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[Sriddymopboi]

GasWork.com - Reference #424478

Reference #424478

www.gaswork.com

Looks like the base salary is 600k. I wonder if that includes the 4 night calls per week AND the one weekend per month calls? They don't specify if it's 24 hours or if you come in at 3 or so and whether or not you get pre or post-call day off. Listing mentions 10 or 12 hour shifts which has me wondering if it's like that EVERY day of the week. Anybody have any insight into this job? The pay seems great but I wonder if there is a catch

Position Highlights:
• Guaranteed base salary
• Relocation assistance
• CME allowance
• 10 weeks paid time off
• Dragon Medical One, Epic-integrated dictation software
• Highly competitive benefit package
• Designated as a Top Workplace in Oregon
• Live amidst Oregon's Wine Country in the beautiful Willamette Valley
• 1 hour drive to the Pacific Ocean, 1.5 hour drive to Mt. Hood, and a 45-minute drive to Portland

Additional Recruitment Incentives for Anesthesia:
Start bonus up to $100,000
Choice of: Student loan repayment of 100k (20k/year for 5 years) OR Retention bonus of 100k (20k/year for 5 years) OR Additional 457f contribution up to 100k (20k/year for 5 years)

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[aneftp]

Looks like it’s hospital employed w2 and not amc.

100% solo cases in level 2 facility usually no bueno. That’s big red flag already. Hospitals needs to add call incentive to the trauma solo calls.

Problem is they cap salary at 650k

My friend out west in California has similar level 2 solo trauma calls. He was 800k plus salary and that was 3-4 years ago. With 12 weeks off with private group.

 

[nicolai]

This is a best job in the region, if you want to PM me I will give you all details. Maximum 4 overnight calls a month, but most of the time 1 or 2, it is 12-14 hour shifts overnight. 12 hour shifts also not often, it helps to relieve people who stuck in the rooms. Maximum 50 hours a week working, but in reality 40-45. Very nicer staff and administration. Total package more like 750 with 457f, 401k matching ext

 

[<(^_^)>]

Wow wasn’t previously familiar with 457f plans before, but there’s no limit to the contribution which seems very interesting to the FIRE crowd…

 

[Sriddymopboi]

Looks like it’s hospital employed w2 and not amc.

100% solo cases in level 2 facility usually no bueno. That’s big red flag already. Hospitals needs to add call incentive to the trauma solo calls.

Problem is they cap salary at 650k

My friend out west in California has similar level 2 solo trauma calls. He was 800k plus salary and that was 3-4 years ago. With 12 weeks off with private group.

Can you elaborate on why 100% solo in level 2 facility is no bueno? Would you rather be supervising for this kind of arrangement?

 

[aneftp]

Can you elaborate on why 100% solo in level 2 facility is no bueno? Would you rather be supervising for this kind of arrangement?

I’ve been in level 2
Solo in California. They are rather busy place. But calls were incentivized with extra stipends.

Now I don’t now how this particular Oregon place is. But you need to have it structure in ur contract to make it call trauma incentive base. That’s my advice. That’s the money ball.

Base pay vs max pay in Oregon place seems very dis incentivized.

 

[linkin06]

"busiest emergency department in the PNW!"

 

[Sriddymopboi]

I’ve been in level 2
Solo in California. They are rather busy place. But calls were incentivized with extra stipends.

Now I don’t now how this particular Oregon place is. But you need to have it structure in ur contract to make it call trauma incentive base. That’s my advice. That’s the money ball.

Base pay vs max pay in Oregon place seems very dis incentivized.

When they say you have to work x number of calls is that typically included in the base salary or is base salary typically without calls?

 

[coffeebythelake]

Wow wasn’t previously familiar with 457f plans before, but there’s no limit to the contribution which seems very interesting to the FIRE crowd…

i'm curious how many places out there do 457f..

 

[USCTrojan11]

i'm curious how many places out there do 457f..

non qualified deferred comp, not saying it's a bad thing but everyone should do their due diligence and fully understand what the non-qualified risks are...

 

[coffeebythelake]

non qualified deferred comp, not saying it's a bad thing but everyone should do their due diligence and fully understand what the non-qualified risks are...

sure, can always take a distribution when you leave, and maybe put it in an IRA

 

[ans2021]

My take away from this job being plastered on everything I see is they have to have a retention bonus (red flag) and busiest ED in the PNW. Who wants that??? Can't be the best job if they are constantly reaching out to every anesthesiologist I know through email, text and linkedin. You're working hard for that income.

