Anesthesiologist shortage 12k by 2033

[GravelRider]

whoever you are supervising is terrible then

There are also a lot more CRNAs being pumped out these days. The quality of their training is worse because they themselves are being trained by relatively inexperienced CRNAs. A lot of bad (weird) habits are being perpetuated. I’ve worked with some really great experienced CRNAs who can make my supervision days a pleasure, but some of these new grad CRNAs are barely functioning at a CA1 level. Those days can be quite stressful. The difference is a CA1 is usually pretty timid, but these new CRNAs are having it ingrained that they are our equal, so they are cocky and make bad decisions. I would much much much rather do my own cases than deal with a 1:4 day supervising a bunch of fresh grad CRNAs.

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[amyl]

The delta is closing between care team and md only…. For lots of places it’s not a $ issue it’s a number of bodies issue.
I do worry that more places faced with the shortage will just end up convincing their surgeons to delegate for the crnas… it’s happening on the outskirts of dallas already. Admin won’t pay us if they can find another way…. And don’t for one sec think that any admin ever cared a rats ass about safety, liability or patient outcome.

 

[DocMcCoy]

The delta is closing between care team and md only…. For lots of places it’s not a $ issue it’s a number of bodies issue.
I do worry that more places faced with the shortage will just end up convincing their surgeons to delegate for the crnas… it’s happening on the outskirts of dallas already. Admin won’t pay us if they can find another way…. And don’t for one sec think that any admin ever cared a rats ass about safety, liability or patient outcome.

Exactly what’s happening at my shop. Fortunately, CRNAs don’t want to cover weekends or calls. The minute they negotiate this, no reason to keep us around.

 

[DaTruMD]

The delta is closing between care team and md only…. For lots of places it’s not a $ issue it’s a number of bodies issue.
I do worry that more places faced with the shortage will just end up convincing their surgeons to delegate for the crnas… it’s happening on the outskirts of dallas already. Admin won’t pay us if they can find another way…. And don’t for one sec think that any admin ever cared a rats ass about safety, liability or patient outcome.

I agree with your last statement. I work outside of the ER and have encountered physicians who are poor clinically but admin keep them around to maintain certifications and keep revenue coming in. As most things in life, it is all about the Benjamins.

 

[aneftp]

Exactly what’s happening at my shop. Fortunately, CRNAs don’t want to cover weekends or calls. The minute they negotiate this, no reason to keep us around.

Crnas are not stupid. At MD only weekends.

I told hospital I do locums at to go ahead and offer crnas $375/hr to do solo cases all weekend including beeper. I’ll be at the beach with my family rather than sit around on beeper.

Guess what. I spoke with a few of my crnas friends. They said they would do the first 8-10 hrs. Lol

Cause they won’t want to be on the hook to sit around on beeper for $100/hr without knowing the exact amount of money they would get.

Crna want guaranteed full hourly rate. U really think a hospital would pay a crna $9000 to do nothing for 12 hrs-15 hrs On beeper ?

And crnas don’t want to get paid $100/hr on beeper, they rather just work 8 hrs and go home and enjoy the rest of their day.

 

[makemoney2024]

Crnas are not stupid. At MD only weekends.

I told hospital I do locums at to go ahead and offer crnas $375/hr to do solo cases all weekend including beeper. I’ll be at the beach with my family rather than sit around on beeper.

Guess what. I spoke with a few of my crnas friends. They said they would do the first 8-10 hrs. Lol

Cause they won’t want to be on the hook to sit around on beeper for $100/hr without knowing the exact amount of money they would get.

Crna want guaranteed full hourly rate. U really think a hospital would pay a crna $9000 to do nothing for 12 hrs-15 hrs On beeper ?

And crnas don’t want to get paid $100/hr on beeper, they rather just work 8 hrs and go home and enjoy the rest of their day.

$9000 for 12 hours or 15 hours? CRNA pay? Where? This planet?

 

[Guillemot]

It is not the bar that is low. It is because these anesthesiologists have significant skill atrophy.

