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Envision is taking advantage of this in south Florida by hiring more and more w2 salaried docs to replace the locums crnas
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Has not been like that at all in the past few years. 400/hr has been there for at least 3 years
Working 4-5 days a week solo in a room for 450k for 44 weeks a year is a bad deal these days.
Especially taxed at 35%.
Why?
1. Your time is valuable and to have to fight for vacation time Xmas Summer spring break weeks is annoying.
2. Let the locums crna take those slots.
W2 doc 4-5 days week Envison can control their time off is the same as a 1099 crna plus agency fee Envison cannot control.
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It's not just math. Not having to participate in a stupid vacation lottery or ever having to ask for time off has great value in itself.
You focus on the rate, I focus on the balance; those that work occasionally for $300/hr close to home and the gig works for them? All good. Those stuck in ****ty W2 gigs working extra for $250/hr? Oops, yea that's dumb.
Correct.
I can’t image doing 42-44 weeks a year at the will of the employer. For 450-500k w2
plus being asked to work on their days off for $250hr w2
A few do carve out some niche “leadership” positions 50k extra to run the board and be pat director. Plus 50k cardiac stipend and still manage to do no over night calls as w2
But for the regular worker bees…they hopefully see the writing on the wall and leave.
I was getting $400/hr back in 2023 LOL. I wouldn't be surprised if the other guy is right though. Most doctors dont even bother to check basic locums listings on gasworks or ask their locums colleagues what they're getting paid.
The rates $350-400/450 an hour don’t really mean much to me. The workload means way more and the hours I can bill.
I made $9000 yesterday and worked 11 physical hours at $375/hr. But had clock running all day.
U guys gotta negotiate like nba and mlb players and negotiate guarantees.
Was offered 12k on Sunday for 24 hr beeper but declined it cause it was my daughter bday So I do have limits and will decline work. It’s endless (at least for the summer time)
Now I’m ain’t gonna to rot solo for $300/hr in Miami while the hospital ceo rapes the hospital for 14 million funding his own lifestyle and is in bed with envision to keep income low for docs.
I question this salary assertion. Seems pretty high. Maybe at some places.
The housing worth is probably true if they bought in about 2000.
Yeah, what aneftp said is less true if the anesthesiologist just graduated within the past five years. Further, the ones working and hustling enough to make 800k only tend to last a couple years if they graduated within the last five years until they reach burnout.
Agreed. Currently doing OB 24 hour for 8K, trading stocks and studying for board exams while CRNAs putting in epidurals and doing sections. until 5PM. Nights are usually quiet. 10 minutes from home.
Way to sell out the specialty
Why?
The asa has sold out the profession decades ago.
The OP doing own epidurals at night. I don’t see the problem.
How so? Theres two C-sections going on at the same time. I cant be in both places at once. There isnt an MD-only place offering locums where I live, and I am not about to go work in a different state just to stay MD-only.
I do MD-only OB when I am on nights or on the weekends, but it would be stupid to pull a full 24 by myself when I have CRNAs that can sit the stool in sections and do epidurals.
He said the CRNAs were placing epidurals while he was trading stocks
plenty of down time especially in a place that isn’t busy OB to make phone calls, trade stocks.
people spend more time on their phones than making a few stock trades
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Yup. At the right place OB can be very chill. Either adequate (or more than adequate) CRNA coverage or just a slow place. There have been calls in which I never left the call room.
cittykat
Full Member
I know a place that went independent CRNA only on L&D. ORs staffed by a mix of independent CRNAs and MDs. The only rooms guaranteed an anesthesiologist are pump cases and structural hearts. If anesthesiologists are willing to step back, CRNAs are happy to move in. We are not as essential as some people believe.
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Daytime hours yes cheaper to have crna
I practically begged a place to employ crna only. And get rid of me
Cause it would cost them 1.4 million per crna with the schedule they want 4 docs to cover ob and or 24/7/365. And that’s being generous and the crnas only charging them around $180/hr.
Admin was not laughing cause crnas are not stupid they bill per hour on ob. And per hour in the or. Whether it’s running or not running.
And?
Should I also stop the nurses from putting in IVs and do that myself?
In fact, when a CRNA CANT get an epidural or spinal and I have to take over and do it myself, THAT is what shoes the surgeons and administrators why we are there. Because we can do it when they cant.
You gonna get upset at the surgeon who lets the first assist PA close skin? Did he/she sell out their profession by not suturing every incision?
You probably could be doing the epidurals if the CRNAs aren’t independent. The desirable practices in my region with strong physician leadership have docs doing the epidurals while CRNAs sit the sections.
Why don’t the md just sit their own cases if cs is called after epidural is already running or place spinal and sit own cs case.
