Anesthesiologist shortage

[GassYous]

What time would you finish?

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[Howard888]

Most days 2-3 leave for most MDs. Waterfall type schedule though. About 2/3 of ORs done by 3 then they peel off every hour. Usually 4 or less ORs by 5, so all MDs but one done by 5/5:30. Direction morels obviously

 

[DolphinVA]

OK, Texas, NC, and TN-big cities, Nashville, Charlotte, Dallas

Literally every hospital. 6:30 was more common than 7:30. Most were 6:45-7 in room but usually 2-4 6:30 in room every day. Orthopedic ASCs in room 6-6:15 for one or two rooms. Usually Neuro or ortho was 6:30 but would even be gyn or something sometimes. Nursing staff actually preferred these starts as their shift finished at 2:30.

7:30 as the norm was unheard of.

TX here. 0730 to the room everywhere I've been. When surgeons ask for 0700 starts we just say NO. That 30-60 minutes earlier does nothing but stroke their ego at the cost of wrecking your sleep and stealing time from your family.

 

[ambiturner]

TX here. 0730 to the room everywhere I've been. When surgeons ask for 0700 starts we just say NO. That 30-60 minutes earlier does nothing but stroke their ego at the cost of wrecking your sleep and stealing time from your family.

If you left in the afternoon 30-60 minutes earlier wouldn’t you have more time with your family? I would assume they’re asleep when you leave for work. Assuming of course the early start isn’t a Trojan horse which it usually is.

 

[DolphinVA]

If you left in the afternoon 30-60 minutes earlier wouldn’t you have more time with your family? I would assume they’re asleep when you leave for work. Assuming of course the early start isn’t a Trojan horse which it usually is.

Always more cases than time in my experience. The ask for earlier start isn't an offer to finish earlier. It's an effort to stack more cases or utilize us across more providers. No surgeon or interventionist wants to curtail their block time, if it's even that organized.

 

[aneftp]

OK, Texas, NC, and TN-big cities, Nashville, Charlotte, Dallas

Literally every hospital. 6:30 was more common than 7:30. Most were 6:45-7 in room but usually 2-4 6:30 in room every day. Orthopedic ASCs in room 6-6:15 for one or two rooms. Usually Neuro or ortho was 6:30 but would even be gyn or something sometimes. Nursing staff actually preferred these starts as their shift finished at 2:30.

7:30 as the norm was unheard of.

It all depends on nurses staffing

These days they usually have 5 minute huddles at the front board.

If they want to start 630am. Nurses have to show up at 6am.

If u lose nurses by 2-230p. U can only run so many rooms affer
That time

The hospital admin thinks in a perfect work there are suckers who don’t mind coming in at 11am-730p to fill the gap

That’s the same with anesthesia staffing. Most people hate coming in to do junk 11-7 or even 1-9
Shifts.

Unles there is money involved for extra pay. And employers will try to get away not paying extra

 

[aneftp]

If you left in the afternoon 30-60 minutes earlier wouldn’t you have more time with your family? I would assume they’re asleep when you leave for work. Assuming of course the early start isn’t a Trojan horse which it usually is.

If it’s hard 230p cut off time like I had with Gi gig I had. I showed up at 545am. For 6am Gi starts Gi center. Cases done around 145-2p. I was out the door at 215 most day.

U can only have controlled hour at outpatient places. Not hospital if they want to start early.

Same with some early 630am ortho centers. They do run late. I did have a 1.5x clause after 5pm. But as u can see that’s already 11 hours at outpatient surgery center before the 1.5x kicks in. Even than it wasn’t worth it. Most days finish between 530-630pm. That gets old.

 

[Howard888]

Not sure where in Texas you were but in Dallas if you told a profitable ASC no to a 6:30 start..there was another group lined up ready to do it. That’s pretty much any large metro area. If you’re in a smaller place with no competition maybe.

 

[neutro]

It all depends on nurses staffing

These days they usually have 5 minute huddles at the front board.

If they want to start 630am. Nurses have to show up at 6am.

If u lose nurses by 2-230p. U can only run so many rooms affer
That time

The hospital admin thinks in a perfect work there are suckers who don’t mind coming in at 11am-730p to fill the gap

That’s the same with anesthesia staffing. Most people hate coming in to do junk 11-7 or even 1-9
Shifts.

Unles there is money involved for extra pay. And employers will try to get away not paying extra

If done properly, 11-7 shifts are pretty amazing.
Atleast you get the morning off and others get to go home early

Otherwise everyone works til 6/7 pm and starts at 7 am.