Yeah… Sure… “skill atrophy”

 

[coffeebythelake]

$9000 for 12 hours or 15 hours? CRNA pay? Where? This planet?

He's just making up random numbers. Clearly not being paid 700 an hour.

 

[Dr. Rude]

It is not the bar that is low. It is because these anesthesiologists have significant skill atrophy.

Nah, we were never any good. Not like you young wizards.

 

[aneftp]

He's just making up random numbers. Clearly not being paid 700 an hour.

No. I mean crnas won’t want to be on beeper rate. They want their full rate or won’t work beeper on weekends.

I know the games everyone plays on the locums trails. The professional locums crnas are raking in 25k-30k a week in rural areas. Meaning they want all billable hours $280/hr x 130 hours billed for crnas in rural areas. Just do the simple math

 

[makemoney2024]

No. I mean crnas won’t want to be on beeper rate. They want their full rate or won’t work beeper on weekends.

I know the games everyone plays on the locums trails. The professional locums crnas are raking in 25k-30k a week in rural areas. Meaning they want all billable hours $280/hr x 130 hours billed for crnas in rural areas. Just do the simple math

You mean each hour on the pager gets paid the same? Not a flat rate to cary and then get paid while going in? Even then at 15 hours that’s $600 an hour.

 

[aneftp]

You mean each hour on the pager gets paid the same? Not a flat rate to cary and then get paid while going in? Even then at 15 hours that’s $600 an hour.

Whatever you want to call it. Its a continuous rate/flat rate/guarantee. Many names for it. CRNAs want to get PAID. They aint' sitting around outside the hotel for anything less than their REGULAR ON SITE/IN HOUSE rate. So they can be back at hotel/air b n b getting the same guarantee as it they are working. Everything is negotiable.

So if they get hammered with 20 hours of work its the same as doing 5 hours of work. Crnas take advantage of these rural hospital who cough up the money to have them continuously available. That's how they make 25k, 30K in a week when the total NON GI cases are less than 20 the entire week. Of course places use GI procedures to inflate the number of procedures they do.

 

[kidthor]

At the ASA Advance meeting they were pushing 1:10+ with some sort of dip$**** anesthesiologist watching it all remotely because “we made anesthesia so safe”. So our own professional organization is setting us up for absurdity.

Sign me up for solo cases any day. I don’t care what you pay me, I’ll never do more than 1:3 and I’ll always prefer providing patient care by myself. And magically whenever there’s a special request from staff for anesthesia they want a solo doc every time (which I’m more than happy to oblige).

 

[NightyNight]

At the ASA Advance meeting they were pushing 1:10+ with some sort of dip$**** anesthesiologist watching it all remotely because “we made anesthesia so safe”. So our own professional organization is setting us up for absurdity.

Sign me up for solo cases any day. I don’t care what you pay me, I’ll never do more than 1:3 and I’ll always prefer providing patient care by myself. And magically whenever there’s a special request from staff for anesthesia they want a solo doc every time (which I’m more than happy to oblige).

Name of dipsheez probably doing half as preops only? Employed by AMC?

 

[aneftp]

Name of dipsheez probably doing half as preops only? Employed by AMC?

Some peeps refuse to go into rooms even for breaks. Let alone paycheck.

At my real time place it’s mainly medical direction 1/2 or 1:3. Doc do go solo in a room probably 10-20%. I’m just doing solo for another doc tomorrow cause they don’t want to do their own cases lol. It doesn’t bother me. My reward is I’d probably be out by 12p. Fair trade!

 

[Dr. Rude]

Some peeps refuse to go into rooms even for breaks. Let alone paycheck.

At my real time place it’s mainly medical direction 1/2 or 1:3. Doc do go solo in a room probably 10-20%. I’m just doing solo for another doc tomorrow cause they don’t want to do their own cases lol. It doesn’t bother me. My reward is I’d probably be out by 12p. Fair trade!

If you get to cherry pick the room you do solo, it is a much better deal for you even if you don't get out early.

