NAPA in trouble in NJ

[Mman]

Then let the pvt insurance company subpoena the charts in question. The hospital networks shouldn't devote an etnire office of disgruntled bedside nurses rifling through charts. this is so normalized that everyone on here thinks it is ok.

random chart/case reviews is essentially "standard of care" (so to say) at the hospital level when it comes to quality measures. This is like quality 101 stuff and is usually tied to something like recredentialing. If something bad happened in the future, they want a paper trail showing that there was continual assessments of your competence and that the hospital wasn't negligent in letting you practice without any periodic review.

We just randomly pull a certain number of charts for each doc and anesthetist each quarter and have various measures that we survey those charts for.

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[Status Sciaticus]

random chart/case reviews is essentially "standard of care" (so to say) at the hospital level when it comes to quality measures. This is like quality 101 stuff and is usually tied to something like recredentialing. If something bad happened in the future, they want a paper trail showing that there was continual assessments of your competence and that the hospital wasn't negligent in letting you practice without any periodic review.

We just randomly pull a certain number of charts for each doc and anesthetist each quarter and have various measures that we survey those charts for.

exactly this. How else will the group know who is properly documenting and staying up to date (pun intended) with current practices, maintaining standard of care, and not doing outdated things.

 

[Mman]

exactly this. How else will the group know who is properly documenting and staying up to date (pun intended) with current practices, maintaining standard of care, and not doing outdated things.

it unfortunately can also serve as a warning sign for narcotic diversion when you see average meds use for various types of cases

 

[OptionOffense]

random chart/case reviews is essentially "standard of care" (so to say) at the hospital level when it comes to quality measures. This is like quality 101 stuff and is usually tied to something like recredentialing. If something bad happened in the future, they want a paper trail showing that there was continual assessments of your competence and that the hospital wasn't negligent in letting you practice without any periodic review.

We just randomly pull a certain number of charts for each doc and anesthetist each quarter and have various measures that we survey those charts for.

Again, having a disgruntled nurse in an office cubicle rifling through random charts to their liking is not quality 101 it is stupidity 101. If someone qualified wants to come down every so often to watch me practice I am ALL FOR IT. I would even welcome someone come to the OR every day to watch me practice. But that endeavor is way too hard for them. They already have OPPE. THat is supposed to assess quality and that is supposed to be assessed every 6 months.

Anyway, this has become so normalized that it is indoctrinated even in the most experienced. We are doubling down on things that are *****ic. Of course, the tail wags the dog.

 

[nimbus]

Again, having a disgruntled nurse in an office cubicle rifling through random charts to their liking is not quality 101 it is stupidity 101. If someone qualified wants to come down every so often to watch me practice I am ALL FOR IT. I would even welcome someone come to the OR every day to watch me practice. But that endeavor is way too hard for them. They already have OPPE. THat is supposed to assess quality and that is supposed to be assessed every 6 months.

Anyway, this has become so normalized that it is indoctrinated even in the most experienced. We are doubling down on things that are *****ic. Of course, the tail wags the dog.

I click all the right boxes on ePreop and never have complications

 

[IMGASMD]

I click all the right boxes on ePreop and never have complications

Exactly what I do with my paper charts…..
Reviewed all the right stuff and absolutely uneventful PACU courses.

 

[Dr. Rude]

I click all the right boxes on ePreop and never have complications

our complication rate is zero as it is all self reported.

 

[Mman]

Again, having a disgruntled nurse in an office cubicle rifling through random charts to their liking is not quality 101 it is stupidity 101. If someone qualified wants to come down every so often to watch me practice I am ALL FOR IT. I would even welcome someone come to the OR every day to watch me practice. But that endeavor is way too hard for them. They already have OPPE. THat is supposed to assess quality and that is supposed to be assessed every 6 months.

Anyway, this has become so normalized that it is indoctrinated even in the most experienced. We are doubling down on things that are *****ic. Of course, the tail wags the dog.

why do you assume it is some random disgruntled nurse?

We have support staff (including some nurses) that pull the charts and collect the information for us and then an anesthesiologist reviews the case. The support staff still have to go into the chart to get the info but they are not the ones reviewing your actions/documentation. At least how we do it. It's far more efficient to use them to go through the chart to get me the info I need instead of me going through combing through it all.

 

[IMGASMD]

I was an IM resident then a hospitalist. You think our documentation is scrutinized? I had “documentation specialists” on my ass constantly as an intern. Part of the dumb evaluation later on is EMR utilization rate, which is somehow used as how often you put in “orders”.

