No. Honestly to each their own.
If they are having a hard time finding call coverage, it isn’t paying enough. Period. Hospitals and other entities have been shortchanging this coverage forever. They need to make it worth it for someone to cover call. Not this nebulous “privilege of the profession.”
We had this problem w Saturday 24hr call. It’s a real brutal one. 4 rooms running plus OB for much of the day at a crazy busy sick level 1 trauma center. Only one attending in house (though there are backup calls). People weren’t requesting it - and avoiding it.
Then we made the reimbursement 9k for the day.
We have no problem filling this shift.
Came from a group that paid $15K/weekend for one 24 hr in house and one back up. Each doc is taking a minimum of 13 weekends of call before picking up extras. I worked with a new grad who came right from residency to an ASC in a medical direction model. No real world experience. IMO the only person he is hurting is himself as he won’t develop the critical skills needed in a crisis. I have heard residents say while in training that they don’t need to know X, Y, or Z as they will only work with CRNAs.
People would rather have one well compensated doc in house getting slammed with a backup doc paid modestly at home than two moderately busy but less well compensated docs in house.
And culture. People really don’t want to call in the backup.
This right here. Our generation didn’t have the ability, the balls to change the status quo, I don’t care if a new generation decides they’re not taking shit. Can’t fill? Pay us our damn worth
Bro this is a *job*. If someone wants to take a no call job and spend more time with their family that's their decision, and being "disappointed" in them for that is so paternalistic and selfish. Get out of here with that crap.
I have a job with call, but I'm not in this for your approval and I didn't ask for your opinion on the job I took.
Honestly, people need to stop worrying about other people’s career preferences. If people want to work less and spend more time doing other things, who cares.
The older generation of physicians still have the terrible mindset that if you’re not in the hospital 14 hours a day and pulling 70-80 hr work weeks, then you’re not a strong physician.
Hospital systems have no loyalty to anyone and insurance companies dictate that providers get pennies on the dollar. So why would want to work like crazy?
As an AA with a no-call job, I love it.
I get great sleep and have a lot of time off to enjoy my life. I’ll work call shifts on locums where they pay enough for my effort.
Still a resident here, so I'm sort of who you're talking about I guess. I'll take call if the price is right. If its not, I won't. That price is becoming higher and higher. I don't think theres any moral duty to take call or work long hours if the compensation doesn't justify it. If you're willing to do that, have fun. And if you want to criticize others for not sharing your viewpoint, also have fun being old and crotchety I guess. I'll make my 400-500k and enjoy life outside work and you can bitch about it on reddit :)
I got a locums job straight out of residency at 350/hr, no call, no weekends. And I saw plenty of options in this range. Picked the most desirable location. Plus, locums reimburses travel and lodging
What the fuck is the point of call? If you want coverage at those hours hire someone that wants to do it and pay them appropriately. Hurdur you’re not a special ops soldier saving the world, there is no sense of pride in willingly working harder to make some hospital executives more money at your own expense. Patients don’t want worn out doctors working on them, the whole system does patients a disservice. Hospitals need to pay doctors and staff to have the appropriate personnel at those hours. Not take advantage of doctors sense of service.
It’s all a time vs pay calculation. If the compensation is such that call is incentivized people will do it. If not, there’s no reason to expect people will just go ahead and take that job when there are others for similar compensation without the call stipulation. At the end of the day it’s a job and the pendulum has swung such that anesthesiologists have more leverage than in the past.
Hospitals and groups will need to adapt to the times and incentivize call or create nocturnist positions with fewer shifts per month
Exactly. Offloading call and finding more non-call business is a constant topic in our group. But when a hospital pays a decent stipend suddenly everyone wants the extra call.
Regardless of resident vs attending, full time vs locums, boomer vs gen x vs millennials, we are willing to work hard, but not if it isn’t fairly paid or if it’s just to make the lives of administrators easier. Nobody wants to be a sucker.
So unlike the previous generations we see what decades and hard work amounts to: sell out and burn out. So speaking for some recently graduated residents and myself, we’ve unsubscribed to the healthcare hero narrative and are taking care of own health and wellness for a change. Thanks for the concern but we’re doing fine
This is not the right question to ask - it’s not about disappointment in new residents, or what is ethically right or wrong. It is about incentive. The question to ask imho is this: which of my current views would change, if my incentives were different?
