Avoiding the same fate as emergency medicine

[chessknt]

Come on. Not all of us who are locums practice crappy medicine. Some of us just like traveling and don’t like behind tied down for whatever reasons.

If you had a MI and were driving to an er Would you rather go to a hospital staffed by locums interventional cards/hospitalists because they fired the group that staffed them or the hospital who has had a private group staffing them for many years? Of course there are exceptions but on the whole locums providers are not typically providing the best possible care in my experience for various reasons (personal deficits, not knowing local culture, burnout etc).

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[Status Sciaticus]

like I said, there is risk. But there is also reward. You aren't going to ever get the high paycheck without taking the risk. Join a group that has not fired associates and has been open and honest with the partnership track because here's the thing, as a successful private group we aren't just going to hand you the keys to the castle without you putting in some time to earn it.

Find a great group that will reward your contributions over time.

I went out on that limb myself and it worked out better than imaginable for me in the long run. Worst that happens is you get burned and 2 or 3 years later you can take those lame AMC jobs that are always going to be there.

How do you find out if the group gives you honest answers? Group could have fired associates and straight up lied to your face about it. Its not like there is a registry.

Key differences that I think will prevent anesthesia from going the way of EM:
1) our midlevels have a much higher barrier for entry. CRNA school is much, much more difficult than NP school which will weed out lots of folks who don’t want to do the work. NP is a much easier path
2) our midlevels are much more expensive, in fact I would argue they’re pricing themselves out of the market to an extent for what they are (nurses)
3) anesthesia has more viable fellowship options that actually do separate the doctor from the midlevel
4) the residency is longer, and the residency requirement hoops are more difficult than EM to jump through, keeping sketchy programs at bay to an extent
5) demand for anesthesia services has only gone up, the breadth of what we are needed for is greater
6) anesthesia has another “customer” other than the hospital. The surgeons/proceduralists. At my hospital, they have single handedly kept CRNAs out. They want nothing to do with them. While I realize this isn’t the case everywhere it is in fact a “thing”. Surgeons who own their surgery centers overwhelmingly choose anesthesiologists to staff them in my neck of the woods.
What’s happening in EM is BS. I for one will always choose an ER with actual physicians if I am conscious and have a choice.

Is your hospital in a rural/suburban area or in a decent metro?

I don’t know. I think people shy away from partnership tracks that are long. Like >2 years. Why do they need to be that long? You can’t figure out if someone is a
s hitty partner in 18 months?

just like residency, source for cheap labor.

 

[deleted162650]

How do you find out if the group gives you honest answers?

The group should provide you with contacts of people who have left if you ask for them. If they refuse, that’s a red flag.

 

[chocomorsel]

If you had a MI and were driving to an er Would you rather go to a hospital staffed by locums interventional cards/hospitalists because they fired the group that staffed them or the hospital who has had a private group staffing them for many years? Of course there are exceptions but on the whole locums providers are not typically providing the best possible care in my experience for various reasons (personal deficits, not knowing local culture, burnout etc).

There are plenty of groups out there who have contracts and are abusing the system by doing all kind of shady **** w the patients in the name of money. Just because they are “private” does not make them immune from being “parasitic” or “unethical” doctors. There is plenty of greed in medicine. And a lot of it comes from private physicians themselves.
I travel, and I see a lot. So let’s not make blanket generalizations.
Locums docs, for the most part as far as I know, get paid per the hour so there is no incentive to do unnecessary procedures, or keep patients hospitalized longer, in the name of money. There is that incentive in the private practice world. There are plenty of doctors, I’m going to medicine strictly to exploit the system and the patients. I have been around almost 10 years ad an attending, and I’ve seen a lot.