 

[gunnershow]

"collaborative practice model" stopped reading there

 

[amyl]

I wondered what that “collaborative” term meant as well? I thought that meant Crnas worked independently but they expected docs to do preops or something for them… then it says supervision. 🤷‍♀️. What does this term mean?

 

[nicolai]

CRNAs bill QZ and they work independently, they do their own preops, and postops, anesthesiologist just help them to formulate plan and be additional pair of skilled hands if anything happens. You are paired up with CRNAs approximately once a month, the rest is solo MD cases. It is a busy place, but you work only 45 hours a week on average, and you guarantee to go home at 5 pm unless you on call.

 

[aneftp]

CRNAs bill QZ and they work independently, they do their own preops, and postops, anesthesiologist just help them to formulate plan and be additional pair of skilled hands if anything happens. You are paired up with CRNAs approximately once a month, the rest is solo MD cases. It is a busy place, but you work only 45 hours a week on average, and you guarantee to go home at 5 pm unless you on call.

5pm is long day assuming you roll in at 645am. That’s 11 hours practically

45 hours means
645-345p x 5 days a week on average.
Does that happen?
Or calls start 5pm-7am? With next day off?

 

[gunnershow]

CRNAs bill QZ and they work independently, they do their own preops, and postops, anesthesiologist just help them to formulate plan and be additional pair of skilled hands if anything happens. You are paired up with CRNAs approximately once a month, the rest is solo MD cases. It is a busy place, but you work only 45 hours a week on average, and you guarantee to go home at 5 pm unless you on call.

This is the worst of all worlds. Sends a message to surgeons, patients, and bean counters that you are functionally equivalent to a CRNA (you work side by side, after all!), and yet you're still legally on the hook for any bad outcome that transpires.

 

[nicolai]

We count days 7am till 5 pm, lot of the time you are done early, and go home 3-4 pm. Night call starts 5 pm till 7 am and next day is always off. If you on call during weekend, you are automatically get 2 days off during the week. It is very nice setup we all are very happy with schedule. Plus 10 weeks of paid vacations.

 

[nicolai]

This is the worst of all worlds. Sends a message to surgeons, patients, and bean counters that you are functionally equivalent to a CRNA (you work side by side, after all!), and yet you're still legally on the hook for any bad outcome that transpires.

I'm not sure that you are legally on the hook, since your name is not on chart at all, you just helping when friend needs assistance. And believe me surgeons, and patients know that you are not equivalent to CRNAs. It is just these days is very hard to find enough physicians to cover all needs.

 

[neutro]

I'm not sure that you are legally on the hook, since your name is not on chart at all, you just helping when friend needs assistance. And believe me surgeons, and patients know that you are not equivalent to CRNAs. It is just these days is very hard to find enough physicians to cover all needs.

What does the state law and your medical staff bylaws say?

Is your anesthesia department policy in line with the above?

Staffing comes as a result of above.

Medical staff bylaws consider anesthesiology a discipline of medicine - not nursing. Therefore ultimately, the anesthesiologist is responsible for any and every patient. Some anesthesiologist, somewhere. Or the proceduralist/ surgeon is responsible for the crna.

It has to be a doctor.

Do the patients know about all this when you guys are consenting as to who’s the doctor responsible for their anesthesia?

Have surgeons accepted this role and that they may be accidental “delegators” when the anesthesiologist is not immediately available?

I mean this is why annestgesiologists are on call.

To be part of most of medical staff, bylaws dictate that physicians, not a formulation of a nurse(crna/np etc) be responsible for patients 24/7, 365.

“doctor shortage” is not a reasonable excuse. Seems more like opting for cheaper and possibly shady staffing.

again, look at facility bylaws plus your state’s requirements and its definitions of delegation/supervision etc.

Money is important but not everything.

“Collaboration” is not a recognized term, just like “delegation” is not a defined relationship between an anesthesiologist and crna as far as standard goes.

There is a lot of muddling of roles and vaguery these days because of short staffing.

People need to be aware.

Patients need to be aware for ethical reasons at the time of consent.

It’s either direction or supervision as far as anesthesia is concerned. Rest of the terms are purposely similar but inaccurate and possibly against standard of care.

 

[neutro]

I'm not sure that you are legally on the hook, since your name is not on chart at all, you just helping when friend needs assistance. And believe me surgeons, and patients know that you are not equivalent to CRNAs. It is just these days is very hard to find enough physicians to cover all needs.

No man
You’re liable

If you’re not liable then why do they need an anesthesiologist?