Doesn’t seem like much leadership if they can’t do it 100% of the way.
like my sarcasm.
bruh. What you just stated is NOT leadership.
It’s off loading work to crna as well.
There’s usually more than one section at a time. But yeah, unfortunately that’s just how anesthesia is in most places these days. Docs still do all preop, blocks, lines, epidurals though
It’s not leadership. It’s profit margin trying to hire mid levels.
Which is the point I’m making.
From interview to placement of epidural and making sure it’s working takes on average 10-15 min 90% of the the time for most of us.
Real leadership is all MD models. All docs do all their own cases. And like you said. We have manpower issue with staffing.
I cover ob solo at nights. But its no skin off my back to have crna do epidural if I’m busy trading stocks in from 930-359pm eastern time (another sarcasm).
Epidurals, lines, blocks are all trained
monkey skills.
Management of intraop CS is actually more important than placing the epidural. And your leadership has decided doing training monkey procedure is more important
I mean yeah, all MD practices would be the gold standard. But most areas of countries it is impossible. But when comparing different ones out there, there are good ones and bad ones. You have ones where you’re just a preop monkey while CRNAs do everything else. You have ones where you are supervising 1:6 or more. You have ones where the docs just sit in the break room and don’t even see any patients and are just the liability sponge. Maintaining control in how a medical direction is done is important in my opinion if you can’t be a solo MD practice.
I’m still not buying what you are writing how this all ties into leadership when practices don’t sit their own cs cases.
It has nothing to do with leadership. It has to do with monetary profits to have crna sitting in a room vs md in a room.
It's more of a staffing thing than a money thing. At least in our group, we even try our hardest not to run 1:4 which would obviously be maximum profits. The leadership is just maintaining control of our practice and how we want to run it despite administration push back.
That’s not leadership. That’s resource utilization. If these practices truly had strong physician leadership, they wouldn’t take CRNAs at all and do everything on their own.
If both sections are going on simultaneously then it’s obviously me doing the epidural during the day.
Agreed on all points.
Oh is it a staffing thing? Or is it a leadership thing?
If it’s a staffing thing, then why not just queue the sections to go consecutively instead of concurrently? More MD only time, and more ownership and maintaining control of the practice.
1:4 maximizes profits under direction, but also liability. If you’re really about physician leadership in the manner you are describing, kick out all the CRNAs and go MD only, or hire AAs. The reason you don’t do it is because you need to make money, and direction allows that to happen.
In certain parts of the country it is certainly possible to remain MD only but not in the southeast. My group would go full MD only if we could hire enough docs. In fact, the group used to be nearly full MD only but due to shortages over the years had to hire more CRNAs. AA's would be better but not yet available in our state. Our group continues hiring docs even though we could all make more money by increasing supervision ratio.
Physician leadership isn't just about having full MD practice. It's also about managing a practice the way you want to. And not letting CRNA's full reign to do whatever they want and "practice to their full ability of their license" and having them do all the preops, blocks, lines, TEEs, epidurals. Or allowing supervision rations greater than 4. Etc. It just makes us less expendable if a hospital wants to go full independent CRNAs.
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It’s nearly impossible to meet all 7 Medicare requirements for medical direction in a true 1:4 model. And yes that’s includes GI sedation cases.
That’s why I don’t buy the physician leadership angle with the act model you are defending. It’s just survival mode for anesthesia practices with labor shortages using crna or even AA.
There is nothing wrong with your practice. But you can’t be criticizing another act model where the crnas are placing the epidurals and the md is medically directing.
Unless the MDs in your practice are actively involved in the cs when incision (critical aspect) of the cs to delivery (another critical aspect). That’s not direction if they aren’t in the room the first 10-15 min of the case.
That’s true. It is difficult to maintain full medication direction for all cases. You’re right that this is just result of staffing shortages but physician leadership still is important in how a group is run as I mentioned above.
I might be a little too harsh but there really is no need for anyone other than an MD to be doing epidurals if there is a dedicated MD on OB. Usually those type of practices give the CRNAs a lot more autonomy in other areas which I don’t agree with. But maybe his practice isn’t like that.
And yes, we do stay in the room from spinal to baby out and epidurals wait until baby is out. My group still isn’t full medical direction as we have more docs than CRNAs so we still do a lot of our own cases including the bigger cases. But my group probably is a dying breed.
I might be a little too harsh but there really is no need for anyone other than an MD to be doing epidurals if there is a dedicated MD on OB. Usually those type of practices give the CRNAs a lot more autonomy in other areas which I don’t agree with. But maybe his practice isn’t like that.
