Job opening in Resort town

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
D

doesntbodewell

Full Member
10+ Year Member
Joined
Feb 18, 2013
Messages
12
Reaction score
30
Hiring 2 General Anesthesiologists and 1 CV Anesthesiologist in Coeur d Alene, Idaho. Resort town 30 min from Spokane, WA and Gonzaga.

Come live by the lake and enjoy the outdoors (biking, mountains, snow skiing, lake surfing, etc). Great schools for kids. Great balance of hours, vacation, and compensation.

We’re hiring due to expansion of services, OR expansions, and one partner retiring in the near future.

Private Anesthesia group owned and run by the group, 2 year partnership track, do your own cases, Epic charting, fair and equitable.

Level 2 Trauma hospital with an ASC that is yards away from the main hospital ORs.

General, ENT, Vascular, OBGyn, Urology, endo, healthy peds, ortho, CV/Thoracic (only for those that want to do CV/TEE and fellowship trained), etc.

PM me for more details or ask
Members don't see this ad.
 
  • Like
Reactions: 3 users
Members don't see this ad :)
Is this working alongside independent CRNAs, medical direction or supervision?
 
  • Like
Reactions: 1 user
Alongside. Idaho let’s them be independent, it’s the reality of the area. MDs do their own cases and are responsible for our own cases. We have a positive relationship between the MDs, CRNAs, surgeons, ICU docs, the administration, etc. The anesthesia group is separate from the hospital and the partners run the business. The setup we have is not normal, and has worked for many years so far.

Not what this forum usually likes in that regard, and if anyone is still interested, we can go into more details about anything at another time.

So why go to this forum? I see posts from intelligent, passionate anesthesiologists, and I want someone like that to be a partner in our business.
 
  • Like
Reactions: 2 users
I’m in no position to move to Idaho unfortunately but just curious about the setup: Are the CRNAs employed by your group?
 
  • Like
Reactions: 1 users
IMGASMD said:
Compensation and benefits?
Click to expand...
MD partners >500k, depends on profit share for the year. 8-10 wks off. Sit your own cases

Edit: Not eat what you kill, no one’s fighting over which cases to do or which insurance the patient has because all the units go into the business for distribution.
 
Last edited:
  • Like
Reactions: 2 users
circleK said:
I’m in no position to move to Idaho unfortunately but just curious about the setup: Are the CRNAs employed by your group?
Click to expand...
A portion of them are business partners with an appropriate share of profits and responsibility. The other CRNAs are shift taking 1099s.
 
  • Like
Reactions: 3 users
What are the numbers of physicians versus CRNAs? Are the CRNAs doing the CT cases? Any difference in the call (acuity or frequency) between the two? Three seems like a large recruitment for a hospital that size. What's driving the need and is there a concurrent CRNA recruitment going on (as they seem interchangeable as independent practitioners)? I am wondering if the cost of CRNAs has caused a pivot toward MD/DOs to fill the positions.

Leinie
 
  • Like
Reactions: 1 users
Leinie said:
What are the numbers of physicians versus CRNAs? Are the CRNAs doing the CT cases? Any difference in the call (acuity or frequency) between the two? Three seems like a large recruitment for a hospital that size. What's driving the need and is there a concurrent CRNA recruitment going on (as they seem interchangeable as independent practitioners)? I am wondering if the cost of CRNAs has caused a pivot toward MD/DOs to fill the positions.

Leinie
Click to expand...

We want 8 MDs, have 6 currently (5 CV, 1 non-CV). There’s about 30 something CRNAs, some full time partners in the business, some 1099 hourly workers.

Separate CT call and team. MD only. CT surgeons only want us, CRNAs really don’t want to go near a heart or lung case.

OB call and general OR call are split amongst the MD and CRNA call taking partners (except CV MDs get less of that because they are taking CV call).

We’ve hired 3 MDs in the past 10 years due to growth and expansion of the hospital. Increased footprint, increased services, increased acuity, becoming a regional center less dependent on Spokane’s hospital system for certain patients, and large increase in population of the area.