 

[2021Doctor]

Key differences that I think will prevent anesthesia from going the way of EM:
1) our midlevels have a much higher barrier for entry. CRNA school is much, much more difficult than NP school which will weed out lots of folks who don’t want to do the work. NP is a much easier path
2) our midlevels are much more expensive, in fact I would argue they’re pricing themselves out of the market to an extent for what they are (nurses)
3) anesthesia has more viable fellowship options that actually do separate the doctor from the midlevel
4) the residency is longer, and the residency requirement hoops are more difficult than EM to jump through, keeping sketchy programs at bay to an extent
5) demand for anesthesia services has only gone up, the breadth of what we are needed for is greater
6) anesthesia has another “customer” other than the hospital. The surgeons/proceduralists. At my hospital, they have single handedly kept CRNAs out. They want nothing to do with them. While I realize this isn’t the case everywhere it is in fact a “thing”. Surgeons who own their surgery centers overwhelmingly choose anesthesiologists to staff them in my neck of the woods.
What’s happening in EM is BS. I for one will always choose an ER with actual physicians if I am conscious and have a choice.

Also, HCA has ramped up EM residencies faster than anesthesiology.

“The learning experience of a lifetime” – HCA Healthcare welcomes more than 1,800 residents and fellows during COVID-19 - HCA Today

During the COVID-19 pandemic, HCA Healthcare's Graduate Medical Education program welcomed a record class of 1,842 new residents and fellows on July 1, 2020

hcatodayblog.com

 

[Hoya11]

Do you advertise or do you just await for cold calls and connections?

we did both. we even paid some ridiculous fee to gaswork for premium advertising.

My point is all groups around me struggle to hire MDs AND CRNAs. And I'm in a somewhat populated and desireable area

 

[Arch Guillotti]

I don’t know. I think people shy away from partnership tracks that are long. Like >2 years. Why do they need to be that long? You can’t figure out if someone is a
s hitty partner in 18 months?

?

You do the time that everyone before you did.

 

[chocomorsel]

?

You do the time that everyone before you did.

And that’s where I disagree. If you are having a difficult time recruiting you can totally vote to change the time track.
Why? “Because that’s how we’ve always done it” is most often never a good answer.
Life is about change, and progression. Not stagnation. It’s inevitable.

 

[Ezekiel2517]

Hmm. In CA (an opt out state) at least, generally speaking you need 2-3 crnas to cover for 1 anesthesiologist, due to the nature of their shift work vs the hours we work, call we take, etc. When you count up their salaries and also factor in the cost of benefits for each person, there is no cost savings at all. They’re actually more costly. If a hospital simply can’t find enough anesthesiologists to provide coverage, I can see them having to hire crnas.

 

[DazedWanderer]

Anesthesiology will be down the same if not worse path as EM. If hospitals are willing to staff just NPs in the ER then the writing would be on the wall for EM. CRNAs only staffing is a death blow to anesthesiology IMO.

But I see most of medicine going down this path. Healthcare cost is unsustainable. Something has to be cut and physician salary is the low hanging fruit. All it takes is one hospital to prove that you don't need EM docs, Anesthesiologist, Hospitalist, Radiologists.

Just takes one

It is already happening in states that allow solo CRNA practice. Just as APPs are often assigned to see fast-track ED patients solo (the cases of sniffles, simple UTIs, suture removals, and other cases that shouldn't have even come to the ED in the first place), CRNAs are now often being assigned to endoscopy lab and other "straight forward" procedures solo in states that allow it. The only difference is that it's a hell of a lot easier to kill a patient with propofol sedation than it is for the independent ED NP doing fast track to kill a pt with a foot xray or a protocolized prescription of antibiotics for a simple UTI.

 

[DazedWanderer]

Come on. Not all of us who are locums practice crappy medicine. Some of us just like traveling and don’t like behind tied down for whatever reasons.

