Question for those doing their own cases

[Urzuz]

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Hi all,

I'm graduating this coming June and am joining a private practice where I will be responsible for all my own cases. I'm trying to hone my skills and get ready for this model. I had a quick kind of random question though...during routine inductions, is there a nurse or tech that helps you? Obviously if you need someone to hold cricoid there is someone there, but during routine inductions, is there someone there that is just there to "help" (eg: hold tracheal manipulation, pull the stylet if you use one, etc)? I'm trying to become as independent as possible at this point but was just curious...I still find it helpful to have an extra set of hands, especially during some more challenging intubations.

Thanks! Any other tips/recommendations that you guys have for a new grad would be much appreciated as well!

 

[ryanjmy]

You'll be pleasantly surprised how helpful the ancillary staff is in PP. At least I was. I did an avr/cabg yesterday. The in house CRNA gave me a sandwich break during the pump run otherwise I did it solo. That would have been imposible to do at the place I trained.

 

[psychbender]

On days where I get to actually do my own cases, I can usually count on someone in the room doing little things to help me. The circulators usually stand by to hold cricoid or pull the stylette during induction, the perfusionist will often attach the PAC and work the balloon during insertion (or push bits of pressor if I'm scrubbed in on the line). Its a nice change from being a resident.

 

[sevoflurane]

Yes. Plenty of help.

 

[sleepallday]

In private practice, I do not believe I have induced a patient yet without the circulator standing at the patients side.

 

[deleted126335]

Kudos to you for taking a job where you do your own cases. If I could do it over that is the one thing that I would do differently.

 

[chocomorsel]

I am about to leave and ACT model to join a physician only fee for service group. My question is about benefits. If anyone can provide me with an idea on how much they are spending on health insurance for a family of two and malpractice. I will be practicing in Texas. Leaving a group where I am an employee, (partner had I stayed) and every benefit is covered, going to one where I have to cover everything on my own. A little daunting, but ready to leave, go to better climate and do my own cases.

 

[Direct Laryngoscopy]

I'm also joining an all physician group post fellowship (yay to doing my own cases), and it's assumed the circulator is there to give cricoid, pass tube or any other assistance during induction.

 

[OB1🤙]

All MD is the only way to be!

We have excellent anesthesia techs who help us with the particulars.

 

[sleepallday]

I am about to leave and ACT model to join a physician only fee for service group. My question is about benefits. If anyone can provide me with an idea on how much they are spending on health insurance for a family of two and malpractice. I will be practicing in Texas. Leaving a group where I am an employee, (partner had I stayed) and every benefit is covered, going to one where I have to cover everything on my own. A little daunting, but ready to leave, go to better climate and do my own cases.

Be prepared for how much all these benefits actually cost. I went for paying $350/month for health insurance for my family of four during my employed position to now spending $1200/month for the same coverage with my fee for service physician owned group.

 

[deleted171991]

Being your own master... priceless.

 

[deleted126335]

Being your own master... priceless.

You are still not your own master in an MD Anesthesia practice. I just think the work day is far more satisfying. My best days (10% of my professional time) are doing my own cases. It is like a few hours in the Carribbean.
I was trained to give anesthesia. Not sanction it.

 

[aneftp]

You are still not your own master in an MD Anesthesia practice. I just think the work day is far more satisfying. My best days (10% of my professional time) are doing my own cases. It is like a few hours in the Carribbean.
I was trained to give anesthesia. Not sanction it.

I agree 100%. My first 4 years were 90-95% solo anesthesia. In California it's 100% solo md only. Safest anesthesia. Responsible for your own patient.

Last 6 years have primarily been in act model. Maybe 5% doing my own unless I covered a friends surgery center than it was doing my own cases.

 

[aneftp]

Be prepared for how much all these benefits actually cost. I went for paying $350/month for health insurance for my family of four during my employed position to now spending $1200/month for the same coverage with my fee for service physician owned group.

Oh yeah. The individual market is whAt most people are complaining about with "jacked" up premiums and deductibles for any family of 4 making more than $94k with obamacare/ACA for most healthy people.

As a single policy holder I was paying $170/month with a max $2500 deductible HSA compatible. (I had my own policy with care first blue cross Maryland)Under the ACA I would be paying the same $175 but my deductible jumps to $6000.

With family of 3 for my wife and 2 kids. I was paying roughly $700/month with a $6000 HSA family deductible in 2013. We took off the maternity rider because we were done with having kids. Maternity rider was $200/month. That was 2013 plan.

Under the ACA in Florida I would be paying $700/month with a $12000 deductible. Or paying $1100/$6000 deductible.