Currently, hiring to have a Net 2 more MDs.
1 to replace a retiring CV MD.
2 more for even more ORs, hybrid room, GI rooms, etc being built; to keep our ratio of MD:CRNAs in our business at a good number that we like (we’ve also hired a lot of CRNAs over the past 10 years); to keep an MD:CRNA ratio that the hospital likes (believe it or not, they want MDs as well, we are not hospital employees but have a strong relationship with admin); and to make home call reasonable for upcoming Federal Level 2 Trauma status (currently State Level 2, so the trauma and types of cases won’t change, but some of the requirements for anesthesia, ICU docs, and surgeons are different).

Cost of CRNAs is definitely cheaper than MDs
 
  • Like
Reactions: 4 users
Members don't see this ad :)
If I were in a position to move to Idaho this would be on my radar. There are some issues to watch out for, but overall sounds solid.
 
So CRNA partners don’t make >500k? And they are ok with that? Since you know they are partners and all? This sounds so weird to me. Like meetings are had, books are shared with the CRNA partners but they make less? Never heard of anything like this before.
 
  • Like
Reactions: 1 user
chocomorsel said:
So CRNA partners don’t make >500k? And they are ok with that? Since you know they are partners and all? This sounds so weird to me. Like meetings are had, books are shared with the CRNA partners but they make less? Never heard of anything like this before.
Click to expand...
Seems to be the idaho model. CRNAs are treated as equals/partners.
 
chocomorsel said:
So CRNA partners don’t make >500k? And they are ok with that? Since you know they are partners and all? This sounds so weird to me. Like meetings are had, books are shared with the CRNA partners but they make less? Never heard of anything like this before.
Click to expand...
Of course the CRNAs don’t make what the MDs do. They get CRNA pay, and we get MD pay.
Militant “Nurse Anesthesiologists” have no place in this practice.
Books are shared, many meetings are had, and actively managed. We know how much we bring in a month/year, how much a share is worth, and who gets what. We all can see every expense, line by line.
This is by no means a conventional set-up, and would be impossible if we didn’t have some standards and expectations.
 
  • Like
Reactions: 1 users
chocomorsel said:
Well I would love for the OP to explain this. Because if they pay then the same, then F that. On principle alone I would exit stage left. No Sir, no Ma’am.
Click to expand...
All our money post-expenses is made into a pizza. The CRNAs get a slice of pizza, MDs get a much bigger slice of pizza. Everyone wants the the pizza to be as big as possible so their slice can grow as well.
 
  • Like
Reactions: 6 users
doesntbodewell said:
All our money post-expenses is made into a pizza. The CRNAs get a slice of pizza, MDs get a much bigger slice of pizza. Everyone wants the the pizza to be as big as possible so their slice can grow as well.
Click to expand...
I may have missed this but do you employ the CRNA’s?
 
This practice seems like a breath of fresh air if you ask me. As long as the hospital is supportive of the group, the surgeons buy in, and both CRNAs and MDs are happy I think this is the way to go.
 
  • Like
Reactions: 1 user
A perfect example of the AANA claim of equivalence and independent practice model. This may be good for the OP but it is very bad for the profession unless you want independent CRNA practice to be the norm.

With this type of practice it is very hard to argue CRNAs shouldn't be given full autonomy in all cases and all hospitals. This would result in a lot of unemployed anesthesiologists and AAs; in addition, hospitals and AMCS would love to embrace this type of model.

The practice sounds fine for those who don't mind working with 100% independent CRNAs as their business partners. I always knew that one day a CRNA would be my boss and this pretty much confirms it.
 
  • Like
  • Dislike
Reactions: 17 users
BLADEMDA said:
A perfect example of the AANA claim of equivalence and independent practice model. This may be good for the OP but it is very bad for the profession unless you want independent CRNA practice to be the norm.

With this type of practice it is very hard to argue CRNAs shouldn't be given full autonomy in all cases and all hospitals. This would result in a lot of unemployed anesthesiologists and AAs; in addition, hospitals and AMCS would love to embrace this type of model.

The practice sounds fine for those who don't mind working with 100% independent CRNAs as their business partners. I always knew that one day a CRNA would be my boss and this pretty much confirms it.
Click to expand...