I've worked with a lot of great locums. The issue can be the lack of familiarity with the facility, supplies, equipment during short stints as a locum. Arriving at a new gig and not knowing the intricacies of adjusting the particular model of ventilator used at that hospital, or not knowing where certain emergency equipment is in a pinch, which particular drawer the exact supply you need right this second is located in etc. Not knowing any of the surgeons strengths/weaknesses or which ones you need to pay particularly close attention for; these can be safety issues given the level of acuity of anesthesia. Not meant as a criticism of the skill/knowledge of locums whatsoever, everyone experiences the same learning curve in starting a new gig at a new hospital and having to familiarize yourself with all of the above. It's like being a professional formula 1 driver who is suddenly put on a new track and asked to immediately perform at the same level as other similarly skilled racers who have been practicing on that track for years. You're probably not going to perform quite as well at first, that doesn't mean you are any less skilled of a driver though.

 

[wamcp]

Demand for anesthesia care has skyrocketed in the last 10 years. Boomers getting older and needing more healthcare combined with even more invasive things being done outside the OR (cath labs, GI, etc). I don't see that trend stopping any time soon.

And as you note, there are not enough anesthesiologists to take care of all those patients in a physician only model (in respect to our DO colleagues I cannot call it MD only). Would probably need 2-3x the amount of graduating residents each year for 10+ years to come close.

This talk sounds like it could be a scary parallel to EM. You get blindsided before you even realize it.


This was stuff posted only in 2017, pretty much 1 year before EM began its collapse:

Economics of outrageous Locum Tenens hourly rates

You say this now. I said it "then" as well. Its not do-able. The gulf from senior resident to attending is wide and deep. I have no experience of being an EM physician but before med school I volunteered at an ER, so I could imagine how tough it would be to work 20, 12-hr shifts a month...

forums.studentdoctor.net

“If you are a smart locums you are.

I avg 510/hr last yr. Just went full locums and made as much in 6 shifts as I did 15 at W2.

I have never done a shift at rate and never will.”


“I get a contracted "travel bonus" but I have to give a minimum of 6 shifts. Technically a moderate "bonus" for each of those 6 shifts. For any shifts I pick up over that, I wait until they are offering an additional bonus of > $1500 per shift. Over Christmas for example, the shift bonus was $3000/shift.”

“Update: Year 4 of locums, and I'm still at my regular "part-time" job doing 100 hours per month. The base "exhorbitant" rate has stayed the same. The shortage of physicians has worsened, and we now have > 20 open shifts in March. $2000/shift bonuses generally being offered to pick up the unfilled shifts 1 month out. Life has never been better.”

 

[Mman]

I don’t know. I think people shy away from partnership tracks that are long. Like >2 years. Why do they need to be that long? You can’t figure out if someone is a
s hitty partner in 18 months?

we let them know they will be partner long before the track ends and they are getting paid just fine with annual raises and bonuses along the way

 

[Mman]

This talk sounds like it could be a scary parallel to EM. You get blindsided before you even realize it.


This was stuff posted only in 2017, pretty much 1 year before EM began its collapse:

The catastrophic risk to anesthesia is Medicare for All, not CRNAs. Our specialty probably takes the biggest cut in salary by Medicare rates of any so when single payer systems all talk about just using medicare rates it is literally the end of anesthesia reimbursement. Taking a potential 80% paycut is massive.

 

[nimbus]

We had the same fate as EM 27 years ago when the Abt report was published. That led to a shortage and a booming job market.

DEFINE_ME

 

[deleted126335]

We had the same fate as EM 27 years ago when the Abt report was published. That led to a shortage and a booming job market.

DEFINE_ME

Granted, The Abt report was way off. But you give it too much credit for affecting the job market. Very simply, new grads were grossly underemployed. Word got back to the Med students who stayed away. They chose other fields. In the 90s there were several thousand more residency slots than US medical school graduates. Subsequently, there were a few thousand less anesthesia residents. They did a helluva lot of work that now needed to be done by CRNAs or attendings. Suddenly no excess of bodies and more importantly an empty pipeline. This gave birth to the good job market of 2000-201?.

