In what ways does PP differ from academic practice?

[Nivens]

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Spinning off a current thread, as a resident who's only ever known big academic centers, I'm curious how different PP environments differ from academia. Obviously each shop is unique, but generally speaking.

 

[Consigliere]

More money, work harder.

 

[Aether2000]

By far the greatest difference I noted was that the surgeries are conducted at a much more rapid pace, frequently taking 1/2 to 1/3 as long as in academia. Room turnovers are moderately speedy in private practice and there is not the array of ultra-specialized high tech and experimental equipment that takes significant time to deploy or locate. There is much less use of full neuromuscular blockade throughout the cases in private practice.

 

[aneftp]

More money, work harder.

too many variables to consider these days.

In the past the earning potential which PP was almost double (or more) compared to academics (including benefits) .

Now factoring in benefits pay academics vs private especially in AMC dominated areas. The spread difference may only be 20-30% pay. But once u re factor in work hours. The difference in pay may actually favor academic pay adjusted for hours worked/calls taken.

 

[Hoya11]

Spinning off a current thread, as a resident who's only ever known big academic centers, I'm curious how different PP environments differ from academia. Obviously each shop is unique, but generally speaking.

Coming from a PP generalist...

PP: Usually a smaller hospital than where you trained. More Money. More job security as partner. More Vacation. Your a big fish. Easier rooms but more rooms. However sometimes doing cases solo you never would have thought you would be like pyoloromytomies. Less thinking about the case and more doing the case the quickest/easiest/cheapest way possible. Things you think are commonplace (just coming out of training) are new to your partners (ultrasound for a popliteal really?). Usually being surrounded by less "thoughtful" people. (ie sometimes i think when im in the urology suite in the middle of the night with backup call nurses doing a BMI 60 case im the only one who has any idea what is actually at stake) Pleasing surgeons, smoothly and rapidly avoiding issues/being in multiple places, being closely tied to the business relations of the group. Covering surgical centers where your day may be very boring and void of any procedures on occasion. Having to climb the hierarchy in your group. Supervising people that dont care for your teaching and just want to get the job done. Not being really sure about how the group works at first until things are revealed to you. Overall, PP is a risk that has upside (money, vacay, hours, clout) and downside (possibly not making partner, sketchy people, vague contracts, wasted time working for less than market).

Academics: Usually a larger hospital. Less money. Slower pace. Your just another worker. On average more tougher/bigger cases but not as many simultaneous cases. Plenty of time for teaching/discussing esoteric anesthesia stuff. MOre opportunity for research. Less opportunity for significant advancement and higher levels of income. More of a conservative choice overall. I think this is the more likely choice if you are looking to stay in a big city especially starting out, a safe bet. You can go to PP from here or anywhere from here easily.


In your job search there are usually other factors that end up being more important than whether PP or academics. Like location, reputation of the PP groups, salary of the academic groups.

First pick where you want to live. Then apply to both PP, AMC, and academic groups in the area. See what the best deal is, try to get the inside scoop on all potential employers by contacting some past employees.

 

[Man o War]

Speed of surgeons and pace of cases. Things move much faster in PP and if you're the one who slows it down you will hear about it.

 

[Consigliere]

too many variables to consider these days.

In the past the earning potential which PP was almost double (or more) compared to academics (including benefits) .

Now factoring in benefits pay academics vs private especially in AMC dominated areas. The spread difference may only be 20-30% pay. But once u re factor in work hours. The difference in pay may actually favor academic pay adjusted for hours worked/calls taken.

Unfortunately you are correct.

 

[deleted162650]

In PP you tend to focus more on things that are . . . Important.

 

[MoMoGesiologist]

In PP you tend to focus more on things that are . . . Important.

Please elaborate and give some examples! As a resident, sometimes it's hard to figure out what is important because all the attendings have such different preferences and practice styles.

 

[sevoflurane]

Spinning off a current thread, as a resident who's only ever known big academic centers, I'm curious how different PP environments differ from academia. Obviously each shop is unique, but generally speaking.

Totally different. I remember having to rush academic OBs to hurry TFU cuz my spinal was going to wear off. Now a C/S takes 60 min. max (rare exceptions) from in the room to pacu- this includes positioning, monitors, spinal, stupid FHT after spinal, 5 minute prep, c/s, uterine squish, transfer to bed, pacu and then ink to end time after vital signs.

