Right to practice: CRNA vs Anesthesiologist in a Medical Direction model

[Hoya11]

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I used to think that way. But with facilities fees so high. Hospitals don’t care if they need to pay extra for overtime etc. they will complain about coverage with anesthesia if u are third party or independent private practice.

But they will
Cough up
The cash these days.

I agree that the way our system works this makes financial sense for the hospital.

But it shouldn’t work that way ..

Surgery shouldn’t be such an industry , it should be a last resort . Until that culture changes we will be in shortage

 

[amyl]

My current hospital gives most surgeons a flip room. If the surgeons are fast enough it makes sense - as stated facility fees are where the $ are….

 

[aneftp]

My current hospital gives most surgeons a flip room. If the surgeons are fast enough it makes sense - as stated facility fees are where the $ are….

and it’s gonna to be that way for a long time. Ride the wave

 

[NPJR]

Normal market forces do still apply for anesthesia. If a hospital offers $350k for 55hrs/wk 1:4 direction, and 8 weeks off, and they're not in a highly desirable area, few will apply. The problem for that hospital is not a national lack of supply, it's a local lack of supply caused by inadequate compensation for work expected. Increase compensation and change work conditions, and the effective supply of anesthesiologists to that location will increase.

I also don't think that the majority of anesthesiologists are as financially secure, and not willing to go after extra work, as you claim. We have many on this forum living the money-chasing locums life, many more supplementing their fulltime jobs with locums, I know a ton leaving their fulltime jobs for more control and money elsewhere, and a lot more that are uncertain enough in their financial wellbeing that they put up with an abusive system instead of looking for other work.

People who run hospitals are not the brightest bunch. While being in the boonies, instead of going up on the salary until you hit a # that people apply they wait for damaged candidates to apply and low ball them. This doesnt do anybody favors not the least of which are your patients.

On another note on financial security: I work with a doc who got a windfall of 17 Million dollars on a trust he has available to him and still fighting me for call. That is pathology

 

[aneftp]

People who run hospitals are not the brightest bunch. While being in the boonies, instead of going up on the salary until you hit a # that people apply they wait for damaged candidates to apply and low ball them. This doesnt do anybody favors not the least of which are your patients.

On another note on financial security: I work with a doc who got a windfall of 17 Million dollars on a trust he has available to him and still fighting me for call. That is pathology

Yup I can relate. My 60 year old colleague literally showed me his portfolio at 19 million. Plus his paid off home 1.5 and his kids are long gone and have incomes and graduate level and doctorate degrees also. And he’s fighting me for a Feb 2026 surgery center date I want to make extra.

The struggle is real. Now I’m left scrambling.

 

[BLADEMDA]

My current hospital gives most surgeons a flip room. If the surgeons are fast enough it makes sense - as stated facility fees are where the $ are….

I have a 66 year old colleague who just had a cardiac ablation procedure for A. Fib. He said United Health Care paid the hospital over $100,000 for the facility fee. That's why the stipends for anesthesia will continue because the hospitals can mint money doing procedures.

 

[Mman]

I have a 66 year old colleague who just had a cardiac ablation procedure for A. Fib. He said United Health Care paid the hospital over $100,000 for the facility fee. That's why the stipends for anesthesia will continue because the hospitals can mint money doing procedures.

facility fees for cath and EP labs are insanely high, they make surgeries look cheap.

 

[aneftp]

facility fees for cath and EP labs are insanely high, they make surgeries look cheap.

If hospitals were smart.

I’d pay every anesthesiologist who’s solo $300/hr 7-3
I’d pay $325hr for (3-5p)
$350/hr (5-7p)
$400/hr after 7p

I’d tweak it if the doc can come in at 11-7p ($350/hr)
If the want to be act model to prevent docs who just want to chill from cherry picking $250-hr (1:4) 7-3p

night float act id Tweak it even more 7p-7a $375-hr

If solo nights $425/hr

So many versions of adjusting pay on the fly.

That’s why some amc already do with crnas. Tweaking their hourly pay.

 

[NPJR]

If hospitals were smart.