This time the Med students don’t have other places to go.

 

[nimbus]

Granted, The Abt report was way off. But you give it too much credit for affecting the job market. Very simply, new grads were grossly underemployed. Word got back to the Med students who stayed away. They chose other fields. In the 90s there were several thousand more residency slots than US medical school graduates. Subsequently, there were a few thousand less anesthesia residents. They did a helluva lot of work that now needed to be done by CRNAs or attendings. Suddenly no excess of bodies and more importantly an empty pipeline. This gave birth to the good job market of 2000-201?.

This time the Med students don’t have other places to go.

Yes. Finished residency in 1996 so I remember.

I agree the situation is a bit different now because of the shortage of overall GME spots. People may be willing to do EM residency even if there are no job prospects. EM residencies might still fill unlike anesthesia residencies in the late 1990s.

 

[deleted126335]

Yes. Finished residency in 1996 so I remember.

I think the 1996 match was the worst for the specialty. I was looking for a job then. A recruiter called me a few days after the match and said that a big training program put in a request for “20 Anesthesiologists or CRNAs”

 

[nimbus]

I think the 1996 match was the worst for the specialty. I was looking for a job then. A recruiter called me a few days after the match and said that a big training program put in a request for “20 Anesthesiologists or CRNAs”

Yep. See the chart I added above. The nadir for new grads was 2000. Those folks matched in 1996. Only 392 were US grads.

 

[deleted126335]

Yes. Finished residency in 1996 so I remember.

I agree the situation is a bit different now because of the shortage of overall GME spots. People may be willing to do EM residency even if there are no job prospects. EM residencies might still fill unlike anesthesia residencies in the late 1990s.

View attachment 334642

They will fill. Just like anesthesia will fill if our job market becomes as bad. What alternatives does a medical school graduate have other than to do some training program? Even if it is their third choice of specialty.

 

[chocomorsel]

I've worked with a lot of great locums. The issue can be the lack of familiarity with the facility, supplies, equipment during short stints as a locum. Arriving at a new gig and not knowing the intricacies of adjusting the particular model of ventilator used at that hospital, or not knowing where certain emergency equipment is in a pinch, which particular drawer the exact supply you need right this second is located in etc. Not knowing any of the surgeons strengths/weaknesses or which ones you need to pay particularly close attention for; these can be safety issues given the level of acuity of anesthesia. Not meant as a criticism of the skill/knowledge of locums whatsoever, everyone experiences the same learning curve in starting a new gig at a new hospital and having to familiarize yourself with all of the above. It's like being a professional formula 1 driver who is suddenly put on a new track and asked to immediately perform at the same level as other similarly skilled racers who have been practicing on that track for years. You're probably not going to perform quite as well at first, that doesn't mean you are any less skilled of a driver though.

Totally agreed. But I doubt that is what @chessknt was trying to point out. We locums docs have a bad reputation and I don’t get where the stereotype comes from. Lots of bad seeds in locums but I have seen lots of bad seeds in private practice so I don’t understand the generalization that someone will potentially get bad care because the hospital is using locums docs.
Many of us just prefer the freedom of locums life and it’s not because we suck.

 

[emergentmd]

Any hospital based Doc is just fooling themselves that they are secure. Unless a med student wants to do a hospital based specialty regardless of money, I would recommend avoiding hospital based fields.

I am not just talking about potential money. The path with controlling medical practice, non clinical pressures, etc is not a path I would recommend.

If you are a doc and happy to do some medical based practice for 200-250K/yr, then you will be happy.

If you see older doc used to making 4-600k/yr, you will not be happy b/c this is not sustainable.


There are smarter more business savvy people and they will make changes/cuts before docs know what hit them.

 

[gaspasser127]

remember when we were growing up and everyone said to go into healthcare or to be a doctor because “there will always be job security?”

lol.