Lap appys and choles.. hella fast. I like the Sugga for those cases 4 sure.

TKA- 45 minutes- 1 hr.
Fem. nails 15-20 minutes.... hemi's a tiny bit longer.

T&A... don't even sit down.

 

[Aether2000]

My experience is that the rapidity of the surgeries in private practice compared to academia causes a paradigm shift in the conduct of the anesthesia. The amount of neuromuscular blockers used becomes far more important in the shorter surgeries, unless you have a supply of sugammadex, something that many surgery centers will not have. The longer acting neuromuscular blockers are avoided altogether. The depth of the anesthetic need not be as deep, spontaneous respiration throughout at least the last part of surgery if not the entire procedure is not infrequently used, and the tendency is to avoid sedating co-drugs in surgery centers or short cases (e.g. midazolam, phenergan, judicious use of fentanyl). Turnover times are usually (but not always) faster in private practice. There is also a penchant in private practice to avoid overthinking the preop planning and over-monitoring the shorter surgical cases, even for ASA 3 patients. This does not imply what academic institutions do is always overkill, but in a teaching institution, sometimes the more obtuse rather than the direct route is chosen, partially for teaching purposes. The goals are also different. In academia, the goal is to deliver a perfect anesthetic for a particular patient using it as a learning experience. In private practice, the goal is to make the anesthetic delivery a seamlessly smooth part of the process of surgery and keeping it as simple as is reasonable.

 

[ZzzPlz]

Totally different. I remember having to rush academic OBs to hurry TFU cuz my spinal was going to wear off. Now a C/S takes 60 min. max (rare exceptions) from in the room to pacu- this includes positioning, monitors, spinal, stupid FHT after spinal, 5 minute prep, c/s, uterine squish, transfer to bed, pacu and then ink to end time after vital signs.

Lap appys and choles.. hella fast. I like the Sugga for those cases 4 sure.

TKA- 45 minutes- 1 hr.
Fem. nails 15-20 minutes.... hemi's a tiny bit longer.

T&A... don't even sit down.

YES!!! Wtf is with that? FHT's look good--great let's do a section now. FHT''s look bad--uh oh, better do the section now. Only thing this does is delay everything and impede my ability to check the level of my block

 

[dhb]

Only thing this does is delay everything and impede my ability to check the level of my block

You check a level?

 

[ZzzPlz]

You check a level?

Sometimes

 

[deleted162650]

Please elaborate and give some examples! As a resident, sometimes it's hard to figure out what is important because all the attendings have such different preferences and practice styles.

Well the point of residency is so that you can learn what's important and what's not. I hope you're not a CA-3 asking this question. It's great that you have a variety of attending styles to work with. Take things from all of them and see what works and what doesn't/is a waste of time. Important things are things that will change whether or not you proceed with the case (not too many of these really), and what will actually lead to changes in your anesthetic plan and management.

 

[pgg]

You check a level?

The surgeon checks it for me.

 

[Ronin2258]

Saw bit of it when I went from quasi-academic (two private practice groups we trained with,) to locums at a small private hospital.

Just enough roc to put the tube in (may have used sux more,) and just gases ran deep for lap choles. Antibiotics, time out, 100-200mcg fentanyl total (100mcg with tube,) and some IV acetamenophen. Medical/legal reversal for roc (would have loved Sugga,) criteria met, suction, extubate, and off to PACU. Next patient.

Buck or tight under GA? Add propofol, and the gall bladder was out in 30 minutes. No further relaxant unless a problem happens (very rare, as the screening was pretty thorough.)

Without trainees in the picture, surgeons are blindingly fast in comparison. Our surgical colleagues don't generate speed until they start working out in private practice or near the end of training. Attending surgeons in training environments (rightfully,) want to take their time to make sure the residents are looking for all the problem spots. At my locums site, there was a newly minted orthopod I talked to who that confirms he got faster after graduation, but maintained the same thoroughness as he was trained.

 

[aneftp]

Just wanted to make it clear to trainees. Not everyone is quick in private practice. 30% of surgeons ( my best estimate in my 12.5 years out in practice) are rather slower surgeons. Not every private surgeon does a gallbladder in 15-20 minutes.

Just like not everyone anesthesiologists is a super star.

 

[Arch Guillotti]

Just like not everyone anesthesiologists is a super star.