Let the crna practice independently

 

[neutro]

CRNAs bill QZ and they work independently, they do their own preops, and postops, anesthesiologist just help them to formulate plan and be additional pair of skilled hands if anything happens. You are paired up with CRNAs approximately once a month, the rest is solo MD cases. It is a busy place, but you work only 45 hours a week on average, and you guarantee to go home at 5 pm unless you on call.

QZ billing has nothing to do with liability.

We had this discussion right here 2 months ago.

 

[neutro]

Wow wasn’t previously familiar with 457f plans before, but there’s no limit to the contribution which seems very interesting to the FIRE crowd…

457fs are also called golden handcuffs and are subject to your employers existence

 

[coffeebythelake]

No man
You’re liable

If you’re not liable then why do they need an anesthesiologist?

Let the crna practice independently

Yeah. Exactly. This is describing the role of the anesthesiologist as someone to put out fires.

When everything goes fine the CRNA works "independently" and they play doctor since they "do everything we do". But when 💩 hits the fan the cRNa is "just a nurse" and they call for your help as an "extra set of hands" and you can bet your name will be attached to that chart.

 

[coffeebythelake]

457fs are also called golden handcuffs and are subject to your employers existence

You can't disburse or roll it over when u leave?

 

[nicolai]

You can't disburse or roll it over when u leave?

I agree that 457f is golden handcuffs, when you leave you have to take them with you, means you pay taxes in the end of year. But it is still decent amount of free money, and overall compensation is amazing. It is relatively low cost leaving area with mountains and ocean close by.

 

[aneftp]

We count days 7am till 5 pm, lot of the time you are done early, and go home 3-4 pm. Night call starts 5 pm till 7 am and next day is always off. If you on call during weekend, you are automatically get 2 days off during the week. It is very nice setup we all are very happy with schedule. Plus 10 weeks of paid vacations.

So it probably better to be say post call Monday. Off 2 days.

Take call Wednesday 5pm. Post call Thursday 7am

Work 7-5pm Friday?

That would be ideal

Cause working 7-5 (m-f) with no mid week calls would suck and no off days. IMHO

 

[turnupthegas]

Can I ask what part of CA? 800k 12 weeks is pretty good. I'm assuming you're busy busy during your 3 of 4 weeks.

 

[sevo00]

I'm not sure that you are legally on the hook, since your name is not on chart at all, you just helping when friend needs assistance. And believe me surgeons, and patients know that you are not equivalent to CRNAs. It is just these days is very hard to find enough physicians to cover all needs.

lol “friend needs assistance”
But when you turn your back this friend prob proclaims how they don’t really need you

 

[neutro]

rule # 1 of being an anesthesiologist: CRNAs are never your friends.

Rule # 2: surgeons are not your friends.

They are the first to backstab you to save themselves. Seen it a billion times.

Im not saying don't be professional, collegial or kind and helpful to everyone including CRNAs and surgeons, but don't confuse professionalism with friendship. Both of you (crna and anesthesiologist) are working at the hospital to earn a living in exchange of your skill. It's not friendship.

 

[neutro]

You can't disburse or roll it over when u leave?

457fs cannot be rolled over to an IRA or 401k
so when you exit - because they are institution specific, you can either leave it with the institution (very risky - you will lose that money if the hospital gets bought out or ends) or must take a distribution and therefore, pay taxes.

i took a distribution. paid taxes.

not a good plan imo.

its like when someone advertises the job and says "WE PAY VISION INSUARANCE" or "PET INSURANCE" or "LEGAL INSURANCE" as like top of the line items for benefits

Its all bogus.
-can buy glasses/eye exams cheaper/better for cash at Costco
-Pet insurance has never made sense to me - many vets dont take it or dont like taking it.
- Legal insurance - LMAO. Covers nothing. Waste of money.

cash is king for the above 3.

I mean these are just fillers and not real benefits. Once you study these things, you will realize that they are "meh - whatever" and not really a deal breaker or an astonishingly fantastic benefit to pick any job. 457F is one of those.

Actually when companies or groups have these long lists of benefits I actually get curious and question what exactly are they hiding behind these lame "benefits". The only thing that matters is pay, avg hours, schedule, work distribution, vacation, call type and location. maybe benefits like healthcare and malpractice and 401k.

or better yet - just do 1099 - so much simpler.
rest of these "benefits" are just fillers.