Now they keep track even more, our department gets an aggregated report of some sort to our chair, then we can get a talked to. It’s all there now, in the big data storage sky interweb. Those who are trained within the last 10 years just don’t know that with EMR it comes with convenience, but also a lot of data people can use to against you. Most people don’t recognize anymore that the medical records originally were used for billing, and notes for self and the next physician. It’s just something to show that I did something therefore I deserve to be paid for my time and service.

That being said, our “real” QA is done by fellow anesthesiologists; however, any deficiencies still go to our “hospital file.” I am super excited whenever I can use a paper chart and watch all the nurses freak out during Cerner/Epic downtime, just to stick it to the man.

 

[OptionOffense]

why do you assume it is some random disgruntled nurse?

We have support staff (including some nurses) that pull the charts and collect the information for us and then an anesthesiologist reviews the case. The support staff still have to go into the chart to get the info but they are not the ones reviewing your actions/documentation. At least how we do it. It's far more efficient to use them to go through the chart to get me the info I need instead of me going through combing through it all.

As long as we are getting to the bottom of quality. The point is, nobody should be going through the chart for ANY god damn reasonIt should be a felony. Who else would do a dumb job as such but a disgruntled "whomever" and it is usually a nurse. And usually the people who champion Quality, aren't quality themselves

 

[IMGASMD]

As long as we are getting to the bottom of quality. The point is, nobody should be going through the chart for ANY god damn reasonIt should be a felony. Who else would do a dumb job as such but a disgruntled "whomever" and it is usually a nurse. And usually the people who champion Quality, aren't quality themselves

You know that. I know that. But it’s just all for show. You cannot really discern quality with self reported data. Most of “their” “matrix” aren’t really measuring what they think they’re measuring. Just more time consuming BS.

 

[Mman]

As long as we are getting to the bottom of quality. The point is, nobody should be going through the chart for ANY god damn reasonIt should be a felony. Who else would do a dumb job as such but a disgruntled "whomever" and it is usually a nurse. And usually the people who champion Quality, aren't quality themselves

I'm just going to go ahead and disagree with you.

I literally cannot even imagine a method to track quality at the hospital level that does not involve going through charts. I mean how would you even begin to track things like central line infections or postop wound infections or measures for time from decision to action for things that have demonstrable benefit.

If you don't go through the chart to verify things, you literally let the dumbest of the dumb provide terrible care with no monitoring or ability to help improve what they are doing.


We either monitor ourselves or we let outsiders come in and monitor us instead and they would do an infinitely worse job.

 

[dannyboy1]

I'm just going to go ahead and disagree with you.

I literally cannot even imagine a method to track quality at the hospital level that does not involve going through charts. I mean how would you even begin to track things like central line infections or postop wound infections or measures for time from decision to action for things that have demonstrable benefit.

If you don't go through the chart to verify things, you literally let the dumbest of the dumb provide terrible care with no monitoring or ability to help improve what they are doing.


We either monitor ourselves or we let outsiders come in and monitor us instead and they would do an infinitely worse job.

most anesthesia charts are pure fairy tales. Nobody knows what goes on behind the drapes and everyone checks the correct “boxes”. So long as the patient wakes up and the surgeon is happy nobody knows nothing.

 

[Status Sciaticus]

most anesthesia charts are pure fairy tales. Nobody knows what goes on behind the drapes and everyone checks the correct “boxes”. So long as the patient wakes up and the surgeon is happy nobody knows nothing.

I wouldnt say that the automated data pulled into intraop vitals/monitoring is fairy tales. If something goes down, there is a trail based on the vital signs that is continuously collected to tell the story.

 

[dannyboy1]

I wouldnt say that the automated data pulled into intraop vitals/monitoring is fairy tales. If something goes down, there is a trail based on the vital signs that is continuously collected to tell the story.

Still on paper charts here

 

[Mman]

most anesthesia charts are pure fairy tales. Nobody knows what goes on behind the drapes and everyone checks the correct “boxes”. So long as the patient wakes up and the surgeon is happy nobody knows nothing.

the intraop record is merely a portion of what gets reviewed. For example, what is your personal PONV rate for various types of surgery compared to your colleagues and what premeds are you using compared to them? What is the infection rate in CVPs that you place?

 

[aneftp]

Ha ha. Love how this thread has gotten so off track about charting and audits. So back to the topic. Is Napa really in trouble overall? Not just New Jersey. Napa is basically a huge version of somonia.

Not saying this is true across all AMCs. As each facility is run differently depending if original partners who sold out still maintain control. Or AMCs just appoint some local medical director and let them manage things. And some of those local medical directors real objective is to try to do as little work as possible themselves.

