NAPA Now in Trouble in Maryland

[IMGASMD]

It's "learning."

It also builds character….

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[OptionOffense]

Personally pushing prop for endo is easy from an anesthetic perspective (outside of the occasional ASA 3.5 or 4). The "difficult" part is the annoyance of having to turn over the room, clean the monitors, pull up the meds, etc 18 times. That is, to say, the part that makes it difficult is the part that doesn't necessarily require an anesthesiologist's expertise. I'm not trying to make it a pissing contest, but the reality is I can do that job if I wanted to- I would just rather choose not to. For most cardiac cases, you (non cardiac folks) can't do my job even if you wanted. There lies the difference.

It sounds like it's too much and Cardiac room is easier. That is what Im hearing!

 

[Pappy Van Propofol]

It also builds character….

There was an interesting editorial several months ago in I think maybe the ASA Monitor that talked about we needed to stop training residents to do nursing tasks.

 

[vector2]

It sounds like it's too much and Cardiac room is easier. That is what Im hearing!

I've already explained the difference between doing the repetitive and tedious tech/nursing tasks associated with high turnover endo....and doing an actually difficult anesthetic. But feel free to keep trolling as you're typically wont to do.

 

[Ashers]

On the note of no one to do turn overs and CRNAs, I was at a "hospital" more of a glorified surgery center with several overnight beds, and the anesthesia tech called in sick. The charge nurse ran into my room to ask me to do the morning initial machine check for one of the independent CRNAs because that person didn't know how to do it, and they couldn't find a CRNA who knew how to check that specific machine. I told her no that I'm getting my own stuff ready since nothing had been restocked and doing my own machine check. Eventually, they found someone to do the machine check for that CRNA. (We worked parallel to them -- I did my case, they did theirs, technically, the surgeon was in charge of the CRNAs' anesthetics at this location, at least that's what the surgeons signed, but none of them remembered it.)

In residency I would often over my own room, and at university satellite hospital as an attending, unless I called the anesthesia tech in from home on the weekend, I was it for turnover as well. I'm in a place now as locums where people do turnover, help me, and it's amazing. I've been doing so much on my own for so long!

 

[kidthor]

technically, the surgeon was in charge of the CRNAs' anesthetics at this location

Hmm... the surgeon should have done the machine check in that case, as the all knowing supervising physician.

 

[OptionOffense]

I've already explained the difference between doing the repetitive and tedious tech/nursing tasks associated with high turnover endo....and doing an actually difficult anesthetic. But feel free to keep trolling as you're typically wont to do

I disagree that pushing propofol is a nursing task. It may be the high turnover amd potential for airway catastrophe on many patients that usually turns many people off not necessarily the mundane nursing tasks which I am happy to do. Perhaps that is what youre talking about.

 

[crash2500]

I disagree that pushing propofol is a nursing task. It may be the high turnover amd potential for airway catastrophe on many patients that usually turns many people off not necessarily the mundane nursing tasks which I am happy to do. Perhaps that is what youre talking about.

He clearly said, it's the cleaning of monitors, drawing up drugs, changing the circuit.

 

[IMGASMD]

There was an interesting editorial several months ago in I think maybe the ASA Monitor that talked about we needed to stop training residents to do nursing tasks.

It was more of a tongue in cheek response to the “learning” experience.

On that note, there was a discussion a while ago regarding “scut” work. I think there is some gains from doing “nursing” tasks…. at least initially, blood draw or placing IV comes to mind. In regards to setting up cardiac rooms. There’s learning too. Which drips needs to be set up. How to program a pump. What catheter to use for aline. How to set up the TEE prob, run teg calibration…. Sure, some of those are mindless, but at least initially, can be interesting.

We didn’t have any good/“real” anesthesia techs in residency. As residents, we all can set up a cardiac room within 15 mins by end of our CA1 year, if we put our mind to it. Is that “abuse”, is that a nursing task, is that a tech task? Depend where you are in your training I suppose. We actually have a nurse to set up cardiac room and do “nursing” tasks now. Because our “techs” are only good for stocking and cleaning, occasionally help to fetch some things.

If ASA actually care about me…. I would certainly contribute more than what I contribute now. (Not zero, but no much more than zero….).

