NAPA in trouble in NJ

[Twiggidy]

im in academic and here we cant take our sick days for family member having surgery i believe. no problem if its your own surgery.

crnas are telling me there are bunch of places paying 200 a hr per diem, and highest ive heard was 250/hr for crna. the crnas here make more than docs (but they do also work 12 hr shifts so they are guaranteed 12 hrs per day)

that's 12hr with two guaranteed breaks and a guaranteed lunch too

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[anbuitachi]

that's 12hr with two guaranteed breaks and a guaranteed lunch too

what exactly happens if you dont give them the break? quit?
its sad because in residency, they made it seem like crna getting breaks and leaving on time is the most important thing in the universe. insane.

 

[aneftp]

Curiously, do people really take so many sick leave days? Say you are in your 30s, 40s, healthy. What are the excuses? I am not talking about maternity/paternity leave, Covid leave etc.

Scheduled sick leave is easy. You aren’t hurting staffing at all when it’s planned. Dental
Visits. Kids doctors visits.

The average American takes 7-8 sick days a year

Private industry workers with sick leave benefits received 8 days per year at 20 years of service : The Economics Daily: U.S. Bureau of Labor Statistics

On average, workers in private industry received 7 days of sick leave per year at 1 year of service. The average also was 7 days at 5 and 10 years of service and 8 sick days per year at 20 years of service. Employees in smaller establishments received fewer paid sick days, on average, than...

www.bls.gov

Private groups that offer 9-10 weeks of vacation. Many require one full week off

I found that very cumbersome. Almost all that had 12 PAID plus weeks off was one week at a time.

Of course there are some remaining eat what you kill private groups. Those guys either tend to only take 4-5 weeks off and make 800k-900k solo MD. Or take 15-16 weeks off but work super hard those other 36-37 weeks and still pull 500k.

Covering 3-4 crnas (employed by private group) as a true private group is getting rarer and rarer. Almost all my friends in flordia and Georgia true private groups with crnas in the last 10 years have sold out/lost contracts to amc or been absorbed as w2 hospital employees.

 

[nimbus]

Wow. With your cost of living and you aren't getting $300 per hour? About 1/2 my state is asking for and getting $275 per hour at a minimum with the max rate around $375 per hour. This is the physicians getting that rate not the locums companies which are charging much more in the $450 per hour range. CRNAs are getting $170-$180 per hour with extra stipends for living expenses with some groups paying as much as $200 per hour (1099) for a CRNA.

I’m 55yo and done chasing money. In fact I’m cutting back. The COL wasn’t always ridiculously high. I was lucky enough to be in the SoCal real estate market since the late 1990s. Still own the first home we ever bought for $119k which is now a rental. Besides who would water my hydrangeas and walk my dog if I’m out of town doing locums? I have the life I want.

 

[Twiggidy]

what exactly happens if you dont give them the break? quit?
its sad because in residency, they made it seem like crna getting breaks and leaving on time is the most important thing in the universe. insane.

Nursing union…that’s when you find out CRNAs are still nurses

 

[IMGASMD]

Nursing union…that’s when you find out CRNAs are still nurses

How fuking convenient.

 

[Mman]

Nursing union…that’s when you find out CRNAs are still nurses

unlike residents, if the CRNA doesn't like their job they can quit tomorrow and get a job elsewhere. The residents are guaranteed cheap labor that can't ever go anywhere else.

 

[Twiggidy]

unlike residents, if the CRNA doesn't like their job they can quit tomorrow and get a job elsewhere. The residents are guaranteed cheap labor that can't ever go anywhere else.

Exactly

 

[dannyboy1]

So then what kind of leverage do any of the AMCs have? Pick off the smaller groups? Stop expansion?
Isn’t this the biggest protection they have from people reform after a buy out?

NAPA and envision have serious problems. They have to make a profit off anesthesia. The hospital can take the service at a loss because they at least get the ORs. There is no way that anesthesia reimbursement covers paying someone 350-400/hr. Also new grads are not fools anymore. They all want hourly rate.

 

[2Fast2Des]

Nursing union…that’s when you find out CRNAs are still nurses

CRNA is the best job in medicine period. Can make the job whatever you want, make a boat load of money (more than many physicians). Get to play doctor, deny and transfer blame the supervisor when they cause issues, guaranteed multiple breaks, out on the clock and not a minute over, no non-compete, can work as many jobs as they feel, list goes on and on...

