Jet Loses His Contract

[jetproppilot]

Yep, thats right.

My hospital has chosen to outsource anesthesia and radiology to out-of-hospital management service oriented groups.

Geez....I was a partner in a fee-for-service anesthesia group before ditching that gig to move to New Orleans for family reasons....and now this....can you taste the bitterness?

My hospital doesnt want to employ doctors anymore.

So they've given the anesthesia contract to a New Orleans group owned by a few anesthesiologists and businessmen who employ anesthesiologists. Albeit at a respectable salary.

But I can't do it, considering my roots.

I can't work for a group owned-partly by anesthesiologists.

Who "employ" other anesthesiologists.

Because that means I'll never have a shot at being a partner.

So while I'm putting in a labor epidural on New Years Eve at 2am, one of the partners is at home, fu kk ing his girlfriend, and making money off of me.

Can't do it.

So as of Feb 25th, I'm jobless. No panic necessary...maybe I'll take a year off...

Nor to say I don't have opportunity.

My old gig told me "whatever we need to do to get you back here, we'll do it." But that means I'll move back to Bumfuk Egypt...

And on the New Orleans front, my buddy Alan Kaye is the Chair of LSU Anesthesia....I could stay in this decrepid city with an OK job with LSU....

I knew this was a risk when I moved to New Orleans, where competition is fierce.

Doesnt matter what type of clinician you are.

Its all about the C notes.

ANYBODY WANNA HIRE JET?????

Tough call....

go back to the old gig (albeit bumfuk egypt) for nice cash, or stay in the New Orleans mosh pit for less...

...or consider a totally new location altogether....

all I know is some partner dude ain't gonna be at home boinking his girlfriend making money off of me while I put in the New Years Eve labor epidural....

so heres a question for da forum:

WHERE DOES JET GO FROM HERE?????

---

Members don't see this ad.

 

[amyl]

go back to the old gig (albeit bumfuk egypt) for 500 large, or stay in the New Orleans mosh pit for less...

...or consider a totally new location altogether....

wow! -- sorry to hear. doesn't hurt to see what else is out there other places so i would start looking.... how much do you love new orleans? where exactly was the old gig?

 

[VentdependenT]

sorry to hear that jet.

you'll pull through man. fer cryen out loud not only are you a badass anesthesiologist you survived one of the most devastating hurricanes in american history.

500k sounds mighty mighty tempting. that sounds like early retirement cash.

 

[i want out]

another option, is to go to Parish anesthesia, and tell them that the only way you will work for them is if they let you buy a percentage of the business over the next several years, and get a written contract stating that they will take X amount of your pre tax earning and put it toward buying in.

worst they can say is No, then you have all the other options still open.

i want out (of the Navy)

Yep, thats right.

My hospital has chosen to outsource anesthesia and radiology to out-of-hospital management service oriented groups.

Geez....I was a partner in a fee-for-service anesthesia group before ditching that gig to move to New Orleans for family reasons....and now this....can you taste the bitterness?

My hospital doesnt want to employ doctors anymore.

So they've given the anesthesia contract to Parrish Anesthesia, a New Orleans group owned by a few anesthesiologists and businessmen who employ anesthesiologists. Albeit at a respectable salary.

But I can't do it, considering my roots.

I can't work for a group owned-partly by anesthesiologists.

Who "employ" other anesthesiologists.

Because that means I'll never have a shot at being a partner.

So while I'm putting in a labor epidural on New Years Eve at 2am, one of the partners of Parrish Anesthesia is at home, fu kk ing his girlfriend, and making money off of me.

Can't do it.

So as of Feb 25th, I'm jobless. No panic necessary...maybe I'll take a year off...

Nor to say I don't have opportunity.

My old gig told me "whatever we need to do to get you back here, we'll do it." But that means I'll move back to Bumfuk Egypt...

And on the New Orleans front, my buddy Alan Kaye is the Chair of LSU Anesthesia....I could stay in this decrepid city with an OK job with LSU....

