"How a CRNA-led anesthesia group plans to grow: 5 key notes"

[Carbocation1]

How a CRNA-led anesthesia group plans to grow: 5 key notes

Written by Laura Dyrda | March 13, 2017

Two certified registered nurse anesthetists, Frank Grasso, CRNA, and Kyle Griffith, CRNA, founded G & G Anesthesia and they're preparing for growth, according to a River Bender report.

Here are five key notes:

1. The company was founded to focus on the CRNA while also employing anesthesiologists; G & G Anesthesia includes 15 CRNAs and three anesthesiologists. It's among the only CRNA-owned anesthesia groups in the country.

2. The anesthesiologists serve as medical directors of the group while CRNAs work independently on all types of cases.

3. The G & G Anesthesia clinical sites also train current nursing and medical students, giving them an opportunity to work in the CRNA-owned group. Both founders graduated from Southern Illinois University Edwardsville's nurse anesthesia program, which is now a doctor of nursing practice program.

4. The group is working with SIUE to develop a corporate agreement for employees to enroll in the post-master's program with the support of the practice.

5. The practice founders are planning to expand their model into pain management, according to the report.

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[Carbocation1]

How common are CRNA led groups? Are the surgeons/hospital OK with this setup, not to mention the patients?

 

[BLADEMDA]

How common are CRNA led groups? Are the surgeons/hospital OK with this setup, not to mention the patients?

1. I expect more CRNA run groups with CRNA management employing Anesthesiologists. They can "bid" for contracts at even lower amounts than the others.
2. Hospitals want low costs even it means a monkey giving anesthesia
3. Surgeons mostly don't care and just want to do their cases.

Since AMCs employ 1/3 of all Anesthesiologists some of them won't care whether their boss has an MBA or a CRNA DNP after his/her name.

DetroitNews: "Don’t go under with only a nurse"

 

[BLADEMDA]

Here is how management companies view the new anesthesia grad:

There is a famous story about sex and money that I have heard in myriad variations. A man asks a woman if she would be willing to sleep with him if he pays her an exorbitant sum. She replies affirmatively. He then names a paltry amount and asks if she would still be willing to sleep with him for the revised fee. The woman is greatly offended and replies as follows:

She: What kind of woman do you think I am?
He: We’ve already established that. Now we’re just haggling over the price.

 

[BLADEMDA]

 

[BLADEMDA]

 

[BLADEMDA]

 

[Planktonmd]

How a CRNA-led anesthesia group plans to grow: 5 key notes

Written by Laura Dyrda | March 13, 2017

Two certified registered nurse anesthetists, Frank Grasso, CRNA, and Kyle Griffith, CRNA, founded G & G Anesthesia and they're preparing for growth, according to a River Bender report.

Here are five key notes:

1. The company was founded to focus on the CRNA while also employing anesthesiologists; G & G Anesthesia includes 15 CRNAs and three anesthesiologists. It's among the only CRNA-owned anesthesia groups in the country.

2. The anesthesiologists serve as medical directors of the group while CRNAs work independently on all types of cases.

3. The G & G Anesthesia clinical sites also train current nursing and medical students, giving them an opportunity to work in the CRNA-owned group. Both founders graduated from Southern Illinois University Edwardsville's nurse anesthesia program, which is now a doctor of nursing practice program.

4. The group is working with SIUE to develop a corporate agreement for employees to enroll in the post-master's program with the support of the practice.

5. The practice founders are planning to expand their model into pain management, according to the report.

 

[aneftp]

Medicine is changing very fast. Technology has made medicine safer as well. I call it the 80/20 rule. Most non MD can do the basic "doctor" thing 80%. Which is good enough for the public as long as they think they are saving money.

And in some specialties. It may be closer to 95/5 rule like anesthesia. Where it safe to perform anesthetics with almost any "provider". The tougher cases will get punted to the tertiary care centers and the excuse won't be about "safety" or lack of training by the provider. But rather more "Resources" available at tertiary medical centers.

 

[deleted126335]

How common are CRNA led groups? Are the surgeons/hospital OK with this setup, not to mention the patients?

They put that **** out there to irritate us. Just like they put out pictures of CRNAs doing pain and TEEs. Those things do exist, but, they are rare birds. F#ck'em. they are still licking their wounds on the VA thing.

 

[GA8314]

They put that **** out there to irritate us. Just like they put out pictures of CRNAs doing pain and TEEs. Those things do exist, but, they are rare birds. F#ck'em. they are still licking their wounds on the VA thing.

Agreed. Keep your hands on skills, acquire new skills, refresh old ones, do a good job. You will have a decent job.

