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TheLoneWolf

TheLoneWolf

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Posting on behalf of a buddy who does not wish to be identified.

Current full time job has him doing high risk vascular (TAMBEs, aorto-bifems), EP lab, high risk OB - accretias, percretas weekly (busiest OB service on the city, 40+ OBGYNs on staff); and prebariatric EGDs with an incredibly slow surgeon (15-20+ minutes of each EGD scope time) on BMIs 60-80 in a small out of OR room with no glidescope or anesthesia machine. That's about 90% of his work. 90% solo. 10% running 1:2 (mostly vascular)+ epidural pager + ACLS/airway pager.

Majority of call and day staff in the department come in to do general surgery, orthopedics, plastics, and outpatient gyn and never enter vascular, OB, or GI. All salaried and take home the same pay.

Department heads say that others lack the skillset to cover these cases (untrue, some have been in practice 10-20+ years before him) and are pretty set on not changing any daily assignments.

Nonstop high risk cases vs sitting in a robot room all day for same pay isn't sitting well. Liability sponge.

At this point, I can't imagine him going to an ASC or even another hospital job could be any worse.

Anyone go from solo to mostly supervision of 1:2, 1:3 ? How did it turn out?
Members don't see this ad.
 
Last edited:
Members don't see this ad :)
TheLoneWolf said:
Posting on behalf of a buddy who does not wish to be identified.

Current full time job has him doing high risk vascular (TAMBEs, aorto-bifems), high risk OB - accretias, percretas weekly ( busiest OB service on the city, 40+ OBGYNs on staff); and prebariatric EGDs with an incredibly slow surgeon (15-20+ minutes of each EGD scope time) on BMIs 60-80 in a small out of OR room with no glidescope or anesthesia machine. That's about 90% of his work. 90% solo. 10% running 1:2 (mostly vascular)+ epidural pager + ACLS/airway pager.

Majority of call and day staff in the department come in to do general surgery, orthopedics, plastics, and outpatient gyn and never enter vascular, OB, or GI. All salaried and take home the same pay.

Department heads say that others lack the skillset to cover these cases (untrue, some have been in practice 10-20+ years before him) and are pretty set on not changing any daily assignments.

Nonstop high risk cases vs sitting in a robot room all day for same pay isn't sitting well. Liability sponge.

At this point, I can't imagine him going to an ASC or even another hospital job could be any worse.

Anyone go from solo to mostly supervision of 1:2, 1:3 ? How did it turn out?
Click to expand...
Terrible job. Leave ASAP. Do locums; market is receptive for now.
 
TheLoneWolf said:
Posting on behalf of a buddy who does not wish to be identified.

Current full time job has him doing high risk vascular (TAMBEs, aorto-bifems), EP lab, high risk OB - accretias, percretas weekly (busiest OB service on the city, 40+ OBGYNs on staff); and prebariatric EGDs with an incredibly slow surgeon (15-20+ minutes of each EGD scope time) on BMIs 60-80 in a small out of OR room with no glidescope or anesthesia machine. That's about 90% of his work. 90% solo. 10% running 1:2 (mostly vascular)+ epidural pager + ACLS/airway pager.

Majority of call and day staff in the department come in to do general surgery, orthopedics, plastics, and outpatient gyn and never enter vascular, OB, or GI. All salaried and take home the same pay.

Department heads say that others lack the skillset to cover these cases (untrue, some have been in practice 10-20+ years before him) and are pretty set on not changing any daily assignments.

Nonstop high risk cases vs sitting in a robot room all day for same pay isn't sitting well. Liability sponge.

At this point, I can't imagine him going to an ASC or even another hospital job could be any worse.

Anyone go from solo to mostly supervision of 1:2, 1:3 ? How did it turn out?
Click to expand...
Whats a tambe?
 