Community hospitals with busy surgeons who add on cases after clinic - this is a very common problem

 

[jwk]

A 2-3 day a week crna working 16/24 equivalent of to really losing an extra crna for the other 3 days. You aren’t saving money with crnas anymore

That's a part timer. We use them to fill in the gaps. That's all.

But you're right - even someone working 3x12 - someone has to be there at 7am the other two days.

 

[jwk]

Which states? I've worked in 3 Georgia hospitals, and none started before 0730, except for cardiac at one (0700).

We offer a few 6:45 rooms at all three of our Atlanta hospitals. At our joint center, we're there at 6am, with first spinals going in shortly after that. Thankfully I'm not on staff there.

 

[psychbender]

We offer a few 6:45 rooms at all three of our Atlanta hospitals. At our joint center, we're there at 6am, with first spinals going in shortly after that. Thankfully I'm not on staff there.

I'm a morning person, but **** that noise. One place I interviewed for CCM fellowship said that Neuro ICU rounds started at 0545, so the fellow could round with the neurosurgery chief resident before he left for cases. I told them during the interview process that I thought that practice was disrespectful to the fellow, and if the neurosurgerychief resident wanted to communicate the plan with the fellow, then he can do so during normal daylight morning rounds.

 

[makemoney2024]

I would never join a practice that wanted incision at 7 , and I would leave if a shift to that were proposed. Lol **** that **** you’re risking early onset dementia depriving yourself of sleep for years

I am a locums. It’s temporary. They have wanted to recruite me for years but I like my freedom.

 

[makemoney2024]

Is all this for real? I’ve worked in 3-4 major metropolitan areas (each with 6/8 hospitals). At 80% of these facilities we’d had 2-4 rooms every morning that were 6:30 in room. Then a good few rooms 6:45 in room and rest 7. Maybe only 1-2 rooms later than 7am. I’ve worked at surgery centers that were 6am in room with blocks in preop.

6:30 in room pretty standard. At least in southeast.

Guess other areas in country different? Good luck finding a job with 7:30 starts in southeast

I have been staff at multiple hospitals. Maybe 30? And no, it’s not standard as far as I have seen. This is the only ever place where Cut time was 0700, not room time. It’s atrocious. You have just been used to abuse. Hahahah.

 

[makemoney2024]

My fellowship institution did in-OR start times of 0630 for hearts and for each of the 365 days I was there I fully understood how weird and ridiculous and unnecessary that was. The lifers at that institution didn't see anything amiss.

0730 is early enough. I get annoyed when I see the odd 0715 on the board where I work now.

I am with you. Totally agree. If this is all you know, then you think it’s normal. It is absolutely not.

 

[makemoney2024]

My first institution trauma one center

The night team coming off duty started the 630am heart cases. Lines in by 650-7am

Cardiac wanted 7am cut time.

These days the night float team leaves at 630am to go to their second job across town to make more money.

Hahahah. So what is happening with the hearts? Are these patients dying because things are pushed to later? Are the surgeons suffering mentally and can’t operate because the ORs are starting too late? Hahhaha
This is hilarious to me!!! It is time for us to take back our power!!!!!!

 

[makemoney2024]

OK, Texas, NC, and TN-big cities, Nashville, Charlotte, Dallas

Literally every hospital. 6:30 was more common than 7:30. Most were 6:45-7 in room but usually 2-4 6:30 in room every day. Orthopedic ASCs in room 6-6:15 for one or two rooms. Usually Neuro or ortho was 6:30 but would even be gyn or something sometimes. Nursing staff actually preferred these starts as their shift finished at 2:30.

7:30 as the norm was unheard of.

How are they doing in 2024 with the severe shortage? I mean it’s time Anesthesia took some control of some ****. This is ridiculous. 6 am OR time? What idiot took that job and why?

 

[makemoney2024]

I'm a morning person, but **** that noise. One place I interviewed for CCM fellowship said that Neuro ICU rounds started at 0545, so the fellow could round with the neurosurgery chief resident before he left for cases. I told them during the interview process that I thought that practice was disrespectful to the fellow, and if the neurosurgerychief resident wanted to communicate the plan with the fellow, then he can do so during normal daylight morning rounds.

Hahahahah!!! Love it!!! Good on you!!!

 

[makemoney2024]

TX here. 0730 to the room everywhere I've been. When surgeons ask for 0700 starts we just say NO. That 30-60 minutes earlier does nothing but stroke their ego at the cost of wrecking your sleep and stealing time from your family.

I love this!!! NO is a complete sentence.

