Manpower?

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caligas said:
So what happens, guys go decades without doing a case themselves and they literally forget how to intubate etc?
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These CRNAs are funny. First you hate 'em, then you get used to 'em. Enough time passes, you get so you depend on them. That's institutionalized.
 
How has the vaccine mandate effected y’all? I work at a Midwest regional hospital that is part of a huge hospital system - first shot is due in December. There’s big talk of a system wide walk out by the unvaccinated. Ancillary staff like dietary, rad tech, and EVS quitting left and right.
 
gcc322 said:
How has the vaccine mandate effected y’all? I work at a Midwest regional hospital that is part of a huge hospital system - first shot is due in December. There’s big talk of a system wide walk out by the unvaccinated. Ancillary staff like dietary, rad tech, and EVS quitting left and right.
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Our hospital is requiring vaccine OR weekly COVID test. Saved a lot of people from quitting. Vaccination rates in the hospital are something like high 80s low 90s I believe.
 
pgg said:
These CRNAs are funny. First you hate 'em, then you get used to 'em. Enough time passes, you get so you depend on them. That's institutionalized.
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dr doze said:
-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.
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How is hiring a physician a guaranteed short term pain with no assurance of long term gain? Please explain.
You staff a room with a doc and they work longer hours, don't get all those twice a day breaks, if fee for service they are motivated to keep things moving.... I don't see the problem. One doc probably overall does the job of two CRNAs
Yes, everyone gets paid equally regardless of who is in their own cases versus supervising. That's why you rotate the physician only days. Easy fix.
If you got people who aren't able to do their own cases, then that's a systems issue. That is why it's good to be in a practice that does at least some of your own cases so you don't forget how to sit the stool.

Practices like yours seems to just be all about the money and find all kinds of excuses to be all about using the CRNAs strictly to make money. Hell we all want to make money, but come on. You don't think finding a good doc or two to replace the CRNAs would be a good long term solution? Money aside, as in you potentially getting a smaller slice of the pie, why the hell not?

Some of these CRNAs are horrendous. I work in a hospital where the CRNAs are independent and one gave my 94 year old patient 200mg of Ketamine for a simple EGD from a stoma. And she's demented AF. Don't even begin to ask me about why we are scoping 90+ year olds, that's another story altogether. And we have all saved their asses repeatedly because they are doing stupid **** unknowingly.

I know there are some bad docs out there (and sounds like so in your practice i.e "aren't able to do their own room") but these CRNAs are overall way more questionable.
 
chocomorsel said:
How is hiring a physician a guaranteed short term pain with no assurance of long term gain? Please explain.
You staff a room with a doc and they work longer hours, don't get all those twice a day breaks, if fee for service they are motivated to keep things moving.... I don't see the problem. One doc probably overall does the job of two CRNAs
Yes, everyone gets paid equally regardless of who is in their own cases versus supervising. That's why you rotate the physician only days. Easy fix.
If you got people who aren't able to do their own cases, then that's a systems issue. That is why it's good to be in a practice that does at least some of your own cases so you don't forget how to sit the stool.

Practices like yours seems to just be all about the money and find all kinds of excuses to be all about using the CRNAs strictly to make money. Hell we all want to make money, but come on. You don't think finding a good doc or two to replace the CRNAs would be a good long term solution? Money aside, as in you potentially getting a smaller slice of the pie, why the hell not?

Some of these CRNAs are horrendous. I work in a hospital where the CRNAs are independent and one gave my 94 year old patient 200mg of Ketamine for a simple EGD from a stoma. And she's demented AF. Don't even begin to ask me about why we are scoping 90+ year olds, that's another story altogether. And we have all saved their asses repeatedly because they are doing stupid **** unknowingly.

I know there are some bad docs out there (and sounds like so in your practice i.e "aren't able to do their own room") but these CRNAs are overall way more questionable.
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At least that crna knew where to get the ketamine from. Maybe can't say the same about some of the pure supervising docs.
 