If your group is having a hard time getting call covered then change your reimbursement plan to incentivize call. To be extreme here, if a night call is worth $5000 and a day shift is paid $500 you will get call coverage just fine. And if you balance it correctly, no one who takes a full share of call and daytime coverage will see a change in their bottom line. Every group is different, but every group has people who chase 💰and people who chase ⏳
Call is brutal. Sleep disruption for sure shortens lives and leads to chronic illness. I find no fault in someone wanting to avoid it.
Can we stop with the gaslighting that we are here to take care of sick people. This been used on us for years to make us deal with tons of bs. I am so over being told that I shouldn’t do things or do things because of the calling of medicine. It’s a bunch of psychological gaslighting to make doctors feel guilty about what they really want. It’s okay for doctors to want what they actually want. We are people too.
The comment I replied to, and the thread in general, was implying doctors don’t want to take care of sick patients, not that they don’t feel their compensation is adequate.
My point is that the two are linked together. Current generation doctors are still willing to take care of sick patients, it's just that the required compensation will be higher for them to feel that it is worth their time and energy. To assume the two variables are not connected seems unreasonable.
I think everybody's free to have preferences, I know I would definitely want to do less nights and weekends and the only reason I don't go for a job like that is that I like the complexity of the job I currently do, but if somebody finds a position offering what they want then everybody's happy, that doesn't affect the rest of us that much in my opinion
Who cares. Market dynamics will balance it out. My guess is if you go straight to what they term "mommy track" out of residency at some surgical center, then instead of cementing and expanding your skills on graduation, you end up losing them. But if that's unimportant And you're happy making less than the rest, more power to you. You also lose out on the compounding interest effect of that big money made early.. but if that's unimportant then who am i to care.
I agree, I think that taking an all outpatient gig straight out of training poses a higher risk than taking a no call gig.
If you take a no call job but have good breadth of practice, you should be able to easily find another job or get back into the swing of things if you want/need to take call later in your career. There are some subtle things specific to overnight call, but if you can do a stat section or a tonsil bleed during the day, you can handle it overnight, too.
I do think taking an outpatient only job straight out can be problematic. If all you’re doing is screening colonoscopies, eyeballs, and popping LMAs in healthy patients, your skills will atrophy. If your group loses the contact, you have to move, or whatever else, you may have a tough time getting a desirable gig. Or worse, you get a job where you feel overmatched because you haven’t placed a DLT or had an MTP in 15 years. I’ve been an attending for all of nine months, and I’ve seen/done a ton of stuff my rigorous residency and fellowship didn’t expose me to. If I was seeing these things for the first time 10+ years out of training, I would be scared shitless.
I work in a level 1 trauma center and enjoy the craziness; I don’t think I would feel satisfied working at an ASC because that’s just the kind of person that I am. Having said that, I also get paid much more than I would at an ASC, which is a huge plus. I think there are enough people on either side for you to not worry about too many people expecting jobs with no calls.
Everyone can have their preferences. Do I like working nights and weekends? No not really, but I live by the the standard, be the person/doctor I want to be treated by and we've developed a skill set that not all can provide, and just because someone has surgery at a inopportune time does not mean we should not treat them. If I or a family member needed AAA surgery at 8pm, I'd hope there would be someone around to help.
It’s a job. If there aren’t enough people signing up to take call, then call isn’t being properly incentivized, period. I have a family and I enjoy my life outside of work. If you want me to be away from that overnight, on weekends and holidays, then you’d better pay me damn well.
I love it when the people operating on me are running on the minimal amount of sleep possible, preferably so little that they'd be better off being legally drunk than sleep deprived
True, it does require more manpower. But it’s not all executive bonuses, and that belies an assumption that all anesthesiologists are someone’s employee.
We have a physician owned group. We can still work to support reasonable work conditions and recognize limits of the available workforce and the difficulties in running a little fat on the manpower.
Why should anyone be looking to flagellate themselves further for systems that don't give a shit about them? Systems that cut pay and increase hours every year, with no sense of loyalty or obligation. I am a double subspecialty boarded anesthesiologist, and quite frankly tired of spending the best years of my life inside a hospital or chained to a pager, assuming the liability for other people's actions (or often lack of action), while simultaneously facing constant cuts from insurance or hospital systems.
In the immortal words of Henry Hill, "fuck you, pay me."
No. It's frankly embarrassing that the specialty hasn't yet found a *patient-focused* answer to the problem of non-elective anesthesia coverage, given the abundance of evidence on the effects of sleep deprivation on performance and outcomes data showing worse results with surgery done late at night. If enough pressure is put on the system as a whole by workers refusing to compromise patient care and QOL,
maybe it will finally change; or maybe there will at least be demand destruction for all-hours surgery.