And yes, we do stay in the room from spinal to baby out and epidurals wait until baby is out. My group still isn’t full medical direction as we have more docs than CRNAs so we still do a lot of our own cases including the bigger cases. But my group probably is a dying breed.
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It's debatable whether those specific events require the anesthesiologist's presence in a med direction model. I'd argue that incision certainly is NOT. (It certainly isn't for any other case done under general, regional, or sedation.)
I stay until delivery 99% of the time, even if it means I have to make other ORs wait on me, because until the baby is delivered there's dramatically higher medicolegal risk if anything goes sideways. But I do that because I'm paranoid and worried about ninjas and assassins in the room, not because of any billing compliance issues.
~20 years ago we had a CRNA spike the pitocin and open it up prior to incision ...
livinlavidalocums
Full Member
It’s all a matter of opinion. I like doing my own cases. Some like direction and supervision. Neither side means leadership skills or lack there of. In my opinion a fellowship trained md who has his own businesses and has entrepreneurial ideas gets my applause and respect. I personally like to deal with less headcahe. Give me a room and leave me alone. Have been the leader for years in the past, it’s more headache than I like.
Theres definitely enough MDs out there, but your group likely doesn't want to pay market rate. Again, a cost consideration thing, not a leadership thing.
I would argue that physician leadership is about having an all-MD/DO practice because every patient in that scenario deserves the best care, which is direct physician-provided care.
I do locums at a place that does MD only and also at one that does CRNA supervision under a 1:4 ratio because they cant meet the TERFA guidelines. The CRNA place sees the need for anesthesiologists being essential much more than the all-MD practice.
If youre worried about being less expendable, then you've already lost that battle. You shouldnt have to convince someone of your expertise and need. Do CT surgeons do this? Do they have to convince admins that their PAs are good enough and they dont need those CT surgeons? How about urologists? How about any other major OR specialty?
Its good that you acknowledge you made an assumption, one that isn't correct.
If you are staying in the room from spinal to delivery with a CRNA also in the room, then thats a massive waste of resources. Closing after delivery is like 15-20 minutes. if there is hemorrhage or complications, then you gotta come back into the room since thats the direction requirements to be present at all critical portions of the case. And if you are in the room during the spinal to baby time, then you cant start the other case, in which case a second CRNA is also a waste of resources. Those wasted resources could have gone to another MD on your OB service, but instead you have a CRNA there. Solid physician leadership.
livinlavidalocums
Full Member
Thankfully not everyone is like me or we wouldn’t have any leaders. Someone has to do it. Lol
There are definitely not enough docs to staff all MD in certain parts of the country. Don’t know where you are from but we wouldn’t be in a shortage if that wasn’t the case. And we are a lot above median MGMA. Again, physician leadership for supervision practices does make a big difference in how a practice is run. Or group can end up like @amyl’s old group with increasing supervising ratios. But agree to disagree.
As for OB, it is staggered enough that it works out. And the closures and turnovers take the longest part (there are residents), so doing all the elective cases, let alone the add ons, in one room would just not work.
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does your program have SRNAs?
I've worked in the northeast (NYC), Seattle, and Texas. Sam story everywhere. everyone wants an MD but doesn't want to pay MD prices. If you're paying your docs say 700k and 12 weeks off, I would be surprised if you had trouble hiring.
We’re southeast but non coastal. Median salary is about 700k with 10 weeks. We hire about 1-3 a year since covid but still not enough to run just docs. We do have more docs than CRNAs so we still do about 50% own cases. I know the west coast is better able to run full MD practices though.
Reasonable. If you're open to trying a permanent placement agency, then let me know as we can source anesthesiologists who would be interested in that type of comp, assuming its not a non-metro city.
“assuming its not a non-metro city.”
Reworded you mean
“As long as it's not a small town”
Or
“Assuming it is a major metropolitan area or suburban area”
He/She/Them said florida so lets assume that.
if this location is an academic center(since residents were mentioned), 700k/10 weeks off in ORL, FTL, MIA is fantastic. Tampa, Jackonville... eh. Destin, Clearwater, etc... naw.
There’s no jobs like that in Florida. It’s 500-600 tops with envision USAP Sound etc
Agree. Very few jobs that average 40-45 hr weeks inclusive of beeper or in house calls that pays 700k plus 10 weeks off
There are a few true private practices (left) that pay around 700-800k in Florida but they work closer to 55 hrs a week and take 8 weeks off. And they are under so much pressure many of them have lost their supplemental surgery centers incomes to all crna practices or AMC.
