Struggling Anesthesia Management Companies

[HenryH]

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Not in my old neck of the woods. My old hospital looked like a spa. Beautiful in and out. Great place to work, just terrible location.




In BFE, you get a subsidy because of location. When you negotiate $50 a unit for all medicaid/medicare, then things tend to even out. You are also a very valued commodity to the OR environment when you form a group and bring stability... especially if you are replacing a terrible AMC with bad outcomes that can devastate the reputation of a regional or community hospital.
I've been there and lived that.

Thanks for the explanation; so what's the deal with AMC takeovers in non-BFE areas that happen to have a very high proportion of Medicaid/Medicare patients? What happened with the local hospital network in my area is actually the exact opposite of what you describe in the bolded portion of your post; there was a longstanding private group (anesthesiologist-owned) that had held the contract with the hospital network for decades, and a few years ago, they were suddenly ousted by the hospital administration and an AMC was brought in to replace them (however, the details as I know them are somewhat murky, because I was told that there was also an anesthesiologist who "screwed-over" the other anesthesiologists, so I'm not 100% sure what went down...).

Also, if the AMC's performance/reputation has suffered over the last few years, then what's preventing the hospital administration from canceling their contract and putting it up for bid (even if to just end-up going with another AMC)? The reason I ask this is because the hospital just renewed the contract with the AMC for another 2 years back during the winter, so despite not being able to maintain a stable roster of providers and purportedly pissing-off the surgeons, the hospital is apparently "satisfied enough" with the AMC's level/quality of service to justify renewing their contract.... ?

 

[nimbus]

Quite the opposite in many areas. If you don't like it in BFE you leave town...! 🙄 and you never know what the hospital is going to get.

Physician retention is an ongoing endeavor in many places. I wrote a LOR for one of my old orthopod friends when he was jumping ship at the same time I was. Once administration caught wind of that he suddenly received a huge retention raise (think >90% orthopod MGMA).

I love the sound of that... Physician Retention.

I'm just saying our surgeons don't need to move and uproot their families in order to operate at a different hospital. It's just a 20min commute instead of a 15 min commute.

Secondly, your example illustrates that we are kidding ourselves about "surgeon dissatisfaction" regarding anesthesia. They don't really give a s*** as long as we aren't actually murdering the patients. What will actually cause surgeons to walk is dissatisfaction with their own incomes.

 

[nimbus]

While this is true, don't undermine the fact that said hospitals can hire their "own" surgeons and get rid of the existing surgeons priveleges at said facility (for better or worse).

This is true. My own hospital recently purchased the practice of our best and busiest OB/gyn. He works for the hospital now. However, we are still an open staff. I don't forsee my hospital getting rid of any surgeons. They are constantly trying to attract more business.

 

[amyl]

There's a few Drs leaving my bfe hospital now. Admin actually told our rads onc dr that they have no problem letting a high rvu generating physician go... We are all replaceable.

 

[Mman]

There's a few Drs leaving my bfe hospital now. Admin actually told our rads onc dr that they have no problem letting a high rvu generating physician go... We are all replaceable.

physicians don't really bring patients to a hospital except in highly competitive markets. In a 1 hospital town, every person in town is going to that hospital regardless.

 

[deleted50478]

physicians don't really bring patients to a hospital except in highly competitive markets. In a 1 hospital town, every person in town is going to that hospital regardless.

In the highly competitive market where I work, surgeons threaten to leave and occasionally do. A large practice switched locations recently and are being replaced at their old hospital by employed surgeons. I think this is unusual but more feasible in a 'desireable location' such as this one, where surgeons might be willing to be employed to live here.

 

[BuzzPhreed]

They don't really give a s*** as long as we aren't actually murdering the patients.

Yes and no. They also care if you are slow in turnover time. They also care if the patient moves during a case. Besides that, yeah murdering patients is a bad thing. That's about it. And even then it's hard to get rid of some absolute hack anesthesiologist in some places.

 

[Noyac]

Yes and no. They also care if you are slow in turnover time. They also care if the patient moves during a case. Besides that, yeah murdering patients is a bad thing. That's about it. And even then it's hard to get rid of some absolute hack anesthesiologist in some places.

And even harder to get rid of a butcher of a surgeon.

