Jet Loses His Contract

[joshmir]

quoting jet-

>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,

jet, is there anything positive in this deal for the surgeons? have they provided any kind of organized response on behalf of your group?

have you guys stuck by them before when they were in trouble?

what's up with the outgoing radiology group? any organized defence? will the new radiology group provide IR services? what do the surgeons think of that?

I was told where i did my internship that the anesthesia group dodged some kind of bullet b/c the surgeons stuck up for them in response to years ago the anesthesia group sticking their necks out for them...i'm pretty ignorant of why admins make the decisions they do, but it sounds like sticking up for other groups in the hospital (in the hopes that they will do the same) may make it easier for the amc's to convince the suits that they should drop you...any thoughts?

---

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[zippy2u]

Oh you want solutions? The government and insurance co.s are slowly ratcheting down the purse strings so that physicians make less money and have been doing this for years. The solution doesn't start with the anesthesia crowd but the primary care physician. Occasionally you will hear or read about that renegade doc who has decided he has had enough of all the BS of managed care and whatever else the confusionists label it. This doc has decided to not take any form of insurance including medicare and medicaid. Cash, credit or check is the solution. Initially, he will suffer from cash flow but with word of mouth and advertisement his practice should grow if he's top notch. I've met many plastic surgeons who operate on this very same principle-- cash, credit or check-- they got boatloads of money. You may have a few of these renegade docs in your community or nearby. Rather than throw your money away with lost causes such as local, regional and national medical societies, PACs and other thiefs save it up for the true heroes of medicine(cash, credit or check docs). Donate to them as they are truly your only real solution. Regards, ---Zip

 

[zippy2u]

It looks to me like there are 2 take home messages to this tragedy: 1.) Never trust the administrative bean counters. 2.) After 10 or more years removed from residency, you do not want to be doing that 2AM labor epidural, but rather, sleep or my favorite, obtaining a rock-hard-porn-star woodie so that your significant other may straddle it. Regards, ----Zip

 

[militarymd]

Joshmir,

Although I'm an advocate of CCM training and certification...I'm aware that most folks who go into anesthesia does not want to do this.

However, "stool sitting" is something that is easily replaced...THAT is what I'm saying.

At the end of the day...it just about the money....How much the bean counters can save....how little they can pay you...

As long as someone else can do the same job for less...you are in trouble.

There are many, many different models out there...whatever niche you find your self in....realize that as long as someone else can do the same job for less....you're in trouble.

As for my practice....I'm not giving up any secrets....

and "bribes" and "kickbacks"......those are things that disgruntled folks make up to explain their failures.

 

[VolatileAgent]

Oh you want solutions? The government and insurance co.s are slowly ratcheting down the purse strings so that physicians make less money and have been doing this for years. The solution doesn't start with the anesthesia crowd but the primary care physician. Occasionally you will hear or read about that renegade doc who has decided he has had enough of all the BS of managed care and whatever else the confusionists label it. This doc has decided to not take any form of insurance including medicare and medicaid. Cash, credit or check is the solution. Initially, he will suffer from cash flow but with word of mouth and advertisement his practice should grow if he's top notch. I've met many plastic surgeons who operate on this very same principle-- cash, credit or check-- they got boatloads of money. You may have a few of these renegade docs in your community or nearby.

zip, we don't go out find patients. we are back-end providers. your heroic stance does not work in our profession. sorry.

Rather than throw your money away with lost causes such as local, regional and national medical societies, PACs and other thiefs save it up for the true heroes of medicine(cash, credit or check docs). Donate to them as they are truly your only real solution. Regards, ---Zip

you need to do both. the asa is not a "lost cause" as you would have it. no one would argue that all of us, if we're solely in it for the money, wouldn't we all want to provide anesthetics for boob-jobs on cash-paying healthy twenty-five year-olds. the reality is that very few of us can make a living doing that. so, we have to learn to effectively bargain and negotiate - collectively - with those who are paying the bills. your escapist mentality just doesn't work. people will stop having surgery and die if they're forced to pay cash... and in the end they will hate doctors even more than they already do.

