Leaving the hospital for ASC?

[GassedOut12]

---

Members don't see this ad.

Anybody work in a hospital for like 10 years and then thought “F weekends and call” to go to ASCs.

You wish that you stayed?
Trouble going back since haven’t done certain cases in years like OB?
Credentialing problems?
Bad stuff about ASCs?

I’m thinking I may ditch the hospital but is that short sighted when I have another 20 years to go? I’m also in major metro area.

 

[SilkyBruh]

If you're that worried, pick up per diem/PRN OB/general OR shifts. Major metro area probably has many opportunities.

 

[ERRES2288]

Be careful grinding 6-4 everyday m-f is probably worse than call.

 

[Ashers]

I did, and I'm back doing locums in hospital settings, but working until 3pm. My ASC job I started work usually at 0600 (sometimes 0530 for 0600 case starts, but that surgery center was an hour from my house, so that was fun), and some days I'd have 1 case, some days none, and some days I'd work until 2300. I'd also work most Saturdays. It was much harder than call, and I never knew what time I'd finish, but I had to stay until the end of the day because there was no relief, and I had to wait until all patients were discharged from PACU. This uncertainty in my schedule is one big reason for me switching to locums M-F 0630-1500. I love my life now -- except the travel gets tiring after a while.

You also have to deal with patients who shouldn't be in a freestanding ASC because of lack of resources, but the surgeon doesn't want to cancel, and if something happens, it's on you, and you get to transfer to a hospital. I canceled cases rarely (active pneumonia, admitted drug recent use because no one actually ran the tests, decompensated heart failure). There's usually something that says "no ASA 4s."

I stopped doing OB while at a hospital in 2015, so I can't comment on that. I started tailoring my job to what I wanted to do a while ago.

 

[Simba1711]

I’m debating this exact same thing. The main hospital we do call at is closing. Our pp group will still exist since we work at a few ascs and Endo centers but I’m leaning towards leaving. I’m worried about skill atrophy and how it will look to employers when I’m looking for a job. It’s also nice to be able to eat in between cases. That’s difficult to do at an asc. Also if the call isn’t busy the post call is nice to be able to do errands. I personally don’t get that much job fulfillment from doing outpatient cases.

I looked at picking up per diem work on the weekends to keep my skills up but didn’t have any luck. I live in a major city on east coast. I don’t think hospitals would be willing to pick up someone for just the weekend when they don’t know you and you don’t know any of the surgeons or any of the equipment is.

 

[aneftp]

Be careful grinding 6-4 everyday m-f is probably worse than call.

It’s more 6am-6p at many places now at asc. Up to 12 hr days.

The true asc 7-3 are rarer and rarer these days I’m taking about 7-2 with 1 hr pacu time.

And some are super busy 1:3/4 staffing crnas lucky to squeeze 10-15 min lunch breaks

That’s why unless u get a good deal (salary wise)

Or lower work load (1:2) most days

Hospital work is better in most cases

 

[POW16]

Anybody work in a hospital for like 10 years and then thought “F weekends and call” to go to ASCs.

You wish that you stayed?
Trouble going back since haven’t done certain cases in years like OB?
Credentialing problems?
Bad stuff about ASCs?

I’m thinking I may ditch the hospital but is that short sighted when I have another 20 years to go? I’m also in major metro area.

Do you have the option of hospital work with no/minimal call ? ASC pace can be brutal.

 

[sevoflurane]

We have non-call takers in our group.
M-F 7-3/5 is brutal. Having post call or early days in the middle of the week is really nice.

 

[sevoflurane]

We have post 1,2, 3rd off. Trauma and OB are off as well. 4th- 5th usually off. I’m post 4th today and at home. Have some errands I will def run today.

 

[sevoflurane]

Another thing to keep in mind is that ASC’s are not the income producers they once were. Plenty of ASC’s failing or just breaking even. That’s not to say all of them. Also skill attrition and “boring same type of cases” can be a real thing if that is important to you.

 

[abolt18]

We have post 1,2, 3rd off. Trauma and OB are off as well. 4th- 5th usually off. I’m post 4th today and at home. Have some errands I will def run today.

How late are 2nd, 3rd, 4th usually in the hospital? I 1st call in house? Or just trauma?

 

[sevoflurane]

All call from home except trauma and OB.
1st call comes in at 3pm. But it only takes one 2am ex-lap to screw things up.
Was home around 6pm on 4th last night.
Sometimes you win, sometimes you loose. Generally, 3/4th calls are fairly good calls.
3rd is my favorite as you generate income, usually sleep all night once you get home and have the next day off. Subspecialty calls can screw that up, but our call backs on peds and hearts is fairly forgiving.

