How’s that expansion going?

[dizzy21]

I see a lot of job postings saying that the hospital is planning on site expansions and needing to recruit.

I don’t understand how all of these health care centers are all planning to expand their OR capacity. There are not enough anesthesiologists or CRNAs, not enough nurses. Are there even enough surgeons/proceduralists for all of this increasing capacity?

Job markets are supposed to be local but I would say the shortage of healthcare workers is national and yet all the C suite guys are pushing expansion of procedural sites.

So my question to you guys is how is that expansion going where you are?

I’ll go first, hospital opened several surgical centers. Couldn’t staff with home anesthesia department, brought in two different AMCs to help staff outside sites both couldn’t reliably deliver, all sites brought back in house and now utilizing locums.

Previous hospital I worked at did not have enough RNs so had to close several ORs. Opened new outpatient orthopedic site. Can’t run at capacity due to RN staffing.

---

Members don't see this ad.

 

[Dr. Rude]

I see a lot of job postings saying that the hospital is planning on site expansions and needing to recruit.

I don’t understand how all of these health care centers are all planning to expand their OR capacity. There are not enough anesthesiologists or CRNAs, not enough nurses. Are there even enough surgeons/proceduralists for all of this increasing capacity?

Job markets are supposed to be local but I would say the shortage of healthcare workers is national and yet all the C suite guys are pushing expansion of procedural sites.

So my question to you guys is how is that expansion going where you are?

I’ll go first, hospital opened several surgical centers. Couldn’t staff with home anesthesia department, brought in two different AMCs that couldn’t reliably deliver, brought back in house and now utilizing locums.

Previous hospital I worked at did not have enough RNs so had to close several ORs. Opened new outpatient orthopedic site. Can’t run at capacity due to RN staffing.

We are also expanding. We are employed. Docs and CRNAs. Hospital fu#ked it up initially and people left. costing them big time. So they have hired more people. Offered incentive pay for signing up to work vacation, post call, etc. Actually are breaking the eggs to make the omelet with the surgeons...Don't fill your block time...it's gone...FU. DOn't be efficient with flip rooms....They're gone...FU. Of course the rules don't apply to all the surgeons. Not CT or Near, etc. Just the middle of the pack.

 

[Iso4ane]

I believe there are (or appear to be) enough surgeons. There does definitely appears to be not enough anesthesia personnel.

Think about all the procedural residencies and fellowships that may be offered at a single hospital (Gen Surg, Ortho, ENT, CT, IR, IP, EP, etc) add those all together and compare that to the size of the anesthesia residency. Now the ratio required probably isn’t 1:1 but I’d imagine it close.

 

[dizzy21]

We are also expanding. We are employed. Docs and CRNAs. Hospital fu#ked it up initially and people left. costing them big time. So they have hired more people. Offered incentive pay for signing up to work vacation, post call, etc. Actually are breaking the eggs to make the omelet with the surgeons...Don't fill your block time...it's gone...FU. DOn't be efficient with flip rooms....They're gone...FU. Of course the rules don't apply to all the surgeons. Not CT or Near, etc. Just the middle of the pack.

Yes better block time scheduling and efficient utilization would help with RN and anesthesia staffing. Also better tracking of surgeon operative times. I’m sure every institution has a surgeon who books a case for 2 hours and takes 6. Not sure why they think it’s in his or her interest to misrepresent the operative time. It ends up screwing up everyone including other surgeons.

 

[T-burglar]

Not well. We can’t seem to hire enough anesthesia providers . Everyone is burned out and people are leaving which stresses the people left over even more

 

[DocMcCoy]

Agree that their doesn’t appear to be a shortage of surgeons, or at least not a shortage of surgical volume they are willing to cover.

My hospital system has a grow or die mentality without the thought of how to deal with the critical shortage of “ancillary” personnel (anesthesia included)

We can’t hire the numbers to be fully staffed and can barely cover as is with copious locum and traveler coverage who get money literally thrown to them in buckets.

We started CRNAS almost 2 years ago. And despite >99th percentile pay they aren’t that easy to recruit either. Though their hiring outpaces anesthesiologists about 3:1.

It’s been a constant cycle for the last 6 years. Grow bigger. Squeeze staff to point of nearly breaking. Throw a little more money and some minimal effort in hiring until things are getting somewhat better. Then repeat.

They are obviously making money hand over foot with new buildings and services starting nearly every quarter.