Except on SDN😎

 

[Consigliere]

Just wanted to make it clear to trainees. Not everyone is quick in private practice. 30% of surgeons ( my best estimate in my 12.5 years out in practice) are rather slower surgeons. Not every private surgeon does a gallbladder in 15-20 minutes.

Just like not everyone anesthesiologists is a super star.

Only on SDN, right? Where blocks never fail and 9 central lines are placed flawlessly daily.

 

[deleted643396]

I think the idea that private practice is at warp speed compared to academics is somewhat overblown...at least in my limited experience. I work at a private practice, but the majority of the surgeons are hospital employed. I knew senior surgical residents who could do appys and lap choles faster than these choke artists. Where I am a knee or hip will routinely take 3+ hours. An appy is a 2 hour minimum case. A 1 level lumbar lami...3 hours. I've actually had to slow myself down from where I was at in residency. As more physicians...including surgeons...go towards the hospital employment model then you will see things slow down a bit.

 

[skypilot]

I think the idea that private practice is at warp speed compared to academics is somewhat overblown...at least in my limited experience. I work at a private practice, but the majority of the surgeons are hospital employed. I knew senior surgical residents who could do appys and lap choles faster than these choke artists. Where I am a knee or hip will routinely take 3+ hours. An appy is a 2 hour minimum case. A 1 level lumbar lami...3 hours. I've actually had to slow myself down from where I was at in residency. As more physicians...including surgeons...go towards the hospital employment model then you will see things slow down a bit.

I work at a low volume private practice in a community hospital. 45 minutes to an hour for an Appy or Lap Chole. One hour for a vag/hyst. 1 hour for a knee.
The fastest surgeons are usually the self employed ones, who are off to the next hospital after they finish the case. Employed surgeons tend to slow down a little bit.

 

[deleted643396]

I work at a low volume private practice in a community hospital. 45 minutes to an hour for an Appy or Lap Chole. One hour for a vag/hyst. 1 hour for a knee.
The fastest surgeons are usually the self employed ones, who are off to the next hospital after they finish the case. Employed surgeons tend to slow down a little bit.

Yes. We still have a handful of private practice surgeons who are quick, but the hospital employed ones are painfully slow.

 

[sevoflurane]

I think the idea that private practice is at warp speed compared to academics is somewhat overblown...at least in my limited experience. I work at a private practice, but the majority of the surgeons are hospital employed. I knew senior surgical residents who could do appys and lap choles faster than these choke artists. Where I am a knee or hip will routinely take 3+ hours. An appy is a 2 hour minimum case. A 1 level lumbar lami...3 hours. I've actually had to slow myself down from where I was at in residency. As more physicians...including surgeons...go towards the hospital employment model then you will see things slow down a bit.

An appy is a 2 hr minimum?
1 level lami is 3 hours?
TKA, THA 3 hrs?

Wow.

We have spine and orthopod surgeons where we given them 2 rooms. We'll do 8-10 cases by 4-5 pm in those rooms. Ya it's busy. And we actually pay the anesthesiologist a bit more because they are crusher fast paced days. Our collections for those rooms are excellent.

We don't have any hospital employeed surgeons where I am at tho.

I am sure practices vary, but in general you should be able to keep up with a faced paced room if you are in PP.

For example... we have several foot and ankle surgeons.

We do catheters with OnQ we place between cases + ACB for TAA. For most of the other foot stuff, we block. Rinse and repeat all day long.
Not exactly an easy day if you want to make turnovers and get out at a decent time.

Note to residents:

Unless you are employeed by the hospital, this is the kind of practice that you want to join if you are collecting and paying yourself.

 

[deleted643396]

An appy is a 2 hr minimum?
1 level lami is 3 hours?
TKA, THA 3 hrs?

Wow.

We have spine and orthopod surgeons where we given them 2 rooms. We'll do 8-10 cases by 4-5 pm in those rooms. Ya it's busy. And we actually pay the anesthesiologist a bit more because they are crusher fast paced days. Our collections for those rooms are excellent.

We don't have any hospital employeed surgeons where I am at tho.

I am sure practices vary, but in general you should be able to keep up with a faced paced room if you are in PP.

For example... we have several foot and ankle surgeons.

