Medical Direction of CRNAs

[HalO'Thane]

For those that are in a medical direction practice with CRNAs, do you have anything in writing for how conflicts are resolved? Say, for example, there is a disagreement about whether you think a patient for a trauma needs blood or a disagreement on whether to intubate a patient vs an LMA, is it written anywhere that the final decision is ultimately with the anesthesiologist? If there continues to be conflict, particularly if you think patient safety is at risk, is there a formal policy on how to escalate this up the chain of command, either within the department or beyond?

I would say about 90% of my interactions with CRNAs go pretty smoothly, but there are a small handful of them that have that undesirable combination of being strong willed and incompetent that makes for a strong day.

I am purposely asking for those in a medical direction model as it is my understanding that the CRNAs in a medical supervision model have a little more autonomy. I would also be more interested in those who are hospital/academic employees along with the CRNAs. I have previously worked in a private practice setting so I know that if you have the ability to directly hire and fire them yourself you will not have nearly as much conflict.

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[Urzuz]

Posts like this remind me of why I will do everything in my power to never leave an MD only practice, regardless of the financial/physical benefits that “directing” CRNAs from the lounge may offer.

 

[venacontracta]

One of the requirements for medical direction is that the anesthesiologist "prescribe the anesthetic plan." If the CRNA directly contradicts the anesthetic plan prescribed by the anesthesiologist, is this still medical direction?

 

[Mikkel]

For those that are in a medical direction practice with CRNAs, do you have anything in writing for how conflicts are resolved? Say, for example, there is a disagreement about whether you think a patient for a trauma needs blood or a disagreement on whether to intubate a patient vs an LMA, is it written anywhere that the final decision is ultimately with the anesthesiologist? If there continues to be conflict, particularly if you think patient safety is at risk, is there a formal policy on how to escalate this up the chain of command, either within the department or beyond?

I would say about 90% of my interactions with CRNAs go pretty smoothly, but there are a small handful of them that have that undesirable combination of being strong willed and incompetent that makes for a strong day.

I am purposely asking for those in a medical direction model as it is my understanding that the CRNAs in a medical supervision model have a little more autonomy. I would also be more interested in those who are hospital/academic employees along with the CRNAs. I have previously worked in a private practice setting so I know that if you have the ability to directly hire and fire them yourself you will not have nearly as much conflict.

Write every single thing you would do for a "good" anesthetic in the "plan" section of every pre-op evaluation, and make it a default template.

What's written is your plan, and failure to follow your plan is the mid-levels' failure.

 

[AdmiralChz]

I am purposely asking for those in a medical direction model as it is my understanding that the CRNAs in a medical supervision model have a little more autonomy. I would also be more interested in those who are hospital/academic employees along with the CRNAs. I have previously worked in a private practice setting so I know that if you have the ability to directly hire and fire them yourself you will not have nearly as much conflict

Yeah, this really is the key - if you’re involved in the hiring process you let them know up front this is a patient-centric, physician-led practice and all major decisions and portions of the case must involve the supervising physician. If they want a more CRNA-independent setup they are welcome to look elsewhere as this isn’t that kind of set up. Also on the backend if issues arise then you issue a formal warning during an in-person meeting and let them try to correct the issue or show them the door if it continues.

I’ve been medically directing for 18 months now and just about never has the CRNA tried to change the plan for something more liberal - it is nearly always a more conservative approach (intubate anyone with GERD on the chart for example), and I usually just go with it as it is nearly never dangerous.

However, I have definitely had situations where I wasn’t informed or decisions were made without my input - dealing with these issues ahead of time if possible is usually the best course. Come up with a plan in preop and go overspecifics - like a deep extubation, drips for a neuro case etc.

If you’ve got problem children that are going against you as you suggest, OP, I’d probably try to sideline them and try to address it. Be specific with why the selected management was poor and what changes you are making, then reiterate that this is medical direction and you have final say. Try to meet them halfway and see what their thoughts were and correct if necessary - don’t treat them with a top-down nasty approach one would with residents or everyone will hate your guts.

