No group is safe

[amyl]

Yes it's annoying. Another scrub and nurse are ready to go in another room so surgeon can keep going.... So the rate limiting step is anesthesia. While I'm waking up someone they ask me if I need to talk to the next one. It's annoying. No time between cases for the ladies room or a bite to eat... Which is a problem bc there's never anyone for a quick potty break or lunch. I can't get out of here soon enough. There's no one to cover ever... If I'm sick I come to work or surgeries are all cancelled at the last minute. Food poisoning and barfing in the OR garbage but there's no one to send me home so I stay. Four days left and counting.... I wouldn't stay if they doubled my salary

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[IlDestriero]

Yes it's annoying. Another scrub and nurse are ready to go in another room so surgeon can keep going.... So the rate limiting step is anesthesia. While I'm waking up someone they ask me if I need to talk to the next one. It's annoying. No time between cases for the ladies room or a bite to eat... Which is a problem bc there's never anyone for a quick potty break or lunch. I can't get out of here soon enough. There's no one to cover ever... If I'm sick I come to work or surgeries are all cancelled at the last minute. Food poisoning and barfing in the OR garbage but there's no one to send me home so I stay. Four days left and counting.... I wouldn't stay if they doubled my salary

That's the problem with that set up. You're working your ass off, running all day and eating power bars while you do a machine check, and all the surgeons say, and admin hears, is that anesthesia is always the problem, they're never available... Then they don't want to work with you for a subsidy or another hire, etc.
If our rooms/locations sat open like that, the management would all be fired. So much wasted with all those sites available and unused. Of course if their is no patient volume, I guess it actually helps you all leave earlier.

 

[chocomorsel]

Amyl honey, I would have totally cancelled everyone's cases had I had food poisoning. No chance I am gonna be stuck in a room with vomiting and GE. Weren't you worried about the diarrhea?
Would not have felt guilty at all!!!

 

[kazuma]

Amyl honey, I would have totally cancelled everyone's cases had I had food poisoning. No chance I am gonna be stuck in a room with vomiting and GE. Weren't you worried about the diarrhea?
Would not have felt guilty at all!!!

Not worried at all......

 

[anes121508]

Yes it's annoying. Another scrub and nurse are ready to go in another room so surgeon can keep going.... So the rate limiting step is anesthesia. While I'm waking up someone they ask me if I need to talk to the next one. It's annoying. No time between cases for the ladies room or a bite to eat... Which is a problem bc there's never anyone for a quick potty break or lunch. I can't get out of here soon enough. There's no one to cover ever... If I'm sick I come to work or surgeries are all cancelled at the last minute. Food poisoning and barfing in the OR garbage but there's no one to send me home so I stay. Four days left and counting.... I wouldn't stay if they doubled my salary[/QUOTE

As a resident at an academic place where attendings cover 2:1 and often 1:1 if the patient is sick I haven't gotten much of an education on OR staffing and efficiency.

Looking around at jobs...

Private group A makes more than private group B in same city, same vacation, same hours of work, 4:1 coverage.

Group A says they do significantly better because they "run thin". What's the difference in terms of staffing between being efficient and "running thin"? Or are they the same thing in today's world? What is an example of "running thin" in an unsafe manner that makes your life miserable vs busting your rear and being efficient? What are good questions to ask a group when they say we "run thin", to determine whether it's just being smart and efficient vs unsafe and miserable?

I've been exposed to the horribly inefficient end of things at an academic center where people work long hours filled with wayyyyyy to much down time....I can't handle a job like that. The sitting around doing nothing drives me nuts. At the same time though, I would hate to be naive and get myself into a situation where I'm miserable as described above.

Any general info or fundamental principals on how a PP group handles staffing throughout the day and maximizes efficiency would be helpful too. Thanks!

 

[Ignatius J]

As a resident at an academic place where attendings cover 2:1 and often 1:1 if the patient is sick I haven't gotten much of an education on OR staffing and efficiency.

Looking around at jobs...

Private group A makes more than private group B in same city, same vacation, same hours of work, 4:1 coverage.

Group A says they do significantly better because they "run thin". What's the difference in terms of staffing between being efficient and "running thin"? Or are they the same thing in today's world? What is an example of "running thin" in an unsafe manner that makes your life miserable vs busting your rear and being efficient? What are good questions to ask a group when they say we "run thin", to determine whether it's just being smart and efficient vs unsafe and miserable?

I've been exposed to the horribly inefficient end of things at an academic center where people work long hours filled with wayyyyyy to much down time....I can't handle a job like that. The sitting around doing nothing drives me nuts. At the same time though, I would hate to be naive and get myself into a situation where I'm miserable as described above.

Any general info or fundamental principals on how a PP group handles staffing throughout the day and maximizes efficiency would be helpful too. Thanks!

I would be very suspicious if a group came to me and said all the variables were the same except the pay. One big thing I have found is that the same issues as residents creep up in a private practice, just with a different name. Are the older guys going home earlier? Do they put a bigger call burden on the younger guys? Is holiday call distribution equitable?