 

[Mman]

And even harder to get rid of a butcher of a surgeon.

not as much any more

We've gotten rid of 3 recently. Apparently the publishing of data that can make a hospital look bad and/or a hack that has horrible results that can eat into their bottom line can embolden a hospital to offload poor performers.

 

[Noyac]

True. I think we went thru a few locums surgeons this way a few years back. In case anyone thinks locums anesthesiologists are bad, you should work with a surgeon. Holy crap!

 

[missiongirl]

Yes and no. They also care if you are slow in turnover time. They also care if the patient moves during a case. Besides that, yeah murdering patients is a bad thing. That's about it. And even then it's hard to get rid of some absolute hack anesthesiologist in some places.

What is acceptable turnover time if you are doing your own cases (physician only group) for general cases... From time to out of OR, drop last patient off in pacu, give your sign out, then see the next patient, verify preop, explain consent and go over the anesthesia...to back in the OR with next patient (no lines or blocks, just regular general case)? 15-20 minutes acceptable as a rule?

 

[fakin' the funk]

What is acceptable turnover time if you are doing your own cases (physician only group) for general cases... From time to out of OR, drop last patient off in pacu, give your sign out, then see the next patient, verify preop, explain consent and go over the anesthesia...to back in the OR with next patient (no lines or blocks, just regular general case)? 15-20 minutes acceptable as a rule?

If the surgeon is a "pusher," I try to be ready (door out to door in) in 8-10 min. Invariably, the tech and nursing staff aren't ready with equipment by then. 20 minutes is acceptable at my location(s) and most of our surgeons would view that as fast-ish.

 

[Mman]

If the surgeon is a "pusher," I try to be ready (door out to door in) in 8-10 min.

I have a hard time reconciling the logistics with how you could roll out the door with one patient and roll in with the next in 8 minutes. I'd assume you will spend 60 seconds getting from the OR to the PACU and even for an ASA 1 patient you probably spend at least 1-2 minutes giving report to the PACU RN and maybe another 60 seconds finishing up your paperwork (you have to document a set of vitals and what not). That's 4 minutes just getting rid of the last patient. I can't imagine you could walk over and meet the next one and have a quick exam/discussion and check the room (even if you aren't the one putting the circuit on and checking it I'll assume you at least eyeball it) and then round them up and roll back and be in the room in another 4 minutes.

If so, bravo.

Normal fast turnover time for anybody is around 15 minutes give or take depending on the location setup. Less than 10 minutes is virtually impossible.

 

[deleted162650]

If you're going back into the same OR then you will never be the rate limiting step. I can have the pt dropped off, tucked in, and the next one seen in 10ish minutes. At this point they're typically still mopping floors. Times when I've had motivated nurses/techs and not a lot of set-up slightly under 20min wheels out to wheels in is doable. Average pace at my shop is over 30min though. Flipping rooms saves a little time, but having a whole 2nd nursing/tech crew is when you can really speed up. I've done 2 appy's in under 60 min anesthesia start time to finish time both cases having 2 separate OR teams (got 3 done in 1'40" but the third was ruptured so it took a little longer).

 

[nimbus]

I have a hard time reconciling the logistics with how you could roll out the door with one patient and roll in with the next in 8 minutes. I'd assume you will spend 60 seconds getting from the OR to the PACU and even for an ASA 1 patient you probably spend at least 1-2 minutes giving report to the PACU RN and maybe another 60 seconds finishing up your paperwork (you have to document a set of vitals and what not). That's 4 minutes just getting rid of the last patient. I can't imagine you could walk over and meet the next one and have a quick exam/discussion and check the room (even if you aren't the one putting the circuit on and checking it I'll assume you at least eyeball it) and then round them up and roll back and be in the room in another 4 minutes.

If so, bravo.

Normal fast turnover time for anybody is around 15 minutes give or take depending on the location setup. Less than 10 minutes is virtually impossible.

We routinely turn over our cataracts in 4-5min at our surgery center wheels out to wheels in. We have EMR so I can review the following patients chart during a case.

The hospital is a different story. The best we can do is 20min.

 

[risnwb]

We turn over cataracts in 5 or less
Most healthy quick cases turnover between 5-8 minutes.
I do not go back to room and eyeball anything. Techs are good.
Rarely are we waiting for room turnover due to cleanup /setup.
Mostly my rate limiting step is waiting for the nibp to spit out a number.

