Manpower?

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ryanjmy said:
To what end? I assume at some point it becomes cost prohibitive to do elective cases, but maybe I’m wrong and what we make is trivial to the bottom line.

It is interesting to me that a hospital is happy to pay a locums $20k a week when they are collecting a fraction of that for professional fees.
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Well when the facility fees for one case can cover that week...
 
aneftp said:
I traveled locums all over the country for 18 months (before kids) after leaving my full time first job of 3 years. It was fun. Made a ton of money. Literally had one suitcase and purchased clothes as needed. Did have a home but rented it out to a buddy of mine for cheap. 80% upgraded to first class with miles. I think the stigma of locums doc disappears quickly after one week. People get to know you. As long as you aren’t an a-hole. Safe. On time. I’ve never had a problem where I’ve been.
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Locums companies arent offering first class?! *shocked pikachu*

ryanjmy said:
To what end? I assume at some point it becomes cost prohibitive to do elective cases, but maybe I’m wrong and what we make is trivial to the bottom line.

It is interesting to me that a hospital is happy to pay a locums $20k a week when they are collecting a fraction of that for professional fees.
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I would say to the end you get someone hired. Currently that is hovering around the 400/hr mark for locums and about 550/year for W-2. And I dont expect it to get any easier. If the alternative is that you make less profit, it still makes sense to keep the ORs running to generate postop revenue as well as reduce the backlog that will keep piling up. a profit of 2000 instead of 3000 is still better than 0 dollars.

If hospitals are able to hire traveling RNs for 10k/week for 30 hours of work, they can definitely afford to pay docs more to keep their revenue machines (the ORs) running. Not only do they make a lot from the surgery, but also from the postop stays.
 
GandalfTheWhite said:
Locums companies arent offering first class?! *shocked pikachu*



I would say to the end you get someone hired. Currently that is hovering around the 400/hr mark for locums and about 550/year for W-2. And I dont expect it to get any easier. If the alternative is that you make less profit, it still makes sense to keep the ORs running to generate postop revenue as well as reduce the backlog that will keep piling up. a profit of 2000 instead of 3000 is still better than 0 dollars.

If hospitals are able to hire traveling RNs for 10k/week for 30 hours of work, they can definitely afford to pay docs more to keep their revenue machines (the ORs) running. Not only do they make a lot from the surgery, but also from the postop stays.
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It’s interesting because groups that don’t take stipends might not be able to compete
 
We are constantly expanding so we are always a few CRNAs short. When we finally fully staff, someone leaves or retires or we expand the staffing more. That’s probably pretty typical though. The OR and PACU nurses are a different story. There’s been 150% turnover there. I don’t know any other industry that would see that huge level of turnover as business as usual. Heads would roll due to obviously terrible management. They view the OR nurses as completely replaceable cogs and sometimes the surgeons complain, but it falls on deaf ears. Eventually it will affect care in a crisis, but it probably still will be ignored.
 
ERRES2288 said:
It’s interesting because groups that don’t take stipends might not be able to compete
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Then the partners should take more call, and work more.
With great power (and pay) comes great responsibility.
Alternatively, bring your practice in-house and sell it to the hospital.
 
GandalfTheWhite said:
Then the partners should take more call, and work more.
With great power (and pay) comes great responsibility.
Alternatively, bring your practice in-house and sell it to the hospital.
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Sell it to the hospital, lol.
 
I think 450k (built in benefits vs 1099) 5 days a week/40 hours is reasonable these days.

I’d you do weekend calls. That’s should be another $6000-7000 per 24 hour calls (adjusted for trauma/in house Vs beeper (beeper should be $3000 per 24 hours assuming light call backs)

So new grads if they want to take 2 (24 hour) weekends they can make an extra 12-14k each month. That would push their salary up to mid 500s but also push their average hours up to 65 hours if they do one weekend call and the other weeks 40 hours. .

Most MD (no subsidy/no Ponzi scheme partner track) docs assuming 50% good payor mix should do 12000 units and make 600k ish-700k ish but they work an average 55-60 hours

The only practice making more than 700k-800k MD only will average close to 60-70 hours a week

People want to make 600k and work 40 hours with no calls a week. Those opportunities are rare unles they get lucky with good payor mix outpatient. It’s possible. But rare unless the money is being shifted from crna to md
 
aneftp said:
I think 450k (built in benefits vs 1099) 5 days a week/40 hours is reasonable these days.

