Possible new normal?

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vigocarpathian

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We are currently seeking a BC/BE Anesthesiologist in southern Indiana.



* Hospital employed
* Become 3rd physician in the group
* Call Coverage 1:13. Call rotations for 1st, 2nd, 3rd call. 1st call always has the next day off.
* Scheduling: 9 daily: 6 OR, 2 OB, 1 GI
* Average volume of 4,800 surgical cases per year
* ***11 CRNAs that function independently***
* Large signing bonus and relocation assistance
* 10 weeks off. Includes vacation, sick, personal and CME time
* need due to replacement – physician is relocating to be closer to aging family members



This small town is a great place to raise your family! Economically strong area that consistently boasts one of the lowest unemployment rates in the state. Schools in the area provide excellent academic preparations and offer a wide variety of extracurricular activities and sports programs. The area provides tremendous outdoor recreational activities including golf, fishing, biking, hiking and close to a 200+ acres lake. Easy access to larger cities such as Louisville, KY (1.15 hours), Indianapolis, IN (2.5 hours), Nashville, TN (3 hours) and St. Louis, MO (3 hours).



If interested in more information, please feel free to contact me.
Thanks in advance,
Karen

Karen Izmirlian, MBA
President
Trouveer Associates, Inc.
St. Louis, Missouri
1-800-323-0834
(o) 314-822-9900
(f) 314-822-7221
(c) 314-607-1650



See bolded above. I heard Indiana was one of the last great places to work. The question here would be if the MDs on staff would be responsible for the "independent CRNAs." Depending on the answer to that question, it might be a pretty good gig.
 
Just 9 locations a day. I’d say that you would be working parallel with the CRNAs. You would get the harder cases, I would assume.

Independent means independent, presumably.
 
caligas said:
Just 9 locations a day. I’d say that you would be working parallel with the CRNAs. You would get the harder cases, I would assume.

Independent means independent, presumably.
Click to expand...
Exactly. With all these independent crna’s Why are they trying to hire an MD? The obvious answer is to do the hardest cases that they are afraid to let the crna’s do. In a few years we might even see a study about how crna’s working independently in the same hospital as mds had superior outcomes (comorbidity data not presented or analyzed statistically as it would interfere with intended results of the study).
 
How I read this:
This is a terrible location, they have a hard time recruiting docs so allow CRNAs to practice independently. So compensation
likely sucks. Docs will possibly need to be available for their “consults” if they have a question. Possible liability exposure not clear.
They would like a few docs on staff to take the hardest/sickest cases that the nurses can’t handle.
 
Psai said:
This job sounds like ****
Click to expand...

I imagine **** with a 10% MGMA paycheck tastes different than **** with a 90% MGMA paycheck.

gourmet.gif
 
I legitimately can not fathom taking this gig. If it’s your group, it costs you your soul. If it’s not your group it would take a Brinks truck to convince me to go there and pay off my loans in 2 years, and that’s if I’m not expected to also save other independent practitioners.

I wonder if it’s a CRNA owner of that group.
 
I know residents who have taken jobs like this. Not to the extent of 11 independent CRNAs and 3 docs, but something like 3 and 1 in BFE. Lots of money to be made.
 
Man o War said:
How I read this:
This is a terrible location, they have a hard time recruiting docs so allow CRNAs to practice independently. So compensation
likely sucks. Docs will possibly need to be available for their “consults” if they have a question. Possible liability exposure not clear.
They would like a few docs on staff to take the hardest/sickest cases that the nurses can’t handle.
Click to expand...

I have never understood the logic of “having a hard time recruiting doctors compared to nurses”.

What is it about doctors that makes them hard to recruit to BFE? Money? Because isn’t the money typically better in BFE?

What makes nurses want these BFE locations more than docs?
 
chocomorsel said:
I have never understood the logic of “having a hard time recruiting doctors compared to nurses”.

What is it about doctors that makes them hard to recruit to BFE? Money? Because isn’t the money typically better in BFE?

What makes nurses want these BFE locations more than docs?
Click to expand...

I thought it had to do with the government tossing ridiculous sums of money at these rural hospitals for hiring nurses.
 
if you are talking RNs, they are much more likely to be hometown folks. If you are talking CRNAs, independent practice (or nearly so) is still a rare bird. Lots of them will tolerate BFE in exchange for working without the supervision of an anesthesiologist.
 
dr doze said:
if you are talking RNs, they are much more likely to be hometown folks. If you are talking CRNAs, independent practice (or nearly so) is still a rare bird. Lots of them will tolerate BFE in exchange for working without the supervision of an anesthesiologist.
Click to expand...

