I don’t want to supervise and you can’t make me!

[CTA/CCM MD]

As the title suggests I don’t ever again want to supervise/medically manage/whatever you call it. I’ve done it before and I hated it. I’m in a physician only practice at the moment and I love it. It has also made me realize how much of a better anesthesiologist I am when I do my own cases. I want to be responsible for no one’s actions but my own. However, there is always pressure to convert to a “care team” model, mainly from administration.

So my question is, why do we accept others forcing us to supervise? Why don’t we stand up and say no! Have we not earned that right, the right to practice medicine and care for our patients directly, as physicians? Has there ever been legal action against a hospital for being forced to supervise?

---

Members don't see this ad.

 

[Straight2eight]

As the title suggests I don’t ever again want to supervise/medically manage/whatever you call it. I’ve done it before and I hated it. I’m in a physician only practice at the moment and I love it. It has also made me realize how much of a better anesthesiologist I am when I do my own cases. I want to be responsible for no one’s actions but my own. However, there is always pressure to convert to a “care team” model, mainly from administration.

So my question is, why do we accept others forcing us to supervise? Why don’t we stand up and say no! Have we not earned that right, the right to practice medicine and care for our patients directly, as physicians? Has there ever been legal action against a hospital for being forced to supervise?

No one can force you to supervise they just may not welcome your employment anymore if you are not interested in changing practice which is fine, that’s their right and your right to disagree. Plenty of places I gather where you can still do your own cases but economic pressure is going to continue to push against it. One way out is to prove the value proposition of paying whatever amount more for MD only care.

 

[Greenbayslacker]

 

[aneftp]

Community hospitals with feeder/referrals to tertiary hospitals can still get away with MD only.

It’s getting harder and harder.

Trauma 1 hospitals and most trauma 2 hospitals cannot get away with MD only.

It all come down staffing needs.

One doc OR/beeper
One doc OB (or no ob at hospital)

No way you can swing that in more acute care center with MD only

Most you can run is 2 Or rooms doc only to 9pm-10pm cause at least one docs gotta work next day

It doesn’t become a sustainable model when hospital want to run more rooms after 7pm MD only.

 

[nimbus]

Community hospitals with feeder/referrals to tertiary hospitals can still get away with MD only.

It’s getting harder and harder.

Trauma 1 hospitals and most trauma 2 hospitals cannot get away with MD only.

It all come down staffing needs.

One doc OR/beeper
One doc OB (or no ob at hospital)

No way you can swing that in more acute care center with MD only

Most you can run is 2 Or rooms doc only to 9pm-10pm cause at least one docs gotta work next day

It doesn’t become a sustainable model when hospital want to run more rooms after 7pm MD only.

We do it.

Night call works 5pm-7am. Often sleep midnight to 7am.

2nd call typically works 7am-11pm or midnight. The following day is a very short day or a day off.

Both positions stipended.

 

[Urzuz]

If you have a contract with the hospital to provide anesthesia services, they don’t give a flying **** as to how you cover it, as long as the cases get done with an acceptable morbidity/mortality rate. The only reason why any group hires CRNAs is because 1) they can’t find other physicians, but more commonly, 2) they want more money & better work/life balance.

I commend you for not selling your soul and supporting physician-only anesthesia.

 

[skypilot]

Just because you are in a hospital with a care team model doesn’t mean you need to be the one supervising. A mixed model with docs doing their own cases and supervised CRNAs works too.

 

[turnupthegas]

MD only forever

 

[Drwine]

Just because you are in a hospital with a care team model doesn’t mean you need to be the one supervising. A mixed model with docs doing their own cases and supervised CRNAs works too.

I have worked in various models during my career and a mixed model offers a lot of flexibility in getting the work done with minimal disruption. The amount of out of the OR requests for our services have exploded as has the number of the requests for post op pain. The availability of an extra set of hands for an unanticipated difficult airway or a complicated case also has value. One of our sites has a lot of excess OR capacity and their schedule has a lot of wobble during the day and from day to day.

