Manpower?

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chocomorsel said:
Have you asked your admin why they would rather waste money with a locums instead of negotiating directly with the doc? It makes no sense to me and I used to do full time locums.
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I don’t think admin really has answers because suit thinking is different. I am trying to think of the value added by a staffing company. Covering travel, arranging credentialling, arranging licensing, malpractice coverage? What am I missing?
 
pmichaelmd said:
The gulf between what the middle man takes and what the doc was actually making is crazy. The locums company told us they were seeing rates as high as $500/hr for their doc placements. Turns out my friend was making $225/hr and wanted a bump to $275/hr. For that bump, the locums company wanted to charge our hospital $437/hr. So strange that most hospitals won't negotiate with individual practitioners but would rather pay more than the doc would ask to a locums agency.
The bubble seems to be bursting a bit as the higher rates are likely unsustainable, at least from the perspective of the C-suite (especially the CRNA salaries that have been bananas post-pandemic). It is encouraging to read that the most recently released MGMA survey showed an increase in doc compensation across the board with some normalization as we emerge from Pandemia.
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Does it take anything to become a locums agency? Maybe I should pass myself off as an agency and place myself. Would have to get my own malpractice and take care of credentialing but it should be doable…
 
pmichaelmd said:
I don’t think admin really has answers because suit thinking is different. I am trying to think of the value added by a staffing company. Covering travel, arranging credentialling, arranging licensing, malpractice coverage? What am I missing?
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I've heard "different pots of money." So, money to a locums agency comes out of X budget or is reported as an expense one way, but pay to employees (even 1099 independent contractors) comes out of a different pool, and is reported differently. I am sure it likely has some tax implications, as well. Otherwise, I would think that the top suits would actually care that they are spending tens of thousands more than they need to by only going with big agencies, rather than having a few individual contractors.
 
pmichaelmd said:
The gulf between what the middle man takes and what the doc was actually making is crazy. The locums company told us they were seeing rates as high as $500/hr for their doc placements. Turns out my friend was making $225/hr and wanted a bump to $275/hr. For that bump, the locums company wanted to charge our hospital $437/hr. So strange that most hospitals won't negotiate with individual practitioners but would rather pay more than the doc would ask to a locums agency.
The bubble seems to be bursting a bit as the higher rates are likely unsustainable, at least from the perspective of the C-suite (especially the CRNA salaries that have been bananas post-pandemic). It is encouraging to read that the most recently released MGMA survey showed an increase in doc compensation across the board with some normalization as we emerge from Pandemia.
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IDK about that. Still getting rates for 400/hr. and seeing rates for CRNAs around 150-200/hr
 
GandalfTheWhite said:
IDK about that. Still getting rates for 400/hr. and seeing rates for CRNAs around 150-200/hr
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What are your staring offers? What part of the US is this? Supervision or your own cases? How many hours a week? I am not lazy but not interested in killing myself for a dollar. Them days are over!
 
psychbender said:
I've heard "different pots of money." So, money to a locums agency comes out of X budget or is reported as an expense one way, but pay to employees (even 1099 independent contractors) comes out of a different pool, and is reported differently. I am sure it likely has some tax implications, as well. Otherwise, I would think that the top suits would actually care that they are spending tens of thousands more than they need to by only going with big agencies, rather than having a few individual contractors.
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This. Different “cost centers.”
 
med2010 said:
This. Different “cost centers.”
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Company money and department money….. is different money.
I don’t care about saving company money, as long as I am not over budget, I am good.

Same thing goes to AMCs. I’d thought that by deal with them directly, they’d be happier. Nah. They’d rather just deal with one or two locum companies, spent the money, and not dealing with all of youz (me included) sorry a$$es.
 
med2010 said:
This. Different “cost centers.”
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Yup.

In order for hospitals to use some state and federal grants, they need to show staffing shortages. Then they get money which they can use on travelers.

That money doesn't come in if they give their existing staff a raise to keep them or hire more regular staff.
 
GandalfTheWhite said:
IDK about that. Still getting rates for 400/hr. and seeing rates for CRNAs around 150-200/hr
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I am still seeing our CRNA locums getting around $175/hr with some of them talking about other facilities offering $200/hr, but for how long? With the administrative structure as it currently stands, I don't know how the C-suite will be willing to continue to pay those wages. If it is sustainable for more than the next 6-12 months, then I wonder if they won't price themselves out of the market. But who knows?
 