@chocomorsel this.
The militant ones can’t stand being supervised and would probably live in an igloo in Antarctica if they had to in order to avoid that.
We had a CRNA who quit and moved to a complete crap hole just so he could work without supervision. According to him, not even to make anymore money when you took into consideration benefits.
 
nolagas said:
Exactly. With all these independent crna’s Why are they trying to hire an MD? The obvious answer is to do the hardest cases that they are afraid to let the crna’s do. In a few years we might even see a study about how crna’s working independently in the same hospital as mds had superior outcomes (comorbidity data not presented or analyzed statistically as it would interfere with intended results of the study).
Click to expand...
Yes, most definitely. The nurses will exploit this setup.
 
Man o War said:
How I read this:
This is a terrible location, they have a hard time recruiting docs so allow CRNAs to practice independently. So compensation
likely sucks. Docs will possibly need to be available for their “consults” if they have a question. Possible liability exposure not clear.
They would like a few docs on staff to take the hardest/sickest cases that the nurses can’t handle.
Click to expand...
Well, I see it somewhat differently. It is a sh*thole location most likely for the vast majority of people. But there are some MD’s that will certainly prefer it. The pay I would imagine is pretty darn good for the docs. And the liability is completely covered by the hospital. The nurses are responsible for their own cases. Docs may jump in and help out at their discretion but probably “not expected too” by the clueless administrators. These administrators either don’t understand the difference btw a doctor and a nurse or they just need to go this route strictly due to finances and their own bonuses. I’m suggesting it is the latter. The admin wants some docs in the OR to keep the order and meet certain standards like committee appointments. This also allows them to claim that they are a physician led organization (the new admin buzz term). I imagine these 3 docs will be well paid and have more than average vacation and because of this they will have people apply for the position. They are plenty of docs out there that don’t care about the future of our specialty.
Finally, admin will more than likely allow the surgeons, anesthesiologists and nurses decide who does what cases.

So my point is that this is a financial decision almost completely. Nurses are half the cost of docs and they generally get less time off which on,y adds to the cost difference. Plus the billing is the same.
 
chocomorsel said:
I have never understood the logic of “having a hard time recruiting doctors compared to nurses”.

What is it about doctors that makes them hard to recruit to BFE? Money? Because isn’t the money typically better in BFE?

What makes nurses want these BFE locations more than docs?
Click to expand...

Rural pass-through legislation. Hospitals get paid to hire CRNAs, so they're able to offer better salaries than MDs.

Rural Pass Through Legislation - American Society of Anesthesiologists (ASA)
 
Noyac said:
Well, I see it somewhat differently. It is a sh*thole location most likely for the vast majority of people. But there are some MD’s that will certainly prefer it. The pay I would imagine is pretty darn good for the docs. And the liability is completely covered by the hospital. The nurses are responsible for their own cases. Docs may jump in and help out at their discretion but probably “not expected too” by the clueless administrators. These administrators either don’t understand the difference btw a doctor and a nurse or they just need to go this route strictly due to finances and their own bonuses. I’m suggesting it is the latter. The admin wants some docs in the OR to keep the order and meet certain standards like committee appointments. This also allows them to claim that they are a physician led organization (the new admin buzz term). I imagine these 3 docs will be well paid and have more than average vacation and because of this they will have people apply for the position. They are plenty of docs out there that don’t care about the future of our specialty.
Finally, admin will more than likely allow the surgeons, anesthesiologists and nurses decide who does what cases.

So my point is that this is a financial decision almost completely. Nurses are half the cost of docs and they generally get less time off which on,y adds to the cost difference. Plus the billing is the same.
Click to expand...

Could be. I would submit that CRNAs are not half the cost though if there’s that many working independently. At least not from what I’ve seen in general. Maybe if it’s a critical access hospital that is eligible for pass through money. In that case, I’m sure they are cheaper.
 
Ronin786 said:
Rural pass-through legislation. Hospitals get paid to hire CRNAs, so they're able to offer better salaries than MDs.

Rural Pass Through Legislation - American Society of Anesthesiologists (ASA)
Click to expand...
Well then, it's not that these little hospitals are having a difficult time recruiting anesthesiologists, it's that they would rather hire CRNAs because of their funds.

Honestly if some of these small hospitals offered 30-50% MGMA for their region to anesthesiologists, they wouldn't have any problems staffing them. Plenty of us like the country side. I don't think that we are so uppity that we, rather than nurses, all want to be in urban and suburban areas.

I also thought rural pass thru was for hospitals that had 25 inpatient beds or less. There's a name for those teeny hospitals that I can't think of right this minute. Oh yeah, critical access hospitals. A place that has 9 CRNAs and 3 docs is not a rural critical access hospital.
 