My experience and I only speak for myself with knowledge of friends who have actually worked for these amc is that Napa and somonia are truly the worst of the worst. NorthStar is very close to as bad as well Again that varies. My friend got a buyout from north start. He even showed me their check. Nice little seven digit figure so NorthStar leaves his practice alone for now.

 

[pro-propofol]

With USAP the 50% stock has turned out to be worthless, they are giving it away free!
The employed physicians haven’t had a raise in 6 yrs and when that goes up it will eat into partners profits.

 

[IMGASMD]

With USAP the 50% stock has turned out to be worthless, they are giving it away free!
The employed physicians haven’t had a raise in 6 yrs and when that goes up it will eat into partners profits.

There are some members here who are happy with usap. I haven’t seen anyone “happy” with other AMCs.
Sometimes it’s the devil you know vs the devil you don’t. But they all are the same. There’s only so much money in anesthesia, I am not sure how to extract more with less is possible.
All that being said, was discussing AMCs or any kind of management company with a pretty smart guy.

I said I don’t understand why VC would put any money in AMCs. He said, it’s a very stable business. They can almost count on how much they can get by end of the year. Whether that’s 10% or 5% of their investment, they can count on steady income. Which makes a lot of sense to me.

 

[dannyboy1]

There are some members here who are happy with usap. I haven’t seen anyone “happy” with other AMCs.
Sometimes it’s the devil you know vs the devil you don’t. But they all are the same. There’s only so much money in anesthesia, I am not sure how to extract more with less is possible.
All that being said, was discussing AMCs or any kind of management company with a pretty smart guy.

I said I don’t understand why VC would put any money in AMCs. He said, it’s a very stable business. They can almost count on how much they can get by end of the year. Whether that’s 10% or 5% of their investment, they can count on steady income. Which makes a lot of sense to me.

Not these days. New generation of docs have wised up. Most will insist on an hourly rate or just work locums. The AMC’s made money when the young guys signed on for what looked like a nice salary but ended up being worked to the bone. No more…

 

[IMGASMD]

Not these days. New generation of docs have wised up. Most will insist on an hourly rate or just work locums. The AMC’s made money when the young guys signed on for what looked like a nice salary but ended up being worked to the bone. No more…

Just who will call the other side’s bluff first.

 

[Dr. Rude]

Just who will call the other side’s bluff first.

Neither is bluffing. Except on a local group or individual level.

The market is currently favoring the doc. Especially those who are flexible and mobile. There have been periods when the individual doc had to eat ****. No matter who was serving it- exploitive senior docs, AMC employer, Hospital Employer, Academic employer.

The market can change rather quickly. Best advice is to keep your skills current. Don't fall in love with a location.

 

[Status Sciaticus]

Still on paper charts here

Dang you must have a lot of train track cases

Just who will call the other side’s bluff first.

Based on the locums of 400/hr being offered, I think we can tell which way the tide is turning.

 

[aneftp]

There are some members here who are happy with usap. I haven’t seen anyone “happy” with other AMCs.
Sometimes it’s the devil you know vs the devil you don’t. But they all are the same. There’s only so much money in anesthesia, I am not sure how to extract more with less is possible.
All that being said, was discussing AMCs or any kind of management company with a pretty smart guy.

I said I don’t understand why VC would put any money in AMCs. He said, it’s a very stable business. They can almost count on how much they can get by end of the year. Whether that’s 10% or 5% of their investment, they can count on steady income. Which makes a lot of sense to me.

Venture capital is all leverage debt. Remember thjs are borrowIng a lot of money that is due. Just google envision debt restructure.

It’s like a home mortgage arm loan that is interest free for 3 years. It’s all shifting money.

If I purchased a home for 1 million with 5% down. 50k. Borrowed 2% interest rate and only paid interest. Home value goes up to 1.4 million in 2 years. Which is 20% gain. My initial 50k investment nets me 400k gain. 350k net gain. You rent the house in the meantime. Maybe make. A little profit or break even in the 2-3 years u own it and lease it out.

The issue is the debt bond is due as a balloon payment. It’s a game of chess. The goal is not to run anesthesia. Very little profit after expenses. Kkr cAnnot afford to be making 10-20% profit when a balloon payment is due. It will completely wipe out any profit and potentially put them in the negative net gain.

the 9 billion dollar envision original deal. They just pushed the bond debt back a couple of months ago. They will need to actual pay it or sell it. It’s certainly not worth 9 billion anymore. But like home owners scammers during 2008-2015. Like my friends who didn’t pay the mortgage for 5-6 years and collected rent. That’s exactly what Envison is doing. Collecting rent and just paying the bare minimum HOA dues to keep
The game going. But not paying into the principal. They are making money. Only because the bond debt is not being paid.

