The “hourly MD employee” models especially in house calls

[aneftp]

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One of the biggest differences that is often ignored between CRNA jobs and Anesthesiologist jobs is that many physician employment contracts don’t allow outside moonlighting. A CRNA can get that 2-3 day per week job that gives them benefits and then are free the rest of the week to rake in high-paying per diem shifts. However, many physician employment contracts specifically prohibit outside moonlighting, so while you can find a job working 2 days a week, you won’t be allowed to pick up outside contractual work.

There is also the prickly thing about non-compete clauses that prevent physicians from these kinds of arrangements. CRNAs have largely been left out of the arms race of worsening non-compete clauses that large employers deploy against us.

I know of zero physicians who are restricted from doing side gigs are different hospitals who are currently employed elsewhere.

The issue is really time off for these docs. They have to take annual leave to cover the hospitals as 1099 elsewhere

W2 Crna’s have built in days off 30-60 days they know in advance so they can fill in at other 1099 places. Of can do extra w2 shifts for extra pay for their off days at their home base hospital if there are needs

The docs don’t really have that flexibility outside of extra call shifts as w2

 

[GravelRider]

I know of zero physicians who are restricted from doing side gigs are different hospitals who are currently employed elsewhere.

The issue is really time off for these docs. They have to take annual leave to cover the hospitals as 1099 elsewhere

W2 Crna’s have built in days off 30-60 days they know in advance so they can fill in at other 1099 places. Of can do extra w2 shifts for extra pay for their off days at their home base hospital if there are needs

The docs don’t really have that flexibility outside of extra call shifts as w2

Maybe it’s a regional thing, but I have seen and had employment contracts myself that specifically restrict moonlighting. It could be a regional thing when there are only a handful of employers that have non-competes that exist for each other. However, in many places this is one of the big barriers to physicians engaging in hourly payment structures.

 

[D P356]

Maybe it’s a regional thing, but I have seen and had employment contracts myself that specifically restrict moonlighting. It could be a regional thing when there are only a handful of employers that have non-competes that exist for each other. However, in many places this is one of the big barriers to physicians engaging in hourly payment structures.

Probably regional. In today’s anesthesia job market, it would be poor for a group or hospital to be stuck on a no outside moonlighting clause. That should easily be negotiated out or an addendum could be added (assuming one gets their own malpractice insurance for those assignments).

 

[Arch Guillotti]

I know of zero physicians who are restricted from doing side gigs are different hospitals who are currently employed elsewhere.

The issue is really time off for these docs. They have to take annual leave to cover the hospitals as 1099 elsewhere

W2 Crna’s have built in days off 30-60 days they know in advance so they can fill in at other 1099 places. Of can do extra w2 shifts for extra pay for their off days at their home base hospital if there are needs

The docs don’t really have that flexibility outside of extra call shifts as w2

I know some.

 

[Izzyman]

Several in Chicago are like this, restricted moonlighting at other places

 

[aneftp]

Several in Chicago are like this, restricted moonlighting at other places

Are the crna’s under the same restriction?

 

[MirrorTodd]

72K???

I'm fairly certain they meant 7200, because 72K equals $3000/hr lol

 

[Izzyman]

Are the crna’s under the same restriction?

No,
Although I’m starting to hear about some flexibility

 

[periopdoc]

We are restricted from practicing anywhere else within our county, but we make the hospital pay additional for using us to restrict competition in this way.

 

[GravelRider]

We are restricted from practicing anywhere else within our county, but we make the hospital pay additional for using us to restrict competition in this way.

What does that mean? Did you get a bonus or pay increase tied to a non-compete? What if you refused the pay increase?

 

[periopdoc]

What does that mean? Did you get a bonus or pay increase tied to a non-compete? What if you refused the pay increase?

For a non-compete to be legally valid, there needs to be a consideration offered in exchange for the agreement to not compete. Mentioning the specifics of the consideration we demanded from the hospital would be too revealing to the specifics of how our contract works, but it is a reasonable consideration with conditions that the hospital has to maintain else the non-compete is voided.