Southpaw said:
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.
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there are simply more CRNAs available to work a shift here or there. Lots of them only work 3 12 hour shifts a week at their day job. There are very few anesthesiologists that do not already have a full time job taking up 95% of their time.
 
My group in the NorthEast is extremely short. Partners like myself are working more hours, post call, late days and increased volume (due to pts reaching their deductible) hasn’t helped. We don’t have significant help on the way unfortunately. The last 2 years have accelerated my plans to reclaim some of my time by stopping call sooner than later. I have plans to be a snow bird during the winter months and work somewhere warm so I can continue golfing in perpetuity
 
Mman said:
there are simply more CRNAs available to work a shift here or there. Lots of them only work 3 12 hour shifts a week at their day job. There are very few anesthesiologists that do not already have a full time job taking up 95% of their time.
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Agree with you there. Doesn’t change the fact that if a hospital is short and considering closing ORs due to CRNA shortage a viable solution is opening it up to anesthesiologists as well as CRNAs, especially if the locums rate for CRNAs is holding the system hostage. But whatever. Hospitals are paying it and far as I can tell they aren’t crying ‘uncle’. Just seems absurd.
 
Mman said:
there are simply more CRNAs available to work a shift here or there. Lots of them only work 3 12 hour shifts a week at their day job. There are very few anesthesiologists that do not already have a full time job taking up 95% of their time.
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I work a week on week off in TX. On my week off I have tried finding a shift or two here and there. Do you know what I have been offered? Less than $200. So I keep doing ICU prn work instead.
Also there are part timers out there who are looking for shifts here and there in every city I bet. People who don’t want to work full time for a multitude of reasons. Part time work ain’t only for nurses you know. Have you put out an ad for a prn doc and not gotten anything? I know your practice is 1:4 ACT, so that’s not what you look for.
I would love for you to prove me wrong and say, we have tried and failed to bring on part time docs or even a full time one instead of “there are more CRNAs out there”
 
chocomorsel said:
I work a week on week off in TX. On my week off I have tried finding a shift or two here and there. Do you know what I have been offered? Less than $200. So I keep doing ICU prn work instead.
Also there are part timers out there who are looking for shifts here and there in every city I bet. People who don’t want to work full time for a multitude of reasons. Part time work ain’t only for nurses you know. Have you put out an ad for a prn doc and not gotten anything? I know your practice is 1:4 ACT, so that’s not what you look for.
I would love for you to prove me wrong and say, we have tried and failed to bring on part time docs or even a full time one instead of “there are more CRNAs out there”
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we haven't had to use locums recently so I do not know what responses we would get. If we did it would still be infinitely cheaper for us to hire a CRNA than a doc, even part time. I do not live in a large city. I do not think there is a single unemployed anesthesiologist within 75 miles of me. The ones in our area that do locums just use their week of vacation to go cover somebody else's week of vacation elsewhere. If one of the hospitals needed another person, it would require hiring someone full time from elsewhere. I also don't know of anywhere around that has been closing ORs for lack of staff.
 
Right now the better locums rates seem to be at surgicenters and offices. That’s where you can find a supply of anesthesiologists looking for work. I hear about rates $300/hr or more in the northeast. I’ve had a couple friends leave their employed jobs making >$500k to pursue the locums opportunities that are out there. Whether or not that is a good decision remains to be seen. CRNAs are also in high demand right now and many won’t work for anything under $200/hr. If the CRNA rates keep climbing, they may price themselves out of the market.

It’s also a good time to be a critical care nurse. Rates $100/hr are common and closer to $150/hr is not impossible to find.
 
We don't use locums docs or anesthetists at all. With our large group, we can almost always get someone to work on one of their vacation days when we're short-handed. We work with the OR schedulers to combine rooms as needed and where possible based on staffing. This occasionally means people will have to cross facilities during the day, but we do what we have do to.

