Residents: How many cases, on average, are you doing per day?

[coprolalia]

I just tabulated my cases so far this month. As of today, I've already done 35 cases.

Now, given the fact that I worked 8 days so far this month (and am post-call today), that averages out to 4.4 cases/day.

I'm not sure how much is billed (and subsequently collected) based on this... someone please correct me if I'm wrong... but, let's say that the average fee collected from a case I did is $750, which is pretty conservative considering some of the crap I've done over the past two weeks.

That's $26,250 in fees that should be collected for my work over the past eight days.

I'm paid, as a resident, roughly $52,000/yr. That's divided into 26 pay periods, which makes the math easy - $2,000 every two weeks before Uncle Sam gets his cut. In those 8 days of work, then, I made about $1,600 gross before taxes.

So, the gross "gain" (minus, obviously the various people skimming from that... ancillary staff, attending anesthesiologist, billing people, equipment costs, etc. ... necessary in the generation and collection of that fee) for the hospital was about $24,650!

I'm essentially doing it all on my own right now. If the attending comes in the room (at all), it's just to stand there, watch me work, and then sign the chart (NB: believe me, I'm not diminishing that role... so check your hate before you lay it out).

What's my point? I'm making someone a sh*tpile of money right now.

-copro

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[9french]

I just tabulated my cases so far this month. As of today, I've already done 35 cases.

Now, given the fact that I worked 8 days so far this month (and am post-call today), that averages out to 4.4 cases/day.

I'm not sure how much is billed (and subsequently collected) based on this... someone please correct me if I'm wrong... but, let's say that the average fee collected from a case I did is $750, which is pretty conservative considering some of the crap I've done over the past two weeks.

That's $26,250 in fees that should be collected for my work over the past eight days.

I'm paid, as a resident, roughly $52,000/yr. That's divided into 26 pay periods, which makes the math easy - $2,000 every two weeks before Uncle Sam gets his cut. In those 8 days of work, then, I made about $1,600 gross before taxes.

So, the gross "gain" (minus, obviously the various people skimming from that... ancillary staff, attending anesthesiologist, billing people, equipment costs, etc. ... necessary in the generation and collection of that fee) for the hospital was about $24,650!

I'm essentially doing it all on my own right now. If the attending comes in the room (at all), it's just to stand there, watch me work, and then sign the chart (NB: believe me, I'm not diminishing that role... so check your hate before you lay it out).

What's my point? I'm making someone a sh*tpile of money right now.

-copro

You are making nowhere near $750/case. At 4.4 cases per day, assuming an average of 12 hours in the O.R. per day and a 30 minute turn over, that means your cases average approximately 2.5 hrs per case. This comes out to 10 time units per case. At most academic centers, the payor mix tends to be poorer than in private practice. Medicare pays about $17 a unit. Since you likely have many medicaid, which pays far worse then medicare and "self" pays, I would assume your blended unit is not too far off of a medicare unit. If you add another three base units on average to your cases you have 13 units/case multiplied by $17/unit. This comes out to about $221/case, or approximately $1000/day. This money must pay for your attendings salary, billing, overhead such as malpractice insurance and health insurance for both you and your attending, and finally your cost to the program. So, realistically, if anything, you are barely paying for yourself with your cases or perhaps not even paying for yourself.

 

[coprolalia]

Our payer mix at our hospital is approximately 60% BC/BS. Our blended-unit is probably more in the neighborhood of $40-45 dollars (although we haven't been expressly told this outright by our chair), as BC/BS actually pays closer to $70/unit.

I have done at least two cases in the past week that got a 4 unit premimum just for set-up. In two other cases, we got additional billing for using ultrasound during block placement and putting in a central line (an additional $70 each just for printing out the picture and filling out the form... less than 5 minutes work).

Likewise, I spent a day in endoscopy (hence the high case number) where you get 1 unit just for signing the form. I think I did about 11 cases that day.

I put in two labor epidurals, and I know through BC/BS just putting the thing in the patient we get $400.

And, don't forget that Uncle Sam foots most of the bill for my training, to the tune of about $100k/yr payment to the hospital. No one is losing money having me around, trust me.

-copro

 

[Consigliere]

And, don't forget that Uncle Sam foots most of the bill for my training, to the tune of about $100k/yr payment to the hospital. No one is losing money having me around, trust me.

-copro

No, they most certainly are not. You are correct in that you are making them a sh$tload of money. I guess this is part of the reason ONE of our chairmans' cars was a Lambourghini.

 

[ozzie20]

I think the govt pays more per resident/year. I spoke with an administrator who said that its more in tune with 150,000/year/resident. So, -50k to pay the resident, and you're left with 100k to pay insurance premiums, any overhead waste the resident makes, and you've essentially got a small profit off of a resident without him/her having to do anything. The same administrator stated that if the hospital were to cut costs, the LAST thing to go before the hospital shutting down would be the residencies simply because they make so much money for them without having to do anything. The way it was described to me, its akin to having someone pay you to make someone else make money for you.

 

[coprolalia]

I think the govt pays more per resident/year. I spoke with an administrator who said that its more in tune with 150,000/year/resident.

Could be, but I think this is very hard to determine on a per-program basis.

From what I understand, the money is disbursed from Medicare funding (at the federal level) through Medicaid (at the state level). Out of that money, each hospital gets a percentage of "funded" GME spots (not all spots are funded). That money is then disbursed to the hospital.

Essentially, you could take that payment and divide it up by the number of residents to get a per-resident fee. Out of that, the hospital pays your salary, insurance, FICA, GME training funds, (etc.) to have you there. The rest is gravy.

And, you're right, that's how the hospital administrators see us: gravy. There's got to be some incentive to train us, or they wouldn't do it. The quid pro quo is that we're supposed to get an education in the process. Lately, I feel like nothing more than a Clydesdale pulling a heavy load... and lining the hospital's coffers in the process. What makes matters worse is that I already know what I'm going to be making starting mid-July... and my mind is working against me right now.

-copro

 

[doctor712]

Copro,

I'm just curious, having heard your perspective on all this, whether or not you will be doing an anesthesia fellowship after PGY4? (if so, which area?)

Just wondering if someone in your shoes would even consider one. I know what happens when you subspecialize, just curious if it's worth another year for you at this current level of pay...?

If your answer is an absolute YES, ya haftoo dude, then that says something to me.

I know this is the million dollar question, but I thought it would be good to get your perspective...

Best,
D712

 

[dhb]

Over a year close to 3.5 cases per day.

Call yesterday:
labor epidurals x 6
ankle fracture
strangled hernia
removal of broken pieces of a craniectomy replacement
pericardial drainage
subdural hematoma
c section
appy

I earned 150€ before taxes for call so yes someone is making a $hit load of me. An epidural is 175€ to 450€ depending on insurance...