How will you handle possible stop to elective surgery?

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Mman said:
I file the potential for having to chip in without getting paid in a national emergency under professionalism. I would suspect people that bailed and didn't help out if they were able to could be reported to state medical boards for sanctioning and license suspension.

Nobody is waving a flag saying "hey I will work for free". But if there is critical work to be done, we must do it and figure out the payment later.
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If the hospital wants a service they can figure it out now. It’s not complicated.

Just like some like to pitch that credentials takes weeks at best, if they really need someone tomorrow they can actually do credentials in an hour. It’s a dangerous step to start implying that anyone owes free labor
 
Mman said:
They will remember and they will care. Our field is based on service.
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Look that's your opinion and your entitled to it. But it's naieve.

If I say tomorrow I'm self quarantined due to fever but it's actually cause I'm not getting paid, who's gonna ever know?

The guy who's so low he won't go to work during a crisis for a few beans is also probably savvy enough to not publish it online. He's also the same guy who's been ****ing us all over for years.

Hell r meek er CRNA and that plastics dude will still find work. Don't pretend that karma actually exists for these people. It might. But most times it doesn't.


BTW, I'm getting absolutely ****ed over right now. And I'm still going to work for peanuts
 
Newtwo said:
Look that's your opinion and your entitled to it. But it's naieve.
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It is my opinion and it is probably shared by the majority of people making hiring decisions and handing out contracts for staffing. It is certainly not naive.
 
sb247 said:
If the hospital wants a service they can figure it out now. It’s not complicated.

Just like some like to pitch that credentials takes weeks at best, if they really need someone tomorrow they can actually do credentials in an hour. It’s a dangerous step to start implying that anyone owes free labor
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Nobody has said or implied anybody "owes free labor". What I am saying is you have a professional duty to aid during an emergency.
 
Mman said:
Nobody has said or implied anybody "owes free labor". What I am saying is you have a professional duty to aid during an emergency.
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You are saying that professional duty includes showing up without a commitment to be paid or knowledge of how much.....that’s free labor
 
sb247 said:
You are saying that professional duty includes showing up without a commitment to be paid or knowledge of how much.....that’s free labor
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Under normal day-to-day circumstances of the business world, your above comment is certainly valid.

Under once-in-a-generation circumstances which theoretically pose an existential threat, your above comment takes a back seat to caring first and foremost about societal good based on the education, status, position, and professional duty expectations of you as a physician. Comes with the territory.

The ”Cajun Navy” had no such concern showing up to rescue hundreds from Katrina flood waters, using their own boats and gas, and after driving potentially long distances, completely unreimbursed.
 
Monty Python said:
Under normal day-to-day circumstances of the business world, your above comment is certainly valid.

Under once-in-a-generation circumstances which theoretically pose an existential threat, your above comment takes a back seat to caring first and foremost about societal good based on the education, status, position, and professional duty expectations of you as a physician. Comes with the territory.

The ”Cajun Navy” had no such concern showing up to rescue hundreds from Katrina flood waters, using their own boats and gas, and after driving potentially long distances, completely unreimbursed.
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And I thought those guys/gals were awesome. That was volunteer. A doc who chooses to work for free is also very charitable and awesome.

It’s not at all the same as saying if they don’t go out for free we seize their boats and never let them on the water again. It’s the demand that’s inappropriate.
 
Newtwo said:
No one's going to know or remember or care.
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Oh, they'll remember.

They may even pretend they don't, show you a smile when it's all over. Who we are and what we do has consequences. Just because some people go through life blissfully and naively unaware that people are taking note of their behavior, doesn't mean they aren't.

Newtwo said:
Were not saving the world anytime soon.
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Not with that attitude you're not! 😉
 
sb247 said:
And I thought those guys/gals were awesome. That was volunteer. A doc who chooses to work for free is also very charitable and awesome.

It’s not at all the same as saying if they don’t go out for free we seize their boats and never let them on the water again. It’s the demand that’s inappropriate.
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Focusing on the ”demand” word, I will simply say I view that potential aspect of my professional life as a cost of citizenship. You have the right, with which I respectfully disagree, to view it through a different lens of your own design.

PS. I changed my avatar to my previous unit’s emblem. The Latin motto at the bottom has always held a significant meaning to me.
 
sb247 said:
You are saying that professional duty includes showing up without a commitment to be paid or knowledge of how much.....that’s free labor
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We're not landscape architects, where the no-show risk to society during a crisis of sunny weather and gentle overnight rains is a bunch of ghastly overgrown lawns.

Can you at least acknowledge, for once, that we live in a society where there is SOME level of collective responsibility and obligation of duty to the whole, sometimes, under extraordinary circumstances? And that if you wish to enjoy the security and civilization benefits of living in a country led by elected representatives, every once in a while, it might be OK for those leaders to, you know, lead, and for you to follow?