 

[lotsapain]

Yes better block time scheduling and efficient utilization would help with RN and anesthesia staffing. Also better tracking of surgeon operative times. I’m sure every institution has a surgeon who books a case for 2 hours and takes 6. Not sure why they think it’s in his or her interest to misrepresent the operative time. It ends up screwing up everyone including other surgeons.

Been there done that... issue is enforcement... its a paradox of a loop: "I don't want to loose surgeons so I cannot tell them to be more efficient or loose first case start time......" - but you will loose everyone else AND money....." hmmmm....." fear of loosing surgeons continues even though it should not be there as someone else above said. there has to be consequences - you are not efficient, not safe not showing up on time - BAH BYE..... .

It is the same everywhere - more cases, more ORs more service lines - why? if you can do what you do better with better quality metrics get paid more... but hospitals (for example in NJ or NY) a dime a dozen and compete for same business so systems in tristate area try to expand and dable into service lines they can't handle to be competitive...

 

[lotsapain]

Agree that their doesn’t appear to be a shortage of surgeons, or at least not a shortage of surgical volume they are willing to cover.

My hospital system has a grow or die mentality without the thought of how to deal with the critical shortage of “ancillary” personnel (anesthesia included)

We can’t hire the numbers to be fully staffed and can barely cover as is with copious locum and traveler coverage who get money literally thrown to them in buckets.

We started CRNAS almost 2 years ago. And despite >99th percentile pay they aren’t that easy to recruit either. Though their hiring outpaces anesthesiologists about 3:1.

It’s been a constant cycle for the last 6 years. Grow bigger. Squeeze staff to point of nearly breaking. Throw a little more money and some minimal effort in hiring until things are getting somewhat better. Then repeat.

They are obviously making money hand over foot with new buildings and services starting nearly every quarter.

Usual bull****.... because passengers are running the airlines... more physicians in leadership positions with understanding what medicine is about will remedy this hopefully.... business people who ran restaurants can't possibly apply same logic to healthcare combined with reduced insurance rates, greedy personnel (not their fault at this point really ) ... results in a deathly spiral of uncontrolled expansion.... which of course burns tons of cash until hospitals fail.... though some are too big to fail... I say let some hospitals close to combine personnel but who wants to hear that .

 

[Sriddymopboi]

Agree that their doesn’t appear to be a shortage of surgeons, or at least not a shortage of surgical volume they are willing to cover.

My hospital system has a grow or die mentality without the thought of how to deal with the critical shortage of “ancillary” personnel (anesthesia included)

We can’t hire the numbers to be fully staffed and can barely cover as is with copious locum and traveler coverage who get money literally thrown to them in buckets.

We started CRNAS almost 2 years ago. And despite >99th percentile pay they aren’t that easy to recruit either. Though their hiring outpaces anesthesiologists about 3:1.

It’s been a constant cycle for the last 6 years. Grow bigger. Squeeze staff to point of nearly breaking. Throw a little more money and some minimal effort in hiring until things are getting somewhat better. Then repeat.

They are obviously making money hand over foot with new buildings and services starting nearly every quarter.

Whats the CRNA vs MD salary at your place? How many hours/wk is it? Just curious what 99 percentile CRNA pay looks like

 

[Hoya11]

I say let some hospitals close to combine personnel but who wants to hear that .

That is the key point. You can’t have efficiency when you scatter your resources around different hospitals and different sites doing the same number of cases.

 

[buccsmf1]

I see a lot of job postings saying that the hospital is planning on site expansions and needing to recruit.

I don’t understand how all of these health care centers are all planning to expand their OR capacity. There are not enough anesthesiologists or CRNAs, not enough nurses. Are there even enough surgeons/proceduralists for all of this increasing capacity?

Job markets are supposed to be local but I would say the shortage of healthcare workers is national and yet all the C suite guys are pushing expansion of procedural sites.

So my question to you guys is how is that expansion going where you are?

I’ll go first, hospital opened several surgical centers. Couldn’t staff with home anesthesia department, brought in two different AMCs to help staff outside sites both couldn’t reliably deliver, all sites brought back in house and now utilizing locums.

Previous hospital I worked at did not have enough RNs so had to close several ORs. Opened new outpatient orthopedic site. Can’t run at capacity due to RN staffing.

tampa area, everyone keeps building and expanding regardless of staff. Brand new hospital just opened, they can only staff 2 ORs. Hospital group from orlando planning to build another hospital in tampa, absolutely no clue who theyre going to get to staff that thing either. Orlando group maybe starting to see the shortage, as apparently theyve slashed from 500 beds to 150.

 

[narcotics999]

I am seeing 200K, 300K signing bonus. Really so desperate???