 

[amyl]

Rule 3- hospital admins are not your friends

 

[USCTrojan11]

I'm not sure that you are legally on the hook, since your name is not on chart at all, you just helping when friend needs assistance. And believe me surgeons, and patients know that you are not equivalent to CRNAs. It is just these days is very hard to find enough physicians to cover all needs.

This is complete BS. Talk to your own leadership.

Your own leadership during the interview said they couldn't get it in the bylaws after attempts and complaints to admin. The CRNAs have been putting in quick notes every time a supervising doc shows up. For ex "doctor supervisor called to room, gave rec to start neo gtt". Sure it's up to the lawyers for who to go after but you are NOT protected and you are DEFINITELY documented as part of the care. The semantics won't protect you and you better hope it doesn't go to jury.

 

[anaesthetic]

I'm not sure that you are legally on the hook, since your name is not on chart at all, you just helping when friend needs assistance. And believe me surgeons, and patients know that you are not equivalent to CRNAs. It is just these days is very hard to find enough physicians to cover all needs.

“Well, your Honor, the chart doesn’t have my name on it, so technically, I wasn’t there helping my friend in need of assistance.”

 

[neutro]

This is complete BS. Talk to your own leadership.

Your own leadership during the interview said they couldn't get it in the bylaws after attempts and complaints to admin. The CRNAs have been putting in quick notes every time a supervising doc shows up. For ex "doctor supervisor called to room, gave rec to start neo gtt". Sure it's up to the lawyers for who to go after but you are NOT protected and you are DEFINITELY documented as part of the care. The semantics won't protect you and you better hope it doesn't go to jury.

This is a very important point and this scenario is getting increasingly common due to anesthesiologist labor shortage and increase volume - esp in non desirable markets.

Forget the bylaws and internal staffing on how each group staffs cases - the patient needs to be aware who’s responsible for them. Are the CRNAs clearly and definitively having this discussion on pre op? Is this ethical practice in your opinion?

In the above example, let’s say the “friendly anesthesiologist” is not immediately available because they never got a chance to preop or eye ball the patient so didn’t know anything to anticipate anything.

Now they are immediately being asked to help and at the same time trying to diagnose and put the fire.

No.

They’re unprepared.

Will lead to worse outcome.

This is where catastrophic care/ firefighter anesthesia sucks and should be discouraged.

It removes the MD from preop process/ planning/ scheduling/ work ups and discussions from surgeons.

Essentially it diminishes an important role of anticipating complications.

At least with medical direction or supervision you participate in the patient’s care - or by default that dynamic between crna and md is specified.

With friendly anesthesia it’s not. You’re trusting the judgment of a crna. You’re depending on the crna to “consult you”.

I’ve been a part of a similar practice and often the crna will call another crna over the MD. Because they’re truly “friends”. You think 2 heads is better than 1 in that case? Think again.

So idk - the job sounds nice with md presence etc with the exception of this nebulous friendship anesthesia.

If you can decline to do that and do your cases 100%, may be a good gig.

 

[GassYous]

“Well, your Honor, the chart doesn’t have my name on it, so technically, I wasn’t there helping my friend in need of assistance.”

I've seen some bizarro things in the ed recently. The top of the note will be signed by the attending saying "I was available in the department but I was not consulted or involved in this patient's care in any way."

Well then why the f are you writing a note in this patient's chart??

 

[neutro]

I've seen some bizarro things in the ed recently. The top of the note will be signed by the attending saying "I was available in the department but I was not consulted or involved in this patient's care in any way."

Well then why the f are you writing a note in this patient's chart??

Likely because they can’t submit it for billing unless it’s signed off by an md…

 

[coffeebythelake]

I've seen some bizarro things in the ed recently. The top of the note will be signed by the attending saying "I was available in the department but I was not consulted or involved in this patient's care in any way."

Well then why the f are you writing a note in this patient's chart??

Obviously because thry were dragged into something before and learned their lesson. This is something mjdlevels and hospital admin wants. The only people who lose are the patients and the physician unwittingly dragged into this

 

[NeedleJockey]

Word is the CEO of this hospital is so toxic that the former group’s legal counsel forbid them to continue.

 

[nicolai]

Word is the CEO of this hospital is so toxic that the former group’s legal counsel forbid them to continue.

Split up with private practice was ugly, but 90% of physicians stayed, which speaks the volume about place. We are very happy with CEO and administration now.

 

[gaspusher]

Looks like it’s hospital employed w2 and not amc.

100% solo cases in level 2 facility usually no bueno. That’s big red flag already. Hospitals needs to add call incentive to the trauma solo calls.