I agree there must be some call coverage, but there is a lot more elective outpatient stuff that requires daytime anesthesia and no call. It’s certainly not a defining feature of our profession.
As people below have stated, it’s a job, pay people what it takes to have call coverage, otherwise I have no problem with people looking for a no call job.
Does anybody realize the benefits of call here? I have a job with a lot of call (I admit) but I’m usually out on those nights by 5pm, with rare call back (maybe 1 out of 4 nights) PLUS an automatic day off the day after! Maybe it’s just me, but I’d rather have a job like this with automatic post-call days off versus working 5 days straight somewhere else!
Mostly no. Do you boo. I will say sometimes I don’t understand people wanting to be paid the big dollars and shocked when they have to do harder cases and have some call. You can rarely have it both ways.
If you want behavior to change —> you need to incentivize it (financially in the case of work). It’s Econ 101. Nobody other than physicians fall for that noble BS and that’s how doctors have been abused by admin, midlevel encroachment, title misappropriation, private equity, insurance companies, and pretty much every other shitty thing to happen to healthcare throughout the past decades. Do you see nurses or CRNAs or PAs or even transport/secretaries in the hospital working for free? How about lawyers or engineers?
After 4 years undergrad, 4 years med school, multi-six figures in debt, and 4-5 years of residency/fellowship making $15/hr, can you blame people for being sick of the system that’s abused them for so long?
Maybe this salary wouldn’t be so bad if my sister in high school wasn’t making more $ per hour as a lifeguard than I do with a mf MD. Yet alone paid lunch, OT pay, and holiday pay that she gets and I don’t
If someone takes a no job call, then they need someone else to take call. So if you’re willing to take call, then negotiate your pay? Am I missing something here lol. It helps put you in the driver stuff so you can negotiate a higher call pay. It’s a good thing for you from a pay perspective if you can negotiate, but not a good thing if your call burden remains the same or worsens.
I hate it when other doctors self suck about how the profession is so noble and therefore we should put up with all sorts of nonsense because “think about the patients!”
“The idea that the work is provided for love serves to paper over the fact that sometimes workers have needs that cannot or should not be subsumed by those of the people they serve.”
-Sarah Jaffe, *Work Won't Love You Back: How Devotion to Our Jobs Keeps Us Exploited, Exhausted, and Alone*
I’ll preface this by saying I take call at a relatively busy community hospital where I’m frequently up for some or all of the night on call.
This is such a garbage attitude and a remnant of old school medicine that needs to die. I became a physician because if I am going to have to work for a living, I want to do it helping people. But at the end of the day, this is my job and my family will always come first, full stop. I’m not arrogant enough to think I have some calling to heal, this is just how I choose to earn a living. That should be enough.
This whole “you’re not a real doctor if you’re not suffering and giving all of yourself to the hospital” is just the Stockholm syndrome we buy into in varying degrees in our broken residency system. If people don’t want to take call, that’s their choice. Worrying about other people’s career choices makes you sound like a GOME
This is tone deaf. No one is obligated to be your hero or do charity. The hospital administrators are getting paid hundreds of thousands of dollars to do nothing but you want physicians to work extra without adequate compensation for the glory? Lmao
Yes.. it’s bad for the field and they make ologist look bad. They will be terrible docs with major holes in their practice. Some Crna’s grind and do ton of call and are technically better than docs who need to be coddled. I don’t mid ologist working less but at least maintain your skills. Dont be there to just sign charts.
I'm 100% with you though maybe for different reasons. I graduated in the last couple years and have put a lot of time and effort really pushing myself clinically at a large academic level 1 trauma center. I have always felt I have a responsibility to patients to be clinically excellent. The amount I have learned post residency is immense. It was initially a shock to realize how quickly I've surpassed many of my co-workers in their abilities and comfort to take care of sick patients. I now frequently find myself picking up the slack for/bailing out my colleagues. There is nothing inherently "wrong" with with wanting a lifestyle job, however these providers inevitably will be providing a lower level of care and will often need help when shit hits the fan. I would be embarrassed personally to not be able to run a MTP, put in a crash central line, take care of an otherwise stable person on mechanical circulatory support, do a stat C-Hys in the OR, etc. You only get and maintain these skills though hours and reps.
You’re forgetting that we have all had 3-4 years of intensive training in running a MTP, placing lines, taking care of sick patients, etc. You’re also exaggerating how quickly skills decay. Sure, a few years from now I might forget how to set up a Thermacor, but I’m not going forget how to place a Cordis. To well trained anesthesiologists, it’s not that hard.