I knew this was a risk when I moved to New Orleans, where competition is fierce.

Doesnt matter what type of clinician you are.

Its all about the C notes.

ANYBODY WANNA HIRE JET?????

Tough call....

go back to the old gig (albeit bumfuk egypt) for nice cash, or stay in the New Orleans mosh pit for less...

...or consider a totally new location altogether....

all I know is some Parrish Anesthesia partner dude ain't gonna be at home boinking his girlfriend making money off of me while I put in the New Years Eve labor epidural....

so heres a question for da forum:

WHERE DOES JET GO FROM HERE?????

 

[The_Sensei]

Jet,

Sorry to hear that bullsh$t, man. They don't deserve you; fuc* em.......

Anyway, I am with you 100% on the whole anesthesia management company thing. Seems like selling your soul to the devil. I'd rather work at McDonalds then let some jag-off get rich off my labors.

I hate to say this, but looks like the beginning of Mil's ominous predictions of a bleak future dominated by AMCs. Sucks.

 

[lvspro]

Jet
Sorry to hear about the dilemma man. Even so, way to man up to the corporate fukkers. We've witnessed how much they botched up medicine with managed care, and not letting them in any deeper is prudent if ya ask me.
GL with finding a new gig, but I got a hunch that someone, somewhere in a desirable location is going to be looking for a rockstar anesthesiologist.


Friggin businessmen Always looking to rape anyone who's even mildy profitable.

 

[militarymd]

Jet,

Want to head north to the South and take a look? Timing may be an issue, but we could be partners.

 

[militarymd]

Or tell the CEO of your hospital that you want to be shareholders in the new group....

Or even better, HAVE your own group....what can Parrish offer that you can't?

 

[dogbone65]

That sucks JPP. Just shows once again that nobody looks out for #1 except #1. All the best with whatever you choose.

 

[VolatileAgent]

dude, what can i say other than good luck.

 

[bigdan]

Good luck Jet.

If anyone deserves good karma, you do.

dc

 

[jetproppilot]

Jet,

Want to head north to the South and take a look? Timing may be an issue, but we could be partners.

Thanks for the kind words everyone.

It'll all work out.

Mil, I'll PM you later.

 

[Noyac]

Sounds like it might be time to talk to the old lady. See if you can talk her into moving. Tell her you know a coupla coonasses in Colorado that could make her feel at home.

 

[joshmir]

jet-

what are your other former partners doing? any efforts to organize their actions?

what is the name of the AMC?

much respect for your decision. if you decide to consider moving on, let us know what locations you are interested in, and i'm sure you'll get some PMs with leads.

and if you take a year off, you've earned it....

 

[joshmir]

and many thanks for sharing with us something that is a royal crock for you, in that all the readers can learn from a true playa like yourself having to endure what is no longer theoretical...

this goes far to forward one of the most useful aspects of this forum...to teach us cats in residency aspects of the private world that our academic programs don't...and save us from making mistakes that hassle our patients, surgeons, and wasting years from making the wrong job decision...

jet you and the others are the first class of "Made Men" for this new SDN anesthesia generation...we'll be lookin out for you...

 

[rufio173]

Hey Jet,

Good luck on getting that next dream job! Like you said, I'm sure it'll all work out...

Did this thing all come out of left field, or was it slowly building and this its final form?

Peace,
John

 

[Gimlet]

Sorry to hear that Jet. I don't have anything productive to add, but if I had an anesthesia group you would have a partnership contract on its way in the mail already. Best of luck in whatever you choose...I guess I would view this as a good excuse to bail the f*ck out of New Orleans.

 

[Noyac]

Call JP.

 

[dhb]

sorry to hear this
on the bright side you have several options from which your wife will have to choose from

1. Old gig very good $ bad location
2. New gig less $ less hours sweet life good location (NO)
3. New gig good $ new location
4. Rockstar aliance with MMD

Best of luck convincing the lady

 

[jetproppilot]

sorry to hear this
on the bright side you have several options from which your wife will have to choose from

1. Old gig very good $ bad location
2. New gig less $ less hours sweet life good location (NO)
3. New gig good $ new location
4. Rockstar aliance with MMD

Best of luck convincing the lady

HAHAHAHAHA

You're dead-on.