From speaking with partners and former co-residents now in private practice, this is the big thing that will get new graduates jaded soon in private practice. 50 hours of week and 4 calls monthly with 6 weeks vacation may not sound too bad, until you get there and realize older guys are working 35-40 hours per week with 2-3 calls (usually on weekdays) and 12 weeks vacation, and somehow you find yourself as the guy always there at 4pm while Dr. McOldStuffins is already starting the back 9 at the golf course.

May seem okay at first, but overtime it may piss you off that it isn't nearly equitable.

 

[criticalelement]

May seem okay at first, but overtime it may piss you off that it isn't nearly equitable.

Thats the understatement of the century...


WWW.regulations.gov
in the search box put in ap44 and comment on the advanced pracice legislation that the va nurses are trying to effect
this is to save the speacialty

 

[Ignatius J]

Thats the understatement of the century...


WWW.regulations.gov
in the search box put in ap44 and comment on the advanced pracice legislation that the va nurses are trying to effect
this is to save the speacialty

Oh, just wait until the explanation is "Because that's the way it has always been" and the dinosaurs try to paint the new guy as lazy, when you know those dinosaurs did less years of residency training and no longer have to go through the tedious, cumbersome, expensive, MOCA process because they are "grandfathered" in.

Apparently, that means you don't have to even try to use an ultrasound or do peripheral nerve blocks.

Btw, I've lucked out and found a group that has none of this in my experience. These are war stories from colleagues.

 

[GravelRider]

Oh, just wait until the explanation is "Because that's the way it has always been" and the dinosaurs try to paint the new guy as lazy, when you know those dinosaurs did less years of residency training and no longer have to go through the tedious, cumbersome, expensive, MOCA process because they are "grandfathered" in.

Apparently, that means you don't have to even try to use an ultrasound or do peripheral nerve blocks.

Btw, I've lucked out and found a group that has none of this in my experience. These are war stories from colleagues.

This is all too real...and extraordinarily frustrating.

 

[anes121508]

I would be very suspicious if a group came to me and said all the variables were the same except the pay. One big thing I have found is that the same issues as residents creep up in a private practice, just with a different name. Are the older guys going home earlier? Do they put a bigger call burden on the younger guys? Is holiday call distribution equitable?

From speaking with partners and former co-residents now in private practice, this is the big thing that will get new graduates jaded soon in private practice. 50 hours of week and 4 calls monthly with 6 weeks vacation may not sound too bad, until you get there and realize older guys are working 35-40 hours per week with 2-3 calls (usually on weekdays) and 12 weeks vacation, and somehow you find yourself as the guy always there at 4pm while Dr. McOldStuffins is already starting the back 9 at the golf course.

May seem okay at first, but overtime it may piss you off that it isn't nearly equitable.

Both places have equal vaca time, call responsibilities, and hours. They were both very upfront and insistent on how even they split up the work and call schedule.

I agree, it'd be tough hustling around as the new guy making <1/2 partner pay knowing the other's are out the door by 2pm, covering 2:1, and taking an extra 3 weeks vacation.

 

[anes121508]

Let's assume ultimate equal group, where all partners are working hard while they are there....where is the line between maximum efficiency and spread too thin? In terms of staffing, what makes sense to maximize profit vs is a red flag that is going to make for an unsafe situation and be miserably jaded?

 

[deleted126335]

Let's assume ultimate equal group, where all partners are working hard while they are there....where is the line between maximum efficiency and spread too thin? In terms of staffing, what makes sense to maximize profit vs is a red flag that is going to make for an unsafe situation and be miserably jaded?

That is something that reasonable people will disagree about.
Also it depends on a multitude of factors:

1. Expectations for anesthetic care.
2. Case acuity and complexity.
3. Skill level of the docs and anesthetists.
4. Level of cooperation (control) the docs have over the anesthetists
5. The extent to which care protocols and algorithms have been initiated.

 

[ryanjmy]

Let's assume ultimate equal group, where all partners are working hard while they are there....where is the line between maximum efficiency and spread too thin? In terms of staffing, what makes sense to maximize profit vs is a red flag that is going to make for an unsafe situation and be miserably jaded?

It's different for everyone. It's more about how efficient you are and are you comfortable giving autonomy to the crnas and are you competent to bail them out when they eff up. Chances are wherever you're considering practicing they aren't knocking off pts left and right. So if they are running lean, they could be strong MDs, have good systems, strong crnas or all three. If you're effeicent, competent, and adaptable you'll be fine wherever you go. Just make sure you get the rewards for your hard work. I work hard and at times feel I'm spread too thin but I'm a partner and get paid well. I wouldn't work like this for an amc making 350.

 

[anes121508]

It's different for everyone. It's more about how efficient you are and are you comfortable giving autonomy to the crnas and are you competent to bail them out when they eff up. Chances are wherever you're considering practicing they aren't knocking off pts left and right. So if they are running lean, they could be strong MDs, have good systems, strong crnas or all three. If you're effeicent, competent, and adaptable you'll be fine wherever you go. Just make sure you get the rewards for your hard work. I work hard and at times feel I'm spread too thin but I'm a partner and get paid well. I wouldn't work like this for an amc making 350.