I’d you do weekend calls. That’s should be another $6000-7000 per 24 hour calls (adjusted for trauma/in house Vs beeper (beeper should be $3000 per 24 hours assuming light call backs)

So new grads if they want to take 2 (24 hour) weekends they can make an extra 12-14k each month. That would push their salary up to mid 500s but also push their average hours up to 65 hours if they do one weekend call and the other weeks 40 hours. .

Most MD (no subsidy/no Ponzi scheme partner track) docs assuming 50% good payor mix should do 12000 units and make 600k ish-700k ish but they work an average 55-60 hours

The only practice making more than 700k-800k MD only will average close to 60-70 hours a week

People want to make 600k and work 40 hours with no calls a week. Those opportunities are rare unles they get lucky with good payor mix outpatient. It’s possible. But rare unless the money is being shifted from crna to md
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Depends greatly upon what part of the country you are in. Might be reasonable on some parts and extremely rare in other parts
 
Arch Guillotti said:
garage sale
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Animated GIF
 
narcusprince said:
Private Practice ASC life….. Short staffed combined with rapid expansion. Good to be needed…..
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A lot of ASCs are not easy. The guys I know who own their own contracts at ASCs do really well. 600k. They hustle. Not just one ASC. Multiple. A few days finish 12-1pm. Many days finish 6pm.
 
aneftp said:
A lot of ASCs are not easy. The guys I know who own their own contracts at ASCs do really well. 600k. They hustle. Not just one ASC. Multiple. A few days finish 12-1pm. Many days finish 6pm.
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You are absolutely right some early days some late ones. At the end I sleep in my own bed at night every night. I stood 24 hr and 16 hr watch in academic military land for far cheaper. I will never take in house call again in my life….. unle$$
 
This is crazy. In the Chicago area you would be lucky to get 300 for a 40 hr non call job. If your looking in a big city, definitely lower expectations compared to what some people are saying here.
 
dabears505 said:
This is crazy. In the Chicago area you would be lucky to get 300 for a 40 hr non call job. If your looking in a big city, definitely lower expectations compared to what some people are saying here.
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Or, just do locums and squeeze every ounce from the admins for the same 40 hour non call jobs.
 
We are short staffed for crnas and looking to hire docs as well. we want more day docs or prn docs as well as partner track doctors. We are paying more and we are shortening the partner track.
Part of our issue recruiting is two fold- 1 we are in Texas and the medical board takes forever to license people- took 6-8 months pre covid. 2- at our main hospital credentialing for a call taking doc is hard - it’s a level one trauma center, transplant center etc. while we have separate teams for livers and hearts, every partner or partner track person has to do trauma call and the hospital credentialing looks for experience with level one. We can be much more flexible w credentialing day docs who won’t take trauma call.
 
amyl said:
We are short staffed for crnas and looking to hire docs as well. we want more day docs or prn docs as well as partner track doctors. We are paying more and we are shortening the partner track.
Part of our issue recruiting is two fold- 1 we are in Texas and the medical board takes forever to license people- took 6-8 months pre covid. 2- at our main hospital credentialing for a call taking doc is hard - it’s a level one trauma center, transplant center etc. while we have separate teams for livers and hearts, every partner or partner track person has to do trauma call and the hospital credentialing looks for experience with level one. We can be much more flexible w credentialing day docs who won’t take trauma call.
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Weird - how recent do they want level 1 experience and what if someone has level 2 experience only? That all seems entirely unnecessary.

Also as great as Texas is in many ways, I wonder if the abortion ban is going to deter doctors from wanting to move there. I personally wouldn’t move there now, but would have considered it before….
 
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We gets lots of bad traumas- stat cranis for Neuro and bad AAAs, gsw etc. What’s covered in level 2-
It may be something we can negotiate - historically most everyone had a cards fellowship and they made exceptions for level one trauma experience. If someone is confident they can handle the cases we do and are a good match for the group im sure we could push it through.
 
ryanjmy said:
To what end? I assume at some point it becomes cost prohibitive to do elective cases, but maybe I’m wrong and what we make is trivial to the bottom line.