We still need docs and anesthetists because we're always expanding. Closing ORs is not remotely being considered since we re-opened them in 2020 after the first wave. Our doc turnover is not too bad. Our anesthetist turnover is higher than I'd like, but hopefully being addressed at the corporate level. That's something I HATE about AMCs. Decisions, particularly those dealing with hiring and compensation, that used to be made locally now have to run up the corporate ladder and wait for decisions from several layers of "management". What could previously be addressed in a couple of weeks now takes many months.
 
Mman said:
we haven't had to use locums recently so I do not know what responses we would get. If we did it would still be infinitely cheaper for us to hire a CRNA than a doc, even part time. I do not live in a large city. I do not think there is a single unemployed anesthesiologist within 75 miles of me. The ones in our area that do locums just use their week of vacation to go cover somebody else's week of vacation elsewhere. If one of the hospitals needed another person, it would require hiring someone full time from elsewhere. I also don't know of anywhere around that has been closing ORs for lack of staff.
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How infinitely cheaper? $200 hr versus $275-300 hour? That's infinitely cheaper?
And maybe there aren't unemployed docs, but you can probably find some part time docs. They are everywhere, mostly women, being dragged by their spouses to many of these smaller towns where they often don't have to work that much. I locums in a lot of small towns and always run into part time women.
 
chocomorsel said:
How infinitely cheaper? $200 hr versus $275-300 hour? That's infinitely cheaper?
And maybe there aren't unemployed docs, but you can probably find some part time docs. They are everywhere, mostly women, being dragged by their spouses to many of these smaller towns where they often don't have to work that much. I locums in a lot of small towns and always run into part time women.
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Our CRNAs that do locums on their time off generally go make $125-150/hr (at least that is what they tell me), the docs around $225-$250/hr. But hiring a full time doc (or even part time equivalent) costs us way more than that locums rate, since we treat them fairly.
 
Had no idea that the nation was facing our group’s same conundrum.

We have ~11 docs on site and supervise ~1:3. Usually a doc or 2 has their own room, at least from 7:30-lunch.

CRNAs have left for signing bonuses elsewhere, and because ORs have gotten busier/later. We’ve also acquired more surgery centers so some staff is covering there; hospital coverage is that much tighter. With less hospital CRNAs around, there’s no break CRNAs and the call team of 3 CRNAs works closer to 24h in rooms instead of being break and lunch people, and then going into a room in the evening.

Call CRNAs working every minute of a 24h shift upsets them.
Noncall CRNAs aren’t getting breaks - they’re upset.
Docs accustomed to signing charts and drinking coffee are captive in room for 5 hours breakless.
And ORs are as busy as ever so more docs are having to stay till 5, 6, 7pm.

Everyone is down in the dumps but I still find enjoyment in giving anesthesia, and try to keep a good attitude. I Never minded working hard, but frequently working late can be the pits.
 
ISoNitrous said:
Had no idea that the nation was facing our group’s same conundrum.

We have ~11 docs on site and supervise ~1:3. Usually a doc or 2 has their own room, at least from 7:30-lunch.

CRNAs have left for signing bonuses elsewhere, and because ORs have gotten busier/later. We’ve also acquired more surgery centers so some staff is covering there; hospital coverage is that much tighter. With less hospital CRNAs around, there’s no break CRNAs and the call team of 3 CRNAs works closer to 24h in rooms instead of being break and lunch people, and then going into a room in the evening.

Call CRNAs working every minute of a 24h shift upsets them.
Noncall CRNAs aren’t getting breaks - they’re upset.
Docs accustomed to signing charts and drinking coffee are captive in room for 5 hours breakless.
And ORs are as busy as ever so more docs are having to stay till 5, 6, 7pm.

Everyone is down in the dumps but I still find enjoyment in giving anesthesia, and try to keep a good attitude. I Never minded working hard, but frequently working late can be the pits.
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did you get a raise? or at least overtime pay?
 
ISoNitrous said:
Had no idea that the nation was facing our group’s same conundrum.

We have ~11 docs on site and supervise ~1:3. Usually a doc or 2 has their own room, at least from 7:30-lunch.