 

[DocMcCoy]

Whats the CRNA vs MD salary at your place? How many hours/wk is it? Just curious what 99 percentile CRNA pay looks like

CRNAs around 300k total comp package, no call, no weekends, no holidays. they do one or two late stays a week probably averaging out at 6pm, normal day probably averaging 7a-2p. 35-40hrs week as my best guess. I don't volunteer to supervise and don't follow them that closely.

 

[lotsapain]

tampa area, everyone keeps building and expanding regardless of staff. Brand new hospital just opened, they can only staff 2 ORs. Hospital group from orlando planning to build another hospital in tampa, absolutely no clue who theyre going to get to staff that thing either. Orlando group maybe starting to see the shortage, as apparently theyve slashed from 500 beds to 150.

Tampa area is indeed saturated.... thousands of ASCs, many hospitals HCA leading the charge with Advent etc. Morton Plant the group walked out and that is a nice hospital. TGH has huge issues with staffing by TeamHealth.... shortages everywhere, CRNAs have the cake though.... maybe I should go to nursing school... seems like a better gig.

 

[lotsapain]

CRNAs around 300k total comp package, no call, no weekends, no holidays. they do one or two late stays a week probably averaging out at 6pm, normal day probably averaging 7a-2p. 35-40hrs week as my best guess. I don't volunteer to supervise and don't follow them that closely.

Think its time to go to nursing school. I think in 10-15 years there will be no physician anesthesiologists anywhere except large academic centers the way things are going.... it has become a horrible profession.

 

[Dr. Rude]

Think its time to go to nursing school. I think in 10-15 years there will be no physician anesthesiologists anywhere except large academic centers the way things are going.... it has become a horrible profession.

That is a huge exaggeration. The left side of the CRNA curve is horrific. Will there be less MD anesthesia? Yes. Will the hourly rate of a CRNA approach that of an anesthesiologist? Yes. The model will most likely be “how few anesthesiologists can we get away with to supervise a passel of CRNAs?”

 

[HalO'Thane]

Usual bull****.... because passengers are running the airlines... more physicians in leadership positions with understanding what medicine is about will remedy this hopefully.... business people who ran restaurants can't possibly apply same logic to healthcare combined with reduced insurance rates, greedy personnel (not their fault at this point really ) ... results in a deathly spiral of uncontrolled expansion.... which of course burns tons of cash until hospitals fail.... though some are too big to fail... I say let some hospitals close to combine personnel but who wants to hear that .

Do you really think having physicians in leadership positions will remedy this? At my hospital we have had plenty of physicians in leadership positions (CMOs, CEOs, CFOs, etc.). I feel like once they step away from full time clinical medicine and ditch the scrubs for a suit they all become the same: touting their case volume, revenue, service lines, etc without any real clue (or care) for what actually goes on in the trenches; so long as their compensation is tied to all of these metrics.

 

[rowsdower88]

I am seeing 200K, 300K signing bonus. Really so desperate???

300k SIGNING bonus??? How long do they own you for that?

 

[Dr. Rude]

Do you really think having physicians in leadership positions will remedy this? At my hospital we have had plenty of physicians in leadership positions (CMOs, CEOs, CFOs, etc.). I feel like once they step away from full time clinical medicine and ditch the scrubs for a suit they all become the same: touting their case volume, revenue, service lines, etc without any real clue (or care) for what actually goes on in the trenches; so long as their compensation is tied to all of these metrics.

Oh, they absolutely have a clue.

 

[lotsapain]

That is a huge exaggeration. The left side of the CRNA curve is horrific. Will there be less MD anesthesia? Yes. Will the hourly rate of a CRNA approach that of an anesthesiologist? Yes. The model will most likely be “how few anesthesiologists can we get away with to supervise a passel of CRNAs?”

You won't need anyone to supervise them I am sure we will loose that battle soon enough

 

[lotsapain]

300k SIGNING bonus??? How long do they own you for that?

Envision for 4 years for 200k it seems.... I can't imagine what it is for 300k. Signon bonuses are nonsense... so are contracts... all of the contracts I have seen say the same thing: "we can let you go for cause or no cause at any time"...... BUT YOU still have to give us 90 days or else .......

 

[lotsapain]

Oh, they absolutely have a clue.

Yeah that is true, I am still hopeful that there are some physicians out there... historically CMOs are IM or FM physicians they never had a clue to begin with ...... It would be nice to see more Anesthesiologists or EM guys in leadership, after all who is better fit to run things under duress or have operational knowledge of the bloodline of the hospital...