 

[aneftp]

We do it.

Night call works 5pm-7am. Often sleep midnight to 7am.

2nd call typically works 7am-11pm or midnight. The following day is a very short day or a day off.

Both positions stipended.

Exactly. It has to be stipend. Like one of my friend trauma 2 md only place in California

No stipend. It’s a big big problem.

 

[We'llBeDoneIn15Minutes]

As the title suggests I don’t ever again want to supervise/medically manage/whatever you call it. I’ve done it before and I hated it. I’m in a physician only practice at the moment and I love it. It has also made me realize how much of a better anesthesiologist I am when I do my own cases. I want to be responsible for no one’s actions but my own. However, there is always pressure to convert to a “care team” model, mainly from administration.

So my question is, why do we accept others forcing us to supervise? Why don’t we stand up and say no! Have we not earned that right, the right to practice medicine and care for our patients directly, as physicians? Has there ever been legal action against a hospital for being forced to supervise?

Agree with everything you say...
Except...

I don't want to sit on the stool and you can't make me! 😂

 

[Status Sciaticus]

Agree with everything you say...
Except...

I don't want to sit on the stool and you can't make me! 😂

then get a chair. We have some nice herman miller aerons in our ORs

 

[nimbus]

Exactly. It has to be stipend. Like one of my friend trauma 2 md only place in California

No stipend. It’s a big big problem.

On weekdays, the stipends just make us revenue neutral for being off pre and postcall. The bonuses are really the pre and postcall days when we can get our teeth cleaned or get a haircut.

 

[ProwlerturnGas]

I’ve done both and will not take any jobs that require supervision of CRNAs.

 

[IMGASMD]

I’ve done both and will not take any jobs that require supervision of CRNAs.

Know of any places without supervision around the east coast?

 

[Southpaw]

Know of any places without supervision around the east coast?

Some in Virginia. I don’t personally know of a single practice south of Virginia that routinely allows you to do your own cases (not counting weeknights or weekends - which IMO is the worse possible time to do your own cases if you don’t do it routinely).

 

[teacher2md]

I talked with one group (Holy Cross Anesthsia) in the DC area that was physician-only.

From the looks of it on GasWork, they might have sold out or lost the contract to USAP…

 

[abolt18]

Know of any places without supervision around the east coast?

Coworker of mine had practiced in NJ previously and worked doing his own cases for 15-20 years there. Left about 5 years ago. No idea if it's still physician-only.

 

[IMGASMD]

Coworker of mine had practiced in NJ previously and worked doing his own cases for 15-20 years there. Left about 5 years ago. No idea if it's still physician-only.

There were a few for sure in NJ. I didn’t look hard enough, because…. It’s New Jersey…. But you all are right, if that’s my own only criteria, I can’t be too choosy.

 

[sevo00]

Hackensack NJ is physician only

 

[aneftp]

I talked with one group (Holy Cross Anesthsia) in the DC area that was physician-only.

From the looks of it on GasWork, they might have sold out or lost the contract to USAP…

The old private group abandon the contract there (actually told the hospital) cause of hospitals demands but kept their more profitable surgery center. So hospital took in Usap. Usap is paying almost close to what the full partners were making. So that means the associate partnership track people getting bump up in pay with Usap. The margin for profit is razor thin. 10%. Even with more “efficient billing” and doing their own billing company. I don’t think there is much to the profit model there when everyone is making the same. Associates and full partners combined into one salary.

That’s what I keep telling u guys. Usap is a scraping for contracts like mednax scraped from 2014-2018. There is very little extremity profitable places left to buyout. So Usap is just expanding but not taking on a lot of great payor mix.

 

[Simba1711]

I do own cases in Manhattan. Pp. Very competitive salary and we are actually hiring because older guys want to retire . Can give you more info if you pm me.