This is how ACA work. It's all smoke and mirrors when the liberal media says the premiums are lower. Notice my premiums are the same but they double the deductible. Or I can keep my same deductible but they increase the premiums 40%.

In Texas my friend with a pre existing condition was paying $1600/month with a $4000 deductible for family of 4 self employed. Under the ACA. He pays $1500/month with a $6000 deductible. So he's being helped by the ACA because of a prior pre existing condition.

Bottom line. Health care is expensive for self employed with the ACA. You can write off premiums but under S corp rules you must re add those premium deductions to your W2 wages.

 

[pjl]

The circulating nurse is your nurse until you dismiss them in PP.

 

[chocomorsel]

Be prepared for how much all these benefits actually cost. I went for paying $350/month for health insurance for my family of four during my employed position to now spending $1200/month for the same coverage with my fee for service physician owned group.

**** me!!!!! Is it better then to be a W2 with benefits? That's a lot of money!!! Will ask the group what plans they offer or recommend. I thought fee for service is where it's at?

 

[IlDestriero]

The benefits of some employed systems are very valuable and can be extremely variable. Make sure y'all take a hard look into that when comparing jobs.
$20k vs 5k for healthcare coverage, $25k vs $0 for malpractice, type of malpractice ins, tail vs no tail, matching retirement plans, supplemental annuities, traditional pensions, etc. It can add up to a LOT of money. Of course being self employed has other benefits, deductions, etc. not available to employed people.
Make sure you know how to maximize your particular situation.

 

[chocomorsel]

The benefits of some employed systems are very valuable and can be extremely variable. Make sure y'all take a hard look into that when comparing jobs.
$20k vs 5k for healthcare coverage, $25k vs $0 for malpractice, type of malpractice ins, tail vs no tail, matching retirement plans, supplemental annuities, traditional pensions, etc. It can add up to a LOT of money. Of course being self employed has other benefits, deductions, etc. not available to employed people.
Make sure you know how to maximize your particular situation.

I have to admit, I have a sweet deal where I am now doing lots of bread and butter, but hate the location(cold and far from family) and would like to do my own cases. My benefits are amazing and if I could pick this up and ship it south, I would certainly stick with it for a while. But, alas, I am not made for cold weather.

 

[Consigliere]

All MD practices are disappearing at an alarming rate.
http://online.wsj.com/article/PR-CO-20140506-905341.html

 

[aneftp]

All MD practices are disappearing at an alarming rate.
http://online.wsj.com/article/PR-CO-20140506-905341.html

They are not all MD practice. I know one of those guys. It was a done deal several months ago.

 

[Consigliere]

I know this. What I'm saying is that the number of jobs available to anesthesiologists where you do all your own cases, is disappearing.

 

[Foodie]

Hi all,

I'm graduating this coming June and am joining a private practice where I will be responsible for all my own cases. I'm trying to hone my skills and get ready for this model. I had a quick kind of random question though...during routine inductions, is there a nurse or tech that helps you? Obviously if you need someone to hold cricoid there is someone there, but during routine inductions, is there someone there that is just there to "help" (eg: hold tracheal manipulation, pull the stylet if you use one, etc)? I'm trying to become as independent as possible at this point but was just curious...I still find it helpful to have an extra set of hands, especially during some more challenging intubations.

Thanks! Any other tips/recommendations that you guys have for a new grad would be much appreciated as well!

Congrats on doing your own cases. I was in your shoes last year, and this forum was incredibly helpful when I started as a fresh graduate at an all-MD practice. I'm a hospital employee and we do bread and butter cases. The circulator is on the right side of me when I intubate or place LMA to assist in whatever I may need -- giving cricoid pressure, tilting pt's head back, putting cuff up, pulling stylet out (rare occasion as I don't really use stylets when I intubate anymore), etc. The circulator is the one who sets up suction between cases and brings drugs (even opioids) and kits for a-lines and CVC's if I need them in the middle of a case.

You mentioned having an extra pair of hands during challenging intubations. If a pt is a known difficult intubation, we change the schedule beforehand to have another anesthesiologist be available for the intubation. When I do awake FOI, I always have a colleague helping me out in the room. While we work for the hospital, the administrators have not yet interfered with how we have been doing things because we vehemently emphasize patient safety as our top priority. No one can argue with safety and we haven't compromised any surgeon's schedules.

I advise you to remember that you are part of a surgical team with the goal of taking care of a patient. I do whatever it takes to move a case along safely and as quickly as possible. Surgeons and admins both love me and want me to stay forever. I suppose it helps that I'm also really really good-looking, but that's besides the point.

The days are sometimes long without breaks during a case because everyone is in a room, but at the end of the day I feel like I've done a good day's work and sleep soundly. I don't have to worry about some CRNA f***ing up my patient when I step out of a room.