UscGhost said:
Yup.

In order for hospitals to use some state and federal grants, they need to show staffing shortages. Then they get money which they can use on travelers.

That money doesn't come in if they give their existing staff a raise to keep them or hire more regular staff.
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So true and such a sorry state of affairs. There is no incentive to reward loyalty with retention $$ if they get state/fed money for shortages and to spend even more $$ on travelers.
 
pmichaelmd said:
I am still seeing our CRNA locums getting around $175/hr with some of them talking about other facilities offering $200/hr, but for how long? With the administrative structure as it currently stands, I don't know how the C-suite will be willing to continue to pay those wages. If it is sustainable for more than the next 6-12 months, then I wonder if they won't price themselves out of the market. But who knows?
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I expect consolidation and reduction in services in the not too distant future. Very busy winner take all (or most) hospitals, some others radically downsized.
 
Dr. Rude said:
I expect consolidation and reduction in services in the not too distant future. Very busy winner take all (or most) hospitals, some others radically downsized.
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Sadly, largely agree. Our system is undergoing lots of growth so our admins will likely have to take a different track as we expand into the world of open heart and ASC coverage. I expect there to be a bidding war of sorts that will yield a more efficient (and cheaper) staffing model.
 
psychbender said:
I've heard "different pots of money." So, money to a locums agency comes out of X budget or is reported as an expense one way, but pay to employees (even 1099 independent contractors) comes out of a different pool, and is reported differently. I am sure it likely has some tax implications, as well. Otherwise, I would think that the top suits would actually care that they are spending tens of thousands more than they need to by only going with big agencies, rather than having a few individual contractors.
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Exactly. Lots of shady accounting tricks when it involves “locums” money.

When team health took over our true private practice. The hospital bled money. Since if a small 2 hospital system small town feel. Long time Docs on board. They know admin Tricks in budgeting

They ended up paying team health 50% of the locums cost for first 12 months

That 50% came out of the “physican recruitment budget” So the admin claimed to have saved almost 2 million in “anesthesia subsidy” yet they spend 2.5 million in subsidy locums cost for the first year.

Someone trading the accounting budget for this 501c non profit will think admin “saved” 2 million for the hospital!! Since they didn’t have to “subsidize” anymore. Accounting tricks.
 
Ok my group has been going through some turmoil lately with a rash of retirements and people leaving. Spirits are low and threats of more and more people leaving. Now my AMC claims they will increase to 575/year, which does sound pretty good. They claim next 90 days I’ll see the raise, but they need to go to hospital to get more stipend. To me, maybe they’re just stringing us along for now so there’s not a total implosion. I distrust the situation, and now I wonder more if the hospital could pay more if these types of grants are just for shortages.
 
UscGhost said:
Yup.

In order for hospitals to use some state and federal grants, they need to show staffing shortages. Then they get money which they can use on travelers.

That money doesn't come in if they give their existing staff a raise to keep them or hire more regular staff.
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So a 1099 that they pay for an airline ticket from out of town, hotel room and car does not count as a temporary staffer?
Can someone please explain this to me?
 
linkin06 said:
Ok my group has been going through some turmoil lately with a rash of retirements and people leaving. Spirits are low and threats of more and more people leaving. Now my AMC claims they will increase to 575/year, which does sound pretty good. They claim next 90 days I’ll see the raise, but they need to go to hospital to get more stipend. To me, maybe they’re just stringing us along for now so there’s not a total implosion. I distrust the situation, and now I wonder more if the hospital could pay more if these types of grants are just for shortages.
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So the raise is contingent on a larger hospital stipend but a smaller AMC tax is off the table? Sounds like an AMC. They’d rather blow up the practice than compromise with a smaller cut.
 
linkin06 said:
Ok my group has been going through some turmoil lately with a rash of retirements and people leaving. Spirits are low and threats of more and more people leaving. Now my AMC claims they will increase to 575/year, which does sound pretty good. They claim next 90 days I’ll see the raise, but they need to go to hospital to get more stipend. To me, maybe they’re just stringing us along for now so there’s not a total implosion. I distrust the situation, and now I wonder more if the hospital could pay more if these types of grants are just for shortages.
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Interesting time to retire
 
Stipends and subsidies take a LONG time to negotiate and get approval, much less implement. It’ll be awhile…and they don’t HAVE to play ball.
 