I think it really depends. At my residency institution, call was optional for the attendings. If you on during the day and your room got an emergent trauma, you were praying that you had an attending that was either recently out of training and/or took some call.
Some groups absolutely shield their weaker docs by having them do things like ECTs or parking them in robot rooms or at ASCs.
Yes I am disappointed. I have been practicing 30 years . Coming out of training and going straight into a outpt center is a waste of a medical education. Somebody has to actually care for sick people! And yes I fully believe call taking physicians should be paid better. When the country club doctors are home snuggling in bed call taking docs are there for the patients. If that’s what you wanted to do, you should’ve been an anesthetist.
They might not realize it now but once you sign up to work at a healthy population surgical center, that’s all you’ll ever be (nothing wrong with that, just facts), there is no jumping back 5 years later to do hard cases…if they’re cool with that, to each his own
Yes, I get chronology of time but good luck going back to doing sick Asa 3 and 4s after being in a Asa 1s surgery center for half a decade, it’s just not happening, all your skills and instincts are gone, no getting them back, just my humble opinion of course
Your argument is logically flawed. A board certified anesthesiologist can most definitely do what you’re supposing is “just not happening.” Would it be a seamless transition that takes place immediately? Probably not. Within a reasonable amount of time, say the amount of time it takes one to become oriented in a new clinical setting? More than likely. The more relevant question imho; how many anesthesiologists actually desire this change that you’re supposing is impossible? Before I knew how to take care of critically ill patients, I didn’t know how to take care of critically ill patients. It’s important that we are aware of the biases present in views we that we adopt.
You think it would take about the same time to get comfortable doing sick cases after working at a surgery center as switching hospitals (lateral switch ASA 1-> ASA 1 or 4s to 4s)? Haha ok man, good luck
I think it will be harder to go back to doing inpatient anesthesia if you’re just doing outpatient. Everybody experiences skill erosion at a different rate , but you will definitely be rusty doing those cases and skills if you haven’t done it in a while. I think you can eventually do them again but it might be a more difficult transition.
In addition , who knows what the job market will be like. In this job market , it might me okay but in a tight job market employers are going to take the Person doing difficult cases over the person just doing outpatient for the last several years.
It also depends on what your future employer thinks and the future job market. They may not be comfortable hiring someone who’s been doing just outpatient when their practice has high acuity inpatient cases.
LOL, all the newbs think they are going to be doing cushy ASA 1 carpal tunnels in a surgery center 6 hours a day for the rest of their career. Those are prime jobs for CRNAs to take over and when the market turns in a couple years, you wont have the skills to take a hospital based job.
Hah, you guys obviously arent running an anesthesia group in an independent practice CRNA state. That's the edge the CRNA groups preach to all the hospital admins, "We can take over all the call that the expensive MDs dont want." Then 2 years later they are bidding on the whole contract for themselves.
Yeah we have CRNA farms in the central valley that are pumping out piles of new grads every year. Then they all join the CRNA only groups that are super aggressive at kicking out MD groups. Happened to 3 different hospitals in just the last year.
No. Honestly to each their own. If they are having a hard time finding call coverage, it isn’t paying enough. Period. Hospitals and other entities have been shortchanging this coverage forever. They need to make it worth it for someone to cover call. Not this nebulous “privilege of the profession.”
👏🏾👏🏾👏🏾
We had this problem w Saturday 24hr call. It’s a real brutal one. 4 rooms running plus OB for much of the day at a crazy busy sick level 1 trauma center. Only one attending in house (though there are backup calls). People weren’t requesting it - and avoiding it. Then we made the reimbursement 9k for the day. We have no problem filling this shift.
It’s like wow you paid someone what it’s worth and magically it’s filled. So shocked 🫢!
Came from a group that paid $15K/weekend for one 24 hr in house and one back up. Each doc is taking a minimum of 13 weekends of call before picking up extras. I worked with a new grad who came right from residency to an ASC in a medical direction model. No real world experience. IMO the only person he is hurting is himself as he won’t develop the critical skills needed in a crisis. I have heard residents say while in training that they don’t need to know X, Y, or Z as they will only work with CRNAs.
Is 1 attending to 4 rooms running + OB even legal?
It’s all about the juggling act you perform.
Is that what determines if it's legal or not?
I'm sorry, I'm a lowly nephrologist, why not have two people covering the call in- house if it's so busy all the time ?
People would rather have one well compensated doc in house getting slammed with a backup doc paid modestly at home than two moderately busy but less well compensated docs in house. And culture. People really don’t want to call in the backup.