CRNAs have left for signing bonuses elsewhere, and because ORs have gotten busier/later. We’ve also acquired more surgery centers so some staff is covering there; hospital coverage is that much tighter. With less hospital CRNAs around, there’s no break CRNAs and the call team of 3 CRNAs works closer to 24h in rooms instead of being break and lunch people, and then going into a room in the evening.

Call CRNAs working every minute of a 24h shift upsets them.
Noncall CRNAs aren’t getting breaks - they’re upset.
Docs accustomed to signing charts and drinking coffee are captive in room for 5 hours breakless.
And ORs are as busy as ever so more docs are having to stay till 5, 6, 7pm.

Everyone is down in the dumps but I still find enjoyment in giving anesthesia, and try to keep a good attitude. I Never minded working hard, but frequently working late can be the pits.
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Fourth paragraph, 1st three lines.
And that is the problem right there.
People are upset because they are actually WORKING, at work.

I must have missed the memo.
I don’t suppose you see anything wrong with that do you?

In physician only groups, there is most often no lunch or break person. The docs do sometimes rot in rooms or work the entire call shift. I am not necessarily a fan of the go, go, go no break mentality, however I am also not a fan of “I need my two breaks a day” or “please don’t let me rot in a room for five hours when all I know and am comfortable doing is signing charts, drinking coffee and watching Fox News.”

Come on.
 
chocomorsel said:
Fourth paragraph, 1st three lines.
And that is the problem right there.
People are upset because they are actually WORKING, at work.

I must have missed the memo.
I don’t suppose you see anything wrong with that do you?

In physician only groups, there is most often no lunch or break person. The docs do sometimes rot in rooms or work the entire call shift. I am not necessarily a fan of the go, go, go no break mentality, however I am also not a fan of “I need my two breaks a day” or “please don’t let me rot in a room for five hours when all I know and am comfortable doing is signing charts, drinking coffee and watching Fox News.”

Come on.
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I agree with you. And being only 15 months out of training, Im accustomed to working for the entirety of the work day.

But when a precedent has been set for people that have worked there for decades, and people take jobs under the pretense that “on a 24call day, you’ll get to have a light daytime in preparation for a sleepless night/we never spend 22hours of the shift in the room,” people grow upset.

I’m not sure if the nursing breaks are union guaranteed or anything, but if a CRNA has been getting breaks consistently throughout their tenure, and now the “perk” disappears - working more for no extra pay is a worse deal. Hence their distaste.
 
Can anyone elaborate on how this scenario is playing out at the fee for service/eat what you kill groups? More work=more$$$? Is there the same morale hit amongst the docs?
 
caligas said:
Bumping.

I assume the situation is worse for most folks out there? We are struggling to recruit.
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All groups are hiring in our big metro area. We’ve recruited maybe a third of our total needed workforce so far. Hours are long.
 
We had a major bump for CRNA salaries. Now it is less terrible and moving in the right direction. Still have a ways tom go.
 
Maybe your group/institutions aren’t offering enough to compete if you are still short staffed. People still want to offer 350-400k for partner track and similar for employed models LMAOOO.

Offer 550+/8weeks and I bet you will start getting interested MD/DOs
 
JiPo said:
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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A lot of our travelers will work for 2-3 months, then take 6 weeks off. The higher pay is aggravating the labor shortage.
 
GandalfTheWhite said:
Maybe your group/institutions aren’t offering enough to compete if you are still short staffed. People still want to offer 350-400k for partner track and similar for employed models LMAOOO.

Offer 550+/8weeks and I bet you will start getting interested MD/DOs
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Even with those offers, many places are still short.
 
Issue is that there isn't enough supply. All the groups are just poaching from each other.

Alot of older docs retired or left the state and newer docs don't want to work as hard
 
UscGhost said:
Issue is that there isn't enough supply. All the groups are just poaching from each other.