 

[LostTommyGuns]

That suck-diddily-ucks. I give them an enthusiastic two thumbs down for that decision. I support you whatever you do but LSU/Tulane/Ochsner could always use worthwhile teachers... I say you see what kinda deal Parish would give you.

 

[Trisomy13]

might I refer you to the WVU post in the "positions" post? Morgantown is a small college town with personality, and miles of wilderness in every direction for the adventure-minded, but with a few "real" cities nearby. and there is a small airport within a 5 minute drive from the hospital. you could be the shot in the arm we need and bring invaluable teaching to a residency program. humor me.

 

[chesterfield]

jet-

what are your other former partners doing? any efforts to organize their actions?

....

Jet, I hate to hear about yet another place lost to the AMC liars.

Since they do not start until March you have time to convince the administrators of the bad news the AMC represents. I have heard of a number of places where the AMC was kept out when the doctors, anesthesia and/or surgeons banded together and refused to work with the AMC. The fact that they are offering good salary is most likely the carrot to try to keep you on through the transition period until the AMC can get a vice grip on the hospital and the administration at which time the will most likely get some visa workers, clueless new graduates or doctors with substance or personality issues to work for next to nothing and can you and your current partners.

This is one of their weaknesses they need some of the current anesthesia providers to stay on to make a smooth transition. If the current providers refuse to sign up with the AMC they will have to take over with an all locums work force, which will not look good to the surgeons and administration

Someone must know of a good study with outcome results that you could give the administrators to show them the problems they are in for. Every AMC has some skeletons in their closet, big lawsuit or hospital they were kicked out of, you just got to find the dirt and show to your partners, the surgeons and the administration to try to keep the AMC liars out.

 

[jetproppilot]

Jet, I hate to hear about yet another place lost to the AMC liars.

.

Man, that is soooo true.

Additionally, the administration here didnt tell the surgeons their plan.

One of our frequent ortho players was so angry yesterday he literally had to stop operating for a cuppla minutes as he fumed over the fact that most of our group won't be staying.

We were hard workers, the surgeons were happy, we had good outcomes, and even though our CRNAs were the lowest paid in the city we had NO attrition. We functioned as a team and people WANTED to work here.

Administration really missed the boat on this one.

 

[gaspasser2004]

At the ASA, I went to a panel titled "My hospital has just sent out an RFP, now what?". It was really an eye-opener to see how contracts are negotiated and what the future potentially holds for anesthesiologists. Here are my brief conclusions:


1. The only way to truly become wealthy in America is to work for yourself.

You obviously aren't going to become rich doing those new year's epidurals for someone else, as Jet explains. However, not everyone has the skills/mindset/disposition to run their own business. I guess the ideal situation is that you are a partner in a democratic group where you own a piece of of the pie while contributing your fair share of the work.


2. We need more MD/MBA's in anesthesia.

Not everyone wants to pursue formal business training nor should they to do anesthesia. But if none of us knows how to run a business (i.e. contracts, scheduling, etc), someone else (i.e. 26 y/o MBA graduate of Phoenix online school of business) will happily do it for us as our boss. Each group should ideally have at least one guy who knows whats going on.


3. We need to be indispensible to our current institutions.

The appeal of anesthesia to many of us is that we start a case, finish a case and go home. No rounding or other pesky chores to keep us in the hospital. Sweet. However, if all we do is anesthesia, then it is easy to replace us. The panel at the ASA talked about infiltrating the hospital's boards, committees and other governing bodies. When anesthesiologists are visible to other staff (not just surgeons) and make important contributions to the well being of a hospital, the administration will get a lot more grief from the medical staff when they want to get rid of us and hire an AMC.