 

[aneftp]

Another thing to keep in mind is that ASC’s are not the income producers they once were. Plenty of ASC’s failing or just breaking even. That’s not to say all of them. Also skill attrition and “boring same type of cases” can be a real thing if that is important to you.

A small true private surgery center (surgeons did not sell out) my friend moonlights at has to PAY anesthesia a 15-20k a month stipend just to keep up with anesthesia demands.

And it’s small place 1:2 sometimes 1:3 staffing ratio.

They can’t even hire full time docs or crnas for 500k no calls or weekends plus 8 weeks paid off. Does that tell u something??

Because it’s just high pace place that runs to 5-6p
Consistently.

So Becareful of
That no call no weekend ad u see from asc.

 

[IDGARA]

Anybody work in a hospital for like 10 years and then thought “F weekends and call” to go to ASCs.

You wish that you stayed?
Trouble going back since haven’t done certain cases in years like OB?
Credentialing problems?
Bad stuff about ASCs?

I’m thinking I may ditch the hospital but is that short sighted when I have another 20 years to go? I’m also in major metro area.

I'm in this exact boat. So far I'd say that the ASC life is better than the hospital life. When I leave the ASC I know I'm done for the day. The patient's tend to be healthier and the people working there are good at what they do and treat me like a physician, not just the random provider in the room for the day.

That being said, the down sides so far are thus:
1. Since the surgeons/proceduralists own the place, they think they can dictate how the other docs and I practice medicine. This hasn't come to me directly yet, just something I've heard from the there anesthesiologists. They still think deliberate hypotension is the best thing in the world.
2. Philosophically, I think private ASCs are parasites whose main purpose is to take money from facilities that need it in order to make already wealthy surgeons and PE a$$hats wealthier. Taking care of patients is like #12 on the list. Hospitals need to exist, private ASCs don't.
3. There's a good chance you'll be practicing medicine in austere conditions. I've had to ration sugamadex way too many times and was once told that we only had 2 vials of fentanyl for the day.
4. The hours are really variable. At least once a week we have a case that will be added on to start before 0700.

100% ASC work isn't for me. I think I'll do like 66% ASC and 33% hospital locum stuff at some point.

 

[NightyNight]

I feel personally all the hospital and ASC gigs aren’t truthful about the downsides. Been a couple interviews. They have red flags that you find out later. People aren’t honest about the bad stuff to expect. Collegiality and stability is what I want. I also don’t want to work full time per se and be looked down on it for being that. Too much politics

 

[AKMD_1984]

I feel personally all the hospital and ASC gigs aren’t truthful about the downsides. Been a couple interviews. They have red flags that you find out later. People aren’t honest about the bad stuff to expect. Collegiality and stability is what I want. I also don’t want to work full time per se and be looked down on it for being that. Too much politics

Oh you mean to tell me they won’t tell you about the chair who has “meetings” at 730 am? Or the guy who does the schedule naturally is not credentialed at the affiliated ASC that has 6 am starts so he never staffs that site?

Yeah…

And no - they won’t tell you all this on the interview and you expecting that honestly makes you naive.

 

[NightyNight]

Oh you mean to tell me they won’t tell you about the chair who has “meetings” at 730 am? Or the guy who does the schedule naturally is not credentialed at the affiliated ASC that has 6 am starts so he never staffs that site?

Yeah…

And no - they won’t tell you all this on the interview and you expecting that honestly makes you naive.

I’m not naive. But all the fishing for info while keeping a good face is annoying. Like I’m not credentialing at one place and going to withdraw after they sent an app cuz I find out the shadiness.

 

[aneftp]

At least in my state (from west side to east side and northern side and southern side )

Most surgery centers are a patchwork of prn docs.

Unless u get a rare one that finishes super early 12/1 pm with guaranteed 500k/10 weeks paid vacay plus free private healthcare (yes there is a surgery center like that) but it’s rare.

Or find one that’s guaranteed one day off a week (ur choosing) like a Monday or Friday. 7-5. U need that day off. Overtime after 40 hours.

But most other surgery center have older docs doing prn, some locums docs cover prn, some moms covering prn.

I would not cover any surgery center w2 unless very specific built in hours and significant overtime if it runs over.

 

[caligas]

What’s with the 0600 start times folks are talking about? Never heard of that. Patient would have to arrive at 5 AM?

