Worst job in America

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nimbus

nimbus

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Recently got this email. 4 calls per week and 72hrs in-house call/week? Independent CRNAs? In Stockton?? It’s got to be some kind of prank.



Good Morning Dr. ,

I hope this message finds you well!

Dignity St. Joseph’s Medical Center in Stockton, CA is developing an anesthesia residency program and is seeking core faculty to build the department. Our faculty will be extremely engaged with resident education and career development.New grads welcomed! $25k stipend!

We have the following positions available:

Core Faculty Regional & Pain
Core Faculty OB
Core Faculty General Anesthesiologist

Job Summary
• St. Joseph’s Medical Center | Stockton, CA | (St. Joseph's Medical Center Stockton)
• 8 ORs | 357 Beds
• OR Start times between 7 AM – 7:15 AM
• 12,500 cases | General, Colorectal, Ortho, Spine, Thoracic, Cardiac, Vascular, Cath lab, IR, Endo, OBGYN, ENT, Podiatry, Plastics, some Peds | OB 2,500 cases
• Case mix - Hospital and ASC environment with fair schedule
• Four calls per week: 1st call in house one time per week, 2nd call one time per week from home, 24-hour OB call one time per week, 24-hour OB call one time during weekend.
• Post call off after 1st call not 2nd
• Independent CRNA practice in a collaborative MD/CRNA model
• We offer flexible schedule (Full Time, Part Time, Per Diem, No Call contracts offered)

Anesthesia Residency Program, Core Faculty:
1. Anesthesia Residency, Core Faculty in the daily leadership, oversight, and direction of the anesthesiology residency program to ensure that the residents compliantly meet and exceed the necessary training requirements.
2. Provide evidence of progressive and increasing responsibility by the resident as his/her training.


If you or someone you know is interested, please send your CV to [email protected].
I look forward to hearing from you soon!


Recruitment Marketing Manager
Somnia Anesthesia
Members don't see this ad.
 
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After seeing that ad I'm interested

















In calling the police to report a crime in progress against all anesthesiologists
 
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Members don't see this ad :)
since you're doing like 3-4 people's work, i expect 1.5-2 milli
 
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Typical somnia amc contract.

Somnia makes envision and Napa look like angels.
 
I sent them an application touting my accomplishments of reconquering my heroin addiction and finally getting off the sex offender registry. They said that I was fine to continue the process as long as I had no open warrants.
 
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One the one hand the profession needs more residents so docs can sit their own cases. But what kind of faculty would take that gig?! Such a paradox….collaborative model and independent CRNAs.
 

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Interesting differences between this ad and the OP. They've increased the sign-on to 50k and suspiciously they leave out everything related to call obligations. Salary starting at 515k.
 
Members don't see this ad :)
Careful what you wish for.
We had a “collaborative model” a little south from us. One MD for the hospital and one MD for the surgery center. Firefighters. Pay was decent… 600ish. Crnas did OB solo at night and MD “signs off” the next morning. Last week a crna gave IT digoxin instead of bupi. Patient died. Super sad.
ALL savings with a collaborative model are now washed down the drain for years and years to come as this is going to be a big settlement- horrendous PR. You put your license on the line with these setups AND you put patients at risk. Do yourself a favor and walk away from these jobs (especially CRNA teaching jobs).
Not worth it for you or the patients you take care of.
 
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sevoflurane said:
Careful what you wish for.
We had a “collaborative model” a little south from us. One MD for the hospital and one MD for the surgery center. Firefighters. Pay was decent… 600ish. Crnas did OB solo at night and MD “signs off” the next morning. Last week a crna gave IT digoxin instead of bupi. Patient died. Super sad.
ALL savings with a collaborative model are now washed down the drain for years and years to come as this is going to be a big settlement- horrendous PR. You put your license on the line with these setups AND you put patients at risk. Do yourself a favor and walk away from these jobs (especially CRNA teaching jobs).
Not worth it for you or the patients you take care of.
Click to expand...