Unfortunately, another aspect of being "indispensible" is being "surgeon friendly". AMC's like to toss that word around A LOT when negotiating contracts. Obviously, there is a reasonable limit to what a group should be willing to do, but doing an extra add on case here and there to create the perception of being "indispensible" can also help tremendously when it comes time to re-negotiate.


4. We are our own worst enemies.

AMC's are bad and make money off anesthesiologists, but is it really any different from the malignant groups that fire new grads one month before becoming parnter? Some AMC's treat their people better than the groups owned by anesthesiologists. I stopped by the "Premier Anesthesia" booth at the ASA and found that new grads were making 300K with 15K towards benefits, with a paid tail. That is a better deal than at other places where you may or may not make partner. The senior guys running these groups need to be more fair to the new grads and the new grads need to realize that working for an AMC is ultimately going to hurt all anesthesiologists in the end.


You are welcome to agree or disagree.

 

[Noyac]

3. We need to be indispensible to our current institutions.

The appeal of anesthesia to many of us is that we start a case, finish a case and go home. No rounding or other pesky chores to keep us in the hospital. Sweet. However, if all we do is anesthesia, then it is easy to replace us. The panel at the ASA talked about infiltrating the hospital's boards, committees and other governing bodies. When anesthesiologists are visible to other staff (not just surgeons) and make important contributions to the well being of a hospital, the administration will get a lot more grief from the medical staff when they want to get rid of us and hire an AMC.

Unfortunately, another aspect of being "indispensible" is being "surgeon friendly". AMC's like to toss that word around A LOT when negotiating contracts. Obviously, there is a reasonable limit to what a group should be willing to do, but doing an extra add on case here and there to create the perception of being "indispensible" can also help tremendously when it comes time to re-negotiate.

This is why when we got the go ahead to hire another anesthesiologists we decided that this position would need to be filled by someone with experience. Experience in handling administration, surgeons, hospitalist, and could sit on committees with the rest of us. This is extremely important when it comes to making your group indispensible.

 

[militarymd]

I hope you all know what it means to be "indispensible".....It means doing things beyond stool sitting....

It means taking care of patients in the hospital outside of the OR....it means Critical Care Medicine.

It means Hospitalist services.

Private practitioners make their revenue in their offices....in-patients are frequently left to fester in the hospital...developing complications that keep them in the hospital to fester some more.

That is where anesthesiologists are headed....that is if you want to be "indespensible".

Any joe-blow can sit on committees......I know because I sit on every stinkin committee in my hospital.

 

[blocks]

So the future of anesthesiology is to be an internal medicine hospitalist who also supervises CRNAs...awesome.

 

[me454555]

So the future of anesthesiology is to be an internal medicine hospitalist who also supervises CRNAs...awesome.

I don't think so, I'd rather work for an AMC than be a hospitalist for gomers in the ICU. Most people go into anesthesia b/c they enjoy being in the OR. We enjoy the procedures and manageing the cases throughout.

1. The only way to truly become wealthy in America is to work for yourself.

While this may be true in other fields such as business where you won't make more than 100k working for somoene else, it's less so in anesthesia where you can make between 200 and 300k working for someone else. If you invest wisely there's no reason you can't become wealthy on 300k/year.

 

[militarymd]

.....

1. The only way to truly become wealthy in America is to work for yourself.
..........

I disagree....the only TRUE way to become wealthy is have OTHER people WORK for you.

 

[VolatileAgent]

well, (not suprisingly) i disagree with mil. having employees sucks. i've done it. you REALLY gotta work to get wealthy that way, especially when you're job is tantamount to being a babysitter most of the time. don't believe me? ask anyone who owns a restaurant. now, that's work.

anymore there are only two ways to become wealthy and - of equal importance - happy in this world:

1) own prime real estate
2) invent something everyone needs

 

[militarymd]

well, (not suprisingly) i disagree. having employees sucks. i've done it. you REALLY gotta work to get wealthy that way, especially when you're job is tantamount to being a babysitter most of the time. don't believe me? ask anyone who owns a restaurant. now, that's work.

anymore there are only two ways to become wealthy and - of equal importance - happy in this world:

1) own prime real estate
2) invent something everyone needs

The wealthiest anesthesiologists.....are guess who? The owners of anesthesia groups.