Our ASCs start 7:30, I can easily roll in at 7:00 (solo MD)

 

[Hoya11]

Anybody work in a hospital for like 10 years and then thought “F weekends and call” to go to ASCs.

You wish that you stayed?
Trouble going back since haven’t done certain cases in years like OB?
Credentialing problems?
Bad stuff about ASCs?

I’m thinking I may ditch the hospital but is that short sighted when I have another 20 years to go? I’m also in major metro area.

I left for an ASC after 10 years in a hospital, simply due to an opportunity that arose and I wanted to give it a try.

It has worked out great. For me personally, with kids in school all day 8-4 for the next 10+ years, my schedule matches theirs.

I am gone when they wake up in the morning and I am back maybe an hour after they get home, sometimes a little later, but sometimes I'm home before they get home. We almost always eat dinner together. And when the weekend comes we are all off together. Holiday weekends like July 4th and Memorial Day - not even a question that you will be off all 3 days. Christmas, New Years, no fighting with colleagues to be off, the place is closed.

I still take care of kids as young as 2. Do blocks, intubate, do spinals for total joints. And I make more and have more time off than when at the hospital. I could not do it if the centers were only GI/Eyes no matter what the schedule or compensation. And I would not do it if it was a significant pay cut compared to the hospital. But from what I have seen, the per diem rates are essentially the same as the hospital, and sometimes at the ASC they let you out early due to a case cancelling or low number of cases, but all good because your hours are guaranteed - whereas at the hospital you are less likely to leave early

 

[AKMD_1984]

What’s with the 0600 start times folks are talking about? Never heard of that. Patient would have to arrive at 5 AM?

Our ASCs start 7:30, I can easily roll in at 7:00 (solo MD)

Very common - or I should say not unusual
Orthopedic surgeon wanting 6 am starts with flip rooms
6 am cases usually a knee to so they can start rehab the same day

 

[AKMD_1984]

I’m not naive. But all the fishing for info while keeping a good face is annoying. Like I’m not credentialing at one place and going to withdraw after they sent an app cuz I find out the shadiness.

It’s dishonest more than annoying.
It’s dishonest because almost every group is short, so they want to hire but won’t disclose the causes.

 

[Ashers]

What’s with the 0600 start times folks are talking about? Never heard of that. Patient would have to arrive at 5 AM?

Our ASCs start 7:30, I can easily roll in at 7:00 (solo MD)

Not uncommon, surgeons would schedule them before operating in hospitals. What sucked for me is I lived almost an hour drive away, so I'd have to get up super early. Once the patient came late, so I sat around then did that case at 0700, and then I had to drive to another surgery center, so I was nearly late for my next case.

Once I had 1 0600 case that lasted for 20 minutes. It was a 30 min commute each way, so it wasn't even worth my time to drive down for it and back home, especially being so early. That was the only case I was assigned the whole day.

Edit: I was paid for OR time only. I quit this job.

 

[aneftp]

Not uncommon, surgeons would schedule them before operating in hospitals. What sucked for me is I lived almost an hour drive away, so I'd have to get up super early. Once the patient came late, so I sat around then did that case at 0700, and then I had to drive to another surgery center, so I was nearly late for my next case.

Once I had 1 0600 case that lasted for 20 minutes. It was a 30 min commute each way, so it wasn't even worth my time to drive down for it and back home, especially being so early. That was the only case I was assigned the whole day.

We all know that’s inefficient staffing. 1 hr of labor wasted with ur commute. Good if u are w2 employees or hourly employee

Bad if private practice depending on purely unit billing.

 

[ucladoc2b]

Not uncommon, surgeons would schedule them before operating in hospitals. What sucked for me is I lived almost an hour drive away, so I'd have to get up super early. Once the patient came late, so I sat around then did that case at 0700, and then I had to drive to another surgery center, so I was nearly late for my next case.

Once I had 1 0600 case that lasted for 20 minutes. It was a 30 min commute each way, so it wasn't even worth my time to drive down for it and back home, especially being so early. That was the only case I was assigned the whole day.

The surgery center we staff is starting to have more 0600 starts. Used to only be on occasion. Now it’s three times a week.

The other issue is often the rooms run late and we have to stay until the patients leave recovery. Often a member of our call team has to cover. Can be anywhere from 6 - 11 pm (the late ones are always joint patients).

Of course, our group is fearful of losing the business so we go along with it. But we have lost partners over this issue.