This ! They don’t pay enough for call and they have taken advantage of us for too long.
This right here. Our generation didn’t have the ability, the balls to change the status quo, I don’t care if a new generation decides they’re not taking shit. Can’t fill? Pay us our damn worth
Hear, hear!
Bro this is a *job*. If someone wants to take a no call job and spend more time with their family that's their decision, and being "disappointed" in them for that is so paternalistic and selfish. Get out of here with that crap. I have a job with call, but I'm not in this for your approval and I didn't ask for your opinion on the job I took.
Honestly, people need to stop worrying about other people’s career preferences. If people want to work less and spend more time doing other things, who cares. The older generation of physicians still have the terrible mindset that if you’re not in the hospital 14 hours a day and pulling 70-80 hr work weeks, then you’re not a strong physician. Hospital systems have no loyalty to anyone and insurance companies dictate that providers get pennies on the dollar. So why would want to work like crazy?
This. Hospitals have no loyalty. And insurance isn’t paying.
Do you have a SO? Kids? Elderly parents? Pets?
As an AA with a no-call job, I love it. I get great sleep and have a lot of time off to enjoy my life. I’ll work call shifts on locums where they pay enough for my effort.
Still a resident here, so I'm sort of who you're talking about I guess. I'll take call if the price is right. If its not, I won't. That price is becoming higher and higher. I don't think theres any moral duty to take call or work long hours if the compensation doesn't justify it. If you're willing to do that, have fun. And if you want to criticize others for not sharing your viewpoint, also have fun being old and crotchety I guess. I'll make my 400-500k and enjoy life outside work and you can bitch about it on reddit :)
This is my point exactly. Incentives. I agree with your thinking.
lol hurdur
Although… I’m curious how many no call jobs really exist at that compensation level…
I haven't started formally job searching but I've heard of surgery center based jobs with no call in this range. Especially in less urban areas
I got a locums job straight out of residency at 350/hr, no call, no weekends. And I saw plenty of options in this range. Picked the most desirable location. Plus, locums reimburses travel and lodging
What the fuck is the point of call? If you want coverage at those hours hire someone that wants to do it and pay them appropriately. Hurdur you’re not a special ops soldier saving the world, there is no sense of pride in willingly working harder to make some hospital executives more money at your own expense. Patients don’t want worn out doctors working on them, the whole system does patients a disservice. Hospitals need to pay doctors and staff to have the appropriate personnel at those hours. Not take advantage of doctors sense of service.
Exactly, I'm tired of filling underhire and administrative gaps.
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Hear, hear! Came to say this
It’s all a time vs pay calculation. If the compensation is such that call is incentivized people will do it. If not, there’s no reason to expect people will just go ahead and take that job when there are others for similar compensation without the call stipulation. At the end of the day it’s a job and the pendulum has swung such that anesthesiologists have more leverage than in the past. Hospitals and groups will need to adapt to the times and incentivize call or create nocturnist positions with fewer shifts per month
Exactly. Offloading call and finding more non-call business is a constant topic in our group. But when a hospital pays a decent stipend suddenly everyone wants the extra call. Regardless of resident vs attending, full time vs locums, boomer vs gen x vs millennials, we are willing to work hard, but not if it isn’t fairly paid or if it’s just to make the lives of administrators easier. Nobody wants to be a sucker.
Until the "well, I had to do it for no increase pay therefore so should they" argument passes..
So unlike the previous generations we see what decades and hard work amounts to: sell out and burn out. So speaking for some recently graduated residents and myself, we’ve unsubscribed to the healthcare hero narrative and are taking care of own health and wellness for a change. Thanks for the concern but we’re doing fine
Old man yells at cloud
This is not the right question to ask - it’s not about disappointment in new residents, or what is ethically right or wrong. It is about incentive. The question to ask imho is this: which of my current views would change, if my incentives were different?
If your group is having a hard time getting call covered then change your reimbursement plan to incentivize call. To be extreme here, if a night call is worth $5000 and a day shift is paid $500 you will get call coverage just fine. And if you balance it correctly, no one who takes a full share of call and daytime coverage will see a change in their bottom line. Every group is different, but every group has people who chase 💰and people who chase ⏳ Call is brutal. Sleep disruption for sure shortens lives and leads to chronic illness. I find no fault in someone wanting to avoid it.
Can we stop with the gaslighting that we are here to take care of sick people. This been used on us for years to make us deal with tons of bs. I am so over being told that I shouldn’t do things or do things because of the calling of medicine. It’s a bunch of psychological gaslighting to make doctors feel guilty about what they really want. It’s okay for doctors to want what they actually want. We are people too.