 

[teeva]

Today I did 5 D&C in just under 2:20 at an ASC with one set of OR crew and 2 ORs. No downtime between cases. Billed for every single minute during that time. Two minutes for preop eval/consent/charting, go to OR and do case, roll pt into PACU, one minute to get vitals, report is self explanatory because the PACU nurse also did the preop, one more minute to finish up charting, and move on to the next pt for quick assessment and consent, and within a few minutes the pt is rolled into the other OR. Someone turns over the room for me (I never see who does it because I'm in pacu), and I draw up meds as nurse puts on monitors and positions pt, by the time the first BP is taken I'm pushing meds. BTW, I do all D&C under general/mask/spontaneous breathing with propofol plus sevo, and every single pt was awake at the end of the case and moved themselves over to the gurney.

The other day I did 6 D&C and an ovarian cystectomy in under 3.5h.

I do 95% of my charting during the case. By the time I finish the last 5% (making sure everything is complete) of the charting after all the cases are done and get billing info together, the last pt is ready to go home.

 

[Mman]

We routinely turn over our cataracts in 4-5min at our surgery center wheels out to wheels in. We have EMR so I can review the following patients chart during a case.

I wouldn't include cataracts when somebody asks about turnover during GA cases as the original question did.

 

[urge]

I have a hard time reconciling the logistics with how you could roll out the door with one patient and roll in with the next in 8 minutes. I'd assume you will spend 60 seconds getting from the OR to the PACU and even for an ASA 1 patient you probably spend at least 1-2 minutes giving report to the PACU RN and maybe another 60 seconds finishing up your paperwork (you have to document a set of vitals and what not). That's 4 minutes just getting rid of the last patient. I can't imagine you could walk over and meet the next one and have a quick exam/discussion and check the room (even if you aren't the one putting the circuit on and checking it I'll assume you at least eyeball it) and then round them up and roll back and be in the room in another 4 minutes.

If so, bravo.

Normal fast turnover time for anybody is around 15 minutes give or take depending on the location setup. Less than 10 minutes is virtually impossible.

I'm with you.

I think it is just people's perception of time.

I don't see how you could bring the next patient in less than 20 min, unless you are just pushing the bed.

 

[aneftp]

Today I did 5 D&C in just under 2:20 at an ASC with one set of OR crew and 2 ORs. No downtime between cases. Billed for every single minute during that time. Two minutes for preop eval/consent/charting, go to OR and do case, roll pt into PACU, one minute to get vitals, report is self explanatory because the PACU nurse also did the preop, one more minute to finish up charting, and move on to the next pt for quick assessment and consent, and within a few minutes the pt is rolled into the other OR. Someone turns over the room for me (I never see who does it because I'm in pacu), and I draw up meds as nurse puts on monitors and positions pt, by the time the first BP is taken I'm pushing meds. BTW, I do all D&C under general/mask/spontaneous breathing with propofol plus sevo, and every single pt was awake at the end of the case and moved themselves over to the gurney.

The other day I did 6 D&C and an ovarian cystectomy in under 3.5h.

I do 95% of my chartItring the case. By the time I finish the last 5% (making sure everything is complete) of the charting after all the cases are done and get billing info together, the last pt is ready to go home.

Try doing 6 d and C when 3 of them are asa 3 or 3.5 at outpatient.

When 2 of of bmi over 60 including one over 400 pounds.

Let me know if can you if in 2.5 hours.

You can't say you do so those d and c without mentioning patient selection bias.

Yes can preop quickly if patients healthy. But different story when they give you shady history.

Try masking and pushing propofol on my 5 4 420 pounder who can't lay flat for DC and tell me how it goes.

Again. You need to explain patient selection bias for "quick cases" and "quick turnover time and cases"

 

[pjl]

One place I worked required the OR staff to submit a written reason for the delay if the next case was not in the room 15 minutes after the first left the room. Even at that rate "anesthesia" was never the rate limiting step unless there was a very significant medical history that was completely ignored by the surgeon preoperatively.
5 minutes to drop off and report and 5 minutes to preop and return to room is pretty generous unless you are walking a long distance between locations or going back and forth a few times. In the era of EMR you should know the history and results before you get to the preop area.