 

[aneftp]

Not these days. New generation of docs have wised up. Most will insist on an hourly rate or just work locums. The AMC’s made money when the young guys signed on for what looked like a nice salary but ended up being worked to the bone. No more…

I find new generation of docs just don’t want to do a lot of calls. Those are the ones with no debt. They are all happy making 400k with no calls or very little calls . No weekends. And 10 weeks off. But they also don’t want to work hard for that.

The ones who owe a lot of money will want to work like dogs. They really do. But they want 500k plus starting out. They won’t settle for partnership track for 350-400k/6 weeks off working like dogs while the partners make 600k/12 weeks off and up for the next 3 years. Most will take the 500k/10 weeks off immediately. Take the cash grab. They live for today. Not 3 years in the future.

 

[Status Sciaticus]

I find new generation of docs just don’t want to do a lot of calls. Those are the ones with no debt. They are all happy making 400k with no calls or very little calls . No weekends. And 10 weeks off. But they also don’t want to work hard for that.

The ones who owe a lot of money will want to work like dogs. They really do. But they want 500k plus starting out. They won’t settle for partnership track for 350-400k/6 weeks off working like dogs while the partners make 600k/12 weeks off and up for the next 3 years. Most will take the 500k/10 weeks off immediately. Take the cash grab. They live for today. Not 3 years in the future.

Maybe they want to work a regular job, and not be defined by it. I find that the prior generation's identity was largely defined by their work. They lived to work. The current generation works to live, and have other interests. Medicine isn't a calling, its a profession. No need to ruin your health, interpersonal relationships, and wellbeing to get underpaid and overworked, even if it is for 3 years.

Also, 350K pre-pandemic is close to 425-450k now when you account for inflation. Getting paid the same in dollar amount is actually getting paid less in purchasing power. New generation isn't stupid

 

[aneftp]

Maybe they want to work a regular job, and not be defined by it. I find that the prior generation's identity was largely defined by their work. They lived to work. The current generation works to live, and have other interests. Medicine isn't a calling, its a profession. No need to ruin your health, interpersonal relationships, and wellbeing to get underpaid and overworked, even if it is for 3 years.

Also, 350K pre-pandemic is close to 425-450k now when you account for inflation. Getting paid the same in dollar amount is actually getting paid less in purchasing power. New generation isn't stupid

The current gen isn’t exactly healthy that I know. Vap (legally). Party. Excessive alcohol. To each their own. They are welcome to live whatever life they want.

Even the residency 80’hour work week. Numerous studies have shown residents aren’t sleeping more. They are just going out more during their residency.

 

[Status Sciaticus]

The current gen isn’t exactly healthy that I know. Vap (legally). Party. Excessive alcohol. To each their own. They are welcome to live whatever life they want.

Even the residency 80’hour work week. Numerous studies have shown residents aren’t sleeping more. They are just going out more during their residency.

I'm not saying that the current generation is making healthy life decisions, but the decisions are theirs. Whereas by working 80+ hours/week and being gaslighted into thinking that this workload is normal was previously out of their control. Theres numerous studies showing the deleterious effects of shift work on physicians including reduced life expectancy.

To your second point, it doesnt matter what residents are doing with their free time. what matters is that they have free time to distribute as they wish. If they want to party and go out, thats their decision, not someone else making it for them.

Some places avoid this entire issue by incorporating a night float team. Physicians avoid this by reducing their calls or taking non-call jobs.

 

[aneftp]

I'm not saying that the current generation is making healthy life decisions, but the decisions are theirs. Whereas by working 80+ hours/week and being gaslighted into thinking that this workload is normal was previously out of their control. Theres numerous studies showing the deleterious effects of shift work on physicians including reduced life expectancy.

To your second point, it doesnt matter what residents are doing with their free time. what matters is that they have free time to distribute as they wish. If they want to party and go out, thats their decision, not someone else making it for them.

Some places avoid this entire issue by incorporating a night float team. Physicians avoid this by reducing their calls or taking non-call jobs.

The real issue is 30-40% of young(er) people on these boards live in fantasy land. And yes. I do have outside discussions on private message on these boards. I have taken strictly outpatient/non call/beeper call/trauma call at various times during my career. Each has its plus and minus. There is no perfect job. Or that perfect job may exist but it’s fleeting. Meaning it’s not longer than 1-2 years.