Members don't see this ad :)
Minus the GI, I actually kinda like that job. But to each their own. Agreed, though, that it's BS that his "partners" don't do any of those higher risk cases, but receive the same compensation. If he's the only one in the department that can do them, then those skills need to be properly reimbursed.
 
psychbender said:
Minus the GI, I actually kinda like that job. But to each their own. Agreed, though, that it's BS that his "partners" don't do any of those higher risk cases, but receive the same compensation. If he's the only one in the department that can do them, then those skills need to be properly reimbursed.
Click to expand...

My group doesn’t differentiate between cases/surgeons/patient acuity for compensation purposes, either. In a democratic group, cases really shouldn’t be assigned that way (becomes closer to a production/EWYK model vs an availability model). Specialists are paid extra (Cardiac, peds). Someone who graduated from an anesthesia residency should be able to do TAMBEs, OB, vascular. Willing to is a different story…

However, good board runners/schedulers should be trying to equalize assignments as much as possible over time (everyone has their day in “that” room and with “that” surgeon). The real concern is that the schedulers aren’t doing this (and that pay is way below market).

Your friend should start sending out their CV.
 
ucladoc2b said:
My group doesn’t differentiate between cases/surgeons/patient acuity for compensation purposes, either. In a democratic group, cases really shouldn’t be assigned that way (becomes closer to a production/EWYK model vs an availability model). Specialists are paid extra (Cardiac, peds). Someone who graduated from an anesthesia residency should be able to do TAMBEs, OB, vascular. Willing to is a different story…

However, good board runners/schedulers should be trying to equalize assignments as much as possible over time (everyone has their day in “that” room and with “that” surgeon). The real concern is that the schedulers aren’t doing this (and that pay is way below market).

Your friend should start sending out their CV.
Click to expand...
That's my point, though. They should be spreading the misery about equally, if everyone is paid equally. If they are consisting only scheduling him for these cases because "no one else can do them," then he should be paid extra, or given some other form of compensation. His partners are dip****s that are exploiting him.

For the area, we don't really know if it's below market. All markets are local. It could very well be that for that specific geographic area, that would be median pay for that workload. Not every place in the country is $700k for 36hrs, no work after 5pm.
 
TheLoneWolf said:
Posting on behalf of a buddy who does not wish to be identified.

Current full time job has him doing high risk vascular (TAMBEs, aorto-bifems), EP lab, high risk OB - accretias, percretas weekly (busiest OB service on the city, 40+ OBGYNs on staff); and prebariatric EGDs with an incredibly slow surgeon (15-20+ minutes of each EGD scope time) on BMIs 60-80 in a small out of OR room with no glidescope or anesthesia machine. That's about 90% of his work. 90% solo. 10% running 1:2 (mostly vascular)+ epidural pager + ACLS/airway pager.

Majority of call and day staff in the department come in to do general surgery, orthopedics, plastics, and outpatient gyn and never enter vascular, OB, or GI. All salaried and take home the same pay.

Department heads say that others lack the skillset to cover these cases (untrue, some have been in practice 10-20+ years before him) and are pretty set on not changing any daily assignments.

Nonstop high risk cases vs sitting in a robot room all day for same pay isn't sitting well. Liability sponge.

At this point, I can't imagine him going to an ASC or even another hospital job could be any worse.

Anyone go from solo to mostly supervision of 1:2, 1:3 ? How did it turn out?
Click to expand...
Where is this job so we can all cross it off our list permanently?

It's wild that anyone would work like this in the current market. Pathetic that others in this feeble department won't do these cases equally. Scum.
 
Maz777 said:
Where is this job so we can all cross it off our list permanently?

It's wild that anyone would work like this in the current market. Pathetic that others in this feeble department won't do these cases equally. Scum.
Click to expand...


Also feeble that they do high risk endo cases without adequate equipment. Department can’t be bothered to address a problem with a simple solution.
 
Relevant article about how incentives work in anesthesia.

www.coronishealth.com

You Finally Got Some Assistance: How Should You Distribute It? | Coronis Health

Anesthesiologist compensation systems fall along a spectrum from “equal share” on one end to “eat what you kill” (EWYK) on the other. In between, we have shift/ hourly systems, units/points systems, and multiple iterations of all the above.
www.coronishealth.com www.coronishealth.com
 
Tell him to contact me. I will show him the way. I’m the master of easy work load.