I think if we are really honest with the patients, then I have no problem with this model.
The patient pays the premium and the co-pay. If they’re okay getting a nurse, then that’s their prerogative.
If they want to pay less for a nurse, and create a two tier system, then they can too. It’s a free market right? No one has the time nor have the will to make it simple for the patients to understand.

The problem is foresee is that since they are all “partners” (MDs and CRNAs), what happens if something were to go wrong in a case, and MDs were to step in to help…. Do they all carry the same insurance? Will the patient more likely to sue MD when they think we have the deeper pockets?

AirPods from Apple store: $150
1 year hassle free Warranty

FakePods from Alibaba: $15
Warranty? What do you think this is Apple Store?
 
BLADEMDA said:
A perfect example of the AANA claim of equivalence and independent practice model. This may be good for the OP but it is very bad for the profession unless you want independent CRNA practice to be the norm.

With this type of practice it is very hard to argue CRNAs shouldn't be given full autonomy in all cases and all hospitals. This would result in a lot of unemployed anesthesiologists and AAs; in addition, hospitals and AMCS would love to embrace this type of model.

The practice sounds fine for those who don't mind working with 100% independent CRNAs as their business partners. I always knew that one day a CRNA would be my boss and this pretty much confirms it.
Click to expand...
Definitely a unique practice that cannot and should not be universally applied. The mix of individuals make it possible.

Our independence and hospital involvement, while taking very very little from the hospital, creates stability in our relationship with the hospital (some friends have told me how much the hospital gives them as a stipend yearly, and it is much larger than our past 10 years combined).
I would also love an MD only practice, but it’s not possible here without a large stipend. The MD only practices I know of in the PNW make less, work harder, and are dependent on the hospital.

There are CRNA only ASCs or small hospitals in Idaho that we are not affiliated with, and I know enough about some of their morbidity/mortality in ASA 2 patients to know I wouldn’t go there.

The ASA needs to look at these places for data to fight back, change the narrative, and fight for better insurance rates. That would mean they’d have to divert their focus from increasing profits from MOCA requirements, though.
 
  • Like
Reactions: 1 users
IMGASMD said:
I think if we are really honest with the patients, then I have no problem with this model.
The patient pays the premium and the co-pay. If they’re okay getting a nurse, then that’s their prerogative.
If they want to pay less for a nurse, and create a two tier system, then they can too. It’s a free market right? No one has the time nor have the will to make it simple for the patients to understand.

The problem is foresee is that since they are all “partners” (MDs and CRNAs), what happens if something were to go wrong in a case, and MDs were to step in to help…. Do they all carry the same insurance? Will the patient more likely to sue MD when they think we have the deeper pockets?

AirPods from Apple store: $150
1 year hassle free Warranty

FakePods from Alibaba: $15
Warranty? What do you think this is Apple Store?
Click to expand...

doesntbodewell said:
Definitely a unique practice that cannot and should not be universally applied. The mix of individuals make it possible.

Our independence and hospital involvement, while taking very very little from the hospital, creates stability in our relationship with the hospital (some friends have told me how much the hospital gives them as a stipend yearly, and it is much larger than our past 10 years combined).
I would also love an MD only practice, but it’s not possible here without a large stipend. The MD only practices I know of in the PNW make less, work harder, and are dependent on the hospital.

There are CRNA only ASCs or small hospitals in Idaho that we are not affiliated with, and I know enough about some of their morbidity/mortality in ASA 2 patients to know I wouldn’t go there.

The ASA needs to look at these places for data to fight back, change the narrative, and fight for better insurance rates. That would mean they’d have to divert their focus from increasing profits from MOCA requirements, though.
Click to expand...

Yeah I'm wondering the same thing about how the liability and malpractice premiums work for the practice and the hospital in these types of collaborative practices.
 
doesntbodewell said:
Definitely a unique practice that cannot and should not be universally applied. The mix of individuals make it possible.

Our independence and hospital involvement, while taking very very little from the hospital, creates stability in our relationship with the hospital (some friends have told me how much the hospital gives them as a stipend yearly, and it is much larger than our past 10 years combined).
I would also love an MD only practice, but it’s not possible here without a large stipend. The MD only practices I know of in the PNW make less, work harder, and are dependent on the hospital.