I see it as it is. People can get mad at napa. Or envision. But I can tell you outside a very few select great payor mix (they do exist but those are in the minority). The average payor mix combined between Medicare/Medicaid/commercial if you are lucky is $50 a unit. Most small private practice average lower than that. Especially out west or in the northwest. Most new grads don’t get it. Eyeballs pays $75/case at most. You would need to do 32 eyeballs if you want to pay someone $300/hr since majority of eyeballs are Medicare. It’s simple math.

My two family members do fee for service billing. It’s rough. No subsidy. Sure it’s great to be your own boss. But also major disadvantages. The ob calls can suck. The payor mix can suck.

 

[dannyboy1]

Venture capital is all leverage debt. Remember thjs are borrowIng a lot of money that is due. Just google envision debt restructure.

It’s like a home mortgage arm loan that is interest free for 3 years. It’s all shifting money.

If I purchased a home for 1 million with 5% down. 50k. Borrowed 2% interest rate and only paid interest. Home value goes up to 1.4 million in 2 years. Which is 20% gain. My initial 50k investment nets me 400k gain. 350k net gain. You rent the house in the meantime. Maybe make. A little profit or break even in the 2-3 years u own it and lease it out.

The issue is the debt bond is due as a balloon payment. It’s a game of chess. The goal is not to run anesthesia. Very little profit after expenses. Kkr cAnnot afford to be making 10-20% profit when a balloon payment is due. It will completely wipe out any profit and potentially put them in the negative net gain.

the 9 billion dollar envision original deal. They just pushed the bond debt back a couple of months ago. They will need to actual pay it or sell it. It’s certainly not worth 9 billion anymore. But like home owners scammers during 2008-2015. Like my friends who didn’t pay the mortgage for 5-6 years and collected rent. That’s exactly what Envison is doing. Collecting rent and just paying the bare minimum HOA dues to keep
The game going. But not paying into the principal. They are making money. Only because the bond debt is not being paid.

So they are borrowing a lot of money they can’t possibly pay back, but I’m n the meantime they will pay me with that $$, then declare bankruptcy at some point in the future when the debt comes due. Sounds fine to me….

 

[Status Sciaticus]

The real issue is 30-40% of young(er) people on these boards live in fantasy land. And yes. I do have outside discussions on private message on these boards. I have taken strictly outpatient/non call/beeper call/trauma call at various times during my career. Each has its plus and minus. There is no perfect job. Or that perfect job may exist but it’s fleeting. Meaning it’s not longer than 1-2 years.

I see it as it is. People can get mad at napa. Or envision. But I can tell you outside a very few select great payor mix (they do exist but those are in the minority). The average payor mix combined between Medicare/Medicaid/commercial if you are lucky is $50 a unit. Most small private practice average lower than that. Especially out west or in the northwest. Most new grads don’t get it. Eyeballs pays $75/case at most. You would need to do 32 eyeballs if you want to pay someone $300/hr since majority of eyeballs are Medicare. It’s simple math.

My two family members do fee for service billing. It’s rough. No subsidy. Sure it’s great to be your own boss. But also major disadvantages. The ob calls can suck. The payor mix can suck.

I dont think its the younger people on these boards that live on fantasy land....
Good luck doing surgeries without anesthesia.
By your logic, EM docs should be paying the hospital money since the ED is "a loss leader"
Simple math is you pay me X amount for X case. I dont care what you get in billing for anesthesia services. Cut me a piece of that facility fee or that site of service differential.

So they are borrowing a lot of money they can’t possibly pay back, but I’m n the meantime they will pay me with that $$, then declare bankruptcy at some point in the future when the debt comes due. Sounds fine to me….

 

[aneftp]

You all keep talking about payor mix as if it should be taken as the limit for our income. The sooner we get away from the “anesthesia billing” mindset and get into the subsidy business, the better off this profession will be, full stop.

Locums rates are what our value is. Less than that rate, and your hospital is stealing your money, regardless of what your payor mix is for the area.

If USAP disappeared tomorrow do you think hospitals could just pay MDs 300k since they can’t “bill enough?” It literally doesn’t happen, and I know guys who make 750 because they live in smaller places with huge demand. They don’t bill 750 in any universe I guarantee you that.

There has always been money made in rural or semi undesirable places. My buddy made 820k in his last big year in California. And it was with a hospital subsidy. But more than 60 minutes from the major metro area. So he had to maintain two homes.

Same with upper Midwest. We all
Know the big cities in the upper Midwest. Guy made 720k min for the last 20’plus years. Would I ever want to live there? No. Small city. More than 60’plus minutes from the suburbs of a major city. And the out surburbs takes
Another 45 min to get to the city center.