God forbid you occasionally have to uphold some semblance of a social contract and follow orders to help fellow humans in your own country. It's not like you're being commanded to strangle a bunch of kittens.
 
sb247 said:
You are saying that professional duty includes showing up without a commitment to be paid or knowledge of how much.....that’s free labor
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If you are a paid employee, you are already getting a paycheck so nobody is asking you to do anything for free.

If you are in a private practice collecting your own billing, then you show up to work every day of the year not knowing if or what you will collect for a given case or day. And if you are in that setting, pissing off the hospital by not chipping in is a death sentence to your continued ability to work there.


Also for whatever it is worth, if anybody wants to argue they are better than the doctor nurses I would suggest acting like you deserve to be held in higher regard professionally.
 
Mman said:
If you are a paid employee, you are already getting a paycheck so nobody is asking you to do anything for free.
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The issue is that we are employed by the AMC which may lay us off if elective surgeries go to zero, yet will still be asked to come in by the hospital (which we are credentialed at but not employed by) and “help out”. Unlike every other physician who will see these patients and will bill them. The employed ICU and ED docs are fine, they will have plenty of patients to see, they will continue to draw a salary and their employers will continue to bill.
 
Has anyone seen preliminary worst-case planning for keeping x% of ORs available for true emergencies which will occur (SBOs, appys, GSWs, etc), and not turning them into overflow ICUs where the anesthesia machines are commandeered for the vents? Out of academic curiosity, what percentage of total non-obstetrical procedures are genuinely “must go, cannot wait?”
 
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dannyboy1 said:
The issue is that we are employed by the AMC which may lay us off if elective surgeries go to zero, yet will still be asked to come in by the hospital (which we are credentialed at but not employed by) and “help out”. Unlike every other physician who will see these patients and will bill them. The employed ICU and ED docs are fine, they will have plenty of patients to see, they will continue to draw a salary and their employers will continue to bill.
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I imagine if some kind of worst case scenario happens where you get laid off by the AMC, but are needed by the hospital in an “all hands on deck” situation then you would be rehired by the hospital in whatever capacity they deem necessary. We are looking at a potential major stress on resources, not the end of civilization.

My point of contention is that if the government can dig up trillions of dollars to bail out cruise ship companies then they can find some emergency funds to compensate the doctors and nurses who are making the sacrifices to care for the population.
 
dannyboy1 said:
The issue is that we are employed by the AMC which may lay us off if elective surgeries go to zero, yet will still be asked to come in by the hospital (which we are credentialed at but not employed by) and “help out”. Unlike every other physician who will see these patients and will bill them. The employed ICU and ED docs are fine, they will have plenty of patients to see, they will continue to draw a salary and their employers will continue to bill.
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so you get a paycheck to come to work and are concerned that you may later lose your job? No offense, but if the AMC craters and you would like to take over at your hospital I would assume you will want to stay on that hospitals good side.

And from a business point of view, this isn't going to put an AMC out of business that wasn't already going out of business. While surgical volume will crater short term, all those people needing a knee replacement will still come back later in the year. And for somebody like Mednax where anesthesia collections are probably something like 5% of their revenue it certainly will not put them into insolvency.

As an owner of a private practice, my income will personally crater in the short term but all of our employees will still get paid and we will take out loans to pay them if necessary. That's what happens when you own a business. AMCs have the same mandate to their own employees. I mean imagine the fun of trying to enforce those noncompetes if you actually laid people off.
 
pgg said:
We're not landscape architects, where the no-show risk to society during a crisis of sunny weather and gentle overnight rains is a bunch of ghastly overgrown lawns.

Can you at least acknowledge, for once, that we live in a society where there is SOME level of collective responsibility and obligation of duty to the whole, sometimes, under extraordinary circumstances? And that if you wish to enjoy the security and civilization benefits of living in a country led by elected representatives, every once in a while, it might be OK for those leaders to, you know, lead, and for you to follow?

God forbid you occasionally have to uphold some semblance of a social contract and follow orders to help fellow humans in your own country. It's not like you're being commanded to strangle a bunch of kittens.
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For a civilian? No enforceable obligation

Contracts require terms up front and two parties agreeing to them. I don’t acknowledge the nebulous “social contract”.
 
sb247 said:
For a civilian? No enforceable obligation

Contracts require terms up front and two parties agreeing to them. I don’t acknowledge the nebulous “social contract”.
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There are laws pertaining to the military drafting physicians if needed even if you are a civilian. It's a part of having a medical license. So while it has not ever happened, there are laws allowing them to do that.

Also not the best look to run in a corner and hide during a time of emergency.
 
Mman said:
so you get a paycheck to come to work and are concerned that you may later lose your job? No offense, but if the AMC craters and you would like to take over at your hospital I would assume you will want to stay on that hospitals good side.