 

[deleted50478]

Maybe I'm a little slow on the uptake, but how are AMC's able to outbid you? They have to hire just as many Anesthesiologists as an MD group, but they have the added cost of paying their MBA salaries without the MBAs billing patients for anything. It seems that a group where everyone can take part in patient care should be able to provide the same service at a lower cost that an AMC. I know the MBAs are making up their salaries by taking money from the docs, but the docs still get paid plenty. If you take the same salary as an AMC employee would, then you can undercut their bid. Once they get established they'll start controlling the market, playing MDs against each other, and lowering our salaries, but they can't do that until they're established. Better to edge them out now while they have to pay high salaries than to watch them take over and give us the squeeze down the road..

 

[VolatileAgent]

Maybe I'm a little slow on the uptake, but how are AMC's able to outbid you? They have to hire just as many Anesthesiologists as an MD group, but they have the added cost of paying their MBA salaries without the MBAs billing patients for anything. It seems that a group where everyone can take part in patient care should be able to provide the same service at a lower cost that an AMC. I know the MBAs are making up their salaries by taking money from the docs, but the docs still get paid plenty. If you take the same salary as an AMC employee would, then you can undercut their bid. Once they get established they'll start controlling the market, playing MDs against each other, and lowering our salaries, but they can't do that until they're established. Better to edge them out now while they have to pay high salaries than to watch them take over and give us the squeeze down the road..

management company has more flexibility and resources to staff at a lower cost than does a private group. it's the difference between having enough people to work at 3:00 AM when the private practice group can't/isn't willing to/gets tired staffing. they shove their "junior" partner or associate in there, who finally gets sick of doing it.

eventually, the guys on the "low end" of the private practice group food chain go work for the management company for often better hours and more pay (on a $$/hr basis). they get a better deal up front than many private practice groups can offer. they may make a little less money at first, but the hours are better... and the rewards are bigger if they stay in the group in the long run.

you have to understand the model. yes, they hire people to manage the practice in PM companies, but so do anesthesia groups. you can pay managers less money than anesthesiologists demand, and you can then dedicate the anesthesiologist to doing what they're supposed to do instead of trying to run the business: generate revenue. every hour an anesthesiologist is outside the OR, he/she is losing money.

the management company can do a better job of managing the contracts and getting maximum working hours out of each individual. result? more money flows into a more effectively managed group. then, they can offer a better deal to the hospital, based on a solid track record that they can show to the administrators as to how it's been done at x,y,z other hospitals where they have contracts. small, mom&pop practice doesn't have the same street cred and has to rely on past performance on their previous contract. the management group can "underbid" for the service to win the contract. or, they can negotiate to take-over the management of the group already there, and thus relieve them of having to do all the billing, management, benefits, etc. of running a practice. a lot of small practices go for this option too, and become part of the larger group. how do you think these groups get so big so fast?

the fact is this: the management company offers, to the administrators mind, the same service at a lower price with a better "disaster plan" than the mon&pop private practice group. knowing that, who do you think the hospital is going to award the contract to?

 

[amyl]

[the fact is this: the management company offers, to the administrators mind, the same service at a lower price with a better "disaster plan" than the mon&pop private practice group. knowing that, who do you think the hospital is going to award the contract to?[/QUOTE]

exactly...how do you think all the mom and pop video stores lost out to blockbuster? how do you think hardware stores are competing with home depot and lowes? .....walmart and target? now they have superwalmarts and targets trying to put the grocery stores out of business too. thats the way society has gone...just hitting medicine now.

 

[toughlife]

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?????

I heard my program pays academic attendings salaries starting in 280K+. Maybe it's time for "Professor Jet"?

 

[jetproppilot]

quoting jet-

>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,

jet, is there anything positive in this deal for the surgeons? have they provided any kind of organized response on behalf of your group?

have you guys stuck by them before when they were in trouble?

what's up with the outgoing radiology group? any organized defence? will the new radiology group provide IR services? what do the surgeons think of that?

I was told where i did my internship that the anesthesia group dodged some kind of bullet b/c the surgeons stuck up for them in response to years ago the anesthesia group sticking their necks out for them...i'm pretty ignorant of why admins make the decisions they do, but it sounds like sticking up for other groups in the hospital (in the hopes that they will do the same) may make it easier for the amc's to convince the suits that they should drop you...any thoughts?

The word was disseminated to the surgeons (via memo) about three weeks after the announcement was made to us.

Several surgeons found out via us earlier but the whole crowd didnt know 'til later.

Administration holds steadfast.