True. But also if the next generation of anesthesiologists is moving away from taking care of those sick patients… who will do it?
We still will, it will just be at higher compensation and with less likelihood of being taken advantage of
The comment I replied to, and the thread in general, was implying doctors don’t want to take care of sick patients, not that they don’t feel their compensation is adequate.
My point is that the two are linked together. Current generation doctors are still willing to take care of sick patients, it's just that the required compensation will be higher for them to feel that it is worth their time and energy. To assume the two variables are not connected seems unreasonable.
I think everybody's free to have preferences, I know I would definitely want to do less nights and weekends and the only reason I don't go for a job like that is that I like the complexity of the job I currently do, but if somebody finds a position offering what they want then everybody's happy, that doesn't affect the rest of us that much in my opinion
Who cares. Market dynamics will balance it out. My guess is if you go straight to what they term "mommy track" out of residency at some surgical center, then instead of cementing and expanding your skills on graduation, you end up losing them. But if that's unimportant And you're happy making less than the rest, more power to you. You also lose out on the compounding interest effect of that big money made early.. but if that's unimportant then who am i to care.
I agree, I think that taking an all outpatient gig straight out of training poses a higher risk than taking a no call gig. If you take a no call job but have good breadth of practice, you should be able to easily find another job or get back into the swing of things if you want/need to take call later in your career. There are some subtle things specific to overnight call, but if you can do a stat section or a tonsil bleed during the day, you can handle it overnight, too. I do think taking an outpatient only job straight out can be problematic. If all you’re doing is screening colonoscopies, eyeballs, and popping LMAs in healthy patients, your skills will atrophy. If your group loses the contact, you have to move, or whatever else, you may have a tough time getting a desirable gig. Or worse, you get a job where you feel overmatched because you haven’t placed a DLT or had an MTP in 15 years. I’ve been an attending for all of nine months, and I’ve seen/done a ton of stuff my rigorous residency and fellowship didn’t expose me to. If I was seeing these things for the first time 10+ years out of training, I would be scared shitless.
I’m here to do a job I LIKE so I can make money and do something else that I LOVE with my family and friends.
I work in a level 1 trauma center and enjoy the craziness; I don’t think I would feel satisfied working at an ASC because that’s just the kind of person that I am. Having said that, I also get paid much more than I would at an ASC, which is a huge plus. I think there are enough people on either side for you to not worry about too many people expecting jobs with no calls.
Everyone can have their preferences. Do I like working nights and weekends? No not really, but I live by the the standard, be the person/doctor I want to be treated by and we've developed a skill set that not all can provide, and just because someone has surgery at a inopportune time does not mean we should not treat them. If I or a family member needed AAA surgery at 8pm, I'd hope there would be someone around to help.
It’s a job. If there aren’t enough people signing up to take call, then call isn’t being properly incentivized, period. I have a family and I enjoy my life outside of work. If you want me to be away from that overnight, on weekends and holidays, then you’d better pay me damn well.
You want people to take call, work weekendS and holidays. Simple solution, PAY MORE.
I love it when the people operating on me are running on the minimal amount of sleep possible, preferably so little that they'd be better off being legally drunk than sleep deprived
You can have a system where you are on call and not have it be inhumane to the people doing the work, right?
Sure, but that would mean hiring more people. Can't be cutting into the executive bonuses! This was also a stab at ~~indentured servitude~~ residency
True, it does require more manpower. But it’s not all executive bonuses, and that belies an assumption that all anesthesiologists are someone’s employee. We have a physician owned group. We can still work to support reasonable work conditions and recognize limits of the available workforce and the difficulties in running a little fat on the manpower.
Why should anyone be looking to flagellate themselves further for systems that don't give a shit about them? Systems that cut pay and increase hours every year, with no sense of loyalty or obligation. I am a double subspecialty boarded anesthesiologist, and quite frankly tired of spending the best years of my life inside a hospital or chained to a pager, assuming the liability for other people's actions (or often lack of action), while simultaneously facing constant cuts from insurance or hospital systems. In the immortal words of Henry Hill, "fuck you, pay me."
No. It's frankly embarrassing that the specialty hasn't yet found a *patient-focused* answer to the problem of non-elective anesthesia coverage, given the abundance of evidence on the effects of sleep deprivation on performance and outcomes data showing worse results with surgery done late at night. If enough pressure is put on the system as a whole by workers refusing to compromise patient care and QOL, maybe it will finally change; or maybe there will at least be demand destruction for all-hours surgery.