If all that fails, talk to your more senior colleagues and see what they’ve done. At the majority to academic centers, mid level contracts explicitly dictate a physician is to provide supervision and direction. There may be a mid level office or administrator you could speak with as well - again, use specifics and avoid emotional “I am the captain now” mentality. You could also bring it up at a departmental meeting or a medical staff meeting.

And peeps on this thread - try to be constructive here. Advice of “go find a MD only group” isn’t practical for most of us and we need to help our colleagues protect our physician-led care. If one is part of a group that allows significant mid level independence “top of license” nonsense like i saw in residency, ring the alarm and do what you can to protect your patients. For what it’s worth, the ICUs and EDs has much more difficulty controlling their NPs and PAs than our department did the CRNAs.

 

[PieOHmy]

This is prob. the least desirable things to deal with. In a Medical direction model you make many concessions.
The problem with "Its my way or the highway" attitude is that you will have a revolving door of crnas because they will all leave. They will make your life difficult, and eventually you will concede. This is the way it is in medical direction. Frankly, even if you play hard-ass, your colleagues are laissez faire and this will sabotage you. How can you be the only one who says,"You better call me for extubation.. when your colleagues are NEVER saying that.
And nobody will help you deal with a conflict.. If you have ac onflict with a crna they will get rid of you before the crna

 

[deleted126335]

I have said this verbatim:

You are here to help implement my anesthetic plan. I am not here to rubber stamp yours. I am your supervisor. The docs in this department vary with supervision style and personal preferences. You just have to accept this or we will have a problem. If I ask you to do something that you beieve is unsafe I expect you to speak up. If I ask you to do something that is not your personal preference you just have to bite your tongue and do it. I am your supervisor. I am willing to take this further if need be."
If they don't believe that you have the ability and willingness to follow through, it will not be effective.
You will make blood enemies. But you will feel better if they don't drive you out. Also, the other docs may play politics against you with the other CRNAs. Been there.

 

[Mman]

For those that are in a medical direction practice with CRNAs, do you have anything in writing for how conflicts are resolved?

I (we) sign their paycheck. That's in writing enough. Don't like it, don't get paid. We have zero problems.

 

[PieOHmy]

I have said this verbatim:

You are here to help implement my anesthetic plan. I am not here to rubber stamp yours. I am your supervisor. The docs in this department vary with supervision style and personal preferences. You just have to accept this or we will have a problem. If I ask you to do something that you beieve is unsafe I expect you to speak up. If I ask you to do something that is not your personal preference you just have to bite your tongue and do it. I am your supervisor. I am willing to take this further if need be."
If they don't believe that you have the ability and willingness to follow through, it will not be effective.
You will make blood enemies. But you will feel better if they don't drive you out. Also, the other docs may play politics against you with the other CRNAs. Been there.

LOL
I believe everything you are writing and agree with it. However, in a true busy 4:1 medical direction model when you are signing into 18-24 charts per day if you start picking little turf battles and pulling rank often you just simply wont survive and the reason has nothing to do with what the CRNAs will do to you. You just simply will run out of steam and either quit or end it all.

So most take the path of least resistance which is why we are where we are.

 

[narcotics999]

What is difference between medical direction and medical supervision?

Direction: you recommend a plan. CRNA is free to take it or ignore it?

Supervision: you are the boss.

Either way, when sh?t happens, the MD is on the hook?

 

[Consigliere]

I am purposely asking for those in a medical direction model as it is my understanding that the CRNAs in a medical supervision model have a little more autonomy. I would also be more interested in those who are hospital/academic employees along with the CRNAs. I have previously worked in a private practice setting so I know that if you have the ability to directly hire and fire them yourself you will not have nearly as much conflict.

There's the problem. I did this for a couple years and will NEVER do it again. You have no power over the disgruntled, know-it-all anesthesia nurses and they know it. Discipline them? Won't be done. Fire them? Nope. You are the problem, you are more expendable, and you will be on Gaswork looking for a job.

