I got offered a job straight out of residency in a Big OB/GYN hospital, should I accept?

[OptionOffense]

21 epidurals in 24 hours one time. Misery although most of them were during the day.

I hope you are on a rvu based pay model

---

Members don't see this ad.

 

[sevoflurane]

Ya that’s easily 12k at 45/unit.

 

[Gasmd98]

21 epidurals in 24 hours one time. Misery although most of them were during the day.

12 epidurals + 12 C/s in 24 hr shift as a resident. Fellow broke me out of c sections so I could get epidural ”experience.” Thought I was in the clear the next day at 0700 with only 30 minutes to go till relief. Nope. Beeper goes off and perky L&D nurse announces that OB residents have another section and they are rolling back. Failure to progress just can’t wait 30 freakin minutes. I almost had a stroke. OB sucks.

 

[aneftp]

I'm not following. Are you saying it takes valvular problems to qualify for ASA 3?

Edit:. No, I haven't been to a tertiary women's hospital. If what you're saying is that they ship out all the BMI >45 (and no, I don't give a BMI 35 otherwise healthy an ASA 3), poorly controlled diabetics, poorly controlled epileptics, acutely intoxicated and chronic drug abusing, pre-eclamptics with severe features, etc, then I'll take your word for it.

You simply don’t have enough case variations as new grad if you just cover strictly women’s hospital.

Of course there are people who make a career out of single speciality anesthesia. I have known people who have done strictly gi anesthesia for 15 plus years. And they have done alright. Portably made more per hour worked than most of us who have slaved away acute care hospitals with overnight calls.

 

[2Fast2Des]

I think I did 9 c/s and 14 epidurals one shift a few years ago.
Absolute misery.
High volume centers will give you uterine ruptures, percretas, exit procedures, amnio embolisms, peripaetum cardiomyopathies, amongst others. So you do need to be on your game at those centers.

Had a hypoplastic left heart yeaterday.

Well when you put it that way... Thank God there's an academic shop 15 min down the street we can ship her off to if they ever roll through the door

 

[DocVapor]

You simply don’t have enough case variations as new grad if you just cover strictly women’s hospital.

Of course there are people who make a career out of single speciality anesthesia. I have known people who have done strictly gi anesthesia for 15 plus years. And they have done alright. Portably made more per hour worked than most of us who have slaved away acute care hospitals with overnight calls.

Oh I agree with that. I thought we were having a very different discussion. I was wondering where you know of that ASA1's and 2's make up the majority of the patients, even with it being obstetrics based.

 

[IMGASMD]

Yeah. Let’s say you places a block as soon as you arrive for shift and it’s runs 12 hrs
5 units insert
4 units first hour (and I mean the entire hour)
2units/hr for 11 hrs

31 units x $70/unit = $2170
And we know a one block and do nothing else day is not often so maybe add a section and another block or two you picked up or placed. Easily a 5k shift

Now this is mostly just if you’re in a group that can stand up to an insurance company in negotiations. If we’re being conservative with a diverse payor mix/well run group it’s probably close to $45-$50/unit. In that’s case, $1800 for a block isn’t that bad especially if they deliver under 12 hrs

We still have plenty of *****s who won’t let us pop the epidural in until 6cm.
I always hoping for less than 12…
But either way, it’s very lucrative if you are at a nice suburban area with healthy patients.

 

[woopedazz]

The public hospital obstetric centres in Australia are a pretty sweet gig. They're all training centres, so you do call from home and rarely get called in overnight unless the residents are really junior.

Very enticing, easy, rewarding work... Except for when it isn't. Then it's terrible...

I'd never do more than 0.3 FTE at these centres as you de-skill so fast. The trainees want to do everything and learn clinical/non-clinical skills, so you don't even get to sink many epidurals or triage stuff. I assume it's like supervising CRNAs in the US.

Private obs-only is a hard slog. The obstetricians have the contract with the hospitals (most at a few places within a 45min radius). The anaesthetic group also has their contract with the obstetrician; not the hospital. So you get flung from one centre to another as each individual obstetrician has Emerg sections at one of their multiple hospitals. During work hours when you've got elective lists you need to rely on people on days off to cover it. After hours there's more staff free to cover. Most groups that do obs have a credit/debit system of cover to make it attractive and keep your group contracts attractive to the obstetricians.