 

[abolt18]

Envision for 4 years for 200k it seems.... I can't imagine what it is for 300k. Signon bonuses are nonsense... so are contracts... all of the contracts I have seen say the same thing: "we can let you go for cause or no cause at any time"...... BUT YOU still have to give us 90 days or else .......

Mine says that they have to give me 90 days, but that they can forbid me from working during the 90 days, and they will still pay me during the that time even if I don't work.

 

[lotsapain]

Mine says that they have to give me 90 days, but that they can forbid me from working during the 90 days, and they will still pay me during the that time even if I don't work.

Well that is not a bad deal, I assume that is not with a large national organization ?

 

[abolt18]

Well that is not a bad deal, I assume that is not with a large national organization ?

Hospital employed in what I'd consider a medium sized healthcare system. ~1100 physicians and midlevels throughout the whole system.

 

[lotsapain]

Hospital employed in what I'd consider a medium sized healthcare system. ~1100 physicians and midlevels throughout the whole system.

I am happy for you guys that at least there is that - that you can't be thrown away like a piece of trash like the big AMOs do.....

 

[pgg]

Think its time to go to nursing school. I think in 10-15 years there will be no physician anesthesiologists anywhere except large academic centers the way things are going.... it has become a horrible profession.

This kind of emo-hyperbole is ridiculous.

 

[DocMcCoy]

Envision for 4 years for 200k it seems.... I can't imagine what it is for 300k. Signon bonuses are nonsense... so are contracts... all of the contracts I have seen say the same thing: "we can let you go for cause or no cause at any time"...... BUT YOU still have to give us 90 days or else .......

…With a big fat noncompete clause thrown in for good measure

 

[IlDestriero]

We expanded a year or so ago with 5 new anesthetizing locations. We were able to expand and cover that well enough but this year we lost a few MDs and CRNAs and we are looking at 2 more locations next year and 6-8 a couple of years after that and I’m definitely worried about how to cover our losses and expand. It’s hard enough for you guys to recruit, imagine complex peds. We have a fellowship, but a lot of the fellows are on the $$ now and go do adult and peds jobs.
The hospital doesn't care, there are enough surgeons and the surgical wait times are several months. What will help is the lack of OR nurses, but I guess they can just get travelers.

 

[anbuitachi]

I see a lot of job postings saying that the hospital is planning on site expansions and needing to recruit.

I don’t understand how all of these health care centers are all planning to expand their OR capacity. There are not enough anesthesiologists or CRNAs, not enough nurses. Are there even enough surgeons/proceduralists for all of this increasing capacity?

Job markets are supposed to be local but I would say the shortage of healthcare workers is national and yet all the C suite guys are pushing expansion of procedural sites.

So my question to you guys is how is that expansion going where you are?

I’ll go first, hospital opened several surgical centers. Couldn’t staff with home anesthesia department, brought in two different AMCs to help staff outside sites both couldn’t reliably deliver, all sites brought back in house and now utilizing locums.

Previous hospital I worked at did not have enough RNs so had to close several ORs. Opened new outpatient orthopedic site. Can’t run at capacity due to RN staffing.

we are expanding as well by about 20% more ORs in our hospital. we have had no issue hiring more anesthesiologists and nurses. there seems to be plenty of people needing a job.

if you look at the job reports published, healthcare has been consistently one of the top additions in job recently

but for them to open, that means there are more cases to be done and more surgeons/procedurelists willing to staff it. at the same time, there will be anesthesiologists often times who are willing to work MORE and pick up a shift here and there

 

[anbuitachi]

I believe there are (or appear to be) enough surgeons. There does definitely appears to be not enough anesthesia personnel.

Think about all the procedural residencies and fellowships that may be offered at a single hospital (Gen Surg, Ortho, ENT, CT, IR, IP, EP, etc) add those all together and compare that to the size of the anesthesia residency. Now the ratio required probably isn’t 1:1 but I’d imagine it close.

have you seen the 'crna residencies'?! exploding

 

[anbuitachi]

Envision for 4 years for 200k it seems.... I can't imagine what it is for 300k. Signon bonuses are nonsense... so are contracts... all of the contracts I have seen say the same thing: "we can let you go for cause or no cause at any time"...... BUT YOU still have to give us 90 days or else .......

Mine says that they have to give me 90 days, but that they can forbid me from working during the 90 days, and they will still pay me during the that time even if I don't work.

most docs dont even know what they are signing. and most dont even attempt to negotiate.