 

[nimbus]

Attention: Business Opportunity/ Partnership for Anesthesia Contract in NY

 

[GravelRider]

Wasn't Northstar co-founded by a CRNA?

I think a more concerning trend is the employment of physicians as a whole...whether it's by crnas, academics, hospitals, or AMCs. There are a lot of conflicts of interest that arise out of the physician employment trend. There is the potential for shareholders who have no contact at all with patients to incentivize their employees out of pure economic interest. The employment of physicians not only disengages us from the profession itself, but takes us away from our role as patient advocates. The extreme consolidation, employment of physicians, and out-sourcing our roles to lesser "providers" is the natural evolution of capitalism in healthcare. These CRNAs are only taking advantage of the current environment. Frankly, a couple of MBAs can employ a few anesthesiologists and then bid for some surgery center contracts.

 

[BLADEMDA]

Wasn't Northstar co-founded by a CRNA?

I think a more concerning trend is the employment of physicians as a whole...whether it's by crnas, academics, hospitals, or AMCs. There are a lot of conflicts of interest that arise out of the physician employment trend. There is the potential for shareholders who have no contact at all with patients to incentivize their employees out of pure economic interest. The employment of physicians not only disengages us from the profession itself, but takes us away from our role as patient advocates. The extreme consolidation, employment of physicians, and out-sourcing our roles to lesser "providers" is the natural evolution of capitalism in healthcare. These CRNAs are only taking advantage of the current environment. Frankly, a couple of MBAs can employ a few anesthesiologists and then bid for some surgery center contracts.

That's my entire point in a nutshell: we are just a commodity like any other so whether a CRNA or an MBA hires us it's pretty much the same thing. The vast majority of new grads will end up as a cog in the machine working for the man or woman.

 

[ProRealDoc]

People, don't sweat it. The CRNAs have and/or will become cogs in the wheel of healthcare. No one is immune. Look around you at the hoards of PAs and NPs in other specialties.

After half a decade in PP, the best advice I can give to the young ones is live modestly, take the highest paying gig you can get and save your cash you can so you can walk away when the bottom falls out.

CRNAs don't bother me, it's healthcare as a whole that does.

 

[leaverus]

i can't believe any self-respecting physician would be employed by a CRNA

 

[deleted171991]

i can't believe any self-respecting physician would be employed by a CRNA

You mean none of us should work in all those nurse-run hospitals?

 

[Man o War]

i can't believe any self-respecting physician would be employed by a CRNA

I can't imagine what the number would have to be for me to accept this type of arrangement....they couldn't afford me.

 

[Scotty_G]

There are people on this board employed by northstar...

 

[GravelRider]

I can't imagine what the number would have to be for me to accept this type of arrangement....they couldn't afford me.

What about an MBA? Or a hospital who's CEO is a nurse? Or an AMC that is ultimately owned by some Wall Street investors? What's the difference?

 

[deleted126335]

I can't imagine what the number would have to be for me to accept this type of arrangement....they couldn't afford me.

You have alternatives. People who take these jobs frequently have few-none: Problem CV, severe personality issues, poor communication skills, etc.

 

[deleted126335]

What about an MBA? Or a hospital who's CEO is a nurse? Or an AMC that is ultimately owned by some Wall Street investors? What's the difference?

Psychologically more disturbing. Being owned by an MBA or CPA is less disturbing than being owned by a fellow doc. Far less disturbing than being owned by a CRNA.

 

[Man o War]

What about an MBA? Or a hospital who's CEO is a nurse? Or an AMC that is ultimately owned by some Wall Street investors? What's the difference?

What about an MBA? Or a hospital who's CEO is a nurse? Or an AMC that is ultimately owned by some Wall Street investors? What's the difference?

I will never assist a CRNA owned group grabbing private contracts, that includes AMCs with CRNA ownership. Their lobbying and political rhetoric disgusts me to the point that I won't even work with them anymore.
I don't know of any facilities with CRNA ownership, so that's a non issue.
If I'm employed, an MBA or nurse CEO bother me less than a CRNA employing me to be the fall guy, putting my license and personal assets at risk. Or, employing me to satisfy the hospital's requirement to have a "medical director" so that they may keep the contract. There are so many other better practice arrangements available than that.

 

[Man o War]

You have alternatives. People who take these jobs frequently have few-none: Problem CV, severe personality issues, poor communication skills, etc.

Fortunately I can walk away if my option is CRNA employment or nothing!