If you attend an emergency section in/out of hours you may not have anyone else from your group in the same building, but a competing group in the theatre next door will lend a hand when required. Very weird work setup and really needs to be overhauled in my state, but can't seem to get buy in from the hospitals/obs/anaes groups. It would be cheaper, safer, and less work if the anaes were contracted to the hospital, not obstetrician like in the US.

Ignoring the dumb emergency section... The elective obs lists pay well and are all low risk. As long as you can put up with the 5am add-ons at the start of every elective list (to avoid the **** show described above).

All in all, obstetrics is not great in Australia unless you really like supervising/teaching, or, you have a group where everyone pulls their weight. If you've got those things, then it's pretty good. I like teaching so I'll probably do a bit of public obstetrics work for good work-life balance.

 

[abolt18]

I think I did 9 c/s and 14 epidurals one shift a few years ago.
Absolute misery.
High volume centers will give you uterine ruptures, percretas, exit procedures, amnio embolisms, peripaetum cardiomyopathies, amongst others. So you do need to be on your game at those centers.

Had a hypoplastic left heart yeaterday.

Your workplace seems like a Dreamland of awesome cases to me!

 

[Simba1711]

This is off topic but I’ve always wondered. Why don’t we put the epidural in patients that want one when they arrive on the floor. We can always start it when they start feeling pain. The nurses always call us while we are busy with something else or they’re screaming in pain and have difficulty sitting still.

 

[sevoflurane]

This is off topic but I’ve always wondered. Why don’t we put the epidural in patients that want one when they arrive on the floor. We can always start it when they start feeling pain. The nurses always call us while we are busy with something else or they’re screaming in pain and have difficulty sitting still.

Nothing wrong w that and how we did it at an OB hospital I worked at years ago. Run it at 1-2 cc/hr and turn up from there. I still place “dry” epidurals during the day time in order to save me the hassle at 3 am.

 

[sevoflurane]

So long as all boxes are checked and they are in labor, it’s a reasonable way to run a busy OB anesthesia practice.

 

[vector2]

This is off topic but I’ve always wondered. Why don’t we put the epidural in patients that want one when they arrive on the floor. We can always start it when they start feeling pain. The nurses always call us while we are busy with something else or they’re screaming in pain and have difficulty sitting still.

I used to tell parturients the second they feel like they've settled in to the suite and they're ok with laying in bed from that point on (and getting a foley), I'll come do the epidural.

You really gotta specifically tell them 1. They actually don't need to reach some arbitrary threshold level of pain to get one placed, 2. It's much safer for them (and me) if I don't have to jam a big needle in their back while they're thrashing about

 

[2Fast2Des]

This is off topic but I’ve always wondered. Why don’t we put the epidural in patients that want one when they arrive on the floor. We can always start it when they start feeling pain. The nurses always call us while we are busy with something else or they’re screaming in pain and have difficulty sitting still.

Certainly would make life easier than the middle of the night call... But I gotta say, my wife did like being able to get out of the bed when she was laboring before she needed her epidural instead of plopped in bed only. Depends on how mobile the woman is and if they are okay with chilling in bed for however long

 

[chocomorsel]

n=1, but I know a practice that does exclusively Ob. They get paid very well, have been doing it for at least two decades, and are almost completely useless outside of their Ob enclave, so much so that they ship us their C-hyst patients because they suddenly forget how to do anesthesia when the uterus needs to come out.

Wait what? That cannot be good. These patients by the time they get to you are doing terribly I would guess no?

 

[nimbus]

Nothing wrong w that and how we did it at an OB hospital I worked at years ago. Run it at 1-2 cc/hr and turn up from there. I still place “dry” epidurals during the day time in order to save me the hassle at 3 am.

Nice. When did the billing start?

 

[sevoflurane]

Nice. When did the billing start?

Two answers to this depending on set up.
1) Flat epidural rate
2) Bill 7 units for placement, then start billing hourly rate once the patient starts to have pain. Let’s just say pit was used liberally,

 

[pgg]

I think I did 9 c/s and 14 epidurals one shift a few years ago.
Absolute misery.
High volume centers will give you uterine ruptures, percretas, exit procedures, amnio embolisms, peripaetum cardiomyopathies, amongst others. So you do need to be on your game at those centers.

Had a hypoplastic left heart yeaterday.

It's pretty amazing that these patients are living long enough to reproduce.

The good news is that delivery is good for Fontan physiology.

 

[sevoflurane]

It's pretty amazing that these patients are living long enough to reproduce.

The good news is that delivery is good for Fontan physiology.

That would have been a juicy case. 💥

Neonate had hypoplastic left heart. 🌝