 

[aneftp]

I dont think its the younger people on these boards that live on fantasy land....
Good luck doing surgeries without anesthesia.
By your logic, EM docs should be paying the hospital money since the ED is "a loss leader"
Simple math is you pay me X amount for X case. I dont care what you get in billing for anesthesia services. Cut me a piece of that facility fee or that site of service differential.

EM is a huge money maker for most major hospital systems. Why do you think they are expanding and setting up stand alone ERs everywhere. Not sure what you are smoking. You are thinking Trauma with uninsured patients. Or ghetto ERs with indigent patients. But The vast majority of patients in ER have insurance.

 

[GravelRider]

I’m waiting for someone to say millennials…

 

[Status Sciaticus]

EM is a huge money maker for most major hospital systems. Why do you think they are expanding and setting up stand alone ERs everywhere. Not sure what you are smoking. You are thinking Trauma with uninsured patients. Or ghetto ERs with indigent patients. But The vast majority of patients in ER have insurance.

LMAOOOOO, you havent answered any of the points I brought up, and basically generalized all the new generation of anesthesiologists as partying, alcoholic, vap-ers. Then proceeded to gaslight people by saying getting paid $75 bucks for a cataract makes mathematical sense. Not sure what boomer arithmetic you are using there.

But yeah, its the new anesthesiologists who are delusional. Also I'm not smoking anything. Smoking is bad for you, m'kay?

 

[Arch Guillotti]

Why do you think they are expanding and setting up stand alone ERs everywhere.

I thought free standing ER's were on the way out?

 

[aneftp]

I thought free standing ER's were on the way out?

I thought free standing ER's were on the way out?

Depends on states. In florida they are a dime a dozen. And still opening more. It’s really almost a Trojan horse in some instances to build new hospitals eventually.

The urgent cares are obviously a dime a dozen as well. Now blue cross is got their wholly own side gig surgery centers as well as their own urgent care centers.

 

[nimbus]

I’m waiting for someone to say millennials…

Damn millennials. Now get off my lawn!!

 

[Mman]

You all keep talking about payor mix as if it should be taken as the limit for our income. The sooner we get away from the “anesthesia billing” mindset and get into the subsidy business, the better off this profession will be, full stop.

Locums rates are what our value is.

it would be difficult to be more incorrect.

Locums rates are not what you are worth because by their very nature they are short term stop gap solutions that cannot be afforded to continue long term. The hospital is admitting they cannot afford to pay this rate, but they will suck it up for little bit until they get permanent staffing.

 

[aneftp]

LMAOOOOO, you havent answered any of the points I brought up, and basically generalized all the new generation of anesthesiologists as partying, alcoholic, vap-ers. Then proceeded to gaslight people by saying getting paid $75 bucks for a cataract makes mathematical sense. Not sure what boomer arithmetic you are using there.

But yeah, its the new anesthesiologists who are delusional. Also I'm not smoking anything. Smoking is bad for you, m'kay?

Go work in BFE. There is money to be made doing locums. Upper Midwest. $350 x guarantee 60 hours a week. Guarantee 4 months with option to continue That’s where a friend is mine is at now. His kids are grown. He’s making one final push.

What I’m generalizing is the new gen of docs feel entitled. It the simple truth.

The Texarkana job exists…do you feel that hospital is just waiting for a sap to take the job for a year then cut that persons pay in half to what they can “afford?” Tons of hospitals in California pay extremely well for anesthesia services to make up for the additional taxes their employees have to pay, all with alleged unit values in the 30s.

If you had to put it down as a single number, what do you feel is a fair market rate per hour for general/cardiac/pediatric anesthesia services over the course of a year’s work? I’d say 250-300 per hour for general, 325+ for anything specialty.

Hospitals are notorious for poor mouthing their more gullible employees. The “non profit” organization will come up with billions of dollars to build a new tower or vip wing, to balance their books to maintain their “non profit” status. Then they say “sorry guys no money” to all the doctors there.

I think newer generations just see healthcare spending increasing exponentially and realize that someone is getting rich, and it ain’t us. That money is going somewhere, and most of the time it’s the hospital coffers or executive pay. Demand your share, don’t let them off the hook.

right now the door is wide open. Make as much as you can. The market goes in cycles.

Many of you have not lived through 1994-1997 job market years.

Than it began slowly opening up in the late 1990s. The super AMCs started to form in the late 2000/ early 2010s. Causing pay to stagnate between 2010-2017 in many parts of the country.

It’s been a great time to be locums the last 3-4 years. $250/hr is the bare minimum anyone should take these days. $300/hr is average. $350/hr plus when hospitals are desperate.