For those who say they are just as fast as ACT, what you dont realize is that there is often a shorter or negative turnover time in that model because the next case is in a different room with a different provider before the first case is out of the room.
If you are going back to the same room I would imagine as long as you are not the rate limiting step you are just as fast, which should be easy as long as patients are either healthy or properly worked up. Your room should be turned over by a low cost tech except for drugs, which you can draw up fast either during previous case or as BP cuff is going off.
More noticeable is having a consistently slow wakeup time 🙂

 

[aneftp]

I am all for "effiency". But it could come a a big cost: costly mistakes.

There was an article published around 2010 saying it's all cool to say you reduced OR turnover time from 35 minutes to 20 minutes in a full service hospital.

That looks great on paper and for high fives in the board room.

But real practical world says it comes at as a significant cost: mistakes and stress.

Hospitals that do not provide enough support staff to be more "efficient". Meaning they have limited staff doing too much work (having tech clean the rooms as well as try to restock for next case). Only adds to mistakes.

And guess what. Cool. You save a whopping 15 minutes. Most tertiary hospital run 2-3 rooms during normal block time (regular business hours).

Which means all your 30-45 minute savings most likely cannot fit another case into the or schedule.

 

[Mman]

I'm with you.

I think it is just people's perception of time.

I don't see how you could bring the next patient in less than 20 min, unless you are just pushing the bed.

Self reported turnover times have as much value as a random surgeon telling me he'll be done in 30 minutes. An actual stopclock will generally see them underestimating their own time. When you put an actual clock on it, then you get some data.

 

[aneftp]

While this is true, don't undermine the fact that said hospitals can hire their "own" surgeons and get rid of the existing surgeons priveleges at said facility (for better or worse).

Yes this is getting more and more popular especially with General surgeons who are getting more tired having to maintain their own office and overhead.

Surgeons get guarantee X income plus benefits plus more income depending how much revenue they can generate.

 

[Psai]

Self reported turnover times have as much value as a random surgeon telling me he'll be done in 30 minutes. An actual stopclock will generally see them underestimating their own time. When you put an actual clock on it, then you get some data.

from my limited experience, i've found that actual time = surgeon's estimate x 2

 

[nimbus]

Self reported turnover times have as much value as a random surgeon telling me he'll be done in 30 minutes. An actual stopclock will generally see them underestimating their own time. When you put an actual clock on it, then you get some data.

It is clocked data. These are actual times recorded on the anesthesia record with EMR. Also easy enough to look at your watch when you roll out and roll in.

 

[pgg]

Turnover to the PACU nurse can take seconds for an ASA 1 or 2 patient, if there's an EMR the RN can review prior to arrival. In those cases I can be done giving report before the NIBP can dump my closing vitals into the record.

But the OR is never ready before us anyway, so no rush.

Self reported turnover times have as much value as a random surgeon telling me he'll be done in 30 minutes. An actual stopclock will generally see them underestimating their own time. When you put an actual clock on it, then you get some data.

Our EMR records out-of-OR and in-OR times to the minute, so we get good data. Last I heard, some overpaid consultants came through our hospital, mined the data, and told us our average turnover time was 35 minutes. They also said the nationwide average was 28 minutes. I find those numbers believable for an average of all cases at an academic place. Certainly the peds ENT days full of ASA 1 & 2 mask cases have faster turnovers.

 

[pgg]

from my limited experience, i've found that actual time = surgeon's estimate x 2

MOFAT = mandatory orthopedic f*** around time = double the estimate and add 30 minutes

 

[nimbus]

MOFAT = mandatory orthopedic f*** around time = double the estimate and add 30 minutes

And rolling out of the OR with the LMA in minimizes anesthesia f*** around time.

 

[urge]

Try doing 6 d and C when 3 of them are asa 3 or 3.5 at outpatient.

When 2 of of bmi over 60 including one over 400 pounds.

Let me know if can you if in 2.5 hours.

You can't say you do so those d and c without mentioning patient selection bias.

Yes can preop quickly if patients healthy. But different story when they give you shady history.

Try masking and pushing propofol on my 5 4 420 pounder who can't lay flat for DC and tell me how it goes.