 

[Arch Guillotti]

Agree. Full time locums docs pulling easily 1 million a year. One dude I know is gonna to be close to 1.5 million for the year. He’s already surprise $700k for the first 6 months. Yes he works like 70-80 hours a week. But he’s a work hard, plays hard type of guy. Takes 8 full weeks off and actually home for his kids events.

No.

 

[BLADEMDA]

No.

Arch, there is guy I know who signs up for in house call 64 hours in a row. He also works a day shift then takes call at night. One week that guy worked like 112 hours. There are people who will literally kill themselves for money. FYI, he was averaging $300 Per hour for those 112 hours.

if all you care about is money the work is there in my state. Almost every practice needs Locums and will pay up to get them.

 

[Fpg1245]

NAPA and envision have serious problems. They have to make a profit off anesthesia. The hospital can take the service at a loss because they at least get the ORs. There is no way that anesthesia reimbursement covers paying someone 350-400/hr. Also new grads are not fools anymore. They all want hourly rate.

It’s starting to feel a lot like EM right before everything went to hell.

 

[2Fast2Des]

Arch, there is guy I know who signs up for in house call 64 hours in a row. He also works a day shift then takes call at night. One week that guy worked like 112 hours. There are people who will literally kill themselves for money. FYI, he was averaging $300 Per hour for those 112 hours.

if all you care about is money the work is there in my state. Almost every practice needs Locums and will pay up to get them.

To each their own... If one can stomach it to make a killing. Then there's normal people who enjoy sunlight

 

[narcotics999]

It’s starting to feel a lot like EM right before everything went to hell.

No it is not. In ER, you can staff as many midlevels as you want and there is a huge pool of midlevels.

Not in OR. Only anesthesiologists and crnas can work there. CRNAs are not cheap.

 

[Fpg1245]

No it is not. In ER, you can staff as many as midlevels you want and there is a huge pool of midlevels.

Not in OR. Only anesthesiologists and crnas can work there. CRNAs are not cheap.

I would argue you can staff a ton of MLPs in the OR MD CRNAs AA and what ever other degree is next in line to deliver anesthetics. It honestly wouldn’t surprise me if they tried DNPs through a cert program. Supervision ratios will get more and more lax. Bad outcomes will be settled out of court and the show will go on. Plus new anesthesia programs are opening up. This ain’t gonna last man. 2 years tops.

 

[Status Sciaticus]

So then what kind of leverage do any of the AMCs have? Pick off the smaller groups? Stop expansion?
Isn’t this the biggest protection they have from people reform after a buy out?

They can still file to enforce the non-compete or breach of contract penalties. You would have to retain a lawyer and at least go through the first few phases of trial which isn't cheap. A retainer alone can be 10,000+. I've seen a few with 30,000+. The cost of going to trial is the leverage, not the unenforceable non-compete

 

[anbuitachi]

They can still file to enforce the non-compete or breach of contract penalties. You would have to retain a lawyer and at least go through the first few phases of trial which isn't cheap. A retainer alone can be 10,000+. I've seen a few with 30,000+. The cost of going to trial is the leverage, not the unenforceable non-compete

so cant north well just pay off all the napa non compete penalties ?

 

[Status Sciaticus]

so cant north well just pay off all the napa non compete penalties ?

why would napa accept a lower payout when they would rather earn their contract rate from northwell?
Why would Northwell pay off their contract rate or even buy out the non-compete, for work that hasnt been performed yet and then hire all the physician for additional millions?

 

[Dr. Rude]

why would napa accept a lower payout when they would rather earn their contract rate from northwell?
Why would Northwell pay off their contract rate or even buy out the non-compete, for work that hasnt been performed yet and then hire all the physician for additional millions?

Because litigation is unpredictable and expensive.

 

[chocomorsel]

No.

Hell to the naw naw naw!!!

 

[Status Sciaticus]

Because litigation is unpredictable and expensive.

And I'm sure theyve made that assessment and weighed it against the unpredictability and expense of losing said contracts.

 

[IMGASMD]

And I'm sure theyve made that assessment and weighed it against the unpredictability and expense of losing said contracts.

Love to see corporations fight.
Then everyone signs non-disclosure….

 

[Twiggidy]

so cant north well just pay off all the napa non compete penalties ?