There are CRNA only ASCs or small hospitals in Idaho that we are not affiliated with, and I know enough about some of their morbidity/mortality in ASA 2 patients to know I wouldn’t go there.

The ASA needs to look at these places for data to fight back, change the narrative, and fight for better insurance rates. That would mean they’d have to divert their focus from increasing profits from MOCA requirements, though.
Click to expand...
Please don't misconstrue my posts. My former group was faced with financial issues due to the hospital not wanting to pay much of a stipend. The group went from 1:3 (before I came) to 1:4 then 1:5 and finally no ratios at all. Even at 1:4 the case acuity is sometimes too great for that ratio to safely cover the patients. That's why this field is ultimately destined to have a "provider" in the room without much supervision at all. CMS doesn't pay enough for a physician and even CRNAs are starting to exceed CMS reimbursement levels (requiring a small subsidy for CRNA only care).

There are still opportunities out there to earn $500K plus either doing your own cases (without any CRNA responsibilities) or supervise 1:3. If you want or need to live in the PNW I agree the pay is typically in the $350K range for most physician only practices.

But, there are also academic positions with great benefits paying $400K albeit not in the PNW. Your posting for the job was honest and transparent which is all one can ask for when applying for a job.

The CRNA partners will indeed be the new hires "boss" for the first 2 years he/she works in your practice. In the PNW there is no free lunch as you either work harder for less money with a hospital stiped or you embrace the AANA/CRNA independent practice model.
 
  • Like
Reactions: 1 users
BLADEMDA said:
Some CRNAS are employed as 1099 workers while others are full partners in the business.
Click to expand...
Completely anecdotal but I recall reading on this board or maybe Sermo back when it was good, that this practice was one of the most militant/malignant places in the country to work because of their setup.
 
  • Like
Reactions: 1 user
Arch Guillotti said:
Completely anecdotal but I recall reading on this board or maybe Sermo back when it was good, that this practice was one of the most militant/malignant places in the country to work because of their setup.
Click to expand...

Curious. What's there to be malignant about? There's no MD micromanaging or dictating the CRNA led anesthetic. It's just the CRNA. They decide, plan, and execute all of it in total, procedures included. How would the malignancy manifest? In a supervisory practice there's often a smug undercurrent of 'I can do this without you' from the CRNA which is palpable and could be sliced with a knife. This is all gone in the OPs practice.
 
Southpaw said:
Curious. What's there to be malignant about? There's no MD micromanaging or dictating the CRNA led anesthetic. It's just the CRNA. They decide, plan, and execute all of it in total, procedures included. How would the malignancy manifest?
Click to expand...
No idea but no chance I would work in a place where CRNA's are business partners and sit their own cases separately.
 
  • Like
Reactions: 6 users
Arch Guillotti said:
No idea but no chance I would work in a place where CRNA's are business partners and sit their own cases separately.
Click to expand...

Yeah, I get that. That doesn't make it malignant though. Interestingly, the hospital employed CRNA doesn't give a flying flip whether or not the private practice supervising anesthesioligst succeeds as a business entity. The CRNA doesn't even think they need to be there. If it's true that the hospital and surgeons want MDs there, then the CRNA business partners would be invested in that also. They want their business to succeed.

I understand this type of practice wouldn't be for everyone. However, none of that makes it malignant or a bad place to work. It's an awesome location.

Every supervising anesthesiologist I've worked with or spoken to is fully aware that independent practice WILL occur at some point and the days of supervising CRNAs are limited. What then? I guess if you want to make a living in anesthesia then you'll head into the OR and provide it yourself. This practice gets right to it. And the state is already independent practice green lit. I can't fault them for any of it. They didn't create this mess, they're just trying to make the best of it.
 
I am aware of other practices where the CRNAs sit their own cases alongside MDs. After schmoozing, you find out that you are still liable as the CRNA backup should they encounter issues. Always useful to read the CRNA job advertisements for the same groups to understand what they are being promised.
 