 

[GravelRider]

I will never assist a CRNA owned group grabbing private contracts, that includes AMCs with CRNA ownership. I don't know of any facilities with CRNA ownership, so that's a non issue.
If I'm employed, an MBA or nurse CEO bother me less than a CRNA employing me to be the fall guy, putting my license and personal assets at risk. Or, employing me to satisfy the hospital's requirement to have a "medical director" so that they may keep the contract. There are so many other better practice arrangements available than that.

And who is to say that the MBA or nurse CEO isn't going to employ an anesthesiologist just to be the fall guy or to satisfy the medical director requirement? If you have the option to own your own practice and therefore own your own work then by all means. These CRNAs are just engaging in capitalism. If they succeed, who is to say it's wrong? We love to tout the benefits of capitalism in healthcare and this is capitalism in action. Hopefully they fail, but maybe they won't. People buy a product because it's either better or cheaper. These CRNAs are likely going the cheaper route.

 

[Man o War]

And who is to say that the MBA or nurse CEO isn't going to employ an anesthesiologist just to be the fall guy or to satisfy the medical director requirement? If you have the option to own your own practice and therefore own your own work then by all means. These CRNAs are just engaging in capitalism. If they succeed, who is to say it's wrong? We love to tout the benefits of capitalism in healthcare and this is capitalism in action. Hopefully they fail, but maybe they won't. People buy a product because it's either better or cheaper. These CRNAs are likely going the cheaper route.

They're more than welcome to do that, I'm just not going to assist them.
If I'm doing my own cases, the only person I have to worry about screwing me legally is me, and if I'm the medical director, they're going to pay me for my time at a rate commensurate with the time requirement.

 

[aneftp]

They're more than welcome to do that, I'm just not going to assist them.
If I'm doing my own cases, the only person I have to worry about screwing me legally is me, and if I'm the medical director, they're going to pay me for my time at a rate commensurate with the time requirement.

What's the magic number?

Everyone has a magic number. I bet u 95% of anesthesiologists magic number (if "reasonable" work hours"). Reasonable work hours being q6 calls is around 375-425k and 8 weeks off. Working 50-55 hours.

The all crna group offer you that plus a "25k" medical director to attend some bs hospital committee meetings.

Who's gonna to take that? If you won't. 95% of MDs will take it.

 

[Consigliere]

What's the magic number?

Everyone has a magic number. I bet u 95% of anesthesiologists magic number (if "reasonable" work hours"). Reasonable work hours being q6 calls is around 375-425k and 8 weeks off. Working 50-55 hours.

The all crna group offer you that plus a "25k" medical director to attend some bs hospital committee meetings.

Who's gonna to take that? If you won't. 95% of MDs will take it.

Very, very true. I'd put that number at 98% though. I'm the 2%. I'd rather flip burgers than work for a nurse.

 

[deleted162650]

What's the magic number?

Everyone has a magic number. I bet u 95% of anesthesiologists magic number (if "reasonable" work hours"). Reasonable work hours being q6 calls is around 375-425k and 8 weeks off. Working 50-55 hours.

The all crna group offer you that plus a "25k" medical director to attend some bs hospital committee meetings.

Who's gonna to take that? If you won't. 95% of MDs will take it.

That sounds like a pretty typical package to me. Would take way more than that to get me to be the patsy for a group of CRNA's.

 

[Man o War]

What's the magic number?

Everyone has a magic number. I bet u 95% of anesthesiologists magic number (if "reasonable" work hours"). Reasonable work hours being q6 calls is around 375-425k and 8 weeks off. Working 50-55 hours.

The all crna group offer you that plus a "25k" medical director to attend some bs hospital committee meetings.

Who's gonna to take that? If you won't. 95% of MDs will take it.

It's so high it would never happen, so I haven't really sat and tried to quantify it.

 

[Notorious T.E.E.]

This.....

After half a decade in PP, the best advice I can give to the young ones is live modestly, take the highest paying gig you can get and save your cash you can so you can walk away when the bottom falls out.
.

Will lead to this....

Very, very true. I'd put that number at 98% though. I'm the 2%. I'd rather flip burgers than work for a nurse.

Money in the bank gives you options.

 

[GravelRider]

What's the magic number?

Everyone has a magic number. I bet u 95% of anesthesiologists magic number (if "reasonable" work hours"). Reasonable work hours being q6 calls is around 375-425k and 8 weeks off. Working 50-55 hours.

The all crna group offer you that plus a "25k" medical director to attend some bs hospital committee meetings.

Who's gonna to take that? If you won't. 95% of MDs will take it.

Yup. This is the market now. One of the above linked CRNA overlord groups was in upstate NY and that is a wasteland of underpaying employed jobs in some very undesirable areas. All they need to do is offer 25k more and 2 extra weeks vacation and you'll have people lining up to take that cushy surgicenter job.