 

[Consigliere]

What is difference between medical direction and medical supervision?

Direction: you recommend a plan. CRNA is free to take it or ignore it?

Supervision: you are the boss.

Either way, when sh?t happens, the MD is on the hook?

You got that bass ackwards, pal.

 

[2Fast2Des]

The amazing part is how easily expendable a doc is compared to a CRNA. 1 CRNA in our group is causing trouble, making enemies among nurses, surgeons and causing pt harm, no problem! Couple of our docs got canned because the senior guys didn't like being questioned, but the CRNA is immune, it's amazing

 

[MoMoGesiologist]

I’ve found CRNAs (at least where I am), tend to be more timid and conservative (maybe because they’re younger?), so I am usually comfortable with the changes they suggest.

Are your CRNAs suggesting dangerous things, like LMA in an SBO? Or are we talking about personal preferences like giving ketamine?

I’ll usually say “if you are uncomfortable with anything, let me know and we can make some changes, and if I am uncomfortable, I’ll let you know and we can adjust the plan”. People respond well when they feel heard and respected and part of the team. If the CRNA is dangerous and unwilling to listen, bump that up. But be careful, admin usually doesn’t like people who make waves and cause issues. If the other MDs can work at this place, why are you unable to (they will ask).

 

[IlDestriero]

It all starts at hiring. We are crystal clear that we are actively involved in the anesthetic, develop the plan, place the lines, need to be notified of changes, etc. This isn’t a practice where they will have much autonomy, develop their own plans, etc.
There’s a group across town that is completely the opposite. 4:1 all the time, minimal involvement, placing blocks and signing charts all day. Go there if you want. We are 2:1, high acuity, involved, etc. Tow the line.
How to deal with it? Nip it in the bud. Discuss it at your MD only meeting. Right the ship. If it’s not a supervision job, it’s your plan, your anesthetic, your case. If they don’t like it, it’s not your problem. If your partners are not on board, it’s not the job for you.
We actually recently hired a CRNA that I’d bet $1000 won’t be here in 24 months. But they will tow the line while they’re here. They want to be working across town, they just haven’t realized it yet.

 

[HalO'Thane]

I am grateful for everyone’s suggestions. Some great ideas. I get the feeling that our department has grown too much too fast, both with the anesthesiologists and the CRNAs. We have hired a few problems CRNAs that want to have their cake and eat it too; where they want to act like they are our equals but when crap actually hits the fan they are content to walk away from the situation and let the physician deal with it. The scary thing is that most of them don’t realize how little they know. As a group I think my colleagues and I need to band together to address these issues more frequently and nip them in the bud sooner. There are practices in town that offer more autonomy which we need to make clear that they can go too if they are unhappy here.

 

[PieOHmy]

It all starts at hiring. We are crystal clear that we are actively involved in the anesthetic, develop the plan, place the lines, need to be notified of changes, etc. This isn’t a practice where they will have much autonomy, develop their own plans, etc.
There’s a group across town that is completely the opposite. 4:1 all the time, minimal involvement, placing blocks and signing charts all day. Go there if you want. We are 2:1, high acuity, involved, etc. Tow the line.
How to deal with it? Nip it in the bud. Discuss it at your MD only meeting. Right the ship. If it’s not a supervision job, it’s your plan, your anesthetic, your case. If they don’t like it, it’s not your problem. If your partners are not on board, it’s not the job for you.
We actually recently hired a CRNA that I’d bet $1000 won’t be here in 24 months. But they will tow the line while they’re here. They want to be working across town, they just haven’t realized it yet.

The problem with taking the hard-line with them is there are practices such as the one you discuss across town that allow them to do all central lines, blocks, epidurals with m inimal involvement and you will continually lose crnas to. Recruiting and retention is a problem nowadays. SO unless you have a steady stream of CRNAS yearly you wont be hiring any crnas. This is why there needs to be AA legislation in all states.