AMC claims they’ll eat cost for now We’ll see…ill believe it when I see the money in bank account hopefully soon. Otherwise, this market seems red hot, as everyone has discussed.
 
pmichaelmd said:
I am still seeing our CRNA locums getting around $175/hr with some of them talking about other facilities offering $200/hr, but for how long? With the administrative structure as it currently stands, I don't know how the C-suite will be willing to continue to pay those wages. If it is sustainable for more than the next 6-12 months, then I wonder if they won't price themselves out of the market. But who knows?
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who says its not sustainable? It costs less to pay the CRNA 200/hr and the physician 400/hr than to not utilize an OR and bill for the procedures that could be done. Facility fee for one procedure alone will cover the hourly for the whole day if not multiple days.

linkin06 said:
Ok my group has been going through some turmoil lately with a rash of retirements and people leaving. Spirits are low and threats of more and more people leaving. Now my AMC claims they will increase to 575/year, which does sound pretty good. They claim next 90 days I’ll see the raise, but they need to go to hospital to get more stipend. To me, maybe they’re just stringing us along for now so there’s not a total implosion. I distrust the situation, and now I wonder more if the hospital could pay more if these types of grants are just for shortages.
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I wouldn't trust it unless its in writing.
 
linkin06 said:
Ok my group has been going through some turmoil lately with a rash of retirements and people leaving. Spirits are low and threats of more and more people leaving. Now my AMC claims they will increase to 575/year, which does sound pretty good. They claim next 90 days I’ll see the raise, but they need to go to hospital to get more stipend. To me, maybe they’re just stringing us along for now so there’s not a total implosion. I distrust the situation, and now I wonder more if the hospital could pay more if these types of grants are just for shortages.
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You believe what AMC says? Why not write on the paper that you will get 575/year from 9/1/2022?
 
narcotics999 said:
You believe what AMC says? Why not write on the paper that you will get 575/year from 9/1/2022?
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Same thing happens at private groups and will continue to do so.

When Medicare cuts hit each year, the private groups get the same financial hit. Those groups lose people and then try to keep ther existing guys by promising to negotiate a stipend.

Sometimes it works, sometimes it doesn't.
 
Honestly, many of you are getting "low balled" these days by academia, AMCs and hospitals. Salaries are up in 2022 in order to retain and recruit talent. If you aren't getting that raise in 2022 you better have gotten one in 2021. You should be getting a minimum of 3-5% just as a cost of living adjustment. When you factor in the market for talent that is another 5% over 2021. Unfortunately, most anesthesiologists are just terrible at negotiating their worth.
 
BLADEMDA said:
Honestly, many of you are getting "low balled" these days by academia, AMCs and hospitals. Salaries are up in 2022 in order to retain and recruit talent. If you aren't getting that raise in 2022 you better have gotten one in 2021. You should be getting a minimum of 3-5% just as a cost of living adjustment. When you factor in the market for talent that is another 5% over 2021. Unfortunately, most anesthesiologists are just terrible at negotiating their worth.
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The interesting part is where the money is coming from.

Seems like payors are no longer raising contracted rates and dropping some contracts if the unit rate is too high.

Are groups asking for hospital stipends again? Reducing profit margins for the senior partners or AMC?

I know the big local private group has had to slash it's partnership track length significantly in the last few years to retain talent..but their unit values have still dropped
 
UscGhost said:
The interesting part is where the money is coming from.

Seems like payors are no longer raising contracted rates and dropping some contracts if the unit rate is too high.

Are groups asking for hospital stipends again? Reducing profit margins for the senior partners or AMC?

I know the big local private group has had to slash it's partnership track length significantly in the last few years to retain talent..but their unit values have still dropped
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Maybe the mentality should be changed. The $ we collect from the insurance companies are just part of our professional fees. Part of the facility fee belongs to us too. We evaluate patient in the preop area; we take care of patients in the PACU. These are not free.