Southpaw said:
Yeah, I get that. That doesn't make it malignant though. Interestingly, the hospital employed CRNA doesn't give a flying flip whether or not the private practice supervising anesthesioligst succeeds as a business entity. The CRNA doesn't even think they need to be there. If it's true that the hospital and surgeons want MDs there, then the CRNA business partners would be invested in that also. They want their business to succeed.

I understand this type of practice wouldn't be for everyone. However, none of that makes it malignant or a bad place to work. It's an awesome location.

Every supervising anesthesiologist I've worked with or spoken to is fully aware that independent practice WILL occur at some point and the days of supervising CRNAs are limited. What then? I guess if you want to make a living in anesthesia then you'll head into the OR and provide it yourself. This practice gets right to it. And the state is already independent practice green lit. I can't fault them for any of it. They didn't create this mess, they're just trying to make the best of it.
Click to expand...
Quite a change in your attitude from when you joined SDN. Are you working for the AANA now? Or, just tired of supervising CRNAs? You are certainly entitled to your viewpoint but in my state CRNAs can't practice independently and I support my FSA/ASA to keep it that way. If a physician wants to supervise the CRNA at his/her own ASC or plastic surgery center then by all means go at it. When something happens the fault will be shared equally among all the providers not just the CRNA.

My comments have nothing to do whether this practice by the OP is a "good place to work" but if CRNAs are perceived as equal/equivalent providers then for many of us this would be a non starter. Perhaps, in 10 years this model will be the norm as I have seen more and more encroachment by the AANA during my 15 years on SDN.
 
  • Like
Reactions: 2 users
BLADEMDA said:
Quite a change in your attitude from when you joined SDN. Are you working for the AANA now? Or, just tired of supervising CRNAs? You are certainly entitled to your viewpoint but in my state CRNAs can't practice independently and I support my FSA/ASA to keep it that way. If a physician wants to supervise the CRNA at his/her own ASC or plastic surgery center then by all means go at it. When something happens the fault will be shared equally among all the providers not just the CRNA.

My comments have nothing to do whether this practice by the OP is a "good place to work" but if CRNAs are perceived as equal/equivalent providers then for many of us this would be a non starter. Perhaps, in 10 years this model will be the norm as I have seen more and more encroachment by the AANA during my 15 years on SDN.
Click to expand...

I remember reading blades posts as a medical student years ago and the perception of some on the board that he is either too militant or pushing a tin foil sky is falling mentality. Looking back and even now, I agree wholeheartedly with his views on the CRNA issue.

I believe the AANA is approaching the issue of independent practice through multiple avenues including their militant we are all equal arm and the moderate let's integrate and work side by side sit our own cases approaches.

I find it rather funny sitting for a recorded lecture by a former ASA president stating that the future of anesthesia was an increase of supervision ratios up to 1:8. I thought that was nuts as a med student and think it's even crazier now.
 
BLADEMDA said:
Quite a change in your attitude from when you joined SDN. Are you working for the AANA now? Or, just tired of supervising CRNAs? You are certainly entitled to your viewpoint but in my state CRNAs can't practice independently and I support my FSA/ASA to keep it that way. If a physician wants to supervise the CRNA at his/her own ASC or plastic surgery center then by all means go at it. When something happens the fault will be shared equally among all the providers not just the CRNA.

My comments have nothing to do whether this practice by the OP is a "good place to work" but if CRNAs are perceived as equal/equivalent providers then for many of us this would be a non starter. Perhaps, in 10 years this model will be the norm as I have seen more and more encroachment by the AANA during my 15 years on SDN.
Click to expand...

I'd PM you but it won't let me for some reason. I've detracted enough from the OP already and I don't like putting my personal thoughts out in the open on a public forum as they're easily manipulated and misconstrued by readers for other purposes. No, I don't work for the AANA. That's silly.
 
The OP is correct about at least one thing in his posting: Independent CRNA practice is preferable to supervising more than 4 CRNAs. I find that 4 is definitely the limit with 3 being a better ratio for coverage.