Thanks for the advice. Makes complete sense. It's a considerable amount more pay than another pp group in town doing 3:1.

 

[deleted171991]

As a resident at an academic place where attendings cover 2:1 and often 1:1 if the patient is sick I haven't gotten much of an education on OR staffing and efficiency.

Looking around at jobs...

Private group A makes more than private group B in same city, same vacation, same hours of work, 4:1 coverage.

Group A says they do significantly better because they "run thin". What's the difference in terms of staffing between being efficient and "running thin"? Or are they the same thing in today's world? What is an example of "running thin" in an unsafe manner that makes your life miserable vs busting your rear and being efficient? What are good questions to ask a group when they say we "run thin", to determine whether it's just being smart and efficient vs unsafe and miserable?

I've been exposed to the horribly inefficient end of things at an academic center where people work long hours filled with wayyyyyy to much down time....I can't handle a job like that. The sitting around doing nothing drives me nuts. At the same time though, I would hate to be naive and get myself into a situation where I'm miserable as described above.

Any general info or fundamental principals on how a PP group handles staffing throughout the day and maximizes efficiency would be helpful too. Thanks!

Better go nuts sitting around than run around for hours praying that the CRNA is not hurting your patient while you don't have time to check on him/her.

 

[deleted171991]

Thanks for the advice. Makes complete sense. It's a considerable amount more pay than another pp group in town doing 3:1.

Both suck, if you're just an employee.

I am not doing 3:1 unless I am a partner, or paid accordingly.

 

[anes121508]

Both suck, if you're just an employee.

I am not doing 3:1 unless I am a partner, or paid accordingly.

Sounds like general sentiment is that 4:1 is awful?

 

[deleted171991]

Sounds like general sentiment is that 4:1 is awful?

Even 3:1 is a lot of work, if you do your job as you're supposed to. 4:1 is basically lending your license to the CRNAs to do anything they want with it, while you're playing firefighter.

If you want to feel like a poor employed family doc supervising a ton of FNPs, running around like crazy, feeling constantly out of control and sync, try 4:1. For my taste, 2:1 is the only one acceptable, hence I prefer academics or solo. I want to take great care of my patients and sleep well at night. 3:1 can be done in the right place, with the right patients and CRNAs, and for the right partnership.

Ask Blade how much he makes for 4:1.

 

[anes121508]

Even 3:1 is a lot of work, if you do your job as you're supposed to. 4:1 is basically lending your license to the CRNAs to do anything they want with it, while you're playing firefighter.

If you want to feel like a poor employed family doc supervising a ton of FNPs, running around like crazy, feeling constantly out of control and sync, try 4:1. For my taste, 2:1 is the only one acceptable, hence I prefer academics or solo. I want to take great care of my patients and sleep well at night. 3:1 can be done in the right place, with the right patients and CRNAs, and for the right partnership.

Ask Blade how much he makes for 4:1.

Haha so blade....what's ur input?

I see your point about 4:1....anybody else have a different opinion of 4/1 coverage?

I think on one of the other threads somebody commented on how 4:1 coverage is basically allowing crnas do to as they please and fueling the crna independence argument

 

[Man o War]

Haha so blade....what's ur input?

I see your point about 4:1....anybody else have a different opinion of 4/1 coverage?

I think on one of the other threads somebody commented on how 4:1 coverage is basically allowing crnas do to as they please and fueling the crna independence argument

Totally agree with @FFP. I moonlit for an AMC group doing 4:1. I worked a few shifts and was scared out of my mind at how scary these CRNAs were...I barely had time to preop the patients, much less pay attention to what they were doing. Had a couple close calls, and I was done. 3:1 MIGHT be ok if you as partners having hiring/firing power over CRNAs and have control over the scheduling. The worst feeling is working with a bunch of dangerous CRNAs that you can't fire on the spot if they are incompetent.

 

[Mman]

I think on one of the other threads somebody commented on how 4:1 coverage is basically allowing crnas do to as they please and fueling the crna independence argument

It all depends on scheduling. We are usually anywhere from 2:1 to 4:1 depending on case complexity, occasionally 1:1 for a disaster. 4:1 can be done safely with the right people and cases. If I'm 4:1 and have 2 rooms doing long boring cases that are going to go for hours and 2 rooms with medium amount of turnover, it really isn't that big of a deal. I mean I'm present for every induction, every emergence, and every 30-60 minutes in between. Once in a blue moon I'll need help to preop somebody but that is a very rare event.

We don't give somebody 4 rooms with a bunch of quick rapid turnover cases. That's just stupid.

It isn't the ratio that is important, it's the case mix.

 

[deleted162650]

I want to take great care of my patients and sleep well at night.

It's been said "You can either eat well, or you can sleep well"