It is interesting to me that a hospital is happy to pay a locums $20k a week when they are collecting a fraction of that for professional fees.
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Does the nurses or scrub techs collect any professional fees?
 
docs are not too short here. despite low pay. crnas are short because they are all locum/per diem so theres a lot of changing locations to other places with higher pay. docs are w2... but volume has gone up maybe bc of covid back log so work hours is up up! and crimes are up and people are going out so more emergencies
 
amyl said:
In all fairness, that is an old article. I don’t love Texas or dallas but I have yet to find a place that I like better where I can make a good living.
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Well the picture they used is from last year, but these 6 power plants went offline yesterday. They’re asking people to keep their thermostats at 78.
 
narcusprince said:
Private Practice ASC life….. Short staffed combined with rapid expansion. Good to be needed…..
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Enjoy, but don't get institutionalized too badly.

Someday you may wish to practice real anesthesia again. 🙂 The longer you're away from it the harder it is to get back in.
 
narcusprince said:
Private Practice ASC life….. Short staffed combined with rapid expansion. Good to be needed…..
Click to expand...

You never know though. A few retirements or a bad personnel change here or there and the whole thing can fall apart in a matter of months.

I feel like ascs can be very hit or miss depending on how much volume/case mix the surgeons are bringing in.
 
pgg said:
Enjoy, but don't get institutionalized too badly.

Someday you may wish to practice real anesthesia again. 🙂 The longer you're away from it the harder it is to get back in.
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If he’s lucky he’ll get to be at an ASC where they do shoulder cases on pts wearing external defibrillators.
There could still be exposure to the same hospital case co-morbidities.
 
IlDestriero said:
They view the OR nurses as completely replaceable cogs
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They're not?

I'm not trying to be too snarky, and certainly they can contribute to or detract from efficiency. But I honestly haven't ever really understood why that job needs to be done by a nurse.
 
D P356 said:
If he’s lucky he’ll get to be at an ASC where they do shoulder cases on pts wearing external defibrillators.
There could still be exposure to the same hospital case co-morbidities.
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What's funny here is that I'm pretty sure @narcusprince and I have both done some moonlighting work at a particular ASC not far from the place we both used to work. I did a preop consult for a patient with an external defibrillator coming in for a general anesthetic (i.e. not some trivial BS like a cataract), I said no, they scheduled the patient anyway for a day I wasn't there, and I asked WTF they asked me to do the consult for if they were going to ignore my veto. Between that and the ophthalmologist who incessantly nagged me to do his retrobulbar blocks for him, I quit.
 
pgg said:
What's funny here is that I'm pretty sure @narcusprince and I have both done some moonlighting work at a particular ASC not far from the place we both used to work. I did a preop consult for a patient with an external defibrillator coming in for a general anesthetic (i.e. not some trivial BS like a cataract), I said no, they scheduled the patient anyway for a day I wasn't there, and I asked WTF they asked me to do the consult for if they were going to ignore my veto. Between that and the ophthalmologist who incessantly nagged me to do his retrobulbar blocks for him, I quit.
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Pgg
I miss our workplace AM conversations. At my particular ASC home my periop nurses have been very valuable. We are finally opening the ASC next week. I have been cross covering at other ascs. The group I work with the nurses are helpful hard working and definitely not adversarial. Here the surgeons are surprisingly good at shunting sick patients to the hospital and those that fall through the cracks get picked up by our preop nurses.
Due to the litigious nature of the state nobody is interested in taking unnecessary risks.
If I could give one advice to those back in the .mil. The APS service is worth its weight in gold. Probably the most marketable skill the military sends you out with whether a resident or a staff.
 