It’s much easier for northwell to hire new people and run lean by asking some of their people to travel until they staff up

 

[GravelRider]

so cant north well just pay off all the napa non compete penalties ?

The rumors are that Northwell will reimburse for legal costs. Since Northwell is taking all NAPA sites at once, NAPA can’t argue that you can just work for them at one of their other nearby sites. Essentially NAPA can’t employ them without forcing the anesthesiologists to move. How can NAPA enforce a non-compete on someone if they can’t employ them? The anesthesiologists there are probably safe from legal expenses.

That’s at least the thinking. Whether or not it stands up in court, is another thing. NY/NJ metro is going to be a mess for a few years.

 

[dannyboy1]

They can still file to enforce the non-compete or breach of contract penalties. You would have to retain a lawyer and at least go through the first few phases of trial which isn't cheap. A retainer alone can be 10,000+. I've seen a few with 30,000+. The cost of going to trial is the leverage, not the unenforceable non-compete

Northwell can fund the legal fees. That’s what RWJ is doing. It is pennies to a big corporation.

 

[narcotics999]

The rumors are that Northwell will reimburse for legal costs. Since Northwell is taking all NAPA sites at once, NAPA can’t argue that you can just work for them at one of their other nearby sites. Essentially NAPA can’t employ them without forcing the anesthesiologists to move. How can NAPA enforce a non-compete on someone if they can’t employ them? The anesthesiologists there are probably safe from legal expenses.

That’s at least the thinking. Whether or not it stands up in court, is another thing. NY/NJ metro is going to be a mess for a few years.

It is not good for non-NAPA non-Northwell anesthesiologists. Because of their competitions, other groups have been paying up to attract anesthesiologists.

 

[GravelRider]

It is not good for non-NAPA non-Northwell anesthesiologists. Because of their competitions, other groups have been paying up to attract anesthesiologists.

Agreed. Once Northwell takes over from
NAPA and controls >50% of the NY metro market, pay will decrease substantially. Northwell has a reputation of giving favorable terms upfront, but then changing things for the worse once they own you.

 

[Dr. Rude]

Agreed. Once Northwell takes over from
NAPA and controls >50% of the NY metro market, pay will decrease substantially. Northwell has a reputation of giving favorable terms upfront, but then changing things for the worse once they own you.

So does every employer. First contract is always the best. (Absent a market change) Accept it.

 

[amyl]

In my experience, most take very few. However, if a family member has surgery or something of that nature, it’s nice to have them. I rarely take more than one or two days a year and it’s almost always because of the health need of an immediate family member. There are some places where it is the culture to treat them as vacation days. Notably, I’m speaking of the VA.

Geez - I’ve been an anesthesiologist for ten years and never called in sick once.

 

[Gern Blansten]

Geez - I’ve been an anesthesiologist for ten years and never called in sick once.

Same. I’ve called in sick like three times in a long career. But I have scheduled surgeries, colonoscopies, and taken a day off to care for a loved one who had surgery, for which we charge it to “sick time.”

 

[narcotics999]

I’m 55yo and done chasing money. In fact I’m cutting back. The COL wasn’t always ridiculously high. I was lucky enough to be in the SoCal real estate market since the late 1990s. Still own the first home we ever bought for $119k which is now a rental. Besides who would water my hydrangeas and walk my dog if I’m out of town doing locums? I have the life I want.

"water my hydrangeas"? I am going to report you to the state, lol. My place we are only allowed to water once a week.

 

[nimbus]

"water my hydrangeas"? I am going to report you to the state, lol. My place we are only allowed to water once a week.

I’m probably breaking the law but my car is real dirty.

 

[anbuitachi]

Geez - I’ve been an anesthesiologist for ten years and never called in sick once.

well you must be very healthy which is good. or you were sick and came into work anyway and risk infecting your coworkers. i hope its the first

 

[2Fast2Des]

Geez - I’ve been an anesthesiologist for ten years and never called in sick once.

If you're a corporate AMC lackey and there is plenty of staff to pick up slack, then there's no reason to not use sick leave. Your employer won't give 2 crap about all your dedication and sacrifice. Why do you think nurses play hookey all the time? They manage to make it work somehow

 

[Dr. Rude]

If you're a corporate AMC lackey and there is plenty of staff to pick up slack, then there's no reason to not use sick leave. Your employer won't give 2 crap about all your dedication and sacrifice. Why do you think nurses play hookey all the time? They manage to make it work somehow

The problem is that there often isn’t plenty of staff to pick up the slack. You are dumping on your overworked underpaid colleagues.