 

[PainInTheAnes]

At the ASA Advance meeting they were pushing 1:10+ with some sort of dip$**** anesthesiologist watching it all remotely because “we made anesthesia so safe”. So our own professional organization is setting us up for absurdity.

Sign me up for solo cases any day. I don’t care what you pay me, I’ll never do more than 1:3 and I’ll always prefer providing patient care by myself. And magically whenever there’s a special request from staff for anesthesia they want a solo doc every time (which I’m more than happy to oblige).

There are ample opportunities for a person to make 350-400k working 50 hours a week for 46 weeks doing what you want to do.

If you want stability on a W2 to do this, you'll make 250 an hour in a desirable location, off hours or not.

 

[makemoney2024]

Whatever you want to call it. Its a continuous rate/flat rate/guarantee. Many names for it. CRNAs want to get PAID. They aint' sitting around outside the hotel for anything less than their REGULAR ON SITE/IN HOUSE rate. So they can be back at hotel/air b n b getting the same guarantee as it they are working. Everything is negotiable.

So if they get hammered with 20 hours of work its the same as doing 5 hours of work. Crnas take advantage of these rural hospital who cough up the money to have them continuously available. That's how they make 25k, 30K in a week when the total NON GI cases are less than 20 the entire week. Of course places use GI procedures to inflate the number of procedures they do.

Have you negotiated a continuous rate yourself? Are docs doing this?
At 24hours that’s $375 per hour. Are CRNAs making this?

 

[aneftp]

There are ample opportunities for a person to make 350-400k working 50 hours a week for 46 weeks doing what you want to do.

If you want stability on a W2 to do this, you'll make 250 an hour in a desirable location, off hours or not.

Are u crazy. Crnas make 400k working 50 hours a week these days for 46 weeks.

Have you negotiated a continuous rate yourself? Are docs doing this?
At 24hours that’s $375 per hour. Are CRNAs making this?

Of course. It’s everywhere I got this one place up to 60k a week guaranteed for the summer in Midwest.

The money keeps going up and up.

There is so much work. Have 7-8 places u can go simultaneously and work it against each other.

Crnas negotiating their own rates. Crna last night made 6k not working. Well they worked around 7 hrs 8-3p. U can be called in anytime just luck of the draw and the white cloud on call or not.

We (me and crna) all laughing about it at the restaurant watching nba playoffs Lakers and nuggets game last night. (I wasn’t working , my buddy was working). He was coveting ob so he’s got 30 min rule. Crna has soft 45-60 min return rule.

Crna in the south settle for $250/hr continuing billing. Midwest is $300/hr. It’s all depends how desperate hospitals get.

 

[makemoney2024]

Are u crazy. Crnas make 400k working 50 hours a week these days for 46 weeks.

Of course. It’s everywhere I got this one place up to 60k a week guaranteed for the summer in Midwest.

The money keeps going up and up.

There is so much work. Have 7-8 places u can go simultaneously and work it against each other.

Crnas negotiating their own rates. Crna last night made 6k not working. Well they worked around 7 hrs 8-3p. U can be called in anytime just luck of the draw and the white cloud on call or not.

We (me and crna) all laughing about it at the restaurant watching nba playoffs Lakers and nuggets game last night. (I wasn’t working , my buddy was working). He was coveting ob so he’s got 30 min rule. Crna has soft 45-60 min return rule.

Crna in the south settle for $250/hr continuing billing. Midwest is $300/hr. It’s all depends how desperate hospitals get.

Well how about share this information so others can use it. Or is it all about gatekeeping?
$60k per week? How? Teach us if you could. PM people with this info. I have no desire to play a fire fighter with dangerous CRNAs or too 1:5 supervision ratio thou. Hell 1:3 is enough.

 

[LowWafer8]

Yes I'm interested in this too please!

 

[aneftp]

Well how about share this information so others can use it. Or is it all about gatekeeping?
$60k per week? How? Teach us if you could. PM people with this info. I have no desire to play a fire fighter with dangerous CRNAs or too 1:5 supervision ratio thou. Hell 1:3 is enough.