And my parents owned a restaurant...which I managed on occasion while in school....so I know what it means to "employ"

 

[VolatileAgent]

The wealthiest anesthesiologists.....are guess who? The owners of anesthesia groups.

And my parents owned a restaurant...which I managed on occasion while in school....so I know what it means to "employ"

dude, you are far from happy. that much is obvious.

 

[lakerjock]

Gaspasser, I was at the panel too, and it appears that Noyac was there as well. Glad to see so many SDNers taking an active roll in learning more about an important topic. As a resident, its nerve racking to see the curve balls our field is throwing us - from CRNA independence, Anesthesia Managment Companies, GI Docs using propofol, etc. I agree, we need more MD/MBA's in our field (I am one) to help us with the business of anesthesia - but we really need to build relationships with hospital administrations aiding them in understanding the importance of our function, that we're not replaceable, and what they'll lose with a AMC. The panel highlighted some of the negatives of the overpromising/underdelivering AMCs, but in the end, if we aren't careful, they will succeed. Good luck Jet.

 

[militarymd]

dude, you are far from happy. that much is obvious.

huh?

 

[militarymd]

When anesthesiologists are visible to other staff (not just surgeons) and make important contributions to the well being of a hospital, the administration will get a lot more grief from the medical staff when they want to get rid of us and hire an AMC.

What important contributions are you referring to that are "indispensible"?

 

[chesterfield]

4. We are our own worst enemies.

AMC's are bad and make money off anesthesiologists, but is it really any different from the malignant groups that fire new grads one month before becoming parnter? Some AMC's treat their people better than the groups owned by anesthesiologists. I stopped by the "Premier Anesthesia" booth at the ASA and found that new grads were making 300K with 15K towards benefits, with a paid tail. That is a better deal than at other places where you may or may not make partner. The senior guys running these groups need to be more fair to the new grads and the new grads need to realize that working for an AMC is ultimately going to hurt all anesthesiologists in the end.

The malignant group vs the AMC (anesthesia management Company)

While both are bad and point to the achilles heel of our profession, the exclusive contact that is given by the administrators to whom ever they like the most (I.E. who willing to Promise the most services and pay the biggest bribes to the administrators.)

The AMC is a much greater threat because they have multiple locations and are screwing many more people than a malignant group with a single town or hospital. The more places they control and the more people they screw the better they get at it. Many of the larger AMC have screwing Anesthesiologist down to an science. You as an individual anesthesia provider have no chance of getting a fair deal, since they have screwed so many people before you; they know exactly what to say and do to separate you from the money you thought you were promised. Comparing the Anesthesia skill of a fist week CA1 versus someone who is a fifth year attending at a busy place is the similar to comparing the skill of a single malignant group verse an AMC at screwing their employees.

I disagree....the only TRUE way to become wealthy is have OTHER people WORK for you.

Mil is right,
Look at any list of the richest people and almost without exception, they got their money by owning or running an organization that profited off the work of others. Yes you can be comfortable and make a good salary working for yourself but to make the really big bucks you need to profit from the labor of others.

________________________________________________________
The bum on the rod is hunted down
As the enemy of mankind;
The other is driven around to his club
And feted, wined and dined.
And they who curse the bum on the rods
As the essence of all that is bad

Will greet the other with a winning smile
And extend him the hand so glad.
The bum on the rods is a social flea
Who gets an occasional bite;
The bum on the plush is a social leech,
Blood-sucking day and night.

The bum on the rods is a load so light
That his weight we scarcely feel,
But it takes the labor of dozens of men
To furnish the other meal.