Problem is they cap salary at 650k

My friend out west in California has similar level 2 solo trauma calls. He was 800k plus salary and that was 3-4 years ago. With 12 weeks off with private group.

With a typical $50 per unit payer mix, it’s really hard for someone working full time to get above the 600s! Now if trauma call was compensated equal to cardiac at that hospital with the stipend, it’s very possible. A general anesthesiologist (non cardiac) making over $600k (non locums) is very much out of the norm. Unless they work all the time and take up tons of call!

Full time cardiac should be in the 7xxk or above.

Note, I speak only of the west coast of the US. I have no idea what happens on the east coast with all those crnas model jobs.

 

[aneftp]

With a typical $50 per unit payer mix, it’s really hard for someone working full time to get above the 600s! Now if trauma call was compensated equal to cardiac at that hospital with the stipend, it’s very possible. A general anesthesiologist (non cardiac) making over $600k (non locums) is very much out of the norm. Unless they work all the time and take up tons of call!

Full time cardiac should be in the 7xxk or above.

Note, I speak only of the west coast of the US. I have no idea what happens on the east coast with all those crnas model jobs.

Don’t think like that. Hospital admin wants anesthesia docs to think like that

Hospital reimbursement for facility fees are through the roof after Obamacare and mega mergers and forced higher payments from insurers.

Notice the FCC picking on little usap anesthesia company for their monopoly driving up prices in Colorado.

Yet FCC doesn’t dare touch some communities where 2-3 mega hospitals systems dominant and drive facilities through the roof

 

[Xcellerator]

With a typical $50 per unit payer mix, it’s really hard for someone working full time to get above the 600s! Now if trauma call was compensated equal to cardiac at that hospital with the stipend, it’s very possible. A general anesthesiologist (non cardiac) making over $600k (non locums) is very much out of the norm. Unless they work all the time and take up tons of call!

Full time cardiac should be in the 7xxk or above.

Note, I speak only of the west coast of the US. I have no idea what happens on the east coast with all those crnas model jobs.

Agree with aneftp about hospital admins.

If hospital employed, you should also definitely be getting stipends for every call shift you are doing whether it be Trauma, Cardiac, OB, 1st/2nd, etc. in addition your base. This should be a job for full time Generalist for $600k+, Cardiac should definitely be at least $700k+.

 

[mmag]

Split up with private practice was ugly, but 90% of physicians stayed, which speaks the volume about place. We are very happy with CEO and administration now.

If 90% of the physicians stayed and it was previously a physician only practice, why all this recruitment?

 

[Beeftenderloin]

If 90% of the physicians stayed and it was previously a physician only practice, why all this recruitment?

My group just went through a similar situation. We were killing ourselves to keep up with the volume as a private group with no stipend, and couldn’t hire because of it. Became employed, about 6 people left (only ~4 FTEs). Part of the contract negotiation was that they would have to hire 10+ FTEs in excess of pre-negotiation numbers, and they are. So we’re in a big hiring kick right now, despite retaining vast majority of group.

 

[amyl]

Agree with aneftp about hospital admins.

If hospital employed, you should also definitely be getting stipends for every call shift you are doing whether it be Trauma, Cardiac, OB, 1st/2nd, etc. in addition your base. This should be a job for full time Generalist for $600k+, Cardiac should definitely be at least $700k+.

I agree - unless it’s a 40h a week gig experienced generalists should be north of 600 plus benefits and 8 weeks vacation… if it’s in a high cost of living place (Cali, Oregon, etc.) it should be more

 

[nicolai]

Sorry, I'm getting confused, may be thread just moved far away from original question from OP, but this job offers 600 base plus 100-150 incentives, and 10 weeks of vacations, if you are cardiac it is even more.

 

[USCTrojan11]

Agree with aneftp about hospital admins.

If hospital employed, you should also definitely be getting stipends for every call shift you are doing whether it be Trauma, Cardiac, OB, 1st/2nd, etc. in addition your base. This should be a job for full time Generalist for $600k+, Cardiac should definitely be at least $700k+.

Except their cardiac volume here is very little. The surgeons were in a fight with the cardiologists so no referral base outside of ED and in house emergencies and the rare PCP referral

 

[USCTrojan11]

Sorry, I'm getting confused, may be thread just moved far away from original question from OP, but this job offers 600 base plus 100-150 incentives, and 10 weeks of vacations, if you are cardiac it is even more.

Comp package is one of the strongest for PNW just the CRNA thing is a major concern, especially with the aggressive documentation practiced