The “hourly MD employee” models especially in house calls

[aneftp]

Had a good frank discussion yesterday with one of the locums docs. They are correct in this thinking

Crna’s have been way ahead of the game with the “hourly model”

Most only work 2-3 days a week at busy hospitals. It makes so much sense. They can pickup extra when WHEN. THEY WANT to. On THEIR OWN TIME. When they choose to.

As soon as docs get into this line of thinking. Hospital administrators will be F’d.

It’s really the call coverage that w2 docs get screwed on. We all know that.

Think about this. The average CRNA 40 hour (1.75 days (one 24 and one 16 hour) is 220k plus full benefits. Plus 9 weeks off. Plus Paid state holidays. (Basically another 2 weeks off).

Some work 16 hours Fridays/24 hour Sunday’s.
Frees up their entire week to work elsewhere or just chill somewhere. Or vacay without even using any vacation days.

Crna’s aren’t cheap either.

It’s the number of days worked that matters most. The 8-10 hour daytime slot is getting harder and harder for most people to work 5 days a week or even 4 days a week. People want time off.

I work mainly daytime. But I’m done at 12pm a lot.

I couldn’t do 7-3 5 days a week.

---

Members don't see this ad.

 

[GassYous]

Even before rates went through the roof I knew a CRNA in residency who worked 2 days with us and 3 days somewhere else and made more than our attendings.

 

[Anesthesia_Guy]

Even before rates went through the roof I knew a CRNA in residency who worked 2 days with us and 3 days somewhere else and made more than our attendings.

A lot do. We're the re_tards who accept BS rates/hours/working conditions. Well, at least I used to. These days homie don't play dat!

 

[2Fast2Des]

The MD mantra is that we're the gold standard and need to feel the pain to let everyone know what we bring to the table. F that noise! You think the C Suite gives a damn? They're laughing all the way to the bank, at HOME while you sleep in your dinky little call room and waking up in the middle of the night for the epidural or emergency case. The boomer docs that are the leadership in most groups need to accept that mentality and offer their docs and future hires the option to work hourly, and see that the hospital pays for that

 

[Simba1711]

In my residency , the crnas would do 24 hour call with us. We would do all the work which included all the ob stuff while they slept. Then they would work somewhere else for the other 16 hours for their 40 hour week.

 

[Dantrolene FC]

In my residency , the crnas would do 24 hour call with us. We would do all the work which included all the ob stuff while they slept. Then they would work somewhere else for the other 16 hours for their 40 hour week.

Same thing happens where I’m at.

 

[aneftp]

In my residency , the crnas would do 24 hour call with us. We would do all the work which included all the ob stuff while they slept. Then they would work somewhere else for the other 16 hours for their 40 hour week.

It’s the flexibility working 2-3 days a week affords crna’s. It’s their decision whether to pickup shifts for extra pay or not

As long as MDs are willing do W2 with calls and settle for “short days/pre call/post call days off”. It’s only gonna to help staffing for whoever controls the anesthesia contract.

They need bodies there 5 days a week day time especially. The vast majority of crna’s do not work 5 days a week. At my place. Only 2 crna’s work 8 hours 5 days a week regularly. Shockingly. It’s 2 guys. The women hustle. They work 2-3 days a week. Than to work at surgery centers elsewhere on their off days.

The whole hourly pay for full time docs will completely destabilize all staffing models administration wants. It will be highly cost prohibitive. Most people once they show up for work. It doesn’t matter if you work 4/8/12/16/24 hours.

 

[nimbus]

It’s the flexibility working 2-3 days a week affords crna’s. It’s their decision whether to pickup shifts for extra pay or not

As long as MDs are willing do W2 with calls and settle for “short days/pre call/post call days off”. It’s only gonna to help staffing for whoever controls the anesthesia contract.

They need bodies there 5 days a week day time especially. The vast majority of crna’s do not work 5 days a week. At my place. Only 2 crna’s work 8 hours 5 days a week regularly. Shockingly. It’s 2 guys. The women hustle. They work 2-3 days a week. Than to work at surgery centers elsewhere on their off days.

The whole hourly pay for full time docs will completely destabilize all staffing models administration wants. It will be highly cost prohibitive. Most people once they show up for work. It doesn’t matter if you work 4/8/12/16/24 hours.

At that point, administration will actually care about turnover time.

 

[aneftp]

At that point, administration will actually care about turnover time.

