Manpower?
Started by caligas
Academics here. Attending staffing has stayed the same. CRNAs are short-staffed. Residents are tired and have longed longer hours as a result. Education has fallen off as a result. PACU nurses have quit in droves. Pre-op has stayed fairly constant. OR scrub nurses and circulators are super short-staffed. Travel nurses everywhere. Several ORs closed every day. Overall morale is down. Admin doesn't care. Still running cases at 105% of 2019 numbers so hospital revenue is up and massive covid bailout money is in the coffers, but is not being shared.
are we in the same group?
Short staffed in the anesthesia department. Also nurses, techs are short staffed with many locums.
"PP" AMC here. There is a huge OR nursing and scrub tech shortage at my shop. Most left due to administration flaws with a second smaller exodus due to vaccine mandates. Because of this we are running at about 25% OR capacity - much worse than peak covid era. At 25% OR capacity we are overstaffed from an anesthesia standpoint. However, if we were at 100%, we would be understaffed at both attending and CRNA level.
He’s describing my place too
Small PP. Attending status always runs lean but we're managing. CRNAs short staffed and unable to find enough locums. Anes techs getting run ragged. OR staff short and losing more. Hospital over 115% capacity so no beds to get people out of PACU if they need admission, and PACU staff are all threatening to walk out if it becomes an overflow unit.
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Academic hospital, large city with a (currently) low COVID burden. Attendings/CRNAs fully staffed. We have some traveler OR staff and a lot of the circulators/scrubs are working overtime for big money. Preop is short and PACU has some people in orientation but should be fully staffed soon, but neither has affected day surgery throughput.
Biggest issue now is ICU/ER/floor nurse staffing - they're really stretched and the capacity of the hospital has been the limiting factor in OR volume.
Biggest issue now is ICU/ER/floor nurse staffing - they're really stretched and the capacity of the hospital has been the limiting factor in OR volume.
Short staffed unless you pay up for some questionable/mediocre folks.
I get that there are reasons to leave, but where do all the nursing staff and OR staff go? Do they just say “**** it” and retire? Staff shortage seems to be a nationwide issue.
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deleted126335
On a nationwide basis I think that it is a combination of factors.
Almost nobody was overstaffed with personnel pre-covid
Some have retired.
Some have just decided to work less and follow the money doing locums. If your hourly rate goes up, don't need to work as many hours to make same income. Some feel richer due to elevated financial and real estate holdings.
Some care has been postponed during covid. As a result there is a backlog of patients and they are sicker. As a result, Hospitals are running at full capacity almost continually when they would only do so intermittently.
Demographics are also finally coming home to roost. Boomers are getting older. Boomers are also fatter and sicker and need more care.
Our practice is OK with docs. Maybe a little short. Very short on CRNAs.
Travel nursing…. circulating nurses making almost 200/hr while still moving like a sloth bear as they get trained at their new travel assignment. Should have just bumped the pay of the local nursing staff so we could retain more. We are still busy as hell during the week and weekends (1-2 elective spine lines on sat/sun). However, the cost of nursing to run those lines has sky rocketed. AMC/No CRNA’s.
Also, accelerated burnout from a variety of factors including Covid issues/patients and vaccine resistance
When I work my primary job with the military we almost never do cases at night or on the weekends, we are all salaried so no incentive for our surgeons to lose sleep or work extra. Everyone wants to go home at 3pm.
I locums at several civilian hospitals and it is the exact opposite. Call in people from home any time, day or night, for non-emergent cases. It is only tolerable for me since I get paid extremely well and I pick the days I want to work. I can’t see those hospitals ever being fully staffed :/
I locums at several civilian hospitals and it is the exact opposite. Call in people from home any time, day or night, for non-emergent cases. It is only tolerable for me since I get paid extremely well and I pick the days I want to work. I can’t see those hospitals ever being fully staffed :/
Short on CRNA's.
COVID money made paying high prices for locums viable. Many FT CRNA's jumped to locums for the cash grab ($200-240/hr). Which left spots needing to be filled, so they stole other FT CRNA's or went with locums further increasing demand. Repeat cycle with more FT CRNA's jumping to locums. At this point it is best to try to retain/keep current staff gruntled.
Just need to weather this storm. Who would've guessed that excessive government assistance would be detrimental? (By excessive I mean, a local hospital was profitable for the first time in 6 years!?!?! Help like that doesn't help)
COVID money made paying high prices for locums viable. Many FT CRNA's jumped to locums for the cash grab ($200-240/hr). Which left spots needing to be filled, so they stole other FT CRNA's or went with locums further increasing demand. Repeat cycle with more FT CRNA's jumping to locums. At this point it is best to try to retain/keep current staff gruntled.
Just need to weather this storm. Who would've guessed that excessive government assistance would be detrimental? (By excessive I mean, a local hospital was profitable for the first time in 6 years!?!?! Help like that doesn't help)
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deleted87051
The grill in our cafeteria is closed because they don’t have enough people to staff it. Things are bad.