How do you give IT dig?
 
sevoflurane said:
Careful what you wish for.
We had a “collaborative model” a little south from us. One MD for the hospital and one MD for the surgery center. Firefighters. Pay was decent… 600ish. Crnas did OB solo at night and MD “signs off” the next morning. Last week a crna gave IT digoxin instead of bupi. Patient died. Super sad.
ALL savings with a collaborative model are now washed down the drain for years and years to come as this is going to be a big settlement- horrendous PR. You put your license on the line with these setups AND you put patients at risk. Do yourself a favor and walk away from these jobs (especially CRNA teaching jobs).
Not worth it for you or the patients you take care of.
Click to expand...
Just curious what state this was in? We have a similar setup in my current (temporary) job. Doc on call 7a-7p and solo crna covering OB 7p-7a. I have made it clear with admin and the OB docs that the OB on record is the collaborating physician at night. There was a little pushback at first but admin stepped in and somehow shut down their concerns. In my state any physician or dentist can supervise a crna and the hospital’s crna protocol states this as well. I have personally sidestepped this issue by refusing OR call or any kind of “backup” call setup where my name would appear anywhere on a chart or a schedule while the solo crna is covering. As of now the only signature appearing on consents or records is the crna.

Funny thing is that the last group was given the boot for leaving crnas unsupervised and once the hospital got a taste of how much 24/7 MD coverage was gonna cost they decided that solo crnas weren’t that bad after all.
 
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ucladoc2b said:
How do you give IT dig?
Click to expand...

They are both ampules of similar size. Change in vendor, not reading the label, pharmacy tech vending to wrong slot in the Pyxis, other “holes in the Swiss cheese lining up”, etc.



ETA: Just speculation on my part.. I have no specific knowledge of the incident.
 
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Dr. Rude said:
They are both ampules of similar size. Change in vendor, not reading the label, pharmacy tech vending to wrong slot in the Pyxis, other “holes in the Swiss cheese lining up”, etc.
Click to expand...

Figured. Dig shouldn’t even be anywhere near an OR pyxis. Can’t think of any need for it.
 
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1. Job from OP sounds terrible

2. To whoever needs to hear this: remove all digoxin vials from your Ob suites. Or your entire anesthesia footprint. We had a case of IT Dig given in our region, with absolutely catastrophic results. I do cardiac anesthesia and did CICU for 5y. I wrote for IV Dig <10 times and have never personally drawn it up to give. What does anyone need access to IV Dig vials for in women who’s hearts are strong enough to carry a parasit…I mean fetus…to term?
 
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Pause. What kind of janky residency program are they going to create with 8 ORs, independent CRNAs, etc.. Reminds me of the HCA programs in Fl
 
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Dr. Rude said:
They are both ampules of similar size. Change in vendor, not reading the label, pharmacy tech vending to wrong slot in the Pyxis, other “holes in the Swiss cheese lining up”, etc.
Click to expand...
Has anyone ever tried any sort of standardization with vials? Having bright orange/red caps is great for paralytics. Maybe some see it as overkill but it would be great if there were some other standard cap colors for meds that need diluting, anti hypertensives, etc. For some patients there are meds more dangerous than even paralytics.

Obviously isn’t excusing a med error. Diligence is always the most important skill in anesthesia. But establishing more safety nets isn’t a bad idea.
 
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ucladoc2b said:
How do you give IT dig?
Click to expand...

No clue. That is several layers of incompetence at that facility. I can’t remember the last time I gave dig to a patient. Probably ICU rotation as a resident.
 
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The Duck Knows said:
Obviously isn’t excusing a med error. Diligence is always the most important skill in anesthesia. But establishing more safety nets isn’t a bad idea.
Click to expand...

You are 1000% right. I had an older partner that ran one of our surgery centers not get that. You NEED to setup your facilities so your anesthesiologists can succeed and not get into trouble. No reason to have blue top dexamethsone, zofran AND 10mg of neo next to ea. other- EVER. We have since made changes to our pixis and pressors are kept in a completely different drawer across most (if not all) of our facilities. You still need to check as you draw drugs up… but I feel it’s one less hole in the swiss cheese model when you set things up to succeed.
 
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What happened at this hospital is so many levels of wrong I can hardly get my head around it.
 
This case should never happen, but it got me thinking… I think I would give serious thought to IT digibind.
 
sevoflurane said:
This case should never happen, but it got me thinking… I think I would give serious thought to IT digibind.
Click to expand...
Is the digoxin/digibind complex + any additional preservatives or additives to the digibind less toxic than IV digoxin by itself?
I suspect that nobody anywhere knows the answer to that question.
What is the most CSF that could be safely taken off quickly? Lumbar drain maybe with an epidural kit?
 