Numerous studies have shown in hospital based environment “efficient “ turnover does not generate any more revenue.

It’s very simple. The average turnover at most inpatient hospitals is 27 min. Even if you shorted the turnover to 15 minutes. The max you will save is 12 minutes

Say average is 3 cases per 8 hours OR block time. That’s 36 min saved. Can’t run another case

Even if it’s 4 cases in the same room. That’s still only 48 minutes saved. Still not enough to run another case.

You speed up turnover time. If you use the same staff. They will feel too pressured and don’t want to make mistakes with counts supplies etc. so it’s catch-22 admin knows that.

Or they can hire more nursing staff/tech for rooms but that defeats the turnover times cause it’s cost more in labor.

OR efficiency teams know this.

This is where the C suites just hope the general medical personnel doesn’t understand turnover like I do.

You need manpower for turnover. That cost money.

Sure simple cases you can turnover in less than 15 minutes. But most simple cases are done at surgery centers not hospitals.

 

[GassYous]

It may not improve revenue but it might keep you from paying overtime and also contribute to keeping the sanity of your physicians

 

[dmk5n]

the elephant in the room is operative time. 3 hr gallbladders and 6 hr breast reductions in medicaid patients = bankruptcy. turnover time aint squat.

 

[dannyboy1]

It may not improve revenue but it might keep you from paying overtime and also contribute to keeping the sanity of your physicians

Surgicenter turnover time is much quicker because staff don’t go home until things are done. It’s amazing what the right motivation can accomplish.

 

[deleted875186]

the elephant in the room is operative time. 3 hr gallbladders and 6 hr breast reductions in medicaid patients = bankruptcy. turnover time aint squat.

Absolutely. But there is not an abundance of surgeons available, so hospitals will take any surgeon they can hire to get cases.

 

[periopdoc]

the elephant in the room is operative time. 3 hr gallbladders and 6 hr breast reductions in medicaid patients = bankruptcy. turnover time aint squat.

The hospital still makes more money off of the 3 hour gallbladder than they do off of the gallbladder that goes to the next hospital, because there is no surgeon available to do it in house.

 

[periopdoc]

What galls me is when they $41+ can the guy who does a gall bladder in 45 min, because he requests a higher wage than the 3-hour guy.

Meanwhile, they retain 3-hour guy, because he, "is cheaper," and he spends much of his day sucking up to the c-suite, and providing "value added services" to the institution.

 

[Planktonmd]

If we become hourly workers like the CRNAs why would the hospital CEO hire us at a higher rate than a CRNA? Remember most of them see you as a vendor of a service and would actively try to obtain that service at the cheapest price possible.

 

[aneftp]

If we become hourly workers like the CRNAs why would the hospital CEO hire us at a higher rate than a CRNA? Remember most of them see you as a vendor of a service and would actively try to obtain that service at the cheapest price possible.

That’s exactly the way C suites want docs to think. It’s the wrong way to look at it.

Crna’s aren’t cheap. Daytime crna’s already command $200/hr plus agency fees another 30% markup. So who exactly is the “cheapest”. That’s just daytime crna’s with supervision

The independent CRNA are already making 450-500k at “collaborative” models.

Once MDs get this. They will realize there is no cheap model left anymore. The cheap model was the pyramid partnership track that took advantage of the employee docs under paying them plus keeping CRNA salaries low as well.

 

[anbuitachi]

Even before rates went through the roof I knew a CRNA in residency who worked 2 days with us and 3 days somewhere else and made more than our attendings.

this isnt uncommon here. and they have predictable hours. they know exactly when they will get out
pay for crna ranges from 200 to 250 a hr here.

all of them are hourly workers. they easily determine which shift they want and when they want bc there is a shortage even at those rates. and many of them work elsewhere too. if their first gig is busy or something happened, they may just call out for the 2nd gig.

 

[anbuitachi]

In my residency , the crnas would do 24 hour call with us. We would do all the work which included all the ob stuff while they slept. Then they would work somewhere else for the other 16 hours for their 40 hour week.

im sure they talk about how stupid MDs are

 

[anbuitachi]

If we become hourly workers like the CRNAs why would the hospital CEO hire us at a higher rate than a CRNA? Remember most of them see you as a vendor of a service and would actively try to obtain that service at the cheapest price possible.

That’s exactly the way C suites want docs to think. It’s the wrong way to look at it.