 

[jetproppilot]

I heard my program pays academic attendings salaries starting in 280K+. Maybe it's time for "Professor Jet"?

I will be if I stay in town.

If I'm gonna be vulnerable to an administrator's pen changing my destiny overnight, next time the administrator will be a buddy of mine.

 

[Trisomy13]

I heard my program pays academic attendings salaries starting in 280K+. Maybe it's time for "Professor Jet"?

that's what i'm talking about. um.. except at my program, not yours

 

[racerx]

that's what i'm talking about. um.. except at my program, not yours

JPP, it looks like a resident catfight is brewing over you!

Mee-oww!

 

[EV-Stentor]

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?????

Dude sorry to hear this . I would go back to old gig in a minute but no worries for an experienced slick like yourself...you can pick and choose but tell me Jet what makes NO so cool to you and your family? I had a surgeon friend who did his fellowship here in NYC but couldn't wait to get back to NO....

 

[jetproppilot]

..you can pick and choose but tell me Jet what makes NO so cool to you and your family? ....

I've yet to figure that out, EV.

Moved here because wife is from here....

Not a good environment to be an anesthesiologist for sure. Its a bowl fulla sharks. Always looking over your shoulder.

As far as night life it cant be beat. If I wasnt on call this Halloween night, I'd be sittin' at a rail-seat in the House of Blues Foundation Room right now, watching The Cult rock out with their c oc ks out....

Queensryche is coming in November....

so for live music/partying its hard to top.

Only problem is you have to wear a bullet-proof vest to get there....5 people were shot justa cuppla blocks from HOB last night....

So other than the destruction of half the city from Katrina, piss-poor public schools, very-very expensive private schools, the terrible roads, political corruption, ineffective police force, returning gangstas hell-bent on protecting their turf, random shootings, non-random murders, difficult parking in downtown/uptown, inadequate pumping stations/levies, and the continued hurricane threat, New Orleans aint so bad.

Great place to raise kids.

 

[jetproppilot]

I had a surgeon friend who did his fellowship here in NYC but couldn't wait to get back to NO....

First name Gene?

 

[deleted50478]

First name Gene?

or Sander?

 

[EV-Stentor]

First name Gene?

Hey Jet that HOB stuff sounds like some serious shangri la....joie de vivre ooh lala.. Wait a minute nolagas is spot on My buddy's first name is Sander....one the best hands I've seen in anastamosing vessels and changing "parts"

 

[EV-Stentor]

or Sander?

You know him Please PM me bro I got to check this bro up....lost all contact and was worried stiff with Katrina But some of the dudes @ the hospital assured me he would be okay..damn what a small world

 

[Monty Python]

or Sander?

Would that be Sander F., now an abdominal xplant guru at Tulane? If so please also tell him hello for me. He and I responded to a lovely ICU code blue at Huey P. Long while he was a resident and I (Don) was working up there. He's probably forgotten though, it was ~1999 or so.

 

[Monty Python]

I've yet to figure that out, EV.

Moved here because wife is from here....

The city holds a mystic grip on its' natives. My dad moved to NO from Florida strictly to attend dental school and then high-tail it back. Met his future wife (a NO native and Tulane co-ed) while in dental school and ........ never left. Despised the city 'till the day he died.

So other than the destruction of half the city from Katrina, piss-poor public schools, very-very expensive private schools, the terrible roads, political corruption, ineffective police force, returning gangstas hell-bent on protecting their turf, random shootings, non-random murders, difficult parking in downtown/uptown, inadequate pumping stations/levies, and the continued hurricane threat, New Orleans aint so bad.

It's definitely not the city I grew up in (born in 1956) I got to experience NO when it was still a really fun, unique, relatively safe, relatively well-maintained city. Not until I was an adult did I realize that not every city has a French Quarter, streetcars, more history than you can shake a stick at, unique architecture, etc etc etc. To a native like me, the city's slow and painful demise over the last three decades has been excruciating to watch, and Katrina, well, ....................................... I now work at LSU, and frequently drive past Charity Hospital on my way to the park to run. Seeing it shuttered, boarded up, lights off is beyond words.

 

[jetproppilot]

Hmmmmmm.....

No CRNA attrition during my tenure at this hospital, despite the fact that they were among the lowest paid in the city.

Since the announcement, 8 (out of 15) CRNAs have resigned.