I’m not sure. Nothing out there, but for digibind to make its way to the csf in any significant amount via PIV/central line would take quite some time. Lumbar drain is a good idea, but I think the issue is brain stem and na/k pumps.
 
I mean are they not buying the kits that has the 2ml bup already in the kit? I've seen some weird ass meds in some of these med carts/pyxis machines at some of the locums places I've rotated at. Latest one had like 10 vials of papaverine. I def agree that pharm/anes needs to work together to create better med carts. Dig shouldn't be anywhere near our carts at this point.
 
The Duck Knows said:
Has anyone ever tried any sort of standardization with vials? Having bright orange/red caps is great for paralytics. Maybe some see it as overkill but it would be great if there were some other standard cap colors for meds that need diluting, anti hypertensives, etc. For some patients there are meds more dangerous than even paralytics.

Obviously isn’t excusing a med error. Diligence is always the most important skill in anesthesia. But establishing more safety nets isn’t a bad idea.
Click to expand...
Paralytics should all be red, and local anesthetics should all be gray, narcs blue, at a minimum. Then, at least, if folks were drawing up something for a block, maybe people would at least wonder why their “supposed” local anesthetic had a top that wasn’t gray.
 
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Gasworks said:
Just curious what state this was in? We have a similar setup in my current (temporary) job. Doc on call 7a-7p and solo crna covering OB 7p-7a. I have made it clear with admin and the OB docs that the OB on record is the collaborating physician at night. There was a little pushback at first but admin stepped in and somehow shut down their concerns. In my state any physician or dentist can supervise a crna and the hospital’s crna protocol states this as well.
Click to expand...
So the OB is in house whenever the CRNA places the epidural?
 
Urzuz said:
Wet tap them with a 17g Tuohy and let the CSF flow.
Click to expand...
I remember being tested for boards and MOCA that CSF levage is a treatment option for high spinal (though I don’t see myself ever doing that in practice)
Replace amount removed with normal saline and hope for the best

Maybe that’s safer that digibind in the CSF?

pubmed.ncbi.nlm.nih.gov

Reversal of high spinal anesthesia with cerebrospinal lavage after inadvertent intrathecal injection of local anesthetic in an obstetric patient - PubMed

We show that exchange of CSF for normal saline can be used successfully to manage a high spinal in an obstetric patient. Our results suggest that CSF lavage could potentially be an important and helpful adjunct to the conventional supportive management of obstetric patients in the event of...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
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Onefellswoop87 said:
I remember being tested for boards and MOCA that CSF levage is a treatment option for high spinal (though I don’t see myself ever doing that in practice)
Replace amount removed with normal saline and hope for the best

Maybe that’s safer that digibind in the CSF?

pubmed.ncbi.nlm.nih.gov

Reversal of high spinal anesthesia with cerebrospinal lavage after inadvertent intrathecal injection of local anesthetic in an obstetric patient - PubMed

We show that exchange of CSF for normal saline can be used successfully to manage a high spinal in an obstetric patient. Our results suggest that CSF lavage could potentially be an important and helpful adjunct to the conventional supportive management of obstetric patients in the event of...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Click to expand...
In my experience and from what I have heard from others, a high spinal recedes to lower dermatomes fairly quickly (maybe 10 minutes). Have others seen this as well? Doing a CSF lavage seems excessive to treat something that, if supported with ventilation and vasopressors, will be better very soon. Maybe this is just for academic purposes to show that it may offer some benefit.
WRT to the treatment of accidental intrathecal digoxin, CSF lavage may certainly be something to consider.
 
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This spinal post is giving me anxiety. I’ve always been paranoid about drawing up a spinal, meds, dose and sterility, and I can’t stand if anyone interrupts me while I’m doing it. I have a routine and I follow it exactly the same way every time. Appropriate anxiety and a routine are very valuable. I’ve done a few GAs when the surgeon replied to my “is there time for a spinal?” question with, “If you can get it in a couple minutes.”
No, we’ll go to sleep.
The Stockton job sounds like hell at 2x the pay.
 