 

[aneftp]

Everyone has to make decisions what's best for them. Many of you guys may or may not have families or area ties. It's easy to say "I'm not gonna to take the job" when you are single and have no family ties.

I easily could say this my first 6-7 years out in practice. No kids, mobile, can pick up and go.

Try to make those same decisions when you got kids in schools with their own friends and wife doesn't want to leave the area. You are talking a whole different ball game.

Work is work. People just want to be fairly compensated for the work/hours/calls/acuity of work. The whole package.

In the end. You look like a fool holding out and not working out of spite if you refuse to work for someone. Sure you can travel do locums for 6-12 months to see if something better comes out. Maybe it comes up. Maybe it doesn't.

 

[aneftp]

I ate **** for a few years in my first job. Exploitive lying bastard employer. Job Market sucked. Had a mortgage, school loans, car loans, wife and baby.

Yup. 1994-1997/98 were the bad years.

That's why many of this board just pound their chests and say they won't work.

U gotta do what u gotta do to make ends meet.

I got a family now. Not sure if the others have family or kids. Makes a world of difference how cocky u want to boast u will never work for crna owned practice.

 

[chocomorsel]

Yup. 1994-1997/98 were the bad years.

That's why many of this board just pound their chests and say they won't work.

U gotta do what u gotta do to make ends meet.

I got a family now. Not sure if the others have family or kids. Makes a world of difference how cocky u want to boast u will never work for crna owned practice.

I will NEVER work for a CRNA owned group. Hell no!!!!
I have a family now. I chose to travel and do locums before I work for a CRNA group to be the fall guy.
And sometimes, your spouse needs to understand that you must make that move or lose your damn mind. And be more accommodating, unless his or her salary can afford to keep you comfy at home or working part time.

And why do we give kids so much damn power anyway over us? They are kids!! Food, shelter, clothing, love. That's all they need. They can make new friends wherever we go. There's a reason we have so many entitled teenagers and young adults nowadays. Parents all bowing down to their kids wants.... blah blah blah. Didn't get that when I was a kid. I did what I was told. And went where the parents were.

 

[aneftp]

I will NEVER work for a CRNA owned group. Hell no!!!!
I have a family now. I chose to travel and do locums before I work for a CRNA group to be the fall guy.
And sometimes, your spouse needs to understand that you must make that move or lose your damn mind. And be more accommodating, unless his or her salary can afford to keep you comfy at home or working part time.

And why do we give kids so much damn power anyway over us? They are kids!! Food, shelter, clothing, love. That's all they need. They can make new friends wherever we go. There's a reason we have so many entitled teenagers and young adults nowadays. Parents all bowing down to their kids wants.... blah blah blah. Didn't get that when I was a kid. I did what I was told. And went where the parents were.

It's the wife who matters more.

I have been away for 6 months in between full time jobs before. It can cause a lot of strain. Trust me.

Wife plus kids plus being away as Locums.

Most of us can get a job anywhere. But gotta make compromises in life.

 

[Consigliere]

I will NEVER work for a CRNA owned group. Hell no!!!!
I have a family now. I chose to travel and do locums before I work for a CRNA group to be the fall guy.
And sometimes, your spouse needs to understand that you must make that move or lose your damn mind. And be more accommodating, unless his or her salary can afford to keep you comfy at home or working part time.

And why do we give kids so much damn power anyway over us? They are kids!! Food, shelter, clothing, love. That's all they need. They can make new friends wherever we go. There's a reason we have so many entitled teenagers and young adults nowadays. Parents all bowing down to their kids wants.... blah blah blah. Didn't get that when I was a kid. I did what I was told. And went where the parents were.

Now I don't have to write anything.

 

[rakotomazoto]

I have two kids and a mountain of med school debt. Personally, I would not feel comfortable working for a CRNA group even if that meant taking a worse paying job with different terms and involved a long distance move.

I don't trust their leadership, so why would I be comfortable working under them? As the physician, the lawyers are coming after you once the ship starts sinking for some reason, you are the responsible one. Yet, they are reaping all of the financial benefits until that happens since they are your boss. It's such a terrible organizational model.

And don't tell me that the whole field is going to be owned by CRNA's in 5 years. Even if that is the overall trend, healthcare is a big ship and it usually doesn't change course as quickly as many on this board like to theorize, not at a system level. Sure, local conditions can change quickly, but that just means its time to move. And the wife and the kids will be just fine, I grew up military and moved frequently. It doesn't have to be that big of a deal.