Most are going to work under Alan Kaye at LSU.

Wonder why that is.

In a few weeks we arent going to be able to cover the operating room.

And I have no idea how the AMC taking over the contract is gonna find the people to cover our hospital, since most likely all the docs are leaving as well.

Goes to show you what happens when Paper Pushing Administrators take charge of "making things better".

So lets see.....we had NO attrition, the surgeons were happy, we worked as a cohesive team, and had good patient outcomes.

Now look at it, after your intervention, Mr Administrator:

resignations continuing, and you've made a deal with the smoke-and-mirrors-devil, who I'm still trying to figure out where they're gonna get the coverage for our hospital....

Best of luck to you.

 

[racerx]

Hmmmmmm.....

No CRNA attrition during my tenure at this hospital, despite the fact that they were among the lowest paid in the city.

Since the announcement, 8 (out of 15) CRNAs have resigned.

Most are going to work under Alan Kaye at LSU.

Wonder why that is.

In a few weeks we arent going to be able to cover the operating room.

And I have no idea how the AMC taking over the contract is gonna find the people to cover our hospital, since most likely all the docs are leaving as well.

Goes to show you what happens when Paper Pushing Administrators take charge of "making things better".

So lets see.....we had NO attrition, the surgeons were happy, we worked as a cohesive team, and had good patient outcomes.

Now look at it, after your intervention, Mr Administrator:

resignations continuing, and you've made a deal with the smoke-and-mirrors-devil, who I'm still trying to figure out where they're gonna get the coverage for our hospital....

Best of luck to you.

They made their bed, now they get to sleep in it.

Good luck to you JPP.

 

[jetproppilot]

Good luck to you JPP.

And Godspeed to you, Dude.

 

[Noyac]

I assume that the AMC that took over your job (I didn't read everything here so you may have mentioned w/c one it was) is Parrish. They came into one of our dumps in BR when I was there and took over which was actually fine for the partners but not so much for the associates since we made a mint covering OB b/c the partners didn't want to. Parrish found enough warm bodies to cover the cases but thats all they were, warm bodies. The CVT surgeons were livid with the change since no one with Parrish could do a heart case much less off pump. They (CVT that is) asked me and another associate if we would consider training them b/4 the real switch occurred. I said sure, as soon as you pay me 1 millllllllion dollllars! These guys were awful. But after some period of time everything settled down and it was business as usual. It really is a poor choice on the admin's side.


I'm still holding that dream spot for you here, Jet.

 

[deleted50478]

Would that be Sander F., now an abdominal xplant guru at Tulane? If so please also tell him hello for me. He and I responded to a lovely ICU code blue at Huey P. Long while he was a resident and I (Don) was working up there. He's probably forgotten though, it was ~1999 or so.

Yeah, that's the one I was guessing. Small world.

 

[jetproppilot]

I assume that the AMC that took over your job (I didn't read everything here so you may have mentioned w/c one it was) is Parrish. They came into one of our dumps in BR when I was there and took over which was actually fine for the partners but not so much for the associates since we made a mint covering OB b/c the partners didn't want to. Parrish found enough warm bodies to cover the cases but thats all they were, warm bodies. The CVT surgeons were livid with the change since no one with Parrish could do a heart case much less off pump. They (CVT that is) asked me and another associate if we would consider training them b/4 the real switch occurred. I said sure, as soon as you pay me 1 millllllllion dollllars! These guys were awful. But after some period of time everything settled down and it was business as usual. It really is a poor choice on the admin's side.


I'm still holding that dream spot for you here, Jet.

Chaps my ass, Noy, that we all know about the smoke and mirrors of an AMC, Parrish in this instance....and yet administration is oblivious...kinda like a teenager listening to a car salesman describe the teenager's dream car...

Man, Noy, snowboarding every day in the winter....hmmmm...maybe you could even teach me how to put up that radical spray of yours.....

 

[Noyac]

Chaps my ass, Noy, that we all know about the smoke and mirrors of an AMC, Parrish in this instance....and yet administration is oblivious...kinda like a teenager listening to a car salesman describe the teenager's dream car...

Man, Noy, snowboarding every day in the winter....hmmmm...maybe you could even teach me how to put up that radical spray of yours.....

Dude, you come here and I'll have you droppin in some sick lines and never wanting to ride a lift again.