Crna’s aren’t cheap. Daytime crna’s already command $200/hr plus agency fees another 30% markup. So who exactly is the “cheapest”. That’s just daytime crna’s with supervision

The independent CRNA are already making 450-500k at “collaborative” models.

Once MDs get this. They will realize there is no cheap model left anymore. The cheap model was the pyramid partnership track that took advantage of the employee docs under paying them plus keeping CRNA salaries low as well.

EM works in shifts. defined in and out. so it's kind of hourly.

 

[anbuitachi]

the elephant in the room is operative time. 3 hr gallbladders and 6 hr breast reductions in medicaid patients = bankruptcy. turnover time aint squat.

this. they constantly focus on turnover time but doesnt say anything about intraop surgery time. its crazy. anesthesiologists running in between cases, while surgeons do 2 hr appys and 5 hr hsyterectomys

 

[ChiDO]

Numerous studies have shown in hospital based environment “efficient “ turnover does not generate any more revenue.

It’s very simple. The average turnover at most inpatient hospitals is 27 min. Even if you shorted the turnover to 15 minutes. The max you will save is 12 minutes

Say average is 3 cases per 8 hours OR block time. That’s 36 min saved. Can’t run another case

Even if it’s 4 cases in the same room. That’s still only 48 minutes saved. Still not enough to run another case.

You speed up turnover time. If you use the same staff. They will feel too pressured and don’t want to make mistakes with counts supplies etc. so it’s catch-22 admin knows that.

Or they can hire more nursing staff/tech for rooms but that defeats the turnover times cause it’s cost more in labor.

OR efficiency teams know this.

This is where the C suites just hope the general medical personnel doesn’t understand turnover like I do.

You need manpower for turnover. That cost money.

Sure simple cases you can turnover in less than 15 minutes. But most simple cases are done at surgery centers not hospitals.

Hospitals ORs are slow, ineffienct and expensive. Average turnover time is probably at min 60 mins. Easily can do an extra case if they hustled.

I do 6-8 joints by 12-2pm at the asc versus 6 at the hospital by 4-5.

So at the asc, I can probably do 10-12, or another partner can addon 1-2 cases or staff get to go home.

 

[anbuitachi]

Hospitals ORs are slow, ineffienct and expensive. Average turnover time is probably at min 60 mins. Easily can do an extra case if they hustled.

I do 6-8 joints by 12-2pm at the asc versus 6 at the hospital by 4-5.

So at the asc, I can probably do 10-12, or another partner can addon 1-2 cases or staff get to go home.

but do you make double for working at asc? cause sounds like you do twice the work per hr!

 

[GassYous]

but do you make double for working at asc? cause sounds like you do twice the work per hr!

Professional fees + facility fees he makes more than double at the asc

 

[DocMcCoy]

but do you make double for working at asc? cause sounds like you do twice the work per hr!

Where’s the carrot for hourly employees? I get it, especially since we went to hourly. It’s hard to be motivated to work hard when literally the only ones who profit are the hospital and maybe the surgeons.

 

[aneftp]

Hospitals ORs are slow, ineffienct and expensive. Average turnover time is probably at min 60 mins. Easily can do an extra case if they hustled.

I do 6-8 joints by 12-2pm at the asc versus 6 at the hospital by 4-5.

So at the asc, I can probably do 10-12, or another partner can addon 1-2 cases or staff get to go home.

Than do all your cases at the asc.

But you can’t.

The Asa 3/4 bmi over 40 Medicare patients usually shifts over to the hospital setting

Most ASC have selection bias. It takes 5 minutes or longer to wake up a morbidly obese patient with copd/sleep apnea and other medical problems usually. Takes a couple of extra minutes to move them over to the stretcher as well. There goes 8 plus minutes of efficiency.

Try to turn over a messy hip replacement at an asc in 10 minutes. You can’t. Selection bias folks.

 

[Simba1711]

im sure they talk about how stupid MDs are

Probably. We complained to the chair and attendings during a meeting about the ob call. Their response was to increase the amount of ob call we did and make us solely responsible for carrying the pager. we were responsible for contacting them if we had issues.

 

[anbuitachi]

Than do all your cases at the asc.

But you can’t.

The Asa 3/4 bmi over 40 Medicare patients usually shifts over to the hospital setting

Most ASC have selection bias. It takes 5 minutes or longer to wake up a morbidly obese patient with copd/sleep apnea and other medical problems usually. Takes a couple of extra minutes to move them over to the stretcher as well. There goes 8 plus minutes of efficiency.