THE TWO BUMS
(AUTHOR UNKNOWN, FIRST PRINTED IN GEORGE MILBURN'S THE HOBO'S HORNBOOK, NEW YORK, 1930)

 

[UTSouthwestern]

Call/e-mail me Jet.

 

[nimbus]

I hope you all know what it means to be "indispensible".....It means doing things beyond stool sitting....

It means taking care of patients in the hospital outside of the OR....it means Critical Care Medicine.

It means Hospitalist services.

Private practitioners make their revenue in their offices....in-patients are frequently left to fester in the hospital...developing complications that keep them in the hospital to fester some more.

That is where anesthesiologists are headed....that is if you want to be "indespensible".

Any joe-blow can sit on committees......I know because I sit on every stinkin committee in my hospital.

We have hospitalists where I work. I believe they could be bought and sold just like any other hospital based specialty-anesthesia/rays/ED/path. Before we got the shaft at my old hospital, the neonatologists were given a take it or leave it offer. Most of them left but were quickly replaced. We are all at the bottom of the food chain.

Primary care, OB/gyn, derm, plastics are at the top. Medical specialists (cardiology, GI) and surgeons are in the middle. We are the bottom feeders.

The only times we are irreplaceable are when there are local AND national manpower shortages. This occurred in the early 2000s but the tide has turned. Nothing we do individually in our practices can make us indispensible. You can be chief of staff or sit on the board of the hospital. It doesn't matter. Our job security and negotiating power are inversely related to the influx of people entering the specialty. Chances are your replacements will be just as slick and friendly as you are. The surgeons, nurses and scrub techs will say they really miss you when you run into them at the grocery store. But they won't really mean it. The future does not bode well.

 

[aredoubleyou]

What important contributions are you referring to that are "indispensible"?

I think you're dead on. Unless you’re providing a service for cheaper (more efficient, etc) or providing a clearly better service than others can advertise, you are probably not indispensable to profit driven business types. By infiltrating the ICU, maybe (hopefully not) playing some limited role in inpatient management, you are harder to replace by a company placing employees who have little direct motivation in improving the efficiency/quality/profitability of a particular hospital. People will sell their mothers for stack of the green stuff, especially the suits - don’t be surprised when your friends on the committee apologetically tell you your out of a job,and they really had no choice, and it wasnt up to them, etc, etc, etc. As long as anesthesiologists are viewed as providing a service and not physician consultants, they will be treated as "service providers," which inherently are often easily replaced.

Jet - hope things work out well for you, New Orleans hasn't been kind to you. Maybe the cozmos is telling you to move on and set up shop out West...and then hire me in a few years

 

[militarymd]

We have hospitalists where I work. I believe they could be bought and sold just like any other hospital based specialty-anesthesia/rays/ED/path. Before we got the shaft at my old hospital, the neonatologists were given a take it or leave it offer. Most of them left but were quickly replaced. We are all at the bottom of the food chain.

Primary care, OB/gyn, derm, plastics are at the top. Medical specialists (cardiology, GI) and surgeons are in the middle. We are the bottom feeders.

The only times we are irreplaceable are when there are local AND national manpower shortages. This occurred in the early 2000s but the tide has turned. Nothing we do individually in our practices can make us indispensible. You can be chief of staff or sit on the board of the hospital. It doesn't matter. Our job security and negotiating power are inversely related to the influx of people entering the specialty. Chances are your replacements will be just as slick and friendly as you are. The surgeons, nurses and scrub techs will say they really miss you when you run into them at the grocery store. But they won't really mean it. The future does not bode well.

Your're right...I guess what I'm saying is that there is going to be no shortages of stoo sitters, but there will be a shortage of outside of the OR anesthesiologists.