 

[GassYous]

I wonder if there is a way to codify partnership tracks this to remove the whims of baby boomers. People coming out now have been burned repeatedly by boomers throughout their lives, and after my own experience, even I am extremely hesitant to trust promises that aren’t written, and until this experience I was a huge advocate of private practice.

lol.

Doctor or lawyer lolol

 

[emergentmd]

Lets not pretend the last generation of physicians didn’t enable this by selling their practices to private equity instead of other physicians so they could make extra money and ensure a consolidating oligopoly of oppression for the doctors that followed them. Maybe when a noctor delivers their oncology plan or anesthetic or primary care by following the envision approved algorithm they’ll realize the costs but probably not.

I am not disputing that many docs sold for profit but there are many that were forced to sell.

Our Private group had the option of selling for a smooth transition or being taken over for a difficult transition. With those choices, what real choices do we have?

And Even the docs that sold out voluntarily, the writing was on the wall. They could have held out for a few more years but then would have had the same takeover decision to make.

Don't blame the docs who sold out b/c they at best hastened CMG/HCA takeover.

 

[chessknt]

I am not disputing that many docs sold for profit but there are many that were forced to sell.

Our Private group had the option of selling for a smooth transition or being taken over for a difficult transition. With those choices, what real choices do we have?

And Even the docs that sold out voluntarily, the writing was on the wall. They could have held out for a few more years but then would have had the same takeover decision to make.

Don't blame the docs who sold out b/c they at best hastened CMG/HCA takeover.

I do blame them and their predecessors. There is nothing I love hearing more than how someone 'had' to accept a wad of money and sell the practice while screwing over the associates. The docs before you sold and helped create the CMGs that 'forced' you out and you don't fault them? How would you have felt if you moved, started a job, put in your X years, then the partners tell you they had no choice but to take a buyout and now you get nothing and your job is going to change to a ****tier one? Don't blame them because they had no choice?

 

[chocomorsel]

I am not disputing that many docs sold for profit but there are many that were forced to sell.

Our Private group had the option of selling for a smooth transition or being taken over for a difficult transition. With those choices, what real choices do we have?

And Even the docs that sold out voluntarily, the writing was on the wall. They could have held out for a few more years but then would have had the same takeover decision to make.

Don't blame the docs who sold out b/c they at best hastened CMG/HCA takeover.

Someone started all the shenanigans . And then it caught on. Those are the people we are talking about. Whoever thought it a good idea to sell off in the first place somewhere in God Forsaken Florida.

 

[dannyboy1]

I do blame them and their predecessors. There is nothing I love hearing more than how someone 'had' to accept a wad of money and sell the practice while screwing over the associates. The docs before you sold and helped create the CMGs that 'forced' you out and you don't fault them? How would you have felt if you moved, started a job, put in your X years, then the partners tell you they had no choice but to take a buyout and now you get nothing and your job is going to change to a ****tier one? Don't blame them because they had no choice?

This just points out the absurd way partnership tracks work. You put in sweat equity without any contract spelling out what that sweat equity is worth with the hope that the partners will let you in at some vague time in the future. Of course someone else who takes over isn’t gonna honor your handshake agreement. It should be clearly spelled out, in writing, how much the practice owes you for your time if you don’t make partner...

 

[deleted162650]

You put in sweat equity without any contract spelling out what that sweat equity is worth with the hope that the partners will let you in at some vague time in the future.

If you sign on for a partner track that is that vague/ambiguous, you have yourself to blame.

 

[HemeOncHopeful19]

If you sign on for a partner track that is that vague/ambiguous, you have yourself to blame.

For those of us youngins, what should a partner track contract include?

 

[deleted162650]

For those of us youngins, what should a partner track contract include?

The terms should be clearly laid out. Length of track, buy-in amount, objective measures for being made partner, etc. All of this should be clearly elucidated. It should not be ambiguous or TBD. Not a bad idea to have an attorney review the contract if you aren't sure what you're looking at.