 

[GravelRider]

Still don't see the difference of working for a CRNA vs MBA vs ancient partner who hasn't touched a laryngoscopes in 10 years vs nurse CEO. It's all semantics. Someone is your boss. You decide whether or not the role they set for you is worth your time/money/standards. Why such a principled fight against CRNA bosses, but not against the business people who know even less about medicine?

 

[BLADEMDA]

I have two kids and a mountain of med school debt. Personally, I would not feel comfortable working for a CRNA group even if that meant taking a worse paying job with different terms and involved a long distance move.

I don't trust their leadership, so why would I be comfortable working under them? As the physician, the lawyers are coming after you once the ship starts sinking for some reason, you are the responsible one. Yet, they are reaping all of the financial benefits until that happens since they are your boss. It's such a terrible organizational model.

And don't tell me that the whole field is going to be owned by CRNA's in 5 years. Even if that is the overall trend, healthcare is a big ship and it usually doesn't change course as quickly as many on this board like to theorize, not at a system level. Sure, local conditions can change quickly, but that just means its time to move. And the wife and the kids will be just fine, I grew up military and moved frequently. It doesn't have to be that big of a deal.

No, the CRNAs will not own the field in the next 5 or 10 years as that privilege will go to the national AMCs like Envision, Mednax, TeamHealth, Northstar, NAPA and USAP just to name the big dogs.

 

[Man o War]

I will NEVER work for a CRNA owned group. Hell no!!!!
I have a family now. I chose to travel and do locums before I work for a CRNA group to be the fall guy.
And sometimes, your spouse needs to understand that you must make that move or lose your damn mind. And be more accommodating, unless his or her salary can afford to keep you comfy at home or working part time.

And why do we give kids so much damn power anyway over us? They are kids!! Food, shelter, clothing, love. That's all they need. They can make new friends wherever we go. There's a reason we have so many entitled teenagers and young adults nowadays. Parents all bowing down to their kids wants.... blah blah blah. Didn't get that when I was a kid. I did what I was told. And went where the parents were.

+++++++++++1

 

[Mad Jack]

i can't believe any self-respecting physician would be employed by a CRNA

Remember that job listing someone posted a while ago that was a CRNA group hiring an anesthesiologist that was basically, "you'll just be a body to fill our medical director position, you will provide no anesthesia, have no clinical duties, and take call by phone?" There are people with no self respect out there, the sort of scum that take jobs like that with a smile on their face.

 

[chocomorsel]

Now I don't have to write anything.

Ain't that something Consigliere? We agree on something!!!! Love it!!!
Some people will do anything for the mighty dollar. Have no sense of pride or principle. I don't get it.

 

[chocomorsel]

It's the wife who matters more.

I have been away for 6 months in between full time jobs before. It can cause a lot of strain. Trust me.

Wife plus kids plus being away as Locums.

Most of us can get a job anywhere. But gotta make compromises in life.

I am the wife. Maybe that's why.
And will not give that much power to the children.

 

[ProRealDoc]

I will NEVER work for a CRNA owned group. Hell no!!!!
I have a family now. I chose to travel and do locums before I work for a CRNA group to be the fall guy.
And sometimes, your spouse needs to understand that you must make that move or lose your damn mind. And be more accommodating, unless his or her salary can afford to keep you comfy at home or working part time.

And why do we give kids so much damn power anyway over us? They are kids!! Food, shelter, clothing, love. That's all they need. They can make new friends wherever we go. There's a reason we have so many entitled teenagers and young adults nowadays. Parents all bowing down to their kids wants.... blah blah blah. Didn't get that when I was a kid. I did what I was told. And went where the parents were.

Finally someone with some common sense.

 

[Psai]

I am the wife. Maybe that's why.
And will not give that much power to the children.

You uhhh...single?

 

[mmag]

What's the pay cut folks are willing to take to be in a physician only practice? There's no way you can come close $ wise even working your butt of vs supervising 4 rooms.

 

[Wiscoblue]

You can make a very decent living in an MD only practice, if the blended unit is 45 or more. 250-300 units a week is not very busy. And it's fun to do your own cases.


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[chocomorsel]

What's the pay cut folks are willing to take to be in a physician only practice? There's no way you can come close $ wise even working your butt of vs supervising 4 rooms.

My town is physician mostly, and the docs here are doing well. Even the ones making $30-35 a unit. Some of us hate supervising CRNAs.

 

[Lurch]

You can make a very decent living in an MD only practice, if the blended unit is 45 or more. 250-300 units a week is not very busy. And it's fun to do your own cases.


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What tips do people have for negotiating your group's conversion factor with private insurers, especially as this might apply to small and medium sized groups? Obviously the squeeze is on these groups in particular as they go toe to toe with corporate medicine.