We do catheters with OnQ we place between cases + ACB for TAA. For most of the other foot stuff, we block. Rinse and repeat all day long.
Not exactly an easy day if you want to make turnovers and get out at a decent time.

Note to residents:

Unless you are employeed by the hospital, this is the kind of practice that you want to join if you are collecting and paying yourself.

Yup. It's pathetic. Things were much faster paced where I did residency. We had a dedicated block team (acute pain service), but other than that my residency was closer to what you describe than this private practice I'm at now.

 

[Arch Guillotti]

We have spine and orthopod surgeons where we given them 2 rooms. We'll do 8-10 cases by 4-5 pm in those rooms. Ya it's busy. And we actually pay the anesthesiologist a bit more because they are crusher fast paced days. Our collections for those rooms are excellent.

Do you sit your own cases?

 

[sevoflurane]

Do you sit your own cases?

Yes, but we have a second anesthesiologist in the other room. Spine/Orthopod surgeon scrubs out while PA closes and then immediately scrubs back into the next room and makes incision (+/- dictation). Meanwhile, we finish the current case, block, induce +/- flip prep and wait for surgeon to come through the door. We are in constant communication so we don't bring in a patient early which is a rarity.

 

[pjl]

Yes, but we have a second anesthesiologist in the other room. Spine/Orthopod surgeon scrubs out while PA closes and then immediately scrubs back into the next room and makes incision (+/- dictation). Meanwhile, we finish the current case, block, induce +/- flip prep and wait for surgeon to come through the door. We are in constant communication so we don't bring in a patient early which is a rarity.

So this is the equivalent of each anesthesiologist doing 4-5 spine cases in an 8 hour day from a billing standpoint, right?
A good day, but really it sounds like the only person getting far better compensation from that arrangement is the spine guy. The anesthesiologists split the billing for the 10 cases, so just 5 each (still pretty great)


With regards to the speed component, we have a mix. We have guys (actually one is a girl) who do choles in 30 minutes, and guys who do them in 90 minutes. A knee guy who takes less than an hour, and a guy who takes 2.5 hours. Lamis are 45 minutes or 2 hours...
The only thing consistently fast is c/s, which only go over 45 minutes surgically if something horrible is happening, with the average time in the 30-40 minute range from door to door.

The #1 biggest benefit of private practice that I have seen is that you are compensated for your time. If you are there, you are doing something which will make you money. If you want to see your family more, most of the time there is someone else that wants to make more money around, so will stay.


Sent from my iPad using SDN mobile app

 

[sethco]

Yep...

Couple of my surgeons can do a CABG X 4 (Off Pump) skin to skin in about 1.5 hours. The one I am with today took about 3.5 hours (despite having an assistant doing vein harvesting) just to get on bypass. Uggghhh!!!!

 

[IlDestriero]

Yup. It's pathetic. Things were much faster paced where I did residency. We had a dedicated block team (acute pain service), but other than that my residency was closer to what you describe than this private practice I'm at now.

I can't even do Roc for an appy because the cases are too fast. That's with a fellow and resident doing the case.
Prop, sux, tube.


--
Il Destriero

 

[sevoflurane]

So this is the equivalent of each anesthesiologist doing 4-5 spine cases in an 8 hour day from a billing standpoint, right?
A good day, but really it sounds like the only person getting far better compensation from that arrangement is the spine guy. The anesthesiologists split the billing for the 10 cases, so just 5 each (still pretty great)

Correct. The thing is we have a handful of neurosurgeons that are banging out 35-40 cases a week. It's a win for them, but it's a win for us as well- we grow, dilute the call schedule, take more vaca all the while picking up fast cases that are well compensated. We use a ton of neuromonitoring, so setting up a spine case, flipping, executing a timely extubation does require some finesse and having the appropriate individuals in those rooms is key to a fast day.

 

[urge]

At my locums site, there was a newly minted orthopod I talked to who that confirms he got faster after graduation, but maintained the same thoroughness as he was trained.

Doubt anyone will confess they got faster at the expense of being sloppy, thus accepting they are mediocre at best.

 

[aneftp]

Correct. The thing is we have a handful of neurosurgeons that are banging out 35-40 cases a week. It's a win for them, but it's a win for us as well- we grow, dilute the call schedule, take more vaca all the while picking up fast cases that are well compensated. We use a ton of neuromonitoring, so setting up a spine case, flipping, executing a timely extubation does require some finesse and having the appropriate individuals in those rooms is key to a fast day.