Man o War said:
Could be. I would submit that CRNAs are not half the cost though if there’s that many working independently. At least not from what I’ve seen in general. Maybe if it’s a critical access hospital that is eligible for pass through money. In that case, I’m sure they are cheaper.
Click to expand...

Yes, half the cost for half the work. Not really cheaper at all, at least where I work.
 
My high school kid used to joke that he could be a physician: Headache? MRI, CTA, consult neurosurgery, neurology, ENT and psychiatry. Anyone can be a physician with enough resources.

Physicians need to be able to prove that despite a higher salary, we are cheaper in the long run. If you can't show that you are cost-effective, you will go the way of the woolly mammoth.
 
Vandalia said:
My high school kid used to joke that he could be a physician: Headache? MRI, CTA, consult neurosurgery, neurology, ENT and psychiatry. Anyone can be a physician with enough resources.

Physicians need to be able to prove that despite a higher salary, we are cheaper in the long run. If you can't show that you are cost-effective, you will go the way of the woolly mammoth.
Click to expand...

It never made sense to me that the people whose work brings in all the billing have to justify their existence to a useless, parasitic class.
 
Psai said:
It never made sense to me that the people whose work brings in all the billing have to justify their existence to a useless, parasitic class.
Click to expand...

I think Karl Marx said something about that roughly 170 years ago.
 
Vandalia said:
My high school kid used to joke that he could be a physician: Headache? MRI, CTA, consult neurosurgery, neurology, ENT and psychiatry. Anyone can be a physician with enough resources.

Physicians need to be able to prove that despite a higher salary, we are cheaper in the long run. If you can't show that you are cost-effective, you will go the way of the woolly mammoth.
Click to expand...
There is no real way to prove this. It is very hard to measure bad outcomes avoided. And anesthesia services are very much in demand and will continue to be. The only question is will the CRNA’s gain independence everywhere and bring our salaries more in line with theirs. Time will tell
 
Psai said:
It never made sense to me that the people whose work brings in all the billing have to justify their existence to a useless, parasitic class.
Click to expand...
Maybe for surgeons. We don’t bring in any billing.
 
Doing the math....11 CRNA's + 3 MD's....3 people off each week for vacation/1 off for postcall/10 people to cover 9 locations. That doesn't sound like a terribly efficient setup. You are pretty much guaranteeing 5 people off each day.

Doing the harder cases can be a challenge to prove your worth, or a negative because it is not bread and butter cases. It is all in how you look at it. I find perception is mainly what influences how good my day is. If I expect an easy day and end up working 8 hours, it is bad day. Or I can just expect a busy day and end up working 8 hours, it can be a good day. I never enjoyed working with the people who watched the board. They always end up being upset and negative that it didn't go as good as they hoped (almost always the day ends up being longer, not shorter).
 
I’m assuming this job would pay >500k from the get go or can’t see why anyone would take this.
 
I have some friends that interviewed for such jobs and I know some SDN members do this sort of work... it typically pays ridiculously well from my understanding, but of course you should know you’re just a liability tank. Be SURE they pay for your malpractice tail coverage.
 
AdmiralChz said:
I have some friends that interviewed for such jobs and I know some SDN members do this sort of work... it typically pays ridiculously well from my understanding, but of course you should know you’re just a liability tank. Be SURE they pay for your malpractice tail coverage.
Click to expand...

This is an easier job than 4:1 supervision. You do your cases, they do theirs. Your name is nowhere on their chart unless you're called to bail them out in their straightforward cases (rare unless they're horrendous). If the hospital accepts their liability, why do you care outside of realizing the reality of independent practice? You'll do the harder cases for sure. Presumably, the working relationship between the MD and CRNA is good (they're independent, which if they're working there is what they want...) so I imagine if they have questions or concerns they'd come to you. It's not what I'd want, but let's be honest, who WANTS to supervise 4 rooms all day? That's easy to type, but very difficult in reality if you're doing it by the letter of the law.
 
Southpaw said:
This is an easier job than 4:1 supervision. You do your cases, they do theirs. Your name is nowhere on their chart unless you're called to bail them out in their straightforward cases (rare unless they're horrendous). If the hospital accepts their liability, why do you care outside of realizing the reality of independent practice? You'll do the harder cases for sure. Presumably, the working relationship between the MD and CRNA is good (they're independent, which if they're working there is what they want...) so I imagine if they have questions or concerns they'd come to you. It's not what I'd want, but let's be honest, who WANTS to supervise 4 rooms all day? That's easy to type, but very difficult in reality if you're doing it by the letter of the law.
Click to expand...

Won’t see me arguing that, job I’m going to is 1:2-1:3, which I’m fine with. No CRNA independence in my state, so not really a possibility.
 
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