Try to turn over a messy hip replacement at an asc in 10 minutes. You can’t. Selection bias folks.

it also takes way longer for high bmi to get onto OR table

 

[ChiDO]

BMI limit 50 at the asc.

We also have our own inpatient hospital. Once again, 6-8 cases by 12-2.

My surgical times do not vary between facilities. Typically I get assigned two good anesthesiologists for community hospital. But it's the staff, preop, spd, ect. Too many moving parts, no incentives. You have to remember, this is a two room setup. I'm doing an entire surgery next door and still takes that much extra time to turnover. And it takes till5 with 6 elective primary joints.

Our asc and hospital, everyone ia incentivized. Bonuses, paid for extra hours, go home early, no call.

 

[aneftp]

BMI limit 50 at the asc.

We also have our own inpatient hospital. Once again, 6-8 cases by 12-2.

My surgical times do not vary between facilities. Typically I get assigned two good anesthesiologists for community hospital. But it's the staff, preop, spd, ect. Too many moving parts, no incentives. You have to remember, this is a two room setup. I'm doing an entire surgery next door and still takes that much extra time to turnover. And it takes till5 with 6 elective primary joints.

Our asc and hospital, everyone ia incentivized. Bonuses, paid for extra hours, go home early, no call.

I’ve never seen an ortho surgeon do 6-8 reverse total shoulders by 2pm. And my good friend is the shoulder guy specialist.

He can do routine shoulder and knees scopes. By 2pm. Not totals.

Again selection bias. Even with 2 rooms.

He also does his carpal tunnels in 15 min.

So you need to be super specific on what the actual procedure you are doing.

 

[teacher2md]

I'm doing an entire surgery next door and still takes that much extra time to turnover.

I wish CMS and insurers would acknowledge this fact—that the preop, patient positioning, spinal/ induction of GA, emergence, transfer to stretcher/PACU is a lot of work.

Do you know how much we get paid for total knee that takes 1 hr? If it’s a Medicare patient, we get about $220.

According to Google, the average ortho physician fee is about $1300. I acknowledge there should be a difference, but should it be 6.5x??

 

[aneftp]

I wish CMS and insurers would acknowledge this fact—that the preop, patient positioning, spinal/ induction of GA, emergence, transfer to stretcher/PACU is a lot of work.

Do you know how much we get paid for total knee that takes 1 hr? If it’s a Medicare patient, we get about $220.

According to Google, the average ortho physician fee is about $1300. I acknowledge there should be a difference, but should it be 6.5x??

Medicare for anesthesia billing is all screwed up. But commercial reimbursement for anesthesia is also screwed up (for the benefit) for anesthesia billers.

We can’t have our cake and eat it also.

Why is anesthesia getting reimbursed $600-800 for a 12-15 min colonoscopy private insurer while the Gi doc gets $300? Does that make sense to you?

But anesthesia gets $75 for same Medicare colonoscopy case and gi doc gets $200 for the same Medicare colonoscopy.

So Medicare pays around 60-70% of what commercial pays for procedurist. But 17-20% for anesthesia. But commercial insurers overpays for anesthesia. So I don’t know how to fix it.

 

[Hoya11]

Medicare for anesthesia billing is all screwed up. But commercial reimbursement for anesthesia is also screwed up (for the benefit) for anesthesia billers.

We can’t have our cake and eat it also.

Why is anesthesia getting reimbursed $600-800 for a 12-15 min colonoscopy private insurer while the Gi doc gets $300? Does that make sense to you?

But anesthesia gets $75 for same Medicare colonoscopy case and gi doc gets $200 for the same Medicare colonoscopy.

So Medicare pays around 60-70% of what commercial pays for procedurist. But 17-20% for anesthesia. But commercial insurers overpays for anesthesia. So I don’t know how to fix it.

My feeling is that it’s set up like that on purpose. Private insurance funds the whole system and keeps government from paying what they should for the publics healthcare needs. In exchange the government allows these parasites to continue to operate and skim off of our healthcare dollars. Government makes sure the companies can’t lose via unfair laws.

 

[aneftp]

My feeling is that it’s set up like that on purpose. Private insurance funds the whole system and keeps government from paying what they should for the publics healthcare needs. In exchange the government allows these parasites to continue to operate and skim off of our healthcare dollars. Government makes sure the companies can’t lose via unfair laws.