 

[anbuitachi]

I was patrolling the USAjobs site for VA anesthesiology positions before the CRNA ruling and there were roughly 7-8 openings (the average number of openings for specialists on that site). A couple of months after the ruling there were only 3 positions. Checking now and there is a significant jump to 11 openings for anesthesiologists, in decent areas of the country too. I think for some reason or another, the VA is still finding use for anesthesiologists even though CRNAs are allowed to practice independently. As long as we don’t let the HCA keep opening random anesthesiology residencies like they did with EM, I think we can preserve the field.

i see 2-3 jobs on the VA website..

 

[anbuitachi]

i think EM is in a worse spot because a decent % of patients dont need to be in the ED in the first place. our country overuses the ER service way tooo much. i remember my EM rotation not that long ago, so many people with the most non emergent complaints ever.

But yes anesthesiology continuing its slow decline

 

[ace_inhibitor111]

i see 2-3 jobs on the VA website..

You have to type anesthesiologist and press enter without clicking the autopopulated title

 

[anbuitachi]

You have to type anesthesiologist and press enter without clicking the autopopulated title

i dont understand those jobs paying 125k...

 

[anbuitachi]

Our salaries have always been competitive and a better deal than AMCs.

Where I am, not too many good candidates come through and want to join our hospital (poor, traumas, busy) when there are so many others in the area.

Especially if you are looking for something specific like cardiac or pain.

There aren't that many candidates to begin with who stay around here after they train, and the ones that do can go wherever they want if they are good.

There are folks with known opiate addictions, sexual harassment issues who have been kicked out of multiple practices, they get hired somewhere else immediately...

My takeaway from my years looking at resumes and hiring is that outside of a few niche markets (nyc, boston, la, sf) there are lots of good options and lots of demand for the foreseeable future.

just curious, but since you mentioned your area is poor, busy, traumas, and there are many others in the area, do you mean its difficult to compete with the nearby places with better payor mix

 

[anbuitachi]

when i interviewed for jobs some years ago, private practice with partnership offered 4-5 years partner ship track. i think one offered 3 years . but as a new grad it's insanely hard IMO to commit to a 4-5 year partnership track since starting salary is usually lower, would have to stay for 2x+ partnership track length to make it worth it.

but although my job pays low, calls are high, one thing i am glad about is that we are mostly do our own case, with only a few CRNAs compared to MDs

 

[chessknt]

This just points out the absurd way partnership tracks work. You put in sweat equity without any contract spelling out what that sweat equity is worth with the hope that the partners will let you in at some vague time in the future. Of course someone else who takes over isn’t gonna honor your handshake agreement. It should be clearly spelled out, in writing, how much the practice owes you for your time if you don’t make partner...

Sure this is technically the correct answer but even with that language there is no way they are going to let you get a share starting day one and that puts you at risk for being screwed by a sale before you get that chance. Not to mention this is doctors at the end of their career screwing over other doctors at the start of theirs. It is predatory and inexcusable since we all went through roughly the same ****. Maybe it’s my fault for expecting my colleagues to act different from a Wall Street eat the young investment firm.

 

[Hoya11]

just curious, but since you mentioned your area is poor, busy, traumas, and there are many others in the area, do you mean its difficult to compete with the nearby places with better payor mix

there are more than 6 different entities in my area that you can work for..

all are going to offer you ~400k, 6-8 weeks vacation, nebulous end of year bonus, full time call taking... i have had offers from them all and they are all pretty much the same.

what separates them is what the job actually entails...

one place is a big academic place and you know your going to be busy, doing traumas, but academic like (cush) hours/resources..
most other places are smaller hospital systems/groups where call is usually from home, traumas happen but not major ones, where a crani would be a big deal
some hospitals/systems are in nicer, affluent, safe areas, some are in horrible areas..

we had the combination of busy and serious in-house call, horrible area, yet resources/infrastructure stretched like that of a small-medium private hospital..

compared to the work environment of our competitors, you had to come to us looking to do call/trauma/serious stuff in a S hole no-name hospital
lots of people took jobs with lighter call and nicer hospitals/areas
lots of people took the academic job with the better-defined hours

And that was from a pool of not a lot of people to begin with..