Is anyone shocked that no one would work if they get a bunch of free money from our tax dollars?
btw sevo do you have a link to apply to be a circulator at your hospital? I could use some more moonlighting.
btw sevo do you have a link to apply to be a circulator at your hospital? I could use some more moonlighting.
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deleted643396
Nurses have always been good about demanding the highest price for the value they provide. Physicians, on the other hand, are taught to turn the other cheek…
We had an unexpected retirement, so we are looking for a doc now. We will also hire a cards guy next summer. We are short on crnas.
Interestingly enough, my husband is a pilot and their job market is hot for the candidates now. It isn’t all government money…. Some People retired, some changed careers, some want to scale back and not work so hard.
I think we under estimate the morbidity of covid - we aren’t counting those that are disabled and out of the work force from complications of blood clots, decubitus, or those w residual activity limiting heart and/or lung issues
Interestingly enough, my husband is a pilot and their job market is hot for the candidates now. It isn’t all government money…. Some People retired, some changed careers, some want to scale back and not work so hard.
I think we under estimate the morbidity of covid - we aren’t counting those that are disabled and out of the work force from complications of blood clots, decubitus, or those w residual activity limiting heart and/or lung issues
It seems everyone everywhere is short and hiring. I just found a practice to join next summer when I get out of the Navy, and the hard part was choosing between several really great options. Beyond what I was expecting just a few years ago.
My email and phone are full of locums needs every day. The places I've done locums at this year are chronically short and the rates are the highest I've seen since I finished residency in 2009.
It's a good time to be looking for a job.
My email and phone are full of locums needs every day. The places I've done locums at this year are chronically short and the rates are the highest I've seen since I finished residency in 2009.
It's a good time to be looking for a job.
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deleted126335
Yup. Pleasantly surprised. A few years ago, I would have bet good money that the job market would be **** about now. Said so in multiple posts.
On the flip side: Supervision ratios are up, Physician administered anesthesia is down. I would bet that units produced per doc per year is up and OR efficiency is up. In short, definitely earning your salary. We seem to always be running four rooms per doc throughout the day.
We're looking at one on Tuesday that's on 65. About 19-20 minutes from the main hospital. If it lives up to the photos we'll make an offer on it. If it doesn't pan out we'll keep looking. No real rush since we're not moving until May. Plenty of time to find something great.
The practice I'm joining has a good mix of solo practice, and some 1:3 days. One of the other finalists was 1:4 all the time - it's a really well run place, and pay was spectacular, and the hours/vacation were great, but I didn't want to completely give up solo practice and the geography wasn't ideal. It was hard to turn down though. I did consider one practice that's 100% physician-only, a real rarity on the east coast, perfectly equitable, but it didn't feel like as good a personal fit. That was tough to turn down also. In the end accepted a bit less money for what I think is the perfect group for me. Hoping to be there for the rest of my career.
If theres such a shortage, why are people still getting lowball offers? You'd think they would increase the comp rather than let ORs go unused.
United States Faces a Shortage of Anesthesia Providers
Labor market trends suggest that the U.S. is experiencing a shortage of both anesthesiologists and certified registered nurse anesthetists. This could limit access to high-quality care, especially in light of growing demand for surgical and interventional procedures for an aging population.
Same reason why pharmacy bitches about sugammadex use when it clearly decreases the number of patients who have respiratory issues/need a vent postop
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Private practice in Ca
The big Hospital has not done elective cases for several months “COVID” and driving all the surgeons / patients to the surgery center/ with ability to admit patients for postop pain control. The surgery center owned by USPI / tenet? is busy like hell every day starting from 6 am and goes on till 8 pm . Most rooms however get done by 4-5 pm. Even saturdays one room is running. Severe shortage of experienced OR nurses. Full off recent nurse grads in or (clueless) and in PACU. Lots of turnover of CRNA. The surgeons are tired of seeing new faces every day and the admin is driving the Surgeons Crazy.
The big inefficient Hospital is going to be turned into a county teaching hospital with all its woke politics and huge taxpayers subsidies, while another hospital is going to get 600 million dollars to build 100 bed hospital. (inflation is 300%; it used to be 2 million dollars per bed)
One of the busy spine surgeon /orthopedic wants only doctors in his rooms. The pain physicians don’t want their patients to get a huge anesthesia bill, they prefer sedation nurses over CRNA. They are very few well trained experienced nurses who are comfortable giving sedation.
very interesting times
The big Hospital has not done elective cases for several months “COVID” and driving all the surgeons / patients to the surgery center/ with ability to admit patients for postop pain control. The surgery center owned by USPI / tenet? is busy like hell every day starting from 6 am and goes on till 8 pm . Most rooms however get done by 4-5 pm. Even saturdays one room is running. Severe shortage of experienced OR nurses. Full off recent nurse grads in or (clueless) and in PACU. Lots of turnover of CRNA. The surgeons are tired of seeing new faces every day and the admin is driving the Surgeons Crazy.