U also need the hospital to be on board with staffing

I used to work at 2 hospitals. (Same system!) 12 miles apart.

Yet one hospital was fully staff nursing and tech to be able to fully afford ortho pods (min 4 cases usually have 7-9 cases each) and even general surgeons (8-10 cases). So there was full staff (or nurses:tech and anesthesia ) to "flip" as their PA/SA was closing

Yet other hospital 12 miles away did a fake flip cause while they gave surgeon additional room. Even with another anesthesia person (usually crna available). The nurse administrator used same tech and nursing staff from same room surgeon was in. It was a pretty worthless flip. Same Nursing staff was rushed trying to get other room ready after finishing one room.

Created lots of stress and nurses and tech left and wanted to transfer to hospital 12 miles away that was more fully staff.

Suffice to say. The ortho docs and general surgeons preferred to be at hospital with true flip rooms.

The irony of this is the head nurse administrator at the hospital that didn't afford the true flip got rewarded with more power "by saving money" using less staff. Even with the high staff turnover. She got rewarded by getting super power over both hospitals! And the nurse administrator at true flip hospital got reassigned to lower position.

Gotta love "metrics". She could point to "staff cost savings" to hospital administrator yet they ignore the high staff turnover.

 

[IlDestriero]

Sadly that kind of thing is a common story.


--
Il Destriero

 

[Mman]

the question of PP vs academics depends on what you are asking.

From a department POV? In PP people just want to get the job done as safe and efficiently as possible. Not a lot of complaining about picking up rooms from someone else so they can go home, nobody cares if cases get added into their room, etc. When I was a resident I remember attendings going bonkers if someone moved a case into their room because they'd have to work longer. In PP, you just send the person home and someone else can do the case. When it's your turn to go home, you go home. When you work late, you pick up other rooms even when yours are finished.

In terms of speed/quality of surgeons, that is a different question and not necessarily related. In general, PP surgeons move a lot faster than academic ones. For one thing, they aren't teaching anybody how to do something so that saves an immense amount of time right there. No need to talk about what instrument to use and how to use it, they just do it. I work in PP anesthesia, but in a few locations we still work with academic surgeons and all that comes with including residents and med students. So while we can do the anesthesia part lickety split, the 2 hour appy or 5 hour lap chole still happens.

In terms of the anesthesia day to day stuff, I think in PP there is far less caring about being fancy or doing things because you can. Keep it safe, quick, and simple. We don't really spend time experimenting with the 3725th way to skin the cat, because we are already really damn good at the 1st way and the goal is to provide the safest and best experience for the patient, not to see how cool it would be for us to do it some other way.


From a day to day work POV, I enjoy PP because I like doing things and I don't like teaching others how to do them. Epiduals, CVPs, a-lines, difficult intubations, PNBs, etc. I'd rather do it myself in 1/10 the time it takes to walk someone else through it.

 

[urge]

U also need the hospital to be on board with staffing

I used to work at 2 hospitals. (Same system!) 12 miles apart.

Yet one hospital was fully staff nursing and tech to be able to fully afford ortho pods (min 4 cases usually have 7-9 cases each) and even general surgeons (8-10 cases). So there was full staff (or nurses:tech and anesthesia ) to "flip" as their PA/SA was closing

Yet other hospital 12 miles away did a fake flip cause while they gave surgeon additional room. Even with another anesthesia person (usually crna available). The nurse administrator used same tech and nursing staff from same room surgeon was in. It was a pretty worthless flip. Same Nursing staff was rushed trying to get other room ready after finishing one room.

Created lots of stress and nurses and tech left and wanted to transfer to hospital 12 miles away that was more fully staff.

Suffice to say. The ortho docs and general surgeons preferred to be at hospital with true flip rooms.

The irony of this is the head nurse administrator at the hospital that didn't afford the true flip got rewarded with more power "by saving money" using less staff. Even with the high staff turnover. She got rewarded by getting super power over both hospitals! And the nurse administrator at true flip hospital got reassigned to lower position.

Gotta love "metrics". She could point to "staff cost savings" to hospital administrator yet they ignore the high staff turnover.

Having two teams of nurses so that an orthopod can save 30 min per turnover does not seem economically plausible, especially for days with 3 turnovers only. Plus days with 8 turnovers the cases tend to be so small that there is nothing to turnover.