Again. You need to explain patient selection bias for "quick cases" and "quick turnover time and cases"

I'm concerned about the value we bring to such practices.

Couldn't anyone do such mindless cases?

How do you distinguish yourself? Turning over in 7 min?

 

[urge]

Turnover to the PACU nurse can take seconds for an ASA 1 or 2 patient, if there's an EMR the RN can review prior to arrival. In those cases I can be done giving report before the NIBP can dump my closing vitals into the record.

But the OR is never ready before us anyway, so no rush.




Our EMR records out-of-OR and in-OR times to the minute, so we get good data. Last I heard, some overpaid consultants came through our hospital, mined the data, and told us our average turnover time was 35 minutes. They also said the nationwide average was 28 minutes. I find those numbers believable for an average of all cases at an academic place. Certainly the peds ENT days full of ASA 1 & 2 mask cases have faster turnovers.

Turnover depends on many things that are institutional like ivs being placed for you or you placing them, the patient being brought to you or you bringing the patient, techs turning over for you or not, patient record on inhouse emr or outside paperwork, pacu nurses waiting for you or you having to find them, preop clinic, having to get consent for anesthesia or not...

In my residency I had the worse of all above options plus I had to present my case to the attending hanging in the lounge because they wouldn't even bother, and then had to listen to the surgeon and OR director for my turnover being half an hr instead of 20 min.

 

[teeva]

Again. You need to explain patient selection bias for "quick cases" and "quick turnover time and cases"

I get your point. My point was just that turnover and throughput can be fast if the institutional culture, staff, and pt population are set up for it. ASA 1-3, 50-350lb is all the same to me for D&C, +/- propofol dose.

I do ask though...There are a few red flags that may arise, but what in a sketchy history/eval would lead to changing your management for a D&C, to cancel a case, refer to hospital facility for surgery, put in an Aline, do a spinal, awake FOI?

What do you guys do for your cataract/eye cases under local/topical? If pt can lie flat and still they are optimized for surgery? EKG? Labs? Full H&P and med recon?

 

[teeva]

How do you distinguish yourself? Turning over in 7 min?

It couldn't hurt. That's how I'm booked on my post call off days at ASC that only accepts PPO insurance.

 

[aneftp]

Turnover depends on many things that are institutional like ivs being placed for you or you placing them, the patient being brought to you or you bringing the patient, techs turning over for you or not, patient record on inhouse emr or outside paperwork, pacu nurses waiting for you or you having to find them, preop clinic, having to get consent for anesthesia or not...

In my residency I had the worse of all above options plus I had to present my case to the attending hanging in the lounge because they wouldn't even bother, and then had to listen to the surgeon and OR director for my turnover being half an hr instead of 20 min.

Yup. There are so more rate limiting steps than anesthesia.

Many places now want you to turn in ur narcotics in after each case to OR satellite pharmacy and get a new bag. (For those that don't have Pyxis machines inside the or rooms).

Many won't let you block a patient unless surgeon has signed off.

Sometimes antibiotics not ready at pharmacy

I am sure some CEO will just decide to make anesthesia people take back the patient.

Have the RNs help clean the room. They will figure they can save paying OR cleaning crew.

I get your point. My point was just that turnover and throughput can be fast if the institutional culture, staff, and pt population are set up for it. ASA 1-3, 50-350lb is all the same to me for D&C, +/- propofol dose.

I do ask though...There are a few red flags that may arise, but what in a sketchy history/eval would lead to changing your management for a D&C, to cancel a case, refer to hospital facility for surgery, put in an Aline, do a spinal, awake FOI?

What do you guys do for your cataract/eye cases under local/topical? If pt can lie flat and still they are optimized for surgery? EKG? Labs? Full H&P and med recon?

1. Asa 1-3 50-350 pounds is all the same to you? And you do your anesthetic the same? Sure. Starting stats 88% room air. Patient takes 3-5 minutes (with assistance to move over to the or table). Go ahead and push propofol and start masking the 420 pounder. Oh did I mention they took 4 DL attempts on a previous surgery in 2009 before finally getting it with glidescope which they called a "grade 2 view with lots of cricoid pressure".