We certainly could have refused to sign it. Instead, we calculated the value lost by being unable to staff local ASCs and clinic practices, then built that value into several other parts of the contract. The beauty of it is, if the hospital does not meet the conditions for continuation of the non-compete, we still get a significant amount of the additional value we negotiated, plus the additional income we will earn from expanding our practice.

 

[thinkorswim]

I have worked at a couple groups that require approval from the board to practice outside of the group. I'm not sure if this is for liability or competition purposes, but I suspect more the latter.

A few years ago we had one partner who decided to roll the dice and didn't let anyone know. It got really interesting when they rolled up to our hospital ED in the back of an ambulance with a patient who had a terrible complication at a nearby surgery center.

 

[Mad Jack]

Had a good frank discussion yesterday with one of the locums docs. They are correct in this thinking

Crna’s have been way ahead of the game with the “hourly model”

Most only work 2-3 days a week at busy hospitals. It makes so much sense. They can pickup extra when WHEN. THEY WANT to. On THEIR OWN TIME. When they choose to.

As soon as docs get into this line of thinking. Hospital administrators will be F’d.

It’s really the call coverage that w2 docs get screwed on. We all know that.

Think about this. The average CRNA 40 hour (1.75 days (one 24 and one 16 hour) is 220k plus full benefits. Plus 9 weeks off. Plus Paid state holidays. (Basically another 2 weeks off).

Some work 16 hours Fridays/24 hour Sunday’s.
Frees up their entire week to work elsewhere or just chill somewhere. Or vacay without even using any vacation days.

Crna’s aren’t cheap either.

It’s the number of days worked that matters most. The 8-10 hour daytime slot is getting harder and harder for most people to work 5 days a week or even 4 days a week. People want time off.

I work mainly daytime. But I’m done at 12pm a lot.

I couldn’t do 7-3 5 days a week.

Be careful. When you become a widget, you get treated like a widget.

 

[mmag]

Be careful. When you become a widget, you get treated like a widget.

The widget union is pretty good.

 

[psychbender]

Be careful. When you become a widget, you get treated like a widget.

You mean you're not already?

 

[Mad Jack]

You mean you're not already?

Not yet. Still a hot commodity where I'm at

 

[USCTrojan11]

Going along with turnover time, how does everyone deal with PACU holds?

At times, PACU holds are secondary to a shortage of pacu nurses able to accept patients into pacu. At times, PACU holds are secondary to the hospital floor beds being full so the recovered first cases in the pacu are unable to secure floor beds and languish in pacu for several hours causing delays in getting awake patients out of the OR.

How do we as a specialty get hospitals to compensate us for their poor operational management and resource utilization?

Every minute that I sit on pacu hold is another minute that the turnover between cases gets delayed and is another minute that delays me going home at the end of the day

Hospital stipends are supposed to be modeled to a revenue guarantee. A hypothetical one I know of - hospital pays for unit value of $XX.XX multiplied by 32 for the 8 hours of 7-3pm for each doc staffing a 10-site model. All billing for startup units goes to the group, the time billing goes to the hospital. This way, there is a revenue guarantee for each MD who shows up that day. So even if the surgeon calls in sick, the patient ate, the surgeon running late, trays missing, hospital catches on fire - stipends will make sure the MD is paid for showing up that day. Any work you do is gravy, sites come down at 3 - stipends cover call and unit value is 1.5x after 3.

 

[Iso4ane]

So with these hourly shift models for MD what are the usual expectations? To some degree I understand it may help the hospital because they can request X numbers of workers per a day, but what happened if rooms finish early or run late? Or how are assignments given out or parity between assignments handled. (I.e Thursday call might be worth more if you’re more likely to get the post call day off and a three day weekend). What other ways are there to ‘game’ the system from both the hospital side and the MD side?