 

[VolatileAgent]

I'm still trying to figure out where they're gonna get the coverage for our hospital....

Best of luck to you.

they'll find it, jet. they'll get locums to cover it if they have to until they can build staff up, but they'll cover it. that's their power. sure, there's going to be a rough transition period, but this is how it works. even if they LOSE money for the first year or two, it's more important for them to get (and keep) the contract. they'll fly people in from all over hell and creation, if necessary. there's a lot of young whipper snappers willing to live in the big easy for less than the coin you were making.

this is the way big business works. doesn't matter who they squash in the process. it's all about the almighty dollar. in a couple of years, those same surgeons you had the great rapport with will only vaguely (but still fondly) remember you.

take heed, everyone. take heed. this is the future of our profession.

 

[VolatileAgent]

and, what's worse is by the time your hospital realizes that they've made a mistake, all you guys will be gone.

competition is okay, provided that it's on a level playing field. i think that small practices are going to be forced to band together in business alliances. it's going to be the "ace hardware" model against the home depots and lowe's of the world.

and, the sad thing is, they patient (customer) doesn't really care who they buy their shovel from. we're like the guy providing them the tools: they don't care who's selling it so long as it works, and they're paying the best price for it.

 

[Noyac]

and, the sad thing is, they patient (customer) doesn't really care who they buy their shovel from. we're like the guy providing them the tools: they don't care who's selling it so long as it works, and they're paying the best price for it.

Not were I live and work. Our customers are educated, well informed and they do their homework. They don't want nurses or locums and they frequently call us ask around and quiz the surgeons regarding their anesthesiologist. Request cases are very common here.

 

[EV-Stentor]

Yeah, that's the one I was guessing. Small world.

Yep thats the man with the diamond hands..give my regards also, peace from NYC.

 

[cfdavid]

Not were I live and work. Our customers are educated, well informed and they do their homework. They don't want nurses or locums and they frequently call us ask around and quiz the surgeons regarding their anesthesiologist. Request cases are very common here.

Where's here Noy?? Also, any ideas on how to better inform the public?
What is different about your patient population/case load?

FYI, I'm being serious, and not instigative.

 

[Noyac]

Where's here Noy?? Also, any ideas on how to better inform the public?
What is different about your patient population/case load?

FYI, I'm being serious, and not instigative.

I am in a small college town in Colorado (everyone knows its Durango) were the population is very healthy, educated, and athletic. Word gets around here very easily and for some reason people take their health pretty seriously here. I don't know how to make people become interested in their providers and their health but it is nice when they do. With all this that I have said, they do have some crazy ideas regarding their care (midwives for one, alternative medicine practicioners, acupuncture, message, blah blah blah). I don't mean to say that using these forms of healthcare is crazy. They are just that, alternatives.

If you want a better informed public, you need to advertise (ie: All MD anesthesia at ...... hospital). You need to take the information to them. They won't seek it on their own usually. I don't want to get carried away with this. You can PM me if you have more questions.

 

[cfdavid]

I am in a small college town in Colorado (everyone knows its Durango) were the population is very healthy, educated, and athletic. Word gets around here very easily and for some reason people take their health pretty seriously here. I don't know how to make people become interested in their providers and their health but it is nice when they do. With all this that I have said, they do have some crazy ideas regarding their care (midwives for one, alternative medicine practicioners, acupuncture, message, blah blah blah). I don't mean to say that using these forms of healthcare is crazy. They are just that, alternatives.

If you want a better informed public, you need to advertise (ie: All MD anesthesia at ...... hospital). You need to take the information to them. They won't seek it on their own usually. I don't want to get carried away with this. You can PM me if you have more questions.

cool. i was just curious. seems like it's a pretty good situation.

 

[VolatileAgent]

Not were I live and work. Our customers are educated, well informed and they do their homework. They don't want nurses or locums and they frequently call us ask around and quiz the surgeons regarding their anesthesiologist. Request cases are very common here.

i think you're type of practice is the kind that's always going to be safe. the management companies are, quite frankly, not interested in trying to chip into your turf.

what i'm talking about is more the major metropolitan areas and large suburbs thereof. these are the so-called "desirable" locations by some (although i think where you're at is plenty desirable).

and, request cases are by far the exception, not the rule. i think it's great that you've been able to build your practice in such a manner. i'm probably going to soon sign the contract on a job back in the midwest (based primarily at a mid-size suburban hospital also catering to a network of surgicenters and diagnostic clinics).

my goal is to do likely what you've done: get the opportunity to provide the care to the patient getting the endoscopy (etc.), be sure to hand a business card and follow-up by phone later (how hard is that?), and hopefully if/when the time comes for surgery i'll have become their "personal anesthesiologist".

i think that's the way we have to make the effort to change our practices. we're going to have to do a better job of selling our services to individual patients.