 

[IlDestriero]

I practice in a big desirable city in an Ivory Tower specialty hospital. We don’t have problems recruiting and retaining CRNAs. We’ve lost a couple to that practice and others, and that’s fine. If that’s what they want, let them go. They come here to work here, do specialized peds cases, do crazy high acuity stuff frequently, syndromes you’ve never heard of, be at the tip of the spear. Across town they may take care of some sick old people, but they’re not at the cutting edge of anything.
The couple former CRNAs that I miss the most left to work at SRNA training programs. But that’s where they belong and that’s what makes them happy. They will be great there.

Don’t forget that the key here is to pick your battles wisely. I’m particular about a few things, I have reasons I’m happy to share if they ask. Other faculty may be particular about other things or more “liberal”. They need to learn that and follow the plan of the day.

 

[deleted50478]

The problem with taking the hard-line with them is there are practices such as the one you discuss across town that allow them to do all central lines, blocks, epidurals with m inimal involvement and you will continually lose crnas to. Recruiting and retention is a problem nowadays. SO unless you have a steady stream of CRNAS yearly you wont be hiring any crnas. This is why there needs to be AA legislation in all states.

You can do all the lines and blocks and the CRNA’s still won’t move across town if you pay a couple of bucks more per hour or let them leave at a predictable time more than the other practice. Some (not all, probably not most) CRNA’s value pseudo-autonomy more than money and scheduling, but most don’t. I think most don’t want real autonomy.
Also, you can do all the lines and blocks and have final say in the plan (obviously) and still have a good relationship with CRNA’s if you treat them as valued members of the team. The linemen know they are linemen and not the quarterback, but unless the quarterback is a prick and they feel disrespected and unappreciated, they’re happy doing their job.

 

[dannyboy1]

For those that are in a medical direction practice with CRNAs, do you have anything in writing for how conflicts are resolved? Say, for example, there is a disagreement about whether you think a patient for a trauma needs blood or a disagreement on whether to intubate a patient vs an LMA, is it written anywhere that the final decision is ultimately with the anesthesiologist? If there continues to be conflict, particularly if you think patient safety is at risk, is there a formal policy on how to escalate this up the chain of command, either within the department or beyond?

I would say about 90% of my interactions with CRNAs go pretty smoothly, but there are a small handful of them that have that undesirable combination of being strong willed and incompetent that makes for a strong day.

I am purposely asking for those in a medical direction model as it is my understanding that the CRNAs in a medical supervision model have a little more autonomy. I would also be more interested in those who are hospital/academic employees along with the CRNAs. I have previously worked in a private practice setting so I know that if you have the ability to directly hire and fire them yourself you will not have nearly as much conflict.

Like everything else in life, it’s knowing when to bend and when to take a stand. If you have to refer to some written rule somewhere and escalate disagreements then you have already lost.

Also, you can do all the lines and blocks and have final say in the plan (obviously) and still have a good relationship with CRNA’s if you treat them as valued members of the team. The linemen know they are linemen and not the quarterback, but unless the quarterback is a prick and they feel disrespected and unappreciated, they’re happy doing their job.

Surgeon is the quarterback. We are the fat offensive linemen. The CRNA’s are sometimes the cheerleaders and sometimes Antonio Brown....

 

[Bearsfan01]

Like everything else in life, it’s knowing when to bend and when to take a stand. If you have to refer to some written rule somewhere and escalate disagreements then you have already lost.

Surgeon is the quarterback. We are the fat offensive linemen. The CRNA’s are sometimes the cheerleaders and sometimes Antonio Brown....

For some reason in a lot of academic departments it is very hard to get rid of even the most incompetent of people. This is why you have to go through hoops like create written policies and create paper trails to document when providers aren’t being team players or are practicing unsafe anesthesia.

The medical field seems to be the only place that tolerates this level of BS. I just can’t imagine professionals working at places like Microsoft or BP having to put up with this type of crap from people that they are managing.

 

[caligas]

I’ll give a different perspective from from of the tough guys on here.