It’s like divorce settlements. Ask for the world. And see what fish bites.

At first they think ur demands are outrageous. But than they start to cave.

 

[makemoney2024]

It’s like divorce settlements. Ask for the world. And see what fish bites.

At first they think ur demands are outrageous. But than they start to cave.

Very unhelpful. It’s nice to be on here bragging about things though.

 

[makemoney2024]

Yes I'm interested in this too please!

You won’t get anything. There was a FB I belonged to for women that shared this info that I have since left cuz the lady in charge pissed me off. But it was mostly OBs

 

[aneftp]

Very unhelpful. It’s nice to be on here bragging about things though.

I’ve given hints in multiple places. Places not to go. Places to go.

Remember locums places comes and goes. Like Virginia place was paying really well $485/hr Easy 80 hrs for the week and fly out by Saturday. That door has closed. But as one door closes another opens. Wisconsin u can make 45k right now for the week. The other Wisconsin place closed its window to make big money last year. How long does this gig last? I don’t know. Locums isn’t even my real job. I take vacation weeks off to cover or cover on weekends.

Don’t worry if amc is running it. Follow the money who is paying the locums tab. The amc isn’t paying the locums tab. It’s the hospital.

This isn’t about bragging. It’s trying to explain to people locums comes and goes. My best advice is to have at least 5 places in a driving window u can cover at the last minute (2-3 hour radius) have active credentials. I know guys with 12 active privileges. That’s a lot.

Everyone focus on Sarasota and Memphis or that Montana practice. By the time the word is out on the street. The real locums docs have already secured the highest rates. Than the rates start going down and down. Than the real locums docs leave move on to their next project.

 

[makemoney2024]

I’ve given hints in multiple places. Places not to go. Places to go.

Remember locums places comes and goes. Like Virginia place was paying really well $485/hr Easy 80 hrs for the week and fly out by Saturday. That door has closed. But as one door closes another opens. Wisconsin u can make 45k right now for the week. The other Wisconsin place closed its window to make big money last year. How long does this gig last? I don’t know. Locums isn’t even my real job. I take vacation weeks off to cover or cover on weekends.

Don’t worry if amc is running it. Follow the money who is paying the locums tab. The amc isn’t paying the locums tab. It’s the hospital.

This isn’t about bragging. It’s trying to explain to people locums comes and goes. My best advice is to have at least 5 places in a driving window u can cover at the last minute (2-3 hour radius) have active credentials. I know guys with 12 active privileges. That’s a lot.

Everyone focus on Sarasota and Memphis or that Montana practice. By the time the word is out on the street. The real locums docs have already secured the highest rates. Than the rates start going down and down. Than the real locums docs leave move on to their next project.

The question is how do you hear about this? Your friends? Your connections?
And the 45k is for how many hours? This matters too.

 

[aneftp]

The question is how do you hear about this? Your friends? Your connections?
And the 45k is for how many hours? This matters too.

It’s not the hours. It’s the workload. People focus on hours. I focus on workload. I focus on sleep. The money is in the calls. But don’t killed urself for calls. Workload. How busy is the calls? Surprisingly some trauma one are the same same as other trauma one calls. Same with trauma 2 call centers. The workload varies. Some community places are much busier at night than others. So I pop in. Get a feel for the place before committing to taking calls for them. But that’s the money ball. The calls.

I get most of my 1099 via friends. Even crnas friends who hook me up. So I backdoor my way in. Than contact the agency that has the contract. It’s a weird way of doing things but it works. It’s a pain to call the hospital directly. Just the way things work.

Even my newly signed locums contract I signed last week. The lady doc there is a friend of mine and she was in meeting with them just reviewing my cv and just rubber stamp it for the locums company. The locums company calls me back a few hours later and said I’m approved….yeah yeah, I know that already.