Alot of older docs retired or left the state and newer docs don't want to work as hard
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I'd happily work residency hours for 400/hr, Problem is, are hospitals willing to pay for it? Theyd rather let the OR go unutilized lol
 
UscGhost said:
Issue is that there isn't enough supply. All the groups are just poaching from each other.

Alot of older docs retired or left the state and newer docs don't want to work as hard
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You forgot two words: “…newer docs don’t want to work as hard for less.”
 
gcc322 said:
Newer doc here…I enjoy my time off. Student loans paid off. Just a mortgage. Save plenty. What’s more money going to get me? More problems…
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I’m not a high baller . . . But a paid off mortgage is a nice place to be. The expenses are gas, electricity, phones, internet, and taxes.
 
aneftp said:
There was so much Covid money the last 24 months. It’s drying up. The smart ones left 20 months ago to make the cash.

I know locums docs making 1 million plus Crnas locums making 400k

Pay up. People know their worth.
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Agree. Make hay while the sun is shining. Interesting to see if a (possible) bad bear market in stocks and real estate will make people work harder, defer or even come out of retirement.
 
Dr. Rude said:
Agree. Make hay while the sun is shining. Interesting to see if a (possible) bad bear market in stocks and real estate will make people work harder, defer or even come out of retirement.
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Thought provoking for sure.
 
I wonder if the trend among new grads/newer grads is the lifestyle control locums offers until you decide you want to slow down. Any new grad money is better than resident money and I wouldn't be shocked if the current attitude is "Work a month. Vacation a month". Even 6 months of locum salary is way more than resident salary and you're not constraining yourself to a "track".
 
Dr. Rude said:
Agree. Make hay while the sun is shining. Interesting to see if a (possible) bad bear market in stocks and real estate will make people work harder, defer or even come out of retirement.
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I would make a guess that most physicians that chose retirement over the past couple years are probably paid up on their homes or sold and moved to lower COL areas.
 
Twiggidy said:
I would make a guess that most physicians that chose retirement over the past couple years are probably paid up on their homes or sold and moved to lower COL areas.
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Yeah, but how many of them held more stocks than they should because of crappy yields?
 
GravelRider said:
You forgot two words: “…newer docs don’t want to work as hard for less.”
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Not necessarily saying it's a bad thing that they want to work less..just that it's a different calculation when looking at staffing.

Many older docs are comfortable taking more call, working post call, etc. Maybe it's because they have an expensive cocaine habit, divorce or like fast cars.

But now we need to hire 1.2 FT docs to produce the same coverage as 1 older FT doc.

"Less" pay is debatable. Our group pays more now than it has in years. Probably less than the golden years of medicine though....
 
UscGhost said:
Not necessarily saying it's a bad thing that they want to work less..just that it's a different calculation when looking at staffing.

Many older docs are comfortable taking more call, working post call, etc. Maybe it's because they have an expensive cocaine habit, divorce or like fast cars.

But now we need to hire 1.2 FT docs to produce the same coverage as 1 older FT doc.

"Less" pay is debatable. Our group pays more now than it has in years. Probably less than the golden years of medicine though....
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I mean, ill definitely bust my ass to ride in that 911 Turbo S... atleast until its paid off.
 
Twiggidy said:
I wonder if the trend among new grads/newer grads is the lifestyle control locums offers until you decide you want to slow down. Any new grad money is better than resident money and I wouldn't be shocked if the current attitude is "Work a month. Vacation a month". Even 6 months of locum salary is way more than resident salary and you're not constraining yourself to a "track".
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Not impossible to make 400k (1099, so caveats apply) doing locums and still take 6 months off.
 
nimbus said:
There’s the catch. Kids in school and childcare duties are not compatible with locums lifestyle.
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Very happily married with kids, but man, some days I reminisce about simpler times. I’m sure it’s not all good into your later years, but I was damn happy being single back then.
 
Twiggidy said:
I believe it. If I were single with no children I would absolute do the "traveling anesthesiologists" thing.
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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.
 
GandalfTheWhite said:
Then offer more......
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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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