I’d pay every anesthesiologist who’s solo $300/hr 7-3
I’d pay $325hr for (3-5p)
$350/hr (5-7p)
$400/hr after 7p

I’d tweak it if the doc can come in at 11-7p ($350/hr)
If the want to be act model to prevent docs who just want to chill from cherry picking $250-hr (1:4) 7-3p

night float act id Tweak it even more 7p-7a $375-hr

If solo nights $425/hr

So many versions of adjusting pay on the fly.

That’s why some amc already do with crnas. Tweaking their hourly pay.

You would pay a doc less for ACT. Then why would we do it?

 

[Lab Lover]

You would pay a doc less for ACT. Then why would we do it?

Because it may be the only option available-depending on where you live. Excluding residents, how much MD Anesthesia is left in the US? I know there are some regions where it is still pretty prevalent-but there are regions where it exceptionally rare. Anyone got any data?

 

[NPJR]

Because it may be the only option available-depending on where you live. Excluding residents, how much MD Anesthesia is left in the US? I know there are some regions where it is still pretty prevalent-but there are regions where it exceptionally rare. Anyone got any data?

Aneftp is talking about in the same facility paying a doc less to manage 4 rooms vs doing solo. That is ridiculous. Even he has drunk the Kool-Aid.

 

[aneftp]

Aneftp is talking about in the same facility paying a doc less to manage 4 rooms vs doing solo. That is ridiculous. Even he has drunk the Kool-Aid.

There are some facilities docs just chill do some random preops kick back the rest of the day cough cough covering 4 rooms. Low acuity. Very a doc rotting all day in a room.

It’s all about pace and workload. Think this over

One doc has 4 rooms. (2 super slow 5-6 hr neuro rooms) and 2 robotic general rooms

Vs one doc solo x 6-7 cysto.

Who has the easier day?

Think very closely. It’s so simple to figure who has the easier day.

On the flip side. Covering an ASC 1:4 is way different than covering a hospital 1:4. The hospitals generally has more downtime than an ASC.

One would argue an ASC due to the over and lack of downtime should be paid more.

 

[NPJR]

There are some facilities docs just chill do some random preops kick back the rest of the day cough cough covering 4 rooms. Low acuity. Very a doc rotting all day in a room.

It’s all about pace and workload. Think this over

One doc has 4 rooms. (2 super slow 5-6 hr neuro rooms) and 2 robotic general rooms

Vs one doc solo x 6-7 cysto.

Who has the easier day?

Think very closely. It’s so simple to figure who has the easier day.

On the flip side. Covering an ASC 1:4 is way different than covering a hospital 1:4. The hospitals generally has more downtime than an ASC.

One would argue an ASC due to the over and lack of downtime should be paid more.

Doesn't matter who has the easier day. It matters the value the work brings.
If you want to pay for how hard you work the floor scrubber works a lot harder than I do.

 

[jwk]

I have a 66 year old colleague who just had a cardiac ablation procedure for A. Fib. He said United Health Care paid the hospital over $100,000 for the facility fee. That's why the stipends for anesthesia will continue because the hospitals can mint money doing procedures.

Bingo! I just had my 3rd joint replacement. Two hips, and now a shoulder, all as an outpatient at the local hospital. All three were ballpark $100k non-discounted, and $35-40k reimbursed by insurance and the last one Medicare. Longest time actually in the hospital was 6 hours from walking in the front door till I got in my car to go home. They're not losing money.

 

[linkin06]

Public Comment Period Closes on Nursing & Professional Degree List

The Trump administration's "One Big Beautiful Bill" excludes nursing from graduate degree programs deemed as 'professional.' The move impacts loan funding, healthcare delivery, and patient care access. 140 Lawmakers, from both parties, sent a letter urging the administration to add nursing to...

nurse.org

Wasn’t sure where to post but wonder if this affects any aspect of crnas. If they’re not even professional degrees, how can they be “doctor”

Also lol theology over nursing?