I give the CRNAs some freedom. I respectfully listen to their thinking and If it’s safe, then fine. If not (which really is pretty unusual), then I use my authority to make the final call.

 

[tennessee2244]

I’ll give a different perspective from from of the tough guys on here.

I give the CRNAs some freedom. I respectfully listen to their thinking and If it’s safe, then fine. If not (which really is pretty unusual), then I use my authority to make the final call.

I bet you are a well respected leader in the perioperative arena. Listen up kids.

 

[deleted126335]

I’ll give a different perspective from from of the tough guys on here.

I give the CRNAs some freedom. I respectfully listen to their thinking and If it’s safe, then fine. If not (which really is pretty unusual), then I use my authority to make the final call.

No kidding.
But that just doesn’t work in some departments with select CRNAs. Some of them just hate our presence and are openly disrespectful and are openly hostile and try to undermine our position to the extent that they can.






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[AdmiralChz]

For some reason in a lot of academic departments it is very hard to get rid of even the most incompetent of people

This is absolutely dead on the money and certainly not limited to anesthetists.

 

[PieOHmy]

For some reason in a lot of academic departments it is very hard to get rid of even the most incompetent of people. This is why you have to go through hoops like create written policies and create paper trails to document when providers aren’t being team players or are practicing unsafe anesthesia.

The medical field seems to be the only place that tolerates this level of BS. I just can’t imagine professionals working at places like Microsoft or BP having to put up with this type of crap from people that they are managing.

How can it be hard to get rid of someone? Just don't renew their contract. Solved.

 

[chocomorsel]

There's the problem. I did this for a couple years and will NEVER do it again. You have no power over the disgruntled, know-it-all anesthesia nurses and they know it. Discipline them? Won't be done. Fire them? Nope. You are the problem, you are more expendable, and you will be on Gaswork looking for a job.

Yeah.... but how much Moolah did you make off those nurses?
I actually thought when you worked with them that YOU hired and fired them no?

 

[chocomorsel]

No kidding.
But that just doesn’t work in some departments with select CRNAs. Some of them just hate our presence and are openly disrespectful and are openly hostile and try to undermine our position to the extent that they can.






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Then leave.

 

[deleted126335]

Then leave.

I did. That was my last practice.


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[deleted573262]

I did. That was my last practice.


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this will only become more common as crna distinction blurs. all part of the plan to decrease reimbursement for docs.

 

[chocomorsel]

I did. That was my last practice.


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Good for you. Been there, done that as well. Currently working at two gigs. One with rogue CRNAs and one with very pleasant ones. Good thing it’s only temporary.

 

[PieOHmy]

this will only become more common as crna distinction blurs. all part of the plan to decrease reimbursement for docs.

It really is a conspiracy and everyone is in on it, the hospitals, licensing boards, specialty boards, the congressmen and senators, the insurance companies, obama was in on it. I can see it clear as day. They stack the deck against us so much, and when there is a bad outcome the legal system comes down on us like a ton of bricks.

 

[deleted126335]

this will only become more common as crna distinction blurs. all part of the plan to decrease reimbursement for docs.

More likely to see decreased effort from docs and more of a civil servant mentality while keeping current gig. Look for reasons not to do things, CYA, don’t piss off too many people, etc. That’s what the scene is like at that practice for a very long time. Now owned by one of the big AMCs


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[Consigliere]

Yeah.... but how much Moolah did you make off those nurses?
I actually thought when you worked with them that YOU hired and fired them no?

Correct. At first they were hospital employees, but after a few years of effective negotiating, we hired them. We immediately fired the troublemakers, hired a few more, expanded, and make a filthy amount of money. The end.

 

[Consigliere]

Oh yeah.....EAGLES NFC EAST CHAMPS!!

 

[Arch Guillotti]

Correct. At first they were hospital employees, but after a few years of effective negotiating, we hired them. We immediately fired the troublemakers, hired a few more, expanded, and make a filthy amount of money. The end.

How much stipend did you get?

 

[Consigliere]

How much stipend did you get?