One can easily pull 60k a month working 50 hours a week locums (That’s around 20-22 business working days). Many can make more if they work more. But you gotta plan ahead. Always be on step ahead.

 

[Mman]

The Texarkana job exists…do you feel that hospital is just waiting for a sap to take the job for a year then cut that persons pay in half to what they can “afford?” Tons of hospitals in California pay extremely well for anesthesia services to make up for the additional taxes their employees have to pay, all with alleged unit values in the 30s.

If you had to put it down as a single number, what do you feel is a fair market rate per hour for general/cardiac/pediatric anesthesia services over the course of a year’s work? I’d say 250-300 per hour for general, 325+ for anything specialty.

fair market rate? The market is extremely varied. What you can get in BFE doing locums is quite different than what the market rate is in a desirable location. I mean that's how markets work.

But yes, locums are by definition not sustainable for a location. All the hospitals that had to pay crazy amounts for locum nurses the last couple years are finding out just how unsustainable it is.

I agree people should get what they can get, just don't get offended when a hospital can find someone to do the same work cheaper than you want to do it.

 

[Gasmd98]

The real issue is 30-40% of young(er) people on these boards live in fantasy land. And yes. I do have outside discussions on private message on these boards. I have taken strictly outpatient/non call/beeper call/trauma call at various times during my career. Each has its plus and minus. There is no perfect job. Or that perfect job may exist but it’s fleeting. Meaning it’s not longer than 1-2 years.

I see it as it is. People can get mad at napa. Or envision. But I can tell you outside a very few select great payor mix (they do exist but those are in the minority). The average payor mix combined between Medicare/Medicaid/commercial if you are lucky is $50 a unit. Most small private practice average lower than that. Especially out west or in the northwest. Most new grads don’t get it. Eyeballs pays $75/case at most. You would need to do 32 eyeballs if you want to pay someone $300/hr since majority of eyeballs are Medicare. It’s simple math.

My two family members do fee for service billing. It’s rough. No subsidy. Sure it’s great to be your own boss. But also major disadvantages. The ob calls can suck. The payor mix can suck.

Agree 100%. I am amazed when I talk with younger docs starting out. They seem to think that they can clear lots of easy cash, live in a great area and have tremendous work/life balance. When I started out in the 90s it was possible to swing a dead cat and hit an anesthesiologist making oodles of money. But you still had to put in the hours unless you were running a stable of SRNAs and doing some questionable billing. Times have changed. Yes, we are in a shortage situation and anesthesiologists have the upper hand, especially if geography isn’t a major factor. Hospitals are still forced to pay big stipends. This will not last forever. My unsolicited advice is to make hay while the sun is shining and bank as much as you can. There is no law that says anesthesiologists must make $200K more than pediatricians.

 

[GravelRider]

Go work in BFE. There is money to be made doing locums. Upper Midwest. $350 x guarantee 60 hours a week. Guarantee 4 months with option to continue That’s where a friend is mine is at now. His kids are grown. He’s making one final push.

What I’m generalizing is the new gen of docs feel entitled. It the simple truth.

right now the door is wide open. Make as much as you can. The market goes in cycles.

Many of you have not lived through 1994-1997 job market years.

Than it began slowly opening up in the late 1990s. The super AMCs started to form in the late 2000/ early 2010s. Causing pay to stagnate between 2010-2017 in many parts of the country.

It’s been a great time to be locums the last 3-4 years. $250/hr is the bare minimum anyone should take these days. $300/hr is average. $350/hr plus when hospitals are desperate.

One can easily pull 60k a month working 50 hours a week locums (That’s around 20-22 business working days). Many can make more if they work more. But you gotta plan ahead. Always be on step ahead.

Entitled to what? Getting paid for time and skill? Did you miss the “what the old timers made” thread? I would hardly say that new docs are entitled. That mindset doesn’t even make sense.

 

[Status Sciaticus]

If that were true, then hospitals that chronically need locums coverage would cease to exist. Make no mistake, every hospital can afford these rates, they can just get people to work for less than they can demand because their kids go to school in the area and they’re chained to a house or extended family.

They’ll just take the money they could have paid you and buy a new ICU tower in the hottest part of town. Happens in every big city I’ve lived in.

Supply and demand is all that matters for us as a profession. What I’m contending is that billing values are irrelevant except in the extremely lucrative practices where you can exceed what you could otherwise demand as a locums in a desperate hospital. They’re rare, but they exist.