 

[makemoney2024]

If done properly, 11-7 shifts are pretty amazing.
Atleast you get the morning off and others get to go home early

Otherwise everyone works til 6/7 pm and starts at 7 am.

Community hospitals with busy surgeons who add on cases after clinic - this is a very common problem

I like the idea of an 11-7 shift. Can work out in the AM and relax a bit and still have time for a quick meal at 8pm.

 

[makemoney2024]

It all depends on nurses staffing

These days they usually have 5 minute huddles at the front board.

If they want to start 630am. Nurses have to show up at 6am.

If u lose nurses by 2-230p. U can only run so many rooms affer
That time

The hospital admin thinks in a perfect work there are suckers who don’t mind coming in at 11am-730p to fill the gap

That’s the same with anesthesia staffing. Most people hate coming in to do junk 11-7 or even 1-9
Shifts.

Unles there is money involved for extra pay. And employers will try to get away not paying extra

The First Set of Nurses for preop literally get here at 0345. Atrocious.

 

[makemoney2024]

Not sure where in Texas you were but in Dallas if you told a profitable ASC no to a 6:30 start..there was another group lined up ready to do it. That’s pretty much any large metro area. If you’re in a smaller place with no competition maybe.

Money isn’t everything.

 

[aneftp]

The First Set of Nurses for preop literally get here at 0345. Atrocious.

Holy crap. It’s beyond ridiculous but guess they can be done by 12pm

 

[aneftp]

Hahahah. So what is happening with the hearts? Are these patients dying because things are pushed to later? Are the surgeons suffering mentally and can’t operate because the ORs are starting too late? Hahhaha
This is hilarious to me!!! It is time for us to take back our power!!!!!!

Hearts start at 745am now

They used to do 15-18 hearts back in the days
6 true dedicated heart rooms. Each doing 2-3 per day. Massive facility.

Now they are down to 5-8 hearts a day so only use 3-4 rooms so not in a rush to do them all early.

 

[makemoney2024]

Holy crap. It’s beyond ridiculous but guess they can be done by 12pm

It’s a town of 50k. There is NOTHING to do. Hahha. But many like having that me time away from their kids in the afternoon. Hahaha.

 

[Howard888]

Easily 30+ facilities I’ve seen 6:30-6:45 in room times. Super common. 6-6:15 has only been at ortho centers/ASCs though. These are very lucrative practices for anesthesia.. Upper 10% in country probably. So you don’t say no to these facilities.

I honestly don’t see the big deal. Most days I was done 2-2:30. Waking up at 5-5:30 not a problem. I get more daylight hours in afternoon. In fact I’d much prefer 6:30 in room done at 2:30 vs 7:30 in room done at 4.

My whole point in bringing it up was the concept that 6:30 is too early or you should expect all 7:30 in room times in this field. Not in big city lucrative practices at least that clear 7/800k or more. You need the busy ortho/neuro facilities with good payer mixes. Those surgeons want early in room times. Do a waterfall schedule and the late md rotates-maybe one day a week you’re late. Good job good pay.

You want 7:30 starts all the time-you’ll be a hospital employee, doing locums, or in a smaller place with a lower payer mix and stipend reliant. I’m sure there are a couple exceptions to this, but like the Atlanta poster said: big city, good payer mix, ortho or neuro, you’ll be doing early starts

 

[kidthor]

Easily 30+ facilities I’ve seen 6:30-6:45 in room times. Super common. 6-6:15 has only been at ortho centers/ASCs though. These are very lucrative practices for anesthesia.. Upper 10% in country probably. So you don’t say no to these facilities.

I honestly don’t see the big deal. Most days I was done 2-2:30. Waking up at 5-5:30 not a problem. I get more daylight hours in afternoon. In fact I’d much prefer 6:30 in room done at 2:30 vs 7:30 in room done at 4.

My whole point in bringing it up was the concept that 6:30 is too early or you should expect all 7:30 in room times in this field. Not in big city lucrative practices at least that clear 7/800k or more. You need the busy ortho/neuro facilities with good payer mixes. Those surgeons want early in room times. Do a waterfall schedule and the late md rotates-maybe one day a week you’re late. Good job good pay.

You want 7:30 starts all the time-you’ll be a hospital employee, doing locums, or in a smaller place with a lower payer mix and stipend reliant. I’m sure there are a couple exceptions to this, but like the Atlanta poster said: big city, good payer mix, ortho or neuro, you’ll be doing early starts

I suspect most places that want a 6:30 in room time aren’t also getting you out at 2:30 - though on your end it sounds like it went well.