 

[jwk]

Public Comment Period Closes on Nursing & Professional Degree List

The Trump administration's "One Big Beautiful Bill" excludes nursing from graduate degree programs deemed as 'professional.' The move impacts loan funding, healthcare delivery, and patient care access. 140 Lawmakers, from both parties, sent a letter urging the administration to add nursing to...

nurse.org

Wasn’t sure where to post but wonder if this affects any aspect of crnas. If they’re not even professional degrees, how can they be “doctor”

Also lol theology over nursing?

It does affect CRNAs - and CAAs as well.

 

[NPJR]

Nurses have fragile egos.

If they excluded Medicine as a profession and made it a trade, I would not write about it one iota. Who cares?

 

[narcotics999]

People who run hospitals are not the brightest bunch. While being in the boonies, instead of going up on the salary until you hit a # that people apply they wait for damaged candidates to apply and low ball them. This doesnt do anybody favors not the least of which are your patients.

On another note on financial security: I work with a doc who got a windfall of 17 Million dollars on a trust he has available to him and still fighting me for call. That is pathology

How many ex-wives to support?

I saw no wife no kid in late 50s work 80 hours a week. On the other hand, I had a coworker who got two kids in 70s. He got letters from the state board due to pts' complaints about surprise billing.

 

[narcotics999]

I have a 66 year old colleague who just had a cardiac ablation procedure for A. Fib. He said United Health Care paid the hospital over $100,000 for the facility fee. That's why the stipends for anesthesia will continue because the hospitals can mint money doing procedures.

10 years ago I had an outpatient surgery, in and out of hospital in 3 hours. BCBS ppo paid 50K facility fee, 5000 surgeon fee, ~2500 anesthesia fee (units around 12), and ~1200 pathology fee. Crazy.

 

[pgg]

Nurses have fragile egos.

If they excluded Medicine as a profession and made it a trade, I would not write about it one iota. Who cares?

It's just economics. It impacts their student loan options, to some degree. And maybe it'll impact their argument to expand their scope of practice.

As for ego - probably part of it.

I was always under the impression that the classic professions were medicine, the clergy, and the military. That use of the term dates back many 100s of years and only very recently came to include other people with advanced education (like law).

Words matter, titles matter. Else we wouldn't rightly get angry when RNs with online DNPs start prancing around in long white coats introducing themselves as "doctors" ...

 

[pgg]

I have a 66 year old colleague who just had a cardiac ablation procedure for A. Fib. He said United Health Care paid the hospital over $100,000 for the facility fee. That's why the stipends for anesthesia will continue because the hospitals can mint money doing procedures.

EP is a gold mine for the hospital.

Ours is building out more EP labs and hiring as fast as they can get the machinery installed and support staff hired.

EP gripes because their guaranteed 0700 - 1900 anesthesia staffing isn't enough. Every day. It's incredible. They book a full day of ablations before starting to add on all the inpatient devices. Admin are tripping over themselves trying to get them more capacity. By square footage and headcount I think EP is far and away the biggest cash cow for the system.

 

[Mman]

Admin are tripping over themselves trying to get them more capacity. By square footage and headcount I think EP is far and away the biggest cash cow for the system.

I mean it's great right now. In 3-4 years when the facility fees get dropped by 70% it will be getting dropped like a hot potato. Make hay while the sun shines.

 

[narcusprince]

Hospitals would have a much easier time with anesthesia staffing if they made their surgical scheduling efficient and not catered to the surgeons.

The idea that surgeons are the top of the pyramid and everyone must bend and cater to them and bring in staff they like and buy equipment they prefer is the root of the problem.

Yes you have to wait. No this isn’t an emergency. I don’t care that your schedule is full at your asc tomorrow. No you don’t get 2 rooms. No that case is cancelled she’s 90 and intubated her hip doesn’t need fixing.

Until we settle those issues , our staffing problems will go on. Good for our bottom line I guess. That’s why I think everyone is quiet about it. But what a tremendous waste for the healthcare system ..