 

[OptionOffense]

. the crnas here make more than docs (but they do also work 12 hr shifts so they are guaranteed 12 hrs per day)

Why on earth would a CRNA pay be more than an MD? What world is this? If thats the case, there is nO need for CRNAs

 

[OptionOffense]

Am i missing something? Is northwell kicking NAPA out of NYC?

 

[2Fast2Des]

Why on earth would a CRNA pay be more than an MD? What world is this? If thats the case, there is nO need for CRNAs

We live in an upside down world...

 

[Zekchar]

The problem is that there often isn’t plenty of staff to pick up the slack. You are dumping on your overworked underpaid colleagues.

My work is exactly what my contract states is required of me for the precisely negotiated price. My free time for money. The company's failure to prepare and staff apropriately is not my emergency. All you dunces who are not using your sick leave are working those days for free. I dunno about you but I dont work for free. Thus I use all my alloted sick leave. Stop thinking like an owner and start thinking like the employee that you are.

You don't get a pat on the back for not taking sick leave. You get laughed at for providing free labor.

Obviously eat what you kill, small private practices, etc are different. This is for the W2 / AMC employee.

 

[Dr. Rude]

My work is exactly what my contract states is required of me for the precisely negotiated price. My free time for money. The company's failure to prepare and staff apropriately is not my emergency. All you dunces who are not using your sick leave are working those days for free. I dunno about you but I dont work for free. Thus I use all my alloted sick leave. Stop thinking like an owner and start thinking like the employee that you are.

You don't get a pat on the back for not taking sick leave. You get laughed at for providing free labor.

Obviously eat what you kill, small private practices, etc are different. This is for the W2 / AMC employee.

I understand your point of view. It is not without merit. However, the doc who now has to stay post call to start cases or the doc who was expecting an early day who now has to work a late day because you called in might have a different viewpoint.

 

[Twiggidy]

My work is exactly what my contract states is required of me for the precisely negotiated price. My free time for money. The company's failure to prepare and staff apropriately is not my emergency. All you dunces who are not using your sick leave are working those days for free. I dunno about you but I dont work for free. Thus I use all my alloted sick leave. Stop thinking like an owner and start thinking like the employee that you are.

You don't get a pat on the back for not taking sick leave. You get laughed at for providing free labor.

Obviously eat what you kill, small private practices, etc are different. This is for the W2 / AMC employee.

I agree with what Dr. Rude just posted. If you're not using paid sick time because you never got sick then you should either be reimbursed those days or it should bank over time. That's the way more normal companies do it, but we know medicine is far from normal

 

[anbuitachi]

I understand your point of view. It is not without merit. However, the doc who now has to stay post call to start cases or the doc who was expecting an early day who now has to work a late day because you called in might have a different viewpoint.

then that depends on the group. its the way it's set up. i read somewhere that literally said if you call out sick and the other employees hate you for it because you are making their day miserable bc of your sick out, then the employer did something wrong. obviously you can argue this but its not without reason.

 

[anbuitachi]

Why on earth would a CRNA pay be more than an MD? What world is this? If thats the case, there is nO need for CRNAs

it depends. in some scenario, if the difference isnt THAT large, it can still make sense.

for example, if we are a level 1 trauma hospital. having a few crna provide flexibility. where as having all MD only can create a problem, because if all the MD are in rooms, theres no one to give breaks, you give our own break/lunch. also if a trauma comes in, who is doing it? everyone is in room. who is covering the pacu? we do sick patients, and our PACU have patients waiting for ICU, post strokes/thrombectomies, etc.

so if its MD only, do you have 1 MD just sitting there waiting for traumas? do you have 1 person sitting there just for PACU? with crna we can cover a room, generate some revenue, while still cover PACU, and trauma if it hits by pulling a CRNA from another room. and it makes it safer by having more than 1 pair of hands for big cases. its impossible to manage sick patients, chart, MTP, with 1 anesthesiologist and no help

unfortunately, crnas getting more is just the supply vs demand right now. the crnas dont want to work for less than their rate, while for a lower rate we have MDs applying for the job.

 

[kidthor]

I understand your point of view. It is not without merit. However, the doc who now has to stay post call to start cases or the doc who was expecting an early day who now has to work a late day because you called in might have a different viewpoint.