You are not going to be able to single hand mask some really fat patients and push propofol and mask. And there are some ob/gyn who take a longer time. And to just say I do them all the same shows (or I think shows) you simply haven't been exposed to the same type of patient population. Trust me. I've worked in inner city (poor), inside the city (affluent) suburban (affluent areas) and even some smaller community hospitals (more country atmosphere/poorer)

They are not all the same. Or you haven't encounter the bad ones.

2. Sketchy history: "I am short of breath" You look up sats 88%. "Are you always sob?" "Some days" Woman is 40 years old. "Do you snore?" "I don't know, I live alone". "Can you lay flat". "No?, I get short of breath". How did you do with your last anesthetic? "I got sent to icu cause I stopped breathing in the recovery room"
Sure D and C is easy case 99% of the time. But we get train wrecks like this it seems every week in the hospital. This type of patient isn't going to be done at stand a lone outpatient place. There is a reason ob/gyn booked it at hospital.

That's the type of shady history I encounter often.

You can select patients for stand a lone outpatient centers. That's the easy part. We cover outpatient and inpatient.

But to say everything can be efficient with all the parts in place theory doesn't translate very well when it comes to inpatient services.

1. Hospital cuts back on staffing (they don't want to spend the money on more tech, nurses etc).

My brother is anesthesiologist in Los Angeles. Full service including cardiac. Guess what the hospital did 2 months ago? They let all the anesthesia techs go! So the anesthesiologist (all Md group) stock their own carts. Set up their own lines etc. sometimes nurses available. Sometimes not.

2. Patients themselves. Like the 420 pounder D and C done at hospital. She's going to take 3-5 minutes to move over to OR table regardless if you do it outpatient or inpatient. They gotta call all
Moving help to get her over. Question? Where is the moving help? No where to be seen. Cause hospital cuts back on staffing. So have to wait for moving help to become available.

Hospital management always go with business 101. What's the best way to cut costs? Easy. Cut employees.

As for cataracts and other eye procedures. We get the ones who can't lie flat. And they are coughing up a lot of flim the day of surgery. How are you going to handle that at ur stand a lone outpatient center. I am sure you aren't going to have a 2 minute preop and say lets roll the patient back.

 

[teeva]

Yes, we still don't disagree that those sicker pts shouldn't/don't come to ASC.

 

[sleepallday]

It couldn't hurt. That's how I'm booked on my post call off days at ASC that only accepts PPO insurance.

There is something about this that just doesn't sit right with me. And I don't mean any disrespect to you, but is this the metric used to determine the skill of an anesthesiologist?

 

[Gasworks]

In my community based small OR hospitals (4-5 rooms) we turn over total joints and bariatric cases in 20 minutes. Urology, knee scopes, minor gyn rooms can be done in 10 minutes and pain cases are even less. What this takes is and extra nurse per room and 2 housekeeping teams. It takes me 5 minutes to confidently park a patient in recovery and another couple of minutes to see the next patient. Every member of the team needs to be on point to keep an OR moving like this and if you stop for a cup of coffee between cases chances are they're going to be looking for you. Stressful? I dunno.. going home an hour early on a busy day is worth the effort to me.

 

[gasdoc77]

There is something about this that just doesn't sit right with me. And I don't mean any disrespect to you, but is this the metric used to determine the skill of an anesthesiologist?

Unfortunately, these are becoming the metrics used to compare all anesthesia "providers" by the ignorant. No wonder these buffoons think we are interchangeable. The AANA seeks to capitalize on this with empty rhetoric. Meanwhile, bad outcomes get blamed on nebulous causes

 

[Ezekiel2517]

what the hell kind of thread is this? This thing derailed somewhere

 

[aneftp]

Yes, we still don't disagree that those sicker pts shouldn't/don't come to ASC.

My point (counterpoint ) to your response was that it was an institutional issue and there are systemic problems that can be solved to speed turnover time.

That's what you stated. In my opinion. You over generalize too much.

But my response is you can't apply saying what goes on in outpatient surgery where you can hand pick patients to make turnover time faster.

You don't get a choice with hospital patients. There are way too many variables that goes into hospital turnover time vs outpatient turnover time.

 

[teeva]

There is something about this that just doesn't sit right with me. And I don't mean any disrespect to you, but is this the metric used to determine the skill of an anesthesiologist?