 

[Noyac]

i think you're type of practice is the kind that's always going to be safe. the management companies are, quite frankly, not interested in trying to chip into your turf.

what i'm talking about is more the major metropolitan areas and large suburbs thereof. these are the so-called "desirable" locations by some (although i think where you're at is plenty desirable).

Exactly!

At least for now, the management companies will leave us alone.

 

[Mr. Freeze]

Do most of the AMCs use CRNAs pretty extensively, with only a few MDs?

Somebody (MDs) has to go work for these people, so why are they taking less money than they would if they just went to work for a MD-owned group? Why bite the hand that feeds you??

I think something very similar is going on at a local hosp here, because I heard several MDs in the lounge saying that their contract was going to be up 1 Nov, but the AMC or whoever was taking over wasn't ready to do so. I don't know if they did, but it sounded a lot like they just weren't going to show up that Wed.

I'm woefully uneducated in these matters, just trying to become less so...

Sorry the opportunity to learn stems from JPP being in a pickle.

 

[nimbus]

Not were I live and work. Our customers are educated, well informed and they do their homework. They don't want nurses or locums and they frequently call us ask around and quiz the surgeons regarding their anesthesiologist. Request cases are very common here.

Not around here

Actual patient from last year--Homeless guy calls 911 and tells them his ankle hurts. He is told that is not an emergency. He proceeds to swallow 6 razor blades, calls 911, and says, "I just swallowed 6 razor blades." They sent out an ambulance right away.

Also, how come I mostly get requested by patients who have >25 "allergies" including "all plastics", "all anesthetics", "all narcotics", and "All Eli Lilly products"?

 

[Noyac]

Not around here

Actual patient from last year--Homeless guy calls 911 and tells them his ankle hurts. He is told that is not an emergency. He proceeds to swallow 6 razor blades, calls 911, and says, "I just swallowed 6 razor blades." They sent out an ambulance right away.

Also, how come I mostly get requested by patients who have >25 "allergies" including "all plastics", "all anesthetics", "all narcotics", and "All Eli Lilly products"?

 

[SleepIsGood]

been real busy, so sorry for being MIA.

Jet, my heart goes out to you on this one..really do feel for you.

People wake up though. Toughlife and I have been saying this for quite some time now. It's time for the ASA to step it up a notch. AMCs and cheaper alternatives like CRNAs will be the way of the future if we do not stop them from proliferating. There's nothing like "stool sitting". That little inch of power that you give away to a midlevel is all that is needed for corporate groups (like AMCs) to feel that you are replaceable. Why do a lot of lay ppl think anesthesia is provided by nurses? Well because we have CRNAs out there providing this.

It's unfortunate, but the hands that fed these CRNAs are finally realizing their miscreation. It has NOTHING to do with how much surgeons 'love you'. As Volatile and others have alluded to, it's about the $$$. I wouldnt be surprised if the surgeons and administrators have collaborated with AMCs,however, have put up the 'front' that they are in support of the anesthesiologists. It's sleazy, but it's how corporate America runs all the time.

Is it too late for us? No. There are plenty of med students willing and ready to go into anesthesiology, so why increase the midlevel presence? Yes, there was a shortage of anesthesiologists in the past, but just look at interest levels nowadays to tell me there still is lack of interest in our specialty. Private practice attendings, it's you guys that are hiring CRNAs and that is hurting us. If it's not you all, it's the hospitals that are hiring these folks. Don't cut and run for the 'cheaper labor', have anesthesiologists work for you. Sure your pay check will be less having had to share it with an anesthesiologist, but atleast you are keeping our profession safe. It's academic centers that train these CRNAs that are also hurting us. AMCs will and have hired only a few MDs and then stuffed the 'group' with CRNAs to run surgeries...so it is happening unfortunately.