The nursing staff/scrub techs get nothing from insurance companies. Hospitals pay them, they should pay us too.
 
narcotics999 said:
Maybe the mentality should be changed. The $ we collect from the insurance companies are just part of our professional fees. Part of the facility fee belongs to us too. We evaluate patient in the preop area; we take care of patients in the PACU. These are not free.

The nursing staff/scrub techs get nothing from insurance companies. Hospitals pay them, they should pay us too.
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I think it definitely will over the next 10-15 years. Private practice is dying off as insurers continue to depress physician reimbursement.

Large health groups and hospital organizations have leverage in negotiations that we simply don't have. They can continue to inflate facility fees and we will soon get bundled in as a cost.

Eventually the hospitals will lose money on us but make up for it with the higher facility fee. They will need us to staff the cases like a nurse, tech,etc
 
Bumping to ask, does anyone know of partners that have delayed planned retirement (or unretired) due to the recent inflation/stock market downturn? I still think that delayed retirements are the major threat to our currently excellent market.

We have one person retiring this year and finances did not play a role in the timing.
 
ambiturner said:
Bumping to ask, does anyone know of partners that have delayed planned retirement (or unretired) due to the recent inflation/stock market downturn? I still think that delayed retirements are the major threat to our currently excellent market.

We have one person retiring this year and finances did not play a role in the timing.
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If you're unable to retire due to the market you're doing it wrong
 
GassYous said:
If you're unable to retire due to the market you're doing it wrong
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In theory, I agree with you, but it is pretty nice to have the ability to work another year or two to avoid "Sequence of Return" risk of a bear market during your first couple years of retirement. That way you're not drawing down assets during a market crash
 
ambiturner said:
Bumping to ask, does anyone know of partners that have delayed planned retirement (or unretired) due to the recent inflation/stock market downturn? I still think that delayed retirements are the major threat to our currently excellent market.

We have one person retiring this year and finances did not play a role in the timing.
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Still a wide open market with shortages in staffing I have never seen in 30 years. The thing is many of you just don’t know the market for services is so strong you can almost dictate hourly rates. This specialty needs the folks like me to stay in the game because there aren’t enough providers to go around
 
BLADEMDA said:
Still a wide open market with shortages in staffing I have never seen in 30 years. The thing is many of you just don’t know the market for services is so strong you can almost dictate hourly rates. This specialty needs the folks like me to stay in the game because there aren’t enough providers to go around
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If you guys would retire, we’d be even more in demand and get even higher rates, Blade.
 
BLADEMDA said:
Still a wide open market with shortages in staffing I have never seen in 30 years. The thing is many of you just don’t know the market for services is so strong you can almost dictate hourly rates. This specialty needs the folks like me to stay in the game because there aren’t enough providers to go around
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Our group may get rid of our mandatory retirement age because we can’t afford to lose the manpower.
 
nimbus said:
Our group may get rid of our mandatory retirement age because we can’t afford to lose the manpower.
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What I can tell you is that most, not all, anesthesiologists lose a step or two as they reach age 65-70. The decline is real and happens to most in that age range. I am NOT saying they can't deliver a safe anesthetic but if they were a top superstar at age 55 they may be more middle of the road by age 70. I just wish more providers would police themselves and adjust their practice to their ability vs being told by others or being forced to do so.
 
sethco said:
In theory, I agree with you, but it is pretty nice to have the ability to work another year or two to avoid "Sequence of Return" risk of a bear market during your first couple years of retirement. That way you're not drawing down assets during a market crash
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if you do it right, you should be able to weather at least 5 years of major downturn by drawing from things like bonds/cash/treasuries. I suggest never having money you might need in the next 5-10 years in stocks.
 
BLADEMDA said:
Still a wide open market with shortages in staffing I have never seen in 30 years. The thing is many of you just don’t know the market for services is so strong you can almost dictate hourly rates. This specialty needs the folks like me to stay in the game because there aren’t enough providers to go around
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How good?
 
chocomorsel said:
Why do people in our tax bracket need or want to work at that age?
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Mostly I'd guess a series of divorces and/or an obsession with keeping up with the Joneses next door (when Jones is an ortho spine surgeon) ...

Or maybe some people just like putting in epidurals at 3 AM. There's no accounting for taste. 🙂
 
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