At my old place they would routinely start pushing earlier start times (normal was 7:30 but this because 7:00 which became 6:30) without paying the anesthesiologists more, and still getting them out around 5pm or later. It was straight up obnoxious surgeon placation without regard for anyone else. Their anesthesiologist turnover is so high that they just build it into their business model rather than attempting to retain people.

This is all to say that I’m wary of creeping up start times.

 

[DolphinVA]

Easily 30+ facilities I’ve seen 6:30-6:45 in room times. Super common. 6-6:15 has only been at ortho centers/ASCs though. These are very lucrative practices for anesthesia.. Upper 10% in country probably. So you don’t say no to these facilities.

I honestly don’t see the big deal. Most days I was done 2-2:30. Waking up at 5-5:30 not a problem. I get more daylight hours in afternoon. In fact I’d much prefer 6:30 in room done at 2:30 vs 7:30 in room done at 4.

My whole point in bringing it up was the concept that 6:30 is too early or you should expect all 7:30 in room times in this field. Not in big city lucrative practices at least that clear 7/800k or more. You need the busy ortho/neuro facilities with good payer mixes. Those surgeons want early in room times. Do a waterfall schedule and the late md rotates-maybe one day a week you’re late. Good job good pay.

You want 7:30 starts all the time-you’ll be a hospital employee, doing locums, or in a smaller place with a lower payer mix and stipend reliant. I’m sure there are a couple exceptions to this, but like the Atlanta poster said: big city, good payer mix, ortho or neuro, you’ll be doing early starts

I genuinely find your experience interesting, since we have very different experiences (and philosophy) in the same market. Admittedly, my specialization has me rarely doing Ortho or neuro and never ASCs. But I'm very happy with my salary, and still living in a "big city". Moral of story I guess is that culture can be drastically different not just geographically, but also depending on practice setting.

Still don't think I'd ever be ok with walking back the first starts before 0730 routinely.

 

[pgg]

Maybe I'm skeptical because very time I've heard a surgeon suggest starting at 7 instead of 7:30, or 6:30 instead of 7, it was their response to the days running so long. And their "solution" to finishing cases at 6 PM was to start 15 or 30 minutes earlier. Or to pressure us into doing lines in awake preop patients.

In other words, offloading their inefficiency and self-centeredness onto us and other staff.

Sure as hell wasn't any hope of getting out at 2 ... always a scheme to compensate for their slowness and/or cram more cases into the day. It's not a burden for a surgeon who operates twice or three times per week and can enjoy other shorter days. But it's a burden for everyone else.

I'd have to be looking at a spectacular premium in pay, or a plausible very early finish time, to get on board with this 6 AM bull****. But to each their own.

 

[GassYous]

This thread makes me appreciate my surgeons so much more

 

[Howard888]

Yes I agree with your points on culture and facility/specialty specific. again this is almost always ortho or neuro but I have seen a few hospitals use 6:30s or 6:45s for any specialty-they basically just have 2-4 rooms every day that start at these times. But even then almost all other rooms were in room at 7. 7:30 happened was the minority, not the majority,

All I know is these ortho/neuro heavy facilities were by far the highest revenue generating per FTE-so you didn’t say no as there were other groups around.

And realize just because I finished at 2, doesn’t mean all the ORs finished at 2. This was because of medical direction and a waterfall schedule. Say there are 20 rooms. 5 MDs, each 4 rooms. 2-4 start 6:30-6:45, 10-12 7:00, 2-4 7:30.

By 2-2:30, 4-5 of the 20 rooms are wrapping up for the day. The first out md (the one who came in to start the early rooms) leaves then and other 4 MDs take over the remaining 14-15 rooms. After 2:30 rooms come down pretty quickly and it’s usually 4 rooms or less by 5. So between 2 and 5 the other 3 docs leave. A call doc comes in at 3-4 and gets another MD out. Only one of the original 5 MDs is working until 4/5pm. The other 4 MDs are done 2-4pm. You rotate those days evenly throughout the year. Who’s first out, call, late etc. there are days you are out before 2pm too. Some 11am-1pm days. Depends on time of year.

It’s a very nice schedule. But 6:30/6:45 starts common.

 

[makemoney2024]

Easily 30+ facilities I’ve seen 6:30-6:45 in room times. Super common. 6-6:15 has only been at ortho centers/ASCs though. These are very lucrative practices for anesthesia.. Upper 10% in country probably. So you don’t say no to these facilities.

I honestly don’t see the big deal. Most days I was done 2-2:30. Waking up at 5-5:30 not a problem. I get more daylight hours in afternoon. In fact I’d much prefer 6:30 in room done at 2:30 vs 7:30 in room done at 4.