How can we stop this? Well for you interns (PGY1s) out there, it's all about the 'small' things. 1)Increase your prsence at your hospital. At my institution, myself and an attending are on committees that create the formularies at our hospital. 2)As an intern during your medicine and surgery rotations when patients have questions about surgery,etc talk to them. Many patients were completely amazed at the fact that there werent MDs providing the anesthesia during surgeries at times. Sure it's a grassroots type of movement, but if you can educate patients on the importance of MD/DO provided anesthesia, the importance of our profession will catch on as these patients go home and tell their friends. If you dont thnk pts will talk to their friends, try it and see. Ppl do talk.

Why do I think the last suggestion works? At my institution even interns have anesthesiology written on their white coats. For the most part patients see that 'anesthesiology' part on our coats and ask us "so what do you think about that case involving that Dentist and anesthesia". It's times like that YOU need to seize the opportunity and inform the patient about the importance of having a MD provide your anesthesia. Bring anecdotes about how patients have died intraop by having plastic surgeons using their gfs to provide anesthesia (see TIME article). Tell them that anesthesia, although can be dangerous, however, IF GIVEN by the right hands is safe. The right hands are those of a MD/DO.

That's how you promote our specialty to patients. The patients will then DEMAND anesthesiologists from surgeons.

 

[OldManDave]

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...

Jet,

Dude, that SUCKS $HIT! However, I've been to N'Owlins many many times - it ain't that great...hangovers too frequent & the crime is HIGH! So, maybe this is a surreptitious hint that it is time to explore other pastures? Maybe the grass really will be greener there?

Besides, if I may be so nosey - where if Bum-Phuck, Egypt?

Lastly, the "year off" sure as hell does not sound too bad. Of course, being 8 mos from finishing gas [+ 1 year of a critical care fellowship] I just want a freaking job!

 

[Monty Python]

...... So, maybe this is a surreptitious hint that it is time to explore other pastures?

Not meaning to speak for JPP nor put words in his mouth, but he married a local native, just as my Florida-born father did, and (to date) neither Floridian ever left the general area afterwards. Natives are somehow tethered to "Gawd's country."

Personally I'm hoping JPP and I have the same employer again in the near future. Let's see, where's AK's phone number?

 

[Noyac]

Not meaning to speak for JPP nor put words in his mouth, but he married a local native, just as my Florida-born father did, and (to date) neither Floridian ever left the general area afterwards. Natives are somehow tethered to "Gawd's country."

Personally I'm hoping JPP and I have the same employer again in the near future. Let's see, where's AK's phone number?

Trin, As far as I know I may be the only one to successfully have removed a native from the area. And I still struggle with the old lady from time to time because of this. But a plane ticket home every month (when its not snowing at least) has curtailed that somewhat.

 

[OldManDave]

Not meaning to speak for JPP nor put words in his mouth, but he married a local native, just as my Florida-born father did, and (to date) neither Floridian ever left the general area afterwards. Natives are somehow tethered to "Gawd's country."

Not to be nosey, but where is this land of "milk & honey"? I am, afterall, looking for future employment & anywhere that has this profound of a draw should be on my radar screen.

Do tell...do tell!

 

[Monty Python]

Not to be nosey, but where is this land of "milk & honey"? I am, afterall, looking for future employment & anywhere that has this profound of a draw should be on my radar screen.

Do tell...do tell!

While the milieu and culture of the general New Orleans area maintain a strong emotional grip on its natives, this is especially prevalent on folks raised in St. Bernard Parish, an outlying area adjacent to Orleans Parish (Louisiana has parishes, not counties).

The main city in St. Bernard Parish is Chalmette, site of Gen. Andrew Jackson's famous fight against the British in the Battle of New Orleans (War of 1812) with lots of help from the pirate Jean Lafitte and his band of merry mischief-makers. Even though the peace treaty had already been signed, that little news titbit hadn't yet reached this part of the world. Historians continue to debate what would have happened if the British had won that battle and seized control of the mouth of the Mississippi River - they might have turned their backs on the peace treaty. But I digress.

(I was blessed to have three years of local history in high school taught by the granddaughter of Mr. Allard, who used to own a plantation on what later became City Park [6th largest in the country]. Miss Allard had won some national award as an outstanding history teacher and she knew this stuff cold.)

Natives of Chalmette are referrred to as "Chalmations" and it takes a nuclear blast to dislodge them from the local area.