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Gern Blansten said:
In my experience and from what I have heard from others, a high spinal recedes to lower dermatomes fairly quickly (maybe 10 minutes). Have others seen this as well? Doing a CSF lavage seems excessive to treat something that, if supported with ventilation and vasopressors, will be better very soon. Maybe this is just for academic purposes to show that it may offer some benefit.
WRT to the treatment of accidental intrathecal digoxin, CSF lavage may certainly be something to consider.
Click to expand...
Completely agree, the relatively high spinals I’ve seen do recede quickly and in that case it’s probably better to manage the cardiovascular symptoms over a CSF levage.

But in the case of IT dig, I can only predict the eons it would take to get digibind from the pharmacy, so I might consider a CSF levage in that case.
 
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Onefellswoop87 said:
Completely agree, the relatively high spinals I’ve seen do recede quickly and in that case it’s probably better to manage the cardiovascular symptoms over a CSF levage.

But in the case of IT dig, I can only predict the eons it would take to get digibind from the pharmacy, so I might consider a CSF levage in that case.
Click to expand...
Given the dire reports of death and devastating neurologic outcomes, it would seem to be a very logical and defendable option. Expectant management would seem to be unlikely to have a good outcome. I just looked up and they have studied this scenario in rabbits and small doses seem to be tolerated in that species.
 
Eye drops are standardized in terms of colors. It’s interesting to think how that is the one field that seems to have figured that out. Pharmacists routinely post pictures of easily confused bottles on the pharmacy subreddit, the vial problem is similar.

I’m an ER doc so not drawing and giving lots of medications have seen and heard of many med errors that could maybe be prevented this way. (Including an intrathecal dig case involving anesthesia at a hospital I work at. Sad that it seems to be not all that rare.)
 
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I was helping a junior resident set up a spinal for an elective csection. I luckily caught the resident drawing up digoxin instead of bupivicaine. The junior resident should be vigilant and double check every medication. At the same time , the vials look similar and not sure why it’s in ob Pyxis. After I left , I heard there was an incident where digoxin was inadvertently given in spinal. During fellowship , a resident almost gave the local infiltration lidocaine into the spinal. Attending noticed before any harm was done.
 
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Having not seen or used a vial of digoxin in two decades, I am curious where this onslaught of digoxin vials is coming from, in L&D of all places. This has quickly gone from something I have never heard of happening to now almost everyone has seen a close call with it.
 
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Simba1711 said:
I was helping a junior resident set up a spinal for an elective csection. I luckily caught the resident drawing up digoxin instead of bupivicaine. The junior resident should be vigilant and double check every medication. At the same time , the vials look similar and not sure why it’s in ob Pyxis. After I left , I heard there was an incident where digoxin was inadvertently given in spinal. During fellowship , a resident almost gave the local infiltration lidocaine into the spinal. Attending noticed before any harm was done.
Click to expand...
Have to double and triple check what your injecting intrathecal. I force myself to do it every spinal. Never open anything ahead of time. I stop when I pick up the bupi ampule and read it and the expiration date, make sure no preservatives and not expired, make sure I have a filter needle. The premade kits make an error unlikely if meds included, but you still have to pause. Can’t think of any IV injection that can’t be saved if an error occurs … the digoxin spinal is universally fatal.

I’ve supervised some CRNAs who open the spinal kits ahead of time and draw meds in the OR and leave them unattended when they go to get the patient …. Probably nothing wrong but I personally am just paranoid, like to open a fresh kit and inspect everything before injecting an intrathecal med.
 
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nimbus said:
Sadly it’s not the first time.


Click to expand...
I didn’t read this whole thing but does it go into why IT digoxin messes you up so bad?

Fun trivia question from my
1st year physiology class, where is the only place in the body you find the Na/K pump on the opposite membrane (apical I think?)? Answer is choroid plexus, so I can’t imagine the CSF is a great place to put digoxin…
 
ranvier said:
One the one hand the profession needs more residents so docs can sit their own cases. But what kind of faculty would take that gig?! Such a paradox….collaborative model and independent CRNAs.
Click to expand...
It becomes "collaborative" when the "independent" CRNA gets into serious trouble, has no idea what to do, and calls you for help. If that's not the definition of collaborative, I don't know what is.
 
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