That’s true for almost every medical speciality.

But only in anesthesia is the spread difference between commercial insurance and Medicare reimbursement so vastly on opposites ends.

$70-100/unit for commercial vs $20/unit for Medicare

The ortho docs get around 65% of commercial. I know that for a fact. I have orthopedics friends who own their own practices.

 

[Justice4all]

As much as I love the efficiency of the ASC but patient selection allows for that.
At the main hospital , do not expect same output with the non-compliant/cardiac/pulm cripple with always some surprise issues.

 

[GassYous]

As much as I love the efficiency of the ASC but patient selection allows for that.
At the main hospital , do not expect same output with the non-compliant/cardiac/pulm cripple with always some surprise issues.

The setup is still the same though so don't know why it takes some people an hour to do what others can do in ten minutes.

 

[nimbus]

The setup is still the same though so don't know why it takes some people an hour to do what others can do in ten minutes.

The folks at specialty hospitals do the same thing all day every day. SPD at the general hospital are preparing trays for robo mitral repairs and c-sections in addition to the joints. And all hospitals struggle with high staff turnover.

We have orthos who do a lot of their joints at their own surgicenter but when they need to do a Friday or Saturday night joint washout or explant, they don’t call in their surgicenter staff. They do it at the hospital. Of course the surgicenter is more efficient and less expensive. But you can’t go there when you get munched by a truck.

 

[dmk5n]

our hospital OR and ASC(HOPD) and endo is basically a commode for private guys. All we see are fattys, ASA 3,4's, dialysis pts, medicare, medicaid...Stuff that can't or wont be done at an ASC. i don't see how it's sustainable for hospitals....i guess with patient complexity, the operative time increases (duh)...however, i am seeing some services dialed back. I imagine thats how you ration health care. Just dial back the services. there's only so much entropy that can be reversed. and the money is vaporizing in this shrink-flation economy. (sorry for being a drag, i got 20 more years in this gig.)

 

[ProEra]

Going along with turnover time, how does everyone deal with PACU holds?

At times, PACU holds are secondary to a shortage of pacu nurses able to accept patients into pacu. At times, PACU holds are secondary to the hospital floor beds being full so the recovered first cases in the pacu are unable to secure floor beds and languish in pacu for several hours causing delays in getting awake patients out of the OR.

How do we as a specialty get hospitals to compensate us for their poor operational management and resource utilization?

Every minute that I sit on pacu hold is another minute that the turnover between cases gets delayed and is another minute that delays me going home at the end of the day

 

[dannyboy1]

Going along with turnover time, how does everyone deal with PACU holds?

At times, PACU holds are secondary to a shortage of pacu nurses able to accept patients into pacu. At times, PACU holds are secondary to the hospital floor beds being full so the recovered first cases in the pacu are unable to secure floor beds and languish in pacu for several hours causing delays in getting awake patients out of the OR.

How do we as a specialty get hospitals to compensate us for their poor operational management and resource utilization?

Every minute that I sit on pacu hold is another minute that the turnover between cases gets delayed and is another minute that delays me going home at the end of the day

You just need to get paid hourly. Every minute I am physically at work is clocked and I get paid.

 

[aneftp]

You just need to get paid hourly. Every minute I am physically at work is clocked and I get paid.

Even on call in house hours? That’s really the crux of my post.

The money for locums docs is overnight calls and continuous 24 hour weekend coverage. They are literally making 25-30k per Friday night-Monday morning coverage for hospitals.

Basically work 3 weekends nights in a row x 2 weekends at a time can general 50-60k for those 5.5 nights.

 

[dannyboy1]

Even on call in house hours? That’s really the crux of my post.

The money for locums docs is overnight calls and continuous 24 hour weekend coverage. They are literally making 25-30k per Friday night-Monday morning coverage for hospitals.

Basically work 3 weekends nights in a row x 2 weekends at a time can general 50-60k for those 5.5 nights.

Why should working at 3 am pay less than 3 pm?
If it’s a sleepy little hospital with cases that are only truly emergent and beeper call that is one thing. If I have to be physically in the hospital, that’s work

 

[aneftp]

Why should working at 3 am pay less than 3 pm?
If it’s a sleepy little hospital with cases that are only truly emergent and beeper call that is one thing. If I have to be physically in the hospital, that’s work

Beeper is still being on the clock. Are u getting paid the same hourly rate on beeper ?