 

[mrrogers]

It’s not the hours. It’s the workload. People focus on hours. I focus on workload. I focus on sleep. The money is in the calls. But don’t killed urself for calls. Workload. How busy is the calls? Surprisingly some trauma one are the same same as other trauma one calls. Same with trauma 2 call centers. The workload varies. Some community places are much busier at night than others. So I pop in. Get a feel for the place before committing to taking calls for them. But that’s the money ball. The calls.

I get most of my 1099 via friends. Even crnas friends who hook me up. So I backdoor my way in. Than contact the agency that has the contract. It’s a weird way of doing things but it works. It’s a pain to call the hospital directly. Just the way things work.

Even my newly signed locums contract I signed last week. The lady doc there is a friend of mine and she was in meeting with them just reviewing my cv and just rubber stamp it for the locums company. The locums company calls me back a few hours later and said I’m approved….yeah yeah, I know that already.

any hints on where this wisconsin practice is?

 

[dabears505]

Believe me, I am plenty fast... Open AAA (on my own) gets thoracic epidural, induced, and lined up in 20-25min (without anesthesia tech support). But I can't be in multiple places at once. You've never had 2 or 3 ASA 4 730 starts? It's maddening trying to navigate this. The 1:4 doc just has the CRNA induce on their own and never shows their face in the room. I'm not interested in that kind of practice.

Wow man. That's impressive.

 

[GassYous]

Wow man. That's impressive.

If you have good nursing support it's possible. Don't waste time on dumb things. I used to have some nurses who would lay the patient down on the table to put on monitors instead of just sitting them up from the start.

Sit them up, prep. 3 minutes. Epidural in. 5 minutes. Then lay them down and nurse holds the mask while you push drugs. 3 minutes. I like to put the tourniquet on for another iv before preox to give the veins time to plump up. iv in then prep for a line and cvl simultaneously. 2 minutes. Place the a line then go right to the cvl. 2 minutes. Put a subclavian so you don't have to waste time with draping and putting gel in the ultrasound. 5 minutes.

Of course if you have a difficult patient (scoliosis, high bmi, sick) then everything tends to take longer.

 

[Howard888]

Kind of irrelevant since open AAAs rarely happen anymore.

Surgical disruption….this is a big part of this. Surgeons have gotten much better and technology has helped. While yes there are still plenty of sick patients and big cases…the needs on our end our less. Vats vs open thoracic. Robotic whipples or liver resections. Endo vascular vs open AAAs

I do plenty of these but most don’t require the setup you speak of. ESP blocks in preop Vs thoracic epidural. I do a line while good crna intubates. Rarely put a central line in anymore. No need.

Running 4 rooms with good CRNAs isn’t that big of a deal

 

[aneftp]

Kind of irrelevant since open AAAs rarely happen anymore.

Surgical disruption….this is a big part of this. Surgeons have gotten much better and technology has helped. While yes there are still plenty of sick patients and big cases…the needs on our end our less. Vats vs open thoracic. Robotic whipples or liver resections. Endo vascular vs open AAAs

I do plenty of these but most don’t require the setup you speak of. ESP blocks in preop Vs thoracic epidural. I do a line while good crna intubates. Rarely put a central line in anymore. No need.

Running 4 rooms with good CRNAs isn’t that big of a deal

Running 4 acute high risk cases with 2 iffy crnas and 2 good crnas can be risky.

That’s the key. If u have bad crnas. It can be extremely stressful.

 

[makemoney2024]

If you have good nursing support it's possible. Don't waste time on dumb things. I used to have some nurses who would lay the patient down on the table to put on monitors instead of just sitting them up from the start.

Sit them up, prep. 3 minutes. Epidural in. 5 minutes. Then lay them down and nurse holds the mask while you push drugs. 3 minutes. I like to put the tourniquet on for another iv before preox to give the veins time to plump up. iv in then prep for a line and cvl simultaneously. 2 minutes. Place the a line then go right to the cvl. 2 minutes. Put a subclavian so you don't have to waste time with draping and putting gel in the ultrasound. 5 minutes.