Hospital administrators need to adhere to prime time staffing. The reason anesthesia isn’t profitable is due anesthesia groups being managed by the hospital. If it was private equity they would cut sites lf service and surgeons would have to wait on the operating room. Surgeons don’t want to wait and have the leverage. Its the classic if I don’t like it here i will bring my cases elsewhere.

 

[pgg]

I mean it's great right now. In 3-4 years when the facility fees get dropped by 70% it will be getting dropped like a hot potato. Make hay while the sun shines.

I don't feel like I have any confidence in projections for where facility fees for anything will be in 3-4 years.

If the hospital wanted to go crazy and pay us a call premium and appropriately staff the place to run a 24 hour line in EP, 7 days a week, like it's the only MRI within 500 miles, well, OK. Happy to oblige.

The only thing that annoys me is that EP plays games that just aren't tolerated anywhere else in the hospital, because (for now) they poop out mounds of gold doubloons for the hospital. Today their first case was posted for 7:30. They showed up at 8:25 because they had a meeting. Even odds they'll disappear for an hour around lunch to eat Chick Fil A with some device rep selling a new catheter or rainbows. At 6:30 PM tonight they're going to want everyone to stay late to cover an inpatient pacemaker add on.

It used to be only GI could get away with that behavior.

So it goes.

 

[Southpaw]

I don't feel like I have any confidence in projections for where facility fees for anything will be in 3-4 years.

If the hospital wanted to go crazy and pay us a call premium and appropriately staff the place to run a 24 hour line in EP, 7 days a week, like it's the only MRI within 500 miles, well, OK. Happy to oblige.

The only thing that annoys me is that EP plays games that just aren't tolerated anywhere else in the hospital, because (for now) they poop out mounds of gold doubloons for the hospital. Today their first case was posted for 7:30. They showed up at 8:25 because they had a meeting. Even odds they'll disappear for an hour around lunch to eat Chick Fil A with some device rep selling a new catheter or rainbows. At 6:30 PM tonight they're going to want everyone to stay late to cover an inpatient pacemaker add on.

It used to be only GI could get away with that behavior.

So it goes.

Ep does that here also. Starts late. Hour long catered lunches. Add on cases that run late. When they call at 4p asking to staff the add on pacemaker we say No that gets added to the list you can wait. I guess admin says you have to staff?

 

[dannyboy1]

Hospital administrators need to adhere to prime time staffing. The reason anesthesia isn’t profitable is due anesthesia groups being managed by the hospital. If it was private equity they would cut sites lf service and surgeons would have to wait on the operating room. Surgeons don’t want to wait and have the leverage. Its the classic if I don’t like it here i will bring my cases elsewhere.

Why are you advocating for this? Demand for anesthesia services is good for us.
God bless those surgeons.

 

[pgg]

Ep does that here also. Starts late. Hour long catered lunches. Add on cases that run late. When they call at 4p asking to staff the add on pacemaker we say No that gets added to the list you can wait. I guess admin says you have to staff?

Admin agreed to pay for additional anesthesia staff to guarantee them one line until 5 PM and another until 7 PM. No matter what else is going on elsewhere in the hospital.

To their credit, this largely solved the end-of-day crunch problems caused by EP. They're doing better about not always running past their end times.

Unfortunately, the start time is entirely up to EP. Admin doesn't seem to care (or even know?) about the $ they spend every day to have anesthesia and nursing and tech staff standing around from 0730 to whenever.

EP has interpreted those guaranteed staffing hours as freedom to be as inefficient as possible. Like a hoarder with a big house, whose hoard expands to fill the empty space, the EP cases space out with late starts and long turnovers on the days when their schedule is light. We often wait for the EP doc to arrive well after induction and intubation.

They don't seem to understand that unnecessarily filling their block time to the very end means other staff, elsewhere, get relieved later. And that their own staff work later, with more OT, than necessary. This is my primary gripe. I think it's inconsiderateness born of obliviousness - which somehow makes it harder to complain to them, and get them to change their ways.

OR-based surgeons/services that have to compete with other surgeons/services to get their add-ons into an OR have an implicit understanding that there are other people working in the hospital and that they're not the absolute center of the universe.