 

[T-burglar]

Lol these work conditions are horrifying

 

[Howard888]

If your private practice salary is >700k+ 6:00 am starts for a profitable orthopedic center worth it. Otherwise not.

Staying until leave recovery isn’t worth that even. Lots of posts on that. No regulations require you stay until leaves recovery only until phase 2 discharge-unless you signed a facility contract saying you would . 6am starts fine. Would have to pay me 7 figures to stay until patient leaves recovery as it’s pointless

 

[nimbus]

The surgery center we staff is starting to have more 0600 starts. Used to only be on occasion. Now it’s three times a week.

The other issue is often the rooms run late and we have to stay until the patients leave recovery. Often a member of our call team has to cover. Can be anywhere from 6 - 11 pm (the late ones are always joint patients).

Of course, our group is fearful of losing the business so we go along with it. But we have lost partners over this issue.

Do you get any hourly compensation for waiting around until patient is discharged from PACU?

 

[GassYous]

If your private practice salary is >700k+ 6:00 am starts for a profitable orthopedic center worth it. Otherwise not.

Staying until leave recovery isn’t worth that even. Lots of posts on that. No regulations require you stay until leaves recovery only until phase 2 discharge-unless you signed a facility contract saying you would . 6am starts fine. Would have to pay me 7 figures to stay until patient leaves recovery as it’s pointless

Ain't nobody got time for that

 

[GassedOut12]

If one maybe two days a week is late, okay. Everyday then no

 

[ucladoc2b]

Do you get any hourly compensation for waiting around until patient is discharged from PACU?

From the surgery center, no. It is not compensated above our normal anesthesia billing fees for the cases done. Our group doesn’t earn any additional revenue above and beyond what we get for the case.

 

[narcotics999]

From the surgery center, no. It is not compensated above our normal anesthesia billing fees for the cases done. Our group doesn’t earn any additional revenue above and beyond what we get for the case.

SoCal is still an anesthesia wasteland.

 

[kidthor]

SoCal is still an anesthesia wasteland.

It is? I’m in socal and enjoying life with a job I like…

 

[O2sats]

It is? I’m in socal and enjoying life with a job I like…

What part, if you don't mind me asking?

 

[GassYous]

What part, if you don't mind me asking?

Probably oc

 

[Burned_Out]

What part, if you don't mind me asking?

I bet somewhere in Watts or East LA.

 

[GassedOut12]

Anybody happy with their ASC jobs in Chicago suburbs??

 

[deleted1183938]

The surgery center we staff is starting to have more 0600 starts. Used to only be on occasion. Now it’s three times a week.

The other issue is often the rooms run late and we have to stay until the patients leave recovery. Often a member of our call team has to cover. Can be anywhere from 6 - 11 pm (the late ones are always joint patients).

Of course, our group is fearful of losing the business so we go along with it. But we have lost partners over this issue.

Money, greed. Money, greed. Scared of losing the contract so you guys are the surgeons lackies. Good luck with that.

 

[dannyboy1]

Have done both. Certainly worked a hell of alot harder at the surgicenter. Minimal turnover time and quick procedures combined with early starts and late evenings. As I have always worked by the hour the hospital is a lot more relaxed….

 

[arsene19]

I did it after working for yrs in PP tertiary community hospital. Did 2 yrs bopping around in a group covering ortho ASCs. Texted the night before where you're going. 2 CRNAs - do blocks, they do propofol gtt. 4 Total knees in 1 OR (SAB and adductor) and 5 knee scopes in the other room, surgeon flip flops. Or healthy Peds ENT day, or 5 quick hernias.

You get efficient and proficient at blocks, and also being solo, timing emergence after count is correct and as they're splinting, etc. Do it if you want to get really good at regional. I still did an occasional MD-only OB shift.

Was exciting at first, then boring. Pop/saph propofol gtt for obese prone achilles repair in procedure room without anesthesia machine: you can do it Ricky Bobby! But...why am I pushing the envelope?

You are at the mercy of the surgeon. PM surgeon late arriving? Slow guy got to book 3 total joints this Friday? Surgeon dances out at 1900 after dictating. You're stuck until 1930-1945 even with the best PACU RN. I remember one time we rapid-turnovered, only to hear the surgeon had left for a 90 minute lunch meeting between cases.

Switched to a higher paying, slower paced teaching job with set hours/set your own vac schedule 6 mos in advance. As I got to the end of accumulation phase, and time started mattering more, I got really of the lottery-for-vacation, let's see how lean our PP/AMC can run thing.