Nowadays, maybe. I think the only thing admins look for foremost is no bad outcomnes, followed by no complaints by surgeons/nurses that are triggered by things like slowness, cancelling cases for weak reasons, and speed.

My normal job is at a community hospital, ASC is just random post call days. I don't think speed and skill are necessarily inversely proportional. I'm not quite sure why there's such objection when we talk about speed.

 

[nimbus]

Nowadays, maybe. I think the only thing admins look for foremost is no bad outcomnes, followed by no complaints by surgeons/nurses that are triggered by things like slowness, cancelling cases for weak reasons, and speed.

My normal job is at a community hospital, ASC is just random post call days. I don't think speed and skill are necessarily inversely proportional. I'm not quite sure why there's such objection when we talk about speed.

Just like we say about surgeons, there are good fast anesthesiologists and bad fast anesthesiologists but there aren't any good slow anesthesiologists.😉

 

[Laryngophed]

I love the sound of that... Physician Retention.

Is that too much anti-cholinergic activity or something? 😉

 

[Referendum]

Back to the original thread / post. If anybody is thinking about joining Somnia, Inc. as a CRNA or Anesthesiologist..... I vehemently advise to remain far away from this predatory agency. Both myself and a colleague were independently contracted with this immoral organization over the past few years. Sadly, the contracts aren't worth the paper they're printed on. From the C-suite all the way down their motives are the same; undercut and compensate the clinicians at the lowest common denominator (25 percentile). All awhile maintaining aggressive call schedules and experiencing little time-off. Reason being is that they squander 10-15% of the compensation pool that the facilities allocate to the anesthesia department. They burn through providers like roman candles on the 4th of July. All awhile passing the cost onto the hospital. Eventually the hospital becomes wise to this practice and terminates the contract. The providers are left holding the stinking pile of $&^% and are often being threatened with non-compete sanctions and the like. Perhaps the most shocking is that the CEO, General Counsel, VP Clinical affairs, CMO, ect... are all purposely dishonest.

If you have any specific questions feel free to reach out for specifics.

 

[ranvier]

Just like we say about surgeons, there are good fast anesthesiologists and bad fast anesthesiologists but there aren't any good slow anesthesiologists.😉

Tape the eyes shut in preop to save time.

 

[Consigliere]

Back to the original thread / post. If anybody is thinking about joining Somnia, Inc. as a CRNA or Anesthesiologist..... I vehemently advise to remain far away from this predatory agency. Both myself and a colleague were independently contracted with this immoral organization over the past few years. Sadly, the contracts aren't worth the paper they're printed on. From the C-suite all the way down their motives are the same; undercut and compensate the clinicians at the lowest common denominator (25 percentile). All awhile maintaining aggressive call schedules and experiencing little time-off. Reason being is that they squander 10-15% of the compensation pool that the facilities allocate to the anesthesia department. They burn through providers like roman candles on the 4th of July. All awhile passing the cost onto the hospital. Eventually the hospital becomes wise to this practice and terminates the contract. The providers are left holding the stinking pile of $&^% and are often being threatened with non-compete sanctions and the like. Perhaps the most shocking is that the CEO, General Counsel, VP Clinical affairs, CMO, ect... are all purposely dishonest.

If you have any specific questions feel free to reach out for specifics.

I've been saying this for years....

 

[Robotic Wis-Hipple]

Just like we say about surgeons, there are good fast anesthesiologists and bad fast anesthesiologists but there aren't any good slow anesthesiologists.😉

Eh, I've met some peds ones. Where this rapid turnover and maximum billing efficiency crap isn't the primary goal of the hospital.

 

[easternether]

North shore has done precisely that. Most physicians are employees and billing is done by hospital...extremely profitable for a hospital system but very ominous for physicians who are not content with this model.

 

[facted]

North shore has done precisely that. Most physicians are employees and billing is done by hospital...extremely profitable for a hospital system but very ominous for physicians who are not content with this model.

North Shore is still a NAPA site. Not sure where you're getting your info. They are trying to hire their own people for a surgi center and struggling mightily.

 

[nimbus]

Eh, I've met some peds ones. Where this rapid turnover and maximum billing efficiency crap isn't the primary goal of the hospital.

It's not just the hospital, there's nothing wrong with efficiency. And our local peds hospital is probably the most efficient in town. My partners who work there love it.