So it goes. It's a 1st world problem, to be sure.

 

[AKMD_1984]

People who run hospitals are not the brightest bunch. While being in the boonies, instead of going up on the salary until you hit a # that people apply they wait for damaged candidates to apply and low ball them. This doesnt do anybody favors not the least of which are your patients.

On another note on financial security: I work with a doc who got a windfall of 17 Million dollars on a trust he has available to him and still fighting me for call. That is pathology

lol…17m and fighting you to work extra???

wow…

that’s 680k on a 4% withdrawal rate…and it will go up every year

i’d just take a cush academic 30 h a week f/t no call job with amazing benefits and focus on my health and travel if it were me

 

[aneftp]

lol…17m and fighting you to work extra???

wow…

that’s 680k on a 4% withdrawal rate…and it will go up every year

i’d just take a cush academic 30 h a week f/t no call job with amazing benefits and focus on my health and travel if it were me

Dude. My 2 mil a year anesthesia bros are pushing 35 mil net worth. And still taking calls. The work ethic is insane. And they ain’t 50 years old yet.

But they gotta stop soon. It’s not worth it.

 

[AKMD_1984]

Dude. My 2 mil a year anesthesia bros are pushing 35 mil net worth. And still taking calls. The work ethic is insane. And they ain’t 50 years old yet.

But they gotta stop soon. It’s not worth it.

“i wish i did one more shift”


said no one ever on their death bed…

 

[aneftp]

“i wish i did one more shift”


said no one ever on their death bed…

These dudes are greedy. It’s psychological. Psychology about “touching their principal” bank sheets

So if they have 35 million they don’t want to touch it. Only want to spend the money they are making

 

[AKMD_1984]

These dudes are greedy. It’s psychological. Psychology about “touching their principal” bank sheets

So if they have 35 million they don’t want to touch it. Only want to spend the money they are making

i’d stay away from these type of people. their brain chemistry does not seem balanced.

 

[JoelJoel84]

Dude. My 2 mil a year anesthesia bros are pushing 35 mil net worth. And still taking calls. The work ethic is insane. And they ain’t 50 years old yet.

But they gotta stop soon. It’s not worth it.

This sounds so meaningless and sad; they must be completely alone with no wife, children, or family. But have fun driving alone all day, to the next 24hr locums gig in the new Ferrari?

Something to be said for a nice stable job working with people you know and enjoy, a cozy house, putting your kids to bed, and sleeping next to your spouse every night.

 

[aneftp]

This sounds so meaningless and sad; they must be completely alone with no wife, children, or family. But have fun driving alone all day, to the next 24hr locums gig in the new Ferrari?

Something to be said for a nice stable job working with people you know and enjoy, a cozy house, putting your kids to bed, and sleeping next to your spouse every night.

No. Married with baby mamas. Baby mamas just turn the other way cause gonna know.

The hookers and hoes. Golfers too. Nice seats at nfl games. Nice seats at nba games.

They are home every night. It’s hard to describe their gig. Weekends is where they crush it. But they don’t work every weekend. But Monday -Thursday night home Every night.

 

[ambiturner]

No. Married with baby mamas. Baby mamas just turn the other way cause gonna know.

The hookers and hoes. Golfers too. Nice seats at nfl games. Nice seats at nba games.

They are home every night. It’s hard to describe their gig. Weekends is where they crush it. But they don’t work every weekend. But Monday -Thursday night home Every night.

My area like this as well - you could make much more than entire week of day shifts taking just one weekend of call. This is well known though and the shifts get snapped up quick so I imagine if one is to make this happen you’d need to be on staff and willing to travel to a lot of hospitals.

 

[MH198886]

No. Married with baby mamas. Baby mamas just turn the other way cause gonna know.

The hookers and hoes. Golfers too. Nice seats at nfl games. Nice seats at nba games.

They are home every night. It’s hard to describe their gig. Weekends is where they crush it. But they don’t work every weekend. But Monday -Thursday night home Every night.

I want to do it just for 2-3 years and be done. 4 mln in savings, then get a Kaiser or VA job.