There is a reason one person got promoted over the other, and it is that the orthopod does not bring that much money to have 2 teams.

 

[aneftp]

Having two teams of nurses so that an orthopod can save 30 min per turnover does not seem economically plausible, especially for days with 3 turnovers only. Plus days with 8 turnovers the cases tend to be so small that there us nothing to turnover.

There is a reason one person got promoted over the other, and it is that the orthopod does not bring that much money to have 2 teams.

No

U aren't understanding. The nurse administrator who was cutting cost with staff was getting promoted. But they also have 110% turnover over the past 24 months at same hospital. All hospital admin see if cost savings without factoring in nursing recruitment and staff turnover.

The Otho docs are the same ones bringing 8-10 cases a day to the same hospital system.

The only variable is staff available. And the one "saving" money got promoted

 

[urge]

No

U aren't understanding. The nurse administrator who was cutting cost with staff was getting promoted. But they also have 110% turnover over the past 24 months at same hospital. All hospital admin see if cost savings without factoring in nursing recruitment and staff turnover.

The Otho docs are the same ones bringing 8-10 cases a day to the same hospital system.

The only variable is staff available. And the one "saving" money got promoted

I get it prefectly well. You on the other hand don't.

It is preposterous to pay for a second full team in order to get the orthopod 2 hrs earlier. He can stay 2 hrs late and his team can get overtime if need be. It is a lot cheaper than giving him 2 rooms.

Or he can pay the salaries out of pocket for his second room if his time is so valuable.

You are not taking into consideration the salary of the person doing the anesthesia either.

2 rooms is a money losing proposition unless both rooms are occopied about 70% of the day.

Sure, the surgeons will claim that the hospital giving him 2 rooms is so much better, but at the end of the day money talks.

 

[Noyac]

Pl

I think the idea that private practice is at warp speed compared to academics is somewhat overblown...at least in my limited experience. I work at a private practice, but the majority of the surgeons are hospital employed. I knew senior surgical residents who could do appys and lap choles faster than these choke artists. Where I am a knee or hip will routinely take 3+ hours. An appy is a 2 hour minimum case. A 1 level lumbar lami...3 hours. I've actually had to slow myself down from where I was at in residency. As more physicians...including surgeons...go towards the hospital employment model then you will see things slow down a bit.

Please don't tell me these same surgeons complain about turnover times as well.

 

[Hoya11]

I get it prefectly well. You on the other hand don't.

It is preposterous to pay for a second full team in order to get the orthopod 2 hrs earlier. He can stay 2 hrs late and his team can get overtime if need be. It is a lot cheaper than giving him 2 rooms.

Or he can pay the salaries out of pocket for his second room if his time is so valuable.

You are not taking into consideration the salary of the person doing the anesthesia either.

2 rooms is a money losing proposition unless both rooms are occopied about 70% of the day.

Sure, the surgeons will claim that the hospital giving him 2 rooms is so much better, but at the end of the day money talks.

Money talks is why the orthopod gets the two rooms...

Your going to tell the guy who brings in all that revenue that he has to wait two hours because you dont want to pay a scrub tech and a nurse in an already available OR?

If your the CEO your thinking: maybe that extra wait time (or perception of being not accommodating ) is going to make him bring his cases elsewhere.

I guess it depends on how big the ortho guy is. Is he doing total joints/spines multiple days a week? Two rooms do whatever he wants. Is he doing <10 scopes/week? sorry its too tight today to flip.

 

[aneftp]

I get it prefectly well. You on the other hand don't.

It is preposterous to pay for a second full team in order to get the orthopod 2 hrs earlier. He can stay 2 hrs late and his team can get overtime if need be. It is a lot cheaper than giving him 2 rooms.

Or he can pay the salaries out of pocket for his second room if his time is so valuable.

You are not taking into consideration the salary of the person doing the anesthesia either.

2 rooms is a money losing proposition unless both rooms are occopied about 70% of the day.

Sure, the surgeons will claim that the hospital giving him 2 rooms is so much better, but at the end of the day money talks.

It's usually

I get it prefectly well. You on the other hand don't.

It is preposterous to pay for a second full team in order to get the orthopod 2 hrs earlier. He can stay 2 hrs late and his team can get overtime if need be. It is a lot cheaper than giving him 2 rooms.