For me it was my home hospital servicing my hometown so that was my connection, and there was the opportunity for true partnership.

 

[Hoya11]

Sure this is technically the correct answer but even with that language there is no way they are going to let you get a share starting day one and that puts you at risk for being screwed by a sale before you get that chance. Not to mention this is doctors at the end of their career screwing over other doctors at the start of theirs. It is predatory and inexcusable since we all went through roughly the same ****. Maybe it’s my fault for expecting my colleagues to act different from a Wall Street eat the young investment firm.

you have to do personal research on each group individually to determine if they are genuine/benevolent or predatory...

benevolent groups and true partnerships DO exist

talk to the past docs, new partners, new hires, see if anyone has not made partner recently and why...

 

[anbuitachi]

there are more than 6 different entities in my area that you can work for..

all are going to offer you ~400k, 6-8 weeks vacation, nebulous end of year bonus, full time call taking... i have had offers from them all and they are all pretty much the same.

what separates them is what the job actually entails...

one place is a big academic place and you know your going to be busy, doing traumas, but academic like (cush) hours/resources..
most other places are smaller hospital systems/groups where call is usually from home, traumas happen but not major ones, where a crani would be a big deal
some hospitals/systems are in nicer, affluent, safe areas, some are in horrible areas..

we had the combination of busy and serious in-house call, horrible area, yet resources/infrastructure stretched like that of a small-medium private hospital..

compared to the work environment of our competitors, you had to come to us looking to do call/trauma/serious stuff in a S hole no-name hospital
lots of people took jobs with lighter call and nicer hospitals/areas
lots of people took the academic job with the better-defined hours

And that was from a pool of not a lot of people to begin with..

For me it was my home hospital servicing my hometown so that was my connection, and there was the opportunity for true partnership.

thats a lot of competition in an area 1 hr away from nyc! i guess if you are perpetually short, and desperate for people, why not change offers such as shorter partnership track (how long is the track), or get rid of partnership and have everyone same salary, but if they suck, can still be somewhat easily fired? doesnt that beat perpetual understaffing?

 

[coffeebythelake]

There are plenty of groups out there who have contracts and are abusing the system by doing all kind of shady **** w the patients in the name of money. Just because they are “private” does not make them immune from being “parasitic” or “unethical” doctors. There is plenty of greed in medicine. And a lot of it comes from private physicians themselves.
I travel, and I see a lot. So let’s not make blanket generalizations.
Locums docs, for the most part as far as I know, get paid per the hour so there is no incentive to do unnecessary procedures, or keep patients hospitalized longer, in the name of money. There is that incentive in the private practice world. There are plenty of doctors, I’m going to medicine strictly to exploit the system and the patients. I have been around almost 10 years ad an attending, and I’ve seen a lot.

U should go into academic medicine.

 

[chocomorsel]

U should go into academic medicine.

Except I want to get paid!!!
And I can’t stand the academic world and all its MD egos and jerk nursing staff. Much prefer private practice nurses. I am still traumatized by my winter assignment in an academic institution. Constant fighting with the nursing staff, one refusing to get me a crash cart in a patient who died. The nurses who had a clue and were cooperative were the travelers.
Yeah, academics is a no go for me.