And from a business point of view, this isn't going to put an AMC out of business that wasn't already going out of business. While surgical volume will crater short term, all those people needing a knee replacement will still come back later in the year. And for somebody like Mednax where anesthesia collections are probably something like 5% of their revenue it certainly will not put them into insolvency.

As an owner of a private practice, my income will personally crater in the short term but all of our employees will still get paid and we will take out loans to pay them if necessary. That's what happens when you own a business. AMCs have the same mandate to their own employees. I mean imagine the fun of trying to enforce those noncompetes if you actually laid people off.
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All these people needing new knees are in the highest risk patient pool that will likely be wiped out by this thing.
The Italian doc on the podcast says obesity is a big risk factor. Fat, diabetic, older patients = not a good outcome if this thing gets worse.
 
Mman said:
There are laws pertaining to the military drafting physicians if needed even if you are a civilian. It's a part of having a medical license. So while it has not ever happened, there are laws allowing them to do that.

Also not the best look to run in a corner and hide during a time of emergency.
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Public law 779 of the 81st Congress: GOVERNMENT SERVICES (Didn't look to see if it is still on the books)

This is part of what the series MASH was based on - physicians being drafted into service.
 
Mman said:
so you get a paycheck to come to work and are concerned that you may later lose your job? No offense, but if the AMC craters and you would like to take over at your hospital I would assume you will want to stay on that hospitals good side.

And from a business point of view, this isn't going to put an AMC out of business that wasn't already going out of business. While surgical volume will crater short term, all those people needing a knee replacement will still come back later in the year. And for somebody like Mednax where anesthesia collections are probably something like 5% of their revenue it certainly will not put them into insolvency.

As an owner of a private practice, my income will personally crater in the short term but all of our employees will still get paid and we will take out loans to pay them if necessary. That's what happens when you own a business. AMCs have the same mandate to their own employees. I mean imagine the fun of trying to enforce those noncompetes if you actually laid people off.
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We are now having a discussion as to using our line of credit to pay CRNA salaries during this period. Some want to avoid that and “furlough” the crnas. I’m in favor of borrowing to pay them. Interested in others opinions who are in the same boat.
 
SaltyDog said:
If you choose not to volunteer your time in a crisis, don’t be surprised if your colleagues choose to think you’re a douchebag and choose not to work with you anymore.
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These same people are your former co-residents who would page board runner at 305pm asking if they’re getting relieved
 
Monty Python said:
Has anyone seen preliminary worst-case planning for keeping x% of ORs available for true emergencies which will occur (SBOs, appys, GSWs, etc), and not turning them into overflow ICUs where the anesthesia machines are commandeered for the vents? Out of academic curiosity, what percentage of total non-obstetrical procedures are genuinely “most go, cannot wait?”
Click to expand...
Off my experience in a few academic centers, a call team of 1-2 OR teams can usually take care of the burden of emergency cases. From a logistical standpoint, would make sense to wall off 4 ORs or a specific section for general emergency cases.
 
Nobody can force you to work, we're not in a tyranny.

The federal government can try to force you to work through conscription, and penalties if you refuse.

State governments already can tie licensure with forcing you to accept Medicaid patients.

Hospitals don't have to pay you if you volunteer your services.

Hospitals can rapidly credential in an emergency.

You can ruin a hospital relationship with refusal to serve in a physician capacity.

You can ruin partner relationships by refusing.

You can bet that social media will destroy you if you refuse to help those in need.



All true statements.
 
As I say again, I'm going to work. I've lost as much and probably more than most over this already.

But how is it any different to the **** we get from colleagues on a regular day? I inherit dog **** cases on a daily basis 'because I do echo'. And nothing happens to those weak ass cvnts. I don't really see a difference
 
Small private practice group - I'm a w2, non partner. We're on the verge of canceling elective cases. Main boss wants docs to take a week of call at a time (small rural hospital, not that bad actually) but then to use PTO for the next two weeks that you're off work. That's not legal, right?
 
gcc322 said:
Small private practice group - I'm a w2, non partner. We're on the verge of canceling elective cases. Main boss wants docs to take a week of call at a time (small rural hospital, not that bad actually) but then to use PTO for the next two weeks that you're off work. That's not legal, right?
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The alternative may be that he fires you. Which one do you prefer?
 
I'm on salary. If I wind up having to use a bunch of PTO, I may want to take some non-paid time off later in the year when I can actually do stuff... Hopefully that wont be an issue for my employer. I guess I'm lucky to be in that position...
 
gcc322 said:
Small private practice group - I'm a w2, non partner. We're on the verge of canceling elective cases. Main boss wants docs to take a week of call at a time (small rural hospital, not that bad actually) but then to use PTO for the next two weeks that you're off work. That's not legal, right?
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Or you can be laid off. Maybe try working out a deal where you take unpaid leave, but still get benefits?