MD only is fine. But ur friend’s way of doing MD only is brutal.


425k private practice? Either its limited calls or something or tons of vacation? The math isn’t adding up here
 
circleK said:
Is he a full partner? This information will help in our advice for next steps. But regardless this is outrageous and needs to be immediately addressed.
Click to expand...
This does not sound like a partnership private practice.

Most amc are private practice also.

Notice the key words. All salaried.
 
TheLoneWolf said:
Posting on behalf of a buddy who does not wish to be identified.

Current full time job has him doing high risk vascular (TAMBEs, aorto-bifems), EP lab, high risk OB - accretias, percretas weekly (busiest OB service on the city, 40+ OBGYNs on staff); and prebariatric EGDs with an incredibly slow surgeon (15-20+ minutes of each EGD scope time) on BMIs 60-80 in a small out of OR room with no glidescope or anesthesia machine. That's about 90% of his work. 90% solo. 10% running 1:2 (mostly vascular)+ epidural pager + ACLS/airway pager.

Majority of call and day staff in the department come in to do general surgery, orthopedics, plastics, and outpatient gyn and never enter vascular, OB, or GI. All salaried and take home the same pay.

Department heads say that others lack the skillset to cover these cases (untrue, some have been in practice 10-20+ years before him) and are pretty set on not changing any daily assignments.

Nonstop high risk cases vs sitting in a robot room all day for same pay isn't sitting well. Liability sponge.

At this point, I can't imagine him going to an ASC or even another hospital job could be any worse.

Anyone go from solo to mostly supervision of 1:2, 1:3 ? How did it turn out?
Click to expand...
Your friend does not want to be identified but in what general area of the country is this?

I would say it would be easier for this person to transition to a job doing mostly medical direction (sounds like he is already doing some), than for someone that has been supervising their entire career to go into solo practice.

Not an ideal situation, and it seems as though he is being taken advantage of; it'll continue unless he stands up and advocates for himself or leaves, but only he can do that. If you are not able AND willing to leave a place, there is little use complaining.
 
TheLoneWolf said:
Posting on behalf of a buddy who does not wish to be identified.

Current full time job has him doing high risk vascular (TAMBEs, aorto-bifems), EP lab, high risk OB - accretias, percretas weekly (busiest OB service on the city, 40+ OBGYNs on staff); and prebariatric EGDs with an incredibly slow surgeon (15-20+ minutes of each EGD scope time) on BMIs 60-80 in a small out of OR room with no glidescope or anesthesia machine. That's about 90% of his work. 90% solo. 10% running 1:2 (mostly vascular)+ epidural pager + ACLS/airway pager.

Majority of call and day staff in the department come in to do general surgery, orthopedics, plastics, and outpatient gyn and never enter vascular, OB, or GI. All salaried and take home the same pay.

Department heads say that others lack the skillset to cover these cases (untrue, some have been in practice 10-20+ years before him) and are pretty set on not changing any daily assignments.

Nonstop high risk cases vs sitting in a robot room all day for same pay isn't sitting well. Liability sponge.

At this point, I can't imagine him going to an ASC or even another hospital job could be any worse.

Anyone go from solo to mostly supervision of 1:2, 1:3 ? How did it turn out?
Click to expand...

hours? vacation? call? I know that's not the point of the post, but honestly it sounds like this person is getting absolutely hosed. It makes me wonder if people like this just become content rather than understanding market dynamics and how in demand anesthesiologists truly are right now. Never become content, always stay hungry.
 
SRYSPAC said:
Your friend does not want to be identified but in what general area of the country is this?

I would say it would be easier for this person to transition to a job doing mostly medical direction (sounds like he is already doing some), than for someone that has been supervising their entire career to go into solo practice.