Of course if you have a difficult patient (scoliosis, high bmi, sick) then everything tends to take longer.

Wait what? Admittedly I don’t know how to do subclavians but what do you mean no draping?

 

[makemoney2024]

Kind of irrelevant since open AAAs rarely happen anymore.

Surgical disruption….this is a big part of this. Surgeons have gotten much better and technology has helped. While yes there are still plenty of sick patients and big cases…the needs on our end our less. Vats vs open thoracic. Robotic whipples or liver resections. Endo vascular vs open AAAs

I do plenty of these but most don’t require the setup you speak of. ESP blocks in preop Vs thoracic epidural. I do a line while good crna intubates. Rarely put a central line in anymore. No need.

Running 4 rooms with good CRNAs isn’t that big of a deal

Ok maybe to you it isn’t. Sick patients. And even if not so sick there is pre op, PACU, blocks. And four rooms?
I am good. I will pass. Don’t care how good the CRNAs are. **** goes down in one room? PACU? Another room? Just asking for it.

 

[gunnershow]

Kind of irrelevant since open AAAs rarely happen anymore.

Surgical disruption….this is a big part of this. Surgeons have gotten much better and technology has helped. While yes there are still plenty of sick patients and big cases…the needs on our end our less. Vats vs open thoracic. Robotic whipples or liver resections. Endo vascular vs open AAAs

I do plenty of these but most don’t require the setup you speak of. ESP blocks in preop Vs thoracic epidural. I do a line while good crna intubates. Rarely put a central line in anymore. No need.

Running 4 rooms with good CRNAs isn’t that big of a deal

You just talked about a fair amount of work for just one room... What are you doing with your other three high risk rooms, also with 730 starts?

4:1 direction only "works" with anesthesiologists who fraudulently bill patients for stuff they were never there for. If you think it's not a big deal to defer the anesthetic care for ASA4s (or even 3s or 2s) to your nurses, then more power to you. That's not for me. To be honest, the only people I've seen who enjoy doing that are checked out greedy boomers.

 

[sevo00]

Running 4 rooms with good CRNAs isn’t that big of a deal

guaranteed when youre not in the room the crna is thinking too themselves how useless you are and that they can do this job by themsevles or with the help of just another crna. I dont know how you can work with and "supervise" people that think of you that way everyday

 

[abolt18]

Wait what? Admittedly I don’t know how to do subclavians but what do you mean no draping?

I think he was saying no draping of the US probe with a probe cover.

 

[Gern Blansten]

I think he was saying no draping of the US probe with a probe cover.

He described prepping for both a-line and subclavian at the same time, almost as if he is doing both sequentially with the same prep and the same gloves and no drapes for either. That is how I read it.
This makes me wonder what the infection rate is for the central line (CLABSI). That wouldn’t fly at my hospital.

 

[pgg]

Admittedly I don’t know how to do subclavians

It's under the clavicle

 

[makemoney2024]

It's under the clavicle

Is this supposed to be funny? Helpful? Sarcastic? Rude? You think I don’t know where it is?

 

[makemoney2024]

guaranteed when youre not in the room the crna is thinking too themselves how useless you are and that they can do this job by themsevles or with the help of just another crna. I dont know how you can work with and "supervise" people that think of you that way everyday

Yup!!

 

[makemoney2024]

He described prepping for both a-line and subclavian at the same time, almost as if he is doing both sequentially with the same prep and the same gloves and no drapes for either. That is how I read it.
This makes me wonder what the infection rate is for the central line (CLABSI). That wouldn’t fly at my hospital.

Hopefully he starts centrally and goes distally!!

 

[pgg]

Is this supposed to be funny? Helpful? Sarcastic? Rude? You think I don’t know where it is?

Joking. Lighten up.

Are you SURE you're not choco?

 

[Coffee PRN]

Joking. Lighten up.

Are you SURE you're not choco?

Not enough rants about "racism."

 

[Gern Blansten]

Is this supposed to be funny? Helpful? Sarcastic? Rude? You think I don’t know where it is?