 

[militarymd]

I think you're dead on. Unless you’re providing a service for cheaper (more efficient, etc) or providing a clearly better service than others can advertise, you are probably not indispensable to profit driven business types. By infiltrating the ICU, maybe (hopefully not) playing some limited role in inpatient management, you are harder to replace by a company placing employees who have little direct motivation in improving the efficiency/quality/profitability of a particular hospital. People will sell their mothers for stack of the green stuff, especially the suits - don’t be surprised when your friends on the committee apologetically tell you your out of a job,and they really had no choice, and it wasnt up to them, etc, etc, etc. As long as anesthesiologists are viewed as providing a service and not physician consultants, they will be treated as "service providers," which inherently are often easily replaced.

Jet - hope things work out well for you, New Orleans hasn't been kind to you. Maybe the cozmos is telling you to move on and set up shop out West...and then hire me in a few years

I know of an anesthesia group where the partners sit of the board of trustees....and the board had a secret meeting without them ....and they recently got replaced by an amc

 

[nimbus]

Your're right...I guess what I'm saying is that there is going to be no shortages of stoo sitters, but there will be a shortage of outside of the OR anesthesiologists.

It depends on your practice situation. In a small town, doing out of OR hospitalist/CCM duties may buy you friends. Where I work, we have 4 pulmonary /ICU docs who make a living managing drips/vents/lines/abx etc. We also have hospitalists who manage patients on the wards (not sure of their exact number). We would just be unwanted competition.

 

[VolatileAgent]

it's funny how i was saying a lot of this over the past few weeks... and was attacked for it. now, it happens to jet, and all of the sudden everyone is saying essentially what i already said before... and was attacked for it.

hmmm... strangely, this thread makes me feel somewhat vindicated, not that i don't feel bad for jet.

the point is, and i'll say it again, you have to adapt or die. are profession is going to be viewed, as other people nicely put, as solely an end-service provider if we don't re-establish our specialty as critical to the patient's well-being. as i said numerous times before, we are in many ways a victim of our own successes (ie., namely in improvements in patient safety). anesthesia these days is viewed as "safe" and not that hard of a specialty. what can we do to change that? i don't think we can.

so, i'm going to say it again: you private practice guys have GOT to start hiring crna's, and making it lucrative in the long run to take ownership of their services. as long as they are the constant in the equation (ie., hospital employees) it's too easy for practice management firms to put some schlep in there at a lower cost than you can provide services under the current paradigm.

listen to me now. i'm dropping some golden, free business advice here because i care about our profession. we've been fighting this battle with crna's the entirely wrong way. it's time to bring them into the fold. you need to negotiate contracts where you have your own crna's, and you don't use - at all - the hospital provided ones. this forces them to come work for you, where you control what they do and where they go. there is no fee-splitting issues because all you bill using them comes into your practice. are you going to take a hit up front? maybe. but, in the long run, this is the only way you are going to be able to fight-off this onslaught of practice management that's threatening to take over.

 

[ketamine]

so, i'm going to say it again: you private practice guys have GOT to start hiring crna's, and making it lucrative in the long run to take ownership of their services. as long as they are the constant in the equation (ie., hospital employees) it's too easy for practice management firms to put some schlep in there at a lower cost than you can provide services under the current paradigm.

listen to me now. i'm dropping some golden, free business advice here because i care about our profession. we've been fighting this battle with crna's the entirely wrong way. it's time to bring them into the fold. you need to negotiate contracts where you have your own crna's, and you don't use - at all - the hospital provided ones. this forces them to come work for you, where you control what they do and where they go. there is no fee-splitting issues because all you bill using them comes into your practice. are you going to take a hit up front? maybe. but, in the long run, this is the only way you are going to be able to fight-off this onslaught of practice management that's threatening to take over.

aaa

 

[militarymd]

Does anyone know if the hospital can make more that an MDA can make by hiring them and charging for the services of CRNAs?

It depends on the type of reimbursement contract that the 3rd party payers have with the hospital.

Always different...always more complicated than it needs to be....always with middle men making money.

 

[militarymd]

It depends on your practice situation. In a small town, doing out of OR hospitalist/CCM duties may buy you friends. Where I work, we have 4 pulmonary /ICU docs who make a living managing drips/vents/lines/abx etc. We also have hospitalists who manage patients on the wards (not sure of their exact number). We would just be unwanted competition.