If your unit value goes down as a practice, then you need to get a subsidy or cut services. Unit values fluctuate constantly, so they’re hardly a model for “security.” There’s no reason to just accept lower pay outright in that situation (unless your kids are in school, of course)

Funny how people forget about those hospitals that always have locums. Where's that money coming from pray tell? Anyone take a look at BWHs new 2.1 BILLION dollar tower that they're planning on putting up? Guess they must be paying their docs $75 for eyeballs to be able to afford that

Entitled to what? Getting paid for time and skill? Did you miss the “what the old timers made” thread? I would hardly say that new docs are entitled. That mindset doesn’t even make sense.

Its the good ol' boomer "holier than thou" attitude of moral superiority. They just think they are better than the current generation because they used to work for less for during a period of oversupply... I'm surprised he/she didnt say verbatim "back in my day...."

 

[pgg]

s/he or it shouldnt be looking through your charts. It is a hippa violation

Come on, peer review and QI is explicitly excluded. You know this.

Billing personnel are also explicitly excluded. And of course 100% they'll tattle on serial chart-****ters to the clinical leadership, as they should.

 

[Hoya11]

Funny how people forget about those hospitals that always have locums. Where's that money coming from pray tell? Anyone take a look at BWHs new 2.1 BILLION dollar tower that they're planning on putting up? Guess they must be paying their docs $75 for eyeballs to be able to afford that



Its the good ol' boomer "holier than thou" attitude of moral superiority. They just think they are better than the current generation because they used to work for less for during a period of oversupply... I'm surprised he/she didnt say verbatim "back in my day...."

i dont know where this 75 dollars per cataract comes in

in my group we get 300 (start up units and time units), with a largely medicare population (~50%), this is legit data from our actual billing company in the real world.

say you do 35 cases per day - which we do. 2 CRNAs and a doc. do the math..

its easy to discount anesthesia billing as value when you dont understand how a real succcessful and fair group runs

there are guys out there (myslef included) with some sweet situations (way better than travelling around doing locums) due to the ability to bill for our own services. but i do understand your points.. the opportunity has to be right and the doc has to be able to recognize it

 

[Status Sciaticus]

i dont know where this 75 dollars per cataract comes in

in my group we get 300 (start up units and time units), with a largely medicare population (~50%), this is legit data from our actual billing company in the real world.

say you do 35 cases per day - which we do. 2 CRNAs and a doc. do the math..

its easy to discount anesthesia billing as value when you dont understand how a real succcessful and fair group runs

there are guys out there (and on this board) making >700k and home by dinner every night with no call while you guys go on about "beating the system" travelling around the country doing locums. these are the guys who did the partnership track and succeeded to vet it and attain partnership successfully..

yes there are scams, but there is also opportunity by doing your own billing if you know what you are doing

It comes from the other poster above telling new grads that we should expect $75 for eyeball cases. Typical gaslighting to justify underpaying people.

 

[nimbus]

i dont know where this 75 dollars per cataract comes in

in my group we get 300 (start up units and time units), with a largely medicare population (~50%), this is legit data from our actual billing company in the real world.

say you do 35 cases per day - which we do. 2 CRNAs and a doc. do the math..

its easy to discount anesthesia billing as value when you dont understand how a real succcessful and fair group runs

there are guys out there (myslef included) with some sweet situations (way better than travelling around doing locums) due to the ability to bill for our own services. but i do understand your points.. the opportunity has to be right and the doc has to be able to recognize it

Medicare cataract. 4 base units+2 time units at $21-22/unit ends up being about $120/case. Maybe you have commercial insurance cases mixed in. We pool our units so Medicare cataract work is subsidized by other cases. But Medicare cataracts are bad for the bottom line and a drag on our unit value. We recently left an eye surgery center because of that.

 

[Hoya11]

Medicare cataract. 4 base units+2 time units at $21-22/unit ends up being about $120/case. Maybe you have commercial insurance cases mixed in. We pool our units so Medicare cataract work is subsidized by other cases. But Medicare cataracts are bad for the bottom line and a drag on our unit value. We recently left an eye surgery center because of that.

Agree and yes we have about 50 percent government and the rest commercial . Our average is 300

 

[aneftp]

Entitled to what? Getting paid for time and skill? Did you miss the “what the old timers made” thread? I would hardly say that new docs are entitled. That mindset doesn’t even make sense.

No. Entitled means not understanding market conditions. Location, practice etc. all these complaints about amc’s. They are not one glove fits all. I’m not defending them. Some are really bad. But some are more locally run and better.

And yes. I’ve had tons of discussions with newer gen docs ranging in age from 31-38. So some fresh out and some 5-7 years out. It’s just a different generation. All work in various practices from academics to private track partnership to amcs.