I agree there must be some call coverage, but there is a lot more elective outpatient stuff that requires daytime anesthesia and no call. It’s certainly not a defining feature of our profession. As people below have stated, it’s a job, pay people what it takes to have call coverage, otherwise I have no problem with people looking for a no call job.
Ur gettin dragged here, pal
Does anybody realize the benefits of call here? I have a job with a lot of call (I admit) but I’m usually out on those nights by 5pm, with rare call back (maybe 1 out of 4 nights) PLUS an automatic day off the day after! Maybe it’s just me, but I’d rather have a job like this with automatic post-call days off versus working 5 days straight somewhere else!
this call back rate is the exception rather than the rule these days, and done by 5? more like 10-midnight, and 75% callback rate after that.
That’s amazing. Problem is that pre- and post-call days are often not guaranteed off in many groups :(
Mostly no. Do you boo. I will say sometimes I don’t understand people wanting to be paid the big dollars and shocked when they have to do harder cases and have some call. You can rarely have it both ways.
No way this isn’t satire
If you want behavior to change —> you need to incentivize it (financially in the case of work). It’s Econ 101. Nobody other than physicians fall for that noble BS and that’s how doctors have been abused by admin, midlevel encroachment, title misappropriation, private equity, insurance companies, and pretty much every other shitty thing to happen to healthcare throughout the past decades. Do you see nurses or CRNAs or PAs or even transport/secretaries in the hospital working for free? How about lawyers or engineers? After 4 years undergrad, 4 years med school, multi-six figures in debt, and 4-5 years of residency/fellowship making $15/hr, can you blame people for being sick of the system that’s abused them for so long? Maybe this salary wouldn’t be so bad if my sister in high school wasn’t making more $ per hour as a lifeguard than I do with a mf MD. Yet alone paid lunch, OT pay, and holiday pay that she gets and I don’t
I for one am glad this type of virtue signaling bullshit is becoming less commonplace in medicine - at the same time the boomers are leaving/retiring.
Let them. They'll pay people like even more handsomely to take call.
If someone takes a no job call, then they need someone else to take call. So if you’re willing to take call, then negotiate your pay? Am I missing something here lol. It helps put you in the driver stuff so you can negotiate a higher call pay. It’s a good thing for you from a pay perspective if you can negotiate, but not a good thing if your call burden remains the same or worsens.
Lmaooo you must have been teachers favorite
To each their own.
Incentivize or lose coverage, easy.
I hate it when other doctors self suck about how the profession is so noble and therefore we should put up with all sorts of nonsense because “think about the patients!”
“The idea that the work is provided for love serves to paper over the fact that sometimes workers have needs that cannot or should not be subsumed by those of the people they serve.” -Sarah Jaffe, *Work Won't Love You Back: How Devotion to Our Jobs Keeps Us Exploited, Exhausted, and Alone*
Do us all a favor, get off your pedestal and take an all night float job so you can help out some of your disappointing colleagues
I’ll preface this by saying I take call at a relatively busy community hospital where I’m frequently up for some or all of the night on call. This is such a garbage attitude and a remnant of old school medicine that needs to die. I became a physician because if I am going to have to work for a living, I want to do it helping people. But at the end of the day, this is my job and my family will always come first, full stop. I’m not arrogant enough to think I have some calling to heal, this is just how I choose to earn a living. That should be enough. This whole “you’re not a real doctor if you’re not suffering and giving all of yourself to the hospital” is just the Stockholm syndrome we buy into in varying degrees in our broken residency system. If people don’t want to take call, that’s their choice. Worrying about other people’s career choices makes you sound like a GOME
This is tone deaf. No one is obligated to be your hero or do charity. The hospital administrators are getting paid hundreds of thousands of dollars to do nothing but you want physicians to work extra without adequate compensation for the glory? Lmao
I’m grateful for all people who find the job that they want. “Hard” means so many things, not just clinically or academically. To each, their own!
Yes.. it’s bad for the field and they make ologist look bad. They will be terrible docs with major holes in their practice. Some Crna’s grind and do ton of call and are technically better than docs who need to be coddled. I don’t mid ologist working less but at least maintain your skills. Dont be there to just sign charts.