The big inefficient Hospital is going to be turned into a county teaching hospital with all its woke politics and huge taxpayers subsidies, while another hospital is going to get 600 million dollars to build 100 bed hospital. (inflation is 300%; it used to be 2 million dollars per bed)
One of the busy spine surgeon /orthopedic wants only doctors in his rooms. The pain physicians don’t want their patients to get a huge anesthesia bill, they prefer sedation nurses over CRNA. They are very few well trained experienced nurses who are comfortable giving sedation.
very interesting times
We are properly staffed for Physicians but need more CRNAs, always. There’s lots of competition in the city and we are not the highest offer, nor the most flexible, and lots of people want nothing to do with super sick kids. We haven't gone a year without hiring at least one physician in probably 20 years. Always expanding. The one benefit of being chronically down in CRNAs is we do a lot of cases solo, which is fine by me. I probably do close to 30% of the work myself. I can’t imagine covering 1:4, you really couldn’t pay me enough. Well, you probably could, but nobody would. 😆
The ORs have been understaffed for nursing since before covid. That’s a miserable bunch. A few left for huge income travel nursing jobs.
The ORs have been understaffed for nursing since before covid. That’s a miserable bunch. A few left for huge income travel nursing jobs.
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For all those who are short on CRNAs, why not change your staffing model and bring Physcians on board? I don’t understand.
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deleted126335
-Guaranteed short to intermediate term pain with no assurance of long term gain.
-staffing a room with a doc still (usually) costs more than staffing a room with a CRNA assuming (1:4)
-do you pay the doc who does their own room the same as one who covers four rooms and carries the pager?
-Some are willing and able to do their own room. Some not. Creates conflict.
I’m sorry, but this makes me cringe.
It should. I suspect it’s also reality in every supervision (including academics) practice across the country.
are their unemployed anesthesiologists sitting around doing nothing? Hiring physicians is a zero sum game nationally.
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Do you mean ‘there’? There may be physicians looking for a change of pace and desiring to do their own work. There may be anesthesiologists willing to help a place staff cases while on their vacation. This is what a lot of CRNAs do. Seems to me to be a poor business model for hospitals to offer the rates I’m seeing for locums CRNAs. >$200/hr for at times poor and at best unreliable care seems absurd if you ask me.
Three locums jobs I work now -
1099 262.50 - 285.00 / hr but I have to fly to get there, academic, cardiac work 1:1 with resident or general work 1:2
1099 227 / hr for general work 1:4, with flat rates around 1500/3000 for overnight/weekend call (usually light but sometimes busy), short travel by car but far enough that I have to stay in a hotel
W2 220 / hr general + cardiac work, no travel, stay at home
First job through locums agency. Others by word of mouth, networking with friends.
I mostly don't follow up on the headhunter emails and calls I get. Standing offer I leave with them is if they can find me majority cardiac work for over 270/h I'll look at it.
I'm getting out of the Navy in a few months though, joining a group full time. My locums traveling days are about done. I may occasionally cover a weekend or something at job #2 to help them out, but probably not often.
ill be honest, there are some docs out there that i cant even hire to supervise 2 rooms. forget about do their own cases. there is always an issue or problem they cause. lots of bad docs out there who are the ones available. in general, good docs typically stay employed for years at one place
because there are more CRNAs around, theres not just a pool of capable anesthesiologists ready to help out when called upon. crnas are more transient and typically have days off during the week ( 4 10hr shifts and they look to fill that extra day), no call obligations, etc..
Short staffed attendings and CRNAs. Running over 100% capacity compared to previous fiscal years. Not paid any bonuses. Where the **** is the money going?
I think you know.
Academic practice in Midwest. Multiple hospitals; worst shortages at the big Trauma & Transplant shop.
CRNAs now getting $45,000 sign-on, which is around $45,000 more than I got 6 yrs ago.
We’re having the “physicians-staff-rooms” discussions now; several are apoplectic (read: terrified) at the very notion of it, while we close rooms due to no CRNA staffing.
Ditto all others on the RNs and techs in the ED, ICU, and OR staffing. We actually have some that quit, joined a staffing company, have returned and are making THREE times the amount of the folks they worked with arm-and-arm for years, which has done wonders for morale.
CRNAs now getting $45,000 sign-on, which is around $45,000 more than I got 6 yrs ago.
We’re having the “physicians-staff-rooms” discussions now; several are apoplectic (read: terrified) at the very notion of it, while we close rooms due to no CRNA staffing.
Ditto all others on the RNs and techs in the ED, ICU, and OR staffing. We actually have some that quit, joined a staffing company, have returned and are making THREE times the amount of the folks they worked with arm-and-arm for years, which has done wonders for morale.
So what happens, guys go decades without doing a case themselves and they literally forget how to intubate etc?
I think probably more the knowing the flow of things. How to use the computer, where to get supplies, etc
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deleted87051
On his last day, I was asking one of our circulators about his new travel job. He said the same thing….that his pay would be 3x what he was getting at our place. I can’t say I blame people for taking these jobs. If I were in their shoes, I would probably do the same. We probably have retained 20-25% of the same staff we had at the beginning of 2020.
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