 

[anbuitachi]

We expanded a year or so ago with 5 new anesthetizing locations. We were able to expand and cover that well enough but this year we lost a few MDs and CRNAs and we are looking at 2 more locations next year and 6-8 a couple of years after that and I’m definitely worried about how to cover our losses and expand. It’s hard enough for you guys to recruit, imagine complex peds. We have a fellowship, but a lot of the fellows are on the $$ now and go do adult and peds jobs.
The hospital doesn't care, there are enough surgeons and the surgical wait times are several months. What will help is the lack of OR nurses, but I guess they can just get travelers.

city hospitals in nyc are tired of getting travelers i guess. i heard traveling circulators are 150/hr ...

recently the nursing union got their nurses a 37% raise over 5.5 years!! imagine that, plus these nurses get a pension. soon i believe nurses at private hospitals will go work for city hospitals. same pay, less work, plus fat pension

 

[sakata8242]

Oh, they absolutely have a clue.

They sure do. They just stop giving a **** once they've achieved administrator status and are only interested in protecting themselves. One of my colleagues used to joke, "The ultimate goal in this department is to find a way to be paid like a full time clinical anesthesiologist, without actually doing clinical anesthesia." That means getting an admin role (most of the time these are "soft" roles) that gives you non-clinical time (i.e. admin days off) of 0.2 to 0.6 FTE, an administrative pay differential, and because of how compensation here works, still receiving the full quarterly clinical incentive that's based on your total FTE, not your time on patient care or RVUs. And since you are not required to actually physically come to the hospital on admin days, these are effectively flexible days that can and often are used for personal needs. Costco run at 10 in the morning? Sure! Drop off and pick up your kids? That's some quality family time! Need a Dr's appointment? No need to call in or schedule it on a post-call or vacation day! Got the flu and you're admin tomorrow? No need to use a sick day! Going on vacation this weekend and want a head start? No need to use a vacation day! Here's a Friday admin day; just be reachable by email . And so on. Make $400K (or more) and only do one or two days a week of clinical work. Who would want to give this up by changing anything?

Whats the CRNA vs MD salary at your place? How many hours/wk is it? Just curious what 99 percentile CRNA pay looks like

Couldn't find the most recent numbers but for 2020-2021, the maximum base pay for CRNAs here was $224K annually. I think this is for 40 hours max. Many of them moonlight on weekends/days off. I'm pretty sure it's over $250K now. Their union looks out for them big time. With benefits it's well over $300K. They do have to do some weekends/call/holidays, but we have so many of them, the frequency for any one CRNA is pretty low.

During the same time my base pay was around 270K. With call/overtime/incentives it came out to about $400K gross. With benefits close to $450K. We do around 50-55 hours/week on average. We can't moonlight.

 

[kidthor]

We can't moonlight.

I’ve always found it very weird that departments will disallow physician moonlighting and the promote crna moonlighting.

 

[abolt18]

They sure do. They just stop giving a **** once they've achieved administrator status and are only interested in protecting themselves. One of my colleagues used to joke, "The ultimate goal in this department is to find a way to be paid like a full time clinical anesthesiologist, without actually doing clinical anesthesia." That means getting an admin role (most of the time these are "soft" roles) that gives you non-clinical time (i.e. admin days off) of 0.2 to 0.6 FTE, an administrative pay differential, and because of how compensation here works, still receiving the full quarterly clinical incentive that's based on your total FTE, not your time on patient care or RVUs. And since you are not required to actually physically come to the hospital on admin days, these are effectively flexible days that can and often are used for personal needs. Costco run at 10 in the morning? Sure! Drop off and pick up your kids? That's some quality family time! Need a Dr's appointment? No need to call in or schedule it on a post-call or vacation day! Got the flu and you're admin tomorrow? No need to use a sick day! Going on vacation this weekend and want a head start? No need to use a vacation day! Here's a Friday admin day; just be reachable by email . And so on. Make $400K (or more) and only do one or two days a week of clinical work. Who would want to give this up by changing anything?


Couldn't find the most recent numbers but for 2020-2021, the maximum base pay for CRNAs here was $224K annually. I think this is for 40 hours max. Many of them moonlight on weekends/days off. I'm pretty sure it's over $250K now. Their union looks out for them big time. With benefits it's well over $300K. They do have to do some weekends/call/holidays, but we have so many of them, the frequency for any one CRNA is pretty low.

During the same time my base pay was around 270K. With call/overtime/incentives it came out to about $400K gross. With benefits close to $450K. We do around 50-55 hours/week on average. We can't moonlight.

What's your general region? This is not particularly different from my experience as an academic attending.