 

[IMGASMD]

Even on call in house hours? That’s really the crux of my post.

The money for locums docs is overnight calls and continuous 24 hour weekend coverage. They are literally making 25-30k per Friday night-Monday morning coverage for hospitals.

Basically work 3 weekends nights in a row x 2 weekends at a time can general 50-60k for those 5.5 nights.

Where you getting paid $1000/hr for overnight calls? Sign me up!

The best I’ve found so far is paying same the rate as regular time within the radius that I would travel…. So 72K for 24 hour….. I told the agencies specifically, I will not accept beeper calls, especially when I get paid less than $100/hr.

 

[dannyboy1]

Beeper is still being on the clock. Are u getting paid the same hourly rate on beeper ?

I don’t take beeper call. Only in house. I’m an hourly employee and can supplement my income by taking calls. I just add those hours to my weekly. If it happens to be an extra 24 hours, so be it.

 

[aneftp]

I don’t take beeper call. Only in house. I’m an hourly employee and can supplement my income by taking calls. I just add those hours to my weekly. If it happens to be an extra 24 hours, so be it.

What about the full time docs? How are they compensated for beeper calls?

 

[aneftp]

Where you getting paid $1000/hr for overnight calls? Sign me up!

The best I’ve found so far is paying same the rate as regular time within the radius that I would travel…. So 72K for 24 hour….. I told the agencies specifically, I will not accept beeper calls, especially when I get paid less than $100/hr.

Their rate is $300/hr plus $1500 (per 24 hour stipend). That works out to $8700/day/24 hours at a couple of places. Another has a $1800/day stipend. Continuously billing

 

[GravelRider]

Had a good frank discussion yesterday with one of the locums docs. They are correct in this thinking

Crna’s have been way ahead of the game with the “hourly model”

Most only work 2-3 days a week at busy hospitals. It makes so much sense. They can pickup extra when WHEN. THEY WANT to. On THEIR OWN TIME. When they choose to.

As soon as docs get into this line of thinking. Hospital administrators will be F’d.

It’s really the call coverage that w2 docs get screwed on. We all know that.

Think about this. The average CRNA 40 hour (1.75 days (one 24 and one 16 hour) is 220k plus full benefits. Plus 9 weeks off. Plus Paid state holidays. (Basically another 2 weeks off).

Some work 16 hours Fridays/24 hour Sunday’s.
Frees up their entire week to work elsewhere or just chill somewhere. Or vacay without even using any vacation days.

Crna’s aren’t cheap either.

It’s the number of days worked that matters most. The 8-10 hour daytime slot is getting harder and harder for most people to work 5 days a week or even 4 days a week. People want time off.

I work mainly daytime. But I’m done at 12pm a lot.

I couldn’t do 7-3 5 days a week.

One of the biggest differences that is often ignored between CRNA jobs and Anesthesiologist jobs is that many physician employment contracts don’t allow outside moonlighting. A CRNA can get that 2-3 day per week job that gives them benefits and then are free the rest of the week to rake in high-paying per diem shifts. However, many physician employment contracts specifically prohibit outside moonlighting, so while you can find a job working 2 days a week, you won’t be allowed to pick up outside contractual work.

There is also the prickly thing about non-compete clauses that prevent physicians from these kinds of arrangements. CRNAs have largely been left out of the arms race of worsening non-compete clauses that large employers deploy against us.

 

[GassYous]

Where you getting paid $1000/hr for overnight calls? Sign me up!

The best I’ve found so far is paying same the rate as regular time within the radius that I would travel…. So 72K for 24 hour….. I told the agencies specifically, I will not accept beeper calls, especially when I get paid less than $100/hr.

72K???

 

[Izzyman]

One of the biggest differences that is often ignored between CRNA jobs and Anesthesiologist jobs is that many physician employment contracts don’t allow outside moonlighting. A CRNA can get that 2-3 day per week job that gives them benefits and then are free the rest of the week to rake in high-paying per diem shifts. However, many physician employment contracts specifically prohibit outside moonlighting, so while you can find a job working 2 days a week, you won’t be allowed to pick up outside contractual work.

There is also the prickly thing about non-compete clauses that prevent physicians from these kinds of arrangements. CRNAs have largely been left out of the arms race of worsening non-compete clauses that large employers deploy against us.

This
Why doesn’t a non compete and prohibition of moonlighting exist for crnas?? Not like they can’t take away your job and set up shop somewhere