 

[chocomorsel]

there are more than 6 different entities in my area that you can work for..

all are going to offer you ~400k, 6-8 weeks vacation, nebulous end of year bonus, full time call taking... i have had offers from them all and they are all pretty much the same.

what separates them is what the job actually entails...

one place is a big academic place and you know your going to be busy, doing traumas, but academic like (cush) hours/resources..
most other places are smaller hospital systems/groups where call is usually from home, traumas happen but not major ones, where a crani would be a big deal
some hospitals/systems are in nicer, affluent, safe areas, some are in horrible areas..

we had the combination of busy and serious in-house call, horrible area, yet resources/infrastructure stretched like that of a small-medium private hospital..

compared to the work environment of our competitors, you had to come to us looking to do call/trauma/serious stuff in a S hole no-name hospital
lots of people took jobs with lighter call and nicer hospitals/areas
lots of people took the academic job with the better-defined hours

And that was from a pool of not a lot of people to begin with..

For me it was my home hospital servicing my hometown so that was my connection, and there was the opportunity for true partnership.

Sounds like you left.

 

[PainDrain]

I don’t know. I think people shy away from partnership tracks that are long. Like >2 years. Why do they need to be that long? You can’t figure out if someone is a
s hitty partner in 18 months?

Yah. Never understood the 5 year partner track with the outrageous buy in at the end of it. It’s indentured servitude.

 

[Hoya11]

thats a lot of competition in an area 1 hr away from nyc! i guess if you are perpetually short, and desperate for people, why not change offers such as shorter partnership track (how long is the track), or get rid of partnership and have everyone same salary, but if they suck, can still be somewhat easily fired? doesnt that beat perpetual understaffing?

actually i think the allure of true partnership was our only saving grace, we did ok with staffing, but my point is to show that the anesthesiologist has lots of options and may be more in demand than they appreciate even in somewhat desireable areas.

 

[Hoya11]

Sounds like you left.

still with the group and still a partner but the group has gone through lots of changes, worked out well for me actually

 

[emergentmd]

Ocala Hospital

Our full-service hospital offers a range of services, including a 24/7 emergency room, cardiac care and a Level II Trauma Center.

ocalahealthsystem.com

If you do not think HCA and the CMGs will not flood all hospital based specialties to drive down pay, then just look at this. One of many HCA anesthesia residencies. What a stellar group of med students they got. Much easier group to mold, setting the pay bar low. Actually brilliant of them. 4 yrs of low pay residents. Watch them match these programs with large CRNA programs, another cheap work force.

I found about 10 Anesthesia programs, watch these grow and filled by the caribbean mecca schools.

Like EM, you guys better make your money soon because these 100 per year hungry residents will soon be 500/yr.

 

[emergentmd]

Surgeon's think they are safe? More fine Caribbean dominated hungry residents coming to flood the market.

Ocala Hospital

Our full-service hospital offers a range of services, including a 24/7 emergency room, cardiac care and a Level II Trauma Center.

ocalahealthsystem.com

The radiologist who thought it would be hard to start a rad residency? Say hello to yesterday. 1st pilot one likely to have many more to follow

Diagnostic Radiology Residency Program | MountainView Hospital

Read more about the training, benefits and highlights provided by our Diagnostic Radiology Residency in Las Vegas, NV.

mountainview-hospital.com

Orthopedics - Got them too filled with bunch of caribbean grads

You think Dermatology is hard to get into. Wait 10 yrs when there are 50 HCA derm programs

Graduate Medical Education Programs at HCA Healthcare

With 300+ residency and fellowship programs across 16 states, HCA Healthcares GME program offers extensive training for the next generation of physicians.

medicalcityhealthcare.com

You think anyone is safe? HCA has the vast majority of specialties covered and I am quite sure more to come.

Graduate Medical Education Programs at HCA Healthcare

HCA offers innovative, high-quality graduate medical education programs.

hcahealthcare.com

 

[Mman]

Yah. Never understood the 5 year partner track with the outrageous buy in at the end of it. It’s indentured servitude.

indentured servitude seems a bit harsh, I mean I know groups you are describing that are paying those indentured servants a total package of $500K per year for < 50 hours of work per week. I mean they make a lot more once they become a partner but it isn't like they are suffering until then.