We have been using the term "indispensible"....the reality is NO ONE is "indispensible"....just..."more" or "less" so...

Even surgeons are replaceable....hospitals will recruit surgeons and primary care providers into the hospital's catchment area...with revenue guarantees for a period of time....These surgeon/primary teams CAN and WILL take business away from established surgeons....

Sooo...no one is "indispensible" ....just perhaps harder to replace.

 

[jetproppilot]

It depends on the type of reimbursement contract that the 3rd party payers have with the hospital.

Always different...always more complicated than it needs to be....always with MIDDLE MEN making money.

Hence the problem. Money that should be going into the clinicians pockets....the clinicians who are up at 2 am putting in labor epidurals while the middle men are at home asleep.

 

[militarymd]

it's funny how i was saying a lot of this over the past few weeks... and was attacked for it. now, it happens to jet, and all of the sudden everyone is saying essentially what i already said before... and was attacked for it.

hmmm... strangely, this thread makes me feel somewhat vindicated, not that i don't feel bad for jet.

the point is, and i'll say it again, you have to adapt or die. are profession is going to be viewed, as other people nicely put, as solely an end-service provider if we don't re-establish our specialty as critical to the patient's well-being. as i said numerous times before, we are in many ways a victim of our own successes (ie., namely in improvements in patient safety). anesthesia these days is viewed as "safe" and not that hard of a specialty. what can we do to change that? i don't think we can.

so, i'm going to say it again: you private practice guys have GOT to start hiring crna's, and making it lucrative in the long run to take ownership of their services. as long as they are the constant in the equation (ie., hospital employees) it's too easy for practice management firms to put some schlep in there at a lower cost than you can provide services under the current paradigm.

listen to me now. i'm dropping some golden, free business advice here because i care about our profession. we've been fighting this battle with crna's the entirely wrong way. it's time to bring them into the fold. you need to negotiate contracts where you have your own crna's, and you don't use - at all - the hospital provided ones. this forces them to come work for you, where you control what they do and where they go. there is no fee-splitting issues because all you bill using them comes into your practice. are you going to take a hit up front? maybe. but, in the long run, this is the only way you are going to be able to fight-off this onslaught of practice management that's threatening to take over.

I hate to burst your bubble....You don't get it....it may work the way you say in some microcosm where you have limited experience...but the models are different everywhere you go...every state is a little different...every hospital is a little different....It is not as simple as employing the CRNAs...

There is a big, successful, and lucrative group 2 hours drive from me where the CRNA's employ the MD's.....

 

[joshmir]

mil-

i respect your opinions a lot.

1)i know you have advocated anesthesiologists getting critical care boarded and staffing the units...how does that work in the real world to prevent and amc takeover? something the hospital risks losing and the amc risks being unable to replace? it sounds like it would be a *long* time before non-academic groups can get enough CCM trained anesthesiologists to fully staff units...do you think that in the transition, as we share units with medicine and Pulm, we would be seen as unwanted competition? could that hurt the specialty in the interim? I know that it's tough to find CCM trained providers nowadays...

2) likewise, do you see staffing/running an interventional pain management service as a way to make us seem harder to replace? I haven't heard anybody comment on the relative merits of that...it seems a much easier trend to implement with current/future manpower than staffing units...

3)if you don't mind my asking, other than providing your CCM services to your colleaugues and sitting on committees, are there any other steps you are taking at your hospital?


4)what principles should we keep in mind as we look at graduating and looking at real jobs? it sounds like no group is really "safe" from this? should we look at groups that have many years left in an exclusive contract with the hospital?

5) as i understand the posts thus far, the incentive for the hospital is that the administrators get a "bribe" up front, and assume that they can use expensive locums as stopgaps to get by when the staffing is thin, and in the end get control over a piece of the market and force qualified anesthesiologists to accept a lower salary or go elsewhere?

-j
ca-2