the time. The alternative is they can't hire one and then it's the surgeon supervising every case. The surgeons figure they can do nearly all their work during the day anyway since they are in PP and will almost never come in at night.