 

[aneftp]

There is an asc right across from my place that can’t get a full time 1099 doc even for 475-500k/8 weeks off. That tells you the no calls and no weekends isn’t the selling jack anymore propaganda. It’s a super busy asc with tons of regional.

I believe it’s a 750k/10 weeks off job. They work close to 50/55 hrs on average.

Another asc even either that works 45-50 hours a week can’t get a doc for 450k/8 weeks off. It does general and some ortho and gyn and some gi. A more diversify asc still underpaid in this market.

People want it all and I don’t blame them. I want more weeks off and I worry about my workload.

 

[arsene19]

It is a RAPIDLY EVOLVING market. Especially if you work in a state where ASCs don't need a Certificate of Need or have some such onerous process. In my area, anyone can open one - so in the 2010s, the fast/good surgeons did, and took all the paying cases to them. The good MD anesthesiologists followed them, and ASCs had their pick.

FF to post-Covid anesthesia shortage. ~10 ASCs open every year in my state, requiring ~3 FTE on average to staff (2 locations per ASC = 2 working, 1 on vac). That's adding 30 FTEs per year, equivalent of a community hospital.

Only the slow/non regional anesthesiologists are left in the hospitals taking call. For fast/good anesthesiologists, the salaries are increasing and the hours worked decreasing, with ASCs/surgeon owners having to stipend their anesthesiologists.

So get really good at what you do, then know your worth (350-400/hr) and start negotiating.

 

[TheLesPaul]

2. Philosophically, I think private ASCs are parasites whose main purpose is to take money from facilities that need it in order to make already wealthy surgeons and PE a$$hats wealthier. Taking care of patients is like #12 on the list. Hospitals need to exist, private ASCs don't.

ASCs exist because hospitals are inefficient at outpatient surgery. I don't have to fight with CT or neurosurgery or ortho -- at my ASC I get the cases on when I want them, and the turnover is quick. I get the same scrub techs and staff every time so they know my routine. The center is built nicely so it is suitable for cosmetic patients. When I start a case, all the stuff I want is there and everyone knows what to do.

At the hospital (that I've been at for years), if I book a case -- I always walk into a room where everyone is milling around aimlessly, neither anesthesia nor the circulator have seen the patient, and the first question I am asked is "doctor what do you need for this case?" So frustrating.

 

[ambiturner]

ASCs exist because hospitals are inefficient at outpatient surgery. I don't have to fight with CT or neurosurgery or ortho -- at my ASC I get the cases on when I want them, and the turnover is quick. I get the same scrub techs and staff every time so they know my routine. The center is built nicely so it is suitable for cosmetic patients. When I start a case, all the stuff I want is there and everyone knows what to do.

At the hospital (that I've been at for years), if I book a case -- I always walk into a room where everyone is milling around aimlessly, neither anesthesia nor the circulator have seen the patient, and the first question I am asked is "doctor what do you need for this case?" So frustrating.

At least at my hospital it would be much easier to be efficient if our good techs and nurses didn’t keep getting poached by surgery centers and other easier jobs. That’s not the fault of the surgery centers but rather the hospitals for not making the jobs more palatable, who could blame them for leaving when you can have better hours and more pleasant working conditions for similar money?

 

[arsene19]

Lots of surgeon friends have ASC membership. I 100% support ASCs for surgeons - grab the facility fee, have your own custom staff/bartender/protocols for exactly how you want it.

ASCs are Jiffy Lube. They do only 1 specialty, over and over, and have the same staff. Oil change in 20 minutes, do 3 an hour.

Hospitals are your car dealership service center. Have to take care of everything, from cosmetic to transmission to electronics to tires to batteries to oil changes. Trauma/OB/ortho/gen surg/ENT. Their CSP is a hodge-podge of a bazillion sets from 10+ service lines and everyone complaining about bioburden/sets missing stuff. Go here if you need specialized tertiary care. But an oil change takes 2 hours.

But for an anesthesiologist...outside of regional, there's no real other reason to do it. I know some end-of-line anesthesiologists who are affable enough and staff a ASA 2 GYN ASC (4 LMAs, 2 ETTs a day). No special skills needed and they prob get about $2k a day.

 

[SRYSPAC]

At least at my hospital it would be much easier to be efficient if our good techs and nurses didn’t keep getting poached by surgery centers and other easier jobs. That’s not the fault of the surgery centers but rather the hospitals for not making the jobs more palatable, who could blame them for leaving when you can have better hours and more pleasant working conditions for similar money?

or MORE money...