Not an ideal situation, and it seems as though he is being taken advantage of; it'll continue unless he stands up and advocates for himself or leaves, but only he can do that. If you are not able AND willing to leave a place, there is little use complaining.
Click to expand...
The market is so wide open in 80-90% of the country within 1 hr driving distance of their home base. It’s hard to image someone who is “stuck in any job” besides complacency or just use to the daily grind/routine

Look. I’d love to have a 9-10 min commute at my dream job. But I’d rather drive 40-45 minutes to be at a better job. I can tolerate up to 60 minutes daily drive. Key word being tolerate and daily drive.

But there are others who can’t or won’t do more than a 20 minute commute. These are personal decisions. We have seen other posters post similar job descriptions with commute time etc.

This is a amc type of private job the op is posting about his friend. This is not a partnership track job if everyone is on the same salary.

The complexity of cases matter on a day to day basis if you are solo. If everyone is getting paid the same. It needs to be spread over evenly.

I’d do gyn plastics ortho cases all day long solo over complex vascular cases. I just had a sick vascular patient code 2 days ago as we were about to roll back for the aorto bi fem. These vascular patients are ticking time bombs.
 
circleK said:
There are partnership PP jobs where all partners are on the same salary.
Click to expand...
Until the op chimes in. It’s all speculation if this is private practice amc style

Or private practice partnership

I can’t fathom a true private practice partnership that functions like the way the OP is describing (equal salary, but unequal workload).
 
aneftp said:
Until the op chimes in. It’s all speculation if this is private practice amc style

Or private practice partnership

I can’t fathom a true private practice partnership that functions like the way the OP is describing (equal salary, but unequal workload).
Click to expand...
It sounds pretty bad. I thought having a dinosaur partner who refused to do blocks was prettty bad.
 
The question i have is where is the rest of the income going that he is generating?

Someone is basically stealing his money.

You can be the guy in the group to do the sickest patients and get paid for it, or you all do exactly the same and make the same but you cant do the sickest patients and make the same... the math ain't mathing
 
aneftp said:
Tell him to contact me. I will show him the way. I’m the master of easy work load.

MD only is fine. But ur friend’s way of doing MD only is brutal.


425k private practice? Either its limited calls or something or tons of vacation? The math isn’t adding up here
Click to expand...

PP group. Group has twice as many non call takers "day docs" as partners. Doesn't take call. 8 weeks vacation. Averages 45 hours a week.
 
TheLoneWolf said:
PP group. Group has twice as many non call takers "day docs" as partners. Doesn't take call. 8 weeks vacation. Averages 45 hours a week.
Click to expand...
That explains its. I knew there was something to it. Non call partners just want to ride off into the sunset doing bread and butter.

Depending on location he may not have a lot of options for full time work. I think people just don’t know how to explore work options. Afraid to venture out. I don’t know his family dynamics. Wife kids? Want to be home by 5pm daily? That probably plays a factor.

I know every location/state is different. But there is so much 1099 or even w2 per diem work in almost every city you can patch yourself a little schedule and make 425k so easy with no calls and no weekends. Unless he’s in a small town. Than options become limited in terms of travel and wanting to be home.

But unless he’s the whopping boy of the group and he likes it, he shouldn’t be taking on all the high risk cases without getting more money.
 
aneftp said:
This does not sound like a partnership private practice.

Most amc are private practice also.

Notice the key words. All salaried.
Click to expand...

Not an AMC. Large metropolitan hopsital in the downtown. Same handful of schedulers making the daily schedules. Non call takers are all salaried. Even the partners are, in a sense, salaried, as they are only surviving on a fat hospital stipend. Payor mix, as with most cities, is trash.
 
TheLoneWolf said:
Not an AMC. Large metropolitan hopsital in the downtown. Same handful of schedulers making the daily schedules. Non call takers are all salaried. Even the partners are, in a sense, salaried, as they are only surviving on a fat hospital stipend. Payor mix, as with most cities, is trash.
Click to expand...
Messy.

If ur friend is in a large metro area. There should be a plenty of work for non call doctors. W2 per diem or 1099 within driving distance. (Less than one hour) Daytime partner (for job security) is stupid mentality these days.