$500k at the one hospital.....$350k at the other. Nothing for the surgicenter (obviously).

 

[chocomorsel]

Correct. At first they were hospital employees, but after a few years of effective negotiating, we hired them. We immediately fired the troublemakers, hired a few more, expanded, and make a filthy amount of money. The end.

So I misread your statement. You changed the setup, but still work with them and now have total control over them. Thought you were trying to say that you left ACT practice.
Go ahead my brother!!! I don't hate the player if you must play the game. Are you making more money now that they are under your wing?

It seems like I see many practices saying they can't afford to hire them directly so would rather they be hospital employees instead. I don't understand that but have never been a partner to see the inner workings of running a practice and paying nurses, but I would think things would be much more smoother by having them as one's employees. Of course in the practice I left, there was this buddy-buddy relationship between the chief and one of the know it all CRNAs so that didn't work well either.

 

[Maverikk]

I practice in a big desirable city in an Ivory Tower specialty hospital. We don’t have problems recruiting and retaining CRNAs. We’ve lost a couple to that practice and others, and that’s fine. If that’s what they want, let them go. They come here to work here, do specialized peds cases, do crazy high acuity stuff frequently, syndromes you’ve never heard of, be at the tip of the spear. Across town they may take care of some sick old people, but they’re not at the cutting edge of anything.
The couple former CRNAs that I miss the most left to work at SRNA training programs. But that’s where they belong and that’s what makes them happy. They will be great there.

Don’t forget that the key here is to pick your battles wisely. I’m particular about a few things, I have reasons I’m happy to share if they ask. Other faculty may be particular about other things or more “liberal”. They need to learn that and follow the plan of the day.

Sounds like you've had experience. What are the things that you're particular about? Why?
And to all the soon to be attendings, and to remain constructive, doing your own cases initially gives you a leap on the learning curve and a big one. I know this from talking to other peeps who jumped right into supervision. When you're doing the bleeding tonsil for a 300lb teenager at 3am, the 98 year old for a hip nail or the SBO in with multiple medical problems and you're the only person besides a circulator who may be a traveling nurse without any experience you get very comfortable about communication and giving direction.

 

[Consigliere]

So I misread your statement. You changed the setup, but still work with them and now have total control over them. Thought you were trying to say that you left ACT practice.
Go ahead my brother!!! I don't hate the player if you must play the game. Are you making more money now that they are under your wing?

It seems like I see many practices saying they can't afford to hire them directly so would rather they be hospital employees instead. I don't understand that but have never been a partner to see the inner workings of running a practice and paying nurses, but I would think things would be much more smoother by having them as one's employees. Of course in the practice I left, there was this buddy-buddy relationship between the chief and one of the know it all CRNAs so that didn't work well either.

We get a stipend and I am probably gonna be leaving anesthesia to do something different. Stick a fork in me kid, cuz I'm done.

 

[chocomorsel]

We get a stipend and I am probably gonna be leaving anesthesia to do something different. Stick a fork in me kid, cuz I'm done.

I wish I had that option. I am still grinding and gonna be for a minute. But not in this country for ever so at least the politics will change.
Good for you.

 

[Consigliere]

I wish I had that option. I am still grinding and gonna be for a minute. But not in this country for ever so at least the politics will change.
Good for you.

Thanks. Best of luck to you. Keep ya' head up!

 

[jwk]

For those who do "medical direction" and are also the employer - the problem CRNA (or CAA) should be a non-issue. You do it our way, or there's the door. Period. This is well-understood in our practice from the day of the interview before an offer is ever extended. We don't deceive anyone about the way we practice -we're very up-front about it. We are a fully medically-directed ACT practice and the anesthetists do not do regional anesthesia or central lines. The group has been this way for 50 years and is not going to change. We run anywhere from 2:1 to 4:1, all day every day. We hire quality people, both CAAs and CRNAs, and many stay for decades. We have turnover like any other practice for any number of reasons, but not liking the way the practice operates is rarely an issue.