Or he can pay the salaries out of pocket for his second room if his time is so valuable.

You are not taking into consideration the salary of the person doing the anesthesia either.

2 rooms is a money losing proposition unless both rooms are occopied about 70% of the day.

Sure, the surgeons will claim that the hospital giving him 2 rooms is so much better, but at the end of the day money talks.

I should have made it a little more detailed. It's generally 3 rooms to split among 2 surgeons. Usually the ortho docs. The staff isn't waiting on them for 2 hours. Likely 20 minutes at most. Either one surgeon is out of the room/PA closing to go into another room and second surgeon is still operating. So the 3rd room is the true flip room with a dedicated staff. And yes, it's utilized more than 70% of the time. Lots of room switching.

But the other hospital has no free staff for another room. No cleaning crew. They only pay one cleaning crew for the entire OR. So it's the same nursing team/tech usually trying to turn over a room because the cleaning team may be cleaning another room. So yes, the surgeons are annoyed having to wait. If they have 3 total shoulders/2 quick shoulders/2 knee scopes (1 surgeon). Turnover (from the time he leaves the room). 10-20 minutes for PA to close. Another 10 minutes to wake up and get patient out of the room. 15 minutes to clean the room. You are taking 45 minutes x 6 cases (from the time he leaves the room). That's 3 hours of his time. Thus he doesn't want to come to the sister hospital that cuts staffing. Would you?

And big hospital system in town, the main ortho doc is even worst. He does have his own dedicated 2 room team. He has that much pull cause of the cases he brings in. Because they are 80% private paying patients. Hospital does bend over backwards for him. He actually wanted his own dedicated anesthesia team but the huge anesthesia group which has multiple contracts within the same hospital system won that battle. But he still gets his two rooms guaranteed.

 

[Mman]

Your going to tell the guy who brings in all that revenue that he has to wait two hours because you dont want to pay a scrub tech and a nurse in an already available OR?

The relevant question is how busy the OR is. I mean are we talking at a hospital that literally has unused ORs just sitting there with no cases that can be put in them other than flipping the orthopod into a 2nd room? Or are there other surgeons that have waitlisted cases that could get them done in that room instead of flipping the orthopod?

I mean if you have a totally unused room, the relative cost of paying a total of maybe $60/hr to a circulator and scrub is pretty minor. If you have other cases that could be done instead of saving a little time, the math gets a lot more complicated.

 

[abolt18]

I get it prefectly well. You on the other hand don't.

It is preposterous to pay for a second full team in order to get the orthopod 2 hrs earlier. He can stay 2 hrs late and his team can get overtime if need be. It is a lot cheaper than giving him 2 rooms.

Or he can pay the salaries out of pocket for his second room if his time is so valuable.

You are not taking into consideration the salary of the person doing the anesthesia either.

2 rooms is a money losing proposition unless both rooms are occopied about 70% of the day.

Sure, the surgeons will claim that the hospital giving him 2 rooms is so much better, but at the end of the day money talks.

The community hospital where I've done a lot of rotations often puts surgeons in 2 rooms. One guy will knock out a gallbladder or two, and 10 gastric sleeves in a day. His NP or PA or whatever she is will close while he starts the next case. Not usually a lot of down time for the anesthesia resident or crna between cases. Barely enough time for cleanup and turnover for the nurses. They do the same with a few Ortho guys, specifically if they're knocking out scopes or TKA/THAs because they're generally quick, and the PA does all the closure. ENT frequently has 2 rooms. I think I've seen one urologist have 2 rooms before as well. This hospital has 11 ORs in total, and I think in most cases these rooms would be empty if not doubled up.

 

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The community hospital where I've done a lot of rotations often puts surgeons in 2 rooms. One guy will knock out a gallbladder or two, and 10 gastric sleeves in a day. His NP or PA or whatever she is will close while he starts the next case. Not usually a lot of down time for the anesthesia resident or crna between cases. Barely enough time for cleanup and turnover for the nurses. They do the same with a few Ortho guys, specifically if they're knocking out scopes or TKA/THAs because they're generally quick, and the PA does all the closure. ENT frequently has 2 rooms. I think I've seen one urologist have 2 rooms before as well. This hospital has 11 ORs in total, and I think in most cases these rooms would be empty if not doubled up.

That surgeon is an anesthesiologist's wet dream.