Just quit the partnership.

There is so much work everywhere these days. I’m in Florida. I have 3 different hospitals begging me to work this weekend even daytime if I can’t cover nights.

I’m just choosing to stay home this weekend, relax.

Same with work next week days or nights. I’m like texting my other friends if they want to work. It’s actually better to be credentialed at so many places and just sit around all week. Almost guaranteed to be asked to work 1-2 of those days especially Monday and Friday.

Almost any major metro area , tell him to get credential prn status. And build up his pool of hospitals. This will take 3-6 months but once he gets started. He won’t ever look back.
 
circleK said:
Is he a full partner? This information will help in our advice for next steps. But regardless this is outrageous and needs to be immediately addressed.
Click to expand...

He sat down with the group heads about it. They said to his face it isn't happening. When he showed them months worth of assignments, they unashamedly said yes it is happening, and that it is a good thing as no one else has the skillset to cover those cases.

When he pointed out the same attendings always in robot, breast, and podiatry rooms, they said "oh, they have poor room turnover times and their skills arent great, so it's the safest place to put them so they can't injure anyone."

Place has had some locums since Covid started. Not a single one has agreed to cover vascular, OB, C sections, endoscopy, or even holding the pagers.

I called him yesterday and told him to move a bit more south. Quite literally any job will be at least a marginal bit better. Even call taking jobs with similar hours with much better pay and benefits. Looked up gasworks and 8/10 hospitals within an hour of him are hiring. Also told him to avoid jobs with a busy OB service, for his own sanity.

Even the worst AMC couldn't get away with such behavior.
 
If a dept can say to a person “yeah you are getting hosed but you’ll just need to deal with it because it ain’t changing” then there is only one option for the person - leave.

Given the current workforce market, he should have made that decision yesterday. @aneftp espouses the glories of the locums life, but it is also having a positive trickledown effect on employment packages and opportunities.

Your friend needs to overcome the inertia of staying at his current job. Literally there are better opportunities immediately available if he will just take a few minutes to look, and those are just the advertised options.
 
TheLoneWolf said:
He sat down with the group heads about it. They said to his face it isn't happening. When he showed them months worth of assignments, they unashamedly said yes it is happening, and that it is a good thing as no one else has the skillset to cover those cases.

When he pointed out the same attendings always in robot, breast, and podiatry rooms, they said "oh, they have poor room turnover times and their skills arent great, so it's the safest place to put them so they can't injure anyone."

Place has had some locums since Covid started. Not a single one has agreed to cover vascular, OB, C sections, endoscopy, or even holding the pagers.

I called him yesterday and told him to move a bit more south. Quite literally any job will be at least a marginal bit better. Even call taking jobs with similar hours with much better pay and benefits. Looked up gasworks and 8/10 hospitals within an hour of him are hiring. Also told him to avoid jobs with a busy OB service, for his own sanity.

Even the worst AMC couldn't get away with such behavior.
Click to expand...
Beauty of locums. U can pick and choose.

But locums can’t refuse to do certain cases if they are privileged for it. They are paid well and mercenaries hired to do the job.

The fault lies with the schedule makers. They suck (not just scheduling but their own skill set). I made the schedule a lot previously. If people aren’t happy with their assignments I offer to switch with them and do the case myself. That’s when you know who is a good schedule maker. Tell the schedule maker to do the case themselves.

This means the place ur friend is a crap hole and not worth staying at for 425k. For what? To take no calls?

Start getting the cv ready and move on.
This job market is still amazing in most parts of the country.
 
NICMAN said:
Run. Unless your friend isn’t bothered by the specter of a malpractice suit and doesn’t mind the daily moral injury.
Click to expand...

I told him yesterday, "look, these people are using you as f***ing cannon fodder, if you stay, you will get sued for a bad outcome; sooner or later. These idiots have a good thing going and will attempt to fill your position with some green new grad who has no idea what he's in for."
 
Arch Guillotti said:
Whats a tambe?
Click to expand...
1746278541236.gif
 
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