My whole point in bringing it up was the concept that 6:30 is too early or you should expect all 7:30 in room times in this field. Not in big city lucrative practices at least that clear 7/800k or more. You need the busy ortho/neuro facilities with good payer mixes. Those surgeons want early in room times. Do a waterfall schedule and the late md rotates-maybe one day a week you’re late. Good job good pay.

You want 7:30 starts all the time-you’ll be a hospital employee, doing locums, or in a smaller place with a lower payer mix and stipend reliant. I’m sure there are a couple exceptions to this, but like the Atlanta poster said: big city, good payer mix, ortho or neuro, you’ll be doing early starts

Like I said, money isn’t everything. I prefer my mental health and minimal burnout. But do you. I don’t know how long I am gonna last here for sure.

 

[NightyNight]

Easily 30+ facilities I’ve seen 6:30-6:45 in room times. Super common. 6-6:15 has only been at ortho centers/ASCs though. These are very lucrative practices for anesthesia.. Upper 10% in country probably. So you don’t say no to these facilities.

I honestly don’t see the big deal. Most days I was done 2-2:30. Waking up at 5-5:30 not a problem. I get more daylight hours in afternoon. In fact I’d much prefer 6:30 in room done at 2:30 vs 7:30 in room done at 4.

My whole point in bringing it up was the concept that 6:30 is too early or you should expect all 7:30 in room times in this field. Not in big city lucrative practices at least that clear 7/800k or more. You need the busy ortho/neuro facilities with good payer mixes. Those surgeons want early in room times. Do a waterfall schedule and the late md rotates-maybe one day a week you’re late. Good job good pay.

You want 7:30 starts all the time-you’ll be a hospital employee, doing locums, or in a smaller place with a lower payer mix and stipend reliant. I’m sure there are a couple exceptions to this, but like the Atlanta poster said: big city, good payer mix, ortho or neuro, you’ll be doing early starts

I will never still understand the “need” to have a 7am or earlier start. It’s like surgeons need to wake up before even any birds chirp. Do they finish up and do anything special after the OR day? Or just go to bed at 8pm?

 

[makemoney2024]

I will never still understand the “need” to have a 7am or earlier start. It’s like surgeons need to wake up before even any birds chirp. Do they finish up and do anything special after the OR day? Or just go to bed at 8pm?

Not the surgeons. US!!! They can wake up at 615 and roll in ready to go at 650! It’s US who have to wake up before the birds are chirping!!

 

[centdoc]

Is all this for real? I’ve worked in 3-4 major metropolitan areas (each with 6/8 hospitals). At 80% of these facilities we’d had 2-4 rooms every morning that were 6:30 in room. Then a good few rooms 6:45 in room and rest 7. Maybe only 1-2 rooms later than 7am. I’ve worked at surgery centers that were 6am in room with blocks in preop.

6:30 in room pretty standard. At least in southeast.

Guess other areas in country different? Good luck finding a job with 7:30 starts in southeast

Worked my entire career in Texas... we've never had 0630 as a standard in multiple hospitals in Houston or DFW metroplex. It has always been 0730. Of course, we had exceptions occasionally. I was in a full on private practice, eat what you kill. Volume was king, but we never did 0630 as a standard.

 

[turnupthegas]

I’ve been in NY, NorCal, and SoCal and overwhelming it has been 730 start. There are occasional 700 starts. 630 is wild.

I’m not a morning person, sometimes I wonder how I ended up here lol.

 

[coffeebythelake]

730 start norm
Occasionally some surgeons demand and get 630 start

 

[norski]

For those of you who do the 630 starts; is the PAC completed in person, day of surgery, day before, or do the patients just provide you with their medical records well in advance, so the first face to face you get with the patient is right before induction?

Very curious. We do 6AM starts every once in a while, but this is rural Norway, so it's usually because something excised needs to go to a pathology lab quickly. PAC done the day before, patient spends the night before in the hospital.

 

[Dantrolene FC]

For those of you who do the 630 starts; is the PAC completed in person, day of surgery, day before, or do the patients just provide you with their medical records well in advance, so the first face to face you get with the patient is right before induction?

Very curious. We do 6AM starts every once in a while, but this is rural Norway, so it's usually because something excised needs to go to a pathology lab quickly. PAC done the day before, patient spends the night before in the hospital.

In the US, the anesthesiologist first meets the patient the day of surgery. It’s not atypical for cases to be assigned by the overnight call person, meaning you wouldn’t even know what cases you’re doing until the day of. At best, you would chart review the patient the day before their surgery.