AMC pay anywhere in the low 400s in south Florida plus some bs sign on bonus and 8 weeks for. It’s pretty bad in south Florida
And it’s just not Envison. This job here is in boonies Spring Hill Florida (50 min from downtown Tampa) paying $445k for days. It’s a joke
New! NorthStar seeks Anesthesiologist in Tampa/Spring Hill. $445K+ base. $100K Sign-On. Diverse cases, flex shifts, great benefits. Days
My definition of the boonies is if it’s more than 25 min from downtown Tampa or 20 min from Apple retail store lol 😂.
So even the boonies places get low balled. Not just the big city
He mentioned 700k/10 weeks off, but non coastal, so I imagine they exist.
My only alternate thought would be to do locums elsewhere 2 weeks a month and PRN in florida 1-2 weeks per month to make that level of income.
Correct. U can make an easy 20-25k almost anywhere each week outside of Florida with limited calls 1099. With calls u can make a ton more.
But people do get tired traveling. It’s fun and games for 6-12 months but if u have a family , it requires a lot of coordination.
Most people with family and school age kids doing the professional locums year round have to map out their assignments closely.
So that’s why a lot of people with homes really don’t want to travel much.
The real issue with 1099 prn work is you gotta show some consistency in your availability. Me and couple of other docs do get preference in some nice gigs. Not because we are any better. But it’s that we provide coverage for a few hospitals and if push comes to shove. We get priority over docs who pop in and out. Hospital needed 24 hr call last Sunday. They asked me. I couldn’t do it cause to was my daughter bday. But another doc was able to pickup. So they do appreciate the coverage. I picked up weekend next week for them. Obviously we aren’t cheap. But it’s a service we provide.
This is absolute nonsense
It's like saying the only reason residential plumbing isn't made with gold alloy pipes is because people aren't willing to pay for it.
Even unlimited resources can't buy more of something than exists in the universe.
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The AANA prefers docs to do solo. Crnas to do solo and blur the lines that crna =md. We all know their games
I go over to the crna locums Facebook all the time. So many brand new or newer crna grads ask for “supported” system in place to do 1099 work. That’s not independent practice. A Brand new crna is not ready for independent practice and the aana tries to make it that they are qualified.
I go over to the crna locums Facebook all the time. So many brand new or newer crna grads ask for “supported” system in place to do 1099 work. That’s not independent practice. A Brand new crna is not ready for independent practice and the aana tries to make it that they are qualified.
Professional locums life with travel in hotels and airplanes is not for everyone. I can’t image anyone doing it for more than 2 years. I was home sick my one true travel locums year many moons ago racked up 280 days in hotel (before kids and marriage)
One of the docs from Florida making big cash in usual cold weather states the last 18 months but he’s says he ready to go back home. Had a phone call from him this morning. He lives 10 min from me. But he doesn’t want to do any more trauma or ob and just days.
Locums up north afforded him the ability to work days and make good money. But there is nothing like being home. He doesn’t have any kids. Just misses his husband and his dog, their big house and being on the boat.
One of the docs from Florida making big cash in usual cold weather states the last 18 months but he’s says he ready to go back home. Had a phone call from him this morning. He lives 10 min from me. But he doesn’t want to do any more trauma or ob and just days.
Locums up north afforded him the ability to work days and make good money. But there is nothing like being home. He doesn’t have any kids. Just misses his husband and his dog, their big house and being on the boat.
How so? How many locums docs are there? In my mind, its not an absolute shortage, but a relative one that is accentuated by the average age of current anesthesiologists due to the undersupply that started in 2008-10 (due to the cyclical glut in workforce). Anesthesia is one of the most competitive fields right now, and the supply will be there in 4-6 years.
How many locums docs do you think would give up locums and go full time in their home city if the pay was more competitive? I bet a whole bunch. I believe the a big reason is you have a much larger locums pool that grows larger by the day, and doesnt enter the regular workforce.
It’s all about hourly pay inclusive of beeper or in house call.
Very simple math. 1099 crnas are starting to freak out in some parts of Florida. Because admin has thrown a 325k/42 weeks a year package plus some other w2 perks like maternity paternity leave healthcare etc. 4 days a week. No call no weeks.
Those are the w2 packages are are close to $200/hr true pay when adjusted for benefits etc.
And MD similar package is closer to $325/hr w2 when u average the math. That’s why the 73 calls a year 24 hr gig with 292 days off gets instantly grabbed by docs. 550k/73 calls/293 days off add in healthcare. Paternity/family leave off 8 weeks on top of their 293 days off. Etc
It’s an averages to around $350/hr. Solid deal most 1099 docs would switch to w2 for that package.
Now some 1099 docs are so addicted to the tax schemes and deductions.
But if u are single wage earner married with kids. U won’t be paying much more in terms of taxes as a w2 making AGI less than 540k as married person. Especially when the hospital gives u 401a/457b tax deductions on top of their 403b plus loan forgiveness.