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amyl said:
We are short staffed for crnas and looking to hire docs as well. we want more day docs or prn docs as well as partner track doctors. We are paying more and we are shortening the partner track.
Part of our issue recruiting is two fold- 1 we are in Texas and the medical board takes forever to license people- took 6-8 months pre covid. 2- at our main hospital credentialing for a call taking doc is hard - it’s a level one trauma center, transplant center etc. while we have separate teams for livers and hearts, every partner or partner track person has to do trauma call and the hospital credentialing looks for experience with level one. We can be much more flexible w credentialing day docs who won’t take trauma call.
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Just sent you a PM.
 
anbuitachi said:
well soon, in july we will be getting like 1000++++ new anesthesiologists and millions of new CRNAs on the market. that may change things
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Probably going to be met with 1000++++ old anesthesiologists looking to GTFO. Also, most of those new anesthesiologists have already signed contracts by now, so I doubt any real change will be seen in this skewed demand/supply equation.
 
pgg said:
What's funny here is that I'm pretty sure @narcusprince and I have both done some moonlighting work at a particular ASC not far from the place we both used to work. I did a preop consult for a patient with an external defibrillator coming in for a general anesthetic (i.e. not some trivial BS like a cataract), I said no, they scheduled the patient anyway for a day I wasn't there, and I asked WTF they asked me to do the consult for if they were going to ignore my veto. Between that and the ophthalmologist who incessantly nagged me to do his retrobulbar blocks for him, I quit.
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Ah yes, the Wild West that is the ASC...

"But why are you canceling my case when medicine/cardiology cleared the patient?!” yelled the surgeon, blissfully unaware that the patient was only cleared for the surgery itself, not for it to be done in the back of his pickup truck in the hospital parking lot.

"This is ridiculous! If anything happens we can just admit the patient to the hospital across the street!" the surgeon continued to lament, already unhappy that he arrived late and the breakfast burritos were cold, and further unaware that such an incident would need to be reported to the state medical board.

We work with some really special people sometimes.
 
thinkorswim said:
Ah yes, the Wild West that is the ASC...

"But why are you canceling my case when medicine/cardiology cleared the patient?!” yelled the surgeon, blissfully unaware that the patient was only cleared for the surgery itself, not for it to be done in the back of his pickup truck in the hospital parking lot.

"This is ridiculous! If anything happens we can just admit the patient to the hospital across the street!" the surgeon continued to lament, already unhappy that he arrived late and the breakfast burritos were cold, and further unaware that such an incident would need to be reported to the state medical board.

We work with some really special people sometimes.
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I just had a cardiologist "clear" a patient for ASC surgery with a CVA 6 months ago and worsening dyspnea on exertion. They ordered a stress test and carotid US but said they could be done after surgery. WTF.
 
I’ve gotten a few “what do you think? Looks ok for the ASC” emails from med directors only to look at the notes and see recommendations for additional testing, follow up, etc that was never done or delayed. I generally say no. As I get older I am more confident I can get them through whatever happens, but I don’t want to be dealing with that stool at the ASC. So they can go to the big house, or reschedule after all the testing they blew off.
 
kidthor said:
I just had a cardiologist "clear" a patient for ASC surgery with a CVA 6 months ago and worsening dyspnea on exertion. They ordered a stress test and carotid US but said they could be done after surgery. WTF.
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So.... Did you do the case?
 
USCTrojan11 said:
I'm wondering if we were in the same ASC together or this isn't as rare as we hope it is. Happened to me in residency lol
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I doubt it’s the same. No residents there.

The surgicenter was across a parking lot from a level 1 trauma center that stocks O neg whole blood. Thankfully the trauma/vascular surgeon at the hospital came over to help out, the hospital sent over a vascular tray, the blood bank tech was reasonable and was willing to release blood to a patient that wasn’t even registered in the hospital. The patient survived.
 
nimbus said:
I doubt it’s the same. No residents there.

The surgicenter was across a parking lot from a level 1 trauma center that stocks O neg whole blood. Thankfully the trauma/vascular surgeon at the hospital came over to help out, the hospital sent over a vascular tray, the blood bank tech was reasonable and was willing to release blood to a patient that wasn’t even registered in the hospital. The patient survived.
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Meanwhile I can't even get blood for a scheduled case before the case is over. The shenanigans are endless "has to be drawn twenty minutes apart, you didn't date and sign and initial, patient sticker needs to be perpendicular not parallel and you should deliver it with a courier born in the 70s not the 80s"
 
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