Ah - but your employer can play you with that mindset. Often they'll use your professionalism and good will against you by suggesting the systems problems are actually created by you, the worker-bee. If the system they created allocates paid sick days as suggested and you don't use them then the system benefits at your expense.

Similarly the guy working a late day is also getting played unless they get paid overtime, which they probably don't.

I in large part agree with Dr. Rude that employees should think like employees. Be professional but don't let the system play you.

And as noted it's an entirely different ballgame when you're a partner/owner or slated to be one. Being a true partner is like owning the McDonald's franchise vs being a burner-flipper. As a burger-flipper I'm taking my sick days.

 

[kidthor]

it depends. in some scenario, if the difference isnt THAT large, it can still make sense.

for example, if we are a level 1 trauma hospital. having a few crna provide flexibility. where as having all MD only can create a problem, because if all the MD are in rooms, theres no one to give breaks, you give our own break/lunch. also if a trauma comes in, who is doing it? everyone is in room. who is covering the pacu? we do sick patients, and our PACU have patients waiting for ICU, post strokes/thrombectomies, etc.

so if its MD only, do you have 1 MD just sitting there waiting for traumas? do you have 1 person sitting there just for PACU? with crna we can cover a room, generate some revenue, while still cover PACU, and trauma if it hits by pulling a CRNA from another room. and it makes it safer by having more than 1 pair of hands for big cases. its impossible to manage sick patients, chart, MTP, with 1 anesthesiologist and no help

unfortunately, crnas getting more is just the supply vs demand right now. the crnas dont want to work for less than their rate, while for a lower rate we have MDs applying for the job.

That doesn't make any sense if, as you noted, the CRNAs are paid more than the physicians. Then in every scenario you suggested it would be cheaper to just have the MD sitting around. Having an MD sitting around is cheaper than having the CRNA sit around, provided the CRNAs are paid more.

 

[Status Sciaticus]

I understand your point of view. It is not without merit. However, the doc who now has to stay post call to start cases or the doc who was expecting an early day who now has to work a late day because you called in might have a different viewpoint.

But this would even out if everyone did this though right?

 

[vector2]

it depends. in some scenario, if the difference isnt THAT large, it can still make sense.

for example, if we are a level 1 trauma hospital. having a few crna provide flexibility. where as having all MD only can create a problem, because if all the MD are in rooms, theres no one to give breaks, you give our own break/lunch. also if a trauma comes in, who is doing it? everyone is in room. who is covering the pacu? we do sick patients, and our PACU have patients waiting for ICU, post strokes/thrombectomies, etc.

so if its MD only, do you have 1 MD just sitting there waiting for traumas? do you have 1 person sitting there just for PACU? with crna we can cover a room, generate some revenue, while still cover PACU, and trauma if it hits by pulling a CRNA from another room. and it makes it safer by having more than 1 pair of hands for big cases. its impossible to manage sick patients, chart, MTP, with 1 anesthesiologist and no help

unfortunately, crnas getting more is just the supply vs demand right now. the crnas dont want to work for less than their rate, while for a lower rate we have MDs applying for the job.

States designate hundreds of millions of taxpayer dollars to subsidize trauma care at their trauma centers. Your department can use some of that money to make sure there is an MD at the board, an MD on regional/PACU, and an MD holding the trauma pager. All of those people can help start a trauma. And if you need extra hands to spike blood and hand you stuff, the answer is anesthesia techs, not more CRNAs.

 

[GravelRider]

I understand your point of view. It is not without merit. However, the doc who now has to stay post call to start cases or the doc who was expecting an early day who now has to work a late day because you called in might have a different viewpoint.

Sounds like a problem with the employer to me. I honestly don’t want someone coming to work and coughing and spreading their Ebola around. Now that means I’ll likely get sick and more often than not it’ll be an inconvenient time for me. I’d rather work a few extra hours than be sick on my upcoming vacation because you were too chicken to call out.

If someone is inconvenienced more than a couple daylight hours because someone else called out then they should be compensated appropriately.

 

[nimbus]

That doesn't make any sense if, as you noted, the CRNAs are paid more than the physicians. Then in every scenario you suggested it would be cheaper to just have the MD sitting around. Having an MD sitting around is cheaper than having the CRNA sit around, provided the CRNAs are paid more.

If CRNAs are paid more than MDs, the cheapest way to staff is MD only assuming you can find enough MDs.