At least if you join the OP's practice you can sit your own cases without worrying about what a CRNA is doing in the other room. Still, if there is an issue or bad outcome in a CRNA case will that provider try to drag you into the mess? Will you be expected to "bail out" the CRNA? I suspect the OP will say "no" but that fact needs to be confirmed when you actually interview at the practice.
 
  • Like
Reactions: 1 user
How is this viewed from the surgical side of things? I would feel very uncomfortable being viewed as interchangable to CRNAs by surgeons, even worse, ‘but Jack the CRNA was able to do this, can you ask him’ when you refuse stupid requests from surgeons and not bullied into doing unsafe things like nurses.


I dont know, I think I would feel weird as a new grad working in this environment.
 
  • Like
Reactions: 5 users
UnoMas said:
How is this viewed from the surgical side of things? I would feel very uncomfortable being viewed as interchangable to CRNAs by surgeons, even worse, ‘but Jack the CRNA was able to do this, can you ask him’ when you refuse stupid requests from surgeons and not bullied into doing unsafe things like nurses.


I dont know, I think I would feel weird as a new grad working in this environment.
Click to expand...

CRNAs will let the surgeon do whatever they want. Sometimes surgeon prefer them that way…. Until there’s a **** case, that the crna doesn’t know how to handle.
 
  • Like
Reactions: 4 users
Man, I am torn on this collaborative practice issue. On one hand, the thought of total separability and not having to supervise them at all is great. OTOH, I don't like the idea of CRNAs doing any cases totally solo because what would I want if it were me or my family member under the knife?

And beyond that what precedent does it set when administrators who see solo practice and are totally clueless start pushing the boundaries of the case difficulty the solo CRNAs are doing?
 
  • Like
Reactions: 1 users
I wouldn’t be surprised if this model starts to appear in more places as staffing shortages persist. It’ll be hard to justify a bunch of anesthesiologists sitting in the lounge “supervising” if hospitals aren’t able to keep all ORs humming along.
 
  • Like
Reactions: 1 user
GravelRider said:
It’ll be hard to justify a bunch of anesthesiologists sitting in the lounge “supervising” if hospitals aren’t able to keep all ORs humming along.
Click to expand...

This hits at the heart of it. And I’m willing to provide some commentary but not in an open forum. Though I don’t think most anesthesiologists care to have an educated, nuanced discussion on the matter or have a mirror held up to their practice. They’d rather go down in flames in the burning house.
 
  • Like
Reactions: 2 users
GravelRider said:
I wouldn’t be surprised if this model starts to appear in more places as staffing shortages persist. It’ll be hard to justify a bunch of anesthesiologists sitting in the lounge “supervising” if hospitals aren’t able to keep all ORs humming along.
Click to expand...

The trend has def already started. I am (was) in a supervisory practice and we're so short crnas that a doc has had to start doing solo cases until midday'ish. Luckily we still have enough docs that all the crnas are still medically directed though
 
GravelRider said:
I wouldn’t be surprised if this model starts to appear in more places as staffing shortages persist. It’ll be hard to justify a bunch of anesthesiologists sitting in the lounge “supervising” if hospitals aren’t able to keep all ORs humming along.
Click to expand...
Unfortunately, this. When independent practice comes it will be at least partly the fault of the lounge sitters. They don’t even pretend to “supervise” and everyone knows it…..
 
  • Like
Reactions: 2 users
dannyboy1 said:
Unfortunately, this. When independent practice comes it will be at least partly the fault of the lounge sitters. They don’t even pretend to “supervise” and everyone knows it…..
Click to expand...
Yup. I have encountered a good number who won’t (/can’t) do a case solo. Personally I’d rather be in the room solo than directing/supervising.
 
  • Like
Reactions: 4 users
You must log in or register to reply here.
Next unread thread

Similar threads

D
Houston CV Job Opening
Replies
7
Views
1K
DolphinVA
D
A
PP job opening
Replies
18
Views
2K
pgg
pgg
greenrustVT
DC Job Market
Replies
6
Views
864
aneftp
A
G
CA1 Opening?
Replies
3
Views
2K
nimbus
nimbus
A
Pennsylvania job market? Details on jobs?
Replies
3
Views
661
lotsapain
L
Top