I’m already getting emails from staffing agencies looking to hire people for COVID19 staffing. Anesthesiologists were among the specialties listed. I think there will be plenty of work to go around pretty soon.
 
We have gone urgent/emergent only now. Plan is 2 weeks down and reassess next Thursday and extend or plant to start up again. It’s hard to justify bringing in sick kids and parents (both of which I saw multiples of last week) potentially infecting others, staff, etc. risking lives for totally elective cases that can wait weeks, months or years. I was pissed having to evaluate and cancel obviously ill children and interact with sick parents sitting there in masks we had to give them. There’s a GD pandemic here, GTFOH a-hole! You’re going to kill someone, or many people. And they still get all annoyed when you cancel the circumcision, ear tube, whatever. They should have turned them away at the door, but we’re not there yet.
We are an academic practice in a big city. The days off are paid academic time. I expect we will take a big hit in our annual bonus this year, or overload the schedule in a month or two to get all caught up. That would be good for the bonus. All the academic meetings, lectures, workshops being cancelled is going to hurt people up for promotion as well, but it’s a small price to pay.
 
Mikkel said:
I'm waiting for the CRNAs to pipe up and say they'll be able to practice critical care medicine in place of the intensivists because they were nurses in the ICU at some point.



IgG?
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In a situation where people are taking risk and working for free....I'm not sure I see CRNA's lining up at the door. I may be wrong though.
 
I'd probably feel a little bit better about working for free if I thought the Major Hospital System CEO wasn't going to be pulling home a cool $10M from the safety of his/her office. Maybe a couple mil bonus for extracting maximum work out of their employees and getting through the crisis.

I'm all about the "all hands on deck"/"good of society"/"physician responsibility" mindset, but just because there's a national emergency doesn't mean there aren't people willing to take advantage of you. It IS possible to be magnanimous and also expect a reasonable compensation for the risk.

Servicemen and women are both magnanimous (put themselves in harms way for our country voluntarily), but also get rewarded (combat/hazard pay, GI bill, health care for life). No one expects them to take a bullet for free.

This is not quite that, but it's getting pretty close.
 
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102CF54C-ABDE-4CCD-BA50-C703EA0CF320.jpeg
 
MoMoGesiologist said:
I agree it’s an extreme statement. And you have the right to not show up to work if you are not being paid.

But if the stories coming out of Italy are real and materialize here (not enough beds, ORs turned into ICUs), and the hospital can’t do elective surgery and is losing money and asks you to volunteer, you really wouldn’t help? This isn’t asking you to work for free because hospital wants to take advantage of you, this is if it’s a national crisis and all hands on deck situation. What does being a physician mean in this situation?
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It would be pretty bold for society to ask doctors and nurses to work for free on the front lines while they sign multi-billion dollar bailout bills for tourism and hospitality industries. Perhaps equally as bold for the hospital to ask people to work for free when they are operating at a loss... because I absolutely guarantee you that when normalcy returns and they are once again making steady profits off our work in the OR they are not going to retroactively volunteer to compensate you for your volunteered time using those profits but instead will continue funneling those restored profits into executive bonuses and that swanky new lobby renovation as previously earmarked; your extraordinary efforts and selfless charity forgotten in the blink of an eye. Your worth to the hospital quickly summed up as a tool from which they can extract profits when times are good and a tool which they can shunt financial losses onto by exploiting free labor when times are bad. Healthcare workers are expected to be altruistic by nature, which is reasonable. Unfortunately savvy healthcare MBAs will absolutely take advantage of that societal expectation quite readily and without remorse.

Our large tertiary center is already encouraging employees to donate PTO to fellow colleagues who need more due to quarantine restrictions... meanwhile the hospital itself (part of a large health systems in no danger of bankruptcy) is not offering any additional PTO for those who are on mandatory leave due to a disease they contracted at work... but asking their employees to donate their PTO to colleagues and take a loss so that the hospital doesn't have to. I'd be more disgusted if it wasn't all so predictable.
 
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Hospitals are getting a lot of FEDERAL assistance money.


www.politico.com

Hospitals bid for $100 billion in next coronavirus package

Hospitals want $100 billion in the next relief package along with targeted changes to tax laws.
www.politico.com www.politico.com


The $100 billion ask from the American Hospital Association — joined by the American Medical Association and American Nurses Association — is built around the argument that it's better to get federal assistance before the full force of the pandemic hits, to fortify a health system that lacks the beds, necessary equipment and the workforce to deal with a pandemic. Hospital lobbyists want a massive infusion of cash for specialized gear to protect workers, child care for doctors and nurses and to offset revenue lost from the suspension of elective surgeries and other new costs.
 
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