For those who are not the employer, it's more of a problem. That should be dealt with at the medical staff / credentialing / hospital bylaws level. If you're a medically directed practice, that should be spelled out up front and expectations made clear.

 

[deleted126335]

For those who do "medical direction" and are also the employer - the problem CRNA (or CAA) should be a non-issue. You do it our way, or there's the door. Period. This is well-understood in our practice from the day of the interview before an offer is ever extended. We don't deceive anyone about the way we practice -we're very up-front about it. We are a fully medically-directed ACT practice and the anesthetists do not do regional anesthesia or central lines. The group has been this way for 50 years and is not going to change. We run anywhere from 2:1 to 4:1, all day every day. We hire quality people, both CAAs and CRNAs, and many stay for decades. We have turnover like any other practice for any number of reasons, but not liking the way the practice operates is rarely an issue.

For those who are not the employer, it's more of a problem. That should be dealt with at the medical staff / credentialing / hospital bylaws level. If you're a medically directed practice, that should be spelled out up front and expectations made clear.

You have a gift for understatement.

 

[HalO'Thane]

You have a gift for understatement.

Unfortunately the trend is for more and more anesthesiologists becoming employees of an organization: hospital, academic department, or AMC. Based on some of these posts, it seems like some of the private groups don’t even offer a path to partnership as they cannibalize their newer hires by either offering no partnership track or requiring 5 to 6 years to partnership.

 

[2Fast2Des]

Unfortunately the trend is for more and more anesthesiologists becoming employees of an organization: hospital, academic department, or AMC. Based on some of these posts, it seems like some of the private groups don’t even offer a path to partnership as they cannibalize their newer hires by either offering no partnership track or requiring 5 to 6 years to partnership.

My current gig is employee track only in a PP among partners, we are all on productivity model, employees work the same hours\calls as partners without any benefits that partners get. It's hard not to feel like I'm getting scammed, especially when partners divy cases to help themselves and we employees get the **** units. That being said hours and work life balance is good overall and not many better jobs out there in this marketplace so hoping that they offer partnership one day.

 

[chocomorsel]

My current gig is employee track only in a PP among partners, we are all on productivity model, employees work the same hours\calls as partners without any benefits that partners get. It's hard not to feel like I'm getting scammed, especially when partners divy cases to help themselves and we employees get the **** units. That being said hours and work life balance is good overall and not many better jobs out there in this marketplace so hoping that they offer partnership one day.

That really really sucks. I would honestly never accept that and I don’t make much money nor ever been a partner. I guess I technically was for about six months and my pay barely went up.

Talk about a worse deal than even an AMC. Why must you be stuck there? Family? They will never offer partnership. People are greedy.

 

[PieOHmy]

Just for an opinion. what do you guys think is the minimum per hour you guys would work for supervising 3-4 rooms at a time signing into about 18 cases per day between 1-2 hospitals and 1 surgery center. The hospitals are higher acuity. AMC in there now and some of the older partners are there. call is in the mix in addition to heavy ob and a smattering of peds. Im looking at this job its in the mix.. its mid atlantic area

 

[chocomorsel]

Just for an opinion. what do you guys think is the minimum per hour you guys would work for supervising 3-4 rooms at a time signing into about 18 cases per day between 1-2 hospitals and 1 surgery center. The hospitals are higher acuity. AMC in there now and some of the older partners are there. call is in the mix in addition to heavy ob and a smattering of peds. Im looking at this job its in the mix.. its mid atlantic area

300 an hour.
That’s sounds like a crap job though. So I would ask for a lot.

 

[Arch Guillotti]

My current gig is employee track only in a PP among partners, we are all on productivity model, employees work the same hours\calls as partners without any benefits that partners get. It's hard not to feel like I'm getting scammed, especially when partners divy cases to help themselves and we employees get the **** units. That being said hours and work life balance is good overall and not many better jobs out there in this marketplace so hoping that they offer partnership one day.

You are getting scammed because of greedy partners. Unfortunate that practices like this are allowed to exist.