 

[ambiturner]

On the note of no one to do turn overs and CRNAs, I was at a "hospital" more of a glorified surgery center with several overnight beds, and the anesthesia tech called in sick. The charge nurse ran into my room to ask me to do the morning initial machine check for one of the independent CRNAs because that person didn't know how to do it, and they couldn't find a CRNA who knew how to check that specific machine. I told her no that I'm getting my own stuff ready since nothing had been restocked and doing my own machine check. Eventually, they found someone to do the machine check for that CRNA

This is an awesome story. Can’t you just crank up the pop off to 30 and see if it holds positive pressure? Keep gold like this coming I’ve been in ivory towers my whole life and haven’t had the pleasure of working in a place like this.

That said I do the majority of my own case setups due to chronic tech shortages and a poor workflow for turnovers. I think this is common in any system that knows it can always dump an extra task on the anesthesiologists/residents.

 

[GravelRider]

absolutely there is increased risk for you to get roped into a law suit.

Collaborative model about 30 minutes from us recently had a relatively healthy beach chair position shoulder stroke out and lawyers are grabbing anybody they can.

You “may” get dropped, but what a PITA, especially if you have to give sworn testimony. It’s not always monetary damages. It’s the stress of being served that also accounts for the difficulty of these situations.

So the “board runner,” “fire fighter,” or the anesthesiologist doing a case in another room got sued as well? Someone in the anesthesia department other than the independent CRNA sitting the case was sued? That’s what I’m asking.

 

[Ashers]

Hmm... the surgeon in should have done the machine check in that case, as the all knowing supervising physician.

When I asked surgeons if they knew the CRNAs were under their licenses, most of them didn't know they weren't anesthesiologists. They were just someone doing anesthesia. They also often call themselves "nurse anesthesiologists" to patients. I cringed every time I heard it.

BUT one day, one of the preop nurses told one of the surgeons that the "CRNAs had to do their own IVs because we're too shortstaffed." She thought the young orthopaedic surgeon was a CRNA. She also meant me. He came into the room indignant that he was called a CRNA and that I was also being lumped into being called a CRNA. He's one of my favorite surgeons. I left the group, and I get texts from him (and 2 others) occasionally to work with him when I'm in town.

It got worse at this place. I left.

 

[Anestheski]

Napa usually huffs and puffs demanding shake down non compete pay off money. But I think most places are calling Napa’s bluff. Gbmc (greater Baltimore) is going in house w2 from what I’m told. It’s a complete safe harbor strategy so napa has zero rights to enforce non compete.

Who’s a judge gonna to side with? A non profit hospital in Maryland needing anesthesia people to provide essential services for the community? Or suits from New York based napa company? That’s an easy call

That’s how the North Carolina mednax fiasco got decided as well a few year ago. Even though that North Carolina system did shady things front funding the fake side anesthesia company for that guy to run.

But even if NAPA ultimately loses non compete battles in court, how’s a physician supposed to shoulder thousands and thousands of litigation costs and years of litigation to get to the point where the non compete is found by a judge to be unenforceable?

 

[dannyboy1]

But even if NAPA ultimately loses non compete battles in court, how’s a physician supposed to shoulder thousands and thousands of litigation costs and years of litigation to get to the point where the non compete is found by a judge to be unenforceable?

The hospital fights the battle when they hire the group from under NAPA. That’s how it worked in Reno. The whole concept is actually strange. The non compete is worded as “there to protect the business interest of the employer “, or something to that effect. Once the hospital kicks the AMC out, what is the business interest? Maybe someone with a legal background can weigh in….

 

[nimbus]

But even if NAPA ultimately loses non compete battles in court, how’s a physician supposed to shoulder thousands and thousands of litigation costs and years of litigation to get to the point where the non compete is found by a judge to be unenforceable?

In these situations, it seems common for the new employer to shoulder the burden because they need anesthesiologists.

 

[nimbus]

Napa usually huffs and puffs demanding shake down non compete pay off money. But I think most places are calling Napa’s bluff. Gbmc (greater Baltimore) is going in house w2 from what I’m told. It’s a complete safe harbor strategy so napa has zero rights to enforce non compete.

Who’s a judge gonna to side with? A non profit hospital in Maryland needing anesthesia people to provide essential services for the community? Or suits from New York based napa company? That’s an easy call

That’s how the North Carolina mednax fiasco got decided as well a few year ago. Even though that North Carolina system did shady things front funding the fake side anesthesia company for that guy to run.

Does anybody know how many of the Mednax anesthesiologists went to work for Scope?

 

[Anestheski]

In these situations, it seems common for the new employer to shoulder the burden because they need anesthesiologists.

Why would the hospital inject themselves into a massive legal battle that will go public and cost hundreds of thousands of dollars when they can just get locums? Granted NAPA prob wouldn’t want the bad press either that comes with being fired and then keeping the doctors away from the hospital but that’s the only leverage NAPA has in these scenarios so they prob want to protect even if they have no leg to stand on legally. It will be interesting to see what happens with the DOJ now saying these noncompetes may be antitrust violations.