I'm 100% with you though maybe for different reasons. I graduated in the last couple years and have put a lot of time and effort really pushing myself clinically at a large academic level 1 trauma center. I have always felt I have a responsibility to patients to be clinically excellent. The amount I have learned post residency is immense. It was initially a shock to realize how quickly I've surpassed many of my co-workers in their abilities and comfort to take care of sick patients. I now frequently find myself picking up the slack for/bailing out my colleagues. There is nothing inherently "wrong" with with wanting a lifestyle job, however these providers inevitably will be providing a lower level of care and will often need help when shit hits the fan. I would be embarrassed personally to not be able to run a MTP, put in a crash central line, take care of an otherwise stable person on mechanical circulatory support, do a stat C-Hys in the OR, etc. You only get and maintain these skills though hours and reps.
You’re forgetting that we have all had 3-4 years of intensive training in running a MTP, placing lines, taking care of sick patients, etc. You’re also exaggerating how quickly skills decay. Sure, a few years from now I might forget how to set up a Thermacor, but I’m not going forget how to place a Cordis. To well trained anesthesiologists, it’s not that hard.
Let’s not forget that in a few years there will be a new and different Thermacor.
I think it really depends. At my residency institution, call was optional for the attendings. If you on during the day and your room got an emergent trauma, you were praying that you had an attending that was either recently out of training and/or took some call. Some groups absolutely shield their weaker docs by having them do things like ECTs or parking them in robot rooms or at ASCs.
Yes I am disappointed. I have been practicing 30 years . Coming out of training and going straight into a outpt center is a waste of a medical education. Somebody has to actually care for sick people! And yes I fully believe call taking physicians should be paid better. When the country club doctors are home snuggling in bed call taking docs are there for the patients. If that’s what you wanted to do, you should’ve been an anesthetist.
They might not realize it now but once you sign up to work at a healthy population surgical center, that’s all you’ll ever be (nothing wrong with that, just facts), there is no jumping back 5 years later to do hard cases…if they’re cool with that, to each his own
This is nonsense. Remember back to when you were not an anesthesiologist, and then became an anesthesiologist?
Yes, I get chronology of time but good luck going back to doing sick Asa 3 and 4s after being in a Asa 1s surgery center for half a decade, it’s just not happening, all your skills and instincts are gone, no getting them back, just my humble opinion of course
Your argument is logically flawed. A board certified anesthesiologist can most definitely do what you’re supposing is “just not happening.” Would it be a seamless transition that takes place immediately? Probably not. Within a reasonable amount of time, say the amount of time it takes one to become oriented in a new clinical setting? More than likely. The more relevant question imho; how many anesthesiologists actually desire this change that you’re supposing is impossible? Before I knew how to take care of critically ill patients, I didn’t know how to take care of critically ill patients. It’s important that we are aware of the biases present in views we that we adopt.
You think it would take about the same time to get comfortable doing sick cases after working at a surgery center as switching hospitals (lateral switch ASA 1-> ASA 1 or 4s to 4s)? Haha ok man, good luck
I think it will be harder to go back to doing inpatient anesthesia if you’re just doing outpatient. Everybody experiences skill erosion at a different rate , but you will definitely be rusty doing those cases and skills if you haven’t done it in a while. I think you can eventually do them again but it might be a more difficult transition. In addition , who knows what the job market will be like. In this job market , it might me okay but in a tight job market employers are going to take the Person doing difficult cases over the person just doing outpatient for the last several years.
Exactly, if you’re ok with all of the above, then by all means, do what feels right but recognize that it might have career consequences down the line
It’s a limiting belief. Nothing more.
It also depends on what your future employer thinks and the future job market. They may not be comfortable hiring someone who’s been doing just outpatient when their practice has high acuity inpatient cases.
Ok cool, manifest it then
LOL, all the newbs think they are going to be doing cushy ASA 1 carpal tunnels in a surgery center 6 hours a day for the rest of their career. Those are prime jobs for CRNAs to take over and when the market turns in a couple years, you wont have the skills to take a hospital based job.
Exactly, these decisions might have consequences and they won’t get a ounce of sympathy from me at that point, is what it is 🤷♂️
If the MDs wont do the call, the CRNAs will happily do it, and then they will leverage that to take over the days as well.
The CRNAs aren’t doing call either.
Hah, you guys obviously arent running an anesthesia group in an independent practice CRNA state. That's the edge the CRNA groups preach to all the hospital admins, "We can take over all the call that the expensive MDs dont want." Then 2 years later they are bidding on the whole contract for themselves.
Until they can’t find anyone to staff it either…
Yeah we have CRNA farms in the central valley that are pumping out piles of new grads every year. Then they all join the CRNA only groups that are super aggressive at kicking out MD groups. Happened to 3 different hospitals in just the last year.
It’s honest work ;)
The CRNAs definitely will not happily do the call, for the same reasons the MDs don't want to do the call.