 

[OptionOffense]

Why would the hospital inject themselves into a massive legal battle that will go public and cost hundreds of thousands of dollars when they can just get locums?

I don't think it's as easy as it once was to find locums. And even harder to find locums that fit

 

[Dr. Rude]

Why would the hospital inject themselves into a massive legal battle that will go public and cost hundreds of thousands of dollars when they can just get locums? Granted NAPA prob wouldn’t want the bad press either that comes with being fired and then keeping the doctors away from the hospital but that’s the only leverage NAPA has in these scenarios so they prob want to protect even if they have no leg to stand on legally. It will be interesting to see what happens with the DOJ now saying these noncompetes may be antitrust violations.

It doesn't happen super often, but it does happen. Depends on the perception of cost and perception of risk of not indemnifying the docs and trying to replace a whole department. Disrupting the OR for any length of time can be catastrophic financially.

 

[IMGASMD]

It doesn't happen super often, but it does happen. Depends on the perception of cost and perception of risk of not indemnifying the docs and trying to replace a whole department. Disrupting the OR for any length of time can be catastrophic financially.

I think this is how it will be resolved at the other Napa site(s).

If the hospital convert anesthesia department to employee model, maybe it’ll make sense. It can also be a win for Napa, because they’d have to deal with “transferring” all their employees out to other practices and having even more disgruntled workers.

 

[jwk]

Why would the hospital inject themselves into a massive legal battle that will go public and cost hundreds of thousands of dollars when they can just get locums? Granted NAPA prob wouldn’t want the bad press either that comes with being fired and then keeping the doctors away from the hospital but that’s the only leverage NAPA has in these scenarios so they prob want to protect even if they have no leg to stand on legally. It will be interesting to see what happens with the DOJ now saying these noncompetes may be antitrust violations.

Easier said than done. Maybe not so hard when you have just a few docs. My department has nearly 300 credentialed.

 

[GravelRider]

Why would the hospital inject themselves into a massive legal battle that will go public and cost hundreds of thousands of dollars when they can just get locums? Granted NAPA prob wouldn’t want the bad press either that comes with being fired and then keeping the doctors away from the hospital but that’s the only leverage NAPA has in these scenarios so they prob want to protect even if they have no leg to stand on legally. It will be interesting to see what happens with the DOJ now saying these noncompetes may be antitrust violations.

The hospitals want NAPA out because many times NAPA is getting a stipend and that money is going directly to private equity investors. The hospitals can save money by employing anesthesia directly…at least that’s their thinking. NAPA is losing the contract no matter what, so why spend the money just to go after some individual anesthesiologists when you can’t even employ them anyway? There is no way a judge is going to uphold the non-competes if NAPA can’t even employ them in that region. The hospitals are indemnifying the anesthesiologists against any legal liability they may face from a vindictive NAPA. The hospitals are assuming the legal risks, though I think those risks are small.

 

[Anestheski]

The hospitals want NAPA out because many times NAPA is getting a stipend and that money is going directly to private equity investors. The hospitals can save money by employing anesthesia directly…at least that’s their thinking. NAPA is losing the contract no matter what, so why spend the money just to go after some individual anesthesiologists when you can’t even employ them anyway? There is no way a judge is going to uphold the non-competes if NAPA can’t even employ them in that region. The hospitals are indemnifying the anesthesiologists against any legal liability they may face from a vindictive NAPA. The hospitals are assuming the legal risks, though I think those risks are small.

First of all, who says that NAPA can’t employ them in that region? They can offer to put them in other locations depending on their resources in the region. Second, NAPA’s only leverage is their noncompetes. One would expect them to defend that vigorously, otherwise they’ll lose all their contracts. Maybe massive hospitals can shoulder the costs of fighting noncompetes in court but smaller hospitals will most likely be hamstrung by their other expenses. Are you sure that you’ve heard every hospital that fired NAPA is indemnifying? Is that true for Gbmc?

 

[nimbus]

But even if NAPA ultimately loses non compete battles in court, how’s a physician supposed to shoulder thousands and thousands of litigation costs and years of litigation to get to the point where the non compete is found by a judge to be unenforceable?

Did 3 weeks, most of the former NAPA docs and CRNAs stayed on after the hospital guaranteed covering any legal issues. Apparently they got a much more favorable package from the hospital.

They have free electric vehicle charging stations if that's an incentive for anyone